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Dr. Murrison: Would the hon. Gentleman like to comment on whether health inequalities have widened or narrowed since 1997?
Andy Burnham:
I would confidently assert that serious inroads have been made into some of the problems that scarred my constituency. For instance, deaths from coronary heart disease have been reduced by the prescription of statins under the national service framework. If the hon. Gentleman wants to argue that the Conservatives are in favour of tackling health care in the poorest communities, why on earth do not they say so, and why have they never shown any willingness to tackle the issue head on? I am proud to stand behind a Minister and a Government who are doing something
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about it. I urge them to take one more leap forward in this spending round, because many PCTs are some way below their target funding.
Mr. Simon: Is my hon. Friend aware that my own PCT is in eastern Birmingham, which is another traditional working-class community that is not projected to be funded as it had expected and as we would like?
Andy Burnham: I do recognise that. In many cases, inner cities and communities such as mine are suffering the most.
Mrs. Patsy Calton (Cheadle) (LD): Will the hon. Gentleman give way?
Andy Burnham: I want to draw my remarks to a close, because other hon. Members want to speak.
We should not take money away from places that are well provided for—they should at least keep in line with NHS inflation so that there are no cuts to services—but we should put the new money into areas where health care needs are greatest. The Government are doing great things in health and I can see their vision emerging. All power to the Minister in what she is doing, but I ask her to give us that extra bit more money so that we can improve the health of those who are most in need.
Madam Deputy Speaker (Sylvia Heal): Order. Several Members are hoping to catch my eye. If hon. Members can be concise in their remarks, more may be successful.
3.16 pm
Mr. Desmond Swayne (New Forest, West) (Con): In July this year, my primary care trust took on the out-of-hours care for the New Forest, and together with other local PCTs contracted Primecare to carry out the service. Let me give those Members who do not have that new system a taste of what they are in for.
I discovered that something was radically wrong right at the outset when a retired doctor contacted me to say that he was being telephoned by his former patients, asking him if he could do anything for them because they could not get anything out of the out-of-hours service. I have here the minutes of a meeting at a doctors' surgery—I shall not give its name, but it is in God's own town of Lymington. Dr. X introduced the meeting as follows:
"This meeting is to make clear our serious concern for our patients' welfare — and to highlight some of the causes so that they may be addressed without delay, thereby avoiding serious trouble."
He goes on to list some of the problems:
"Triage delay . . . Lack of feedback from doctor to doctor . . . Inadequate feedback, slow and poor quality . . . Hopeless record-keeping and doctor contact . . . Poor car-organisation . . . To this I would add . . . Low standard of triage, which is unsafe . . . Poor quality of outcome . . . Poor communication . . . Cavalier attitude regarding handing-on of work . . . Dire cost-effectiveness".
Mr. Simon: Will the hon. Gentleman give way?
Mr. Swayne:
No, I will not.
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"The Forest GPs have an enviable and hard-won reputation for looking after their patients' properly, and are deeply unhappy to find that this is already being undermined. We will not tolerate this, finding ourselves in the situation of being blamed by patients for inexcusably bad service from the new"—
out-of-hours—"system." So that is what the doctors think.
Let me give a vignette from my postbag as to what the patients think about this service. I received a letter from a lady in Milford-on-Sea who turned out to be suffering from a severe bladder infection. She did not know that at the time—she was simply in pain when she rang up at 8.30 in the morning only to get a robot voice telling her that no operators were available. After 10 minutes, she gave up and rang the other number, on which she reached an operative who could not understand what she was telling him and handed her to another operator who also could not understand. The call took 15 minutes, and as it was an 0845 number she was paying a premium rate. Eventually a nurse called back and the problem was sorted out with a visit to the local hospital, after she had been in pain for 10 hours.
Another wonderful example came from the other end of my constituency, in Ringwood. A lady's father had his toe amputated and came to stay with her to be looked after, but the dressing fell off, so she telephoned for some assistance. She wrote that at
"approximately 10.30 pm his dressing came off his foot—I phoned Prime Care and after the telephonist spoke to someone I was told he needed to see a nurse and they would phone me back and give this 'top' priority. Three quarters of an hour later I phoned again and I was told it was 'top' priority and someone would be phoning shortly. I am still waiting!!!"
Mr. Kelvin Hopkins (Luton, North) (Lab): Will the hon. Gentleman give way?
Another example came to me from Diabetes UK, which is making representations on behalf of one of my constituents. The woman in question had shingles—she did not know that at the time, but she suspected it—and diabetic complications. She rang up at 10 am, and eventually, 12 hours later, she got to see a doctor— 12 hours later for an out-of-hours service.
Another example came from Fordingbridge. It was a case of suspected stroke, in which the district nurse was contacted and handled the contact with Primecare. That contact began at 7 o'clock in the evening, with repeated calls at 9 pm and 10 pm, and the person was told that a doctor was coming. At a quarter past midnight, a doctor rang to say that he would not call after all.
Then there was a lady in Milford-on-Sea who rang up with her problem, got a foreign-sounding man on the phone, and could not get any sense out of the conversation. Eventually, a nurse rang back, who, having offered the woman the option of being treated at Bournemouth or Southampton, and having been told that that would involve either a 50 mile or a 30 mile
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round trip, said that she did not know where either of those towns were, because she was phoning from Sheffield. After further considerable delay—
Mr. Hopkins: Will the hon. Gentleman give way?
Mr. Swayne: The hon. Gentleman is so persistent that I cannot resist.
Mr. Hopkins: Could the hon. Gentleman inform me whether Primecare is a private company? Is this what private health care is like?
Mr. Swayne: I will come to why it is like this in a moment. Let me finish with this particular lady's difficulties.
After four hours' delay, and having got to a centre—having been offered in the interlude Brighton, Winchester and Andover, moving in an elliptical orbit of increasing distances away from the caller—she finally got to a doctor. After telling the story of what was wrong and giving her name, address and medical history so many times, she then found that the doctor had the wrong name and no other information about her.
Finally, I shall give the example of a lady in Ringwood, who wrote:
"The nurse asked my father a lot of questions which were unsuitable as he could not get his breath, let alone talk."
Eventually, they got to a treatment centre, where her father
I sympathise with the point on which she finished her letter:
"My father has worked hard all his life. It is only now he needs medical help and this is what he has to put up with."
That is just a small selection of the complaints that I have been receiving from the New Forest. Ministers may live in planet Richmond house, but the reality of people's experience of primary care, and particularly of the out-of-hours service, is as I have described.
The hon. Member for Luton, North (Mr. Hopkins) asked whether a private company was involved. As I understand it, the problem is—I will meet the primary care trust again tomorrow, so see whether this is the case—that the service is costing vastly more than it is being reimbursed by the NHS for providing it. With respect to it being a private company, the reality is that most of the provision is by the people who have always provided it—the doctors in the New Forest. The chaos is engendered by the fact that this has been taken over by the primary care trust and then subcontracted to someone else. Were it still being run and led by the doctors of the New Forest, we would not be exposed to this problem.
I want to abide by your strictures about being brief, Madam Deputy Speaker, but I want to address one other problem about which doctors in the New Forest have been complaining to me. That is their fear that the system used by about 60 per cent. of them—EMIS—is going to be discontinued, and that they will have to abandon their tried and tested system and adopt
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something that will be expensive, unfamiliar and unhelpful. I have made a number of representations on their behalf. The story that we have got is that it will not work like that at all, and that EMIS might survive. During my research, I have found that that is not the case.
The Minister referred to the guidance. I have examined the document on the internet—"NPfITsuppliersguide.pdf"—which says:
"and the two 'core' clinical applications for the NHS, it has been implicit that these systems will ultimately replace existing NHS clinical systems over time".
The reality is that the systems that our GPs are using now will be discontinued. During my research, I came across a very interesting document—the minutes of a board meeting of the Surrey and Sussex strategic health authority, which stated:
"Professor Lawrenson raised the issue of the pressure being placed on surgeries to conform with NPfIT, when funds and culture were perhaps adverse."
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