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Dr. Richard Taylor (Wyre Forest) (Ind): I find myself in a very privileged position in debates such as this. I can congratulate the Government when I think they are getting things right, and warn them when I think they are getting things wrong.
I was going to spend the first half of my speech congratulating the Secretary of State for Health, but he has had his enjoyment for today, and time is limited. Tribute has already been paid to improvements in cardiac surgery and cancer care; I add my tribute to the improvements in consultation, the forming of overview and scrutiny committees, patients forums and the independent reconfiguration panel, and above all the paper "Keeping the NHS local", which paints a good picture for the future of patient and public involvement.
Let me now make some rather more critical comments. As the Secretary of State knows, I welcome the public health White Paper. I particularly welcome its emphasis on sexual health, which has been discussed many times. It reinforces warnings of the risks of unprotected sex, which have faded into the background since the first HIV scares. The current goal is that by 2008 waiting time for an appointment in a genito-urinary clinic will be down to 48 hours. I hope that that will not lead to what has happened in primary care. The goal of 48 hours has sometimes been taken to represent the time by which appointments must be made, and poor unsuspecting patients have telephoned at 8.30 am hoping that they can secure an appointment because they are unable to make one further in advance.
The Department of Health has certainly taken on board many of the concerns about obesity reported by our Health Committee. I am delighted with the promise of clear and effective food labelling, and I am pleased that the food industry seems to be beginning to realise that it has a part to play. Although I must admit that I enjoy the occasional Burger King, representatives from both Burger King and Pepsi-Cola are coming to see me later in the week, when I hope to persuade them that they are part of the solution.
David Taylor : Does the hon. Gentleman agree with me, and with a constituent who approached me this week in my Coalville office, that we risk condemning out of hand all who are obese for their unsatisfactory diet or lack of exercise although the reasons are sometimes genetic or medical?
Dr. Taylor: I thank the hon. Gentleman for that intervention. The Health Committee report virtually bent over backwards in its efforts not to condemn such people for what had happened to them. It is increasingly recognised that obesity is not in all cases simply a question of diet and exercise; some people have definite medical conditions that make matters more difficult for them.
I turn to exercise, which is also terribly important. The Department of Health recognised in its White Paper the importance of walking to school, which, along with walking to work, is by far the most effective way to get
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people to exercise. I hope that the teaching of health economics and food technology, which is currently limited to cooking clubs and such like, will become part of the curriculum.
While I welcome the White Paper on health, I fear that it could be just words, but I am certainly hoping that it will lead to action. The Secretary of State himself said that it is the start of the journey, not its end, and that it is the vision of the future. There are some milestones by which we can judge whether success is coming. First, will the target concerning the provision of fruit in school for four to six-year-olds be achieved by the end of this year? The new rules on alcohol advertising are supposed to be introduced by the beginning of 2005, so we will be able to see whether they have an effect. On salt reduction, Sir John Krebs says:
Will the industry achieve that reduction completely by that date? On food labelling, the recommendation is that the effective new system of "traffic light" identification of good foods and less healthy foods be in place by early 2006. We will watch very closely to see whether the targets are met, and whether the achievements match the Government's hopes and aspirations.
I have some other concerns, the major ones being the Government's review of arm's-length bodies and the abolition of the Commission for Patient and Public Involvement in Health, which has been in place for only a very short time. My worry is that this body, which supports the vital patients forums, is being taken away before the proper follow-up arrangements have been made. Such arrangements are crucial. The commission itself is fading awayits chief executive has already movedso it is vital that we get alternative plans in place quickly.
I am very anxious about two other vital arm's-length bodies: the Healthcare Commission and the Commission for Social Care Inspection, which are crucial to the Government's monitoring of developments. I met the chair of the CSCI just last week, and I was delighted to hear that she is re-examining its method of inspecting facilities. She is determined that most future visits will be unannounced, and she intends to concentrate on the views of users of the services that the CSCI inspects. But will she be able to do so? Are the Government going to grant her the extra funds that the CSCI will need to carry out the extra duties that it will have to take on?
I have always been a critic of star ratings, and particularly of that ridiculous thing called the "balanced score-card approach". It simply eroded patients' opinions of the health service and did not allow their views to be taken into account in the star ratings. I am delighted, therefore, that the Healthcare Commission is also planning unannounced visits. It plans fewer visits, but wants to co-ordinate them with other visiting bodies, which is absolutely crucial.
Dr. John Reid:
I thank the hon. Gentleman for his comments; I know that he is an experienced and acute observer of these matters. I just wanted to take the opportunity of saying to the hon. Gentleman, who has been in exchanges with me on a number of occasions, how much I welcome the development of a more sophisticated assessment process and the publication of
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results both by the Commission for Social Care Inspection and the Healthcare Commission. I want to put that on the record because there have been some reports that I am at odds with what has been done. That is not the case. It was always envisaged that once we started assessments on a simplified basis, they would be handed over to more independent bodies, which would fashion them in a more sophisticated, though relatively simple, way. The key thing for all of us is that the public know
Dr. Taylor: Thank you, Mr. Deputy Speaker, though I warmly welcome the Secretary of State's intervention. Today's newspapers implied that he was indeed against these developments, so I am very reassured by what he just said.
My next concernthe Secretary of State is aware of itis about NHS treatment centres, which have spare capacity but are not used to the full because primary care trusts do not have enough money. That results from the Government giving the money directly to the private-sector and independent-sector treatment centres. Inexplicably, instead of using the capacity available in the NHS sector, capacity in the independent sector is being called in when it is not really needed. Despite bulk purchasing, it remains more expensive to do things that way.
Some other concerns about independent-sector treatment centres were relayed to me only yesterday by a consultant orthopaedic surgeon. The selection of low-risk cases by the independent sector leaves the NHS to concentrate on the complex cases with longer periods of admission. The independent-sector surgeons may be on the specialist register, but may not have gone through the independent appointments process that is so important for NHS consultants. Concern was also expressed about follow-up arrangements.
I shall be brief in expressing my concern about out-of-hours care. When PCTs take over certain responsibilities this weekend, our constituents are going to be hit by the sudden loss of Saturday morning clinics, which have been run by many practices on behalf of the people who work all week and find it difficult to see a doctor. In the Health Committee report on out-of-hours care, we wrote:
"We deplore the loss of GP Saturday morning surgeries which will limit access to their GP for many working people, and we recommend that PCTs should provide such clinics in primary care centres or co-located emergency departments."
"routine appointments on Saturday mornings can be provided to patients . . . PCTs can commission Saturday morning GP surgeries as a Locally Enhanced Service, the cost of which is negotiated locally with the practice, and funding for which is included within the new GMS Enhanced Services Floor."
Finally, I am seriously concerned about the weaknesses of the Standing Committee system on recent health-related Bills. The Human Tissue Bill was
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certainly in desperate need of amendment, which was not achieved in Committee. Thank goodness, sensible Ministers actually changed it before Report and, in conjunction with further House of Lords amendments, it became an acceptable Bill. I am told that the Mental Capacity Bill, which will come before us very soon, was again not amended in Committee. In the debate on Second Reading, which was excellent because it did not take on party political lines at all, it was suggested that the Bill will open the door to euthanasia by neglect. There is widespread fear about that, so I hope that Ministers have listened and that perhaps the Government will table some amendments at the eleventh hour.
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