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Question put and agreed to.

Bill accordingly read a Second time.
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Motion made, and Question put forthwith, pursuant to Standing Order No. 83A (6) (Programme motions),

Question agreed to.


Queen's recommendation having been signified—

Motion made, and Question put forthwith, pursuant to Standing Order 52 (1) (a) (Money resolutions and ways and means resolutions in connection with bills),

Question agreed to.


Motion made, and Question put forthwith, pursuant to Standing Order No. 119 (9) (European Standing Committees),


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Question agreed to.





Isobel's Law

7 pm

Mr. Paul Truswell (Pudsey) (Lab): I have great pleasure in presenting a petition that has been signed by more than 4,000 of my constituents and others in support of a ban on doorstep cold calling for property repairs and maintenance. The national campaign has come to be called Isobel's law. It is named after Isobel Gray, an 82-year-old lady who was brutally murdered by intruders associated with bogus repairers.

I am grateful to all the individuals and groups that have collected signatures. I would also like to express my gratitude for the support of the Yorkshire Evening Post on the campaign, to Brian Steele, the former detective chief superintendent who investigated Isobel's death, Stuart Pudney of the Trading Standards Institute and Councillor Mick Grubb, who has been awarded the Queen's police medal and is chair of Horsforth town council. As a former police officer, he tackled cases of distraction burglary and property crime.

The petition states:

To lie upon the Table.
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Medical Services (Northumberland)

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Watson.]

7.2 pm

Mr. A. J. Beith (Berwick-upon-Tweed) (LD): I am glad to have the attention of the Minister with responsibility for public health on the problems that we face in Northumberland because, in more than 30 years of representing Northumberland in Parliament, I have never received so many complaints and representations about failings in the local health service as I have had since the new out-of-hours system was introduced last September. Patients and their families are angry about it, and professional nursing and ambulance staff are concerned that they are expected to make decisions without the back-up of a doctor and that they have to explain to patients that they need to be taken 50 miles for treatment, which used to be available locally from the GP on duty.

Once the Government signed the new GP contract, under which practices no longer have responsibility for cover after 6 pm or at weekends, a system had to be created to replace them. That was difficult enough, but it is even more difficult in a scattered rural area where patients are at least 20 miles and often 50 miles from a general hospital. We rely on the infirmaries in Alnwick and Berwick, the community hospital at Rothbury and GPs for a wider range of services than is necessary when there is a major hospital nearby.

Two problems were clear from the start. First, it would not be adequate to have one doctor to provide sole cover for three hospitals and home visits in an area of 1,000 square miles, yet that is all that was thought necessary between midnight and 8 am. Secondly, most local GPs did not want to take part in the new service, so it depended on bringing doctors in from London or Wales, or flying them in from Germany at high rates of pay—£115 an hour in some cases. Apparently, £1,000 a night is the going rate in some other remote areas.

I was told about a German doctor who likes to play golf. It is difficult to get on the golf courses in Germany at the weekend. He therefore comes over, does a weekend's work and has a good income and a good living out of that work in England. He flies back to Germany on a Monday and gets on the golf courses for the whole week. This has helped us out in a crisis, but it does not seem to be quite the right way to run our health service.

The arrangements are the joint responsibility of two trusts. The hospitals come under the Northumbria Healthcare NHS trust, while house calls are the responsibility of the Northumberland Care trust. The names are confusing enough. The primary care trust has had a financial crisis leading to the resignation of its chairman and chief executive, and the joint chief executive of the hospitals trust is now doubling as acting chief executive of the primary care trust. One benefit of this presumably temporary situation is that there can be a single focus of responsibility for putting matters right. I have discussed the problems extensively with the chief executive and I expect to have a further meeting with him in the next few weeks. Indeed, I have been having meetings with the health authorities since before this new arrangement began.
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The same doctors provide the service for both trusts, but they are engaged by an agency, Northern Doctors Urgent Care, which is located well outside the area, at Longbenton, on the edge Newcastle. The same organisation provided GP night cover in parts of my constituency before the new system came in, but it was then more closely integrated with the GP service.

In some cases, the arrangements have broken down completely. For example, on 26 November, three local councillors attended Alnwick infirmary to observe the new arrangements. At 6.30 pm, no doctor was present to support the busy casualty department or to do home visits. At 8 pm, the hospital was told that a doctor was on her way from London, but that the train was late. At 8.30 pm, the doctor arrived at Newcastle station, 30 miles away, but there was no driver for her. She eventually arrived at 9.40 pm. There was no back-up or alternative cover.

On another recent occasion, a dying patient in a care home needed pain relief, which could not be prescribed by the care home staff. The doctor who was at the infirmary a mile away could not attend because no driver was available. It did not seem to occur to them to call a taxi, although there are plenty available. The patient had to be put into an ambulance, and died on the short journey to hospital, without the comfort and dignity to which she was entitled in her final hours.

I have been told of one occasion on which a doctor was brought more than 60 miles from Newcastle to write a prescription for pain relief in a similar case because no doctor was available locally. In another case, which I took up with the trust as a complaint, a doctor did not arrive to see a leukaemia sufferer with suspected pneumonia for 12 hours after her sister had called the emergency line. The doctor arrived at 9 pm on a Saturday, the call having been made at 9 am.

For many patients, the consequence of the change has been long journeys to Wansbeck hospital, which is in Ashington, more than 50 miles from Berwick. These journeys tie up an emergency ambulance for two hours. Some of the visiting duty doctors will apparently not carry out basic procedures such as stitching, saying that it is not in their contract. The acting chief executive of the care trust has admitted in a letter to me that the agency was

As a result, many more patients are being taken by ambulance to Wansbeck hospital, where ambulances have been queuing up to get patients in. The health care trust admits that it has

part of which is clearly caused by the new out-of-hours system.

So serious is the crisis at Wansbeck that a third of the beds at Alnwick infirmary have now been temporarily closed so that staff can be shifted to Wansbeck in an attempt to relieve the situation. The ambulance service is having great difficulty in meeting the increased demand caused by moving so many patients so far at night. Serious gaps in the emergency ambulance cover in the rural area are inevitable while ambulances are detained so far away. In many cases, the ambulance is being expected to take the place of both the local
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hospital and the doctor's house call. Nursing staff have been issued with instructions that if a patient on a ward has a cardiac arrest after 6 pm or on a bank holiday, they should ring 999. I have here the piece of paper that they were issued with. Clearly, some conditions could make such a 50-mile transfer—or a 40-mile transfer to the Borders general hospital at Melrose—essential. However, many cases could be dealt with locally, and they should not be filling up the larger hospitals or diverting the hard-pressed ambulance service.

The way in which most people approach the new service is to ring an emergency number. One of these numbers connects them to NHS Direct, where they have to explain first to an operator and then to a nurse why they are in urgent need of a doctor. If they get through those hurdles, they will be transferred to an operator at Northern Doctors Urgent Care, where, no matter how distressed or anxious they are, they will have to go through the whole explanation again, possibly twice. If they are successful in negotiating this obstacle course, they will be told that a doctor will ring them, although that could take up to an hour. A visit is still further away.

So what people do, if they can, is get into a car and get driven to the infirmary, where they might be told that no doctor is available. They might then have to drive another 50 miles to Ashington, where they will queue up with those who have been brought in by ambulance. I understand that the care trust is reconsidering the multiple-triage system with a view to eliminating NHS Direct from the process. That would certainly be an improvement. Leaflets have been issued, including the Northern Doctors Urgent Care number, which should also be on the answerphones of all GPs' surgeries.

A separate problem arises from the fact that patients no longer have access to doctors on Saturdays for relatively urgent but non-emergency consultations. People were astonished when notices suddenly appeared in every doctor's surgery saying that there would be no more Saturday morning surgeries after 1 September. I raised the matter in the House on 14 September. The Secretary of State replied that under new national requirements there would be,

That does not appear to be happening. Someone who has struggled to work all week with a bad bronchial condition may want to consult the doctor on Saturday to establish whether he or she is fit to return to work on Monday. The only recourse is to go to accident and emergency and ask the doctor to deal with the case as an emergency, alongside all the injury cases. Casualty departments are not equipped or specifically trained for work of that kind. They are busy dealing with injuries.What is supposed to be happening to meet the Saturday surgery requirement that the Secretary of State set out so clearly in the House, and what information will be given to the public? I hope the Minister will be able to make that clear.

I also hope she will tell us whether there are examples of best practice in new arrangements for out-of-hours care in other remote rural areas. If there are, I should like the health trusts in our area to take them up.
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I am sure it cannot be said that the defects of the new service are a result of attempts to do things on the cheap. It must be fabulously expensive, given the very high rates being paid to entice doctors from Germany and the great increase in ambulance journeys, as well as the cost of staff transfers to deal with the increased pressure on Wansbeck hospital. There really must be a better way of using this money to provide a service that is tailored to local needs.

There are certain requirements for that service. Given that doctors must cover both hospital and home-visit cases, we need a doctor in Berwick and a doctor in Alnwick throughout the out-of-hours period, and each must have a driver. Sometimes one is shared between two places, which is a hopeless arrangement. Even an account with a taxi firm would be an improvement on circumstances in which a doctor cannot go out on calls. A back-up arrangement with local doctors needs to be in place in case doctors cannot reach an urgent case, or are delayed as they fly in from wherever they are coming from. I should like to see a major effort to attract local GPs to participate in the service, and I hope the Minister agrees.

More forms of treatment should be available at local hospitals to reduce the number of long-distance ambulance transfers that the system has generated. Staff should feel that they have adequate back-up and are doing work that is appropriate to their training and grade. The public should be able to speak to a doctor by telephone in urgent cases without having to go through numerous intermediaries, and should be able to secure a house call when it is needed. Saturday morning surgeries should cater for all patients who cannot reasonably be expected to put off seeing a doctor until Monday, or who have real difficulty in attending during the working day.

All those services were available in Northumberland when we had a GP-led out-of-hours service. Now they are not, and people are very angry about what they see as a serious and threatening reduction in the national health service. The care trust has stopped saying, as it said last August, that patients would see no difference in the standard of service. Today, I understand, it has said it is "different but adequate". It is certainly different, and it is costing a lot more money; but it is an inferior service. It is not adequate, and I want Ministers to act to help put it right.

Today the Northumbria health care trust issued a press release announcing that the two trusts have agreed jointly to review the urgent-care system across the county. That may be the first result of today's debate, but the review needs to be fundamental, starting with patient needs rather than with the trust's existing structures. It needs to examine alternative models for the provision of out-of-hours care in scattered and remote rural communities. It needs to consider how we can increase, rather than decrease, the role of local hospitals in Alnwick, Berwick and Rothbury. It needs to consider the fact that extensive medical equipment and facilities in GPs' surgeries, which were provided with the support of public funds, are locked up and unused from 5.30 on Friday until 8 o'clock Monday morning, and throughout the Christmas and new year periods. It needs to consider reducing dependence on flying in
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doctors from the south and from Germany at vast expense, and to look for ways of attracting the support and involvement of as many local GPs as possible. It needs to make use of best practice in other remote rural areas; above all, it needs to listen with an open mind to the concerns of patients, NHS staff and the community. It is those concerns that I have tried to voice tonight.

7.15 pm

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