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House of Commons

Tuesday 22 March 2005

The House met at half-past Eleven o'clock

PRAYERS

[Mr. Speaker in the Chair]

PRIVATE BUSINESS

London Local Authorities And Transport For London Bill (By Order)

Order for Second Reading Read. To be read a Second time on Tuesday 5 April.

Oral Answers to Questions

HEALTH

The Secretary of State was asked—

Doctors' Services (Northumberland)

1. Mr. A. J. Beith (Berwick-upon-Tweed) (LD): What assistance his Department has given to the review of out-of-hours doctors' services in Northumberland carried out by the Northumbria Healthcare NHS Trust and the Northumberland primary care trust. [223078]

The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): As the right hon. Gentleman will be aware, I made my views on this matter known in the Adjournment debate that took place in January. A review has since taken place, and it is right and proper for the local health trust to take action on the recommendations, as it is now doing.

Mr. Beith: In thanking the Minister for her interest, may I ask her to put the weight of her Department behind the recommendations of the review team, particularly to ensure that doctors working in community hospitals 50 miles from the general hospital are suitably trained, and that cross-border arrangements are used to help to provide a stronger service in Berwick and other new arrangements in Alnwick? In particular, will she look again at the reasons why Northumberland is not getting rural money designed to help with situations just such as this, given that it is about the most rural and thinly populated part of England?

Miss Johnson: The right hon. Gentleman is aware that funding goes to the strategic health authorities and, across the strategic health authority, it does not qualify for rural funding. But, as I am sure he knows, money is not the issue in regard to the out-of-hours service. I agree that the trust now needs to take forward the recommendations that address the points that he has
 
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made about training and access. I think that that will address the issues that we have been trying to deal with, and I think that the right hon. Gentleman also believes that to be the case.

Mr. Peter Atkinson (Hexham) (Con): It is all very well for the Minister to push this matter back on to the local primary care trust, but one of the problems is the new general practitioners' contract, under which many GPs in Northumberland do not work on Saturdays. The consequence is that the Northern Doctors Urgent Care service gets nearly 1,000 calls on a Saturday, which is overwhelming the service. Doctors are travelling 70 or 80 miles to answer calls in rural Northumberland because of the pressure on the business. Surely the Minister should revisit the GP contract.

Miss Johnson: Eighty per cent. of GPs supported the new contract. The hon. Gentleman will also be aware that there were already arrangements in place under which large numbers of GPs delegated their responsibilities to co-op arrangements, so very little has changed in that regard—it is just that responsibility can now be passed back to the primary care trust. That has huge advantages for addressing service fragmentation and getting a better service. Indeed, in areas such as Cheshire, a much better service is now being provided. I trust that areas in which there are issues will look at the areas in which there is good practice, so as to develop the same best practice and to provide patients with the best possible out-of-hours service in all areas.

Paddington Health Campus

2. Mr. John Randall (Uxbridge) (Con): What recent meetings he has held to discuss the Paddington health campus; and if he will make a statement. [223079]

The Minister of State, Department of Health (Mr.   John Hutton): My right hon. Friend receives regular updates on major NHS projects, including the Paddington basin development. Officials are currently reviewing the outline business case submitted by the Paddington health campus team in December.

Mr. Randall: The Minister knows of my interest in this project. At the Royal Brompton and Harefield NHS Trust board meeting on 23 February, the acting chief executive gave a firm assurance that the necessary addendum to the December 2004 outline business case for the project would be submitted to the Department of Health by 15 March. Has the Minister received it yet? If not, will he tell us when he expects to do so, and why it has not arrived?

Mr. Hutton: No, I have not received it yet, but I hope to receive it from the trust shortly. I think that the issue to which the hon. Gentleman refers relates to a recent proposal from Westminster city council—a Conservative-controlled authority—to facilitate the development of Paddington by releasing some land that would provide a significantly improved value-for-money solution to the development. I hope that there is a way forward that will provide us with such a solution, and I look forward to receiving that communication from the trust as soon as possible.
 
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Mr. John Wilkinson (Ruislip-Northwood) (Con): Will the Minister bear it in mind that, when this project was put out to consultation, the public were informed that the net cost would be £135 million? Last autumn, the Secretary of State admitted that the estimated cost had risen to £800 million. It is now £1.1 billion. At that rate, is not this the fastest escalating estimated cost in the history of the NHS? When will the Treasury take an interest in the project and get things under control?

Mr. Hutton: I can assure the hon. Gentleman that the Treasury has taken a close interest in this project right from the beginning, and rightly so. We should not lose sight of the important point that, if there is a value-for-money solution for the Paddington health campus, and if we can find that way forward, the campus will provide a significantly better service not only for the hon. Gentleman's constituents who might need to use its specialist services but for millions of patients across the south of England. I would have thought that he would lend his support to that improvement. His real problem today, however, is not my view on this matter, but that   of the hon. Member for South Cambridgeshire (Mr. Lansley), who, in May last year—

Mr. Speaker: Order.

NHS Charging

3. Mr. Stephen McCabe (Birmingham, Hall Green) (Lab): If he will make a statement on charging of patients in the NHS. [223080]

The Secretary of State for Health (Dr. John Reid): The Government believe in upholding the founding principle of the national health service: a service free to all at the point of need and equally available to all, because access to treatment is determined by clinical need, not by the ability to pay. That is why we have no plans to introduce charges for hospital operations.

Mr. McCabe: Has any work been done within the Department on extending the scope for charges? If so, what are the implications of that approach?

Dr. Reid: We have considered the whole set of proposals to charge patients for basic operations, but have rejected them completely. One of the reasons is that it would be grossly unfair to ask people, particularly old people, to pay about £2,500 for a cataract operation or up to £11,500 for a heart bypass. We have considered and rejected completely such proposals, as they would be unfair, immoral and, as it happens, illegal.

Mr. Edward Garnier (Harborough) (Con): The Secretary of State said, and I agree with him, that the national health service should be free to all and equally available to all. One of the problems that we have found in my area, which is covered by the Melton, Rutland and Harborough primary care trust, is that it has a deficit of £2.3 million, and it will be asked to take on the health provision for HMP Ashwell and HMP Gartree, which will only add to the burden. How will the Secretary of State prevent my constituents from being further taxed,
 
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if not further directly charged, for access to the national health service, when the PCT, and particularly its out-of-hours service, is running at a massive deficit?

Dr. Reid: On one of the hon. and learned Gentleman's points, additional funding will go with the new arrangements. Secondly, we offer equal access to everyone in a faster and comprehensive fashion by increasing investment year on year. Thirdly, it would be a disaster to reverse that, since he believes, as I do, that equal access to health care means that access to speed of treatment should depend entirely on clinical need and not on the amount that one can afford to pay. It would therefore be a disaster to withdraw investment and ask patients to pay to get quicker operations, and we have no intention of doing that.

Mr. Adrian Bailey (West Bromwich, West) (Lab/Co-op): First, I welcome the Secretary of State's commitment to free NHS treatment, but Secretaries of State come and go. Secondly, what assessment has he made of the legal position should any future Secretary of State want to change that particular policy?

Dr. Reid: My hon. Friend is right on both points. First, Secretaries of State do come and go—some more rapidly than others, I must say, from my career. Secondly, he is right that the founding principle of the NHS stays: it is enshrined in the National Health Service Act 1946 and the National Health Service Act 1977, which states:

"the services so provided shall be free of charge except in so far as the making and recovery of charges is expressly provided for".

There is absolutely no provision under the law for any charges or co-payment for basic hospital operations. That is why I say that any plans to introduce such charges would be unfair, immoral and illegal.

Dame Marion Roe (Broxbourne) (Con): Will the Secretary of State explain to the House how NHS income from patient charges has increased by almost £500 million to £1.5 billion a year since Labour came to power? If the Labour party wins the next general election, will he guarantee that it will not increase patient charges by another £500 million?

Dr. Reid: Yes, I can explain that to the hon. Lady. There are express provisions in the 1946 Act and the 1977 amendment for certain charges such as prescription charges, dental charges and the recovery of compensation not from the patient but from those who have been negligent, as a result of which the patient has suffered injury. However, charges for basic operations are expressly prohibited under the law. Therefore, it is not legal to charge £7,550, for instance, for a knee replacement, or £3,800 for a hysterectomy. That is contrary to the basic founding principle of the national health service. If I can be courteous to her, since I believe that this may be her last Health questions, may I say how much we have enjoyed her contributions at Health questions over the years?

Kali Mountford (Colne Valley) (Lab): May I tell my right hon. Friend about a constituent of mine who told me on Friday that he needs knee surgery and is to be admitted into a Nuffield hospital for treatment paid for
 
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by the NHS? Has my right hon. Friend considered, given that the Wanless report recommended that treatment free at the point of need was the most effective and efficient way of delivering health services, how we can expand capacity while not burdening people with an unexpected charge beyond the national insurance that they have already paid?

Dr. Reid: I am glad that my hon. Friend's constituent is getting quick access to health care. We have broken down the old dogma that says that we will never use anything except directly provided services, but we have maintained the old principle that any such services—even if purchased in bulk from the independent sector—will be delivered free at the point of need. For instance, that means that her constituent does not have to pay some £7,550 for a knee replacement, and it is one reason why the NHS is getting more and more commendations throughout the country.

Mr. Speaker: Order. I think that we should move on.

Mr. Andrew Lansley (South Cambridgeshire) (Con): So far as I am aware, the only party in this House that proposes to levy charges for NHS treatment is Labour. [Interruption.] It is a question. Let us consider section 150 of the Health and Social Care (Community Health and Standards) Act 2003, which is entitled "Liability to pay NHS charges"—a provision introduced by this Government 18 months ago. Following the consultation started by the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton) on 24 September, the Government propose to increase from £105 million to £250 million the amount received through charges for personal injury cases. Do the Government propose to proceed with those charges? They legislated for extra NHS charges, and as my hon. Friend the Member for Broxbourne (Dame Marion Roe) rightly said, such charges are up by £500 million. Does the Secretary of State intend to implement his plan, as set out in legislation, to increase charges by another £150 million, or is he going to tell us today that he is abandoning it?

Dr. Reid: Mr. Speaker, the House and you in particular, will be interested to know that the hon. Gentleman is talking not about charges and patients but about the recovery of costs from third parties whose negligence has resulted in people being admitted to hospital. On the other hand, since he seems unaware of the subject of charges, let me point out to him the following:

"If an independent hospital charges more for an operation than the NHS, patients will be entitled to 50 per cent. of the NHS cost as a contribution towards their bill."

That quote is from page 6 of the hon. Gentleman's own party's manifesto, which he clearly has not even read. However, I will stay within order, Mr. Speaker, and merely repeat that we will not introduce charges for basic hospital operations. We are delighted that the hon. Gentleman is putting his policy to the country.

Dr. Brian Iddon (Bolton, South-East) (Lab): Many of my constituents have to use dentists operating in the private sector and such dentists are increasingly requesting that their patients take out nominated
 
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insurance policies. Has my right hon. Friend received any complaints about this practice and if not will he examine these nice little earners for dentists in the private sector?

Dr. Reid: I will examine them because, given all the difficulties that we face in dentistry, we want to ensure that, by bringing in 1,000 more dentists in the short term and by replacing the two dental schools closed by the last Conservative Government, we increase the number of dentists available. I should point out to my hon. Friend that such experience is not typical, according to the many surveys of people's experience of NHS services throughout the country. Indeed, a recent survey showed that 30 per cent. of people categorised the NHS as "excellent", 40 per cent. rated it "good" and 18.5 per cent. rate it "adequate". So 88.5 per cent. of people rated the NHS as "excellent", "good" or "adequate", and I thank the shadow Chancellor, the right hon. Member for West Dorset (Mr. Letwin), for carrying out that survey in his own constituency, and for publishing it for our benefit.

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