|Previous Section||Index||Home Page|
That, for the purposes of any Act resulting from the Violent Crime Reduction Bill, it is expedient to authorise the payment out of money provided by Parliament of any increase attributable to that Act in the sums payable out of such money under any other Act.[Mr. Heppell.]
Dr. Richard Taylor (Wyre Forest) (Ind): Thank you, Madam Deputy Speaker, for allowing me this opportunity to speak on this incredibly important and wide subject. It has nothing to do with my own constituency in particular, but I believe that it is of interest to everyone in the House. I welcome the new Minister to his position. I shall give him a fairly easy run, as I fear that I shall overstep my allocated time because I have so much to say. Also, there will not be many questions for him to answer because I want to make my points to a much wider forum than just the small number of Members who remain in the House.
After being re-elected as an independent Member, my thoughts turned to the previous independent who managed to sit through more than one term. He was, of course, A. P. Herbert, the hon. Member for Oxford University. In reading his book, "Independent Member", I noticed many parallels and many things on which I agree with him, and I should like to give the House a brief quote from it. During the terrible days of Munich, he wrote:
"I have even thought that, on great occasions where the parties were furiously raging together, the votes of Independents (cast with, of course, more conscience) might be as straws in the wind and show the party leaders which way the pure air of free opinion blows. Some horrid pride here, no doubt: but at least no 'levity' or lack of conscience."
I should like to think that, because I speak as an independent, without any party axe to grind, my comments will be taken in the spirit of helpfulness in which they are made, although there are some fairly marked warnings coming up.
I cannot speak without paying tribute to the undoubted improvements that have occurred in the NHS. I am thinking particularly of cancer and cardiac care, and of the public health White Paper, which brings to the fore such subjects as obesity and sexual health. I pay tribute to the formation of the Healthcare Commission, and to the move away from star ratings and targets towards standards, which will be less prescriptive and allow managers, in particular, to spend less time thinking about targets and more about what happens to the patient. I congratulate the Government on the institution of patients forums and overview and scrutiny committees, on the independent reconfiguration panel and on the paper, "Keeping the NHS local".
I want to dwell on some of the potential risks to further progress. They include the risk of alienating staff and patients by implementing major changes that have not been properly thought through and whose long-term consequences have not really been considered. In a recent edition of the British Journal of Health Care Management, Professor Alan Maynard of York university begins his article, which was written just before the general election and is entitled "Heading for the cliff edge?", in this way:
I want to talk about three subjects: choice, continuity of care and communication, and increasing use of the market and the private sector. No one is in any doubt that what patients want is prompt access to quality care as near home as is possible, so no one is against choice. Before the market, there was infinite choice in terms of referral, at least for doctors. Whether the doctors passed the choice on to all their patients, I am not entirely sure, but I know that some did. Since the market, choice has been severely constrained by contracts. Even when I retired, everyone working in the health service knew of the tremendous problems with extra-contractual referrals, which were dreadfully difficult to organise.
The Government's emphasis on choice is welcome, but I want to say something about choose and book. Along with other members of the Health Committee, I visited Richmond house to see a mock-up demonstration of how it would work. I could not help thinking back to the time when my hospital organised a mock-up demonstration of a brand-new computer system that would revolutionise monitoring in our intensive care unit. The model worked beautifully. We bought it and plugged it in, but it did not work on patients and we had to ask for our money back. I am terribly worried that these models that look so marvellous may not work as well as promised.
Choose and book has been very badly sold to the professions. The use of that method for 50 per cent. of GP referrals by October is out of the question. Will the Government at least agree to a delay? There is no urgencythere are at least four years in which they can get things right.
This is the ideal subject for a pilot trial. I have spoken to my local primary care trust. It knows that most practices resist the idea, but it tells me that at least five practices in my county, Worcestershire, would be willing to undergo pilot trials. There would have to be a firm set of questions to answer, there would have to be a time scale and the trials would have to be allowed to finish. Many NHS trials in the past have been scrapped before they were finished. Local hospitals would need time in which to get their act together so that they could actively compete. The Government must help local hospitals to focus their resources in local services.
My second warning relates to continuity of care and communication. Most local patient complaintsI receive a good many from further afield, although I try not to deal with them when they come from other Members' constituentsare based on a lack of communication between clinical staff and patients and their families, or between hospital staff and GPs. Those difficulties have become worse and worse since the introduction of the shift system. The position is described graphically in a recent article in the Journal of the Royal Society of Medicine headed, "A post-take ward round", by the professor of medicine at University college London. It states:
"Our round starts on the coronary care unit and the group consists of a night team, a day team, some of yesterday's team and a cardiologist . . . The number of doctors on the round has increased but the chances of any one doctor knowing the full course of the patient from admission from post-take round is virtually nil. On the other hand, the junior doctors come into contact with many different consultants and the consultants get to
I hope that the Healthcare Commission will pick up on that matter in its complaints handling and deal with it. Is slavish following of the European working-time directive correct? Trainees are beginning to speak out against the current scheme. I shall give a few useful quotes from trainees themselves in a recent edition of Hospital Doctor. A registrar in general medicine said:
"There is no continuity of care any more. You might meet a patient at 6 pm, go home at 9 pm and don't follow them through, which affects training, as you miss out on seeing the whole spectrum of complications."
"I have calculated I've lost 25 per cent. of endoscopy experience, do 25 per cent. fewer ward rounds and get to 30 per cent. fewer clinics. The only reason I feel confident is because I had a couple of years under the old system."
"Most of the trainees I talk to still see medicine as their vocation and are prepared to balance personal demands with improved training and service delivery, even if that means a few hours more work. But you don't hear that important voice in the working time debate, which is a shame, because it just might help make it workable."
There is a feeling at the moment that we can revolt in some ways against Europe. I would very much like to see a revolt against the European working time directive and some compromise that made it a little more workable.
I move on to my third warning, which is the most important. It is about the rapid extension of the NHS market and the increasing use of the private sector. Most staff and patientsI still have contacts with a lotwould prefer short-term use of the private sector while the NHS is strengthened. Lots has been written recently about independent sector treatment centres. The fear is that they will cherry-pick the easy cases, removing them from NHS hospitals that would use them for training.
Follow-up is a puzzle. Who is going to deal with the complications that occur in those independent sector treatment centres? What is the cover at weekends and during holidays? How will they be staffed? Will it be by robbing other countries of staff? We have examples of recruitment agencies advertising for as many as 30 doctors from central European countries and South Africa, to say nothing of nurses, so we are going to have an unstable short-term work force.
Another worry, which I have not had time to check and I am sure the Minister will look into, is accreditation. I am told that, in some countries, accreditation is rather less stringent than in this country and that a professor may accredit his juniors to work
20 Jun 2005 : Column 631
under him, rather than them working as individual responsible consultants elsewhere. If that is the case and those people are being accepted into this country to work unsupervised, that is worrying.
The thing that bothers me is that, as soon as a consultant objects to the NHS using the private sector more and more, the response from most health service managers and many MPs is to think that consultants are interested only in the money in their pockets and that they would condemn anything that affects that. In my career, I did very little in the way of private medicine and knew very few colleagues who abused the system. That is backed up by a recent article in the Health Service Journal, where a former NHS finance director wrote that he had met
"by altruism and concern for patients' best interests. They have survived decades of underfunding followed by constant administrative change only to find that the money being put into the NHS is being siphoned off to the private sector."
The NHS is incredibly precious to people and to its professionals. There is tremendous resistance to increasing use of the market and of the private sector at advantageous terms. With exceptions, professionals are not good at protecting the NHS. They are very short of weapons. Doctors and nurses cannot strike effectively. There have been attempts in the past to work to rule but these just did not work because whatever is done impacts on the patients. I feel that the Government know that there are no real weapons.
"should be fully assessed and where possible piloted before general introduction. Its effects should be monitored with particular reference to longer term consequences . . . .There is no evidence that the enforced purchase of services from private institutions provides more efficient or effective health care than would investing the same funds in the NHS."
"The aim should be that essential additional funding is used for patient care and not wasted in market bureaucracy such as billing, invoicing and marketing, nor in the diversion of public funds to private profit."
At first hearing, we welcomed the reports that the Secretary of State would listen, but at the same time she has promised to keep her foot on the accelerator. One wonders what hope there is for a change of pace or direction. Listening is not the end. Shakespeare, as always, has it succinctly and absolutely correctly:
To whom should the Secretary of State listen? She should listen to patients, forum members, the Patients Association and obviously the professionsnot only the BMA and the RCN, but royal colleges, the
20 Jun 2005 : Column 632
Academies of the Medical Royal Colleges, the Hospital Consultants and Specialists Association and the NHS Consultants Association.
I very much welcome the reports that the Secretary of State will try to go incognito into hospitals and theatres, gowned so that no one recognises her. I hope that that will be possible, because talking to people without civil servants and hospital managers would give a true picture. Why should she listen? She should do so because the ultimate weapon of the ordinary person is the ballot box. As several Labour Members have suggested, the introduction of market pressures into health and education is in flat conflict with our traditional values. The power of the ballot box is emphasised absolutely by my presence in this place.
"If the threats to shut down Kidderminster hospital's accident and emergency department lost Labour its seat in the town in 2001, what is the government's new competitive health market going to do in the 2009 election with hospital departments and wards being closed up and down the country?"
|Next Section||Index||Home Page|