|Previous Section||Index||Home Page|
Mr. Lansley: Yes, it is astonishing that at the same moment as the Government are talking about the desirability of transferring greater responsibility into the hands of GPs, one of the core responsibilities of general practitionersdetermining to whom referrals should be made and how patients should be treatedis being taken out of their hands by the local primary care trusts. That is not to say that there is not a role for GPs with special interests, but we have been talking about this matter for years and nobody should be under any illusions.
Mr. Lansley: It is quite difficult and probably quite expensive to develop GPs with special interests. [ Interruption. ] Yes, I will give way in a minute. The silent one on the Government Benches seems to think that the doctor from Dartford needs to be heard. Well, we have heard from the doctor from Dartford too many times before to think that we could learn anything from him. [ Interruption. ] I do not think that we could. The point is that if GPs with special interests are valuable, their colleagues will know that and they can make referrals to them. [ Interruption. ] I will give way to the hon. Member for Dartford (Dr. Stoate), and then we will find out what he has to say.
Dr. Stoate: I grateful to the hon. Gentleman for giving way, particularly after his warms words about me. I think that I am right in saying that I am the only person present who uses the choose and book system. I use it regularly and the only thing that I find wrong with it is that there are not yet enough specialties for which we can use choose and book. The faster it expands and becomes universal for all referrals, the better. I can now sit down with one of my patients, go through every available hospital in my district and tell them precisely how long each waiting list is for each consultant. It cannot get much better. It needs to improve, but the basic system is very effective.
Mr. Lansley: I am sorry, but the hon. Gentleman is completely missing the point. A GP in Yorkshire who used choose and book said that he made a decision on the basis of the available waiting times at different hospitals. The primary care trust then took that decision away and negated it by saying that people had to wait 17 weeks anyway. I do not see what point the hon. Gentleman is making. We are not against direct booking or online booking. He ought to take the matter up with his colleagues on the Front Bench, whose job it was to deliver choose and book on time and who have not done so. Norman Warner pushed off. He was supposed to deliver choose and book, but he has gone already. He has got other fish to fry, and perhaps we will talk about them later.
Sorry. With regard to reconfiguration, does my hon. Friend agree that areas such as Shropshirerural countiesare far more
affected because of the huge distances that constituents have to travel? Will he press that point strongly to the Secretary of State?
There should be no argument about the desirability of moving acute hospital services forward and of adapting and improving. In my experience, all the campaigns that we have been talking about across the country are not saying that nothing must change
Mr. Lansley: Well, except perhaps where the Labour party chairman was concerned. In my experience [ Interruption. ] The hon. Gentleman says Hinchingbrooke. I seem to remember that in the last debate we had on this subject he was at pains to quote me as saying that I believed that there needed to be change at Hinchingbrooke so that, for example, blue-light ambulances took people with certain specialised conditions past that front door to Addenbrookes hospital in my constituencyso I will not have any of that nonsense.
The preferred catchment population size, as recommended in previous reports, for an acute general hospital providing the full range of facilities, specialist staff and expertise for both elective and emergency medical and surgical care would be 450,000-500,000.
The majority of acute hospitals currently have, and are likely to continue to have, a catchment population of approximately 300,000.
Where more centrally located units will have the option of closing down services on one site to be provided on another, the rural units do not have such inherent flexibility. Furthermore, in many cases, the Trust must provide, for example, A&E services on each site and have no hope, therefore, of lowering their reference cost.
The College would strongly urge the government to consider the plight of rural hospitals and act accordingly to protect them.
To continue my point about a decade of this issue, the recommended catchment population size in the Royal College of Surgeons report was not invented in 2006; it was in documents that it published in 1998. Ministersnot just current Ministers, but previous Ministershave been sitting around debating this
matter for years, and then they pop up in 2006 and say, Weve got to do it and weve got to do it now. What they meant is not that we have to do the reconfigurations and specialisation in 2006, but that we have to cut the hospital budgets and do that now.
Lembit Öpik: On rural areas, I assume that the hon. Gentleman would agree that if the acute system is to work, we must have cottage hospitals to manage non-acute patients. If those hospitals are closedLlanidloes hospital in my area is threatened with closurepressure is increased on the acute services and they end up doing the jobs that they are not best placed to do. Does the hon. Gentleman agree that if we see the persistent shutting down of rural services, the pressure on acute services will increase so that no one will get the service that they need at an affordable price?
Mr. Lansley: Yes, I agree with the hon. Gentleman. He might recall our debate on maternity services at the beginning of January, when that point was illustrated well. When I visited Brecon Memorial hospitalit is not in his constituency, but it is close byI could see that it provided an excellent service. The hospital makes an enormous difference to the mothers who give birth there and also relieves what would otherwise be serious pressures on other hospitals.
Modern medicine means also that we can treat more patients with fewer beds. Many more services can be provided outside hospital.[ Official Report, 16 February 1993; Vol. 219, c. 133.]
Mr. Lansley: The Secretary of State is agreeing not with herself, but with what the then Conservative Secretary of State said on 16 February 1993. The argument has not changed; the point is, what have the Government been doing about it? They have not been doing anything.
Let us have a look at what the Government have been saying. Their amendment to the motion focuses on some of the things about which they have started to talk. Suddenly, in December 2006, the clinical directors at the Department were invited to pop up and say why there was a case for the reconfiguration of clinical services. We had a maternity services debate on 10 January and, lo and behold, by 6 February the clinical director for childrens and maternity services popped up with a reportwe will come to that in a minute.
As was illustrated by the clinical directors reports on accident and emergency and cardiovascular services, the question of A and E is often at the heart of this. A central point that has been argued for a long time is that full access in A and E to every specialised form of treatment cannot be maintained. Conservative Membersand certainly Conservative Front Benchersdo not
argue that every A and E department in the country should be able to treat every patient. We have never believed that. For example, when Richard Hammond had his accident, he went to not the local hospital, but to Leeds general infirmaryquite rightly so, because it was able to provide excellent neurological care. The same will be true in every part of the country, but the question is how far that specialisation should go.
The Governments documents focus on such issues as heart attacks and stroke. With regard to heart attacks, they talk especially about primary angioplastythe Government cite that in their amendmentwhich is a mechanism whereby rather than giving thrombolysis in all cases, even if this takes a little more time, a balloon is put in a patients artery to re-engage the blood flow, after which a stent is put in to maintain the flow.
The procedure is not new. We did not suddenly discover it at the end of 2006. When Roger Boyle, the clinical director, produced his document, I asked him on what clinical evidence he based it. I was referred to an article of January 2003, which itself said:
In 1995 and in 1997, systematic reviews of this topic were published, with the later analysis of 2,606 patients, showing improved short-term clinical outcomes ... with primary PTCA
compared with thrombolytic therapy.
I am not saying that the Governments study discovered that in 2006. Towards the end of 2004, they began pilot studies. The hon. Member for Pudsey talked about Leeds. I visited Leeds general infirmary in March 2005, when it was involved in the pilot studies on primary angioplasty. However, I remember a conversation with the clinical directorif he puts himself in the frame of being the Governments mouthpiece, he must take thiswhen I hosted a reception here on saving minutes, saving lives to celebrate success on call-to-needle times for thrombolytic therapy. I asked him what plans he was putting in place to move beyond that procedure to primary angioplasty, and he said, Well, for the moment, were going to concentrate on the target and well worry about that later.
I will not take lessons from Government Ministers about us standing in the way of progress when the situation regarding the procedure has been clear for a long time. A million cardiological interventions involving primary angioplasty already take place in Americait is increasingly routine. I remember a cardiologist telling me in early 2004 that although the procedure was routine in the Czech Republic, it was virtually not happening at all in this country. The one place in this country where it is increasingly routine is London. There are 32 accident and emergency departments in London, nine of which offer primary angioplasty. Patients with myocardial infarction are going to those nine departments. Why are they going there? It is not because the Government have published anythingthey are still spending their money and time on pilot studies and it will take a while before they publish the evaluationbut because the London ambulance service has taken the initiative. Frankly, if the Government got out of the way and people in the
national health service were given greater freedom to deliver the services that they know are right, we would make more progress, more quickly.
Frank Cook (Stockton, North) (Lab): I am somewhat disappointed by the hon. Gentleman. I usually have high regard for what he says, but today he appears to be trying to turn fiction into fact. Of course the procedure is routine in America and the Czech Republic. It is routine on Teesside. In 2003, I had angioplasty and several stents inserted in my left anterior descending artery. Routine? How routine does he want to get?
Mr. Lansley: The hon. Gentleman might say that, but the procedure is not routine in this country. There are 11 pilot sites, and a limited number of places throughout the country in which it is offered.
Mr. Lansley: Is he? Oh well [Interruption.] If the hon. Member for Stockton, North (Frank Cook) had angioplasty, that is one thing, but if he had primary angioplasty, it is another. If he had an acute MI [ Interruption. ] It helps to have a doctor, although I prefer my doctor to the one from Dartford.
The hon. Member for Stockton, North might be right. Angioplasty is absolutely routine. However, primary angioplasty, which takes place when someone in a blue-light ambulance who has had a heart attack goes straight to having a balloon and a stent put in, instead of having thrombolysis, is not routine in this country. It happens in some places, but not in others.
Mr. David Wilshire (Spelthorne) (Con): Does my hon. Friend agree that the reports suggesting that change is for the better would be more convincing if they were not being used as a smokescreen? In March 2005, Surrey Members were told that a hospital and its A and E department had to be closed to save £120 million. Nine months later, a report was commissioned and it is now being waved about as an alternative justification for something that we were told was being done to save that money. No wonder we do not believe reports if they are used as smokescreens.
Mr. Lansley: My hon. Friend is absolutely right. St. Peters and Ashford hospitals, along with others in Surrey, are wondering where on earth the evidence is for the reconfiguration that will be forced upon them. They know that it will be forced upon them because the Secretary of State went to a meeting with the chairman and chief executives of the then strategic health authority, at which she told them that a hospital needed to shut and that she would be prepared to push that through. She can always intervene to deny that if it is not true.
The clinical directors produced documents with the intention of somehow pretending that there was an established case for reconfiguration and that we were standing in the way of that. That is not true at all.
Let us consider strokeI declare an interest as the chair of the all-party group on stroke. In October 2004, I went to see Gary Ford, the consultant stroke physician at Newcastle Freeman hospital. He gave a presentation about stroke care, the acute care of stroke and the use of thrombolysis for stroke. One of the slides that he used contained a quote from a Scandinavian consultant:
What is most striking for a non-UK stroke physician is the organisation and medical management in the acute phaseit appears that stroke is not seen as a medical emergency in most UK hospitals.
Back then, in late 2004, the all-party group on stroke and I pressed the Government to treat stoke as a medical emergency and to introduce the routine use of thrombolysis for stroke patients where appropriate, so I will not listen to any lectures from the Government on that. Roger Boyle and George Albertis document says that the changes have to be made somehow, and the all-party group, the Stroke Association and the ambulance service have all been asking and arguing for that to happen. We want it to happen, but it is not happening for two reasons. First, the Government have not amended the tariff, so there is a financial disincentive for hospitals to provide acute care for strokes. That is the Governments responsibility, and they have not made the necessary changes. Secondly, they have not produced the national stroke strategy.
The Public Accounts Committee produced a damning report on the Governments failure to recognise that they could actually save money and lives by implementing changes to acute care for strokes, in a way that is now routine in other countriesin America, on the continent of Europe, and in Australia, where up to 15 per cent. of stroke patients receive thrombolysis. In this country, the figure is 0.2 per cent.
Mr. Lansley: The Minister says that, and she is responsible for the issue, but as she will know, because she came to see the all-party group, we want action and we want it now. We are not standing in the way of it, so I will not take any lectures from her, or from the national clinical director. They produce documents that say that it is important that we adopt those measures, but it is they who have been standing in the way of those changes.
|Next Section||Index||Home Page|