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I also want to draw attention to the extent of geographical variation in access to health care—the so-called health care lottery. It is often said that one of the risks of moving towards a more decentralised system—one that I favour—is that we end up with a postcode lottery. Well, the fact is that we already have a postcode lottery with a vengeance under the existing highly centralised system. Another problem is that there is no local accountability to achieve any change. One example of variation in access to services is care of the elderly. There is massive variation in how the criteria are interpreted from one area to another, so that people in one area can get access to free long-term care for the elderly under the NHS, but people in another area cannot. The Secretary of State should also look further into audiology—another example of where the variations are enormous. Hundreds of thousands of people are on a waiting list for digital hearing aids. In some parts of the country, there is no wait at all—the Health Committee looked into that—while in other areas people are waiting two or
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more years for access to and the fitting of a digital hearing aid. Reassessments for people who have had an analogue hearing aid and who want a digital one can involve a wait of up to 260 weeks—five years.

Macular degeneration—a condition under which people lose their sight—provides yet another example of where people in some parts of the country can get access to the drugs that prevent sufferers from going blind and others cannot. People living in the no-access areas who have money are okay because ultimately, they can pay for the treatment, but people who have no money go blind. It is as simple as that. I would hope that we all find that completely unacceptable, yet it is happening now and it needs to be dealt with. The excuse provided by many PCTs is that they are waiting for a ruling from NICE. In fact, NICE has provided a rather unfavourable ruling, which leads me to question the criteria that it follows.

Variations across the country are enormous. The subject of dentistry and orthodontic waiting times may have been mentioned in an earlier sedentary intervention. The waiting time is enormous in some parts of the country. More general access to NHS dentists is another problem. In some areas, it is almost a thing of the past. Many people moving to a new area can often simply not get access to an NHS dentist.

Mr. Graham Stuart: I understand that the wait for orthodontics for children in Hull—the Secretary of State’s constituency—is now more than 60 weeks.

Norman Lamb: I am grateful for that intervention and I suspect that the Secretary of State will be aware of that. Waits of that length are unacceptable. There is a genuine and serious debate to be had about how best to use public funds to ensure access to top-quality dental care for those who need it most.

Two or three years ago, the Audit Commission was very critical of the ineffective use of public money to ensure access to NHS care for those who cannot afford the option of going private. The King’s Fund pointed out massive variations in spending on mental health across the country last year, while Sir Liam Donaldson also highlighted concerns about treatment following a heart attack, which varies enormously from one part of the country to another.

I would like briefly to consider the Conservative party proposals set out in their paper. The Conservatives have campaigned vigorously over recent years against reconfigurations, hospital closures and so forth, but I believe that the inevitable consequence of their proposals will be to make reconfigurations and closures more rather than less likely. The critical issue then becomes: who decides, under Conservative policy, if and when a hospital should close? As I have already said, the Conservatives propose a substantial shift of budgets towards practice-based commissioning, very much giving power to GPs rather than to PCTs. They also propose a significant shift towards using the private sector, while their document also endorses, of course, the principle of payment by results. The inevitable consequence will be that some hospitals will become unviable. The Conservative spokesman referred to the importance of care closer to home, which is again likely to make some hospitals unviable.

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I would like to see a degree of honesty from Conservative Members on this issue— [Interruption.] The critical issue, as I have said, is who decides to close the hospital. Ultimately, it will be the national NHS board. If and when the system came into force, local people would end up asking why an unaccountable, national, remote quango was closing their local hospital. That is the inevitable consequence of what is being proposed. The board will take decisions, independently of Parliament, to close local hospitals.

I consulted the Library to check that my understanding of the document was correct and it appeared to agree with me. Specific reference was made to paragraph 2.17, which talks about HealthWatch, the new body to safeguard patients’ interests.

It states:

That is remarkable. In a decentralised world—which I thought the Conservatives believed in—we would have the NHS board deciding whether to close an A and E department. That is utterly ridiculous. I can imagine what local people would feel when such a decision was taken by a remote national quango. I do not think that it would be as attractive a proposition in reality as it might seem in theory.

I accept that tough decisions have to be made and that services sometimes have to be reconfigured. We have to ensure that health care is delivered in the safest possible way.

Dr. Stoate: Does the hon. Gentleman share my view that it is far better to have planned reconfiguration of services resulting from a proper discussion on where is the best place to provide them, rather than adopting a practice-based commissioning approach—under which some hospitals might end up doing things that were not necessary and others would inevitably wither on the vine—in a completely unstructured fashion, with almost no control for local people? Surely that would be the greater evil by far.

Norman Lamb: As I have already outlined in some detail, there is a real risk that, in achieving the result that the Conservatives say they are concerned about, we might lose local hospitals even though they are socially important for delivering care to a particular area, because of the drift of the market following decisions made by GPs. There would be no powerful local body with a role to play in such arrangements. The public would have no say in what happened and, ultimately, it would be the national board that made the decision to close the local A and E unit, for example. I do not think that that would be the right way to proceed.

As I was saying, I accept that tough decisions have to be made, but they should be made locally. This is where I disagree with the Government’s approach. Interestingly, one of the Labour deputy leadership candidates floated the idea of locally elected boards. Even the former Secretary of State floated the idea of
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elected boards. It was interesting to hear the new Secretary of State, towards the end of his speech, using words that were identical to those in a speech given by the former Secretary of State at the London School of Economics about three weeks ago. Perhaps there will not be too much change of approach. It is interesting that, after all the tough experiences that the former Secretary of State has had, she recognises that there is a democratic deficit that has to be addressed.

The motion also refers to the importance of community hospitals. The hon. Member for Beverley and Holderness (Mr. Stuart) has been prominent in his campaigning for community hospitals and I applaud his work. I have been campaigning in my constituency to protect a number of community hospitals that are under threat. I urge the Government to recognise the value that local communities place on those institutions. There is, perhaps, something rather nebulous about it, but they are seen as very important local institutions.

It is remarkable how much money is raised by local communities for their community hospitals. On Sunday, I took part in the Great London Run to raise money for Wells hospital, which is now run as a charitable trust. That is an interesting development, and one that the former Secretary of State highlighted in Parliament last year when launching the White Paper. The idea of social enterprises of that sort running the local cottage hospital is an attractive proposition that ought to be explored further. If we close those local units, we lose the community involvement, the fundraising effort and the voluntary money that is going into our health service. We also lose a valuable local institution.

The motion rightly draws attention to the importance of choice in maternity services. There is a sense at the moment that the funding of maternity services is unbalanced. We now have a remarkable situation in which 23 per cent. of births involve a caesarean section—

Sandra Gidley: It is 24 per cent. now. It has gone up.

Norman Lamb: It is now 24 per cent. The World Health Organisation says that when we get beyond about 15 per cent., we achieve no health benefits, yet we are committing enormous resources to caesarean sections for the 24 per cent. of women who give birth in that way. Only 3 per cent. of women give birth at home, compared with about 30 per cent. in Holland. There is something wrong there. That suggests to me that women are not effectively being given a proper, informed choice—

Dr. Andrew Murrison (Westbury) (Con): They might not want that.

Norman Lamb: The hon. Gentleman might say that, but the remarkable difference between this country and Holland, where women are given a full opportunity to make a choice, suggests something rather different.

Dr. Murrison: Of course women want choice, but the point that I was trying to make was that they might want to have their babies in midwife-led units, such as the one that is about to be shut down in my constituency.

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Norman Lamb: I do not think that we are in any disagreement. I absolutely agree about the importance of choice— [ Interruption. ] This argument is not going anywhere. The hon. Gentleman and I agree on the importance of choice in maternity services.

On access to GPs, there are clearly problems with out-of-hours services and with the straitjacket that the Government have placed on GPs’ hours through the contract. There is an urgent need for that to be reviewed. I would be grateful if the Minister would also respond to a concern about independent sector treatment centres. There was a report in the press last week that two proposed new independent sector treatment centres had been cancelled. I would be interested to find out whether that suggests a change of approach, or whether the Government have at last recognised that it is not sensible to impose these private sector treatment centres from the centre. Such decisions should be made locally.

The NHS chief executive’s annual report described

He went on to ask:

The former Secretary of State, learning from bitter experience, drew attention to the fact that if the NHS were a country, it would be the 33rd biggest economy in the world. It would be larger, for example, than Romania or Bulgaria, and four times larger than Cuba—and, as she pointed out, “more centralised” than Cuba. It is the fourth largest employer in the world after the Chinese army, Indian Railways and Wal-mart. It is a remarkable organisation, but it cannot continue to exist as such a centrally driven institution.

The former Secretary of State admitted that there was a democratic deficit in health services and, as I mentioned earlier, she floated the idea of locally elected boards. Local accountability and local responsibility are absolutely crucial and provide the best way to secure services that are relevant to the local area, combined with national entitlements for citizens so that they know what to expect from their health service. In his statement today, the Prime Minister talked about devolving power in the delivery of public services. Will that be a reality in the health service? It is badly needed.

Several hon. Members rose

Mr. Deputy Speaker: Order. There are 51 minutes left before the wind-ups are due to take place. Eight hon. Members are seeking to catch my eye, and Mr. Speaker has placed a 10-minute limit on Back-Bench speeches. I hope that favourable deductions will be concluded.

6.19 pm

Anne Snelgrove (South Swindon) (Lab): May I add my congratulations to my right hon. Friend the new Health Secretary on his flying start today? I also offer my best wishes to his new health team in their new roles. May I also add my tribute to the previous Health Secretary, my right hon. Friend the Member for Leicester, West (Ms Hewitt)? I was her Parliamentary Private Secretary for the past 10 months. It was a
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privilege to serve her. I wish to say so in public, because I have said it to her in private. Her intellect, tenacity and dignity under fire were amazing. She will be remembered for having the courage to tackle the difficult issue of NHS deficits and pulling that off, which many Members on both sides of the House thought that she would not achieve. I hope that she enjoys her time on the Back Benches, but I hope that it will be a limited time.

Access to health care has improved around the country, and in my Swindon constituency. Local plans are under way to improve it still further. The hon. Member for South Cambridgeshire (Mr. Lansley) has once again shown a fondness for picking isolated cases and testimonies, then manipulating and exaggerating them. For example, he mentioned the reorganisation of NHS Direct, and criticised the Government in a sweeping statement for reducing the number of call centres. In fact, that was a patient-led change. People’s habits change, medicine changes and organisations change over time. NHS Direct was reorganised because more people were using the web service, and fewer people were using the telephone service. It was rightly reorganised because people’s habits and demands had changed, and the hon. Gentleman should pay attention to that. His criticisms, both today and in previous Opposition day debates, are empty, and they do not add up to an holistic health policy.

Fay Howard, a councillor and a nurse in my constituency, works at the Great Western hospital, which was built by Labour and opened in 2003. She is part of an NHS team treating more patients more quickly with better outcomes and higher patient satisfaction every year in Swindon. Apart from better access to GPs, accident and emergency services, and emergency care, Fay thinks that Labour’s programme of delivering care at home is crucial, and she gave me powerful anecdotal evidence:

Things have changed, because health care has changed and people’s expectations have changed. My constituents expect the best: they also expect choice and appropriate treatment in the most appropriate place, whether that is in a hospital, a GP’s surgery or at home.

On a local level, front-line staff in Swindon are innovating to improve access, and I pay tribute to their hard work and dedication. The Government need to acknowledge that more: we must tell our NHS staff that they are doing a fantastic job, and listen to their views of the improvements and changes that we need to make. Swindon and Marlborough NHS trust is considering setting up a birthing centre to allow women with uncomplicated pregnancies to give birth in a homely environment, cared for by the midwifery team. That obviously improves access, but it also improves patient choice. Our sexual health clinic has developed a patient numbering system to protect anonymity, which encourages people to seek help. It also uses mobile text messaging for patients, which keeps the service anonymous so people return, which is crucial.

The cardiology department launched a new service in May for heart patients who need angioplasties. It carries out procedures under local anaesthetic on 100 patients
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a year who would otherwise have to travel 50 miles to Bristol. Our radiography waiting times are among the lowest in the country. There is a filmless radiography department—it is all digital. If people transfer to Bristol, their X-ray can be e-mailed to the doctor, which means that there is no waiting. I am pleased that my local health service is listening to patient feedback. People wanted the audiology clinic to extend its opening times; it has done so, and likewise the booking centre. We have been helped by the Department of Health. Last month, it published progress on the 18-week target and everyone in my community was concerned that Swindon was low on the list. I am pleased that an action plan is in place, and that there will be regular consultations with MPs. I hope that the new health team will continue that excellent initiative, because we need to know how well our health service is doing.

As well as acute care, primary care services have provided better access to patients in Swindon. Our walk-in clinic is a local success story, and constituents tell me that it is a great improvement on waiting to see a GP or going to accident and emergency. They have also praised increased pre-emptive care initiatives such as the falls clinic, which helps the elderly both to deal with falls and to prevent them at home, and the Alzheimer’s clinic, which has become well known in Swindon under the leadership of Dr. Bullock. There is therefore increased access, choice and patient satisfaction. From next week, a new Government initiative—the telehealth initiative—goes live in Swindon. It will provide specialist monitoring equipment at home for people with respiratory disease, and is another measure that brings health care closer to home. It is a Labour initiative, and we are proud of it. It helps to explain why, throughout the country, we have 98 per cent. satisfaction rates among patients using the national health service —[ Interruption. ] The Opposition are heckling me, because they do not want to hear that 98 per cent. of people who use the health service, whether in a Tory, Liberal Democrat or Labour constituency, are satisfied with it. Patients love our local NHS, but they often tell me that the reports they read in the paper suggest that their experience is not the norm. Even though I am biased when it comes to Swindon; I can confirm from my time on the Government’s health team that the NHS is good and improving all over the country, as I am sure we will hear from colleagues.

We in Swindon remember the national headlines about lack of access: 60,000 general and acute beds were lost, waiting lists rose by 400,000, and the total number of hospitals went down under the Tories. They closed our local hospital—the Princess Alexandra—and let our other hospital go to rack and ruin. Then, as now, the Conservative party had no proper strategy for increasing access. It has been my dubious pleasure to listen to every health Opposition day debate for the past 18 months. I have been proud to be on the front line since 2005. The Government will continue— [ Interruption. ]

Mr. Deputy Speaker (Sir Michael Lord): Order. We must not have continual chuntering.

Anne Snelgrove: I am about to finish, but I am grateful, Mr. Deputy Speaker. The Opposition are chuntering, because they do not like it. The new
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Parliamentary Private Secretaries, along with other Labour Members, will defend the improvements against the mud slinging from the Opposition.

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