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9 Oct 2007 : Column 58WH—continued
We may consider, for example, electricity, which is an essential good of modern life. We could not imagine modern life without it, yet a badly wired house can be a
danger to life. My hon. Friend mentioned the internet, which is certainly one of the most amazing inventions of my lifetime. It has opened up a vast, unimaginable array of information to people and enables families and friends to stay in touch, if they live in different countries, far more easily than before. Yet, as she said, through social networking sites and so on, which are mostly beneficial, it can also be used in a manner that could place people in danger or, as we have seen, to help promote political extremism. Each technological advance opens up new opportunities and horizons but can also pose new risks.
I turn to some of the specifics. My hon. Friend mentioned surveillance, which is a topic of considerable political interest. Is more surveillance good or not? Speaking from my own constituency experience, the demand from my constituents is often for more surveillance of their streets—more cameras, more of a presence of the state by way of the police force and more control over what happens on their streets. Yet some people, of course, have concerns about that.
Child location services, enabled by the kind of technologies that my hon. Friend mentioned, can offer an important comfort to parents who want to know where their children are, conscious, as parents are, that their children are growing up in a world of probably far greater opportunities than ever before, but also of risks that we did not have to worry about in the past. She rightly said that the issues she raised were of relevance not just to child safety, although that is her principal concern today, but in cases of domestic violence, for example. She is right that the victims of domestic violence quite rightly want to keep their locations secret from abusive former partners.
Perhaps it would be helpful if I set out the regulations that are in place, because the area is not unregulated. The technology is new and developing, and in setting out the position I am not saying that we could never go further. However, I hope that my hon. Friend will understand that I will not be promising her today more regulation in the field. At the moment, the Privacy and Electronic Communications (EU Directive) Regulations 2003 apply a number of privacy safeguards to services based on traffic and location data, including a requirement of informed consent from subscribers to, or users of, the services involved. For services involving children, consent must be given by a child’s parents or guardian.
The code to which my hon. Friend referred calls for checks to confirm the identity of those applying. I could go into detail, but given the time perhaps it will suffice if I say that that involves the sending of e-mails, the supplying of PIN numbers, PIN numbers being returned and so on. Subscribers or users must be able at any time to withdraw their consent. That can be done temporarily in relation to each connection to the network, or on a permanent basis. The processing of personal data is regulated by the Data Protection Act 1998.
Enforcement lies with the Information Commissioner’s Office, which to date has not needed to take enforcement action against any company operating a location-based service. It has rightly had considerable input into location-based services, out of a general concern about surveillance
conducted through mobile phone technology. It works closely with the industry and with child safety experts on an ongoing basis.
As far as the Government are concerned, the legislation is supplemented by a self-regulatory framework developed by the Home Office in partnership with the industry. In 2004, the voluntary code of practice called the “Code of Practice for the use of passive location services in the UK” was developed by a working group comprising UK location service providers, five mobile phone network operators and children’s charities.
Judy Mallaber: Does the Minister accept, first, that that code is voluntary, and secondly that it was developed with those using mobile phone technology, not new technology? As I understand it, there are no particular legal controls requiring someone selling a product, for example, to check up on who is being tracked and how.
Mr. McFadden: My hon. Friend is right that the code is voluntary and applies to mobile phone technology. I shall come to the issue of global positioning systems in a moment.
The code is subject to regular review so that it remains relevant to the needs of consumers and the industry and is compliant with applicable law. All location service providers using location data supplied by mobile network operators in the UK should, as a minimum, observe that code of practice. It states that child location services should not be marketed in any way that exploits parents’ concern or fear that their children may become victims of crime, and that services should take account of the fact that someone knowing where their child’s phone is does not necessarily tell them where their child is. It is taken seriously because of the implications for child safety.
My hon. Friend asked about GPS technology. It is a valid question, and we understand the concerns expressed that it might be possible to overcome some of the security and privacy protections laid down in legislation and in the code. The Home Office has set up a location-based services group consisting of the representatives whom I have mentioned. It was established to oversee and monitor the working of the code, and I am happy to tell her today that that group is examining developments in relation to GPS and the potential for misuse arising from it.
Judy Mallaber: Will the Minister undertake to meet me and people from the children’s charities, or ask one of his colleagues to do so, to discuss the gaps that we see? Will he also undertake to ensure that, where child safety issues fall within the purview of his Department, rather than the Home Office, they are taken into account and that the appropriate charities are consulted before decisions are taken that simply relate to an industrial interest?
Mr. McFadden: I am certainly happy to say that I or my officials will meet my hon. Friend when we consider such issues. We are not convinced that a system of licensing is necessarily the way forward, but we have certainly heard what she has said and I am sure that my officials will take seriously the points that she has made today.
General Practice (Northamptonshire)
1.29 pm
Mr. Philip Hollobone (Kettering) (Con): I am sure that you have had a busy and productive morning, Mr. Taylor, but I suggest that this debate will be the highlight of your entertaining morning. I thank Mr. Speaker for granting me permission to hold the debate, and I also thank general practitioners throughout Northamptonshire and all their staff for the wonderful job that they do for people in Kettering and across the county.
One of my reasons for seeking today’s debate is that when we talk about the national health service, all too often we talk about hospitals and do not spend enough time talking about GPs. Yet most people’s most frequent contact with the NHS is through their local family doctor. Having talked to GPs in Northamptonshire, I know that their impression is that they are an overlooked part of the NHS. When the Government talk about schools and hospitals, they should not forget that GPs provide an extremely important part of our NHS.
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): The hon. Gentleman has rightly said that we should value GPs, that they ought to have more priority and that there is too much emphasis on hospitals. How does he feel that ripping up GPs’ contracts will enhance morale amongst GPs in his community?
Mr. Hollobone: I am not suggesting that GP contracts should be ripped up. If the Minister wants to expand on his question, I will be happy to tackle it.
Mr. Lewis: May I say gently to the hon. Gentleman that at his party’s conference, the shadow Secretary of State for Health announced his intention to rip up GPs’ contracts and start again. I assume that the hon. Gentleman is bound by the policy of those on his own Front Bench.
Mr. Hollobone: The purpose of today’s debate is not, from my perspective, a party political one. I am a Back-Bench Member of Parliament, I speak my own mind on these issues and I am disappointed, to be blunt, with the Minister’s tone in these opening exchanges. For me, the purpose of this debate is to draw his attention, as a Minister of the Crown, to the future of general practice in Northamptonshire. I suggest that whether I am a Conservative or Labour Member, many of the things that I shall say today are comments that any MP would want to put to him.
One of the biggest and most important issues affecting GPs in Northamptonshire is the fact that it is a designated growth area. The population of the county is due to increase by between one third and one half in the next 15 to 20 years. I should like the Minister to clarify how PCTs are funded in that respect. It is certainly the impression of local GPs that PCT funding is determined by the number of patients who are registered with GPs rather than the actual number of people resident in the area. One statistic that I have been given is that there are an estimated 20,000 unregistered patients in the county town of Northampton alone. Such people tend to make extensive and often inappropriate use of accident and
emergency facilities at a cost to the PCT under the payment by results plan, which means that resources that could be provided to local GP practices are not being provided. The Government’s own statistics, given in answer to one of my parliamentary written questions, told me that the average practice list size of a GP practice in Northamptonshire is 8,000 patients, which is 30 per cent. above the national average of 6,000. Even before the very rapid increase in population that the Government have planned for Northamptonshire, general practice list sizes in the county are already one third above the national average.
Mr. Peter Bone (Wellingborough) (Con): I congratulate my hon. Friend on securing what is an important debate for Northamptonshire. Is he aware that in many areas in my constituency it is almost impossible to get on to the list of a GP practice? I had a case in which an 80-year-old who came to the town could not get on to a list. She had to apply and was put on a list elsewhere in the town. That has occurred before the growth has taken place.
Mr. Hollobone: I know that my hon. Friend attaches great importance to health service issues as part of his “Listening to Wellingborough and Rushden” campaign, and I am delighted that he has taken this opportunity to highlight what is a real problem for many vulnerable people in Wellingborough and Kettering. Often, several members of the same family will find themselves being registered with different local GPs, which cannot be the best outcome.
An increasingly important issue in Kettering and Northamptonshire is the number of people arriving from eastern Europe and seeking GP services. That is causing problems for GPs with language—many such people are unable to speak proper English, especially when it comes to medical terms—and with gaining access to previous medical records. Every GP to whom I spoke in the summer recess said that they had new arrivals from eastern Europe on their books and that it is a genuine problem for them. Many GPs feel that it is inappropriate to include translation services, which are paid for by the PCT, in the enhanced services budget, because the PCT can then claim that it spends more than the indicative sum on enhanced services. That effectively deletes the money that is available for the development of medical GP services. Will the Minister be kind enough to look into that important issue?
GPs are also concerned about the recent NHS reorganisation in the county. The PCTs that existed two years ago have been merged into one PCT that covers the whole county. My hon. Friend the Member for Wellingborough (Mr. Bone) and I opposed that reorganisation, as I understand Labour Members in the county did, but the Government nevertheless went ahead with it. The problem is that part of the big overspend in the south of Northamptonshire has effectively been transferred to the north, where the overspend was not nearly as great, putting budgetary pressures that did not previously exist on GP practices in the north. As a result, GPs are prescribing cheaper drugs than they would otherwise prescribe because of the budgetary pressures from the PCT and the strategic health authority.
Another big concern that local GPs have brought to my attention is the state of children’s mental health services in the county. One GP wrote to tell me:
“I think the most significant aspect of healthcare in the Shire is the poor service available in Mental Health and particularly Children’s Mental Health. Only this week...we have a 13-year-old girl with...an Eating Disorder who has been dismissed as “depressed” by the Service and she is too young to access alternative services so her (not well-heeled parents) are referring her privately.”
“If young people’s mental health problems are not properly addressed, they are at best emotionally scarred for life and grow up to be emotional cripples, unable to sustain healthy relationships, and at worst end up in crime”
or on drugs. All the GPs to whom I spoke highlighted that as being an issue—patients requiring services that, all too often, simply are not available.
It has been brought to my attention that computerised cognitive behaviour therapy has been proposed by the National Institute for Health and Clinical Excellence as an effective tool for many patients. It was announced some six months ago that CCBT would be available. It is due to become available in Northamptonshire this month, but the responsible PCT team has only just been appointed. To add further insult, access to the therapy is being restricted to patients with severe depression, whereas NICE recommends it for mild depression and neuroses such as obsessive-compulsive behaviour. Again, there is a real concern that GPs are not able to access the services that they would want to access from the local mental health team.
GPs are also concerned that they are required to spend a growing amount of time on collecting and producing data under the quality and outcomes framework. They rightly say to me that, all too often, they spend far too much time on data processing instead of patient care, particularly as they have to deal with lists that are 30 per cent. above the national average.
Unfortunately, there are also problems with the choose and book scheme. One example that I can put before the Minister is from a local GP who referred a patient through choose and book for orthopaedics. The GP phoned the number, and someone took the details and said that the patient should phone the office where orthopaedic referrals were triaged. The GP phoned the number, but an answerphone said that staff were on holiday for two weeks and to phone another number. The GP phoned the other and was told that the office was not taking bookings like that but that it would wait for a GP letter and then write back. Two weeks later, a letter was received advising that the patient needed to see an orthopaedic consultant and to phone yet another number. The GP phoned the number six times, each time being cut off when the phone was answered. The GP finally got through and was told that the phone “is always doing that”. Those are frustrating circumstances for hard-pressed GPs. They made a particular point of wanting me to highlight the fact that choose and book is not working as it should.
Now we come to the issue of GP contracts. In good faith, the Government negotiated contracts with GPs. Reference was made to out-of-hours services. NHS survey data published in July show that 85 per cent. of patients in Northamptonshire are satisfied with GP surgery opening hours. Only 7 per cent. of patients said that they would like GP surgeries to open at weekends. There may be demand for surgeries to open in the
evenings and at weekends, but having asked my constituents and having spoken to GPs, I can detect no such surge of opinion in Kettering or Northamptonshire.
GPs rightly say that they would expect few people to take advantage of the service if they were to open for weekend surgeries. They also point out that although the Government may be pressing the issue because they are embarrassed that, in their view, they are paying GPs more than they should get, there would be extra costs outside the GPs’ remuneration for paying for staff and building occupancy at weekends.
Local GPs provide an out-of-hours service through the Keydoc service. It is provided on a rota basis, and I can tell the Minister that it does a better job than NHS Direct, and at a far lower cost. In many cases, phone callers find themselves speaking with the Keydoc service because NHS Direct is unable to cope with the volume of calls that it gets. I am not saying that Keydoc is perfect. I have had complaints about it, but I have also had complaints about NHS Direct. I draw the Minister’s attention to the concerns of a constituent who e-mailed me. He stated:
“I today had occasion to contact the NHS Direct service. I needed medical advice after swallowing an object...I tried to call for over 4 hours and constantly received an engaged tone. In the end I contacted my GP surgery who were able to reassure me. A quick straw poll of work associates shows this is typical and generally they call the out of hours GP service because NHS Direct is either busy or is so general in advice that it is not sufficient for purpose.”
That unsolicited e-mail was from a constituent in Rothwell. Local GPs are concerned about the amount of money that the Government put into NHS Direct, particularly when they compare its cost-effectiveness with that of Keydoc.
Overall, the message from Northamptonshire is that GPs are extremely hard-working. In general, the system is working well, but GPs are beginning to feel unappreciated by the present Government, particularly in respect of the unnecessary pressure to extend opening times outside the weekday appointments system. There is growing concern about the amount of data that they have to collect, and they feel that the Government ought to reprioritise GP care rather than concentrate only on hospitals when they talk about the NHS.
I close by placing on the record three surgeries in the Kettering constituency that in a recent NHS survey achieved levels of satisfaction that were higher than the national average. The Guilsborough, Dryland and Mawsley surgeries are setting an extremely good example for local GP surgeries throughout Northamptonshire.
1.46 pm
The Parliamentary Under-Secretary of State for Health (Mr. Ivan Lewis): It is always a pleasure to serve under your chairmanship, Mr. Taylor. I congratulate the hon. Member for Kettering (Mr. Hollobone) on securing this Adjournment debate. The intervention of the hon. Member for Wellingborough (Mr. Bone) was obviously important from his constituents’ point of view. I have to say, as a Manchester City supporter, that he would be greeted in a positive way if he were to venture into Manchester these days, in view of his well-known likeness to a certain high-profile football manager.
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