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12 Dec 2007 : Column 130WH—continued
“73 per cent. of respondents believed that local health services have got better or stayed the same in recent times.”
Obviously, it would be nice if the figure were even higher; none the less, taking into account that people may be more inclined to respond to surveys if they have a grievance, I was encouraged that three quarters of the people who responded believed that the services were as good or, in many cases, better than they were in recent times. Secondly,
“94 per cent. of people surveyed”—
an overwhelmingly large figure—
“felt that the waiting time to see a GP locally was reasonable.”
Only 3 per cent. reported that they waited longer than was reasonable to see a doctor in my area. Thirdly,
“70 per cent. of people said that they were very satisfied with the consultation they received from their GP.”
Only 1 per cent. of the remaining 30 per cent. reported that they were not very satisfied.
As we can see, there is general satisfaction with the services, and it goes right across the board, even to the hospital food. I spent half a day at Musgrove Park hospital a few months ago to find out about its food and catering operations and to meet all the staff who work in that area, which has traditionally been the subject of jokes. People malign hospital food and those who serve it, and comment on whether it tastes good enough, is hot enough, and so on. However, 76 per cent. of people who had hospital food during their stay in hospital said that they were very or fairly satisfied with it, and only 8 per cent. said that they were not at all satisfied.
The overall level of satisfaction with provision and services both at the hospital and at GP levels was encouraging. It is important to make that point. To summarise, when people were asked how satisfied they were with the NHS in Taunton Deane,
“30 per cent. said they were very satisfied, 56 per cent. of people were fairly satisfied”,
and only 14 per cent. of people said they were not very satisfied, but, of the several thousand who responded, nobody said that they were not at all satisfied. Fourteen per cent. erred on the side of dissatisfaction, but even they were not totally negative in their observations on the NHS.
We have many things to look forward to in my area. A cancer centre is to be built at Musgrove Park hospital—in fact, work has already commenced on it, and it is due to open in 2009. That is an extremely important development for my constituents because, at present, many who have cancer need to go as far as Bristol for treatment. Obviously, that 100-mile round trip from Taunton is distressing for them and their families; it is also expensive and physically tiring at a time when they are least well equipped to deal with such a journey. That issue, which is of huge importance to my constituency, is being addressed, and I believe that I can say with absolute confidence that my constituents very much welcome that change.
Having said all those things, it is only reasonable to point out where there are concerns. It would be interesting to hear from the Minister how we might go about tackling them effectively. I will run through some of them. They are not in any particular order, but it is
worth starting with the one that has perhaps received the most attention in my area. The survey indicated that
“40 per cent. of people rated the out of hours care they received from their GP as poor. 43 per cent. thought it was average and only 18 per cent. rated it as being good.”
Compared with the figures that I gave earlier on other aspects of the NHS, those figures are very low indeed and should give rise to concern, particularly as the Government have recently altered the arrangements for out-of-hours services at the evenings and weekends. I welcome the new Somerset primary care trust five-year strategic health plan, which includes in its summary a commitment to
“Developing more flexible opening hours for GP surgeries, including extended opening at evenings and weekends for half of the county’s GP practices.”
I hope that the Minister will be able to give us some encouraging news this afternoon about improvements in this aspect of the service. People in my area are keen to have an efficient out-of-hours service, particularly elderly people who may need to access GP services outside conventional working hours. It is of huge importance to them.
The second concern that I am keen to raise is the availability of NHS dentists. It is true that, according to the figures that I have been given, 69 per cent. of the population in Taunton Deane are registered with an NHS dentist. That is considerably higher than the national average, but of course it still leaves almost one third not registered with an NHS dentist. There is evidence of problems with dentistry in Somerset. Taunton Deane has a high level of tooth decay in 10 and 11-year-olds, according to Somerset county council’s health scrutiny sub-committee, and although availability of and access to NHS dentistry in Taunton Deane is less problematic than in some other parts of the country, it was raised as a concern by a number of people
Another aspect of concern was the continued existence of mixed-sex hospital wards. In my survey, two thirds of people—67 per cent.—of those who responded thought that mixed-sex wards were not acceptable, and only 16 per cent. thought that they were okay. I hear that anecdotally from people who, when they may feel compromised in their health and general appearance, would rather not have the indignity of being on a ward with people of the opposite sex who are strangers to them. I know that the Government have turned their attention to that in the past, but it remains a problem in Taunton Deane and elsewhere in the country. It would be a significant step in the right direction if mixed-sex wards no longer existed in Musgrove Park hospital and elsewhere.
The fourth of the six areas that I shall touch on is nurses’ pay, which is topical, given that police officers’ pay is at the forefront of our minds. Many people felt that the nurses’ pay rise this year was less generous than it should have been. I recognise that pay has improved in recent years, but there has been a spending squeeze this year.
Caution was expressed about excessive centralisation and target setting in the NHS. I am not against targets in all circumstances, and I believe that most people are not against them in all circumstances. People rail against them, but they respond positively if they are given an example such as the target of patients being
seen within 14 days if they are suspected of having cancer. However, they are anxious about excessive centralisation and micro-management of services by central Government, with less discretion being given to people in each geographic area, such as Taunton Deane, to run and to shape services appropriately for their community.
The final concern is cleanliness and hospital infections. In the past year or so, I spent half a day with the cleaning staff at Musgrove Park hospital, and I was impressed by how seriously they take their duties and the progress that they are making to improve the overall standard of cleanliness. However, 18 per cent. of those responding to the survey reported that they were aware of a problem with MRSA or other hospital-related infections during their stay. That has been a problem at the hospital in Taunton and at other hospitals. It causes great anxiety to people who fear that they will end up being made more ill rather than cured during their time in hospital.
In conclusion, I recognise that there have been improvements in NHS services in Taunton Deane. I want to be reasonable and to pay tribute to those improvements when it is deserved. I particularly recognise the work of doctors, nurses, administrative staff, all the support staff, such as porters and receptionists, whose work is often overlooked, and all those who work within the primary care trust and the strategic health authority. I have had good relations with them while I have been a Member of Parliament, and their work is hugely valued by people in my area.
There is great loyalty to the services. The friends of Musgrove Park hospital and the friends of Wellington community hospital are both well supported organisations, and that recognises the general feeling of well-being directed towards those two hospitals in the community as a whole. However, that does not mean that there is no scope for services to improve, and there is still some way to go with out-of-hours access to GPs and mixed-sex wards. If the Minister can demonstrate progress in such areas, I will ensure that next time I undertake such a survey in Taunton Deane the findings will be even more positive and encouraging than on this occasion.
4.14 pm
The Minister of State, Department of Health (Mr. Ben Bradshaw): I congratulate the Member for Taunton (Mr. Browne) on securing this debate, and I thank him for congratulating NHS staff in his constituency on the excellent job that they do. I had the privilege of seeing a copy of the hon. Gentleman’s survey. He has alluded to some of its findings, which were helpful and encouraging. Among the figures that he cited, 73 per cent. of residents thought the health service had got better or stayed the same, and 86 per cent. were satisfied or very satisfied. More than nine in 10 had no problems getting an appointment with their GP, and two thirds said that they were seen within an hour at accident and emergency, which is impressive. Of those who had visited hospital, 100 per cent. had rated their stay as being good or very good.
Given the results of hon. Gentleman’s survey, I was a little surprised to see that it is entitled, “SOS for the
NHS”. I accept that there are still challenges, and I shall come to some of his specific concerns. It is important that we do not talk down the NHS, and he did not do that in his speech.
4.16 pm
Sitting suspended for a Division in the House.
4.31 pm
Mr. Bradshaw: As I was saying, I was also pleased to read in the survey conducted by the hon. Member for Taunton that nine in 10 Taunton residents rejected the suggestion that the NHS wastes money. Of course, in 1997 the NHS suffered from massive under-investment. We have more than doubled spending in Taunton and across the country, and just in the past two years, funding for Somerset primary care trust has increased by 22 per cent. Without that additional investment, accompanied by reform, we would not have seen the significant reductions in waiting times and waiting lists that have been achieved.
In Taunton and Somerset NHS Trust in 1997, more than 1,000 people were waiting more than six months for treatment; today, nobody is. I can announce to the House today that by the end of this month, no one at the trust will have to wait more than 18 weeks from referral by their GP for treatment. That is a year ahead of the national target—a remarkable achievement. I congratulate all the NHS staff in Taunton and the surrounding area who have worked so hard to achieve that goal. I have to tell hon. Members that Taunton is only the second place in the country to achieve that historic milestone, the first being Yeovil—[Interruption.] There is a traditional rivalry within Somerset. I also congratulate the trust on achieving foundation trust status earlier this month. I hope that the trust will continue to work in partnership with all the other NHS organisations to provide the best possible service to the local community.
I come now to the concerns raised by the hon. Gentleman. As he will know, the out-of-hours service in Taunton is provided by Somerset primary care trust, with calls from patients handled by the South Western Ambulance Service NHS Trust. I was a little surprised by the conclusions of his survey, as recent official patient surveys have found that 92.2 per cent. of patients describe their satisfaction levels as good or excellent. The Department requires all out-of-hours providers to meet the quality requirements as a contractual obligation. The requirements stipulate that patients will be guaranteed a GP consultation, including a home visit if there is a clinical need; patients are treated by the clinician best equipped to meet their needs in the most appropriate location; and services will be regularly audited to ensure that patients are receiving quality care.
An audit of the service in Somerset conducted by the National Audit Office in 2006 found it to be effective, clinically safe, meeting patient needs and expectations and providing value for money. It has been highlighted as an example of good practice for use across the country. Perhaps one explanation for the findings of the hon. Gentleman’s survey is that there is an element of confusion between out-of-hours service and the opening hours of GPs, which is a slightly different
matter. Because of the questioning in the survey, some respondents may have thought that they were being asked about extended opening hours for GPs, which we acknowledge is still a problem not just in Taunton Deane but around the country. As the hon. Gentleman will know, we are taking measures both locally and nationally to increase the flexibility of GP surgery hours.
I have to tell the hon. Gentleman that many hon. Members would be delighted if 69 per cent. of their constituents were registered with an NHS dentist. I think that the national average is about 56 per cent. and it has never been more than 60 per cent. across the country, so Taunton enjoys a higher level than has ever been achieved anywhere in the country. I understand that there are 15 dental practices in Taunton Deane, with four currently taking on new NHS patients—two in Taunton and two in Wellington—so the hon. Gentleman’s constituents should not have too many problems finding an NHS dentist. Spending on dentistry has increased by 30 per cent. since 2003-04. We have also opened two new dental schools, including one in the south-west, and increased the number of undergraduate training places by 25 per cent.
The South West strategic health authority has told me that Musgrove Park hospital complies with the Department’s guidance on single-sex accommodation. I understand that all wards are single sex except where patients are admitted as emergencies. That is a common practice around the country. I understand that when patients are admitted to a mixed-sex ward, the foundation trust always attempts to put them in a single-sex bay and to move them to a single-sex ward as soon as practically possible. Every effort is made to ensure that patients’ privacy and dignity are respected.
The hon. Gentleman drew attention to the problem of nurses’ pay. We acknowledge that this year’s pay round was a very tight one, but we cannot stress enough the importance of avoiding inflationary pressures in the economy, because no one, least of all public sector workers, benefits from spiralling wage, and therefore price, inflation. In the long term, inflation means less investment in public service, fewer jobs and lower pay. The same sort of pay restraint is having to be endured, as the hon. Gentleman himself said, by all staff in the public sector and, indeed, the private sector.
The hon. Gentleman is right to say that in the past 10 years we have had to rely quite a lot on top-down targets. They have been very important in driving some of the improvements that we have seen in mortality rates for some of the major killers in this country, such as cancer and stroke, and to get the appallingly long waiting times that existed a few years ago down to the levels that we are enjoying now. However, as we have achieved that, increased the capacity of the services
and invested in more doctors and nurses, we can now move away from the top-down culture; indeed, we are doing that.
When the annual NHS framework document—an annual document that the Department publishes to give the service its instructions for the next 12 months—is published tomorrow, the hon. Gentleman will see that we have made a significant shift away from top-down targets, although there are still one or two areas where we think the public are so concerned that they should be national priorities. He touched on one of those—hospital cleanliness and hygiene. However, we are going to leave it much more up to local health services, in consultation with their local communities, to decide what the most appropriate priorities are for them.
With regard to hospital-acquired infections in the hon. Gentleman’s area, I understand that Somerset is working towards its clostridium difficile target and it has made good progress in reducing MRSA, but we are not taking the pressure off. As I am sure the hon. Gentleman is aware, we have taken a number of decisions in the past few months to help to continue the drive to reduce hospital-acquired infections. That problem, which affects all developed countries, does not have one simple solution. Cleanliness and hand washing are very important, but so is good prescribing—the right prescribing policy for antibiotics—as poor prescribing can lead to problems in many areas. It is important that less well performing hospitals and trusts learn from the experience and practice of the best performing ones.
The hon. Gentleman referred to the local strategic framework, which he rightly said, I think, will be a very exciting document, setting out the vision for health care in his area for the next few years. It includes a £2 million investment programme to reduce health inequalities, and joint working with GP practices on practice-based commissioning—again, that is bottom-up health care priority setting. There are also local targets to reduce avoidable emergency admissions by 10 per cent. by March 2009; to improve palliative care services; to build four new community hospitals, at Frome, Minehead, South Petherton and Bridgwater, by 2012; and to commission, as the hon. Gentleman said, a new cancer centre at Taunton and Somerset NHS Trust by 2009 and a new surgical centre by 2013.
I am extremely grateful to the hon. Gentleman for showcasing the excellent quality of health care in the Taunton area. Taunton is in the lead in a series of areas, and I congratulate and thank staff and local and regional NHS managers for their fantastic dedication and hard work. It means that when we celebrate the 60th birthday of the NHS next year, the people of Taunton will have particular cause for celebration. Of course there will always be room for improvement, but I know that the local health service is committed to building on its success, and I am sure that it will enjoy the hon. Gentleman’s support as it does so.
Chewing Gum (Cleaning)
4.40 pm
Mr. Graham Allen (Nottingham, North) (Lab): I hope that you, Mr. Benton, have never suffered from Montezuma’s revenge, but you and your constituents have certainly suffered from the revenge of another defeated Mexican general, Antonio Lopez de Santa Anna, best known to moviegoers for his siege of the Alamo. That general was decisively defeated in the later Mexican-American war and went into exile in New York, where his minder was an inventor called Mr. Adams. The general persuaded Mr. Adams to import a consignment of chicle, the native gum of Mexico. After unsuccessful attempts to turn it into carriage and bicycle wheels, Mr. Adams turned the remainder into chewable candy. The rest, as they say, is history.
In my city of Nottingham, where we have spent millions of pounds enhancing our beautiful city centre and our square in the middle of town, we are unfortunately already seeing gum being deposited and we are having to have people almost permanently on station to remove it. Gum is a plague on modern cities and it defiles quality of life in places such as Nottingham, Derby, Leicester and Lincoln, representatives of which I have spoken with today. That has to change.
Those who can act with impunity—the manufacturers that supply gum—face no costs whatever. The clean-up costs are all down to our local council tax payers and income tax payers. Either the manufacturers should start picking up the bill or, far more preferably, the Government should help them to see the light and move towards a biodegradable gum.
The first chicle introduced from Mexico was a vegetable substance. I am sure that, with a little prodding and incentive from the Government, we can get the manufacturers to go back to a biodegradable gum and reduce this plague—this blight—on our cities, which reduces people to bringing gum into their own houses and on to their carpets from the streets. Children get it in their hair and on their clothes. People with disabilities get it on their wheelchairs. It is about time that we started to do something about it so that cities such as Nottingham can be the joyful and clean places that citizens want them to be.
This scourge promotes antisocial behaviour, blights the environment and public property, and costs local government and national Government millions to clear up. It is a hidden menace to every walker and to wildlife and pets, and is an additional and unpleasant hazard to disabled people and young children. In this short debate, I shall look at some of those costs in more detail and make a simple proposal to deter and reduce the consumption of chewing gum and to raise additional revenue from those who cannot do without it to deal with its consequences.
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