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Sick people and their families should not be asked to pay over the odds to contact local NHS services,
changes were made to deal with 0870 numbers. There is already a system established. From 1 April 2005, NHS organisations providing local services could not adopt those numbers. The measures, the techniques and the interventions are established. There is a contractthe money is voted for by the Houseand it is entirely appropriate in this case that guidelines should be laid down by Ministers. We have existing guidelines to do that, so the Minister just needs to stop making party political points and agree that something should be done.
Mr. Lewis: May I say gently to the hon. Gentleman that of course the Government believe that, on occasion, it is appropriate for Ministers to intervene to make clear what is acceptable in regard to the decisions made about our public services? That has been the hallmark of this Government over the past 10 years. The difficulty we have is that the Opposition parties constantly question that way of governance and decision making in public services.
I want to address this point seriously and to comment on the substantive contribution that the hon. Gentleman has made. It is entirely unacceptable for any professional working under the banner of the national health service to rip patients off by charging them more than the standard local call rate for contacting their surgeries. That is the Governments position. Difficulties arise, however, when individuals are tied into existing contracts. That involves a commercial arrangement. The hon. Gentleman will be aware that GPs are self-employed; they are not employees of the state. I am not sure whether he is proposing to change that arrangement.
We need to consider the best way to achieve our common goal of preventing the exploitation of patients and stopping this practice being regarded as acceptable. It is regrettable, and almost disappointing, that politicians have to make this point to the national health service.
Grant Shapps: Does the Minister think that the problems that people have getting through to their GPs surgeries are a significant contributory factor, particularly in regard to the premium rate numbers that charge more than the local call rate, when people sometimes have to wait upwards of 20 minutes to get through? Does he think that that contributes still further to the problems relating to charging?
I am now being asked to get even further into micro-management by analysing the demand on a telephone system and the reason why people might have to wait for a specific period of time. Hon. Members
will be familiar, from their own household experiences of trying to contact utility companies, with the often inordinate length of time that they have to wait before their call is taken. It is impossible for me to make a sweeping, generalised statement about whether people are having to wait an unduly long time because GPs and other professionals are choosing inappropriate telephone systems with inappropriate cost levels, or whether they have to wait a significant length of time because of the demand and pressures that any phone system would experience.
Surely the question here is one of transparency, as the hon. Member for Beverley and Holderness said. The charging implications should be absolutely clear to patients and, indeed, to other professionals telephoning GP practices in these circumstances. Transparency is incredibly important, as is fairness. The hon. Gentleman was also right to talk about people on low incomes, isolated older people and people with chronic conditions. We do not want to see such people being ripped off or exploited in any way.
Mr. MacNeil: If calls are being charged for in this way, there must surely be an incentive for those who err on the side of the unscrupulous to keep their patients waiting even longer, so that they can get even more money. On the Ministers point about transparency, perhaps the last thing people who are in ill health need to know is that it is going to cost them 50p a minute to be kept waiting for 10 minutes. That might put them off waiting, and the GP practice would have spoiled the ship for a haporth of tar.
Mr. Lewis: There may be one or two candidates in the Chamber for interpreters of the hon. Gentlemans contribution, but he makes a valid point. There are incentives within GP contractsresponse times, including telephone response times, for exampleand they are usually measured through patient satisfaction surveys. The system of contractual relationships with GPs thus provides some incentive for them to respond as quickly as possible.
I would also say to the hon. Member for Beverley and Holderness that it is important to be measured. The vast majority of GPs would not dream of deliberately seeking to exploit patients by keeping them hanging on the end of a telephone simply to generate income. It would be extremely unfair and unfortunate if any Member were to give the impression that significant numbers of GPs would engage in such practices. I do not believe that they would.
My hon. Friend has characterised these numbers as unfair, particularly for the sick and the elderly, and I quite agree with him. He also made a valid point about how much command and control can be exercised from Whitehall, and he referred to GPs
who already have contracts in place. Will he assure the Chamber that when the contract next comes up for NHS Direct, which is under the control of Whitehall, it will not be renewed at an 0845/46/47 or similar higher-rate telephone charge?
Mr. Lewis: I can give my hon. Friend a cast-iron guarantee that that will not be allowed to continue when the NHS Direct contract comes to an end. That provides a very important example of the Government leading by example in this area.
The hon. Member for Beverley and Holderness and I have a shared objective and belief in transparency and fairness. The question is how we achieve our objective. I think that, as a precursor to further guidance or diktat from Westminster or Whitehall, we need to gather some hard evidence in the period ahead, so that we can be absolutely clear about the nature and extent of this problem and the range of potential solutions. For example, it is important to establish what proportion of GP practicesand it applies to other professionals in similar circumstancesare tied into long-term contracts on this basis, which would render hollow any Government promises issued from the Dispatch Box about patient experiences.
What I will commit to tonight is ensuring that the Department begins a serious and substantive gathering of evidence. I invite hon. Members to submit their evidence to that process so that, having established the facts, we can look into the case either for guidance or for going beyond it. I believe that it is an all-party view that no patient or user of the national health service in this country should be ripped off or exploited in this context.
Mr. Stuart: I am grateful for what the Minister has just said and I believe anyone listening to the debate will also be grateful. I put it to him that in addition to having extensive and proper research into the issues, he should look further into dealing with the surgeries that have not yet signed a contract. If the Minister could try to influence the Government as soon after tonight as possible so that guidance could be issued to stop any more practices signing contracts that will doubtless have to be honoured in some way, that would represent at least some steps forward. We could then see the way forward to the future.
Mr. Lewis: I am happy to send a strong signal to any practices currently contemplating decisions on the issue. I urge them to reflect on the fact that many of their patients will be on low incomes and particularly vulnerable. In those circumstances, they should consider whether it is consistent with best professional practice to go down the road of charging patients above the local rate. I am happy to make that clear from this Dispatch Box.
I also caution such practices that as the Government are consistently focusing on the issue and will begin a serious evidence-gathering process, that might lead in the not-too-distant future to even stronger guidance on what will be expected of GPs and associated professionals. GP and primary care practices were cited in the debate, but it is unclear, and we must establish, whether other organisationsmy hon. Friend the Member for Wolverhampton, South-West (Rob Marris) referred to
a range of public services in which this is an issuesuch as NHS provider organisations, are engaged in the activity.
The issue is an important one, and the Government are determined to get to grips with it. Our common
duty is to ensure that patients are not exploited and not ripped off, and that we create a system that is both fair and transparent.