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I should like to make a few general points about family doctor services. That is the subject of the debate; it is not just about health centres and polyclinics. At the kernel of the debate is a question of honesty and integrity on the part of the Government. I do not believe that they have made the case transparently and openly for a Kaiser Permanente, California model of private sector health provision. They know full well that were they to make that case, they would not get it past their own parliamentary party, the health sector trade unions or other health care professionals. There may be merit in their model, but at the moment we are not having an honest debate about it. It is incumbent
upon the Government to put their cards on the table and make the case for polyclinics or health centres.
It is ironic that the Secretary of State was in crowing mood. As I said earlier, we always see the vacuity of the Labour party’s record and arguments on the health sector when it has to go back 60 years, to historic documents about what was or was not said by general practitioners and medical practitioners in 1947. The fact is that this Government have presided over a doubling of expenditure on the health service but barely any change in outputs and the impact on patients. Their work force planning was described in the Select Committee’s report last year as “disastrous”. The right hon. Member for Rother Valley (Mr. Barron) was noticeably shy in not sharing that with the House.
The Government have presided over a health service in which one is more likely to die of a hospital-acquired infection than, for instance, in a road traffic accident. They will have spent approximately £100 billion on the health service, and we will not take any lectures from a Government who, for example, have increased GP salaries by 50 per cent. for less work. I do not blame the general practitioners for that; it is this Government’s cack-handed mismanagement that has resulted in that situation.
I well remember that the then Prime Minister came to Peterborough in April 2000 to open the walk-in centre in Midgate, in the city centre. Such centres were then the great thing, the next big thing of Labour’s Maoist onward march of health reform. They were going to solve all the problems and take up the slack in the primary care sector. Of course, they are not in fashion now, so we have even more change.
My opposition to the scheme is not a knee-jerk opposition to change. Dare I say it, I am quite Fabian in my approach—I believe in the inevitability of gradualism. In such a big organisation, there will always be change, but I object to the top-down approach of the change and the fact that there is no real autonomy, authority or democracy in respect of general practitioners, health care professionals, nurses, managers, elected councillors and others at local level. The change is being imposed. That is to be regretted—a point made by Members across the House.
General practitioners in particular need to be properly consulted; they need buy-in to the new health centres or polyclinics. It is no good the Secretary of State, in his rather uncharacteristically sneering remarks, belittling the work of GPs, who are the most trusted health care professionals in the UK—perhaps the only point in my speech with which the hon. Member for Dartford will agree. It ill behoves the Secretary of State to take that confrontational tone, and it is no wonder that such a significant number of GPs are not predisposed to vote Labour at the next general election.
I want to give the House a slight history lesson about primary care in the city of Peterborough. The city pioneered collaboration between adult social care and primary care, which the Liberal Democrat spokesman, the hon. Member for North Norfolk (Norman Lamb), described as an exemplar for the country. If I may, briefly, be positive, one of the only aspects of the Government’s health policy with which I agree was that they listened to us about Peterborough’s primary care
reorganisation in 2005. We in Peterborough said that as we had pioneered collaboration between adult social care and primary care it would be ludicrous to throw it away in an unpopular and uncalled-for reorganisation. The Government listened, and the former Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), threw out the plans.
There were other reasons why we insisted that we should have a city-wide health care body or primary care trust. We in Peterborough have specific health needs and health inequalities. Even in a relatively small area such as Cambridgeshire there is a great gulf between the needs of my constituents and, for instance, those in a relatively wealthy constituency such as Cambridge. We have issues around asthma, chronic obstructive pulmonary disorder, diabetes and heart disease. We have a large ethnic minority population who are predisposed to some chronic conditions. We felt that to be subsumed into a greater Cambridgeshire PCT was not appropriate—the fact that the trust was approximately £30 million in deficit at the time concentrated our minds somewhat, too. The Government listened, and we went forward.
I pay tribute to the PCT in Peterborough and the professionals who work in the organisation, especially Angela Bailey, the chief executive. However, when I read the proposals and listen to the Secretary of State, I am astonished that a Government who exult in the fact that the NHS is 60 years old and that they were responsible for founding the national health service could really be presiding over changes that would give the sickest, the very oldest, the very youngest and the poorest—the least able to speak up for themselves—a second-class primary health care system. As I said earlier, I cannot believe that of a Government who seem to be having a nervous breakdown in their interaction with those who should be their core supporters. We know that the Labour party has always had a rather sanctimonious, smug attitude—only Labour cares about public health, the poorest people in our society and the health service. Of course, that has never, ever been true.
Sir Nicholas Winterton (Macclesfield) (Con): In an area such as Macclesfield, which I represent, where there is an out-of-hours service staffed by GPs at the district general hospital and where all the GP practices in the town came together, with the agreement of the PCT, in a super-surgery to provide the wide range of facilities that the hon. Member for Dartford (Dr. Stoate) described, does my hon. Friend agree that it should be the PCT that takes the decision and not central Government?
Mr. Jackson: I am grateful to my hon. Friend for making the pertinent point, alluding to his constituency, that where we trust NHS professionals and give them authority, autonomy and budgets, they will work for their benefit and the benefit of patients and the whole community. We can see an example of that co-operative work in the primary care sector in Cheshire, particularly in Macclesfield. I pay tribute to my hon. Friend for his role in producing that outcome.
As of March 2009, a polyclinic or health centre, or whatever it is to be called, will be foisted on my constituents in Peterborough, with only partial lip service to democracy—the gloss of democracy—via the city council health overview and scrutiny committee. What is the
strange beast that will be foisted on us? Open 12 hours a day, seven days a week, it will apparently provide a one-stop, multidisciplinary medical assessment, diagnosis and treatment facility, supposedly located in a deprived area of the city. All fine and dandy in principle, but what does one-stop medicine actually mean? Where will the doctors to staff the polyclinic come from? No established doctor who has his or her own family practice will want to give it up to work at a polyclinic. Does that mean that less experienced and capable staff will be recruited? I hope not. When we board an aeroplane we hope it will be flown by a pilot, not an air stewardess. I hope that when my constituents go to a polyclinic they will receive the highest possible standard of primary care from clinicians and NHS professionals.
We have already seen shortages across the country—for example, of fully trained radiographers, as my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) said, and of specialist nurses and hospital doctors. What about X-rays, scans and blood tests? Will there be consultants on site to oversee such work? If so, who will cover their work at Peterborough district hospital and Edith Cavell hospital? What are the resource implications?
Will polyclinics deal only with straightforward cases, such as the young, the wealthy and the only occasionally poorly—Tarquin and Jocasta popping down in their 4x4 before they go off on a business trip? Will polyclinics treat only the so-called worrying well? That may be the case. What about the very old, the poor and people with chronic conditions, such as chronic mental health issues? Will they be welcome at the polyclinic? I am not entirely convinced.
What will be the future of the family doctor service in my constituency? Will those services go the way of local shops and pharmacies? Mention was made earlier of the impact of the 2005 regulations on small pharmacies, which are closing at an alarming rate, giving way to the provision of pharmaceutical services in large supermarkets such as Sainsbury’s and Asda. Will those services go the way of NHS dental surgeries and of post offices? We know of the Government’s lamentable record of duplicity about post office closures over a number of months and years.
The Department of Health has promised more money for polyclinics, but will it be from existing, struggling NHS local budgets? I beg the indulgence of the House while I make my next point—one with which my hon. Friend the Member for Boston and Skegness (Mark Simmonds) will have some sympathy. We have had a huge influx of EU migration in Peterborough that has put massive strain on surgeries across the city, notably the surgery of Drs. Modha and Modha at Thistlemoor road, New England, and Dr. Prasad’s surgery at the Westwood clinic. They are straining under the weight of inward migration from the EU. Will that be taken into account in the national template forced on local PCTs? No one in Peterborough has voted to end the relationship between patients and their local, trusted and—mostly—friendly general practitioners for the sake of those super-surgeries.
We should be opening more family practitioner surgeries in the poorest areas of my constituency. We should not be centralising and putting everything in one place—a place that people who have travel and transportation problems as a result of their illnesses and medical conditions may find it difficult to reach.
As always happens under this Government, there will probably end up being a great fanfare and lots of money spent, but at the end of the day there will be depersonalised services, dumbed-down care and a system without comprehensive budgeting, risk assessment or proper consultation.
Mr. Graham Stuart: I apologise for my late return to the debate. I wonder whether my hon. Friend agrees that we may end up with another situation that often arises under this Government. Government Members are fighting against their own tax rates, and Government Members who have voted to close post offices are leading campaigns to protect their local post offices. Does my hon. Friend believe that we will see Labour Members leading protests against the closure of family practices, even though they will doubtless vote for those closures later this afternoon, having had yet another loss of conscience?
Mr. Jackson: Labour Members of Parliament, who are in a weird parallel universe with the Prime Minister, voted against a Conservative motion on post offices in the Lobby, and then ran hotfoot to their constituencies to address public meetings, in which they said how hard they were working to keep post offices open, having issued press releases and put them on their websites. I am an old cynic, but I foresee occasions when my Labour opponent will be fighting tooth and claw to protect surgeries that his own Government have led to be closed.
My admiration for local NHS staff is well known, and we are fortunate to have good managers in our area, but my job as a Member of Parliament is to stick up for the people in my constituency who do not have a voice, and to ask awkward questions. I will continue to ask those questions until we have full, honest and transparent answers from the Government on polyclinics, and until we concentrate on the really important issues—on making the whole of our communities better—instead of on gimmicks that will lead to disaster.
3.2 pm
Mr. Kevin Barron (Rother Valley) (Lab): I declare an interest: I am a lay member of the General Medical Council. First, I want to reply to a comment made by the hon. Member for Wyre Forest (Dr. Taylor) about clinical judgment being superseded by the needs of a company—I think that he was quoting from the NHS campaign group, Keep Our NHS Public. In all my years on the GMC, that has not happened. People who work in the independent sector come before the GMC from time to time, but I have never met anyone in the medical profession who felt that they would have to do something that was against their clinical judgment; that would be wholly wrong and unprofessional. We may argue about one pharmaceutical prescription as opposed to another, but I do not see any proposals that would endanger the patient.
The hon. Member for Peterborough (Mr. Jackson) was a member of the Select Committee on Health a few months ago. We criticised the national health service, and therefore the Government, on work force planning. That is absolutely right. As most people in the national health service would agree, work force planning has been dysfunctional for a long time now. That situation
is beginning to get a little bit better—I am pleased about that, and I hope that the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), is, too—but it in no way threatens family doctor services.
I point out to my hon. Friend the Minister that family doctor services have been the backbone of the NHS for the vast majority of our constituents since 1948, and will remain so. It is true to say that those services are not always the first port of call. The hon. Member for Romsey (Sandra Gidley) would probably jump up and tell us that our constituents’ first port of call for health care help and professional advice is the local pharmacist, and not the local GP; that will remain the case. The vast majority of doctors who work in family care services are committed to their flock—their patients in the community where they practise. I have no doubt about that, and I do not feel that they are under threat in any way.
Let me say why I do not support the Opposition motion and why I support the Government amendment. In their changes, the Government are investing an extra £250 million to establish more than 250 new primary care services, which will include both GP-run health centres and GP practices. Some 113 of them will be established in some of the most deprived communities in the country which have historically been under-doctored. There will be 152 new state of the art GP-led health centres, which will be open between 8 am and 8 pm, seven days a week. One such structure will be built in a constituency that neighbours mine, but it will serve my constituents well. Those health centres will offer a wide range of health services, including pre-bookable GP appointments and walk-in services for registered and non-registered patients, and a range of specialist services.
I had discussions last September with the local foundation trust. It will bid to provide some of the services that will be offered in the new primary care centre, as we will call it in Rotherham. Those services may not be offered in the district general hospital. Particularly for those who do not have their own transport, it is a lot easier to go to the town centre by bus than it is to get to the local hospital, so it will be a great advantage to urban Rotherham to have that facility, which will be open seven days a week, 12 hours a day.
Mr. Bone: Has the Chairman of the Select Committee had a lot of people in his area writing letters or coming to his advice surgery to demand those extra hours—the Saturday and Sunday service, and for services to be open 12 hours a day? Has there been a lot of demand for that?
Mr. Barron:
No, there has not; that is the true and honest answer to the question. Around the time of the last general election, there were problems with the way in which one practice near my constituency office interpreted the 48-hour rule that was introduced a few years ago. That was the only time that anything was said about the health service at the time of the general election. People were upset that they had to phone in the morning for an appointment that day—an impossible task, particularly for people who work and
people with young families. I thought that that was a gross misinterpretation of the agreement, and so did the primary care trust. It had to try to negotiate with the GP practice on whether it would relax its strict interpretation of the rule and free-up access in a reasonable way. We were not talking about opening the practice seven days a week, 12 hours a day; we just wanted to free-up access in a reasonable way, so that people who were on that family doctor services list could get seen in a more reasonable time. That was a complaint about one surgery; there were no complaints about the many other GP surgeries in my constituency.
Dr. Stoate: Perhaps I can help my right hon. Friend. The issue is not so much about the number of people who demand such services when they are well as it is about the number of people who are using accident and emergency departments on a Saturday and Sunday, but who would far rather be seen in their local clinic, a bus ride away, by their local GP, pharmacist or practice nurse. The real benefit of opening 12 hours a day, seven days a week, is far more to do with keeping people away from accident and emergency departments—many of which may be 10 or 20 miles away, or even more—that are inappropriate for them. We should localise the care that is appropriate to their needs, so that it is far closer to their homes.
Mr. Barron: I agree. The question posed in the motion, and asked by the hon. Member for South Cambridgeshire (Mr. Lansley), is what about walk-in centres. Our walk-in centre in Rotherham will close. It is based in a pretty old building that used to be a hospital. It is not an acute hospital now, although services such as podiatry are based there. People will instead go to the new primary health care centre—we are not calling it a polyclinic—that will be built in Rotherham. I had an e-mail from the primary care trust earlier this week saying that there will be two new GP practices in there. Those practices will not be transferred; they will be new. It also said that local GPs who want to bid for that contract will have the right to do so. Family doctor services could even expand if they are successful in obtaining an NHS contract to provide that type of service in the Rotherham primary care centre. We should recognise that no matter who runs such centres, those are national health service contracts designed to provide better services for our constituents.
Sir Nicholas Winterton: I am grateful to the current Chairman of the Health Committee, which I had the honour to chair in the past, for giving way. Will he say to the House that polyclinics should not be forced upon areas where there is already adequate cover by way of out-of-hours services, staffed by local GPs—in my case, as I said in an earlier intervention, at the district general hospital? In Macclesfield all the GPs’ services have come together in an excellent super-surgery, where they operate separately as individual practices, which is so important to people. Is it not right that a polyclinic should not be forced on areas where there is already adequate coverage?
Mr. Barron:
The hon. Gentleman is not the first to cite that example. His better half, the hon. Member for Congleton (Ann Winterton), mentioned family doctor services in Macclesfield earlier. There is and always has
been the flexibility in the national health service for that to happen. The question is whether it does. I shall come to that.
Mr. Graham Stuart: I know that the right hon. Gentleman shares my concern about provision in rural areas. There is, as my hon. Friend the Member for Macclesfield (Sir Nicholas Winterton) observed, a fear about the imposition of polyclinics. The policy will go down particularly ill in rural areas where minor injuries units in community hospitals have been shut down or had their hours massively reduced. If Ministers suddenly espouse the need for provision 12 hours a day, seven days a week, people in those communities will not understand why that has been removed from community hospitals throughout the country, and they will not believe that the policy is likely to lead to the improvement in rural areas that the right hon. Gentleman implies will happen.
Mr. Barron: I am no expert on the hon. Gentleman’s constituency but, as was said earlier, and not by me, there is and should be flexibility. It might be the local community hospital that delivers the service. That might be a structural matter. Years ago I visited some of the community hospitals outside my constituency; they were so old that they were hardly suitable for the 20th century, let alone the 21st. A decision will have to be taken at local level about how and where the service is provided.
The motion states that the Opposition are against the imposition of polyclinics
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