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Thirdly, requiring a core set of indicators that apply to all authorities would enable more specific comparisons between small areas across the country. It would also promote a wider and more interesting debate nationally about the causes of inequality and social deprivation.
I confess to a personal stake in this issue. The local councils that make up my constituency—Westminster and Kensington and Chelsea—consistently come near to the top of national league tables for wealth and income. The prosperity of Knightsbridge, Belgravia and Chelsea, where some councillors think that international bankers constitute a “hard to reach group”, masks the fact that, as recent reports have confirmed, the Mozart estate in Queen’s Park in my constituency is the most deprived neighbourhood in the whole country, and Westbourne ward has the country’s highest proportion of children in workless households. But I—and my colleagues in other areas with generally affluent average figures—struggle to get the implications of that understood locally and nationally, and families and pensioners living in poor neighbourhoods in such areas lose out in consequence.
Local authority social equality audits would be based on existing sources of data. I am not seeking to saddle councils with major new duties in collecting and analysing information, but to bring the vast array of data already buried in the vaults—locally and nationally—blinking into the light.
What would be included? Obviously, I would want short profiles of all neighbourhoods, which currently stay anonymously labelled as “super output areas” buried in the Office for National Statistics. Which are the most prosperous areas and which the poorest? We already have information on employment levels, and the number of children in workless households—that is, families surviving on less than £10 per day for fuel, food, clothing and treats. I would want to include data that exist but are unpublished, collected in school information profiles. League tables offer us information on key stage results and useful, though poorly understood, contextualised added value, but they should be complemented by the information that we hold on all schools about free school meal entitlements and other proxies for deprivation.
Harsh words about school performance miss the target when the breathtaking variations we see in school intake receive so little attention. It would also be useful to include information on benefits and services delivered by local authorities, including housing benefit and take-up of child care and out-of-school services. That would enable more informed discussions about local welfare-to-work policies, the impact of local authority charging policies and so on.
Audits would not be exclusively about ward or neighbourhood data, either, but would include local authority rankings on key deprivation indicators and proxies for deprivation, such as substandard housing, overcrowding and homelessness. Of course, as has proved to be the case with PCT public health reports, it would be good to see themes emerge and to see priorities set from year to year between different communities that reflect local circumstances so that audits become dynamic tools, complementing and informing local area agreements and council decision-making processes.
Information does not by itself make wrongs right. Information can be powerful and can do harm if abused or used partially or selectively, yet the alternative is far worse. We should no more be ignorant about poverty and inequality than we should be about climate change or any of the other great issues of our time. By offering local communities, policy makers and the media clearly presented and comparative data, we might not get all of the right answers but we might at least ensure that people are asking the right questions.
Bill ordered to be brought in by Ms Karen Buck, Mr. Iain Duncan Smith, Mr. David Blunkett, Mr. Frank Field, Simon Hughes, Fiona Mactaggart, Mr. Gary Streeter, Martin Salter, Mr. Terry Rooney, Clive Efford, Lyn Brown and John Battle.
Local Authorities (Social Equality Audits)
Ms Karen Buck accordingly presented a Bill to require local authorities to collate and publish specified social, economic and other data on an annual basis; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 17 October, and to be printed [Bill 122].
Opposition Day
Polyclinics
3.42 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move,
That this House opposes the Government’s plans to impose a polyclinic, or GP-led health centre, in every primary care trust; regrets that this could result in the closure of up to 1,700 GP surgeries; is concerned that the imposition of polyclinics against the will of patients and GPs could be detrimental to standards of care, particularly for the elderly and vulnerable, by breaking the vital GP/patient link; further regrets that these plans are being imposed without consultation; is alarmed at the prospective loss of patient access to local GP services at a time when care closer to home should be strengthened; believes that the Government’s plans would jeopardise the independence and commissioning capability of general practice in the future; supports the strengthening of access to diagnostic and therapeutic services without undermining the structure of GP services; and calls on the Government to reconsider its plans for polyclinics.
Last Thursday, the local medical committees, which are the statutory bodies required to represent GPs across the country, met in conference and passed a vote of no confidence in the Secretary of State and the policies of the Labour Government. On the same day, the British Medical Association delivered to Downing street a petition against the Government’s polyclinic proposals consisting of 1.2 million signatures. Patients care about the future of their local surgeries and about their GP services. They and GPs are concerned that the Government’s top-down, one-size-fits-all imposition of polyclinics in London and in each primary care trust across the country will reduce access to their GP services and undermine the GP-patient relationship, which is at the heart of the successful delivery of health care.
Today’s motion is very simple. It urges the Government to think again. If the Government had offered additional funding to support the creation of extra GP practices in under-doctored areas, we would have supported them.
Mr. Elliot Morley (Scunthorpe) (Lab): My local primary care trust has announced that we are to have an additional clinic, funded with additional money, in an area where some of the GP lists are full, which is an area of deprivation. The clinic will be open from 8 am to 8 pm and will provide drop-in services not only for the local community but for the whole area. Is the hon. Gentleman saying that he would deny the people of Crosby that clinic?
Mr. Lansley: No. The right hon. Gentleman should remember that back in January 2006, the Government promised to provide additional general practitioner services in under-doctored areas such as his. The fact that they are doing that two and a half years on should not be a cause for congratulation; it should be a cause for regret that it has taken so long. My point is simple—
Mr. Lansley:
No, I will answer the right hon. Gentleman’s first question before I come on to the next one. The point is that we need additional GP services in under-doctored areas, and the decision on where and how those services are structured must be the product of
local consultation and agreement, based on local needs and circumstances. For some time—for two and a half years—the Government have been saying that they will provide additional GP services in under-doctored areas, and we are not disputing the need to do so.
Dr. Tony Wright (Cannock Chase) (Lab): The hon. Gentleman mentioned petitions; I went to see my GP the other day, and the receptionist was giving out petition forms. Someone asked what the forms were for, and the receptionist said, “They’re going to close all the local surgeries down.” That is complete nonsense, and the hon. Gentleman knows it, so why does he go along with it?
Mr. Lansley: It is the British Medical Association’s petition, not mine. The Secretary of State and the Minister of State, the hon. Member for Exeter (Mr. Bradshaw), are suggesting that 1.2 million people across the country are being conned by their GPs, but that is not true. The Minister of State pops up and says that the Department had one e-mail from someone saying that they did not really believe in the petition, so I have asked the Minister whether he will publish all the e-mails presented, and every representation made, to the Department of Health. The fact is that across the country doctors have been voicing their concerns that their practice will be undermined to their patients, and I will explain in my speech why those concerns are valid. Doctors have concerns about the impact that the imposition of a polyclinic will have on their practices.
Shona McIsaac (Cleethorpes) (Lab): Will the hon. Gentleman give way?
Mr. Lansley: I will come to the hon. Lady in a minute. The first point to make clear is that the Government could have gone ahead in a far simpler, better fashion. They could have offered primary care trusts extra funding to provide additional practices in under-doctored areas. They could have offered funding to each primary care trust across the country to enable them to provide access to diagnostics and additional therapies in each area, in places that would have made sense from the point of view of local GPs. Everywhere that I have been—that is quite a lot of places—GPs would very happily have got together and agreed where it would be appropriate for such diagnostics and therapies to be available.
Peter Bottomley (Worthing, West) (Con): Is not the point that over the past 10 years the Government have set up a system for commissioning, and are now going outside it, and that any PCT that declines to put a polyclinic somewhere in its area will get disciplined? Is that not shocking?
Mr. Lansley: Yes, it is, and that is the way in which the Government now work. It is simple to say why GPs and patients across the country are angry: it is because, contrary to the Government’s rhetoric about local decision making, and contrary to the Minister’s rhetoric about all the proposals coming from primary care trusts, it is an imposed plan, generated inside the Department of Health and adopted by Ministers who should have known better.
Mr. Tobias Ellwood (Bournemouth, East) (Con): To go back to the first intervention, the people of Crosby may be delighted that there is to be a polyclinic there, but the people of Bournemouth are concerned, and doctors are worried about the patient-doctor relationship being eroded as a result of polyclinics being created. Does my hon. Friend agree that it would have been better to have allowed Bournemouth and doctors an opportunity to have a say in the matter, and then to have determined whether a polyclinic was appropriate?
Mr. Lansley: I absolutely agree with my hon. Friend, and he rightly reflects precisely the kind of points that are being made to all Members of the House. Labour Members may not admit it, but they know that GPs are telling them that they cannot see the rationale for many of the proposed imposed polyclinics across the country.
The Government were not content to bring forward proposals that would have made sense and could have been adapted and used locally. Gripped by a desire for the latest imported ideology of polyclinics, they first told London that there would have to be 150 polyclinics in the capital, and then told every primary care trust that they should have one each.
Of course, we need to strengthen primary care—no one disputes that—but Martin Roland, who is director of the National Primary Care Research and Development Centre in Manchester, said in the British Medical Journal in March:
“Increased patient choice requires more high-quality practices, not the small number of large practices that some polyclinic models suggest. We know that patients in small practices rate their care more highly in terms of both access and continuity. Indeed, although small practices show more variation in quality, on average, they achieved slightly higher levels of clinical quality than larger practices in the quality and outcomes framework.”
Ms Karen Buck (Regent's Park and Kensington, North) (Lab) rose—
Mr. Lansley: I will give way to the hon. Member for Cleethorpes (Shona McIsaac), but perhaps the hon. Member for Regent’s Park and Kensington, North (Ms Buck) will explain later why smaller practices that get better outcomes on the quality and outcomes framework will be shut down in favour of larger practices.
Shona McIsaac: I ask the hon. Gentleman to follow up what was said by my right hon. Friend the Member for Scunthorpe (Mr. Morley). I represent the rural part of north Lincolnshire. We will get a new clinic in north Lincolnshire, but the PCT has told us that that is a local decision to meet local need, and not one rural GP practice will close as a result of these plans. So why is the hon. Gentleman and his hon. Friends scaremongering to the extent that my residents think that their practices will close?
Mr. Lansley:
That is quite interesting, but the hon. Lady needs to look at the material published by the North East Lincolnshire PCT to accompany its memorandum of information, which sets out 34 practices that will be in the proximity of the new polyclinic in Grimsby, with all the implications that might flow from that. That is what we have seen across the country. We
are not scaremongering; people are looking at the material published by PCTs across the country. The Secretary of State for Health peddles the same line as the hon. Lady in saying that no GP practice will be affected and closed, but his own PCT in Hull says that the process will be used as a lever for the reconfiguration of GP services and that, at the end of the day, there will be fewer GP sites.
The Secretary of State for Health (Alan Johnson): The hon. Gentleman has twice mentioned my constituency. What Hull is doing of its own volition is going out to consultation at the moment, and the proposal is additional to the proposals for the new centres that will come to under-doctored areas and additional to the GP-led health centre that we are putting into Hull. It is consulting on three additional health centres to deal with three problems: first, a preponderance of single-handed GPs; secondly, facilities and services that do not even meet the Disability Discrimination Act 2005; and thirdly, the fact that it has no women doctors whatsoever. So the PCT has gone out to consult the people of Hull, quite separately from what we are doing nationally, to seek to address those problems, and so it should.
Mr. Lansley: The Secretary of State is getting desperate. I have here the presentation document from Hull PCT. If it devised the proposal, why does the powerpoint presentation say, “Darzi GP-led health centre”? It does not say that it is something that the PCT thought up. The proposal’s criteria are exactly those that the Department of Health have specified. The document’s conclusion says:
“The number of GP sites will reduce.”
[ Interruption. ] Labour Members should listen. If the Secretary of State is saying that Hull PCT will provide three additional GP health centres, how come the impact will be that the number of GP surgeries will reduce? We know exactly what that means.
Mr. John Redwood (Wokingham) (Con): Is not the central point that we are very happy to see polyclinics if they are additional and wanted by the local community? The element of compulsion is quite wrong, and Labour Members have got a real shock coming to them when they discover that, in their areas, GPs will dislike it but be dragooned and that they will lose their current practices.
Mr. Lansley: I agree, and my right hon. Friend has a reasonable complaint if the Government are providing additional money in his area only on the basis that it will be spent in a certain way. If I recall correctly, his PCT is the lowest funded per capita in the whole country. If anywhere in the country should be given the opportunity to spend the money as it sees fit, it is his constituency.
Mr. Simon Burns (West Chelmsford) (Con): I assure my hon. Friend that certainly GPs in Chelmsford do not think that he is scaremongering in any way. Mid Essex PCT is being forced to have a polyclinic in Chelmsford and GPs in the area are extremely worried that it will have a serious and negative impact on their practices, because of the nature of the things being imposed on them.
Mr. Lansley: I am grateful to my hon. Friend, who has gone to the heart of the issue. At the moment, the Government require PCTs to publish memorandums of information before in effect tendering for the new polyclinics. We have seen the tender documents from 58 PCTs, which identify 608 GP surgeries in proximity to proposed polyclinic locations. Because the Government have insisted that the new polyclinics should register patients, the local practices identified in those documents will see their patient lists undermined, some of them potentially fatally.
The Secretary of State has said that no GP surgery will be closed as a consequence of opening polyclinics, but how can that be true? The Government amendment does not refer to the polyclinics proposal for London, which we should address for a second. The Prime Minister got up at the Dispatch Box and said that there would be 150 polyclinics, that each polyclinic would have 25 GPs and that each polyclinic would serve 50,000 people. The consequence of that would be the closure of more than 70 per cent. of existing GP surgeries in London.
Documents from half the PCTs refer to 600 GP surgeries in proximity to potential polyclinics. If the polyclinics are not additional and the GPs in them are the same GPs who currently work in their own surgeries—or, for that matter, salaried doctors in PCTs—then a number of surgeries will have to close. That was the clear implication of the Government’s proposals for London. If that is not the case and the GPs are genuinely additional GPs in additional GP practices, where will the money come from? We have done that calculation, too. If the Secretary of State is to be believed and the provision is all additional, the cost of that number of GPs in that number of surgeries would be £1.6 billion a year. However, the Government have allocated £250 million over three years, so the situation simply does not add up. One of two things must be true. Either the GPs will be moved and the practices will be moved from their present locations into larger polyclinics, or additional services will be provided and additional costs will be incurred. The Government have not answered the question about which one of those two things it will be.
Ms Buck: In my PCT, the thinking concerns creating a polyclinic based on a hospital. That would reduce inappropriate accident and emergency attendances by people who are not registered with doctors, which hammers the hon. Gentleman’s argument that there is a one-size-fits-all solution. Is it not true that in 1981 the Acheson report addressed the issue of single-handed practices, particularly in London, where single-handed practices were over-represented? For 16 years, Conservative Governments made progress—not enough in my view—on reducing single-handed practices. Although there is good practice in some single-handed practices, by and large the quality of care is not as good as that provided by other practices. Is the hon. Gentleman saying that his party stands four-square behind all single-handed practices, regardless of the quality of care?
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