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Camden primary care trust is already putting a massive effort into promoting polyclinics at University College hospital and the Royal Free hospital, but it is not putting the same effort into two practices in Kentish Town that have put themselves forward as a possible polyclinic. They have not had the same level of involvement from officialdom, yet they have a fine track record. They have been providing primary care. They have arranged for consultants to come out and see their patients in their practices. They have run drug and alcohol clinics. They have helped people suffering from drug and alcohol problems to find employment. They have provided psychological medicine. They have provided help for children and families. Social workers have
operated from their premises, and so have people from the voluntary sector. These people have a proven commitment and competence, and to develop what they are doing would be the sort of organic development to which the Government should be committed—going with the grain, from the point of view of patients and professionals.
The London polyclinic proposals are not like that. The Secretary of State and the London health lot say that the proposals are led by the NHS in London, not the Government. I do not understand that. Professor Ara Darzi, who is a most distinguished surgeon and a highly intelligent and charming man, put forward the polyclinic proposals for London. He is a Minister in this Government. Mr. Paul Corrigan, who used to work at Downing street, is the London director of strategy and commissioning in London, and the benighted Lord Warner is chair of the provider agency in London, following his departure from office as a Minister just before all the trouble arose over the problems of junior doctors. Let us assume for a minute that there is no Government influence in the matter. That means that the strategic health authority, which is not accountable to anyone, and the primary care trust, which is not accountable to anyone, are taking decisions. In the end, however, Ministers are responsible, and I believe that they ought to take a step back.
The next thing I have to say is something conservative: remember the cost of change. The process of change is immensely costly, in terms of money and the amount of time and effort that people have to put into the process of change. I believe that Ministers—
Mr. Deputy Speaker: Order. I have to curtail the right hon. Gentleman at that point.
5.27 pm
Mr. Robert Goodwill (Scarborough and Whitby) (Con): My constituents in Scarborough are perplexed, confused and angered by the proposals. If the Minister comes to Scarborough, as I hope he will very soon, to talk to people there, he will hear that they want more money to be spent on a number of areas in the health service, such as dentistry.
Scarborough hit the headlines two or three years ago when we had queues going round the block, reminiscent of the Soviet Union bread queues, when it was rumoured that an NHS dentistry practice was opening up. People are very concerned about out-of-hours services, and four years ago the local primary care trust upset the applecart when, by putting the out-of-hours service out to tender, local GPs who were covering those services and providing cover at the local community hospital found that they did not get the contract for such services in the countryside, which meant that they could not also cover the hospital. A lot of money was wasted in one case, when dentists from Germany were brought, at £700 a night for 10 nights at a time, to provide cover.
Whitby hospital in the north of my constituency is being subjected to death by a thousand cuts, according to many in that area. Services have been reduced. The accident and emergency service is under siege because of the list of incidents that ambulance drivers are told they must not take to Whitby—only the most minor of injuries and illnesses are dealt with there. Maternity is
currently under review at Whitby because we are told there is no demand for maternity services. That could be something to do with the fact that maternity is open only from 9 until 5. The health service is under siege in my constituency, and the Government are coming up with a solution to a problem that many people do not see.
I would like to share with the House a letter that I recently received from one of my constituents, Mary Thompson. She writes:
“The last time I wrote to an M.P., it was to complain to Lawrie Quinn”—
“about the lack of N.H.S. dentists in Scarborough. The situation has got worse since then, but I must keep trying.
This time, it is still the N.H.S., but I would like to tell you about some of my husband Eric’s experiences since being diagnosed with bowel cancer four years ago.
After two major operations, chemotherapy and radiotherapy, the cancer returned and Eric was referred to the Leeds General Infirmary by Scarborough Hospital, who were unable to do any more for him. We saw a Mr. Sagar who arranged for several tests, including a PET scan in London”—
“for which we had to arrange and pay for transport ourselves—no mean feat for someone who had great difficulty sitting comfortably due to the nature of his illness. Eric’s operation was arranged for August 18th, the long delay”
“in part due to the fact that a urology team had to be on stand-by as well as the bowel team, and a high dependency bed was also needed as it was not certain that he would even stand the surgery, so big an operation was planned. On the day, Eric was gowned and ready for theatre when Mr. Sagar arrived to see him, extremely angry, to say that the operation would have to be cancelled, because of the two high dependency beds available to him, one had been given to a road accident victim, and the other was needed for the person whose operation was before Eric’s—his need was deemed the greatest.
Apparently there is a shortage of high dependency beds due to government cuts. Eric was allowed to go home for the weekend, but had to return on the Monday to keep his bed.”
That is a 120-mile round trip. The letter continues:
“The operation now took place the following Thursday, and though successful, was incomplete as he was left with two nephrostomies (tubes leading directly out of his back from his kidneys, emptying into two bags attached to his legs) instead of the urostomy which had been planned. We were never told whether this was due to the postponement of the operation and consequent changes of staff.
After going home, Eric became very ill on September 21st and our G.P. arranged for an ambulance to take him to the A&E at Scarborough Hospital. We waited two hours, then our son arrived, so we cancelled the ambulance and got Eric to the hospital in his car, where we had the usual long wait in A&E. Eric was unable to stand and found the chairs there very uncomfortable, given his condition. I remarked to a nurse that we had been waiting a long time and she snapped back ‘Everyone has to wait—it’s part of the system’”—
Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Gentleman, but he is going into considerable detail on a matter that appears to lie outside the terms of the motion and the amendment, which are about primary care as opposed to the secondary sector, to which he is referring. May I suggest that he try to move back pretty quickly to the primary care sector?
Mr. Goodwill:
I thank you for that guidance, Mr. Deputy Speaker. I am trying to show where we need better spending in the health service. Mrs. Thompson closes
her letter by saying that better medical facilities are needed and that she does not know where all the money is being spent.
In Scarborough hospital, we need money to be spent on the deep clean which has still not been delivered. Last year, 600 jobs were going to be cut. I hope that the Minister will visit Scarborough and see where we need to spend money. We clearly do not need to spend it on a polyclinic.
In February, the PCT was told that there had to be a polyclinic somewhere in Yorkshire, and several sites were considered, including Selby and York, before it was decided that Scarborough would be the place for it. People in Scarborough feel strongly that they do not want it; they want services through their GP. Our local newspaper asked people on the streets what they thought. Mrs. Marcia Waddington said:
“I know change has to happen but I think change is not always for the better. This Government might think bigger is better but sometimes it is not.”
“The older generation especially prefer to see a GP who knows them and their background. It just wouldn’t be the same.”
A lady from Colescliffe road said:
“I don’t want to go to a super surgery. I want to go to my doctor’s surgery. We don’t need these types of surgeries. I know my doctors and like them.”
I pay tribute to Mr. John Palethorpe, who led the campaign last year to save services at Scarborough hospital and has been leading the campaign this week to save our GP services. The relationship between the patient and the GP is the most valuable part of our health service. The proposal to parachute a polyclinic into Scarborough would jeopardise that important relationship. We already have a facility in Scarborough where a variety of services are available, but which is underfunded, namely Scarborough hospital. If the Minister has £1 million in his back pocket, may I suggest that he invest it in Scarborough hospital, rather than providing us with a polyclinic that neither the GPs nor the patients want?
Will the Minister clarify the situation when he winds up the debate? We were told that there would be a single unit in the middle of the old town in Scarborough, but only yesterday there was a report in the Scarborough Evening News of a meeting held on Saturday about the new super-surgery, at which the head of commissioning, Jane Marshall, said that
“the plans would likely encompass services in a number of locations rather than an all-under-one-roof service.”
The Secretary of State was talking about clinics in one place. How will he deliver on the improvements that he claims he can, if services are provided in a number of locations? Will all those locations be open from 8 am to 8 pm, seven days a week, or is the local primary care trust, realising that what is proposed is not wanted, trying to come up with imaginative and innovative ways to spend the money?
The polyclinic in Scarborough is not wanted by patients or GPs. If the Minister has the money to invest in the health service in Scarborough, there are a number of areas, including dentistry, Whitby hospital and Scarborough hospital, where it could be better spent.
Mr. Deputy Speaker: Order. In order to be fair to the seven hon. Members who are seeking to take part in the debate, I am making the time limit nine minutes. That should, I hope, meet everyone’s needs.
5.36 pm
Lynne Jones (Birmingham, Selly Oak) (Lab): The debate has shown that needs differ throughout the country. I cannot understand why the Government are not standing by their rhetoric that all change should be locally led. It is quite clear that change is not locally led, except in the sense that there is a lot of anticipatory compliance in the modern NHS.
When I started receiving communications from my local GPs and constituents about the new provision, which they felt threatened their existing surgeries, I immediately contacted the PCT to find out what it was all about. On the surface, providing additional services seemed an excellent idea, so I got hold of the PCT report about the proposal. As I mentioned in my intervention on the Secretary of State, it is quite clear that the PCT is not leading the proposals. Indeed, when I asked the PCT whether the proposal was one that it would chose to spend the additional resources on, in order to improve health inequalities in south Birmingham, it was clear that it was not.
We do not have an easily identifiable gap in services. The PCT proposes to locate the new 8 am to 8 pm health centre in the Selly Oak part of my constituency, for two reasons. First, it is on a main road. Secondly, because of the short time scale—the PCT has to have the centre up and running by 1 April 2009, a date that it told me was non-negotiable—the PCT is scrabbling around trying to find suitable accommodation and will have to choose a location where it has existing buildings. That is the reason for the one location. The need for a particular building is also the reason for the other location, in another part of my constituency.
On the Bristol road in Selly Oak, where the health centre is proposed, there is a new £2 million investment by one of the local GP practices, which is set to double its GP list—it is expecting to take on an additional 4,000 patients. The development has been five years in the making, with full support from the PCT, and will provide services in addition to GP services. This GP approached me many years ago; he was concerned about the lack of services to combat osteoporosis, which is common in women, and he remains concerned about ill health prevention and equality of access to services.
In King’s Heath, the currently favoured location for the GP-led practice, a new health centre has just opened, providing full GP and other services and an associated new pharmacy. The location of the proposed new practice is near at least three other GP practices. I know that very well, because it is where I live.
Norman Lamb: Is not the approach that the hon. Lady is describing precisely what ends up demoralising local health workers and clinicians so much, because all the things they see developing end up getting undermined by something imposed from above?
Lynne Jones: That is absolutely right. Obviously, the PCT would not earn brownie points if it failed to go along with these proposals.
When I heard about these proposals, I immediately thought, “Why should these new services threaten existing services?”, but it is quite clear that the health centre is expected to take on 6,000 patients, as is the GP-led centre. Yes, they will also take people who are not registered and there is certainly a need for the proposed services, but the GPs say they would be delighted to provide those services if only there were an opportunity for them to expand existing provision. It seems, however, that the rules say that the premises have to be completely new, so they are not in accordance with the idea of expanding existing GP provision.
When I started to investigate these issues I was worried, so I went back to the Darzi interim report and tried to find the logic behind these proposals. I found that Darzi had noted that life expectancy was lower in areas where there were fewer GPs per head of population. That may well be the case, but I am not sure that the conclusion follows—that the way to deal with the problem is to develop 150 GP-led centres and to provide new GP practices in areas where there are health inequalities. It is not exactly logical to deduce that that is the way to deal with the problem. I read the report, but I could not understand the thinking that led Lord Darzi to decide that this was the solution to under-doctoring. I certainly could not understand why he should view it as a blueprint to be applied across all PCTs. The under-doctoring in my constituency, for example, is not particularly great and it is spread out—there is no single location where there is a problem.
It seems to me that the Government should stop portraying the debate over these issues in terms of the BMA and the Tory party being opposed to genuine locally led improvements in service. That is not the case. Two of the GPs who contacted me about this issue are members of the Labour party and they are actively interested in improving services to their patients and reducing inequalities. One made a submission to the Select Committee on Health and is active in the Socialist Health Association. These are not people who naturally look to the Conservative party to champion their cause. They are very worried—and their worries were confirmed by a conversation I had with the lead officer at the PCT—that this is just an excuse to bring in the private sector and provide competition, which is seen as the way to make GPs buck up their ideas and improve their services. I do not think that the GPs in my area need that kind of competition. They want improvements in service. They put in bids to expand their practices. They are outraged because they were told a year or two ago that they should cease providing Saturday morning services and are now being told that that is what they must provide.
Mr. John Leech (Manchester, Withington) (LD): Does the hon. Lady agree that there is already competition among GPs? If people do not like their local GP, there are usually plenty of others in the area to choose from.
Lynne Jones:
Yes. A couple of my constituents recently changed practice. One of them has mental health problems and, having talked to the new GP, felt that he was more sympathetic to her. GPs are even willing to engage with
patients when they want to find out whether it would be a good idea to move to their practice. That is already possible.
Many GPs would like to provide the proposed services, but they say that there is no level playing field. The new provision is being procured through the standard procedure, which gives large alternative provider medical services an administrative advantage. Those services are bidding for other contracts and are set up for that kind of work, which is not the case for GPs. Some GPs who have expressed an interest in bidding for the services were given 24 hours’ notice of a bidder event day. Most of those who have looked into the possibility of tendering do not believe that they are in a position to do so. It would divert their attention from what they should be doing, which is providing high-quality services for their patients.
I ask the Government to look seriously at the criticisms made today, particularly by Labour Members. We believe that the Government have much to be proud of in terms of developments in the health service. There is no doubt that health services have improved dramatically since 1997. We have 5,000 more GPs, and GPs now have more time to spend with their patients. However, the Government should not simply dismiss the concerns of GPs because they think that they are being oppositionist for opposition’s sake. There are many good reasons why the BMA in general and GPs in my constituency are concerned about the proposals. They believe that they will destabilise existing services. How will a practice that is expanding, taking on an additional 4,000 patients, continue when there is going to be a new health centre over the road, potentially taking on 6,000 patients? It will have to take on additional patients if it is to continue to receive funding beyond the five-year allocation. In the end, the money will be allocated to the general pot and there will be no specific allocation for the proposed services.
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