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PCTs...will carry out an open and fair procurement to secure the services they specify.[ Official Report, 16 June 2008; Vol. 477, c. 768W.]
If it really is open and fair, and if account is taken of the lack of need to build new premises if spare capacity in existing health centres is used, existing practices could probably compete on a fair basis with the huge commercial organisations that are gearing up to compete for the provision of such services.
The fears of commercialisation have been rehearsed by Labour Members, and, in the interests of speed, I shall not go into them. I just want to remind the House about the need for local consultation and for accountability to local people. I went to a lunchtime launch of the Local Government Association health commissions final report on accountability, the executive summary of which said:
More recently, there has been a conscious effort to devolve decision-making, giving greater autonomy to NHS providers and setting a smaller number of national standards to sit alongside ones that are locally agreed.
That is how we should decide on GP-led health centres, where they will be and what they will provide. I am convinced that GPs in their existing practices in the health centres could provide accessible 8 am to 8 pm, 365 days a year, drop-in and registrable services.
There are alarms about commercialisation, and I wish to request a meeting with the Minister to rehearse with him some of the alarming allegations that I have
received about how some of the commercial organisations function and to share with him two crucial letters in the medical press that sound warnings about commercialisation from the United States. I also wish to share the sensible points made by the organisation that is completely divorced from the BMA and is thoroughly rooted in the interests of patients: Keep our NHS public. I humbly request such a meeting.
Mr. Neil Turner (Wigan) (Lab): One of the most disappointing things about this debate and the motion is that they are focused entirely on the providers and not on where they should be focusedon the patients. That says an awful lot about the stance of the Conservative party.
The hon. Member for Basingstoke (Mrs. Miller) said that nobody had spoken in favour of polyclinics, although my hon. Friend the Member for Dartford (Dr. Stoate) just did so. One of the reasons why that has been the case is that nobody has a health centre in their constituency. Interestingly, the hon. Member for North Norfolk (Norman Lamb) was calling for pilot schemes. I can tell him that we have quite a number of pilot schemes. In fact, he referred to some of them, in the sense that 12 areas have health centres, and Wigan is one of them. Indeed, Wigan was one of the first boroughs to have a local improvement finance trustLIFTcentre. Parts of the borough have some of the worst health statistics in the north-west and, thus, in the whole country. It is also one of the most under-doctored areas in the country.
The Kings Fund, which was cited by the hon. Member for North Norfolk, has made a number of comments about health centres. I do not recognise those comments in respect of how we run the health centres and our LIFT programme in Wigan. For instance, it mentioned poor management, but each of our six health centres has a manager in charge to ensure that the organisation within, and between, the services provided is properly carried out. The Kings Fund also mentioned a lack of innovation, but Wigan has a new and important innovationour Find and Treat approach, whereby local GPs, through the health centres, go into the community seeking people who are particularly vulnerable to strokes and cardiac problems and try to bring them into the health centres for treatment. Rather than waiting for people to come once they have had their stroke or heart attack, when it is often too late, GPs are going out to ensure that we can treat them before that happens.
Mr. Graham Stuart: Most of the speeches that I have heard today did not attack polyclinics per se and did not say that they cannot contribute to local health needs. The main issue taken up by those opposing the Government plan is that polyclinics are to be imposed from the centre on every area, even when there would be better ways of spending the money. The hon. Member for Wyre Forest (Dr. Taylor) talked very well about how the money could be used creatively, using existing assets to deliver much more benefit for patients.
I disagree with that analysis, because I do not think that is true. I think that health centres and polyclinics for the London area will provide better
services and better outcomes for the patients. Our health centres in Wigan are doing that. They have the strong support of my three colleagues who also represent the boroughmy right hon. Friends the Members for Makerfield (Mr. McCartney) and for Leigh (Andy Burnham), and my hon. Friend the Member for Worsley (Barbara Keeley). They all support the health clinics and the extension of the health clinic principle throughout the borough. Our six centres are all large, modern, adaptable buildings. The primary care trust arranges the sub-leases and each local health centre provides a massive range of services. Fundamental to that is a GP practiceor in several cases, a number of GP practices, all of which are local and none of which is provided by Virgin or any of the other organisations that have been mentioned. They are all local GPs who have voluntarily gone into those health centres to ensure that they can provide a better service from a better facility.
Most of the centres also have a pharmacy, and the centres provide an enormous range of services. We are talking about child care, audiology, district nurses, community mental health, out-of-hours nurses, family planning advice, diabetic retinopathyI am sure that my hon. Friend the Member for Dartford knows what that meansintegrated therapy for children with special needs, minor surgery units, podiatry, physiotherapy, speech and language therapy, and older peoples services. That list goes on and on, and many of those services are provided in most of the clinics.
I want to give a couple of examples of what is done in one or two of the health centres, particularly the Platt Bridge health centre, which is in the Makerfield constituency. It covers a former mining community with immense health and social problems, and severe deprivationit is in the 3 per cent. most deprived super output areas in the country. The health centre is marked out not because of the services it provides, although those are excellentthey include a hydrotherapy servicebut because of the way in which my right hon. Friend the Member for Makerfield managed to get the primary care trust and the local authority to work together so that this is not just a health centre. It is in a huge complex that includes a school, library and community centre, all of which work together to provide a major centre for that deprived community, which has been given a belief in itself and confidence in its future. That would not have been provided unless the LIFT programme had provided the PCT with the catalyst for that centre.
In Wigan, we have Boston House, named after Billy Boston, who was probably the greatest rugby league winger everas I am sure the hon. Member for Leeds, North-West (Greg Mulholland) will agree. It has a GP facility and a pharmacy, and provides nurse training provision, health education, podiatry and audiology. It has a 19-bed physiotherapy unit, but what sets Boston House apart from all the othersand is especially important for the people of Wiganis the fact that it has an 18-bed renal dialysis unit. People from Wigan who needed dialysis used to have to travel to Salford or Bolton, which took a full day. That was disruptive and in some cases distressing for the patients and their families. Now, they can have dialysis in Wigan, and that is much less disruptive. I have talked to the patients involved and I know that it has massively improved their quality of life.
The hon. Gentleman describes a facility that is clearly popular and works. Does he agree that that might work in Wigan, but is not necessarily the answer in Leeds, North-West or other areas? The imposition by the Government is the heart of the problem.
Mr. Turner: One of the problems with this debate is that so many people say that it might not be the answer in their area, but not one of the hon. Members who has said that has had experience of it working in their constituencies. If hon. Members want to see how it works, I invite them to come to Wigan and talk to the people who provide the services in those health centres and, especially, to the patients, to see whether they like the centres. Instead of going along with the BMAs claims, hon. Members should come and see the reality on the ground. Then they might change their minds. The first three health centres in Wigan were not built in my constituency, and I knocked on the door of my PCT to ask when it would get one. Now it has.
We have two other health centres in Wigan. The Sherwood Drive health centre has GPs and provides minor surgery services, a pharmacy and, after a recent extension, a dental practice. The Beech Hill health centre, which is my local one, is a GP centre with a pharmacy attached, and it provides numerous other services.
Boston House health centre was provided by the LIFT programme, the Sherwood Drive health centre was provided by a private sector company, which has since sold it to the PCT, and the Beech Hill health centre was one of the very earliest health centres, built in the 1960s, and the GP practice has now moved into a modern centre. So there are many ways to provide those services. It is not a question of one size fits all.
We will not rest on what we have done, excellent though that is. We welcome the extra funding for the health centres and we hope to have more such centres in the future. For example, one will complement the walk-in centre in Leigh, a second will be based in Ashton and a third in the Whelley/Scholes area in my constituency. The PCT has plans for three further primary care centres, plus one GP-led health centre in Wigan town centre, which will provide the services that the Secretary of State described earlier. In addition, it will provide services for homeless people, which are important.
Mr. Turner: Because we have been so under-doctored, and GPs surgeries have been poor in the past, people have used accident and emergency at the hospital instead. Wigan A and E is a major trauma centreit is next-door to the motorwayand has a high-dependency unit and an intensive care unit. Using doctors trained to provide those services for what is, in essence, primary care had a deleterious effect. The health centres, with their longer opening hours and wider range of services, have a beneficial effect. We need more such health centres, because we want to shift the NHS from being an organisation that treats ill health to one that intervenes to prevent people from getting ill.
Dr. Tony Wright (Cannock Chase) (Lab): I wished to speak only because I have been genuinely shocked by aspects of the campaign that has been waged on this issue. Perhaps I am too easily shocked, but there has been a dishonesty in some of the campaigning that has caused much anxiety and even illness in some people. I had an elderly lady phone my office this week, and she said that when she had gone to her GP surgery she had been told that it would close. I checked with the PCT which told me that the surgery had plans to expand. It may seem clever to campaign in that way, but for people who claim to be concerned with the health of others, it is having a serious and damaging effect.
The Act is part of the nationalisation programme which is being steadily pursued by the Government.
It shall be the duty of every local health authority to provide, equip, and maintain to the satisfaction of the Ministry, premises which shall be called Health Centres.
The BMA said that health centres would be introduced over its dead body and, indeed, 10 years after the NHS was established, there were only 10 health centres in this country. That was because the GPs, represented by the BMA, would not have them. It has taken us a long time to realise that having a network of well equipped and professional health centres will have an immeasurably beneficial effect on the health of the population.
When I was elected to Parliament in 1992, the report from the director of public health in Staffordshire said that my constituency, a former mining area, had the worst health, the greatest number of single-handed GPs and the highest incidence of secondary referrals from GPs to hospitalsusually an indicator of insecure medical practicein the area. It was essential that that situation be transformed, and I can report that in many respects it has been. Because of investment, we now have a raft of state-of-the-art health centres across the district. Nobody would now claim that such developments are not beneficial to the health of the population. The idea that anybody could have resisted the development of health centres sounds so ludicrous now, and it will seem ludicrous in the future that anybody could resist the development of the next stage in health care, which is what we are talking about now.
I am a great admirer of the primary care system of traditional family doctors, but unfortunately it has to be said that it has been very difficult over the years to make the necessary reforms of that system. To compress a short history, I was alarmed for many years that there was no proper system for the clinical audit of general practitioners. It took the horrors of Shipman to produce that system. We have to be realistic and say that it has taken muscle from the centre and often deeply disturbing events to get the general practice system to reform in the ways that it should.
I was interested to hear the comments made by the hon. Member for Wyre Forest (Dr. Taylor). I greatly respect him and his experience. I do not want to misinterpret him, but I think that he was effectively saying that if the primary care system had developed in the way that it
might have, with extended services, the need for these proposals would never have arisen. However, that is not what has happened. The system has resisted all proposals to extend. We need only think of the arguments that we have had just to get a modest increment in evening or Saturday morning provision, which was standard when I was growing upit was quite normal to have evening surgeries or Saturday morning surgeries. We have now had to pay the doctors more to return to a system that we once had.
It is bewildering that we cannot understand that it is possible to extend GP provision in a way that will genuinely extend choice and access for patients. We think about patient groups, and when my children were small we would have been heavy users of a super-surgery in our area. All we had, when children were inconvenient enough to get ill out of doctors surgery times, was the prospect of a visit from an out-of-hours person who knew nothing about us and had no diagnostic back-up of any kind, or of taking the children down the local accident and emergency, which was probably inappropriate. The idea of having an intermediate centre for such situations, just so that tests could be done and people could be checked over, seems a genuine extension of patient choice.
Norman Lamb: I am sure that the hon. Gentleman would agree that we should be developing policy that is based on evidence. Does he not think that we should have serious concerns about the range of points made by the Kings Fund and others? They show that the polyclinics and health centres already established under the LIFT scheme and the experience from abroad suggest that some of the conclusions that he wants to see are not happening.
Dr. Wright: I am grateful for that intervention, as it gives me the opportunity to make my final point, which is about what happens if we cut through some of the nonsense and look at what is being proposed.
As I mentioned in my intervention earlier, I had a very interesting document from the BMA, which was sent out to all GPs and local medical committees in Mayjust last month. The document is called New NHS Primary Care procurements, and it is described as a factual guide. It is an example of the BMA talking sensibly to its own people, rather than getting all excited about a public campaign against things that some people do not like.
The factual guide includes a very nice table that sets out what it calls the key differences between health centres and polyclinics. Hon. Members can read it. It then goes on to describe the background to the policy, which is exactly the point that has been made. It talks about the Darzi review, and says that a central tenet of it
has been the importance of determining primary healthcare services locally.
out a rigorous process requiring any change to be transparent, clinically evidenced, locally led and for the benefit of patients.
When the BMA is talking for grown-ups, it tells the truth about what is on offer, but when it is putting petitions around surgeries and telling people that all their local surgeries will close, it talks dishonestly.
The fact is that we have a proposalit might not have been necessary if primary care services had reformed themselves in the way that they should have done over the years, but they have notthat will extend the range of services available to patients. That is a very good thing and it is dishonest to pretend otherwise.
Shona McIsaac (Cleethorpes) (Lab): Like my hon. Friend the Member for Cannock Chase (Dr. Wright), I think that the BMAs Save our Surgeries campaign has been disingenuous. It has created unnecessary fear and worry that GP surgeries around the country are about to close. That is simply not the case.
I want to talk briefly about the example from north Lincolnshire. My right hon. Friend the Member for Scunthorpe (Mr. Morley) intervened earlier on this point. Parts of Scunthorpe are very deprived, and they also have few GPs, so there is a plan for a GP-led health centre in Scunthorpe. Doctors have been saying that because of that plan other GP surgeries are under threat, particularly in the rural parts of north Lincolnshire. North Lincolnshire MPs went to the primary care trusts to ask what that was all about, and they guaranteed that the money for the centre was additional and that there was no threat to any other GP practice in north Lincolnshire. In fact, they wanted to invest more money in those other practices. People will still have access to their GP, and it is wrong to tell those people that their GP surgeries are about to close.
Mr. Graham Stuart: If the hon. Lady has been following the debate, she will have heard that patients can register with the new centres. If they move their registration from their former rural practice to the new centre, the rural practice will lose that patient and the income and could therefore become non-viable. It is not true to say that this is pure additionality, and the hon. Lady should perhaps have picked up on that by now.
Shona McIsaac: I think that I regret allowing the hon. Gentleman to intervene. He has been talking about peoples GPs, the services that they provide and how much people appreciate those servicesbut people will stay with their GP if that GP provides a service that they want. If they want something else, they can transfer, as they can now. They can transfer from one GP practice to another if they want additional services.
Earlier this year, I went out and consulted my constituents at random about what they wanted to see in primary care, what they wanted from their GP and what type of opening hours they wanted. I wanted to ask 150 people, but through a quirk I ended up with 151. When I asked whether they wanted GPs to open at more convenient times to meet their needs and their lifestyles, only one person opposed that, while 150 wanted access to GP services for more hours. As for evening appointments, 150 people wanted them and one person did not. There was not such strong support for weekend appointments, which were wanted by only 144 out of the 151.
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