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House of Lords

Wednesday, 18 June 2008.

The House met at three o’clock (Prayers having been read earlier at the Judicial Sitting by the Lord Bishop of Norwich): the LORD SPEAKER on the Woolsack.

Health: London Polyclinics

Lord Naseby asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department of Health (Lord Darzi of Denham): My Lords, the costs of service changes in London depend on the specific models pursued and the existing infrastructure in each community. The introduction of polyclinics is not about closing hospital beds but about preparing the infrastructure to cope with future demand for health services. There is an international evidence base for developing integrated services based around the needs of patients and providing access to a range of community-based services with convenient opening hours.

Lord Naseby: My Lords, that is all very well, but I asked what the estimated capital and revenue costs were. As I understand it, the answer is that the Government have absolutely no idea at all. Secondly, of the 31 PCTs in London that signed up, rubber-stamping the idea, how many undertook independent clinical and managerial assessments before they agreed, as the noble Lord stated in his previous paper that they were required to do? Why does the Minister ignore the 1.2 million people who have signed petitions against this idea and the majority of doctors who are against it? Would not the money be better spent on getting rid of the superbugs that have killed 8,000 people and on a number of other areas, not least the waiting lists, as well as the 50 per cent of young mothers who are turfed out 24 hours after having their child?

Lord Darzi of Denham: My Lords, I shall try to answer at least one question. The first question was on cost. As I highlighted, a polyclinic is not a building. In the London report, which I led with 100 clinicians in London, I described a number of different models of polyclinics, one of which is a network, or federated, model. It is not a building; I say that for the record. The costs will have been carefully estimated by London’s SHAs. I shall be more than happy to send the proposals to the noble Lord. As far as the petitions are concerned—I should declare to the House that I am a member of the BMA—I met the chair of the patients’ forum this morning. Patients signed these forms based on their understanding at the time of their visits to their GP practices that the practices were about to close. This is not about closure. We have invested £250 million in

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building additional primary and community services. We have done so because patients expect extended opening hours and opening hours over the weekend. This is to drive patient choice. As a patient and a clinician, I believe in both.

Lord Dubs: My Lords, given the obvious benefits of polyclinics in London to patients, doctors and nurses, can my noble friend suggest why the BMA is so opposed to the idea?

Lord Darzi of Denham: My Lords, as I said, I am astonished and alarmed as a doctor and a clinician that some patients have been misled into signing petitions to save their local surgeries. I am sure that noble Lords will agree that the trusting relationship between any clinician and patient is sacrosanct; it is one of the key values that underpin our professions. Misleading patients and breaking their trust by causing them unnecessary concern and worry breaks that professional vow that we all take.

Baroness Tonge: My Lords, I am polyclinic enthusiast. However, will the Minister please tell us the difference between a large health centre, a community hospital and a polyclinic? Will he confirm that if a primary care trust in London, in consultation with local people, decides to expand the services of an existing community hospital, for example, it will still get the money that it would have got for a polyclinic?

Lord Darzi of Denham: My Lords, we should ignore what we call these things. At the end of the day, this is an investment in the primary and community setting to meet the healthcare provision demands facing the nation over the next 10 years. We are all getting older and we all want to enjoy a better quality of life as we do. We all know that the biggest challenge is long-term conditions. As the noble Baroness said, we are trying to shift diagnostics and care closer to the patient’s home. On funding, whatever the clinics are called, there is a major shift. As we have demonstrated with our investment of £250 million in these new GP-led health centres, our future investment must be in primary and community settings.

Baroness Gardner of Parkes: My Lords, what will be the position of accident and emergency services? No matter how good the polyclinics are—and they may be good if you live right near one—accident and emergency services are important to people in London at all hours of the day and night. Can the Minister assure us that there will be no diminution of those services?

Lord Darzi of Denham: My Lords, I could not agree more. Because of the baseline historical growth in A&E attendance over the past three or four years, this is one of the biggest growth areas that we envisage in London: we calculate a 66 per cent growth in attendance by 2016. The system as it stands will be unable to cope with that. The health centres to which we are referring will cope with the significant number of patients that are currently attending A&E. In my hospital, you could claim that 60 per cent of them could be dealt with in a primary and community setting.



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Baroness Finlay of Llandaff: My Lords, can the Minister assure us that these groups of GPs—call them “polyclinics” or whatever—will be actively involved in teaching undergraduates and postgraduates and in research, evaluating healthcare delivery and contributing to innovation in new NHS treatment? We know that the involvement of people in teaching and research drives up the quality of care.

Lord Darzi of Denham: My Lords, I am grateful to the noble Baroness for highlighting the importance of the role of primary and community services in the education and training of our future practitioners and research. I will have a lot to say about this in the primary and community strategy, which will be published as part of my next-stage review in a few weeks’ time.

Lord Brooke of Alverthorpe: My Lords, as someone who has been required to go to a local or neighbouring hospital at least six times this year for blood tests and X-rays because those facilities are not available from my local GP, I welcome the opportunity of immediate access to such facilities. Will the NHS do some calculations on the likely cost—in time, travel and probably stress—of patients going to hospitals for X-rays and blood tests when these could done nearer to their homes?

Lord Darzi of Denham: My Lords, I am grateful to the noble Lord for highlighting the importance of future planning in the NHS being designed around patients’ needs rather than professional ones.

Lord McColl of Dulwich: My Lords, will the Minister confirm that 50 per cent of PCTs have tendered for polyclinics and that over 600 general practices have been listed as being in competition with these polyclinics?

Lord Darzi of Denham: My Lords, the Joint Committee of Primary Care Trusts, leading the Healthcare for London programme, met in public last Thursday, 12 June. It made 19 final recommendations, including one to implement the polyclinic service model. On competition, I am not aware of the figure that the noble Lord cites. As I said, capacity expansion creates the choice for patients to register with these new health centres if they wish. However, they do not have to change registration; they can just walk into these health centres to get access to treatment.

Armed Forces: Joint Warrior

3.09 pm

Lord MacKenzie of Culkein asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Ministry of Defence (Baroness Taylor of Bolton): My Lords, I am sure that the whole House will wish to join me in offering sincere condolences to the families and friends

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of the four British soldiers who were killed on operations in Afghanistan yesterday. This brings home to us the huge sacrifice made by our Armed Forces and the significant debt of gratitude that we owe them.

The Joint Warrior military training exercise takes place twice a year in the north-west coastal region of Scotland. There is regular consultation between defence officials and the local communities both before and after the exercise, including meetings with the Durness community council and the Cape Wrath Conservation Group.

Lord MacKenzie of Culkein: My Lords, I join my noble friend in offering condolences to the families and friends of the soldiers who tragically lost their lives yesterday.

I declare an interest in the Question, as one of my daughters is a shareholder in the Keoldale Sheepstock Club in Durness. Is my noble friend aware that the Joint Warrior exercise, which consisted of some 36 ships and 70 aircraft, coincided with the lambing season? While the population in Durness and north-west Sutherland has always been supportive of the use of the Cape Wrath range, is she aware that that relationship seems to have deteriorated somewhat since the Army took over responsibility from the Royal Navy in the past couple of years? Does she agree with me that the training needs of the United Kingdom and NATO forces can still be well met by avoiding such crucially important times for a fragile local economy as the lambing season?

Baroness Taylor of Bolton: My Lords, my noble friend is right to say that the local community has been very supportive of the training exercises that take place in this area. It is an area where certain training can be done that cannot be done anywhere else in the United Kingdom. The fact that the training exercise takes place during part of the lambing season is to be regretted, but the lambing season has extended and there were local consultations about when the best time for this exercise would be. As I mentioned, we consult as widely as possible, but my noble friend will be interested to hear that an integrated rural management plan for Cape Wrath went out for consultation today, which includes matters such as military activity, nature conservation and local farming interests. We expect local people to respond to it.

Lord Luke: My Lords, on behalf of these Benches I offer most sincere condolences to the families of the four soldiers whose sad deaths we heard about today. Is there a definite rule concerning consultations in circumstances such as those mentioned? Is there, indeed, an established method of communication between local military bases and the relevant local authorities as well as those further afield? I refer, of course, to one-off military exercises and not those conducted down a fixed line of flight.

Baroness Taylor of Bolton: My Lords, when we engage in military exercises we try to ensure that the local community is given as much notice as possible. We are not always able to accede to all the demands

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but we try to take into account issues such as conservation or disruption to the local population by, for example, low-flying aircraft. We endeavour to give as much information as possible.

Lord Addington: My Lords, I associate these Benches with the condolences offered for the recent casualties in Afghanistan. Will the Minister finally nail this down? If there is severe disruption to farming activities, will the Government agree to offer some form of compensation as to do so cannot be that expensive?

Baroness Taylor of Bolton: My Lords, to my knowledge, the matter of compensation in Cape Wrath has not come up recently. We have tried to engage with the local community to find the best way to conduct these operations without causing disruption. To that end, we have amended flight paths or the times at which aircraft are in an area; we have provided fencing to try to protect some of the sheep; and we have used practice weapons instead of high explosives. Therefore, we have modified our plans in response to local concerns.

Lord Mackie of Benshie: My Lords, has there been any consultation between the Army and the Navy, as the latter obviously got on better with the locals?

Baroness Taylor of Bolton: My Lords, it is not a question of which is the lead service but of trying to ensure that we tailor our requirements in a sensitive way so that we co-operate with people locally. There is a good dialogue, and it must be maintained.

Disabled People: Work Capability Assessments

3.14 pm

Baroness Greengross asked Her Majesty’s Government:

The Parliamentary Under-Secretary of State, Department for Work and Pensions (Lord McKenzie of Luton): My Lords, the new work capability assessment is a more positive assessment of mental and physical function and of the support an individual needs to help them move closer to work. If a person’s assessment results in no entitlement to employment and support allowance, they will be able to claim jobseeker’s allowance and the support that comes with that benefit. Jobcentre Plus personal advisers will ensure that such people receive all the support they need.

Baroness Greengross: My Lords, I thank the Minister for his reply. He will be aware that the introduction of mandatory work capability assessment for all incapacity benefit claimants will come as a great shock to many long-term benefit claimants, particularly those deemed capable of work. As patron of Beginnings, a coalition of organisations working to improve employment

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opportunities for disabled people, I believe it is vital that everything possible is done to assist affected people. To this end, how will the flexible New Deal interact with support provision under Pathways to Work?

Lord McKenzie of Luton: My Lords, the introduction of the employment and support allowance is due to happen for new claimants later this year. The prospect of existing IB claimants being subjected to the new work capability assessment will arise subsequently over the succeeding three years. On the flexible New Deal, the components involve that, at six months of unemployment, Jobcentre Plus advisers will begin intensive work with customers to identify potential barriers to employment and establish action that the customer must take to make themselves more employable. Advisers will work alongside disability employment advisers to ensure that activity identified for disabled customers is appropriate to their needs. Where available, customers will be able to access the department’s specialist disability provision. The purpose of the new assessment is to focus on what people can do rather than on what they cannot. That “cannot” approach, which we previously adopted, consigned millions of people to inactivity and few life choices. That needs to change.

Lord Filkin: My Lords, does my noble friend agree that there is a moral and fiscal responsibility on Government to incentivise people to work wherever they are able to do so, rather than to apply reverse incentives, as we have seen in the enormous growth in claims for incapacity benefit over the past 20 years?

Lord McKenzie of Luton: My Lords, it is important that the benefits and support on offer are individually focused. We believe that should be job-related and supportive of individuals. The number of incapacity benefit claimants fell by 31,000 over the past year, after two decades of inexorable rise. The approach is right. It supports those who can to go back into work. We know that work is generally good for people’s health. It is their best route out of poverty, as well as being good for their general well-being.


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