House of Commons
Tuesday 28 July 1998
The House met at half-past Two o'clock
PRAYERS
[Madam Speaker in the Chair]
PRIVATE BUSINESS
Tamar Bridge Bill
Oral Answers to Questions
HEALTH
The Secretary of State was asked--
General Practitioners
1. Mr. John Healey (Wentworth): What steps he is taking to improve access to general practitioners, with particular reference to areas with a low number of general practitioners per 1,000 population. [50976]
The Minister of State, Department of Health (Mr. Alan Milburn): We have introduced a range of initiatives, such as a salaried general practitioner scheme, that will be beneficial particularly in areas with low GP numbers.
Mr. Healey: I thank the Minister for his response, which was encouraging. However, is he aware that simply to bring our patient waiting list sizes down to the national average, we have to increase the number of GPs by one third in Rotherham, by one quarter in Barnsley and by one fifth in Doncaster? Is he aware that increasing GP numbers is one of the central objectives of the health action zone in the South Yorkshire coalfields? Will he therefore tell me what operating freedoms he is considering giving to health action zones to tackle the problem of GP numbers, and when he expects to reach a decision on the matter?
Mr. Milburn: I thank my hon. Friend for his question. Health action zones are currently working up their outline bids into full proposals, which we shall be examining very carefully. We want to ensure that the difficulties are plugged in all parts of the country, especially those with problems--which the Government have inherited--in recruiting GPs. I can tell my hon. Friend that his health authority has just agreed additional funding for a salaried GP post. I hope that that will be helpful. He will be aware that the Government have concluded negotiations with the British Medical Association to introduce a salaried GP scheme, and also to beef up the GP retainer scheme. As he will also be aware, many general practitioners have
worked in, but left, the national health service. The Government want to recruit them back into work, for the benefit of patients.
Mr. Alan Duncan (Rutland and Melton): I look forward--I say rather unexpectedly--to doing battle with the Minister in the next year. I know that he had high hopes of promotion, which he well deserves. I can only assume that the Prime Minister had given him an early pledge.
Does the Minister agree with the BMA chairman that the extra GP trainee places will come on stream only in about 16 years' time? Moreover, the BMA says that the promised 7,000 extra doctors are those who are already doctors. What proportion of those 7,000 doctors will come from overseas? Does he agree with the BMA that we should use only United Kingdom trained doctors, and that importing doctors from overseas will not solve the problem?
Mr. Milburn:
I had planned on saying that the hon. Gentleman's first remarks were unworthy of him, but perhaps they were not. The British Medical Association is wrong on the more substantive issue that he raised. Doctors do not grow on trees--they cost extra cash, which is precisely what the Government have provided in the comprehensive spending review. If we had not provided extra cash, we would not be able to recruit extra doctors or to give the go-ahead to a massive expansion in the number of GP medical students--which I hope that he will welcome.
2. Mr. Tam Dalyell (Linlithgow):
Pursuant to his answer of 23 June 1998, Official Report, column 491, what representations he has received on methods of reducing clinical negligence litigation. [50977]
The Minister for Public Health (Ms Tessa Jowell):
We have received more than 120 replies to our call for ideas on how to reduce the threat of litigation in the national health service. The replies have come from a wide range of sources, including the health care and legal professions, and the NHS and patients. My officials are currently studying the replies to identify key issues and ideas that we can develop.
Mr. Dalyell:
Are Ministers at all uneasy about the way in which some lawyers--not all--seem to encourage clients to take litigation against medical practices, and about the natural reaction of doctors and their colleagues, therefore, to practise defensive medicine, which may not be in the best interests of patients as a whole? Over the summer, will my hon. Friend and her lawyers look carefully at the submission by Lord Justice Sir Philip Otton--a complex document that I have given to the Department in the hope that legislation can be brought forward to overcome an increasing and delicate problem?
Ms Jowell:
My right hon. Friend the Secretary of State has already met Sir Philip Otton. We shall consider his proposals. We want to avoid patients being led to believe that they have grounds for legal action. The risk of defensive medicine follows. We want to ensure that lawyers are kept out of the operating theatres and doctors are kept out of the courts. That is good for patients.
Hospitals (Clinical Performance)
3. Mr. Dennis Turner (Wolverhampton, South-East): What representations he has received on general practitioners' rights to information about the clinical performance of their local hospital. [50978]
14. Mr. Paddy Tipping (Sherwood):
What representations he has received on access by (a) general practitioners and (b) patients to information about the clinical performance of their local hospitals. [50989]
15. Mr. Peter L. Pike (Burnley):
What plans he has to publish average clinical performance of hospitals by procedure. [50990]
The Secretary of State for Health (Mr. Frank Dobson):
A wide range of people, including general practitioners and members of the public, have expressed strong support for our proposals to give patients and GPs a clear right to know about how their local NHS hospital is performing. As a first step, we shall publish hospital-based indicators in the autumn.
Mr. Turner:
Does my right hon. Friend agree that it is essential in the modern, dependable national health service that we are seeking to build that patients and GPs should have access to information about the performance of their local hospitals? Should not the right to know be our clarion call?
Mr. Dobson:
Yes indeed, I entirely agree with my hon. Friend. It is crucial that the information provided to GPs and local people is accurate, comparing like with like. Providing misleading information would be harmful not just to the hospital and the profession, but to the GPs and patients.
Mr. Tipping:
Is it not the case that knowledge and information are power? Extending information to patients empowers them. That must be right, because they not only use the health service, but pay for it.
Mr. Dobson:
It is certainly right in principle. People want, and are entitled, to know whether their hospital is performing up to national standards. People do not want to go shopping around and travel long distances for treatment, but they want to be assured that their local hospital is up to scratch. The information will help them.
Mr. Pike:
Does my right hon. Friend agree that it is important that, when the information is published, on a hospital-by-hospital basis, improvements are made where there has been shown to be room for them? What role does he see for the Commission for Health Improvement in ensuring such improvements in the interests of patients and GPs?
Mr. Dobson:
The crucial point is that local management and local doctors should know how their performance compares with national standards. If they are not up to the national standards, they should take steps to ensure that they get up to standard. The Commission for Health Improvement, while not quite a long stop, would not be the first organisation to be involved if the local management and local doctors were seen not to be
Mrs. Virginia Bottomley (South-West Surrey):
I endorse a sensitive approach to providing information on clinical outcomes, especially considering the fact that some of the waiting list targets have been such a fiasco for the Government. What steps will the right hon. Gentleman take to reassure the research community, already affronted by the gratuitous cut in its budget, that a clumsy approach to naming and shaming, and hospital league tables, will not result in defensive medicine, a reluctance to take on difficult cases, and a stifling of innovation altogether?
Mr. Dobson:
I shall ignore most of the right hon. Lady's preliminary remarks. On the sensible point that she made about trying to ensure that we do not stifle innovation, it is true that if someone tries a surgical procedure for the first time there will be no standard for it, and it will be a riskier form of treatment than procedures that have been frequently carried out.
I can safely say that at almost every meeting that I have had with doctors on that subject I have tried to emphasise that we do not want rules and standards to be laid down in such a way as to inhibit necessary developments. After all, not long ago the only place in Britain where one could have a hip joint replacement was where John Charnley worked, at the Wrightington hospital in Wigan--
Mr. Lindsay Hoyle (Chorley):
In Lancashire.
Mr. Dobson:
Yes, in Lancashire; I apologise. I must admit that, as a Yorkshireman, I always did think that Wigan was in Lancashire; it always seemed to be there when it played against Yorkshire rugby league clubs.
Similarly, 20 years ago, Oldham--I know that technically, that is part of Greater Manchester, but at one time it, too, was in Lancashire--was the only place in the world where one could have a test tube baby. We must ensure that any new rules that we lay down do not inhibit wonderful developments such as those that took place at Wrightington and at Oldham general hospital.
Mr. Simon Hughes (Southwark, North and Bermondsey):
At the end of last week there were reports that the use of human albumin for transfusions may not be safe, and today there has been another report that the cervical cancer screening carried out by a London hospital has not been entirely safe. Given that last October Ministers said that we must have a national system of quality assurance for cancer screening, and that in December the Secretary of State announced the need for a Commission for Health Improvement to ensure that the whole country has the highest quality standards, can the Secretary of State today assure women in particular, but also all general practitioners and patients, that we will not have to wait any longer for a national system to ensure that transfusions, screening and all other services are of the highest clinical standard everywhere?
Mr. Dobson:
As the hon. Gentleman knows, we are trying--carefully, so as to carry the professions with us, because if we do not, no new system will work--to put in place measures to ensure that standards are maintained.
Rev. Martin Smyth (Belfast, South):
The Secretary of State will be reassured by the fact that I support what he says at that level, not only about medical advice but about other advice. May I press him to tell us whether, when he deals with the procedures, information will be circulated to general practitioners about new procedures, so that they can guide their patients to places where those are being carried out? May I also express the hope that the statistics will major not on mortality figures, but on successful procedures--and not only clinical procedures, because many other procedures are vital for good health?
Mr. Dobson:
I accept the hon. Gentleman's point. Mortality statistics are fairly straightforward, but statistics showing how well people do after an operation--if they have survived--are more difficult to calculate, evaluate and log in any system. We are going to enormous lengths to ensure that our proposals command the support of the profession; indeed, the first figures that we shall be publishing in the autumn command the support of those who are carrying out operations. If we could not carry them with us, the proposal would be absurd.
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