House of Commons
Tuesday 30 March 1999
The House met at half-past Two o'clock
PRAYERS
[Madam Speaker in the Chair]
PRIVATE BUSINESS
University College London Bill
Read the Third time, and passed.
Oral Answers to Questions
HEALTH
The Secretary of State was asked--
Primary Care Groups
1. Mr. Tim Boswell (Daventry): If he will make a statement on the establishment of primary care groups. [77698]
The Secretary of State for Health (Mr. Frank Dobson): Four hundred and eighty-one primary care groups, covering the whole of England, will become operational from 1 April. They will replace the divisive internal market introduced by the previous Government, which set doctor against doctor and hospital against hospital. In place of that, the primary care groups will represent all local family doctors, together with community and practice nurses, representatives of social services and lay people. They should ensure more modern and dependable services and less bureaucracy overall.
Mr. Boswell: Now that PCGs are a reality, is the Secretary of State worried about their management capabilities and about the level of management cost allowance, which was said by John Chisholm of the British Medical Association to be inadequate at £3 a head? Is he concerned about the suggestions by other GPs that PCGs may form a perfect vehicle for rationing health care services?
Mr. Dobson: Primary care groups were introduced with the consent and agreement of the BMA. The level of management costs is neither a floor nor a ceiling; it varies from place to place, and rightly so. I am confident that, as a result of the introduction of primary care groups, people will have more universal access to top-quality care. What we are proposing goes with the grain of what the professions wanted, and that is what we have delivered.
Mr. David Hinchliffe (Wakefield): In developing the policy, will my right hon. Friend consider the future capital resourcing of primary care? Is he aware of the
difficulties with the funding arrangements in respect of GPs' surgeries and health centres, whereby GPs occasionally have to charge exorbitant rents to social services and community health trusts for community psychiatric nurses who are in attendance, which obstructs the close working relationship of health and social services in a primary care setting?
Mr. Dobson: We want to continue improving primary care premises. We have changed the rules to make it easier for people to develop or improve existing primary care premises in health action zones, and we will continue to try to help. As an indication of the progress that has been made, the Turnberg review of health care in London more than a year ago reported that about 50 per cent. of premises were inadequate. That figure is now down to 32 per cent.
Mr. Philip Hammond (Runnymede and Weybridge): Does the Secretary of State recall telling the House on 18 January that
- "primary care groups provided incentives for all concerned to 'level up' to the standards of the best."--[Official Report, 18 January 1999; Vol. 323, c. 594.]?
Mr. Dobson: First, let us get the facts straight. It is not the case that 60 per cent. of GPs were fundholders when we took over. It was about 50 per cent.--a large number of whom were unwilling fundholders, but had decided to go along with the scheme. We have tried to make it clear to health authorities and others that we do not expect people to withdraw services that are presently being provided.
Mr. Hammond: It is happening already.
Mr. Dobson: If it is happening, it should not be--but that is down to local decision making. The decisions will be made by the doctors, the community nurses, the practice nurses, people from social services and lay people who serve on the boards of primary care groups. Decisions will be taken by the people who are responsible for delivering the services in each locality; the first time that that has been the case in the history of the health service.
Ms Sally Keeble (Northampton, North): Is my right hon. Friend aware of the success of the primary care group in Northampton, which built on the work of the commissioning GPs--who existed under the previous Government--and did such important work in terms of commissioning emergency pelvic scanning for women, which has helped deal with the problems of the early stages of pregnancy? Does he agree that, if the doctors of Daventry are having problems setting up their primary care groups, they could come to Northampton where they would learn a great deal?
Mr. Dobson: I take this opportunity to pay tribute to the medical profession. Until 1 April, it will have had
monopoly control over decision making in primary care since primary care was invented. Voluntarily, the profession agreed to give representation to nurses, social services and lay people on the boards of the primary care groups because it thought that that was the best way of serving local people. In nearly every part of the country, the profession has made remarkable strides in developing primary care groups. I emphasise that this is an entirely voluntary arrangement; no law has been changed. However, in every part of the country, the primary care groups have been established with the consent of--and, in most cases, a great deal of enthusiasm from--the professionals on whom we depend.Bed Blocking
2. Dr. Vincent Cable (Twickenham): How many beds are currently blocked in the district general hospitals in west Middlesex and Kingston. [77699]
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton): On 19 March, out of 376 occupied beds at Kingston hospital there were 19 containing patients ready for discharge but still in acute care. In the 319 occupied beds at West Middlesex hospital there were 40 such patients.
Dr. Cable: Does the Minister accept that the considerable problems that those two hospitals have with admissions are being compounded by the fact that the surrounding local authorities, which happen to be respectively Labour, Liberal Democrat and Conservative controlled, are all having to cut their services for the elderly because of the local government settlement? At a national level, what is his reaction to last week's Age Concern report, written by a leading NHS geriatrician, which said that up to 70,000 additional admissions could be secured if the Government were willing to co-ordinate, with local authorities, effective rehabilitation programmes for elderly patients?
Mr. Hutton: That is exactly the direction of our current work within the Government. We want to reduce delayed discharges, and we are working to that end. Last winter, we spent £209 million in additional money on trying to find better ways of managing discharge from acute hospitals into the community. Many of those schemes operated in the hon. Gentleman's constituency. Nearly £1.5 million was spent in Kingston and Richmond health authority area, and one such scheme benefited 40 patients. We are pursuing the right policies and additional resources are being spent. The new national service framework for older people, which we launched last week, will include an expert task group working specifically to improve discharge arrangements from acute hospitals into the community.
Accident and Emergency Services
3. Mr. Jim Cunningham (Coventry, South): What analysis he has made of the impact on employment in the NHS of his accident and emergency modernisation schemes. [77700]
The Secretary of State for Health (Mr. Frank Dobson): Altogether, £100 million extra will be invested
over the coming year in modernising accident and emergency departments. That will be better for patients and staff; it will also help to retain and create jobs. The recent investment of more than £1 million in modernising the accident and emergency department at the Queen Alexandra hospital in Portsmouth provided orders for more than 20 firms from all parts of the country. Rule of thumb suggests that the £100 million investment will provide 100 times as many orders, and that 100 times as many jobs will flow from them.
Mr. Cunningham: May I congratulate my right hon. Friend on one of the biggest hospital development programmes in history, with 31 new hospital developments worth more than £2 billion? Will he publish a list of the companies involved, and the jobs created as a result of that new development?
Mr. Dobson: Yes, I will. As I have pointed out, more than 20 firms received orders for £1 million worth of improvements in Portsmouth. The developments in some parts of the country--at the Norfolk and Norwich, for example, where the total cost of the hospital is £160 million--will result in huge orders being placed all over the country. That is part of our policy not only to benefit the patients and hard-working staff of the health service, but to create jobs all over the country.
Mr. Jonathan Sayeed (Mid-Bedfordshire): The Secretary of State will know that some people being treated in accident and emergency units have to go into an intensive care unit because of the severity of their injuries. He will also know that the director of the ICU at Bedford hospital wrote to him six months ago complaining about the fact that he had had to turn away 58 patients because he did not have enough beds. Why has the Secretary of State not yet replied?
Mr. Dobson: Because I went there and spoke to him.
Mr. Bruce Grocott (Telford): From among the many advisers and specialists that my right hon. Friend talks to in the Department of Health, has he yet received any clinical explanation for the fact that, whenever he gives us good news about the national health service, Opposition Members look depressed?
Mr. Dobson: They look depressed today because we can announce that waiting lists in February fell by 39,000, taking the figure 38,000 below the one that we inherited. Over the past year, more than 450,000 extra operations have been carried out. [Interruption.] It is no good idiots opposite talking about fiddling--
Madam Speaker: Order. I am sure that such language is not necessary. The Secretary of State knows what "Erskine May" says about good parliamentary language.
Mr. Dobson: I withdraw the word "idiots", and replace it with "Tories", Madam Speaker.
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