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Primary Care

6. Mr. Paul Goggins (Wythenshawe and Sale, East): What action he is taking to improve access to primary health care. [142901]

The Secretary of State for Health (Mr. Alan Milburn): The NHS plan sets ambitious targets to improve waiting times in primary care and expand the range of services available locally to patients. In June last year, we made £54.5 million available to kick-start a four-year programme to improve access to family doctors, nurses and other professionals and to extend the range of treatments and services that could be provided in the community.

Mr. Goggins: Does my right hon. Friend agree that one way to improve access to primary health care is to make better use of existing skills and resources? I draw his attention to a new initiative by the South Manchester primary care trust, which is about to introduce a new primary care triage service in which practice nurses give telephone advice to patients who ring up to request a same-day appointment with their GP. The service will not remove their right to see their GP, but it will mean that they receive professional advice immediately.

Mr. Milburn: I am aware of some of the South Manchester PCT's work following my visit, which my hon. Friend will recall. The PCT has been involved in the walk-in centre at Manchester airport and some sure start initiatives. It is doing good work, which goes to show, first, that, provided investment is made, an expansion in primary care services can be achieved--we can do a lot more in the community and in primary care than we have done hitherto. Secondly, the investment agenda has to run alongside fundamental reforms of the way in which primary care services and health care services as a whole are delivered. In some parts of the country, the first fruits of investment in modernisation are coming through to benefit patients. I very much hope that that is the case in my hon. Friend's constituency and in Manchester as a whole.

Mr. David Tredinnick (Bosworth): Does the Secretary of State accept--I have written to him on the subject--that the availability of complementary and alternative

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medicine through primary care groups has been reduced since the switch from GP fundholding? Now that the House of Lords Science and Technology Committee report on complementary medicine has been published and an early-day motion broadly supporting it has been signed by 160 Members of Parliament, should not the Government respond urgently to the report? Can he give a date for that response? What will he do to achieve greater availability of complementary and alternative medicine through primary care groups?

Mr. Milburn: The hon. Gentleman wins the award for consistency at Health questions and for being unrelenting on that issue. I hope that we have responded to at least some of his concerns. As he is no doubt aware, last year, for the first time, we issued detailed guidance to all primary care groups in all parts of the country on the potential uses to which complementary therapies may be put. The report is important and we will respond to it in due course, but the position remains as it always has been: it is for the individual GP to decide what form of treatment--whether a mainstream treatment or a complementary treatment--is best suited to the needs of the individual patient.

Ms Chris McCafferty (Calder Valley): I know that my right hon. Friend is aware of the failure of the complaints system in respect of primary health care services. Will he join me in welcoming the appointment of the new chair and chief executive of the new National Clinical Assessment Authority? Does my right hon. Friend agree that that will provide much better protection for patients and support for doctors? Does he also agree that, if such an authority had been in place earlier, Harold Shipman would have been far less likely to be able to murder so many people over such a long period, particularly in Hyde and in Todmorden in my constituency?

Mr. Milburn: I am aware of my hon. Friend's concerns about matters relating to Todmorden in her constituency and the sterling work that she has been doing to offer whatever help and support she can to some of the families who were affected. It is important that we get the case of Harold Shipman in perspective. Harold Shipman was a cold, calculating, evil killer. He abused his position of trust in an indescribable way, and it beggars belief that he got away with it for so long.

We must now do three things. First, we must offer whatever help, information and support we can to the very many families affected by his actions. Secondly, we must get on with the public inquiry, so that we all learn the lessons of what went wrong. Thirdly, we must take appropriate action to strengthen the bond of trust that exists between our country's excellent family doctor service and patients.

It is important that all hon. Members understand that Harold Shipman was a one-off. We have an excellent family doctor service. Harold Shipman has done enough damage. I am determined--I know that hon. Members in all parts of the House share that determination--to ensure that he does not inflict further lasting damage on the special relationship between family doctors and their patients.

Mr. Graham Brady (Altrincham and Sale, West): Does the Secretary of State agree that, in future, pressure

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on primary care services will be increased if children who need serious surgery do not get it in a timely fashion? Will he take a personal interest in the case of a 14-year-old constituent of mine, Joshua Bruer, who, with 67 other children, is awaiting spinal surgery at the Royal Manchester children's hospital in Pendlebury? Surgery has been delayed as a result of the collapse of the floor of one of the operating theatres, which was built only two and a half years ago. I have corresponded on the matter with the Under-Secretary of State for Health, Lord Hunt. The waiting time is now 14 months for such surgery. Children who need spinal surgery need it quickly, otherwise the injury that they have suffered will be compounded as they grow taller and they will have further problems in later life. Will the right hon. Gentleman take a direct personal interest in the problems of spinal surgery for children in Manchester?

Mr. Milburn: Yes, I assure the hon. Gentleman that I will look into the case.

NHS Complaints

7. Mr. John Austin (Erith and Thamesmead): When he intends to publish a report on his review of the NHS complaints system. [142902]

The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): The evaluation of the complaints procedure has been completed and the project team will submit its report at the end of this month. We will publish the report as soon as possible, once we have had the opportunity to consider its findings.

Mr. Austin: No doubt my hon. Friend has seen the report by Age Concern "Speaking Out", which expressed concern about upper age limits for treatment, negative attitudes to elderly people and the fact that a third of the respondents recorded the difficulty that they had in accessing the complaints machinery and their fear of recriminations. In the light of Age Concern's report, what action is being taken to combat age discrimination in the NHS and to ensure that elderly people have access to and confidence in an independent complaints machinery?

Ms Stuart: I am aware of Age Concern's report. It is important to put it on the record that we do not accept age discrimination within the NHS at any level, whether in the handling of complaints or in treatment. Many accident and emergency departments have fast-tracking for hip fractures, which particularly affect the elderly. We must distinguish between the process of making a complaint and providing support for that. With regard to speeding up the complaints process and giving people the support that they need, we are making progress with our evaluation at the end of the month, and the new patient advocacy and liaison services and the patients forums will provide independent support for all who need it, taking proper account of the needs of people of all ages.

Mr. David Davis (Haltemprice and Howden): How will the new complaints procedure work with the Commission for Health Improvement and, in particular, the National Clinical Assessment Authority?

Ms Stuart: It is important to recognise the Government's commitment that the NHS as an

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organisation should always learn from its mistakes, and complaints are one of the mechanisms by which we learn that mistakes have occurred. From the chief medical officer's report "An Organisation with a Memory" and our acceptance of that report, to the implementation of serious incident monitoring, to the relationship with the patients forums, whenever the Commission for Health Improvement or the National Clinical Assessment Authority investigates an area, there will be a two-way feedback mechanism whereby both organisations can learn from the complaints received. That two-way valve will allow not only the trusts but the NHS as a whole to learn from such feedback. In addition, there will be an assessment of the complaints made against all doctors as part of their review in our annual appraisal system. We hope that the whole package will reduce any necessity for complaints and ensure that serious incidents are picked up at every level.

Mr. David Hinchliffe (Wakefield): Does my hon. Friend agree that a key component of any complaints system should be its independence? Does she accept that the placement of the patient advocacy function contained in the Health and Social Care Bill in the hands of the health authorities that will commission them seriously compromises that independence?

Ms Stuart: We wish independence to be established at every level. The Health and Social Care Bill, which will have its Second Reading tomorrow, contains a clear statutory provision for patients forums, part of whose function will be to ensure that independent support is put in place. Whether local health authorities should provide such independent support or whether there should be some other mechanism will be an ideal subject for debate in Committee.

Dr. Liam Fox (Woodspring): What real redress will patients have when they find themselves in a situation such as that described by Mr. Ross Carter, consultant in gastroenterology and pancreatic surgery, who said today that his unit had inadequate theatre access to deal with emergencies and malignancies, let alone

and little prospect of admission for patients owing to waiting list management transfers on to deferred lists. Ross Carter says:

What redress can patients in that situation have?

Ms Stuart: Patients already have means of redress and they will have even more as a result of our increased investment in the NHS which will provide us with more doctors and nurses. Just for the record, if the hon. Gentleman is interested in what has happened since the Government took office, there have been some 290,000 more emergency admissions than under the previous Tory Government, as well as 623,000 more routine admissions and 686,000 more first out-patient attendances. There is a continuous improvement and that will go on. The Tories' proposal to privatise the NHS is no solution.

Tony Wright (Cannock Chase): I am sure that my hon. Friend will agree that the part of the NHS complaints

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system which has the complete confidence of patients because of its independence is the ombudsman system. The ombudsman also has regular dealings with community health councils as they attempt to negotiate people through the complaints system. Has there been consultation with the ombudsman about the Government's proposals for the abolition of CHCs--and, if not, could there be?

Ms Stuart: It is important to recognise that only something like 50 per cent. of CHCs support individual complainants. To assume that the current structure of dealing with complaints is completely covered by CHCs is not the whole picture. Regarding consultation with the ombudsman, that is something that we can take forward.

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