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7.24 pm

Helen Jones (Warrington, North): Unlike some hon. Members who have spoken tonight, I believe that the Bill marks a major step forward for the NHS. It will move us away from an NHS that has been directed from the top down and in which decision making was often remote and bureaucratic, and allow us to create a health service that empowers its front-line staff, responds to patients' needs and enables us to create real partnerships with communities to tackle some of the health problems that face us. While the NHS has transformed the lives of many people, has an excellent staff and delivers miracles every day, it is still largely a service that was designed for the 1940s. If it is to deliver what we need in this century, it has to be a service that uses the expertise of staff who are now much more highly trained than before, and that can deal with patients who know much more about the health choices available to them and who demand, rightly, much more flexible care.

The key provisions in the Bill, which give the lead in providing health services to primary care trusts, will give us a real opportunity to achieve those aims, but Members of Parliament can only set out the framework. Delivery will be achieved only if those people involved in primary care trusts are really keen on listening to staff who are at the sharp end of the health service. I do not mean merely fulfilling the statutory obligations about who serves on trust boards, but really listening not only to GPs, but to district nurses, midwives and health visitors who know far more about the health needs of their communities, and the social needs underlying them, than many of the staff further removed.

I have spent time in my constituency with health visitors and with GPs delivering personal medical services pilots. I have sat in their clinics and gone out with them on their rounds. I know that they have the vision and energy to change the NHS for the good of the people they serve and they have to be allowed to do it, but so too do the communities that our primary care trusts will serve. We need to involve them if we are deliver the key objective of ending inequalities in health. I make no apology for returning to that theme, because it is a key issue in my constituency and in many others like it.

The areas that I represent in the north of Warrington have much greater health care needs than the more affluent areas in the south of the town. They have higher rates of coronary heart disease and long-term illness and much higher mortality rates. But not only do they get fewer resources than their health needs would suggest, they are under-represented at all levels of decision making—sometimes they are not represented at all—in the NHS. The primary care trusts must ensure that that changes, and the Commission for Patient and Public Involvement in Health, which the Bill will set up, will play a key role in bringing that about. It will need to ensure that such communities are represented not only on advisory bodies but in the real decision-making process of the NHS. It will need actively to seek out people to

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become involved, because the problem is not that those communities do not have people capable of making the decisions.

I know many people in my constituency who run local organisations, manage budgets and know a great deal about the area. It is patronising nonsense to suggest that they are not capable of becoming involved in the NHS. They know far more about strategic partnerships and joined-up working than many people who pronounce on such issues. Those involved in the community can tell us whether there is no point sending patients to a clinic because there is no bus to get them there, or if there is no point treating them for stress because that stress is caused by poor housing or crime and vandalism in the area. They do not need lectures about social exclusion, because they understand that. They need to be included, and the bodies that the Bill will set up must ensure that that happens.

The Bill is about putting patients at the heart of the NHS and two of its features will be important in achieving that. One is the setting up of the independent advocacy service, because most people—in my experience as a constituency MP and as a solicitor who dealt with clinical negligence cases—want their cases dealt with on the spot. As my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said, it will be crucial to ensure that the service is easily accessible, and that it is seen to be independent. I hope that the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), will comment on how the service is to be managed outside the trusts in which it works, so that we can see that independence in fact.

I welcome too those parts of the Bill that allow the Commission for Health Improvement to refer cases in which it considers that patients' safety or welfare is at risk and which have not been tackled. Many of the tragedies that have occurred in the NHS would not have occurred if that provision had existed. The truth about many of those cases is not that people did not know what was happening, but that too many did know and did nothing.

In respect of the protection of patients, I turn now to the matter of regulation. The Council for the Regulation of Health Care Professionals, which the Bill will set up, together with the provisions of the Health Act 1999, will allow us to regulate other health professions much more easily than hitherto. When the Bill is enacted, I hope that the civil service will have run out of excuses for not regulating some of the people currently working in the health service who have not been regulated so far. I refer specifically to operating department practitioners and health care assistants. It is a nonsense that people who deal with controlled drugs and perform intimate services for patients do not come under any form of regulation. That nonsense must be ended.

Finally, I welcome the provisions on the prison health service. They have not been mentioned so far in the debate, and we know that there are no votes in providing good health care for prisoners. However, the prison medical services have long been a disgrace to a civilised society. The arrangements established by the Bill for joint working and pooled funding will go a long way to solving that problem.

Prisons have many serious health care problems. They involve the mental health of prisoners, their greater propensity for suicide and the spread of addiction in prisons. However, we have not been able to attract as

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many good staff as are needed to work in prisons. There are serious shortages of nurses and psychiatrists, and especially of registered mental nurses.

In part, that has happened because there has been no adequate career path for staff working in the prison medical service. The Bill will allow staff to share best practice and update their skills. It will also provide great support for prison medical service staff in the ethical dilemmas and difficult decisions that they have to face every day. In addition, the arrangements in the Bill will facilitate the transfer of patients when that becomes necessary.

In the prison medical service and many other sectors, the Bill offers a real opportunity to transform the health service. It is not about bureaucratic measures: it is about creating a health service fit for the 21st century. I hope that those working in the health service will take the opportunity to build on the foundations that we are laying down tonight. I commend the Bill to the House.

7.33 pm

Dr. Richard Taylor (Wyre Forest): I am grateful for the opportunity to speak in this important debate. I agree with the Secretary of State that NHS practices must change, but I have a problem with the nature and timing of the proposed changes. Some of them are right, but I do not think that now is the right time for such extensive changes.

That is largely because of the crises that exist in the NHS at the moment. The Secretary of State was wise to admit that delays for coronary artery bypass surgery amounted to one specific crisis. Despite the changes that have been made, 216 patients in the west midlands have been waiting more than 12 months for an operation. When one of my constituents was told that he was on the critical list and that he would have to wait six to nine months for his operation, he decided to mortgage his house and get private treatment.

All hon. Members will know from their postbags of the trolley waits that patients still endure. I received a letter only today from the relatives of an 80-year-old woman who waited 11 hours. She was not an unexpected emergency, because the hospital had been warned beforehand about her case.

I quote from a letter written by an orthopaedic surgeon to one of the major national dailies, in which he expressed his concern. He wrote about

who, he said, were very aware of

under which they found themselves

The surgeon added:

A time of crisis is not the right time to thrust ahead with major changes that risk disruption. I therefore plead for delay. Of the three primary care groups in my county of Worcestershire, one is already a primary care trust. It is probably about ready to take on the new responsibilities. The other two are still primary care groups, and are not ready.

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In south Birmingham, 60 per cent. of GPs have voted against the change because they are not ready for it. A report in the local newspaper states that they

They believe:

If primary care trusts are not ready, there is no reason to rush through with the strategic health authorities. I strongly agree with the hon. Member for Wakefield (Mr. Hinchliffe) that community health councils have performed a very useful task. I should much prefer to see them strengthened than removed.

The CHCs enjoyed relatively democratic input. A number of their members were elected councillors, and although some were appointed by the Department of Health, others represented local charities. They were therefore true representatives of local people.

What is the real reason for the abolition of the CHCs? The Secretary of State did not answer that question from the hon. Member for Wakefield. I wonder whether the reason is that CHCs had one tooth: they could refer controversial decisions to the Secretary of State.

If, by chance, my plea for some delay were heard, the question of how to resolve the current crisis would remain, and my approach would probably be considered revolutionary. I believe that now is the time, not for devolution, but for instruction about where the extra money is to be spent.

There have been examples of managers and consultants falling out, with consultants saying that the service is badly managed, and managers trying to blame the consultants. I believe that in many parts of country, health service managers do not perform their duty to the best possible degree, as they should. Given that money is so scarce, is not this the time for direction in the way that it is spent?

Money should be targeted. I fully support the £300 million that has been given to social services. It will be a great help, but will we be given a breakdown of how it will be spent? Although £300 million sounds a vast amount, analysis shows that my county's social services will receive £713,000. That will provide less than one extra place in a care home per week.

I have another suggestion for the way in which money should be targeted. NHS surgeons in my constituency are idle at times because there are not enough staff or beds to enable the operations on their lists to be carried out. That is one occasion when the private sector can be used as an expedient where there is spare capacity. More money should be made available for that.

If the reforms were delayed, more money would be available. No one has yet said how much this will cost and how much it will save. A week or two ago, an advertisement for a chief executive post for one of the new bodies in the Health Service Journal proclaimed that the salary would be £70,000. Considering how many new bodies with chief executives there will be, I cannot believe that if these measures were delayed for a short time, there would not be some extra money.

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I conclude with a quote from an article by the president of the Royal College of Physicians in Hospital Doctor a few weeks ago, in which he wrote:

Modernisation needs time.

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