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Dr. Howard Stoate (Dartford): One of the things that I most enjoy about such debates is the fact that Opposition Members are often candid enough and, in some cases, ill-advised enough to tell us what they really think. We have had a great deal of information from them about all that is wrong with the health service, but we have heard extremely little about how it could be put right and how the Government could be helped to improve matters.
We heard from the right hon. Member for North-West Hampshire (Sir G. Young), who seemed to be calling for a workplace stealth tax to fund the NHS. After many years of being a Minister, the right hon. Member for Charnwood (Mr. Dorrell) seemed to be saying that the NHS was no longer sustainable as a wholly tax-based system. The hon. Member for Wyre Forest (Dr. Taylor) seemed to be calling for a Stalinist approach to spending, as he did not think that managers could make such decisions for themselves and needed to be told how to spend their money.
The hon. Member for Westbury (Dr. Murrison) seemed to be against the idea of increased inspection and accountability in the health service. All I can say is that he should tell that to the relatives of the patients at Alder Hey and Bristol and the patients of Shipman and Ledward. Without more accountability, we cannot expect the public to have sufficient faith in the health service, let alone expect improvements.
I have the privilege of being the only practising doctor in the House, so it is a great honour to speak tonight. As part of my duties, I meet many health professionals from all parts of the health service.
I try to meet as many health professionals as possible. Although many people whom I meet are not necessarily Government supporters, they all seem to concede that the Government are committed to improving the NHS, putting more money into the system and want greater accountability and better outcomes. GP lists are getting smaller and practices are better resourced than ever before. There are more practice nurses and support staff.
What is the problem and how has it come about? How can the Government address it and how can the Bill begin to deal with it? Many important issues have been raised tonight. There are deep structural problems in the NHS, and shortages of doctors, nurses and hospital beds. The Secretary of State laid out in great detail the reasons for that and explained what we are trying to do about it. Certainly, obvious factors need to be taken into consideration.
Society is changing and people are demanding more than they did before. We live in a culture in which people expect much quicker access to services. They are much more likely to call services to account if they do not get what they want, and demand greater access to them. Doctors are losing their position in society. They are slightly more popular than politicians but, nevertheless, they seem to be losing some of their status, which causes them stress and difficulty. Patients who were previously grateful to receive almost any service from doctors are now far more critical and likely to call them to account. One problem is that, while doctors are not necessarily working longer hours than they used to or seeing more patients, their decisions are being called into question far more, which obviously puts a great deal of pressure on them. They now have to account for almost everything that they do and sometimes they have to face the consequences of their actions.
Complaints are certainly rising a great deal. That does not have anything to do with poor practice; it is much more to do with the fact that patients are more likely to complain and call services to account, which causes great difficulties. The Government are therefore in a dilemma because they are responsible for spending vast sums of the public's money. A lot of money is going into the NHS; previously, not so much was going in. But the Government, of course, expect to get something out. If they are putting all that money in on behalf of the public, they have the right, on behalf of the public, to expect better outcomes; that is only reasonable.
Doctors, on the other hand, take the view that they are in the driver's seat and have to produce the extra services. Doctors are onside. Naturally, they want to see patients more efficiently and quickly, improvements in health care, access to the best drugs, treatments and referrals, and the shortest waiting times possible. Nevertheless, they are under great pressure to deliver. They must fulfil the Government's aspirations by delivering. We have already heard that they are under pressure and that there is a shortage of them. They are justifiably upset that they are expected to produce yet more.
Patients are always in a hurry; they want changes to happen quickly. They know that the Government have been in office for more than four years and rightly ask, "Where are the big changes you promised?" It is difficult to explain to someone suffering from a painful hip that it is impossible to train nurses and doctors and build
There is obviously a conflict and tension between the Government, who want to improve the NHS as quickly as possible and put the resources in; doctors, who would like to deliver more, but are finding it difficult; and patients, who are impatient because they pay taxes and want improved treatments. How are we to make progress? There are three ways forward: to increase supply, to limit demand and to change the way in which the service is provided.
The Government are committed to increasing supply. That will happen, but it will take time. Limiting demand is more interesting; many health systems around the world have found ways of doing that by making patients pay for services through co-payment, part-payments or insurance- based schemespatients put their hand in their pocket and pay out. Many in the medical profession and outside have said that if they charge patients for services, they will use them more appropriately. I disagree with that view. If we were to make patients pay for services, they would use them less, but that does not necessarily mean that they would use them more appropriately. My big worry is that introducing charges into the health service as a way of limiting demand would have a very negative and detrimental effect. I would be very resistant to such proposals. I know that the idea has been discussed and called for, but I am very much against it. If we were to introduce an insurance-based system
Dr. Stoate: We are discussing ways of reforming the health service. I am simply exploring ways in which we might provide a health service that is suitable for the 21st century. In a Second Reading debate, it is perfectly reasonable to range around the subject. If you, Mr. Deputy Speaker, do not stop me, I feel happy to continue with my line of reasoning.
I do not think that the type of system to which I have just referred is the answer. However, my third solutionchanging the way in which we use the health serviceis a much more fruitful way forward. The thrust of my argument is that we should make much more efficient use of other health professionals, especially pharmacists, who have enormous expertise and knowledge and could be used far more effectively than in the past. They can provide shop-front services without an appointment and supply a wide range of other services to patients. They are very good at health promotion and they can liaise with GPs and manage patients' medicines and repeat prescribing. Indeed, they can manage in an extremely effective and efficient manner many of the functions that are currently undertaken by GPs. I would like to see much more use of pharmacists. They are available in every high street and are used very widely by the public. With a bit more co-ordination and careful interchange in the exchange of information, we could make good progress in that area.
We can also do much more in primary care and general practice itself. We are not making the most efficient use of primary care resources. As I said, the number of practice nurses has increased, but there is room for another class of health care assistants. One can call them
There have been one or two instances around the country in which health care collaboratives have been used in that way. The national primary care development team has led the way in pilot studies throughout the country in which a significant improvement has been shown. A 20 per cent. reduction in face-to-face consultation was achieved by getting GPs to do follow-ups on the phone, and a 50 per cent. reduction by introducing telephone triage for same-day appointments. A number of things can be done in primary care to make the most efficient and effective use of resources.
I want a much more wide-ranging debate about the use of resources in the health service to arise from the Government's proposals. Resources can be used much more efficiently, which would benefit everybody.