27 January 2010
Mike Penning winds up a debate on Out-of-Hours Care on behalf of the Opposition.
Mike Penning (Hemel Hempstead) (Con): We have had an eminently sensible debate this afternoon. Hon. Members of all parties care about the quality of care that our constituents get. Sometimes we disagree slightly-and sometimes more than slightly-about how it is delivered, but we all care passionately.
Contributions have been measured and understandably passionate. I pay tribute to my hon. Friend the Member for North-East Cambridgeshire (Mr. Moss), who, like us all, would have loved to raise constituency concerns and effects on his constituency. His speech was extremely measured, and he will be a great loss to the House when he retires at the next election.
I am conscious that other hon. Members are retiring at the next election, and I apologise if I do not have time to respond to all who spoke.
The key to many of the contributions was safety-for our constituents and the patients who look to the NHS to give them the care that they deserve and that we would all expect. The problem with the existing contract is that many patients do not feel they are given the care that they deserve, whether they live in rural or urban areas. We have heard much about the different sorts of care that we are offered in rural as well as urban areas. My seat is both very rural and very urban, so I well understand the problems.
The hon. Member for South Derbyshire (Mr. Todd), who eventually decided to take part in the debate-I understand why, and I repeat that it was a sensible debate- made some important points. The first was about knowledge and records. Do people who are called out out of hours know the patients' concerns? We talked about multiple sclerosis, motor neurone disease and other conditions. It is imperative that that information is available when possible. That is why the link to the GP is so important.
As the hon. Member for Dartford (Dr. Stoate) knows, I often bow to his medical knowledge. He is a GP, and I serve on the Health Committee with him. I think he said that GPs grabbed the contract with both hands only to remove the risk and perhaps some of the tiredness from it. That is not quite right. GPs were offered a contract by the Government in 2004-frankly, if they had not bitten their arm off, they would have been silly,
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because the financial benefits were huge. The contract was fantastic for GPs who had been working through the nights and at weekends. All they had to do was give up £6,000 a year-£120 a week. Nine out of 10 did that. I do not think anyone would take on such a work load for such a small amount of money. It is difficult for a hard-working MP who is also a GP to say that this is about tiredness. Surely he is exhausted when he leaves the House late at night or in the early hours of the morning and goes on to be a GP in the morning. The amount of work he does in his constituency must make him a very tired GP, which is worrying.
My hon. Friend the Member for Mid-Bedfordshire (Nadine Dorries), like many colleagues, touched on continuity and safety for patients and what they expect from the NHS. The debate has been very much about-I hope-patient-led services. The key is not what the NHS, GPs or NHS Direct want, but what is right and proper for patients. Quite rightly, we have talked extensively about GPs and GPs out of hours, but that is only part of what we should rightly talk about today.
My hon. Friend the Member for Beckenham (Mrs. Lait) said that we should have a debate not about NHS Direct, out-of-hours care and A and E, but about what a joined-up package would be. One problem with the existing PCT packages is that they are not integrated. There are myriad contacts out there-there are polyclinics and Darzi clinics, care clinics, walk-in units, GP surgeries in railway stations, NHS Direct and NHS Choices.
There are so many different things that it is not surprising that our constituents are confused, which is why I was over the moon when the Government adopted our policy of going to a second number, 111. The number is fine, but do the Government understand what it should involve? I was slightly concerned when my good friend, the hon. Member for Wyre Forest (Dr. Taylor), said that people could be given another number to call after they called 111. That is not the idea. The idea is that people should be triaged through the phone system. Once they have had the courage or fear, or felt the need, to pick up the phone, they should be able to triage right the way through. Once they have dialled 111, they should be able to go all the way through so they can find out which pharmacy is open that night, whether they need to go to A and E, or whether an ambulance should be called to them immediately.
I understand that none of the three pilots includes access through the web portal, which is wrong. We need to have a joined-up situation. We should offer a single 111 service, but it should be replicated on the web. At the moment, that is not included in the pilots. Will the Minister look at that, because it is very important?
Finally, if we want to talk about out-of-hours services, we must look at the emergency care single pathway. As I said, the 111 number is eminently sensible, and I am pleased the Government are using it, but we must look at what service is needed by our constituents when they phone up. Should we look at pharmacies, walk-in centres and social care? Should it be possible to tell people whether they need to make a GP appointment the next day, whether a paramedic needs to be sent straight away and whether that should be a single-responder?
The Minister would be surprised if I did not mention out-of-hours dentistry, which is in crisis-dentistry is in crisis during the day and at night. If the Minister went to A and E units at night and talked to patients, he would find a huge number who are there simply because they cannot get a dentist during the day. We know that in excess of 1 million patients cannot access NHS dentistry, but when people are in pain and turn up at A and E, we need to ensure that the skill base is available for them.
My hon. Friend the Member for Basingstoke (Mrs. Miller) talk mentioned walk-in centres integrating with A and E. I have seen that in action and it absolutely works around the country and releases a lot of the pressure from existing A and E units. I am sure all hon. Members visit their A and E units-I am lucky enough to go and visit very many. Many patients could have been seen at a minor injuries unit, but they go to the A and E because they feel safe. Many in A and E wanted to get a GP appointment but could not, and many are sent to A and E after a long call to NHS Direct, when they could have been triaged in a much better way.
Working as an integrated service is crucial if we are to have the out-of-hours and urgent care that we need. The Government disagree with our policies-that is their prerogative-but they should call an election and let the public decide.
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Mike Penning (Hemel Hempstead) (Con): We have had an eminently sensible debate this afternoon. Hon. Members of all parties care about the quality of care that our constituents get. Sometimes we disagree slightly-and sometimes more than slightly-about how it is delivered, but we all care passionately.
Contributions have been measured and understandably passionate. I pay tribute to my hon. Friend the Member for North-East Cambridgeshire (Mr. Moss), who, like us all, would have loved to raise constituency concerns and effects on his constituency. His speech was extremely measured, and he will be a great loss to the House when he retires at the next election.
I am conscious that other hon. Members are retiring at the next election, and I apologise if I do not have time to respond to all who spoke.
The key to many of the contributions was safety-for our constituents and the patients who look to the NHS to give them the care that they deserve and that we would all expect. The problem with the existing contract is that many patients do not feel they are given the care that they deserve, whether they live in rural or urban areas. We have heard much about the different sorts of care that we are offered in rural as well as urban areas. My seat is both very rural and very urban, so I well understand the problems.
The hon. Member for South Derbyshire (Mr. Todd), who eventually decided to take part in the debate-I understand why, and I repeat that it was a sensible debate- made some important points. The first was about knowledge and records. Do people who are called out out of hours know the patients' concerns? We talked about multiple sclerosis, motor neurone disease and other conditions. It is imperative that that information is available when possible. That is why the link to the GP is so important.
As the hon. Member for Dartford (Dr. Stoate) knows, I often bow to his medical knowledge. He is a GP, and I serve on the Health Committee with him. I think he said that GPs grabbed the contract with both hands only to remove the risk and perhaps some of the tiredness from it. That is not quite right. GPs were offered a contract by the Government in 2004-frankly, if they had not bitten their arm off, they would have been silly,
27 Jan 2010 : Column 909
because the financial benefits were huge. The contract was fantastic for GPs who had been working through the nights and at weekends. All they had to do was give up £6,000 a year-£120 a week. Nine out of 10 did that. I do not think anyone would take on such a work load for such a small amount of money. It is difficult for a hard-working MP who is also a GP to say that this is about tiredness. Surely he is exhausted when he leaves the House late at night or in the early hours of the morning and goes on to be a GP in the morning. The amount of work he does in his constituency must make him a very tired GP, which is worrying.
My hon. Friend the Member for Mid-Bedfordshire (Nadine Dorries), like many colleagues, touched on continuity and safety for patients and what they expect from the NHS. The debate has been very much about-I hope-patient-led services. The key is not what the NHS, GPs or NHS Direct want, but what is right and proper for patients. Quite rightly, we have talked extensively about GPs and GPs out of hours, but that is only part of what we should rightly talk about today.
My hon. Friend the Member for Beckenham (Mrs. Lait) said that we should have a debate not about NHS Direct, out-of-hours care and A and E, but about what a joined-up package would be. One problem with the existing PCT packages is that they are not integrated. There are myriad contacts out there-there are polyclinics and Darzi clinics, care clinics, walk-in units, GP surgeries in railway stations, NHS Direct and NHS Choices.
There are so many different things that it is not surprising that our constituents are confused, which is why I was over the moon when the Government adopted our policy of going to a second number, 111. The number is fine, but do the Government understand what it should involve? I was slightly concerned when my good friend, the hon. Member for Wyre Forest (Dr. Taylor), said that people could be given another number to call after they called 111. That is not the idea. The idea is that people should be triaged through the phone system. Once they have had the courage or fear, or felt the need, to pick up the phone, they should be able to triage right the way through. Once they have dialled 111, they should be able to go all the way through so they can find out which pharmacy is open that night, whether they need to go to A and E, or whether an ambulance should be called to them immediately.
I understand that none of the three pilots includes access through the web portal, which is wrong. We need to have a joined-up situation. We should offer a single 111 service, but it should be replicated on the web. At the moment, that is not included in the pilots. Will the Minister look at that, because it is very important?
Finally, if we want to talk about out-of-hours services, we must look at the emergency care single pathway. As I said, the 111 number is eminently sensible, and I am pleased the Government are using it, but we must look at what service is needed by our constituents when they phone up. Should we look at pharmacies, walk-in centres and social care? Should it be possible to tell people whether they need to make a GP appointment the next day, whether a paramedic needs to be sent straight away and whether that should be a single-responder?
The Minister would be surprised if I did not mention out-of-hours dentistry, which is in crisis-dentistry is in crisis during the day and at night. If the Minister went to A and E units at night and talked to patients, he would find a huge number who are there simply because they cannot get a dentist during the day. We know that in excess of 1 million patients cannot access NHS dentistry, but when people are in pain and turn up at A and E, we need to ensure that the skill base is available for them.
My hon. Friend the Member for Basingstoke (Mrs. Miller) talk mentioned walk-in centres integrating with A and E. I have seen that in action and it absolutely works around the country and releases a lot of the pressure from existing A and E units. I am sure all hon. Members visit their A and E units-I am lucky enough to go and visit very many. Many patients could have been seen at a minor injuries unit, but they go to the A and E because they feel safe. Many in A and E wanted to get a GP appointment but could not, and many are sent to A and E after a long call to NHS Direct, when they could have been triaged in a much better way.
Working as an integrated service is crucial if we are to have the out-of-hours and urgent care that we need. The Government disagree with our policies-that is their prerogative-but they should call an election and let the public decide.
| Hansard
