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Commons Chamber

Volume 477: debated on Tuesday 17 June 2008

House of Commons

Tuesday 17 June 2008

The House met at half-past Two o’clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—


Guidance has existed for more than 20 years. I have today asked Professor Mike Richards—the national clinical director for cancer—to review policy relating to patients who choose to pay privately for drugs not funded on the NHS. Terms of reference have been placed in the Library.

I very much welcome the Secretary of State’s announcement, as will many campaigners up and down the country and in the House. The ban on co-payments was cruel, because, as we know, it took NHS care away from patients who were dying, and it was illogical because co-payments existed in other parts of the NHS. Will the Secretary of State assure the House that the review will not have the effect, however inadvertently, of kicking the issue into the long grass, because, as the case of Linda O’Boyle proved, patients want and need the change in the policy now, not in a year’s time?

The hon. Gentleman has represented his constituent, Mrs. Linda O’Boyle, vociferously in the House and, indeed, on a non-party political basis, and many other Members on both sides of the House have raised the issue. It is time that someone with the expertise of Professor Mike Richards looked at the issue. It will hardly go into the long grass; I want Mike Richards to report in October. When the hon. Gentleman has had a chance to read the terms of reference, he will see that I am asking Mike Richards to look at very complex issues. I am not saying that he should come down one way or the other; I am saying that he needs to review the issue, given the need, which hon. Members on both sides of the House understand, to protect the principles of the NHS as a service free at the point of need and the very understandable concerns of Mrs. O’Boyle’s family and many others involved to find out whether we can ensure that we get guidance that is up to date and related to what is happening now in the NHS, that is fair to everyone and that resolves some of the problems that the hon. Gentleman and others have raised.

May I welcome the Secretary of State’s statement? Many Labour Members welcome it, as well as Opposition Members. I am grateful for his emphasising that this is not a new policy; it is one that the Government inherited. May I add that, by in a sense time-limiting the review, he will increase support in the country for the outcome of the review, whatever it is?

I thank my right hon. Friend. He, too, has raised the issue in various debates in the House. The guidance goes back at least to 1986 and probably before then. I have no need to ask Professor Mike Richards—he will do this anyway—to talk to Members, such as the hon. Member for Billericay (Mr. Baron), my right hon. Friend and others who want to raise specific issues. That can be done in the time scale that has been set—certainly, Professor Richards thinks that it can—and, as I say, that will ensure that I do not stand at the Dispatch Box merely repeating guidance that has existed for 20 or 30 years. We can determine what we need to do now in the NHS to resolve some of these very difficult and complex problems.

I also welcome the review that the Secretary of State has announced. Will he ensure that, in the deliberation, the needs of the silent voices—those who cannot afford the extra payments—are not forgotten?

The hon. Gentleman raises a very important issue. The scenario that many in the NHS feared, which has led to the guidance over the years, is that a patient in the first bed on a ward would be treated completely differently from the one in the second bed, because of their ability to pay. That is not the argument that has been raised by hon. Members in the House. I understand very clearly the fundamental points that are being made, particularly about Mrs. O’Boyle, who did not know that there was an obligation to pay for treatment until she had received it. But the hon. Gentleman, from his experience in the NHS, raises the fundamental, key issue, which I hope he will accept is very clearly set out in the terms of reference.

Will the Secretary of State give an assurance that the review will not result in a lottery system in the NHS, whereby people who can afford to pay can buy better treatment than people who cannot afford to do so? Most hon. Members on both sides of the House would be concerned if that inequality were introduced into the NHS, because it could become the thin end of the wedge for things such as top-up payments for other treatments. Will he assure us that the review will not open up that avenue?

I can give my hon. Friend that assurance. I shall quote the terms of reference, which state that the review should take into account

“the importance of enabling patients to have choice and personal control over their healthcare; and the need to uphold the founding principle of the NHS that treatment is based on clinical need not ability to pay, and to ensure that NHS services are fair to both patients and taxpayers”.

My hon. Friend should be reassured that we are reviewing how the system works in the 21st-century NHS, and that the outcome is not predetermined. Professor Mike Richards is a respected clinician: he led the development of the cancer plan and cancer strategy, and until recently he was chairman of the National Cancer Research Institute. All the cases that I have examined, including Mrs. O’Boyle’s, relate to cancer—mainly bowel cancer and kidney cancer. Professor Richards has spent his whole life in the NHS, so he is the perfect person to review the situation very quickly. The report will be published, so hon. Members will have the chance to see the results.

Desperately ill patients and their families are often vulnerable to the false hope provided by miracle drugs, which are sometimes touted in the media. What consumer advice—it is almost consumer protection—will be given to those people so that they do not waste their time and money or expend their hope on what are cul-de-sacs so far as treatment is concerned?

My hon. Friend raises another dimension to the issue. Professor Richards led on the cancer strategy, which was published in December and pointed out the need to get cancer drugs through the process much more quickly. Consumers who are considering drugs that are available on the internet should, first, take the advice of their clinician; secondly, check whether the drug is licensed; and, thirdly, if it is licensed, ensure that they know where it sits in relation to the NICE process. We can speed up the NICE process, and we will comment on that in the next-stage review, which will be published shortly. The internet contains a range of drugs, some of which are licensed and some of which are not. We must be vociferous in ensuring that consumers get the right advice, and we must do what we can to ensure the proper regulation of such drugs.

I am sure that the House is grateful to the Secretary of State for initiating the review. The Secretary of State will also appreciate that we have not had access to the terms of reference. It would be helpful if the Secretary of State, taking account of the case made by my hon. Friend the Member for Billericay (Mr. Baron) on behalf of Mrs. O’Boyle and her family, were to agree that we need to examine two principles. First, if patients access private treatment beyond the boundaries of NHS care, it should not mean that they lose their entitlement to NHS care. Secondly, NHS care itself should continue to be both comprehensive and free based on need, not ability to pay. I gather from the terms of reference that the Secretary of State has included the latter principle, but has he included the former?

I appreciate that the hon. Gentleman has not had a chance to see the review’s terms of reference, but that sounded like an attempt to pre-empt the outcome. We are clear that someone who has had private treatment can return to the NHS for treatment, and we are also clear that people who have had NHS treatment are perfectly entitled to obtain private treatment. The ambiguity occurs over the term “an episode of care” and whether someone can buy a drug that is not available on the NHS and ask the NHS to pay for its administration as part of their treatment. I want Professor Richards to examine that area, and I do not want to predetermine the review. Professor Richards is well aware of the problems experienced by Mrs. O’Boyle and others, because he deals with such issues all the time. When the hon. Gentleman sees the terms of reference—I will not take up the House’s time by reading them all out, because there are quite a few words—I hope that he will be assured that that point has been addressed. If not, the issue is not party political, and he is welcome to come and see me—indeed, I am sure that Mike Richards would be keen to talk to him.

I look forward to discussing the matter with Mike Richards. The Secretary of State will appreciate why I mention “comprehensive care”. The review particularly relates to many of the new cancer drugs. Mike Richards and the NHS also need to address how patients who rely on the NHS for their treatment can be sure that they will get comprehensive treatment. For example, I have a list of 20 European countries where Erbitux, the brand name for Cetuximab, which was privately provided for Mrs. O’Boyle, is routinely made available for patients with colorectal cancer. In the NHS, Mrs. O’Boyle was told that that drug was not available. Surely we must address that question, too.

I do not believe that that is about the terms of reference. The issue is how we deal with the NICE process. Cetuximab was a specific issue and it had not been through the NICE process. The PCT decided that the circumstances were not exceptional and, therefore, the treatment was not given. There is a whole different dimension to the issue under discussion. The fundamental problems that Professor Richards will look at are confined not to cancer drugs but to drugs per se. There may be many other issues and unintended consequences, because we have been concentrating so closely on the understandably controversial issues surrounding Mrs. O’Boyle and others. But Professor Richards’s remit will be to look right across the range. The worst thing that could happen to the review would be if he were to concentrate on one particular area and on a few particular drugs, and then miss the fact that unintended consequences apply to other illnesses and to other drugs.

HIV Infection

Data on newly acquired HIV infections are not available, but an estimated 5,817 people were reported as newly diagnosed with HIV infection in 2007, compared with 6,769 in 2006. The figures include people with long-standing infections, including many who were infected outside England but who were subsequently diagnosed in this country.

I thank my right hon. Friend for her answer. She will know that there is a serious problem not only with the overall numbers, which, although coming down, were recently still up on the 1997 figure of, I think, 3,000. She will also know about the problem of late diagnosis—people being diagnosed six or seven years after becoming infected, by which time they have become highly infectious and less likely to respond to treatment. She will be aware that London’s strategic health authority has highlighted that big problem and is trying to address it with a target to halve the number of people who are diagnosed late. Will she seek to use her influence to spread that target and practice throughout all health authorities in the country?

My hon. Friend raises a very important point. He will know that the prevalence of HIV in England is one of the lowest in Europe—comparable to that in Sweden, the Netherlands and Denmark. Nevertheless, he is quite correct: about 31 per cent. of those who are infected are unaware of the fact. The steps that the Department has been taking have been, first, to focus on publicising the importance of early testing and on providing extra resources; secondly, to improve timely access to NHS testing, particularly in a variety of settings, not just in genito-urinary medicine clinics; thirdly, to look very specifically at where the highest risks are and to ensure that information and support are provided to those groups to encourage them to come forward for testing; and, finally, to undertake work with those in the voluntary and third sectors, as well as with local health authorities, to try to remove the stigma and the perceived discrimination that many people fear in order to encourage them to come forward.

Has the right hon. Lady had any recent discussions with her colleagues in the Department for Work and Pensions about the growing concerns regarding medical assessments of people with HIV infections, in respect of disability allowances and of fitness for work? It is a growing concern, and it would be very useful if she were to have appropriate discussions with the DWP to ensure that it applies the right tests.

I have not had any discussions recently about that point, but if the hon. Gentleman has specific issues and experience in his constituency I would be very happy if he sent them to me, because clearly we must ensure that medical assessments are conducted correctly, particularly with regard to that very vulnerable group.

I am sure that my right hon. Friend recognises the risks to public health from the greater number of new infections and from people who are undiagnosed. Given that, will she look again at including HIV in the list of infections that are exempt from NHS charges? We must have a balance between the public health risks and the financial costs, recognising that the risks outweigh the costs.

All people who are ordinarily resident in England are entitled to free national health service treatment, including for HIV. My hon. Friend will be aware that that is qualified by exempting categories of individuals from charges under the National Health Service (Charges to Overseas Visitors) Regulations 1989, as amended. He will also be aware that asylum seekers are exempt from charges for all hospital treatment, including for HIV, and will remain exempt for courses of treatment that continue if and when their applications for asylum are rejected. All the points with regard to the threat to public health that he correctly identifies are addressed in the strategies that we use.

The Minister will know even from the Government’s own data that many of the at-risk people to whom she referred are from sub-Saharan Africa. What consideration have the Government given to selected pre-screening of people who apply to move to the United Kingdom through work visas or student visas, or, indeed, as asylum seekers?

The hon. Gentleman will know that the Government have announced that they are investing an extra £2 million, in addition to the moneys already committed to prevention work, to look specifically at groups of highest risk, including gay men and people from African communities. Working through the African communities and the African HIV project, we are addressing particularly the issues that the hon. Gentleman mentions. It is important that people come forward for early testing. It is not necessary to have compulsory testing. We are seeing that testing through the various clinics and measures has increased dramatically—in some cases, by up to 85 per cent.

Does my right hon. Friend agree that there is a danger that as more and more people are living and working with HIV/AIDS, the perception of the disease as being life-threatening recedes, and that any prevention programme therefore needs to recognise that change in perception and to focus very much on the fact that being able to take drugs and in most cases live a long and productive life is not a reason to assume that one is not at risk?

My hon. Friend is absolutely right. With the development of therapies and treatments, it is particularly important that people understand that HIV is still a deadly disease. We particularly need to understand—the Department is taking this forward—which groups in the community may be less aware of the risk, or have a belief that they can live with it, and to target additional information and support to them to encourage them, first, to come forward for testing, and, secondly, to desist from activities that increase their likelihood of HIV infection.

Liver Disease

We are concerned about the increasing incidence of and mortality from liver disease. I congratulate my hon. Friend on his work in the all-party group on hepatology and on the many Adjournment debates that he has introduced on this issue. We are already taking action on a number of fronts to combat its primary causes—alcohol misuse, which is the most common, viral hepatitis and obesity. We accept that there is strong support for developing a national plan for liver disease.

Unlike deaths from other major diseases, which are going down significantly, deaths from liver disease caused by viral infections, obesity and excessive consumption of alcohol are, tragically, rising significantly. What more can my hon. Friend do to reverse that trend, and when will we see a national service framework established in the field of hepatology?

We have engaged with a wide range of stakeholders in order to build a consensus on the issues that my hon. Friend has raised and on what we might do about them. We shall decide on our next steps in the light of that and of preliminary work on the evidence. Much of the evidence is being taken by Professor Ian Gilmore and Professor Eileen Kaner of Newcastle university. Problematic drinking is a key cause of liver disease. In our national alcohol strategy, we support a comprehensive approach, across and beyond Government, to address the consequences of harm caused by alcohol. We have a range of measures in place to tackle hepatitis B and C, such as a national hepatitis C action plan and awareness campaign. Our expert committee, the Joint Committee on Vaccination and Immunisation, is reviewing the national hepatitis B immunisation programme. Tomorrow, I shall meet some officers of the all-party group, and I hope to take the process forward as soon as possible.

Does the Under-Secretary share my concern at the growth in the instance of liver disease among younger people through the misuse of alcohol? What steps is she taking in conjunction with other Departments to target that age group to prevent the problem of binge drinking?

Our national alcohol strategy has been rolled out along with, today, a Home Office initiative on the very subject that the hon. Gentleman rightly raises. Education on liver disease and its serious consequences, which sometimes do not come to light for many years to come, is difficult to get across to young people because they live for today, and serious consequences for the liver may not become apparent for 10, 15 or even 20 years. Much more can be done and I am happy to work with the hon. Gentleman on any initiative he wants to bring to me.

Has my hon. Friend considered a requirement for a Government health warning on all tins and bottles of alcoholic beverages, similar to the warnings that we have on packets of cigarettes? A number of countries throughout the world use them.

I am informed by the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), that there is a voluntary system in place at the moment, but we can always look to do more because the consequences for young people are so serious and because the rate of deaths from liver disease in this country is rising.

What discussions has the Under-Secretary had with colleagues in the Department for Children, Schools and Families and the Ministry of Justice to ensure that there is some sort of co-ordinated action whereby the contents of the strategy can be rolled out in prisons in due course, and within young offender institutions in particular? Action is urgently needed there.

The hon. Gentleman is right. The Department for Children, Schools and Families works closely with the Department of Health. Secretaries of State from both Departments meet regularly to consider the children’s plan and the health plan. It is not only alcohol that causes liver disease and hepatitis, but obesity, too. The obesity plan for young people is currently in place.

GP Surgeries

5. What recent steps he has taken to extend the hours during which GP surgeries are open for patients. (211294)

In March, we agreed changes with the British Medical Association to reward practices that extend their opening to provide weekend or evening appointments. I am pleased to tell the House that 21 primary care trust areas have already achieved our aim that at least 50 per cent. of surgeries should offer extended hours.

But would not the creation of 152 GP-led surgeries, open from 8 am until 8 pm, seven days a week, provide greater choice and better health opportunities for patients—[Interruption.]—rather than leading to closures in Nottinghamshire, or anywhere else in the country, as the British Medical Association suggests?

I agree with my hon. Friend, who makes an important point. I heard some Opposition Members shout, “Not in rural areas.” Yet Cornwall is one of the counties that has already achieved the 50 per cent. target—indeed, it has exceeded 90 per cent. However, some GPs may not want to open in the evenings or at weekends, so we believe that it is perfectly proper that patients in those areas are not denied the ability to remain registered with their GP, if they wish, and to see a GP in the evening or at weekends. They will value that greatly and not understand the Conservatives’ promise to reverse the policy.

I strongly support the idea that GPs’ surgeries should open for longer. In the main, GPs are popular with their patients, are trusted and know the details of the conditions of those on their panel. However, I am reserved about the Government’s proposal to open polyclinics, which I believe would be an expensive duplication of GPs’ services and undermine the position of GP surgeries. Will not the Government reconsider their proposal and perhaps try to work through GPs to extend services, so that the services that people want are available in the evening and at weekends?

The hon. Gentleman is rarely known to be reserved in the House, but I welcome his support for our extended hours drive and invite him to discuss it with his Front Benchers. As I said, they promised to reverse the policy and give the BMA a veto over extended hours. The last time we had an exchange on the subject, the hon. Gentleman highlighted the success and popularity of a GP-led health centre that provides an excellent service in his constituency. We are not imposing anything on any primary care trust, but simply saying that, in every PCT area, there should be a GP-led health centre, such as the one of which the hon. Gentleman is fond in his constituency, for patients whose surgeries are not open in the evenings or at weekends to give them the choice.

In the city of Wolverhampton, some GPs have tried extended opening and found little demand, whereas another surgery is opening on Saturday mornings to trial the policy. Is there any quantitative evidence from the west midlands—or, indeed, the city of Wolverhampton—that might give us a better steer on potential demand from patients for the extended hours service?

Every survey that we conduct of what the public think is the most important improvement that we can make to build on the improvements that we have already made in the health service shows that people want to be able to see a GP at a more convenient time to the patient—at weekends or in the evenings. My hon. Friend’s local primary care trust may not yet have hit the 50 per cent. target, but neighbouring Heart of Birmingham PCT has, with 75 per cent. of GP practices already offering extended hours. It is popular, the public tell us that they like it, and the GPs, once they start doing it, also find it popular.

Does the Minister agree that it is not so much the hours that GPs are available that are important, but the services that each GP practice offers? Is he aware that the White Paper on pharmacy proposed taking away the ability of GP practices in market towns such as Thirsk to dispense? That will reduce the services that they can offer. There is no point in the Minister of State, the right hon. Member for Bristol, South (Dawn Primarolo) shaking her head. I met representatives of GP practices and I also declare an interest as a GP’s daughter and a GP’s sister. We want to keep dispensing services in rural practices.

My right hon. Friend was shaking her head because she wrote the pharmacy White Paper and she knows that it does not do what the hon. Lady suggests. The hon. Lady also knows that we are consulting on all aspects of the White Paper, and I invite her to make a formal representation as part of the consultation.

Does the Minister know that, in areas such as Leek, which is a market town, GPs already successfully offer an out-of-hours service from 10 am until 2 pm, on Saturdays, Sundays and bank holidays? Is not it time that other GPs followed that good practice and recognised that patients want not only high quality but more accessible services to fit in with their lifestyles?

I agree with my hon. Friend, who has given a good example of what happens in an area when one or two GPs start offering the service to patients: other GPs quickly follow suit because they discover that it is popular. It is extraordinary that some hon. Members still believe that, although it is fine for people in some parts of the country to be able to see a GP in the evenings and at weekends, that service should not be available to everybody. Labour Members believe that it should be.

It seems extraordinary that the Minister is claiming credit for the Government reinstating a service that they removed three or four years ago. I want to press him further on the point that my hon. Friend the Member for Vale of York (Miss McIntosh) made. She was absolutely right to say that access to GPs and primary care is about more than just opening hours. Will the Minister acknowledge that the proposals in the pharmacy White Paper that potentially remove the right of GP practices to dispense are causing immense concern both to service providers and, more importantly, to their patients? In consultation with the Minister responsible—the right hon. Member for Bristol, South (Dawn Primarolo), who is whispering in his ear—will he confirm that there will be no changes to the control of entry regime without a full, published, comprehensive and genuine consultation that takes into account the needs of communities that use GP dispensing services and pays particular regard to the proposed changes in the White Paper to the imposed distance criteria?

The hon. Gentleman is doing the same thing as a lot of his hon. Friends—confusing out-of-hours services with extended hours. I am pleased if he is reversing the Conservatives’ policy and saying that they will not reverse the provision for extended hours, because I suspect that he will find shortly that extended hours will be very popular with the public when they begin to access to them. I suspect that the policy is not one that the Conservatives will abandon as quickly as they have most of their other policies.

On the pharmacy White Paper, I have already said in answer to the hon. Member for Vale of York (Miss McIntosh) that there will be a consultation. Our view is that the hon. Gentleman is wrong in his interpretation of the White Paper’s impact, but he is welcome to make his views felt during the consultation.

Standish Hospital

The national health service locally in my hon. Friend’s constituency is continuing to consider the future of the Standish hospital site and is exploring the potential to develop services that would benefit the people of Gloucestershire. We expect the decision to be made shortly.

I thank my hon. Friend for that and commend him on visiting the site. He knows what a beautiful site it is and what potential it has. It would be good to hear that progress is being made. Indeed, I gather from what is happening that this innovative scheme between the learning and disabilities trust, the primary care trust and the voluntary sector will become a reality, so anything that he can do to help it along will be gratefully welcomed in the area.

I am grateful to my hon. Friend for that and for the invitation to visit his constituency, which I recall I did on an extremely wet spring day. My understanding is that the main obstacle to progress is the listing of part of a building on the site. May I suggest to my hon. Friend that he make representations to my right hon. Friend the Minister of State, Department for Culture, Media and Sport, if he has not already done so, to ensure that she is well aware of his views on the merits or otherwise of listing that building?

Infertility Services

Two main issues are currently being addressed. First, the Government conducted a survey of in vitro fertilisation provision in all primary care trusts. A copy of that survey has been placed in the Library today. That is part of the Department’s regular monitoring of IVF provision and tracking of progress towards the National Institute for Health and Clinical Excellence’s recommendations. Secondly, the Infertility Network UK, which is funded by the Department for that activity, is identifying and establishing standard access criteria to fertility treatment.

I very much welcome that statement. As my right hon. Friend knows, next month is the 30th anniversary of the birth of the first test-tube baby. Will she consider marking that by ensuring an end to the postcode lottery that still exists in access to treatment and by increasing entitlement to three rounds of treatment on the NHS, as recommended by NICE?

As my hon. Friend is well aware—she has campaigned extensively in her constituency and in the House—the local NHS takes decisions about the treatment that it provides for its local communities and identifies priorities. In my view, we will reach the NICE recommendations when the local NHS acknowledges the fact that one in seven adults experiences difficulties with fertility, and makes the provision of fertility treatment services a higher priority. Members of Parliament have an important role in discussions with their PCTs, which do a difficult job in trying to reflect local criteria and priorities.

The Minister will know that IVF treatment was suspended in Northamptonshire because of lack of money. Northamptonshire is the worst funded primary care trust in the whole country in respect of the national capitation formula, so the suggestion that it is up to local PCTs to decide on IVF treatment is a little unfair when the problem is the lack of Government money going to Northamptonshire.

That is simply not true. I know that the hon. Gentleman has made representations and that he is very clear in making them for his constituents, but he will also know that his PCT is within the 3.5 band in terms of funding. I have to tell him, in view of the different number of cycles offered, that one of the big debates that remains to be concluded across the country is whether the provision of IVF treatment is a priority for local health services that is equal to other priorities. That matter can be settled locally when it is made clear that the provision of IVF services is important. The hon. Gentleman’s PCT provides other services that it also believes are important, so we need to ensure that equal priority is given.

Cord Blood Programme

There is already a national cord blood programme in place. The NHS cord blood bank, supported by NHS Blood and Transplant and funded by the Department of Health, collects cord blood from four centres. All the cord blood units stored in the NHS cord blood bank are available to NHS patients across the country.

Is the Minister aware that the Anthony Nolan Trust estimates that tens of thousands of pints of cord blood, which could be used for transplantation and research purposes, are discarded every year in the UK? Will the Minister support the charity’s proposed national cord blood bank to ensure that units donated altruistically by mothers are used to drive forward medical research rather than be discarded, thereby totally wasting this valuable resource?

I had a meeting with representatives of the Anthony Nolan Trust recently and I should say to the hon. Lady that the NHS has access through the international bone marrow registry and others to about 10 million samples, and that 72 per cent. of the matches in cord blood in the UK are provided internationally. There are two separate issues here: the first is treatment now and the second is research. The Anthony Nolan Trust is looking particularly into the issue of treatment now. The NHS cord blood bank is currently undertaking a review, which will report to me later this year about how to ensure a greater percentage of matches. We have already put in extra money, particularly for collection in respect of black, minority and ethnic communities. Over and above that, the Anthony Nolan Trust is looking into the development of its services, and I have said that it is crucial that developments at both the NHS blood bank and the Anthony Nolan Trust take place in partnership to ensure that we maximise the benefits for UK patients. That is what we intend to do.

Cardio-vascular Incidents

9. When he was informed of reported increases in the occurrence of cardio-vascular incidents linked to Vioxx (rofecoxib). (211298)

The cardio-vascular safety of Vioxx was intensively monitored and investigated by the Medicines and Healthcare products Regulatory Agency with regular, independent advice from the Committee on Safety of Medicines. That happened since a possible increased cardio-vascular risk was noted in the VIGOR study in 2000, shortly after Vioxx was marketed. The first definitive evidence of increased cardio-vascular risk arose in a long-term placebo-controlled clinical trial, the APPROVe study, in September 2004, at which time the manufacturer withdrew Vioxx from the market.

May I remind the Minister that many hundreds of NHS patients, such as my constituent, Mr. Lowe, who were prescribed Vioxx have subsequently suffered serious side-effects—in Mr. Lowe’s case, a heart attack? What steps will the Minister take to get the manufacturer of Vioxx—Merck Ltd. from the United States—to face up to its liabilities to patients here in the UK in the way that it has been forced to do in the United States of America?

The hon. Gentleman raises an important point. A number of patients within the NHS feel that their lives have been adversely affected very seriously as a consequence of taking the drug. He is right to say that compensation is being paid by the manufacturer in the United States of America. We need to look at the pressure we can apply to that manufacturer in terms of its responsibilities to people in the United Kingdom who have been affected.

May I reinforce the intense sense of anger and injustice felt by the victims of Vioxx in the UK, many of whom attended a lobby of Parliament today? They are in exactly the same position as people in the United States who have benefited from a $4.8 billion settlement. Does the Minister agree that it is an outrage that this drug company is discriminating against UK victims? Will he join me in calling on it to rethink its position and meet an all-party delegation of MPs to see what further pressure, as he says, should be put on the company?

Again, I agree with the hon. Gentleman. I think that I can commit to two things. First, of course I will meet an all-party group of MPs to focus on this particular issue and consider what we might do. Secondly, I will certainly be making sure that the Department contacts the manufacturer to ensure that it fulfils its responsibilities to people who have been affected in the UK in the same way as it is now compensating people in the United States.

Topical Questions

The responsibilities of my Department embrace the whole range of NHS social care, mental health and public health service delivery, all of which are of equal importance.

My supplementary question is on mental health advocacy. What measures is my right hon. Friend putting in place to ensure that there will be adequate resources in April 2009 when measures in the Mental Health Act 2007 on independent advocacy are implemented? How will he ensure that non-statutory services will be safeguarded and improved?

Negotiations on the comprehensive spending review included the introduction of those services in April 2009. The funding is already available for that. Non-statutory funding—assistance of the voluntary sector and so on—is crucial to the success of this project. I give my hon. Friend the assurances that I believe she is seeking.

On the subject of dentistry, in February 2008, the Secretary of State said:

“Access to NHS dentistry is getting better all the time.”—[Official Report, 5 February 2008; Vol. 471, c. 772.]

I do not think my constituents, constituents around the country or dentists are quite certain what figures the Secretary of State was referring to. Recent figures since his contribution in 2008 show that nearly 1 million British members of the public no longer have access to NHS dentistry. Will he now retract his comments and scrap this ludicrous contract?

No, I will not.

“It’s getting better all the time”,

to quote a line from a track on “Sgt. Pepper”. It is getting better in dentistry because the original contract, which the hon. Gentleman seems to want us to reintroduce, was wrong in every respect.

But we are being asked to withdraw the current contract. It replaced the contract that encouraged drill and fill. It meant that when dentists left the local vicinity, the money went with them. Of course, there was a period when dentists did not sign up to the new contract. Gradually, they are coming back and gradually we are getting to a situation in which dentistry is provided not just on the basis of drill and fill, but on a preventive basis, with a much simpler structure and much better access. The money that we are putting into dentistry this year, next year and the year after has gone up, and primary care trusts are commissioning more dental practices as a result.

T4. As my right hon. Friend will know, back in 1997, the construction industry was on the point of collapse. I am proud of the health service’s commitments to new hospitals and clinics, which have revitalised the industry, but I want to ensure that its significant investment leads to training opportunities for young people as part of their apprenticeship programmes. What is my right hon. Friend doing to ensure that those public sector funds are spent on delivering better skills and better-qualified young people? (211318)

My hon. Friend has been a champion of apprenticeships. I think she will accept that what the Department is doing is exemplary in Whitehall terms. Indeed, I hope she will accept that we are “Top of the Pops” in terms of the number of apprentices we are recruiting.

As for what we are doing in the country more generally, my right hon. Friend the Secretary of State for Innovation, Universities and Skills is running an integrated project to establish how we can use the huge public sector investments that we are making in, for instance, hospital-building programmes to ensure that apprenticeships are provided in the construction industry, and also in education, so that we do not waste the valuable opportunity provided by our capital investment to increase the number of apprentices again. It needs to be raised to the level suggested in the Leitch review by 2015.

T3. Would the Minister of State like to have another go at answering my earlier question about HIV/AIDS? Given the increasing number of cases of HIV/AIDS and, indeed, TB in this country, many of them brought in by people from sub-Saharan Africa, will she tell us whether she believes that selective pre-screening of those people before they enter the United Kingdom, not while they are here, is a good idea for Britain? (211317)

I believe that I have already answered the question, but I will answer it again. No, the Government do not consider pre-screening to be necessary. Our policy is to encourage the highest-risk groups to come forward voluntarily for screening. The group that the hon. Gentleman has identified is not the highest-risk group, but it is one of the groups that we are addressing.

T5. The report “Aiming high for disabled children: better support for families” led to additional resources. Can my hon. Friend the Under-Secretary of State assure me that they are being used to enable the services identified in the report to benefit disabled children and their families, and for no other purpose? (211319)

I pay tribute to my right hon. Friend for the work that he did in the House in championing the needs of disabled children and their families, as a result of which we are investing an unprecedented amount to support those families—and so we should.

The money from the Department for Children, Schools and Families is ring-fenced, and amounts to £370 million over three years. In the autumn of this year, the Department of Health will announce the overall sum that we will invest in child health over the next three years. It will include a specific figure to be put into primary care trust baselines to increase support for children with special needs and provide short breaks and support for children with palliative care needs. It is crucial, in all parts of the United Kingdom, for us to prioritise the needs of disabled children and their families, and to ensure that the money allocated for the purpose is spent on improving their quality of life.

Although the number of people admitted to hospital suffering from under-nutrition has increased by 85 per cent. since 1997, I understand that the Minister is scrapping the Nutrition Action Plan Delivery Board that he established last year. What reassurance can he give us that he takes malnutrition in the elderly seriously?

As I have only just established the board, I am hardly likely to be scrapping it. The hon. Lady’s information is completely untrue.

The nutrition action plan is overseen by the director general of Age Concern. It has independence, and is being overseen by someone who has passionately championed the importance of nutrition, particularly in relation to older people. What we have said, as the hon. Lady knows full well, is that the board will do its work for 12 months and then we will review where it goes from there. There has been absolutely no suggestion that we intend to scrap it.

T9. A constituent of mine with cystitis has received treatment for acute episodes at the nurse-led walk-in centre in Milton Keynes, but she has been unable to get an appointment with her GP in order to be referred to a consultant because she is a shift worker and because of the booking system at the surgery. Will the Minister point out to the British Medical Association and the Opposition that this is exactly the sort of problem that could be addressed by the new seven-day surgery proposed by the PCT in Milton Keynes? (211323)

T6. If GP-led health centres are in the interests of patients, does not the Secretary of State believe that primary care trusts will procure them anyway? Why is he running the show like a command economy and requiring 121 PCTs outside London to procure them? (211320)

Because, No. 1, we believe that we ought to enhance capacity in primary care; No. 2, we do not believe that PCTs should be paying for extra facilities from money we have already allocated—we will provide that from the centre; No. 3, we think patients such as the constituent of my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) should be able to access a GP surgery from 8 am to 8 pm, seven days a week, 365 days a year; and, No. 4, we believe that people who cannot get to their GP because, for example, they work in the centre of town or in another town should be able to access primary care. For all those reasons, it is extraordinary that Opposition Members, including the Parliamentary Private Secretary to the Leader of the Opposition, oppose this extra investment in primary care. They will live to rue the day.

T7. I met Dr. Goel at his Carshalton fields surgery a couple of weeks ago and he presented me with a petition with 570 signatures from patients who are very worried about the future of their local family GP practice. Can the Secretary of State confirm that that practice will not be forced to merge with a polytechnic—or a polyclinic, rather—at some point in the future? (211321)

It certainly will not be forced to merge with a polytechnic; I can give the hon. Gentleman that assurance very firmly. Our proposals are for additional GP-led health centres. The name should give the Opposition a bit of a clue as to who will lead these health centres. They will be GP-led, and there is no intention whatever of removing existing services.

Does my hon. Friend have a view on the Council for Healthcare Regulatory Excellence report on the Nursing and Midwifery Council?

We welcome the report and accept its recommendations. It makes some very serious criticisms of the functioning and leadership of the NMC, saying it has failed to carry out its statutory duties to the standard the public have the right to expect and it has lost the confidence of its stakeholders. It is our view and that of the CHRE, the trade unions and other stakeholders that it would be in the best interests of the NMC and the individuals involved if all three senior figures stepped down from their current positions. We welcome the leadership shown by the president and chief executive today in indicating their intentions to resign.

T8. I am sure that the Secretary of State will agree that many of our hospital accident and emergency departments are full of people whose ailments would be better treated elsewhere. On the basis that all of us are in favour of preventive health measures, will the Secretary of State discuss with the Secretary of State for Children, Schools and Families the possibility of introducing first-aid training as part of the school curriculum, in accordance with my excellent ten-minute Bill? (211322)

I will have another look at the hon. Gentleman’s excellent ten-minute Bill, and will doubtless talk about it in the many meetings I have with the Secretary of State for Children, Schools and Families. The hon. Gentleman makes an important point, and one of the fundamental reasons why the NHS in London is proposing polyclinics in London is the number of people clogging up accident and emergency departments who should really be in primary care.

T10. Is the Secretary of State aware that some hospitals have banned people from bringing in flowers for patients on health and safety grounds, and what guidance, if any, does he have for these hospitals? (211324)

I have a full briefing with me that relates to every issue under the sun, but not this one. I do not think that it is a matter for me; I think it is for the local trusts, and I would be very surprised if they took that decision on any grounds other than patient safety. I believe that health care-acquired infections may well be the reason these flowers have been banned, but I will find out, perhaps, and write to the hon. Gentleman.

Does the Secretary of State share my concern that 1 million people appear to have been treated under NHS dentistry since the new contract came in, and that there also appear to be perverse incentives within the contract so that dentists are encouraged by the financial set-up not to treat those with the greatest oral health need? Could we not have a perverse outcome whereby those with least in our society will be able to tell their social class by the state of their teeth—and under a Labour Government?

The hon. Gentleman was probably mistaken in saying that he thinks that there are 1 million more dentist appointments now, because he probably meant the reverse—I do not accept what he says either way. I believe that this is a big issue in relation to heath inequalities, which is why I announced to Parliament our intention to introduce fluoride in more areas. That is the single biggest contribution that we can make to tackling health inequalities. On the dental health of young children in this country, our 12-year-olds have the healthiest teeth in the whole of Europe. That is a great tribute to the dental profession, and I would think that it is not detrimental to the amount of investment that this Government are putting into dental care.

I welcome the fact that the Government are finally talking about reform of our system of care for the elderly. Given the urgency of the crisis—Help the Aged describes our system as being in crisis, Age Concern calls it a disgrace and the Local Government Association yesterday said that it is coming apart at the seams—will the reform, and the legislation to enable it, be brought before the House before the next general election?

May I say to my good friend that as well as the long-term review, we have, from April, been introducing a transformation programme in every local authority area, supported by £500 million of reform money over three years? We will soon be publishing the first ever national dementia strategy and end-of-life strategy; we have announced the extension of our “Dignity in Care” campaign; the Secretary of State has announced a new package of preventive health measures specifically to support older people; we are extending the Human Rights Act 1998 to publicly funded residents of private care homes; and we have announced a new 10-year strategy to support carers. I am not sure that the hon. Gentleman’s party has anything else to offer on this issue.

Points of Order

In response to my question, the Minister of State, my right hon. Friend the Member for Bristol, South (Dawn Primarolo), said that she would arrange for a paper to be placed in the House of Commons Library. I checked, and it has not been placed there. I wonder whether it could be placed there today, because it contains important information that answers questions in which hon. Members would be interested.

Reference has just been made to the report on the Nursing and Midwifery Council that was published yesterday, which highlighted the fact that that body was not fit for purpose and had a bullying culture. That vindicated claims made by many on both sides of this House and, in particular, by my constituent, Moi Ali, who is the whistleblower in this matter. She is a black lady who has a claim for racism against the NMC. She has used the internal systems and approached people, including her MP, externally to raise the matter. Because of Buggin’s turn, she is the vice-president at the moment and, sadly, she is being pressured to resign from her job. I wonder whether, through your good offices, Mr. Speaker, the Minister with responsibility could come to the House to make a statement on that report?

Local Authorities (Social Equality Audits)

I beg to move,

That leave be given to bring in a Bill to require local authorities to collate and publish specified social, economic and other data on an annual basis; and for connected purposes.

The debate about social inequality is beset by stereotypes and simplification. Sometimes stereotypes give us an indication of the truth, but they frequently conceal more than they reveal. So, we hear a lot about the north-south divide, and unemployment and incapacity benefit figures are frequently portrayed exclusively in terms of decayed former industrial communities in the north or in the Welsh valleys. Sometimes Tower Hamlets is contrasted with the Royal Borough of Kensington and Chelsea in what is frequently described as a tale of two cities, revealing the stark divide in average incomes, house prices and life expectancy.

Such attention is broadly welcome because it highlights the continuing extent—and in some ways the worsening or intensification—of the toxin of inequality. It is even more corrosive than poverty, in its own insidious way, as has been so well documented by academics such as Richard Wilkinson. Inequality damages health, undermines community cohesion and is now understood to be more closely correlated with crime than poverty itself.

Inequality is poorly understood. Last year’s report for the Joseph Rowntree Foundation confirmed that people’s knowledge about inequality is limited, and attitudes are complex, ambiguous and apparently contradictory. In turn, policy makers know little about how the perceptions people have are formed, or changed. We could simply choose to ignore the ramifications of inequality, precisely because public attitudes are complex and contradictory. But by doing so, we would be turning our backs on a very real problem. Over the past 20 years a consistently large majority of people have considered the gap between rich and poor to be too large, and only a small minority of people feel that the Government are doing too much to address the problem.

My Bill is intended to make a small contribution to increasing awareness and understanding of social inequality. I seek broadly to mirror the important work done by primary care trusts in their annual public health reports, which have come into their own in recent years as an essential source of data about health inequalities. By requiring all local authorities to produce an annual audit, based on a core basket of indicators, I would hope to achieve three things. First, I would like to get beyond stereotypes, whether of the north-south divide kind, or the Tower Hamlets versus Kensington and Chelsea variety. The reality is far more complex than such stereotypes would have us believe and generalisations limit understanding, not deepen it.

Secondly, I hope that the process of producing and publishing annual audits would generate interest and debate among local policy makers, the media and others, precisely because the information would be local. Of course, there are no guarantees that such interest would sharpen the focus on deprivation and inequality, but it would certainly offer communities a set of tools to hold policy makers to account. That is certainly the experience of PCTs and public health reports in recent years.

Thirdly, requiring a core set of indicators that apply to all authorities would enable more specific comparisons between small areas across the country. It would also promote a wider and more interesting debate nationally about the causes of inequality and social deprivation.

I confess to a personal stake in this issue. The local councils that make up my constituency—Westminster and Kensington and Chelsea—consistently come near to the top of national league tables for wealth and income. The prosperity of Knightsbridge, Belgravia and Chelsea, where some councillors think that international bankers constitute a “hard to reach group”, masks the fact that, as recent reports have confirmed, the Mozart estate in Queen’s Park in my constituency is the most deprived neighbourhood in the whole country, and Westbourne ward has the country’s highest proportion of children in workless households. But I—and my colleagues in other areas with generally affluent average figures—struggle to get the implications of that understood locally and nationally, and families and pensioners living in poor neighbourhoods in such areas lose out in consequence.

Local authority social equality audits would be based on existing sources of data. I am not seeking to saddle councils with major new duties in collecting and analysing information, but to bring the vast array of data already buried in the vaults—locally and nationally—blinking into the light.

What would be included? Obviously, I would want short profiles of all neighbourhoods, which currently stay anonymously labelled as “super output areas” buried in the Office for National Statistics. Which are the most prosperous areas and which the poorest? We already have information on employment levels, and the number of children in workless households—that is, families surviving on less than £10 per day for fuel, food, clothing and treats. I would want to include data that exist but are unpublished, collected in school information profiles. League tables offer us information on key stage results and useful, though poorly understood, contextualised added value, but they should be complemented by the information that we hold on all schools about free school meal entitlements and other proxies for deprivation.

Harsh words about school performance miss the target when the breathtaking variations we see in school intake receive so little attention. It would also be useful to include information on benefits and services delivered by local authorities, including housing benefit and take-up of child care and out-of-school services. That would enable more informed discussions about local welfare-to-work policies, the impact of local authority charging policies and so on.

Audits would not be exclusively about ward or neighbourhood data, either, but would include local authority rankings on key deprivation indicators and proxies for deprivation, such as substandard housing, overcrowding and homelessness. Of course, as has proved to be the case with PCT public health reports, it would be good to see themes emerge and to see priorities set from year to year between different communities that reflect local circumstances so that audits become dynamic tools, complementing and informing local area agreements and council decision-making processes.

Information does not by itself make wrongs right. Information can be powerful and can do harm if abused or used partially or selectively, yet the alternative is far worse. We should no more be ignorant about poverty and inequality than we should be about climate change or any of the other great issues of our time. By offering local communities, policy makers and the media clearly presented and comparative data, we might not get all of the right answers but we might at least ensure that people are asking the right questions.

Question put and agreed to.

Bill ordered to be brought in by Ms Karen Buck, Mr. Iain Duncan Smith, Mr. David Blunkett, Mr. Frank Field, Simon Hughes, Fiona Mactaggart, Mr. Gary Streeter, Martin Salter, Mr. Terry Rooney, Clive Efford, Lyn Brown and John Battle.

Local Authorities (Social Equality Audits)

Ms Karen Buck accordingly presented a Bill to require local authorities to collate and publish specified social, economic and other data on an annual basis; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Friday 17 October, and to be printed [Bill 122].

Opposition Day

[14th Allotted Day]


I beg to move,

That this House opposes the Government’s plans to impose a polyclinic, or GP-led health centre, in every primary care trust; regrets that this could result in the closure of up to 1,700 GP surgeries; is concerned that the imposition of polyclinics against the will of patients and GPs could be detrimental to standards of care, particularly for the elderly and vulnerable, by breaking the vital GP/patient link; further regrets that these plans are being imposed without consultation; is alarmed at the prospective loss of patient access to local GP services at a time when care closer to home should be strengthened; believes that the Government’s plans would jeopardise the independence and commissioning capability of general practice in the future; supports the strengthening of access to diagnostic and therapeutic services without undermining the structure of GP services; and calls on the Government to reconsider its plans for polyclinics.

Last Thursday, the local medical committees, which are the statutory bodies required to represent GPs across the country, met in conference and passed a vote of no confidence in the Secretary of State and the policies of the Labour Government. On the same day, the British Medical Association delivered to Downing street a petition against the Government’s polyclinic proposals consisting of 1.2 million signatures. Patients care about the future of their local surgeries and about their GP services. They and GPs are concerned that the Government’s top-down, one-size-fits-all imposition of polyclinics in London and in each primary care trust across the country will reduce access to their GP services and undermine the GP-patient relationship, which is at the heart of the successful delivery of health care.

Today’s motion is very simple. It urges the Government to think again. If the Government had offered additional funding to support the creation of extra GP practices in under-doctored areas, we would have supported them.

My local primary care trust has announced that we are to have an additional clinic, funded with additional money, in an area where some of the GP lists are full, which is an area of deprivation. The clinic will be open from 8 am to 8 pm and will provide drop-in services not only for the local community but for the whole area. Is the hon. Gentleman saying that he would deny the people of Crosby that clinic?

No. The right hon. Gentleman should remember that back in January 2006, the Government promised to provide additional general practitioner services in under-doctored areas such as his. The fact that they are doing that two and a half years on should not be a cause for congratulation; it should be a cause for regret that it has taken so long. My point is simple—

No, I will answer the right hon. Gentleman’s first question before I come on to the next one. The point is that we need additional GP services in under-doctored areas, and the decision on where and how those services are structured must be the product of local consultation and agreement, based on local needs and circumstances. For some time—for two and a half years—the Government have been saying that they will provide additional GP services in under-doctored areas, and we are not disputing the need to do so.

The hon. Gentleman mentioned petitions; I went to see my GP the other day, and the receptionist was giving out petition forms. Someone asked what the forms were for, and the receptionist said, “They’re going to close all the local surgeries down.” That is complete nonsense, and the hon. Gentleman knows it, so why does he go along with it?

It is the British Medical Association’s petition, not mine. The Secretary of State and the Minister of State, the hon. Member for Exeter (Mr. Bradshaw), are suggesting that 1.2 million people across the country are being conned by their GPs, but that is not true. The Minister of State pops up and says that the Department had one e-mail from someone saying that they did not really believe in the petition, so I have asked the Minister whether he will publish all the e-mails presented, and every representation made, to the Department of Health. The fact is that across the country doctors have been voicing their concerns that their practice will be undermined to their patients, and I will explain in my speech why those concerns are valid. Doctors have concerns about the impact that the imposition of a polyclinic will have on their practices.

I will come to the hon. Lady in a minute. The first point to make clear is that the Government could have gone ahead in a far simpler, better fashion. They could have offered primary care trusts extra funding to provide additional practices in under-doctored areas. They could have offered funding to each primary care trust across the country to enable them to provide access to diagnostics and additional therapies in each area, in places that would have made sense from the point of view of local GPs. Everywhere that I have been—that is quite a lot of places—GPs would very happily have got together and agreed where it would be appropriate for such diagnostics and therapies to be available.

Is not the point that over the past 10 years the Government have set up a system for commissioning, and are now going outside it, and that any PCT that declines to put a polyclinic somewhere in its area will get disciplined? Is that not shocking?

Yes, it is, and that is the way in which the Government now work. It is simple to say why GPs and patients across the country are angry: it is because, contrary to the Government’s rhetoric about local decision making, and contrary to the Minister’s rhetoric about all the proposals coming from primary care trusts, it is an imposed plan, generated inside the Department of Health and adopted by Ministers who should have known better.

To go back to the first intervention, the people of Crosby may be delighted that there is to be a polyclinic there, but the people of Bournemouth are concerned, and doctors are worried about the patient-doctor relationship being eroded as a result of polyclinics being created. Does my hon. Friend agree that it would have been better to have allowed Bournemouth and doctors an opportunity to have a say in the matter, and then to have determined whether a polyclinic was appropriate?

I absolutely agree with my hon. Friend, and he rightly reflects precisely the kind of points that are being made to all Members of the House. Labour Members may not admit it, but they know that GPs are telling them that they cannot see the rationale for many of the proposed imposed polyclinics across the country.

The Government were not content to bring forward proposals that would have made sense and could have been adapted and used locally. Gripped by a desire for the latest imported ideology of polyclinics, they first told London that there would have to be 150 polyclinics in the capital, and then told every primary care trust that they should have one each.

Of course, we need to strengthen primary care—no one disputes that—but Martin Roland, who is director of the National Primary Care Research and Development Centre in Manchester, said in the British Medical Journal in March:

“Increased patient choice requires more high-quality practices, not the small number of large practices that some polyclinic models suggest. We know that patients in small practices rate their care more highly in terms of both access and continuity. Indeed, although small practices show more variation in quality, on average, they achieved slightly higher levels of clinical quality than larger practices in the quality and outcomes framework.”

I will give way to the hon. Member for Cleethorpes (Shona McIsaac), but perhaps the hon. Member for Regent’s Park and Kensington, North (Ms Buck) will explain later why smaller practices that get better outcomes on the quality and outcomes framework will be shut down in favour of larger practices.

I ask the hon. Gentleman to follow up what was said by my right hon. Friend the Member for Scunthorpe (Mr. Morley). I represent the rural part of north Lincolnshire. We will get a new clinic in north Lincolnshire, but the PCT has told us that that is a local decision to meet local need, and not one rural GP practice will close as a result of these plans. So why is the hon. Gentleman and his hon. Friends scaremongering to the extent that my residents think that their practices will close?

That is quite interesting, but the hon. Lady needs to look at the material published by the North East Lincolnshire PCT to accompany its memorandum of information, which sets out 34 practices that will be in the proximity of the new polyclinic in Grimsby, with all the implications that might flow from that. That is what we have seen across the country. We are not scaremongering; people are looking at the material published by PCTs across the country. The Secretary of State for Health peddles the same line as the hon. Lady in saying that no GP practice will be affected and closed, but his own PCT in Hull says that the process will be used as a lever for the reconfiguration of GP services and that, at the end of the day, there will be fewer GP sites.

The hon. Gentleman has twice mentioned my constituency. What Hull is doing of its own volition is going out to consultation at the moment, and the proposal is additional to the proposals for the new centres that will come to under-doctored areas and additional to the GP-led health centre that we are putting into Hull. It is consulting on three additional health centres to deal with three problems: first, a preponderance of single-handed GPs; secondly, facilities and services that do not even meet the Disability Discrimination Act 2005; and thirdly, the fact that it has no women doctors whatsoever. So the PCT has gone out to consult the people of Hull, quite separately from what we are doing nationally, to seek to address those problems, and so it should.

The Secretary of State is getting desperate. I have here the presentation document from Hull PCT. If it devised the proposal, why does the powerpoint presentation say, “Darzi GP-led health centre”? It does not say that it is something that the PCT thought up. The proposal’s criteria are exactly those that the Department of Health have specified. The document’s conclusion says:

“The number of GP sites will reduce.”

[Interruption.] Labour Members should listen. If the Secretary of State is saying that Hull PCT will provide three additional GP health centres, how come the impact will be that the number of GP surgeries will reduce? We know exactly what that means.

Is not the central point that we are very happy to see polyclinics if they are additional and wanted by the local community? The element of compulsion is quite wrong, and Labour Members have got a real shock coming to them when they discover that, in their areas, GPs will dislike it but be dragooned and that they will lose their current practices.

I agree, and my right hon. Friend has a reasonable complaint if the Government are providing additional money in his area only on the basis that it will be spent in a certain way. If I recall correctly, his PCT is the lowest funded per capita in the whole country. If anywhere in the country should be given the opportunity to spend the money as it sees fit, it is his constituency.

I assure my hon. Friend that certainly GPs in Chelmsford do not think that he is scaremongering in any way. Mid Essex PCT is being forced to have a polyclinic in Chelmsford and GPs in the area are extremely worried that it will have a serious and negative impact on their practices, because of the nature of the things being imposed on them.

I am grateful to my hon. Friend, who has gone to the heart of the issue. At the moment, the Government require PCTs to publish memorandums of information before in effect tendering for the new polyclinics. We have seen the tender documents from 58 PCTs, which identify 608 GP surgeries in proximity to proposed polyclinic locations. Because the Government have insisted that the new polyclinics should register patients, the local practices identified in those documents will see their patient lists undermined, some of them potentially fatally.

The Secretary of State has said that no GP surgery will be closed as a consequence of opening polyclinics, but how can that be true? The Government amendment does not refer to the polyclinics proposal for London, which we should address for a second. The Prime Minister got up at the Dispatch Box and said that there would be 150 polyclinics, that each polyclinic would have 25 GPs and that each polyclinic would serve 50,000 people. The consequence of that would be the closure of more than 70 per cent. of existing GP surgeries in London.

Documents from half the PCTs refer to 600 GP surgeries in proximity to potential polyclinics. If the polyclinics are not additional and the GPs in them are the same GPs who currently work in their own surgeries—or, for that matter, salaried doctors in PCTs—then a number of surgeries will have to close. That was the clear implication of the Government’s proposals for London. If that is not the case and the GPs are genuinely additional GPs in additional GP practices, where will the money come from? We have done that calculation, too. If the Secretary of State is to be believed and the provision is all additional, the cost of that number of GPs in that number of surgeries would be £1.6 billion a year. However, the Government have allocated £250 million over three years, so the situation simply does not add up. One of two things must be true. Either the GPs will be moved and the practices will be moved from their present locations into larger polyclinics, or additional services will be provided and additional costs will be incurred. The Government have not answered the question about which one of those two things it will be.

In my PCT, the thinking concerns creating a polyclinic based on a hospital. That would reduce inappropriate accident and emergency attendances by people who are not registered with doctors, which hammers the hon. Gentleman’s argument that there is a one-size-fits-all solution. Is it not true that in 1981 the Acheson report addressed the issue of single-handed practices, particularly in London, where single-handed practices were over-represented? For 16 years, Conservative Governments made progress—not enough in my view—on reducing single-handed practices. Although there is good practice in some single-handed practices, by and large the quality of care is not as good as that provided by other practices. Is the hon. Gentleman saying that his party stands four-square behind all single-handed practices, regardless of the quality of care?

Nobody could responsibly say that “regardless of the quality of care”. The hon. Lady has said that we have suggested that there is a central plan, but I did not make that suggestion. Ara Darzi produced “A Framework for Action” for London, which set out the specific design for a polyclinic—25 GPs, 50,000 people, £800,000 a year rent, a number of out-patient attendances, the employment of a consultant and the provision of a number of nurses. I did not make that up; the Prime Minister stood at the Dispatch Box and paraded the fact that there would be 150 polyclinics in London. It is absurd that the hon. Member for Regent’s Park and Kensington, North has challenged us on single-handed GPs when the evidence is clear that the best quality and outcomes framework results are achieved by practices with two or three GPs. [Interruption.] I know that they are not single-handed practices. Why do the Government propose to push GPs from across London into large polyclinics, when the evidence is clear that accessible local surgeries with two or three GPs achieve the best results?

My hon. Friend has said that the situation is absurd, but there is a further bizarre twist. Is he aware that the Darzi clinics will not be subject to monitoring by health overview and scrutiny committees? The Government are introducing a two-tier NHS: parts of the NHS are subject to scrutiny by health overview and scrutiny committees, whereas independent treatment centres and Darzi clinics will not be subject to scrutiny and monitoring by health overview and scrutiny committees, which seems fundamentally wrong.

I agree with my hon. Friend. Pulse recently looked at the proposals in PCTs, and only a tiny proportion of those that it looked at had been subject to even a semblance of a public consultation. The reason is precisely the same as the reason that my hon. Friend gave: the Government are determined that the proposal should not be subject to scrutiny. Why? Because it will not stand up to that scrutiny, it is not locally determined, it does not arise out of the needs and circumstances of the area and, on the quality of care that will be provided, it is not even evidence-based.

If the aim of the proposal is to force the closure of single-handed practices, why are the Government going to parachute a polyclinic into the middle of Scarborough, where we have a number of good group practices, but not into rural areas, where we have some very good single-handed practices? It does not even follow the logic of the hon. Member for Regent's Park and Kensington, North (Ms Buck).

The Secretary of State says that my hon. Friend can work it out. The reason may be that the chairman of the BMA council is a GP in Scarborough, but there we go. We will see whether the Government’s conspiracy extends even to that. What my hon. Friend says is absolutely true. I have been to rural areas and talked to the head of the local medical committee in north Yorkshire, and it is completely absurd that a town such as Scarborough, which has many health needs but is not under-doctored in terms of GPs, should have money spent on it in that way. Throughout north Yorkshire, it is perfectly clear that access to diagnostics and therapies is required in a range of market towns and centres, not in one centre at the furthest extremities of the area. That is absurd. As it happens, north Yorkshire is technically among the most-doctored areas in the country.

May I thank my hon. Friend for supporting my right hon. Friend the Member for East Yorkshire (Mr. Knight) in his campaign to defend health services in Bridlington, and share with my hon. Friend the concern of people along the east Yorkshire coast about polyclinics being imposed on the area? Bridlington, while its hospital services are being devastated, is having a polyclinic imposed and being told that it represents an improvement in its health care.

It is risible. My hon. Friend will know that from his experience, as will my right hon. Friend the Member for East Yorkshire (Mr. Knight), who represents Bridlington. We visited Bridlington and District hospital together, and it is outrageous that the Government appear set on downgrading its services and then, in pursuit of a “care closer to home” philosophy, on undertaking re-provision on the same site—dressing it up as a polyclinic. We live in bizarre times.

No, I shall not give way.

The hon. Member for Regent's Park and Kensington, North was quite right to talk about London earlier, but it is important to understand that, far beyond that, there are considerable implications in rural areas. My hon. Friend the Member for Scarborough and Whitby (Mr. Goodwill), and my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) in the East Riding, made it clear that there are rural areas where spending such money, so that a polyclinic is established in a place that is already well doctored, is not only wasteful of resources and prejudicial to the GP practices in the area, but, if it threatens other surgeries, could have serious implications for access.

We have done the calculation on access to GP surgeries, and NHS London made a calculation in its consultation document. It says that it has done high-level modelling, meaning that people in London will be on average only 1.5 miles away from their GP surgery. That is quite interesting, because NHS London did not go on to say that, currently, people in London are on average just half a mile away from their GP surgery. So when the Secretary of State says that he is perfectly willing to campaign on the issue, perhaps he would like to tell all the people of London that the distance to their GP surgery will triple. It is quite clear: we have done the calculation and NHS London said that the distance would be 1.5 miles. [Interruption.] It is quite clear. It is a good one. Don’t you worry, it is. [Interruption.] Actually, Ministers should know that the distance will triple in Hull and in Exeter.

In places such as North Cornwall, the distance to a GP would more than triple, rising to more than 9 miles on average. The Government are parading their belief that they can improve access to primary care, but nobody, anywhere in the country, will be able to believe the Government’s arguments if their access to a local surgery is so prejudiced. There is an enormous difference in London between going half a mile and going a mile and a half. Someone who is elderly, vulnerable, frail or a mother with children, without access to a car, becomes reliant on public transport. In rural areas, access to public transport over many of these distances is difficult to contemplate.

I agree with the hon. Gentleman in so far as the Government will end up with another independent treatment centre-type fiasco if they continue with the top-down restructuring of the type that he is criticising. He said earlier that these services should be largely designed by GPs. May I seek a reassurance that he is really trying to tell us that patients and local communities should have a big say in how primary care is designed—that it should not be designed by central Government and imposed on the local community or by those who are contracted to provide the service but designed by the local community itself?

I commend to the hon. Gentleman our document, “The patient will see you now, doctor”, published last September, which clearly set out how we would seek to empower patient choice and involvement, the effect of which would be increasingly to design primary care services around the needs of patients.

The Government and primary care trusts have gone ahead without the semblance of a public consultation. Where, in all this, is the evidence to justify the Government’s imposition of this plan? Since they published their proposals, the King’s Fund, which I am sure that Ministers will acknowledge is independent and respected, looked at the evidence for polyclinics under three criteria—quality, cost and access. On quality, it said:

“The co-location of multiple services presents opportunities for delivering more integrated care, particularly for people with chronic diseases. However, the evidence suggests that in practice these opportunities are often lost.”

On cost, it said:

“Expectations that community-based services will be less costly than hospital-based equivalents are frequently not met.”

On access, it said:

“If a substantial centralisation of primary care were pursued, the consequent reduction in access to these services would be a major sacrifice.”

Overall, it concluded:

“A major centralisation of primary care is unlikely to be beneficial for patients, particularly in rural areas.”

Perhaps the hon. Gentleman can explain how patients will benefit from this centralisation of services.

I think that the hon. Gentleman is concentrating too much on one particular type of polyclinic. There are many models. There is nothing to say that a polyclinic has to include every local GP. There is plenty of opportunity for hub and spoke models whereby the local GPs can remain and the polyclinic can provide central services such as X-ray, physiotherapy, consultant services and so on. There are also models where individual practices can co-locate into polyclinics and remain as individual practices. There are many examples around the country of that happening. The opportunity exists for primary care trusts to negotiate and discuss with local GPs and other providers how that type of model can benefit their area, thereby allowing patients to get the benefit of small practices and central services in one locality.

I have heard that before. The fact is that if there were going to be a hub and spoke model in London, why did the framework for action describe a polyclinic model of 25 GPs and 50,000 people? Why did the Prime Minister refer at the Dispatch Box to 150 polyclinics? Why are GPs in north London telling me that the primary care trust is saying that if they do not move into the polyclinic, their rent reimbursement will be stopped? A GP wrote to me and said that he knew what was about to happen to him because the primary care trust published a map of primary care services in his area and he was left off.

The official Opposition are coming rather late to this issue. People such as myself tabled early-day motion 1465, which flags up the more fundamental flaws with polyclinics outside London and the metropolitan areas. A fatal flaw of the Conservative motion is that it does not consider the potential of free market competition to inflict serious damage to patient access to general practice and public services. No wonder firms such as Serco, UnitedHealth and Virgin Healthcare are lining up outside the Department of Health just outside this place, licking their lips at the prospect of extracting vast sums from the NHS. Why is that not referred to in the Opposition motion? It deserves to fail because of that.

It is not there because when I have talked to, for example, GPs in Islington who were very unhappy about the way in which a tender was awarded to a commercial organisation, I found that they were willing to enter into competition as long as it was fair, and as long as it was based on a level playing field. I am not opposed to personal medical services or alternative, commercially run, providers of medical services practices, but I am opposed to the top-down system of imposing polyclinics, which is undermining the existing GP structure.

It is interesting that the Prime Minister, when challenged at his press conference last week, retorted that there would be thousands of additional GPs. I think that he said that there are already thousands of additional GPs—[Hon. Members: “There are.”] Of course there are more GPs since 1997, and so there should be. But in the last year for which figures are available, 2006-07, there were only six additional GPs in the whole country, so the Government are not in a position to make much progress on that issue. The predictions from the King’s Fund in its recent document show that we would be short of 2,000 full-time equivalent GPs by 2016. Where is the flow of additional GPs who are to fill the polyclinics?

If polyclinics take over existing GP services, local practices cannot be maintained. If primary care trusts provide the funding for polyclinics, they will, as a consequence, force the closure of many other local GP services because it is not possible to use the same money twice. The Secretary of State knows that, but he will not admit it. There is a long-term agenda in his Department to undermine the independent contractor status of most GPs and to compel them to become part of a PCT-controlled primary care structure. That is why a GP in London said the other day that the PCT was

“bending everyone’s arms very strongly. Life will be very difficult if we don’t go in.”

It is interesting to note that the Government’s amendment to the motion does not actually mention polyclinics. I suppose that the Secretary of State is going to pretend that they are health centres, not polyclinics. The Minister of State, the hon. Member for Exeter, is constantly saying that people get confused because those centres are health centres, not polyclinics. I received two answers from the Minister of State on this subject. On 15 May, he said:

“‘Health centre’ is a term used to describe a range of health services characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting.”—[Official Report, 15 May 2008; Vol. 475, c. 1666W.]

A month later, on 16 June, he said:

“‘Polyclinic’ is usually a term used to describe a range of possible health service models characterised by the co-location and integration of different services, including those traditionally provided in a hospital setting.”—[Official Report, 16 June 2008; Vol. 477, c. 767W.]

Those definitions are absolutely the same. As far as I am concerned, if it walks like a duck and quacks like a duck, it is a duck.

No, I shall finish now, if my hon. Friend will forgive me.

If the structure proposed forces local GP surgeries to close, forces GPs into becoming salaried employees of their primary care trusts instead of independent contractors and turns patients into through-puts rather than people, it is a polyclinic. We should follow the evidence, which says that smaller practices are often of higher quality. We know that they are more accessible. We know that patient choice and preference show that they value continuity of care even more highly than rapid access to care. We know that integrated care is about a lot more than putting all the services in one large building. How can access and care closer to home be improved if hospital services are closed down while polyclinics are built on the same site? Why are the Government so obsessed with the ideology that they have brought in, when they should understand that primary care in Britain is one of our comparative strengths? We should develop and strengthen our structure of primary care, not replace it with a German or a US-style polyclinic system.

All hon. Members should be aware of the concern raised throughout the country because of the Government’s top-down imposition of polyclinics. There is a better way. We can strengthen access to community services and strengthen the existing GP structures. We can extend GPs’ commissioning and their responsibility for providing integrated care for their patients. We can use those additional resources to improve access to community services while maintaining access to GPs locally. We can empower patients to choose their general practice and to drive up quality and access improvements through their choices. That would be a better way. The Government should reconsider their polyclinic plans. The motion would require them to do so, and I commend it to the House.

I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:

“welcomes the Government’s support for primary care and proposals to invest £250 million in 113 new GP practices in the most deprived communities and 152 new state-of-the-art GP-led health centres open from 8 a.m. to 8 p.m., seven days a week, in every part of the country; notes that these centres will offer a wide range of health services including pre-bookable GP appointments and walk-in services for registered and non-registered patients; recognises that the exact format and location of each GP-led centre will be decided locally in consultation with patients; notes that GPs will not be forced to work in the new GP-led centres and where that is the case patients will still be able to remain registered with their GPs at their existing location and premises; acknowledges that the expansion of primary care is essential if the overall health of the population is to improve, and inequalities in health are to be addressed; and welcomes plans to ensure enhanced primary care services are capable of meeting the new challenges facing the NHS including tackling lifestyle diseases such as obesity and through more effective screening programmes for the general population.”

We are delighted that the hon. Member for South Cambridgeshire (Mr. Lansley) has used up another of his party’s Opposition day debates to allow us to reiterate our commitment to primary care, set out our record of investment and reform, and explain in detail our exciting plans to expand capacity in primary care.

No previous Government have more clearly demonstrated their commitment to primary care and those who work in it. Let us examine the record since 1997: investment in primary care has more than doubled; there are more than 5,000 more GPs and more than 4,400 more practice nurses; GP pay has increased by around 55 per cent. in real terms; GP hours have reduced by 17 per cent., and the time spent on each patient is up by 50 per cent. That is hardly the record of a Government who are hostile to the role of primary care in the NHS.

I want to set out as clearly as possible exactly what the Government propose throughout the country, what the NHS is seeking to do in London, and to mention briefly other separate developments that clinicians, patients and managers in local PCT areas, including—I am pleased to say—Hull, are leading.

Let me begin by stating firmly what we do not propose. According to the BMA and its political wing opposite, the Government have not one but three evil ulterior motives: to privatise primary care by allowing companies such as Boots to run GP services; to nationalise primary care by making GPs state employees; and to destroy family practices by breaking the GP-patient link.

Conservative Members claim that the accusation of privatisation comes from behind me, but it appears in every BMA leaflet that I have read, at the same time as that of trying to make GPs do what Bevan could never make them do—become state employees. So we are trying to privatise and nationalise simultaneously.

The GPs of Hastings and Rye are not persuaded that the BMA has got it right. Not one has complained. They are delighted with the £15 million that my right hon. Friend has made available for a new health centre in the town centre. Patients are not compiling petitions, either.

My hon. Friend’s experience is replicated throughout the country.

We are supposed to have three ulterior motives. All that is arrant nonsense. It is possibly the most ludicrous misrepresentation made in the House since the equally ludicrous attempts to distort the principles behind the establishment of the NHS 60 years ago, and it derives from exactly the same source.

The motion refers to a Government plan to “impose” “polyclinics.” Opposition Members deliberately use that term because of its impersonal and biomedical connotations. There is a perfectly valid argument for polyclinics. There is no argument for imposing them centrally on every locality as a replacement for GP practices—that is why we do not have such a plan. A polyclinic combines primary and secondary care. The only part of the country where a network of polyclinics is proposed is London, where a comprehensive review of health services took place last year, and the Government had no say in its outcome. It was a London consultation, which the NHS in London led.

The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned north London. In my constituency, the chairman of the local medical committee, who is a local GP, made it clear that premises are limiting the advantages that GPs can offer patients. A plan that provides GP centres is therefore important. It is likely to give us a GP centre in Enfield Lock and in Enfield town—exactly what Sir George Alberti, a leading clinician, said that we need. The people of Enfield, North will not be deprived of that huge investment by the Conservative party’s propaganda.

My right hon. Friend makes an important point about health services in London. We had no role in the outcome of that review; however, like the population of London, we support NHS London’s proposals. I want to take a minute to explain to the House why the proposals, which those on the Opposition Front Bench oppose, are right for London.

If the footfall of a centralised primary care centre is 50,000 people, that adds up to about 50 per cent. of all the GP practices in any one constituency. As a south-east London MP, I should be grateful if the Secretary of State said whether he is seriously proposing that 50 per cent. of our constituents go to one place for their primary care?

I am suggesting that the hon. Lady, like her colleagues on overview and scrutiny committees throughout London, participate in the London consultation, the outcome of which has shown wide support from both the public and politicians of all political persuasions for what is being proposed in London, and well it might.

We hear the trite comments from the Opposition Front Bench, but people in London do not have access to the quality of primary care that they deserve. There are particular problems with access in this city. An Ipsos MORI poll of Londoners revealed significantly lower satisfaction ratings than the national average, and that 54 per cent. of GP practices in London have only one or two GPs, compared with 40 per cent. elsewhere, that nearly 20 per cent. of GP practices in London are unable to offer an appointment 48 hours in advance, that demand for longer opening hours is even higher than in the rest of the country, that 50 per cent. of all patients who attend A and E departments in London can be better treated elsewhere, and that more people clog up A and E in London than in any other city.

One of the justifications for polyclinics is the extension of GP availability. Healthcare for London quotes the patient survey of 2007 as saying that the majority of patients are dissatisfied with their GP’s opening hours. However, the British Medical Association quotes the same survey as saying that 84 out of 100 people are satisfied with their GP opening hours, so is it not better to listen to individual patients and individual GPs? I have not had one GP or patient from my constituency contact me to say that they are in favour of polyclinics.

The hon. Lady is referring to the Healthcare Commission report, which was not a London-only survey and which showed a high level of satisfaction with GP opening hours. However, the 84 per cent. in favour left some 6 million people throughout the country who were dissatisfied. When one looked into the figures, one found that people from black and minority ethnic communities, such as the Bangladeshi community, those from poorer backgrounds and, in particular, those from London were much less satisfied than the rest of the country. According to a BMA survey, 60 per cent. of London GPs say that their facilities are unsuitable for current needs, 75 per cent. think that they cannot meet future needs and 36 per cent. doubt whether their facilities could be adapted to meet the access requirements of the Disability Discrimination Act 2005. Those are the problems in London, which London is seeking to resolve.

The Secretary of State is talking to a large extent about London. Can he tell my constituents why he wishes to impose a polyclinic on the East Riding of Yorkshire PCT, where I assure him there is very little appetite for one? This morning, a GP from Beverley told me:

“Polyclinics will lead to the end of personalised care which current patients enjoy.”

That GP, who is nearing the end of his career, also said—perhaps this will rock the Secretary of State most—that he has voted Labour all his life, but will not do so at the next election, because he has lost confidence in the Government on health.

Will the Secretary of State tell us what the total cost will be of this elaborate reorganisation?

The total cost is estimated at around £150 million, which will be money well spent and a crucial investment in improving the situation in London.

The term polyclinic has been used in London to describe a range of models that allow primary and some secondary care services, such as diagnostics, to be available in each local community, reducing travelling time and making services more convenient for patients. In some cases, that may involve bringing services together under one roof. In other cases, as my right hon. Friend the Member for Enfield, North (Joan Ryan) mentioned—this is a specific option that is part of the London proposals—it involves having a network of GP practices linked to a hub that provides more specialist services. Both of those are available in London.

Interestingly, in the one part of the country where polyclinics are being proposed, Conservative politicians support the proposals, as, indeed, do the public. Every local authority overview and scrutiny committee, including those that are Tory-led, backs the exciting plans to resolve NHS problems in the capital—problems that probably should have been dealt with 20 or 30 years ago.

I certainly welcome the additional investment in primary care, but whatever the problems in London, they are not the same in Birmingham. The report to the PCT on implementing the measures said that there was

“no clear geographical area which warranted investment in an additional three partner practice”

and no real pattern to highlight a need for the GP-led health centre to be located in one particular place. A place was chosen because accommodation was potentially available, even though there are low levels of under-doctoring there. I therefore ask my right hon. Friend please to give this money to the PCTs and to let them decide how to spend it in the interests of the people they serve.

I think that that is the Opposition’s policy—give the money to the BMA and it will decide how to spend it. It is also their policy for GPs to be allowed to set up where they want to, for GPs to be allowed to open when they want to and for GPs who work in disadvantaged areas to get more money. I do not agree with that policy. I believe that when we move on from London and talk about other parts of the country, including the west midlands, my hon. Friend will agree that our proposals are the most sensible way forward.

The Secretary of State accused a Member on his own side of the House of adopting the policy of the BMA, but the hon. Member for Birmingham, Selly Oak (Lynne Jones) actually said was that she wanted to give power to the local area so that decisions could be taken locally. Surely that is what should be done, as it is local people who know what the needs are in any particular area.

That is what we are doing—[Interruption.] I am talking about what is happening in London; I will come on to the rest of the country in a minute. London has had its own analysis of problems, which have been the subject of many reports over the last 20 years. Politicians refused to implement the proposals. We are implementing the proposals, with London’s support.

Is it not interesting to note that the BMA—when not campaigning and producing petitions—wrote a few weeks ago to all GPs and local medical committees describing the new proposals in what it called a “factual guide”? It talked about the key differences between the health centre proposals and the polyclinic proposals; and of the polyclinic proposals it said, “mostly in London”.

I have not seen that particular circular, but that is exactly what I am trying to explain. In London, there is a specific proposal about polyclinics. That is opposed by the Conservative party, despite the fact that the project has been worked up locally by people in London and has been the subject of full consultation with the public and GPs.

In my constituency, we are about to rebuild a new local hospital which will be a 24/7, GP-led urgent care centre with 40 respite beds and diagnostic services that are to be brought right into the heart of our community in Eltham. The hon. Member for South Cambridgeshire (Mr. Lansley) has proposed that any vested interests in the local health economy could scupper that in the face of widespread local support for the scheme. That is not bringing the service back to local people; it is taking it away from them and putting it in the hands of vested interests.

My hon. Friend makes a very powerful point. The Minister of State, my hon. Friend the Member for Exeter (Mr. Bradshaw), will be visiting the area next week.

Unlike the proposals for London, the 150 GP-led health centres that my Department has asked the NHS to develop across the country are not, and have never been, designed to alter the way in which existing GP services operate. The London proposals are so designed, for all the reasons that I have discussed. The proposals for the rest of the country are not seeking to change GP services at all. They are designed purely and simply to increase capacity. The average primary care trust has around 55 GP practices that will continue to provide services to their patients as they do today. In addition to those practices, each PCT will also now have a GP-led health centre, funded from ongoing additional investment, attached to which are only three conditions. No. 1 is that the centre should be in a central location; it should be accessible. No. 2 is that it should be open from 8 am to 8 pm, 365 days a year. The third is that any member of the public must be able to use the centre either to book a GP appointment or to turn up to see a GP or nurse without the need to be registered at the centre—in other words, people can continue to be registered with their local family doctor and benefit from the continuity of care that is provided.

The Secretary of State says that those are the only requirements, but surely it is a requirement that the Department has laid down that these centres—these clinics—should register patients. By extension, therefore, patients will no longer be registered with other GP surgeries.

I just mentioned that—[Interruption.] I did. I said that the third condition allows patients to be registered or to walk in and receive GP services because they are in a more convenient location. Let us consider the logical extension of the hon. Gentleman’s argument. Yes of course members of the public can decide to leave their existing surgery and register at this GP-led health centre. It is called patient choice. They are perfectly entitled to do that. What we expect is that this additional resource will be used to mix and match, as I mentioned. Most patients will want to stay with their existing GP because of the particular benefits that gives them, but they will also want to use the GP-led health service on Christmas day or on a Sunday afternoon knowing that they do not have to be registered there to use its services.

The Secretary of State is trying to share as much information with the House as possible. Is it not true that there are two other conditions? One is that no primary care trust can say, “No, we don’t want to do it.” The second is that there is a rule that no existing GP-led health centre—that is to say, a wide practice—can turn itself into one of these new GP-led health centres.

It is absolutely the case that we are saying that in the interests of greater capacity, greater patient choice and the public being able to access primary care, this is not a zero-sum game. There will be a greater need to access primary care in the future, particularly with the plans that we have for prevention being as important as diagnosis and cure, and there must be one of these centres in each location.

I have set out the three conditions. Beyond those, it is for local GPs and the PCT to discuss exactly how the service is provided.

I thank the Secretary of State for his courtesy in giving way again. I suspect that hon. Members on both sides of the House would agree that many patients are naturally very loyal to their general practitioner. That being the case, does the right hon. Gentleman accept that if there were to be any attempts by financial mechanisms or otherwise to compel general practitioners to move into polyclinics against their will, that would be resisted by the GPs, very likely by their patients, and not least by local Members of Parliament as well?

Further to the point raised by the hon. Member for Birmingham, Selly Oak (Lynne Jones), if the Secretary of State looks at areas such as Cornwall and the Isles of Scilly, he will see that there is a geographical problem. If he is simply imposing a top-down restructuring of the type that he is describing, a single polyclinic in just one area in a place the shape and size of Cornwall will clearly have a destabilising and destructive impact. Why does he not allow that local community to design services that best meet its needs, rather than imposing this top-down, centralised restructuring? Why will he not allow the local community to design its own services and achieve the aims that I think he desires?

We have specified three conditions. The centres must be centrally located, must be open from 8 am until 8 pm seven days a week, and must allow people to use their services on a drop-in basis as well as to be registered if they wish. The money that will be invested is additional money, provided not by the local primary care trust but from the centre, to improve access throughout the country. I think that that is the right thing for a Government to do.

Members of the BMA are not the only people to comment on the proposals. The Royal College of Midwives, of which I am an honorary vice-president, tells me that it is interested in the potential of polyclinics and larger health centres to provide better midwifery services—better antenatal and post-natal care. That means, however, that the centres should provide accommodation for midwifery. Will Ministers and local NHS chiefs encourage the decision makers to provide such accommodation?

My hon. Friend has reminded me why the proposals are so exciting for London. It will be possible to provide services such as diagnostics and maternity care, and to achieve a fundamental advance in primary care in the capital. My hon. Friend has also reminded me that we should listen to the views of Age Concern. The hon. Member for South Cambridgeshire said how dreadful the new arrangements would be for elderly people. This is what Age Concern said in a briefing for today’s debate:

“For many, especially carers and those with mobility issues, the super surgery or polyclinic could be preferable to what they currently have on offer. For those without transport, it can take a whole day to get to the doctor and back, via the pharmacy. If then, they are required to visit the hospital for blood tests, x-rays or anything else, that will take them another day. There is a tentatively enthusiastic welcome to a super surgery or polyclinic that will allow them to do all these things on one day, under one roof.”

When we talk to the public and to patients, they see the attraction. Obviously they listen to the horror stories that are being peddled, because they trust their local GPs, as well they should, but when what we are proposing is contrasted with what Her Majesty’s official Opposition are suggesting that we are proposing, it can be seen that what we are doing is improving primary care throughout the country.

What would my right hon. Friend say to the GPs from the local medical committee in Sunderland who came to see us last week? They welcome the extra investment, but believe that the money could be spent more efficiently if it were spent via existing doctors’ surgeries. When asked why, they say that some of the previous reforms, such as independent treatment centres, have proved quite wasteful.

I would tell those GPs that this is not the only investment being made in primary care. About £500 million is going into primary care this year from one source or another. In Sunderland, as well as in my city of Hull, GPs will have their own plans, but we will ensure that nowhere in the country is there a single patient who cannot gain access to primary care seven days a week, 365 days a year, between 8 am and 8 pm. God forbid that I should make the link between Newcastle and Sunderland, but people who work in Newcastle and live in Sunderland will now be able to go to a GP-led health centre in Newcastle. This is about patient convenience and patient choice.

May I play devil’s advocate, and suggest that my right hon. Friend is not going anywhere near far enough? While I support his plans for super-surgeries that will be open seven days a week—I think that that will really help patient care—my real desire is for them not just to provide GP care seven days a week but to provide visiting consultants, X-rays, physiotherapy and occupational therapy. I want patients to have access to a whole range of services that people in smaller towns and rural communities currently have to travel many miles to receive. I want the centres to provide those services so that patients will not have to travel 20, 30 or more miles to major centres to receive services that they could receive far more efficiently and cheaply in their local communities.

Order. Before the Secretary of State replies, may I just remark that the interventions have been getting steadily longer? I ask everyone to remember that the list of Members wishing to take part in the debate is quite long.

My hon. Friend the Member for Dartford (Dr. Stoate) is right. I am concentrating on primary care because of the attack that these proposals will somehow diminish primary care. Bevan, at this Dispatch Box in 1946 as the National Health Service Act was passing through the House, saw the integration of primary and acute care as one of the fundamental principles of the creation of health centres around the country, and we have an opportunity to revisit that.

We in Barnsley are looking forward to having a super-surgery—or polyclinic, or whatever it will be called. We have traditionally had too few GPs, to the point where one GP practice currently has a patient list of 8,000. Nobody can tell me that that is ideal. We are therefore quite looking forward to the extra capacity that will come with these super-surgeries.

My hon. Friend refers to Barnsley. There has been a ridiculous Conservative press release today claiming that 608 practices will close.

It is stated that the Tories claim that 608 practices may close in 58 PCTs. [Interruption.] Well, I apologise for initially saying “will” instead of “may”. Also, the procurement guidance that was “discovered” hidden away on our website was actually launched by Ministers in December at a public meeting.

Barnsley is cited as one of the Conservatives’ examples; it is said that, because there are all these GP surgeries around the area where the GP-led health centre will be placed, somehow they will all close. However, my hon. Friend the Member for Barnsley, Central (Mr. Illsley) is absolutely right. Barnsley has 49.3 GPs and 25.4 nurses per head of population and all the resultant health problems, while Cambridgeshire—the hon. Gentleman’s part of the world—has 74.6 GPs and twice as many nurses per 100,000 head of population. That is why, as another major part of this proposal, we are putting 130 new GP practices in under-doctored areas, which I presume the Conservative party also opposes. [Interruption.] Well, I am sorry, but it signed up to a petition saying that GPs should be allowed to set up where they want to set up, and if we want them to work in poorer areas, they should get more money. Not even the Brazilian Health Minister, who was talking to me the other week and who is introducing health centres in the favelas in Rio de Janeiro, was saying that the GPs who work there should get more money, but that is what the Conservatives are saying for towns such as Barnsley and Hull.

No, I want to make some progress. I will give way to the hon. Gentleman again later, if I get a chance.

I will certainly give way to the hon. Gentleman shortly.

Many PCTs are looking to provide other services in these health centres, such as diagnostics or pharmacy services. However, that is a matter to be decided locally in consultation with patients, GPs and the public. We have no plans, no intention, no desire, no aspiration and no ambition to force a specific model of primary care on GPs or patients. These new services are designed not to replace existing GP surgeries, but to provide additional access and extra choice for patients.

Nor is this an attempt to get rid of single-practice GPs, which will continue to be an essential part of primary care, particularly in rural areas. However, there has undoubtedly been a general trend in recent years for GPs to come together to work in larger teams so that they can provide a better range of care and more integrated services. There are now more than 500 practices with nine GPs or more. This has been led and encouraged not by Government, but by GPs themselves, who increasingly find that it is more practical to work together in larger, more suitable premises, providing a greater range of integrated services.

No, I will not give way for a while

Therefore, having invested heavily in primary care and increased the number of staff and improved their conditions, the Government now propose to expand primary care capacity, including in the 25 per cent. of PCTs with the poorest GP provision, thereby addressing a major cause of health inequalities.

What have Her Majesty’s official Opposition got to say? Last week, they claimed that there was a £1.6 billion black hole in our plans for GP-led health centres. I note that that ludicrous claim is missing from the catalogue of ludicrous claims masquerading as a motion for today’s debate. Yet again, they mistakenly assume that what has been proposed for London will be transposed to the rest of the country, and there will be 25 GPs in each of the new health centres—in actual fact, the expected number is five not 25.

I think the Secretary of State gave a rather one-sided view of the Age Concern briefing that he mentioned. Does he acknowledge that older people have real concerns about these plans, particularly because, as we know, they are most reliant on family doctor services? There are real concerns that the relationship will be lost. There are also concerns about access during the day; people hope that the extended hours will not mean fewer opportunities to see family doctors during the day, because they are the sort of times on which older people are particularly reliant.

The hon. Gentleman is right to say that the elderly, who use health services more and, as Age Concern points out in the briefing, use primary care services much more, would be worried by any indication that their GP services were to be diminished. As Age Concern points out, the advantage of the polyclinic and the health centre for elderly people is that even if they have to go a little further to get to the polyclinic, they do not have then to go somewhere else to go to the pharmacy, to go somewhere else to get diagnostics and to go to the hospital for other services. That is a very important point.

Incidentally, we have been absolutely stringent in saying that increased access, which the Minister of State, Department of Health, my hon. Friend the Member for Exeter (Mr. Bradshaw) has mentioned has now reached 21 per cent. across the country—that is an 11 per cent. rise since we introduced the policy—must not be at the expense of existing hours. The pay that goes to GPs is only for their giving additional hours; it is not for putting in a Saturday morning and taking away a Thursday afternoon. The hon. Member for Leeds, North-West (Greg Mulholland) is right to raise the point.