A&E Services
Philippa Whitford Excerpts(9 years, 7 months ago)
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Dr Philippa Whitford (Central Ayrshire) (SNP)
It is obviously a lively debate on both sides of the House. As someone who is not long from being on the front line, as a surgeon in the NHS, I find it a bit sad to listen to how angry this debate is. The four-hour target should be a tool and not an end in itself. It is used to take the temperature and to understand what is happening underneath. We would not shove a patient in a bath of ice water if they had a temperature; we would look for the infection, try to understand it and try to treat it. Unfortunately, the four-hour target has simply become a stick, and today that stick just seemed to be being thrown backwards and forwards.
People working in A&E face great difficulty, which is why we are not recruiting trainees to A&E and why we are losing senior doctors at an incredible rate from A&E. Instead of being one of the most rewarding places to work, people see it as the most miserable.
Dawn Butler
Although the target is used as a measure, or to take the temperature, does the hon. Lady not feel that the fact that it has gone up 401% since 2009-10 is something to be worried about?
Dawn Butler
The time that people have had to wait for four hours has gone up—
Madam Deputy Speaker (Natascha Engel)
Order. Interventions should be kept to a minimum. The hon. Member for Central Ayrshire (Dr Whitford) is not on a time limit, but please be aware that many Members are coming in to speak. Thank you.
Dr Whitford
Absolutely, we have seen the performance drop across the UK. The Minister quoted a report showing that England was performing better than Scotland. I would be interested in seeing that one—where it is comparing like for like with core A&E services—because those are not the figures I have seen. However, we all face the same challenge. We are dealing with older patients, who are more complex. The figures from Scotland last winter showed that we did not have a huge increase in numbers, but far more of those patients had to be admitted. Nothing else could be done, and we will face that situation more and more in future. The problem is that we are losing the staff to deal with that, and we are talking about A&E, but in the vast majority of cases, they key issue does not lie with A&E. There are two simple things: the number of patients coming in, which relates to out-of-hours GP access, and patients getting back out, which is described by the Royal College of Emergency Medicine as exit block.
It is important to remember that the four hours does not involve someone sitting on a chair, waiting for four hours. People are often given that impression—that they turn up in A&E and sit there, and no one will touch them for four hours. However, they will be triaged, see a clinician, have a history taken and have investigations. They may well get sewn up or be given something, and they will go home. Those patients are moving through. Our problem is the patients who have to come in, and it results in a whole cascade of issues, such as people stuck on trolleys getting the start of a bedsore, or families made miserable, or staff very depressed at trying to look after people in a corridor. It also results in people ending up boarded to any ward—any port in a storm—so that people are not in the correct ward and not getting the correct treatment from the correct team. We know that that, bizarrely, results in longer patient stays, which exacerbates the problem.
What we need to do—as we have done in Scotland, where we set up the unscheduled care action plan—is to work with all stakeholders. That involves looking at how patients flow through. It is not about people being obsessed with measuring the target and counting it, but about people opening the gates in front of the patient. The data on how long patients wait should be automatically available to staff from their system; it should not require an extra body to generate that data.
If we have the data weekly, which means we are getting them timeously, we can see one week from the other and ought to be able to see the patterns. The problem with monthly data for something that is identified as a currently acute issue is that, by the time they are collated, verified and out, staff may not remember quite what made that a bad week, whereas with weekly data, they can see whether they are getting a response to their actions.
I support keeping weekly measurements, but I do not support them being used as a tool—and certainly not for beating one another across the Benches here. I can tell hon. Members that staff in the NHS feel that they are beaten over the head with these targets, so it is not about having a target, but about how it is used. In the paper released by the Royal College of Emergency Medicine here yesterday, one of its myths was that the four-hour target is a distraction. It pointed out that it allowed a focus.
To try and tackle the problem in Scotland, we have ensured that the majority of our A&Es have a co-located out-of-hours service. I mentioned before that achieving 8 till 8 in every GP practice is so far in the future that it cannot be reckoned on as a solution to this problem. We are unable to fill the GP vacancies we have now. Telling them that they will be working from 8 till 8 on Saturday and Sunday is not overwhelmingly attractive.
The pilots that have been done have started to report in the last fortnight, and they have reported a very poor uptake. When people want to deal with an out-of-hours problem, they come to A&E. Rather than trying to change the whole population, we could have a system in which people are easily diverted once they get there: “If you have this, please step next door to our primary care service.” We need to look at those solutions, and some are working quite well.
The other issue is health and social care. To get patients out at the end of their journey, they need to be able to get into care. We need to remember that, although extra money may be given to health and social care through the health side, if we are cutting local authority budgets at the same time, we end up cutting the legs from under the NHS.
Dr Murrison
The hon. Lady is making thoughtful comments and I am following them carefully. I agree with her that co-location can work in some places, but clearly it is not going to work everywhere. Does she not agree that most people who attend accident and emergency departments are neither accidents nor emergencies, and they would be much better cared for by general practitioners? To do that, however, GPs need to be trained for that case mix and incentivised for it, and most importantly, the public needs to be trained, too, about accessing the proper professional.
Dr Whitford
Before the movement of out-of-hours GP services under the banner of NHS 24, most local areas had a doctors-on-call service. In my county, we had Ayrshire doctors on call, which was provided by local doctors at rooms in the A&E departments in our two hospitals. Patients quickly learned where they could go to be seen quickly. We also had a car service that allowed us to make home visits. That functioned very well until NHS 24 came and pulled it away.
We have to get back to local GPs working like that as part of a co-operative in a focal position. Each practice cannot generate enough GPs or work to have someone sitting there all day Saturday and all day Sunday. When the Secretary of State talks about 8 till 8, it is not clear whether he means that that will happen in each individual practice or on a regional basis. Most of the pilots that have started to publish their experiences have quickly made it into a doctors-on-call service. There is more common sense behind that approach and it is more sustainable.
We have to look at the flow within hospitals. We should not have trackers running around bean counting when patients had what done, but people going in front of patients, opening the gates, looking at bed management and ensuring that patients are in the right place.
All these matters cascade back on to staff. We are struggling to maintain and recruit staff. There was only a 50% take-up of trainees for accident and emergency, and we are haemorrhaging senior people, which exacerbates the problem. We need the co-location of GPs and we need to look at the exit block, not only out of A&E and into the hospital, but out of the hospital.
Marie Rimmer (St Helens South and Whiston) (Lab)
A 25% reduction in the number of GPs and practice nurses has been forecast over the next five years. I have the statistics to prove that. People talk about the cost of agency staff and locums in hospitals, which is out of all proportion. There are also massive increases in costs—
Madam Deputy Speaker (Natascha Engel)
Order. It is essential that we keep interventions to the absolute minimum.
Dr Whitford
The problem with moving patients into hospitals is being exacerbated by the reduction in in-patient facilities. Every new hospital seems to have fewer beds than the old hospital it replaces. The Scottish Government finally accepted the view of clinical staff that that could not go on. We now treat people in a different way. People used to get a hernia done and lie there for a week. My breast cancer patients used to come in and stay for 10 days. That has changed, which is great for those patients, but there is an inexorable rise in the number of older patients who have complex needs. The problem is not that we are living longer. I get quite upset at the phrase, “the catastrophe of living longer”. I suggest that Members think about what the alternative is. At medical school, I was definitely given the impression that people living longer was the point.
People are surviving their first major illness and, actually, their second major illness. They may present with breast cancer in their mid-70s to someone like me and have four co-morbidities. Such patients do not get in and out quickly for elective surgery, and they do not get out quickly when something major goes wrong, such as pneumonia or a chest infection. We therefore need to stop the downward trajectory in the number of beds, because we will not get the flow of patients if we go on cutting beds.
For me, the key things that we need are the co-location of GPs; an out-of-hours service for out-of-hours issues that are better dealt with in primary care; and enough beds in the right places. Finally, we need to smooth the way of our patients to get back to their homes. In Scotland, we have free personal care that allows us to keep more people at home and stop them going into hospital and to get more people back out of hospital.
I commend the “Five Year Forward View”. Much of it is taken from something that was written in Scotland several years ago called “2020 Vision”, which was about integrating health and social care.
Karin Smyth (Bristol South) (Lab)
I am not aware of the position on co-location in Scotland, but one barrier to the successful implementation of co-location in England is that the tariff and the funding mechanism mean that is it not efficient. Will the hon. Lady say what the position is in Scotland, because perhaps we can learn from that in England?
Dr Whitford
As I am sure the hon. Lady is aware, we have a totally separate system, for which I am grateful. We do not have a system of tariffs. We have a single NHS, so we can sit around a table and try to work out a solution. That is one of my concerns about the situation that the NHS in England faces and it is where I would veer away from the “Five Year Forward View”.
The principle of working together and integrating health and social care is commendable. The integration boards in Scotland started work in April because “2020 Vision” is a few years older than the “Five Year Forward View”, but we face the same challenge: local authorities are struggling with their budgets, which can end up eating away at the health side.
The four-hour target is still useful as a weekly target to provide a quick response to what is going on in our hospitals. However, it should not be used as a stick to beat staff or to beat ourselves in this House and make public capital. The NHS is too precious for that.
Maria Caulfield
I will not take any interventions owing to the restriction on time.
I shall give the House an example. When I worked as a nurse in A&E—under the Labour Government—an elderly gentleman was brought in during a busy night shift. He had fallen at home and broken his hip, and he was put in a corridor to wait. After three hours and 30 minutes, he called me over, saying, “Nurse, I desperately need to go to the toilet.” I had nowhere to put him. The best thing I could do was to wheel a curtain around his trolley, and there, in the middle of a busy hospital corridor, that elderly gentleman with war medals on his chest went to the toilet. He was seen within four hours. That box was ticked and he was deemed to have had good healthcare, but I was not particularly impressed with that care. Let us not kid ourselves that meeting that target always means that the patient experience is good or that the outcome is any better.
My second point, which relates to my worry that this debate is being used as a political football, is that the four-hour target is not being seen in the context of the bigger picture. Other targets show that, even with the increased numbers attending A&E, more and more patients are getting their treatment within four hours. Similarly, the clinical outcomes—surely the most important factor—relating to diseases such as heart attacks show that morbidity and mortality rates have improved. There have also been better outcomes for people who have had strokes and for trauma victims. So outcomes for patients are improving despite the four-hour target not having been met during the past 100 weeks. We should welcome that and congratulate our NHS staff on achieving it.
Thirdly, if this is a serious debate about A&E services throughout the whole of the United Kingdom, which we are surely all here to represent, why are we not looking at the rate in Scotland of only 87%, in Labour-run Wales of 83% and in Northern Ireland of 79%? This debate is a political one, and as a healthcare worker, I find that distressing. It is interesting that those Members who have worked in the NHS believe that the four-hour target is a useful tool but that it should not be used as a political stick.
Dr Philippa Whitford
I would like to know where the hon. Lady got her figure of 87% from. Our figure is 92.6%, and we measure it every week.
Maria Caulfield
It is an NHS figure.
I shall attempt to move the debate forward with my fourth point. If we are serious about tackling the issues resulting from the number of patients using A&E services, we need to acknowledge that 15% of patients who go to A&E could receive treatment elsewhere, in local community facilities. We need to look seriously at the Government’s proposals for seven-day-a-week health service, and if Opposition Members are serious about working with healthcare professionals to improve the experience of patients, they should surely welcome the introduction of out-of-hours services to take the pressure off A&E.
The thing I find most distressing about the motion is that it is full of criticism and complaints but offers no solutions. My plea to Opposition Members is that we should work together for the benefit of patients. We cannot continue to have patients whose care is being compromised even though they have ticked the four-hour box. We have only to look at the example of Mid Staffs, where the four-hour target was met time and again while terrible incidents were happening behind the scenes. Let us stop using the NHS as a political football; let us start working together. I would welcome the efforts of all Members to work together with the Government to deliver out-of-hours services and take the pressure off A&E units and the staff who work in them.
Drugs: Ultra-rare Diseases
Philippa Whitford Excerpts(9 years, 7 months ago)
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Dr Philippa Whitford (Central Ayrshire) (SNP)
I was a breast cancer surgeon for more than 30 years, and I often experienced the situation that has been described in the debate with my patients and new cancer drugs. We were turned down for Kadcyla earlier this year. With cancer, it is often end-of-life research that later translates to early treatment research. People read things in the paper and say, “Oh, £90,000 for six months of life—that doesn’t make sense.” Inevitably, however, those drugs move forward. We have a different system in Scotland, and while listening to the debate I have been struck by how what is required is a system that is open and can be approached, and which looks from all angles.
In Scotland, the Scottish Medicines Consortium considers drugs as NICE does, and it considers worldwide evidence. It will work up a drug in detail. The balance for us seems to be slightly more on effectiveness than cost, although obviously cost is part of it. Our impression is that, for NICE, cost would sometimes be a bigger component. They are both looking at cost-effectiveness, and we all know there is not an infinite pot of money.
What has changed in our system over the last year is that we have combined our cancer drugs fund with our rare diseases drug fund and simply called it the new drugs fund. The amount in the fund has been quadrupled from £20 million to £80 million, which means that in any year it is a little more flexible in responding to demand, whether that is for drugs for rare diseases or for a new cancer drug. NICE only assesses three drugs a year, so rare drugs are never going to get that work-up. They need a separate system. In Scotland, we have pathways to follow for rare diseases and ultra-diseases.
The biggest change in Scotland in the last year is patient and clinician evaluation. If the evidence for a drug is so strong that it will go through on the nod and there is not an issue, that is fine and PACE is not engendered; but if things look more finely balanced or the drug will not go through, patient groups or drug companies can request a PACE assessment. That will involve expert clinicians, patients and patient groups, and allows people to get slightly outside the numbers and talk about life change, quality of life and money saved in respect of other aspects of the NHS—things that perhaps do not appear in a research paper. That is what is required: a system.
At the end of the day, the system will not produce a favourable result for every single person and every single new drug in the world, but it has to be fair. We cannot have things not being looked at properly, or individual requests being used as the main way of accessing a drug. The system I am talking about is meant to be a transition—supporting young people, for example, who have been on a trial, by giving them access on a compassionate basis, while we get through the paperwork prior to a drug being accepted. It cannot be left as the main method.
Jonathan Edwards (Carmarthen East and Dinefwr) (PC)
That system sounds excellent. I commend the Scottish Government on their work. That could be a great help to my constituent, Mr Trystan James, who suffers from tuberous sclerosis complex and is reliant on a clinical trial drug to deal with a life-threatening tumour. Of course, his drug prescription is therefore completely at the discretion of the drugs company and his family are going from one prescription to the next. That relates to what the hon. Member for Strangford (Jim Shannon) said about emotional pressure on families. I commend the Scottish Government on their work.
Dr Whitford
The important thing to remember is that if this is all done by individual requests, the NHS does not go to the companies. We need to realise that companies have often made investment over decades and that nine out of 10 drugs they research will go nowhere, but it is important to have a wider debate with companies to get the best price. Hon. Members mentioned that some companies are willing and able to reduce the price to get a drug in.
Drugs are licensed. We must not mix up licensing with funding. Licensing is about asking, “Is this drug safe and proven at a basic level?”, not anyone coming in and saying, “Rare plant juice will cure everything.” These are licensed drugs that we could prescribe—a doctor has the right to prescribe them—but the NHS has to make the decision about whether to fund them; those are funding decisions, not licensing decisions.
It is important that families know what the pathway is and how they move on when their clinician takes a case forward. It is important that they know they can respect decisions and how to lobby at the next step, and that they feel their voice is being listened to. We feel that PACE has, over more than a year, allowed us to do that. Clinicians in Scotland got frustrated about decisions going through without us informing that decision.
There could be a system that sits on the side of NICE, or a sub-group. One of NICE’s three assessments will never be given over to a drug intended for 88 patients when it is also assessing drugs that might be taken by 500,000 people. Rare diseases would always fall behind, and that is why those must have their own system and why the patient voice must be heard in these ways. Obviously, things have changed with the Health and Social Care Act 2012, but I commend such a structure to the Minister.
Mark Durkan (Foyle) (SDLP)
The hon. Lady is making a thoughtful contribution. Does she agree that it would be worth all Administrations in these islands, who together form the British-Irish Council, collaborating on these issues, particularly borrowing from the good example being developed in Scotland, and seeing whether there can be common achievement and common advances, and perhaps even creating some common funding stream, as well as the discrete funds that she has talked about?
Dr Whitford
Obviously, devolution gave us the power to do things differently, but I do not think that we should re-invent the wheel. Often, we will accept work done by NICE or re-evaluate it quickly, to see whether things should be applied differently, but we do not just go back to the beginning. However, I am sure that ideas can be shared in both directions.
It seems that certain drugs were left as orphans when the system changed. We know that patients with the brain tumour form of tuberous sclerosis, which the hon. Member for Carmarthen East and Dinefwr (Jonathan Edwards) mentioned, can access the drug through the cancer drugs fund, but if they have a kidney tumour and are treated by urologists they are not part of that system and simply will not be aware of it. Such random unfairness exists.
Jim Shannon
There is a forum and association, driven by the Health Minister, that discusses matters together with the three regions. A UK-wide strategy is already in place. The process is allowing that to happen already. However, it is delayed and has not happened yet; that is why we are concerned.
Dr Whitford
I think it is a matter of what ideas go on the table and what is being discussed in the meetings. Good ideas are going ahead. I commend the idea of including patients and clinicians in evaluations, because the numerical data from trials will often be small due to the nature of the diseases in question, and we will have to look wider. The problem for children is that if these drugs are to prevent deformity, they have to be got in early. People with Morquio already have the changes. We do not know yet how much change could be prevented, or how much saving there could be on a person’s disability in the long term if metastatic breast cancer treatments, which eventually become adjuvant treatments, are given earlier.
I commend the system I have talked about. I know it is difficult and challenging, but it is clearly fair, with an interim period for compassionate reasons, and people know where their voice should be heard.
NHS Success Regime
Philippa Whitford Excerpts(9 years, 7 months ago)
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Ben Gummer
My right hon. Friend will be aware of the hospitals in Essex that have been placed in special measures. He will also be aware that focusing on one or several particular institutions is not sufficient to sort out the problems in the wider local health economy. That is why the success regime is being brought in—to try and deal with those systemic issues. Once the success regime has been concluded, I hope that his constituents will rapidly see an improvement in the service that they receive and that they deserve, wherever they are in the county.
On his second point about funding per head, he will know that NHS England has already started to look at that and, in some instances, address it. I have the same problem in my constituency in Suffolk, and it needs sorting out in the medium term across the country.
Dr Philippa Whitford (Central Ayrshire) (SNP)
The Minister talks about consulting commissioning groups locally, but why is he not willing to listen to groups of doctors across the country who talk about the point I made on Tuesday—fragmentation? We need integration. Local authorities are having their budget taken away, which means cuts to social care. Social care companies are one thread away from bankruptcy. We need to fund both sides of that, yet we are running round looking at structure. We need to move and look at outcomes. I have heard the Minister talk about “Five Year Forward View”. In Scotland we are already doing that as part of 2020 Vision: look at the patients, as the Minister says.
Ben Gummer
I take this opportunity to congratulate the hon. Lady on her entry into the House and on her maiden speech, which I enjoyed listening to in the Queen’s Speech debate. In England we are addressing the issues surrounding social care and its integration with the health service. That is why we have introduced the £5 billion better care fund. Under the success regime, far from looking at structure, we are trying to see how we can better link up services. That is why local councils will be a key partner at the table in the discussions.
Health and Social Care
Philippa Whitford Excerpts(9 years, 8 months ago)
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Dr Philippa Whitford (Central Ayrshire) (SNP)
I am grateful for the opportunity to take part in this debate as the Front-Bench spokesperson on health for the Scottish National party.
I pay tribute to Charles Kennedy. Obviously, I did not know him in this place but I am a graduate of Glasgow University and was a contemporary of Charles, who spoke eloquently and entertainingly at our first medical year reunion.
I am honoured to have been elected by the people of Central Ayrshire to be their Member in this Parliament for the next five years. My predecessor, Brian Donohoe, was their MP for 23 years, initially for Cunninghame South and then lately for Central Ayrshire. He served on the Select Committee on Transport and even took on an additional duty as a special constable for the British Transport police, something of which he was intensely proud. Now that he is freed from the trammels and duties of being an MP, I know that he plans to develop his hobby of flying remote-controlled helicopters, which will at least keep him out from under the feet of his lovely wife Christine. Unfortunately, he does not golf, which is the other alternative. I wish them both well in his retirement.
Central Ayrshire is a coastal constituency, with beautiful sandy beaches all along its coast. In the south is Prestwick airport, Scotland’s oldest passenger airport and where Elvis stopped off on his way back from national service in Germany in 1960.
Dr Whitford
We now hear that he was once out drinking with Tommy Steele, so we will not go down that road.
The airport is the site of an aerospace park and, as many Members will know, is on the shortlist for consideration as a future spaceport. Unfortunately, the passenger numbers have dropped but a recent report shows the benefit we would accrue from a drop in air passenger duty. It would bring back European visitors to our lovely county and help rejuvenate our tourism industry.
Prestwick golf club was also the site of the first ever Open golf championship in 1860, but that competition is now more closely associated with its neighbour in Royal Troon, where I live. Royal Troon will host the British Open next year, and I invite all hon. Members to it, although they cannot have the spare bed in my house, I am afraid. Book early. Despite the obvious beauty and wealth in Troon, it, too, now hosts a food bank.
In the north of my constituency, Irvine is both an old town and a new town in that it was a royal burgh from 1372 that was suddenly surrounded by modern blocks in the ’60s. Regeneration of the town centre and, in particular, Harbourside is ongoing, but it contains two of the most deprived wards in my constituency. Inland, in the rolling Ayrshire countryside, there is a chain of villages, from the ancient settlement of Dreghorn, childhood home of our First Minister, through Dundonald with its fine castle and Symington with its beautiful church to the mining villages in the south of Annbank and Mossblown. Sadly, they lost their mines decades ago and are left stranded, bereft of work and poorly connected by both transport and digital services.
Tarbolton is the site where Robert Burns, our national bard, founded the Bachelors’ Club. As we might imagine from the name, this debating club was for men only, and the first toast to the Immortal Memory given at a Burns supper by a woman was just this year. We take a bit of time in Ayrshire. Now that the county of his birth is completely represented by Members on the SNP Benches, I would hope, Mr Speaker, that we might host a fine Burns supper next January, and I am sure that we will extend an invitation to you. I am sure that it has been observed by the House that there are nae wee, sleekit, cow’rin’, tim’rous beasties on these Benches.
As a doctor for well over 30 years, of course my interest is in health and the future of the NHS, which I consider to be one of Britain’s greatest achievements of the 20th century. The biggest healthcare challenge we face is developing integrated services to look after our older citizens with complex needs. Breaking up the NHS and franchising it out to rival private companies destroys collaboration and makes achieving that even harder. If the Secretary of State was still in the Chamber, I would point out to him that the report by the Commonwealth Fund to which he referred is based on data from before April 2013, when the Health and Social Care Act 2012 came into effect.
In Scotland after devolution, we went back to our roots, got rid of trusts and again became a single unified public NHS. That has allowed us to work right across our country in developing quality standards and improving safety. We have our challenges; the NHS in Scotland is not remotely perfect; we face the same challenges as the rest of the United Kingdom. But despite the quips that were made by the Secretary of State, it does come down to co-operation and not competition.
Nevertheless, it is important to remember that the NHS does not give you health. Health comes from having a decent start in life. Health comes from strong public health measures to tackle things like the prevention of diabetes, before we are swamped by a deluge of chronic illnesses in the future. But its most important foundation is what happens in childhood and, as we now sadly know, even what happens in pregnancy.
In my constituency, despite unemployment falling from 6% to 4%, child poverty has climbed from 20% to 25% since 2010. That is one in four of our children growing up in poverty. These are not the children of shirkers and slackers, as is often implied: 64.5% of them have a working parent. The causes are short hours, low wages and benefit cuts. I have heard the welfare state spoken about through gritted teeth in this House, but allowing young lives to fail will cost society more money in the long term—in prisons, in police, in addiction services and in long-term benefits. We need to invest in our children—but not just in them; in their families—to change their future. There is no point in talking about focusing on schools if they are sitting shivering and hungry at home at night. The first duty of any Government is the security of their citizens—not with regard to replacing weapons of mass destruction, but the real security that comes from knowing you can keep a roof over your head and food on the table.
I have served the people of Ayrshire for the last 19 years as a breast cancer surgeon. I hope I will be able to serve them further, despite missing that post, in my work here. I intend to work for them in the constituency and speak up for them in this House.
Oral Answers to Questions
Philippa Whitford Excerpts(9 years, 8 months ago)
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Mr Hunt
My hon. Friend is absolutely right to draw attention to that issue. We have plans to train another 5,000 GPs across the country. In the last Parliament, we increased GPs by about 5%. We need to go much further, as part of a real transformation of out-of-hospital care.
Dr Philippa Whitford (Central Ayrshire) (SNP)
How does the Minister intend to find the 5,000 extra GPs when many surgeries throughout the United Kingdom cannot fill the spaces that they have, and how does he plan to fund it? The proposals appear to only fund the setting up of seven-day-a-week, 8 till 8 GP services and not running costs—and these are big running costs.
Mr Hunt
I welcome the hon. Lady to her place. We do need to find these extra GPs and we will do that by looking at GPs’ terms and conditions. We need to deal with the issue of burnout because many GPs are working very hard. We also need to raise standards in general practice. In the previous Parliament, an Ofsted-style regime was introduced, which is designed to ensure that we encourage the highest standards in general practice. That is good for patients but also, in the long run, good for GPs as well.
Dr Whitford
Just so that the Secretary of State is aware, it takes 10 years to produce a GP, so that will not be an immediate response. The £8 billion that the Conservatives have suggested they will add by 2020 was just to stand still, not to fund a huge expansion, and as change, which the NHS requires, costs money, can the Secretary of State perhaps give us an indication of what extra we may expect in the next two years?
Mr Hunt
Well, I can, but may I gently say that under this Government and under the coalition we increased the proportion of money going into the health budget, whereas the Scottish National party decreased the proportion of money going into the NHS in Scotland? The £8 billion is what the NHS asked for to transform services, and that will have an impact, meaning that more money is available for the NHS in Scotland. I hope the SNP will actually spend it on the NHS and not elsewhere.