Health and Social Care Bill

Baroness Gibson of Market Rasen Excerpts

Monday 7th November 2011 Lords Chamber

Moved by

[Baroness Gibson of Market Rasen]

26: Clause 3, page 2, line 34, after “England” insert “in rural and urban areas”

[Baroness Gibson of Market Rasen]

My Lords, I shall be brief, bearing in mind the hour. What I have to say about Amendment 26 applies to all the amendments in this group. Their aim is quite simple: to ensure that those working in the health service and those who are its patients in rural areas are not forgotten as we plough through this enormous Bill. I hope that we will be able to improve the quality of services, protect and improve public health and reduce inequalities in rural areas as we do so. The Bill has not been rural-proofed. Although it is about the National Health Service, too often when we discuss the NHS the emphasis is on urban, rather than rural, areas.

I have declared my interest, as I did at Second Reading. I am the honorary patron of the Dispensing Doctors’ Association and, as such, am very proud to raise issues for dispensing doctors—in other words, rural doctors and their colleagues. Dispensing doctors dispense from their surgeries. They live and work in rural areas, giving a service that is vital to rural patients. Without their dispensing from their surgeries, those living in the more remote areas of our countryside would have to travel first to their doctor’s surgery and then to the nearest pharmacy to get their prescribed medicines. These two places might be many miles apart. Mostly, this would be in areas where public transport services are very few and far between or, more likely, where there are none at all. Therefore, without the care and supervision provided by dispensing doctors, patients would face even more difficulties in getting the analysis of what they need and the correct medicine than they do at present.

Many patients in rural areas do not drive, especially women, older patients, those with disabilities, those with longer-term illnesses and those with small children. In addition, families increasingly cannot afford to run two cars. Therefore, if the main breadwinner needs the car to travel to and from work, the remaining partner finds it difficult to travel distances to collect medicines or prescriptions. That is why the one-stop shop of a dispensing doctor’s surgery is so necessary. Rural areas must not be forgotten in the turmoil of changing the National Health Service in the fundamental ways outlined in the Bill.

This weekend I had the pleasure of attending the annual conference of the Dispensing Doctors’ Association in Chester. I heard at first hand the worries that dispensing doctors and those who work with and for them face. They need to be consulted as changes are proposed. They feel—rightly or wrongly—that they are not given a fair crack of the whip at the present time and that their needs appear to be subsumed under the viewpoint of those working in the overall NHS. If the term “rural” is spelt out in the Bill, it would be much more difficult in future to pass over the needs and aspirations of those working in the health service in rural areas and of the patients themselves, whose involvement is so important.

I feel particularly passionate about these issues, and hope that the Minister will understand my reasoning and have sympathy towards it. I beg to move.

--- Later in debate ---

[Earl Howe]

My Lords, the amendment tabled by the noble Baroness, Lady Gibson, and all the amendments in this group, highlight the importance of ensuring that neither rural nor urban areas are affected by health inequalities. I quite understand the noble Baroness’s concerns—especially given that rural areas have unique circumstances that affect their health needs, such as a diffuse population and long travelling times for patients.

I therefore acknowledge that some significant issues face rural and urban areas, as was highlighted by the Marmot review. In particular, there are concentrations of shorter life expectancy and greater illness, and these tend to occur in some of the poorest areas of England, most of which are urban areas of deprivation. There are particular challenges with the provision of services in rural areas due to the higher cost of delivering services in more locations and the greater sparsity of rural communities.

However, although I am very sympathetic to the noble Baroness’s intentions, I do not feel that the amendments are the most effective way to achieve her aims. Existing reference to “England” or “its area” in the Bill already includes every type of population, including rural and urban populations. The responsibilities for commissioning are absolute across all the communities and individuals for whom they have responsibility. There is no discrimination between different areas. That principle runs throughout the legislation. Moreover, the fundamental and unique change we are making to commissioning is to give local GPs responsibility for securing services for their patients. That vital principle, above all others, will make a decisive break from the past by ensuring that the needs of much smaller groups of patients can be taken into account by the commissioners.

A CCG will be exercising its statutory functions appropriately only if it is meeting the reasonable needs of all the people for whom it is responsible, not just those in particular demographic areas. The guidance on commissioning which the board must issue under the power in new Section 14Z6 could, of course, cover issues relating to commissioning in rural and urban areas.

Although the noble Baroness’s amendments are unnecessary, they could also be damaging. That is because there is the potential under some of the amendments, however inadvertently, to limit the scope of the responsibilities which the Bill places on CCGs. Amendments 188 and 114 could limit the effect of the scope of the duty on reducing inequalities to a duty only in relation to reducing inequalities and access between rural and urban areas. That would not include the duty to tackle the variety of factors which can affect a person's ability to access the care that they need, such as socioeconomic background and ethnicity. The changes proposed to the Secretary of State's duty in new Subsection 1B are particularly problematic in their impact. The Secretary of State may no longer have regard to the need to reduce inequalities between the people of England but only between people in urban and rural areas. Similarly, Amendment 190 could limit the duties regarding reducing inequalities in outcomes to inequalities in outcomes between patients in rural and urban areas only. So I have concerns about the limitations that the amendments may impose.

Despite all that, I hope that I can reassure the noble Baroness that the Bill adequately provides for her worthy intentions—due, in particular, to its coverage of the whole of England. With that in mind, she may consider withdrawing the amendment.

[Baroness Gibson of Market Rasen]

My Lords, I thank the noble Baroness, Lady Jolly, and my noble friend Lady Thornton for their involvement in this short but important debate. I thank the Minister for what I think was his sympathetic reply and his explanation of the amendments, which was very helpful. Under the circumstances, I beg leave to withdraw the amendment.

Amendment 26 withdrawn.