National Health Service

Lord Balfe Excerpts

Thursday 8th January 2015 Lords Chamber

[Lord Balfe (Con)]

My Lords, I congratulate the noble Lord, Lord Turnberg, on securing this debate. My first point is that we may have differences, but the National Health Service is basically safe in the hands of all the parties represented in this Chamber. We disagree about how we do it, but we do not disagree about the fundamental aim: to provide a health service free at the point of demand. I was very interested in what the noble Lord, Lord Desai, said. I have known him since I was at the LSE many years ago. The points that he made about a zero-price service are absolutely spot on.

I am interested, even pleased, to hear that we are top of the world rankings. I am also surprised, having had experience for 35 years of the Belgian and French health service, that we have outranked them, because that has not been my personal experience with those two health services. None the less, I will believe it: the survey is obviously right.

Why do I speak today? When I was at the LSE 45 years ago, I wrote my dissertation on out-of-hours GP services. Although my career moved me to a distinctly different area, that is a subject that has continued to interest me. Today, I want to speak particularly about the problems—note that I say “problems”, because I think that the word “crisis” should be used sparingly—facing the out-of-hours medical service. First, many people do not find the out-of-hours medical service easy to access. That is in part caused by the lack of GP cover. The previous Government negotiated a GP contract which, I am told, gives the average GP the highest pay and the lowest hours in the European Union.

Evidence suggests that about 30% of patients who self-present at A&E would be better advised if they had called NHS 111 first. However, using A&E may be preferable, particularly for young working people, to trying to get an appointment with a GP. Some young and generally healthy migrant workers do not understand our medical system and do not register, so recourse to A&E is a natural consequence of unexpected illness. The out-of-hours service which exists to provide medical cover when doctors are not on duty is not widely understood.

In Cambridge, where I live, we remember Dr Ubani, the doctor with imperfect English who, after a full week’s work, flew in from Germany to do a session of weekend cover and killed a patient through overprescription. Few people are, however, aware of the considerable steps taken to prevent such a tragedy recurring.

Doctors’ surgeries are, for much of the time, dark and closed. A&E services have the lights on and, whatever the figures say, you will be seen swiftly if there is a life-threatening condition. If not, frankly, there is an option of settling down with a book and waiting one’s turn. This is not necessarily an unwelcome scenario, especially if the alternative is taking time off work, sometimes from a zero-hours contract, to see a GP.

We also know that the present system of dealing with calls through the 111 service can lead to additional referrals to A&E. The 111 service is staffed by trained advisers but their training is in operating the system, not in medicine. The system has a fail-safe and evidence would seem to suggest that this can lead to more referrals. However, imagine the outcry if the system allowed discretion without knowledge. We would soon have an outcry, and rightly so, if there were unnecessary deaths.

Finally, there is considerable evidence that in nursing homes and for other carers of the elderly the first manifestation of a medical issue will lead to the calling of an ambulance. This has rightly followed a lot of inquiries about failings in homes but, as a consequence, it adds to the pressure.

It will be evident from what I have said that a stronger and earlier medical input is a crucial part of dealing with this problem. I would like the Minister to look into the following suggestions and, in due course, come back with a response. First, in Cambridgeshire the clinical commissioning group is in the process of establishing a joint emergency team that will provide integrated care covering community and hospital care, for a fixed price per person per year. This project, which begins on 1 April, will provide a round-the-clock emergency service that will work alongside ambulances and out-of-hours GPs. Will the Minister take a close look at this initiative with a view to promoting its use elsewhere? I notice that it is mentioned in the report.

Secondly, I ask that consideration be given to integrating the 111 and out-of-hours service. Thirdly, I suggest that the introduction of a GP input into the A&E front of house or reception areas could deal quickly and effectively with some of the less serious cases. Finally, I ask the Minister to continue to look at ways to extend the hours that GP services are available. We are no longer in an economy nor do we follow lifestyles where a visit to the doctor is easy to fit in. We need to build an element of consumer choice into the provision of medicine.

I have lived partially in Belgium for the last 35 years. It has a fully socialised medical system, not a private system, but the patient can shop around. There is patient power there at GP level, much more than in the United Kingdom. Maybe this is another European practice that is worth studying with a reference to importing more patient power into the National Health Service.