Clause 21 - out of hours medical services
Health and Social Care Bill
10:30 am
Mr Desmond Swayne (New Forest West, Conservative)
In view of what the Minister has told us about the disagreeable consequences of reconvening the dreaded Programming Sub-Committee, it may be for the convenience and relief of the Committee if I kept my remarks as focused as possible. That will be my endeavour.
Amendment No. 168 attempts to remedy the lack of clarity in the clause. What was meant was not entirely clear to us. The explanatory notes state:
The body to be regulated is any body or organisation providing out-of-hours cover to GPs that will have to be accredited by a Health Authority.
Does that mean that the body will have to be accredited by any health authority, not necessarily by every health authority, to which it provides an out-of-hours service? That is our understanding of what the clause means, so we are trying to make it more explicit. After all, we are here to help. The spirit of the amendment follows Oliver Cromwell when he said that no real reform could be achieved unless the whole law was reduced to the bigness of a pocket book, intelligible to all men.
Having said that, and believing that the clause has precisely that meaning, I understand the attractions of its having an interpretation under which a provider would have to be accredited and be on the list of every health authority to which it provided a service. If a complaint were to arise against such a provider, the health authority that received the complaint might be unable to seek redress by taking proceedings against that provider, with a view to removing it from its list. The health authority would have to initiate those proceedings with another health authority that had the provider on its list.
It may be administratively convenient for a provider to be on every health authority's list to which it makes provision. However, that administrative convenience must be set against the huge bureaucratic burden that would be placed on the provider of having to register to be accredited by every health authority to which it provided a service. We tabled the amendment in the understanding that the clause means that once a provider has secured access to the system by gaining accreditation from a health authority, that body can provide those services to all health authorities. We seek to make that explicit in the Bill.
Amendment No. 169 is intended to make one of our principal concerns explicit. We fear that access to NHS services may be becoming fragmented. That concern for continuity of care is not restricted to Conservative Members, but is also a concern among medical professionals. In an article in Doctor on 21 January 2000, Dr. Gillam, the Luton general practitioner who is also a director of the primary care programme at the King's Fund, commented that NHS Direct was part of what he saw as an agenda of fragmenting access to the national health service and that it could destroy continuity of care.
That fear has been echoed in a survey of doctors published in GP Magazine on 25 February 2000, which revealed that 81 per cent. of doctors questioned felt that continuity of care was being jeopardised by NHS Direct and walk-in centres. That concern for continuity of care was expressed in the independent report that was commissioned by the Department of Health ``Raising New Standards for Patients—New Partnerships in Out-of-Hours Care.'' I draw the Committee's attention specifically to recommendation 4 of that report, which states that
all providers should report all out-of-hours consultations to GPs by 9.00 am the next normal working day.
Clearly, the authors of the report share the concern that there should be continuity of care and that that information should be provided. However, even that was only an interim measure and very much a second best, because the ideal solution is the provision of electronic systems. The electronic health record will provide a three-way exchange of data between NHS Direct, the out-of-hours providers and general practitioners. It would assist us if the Minister could say precisely what stage has been reached in the provision of the electronic record and what prospect there is of its delivery in the medium term.
I have a wider concern about the clause, which is not germane to these two rather focused amendments. I am inclined to leave that matter to a stand part debate, but if you decide that there will not be a stand part debate, Mr. Maxton, I shall seek to catch your eye a second time.