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Public Service

Part of the debate – in the House of Lords at 5:26 pm on 24th October 2001.

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Photo of Lord Chan Lord Chan Crossbench 5:26 pm, 24th October 2001

My Lords, it is an honour to follow such distinguished noble Lords in the debate. I had not expected it to be such a momentous occasion, where I would be speaking immediately after the Statements on Afghanistan and Northern Ireland. It is, therefore, with some trepidation that I present my maiden speech.

First, I thank all members of staff who have been so very helpful and courteous to me during my induction into your Lordships' House. They have demonstrated so eloquently the concept of service for which your Lordships' House is renowned. I also thank colleagues from all sides of the House for their warm welcome.

I intend to explore the issue of dissatisfaction in and with the health service. Here I declare an interest. I was a consultant paediatrician in an academic department for almost 30 years before moving into public health.

A MORI poll in March this year found that 89 per cent of the public trust their doctors to tell the truth. The same proportion is fairly satisfied or very satisfied with the way doctors do their jobs. Therefore we may conclude that the public continue to place their trust in doctors.

Other surveys repeatedly show that patients want more than the average seven minutes' consultation time with the general practitioners. GPs are also dissatisfied with this inadequate consultation time. Consultation time is even more constrained by this routine when the patient requires an interpreter because of insufficient English. In these circumstances, all doctors prolong the consultation for as long as is necessary.

People are using the health service more than ever before. Therefore, although the number of patients registered per GP has fallen to 1,800 today, the number of patient consultations per GP has increased since 1984 by nearly 800 every year to 9,000 consultations per doctor per year in 1996. On average, each patient consults a GP five times per year. Children under five years and people over 65 see a GP seven times a year. It is this increasing demand on the time of our GPs and the shortage of general practitioners that have led to dissatisfaction and low morale among primary care doctors, who continue to manage 90 to 95 per cent of consultations without referring on to specialists in hospital.

Nursing shortages based on the March 2001 NHS vacancy survey are around 20,000 across the United Kingdom. For the year 2000, one in three new entrants to the United Kingdom Nursing Register were from outside the United Kingdom. In order to realise the shared goal of reshaping health services to meet the needs of patients, it is vital that the current nursing shortages are reversed. This means ensuring that nurses want to stay in the NHS, encouraging trained nurses to return to the service, and making nursing an attractive option for new recruits. Meanwhile, many nurses are struggling to provide good patient care on under-staffed wards.

The concept of service in the NHS is alive and well. However, increasing demands on primary healthcare and on hospital treatment--with limited beds and serious staff shortages among doctors, nurses and in the professions allied to medicine--make it very difficult for staff to demonstrate personal warmth and give undivided attention to patients and their carers. We also have the smallest number of doctors per 1,000 of the population in Europe. That is further compounded by the increasing verbal and physical abuse thrown at hospital staff by patients and their families. Long working hours with high levels of stress force NHS staff to concentrate on clinical and technical aspects of treatment rather than on the warmth of personal care. Of course, I accept that in all situations doctors and nurses should always try to give comfort to their patients.

In conclusion, the spirit of service in the public sector, especially in the National Health Service, is alive and well and can be fostered if we manage the expectation of patients, carers and service users. We need to communicate clearly the reality of what can reasonably be achieved with the resources that are available today.