Dermatology (Hansard, 8 October 2002)

§ The Parliamentary Under-Secretary of State, Department of Health (Lord Hunt of Kings Heath)
My Lords, we are increasing the number of 141 dermatologists. At March 2002, there were 387 consultants in dermatology, an increase of 24 per cent since 1997. GPs are expected to keep their professional skills up to date and to keep abreast of developments in areas such as dermatology. The appointment of GPs with special interest in dermatology has considerable potential in that area.

§ Baroness Knight of Collingtree
My Lords, is the noble Lord aware that a large proportion of the public—one-third—suffers from one form or another of skin disease, whether it is cancer, psoriasis, alopecia or one of a number of things, yet it is increasingly difficult to get proper medical advice from the NHS? Does he recognise that there are some 96 vacant consultant dermatology posts in NHS hospitals and that whatever he has said about GPs, the truth is that many of them have had no training at all in the treatment of skin disease? What does he intend to do about it?

§ Lord Hunt of Kings Heath
My Lords, the noble Baroness is right to suggest that this is a big issue for many patients. My understanding is that skin conditions account for 15 to 20 per cent of all GP consultations. I have explained that there has been more than a 20 per cent increase in the number of consultants since the Government came into office.
I disagree with the noble Baroness in relation to general practitioners. The fact is that the new scheme designating some GPs as having a special interest in dermatology and other clinical conditions is an excellent way of using the skills of GPs in this area and will enable more people to be treated within primary care. If one adds that to increases in the number of specialist registrars and the use of nurse-led clinics, I am confident that we shall be able to meet some of these pressures.

§ Lord Walton of Detchant
My Lords, the Government's recognition of the need for a major expansion in the consultant establishment is very welcome. But does the Minister accept that what applies to dermatology applies to practically all specialties in medicine. There is a great shortage of consultants across all these specialties. Is the Minister satisfied that sufficient specialist registrars are in training to fill the new consultant vacancies as they arise?

§ Lord Hunt of Kings Heath
Well, my Lords, we are determined to expand the number of specialist registrars and consultants. We have seen a large increase in the number of consultants. In 1997 we had just over 21,000 consultants in the National Health Service. The number has now risen to 26,350. Of course it takes time to train consultants; it takes many years. That is why we have engaged in a major programme of international recruitment. I accept that the key issue facing the National Health Service is capacity. Our ability to attract more doctors and more 142 nurses and to build more facilities is crucial. But I am confident that we are on the right lines and that we will deliver the NHS Plan.

§ Lord Clement-Jones
My Lords, the noble Baroness referred to skin cancer. Its incidence has risen twofold over the past decade. Public awareness of sun protection is extremely important. No doubt the Minister will be aware of the abolition of the sun protection awareness campaign along with the Health Education Authority. The Minister will be aware that there is a proposal in the department for the reinstatement of that campaign. Can he say whether or not it will be reinstated by the department?

§ Lord Hunt of Kings Heath
My Lords, these are matters which of course are always being considered. I agree that encouraging the public to take proper precautions should always be part of a public health programme. Much can be done locally. We would also expect that as primary care trusts take forward their public health programmes, this is an issue they would consider for local health promotion campaigns.

§ Baroness Hayman
My Lords, does my noble friend agree that dermatology is a speciality in which telemedicine can be both cheaply and effectively employed to provide speedier diagnosis for patients and support for GPs and others in primary care? Given some of the problems that have been described, will he undertake to ensure that the potential of this technology for assisting in those problems is fully explored by the department?

§ Lord Hunt of Kings Heath
My Lords, I am keen for telemedicine to be developed in the health service. It: enables us to create networks of care that cross the boundaries between primary, secondary and tertiary care. We have a number of actions on pilots in dermatology that are helping to reorganise and reform services. Telemedicine is certainly one of the factors being considered in some of those pilot programmes.

Lord Campbell of Croy
My Lords, does the Minister agree that simple cuts and abrasions may turn into long-lasting ulcers, especially in the case of elderly people, and that the health service should be prepared for an increase in such skin disorders in an ageing population?

§ Lord Hunt of Kings Heath
My Lords, the noble Lord is right to suggest that we need carefully to consider trends in particular illnesses to ensure that the National Health Service can meet the demands that will be placed on it. Another action that the Government have taken has been to refer the whole issue of skin disease to the National Institute for Clinical Excellence to produce clinical guidelines for the National Health Service for the next few years. That will help the NHS to ensure that we have proper services at local level.

§ Baroness Masham of Ilton
My Lords, perhaps I may declare an interest as a member of the All-Party Group 143 on Skin. Does the Minister agree that more training at graduate and postgraduate level should encourage more doctors into dermatology? Does he further agree that in rural areas such as north Wales there is a tremendous lack of dermatologists?

§ Lord Hunt of Kings Heath
My Lords, the latter point reinforces the question raised by my noble friend Lady Hayman about the potential of telemedicine. The use of nurse-led clinics may also be one way to deal with some problems in rural areas. On training, it is tempting to say that medical students' training should be considerably extended to cover many different conditions. In view of the number of consultations that the public bring to general practitioners' surgeries, medical schools should certainly be encouraged to consider the curriculum to decide whether more should be devoted to dermatology. However, the creation of more GPs with a special interest in dermatology is a significant way to deal with the issue.