HL Deb 26 October 2004 vol 665 cc1247-51

8.2 p.m.

Lord Warner rose to move, That the draft order laid before the House on 14 September be approved [29th Report from the Joint Committee].

The noble Lord said: My Lords, the Primary Medical Services (Northern Ireland) Order 2004 introduced a range of measures required to implement in Northern Ireland the new GP contract that had been agreed for the whole of the United Kingdom between the General Practitioners Committee of the British Medical Association and the NHS Confederation. Similar measures have been made in England and Wales by the Health and Social Care (Community Health and Standards) Act 2003, and in Scotland by the Primary Medical Services (Scotland) Order 2004.

Following the implementation of the Primary Medical Services (Northern Ireland) Order, it has been necessary to make a number of consequential amendments to other legislation. Those amendments needed for Northern Ireland only have been made by Northern Ireland statutory rules. However, due to restrictions on the competence of the Department of Health, Social Services and Public Safety in Northern Ireland, amendments to legislation which need to extend beyond Northern Ireland must be made by Order in Council following approval of the draft order by both Houses of Parliament. That is why this short and, I hope, uncontentious order is before the House today.

The Primary Medical Services (Northern Ireland) Order 2004 (Consequential Amendments) Order 2004, which we are considering today, makes a number of necessary technical but relatively minor amendments to the Medical Act 1983 and to three statutory instruments. These are the Medicines (Pharmacy and General Sale—Exemption Order 1980, the Prescription Only Medicines (Human Use) Order 1997 and the General and Specialist Medical Practice (Education, Training and Qualifications) Order 2003.

Most of the amendments are simply to replace references to the old, pre-April 2004 general medical services in Part VI of the Health and Personal Social Services (Northern Ireland) Order with references to the new wider term, "primary medical services".

The one exception to this is the amendments found at paragraph 4(2)(b) and (4)(b) of the Schedule to the draft order. These amendments remove two paragraphs which imposed restrictions on the right to practise of certain categories of GPs to be included in the GP register by virtue of an acquired right to practise. Those restrictions are no longer necessary in the 2003 order, as they have been replaced as appropriate by restrictions in the legislation relating to the GP contract that deals with conditions for contractors and the qualifications required by performers.

My colleague the Minister of State for Health, John Hutton, has made the following statement on the compatibility of the order with the European Convention on Human Rights: In my view, the provisions of the Primary Medical Services (Northern Ireland) Order 2004 (Consequential Amendments) Order 2004 are compatible with the convention rights". I beg to move.

Moved, That the order laid before the House on 14 September be approved [29th Report from the Joint Committee].—(Lord Warner.)

Earl Attlee

My Lords, it is a pleasure to debate health matters with the noble Lord, Lord Warner, for the first time. Sadly, however, it will not be a usual occurrence. I am grateful for the noble Lord's explanation, and I am content with the order.

Baroness Harris of Richmond

My Lords, I too welcome the debate on this Northern Ireland order. We debated and passed the primary medical services order in January. As the noble Lord reminded us, it was uncontroversial and replicated measures being introduced in England and Wales by Part 4 of the Health and Social Care (Community Health and Standards) Act 2003. The main provision of the order concerned new GP contracts, which we have strongly supported. However, concerns were expressed about the provision of out of hours services. I am finding it hard to work out how substantially different this order is from the one we passed in January. Perhaps the noble Lord will help me on that point.

I think that it is intended that the responsibility for providing services during these hours will transfer to boards as part of their new statutory duties, but we still do not know how this is going to work and what progress might have been made. Let me refer the Minister to the Commons debate on this subject in the Second Standing Committee on Delegated Legislation. The Parliamentary Under-Secretary of State at the Northern Ireland Office, Angela Smith, said: the boards tell me they are confident that by 1 January 2005 they will be able to provide an adequate service". My noble friend in another place, Lembit Öpik, said that, there was a perceived deterioration in service because there were too few doctors trying to do the job in too wide an area". In reply, the Parliamentary Under-Secretary of State said: If any problems are brought to my attention, we will do everything that we can to ensure proper service.".—[Official Report, Commons, Second Standing Committee on Delegated Legislation, 19/10/04; col. 8.] I should be grateful if the Minister would define the words "adequate" and "proper service".

Has any further work been done on analysing possible problems in the light of the experience that has been gained in England and Wales concerning the sparsity factor, transportation to the nearest hospital A&E department or even walk-in facilities—if, indeed, these are ever proposed by the boards?

We on these Benches support the order but I would be grateful if the Minister could reply to those questions.

Lord Maginnis of Drumglass

My Lords, I listened carefully as the Minister presented the order; I am afraid that it is far too technical for a simple old village schoolmaster to understand. However, I would not like to miss the opportunity at least to comment on our health services in Northern Ireland in general terms and to ask the Minister one or two questions.

Obviously I am interested in the state of the health services in Northern Ireland. In my opinion—be it erroneous or otherwise—what was the best regional health service in the United Kingdom 15 or 20 years ago has deteriorated to be among the poorest. None the less, one of the elements that has sustained us over the period has been the productivity and local knowledge of our general practitioners.

We who live in rural areas are perhaps more aware of this than those who live in the larger conurbations, but there is no doubt that primary healthcare appears to have come under considerable pressure. I wonder whether that is why—perhaps the Minister will tell me otherwise—there appears to be some difficulty in implementing the changes to GP contracts in Northern Ireland at the moment.

I do not suppose that the Minister will wish to deal today with my next question, but I will very briefly ask it. Some of the confusion, chaos and mismanagement of our acute hospital services, their rationalisation at inopportune times and absence of proper planning has led to that aspect of healthcare literally gobbling up financial resources that could be more usefully employed in the primary healthcare sector. I do not wish to speak at too great a length—as I said, I am not technically competent to do so—but how will GPs now be able to operate effectively out-of-hours GP services in rural areas and, indeed, in Northern Ireland as a whole?

As to chronic and non-hospitalised patients, is there likely to be a more rapid introduction than we have seen so far of nurse practitioners who are qualified to refer patients and to deal with them in a way that relieves the pressure on our GPs and perhaps allows them to utilise their time more efficiently?

I promised that I would not speak at any great length. I am grateful for the opportunity to contribute. I accept what the Minister said in regard to the benefits that the order is intended to bring to Northern Ireland.

Lord Warner

My Lords, I am grateful for the support offered by noble Lords in this area. I am sure that my exchanges on health with the noble Earl, Lord Attlee, will probably be limited in number, but I am grateful for that on this occasion.

In terms of the difference between this and the previous order, this order only changes some terminology consequential upon the service changes in the previous order. It does not in any way modify the service delivery arrangements that were specified in the previous order; it simply makes consequential changes to some of the legislation which had to be changed through this mechanism because it was outwith the competence of the Northern Ireland authorities to do so. So the changes are purely technical.

On the wider issues, there has been a lot of public debate about the changes in the out-of-hours responsibility. We should be clear that that transfer of responsibility to primary care trusts and their Northern Ireland equivalents is about making those trusts responsible for ensuring that there are proper out-of-hours arrangements. It lifts that responsibility from individual GPs. Those changes will, we think, improve the quality of life for GPs and the recruitment and retention to general practice as well as making it clear that there is a public body with responsibility for ensuring that out-of-hours services are available.

In addition, on 14 October, we introduced the new national quality requirements which, from 1 January 2005, all providers of out-of-hours services will have to meet. So there is a quality control mechanism for ensuring that those changes are introduced against agreed standards.

The noble Lord, Lord Maginnis, raised a number of issues around services in Northern Ireland. I do not have detailed knowledge of the Northern Ireland healthcare system and how it is working. I shall make sure that my colleague, Angela Smith, who has responsibilities in this area, reads Hansard, understands the noble Lord's concerns and considers whether she can do anything to reassure him on this issue.

I have a couple of general points in response to the noble Lord. I know from my own experience over many years in the health field that there is a continuing debate about whether we have got right the balance in terms of resources and priorities between primary care, secondary care and tertiary care. These are not easy judgments to make; successive governments under different administrations have had to wrestle with that and will no doubt have to wrestle with it in the future. However, we are seeing a real attempt to improve the quality of primary care; a new contract and new arrangements will ensure that quality.

In terms of GPs in rural areas, the changes we are making mean that it is the PCT's responsibility to ensure that there are good out-of-hours services wherever people live, whether in rural or urban areas. It is certainly true that nurse practitioners have been expanding their activities in general practice across the UK. One would expect that to continue, because it relieves GPs of doing things which can be done by the nurse practitioners perfectly satisfactorily and which many patients welcome.

I have tried to answer the points raised by noble Lords. I hope that with those assurances, we can agree the order.

On Question, Motion agreed to.

Baroness Andrews

My Lords, I beg to move that the House do now adjourn during pleasure until 8.30 p.m.

Moved accordingly, and, on Question, Motion agreed to.

(The Sitting was suspended from 8.18 to 8.30 p.m.)

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