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Out-of-Hours Care

I will do my best to help, Mr. Deputy Speaker. It is interesting that we have debated the problems of out-of-hours care. That follows endless debates over the years about abuse, or the increasing use, of accident and emergency services, the problems of single-handed doctors, the provision of GP services, and the wide range of options that exist for people to access health care outside the ordinary hours of a GP practice. There are legitimate concerns about the out-of-hours care service. In defence of my own PCT, I should say that it is not a subject that has been raised a great deal with me, I am glad to say, but we have an extended 24-hour-a-day GP practice, a minor injuries unit, and a new accident and emergency department. However, we also have a high proportion of ageing single-handed practices, which is what has driven the breadth of provision. Something profound is going on with people's access to out-of-hours care. Lest I be accused of being a hard-hearted Tory, I shall quote a comment from the hon. Member for South Derbyshire (Mr. Todd), who spoke about economic modelling in the health service. There is a demand, led by patients, for widening the different forms of provision. By concentrating on out-of-hours care today, minor injuries units in another debate tomorrow, or NHS Direct in a debate two weeks from now, we are not putting together the whole provision of out-of-hours care and ensuring that the models that we offer meet the demands of a patient-led service. That is what we would dearly like to move towards, and it is the basis of my Front-Bench team's proposals on that one issue of out-of-hours care. We are trying hard to take health care out of politics, and an NHS board would be able to look across health care provision to ensure that patient-led demand was met most appropriately. As my hon. Friend the Member for Basingstoke (Mrs. Miller) said, there is a need for the out-of-hours service, for the terrified mother who has a child with croup, for the elderly person who suddenly has a fit, or for whatever the crisis might be. Those people cannot get to the extended GP service or to the minor injuries unit, and reaching A and E is even more difficult. However, we must bring into the debate how the ambulance service is used not just as an accident or crisis service, but almost as a social service. I was out with an ambulance team when they were called to put an elderly gentleman back into bed after he had fallen out, and it became palpably obvious that he was lonely. He fell out of bed deliberately to get the ambulance team around—regularly, because they all knew him. That is an abuse of the ambulance service, but it highlights how the service should be part of a seamless out-of-hours service. By focusing on those different areas separately, we do not focus on how we can meet patients' demands, and that, more than anything else, is what the NHS should deliver.