My Lords, I refer to my declaration of interest in the register: I currently work with the Dispensing Doctors’ Association and my father was a dispensing doctor. I congratulate my noble friend the Minister on introducing the Bill, which I broadly support—particularly its emphasis on greater collaboration between GPs, hospitals and local authorities.
If I can paraphrase the noble Lord, Lord Stevens, whom I congratulate on an excellent maiden speech, I agree that all health services are local. However, I disagree with him on his support for the fluoridation of the water supply, and refer him to the case of the petitioner, Mrs McColl, against Strathclyde Regional Council. You might say that I cut my legal teeth on this case because I spent nine months as a Bar apprentice and the remaining time as a devil; my devil master was one of the advocates for Strathclyde Regional Council. Crucially, Mrs McColl had dentures; she had no teeth. She argued that fluoride is a carcinogen and that the action Strathclyde Regional Council sought to introduce, which the Bill also seeks to introduce, was unsafe, ineffective and illegal. I agreed with her. She won her case. I cannot see how it is appropriate to prescribe such an interventionist action that could be achieved by other means: either regularly brushing children’s and adults’ teeth with toothpaste containing fluoride or reducing sugar in the diet. So, on that, we will disagree, but I warmly welcome the noble Lord to the House and congratulate him on his excellent maiden speech.
I am grateful to my noble friend the Minister for the meeting we had to discuss these issues, at which he heard me argue that the NHS and the Department of Health and Social Care tend to be urban-centric. A lot of that
has been proved in many of the speeches this evening. Dispensing doctors have a unique role to play. They are general practitioners who are permitted to dispense medicines—in effect, a GP and a pharmacy rolled into one—for patients who would otherwise have difficulty accessing one or both, not least due to the distance from their home. All these services are in rural areas only. I pay tribute to the role that dispensing doctors play as an integral part of the health service in rural communities, building strong relationships with their patients. They are crucial to the delivery and promotion of preventive services and well-being, which is so dear to the heart of the Conservative manifesto.
I will focus on delivering healthcare and social care in a rural setting. I urge my noble friend to confirm that he will redress the inequalities already identified in this Bill, particularly by the right reverend Prelate the Bishop of St Albans, to restore the balance in favour of spending on rural areas as opposed to urban areas and in favour of spending on primary care as opposed to secondary care. Does he share my concern that the ICSs will be full of secondary care practitioners and that primary care practitioners may not be as well represented as they might be?
I share the concerns expressed by others this evening about the number of GPs, many of whom are facing retirement in the next five or 10 years and have real concerns about their pensions. Again, I regret the fact that the Government—as shown both this evening and with the Health Secretary’s acceptance to the health Select Committee next door in the other place—have not kept their commitment to increasing the number of doctors in the next four, five or six years. That is deeply regrettable.
Will my noble friend the Minister use this opportunity to redress the balance in spending between urban and rural areas? Rural areas are facing issues with isolation and the distance that patients have to travel to access healthcare; they also have disproportionately higher levels of older people with chronic conditions. This is a golden opportunity to address these issues; I warmly invite my noble friend to do so.
*Original translation online at 8:31 pm at https://hansard.parliament.uk/lords/2021-12-07/debates/B05FC5DC-E095-444F-83E3-BD40BF226078/HealthAndCareBill