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Mr. Speaker : Application under Standing Order No. 20.

Mr. Harry Ewing (Falkirk, East) : On a point of order, Mr. Speaker.

Mr. Speaker : No, I shall take the Standing Order No. 20 application first.

Mr. Harry Ewing : On a point of order, Mr. Speaker, arising from the statement.

Mr. Speaker : That may be, but I shall take Standing Order No. 20 first.

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British Coal Science Laboratory (Closure)

4.13 pm

Mr. Peter Hardy (Wentworth) : I beg to ask leave to move the Adjournment of the House, under standing Order No. 20, for the purpose of discussing a specific and important matter that should have urgent consideration, namely,

"the decision by British Coal to close the science laboratory at Wath upon Dearne."

The matter is urgent, because British Coal announced the decision to close this laboratory yesterday afternoon. It is serious, because the effect upon my constituency and the neighbouring areas will be severe. We have suffered a series of devastating economic blows in the past five years. Great effort is being made to secure employment and economic revival and the existence of this successful establishment serves as a most useful and valuable pointer to the fact that we can and must successfully accommodate high-tech development.

For British Coal to transfer the work of this laboratory to a locality that is further from the major coal-producing areas and where economic need is much less severe is regrettable. It will be a cause of some bitterness, because the decision will be seen as a brutal disregard of obligation by British Coal.

There is further anxiety, because much has been achieved at Wath regarding the identification of the origins of coal samples. That research, which is extremely effective in identifying cases of cheating in imported coal supplies, has not been properly admired in some of the quarters where it should have been.

Many of the scientists, who are highly qualified, now face either unemployment or the prospect of uprooting, changing their lives and ending the happy local contact which springs from their successful operations in south Yorkshire.

Last Monday, in Energy Question Time, the Under-Secretary of State for Energy, although he was, in part, most reassuring, made it clear that the responsibility for the decision rests entirely with British Coal.

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I suggest that this matter is one which the House should consider immediately to allow deep anxiety or anger to be expressed. In that way, a view could be formed about this regrettable and serious decision.

Mr. Speaker : The hon. Member for Wentworth (Mr. Hardy) asks leave to move the Adjournment of the House for the purpose of discussing a specific and important matter that he believes should have urgent consideration, namely,

"the decision by British Coal to close the science laboratory at Wath upon Dearne."

I have listened with care to what the hon. Gentleman has said. As he knows, my sole duty when considering an application under Standing Order No. 20 is to decide whether it should be given priority over the business set down for today or for tomorrow. I regret that the matter that the hon. Gentleman has raised does not meet the requirements under the Standing Order and, therefore, I cannot submit his application to the House.

Point of Order

4.15 pm

Mr. Harry Ewing (Falkirk, East) : On a point of order, Mr. Speaker.

I apologise to you, Mr. Speaker, and to my hon. Friend the Member for Wentworth (Mr. Hardy) for interrupting his important Standing Order No. 20 application.

My point of order is simple, Mr. Speaker, and no doubt you will find it easy to deal with it. As you know, the rising sun is now playing an important part in British industry. In order not to offend our good friends in Japan and the Japanese Government could you refer to the House authorities the need for some structural changes to be made so that the rising sun is never again shut out of the Chamber by closing the blinds? I believe that that would be an appropriate step to take.

Mr. Speaker : If I interpret the rumours aright, when we have television--if we have television--the blinds will be permanently drawn. [Hon. Members :-- "Oh."] I must not pre-empt what may be done.

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Football Spectators (No 2)

4.16 pm

Mr. Alan Meale (Mansfield) : I beg to move,

That leave be given to bring in a Bill to establish a statutory liaison body for the sport of football, to include in its membership the various footballing authorities and their agencies, football league clubs, the Sports Council, football supporters' organisations and other necessary bodies and to make provision for changes in the organisation and function of the sport and for connected purposes. The enormity of the tragedy which took place last Saturday at Sheffield's Hillsborough stadium--where many football fans either died or were seriously injured--still lies fresh in the hearts and minds of the British people. I take this opportunity to place on record again the thanks of all hon. Members particularly those who are members of the all-party parliamentary football committee, and to all those who helped the injured or the dying in their time of need or who are now helping in whatever way they can to comfort the living.

So that there may be no misunderstanding or speculation about the reason for this Bill, I place on record the fact that the right to introduce it on the Floor of the House was gained some considerable time ago under the rules which govern the acquisition of a ten-minute Bill opportunity in this House.

The Bill has the objective of establishing a statutory liaison body for the sport of football, with a membership which includes the football authorities, their agencies, league clubs, the Sports Council, football supporters' organisations, local authorities, and others. That body has been widely recognised in this House and elsewhere as an alternative to clause 1 of the Government's proposals to introduce legislation to establish a system of compulsory ID registration for football supporters.

A measure of the strength of the Bill's proposals is demonstrated by the fact that it has considerable cross-party support, including support from the Government Benches. The Bill is supported in name by all the officers of the all-party parliamentary football committee. The Bill is also supported by my hon. Friend the Member for Liverpool, Walton (Mr. Heffer), in whose constituency Anfield football ground is located, and by my hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett) in whose constituency the tragedy occurred on Saturday. It also contains the name of my right hon. Friend the Member for Birmingham, Small Heath (Mr.

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Howell), who is regarded by many in this place and outside as the most respected Member of Parliament in terms of sporting authorities.

My colleagues and I are both mystified and saddened by the Government's decision yesterday to continue with the measures contained within section 1 of their Bill. We feel they are out of touch with the lessons of Sheffield, and the advice they have been given by nearly everyone in football. Further, I cannot personally understand the logic in proceeding with such legislation, particularly at this time. I also feel it is time for a rethink and a different approach to the needs of football--a view shared by almost everyone connected with the game.

I echo the view of my right hon. Friend the Member for Birmingham, Sparkbrook (Mr. Hattersley) that any decision should be delayed until the findings of the independent inquiry into the Hillsborough tragedy and other related matters are available.

Because of these views, Mr. Speaker, and out of respect for the bereaved families and loved ones of those involved in the recent tragedy, I have decided to withdraw my Bill at this stage in the hope that the Government will see sense.

Mr. Speaker : Order. I am afraid the hon. Member cannot do that. If he looks at "Erskine May" on page 383--I believe he has been so advised--he will see that he must proceed with this motion, having moved it.

Mr. Meale : In that case, without further ado, I formally move. Question put and agreed to.

Bill ordered to be brought in by Mr. Alan Meale, Mr. Denis Howell, Mr. Joseph Ashton, Mr. Jim Lester, Mr. Tom Pendry, Mr. Eric S. Heffer, Mr. David Blunkett, Mr. Robert N. Wareing, Mr. Harry Barnes, Mr. Brian Wilson, Mr. Peter L. Pike and Mr. Don Dixon.

Football Spectators (No. 2)

Mr. Alan Meale accordingly presented a Bill to establish a statutory liaison body for the sport of football, to include in its membership the various footballing authorities and their agencies, football league clubs, the Sports Council, football supporters' organisations and other necessary bodies and to make provision for changes in the organisation and function of the sport and for connected purposes : And the same was read the First time ; and ordered to be read a Second time on Friday and to be printed. [Bill 118.]

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Opposition Day

[7th Allotted Day] [First Part]

National Health Service

Mr. Speaker : I must announce to the House that I have selected the amendment in the name of the Prime Minister.

4.22 pm

Dr. David Owen (Plymouth, Devonport) : I beg to move,

That this House rejects the Government's White Paper on the National Health Service as the basis for legislation ; notes the rejection and reservations expressed by the Royal College of General Practitioners, the Royal College of Nursing, the Royal College of Surgeons and the Royal College of Physicians through the Joint Consultants Committee, the British Medical Association, the health service unions and the Institute of Health Services Management ; believes that practice budgets for general practitioners and self-managing hospitals will lead to financial restrictions being imposed on the doctors' right to prescribe medication and treatment for patients on the basis of what is clinically necessary, to the separation of general practitioners and hospital consultants irrevocably damaging the growing links between home and hospital care and reducing the quality of the overall service available to patients ; urges the Government to conduct pilot studies and experiments in relation to these proposals before introducing legislation and thereby to leave time for extensive consultations with the medical and nursing professions which did not take place before the White Paper was published ; and also demands that the Government announce that they will not further extend tax allowances for private health insurance or allow the cost of private medical and surgical treatment to be offset against tax since these measures would lead towards a two-tier system of health care.

The National Health Service is an issue which goes to the heart of the vast majority of the people of this country. This is therefore no ordinary debate and no ordinary subject. Ninety-five per cent. of the people of this country use their family practitioner services ; in any one day, nearly two thirds of a million people consult their doctors. An issue as important as this must therefore concern all Members of this House. It is also, of course, important that more than a million people are employed by the National Health Service. It is not new for Governments to be in conflict with the medical profession, but it is extremely rare for a Government to find themselves at odds with such a very large group of people concerned with the National Health Service. A White Paper was introduced at the start of this year without any consultation with any of the professional bodies in the National Health Service. That in itself is unique. It is thus not unduly surprising that there has been criticism--what is serious, however, is the level of the criticism. The royal colleges, which speak for the profession not in terms of salaries but in terms of education and science and professional ethical standards, are not notorious for political criticism and most Governments have been able to find some support among the royal colleges when dealing with the National Health Service. On this occasion, however, all the royal colleges--including the Royal College of General Practitioners, the Royal College of Surgeons and the Royal College of Physicians through the joint consultants' committee--have criticised the proposals. Indeed, they have gone further and rejected

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them as a basis for legislation for the future of the National Health Service. The British Medical Association and the Health Service unions have also criticised the proposals. The Health Service managers have also criticised them, although in somewhat muted terms.

Taken at face value, the Government's proposals are supposed to benefit patients, but all the patients' organisations have expressed serious concern about them. It is a matter of pride and pleasure to the Social Democratic party to have the first debate on the proposals, although no doubt it is but the first of many. Hon Members of all parties have been confronted in their constituencies with a level of criticism and concern about the Government's proposals which has led Conservative Members to be deeply worried about them. I should be surprised, although perhaps not too surprised, if Conservative Members were able to support the Government amendment to the motion. The Government seem incapable of realising the depth of opposition to their proposals.

I want first to consider the central objections to the proposals. I do not believe that the Government are proposing a genuine internal market. If they were, I should be more enthusiastic about them. Rightly or wrongly, inadvertently or otherwise, the Government have produced proposals for the commercialisation of health care in its entirety. They are not even privatising it--they are commercialising it. Furthermore, they are creating not an internal market, but an open market.

The criticism of the proposals which is heard from every lip is that they involve the fragmentation of health care. Over the decades during which the NHS has operated, an important aspect of the service has been the way in which general practitioners and hospital consultants have gradually come together to provide an integrated pattern of care from home to hospital and from hospital to home. Until the White Paper was produced, it appeared to be common ground among the political parties to support that process of integration of health care--of doctors involving nurses and nurses working in hospitals and in the community, integrating community care and hospital care as part of a continuum. Suddenly, however, without any consultation, the Government have produced proposals which separate hospital health care from family practitioner care.

The proposals refer to the "self-governing" hospital. The Government seem to be trying to incorporate in the Health Service the same principles as they have applied to schools. The terminology is similar, with references to "opting out", and the marketing arrangements are also similar. But a hospital cannot be regarded as a self-contained unit. Let us examine the parallel with schools. A comprehensive school caters for pupils aged from 11 to 16 and often to 18. The school knows what is coming through, so it can plan and project, but it is impossible for a hospital to do that. It is also extremely wasteful to consider acute hospitals as separate entities. One of the most important developments recently has been the policy to use acute hospitals intensively and on occasions to transfer patients from acute hospitals to community hospitals as a halfway house before going home. The services provided in the home--meals on wheels, health visitors, practitioner nurses and community nurses--are also an important part of the continuum of care. If provision in those areas is insufficient, people have to stay longer in hospital. If there is high-quality care in the

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community and at home, it is possible to have more day surgery--something that is increasing all the time--and shorter stays in hospital, thus cutting costs.

One of the absurdities of debates about the National Health Service that is all too often apparent in the House are the great boasts about the number of people treated in hospital. The number has increased significantly, of course, because we have been able to increase the throughput in hospitals and to shorten the time that patients spend there. That is highly desirable, but it adds to hospital costs and additional hospital personnel are needed. It is essential to see the Health Service in the round, as a whole. This is where the fundamental flaw in the Government's proposals arises. They have us talking about the self-governing hospital, when what we should be talking about is the self-governing district health authority because it is the district health authority which provides the continuum of care. We talk about general practice budgets as though the budget of the general practitioner could be separated, as though it existed in isolation from hospital costs and social services costs. When in the past such distinctions have been proposed there has been sufficient flexibility in the Health Service to take account of them.

For example, some years ago it was decided that a cash limit should be placed on hospital prescribing--I remember this because I was actually prescribing in hospitals at the time--so instead of the epileptic clinic prescribing for three months for a person being seen on a three-month cycle, one prescribed for two or three days and shunted the rest of the bill off to the general practitioner. The patient did not mind tremendously, although the general practitioner objected slightly, and we overcame the problem simply by shuffling the hospital pharmacy budget on to the general practitioner. In reality, it cost the Health Service more because hospitals prescribed cheaper drugs bought in bulk, while general practitioners prescribed drugs from the local pharmacy.

Mr. John Redwood (Wokingham) : The right hon. Gentleman is being rather negative. Can he tell us how his internal market would work? How is it possible to have an internal market without doctor choice as to consultants, without patient choice, and without some differentiation in style of hospital?

Dr. Owen : I will deal with that when I come to it in the course of my argument. I prefer to develop first the logical case that general practice costs cannot be separated from hospital costs and that hitherto there has been a thoroughly reputable movement to bring the two together, rather than to separate and fragment them.

To return to the analogy of pharmaceutical costs, if a limit is put on the family practitioner's budget as well as on the hospital budget, there will be no way out because there will be no flexibility. That is rightly seen by general practitioners as limiting their clinical freedom to choose the type of treatment that they think best for the individual patient, so if the Government insist on it they will be starting to challenge a very fundamental aspect of medical practice. These ill-thought-out proposals come at a moment when a large part of the Health Service agrees that there is a need for medical audit. There is now not only a great deal of consent to medical audit within hospitals but a growing

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recognition of a need for medical audit within general practice and of the need for the medical profession to be held accountable for the costs that it incurs. It is beginning to be recognised that one cannot have a narrow concept of medical freedom-- freedom to prescribe exactly what one wants, and to treat exactly as one wants--because that works back. As there is an overall limit to the amount of money that any Government will put into the Health Service, one has to accept some restriction on one's freedom to treat all patients as ideally as one would wish.

Medical audit--the concept of being held accountable for costs--is accepted by the medical and nursing professions and there is a growing understanding of the techniques involved, so why have the Government brought in a blunderbuss in the form of the White Paper? Why do they seek to legislate for those proposals to be applied across the board without a pilot study for a practice budget or any real understanding of self-governing hospitals other than that gained from six experiments, which have wisely been undertaken, in resource management in hospitals?

It is important to remember that, in five out of six hospitals, those responsible for the experiment in resource management have all said that it is far too early to move to self-governing hospitals and that many more lessons need to be learned. They have asked that their hospitals should continue with the experiment and not be diverted by the question of self- governing hospitals. It is not surprising that those five hospitals--the exception is Guy's--which have pioneered new techniques and want to continue the experiment, and which are going with the trend of modern medicine and modern management, should be coming out in criticism of the Government's proposals. Those who manage the Health Service say that the Government's proposals are ill thought out, with consequences that are difficult to foresee, most of them deeply damaging to the NHS.

It is not as though that was always what the Government intended. The proposition for an internal market, which the hon. Member for Wokingham (Mr. Redwood) asked me to discuss, was put into the public domain by Professor Alan Enthoven of Stanford university more than six years ago. Those proposals were bitterly criticised, often by the Department itself, as impractical and undesirable.

It is well known that the Social Democratic party thought that there was considerable merit in the application of an internal market as proposed by Professor Enthoven, but he did not propose self-governing hospitals or general practice budgets--he suggested that district health authorities should be given far greater autonomy to manage the district health authority, free from regional control, and that there should be a modest market between the district health authorities, with some element of patient choice.

We argued then, as we argued today, that the first step towards an internal market is for patients to be given choice so that, faced with a long waiting list in a district health authority--as sadly happens all too frequently, particularly in elective surgery--they should have the right to go to another district health authority with a shorter waiting list, confident in the knowledge that the bill for that will not be taken up by the district health authority which has reduced its waiting list but by the district health authority whence the patients came. That gives an incentive to districts with shorter waiting lists to take

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patients from other districts, and acts as a financial discipline on district health authorities with long waiting lists.

If a district health authority decides that it does not wish to build up its expertise or be self-sufficient in a particular speciality, it will be prepared to accept the cost, knowing what that cost will be. In such a system, the money really does follow the patient. The patient makes the choice, advised by the general practitioner who will need information about waiting lists in neighbouring district health authorities.

Not every patient can move. To put a young mother in a hospital 50 or 60 miles from her home creates a major social problem, quite apart from the considerable costs involved. Although that is the most effective way of dealing with the immediate problem of waiting lists, introducing a welcome measure of patient choice, to be realistic for poorer families it must be accompanied by generous help with the cost of going to hospital and of a minimum visiting programme. We already encounter that problem with perinatal care. Where there are not full facilities for dealing with the highly specialised treatment of prematurely born children, the mother and child have to be taken to a specialised unit. The family then faces very heavy costs for a period of six weeks or more with practically no financial support. That aspect must be dealt with.

Such a system, which is the true internal market that has been discussed for the last five years and criticised by the Department of Health, is now being thrown out of the window as being of no significance and we suddenly have a new proposal for self-governing hospitals. Where did the proposal come from? What great genius created it?

If, as is clear, the medical profession objects, as does the Royal College of Nursing, and if the Institute of Health Services Management foresees considerable problems, do the Government still intend to shunt the proposals through? Are we to have the Official Secrets Act all over again? Will Tory Members behave like Lobby fodder and vote for the proposals? There will be a test of that later today.

How can any Conservative genuinely vote for the Government amendment? Perhaps I should read it out to them. It seeks to leave out from House' to end and add

"expresses full support for the proposals set out in the White Paper Working for Patients' and believes that these will lead to a Health Service that is more responsive to the needs of patients". I hope that general practitioners in the constituencies of Conservative Members who vote for the amendment will ask a few questions tomorrow. If consultation is to mean anything, surely the Government could have phrased it better and said :

"expresses the belief that this forms a reasonable basis on which to progress, in consultation with the medical profession". We are already being told by the Minister of State that there are to be no Dr. Noes and no change in the proposals. We are told that they are to be pushed through. [Interruption.] The Minister has been widely reported as saying that there will be no Dr. Noes. If he did not say that, I am only too delighted.

The Government need to face the fact that there are serious problems in the Health Service. It has caused deep resentment in the Health Service that the White Paper did

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not in any section address underfunding. By any standards, that must be one problem. I agree that the medical profession always wants more money. The Government cannot blame it for that. The teaching profession always wants more money, too. Everybody always wants more money. But it is a fact of life that in comparison with the service in almost any other industrial democratic nation, our National Health Service is asked to carry on with a lower percentage of GDP devoted to it.

The figure in this country is 6 per cent. The average for OECD countries is 7.5 per cent. In the United States the figure is 11 per cent., and in France and Germany it is 8 per cent. to 9 per cent. We are told that the White Paper is to bring about the most radical change in health services since the National Health Service Act 1946. Yet it does not even address financial under-investment. It is no wonder that people who work in the Health Service are asking themselves, "Can the Government really be serious about these proposals?"

Only a few days ago, Bassetlaw district health authority produced an interesting proposal. Instead of asking for its hospital to be part of a self-governing unit, it put in a detailed proposal to the Ministry that it should be allowed to form a National Health Service trust and that, within the National Health Service, the whole district--hospital and community care--should be allowed to be self-governing. It also proposed that the regional health authority should hold the budget and should be the accounting officer. The district health authority went to Price Waterhouse for an assessment of its capacity to do that.

That is the internal market that is really being suggested, and I believe that a pilot study should be conducted into it. Although I am deeply committed to the whole concept of an internal market, the SDP has always argued that it cannot be introduced overnight, that pilot studies must be carried out to prove that it can be done and that the information system on which the management of an internal market critically depends does not exist in the NHS at present. We have argued that it will take many years to develop to its true sophistication before we have an internal market, such as that which I suggested at district level, operating throughout the country. Despite that, however, the Government have introduced proposals for self-governing hospitals, which people do not want. The Government want 200 to 300 of them operating by 1992. What world are they living in? It is certainly not the world in which the majority of people using and operating the NHS live.

There are technical issues. The problem with the White Paper is that of an underlying dogma which is far more ominous. With the Finance Bill we are seeing the first step towards the more dogmatised, ideological basis of the Government's reforms--health insurance tax relief for those aged over 60. Many Conservative Members voted for that proposal, but I hope that before it is implemented, and later extended to the whole of the working population, they will think through the implications. Since the original Tory opposition to the 1948 legislation, it has been a Right-wing dream to have tax relief on health insurance.

One of the more amusing issues in recent months has been the criticism of the doctors. Department of Health Ministers have claimed that if the doctors had had their way originally there would not have been a National Health Service. They forget to mention that if the

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Conservative party had had its way, there would not have been an NHS either because Tory Members of the day voted against the legislation.

Mr. Ray Whitney (Wycombe) : How does the right hon. Gentleman explain the 1944 White Paper which set out the basic principles on which the NHS was founded? The Health Minister at the time was a Conservative.

Dr. Owen : Mr. Brown's White Paper, initially in 1943, followed by the actions of Henry Willink in 1944, was one of the best examples of a coalition Government that we have seen. The social legislation of the 1940s, on education, and so on--R. A. Butler's measure--was important, and if one cares to do so, one can go back in the history of the NHS to the Socialist Medical Association of the early 1930s. Even the British Medical Association had moved its position by the late 1930s. As with most radical changes, a considerable breadth of consensus was needed. It was surprising that when the original NHS Bill came forward from Aneurin Bevan, Sir Winston Churchill and the Tory party opposed it with great vigour. Fortunately, the Conservatives did not overturn the Act in 1951 when they were returned to office.

Since 1948, the NHS has had the unanimous support of all political parties in Britain and, by and large, that has been sustained across the transfers of Government. Now, however, the Government have introduced their White Paper, and there is no question but that if there were a further extension of tax relief for private health insurance covering the whole working population, we would inexorably be heading for a two-tier health service and the American system of health care. If that were buttressed by the demands, of which we hear and about which we read in the newspapers, for tax relief on the cost of private medical treatment or in respect of private surgical treatment--we gather that that is being demanded by some Conservative Back Benchers--the movement towards a two-tier system would be very rapid indeed.

Against that philosophical background, we must consider the other aspects of the White Paper. The Prime Minister is among the small percentage of the population who do not use the NHS. She seems genuinely to believe that if one can pay for private insurance, one almost has a moral obligation to opt out of the NHS, freeing resources for use elsewhere in the service. But the NHS is based on a different concept. It is based on the principle of "count everyone in"--that everyone has insurance cover, that the service is provided for the whole of the population and that nobody, rich or poor, need opt out. There are great advantages in a health care system in which rich and poor participate and all are treated the same, with the judgment being made on the basis of clinical need. We would be taking a major step if we encouraged people to feel that they had a moral obligation to opt out of health care purely and simply because they had enough money to pay for private health insurance.

Let us look at the Government's proposals for self-governing, autonomous hospitals. It is very nice perhaps for teaching hospitals to opt out, but one of the problems of the teaching hospitals, particularly in London, is that they are already opting out of some of their community health responsibilities. If the Minister were to tell us that a particular hospital specialised in orthopaedic work, such as hip replacement operations, and was doing virtually nothing else and that there was a

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case for the hospital being autonomous and run as a self-managing unit, people would say that we ought to try it and would feel that such a move was not unreasonable, since the hospital was not providing a district service and was not part of the health care pattern. If the Government were to encourage that hospital or some other specialised hospital to opt out as an experiment, no one would get very upset about it. Our objection is to taking out the district general hospital--the very core of our intergrated health care--and managing and financing it separately.

Let us take another example. It is suggested that the hospital trusts should have different terms of employment. There is much to be said for a district health authority being the employing authority, having the freedom to employ and making its own contracts. Hospital consultants should have contracts not with the region but with the district health authority. The family practitioner committees should come under the district health authority. If one integrated the district with the family practitioner health service one would create what is, in American terms, a health maintenance organisation, and one would be much better able to achieve some of the benefits that the Government are trying to achieve with the general practitioners contract.

Many of the preventive health measures in the new GP's contract are beneficial to medicine and, operating within the concept of a district health authority, could be of great benefit. But in fact the GP practice is to be fragmented and regarded as a separate unit. That will not work, or, if it does work, it will damage the overall integrated health care pattern.

On top of this, we have been waiting for years for proposals on the community health services, but they have not yet been brought forward. How on earth is it possible to legislate for the National Health Service and to formulate views on the family practitioner service and on the hospital service without any idea how the Government intend to handle the community health service? Those concepts are not separate abstractions--they are closely integrated. Let us take, for example, the question of joint funding which I introduced when I was Minister of Health. Its prime purpose was to bring the social services, hospital services and family practitioner services together, and to provide some money to grease the wheels for integration. How can one consider this White Paper in the absence of any provision for community health? I hope that in this debate the Government will listen to the views of their own Back Benchers--to whom they listen more readily, I fear, than to Opposition Members.

Mr. Stephen Day (Cheadle) : Will they?

Dr. Owen : We must take a realistic view of these matters. I am sad about it. I should like to believe that every word that we spoke would be taken with the utmost seriousness in the Department of Health, but I suspect that four or five speeches of opposition from Conservative Back Benchers might have more impact on No. 10 Downing street, if not on the Department of Health.

This debate is our first real opportunity to flag up that the basis of the White Paper will not provide legislation which will carry the Health Service workers with the Government or carry the country with the Government but will do grave damage to the National Health Service. The question is how to get the Government off the hook.

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That is the issue that Conservative Back Benchers should be worrying about. Here there are some real possibilities that I should like to encourage the House to consider.

First, it would be much better to get the question of the GP contract out of the way as quickly as possible--"Give 'em the money, Barney" used to be the expression, or "Stuff their mouths with gold," as Aneurin Bevan put it. I admit that at one moment when we were in office and when it looked as though we had the hospital doctors, the junior hospital doctors and the general practitioners all opposed to us, we found a way of paying GPs for contraceptive advice. I felt that that was part of the contract of general practitioners and I was bitterly opposed to paying it, but I am afraid that I paid up, so it would not be the first or the last time that Governments have paid up.

That is not, however, what is necessary now because most of the criticisms of the GPs' contract can be overcome by a modification of some of the objections which are fairly soundly based. For example, the criticism made of the immunisation percentage is a real one, although I cannot for the life of me see why we do not put an obligation on parents, when their children enter school or when they claim child benefit, to show that they have participated in an immunisation programme. Making it all a responsibility of general practitioners is wrong. Parents have a responsibility to see that the immunisation programme is undertaken and it is part of the general practitioner's contract to see that it is done or done by the school health service.

Similarly with the cervical cancer smear service, the percentage figure is very high and people have reasonable objections to that. In dealing with the withdrawal of seniority payments, it is necessary to protect pension rights. Something can also be done about payment for night calls. It is not beyond the wit, certainly of the Secretary of State, if he sets his mind to it, to resolve these problems. He is obviously worried that if he makes a few concessions here the British Medical Association will come back asking for more and he will have to negotiate it.

Let the Government settle the issue of the contract in the next couple of months and then deal with the substantive problem, the National Health Service review. Having done that, let them get the GPs to accept medical audit to the extent that hospital consultants have accepted it. Let them extend resource management in the Health Service from the six hospitals that operate it now to 100 hospitals, and gradually build up an information system. Then let them conduct some experiments or pilot studies.

If, for example, a few hospitals are highly specialised and not part of the district health authority, let us have a look at running them autonomously. If there are a few people with large practices who are keen to run a practice budget, let them have a go at it. Legislation is not needed for any of that.

Mr. Day : That is exactly what is being said.

Dr. Owen : No, it is not exactly what is being said. The Government have been arguing for more than 200 hospitals to be operated as autonomous, self-governing units within a short period.

As regards practices, the Government are saying that it is up to the general practitioner--

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