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Mr. Mellor : The document is full of references to preventive medicine, with no suggestions of how to bring it about. The Opposition want preventive medicine but they abuse the contract which is the only way of requiring general practitioners to practise it--

Ms. Harman : Hospitals being paid for how much work they do is a reference in our document not to the internal market but to activity-based budgeting. [Laughter.]

Mr. Mellor : That is illiteracy. One must be able to cost the activities before starting to budget for them.

The hon. Lady is on much safer ground when coming out with the old claptrap in the policy document about private practice, or saving the unions' bacon by not allowing competitive tendering, or about having health authorities that would consist of representatives of local government, health workers and voluntary agencies--so Southwark council, after the triumph of Nye Bevan lodge, would also run the local health service--

Dame Elaine Kellett-Bowman : Will my hon. and learned Friend give way?

Mr. Mellor : In the time that remains, I should like to turn to some of the constructive points that have been raised. I know that my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman) is very concerned about self-governing hospitals.

The expressions of interest in self-governing status are a sign that, whatever hostilities may exist towards the White Paper in some circles, people at the grass roots are recognising the opportunities that the White Paper offers. After all, many of our great hospitals were organised as self -governing hospitals before 1974. Self-governance represents the freedom of action that special health authorities already have.

The Secretary of State will determine, after representations, whether hospitals should be self-governing ; he will examine the credibility of the plans put to him. We hope

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that they will succeed. There will be a phased implementation. Some hospitals will volunteer to come in, others will not initially, although no doubt they will when the scheme becomes a success. I guess that my hon. Friend the Member for Lancaster is particularly concerned to know whether, if a self-governing hospital does not work out, it can withdraw and return to its previous status within the NHS. There is no question of any hospital being outside the NHS--so suggestions to the contrary are spurious.

There will be no cash limits on what general practitioners may prescribe for patients--they can prescribe whatever they want--but they will have to justify their prescribing practices to show whether they are over- prescribing or prescribing over-expensive brands of drugs instead of generic alternatives. What business would ignore £2 billion of costs and allow those who spend the money to be wholly oblivious of value for money?

In the end, the ideas in the White Paper are far too serious to be treated with the derision that the Opposition direct at them. To describe what the White Paper sets out to do I can do no better than quote a document which says, referring to the White Paper : "The programme seeks to preserve the basic principles on which the NHS was founded and to tackle its weaknesses through a series of incremental and imaginative reforms. These reforms centre on the introduction of incentives to doctors and hospitals to provide services that are more responsive to patients. In tandem, competition between providers will be used to stimulate greater efficiency in the use of resources."

Those flashing insights come from Marxism Today. What better commendation to shatter the Opposition? I urge my colleagues to support the White Paper in the Division Lobby.

Question put, That the amendment be made :--

The House divided : Ayes 184, Noes 253.

Division No. 196] [10.00 pm


Abbott, Ms Diane

Adams, Allen (Paisley N)

Allen, Graham

Anderson, Donald

Archer, Rt Hon Peter

Armstrong, Hilary

Ashley, Rt Hon Jack

Ashton, Joe

Banks, Tony (Newham NW)

Barnes, Harry (Derbyshire NE)

Barnes, Mrs Rosie (Greenwich)

Barron, Kevin

Battle, John

Beckett, Margaret

Beith, A. J.

Bell, Stuart

Benn, Rt Hon Tony

Bennett, A. F. (D'nt'n & R'dish)

Bermingham, Gerald

Bidwell, Sydney

Blair, Tony

Blunkett, David

Boateng, Paul

Boyes, Roland

Bradley, Keith

Bray, Dr Jeremy

Brown, Nicholas (Newcastle E)

Buckley, George J.

Caborn, Richard

Campbell, Menzies (Fife NE)

Campbell, Ron (Blyth Valley)

Canavan, Dennis

Carlile, Alex (Mont'g)

Cartwright, John

Clark, Dr David (S Shields)

Clarke, Tom (Monklands W)

Clay, Bob

Clelland, David

Clwyd, Mrs Ann

Cohen, Harry

Cook, Frank (Stockton N)

Cook, Robin (Livingston)

Corbett, Robin

Cousins, Jim

Cryer, Bob

Cunliffe, Lawrence

Darling, Alistair

Davies, Rt Hon Denzil (Llanelli)

Davies, Ron (Caerphilly)

Davis, Terry (B'ham Hodge H'l)

Dixon, Don

Dobson, Frank

Doran, Frank

Duffy, A. E. P.

Dunnachie, Jimmy

Evans, John (St Helens N)

Ewing, Mrs Margaret (Moray)

Fatchett, Derek

Fearn, Ronald

Field, Frank (Birkenhead)

Fisher, Mark

Flannery, Martin

Flynn, Paul

Foot, Rt Hon Michael

Foster, Derek

Foulkes, George

Column 1095

Fraser, John

Fyfe, Maria

Garrett, John (Norwich South)

Godman, Dr Norman A.

Gordon, Mildred

Gould, Bryan

Graham, Thomas

Grant, Bernie (Tottenham)

Griffiths, Win (Bridgend)

Grocott, Bruce

Harman, Ms Harriet

Henderson, Doug

Hinchliffe, David

Hogg, N. (C'nauld & Kilsyth)

Holland, Stuart

Home Robertson, John

Hood, Jimmy

Howarth, George (Knowsley N)

Howells, Dr. Kim (Pontypridd)

Hoyle, Doug

Hughes, John (Coventry NE)

Hughes, Robert (Aberdeen N)

Hughes, Sean (Knowsley S)

Hughes, Simon (Southwark)

Illsley, Eric

Ingram, Adam

Janner, Greville

Jones, Ieuan (Ynys Mo n)

Jones, Martyn (Clwyd S W)

Kaufman, Rt Hon Gerald

Kennedy, Charles

Kilfedder, James

Lamond, James

Leadbitter, Ted

Leighton, Ron

Lewis, Terry

Lloyd, Tony (Stretford)

Lofthouse, Geoffrey

Loyden, Eddie

McAllion, John

McAvoy, Thomas

McFall, John

McKay, Allen (Barnsley West)

McKelvey, William

McNamara, Kevin

Madden, Max

Mahon, Mrs Alice

Marek, Dr John

Marshall, Jim (Leicester S)

Martin, Michael J. (Springburn)

Martlew, Eric

Maxton, John

Meacher, Michael

Meale, Alan

Michael, Alun

Michie, Bill (Sheffield Heeley)

Michie, Mrs Ray (Arg'l & Bute)

Mitchell, Austin (G't Grimsby)

Moonie, Dr Lewis

Morgan, Rhodri

Morley, Elliott

Morris, Rt Hon A. (W'shawe)

Morris, Rt Hon J. (Aberavon)

Mowlam, Marjorie

Mullin, Chris

Murphy, Paul

Nellist, Dave

Oakes, Rt Hon Gordon

O'Brien, William

O'Neill, Martin

Orme, Rt Hon Stanley

Owen, Rt Hon Dr David

Pendry, Tom

Pike, Peter L.

Powell, Ray (Ogmore)

Prescott, John

Primarolo, Dawn

Quin, Ms Joyce

Radice, Giles

Randall, Stuart

Redmond, Martin

Rees, Rt Hon Merlyn

Richardson, Jo

Robertson, George

Rogers, Allan

Rooker, Jeff

Ross, Ernie (Dundee W)

Rowlands, Ted

Ruddock, Joan

Sedgemore, Brian

Shore, Rt Hon Peter

Short, Clare

Sillars, Jim

Skinner, Dennis

Smith, Andrew (Oxford E)

Smith, C. (Isl'ton & F'bury)

Smith, J. P. (Vale of Glam)

Snape, Peter

Soley, Clive

Spearing, Nigel

Steel, Rt Hon David

Steinberg, Gerry

Stott, Roger

Strang, Gavin

Straw, Jack

Taylor, Matthew (Truro)

Turner, Dennis

Vaz, Keith

Wall, Pat

Wallace, James

Walley, Joan

Wardell, Gareth (Gower)

Wareing, Robert N.

Welsh, Andrew (Angus E)

Welsh, Michael (Doncaster N)

Winnick, David

Worthington, Tony

Wray, Jimmy

Tellers for the Ayes :

Mr. Frank Haynes and

Mrs. Llin Golding.


Adley, Robert

Aitken, Jonathan

Alexander, Richard

Alison, Rt Hon Michael

Amery, Rt Hon Julian

Amess, David

Amos, Alan

Arbuthnot, James

Arnold, Tom (Hazel Grove)

Ashby, David

Baker, Nicholas (Dorset N)

Baldry, Tony

Banks, Robert (Harrogate)

Batiste, Spencer

Bendall, Vivian

Bennett, Nicholas (Pembroke)

Biffen, Rt Hon John

Blackburn, Dr John G.

Blaker, Rt Hon Sir Peter

Body, Sir Richard

Boscawen, Hon Robert

Boswell, Tim

Bottomley, Peter

Bottomley, Mrs Virginia

Bowis, John

Boyson, Rt Hon Dr Sir Rhodes

Braine, Rt Hon Sir Bernard

Brandon-Bravo, Martin

Brazier, Julian

Brooke, Rt Hon Peter

Brown, Michael (Brigg & Cl't's)

Browne, John (Winchester)

Bruce, Ian (Dorset South)

Buck, Sir Antony

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