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Mr. Dorrell: My hon. Friend is precisely right. I shall quote some of the speculations of the hon. Member for Peckham on why my hon. Friend's constituents have opted for fundholding. He gave us the answer first: they opted for it because they believe that it is the best way to improve the care that is available to their patients and, furthermore, to give full expression to their commitment to the principles of the national health service.
Mr. Ronnie Campbell (Blyth Valley): Is it not true that the patients of fundholders are getting preferential treatment for operations in hospitals? We have some evidence of that. Is it not a two-tier system?
Mr. Dorrell: It is also true that 70 per cent. of the patients in the hon. Gentleman's constituency are covered by fundholding practices. That reflects the choice made by GPs operating in that health area on how best to serve the interests of their patients and to ensure that an improved national health service is delivered, not just to their patients but to those of all GPs operating in the NHS.
Mr. Simon Hughes (Southwark and Bermondsey): I want to pursue the question asked by the hon. Member
for Blyth Valley (Mr. Campbell). A psychologist working in the NHS with whom I spoke on Sunday confirmed that GP fundholders get preferential treatment for their patients from him and his colleagues at the hospital, not because they want it but because they have the resources to buy it. Will he confirm that that is the position and that the perception in every health authority is that those who have the funds call the tune?
Mr. Dorrell: The hon. Gentleman's intervention is based on a total misapprehension of the position. He can substantiate his proposition that the patients of a particular doctor have an unfair advantage only if the resources available to that doctor to deal with the patients on his list are more generously provided than the resources available to NHS patients as a whole. Within a fundholding practice, a doctor or group of doctors make choices about the use of resources, which certainly allow them to improve the NHS care available to their patients--that is why they do it. That is done on the basis not of an unjust allocation of resources but of better use of the resources available to them.
Mr. Dorrell: I will not give way now, but I will do so again later.
Last October, the right hon. Member for Derby, South (Mrs. Beckett) accepted an invitation to speak to the National Association of Fund Holding Practices. For once, that brought a Labour health spokesman, the predecessor to the hon. Member for Peckham, not up against Ministers, whom the Opposition no doubt think are easy conventional targets, and not in a television studio, but face to face with fundholding GPs--individual doctors committed to the principles and future of the national health service, who had decided that it was in the interests not merely of their patients but of their commitment to the health service as a whole to opt for fundholding. It is interesting to examine what the right hon. Lady said when she was face to face with an audience of fundholders:
[Hon. Members: "Ah.] My hon. Friends should wait, because there is more to follow. She continued:
I cannot detain the House with the entire speech, although there was some good stuff in it, but she also said:
Mr. Denis MacShane (Rotherham):
Will the right hon. Gentleman give way?
Mr. Dorrell:
No, I am going to make my point.
Those three sentiments, every one of which I agree with, have been brought together by the Government in the motion. The motion that the House is invited to agree is no more than the bringing together of those three sentiments out of the mouth of the right hon. Member for Derby, South, coupled with the obvious policy conclusion that, if it is that good, we had better have more of it.
When Labour Members later this afternoon choose to substitute, if that is what they vote to do, the words of the amendment tabled by the hon. Member for Peckham, they will be voting against the words spoken by their health spokesman of only three and a half months ago. It must be relatively rare for the Government to table a motion for debate in the House the sentiments of which were drafted exclusively by the person who held the shadow health portfolio until only months ago.
It is properly described as hypocrisy for the Labour party to endorse a spokesman who went to Harrogate to talk to fundholding GPs in October last year and then invite hon. Members, as no doubt the hon. Member for Peckham will in a few minutes' time, to reject those words when safely away from the audience of fundholders.
Mrs. Alice Mahon (Halifax):
The right hon. Gentleman referred earlier to verbiage about two-tier services. Does he recall that I wrote to him in November and sent him a copy of a letter from a GP in my constituency? At that time, there were no GP fundholders in Halifax. The GP complained that when he desperately needed clinical psychology services for a patient, he was told by the trust to which he tried to refer her that there were no services for anyone who was not from a GP fundholding practice. The only service available was a Relate counsellor. He pointed out that that was not what he wanted and had to wait a considerable time before the health authority eventually referred the woman to a BUPA hospital. Is that not a classic example of two-tier fundholding? Why should that patient not have access to a service to which GP fundholders' patients have access? Why should she have to wait?
Mr. Dorrell:
The hon. Lady said that there were virtually no fundholders in her constituency. In fact, the health authority that covers her constituency will, from next April, have 44 per cent. of its patients covered by fundholders. She is not precisely right.
Mrs. Mahon:
On a point of order, Madam Speaker. The right hon. Gentleman must get it correct. That is not true in Halifax. It is no good using somebody else's constituency.
Madam Speaker:
That is not a point of order. I am sure that if the right hon. Gentleman is incorrect about fundholding in the constituency of Halifax, he will make a correction.
Mr. Dorrell:
As you know, Madam Speaker, health authority and constituency boundaries are not precisely the same. The health authority that covers the hon. Lady's constituency--and this is what I said--will, from next April, have 44 per cent. of patients covered by fundholding practices.
Mrs. Mahon:
Will the right hon. Gentleman give way?
Mr. Dorrell:
I shall give way once more and then I shall answer the hon. Lady's point.
Mrs. Mahon:
Will the right hon. Gentleman guarantee that patients in my constituency who need a clinical psychologist will be able to get one as quickly as would GP fundholders' patients?
Mr. Dorrell:
I will guarantee that in the hon. Lady's constituency, just as in the rest of the health service,
Mr. Dorrell:
I wish to make progress, if I may.
I return to the words of the motion--the words first spoken by the right hon. Member for Derby, South to the National Association of Fund Holding Practices. On24 January 1996, two weeks ago, I quoted those words in the House and the hon. Member for Fife, Central(Mr. McLeish) said, "This is old hat." Three and a half months is a long time in Labour party politics. He was wrong; it was not old hat. It was a flash of inspiration. St. Paul travelled the road to Damascus; the right hon. Member for Derby, South travelled the road to Harrogate. Converts are always welcome.
The right hon. Member for Derby, South is not old hat; Labour's policy on fundholding is old hat. Yet again, the Labour party is on the wrong side of an argument. It is the repeated experience of Labour and Labour Members in the past 20 years. They fought against privatisation of nationalised industries, and history passed them by; they fought for unilateral nuclear disarmament, and history passed them by; they fought against a framework of law for trade unions, and history passed them by; and they fought--how they fought--against GP fundholding, and history is in the process of passing them by on that subject as well.
Mr. John Marshall (Hendon, South):
Does my right hon. Friend agree that the principles of GP fundholding are the same as the principles of grant-maintained schools--that the budget is delegated downwards? Does he find it strange that a person who approves of, and is willing to use, a grant-maintained school opposes the principle of GP fundholding?
"We want genuinely to pay tribute to the role that you as fundholders . . . have played in kick-starting and developing innovative practice in both primary care and the acute sector."
"We understand and welcome the advances that fundholding has brought to many patients."
"I do accept that fundholding has acted as a lever to improve services."
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