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Mr. Dorrell: I have already said so, and I agreethat identical principles underlie fundholding and grant-maintained schools.
The way to improve a state-provided service is to encourage a diversity of approach in the professions and encourage the professions responsible for delivering the service to try new ways to deliver the service. Thehon. Member for Peckham endorses that principle by her private action yet refuses to apply it in the portfolio for which she has policy responsibility.
Mr. Dorrell:
I want to make progress. I will give way to the hon. Member for Hampstead and Highgate(Ms Jackson) in a few moments.
I want to begin at the beginning of fundholding. My right hon. and learned Friend the Chancellor of the Exchequer was the Minister responsible for introducing fundholding. He did it for a simple reason: he wanted, and wants, to make the national health service more accountable to its patients. He wanted to accept the
challenge implicit in the rhetoric about patient-centred care and a flexible health service responsive to its patients, and make those phrases real.
The hon. Member for Peckham made her approach to the subject clear from the start. She said that
Six years later, the evidence on that subject is decisive. She was wrong.
From 1 April 1996, more than half the patients ofNHS general practitioners will be served by fundholding GPs. The hon. Member for Peckham was wrong then in her predictions, just as she is wrong now in her policy prescriptions.
Mr. Dorrell:
I have undertaken to give way to thehon. Member for Hampstead and Highgate in a moment.
The hon. Member for Peckham is now wrong in a different sense, because she now makes a different charge. On 9 November 1995, in Doctor magazine, she said:
That is insulting to the half of NHS GPs who have opted for a voluntary fundholding scheme. It implies that a few letters from me and my predecessors have led them to adopt a scheme that they believe is damaging to their patients and the NHS. Further, I believe that it is a wilful misrepresentation of the facts.
In saying that, the hon. Member for Peckham knows perfectly well that the fundholding scheme is voluntary, that more than half of NHS GPs have opted to join that voluntary scheme and that the words of her1990 prediction are on the record, and she feels the urge to explain them away. She will have to think of a better explanation if her remarks are to carry any conviction.
Ms Glenda Jackson (Hampstead and Highgate):
Is there not another similarity between grant-maintained schools and doctors' fundholding? The imposition of both was fiercely opposed by the professionals--schoolteachers, governors and parents, and certainly the majority of doctors--yet both groups were aware that the only way to provide the necessary educational and medical services was to take the money that the Government were offering them in only one way.
I refer the Secretary of State back to innovative practices. There is little that is innovative about elective surgery, but last year the Whittington hospital in my constituency issued a directive that all elective surgery must stop, save for patients of GP fundholders. If that is not a two-tier system, perhaps the Secretary of State could explain what it is.
Mr. Dorrell:
The hon. Lady is simply wrong, as I said in replying to the hon. Member for Fife, Central. [Interruption.] She is wrong about that fact, just as the hon. Gentleman was wrong to describe the comments of the right hon. Member for Derby, South as "old hat".
The hon. Member for Hampstead and Highgate is wrong because she has said that GP fundholders have more resources available to them to care for their patients than other GPs in the health service. That is not true.
The resources available to GP fundholders are provided on exactly the same basis as the resources that are available for other forms of patient care.
Rev. Martin Smyth (Belfast, South):
I share the Secretary of State's views about the improvement thatGP fundholding has made. The fault with the two-tier system lies not so much with the GP fundholders as with the providing authorities, which are leaving much elective surgery until the end of the year because they can then obtain the roll-over from the health authorities. Is that not the real issue, as the Korner statistics show?
Mr. Dorrell:
The hon. Gentleman makes a very good point. He is correct in pointing out what is happening in different parts of the country where GP fundholders are finding better ways of using the resources at their disposal. As a result, the standard of service that GPs are delivering to their patients--which is measured in waiting times and in a variety of other ways--is being ratcheted up. I do not apologise for that fact: fundholding and the other reforms were introduced partly to improve patient service.
The hon. Gentleman is quite right to point out the second-stage effect. Once a fundholder has found a way of improving the care available to his patients, the system is deliberately established to apply pressure to other fundholders--and to purchasing health authorities acting on behalf of non-fundholders--to raise the quality of service, leading to a relentless improvement in the quality of care that is available across the health service.
I shall return to the question that troubles thehon. Member for Peckham. Why was her prediction wrong and why do more than half of the doctors now plan to be fundholders from the beginning of April? If she will not accept my explanation of why people are opting for fundholding, perhaps she will listen to the words of some independent and friendly advisers. Howard Glennerster said that GP fundholding
That is the reason why GPs are opting for fundholding.
Mr. Alan Milburn (Darlington):
And Julian Le Grand?
Mr. Dorrell:
It is not just Howard Glennerster. I do not intend to quote Julian Le Grand today, but perhapsI shall return to him on another occasion. Brian Abel-Smith, the former special adviser to Lady Castle, who was one of the last Labour Health Secretaries of State, said:
The same theme was picked up by Kathy Jones writing for the Fabian Society. The hon. Member for Fife, Central might do well to read some of the Fabian Society material as it is rather more inspired than some of his speeches. Kathy Jones said:
Those three quotations are from three different sources, each of them putting the finger on the real reason--not the cosmetic reason that the hon. Member for Peckham
prefers, but the real reason--why GPs are opting for fundholding. Not just those commentators but the 13,500 GPs who will be fundholders from April understand the shift in emphasis that has occurred in the national health service as a result of the introduction of fundholding.
Does the hon. Member for Peckham believe that all those people--all 13,500 GPs and all those advisers--are knowingly undermining the health service? Are they all engaged in a conspiracy to break up a service to which they have given their lives? That is absurd. I have quoted the evidence I have about the support for my policy from people responsible for actually delivering the service. The question I am putting to the hon. Lady and herhon. Friends is whether they believe that all those people who are opting for those changes are doing so because they share the suspicion that that is a desirable way of breaking up the health service. That is the charge the hon. Member for Fife, Central levels at me, but--much more damagingly for him--he is levelling it at 13,500 GPs operating in the national health service.
Mr. Deputy Speaker (Mr. Michael Morris):
Order. It is no good Back Benchers standing up for the whole afternoon when it is clear that the Secretary of State is not giving way.
Mr. Dorrell:
The quotations that I have offered, andI could have chosen a thousand others, demonstrate why doctors are opting for fundholding. They are doing so because fundholding is a means of delivering the objective that so often in the past has been espoused by Opposition Members as a desirable health policy objective--the empowerment of GPs and the strengthening of the role of GPs in the health service.
Mr. MacShane:
May I tear the Secretary of State away from his Oxford Union practice, which will be useful when he is in opposition, and bring him to the point about GP fundholders? In my part of the world, and I hope that the Secretary of State will listen, it is GP fundholders themselves who are concerned about the fact that if they nominate someone for a hip replacement at the Royal Hallamshire hospital in Sheffield it will be done in12 weeks, but if a non-fundholding GP down the road does the same--and they are all in the same business--the person has to wait 52 weeks. GP fundholders are also concerned that if they put money into private hospitals, it is denied to NHS hospitals that have to provide accident and emergency cover, which the private hospitals do not.
"there is no support among GPs for the concept of fund-holding practices."--[Official Report, 15 March 1990; Vol. 169, c. 687.]
"Fundholding was not a GP idea. It was imposed on doctors".
"has produced a shift in the balance of power back to general practice for the first time this century."
"Fundholding represents a major transfer of power from specialists to GPs".
"Fundholding gives GPs leverage over hospital doctors, changing the balance of power between them."
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