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Mr. Dorrell: What I am doing is supporting a system that has led to a bigger shift of power in the health service, away from the institutions and towards the GPs, than we have seen at any time since 1948. That has been a matter of common exchange between hon. Members on both sides of the House. That aspiration has been accepted--empowering GPs because they are the people who are
closest to the patients, and allowing them to act as guides and advocates for patients finding their way around the health service.
Spokesmen on both sides of the House have argued that GPs are well placed to design a patient-centred service. The hon. Member for Peckham goes beyond that and has talked about the importance of the development of a broader range of services in primary care. She is right about that too. We have a broader range of provision of post-operative care, shared care arrangements, emergency care arrangements and better provision for GP support for cottage hospitals. All those are important examples of the developments of primary care. What the hon. Lady does not deal with is the fact that the introduction of the fundholding scheme is the biggest single step forward to the delivery of those objectives since 1948.
Mr. Charles Hendry (High Peak):
Will my righthon. Friend come to north Derbyshire to talk to fundholding doctors, including the brother of the hon. Member for Rotherham (Mr. MacShane), about the way in which fundholding benefits the patients of all doctors? Is he aware that in Glossop, because of the way in which fundholders have introduced new surgery cases and new activities at the cottage hospital, waiting lists for ear, nose and throat treatment have fallen from 20 weeks to four and for general surgery from up to 30 weeks to a maximum of eight, not just for patients of fundholders but for all patients? That shows how everybody has benefited.
Mr. Dorrell:
My hon. Friend is right, and a three-part tutorial might be beneficial. I might go to Rotherham and take the brother of the hon. Member for Rotherham(Mr. MacShane) with me to examine the role of fundholding in strengthening the voice of primary care within the national health service.
The hon. Member for Peckham used her defence to my argument in a television programme which I saw beforeI came into the House today. She said that fundholding is not necessary to the delivery of those improvements in primary care, or to the strengthening of the voice of GPs. I ask the House to pause for a moment and consider that argument. For a quarter of century, speeches have been made in the House, from both sides, about the importance of GPs and about how the NHS must deliver a more patient-centred basis of care. Nothing happened. Then we introduced fundholding and it started to happen.
Is it reasonable to assume that there is a link between those two events, or was that just a massive coincidence? Were the two events entirely unconnected? Would all the changes have happened anyway? Is that the hon. Lady's argument? The changes did not happen for a quarter of a century, but they happened on precisely the day that fundholding was introduced. Is that purely a coincidence? That is what the hon. Lady asks us to believe. The GPs know the answer and on 1 April this year over half of them will be fundholders. They are voting with their feet, and they are not voting for the hon. Lady's arguments.
Mr. Richard Burden (Birmingham, Northfield):
Can the Secretary of State explain how it is in the interest of patient care to have millions of pounds lockedaway, unused, in underspends for GP fundholders? In Birmingham, there is a £10 million underspend and the regional executive has suggested that the health authority borrow money from fundholders to get the waiting lists
Mr. Dorrell:
The hon. Gentleman must decide whether he believes the speeches that his hon. Friends have made over a quarter of a century about the best way of using health service resources.
Mr. Dorrell:
I shall come to that argument in a moment.
Does the hon. Member for Birmingham, Northfield (Mr. Burden) believe that the patients' interests are best served by empowering GPs to make decisions in their patients' interests, or does he prefer leaving those decisions to the regional health authorities which we have introduced legislation to abolish? That is the choice. The hon. Gentleman prefers to make great speeches about a primary care-led NHS. He likes to talk about devolving power to enable GPs to act as patients' advocates, but he backs away from the hard facts.
Mr. Richard Tracey (Surbiton):
Does my righthon. Friend agree that, given that 50 per cent. of the country will shortly be covered by GP fundholders, the Opposition are boxing themselves into a potential crisis? The chairman of the National Association of Fund Holding Practices, Dr. Morris, has said that if Labour ever comes to power and takes the steps it has threatened, those GPs will leave the NHS.
Mr. Dorrell:
If the hon. Member for Peckham pursued the policy that she is committed to pursuing,GP fundholders would have a difficult decision, as myhon. Friend rightly says.
The hon. Member for Peckham likes to use another argument; she points to the success--Labour's amendment points to this--of commissioners. On that point at least, I can agree with the hon. Lady. There are, of course, many GPs who are not fundholders but who are improving care as commissioning GPs. The hon. Lady should listen to the commissioning GPs to find out what caused the changes that have allowed their commissioning approach to be effective. Numerous commissioning GPs will tell her, if she listens, that it is the introduction of fundholding that has changed the terms of trade--the terms of the relationship between the primary and secondary sectors. That has made possible the success of the commissioning schemes which the hon. Lady likes to endorse.
The reality of the commitment by the hon. Member for Peckham to replace fundholding with commissioning is that it is bad news not only for fundholders and their patients, as my hon. Friend the Member for Surbiton(Mr. Tracey) said, but for the commissioners. The commissioners are taking advantage of the change in the relationship that the fundholders have brought about. That is a key argument which the hon. Lady prefers to fudge. Indeed, Labour is trying to fudge its way out of an embarrassment. Labour Members know that they are caught in a policy position that does not work. They must decide quickly whether they are prepared to opt for and
to back the fundholding scheme, which would be the best way to convert their fine words about empowering GPs into reality, or whether they confine their ambitions to fine prose and press releases, in which case they can continue their policy of abandoning fundholding.
Mr. Dorrell:
No, I will not give way, because I want to make progress. I may give way later.
Another objective to which the Labour party declares its firm attachment is innovation. Labour is right. Health care is a developing activity and it is important to maintain innovation. There are hundreds of examples of innovations that have been introduced as a result of the initiatives taken by fundholders. However, every one of those is under threat if we accept the two-tier argument that has been the chant from Labour during the debate.
The guts of the two-tier argument are that nobody can have the benefit of an innovation until everyone can have it. That is an absurd argument. What Labour seems completely incapable of understanding is that it is in the nature of an innovation that it is new and has to be done somewhere first. Furthermore, the problem is compounded by Labour's naive belief that standards can be identical in every part of the country, for every patient, all at once. Everybody knows that that cannot be true even in a static service; it is doubly untrue in an evolving service. The key issue that the House must address is not how to make the service identical for every patient everywhere--that is an undeliverable objective--but how to maintain the pressure right across the service for continuing improvement. That is the key question, and general practitioner fundholding is a key part of our commitment to seeing relentless and continuing pressure for improvement within the national health service.
That point is the key distinction between Labour's approach and the Government's approach. Labour values uniformity above all. Labour Members talk of diversity and choice, and they use the language of individual responsibility and initiative, but in their actions they opt unerringly for the uniform formula. That absolutist vision represents the hypocritical face of the Labour party. Labour Members say that they favour innovation and diversity, but they set their face firmly against the most effective way in which to bring those factors about.
The most hypocritical aspect of the whole story is the position of the hon. Member for Peckham. We know that she does not believe this absolutist claptrap; we know that she favours a policy of diversity and choice. We know that she understands that the best way to deliver high-quality social services is to encourage professional people to develop their own approach and to allow responsible citizens to choose which professionals best meet their needs.
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