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5.53 pm
Dame Jill Knight (Birmingham, Edgbaston): I am glad to have the opportunity to make a brief speech in support of the motion. Fundholding has a proven record of success, and it is one more milestone on the road of the Government's achievements in modernising, improving and enhancing our British health service. It cannot be said often enough that our health service today is better than it has ever been in the whole of its history.
Fundholding has indeed done all that the motion says it has. Fundholding doctors know from experience how advantageous it has been for patients, in enhancing primary care and in giving doctors the tools with which to improve their practices.
Doctors who have learnt the advantages at first hand have been talking to their friends, and fundholding is soaring. At the beginning of 1991-92 only 7 per cent. of practices were fundholding. In two months' time the proportion will be 51 per cent. That alone, quite apart from anything that my right hon. and hon. Friends orI may say, is a clear sign of how much the GPs like fundholding systems.
Fundholding has brought so many advantages to patients that I have time to list only a few of them. The range of treatment now available has now improved so much since fundholding started. The quality of care has improved and, as the Opposition agree, waiting lists are much shorter. There has been a reduction in bureaucracy, and services such as chiropody, which is most important for elderly people and makes all the difference to their lives and to whether they can get about without pain and discomfort, have improved.
The minor operations done by doctors in their practices since fundholding began have also helped a great deal.I could also say much about dermatology, because I was closely involved for a long time as the president of one of the groups of people in my area who suffer from skin diseases. Treatment for all such conditions and many others are now available within practices.
That has made a tremendous difference to the burdens that hospitals have to bear. Hospitals today are carrying out more and more complicated operations and treatments, and they need all the alleviation of their work load that can be provided. Fundholding has made an important contribution there. As my hon. Friend the Member for Broxbourne (Mrs. Roe) said, doctors can now negotiate directly with hospital consultants in a way that was not possible before. That, too, has been a help.
Practice nurses are important, because their presence has improved primary care. I was amazed when I learned that since fundholding was introduced the number of practice nurses has increased by 261 per cent. That is marvellous news. I spoke to a practice nurse recently, and she was eulogistic in her support of what had happened in fundholding practices.
Doctors have been able to use the savings to improve their waiting rooms, and in other small ways whereby patients' comfort can be increased. That is most important. Fundholding has given doctors a power over their own domain that they did not have before.
I have always felt that those nearest the point where money is spent, those who know the score and know the specific problems, should decide how money should be allocated. That is equally true of school budgets. Those, too, are better decided by heads and governors than by education committees. Doctors running practices know better than health authorities where money is most needed and how it should be spent.
The Labour party disagrees with all that--at least,I think that it does. It is sometimes difficult to figure out what Labour Members are really saying--especially now we know that, although the motion uses the words of the right hon. Member for Derby, South (Mrs. Beckett), the Labour party apparently proposes to vote against what she said.
Labour's response to the fact that the treatment of patients is very much better than it was is absolutely typical. Labour cannot deny that patients are receiving much better treatment. Indeed, Opposition Members are not advancing that argument--
Dame Jill Knight:
I said that I would make a brief speech. The Opposition are whingeing and whiningthat patients of doctors who are not fundholders are disadvantaged. The argument is not that patients of fundholding practices are getting a bad deal. Those patients are getting such a good deal that it infuriates the Labour party because the service for everybody else is not improving as well.
Mr. Hinchliffe:
They are getting no service. That is the problem.
Dame Jill Knight:
I understand that constant attention is paid to ensuring that money is as fairly allocated as possible between fundholding practices and non-fundholding practices. The difference is that fundholding practices are managing their money much better.
Conservative Members want the benefits that patients of fundholders receive to be spread all over the place. There is no absolute ban on the number of doctors who can become fundholders. There is a stipulation about the size of the practice, but many doctors have overcome that problem by amalgamating with other practices. The Government have not said, as one would think from listening to Labour Members, that nobody else is allowed to become a fundholder because the number is limited. Conservative Members are trying to spread far wider the undoubted benefits of fundholding, which is absolutely right and proper.
The Opposition will have problems if they rubbish fundholding. Although their argument today has not been that fundholding is wrong, they still want to get rid of it. That is extraordinary. The Labour party should recognise that the British Medical Association has given fundholding the seal of approval for good housekeeping, and patients most certainly approve of it.
I am sorry that the hon. Member for Nottingham, South (Mr. Simpson) could not wait to hear the rest of the debate and has already left the Chamber as I wanted to raise a particular point with him. He said that patients were not very keen on fundholding. If patients are receiving so much better treatment from fundholding doctors, why should they not be keen on the system? They are very keen indeed.
The support for fundholding among doctors who have experienced it is undeniable. The National Audit Office has approved of it; the Public Accounts Committee has said what a good system it is. The hon. Member for Peckham (Ms Harman) seemed to imply that theKing's Fund did not approve of the system. I wonder whether she has read the 1994 report which evaluatedNHS reforms and described fundholding as one of the major successes of the reforms. So how can the hon. Lady suggest that the King's Fund is not in favour of fundholding?
It is clear that the Labour party will meet strong opposition to its policy to abolish fundholding. I wonder whether it will include that policy in its manifesto at the next election.
Dame Jill Knight:
Good--that will mean many thousands more votes for us. What a good idea that is. [Interruption.] Labour Members are stuck with it now. They will have to put it in the party's manifesto. Will they argue with the BMA, doctors, patients and theKing's Fund? They should ask themselves whether all those people can be wrong. Labour is in a tizzy--it is in a mess.
I am sorry that the hon. Member for Peckham has left the Chamber as I should have liked to draw her attention to the many instances in her speech when she seemed to be facing both ways. For instance, she complained that money which ought to be used for patients was wasted in fundholding practices on management, but at the same time she had to admit that those patients got better care than any patients of non-fundholding practices. She cannot have it both ways, although she loves to try.
I do not know what the Labour party intends to do, although it has proposed some alternatives--joint commissioning came up again today. So far as I can gather, there is little support for that among doctors who happen to be in the Labour party. I read that the Labour party is suggesting shadow budgets. Labour Members are so used to being shadows that they advocate them even for doctors. Long may they continue being shadows.
Mr. Simon Hughes (Southwark and Bermondsey):
Anybody without prior knowledge of the subject who heard this debate would have thought that it was a dialogue of the deaf and would probably have left without being further enlightened. Although the benefits and disbenefits of fundholding have been cited, nobody so far has explained what fundholding is intended to achieve.I shall describe why I think that the debate has so far been a dialogue of the deaf.
The position of my right hon. and hon. Friends is clear from the amendment that we tabled. Although Madam Speaker did not select it for debate, it is on the Order Paper and sets out what we believe. There are problems with the other two expressions of party opinion. The Government motion, which is fine so far as it goes, does not admit that there is anything wrong with the system at all.
The Labour party's amendment, which rightly points to the failures of the system, does not specifically address the question asked by, for example, the hon. Member for Birmingham, Edgbaston (Dame J. Knight). Does it imply the abolition of fundholding? I have read the Labour party policy document and I know that it proposes the replacement of fundholding with commissioning, but the question of abolition is not answered. Fundholding GPs would want to know the answer to that question.
Despite this rather unsophisticated debate, it is none the less obvious why there is such a difference of view. It is clear that the system that the Government set up to devolve power to GPs by giving them budgets enabling them to buy their own health care for a specific list of activities--obviously not forms of acute care and the like--has been welcomed by some GPs, who see it as an advantage. It is also abundantly clear that the system has produced innovation and a knock-on effect on the way in which other practices are organised.
Disparity of treatment in some areas--described in the document to which the hon. Member for Peckham(Ms Harman) referred, and which, courtesy of thehon. Member for Workington (Mr. Campbell-Savours), has found its way to the other side of the Chamber--has arisen because when hospitals are deciding who is first on the list for treatment, they have to make a choice between keeping fundholding practices happy and keeping the local health authority happy. Non-fundholding GP practices do not have the individual clout of fundholding practices as customers in the marketplace. For example, if GP fundholders do not get put first in the list, they may take their business to another provider or trust. Therefore, the trust will lose out and its budget and prospects will be reduced. That is why there is a difference.
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