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Ms Harman: If the Secretary of State wishes to intervene, will he confirm that he will abolish the extra-contractual referral system, which we warned all along was wrong? Will he abolish it and put the £22 million that it costs every year into patient care? Will he admit that we were right and that the system was market madness?
Mr. Dorrell: The hon. Lady has accurately described the process of the extra-contractual referral system as it now is, but she has omitted to mention that I announced a month ago that it will be simplified.
Ms Harman: I know well the announcement that the Secretary of State made a month ago. I read the document, which has the catchy title "Seeing the wood, sparing the trees"--it emanates not from the Ministry of Agriculture, Fisheries and Food, but from the national health service executive. I have examined carefully what the Secretary of State plans to do with extra-contractual referrals. He seeks not extra-contractual referrals, but compliance with a protocol: it is the same market madness. Until the Secretary of State recognises that he cannot run the service through the market, he will continue to pour hundreds of millions of pounds into bureaucracy that should go into patient services.
The Government are seeking protocol compliance instead of extra-contractual referral approvals. But it will make no difference: it will still tie up GPs, hospital consultants and those in the health authority. However, instead of ECRs, it will be protocol compliance. That is nonsense.
Mr. Dorrell:
You don't understand it.
Ms Harman:
We understood it when the White Paper was put before the House. We predicted what would happen, and it has.
Mr. Dorrell:
The hon. Lady responded to my challenge when I said that she did not understand it. She cannot understand it if she claims that the health authority will still be involved in the approval of ECRs. That is what we are abolishing.
Ms Harman:
Health authorities will be involved in drawing up the protocol and establishing compliance with it. They are specifically included in the protocol requirements with which GPs must conform. It is not me, but the Secretary of State, who does not understand how the system will work.
It cannot be right that, while more managers are being appointed to run the internal market, the number of nurses on the wards is being cut. There are now 20,000 more managers in the NHS than there were five years ago. At the same time, there are 50,000 fewer nurses on the wards. That means that there are more people to count the cost of care and fewer people to provide it. The expenditure
of public money must command public support. The public do not want to see money drained from their front-line services into bureaucracy.
There is no point in the Secretary of State saying that he will reduce the number of managers and that he is "bureau-sceptic". His Government created the internal market and that system demands bureaucracy. Until he scraps the market, the demands for red tape will grow and grow. The administrative costs of the NHS have soared from £2 billion to £4 billion in the past 10 years. But that is only the beginning, because the market is still in its infancy. Only half of GPs are fundholders. If the Government were to take forward their plans and all GPs were to become fundholders, administration costs would double.
A hospital that is quoted in the Secretary of State's report complains that it must have 900 separate annual contracts with 900 different fundholders. If the Tories got into office again, that hospital would have 2,000 fundholders and 2,000 separate annual contracts. It would have to send out hundreds of thousands of invoices every year.
As I predicted, the Secretary of State has said that his recent efficiency scrutiny report will reduce bureaucracy in the NHS. However, the savings that he purports to announce do not exist--they are wishful thinking. It is an inescapable fact that his system--the internal market--drains £1.5 billion a year from patient care into bureaucracy. The Government cannot scrap the bureaucracy because they will not scrap the internal market. They will not do what the people want: cut the red tape and put the money into patient care.
The provision of public services must command public support. Public services must provide what people want and people's expectations will change over time. Labour will renew the NHS. We will strip out the market, strip away the bureaucracy and put the money into patient care. We will also recognise changes in people's lives and in their aspirations. People want services that fit in with their lives--they do not want to reorganise their lives around service provision. People do not want to have to wait and then receive an appointment card through the post--which probably arrives while they are on holiday--telling them when it is convenient for the NHS to treat them.
Last year 5 million patients did not turn up for out-patient appointments--the technical term is "Do Not Attends". Those 5 million people received appointments without being asked whether they could make them and they were unable to cancel them. People receive appointment cards through the post--at last notifying them of the date of their appointment--but if they try to contact the service provider they may get an answerphone or they may be referred to someone else. Therefore, they are unable to cancel their appointments.
People want to book a time for treatment that fits in with what is going on in their lives. It should not be a matter of waiting until a person is told when his or her hernia operation will be done. People should be able to choose the time so that an operation interferes with their work or family arrangements as little as possible. People want a say in where, when and how they are treated. They do not want to wait. The private sector knows that, which is why the newspapers and our letter boxes are full of invitations to go private.
The advertisements say, "The NHS makes you wait. You don't want to wait and you don't have to wait--go private". The system then becomes more unfair and more expensive. Those who can afford it, go private--many of them reluctantly. Those who cannot afford it are left using a service that inexorably becomes a poor service for the poor. Any service that is used exclusively by those who have no other choice is doomed to decline. A public service cannot thrive on a captive audience. While more and more people become refugees out of the NHS, those who cannot afford to pay to go private are left behind. They are not grateful, but resentful because they cannot get the care that they need promptly. People should not have to pay to go private: they should get what they need on the NHS. The Government should cut the waste and cut the waiting. They will not, but Labour will.
The choice before the country is clear: a struggling NHS that is being stripped back to a safety net under the Tories or a one-nation NHS that is renewed as a public service under Labour. The British people want Labour's future for the NHS. That is one of the many reasons why Labour must become the Government after the next election.
Madam Deputy Speaker:
For the convenience of the House, I inform hon. Members that Madam Speaker has decided that there shall be a 10-minute limit on speeches between the hours of 7 pm and 9 pm.
The Secretary of State for Health (Mr. Stephen Dorrell):
I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:
What are the hon. Lady's answers to the questions about the future of primary care? What are her answers to the questions about the future of mental health care and cancer care? How would she organise training and research within the national health service? How would she address the questions of clinical effectiveness that are at the core of modern health care delivery?
The most important question from the British Medical Association this week is how much money Labour would put into the national health service. Will Labour give a commitment to deliver more than an average of 3 per cent. growth in real terms over 17 years? That is what we have done since 1979. Will Labour commit itself to matching our funding record for the national health service?
Ms Harman:
When the Secretary of State mentions the increase in resources that he has taken from the public
5.7 pm
'congratulates the staff of the National Health Service for providing high quality care to a record number of patients, and notes that their achievements have been underpinned by the Government's unique commitment to increasing National Health Service funding, which has meant an extra £9.5 billion since 1992, and is dismayed that the Opposition proposals put ideology before patients, in particular by removing the option of fundholding from the 50 per cent. of general practitioners who have decided that this system offers the best prospect for their patients.'.
This afternoon, the House has witnessed yet again a spectacle with which we have become depressingly familiar during health debates. The hon. Member for Peckham (Ms Harman) had time to set out clear answers to the questions that many people within and outside the national health service are asking about the Labour party's future policies for the NHS.
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