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Mr. Eric Martlew (Carlisle): In 1977, Cumbria had one health authority and the only salary paid was £2,000, to the chairman of that quango. Today, Cumbria has two health authorities and seven trusts at a cost of £332,000. Is that money not spent on bureaucracy?
Mr. Dorrell: The hon. Gentleman is wrong in several respects. In 1977, every part of the country was covered by a general practitioner committee, health authority, area health authority and regional health authority. [Hon. Members: "No."] Labour Members may deny that that happened, but in 1977, every part of the country was within a health region, area and district--and was also covered by a family practitioner committee. Another problem for the hon. Member for Fife, Central (Mr. McLeish) is that Labour is committed to maintaining the distinction between health authorities and health providers.
Two other factors make the Opposition's claim of £1.5 billion savings wholly absurd. One of the big administrative savings which we made in recent years was from the abolition of regional health authorities--which Labour voted against. Removing that unnecessary tier produced savings of £100 million. The £2.4 billion spent on administration accounts for 7.5 per cent. of the NHS total spend. How much does the hon. Lady intend to save from that sum? I have already committed the Government to a programme of administrative savings to reduce administrative costs by £300 million, which is 1 per cent. of the total. If the hon. Lady thinks that she can go beyond that, she owes it to the House and to the country to explain how.
Mr. Simon Hughes (Southwark and Bermondsey):
NHS consultants, the Royal College of Nursing, the British Medical Association and family doctors, apart from asserting that the money spent on administration is
Mr. Dorrell:
I have implemented the recommendations of two efficiency scrutinies which were designed to reduce unnecessary administrative processes. When the Leader of the Opposition addressed the National Association of Health Authorities and Trusts last week, he acknowledged that nowhere in the health service was there an appetite for further fundamental administrative reform, which is why I am confident that Labour would not deliver the pledge that it is fond of making, to abolish the internal market. I am confident, because when Labour Members are asked to demonstrate how they would do that, they never can.
Another question for which we await an answer from Labour Front Benchers relates to fundholding, which has troubled them ever since fundholding was established. The policy background is clear. More than one half of GPs have opted into fundholding because they believe that it delivers the best prospect of care for their patients. [Hon. Members: "No."] Labour Members must ask GPs what other purpose they had. If GPs do not believe that fundholding offers the best prospects of improving patient care, one must inquire why they made that choice.
Mr. Kevin Barron (Rother Valley):
What about the Audit Commission?
Mr. Dorrell:
The Audit Commission recently examined fundholding, and its director was asked about its report. He said on radio:
Does the hon. Member for Fife, Central speak directly and with authority for Labour on the subject of fundholding? On 6 March, he went to Guildford--to the South Thames Fundholders Association--and, to that assembly, committed a Labour Government to abolish fundholding. His words were:
Mr. McLeish
indicated dissent.
Mr. Dorrell:
So it is not the Labour party's policy to abolish fundholding? We cannot run fundholding without
Ms Harman:
I have said that we will replace GP fundholding with GP commissioning. We will do that not only because GP fundholding is unfair, part of a two-tier system, and because it makes it impossible to plan improvements across a locality, but because it costs hundreds of millions of pounds in bureaucracy and provides no extra benefit for patients.
If there is a simple choice between employment of more practice managers or administrators to support practice managers and more health visitors or midwives--that is, in fact, the choice--we will choose to put cash into front-line patient services. We will not, as the Secretary of State is doing, champion mountain upon mountainous layer of extra bureaucracy. How on earth can he justify that?
Mr. Dorrell:
No one can say that I have not given the hon. Lady an opportunity to clarify the policy. The hon. Member for Fife, Central was clear: he said that fundholding would end. The hon. Lady has refused to endorse that policy. If the hon. Gentleman wishes to remove any doubt, I shall give way.
Mr. McLeish:
I am very happy to put the record straight. With his experience, the Secretary of State should be a bit wiser in the material that he uses. The simple fact is that, after addressing a group of south Thames fundholders at their invitation, three of the fundholders--whom I regard as enthusiastic fundholders--provided copy to the periodical to which he referred.
All the comments which were made were complete and utter lies. I cannot say anything more to put the record straight. They were made deliberately to achieve that in which the Secretary of State is indulging. I regret that, but I hope that I have put him straight on the record. I tell him sincerely that those comments and ideas attributed to me were not simply wrong; they were untruths.
Mr. Dorrell:
I accept that the hon. Gentleman was not accurately reported in that meeting, which, in itself, is not the most important issue in the world. What is important is for those who work in the fundholding system to know whether Labour would end fundholding. We still do not have an answer.
Mr. Dorrell:
In that case, why is the hon. Member for Fife, Central at such pains to deny that he defended Labour policy to the south Thames fundholders? It is true or is it not true?
Mr. McLeish:
I expect a great deal more from a struggling Secretary of State. We are replacing fundholding. Read my lips: we are replacing fundholding. I said that the comments to which he referred were simply
Mr. Dorrell:
I understand what happened at the Thames meeting. I am simply picking up on the question of the word "end". I asked whether the Labour party would end fundholding.
Mr. Dorrell:
Again the hon. Member for Peckham says, "Yes." Why is it that the hon. Member for Fife, Central leaps to his feet to deny that he used the word "end" when he went to the south Thames meeting on 6 March? The truth is that Labour Front Benchers have not agreed among themselves--still less have they agreed with anyone else in their party--what their policy is, and that is true not only on the fundholding issue.
The same problem exists on the private finance initiative, which is an absolutely key issue for the NHS. The PFI offers the health service the prospect of escape from a system of capital planning of which it has been a prisoner since the day it was established. The PFI offers escape from short-termism. The Leader of the Opposition understands that. He said:
So the senior people in the Labour party are quite clear where they stand on the PFI--they are in favour of it. The hon. Member for Rother Valley (Mr. Barron) is also in favour of it; he is another member of this "team". He said:
The hon. Member for Rother Valley is keen to be on the record as supporting the PFI. He is a shrewd fellow and clearly thinks that it is more important to his career to be close to the Leader of the Opposition than to be close to his boss on the Front-Bench team--because the hon. Member for Peckham does not support the PFI. His boss on the Front-Bench team takes a distinctively different view of it. She said that the PFI was
"Most fundholders have . . . produced some benefits for patients and 10 per cent. of fundholders have done very well indeed."
Given that 10 per cent. of fundholders have done well and all fundholders have produced some benefits, what is the proper response? We are clear that the right way forward is to level up. Where 10 per cent. of fundholders have led, we should encourage and ensure that others follow, to deliver the same benefits to their patients. Fundholding and the system that lies behind it are a ratchet to improve standards and efficiency. Labour takes a different approach. I want a precise answer to this question.
"Fundholding will end on 31 March 1998",
the year after an election, assuming that it would take place next spring. He went on to say:
"The Audit Commission has shown that fundholding managers have not achieved anything worth saving. They will go."
Is that true? The hon. Gentleman said that fundholding managers will go?
"The PFI is right in principle."
That may be the only matter on which he agrees with the right hon. Member for Kingston upon Hull, East (Mr. Prescott), who claims paternity of the PFI.
"We do not disagree with the PFI. How could we? . . . It was Labour who first thought of partnerships between the public and private sector."
I am not sure that the idea of partnerships between the public and private sector did not antedate the foundation of the Labour party, if truth be told.
"a new trick to privatise the Health Service."
She also said:
"I don't call it the Private Finance Initiative, I call it a privatisation initiative."
We are entitled to know which of these various stars among Labour Front Benchers speak for the Labour party on health. They speak with different voices on different days to different audiences.
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