| Previous Section | Index | Home Page |
Mr. Deputy Speaker:) Order. Time is up.
8.31 pm
Mr. Peter Luff (Worcester): Having listened to the speeches of the hon. Members for Carlisle (Mr. Martlew), for Birmingham, Northfield (Mr. Burden) and for Coventry, North-East (Mr. Ainsworth), I have started to feel sorry for the Opposition. I realised that they have to believe--or try to believe--the worst of absolutely everything, when the reality--if only they would look at it objectively--is so very different. I now know where Eeyore's sad and gloomy place is--on the Opposition Benches.
If time had permitted, I had hoped to share with the House an article written by Roy Porter, a medical historian at the Wellcome Institute for the History of Medicine, that states that the problem goes back some 200 years to the 18th century. It is not so much new Labour as very old Labour indeed.
How refreshing it was to hear the speeches of Conservative Members, particularly the speech of my hon. Friend the Member for Beckenham (Mr. Merchant). My experience reflects his. New facilities have been provided in partnership with the private sector at Evesham community hospital and the Spring Gardens health centre in Worcester. The Worcester royal infirmary has a new accident and emergency service and improved rheumatology services, and we are to have a new hospital at last, having been in the queue for 30 years.
Opposition Members wring their hands in despair at delays of a year here and there. I do not want delays in the building of hospitals, but we have been waiting 30 years for a new hospital under the old Treasury capital funding system, and the PFI gives us the hope of getting one at long last.
The short title of the debate is "Bureaucracy and Patient Care in the NHS". We are all enemies of bureaucracy and in favour of patient care. Bureaucracy is a word that was coined in the 19th century. John Stuart Mill wrote in the "Westminster Review" of
My right hon. Friend the Secretary of State reminded us that, when the right hon. Member for Derby, South (Mrs. Beckett) was the Opposition spokesman on health, she said on television:
I am dispirited by the dishonesty of Labour's attack. A year or two ago, the Opposition targeted company cars, some of which are used by district nurses and health visitors. They totally ignored the reclassification of many nursing grades as managers in their artificially inflated figures for so-called bureaucracy, and, as Conservative Members have repeated time and again, they have resisted every serious attempt by the Government to reduce bureaucracy. They have opposed it nationally and locally.
Labour voted against the abolition of regional health authorities. That saved hundreds of jobs in my region, and released thousands of pounds for better patient care. Locally, the former Labour leader of Worcester city council recently urged his Labour colleagues on the community health council to vote against the merger of two community health trusts. That would have reduced bureaucracy and released funds for patient care. Labour says one thing and does another.
When will Labour come clean on where it stands on my right hon. Friend the Secretary of State's attempt to reduce administrative costs by 5 per cent. in cash terms or 8 per cent. in real terms? It is extraordinary that we have heard nothing about that.
Of course I understand that the change that the Government have brought to the health service threatens established relationships. It makes consultants feel uncomfortable and imposes extra burdens on GPs, but huge benefits flow from that change. GPs are responding magnificently in seeking to reduce bureaucracy. The "GP links" initiative has reduced the number of forms that GPs need to fill in for the health authority. Many practices have direct computer links to the health authority, vastly reducing the administrative burden.
The "patients, not paper" initiative has responded to exactly the same concern. Extensive consultations with GPs and practice managers have achieved dramatic results. Forms have been simplified and eliminated, in a way that would gladden the heart of my right hon. Friend the Deputy Prime Minister.
Form GMS1 for patient registration replaces eight old forms. The new maternity form GMS2 replaces three old forms. Form GMS3--the multi-purpose claim form for non-registered practices--replaces eight old forms. Form GMS4 is a new payment booklet that replaces nine old forms. Those four new forms replace 28 old forms. What an achievement that is, and what a dramatic increase in bureaucracy. For the benefit of Hansard, that was said with irony.
GP fundholders have cut red tape. They are providing in-house services leading to better patient care and less bureaucracy. They provide physiotherapy services,
out-patient clinics and surgical procedures. Some GP practices even offer vasectomies. There are electronic links with hospitals making direct bookings for day case surgery offering patients the choice when they want to be treated. They are improving communications with consultants and reducing unnecessary follow-up out-patient attendance by seeing their patients in their surgeries. They are providing better patient care and less bureaucracy time and again.
Where does Labour stand? What is Labour's policy? I think that we heard it from the Front Bench, although I was unclear earlier. It is to strengthen the power of bureaucrats in the national health service by abolishing GP fundholding and returning responsibility for purchasing to the health authority bureaucrats--managers, as I prefer to call them. They are the very managers who now recognise with stark clarity that GPs are in the best position to manage patient care.
The role of NHS managers in a primary care-led NHS should be to facilitate greater purchasing by GPs. They should manage the performance of GPs and hold them to account, but they should not buy services for patients they do not know and will never meet. The success of GP fundholding in my area is a great tribute to the system, and all the scare stories have been proved false. No practice has overspent in the year that has just ended, and the resources have been used by GPs significantly to improve services. They have done so, for example, by increasing the number of social workers in practices.
The trouble that the Labour party has in this debate is the thought that dares not speak its name and which lurks behind all its rhetoric. The shadow Chancellor will not let Labour Members speak that thought, which is, "Is there more money or not?" That is the question they cannot and will not answer. It is true that the UK spends less on health than most other OECD countries, but that is not because the Government have not provided the expenditure. Other countries are spending more because there is increased spending by free citizens on private health care. Perhaps that is a policy that Labour might like to consider--giving people choice, something that the Conservatives favour.
The BMA says that an extra £6 billion is needed--a figure plucked from the air. It reminds me of what J. Paul Getty said in response to the question, "How much money does it take to be happy?" He replied, "Just a little more." That seems to be the policy of the BMA. In fact, the Government have given a lot more, but there has been little gratitude from the BMA. I must be careful what I say here, but I work in the Lord Chancellor's Department as a PPS, and I am used to professional groups wanting "a little more" and dressing it up as professional concern.
Labour's misrepresentation constantly shocks and amazes me. It chooses the few figures that suit it, and ignores all the others. There are great Labour press releases about the reduction in bed numbers. However, I judge the success of the NHS not by how many beds it has, but by how healthy the country is and by how many patients it treats. The NHS is not an hotel--it is meant to make people better.
"that vast net-work of administrative tyranny . . . that system of bureaucracy, which leaves no free agent in all France, except the man at Paris who pulls the wires."
A bureaucrat is defined in the Oxford English Dictionary as
"An official who endeavours to concentrate administrative power in his bureau."
We are all against bureaucracy, but I hope that we are in favour of management. There are four pages in the Oxford English Dictionary defining management, and almost all are complimentary. I thought that it was common ground across the House.
"I don't think it's really in question any more that the traditional NHS was under-managed".
One would not think that from the speech of the hon. Member for Peckham (Ms Harman) this afternoon.
| Next Section
| Index | Home Page |