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Mr. Dorrell: I begin by welcoming the hon. Gentleman to his new responsibilities. I believe that in an earlier brief he was told to think the unthinkable. I am not sure that he was regarded as a great success there; I hope that he will prove to be a more flexible thinker about health policy.
The hon. Gentleman asked me first about equity of resources. Listening to him, it was hard to remember that it was this Government who introduced the weighted capitation system, precisely to ensure that the historically inequitable distribution of resources as between one part of the country and another was remedied. It is this Government who, every year since the implementation of the reformed health service management structure, have moved the funding of the health service closer to the targets provided by that weighted capitation formula.
So I do not accept for one moment the idea that we have not, consistently and in practice, been interested in dealing equitably with the resources of the health service, directing them to the areas of greatest health need. Indeed, this was one of the very subjects that my hon. Friend the Minister for Health discussed in the primary care listening exercise: to ensure that resources in the primary care world flowed in a more equitable direction. That was one of the principal objectives of the more flexible management system that I have described and which we are committed to introducing.
The hon. Gentleman also asked me about cottage hospitals. Of course it is true that hospitals in various parts of the country will open and close facilities. I am sure that the hon. Gentleman can quote examples of certain hospitals closing when they come to the end of their useful lives. But there are not many Health Secretaries who can report to the House that they have been to Devonshire, or anywhere else, and opened two brand new hospitals on the same day. That is exactly what I did earlier this year.
The Government have been developing new community hospitals, and the fundholding scheme, which the hon. Gentleman loves to hate, has been one of the most effective mechanisms for reopening and underpinning the viability of cottage and community hospitals in the national health service.
That brings me to the principle of GP choice: the choice exercised by the general practitioner as to the best model of care to meet the needs of his or her patients. That is the principle on which this document is based. We look for new ways of delivering high-quality primary care which reflect the ideas of those who have to deliver that care.
The hon. Gentleman's party likes to espouse this cause, but then immediately makes it clear that it would remove from the table the one option that has been chosen by GPs serving 58 per cent. of the patients of this country--namely, the fundholding scheme. How can the hon. Gentleman deploy rhetoric in favour of GP choice while at the same time supporting the abolition of the fundholding scheme that has been chosen by a majority of the GPs of Britain?
Finally, the hon. Gentleman likes to raise the Aunt Sally of privatisation. I made it crystal clear in my statement that I am talking about producing a different way of delivering NHS primary care on the same terms as NHS primary care is currently available--the same charging regime for dentistry, free in general practice. Interestingly, the hon. Gentleman this afternoon avoided the simple proposition that the whole of NHS primary care since Nye Bevan's original NHS Act 1946 has been delivered by private contractors responding to contracts with the national health service--
Mr. Rhodri Morgan (Cardiff, West):
Independent.
Mr. Dorrell:
Not all independent. The pharmacist Boots is a profit-making company--
Mr. Dorrell:
I was under the illusion that it was private. Boots delivers a key NHS service as an NHS pharmacy. It is a contractor delivering an NHS service. So the hon. Member for Islington, South and Finsbury (Mr. Smith) is completely wrong to say that these proposals would let the private sector into NHS primary care for the first time. Ironically, the proposals would let trusts, the public sector, into NHS primary care for the first time. Until now, NHS primary care has been the exclusive preserve of private contractors delivering an NHS service in response to an NHS contract. I want to make that contracting regime more flexible, the better to meet the needs of patients.
Dame Jill Knight (Birmingham, Edgbaston):
Did my right hon. Friend notice an historic, perhaps even unique, event on the radio this morning, when the chairman of the British Medical Association gave his full backing to the White Paper? Is not that a first and does not it make complete nonsense of much of what was said by the hon. Member for Islington, South and Finsbury (Mr. Smith)?
Can my right hon. Friend be a little more specific about the services he envisages will be provided by optometrists? He said that he wants shared care and an extension of services for patients.
Mr. Dorrell:
I am grateful to my hon. Friend. She is right to say that it is unusual, if not unique, for me to appear on the "Today" programme alongside Dr. Sandy Macara and receive his unqualified blessing for my
The purpose of my hon. Friend's exercise was to develop a consensus in the professions about how primary care can best develop. That was reflected in the document that we published in June and it underlies the legislative proposals that I have announced this afternoon. It would be nice if those on the Opposition Front Bench shared in the consensus with those who are responsible for delivering services to patients.
As for the role of optometrists, there will be major opportunities to integrate optometrists more effectively into the primary care team; to consider the relationship between optometrists and general practitioners to ensure a proper flow of information; and to consider the arrangements for referral from optometry to the secondary care services. Those are the options for the development of optometry in integrated NHS primary health care and we shall cover them in more detail later this year in the document to which I have referred.
Mr. Simon Hughes (Southwark and Bermondsey):
Of course I join the Secretary of State in wanting a higher quality and more accessible health service that is tailored to the needs of different communities. That would be a good step forward. There are, however, differences of view between him, some of his colleagues and people in and outside the House about whether all is right with the health service at the moment, and the changes that are needed.
I ask the Secretary of State for five simple assurances. Can we have the resources that it is objectively agreed the health service needs? Can we have the additional staffing that is regarded as necessary even by independent pay review bodies? Can we have some national co-ordination, which does not currently exist? Given the announcement today in particular, can we have an assurance that the new primary care system will be free from commercial profit-making at the expense of the health service? Can we be assured that companies, whether Tesco or Asda, Tarmac or Wimpey, will not be able to employ people in the health service and make profits for the private sector at the expense of patients?
Mr. David Congdon (Croydon, North-East):
What about Boots?
Mr. Hughes:
Not Boots, which is a drug company that deals with pharmacists; I mean any company that could employ GPs.
Mr. Dorrell:
The hon. Gentleman raises a huge range of issues that I cannot deal with in any substance in an answer to a question. We shall continue to ensure that the staffing is available to deliver the kind of service we describe. I must point out, as the Prime Minister did a few moments ago, that we have seen a huge growth in NHS staffing since 1979--[Interruption.]--in clinical staffing, and we have also seen a huge increase in the resources available to the health service, including £4.8 billion over and above inflation in this Parliament alone. Staffing and resources continue to be key concerns of any Health Secretary, as does proper co-ordination.
The hon. Gentleman seems to believe, somehow, in a pure service with no profit motive, which is the only sort that he conceives can be of benefit to patients. Life is much more complex than that. Boots delivers an NHS service: the NHS pharmacy service. Boots and every other NHS pharmacist deliver that service for a profit. The independent contractors who deliver NHS general practice also do it for a living--that is to say, for a profit. Drug companies that sell drugs through the dispensing service do it for a profit. I am interested in a proper reward for those who deliver an efficient, high-quality service for the patient. Provided that I am satisfied that those tests are passed, I am willing to consider proposals made with the support of the professional staff concerned.
Madam Speaker:
Order. The last hon. Member who put a question asked five questions. That is totally unfair, but I allowed him to do so because he speaks for his party on these matters. That was the only reason. Given the number of hon. Members who seek to put questions on this statement, I cannot be fair and call them if we have long questions and long answers. I am sure that the House will oblige: I want brisk questions and brisk answers.
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