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Sir Roger Sims (Chislehurst): As my right hon. Friend will realise, an increasing role will need to be played by nurses, particularly district nurses, health visitors and practice nurses. It is now four years since Parliament approved legislation to enable nurses to prescribe yet we are still waiting for the evaluation of the first pilot sites. Will my right hon. Friend give more priority to nurse prescribing and expedite its implementation?
Mr. Dorrell: My hon. Friend is on to an important point. Some real benefits can be secured through the extension of nurse prescribing provided that it is done in a properly evaluated and disciplined way. The Government are committed to that process. The practice-based contract concept--one of the specific objectives of this legislation is to allow that concept to be developed--will allow broader scope for nurses to deliver primary care services, subject to proper medical oversight. That will allow the development of the independent professional nursing practice that my hon. Friend seeks. It is an attractive option, but it must be introduced in a properly disciplined and controlled way.
Mr. Hugh Bayley (York): The Secretary of State sought to reassure the House that the Government provide for a fair and equitable distribution of NHS resources through their capitation funding formula, but he has forgotten that that funding formula applies to hospitals, not to primary care, which is the subject of this statement. Is he aware that present funding for Cornwall health authority provides enough money for one GP for every 1,660 people in Cornwall, while the funding for Rotherham provides only for one GP for every 2,250 people? What will he do to distribute primary health care money equitably? If he does not distribute it equitably, all his proposals for buying in care from salaried doctors will mean nothing, because the purchasers of care will not have the money to do it.
Mr. Dorrell: The hon. Gentleman clearly was not listening to what I said. I specifically said that the
extension of the weighted capitation basis of funding to primary care was one of the issues that my hon. Friend the Minister for Health raised in the listening exercise and is one of the issues that we are working on.
Mr. David Sumberg (Bury, South): Will my right hon. Friend confirm the vital importance of GP fundholding to primary care? Is he aware that Bury has one of the largest numbers of fundholders in the country? When I meet those fundholders next month, may I confirm that the reports in the press about a change in Labour party policy are totally untrue, and that the Labour party remains committed to abolishing fundholding and all the services that it provides? In the unlikely event of a Labour Government, that step would do great damage to my constituents.
Mr. Dorrell: My hon. Friend may be interested to know that today I was given a document entitled "The Labour Party Policy Handbook 1996"--dateline October 1996. My hon. Friend will be interested to hear that it is in loose-leaf format, so clearly a certain flexibility is intended. With that caveat, the document--it was published within the last 14 days, so it is hot off the press--says that it is Labour party policy to replace fundholding with GP commissioning. I understand the word "replace" to mean that one thing will take the place of another--in other words, fundholding will be abolished. Every GP fundholder, servicing 58 per cent. of patients in this country, should take that into account as we approach the election. The Labour party would abolish fundholding--the option that has been chosen as being in the interests of 58 per cent. of patients.
Mr. Barry Jones (Alyn and Deeside): Will the Secretary of State assure us that the worrying closures of community pharmacies will cease? Is he aware that pharmacies fear the abolition of retail price maintenance and that I have received many petitions about the matter? Supermarkets can close community pharmacies.
Mr. Dorrell: The question of retail price maintenance falls outside the specific responsibility of the Department of Health, and I do not accept that its abolition has inevitable consequences for the viability of the pharmacy network.
I am committed to the development of NHS pharmacy as a key element of primary health care. One simple statistic makes that clear: 3 million people go to pharmacists every day for some kind of health or health-related product. It is a key element in the primary health care team and in the delivery of an integrated national health service in Britain.
Mr. Andrew Rowe (Mid-Kent):
I am at least as great a supporter of the purchaser-provider split as Dr. Sandy Macara, but my right hon. Friend may be aware that in west Kent we are suffering badly as a result of the purchasing authority's failure to control the over-expenditure of fundholding GPs. That is seriously damaging the morale of non-fundholding GPs and provider trusts, which are performing extremely well. Will my right hon. Friend give a commitment to investigate how that situation may be improved in future, and how we may mitigate the damage done so far?
Mr. Dorrell:
I shall certainly look at the position in Kent, as my hon. Friend has suggested. The responsibility
Mr. Dafydd Wigley (Caernarfon):
I welcome the Government's much-needed U-turn on community hospitals. Does the Secretary of State agree that every town of any size should have a proper, modern community hospital, that that will be facilitated and that the private finance initiative, which has held back many community hospital schemes, will not be used in that way any longer? Local authorities should be allowed to proceed without going down that delaying route.
Mr. Dorrell:
The hon. Gentleman is wrong on both counts. The PFI does not hold back community and cottage hospitals: it is the means by which community and cottage hospital projects may go ahead, if there is demand in the area, without having to wait for the capital flow to be approved by the Department of Health and the collective processes of Government.
As to the hon. Gentleman's allegation that this is a U-turn, the most powerful weapon for re-establishing and expanding support for community and cottage hospitals in Britain is the GP fundholding scheme that the Government introduced in 1991. Fundholders, acting on behalf of their patients, have made it clear that they want local community hospitals and are prepared to be involved in the management of medical cover within those hospitals in order to ensure more local care delivery to their patients. That approach is dead right, and I am happy to endorse it.
Dr. Charles Goodson-Wickes (Wimbledon):
My right hon. Friend will be aware that I practised as a physician in the national health service for a number of years. However, he may not be aware that I was on the receiving end of NHS services for much of the recess and thus was able to do a good deal of consumer research. Apart from the superb accident and emergency and in-patient treatment that I received, the most profound and agreeable aspect of my treatment--
Mr. Dennis Skinner (Bolsover):
Private.
Dr. Goodson-Wickes:
NHS, and it always has been for every member of my family. There was superb liaison between GPs, district and community nurses and pharmacists--it could not be better. Is that not an example of Conservative policies raising the level of service for the benefit of the whole community?
Mr. Dorrell:
I am pleased to welcome my hon. Friend back from whatever problem he encountered. He is a clear example of the NHS having worked successfully. I am pleased also to be able to congratulate him on his recovery. His experience--the service he received--is the experience of the huge majority of NHS patients. People regularly say, "I have been lucky." But people who receive high-quality care from the NHS are not lucky; it is the overwhelming experience of the majority of NHS patients.
I am pleased to join my hon. Friend in recording the fact that the care delivered by today's practitioners and professional staff within the NHS is without historical parallel. It is better than it has ever been. It is the Government's determination that it should continue to get better. We shall continue to give those within the NHS the tools to ensure that that happens.
Mr. Skinner:
Is the Minister aware that there is a clear distinction between those who have treatment in the NHS and praise the nurses and the doctors for helping them to get well, and those who take a political stance in the knowledge that, after 17 years of Tory rule, NHS staff are fed up with the way in which the Government are ruining the health service?
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