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Mr. Dorrell: It is certainly true that we have seen a huge growth in the number of care beds for the elderly in private nursing and residential homes. We know that 80 per cent. of them are supported by public funds. There is a delivery of quality care to elderly people which was undreamed of 20 years ago. The hon. Gentleman should talk to the staff of the NHS. He will find that the huge majority of them are proud of the service that they deliver. Of course they want to deliver more service, but they recognise that the service that they have been delivering has been developing and growing and treating more patients year by year since 1979. They deliver and they know that it is a growing service.
Mr. Nicholas Winterton (Macclesfield): Having had to use the services of a non-fundholding practice during the summer recess on two occasions, may I vouch for the excellent quality and speed of service that such practices provide? Having visited a community pharmacy at its request to see the valuable job that it does, may I endorse what has been said about the vital part that such pharmacies play in the community?
To pick up the point of the hon. Member for Alyn and Deeside (Mr. Jones) about the problems that they will encounter as a result of the activities of the superstores--may I say that I have managed to obtain the services of a salaried dentist for my constituency, there having been inadequate NHS dentistry?--I can vouch for the flexibility of the NHS, which appears to be the main feature of my right hon. Friend's statement. Am I right in saying that the Government have pledged to spend more on the NHS above the rate of inflation for every year that we Conservatives are in government after the next election?
Mr. Dorrell:
My hon. Friend is right in almost everything that he has said. In particular, he is right to say that we are committed to continue to support a growing and more flexible health service. As he rightly said, flexibility is the main purport of the proposals that I have announced this afternoon.
Rev. Martin Smyth (Belfast, South):
I endorse the comments about community pharmacies, which want to play a bigger role. The Minister has said, "if pilots are successful". He has said also that they will be monitored and
Mr. Dorrell:
When we introduced pilot fundholding in the National Health Service and Community Care Act 1990, a number of general practitioners who saw the fundholding scheme in operation decided that they wanted to join it. They saw how they could deliver best care to their patients. That was their evidence. The numbers have grown, and now 58 per cent. of patients are covered by the fundholding scheme. I regard pilot fundholding as having succeeded.
The majority of GPs now want to apply the scheme to the benefit of their patients. I have set out in my statement the way in which we intend to pilot a range of different contracting models to ascertain which ones best deliver the claims made for them. What we shall probably find, I suspect, is that some will work in some areas and others will work in other areas and people will learn by the experience of having piloted them.
Mr. John Marshall (Hendon, South):
Will my right hon. Friend congratulate GP fundholders, such as Dr. Brian Golden in my constituency, who have used the opportunities presented by fundholding to perform many more minor operations in the surgery rather than the hospital; who have widened the number of clinics on offer; and who have substantially reduced waiting lists? Is this not the sort of progress that most people welcome, even if the Opposition want to get rid of it?
Mr. Dorrell:
My hon. Friend is right on every count. Fundholding has been a huge success. That is not to undermine the point made by my hon. Friend the Member for Macclesfield (Mr. Winterton)--that there are plenty of high-quality GPs who choose not to be fundholders.
Mr. Kevin Barron (Rother Valley):
What about the 42 per cent?
Mr. Dorrell:
I was just talking about them, if the hon. Gentleman will contain himself in silence for a moment.
There are non-fundholding GPs who also deliver high-quality service--that is perfectly true--but fundholders have been at the cutting edge of the changes in the relationship between primary and secondary care, and some of them have delivered stunning improvements in the quality of care that they deliver to their patients.
Mrs. Alice Mahon (Halifax):
Does the Secretary of State agree that one service that GPs need to retain is the right to send patients to the hospital of their choice? What will he do about the right and the choice of GPs who want to send their patients to the Hillingdon hospital trust if they happen to be over 75 years of age? What choice will GPs in Halifax have to send patients to the new hospital when it is built and the number of beds is reduced from 850 to 500? Will that be a cut-off point based on age?
Mr. Dorrell:
The position in Hillingdon is that the patients who are being talked about are those who live in
In terms of GP choice, the best way for a GP to ensure that he or she can refer his or her patients to the hospital of choice is by becoming a fundholder, because a fundholder is free to place the contract with whichever hospital they choose. If a GP is not a fundholder, every health authority is under an obligation to discuss with its GPs where facilities are provided. On other occasions, the hon. Member for Islington, South and Finsbury is very fond of pointing out that there is a range of different models for consulting GPs, between the health authority and GPs, which have grown up throughout the country and are not fundholding. Fundholding gives the doctor the right to decide all these other models, which the hon. Gentleman quite rightly on other occasions--
Ms Tessa Jowell (Dulwich)
indicated dissent.
Mr. Dorrell:
The hon. Lady cannot just dismiss them, because all her friends on the Labour Front Bench like to talk these schemes up. There seems to be a bit of a muddle about what Labour policy is. These commissioning schemes allow GPs to be consultees, whereas fundholding allows them to decide it for themselves.
Mr. Congdon:
May I welcome the extra flexibility that the White Paper provides for community pharmacists, whether they make a profit or whether they are Boots? Does my right hon. Friend agree that community pharmacists often provide a valuable service to people whether or not they have recently visited their local GP? Will he consider further measures to extend the range of drugs that pharmacists can dispense without prescription?
Mr. Dorrell:
As my hon. Friend knows, that matter is subject to constant review. It is important that drugs that do not need, from a medical safety point of view, the control of prescription access should not be on that list when they do not need to be. That is subject to regular review, but I am sure that my hon. Friend would not wish those decisions to be made on anything other than medical safety grounds.
Mr. Nigel Spearing (Newham, South):
Is it not unfortunate that a significant proportion of resources provided by health authorities are now based on deficit and debt? Is the Minister aware that his departmental answer to me of 22 July refused to provide figures showing the degree of NHS debt on the basis that they were not suitable for publication? He has not, as he knows, replied to my letter on that subject of 31 July. Will he be present himself in the House tomorrow evening to answer an Adjournment debate on both those particulars of failure?
Mr. Dorrell:
I cannot undertake to be present in the House to respond to the debate, but I shall undertake to ensure that I know what will be said before it is said.
Mr. Max Madden (Bradford, West):
What proposals are contained in the White Paper for tackling the drugs
Mr. Dorrell:
The range of services provided to people suffering from drug abuse is subject to national monitoring and some national guidance in terms of protocols and the kind of services which are most effective. Evidence is collected nationally, but it is far better that the service should be designed locally. The more flexible contracting regime which will be delivered by the proposals may well have a significant role in ensuring that we are better able to meet the needs of the type of patient whom the hon. Gentleman describes.
"the results will be evaluated."
Is that an admission that, at an earlier stage of reform of the NHS, pilot studies were not evaluated and that we went down the road of reform far too fast without having the facts before us? Is a plea being made for more certainty on this occasion?
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