House of Commons Hansard Debates for 25 Oct 1996 (pt 1)

We, your Majesty's most dutiful and loyal subjects, the Commons of the United Kingdom of Great Britain and Northern Ireland in Parliament assembled, beg leave to offer our humble thanks to Your Majesty for the Gracious Speech which Your Majesty has addressed to both Houses of Parliament.--[Sir Norman Fowler.]

Question again proposed.

Social Policy

9.34 am

The Secretary of State for Health (Mr. Stephen Dorrell): It is good, in a crowded House on a Friday morning, to see two of the three Opposition health spokesmen whom I have faced as Secretary of State for Health in the past 15 months. Perhaps group therapy will lead to greater clarity of health policies for the Labour Front Bench this morning.

The purpose of today's debate is to examine the social policy measures in the Queen's Speech, which contains a wide variety of different aspects of social policy. The Bill to be presented by my right hon. Friend the Secretary of State for Education and Employment is at the heart of the development of social policy; the various Bills promoted by my right hon. and learned Friend the Home Secretary are at the heart of the delivery of a stable society and of social policy; and the Bill that I and my hon. Friends from the Department of Health will present to the House to develop primary care within the national health service is a key part of the Government's programme for the last Session of this Parliament.

First, I shall set out the background to the introduction of that primary care Bill, the approach that we take to developing NHS primary care and why we regard it as a key element of the totality of the national health service. As I have said many times, I regard NHS primary care and, within primary care, the family doctor service, as the jewel in the crown of the national health service. It is one of the success stories of the NHS--

Mr. Frank Field (Birkenhead): Does the Minister intend to speak to the Bill?

Mr. Dorrell: It is a success story, and I should have thought that the hon. Gentleman would agree with that. It is a widely held view within and outside the health service, and abroad, that NHS primary care is one of the national health service's success stories. It is a success because it has been built on some key principles: first, that patients choose the GP with whom they register. The service is available universally to any patient who wishes to use it, but which practice delivers it to an individual patient is a matter of patient choice. The second principle is that, once a patient has chosen the practice with which he or she wishes to register, the patient becomes the

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responsibility of that practice. That important principle underlies all the reforms to be set out in the Bill that we shall introduce and the policy papers that will follow it.

NHS primary care is not simply a service available to people who walk through the door. When a patient registers with a general practitioner, a GP accepts responsibility for health promotion and health advice, and general responsibility for the health of that patient. That is why we have introduced cervical smear programmes targeted on a GP's whole patient base; that is why we have introduced targets for childhood immunisation; and that is why last autumn I renegotiated the arrangements for delivering health promotion to patients registered with a general practice. The principle that, having chosen a general practice, patients are on a register and the practice recognises its responsibility for the whole practice population, is an important principle of NHS primary care.

Mr. Nigel Spearing (Newham, South): I am grateful to the Minister for giving way so early in his speech, but this is a matter of cardinal importance. He rightly emphasises the importance of the patient. Does he agree that the changes envisaged in the White Paper will encourage competition between health practices, bringing in new sources of finance, perhaps under the private finance initiative or through borrowing? It will turn practices into businesses of which doctors must take account. Some of us feel that that would be to the detriment of patients. Does the Minister agree?

Mr. Dorrell: May I suggest to the hon. Gentleman that we shall have a more structured argument about that proposition, which I know some of his hon. Friends will want to advance, if he lets me develop my argument a stage further first? I do not accept what he says.

General practitioners already operate their practices and, as I emphasised at the outset, patients have absolute--or virtually absolute--freedom of choice on the practice with which they register. The principle of patient choice of practice already exists. I should have thought that the hon. Member for Newham, South (Mr. Spearing), who represents an inner-city constituency, would agree with the Government that the variation in quality of general practice between some of the easier, fashionable areas and some of the more deprived areas should be addressed. We plan to introduce more flexible models for the delivery of NHS primary care precisely to address some of the problems that the hon. Gentleman will encounter in parts of his constituency--the inadequate development of primary care in some inner-city areas, particularly in parts of the east end of London. We seek to address that concern.

Let me develop my argument. We have a system that is based on patient choice. Once patients have chosen a practice, they are registered with the general practitioner. The GP is then responsible for delivering a wide range of health care to those registered patients. The range of care has grown exponentially over recent years and that growth partly reflects changing medical practice. Change has come about through medical advance and the availability of new diagnostic and therapeutic techniques, which make it possible to offer diagnosis and therapy within the surgery in a way that was not possible given the state of medical knowledge and technology a generation ago.

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A broader range of services within the surgery, at the front line of the NHS, is the third principle on which NHS primary care is built. The fourth principle is that when a patient needs health care that is not available in the primary care context, the NHS general practitioner is the most important gateway into the secondary and specialist care services of the NHS.

I have stressed that I regard general practice within the health service as a success. I have no doubt that that is true. That success is not new: it has been built over half a century. During that period, we have seen better trained GPs, the availability of a broader range of medical treatments, a wider range of non-medical professional staff working in a primary care context, and better buildings and facilities to allow those professionals to deliver care to their patients.

The result of the development of primary care is that the patient has greater access to what modern health care can provide. Critically for anyone interested in the sustainability of a tax-funded model for the delivery of health care, the development of primary care offers not only better access to health care, but the discipline of more efficient use of health care resources to ensure that the resources committed to health care are used efficiently and effectively and contain the cost burden inevitably entailed in delivering a modern health service.

NHS primary care is a success, but even the best system can be improved. The Government have made it clear year by year from 1979 that we are committed to the continued development of NHS primary care because we regard it as important for the interests of the patient that health care should be accessible. We regard the development of NHS primary care as the key to maintaining the efficiency lead that the NHS has, compared with health care systems elsewhere in the world. The success story must be continually improved.

When we considered what was good in the health service in 1990 and what needed to be further improved, one thing was clear to anyone who took a dispassionate interest in the NHS primary care sector. Although the services that were available within the primary care sector were developing and were of high quality, there was a frustrating failure to communicate between the primary and secondary care sectors of the health service. Large numbers of general practitioners were frustrated because they considered that resources were being inefficiently used--used in a way that did not represent best value for their patients--in the secondary care sector. They also saw, from the patients' perspective, how the secondary care sector was failing to respond as effectively as it should--[Interruption.] That is another example of modern technology, but it should have an off switch.

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