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Madam Deputy Speaker (Dame Janet Fookes): Order. Madam Speaker has strong views about modern technology--it should not be heard in the Chamber.
Mr. Dorrell: I am sure that the hon. Member for Dulwich (Ms Jowell) will find the high-tech, off switch.
The development of primary care has resulted in a wide range of services being provided in the surgery, but no proper linkage or accountability within the secondary care sector to the views and priorities of the primary sector has been established.
The idea was not partisan, it was not invented in 1990 and it is not recognised only by Conservative Ministers. Every one of my predecessors, from both Labour and Conservative Governments, made that speech about how it was important for the hospital sector to respond to the views and priorities of people in the primary care sector, who saw more patients every day than the hospitals. Every one of them--from Lady Castle to David Ennals and all my predecessors--going right through the 1990s, said that it was important to make secondary care more responsive. It was such a commonplace that it was seldom reported and never listened to--it was simply regarded as conventional orthodoxy. Every Health Minister said it and no one listened--people thought that it had merely come off whatever the predecessor to the word processor was at the Department of Health in the 1960s.
This Government then introduced fundholding--
Mr. Frank Field:
What is the Bill about?
Mr. Dorrell:
The Bill is about the development of primary care--building on the success of fundholding. The Government gave general practitioners the opportunity not simply to continue to deliver services and be frustrated by the failure of the secondary care sector to back them up in the way that they felt it should, but to help shape the secondary care services that their patients needed. That opportunity has been taken up by doctors who cover 58 per cent. of all national health service patients. We have given general practitioners that choice and more than half of them have opted for fundholding.
Not only have more than half of all GPs opted for fundholding, because they think that it is in their patients' interests--more fundamentally, that objective of making the secondary care sector more responsive to the wishes of primary care, which was consistently articulated by Labour and Tory Ministers for more than 30 years, has been delivered.
The relationship between primary and secondary care has changed and not merely for the benefit of fundholders. The majority of GP commissioners--certainly their leaders--recognise that they are using the changed relationship between primary and secondary care that came in with fundholding to develop their ideas for GP commissioning.
The question that anyone who is seriously interested in primary care must ask themselves is whether the fact that that changed relationship--which every one of my predecessors sought--arrived when fundholding was implemented, was a result of that implementation or of a massive historical coincidence, whereby people expressed that ambition for 30 years and it was realised on the day that fundholding was implemented, but the two are unrelated. I simply suggest that there is, to put it mildly, circumstantial evidence to support the Government's assertion that the changed relationship between primary and secondary care, which we have in the health service today and which benefits the patients of both fundholders and non-fundholders, is the result of our introduction of the fundholding scheme.
Mr. Simon Hughes (Southwark and Bermondsey):
I do not disagree with anything that the Secretary of State has said so far, but I wish to ask him a question that he has not yet answered, which is on the controversial issue
Mr. Dorrell:
I do not accept that point, because the basis on which funds are made available for the care of the two groups of patients is the same. I could understand the argument--although I did not agree with it--in the first days of fundholding, when the scheme was developing and not every general practitioner had the opportunity to join. Now that we are six years into the scheme, every general practitioner has exercised a choice. Presumably, some GPs have opted for fundholding because they think that it is in the interests of their patients, and other GPs have opted to be non-fundholders because they think that that is a better way to deliver care to their patients. I am sufficiently humble about the expertise of the Government to think that it is possible, in the different circumstances in which those professional people work, that both groups are right. The idea that everybody has to operate under the same model is absurd.
I seek to offer GPs a choice. They may opt for whichever of the options they think offers the best national health service care to their patients. On the track record so far, the GPs who cover 58 per cent. of patients have opted for fundholding and those who cover the other 42 per cent. have opted for non-fundholding. I am sure that both groups are motivated by the interests of their patients. Some 42 per cent. think that, intheir circumstances, non-fundholding--including GP commissioning and other connections with their health authorities--offers the better model, and 58 per cent. of patients are covered by GPs who have chosen the other option. I am prepared to believe that both groups are right.
Mr. Peter Bottomley (Eltham):
My right hon. Friend's argument is convincing, but it leads to a further problem. If all GPs were fundholders and the same increase in emergency treatments took place during a year, what could be done to bring the resources through so that non-emergency treatments, which may be just as important to many people, could be met by the fundholders and the hospitals? That is not an attacking question, but a logical question.
Mr. Dorrell:
Whether GPs are fundholders or not, the health service must choose its resource commitments to emergency services and non-emergency services, and indeed to all the other services that do not fall neatly into those two categories. It is not as simple as a straight choice between emergency and non-emergency services. Is a maternity service an emergency service? The service is clearly needed--and without delay. It needs to be demand led, but it is not what would normally be defined
Under the present fundholding arrangements, emergency services are outside the fund and are the responsibility of the health authority. The fundholders deal with the rest of the package of care. In the total purchasing pilots, the GPs make choices across the whole range of hospital secondary and tertiary services for their patients. The introduction of a right for GPs, if they so choose, to be the decision makers--in consultation with other GPs, the health authorities and other providers--and not simply consultees, has delivered the change in the relationship between primary and secondary care that every Health Minister from the 1960s onwards has argued for but was unable to deliver, until my right hon. and learned Friend the Chancellor of the Exchequer did so.
Mr. Simon Hughes:
I do not disagree with anything that the Secretary of State has said, but he did not answer my specific question. Like him, we would not abolish fundholding--unlike the Labour party--but fundholding, although it has given choice to GPs, has caused disadvantage for some patients. Does he accept that some patients do not now get the same speed or standard of treatment because of the choice given to fundholding practices?
Mr. Dorrell:
The hon. Gentleman approaches the issue from an odd point of view, because he considers only the difference between the pattern of care provided by a fundholder and that provided by the health authority, but every health authority makes different choices in its use of resources.
Mr. Hughes:
I asked a specific question.
Mr. Dorrell:
The hon. Gentleman asked about the Royal Devon and Exeter NHS trust. People who live in Exeter are close to the eastern county boundary of Devon. On the other side of the county boundary, the health authority in that area will make different choices on the use of resources for its patients.
Mr. Hughes:
That is not a direct answer.
Mr. Dorrell:
It is. The hon. Gentleman seeks to distinguish between two groups of patients--those covered by fundholding and those who are not. Of course, there are differences between the care delivered by one fundholding practice and another fundholding practice, because that is the purpose of introducing the scheme. It allows the fundholding practice to improve the care available to its patients and, by definition, that means that the better care provided by the fundholders--in their opinion--is different from the care provided by the neighbouring practice. Otherwise, there is no point to the scheme.
"The Trust has a fixed price contract for its work for North and East Devon Health Authority. Because of this, if we need to do more emergency work, it is necessary to do less non-urgent work. Patients will continue to be treated as before if they"--
it gives a list, including--
"are the patient of a fundholding GP and the procedure is a fundholding procedure."
Does the Secretary of State accept that fundholding has also brought advantages in speed of treatment to the patients of fundholding practices which other patients do not have?
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