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Mr. Dorrell: Will the hon. Gentleman speculate on how we could rule that out when many NHS trusts have both acute and community facilities?
Mr. Smith: I am coming to that. I was about to point out that the Secretary of State ruled out in the
White Paper the idea of GPs being salaried employees of the health authority. Why has he ruled that out, when it is surely the solution to the problem of trusts that are both community and acute trusts? That would maintain the purchaser-provider split on which the Government are so keen and which we accept as a sensible division. The Government have given no reason for ruling out that option and the Secretary of State has offered no explanation today. We would be delighted if he would amplify the matter.
There is much to welcome in the White Paper, but we have one serious disagreement with the Government. I warned about this last week, and since then there have been various articles and reports in confirmation, yet the Secretary of State is sensitive about the possibility floated in the White Paper that GP services could be provided by commercial companies. He did not tell us that he had ruled out that possibility; he spoke of his belief in the GP service as part of the national health service, which is fine, but he has not disavowed the two paragraphs in the White Paper that clearly spell out the possibility. Chapter 2, paragraph 2.4 of the White Paper deals with
Paragraph 8 of appendix A of the White Paper deals with contracts and states:
In his speech the Secretary of State was right to praise the role of GPs in the British health system. They are the cornerstone of everything good about the NHS over the past 50 years. The GP is an independent, professional person. He is the patient's advocate and friend and if he is answerable not just to his patient but to a commercial company, the independent professionalism of that relationship will be in danger. If that possibility remains in the Bill we shall take a very severe view of it.
Mr. Dorrell:
Is the hon. Gentleman saying that every NHS pharmacist or every NHS pharmacist employed by a company is incapable of offering a professional service to patients?
Mr. Smith:
Of course I am not saying that. In case the Secretary of State did not listen to the last two minutes of my speech I repeat that I am talking about the general practitioner and the relationship between the GP and his patients. That is the crucial point that the right hon. Gentleman has so far ignored.
Mr. Dorrell:
I listened to every word. The pharmacist and the general practitioner are professionals and in some
Mr. Smith:
Of course I am not saying that. The Secretary of State has fallen straight into the trap that he has created because he is saying, "Why cannot a GP provide a professional service?" The implication of that is that he would be perfectly happy to welcome GPs being employed by commercial organisations. That is the logic of his interventions. If that is in the Bill he will have a hard time justifying it.
There is much to be welcomed in the primary care Bill that is flagged up in the Gracious Speech but there are some dangerous loopholes which we shall examine carefully. The Gracious Speech is remarkable more for what is not in it than for what is in it. For example, what has happened to a measure on adoption on which there was a White Paper and a draft Bill? The Secretary of State knows that it is supported by hon. Members in all parts of the House and provides a golden opportunity to put right some of the anomalies in adoption procedures. However, it is not in the Gracious Speech and that seems to suggest that the Gracious Speech is more about trying to embarrass the Opposition parties than about sensible, constructive legislation.
The draft Bill on adoption contained some entirely sensible and welcome proposals. They were a new welfare checklist for adoption agencies and the courts to assess the child's interest when adoption is being considered; a new complaints system to include independent assessment and easier procedures to allow step and foster parents to adopt. At the heart of the White Paper and the draft Bill on adoption was the simple and sensible proposition that the crucial matter in adoption procedures is the ability of the prospective parents to parent--to nurture, love, cherish and bring up the child. It put the child's interests first and had an entirely commonsense approach to adoption issues.
Under pressure from the Opposition saying, "Go on, do it--we agree with it and we will support you," it has become the fashion this week for the Government to pop up and say, "Yes, we will do it." If the Secretary of State presents the Bill on adoption in the same form as the draft Bill and on the lines of the White Paper he will have the Opposition's full support. He can get it through quickly and earn himself a place in the history books for doing the right thing for once. I make that offer and wait in anticipation for a letter from the Prime Minister tomorrow stating that he will do that.
Mr. Mike Gapes (Ilford, South):
Is my hon. Friend aware that a former Secretary of State for Health set up a working party in July 1989 to consider the Bill on adoption? As my hon. Friend has said, the previous Secretary of State published a White Paper three years ago. Can my hon. Friend shed some further light on why it has taken the Government so many years to come up with precisely no legislation although a measure on such an issue would be widely supported and welcomed throughout the country?
Mr. Smith:
My hon. Friend has put the main points of the answer in his question. I look forward to hearing the Secretary of State trying to defend the Government's inactivity on this matter when so much has already been
Not only legislation on adoption but measures on long-term care seem to have fallen through the net. We have not had the Bill that was promised or the legislation that the Prime Minister at last year's Tory party conference and at the one this year said would solve the problem of elderly people having to sell their homes to pay for long-term care. What is the Government's solution to a problem that affects many thousands of people? We are to have a draft Bill. How it will differ from the White Paper I am not sure. That may mean that the Government are having sensible and serious second thoughts about their daft insurance scheme which they said was the big solution to the problem.
Mr. Smith:
It is not. If the Secretary of State looks back at everything that all of us have ever said about long-term care, he will find that we have always criticised the Government's policy of a 1:1, a 1.5:1 or a 2:1 insurance scheme to try to protect the assets of people who are approaching retirement. The scheme is daft because it assumes that people who are approaching retirement will have £5,000 or £10,000 in cash available to put down as payment for an insurance policy premium. If the Government seriously believe that the many hundreds of thousands of people in Britain who are worried about the prospect of losing their homes because of their payments for long-term care are in a financial position to make such a commitment, they are examining the wrong problem.
That is all that we have in the Queen's Speech. It is not much from the Secretary of State for Health. At the same time, he is running around Britain producing White Papers and consultation documents and doing surveys. All sorts of things are happening. Some of them are welcome; some are not.
Let me take just one example: Insight, the firm of management consultants that is considering the role of community health councils. Its draft report makes alarming reading. Among its proposals are that
We have hardly any legislation, but a series of reports producing alarming ideas that fundamentally and adversely change the health service in Britain. The health
service faces a serious crisis this winter. Just a week ago, the British Medical Association consultants' committee set it out clearly. Its chairman, James Johnson, said:
"a salaried option for GPs, either within partnerships or"--
and here is the crucial phrase
"with other bodies, such as NHS trusts."
We have already dealt with that NHS trusts point but the White Paper clearly says "with other bodies", which are unspecified.
"Ordinary contracts would be used when services were provided outside the NHS."
Therefore, in two places the White Paper envisages the possibility of GP services being provided outside the NHS by commercial companies. They may not necessarily be supermarkets. For example I suspect that some pharmaceutical companies may be interested in establishing GP services. If the Secretary of State goes down the road of allowing commercial companies to establish primary care GP services it would pose a serious threat to the importance of the doctor-patient relationship.
"CHCs should consider moving away from monitoring local services towards specific projects agreed with the Health Authority",
that
"CHCs should consider moving away from information provision to the public"
and that
"CHC involvement in supporting complainants should be scaled down".
Clearly, this draft report envisages changes to the patient advocacy role of CHCs, which is one of the most important things that they do. It is clear that the agenda that is being prepared by management consultants for the Government is to get rid of CHCs' patient advocacy role. I hope that the Secretary of State will quickly say that Insight's proposals are no part of the Government's agenda.
"From the reports I have heard today, I fear that the hospital service will be close to collapse this winter. Elective procedures will virtually cease in many parts of the country. What purchasers need to recognise is that you cannot simply open and shut wards at will to control the money flow. When you want to re-open services, you find that the skilled staff are no longer available. In the meantime, patients who are not emergencies but who genuinely need treatment are waiting in pain and distress."
That is the verdict not of the Labour party, but of the BMA's consultants' committee. That is the prospect facing the NHS in the coming winter.
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