---

The Minister for Health (Mr. Gerald Malone): Let me set the hon. Gentleman's mind at rest. General practitioners are not in the NHS; they are independent

21 Jan 1997 : Column 770

contractors. We foresee that they may be able to organise themselves in a different way, either through another body or by coming together to provide services or most likely, as he said, through a community health trust. He asked about acute trusts. The answer, in respect not only of acute trusts but of any other organisation where a conflict of interest might arise in the proposals made, is that the conflict of interest would be recognised and we would not expect such an application to be honoured. Clearly, if there were such conflicts, they would not be desirable.

Mr. Burden: I am grateful for that answer. I shall give way again if the Minister can clarify the matter further. Groups of GPs getting together to provide expanded primary care services is potentially a good development. Labour has been pioneering such developments in talking about local commissioning teams, and local pilot teams have been working. In Birmingham, there are proposals to develop such services. Such a pattern of service would fit more easily with the locality commissioning suggested by the Opposition than grafting it on to the internal market that Conservative Members have imposed on the NHS.

I must press the Minister further on conflicts of interest. I am pleased that he says that if there is a conflict of interest, he would not expect the application to be honoured. Is he saying that acute trusts would not be allowed to employ GPs?

Mr. Malone indicated dissent.

Mr. Burden: If he is not saying that, the Minister is heading down the road of conflicts of interest.

Mr. Malone: I shall say what I said again, because it was perfectly clear. There could be applications where conflicts of interest might arise. If they did, they would be addressed at the time in the light of the individual application. I am not going to rule out an acute trust making proposals. I cannot predict whether there would be conflicts of interest. If there were, they would prevent the proposal from reaching fruition.

Mr. Burden: I am afraid that that is not good enough. It might be just about tolerable if an acute trust employed GPs in its own area, because the pattern of referrals in a given area tends to be static and predictable. Where they can, GPs like to refer patients locally. What if an acute trust tried to contract out of area? That is where conflicts of interest would develop. Such a system could already be in place through the mechanism to which the Minister referred.

What if private health care organisations such as PPP and BUPA wanted to set up a nice little local health centre to employ GPs? GPs would tell the Minister, if he asked them, that there can be pressure on them to refer patients to places that they do not necessarily believe will provide the best clinical services but which are often euphemistically described as the preferred providers. Private patients, perhaps those in insurance schemes, are already affected by such pressure. Currently, GPs can insist that referrals go to the place that they consider to be the most appropriate clinically.

If we move down the road that the Government want to go down, what barrier will there be against a private health insurance firm buying up a local health centre and

21 Jan 1997 : Column 771

employing GPs and against the employer putting pressure on its employees--the GPs--to refer patients to places that are not the most clinically appropriate in the judgment of GPs but that are the preferred providers in the interests of the employer? Those issues need to be addressed. I raise the matter today because when the Secretary of State talks of ensuring that there is a primary care-led NHS, I believe that that is what he wants.

The Secretary of State needs to square a circle in order to achieve his goal, but he cannot do that unless he fundamentally challenges the assumptions according to which the Government have operated the NHS. In answer to my hon. Friend the Member for Islington, South and Finsbury, he said that no one had ever recognised the difference between the internal market and the separation of the commissioning of health care from the provision of it. I must tell him that most other people have always recognised that difference.

Let me tell the right hon. Gentleman precisely what is the difference--I find it sad that he does not know. If he merely believes that the split between those who plan health services and those who provide them is equivalent to an individual contracting relationship, governed by a financial transaction, he has a problem in ensuring that the NHS keeps to the principles on which it was founded. Those principles are meant to guarantee the provision of health care, free at the point at which it is needed and to ensure equity in its provision. If the relationship between the provision and commissioning of health care is purely governed by a financial transaction, those principles cannot be adhered to. That failure is at the root of the problems of the system that the Government have imposed on the NHS.

A new Government will fundamentally change that relationship. We shall get away from a system under which hospital is set against hospital and, increasingly, area is set against area; patient is set against patient; and GP is set against GP. We want to establish a co-operative framework for NHS planning and provision, which allows decisions to be made at the lowest possible level by those who are best able to make them.

The NHS stands or falls by its own recognition of the fact that it is a national service. It must recognise that each branch is dependent on another, be it the doctor who is dependent on the nurse; the nurse who is dependent on ancillary staff; the GP who is dependent on the secondary care centre; or primary care that is dependent on tertiary care. That patchwork of provision, under which decisions are made locally, should be founded on a co-operative ethos, operating in the interests of the patient. That is different from a system in which the market rules, and that is why the Secretary of State is wrong when he says that there is no difference between the internal market and a system for the commissioning of health care. There is a big difference.

Sir Raymond Whitney: Whether the hon. Gentleman realises it or not, he is proposing to take us back to the system of the 1970s with all its inefficiencies, disasters and total failure sensibly to allot resources because people were not aware of the value of those resources. The hon. Gentleman's propositions show that he has a fundamental misunderstanding of the history of the development of the NHS.

Mr. Burden: The hon. Gentleman needs to read the policy document that my colleagues on the Front Bench

21 Jan 1997 : Column 772

have issued about how the NHS will develop under a Labour Government. He will discover that it does not talk about turning the clock back. I agree with him that we need to learn from experience and learn certain lessons about NHS provision. We can learn some lessons from past over-centralisation, but the hon. Gentleman's constituents will be sad if he has not learnt that trying to run the NHS like some glorified supermarket has not been in the interests of patient care, clinicians, or the services. That is at the root of the internal market that has been imposed by the Government.

The end result of that process, which was outlined ably by my hon. Friend the Member for Islington, South and Finsbury, has been the crisis of provision of hospital beds that we have seen this winter. The system has also failed to provide the required number of paediatric intensive care beds. That has happened not by accident but because of a Government who do not understand, or refuse to understand, what a NHS is meant to be, and how it can be run in the interests of patients.

That lack of understanding needs to be changed. In the next few weeks or months, such a change will occur with the election of a different Government.

5.44 pm

Mrs. Marion Roe (Broxbourne): I am as surprised as anyone that the Labour party has called this debate. In doing so, it was surely not unreasonable for those of us on the Conservative Benches to expect, at last, some explanation if not clarification of the Opposition's policies for the national health service. To date, we have had to contend with a mishmash of confusing ideas, coupled with the barest minimum of concrete policy decisions.

The Labour party has had 17 years in which to produce credible ideas of its future vision for the health services. Frankly, so far, the Opposition have failed to do that. Judging by the reaction of the hon. Member for Islington, South and Finsbury (Mr. Smith) to the weekend reports on improving efficiency within the social services, I fear that we might have to wait a long time yet for such ideas.

Once again, we have heard nothing of note from the official Opposition, so once again it has been the Government who have set the pace. I congratulate my right hon. Friend the Secretary of State on continuing to run the agenda.

Since the previous full debate in November on the health service we have had a Budget that has more than met the pledge given by my right hon. Friend the Prime Minister to increase year by year the real level of resources committed to the NHS. We have had the Second Reading in another place of the National Health Service (Primary Care) Bill, when the Government were able to describe and enlarge on their policies for important developments in primary care. Since November, we have also seen the publication of the White Paper, "Delivering the Future", which set out some 70 practical proposals to further the improvement of patient care. A number of other important announcements have been made, for example, the allocation of an extra £25 million which my right hon. Friend the Secretary of State for Health announced on Christmas eve to aid health authorities and NHS trusts with seasonal pressures. I am therefore proud to support a Government who abide by their commitment to the NHS by thought, word and deed.

Debates on the health service are sadly characterised by selective memories--the last one was no exception. When I prepare my speeches, I do not rely on anecdotal

21 Jan 1997 : Column 773

evidence, nor do I try to extrapolate a general picture from a single incident. I turn to the people who can give me an accurate report on the situation. I asked the Queen Elizabeth II hospital, which serves my constituency so admirably, to tell me how it coped in the past few weeks, based on its experiences.

As many hon. Members have already said, the especially cold weather and the 'flu-like illness that took hold over Christmas increased hospital admissions. That happened on top of the already high base line of emergency admissions which, in common with other hospitals in the area, the QE II is experiencing.

The week after Christmas was characterised by an even greater surge of emergency admissions than the typical seasonal influx that traditionally occurs from Boxing day onwards. The hospital saw many people and admitted some 50 patients compared with the average weekly figure for the year of 28 admissions. I would like to emphasise that during that incredibly busy period all elective cancer patient cases continued to be brought. Despite the exceptional number of patients who arrived at the hospital, all were admitted and treated.

---