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Adoptive Mothers (Maternity Leave)
Ms Margaret Hodge accordingly presented a Bill to provide for maternity leave for adoptive mothers and for connected persons: And the same was read the First time; and ordered to be read a Second time upon Friday 28 February, and to be printed [Bill 101].
National Health Service (Primary Care) Bill [Lords]
Order for Second Reading read.
Madam Speaker:
I have selected the amendment standing in the name of the Leader of the Opposition.
3.45 pm
The Secretary of State for Health (Mr. Stephen Dorrell): I beg to move, That the Bill be now read a Second time.
The Bill is an important part of our programme. It delivers Government commitments to review the contract basis of the delivery of primary care in Britain and to open up options for the more flexible delivery of that essential part of the national health service.
The main purposes of the Bill have been agreed not just with those involved in primary care, but on both sides of the House. I should like to remind the House of the words of the chairman of the British Medical Association on the day on which the White Paper was published:
What is perhaps even more remarkable is that, during the debate on the Loyal Address, the hon. Member for Islington, South and Finsbury (Mr. Smith) was almost fulsome in his welcome for the direction of the policy. He said:
The Bill is not being introduced in a confrontational way. It is being introduced in consultation with those responsible for delivering primary care. When the policy was announced--at White Paper stage and when the Bill was published--there was a remarkable degree of
consensus in support of it, particularly bearing in mind the fundamental nature of some of the reforms foreshadowed and made possible by the Bill.
Some concerns have arisen since the announcement of the policy and I am happy to say that I hope to be able to deal with most of those concerns during my speech. The objectives of the Government and those involved in primary care are going down the same line, and I am anxious that they should not be derailed by misplaced concerns.
I want to begin by dealing with the background and the status of primary care within the national health service. I have made clear repeatedly the fact that I regard NHS primary care as one of the key successes of the national health service since its foundation. I believe that the success of NHS primary care in its broadest sense--the delivery of general medical services and other services through the primary care network--has probably been the key element in the success of the wider health service, in meeting health needs and delivering needs-led health care to the people of Britain.
The national health service delivers not simply good-value primary care, although it is certainly that, but care that responds to the specific demands of patients--it is close to the needs of patients and is, in the broadest and most important sense of the word, accessible health care for the patient. Primary care is based on the general practitioner, allowing the GP to act as the advocate and friend of the patient finding his way round the specialist services of the national health service. National health service primary care is an important success story.
However, even the biggest success story can be improved on. Some aspects of primary care need attention. We have an opportunity to improve further on the record of success. One example that is often quoted with some force is that, while high-quality primary care is provided in many parts of the country, too often we find that primary care in inner-city areas does not match the standards available in the rest of the country.
That is a serious issue. It is particularly serious, bearing in mind the mission of the NHS to deliver needs-led health care. Some of the greatest need for primary care is in those inner-city areas, where the service has not been as well developed as it should. The uneven distribution of the quality of primary care--in particular the failure to develop the quality of care in the inner cities as fast as in the rest of the country--is one of the concerns that the Bill addresses.
The Bill also addresses a concern at the other end of the spectrum. Some of those involved in the most innovative practices at the leading edge of high-quality NHS primary care find the national contract provided by the red book a constraint on their ideas to develop primary care. It places constraints on the development of ideas across the primary-secondary divide and of new ideas for skill mix and the use of the human resources available to the health service--through the pharmacy service, dental practitioners and other skills available to the dental service--to meet patient need more effectively. The more flexible contract structure envisaged by the Bill would help.
Mr. Peter Thurnham (Bolton, North-East):
The Secretary of State has spoken about the successes of NHS primary care and about problems in inner-city areas.
Mr. Dorrell:
The hon. Gentleman is right to say that dealing with fluoridation would substantially widen the scope of the Bill in a way that I would not commend to the House. There will be plenty of opportunities to come back to the issue of fluoridation. I suggest that the House might usefully leave that subject for another day.
One of the explicit purposes of the Bill is to allow a more flexible contract structure for the delivery of NHS dental care, precisely to improve access for patients such as those whom the hon. Gentleman was talking about.
Ms Joan Walley (Stoke-on-Trent, North):
Will the Secretary of State tell the House why parts of the country, including my constituency, have virtually no NHS dentists? Often, the only option available to people is to take out insurance policies. Should not that situation be referred to the Monopolies and Mergers Commission?
The Minister for Health (Mr. Gerald Malone):
That is a novel approach.
Ms Walley:
People cannot get access to NHS dental care. I do not understand how the Bill will remedy that.
Mr. Dorrell:
As my hon. Friend the Minister for Health says, it is a novel approach to bring in the Monopolies and Mergers Commission. The Bill approaches the question rightly raised by the hon. Lady by giving greater power to health authorities--in agreement with general dental practitioners in the context of pilots under the Bill--to focus available resources on specific needs, providing precisely the access that she wants. That is a key part of the reason why I am in favour of more flexible contracting power between health authorities and general dental practitioners, and also why money has been provided to the dental access fund, to promote the availability of NHS dentistry in areas where access is a problem.
It is also worth remembering that the number of courses of NHS dental care available has increased over the past 15 years by almost 8 million. The service is not in decline--quite the contrary, it is continuing to grow. Where there are problems--I do not deny their existence--with accessibility, the Bill is designed to address them.
Mr. John Gunnell (Morley and Leeds, South):
Will the Secretary of State discourage the private sector from operating teams of dentists? Would it not be unfortunate if a supermarket employed dentists to provide a service? Those dentists should be employed through the national health service.
Mr. Dorrell:
The hon. Gentleman's proposition is illegal under the Dentists Act 1984, and there is no proposal in the Bill to make it legal.
"We, the BMA, are fully behind the Department of Health in exploring the possibilities for making the delivery of general practice and related family services more readily available."
As I said at the time--on the same radio programme--it is not every day that the Secretary of State for Health appears on the "Today" programme with the chairman of the BMA and secures his endorsement for the policy to be announced that day.
"There is much in the White Paper that the Opposition welcome. We welcome the idea of an enabling Bill"--
which is precisely what the Bill is.
"We support the proposal to develop super-surgeries . . . I welcome the proposal that salaried GPs should be employed by community health trusts . . . There is much to welcome in the White Paper".
The hon. Member for Southwark and Bermondsey (Mr. Hughes), the Liberal Democrat health spokesman, went even further. He said:
"My colleagues and I, subject to finding that the Bill does not say what we expect"--
I think he meant to say, "does say what we expect"--
"will vote for the Second Reading of the Bill that has been announced.--[Official Report, 25 October 1996; Vol. 284, c. 247-69.]
I hope that the Bill does not contain provisions that the hon. Gentleman did not expect and that he will feel able to vote for its Second Reading.
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