| Previous Section | Index | Home Page |
Mr. Dorrell: I hope that the hon. Gentleman will forgive me if I deal with those subjects in the order in which they arise in my speech. I certainly propose to deal with both of them in the course of my remarks.
I was talking about the importance of the pilot-based approach, which is the basis on which the Bill is constructed. The second principle that I want to underline to the House, because I take it extremely seriously, is that the pilots must be properly assessed before we go on to the use of the general powers under part II.
Clause 5 provides specifically for the evaluation of pilots; it says that the Secretary of State has power to provide for evaluation and that that must be taken into account by the health authorities in the approval and promotion of their projects.
The Labour amendment talks about the absence of clear criteria for evaluation. If I may say so to the hon. Member for Islington, South and Finsbury in an open-minded spirit, I think that that arises from a misunderstanding. Inevitably, under the Bill, the criteria for success will vary according to the nature of the pilot that is being promoted. We expect that the purpose for which a pilot was designed would be set out in the paperwork supporting it. When that was set out, the criteria by which success or failure would be judged would be set out.
It would be difficult to set out criteria for evaluation in the Bill, or even in secondary legislation. The purpose of evaluation must be to find whether the pilot delivers the objects for which it was established. Those objects will obviously vary according to the nature of each pilot. The evaluation must be criteria based. That the criteria should be set out at the beginning of the life of a pilot is not controversial; it is clearly an important part of the discipline underlying the piloting approach.
Mr. Gunnell:
I thank the Secretary of State for giving way. Is he able to tell me how long a pilot would be allowed to continue before the evaluation takes place? It seems to me that he has learned from other Departments that have conducted pilots and then acted upon them without actually getting any results from the pilots. Could he tell me how long it will be, because that obviously makes quite a difference?
Mr. Dorrell:
The hon. Gentleman pre-empts my next point. My noble Friend the Under-Secretary of State in another place gave an undertaking there to table an amendment--and table it we shall--to provide for
The first principle is that we have pilots. The second is that they will be properly assessed. The third is that participation in pilots must be voluntary on the part of the professionals concerned. That is why clause 3(2) requires that there should be provision for professional participants to be able to withdraw from a pilot and states:
The fourth principle, after we have reassured practitioners that participation in pilots is voluntary, is that if practitioners decide that they are no longer committed to the pilot or if it is agreed that the pilot is not successful, the Government have undertaken that practitioners must have the assurance that they can return to practise on the existing red book or other equivalent basis. The conditions are set out in schedule 1, under which the Secretary of State has powers to provide for preferential transfer of an individual back to the local practitioners list. Schedule 1 is activated by clause 11.
The principles that I have made clear in introducing the policy are: first, that we proceed by piloting; secondly, that pilots must be properly assessed; thirdly, that participation must be voluntary; and fourthly, that participants must have an assurance of their ability to return to practise on the current basis if the pilot is not successful. The Bill provides for all four of those principles. The principles of voluntarism and the return ticket to practise on the current basis are safeguarded in the permanent schemes proposed by clause 20.
I underline that the changes to the contractual framework within which NHS primary care is provided represent fundamental but incremental change in the structure of that part of the health service. The medical magazine Pulse has said that I am an advocate of "big bang" in primary care--the implication being that, if the legislation reaches the statute book, all the ground rules and relationships in primary care will suddenly change. I underline--as I have done on many previous occasions--that that is not the Government's policy. I do not understand how one can pilot a "big bang". The principles of piloting, voluntarism, proper assessment and the return ticket for the practitioner are firmly entrenched in the Bill. They underline the Government's commitment to important--I do not seek to diminish the importance of the change--but incremental change.
The reason why the Government are committed to the process of incremental change relates to the point that I made at the beginning of my remarks. The fact is that NHS primary care is a success story. Its national contracts--in particular, the red book for general practitioners--are the foundation stone on which that success story is built. The continued delivery of services
on the existing contractual basis must remain an option. That element of the foundation must be safeguarded, and we are seeking to extend the range of options. We are not seeking to diminish or undermine in any sense the continued delivery of NHS primary care on the proven basis of the red book and other national contracts, when individual practitioners wish to deliver care on that basis.
I wish to deal with some of the concerns that have been expressed about the Bill. First, clause 2(5) clearly requires health authorities to consult in accordance with directions given by the Secretary of State before submitting proposals for a pilot scheme. The clause says:
That is why we have set up national consultative groups, and that is part of my answer to the hon. Member for Belfast, South (Rev. Martin Smyth). We have established specific consultative groups to deal with the concerns of GPs, GDPs and other professional groups, to ensure that there is properly based and properly representative national consultation, as well as the local consultation that health authorities must conduct. The obligation to consult is in the Bill, and is reinforced by the Government's assurances and actions in setting up the consultative process.
Mrs. Alice Mahon (Halifax):
I am sure that the Secretary of State will understand why some of us are sceptical about consultation, given our past experience. We consulted widely in Halifax about whether a local hospital should become a trust. Just about everybody said no, but because of the people the Secretary of State had placed there, the hospital became a trust against local people's wishes. Similarly, we do not want to lose 300 beds at the new hospital, and every consultation has agreed with that view. But the people placed by the Secretary of State are saying that we shall lose the beds anyway. Can he give us any guarantees about consultation?
Mr. Dorrell:
Of course, I give the undertaking that the consultation will be serious, but consultation means what it says; it does not mean delegating the decision-making power to a group of individuals and nor can it mean that. It would a gross derogation of the position of the Secretary of State, who is responsible to this House for decisions, if decisions properly taken by the Secretary of State were delegated informally to groups over which he had no direct control. The proposition that there must be consultation before pilots come forward is provided on the face of the Bill, and, as I said, we have established a series of national consultative groups, to ensure that the
Let me refer to the second concern, which is, in a sense, about a specific form of consultation--the role of the Medical Practices Committee. I understand the concerns that have been expressed about that. Both my hon. Friend the Minister for Health and I have met the chairman of the MPC and we have discussed the subject with the British Medical Association and other interested bodies.
The position of the MPC within the existing red book contract remains completely unchanged by the provisions of the Bill. Regarding the position of the MPC in respect of pilots that come forward under the Bill, we propose to move an amendment in Committee to give the MPC a statutory right to be consulted, if the effect of accepting a particular pilot would be to change the total number of GPs practising in a particular health authority area.
The key interest of the MPC is a statutory right to consultation on the balance between different parts of the country. The balance within a health authority area is something that, in the context of the pilot schemes, we would regard as the primary responsibility of the health authority, although the Secretary of State has a clear responsibility to satisfy himself on all those issues before agreeing to any pilot. That is an approach to responding to the concerns of the MPC and those who have taken up its cause which has commanded reasonably widespread support, and my hon. Friend the Minister for Health will commend an amendment to the Committee to give effect to that.
I now come to the issue of so-called commercialisation. I have always felt that the concern about that is misplaced, because I have never made any secret of the fact that the purpose of introducing the Bill is to provide for a more flexible range of contracts to be available between different elements of the national health service for the provision of primary care. The examples that I have always quoted are those of bringing the community trusts into the provision of primary care; of providing practice-based contracts so that the contract does not have to be directly between the Secretary of State and the individual practitioner, but there can be contracts that bind the practice as an entity; and of contracts that deal with the delivery of health care without needing to observe the precise distinction between general medical services and secondary care, which is inherent in the existing legislation.
The purpose of the Bill--from the days when it was in the process, led by my hon. Friend the Minister for Health, of being born--has been to create a more flexible framework within the national health service. I recognise that some real concern has been expressed, both within the House and outside, which is why I met with representatives of the BMA, to examine whether there was a real difference in terms of objectives. In those discussions, it took us almost no time at all to recognise that we were agreed on precisely the set of objectives that we are seeking to deliver.
We have, therefore, concluded that the best way to address the issue is to ensure that, on the face of the Bill, only members of the NHS family--that is: trusts, NHS dentists, GPs, nurses, which answers the point raised by the hon. Member for Southwark and Bermondsey, and the staff who work for them--should put forward proposals
and hold the primary contract with a health authority, or a health board in Scotland, for the provision of personal medical or dental services where a doctor or dentist must be involved, to ensure that the appropriate medical or dental care is given.
"The Secretary of State may not approve proposals for a pilot scheme unless he is satisfied that they include satisfactory provision for any participant other than the authority to withdraw from the scheme if he wishes to do so."
We cannot make the principle of voluntarism any clearer.
"an authority must (in addition to complying with any requirements about consultation imposed by or under any other enactment) comply with any directions given to them by the Secretary of State about the extent to which, and manner in which, they are to consult on the proposals."
The point about the statement in brackets is that the health authority retains the obligation to consult on any substantial change in the structure of the service under existing NHS practice. The clause imposes an extra obligation to consult on the structure of the pilot in accordance with the requirements laid down by the Secretary of State. The Secretary of State has made it clear that there is to be a commitment on the part of health authorities--and, indeed, on the part of the Secretary of State himself--to consult before pilots are agreed under the legislation.
| Next Section
| Index | Home Page |