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Mr. Simon Hughes: Did it come from Tory central office?
Mr. Atkinson: No, it did not come from central office--it was my own composition and I should be happy to send a copy to the hon. Gentleman, who might be educated by it.
I suppose that I should not have been surprised that less than half of those quick questionnaires have been returned so far, such is the work load of GPs. However, the replies that I have received have been interesting, helpful and supportive of the Bill. They all welcomed the opportunity to develop new services for patients. The only caution came from those who already felt overstretched in meeting existing demand from patients. As my right hon. Friend the Secretary of State said again today, however, the opportunities provided for by the legislation are entirely voluntary.
There was no shortage of ideas for new services that my GPs would opt to introduce. Education on drug and alcohol misuse as well as detoxification and support were mentioned frequently, followed by dietetics, chiropody and physiotherapy. Such new services will follow those which GPs have introduced in recent years such as epidurals, vasectomies, sclerotherapy, psychology, counselling, acupuncture, adolescent clinics, participation in schemes for doctors on call out of hours and nurse practitioners.
That all represents an ever wider range of services which are for the greater convenience of patients because they are available at the surgery, closer to the patient, and it is all thanks to the Government's reforms in primary care. Only one failure was reported--by a GP who had introduced a dermatology service which proved too expensive for the health authority and is now back in the hospital.
I received less enthusiastic responses to my question about whether GPs welcomed the new opportunities for budgetary control of wider services. Most of them did not welcome that, because they did not see themselves as financial managers. That is perhaps not surprising, since most of those who responded to my survey are non-fundholding GPs and as such are in a minority among the GPs in the Dorset health authority area. Obviously, I am disappointed about that, as I am sure is my hon. Friend the Minister.
However, I should point out that GPs in the Bournemouth area have not seen budget holding to be as advantageous as GPs elsewhere in the country because of the already high level of service and management provided by Dorset health authority and the equally excellent Dorset Healthcare NHS trust and the Royal Bournemouth and Christchurch hospitals NHS trust--I pay tribute to the chief executives, Ian Carruthers, Roger Browning and Stuart Marples. I regret that the Lib-Lab Bournemouth council has passed a resolution opposing the trusts and their self-managing status, and I intend to pursue that issue in the forthcoming general election.
It was not surprising to find little enthusiasm from my GPs for the opportunity to consider the establishment of new super-surgeries. The supermarket approach was regarded as totally inappropriate. The provision of a surgery service where people shop, and perhaps even a primary care centre where a range of services is available--such as a dentist, an optician and a pharmacy in a one-stop shop--is a bold idea and is more likely to appeal to the new providers such as the NHS trusts, private health care providers and other commercial companies envisaged in the White Paper, "Choice and Opportunity".
The future of the NHS is or should be about bringing the health service closer to the patient, not the other way round. As my right hon. Friend the Prime Minister told the House earlier today, it should be about better ways of delivering national health services to patients.
My questionnaire also asked about the White Paper entitled "Primary Care: Delivering the Future", which includes proposals made possible by the Bill. The GPs all welcomed access to the NHS pension scheme for practice staff from September, but they expect it to be properly funded and not an expense to be faced by the practice. A reservation was raised by a constituent of mine who is a practice nurse. She said that staff employed by trusts and health authorities will have the automatic right to opt into the NHS pension scheme, but practice staff will not. She feels that that would divide staff rather than remove barriers. Perhaps my hon. Friend the Minister will respond to that concern in his reply, as he did in the letter that I received from him last week.
There was a broad welcome for the full implementation of nurse prescribing next year, with the warning that they must also accept the medico-legal risk of any complications rather than its being borne by the GP, who currently accepts the risk.
No doubt my hon. Friend the Minister will take account of yesterday's news about fraud in the payment system of prescriptions to pharmacists. Perhaps he will use this opportunity to comment on that.
There was little welcome for the easing of restrictions on overseas doctors entering general practice here. That will not surprise my hon. Friend the Minister, because he will be aware of the latest report of the medical work force standing advisory committee of the General Medical Services Committee, which said that it was wrong that Britain should continue to be a net importer of doctors.
As my hon. Friend the Member for Chislehurst (Sir R. Sims) said, the number of doctors training for general practice has been falling steadily over the past six years. Rather than lowering the standards by attracting overseas doctors, we should do more to train our own, perhaps by establishing a new medical school. I put it to my hon. Friend the Minister that a new millennium medical school to train more British doctors might be an appropriate initiative for our medical profession to commemorate the millennium.
I have found my consultation with GPs very helpful. As I have said, the results of that consultation contradict what the hon. Member for Southwark and Bermondsey said in my local newspaper, the Bournemouth Evening Echo, when he said:
Mr. Simon Hughes (Southwark and Bermondsey):
The hon. Member for Bournemouth, East (Mr. Atkinson) has a bit of a cheek. I am delighted that he has followed our example and has surveyed his general practitioners. I will happily swap my survey with his, so that he can see the best practice and realise the inspiration for such exercises. General practitioners in Bournemouth and everywhere else have probably never had so many surveys. If the Tory party is now encouraging its people to send them out, it is following the good example of my colleagues and hon. Friends. As the Minister has often said, we have been carrying out surveys for months and they have been very helpful.
I am not sure that the hon. Member for Bournemouth, East understood all the questions that he asked, or the answers. I am not pretending that I do either. Some of the services about which he was reciting responses seemed slightly beyond his present understanding, but we are all here to be educated. I was caught out on a similar subject yesterday.
On Second Reading of the National Health Service Bill, soon after the war, Mr. Clement Davies, then leader of the Liberal party, said:
The Secretary of State said--subject to misunderstanding of the syntax--that so long as the Bill, when published, contained nothing fundamentally different from what was trailed and provided that it dealt with some of the concerns that had been and were being expressed, my hon. Friends and I would be minded to support it. I will therefore explain our position in the light of the Bill and the Secretary of State's speech.
The national health service is probably the most brilliant creation of the British welfare and social services this century. We have to go on building on this great creation. I am in favour of best practice and innovation developing in the health service. I do not want a drab, uniform national health service. To use a phrase from somewhere else, I am in favour of a health service where a thousand flowers bloom--but we are concerned that the blooms in the health service should be in a national health service garden and under the supervision of a national health service gardener. The danger, before the Secretary of State's speech, was that the Bill would breach that principle.
I acknowledge the way in which the Government have gone through the procedure. They published a White Paper and there has been consultation. The Minister
should not be full of self-congratulation about the consultation--to be fair, he has not done so thus far, but others said how wonderful he was. No doubt the consultation was carried out assiduously. I have heard some say that it was a good exercise, while others have been less complimentary. I suppose that that is the lot of any Minister. It was right to carry out that consultation.
I feel that one aspect, however, is missing from the procedures of the House. When a White Paper is published, consideration of it should be charged first to the relevant Select Committee before the measures are incorporated in a Bill. My hon. Friends and I have also often proposed the publication of draft Bills, so that the drafting errors that often occur can be ironed out.
I am not against the idea of the Bill being committed to a Special Standing Committee. This is not the most obvious Bill for that procedure, because of all the work that has been done already and the general happiness of the professions with the measures. I am slightly concerned that the proposal to refer the Bill to a Special Standing Committee may be an excuse to delay it. We have to have an election by 22 May and it is likely to be by 1 May, if not earlier. This would probably not be the first Bill to be considered in the next Parliament, so I would rather we put a Bill on the statute book before then, given that it has broad support.
Unless the wind-up speech from the Labour Front Bench persuades my colleagues and me that the Special Standing Committee has a specific purpose that can add to the benefit of the Bill without delaying it, I shall not be persuaded that it would be appropriate to support the idea. I am not opposed in principle, but I believe that we may be able to achieve the necessary changes in Committee.
I pay tribute to the work done in the other place. Unusually for such a Bill, it started in the House of Lords, where it was well worked over. I pay particular tribute to my colleagues, Lady Robson of Kiddington and Lord Alderdice, who did the bulk of the work for us. They picked up particularly on two issues. One has been addressed fully, but the other has not. The first was that there should be NHS pension rights for nurses. The Government have now conceded that practice nurses, in particular, should be in the NHS pension scheme. That is a welcome advance, which could be written into the Bill. I know that there is always debate about what is written into Bills, but I ask for that to be reconsidered.
The second particular issue raised by my colleagues in the other place was the length of pilot schemes. I am grateful to the Government for having moved on that. The Secretary of State dealt with part of the problem--saying that they should not run for more than three years--but the Government have not yet conceded that they should have a minimum period. My colleagues in the House of Lords argued for an 18-month minimum. I take a more flexible approach and think that they could be shorter, but pilot schemes--I welcome the fact that the Bill is pilot scheme-led--should have a minimum period sufficient to show that the water has been tested. The Minister could usefully accept a 12-month minimum.
I welcome the Secretary of State's confirmation that any of the professions in the health service can lead the pilot projects. Nurses and other professions will welcome that. They will be glad to have heard it and had it read into the record.
Most of all, I welcome the fact that the Secretary of State appears to have listened to the British Medical Association and all the representations made in the House of Lords and in this House by all Opposition parties, as the hon. Member for Islington, South and Finsbury(Mr. Smith) said, that we should restrict the opportunity for commercialisation. That is a considerable change of Government policy, and a welcome one. I regard it as a sensible move to get maximum consensus for the Bill.
I want to raise the matters flagged up in the Labour party's reasoned amendment which have some merit, especially the one dealing with commercialisation. Had there not been an announcement by the Secretary of State, my colleagues and I would have voted for the reasoned amendment. The announcement dealt with the reasoned amendment's main core, although I shall come to some subsidiary matters in a second.
I am prepared to accept that clause 2(5) guarantees--I take what the Secretary of State said to confirm this--that there will be consultation with professional groups and patients on all pilot schemes. I should say, however--the point has been made from the Opposition Benches before--that the health service's record on consultation is not one of brilliant success. We have all been through consultation processes during which the public have expressed an overwhelming view, but the blessed people in charge have ignored it. Will the Minister confirm that, as a result of the Bill, there will be a duty in law not only to take into account consultation responses but to give them reasonable and proper weight? If not, is he prepared to table amendments to ensure that?
Putting aside for a minute the fact that, at local and regional level, we have a very undemocratic health service, about which I have strong views, we cannot ask people for their views--whether on primary health provision, hospital closures or mergers--and then say, "Thank you very much. We have consulted but we are going to ignore you." When we have sought the views of doctors and professionals, just as the hon. Member for Bournemouth, East, myself and others have, we need to take them into account.
The Bill does not address the question that has been raised on both sides of the House about how we will ensure that we have enough GPs for the next generation. I cannot express strongly enough that, unless we make general practice far more attractive, many parts of the country will be short of GPs just as they are short of NHS dentists now. It is a very serious issue indeed. Given that medicine generally for doctors will move away from being as acute based towards being more community-based and primary-care led, which I support, we must ensure that we recruit enough GPs.
I agree with advice that my hon. and learned Friend the Member for Montgomery (Mr. Carlile), the hon. Member for Islington, South and Finsbury, the other two hon. Members who serve on the General Medical Council--the hon. Members for Chislehurst (Mr. Sims) and for Gower (Mr. Wardell)--and I have received. We should amend the Bill--I hope that the Government will--to allow pre-registration training to take place in private practice premises.
"We"--
the Liberal Democrats--
"pride ourselves on always doing our best to find out what is really happening on the ground, unlike the Conservatives."
11 Feb 1997 : Column 172
Having heard what I have said, I hope that he will accept that my consultation exercise is probably far better than anything that he has ever done in my area. I have been following the excellent example of my hon. Friend the Minister, who has listened to and learnt from the professions. I am sure that that has resulted in a better Bill and a better service to patients.
5.40 pm
"Surely, the one consideration should be: What is likely to give the best and fullest service to the people, wherever they may be?"--[Official Report, 1 May 1946; Vol. 422, c. 251.]
That was the right test then, and it is the right test now. It is always the right test for health service legislation. Our primary consideration should not be what is best for doctors, nurses, physiotherapists, radiographers or any other professionals, but what is best for patients. Of course, if the professionals are not on board and their proper concerns have not been addressed, there is a risk of the legislation not being good. That is the spirit in which my party approaches the Bill.
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