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Mr. Chris Smith: I am following closely the hon. Gentleman's argument. Can he, however, tell me how it is possible to base a population-needs funding assessment on a single GP practice? That is surely not possible. It is possible at locality level, however, where several GP practices are grouped together.
Mr. Hughes: I understand the question. I think that funding on such a basis is possible. I would be happy to talk to the hon. Gentleman after the debate about that. Fair funding would mean that, no matter how one organised one's practice, one would be paid pro rata according to the number of patients one treated. Such a basis does not differ according to whether one is talking about a single-handed practice, a six-partner practice or a collection of practices. The criterion for me is the same.
Secondly, we must have a fair funding system for hospital and local community health services. We have a capitation system and weighted capitation, which adds in criteria for deprivation, morbidity, mortality, ethnicity and so on, but we do not weight everything. The reality is that the system is still unfair. The Government are moving towards a fairer system, but until we weight the funding to take account of the needs of the community, more deprived areas will be at a disadvantage. Parts of my constituency, as well as those many others such as the hon. Members for Islington, South and Finsbury, for Halifax (Mrs. Mahon) and for Dulwich (Ms Jowell) are deprived. All health service funding should be needs-based. That we have not yet established.
Thirdly, the Bill does not address the fact that, as is my party's view, GPs should be paid for their core services and additionally paid if they do other things. We need to ensure that that happens not only in theory but in practice.
Fourthly, as I said, I hope that we can write into the Bill that everybody in the NHS can be part of the NHS pension scheme, and therefore avoid the anomaly that people who worked for a GP who worked for the health service could not have pensions funded. That needs to be corrected.
The Bill does not address a set of issues about charges. It is inequitable and conducive to bad health to go on raising money from charging certain people for certain NHS services. I know that there is dispute about this. The Government have not accepted my view. I remind them that not only is my party committed to abolishing charges
for eye and dental checks: the Royal National Institute for the Blind in its briefing for today's debate makes the point clearly when it says:
I ask the Government in Committee or on Report to accept that there should be free eye and dental checks, as well as accepting the principle that, in future, we must review all other charging again--not just for tests but, for example, for glasses. A woman came up to me this morning in my constituency and said "Simon, I am having to pay a huge amount for glasses"--not for lenses, but for glasses--"which goes beyond what I can afford." The whole system of prescription charges and charges for services needs comprehensively reviewing. It needs to be simplified, and we need to avoid pensioners having to fill in a 17-page form for exemption from such services.
I am slightly confused about the role, as enunciated by the Secretary of State, that is envisaged in the Bill for the Medical Practices Committee. My understanding is that the MPC is meant to ensure generally that we have enough manpower. Although it will be consulted, there is a danger of the provision of services becoming divorced from adequate strategic planning.
The health service suffers badly from the lack of strategic planning. I know that the Minister will say that there are regional outposts of regional chairman--chairing nobody--but my party's view is that at almost no additional public cost we could have democratically elected regional health authorities in England and the same sort of bodies in Wales, Scotland and Northern Ireland. Such bodies could be responsible for strategic planning and take advice from and be governed by a body such as the MPC.
Regulation needs to be strengthened. I argued yesterday for an inspectorate to ensure that hospital doctors, nurses, practices and super-surgeries are doing their jobs properly. It could be the umbrella organisation under which bodies such as the Mental Health Commission operate. We also need to ensure that we regulate the professions well.
The hon. Member for Islington, South and Finsbury made a point that I was going to make about people who are currently completely outside the regulatory system. On a recent Radio 5 programme compiled by somebody I know called Ed Hall, the hon. Member for Islington, South and Finsbury and I were asked for our comments about bogus paramedics, bogus ambulance personnel, and so on. This is a scandal, and we should deal with it. There are still many unregulated people around the peripheries of the health service, and there is no excuse for that. They could risk lives and, indeed, cause lives to be lost. We should ensure that the people who carry out primary health care are authorised, professionally competent and certified as able to do the work.
Finally, if we are to ensure that doctors are true to their Hippocratic oath and to themselves, and that they are free agents for the health service, we must ensure that they are not able to be bought, as it were, by other interests. The Secretary of State was helpful in saying that in future all
the people who contract, for the purpose of the pilot schemes, will have to be in the NHS family. I accept that. I strongly share the view--and I have received representations on this--that it would therefore be quite wrong for acute hospital trusts to employ GPs. These trusts should not be empire building--they have plenty to do in running their present services. I hope that the Bill will be amended to make it clear that, at most, only community trusts or those with community purposes might be able to employ GPs. I hope that we can reach agreement on that.
If we are to be absolutely sure that a coach and horses cannot be driven through the theoretical provision that contractors with the NHS will be members of the NHS family, there has to be the same openness--or better--for people in the health service that we in this place are now required to have. All contracts with GPs need to be in the public domain so that I, the hon. Member for Bournemouth, East and all our colleagues, but above all the public, know exactly with whom the GPs in each constituency have contracts and for what services.
I am absolutely in favour of having GPs in my local shopping centre at Surrey Quays. That is fine. I have no problem with that. I have no problem about having GPs in the Elephant and Castle shopping centre or at Victoria station. I am very keen that they should be where the people are. I have never been to Lakeside, that great shopping centre in Essex where everybody goes, which is the largest in the country, although my brother and his wife go there quite often. If thousands of people do all their shopping there, it should have GP surgeries. That is fine, but we have to know that they are independent, free-standing surgeries of GPs who are not dancing to the tune of a supermarket, a drugs company or a load of international arms dealers. How can we know? There has to be a register that every member of the public, every patient, every Member of the House of Commons can look at. That independence must be established at the core of the Bill.
We are moving towards a health service that will have much less conventional practice. We need to take it out into the public, just as the best public health in the early part of the century was taken out to the public in the streets, on the beaches, in the fairgrounds, and so on. At the same time, we need to ensure that people understand that the person with whom they are dealing is an NHS contractor.
Mr. Charles Hendry (High Peak):
The hon. Member for Southwark and Bermondsey (Mr. Hughes) made a comment that I thought particularly interesting. Having
"An eye test is an essential part of any prevention strategy being not simply a sight test but also an eye health check".
It says that eye tests help to prevent blindness, and I entirely support its call on the Government
"as a matter of urgency to extend the exemption categories for free eye tests to include those aged 60 and over".
It says that it would seek ways in which to use the Bill to achieve that.
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