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Mr. Edward Garnier (Harborough): I listened with considerable interest to everything that the hon. Member for Cannock and Burntwood (Dr. Wright) said--I hope that I have got his constituency right. He was fortunate to
follow the hon. Member for Halifax (Mrs. Mahon), who, I think, used to be a nurse in the national health service. Shortly before her came the hon. Member for Belfast, West (Dr. Hendron). I am not sure whether he still has time to practise, but he has considerable experience in the national health service. I shall not follow my hon. Friend the Member for Blaby (Mr. Robathan) with a run-down of my various ailments over the past few years because it would take too long. I congratulate him on the birth of his son--I am sure that that is a happy occasion for all concerned.
Before coming to my main points, I question the way in which the hon. Member for Cannock and Burntwood attempted to elevate his arguments with the word "heresy". I did not find anything that he said in the least heretical and I do not imagine that those on the Labour Front Bench, or anybody else, will send him to the stake for what he has just said. He made a thoughtful, interesting and at times wrong-headed speech, but he should not try to persuade us that his arguments are any the better by describing his interesting remarks as heretical. We all listened with interest, but his arguments are not advanced one jot by over-egging their description.
I agree that not all primary care comes from general practitioners. It is right to stress that. I shall elaborate on it in a moment. I shall also talk about the interdisciplinary practices that he referred to. There is an interesting agreement across the House on those points.
I should like to be controversial to start with by picking a few holes in Labour's reasoned amendment. Why on earth did they draft it in that way? The third line says that the Bill
The reasoned amendment goes on to say that the Bill
Mr. Spring:
Will my hon. and learned Friend give way?
Mr. Garnier:
I ask my hon. Friend to be a little patient, because I am making a fascinating point.
The reasoned amendment goes on to say that the Bill
The amendment winds up with these wonderful words:
Mr. Kevin Barron (Rother Valley):
Will the hon. and learned Gentleman give way?
Mr. Garnier:
I shall give way first to my hon. Friend the Member for Bury St. Edmunds (Mr. Spring), who is sitting patiently.
Mr. Spring:
Does my hon. and learned Friend agree that flexibility is at the heart of the Bill--flexibility to adapt to local conditions that vary from one part of the country to another? Concomitant with that is the fact that pilot schemes for that purpose are inherent in the Bill.
Mr. Garnier:
Labour Members may have drafted the amendment before they had read the Bill. My hon. Friend's point is a good one.
Mr. Barron:
Why was the hon. and learned Gentleman not in the Chamber when the amendment that he has quoted was moved?
Mr. Garnier:
Because I was elsewhere. No doubt the hon. Gentleman will have a chance to wind up.
Mr. Andrew Mackinlay (Thurrock):
He was in his chambers.
Mr. Garnier:
I was not in chambers. The hon. Gentleman has been known to make inaccurate remarks of that sort before. I shall not rise to it.
I want to take issue with the hon. Member for Cannock and Burntwood and some of his hon. Friends who have been here for a little longer than the hon. and voluble Member for Thurrock (Mr. Mackinlay) who sits for the provisional Labour party. The hon. Member for Cannock and Burntwood made some valuable points about the primary care aspects of the Bill. Primary care is not always provided by the general practitioner; it is provided by a range of health professionals who play a complementary role to that of the GP. Visiting our general practitioner is the main point of contact with the NHS for most of us. However, a constituency Member of Parliament has to take a wider view and no doubt Ministers at the Department of Health have a better view of the bigger picture.
My constituency is fortunate in its primary care teams. I trust that they will be strengthened and their flexibility--to use the word chosen by my hon. Friend the Member for Bury St. Edmunds--will be enhanced by some of the provisions in the Bill.
A range of medical professionals operate from Market Harborough, Kibworth, which is half way between Market Harborough and the city of Leicester, and the borough of Oadby and Wigston, which is the part of my constituency closest to the city of Leicester: health visitors; district nurses; occupational therapists; radiographers; and those engaged in the provision of continuing care, particularly for patients who have been in one of the three major hospitals in the city of Leicester and are not ready to go home, but need to convalesce or spend some time in a halfway house first.
All those people perform valuable and valued services in south-east Leicestershire. It is right, as the hon. Member for Cannock and Burntwood said, to think not only of general practitioners. Despite the fact that there is not, I think, a single fundholder, my constituency is fortunate in having excellent general practitioners who are dedicated to the national health service as an institution and to the care of their patients.
Mr. Nicholas Winterton (Macclesfield):
I admit that I have not been present for much of the debate because of other duties in the House, but I was particularly interested in many of the remarks by the hon. Member for Cannock and Burntwood (Dr. Wright). I know his area well--Cannock Chase and Burntwood. There used to be a major mental health hospital--St. Matthew's--in his area.
Does my hon. and learned Friend believe that the patients--the people of this country--would receive better health care, better treatment and better attention if the doctors, male or female, were salaried or, as at present, private professionals contracting to the national health service? Does he believe that the morale of doctors would be improved and that people would get better treatment if, as the hon. Member for Cannock and Burntwood suggests, they were salaried rather than contractors?
Mr. Garnier:
When criticising the reasoned amendment, I pointed out that the allegation that a link with a private company that employs a general practitioner damages the quality of health care is fallacious. I hope that I have therefore already answered my hon. Friend in addressing the terms of the amendment. There may well be some excellent doctors who will want to continue as self-employed practitioners, and some excellent doctors who will want to become employed doctors. To me, what is important is the service and the care that they deliver, not the manner in which they are remunerated.
I should like to expand a little further on the provision of community primary care services, especially in so far as it affects my constituents. We were fortunate to be visited in the past fortnight by my hon. Friend the Minister, who was able to see for himself at first hand the provision of primary care not only in my constituency but in the city of Leicester. I trust that he came back to London with the message that, "If you want to be ill, Leicestershire is the place to do it." The county has some of the best equipment, personnel and hospitals at all levels, and is a credit to the NHS.
My hon. Friend the Member for Blaby has already discussed for some little while the three major acute hospitals in the city of Leicester, so I shall not repeat what he said. However, I remind my hon. Friend the Minister of what he will have been told when he came to Market Harborough not so long ago about the benefits of the local
provision of primary care, particularly that given through the Market Harborough and District hospital on Coventry road in the town and in the local health centres.
I should like to draw the attention of my right hon. and hon. Friends on the Front Bench to clause 27, which deals with pharmaceutical services. There has been considerable debate in my constituency about the provision of such services by rural GP practices. There is a competition, not to say an outright squabble, between pure pharmacists, who have shops and want to provide prescriptions, and rural GP practices, which earn quite a lot of their income by prescribing NHS drugs, thus enabling them to invest in the services that they want to provide for their patients. I trust that we can find our way to a sensible resolution of the dispute between rural GP practices and pharmaceutical service providers during debates on the Bill.
I should like to comment on the huge number of regulations suggested in the Bill. There is hardly a clause that does not provide for the creation of regulations. I am all for the proper use of regulations in order to deliver a particular service well, but I ask my right hon. and hon. Friends on the Front Bench to bear very much in mind the problems of over-regulation. I gently chide them so that we do not end up with so much red tape and the binding of people to regulations that they cannot deliver what they are required to deliver.
The Opposition amendment complains--mention of it has been made by me, if not others--about the link between private employers and the provision of national health service GP services. I want the Government to encourage partnership between the private sector and the public sector.
One extremely good example of such partnership is the Macmillan green ribbon appeal at the Leicester Royal infirmary. As a consequence of that appeal, £1.5 million has been raised in the past year. The appeal committee was chaired by Mr. James Wilson of Gaulby in my constituency. As a result of the huge amount of money that he and his colleagues on the appeal committee have been able to raise, a whole new oncology building has been built next door to the royal infirmary.
"fails to require health authorities to consult with patients and professional groups on pilot projects".
A failure to require that does not mean that they cannot or need not do such things. I suggest that that is a wholly otiose collection of words in that particular part of the proposed amendment.
"fails to provide for nurses and other primary care professionals to participate fully in pilot projects where appropriate".
No doubt they will participate when appropriate. Primary legislation is not required for that.
"fails to establish criteria by which the success of pilot projects can be evaluated and fails to provide for health authorities to employ directly general practitioners".
The Bill may not include such provisions, but that does not detract from its value. The reasoned amendment goes on:
"it includes provisions to allow private companies to employ general practitioners to provide patient care, thereby undermining the doctor-patient relationship".
That is one of the more interesting--or perhaps less interesting--non-sequiturs that new Labour has come up with in recent weeks. The fact that one doctor has a
different contractual arrangement with the person who pays his salary than does another has no bearing on the way in which he should provide patient care. To suggest that the doctor-patient relationship is undermined and damaged by that is simple poppycock. I suspect that the Labour party knows that, and merely wanted to add words to the amendment for the sake of it.
"the destruction of the principle of health care being available according to need and free at the point of delivery."
Nothing that is printed above those final two lines of the amendment has any bearing on that conclusion.
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