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8.51 pm
Mr. John Gunnell (Morley and Leeds, South): I had a nightmare last night that I believe was brought on by the Secretary of State's words following the Queen's Speech, as quoted by my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith). Perhaps it happened because Asda is prominent in my constituency or because I have met Archie Norman once or twice on business connected with Asda and my constituents. He is obviously an able entrepreneur, and I know that he now has other roles in the Tory party.
In my nightmare, I imagined Asda setting up surgeries in my constituency. A patient would go to an Asda surgery and tell the doctor that he was suffering from stress; shortly afterwards, he would receive an advertisement for Asda products--low-fat, easy-to-cook, microwaveable nouvelle cuisine, perhaps--that would be good for his condition. I imagined in my nightmare that such a tie-up might happen.
The Secretary of State told me today that I was completely wrong and that there would be no commercial pressures. My hon. Friend the Member for Islington, South and Finsbury was kind, and the hon. Member for
Southwark and Bermondsey (Mr. Hughes) was disingenuous, in responding to that. The latter regarded it as a pledge that was there for all time, but I believe what Colin Brown wrote in today's The Independent. He said:
I understand that the Minister played a critical role in securing that pledge from the Secretary of State; that is because he has been at the front line of the consultations and knows that GPs do not want commercialisation or commercial pressures, as the BMA made very clear. Will he make it absolutely clear that clause 14 will be dropped from the Bill? It was said that only health service bodies would make provision, but under the clause a non-health service body could do so.
If the clause is dropped, my nightmare will not come true--at least not for the moment: I should like to be completely sure that it was dropped for all time and not merely to woo the electorate. The public have made it absolutely clear that they do not want doctors provided by commercial organisations.
In Morley in my constituency, there is an extremely active community pharmacy, the Janet Ward pharmacy, that has an excellent system of working with a local GP and providing a genuine community service, taking care of all the pensioners and people in serious and urgent need. To do that, it has to maintain large stocks, and it is running an excellent business. It is helpful if such community activities can be part of an NHS contract, as is suggested in the Bill. I am in favour of that.
The pharmacy, however, is just down the road from the Asda store, which undercuts its prices for drugs. As a result, it is becoming more difficult for it to stock the necessary range and quantity of drugs. Two aspects of the Bill are therefore working in conflict with one another. I do not want to deal with the specifics of the sale of drugs and price maintenance, but that is not unrelated to continuing community pharmacies.
We broadly welcome the Bill, as long as the commercial clause 14 is dropped. We consider that the Bill gives a welcome flexibility in GP contracts and view it as a boost for local co-operation in the provision of primary medical services. It is a departure from the narrow competition of fundholding. The patient is currently disadvantaged by the rigidity of a system that prevents GPs from taking a greater role in the development of services.
I am glad that the Government have come to see the value in Labour's policy of local commissioning. Apart from our concern about the role of acute hospitals trusts, which my hon. Friend the Member for Birmingham, Northfield (Mr. Burden) mentioned, the Bill, once it has been pruned of its more dangerous elements, is to be welcomed.
I have some specific questions for the Minister. Nurses and midwives have been mentioned several times. In Committee in the Lords, Baroness McFarlane tabled an
amendment to make the right of nurses to set up a primary practice an explicit part of the Bill. Baroness Cumberlege rejected that as unnecessary, because she believed that the Secretary of State would look favourably on some nurses' pilot schemes; but how will we get such schemes unless that is made clear in the Bill?
I welcome the possibility of pilot schemes in NHS dentistry. It is worrying that NHS dentists have almost disappeared in some places, especially where there is a sufficient potential base of private patients.
On commissioning, I asked the Secretary of State about the time limit for schemes. I was glad that he said that he would table an amendment to set a maximum time of three years but I am surprised that he does not think that we need an amendment to set a minimum time. The British Medical Association suggests 18 months, which is a sensible time for a pilot to run. It is important that pilots run for a complete financial year because the way in which schemes are financed is important.
I am not convinced that the Bill and its explanatory and financial memorandum allow enough money. For the financial year 1997-98, a provisional £6 million has been allowed. Clause 16 allows for public funding of the costs of preparing the pilot schemes. It sets limits on such funding and allows for repayment if conditions are not complied with, but is there a potential additional cost to health authorities that the Secretary of State will not fund? It is unrealistic to think that £6 million will cover the cost of preparing, managing, monitoring and evaluating schemes.
I am worried about the single budget for health care. It is right to have one, but once schemes are up and running, clause 32 provides that health authorities will fund costs from cash-limited expenditure that currently funds hospital and community care. We are told that the single health budget is intended to boost cottage hospitals, but the Government have closed 245 of them since 1990. There is no estimate in the memorandum of how much will have to be transferred from the non-cash-limited budget that is currently used for general practice. Will any shortfall come out of health authority purchasing power? There will also be an effect on secondary care funding. I doubt whether all the changes can be funded from £6 million and efficiency savings in primary care.
We welcome much of the Bill but we need to be convinced that the Secretary of State has really chopped off his previous commitment to the commercialisation of services. I would like to be sure that that is not, as The Independent says, an electoral response. We are concerned about the effect of commercialisation on the doctor-patient relationship.
Mr. Richard Spring (Bury St. Edmunds):
I very much welcome the Bill, which deals with primary care. Primary care is regarded by many as the jewel in the crown of the NHS, and it is also the envy of other health services throughout the world.
It is often said that many professions enjoy low public esteem and certainly--according to the polls--we as Members of Parliament share with journalists and estate agents that low esteem. Even the clergy sometimes have difficulties. But one profession that enjoys considerable public esteem is the medical profession--our GPs. That is because they are a central part of life in our cities, towns and villages. The local accessibility and the trust that they have developed among their patients and in their communities are so valuable. Part of the primary care provision is the role of community nurses, to whom I pay special tribute. Many of my constituents have talked about the role that they play.
In the evolution of GPs--and latterly of fundholders--there has been an expansion in the services they offer. We can all remember the old-fashioned premises in which doctors used to operate, which were not at all user-friendly. Today--particularly in GP fundholding practices--one enters an environment that is wholly different from that of the past. Services such as minor surgery, chiropody, improved diagnostic procedures, ultrasound, X-ray facilities and pharmaceutical services are provided, and these are greatly valued by local communities.
I saw that for myself in the village of Lakenheath in my constituency, which has 5,500 residents. Doctors in the village wanted to increase the scope of the pharmaceutical services that they provided to the community. Another pharmacist came along and wanted to set up a rival operation but, interestingly, local people passionately wanted only the doctors to provide the service. Whatever the pros and cons of that issue were, it underlined the value of primary care services and how much they are trusted and appreciated in our communities.
I have mentioned the enhanced range of services that are available, but following GP fundholding there has been an additional drive to quality. This has been led by the fact that realistic choices are given to GPs to pursue better services for the treatment of their patients. In the past few weeks, I have written to all the GP fundholders in my constituency, and I am slowly beginning to receive replies. Many are concerned about the setting up of the so-called locality GP commissioning groups. They have asked me what these will mean in practice, and whether GPs will lose the right to direct patients to hospitals of their choice. They are concerned about the potential additional bureaucracy of the so-called consultation process involved in the setting up and operation of the commissioning groups.
The truth is that there have been many changes at the primary end of the NHS, but it is now basically working very well indeed. If it ain't broke, don't fix it--that is the principle. However, there is a feeling that the current national arrangements are inadequate as they are insufficiently flexible. It is true that the needs of communities differ from one part of the country to the next. But at the heart of the Bill--this is what makes it so welcome--is additional local flexibility to allow GPs to match their skills to the needs of their communities and patients. The Bill will also provide a legal framework for
medical and dental services. I particularly welcome the fact that pilot schemes are seen as part and parcel of the way in which it is envisaged the Bill will operate.
My hon. Friend the Member for Blaby (Mr. Robathan) referred to preventive medicine. In the expansion of primary care facilities in this country, we have seen an ever greater emphasis on preventive medicine. Health care needs are being brought to the attention of the people. We would all like to live to a ripe old age in a healthy way, and I am sure that hon. Members will agree that Dame Barbara Cartland is a shining example of that.
The fact is that local flexibility needs to adjust to different circumstances. When I served on the Select Committee on Health, I went to the east end of London, where there are considerable problems with respiratory and bronchial ailments that need to be addressed at a primary level. Those problems are being addressed and the services will be enhanced by the Bill.
I also welcome the fact that, as primary care has evolved, there has been greater use of complementary medicine, especially by GP fundholders. Homeopathy is now seen to work at a complementary level and many doctors believe that there is some value in that. Hon. Members will recall that my hon. Friend the Member for Aylesbury (Mr. Lidington) introduced a Bill to bring chiropractic into the mainstream of accepted medical practice and the same change of attitude is happening in respect of osteopathy--an holistic approach, which has been pioneered at the primary level and is so welcome in expanding services in this country.
I am delighted to say that, on Friday, my right hon. Friend the Secretary of State will come to my constituency to visit Newmarket hospital--indeed, some years ago when he was a junior Minister, he was involved in the decisions about the future of the hospital. He will see that out of that £8 million project has come an important bridge from primary care to the sort of services that are offered at the hospital, leading up to acute care facilities. The level of satisfaction among out-patients is high and the services that are offered, working closely with GPs, including radiography and physiotherapy, are greatly valued.
That flexibility is so important. Only this afternoon, I received a letter from a GP in Newmarket telling me how successful the new hospital was and how well he was able to slot in his activities at primary level with those of the hospital. We now have a spectrum of NHS services that is clearly enhancing patient care.
I want to make one point in respect of acute care. Many spurious points have been made about the health of the NHS as a whole. As I go around the main acute care hospital in my constituency, the West Suffolk hospital in Bury St. Edmunds, and look at the staggering range of new facilities that has been introduced over the past few years--from the day surgery centre to the state-of-the-art intensive care wards to a brand-new £500,000 operating theatre--I know that more patients are being treated and better services are being offered. I pay tribute, on behalf of my constituents, to the range of facilities that are now offered.
I ask my hon. Friend the Minister to comment on one issue that has been brought to my attention by GPs in my constituency, which is the fact that many of them feel that the route into working in hospitals--the possibility of moving up and perhaps becoming consultants--has
become increasingly attractive relative to the alternative of staying on as GPs. Many feel that for a variety of reasons the attraction of being a GP, as opposed to working in a hospital environment, has lessened somewhat in the past few years. I should be grateful if my hon. Friend would comment on that.
"Mr Dorrell agreed to revise the clause after the British Medical Association warned that it would ask GPs to make the proposal for 'supermarket surgeries' an election issue."
I rather think that that is why the proposal has been dropped. It is potentially dangerous, because it shows that privatisation, perhaps by stealth, could happen in primary care if the Conservatives won a further term. I am sure, however, that the public will have understood that message.
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