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Mr. Simon Hughes: I share many of the hon. Lady's concerns about the improvements that the Bill must deliver. However, given the Secretary of State's announcement--which I think we all welcome--do the

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hon. Lady and her colleagues intend to press the reasoned amendment? Do they want the Bill to fail tonight, or do they want to get it on to the statute book?

Ms Jowell: We want to ensure that the points that we have made in our reasoned amendment are put to a vote in the House. We believe that, unless they are addressed, the Bill will be seriously weakened. I look forward to hearing the Minister respond to those issues in winding up.

In his concluding remarks, the Secretary of State mentioned that GPs who leave pilot schemes will be able to return to independent contractor status. We welcome that assurance, which will undoubtedly reassure GPs who wish to participate in pilot schemes. However, we were concerned by the Secretary of State's failure to mention any protection for patients who registered for pilot schemes that were discontinued. Listening to the Secretary of State--who is now chatting to his hon. Friend the Minister for Health--one was left with the impression that patients' interests are peripheral to the Bill. That impression was strengthened by the Secretary of State's remarks about the need for consultation with patients, to which we refer in our amendment.

My hon. Friend the Member for Islington, South and Finsbury pointed out the lack of detail on the precise course that any consultation should follow. No reference was made by the Secretary of State to the need for the view of patients to be fully considered before pilot projects are established.

In Committee--if we reach that stage--we shall pursue that issue, and shall seek an assurance from Ministers that pilot schemes will not proceed without first having been open to comment and consultation with patients. We shall also press the Government on the need for patients to be properly protected in the event of a pilot scheme being discontinued, and on the need for proper consultation with patients.

The Secretary of State did not provide any detail on what the proposals in the Bill will do to address the crisis in NHS dentistry and to ensure that people have access to NHS dentists. Many people in the world outside would like to know what the Government intend to do. The British Dental Association found that one in three people have trouble finding an NHS dentist. There are enormous regional variations.

When the White Paper was published, the Secretary of State remarked:

"The last 17 years have seen . . . steady growth of NHS dentistry".--[Official Report, 15 October 1996; Vol. 282, c. 589.]

That glib claim shows no understanding of the real problems that many people face when trying to find an NHS dentist. He should speak to his hon. Friend the Member for Blaby (Mr. Robathan), who admitted that it has become harder in recent years to find an NHS dentist.

Mr. Nicholas Winterton: Will the hon. Lady give way?

Ms Jowell: The hon. Gentleman has not been present for the whole of the debate, so I shall not give way.

We want the Government to explain how the proposals are intended to solve that problem.

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The White Paper, "Choice and Opportunity", was welcomed for its recognition that the two-tier service engendered by the Government's reforms is unacceptable. It stated:

"It will be important not to create inequity of resources for patients of different practices."

Sadly, the Bill offers no safeguards to prevent that. We shall return to that matter if the Bill reaches Committee.

The White Paper also admitted that the Tories have neglected primary care in many parts of the country. That is not a startling revelation to Opposition Members. It says:

"The quality of service for some patient groups in some areas is not always high."

That was another welcome admission, but again the Bill contains no proposals to end the unacceptable variations in the standard of primary care across the country.

Other issues should be given detailed consideration. Whistle blowing was brought back into the spotlight this week by the dreadful revelations at Ashworth hospital. As independent contractors, GPs currently have the freedom to raise issues of concern on behalf of their patients. Should the Bill be passed in its current form, and should the employment of GPs become the responsibility of NHS trusts, that freedom would be curtailed. We do not believe that that would be in the interests of patients. We believe that that freedom should be preserved.

Should the Bill reach Committee, we shall want to discuss the lack of detail on the process by which pilot projects will move to permanent schemes, and the impact of a single budget for health care with its attendant risks, to which a number of hon. Members referred.

This may be the final debate on health in this Parliament: it certainly will be if the Government have their way. The Bill provides a building block, and in part we welcome that. The manner of its management in the other place, and the Secretary of State's announcement today, constitute an extraordinary climbdown. The Government wanted to privatise general practice, but they realised that they could not get away with it.

My hon. Friend the Member for Islington, South and Finsbury made it clear that amendments were withdrawn on Report in the other place and did not reappear on Third Reading, without any adequate explanation. We have now had a major climbdown by the Secretary of State. Given the chaotic management of the Bill, we believe that, before it goes to Standing Committee, consultation should be held with professional interests and groups that will be directly affected. That is an important part of ensuring that the legislation will work in practice.

In essence, the Bill is a long-overdue response to problems of the Government's own making. The British Medical Association has said:

"GP morale is at its lowest ebb for many years, is caused by excessive workload, the continuing out of hours burden, too much bureaucracy and falling remuneration relative to comparable professions".

It is because those problems have been ignored for so long that there is now an acute shortage of GPs in so many areas.

As my hon. Friends have made clear, there is much in the White Paper and the Bill that we welcome, but--as careful reading of, in particular, the White Paper reveals--it is a very quiet and muted apology for the damage that

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the Government have done to the national health service. It comes at the tail end of a Parliament, before a general election that we hope will produce a Labour Government--a Labour Government who will use the acceptable parts of the legislation to rebuild primary care, and to rebuild a national health service in the interests of patients and of all the people of this country.

9.40 pm

The Minister for Health (Mr. Gerald Malone): I listened to the speech of the hon. Member for Dulwich (Ms Jowell) with some interest. I am glad that the Bill is broadly supported by the House; indeed, the hon. Lady claimed that it was long overdue. It is somewhat unusual in such circumstances for the Labour party to table a reasoned amendment that would deny the Bill a Second Reading, and I cannot quite square that with what has been said.

Having heard both the hon. Lady's speech and that of the hon. Member for Islington, South and Finsbury (Mr. Smith), as well as supporting speeches from other Opposition Members, I think it was clear that they were straining to highlight issues that divide the House, when there was a general consensus on the principles of the Bill--although, of course, we shall have to address certain issues in Committee.

I do not think that the hon. Lady made a terribly good job of distancing her party from what the Government are trying to do. She does herself no credit by trying to raise scares, and trying to elevate issues that were, perhaps, always at the periphery of what was happening as we introduced the legislation to a central position that they never held. I am delighted to be able to say that there is a great deal of consensus between the Government and the medical profession, whose members consider the Bill necessary. [Interruption.] We are hearing the normal sedentary interventions from the hon. Member for Cardiff, West (Mr. Morgan). If he had been here to listen to the debate, he would have found that many of his hon. Friends broadly welcomed the Bill.

Let me return for a moment to the genesis of the proposal. Primary care has served the country well since the national health service was brought into being in the late 1940s. It has had an honourable career for some 50 years, but during those 50 years, it has largely remained unchanged: it is still delivered in the same form as when it was first introduced. Those who read the original document advising patients what to do to register with a general practitioner back in 1948 will note that the sonorities are the same--and that, moreover, the details are the same.

A truth has been acknowledged by all the professionals who provide the primary health care team: a truth that is certainly recognised by the Government and, perhaps somewhat grudgingly, by the Labour party. Although Labour Members may now have been converted to some of the principles in the Government's proposals, I do not recall their initiating a debate such as this when they had the opportunity to do so in government. The truth is that this is a service that needs to change. Things have moved on; the ability to deliver primary care has developed, and the various roles of the primary health care teams have changed. Those teams want to perform in a different way, and the Bill, together with the White Paper, takes the debate forward by light years.

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As my right hon. Friend the Secretary of State said, I have had the benefit of going around the country listening to the ideas of all the primary health care professionals about how to take the service forward. I enjoyed that exercise. The Bill has been largely formed not by what Ministers thought should happen to primary care, but on the principles that were set out by primary health care professionals. I pay tribute to all those who were involved in the listening exercise and the exercise that followed it. Much hard work was put into it. I pay tribute both to every professional who attended and to officials in the Department and all the regions, who have been working vigorously to make the Bill a proposal that is fit to come before the House and be put into legislation over such a length of time.

The hon. Member for Dulwich made a point about NHS dentistry, which was not referred to in great detail in the debate, but which was also mentioned by the hon. Member for Morley and Leeds, South (Mr. Gunnell). The answer to her question is that the Bill will provide, should dentists choose to use it, an entirely new and more flexible option of contracting with health authorities to provide dental health care. It was extremely unfair of her to quote selectively from what my right hon. Friend the Secretary of State for Health has said about NHS dentistry. It is true that, in recent years, the overall volume of dentistry provided through the NHS has increased. It is also true that the number of dentists providing that treatment has increased, but the Government have never shied away from the proposition that, in certain regions, there are difficulties in the provision of NHS dentistry, which will be tackled through the Bill and through new arrangements.

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