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Mr. John Garrett (Norwich, South) rose--
Mr. Dorrell: No, I shall move on.
That is not the only threat that the Labour poses to the future of the national health service. The biggest threat hanging over the health service is the threat of another round of bureaucratic change, and the costs that that will entail. The hon. Member for Islington, South and Finsbury made a speech on 3 December, in which he set out his proposals for another round of management change. That speech has rightly been widely reported as threatening real damage to and bureaucratic upheaval in the health service. He began by saying:
The hon. Gentleman continued:
As the Financial Times reported the day after his speech:
Mr. Chris Smith:
First, will the Secretary of State confirm that the last five minutes of his speech have proved comprehensively that his earlier charge that the Labour party has no health policy is untrue? Secondly, will he address what the Health Service Journal said about that speech--that our proposals were coherent and credible?
Mr. Dorrell:
I shall now address what the Royal College of Nursing said about it:
Mr. Heppell:
It is unfair to make comparisons with Labour's plans. We are proposing an alternative to fundholding. The Secretary of State has probably forgotten the Audit Commission report of 22 May 1996. It said that fundholding costs millions of pounds in extra administrative costs, provides no extra benefit to patients, does not fit in with health authority plans for local people and means that decisions about hospital care are taken without the involvement of hospital doctors. That is what we propose to replace, not what the Secretary of State suggests.
Mr. Dorrell:
The hon. Gentleman takes me neatly on to my next point.
The speech by the hon. Member for Islington, South and Finsbury in December meant that Labour had at last come off the fence in respect of fundholding. Month after month there were conflicting messages from different parts of the Labour party about fundholding. The Leader of the Opposition briefed The Sunday Times in October to the effect that he supported fundholding and that fundholders had nothing to fear from Labour. Then the hon. Member for Islington, South and Finsbury briefed two separate newspapers with completely contradictory messages. On 4 December, The Independent reported: "Labour to scrap fundholding". That was based on a briefing offered by the hon. Gentleman. One day later, Doctor magazine reported:
The hon. Gentleman has now made the position clear, however. He made it crystal clear on the Dimbleby programme yesterday. When asked about Labour's proposed replacement for GP fundholding, he said:
The hon. Gentleman has at least made it crystal clear that Labour plans to snuff out fundholding. The hon. Gentleman has bowed to the pressure from old Labour. If he had mentioned that in his speech, he might have got a cheer from his hon. Friends on the Bench below the Gangway. They came in hope and the
hon. Gentleman had an opportunity to throw them a bit of red meat, but instead he told a few anecdotes in an irrelevant journey around the national health service.
That commitment leaves the hon. Gentleman with the difficulty of defending a clear commitment which flies in the face of the views of the majority of GPs. Howard Glennerster at the London School of Economics said that fundholding had provided
Dame Angela Rumbold (Mitcham and Morden):
I have listened carefully to both sides of the debate, including the proposals by the Opposition spokesman. Until the last few moments of the speech by the hon. Member for Islington, South and Finsbury (Mr. Smith), I could discern proposals relating only to an increase in bureaucracy. My right hon. and hon. Friends and I are alarmed to think that reduction or abolition of fundholding practices will decrease the effectiveness of GP care for patients. I should have hoped that a health debate would be about patients and patient care, but instead there has been great discussion about structures in the health service, and the Labour party want to destroy a structure that has really helped patients.
Mr. Dorrell:
I could not agree more. My right hon. Friend is making what is the strongest argument in defence of fundholding. That is why barely one in five GPs believe that Labour has produced an adequate answer to the empowerment of GPs that fundholding has provided. A recent survey of fundholding opinion found that 71 per cent. of GPs surveyed rejected Labour's proposals outright, precisely for the reason that my right hon. Friend gives--they undermine the capacity of GPs to deliver high-quality care to their patients.
David Colin-Thome, a former Labour candidate, said that the proposals of the hon. Member for Islington, South and Finsbury amount to
"Everyone from all parts of the health service tells us that the last thing they want is for us to throw everything up in the air again and try to catch the pieces. 'No more major upheavals, please', they tell us. I have heard that message."
The hon. Gentleman may have heard it, but about four pages later he made it absolutely clear that he would ignore it completely. He went on to say:
"So it is our intention that the strategic planning functions of health authorities and the health care provider responsibilities of hospitals should remain, but the decisions about what treatment to organise on behalf of patients should be drawn together in local GP-led commissioning groups."
The hon. Gentleman went straight on from his promise of stability to set out a new blueprint for the reorganisation of the purchasing function of the national health service. He continued:
"Within each current health authority area, there might therefore be between five and 15 commissioning groups."
Each area has one health authority--one bureaucracy. The hon. Gentleman is now threatening between five and 15 new bureaucracies in every health authority area.
"The health authority would delegate to each local GP group a comprehensive budget covering all aspects of care"--
here is the rub--
"The commissioning group would of course have to have access to the appropriate level of management support."
Of course it would. The hon. Gentleman's speech sets out a blueprint that delegates the main purchaser function from 100 health authorities to 500 new bureaucracies. It is abundantly clear that the new version of purchaser-provider would maintain the internal market, but instead of having 100 health authorities and many GPs acting as purchasers, the hon. Gentleman proposes that there should be 500 bureaucracies all operating in the internal market.
"Labour claims this creation will reduce bureaucracy and increase value for money. What it threatens to do is precisely the opposite: to stifle innovation, produce indecision and replace larger purchasing units with less efficient smaller ones."
Those are not my words. They are a summary by the Financial Times of the hon. Gentleman's proposal to impose a new bureaucratic cost on the health service in contravention of exactly the principle that he enunciated at the start of his speech--that the health service needs a period of stability.
"We are appalled that Labour has failed to recognise nursing's central role in primary health care."
The hon. Gentleman must be the first Labour health spokesman in history to provoke such an unambiguous reaction from the Royal College of Nursing. No wonder he went rushing along to a nursing conference last week to make nurse-friendly noises which added up to a total of £500,000-worth of promises for nursing. I read the hon. Gentleman's speeches to ensure that he is not allowed to get away with the speeches he makes in health debates where he simply reads out a series of anecdotes in order to obscure the damage that Labour's health policy would do to the national health service.
"Labour promises to retain fundholding".
The hon. Gentleman was seeking to take a middle way between preserving fundholding and abolishing it, recognising that more than half of Britain's GPs have chosen fundholding because they recognise that it is the way of delivering the best NHS care to their patients.
"There will be a requirement within three years for GPs to join a locality group."
When Jonathan Dimbleby said:
"All fundholding GPs in individual practices now will have to join up in their locality into one supergroup",
the hon. Gentleman replied, "Yes, indeed."
"a shift in the balance of power back to general practice for the first time this century."
Successive Health Ministers--Labour and Conservative--have sought a shift of power back towards primary care. Fundholding has delivered that, and not just in the opinion of Government supporters and sympathisers. An article in the New Statesman by Mr. Stephen Pollard, a former research director of the Fabian Society, puts the case for fundholding. This scheme has improved the quality of primary care in the health service and, indeed, has improved the health service as a whole.
"the standard health authority model with a few GPs thrown in".
That is what the hon. Gentleman is offering, in the opinion of a former Labour candidate.
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