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Mr. Dobson: Surely there would be no point in having a review if we were satisfied with the lunatic situation in which the previous Government placed the London health service.
Mr. Dorrell: Surely a review looks at the evidence and comes out with a conclusion based on that evidence. How can the Secretary of State expect us to have confidence in a review when he has already ruled out one of the potential conclusions? That is the question that he must answer. He has in fact obstructed the process of change in London's hospitals and he has set up a half-cocked review which will not carry conviction because it will not have the time to look at the evidence that is necessary to assess the issue in detail.
Let us go on to the other questions about the Government's health policy that remain unanswered. Do the Government propose a major management upheaval in the national health service? That should not be a difficult question to answer. Does the hon. Member for Thurrock want a major health service management upheaval?
[Interruption.] The hon. Gentleman is the only Labour Member who has been willing to express an opinion, so I am encouraging him to do so again.
Mr. Mackinlay:
I support my right hon. Friend.
Mr. Dorrell:
I congratulate the hon. Gentleman on his capacity to get the line right. He did not even need to look at his teleprompter to work that out. He conducted a review in five minutes and now he supports the right hon. Gentleman.
For months, the Labour party has spoken with forked tongue on the issue. It says in one breath that it supports the purchaser-provider system and in the next it promises to end the internal market. Last Friday, the right hon. Gentleman went to Leeds to speak to staff at the NHS headquarters there. I applaud him for that. He promised them no major upheaval in the health service. How is that consistent with the abolition of the internal market--a commitment in the Labour manifesto and in the Queen's Speech?
Either we shall have a fundamental change in the running of the health service, in which case the right hon. Gentleman cannot go to Leeds and say that there will be no upheaval, or we shall not. If there is to be no change, we shall continue with the internal market and the purchaser-provider system--the two phrases have exactly the same meaning--that was established by the previous Government in the 1991 legislation.
The Secretary of State is unfortunate in that his three predecessors sat firmly on the fence. Within the next few weeks, he will have to come off the fence because he is committed to producing a White Paper. He will have to tell the national health service, the House and the British people what the Labour Government mean. Do they mean fundamental change or do they propose making a few cosmetic changes and changing a few brass plaques, but basically accepting the system that they have inherited?
An absolutely crucial part of the question whether the Government are going for reform is what they plan to do for GP fundholders. Will they or will they not allow individual primary care practices to continue to operate national health service budgets? Will they continue to allow the system of practice-based budgets to operate? As the Secretary of State will know, I never made it a compulsory system but it was an option available to GPs who felt that it was in the interests of their national health service patients. Will the right hon. Gentleman continue to leave that option available? That is another question that he will not be able to fudge.
Either the doctors will be able to decide what is best for their patients or they will become mere consultees and the right to decide will be shifted from the doctors to the bureaucrats. The right hon. Gentleman will have to decide whether he wants the doctors to decide or whether he wants another tier of bureaucracy in the health service; commissioning, as his predecessor called it. He will have to decide whether he wants to transfer the power from the doctors to the commissioning bureaucrats.
The Labour party loves bashing bureaucrats in the health service but the Labour Government will not be able to continue simply bashing bureaucrats. They will have to develop a policy. The acid test will be whether they prefer doctors or bureaucrats to decide.
That is one of the much wider questions raised by a number of measures in the Queen's Speech. In the national health service the threat is clear. It is that power will be taken from doctors and given to a new tier of bureaucracy. Incidentally, plenty of people within the Labour party will advise the Secretary of State against that course of action. I quote the most recent article by a Labour supporter endorsing fundholding as a key part of a flexible, patient-led health service. Mr. Dick Sorajbi, who until recently was an adviser to the Home Secretary, wrote:
That is a key difference between the approach of the new Government and that of the Conservative Opposition. The Government continue to believe that the way to deliver good public services is to empower well-meaning bureaucrats. We have 50 years of experience to demonstrate that that model does not work, but despite all the evidence, they continue to believe that that is how to deliver a well-run public service.
Our approach in government was different and our approach in opposition will continue to be different. We shall continue to argue that the way to make public services responsible and accountable to the people they serve is to give parents and patients real choice and to give those responsible for managing the services the opportunity and the responsibility to develop those services and to respond to the choice of the people who use them.
Our policy in education, in health and across the whole public sector was to break up impermeable bureaucracies because they are unresponsive and do not deliver high-quality services to the people who rely on them. We shall fight any plans that the Government introduce to recreate bureaucracies that block progress in the public services.
That is not the only theme that runs through the Queen's Speech. In his opening speech, my right hon. Friend the Member for Hitchin and Harpenden identified another key theme and my hon. Friend the Member for Lichfield (Mr. Fabricant) made much of it in his remarks. The Queen's Speech is full of unexceptional sentiments and fraudulent arithmetic. In the national health service, the Government say that they will deliver shorter waiting lists, but that it will not cost any money. In schools, they promise to deliver smaller classes and say that the money
will come from abolishing the assisted places scheme. The fact that no money will come from the assisted places scheme for several years and that all the independent analysis of their proposals says that their arithmetic does not add up continues simply to be brushed aside.
Sooner or later, the Secretary of State for Health and his right hon. Friends will have to get their calculators out. They will have to work out how much the various commitments that they are making will cost. We are told that the commitment on education will cost £250 million. The growth in resources that the right hon. Gentleman needs simply to meet his commitments to increase costs in the health service--never mind treat more patients--will add several hundred million pounds to his budget.
"Fundholding has created an explosion of initiatives in health care . . . This should have been a Labour policy. It puts primary care before secondary care. It is more publicly accountable because citizens can put more pressure on their GP than on a health authority quango."
That was written by a new Labour adviser. I want to hear whether the right hon. Gentleman accepts that advice from his own party or whether he prefers to put his faith in bureaucrats within the health service. If he prefers to put his faith in bureaucrats, he will be applying the same policy in the health service as the Secretary of State for Education and Employment is applying in the education service. It is a consistent theme there, too. There will be less power for schools, governors, and heads. All the power will be concentrated in the local education authority, which will decide not merely the distribution of schools, but the type of schools, and the distribution of pupils. Management vested in the local education authority is the policy which the Secretary of State for Education and Employment has made it clear that he will pursue.
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