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GP Fundholding
3.31 pm
Mr. John Maples (Stratford-on-Avon) (by private notice): To ask the Secretary of State for Health whether he will make a statement on his plans for GP fundholding.
The Secretary of State for Health (Mr. Frank Dobson): My announcement today of fair waiting lists for patients of all general practitioners is an attack on unfairness. It is not an attack on GP fundholding. The previous Government introduced the internal market into the national health service, creating a two-tier system in which patient was set against patient, and GP was set against GP. That was unfair to patients and repugnant to the doctors and nurses who had to apply the system, and it cost a fortune in extra paperwork.
At the general election, we promised to restore fairness to the health service, to end the two-tier system and to ensure that access to treatment is based on need, and need alone. We pledged to change the system so that no patients and no GP practices should suffer any longer from the unfairness introduced by the Conservatives. We are keeping that election promise.
From now on, all NHS trusts must operate a fair waiting list for urgent admissions, regardless of who is commissioning the care. With effect from 1 April 1998, when current contracts run out, all health authorities must establish common waiting time standards for all people living in their area. From the same date, health trusts must not offer preferential treatment to any particular group of patients from health authorities, regardless of whether they are patients of GP fundholders. Faster treatment must be provided only on accepted clinical or social grounds. That change will be fair to every patient, and will be more comfortable and acceptable for doctors and nurses to operate.
My announcement today has been welcomed by the British Medical Association, the Royal College of Nursing and the NHS Confederation. The National Association of Fundholding Practices has made it clear that it fully accepts the principle of fair waiting lists and that, if properly implemented, the new policy will benefit all patients.
In two thirds of all health authorities, the patients of non-fundholding practices have to wait longer for hospital treatment. What is not so well known is that, in the other one third, the patients of GP fundholders lose out under the present system.
We are determined to have a national health service which is fair to all patients. That fairness will be achieved through co-operation in place of the competition and division of recent years. It will be achieved by levelling up to the best that has already been achieved, not by levelling down.
In our general election manifesto, we recognised that the development of fundholding had brought advantages as well as disadvantages. We promised to remove the disadvantages. We are keeping that promise. A month ago, we set out to bring fairness to the financing of non-fundholder practices. Today, we are bringing fairness to their patients.
We are now consulting the professions and patient organisations on how best to develop a primary care system fit for the next century, in which doctors and
nurses can play a leading part in planning local health services for all the patients in their area. In this way, we hope to reconcile the better aspects of fundholding with fairness for all patients. We are discussing this with all the professionals involved, and will test out our proposals through pilot schemes in every part of the country.
The new system, like the announcement that I have made today, will be based on the principle that access to health care is based on need, and need alone. That is the principle of fairness, quality and equality on which the Labour party founded the health service. It is the principle of fairness, quality and equality on which we will run the national health service so that it is fair to every patient. Who could possibly quarrel with that?
Mr. Maples:
Well, the chairman of the Association of Fundholding Practitioners for one, because he did so on the radio this morning. Perhaps the Secretary of State has got at him since, but this morning on the radio he was expressing considerable reservations.
What we have just heard is a prologue to the slow death of fundholding in the national health service. [Hon. Members: "Hear, hear."] That is the authentic voice of the Labour party. It is happy that it is going to be abolished.
Fundholding has been one of the great successes of the NHS over the past few years. It has put money, power and responsibility in the hands of GPs. They are the people who really understand their patients' needs and who know their local hospitals and local consultants. More than half of GPs have voluntarily become fundholders. They account for more than 60 per cent. of all patients. There would be many more if the Secretary of State had not balked at the last wave. Doctors have voted the scheme a success.
We believe that the Secretary of State plans a slow death for fundholding because it does not fit his model. He knows best, and he plans to direct everything from Whitehall. The idea that individuals should be trusted to make decisions or take initiatives is anathema to him and his party. It is the beginning of the end for fundholding. [Hon. Members: "Ask a question."] There will be some questions--do not worry.
If the Secretary of State does not believe us, perhaps he will believe the Audit Commission, which said:
Professor Glennerster, a former member of the Labour research department, said:
Madam Speaker:
Order. I remind hon. Members that this is a private notice question and that the Member who
Mr. Maples:
I am coming to the end of the preamble.
Equality is best pursued by maximising opportunities, not minimising them. Arguing about a two-tier health service is akin to saying that equality in human need is best achieved by starving everybody.
Why does the Secretary of State not extend the power held by fundholders to all GPs and all patients? Why not extend to everyone the advantages of a successful experiment? Will he give us a cast-iron assurance that his policy is not to destroy or neuter fundholding? Will he give a cast-iron assurance that GP fundholders will continue to be free to refer their patients to the consultants and hospitals of their choice? The Secretary of State wanted specific questions, but he is not making any note of them. Will he give a cast-iron assurance that GPs will have the power and the money to make those referrals?
Thousands of fundholding GPs and millions of their patients want answers to those questions. If the Secretary of State cannot give us those answers, we and they will know what we have long suspected--that he plans to end the most successful experiment ever in improving patient care and NHS efficiency. If that is what he plans and does, patient care will deteriorate, waiting lists will increase and he will go down in the history of the NHS as a vandal as well as a dinosaur.
Mr. Dobson:
I think that the hon. Gentleman was better when he was asking questions. He should consider the interests of patients in his area. In his constituency, as in the constituency of the right hon. Member for Fylde (Mr. Jack), the shadow Minister, the patients of fundholding practices are treated more slowly than others. He should pay a little attention to the people whom he allegedly represents.
I assure the hon. Gentleman that what we have announced today has the support of the British Medical Association, which represents all doctors, the Royal College of Nursing and the National Health Service confederation. Mr. Rhydian Morris, who represents fundholders, has explained to me that they support in principle our effort to establish fair and common waiting lists, provided we do that effectively and deliver on our aims. We shall do that.
The hon. Gentleman's contribution shows that the Tories are not interested in patients or in fairness. They are still obsessed with institutions that they introduced, largely on the advice of a heroin addict and prescription fraudster. We are not prepared to continue that system. We shall replace it with a system that will be the product of consultation with all doctors, all nurses and all people involved in providing primary care. We need a decent primary care system that is fair to every patient of every practice. We shall bring that about.
Dr. Howard Stoate (Dartford):
Is my right hon. Friend aware that many GPs, including fundholders, are far from happy with the fundholding system as it stands? Is he
"There is evidence that the direct involvement of GPs had led to improvements in service".
The Organisation for Economic Co-operation and Development said:
"GPs seem to have done a better job of purchasing . . . GPs have been prepared to diversify providers, challenge hospital practices and demand providers".
The King's Fund described fundholding as one of the major successes of the reforms, and an Edinburgh university study found that it had achieved savings.
"All the dire predictions . . . were unfounded.. efficiency gains had more than outweighed costs."
By any standard, fundholding has been a great success. The Secretary of State's excuse for beginning to dismantle it is that it has produced a so-called two tier NHS. Let us be clear that it is an allegation--[Hon. Members: "Question."] It is an allegation--
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