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Mr. Dobson: I welcome my hon. Friend's contribution, drawing on his professional experience as a doctor. I assure him that our consultation on the future of primary care will include all representative organisations, including the representatives of fundholding GPs, who have said to our faces that they approve of the changes that we are making and of our approach to the further changes that we intend. We believe that that is the way forward. We want to carry the profession with us and do not want to force people to do things that they do not want to do. It is my belief that the bulk of the medical profession and the bulk of the nursing profession want to do the best by their patients. That is why they support what we have announced today.
Mr. Simon Hughes (Southwark, North and Bermondsey): The Secretary of State is right. On all three points we support him, and on all three points the Conservative spokesman, the hon. Member for Stratford-on-Avon (Mr. Maples), is wrong. Fundholding, with the right to buy advance treatment, is wrong and unfair, and should go. That does not necessarily mean the end of fundholding. Fundholders support the announcement, and are clear that such advance treatment is unjustified. Fundholders' representatives, including the very man who was on the radio this morning speaking for fundholding doctors, have told me so to my face. The Secretary of State has our unreserved support, and I am delighted that he has been able to make the announcement.
The follow-up question that will be in people's minds is whether, given that we have abolished the two-tier system for GPs, the Secretary of State has in mind the abolition of the multi-tier system which results in shorter treatment times in certain parts of the country and much longer treatment times in other parts. How soon one is treated is, in effect, a national lottery. When will the other manifesto pledge to treat more people, and, by implication, to bring down waiting lists for all, be achieved?
Mr. Dobson:
We are treating more patients. This year, we shall be devoting to patient care £100 million which would have been spent on bureaucracy. Of the £20 million that we will save from the bureaucracy of the eighth wave of fundholding, £10 million is being devoted to breast cancer treatment and £5 million to improvements in
Mr. Robin Corbett (Birmingham, Erdington):
Those of my constituents who did not have fundholding GPs and were told that they had to wait a minimum of nine months for treatment were very upset when they found out that patients of fundholding GPs had to wait only a maximum of six months, so they will commend what my right hon. Friend has said today. Will he include pharmacists in the consultation about primary care? They have an important role to play.
Mr. Dobson:
On the latter point, I can assure my hon. Friend that we shall be consulting everyone involved about the future of primary care and how we can extend the roles of the various professions so that they meet the needs of patients who are feeling poorly. That is the most important thing that we can do.
I think that everybody realises that the present system is manifestly unfair. The bulk of people in this country are profoundly fair people and they want a fair system; they have an unfair system. Such unfairness was emphasised by James Johnson, the chair of the BMA's central consultants and specialists committee, when he said:
Mrs. Virginia Bottomley (South-West Surrey):
Is the right hon. Gentleman aware that the real strength of GP fundholding has been to change totally the balance of power in the NHS towards the family doctor? Is not his real problem that, having so failed with the Chancellor of the Exchequer to get even the amount of money secured for this year by his predecessor, he has already been condemned by the BMA, so, rather than take any steps to help patients, he has thrown an ideological bone to his Back Benchers? It is a classic Labour party levelling down, not levelling up, and no patient will benefit.
Mr. Dobson:
All I can say about funding is that, as a result of the decision announced by my right hon. Friend the Chancellor of the Exchequer, the NHS in England will gain £1.7 billion more next year in comparison with this year--the Budget set by the Cabinet of which the right hon. Lady was a member. If we are expected to take lessons from her about ways of organising the health service, I can only presume that she is saying that she was not one of the Tory Ministers whom Clive Froggatt came to see--before which, according to his memoirs, he used to shoot up.
Ms Julia Drown (South Swindon):
My constituents and I welcome my right hon. Friend's statement, as does the BMA--I have just come from a meeting with it. Does my right hon. Friend agree that his statement will be welcomed not only by the doctors and nurses he mentioned, but by many health care workers? As a former finance director in the health service, I was deeply affected by the internal market introduced by the previous Government.
Before the internal market, I could tell patients that, however difficult the financial circumstances of my hospital, they would be seen in order of clinical priority. If they had the most urgent need, they would be first to be seen by the doctor. It was deeply destructive to doctors, nurses and administrative staff who dealt with patients to turn that round and to have to say, "I am sorry, but it now depends who your doctor is." I welcome with open arms the return of a national health service in which, once again, patients are seen in order of clinical priority. [Interruption.]
Mr. Dobson:
I thank my hon. Friend for her endorsement of my announcement today. It is revealing that her direct experience, like that of my hon. Friend the Member for Dartford (Dr. Stoate), of the problems caused by the internal market is received with mockery by Opposition Members--sorry, I should say Tory Members, in fairness to the Liberals.
Mr. James Paice (South-East Cambridgeshire):
The right hon. Gentleman will know that one of the benefits of fundholding has been that doctors could send patients to the hospital most appropriate for their needs and often most convenient geographically. In my constituency, many people live in one health authority, but the best and nearest hospitals are in a different health authority area. Will the Secretary of State answer the question put by my hon. Friend the Member for Stratford-on-Avon (Mr. Maples) and confirm that fundholding GPs will still be able to send their patients to the hospital most suited to their needs, or will there be some form of central direction of the hospitals they should attend?
Mr. Dobson:
The hon. Gentleman ought to recognise that, until the Conservative party made its changes--[Hon. Members: "Answer the question."] I am answering the question. Before the Tories made their changes, any GP in any part of the country could refer any patient to any hospital that he thought suitable. The Tory party took away that right and then started to hand it out as a privilege. We will ensure that all doctors are in the same position to look after their patients and exercise their clinical judgment, which the fundholding system took away from far too many doctors.
Laura Moffatt (Crawley):
As a nurse who worked in the health service for 20 years, may I share with my right hon. Friend what such an announcement will mean for my many former colleagues? I am so sad to hear the comments from Tory Members about ideological bones, because I can honestly tell my right hon. Friend that--
Madam Speaker:
Order. I am sorry to interrupt the hon. Lady. I have tried to explain that when we are in Question Time hon. Members must ask the Secretary of State a question. I understand the hon. Lady's anxiety and keenness about the statement that has been made and I am sure that she endorses it--I would expect her to do so from the Government side of the House--but she must put a question to the Secretary of State and not make a long speech. I hope that we will soon have a debate on
Laura Moffatt:
Is my right hon. Friend aware that we desperately need some improvement in the morale of health service staff?
Mr. Dobson:
I entirely accept the point made by my hon. Friend in her excellent question. [Interruption.] Well, there was more of a question than we had from the hon. Member for Stratford-on-Avon (Mr. Maples). My hon. Friend is right. The fact that doctors, nurses and others working in hospitals had to treat one patient unfairly compared with another was etched deeply into the morale of all concerned. They will be delighted that that rotten, unfair system is to end and be replaced by one that is fair.
"The present two-tier system is manifestly unfair to patients."
Even more important, he said:
"Elective surgery patients are no longer being treated on the basis of clinical need."
We will put a stop to both those things.
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