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GP Prescription Budgets
8. Miss Anne McIntosh (Vale of York): If he will make a statement on the financial provision for GP prescription budgets. [38678]
The Minister of State, Department of Health (Mr. Alan Milburn): Nearly £4.4 billion has been allocated to health authorities in England to cover the cost of drugs and medicines prescribed by general practitioners this year.
Miss McIntosh: Does the Minister agree with some practitioners that setting cash limits on prescription budgets will detract from their freedom to act in the best interests of their patients and in accordance with their best clinical judgment? Does he agree that it could lead to a loss of morale, especially in the GP profession; might harm recruitment; and might prevent the best relations between doctor and patient from being established? Does he accept that it should be for the GPs to prescribe what is best for their patients?
Mr. Milburn: The answers to the hon. Lady's questions are no, no, and yes. Yes, of course it is for the family doctor to decide what is in the best interests of the individual patient, but I did not hear any howls of protest from Conservative Members when the previous Government cash-limited drug spending for 50 per cent. of GPs by introducing the GP fundholding scheme. There were no protests then, so why the protests now?
Mr. Barry Jones (Alyn and Deeside): Has my hon. Friend guaranteed the clinical judgment of general practitioners?
Mr. Milburn: Yes. As my hon. Friend is aware, we have put family doctors and community nurses in the driving seat. We have removed the artificial barriers between prescribing budgets and referral budgets which, in the past, have got in the way of allowing the family doctor to make the right decision for the patient. We have done no more and no less than increase GP freedom.
Mr. John Maples (Stratford-on-Avon): It was good to hear the Secretary of State say that survey after survey
showed how happy people were with the NHS. He was clearly referring to the British social attitudes survey. There has not been one since the election, so presumably he was referring to people's happiness with the health service when it was being run by us.
I should like to bring the Minister back to the question of GPs' budgets. Under fundholding there was a trade-off for fundholders between prescribing and referrals to secondary care. GPs were limited in a much wider budget and in a great many cases they overran it and the money was made available to them by their health authorities. Under the new primary care groups, that will not be the case, will it? Suddenly, the vast majority of GPs believe that there will be a separate cash-limited prescribing budget within the group's overall budget. That is one of the reasons why so many of them are showing, in survey after survey, their misgivings about the new proposals.
Mr. Milburn:
On his first point, I remind the hon. Gentleman of what he said in Birmingham recently about the previous Government's record on the national health service. He said that they had failed and that the British people had given their judgment on that. Let us be clear about the facts.
Secondly, the hon. Gentleman referred to GPs' prescribing budgets. I say to him, to the House and to GPs throughout the country that no GP will run out of cash, that patients will be guaranteed the drugs and the treatment that they need, and that, if a primary care group overspends, the overspend will be catered for within the health authority's general allocation.
Miss Melanie Johnson (Welwyn Hatfield):
Can my hon. Friend confirm the excellent comments made by my right hon. Friend the Secretary of State for Health at an Association of the British Pharmaceutical Industry event last Thursday evening? He made a well-received speech, in which he rightly said that we would ensure that money spent on pharmaceuticals and on drugs was used most effectively. His concern was not about budgets, but about effective treatment for patients.
Mr. Milburn:
My hon. Friend is absolutely right. The new system that we shall introduce will allow the individual family doctor to decide what is best for the individual patient, without there being any artificial barriers in the way. That may mean that there will be an increase in drugs spending in some GP practices; elsewhere, it may mean an increase in referral patterns to hospital. The key fact is that, in future, decisions will be taken in the best interest of the patient.
9. Mr. David Heath (Somerton and Frome):
How many applications from the south-west of England have been approved under the investing in dentistry initiative. [38681]
The Minister of State, Department of Health (Mr. Alan Milburn):
Since the investing in dentistry initiative was announced last September, my right hon. Friend the Secretary of State has approved 46 funding requests from the area covered by the south and west regional office of the national health service executive.
Mr. Heath:
I thank the Minister for that reply and warmly welcome the initiative, if it provides wider access
Mr. Milburn:
We have received two investing in dentistry applications from the hon. Gentleman's constituency. Both have been approved. We have allocated an extra £50,000 as a consequence, and an extra 4,000 patients in his area will have access to NHS dental care as a result. We want the NHS dental service to be available across the country as part and parcel of a modern and dependable health service, not an add-on or an afterthought. That is why we are tackling access problems through investing in dentistry and through other initiatives. They are working well to date, and we shall continue to monitor to ensure that they work well in the future.
Mr. Peter L. Pike (Burnley):
Is it not a fact that, in the south-west and in the north-west, the Tory party--
Madam Speaker:
Order. We are not concerned about the north-west. I was waiting for someone to widen the question, which is about applications from the south-west of England.
Mr. Pike:
Is not it a fact that people in the south-west cannot get NHS dental treatment, and cannot move anywhere else in the country to get it, because the Tory party destroyed the dental service in the south-west and throughout the country?
Mr. Milburn:
Throughout the south-west and in other parts of the country, we are taking action to tackle the availability problems that are a legacy of the previous Government's rundown of NHS dentistry. Through investing in dentistry, we are making NHS dental services available to an extra 250,000 people across the country who otherwise would not have access to them. That is a good start, but we want it to continue.
10. Dr. Vincent Cable (Twickenham):
When he expects waiting lists will be reduced by 100,000 from the 1 May 1997 levels. [38682]
The Secretary of State for Health (Mr. Frank Dobson):
As I made clear on 18 March, we are committed to reducing waiting lists to 100,000 below the record levels we inherited by the end of this Parliament.
Dr. Cable:
I thank the Secretary of State for his reply. Can he give an assurance that, following the welcome additional money now being used to reduce waiting lists, there will be no further cases of the sort reported to us as constituency Members of Parliament, wherein clinicians have been leaned on by administrators to distort their medical priorities in order to treat politically more embarrassing 18-month waiting list cases?
Mr. Dobson:
I would not have thought that any clinician worth his or her salt would allow themselves to
Mr. Andrew Mackinlay (Thurrock):
As part of the strategy to bring down hospital waiting lists, will the Secretary of State consider approaching the South Essex health authority and Basildon and Thurrock General Hospitals NHS trust to find out whether the spare capacity in wards at Orsett hospital can be used not only for my own area of Basildon and Thurrock, but for the wider regional need to reduce hospital waiting lists?
Mr. Dobson:
I do not pretend to be an expert on every hospital in the country, and I am sure that those in charge in that area, having had it made clear to them by me that they are to get their waiting lists down, will take every sensible step to get them down. In this case, they will be assisted by the £3.8 million that is going into my hon. Friend's area, which takes the total extra money that we have put in to £18.5 million over and above what the Tories intended.
Mr. Patrick Nicholls (Teignbridge):
Does the right hon. Gentleman recall that, in its document "Labour's Early Pledges" and, indeed, in the general election manifesto, the Labour party promised immediate action to reduce waiting lists by 100,000? Is it not a fact that, 12 months on, waiting lists have actually increased by 100,000? Although no one doubts the sincerity of the right hon. Gentleman's commitment to the national health service, is not the truth of the matter that, in the general election campaign, the Labour party made promises about waiting lists that it knew it could not possibly keep, because it did not want political honesty to get in the way of a successful electoral outcome?
Would not the people of this country be better served if, instead of casual ad hoc sums being offered up as a fig leaf to spare the Secretary of State's embarrassment, the right hon. Gentleman came to the House today and pledged that the Government would ensure that their annual increases were at least as great as those of the previous Conservative Government? That would be an announcement worth hearing.
Mr. Dobson:
Talking about casual promises, we could reasonably interpret the hon. Gentleman's remarks as a rejection by their elected representative of the £6 million extra that is going to the two health authorities serving his constituents. The casual ad hoc sums to which he refers are apparently of no consequence to the hon. Gentleman, but I am sure that many of my hon. Friends would welcome them being spent in their area. We are serious about getting waiting lists down. The people of this country are sick to death of waiting lists, year in, year out. It is not the fault of the people working in the health service, but the fault of successive Governments. We have to bring waiting lists down and we are going to bring them down.
Mr. Dennis Skinner (Bolsover):
Instead of wasting too much time listening to hypocritical claptrap from the Tories--they had their chance and they blew it--will my right hon. Friend bear in mind that he probably has the biggest nut to crack in getting down waiting lists, and that £500 million was set aside for contingencies in the Budget
Mr. Dobson:
My hon. Friend knows that both he and I set a great deal of store by propriety. He knows that I have discussions with the Chancellor and the Prime Minister, and that it would be wrong for me to disclose their contents, but we have been successful in obtaining an extra £500 million to be spent on reducing waiting lists this year, and I expect that sufficient sums will be forthcoming to reduce them by 100,000 or more before the end of this Parliament.
I remind those Conservative Members who seem to think that their stewardship of the national health service was popular of the statement made by the hon. Member for Stratford-on-Avon (Mr. Maples), now the principal Tory spokesman on the health service, who, as recently as 22 September 1997, said:
"We had a very clear policy on the health service up until May 1. It was rejected by the electorate."
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