| Previous Section | Index | Home Page |
Mr. Dobson: Some people at the BMA urged the GPs' representatives to hold a ballot and they decided--I assume that they are in contact with the members they represent--that that was not necessary, because the bulk of GPs agreed with what we were doing, following all the consultations we had had with them and the excellent, if tough, negotiations that they had had with my right hon. Friend the Minister of State. It is no good the right hon. Lady screeching away about how terrible our proposal is and what harm it will do to general practice, when the general practitioners accept it.
Miss Widdecombe: But they do not accept it. Since then, the BMA have produced several opinion polls. It was not a comprehensive ballot, but one poll showed that 55 per cent. of doctors wanted nothing to do with the running of primary care groups.
Will the Secretary of State confirm that, if his Bill is not in place by 1 April--and that is a tight and ambitious timetable--his entire upheaval of family doctor services will be in ruins, because he will not have the power to coerce the many unwilling GPs into collectives? Does he have a contingency plan to avert the chaos that that would bring to our health service or is he hoping against hope that fundholding family doctors will come quietly and surrender their autonomy to his regime of political control?
According to a poll in BMA News on 4 February 1998--if the Secretary of State wants the reference, although he has had time enough to catch up with the
findings--55 per cent. of doctors actively want no part in the running of the collective. Can we blame them? Primary care groups are set to make medical eunuchs out of our family doctors by giving them responsibility but taking away power.
Doctors will have responsibility for rationing, through the guidance of NICE and Prodigy, and prescription budgets will be capped for the first time in the history of our health service. I shall repeat that, in case the Secretary of State missed it: prescription budgets will be capped for the first time in the history of our health service. Doctors will bear the responsibility for the Government's failure to meet their fiddled waiting lists, because doctors will have to reduce their referral rates to hospitals.
Mr. Tony McNulty (Harrow, East):
This is no good.
Miss Widdecombe:
No, indeed, the proposals are no good. They are rotten and the hon. Gentleman is right.
Mr. Dobson:
Will the right hon. Lady give way?
Miss Widdecombe:
I shall give way in a minute. Individual family doctors will have no power to manage their budgets. They will have no power to innovate or to maintain the specialised services that they have developed for patients through fundholding. Doctors will have no power to drive improvements to local hospital services. The Secretary of State is keeping all the power, but he is making others responsible for his policies.
Mr. Vernon Coaker (Gedling):
The right hon. Lady has gone to great lengths to defend doctors and their professional status. Will she acknowledge that one of the advantages of primary care groups is that they value not only doctors, but nurses, health visitors and all the other people who contribute to the community's health? She is undermining their role in the primary care groups.
Miss Widdecombe:
The hon. Gentleman should ask the nurses, because they complain bitterly that they have been squeezed out. The nurses say that the Secretary of State and the Minister of State gave way to the doctors. The nurses claim that the situation is exactly the opposite to the one that the hon. Gentleman suggests.
Mr. Coaker:
Will the right hon. Lady give way?
Miss Widdecombe:
No. His first intervention was not worth having and the second one almost certainly will not be.
Miss Widdecombe:
Sit down! I beg your pardon, Madam Speaker. I was not calling on you to sit down. Would the Secretary of State please sit down and wait until I give way to him, which I have said I shall do. I am a lady who keeps her word and I shall give way to him when I come to a natural pause. When I give way I hope that the Secretary of State will answer the following question. Will he admit that his proposals will impose a four-tier service for patients, with the quality of care determined by postcode? Those patients who were previously served in an area with many fundholding
The right hon. Gentleman should take note of the BMA's GP committee chairman, who has stated that collectives will mean that
Mr. Dobson:
For once, the right hon. Lady gave us the origin of one of her facts, saying that a poll had shown that doctors were against our proposals, but she admitted that that poll was published in February. I have to tell her that this summer, the British Medical Association, representing doctors, agreed to accept what we are proposing. It is reasonable to assume that those who had been fundholders might have been the most opposed to what we are doing, but today, Clive Park, general manager of the National Association of Primary Care--to which the National Association of Fund Holding Practices has changed its name--has said that it wants to make sure that PCGs work and work well, and that it will support the Government.
Mr. Michael Fabricant (Lichfield):
Will my right hon. Friend give way?
Miss Widdecombe:
I think that I must first answer the Secretary of State's point. Of course doctors, being responsible, will try to make work any legislation that is foisted upon them. They are not irresponsible people, and they will not sit in the streets, refusing to make it work. They will do their best. The point is that the Government are making that extremely hard for them.
Mr. Fabricant:
My right hon. Friend is absolutely right. My office spoke yesterday to a fundholders' association, and its president said that there was no point in opposing a Government who have such a large majority that they will twist the doctors' arms. That shows how committed that association is.
Miss Widdecombe:
It does not sound like a terribly enthusiastic endorsement of the Government's proposals.
Hitherto, patients have been able to choose a fundholding family doctor if they thought that it would benefit their care. Under the GP collectives system, they will be assigned to a PCG simply on the basis of where they live. We will end up with a four-tier service distributed according to postcode.
Helen Jones (Warrington, North):
I have listened carefully to what the right hon. Lady has said about patients having the choice of a fundholding practice. That clearly is not true in my constituency where the most deprived areas have few fundholding practices. The people who live there do not have that choice. Under the system introduced by the previous Government, those people had lower levels of primary health care, higher rates of limiting long-term illness and a much worse
Miss Widdecombe:
The hon. Lady listened to me so carefully that she has made my point for me. That is exactly what I was saying. We wanted to level services up. We wanted patients who did not have fundholding GPs to be able to go to fundholding GPs. We wanted every GP to be a fundholder or a member of a multi-fundholding practice. I have the interests of the hon. Lady's constituents at heart. She would level them all down.
Quality of patient care will depend on the rung of the primary care group on which the patient's own collective stands. If the collectives are on the first rung, they will be totally toothless, and all that they will be able to do is to advise their health authorities. If they are on the fourth rung, they may have a little freedom, subject to the controls of NICE and CHIMP, to provide something other than a basic service. Labour's collectives will not have any control over their own budgets, or the ability to try to re-develop some of the innovations lost with fundholding until they have been able to wrench free of the grip of the health authorities, and that may take years.
Let us turn to the Secretary of State's favourite boast--waiting lists. It is well known by now that his official statistics do not begin to reflect the full nature of the problem that he has created. He knows better than anyone that the figures are being fiddled and the patients are being diddled.
Mr. McNulty:
Does the script say, "Pause here for laughter?"
Miss Widdecombe:
I shall go on saying that, because it is true. Labour Members may moan and groan, but they will do more moaning and groaning when their constituents realise exactly what the patient care reforms will mean to them. When they realise that they can no longer discuss with their doctor where and to whom they should be referred, there will be moaning and groaning and the Government will be called to account. I would not be at all surprised if it was the Government's stewardship of the NHS that was the most potent factor in bringing them down at the next general election.
It is not merely a question of the massive distortions in clinical priorities that have been caused by treating quick, simple cases at the expense of more complex, and often more serious, ones. We need look no further than the Secretary of State's own figures, which show that the number of people waiting more than 12 months has doubled since he came to power. How he can smile about it, I do not know. The British Medical Association has told him time and again that, unfortunately, giving priority for political reasons to patients whose need is less
The Secretary of State has himself admitted, albeit reluctantly and after a lot of probing and questioning, that there is "some build up" in the waiting list to go on the
waiting list. In other words, he has shifted the bulge from one list to another. So, when will he publish the combined figure with all his waiting lists added together, as he promised? He has the information already. What is he afraid of? Is he afraid that that will prove that the real waiting lists are still rising as a direct result of his bungling?
"people in different parts of the country will receive different levels of service . . . we will see increasing variations in how the NHS is developing . . . this cannot be good for patient care."
The most insidious thing of all about that is that the patient will have no choice.
"is happening because the Government have put themselves and therefore all of us on a most unfortunate hook."
Those are the words of the previous chairman, Dr. Sandy Macara. When he referred to "all of us", I think that he meant patients and not merely practitioners.
| Next Section
| Index | Home Page |