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9.45 pm
The Minister of State, Department of Health (Mr. John Denham): The right hon. Member for Maidstone and The Weald (Miss Widdecombe) launched
a fierce attack in an attempt to divert attention from our success in reducing the numbers on waiting lists. She produced what in some parts of the trade are known as killer facts.
The Official Report will confirm that she told the House that Southampton general's waiting lists have trebled since the election. I can tell the right hon. Lady that the Southampton University Hospitals NHS trust waiting list is now more than 1,000 below the level of March 1997.
The right hon. Lady's second killer fact was the accusation that the chief executive of Salisbury health care NHS trust--I have an interest because I live in Southampton and it is just up the road from me--had written a letter to consultants telling them to stop putting patients on the waiting list. The letter gave three options, and the right hon. Lady mentioned two of them. She said that one option was to reduce the numbers on the list. She did not tell us that the chief executive had said that that risked inconveniencing patients and GPs, that it could expose patients to clinical risk and that it would merely pass the problem on to next year. The other option she mentioned was to use the private sector. That happens in some parts of the country if NHS capacity is full. However, she did not mention the third option, which was to increase NHS capacity, and that is what the Salisbury health care NHS trust did. It treated an extra 500 patients during February and March alone.
The right hon. Lady's speech can be judged on those facts. It was either misleading or just plain wrong. Fortunately, many of the other speeches had considerably greater weight. My hon. Friends the Members for Rother Valley (Mr. Barron) and for Brighton, Kemptown (Dr. Turner) spoke about the importance of the Government's quality agenda. My hon. Friends the Members for Wakefield (Mr. Hinchliffe) and for Bury, South (Mr. Lewis), and the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) talked of the importance of close co-operation between the national health service and social services. They will have noted the important partnership proposals for co-operation, which will enable those two bodies to pool resources and powers.
My hon. Friend the Member for South Swindon (Ms Drown) set out clearly the problems of attempting to apply our proposals for raising quality in the national health service to the independent sector as though the two were exactly the same. My hon. Friends the Members for Dartford (Dr. Stoate), for Bedford (Mr. Hall), for Pudsey (Mr. Truswell), for Cannock Chase (Dr. Wright) and for Crawley (Laura Moffatt) spoke in different ways about the problems that arose from fundholding and the improvements that they envisaged would come from our proposals on primary care. A number of hon. Members spoke of the optimism and achievements of their own primary care groups.
My hon. Friend the Member for Erith and Thamesmead (Mr. Austin) talked about the importance of partnership, and I assure him that health improvement programmes will be published with full details of whom and how they have consulted on the drawing up of those proposals.
The hon. Member for Belfast, South (Rev. Martin Smyth) raised a number of important points. I can tell him that an interim regulatory impact assessment of our pharmaceutical proposals has been produced and is in the Library. A further stage in that process will take place when an agreement has been reached.
The right hon. Member for South-West Surrey (Mrs. Bottomley) raised, among other things, some local PFI issues, and I shall look into those matters for her. The hon. Member for Orpington (Mr. Horam) spoke of the achievements of his local hospitals in reducing waiting lists, and I acknowledge his contribution to the debate. We also heard from a number of hon. Members, including the hon. Members for Uxbridge (Mr. Randall), for Lichfield (Mr. Fabricant) and for Southend, West (Mr. Amess), who expressed scepticism about our proposals, although without a great deal of evidence to back up their arguments. I hope to respond to other hon. Members during my speech.
We must remember that when the Opposition were in government, they fostered division and competition in the health service instead of co-operation and collaboration. They failed to establish a framework to ensure that the NHS delivered consistently high-quality services to patients, wherever they lived. Instead of setting out plans to tackle inequalities in health, they hid the information that revealed that such inequalities existed. It was astonishing to hear talk about the "dispossessed" tonight.
When we were elected, we set about tackling the problems. The Bill is a vital part of our modernisation programme, although it is only a part. It introduces the legislative changes that are needed to carry through reforms that are already under way. With the support of general practitioners, nurses and other health professionals, we have already established 481 primary care groups, and the largest hospital building programme in the history of the NHS is in progress. We have also invested a further £2 billion in the NHS, which will receive an extra £21 billion announced in the comprehensive spending review, which will flow over the next three years. Under existing legislation, we have established the National Institute for Clinical Excellence. NHS Direct already covers 40 per cent. of the country, and an extra 2,500 nurses are already in training.
Throughout those changes, we have worked--as we promised we would--with the NHS, with its users, with carers, with professional bodies and with others. They have helped to shape what we have done, and the way in which we have done it. That is why our reforms have been so widely welcomed--why they are seen so clearly as working with the grain of what the NHS, the staff who deliver the service and the public who rely on it want. Their views have shaped the Bill.
Not everything that we want to do can be done under existing legislation. In key areas--in primary care, in quality, including self-regulation, in partnership, in pharmaceuticals and in the tackling of fraud, the Bill provides a legal framework to complete the modernisation of the NHS on which we have already embarked. That framework will put doctors and nurses in primary care at the heart of the new national health service, with the power and influence to shape and deliver the services that their patients need. It will make possible a new, systematic approach to identify, implement and assure best practice and high clinical standards, and will ensure that each part of the NHS works in partnership with every other part, with local authorities, with voluntary organisations and with local communities to deliver effective services, tackle inequalities in health and improve the health of the public.
The framework will enable us to tackle fraud in the NHS effectively, saving millions of pounds that can be used to treat patients. It will enable us to secure the best deal for patients, the NHS and the pharmaceutical industry from the billions of pounds that the NHS spends on drugs each year.
As for primary care, fundholding is coming to an end, and with that will come an end to the bureaucratic, costly system that fragmented the delivery of services--a system that gave advantages to some patients, but only at the expense of others. The Opposition claim that fundholding was popular; but after years of persuasion and years of generous management allowances, only 50 per cent. of family doctors ever signed up, and many of those did so with real reluctance. Today, only 46 fundholding practices out of 3,400 in England have hung on to fundholding, while 481 primary care groups are up and running.
Primary care groups will bring real benefits to patients. Better services will be available to all people, regardless of who their GPs are or where they happen to live. The transfer of responsibility that we are bringing about is real. I am told that, at the high point, £6 billion of NHS funding had been transferred to the influence of fundholding practices. Already in the current financial year, £11 billion of NHS funding has been transferred to the responsibility of primary care groups, 83 per cent. of which are operating at level two, doing their commissioning directly. That is a real transfer of resources, enabling practitioners in primary care to shape health services in their local areas in the interests of their patients.
Let me deal with the allegations about bureaucracy. We have heard talk of £150 million. That is the amount that it cost to provide the management of fundholding practices; we are using the same amount to provide primary groups that will cover all practices and all patients, right across the country.
After we were elected, we looked at the books and saw that the Conservative party had planned to increase spending on the bureaucracy of fundholding by a further £30 million. We stopped that. We spent £20 million on cancer services and £5 million on children's intensive care services. I believe that patients agree that that was a better way in which to spend that money.
Under our system, doctors will have greater flexibility of referral. There will be an end to the internal market system of extra-contractual referrals, which denied patients and clinicians choice. GPs, nurses and other health professionals will shape health services to the benefit of all patients.
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