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Dr. Brand: I am grateful to the hon. Gentleman for giving way. Is he not surprised that the Government amendment
- "congratulates the staff on providing . . . the fairest and most efficient healthcare system in the world",
Dr. Stoate: I thank the hon. Gentleman for that contribution, although I do not agree with him. I believe that ours is still one of the best health services in the world. We have one of the most dedicated services available. We have notes that go from cradle to grave. We have a commitment to patients that is unsurpassed in most countries, which still envy us. For example, many people still come to visit the Royal College of General Practitioners, of which I am a fellow, to find out how British general practice can be rolled out into other parts of the world. I still take part to some extent in the college activities, and professors from foreign countries come over frequently to find out how British general practice can be used in their own countries for the benefit of their own people.
I simply do not recognise the idea that British general practice and the British national health service have slipped in their position in the world. I still believe that it is an excellent service, with much to offer people in Britain.
General practice has improved markedly over the past few years. That has not just happened recently. It has been going on over a long period. I shall surprise Opposition Members by saying that I do not believe that the service has become wonderful over the past two years having been dreadful before. I take a rather more grown-up approach and say that improvements have happened gradually, over a long period--and yes, some of those improvements have been due to the Conservatives. To a certain extent, I pay tribute to what the previous Government did.
Much of the debate this afternoon has centred on fundholding. Yes, there are aspects of fundholding that did a great deal of good. There was considerable innovation, and many entrepreneurial ideas came from certain general practitioners who were able to run with the ideas and introduce genuine change and improvements for patients in their surgeries. However, there was a problem, which the Opposition have never grasped and to which they have never owned up.
Every improvement that some GPs were able to glean for their patients was at the expense of other GPs who were unable to do so. The fact remained that if money was being top-sliced to be given to fundholders, less was left for the commissioning groups of other GPs who did not have those advantages. There was indeed a two-tier service. For every innovation from which some GPs benefited, others lost out. As someone who has been a GP for a long time--a non-fundholding GP--I felt that keenly in some aspects of patient care. I felt that on many occasions my patients were missing out, because of the activities of fundholders.
Many aspects of fundholding worked, but the problem was that it was unfair. Opposition Members like to speak about free choice and the right of people, including doctors, to make decisions for themselves. I agree with that, but there is a fundamental difference between my view of the world and theirs. In their view, choice and freedom must be right at any cost. In my view, choice and freedom are right only in so far as they do not impinge on the choice and freedom of others. Choice is good, but not at the expense of others. Fundholding undoubtedly reduced the choice of others.
Opposition Members look quizzical, so I shall give a simple example relating to economies of scale. If a fundholder top-sliced the budget for the family practitioners service, as it was then, that left far less money for the non-fundholding GPs. That meant that they were far less able to negotiate bulk contracts with their local providers. They got a worse service and the money ran out sooner. The money was not available for GPs in the non-fundholding practices to make the best of things for their practices.
Although some good things came out of fundholding, I believe that overall it created inequality, unfairness and a two-tier service.
Dr. Fox:
I am grateful to the hon. Gentleman for giving way. If, as he says, fundholding created a two-tier system and there were advantages to fundholding, would it not
Dr. Stoate:
The hon. Gentleman raises an important point, but I cannot agree with it. If, as I believe and as many surveys have shown, fundholders were getting a greater proportion of the resources, those advantages would be lost if all GPs became fundholders, because they could not all have more than their share of resources. The only way that fundholding could turn out to be a great success was by reducing the resources available to non-fundholders.
Surely the way forward in that case is to amalgamate fundholding with non-fundholding to produce the best of all worlds. I shall give an example to Opposition Members, who may not believe me. In my constituency, Dartford, more than 100 GPs, fundholders and non-fundholders working together, formed a primary care pilot. About 70 of them were fundholders and 30 were non-fundholders. They voluntarily gave up that status to work together as 100 GPs. They reduced bureaucracy and achieved much better economies of scale and improvements in services.
Those GPs acted as a model for primary care groups. Now that they have become a primary care group, they are a year ahead of most other GPs and are providing genuine and sustained improvements in service for their patients. They have taken the best of fundholding and rolled those benefits out for all patients and all GPs in the community. They formed a primary care group, precisely as the Government intend, to reduce the inequality that was apparent under the previous system.
We have taken the best and ensured that it is available to all. Of course I accept some of the criticisms from some of my GP colleagues who say that things have happened very fast, that they are not sure what is happening and that there are gaps in service. Some PCGs have obviously been faster and more organised than others, and some are falling behind. However, that is more a matter of things settling down over time and the new service bedding in, rather than a fundamental problem with the service.
I genuinely believe that in a year's time, primary care groups will prove to be the best thing that we could have done under the circumstances. They will provide the maximum improvements for all patients in the community, not just for the favoured few. That is surely what is needed to improve health care for people in Britain.
It is right for this debate to take place and for the House to examine how the health service is working, but it is not right to table motions that run the health service down and frighten people into believing that the health service is getting worse, when it clearly is not. We should be talking up the best of the health service, improving aspects in which improvement is still needed, and most of all building on the successes of the past and ensuring that they benefit everyone.
I pay tribute to the enormous number of doctors, nurses and other health professionals who work extremely hard, who show such dedication, and who work long hours, sometimes at thankless tasks. We should pay tribute to
those people, instead of making them look as though they are running a second-rate service of which no one wants to be part. That is not the case.
I have sat through the debate this afternoon and listened to the comments, and I do not recognise the health service that many hon. Members profess to know all about. I still work in the health service to a certain extent and I shall give Opposition Members three examples of patients whom I have seen in the past few weeks.
We talk about priorities and about whether people get the service that they want, when they need it. I saw a lady with breast cancer. It was in quite an advanced state. I picked up the phone and spoke to a surgeon. He said, "I am still here. How quickly can she get to see me?" She was seen that very morning. That is not a bad service.
I saw a patient recently who had come back from Thailand with a nasty tropical illness which clearly needed investigation. I picked up the phone and arranged for him to be seen by a consultant the same day. He was dealt with immediately with no problem and no queues.
I saw a patient a few weeks ago who was suffering from post-natal depression. I sent a fax to my local psychiatric hospital asking whether she could be seen as soon as convenient. I got a phone call from the consultant the same day, asking me to track the patient down so that she could be seen the same afternoon in the consultant's clinic. That is not a bad service.
Mrs. Virginia Bottomley (South-West Surrey):
Like the hon. Member for Dartford (Dr. Stoate), I can give three examples of what has happened to patients--a gentleman, Mr. Roger Humphreys, admitted to the Royal Surrey county hospital on Sunday lunchtime but not admitted to a ward until Monday evening; a lady, whom I shall not name, with cancer who was left in the accident and emergency department for more than 10 hours; and a young man, a schizophrenic, who should have been seen by either a social worker or a psychiatric nurse as he had just burned his parents' house to the ground--all suffering from the Government's blight on the home counties.
Undoubtedly, matters in South-West Surrey are worse than ever before. I have had more letters than ever before. The waiting lists are up. When I went to the Department of Health, I took the view that a one-year wait was too long to be acceptable. At that time, there were 270,000 one-year waiters. When I left, there were 30,000. When this Government came to power, there were still 30,000; there are now 48,000. How many more examples do the Government want of the fact that the rhetoric, the spin and the trivial nature of their approach to the health service are not delivering?
For the first six months, time and again every Minister said of the previous Government, "We keep our promises; they broke theirs." We have not heard that trite claim today, because it is so blatantly not being delivered.
The Government were going to reduce waiting lists. As we know, that promise is costly--the Government are not delivering, and that promise is distorting priorities.
The Government have attacked managers. They have now reached the stage where managers apparently have to be appointed by the Secretary of State. Breaking all precedents, the chief executive of the National Institute for Clinical Excellence has to be appointed by the Government. I hope that the First Division Association will make its voice heard about that.
The Government are opposed to postcode prescribing. I take the view of my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) that postcode prescribing may not be desirable, but the alternative is centralisation, lack of innovation and the lowest common denominator. We see old Labour at work more in the health service than in any other area.
Professor Le Grand of the London School of Economics health unit--I declare an interest as a governor of LSE--has described how the third way has been adopted across the social agenda by the Labour party, but not in health. I urge the Government to look more pragmatically at the NHS, to have more of a partnership approach and to stop being so politically driven, because these endless irrelevant initiatives are irritating the professionals more and more and creating quite unrealistic expectations among patients.
Walk-in centres and NHS Direct are not bad ideas, but they are centralising. They are taking power to Ministers at exactly the time when, as my right hon. and learned Friend the Member for Rushcliffe said, we should be devolving power down to the levels closest to the patients and the professionals.
Today, we had a welcome announcement on meningitis C. I declare an interest, which appears in the Register of Members' Interests, because I work with Wyeth, which has been closely associated with that initiative. Despite all the rhetoric about health action zones and inequalities, let us consider what the previous Government delivered--please can this Government do better?
Let us take the example of MMR immunisation. In 1989-90 in west Birmingham, among the worst areas in the country, only 49 per cent. of children were immunised. Two years later, as a result of the changes put in place by the Conservative Government--rewarding general practitioners for immunisation, against which the Labour party voted--that figure had risen to 82 per cent. In Newham, again an area of great deprivation, the party which Labour always said did not care about inequalities was responsible for an increase in the number of children immunised from 50 per cent. in 1989 to 81 per cent. in 1991.
I urge the Government to take more seriously the delivery of results. Health care is not about initiatives; it is about implementation and the follow through. That is why I am so appalled by what is happening on junior doctors' hours. I was the Minister who signed the new deal. I was also the Secretary of State who signed up to the targets in the "Health of the Nation" White Paper. I hope that in "Our Healthier Nation", with many similar targets in many similar areas, the Government will deliver. The Government would gain more respect if they left party politics aside--they do not need it with such a big majority--quietened down and delivered.
All these trivial initiatives take the time and energy of senior managers, Ministers and others at a time when, with more humility and pragmatism, they should be asking what the NHS can deliver. My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) put the rationing issue well and truly on the agenda. The worry is that unless the Government are more truthful--this is why I so welcome the appointment of my hon. Friend the Member for Woodspring (Dr. Fox)--they will always give way to the articulate greedy as opposed to the inarticulate needy. The challenge will be the unfashionable causes and the inarticulate groups. The Government should say, "We cannot deliver everything for everybody."
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