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Mrs. Linda Gilroy (Plymouth, Sutton): I am following with great interest the theme that the hon. Gentleman is beginning to set out, especially the part about insurance. Does he agree with the following remark made by the right hon. Member for Maidstone and The Weald (Miss Widdecombe)? She said:

Dr. Fox: It is not our policy--nor, under my stewardship, will it ever be--to charge for access to general practice, for the very reasons that I have mentioned of access to care and barriers of wealth. I hope that that is perfectly clear.

In the delivery of our health care system, we need to use private capital. We need to develop the private health care sector to supplement delivery, whether that provision

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is funded via the NHS or from another source, such as private personal insurance or company-based insurance. The Government have made some progress in that respect, and it is only reasonable that we should welcome that. Under the Government's concordat, primary care trusts are allowed to buy health care for patients directly from outside private sources and are, therefore, able to bypass NHS provision entirely. I welcome that freedom for doctors and patients.

Mr. Milburn indicated dissent.

Dr. Fox: The Secretary of State shakes his head--is he saying that that is not so? It is the case in the concordat. I know that he has spoken to Labour Back Benchers about NHS doctors buying NHS treatment in the private sector for NHS patients, but they can, in fact, buy treatment entirely outside the NHS. I think that that is a good thing and that the element of competition is to be welcomed.

Mr. Bercow: My hon. Friend's attitude to private health care has always been thoroughly sensible. Does he recall the interview given to the Health Service Journal by the Chairman of the Select Committee on Health, the hon. Member for Wakefield (Mr. Hinchliffe), in which, by contrast, the hon. Gentleman had the temerity to abuse all professionals working in the independent health care sector, likening them to illegitimate children? Was that not a disgraceful insult, both to people working in the private health care sector and to illegitimate children? Does it not provide evidence of the profoundly ideological, dogma-ridden, backward-looking, socialist approach of the Labour party?

Dr. Fox: Sometimes, I wish that my hon. Friend would speak his mind a little more clearly. He describes the experience of many Labour Members who have to endure a permanent "Groundhog Day" whereby they wake up in the morning natural socialists, but have to go to bed born-again Blairites. The Bill is full of parallels. However, I am sure that the hon. Member for Wakefield (Mr. Hinchliffe) will prove more than capable of paraphrasing his previous comments when he speaks in the debate, as no doubt he will.

Mr. Hinchliffe: That intervention has appeared in almost every health debate of the past two years and it is getting rather boring. I think that the hon. Member for Buckingham (Mr. Bercow) is aware of the context in which I made certain remarks in respect of the private health care sector. I did so after a sitting of the Health Committee in which a man described how, in a private hospital, he had had to lay out his wife's body because of the lack of care in that hospital. I admit to having been extremely angry and to using possibly intemperate language, but if the hon. Gentleman had sat through what the Committee sat through, he would have shared our shock and concern.

Dr. Fox: I do not wish to intrude on a private dispute between two colleagues. However, it is always wrong to extrapolate a general situation from individual cases. I am sure that the hon. Gentleman would wish to retract his comments if they were disparaging about all the dedicated professionals who work in the private sector.

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I welcome Government developments in two other areas. They have taken up the private finance initiative, which was developed under the previous Government, and advanced it. We have seen a great deal of capital investment as a result. Clause 4 in part I makes provision for the Government to use private investment to improve the premises for primary care. It would be hypocritical and wrong of the Opposition not to welcome Government proposals when we would like those provisions to be advanced.

There is widespread agreement on other areas of the Bill. There are some measures about which we would like to see more detail and some with which we disagree. I shall begin with the good news for the Secretary of State about those parts of the Bill with which we agree. I draw particular attention to the widening of the franchise for prescribing. Again, the pilot for that was started by my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley), when she was Secretary of State for Health. Certainly, with the restrictions on manpower and the length of training for those who work in health care, there is a need to use all health care personnel at the ceiling of their training and ability. I therefore welcome the extension of the right to prescribe to the nursing profession and pharmacists. Indeed, some of the Government's ideas which we would like to explore in Committee very much echo our own ideas on prescription-first medicines and allowing pharmacists to re-prescribe, once the initial prescription has been given by a doctor.

Most hon. Members will understand my own experience as an asthmatic, unable to get an inhaler on a Saturday morning when I was running my constituency surgery. I phoned my doctor and got the receptionist, who was probably a sad loss to the SS--[Interruption.] She happens to be a good friend of mine. I was not allowed to see my GP that morning, and was told that I could not get an inhaler for my asthma. When I asked why not, I was told that I had to go and see the doctor. When I said that I was a doctor, the receptionist said that that did not matter. I said that I had run out of inhalers and could become dangerously asthmatic over the weekend. However, I was told that I still could not have an inhaler. I said that I can write prescriptions for other people, but I was told that I still could not have an inhaler. I said that I was a member of the Royal College of General Practitioners, but I was told that I still could not have an inhaler.

That is nonsense. Simply taking out common prescriptions, such as those for asthma, would stop about 30 million repeat prescriptions going across doctors' desks. That is a sensible policy and if the Government intend to take that forward, expand it and create a new category of medicine in prescription-first medicines--or whatever they want to call it--they will have the Opposition's support. That common-sense measure is long overdue because we have greatly over-regulated prescribing in this country. We could give a good deal more discretion to other professionals.

The Government see potential in personal medical services. I believe that the days of the Red Book in medicine are numbered. There is a limit to how long we can continue with general medical services. We need to move to a quality agenda, and PMS allows us to do that.

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However, we need to avoid excessive centralisation and control. We need a duty to consult on changes to PMS in the Bill, in the same way as we have a duty to consult on GMS. I hope that the Secretary of State will give us that assurance. Perhaps the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), will provide it when he winds up.

Likewise, we welcome the proposal on supplementary lists for locums, part-timers and other employees. The hon. Member for Dartford has already mentioned locums, and the proposal is essential to protecting patients. We could all give examples of horror stories--either anecdotally or from our own experience--of what is happening in locum services throughout the country and what has happened in individual cases in the past. I therefore welcome the proposal.

I also welcome the concept of the need to reward excellence. The Bill includes a proposal to increase funding for those who excel in health care, which makes a great deal of sense. However, how does that fit with the Government's education plans, in which they say that giving money to those who are failing, rather than those who are succeeding, is the best way forward? We look forward to the Minister describing the thinking behind that proposal in Committee.

I welcome the Government's decision to make all nursing care free, and we shall match that. Workability has been mentioned, and there are problems with defining exactly what matters will fall within which category. There is also a danger of creating perverse incentives. Nurses on the ground carrying out the kind of decision making that the Secretary of State described could be forced to claim that some services that might otherwise objectively be deemed social care were nursing care, to qualify for payment. Great care will have to be taken in Committee to ensure that that does not happen.

Mr. Dawson: It is good to hear the hon. Gentleman welcoming so much of the Government's work to put right the mess that his party left behind. Given that he is accepting so much of what is on offer today, will he move on from the medical model and give the House an assurance for which he was asked earlier? In the highly unlikely--in fact, amazingly unlikely--event of his ever being in a position to do anything about it, will he give an assurance that a future Conservative Government would fund the social services element of these matters to the same extent as this Government?

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