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Dr. Fox: I should like to give the hon. Gentleman a lesson in verbal efficiency. I can confirm that our funding proposals relate not only to the NHS budget, but to the Department of Health's budget, which we see increasing from £45.285 million in 2000-01 to the full £59.011 million in 2003-04, including the personal social services funding via the Department of Health and the funding for the Food Standards Agency.
The Secretary of State talked about the balance between local and central Government. I would caution him that he should go back and look at the Red Book figures on funding. They show that the balance between local and central Government in the funding for personal social services changes quite markedly in that period. The Department's funding rises from £713 million to £2,247 million in a period in which the standard spending
assessment funding only goes up from £8,693 million to £9,962 million. In the interests of clarity, that means that the balance of power between local and central Government falls dramatically towards centralised Government. This is a centralising measure; it is in the Red Book, and those in Labour local authorities might be alarmed at the consequences.
The Parliamentary Under-Secretary of State for Health (Yvette Cooper): Has the hon. Gentleman cleared his remarks about matching the Department of Health funding with the shadow Chief Secretary to the Treasury, who said on "Newsnight" that his party was committed only to matching the funding for hospitals?
Dr. Fox: Of course I have cleared them. I have given as clear a statement of policy as I can possibly give. When we give the Labour party a clear statement of our policy, we are immediately told that that is not what we really mean, and that we must mean something else. The hon. Lady should have used up her credit on interventions in a more constructive way.
Mr. Edward Leigh (Gainsborough): Will my hon. Friend give way?
Madam Deputy Speaker (Mrs. Sylvia Heal): Mr. Christopher Chope.
Mr. Leigh: No, I am Edward Leigh, Madam Deputy Speaker. I am sorry--I have only been here for 18 years.
Despite what my hon. Friend says, will he make it absolutely clear that many people believe that we cannot take the debate forward simply by both sides trying to up the ante in terms of matching funds? Many Conservative Members believe that, if we are to deliver a quality health service, we have to increase private sector involvement while keeping the principle of health care being free at the point of demand. We should, for example, increase private sector involvement in capital projects, and we must make that clear.
Dr. Fox: I do not see the matter as a choice between the two systems. There is a case for improving the functioning and the funding of the NHS as well as encouraging the private sector and ensuring that the services are available to a wider range of citizens in our society. By operating the two systems together, as most European countries do, we might achieve the health outcomes, survival rates and cure rates enjoyed in those countries. It has perhaps been our failure, not least in the Conservative party, to make the case for the growth of both the private sector and the NHS, and that has meant that we have not been able to make the progress with outcomes in this country that we might otherwise have made over recent years.
We require more detail on parts of the Bill. The first relates to the abolition of the Medical Practices Committee. I hope that the Secretary of State will accept that the MPC works quite well at present. It controls the number of doctors in each area to a reasonable degree. This is a hugely centralising proposal once again. Moving away from capitation as the sole basis for remuneration is
inevitable--that is the way that medicine is going. We should open the way for quality to be more matched by income. However, if we are to abolish the MPC, we should have an independent review mechanism, not just the view of an omnipotent Secretary of State. I do not mean that as a compliment in case the right hon. Gentleman interprets it as such.In this place we have a boundary review commission to ensure an even match between representatives and the electorate. It would be reasonable to expect, within a certain time frame, a review of how the abolition of the MPC is working in terms of how many patients there are to each doctor across the country. That would be a sensible safeguard to include in the Bill.
I have reservations about confidentiality. We need to protect patient privacy, give clear guidelines to doctors about disclosure and keep the flow of information going for such things as the cancer registry. The provisions are too loosely drawn and leave too much discretion for the Secretary of State. The British Medical Association is worried about the potential conflict between the ethical position of doctors and the law if doctors are forced to disclose information that they believe would be disadvantageous to their patients. We need to tighten up those provisions in Committee.
The approach to the declaration of gifts for doctors is too bureaucratic. Obviously, we need to control excessive gifts to the medical profession, and we require transparency. We will put down amendments in Committee that will liken the treatment of doctors with that of Ministers. I fail to see why Ministers who make the policy for doctors should be allowed to keep gifts to a higher value than they allow for the doctors. It will be interesting to hear the Minister talk about that in Committee.
On the proposed traffic light scheme, rewarding excellence is fine, but the success or failure of this policy will depend on what is currently ill defined--the so-called initial amount of the settlement. It will depend on whether the criteria set are reasonable and whether the targets are fair and attainable. Again, this is a hugely centralising measure--it requires transparency in a way that we cannot currently envisage and the concept of earned autonomy. In other words, doctors will be given some freedom to do what they want only if it is earned under the conditions set down by the Secretary of State. "Earned autonomy" is indeed an Orwellian phrase.
We also have practical worries, as do many medical groups, about the practicalities of recruitment and retention for hospitals which are graded as "red light". How will they go about attracting staff? Will that not make it more difficult for them to recruit and retain staff?
We also require a properly independent body for national health service appointments. The Bill goes in the opposite direction--it gives the Secretary of State more power over recruitment; it allows him to fire those who work in the NHS and replace them with those he chooses. We need an independent body--one that is specifically independent of the Secretary of State--if we are to stop political gerrymandering.
The area of the Bill on which we disagree most profoundly with the Government is the abolition of community health councils. Three things are perfectly clear: there was no consultation on the abolition of CHCs, there was no consultation on the decision since the
abolition, and none of the dialogue on patient empowerment has dealt with the abolition of CHCs. The decision was made in advance and no consultation took place.I reiterate what my hon. Friend the Member for Buckingham (Mr. Bercow) said. The Prime Minister's agent said that the right hon. Gentleman agrees with the motion praising CHCs, congratulates them on the work that they have done and wishes them every success in the future. To be wished every success in the future by this Prime Minister means looking for one's P45. I would be quaking if I were the Secretary of State, come the reshuffle. It is absolute nonsense and profoundly dishonest to claim that there has been any consultation on the abolition of the CHCs.
There is a strong case for reform. We had a very good debate in Westminster Hall in which there was strong agreement on both sides of the House on the need for better standardisation and resourcing. However, we are being asked to accept that, effectively, any body that is under the auspices of the trust and that feels strong enough will be able to criticise it, or that any body in local government will be independent enough to do so. That will be made all the more difficult as Labour has been appointing local government people to health board trusts.
In other words, the Government are asking us to accept that Labour party cronies in local government will be capable of criticising Labour party cronies who have been appointed to the health boards. That is nonsense. As Dame Rennie Fritchie pointed out in her damning indictment of the Government's handling of the position, between 1997 and 1999, 284 Labour councillors were appointed to NHS trust positions, compared with 23 Conservatives and 36 Liberal Democrats. These are the bodies that the Government tell us will be independent of party and able to act independently on behalf of patients. They must think that the public were born yesterday.
We will fight to retain the CHCs. If the Government do not give ground on this, I warn the Secretary of State that we will fight to defeat them in another place, even if it means the loss of the Bill in its entirety.
Mr. Bercow: My hon. Friend will recall that the Prime Minister was all over the shop at Prime Minister's Question Time when he replied to a question from my hon. Friend the Member for Eddisbury (Mr. O'Brien) on that very subject. Does my hon. Friend recall that the Prime Minister--wriggling out of the situation as best he could--subsequently wrote on 20 November to my hon. Friend, saying that the community health councils were to be abolished subject to legislation? He went on to say that that better described the consultation to which he alluded at Question Time. Is that the nearest we get to an admission of error and an apology from the Prime Minister?
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