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Primary Care

5. Mr. Kevin Hughes (Doncaster, North): What proposals he has for delegating spending to NHS primary care groups and trusts; and if he will make a statement. [484]

The Secretary of State for Health (Mr. Alan Milburn): By 2004, we will ensure that primary care trusts control at least 75 per cent. of NHS resources. I also intend to allocate funding direct to primary care trusts rather than through health authorities. That will put the spending power directly in the hands of front-line NHS staff.

Mr. Hughes: I am grateful for my right hon. Friend's answer, but is he aware that constituents of mine in Stainforth are having to wait up to two weeks for an appointment to see their general practitioner at the Field Road surgery? Ten years ago, there were only three GPs at that surgery. Now there are six, along with four nurses, eight receptionists, a practice manager and a practice secretary. It beggars belief that people are having to wait up to two weeks just for an appointment to see their GP. So will my right hon. Friend ensure that when he delegates that money, some of it is spent on ensuring that my constituents do not have to wait that long to see their GP?

Mr. Milburn: Yes--I would not dare say no, after that. There is a real issue here, in that although we have made progress in some aspects of waiting, there is an awfully long way to go. People tend to wait too long for treatment on the national health service, whether for a hospital operation or, sometimes, for a GP's appointment. That varies immensely--in some parts of the country, people can get access to a GP quite quickly, while in other parts, as my hon. Friend has just pointed out, people can sometimes wait two weeks or more to see their GP. We must put that right.

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That is why I think that patients will in the end support the idea in the NHS plan that they will be guaranteed an appointment within a reasonable period of time--within 48 hours. Many GPs already guarantee that level of service to their patients. We reckon that between a third and a half of all GPs are already agreeing appointments within 48 hours. We now need to ensure that we put in place the resources and the reforms to other parts of primary care to make sure that that level of service is guaranteed not just for some patients but for every patient.

Dr. Evan Harris (Oxford, West and Abingdon): May I join the Secretary of State's Back-Bench Members in seeking to keep him on the straight and narrow? Will he accept that however small the pieces of the cake, if the cake is not large enough it will not solve the health service's problems? My health authority tells me that the amount of growth money is dwarfed by the list of "must do" items, and their cost, emanating from the National Institute for Clinical Excellence. Does the Secretary of State accept that when the "must do" list from NICE exceeds the growth money, funding is cut from services that are not subject to that guidance--the Cinderella specialties?

Mr. Milburn: I welcome the hon. Gentleman to his new duties on the Front Bench as the Liberal Democrat spokesman on health matters. His promotion is clearly very good news for him, and it is probably also good news for us. I noticed from the hon. Gentleman's website that he proudly boasts that he used to be an adviser to the hon. Member for Southwark, North and Bermondsey (Simon Hughes)--no doubt advising him in the art of humility and self-effacement. I just hope that the hon. Member for Oxford, West and Abingdon is more successful in his current job than he was in his previous one.

The hon. Gentleman referred to funding for the drugs and treatments that the National Institute for Clinical Excellence says are necessary for patients. As he is aware, we, at least, fought the election campaign on a manifesto commitment that in future, when NICE says yes to a drug or treatment, we would direct local health services to ensure that that is provided for the benefit of all NHS patients. Ultimately--the hon. Member for Runnymede and Weybridge (Mr. Hammond), who is chuntering away, has been urging this on us--the decisions about how the money is spent must be taken locally rather than being taken nationally by me.

Mr. Lindsay Hoyle (Chorley): In ensuring that extra resources go into primary care, will my right hon. Friend ensure that mental health is not forgotten? Will he also ensure that we do not repeat the problems of postcode medicine that have been faced in south Lancashire?

Sandra Gidley (Romsey): Postcode lottery--

Mr. Hoyle: I am asking the Secretary of State, not you.

Mr. Milburn: I do not want to intrude on private grief. My hon. Friend is absolutely right. I am tempted to say that he should perhaps take some tablets too. There has been a postcode lottery in these big services--mental health and so forth--and we must try to solve that. In the national health service, people want to know that they will receive treatment according to their needs and not

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according to where they live, how much they earn or what they are worth. That is why it is right to have national standards and to have institutes such as NICE that can provide advice to people in the NHS about which treatments work and which do not. That is happening now.

I can certainly give my hon. Friend the assurance that, alongside cancer and coronary heart disease, services for the elderly and those who have mental health problems are at the top of our list of priorities.

Dr. Liam Fox (Woodspring): Will the Secretary of State confirm that from now on, following the concordat that he signed with the private sector, primary care groups and primary care trusts will be able to buy care for their patients directly from the private sector, missing out the NHS as the primary provider?

Mr. Milburn: That is a matter for primary care trusts to decide--[Interruption.]. If the hon. Gentleman does not mind, I will answer the question in my own way. He can pose it as he wishes, but just because I do not answer it as he wants does not mean that it is the wrong answer. Primary care trusts will be in the driving seat. They will have to decide how to spend the resources available. That is right and proper. In the end, there is a big difference between the hon. Gentleman's policy and ours. His policy is that public is bad and private is good. Ours is that the answer to the problems of the national health service lies in that service.

Dr. Fox: Why has the Secretary of State tried to pretend in the past few days that the concordat allows less freedom than it does, by talking about strict limitations on what provision the NHS can buy in the private sector? The document that he signed talks of

and, on elective care, of

the only limitation being:

Does the right hon. Gentleman not think that it does a disservice to politics in general when he pretends one thing during the election campaign and another to his Back Benchers, while the truth is that he has taken a major step forward for primary care groups and trusts to miss the NHS out entirely as the provider of care? Why does he not come clean and admit that that is what he is doing?

Mr. Milburn: I have just answered the hon. Gentleman's question. However, a fallacy lies at the heart of that question and, with respect, of his approach. As hon. Members on both sides of the House know, the truth is that, by and large, we thankfully have one monopoly provider and that is the NHS. As long as a Labour Government are in power, that will remain the position. NHS principles and the national health service are not up for sale.

The hon. Gentleman has an entirely different policy--it is one that not only did not win favour at the general election, but one that he is so scared about that he did not even talk about it during the campaign. On one further

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minor point, I hope that he manages to retain his position when there is a Conservative Front- Bench reshuffle, because that would benefit the whole House and certainly the Government. Some of my hon. Friends have been dismayed that he has not thrown his hat into the Conservative leadership contest, but I have some words of comfort--[Interruption.]

Mr. Speaker: Order. I will give the Minister some words of comfort--I call the hon. Member for Stoke-on-Trent, North (Ms Walley).

Ms Joan Walley (Stoke-on-Trent, North): The strength of primary care trusts lies in the way they can respond to and meet local needs. When my right hon. Friend considers delegation, will he ensure that the allocation of money to the trusts is speeded up? Also, in the modernisation process that is taking place in the national health service, will he ensure that we do not end up with larger primary care trusts than those that have just been set up? The trust in my constituency is doing a splendid job and I want it to continue to do so.

Mr. Milburn: Again, that is a matter for local discretion. The primary care groups that are moving towards primary care trust status must have a hand in that decision. It is obviously of benefit when the boundaries between local authorities--which, as has been noted, provide social services, housing services, and so on--and the primary care trusts are coterminous. The value of that is that it makes the system easier to operate and easier for patients to understand.

However, there should be no doubt about the Government's commitment. We want to make sure that the people who were in charge of front-line patient services--such as GPs, community nurses, representatives of the local community and local authorities--are in charge of the resources available for patients. That has to be right.

At present, about 50 per cent. of the NHS is controlled by primary care groups. I hope that 75 per cent. of the overall NHS budget will be controlled by primary care trusts by 2004. What is more, we need to remove some of the tiers of bureaucracy that stand in the way of the ability of front-line staff and services to do their jobs. That is why the NHS regional offices will be abolished, as will two thirds of health authorities.

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