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Chris Grayling: I am intrigued by the hon. Gentleman's reference to the work of Kaiser Permanente. Does he believe that it is right to explore the management of the NHS, and would he support Conservative efforts to think out of the box about health care in this country and consider solutions that could provide genuine options for it rather than sticking to the old paradigms?

Dr. Stoate: Would that the comments about the Conservative party were true. What have we heard from Conservative Members about their vision for the health service? Nothing. We have also heard nothing from the Liberal Democrats. I was looking forward to a constructive debate on the health service because the people of this country expect nothing less from a Parliament of this stature on the world stage. Yet Conservative Members have simply ranted about the way in which we have spent less than they might have spent. I want a constructive debate on providing services.

The Kaiser Permanente study bears close examination because of the much shorter bed stays and fewer bed occupancy days a year per 1,000 of the population. It invests far more money in primary care, information technology and communication technology to enable that to happen. It provides a seamless service from admission

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to convalescence. The Government and the NHS could learn from that. Rather than ranting about the differences between the Labour party and the Conservative party, we should consider improving the health service for people in this country and matching the achievements in other parts of the world.

The conclusion of the paper in the British Medical Journal stated:

That is a fascinating statement because it contends that underinvestment is not the problem. We recently heard that the NHS underspent last year. Throwing money at the problem did not solve it because structural difficulties meant that we were unable to spend the money that was given to the health service. Rather than concentrating on the sterile argument about cost, let us consider provision, types of services, improving efficiency, communication technology, wiring up GPs' surgeries to hospitals and wiring up hospitals to social services to ensure a seamless transition for patients through the service.

Mrs. Shephard: If the hon. Gentleman looks at all the nods and smiles from Conservative Members, he will realise that he is bringing us dangerously close to consensus. I congratulate him on his constructive approach.

Dr. Stoate: Those congratulations are unexpected and welcome. I am happy to accept consensus. We do not have to confine ourselves to a sterile, narrow debate, which upsets people, turns them off politics and damages us all.

Mr. Barker: I share the enthusiasm of my right hon. Friend the Member for South-West Norfolk (Mrs. Shephard) and I, too, welcome such thoughts from Labour Members. It is a refreshing change from the usual ideological rant on the NHS. However, the big difference between Conservative and Labour Members is that Labour Members constitute the Government. They have been in office for almost six years. When will people in this country experience an improvement in the service after Labour Members have grasped the idea that simply throwing money at the NHS is not the answer?

Dr. Stoate: It is so disappointing to listen to Conservative Members. They have nothing to say on the subject. I offer them a chance to set out part of their stall and present their alternative policies, yet all they say is, "You've been in for six years and we're not getting anywhere."

Mr. Salter: Perhaps I can help my hon. Friend, whose speeches we always enjoy. As an acting GP and health professional, perhaps he would care to comment on Conservative policy as set out on 12 November in a memorandum from the hon. Member for Arundel and South Downs (Mr. Flight), the shadow Treasury spokesman. It fortuitously landed on my desk and is now on those of many other hon. Members. It states:

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What does my hon. Friend believe Conservative Members mean by that? How much will the sick have to pay under the Conservatives should they ever return to power?

Dr. Stoate: I thank my hon. Friend, but he should look on the bright side: at least the memorandum set out a policy, which is more than we have heard from Conservative Members this evening. Of course, I disagree with it. It would be interesting to hear how much they propose to charge. Conservative Member after Conservative Member has refused to admit the existence of the so-called charges. One of their spokespeople admits to the prospect of charging, yet others refuse to own up to that. I wonder if any of them are brave enough to admit to the policy.

Chris Grayling: Kaiser Permanente, which the hon. Gentleman mentioned, is part of a health care system in which there is no NHS-style monopoly, as described in the memorandum, and to which individuals make a financial contribution. Has the hon. Gentleman not admitted that it provides better-quality health care than the NHS?

Dr. Stoate: The programme fascinates me because it is a managed care programme that works on a non- profit-making basis and is therefore similar to our NHS. People contribute to it throughout their lives, and it is a pooled risk system. That means that few people in it need to buy top-up private health insurance because it covers all their needs. Even more interestingly, the Kaiser Permanente system does not allow specialists to work outside the organisation. No consultants rush off to the private sector to top up their incomes; they cannot do that. We could learn from that.

I want to consider wastage. I chair the all-party group on pharmacy.

Mr. Oliver Heald (North-East Hertfordshire): Does the hon. Gentleman agree that an important aspect of policy is blunder avoidance? One of the Government's great blunders is that they have ended up with massive bed blocking because they have lost 49,000 care home beds, which is something about which the Opposition warned them.

Dr. Stoate: The care home sector is extremely important, but the hon. Gentleman fails to recognise that the net loss of beds in the sector is only 19,000—though of course that is still serious. The hon. Gentleman also fails to take into account the Government's policy of care at home and managed care in the community, which reduces the need for beds. He is right to say that we need to address the problem of so-called bed blocking, and to move people on through the system much more effectively. I get irritated when my local hospital has so-called blocked beds, reducing the flow of patients. Of course that is irritating, and we have to look at the problem. That is why I am proposing a system in which the patient pathway from entry to exit should be seamless, as has been achieved in the Kaiser Permanente system.

David Taylor (North-West Leicestershire): Is it not the case that, over this year and next, we are investing £300 million to tackle bed blocking head on, in a way never seen under the Conservative Government?

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That should allow at least 2,000 elderly people to leave hospital, rather than blocking beds while they wait for parts of their treatment to be completed.

Dr. Stoate: My hon. Friend is entirely right. The Select Committee on Health, of which I was a member, carried out a study into reducing the Berlin wall between health and social services, and we were able to work with the Government to enable that to happen, and to allow shared budgets and the pooling of resources so that the unblocking of beds could begin. That has been quite successful. My hon. Friend is right to say that the £300 million being put in for that purpose will make a big difference. It will allow a lot more packages of care to be bought not only in nursing homes but in terms of care at home—which is, after all, where people want to be, with their family and friends.

We have not concentrated on the problem of wastage of medicines. As I said earlier, I chair the all-party group on pharmacy. One of the reports that we considered showed that about £220 million-worth of drugs a year is handed back to pharmacists. If we assume, as is reasonable, that that is only the tip of the iceberg, the figure will probably be much higher. One report that we examined showed that about 50 per cent. of people did not take their medication precisely as prescribed by their doctor. There could therefore be enormous wastage in the system.

I am pleased that the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), is on the Front Bench at the moment, because I know that he takes a great interest in this issue. I would like to see how the Government can work with the pharmacy profession to tackle issues of medicines management and medicines concordance in a way that would significantly reduce wastage. If my figures are even partly right, there is a significant amount of wastage of the £5 billion budget that the NHS currently spends on drugs each year. That wasted money could be put to much better use.

I would like to see a scheme in which primary care physicians and nurses can work with pharmacists, and with patients, to ensure that patients take the appropriate medication, to check that that medication is being used appropriately, and to ensure that patients get the chance to discuss with their pharmacist and their GP exactly what they should be taking and when, thereby freeing up significant resources for other uses. There could be enormous benefits from that. My hon. Friend the Member for North-West Leicestershire (David Taylor) had a debate in Westminster Hall only this morning to discuss issues relating to pharmacy.

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