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14 Nov 2002 : Column 185—continued
The Parliamentary Under-Secretary of State for Work and Pensions (Maria Eagle): Tell us what you would do.
Dr. Fox: The Minister may not have gathered that we are debating the Queen's Speech. The reason why we come to the House of Commons is to discuss the Government's programme, which is what we are doing today, and point out the flaws in the Government's approach, which are all too easy to find.
One of the biggest problems with the Government's approach was summed up in the words of just one hon. Member when he said that it is all about schools and hospitals. The Prime Minister is the one who is most responsible for putting forward the idea that hospitals matter and nothing else, irrespective of the fact that 90 per cent. of our patient contacts take place elsewhere. To the Prime Minister it is all about hospitals, reinforcing the idea that it is the secondary sector that is important. What about the GPs, district nurses, midwives, practice nurses and all the therapists that my hon. Friend the Member for Bosworth (Mr. Tredinnick) is for ever going on about? All those people are important parts of the health care system and need to be recognised.
Dr. Fox: There are times when looking ahead is the best policy. I will give way later—much later.
When it comes to the national plan, for the Government to meet their GP targets they had to recruit an extra 2,000 GPs between 2000 and 2004. The net increase throughout the country in 2000 was 18, and in 2001 it was also 18, according to the Government's own figures in a written answer. GPs increasingly look to early retirement to escape from the burden of red tape and paperwork imposed by the Government. It is frightening that fewer GP trainees—those junior doctors who have undergone GP training—are deciding to go into a full-time career in general practice.
We have a particular problem that will hit us when the crisis of south Asian retirement arrives. Most hon. Members will understandably not be aware of that problem, but one in six GPs practising full-time in the NHS qualified medically in a south Asian medical
school and two thirds of them will retire by 2007. It is unlikely that doctors who qualify in south Asia will be a source of general practice recruitment in the future. The posts from which south Asian qualifiers are retiring will be the most difficult to fill because they are often in the practice areas of highest need. So the biggest problem will be in the areas of greatest need and often the areas of greatest social deprivation.The Secretary of State keeps telling us that the money that the Government are putting into the NHS will buy us more GPs and consultants. Where does he think we will buy them from—from GP Argos or the GP supermarket? There are not huge numbers out there waiting to be employed in the NHS. We will have to encourage them into the service.
Management is not immune to demoralisation. The Government's bungling approach to the NHS has resulted in the paradox of a system that is under-managed at the front end but over-bureaucratised from the centre. In other words, those at the sharp end are not allowed to manage because of endless interference from the centre. Is any of that the Government's fault? No. On XNewsnight" the Secretary of State said:
- XWe have national standards in place, if we have poor performance that is because of poor management"—
Mr. Dobson: Does the hon. Gentleman not recognise that if the Government cannot find additional GPs and consultants it is because for 20 years the Tory Government did not recruit enough people into medical schools and postgraduate training?
Dr. Fox: It does not surprise me that the right hon. Gentleman fails to understand the essential point, which is that doctors undergoing GP training are not becoming full-time GPs because they find it an unattractive part of health care. That is the problem, and it is a cultural problem within medical employment. As long as the Government make things more and more difficult for GPs by increasing the amount of red tape, paperwork and restrictions that they face, that problem will continue. All that adds up to a picture of a Government who do not really understand that in a free society people cannot be forced into professions; they have to be attracted to them.
One other area that must worry us is the recent trend in the number of those applying to study medicine. Applications fell from more than 13,000 in 1996 to under 10,500 last year. We have seen a slight increase in the headline figure, but most medical experts have expressed worries about the quality and qualifications of applicants this year.
I said that I must give way to my hon. Friend the Member for Bosworth, and of course I must.
Mr. Tredinnick: I am grateful to my hon. Friend for giving way to me, as he put it, much later. Surely the health service shortages that he is addressing must also be addressed from another angle, and that is by bringing in those who do not work in the health service but who are medical practitioners. Does he not agree that properly regulated herbal therapists, acupuncturists and homeopaths, for example, could ease the burden on doctors tremendously? Are not foundation hospitals a
great opportunity for new initiatives in terms of spreading the burden of the delivery of care—initiatives about which we have heard nothing from the Government?
Dr. Fox: As my hon. Friend is well aware, I think that we should be using all our medical professionals at the ceiling of their ability and skills, to ensure that we are using all our health professionals in the most appropriate way. Moreover, we must be able to prove that any expenditure on such solutions from the public purse is of equal validity and worth to that of other treatments in mainstream medicine. With those two provisos, I have no problem whatever with what my hon. Friend says.
That brings me to the issue of foundation hospitals, which my hon. Friend mentioned. That is one of the relatively few areas in which, if we drew our policies on a Venn diagram, the Secretary of State and I would find that there was quite an intersection. The concept of foundation hospitals is a good one and the policy is in a direction with which an incoming Conservative Government would be comfortable. We were therefore delighted this morning to hear that the current wave of foundation hospitals will be only a start and that the programme will be rolled out to encompass the whole of the NHS where possible. We want all hospitals to be foundation hospitals. If the principle is that they will provide better care to patients in the locality, all patients should be able to access such improvements. We should like to see the hospitals free, self-governing, independent and very much on the not-for-profit basis that the Secretary of State mentioned. We want to see an enabling state that will ensure that our health care is provided but does not see itself as a monopoly provider.
There are contradictions and confusions in the Government's approach, however, and there was certainly a strong feeling among Opposition Members that the Secretary of State had not previously considered many of the questions put by hon. Members on both sides of the House.
One of the most important issues affects my constituency. As has been said, local communities must hold trusts accountable, but what happens in constituencies such as mine that have no hospital trust? Which trust do we hold accountable? Those issues lie at the heart of the workability of the Government's scheme. My hon. Friend the Member for Wycombe (Mr. Goodman) raised the question of star ratings. If a hospital trust goes from three stars to two during the transition process, will it be ineligible for that transition or will hospitals simply not be subjected to star rating at all when they become foundation hospitals? Will the convenience of the system be put before the quality of rigour that the Government claim for the policy?
Clearly, there is huge tension in the Government between the so-called modernisers and those in No. 10 and the official voice of the Chancellor, Ed Balls, who gave the Chancellor's clear view when he spoke to The Guardian recently:
- XWe have to have the confidence to accept that there is a limit to how far you can apply market principles.
The NHS and our public services depend upon an ethic of public service and a commitment to the services. In an area like health or education, if you go down the marketising route, you run grave risks with that ethic of public service."
The briefings that we have received from the Secretary of State in the House differ from the reported briefings to chief executives across the health service. According to the Health Service Journal, the Government said in their latest briefing that
- Xfoundations in five to 10 years would be the norm rather than the exception in the NHS."
- Xthat freedom over pay and conditions would be 'absolute' for foundation"
- XTo argue that we should simply pay everybody the same regardless of labour market conditions is absurd."
We need to move quickly, because of the points raised by many Labour Members on the risk of a two-tier system. The British Medical Association has laid the position out clearly:
- XThese freedoms ought to be available to all hospitals. Our prime concern must be to avoid creating a two-tier service in which patients who live near to Foundation Hospitals or are vocal and assertive in pressing to be referred to them, receive better services than those who are treated in other hospitals."
- XSimilarly, if Foundation Hospitals have more ability to borrow money with the result that there is less opportunity for other hospitals to obtain the resources they need, inequity will result."
I hope that we get clear confirmation that all NHS hospitals will be foundation hospitals, because there is a worry for many of us who have been considering some Government reforms constructively, not least the relationship between primary care trusts and the aim of passing more money and more freedom down to them. There is a rumour, which I hope that the Secretary of State will dismiss now, that there will be new arrangements for foundation hospitals whereby PCT funding will be locked into contracts for five to seven years, thereby negating everything that the PCTs are supposed to be doing: exercising greater freedom over what they do with their funding and, according to the Government's release of a few weeks ago on NHS flows, money moving with the patient.
If the Government are saying that the freedom of PCTs will be sacrificed to give an element of stability to foundation hospitals, that is a significant policy change and the Secretary of State should tell us right now
whether the reports are correct or incorrect. That is vital to today's debate in the House. I take his silence to confirm that many of those rumours are correct.
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