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"in settings that are closer to home and more convenient to patients. Further, there are ways that the NHS as a whole . . . will benefit from more efficient use of services and greater involvement of front line doctors and nurses in commissioning decisions."
in other words, the track record of GP fundholding between 1990 and 1997. I am delighted to be able to endorse the Government's returning to a sensible policy, although I have some questions to ask about it.
Does my right hon. Friend understand the frustration of patients and doctors in Staffordshire, where every GP was a fundholder? It is felt that six years have been wasted in going full circle
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and returning to the original position, where money followed the patient, rather than poor old patients constantly having to follow contracts and money.
Mr. Dorrell: My hon. Friend took my next words out of my mouth. At one level, it is slightly humorous in a party political sense that I am reading words that are virtually the same asin truth, they could be identical tothe words I used 15 years ago to describe the introduction of the policy. At another level, however, we are speaking about real people treating real patients in the health service and about 15 wasted years. The point that my hon. Friend makes is a serious one.
It is worth reflecting that if, instead of going down the dead end that was signposted by the right hon. Member for Holborn and St. Pancras (Mr. Dobson) in 1997, we had continued with the development of the policy that the Government now recognise is right, every GP in the NHS would by now, if they so wanted, be engaged in practice-based commissioning, to use the jargon.
My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) referred to the total purchasing pilots that we were working on before 1997, which showed that this does not have to be a minimalist idea dealing with a few relatively minor patient routines. It can be at the heart of commissioning in the health service in order to make it flexible and responsive to the needs of communities and individual patients. It is not a joke; it is a scandal that we are now back at the starting blocks 15 years on, having to go through the same performance all over again.
Michael Fabricant: Does my right hon. Friend also recall that fundholding GP practices were able to perform minor surgery, thereby taking the burden off cottage hospitals and larger district hospitals? That was abandoned, too, causing the problems that I raised earlier with the Secretary of State for Health.
Mr. Dorrell: I caution my hon. Friend against overstating a powerful case. It would be wrong to suggest that all the minor surgery performed by GPs was unravelled with the end of fundholding. It is true to say that fundholding drove that change process, but quite a lot of it still goes on. What we have lacked in the meantime is the driver for further change to take the process on at the rate at which it was proceeding while the fundholding scheme was in place and driving it.
I have welcomed the fact that, albeit belatedly, we are again using the idea to drive change in the health service. I hope that when he responds to the debate, the Secretary of State for Education and Skills will deal with these matters, or perhaps he will arrange for someone else to do so. Given that we have wasted 15 years, it is important that we have a plan to make this opportunity available to all general practitioners in the national health service. It is important that we have flexible plans that allow GPs to group together, rather in the way that the hon. Member for Huddersfield (Mr. Sheerman) suggested schools should, to allow GPs to create their own informal bodies to operate the commissioning approach, as they were before 1997.
It is important that we develop the concept of practice-based commissioning and that we get back to the concept of total purchasing pilots to allow that idea
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to develop. It is important that there is a target in the Department of Healthwith due apology to my hon. Friend the Member for South Cambridgeshire for my mentioning targetsfor achieving savings out of the primary care trusts that were the more bureaucratic version introduced to supplant fundholding. If we are going down the road of practice-based commissioning and, rightly, committing resources to that idea, let us score the efficiency savings that should be available from PCTs as a consequence.
Mr. Lansley: Happily, my right hon. Friend does not have to apologise to me. We wish to remove Whitehall targets imposed on hospitals, but that does not mean that we will not set ourselves targets for efficiency savings. Indeed, with the James committee, we estimate that changing commissioning roles towards what is in effect practice-based GP fundholding and patient choice for elective treatments will mean that more than £600 million is saved from PCT administration.
Mr. Dorrell: I am grateful to my hon. Friend for setting himself a fairly ambitious target. I hope that the Government will embrace that £600 million target; if they do not do so, they will need to explain why.
One of the oddities about the Government's paper on this matter is their statement that, if a practice achieves savings as a result of innovative commissioningthat is clearly the idea of the exerciseonly 50 per cent. of the savings achieved will be available for the benefit of its patients. I do not understand why there should be a 50 per cent. limit, because its effect is that the other 50 per cent. of the savings achieved by innovative commissioning in one practice area will go to the benefit of patients in an unrelated practice area.
I do not see the logic of that approach. If a practice achieves savings and more efficient commissioning for its own patients, surely the people who should get the benefit of that resource, which will be more efficiently used, are the patients of that practice. I would be grateful if somebody explained to me why 50 per cent. of the savings should disappear into the ether. Why should not 100 per cent. be available to improve the health care of the patients of the practice in question?
In developing the idea of practice-based commissioning, I hope that the Secretary of State for Education will convey to the Secretary of State for Health my heartfelt good wishes for him in his no doubt upcoming battles with the Chancellor of the Exchequer and the Chancellor's friends on the Back Benches. The Health Secretary will have to do better this year than he did last year on foundation hospitals if we are to secure the real benefits that will be available for health service patients and if this idea is to be allowed to run properly. I wish to turn now to the Education Secretary's responsibilities.
Mr. Charles Clarke: Before the right hon. Gentleman moves on, I remind the House that he said that he would comment on the patient's passport. I hope that he will do so before he moves on to education, as I think the whole House would be interested in his analysis of that policy proposal.
I am sure that the whole House is waiting for that with bated breath, but hon. Members are
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probably waiting with even more bated breath for me to sit down so that they can make their own contributions. I would not wish to deny the Education Secretary my thoughts on his departmental responsibilities, so I shall move on, if I may.
Turning to the relaunch of what I would describe as the city technology college programme, I am grateful to the Education Secretary for his hospitality, as he very kindly gave me a dinner in the company of 200 or 300 others at a promotion of his city academies programme. I was glad to go to the city academies dinner, as I thought that it felt very like dinners that I attended before 1997 to promote the development of what used to be called, as hon. Members will remember, city technology colleges. Indeed, so like city technology colleges are the academies that the Secretary of State quoted in his departmental plan of July the example of a very successful academy. I do not know the details, but I am prepared to believe that this is an admirable story, and I would like to read it to the House:
"Walsall Academy opened in September 2003 . . . Its sponsors are Thomas Telford School in Shropshireone of the original City Technology Colleges, with an outstanding record of pupil achievement and innovation in the application of information technology . . . in partnership with the Mercers' Company, a City of London charitable livery company".
"has already raised the proportion of students gaining five good GCSEs from 13 per cent. in 2001 to 49 per cent. in 2003. There are now ten times as many students applying for a place at the school than beforewith 608 applications for September 2004 compared to just 57 students in"
That is a huge success story, and I give the Secretary of State for Education and Skills credit for promoting the city academy programme, which is a relaunched city technology college programme. However, the same comment applies: if it is such a good ideait is plainly a good ideawhy did it have a seven-year sabbatical? Why could the reinvigorated Government post-1997 not follow through on the idea, instead of taking a great historical loop around a dead end? It is to the credit of the Prime Minister and the Secretary of State for Education and Skills that, if the newspapers are to be believedI think that they are largely to be believed on this subjectthey won their battle with the Chancellor on the target of 200 city academies. The policy is good, and I hope that that target is achieved.
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