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GP Fundholding
3.45 p.m.
Baroness Jay of Paddington: My Lords, with the leave of the House, I shall now repeat in the form of a Statement the Answer to a Private Notice Question which
is being asked in another place on GP fundholding. My right honourable friend the Secretary of State for Health said:
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"My announcement today of fair waiting lists for the patients of all GPs is an attack on unfairness. It is not an attack on GP fundholding.
"The previous government introduced the internal market into the National Health Service. This created a two tier system where patient was set against patient and GP was set against GP. That was unfair to patients, repugnant to the doctors and nurses who had to apply it and cost a fortune in extra paper-work.
"At the general election we promised to restore fairness to the health service, end the two tier system and ensure that access to treatment is based on need and need alone. We pledged to change the system so that no patients and no GP practices suffered any longer from the unfairness introduced by the Conservatives.
"We are keeping that election promise. All NHS trusts must operate a fair waiting list for urgent admissions regardless of who is commissioning the care. With effect from April next year, when current contracts run out, all health authorities must establish common waiting time standards for all the people living in their area. From the same date, health trusts must not offer preferential treatment to any particular group of patients from a health authority whether those of GP fundholders or not. Faster treatment must be provided only on accepted clinical or social grounds. This change will be fair for every patient and will be more comfortable and acceptable for doctors and nurses to operate.
"My announcement has been welcomed by the British Medical Association, the Royal College of Nursing and the NHS Confederation. The National Association of Fundholding Practices has made it clear that it fully accepts the principle and that if properly implemented the new policy will benefit all patients.
"In two thirds of all health authorities the patients of non-fundholding practices have to wait longer for hospital treatment. What is not so well known is that in the other one third, it is the patients of GP fundholders who lose out.
"We are determined to have a National Health Service which is fair to all patients. That fairness will be achieved through co-operation, in place of the competition and division of recent years. That fairness will be achieved by levelling up towards the best that is already being achieved and not by levelling down.
"In our general election manifesto we recognised that the development of fundholding has brought advantages as well as disadvantages. We promised to remove the disadvantages. A month ago we set out to bring fairness into the financing of non-fundholder practices. Today we are bringing fairness for their patients.
"We are now consulting the professions and patient organisations on how best to develop a new primary care system in which doctors and nurses can play a leading part in planning local health services more effectively for all the patients in their area.
"In this way we hope to reconcile the better aspects of fundholding with fairness for all patients and all the professionals involved. We are discussing this with them and will test out our new proposals through pilot schemes in different parts of the country.
"The new system will be based on the principle that access to health care will be based on need and need alone. That is the principle of quality and equality on which the Labour Party founded the health service. That is the principle on which we will run the National Health Service--so that it is fair to every patient. And who can possibly quarrel with that?".
3.50 p.m.
Lord McColl of Dulwich: My Lords, the Statement says that this is not an attack on GP fundholding; it is an attack on unfairness. This new Labour policy is an attack on freedom. The Labour Party simply cannot bear to give people the freedom to choose. Fifty-four per cent. of GPs chose to be fundholders, and, of the remainder, half want to be fundholders.
The late Brian Abel-Smith, that highly intelligent socialist who advised the Labour Party for many years on the NHS, strongly recommended that all GPs should become fundholders. If the Labour Government were really interested in fairness, they would encourage all GPs to be fundholders. Then, the so-called two-tier system would disappear.
This new Labour policy will have two effects. First, waiting times and waiting lists will inevitably increase. What the Labour Government have failed to understand is that fundholding gave GPs much more influence over hospitals. It was a shift of power. It enabled them to goad the hospitals into providing a better service. The GP fundholders were made into better advocates on the patients' behalf.
The second effect of this new Labour policy is one that the Labour Government have completely failed to understand; that is, it will completely deprive many patients of operations altogether. Some health authorities have stopped treating varicose veins, lumps and bumps, lipomas and so on. But patients of GP fundholders were able to have those operations. Now they will not. I should like to know what the Minister has to say about that. This is old Labour again. It is a fatal mistake for many people.
Baroness Robson of Kiddington: My Lords, unlike the noble Lord on the main Opposition Benches, I welcome the Statement that has just been made in another place because it will create a fairer system. It will not solve the problems of the NHS. It might mean that patients of GP fundholders will have to wait slightly longer for treatment. But it will make very little difference to the length of time that all patients have to wait. That will be solved only when the Government agree that the NHS needs more funding--and only the Liberal Democrats have costed plans for increasing that funding. I know what the Minister will say about extra funding. The proposal will not come into effect until next year. What are the Government doing about it in the meantime?
I am pleased that the Minister in another place referred to the fact that fundholding has also brought advantages to the health service. One is that the fundholding GPs were much more closely involved in the planning of hospital services through their influence because they had money behind them. I hope that any change will ensure that all the GPs in a health area will have an increased input into the planning of services. They are the people on the ground who know what the general public need in the way of health services; they see them every day in their surgeries.
I also welcome the fact that we are not about to rush into some wonderful new system. The Minister says that he is discussing with all the professions involved what should happen, and that they should test out the new proposals and pilot schemes in different parts of the country. I welcome that.
Baroness Jay of Paddington: My Lords, I am grateful to the noble Baroness for her welcome for the Statement, which certainly accords with that of the professional bodies outside this House, which responded so favourably to what my right honourable friend said.
I confess to being slightly surprised at the tone of the response from the noble Lord, Lord McColl. He seemed to suggest that what I had described, in repeating the Statement in answer to a Private Notice Question in another place, was that the Government were about to abolish GP fundholding. That was certainly not included in the Statement, and it was certainly not the intention of my right honourable friend. The noble Lord may be interested to know that changes are already in hand to examine the next wave of fundholding--the eighth wave--which, as the noble Lord will know, was suspended at the beginning of May in order to free up some much-needed immediate resources for our plans for this year. The NHS Executive is even now working on guidance on budget setting for 1998-99. That will reflect the advantages that we have discovered in some of the aspects of fundholding referred to in the Statement and indeed in our general election manifesto.
As the noble Baroness, Lady Robson, said, the object of the Statement and of the policy decisions reached by the Government today are to establish a fairer system of waiting lists. As she said, they reflect a determination to approach the matter on a long-term basis. That is why I am satisfied, even though the noble Baroness suggested that she was not, with the additional funding mentioned by my right honourable friend the Chancellor of the Exchequer in his Budget Statement, which will enable us (over a longer period) to deal with the long-term problems which the waiting list division has created. I remind the House that the problem at the moment is that not only do we have a whole series of local trusts, created under the internal market--under the unfair system that we are seeking to redress--a record number of local trusts at a record level of debt, but there are also record numbers of people on the waiting lists. This initiative today is, as the Statement said, designed to return equality of treatment based on need to all those people who are waiting.
Lord McColl of Dulwich: My Lords, will the Minister answer my question? As some health authorities have withdrawn treatment for operations for varicose veins, lipomas, lumps and bumps and so on, GP fundholders were able, under the old regime, to request that the hospitals carried out those operations, and they did so. If that part of the system is abolished, what will happen to the patients who cannot have those operations? At the moment they are having to use the private sector. Is that what the Government want?
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