HEALTH BILL [2nd READING]
13th April 1999
I do not share the enthusiasm for the Bill one jot, and nor do doctors in my
constituency.
The Bill exemplifies everything that new Labour stands for. Like others
before it, it sounds like a major advance, an improvement and a benefit to
our people. It is not. In fact--[Interruption.] Gullible Labour Members are
actually cheering me. The Bill is rather like the Budget. The Budget sounded
great at the time, but a few weeks of analysis has exposed gaping holes both
in Labour's arithmetic and in the benefits that it was purported to provide.
The Secretary of State was full of rhetoric. To the gullible on the
Government Benches, may I make one thing very clear? The Bill does nothing
to abolish the internal market that the Minister so deprecates. It cannot,
because even this Government recognise the improvements in patient care that
the market has introduced. Instead, there is tinkering with the system,
which will reduce, not improve, patient care.
At a stroke, 60 per cent. of all patients--the patients who were cared for
by GP fundholders, which includes all patients in my constituency, I might
add--in this nation will see a reduction in standards of care. The remaining
40 per cent. will not see an improvement either. Changes to the way in which
GPs will be funded will put paid to that.
I have news for the Labour Members who have loyally read their party brief.
This Bill will go the same way as the Budget: it looks good, but, when one
has had a chance to analyse it and see what has not been trumpeted, it is
very bad news. It is particularly bad news in Lichfield and Burntwood, where
all GPs have been fundholders.
This is nothing to do with levelling up; it is all about levelling down.
This is about the Government not being able to resist poking their
collective nose into things about which they know nothing: patient care.
Fundholding empowered GPs; this little piece of collectivisation puts power
back into the hands of Big Brother who, in this instance, does not know
best.
I shall air six areas which concern me most. I do not expect the Minister to
answer here and now the various points that I shall put to him, but I ask
him to make a note of them. I should be grateful if he would write to me on
them because they have been raised with me by doctors who know about patient
care.
Although all GPs in Lichfield and Burntwood are fundholders, that is not so
nationally. Unlike the proposals before us, GP fundholding was voluntary.
Have the Government ever asked themselves why some GPs did not want to
become fundholders? It was often because they did not want to become
involved in practice management. Not every doctor has the skill required,
regardless of whether a practice manager is appointed. Now, as my hon.
Friend the Member for Uxbridge (Mr. Randall) pointed out, all doctors will
have to join a primary care group--whether they like it or not, but the
financial resources are just not there to provide adequate practice
management under the proposed scheme.
My constituency is typical. Executive support is quoted to be about £3 a
patient, which is far too low for the work required. Even worse, such
support does not amount to £3 because it is not ring-fenced. Many primary
care groups have not received anything like that level of funding.
The primary care group that covers Lichfield and other towns too has to
share a chief officer with another PCG. According to the PCG newsletter
published in my area, which was received on 8 April, he is the only
permanent member of staff. Furthermore, it is becoming clear that Lichfield
practices are sharing other posts, including that of deputy chief officer
and a PCG accountant. That level of staffing is wholly inadequate.
Secondly, the situation that I have just described may seriously
disadvantage Lichfield and Burntwood, as the other PCG is Tamworth, which
has a new hospital, but needs to secure further funding from the PCG.
Executive underfunding may lead to Tamworth being favoured by the executive,
thus disadvantaging the Lichfield and Burntwood. I do not expect the
Minister to answer the following specific constituency question now, but
will he assure me that Lichfield Victoria hospital and the Hammerwich
hospital will not close as a direct consequence of this Bill and PCGs?
Thirdly, like so much other legislation before the House, there is not
enough detail in the Bill. Too many decisions can be made by the Secretary
of State, and there is no real information about funding.
Fourthly, the majority of GPs are prepared to assist in fair rationalisation
of resources; but, if the system is to be fair, all patients and all doctors
should start with a level playing field. I am sure that the Minister and the
whole House would agree with that. But--and it is a big but--[Interruption.]
It is all very well Labour Members laughing because they have read their
Labour party brief, but have they spoken to GPs in their constituencies?
Have they actually spoken to fundholders? Have they got off their bottoms
and gone back to their constituencies and found out what is really happening
on the ground? I think not, Mr. Deputy Speaker.
The most important aspect in Lichfield and Burntwood will be the handling of
any overspend by the South Staffordshire health authority for the financial
year just ended. My near neighbour, the hon. Member for Cannock Chase (Dr.
Wright), raised that point. If the health authority--any health
authority--is overspent as at 31 March this year, will that money be sliced
off PCG funding for the year 1999-2000?
That is very important because it is not just Lichfield and Tamworth and the
South Staffordshire health authority that have an overspend. I notice that
the House has now gone very quiet, because hon. Members had not thought of
that. If the money were sliced off PCG funding, it would unfairly penalise
GP practices--[Laughter.] If hon. Members have thought about it and are
finding it so funny, what will they tell GPs in their constituencies?
Slicing off the money would unfairly penalise GP practices that are spending
within their budget under fundholding. Will the Minister please write to me
on that point? Would an overspend of the health authority take money away
from the PCGs?
South Staffordshire health authority has ended the year approximately £7
million overspent, as the hon. Member for Cannock Chase said. It is now
clear that PCGs will almost certainly not start with a level playing field,
as that situation will be carried forward to PCG budgets.
Fifthly, handling all the changes to date has taken an enormous amount of GP
time. Do the Government recognise that? Do they understand that the work has
not been recognised by proper funding of locum costs while GPs are away from
their practices, milling through the paperwork that the change has
generated? How do the Government intend to compensate for that? At the
moment, no compensation plan is available.
Finally, improving the quality of GP services to the community is part of a
doctor's philosophy, so many have no problem with the proposals for clinical
governance, the Commission for Health Improvement or the National Institute
for Clinical Excellence. Both are fine in theory.
Unfortunately, the resources for those initiatives are not forthcoming. It
has now been confirmed that South Staffordshire health authority and other
health authorities will provide no financial resources for clinical
governance, and the only conclusion to be drawn from that is that the aim of
most GPs to provide the highest standards of care is not supported by the
health authorities--or the Government, who have not funded it properly.
The recurring theme is that the major changes proposed for the NHS will not
be supported by special funding. Reliance on NHS staff dedication to
continue giving more than they are paid for must come to an end eventually.
So many facets of the latest reforms are not funded, despite headline
increases of the NHS budget, and staff will become alienated as, once again,
they are expected to provide even more for nothing. If the Government truly
support their NHS reforms, why is the funding to allow professionals to
deliver their vision not available?
