§ 10. Mr. Andrew SmithTo ask the Secretary of State for Health what further representations he has received in respect of his proposals to cash-limit general practitioners' budgets.
§ Mr. MellorGeneral practice budgets are not to be cash limited.
§ Mr. SmithUnder the White Paper proposals, both the larger practices that become budget holders and all the rest, through the indicative budgets set for family practitioner committees on drugs costs, will be subjected to cash limits. Is it not the case that that can only have the effect of undermining the confidence of patients in the 826 doctor-patient relationship, as the cash considerations threaten to displace medical considerations? As a result, patients will increasingly fear that the cost of their treatment rather than the medical need for their treatment will take priority. Will this not damage the most valuable part of the NHS?
§ Mr. MellorThe hon. Gentleman builds a house on sand because his basic premises are completely wrong. First, in terms of large practices, anyone who chooses to have a practice budget will choose to do so because he believes that he can operate effectively within it. That is quite different from an imposed cash limit. Secondly, if the hon. Gentleman really thinks that an indicative drug budget is the same as a cash limit, he is being misleading. He should know that an indicative budget is a way to show general practitioners where their prescribing practices place them compared with others. I am happy to repeat that once again. Every patient will get the drugs that he needs, and that is a pledge.
§ Mr. McCrindleIn view of the predictable opposition to indicative drug budgeting by the pharmaceutical companies, will my hon. and learned Friend the Minister take this opportunity to restate what he sees as the benefits to patient care of the Government's proposals?
§ Mr. MellorIt will be in the interests of patients who really need drugs, particularly expensive drugs, and there should be proper control of budgets to allow us in future to pay for the drugs that patients need. I know of no other enterprise for which £2,000 million of expenditure would be treated on the basis that those who sign the prescription forms can do anything they like. There is no threat to patients because doctors are being put under some pressure to prescribe generically instead of prescribing branded drugs which are twice as expensive. If we are to find the elbow room to afford the wonder drugs of the future, we must be sensible about not paying excessively for less than wonderful drugs which are merely branded instead of generic.
§ 11. Mr. Tony LloydTo ask the Secretary of State for Health if he will make a statement on reaction in the North Western regional health authority to his recent White Paper.
§ Mr. MellorReaction from the authority has been most positive. Members of the authority had an opportunity to consider the Government's White Paper "Working For Patients" at a seminar arranged in the region on 17 April. Since then the authority has forwarded to the Department expressions of interest in self-governing status from eight hospitals and one community unit, and in doing so they drew attention to the need, which we fully accept, to protect medical education and research.
§ Mr. LloydWill the Minister take into account the fact that of the eight hospitals in the north-west region, four of them—Christies, Manchester royal infirmary, St. Mary's and the royal eye hospital—are not simply district-based services, but provide regional specialties? Does the Minister recognise that the medical professionals, the ordinary people in the street and the whole of public opinion in the north-west is hostile or suspicious of the Government's proposals? Why will the Government not 827 agree to some form of consultation, or even ballots, outside the districts directly affected? The proposals affect the whole of the north-west region.
§ Mr. MellorWith respect to the hon. Gentleman, it is not true to say that all the groups to which he referred are opposed to the expressions of interest in self-governing status. I can show that there is substantial support already for self-governing status in those hospitals that have expressed an interest.
Regional specialties will continue to be provided and we are aware of the need to ensure that regional specialties are protected. There will also be ample opportunity for people to make their views known before the Secretary of State has to take any decision on self-governing status. Indeed, an expression of interest is not the same as a formal application and none of those hospitals have been invited to, or have made, formal applications.
§ Mr. HindMy hon. and learned Friend will have noticed in the response of the North Western regional health authority to the White Paper "Working for Patients" three expressions of interest to form National Health Service hospital trusts. In Wrightington hospital in the West Lancashire district health authority 95 per cent. of the patients come from all over the region and from the rest of the country. Does my hon. and learned Friend accept that his proposal for money following the patient is ideal for that hospital as it will provide better care and more independence for the doctors at that hospital?
§ Mr. MellorI entirely agree with my hon. Friend and I am glad that he referred to Wrightington hospital. The senior medical staff at Wrightington have been the driving force behind the expression of interest from that hospital for, I suspect, precisely the reasons that my hon. Friend has given.