"Working for Patients" (Hansard, 21 March 1989)

§ 4. Mr. Dykes
To ask the Secretary of State for Health what weight he attaches to the public comments and reaction he is receiving on the White Paper "Working for Patients" in the context of (a) professional groups working within the service and (b) others.

§ 9. Mr. John Marshall
To ask the Secretary of State for Health what representations he has recently received on his White Paper on the Health Service, "Working for Patients".

§ Mr. Kenneth Clarke
I have received a number of representations on the White Paper. I have been very pleased by the positive and constructive nature of many of them.

§ Mr. Dykes
For the sake of those who wish to remain politically deaf—including Opposition Members—will my right hon. and learned Friend repeat that there is no question of privatisation in the proposals, and no question of any disadvantageous effect on the chronically sick or the elderly?

§ Mr. Clarke
I certainly confirm that. I congratulate the hon. Member for Livingston (Mr. Cook) on having given currency to both those myths before the White Paper appeared as there is nothing in it to support either of them. I assure my hon. Friend and everyone else that we have set our back firmly against any prospect of privatising the Health Service, and that our proposals offer no disadvantages to the elderly and chronically sick.

§ Mr. John Marshall
Will my right hon. and learned Friend confirm that the White Paper has been subject to a wicked campaign of misinformation, especially as regards the elderly? Will he also confirm that the basic principles of the Health Service remain unaffected, and that the objective of the White Paper is for more patients to be treated by even more doctors?

§ Mr. Clarke
A wholly predictable string of committees and bodies that I know well have reacted to this as they have to every other reform. People have ignored the fact that the National Association of Health Authorities and the Royal College of Surgeons have reacted favourably to the reforms. The purpose of the reforms is that the interests of patients should be uppermost in mind. We believe that such a change, in addition to all the extra money that we are putting into the Health Service, will produce an improved service to patients which will reflect more closely their choice and preference in the future.

§ Rev. Martin Smyth
Does the Minister recognise that while some interest groups may express their own responses, there is unease in many parts of the profession and among patients that the end that the Minister has in mind may not be achieved by his methods?

§ Mr. Clarke
To take up the hon. Gentleman's last point, the joint consultants council yesterday was the latest medical group to say that it entirely shared the Government's aims of strengthening the service. There are plenty of questions about the means that we propose, but none of our critics has put forward proposals of any substance for reform or improvement. When we continue the prolonged process of discussion with consultants and GPs in practices and hospitals throughout the country and implement the proposals with care, we will demonstrate to the profession and to others that we are strengthening the service through the process of reform on which we have embarked.

§ Mr. Andrew F. Bennett
Does the Secretary of State accept that extremely caring GPs in Stockport and in Denton in my constituency had not one good word for the 895 Government's proposals when they met me? Will he answer a specific question from them? If they are to have control of their own budgets as a group practice, will they be able to contract with a variety of hospitals or with just one hospital? How does that square with giving patients choice? Will the patients have free choice, or will it be the doctors who have the choice so as to control their budgets?

§ Mr. Clarke
If GPs choose to have their own practice budgets, they will be able to place their contracts with as many hospitals as they wish. They will be able to control a large sum of NHS resources to put together a mix of potential care and offer individual patients a choice when that care is needed. That is one of the attractions of practice budgets for many GPs. I know of many GPs who are interested in taking on their own practice budgets. If GPs in Stockport feel that they cannot take on that responsibility, they need not be too troubled as GP practice budgets are available only to practices which want them and can negotiate a satisfactory budget with my Department.

§ Mr. Watts
Is my right hon. and learned Friend aware that some of my constituents have been concerned by what they have been told about the proposals by representatives of vested interests but have been reassured when they have read the proposals? Will my right hon. and learned Friend consider taking steps to ensure that more patients have the opportunity to read the proposals rather than having to rely on the distorted views peddled by producers in the Health Service?

§ Mr. Clarke
We have a short popular leaflet setting out the proposals and we are trying to distribute it as widely as possible through post office counters and GPs' surgeries, where they will carry them, pharmacists' counters, and so on. I agree with my hon. Friend that, while we respect the right of anyone to have a different opinion about the reforms, it is a pity when some people get carried away. As my hon. Friend the Member for Hendon, South (Mr. Marshall) said, I hope that there will be no outburst of misinformation to patients, telling old ladies that they will be deprived of treatment, as only a fringe few of the medical profession will be inclined to indulge in that.

§ Mr. Robin Cook
The short answer to the hon. Gentleman's question is that the Secretary of State does not intend to attach any weight to the public reaction to the White Paper, as if he were to do so it would sink under the weight of criticism. Does he admit that in the past couple of weeks alone it has been rejected by the Royal College of Nursing, the British Medical Association, nine royal colleges and a meeting in Nottingham attended by 160 GPs, many from his own constituency, who unanimously rejected his proposals? In retrospect, does he agree that the panning that his White Paper received shows how wise he was after the 1982 restructuring when he said: Anybody who comes along in any successive Government and talks about yet another restructuring wants his head examined.

§ Mr. Clarke
I could have told the hon. Gentleman before we started that the British Medical Association, the Royal College of Nursing and the Joint Consultative Council would come out against these or any similar proposals. I understand that the meeting of general practitioners in Nottingham was concerned largely with the GPs' contract, about which there is a later question on 896 the Order Paper. All the information that I have received is that the meeting came to no clear conclusion. That is no doubt a matter that I shall take up with the local medical committee when it comes to its conclusions. In my contacts with consultants and GPs, I have found that many of them are interested in the process of reform. They know that the Health Service has had a 40 per cent. increase in expenditure in real terms and they know that on top of that growth in expenditure improvement is needed in the way in which the Health Service is managed, the way in which it adapts to modern services and the way in which it responds to patients. There is a great deal of goodwill throughout the profession which will put the reform into practice as long as we discuss the detailed implementation carefully with it.

§ Mr. Allason
Last Saturday morning, I had a meeting with the GP who represents more than 100 GPs in my constituency. My right hon. and learned Friend may be interested to know that, by and large, that GP expressed broad support for the White Paper. He said that many of the items in it were matters for which he had pressed for a number of years. Will my right hon. and learned Friend also accept, however, that there is a widespread anxiety, especially among patients who have expensive complaints such as those who have had colostomies, who are worried that there is no guarantee from the Government about their continued support? Will my right hon. and learned Friend take this opportunity to give that guarantee?

§ Mr. Clarke
We have sought to address that in the working paper, which makes it clear that for very expensive patients there will have to be a ceiling above which expenditure cannot be carried by any GP's budget. I will bear my hon. Friend's point in mind as we work out the details. I agree with him that we must come up with a system in practice which guarantees that such patients will in no circumstances be deprived of the necessary treatment. It is clear that such a system is perfectly feasible and it will be worked out in discussions with the profession over the coming months.