British Medical Association (Hansard, 23 May 1989)

5. Mr. Robert G. Hughes
To ask the Secretary of State for Health what matters were discussed at the last meeting with the chairman of the British Medical Association.

§ 9. Mr. Hind
To ask the Secretary of State for Health when he last met representatives of the British Medical Association; and what matters were discussed.

§ Mr. Kenneth Clarke
I last met the chairman of the BMA formally on 22 February when I discussed with him the remuneration of hospital doctors. I have since then met the general medical services committee's negotiators on 4 May to discuss the remuneration of GPs under the new GP contract.

Mr. Hughes
Will my right hon. and learned Friend discuss the current advertising campaign with the chairman of the BMA and point out that there are so many inaccuracies in it that it is difficult to believe that those responsible for it have even bothered to read the White Paper? Will he seek a further meeting so that he can present a copy of the White Paper to the chairman, together with one for the chairman's advertisers, so that they can reprint the adverts but this time tell the truth?

§ Mr. Clarke
I was astonished that just three days after the BMA said that it wanted to see me and to have discussions, those advertisements were produced. I was equally astonished that the chairman of the BMA has kept saying that he entirely shares the Government's aims as set out in the preface to the White Paper, and that he and most of his colleagues believe that there is a great deal of good in the White Paper and want us to experiment with and pilot the rest, but followed that with advertisements containing not one word about those positive sentiments and a lot of totally untrue allegations which are simply designed to alarm elderly and chronically sick patients. I should like the BMA to stick to its more constructive proposals and to have a formal word with me about the White Paper for the first time since I presented it to the BMA.

§ Mr. Hind
How can the BMA, the doctors' trade union, describe the NHS as, underfunded, undermined and under threat", 788 when the Government have increased spending on the NHS since 1979 from £8 billion to £26 billion, which includes a substantial rise in doctors' pay? Does my right hon. and learned Friend agree that the advertising campaign is misleading and that it is ovepriced, overwrought and certainly over the top?

§ Mr. Clarke
I do not criticise the BMA for using advertising agencies appropriately, but I advise it not to leave the text entirely to the copywriters. It is best to give instructions to the agency about what one wishes to say that is positive and then to make sure that the text is written by someone who has read and understood the proposals. The BMA has not followed either rule. My hon. Friend's slogan in certainly as effective as that of the BMA.
We all agree that the NHS needs more money, although the Government have increased spending on it by 40 per cent. in real terms since we came to power. That money will have the best effect for the patient if it is spent more sensibly and by a better-run Health Service. I am still waiting to hear what positive ideas the BMA might have for improving the running of the Health Service.

§ Mr. Campbell-Savours
Are not GPs in Kent up in arms over the Secretary of State's proposals—[HoN. MEMBERS: "Where?"] In Kent. Is opting out a solution to the problems of the people of Sevenoaks, who face the closure of Emily Jackson house and the rundown of acute services at Sevenoaks hospital? What about the League of Friends at Sevenoaks, which raised £100,000 for acute service support facilities but finds that that money has been wasted? What about the Tory Members from Kent who bleat to their constituents about what they are doing in Westminster but vote with the Government on all these stupid proposals about budget cuts?

§ Mr. Clarke
The hon. Gentleman's new guise as a man of Kent is intriguing but I suggest that he should do a little more homework on the county before he launches into local politics there in competition with my hon. Friends.
Expressions of interest in self-governing hospitals will come to me and my Department only at the end of this month. They are expressions of interest by doctors, managers and those involved in the hospitals who can see the potential of our proposals to improve the service in their area and give them a greater ability to control what happens in Sevenoaks or wherever. The hon. Gentleman will have to wait and see whether that is pursued in Sevenoaks. Those who are interested will enter into a process of discussion with us so that we can ensure that any hospitals which become self-governing will raise the quality of service for the people whom they serve.

§ Mr. Duffy
What will be the Secretary of State's response to the BMA representatives who voiced the concern of their colleagues, notably in Sheffield, that patients most in need of care, such as the chronically sick and the elderly, stand to be penalised through budgetary considerations arising out of his new proposals?

§ Mr. Clarke
People in Sheffield are still complaining about the contract. Frankly, they would be well advised to take the advice of their negotiators who are commending a package that is fair to doctors and will pave the way for a big improvement in the quality of the family doctor service in this country. The hon. Gentleman's comments on the elderly and chronically sick are the opposite to the truth. There is a greater variety in the quality and range of 789 service provided for the elderly and chronically sick than there is for most other people. The introduction of the new systems of clinical audit and charging district health authorities with the responsibility to use their money to most effect for the services that local residents need most will have the effect of raising the overall quality of care for the elderly and chronically sick. The scares about them are part of the background to the dispute over the new contract for GPs, which I hope is now resolved.

§ Miss Widdecombe
Does my right hon. and learned Friend agree that, bearing in mind the assessment of Kent by the hon. Member for Workington (Mr. Campbell-Savours), the hon. Gentleman would be better advised to spend his time looking after his own constituency in Cumbria? Does my right hon. and learned Friend agree further that all doctors in Kent have had the opportunity to consult their patients and that many of them have expressed approval of the new plans, and that, where there is interest in self-governing hospitals, it is because they believe that it will be in the interests of the provision of better service for the people of Kent?

§ Mr. Clarke
I am sure that the attempt by the hon. Member for Workington (Mr. Campbell-Savours) to be a latter-day Wat Tyler and raise the population of Kent will be highly unsuccessful. My hon. Friend is quite right to say that many people are interested in the proposals. Among them are medical staff and others in Kent. Kent has a tradition of being an extremely go-ahead county in the forefront of many reforms in medical care and social services. Many people in Kent will be eager to see the opportunities that our White Paper gives them for improving their ability to deliver good quality services.

§ Mr. Robin Cook
When the Secretary of State next meets BMA representatives, will he answer their frequent questions about when he will respond to the Griffiths report on community care? Is he aware of the stark contrast between pushing through his proposals, which are opposed by everybody in the medical profession, and the year that he has taken sitting on the Griffiths report, which is supported by the health profession? Did he note the inquest last week into the death of Beverley Lewis who, blind from rubella, starved to death in the community? How many more scandals must there be before the right hon. and learned Gentleman recognises that a growing number of elderly and handicapped people in the community need better community care, and need it urgently?

§ Mr. Clarke
For 10 years we have been giving priority to the needs of elderly, mentally ill and mentally handicapped people. There has been the most enormous development in community services both in the National Health Service and local authorities over that time. As far as I can recall, the Labour party did nothing in that respect. We set up the Griffiths committee and we are now considering its extremely detailed proposals. I tell the BMA, as I tell everybody else, that we will report soon with our conclusions. It is an important and extremely complex problem, and we must determine how best to take forward the continuing development of good quality community services in this country.

§ Mr. Maples
When my right hon. and learned Friend next meets the chairman of the BMA, will he draw his attention to the enormous variations in unit costs 790 throughout the NHS, which are clearly shown by the Department of Health's own performance indicators? Will he point out that they clearly show how much room for improved performance there is in the NHS and that the proposals for an internal market are designed to achieve that improvement?

§ Mr. Clarke
I certainly will. I hope that my hon. Friend will agree that high costs do not always mean the best quality of care and that it is possible to achieve extremely good quality at a reasonable cost and thereby extend the service that we give to patients. In an internal market we will ensure that far more is known than ever before about high quality care, what the variations in cost are and why, and then place doctors and managers in a much better position to make sensible decisions about how to maximise good quality care for their patients.