HC Deb 16 April 1991 vol 189 cc148-50
4. Mr. Eastham

To ask the Secretary of State for Health how many fund-holding general practitioners have not yet completed their contract negotiations in order to implement the provisions of the National Health Service and Community Care Act 1990.

The Secretary of State for Health (Mr. William Waldegrave)

Fund-holding general practitioners are free to make contracts for the hospital services covered by the fund in the way that they judge best for their patients. The indications are that most fund holders have placed contracts in advance for the greater part of the hospital services necessary for their patients and will arrange other contracts on an individual basis as their patients need them.

Mr. Eastham

But are not some general practitioners in a state of chaos, with hundreds of contracts still not completed? That can be put down to the hospitals that are not in a position to carry out adequate pricing and do not have the necessary additional staff or computer facilities, with consequent further delays for people waiting to go into hospital.

Mr. Waldegrave

The answer is no, Sir. In the hon. Gentleman's region, about 90 per cent. of the contracts have been placed in advance. It is sensible to have 10 per cent. to follow patients who cannot be predicted in advance.

Mr. Michael Morris

Is my right hon. Friend aware that in evidence recently given to the Public Accounts Committee, Mr. Nichol, the chief executive of the national health service management executive, stated that budget holding, research and the success of the project should not be carried out from the centre but that it should be left to each region to undertake its own analysis? Is not that an absurd way to proceed? Whatever the merits or demerits, we need an assessment that is objective and will be accepted by all parties. If it is left to each region, it will be useless.

Mr. Waldegrave

No, I think that the regional arms of the NHS are the right people to deal with that. My hon. Friends regularly, and rightly, press me to stop Whitehall's tendency to centralisation. It is those hon. Members with whom I have most sympathy.

Mrs. Mahon

Where contracts have been completed, will the Minister comment on the case of the woman who was referred to Guy's hospital for sterilisation, but then found that her authority would not pay for it although her GP had referred her? Will that be a regular occurrence? Will the Minister say where patient choice comes in, if the GP decides where operations are carried out?

Mr. Waldegrave

That case did not involve GP fund holders, but I am happy to comment on it. The hon. Lady has not followed the story through. It transpired that the district involved had for many years not provided sterilisation of that kind. The present system has brought and will rightly bring that into the open, which enables my hon. Friend the Minister of State to remind the district that in such matters there is a central guideline that that service should be available throughout the kingdom.

Mr. Andrew Mitchell

Are not GP fund-holding practices a successful and valuable attempt to spread choice and opportunity not only to patients, but to the doctors who administer the services? Does my right hon. Friend see any evidence of a desire to spread choice and opportunity for either patients or doctors in the rehashed Labour policy unveiled by the Labour party this morning?

Mr. Waldegrave

I strongly agree with my hon. Friend. An increasing number, although I think that they are a minority, of the GPs who supported the Opposition now take my hon. Friend's view. For example, Dr. David Thomé, who used to appear in party political broadcasts on behalf of the Labour party, has now become a GP fund holder and strongly supports the scheme. In the rather weasel words of today's policy document—I am happy to say that the Opposition have watered it down a little more —we are told: We would expect a progressive withdrawal". "Expect" is a good word. If expectations are confounded —as they will be—I hope that the Opposition will endorse the scheme as strongly as my hon. Friend does.

Ms. Harman

The Secretary of State said that 10 per cent. should be set aside to make it possible for patients to get treatment outside contracts placed by districts or GPs. Is he aware that no district health authority has set aside 10 per cent., that most have set aside only 2 per cent. to provide for extracontractual referrals and that some have provided only 1 per cent. or even less? How does the right hon. Gentleman propose to guarantee choice for patients through a system under which so much of the money is tied up in contracts and so little set aside for extracontractual referrals?

Mr. Waldegrave

I am afraid that the hon. Lady could not have been listening to our discussions. We were talking about GP fund-holders, in respect of whom the much smaller sum involved probably makes it reasonable—in the view of most GPs—for the proportion to be larger than is necessary at district level. That is the answer to the hon. Lady's question.