NHS Reforms (Hansard, 16 July 1991)

§ 1. Mr. Bradley
To ask the Secretary of State for Health when he last met representatives of the British Medical Association to discuss the health service reforms.

§ 2. Mr. Sims
To ask the Secretary of State for Health when he last met representatives of the British Medical Association to discuss the health service reforms; and if he will make a statement.

§ 12. Mr. Atkinson
To ask the Secretary of State for Health when he next plans to meet leaders of the British Medical Association to discuss changes in the national health service.

§ The Secretary of State for Health (Mr. William Waldegrave)
I last met representatives of the British Medical Association on 9 July. We had useful talks on several topics related to the reform programme.

§ Mr. Bradley
I am sure that the Secretary of State is aware that the BMA is concerned about the policy of opt-out for hospitals and I know that he is also aware of the consultations taking place between Withington and Wythenshawe hospitals about the rationalisation of services, especially the closure of the maternity unit. Now that Wythenshawe hospital has expressed an interest in opting out, the management of Withington hospital may now wish to retain all its services, including the maternity unit. Will the Secretary of State give the assurance today that the maternity unit at Withington can remain open until decisions have been taken about whether Wythenshawe can opt out?

§ Mr. Waldegrave
As the hon. Gentleman knows, there is no question of opting out. There has been a first expression of interest in establishing a national health service trust for one of those hospitals. As the hon. Gentleman knows—I believe that he recently met the Under-Secretary of State, my hon. Friend the Member for Loughborough (Mr. Dorrell) to discuss the matter—we are considering that reorganisation, as we are statutorily required to do, on its merits and quite separate from the issue of approving any NHS trusts in due course.

§ Mr. Sims
Is not one of the most important aspects of the reforms the emphasis that is placed on health promotion, by encouraging people to eat and drink sensibly, warning them of the dangers of tobacco products and providing doctors with incentives to provide health checks, immunisation and screening? Is it not a fact that the British Medical Association and all doctors fully support those changes?

§ Mr. Waldegrave
My hon. Friend is right. The British Medical Journal contained a generous leader by Mr. John Ashton, head of the department of public health at the university of Liverpool welcoming the steps that the Government have taken in publishing "The Health of the Nation". There has been widespread welcome for the publication of the report of the Committee on Medical Aspects of Food and for the tougher action that we are 205 taking on cigarette labelling. Together with the general practitioners' contract and its emphasis on preventive medicine, those steps allow the Government to claim that we are the first Government to take forward those matters with such vigour.

§ Mr. Atkinson
Does my right hon. Friend agree that an increasing number of GP members of the BMA are seeking to pass on the undoubted benefits of his reforms to their patients by becoming fund-holders and will he now end the patient list limitation so that an increasing number of doctors can become fund-holders if that is their wish?

§ Mr. Waldegrave
My hon. Friend is right. GP fund-holders are bringing forward many innovative new ideas for the better treatment of their patients, which are already being picked up by the district health authorities for the general benefit. Many GPs are pressing me to lower the list size qualification. We are running some experiments and pilot schemes on that, which I hope will be successful.

§ Rev. Martin Smyth
I welcome the innovative movements, but has the BMA suggested that it needs more GP trainers and trainees? In drawing up the junior doctors' contract, has any consideration been given to increasing the number of medical students?

§ Mr. Waldegrave
Yesterday evening I met the regional deans, including the dean from Northern Ireland, to discuss these matters. Although in general they welcome the new structure, which protects their budget, we discussed real issues about the total number of doctors needed. That is why yesterday I announced the establishment of a new committee chaired by Professor Colin Campbell to examine and measure objectively the total need for doctors in the years ahead.

§ Mr. Rowe
Does my right hon. Friend agree that some of the anxiety expressed by Opposition Members about national health service reforms is caused by their astonishment that the Government have listened so carefully and effectively to what GPs and many others have been saying for many years? For example, in Kent, where the number of practice nurses has trebled in the past three years, general practitioners are finding increasingly that the NHS reforms provide them with a tremendous opportunity to improve and innovate.

§ Mr. Waldegrave
There is absolutely no question but that the improvements which have been made in general practice and community medicine in the past 10 years have in many cases transformed the services available to patients. Patients know that and welcome it warmly, as they have done in my hon. Friend's constituency.

§ Mr. Robin Cook
If the Secretary of State is so anxious to listen to the views of GPs, which of the BMA's conference resolutions will he be most anxious to discuss when he next meets that body? Will it be the one that records the BMA's view that the reforms of the health service mean that the NHS is not safe in his hands? Or will it be the one that expressed concern at the rapid deterioration of the NHS? Or would the Secretary of State rather meet the 600 consultants who paid for a page in The Observer warning that as a result of the changes there are now serious restrictions on patients' choice? If the Secretary of State prefers the views of patients, will he meet the community health councils, whose conference a week 206 ago resolved that contracting could not remedy underfunding? Is not the reality that the Government are not interested in anyone's opinion but their own and will not listen to anyone but themselves?

§ Mr. Waldegrave
I shall address that part of the BMA motion that said that it sought constructive dialogue with the Government rather than confrontation. Of course, that is what we shall seek.
I am surprised to see the hon. Member for Livingston (Mr. Cook) engage in such debate. He recently visited Walton. It was a rather unsuccessful visit during which he involved himself in the affairs of the Fazakerley hospital with the result that one of the consultants said: These electioneering politicians make me sick. They won't talk about the expansion at Fazakerley … The Fazakerley option was what the clinicians wanted. It is clearly the best way to deliver health care on one site. That was followed up by the hospital doctor who said: It is ironic that Labour, which criticises the Government for not listening to the views of doctors on its health reforms, is now itself choosing to ignore medical opinion. A little quiet from the hon. Gentleman would be in order.

§ Mr. Nicholas Winterton
I warmly congratulate my right hon. Friend on the new constructive dialogue which has been established between his Department and the BMA. Will the new committee that has been set up merely discuss the health service and the reforms, or could it be extremely constructive and seek to monitor and evaluate the effects of the reforms in the national health service? If the latter is the case, I should be grateful if my right hon. Friend could confirm it to the House this afternoon.

§ Mr. Waldegrave
I think that my hon. Friend is referring to the joint work that we intend to do on GP fundholding, in particular with the general medical services committee. I assure my hon. Friend that that will be a continuing assessment and that we shall listen to recommendations which come out of that work.