NATIONAL HEALTH SERVICE (PRIMARY CARE) (Hansard, 12 March 1997)

§ Ms Jowell
We have had a full debate both on Report and in Committee. As my hon. Friends have made clear, in many respects we support the Bill, but, having completed its consideration in Committee and on Report, there are still aspects of the Bill that leave with us grave concern.
We believe that the Bill still creates the possibility for commercialisation of primary care—the presence, as the British Medical Association put it, of the third party in the consulting room, compromising the overriding responsibility of general practitioners to their patients, regardless of other considerations. We believe that the Bill still represents a leap in the dark. We do not know how many pilots are likely to develop as a result of the Bill. As it stands, they will be unevaluated, without systematic parliamentary scrutiny through regular annual reports, and without adequate local consultation with local medical committees.
We believe that the strategic role of the medical practices committee has been compromised and we are not satisfied that there are adequate safeguards for patients. There remains the possibility of GPs and staff employed by pilots being gagged and losing their present freedom to speak up for patients when they are concerned about aspects of their clinical care.
At the beginning of the Committee stage, we were promised not only that we would hear the Government's case put by the Minister, which it certainly was, but that Conservative Members would speak up at relevant points in Committee and on Report. However, apart from the odd intervention and some sedentary interventions, they remained silent. It was a case of Malone alone.
We hope that the Bill's provisions will be implemented by a Labour Government, who will replace the drive to commercialise with a drive to restore the national health service and primary care as a public service. We want to put the fragments of the national health service back together again, and consequently end the lottery that has been created by the internal market. We want a national health service that provides proper protection for patients and for staff by ending the gagging that has again been imposed by trusts which are competing under the internal market.
Perhaps most of all, we want an opportunity to restore fairness between patients. Primary care is an essential part of the service that all of us most often use as patients. We are usually not patients in hospital but patients of our general practitioner or of another part of the primary care system. The overriding obligation within that context is 464 to establish fairness between patients, which is the essence of our argument against fundholding. The fundholding system has deliberately been established, not to treat patients on the basis of their clinical need, but to allow patients access to treatment on the basis of their GP's status. We do not think that that is acceptable, because it drives at the very heart of the NHS's purpose.
The Government cannot understand that message, which is why the NHS will be at the centre of a general election campaign that Opposition Members believe will result in the Government being driven from office, and not a moment too soon.

§ Mr. William Cash (Stafford)
I shall speak very briefly indeed. I thoroughly endorse the entire concept of competition that runs through the Bill's provisions. However, I should like to mention briefly the problem of rural dispensing surgeries, on which I have been campaigning for some time. Unfortunately, under current regulations—some of which come under section 43 of the National Health Service Act 1977—some of which are being amended by the Bill, provision of existing services are prescribed for a one-mile radius, thereby creating a monopoly. I believe that that provision creates an uncompetitive situation and that it should be removed.
I know that the Minister is closely involved in current discussions between the British Medical Association and the pharmaceutical industry, and that he is doing his best to knock their heads together in an attempt to reach a sensible solution, which is necessary. I believe very strongly that rural dispensing surgeries are useful and essential for patients and consumers. I should like to have it on the record that the Bill makes no provisions that could in any way prejudice the continuation of rural dispensing surgeries.

§ Mr. Bayley
It is in the nature of our debates to emphasise our differences, because we debate the parts of a Bill on which we disagree. In this debate on the Bill's Third Reading, I should like to say that I support its basic principle, which holds out the prospects of innovation, of new service patterns and—should Ministers desire to do so—of targeting resources on areas with considerable unmet health care need, thereby tackling inequalities. Although the current Government may not implement the Bill to achieve those objectives, I am sure that a Labour Government would.
My single greatest reservation on the Bill is the extent to which it leaves open the door to commercialising services. That is a serious flaw in the Bill but I anticipate that in a few weeks' time the current Minister for Health will be on this side of the House and my hon. Friend the Member for Dulwich (Ms Jowell) will be at the Government Dispatch Box. If that happens after the general election—[Interruption.]

Mr. Deputy Speaker
Order. Third Reading speeches should be confined purely to the content of the Bill and should not involve speculation.

§ Mr. Bayley
I am glad that I have been called to order. I look forward to a statement from a Minister that the commercialisation of primary health care services will not take place. I feel that is likely to happen in a few weeks' time when my hon. Friend the Member for Dulwich is in a position to do so.

§ Mr. Thurnham
I broadly support the aims of the Bill and I should like it to reach the statute book as soon as possible. It gives medical and dental practitioners the opportunity to be innovative and co-operative, so I hope that it will improve health services throughout the country.
I was amazed by the Labour party's failure to support free eye tests for the over-60s as they have in the past. It would be a self-financing measure that would improve the quality of life of over 60-year-olds and reduce the need for expensive health treatment by attending to matters at an early stage.

§ Mr. Bayley
When the House voted on the matter, did the hon. Gentleman vote against the Government's proposal to introduce charges for eye tests?

§ Mr. Thurnham
The hon. Gentleman was kind enough to support my speech in Committee. As I said at the time, I gave the Government the benefit of the doubt. I am now thoroughly persuaded that eye tests should be free, and I hope that the Labour party has not made a U-turn on the matter, as the arguments to support that are so strong.
I hope that the regional differences will be addressed. As I mentioned to the Minister, I celebrated my 5,000 days as a Member of Parliament by distributing 5,000 toothbrushes and tubes of toothpaste to five-year-olds in my constituency. If the Minister has time to visit my constituency, I hope that he will join me in showing five-year-olds how to clean their teeth with those toothbrushes. I support the Bill and look forward to it reaching the statute book.

§ Mr. Simon Hughes
I shall be brief. As I said on Second Reading, it is in essence a good Bill. The Liberal Democrats supported it on Second Reading and we shall support it tonight.
For most people, the test of the health service is primary care. We should allow practitioners to be as innovative as possible and in many ways the Bill does just that.
Like the hon. Member for York (Mr. Bayley), I believe that the Bill could be interpreted in a way that he, I and most people outside the House would not want—that behind a respectable frontage there could be profiteering enterprises in the health service. We must certainly close that loophole.
The Bill is good, but for those who work in the health service the test will be in the resources that are made available to implement its provisions. Although my hon. Friend and I welcome the Government's commitment—if they are re-elected, which seems unlikely—to provide the health service with inflation-linked additional resources every year, that will not keep pace with basic demands, let alone catch up with past requirements.
466 As I have said before, the Labour party's best intentions will come to nothing—if a Labour Government are elected—unless it commits significantly greater resources to the health service. Labour is now well and truly in third place in terms of promising resources for the health service. That should be an embarrassment to Labour Members as it is to many of their supporters. We are happy to go into the election on the basis of supporting primary care and the health service, but unlike the other parties, we put our money where our mouth is.

§ Mr. Malone
It gives me great pleasure to commend this important Bill to the House. I thank the hon. Member for Dulwich (Ms Jowell) for her concern. I have never felt alone during our proceedings, although on occasions I have felt, to use the parlance of the Bill, like a single-handed practitioner. However, they now practise in different—usually high-quality—circumstances in a way that would not have been thought of before.
I thank hon. Members from all parties who have supported what will be an important milestone in primary care in this country. This is the first time that the House has addressed itself in detail to legislation on primary care since the inception of the health service 50 years ago.
The Bill is rooted not so much in Government policy as in NHS practice. It follows a comprehensive listening exercise based on ideas brought to us by the professions on how they could come together to provide better primary care. It addresses many problems of the quality of primary care and the uneven distribution of primary care and dental services in parts of the country.
As the hon. Member for Southwark and Bermondsey (Mr. Hughes) has pointed out, new schemes without additional funding are meaningless. The Government are committed, after being re-elected in the coming election, to developing the legislation and the pilot proposals with additional funding. In the Prime Minister's words, that funding is committed year on year on year on year on year throughout the life of the next Government, which will develop the legislation practically, improving primary care for the whole country. I commend the Bill to the House.

§ Mr. Deputy Speaker (Mr. Michael Morris)
Under Standing Orders, items 9 to 13 on the Order Paper will be dealt with at 10 o'clock. We shall now deal with motions 14 to 18 before a suspension until 10 o'clock.