HC Deb 12 March 1997 vol 292 cc413-26

17DD.—(1) Notwithstanding anything in sections 17C or 17D above, an agreement which constitutes, or is one of the agreements which together constitute, a pilot scheme may not be made by a Board with a disqualified body.

  1. (2) For the purposes of this section, a body is a disqualified body if—
    1. (a) it is a public limited company, or
    2. (b) it is a person or body which provides medical or dental services other than within the National Health Service and does not fall within paragraphs (a) to (d) of section 17D(1) above; or
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    3. (c) it enters into arrangements involving any special obligation or limit on clinical independence or choice, whether by virtue of a purchase, lease, discount or inducement, with any body concerned with the provisions of medical, nursing or pharmaceutical services, or with the provision of medicines or medical or related appliances, other than a person falling within paragraphs (a) to (d) of section 17D(1) above.
  2. (3) for the purposes of determining whether a body is a disqualified body, it shall be sufficient proof that a body is not disqualified if the Secretary of State has issued a certificate that a body is not a disqualified body for the purposes of the agreement specified in that certificate.
  3. (4) A certificate issued under subsection (3) may be withdrawn or cancelled by the Secretary of State, and he shall inform the relevant Board of any such withdrawal or cancellation.".'.

Government amendment No. 11.

Amendment No. 57, in clause 8, page 6, line 28, at end insert—

'(5) If the Secretary of State is satisfied that a party to an agreement which constitutes, or is one of the agreements with together constitute, a pilot scheme is, or has become, a disqualified body (within the meaning of section (Provision of personal medical or personal dental services under a pilot scheme (disqualified bodies)), he must give directions to the authority concerned requiring them to bring the scheme to an end within twelve months in accordance with the directions.'.

Ms Jowell

The purpose of new clauses 2 and 3 is to close the door completely on the possibility of commercial involvements in pilot, schemes and we believe that they go substantially beyond the Government's amendments in providing safeguards against that.

The threat of the privatisation of primary care created by the Bill's provisions has been at the heart of our dispute with the Government over the Bill since its introduction. We remain convinced that this is what the Government actually want and what they actually intended, and we believe that it must be made impossible with all the drafting skill available.

Let me remind the House of the history of the climb-down that led the Government to table new clauses in Committee and to table further new clauses tonight, on Report.

The British Medical Association was strongly opposed to the Government's plans to allow what they describe as a third party in the doctor's consulting room. The BMA had no doubts that the Bill represented the commercialisation of the family doctor service, and it said in its press release of 24 January 1997: It will undoubtedly make the privatisation of services that much easier. GPs must remain the patient's advocate, and any move that threatens to curtail GPs' freedom in the surgery is bad for patients. The campaign against privatisation as created by the Bill has been led by the Labour party and the British Medical Association. However, only after the BMA threatened a hostile campaign in the run-up to the general election did the Government's resolve start to crack. After meetings with the BMA, they agreed to limit the employment of GPs to what they called the "NHS family".

Despite Government promises to ensure that the Bill does not pave the way for commercialisation of general practice, a range of companies insist that the Bill, as amended, does not alter their plans to become involved in NHS primary care. All who want to follow events will no doubt eagerly read the current edition of Pulse, which has provided excellent coverage of this saga.

Let me give you, Madam Deputy Speaker, for example, the words of Sinclair Montrose Healthcare, the owner of a private GP clinic at London's Victoria station, which intends to make several pilot proposals for salaried GPs to work alongside privately employed GPs in its clinics. We can still run NHS services from our centres. UniChem, which has also expressed interest in submitting a bid for a pilot, believes that the Bill, as amended, does not rule it out of the NHS as a primary care service provider. The company said: The door was reasonably wide open but it is now only open a couple of inches. We are waiting to see what the totality of the Bill is before we start drawing up a strategy. Boots says that its plans to strike up a partnership arrangement with groups of GPs are not affected. BUPA is still "very interested" in developing its involvement in primary care, and the company said: We hope the door is not shut. PPP Healthcare is the only company to have drafted a pilot proposal. Its plan to locate GP services at its private London hospitals—with all secondary referrals to the PPP hospital—is still "on the table".

That is why we have tabled new clauses that would keep the door to privatisation not two inches open but completely shut. Since the climbdown on commercialisation, the Secretary of State has tried to claim that concerns about commercialisation were misplaced. He is entirely disingenuous, but a series of statements by Ministers shows that privatisation was absolutely on the Government's agenda. It is also clear evidence that, if the Government were re-elected for a fifth term, they would push ahead with the full-scale privatisation of primary care. During the debate on the White Paper, in refusing to rule out companies employing GPs, the Secretary of State said: I am interested in a proper reward for those who deliver an efficient, high-quality service for the patient. Provided that I am satisfied that those tests are passed, I am willing to consider proposals made with the support of the professional staff concerned."—[Official Report, 15 October 1996; Vol. 282, c. 595.] In an interview with Pulse magazine, he went on to confirm that the Government intended to open up NHS primary care to the primary sector. He said: If it is a difficult area and if a service cannot be provided using other routes, commercial enterprise may offer a solution. The main issue is whether it is an easily recognisable NHS service and it is better than the previous one provided. That is what Ministers said about the private finance initiative.

The noble Baroness Cumberlege stated specifically in Committee in another place that companies would be able to bring forward proposals for pilot schemes. She said: We are serious about tackling these difficulties and do not want to rule out any sensible opportunities, including a GP being employed by a commercial organisation ‣ schemes put forward by commercial organisations will have to be endorsed by health authorities and then approved by the Secretary of State."— [Official Report, House of Lords, 17 December 1996; Vol. 576, c. 1403–4.] It is absolutely clear that in the world outside this place there is a very clear and established view that privatisation of primary care is still possible, despite the Government amendments to the Bill. Kingsley Manning of Newchurch Consultancy was reported in Pulse as saying: I don't think it will remove the private sector. All it will do is to make the arrangements more complicated and more difficult". We ask the House to support our new clauses this evening to make privatisation of primary care in the national health service not more difficult and more complicated, but absolutely impossible.

Mr. Simon Hughes

My colleagues and I expressed concern about this matter on Second Reading. We acknowledged then that the Secretary of State had confirmed to the House that he intended to close the loophole, so we did not support the reasoned amendment tabled by the Labour party at that time.

I understand that the Government have some reservations about the new clauses. I am unhappy that they think that it is not worth trying to bolt down as tightly as possible the chance of private sector intervention. I am troubled also by the fact that, as far as I know, the Government have not yet given an undertaking to establish a register of general practitioners' interests and a register of the interests of all those in the health service, which, like the Register of Members' Interests, would be publicly available. We would then know absolutely whether any GP was acting as a front for someone else—such as the companies to which hon. Member for Dulwich (Ms Jowell) referred a moment ago—who was funding an operation for private commercial profit.

If we are limiting those who can approach the "NHS family" to conduct pilot schemes—as my colleagues and I believe absolutely and firmly that we should—it seems to me that the Government should accept the elaboration of that point in new clause 2.

The British Medical Association is much happier with the position as it now stands in light of amendment No. 11, which the Government undertook to bring forward. However, it remains concerned about one matter. It is worried that, under the new arrangements, there might be some risk to the partnerships that have been created already by GPs, especially for out-of-hours work.

When the Minister responds to new clause 2—which my colleagues and I will support—I ask him to address specifically how the changes in the Bill will impact on current arrangements, and particularly upon those who are working in commissioning or in other forms of partnerships for weekend, evening and night work. The BMA's concern should be addressed, and I would be grateful if the Minister could deal with it.

Mr. Ben Chapman (Wirral, South)

I am grateful, Madam Deputy Speaker, for this very early opportunity to address the House. I would like to begin by paying tribute to my predecessor, Barry Porter, whose sad and untimely death led to the Wirral, South by-election. He was a native Wirralian, and a popular and hard-working constituency Member of Parliament. As the Member for Bebington and Ellesmere Port and then for Wirral, South, he served the people of the Wirral for nearly 20 years. As I go around the constituency, I meet many of his friends and constituents who remember him with the greatest warmth. He was obviously held in the highest regard, and—if I may put it in these terms, Madam Deputy Speaker—he will be a very hard act to follow.

I also take this opportunity to thank the right hon. Member for Wirral, West (Mr. Hunt), who so ably helped to handle constituency affairs while Wirral, South was without a Member of Parliament. Similar thanks are due to my hon. Friends the Members for Wallasey (Ms Eagle) and for Birkenhead (Mr. Field) for all their efforts during that period. Wirral Members of Parliament have traditionally worked together as a team when called upon to do so in order to serve the interests of the Wirral as a whole. That was evidenced this morning in the Adjournment debate, and it is evidenced by the presence of Wirral Members tonight. I intend to join that team, and to play a full part in it. Thanks are also due to my hon. Friend the Member for Ellesmere Port and Neston (Mr. Miller) for the considerable support that he has given me.

I am as proud as I am sure Barry Porter was to serve the people of Wirral, South. That is where I chose to live when I returned to the north-west of England following my time in the embassy in China because of the warm welcome that I received there. It is now my home. Because of its population mix, it is, in many respects, a microcosm of Britain. My constituency stretches from the romantic wilderness of the Dee estuary, through the old village of Heswall, where I live, to a coastal plain and then to present-day Heswall and Gayton.

Travelling across the constituency from east to west, one traverses rolling countryside and farmland in Clatterbridge and Bebington, with villages such as Thornton Hough and Storeton. As one approaches the east of the constituency, one enters the pleasant residential areas of Bromborough, which has a thriving leisure, retail and industrial park, and Eastham. As one gets higher or closer, one begins to get a characteristic, impressive view of the Mersey. Again, in this part of the constituency as in the rural part, villages are a characteristic, but are now sometimes surrounded by urban development.

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Despite its residential nature, the constituency has a long industrial history, of manufacturing in particular. There is a long-standing theme of the relationship of industry to the welfare of the people that surround it in Wirral, South and more widely. Much of the constituency bears the mark and carries the legacy of the first Lord Leverhulme, notably the attractive industrial village of Port Sunlight.

That is appropriate, as, among the world-class firms in the industrial belt of the constituency, Unilever in its various forms is still the biggest employer. There are many other companies of world class, of which Candy and, in a smaller sense, McTay Marine, are but two. Vauxhall, not in the constituency but on the borders, is of course also a world-class company. All those firms provide wealth to the Wirral as a whole because of the residential spread of their employees.

It may be a statement of the obvious, but without such a competitive and successful wealth-creating sector, we cannot prosper as a nation and provide the quality of services that we would like, be it in relation to the education of our children, the care of the elderly, the provision of local services or health services, including primary health care. That is why I want to say a few words about the industry of Wirral, South in a debate about health.

Labour is committed in government to a partnership between industry and Government at national level. Such a partnership is just as necessary at local level. We must understand our businesses and be in dialogue with them in order to avoid, for example, the situation in which Ford announced, apparently out of the blue, the moving of the production of the Escort from Halewood and the consequent potential job losses. The situation was alleviated only by the subsequent intervention of Labour Members of Parliament.

I intend to develop a dialogue with local industry and commerce, a role where I hope that my previous experience at the Department of Trade and Industry and as a commercial diplomat will bring extra added value.

Issues relating to the health service and to law and order dominated the Wirral, South campaign. People there have long ceased to trust the Government in health matters. They do not believe that the health service is safe in Tory hands. They are fed up with the sort of creeping privatisation that we have just heard about. They want a change.

The hospitals that serve my constituency, Clatterbridge and Arrow Park, have excellent staff, but are beset by the problems that beset hospitals throughout the health service—the problems of long waiting lists, long waits for appointments, regular crises in accident and emergency departments, poor staff morale, lack of finances, staff shortages and so on. Typically, someone seeking an orthopaedic appointment in my constituency could wait 156 weeks for the appointment, let alone the treatment. In Wirral one in four patients wait at least six months for treatment, and there are 6,000 people on waiting lists. On occasions, patients assessed for medical admission as emergencies cannot be allocated a bed, resulting in unacceptable trolley waits.

People are fed up to the back teeth with the bureaucracy of the internal market. Health services for people in Wirral, South are creaking under the weight of bureaucracy. Patients charter standards for waiting list admissions and cancelled operations are regularly breached. Since the Government introduced the internal market, the north-west has lost almost 4,500 nurses and gained more than 2,500 bureaucrats. An extra £284,000 a day is spent on bureaucracy—enough for almost 300 extra patients to be treated every day.

That is why the people of Wirral, South welcome new Labour's proposals for a reduction of 100,000 in hospital waiting lists by cutting red tape in the health service and switching funds to patient care. They welcome the prospect of putting pride back into the health service—a service that was created by a Labour Government.

Health, Mr. Deputy Speaker, was the most significant concern of the voters of Wirral, South, which is why I sought to catch your eye in the debate today. The constituency has shown that it is also concerned about law and order, particularly youth crime, job insecurity, unemployment and declining standards in education. I intend to focus on all those and other issues, such as the provision of facilities for our youth, as the Member for Wirral, South in this Parliament and the next. I intend to be a strong voice for Wirral, South on all those matters.

When I took my seat, the Prime Minister advised me not to unpack my bags. Well, the bags are unpacked, the suits are in the wardrobe and the socks are in the drawer. I intend to be around for some years, sustaining a Labour Government who are, after my election in Wirral, South, surely coming in a few weeks.

Mr. Frank Field (Birkenhead)

It is a tradition in the House that we welcome new Members, and I do that unreservedly and with considerable pleasure. I could not help reflecting as I heard my new hon. Friend the Member for Wirral, South (Mr. Chapman) make his contribution, that had I managed to make my maiden speech with such style and with resolve, my parliamentary career might have taken a different turn from the way in which it has developed.

I rise not only to congratulate my new hon. Friend—I hope that I will have many opportunities in the Parliament ahead to take pleasure in his contribution—but because it seemed appropriate today, as this was the last occasion on which I could put on the record the sense of loss and grief that I feel at the death of Barry Porter. He was my friend, and one of the many great pleasures of representing Birkenhead in the House was the fact that I was his Member. I did my very best to represent his interests.

If Barry were here now, he would be making some pretty tough comments from the Bench below the Gangway, saying that there was always a danger of my making a meal when no meal should be made, but I am grateful to have had this chance to record my sense of loss at the death of Barry Porter.

Mr. Malone

I immediately add my warm congratulations to the hon. Member for Wirral, South (Mr. Chapman) on making his maiden speech. Whatever has been said about how temporary or permanent his stay may be was said by the Prime Minister, so I do not intend to add to that.

I thank the hon. Gentleman for his words. I also thank the hon. Member for Birkenhead (Mr. Field) for what the House has come to recognise as a typically generous gesture—his remarks about the late Barry Porter. All Conservative Members who knew him well recognised that he was a first-class constituency Member of Parliament and a valued colleague. I am sure that all those who were close to Barry Porter will read what has been said in the debate and will be most grateful for the warm remarks.

I congratulate the hon. Member for Wirral, South on his comments about his constituency. Although he has only recently come to the House, he has clearly absorbed some of its traditions very quickly. He made a first-class maiden speech, on which I congratulate him.

I slightly envy the hon. Gentleman his task in making a maiden speech. When I was elected to the House in 1983, there was no opportunity to make a maiden speech on Report. I was persuaded by my Whips to make a speech on Second Reading of what I was told was an important and interesting piece of legislation called the Telecommunications Bill. After I had sat down, having made my speech, it was vouchsafed to me that the convention of the House, which had not until then been disclosed to me, was that having spoken on Second Reading, one was expected to serve on the Committee. Many sleepless nights followed for me, so I congratulate the hon. Gentleman on being able to make his maiden speech on Report and Third Reading. I wish that I had been accorded such an opportunity.

During the Bill's passage, we have been through the argument about commercialisation many times. I must tell the hon. Member for Dulwich (Ms Jowell) that, in my opinion, that argument died during the Second Reading debate. The hon. Lady exhumed the corpse on several occasions in Committee, but her attempts to give it artificial respiration failed. Here we have yet another attempt to breathe life into an argument that has long been dead.

In our debates, my right hon. Friend the Secretary of State and I have said—frequently, in my case—that we regard primary care as a jewel in the NHS crown. We said from the outset—in all the debates on the introductory White Papers, as well as debates on the Bill—that the whole purpose of the Bill is to enable primary care to be delivered to an even higher standard, across the country, as part of the national health service. From the start, we have taken very seriously any suggestion that the Bill might undermine the key characteristics of our primary care system. We listened to the arguments put to us by, among others, the health care professions and the British Medical Association, and we tabled a series of important amendments—including amendment No. 11—to ensure that we met those arguments.

I think that I can safely say something to the House—if not to the hon. Member for Dulwich, who I know will not accept any undertakings that I may give: she sees plots where there is none and future agendas where there is none. As I think I pointed out to her in Committee, when the argument is finally lost, she is obliged to invent a hidden agenda. Let me repeat, however, that our amendments have dealt thoroughly with the argument.

The amendments attempt to tighten further the rules governing bodies that may provide piloted services and services in permanent arrangements; but, with the exception—for historic reasons of which the hon. Lady will be well aware—of the handful of dental corporate bodies, public limited companies are already explicitly excluded from providing such services by clauses 2, 3 and 21 of the Bill. Those provisions make it crystal clear that the only companies that qualify as members of the NHS family—with the exception of dental corporate bodies—must have all their shares owned by individuals who are members of that NHS family.

In Committee, it was made clear that that was a watertight provision. I cannot see how it could possibly allow public limited companies to provide personal medical services, for example, and I therefore consider the new clause unnecessary. If the hon. Lady is taking her text merely from what she reads in Pulse, she should refer more to the Official Report of the Committee stage, in which she will find more accurate descriptions of the effect of the Bill.

The hon. Member for Southwark and Bermondsey (Mr. Hughes) mentioned qualifying bodies. We drafted our new clauses carefully, to ensure that all who are properly members of the NHS family could provide services under the Bill. The hon. Gentleman spoke of what might happen with GPs, whether they worked singly, in partnerships or—this was his specific point—as members of a co-operative. He particularly mentioned out-of-hours arrangements. The principle that would apply to such arrangements is no different from the system that would govern any other arrangements.

In drafting the Bill, we have always taken steps to ensure that any grouping involving anyone who is not a member of the NHS family is explicitly ruled out. If an organisation that was currently providing out-of-hours services did not qualify, it would not be able to bid for a pilot or enter into a permanent arrangement, unless it changed its structure to meet the terms of the Bill, and got rid of any of the elements that disqualified it in the legislation as we have amended it.

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Mr. Simon Hughes

What the Minister has said is helpful. I am not trying to trap him into giving an answer that he does not want to give, but may I take it that, according to the advice that he has been given and his understanding, the Bill in its current form protects all existing arrangements involving whatever work NHS general practitioners do? May I take it that none of those GPs will be prejudiced?

Mr. Malone

The Bill will not prejudice GPs who provide the services that they currently provide with the arrangements that they choose. If they are providing out-of-hours services, they can continue to do so in the way that they choose, but if they wish to enter into a contract for the new part I arrangements, and if they wish to use the vehicle that currently provides an element of what they do and it is not a qualifying body, they cannot. They would have to change the position if they wanted to bid for a pilot and enter into part I arrangements.

There may well be examples, although I cannot think of one, in which the vehicle that GPs use now to provide out-of-hours arrangements would not qualify, but it might be easy for them to reform the system if their principal intention was to provide contracted arrangements under part I. I emphasise that simply to prove beyond peradventure that, under the Bill, there is no loophole that would automatically allow GPs, simply because they are currently providing a service connected with primary care, to enter into part I arrangements if the vehicle that they were using did not qualify under the legislation. It is a belt-and-braces approach, which I hope the hon. Gentleman understands. Otherwise, if GPs wished to participate in part I arrangements, it would be simple for them to act on their overwhelming desire to do so.

The new clauses go even further than what was suggested in Committee. They would impose new and, in our view, unreasonable restrictions on qualifying bodies. Under the hon. Lady's proposals, doctors who form themselves into a company to provide personal medical services and who also wish to do a few hours' work as police surgeons, to carry out insurance medicals or to provide some medical services for local authorities—that is quite common nowadays among GPs who are providing primary health care—will immediately become ineligible to provide personal medical services.

I am not sure whether it is intentional, but those restrictions are far tighter than the restrictions that currently exist. I think that they are unreasonable, and I certainly do not believe that they would command any support in the medical profession once their impact was realised. I am at a loss to understand what possible purpose they could serve.

Mr. Hugh Bayley (York)

In Committee, the touchstone phrase that was used to describe what was acceptable or unacceptable was "part of the NHS family". The Minister is now saying that a private company whose directors happened to be doctors, and which provided private medical services for the police and the private sector, would be allowed to bid.

Mr. Malone

No.

Mr. Bayley

The Minister says, "No," but that is the only sort of company that he has been able to suggest that would fall foul of the amendment.

Mr. Malone

Unusually, the hon. Gentleman has not entirely understood the purpose of the new clauses tabled by his own party. He is distorting the point, which is that, to qualify either to bid for a pilot or to enter into permanent part I arrangements, the individuals concerned must be members of the NHS family, or form an agglomeration—either a partnership or, as we discussed in Committee, a corporate body. The hon. Gentleman also missed out the other half of the provision: they could not be directors of that corporate body. The total shareholding of the body would have to be owned by members of the NHS family, legally and beneficially. As I said in Committee, that provision was specifically intended to get rid of any suggestion that those people might be put up as front men for a commercial organisation, which would stand behind the practice that was contracting in respect of part I arrangements.

The new clauses would prevent such an agglomeration of doctors—be they arranging themselves as part of a qualifying corporate company or, indeed, a partnership—from providing, as they do now under part II arrangements, a range of private services on their own account. That would be quite exceptional. It would be absurd to extend into part I arrangements a restriction that goes beyond that placed on doctors under part II arrangements. I am not entirely sure whether the Opposition have considered that it would strike at much of what doctors do now. If that was the case and the medical profession understood that that was so, the Opposition would find—as I did on occasions during the passage of the Bill—that the BMA might beat a path to their door pretty quickly. I cannot see that any of the representative bodies would want to put such a restriction on their members.

Mr. Bayley

My hon. Friend the Member for Dulwich (Ms Jowell) listed a number of private health care organisations that felt that they would still be able to bid. My question is simple. Does the Minister regard BUPA and the doctors employed by it as part of the NHS family? Does he regard Sinclair Montrose Healthcare and Unichem as part of the NHS family?

Mr. Malone

It is not a question of whether I believe. Frankly, the stories that we still see rerun in Pulse are grossly overdone. Whenever I have spoken to anybody with any remote connection with those organisations, the last thing that they have done is express an interest in taking on part I arrangements in primary care. It a question not of my belief, but of examining the Bill and seeing what the shareholding of any company brought together by members of the NHS family would be. The answer is that, as at present constructed, no public limited company with quoted shares, for example, could ever qualify, because the shares would not be held legally and beneficially by members of the NHS family.

I do not know quite how long it will take me to set those fears at rest. Perhaps I have spent long enough in Committee and on Report trying to do so. I cannot make it clearer than that. I certainly do not intend to go through a list of speculative stories that have appeared in Pulse, with no knowledge of the structure of the organisations involved, and rule them out one by one.

I return to the point that I made in Committee. These are clear and firm arrangements, which we shall put in place to ensure that primary care is delivered by members of the NHS family.

Mr. Simon Hughes

What is the result of the Minister's consideration of the idea of a register of GPs' interests? I put that point to him on Second Reading and he said that he would think about it.

Mr. Malone

I am not entirely certain that a specific register would be helpful. Conflicts of interest are regulated by other professional bodies, including the General Medical Council. On reflection, those arrangements have served well over time. If the hon. Gentleman had brought me some evidence to show that they would not serve well in respect of part II arrangements, I might have considered the matter further. They have served well for existing arrangements. I see no reason why they should not serve well under the new arrangements.

Amendment No. 11, in the name of my right hon. Friend the Secretary of State, delivers on the undertaking that we gave during earlier stages of the Bill's consideration and makes it clear that proposals for pilot schemes may be prepared only by health authorities and boards and put to the Secretary of State if they originate from a member of the NHS family as defined in clauses 2 and 3. I commend it to the House.

Perhaps, at long last—I do not live in too much hope of this—I have demonstrated to the hon. Member for Dulwich that the Opposition's new clauses are unnecessary. In fact, they would be downright unhelpful to doctors. I hope that the House will not support the Opposition's new clauses.

Mr. John Gunnell (Morley and Leeds, South)

Will the Minister explain a little further a reply given in the House two days ago to my hon. Friend the Member for Hamilton (Mr. Robertson), who asked the Secretary of State for Scotland to rule out the privatisation of clinical services in the NHS? The Secretary of State said: We would not rule out any proposal from clinicians themselves. When pressed further, he added: if clinicians brought forward a proposal, we would consider it, and would not rule it out in principle."—[Official Report, 10 March 1997; Vol. 292, c. 35.] He rather sidestepped the question that was put to him about privatisation of clinical services in the NHS and made it clear that, as far as he was concerned, he had not quite abandoned the idea of a different provision. It is very clear to us all that the Department of Health has been preoccupied with the privatisation of services recently. This afternoon's statement by the Secretary of State for Health illustrated that only too well.

It is also clear that, despite the Minister's words, we have not quite expunged the idea of the privatisation of GP services. When the Secretary of State for Health spoke after the Queen's Speech, he was extremely clear that he was looking to privatise GP services. We have not expunged that from the minds of those who seek to provide those services. My hon. Friend the Member for Dulwich (Ms Jowell) quoted them today. Recently I saw a statement in Pulse from the chief executive, who said: An amendment will not make any difference to our plans. We will still provide NHS services and have GPs working from our premises and using our facilities around the country. People are quite clearly seeking a way round it, whatever amendments the Minister tables.

My hon. Friend's new clauses make it absolutely clear that we would completely rule out any privatisation, and the wording that we use is absolutely clear in that regard.

I congratulate my hon. Friend the Member for Wirral, South (Mr. Chapman) on his maiden speech and on reminding us that a key issue in the campaign was the national health service. People do not believe that the Conservatives have entirely abandoned the idea of privatising the service. It is clear that they have abandoned the privatisation of very little in this country. There is no reason to believe that the Secretary of State's real view, which he put to us at the end of last year, has fundamentally changed.

Consultations that the Minister has had made him table amendments that are quite different. We know that the committee that discussed the Bill and its wording was the committee of the BMA, not a Standing Committee in the House. We had to wait until the BMA's committee had completed its negotiations before we could begin to discuss the Bill. The Minister has tabled amendments that appear to satisfy members of the BMA, but there are many outside the BMA who will seek to erode and work at the edges of what he said.

People are still concerned about the future of their health services. It is significant that health services and people's fears about them were a significant factor in bringing my hon. Friend the Member for Wirral, South here to make his maiden speech today.

The comments made by the Secretary of State for Scotland show that he is still hedging his bets. Such statements make us realise that, whatever is said, Conservative Members cannot wait to privatise GP services. Given a fifth term in office, I am sure that they would do just that. We are still right to warn the public that that is a possibility if the Conservatives are re-elected.

Mr. Bayley

I, too, congratulate my hon. Friend the Member for Wirral, South (Mr. Chapman) on an extremely good maiden speech, which highlighted the importance that he attaches to improving health care in the Wirral. I am sure that that will happen under a Labour Government. I am sure that he will be an active Member for his constituency under a Labour Government, and will continue that campaign.

Every time the Minister is kind enough to let me intervene in his speeches, whether on the Floor of the House or in Committee, he makes the Government's intentions clearer: to leave the door open to allow the commercialisation of primary health care. If that was not the case, the Minister would have accepted the new clause of my hon. Friend the Member for Dulwich (Ms Jowell), or if he could not bring himself to accept an Opposition proposal to protect NHS primary health care services from commercialisation, he could have tabled his own amendment. He claimed that the amendment that he tabled in Committee would achieve that, and that the bidding for pilot schemes to provide primary health care services would be limited to members of the NHS family. But it has now become clear that the Minister's NHS family is an extremely extended family: it includes suitably experienced medical practitioners, whether they work for the NHS or not.

The Opposition object to that, because, as the Bill is currently drafted, a team of doctors—they would doubtless be good doctors, suitably experienced and qualified to provide primary health care services—who worked in the private sector as private practitioners outside the NHS could bid to provide NHS services paid for by the NHS. Such people do not strike me as being part of the NHS family.

7.30 pm

The Minister said that under the amendment that he tabled in Committee—which is now clause 2—those who will be able to bid for primary health care services will include suitably experienced medical practitioners, whether or not they work for the NHS. We debated in Committee the possibility of their being medical practitioners employed by a pharmaceutical company, who could propose a pilot scheme to improve immunisation levels in parts of the country where immunisation levels were low. As individual practitioners, or as individual members of a private company that counted as a qualifying body and could bid, they would not be able to pass profits made from the work that they undertook on contract to the NHS back to their main employer, the phannaceutical company.

Those people would work on contract to the NHS in an individual capacity or as part of a qualifying body—a private company—limited by guarantee, but they could do what my hon. Friend the Member for Dulwich suggested and, as practitioners operating a pilot scheme, they could commit NHS resources to purchasing secondary health services from their parent company. The legislation does not rule that out, although it should, and it would be ruled out if the Minister accepted our new clause.

In the interests of brevity, I shall put a final point to the Minister. Would it be possible for medical practitioners from abroad who qualified under clause 2 as "suitably experienced medical practitioners" to bid to run pilot schemes? Does the Bill permit that? Would an American health maintenance organisation be able to put in a bid to run a pilot scheme?

Ms Jowell

This has been a crucial debate. It has focused on the part of the Bill on which the Government and the Opposition are divided. As my hon. Friend the Member for Wirral, South (Mr. Chapman) made clear in his excellent speech, one of the main reasons why the people of Wirral, South elected him and came over to new Labour in their thousands was to see off the threat of privatisation and to enable the restoration of the NHS service as a public service. It was a tremendous vote of confidence in new Labour and in my hon. Friend, who we know will provide excellent representation for his constituents for many years to come.

We should like to associate ourselves with the kind tribute that was paid by my hon. Friends the Members for Wirral, South and for Birkenhead (Mr. Field) to Barry Porter, who was a much loved local Member of Parliament. He was greatly admired for the courage with which he faced the cancer from which he died.

It is not my intention to elaborate on the Minister's analogy of corpses, funerals and life-support machines, all of which are more fitting to the Government than to our determination to see privatisation written out of the Bill. We shall withdraw the motion, because we hope that within a few weeks another means will be available to us to safeguard the national health service from the threat of privatisation, and that will be the election of a Labour Government.

I beg to ask leave to withdraw the motion.

Motion and clause, by leave, withdrawn.

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