Prior approval of agreements by Medical Practices Committee (Hansard, 12 March 1997)

§ Mr. Rhodri Morgan (Cardiff, West)
I beg to move. That the clause be read a Second time.

§ Mr. Deputy Speaker
With this, it will be convenient to discuss Government amendments Nos. 61 and 64.

§ Mr. Morgan
My hon. Friend the Member for Edinburgh, Leith (Mr. Chisholm) said that our original expectation—which was somewhat confounded by the way in which the clauses were grouped—was that he would speak on the Medical Practices Committee and I would speak on consultation and evaluation. However, we do not complain about how matters have turned out: we regard it as part of the multi-skilling schemes of the kind that you probably remember, Mr. Deputy Speaker, 440 with the Coal Board, when the electricians had to learn a bit about plumbing and plumbers had to learn a bit about electrical work.

§ Mr. Deputy Speaker
Order. I hesitate to interrupt the hon. Gentleman, but it has just been drawn to my attention that he is not on the list of those who tabled the new clause, so another Member must move it formally.

§ Mr. Chisholm
I beg to move, That the clause be read a Second time.

§ Mr. Morgan
I think that I was picked as a scrum half—I hope that you will excuse my obsession with the events of next Saturday, Mr. Deputy Speaker—as I was the seventh name down and therefore in the second line. I appreciate your point and your correction on that technicality.
We are in the unusual position of trying to restore the reputation of the Secretary of State for Health. On Second Reading, he said that the position of the Medical Practices Committee in the existing red book contract remained unchanged by the Bill. The new clause would make those words true. Unfortunately, without the new clause there is a problem. As the Secretary of State has already had his previously fairly untarnished reputation heavily tarnished over the past few weeks by his comments on Scottish devolution and the European single currency, perhaps it is time for us to help him to burnish his reputation to what it was before he embarked on his new-found middle-aged obsession with banana skins.
The new clause goes to the heart of the philosophy of the Bill. That philosophy has two aspects. One is to let a thousand flowers bloom and have some ideas from the medical and other professions in the national health service family to improve the health care of the nation through the NHS. The other is to try to do that against the problem best encapsulated as the law of inverse care—that those with the fewest health problems tend to get the best health care, while those with the greatest problems tend to get the poorest.
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Since the foundation of the NHS. the Medical Practices Committee has tried to prevent the inevitable drift of the medical profession towards the areas of the country with the fewest health problems. Through its negative vetting power, it tries to correct that by pushing doctors into areas with fewer doctors and more health care problems. The Bill will remove that power and transfer it to the health authorities.
We find that odd. The purpose of the Bill is to improve health care, but it weakens one of the mechanisms preventing the law of inverse care from operating. The Government have taken on board some of the complaints made by the Medical Practices Committee in that regard and have dealt with those in their two amendments—No. 61, which deals with England and Wales, and No. 64, which deals with Scotland. However, those amendments are weak attempts to achieve the same objectives as new clause 5 achieves in a strong, direct and clear manner.
Having removed the MPC's ability to correct the tendency of areas with too many doctors to get more doctors and of areas with too few doctors to get even fewer, the Government are now trying to reassert it in a 441 milk-and-water fashion through their amendments. Why are the Government trying to reinvent that ability when the MPC has done a good job in protecting us from the law of inverse care for the past 50 years, since the creation of the national health service, simply because the Government recognise with a late, guilt-ridden feeling that they should try to reinsert some of those powers? Moreover, their attempt to do so is weak and incompetent.
New clause 5 restores the reputation of the Secretary of State for Health, because what he said on Second Reading would come into effect—namely, the MPC's powers would remain in place. Without the new clause, we simply have a weak reinsertion of the MPC's powers to try to correct the tendency. We entirely understand why that tendency happens: there is a natural incentive for doctors to wish to settle down in leafy suburbia where medical problems may not be quite so great, rather than in inner cities, pit villages or Welsh valleys.
We are suspicious that, in removing the power that the MPC has always had to vet vacancies and try to prevent people from being appointed as additional doctors in areas that already have too many doctors, the Government see no problem in having more doctors, appointed to certain areas. Clearly, the work load is lighter in leafy suburbia and in areas with too many doctors. Areas with too few doctors may require a more challenging, missionary zeal on the part of a doctor.
The basic principle of the involvement of the MPC has been to seek to even out the provision of general practices throughout Great Britain. We do not want to see that diluted. We are suspicious that, in diluting the MPC's ability to correct disparities, the Government are complacent about how the law of inverse care might operate in future. The MPC's powers would, by and large, be transferred to health authorities.
However, whereas there are only two MPCs, there are 120 health authorities or health boards that would take on the powers instead. The 100 health authorities in England and five in Wales and the 15 health boards in Scotland each have a duty to look after its own patch. If there is a disparity in the number of doctors in two neighbouring health authorities, the job of the health authority with too many doctors is not to help the authority next door with too few doctors by saying, "We had better not have too many doctors; it would be greedy, given that the health authority next door has too few." The MPC, in contrast, has exactly that role.
There is also a bureaucracy aspect. Why should one attempt to develop expertise in ensuring a reasonably even spread of general practitioners in 120 health authorities or health boards when that area of expertise is currently carried out by two bodies—the England and Wales MPC and the Scottish MPC? Would the health authorities ever attain the level of expertise of the MPC and the ability to recommend whether to prevent a doctor joining a practice because the area is already well served by doctors and there are vacancies that are difficult to fill nearby? It is absurd to transfer that responsibility to 120 bodies from two, and it could result in a huge proliferation of bureaucracy.
The MPC combines that skill and expertise with another skill: the detection of bogus doctors, or doctors who change their name and reappear elsewhere because doubts have been expressed about their competence to practise. The MPC has an extremely good record in 442 detecting bogus doctors. Why allow health authorities to take on a role that has been satisfactorily conducted by just two bodies for the past two and a half years?
If the Minister wants to help the Secretary of State for Health—perhaps he does not—to restore his reputation for keeping his word, he should accept new clause 5. The Secretary of State said on Second Reading: The position of the MPC within the existing red book contract remains completely unchanged by the provisions of the Bill."—[Official Report, 11 February 1997; Vol. 290, c. 155.] The Minister accepted in Committee that, as the Bill stands, the MPC's role changes. Indeed, he boasted about that change and objected to our amendments Nos. 1, 2, 3, 12 and 4 precisely because they attempted to retain the role of the MPC in evening out the supply of general practitioners. He said: the Secretary of State must lay regulations to the effect that the MPC will retain its current role"— [Official Report, Standing Committee D, 18 February 1997; c. 179.] The Minister seemed to think that that was objectionable, although it was exactly what the Secretary of State for Health had promised on Second Reading would be the effect of the Bill on the MPC's duties.
I appeal, if not for Cabinet unity—that would be too much to expect these days—at least for departmental unity between the Secretary of State for Health and the Minister for Health. I ask the Minister to accept that new clause 5 is far superior to the Government amendments. It should be incorporated into the Bill because of the embarrassment that will otherwise be caused to the Secretary of State for Health.

§ Mr. Malone
Whenever I hear the hon. Member for Cardiff, West (Mr. Morgan) preface a speech by saying that he is about to enter into the philosophy at the heart of the Bill, I know that we are heading for slightly troubled waters. He issued a kindly invitation, but I must point out at the outset that what he said was based on a misunderstanding of the differences between part II arrangements—what happens now in primary care—and what is proposed in the new clause.
The new clause would require health authorities to submit all proposals for personal medical services to the Medical Practices Committee for approval, which is entirely different from the power that the committee currently exercises in deciding how general practitioner manpower, or personpower, should be distributed in respect of part II arrangements.
Health authorities have the responsibility for planning services to meet the needs of their populations. In doing so, they work closely with the profession locally and are able to take full account of local circumstances and needs. As I pointed out in Committee, health authorities are closely involved in matters in which the MPC exercises its current powers, particularly in providing all the necessary information for validation of a doctor's credentials.
I understand the concerns expressed by the profession about the need to ensure an even distribution of the GP workforce, which is why we tabled amendments Nos. 61 and 64, which are the direct result of extensive discussions with the MPC, the profession and others. I referred in Committee to our intention to table such amendments. The discussions resulted in an agreement with the profession to give legislative effect to proposals that 443 recognise that national distribution of the GP work force must be kept in view by the Secretary of State in considering both pilot and permanent schemes.
We agreed to amend the Bill to provide for the MPC to be consulted on pilots where the number of GPs practising in the relevant health authority area would change, and for the Secretary of State to have regard to the effect on the distribution of GPs nationally in approving pilots, and to ensure that any regulations governing the introduction of permanent arrangements are framed with that in mind.
We amended the Bill in Committee to provide the MPC with a consultation role on pilots. Amendments Nos. 61 and 64 will implement our agreement on permanent arrangements by placing a duty on the Secretary of State to consider whether any proposed permanent scheme is likely to have an adverse effect on the distribution of general practitioners. They will provide the framework for proper consideration of the equity issues to which the hon. Member for Cardiff, West (Mr. Morgan) quite rightly referred.
I concede that we need to bring in measures to deal with GP distribution throughout the country. As I said in Committee, in a slightly different context, we shall take the work forward jointly with the resource allocation group, the Medical Practices Committee, representatives of the profession and health authorities.
Our intention is to form a national view of relative need between health authorities that will inform decisions about the distribution of GPs and contribute to the continuing work on a fairer allocation of financial resources. Such a view will be taken in the context of the new provisions in the Bill. I therefore commend the Government amendments to the House and hope that the Opposition will not press the new clause.

§ Mr. Morgan
I am grateful to the Minister for his response, but I do not agree with it—partly because he has not even touched on why the Secretary of State said on Second Reading that the position of the Medical Practices Committee would be unaffected by the provisions of the Bill, if he had no intention of implementing that promise.
Does the Minister accept that, since the merger of the family health services and district health authorities on 1 April 1996, some of the intimacy of contact between the health authorities and the primary health care services has been diluted? In the days of family health services authorities, there was always a specific health authority with the specific role of dealing with primary health care. That is no longer the case, so there has already been a loss of the intimate knowledge of the primary health care side.
What about the expertise of the health authorities? Is the Minister defending the measures as deregulatory, in the manner that we have often heard from the Government in the past 18 years? Does he think that it is much better for 105 health authorities and 15 health boards to have a go at evening out the supply of doctors between under-doctored and over-doctored areas? If so, how would he deal with the issue as between different health authorities, each of which has a duty only to look after its own patch? How could the job currently done by only two MPCs, one for England and Wales and one for Scotland, be done better by 120 health authorities or boards?
444 We believe that the measure is a thoughtless act of deregulation without regard to consequences, but it is most unlikely that it will be implemented as the Government wish because after the change of Government that we and the country now hope for and expect in the next few weeks we can either repeal the section or never make the regulations necessary to put it into effect. I therefore will not press the new clause.

§ Mr. Chisholm
I beg to ask leave to withdraw the motion.