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Mr. Chisholm: The hon. Gentleman has not completely understood what I said. I made a simple point about headline health indicators for Scotland as a whole compared with England as a whole, whereas he is making an entirely different point.

Mr. Fabricant: I am grateful for that clarification. I thought that the hon. Gentleman's point was that Scotland deserves extra money because it is deprived in comparison with England and Wales, with more disease and higher mortality rates. I think that he is now nodding in assent. I am making the same point: deprivation should be taken into account, not only in Scotland but in England and Wales.

Do not we have a national health service? Instead of the service being truly national, serving Scotland, England, Wales and Northern Ireland, it is becoming fragmented and unfair. If an individual is suffering from a complaint, he may be more likely to receive better treatment in Scotland, where more money is available, than in the rest of the United Kingdom. Is not that wrong? Should not money follow the patient, not the nationality?

Dr. Howard Stoate (Dartford): Have not we always had differential spending on health care, depending on circumstances? The resource allocation working party in the 1980s made it clear that money should be allocated in different areas according to need. We currently use Jarman indices to make deprivation payments available to general practitioners. It is wrong to be hung up on the idea that Scotland gets all the money, because different regions have always had different amounts available, dependent largely on need.

Mr. Deputy Speaker (Mr. Michael Lord): Order. Let us not go too far down the road of regional differences. I remind the House that we are talking specifically about arrangements at the border.

Mr. Fabricant: I am grateful for that guidance, Mr. Deputy Speaker.

I agree with the hon. Member for Dartford (Dr. Stoate), who is a GP. However, he reinforces my argument, which is that money should follow need. It should not be allocated according to deals that favour other countries in

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the United Kingdom over English regions. Why should 20 per cent. more money be available, per capita, in Scotland than in England and Wales? It is not because of need or deprivation, but because of Scottish Office deals with the Treasury.

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Patients and doctors will have an incentive to use new clause 18 to move from one part of the borders region to another simply to get extra money and care. Who could blame them? Should not parents expect the best care for their children? If that means crossing the border, they will do so. However, as the hon. Member for Dartford said, money should be allocated according to need. It was a shame that the hon. Gentleman--in whose constituency, incidentally, there was a Tory gain in last Thursday's elections--chose not to be a member of the Committee considering the Bill. He is a GP, and his input would have been valuable, but perhaps the Whips decided that he should not be on that Committee--

Mr. Deputy Speaker: Order. The hon. Gentleman must return to the new clause.

Mr. Fabricant: The new clause is confused. As I said, it is not explicit, and the detail will have to be dealt with by an Order in Council. Much is left to the imagination, and the fear is that the Government will take advantage of that lack of detail when they want to make financial cuts.

We have been led to believe that Scotland will enjoy better health care because of devolution, yet a clause in the part of the Bill that deals with Scotland, to which I shall return later, provides that, under the terms of devolution, the Bill can override legislation passed in the Scottish Parliament. It is clear, therefore, that the Government are merely paying lip service to devolution. They are interested in the soundbite and the general principle, but the Bill allows them to overrule the Scottish Parliament in this matter.

Finally, in our deliberations in Committee, a number of acid tests of the Bill emerged, and one is relevant to the new clause. The Government said that they would abolish fundholding. All the GPs in my constituency were fundholders, and so were able to send patients where they could get the best treatment locally. That secured the future of the two local hospitals in my area, the Hammerwich hospital in Walsall and the Victoria hospital in Lichfield.

We asked the Government to include an acid test in the Bill. The Government had said that primary care groups would not mean a reduction in service, so we asked them to include a clause requiring the publication each year of the details of any service that would be withdrawn or added as a result of the replacement of fundholding with PCGs. That would have tested whether PCGs were improving the health service, and new clause 18 would be less relevant. The Government tacitly admit that the abolition of fundholding and the introduction of PCGs will mean a reduction in service, which is why they are introducing new clause 18.

Patients in border areas may have to cross borders, which would not have been necessary under fundholding. The position became clear in Committee. The Minister chanted the mantra--we have heard it from the Secretary of State--that fundholding was unfair and a two-tier

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system. We suggested that every doctor should be made a fundholder, but we were told that that would be too expensive. That is an admission that fundholding was about excellence, just as grammar schools were. We cannot afford to make all doctors fundholders, so the 60 per cent. of patients who were treated by fundholding practices--practices abolished even before the Bill has been enacted--will instead receive a second-class service.

The hon. Member for Dartford is scribbling hard and may wish to take part in the debate. On the other hand, he may be told by his Whips to keep quiet. Why was the hon. Gentleman never a fundholder? The answer is ideology, not his patients' needs. He should come to Lichfield to meet my doctors.

Miss Ann Widdecombe (Maidstone and The Weald): Do not ask him to do that.

Mr. Fabricant: I should invite the hon. Gentleman to come while he is still a Member. After the next election, if last night's European results are anything to go by, he will not still sit for Dartford.

Dr. Stoate: My practice never became a fundholding practice because it realised that that system was bad value for money and it did not give patients a good deal. On a point of information, the hon. Gentleman may wish to know that general practitioners in Dartford formed one of the first pilot groups for the switch to primary care groups. About 50 per cent. of those GPs were fundholders, but they voluntarily relinquished fundholding because they realised that PCGs offered far better services for patients in Dartford and Gravesham. By doing so, they provided an extremely effective PCG a year ahead of anyone else. It is providing far better services at far better value for money than any fundholding practice did. That is why the Government are not keen on fundholding.

Mr. Fabricant: GPs know one thing: Labour's huge majority allows the Government to jackboot any legislation through the House. They knew that fundholding would be abolished--

Mr. Deputy Speaker: Order. This debate is not about the merits of fundholding. Would the hon. Gentleman please return to the new clause?

Mr. Fabricant: The introduction of new clause 18 at such a late stage is typical of the way in which the Bill was drafted. Clauses were added at the last minute in Committee, and the new clause--the Government call it simple tidying up--is also being added at the last minute. It is impenetrable, referring to the Bill and to preceding legislation. Yet again, we find a lack of detail. Instead, huge powers are given to the Secretary of State to make decisions Upstairs. Who can wonder that GPs are disturbed? Who can wonder that they doubt the Government's motives? Most important of all, who can be surprised that a MORI poll has shown that 30 per cent. of the population now know that the national health service is not safe in the Government's hands?

Mr. Brady: Such was the rousing reception with which the speech by my hon. Friend the Member for Lichfield (Mr. Fabricant) was greeted, Mr. Deputy Speaker, that I could hardly hear that I was being called to speak.

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However, the reception was highly deserved as my hon. Friend made an important contribution to the debate. My contribution will be more technical and I will deal with some of the detail of the new clause.

It would be unwise to suggest that I disagree with your suggestion that the debate should be concerned with the border, Mr. Deputy Speaker, but in my view it is not merely about the border areas but about changing the location of the border for certain purposes. The new clause gives rise to grave concern because of the provision for an Order in Council with all that that implies. When the Minister responds, I would welcome some real detail about what the Government intend to put in the order, and therefore, about the implications for people who live in the border area, whether on the Scottish or the English side.

My concern is that for the purpose of primary health care in particular a different border will be applicable. It is not the border that divides England and Scotland, which is obviously one to which people who live near it have grown used and which has a historical basis. People are comfortable with that border. However, the new clause would change the border. For health purposes, the real border will be that of the health authority area adjacent to the border with Scotland.

The new clause would not simply make arrangements relevant to what happens on one or other side of the border, but would in some ways blur the border between Scotland and England. The critical difference in the treatment that a patient receives will no longer depend on whether he lives on the side of the border that benefits from the Barnett formula and the increased health expenditure to which the broad mass of people in the United Kingdom have been happy to consent for a long time. It will depend on whether people live within the boundaries of the health authority or health board that abuts the border on the Scottish side. That provision has grave constitutional implications and it also has implications for the treatment and funding of health care for the people concerned.

As my hon. Friend the Member for Lichfield sought to suggest, expenditure on health care for the citizens of the United Kingdom differs. It depends on where they live and on the GP with whom they are registered. Due to accidents of geography, there is a question mark over the treatments that people can receive in certain areas. I do not want to stray too far away from the border, but I recently dealt with a constituent who was being denied a treatment that his consultant had told him was essential for his future health. Had he lived on the Manchester rather than the Salford and Trafford side of the health authority boundary, he would have been allowed that treatment.

In the new clause, the difference is writ large--it is between those health authority areas that are English and have roughly 20 per cent. less funding to spend on their residents and those that are Scottish.

We now also have a new distinction between health authorities that have the benefit of abutting the border and those that do not. If the health authority area is at one remove from the border, it will have less flexibility in the planning of its arrangements for the provision of treatment for its residents than if it is directly adjacent to the border. In the planning of treatments that might be discretionary and might contain some element of choice--whether

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handed down by the national institute that will be created, or lying within the discretionary decisions currently taken by health authorities--there will be instances in which a health authority could decide that a form of treatment is too expensive to constitute good value. However, that would not be a problem for residents of that area who could cross the border to Scotland where such treatment might be available, at taxpayers' expense. That treatment would be denied to people living on the English side of the boundary.


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