Reaction to the White Paper "Working for Patients" has been extremely positive. We have published a series of working papers outlining some of our key proposals in greater detail, and we shall be discussing the implementation of these proposals with interested parties in the coming weeks.
I thank my right hon. and learned Friend for his answer. In acknowledging that we have received a warm response from most members of the public and the medical profession, does he believe that the introduction of the White Paper's proposals ought to be fairly flexible? Does he agree that consultations with the medical profession and the consultative committees should take place so that we can provide the absolutely best possible deal for the National Health Service?
The proposals are complicated and go into details about how the service is managed and financed, which normally, as a patient, the average member of the public would not encounter, so understandably there is some public reserve about the proposals. A great deal of discussion is needed, particularly with those who are intimately involved with the way in which the service is run and financed. That is what we propose to embark on in the next few weeks—having published the working papers yesterday—and we are open to all constructive suggestions about how these proposals can best be implemented for the benefit of patients.
Is my right hon. and learned Friend aware that many of his ideas in the White Paper have been received warmly and positively? Does he agree that in principle it is possible for specialist national hospitals to consider opting out while remaining within the NHS system if they are threatened with closure or removal or both, provided that the scheme is viable and the funding properly organised?
I agree with my hon. Friend about reaction to the proposals, and I am surprised that we have not had the bitter outpouring of opposition that sometimes comes automatically on any health service subject from a whole range of people. Only the Labour party and a few trade unions have responded in that way.
I confirm that any hospital is potentially a candidate for being self-governing, if it can demonstrate the ability to be so. Some specialist hospitals could certainly be prime candidates. I put in a reservation about whether they are threatened with closure. If there is a place for that part of the service in the NHS—if doctors want to refer to that unit in that hospital—and if there is a continuous need for that service, they are ideal candidates for self-governing status. Obviously, a hospital that is facing closure because its services are redundant or because they have been replaced by something better would find difficulty in establishing such a case.
With regard to general practitioners managing their own budgets, will my right hon. and learned Friend take this opportunity to clarify the precise mechanism by which practitioners will have spending power once their indicative budgets are used?
I am not sure whether my hon. Friend is questioning me about the practice budgets, about which we had an exchange a few moments ago, or about the indicative drug budgets which all practices will have.
As for practice budgets, general practitioners will not be obliged to close down or to refuse medicine if they go over the budget that they have negotiated and had set for them, but if they overspend without good clinical reasons that they can demonstrate, they will be expected to recover the overspend. They can always apply for a budgetary review if it turns out that there are good clinical reasons for enlarging the budget.
As for the indicative drug budget, that will be an indication of what a practice of that kind should incur by way of prescribing costs. If any practice overspends by a significant amount over that indicative budget, it will be exposed to advice from other doctors and some questioning from the family practitioner committee and will be expected to take some collective measures to make sure that it gets down to a reasonable level of prescribing costs.
Will the Minister explain precisely who will be allowed to decide whether a hospital opts out? It is difficult to understand from the discussion documents just what the position will be. Indeed, the discussion papers are bizarre. May we be told in simple terms who will make the decision?
We are talking about NHS hospitals which will be run by their own managers, doctors and nurses and not be so subject to the district, region and Secretary of State in their day-to-day affairs. The decision as to whether a hospital which wants to become self-governing shall become self-governing will in the end be taken by the Secretary of State for Health after he has received a report and advice from the regional health authority.
The right hon. and learned Gentleman should speak and listen to the consumers of the NHS. Most people see this as the first steps towards privatisation. In that sense, are not the Government abrogating their responsibility for the health of the people of the nation?
If a significant proportion of the population believe that this is a step towards privatisation, they have been absurdly misled by the Labour party. There is not a word in the White Paper which makes it any easier, or any more difficult, for any Government to privatise the NHS. It is obvious to anyone who reads the White Paper that its proposals have nothing to do with privatising the NHS, on which the Government have turned their back.
Does the Secretary of State acknowledge that although there are already reservations, greater reservations may arise when the discussion documents are examined? What place will be given to consumers in local committees, especially with the abolition of participation by councillors?
The various bodies in question—family practitioner committees, district health authorities, regional health authorities, and the boards of NHS hospital trusts—will have a majority of non-executive members; lay people as opposed to professional people. Obviously, we expect to find on all committees people drawn from the local community to represent the consumer interest in its widest sense. They will also be able to make a personal contribution to the management and development of the Health Service.
Does my right hon. and learned Friend agree that rather than take into account the present situation in attempting to preserve the cumbersome bureaucracy of the Health Service—as the Opposition wish to do—one of the Government's most beneficial proposals is to allow hospitals to opt out of cumbersome district health authorities and into the hands of local management? Will he give an assurance that the determinant of opting out will not be the convenience of consultants but local popular demand?
I share my hon. Friend's dismay over the Opposition. I have been a Member of the House and in health politics long enough to recall that, over the past 20 years, the Labour party has opposed every proposed change to the Health Service. They vigorously fought the proposal to establish district health authorities in the form that they now have, and now oppose changes to reform them further. The Opposition opposed Griffiths and every advance in the Health Service, as long as anyone can remember. The acid test of a self-governing hospital, as of any of the reforms, must be whether it improves the service to the nation and makes it stronger and more effective in delivering care to the community. That must be the test which, above all, we apply to suggestions for implementing reforms.
Does the Secretary of State include among the positive responses to the White Paper last week's poll showing that of those members of the public who know of the right hon. and learned Gentleman's proposals, only 14 per cent. approve of them and 71 per cent. disapprove? Is that why the working paper published yesterday makes it clear that the Secretary of State will not risk a ballot on any proposal to opt out? If opting out is about local self-government, why is it that only the right hon. and learned Gentleman will make the decision on every single opt-out? If response to the White Paper is positive and favourable, why is the Secretary of State so reluctant to put opting out to the vote?
As I said a moment ago to my hon. Friend the Member for Harrow, East (Mr. Dykes), the reason for current public reaction is because the public does not yet altogether understand the proposals' details. They are complicated proposals, and the average member of the public does not understand what is done by a family practitioner committee, for example, and how the Health Service is managed and financed. While discussing matters with staff, we must at the same time explain to the public how the proposals will work in strengthening the service. I have no idea who the hon. Member for Livingston (Mr. Cook) thinks we should ballot. I presume that he asks for a ballot of trade union members in the hospital in question to determine the matter. We expect that when the proposals for self-governing hospitals are publicised and fully discussed locally, the decision will be made on the basis of whether that change will improve the ability of the Health Service to deliver care to its patients.