I have had a number of useful discussions with representatives of the medical profession. I look forward to hearing their views on the implementation of the Government's proposals when they have had time to consider the detailed working papers that I published yesterday.
Is not the medical profession up in arms about those proposals because it realises that patient care is being sacrificed on the altar of a preparatory stage on the road to privatisation? Can the Minister confirm that one hospital that had opted out could concentrate on diabetics, another could concentrate on obstetrics and another on hip operations, creating a Health Service in which care was fragmented? Is it not true that whereas after the war the Labour Government created a comprehensive NHS, this Government are proposing a fragmented one?
Many doctors have many different opinions. The most common reaction that I have encountered from doctors and their representatives is a requirement for more detail in order to discuss the matter further. They now have the working papers and I await their reaction. No doctor has so far taken up with me the privatisation argument. I do not think that any doctor takes that seriously. They regard it as knockabout political nonsense put about by the Labour party. I have heard of fears about self-governing hospitals suddenly electing to go for some narrow specialty. Apart from those that are specialist hospitals already, such as the royal national orthopaedic, which my hon. Friend the Member for Harrow, East (Mr. Dykes) may have had in mind, I cannot see any sensible reason why any hospital trust and its doctors and managers should decide to start abandoning particular specialties in serving their town, and nothing in the proposals gives them any incentive to do so.
As the medical profession is there to serve patients, if a patient is not satisfied with the treatment that he receives or with the length of wait, will he be able to take his business elsewhere?
Certainly. We should make sure that the patient is completely free to do so. The rules that inhibit that freedom which are occasionally respected at the moment, will be removed by the Government.
Is the Minister aware that my constituents are very much opposed to the idea of the Walton or Fazakerly hospitals opting out? Is he also aware that we are very much opposed to the closure of the Walton hospital and the concentration of all services at the Fazakerly hospital? Therefore, will he give us an assurance that the Walton hospital will not be closed and that the ideas and high concepts of the people of the area will be accepted?
I am interested to hear that the hon. Gentleman wishes both hospitals to be subject to the direct control of the district and regional health authorities, but then expresses his strong opposition to a policy that those authorities might adopt. The closure of Walton hospital and the concentration of services at Fazakerly hospital will have to be decided first by the health authorities that are responsible for both hospitals at the moment; there will then have to be public consultation, and, if the community health councils disagree, my hon. and learned Friend the Minister of State will have to make the final ministerial decision. That is the present system and will remain the system after the White Paper has been implemented.
May I tell my right hon. and learned Friend how pleased I am to hear that all hospitals will be eligible to opt out, not just the large ones? Will he consider the opting out of Wells and district cottage hospital in my constituency, which would be a most excellent step to take?
Any hospital contemplating becoming an NHS hospital trust will have to draw up its business plan and proposals for serving patients in the area. It will then have to be examined to ensure that the hospital is capable of taking such control over its own affairs and that there is a satisfactory level of demand for its services in the area with an expected level of referrals to justify its existence as an NHS hospital trust. All that is set out in the working paper and I have no doubt that people in Wells and elsewhere will be studying it carefully to see whether it fits the circumstances of their hospital.
Has the right hon. and learned Gentleman consulted GPs about referring patients to hospitals? What will happen under his proposals where the patient and the GP choose a hospital with which the DHA does not have a contract and the DHA refuses to use its contingency reserve? Will the patient get treatment where he or she chooses and who will pick up the bill?
In the precise situation set out by the hon. Lady the same situation could arise as arises now. A GP is free to refer his or her patients if he wishes, but the hospital is not obliged to accept all referrals. Increasingly, in recent years, referrals have not been accepted because there have been no funds for treatment for an out-of-district patient. All our changes in the White Paper will make it easier for money to cross administrative boundaries, and it will be up to the GP to consult his own district health authority about referral patterns. If he wants to be free of the DHA he will have to contemplate having his own practice budget.