It is clear that the first year of the scheme has brought a wide range of benefits to patients, and that has been confirmed by independent evaluation by Professor Glennerster at the London school of economics.
Has my right hon. Friend had a chance to reflect on the excellent report produced by Professor Glennerster and published by the King's Fund, which shows that fund-holding practices are more effective and efficient in delivering health care to patients, and that they use their resources much better? Could not he have arranged for that report to be leaked to the hon. Member for Livingston (Mr. Cook), because that might have prevented the hon. Gentleman from making the foolish pledge that Labour will abolish the excellent reforms?
I do not know whether the hon. Member for Livingston (Mr. Cook) likes to read things published in the normal way. If he had read the report, he would have found in it powerful evidence that his partisan ideological commitment to abolish the scheme is foolish. Professor Glennerster says that his research shows that none of the alleged scares about the scheme could be found to be true. He quotes Professor Maynard, who makes the basic point that decisions made closer to the consumer are more likely to reflect consumer information and preferences than an overall average view taken in a district planner's office. That is the strength of the GP fund-holding scheme.
Mr. Andy Stewart:
Has my right hon. Friend noticed the success of GP fund holding in Nottinghamshire and the benefits that has brought to patients and the national health service alike? Does he agree that there is pressure to extend the excellent scheme and not—as suggested by the would-be Secretary of State for Health for Scotland—to abolish it?
I believe that there are four excellent fund holding practices in my hon. Friend's neighbourhood, and they have been adding to the region's total health care provision and are bringing new services to patients. I am under pressure from a wide range of general practitioners to bring the list size criterion down and to extend the range of care that can be purchased by GP fund holders. I am considering both points.
Is not the Secretary of State being slightly selective in the parts of the report that he uses? Is it not clear that it is an untried system, which is clearly producing a two-tier system for many patients, who are not receiving the very best care because their GP practices are treated as inferior to those that hold contracts?
The hon. Lady selects the wrong argument on which to call Professor Glennerster as witness, because he says that that argument is muddled. He shows clearly that he did not find evidence of the so-called two-tier phenomenon to which the hon. Lady refers, but that the total of care provided was increased. That benefits all patients because it takes the pressure off out-patient departments.
Is it not true that patients are refused access to services on financial grounds by GPs who are fund holders? May I draw to the attention of the Secretary of State the case of a Wakefield man who was refused expensive injections for infertility by a fund-holding GP and told to apply for that treatment to a non fund-holding practice in Wakefield?
May I also draw the right hon. Gentleman's attention to the personal circumstances of a friend whose wife is suffering from serious cancer? She was advised that she could not receive homoeopathic treatment because the fund-holding practice had no appropriate contract. Has not the experiment proved a disaster for vast numbers of national health service patients?
As always with selective, individual cases, there is more to them than meets the eye. I know a great deal about the difficulty of getting homoeopathic treatments referred by general practitioners because there is a homoeopathic hospital in my constituency. It is not a matter of fund holders versus non fund holders. There are a number of general practitioners who do not approve of such treatment.
Professor Glennerster considered carefully the argument that expensive treatments might be refused by fund holders and found no evidence of that yet. We fund the budgets on the basis of past practice so there is no reason for that to be so. I suspect that when we inquire into the matter, we shall find that the general practitioner had doubts about the treatment's clinical appropriateness.
Does my right hon. Friend, who is undoubtedly committed to improving health care, agree that the reforms make planning and the provision of supra-regional specialties very much more difficult? Will he ensure—and give me an assurance—that there will be careful monitoring?
I warmly endorse—of course—the first two parts of my hon. Friend's question, but I do not accept that his criticisms are well founded. Planning is based on good information and the internal market provides better information about GP, district and patient preferences. They can then be planned for.
Those working at a supra-regional and regional level believe that once the services that they can make available are known more widely, money will follow the patients to them.
I remind the Secretary of State that last month he claimed that the majority of GPs supported him on fund holding. Is he aware that the very next week, a poll of GPs showed that they believe, by a massive majority of 65 per cent. to 15 per cent., that his reforms are damaging the NHS? Is that what he calls majority support?
Is the Secretary of State aware that last week in North Tyneside, 53 operations were cancelled, whereas operations on four other patients from fund holders went ahead? Is he aware that in Bath, all cataract operations have been cancelled except for those involving the patients of fund holders and that in Norwich, the patients of fund holders are jumping the waiting list and entering private wards? I call that a two-tier service. Most GPs call it a two-tier service. It has no place in the NHS and the next Labour Government will end it.
I notice from a recent survey that Labour has achieved 13 per cent. support among GPs, so it has some way to go in winning the argument. When the hon. Gentleman finally gave me a straight commitment across the Dispatch Box to abolish GP fund holding, I told him that he delivered the support of the majority of GPs by doing so. I believe that GPs, whether fund holders or not, recognise, like everyone else in the NHS, that Labour's plans to turn all the reforms upside down and to throw away all the gains that have been made in the past three years are the last thing that the service needs. The hon. Gentleman can commit no more money. All he can commit himself to is undoing everything that has been achieved in the past three years.