---

Access to NHS Services

I join in welcoming the Secretary of State and the rest of the ministerial team to their new roles. I believe that we all agree that the national health service is so vital that it is important that they do well in their respective roles. The Secretary of State is right to say that there is some history between us. I remember the Employment Bill in the previous Parliament and my role then as Department of Trade and Industry spokesman. He has always been good and courteous to deal with and I wish him well. The Secretary of State was also right to allude to the state of the NHS in 1997. The proportion of GDP spent on health in 1997 was 6.8 per cent., compared with 9.1 per cent. in the rest of the European Union. That was an enormous gap, which amounted to almost criminal neglect of the health service. The results were clear for all to see. I remember people coming to see me who had to wait three or four years for hip or knee joint operations; the cancer survival rates were appalling compared with other European countries; and so on. The Conservative party has nothing of which to be proud in its record in government. However, the picture that the Secretary of State painted of what has happened since is too rosy and I want to raise some specific issues. I hope that he will take them seriously and reflect on them, especially the important matter of equitable access to services, which the motion rightly covers. The motion is broadly uncontroversial—it is pretty much motherhood and apple pie. I am sure that the Government will vote against motherhood and apple pie, but we will support the motion because we agree with its content. Of course, it is easy to make the commitment, but much more difficult to achieve the motion’s objectives. It is crucial to consider the way in which policies and proposals affect and influence the prospects of achieving equitable access. Like the Conservative spokesman, I want to acknowledge the extraordinary role that staff play in the NHS. We are remarkably lucky as a country to have such a dedicated work force and we all rely on their work. They are a dedicated group of professionals. Before considering equitable access, I want to highlight a part of the motion about which I am concerned. It is the Conservative proposal in their policy document, which I have read, and in the motion for a shift towards practice-based commissioning. There are limits to the extent to which it is sensible to proceed in that direction. Several organisations have expressed concerns about the impact of too much reliance on that. A couple of years ago, the Sainsbury Centre produced a report on the potential impact of practice-based commissioning on mental health. It stated:"““Plans to allow GPs to commission a wider range of mental health treatments will result in substandard care””." The report referred especially to the previous fundholding scheme, which operated under the Conservative Government, and the risk of neglect of patients with severe and enduring illnesses. If we are holding a serious debate, it is important that the Conservatives understand and recognise the potential risks of practice-based commissioning. In June last year, the Audit Commission criticised the Government’s plans for practice-based commissioning. It said that the scheme risked ““exacerbating financial pressures””, ““widening inequalities”” and ““wasting money””. Those conclusions were based on where practice-based commissioning had been initiated and appeared to be working well. There are, therefore, concerns about the scheme, and conflicts of interest could arise when GPs can commission services from organisations that they set up.