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Family Doctor Services

I have absolutely no objection to siting these facilities, whatever they are called, in areas where they are needed. I just want to be able to tell my local PCT that it is up to it to decide what is best for the local area. My real worry about polyclinics is that they could open the door to commercialisation. The hon. Member for St. Ives (Andrew George) touched on that problem in an earlier intervention, but I want to look at it in a bit more detail. People often ask what all the fuss is about, and a letter in my local paper, the Worcester News, carried the headline ““Just what point are GPs trying to make?”” The letter stated:"““Let me try to understand. They are, apparently, totally opposed to the ““privatisation”” of general practice—yet, of course, the private sector is precisely where they themselves work and earn their crust!””" I was rather disappointed by a document distributed at yesterday's NHS Confederation briefing. Headed ““Privatisation and reduced quality””, it stated:"““There is concern that opening up contracts to the private sector will have an adverse impact on quality and that there is not a level playing field between the private sector and incumbent GPs. However, this seems to ignore the fact that GP practices are independent for-profit contractors already.””" The most effective response to that approach comes from the pressure group ““Keep Our NHS Public””. It is not a rabid, left-wing group: its members are highly dedicated professionals who are passionate supporters of the NHS, through and through, and I shall paraphrase some of the points that they make. The group accepts that GPs are independent contractors, but asserts that they are crucially different from the large corporations that stand ready to compete for the provision of health services. It says that GPs know their patients and are driven by local priorities—exactly what the Secretary of State said when he acknowledged the value of the relationship between GPs and local families. The group believes that profits for shareholders drive the private corporations, and that those corporations will decide which patients to treat and which services to offer. The pressure group believes that professional judgment can be overridden by company policy, and that governance and the monitoring of standards of care could be impeded by commercial confidentiality. It also says that the skill mix may be downgraded, and that NHS pay, conditions of service and pensions might not be retained. I believe that such warnings about the dangers of commercialisation need to be taken very seriously, and in that regard I commend to Ministers two seminal articles that have been published recently. The first article appeared in the British Medical Journal, and it looked at the US experience of competition in the health care system. It said that the US has long combined public funding with private health care management and delivery. It noted that extensive research had found that the US' for-profit health institutions provide inferior care at inflated prices, and that the US experience shows that market mechanisms undermine medical institutions that are unable—or unwilling—to tailor care to profitability. Finally, the article said that the poor performance of US health care is directly attributable to reliance on market mechanisms and for-profit firms, and that it should serve to warn other nations from following that path. The second article was published in the New England Journal of Medicine, which is highly respected in this country. It states:"““The extreme failure of the US to contain medical costs results primarily from our unique, pervasive commercialisation …Medicine…does not lend itself to market discipline.””" The article describes in detail the cost-containment tactics and false economies that commercial organisations plan, and it also looks at revenue-maximisation strategies, the concentration on lucrative procedures and the selection of risk. It even pays a tribute to the British system, saying:"““When the British NHS faced a shortage of primary care doctors, it adjusted pay schedules and added incentives for high-quality care, and the shortage diminished. Our commercialised system seems incapable of producing that result.””" The article ends with the observation:"““Sometimes we Americans do the right thing only after exhausting all other alternatives. It remains to be seen how much exhaustion the health care system will suffer before we turn to national health insurance.””" That worry has been reinforced by at least one whistleblower, who was reported in The Guardian on 9 April. I have seen the papers involved, which I think that he probably sent to all members of the Health Committee. They were very long and complicated, so I do not blame any colleague who has not read them through, but the man who provided them has seen the lengths to which organisations that want to break into the market will go to enhance profits. I am reminded of the recent revelations about how a drug manufacturer went to unethical lengths to prolong the life of one of its proprietary drugs that was long out of patent. I have the marvellous privilege of being able to choose how to vote at the end of this debate, but my problem is that I do not know whether to support the motion or the amendment. That terrible quandary arises because I am not completely sure that the NHS as I have known it for years will be entirely safe under either of the two main parties. I do not yet know how I shall decide to vote, but my voting record would suffer if I did not support either proposition. I welcome much of what the Government have done for the NHS. I appreciate the extra money that they have provided and the way that they have handled the service, but I hope that they will look very seriously at the warnings that I have repeated about the dangers of opening up family doctor services to commercialisation. However, I am also worried about the Conservatives. We all know the proverb about how difficult it is for a leopard to change its spots, but it has a corollary—that even when a leopard does change its spots, it remains rather proud of having had them. The changes to the NHS made by the previous Tory Government included the introduction of market forces, the purchaser-provider split and the private finance initiative. I therefore cannot quite accept that any future Conservative Government would oppose the commercialisation that I strongly believe is not welcome in general practice.