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Internal Market

Volume 456: debated on Tuesday 6 February 2007

5. What assessment she has made of the effects of the operation of the internal market in the national health service on staff morale and job numbers in trusts which lose service provision. (118588)

We had ample opportunity to assess the disastrous effects of the NHS internal market that the Conservative Government introduced in the 1990s, which is why we scrapped it. By contrast, this Government’s approach has seen record investment in the NHS with about 300,000 more staff compared with 1997, better pay and longer holidays for our NHS staff, more choice for patients and waiting lists at their lowest level since records began.

I thank the Secretary of State for that reply. I was not allowed to use the word “marketisation” when I tabled the question, but marketisation certainly still exists. That was brought home to me by letters from constituents—highly skilled cytologists in the county of Worcestershire. That county has just lost the contract for its own cytology services to Gloucester, which is 40 to 50 miles away from where my constituents live. With the increasing impact of marketisation on health care, this problem will—

Order. I try to give the hon. Gentleman some leeway because he is an independent Member and works on his own, but a long speech is not proper in these circumstances.

Thank you, Mr. Speaker. As it happens, I have had the opportunity to see the hon. Gentleman’s column in his local newspaper, Kidderminster’s The Shuttle, in which he objected to the fact that his local NHS was getting its cervical smear service in the most efficient way possible. I draw his attention to what Dr. Abudu, the cervical screening co-ordinator for the local primary care trust, said—that the new cervical cancer screening service will give women faster and better results and that they will go on having their samples taken locally. Although I have great respect for the hon. Gentleman’s clinical expertise, I would expect him to support his local NHS in getting the best value and the best services for his local constituents, which is—

Is it not the case that the various royal colleges speak out strongly in favour of an internal market and service reconfiguration? What more can the Secretary of State do to ensure that senior consultants argue strongly for service reconfiguration when it is in the best interests of good clinical practice.

My hon. Friend is absolutely right that clinicians need to be in the lead in deciding how best to organise local services and then in arguing the case—if the decisions are difficult, as they sometimes are—with the local public. I am glad to say that this morning we published two excellent clinical reports from the national clinical director for maternity and children’s services making the case for change and yesterday we published a report from the national clinical director for primary care services. That is exactly the kind of approach that the royal colleges are, I am glad to say, supporting.

May I ask the Secretary of State about the impact that the private clinical assessment, treatment and support centres—to which patients will be referred by their GPs, first in Cumbria and Lancashire—will have on what seems to me to be the internal market? Is not there a risk that these centres, with their guaranteed income, will distort the internal market, and directly undermine patient choice and staff morale? Might not they create the possibility of a conflict of interest in which the same group runs the treatment centre to which patients will be referred? Will they not also undermine the viability of local hospitals?

Clinical assessment and treatment services are an essential part of continuing to give patients better and faster care and, in particular, of ensuring that we achieve our goal of reducing waiting times to an absolute maximum of 18 weeks for most hospital operations by 2008. For most patients, of course, the waiting time will be far less. Whether those services are run by NHS organisations or by the independent sector will depend on decisions being made in each region on how to get the best services and the best value for money. I hope that the hon. Gentleman will support that, because it is in the interest of patients.