Health and Social Care Bill

I have already said that we on the Labour Benches recognise the need to drive efficiencies and, as part of that, we recognise the need to increase productivity. We made massive strides in the 13 years that we were in power, and those on the Government Benches would do well to remember that. The allocation of resources in the NHS is all about economics and the tension created by infinite demands and finite resources. Difficult questions that are at the heart of commissioning need to be answered at a macro level—questions such as how do we value the improvement or lengthening of one person's life compared with another's; and what is the cost of investing in one drug compared with another or with an existing treatment? These are not easy questions to answer, and clinicians are making decisions at a micro level. Faced with a limited budget, clinicians will call for more resources to be allocated to their field. Oncologists will argue for a greater share of the budget to be spent on cancer treatment. Paediatricians will argue for more money for paediatrics. As well as prioritising primary care, GPs might well bid for more resources for treatment or minor surgery that their practice offers—a potential conflict of interests against which the Bill does not safeguard sufficiently. GPs are trained to be advocates of their patients, and rightly so, treating them as individuals, not as a particular percentage of the population. Their training does not equip them with the tools to make the tough, unpopular decisions about the allocation of limited resources. Perhaps in his winding-up speech the Minister will tell the House what percentage of GPs he thinks have had to grapple with the complexities of the modified Portsmouth scoreboard or the quality-adjusted life years measure. Those are the instruments used day in, day out by people who make commissioning decisions. As my right hon. Friend the Member for South Shields (David Miliband) said so eloquently, the choice is not between reform or no reform. We are not against reform or driving efficiencies, but we are against the ill-considered, costly, reckless reform contained in the Bill, which will undermine the drive for efficiency, jeopardise quality of care and fails to take into account the fact that GPs do not have the expertise or the training to make the macro-level decisions on the allocation of resources.