Parliament and Politics: Fundholding GPs to offer extended services: Bottomley acknowledges 'pockets of difficulty' within NHS as Labour condemns its commercialisation

FAMILY DOCTORS who are GP fundholders are to be allowed to offer a wider range of services from April, Virginia Bottomley, Secretary of State for Health, told the Commons yesterday as she countered a Labour attempt to dent her image as 'the mother superior of the NHS'.

David Blunkett, Labour's health spokesman, said Mrs Bottomley was 'weak and indecisive', pursuing publicity stunts while the service went underfunded. Opening an Opposition debate condemning the commercialisation of the NHS and the development of 'two-tier health care', Mr Blunkett predicted an increase in prescription charges to pounds 4 or pounds 4.25.

Mrs Bottomley accused Labour of 'wallowing in the politics of envy' and suggested that with Mr Blunkett in charge it would not be long before local government took over the health service.

'Mr Blunkett's prescription for the health service would be Lambeth-style militancy, Lambeth-style madness and, I fear, Lambeth- style fraud.'

She acknowledged there were 'pockets of difficulty' where hospitals were 'unexpectedly slowing down on elective admissions or going on yellow or red alert' because of end-of-term budget pressures. Sometimes doctors and managers were not working out how to plan activity through the year, she said. Duncan Nichol, chief executive of the NHS, will shortly issue further guidance stressing the need for managers and clinicians to work together.

Mrs Bottomley said the Government was going to make it easier for GP fundholders to extend services for patients. Regulations would be changed to ensure budget-holders could cover the cost of providing a wider range of services, covering a range of diagnostic testing and minor surgical procedures which are outside their existing contract. GPs will be able to provide the extra services themselves where they are qualified to do so, and to bring specialists into their practices.

With Mr Blunkett accusing the department of trying to conceal growing waiting lists by 'fiddling the figures', Mrs Bottomley said pounds 2m was being made available to pump-prime 30 'pacesetter' projects to reduce waiting times.

The projects are intended to bring a fresh focus to reducing waiting times and setting standards for other parts of the NHS. One initiative cited by the department was the development of new 'express' services. For example, a scheme at the Royal Liverpool Hospital will ensure that women with breast cancer symptoms can be seen within 48 hours of attending their GP. Mrs Bottomley announced the establishment of a health helpline - 0800 665544 - to provide free and confidential information, and confirmed that local authorities are to be legally required to consult with the private and voluntary sectors in drawing up their plans for community care.

Mr Blunkett said there was a crisis at the heart of the NHS. 'It is underfunded. It is being undermined. And it is under the direction of a weak and indecisive Secretary of State, a sophisticated sophist of statistics invented by her public relations department who present her, albeit wonderfully, in the guise of the mother superior of the NHS.'

Mrs Bottomley said only those who were interested in politicising the NHS whined about underfunding rather than trying to get to grips with the complex issues.

Dame Jill Knight, chairman of the Tory backbench health committee, called on Mrs Bottomley to allow HIV-screening of patients in the NHS to protect nurses, surgeons and other medical staff from Aids infection.

Dame Jill said: 'I don't want to harass Aids victims or multiply their agony, but I want to protect nurses, surgeons and staff who may be putting their lives at risk by caring for someone with Aids.

'Doctors are allowed to test for venereal disease, diseases like syphilis. The patient doesn't know that the test has been carried out. If he hasn't got that disease, well and good, no problem.

'Surely, we ought to follow that rule in the case of Aids. Why not extend the practice? I don't believe it is right to sacrifice medical staff's health and peace of mind and their ability to nurse for the fear that here are people, although tragic, who are undoubtedly a serious threat,' she said.

Liz Lynne, for the Liberal Democrats, said hospitals were running out of money and closing wards while many GP fundholders had excess funds.

'Locality fundholding could be a way round this problem. GPs in particular areas would come together and become fundholders between themselves, thus avoiding the two-tier system,' she said.

Winding up the debate, Brian Mawhinney, Minister for Health, said almost pounds 43m was to be given to health authorities in the coming year to help them provide support to voluntary hospices.

A Labour motion calling on the Government to tackle the 'crisis' in the NHS and review its 'so-called health reforms' was rejected by 316 votes to 281.