Conservatives toiling on the Health Bill standing committee have been fearless in their doomed attempts to gain some ground, writes Patrick Butler
'As is my wont on a Sunday evening, I was reading schedule one shortly before falling asleep...' shadow health spokesman Philip Hammond, told the Health Bill standing committee.
There is an element of the indomitable and valiant, as well as the foolhardy, about the way opposition MPs have applied themselves to Health Bill standing committee work.
Only egotistical idealists like MPs would subject themselves to such grind and humiliation for so little reward.
And at the end of it all, the committee's inbuilt majority of largely passive Labour MPs, under the watchful eye of health minister John Denham, dutifully votes it all down.
Last week, after eight sittings of the committee in a fortnight, neither opposition party had secured an amendment. There are about another 10 sittings to go before the committee finishes on 25 May, but it would be surprising if the government budges on anything.
The committee has considered those parts of the bill relating to the abolition of fundholding, primary care trust organisation and finance. The Commission for Health Improvement, duty of partnership, price controls on pharmaceutical companies, fraud in the NHS, and high-security psychiatric services will follow.
The Conservative approach has been - on the whole - jarringly confrontational. 'It is fair to say that no one landing on this planet... able to understand English could read the bill and understand the government's overall intention towards the NHS,' Mr Hammond said by way of introduction.
David Amess, the rarely understated MP for Southend ('I do not want to use intemperate language but this bill is a constitutional outrage'), and his colleague Michael Fabricant, MP for Lichfield, both spoke for hours in favour of an amendment that would delay the abolition of fundholding for a year.
It eventually became clear that this was all a huge valedictory tribute to fundholding. 'We recognise that the amendment is largely symbolic and that we tabled it because the bill's initial clause (to abolish fundholding) involved a huge issue of principle for us,' said Mr Hammond.
'The move against fundholding is vindictive because it is motivated by the not-invented-here syndrome. If the Labour Party had dreamed up fundholding, the government could have made a perfectly plausible and logical argument within the framework of their overall principles for retaining it,' he said.
Shadow health secretary Ann Widdecombe taunted the assembled Labour ranks. 'Had we invented primary care groups - and I am very glad that we did not - then the Opposition would have accused us of inventing the internal market.'
It was not always clear whether they were angry that fundholding had been terminated or proud that their brainchild had been adopted by their successors.
Mr Denham refused to rise to the bait. 'It is accepted that not everything about fundholding was bad; it included many innovative ideas, but often the benefits were gained only for some patients at the expense of others.'
The Conservatives also persisted with amendments that would give GPs the power of veto over decisions to turn PCGs into primary care trusts, and power for individual practices to 'contract out' out of PCTs. Both amendments were mown down by Labour's silent assassins.
Dr Evan Harris, Liberal Democrat MP for Oxford West and Abingdon, also had a number of his amendments ditched, almost without question, although he did withdraw an amendment seeking to ensure PCT chairs were elected by their board rather than appointed, after Mr Denham assured him this was already government policy.
But it has not been an entirely unfruitful endeavour.
Mr Hammond was relieved when Mr Denham confirmed that PCTs equipped with salaried GPs would not be able to muscle in on independent contractors, or 'acquire' general medical services.
The health minister revealed that PCTs will cost an average£200,000 each to set up, on top of the£60,000 spent on creating each PCG. Chief executives will be appointed by the board chair, not the health secretary. PCTs may be set up in mid-year after
1 April 2000, although no decision has yet been made.
Mr Denham confirmed, variously, that community health councils have nothing to fear - 'Nothing in the bill reduces or undermines the current role or activities of CHCs'; that PCTs would be allowed to pool information technology, estate and payroll management with other NHS bodies; and there was no chance of local and health authorities merging.
Dr Harris even introduced a new word to the NHS vocabulary: 'posteriorisation'. This was more correct than 'prioritisation', he explained. 'HAs are not saying: 'This is our priority,' but: 'This is our least priority - our posteriority.''