National Health Service (Hansard, 9 February 1988)

§ 3. Mr. Cohen
To ask the Secretary of State for Social Services if he will make it his policy to review the hitherto unimplemented recommendations of the 1979 report of the Royal Commission on the National Health Service; and if he will make a statement.

§ The Minister for Health (Mr. Tony Newton)
While the Royal Commission report remains a valuable survey of the Health Service, I do not consider the hon. Gentleman's suggestion to be a productive way of moving forward the current debate on health issues.

§ Mr. Cohen
Did not recommendation 112 of the 1979 Royal Commission on the National Health Service say that there was a firm case for a gradual but complete extinction of charges? Have not the Government done exactly the opposite? Have not the new eye test charges and higher dental charges been overwhelmingly condemned? Is not the policy of the Government that of tax cuts for the rich, paid for by making charges on the sick?

§ Mr. Newton
The answer is no. The reason why we have not accepted the Royal Commission's recommendation is that we do not agree with it.

§ Mr. Heathcoat-Amory
Does my right hon. Friend agree that the 1946 constitution of the National Health Service is becoming increasingly difficult to fund because of the explosive demands of new technology and new courses of treatment? When he examines these recommendations, will my right hon. Friend make explicit what doctors already know—that we must allocate priorities in the National Health Service and keep it open to all, but narrower in its scope?

§ Mr. Newton
I am grateful for my hon. Friend's constructive comments, which echo much of the general comment of the Royal Commission, to which the original question referred. Our resource management initiatives are directed to the point that my hon. Friend has in mind.

§ Mrs. Clwyd
As a former member of the Royal Commission—the only such hon. Member—I should tell the Government that they would not be in the mess that they are in now with the National Health Service if they had implemented the recommendations of the Royal Commission. Does the Minister agree that the numbers of late abortions would have been considerably reduced if he had implemented the recommendation of the Royal Commission, that 75 per cent.—rather than the present figure of 46 per cent.—of abortions on resident women in Britain should be carried out by the National Health Service?

§ Mr. Newton
I simply do not accept the general presumption of the hon. Lady's supplementary question, which is that a good deal of progress has not been made on the general recommendations of the Royal Commission. Great progress has been made in streamlining the administrative structure, by cutting out a tier, and in the development of services such as cancer screening and a number of other important developments.

§ Mr. Jessel
The Royal Commission referred to the use of hospital beds. Does my right hon. Friend realise how many hospital beds are being wasted because patients are admitted for operations a full day or more before their operations are carried out, principally to ensure that they do not eat anything? In view of the length of waiting lists, can action be taken in appropriate cases to ask patients to certify that they have not eaten anything?

§ Mr. Newton
I shall consider my hon. Friend's suggestion. He will be aware that there have been considerable improvements in the efficient use of beds. 174 The performance indicators that we publish—a new set is due shortly—will facilitate comparisons between the performances of different health authorities.

§ Ms. Harman
Will the Government withdraw their plans to charge patients for screening examinations of their eyes, teeth and mouths? Why do the Government persist in thinking that they are right to press ahead with those plans, when everyone else, including family practitioner committees, the British Medical Association, health authorities and consumer associations think that the Government are wrong?

§ Mr. Newton
Because we believe that these proposals are a reasonable way of contributing a relatively modest sum to the much larger increase in expenditure that we plan on family practitioner services generally, with the emphasis on preventive care.

§ Mr. Burns
Does my right hon. Friend agree that one of the most telling points of the Royal Commission's report was that the demand for resources in 1979 was so great that we could quite easily have spent the whole of our gross national product on the Health Service?

§ Mr. Newton
Yes, indeed. As I said a moment ago, the Royal Commission made some sensible comments about the relationship between demand and resources. It is in that spirit that we have been seeking to tackle the problems of the Health Service.

§ 4. Mr. David Winnick
To ask the Secretary of State for Social Services what progress has been made in the Government's consideration of the National Health Service; and when he now expects to bring forward proposals for consultation.

§ The Secretary of State for Social Services (Mr. John Moore)
The Government have now embarked on an internal review of the National Health Service. We shall bring forward our proposals in due course.

§ Mr. Winnick
Why does the Secretary of State not admit that the Government's real purpose is to prepare the ground for the private sector to take over much of the National Health Service? Is the right hon. Gentleman aware that the British public certainly do not require impertinent lectures from the Parliamentary Under-Secretary of State, the hon. Member for Derbyshire, South (Mrs. Currie), about paying for health care? People pay through their taxes and national insurance contributions, and they expect the National Health Service to be adequately funded by whichever party happens to be in government.

§ Mr. Moore
The British public will share my admiration of my hon. Friend the Parliamentary Under-Secretary of State for the sensible way in which she addressed the nation about the issues and values that face a free society which, by choice, spends £17 billion on alcohol.
Beyond that, the gravamen of the point made by the hon. Gentleman related to the review. As I have told him in a written answer, the review will be wide-ranging and fundamental. It is clear that we are concerned with the development of the Health Service to meet the country's needs in the years to come. We shall look at all alternatives that allow us to ensure what we care most about—the health of our country.

§ Dame Jill Knight
May I suggest to my right hon. Friend that many thousands of people are aware from their own personal experience that today the Health Service is treating and curing people who only two or three years ago would have been sent home to die? When my right hon. Friend considers long-term plans, may I suggest to him that the vast majority of people in Britain are willing to pay more money for health services and care, provided that whatever schemes are adopted—and there are many— the money goes to the Health Service and not to the general exchequer?

§ Mr. Moore
My hon. Friend is quite right. That is why we must look so carefully at the way in which resources are used. We must ensure that they are spent on patient care, and not wasted. My hon. Friend was right to identify something that should unite both sides of the House. It is extraordinary that in the past year about 32 million of our citizens have used hospital services in Britain. That is an astonishing example of the achievement, for which we should give credit to all those who work in the Health Service.

§ Mr. Galbraith
Has the Secretary of State's review made him aware that a more efficient use of resources, such as operating theatres and beds, will require an increase in resources? Therefore, will he guarantee to make more funds available so that we can utilise beds and operating theatres more efficiently?

§ Mr. Moore
We will consider everything. Obviously we shall consider the way in which increased efficiency improves the ways in which the Health Service can treat more patients. However, as the hon. Gentleman knows from his experience in Scotland, where a greater percentage of GDP resources has been expended on health care, that has not improved the relative ratios of waiting times compared with England. Therefore, it is a matter, not simply of resources, but of the way in which those resources are effectively used in patient care.

§ Mr. Sims
There is no question of privatising the NHS, as the hon. Member for Walsall, North (Mr. Winnick) implied, but will my right hon. Friend confirm that there have been many examples of co-operation between the NHS and the private sector, to their mutual advantage? Will his Department collate those examples and circulate them to some of the authorities which, for political or ideological reasons, refuse to use that co-operation for the benefit of patients?

§ Mr. Moore
My hon. Friend is absolutely right. We are concerned with patient care, which means co-operation in the use of all the resources that we have. I draw his attention to an excellent article by the King's Fund, which illustrates the way in which the private and public sectors are already working together. We should encourage that because, as I keep saying, our only concern should be patient care, not sterile politics.

§ Mr. Redmond
Will the Secretary of State tell the House what monetary value he places on human life?

§ Mr. Moore
If it is pure money that we are talking about, the Secretary of State and the Government place greater value on human life than did the Labour Government when they reduced the proportion of GDP that they spent on health care. However, if we talk in that kind of sterile language, we shall not rationally find a way to improve the health of our country.

§ Sir Peter Hordern
Will my right hon. Friend confirm that his review will not be confined to the role of the NHS alone, but will review the other means of providing health services to our people, including possibly a form of national health insurance scheme?

§ Mr. Moore
Like my hon. Friend, who served for many years on the Public Accounts Committee and who has noticed so many times the way in which we do not necessarily use our resources as effectively as we might, I shall ensure that we examine each and every alternative. All alternatives will be considered on their merits so that we can ensure that our prime goal of improving the health of our nation is uppermost in our minds.

§ Mr. Robin Cook
Will the Secretary of State now answer the questions that I have put to him twice in writing? What opportunity will there be for the public to join in the review of their Health Service? How will the professional organisations which work in the Health Service get a hearing in the review? Why do Ministers propose to consult us only when they have made up their minds? May we be told even the terms of the review? Does the Secretary of State not appreciate that the NHS belongs to the public and that its future cannot be disposed of in a basement in Downing street, still less in a dining room at the Carlton club?

§ Mr. Moore
Perhaps I could draw the hon. Gentleman's attention to the answers to the written parliamentary questions that were addressed to his hon. Friend the Member for Walsall, North (Mr. Winnick), who asked the question, in which I made it absolutely clear that any submissions brought forward would be considered. It might also be of interest to the hon. Gentleman to discuss this matter with the Trades Union Congress, most of the general secretaries of which came to see me, because again I made it absolutely clear — they obviously have not communicated it to the Opposition Front Bench—that I look forward to any and all submissions from the TUC and from any other reputable body.