HC Deb 16 January 1996 vol 269 cc530-3
6. Sir David Knox

To ask the Secretary of State for Health what percentage of the gross domestic product was spent on the NHS in the most recent year for which figures are available; and what was the percentage in 1978. [7496]

Mr. Dorrell

National Health Service spending in the United Kingdom as a whole has risen from 4.7 per cent. of gross domestic product in 1978–79 to an estimated 5.7 per cent. in 1995–96.

Sir David Knox

Does my right hon. Friend agree that those figures show clearly the different priorities of Conservative and Labour Governments for the NHS?

Mr. Dorrell

My hon. Friend is right. The figures show also how right the hon. Member for York (Mr. Bayley) was when he wrote in his paper to the Fabian Society: Labour's health policy will not look credible at the General Election if we do not commit ourselves to matching the rate of growth delivered by the Conservatives in recent years. The hon. Gentleman is precisely right to set our spending as the standard to which the Labour party has yet to rise.

Mr. Bayley

The Secretary of State should read more than the articles that his civil servants dig out. He might have read my recent article in the New Statesman in which it was acknowledged that health spending has increased in real terms under the Conservatives, but not as fast as it did under the Labour Government. The real issue is whether all patients in all parts of the country are given equal priority.

The Government have introduced a weighted capitation funding formula for hospital services; why do they not do the same for general practitioner and family health services, given the recent York report that shows that the north of the country and inner-city areas are deprived of GPs when compared with the leafy shires?

Mr. Dorrell

The hon. Gentleman has raised an interesting prospect, which is that the Labour party should commit itself to tearing up the GP national contract. I look forward to hearing that policy endorsed from the Opposition Front Bench.

Mr. Nicholas Winterton

The increase in expenditure on the health service by the Government is extremely commendable and I congratulate my right hon. Friend. Does he accept, however, that there is still a problem in community care, which has already been referred to this afternoon? Does he accept that there is a gap in the provision of care between the health service and social services when it comes to the mentally ill and those with behavioural problems? I refer especially to the cases in my constituency of Lynn Fox and Emma Larkins. Lynn Fox was stabbed to death because of the tremendous problems that she was creating for her neighbours. Emma Larkins burnt herself to death. Does my right hon. Friend agree that these things should not occur in a modern, civilised society and that we need to close the gap in the provision of care?

Mr. Dorrell

What my hon. Friend shows is that, not only in the mental health services but across the other services of the health service, expectations of the quality of service that we want to see are rising, and that opportunities to improve the quality of service provided by medical science are rising, too. The Government's spending record has allowed us to reconcile those rising expectations with the resources available.

My hon. Friend can certainly have the assurance that we shall continue to deliver our election commitment: to increase the resources available in real terms to the health service and use them to improve the quality of all the health services, which include the mental health services to which he referred.

Mr. Simon Hughes

If the view of the professionals in the health service and those who speak on their behalf is that there are insufficient resources to ensure that the core services of the NHS—the acute and emergency services—can be comprehensively delivered in the country, what is the explanation? Is it that the NHS, for which the Secretary of State is responsible, is not efficient with its resources? Or is the truth that, although there has been real growth of about 10 per cent. since 1979, there is now barely any, and the next two years will see a cut in real resources to the NHS in real terms for the first time in 25 years?

Mr. Dorrell

Almost every one of the figures that the hon. Gentleman quoted was wrong. He talked about an increase in real resources since 1979 of 10 per cent.; the actual figure is 71 per cent. He talked about a decline in real resources in the years ahead; that is not true, either. I announced before Christmas an increase of 1.6 per cent. in the real spending resources available to the health service next year over this year. That is building on the Government's record since 1979 of demonstrating the priority that they attach to health care by increasing the real resources available to the health service.

Dame Elaine Kellett-Bowman

Is my right hon. Friend aware that the Lancaster Acute Hospitals NHS trust has used its share of the increased gross national product to build the most up-to-date hospital in the country, including an overhead X-ray gantry in the resuscitation room, which is linked directly with the X-ray room, and to install—the first in Europe—a digital X-ray system that puts images immediately on to computer, which can be flashed out instantly to general practitioners in other hospitals anywhere in the world?

Mr. Dorrell

My hon. Friend referred to the use of capital within the health service. She was quite right to say that, because we have a record capital programme in the health service, we are able to invest in the things to which she referred. There is a problem for the Labour party in the capital programme. We made it clear that we abolished capital rationing in the health service by introducing the private sector through the private finance initiative.

That policy was endorsed by the Leader of the Opposition when he said during the Budget debate: The PFI is right in principle."—[Official Report, 28 November 1995; Vol. 267, c. 1077.] His health spokesman, the hon. Member for Peckham (Ms Harman), said, in my hearing on Saturday morning, "I don't call it the private finance initiative. I call it the privatisation initiative."

Either Labour is in favour of privatising the health service or it is against the PFI—or should be, according to the views of the hon. Member for Peckham. Is the Labour party for or against the PFI? We need to know.

Ms Harman

Will the Secretary of State recognise that, despite his claims about extra resources, many hospitals are so overstretched that they are turning patients away from their casualty wards and that patients face waits of up to 20 hours on trolleys before they can get a bed? Will he consider my proposals today for a four-point plan to tackle the casualty crisis? Will he declare a moratorium on further bed cuts? Will he appoint someone in each health authority to identify and take action locally? Will he monitor and publish a weekly report on the crisis and issue clear national guidelines to end the uncertainty about who pays for continuing care?

Mr. Dorrell

The hon. Lady asks for a moratorium on bed cuts to deal with the pressure on the emergency services. Let me tell the House what has happened since the beginning of the year with regard to the availability of beds for emergency cases. An extra 10 beds have been opened in Consett, 26 in Sunderland, 24 in Good Hope hospital in Birmingham, 12 in the West Middlesex, 32 in Newham general, 28 in Chester, 28 in Crewe, 10 in Warrington, 25 in Aintree, and so on. So much for bed cuts. I do not think that the hon. Lady is quite up to date.

Mr. Congdon

I welcome the extra resources that have been put into the NHS, but does my right hon. Friend agree that it is essential that they are used effectively? Does he agree that it is important that health authorities identify the health needs in their area, look at those procedures that are ineffective and ensure that less money is spent on them so that more money can be spent on those procedures that are effective and will deliver improved patient care?

Mr. Dorrell

My hon. Friend is on to an extremely important point. What we need to do in the health service is to ensure that clinical effectiveness is the test applied by clinicians in making their clinical judgments. That is not controversial within the clinical profession; the profession is committed to delivering it. That is why, when I announced guidelines on the subject last week, I was pleased to have the specific endorsement of representatives of the general practitioner fraternity and the hospital doctors for the important principle that my hon. Friend enunciates.