§ Mr. Deputy Speaker (Mr. Michael J. Martin)
I inform hon. Members that Madam Speaker has selected the amendment standing in the name of the Prime Minister.
§ Mr. John Maples (Stratford-on-Avon)
I beg to move,That this House expresses deep concern that the Government, in implementing its review of the National Health Service, has refused to rule out extending charging for NHS services, particularly the possible imposition of prescription charges for pensioners, charges for hospital hotel services and charges for visits to general practitioners.It is some years since I spoke in the House. My absence was entirely involuntary, and I am delighted that it has been remedied recently. I represented a part of inner London in my previous incarnation, and I now represent Stratford-on-Avon. I feel fortunate to have represented both inner-city and rural seats in the House. That combination gives one a broad range of experiences and insights that is not available to many hon. Members.
Whereas Lewisham was four square miles, Stratford-on-Avon is 400 square miles—of fields as opposed to tarmac—comprising lovely villages and towns. In the middle is Stratford itself, which is perhaps one of England's most beautiful and historic towns. In future, I intend to speak often in the House about the rural economy, agriculture and development. It is a wonderful place to represent and to live.
I thought that I should say something courteous about my constituency and my predecessor. I am in an unusual position, as my predecessor is still a Member of Parliament—although he is on the wrong side of the House. When I was selected to represent the Conservative party, I promised my supporters that on television on election night they would see five words that they never expected to see: "Stratford-on-Avon: Conservative gain". My constituency had the largest Labour to Conservative swing of the night, and I understand why my predecessor did not hang around. As his defection created this opportunity for me, I remain grateful to him.
I turn now to the motion. It must amaze everyone that the Government have managed to get into such a mess on this issue so quickly, and that we should be in the position of choosing—on the first Opposition Supply day of this Parliament—to debate charges in the national health service under a Labour Government. We are debating the allegation that the Government are considering introducing charges for pensioners' prescriptions, the hotel costs of stays in hospitals and visits to general practitioners.
During the election, we showed repeatedly that Labour's sums did not add up, but few people, including even me—I am about as cynical about Labour's tax promises as one can get—could have imagined that Labour would have thought of squaring the circle by imposing new taxes on sick people.
We could shorten the debate a great deal. The Secretary of State could now—if he wants to do so, I shall give way to him—categorically deny all this. If he will now say that none of that to which I have referred is even being considered and that he rules out such charges completely, categorically and for all time, perhaps we can go home 906 early. Does the right hon. Gentleman wish to intervene? My right hon. Friend the Member for Fylde (Mr. Jack) and I will even put in a good word at the Treasury for him. We have a few friends there and we know that we are dealing with a Treasury-driven exercise. It seems, however, that that is not enough. We might even put in a good word for the Minister without Portfolio, the hon. Member for Hartlepool (Mr. Mandelson), because I think that he has something to do with the exercise. I think that the response was to be expected. At least I shall get to make the rest of the speech that I have prepared.
The story first appeared in the Financial Times on Monday 9 June in an article written by, I think, one of our most respected health commentators among journalists. The article read:The Department of Health's review is expected…to examine charges for NHS 'hotel' costs and GP visits…But a review of the structure of prescription charges could see the better off elderly being asked to pay.The story was then taken up the next day by the Daily Mail, which made it clear that the exercise was Treasury-driven. The article stated:Two million pensioners may have to pay prescription charges as Labour cracks down on the NHS budget…The Chancellor…is determined"—this is interesting—to slow the ballooning growth of the NHS budget".That is not a story that we often hear from Labour Health Ministers.
Senior insiders were quoted as saying thatthe entire structure of the charges is being reviewed and non-pensioners could also face paying more. A senior Whitehall source confirmed last night that a cutback on free prescriptions was being considered…There may also be 'hotel-style' chargesfor stays in hospital.
Both stories clearly originated from an official civil service briefing. The journalists involved did not invent the stories, and they say as much in them.
The very next day, pulling the pieces of the puzzle together—they need to be put together because the Secretary of State has certainly not made it clear what is going on—the Chief Secretary to the Treasury announced to the House what appeared to be a run-of-the-mill public spending review. There was no indication from him or the Secretary of State for Health how far-reaching it was intended to be. That did not emerge until the next day, when the Secretary of State was apparently rather indiscreet with journalists after speaking to the Institute of Health Service Managers at Cardiff.
The right hon. Gentleman did not come clean in his speech at Cardiff. Indeed, he deliberately confused the issue. The day before, his Minister of State announced a review to the House. Perhaps we were intended to confuse that announcement with the review that I am discussing. A much narrower review was announced with a named team that would examine ways in which more money might be directed to patient care.
After the Cardiff events, the cat was pretty well out of the bag. That Friday, a rescue exercise was attempted by means of a press release quoting the chief executive of the NHS and the Secretary of State as saying that the health service would remain free. But neither of them used that opportunity or has used any opportunity before or since to deny our fundamental allegation that the review would include possible charges for patients.
907 As if to confirm our suspicions, the Secretary of State was quoted in The Times on 14 June as saying:We are going to look at charges.How could the Secretary of State have got himself into such a mess with what is supposed to be a simple review of health service spending and public expenditure? According to the next day's edition of the Daily Mail, the Prime Minister had the same reaction. The article stated:Tony Blair is furious with Frank Dobson's 'incompetent' handling of the row over charging patients for health services. The Premier is angry that his Health Secretary confirmed the Government is considering making people pay for GP visits, staying in hospital, and forcing pensioners to pay…for prescriptions.That is rather restrained language. I imagine that if that message was delivered to the Secretary of State by either the press secretary or the Minister without Portfolio, it was in rather more robust language than that used by the Daily Mail.
The Secretary of State may, however, have taken some comfort from the fact that the story was given fresh life and credibility by the Prime Minister during Prime Minister's Question Time on the Wednesday. We are all rather grateful to the Prime Minister for dropping into the House occasionally, taking intervals in his world lecture tour. We now understand clearly why he wanted to have only one session of Prime Minister's Question Time each week. He was planning to be in the country for only about one day a week.
We know that it must be much more agreeable cuddling up to Lionel, Helmut and Bill than to come to the House to clear up the mess left by the Secretary of State. Instead of lecturing European Heads of State on flexible labour markets—a concept that was entirely alien to the right hon. Gentleman until a few month ago—or lecturing the Americans on their environment, perhaps he should spend more time here getting right the line on the NHS.
During Prime Minister's Question Time on 18 June, my right hon. Friend the Member for Huntingdon (Mr. Major) asked the Prime Minister five times to confirm or deny the story. The Prime Minister, even by his own standards, was pretty loquacious in his answers. The first answer took 144 words but the right hon. Gentleman failed to answer the question. The second time he got down to 124 words. The third time—he must have been getting a bit rattled—he got back up to 157 words. Answers four and five consisted of 127 and 143 words respectively. On none of the five occasions, however, did the right hon. Gentleman answer the question. It was a pretty straightforward question but he took 695 words to say nothing.
We know that precis is not part of the lawyer's art, but civil servants are rather good at it. I suggest that the Prime Minister let them draft his answer next time. I suspect that it will be very short. I suspect that on 18 June the answer would have been yes.
The Prime Minister may have prevaricated, but by not denying the story he has, of course, confirmed it. There is a Treasury-led review of NHS spending that will include consideration of charging patients for services in areas where there are currently no charges.
Both my right hon. Friends on the Opposition Front Bench, the Members for Fylde and for Charnwood (Mr. Dorrell) know something about the Treasury. We all 908 had our postgraduate educations there. I can only say to the Secretary of State that if the Treasury is in control of the exercise, it will fight its case to the wire and will win. For a start, Treasury officials were much cleverer than anyone else in the civil service.
Charging patients for services is firmly on the Government's agenda. Within six weeks of the election and of taking office, the Government are seriously considering something that, had we even hinted at it before the election, they would have raised an enormous moral hue and cry about. Perhaps that explains why the Secretary of State did not announce the review or its terms.
It has not escaped the attention of the House that the Secretary of State is more than a little sneaky with his reviews. Last Friday—a day when he knew that hardly any hon. Members would be in the House—he announced yet another review, of London hospitals. Surprisingly, however, quite a few Labour Members seemed to have advance notice.
§ The Secretary of State for Health (Mr. Frank Dobson)
I made it clear on the Friday that I made an effort to get in touch with all London Members whose constituencies were affected by the four hospitals named in my statement. I personally spoke to the one Conservative Member concerned and the one Liberal. Other Liberal Members were informed and were grateful, as was the right hon. Member for Cities of London and Westminster (Mr. Brooke). A number of Labour Members were also grateful.
The hon. Gentleman chides me for getting in touch with only a limited number of right hon. and hon. Members, but my actions were rather better than those of the last but one Secretary of State for Health, who sneakily announced the closure of Bart's, not in a statement on a Friday but in a written answer that was smuggled out because she was so gutless that she dare not come to the House.
§ Mr. Maples
I am interested that, of all the opportunities the right hon. Gentleman has had so far to intervene in my speech, he has chosen not to intervene on the substance of what we are debating. He is obviously rather sensitive. I suspect that he will make a speech not about the matters that I have raised but about something completely different. We shall see.
The Secretary of State is obviously rather sensitive about Fridays. I can only say that statements on sensitive subjects on Fridays are always regarded, justifiably, with much suspicion.
In any event, the Friday statement was part of a pattern of events. The right hon. Gentleman could have come clean and told the House what he was doing in the review of which I am speaking. After all, we are apparently in a new era of open government. Perhaps he has not heard about that. On the Tuesday after the Friday statement, however, the story had to be wrung out of the right hon. Gentleman.
On the same day, his Minister of State sent a detailed letter to hon. Members about a review of the private finance initiative in the NHS. I commend the Minister for doing so, but the Secretary of State should have done the same. Last week, the Secretary of State for Defence sent every hon. Member a letter announcing a defence review.
909 Reviews are becoming part of the Government's way of life, but why cannot the Secretary of State for Health be open about his, like his colleagues are about theirs?
The Secretary of State has consistently refused to explain what is happening. Only yesterday in Health questions I sought to elicit a narrowing of the gap. I asked the Under-Secretary to confirmthat in no circumstances will the parents of young children who are ill have to contribute financially to the costs of their medical treatment".—[Official Report, 24 June 1997; Vol. 296, c. 657.]Even I would have thought that the Labour party could clearly confirm that, but the hon. Gentleman could not do so. Perhaps he has had some line dictated to him by the Treasury, because his answer was remarkably short for him—it is a few years since I have heard him speak, but he used to go on a bit and he got his answer into four lines. I suspect that he could not confirm that because the Government are reviewing all areas of charges.
It is conceivable that the parents of sick children will be asked to contribute financially. Would any Minister like to deny that now? Would the Secretary of State like to deny that it is on the agenda? If he will not do so, it is reasonable for us to assume that it is on the agenda.
§ Mr. Maples
Even the right hon. Gentleman would deny that he was going to do that.
It is no wonder that this fire refuses to die down. We have had to use a Supply day to drag the Secretary of State to the House to explain himself and his actions. The Government's job is to make decisions, not to conduct reviews. The Labour party had 18 years to think about what it was going to do with the health service, and for most of that time it did nothing but criticise our handling of the health service. When Labour finally gets into power, it does not know what it is going to do. Those 18 years apparently produced no decisions and no clear policies.
No fewer than three reviews that we know about are being undertaken by the Department of Health alone. Reviews are not decisions: they are not even substitutes for decisions. They are usually undertaken to avoid decisions and to kick problems into touch. Perhaps the Secretary of State hopes that, by the time someone throws this ball back in, he will have moved on and the problem will be his successor's—there is probably a good chance of that.
I hope that the Secretary of State will note our questions, because the House is entitled to an answer. We want to know the exact terms of the review. It is instructive that the right hon. Gentleman is not making any note of that. That is an example of the increasing arrogance with which the Government treat the House, as though it is not entitled to ask questions of the Government and of Ministers and to expect answers. If he does not answer these questions, they will be tabled for written answer very shortly. What are the terms of the review? What is its timetable for reporting? Who is conducting it? Are any Ministers directly involved, and what Departments are represented?
The Government have tabled an amendment that is designed to allow the Secretary of State to avoid dealing with the issues and to attack us instead. It gives him an excuse for not coming clean with the House. I remind him that he is now a very senior Minister, responsible for one of our great Departments of State with a budget of more than £30 billion a year. That money is voted by the House, which is entitled to explanations of how the Department is run.
910 I invite the Secretary of State to respond openly to the debate: if he chooses to do so, he can clear the matter up once and for all in a simple sentence. If he does not, we are entitled to stick to our temporary and provisional conclusion that the Government are considering levying new charges on patients in at least three areas: pensioners' prescriptions, hospital hotel services and visits to general practitioners.
§ Mr. Richard Burden (Birmingham, Northfield)
Most people will recognise that the Government have been more open in the past month and a bit than the previous Government were in 18 years. Does the hon. Gentleman accept that it sounds odd for him to talk about Governments being open, as he penned a report for the previous Government in which he recommended that it would be best if no one said anything about their health policies for at least 12 months?
§ Mr. Maples
I expect that the Secretary of State will receive the same advice pretty soon if he goes on running health policy like this.
The British Medical Association and the Royal College of Nursing have expressed considerable concern about these proposals. Vulnerable people up and down the country will be worried about them. Even if the Secretary of State does not think that the House deserves an explanation, patients, taxpayers and people who are worried about the proposals deserve one. Apart from the merits or otherwise of introducing these charges, such an action would be a massive breach of faith with the electorate.
There is no mention of reforms to charges in Labour's manifesto. In fact, it is very short on health service reform. It simply says:access to it will be based on need and need alone—not on&ability to pay.If that is all it is based on, why does not the Secretary of State deny these rumours and deny that he is even considering charges? He cannot.
Labour has spent much of the past 18 years anathematising the very idea of charges whenever they have been raised, suggested, introduced or discussed. It tried to scare the electorate into thinking that this was Conservative policy. What hypocrisy that will turn out to be if all along it was Labour that was planning to introduce charges.
I shall quote a little of the fire that has been directed at us on this subject in the past few years to show just how rich an irony this matter will prove to be if it were not so potentially damaging to vulnerable people. If the Secretary of State plans to introduce these or any other charges, there will be an elaborate diet of his own and his hon. Friends' words for eating. We want to give him a little look at the menu, because, if our suspicions prove to be correct, he will be force-fed with those words, and we will enjoy watching him eat them very slowly indeed.
I have quotes from a series of shadow Health Secretaries going back a long way, but we do not have to go back very far for the first statement. During the election, the then shadow Health Secretary, the right hon. Member for Islington, South and Finsbury (Mr. Smith), said:A fifth Tory term will make hospitals and GP practices profit centres".It seems that at that time his party was thinking about doing exactly that.
911 Going back a little further to February 1996, the then shadow Secretary of State for Health—[Interruption.] I will give way any time a Minister wants to deny that the imposition of these charges is under consideration. In February 1996, the then shadow Health Secretary, the right hon. Member for Camberwell and Peckham (Ms Harman), said of a rise in prescription charges:This is yet another hidden tax rise, taxing people who are ill. Now people on low incomes face a cruel choice between paying through the nose or doing without vital medication.Apparently, they will have painful choices to make in a whole lot more areas if the right hon. Gentleman gets his way.
Earlier the same month, the then Leader of the Opposition, now the Prime Minister, said in one of his familiar attempts to scare voters about what the Conservatives were up to:A Tory fifth term is the nightmare. Will you be paying to see a doctor? … Will they say one thing before an election, and do another afterwards?How prescient it would have been, if the leader of the Conservative party had said that instead of the leader of the Labour party.
In a debate on these matters in 1995, a previous shadow Health Secretary, the right hon. Member for Derby, South (Mrs. Beckett), said:they are not just a tax but a fiscal mugging…we never have and never would use prescription charges as a tax on the sick".—[Official Report, 29 March 1995; Vol. 257, c. 1130–31.]Not unless the sick are pensioners.
The previous shadow Secretary of State for Health was the right hon. Member for Sheffield, Brightside (Mr. Blunkett), who described theidea of charging the sickas adisgraceful act".—[Official Report, 15 March 1993; Vol. 221, c. 118.]The shadow Secretary of State for Health before that was the right hon. Member for Livingston (Mr. Cook). This is a pretty complete record of all of them. He described the Health and Medicines Act 1987 as a "tawdry Bill", and said:The measures are objectionable … in themselves".It is interesting, given what is apparently being considered in the review, that the right hon. Member for Camberwell and Peckham, who wound up that debate, said:Will the Government ask health authorities to insist on charges for relatives who stay with a sick child in hospital? … It would be quite wrong to implement charges for relatives of children in hospital."—[Official Report, 7 December 1987; Vol. 124, c. 49, 100.]Perhaps the Government will deny that that is on the agenda.
§ Audrey Wise (Preston)
The Cystic Fibrosis Research Trust gave evidence to the Select Committee on Health about children with cystic fibrosis who need lung transplants, which is often a suitable treatment. It stated that it was unaware of any lung transplant centre that did not levy hotel charges for mothers who stayed with their children.
§ Mr. Maples
I think that what is under discussion now is whether the patient will have to pay hotel charges following the review.
912 Those are all quotes from what the present Government said about us. It is staggering hypocrisy, in the light of what is now being considered. The truth is that not we but the Government have been considering a massive extension of charges. [Interruption.] Labour Members sigh. If they want to deny that any of those proposals is on the agenda, I shall be happy to give way to them, but until they do I think that we are entitled to assume that the proposals are on the agenda. [Interruption.] The Under-Secretary of State for Health, the hon. Member for Brent, South (Mr. Boateng), nods and mutters a good deal, but yesterday he declined the opportunity to deny that sick children would be charged for hospital care.
The Government have another problem, and it is a particular problem for the Secretary of State. Ten years ago, a Labour Member of Parliament, a Frank Dobson—obviously he was nothing to do with the current Secretary of State, as they do not seem to agree on much—said in his 1987 election address:Labour will … get rid of prescription charges.I know that 10 years is a long time, but to go from getting rid of prescription charges to extending them is quite a jump.
The same Frank Dobson was quoted in the Morning Star. That shows how far back we are going: I do not think that he would want to be quoted in the Morning Star now. On 26 May 1987, it reported:Forcing the sick to pay to see a doctor could become the shocking reality under a third … Tory term.Charges to enter and stay in hospital … Frank Dobson revealed yesterday 'All Mrs. Thatcher's friends are absolutely mad on the idea.'It would be interesting to find out whether they are mad about the ideas that the right hon. Gentleman is now coming out with.
That was obviously based on a Department of Health press release issued a few days earlier, in which Frank Dobson said:The Tories know that the people of this country fear for the future of the NHS. That is why they have kept under wraps the far right ideas of charging for visiting the doctor or for staying in hospital.There we have it. There is one more report—in The Guardian, which is a bit more respectable than the Morning Star. It reported in April 1996:Labour's health spokesman, Mr. Frank Dobson, said: 'We will reduce prescription charges immediately with a view to abolition.Can that be the same Frank Dobson who is now Secretary of State? Perhaps someone has been going around Holborn and St. Pancras impersonating the right hon. Gentleman, trying to make a fool of him. He was still there in 1992, however. His 1992 election address was one of those election addresses that quote constituents saying nice things, and a lady was quoted as saying:Frank Dobson really knows what he's on about when it comes to the NHS.Well, that lady was right. Frank certainly knew what he was on about; he just did not tell the rest of us. I imagine that she would be very surprised to realise just how much he knew, and just how little he told her.
I suggest to the Secretary of State that that pile of words would make an awfully indigestible meal for him and his friends, but I say to him honestly that I hope that he does 913 not have to eat it. All that he has to do is say now that there is no way in which the review will even consider those possibilities, and that he guarantees that the Government will never charge pensioners for their prescriptions, charge patients to stay in hospital or charge people to visit their general practitioners.
The right hon. Gentleman has missed all sorts of other opportunities; perhaps he will take this one. He could deny the whole story. He could still go home early. If he denies the whole story, and states categorically that he is not considering such action and that it will not happen, I promise him that we will forget the whole thing and not mention it again. I hope that he will do that, but I somehow doubt that he will. I expect that we are about to hear not an answer to our charges or an explanation of policy, but a diatribe against the last Government and their record. We have heard that a good many times.
The Labour party is now in charge, however. The Secretary of State is famous for his bluff bullying, but we shall see it—as, I suggest, will those sitting behind him—for the smokescreen that it is, designed solely to avoid living up to the responsibilities of his office. I say to him, why not make a change and rise to the occasion for once? He should speak for the Government. He should speak like a Secretary of State, and tell us and his Back Benchers that what we have said is not true.
§ The Secretary of State for Health (Mr. Frank Dobson)
I beg to move, as amendment to the motion, To leave out from "House" to the end of the Question, and to add instead thereof:welcomes the commitment of Her Majesty's Government to the historic principle of the National Health Service that if someone is ill or injured there will be a national health service to help, with access to it based on need, not on ability to pay or on who their general practitioner happens to be or on where they live; notes the steps which are being taken to end the internal market, which is unfair both to patients and staff and which has resulted in massive sums being consumed by bureaucracy; welcomes the shift of funds into patient care, including cancer treatment, instead of paperwork; and looks forward to further changes which will ensure that once again the National Health Service provides the best health services for all and is ready to meet the challenges of the 21st century.I congratulate the hon. Member for Stratford-on-Avon (Mr. Maples) on his election, and on his new job as shadow Health Secretary. I hope that he will bring to the task the honesty that he displayed in his most famous contribution to modern politics—the Maples report, which spelled out what the people thought of the Tory Government, in the hon. Gentleman's opinion. He reported to the then Prime Minister that the British people believed that what the Tories were saying wascompletely at odds with their experience, which led them to concludethat the Tories were "stupid", "out of touch" and "lying", and "didn't care"; that they had "let voters down". They had been "in government too long", were "complacent" and hadlost a sense of direction.They hadfailed to fulfil their promises".For good measure, the hon. Gentleman also reported that people perceived the health reforms asclumsy, and believe what doctors and nurses say about them".914 How right he was. He went on to suggest that the Tories should identify what he described as some killer facts about their record, and repeat them endlessly.
I have always been one to take good advice, wherever it comes from, so I have collected some killer facts about the Tory record on health. None of what I am going to say is fiction; it is all facts—the facts about the position that we have inherited from the Tories after 18 years of Tory government.
The facts are that 59 of the 100 health authorities in England ended last year in deficit, 128 of the 429 NHS trusts ended last year in deficit, 42 health authorities were judged by the Department to have serious financial problems and 55 trusts were judged to have serious financial problems. Hospital waiting lists are at an all-time record at 1,164,000. Hospital waiting lists have increased by more than 100,000 since March last year. Waiting times are rising again, and the number of people waiting for more than 12 months has increased sevenfold since last year.
Capital investment in the NHS is at its lowest for a decade. The number of emergency operations is growing faster than the number of operations for people on the waiting list. The debt that the NHS owes its suppliers is at its highest-ever level. Prescription fraud is losing the NHS more than £85 million a year. The number of complaints to the health service ombudsman is at its highest-ever level. The Government's programme to put private finance into the NHS failed to build a single hospital, but that private finance initiative programme has cost the NHS more than £30 million in fees paid to consultants—who, moreover, did not manage to produce a single hospital.
Prescription charges are now 10 times higher in real terms than they were before the last Government came to power. The maximum dental fee is now 11 times higher than it was under the last Labour Government, and in some areas it is very difficult, if not impossible, to receive dental treatment on the NHS. Those are the facts, and there is no point in the Tories' trying to deny them. It is no good their trying to avoid the truth.
As I have discovered recently, the truth is a dangerous commodity in politics. I was found out telling the truth: I was what the shadow Secretary of State called indiscreet. What a heinous crime—a politician telling the truth. The truth that I told was that, as promised in our general election manifesto, the Labour Government were conducting, in and across each Department, comprehensive reviewsto assess how to use resources better, while rooting out waste and inefficiency".We are organising a comprehensive review of spending by the Department of Health, the NHS and the social services departments of local authorities—and so we should when such huge sums are involved. The NHS spends £36 billion a year, about £100 million a day of taxpayers' money.
§ Mr. Dobson
I explained that the review was to be intellectually honest and thorough, and that therefore nothing was ruled out and nothing was ruled in. Of course that included charges, as the Chief Secretary to the Treasury told the House on 11 June.
§ Mr. Forth
Before the right hon. Gentleman leaves the subject of truth, perhaps I may give him another opportunity to indulge in the use of that commodity. On Wednesday the Prime Minister said:We will have a national health service restored to the basic principles of the British NHS—the health service that we founded".—[Official Report, 18 June 1997; Vol. 296, c. 304.]Is one of the principles of the NHS to which the Prime Minister alluded that no patient should ever be charged at the point of treatment?
§ Mr. Dobson
The right hon. Gentleman ought to know that there are currently charges for treatment at the point of receipt. Our election manifesto included other promises relating to the national health service. We promised:If you are ill or injured there will be an NHS there to help…access to it will be based on need and need alone, not on your ability to pay or who your GP happens to be or where you live".Every aspect of our spending review will be judged against those criteria. The questions will be: would a particular proposal mean that access remained based on need alone or would it mean that access became related to the ability to pay? Would the introduction or the increase of a charge put people off seeking the treatment or care that they need? We intend to keep our promises, and they are the criteria that we shall use to make judgments in the review.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
The Secretary of State knows, because I have said it in the House, that it is perfectly proper for an incoming Government to look at Government spending and the spending of each Department. There is no argument about that. However, the debate is about the raising of money, and it would be helpful if the Secretary of State could answer a simple question. Why have the Government decided, according to what we have heard about the review, that charging is ruled in as a way to raise money for the health service while further taxes are ruled out?
§ Mr. Dobson
We intend to keep all our manifesto pledges, some of which relate to income tax. I know that the hon. Gentleman's party has made some manifesto pledges in the opposite direction about tax, but as we won the election we have to keep our election promises and not his.
There is no point in the Tories bleating about prescription and other charges. They increased prescription charges tenfold and top dental charges elevenfold. They pushed through the House laws that forced pensioners to pay for eye tests and dental examinations. They also failed to deal with the unfairness and the anomalies in the current charging arrangements. As the Chief Secretary to the Treasury has told the House, we will not ignore that unfairness and the review will look at the anomalies.
916 I shall give some examples of anomalies that the Conservative Government were apparently quite happy to put up with. The present exemptions from charges were agreed in 1968 but much has happened since then. There is now transplant surgery. Under the 1968 arrangements, people who needed lifelong medication were supposed to get free prescriptions, but transplant patients do not even get free prescriptions for their anti-rejection drugs. Another example is that people who receive chemotherapy for cancer and who have lost their hair can get free wigs if they are in-patients but must pay for them if they are day patients.
There is also the ridiculous case of elastic support stockings. Those who need two such stockings have to pay for two prescriptions, one for each leg. That is the anomalous charging system with which the Conservative Government were apparently quite content. As we know, that system is wide open to fraud, about which the Tory Government did next to nothing. What can one say about a system about which the official report stated that more than one pharmacist conceded that they had accepted forms from men who claimed exemption on the ground of pregnancy? That is the system that the Tory Government were happy to run and which the Tory party would like to protect.
Unlike the Conservative Government, we are prepared to take action to stop the fraud that is haemorrhaging £85 million a year from the NHS. We shall incorporate anti-theft and anti-counterfeiting devices in the printing of prescription forms. We shall have a scheme to reward pharmacies which detect stolen or counterfeit prescription forms. We are working on a new criminal offence of evading a prescription charge and on a fixed penalty for non-payment. We are examining the use of an electronic data interchange system for transferring prescription information, and we want to make more effective use of information technology by the fraud investigation unit.
§ Mr. Maples
Will the new criminal offence apply to people who try to get out of paying their GPs for going to see them?
§ Mr. Dobson
If Opposition Members who were in government, one at the Treasury and the other a Secretary of State, had done anything about fraud, this year the NHS would have £85 million more to spend on patients.
Every aspect of the NHS will be carefully examined in our comprehensive review. It will be careful and thorough and will involve Health Department officials, NHS staff and people from outside both services. I and other Ministers will be involved at all stages. As I have said, we shall judge all the propositions that are put to us against the need to keep our promise that access to the national health service will be based on need and need alone and not on the ability to pay.
§ Mr. Dobson
I shall finish this point before giving way.
I say to hon. Members, those in the health service and others, do not judge our review by what other people say is going into it. Judge it by what comes out of it. It is a bit like judging an operation, because it is the outcome that counts.
§ Mr. Michael Jack (Fylde)
I am grateful to the Secretary of State for outlining how we should judge the 917 review. So that we may be better informed, will he give an undertaking to publish the cost of putting right the failings that he has enunciated? Will he also publish the cost of correcting the anomalies that he identified? We need that information to judge the validity of his review. Will he supply it?
§ Mr. Dobson:
As I have said about three times and as I have said outside the House—causing a fracas—we shall consider everything in the review and publish such information as we think proper when we publish the outcome. I understand that every Department will publish the terms of reference of each review. That in itself will be a giant step in terms of public information about Government reviews of spending, because the Conservative Government never did that.
§ Mr. Dobson:
I shall not give way.
I shall accept no Tory criticism of our review. The systematic way in which we are going about the review is in marked contrast to the way that the Tory Government formulated their health policy. Their reorganisation of primary care was based on advice from a Tory doctor who was a smackhead, Dr Clive Froggatt. He advised Margaret Thatcher and successive Tory Health Secretaries, ending up with the right hon. Member for South-West Surrey (Mrs. Bottomley). He told the Observer that he was taking heroin every day
shooting up before meetings with Ministers".He added:no-one in Westminster noticed anything wrong".Conservative Members may be interested to know how he financed his heroin habit. He did it through prescription fraud, obtaining pure heroin in the names of dead or terminally ill patients. He ended up being convicted for fraud. Therefore, the Tories were advised on their major reorganisation of the NHS by a junkie and a fraudster. No wonder it is in such an organisational mess. No wonder we need a review.
Let me emphasise that the NHS is not going to stand still while the review is going on. We are getting on with keeping our election promises. We have already started cutting paperwork and unnecessary management costs, shifting the money instead into patient care. We have deferred the eighth round of fundholding and that has released £20 million from the NHS budget. That money has been redeployed. The first £10 million has gone into breast cancer diagnosis and treatment. Another £5 million is going into improving children's intensive care.
Surely everyone has to accept that that money is better spent on women and children in need than on the paperwork of fundholding, which is where the previous Government were going to spend it.
§ Mr. Dobson:
Because I do not want to. Other hon. Members want to speak and this is a short debate.
918 We are following that up by taking further steps to reduce the flow of invoices and other costly paperwork. To end the two-tier system, we will introduce a system of common waiting lists so that people are treated on the basis of need and need alone. That was our promise in our election manifesto and we will keep it.
With the support of clinical professionals, we are encouraging new ways of improving primary care and we are developing pilot schemes for local commissioning to take the place of fundholding and health authority contracting. The Minister of State, Department of Health, my hon. Friend the Member for Darlington (Mr. Milburn), will make an announcement about that shortly.
We have been sorting out the shambles that the Tory Government used to grace with the title "private finance initiative". They could have been prosecuted under the Trade Descriptions Act 1968, because they displayed no initiative and raised no finance. Far from keeping things private, they repeatedly made misleading public statements. They boasted about using the PFI to build hospitals and never built any. We will get them built using the PFI.
As our manifesto also promised, we are taking action against tobacco advertising. On 14 July, we are hosting an international summit on tobacco, which is being organised by the Minister of State, Department of Health, my hon. Friend the Member for Dulwich and West Norwood (Ms Jowell). We are also keeping our promise to establish an independent food standards agency.
We have commenced a drive to reduce inequalities in health. Poor people are ill more often and die sooner, and the ultimate inequality is the difference between being alive and being dead. Under the previous Government, the words "inequalities in health" were described as politically incorrect and the only phrase that civil servants were allowed to use in the Department of Health was "variations in health". The previous Government could not even stand the truth on that.
We have established an NHS efficiency task force to root out inefficiency and to identify savings throughout the NHS. The Under-Secretary of State for Health, my hon. Friend the Member for Brent, South (Mr. Boateng), is reviewing long-term care for elderly people and other groups, and he is making a series of visits throughout the country to promote more and better co-operation between health authorities, trusts and local authorities.
One other major problem that we inherited was the fear of abuse and assault among staff in the health service. Recently, I went to Queen Alexandra hospital in Portsmouth, where I spoke to a nurse who had been slashed a year ago and where I was told of a pregnant woman consultant who, in the accident and emergency department, was kicked in the belly by a lout who was drunk.
We are determined to do something about that. In conjunction with my right hon. Friend the Home Secretary, I am determined to ensure that the criminal justice system offers the maximum protection to staff and the maximum deterrent to loutish behaviour. As I have said, I give notice that people who start off by assaulting the "hello nurse" will end up in the arms of the "cheerio gaoler", and I want them to stay there for a long time.
§ Mr. Dobson
No, I will not. 919 I do not have time this evening to spell out all we have been doing to change the health service, to change it for the better and—unlike the previous Government—to change it with the agreement and enthusiasm of the staff involved, but that is what we are determined to do and what we are doing.
It is nearly 50 years since the Labour Government founded the national health service, in the teeth of opposition from the Tory party. They founded it on the basis that the best health services should be available to all: that quality and equality should be available to all. Those principles were put into practice. The NHS worked—until recently—exceptionally well.
The system was fair to patients and, because of that, it was comfortable for staff to run it. It was based on need, so it was clinically sound; people were treated because they needed to be treated. It was managerially straightforward because such a system kept paperwork to a minimum. As a result of the Tory changes, the NHS developed into a two-tier system that was unfair to patients, repugnant to the staff who had to run it and managerially complex and wasteful. That is why we are ending the internal market, as we promised in our manifesto.
Next year will mark the 50th anniversary of the national health service, which has served our country so well for so long. People everywhere will want to celebrate that anniversary; so we should and so we will. We will pay tribute to the founders of the NHS and to the generations of dedicated people who have made it work, but we must resist the temptation to spend the coming year looking back.
That is not what the founders of the health service did. They looked forward. They drew on their experience of what had gone before and they married that experience to their hopes of better things to come. That is what we must do: take stock of what we have, discard what does not work and build on what does. It is our job to fashion a health service for the future—for the next 50 years.
That is what this new Labour Government will do. The NHS is in the hands of the party that founded it and that believes in it. At the end of this Parliament, the NHS will be fit for the 21st century. It will provide the best health services for all—quality and equality, the watchwords of the Labour party, old and new.
§ 8.7 pm
§ Sir Geoffrey Johnson Smith (Wealden)
I heard an interesting speech from my hon. Friend the Member for Stratford-on-Avon (Mr. Maples) and I expected something better from the Secretary of State for Health. After all, what he suggested—the sum of the reviews that are likely to come up—is that £80 million should be saved here and that £300 million should be saved somewhere else. Obviously, it is useful to be able to save some money, but what he has announced so far is peanuts in comparison with the NHS' s total bill, of about £43.5 billion.
The Secretary of State's words would have carried more conviction if, when he said that nothing would be ruled out, he had outlined the sort of philosophical approach that he would bring to that phrase "nothing is ruled out". I should like to suggest to him some of the things that we would expect to come out of the review.
920 Frankly, the Secretary of State's speech was a disgrace to the House and to the way in which we run our health service. It was based on the same old party political battle. We claim to have made some progress in the pursuit of better health standards and of an improved health service. Anyone considering the standards that we have today, with the variety of operations, surgical techniques and the rest of it, would agree that we have made enormous strides, but, despite the innovations and improvements that have been made over many years, all we have had is an attack on what was achieved by the previous Government.
Basically, the attack has been based on the concept that what was introduced when the health service first came into being in this country, the principles that motivated it and the manner in which we financed it, could not in any sense be sacrificed.
The principles are fine—a service free at the point of demand. But do the Government really expect to be able to finance the further expectations of Britain' s patients without changing the way in which those services are delivered? No country that examines the way in which we finance health care regards ours as the envy of the world. We know that, when the NHS started, patients' needs were simple compared with those of today. That is one reason why there has been such a huge escalation in costs.
The NHS had a budget of some £9 billion in 1979 when the Conservative Government took office and it is now spending £43.5 billion. Do the Government really expect to continue to meet some of their targets under the present system of financing the NHS? Do any of members of the Government believe that it can be done? Neither the Secretary of State nor his colleagues have accepted that there might be some need to reassess the financing of the NHS; on the contrary, they have consistently rubbished every achievement of the previous Government.
We know why the NHS, as financed, forces any Chancellor of the Exchequer to face up to enormous financial difficulties. First, there are more elderly people. The cost of providing care for elderly people has escalated beyond the imagination of those who founded the NHS. Secondly, the explosion of modern medical technology and diagnostic techniques has far surpassed anything that many envisaged when the NHS was introduced. Thirdly, as I have mentioned, as a consequence of the progress that has been made, expectations have risen.
Nothing that I have heard today has given me reason to believe that the Government understand that there is no point in trying to rubbish the previous Government's record at a time when there was a massive explosion in health expenditure in Britain unless nothing really is to be ruled out.
I can remember when there were cuts in the hospital building programme, not the increases that we have seen since 1979. I can remember when prescription charges were first introduced. I have seen not cuts but an increase in real terms in public expenditure on the NHS, the like of which was never achieved by a Labour Administration.
§ Sir Geoffrey Johnson Smith
It is not rubbish. There may have been the odd year when there were cuts. I have heard the hon. Gentleman speak on this subject, but he 921 well knows that no Labour Government had to face the explosion in the number of elderly people and in new technology that has occurred. Instead, the Labour Government have made a political football of the NHS.
Not one country that has sent an expert to Britain has followed our example of trying to finance the huge explosion in medical expenditure almost exclusively out of public funding. I would take more heart if the Secretary of State showed a little more humility as he approached his task, rather than trying to kid us that nothing will really change.
The right hon. Gentleman, like his predecessors, accuses us of not spending as much on health care as other countries, but he knows very well that, unlike us, other countries have not accepted that there should be a gap between private and public expenditure. They have managed to bring the private sector into the funding of their public health service, either through non-profit organisations or through private insurance and a raft of other methods. There is not the divide that exists in Britain.
I hope that, when the right hon. Gentleman comes to rule nothing out, he will examine the role of the friendly societies, the mutual societies and non-profit organisations and groups that try to run some of our hospitals. In the 19th century, they and the trade unions played their part, and they are only too willing to try to play their part today in bringing additional funding to the NHS.
Instead of denying to elderly people the right to some tax relief from the age of 60, the Government should encourage people through the tax system to take on some responsibility for their own health care. Unless people take on that responsibility, as people do in France, Holland, Spain and throughout the western world, the only way in which the needs of modern health care can be met will be through the taxpayer, and I do not believe that that will work.
The right hon. Gentleman knows that, despite the huge increase in expenditure, we face a serious problem. Britain has fewer consultants than Holland. The Government might try to discover why we go through so many GPs and why, compared with America and elsewhere in Europe, we do not have enough specialists. That is a problem that needs tackling face to face with the medical profession.
The Government might wonder why there are recruitment problems in the NHS. That might have something to do with the pay structure and doctors' working hours. They might also consider the disproportionate influx of doctors from overseas. When those doctors now in their 50s retire, the Government will have to find replacements for them. Will they come from overseas or will the Government increase expenditure on the training of medical students and attract more people to the profession? There are weaknesses in today's NHS, and I have heard nothing from the right hon. Gentleman about that.
I come now to a matter that I hope the Government will recognise deserves their attention as well as that of anyone else with an interest in the NHS. Why has the Labour party always regarded any form of health provision outside the NHS as, by definition, tainted with capitalism or private profit? That could not be further from the truth. I have here a document giving instances of how it is possible today for people, although on a 922 smaller scale than one would like, to give professional and financial help to the health service. It is a document written by Fabians called "Towards a More Cooperative Society: Ideas on the Future of the British Labour Movement and Independent Healthcare".
Why does the right hon. Gentleman not give some obeisance to such a document? Perhaps he wants to discard it, or perhaps it is the sort of approach that he would like to see introduced. It would have been better if he had shown some humility instead of indulging in the usual rabble rousing, saying how everything is rotten under the present system. It can be improved, and he knows how. I assume that some Labour Members believe that something of that nature can be done.
The Secretary of State for National Heritage, the right hon. Member for Islington, South and Finsbury (Mr. Smith), welcomed participation by the private sector. In The Times of 8 May 1996, he said:
Surely it is time to get away from the sterile battle lines of public and private and instead look to how the two can best work together in the interests of the citizen—and in the interests of all citizens, at that.The hon. Member for Hartlepool (Mr. Mandelson) and Mr. Roger Liddell claimed in their book "The Blair Revolution":New Labour's objective should be efficiency, diversity and innovation in the provision of public services—not privatisation for its own sake. Service providers will not necessarily be conventional private companies. They might be employee-owned or they might be co-operatives. Many will be in the voluntary sector…what is most desirable is the emergence of a new generation of 'social entrepreneurs'.In other words, the distinction between private and public becomes irrelevant. That, I hope, is part of the thinking that leads the Secretary of State for Health to say that nothing is ruled out.
How encouraging it would be if, some months from now, after this comprehensive review, the right hon. Gentleman came back to the basic principle and the Labour party turned its back on the old-fashioned socialist dogma, according to which the health service can be safe in its hands only if it is financed almost exclusively by the taxpayer. I hope that the Labour party will come to accept the spirit behind the reforms that have been introduced slowly and steadily—too slowly, in my opinion—by the previous Government.
If that is the message that comes forth today, although I doubt it, I hope that it will be the first important step in taking the health service out of the rows that we have in politics today, and that confuse patients and people who work in the medical profession. They hate being made into a political football. I hope that, in the next few months, that will end.
§ Dr. Howard Stoate (Dartford)
Thank you, Mr. Deputy Speaker, for calling me to speak. I am pleased to be given the opportunity to speak on a subject that is of concern to my constituents and about which I have received many letters. I also have relevant experience of the subject in that, until the good people of Dartford elected me on 1 May, I was a full-time, non-fundholding general practitioner in the national health service. I know first hand how important it is to patients that the NHS is there to help them.
923 I congratulate my right hon. Friend the Secretary of State on his eloquent statement on how the NHS will be safeguarded and, indeed, improved under his stewardship. However, as this is my maiden speech, I should like to begin by paying tribute to my predecessors as Members of Parliament for Dartford since 1945 before making my substantive points.
Norman Dodds was elected in the landslide victory of 1945, which many thought would never be repeated—until the night of 1 May this year. In 1955, Sydney Irving began his first term as the Member of Parliament for Dartford. He was a good friend of mine and a colleague on Dartford borough council. I have followed his example in holding the position of chair of finance on the council and now as Member of Parliament for Dartford.
Sydney was loved and respected in Dartford. He was also admired in the House as a kind and intelligent parliamentarian. He rose to become a Deputy Speaker, before his defeat in 1979 when he became Lord Irving and moved to another place.
My immediate predecessor was Bob Dunn, who held the seat for 18 years from 1979. He held office as a junior Minister in the Conservative Government and served on the executive of the 1922 Committee. He was well respected in Dartford as a hard-working constituency Member of Parliament who always did his best for the people he served. I know that he took a close interest in many of the problems that were brought to him, and I hope to emulate his example and work hard for the people I serve.
Bob Dunn boasted in his election address that he had written more than 60,000 letters on behalf of his constituents during the time that he was in office. As well as seeking to help his constituents, I am sure that that was a valiant effort on his part to support the paper industry in Dartford, which has existed since Britain's first commercially successful paper industry was built in the town as long ago as 1588.
That brings me to the history of Dartford, which is probably best known as the southern end of the tunnel and bridge crossings that carry the M25 across the Thames. Dartford is, however, centred on the crossing of another river, the Darent. It was an important post on one of the earliest Roman roads to be built in Britain. Watling street joins London to the coast and continues to be the name of a major artery through the town.
Dartford continues to develop and there are still indications, in the forms of buildings and street names, of many of the ages in which the town thrived. The manor of Dartford was the source of taxes amounting to £82.12s, according to the Domesday book. I am sure that that compares favourably with the council tax that I set with my colleagues earlier this year, and I am convinced that the Labour council provides better services for the people of Dartford than they would have received in the 11th century.
The constituency is diverse and extends from the industrial banks of the Thames to the villages of rural Kent. The town reflects that diversity and looks two ways from its position between London and the coast. It is 15 miles from London, and many people commute to work in the City. It is also at the heart of the Thames gateway, which is the link to Europe from many parts of the country.
924 Dartford has a history as a centre for innovation. Richard Trevithick, famous for inventing the first railway locomotive, lived and worked in the town. He came to Dartford to work for a company that continues to have a prominent place in the town—J. and E. Hall Ltd. The tradition of innovation and commercial success continues to the present day with the presence of a major plant of Glaxo Welcome. Dartford is also the home of Electrosonics, a company at the forefront of technology in lighting and audio-visual displays.
Amid this wealth of industry and commerce, Dartford can also claim to be a centre of culture. As well as its own theatre—the Orchard—Dartford was the home of Mick Jagger, who was educated at one of the constituency's schools. He now has a performing arts centre named after him.
I now move on to the subject of the debate—charging for NHS care. As a full-time GP until the election on 1 May, I welcome the announcement by my right hon. Friend the Secretary of State of a thorough and wide-ranging review of the national health service. It has been a major backbone of the welfare state since its inception in 1948, and I believe that it still offers the best system of health care in the world. However, it is overdue for review.
One of my particular concerns—a point touched on by my right hon. Friend the Secretary of State—relates to the inconsistencies among the various exemptions from prescription charges. Let us consider the example of two patients whom I have treated personally. They have both suffered from asthma for many years and have always had to pay for their drugs on prescription. One of them has since developed hypothyroidism and, as a result, has become exempt from prescription charges—not just for her thyroid disease but for the drugs required for her asthma treatment. The other has developed hyperthyroidism and now suffers the double cost of paying for the drugs to treat that condition while continuing to pay for drugs for her asthma.
There is some logic in the history of this anomaly, in that replacement therapies are generally exempt from charges, whereas treatments for conditions of excess are not. As hon. Members are painfully aware, one usually pays for one's excesses sooner or later, and that philosophy certainly holds true for drugs. However, this rationale has been blurred by time, and conditions such as epilepsy and fistulae, neither of which involves replacement therapy, attract exemptions. Those differences are difficult to comprehend, and I know from experience that they anger patients who cannot understand why treatment is, or is not, exempt. GPs and pharmacists find it hard to explain and administer a system that is, at best, outdated and inconsistent and, at worst, unfair and that clearly penalises some people.
Multiple prescription charges are also a problem for patients. Hormone replacement therapy is an example. It is an increasingly popular therapy, being effective for both the treatment and prevention of disease. Women on HRT suffer less osteoporosis in later life. As well as decreasing the personal suffering of women who have fewer fractures as a result of that treatment, it saves significant sums for the NHS by reducing the number of women who need hospital treatment for fractured hips.
A number of different drug regimens is available, and different types suit different women. It is important for the patient and her doctor to identify the correct one if the 925 HRT is to be effective. For sound medical reasons, some of these therapies require the prescription of one drug, while others require a combination of two. Simply as a result of an appropriate, but different, type of HRT required, one woman can face charges twice those facing another.
Despite the exemptions for pensioners and people on benefits, I have too often been asked by patients to advise them which of two or three items prescribed they should obtain as they cannot afford more than one prescription charge. That presents a great dilemma for health professionals who have prescribed drugs in accordance with their best abilities but are asked to judge which would be the most appropriate for the patient. That is obviously second best and unsatisfactory.
The anomalies which I have mentioned have existed for many years and were not adequately addressed by the previous Government. The increases in prescription charges have not helped. At this point, I beg to differ with my right hon. Friend. In fact, prescription charges have risen from 20p in 1979 to £5.65 this year—an increase of 2,825 per cent., which is well above the increase in inflation for that period. According to my research, an increase based on inflation would leave prescription charges at slightly less than 60p today.
I welcome the proposed review and the commitment of my right hon. Friends the Prime Minister and the Secretary of State for Health to care provided on the basis of clinical need, not on the ability to pay.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
I am happy to follow the hon. Member for Dartford (Dr. Stoate). There has been a great influx of medics to the House. I am surrounded by them on our Benches. There are others on the Government Benches, although I am not sure whether there are any on the Conservative Benches. I am glad that there are some of us lay people left.
The hon. Member for Dartford and I are linked by one esoteric political fact that he may not know. By sweeping away his immediate predecessor, he joins the citizens of my borough, who swept the same predecessor away from Southwark borough council, where he was previously a Conservative councillor. That is now pretty well a no-go area for Tories. As part of the progressive movements in the south-east of England, I share some of his delight and wish him well. Dartford always strikes me as having a dilemma, not knowing whether it is outer London or deepest Kent, or something between. 1 have been there periodically and I am sure that it will benefit from his assiduous representation here. I hope that he enjoys his time here greatly.
During the general election campaign, members of the Labour party claimed that pensions would not be safe with the Tories. They wanted people to believe that, as the present Prime Minister said,
A vote for the Tories is a vote to get rid of the state pension.They were wrong. That was an unfair and disreputable allegation that was not founded on facts, but it unjustifiably frightened people. Today we are dealing with another allegation—that the Labour Government are thinking of charging people for a range of health service functions.
926 The difference between the allegation about the state pension being at risk under the Tories and that about charging in the national health service is that this one does not come from the Opposition, but is based on a Government statement. Today's debate is self-induced by the Government. The issue is on the agenda because the Government put it there, telling the country that they were going to have a review of charges in the national health service. The Government may not like the choice of subject for the first Opposition day debate, but it is their fault.
It is also a paradox that the Conservative party should choose the NHS as the subject of its first attack on the Labour party.
§ Mr. Hughes
Because for a long time, certainly until about three years ago, the NHS was not regarded as safe in the hands of the Tory party. Lady Thatcher's actions gave no great credibility to the claim that the health service would be safe in Tory hands. To his credit, her successor as Prime Minister tried hard to ensure that the NHS was seen to be as strongly supported and cared for by the Tories as by other parties.
Although there were many reasons for us to criticise the Tory Government on health—the two-tier system, the differing speed of treatment depending on who a patient's general practitioner was and the differing access to the health service depending on where a patient lived—I have never alleged that the right hon. Member for Huntingdon (Mr. Major) sought to do other than to preserve the NHS as a service paid for through taxation, or that he intended to privatise it. That was another unjustifiable allegation.
I did not know the precise date until my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) went round the corner just now to check, but I can now confirm that it was on 10 May 1951—seven days before I was born—that the then Labour Government passed
An Act to authorise the making and recovery of charges in respect of certain dental and optical appliances under the National Health Service Act, 1946, and the National Health Service (Scotland) Act, 1947".There have been charges in the NHS since the first post-war Labour Government. They were fought about in the post-war Labour party, but in the end the Labour Government introduced both the facility to charge and some charges. Of course they have been extended. They were supported and retained by the Labour Government in the 1970s and then extended again—in our view unacceptably—by the Tory Government under Lady Thatcher, who introduced charges for dental checks and optical tests for people who wanted to check whether they needed treatment.
Let us strip away the pretence. There have been charges in the health service since its inception. That is why it is perfectly proper for a new Government to consider charges. As one of the authors of the health section of our manifesto and a member of our policy committee, I made sure that our policies on health were worded correctly. We had a manifesto commitment at the election to freeze prescription charges, but then to review them. There are clearly all sorts of anomalies in the system of prescription charges. I have been in Committees that have addressed the matter, but never dealt with it.
927 Having also considered charges for eye tests and dental checks, we went into the election with the clear view that, on balance, they ought to go. People understood that we made a costed commitment to abolish charges for dental and eye checks. There may be a debate about whether that was right, but we carried out a review and came to that conclusion.
§ Mr. Paul Burstow (Sutton and Cheam)
I want to draw my hon. Friend's attention to an interesting answer to a written question that I received today, which is relevant to the debate. Does he agree that eye test charges deter people from taking the opportunity of having a regular eye check and therefore from gaining the health benefit that they would derive from it, and that free eye tests are a sound investment in preventive health care? Does he therefore share my surprise that, in the written answer that I received today, Ministers admitted that they have not even drawn up the terms of reference for a review of eye test charges and that no research has been commissioned? That seems strange.
Does my hon. Friend agree that the charges should be ended now, not later? More than 500,000 people over the age of 60 are not having regular eye tests. They are running the risk of losing their sight and will cost the health service far more as a consequence.
§ Mr. Deputy Speaker (Mr. Michael Lord)
Order. I remind the House that interventions must be brief and to the point.
§ Mr. Hughes
My hon. Friend was getting carried away by the novelty of being able to make an intervention, but his point was valid. [HON. MEMBERS: "But long-winded."] No. He was referring to a ministerial answer. I do not know and the Minister on the Front Bench now may not know precisely what the Chancellor will say next week. Indeed, I hope for his sake that he does not, because such matters are meant to be kept in the Treasury. However, the Chancellor has the option to deal with some of those matters next week.
One of the valid criticisms of the Government's review is that it appears to have no terms of reference apart from the generic phrase, "Nothing is ruled in and nothing is ruled out." There is a problem with that—it is not true. Of course it is appropriate to review spending in the NHS. I sought to put that point to the Secretary of State earlier and the Minister knows that I share his view. Money may be wastefully spent on all sorts of things, although I believe that the NHS is pretty well squeezed down because the Tory Government required it to cut costs year on year. However, we are talking not about expenditure but about raising revenue, and I have to tell Ministers on the Treasury Bench that they are different things.
Revenue is raised for the health service traditionally from only two sources—taxes or charges. I am not aware that significant amounts of money come in in any other way. The NHS can of course sell land if it is surplus to requirements and charge for private services that it contracts out, but the fundamental sources of revenue are taxes and charges. So today we need to hear where the Government stand on both those things. Sadly, and unfortunately for the Government, they have fudged the issue on both.
928 The argument is made even easier for Opposition Members. When the Labour party was in opposition only a year ago, it knew the score as well as it knows the score now. The right hon. Member for Edinburgh, Central (Mr. Darling), now the Chief Secretary to the Treasury, said in the Budget debate last November:
a year after the general election"—he was looking at the Red Book for the coming year—
we find that spending on health is set to be reduced in real terms.… It is abundantly clear in the Red Book that public spending on the health service is due to be reduced in real terms."—[Official Report, 3 December 1996; Vol. 286, c. 896.]The present Prime Minister, then the Leader of the Opposition, said earlier in the Budget debates:
the Department of Health's actual total spending in the year after next … will in fact fall by 0.7 per cent."—[Official Report, 26 November 1996; Vol. 286, c. 176.]If that was true then, to some of us it was bizarre that, until about a week before the election campaign began, the Labour party was committed to spending on the health service that was below even that of the then Tory Government. In a belated conversion—in Essex, if I remember correctly—the present Chancellor decided that he would up the amount of tax and spending to which the Labour party was committed to the same as that to which the Tories were committed. It is clearly not enough.
I do not believe that hon. Members from any party will find a single constituent who believes that a projected increase in health service spending of 0.2 per cent. per year for the next two years is enough when we have had 3 per cent. per year for the past five years. So someone has to grasp the nettle and say that more money must be collected from somewhere. It is no good waiting until the year after the year after next.
We have a deficit this year in the health service of about £300 million. The Minister of State, Department of Health, the hon. Member for Darlington (Mr. Milburn), has admitted it. He asked the questions when he was shadowing the health team in the previous Government.
§ Mr. Hughes
I shall give way to the Minister if he wishes. The figures on trusts and authorities at the end of the last financial year show a deficit of £300 million. If the Minister wants to correct me, I stand to be corrected. There has been a cumulative pattern. In the past few years, by all sorts of funny dealings, health authorities and trusts have had to borrow against the money ahead of them to keep themselves afloat. They have a duty to balance their budgets. That money could be found now and the debts could be paid off, but it can be found only from charges or from taxes.
My colleagues and I have said today, as we said before the election, that the money ought to be found by increasing taxes. Even if the Government want to hold to their commitment not to increase income tax, when the Chancellor comes to the House next week, he ought to find other taxes by which he can raise money for the health service. We offered to the Government and we offer them again the suggestion of an increase in employers' national insurance contributions, so that everything given to an employee as a perk as opposed to salary is chargeable. That would raise about £250 million 929 according to Treasury figures and more than £300 million according to our figures. The Government could put extra tax on cigarettes. According to the last Government figures, 5p on a packet of cigarettes produced about £200 million. That could make free dental and eye checks available again.
I am not telling the Chancellor to do either of the specific things that I have suggested, but the immediate need is not for the end-product of a review with no terms of reference, but to bring some money into the health service. If that does not happen, the Government can have a wonderful review. They can save money and in two or three years we may get the benefit of those savings. But the review will not benefit now the people who are waiting for 18 months between seeing a consultant and being treated. It will not deliver for the many people who are not being treated by the NHS today.
Another nonsense was again confirmed by the Chief Secretary to the Treasury the other day. There was a bit of a wobble in the Government at the weekend because it looked for a while as if they might change their position. Even if Government policy is successful—I hope that it is—and the social security bill goes down and more people go back to work—I hope that they do—we shall not be able to transfer the money saved from the Department of Social Security to the Department of Health. That is lunacy. Even if one is being the iron Chancellor and saying that the Government will not increase public expenditure overall above the Tory planned levels, it is nonsense not to be willing to spend the £30 million, £40 million or £50 million saved from one Department when people are knocking at the door of another.
I remember when the Prime Minister said that Labour would never put dogma before children's education. I ask the Minister to pass on personally, before Wednesday, my request to the Prime Minister and to the Chancellor that they should say that Labour will never put dogma before patients' health. It is dogma, and dogma alone, which prevents the Labour party from saying to the House, "We have inherited certain conditions, but patients and youngsters at school are the priority for the country, and we must produce some more money for them." Political U-turns can be popular. To say that one is wrong and to change before it is too late is better done early, before the winter comes and people are waiting on trolleys, and the Government find themselves under attacks similar to those made against the previous Government. I hope that the Government undertake that change.
I have a few questions that relate to where the necessary money will come from. The Government have made an honourable commitment to reduce the number of people on waiting lists by 100,000. How will we know when that is achieved? If the waiting lists go up by 500,000, will the Government then say, "Ah, that figure should have been 600,000." We need a few rules to judge how Government money will reduce the waiting list by 100,000 people.
The Government have also said that they will get rid of the Tory internal market. The Minister knows that I share his view about that, but I want to know when and how it will be possible for the constituents of Southwark, Darlington, Dartford and all the rest to receive the same treatment from their GPs, irrespective of whether they are fundholders.
930 There is also the mystery about the private finance initiative. First of all the Government said that they were against it, then they were for it and now they do not know. Eventually, the Government will have to come up with a clear view about a proper policy of public-private partnership in the health service. I am absolutely convinced that the Minister does not think that the PFI is wonderful, although I know that he will have to let a couple of schemes through on the nod, because some are banging at the door to be agreed. We must have a stable system that provides secure finance for capital expenditure in the health service, and that will not achieved by the PFI.
As for charges, I want to put my cards on the table. The Government have quoted their manifesto commitment, so let me do the same:
Labour commits itself anew to the historic principle: that if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone—not on your ability to pay, or on who your GP happens to be or on where you live.That pledge has some significant implications. It means that the Government should rule out now that people would be charged to see their GP or hospital doctor. If one was charged, by definition the NHS would be governed by payment at the point of access, and would not be free.
The Government have also not addressed what will' happen to a person who needs a particular drug, which he normally has to pay for on prescription. According to the Labour manifesto statement, if that person has a clinical need or a health need for that drug, it should be free. According to the press release of 13 June, the Labour party pledged that NHS care would be available to all according to need and would be free at the point of use.
If the NHS was bizarre enough to plan for someone to stay on a water bed in a five-star hotel while waiting for an operation, there is all the difference in the world between charging for that, which has nothing to do with health need, or charging for cosmetic treatment in terms of the surgery involved or the appliances used—again, nothing to do with health need—and charging people for things that they need because of a clinical condition. That is the test.
We believe that the Labour Government should have been able to say that there would a review of spending and charging, but that they had some principles to which they would adhere. They should make it clear now that they will not charge for the health care that the NHS provides, because that will be funded by taxation.
We thought about those matters before the election. I agree with the hon. Member for Stratford-on-Avon (Mr. Maples): the Labour party has had 18 years to think about what it would do when in government and, having arrived after 18 years' preparation, it is a bit thin, weak and inadequate for it to come to the country and say, "We know there is a problem and we know we need the money, but we haven't got a clue yet about how we're going to raise it." That just ain't no answer. It really is inadequate.
Two thirds of my constituents are on welfare benefits; 25 per cent. are out of work; and I probably represent fewer people with private health care—apart from those in the new riverside developments—than any other Member of Parliament. My constituents are troubled by 931 the thought that the Labour party has not sorted out its line on those matters and is now introducing an agenda item that had not previously been thought of.
In conclusion, I offer the Minister some suggestions. Tell the Chancellor to raise some taxes in the Budget next week. For example, about £500 million would be relatively painless, and I gave two suggestions earlier on how that could be done. Fund a moratorium on London and outside London reductions in service, so that we can see what is going on before planning what we do next. [Interruption.] I am asked how much that would cost; the answer is that it would cost about £185 million. Merge trusts in the many places around the country where separate community and acute trusts are not needed and we shall save a lot of money.
Move as the Government want to do, but as quickly as possible, to five-year contracts between trust and health authority. Replace local with national pay bargaining and establish a single pay review body. Collect the money from the private sector to cover the cost of training all the people who have left the NHS—private companies have never been charged the full cost of that. Implement the recommendations of the Select Committee on Health, on fair distribution of resources around the country. Look broadly at private finance options, but do not limit that to the PFI. Finally, the Government should put their hands up and admit that there will always be rationing in the health service—it is a matter not of whether, but of how.
This month, it is every commentator's comment that the Labour party is wrong to think of reviewing charges but not of raising taxes. Labour has come to government with very modest commitments on health—they are far too modest and they are inadequate to the task. A review of charging that rules nothing in and nothing out without facing the real issue of raising money through taxes—which is the way in which the NHS should be funded—will not just disappoint the Government's supporters. It might, as it did for the Canadian Government when they did the same, result in a much speedier ejection from office than this Government bargained for.
§ Mr. Tony McWalter (Hemel Hempstead)
Thank you, Mr. Deputy Speaker, for giving me this opportunity to make my maiden speech this evening. I must begin by apologising to the Opposition for using a short period of the Supply day in order to obey the normal conventions governing such speeches. I hope that I will be forgiven for that.
In connection with those conventions, I want to introduce myself as the Member of Parliament for Hemel Hempstead. Of the four people who have been closely associated with the seat, three still have the distinction of serving in the House. One is the hon. Member for South-West Hertfordshire (Mr. Page). Of the two others, one sits on the Opposition Benches and the other on the Government Benches. The one on this side is my hon. Friend the Member for Birmingham, Erdington (Mr. Corbett), and many people in my constituency still think that he is their Member of Parliament.
My immediate predecessor was Robert Jones, who served with great distinction on environmental matters. In 1986, he produced a Bill to preserve hedgerows; he was 932 Chairman of the Select Committee on the Environment; and he later served as a Minister at the Department of the Environment. I pay tribute to his work in that connection and, as a member of various environmental organisations such as Greenpeace and Friends of the Earth, I hope to be able to continue his work. I particularly want hedgerows to be preserved, even if they contain somewhat fewer than seven separate identifiable species of leaf, which seems to me to be still too little protection. My predecessor served for 14 years, and I believe it would be fair to say that he was rather surprised by the general election result, but that is the way that things go in politics.
My constituency is called Hemel Hempstead, but it includes quite a lot of countryside around the new town that gives it its name. That countryside includes the Ashridge National Trust property, which I believe to be one of the few areas in the south of England that is owned by the National Trust. If one flies over the constituency, one gets a strong sense of greenery and of rural atmosphere.
There are villages in the north: Great Gaddesden and Little Gaddesden—in the British way, the latter is larger than the former—Markyate and Flamstead. In the south of the constituency is Kings Langley, which the hon. Member for South-West Hertfordshire used to represent and which I now do.
In the east of the constituency is the M1—most people only see the sign and zoom straight by—near Leverstock Green, where there is long-standing evidence of Roman settlements.
The major part of the constituency is Hemel Hempstead, a new town which has been fantastically successful. It is a great tribute to the concept of planning—the concept that each community in the town could have a green area for recreation and that good-quality housing could be provided for people who were being moved away from the devastation that had been caused by the second world war.
The town has running through it one of the longest stretches of canal in my constituency. I should very much like to see a major improvement in transport which might put Hemel Hempstead more prominently on the map.
To come to health matters, within that town is a hospital. The hospital is badly located, as so many hospitals are. Access to the general hospital is difficult; but it would not be difficult if a very short section of road were constructed from the A414, across a field that was long ago nominated for the purpose.
I have heard much from Opposition Members about how we might get additional funds into the health service, but I note that, in today's edition of The Times, it is suggested that the windfall tax proposed by the Government might be interpreted much more generously than has been thought.
I have taken the opportunity to suggest to my right hon. Friend the Member for Dunfermline, East (Mr. Brown) that my link road—very short, very cheap—would enable people to develop skills, that the revenue implications in future years would be very insignificant, and that that road might be used as part of that programme. After all, if young people must work, they must work on something, so why not a road to my hospital?
Perhaps in future we shall be more imaginative about the ways in which we raise funds than the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) has 933 suggested. I wrote to my right hon. Friend the Secretary of State for the Environment, Transport and the Regions about my road, but I have not yet had a reply. I suspect that I shall not have one until after Wednesday 2 July, and in many ways this debate seems extremely premature, because we do not know what the funding arrangements will be.
The other aspect of my local hospitals is closed wards. Fifty-six beds are being pulled out of service. The local NHS trust has a deficit of £2.5 million, and the health authority has a reputed deficit of £10 million. That is the local variation of our inheritance from the Conservatives.
It is often felt that, when the Conservatives were in government, they wanted a system that meant that, if one could afford to go private, one would be cosseted and looked after, but, if one went into the public sector, one would have to make do with a really bad system. The idea was that as many people as possible who had the money would remove their custom from the public to the private sector.
Wards are closed for all sorts of reasons—sometimes for refurbishment. The closure of our wards means that older people are denied access to them, and paediatric provision is being cut. The fact is that wards are usually closed for lack of money.
It is therefore right to ask whether we are ingenious and committed enough to halt the decline in services which is our inheritance from the Opposition. I really hope that ways will be found to provide my general hospital with proper access, so that it can flourish and people can go there secure in the knowledge that they will be treated properly. I hope that they will not find, on turning a blind corner, a place full of dust and decay. They should not be worried about leaving sick relatives there.
We have a long way to go, and I hope that the new Government will approach the funding of the health service with a different and better philosophy, based on co-operation and a great deal more commitment to caring for the health of those who cannot be treated in the private sector.
§ 9 pm
§ Mrs. Theresa May (Maidenhead)
I congratulate the hon. Member for Hemel Hempstead (Mr. McWalter) on an excellent maiden speech and on having spoken without notes. That is a brave move in the House—almost as brave as asking Ministers for money to be spent in his constituency.
During the short time I have been in the House, the mantra consistently heard from Ministers has been that they are doing whatever they are doing because it was in the manifesto. One might applaud that apparent commitment to the manifesto, were it not for the fact that Ministers have just as consistently turned their backs on the manifesto and broken their election promises. Take, for instance, the Local Government Finance (Supplementary Credit Approvals) Bill, which does not release local government's capital receipts, but merely increases borrowing. The assisted places scheme is being abolished, but no extra money is going into primary schools to reduce class sizes.
Nowhere has this disregard for election commitments and manifesto promises been so callous as in the subject under debate tonight, the national health service. Time 934 and again, before and during the election, the Labour party told us, and the electorate, that, if the Conservatives got back into government, the future of the NHS would be dire; but, if Labour got in, everything would be rosy. Suddenly, it was claimed, all the problems in the NHS would be solved: the electorate could trust the Labour party with the NHS.
Labour's manifesto has already been quoted by several hon. Members, but I make no apology for quoting it again. It is important to remember exactly what it said:
Labour commits itself anew to the historic principle: that if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone—not on your ability to pay".Yet, a few weeks after the election, the new Secretary of State for Health announces that there will be a review, with no holds barred. Everything is on the agenda:
We are ruling nothing out".When asked specifically about charges for seeing a GP, he said:
You can't pick bits out of it. We are going to look at everything.Today, the Secretary of State said that he was paying the price for telling the truth. He cannot, however, have it both ways. Either the Labour election manifesto was telling the truth or the Secretary of State is. The statement that access to the NHS will be based on need and need alone, not ability to pay, is incompatible with the Secretary of State's refusal to rule out charges for pensioners' prescriptions, stays in hospital, or visits to the GP. I challenge the Government to tell us which we should believe: the Labour party manifesto or the Secretary of State for health?
In his opening remarks, the Secretary of State gave some insight into the review, but it did not amount to much. He said that the criterion against which the proposed charges would be judged was whether access would be related to ability to pay or whether people might be put off using the national health service. As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) pointed out, charging people for visiting a GP is entirely inconsistent with that criterion.
It is open to the Minister who will respond to the debate to state clearly that he accepts what is in the manifesto—that access will be based on need, not on ability to pay—and recognises that, as both Conservative and Liberal Democrat Members have pointed out, charging people to visit a GP is contrary to the principles set out in the Labour party manifesto. Will he put our minds at rest tonight by saying that there will be no charges for hospital stays, access to GPs or prescriptions for pensioners?
It is a simple matter. The Labour party manifesto sets out principles for the national health service. Either the Government believe in those principles or they do not. If they believe in them, they should rule out the three possibilities of charges that are raised in the motion, because they are clearly incompatible with the principles set out in the manifesto. I urge them to give a commitment tonight, not only to Opposition Members but to Government Back Benchers and people who are extremely worried by statements that they have heard from the Secretary of State for Health on those issues.
Last Friday, this issue hit the front page of the Maidenhead Advertiser, the main paper in my constituency—[HON. MEMBERS: "A very important 935 paper."] Absolutely. Labour Members may scoff, but the issue hit the front page because of the significant number of my constituents who will be affected if pensioners are charged for prescriptions.
My constituents are extremely worried, and they want to know why a Labour Government who, in opposition, said that the health service was safe in their hands, and claimed that the Conservative party was a threat to pensioners' access to the health service and to pensioners' way of life, were now considering charging pensioners for prescriptions, and had gone back on statements made during the election and in their manifesto.
I have often heard Labour Members say that the Government will govern in fairness. Is it fair to worry pensioners by refusing to rule out the possibility of those charges? Is it fair to charge pensioners for prescriptions? Is it fair to charge a mother for taking her sick child to a GP?
The answer lies in the hands of those on the Government Front Bench tonight. It is simple. The Government say that they are sticking by their election manifesto. If they believe in the principle set out in the manifesto—that access to the national health service should be based on need, not on ability to pay—the Minister should stand up tonight and rule out the possibility of charges for prescriptions for pensioners, charges for stays in hospital and charges for visits to the GP. That is what people want to hear from the Government. If they believe their own manifesto, that is the commitment that they will give the House tonight.
§ 9.9 pm
§ Mr. Harold Best (Leeds, North-West)
I am grateful for the opportunity to make my first contribution to this honourable House by participating in the debate.
Tradition has it that I should comment about my constituency and my predecessor. I can do both with considerable pleasure. My predecessor was Keith Hampson, whom I got to know fairly well. By common consent of all in the constituency, he was a good constituency Member of Parliament. He worked on behalf of his constituents, and he also played an important role on behalf of his party. He supported the Government most of the time, I understand, while maintaining that critical faculty which is essential for any self-respecting, active politician.
As an opponent in the recent general election, Keith Hampson's behaviour was both warm and proper. I am truly grateful for the way in which he behaved, and I have fond memories of him. In short, he was a good man, and, I am pleased to say, remains a good man. I look forward to seeing him again, but not in this place.
My constituency, Leeds, North-West, is a wonderful mixture of places and people. It runs from an inner-city area known locally as Hyde Park, out to the beautiful lower Wharfedale. In the lower part of lower Wharfedale, it encompasses the lovely little town of Otley, which is picturesque but extremely hard-working. The constituency is a fine mixture of industrial and urban life, and rural idyll.
The constituency manages to mix high technology in the electrical engineering industry—the production of precision electrical switchgear—with a successful farming industry. Sadly, there is also considerable unemployment in the inner-city part, and other associated problems.
936 We have in the constituency the greater part of two large universities. Living in a particular area are 35,000 students, who have not been without significant influence on the electoral process. Given their recent voting pattern, I hope that that remains so. I am one of the few candidates who moved from third place in the constituency to first place.
We also have two large hospitals in the constituency. Wharfedale general hospital is an extremely successful general hospital. It provides exactly the kind of services needed from a general hospital and, in addition to serving the health needs of the people of Wharfedale, it provides 600 jobs, which is not insignificant in a rural area.
Cookridge hospital specialises in radiotherapy treatment. It helps thousands of people from all over the area, as far and wide as Newcastle and Sheffield. It is seen largely as a regional hospital treating cancer patients.
In recent years, those fine hospitals have been under a cloud of uncertainty and anxiety about their future. We have tried to resolve the matter within the constituency. People need to know that hospital services will be available when they need them. It is a question not just of the services being freely available, but of their being available when they are needed.
There are serious doubts about the continued operation of Wharfedale hospital. A review has been conducted, and we have tried to obtain the results. During the review process, the representatives of various management levels attended public meetings, and assured all concerned that they would soon know about the proposals.
Although we have addressed the appropriate questions to the appropriate levels, we are none the wiser. Most people believe that the problem lies with the last few years of Conservative government. When we have received replies from management, I have been reminded of the American President Calvin Coolidge in the early part of the century, of whom it was said:
He didn't say much but, when he did, he didn't say much.That is the kind of response that we have received from Tory Ministers and the layers of hospital management with which we have had to deal.
It is not that local people have not made an effort: town and district councillors have campaigned on behalf of the hospital, and petitions have been organised. However, the deafening silence continues. Otley town council enlisted the assistance of a local employer, and located a large plot of land. The council and that employer may be able to find the funding necessary to develop a private finance initiative project. However, we have received no response from Government—until now.
It seems that the future of Wharfedale was taken seriously by everyone except the Tory Government and the hospital administration. I am pleased to see that that situation has changed. I have written to my right hon. Friend about the issue, and I have already received a reply. We are looking forward to the conclusion of further developments that will bring light and hope to my area. We are certain that the review's findings will be positive.
The Cookridge hospital is also under threat, and I am sure that my right hon. Friend will hear about that in the near future. We look forward to the implementation of Labour's manifesto promises. There must be an end to waiting lists for cancer surgery and an improvement in the diagnostic systems available to women suffering from 937 breast cancer. The people of Leeds, North-West, whom I am pleased to represent, voted for many things in the election: not least for a one-class—a first-class—health service that is available to all people in their time of need. My right hon. Friend has reiterated those promises tonight, and I look forward to seeing them delivered in my area.
§ Mr. Tim Loughton (East Worthing and Shoreham)
I congratulate the hon. Member for Leeds, North-West (Mr. Best) on his eloquent maiden speech and thank him for his kind words about his predecessor, Keith Hampson. The hon. Gentleman is truly privileged to represent a constituency in God's county.
I congratulate other hon. Members who have made their maiden speeches tonight. The hon. Member for Hemel Hempstead (Mr. McWalter) referred to Robert James. I agreed with the hon. Gentleman about hedgerows and driving up the M 1. However, when he spoke of the Conservative Government's treatment of a hospital in his constituency, my foot remained on the accelerator and I continued along the Ml.
I should also mention the exceedingly eloquent contribution of the hon. Member for Dartford (Dr. Stoate). It must be satisfying to be able to contribute to a debate on a subject in which one has professional knowledge and for which one has trained. Alas, for my part, I decided it was politic not to wait for a debate on Mesopotamian architecture before I pitched in with my contribution. If the hon. Gentleman's skills as a doctor match his skills as an orator, he must have a healthy bunch of constituents.
The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) rightly said that it was ironic that the Opposition are using the first opportunity presented to them to attack the Government on the words that they are using about the national health service.
The Secretary of State made an interesting and informative speech: alas, that was not this evening and not in the Chamber. The right hon. Gentleman has, of course, brought the debate upon himself by the words that he has uttered recently. It is ironic that only a few weeks ago the electorate faced the scam of a manifesto that, in effect, carried the banner, "We shall save the NHS". Appalling scaremongering about the NHS went with that. With indecent haste, the "Save the NHS" banner has become "Let's save the NHS a lot of money" by introducing charges never contemplated by the Conservative Government.
The Secretary of State promises one of the now legendary Government reviews. We are promised that it will be a no-holds-barred review. The right hon. Gentleman says, "We are counting nothing in and nothing out." That hokey-cokey approach to election pledges is symptomatic of the steamroller approach that is characteristic of the Government's early days.
My hon. Friend the Member for Stratford-on-Avon (Mr. Maples), speaking from the Opposition Front Bench, repeatedly invited the Secretary of State to deny that the Government have any intention of introducing the charges to which I have referred and to say that they are counting the fundamental tenets of the NHS out of their review. Those tenets include free-at-the-point-of-access care and other fundamental beliefs on which Conservatives have run the NHS for most of the century.
938 The Secretary of State refused to rule out the possibility that the Government are considering introducing charges for hotel accommodation. The right hon. Gentleman refused also to rule out the introduction of charges for interviews with general practitioners. He refused again, most markedly for my constituency, which has the highest proportion of pensioners in the country, to rule out the prospect of charging pensioners for prescriptions.
§ Mr. Loughton
I shall continue. There is not long before the Front Bench spokesmen respond to the debate.
A few years back, the Secretary of State, as he now is, said:
The Tories know that the people of this country fear for the future of the NHS. That is why they have kept under wraps the far right ideas of charges for visiting the doctor or for staying in hospital.Far right—that is scary stuff. The Labour party has come a long way.
I take up the issue of charges for interviews with GPs. In West Sussex generally we have a fine reputation for GP fundholders. Over two thirds of GP practices in the county are fundholding practices. I spent much time with skilled fundholders. I sat in surgeries and watched pensioners come in and go out.
In one surgery, which I have visited many times, an elderly patient saw the doctor about some growths on his wrist. It is a common ailment for elderly people. The doctor asked him, "Can you come back tomorrow? I shall do it then." The patient, who lived just up the road, was able to return 24 hours later and have the growths removed under local anaesthetic by his own GP, one of more than 80 per cent. of GPs who are qualified to perform minor surgery. That cost a fraction of what it would have cost to send him to the nearby Worthing hospital, where he would have been put on a waiting list and have had to wait months for that treatment. Will such treatment be liable for charges? Is there any incentive for that person and many like him to go to such a local community hospital GP fundholder practice to be cured of minor ailments? I contend that there is no incentive.
West Sussex is already penalised by not having a fair share of the NHS funding cake, especially in the Worthing district. The prospect of pensioners having to pay for prescriptions is already causing untold worry to many of my constituents. The issue has appeared on the front pages of my local press, as it did in the local newspaper of my hon. Friend the Member for Maidenhead (Mrs. May). Under the previous Government, more than 82 per cent. of prescriptions were free, and the number of NHS treatments that registered a charge declined, so that they accounted for less than 2 per cent. of overall NHS funding. That is a worthy record of declining charges, but now, unless the Government deny it, it will be severely reversed.
Only two countries in the European Union charge pensioners for prescriptions. We are one of the few European Union countries that does not charge for visits to GPs. Are we to be subjected to a harmonisation of GP and prescription charges to show ourselves as good Europeans?
939 We have been promised—and are likely to see in the Budget next week—the abolition of tax breaks for pensioners who have taken out private health care insurance. That is yet another example of false economy. Those people who, as a result, will not be able to pay for private health care will be added to NHS waiting lists, just as those who are unable to go on the assisted places scheme will add to the supposed overcrowding in many classrooms.
It is clear that we are starting to see the Government's hidden agenda. They want to claw back money from the elderly and the vulnerable to make up for the shortcomings of their commitments. They want to make up for the enormous bill that the minimum wage will generate when it is introduced into the NHS: it will probably amount to more than £500 million. They want to make up for adding pensioners to waiting lists by scrapping the tax relief on their private health care policies, which will have a domino effect.
They want to make up for the enormous costs of abolishing GP fundholders and the massive disincentive to existing GP fundholders: they will no longer be responsible for their budgets, so why should they bother to keep within them? They want to make up for the costs of dismantling trusts and returning to the nanny state approach, so that the success of locally run, locally purchasing and locally planning hospital trusts will be crushed under the steamroller of centralised bureaucratic placemen. None of those things will add one iota to patient care and to the good of patients.
It is shameful that we have had to have this debate. It is more shameful that Ministers have treated with contempt this opportunity to allay the fears of my constituents, especially the sick and the elderly.
§ Mr. David Lock (Wyre Forest)
I am grateful for the chance to make my maiden speech on the important issue of health. Bearing in mind the time, I shall be shorter than I might otherwise have been, but I hope that brevity will assist in the quality of the speech.
It is a privilege to be sent to the House to represent the people of Wyre Forest. The constituency covers north-west Worcestershire, including the towns of Kidderminster, Stourport, Bewdley and many surrounding villages. Bewdley is a delightful mediaeval town nestling in the Severn with a well-deserved reputation as a tourist venue. It has an excellent festival. Kidderminster and Stourport have long traditions in the carpet industry. The factories may not be as numerous as in earlier years, but people in Kidderminster know the difference between a woven and a tufted carpet like no one else in Britain.
The industry has suffered in recent years, but we have some fine companies that are investing in a confident future. They include Brintons—a predecessor of mine in the constituency, Sir Talton Brinton, was the second member of the Brinton family to represent Kidderminster—and Tomkinsons and Victoria, which are investing in the future to provide secure jobs for the highly skilled work force in the area.
I thank and pay tribute to my predecessor, Anthony Coombs, who held the seat for 10 years. He was a diligent constituency Member: he became someone on whom his 940 constituents could count, and he was always most courteous in his dealings with me. His concern for his constituents has risen above his disappointment at losing his seat. He was gracious at the count, and has been very co-operative in handing over constituency case files. I am grateful for his assistance in breaking me in to this most unusual but privileged of jobs.
This debate, however, is about the NHS. In Worcestershire, we have a health authority that is in deficit—one of 59 such authorities. The trust that runs Wyre Forest's only hospital, Kidderminster general, is carefully managed; but it is in deficit, and the fact that it is an agreed deficit, anticipated in the budget, does not remove that deficit. For years the trust has been spending in the hope of rises in future years, but its hopes were dashed each time by the previous Government. A review is in progress at the moment, but I am confident that it will uphold the position of smaller hospitals such as Kidderminster. It is an impressive hospital with an excellent accident and emergency department, and I am sure that the strong arguments in support of it will be maintained.
In the short time available to me, let me say that we shall need—among other things—a serious national debate on priorities for the health service. For too long, doctors have been asked to make all the choices, and service provision is patchy across the country. The market beloved of Adam Smith and the Conservative party is an amoral device, and many issues in health care require moral decisions.
I wish to raise four specific matters. First, what will be the weighting between new drugs and established treatments? The former may offer the possibility of better results for the few, while the latter may benefit larger numbers at lower cost. What of social factors, such as bad housing—and smoking, which kills 1,600 a year in my constituency and adds half a million pounds to the costs at Kidderminster general hospital? The better a person's circumstances, the more treatment may help that person from an objective point of view; but it cannot be right to refuse treatment to the poor while allowing it to those in better circumstances.
What of the elderly? The fact that so many people are living longer is a tribute to the success of medicine, but is there to be a cut-off date? What of specialist treatments, which are vital to the few but ignored by the many? As a parent, I know the joys of children, but what level of funding should we give fertility treatment?
Those are difficult issues. We have a national health service now, but there is a lottery of care across the country. In each of the examples that I have given, different policies are pursued by different health authorities in different parts of the country. We need a national debate on priorities in health care—a debate way outside the confines of the narrow motion that we are discussing—and I am confident that the new Government are prepared to embrace such a debate. We also need a debate that goes beyond the medical profession and the Government, so that the people can have a say in decisions about the people's choices for the people's NHS.
This debate on charges is a tiny part of a much larger debate. I have every confidence that Ministers have the ability, the wisdom and the courage to face those difficult issues in the months and years ahead.
§ Mr. Michael Jack (Fylde)
I congratulate the hon. Member for Wyre Forest (Mr. Lock) on his splendid maiden speech. He will be a great asset to the Opposition Whips because he did exactly what they told him to do by cutting his speech to leave time for the winding-up speeches. I thank him for that.
I congratulate my hon. Friend the Member for Stratford-on-Avon (Mr. Maples) on his comeback speech. He made a telling contribution; during his absence from the House he lost nothing of his incisive ability to get to the heart of the matter. He exposed the Secretary of State for what he is—the purveyor of large amounts of smoke, a screen and waffle. He did not respond to any of the Opposition's substantive points.
I also congratulate the hon. Member for Dartford (Dr. Stoate) on his speech and thank him for his kind words about his predecessor, Bob Dunn. Mr. Dunn will be grateful for the hon. Gentleman's comments and I am pleased to know that we have another doctor in the House.
In a telling contribution, the hon. Member for Hemel Hempstead (Mr. McWalter) showed that he will be a real handful for the Labour Whips because within seconds of rising he asked for money. That is dangerous, and not only the Minister without Portfolio but the Chancellor of the Exchequer will have a word with him.
The hon. Member for Leeds, North-West (Mr. Best) made kind comments about Keith Hampson and I was delighted to hear what he said about Leeds. I know the city well and he spoke of it with passion and conviction. The hon. Member for Wyre Forest mentioned Anthony Coombs and it would be remiss of me not to thank him for those kind words. He also made some interesting comments about challenges for the national health service.
There were some useful and thoughtful Opposition speeches. My right hon. Friend the Member for Wealden (Sir G. Johnson Smith) spoke from his great experience and properly drew the House's attention to the challenges that will face the NHS in the 21st century. He was right to speak about the long term. The theme of the debate was to try to prise from the Government their short-term thinking, never mind their long-term thinking, and that proved extremely difficult. The Secretary of State, a senior Minister, failed lamentably to rise to the challenge of answering straightforward questions from my hon. Friend the Member for Stratford-on-Avon.
My hon. Friend the Member for Maidenhead (Mrs. May) delivered another of her well-crafted and perceptive speeches in which she listed some of the Government's pledge formulations. I shall add to her list the third formulation of the amendment. Already the ground continues to shift and I shall speak later about that.
My hon. Friend the Member for East Worthing and Shoreham (Mr. Loughton) put his finger on the important issue of charging and, in a way, he associated himself with the speech by the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) because they both got to the heart of the matter. If the Government's endless wish list of possibilities is to be anything more than that, and if they hope to satisfy the ever-louder cries of their Back Benchers, they will have to find more money. The platitudinous approach to health care policy will not do.
In his reply to allegations about charging, the Secretary of State said that the Government were going back to the basics of the health service. It is interesting to do that. 942 I commend to the Secretary of State, who is a good socialist, Aneurin Bevan's biography. When Gaitskell got into the Treasury he had the then Secretary of State for Health for breakfast, lunch and tea. It was a typical Treasury pressure job. The Secretary of State was told, "You are spending too much. Where is more money to come from?" We know what happened. Bevan eventually capitulated and charges came in.
That was the response then, and if the Government intend to go back to basics in the health service, we are entitled to conclude that that is exactly what they will do now. Indeed, the Secretary of State had better be warned that, even if he is bold enough to go down the route of charges under pressure from the Treasury—and we believe that he is, as he has offered no evidence to the contrary this evening—he will have his just desserts. He has said nothing to convince us that money raised through charges would do other than go straight into the Treasury's coffers.
My hon. Friend the Member for Stratford-on-Avon put his finger on the truth when he pointed out that Mr. Nicholas Timmins, an experienced and knowledgeable journalist, had flushed out the Government's objectives on charges. His article makes it absolutely clear that the Department of Health is examining hotel costs and general practitioner visits. Those are not new; they were there in 1947 and in 1948. It has just taken the Labour party a little time to return to its original agenda of the founding fathers of the NHS.
Until the Secretary of State or the Minister of State has the courage to rise at the Dispatch Box and tell the House straightforwardly what their plans are, we have every justification for believing that charges will be introduced. Indeed, more justification was presented to us in the Secretary of State's statement to the House. He told us that in London we were going to havetop-quality primary care … top-quality continuing careandtop-quality mental health services".What does he mean by all this top-quality business? Does he mean the best in the world or a service that is better than what we have at present? If he does mean that, and bearing in mind the fact that he is wedded to our spending proposals, by definition he will require some more money. That is why he is thinking of charges. He knows full well that that is the only route out of the dilemma and the traps that he has set himself through his own rhetoric.
The Secretary of State said:All that is in line with the Government's vision of a range of top-quality services for all Londoners."—[Official Report, 20 June 1997; Vol. 296, c. 544.]So that we might get to the truth of the matter, will the Minister of State assure the House tonight that he will define numerically what the Secretary of State means by "top-quality"? Will he actually let us know what that means and how much these things will cost?
§ Mr. Jack
The Secretary of State is a statistical ignoramus because he is unable to understand what it means to define, in money terms, the sort of meaningless rhetoric that he puts forward.
943 Perhaps I should refresh the Secretary of State's memory of what he said earlier today. He went to the seaside for an away-day and made a speech on health, in which he went even further. Not content now just with London, he is promising us top-quality primary scare—[Interruption.] [HON. MEMBERS: "A scare."] My hon. Friends have flushed out Ministers, who talk about top-quality continuing care and top-quality mental health.
In his speech in Brighton, the Secretary of State ruled out any closures of any local hospitals—[Interruption.] Well, that is what he said in Brighton today. Do not shake your head like that.
§ Mr. Deputy Speaker
Order. The occupant of the Chair does not have responsibility for these matters.
§ Mr. Jack
Mr. Deputy Speaker, I am grateful to you for your kind words of advice.
In his speech, the Secretary of State made it extremely clear that he was welding himself effectively to an unchanged health service. That, in its own way, will have costs.
The Secretary of State tells us that he wants to have an excellent information service. The Government must come clean and tell us what all this means in terms of something that is quantifiable. We know that such promises will cost a lot of money and we have every justification in asking the Government for solid answers on how much this wish list will cost. Will the Minister of State give me an assurance tonight, first, that he will publish, in pursuit of his obligations to open government, the questions that will be the subject of this fundamental expenditure review? So that we may show the validity of our charge that the Government wish to introduce charges to raise revenue to fulfil their wish list, will the Secretary of State publish the questions that he is going to pose as part of the review that he mentioned in his press release?
We are entitled to believe that the Government of the day will require more money for this impressive list of ideas. In Scotland on Sunday, Mr. John Lloyd put forward this view:We can be reasonably sure of one thing. The review will require more payment by the individual for his or her treatment in some way at some time soon. It will further breach the principle of a service free at the point of use.The Government's amendment talks about access to the NHS based on need. "Access" is an interesting word. Access refers to the way in. No Labour Member has talked about what happens on the way out. On the way out is where one pays the bills—the new bills from the Labour Government.
The Minister of State puts his head in his hands, but that is just a simple way of trying to hide the fact that we have flushed out the truth of this matter. [Interruption.] The Minister is now barracking—another standard technique to avoid telling the truth.
I remind the Minister that the NHS chief executive, Mr. Alan Langlands, told us thatwe must look at the case for further investment in the NHS with the right combination of compassion and hard-headedness."Hard-headedness" is a code word for charges. That is clear.
944 The Government's amendment criticises the previous Government. I expect that the Minister of State, in an effort to rebut the accusation with regard to charges, will once again go through the same litany as the Secretary of State on the subject of NHS bureaucracy.
I want the Minister to assure me that he will look at the staff salary costs for the NHS in 1992–93 at the time of the previous election. He will see that that came to 6.8 per cent. of the spending on the NHS. I want him to compare those figures, as I did this afternoon in the Library, with the figures for 1997– 98, taking into account the £350 million reduction in staff costs occasioned by the terms of the 1992 legislation. The effect of that legislation was to reduce the bureaucracy costs of the NHS from 6.8 per cent. in 1992– 93 to 6.5 per cent. in 1997– 98.
That shows that Conservative policies contributed more money to front-line patient care, creating a health service of which we can be proud and which delivers more patient care than ever before, with a greater percentage of GDP than ever before. They delivered a health service that is not rotten with bureaucracy, because we cut out the problem and made more money available.
If we have done all that, we are entitled to return to the central issue of charges. if the Government are to deliver their incredibly long wish list, they will need more money. They have to tell us the funding deficit in the health service so that we can judge their actions in the future and know exactly where they will get the money. We believe, because they have not said otherwise, that it will come from charges.
§ The Minister of State, Department of Health (Mr. Alan Milburn)
I welcome the right hon. Member for Fylde (Mr. Jack) to his new responsibility as shadow Health Minister. I enjoyed working opposite him when he was in the Treasury and I look forward to working with him now. I urge him to be slightly cautious about bandying statistics around on bureaucracy in the NHS. I remind him that the Conservative party is not the enemy of red tape in the NHS but the friend of bureaucracy in the NHS. The Conservatives managed to spend an extra £900 million in extra administrative salaries alone in the first six years of this decade. Far from cutting red tape in the NHS, they increased it.
We have had a fairly a wide-ranging debate. The right hon. Member for Wealden (Sir G. Johnson Smith) talked about the cost of care for the elderly and the problems caused to the NHS by a growing elderly population. There are some dangers in being a prophet of doom, because the NHS has coped admirably with growing numbers of elderly people in every year since it was created in 1948. Even the previous Administration, in the evidence that they gave to the Select Committee on Health in the last Session, managed to recognise that, while the number of elderly people will continue to grow, we are past the worst.
Like many Tory Members, the hon. Member for Maidenhead (Mrs. May) quoted the Labour party's manifesto from the last general election. I am pleased that she did so. She asked me for an undertaking that we would honour our pledges in that manifesto, and I give her that undertaking unequivocally. The hon. Member for East Worthing and Shoreham (Mr. Loughton) talked, 945 unwisely in my view, about prescription charges for pensioners. I caution him about lecturing us about increasing charges for pensioners when it was the Conservative Government who introduced value added tax on fuel, which so penalised pensioners.
As always, the Liberal spokesman, the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), was the font of much advice, even urging me to beg the Chancellor of the Exchequer for more cash. I am grateful to him for one thing at least—his support for a review of the anomalies in prescription charges and of NHS spending. However, I remind him that we shall keep not only our manifesto pledges on the health service but our pledges and promises on other issues, not least taxation.
I deal now with the maiden speeches made by my hon. Friends. My hon. Friends the Members for Hemel Hempstead (Mr. Mc Walter) and for Wyre Forest (Mr. Lock) talked about the difficult problems they face in their areas because of the legacy that the NHS inherited. They talked in particular about the burden of debt facing health authorities and trusts. It is a difficult legacy, one that we shall have to tackle in the coming months, but they will be aware, as much I am, that there are no easy solutions or quick fixes to the problem.
From his own experience as a GP, my hon. Friend the Member for Dartford (Dr. Stoate) rightly talked about the anomalies in the current exemption regime for prescription charges. I am grateful for his support for the review that we shall be undertaking.
Finally, in an impressive maiden speech, my hon. Friend the Member for Leeds, North-West (Mr. Best), used a very important phrase about the sort of national health service we want. He said that we want a one-class NHS—a first-class NHS.
I deal briefly with the two other maiden speeches we have heard this evening, which were made by Opposition Front Benchers. I am sorry for the Opposition health team's having to make their debut on the NHS because they have been forced to defend the indefensible—the Tories' record on health and their running down of the NHS. The Tories leave a quite appalling legacy—[Interruption.] I know that Opposition Members do not want to listen because they do not want to face the truth about record waiting lists, record cuts in capital expenditure and record debt in the NHS.
The hon. Member for Southwark, North and Bermondsey asked us what we were going to do about the private finance initiative. We shall do one very simple thing—we will make it work and get hospitals built. It will take more than eight weeks for the new Government to put right the Tory record of 18 years, so we will not take any lectures from Opposition Members about our handling of the NHS.
§ Mr. Simon Hughes
Of course the Government have to deal with some matters quickly, but if the Minister thinks that the PFI is the solution that will get more money from the private sector to the NHS, he is badly mistaken. A far more fundamental review is needed; the PFI is not the way forward.
§ Mr. Milburn
I have two comments in reply to that. There is a queue of 43 major acute hospital projects for which communities up and down the country have been waiting for funding not just from the private finance 946 initiative, but, for dozens of years in many cases, from public sector capital. We are determined to give some of those communities the hospitals that they need. Of course we shall consider reviewing the private finance initiative in the longer term to bring in a modernised form of public-private partnership to the national health service.
§ Sir Peter Emery (East Devon)
I have listened very carefully to the Minister. He has suggested that the Government would be able to have many more hospitals built through the private finance initiative. We are having a reasonable debate. How many hospitals does he expect to get built under the PFI?
§ Mr. Milburn
I assure the right hon. Gentleman that it will be more than his Government got built.
The Tories lost the general election on I May for one simple reason—they had lost the trust of the British people. Labour won because we won the trust of the British people. On no issue is that more true than on the national health service. After all, the NHS was created by a Labour Government. I remind Conservative Members that that was done in the teeth of Conservative opposition.
Labour also warned that the introduction of the internal market would undermine the principles of the NHS and would cause a public outcry. No wonder the best advice that the hon. Member for Stratford-on-Avon (Mr. Maples) could give in his famous memorandum to colleagues was to aim for "zero media coverage" about the national health service.
Is that any surprise when hospital was set against hospital, doctor against doctor and patient against patient? The NHS has been strangled in red tape, with enough invoices from general practitioners alone to stretch from London to Paris and back. In the two-tier health service, access to care depends on the lottery of patients' post codes and their GP practices. More patients have been forced to go private because the NHS was not there when they needed it. We have had a Secretary of State for Health who was reported as being prepared to support a private GP service. The Tory Administration saw nothing wrong in privatising clinical services at Stonehaven hospital.
In a debate about NHS charges, let us also remind ourselves who slapped charges on dental checks and eye tests. It was not the Labour party or a Labour Government, but the Conservatives. The Tory Government also increased prescription charges by almost 1,000 per cent. during their period in office. Charges rose every year from 1979. For the Conservatives to accuse us of undermining the national health service is, to put it at its politest, hypocrisy of the highest order.
§ Mr. Milburn
Before the hon. Gentleman jumps up and down any more, trying to intervene on me in the few moments that I have left to speak, I remind him that a bit of humility would not come amiss from the Conservatives. The public know that his charges are hypocrisy, as do staff in the national health service.
We will keep our manifesto promises. Indeed, we are already keeping them. We promised to cut NHS bureaucracy, and we are—by £100 million this year alone. We promised to invest in front-line patient services, and 947 we are doing so. We promised to scrap the absurd internal market in the NHS, and we are doing so. We promised to bring back fairness in treatment and funding, and we are doing so. Above all, we promised that access to the NHS would be based on need and not on ability to pay. We stand by that commitment to the historical principle of the national health service. I can tell Opposition Members that we will do nothing to betray that trust.
We promised something else in our manifesto—a comprehensive spending review. That review will be framed in the context of our manifesto. We will honour the pledges that we gave to the people of Britain—
§ Mr. James Arbuthnot (North-East Hampshire)
rose in his place and claimed to move, That the Question be now put.
§ Question, That the Question be now put, put and agreed to.
§ Question put accordingly, That the original words stand part of the Question:—
§ The House divided: Ayes 148, Noes 328.950
|Division No. 40]||[9.59 pm|
|Ainsworth, Peter (E Surrey)||Flight, Howard|
|Amess, David||Forth, Eric|
|Ancram, Rt Hon Michael||Fowler, Rt Hon Sir Norman|
|Arbuthnot, James||Fox, Dr Liam|
|Atkinson, Peter (Hexham)||Fraser, Christopher|
|Baldry, Tony||Gale, Roger|
|Beggs, Roy (E Antrim)||Garnier, Edward|
|Bercow, John||Gibb, Nick|
|Beresford, Sir Paul||Gill, Christopher|
|Blunt, Crispin||Gillen, Mrs Cheryl|
|Body, Sir Richard||Goodlad, Rt Hon Alastair|
|Boswell, Tim||Gorman, Mrs Teresa|
|Bottomley, Peter (Worthing W)||Gray, James|
|Bottomley, Rt Hon Mrs Virginia||Green, Damian|
|Brady, Graham||Greenway, John|
|Brazier, Julian||Grieve, Dominic|
|Brooke, Rt Hon Peter||Hague, Rt Hon William|
|Browning, Mrs Angela||Hamilton, Rt Hon Sir Archie|
|Bruce, Ian (S Dorset)||Hammond, Philip|
|Burns, Simon||Hawkins, Nick|
|Butterfill, John||Hayes, John|
|Cash, William||Heathcoat-Amory, Rt Hon David|
|Chope, Christopher||Horam, John|
|Clappison, James||Howard, Rt Hon Michael|
|Clark, Rt Hon Alan (Kensington)||Howarth, Gerald (Aldershot)|
|Clark, Dr Michael (Rayleigh)||Hunter, Andrew|
|Clifton-Brown, Geoffrey||Jack, Rt Hon Michael|
|Collins, Tim||Jackson, Robert (Wantage)|
|Colvin, Michael||Jenkin, Bernard (N Essex)|
|Cormack, Sir Patrick||Johnson Smith,|
|Gran, James||Rt Hon Sir Geoffrey|
|Curry, Rt Hon David||Key, Robert|
|Davis, Rt Hon David (Haltemprice)||King, Rt Hon Tom (Bridgwater)|
|Davies, Quentin (Grantham & Stamford)||Kirkbride, Miss Julie|
|Day, Stephen||Laing, Mrs Eleanor|
|Dorrell, Rt Hon Stephen||Lansley, Andrew|
|Duncan, Alan||Leigh, Edward|
|Duncan Smith, Iain||Letwin, Oliver|
|Emery, Rt Hon Sir Peter||Lewis, Dr Julian (New Forest E)|
|Evans, Nigel||Lidington, David|
|Faber, David||Lilley, Rt Hon Peter|
|Fabricant, Michael||Lloyd, Rt Hon Sir Peter (Fareham)|
|Fallon, Michael||Loughton, Tim|
|Lyell, Rt Hon Sir Nicholas||Soames, Nicholas|
|MacGregor, Rt Hon John||Spelman, Mrs Caroline|
|MacKay, Andrew||Spicer, Sir Michael|
|Maclean, Rt Hon David||Spring, Richard|
|McLoughlin, Patrick||Stanley, Rt Hon Sir John|
|Madel, Sir David||Steen, Anthony|
|Malins, Humfrey||Streeter, Gary|
|Maples, John||Swayne, Desmond|
|Mates, Michael||Syms, Robert|
|Maude, Rt Hon Francis||Tapsell, Sir Peter|
|Mawhinney, Rt Hon Dr Brian||Taylor, Ian (Esher & Walton)|
|May, Mrs Theresa||Taylor, Sir Teddy|
|Merchant, Piers||Temple-Morris, Peter|
|Moss, Malcolm||Thompson, William|
|Nicholls, Patrick||Tredinnick, David|
|Norman, Archie||Trend, Michael|
|Ottaway, Richard||Tyrie, Andrew|
|Page, Richard||Viggers, Peter|
|Paice, James||Walter, Robert|
|Paterson, Owen||Wardle, Charles|
|Pickles, Eric||Waterson, Nigel|
|Prior, David||Wells, Bowen|
|Redwood, Rt Hon John||Whitney, Sir Raymond|
|Robathan, Andrew||Widdecombe, Rt Hon Miss Ann|
|Robertson, Laurence (Tewkb'ry)||Wilkinson, John|
|Roe, Mrs Marion (Broxbourne)||Willetts, David|
|Rowe, Andrew (Faversham)||Winterton, Mrs Ann (Congleton)|
|Ruffley, David||Woodward, Shaun|
|St Aubyn, Nick||Young, Rt Hon Sir George|
|Shephard, Rt Hon Mrs Gillian||Tellers for the Ayes|
|Shepherd, Richard (Aldridge)||Mr. Oliver Heald and|
|Simpson, Keith (Mid-Norfolk)||Mr. John Whittingdale|
|Adams, Mrs Irene (Paisley N)||Cann, Jamie|
|Ainger, Nick||Caplin, Ivor|
|Ainsworth, Robert (Cov'try NE)||Casale, Roger|
|Allen, Graham (Nottingham N)||Cawsey, Ian|
|Anderson, Donald (Swansea E)||Chaytor, David|
|Anderson, Janet (Ros'dale)||Chisholm, Malcolm|
|Armstrong, Ms Hilary||Church, Ms Judith|
|Ashton, Joe||Clapham, Michael|
|Atkins, Ms Charlotte||Clark, Rt Hon Dr David (S Shields)|
|Barnes, Harry||Clark, Dr Lynda (Edinburgh Pentlands)|
|Barron, Kevin||Clark, Paul (Gillingham)|
|Bayley, Hugh||Clarke, Eric (Midlothian)|
|Beard, Nigel||Clarke, Rt Hon Tom (Coatbridge)|
|Begg, Miss Anne (Aberd'n S)||Clwyd, Mrs Ann|
|Bell, Stuart (Middlesbrough)||Coaker, Vernon|
|Benn, Rt Hon Tony||Coffey, Ms Ann|
|Bennett, Andrew F||Cohen, Harry|
|Benton, Joe||Connarty, Michael|
|Bermingham, Gerald||Cook, Frank (Stockton N)|
|Berry, Roger||Cooper, Ms Yvette|
|Best, Harold||Corbett, Robin|
|Betts, Clive||Corbyn, Jeremy|
|Blackman, Mrs Liz||Corston, Ms Jean|
|Blizzard, Robert||Cousins, Jim|
|Blunkett, Rt Hon David||Cranston, Ross|
|Boateng, Paul||Crausby, David|
|Bradley, Keith (Withington)||Cryer, John (Hornchurch)|
|Bradley, Peter (The Wrekin)||Cummings, John|
|Bradshaw, Ben||Cunningham, Jim (Cov'try S)|
|Brinton, Mrs Helen||Cunningham, Rt Hon Dr John (Copeland)|
|Brown, Rt Hon Nick (Newcastle E & Wallsend)||Dalyell, Tam|
|Brown, Russell (Dumfries)||Darling, Rt Hon Alistair|
|Browne, Desmond (Kilmarnock)||Darvill, Keith|
|Buck, Ms Karen||Davey, Valerie (Bristol W)|
|Burden, Richard||Davidson, Ian|
|Burgon, Colin||Davies, Rt Hon Denzil (Llanelli)|
|Byers, Stephen||Davies, Geraint (Croydon C)|
|Campbell, Alan (Tynemouth)||Davies, Rt Hon Ron (Caerphilly)|
|Campbell-Savours, Dale||Dean, Ms Janet|
|Denham, John||Johnson. Alan (Hull W)|
|Dewar, Rt Hon Donald||Johnson, Ms Melanie (Welwyn Hatfield)|
|Dismore, Andrew||Jones, Barry (Alyn & Deeside)|
|Dobbin, Jim||Jones, Ms Fiona (Newark)|
|Dobson, Rt Hon Frank||Jones, Helen (Warrington N)|
|Donohoe, Brian H||Jones, Ms Jenny (Wolverh'ton SW)|
|Doran, Frank||Jones, Jon Owen (Cardiff C)|
|Dowd, Jim||Jones, Dr Lynne (Selly Oak)|
|Drew, David||Jones, Martyn (Clwyd S)|
|Dunwoody, Mrs Gwyneth||Jowell, Ms Tessa|
|Eagle, Angela (Wallasey)||Kaufman, Rt Hon Gerald|
|Eagle, Ms Maria (L'pool Garston)||Keeble, Ms Sally|
|Edwards, Huw||Keen, Alan (Feltham)|
|Efford, Clive||Keen, Mrs Ann (Brentford)|
|Ellman, Ms Louise||Kemp, Fraser|
|Ennis, Jeff||Kennedy, Jane (Wavertree)|
|Fitzsimons, Ms Lorna||Khabra, Piara S|
|Flint, Ms Caroline||Kidney, David|
|Flynn, Paul||Kilfoyle, Peter|
|Follett, Ms Barbara||King, Andy (Rugby)|
|Foster, Rt Hon Derek||King, Miss Oona (Bethnal Green)|
|Foster, Michael Jabez (Hastings)||Kumar, Dr Ashok|
|Foulkes, George||Ladyman, Dr Stephen|
|Galbraith, Sam||Lepper, David|
|Galloway, George||Leslie, Christopher|
|Gapes, Mike||Levitt, Tom|
|Gardiner, Barry||Lewis, Terry (Worsley)|
|George, Bruce (Walsall S)||Livingstone, Ken|
|Gerrard, Neil||Lock, David|
|Gibson, Dr Ian||Love, Andy|
|Gilroy, Mrs Linda||McAllion, John|
|Godman, Dr Norman A||McAvoy, Thomas|
|Godsiff, Roger||McCabe, Stephen|
|Goggins, Paul||McCafferty, Ms Chris|
|Golding, Mrs Llin||McCartney, Ian (Makerfield)|
|Gordon, Mrs Eileen||McDonagh, Ms Siobhain|
|Grant, Bernie||Macdonald, Calum|
|Griffiths, Ms Jane (Reading E)||McFall, John|
|Griffiths, Win (Bridgend)||McGuire, Mrs Anne|
|Grocott, Bruce||McIsaac, Ms Shona|
|Grogan, John||McKenna, Ms Rosemary|
|Gunnell, John||Mackinlay, Andrew|
|Hain, Peter||MacShane, Denis|
|Hall, Patrick (Bedford)||Mactaggart, Fiona|
|Hamilton, Fabian (Leeds NE)||McWalter, Tony|
|Hanson, David Harman, Rt Hon Ms Harriet||McWilliam, John|
|Heal, Mrs Sylvia||Mahon, Mrs Alice|
|Healey, John||Marek, Dr John|
|Henderson, Doug (Newcastle N)||Marsden, Gordon (Blackpool S)|
|Hepburn, Stephen||Marsden, Paul (Shrewsbury)|
|Heppell, John||Marshall, David (Shettleston)|
|Hewitt, Ms Patricia||Marshall-Andrews, Robert|
|Hill, Keith||Martlew, Eric|
|Hinchliffe, David||Maxton, John|
|Hodge, Ms Margaret||Meale, Alan|
|Hoey, Kate||Merron, Ms Gillian|
|Home Robertson, John||Michael, Alun|
|Hood, Jimmy||Milburn, Alan|
|Hoon, Geoffrey||Mitchell, Austin|
|Hope, Philip||Moffatt, Laura|
|Howarth, Alan (Newport E)||Moonie, Dr Lewis|
|Howarth, George (Knowsley N)||Moran, Ms Margaret|
|Howells, Dr Kim||Morgan, Ms Julie (Cardiff N)|
|Hoyle, Lindsay||Morgan, Rhodri (Cardiff W)|
|Hughes, Ms Beverley (Stretford & Urmston)||Morley, Elliot|
|Hughes, Kevin (Doncaster N)||Morris, Ms Estelle (B'ham Yardley)|
|Humble, Mrs Joan||Morris, Rt Hon John (Aberavon)|
|Hurst, Alan||Mudie, George|
|Hutton, John||Mullin, Chris|
|Iddon, Brian||Murphy, Jim (Eastwood)|
|Illsley, Eric||Murphy, Paul (Torfaen)|
|Jackson, Ms Glenda (Hampst'd)||Naysmith, Dr Doug|
|Jackson, Mrs Helen (Hillsborough)||Norris, Dan|
|Jenkins, Brian (Tamworth)||O' Brien, Mike (N Warks)|
|O'Brien, William (Normanton)||Soley, Clive|
|O'Hara, Edward||Southworth, Ms Helen|
|Olner, Bill||Spellar, John|
|Organ, Mrs Diana||Squire, Ms Rachel|
|Osborne, Mrs Sandra||Starkey, Dr Phyllis|
|Palmer, Dr Nick||Stevenson, George|
|Pearson, Ian||Stewart, David (Inverness E)|
|Perham, Ms Linda||Stewart, Ian (Eccles)|
|Pickthall, Colin||Stinchcombe, Paul|
|Pike, Peter L||Stoate, Dr Howard|
|Plaskitt, James||Stott, Roger|
|Pollard, Kerry||Strang, Rt Hon Dr Gavin|
|Pond, Chris||Straw, Rt Hon Jack|
|Pope, Greg||Stuart, Mrs Gisela (Edgbaston)|
|Pound, Stephen||Sutcliffe, Gerry|
|Powell, Sir Raymond||Taylor, Rt Hon Mrs Ann (Dewsbury)|
|Prentice, Ms Bridget (Lewisham E)||Taylor, Ms Dari (Stockton S)|
|Prentice, Gordon (Pendle)||Taylor, David (NW Leics)|
|Primarolo, Dawn||Thomas, Gareth (Clwyd W)|
|Prosser, Gwyn||Thomas, Gareth R (Harrow W)|
|Purchase, Ken||Timms, Stephen|
|Quin, Ms Joyce|
|Quinn, Lawrie||Tipping, Paddy|
|Rammell, Bill||Touhig, Don|
|Rapson, Syd||Trickett, Jon|
|Raynsford, Nick||Truswell, Paul|
|Reed, Andrew (Loughborough)||Turner, Dennis (Wolverh'ton SE)|
|Reid, Dr John (Hamilton N)||Turner, Dr George (NW Norfolk)|
|Robertson, Rt Hon George (Hamilton S)||Twigg, Derek (Halton)|
|Rooker, Jeff||Twigg, Stephen (Enfield)|
|Rooney, Terry||Vaz, Keith|
|Ross, Ernie (Dundee W)||Vis, Dr Rudi|
|Rowlands, Ted||Walley, Ms Joan|
|Roy, Frank||Ward, Ms Claire|
|Ruane, Chris||Watts, David|
|Ruddock, Ms Joan||White, Brian|
|Russell, Ms Christine (Chester)||Wicks, Malcolm|
|Ryan, Ms Joan||Williams, Rt Hon Alan (Swansea W)|
|Salter, Martin||Williams, Dr Alan W (E Carmarthen)|
|Savidge, Malcolm||Williams, Mrs Betty (Conwy)|
|Sedgemore, Brian||Wills, Michael|
|Shaw, Jonathan||Winnick, David|
|Sheldon, Rt Hon Robert||Winterton, Ms Rosie (Doncaster C)|
|Simpson, Alan (Nottingham S)||Wise, Audrey|
|Singh, Marsha||Wood, Mike|
|Skinner, Dennis||Woolas, Phil|
|Smith, Rt Hon Andrew (Oxford E)||Worthington. Tony|
|Smith, Ms Angela (Basildon)||Wright, Dr Tony (Cannock)|
|Smith, Miss Geraldine||Wyatt, Derek|
|(Morecambe & Lunesdale)||Tellers for the Noes:|
|Smith, John (Glamorgan)||Mr. David Jamieson and|
|Snape, Peter||Mr. David Clelland.|
§ Question accordingly negatived.
§ Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments):—
§ The House divided: Ayes 309, Noes 148.954
|Division No. 41]||[10.15 pm|
|Adams, Mrs Irene (Paisley N)||Barnes, Harry|
|Ainger, Nick||Bayley, Hugh|
|Ainsworth, Robert (Cov'try NE)||Beard, Nigel|
|Allen, Graham (Nottingham N)||Begg, Miss Anne (Aberd'n S)|
|Anderson, Donald (Swansea E)||Bell, Stuart (Middlesbrough)|
|Anderson, Janet (Ros'dale)||Benn, Rt Hon Tony|
|Armstrong, Ms Hilary||Benton, Joe|
|Ashton, Joe||Bermingham, Gerald|
|Atkins. Ms Charlotte||Berry, Roger|
|Betts, Clive||Flynn, Paul|
|Blackman, Mrs Liz||Follett, Ms Barbara|
|Blizzard, Robert||Foster, Rt Hon Derek|
|Boateng, Paul||Foster, Michael Jabez (Hastings)|
|Bradley, Keith (Withington)||Foulkes, George|
|Bradley, Peter (The Wrekin)||Galbraith, Sam|
|Bradshaw, Ben||Galloway, George|
|Brinton, Mrs Helen||Gapes, Mike|
|Brown, Rt Hon Nick (Newcastle E & Wallsend)||Gardiner, Barry|
|Brown, Russell (Dumfries)||George, Bruce (Walsall S)|
|Browne, Desmond (Kilmarnock)||Gerrard, Neil|
|Buck, Ms Karen||Gibson, Dr Ian|
|Burden, Richard||Gilroy, Mrs Linda|
|Burgon, Corn||Godman, Dr Norman A|
|Byers, Stephen||Godsiff, Roger|
|Campbell, Alan (Tynemouth)||Goggins, Paul|
|Campbell-Savours, Dale||Golding, Mrs Llin|
|Canavan, Dennis||Gordon, Mrs Eileen|
|Cann, Jamie||Grant, Bernie|
|Caplin, Ivor||Griffiths, Ms Jane (Reading E)|
|Casale, Roger||Griffiths, Win (Bridgend)|
|Cawsey, Ian||Grogan, John|
|Chaytor, David||Gunnell, John|
|Chisholm, Malcolm||Hall, Patrick (Bedford)|
|Church, Ms Judith||Hamilton, Fabian (Leeds NE)|
|Clapham, Michael||Hanson, David|
|Clark, Rt Hon Dr David (S Shields)||Harman, Rt Hon Ms Harriet|
|Clark, Dr Lynda (Edinburgh Pentlands)||Heal, Mrs Sylvia|
|Clark, Paul (Gillingham)||Healey, John|
|Clarke, Eric (Midlothian)||Hepburn, Stephen|
|Clarke, Rt Hon Tom (Coatbridge)||Heppell, John|
|Clwyd, Mrs Ann||Hewitt, Ms Patricia|
|Coaker, Vernon||Hill, Keith|
|Coffey, Ms Ann||Hinchliffe, David|
|Cohen, Harry||Hodge, Ms Margaret|
|Connarty, Michael||Hoey, Kate|
|Cooper, Ms Yvette||Home Robertson, John|
|Corbett, Robin||Hood, Jimmy|
|Corbyn, Jeremy||Hoon, Geoffrey|
|Corston, Ms Jean||Hope, Philip|
|Cousins, Jim||Howarth, Alan (Newport E)|
|Cranston, Ross||Howarth, George (Knowsley N)|
|Crausby, David||Hoyle, Lindsay|
|Cryer, John (Hornchurch)||Hughes, Ms Beverley (Stretford & Urmston)|
|Cummings, John||Hughes, Kevin (Doncaster N)|
|Cunningham, Jim (Cov'try S)||Humble, Mrs Joan|
|Cunningham, Rt Hon Dr John (Copeland)||Hurst, Alan|
|Dalyell, Tam||Hutton, John|
|Darling, Rt Hon Alistair||Iddon, Brian|
|Darvill, Keith||Jackson, Ms Glenda (Hampst'd)|
|Davey, Valerie (Bristol W)||Jackson, Mrs Helen (Hillsborough)|
|Davidson, Ian||Jenkins, Brian (Tamworth)|
|Davies, Rt Hon Denzil (Llanelli)||Johnson, Alan (Hull W)|
|Davies, Geraint (Croydon C)||Johnson, Ms Melanie (Welwyn Hatfield)|
|Davies, Rt Hon Ron (Caerphilly)||Jones, Barry (Alyn & Deeside)|
|Dean, Ms Janet||Jones, Ms Fiona (Newark)|
|Denham, John||Jones, Helen (Warrington N)|
|Dewar, Rt Hon Donald||Jones, Ms Jenny (Wolverh'ton SW)|
|Dismore, Andrew||Jones, Jon Owen (Cardiff C)|
|Dobbin, Jim||Jones, Dr Lynne (Selly Oak)|
|Dobson, Rt Hon Frank||Jones, Marlyn (Clwyd S)|
|Donohoe, Brian H||Jowell, Ms Tessa|
|Doran, Frank||Kaufman, Rt Hon Gerald|
|Dowd, Jim||Keeble, Ms Sally|
|Drew, David||Keen, Alan (Feltham)|
|Eagle, Angela (Wallasey)||Keen, Mrs Ann (Brenfford)|
|Eagle, Ms Maria (L'pool Garston)||Kemp, Fraser|
|Edwards, Huw||Kennedy, Jane (Wavertree)|
|Efford, Clive||Khabra, Piara S|
|Ellman, Ms Louise||Kidney, David|
|Ennis, Jeff||Kilfoyle, Peter|
|Fitzsimons, Ms Lorna||King, Miss Oona (Bethnal Green)|
|Flint, Ms Caroline||Kumar, Dr Ashok|
|Ladyman, Dr Stephen||Rammell, Bill|
|Lepper, David||Rapson, Syd|
|Leslie, Christopher||Raynsford, Nick|
|Levitt, Tom||Reed, Andrew (Loughborough)|
|Lewis, Terry (Worsley)||Reid, Dr John (Hamilton N)|
|Linton, Martin||Robertson, Rt Hon George (Hamilton S)|
|Livingstone, Ken||Rooker, Jeff|
|Lock, David||Rooney, Terry|
|Love, Andy||Ross, Ernie (Dundee W)|
|McAllion, John||Rowlands, Ted|
|McAvoy, Thomas||Roy, Frank|
|McCabe, Stephen||Ruane, Chris|
|McCafferty, Ms Chris||Ruddock, Ms Joan|
|McCartney, Ian (Makerfield)||Russell, Ms Christine (Chester)|
|McDonagh, Ms Siobhain||Ryan, Ms Joan|
|Macdonald, Calum||Salter, Martin|
|McFall, John||Savidge, Malcolm|
|McGuire, Mrs Anne||Sedgemore, Brian|
|McIsaac, Ms Shona||Shaw, Jonathan|
|McKenna, Ms Rosemary||Simpson, Alan (Nottingham S)|
|Mackinlay, Andrew||Singh, Marsha|
|MacShane, Denis||Skinner, Dennis|
|Mactaggart, Fiona||Smith, Rt Hon Andrew (Oxford E)|
|McWatter, Tony||Smith, Ms Angela (Basildon)|
|McWilliam, John||Smith, Miss Geraldine (Morecambe & Lunesdale)|
|Mahon, Mrs Alice||Smith, John (Glamorgan)|
|Marek, Dr John||Snape, Peter|
|Marsden, Gordon (Blackpool S)||Southworth, Ms Helen|
|Marsden, Paul (Shrewsbury)||Spellar, John|
|Marshall, David (Shettleston)||Squire, Ms Rachel|
|Marshall-Andrews, Robert||Stevenson, George|
|Martlew, Eric||Stewart, David (Inverness E)|
|Maxton, John||Stewart, Ian (Eccles)|
|Meale, Alan||Stinchcombe, Paul|
|Merron, Ms Gillian||Stoate, Dr Howard|
|Michael, Alun||Straw, Rt Hon Jack|
|Milburn, Alan||Stuart, Mrs Gisela (Edgbaston)|
|Mitchell, Austin||Sutcliffe, Gerry|
|Moffatt, Laura||Taylor, Rt Hon Mrs Ann (Dewsbury)|
|Moonie, Dr Lewis||Taylor, Ms Dari (Stockton S)|
|Moran, Ms Margaret||Taylor, David (NW Leics)|
|Morgan, Ms Julie (Cardiff N)||Thomas, Gareth (Clwyd VW)|
|Morgan, Rhodri (Cardiff W)||Thomas, Gareth R (Harrow W)|
|Morley, Elliot||Timms, Stephen|
|Moms, Ms Estelle (B'ham Yardley)||Tipping, Paddy|
|Mudie, George||Touhig, Don|
|Mullin, Chris||Trickett, Jon Truswell, Paul|
|Murphy, Jim (Eastwood)||Turner, Dennis (Wolverh'ton SE)|
|Murphy, Paul (Torfaen)||Turner, Dr George (NW Norfolk)|
|Naysmith, Dr Doug||Twigg, Stephen (Enfield)|
|Norris, Dan||Vaz. Keith|
|O'Brien, Mike (N Warks)||Vis, Dr Rudi|
|O'Brien, William (Normanton)||Ward, Ms Claire|
|O'Hara, Edward||Watts, David|
|Olner, Bill||White, Brian|
|Organ, Mrs Diana||Wicks, Malcolm|
|Osborne, Mrs Sandra||Williams, Dr Alan W (E Carmarthen)|
|Palmer, Dr Nick||Williams, Mrs Betty (Conwy)|
|Pearson, Ian||Wills, Michael|
|Perham, Ms Linda||Winnick, David|
|Pickthall, Colin||Winterton, Ms Rosie (Doncaster C)|
|Pike, Peter L||Wise, Audrey|
|Plaskitt, James||Wood, Mike|
|Pollard, Kerry||Woolas, Phil|
|Pond, Chris||Worthington, Tony|
|Pope, Greg||Wright, Dr Tony (Cannock)|
|Pound, Stephen||Wyatt, Derek|
|Powell, Sir Raymond||Tellers for the Ayes:|
|Prentice, Ms Bridget (Lewisham E)||Mr. David Jamieson and|
|Prentice, Gordon (Pendle)||Mr. David Clelland.|
|Quin, Ms Joyce|
|Ainsworth, Peter (E Surrey)||Jackson, Robert (Wantage)|
|Amess, David||Jenkin, Bernard (N Essex)|
|Ancram, Rt Hon Michael||Johnson Smith,|
|Arbuthnot, James||Rt Hon Sir Geoffrey|
|Atkinson, Peter (Hexham)||Key, Robert|
|Baldry, Tony||King, Rt Hon Tom (Bridgwater)|
|Beggs, Roy (E Antrim)||Kirkbride, Miss Julie|
|Bercow, John||Laing, Mrs Eleanor|
|Beresford, Sir Paul||Lansley, Andrew|
|Blunt, Crispin||Leigh, Edward|
|Body, Sir Richard||Letwin, Oliver|
|Boswell, Tim||Lewis, Dr Julian (New Forest E)|
|Bottomley, Peter (Worthing W)||Lidington, David|
|Bottomley, Rt Hon Mrs Virginia||Lilley, Rt Hon Peter|
|Brady, Graham||Lloyd, Rt Hon Sir Peter (Fareham)|
|Brazier, Julian||Loughton, Tim|
|Brooke, Rt Hon Peter||Luff, Peter|
|Browning, Mrs Angela||Lyell, Rt Hon Sir Nicholas|
|Bruce, Ian (S Dorset)||MacGregor, Rt Hon John|
|Burns, Simon||MacKay, Andrew|
|Butterfill, John||Maclean, Rt Hon David|
|Cash, William||McLoughlin, Patrick|
|Chope, Christopher||Madel, Sir David|
|Clappison, James||Malins, Humfrey|
|Clark, Rt Hon Alan (Kensington)||Maples, John|
|Clark, Dr Michael (Rayleigh)||Mates, Michael|
|Clifton-Brown, Geoffrey||Maude, Rt Hon Francis|
|Collins, Tim||Mawhinney, Rt Hon Dr Brian|
|Colvin, Michael||May, Mrs Theresa|
|Cormack, Sir Patrick||Merchant, Piers|
|Cran, James||Moss, Malcolm|
|Curry, Rt Hon David||Nicholls, Patrick|
|Davis, Rt Hon David (Haltemprice)||Norman, Archie|
|Davies, Quentin (Grantham & Stamford)||Ottaway, Richard|
|Day, Stephen||Page, Richard|
|Dorrell, Rt Hon Stephen||Paice, James|
|Duncan, Alan||Paterson, Owen|
|Duncan Smith, lain||Pickles, Eric|
|Emery, Rt Hon Sir Peter||Prior, David|
|Evans, Nigel||Redwood, Rt Hon John|
|Faber, David||Robathan, Andrew|
|Fabricant, Michael||Robertson, Laurence (Tewk'b'ry)|
|Fallon, Michael||Roe, Mrs Marion (Broxbourne)|
|Flight, Howard||Rowe, Andrew (Faversham)|
|Forth, Eric||Ruffley, David|
|Fowler, Rt Hon Sir Norman||St Aubyn, Nick|
|Fox, Dr Liam||Sayeed, Jonathan|
|Fraser, Christopher||Shephard, Rt Hon Mrs Gillian|
|Gale, Roger||Shepherd, Richard (Aldridge)|
|Garnier, Edward||Simpson, Keith (Mid-Norfolk)|
|Gibb, Nick||Soames, Nicholas|
|Gill, Christopher||Spelman, Mrs Caroline|
|Gillan, Mrs Cheryl||Spicer, Sir Michael|
|Goodlad, Rt Hon Alastair||Spring, Richard|
|Gorman, Mrs Teresa||Stanley, Rt Hon Sir John|
|Gray, James||Steen, Anthony|
|Green, Damian||Streeter, Gary|
|Greenway, John||Swayne, Desmond|
|Grieve, Dominic||Syms, Robert|
|Hague, Rt Hon William||Tapsell, Sir Peter|
|Hamilton, Rt Hon Sir Archie||Taylor, Ian (Esher & Walton)|
|Hammond, Philip||Taylor, Sir Teddy|
|Hawkins, Nick||Temple-Morris, Peter|
|Hayes, John||Thompson, William|
|Heathcoat-Amory, Rt Hon David||Tredinnick, David|
|Horam, John||Trend, Michael|
|Howard, Rt Hon Michael||Tyrie, Andrew|
|Howarth, Gerald (Aldershot)||Viggers, Peter|
|Hunter, Andrew||Walter, Robert|
|Jack, Rt Hon Michael||Wardle, Charles|
|Wells, Bowen||Woodward, Shaun|
|Whitney, Sir Raymond||Young, Rt Hon Sir George|
|Widdecombe, Rt Hon Miss Ann||Tellers for the Noes:|
|Wilkinson,John||Mr. Oliver Heald and|
|Willetts, David||Mr. John Whittingdale.|
|Winterton, Mrs Ann (Congleton)|
§ Question accordingly agreed to.
§ MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the commitment of Her Majesty's Government to the historic principle of the National Health Service that if someone is ill or injured there will be a national health service to help, with access to it based on need, not on ability to pay or on who their general practitioner happens to be or on where they live; notes the steps which are being taken to end the internal market, which is unfair both to patients and staff and which has resulted in massive sums being consumed by bureaucracy; welcomes the shift of funds into patient care, including cancer treatment, instead of paperwork; and looks forward to further changes which will ensure that once again the National Health Service provides the best health services for all and is ready to meet the challenges of the 21st century.