§ Mr. Llew Smith (Blaenau Gwent)Some anniversaries, like birthdays, are best forgotten, but others cry out for recognition because of their relevance to present-day society. Fifty years on, the national health service is one such example. As a Labour Member of Parliament and one who has the privilege of representing a constituency that in many ways gave birth to that service, I believe that that legislation was the finest piece of socialist legislation this century and created the jewel in our crown. We should never forget that the service was created when we had just gone through another world war and this country was just about bankrupt.
There is a certain irony here in that, 50 years on, we are still not only debating what form the national health service should take but, in the rich country that we are today, whether we can afford the sort of service that my predecessor Nye Bevan envisaged. When he spoke on Second Reading of the National Health Service Bill on 30 April 1946, he outlined his vision of a health service, saying:
it will lift the shadow from millions of homes. It will keep very many people alive who might otherwise be dead. It will relieve suffering. It will produce higher standards for the medical profession. It will be a great contribution towards the wellbeing of the common people in Great Britain."—[official Report, 30 April 1946; Vol. 422, c. 63.]As we were reminded, it was to be a national health service in which the rich and the poor were to be treated alike, where poverty was not a disadvantage and wealth not an advantage.I was reminded of that many years ago when Professor Richard Titmus recalled a visit to a London hospital for the treatment of cancer. He was being treated at the same time and the same place by the same doctor for the very same reason as a young West Indian lad. Titmus observed that what determined who would be treated first each day had everything to do with the vagaries of London's traffic and nothing to do with the amount of money that they had in their pockets.
How different that philosophy and that of the early pioneers of the NHS is from what happened during those awful 18 years of Tory government. We all remember the then Prime Minister, now Baroness Thatcher, proclaiming to the world that the national health service
is safe in our hands",when in reality she was transforming the service to one that someone described as geared to meet the young, the rich and the healthy, ignoring the poor, the old and the chronically sick.Obviously, I am pleased that the Government are making considerable efforts to reverse that trend and rectify those wrongs. Additional investment in the service is one of the many ways in which they are doing so. However, Nye also recognised that good health did not depend merely on the health service. He was the first to draw comparisons and to state that, to have good health, 295 one also needed a good standard of living—therefore, if one wanted to tackle bad health, one had to tackle poverty. That was also recognised many years later with the publication of the Black report, which explained
inequality in health can only be understood in relation to poverty and poor working conditions.That is still obvious in my constituency, the birthplace of the national health service, which unfortunately is either at or near the top of the league tables for heart and respiratory diseases, cancers, mental health problems, long-term sickness, disabilities and rates of infant mortality, standardised mortality and low birth weight babies. No one will be surprised, if one accepts the link between poverty and bad health, that my constituency is in one of the poorest local authority areas in Wales. We have the highest unemployment in Wales and some of the lowest income levels in the United Kingdom. We also have inadequate housing. If all those and many other factors are brought together, one gets the sort of deprivation that we experience every day.Neither this debate nor the 50th anniversary celebrations should be an exercise in nostalgia. I suspect that Nye would treat such an exercise with disdain and that he would want us to learn from those 50 years how we can build on his achievements and those of others. Nye would also be honest enough to see the need to point out where successive Governments have been going and are going wrong in their attempts to tackle bad health.
Once again, I shall give an example from my local authority, which is one of the smallest and poorest in Wales. In the past three years, successive Governments with their cuts have made the local authority make resulting cuts of approximately £14 million. One cannot have such cuts in a poor local authority area without adversely affecting the service provided and the health and standard of living of people in the community.
Local authorities like mine also lose out in other ways. For example, many of our health clinics have poor resources and many of the valley constituencies, including mine, also lose out because they find it difficult to attract doctors to set up practices. In my constituency, that situation has been exacerbated by the actions of the local area health authority. For example, a doctor retired in Cwm, Ebbw Vale, which has serious health problems, as do other parts of the constituency. Instead of the health authority replacing that doctor with another, it decided to transfer his work load to another local general practitioner. Obviously, that was not good enough and did not respond effectively to the problems of our community. Much to their credit, the local people raised their voices in protest and, as a result, the health authority was forced to reverse its plans. It then promised us another full-time permanent doctor, but we are still awaiting the replacement a number of years later and we still have only a part-time, temporary doctor.
The Government are not only aware of the link between bad health and deprivation, but are trying to do something about it and, for me, the most important legislation during this Parliament must be the introduction of a minimum wage. However, the effectiveness of such a wage in combating poverty will obviously depend on the level at which it is set. I accept the arguments put forward by many individuals and trade unions, including those representing health service workers, that, if the wage is to be effective, it should be set at £4.60 per hour.
296 My next question concerns the possible privatisation of the health service. Successive Governments have proposed or enacted legislation to privatise different public services. Indeed, they seemed to want to copy the United States of America, for example, and how it runs such services.
Many years ago, I read a book on health care in the United States, which mentioned that the chair of Kentucky Fried Chicken had decided to resign his position to head the new Hospital Corporation of America because, as he said:
The growth potential in hospitals is unlimited. It's even better than Kentucky Fried Chicken.I do not know how many hon. Members have tasted Kentucky Fried Chicken but, if they have, they will be justifiably concerned that the quality of the product will be what we could expect if the health service is privatised. To allow such an organisation to be involved in the health service would be as nonsensical as to allow McDonald's, for example, to be involved in the organisation of education zones.I know that the usual response to those who warn about the privatisation of the health service is to say that it will never happen, but the reality is different—one has only to think of the private finance initiative, for example. It is good to see the Secretary of State for Wales here today. He was sponsored for many years by the National Union of Public Employees, and then by Unison, as it became. Unison described the PFI as creeping privatisation, and I agree with that sentiment. It referred to Labour's announcement of major acute hospital PFI schemes, and reminded us that
PFI in the NHS is not simply about bricks and mortar. It is about the ownership and control of NHS assets, services and staff… Private consortia will finance, build, own and run new hospitals or services and lease them back to the NHS… PFI is also beginning to dominate other forms of investment and service delivery in the NHS. For example, the lack of public investor finance for sterile supplies or NHS catering facilities is resulting in PFI being used extensively in this area also.Responsibility for running services is being handed to the private sector in return for private finance. That, as Unison argues, is creeping privatisation, which will, in the long term, be very expensive for the NHS.If Government spokespersons are not willing to accept the opinions of so great a union as Unison, I am sure that they will want seriously to consider the words of my right hon. Friend the Secretary of State for Social Security, whom we all respect. In 1996, as a shadow health spokesperson, she said to a Unison conference:
When the private sector is building, owning, managing and running a hospital, it has indeed been privatised.I agree with what she said then, just as I agree with Unison now.If Nye had wanted a health service to be provided by private companies, he would not have created the national health service. He inherited a patchwork of voluntary, local authority and private hospitals, from which he created a national health service free at the point of use—a service for people, not for profit. If he had wanted a national health insurance system, he would have created one. Nye believed that it was vital that the NHS should be provided by the public sector—the PFI undermines that vision.
As we celebrate the 50th anniversary of the foundation of the NHS, the Welsh Office has published a consultative document proposing a trust to cover the whole of Gwent. 297 I believe that that will damage the service in the northern part of Gwent. I want Gwent to have two trusts, but that is not my opinion alone—it is also the opinion of the Blaenau Gwent borough council, Monmouthshire county council, the community councils in the area, the Nevill Hall trust, the community health councils in north Gwent, many voluntary organisations and thousands of people who have signed a petition.
If the Minister is unwilling to listen to those bodies, perhaps he will listen to the 166 general practitioners who have gone public in their opposition to the Welsh Office's one-trust proposal. When I raised the issue some months back, only 50 GPs opposed the proposal; now, 166 GPs oppose it, and that number is increasing every day. Those people should not be ignored. I know that the Welsh Office will say that Gwent health authority supports the scheme, but, in fact, the health authority expressed only a marginal preference for that option. All the main players—for want of better description—have come out in opposition to the Welsh Office proposal.
I am aware that one of the reasons why the Under-Secretary of State for Wales, my hon. Friend the Member for Bridgend (Mr. Griffiths), opposes the two-trust option for Gwent is that he does not want to break up local authority areas. However, in giving trust status to Cynon Valley and Merthyr as part of the North Glamorgan trust, he accepted the need to break up the Rhondda Cynon Taff local authority area. We in my constituency do not object to that proposal—indeed, we applaud the Minister's wisdom—but we argue that he should apply the same reasoning to our community. He may argue that Cynon Valley and Merthyr already had their own trust, but that does not detract from the fact that he is willing to break up local authority areas.
It is proposed that there will be 15 trusts in Wales to serve 2.9 million people—each trust will, on average, serve just under 200,000 people. However, a single trust for Gwent would cover some 550,000 people, although even that is a considerable underestimate, as it does not take into account the catchment areas in Powys and, indeed, parts of Herefordshire.
On 30 March, my hon. Friend the Member for Bridgend perceptively conceded that the trust, if approved, would be very large. In the consultation document, he said:
With a project turnover of £240 million in 1999–2000 and fixed assets of £180 million, the trust would be one of the largest in the UK.He could also have said that it would employ a massive bureaucracy of 10,000 people and that it would probably cover an area of some 300 square miles. He seemed to be of the opinion that, for Gwent, big is beautiful. However, for some reason, he decided to reject that philosophy for his constituency. Indeed, the trust that he has set up to cover his constituency and the two neighbouring constituencies will serve a population of only 270,000. I wonder why that is. If we accept the logic of the view that big is beautiful—that trusts to serve 550,000 people are acceptable—Swansea should be added to the trust that will cover those three constituencies, as such a trust would be similar in size to the one that is proposed for Gwent. We in my area and in the area of my hon. Friend the Member for Monmouth (Mr. Edwards) do not argue that the trust serving Bridgend, Port Talbot and Neath should be merged with the one serving Swansea. All we are saying is that that is the logic of the Minister's position.298 We want a trust in north Gwent that can concentrate on the health problems that I have outlined. We do not want a single trust covering the whole of Gwent, under which we would be lost, as we have been lost in the past. The present health funding formula does not take into account the number of people who need long-term care, so areas such as Blaenau Gwent are discriminated against because of their poverty and serious health problems. That is hardly a socialist principle, but it is the reality.
To deal with the winter bed crisis, north Gwent received only 22.5p per patient, whereas the south of the county received £3.47. A year or two ago, it was decided that the provisions for mental health in Gwent should be reorganised. The person appointed to carry that out admitted at a public meeting that he knew nothing about the area. He did not bother to consult the patients, their families and friends, nurses, doctors, local authorities, community councils, trade unions, Members of Parliament or the community health council. That is how we in Gwent have been treated, and we do not want history to repeat itself.
The Minister says that there will be a phased replacement of existing technology and information systems. How long will that take and what will it cost? He says that the existing management responsibilities will be retained until April 1999 and that key responsibilities will be identified as soon as possible. Tell that to a demoralised staff, who are facing yet another major upheaval.
The Minister tells us that locally delivered services will continue to be provided in north Gwent, but he does not say whether they will be the existing services or whether they will be enhanced or reduced. Of course local services will be provided locally: they would not be local services otherwise. What guarantee do my constituents have that they will not have to travel 30 miles to a hospital for treatment or to visit friends or family?
I warn my colleagues in other parts of Gwent that, if high-quality clinical and surgical services are transferred to south Gwent, day-to-day routine operations could be transferred to the north. That would not only affect morale and recruitment in the north but would mean that patients and visitors from Newport would have to travel to Abergavenny.
There are no real health arguments for the one-trust option, and even the possible savings seem to have been watered down. The Government's penny-pinching attitude does them no credit in a country that is now so rich and that was so desperately poor when the national health service was created 50 years ago.
We are told that this is a consultation exercise. We hope that it is; if it is, the Minister will find out that virtually all the community is opposed to the proposals. If it is consultation, and not merely another public relations stunt, the Minister will have the courage to alter the proposals from one trust for Gwent to two. If he fails to do that, we shall all know that it was consultation in name only, and our communities will lose out once again.
We hope that the legacy of the Government will not be one of damaging the national health service that Nye and others had the imagination and courage to create. Future generations would not forgive us for that. Let us build on the positive aspects of the Government's work in the national health service and ensure that, this time at least, justice is done for the people in our communities.
§ Sir Geoffrey Johnson Smith (Wealden)It is a pleasure to follow the hon. Member for Blaenau Gwent (Mr. Smith), who represents a constituency that, as he said, was once represented by the right hon. Gentleman who is associated with the founding of the national health service, the 50th anniversary of which we are celebrating.
Let me say en passant that I understand the philosophy behind the primary care groups, but we do not contemplate anything in my part of England that would be as large as the hon. Gentleman suggested for his part of Wales. The group that has been proposed for my health authority would involve 50-odd general practitioners and cover a population of 80,000.
I know a little about the medical profession, and I find that GPs have their own way of doing things: they and other members of the medical profession rightly have an independence of attitude towards the way in which they carry out their duties and ply their skills. There are those in rural practices who have developed particular attitudes to fit the needs of their patients, and if we amalgamate all those people with their different priorities, combining urban and rural areas, I fancy that it will not always be easy to find the harmony that one would expect among professional people carrying out their duties on behalf of the public.
I do not want to go into great detail, because I want to cover a wider canvas on the question of the national health service, but I want to fire a warning shot across the Minister's bows—I welcome his presence, because I know that he takes a keen and practical interest in these matters—to show that I hope to get an assurance, at some future date, that my worst fears are not well founded.
It is an honour to speak in this debate and to pay tribute to the national health service and to all those who work or have worked in it, giving of their time, skill and dedication—bywords among many of us who have had the opportunity to meet at their work those who have given such excellent service to the public.
I was almost in at the birth of the national health service, as I am one of the few Members of Parliament who was alive and well at the time of its introduction. Little did I know that, some years later, I would represent the constituency now represented by the Secretary of State for Health—Holborn and St. Pancras, South, as it then was—which contains some of the finest teaching hospitals in the world. I got to know members of the medical profession, nursing staff and administrators extremely well. I pay a warm tribute to them, as they carry on the best traditions of medicine to be found anywhere on the globe.
I also compliment those who give service in my health authority area—they are dedicated, as one would expect, and try to observe the highest standards, although it is not always easy for them so to do—and especially those who give of their time and money to help out the smaller hospitals.
We are fortunate enough to have two community hospitals. It took two deputations to persuade the previous Government not to close the community hospital at Crowborough, which, like so many in the 19th century, was founded by voluntary contributions. Today, it is still charged with raising £2 million—it has raised £1 million—to ensure, with help from the health authority, that it can be modernised and fulfil the 300 important function of allowing elderly people and women with babies not to have to travel to the district general hospital in a congested town far away. I pay an especially warm tribute to the voluntary side, which has spent so much time trying to raise money, with some success, although there is still a long way to go.
I also congratulate the previous Government, whom I have heard rubbished on more than one occasion, including at yesterday's Question Time. It is now part of the ritual to say, "No, we spent more than you did," "No, you didn't, you spent less," "You destroyed what we tried to build up," and so on. All new Governments say such things. The previous Government did the same after the cuts in the health service imposed by the previous Labour Government during the stormy economic days of 1976 to 1979.
I wish to goodness that we could get rid of some of the ridiculous party politics. One reason why the national health service is failing us—not in terms of health, but in terms of its structure—is that the concept of it leads to too much low-grade politicking. I try to avoid that, but I do not think that it was pointed out yesterday that, overall, we increased expenditure on the health service by 3 per cent. in real terms. Of course, the amount varied from one year to another; we would have liked a smoother financial passage.
When the last Conservative Government came to office in 1979, expenditure on the NHS in England, as opposed to the United Kingdom as a whole, was some £9 billion. When we left office, it was well over £35 billion—and that was not small beer. We spent more, standards improved, and so it went on. I do not think that that record should be rubbished.
Nor should our record be rubbished in respect of the birth of the national health service. It is true that Conservative Members of Parliament opposed it, but so did doctors. It should not be assumed that a politician who opposes the NHS does not care for the people, any more than doctors who opposed it should be accused of not caring for the people. What they did not like was state control over health matters, which they saw as socialism.
Even Lord Beveridge, the architect of the modern welfare state, was not keen on the creation of a national health service. He had certain things to say about it. They may sound rather old-fashioned now, but I think that they are worth repeating. He said:
It is a logical corollary to the receipt of high benefits in disability that the individual should recognise the duty to be well and to co-operate in all steps which may lead to diagnosis of disease in early stages when it can be prevented. Disease and accidents must be paid for in any case… One of the reasons why it is preferable to pay for disease and accidents openly and directly in the form of insurance benefits, rather than indirectly, is that this emphasises the cost and should give a stimulus to prevention.That is, perhaps, a rather Victorian concept.Beveridge went on to say:
British people are clearly ready and able to pay contributions for institutional treatment. Should a payment for this purpose be included in the compulsory insurance contribution and be passed on as a grant from the Social Insurance Fund to the health departments towards the maintenance of the institutions?He referred tothe importance of securing that suitable hospital treatment is available for every citizen and that recourse to it, at the earliest moment when it becomes desirable, is not delayed by any financial considerations. From this point of view, previous contribution"—301 through the insurance system, I assume—is…better even than the free service supported by the tax-payer. People will take what they have already paid for without delay when they need it, and they pay for it more directly as contributors than as tax-payers.It is possible that, because it is free at the point of demand, the NHS has weakened that link—weakened the citizen's feeling that he should take responsibility for his own health, and his awareness of the connection between his treatment and the cost to the nation, as well as to his family. That point is ripe for debate, because it cuts right across the concept of the service being free at the point of demand. I am merely quoting the views of someone who was not cruel or hard-hearted, and who recognised the importance of health treatment to the poorer members of the community, but who thought that there was another way—perhaps a more responsible way—of ensuring that there was a link between the insurance taken out by a citizen and the service that he received as a consequence.The hon. Member for Blaenau Gwent spoke of Aneurin Bevan's dedication to the health service. Bevan, however, realised that he was opening the floodgates. He referred to the cascade of medicine that would flow down the throats of the British people. Even at that time, he was aware of the mounting costs of the health service. Although he did not want to, Bevan—and the House of Commons—had to accept that prescription charges would have to be introduced. Then came the question of paying for spectacles, and so on.
Bevan was clearly disappointed, because he resigned, but he understood what had happened. He is on record as saying that costs were increasing at an alarming rate—more than he had ever imagined.
§ Mr. Llew SmithIf the right hon. Gentleman reads Nye Bevan's resignation speech, he will see that Bevan resigned not just over prescription charges, but over such issues as defence spending. He thought that one area of spending was causing problems to another. It is interesting to read that speech.
§ Sir Geoffrey Johnson SmithI am sure it is, but I do not think it can be denied that Bevan realised that the floodgates had been opened to heavy expenditure that he had not envisaged. I lived through it, and I know that, at the time, many people said that the health of the nation would improve and that costs would therefore fall. How wrong they were. I cannot criticise them, because that was the received wisdom at the time; but they did not realise that the health service was not the only vehicle for improving the health of the nation. Health can be improved by a better standard of living—by a better diet, better housing and better education. The health of the nation does not improve markedly more than that of any other nation because we have a national health service.
Although I admire what has been done and what is still being done, I think that we must face up to the reality of the NHS and what it has achieved. We should not just look back; we need to look forward, and ask ourselves how we can provide a better and more affordable health service. The present system is not good enough, for many reasons. It can be improved.
Since 1948, most countries have looked at their own health services. Germany, for instance, has continued with a system that was introduced years ago by Bismarck. 302 Its system of compulsory insurance for health treatment must have influenced Beveridge; otherwise, he would not have made the comments that I quoted. New Zealand, Canada and Holland have looked at their health services in recent years, and have introduced reforms on the principle to which most of us adhere: that the door should not be closed to people who happen to be poor. Such people should not be deprived of decent medical care.
Interestingly, not one country that has examined our system has adopted it. That should make us, on this 50th anniversary, take stock of the present situation, and ask ourselves what we can do to improve our service in the face of rising costs—costs that I cannot see declining, for several reasons.
First, the health service is labour intensive. As the Minister knows, a fair proportion of low-paid people work for the NHS. One reason why they put up with low pay is their feeling that they are doing something for others: that voluntary spirit is very strong in the health service. Those workers are better paid than many others, but, given the range of skills that they possess, and the salaries that such skills would command in other walks of life, they are not overpaid, by a long chalk. If we want to improve recruitment and reduce the notorious wastage in the NHS—especially among nurses—we must consider that point.
Secondly, there is the problem of the aging population, but I shall not dwell on that. Then there are the sensational advances in medical care and diagnostic technology. We all know how expensive that technology is. Someone was telling me the other day—I do not know whether it is true—that a little drip feed that could once be bought for very little now costs £140. Why is it so expensive? It is computerised, so doctors do not need to attend to it. They know what is going into the patient, and whether the mixture is right. That is a great advance, but it is expensive.
Expectations are always rising. I will never forget being absolutely astonished to meet a woman who I thought had gone into hospital, but who was back and walking after her hip operation. It is not uncommon to meet people who have had two hip operations. Expectations are rising because people know that a wide range of surgical techniques hitherto undreamt of—and certainly unthought of by the medical profession at the foundation of the health service—are now available, and might improve the quality of their lives.
Dr. Chris Adams, a consultant to the department of neurosurgery at the Radcliffe infirmary, Oxford, is not regarded as a wild, radical doctor who runs ahead of the pack. In the November edition of Parliamentary Review, whose editorial judgment would, one assumes, lead it to employ only those whom it believes to be reasonably rational, Dr. Adams said:
Financing medical care is a world problem.However, we need not feel guilty about that,Because each year advances make medicine more expensive—and that trend will accelerate. This country cannot afford a comprehensive free health service, and it is not providing one.He went on to say, as others do, that we should not put up with the present system of rationing. It is, of course, not always called "rationing", but there are long waiting lists for certain treatments for which there is great demand. If one believes that the health service should be free at the point of demand, one might argue that that is immoral.303 I do not want to generate party political heat, so I recognise that the Government do not accept that gloomy prognosis. The White Paper takes a different view, saying that, at its best, the NHS is the envy of the world. I do not use the word "envy"; I have seen too often how other countries employ the best techniques. I do not envy them that; they are pretty good, and we are pretty good, too, and have institutions and practices that are as good as any. However, as the hon. Member for Blaenau Gwent said, we are a rich country, so that might be expected.
The White Paper also says that the Government reject arguments that the NHS cannot cope with the pressure of public expenditure without a huge increase in taxation or charges for services or radical restriction in patient care. It states:
The health service is a strong and resilient organisation.It also says that the NHS has met past challenges and will rise to future ones. It is not my purpose to say dogmatically that the Government are wrong, but hon. Members may have gathered that I have my doubts. They are not irrational doubts, and they are not motivated by emotion, but I have practical doubts about whether the Government's worthy aims can be met.Funding the NHS by taxation always involves the menacing figure of the Chancellor. Chancellors are not cold-blooded men; even the present one has decent feelings, just as his predecessors did. However, Chancellors have a duty to the nation. They must consider defence, and there may be arguments about why defence should have more money. The hon. Member for Blaenau Gwent mentioned that Nye Bevan was concerned not only about the increasing costs of the health service and charges, but about the cost of defence. Chancellors are always concerned about rising costs. There are always battles between one Department and another.
Perhaps that is one reason why we are more politically conscious of the health service than virtually every country that I have visited. The politics of health in the United Kingdom stem largely from the fact that so much decision making lies here because we—rather, Chancellors—control the purse. The Chancellor has more control over decisions balancing how much should go to defence or other parts of public expenditure than any other Minister. Although the economy does not have to go from boom to bust, we all know that no economy can sail along year after year in the assumption that things will get better and better. There may be a world economic crisis from which we cannot be insulated, especially now that there is a global economy. That would have a profound effect on the Government's ability to deliver from taxation all the services that they want. That is one reason why people think it would be a good idea if the Government were to consider additional ways to finance health.
The Government should not underestimate the serious defects of the NHS. First, there is the money problem. In a few days, the Government will announce an extra injection of money, and I have read that it will be a greater real-terms per annum increase than has been accomplished before. I do not know if that is so, but there will be a substantial increase. All will look good for three years, but the Government cannot guarantee that there will not be some change in the economy that will leave the Chancellor having to tell a Secretary of State for Health that the belt has to be tightened. One of the service's problems is that it is wholly dependent on money from taxation.
304 There is an acute shortage of personnel—a particularly serious problem among nurses, doctors and specialists. One reason why there is a waiting list is that there are appallingly few consultants. According to 1994 figures, not very out of date, and still true, we have 9.5 consultants per 10,000 of the population. Sweden has 20 consultants, Germany 19, France 14, Finland 15 and the Czech Republic 20. We are not quite as badly off for general practitioners, but France has 14 per 10,000 of the population, while Great Britain has six. Germany has 11, and I could list other countries. The simple message is that the people on whom we rely for skilled advice and knowledge are in short supply. The NHS executive has also mentioned that we are short of modern equipment. We simply do not have enough of it. I visited the United States recently, and found that magnetic resonance imaging was everywhere. Here, we have made a start, but there is much to do.
I should like the Minister to pay attention to training—a difficult problem. The training of our medical profession is too unstructured and is inefficient. What happened at Bristol would not have happened if training and qualifications had been more specific. Junior doctors spend hours walking round wards looking after patients, but those hours are out of all proportion to the time when they should be provided with specific teaching. Our emphasis on teaching is not high enough. Of course, more teaching will not come cheap.
It is difficult to understand why the Government refuse to consider topping up revenues for the NHS, as happens in the European Union. Stephen Pollard, a former director of the Fabian Society, has said:
Continental Socialists find little time for the politics of narrow-minded statism which has in recent decades characterised the British Labour movement's approach to healthcare. In countries such as France, Spain, Belgium and Greece, they really accept the complementary benefits that can be derived from actively involving their independent healthcare sectors and putting them to good use.The socialist Government in France have no problem about topping up their taxpayers' contribution in that way. Other international comparisons also show the use of additional sums from, for example, non-profit mutual societies—an old Labour conceptߞand friendly societies. I cannot think why we do not make better use of them. For those reasons, the time has come for us, and especially the Government, to examine the matter and perhaps to go back to some of their old Labour roots to find how much we can better use our resources to ensure that the NHS is better funded and well funded.
§ Mr. Deputy Speaker (Mr. Michael Lord)Order. Before I call the next speaker, I remind the House that this is a brief debate. Many hon. Members wish to speak. If they are brief, many will get in; but if they are not, many will be disappointed.
§ Mr. Paul Flynn (Newport, West)I congratulate my hon. Friend the Member for Blaenau Gwent (Mr. Smith) on securing his sixth Adjournment debate in this Parliament. He almost holds the record, but two Members have had seven. I have several points which, unfortunately, cannot be made in a couple of minutes. I want to draw attention to what I believe are the NHS's major weaknesses.
305 Like the right hon. Member for Wealden (Sir G. Johnson Smith), I remember the start of the health service. As a 13-year-old schoolboy at a May day rally in Sophia gardens in Cardiff, I heard Aneurin Bevan speak about the NHS. I remember it more vividly than, say, the events of yesterday evening, which is probably just as well. He used as a measure of the success of the health service something that strikes us as astonishing today—the increase in the birth rate. He pointed out that he was not claiming any personal responsibility for the increase. How extraordinarily things have changed. He would have been surprised that we rate the NHS by the crude measures of waiting lists and the amount of money spent.
I am sometimes critical of the Government, but we are doing splendid work on the NHS. I congratulate Ministers on tackling the major weaknesses. People will look back in 50 years and say that this was a turning point in the reform of the health service. I refer to the Government challenging the omnipotence of clinicians, which led in part to the terrible Bristol tragedies. So much of medicine is based on mythology, on the first thing that comes into a doctor's head, not on science or evidence. A series of individuals make thousands of decisions in their domains. Hip operations—on which I had a debate many years ago—are an example on which research and evidence exist.
The main weakness of the health service is not private medicine but the commercialisation of all medicine, with so much being done not for the needs of the patients or to advance medical science but to serve the interests of commercial companies. It was true even five years ago that anyone having treatment for cancer would have had as good treatment in the health service as they would have had privately. That is no longer true. It is now a gamble. People's treatment depends on where they live and whether drug companies are conducting trials in the area. The drug companies are leading research into cancer treatment. The whole business is a sad gamble with people's lives, because it is commercially driven.
Enormous damage is done by the vast over-use of medicinal drugs. It is a great tragedy and lives are being lost. We make a great fuss about illegal drugs, but the figures for Wales over the past four years show that six people died from heroin and only 13 from all illegal drugs, while 108 died from paracetamol, 28 from co-proxamol and 55 from methadone, which is a legal drug. In the UK, 2,500 people die annually from the misuse of medicinal drugs.
To see zombies with damaged lives who exist in a perpetual trance, one should go not to some slum to find kids with needles sticking out of them but to the residential homes. There, people are drugged unnecessarily with neuroleptic drugs. There have been two major reports in Britain on the subject. One was in a northern town, but I cannot say where because the report has not been published. It discovered that 54 per cent. of residents of such homes who were on neuroleptic drugs did not need them; 20 per cent. of admissions to hospital for elderly people resulted from misuse of medicinal drugs. That involved not only neuroleptic drugs but the interactions between all drugs. An identical figure was found at Gloucester royal hospital: 20 per cent. of elderly admissions were for misuse of such drugs. A Glasgow 306 study showed that the figure was 88 per cent. These terrible, powerful drugs mimic the symptoms of dementia and Alzheimer's disease.
Many people have stories of relatives entering homes frail but with alert minds. Within weeks, they are put on regular prescribed medication. It becomes routine and they are turned into zombies with a poor quality of life. The study that I mentioned visited hospitals with a pharmacist and a doctor and examined all the medication that the elderly took. They were able to reduce it by at least half. Each individual was taking an average of six drugs. Some had been taking them for years and did not realise why. It had all been forgotten. The interactions between drugs were doing great harm. Neuroleptic drug use was cut enormously. The result was a better quality of life. People returned to being sensible and taking an interest in what was happening around them and they lived longer.
That is going on now in this country. We must address it. I hope that there will be support for a Bill that will come up during the slaughter of the innocents this Friday when 60-odd Bills come before Parliament. I hope that no Conservative King Herod will kill them all. We must address the problem. The Bill chimes in with what the Government are doing by saying that we need transparency. The Government have a battery of measures to ensure that we can know what is happening. When we find a residential home where 100 per cent. of residents are on neuroleptic drugs, that cannot possibly be right. The savings which can be made by dealing with this issue can be applied to other areas of care in the homes which greatly benefit people.
Drugs are misused in many other parts of the health service. We know about antibiotics, with the creation of methicillin-resistant staphylococcus aureus. The philosophy of medicine is vast over-use of drugs because of the commercial interests and bodies that press, influence and lobby us and the health service to oversell drugs. We have become a society that does not want to accept the human condition. If we are sadder today than yesterday, we feel that we need a pill to take. For every discomfort, grief or pain, we think that there is an answer. Common sense tells us that someone suffering from a bereavement must suffer, weep and wail. We cannot smother it with drug-created euphoria, because the grief will recur in a more damaging form.
People going to hospital will routinely be told that they have to take daily pain-killers when they are not in pain, just in case, or anti-depressants when they feel happy. Huge amounts of drugs are then given to counteract the effects of other drugs. When the House meets in 50 years, our time will be seen as a period when people were obsessed and our lives full of drug use. That is the main heresy of our time.
The answer to many of our problems is not to be found in superficial measures. People are far better on a waiting list than having their babies attended at Bristol royal infirmary or having a dodgy hip replacement. We must examine the quality of the health service. That is the measure that will improve things. We must escape from the present situation, where so much of the health service is driven not by the needs of patients but by the greedy needs of commerce to make extra profits.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)I am conscious that we have far too little time, so I shall be brief. I thank the hon. Member for Blaenau Gwent (Mr. Smith) for giving us the opportunity to say thank you to the national health service. On behalf of my Liberal Democrat colleagues, I pay tribute to that 50 years of history. We stake our claim to the genesis of the NHS. After the Webbs in the 1920s, Beveridge in the 1930s and 1940s—he was briefly a Liberal Member of Parliament and then a peer—wrote the report that said that a precondition of a welfare state was a national health service that dealt with all conditions. For those who have not read it yet, I recommend the book by Nick Timmins as a very good and timely read about the history of the welfare state in those great days.
Nye Bevan did the country proud and the Labour Government did the country right after the war. The rest of us have a duty to build on the basis of that. We could all eulogise the good things that the health service has done in all four countries of the United Kingdom, this great capital city and our constituencies. I add my words of thanks to those who work and have worked for the health service, not only at the sharp end—consultants doing difficult and acute operations every day, experts in paediatrics and intensive care—but people such as health visitors going out and about and those who work for environmental health improvement. As the right hon. Member for Wealden (Sir G. Johnson Smith) said, for every curative health service, we need a preventive health service to match. The two work hand in hand.
Like others, like the House as a whole and, thank goodness, like almost everyone in Parliament, we are committed to retaining in this country a health service free at the point of delivery. I have seen the recent figures. We spend £45 billion a year on the health service. Last year, 30 million people used it. That means that for every person who used it, it cost £1,500. For all of us, who might need it any day, it costs less than £1,000 a year. We pay 6.5p in the pound in tax for the NHS. It is very good value for money.
The debate, which I welcome, is about what the health service should do in the years to come. My colleagues and I believe that we have to connect—in Forster's words, "only connect"—the funders and the job. We have to agree as far as possible what the NHS should do, what is the core service, what is the provision. The Minister of State, Department of Health, the hon. Member for Darlington (Mr. Milburn), was honest enough yesterday to admit to the House that in some parts of the country services are available while in other parts they are not. He said that we should have parity of service. I share that view. The public want to be engaged. I read in the newspapers today that a survey by the Institute of Health Services Management for the conference down the road reveals that one of the things that matters most to people is what the health service does, and that they want much more involvement in the debate about what it does. I hope that, in future, the debate about the boundaries of the NHS will become a public, orderly and regular debate and one in which we can all take part. If things cannot be agreed nationally, our local councils and health authorities—we believe that they should be together—should be able to decide to add on services and to raise the money locally to do so.
308 I welcome the fact that the Government are soon to announce significant amounts of money for the health service. All the indications are good. I will not be churlish. I shall analyse the figures carefully and see how much the real increase is in percentage terms. I shall criticise it if it is not enough, but the recognition that we need a lot more money to catch up and then consistent increased growth to sustain the health service is welcome. The Minister knows the priorities. A health service cannot be run without staff. The right hon. Member for Wealden has made the point that we are desperately short of staff. We have to find incentives to people to train and stay with the health service.
We need capital to provide the buildings. I share the scepticism of the hon. Member for Blaenau Gwent about the private finance initiative, as do my colleagues. We need an information technology base to ensure that we make efficient use of our resources. I share the view of the hon. Member for Newport, West (Mr. Flynn) that far too many drugs are given to people, and that we depend on drugs far too much. If we can massively reduce the drugs bill and improve health in a drug-free way, we shall be doing the country a good service.
My pager—as well as warnings through the press—tells me that the Secretary of State has announced to the conference in Earls Court the Commission for Health Improvement. In our manifesto—the health section of which I drafted last year—we said that there should be an inspectorate of health and social care. I welcome the commission, on which I gather there will be consultation. I put it to the Minister that there should be—the consultation paper appears in the Minister's hands as if by magic—regular inspection similar to Office for Standards in Education inspections of schools. Any patient or health service professional should be able to telephone the commission and ask it to go in and inspect a GP, hospital or clinic if he does not think that they are doing the job properly. The stronger the commission is, the better. That is where we get a quality health service.
In the 50 years to come, the NHS will be coming home. In the next couple of years we shall, in effect, have four national health services in the four countries of the United Kingdom—one in Wales, one in Northern Ireland, one in Scotland and one in England. I welcome that. The respective services may take on a different style, but it will be no less a national health service. I hope that it will be the people's health service and not the professionals' health service, and that people will have a greater say.
The Secretary of State said yesterday that waiting lists were the supertanker that was turning round. We shall debate that later, but for today we need to say that the NHS is the flagship of the public service fleet. The higher the flag flies, the more contented and healthy the people are. We salute it and wish it a successful voyage in all the 50 years ahead.
§ 12.5 pm
§ Ms Julie Morgan (Cardiff, North)I am pleased to speak in this historic debate on the national health service. I congratulate my hon. Friend the Member for Blaenau Gwent (Mr. Smith) on securing a debate this week on the anniversary of the NHS. I represent a Cardiff seat but, like my hon. Friend, I come from the south Wales valleys. I am proud of the fact that the NHS was born in Wales. I strongly support the principle behind it—that it should be free at the point of delivery—which has been covered in many of the speeches today.
309 I want to focus briefly on some of the key issues that face the NHS today, all of which have arisen in my constituency. I represent a constituency in which there is an excessive number of hospitals. We have three major hospitals in Cardiff, North—Velindre, which is the major cancer hospital in Wales, the University Hospital of Wales, a major teaching hospital, and Whitchurch hospital, a psychiatric hospital. The nature of the first two hospitals means that many of the issues that are brought to me are of an acute nature, involving people who are very sick, their families, or their doctors. They are about treatment for very sick people. The Government's emphasis on public health, preventive care and the links with bad housing, poverty and the minimum wage—all those issues that have been raised today—is of tremendous importance, but we have to deal with, and debate in public, the provision of acute services. Some of those issues have been aired today.
Although some of the problems of the purchaser-provider split are being tackled, we probably still have to take further steps to reintegrate the NHS, especially in relation to acute services. Can the NHS operate properly with a split between commissioners and providers of very acute services when it is dealing with the advances in medical science that have been mentioned this morning? With advances in drug therapy for cancer, for example, is it reasonable to think that decisions about new drugs can be dealt with at a local commissioner-provider level? Will the health care commissioners have sufficient knowledge to decide which drugs to buy?
There has been much publicity lately about the improvement in cancer care in the United Kingdom, but also about how much it lags behind that in other countries. The figures are sometimes dramatic. Survival rates for different cancers vary enormously throughout the world. The publicity around cancer care raises public expectations. I believe that it is right that they are raised and that people should know about advances and treatments that might be available. However, that presents a dilemma about how to deal with that knowledge and deliver the service.
One problem, especially in relation to cancer treatment, is that much of the research is in the hands of the pharmaceutical companies, as my hon. Friend the Member for Newport, West (Mr. Flynn) said. It is a big issue—and a big debate, which we must have. We have to decide who is to have treatment and what treatment should be made available.
The other big issue that has come up in my constituency is acute heart surgery. The proposed heart transplant unit in Wales has been on then off, on then off, for the past three years. Before the Welsh Office and the University Hospital of Wales Healthcare NHS trust commit to it, the views of all the health areas in south Wales have to be taken.
In 1996, the right hon. Member for Wokingham (Mr. Redwood) changed the health authority boundaries and removed the central planning capacity of the NHS in Wales to take strategic decisions about the provision of services such as the heart transplant unit for Wales and the ability to top-slice health authorities. That meant that the planning mechanism for those acute services had gone. There have been about three years of discussion and 310 waiting to see whether the heart transplant unit will be provided in Wales. Wales should have such a unit. There is much discussion about the rebranding of Wales, and a top heart transplant unit is one of the greatest services that could be provided: heart transplantation is becoming common and should be available locally.
In September, the paediatric heart surgeon at the University Hospital of Wales in my constituency, who has had tremendous success in treating children with severe heart problems and has built up the unit, is to return to Italy. He has an empty theatre in which to operate, but he does not have the nurses and the paediatric intensive care beds to do the amount of surgery that he wants to do. It is frustrating not to have the ability to develop that work at the hospital. At the same time as that surgeon is leaving for Italy, the cardiologist is leaving to go to Bristol. Bristol's gain is Wales's loss. The chair of cardiology in that same teaching hospital remains vacant while a decision is awaited on whether there will be transplant surgery in Wales. Everybody is waiting for everybody else, and the result is the loss of a first-class service in Wales. I appeal to the UHW and the Welsh Office to ensure that we can continue as before with paediatric cardiac work in Wales.
The same is true of other advanced treatments. The UHW has the capacity to develop advanced in vitro fertilisation treatments, but consultants have to visit health authorities to see whether people will buy their product. There must be a simpler way. The purchaser-provider split is not effective in such acute, expensive areas of medicine, but it is important to make them available.
There must be a debate on how to fund and decide health service priorities. Advanced developments must be examined strategically. The health service may face huge challenges, but this week we must celebrate 50 years of the NHS. I am proud that it was born in Wales. Health provision must continue to be free at the point of delivery, but we must find a way to make available to people the tremendous advances in health care.
§ Mr. Elfyn Llwyd (Meirionnydd Nant Conwy)I congratulate the hon. Member for Blaenau Gwent (Mr. Smith) on securing time to debate the important issue of the 50th anniversary of the NHS. The service is under great pressure, especially in Wales, and I hope that the Welsh assembly will formulate a policy to serve the needs of Wales. There are many reasons for differences in Wales, where there are more heart complaints and more premature deaths, and where a host of other problems are endemic. Those problems need to be addressed, and I hope that the assembly will do just that.
I have been brief, because I know that other hon. Members wish to contribute to the debate. I have jettisoned most of my speech but I am pleased, none the less, to take part in the debate.
§ Mr. Philip Hammond (Runnymede and Weybridge)We welcome the debate and I congratulate the hon. Member for Blaenau Gwent (Mr. Smith) on securing it. I join other hon. Members in paying tribute to those who have built the health service over the past 50 years and who continue to give dedicated service. The service's 50th anniversary is the time to celebrate past 311 achievements, to take stock of the present and to look forward to the future. The hon. Member for Blaenau Gwent ranged fairly widely in an attack on Government policy. He spoke about the minimum wage, the private finance initiative and education zones. We sympathise with what he said about the situation in Wales and I assure him that the Opposition will listen to what the people of Wales have to say over the next few months. Other hon. Members struck a more consensual tone. I was delighted to listen to my right hon. Friend the Member for Wealden (Sir G. Johnson Smith) and to the hon. Members for Newport, West (Mr. Flynn), for Southwark, North and Bermondsey (Mr. Hughes) and for Cardiff, North (Ms Morgan).
The national health service is a truly national institution. It enjoys universal public appeal and no party or faction can claim ownership of it. The Beveridge report was commissioned by the wartime coalition Government, and in the 1945 general election both main parties were committed to the introduction of a universal health service that was available to all. It fell to a Labour Government to introduce the NHS in 1948, and Labour is rightly proud of that achievement. We in the Conservative party had control of the NHS for 35 of the past 50 years and we are proud of our stewardship of the service.
The NHS has prospered and grown under Conservative Governments. In the period between 1979 and 1997, NHS spending grew by 3.1 per cent. in real terms on average. Treatments went up by 3 million and the number of nurses, doctors, dentists and midwives increased. Capital spending increased by 50 per cent. in real terms in that time. I hope that we shall not hear from Labour Members the old, tired mythology that the NHS is somehow a product of the Labour party and that only it holds the NHS dear.
There is broad, cross-party consensus on the objectives for the modern NHS. They are to provide cost-effective, state-of-the-art health care that is free at the point of delivery and based on clinical need. There is political debate on the NHS but it is not about the objectives of the service: it is about differences in view on how best to achieve those objectives. There is an urgent need for debate on innovative and imaginative ways of ensuring the provision of the extra resources that the NHS will need to flourish and prosper in future. As medical technology develops and demography changes, the demand for more resources will increase. New technologies will allow better prediction of genetic predisposition to diseases, and that will allow preventive medicine to be better targeted. That will lead to long-term savings but it will demand greater short-term investment.
It is important to begin that innovative debate about the means of ensuring the availability of resources that the service will need in future. If the debate is to be meaningful, it is important to determine the underlying core principles that are important to patients—the users of the service—and to distinguish them from the sacred cows. The principle of universal availability on the basis of clinical need, free at the point of delivery, should be inviolable. Beyond that, the resourcing of the service should be based not on political dogma but on the determination to deliver the best possible service to users within the constraints of prudent fiscal policy.
Hon. Members on both sides of the House are proud to join in the celebration of the 50th anniversary of the NHS. The best birthday present that we, as politicians, can give 312 the NHS is to break out of the sterile debates of the past and launch a real debate on future resourcing of the service so that it can effectively deliver a modern national health service offering the level of service that the British people are entitled to expect in the new millennium. We need a debate that acknowledges the consensus on objectives that exists across the political divide, the commitment among hon. Members on both sides of the House to the future of the NHS and the real issues of escalating demand and finite tax-based resources; recognises the reality of rationing that exists now in the system; and does not shrink from hard questions in seeking to ensure the proper resourcing of our health service.
§ The Minister of State, Department of Health (Mr. Alan Milburn)I am delighted to have the opportunity to respond to the debate, which has been initiated by my hon. Friend the Member for Blaenau Gwent (Mr. Smith). He has secured it at an appropriate time not just for his constituents, but for the whole nation. It is particularly appropriate that it should fall to my hon. Friend to open the debate on the 50th anniversary of the NHS as one of his predecessors, Aneurin Bevan, was the founding father of our NHS. I think all hon. Members would want to pay tribute to Nye Bevan for his work, in the 1940s and subsequently, in giving the nation the sort of NHS that we have now.
This has largely not been a party political occasion, but I must point out that the hon. Member for Runnymede and Weybridge (Mr. Hammond) seemed to be suffering from a slight case of selective amnesia. In 1946, when we debated this issue in the House, his party opposed the National Health Service Bill tooth and nail. It fought it throughout—on Second Reading, Third Reading, Report and subsequently.
§ Mr. Nicholas Soames (Mid-Sussex)I am sorry that I was not here for the whole debate. Will the Minister acknowledge that the doctors opposed the establishment of the NHS, too? It is not a matter of pride for anyone that they should have opposed the creation of the NHS. The fact is that it is a truly wonderful service. All parties in the House should acknowledge that, and try to minimise, not maximise, the amount of politics involved.
§ Mr. MilburnAs the hon. Gentleman knows, I am all for keeping politics out of this place. I remind him that 90 per cent. of doctors voted in favour of the NHS in their ballot. There are interesting parallels with the situation today because, at their conference last week, 85 to 90 per cent. of general practitioners voted in favour of this Government's policy on NHS modernisation.
The NHS was founded on a simple principle: the best health services should be available to all—quality and equality. That appealed to the fair-minded people of our country then and it still appeals to them now. No one dares challenge those principles. No one says that the best health services should not be available to all. Indeed, the NHS embodies the principles in which the Government and my party believe.
We achieve more together than we do alone, and we have a duty to look after the weak as well as the strong. The NHS not only binds the nation's wounds, but binds 313 the nation together. Each and every family in the land has a stake in the NHS and in its future. This Government were elected on the principle that the best health services should be available to all on the basis of need—not according to ability to pay or, indeed, who one's GP happens to be.
My right hon. Friend the Secretary of State recently had the honour to meet one of the first patients to be treated in the NHS, a lady called Sylvia Diggory, who summed it up far more eloquently than perhaps any hon. Member—including me—has been able to do in this debate. She said:
Britain is one of the few countries where they feel your pulse before they feel your wallet if you collapse in the street".That is a lasting testimony to the sort of national health service that Nye Bevan wanted to create.It is a privilege to be a Minister with responsibility for health in the 50th year of the health service. As hon. Members will know, this Sunday, we celebrate the 50th anniversary of the founding of the NHS. My hon. Friend the Member for Blaenau Gwent reminded the House that, during the passage of the Bill, Nye Bevan talked of how the new NHS would lift the shadow from millions of homes. He was right. It is now impossible to imagine life in Britain without the NHS. Its achievements in those 50 years have been immense.
The NHS has banished the fear of being ill and becoming ill for millions of our fellow citizens. It is our country's greatest institution and it is my party's proudest achievement in government. It is living proof that public services can be both efficient and popular. Quite simply, the NHS has delivered the goods, as Nye Bevan promised it would.
I pay tribute in particular to all the people who work in the health service and who have given so much day in, day out over the past 50 years in the service of others. Without them, the achievements of the NHS simply would not happen.
Some people said in 1946, 1947 and 1948, and some people still say, that we cannot afford the best—that the principles of the NHS are not practicable, that they cannot be delivered. The past 50 years have proved those prophets of doom and gloom wrong because our NHS has served this country well for the vast majority of the time. The vast majority of patients over the vast majority of the country have received top-quality treatment and care, and the NHS has proved to be the cheapest and most cost-effective health care system in the developed world.
That is not despite the principles on which the NHS was based; it is because of those principles. Fairness and cost-effectiveness have gone together. They are two sides of the same coin. The basic financial principle of the NHS is that it is paid for out of taxation and free to people when they use it. That is a fine principle and, contrary to what the right hon. Member for Wealden (Sir G. Johnson Smith) said, it is also phenomenally efficient because it avoids the horrendous costs of paperwork that are inevitable in any system where patients have to pay for treatment.
That is the main reason why our system is so cost-effective. It puts a bigger proportion of resources into patient care, and a lower proportion into paperwork, 314 than any other system. That is true even now, when we still suffer from the after-effects of the competitive internal market. It is one of the reasons why the Government are sweeping away the internal market, but it is not the only reason. The internal market introduced a new competitive ethos into the NHS that was anathema to the basic principles of the NHS. It was also deeply inefficient.
Our NHS is based on the basic common-sense idea that we achieve more together in partnership than if we compete. It is that idea of partnership and co-operation—helping each other out—that is at the heart of the NHS. Indeed, it is one of the reasons why my right hon. Friend the Secretary of State for Wales has proposed a series of trust mergers to cover the Principality.
I know that my hon. Friend the Member for Blaenau Gwent has concerns about those issues. My right hon. Friend has been here to listen to those concerns. He has listened to them in the past. My understanding is that what is taking place is a genuine consultation, where the views that my hon. Friend and his constituents have expressed will be taken into account when final decisions are taken.
§ Mr. Huw Edwards (Monmouth)On the issue of the trust merger in Gwent, may I assure my hon. Friend that all the Government's priorities and policies will be fulfilled if we have a separate trust for north Gwent?
§ Mr. MilburnI am sure that my right hon. Friend the Secretary of State for Wales was listening to that intervention, and that those considerations will be taken into account when final decisions are taken.
As hon. Members have said, this is a great time for looking back and celebrating what we have achieved, but it is important also that we look forward and that, in particular, we look to build the sort of modern and dependable health service that people want. That is what the Government are committed to doing. That is why we are intent on cutting waiting lists, and are now achieving that. That is why we are intent on enshrining quality at the heart of the NHS; my right hon. Friend the Secretary of State for Health has launched a consultation on how we better ensure quality and transparency for all patients in the NHS. That is why we want a much more integrated form of care than was ever possible under the internal market. We want to break down barriers between services—between health care, social care and housing care—so that patients receive the benefit of all those services. The patient should be at the heart of the national health service.
We also realise, as my hon. Friend the Member for Blaenau Gwent asked us to do, that—if we are to improve the health of the nation, and, more important, if we are to improve the health of the poorest at a faster rate than the health of the overall population—we will have to tackle the root causes of ill health, which means tackling poverty, creating jobs, building homes and greening the environment.
The Government have embarked on the biggest anti-poverty, pro-health crusade that the United Kingdom has seen in two decades. To underpin that crusade, we shall annually invest more in the national health service, as we promised to do. We have embarked on the biggest new hospital building programme that the national health service has ever seen.
315 On the private finance initiative, I remind my hon. Friend the Member for Blaenau Gwent that the Government were elected—