§ Dr. Liam Fox (Woodspring)
I beg to move,That this House applauds the dedication and commitment of National Health Service staff whose tireless efforts alone have kept the Service going throughout the present crisis; deplores the Government's inadequate preparation for predicted winter pressures and Ministers' complacency and continual unwillingness to accept responsibility for their failures, including withholding information and misuse of statistics; notes the catalogue of mismanagement of the National Health Service by the Government, including the distortion of clinical priorities, reduced patient access to specialist care and its flawed cancer initiative; regrets the Prime Minister's assertion that there is no alternative to the Government's existing strategy; and calls on the Government to abandon ideology, put the well-being of patients before political dogma and create a health care system fit for the 21st century with a strengthened National Health Service at its centre.On Saturday, at my constituency surgery, Mrs. Jones, from Portishead, came to see me. She told me that, since last July, although suffering from a serious illness, she has had a liver biopsy cancelled four times. That is serious enough; however, all the time Mrs. Jones has been waiting for her treatment, minor procedures have been performed in the same hospital. It is a classic example of priorities being distorted.
My hon. Friend the Member for Gosport (Mr. Viggers) has been campaigning for a woman who has already waited 13 months, and may have to wait up to 17 months, for a triple heart bypass operation at Southampton General hospital. When she saw her general practitioner in December, 1998, she was informed that the wait would be about nine months. Last November, the wait was extended to between one year and 15 months. Now the woman has been told that, because of the winter crisis, the wait might be extended again.
In Staffordshire, Duncan Sheppard, a financial adviser, has had to remortgage his home for £12,000, to pay for a quadruple heart bypass. Mr. Sheppard had the operation at the private Priory hospital, in Birmingham, after being told that he would have to wait 14 months for the operation at the NHS Good Hope hospital. His wife said:We are just so lucky, because we were later told he only had weeks to live. We are very pleased we took this option.That is—the option of remortgaging his home to pay for health care.
Perhaps the most worrying case was brought to my attention yesterday from North East Anglia health authority area. A man writes:My wife was left on a trolley for eight hours in dire need of urgent treatment for her asthma. She was left passed out for 20 minutes before a nurse came. The consultant said she needed a bed, but there were none available. She was sent home, where she collapsed. I called an ambulance. It took half an hour to arrive. She is now lying in ITU. The consultant says she may be brain damaged. I have two children and they may not now have a mother. This is disgraceful. It cannot be allowed to continue. Mr. Blair needs to do something.692 Those are not typical cases of what happens in our health care system, but neither, sadly, are they isolated examples. All hon. Members are getting an increasing post bag of sad cases in which our health care provision is failing our constituents. Just before the election the Prime Minister told voters that they had 24 hours to save the NHS, but three years into his term in government, people are asking what has gone wrong. The people to whom he made promises feel angry, frightened and, above all, betrayed. How right Lord Winston was when he said:We have made health care unsatisfactory for a lot of people".What an understatement that was.
What has been the response of the Secretary of State and his Ministers? In the midst of the current flu epidemic, then flu outbreak, then bronchitis outbreak, we discovered that the health care system of the world's fifth biggest economy can be brought to its knees by something cyclical, predictable and common. The Secretary of State's view is that the NHS is coping very well. The cases that I have mentioned and the hundreds of others that any Member of Parliament could cite show that it is not. The Government are guilty of complacency.
§ Dr. Fox
I shall give way in a moment. The NHS is only running at all thanks to the herculean efforts of its staff, to whom we all give the greatest credit. The Government's management tools for running the health service, when they are not just being complacent, are bullying and the withholding of information. I shall give examples. I caution the hon. Gentleman to remember that before he makes his intervention.
§ Mr. Blizzard
The hon. Gentleman is not prepared to believe the Prime Minister when he says that hospitals are managing the crisis. I wonder whether he will accept information from my local hospital. I telephoned the James Paget Healthcare NHS trust this morning and was told that the hospital was managing very well. The management are also pleased that they have just started work on a £700,000 refurbishment of the accident and emergency department and are looking forward to the £80,000 that they are going to get to treat cancer patients.
The hon. Gentleman uses anecdotes. My local hospital is managing very well. It started routine operations again last week, despite taking people from other areas in its intensive care units.
§ Dr. Fox
The hon. Gentleman says that his local hospital has restarted routine operations. We must ask why they had been stopped if the system was coping so well. The hon. Gentleman should be very grateful if his local hospital is coping well, because that is not the experience of many Members of Parliament.
The Government employ various means of running the national health service, including bullying. The experience of Lord Winston last week was interesting. Let us look at what he said and how he was treated by the Government. He said:The NHS is just deteriorating because we blame everything on the previous Government.693 We know that. Not a single Minister will take responsibility for their own failures. Lord Winston said of the appalling treatment of his 83-year-old mother:It is normal. The terrifying thing is that we accept it.We do not accept it. That is why we are having this debate. He also said:There is a lot wrong with the health service and no one is prepared to say so. I shouldn't really be saying these things to you now.What sort of attitude is that? In a free Parliament, no member of either House should have to worry about what they are saying for fear of bullying.
§ Mr. Andrew Love (Edmonton)
The hon. Gentleman has quoted a number of Labour Members. Let me quote his speech to the Tory party conference, where he said:I think what we are proposing will revolutionise private insurance in the way we revolutionised pensions in the 1980s.Following the statements at the weekend on the current issues before the health service, will the hon. Gentleman now come clean? The Tories state that they want an alternative, non-ideological strategy. What will that strategy be—private health insurance?
§ Dr. Fox
I would urge the Labour Whips to try to give the interventions to their Back Benchers in a form that they can at least read. I will come to the explanation that the hon. Gentleman seeks later. It will be available in a monosyllabic form for Labour Back Benchers later on.
Lord Winston was so cowed after his comments because he could see what was coming. In the twilight world of new Labour spin, the dark shadow of Alastair Campbell was fast approaching. It seems that the Prime Minister's press secretary is better able to gain retractions and recantings from heretics than the inquisition ever was. The result of the grand inquisitor's intervention on this occasion was, incredibly, that Lord Winston—having made an impassioned plea for improvements in the NHS and having pointed out the deficiencies that exist— suddenly told us that he meant no criticism of the Government in any way at all. Remarkable—but it was sad to see a man of such integrity treated so shabbily by the Government's ruthless propaganda machine.
§ Mr. Geraint Davies (Croydon, Central)
Over the weekend, the Prime Minister essentially promised billions extra for the health service, through guaranteeing real increases in expenditure towards the EU average. Could the hon. Gentleman match that pledge, given that he acknowledges that there is a need for more money? Or does he acknowledge that his tax guarantee will mean the inevitable privatisation of the health service?
§ Dr. Fox
We are now told that it was a pledge from the Prime Minister to raise spending to the EU average within five years. I look forward to the Secretary of State confirming that that was a pledge. I look forward to hearing which programmes from the public spending review will be sacrificed to make up the vague billions that the Prime Minister promised. That will be an interesting passage of the Secretary of State's speech.
§ Dr. Fox
I have given way several times. I shall do so again, but not for the moment.
694 We must look at the way the Government run the health service. The culture of this Government is that if information is inconvenient, deny it, corrupt it or change it—even better, withhold it. We know that the bed availability and occupancy report, which is normally published in October, has been sitting on the Secretary of State's desk. Why, we wonder? Is it because it may be slightly more critical than the Government's own report card, issued in the summer? Perhaps it is unlikely to boost the standing of the most unpopular member of the Cabinet, although I notice—to be fair—that the Secretary of State is also the least known member of the Cabinet. Goodness knows what will happen when he is better known.
Is the report being withheld because beds are being lost all the time under a Government who pretend that the trend is in exactly the opposite direction? I look forward to the Minister promising the immediate publication of the report.
If withholding information does not work, the Government can try deceptions, half-truths and smokescreens. Let me give two examples. The Intensive Care Society recently asked about the number of extra intensive care beds that the Government claimed to have created. They were told by the Department of Health that the figure was 100. Then the line changed. No.10 said that there were 100 critical care beds. Then the line changed again. The Prime Minister told Sir David Frost that perhaps about one third were intensive care beds. The answer seems to be different every time the question is asked.
The Secretary of State sent me a letter on 6 January which said that 100 extra intensive care beds had been made available this year. The Secretary of State gave an answer which was factually incorrect. He looks at the letter, which he may well not remember signing. It does say that it was approved by the Secretary of State, and signed in his absence. The information changes from day to day. It is tidal, it comes and goes. There is no such thing as truth under this Government, merely convenience and inconvenience.
§ Caroline Flint (Don Valley)
Some tit-for-tat fun always takes place in these debates, but there is a serious point that goes to the heart of the discussion of our national health service—how it should be funded. I ask the hon. Gentleman point blank: does he or does he not support compulsory health insurance to fund the NHS, and does he recognise the great inequalities that that would create?
§ Mr. David Wilshire (Spelthorne)
My hon. Friend's comments about the claims for the number of intensive care beds changing almost daily may be more prophetic than he realises, because the Government are considering plans to close four intensive care beds in Ashford hospital in my constituency.
§ Dr. Fox
I am grateful to my hon. Friend for that point. The Department of Health will doubtless issue a press 695 release claiming that the number of intensive care beds in that hospital has increased, because there is no such thing as truth or lies in this Government's culture. The information released is what suits them.
§ Mr. Julian Brazier (Canterbury)
Will my hon. Friend comment on the proposed closure of the accident and emergency and intensive care units in my local hospital? In answer to questions about the new configuration for hospitals in my area—which will include a 15 per cent. cut in beds—we were told, "We cannot give details because there is no robust medical plan in place yet."
§ Dr. Fox
That does not surprise me at all. I know that my hon. Friend has campaigned long and hard about intensive care beds and he may wish to raise that issue with the Secretary of State when he makes his speech. It would be interesting to know what plans he has for health care in my hon. Friend's area.
§ Dr. Fox
I shall give way shortly. Yesterday, in what was billed as a great boost and a propaganda coup for the Government, the pay awards for NHS staff were brought forward in a panic measure after the Prime Minister's speech at the weekend. However, the Government failed to understand that NHS staff would spot immediately that the awards were unfunded. This morning, The Guardian said that NHS services would be squeezed and The Mirror said, graphically:Brilliant! But how will nurses be paid?The pay award issue goes to the heart of how the Government run our health care. Lord Winston said:I think we've been quite deceitful about it. We haven't told the truth and I'm afraid there will come a time when it will be impossible to disguise the inequality of the health service from the general population.Those are damning words from one of our leading health experts who is also a notable ally of the Prime Minister.
Of all the factors that prevent us from having a meaningful debate on health care, one of the most obstructive is the Government's dogmatic approach to the independent sector. The private sector tells us that, if there had been earlier consultation before the winter flu outbreak, it would have been able to make more beds available for the NHS when it was overstretched. It is the Labour party's dogmatic hatred of the independent sector that makes the Government incapable of any meaningful negotiation with it in the interests of patients.
§ Dr. Fox
The hon. Lady must not jump up and down like a demented meerkat. I shall give way in a moment.
The Prime Minister's press secretary, who now doubles as prime ministerial stand-in and as a Treasury spokesman, intervened in the debate today. The Press Association reported:Blair rules out tax breaks for private health insurance".However, it was his press secretary who said:We don't have an ideological hatred of the private sector, it's just that we don't see it as a solution to the problems of the NHS.
§ Dr. Stephen Ladyman (South Thanet)
The hon. Gentleman mentioned the pay awards and I can tell him 696 that the nurses will get their pay rise from the biggest boost in spending on the NHS in its history, which this Government have delivered. However, the Conservatives' guarantee to cut taxes, even in a recession, means that if they were in power they would have guaranteed to cut spending on the health service and hand it over entirely to the private sector.
§ Dr. Fox
That is a bizarre intervention. The hon. Gentleman suggests that health expenditure cannot be increased at the same time as taxes are cut. He does so just two months before the Government cut taxes by 1p to compensate for the stealth taxes that they have already imposed. That is a ridiculous argument.
No one begrudges the nurses' and junior doctors' pay rise, which they thoroughly deserve. However, allocations to health authorities and spending plans were already complete before those fully accepted—but not fully funded—pay rises were announced. So some cuts will have to be made in the allocations for the patient programmes already planned by health trusts and health authorities. The hon. Member for South Thanet (Dr. Ladyman) is grinning, but it is not funny for the people whose services will be squeezed and cut.
§ Jean Corston
I am very grateful to the hon. Gentleman for giving way, however reluctantly. The Avon health authority provides hospital services for people in my constituency and the hon. Gentleman's. It said today that, despite an average daily increase of 14 per cent. in emergency admissions during the flu epidemic, no health trust had had to refuse emergency admissions. It also said that, although some routine surgery had had to be cancelled, plans were in hand to cut waiting times. Does not that show that the health service for our constituents has responded magnificently to a once-in-a-decade epidemic? Does it not also throw into stark relief the hon. Gentleman's assertion to the Tory party conference that the NHS could only ever provide a second-rate service?
§ Dr. Fox
The hon. Lady was doing quite well for the first four or five minutes of her intervention. I was going to welcome what she was saying, and I am grateful that her constituents and mine live in the area of a health authority that has coped reasonably well.
However, the hon. Lady said that this epidemic has been the worst in a decade. In reality, it is probably only the fourth worst outbreak in 10 years, and it is not so different from other outbreaks. In any case, why should routine surgery have to be cancelled? Outbreaks of flu in our health care system happen in most years, so why should we be grateful that emergency admissions have not been stopped? The hon. Lady's remarks reveal an almost incredible complacency.
The Secretary of State is second to none in his dislike of independent health care. I have a letter from the former chairman of the St. Helier health trust, describing what happened on Thursday 26 March 1998 at the Department of Health building at Elephant and Castle. He and his 697 colleagues were to be lectured on their obligations by the then Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). However, because the right hon. Gentleman was late, the present Secretary of State gave the lecture. The letter states that the Secretary of State admonished the audience to deliver the Government's promise on waiting lists. The letter adds:During questions, someone (I think, but cannot be sure, that it was Dr. Tudor Thomas, the Chief Executive of Epsom Healthcare NHS Trust) referred to a satisfactory arrangement his Trust had with a local private hospital.The present Secretary of State was described as "furious". The letter states that hetold us all that he would 'come down like a ton of bricks' on anyone who had anything to do with the private sector.The letter went on:I was sitting next to Sir William Rous (sadly deceased) chairman of Kingston Hospital NHS Trust, and he was as incensed as I was at the dogmatic and nonsensical attitude.That dogmatic and nonsensical attitude persists to this day at the heart of the Department of Health.
The real reason for today's debate is that matters need not be as they are. Up and down the country, doctors, nurses, other health care professionals and voters do not want the NHS to be used as a political football in future. [Interruption.] The mechanism for delivering health care in this country need be no more controversial than it is in other developed countries. That is entirely possible.
Today, my right hon. Friend the Leader of the Opposition and I made an offer to the Government and to the Liberal Democrat party. Three things can be done to remove the national health service from this febrile political atmosphere. First, we offer the NHS a guarantee. It needs long-term stable financing and less political interference. We believe that there should be increased NHS funding year on year in real terms. We believe that there should be improved NHS management, allowing hospitals to get on with the job of treating patients, and no privatisation—instead, as now, there should be a continued commitment to publicly funded health care, free at the point of delivery.
Secondly, the NHS should give patients a guarantee. [Interruption.] This is a serious debate; it requires something more than the primary school outing that is being held on the Government Back Benches.
Patients should have a guaranteed waiting time, determined by the clinical priorities of doctors, not the political priorities of spin doctors. There should be an agreement that if the NHS cannot meet the guarantee, independent health care resources should be used. What matters is when patients are treated, not where they are treated or what sector they are treated by.
Overall, our health service requires more resources. We need to increase our expenditure in the NHS—the state-funded sector—and in the private sector. There should be no ideological block to partnership with independent health care providers. I mentioned how the crisis in the health service could have been averted had we used the independent sector better. However, there should be no punishment through the taxation system for those who take out independent health care provision, and we should review the tax treatment of health care costs 698 on companies and individuals. We should create the opportunity to expand total health spending in both the public and personal sectors to reach more quickly the level spent on health by our major European partners.
We believe that a mixed provision in health care will enable us to reach the health outcomes of our European partners, but far more quickly than the target set by the Prime Minister. The dogma of the Labour party, however, prevents us from doing so.
§ Dr. Howard Stoate (Dartford)
I am grateful to the hon. Gentleman for giving way. He is right to say that the NHS is under great stress. He is also right that the health service does not have enough beds, doctors or nurses. Could he therefore tell the House why his Government cut the number of beds by 40,000 and the number of nurse training places by 2,000 a year, which is what got us into this mess in the first place?
§ Dr. Fox
The number of doctors in the health service was higher at the end of our term of office than at the beginning—as was the number of nurses. I should have thought that that was record enough. As for nurse training places, I know that the hon. Gentleman knows that the number of nurse training places had already increased for the two years before the Conservatives left office, a trend that is happily being followed by the current Government.
Before we can entertain a proper, mature health debate, we have to accept three basic facts. First, the NHS cannot do everything at a time when medical science is expanding faster than our ability to fund it. Secondly, we no longer have the best health care system in the world— we used to, but we have fallen behind. Thirdly, the NHS has failed as a welfare model, because the poorest in our society have not only the poorest access to health care but the worst health outcomes. That must be addressed.
The Labour party is in a panic over the one issue that it arrogantly and complacently believed was its own. The Secretary of State was undermined by the Prime Minister over the number of intensive care beds. He was in the dark about the Prime Minister's announcement about funding on the David Frost programme. The Secretary of State is no doubt being lined up as the fall guy by the propaganda machine for when the trust ratings fall further.
Before No. 10 starts briefing that the Secretary of State is going to run as mayor of Darlington, and before he plumbs new depths of unpopularity, he has one chance to safeguard and protect his future and that of the NHS. He should drop the dogma, the soundbites and the deception, and should join us in creating a health care system fit for Britain in the 21st century.
§ The Secretary of State for Health (Mr. Alan Milburn)
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:applauds the dedication and commitment of National Health Service staff for their tireless efforts at all times and in particular during the millennium holiday period and the current severe outbreak of flu; welcomes the Government's acceptance of the recommendations of National Health Service Pay Review bodies in full and without staging for the second year, in stark contrast to the practice of the previous administration; notes that, between 20th December and last weekend, there were 350,000 999 calls, over 800,000 attendances at Accident and Emergency departments and there have been over 250,000 emergency admissions; recognises 699 the vital role in meeting these pressures played by the unprecedented level of planning for the winter, covering health and social services and the extension of NHS Direct to two-thirds of England; welcomes the measures already taken by this Government to increase the capacity of the National Health Service, including increased provision of critical care beds, the modernisation of Accident and Emergency departments, the biggest ever National Health Service hospital building programme, the employment of additional doctors and the recruitment of more nurses, the cuts in in-patient waiting lists, the extra investment to modernise cancer, coronary and mental health services and the commitment to increased investment in and modernisation of the National Health Service; and rejects the Opposition's proposals to privatise the National Health Service.May I say first that we already have a good mayor in Darlington?
Today's debate is not only about the state of the national health service. As the hon. Member for Woodspring (Dr. Fox) said, it is about the future of health care itself. There are no closed minds in the Government when it comes to radical reform of the NHS. That is precisely what we have been doing for the past two and a half years. The Labour Government made the private finance initiative work in the NHS, and will continue to do so. [Interruption.] The Conservative Whip may scoff, but as a consequence of the PFI, 16 new hospitals are being built, some in parts of the country that had been waiting for decades.
§ Mr. Milburn
I shall give way to the hon. Member for Rutland and Melton (Mr. Duncan), because he, too, is a radical.
§ Mr. Alan Duncan (Rutland and Melton)
The Secretary of State says that there are no closed minds on the Labour Benches. Will he therefore dissociate himself from the comments made by the hon. Member for Wakefield (Mr. Hinchliffe), the Chairman of the Select Committee on Health, who said:All private medicine is immoral. I hope all private medicine withers and dies.
§ Mr. Milburn
The hon. Gentleman and the hon. Member for Woodspring have raised the matter of private medicine several times, and are starting to be—
§ Mr. Milburn
The right hon. Gentleman seems to have a hearing problem. I know that he returned to the House only recently, but if he bears with me, he will hear the answer. The Conservative party is beginning to act as if it were the political wing of the private health insurance movement. Let me make it absolutely clear that no matter how serious the challenges facing the NHS—I readily admit that there are many—a private alternative is not the right remedy for Britain.
Modernisation and the investment that goes with it are the only means by which our health care system can serve the whole nation. No one pretends that there are no problems in the NHS, or that all patients are receiving the care that we all wish them to have. If we thought that nothing was wrong, we would not be working hard to put matters right.
§ Miss Anne McIntosh (Vale of York)
Does the Secretary of State regret the Government's early decision 700 to abolish tax deductibility on private health care insurance for the over-60s? Will he move rapidly to reinstate it?
§ Mr. Milburn
No, I do not regret that decision. Anyone who reads Lord Lawson's memoirs will gain an interesting insight into the debate that took place between him, when he was Chancellor of the Exchequer, and the then Prime Minister, Lady Thatcher, about private health care insurance. In fact, tax relief on private health insurance meant that the number of elderly people who took it out barely moved for seven years. When we abolished it, we put £140 million to much better effect by cutting value added tax on fuel.
§ Mr. Milburn
It would be an interesting development in the Conservative party if the hon. Gentleman was advocating foisting on the British people the German or French models. The Government do not support that development for reasons to which I shall come shortly. [Interruption.] It is not about dogma or ideology but about what works best for Britain.
Nobody pretends that there are no problems in the national health service. The difference between the Labour Government and the previous Conservative Government is that we recognise the problems, and— what is more—we are taking action to tackle them. As I made absolutely clear in my statement to the House eight days ago, the NHS has been under severe pressure this winter. The doctors, nurses and other staff of the health service have done a brilliant job during the past few weeks—the hon. Member for Woodspring is quite right about that. However, to listen to the hon. Gentleman and some of his hon. Friends—and, indeed, some of the more hysterical parts of the media—one would think that the health service had simply ground to a halt. It has not. During the past four weeks alone, there have been more than 350,000 999 calls; almost 820,000 attendances at casualty departments and more than 250,000 emergency admissions to hospitals.
The Conservatives accuse us of mismanaging the NHS this winter. That is not what health service managers are saying. The NHS Confederation describes health service planning for this winter as "excellent" and "unprecedented". Doctors' leaders agree. Dr. Ian Bogle, the chairman of the British Medical Association, said thatthanks to the high level of planning across the country the NHS is coping.The hon. Member for Woodspring has been quoting doctors. Let me quote from a letter that I received today from 20 senior clinicians throughout the country—a letter, incidentally, that The Times refused to publish. [Interruption.] All of a sudden, Conservative Members are keen to listen to doctors' leaders—let them listen to what those doctors have to say. The letter stated:To suggest as some commentators have done that the NHS is offering 'third world care' or that the health service failed to prepare adequately for the pressures of winter is incorrect … the Government's policy is moving the NHS in the right direction. The NHS represents the fairest and most effective way of delivering 701 health care. The British people are right to press for it to be properly funded and modernised. To dismantle it would be a disaster we would live to regret.The letter was from clinicians in London, Birmingham, Cheltenham, north Tyneside and other parts of the country.
§ Sir Raymond Whitney (Wycombe)
As we are comparing letters from doctors, will the right hon. Gentleman comment on the letter, dated 15 January, from five consultants at Wycombe hospital that asks him formally to take responsibility for the rundown state of intensive care in this country?
§ Mr. Milburn
It is undoubtedly true that there has been particular pressure on intensive care beds, despite the fact that we provided extra beds this winter. It is not true, as the hon. Member for Woodspring alleges, that those critical care beds do not exist. They do exist; throughout the country, there are extra intensive care beds and extra high-dependency beds.
§ Mr. Brazier
What does the Secretary of State say to people in east Kent who face the loss of the accident and emergency unit at the Kent and Canterbury hospital, and a 16 per cent, fall in total bed numbers over the next three or four years?
§ Mr. Milburn
I shall come to bed numbers in the next sentence or two. However, I point out to the hon. Gentleman and to his Front-Bench colleagues that, every time today's Tories talk about health care, there is an epidemic—an epidemic of hypocrisy and an outbreak of selective amnesia. Nowhere is that more evident than on bed numbers. We shall take no lectures on beds from the hon. Member for Canterbury (Mr. Brazier), from his Front-Bench colleagues or from the Conservative party.
The Conservatives cut 40,000 beds from our hospitals during their last 10 years in office. That is why we set up the national beds inquiry—
§ Mr. Milburn
I will give the hon. Gentleman the answer, if he will remain patient for a moment or two. I shall publish the results of that national inquiry within the next few weeks. It will make the case for an increase in bed numbers. It will end two decades of orthodoxy and ideology that declared that beds were bad. Modernising the health service means expanding health services.
§ Dr. Fox
I am extremely grateful to the Secretary of State. As I referred to his letter of 6 January, and as it would be extremely unfortunately to have the Secretary of State or his Department's officials accused of either misinformation or disinformation when the Prime Minister said that there would be 30 extra intensive care 702 beds and the Secretary of State said that there would be 100, will the Secretary of State assure the House that he will publish where those 100 beds are?
§ Mr. Milburn
I can give the hon. Gentleman some of the details today if that is helpful. There are extra beds at St. Mary's in London; extra beds in Norfolk and Norwich hospital; extra beds in Leicester general; extra beds in Warrington hospital and extra beds in the Royal Victoria infirmary in Newcastle. They are all extra intensive care beds. [HON. MEMBERS: "HOW many?"] Conservative Members ask "How many?" There will be two at St. Mary's; two at Norfolk and Norwich; one at Leicester general; two at the Royal Victoria infirmary and one extra intensive care bed at Warrington hospital. The hon. Member for Woodspring asked for a full list. He will get a full list when we publish it.
§ Mr. Milburn
I will give way to the hon. Gentleman in a moment or two, because I always like giving way to him. For the moment, however, I ask him to calm down.
It is the same story when it comes to nurse training: the same amnesia and the same hypocrisy from the Conservative party. The Conservatives say that we have left the NHS short of nurses, but it was the Conservative Government who cut the number of nurse training places by almost 4,000. It is this Government who are increasing the number of nurses, and of nurses in training, with 5,000 more nurses returning to the NHS; 4,500 more training places; and 14,000 more applicants for courses. Just today, the first 140 nurse-consultant posts have been established in all parts of the country.
§ Mr. Milburn
No, I will not. I have given way several times. I might give way in a moment or two if the hon. Lady will just calm down.
Let us not forget, either, the two largest real-terms increases in pay that nurses have received in almost a decade and a half. They have been paid in full—and unlike under the Conservative party—without any staging. They are fair pay rises so that we get more doctors and more nurses into the health service and make it more worth their while to stay in it too. Expanding the staff of the health service is the way that we will expand services to patients.
That is one of the differences that the Labour Government are making to the state of the national health service, and I shall tell—
§ Madam Speaker
Order. The Secretary of State is not giving way for the moment. Members should know better than to continue to try to intervene.
§ Mr. Milburn
The hon. Member for Woodspring, and the Conservative party generally, are very keen to talk 703 about mismanagement. Let us talk about it, then. Mismanagement is when one wastes £30 million on legal and consultancy fees for private finance initiative—
§ Madam Speaker
Order. Let me just get this straight. Is the Secretary of State giving way to the hon. Lady?
§ Mr. Milburn
I have given way several times to Conservative Members and I deeply regret the fact that I have. If the hon. Member for Chesham and Amersham (Mrs. Gillan) is patient, I might give way to her at the end of my speech.
Mismanagement is wasting £30 million on legal and consultancy fees for private finance initiative hospital schemes that one could not even get off the ground. Good management is building 16 new hospitals worth £1.3 billion as part of the biggest hospital building programme that the health service has ever seen. That is the difference between this Government's management of the health service and the Conservative Government's mismanagement of it.
The Opposition motion deplores mismanagement. I deplore it too. That is precisely why we have abolished the internal market that the Conservatives created—an insane competition between hospitals that fragmented services and wasted millions. That is why we have ended two-tier care and that is why we are well on the way to moving £1 billion out of NHS bureaucracy and into front-line patient care.
Mismanagement is when a Government, in the name of free-market ideology, turn a blind eye to poor hospital standards and second-rate performance. Good management is when a Government have the courage to establish for the first time an independent inspectorate and a systematic dismantling of the lottery of care. Mismanagement is when in-patient waiting lists rise by 400,000. Good management is when they fall by 87,000. Mismanagement is when a Government leave office with investment in new NHS building, plant and equipment at a 10-year low. Good management is when that investment is at an all-time high. There is more investment in cancer and in GP surgeries, and 150 casualty departments are already being modernised.
Mismanagement is when cancer and cardiac services— the services that deal with our country's biggest killers— are left neglected and under-invested for decades. Good management is when more money is being invested, more doctors are being trained and more operations are being performed. That is the difference that the Labour Government have started to make. More hospitals are being built; more nurses are being recruited; more doctors are being trained and more patients are being treated.
§ Mr. Bercow
In the light of what the Secretary of State has said, what does he have to say to my constituent, Colonel Bruce Owen from Marsh Gibbon in Buckingham—[Laughter.] It is not a laughing matter for him. He suffered a heart attack on 7 July last year, 704 eventually saw a consultant surgeon at Harefield hospital in the middle of November and was told that he would have to wait at least 12 months for the triple bypass surgery that he requires. Will the right hon. Gentleman tell my constituent and the House why that individual, who has saved and who has contributed to this society throughout the 60 years of his life, should have to spend £13,000 of his hard-earned savings on the treatment of which the inadequate health service is currently depriving him?
§ Mr. Milburn
The hon. Gentleman raises an important constituency case. I say to him that of course we always regret circumstances in which patients do not get the care that they deserve from the national health service. Let me say to him, however, that it is fatuous to pretend that problems in cardiac services began on 1 May 1997. It is fatuous to pretend that problems in cancer services began on that date. The truth is that for decades the previous Government failed adequately to invest in cancer and cardiac services. They left those services under-invested, under-doctored and under-nursed. That is why we have made those services our top priority for modernisation.
§ Mr. Blizzard
Has my right hon. Friend noticed that, while Conservative Member after Conservative Member has risen to point out some deficiency in the NHS, all that the Conservative Front-Bench spokesman could offer has been privatisation, privatisation and privatisation? He could not offer the new public resources that the Government are investing because his Front-Bench colleagues described those resources as "reckless".
§ Mr. Milburn
As ever, my hon. Friend makes an extremely telling point. [Laughter.] Conservative Members are laughing now, but they will not be laughing in a moment or two because I am about to turn to that very matter.
We are making progress. The NHS is modernising and changing. There are new services, but there are also severe capacity problems. As my hon. Friend the Member for Dartford (Dr. Stoate) said in an earlier intervention, we need more doctors, more nurses and better services. Sadly, that takes time. It takes three or four years to train a nurse and double that to train a doctor, and it takes more money.
In the past 20 years NHS funding has grown by just 3 per cent. a year. That is the real legacy of the Conservative party. From last April, this Government have raised those levels of investment by a further 50 per cent. There is more money this year; there will be more money next year and more money the year after, but that is just the start. We know that we lag behind the rest of the European Union on health spending. We are determined to close the gap. As the Prime Minister said—
§ Mr. Deputy Speaker (Sir Alan Haselhurst)
Order. I am sorry to interrupt the Secretary of State. The right hon. Gentleman is clearly not giving way and the hon. Member for Chesham and Amersham (Mrs. Gillan) must resume her seat.
§ Mr. Milburn
As my right hon. Friend the Prime Minister said on Sunday, if we can get real-terms 705 increases in funding of 5 per cent. a year, we shall get up to the European level. Our ambition is to have a health service that is doing more than coping. We want an NHS that is growing and modernising.
§ Mr. Mike Hancock (Portsmouth, South)
If the Secretary of State genuinely believes what he has told the House this afternoon, why is it that the majority of people outside the House do not have the same confidence in the NHS and do not share his confidence in the Government's ability to protect it? I take the right hon. Gentleman back to his point about intensive or critical care beds. He said that there are 100 new beds, but he has been able to identify only eight of them. Where are the other 92?
§ Mr. Milburn
I shall deal with the hon. Gentleman's last point first. I shall publish the figures on intensive and high dependency beds in due course.
The hon. Gentleman talks about lack of public confidence. Of course there are problems with the NHS. Everybody understands that. The Government are addressing them, but there is a fundamental political debate taking place between the Government and the Opposition about the way in which health resources can grow in future. There are two very different futures on offer.
Everybody knows that we need to spend more money on the NHS, except the members of today's Conservative party. Only the Conservative party could argue that the Government have gone soft on public spending on class sizes and waiting lists. Only the Conservative party could impose on itself the straitjacket of the tax guarantee, which would mean less investment in public services such as the NHS and more investment in the Conservative party's priorities, including top-rate tax cuts for the privileged few.
It is no wonder that the former Prime Minister, the right hon. Member for Huntingdon (Mr. Major), said what he did about the tax guarantee. He said:To say that you are going to reduce the proportion of taxes to GDP in all circumstances is mad. You simply"—[Interruption.] That is what the right hon. Gentleman said. I note that Conservative Members are not laughing now. Their former Prime Minister said that that was mad. He then said:You simply don't unless you make swingeing cuts in the Health Service.Those were the words of the last Conservative Prime Minister.
The simple truth is that we are spending more on the Health Service and Conservatives want to spend less.
§ Mr. Deputy Speaker
Order. Did I hear the hon. Member for Woodspring (Dr. Fox) say, "On a point of order"?
§ Mr. Deputy Speaker
Order. The hon. Gentleman has been here long enough to know that that is a point of debate and not a point of order.
§ Mr. Milburn
I know that it is a narrow judgment call, but if the question is whether I trust most the hon. Gentleman or the former Prime Minister, the right hon. Member for Huntingdon, I will go with the former Prime Minister.
The Conservatives want to force more people to go private. The hon. Member for Woodspring calls his patients' guarantee a Trojan Horse. I think that that was the phrase he used. We are beginning to see what lies within that horse.
The hon. Gentleman could not have been more explicit in his interview with The Sunday Times only two days ago. He boasted:Philosophically, we have moved on".That is, moved on from the NHS. He added:Insurance companies could cover conditions that are not high-tech or expensive, like hip and knee replacements and hernia and cataract operations.Now we know the first set of treatments that the Tories' patients' guarantee would surgically remove from the NHS. Every year—
§ Mr. Milburn
Oh no. I shall give way at the end.
Every year a third of a million people have hip, knee, hernia and cataract operations on the NHS. Under the patients guarantee, those 300,000 people would be denied NHS care because the hon. Gentleman thinks that their condition is too trivial. Instead, they will have to pay privately for treatment that they now receive free.
The average cost to the NHS of a hip replacement operation is £3,755. In the case of a knee replacement, the bill rises to £5,157. However, the cost of the operation is only half the picture. If those operations are beyond the pale of the NHS, who pays the bill for the initial consultant referral? The patient pays. Who pays the bill for the pre-operative out-patient assessment? The patient pays. Who pays the bill for community physiotherapy? The patient pays. Who pays the bill for the district nurse visit to remove sutures? The patient pays.
Who pays the bill for the follow-up at six weeks? The patient pays. Who pays at six months? The patient pays. Who pays at 12 months? The patient pays. Time and again, the Conservative guarantee is that the patient pays.
§ Dr. Fox
Sadly for the Secretary of State, I write the Conservative health policy, not him. He can make up as 707 much of it as he fancies in his little fantasy world. We intend that patients will get a maximum guaranteed waiting time. Many of the procedures that he mentions are carried out at present through many different independent schemes, including through trade union schemes.
§ Mr. Milburn
I look forward to the retraction in The Sunday Times. I presume that even now there is a letter winging its way. Is that right or is it wrong?
§ Dr. Fox
The Secretary of State is trying to create yet another smokescreen with yet another example of what the Labour party does best—half-truth, misinformation and disinformation. We have made it clear in this debate that we believe in increasing spending on the NHS year on year in real terms. We believe in encouraging as many people as possible to take up independent provision, because that increases the total capacity of health care in this country. It is a shame that the Secretary of State is so intellectually sterile that he cannot accept the argument, as can other socialists in Europe and every commentator in the United Kingdom.
§ Mr. Milburn
I look forward to reading the letter. The hon. Gentleman did not convince his own side, let alone the House.
Let us have a debate about the merits of private health insurance. I am happy to engage in such a debate. The patients who would be forced to pay private health insurance under the patient guarantee and the tax guarantee are precisely those who could least afford to do so.
Two thirds of patients in hospital are elderly people. Together, the very young and the very old are the biggest consumers of health care in our country, but they are the very people who would be priced out of the health insurance market. The very people who need most care, and the very ones who are most at health risk, are they very people who would be least able to get it.
The second reason why private health insurance is the wrong answer is that it would divert hundreds of millions of pounds that should be spent on the NHS into a huge cash handout in tax reliefs and subsidies.
§ Mr. Milburn
There seems to be some dispute on the Opposition Front Bench. The hon. Member for Woodspring was urging me to reinstate private health insurance subsidies. The hon. Member for North Essex (Mr. Jenkin) indicates that that is wrong. Which is it? Is the hon. Member for Woodspring right? I presume he is.
§ Mr. Milburn
The hon. Gentleman should keep digging because he is doing a good job for us. Today's Conservative party, like that of the 1990s, wants to give a huge cash handout in tax reliefs and subsidies for private medical insurance. Much of that would go to people who already have private medical insurance. The hon. Gentleman quoted the Daily Mail, which reported today that the costs of subsidising employers would be £368 million. That is before a single extra person signs up to an extra health insurance policy. That £368 million from the national health service budget is the equivalent of 1,050 intensive care beds or 16,000 nurses. Yet Conservative Members have the gall to claim that their policy is about expanding access to health care. It would be money down the drain.
It is fatuous to pretend, as the hon. Member for Woodspring does, that more private health care would lift the burden from the health service. It would impose an extra burden.
§ Mr. Milburn
No. There is no reserve army of unemployed oncologists or cardiac surgeons waiting for a private call to arms.
§ Mr. Milburn
No. An expanded private sector would mean a contraction of the public sector, which would face higher costs with fewer staff. It would mean a brain drain from the NHS. The Conservatives' proposals on private health insurance are wrong. They affect the wrong people at the wrong cost and have the wrong effect.
Private health insurance, the knee-jerk reaction of the Conservative party, could not provide an efficient or fair health care system. It would take the United Kingdom back to an era when access to health care depended not on clinical need, but on ability to pay. That is not the future for health care in our country. The Government reject the idea that the NHS should be a residual safety net service for the poor, which will inevitably become a poorer service. We reject that not on ideological grounds but because it simply would not work.
§ Dr. Stoate
How would the private insurance sector respond to people who have chronic conditions such as diabetes or rheumatoid arthritis, or those who have chronic health problems, most of which are excluded from the majority of health insurance programmes?
§ Mr. Milburn
My hon. Friend, who is a general practitioner, makes a good, telling point. He knows that the private insurance sector would be incapable of insuring the people whose health is most at risk. That is why Conservative arguments are so fatuous. We do not oppose them on ideological grounds [HON. MEMBERS: "Oh!"] We do not. We oppose them because they would not work. There are two possible futures for health care in our country: privatisation with the Conservatives and 709 modernisation with Labour. We have the courage of our convictions. We believe in a comprehensive, modernised and well-resourced NHS, which provides care that is based on need, not ability to pay. We believe in a truly national health service, which is worthy of the name. The people of our country expect that. Tax relief for private health care is not an answer to the challenges of the health service. The answer is a rising level of resources for the NHS, funded through general taxation, in a way that the people can understand and in which they can have confidence. That is the way forward for the modern, 21st-century health service that our nation needs.
The NHS is one of the greatest achievements of the 20th century; it must now undergo one of the greatest modernisations of the 21st century. No matter how much Conservative Members rant and rave, we will not yield one inch to the privatisers of our nation's health. We stand firm for the NHS—not as it is, but as the modern health service that it could be. The nation now knows the choice that it faces—between those who want to privatise the NHS and those who want to modernise it. The nation should know that we will deliver a modern NHS—a new NHS fit to face the challenges of the new millennium.
§ Mr. Nick Harvey (North Devon)
As we have this debate, the Government have been under fire over the national health service, in the media and politically, for getting on for three weeks. It is hard to think of any occasion since 1 May 1997 on which their spin doctors have so lost control of the agenda that they have found themselves under fire on a domestic policy issue for three weeks solid, but this is largely a mess of their own making. Listening to the hon. Member for Woodspring (Dr. Fox), who introduced the debate on behalf of the Conservative party, one could have been forgiven for thinking that all those problems had miraculously started on 1 May 1997. Nothing, of course, could be further from the truth.
The 18 years of Conservative misrule led to a great many of the problems. It is not the present Government's fault that they inherited a mess, but it is their fault that in three years they have not made more progress in putting some of that mess right. They played the health issue up strongly at the general election, saying that they alone could save the NHS, but what they have done since— certainly in terms of investment in the NHS—has not even kept up with the year-on-year funding increases made by the Conservatives. The changes that they have made, which the Secretary of State described as radical modernisation, have been over-hyped, although some have started down useful tracks. The recent flu crisis, outbreak or wave—whatever hon. Members care to call it; regrettably, I have sampled it from a patient's perspective—validated the warnings given by health managers, doctors, nurses and others about the pressure that the NHS was under. It took the recent outbreak to show the situation in its true light.
§ Mr. Bercow
Does the hon. Gentleman support the hon. Member for Wakefield (Mr. Hinchliffe) who denounced all who work in the independent health care sector, using a word that begins with "b" and ends with "s", or does he agree that that outrageous attribution in 710 The Health Service Journal was a profound insult, both to people working in the independent sector and, indeed, to children born out of wedlock?
§ Mr. Harvey
The hon. Member for Wakefield (Mr. Hinchliffe) must speak for himself, but we regard the private sector and the private health insurance industry as perfectly legitimate parts of the health service. If it is possible for them to grow and play a bigger part we are perfectly happy for them to do so, but we cannot conceive of any circumstances in which taxpayer funds should be used to enable that to happen.
The hon. Member for Woodspring introduced the debate in an entertaining knockabout style and with his usual good humour, but I was rather puzzled that, halfway through, he suddenly launched an initiative to stop the NHS being a political football and called for all-party talks on the issue. We have not had an encouraging start, as his speech made precisely that of the NHS. However, if it is possible to get some all-party dialogue going on health, if we are to break certain taboos and accept, for example, that rationing exists, and if we are to debate what the health service can or cannot do and how it is to be funded, we are ready to take part.
I shall look back to the proposals by which the Government invited the nation to measure their performance at the general election. They pledged that they would bring down waiting lists by 100,000 and maintain that they are making progress towards that figure. They have made progress in bringing down in-patient waiting lists, but unfortunately that has been more than outweighed by an increase in out-patient waiting lists from 295,000 at the time of the general election to 513,000 now. The number of people, and the time for which they are waiting, have grown.
The folly of all this is demonstrated by the fact that, according to any health service professional to whom one speaks, the waiting list pledge itself was completely misguided, has caused a distortion of clinical priorities in the vast majority of hospitals, and is not the best measure of the progress that the Government are making in the health service.
§ Mr. Leigh
The hon. Gentleman mentioned cross-party consensus, and then talked about waiting lists. Will he at least accept—so that we can secure as big a majority as possible for this view—that the NHS is helped, and in no way harmed, if people relieve pressure on it by taking out private health insurance?
§ Mr. Harvey
I hope that I made it clear that that was my view in my response to the hon. Member for Buckingham (Mr. Bercow). There is certainly no harm done—indeed, it is welcome—if the private sector can play a part in relieving pressure on the NHS. If people choose to take out private insurance, that is entirely a matter for them and a positive development.
We believe that the private sector could have a growing role in undertaking work commissioned by the NHS, and there is no reason why the reverse should not happen from time to time. The private sector occasionally needs to fall back on the services of the NHS—[HON. MEMBERS: 711 "Frequently."] Yes, frequently—not least in the case of intensive care, which is one of the aspects on which people have focused over the past couple of weeks.
§ Dr. Jenny Tonge (Richmond Park)
Does my hon. Friend agree that the private sector should also play a part in the training of nurses and doctors, and contribute financially?
§ Mr. Harvey
Absolutely. It would be good to see the private sector taking a practical role in training. The idea of private sector contribution to the cost of that is also good in principle, but it is difficult to see how such a charging mechanism would be organised, and we do not know how much it would raise. If a way could be found to make it work, there is no good reason why we should not give it a try.
The Government have established a National Institute for Clinical Excellence to test the clinical effectiveness— and cost-effectiveness—of drugs. That too is a good idea in principle, but we have major misgivings about the remit, especially as it has been changed by means of a statutory instrument. That has brought into play considerations of affordability, which we consider to be properly in the domain of the Secretary of State and the political community. We think that it is for them to decide what the nation can afford.
There is a world of difference between cost-effectiveness and affordability. Something can be extremely cost-effective, but very expensive. It is entirely right to establish a panel of experts to decide what is cost-effective, but affordability must ultimately be a political decision. When it comes to deciding what the nation can afford, the buck must stop with Ministers.
Funding is a major issue that has interested the nation of late. The Government have not been as candid as they should have been about the extra funds that they have invested since coming to office. For the first two years, they stuck to the Conservatives' spending plans. Goodness knows why; I do not for a moment imagine that, in the unlikely event of the Conservatives' having returned to office, they would have stuck to those plans themselves. The Government, however, set themselves an austerity programme, stuck to the Conservatives' targets, and embarked this year on the first of the three years of spending covered by the comprehensive spending review.
If the Government manage to complete those three years and to spend all that has been promised for the NHS, at the end of the full five years they will just about have spent, year on year, more than the Conservative year-on-year increases. If there is a general election after only four years, however, they will not even have achieved that, and their year-on-year increases will not even be as great as those of the Conservatives.
I am glad that, over the last couple of weeks, public attention has turned to the proportion of our national income that we spend on the health service. I am pleased that everyone seems to agree that it should increase. We do not keep up with our European competitors, but, more shockingly, we do not even keep up with America. Many people regard the state-funded health system in America as an emergency back-up, a safety net, a last chance if all else fails. Legion are the stories, probably apocryphal, of people in America who are found at the roadside after accidents and who, unless they have a credit card, 712 or insurance policy, will not be taken in and cared for, yet the Americans spend 6.5 per cent. of their gross domestic product on that emergency, last-resort, back-stop system. We are floundering at a figure that is variously estimated at between 5.5 and 5.8 per cent. of our GDP, so we must do better.
§ Dr. Stoate
I note the hon. Gentleman's point that the Americans spend about 6.5 per cent. of their GDP on their publicly funded system, but does he agree that they get extraordinarily bad value for money in that 45 million Americans have no health care cover of any sort, that one quarter of all bankruptcies in America are due to unpaid health bills and that health outcomes are, in many ways, disappointing, particularly for the richest country in the world?
§ Mr. Harvey
I agree. The Americans do not get particularly good value out of either their public or private systems. In total, they spend 14 per cent. of their GDP on the health system. At its best, it is very good, but, overall, I am not sure that it is all that remarkable.
What was remarkable was the Prime Minister's pledge yesterday that the Government would get spending up to the EU average in the course of five days—[Interruption.] In five years; I beg the House's pardon. What he promised was remarkable enough. Whether he is any more likely to attain it over five years than over five days, I do not know. Certainly, some of his arithmetic seemed highly dubious. Whether he was supposed to say that, was on message and had been cleared to say it, I do not know. It may have been like his fox-hunting pledge, which he gave when under a bit of pressure at Question Time, but it smacked of a back-of-a-fag-packet calculation.
If the Prime Minister thinks that putting a mere £2 billion a year in over the next five or six years will get us up to the European average, he could not be more wrong, or is he counting these things in the way that the Chancellor of the Exchequer does? The Chancellor would have us believe that, if we put in £3 billion in the first year, another £3 billion in the second year and another £3 billion in the third year, it makes a glorious total of £18 billion.
§ Mr. Eric Martlew (Carlisle)
The hon. Gentleman referred to the Prime Minister's promise. Can we have an assurance that the Liberal Democrats support that promise?
§ Mr. Harvey
We do. We wish the Prime Minister well in his efforts to achieve that. If it comes to votes to get the funds in place to do it, he can rely on our support. However, I am still sceptical as to whether he will achieve it.
§ Dr. Peter Brand (Isle of Wight)
Did my hon. Friend notice that, towards the end of the Secretary of State's speech, he refused to take interventions? The one matter of substance in his speech was the undertaking to increase spending by 5 per cent.—per cent. of what he did not define. Might it be helpful if my hon. Friend explored what the baseline of the 5 per cent. is and accepted an intervention from the Secretary of State to see whether he could answer that question?
§ Mr. Harvey
My hon. Friend makes a good point. I was hoping that the Secretary of State might have cast 713 a little more light on the Prime Minister's commitment. I think that the Secretary of State said that there would be an increase of 5 per cent. in real terms. Does that mean 5 per cent. over and on top of normal NHS inflation— that is to say, over and on top of anything that we have heard about to date in any comprehensive spending review? Will the comprehensive spending review that we expect in July factor that all in on top?
When the Prime Minister says that he will put in £2 billion a year, does he mean that he will put in £2 billion in the first year, continue that into the second year, adding £4 billion in that year, and continue that into the following year, adding another £2 billion, making £6 billion in that year? If so, he had only to consult the Chancellor, who could have explained that that adds up to £42 billion. If they put in £42 billion, they might begin to get somewhere near the European average in five years.
§ Dr. Stoate
Will the hon. Gentleman clarify the Liberal Democrat policy? Does he subscribe to the view of the hon. Member for Isle of Wight (Dr. Brand), who said on a television programme on which he appeared with me last week that he would be happy for income tax to rise by anything up to 10p in the pound over the next 10 years to pay for Liberal Democrat promises? Is that Liberal Democrat policy?
§ Mr. Harvey
The hon. Gentleman misquotes my hon. Friend, who said that, if we were to reach the European average, the necessary investment would be equivalent to that rate. He was not necessarily advocating such an increase or saying that we could reach the average overnight. However, it will take massive investment to reach.
It would not make sense to reach the average at once, as the principal investment that we have to make is in staff and personnel, who take time to train. As the Prime Minister said, it takes three or four years to train a nurse. However, if he had recognised that three years ago and started a drive to recruit more nurses, they would have been coming on stream this summer and in post to help cope with any influenza epidemic that might occur next winter.
§ Mr. John Burnett (Torridge and West Devon)
I am extremely grateful to my hon. Friend and neighbour for giving way. He is making a powerful point: there is great need for staff and personnel. I draw his attention to the case of one of my constituents—Mrs. Hopkins, of Germansweek—who visited my advice surgery last weekend. She is suffering from frequent bouts of fainting and giddiness, for which her general practitioner referred her to a consultant. The Royal Devon and Exeter Healthcare NHS trust has written to her to say that, although she will have an appointment, she will have to wait 140 weeks. Does my hon. Friend agree that such delays are caused by failure properly to fund the NHS and are an utterly unacceptable national disgrace?
§ Mr. Harvey
I can only agree with my hon. Friend that it is absolutely disgraceful that anyone should have to wait 140 weeks—almost three years—simply to see a consultant. Goodness knows how many weeks after seeing a consultant one would have to wait for any 714 operation that the consultant might think necessary. The case that he describes is about the worst that I have heard, and underlines the fact that, whatever progress is being made on in-patient figures is more than counterbalanced by the extra time that people are waiting on out-patient lists. As he says, it is an absolute disgrace.
In recent years, there has been a staggering decrease in the number of nurses working in the NHS. In 1987, there were 514,600 nurses and midwives working in the NHS; today, there are only 373,000. It is incredible that there should have been such a decrease in only 12 or 13 years. Currently, 15,000 nursing vacancies are being advertised, and we are struggling to fill them.
A great deal more will have to be done than yesterday's pay increase—welcome though that was—to turn the nursing profession into something that people are attracted to at the start of their career and will stay with loyally throughout their working lives as they try to build careers. Year after year, many pay increases will be required. Better still, if we are to make necessary progress in recruiting nurses, there should be a complete re-evaluation of our views on the nursing profession and of the value that we place on it both in the NHS and in society overall.
On how pay rises will be paid for, it has been noted that health authorities were given their budgets for the coming year just before Christmas. The Minister has made it clear that the rises will have to be paid for out of those budgets.
§ Kali Mountford (Colne Valley)
Given the hon. Gentleman's comments on nurses and the length and cost of nurse training, will he congratulate the Government and nurses on the number of nurses who have chosen to return to the profession? They are ready to be on the job on the very day of their return.
§ Mr. Harvey
I am delighted that some nurses have been attracted back to the job, and of course I congratulate the Government on any nurses whom they have managed to lure back or recruit to the profession. Last year, the Government increased pay for those who are on the starting levels in the nursing profession, and that was a useful start. This year, Ministers are beginning to deal with various anomalies. However, there is much further to go before the nursing profession will look sufficiently attractive to persuade people to spend an entire career in it.
How will the pay rises be funded? The increases in authority budgets that were announced before Christmas mean that there is enough cash to fund the pay rises, but if they are to be fully funded from those budgets, something else has to give. Will it be progress on waiting lists or the Government's modernisation agenda? Whatever the authorities and trusts sacrifice to fund the pay increases, the result will be slower progress on improving the health service in the way that we all want and more cases of the kind that my hon. Friend the Member for Torridge and West Devon (Mr. Burnett) mentioned.
§ Mr. Harvey
My hon. Friend is right to point out that there are great inequalities between different health 715 authorities around the country. I am glad that there is a review of the formulae and I hope that the difficulties faced by rural health authorities in particular will be better recognised. Scotland, Wales and Northern Ireland use formulae that recognise those difficulties better than the English system.
On top of the difficulties with nursing that we have already dealt with, the Government are spending an increasing amount on agency nurses to make up for the shortfall in NHS nurses. Between 1991 and 1998, spending on agency nurses doubled to £216 million. In the past year, that figure has increased by more than 25 per cent. It now costs the taxpayer more than £273 million to bring in private sector agency nurses, most of whom have been trained in the NHS, to cover NHS vacancies that would not exist if we were paying our nurses properly and recruiting adequate numbers into the profession. That is not good value for the taxpayer.
The Conservatives have been talking up the benefits and advantages of the private health sector and private insurance. I have made it clear that we think that there should be a mixed economy and that both sectors can play a useful role, but they seem to imagine that it is possible to engineer a massive increase in the number of people taking up private health insurance. There is a competitive market for private health insurance. I am sure that other hon. Members, like me, receive direct mail fliers from health insurance companies almost every week touting their wares and policies.
There is no reason why there should be a big increase in take-up unless there is a policy to engineer one. There are three possibilities: it might be made compulsory to take out private insurance, there might be a tax incentive, or the NHS might be run down to such a pitiful state that people would be bound to take out private insurance because they would regard it as the only way to get any health cover. If the Conservatives want a financial inducement, we shall oppose them head-on. There is no justification for taxpayer funds that could otherwise be spent on the NHS to bring about the improvements that people want being diverted to induce people who can afford, or are on the verge of being able to afford, private health insurance.
We know from last year's Budget that there is to be another 1p reduction in income tax from April. We have conducted opinion polling on that, as have some newspapers. The results show that the public do not want a 1p tax cut to be put ahead of getting extra investment into the health service. Nearly 80 per cent. would rather have the money spent on the health service now than on a 1p tax cut in April.
Our call to the Government—who made promises at the general election and have done so over the past three years, with the Prime Minister making more promises the other day—is that they should get on with carrying out those promises and achieve the target of reaching European average spending. Only then, having achieved that for all to see, should they imagine that taxpayers want to enjoy the dividend of a tax cut. They are putting the wrong value on those matters, and they do not understand what people want. If they do not wake up to that soon, there will be a huge price to pay.
§ Mr. David Hinchliffe (Wakefield)
I welcome the opportunity of today's debate. We are all aware of the difficulties facing the NHS. It is important that we discuss them, and that we contrast the Government's attitudes in terms of policy with those of the Opposition.
At the outset, I should make clear that I am the constituency Member of Parliament of Mrs. Mavis Skeet, whose case received a great deal of coverage in the national press last week. I should make it clear that I do not have the family's permission to go into the details of the case. However, I spoke to the Secretary of State last week about my concerns over the handling of the case. I hope that, with the family's consent, at some point he will make public the outcome of his investigations into her treatment.
I came into politics to fight to ensure that people such as Mrs. Skeet receive proper treatment. I am sure that most Labour Members, and some Opposition Members, would want to ensure that such problems do not arise. I am driven, in part, by my personal experiences, which I have shared with the House before—my father faced a two-year wait for a heart bypass and died before he got the operation—so I understand how families in such circumstances feel. It will not only be Mrs. Skeet; others will be going through difficulties of this nature.
§ Mr. Hinchliffe
With respect, I shall not take interventions. I know that many hon. Members wish to contribute, and the hon. Lady may well have the opportunity to make her own point.
Let us not deny the fact that the NHS faces serious problems. As the Chairman of the Select Committee on Health, I would not deny that, as we see those problems. Most hon. Members looking at their local health services would accept that there are difficulties. However, those problems have not developed overnight and will not be cured overnight. The problems have occurred over a long period. It is easy to blame previous Governments. When we talk about how the health service is run, however, we should understand that today's policy changes will not impact in many areas for five or 10 years, or more.
The current difficulties underline elements of Labour's inheritance on health policy and what we faced when we came to power. I want to make clear one or two areas for which I think the previous Government are responsible in terms of the current difficulties and those that we shall no doubt face again in the months and years to come.
First, the previous Government broke down the national service that we had had since 1948 into numerous competing fragments. We inherited the hugely expensive bureaucracy of the internal market—a wasteful exercise introduced by the Tories, where money that should have been spent on patient care was spent on chasing pieces of paper. Secondly, under the Conservatives, the national health service was heading rapidly in the direction of American-style private medical care. There is no doubt about that. The policies that they introduced included tax breaks for private medicine—mentioned again today—the wholesale privatisation of community care provision and two-tier access, which was clearly the case in my constituency. I have named constituents in the past who were denied certain services that their next-door 717 neighbours could get because they happened to have a non-fundholding rather than a fundholding GP. That was the reality of Conservative policies.
Having spent time talking to health service staff, I know that we had a demoralised staff who were leaving the service in droves—often to go to the private sector, which was expanding under the Tories—because they believed that the NHS had no future.
I welcome many of the positive steps that the Government have taken to return health to the vision of Bevan and the socialist pioneers to whom I look in terms of where I want the health service to go. If we stick to those principles, the majority of people will support the steps that we take. I welcome the increased funding that the Government have been able to devote to health recently. Indeed, although I suspect that people will feel differently about tax in two months' time, I would be happy for the Chancellor to cash in on the current concerns of people who would be prepared to forgo the reduction in income tax if the money were devoted to the NHS.
I welcome the proposals in the Health Act 1999, which largely abolish the internal market. The duty to co-operate is common sense and will return the health service to what it was in the beginning. However, will my right hon. Friend the Secretary of State consider further the splits in responsibility at local level between the different elements that we inherited? My constituency has seven different elements dealing with health and community care, not including primary care. Many of those bodies could be combined.
I also welcome the Government's moves to emphasise quality of provision, because I have come across some worrying problems in my work on the Health Committee in recent years. It is early days yet, but I commend the results so far. I also welcome the emphasis on primary care, which was part of Bevan's vision but has never been realised, and the proposals for public health and prevention. That was a non-issue for the Conservative Government, but it is crucial in addressing the problems that people face.
I welcome the staffing strategy, the recruitment work that the Government have undertaken, and their work on winter pressures. I know that we have recently had some problems, but they would have been far worse without the Government's steps to prepare local agencies to work together. My right hon. Friend the Secretary of State and his team know that I welcome the work they have done on bringing the NHS and social services closer. As someone who worked before 1974 in a local authority with a health department, I think that my right hon. Friend should go further and consider full integration of the NHS with local authority social services. He will know that the Health Committee also recently recommended that approach.
The debate this week has been about more than simple practical proposals. It has been about the fundamental issue of whether we as a society can afford a national health service. The great and good have been wheeled out on both sides. For example, Mr. Roy Lilley suggested at the weekend that we penalise smokers and obese people. He did not mention that obesity and smoking are most common among the poorest and most disadvantaged in our society, as I know from my constituency.
718 Private health insurance has also been mentioned, but no thought has been given to the fact that many people with pre-existing conditions, or of a certain age, would never get private cover. What would they do? They are why we have a national health service in the first place, and we should be proud of that. Regardless of people's background, class, income, social status or health problems, they receive equal treatment in the NHS. That is the objective that we set back in the 1940s.
We have heard consistently during this Parliament the Tories' belief that expanding the private health sector is the only way forward for health provision. Last week, the shadow Secretary of State was quoted in The Sunday Times as saying:The Conservatives are no longer concerned with the maintenance of the NHS as the primary provider".That is on the record in the paper—[Interruption.] The Tories may be sending letters to The Sunday Times, but that quotation is there in print and available in the Library. We know about the Tories and the NHS. They never believed in maintaining the NHS right from the start, but their obsession with the private sector ignores reality.
My views on the private sector are not based solely on ideology. I am concerned with the practical effects of expanding the private sector. The Select Committee was unanimous in its concern over the private sector's abysmal record in quality of provision. In one instance, I was accused of using strong language, but where I come from we call a spade a spade, as my hon. Friend the Member for Rother Valley (Mr. Barron) will confirm. We say what we mean, and people respect us for it. I was criticised for comments that I made after listening to a man whose wife had been treated in a private hospital. He told me that, when she died, he had to lay out her body because there was no one else to do it. I admit that I was angry about what I consider to be an unforgivable situation. If I had time, I could give other examples of the lack of quality in the private sector. The Opposition take no account of the genuine unease—even within the private sector—about the standards of the care that that sector provides.
The Select Committee report examined staffing levels, and our finding was clear: staff haemorrhaged from the NHS are going to the private sector, where they get more money and sometimes enjoy better conditions of service. We concluded that expanding the private sector merely removes staff from the national health service. It is nonsense, therefore, to suggest that it is somehow helpful to expand the private sector. It is helpful only if, for political reasons, the NHS is to be run down. That is the Tory party's approach.
I urge the Government to go in the opposite direction and bring about, at the very least, the complete separation of the NHS from the private sector. I should be interested to find out what impact there would be on waiting lists if part-time NHS consultants worked full time and cared for people on the basis of need and not ability to pay.
Finally, I want to let the House into a secret: before last Friday morning, I had never heard of Lord Winston, even though I know most of the great and good in the national health service. Moreover, the man from BBC national radio who telephoned me on Friday morning for a comment had never heard of him either, so it was not just a matter of me being a thick Yorkshireman.
No one is sure of what Lord Winston meant or said, but he appeared to suggest that a middle road—some sort of third way, perhaps—existed between the state system 719 and the private sector. I believe that, in this instance, there is no such third way. Either one believes in the national health service concept and subscribes to its principles, or one does not. The Tories have shown today that the Government believe in that concept, and that they do not.
§ Sir Norman Fowler (Sutton Coldfield)
The hon. Member for Wakefield (Mr. Hinchliffe) rather wrecked his credibility with his display of ignorance about Lord Winston. However, I shall follow his example and be brief.
The trouble with the speech by the Secretary of State was that it offered nothing to the public. The House should recognise that people are genuinely worried about the present state of the health service. The right hon. Gentleman rejected all new thinking and ideas—a ridiculous approach to adopt. The Government must accept that they alone are to blame for the criticism heaped on them in the past few weeks.
No party could have done more to exploit the inevitable difficulties that occur in the health service than the Labour party in opposition. I was Secretary of State for Health and Social Security for six years. My abiding memory is that the Labour Opposition opposed all changes in the service—even the introduction of general managers, which the Labour Government have now adopted. It is a bit rich, therefore, for the Secretary of State to say that he believes in good management of the national health service.
However, that Labour Opposition did more than just attack the then Conservative Government. They also raised the public's expectations. Their promise was specific: vote Labour, and the problems of the health service would be ended. That message has now been radically altered. The promise is that if people vote Labour, the problems may be over in 10 years' time. The angry reaction to that change of position is not surprising.
The issue today is whether we continue down this dismal road of political recrimination and simply continue the party battle of slogans, or whether we have a serious debate on a better way forward for the health service. I have no doubt that that is what the public want us to do. There may be some very important interest groups in the health service, but what the public—the patients—want should be crucial. I think that the public want a serious debate about how to achieve better health care.
I should mention that I am chairman of Numark, an industrial provident society with more than 1,300 community pharmacies. Having declared that interest, I intend to speak not about pharmacy, however tempting it may be, but more generally.
In the years since 1947, the health service has developed steadily under Governments of both colours. When the Prime Minister says that today more patients are being treated, more operations are being carried out and more hospitals are being built, that is precisely the case that I put forward 15 years ago. It was the case that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) put forward when he was Secretary of State for Health, as, I am sure, did my hon. Friend the Member for Wycombe (Sir R. Whitney) when he was Under-Secretary of State for Health. It was true then and it is true today. However, it does not answer the fundamental question of whether enough patients are being treated or enough operations carried out.
720 This country has the best-value health service in Europe. By that I mean that we get more value for the money that we use than any other health service that I know of. That is a tribute to the doctors, nurses, staff and managers of the national health service. However, running a cost-effective health service is no longer enough. The public expect more, and I think that they are right to do so. The most important principle of the health service is that no one should be deprived of health care because of lack of income. Whatever other judgments are used on who will have health care, the question of a man or woman's income does not enter the equation. That remains fundamental. No one wants a system in which people are excluded from health care provision because of lack of income.
Increasingly, people feel that in addition they should not be deprived of self-evidently important health care because of a lack of resources in the health service. The dilemma was most famously put by Enoch Powell, who said that any health service faces the problem of infinite demand meeting finite resources. That is the dilemma of the health service in this country and anywhere else. No system is perfect; equally, it does not have to be as imperfect as ours. It is clear from the cases that have been widely reported over the past few weeks that people who should be treated are not being treated. No one, whatever their political party, wants that.
The real question is how to bring those extra resources into the health service. How do we ensure that those resources are best used? The issue should be about how to achieve the best possible health care for the maximum number of people. In achieving that, we should consider all the options. That is where I quarrel with the Government. It is not written in stone that general taxation is the only means whereby money can be raised for the health service. That is not a fundamental principle of the health service—it is simply the way that it has always been.
I remember talking to Margaret Thatcher about the health issue before the 1987 election. She thought that a royal commission on health was the way forward. That was unusual, because Margaret Thatcher was not renowned for appointing royal commissions—I could put it more strongly than that. In the event, no commission was appointed, but today, three years after the 1997 election, the case for an inquiry—at least—into the financing of the health service is overwhelming. A royal commission or some other independent and authoritative inquiry would allow us to consider all the options by which we could bring extra resources to health.
We can continue to make the health service entirely dependent on general taxation. That seems to be the approach taken by the Prime Minister, and by the Secretary of State, who says that there is no alternative to public spending, which will bring us up to European standards, not now, but in six to eight years' time. There are strong arguments against that course. Of all the health slogans that I can think of, "The health service is safe in the hands of the Treasury" would certainly be the oddest. My right hon. and learned Friend the Member for Rushcliffe is sitting behind me, so I shall be gentle, but the idea that the Treasury is populated by kindly Ministers and officials eager to resource health care is somewhat fanciful. Public spending has not resourced the health service adequately to date. That fact is a commentary not on the present or the previous Governments, but on all the Governments of the past half century.
721 If we make health an overwhelming public spending priority, other priorities such as education, law and order, defence and pensions will suffer. To rely exclusively on general public spending is a triumph of hope over experience. We should look at other options. One possibility is a health tax, which might have the advantage of creating some connection between the taxpayer and the health provider. Another option is to raise revenue by some form of personal insurance to add to public funding from tax. Many European countries already use that system, and it is both foolish and depressing to reject that prospect out of hand. It is wrong to suggest that that system would Americanise—or even privatise—the health service.
In Germany, I am told, there have been many television pictures of patients in Britain lying on trolleys and so on. Newspaper comment in Germany has been not about how wonderful the British health service is, but about how the Germans do not want our system of shortages. We deceive ourselves if we think that the rest of the world regards the method by which we finance our health service as the way it should be done. People in other countries may well say that our doctors, nurses and other staff are dedicated professionals who make the most of every penny. I hope that they do, and they would be right to say so, but no one advocates moving towards our system of finance.
I fear that, if we do not seek new paths, in 10 years' time we shall still be debating these problems in the same depressing way. There is no doubt that the old national health service has achieved a vast amount and, having served as Health Minister for six years, I certainly applaud that. But we need change. We need a new national health service, possibly run as a separate commission, but certainly receiving new and consistent streams of income. Such a service could achieve so much more. The Government have turned their face against change, and I deplore that. If they do not alter that stance, my party will rise to the challenge. The present crisis, following past crises, provides an opportunity to think anew.
§ Mr. Kevin Barron (Rother Valley)
In view of the remarks made by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and by the right hon. Member for Sutton Coldfield (Sir N. Fowler), perhaps I should point out that I have known Lord Winston for many years. I first met him in 1984, when he was Robert Winston and I was a Member of the House, helping to talk out a Bill sponsored by Enoch Powell, which would have stopped research into the human embryo and thus into infertility. At that time, I thought that Robert Winston was a brilliant clinician and, having considered the events of the past few days, I still think so, although he is now a politician—we are led to believe.
I am sorry that the hon. Member for Woodspring (Dr. Fox) has left the Chamber, because I quite enjoyed the earlier knockabout over his and the Opposition's perceptions of NHS funding. When he got down to his three ways to save the NHS, which I understand have been expressed in a letter from the Conservative party to my right hon. Friend the Secretary of State and Members in other parties, he mentioned two points in particular. The first was that the Conservatives wanted long-term 722 funding of the NHS. The second was that they wanted increased funding year by year. That was not our experience during the last five years of the previous, Conservative Government. [HON. MEMBERS: "Yes, it was."]
The right hon. Member for Sutton Coldfield said that the Conservatives had built hospitals every year. Under the Tory Government, they did not build hospitals for many years. What really happened was that they cut back savagely on capital expenditure in the NHS—not £10 million or £15 million but hundreds of millions of pounds. That was the amount that they cut from capital expenditure during their last three years in office. Consequently, my right hon. Friends who have held the position of Secretary of State for Health have had to use the private finance initiative to restore some of the savage cuts to building in the NHS. For the Conservatives to say that they built hospitals is absolute nonsense.
§ Mr. Barron
My hon. Friend agrees. He and I were involved in many debates on the NHS.
At a fringe meeting at the Conservative party conference, the hon. Member for Woodspring said:I think what we are proposing will revolutionise private health insurance in the way we revolutionised pensions in the 1980s.When the Labour Government came to office in 1997, they had to put right many wrongs; for example, the case of my constituents who had been robbed by going into private pension schemes. The Government had to set up schemes so that people could get back the money that had been taken off them by private pension plans. After the Conservatives were defeated in 1997, I thought that they would have learned something, but they have learned nothing from the way they ran the Government—getting citizens into a mess.
In relation to the announcement that was made just before Christmas, my own health authority—the Rotherham health authority—received an increase of 7.28 per cent. That is a real-terms increase of 4.6 per cent. It is the best increase for many years—since long before May 1997. That real increase will do something about the real problems in our area.
During the past few weeks, we have seen vested interests at play in the NHS and in politics. We know that the Opposition have a vested interest; in theory, it is to oppose. They claim that the NHS is not just in acute crisis, but that it has been brought to its knees. I do not believe that, nor does anyone working in the NHS.
Since 1997, the Government have been changing the way money is spent in the NHS. They have built up public health services and supported primary care groups. They have spent money on services that were formerly poor relations in the NHS. They have deliberately done all that to try to improve public health so that we can hope that, in 10, 20 or 30 years' time, there is not the need for an acute sector of the size it is today.
Our debates on the national health service always concentrate on hospitals and repairing people who have been damaged or who have become the victims of circumstances, but they are not sensible debates about promoting public health. The Government have rightly targeted the biggest killers, such as cancer and 723 heart disease. They have spent money on those diseases, but they have been criticised for doing so. I think that such criticism is wrong.
The Government have reduced waiting lists. I do not care what anyone says about that. Waiting lists peaked in April 1998 and they have fallen by 18 per cent. since then. Hon. Members can come to the Chamber to say how long X and Y have waited, but they should talk to the people who are waiting for less time now than they were in April 1998. They will say that the Government are doing the right thing.
§ Mr. Barron
I might give way in a minute.
The Government are improving joint action between local health authorities and local authorities to improve care for people in the community with disabilities and to improve mental health care. We have waited years for such an agenda and for joint co-operation. Money has gone into that as well as into the modernisation of the national health service.
Since 1948, the health service has been riven by an internal debate between hospitals and general practitioners and between the acute sector and primary care. The Government are taking those issues on. Such action is perceived to hurt some people and especially those who work in the acute sector. They do not like what is happening. Their empires are being realigned, but the Government are absolutely right to realign them and I will defend them when they do. When we hear from the vested interests and organisations involved in hospital care, we must always remember that the Government's aim is to improve public health and the health of the nation.
The Government are modernising the national health service. None of the new money—as much as it is—that is going into health authorities such as my own is being given to them so that they can continue to spend in the way they did in the past. Packages tell them that they must spend differently. The Government are also making the health service more modern by improving information technology and using such wonderful technology for the general good.
The Government are improving clinical practice. They are not just putting money into the national health service, but are making sure that it is spent properly. Let us forget about the cost of the private sector; let us instead examine the reference costs on which the Government reported a few weeks ago. They considered the actual costs of certain procedures in the health service and clinical outcomes, so that, after 50 years of its existence, we can begin to have an idea of what goes on in the NHS.
A press release in the Library provides three examples of reference costs. It shows how we should be able to ensure better care and get the most effective use of resources. I have suffered from lower back pain over the years, and the press release shows that one course of treatment for that can cost £638 in some hospitals, but that the costs rise elsewhere to £1,578. We ought to know why.
Day care for rheumatoid arthritis can cost £183 in some hospitals but £370 in others. The national health service should provide that service, but there should not be such a difference in costs. The costs of bronchial pneumonia 724 emergency admissions range from the lowest figure of £828 up to the highest, £1,617. Wherever it comes from, that is taxpayers' money that is spent on health care, but there are great cost discrepancies in the national health service. The Government are absolutely right to look into such matters, which concern people who work in the health service because such examination requires them to consider their costs, their use of resources and their clinical effectiveness. Numerous measures are being taken to improve clinical effectiveness.
I know from my experience in this House that any Member can go to the Library and read reports from the National Audit Office and the Public Accounts Commission about expenditure in our health service and many other areas of public life. Those reports reveal extraordinary divergences of cost and expenditure.
I remember a report about procurement in the NHS, which was published about four years ago. I have it in my office. It told how a hospital, which was not identified, bought a syringe drive for £800 from a manufacturer in October of the year concerned. The following March—in the same financial year—another department in the same hospital bought a syringe drive from the same supplier for £1,036. That department was trying to get rid of its annual budget by the end of March because in April it was to get another departmental budget. The report showed that procurement practices in the NHS are costing us tens of millions of pounds per annum.
I am all in favour of the Government putting new money into the NHS, and I am pleased that my health authority has received a big increase of 4.66 per cent. in real terms for the next financial year. However, I am also concerned to ensure that the health service is spending money properly in the most cost-effective and clinically effective way. I am unconvinced that it is doing so.
I turn now to a vested interest. The Secretary of State quoted a letter that was sent to The Times but which was not published today. In that letter, clinicians were saying that the situation was not as bad as it was being painted in the media. I do not think that the situation is that bad; nor do most people who know the national health service.
A front page article in The Times today contains a quote that I assume is connected with the increase that nurses have received this year. As the hon. Member for North Devon (Mr. Harvey) said, nurses received a big increase this year and last year, which is aimed to sustain nurses and to get more of them back into the NHS. We should all be pleased about that increase. The quote in The Times is from Dr. Ian Bogle, the chairman of the British Medical Association, who said:Doctors' pay is now seriously out of line with other professionals. It needs to be restored to the appropriate level.When I read that, it took me back to the years before I came to this House—the '70s—when the then Labour Government were giving flat-rate increases to people who were poorly off because they wanted to try to make work pay for them. At that time others asked, "What about our differentials?" I hope that I have not misquoted Dr. Bogle or the BMA, but if that is their line, we have returned to the argument about differentials.
We should all—doctors and nurses included—be concerned about having a health service that provides for this nation. We should forget about vested interests in society, and some of the vested interests in the NHS ought to be removed. We ought to be improving clinical effectiveness and spending resources better.
725 Conservative Members sit there smiling because they have been in government and they refused to start the modernisation that this Government have introduced. This Government certainly have my support.
§ Mr. Kenneth Clarke (Rushcliffe)
This is the third time in less than 12 months that I have taken part in a health service debate. I therefore hope to make it my shortest speech because I want to hear the remarks of many of the other hon. Members who wish to take part in this short debate.
Looking back on what I said before, I find that I warned about the impending sense of crisis in the national health service. I said that unless the Government shook themselves out of their complacency, they would take us into a series of winter crises like those that we have seen before. It gives me no pleasure to say that that is exactly what has happened because the response on previous occasions has been a combination of complacency and slogans—until the Secretary of State now finds himself in a serious position.
It is certainly true, as the hon. Member for Wakefield (Mr. Hinchliffe) said, that we have experienced winter crises before. That is all the more reason for predicting them when we realise that things are going wrong. It was no remarkable insight on my part or that of the other hon. Members who spoke in those earlier debates to talk of an impending crisis. Any Member of Parliament who kept in touch with the NHS would have received repeated warnings about the mounting problems, mainly financial, in health authority after health authority.
Long before this winter began, every Member of Parliament was receiving an increased burden of correspondence from people complaining about the steadily deteriorating service that they were receiving. The Government's response was a party political debate. There was almost a complete absence of constructive long-term policy to address the problem. I am not sure that they are accepting even now that they have had a bad winter, after a predictable increase in flu cases hit a vulnerable system. Having listened to them, I think that they have returned with more complacency and slogans for the future.
§ Mr. Clarke
I shall not give way only because of the pressure of time. I usually enjoy giving way.
I shall outline why I think we face the present crisis, what the short-term causes have been and what the immediate response should be. I believe that the principal underlying cause of the present problems is financial. Indeed, it is a financial crisis. As I have said before, the Government got the money wrong. They have set about tackling public expenditure problems in a most peculiar way, which has damaged the health service most especially.
It is not true that the Government followed for the first two years the spending plans that a Conservative Government would have followed. That is a slogan, but it 726 is untrue. We had annual spending rounds during which Secretaries of State for Health discussed with the Treasury the current situation in the health service and what it would be reasonable to spend in the light of economic circumstances during the next year.
I do not believe that any Conservative Secretary of State for Health ever accepted that in years two and three there would be handed out what had been pencilled in during previous years. It was the now candidate for mayor of London, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), who had the unfortunate experience while Secretary of State for Health of being told that that was exactly what would happen to him. If a Major Government had been returned to office, I do not believe that we would have contemplated anything of that sort.
The idea that health service expenditure would be fixed for three years in that way and never revised has been addressed only in the final years of this Parliament. As the hon. Member for North Devon (Mr. Harvey) has said, if the Government stick to their present plans they will, at the end of this Parliament, get back to a percentage increase in NHS spending that matches that of the former Conservative Government. That illustrates what was wrong; the Government made no attempt to address what was going on.
It is not true that the Government were constrained by public sector debt problems, for example. They simply went to a slogan-based approach to public spending that bore no relation to the needs of the NHS.
What has been the Government's reaction so far? I watched the Prime Minister on the Frost programme, and it seems that the Government have come up with another slogan. It seems that £21 billion is now discredited. I shall not repeat the excellent description of the way in which that ridiculous figure was arrived at that the hon. Member for North Devon gave the House. No one outside the House believes that the figure is an honest description of the Labour party's spending plans. Lord Winston is not the only one with doubts.
We now have not a three-year but a five-year target. When the next three years have passed, we shall have expenditure on the NHS that equals average percentage GDP across the European Union. That target does not address the needs of the service or priorities within government. It is a slogan that has already been produced for the next election campaign. Whether it is realised depends on many unforeseeable events, most of which are utterly beyond the Government's control. To what extent will our GDP grow over the next few years? Many European Governments are trying to reduce their health expenditure. To what extent will their GDPs grow? What rate of increase in expenditure will in practice be the outturn in other European countries?
At present, no one can seriously guess what the average percentage of GDP spent on health will be throughout the European Union. Nobody knows what our GDP will be. We have only a press release for a Frost interview, not a serious and fresh look at the funding needs of the NHS. The police service, which has also been badly dealt with by the Government, and the education service, which thought that it was the first priority, have already started saying, "What does this mean for us?" If EU average expenditure on health races ahead or if United Kingdom GDP dips, what will happen to our claims for our needs? The Government's approach is absurd.
727 The Government should not adhere to their present three-year comprehensive spending review without revisiting it. It was a dreadful mistake to give up annual spending rounds, and the NHS is one of the victims. It is impossible to set in stone arbitrary targets for spending and not allow the Secretary of State to revisit them. I do not believe that the Chancellor of the Exchequer and the Government will stick to their published plans for this year, next year and the year after, whatever the next comprehensive spending plan produces.
The Prime Minister had the nerve to say, correctly, that the problems of the NHS should be tackled by a combination of money and reform. I think that we are all agreed upon that. Quite a few Conservative Members have taken part in various attempts at reform in the past, and reform is further needed. The difficulty is that the Government's approach to reform so far has been essentially slogan-based and extremely political. It is a rather short-term reaction to what they inherited. When genuine new ideas are put forward for the medium or longer term, the Government are deeply resistant to contemplating any fresh look at how the health service might be financed or run.
Lord Winston said that the Government have not told the truth about the abolition of the internal market. Only the Labour party calls it the internal market. I am glad to say that the Government do not tell the truth when they claim that they have abolished the former arrangements. They have kept the purchaser-provider divide and much of the management information. They tell the hon. Member for Wakefield that they have abolished the internal market. Actually, they still have it in place. In fact, they are messing about with it in a somewhat ill thought-out way. I believe that when the Government's reforms are handed over, they will not be in a state of perfection. We made dramatic changes to the way in which the NHS was run and it could reasonably be expected that there would be continued evolution from where we were—but evolution was certainly required.
The purchaser-provider split gives distinct people in the health service, particularly GP practices, health authorities and advisers to patients, the chance to question what health needs are most dominant locally and how best to commission the highest standard of care delivery. That is what purchasing the service means. Someone examines the greatest priority need and decides how to use resources to meet it.
Providers are able to respond to demands. Slogans such as "Let us go for co-operation and not competition" have been used as an excuse for inhibiting the ability to switch from one source to another so that those involved might have a choice in how they best provide the service in their locality. That should not have happened. I have talked in the past about the replacement of GP fundholding with primary care trusts. It was a retrograde step, which has reduced the role of GPs.
NHS Direct was set up far too rapidly. The new Secretary of State was dominated by consumerism when he first took office. I do not mind being dominated by that, but NHS Direct may or may not work. It is a rather ill-tried concept. Money is being put into it when funding is not obviously readily available. The danger is that that will increase expectations of, and demands on, the service without proving to be an effective way forward. It is costing money and staff at a time when that expenditure could be better directed elsewhere by others in the service.
728 I shall comment briefly on other reactions to the crisis. The nurses' pay settlement has been mentioned. I am glad that the Government stick with the review body system, which they used so to dislike and which they inherited from the Conservative Government. Of course, it is nice to be able to implement a review body award in full straight away. The Government make the point that we did not do so and that we used to phase awards. We phased them because we used to have regard to the ability of the service to afford the pay increase that was to be introduced.
We always implemented review body awards in full. However, it would have been irresponsible to say to health authorities, "We are now going to implement the pay award in full when we know that you do not have the funds." The Government, who panicked over the weekend about the health service, have done just that. They believe that, as it is in local areas that they will carry the consequences of a diminished ability to deliver the service, they can have their press release now about how they are implementing pay increases in full and straight away.
My right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) said most of what I wished to say about the longer term, and I have taken up my time speaking about the shorter term, but I could not put it better than my right hon. Friend has already done.
Every time an Opposition Member speaks about change, we are accused of wanting to privatise the NHS. That sterile argument is ridiculous. My hon. Friend the Member for Woodspring (Dr. Fox) made it clear that we are committed to the NHS, to its principles and to increased expenditure on it. We wish to explore ways in which the resources available to health care as a whole can be increased. Some suggestions are ill thought-out. I do not approve of the American system, and under the continental system, Governments must be careful about the costs that they impose on employers and hence on employment, with the prospect of causing unemployment.
We favour an imaginative look at alternative ways of funding health care. We have consistently supported partnership with the private sector. The Liberal Democrats, in the shape of the hon. Member for North Devon, were more than usually prepared to concede that expanding the private sector would ease the pressure on the NHS.
Labour Members argue that if the private sector were allowed to grow, it would compete with the NHS for staff, so we should not even try to contemplate new resources coming into the health service from outside general taxation, because that would increase competition for doctors and nurses. That argument is fatuous and could be used against the expansion of resources in practically every other sector of the economy.
The Prime Minister said on Sunday that of course his Government were in favour of partnership with the private sector. He seems to have lost touch with his own party, as well as with the state of affairs in the NHS. One has only to listen to the present Secretary of State and the previous one, and hear of experiences of attempts to develop further partnership with the private sector, to know that the Labour party is still marked by deep and bitter hostility to the idea that we should source health care other than from the national health service, financed by general taxation.
729ery other developed country in the world has found that a sterile approach. At a time when the Labour party has got into its first health service crisis, does not know why and has no policy for getting out of it—apart from a few slogans—it should be more receptive to the original and constructive propositions being put forward by the Opposition.
§ 6.2 pm
§ Dr. Howard Stoate (Dartford)
It always gives me great pleasure to take part in health debates: I am one of the few Members who still has personal contact with the NHS, as I still do some medical surgeries in general practice.
We have heard some extraordinary statements today. The one from the right hon. and learned Member for Rushcliffe (Mr. Clarke) takes the biscuit. He tried to explain that he phased in the pay awards when he was Secretary of State because the health authorities could not afford to pay them. Of course they could not—the previous Government did not give them the money. Had the Government given health authorities the 6.8 per cent. average that we have given, they would have been able to afford decent pay awards for decent staff.
§ Dr. Stoate
I shall give way in a moment.
To cool the temper of the debate, I shall try to establish whether there is a genuine crisis in the NHS. I shall do so by reference to my own experience. As the House knows, I am a general practitioner. This morning I contacted my local health trust to find out what was happening. It is indeed under severe strain, among other reasons because it is 92 nurses—about 13 per cent. of the nurse complement—short.
Why are health trusts short of nurses? Because they cannot get trained nurses. Why can they not get trained nurses? Because there are not enough trained nurses in the health service. They are doing their best to put that right, as are the Government, but it is nonsense to suppose that we can produce trained nurses out of a hat.
The idea that complementing the health service by using the private sector would solve the problem is even greater nonsense. The same number of trained nurses would be split between two hospitals—the national health hospital, which would be struggling to keep them, and the private hospital, which would be struggling to poach them. It is fairly obvious that there would be winners and losers, but we cannot stretch the number of nurses, unless we want them to do double shifts and work 16 hours a day.
§ Dr. Stoate
I shall give way later, but I want to make progress first.
It is impossible to get more out of our dedicated staff. That applies not just to nurses, but to professions allied to medicine, including technicians, and of course doctors. If doctors are doing coronary artery bypass grafts down the road at the private hospital, they are not doing them in the NHS hospital. The idea that twice as many coronary artery 730 bypass grafts could be done if the private ward down the road were opened does not accord with the facts, because the same surgeons work in both the private sector and the NHS.
When I refer patients for surgery, they often ask me whether they can go privately. The answer is yes, they can go privately, but they will see the same consultant and get the same treatment. And guess what? If they get the treatment privately, the consultant whom they see will not be in the NHS hospital. We cannot have it both ways. The idea of expanding the private sector as some miraculous panacea will not do the business.
We heard tell of Lord Winston's comments. Lord Winston is an honourable and decent physician, and he has a point of view, but I cannot agree with it. Consultants are feeling frustrated and let down. As has been pointed out, the reason is that the Government's health reforms, putting primary care in the driving seat, threaten some interest groups. The reforms threaten the monopolies of certain physicians and specialists, who are seeing some of their power put back into primary care, where doctors, nurses, social service staff and others are making decisions on what constitutes the best health care for their area, in conjunction with health improvement programmes, the Commission for Health Improvement and the work of the National Institute for Clinical Excellence. All that will improve health care, but may well damage some personal empires and private interests in the health service. I understand that view, although I disagree with it, but to sensationalise the position is quite wrong.
We also heard it said that we need to increase health resources to the European average. That is certainly a target, but we must be careful to compare like with like. In the UK, NHS spending and private health spending together represent about 6.8 per cent. of gross domestic product. The European average is about 8.8 per cent. of GDP—about 2 per cent. more. However, if we analyse those systems, we find that they are much more bureaucratic than ours.
In the 1960s and 1970s the NHS used to spend 3 to 4 per cent. of its total budget on administration and bureaucracy. The Conservatives managed to increase that to 6 per cent. by introducing their market reforms, which increased administration costs, if not clinical costs. In most European systems, the administration costs are far higher—10 per cent. in some cases. In America, administration costs are even higher, and can reach 12 or 15 per cent. If that money is stripped out, the European average of 8.8 per cent. of GDP is closer to 7.8 per cent, which is not so very far above our 6.8 per cent.
I am not arguing that the NHS has enough money. No hon. Member believes that—it clearly does not have enough money. Everyone in the House believes that we need to spend more. There is no argument about that. The question is how we do it.
I listened closely to suggestions from the Opposition about how we could increase the contribution of the private sector. Let us assume that there are enough doctors and nurses, and concentrate on funding. Various alternatives have been proposed, and it is unfair for the Opposition to claim that the Government have not thought them through. The Government have considered them carefully.
731 The alternatives are compulsory insurance or voluntary insurance. Both have costs. Compulsory insurance is merely a stealth tax. If people are told that they must have private insurance, that is the same as taxation. Where is the advantage in that? We might as well pay for the service out of general taxation. If people are urged to have voluntary insurance, something different will happen. People will say, "If I'm going to pay voluntarily for health insurance, I want something more in return than the bloke down the road, who doesn't have it."
That will create a huge split in the service and a massive two-tier system. I do not believe that the British people's sense of fair play would allow that. There are far greater problems. As my right hon. Friend the Secretary of State said, the people who need health insurance— those with chronic illnesses and pre-existing conditions— will not get health insurance.
I should like to see the health insurance company that would take on someone with chronic diabetes, renal failure and eye problems. It would be crazy if it did, and I am sure that actuarial advisers would say that that was a bad bet, in the same way as insurance companies will not take on a young driver with four convictions for drunk driving. They do not want to know such people, and they will not want to know people with chronic health problems. If, however, private health insurance companies were forced to take those people on, it would merely force up the premiums for everyone else, and we would be back where we started. People will not want to pay hugely inflated premiums. Private health insurance simply does not cut the mustard. It is not fair for Conservative Members to claim that we have not thought the matter through. We have considered it for many years.
I want to comment on the suggestion that the health service has deteriorated rapidly since the Labour party took office. When I qualified in medicine 20 years ago, our health service was the envy of the world. Nobody challenged that slogan. Twenty years on, however, we are led to believe that we have the worst system in Europe— a health service that is even worse than Poland's. For 18 of those 20 years, the national health service was in the hands of the Tory party; it has been in the hands of the Labour party for only two years or so. That sets alarm bells ringing and makes people wonder what happened. Could it be that the previous Government were not especially interested in preserving the health service? Perhaps they liked the idea of the slow decline of the NHS into a second-rate service; perhaps it served their purpose. When my hon. Friend the Member for Wakefield (Mr. Hinchliffe) read out The Sunday Times article, which outlined the wishes of the hon. Member for Woodspring (Dr. Fox) for the NHS, the matter began to become clear. Perhaps the hon. Member for Woodspring does not want the NHS to be the primary provider in the new century.
I want to consider the flu epidemic. I shall not speak for too long because other hon. Members want to contribute, but most of the media interest has sprung from the so-called flu epidemic. Frankly, I am not sure whether there is a flu epidemic—and I do not even care, because the answer depends on the way in which one measures an epidemic. A traditional measurement is 400 sufferers per 10,000 visiting a general practitioner in one week. However, nowadays, more options are open to those who suffer from flu. They can visit their pharmacist, phone NHS Direct, go to casualty, speak to a neighbour or take 732 home remedies. Many people are far better informed and do not go to their GP. However, the people who visit their doctor with flu are more ill than in previous years. There are far more cases of genuine flu rather than the flu-like symptoms of previous years. Patients are more ill, need far more treatment and take longer to get over the illness. Some people have taken three or four weeks to recover.
This morning, I saw a lady who was very ill through flu complications. In previous years, I would have sent her to hospital. However, the Government have made a real advance: for the first time, I had an option. I could tell that lady that she did not need to go to hospital because we could manage her condition at home with proper nursing, physiotherapy, and through involving social services. For the first winter I can remember, we can manage that patient at home on an acute basis. The NHS is well prepared for the crisis. I turned up and said what needed to be done. In a few minutes, we took action, the services were provided and the lady could be looked after at home, where she wanted to be. The NHS is thus more modern and better prepared than some hon. Members claim.
I want to consider flu injections. Much research shows that flu injections work, although they are not perfect. However, there are two provisos. The injections need to be targeted at vulnerable groups and we need to increase the herd immunity of the population. I hate to refer to hon. Members as a herd, but the description fits the concept of immunity. Those needs mean vaccinating more widely. The Government should consider carefully widening the net for flu jabs in an epidemic year. That means targeting not only all those who are at risk but their carers. I suggest targeting those who are over 65 rather than over 75, and injecting crucial care workers and others who perform an essential service in society. If a carer is sick with flu, it is a tragedy not only for the carer but the person who is cared for. The Government should consider widening the availability of flu immunisation to cover far more people. We can thus spare the NHS significant strain. If it is true that the NHS is under strain as a result of the flu bug, it is also true that much of the problem would disappear if it was controlled.
The NHS ain't broke, but it needs fixing. It comprises a dedicated group of staff: doctors, nurses, staff in the professions allied to medicine, managers and others do a splendid job in difficult circumstances. We should pay tribute to them because they keep the NHS going. Clearly, we must do something to provide more resources for the NHS. The Government are honest and open in admitting that we need more money and in holding a debate on the source of the funding. For all the reasons that I and other hon. Members have given, privatising more of the health service or increasing private insurance will not provide what we want. We need a modern health service for this century. Privatisation and private health insurance are not the answer; we require a better-funded public health service. I will leave the calculations to the Chancellor and his colleagues because that is their field, but I call for greater funding in future.
If Conservative Members want to reform a bankrupt and outdated institution, they need look no further than their party. I wonder whether the private sector would be interested in buying it from them.
§ Mr. Michael Portillo (Kensington and Chelsea)
I want to talk about money and pick up on the excellent speech that my right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) made. I also want to show that the way in which we fund the health service is largely an historical accident, and not replicated in any other country in the world.
The source of money in any society is its citizenry. However a service is funded—through insurance or taxes—the people of a country are the only source of money. However, it is easier to raise money for a purpose such as the national health service if the funds available are numerous and varied. If there are several pots from which to draw money, the strain is far less than when the entire burden is placed on one source: in the case of the NHS, taxation.
§ Mr. Portillo
I shall not give way at all.
The method of funding the NHS in this country came about in an arbitrary manner. Beveridge, who produced his report in 1942, tackled the NHS only briefly. None the less, he commented thatprevious contribution—by which he meant previous insurance contribution—is the ideal, better even than free service supported by the taxpayer.Bevan devised the idea that the service should be funded only by the taxpayer. In a recent history of the NHS by Geoffrey Rivett, he stated thatfew other countries, outside the Eastern bloc, followed the … routethat Britain took. However, even Nye Bevan recognised that the NHS could survive only if it leant on the private sector. He realised that he could not afford to pay consultants to work in the NHS for the money that was necessary to engage their services. He permitted them to work privately and allowed pay-beds in NHS hospitals. He said:I stuffed their mouths with gold.In other words, he bought off consultants. Labour Members know that that is true. For some Labour Members, especially the hon. Member for Wakefield (Mr. Hinchliffe), to talk of the private sector as though it were evil or inimical to the NHS is not only stupid but unhistorical. The NHS has changed little, and continues to depend fundamentally on a cross-subsidy from private patients, which enables it to have consultants' services at cut prices.
Bevan invented the principle that the health service should be funded almost exclusively by taxpayers. As Labour Members know, he and the rest of the Labour Cabinet fell out about that because even the Labour Cabinet that introduced the NHS favoured prescription charges and charges for spectacles. Many supported charging for hospital stays. Even the Labour Government who introduced the NHS believed that it could not survive on taxpayers' funding alone.
When Nye Bevan resigned, the right hon. Member for Chesterfield (Mr. Benn)—who was a witness to all those 734 events and is in the Chamber now, I think because I told him that I would be quoting him—said, most interestingly:On this question of 'principle' of a free health service, it is nonsense. There are many national scandals it would be costly to correct. This is not a matter of principle, but to the contrary it is a practical matter. There is only one test we can apply and it is an overall one: 'with what we have and can get by way of revenue, how can we lay it to the best advantage of those who need it most?'
§ Mr. Tony Benn (Chesterfield)
The right hon. Gentleman said that he would quote from the diary. It was from this seat that I heard Aneurin make his resignation speech. If the right hon. Gentleman reads a little further, he will see that I was in favour of increasing income tax to finance the service. Perhaps he will do me the justice of quoting what I wrote 49 years ago.
§ Mr. Portillo
I am most grateful to the right hon. Gentleman, and my purpose in warning him that I would quote him was intended to enable him to be here if he wanted. His practical approach of all those years ago contrasts sharply with the dogmatic approach of his party's Front Benchers in today's debate. The irony is that Bevan—who resigned in 1950 and was regarded as an outcast, at least by the Labour Cabinet and even by much of the Labour party—subsequently became a hero, and the idea that the health service had to be funded from taxpayers' money alone was raised to the status of a dogma. That dogma, I am afraid, has dogged the debate ever since.
In 1949, the health service absorbed 3.5 per cent. of gross domestic product. Today, that figure is still under 6 per cent. Over 50 years, there has been a minimal increase in the percentage of GDP dedicated to the health service as people—[Interruption.] I do not know what the hon. Member for Liverpool, Garston (Maria Eagle) is crying about. As every Member of the House knows, this country contrasts sharply with most others where health services have not been funded exclusively by taxpayers. Let me cite figures that appeared in The Times yesterday: Britain spends £889 per head of population; France, £1,433; and Germany, £1,634. We have heard that the United States spends twice the proportion of GDP that we do, but it may astound Labour Members to know that 43 per cent. of its health spending was spent by the public sector in 1993 and it is likely that that figure has increased substantially. That means that the United States public health sector spends more per head of population than the British Government. [Interruption.] The hon. Member for Dartford (Dr. Stoate) shakes his head, but it is so. Getting on for 50 per cent. of health spending in the United States is spent by the Government. If that is divided by the population, the figure is more than we ourselves spend.
I want to get on to the point about diversity of sources. In the Netherlands, 68 per cent. of health spending comes from social health insurance; 14 per cent. from private insurance; and only 10 per cent. from taxes. The insularity of the Labour party shocks me, as does the idea that a country that is only a few miles away has a system that must self-evidently be rotten or imperfect. The Secretary of State said that he did not want to look at Germany because things did not work there. That must be news to the Germans, but, for the record, about 14 per cent. of health spending in Germany comes from the Government. Here is the appalling fact for us all to face: not only is the 735 NHS not regarded as the best health service in the world, but we now have the most inequitable system in the world. I do not know of many countries where having money makes as much difference as it does in this country to the treatment received. We know that a person with money can get an operation immediately, and that a person who does not may have to wait several years.
§ Mr. Deputy Speaker
Order. I am sorry to interrupt the right hon. Gentleman, but may I say to the hon. Lady that the silence of parliamentary private secretaries is a wondrous thing?
§ Mr. Portillo
Given that this country has what appears, at least on paper, to be the most socialist of all health services that I can think of—as Geoffrey Rivett would say, at least outside the old eastern bloc—it is a national disgrace that this is the country where having money makes the biggest difference to whether a person receives timely health treatment.
§ Mr. Portillo
No, I am about to end my speech.
There is an extraordinary paradox: the Prime Minister says that he wants to modernise Britain, but on the health service he is completely paralysed and unable to look outside the blinkers of the way in which we have done things for 50 years. The right hon. Gentleman regards himself as outward looking and internationalist and wants to be at the heart of Europe, but apparently cannot see through the fog of the channel to look at how things are done differently in different places. It is extraordinary to see such a Prime Minister so dug in and so dogmatically wedded to everything that we have done in the past and to the way in which we have done it. There is no other part of the heritage of the Labour Government of the 1940s to which the Prime Minister is wedded in such a way. Exclusively, apparently, the health service has to remain frozen and preserved in aspic.
The Prime Minister's comments have been disappointing and unworthy. The slogan that has been developed—"the only alternative to modernising is privatising"—is downright dishonest, and many of my right hon. and hon. Friends were deeply depressed that the new Secretary of State was content to sloganise and wanted to make the NHS an election issue, apparently refusing to address the serious point. My conclusion is that Nye Bevan may indeed have done a great service to this country by freeing its people from fear of medical bills, but that, by raising to the status of dogma the financing of the national health service by the taxpayer, he has frozen in fear, in perpetuity, the politicians who ought to be addressing this serious issue.
§ Laura Moffatt (Crawley)
I have a couple of minutes to make my points, in particular about staff. I have been astonished by some of the comments of Conservative Members. There were amazing understatements, such as 736 that from the right hon. and learned Member for Rushcliffe (Mr. Clarke), who said, "I believe that we did not leave the reforms of the health service quite at the point at which we would have liked." The right hon. Member for Kensington and Chelsea (Mr. Portillo) said that the health service is preserved in aspic, as though the only issue relating to modernisation is the way that it is funded. Was he entirely satisfied with the state of the NHS when he lost his job in 1997? I suspect not, if what he said today is true.
It is dishonest of the Opposition not to say that the so-called reforms that they put in place have caused these difficulties because they have. There is no question about that. We have gone down a path that has caused the greatest difficulty for our staff in the NHS and the Labour Government are making sure that we get back on the straight and narrow, get people back into the health service and properly respond to their needs, particularly in cash. However, that is not the only issue. It is right and proper to reward nurses, but no one could do the job just for the money.
Not one Conservative Member talked about the safety issues facing the NHS. If people are our most precious commodity, as they are in the NHS, we must respect them and understand that they want to work in an NHS that is safe and does the job that they as professionals expect it to do. It is important that we respond properly to their needs. For example, in the south-east, the availability of affordable housing is an issue and we have to make sure that people can work in places where it is extremely difficult to recruit. The NHS becomes unsafe because we cannot get people to work in it.
We talk about beds, beds, beds and say that there are not enough in the NHS, but that is not the issue. One can go to Ikea and get as many beds as one wants. This is about the people who are working to ensure that the patients in the beds are safe, and are being cared for according to the standards that we all expect.
The modernising agenda is there. The Labour party is responding to the needs. We, not the Conservative party, are listening to people, and that is why we will get it right.
§ Mr. Philip Hammond (Runnymede and Weybridge)
I have listened carefully to all that has been said, some of which has been very interesting. The hon. Member for North Devon (Mr. Harvey) agreed with my hon. Friend the Member for Woodspring (Dr. Fox) that the growth of the private sector would complement the national health service. I welcome that uncharacteristic display of openness from a Liberal Democrat.
The hon. Member for Wakefield (Mr. Hinchliffe), who is not present, is at least consistent, and I would not expect him to move an inch. I disagree with him entirely, but I respect his consistency: he is one of the few Labour Members who have stuck to a position that they have maintained for many years. He did, however, manage to ignore the experience of the rest of Europe and, indeed, the rest of the world.
My right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) helpfully drew attention to the sterility of much of the political debate about the NHS. He referred to longer-term trends extending over periods exceeding any Government's time in office. The conclusions that we must draw from those longer-term trends underline that, 737 notwithstanding the rhetoric, all Governments over the past 20 years or so have spent more on the NHS, and the problems have not gone away. That emphasises the need for serious consideration of strategic approaches to those problems.
The hon. Member for Rother Valley (Mr. Barron) seemed to suggest that doctors were to blame, because they are building and defending their empires. He apparently supports the idea that the Government should tell doctors how to spend their resources. He calls it modernisation; I suspect that most people in the health service would call it meddling. Most telling of all, after his condemnation of the internal market, he gave figures relating to the differing costs of certain procedures in different hospitals. He was right to draw attention to the disparities, but had it not been for the internal market he would not have had the figures.
§ Mr. Barron
According to the hon. Gentleman, I said that doctors were to blame. In fact, he has answered his own point. The figures that I gave relate to the practices of clinicians in the NHS. I asked why some clinical interventions cost three times as much as others. Surely he accepts that ensuring that our money is used in a resourceful way should be a priority.
§ Mr. Hammond
It is an important issue, and the hon. Gentleman is entirely right; but without the internal market he would not have the figures that he has been quoting at us, and we could not pursue his argument and, hopefully, make the necessary savings.
In our last health debate, my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) warned the Secretary of State that winter crises would inevitably recur unless the fundamental issues were addressed. I remember that very well. My right hon. and learned Friend is eminently qualified to draw attention to the myth continually promoted by the Government that a re-elected Conservative Administration would have stuck to the draft spending plans. Everyone knows that we had annual spending rounds, and spending on the NHS would—as it always had—have increased year on year. By pretending that they would follow the Conservative spending plans, the Government starved the NHS for the first two years; now they wonder why the patient is not responding to force feeding.
My right hon. and learned Friend spoke of the discredited £21 billion slogan. As he said, it has now been replaced by a new slogan referring to a "five years ahead" target to match a European spending average that has not been defined for us. It is not even clear to me that that constitutes a pledge. I hope that the Minister can tell us whether the Prime Minister gave a clear commitment on Sunday.
The hon. Member for Dartford (Dr. Stoate), who often speaks on these matters, said that the NHS wasn't broke, but did need fixing. He seemed to miss an important point about additional resources. He said that expanding private spending would simply denude the NHS of resources. Let me tell him that, whether financial resources come from the private sector or the public sector, they will contribute exactly the same to the pot, and the problem will be exactly the same: how to turn financial resources into real 738 resources. The Secretary of State may say that that problem can be solved by injecting more public money, but it can equally be solved by finding other financial resources.
§ Dr. Stoate
It is generous of the hon. Gentleman to give way to me in his winding-up speech. In fact, I was referring to NHS staff. There are not enough doctors, not enough nurses and not enough members of professions allied to medicine. Until we have trained more people— as the Government are doing—reapportioning the same number of staff between the private and public sectors will not improve the situation.
§ Mr. Hammond
What the hon. Gentleman said was that more private spending would denude the NHS of resources. More needs to be spent on health care, but the problem of translating financial resources into real resources—doctors and nurses—will be the same whether the money comes through additional private spending, a mixed model or more state expenditure.
My right hon. Friend the Member for Kensington and Chelsea (Mr. Portillo) drew our attention to the important fact that it is largely through historical accident that our national health service is funded as it is. He posed a good question: why is it, outside the eastern bloc, a unique model for the delivery of health care? If it had so much to recommend it, why did not other countries in western Europe copy it when rebuilding their economies in the 1950s and 1960s? He also drew attention to the insularity of the Labour party. The party that does not want to be isolated in Europe has refused to learn anything from the lessons of all our European neighbours over 30 or 40 years.
I am delighted that the Under-Secretary of State for Wales is to wind up the debate, but I find it odd that, with four junior health Ministers in the House, it was not possible to find one who was willing and able to do so.
We have heard from Labour Members—not least the hon. Member for Crawley (Laura Moffatt)—a catalogue of complacency, in the face of the worst short-term crisis that the NHS has faced in living memory and against a backdrop of growing discontent with the state of our health system overall. The Government stand exposed as complacent, ill-prepared, shifty and manipulative when under pressure, and simply not credible when attempting to formulate a policy response to the longer-term strategic questions that face health services, while refusing to abandon any of their dogmatic baggage.
I thought it a telling insight into new Labour's priorities that, at the beginning of last week, with patients dying for want of intensive-care beds, staff working at breaking point and hospitals bursting at the seams, there was, according to the Secretary of State, "not a crisis". But by the end of the week, one doctor speaking his mind and telling the truth about Labour's national health service had become a crisis of such proportions that it required the direct involvement of the Prime Minister.
Labour has no credible policy solution to the problems of the NHS: the Prime Minister's intervention confirmed that. We have no clue about how the Government would deal with the real problems in the long term. Their prescription is "more of the same"—although it is obvious to every qualified observer that, after nearly three years, the new Labour medicine simply is not working.
739 As my right hon. Friend the Member for Sutton Coldfield commented, in the Secretary of State's whole rambling speech, there was not a single new idea for the resourcing of our national health service.
The Secretary of State said that he had an open mind, but it was abundantly clear during his speech that he has not. As my right hon. Friend the Member for Sutton Coldfield said, it is unbelievably depressing. The Secretary of State's dogmatic hostility to the private sector was tangible throughout his speech.
Many hon. Members paid tribute to the valiant efforts of the dedicated staff—just about the only thing holding the health service together. I associate myself with those remarks, but the fact is that, despite those efforts, the NHS is not providing a basic acceptable level of service to all. The Prime Minister has acknowledged as much, snatching the rug as he did so from under the Secretary of State, who just a few days earlier had denied that that was the case.
As it is currently managed and run, the NHS clearly cannot cope when faced with a sudden surge in demand. People living in an advanced, affluent democracy—the world's fifth largest economy—at the outset of the 21st century should not have to ask themselves, "If I fall sick, will there be a hospital bed available for me?" or, "If I need an intensive care bed, how many hundreds of miles will I have to be transported to get it?"
Our neighbours in France, Germany, Belgium and the Netherlands take such a service for granted. It is increasingly clear that the British public are no longer willing to be denied the levels of health care that their neighbours enjoy simply because of the Government's dogmatic political ideology.
The current crisis in the NHS is a catalyst that demands a triple response. First, we need an immediate short-term response from the Government. On that count, they have clearly failed. They failed to give a clear undertaking to hospitals that they could devote resources to medical priorities without risking penalisation under the Government's waiting list scheme. They have failed to take the lead in encouraging NHS hospitals to use the private sector where that is sensible. Instead, they have ducked and weaved, relying on spin, rather than looking for real solutions.
The Government tried to exaggerate the status of the flu epidemic outbreak. They then misled us over the number of intensive care beds that had been created and suppressed the report of the inquiry into NHS beds, which will show that, despite their rhetoric, bed numbers have fallen under Labour.
Secondly, in the medium term, we need an end to the system of initiatives that is doing so much to damage the NHS, particularly the Government's waiting list pledge, which has grotesquely distorted clinical priorities throughout the service in favour of Labour's political priorities. Since they came to office, they have doubled the number of in-patients waiting more than 13 weeks and doubled the number of people waiting for an out-patient consultation. We need an end to that distorting system immediately.
Thirdly and perhaps most importantly, the crisis shows the need for a longer-term, more measured response to the underlying problems of the NHS: not a panic reaction such as the one that has occurred in the past couple of 740 days, with wild half promises and vague commitments, but a measured, serious review of the options for future delivery of health care.
We have invited the Government to join in such a review, starting without any ideological baggage and looking at all the options with the open mind that the Secretary of State claimed he had. It has been made abundantly clear from the things that he has said that he rejects that opportunity to take the NHS off the political battlefield and to deal with it rationally.
So far, the Government's only response to serious debate on the future of the health service is to level the rather pathetic charge that anyone who dares to question the sustainability of the present model—which is now almost all serious commentators—wants to privatise the NHS. That seems to be the only argument that the Government can deploy in defence of the status quo. They do not deploy reasoned arguments, call for open discussion of the options, or review experience elsewhere. It is simply a knee-jerk reaction. That strikes me as the position of a Government who are not confident of their case, but have a bunker-style mentality, are increasingly isolated at home on the issue and are in a minority of one, even among their socialist colleagues in Europe.
The Conservative position could not be clearer. The Leader of the Opposition has made it clear, as did my hon. Friend the Member for Woodspring again today. We are committed absolutely to the NHS, free at the point of delivery. We are committed to increases year on year in real terms in NHS funding under the next Conservative Government. However, we recognise that, even with that commitment to tax-funded NHS spending, it will not be enough in the face of the explosion in medical technology and the imminent genetics revolution. All serious commentators now agree that what is needed is strategic and innovative thinking about the NHS. We have seen that there is no appetite on the Government Benches for such a debate.
The irresistible conclusion for anyone with an open mind on the subject is that a great part of the additional spending that we will have to deploy to deliver the health services that the people of this country demand and deserve in the 21st century will have to come from sources other than general taxation. That is not to supplant the NHS, but to supplement it. It is to ensure sustainable growth in the overall resources that are available for health care.
As a result of this debate, the Government need to recognise, if nothing else, that it is not the ideological purity of the NHS that matters to the people of Britain, but the practical reality of effective health care that is free at the point of delivery and there for them when they need it—as, tragically, it was not for Mavis Skeet and many others.
§ The Parliamentary Under-Secretary of State for Wales (Mr. David Hanson)
We have had an interesting debate, although it has been somewhat curtailed because of the time available, on the important subject of the NHS. To answer the hon. Member for Runnymede and Weybridge (Mr. Hammond) immediately, I am here as the Under-Secretary of State for Wales because we are a United Kingdom Parliament. There are Labour Members who are interested in Scottish, Welsh and Northern Ireland health 741 matters and issues in a UK context. I recognise that the Conservative party does not have seats in any of those places, but it is important for us to look at the health service in the context of the UK. As hon. Members can see, the amendment has been tabled in the names of my right hon. Friends the Secretaries of State for Scotland, for Northern Ireland and for Wales, whereas the Conservative party motion refers to the UK as a whole.
Some central themes have been raised: change, funding, modernisation and reform. However, there has been a marked divergence between the approach of the Conservative Opposition and that of Labour Members. Interestingly, the three Members who spoke from the Conservative Back Benches were the right hon. Members for Sutton Coldfield (Sir N. Fowler) and for Kensington and Chelsea (Mr. Portillo) and the right hon. and learned Member for Rushcliffe (Mr. Clarke). They were all Cabinet Ministers in the Conservative Government, who were in office for 18 years and caused many of the problems that we face today.
The Conservative Opposition have suggested that there is under-funding in the NHS. They have made some imaginative suggestions about increased involvement of the private health sector in funding the NHS. Alternative ways have been suggested to allow the private sector to take over some of the responsibilities that are funded by taxation. All those ideas are contrary to the spirit of what the Government believe in, to which Labour Members have referred. It is interesting that, while serving their party in government for 18 years, those three Conservative Back Benchers supported the NHS by reducing its funding. They now come forward—
§ Mr. Hanson
I will give way in a moment.
Those Members reduced funding in overall terms— [Interruption.]
§ Mr. Deputy Speaker (Mr. Michael J. Martin)
Order. We cannot have such behaviour. The hon. Member for Grantham and Stamford (Mr. Davies) should not shout across the Chamber.
§ Mr. Hanson
In that time, those Conservative Members reduced the NHS's real funding and caused difficulties, but they now suggest using the private health sector as an option for funding.
§ Sir Raymond Whitney
Will the hon. Gentleman retract the misinformation that he has just given the House? The figures show that, in the 18 years of Conservative Government, real-terms spending on the health service increased by 75 per cent.
§ Mr. Hanson
This Government will be providing additional resources to the national health service, over 742 and above what the Conservative Government provided. As a constituency Member of Parliament, my experience has been—[HON. MEMBERS: "Withdraw."]
§ Mr. Deputy Speaker
Order. There is no point in hon. Members shouting withdraw. The Minister is in order. Had he been out of order, I would have been the first to say so.
§ Mr. Hanson
My experience as a constituency Member of Parliament is that, when the previous Government were in office, the number of beds in my constituency and overall NHS real-terms funding were reduced.
In today's debate, my hon. Friends the Members for Wakefield (Mr. Hinchliffe), for Crawley (Laura Moffatt), for Rother Valley (Mr. Barron) and for Dartford (Dr. Stoate) have offered real alternatives in ensuring modernisation, commitment and long-term funding of the NHS and in tackling the consequences of the Tory record on the national health service. My hon. Friend the Member for Dartford expressed strong views on illness prevention, a primary issue that will have to be addressed if we are to ensure that the NHS is strongly supported.
In this debate, there was, as ever, disagreement among Liberal Democrat Members. The hon. Member for North Devon (Mr. Harvey) certainly welcomed the Government's plans to achieve additional expenditure on health services, so that it matches the similar expenditure of our European partners. However, the hon. Member for Richmond Park (Dr. Tonge), who has left the Chamber, did not particularly support his comments, or those of Conservative Members, on private-sector involvement.
We have had an interesting debate, in which hon. Members have raised various issues, but the themes developed by Conservative Members—on the private health sector and on underfunding—have not chimed with it.
I am proud to be a member of a Labour Government— such as the one who founded the national health service. The right hon. Member for Kensington and Chelsea mentioned Bevan's founding of the health service, but not the fact that Conservative Members voted 51 times against its founding. I am proud to be a member of a Government who are committed to modernising the health service and to looking forward.
There is great pressure on the national health service, and my right hon. Friend the Secretary of State for Health and others recognise that pressure. However, we should remember that, over Christmas, hundreds of people across Wales, Scotland and England received emergency care and were admitted to hospital, and that hundreds of thousands of people received other support and help from the NHS.
§ Mr. Crispin Blunt (Reigate)
The hon. Gentleman relies on his own constituency experience to deny the 75 per cent. real funding increase provided by the Conservative Government. My constituency experience includes a 75-year-old lady who, on Christmas eve, was turned away from the Redhill hospital and sent to find an intensive care bed in Great Yarmouth. What does the Minister tell her and her family about the treatment that she received?
§ Mr. Hanson
As my right hon. Friend the Secretary of State said, there have been problems—no one denies that. 743 At the start of 2000, there were 190 cases of flu per 100,000 population in Wales, whereas four weeks previously only three people per 100,000 had flu. It was a major increase in a short time. We have to recognise that, as my hon. Friend the Member for Dartford said, people are now suffering from flu for longer—on average, 10 to 12 days rather than four to five days—and that more older people are suffering from it.
Certainly in Wales, and probably also in England, the pressures are the greatest in 25 years—[HON. MEMBERS: "No."] The Government have provided extra resources in England and Wales—[Interruption.] Pressures on health services in my part of Wales are certainly the greatest that they have been for 25 years, due largely to the number of people who have had flu—[Interruption.] We need to—
§ Mr. Deputy Speaker
Order. I cannot allow the situation to continue. The Minister is entitled to a hearing.
§ Mr. Hanson
Pressures on the health service have increased substantially because of the flu, but those pressures are being dealt with. We have provided additional resources to deal with winter pressures and undertaken severe long-term planning to deal with them.
Today's debate gives us an opportunity to focus on the future, not simply on the current winter crisis. Since the general election, the Government have increased real-terms spending on the health service.
§ Mr. Hanson
I shall give way in a moment.
Since the general election, an additional £1.9 billion has been pledged in England and, in the next three years, another £18 billion of extra expenditure will be provided. In those two years, in my part of Wales £291 million over and above the resources planned by the Conservative Government has been provided, and £1.3 billion of expenditure is pledged for the next three years. It is about the need to ensure long-term planning, modernisation, change and funding—which is the exact point made by my hon. Friend the Member for Rother Valley.
§ Mr. Wilshire
If there is so much extra money sloshing around, why has my health authority been ordered to cut £20 million of its spending in the next three years?
§ Mr. Hanson
As my hon. Friend the Under-Secretary of State for Health said, there have been huge deficits in some health authorities.
We should consider the Tory record. Under the previous Government—and the stewardship of the right hon. Member for Richmond, Yorks (Mr. Hague), who was Secretary of State for Wales—Wales lost 1,200 hospital beds, inpatient waiting lists increased by 5,800, and 300 nurses, midwives and home visitors were lost.
§ Mr. Hanson
No; time is pressing. [HON. MEMBERS: "Give way."] The hon. Gentleman overran his time.
744 We should focus on the Labour initiatives that the Government have taken in Wales and elsewhere. To date, NHS Direct has received almost 1 million calls. In Wales, NHS Direct has received—
§ Mr. Hanson
The national health service, under the stewardship of my right hon. Friend the Secretary of State, has provided an additional £80 million for cancer services and an additional £3.5 million in Wales. The funding is part of meeting the target—in which the Prime Minister is directly interested—of saving 100,000 lives.
§ Mr. Hanson
Additional resources have been provided to assist nurse recruitment in Wales. Extra nurse posts are available in Wales and elsewhere. The Government have spent additional sums on walk-in centres, with 20 pilot centres established in the current year in England. Since the general election, the capital programme has increased dramatically.
§ Mr. Deputy Speaker
Order. It is clear that the Minister will not give way. The hon. Member for Chesham and Amersham (Mrs. Gillan) should not remain on her feet, but should take the hint that he is not giving way.
§ Mr. Hanson
We have ensured the largest capital programme in the history of the national health service, with £8 billion of additional expenditure in the United Kingdom.
We are also making a commitment to modernise and invest for the future. The Labour commitment is for improved funding. As the Prime Minister said, we shall invest an average funding increase to ensure that, as a percentage of gross domestic product, the United Kingdom provides the same funding levels as those provided by our European partners. We shall ensure that, over five years, there is a 5 per cent. real-terms funding growth in the national health service to ensure that we bring ourselves up to the European average.
The Government are about modernisation and aiming for higher standards. We are also about ensuring that we provide decent levels of care for our people. Conservative Members offer privatisation, but private health insurance is not a solution to the national health service's funding problems. They argue that people should insure themselves privately, but the people who might need private health insurance under the Conservatives are the ones whom the private health insurers will not touch. 745 We are committed to funding and modernising the national health service and to ensuring real improvements over the next five years under this Government and beyond.
If people want privatisation, they should follow the route of the right hon. Member for Kensington and Chelsea, who said that it was just a historical fact that the national health service was founded under Labour. He said that, under the Conservatives, private health insurance would become the norm. We reject that approach. We stand for extra funding for the national health service.
Question put, That the original words stand part of the Question:—
§ The House divided: Ayes 183, Noes 328.748
|Division No. 30]||[7 pm|
|Ainsworth, Peter (E Surrey)||Emery, Rt Hon Sir Peter|
|Allan, Richard||Evans, Nigel|
|Amess, David||Faber, David|
|Ancram, Rt Hon Michael||Fallon, Michael|
|Arbuthnot, Rt Hon James||Fearn, Ronnie|
|Atkinson, David (Bour'mth E)||Flight, Howard|
|Atkinson, Peter (Hexham)||Forsythe, Clifford|
|Baldry, Tony||Forth, Rt Hon Eric|
|Ballard, Jackie||Foster, Don (Bath)|
|Bell, Martin (Tatton)||Fowler, Rt Hon Sir Norman|
|Bercow, John||Fox, Dr Liam|
|Beresford, Sir Paul||Fraser, Christopher|
|Blunt, Crispin||Gale, Roger|
|Body, Sir Richard||Garnier, Edward|
|Boswell, Tim||George, Andrew (St Ives)|
|Bottomley, Peter (Worthing W)||Gibb, Nick|
|Bottomley, Rt Hon Mrs Virginia||Gill, Christopher|
|Brady, Graham||Gillan, Mrs Cheryl|
|Brake, Tom||Gray, James|
|Brand, Dr Peter||Green, Damian|
|Brazier, Julian||Greenway, John|
|Breed, Colin||Grieve, Dominic|
|Brooke, Rt Hon Peter||Hague, Rt Hon William|
|Browning, Mrs Angela||Hamilton, Rt Hon Sir Archie|
|Bruce, Ian (S Dorset)||Hammond, Philip|
|Bruce, Malcolm (Gordon)||Hancock, Mike|
|Burnett, John||Harris, Dr Evan|
|Burstow, Paul||Harvey, Nick|
|Butterfill, John||Hawkins, Nick|
|Cable, Dr Vincent||Heald, Oliver|
|Campbell, Rt Hon Menzies (NE Fife)||Heath, David (Somerton & Frome)|
|Heath, Rt Hon Sir Edward|
|Cash, William||Hogg, Rt Hon Douglas|
|Chapman, Sir Sydney (Chipping Barnet)||Horam, John|
|Howard, Rt Hon Michael|
|Chidgey, David||Hughes, Simon (Southwark N)|
|Chope, Christopher||Hunter, Andrew|
|Clark, Dr Michael (Rayleigh)||Jack, Rt Hon Michael|
|Clarke, Rt Hon Kenneth (Rushcliffe)||Jenkin, Bernard|
|Johnson Smith, Rt Hon Sir Geoffrey|
|Colvin, Michael||Jones, Nigel (Cheltenham)|
|Cotter, Brian||Keetch, Paul|
|Cran, James||Kennedy, Rt Hon Charles (Ross Skye & Inverness W)|
|Curry, Rt Hon David|
|Davey, Edward (Kingston)||Key, Robert|
|Davies, Quentin (Grantham)||King, Rt Hon Tom (Bridgwater)|
|Davis, Rt Hon David (Haltemprice)||Kirkbride, Miss Julie|
|Dorrell, Rt Hon Stephen||Kirkwood, Archy|
|Duncan, Alan||Laing, Mrs Eleanor|
|Duncan Smith, Iain||Lait, Mrs Jacqui|
|Lansley, Andrew||Shephard, Rt Hon Mrs Gillian|
|Leigh, Edward||Shepherd, Richard|
|Letwin, Oliver||Simpson, Keith (Mid-Norfolk)|
|Lewis, Dr Julian (New Forest E)||Smith, Sir Robert (W Ab'd'ns)|
|Lidington, David||Smyth, Rev Martin (Belfast S)|
|Lilley, Rt Hon Peter||Spelman, Mrs Caroline|
|Lloyd, Rt Hon Sir Peter (Fareham)||Spicer, Sir Michael|
|Llwyd, Elfyn||Spring, Richard|
|Loughton, Tim||Stanley, Rt Hon Sir John|
|Luff, Peter||Steen, Anthony|
|Lyell, Rt Hon Sir Nicholas||Streeter, Gary|
|MacGregor, Rt Hon John||Stunell, Andrew|
|McIntosh, Miss Anne||Swayne, Desmond|
|MacKay, Rt Hon Andrew||Syms, Robert|
|Maclean, Rt Hon David||Tapsell, Sir Peter|
|Maclennan, Rt Hon Robert||Taylor, Ian (Esher & Walton)|
|McLoughlin, Patrick||Taylor, Rt Hon John D (Strangford)|
|Madel, Sir David||Taylor, John M (Solihull)|
|Maples, John||Taylor, Sir Teddy|
|Mates, Michael||Thompson, William|
|Maude, Rt Hon Francis||Townend, John|
|Mawhinney, Rt Hon Sir Brian||Tredinnick, David|
|Michie, Mrs Ray (Argyll & Bute)||Trend, Michael|
|Moss, Malcolm||Tyler, Paul|
|Norman, Archie||Tyrie, Andrew|
|Oaten, Mark||Viggers, Peter|
|O'Brien, Stephen (Eddisbury)||Walter, Robert|
|Ottaway, Richard||Wardle, Charles|
|Page, Richard||Waterson, Nigel|
|Paice, James||Webb, Steve|
|Paterson, Owen||Wells, Bowen|
|Pickles, Eric||Whitney, Sir Raymond|
|Portillo, Rt Hon Michael||Whittingdale, John|
|Prior, David||Widdecombe, Rt Hon Miss Ann|
|Redwood, Rt Hon John||Wilkinson, John|
|Rendel, David||Willetts, David|
|Robathan, Andrew||Willis, Phil|
|Robertson, Laurence||Wilshire, David|
|Roe, Mrs Marion (Broxbourne)||Winterton, Mrs Ann (Congleton)|
|Ross, William (E Lond'y)||Winterton, Nicholas (Macclesfield)|
|Rowe, Andrew (Faversham)||Young, Rt Hon Sir George|
|Russell, Bob (Colchester)||Tellers for the Ayes:|
|Sanders, Adrian||Mr. John Randall and|
|Sayeed, Jonathan||Mr. Stephen Day.|
|Abbott, Ms Diane||Blizzard, Bob|
|Adams, Mrs Irene (Paisley N)||Blunkett, Rt Hon David|
|Ainger, Nick||Boateng, Rt Hon Paul|
|Ainsworth, Robert (Cov'try NE)||Borrow, David|
|Alexander, Douglas||Bradley, Keith (Withington)|
|Allen, Graham||Bradley, Peter (The Wrekin)|
|Anderson, Donald (Swansea E)||Bradshaw, Ben|
|Anderson, Janet (Rossendale)||Brinton, Mrs Helen|
|Armstrong, Rt Hon Ms Hilary||Brown, Russell (Dumfries)|
|Ashton, Joe||Browne, Desmond|
|Atherton, Ms Candy||Burden, Richard|
|Austin, John||Burgon, Colin|
|Banks, Tony||Butler, Mrs Christine|
|Barnes, Harry||Byers, Rt Hon Stephen|
|Barron, Kevin||Caborn, Rt Hon Richard|
|Bayley, Hugh||Campbell, Alan (Tynemouth)|
|Beard, Nigel||Campbell, Ronnie (Blyth V)|
|Bell, Stuart (Middlesbrough)||Campbell-Savours, Dale|
|Benn, Hilary (Leeds C)||Cann, Jamie|
|Benn, Rt Hon Tony (Chesterfield)||Caplin, Ivor|
|Bennett, Andrew F||Casale, Roger|
|Benton, Joe||Caton, Martin|
|Bermingham, Gerald||Chapman, Ben (Wirral S)|
|Berry, Roger||Chaytor, David|
|Best, Harold||Clark, Rt Hon Dr David (S Shields)|
|Betts, Clive||Clark, Dr Lynda (Edinburgh Pentlands)|
|Blair, Rt Hon Tony||Clark, Paul (Gillingham)|
|Blears, Ms Hazel||Clarke, Charles (Norwich S)|
|Clarke, Rt Hon Tom (Coatbridge)||Hanson, David|
|Clarke, Tony (Northampton S)||Harman, Rt Hon Ms Harriet|
|Clwyd, Ann||Heal, Mrs Sylvia|
|Coaker, Vernon||Healey, John|
|Coffey, Ms Ann||Henderson, Doug (Newcastle N)|
|Cohen, Harry||Henderson, Ivan (Harwich)|
|Coleman, Iain||Hepburn, Stephen|
|Colman, Tony||Heppell, John|
|Connarty, Michael||Hesford, Stephen|
|Cook, Frank (Stockton N)||Hewitt, Ms Patricia|
|Cooper, Yvette||Hill, Keith|
|Corbyn, Jeremy||Hinchliffe, David|
|Corston, Jean||Hoey, Kate|
|Cousins, Jim||Hood, Jimmy|
|Cranston, Ross||Hope, Phil|
|Crausby, David||Hopkins, Kelvin|
|Cryer, Mrs Ann (Keighley)||Howarth, Alan (Newport E)|
|Cryer, John (Hornchurch)||Howarth, George (Knowsley N)|
|Cummings, John||Howells, Dr Kim|
|Cunningham, Jim (Cov'try S)||Hoyle, Lindsay|
|Curtis-Thomas, Mrs Claire||Hughes, Ms Beverley (Stretford)|
|Dalyell, Tam||Hughes, Kevin (Doncaster N)|
|Darling, Rt Hon Alistair||Humble, Mrs Joan|
|Darvill, Keith||Hurst, Alan|
|Davidson, Ian||Hutton, John|
|Davies, Rt Hon Denzil (Llanelli)||Iddon, Dr Brian|
|Davies, Geraint (Croydon C)||Illsley, Eric|
|Davis, Rt Hon Terry (B'ham Hodge H)||Jackson, Helen (Hillsborough)|
|Dawson, Hilton||Jenkins, Brian|
|Denham, John||Johnson, Alan (Hull W & Hessle)|
|Dobbin, Jim||Johnson, Miss Melanie (Welwyn Hatfield)|
|Donohoe, Brian H|
|Doran, Frank||Jones, Rt Hon Barry (Alyn)|
|Dowd, Jim||Jones, Ms Jenny (Wolverh'ton SW)|
|Dunwoody, Mrs Gwyneth||Jones, Jon Owen (Cardiff C)|
|Eagle, Angela (Wallasey)||Jones, Dr Lynne (Selly Oak)|
|Eagle, Maria (L'pool Garston)||Jones, Martyn (Clwyd S)|
|Edwards, Huw||Kaufman, Rt Hon Gerald|
|Ellman, Mrs Louise||Keeble, Ms Sally|
|Ennis, Jeff||Kennedy, Jane (Wavertree)|
|Etherington, Bill||Khabra, Piara S|
|Field, Rt Hon Frank||Kidney, David|
|Fisher, Mark||King, Andy (Rugby & Kenilworth)|
|Fitzpatrick, Jim||King, Ms Oona (Bethnal Green)|
|Fitzsimons, Lorna||Kumar, Dr Ashok|
|Flint, Caroline||Ladyman, Dr Stephen|
|Flynn, Paul||Lawrence, Mrs Jackie|
|Follett, Barbara||Laxton, Bob|
|Foster, Rt Hon Derek||Lepper, David|
|Foster, Michael Jabez (Hastings)||Leslie, Christopher|
|Foulkes, George||Levitt, Tom|
|Fyfe, Maria||Lewis, Ivan (Bury S)|
|Galloway, George||Lewis, Terry (Worsley)|
|Gapes, Mike||Lloyd, Tony (Manchester C)|
|Gardiner, Barry||Love, Andrew|
|George, Bruce (Walsall S)||McAvoy, Thomas|
|Gerrard, Neil||McCabe, Steve|
|Gibson, Dr Ian||McCafferty, Ms Chris|
|Gilroy, Mrs Linda||McCartney, Rt Hon Ian (Makerfield)|
|Goggins, Paul||McDonagh, Siobhain|
|Golding, Mrs Llin||Macdonald, Calum|
|Gordon, Mrs Eileen||McDonnell, John|
|Graham, Thomas||McGuire, Mrs Anne|
|Griffiths, Jane (Reading E)||McIsaac, Shona|
|Griffiths, Nigel (Edinburgh S)||McKenna, Mrs Rosemary|
|Griffiths, Win (Bridgend)||Mackinlay, Andrew|
|Grocott, Bruce||McNamara, Kevin|
|Grogan, John||McNulty, Tony|
|Gunnell, John||MacShane, Denis|
|Hain, Peter||McWilliam, John|
|Hall, Mike (Weaver Vale)||Mallaber, Judy|
|Hall, Patrick (Bedford)||Marsden, Gordon (Blackpool S)|
|Hamilton, Fabian (Leeds NE)||Marshall, David (Shettleston)|
|Marshall, Jim (Leicester S)||Shaw, Jonathan|
|Marshall-Andrews, Robert||Sheldon, Rt Hon Robert|
|Martlew, Eric||Shipley, Ms Debra|
|Maxton, John||Simpson, Alan (Nottingham S)|
|Meacher, Rt Hon Michael||Smith, Rt Hon Andrew (Oxford E)|
|Meale, Alan||Smith, Angela (Basildon)|
|Merron, Gillian||Smith, Jacqui (Redditch)|
|Milburn, Rt Hon Alan||Smith, John (Glamorgan)|
|Miller, Andrew||Smith, Llew (Blaenau Gwent)|
|Mitchell, Austin||Snape, Peter|
|Moffatt, Laura||Soley, Clive|
|Moonie, Dr Lewis||Southworth, Ms Helen|
|Moran, Ms Margaret||Spellar, John|
|Morgan, Ms Julie (Cardiff N)||Squire, Ms Rachel|
|Morley, Elliot||Starkey, Dr Phyllis|
|Morris, Rt Hon Ms Estelle (B'ham Yardley)||Steinberg, Gerry|
|Morris, Rt Hon Sir John (Aberavon)||Stewart, David (Inverness E)|
|Stewart, Ian (Eccles)|
|Mountford, Kali||Stoate, Dr Howard|
|Mowlam, Rt Hon Marjorie||Strang, Rt Hon Dr Gavin|
|Mudie, George||Straw, Rt Hon Jack|
|Mullin, Chris||Stringer, Graham|
|Murphy, Jim (Eastwood)||Stuart, Ms Gisela|
|Murphy, Rt Hon Paul (Torfaen)||Taylor, Rt Hon Mrs Ann (Dewsbury)|
|Naysmith, Dr Doug|
|O'Brien, Bill (Normanton)||Taylor, David (NW Leics)|
|O'Brien, Mike (N Warks)||Temple-Morris, Peter|
|O'Hara, Eddie||Thomas, Gareth R (Harrow W)|
|Olner, Bill||Timms, Stephen|
|O'Neill, Martin||Tipping, Paddy|
|Organ, Mrs Diana||Todd, Mark|
|Osborne, Ms Sandra||Touhig, Don|
|Perham, Ms Linda||Trickett, Jon|
|Pickthall, Colin||Truswell, Paul|
|Pike, Peter L||Turner, Dennis (Wolverh'ton SE)|
|Plaskitt, James||Turner, Dr Desmond (Kemptown)|
|Turner, Neil (Wigan)|
|Pollard, Kerry||Twigg, Derek (Halton)|
|Pond Chris||Twigg, Stephen (Enfield)|
|Pope, Greg||Vis, Dr Rudi|
|Pound, Stephen||Walley, Ms Joan|
|Powell, Sir Raymond||Ward, Ms Claire|
|Prentice, Ms Bridget (Lewisham E)|
|Prentice, Gordon (Pendle)||Wareing, Robert N|
|Prescott Rt Hon John||White, Brian|
|Primarolo, Dawn||Whitehead, Dr Alan|
|Purchase, Ken||Williams, Rt Hon Alan (Swansea W)|
|Rapson, Syd||Williams, Mrs Betty (Conwy)|
|Reed, Andrew (Loughborough)||Wills, Michael|
|Reid, Rt Hon Dr John (Hamilton N)||Winnick, David|
|Robinson, Geoffrey (Cov'try NW)||Winterton, Ms Rosie (Doncaster C)|
|Rooker, Rt Hon Jeff||Wise, Audrey|
|Rooney, Terry||Wood, Mike|
|Ross, Ernie (Dundee W)||Woodward, Shaun|
|Rowlands, Ted||Woolas, Phil|
|Roy, Frank||Worthington, Tony|
|Ruane, Chris||Wray, James|
|Ruddock, Joan||Wright Anthony D (Gt Yarmouth)|
|Russell, Ms Christine (Chester)||Wright, Dr Tony (Cannock)|
|Ryan, Ms Joan||Wyatt Derek|
|Sarwar, Mohammad||Tellers for the Noes:|
|Savidge, Malcolm||Mr. David Clelland and|
|Sawford, Phil||Mr. Gerry Sutcliffe.|
§ Question accordingly negatived.
§ Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
§ Mr. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.
That this House applauds the dedication and commitment of National Health Service staff for their tireless efforts at all times and in particular during the millennium holiday period and the current severe outbreak of flu; welcomes the Government's acceptance of the recommendations of the National Health Service Pay Review bodies in full and without staging for the second year, in start contrast to the practice of the previous administration; notes that, between 20th December and last weekend, there were 350,000 999 calls, over 800,000 attendances at Accident and Emergency departments and there have been over 250,000 emergency admissions; recognises the vital role in meeting these pressures played by the unprecedented level of planning for the winter, covering health and social services and the extension of NHS Direct to two-thirds of England; welcomes the measures already taken by this Government to increase the capacity of the National Health Service, including increased provision of critical care beds, the modernisation of Accident and Emergency departments, the biggest ever National Health Service hospital building programme, the employment of additional doctors and the recruitment of more nurses, the cuts in in-patient waiting lists, the extra investment to modernise cancer, coronary and mental health services and the commitment to increased investment in and modernisation of the National Health Service; and rejects the Opposition's proposals to privatise the National Health Service.