National Health Service: Funding (Hansard, 15 June 1990)

§ Baroness Blatch
My Lords, the Government have no plans to alter the present arrangements for resourcing the National Health Service largely through general taxation. With regard to the assumption made in the Question that 82 per cent. of its resources is from general taxation, I put on record that 78.3 per cent. is from taxation and allocated from the Consolidated Fund; 16.2 per cent. is NHS allocation from national insurance; 4 per cent. is from charges and 1.5 per cent. from miscellaneous, which includes land and property sales.

§ Lord Molloy
My Lord, I thank the noble Baroness for her reply. Is she aware that the Prime Minister, when she wrote the foreword in the document Working for Patients, said that the NHS would be financed mainly out of general taxation? The figure was then running at 82 per cent. Later on, however, in an article in the Evening Standard Mr. Kenneth Baker, the chairman of the Conservative Party, said that the NHS would be largely financed out of general taxation. I am sure that the noble Baroness will agree that there is a grave nuance of difference between the words "mainly" and "largely". Can we assume that the words of the Prime Minister will prevail?

§ Baroness Blatch
My Lords, I am aware of the statement made in the preface to Working for Patients. I am also aware of what was said by my right honourable friend Kenneth Baker. We shall continue to fund the National Health Service largely from general taxation.

§ Lord Ennals
My Lords, let us move away from semantics. I have two questions for the noble Baroness. First, is it still the government's aim to see more and more health care provided by the private sector as opposed to the National Health Service? Secondly, will she accept that by snipping away at NHS provisions, such as the introduction of charges for eyesight tests, the health of the nation is increasingly imperilled as a result of government policy?

§ Baroness Blatch
My Lords, I believe that we live in a free country. It will be for the private sector to continue to grow at the rate at which it wishes to grow. The hope is that we shall all work together for the benefit of patients. With regard to the assumption that the noble Lord makes about underfunding, I do not accept that premise. Spending has risen from £8 billion to £29 billion in the lifetime of this Government—an increase of 44 per cent. in real terms. Even as a percentage of GDP, the record is better now than it was 10 years ago. As per capita spending it is also better than it was 10 years ago. However, we all agree that there is scope 535 for better management and better application of resources. The Government are concerned with output as well as with input.

§ Baroness Phillips
My Lords, will the Minister confirm or deny the comment made on the radio this morning that the part-time chairmen of the health authorities are to receive a substantial increase in salary, whereas the workers, the practitioners, are denied a very reasonable increase in their wages?

§ Baroness Blatch
My Lords, I am aware of the statement that was made on the radio this morning. However, I cannot agree that the workers have been neglected in the pay awards this year.

§ Lord Monson
My Lords, given that 4 per cent. of NHS income already comes from charges, will the noble Baroness say whether Her Majesty's Government have considered levying a nominal bed-and-board charge on those patients, amounting to approximately 50 per cent. of hospital in-patients, who could well afford it?

§ Baroness Blatch
My Lords, I do not know of any plan to charge for bed and board in the NHS.

§ Lord Mellish
My Lords, I shall repeat what I said earlier because it is worth saying. Is the noble Baroness aware that no matter how much money is put into the National Health Service it will never be enough? She stated that spending had increased to about £28 billion. Is the Minister aware that it is still not enough and that whatever she does she will be criticised?

§ Baroness Blatch
My Lords, the noble Lord is absolutely right. Whatever sum of money is available there will always be a demand for it. However, it is right to repeat that in terms of what the country can afford I believe that the record at the moment is second to none. Spending stands at £29 billion. Of course if there were more money it could be spent. It might also be interesting to note that each time taxes have been lowered, revenue has been increased and spending on services has also been increased.

§ Lord Fraser of Kilmarnock
My Lords, would the noble Baroness agree that, since more than 90 per cent. of the population have used the health service virtually since its birth, there is a certain symmetry between the figure of over 90 per cent. using the health service and the fact that 82 per cent. of the resources for the health service should come from general taxation?

§ Baroness Blatch
My Lords, I am not sure I understand the particular point that the noble Lord makes.

§ Lord Fraser of Kilmorack
My Lords, does the noble Baroness agree with my point?

§ Baroness Blatch
My Lords, I note that he is saying that the majority of those people use it and that all taxpayers pay for it.

§ Lord Fraser of Kilmorack
My Lords, that seems fair and proper.

§ Baroness Blatch
My Lords, it does indeed.

§ Lord Molloy
My Lords, is the noble Baroness aware that much of what she said will give encouragement to the British Medical Association, the Confederation of Health Service Employees and the royal colleges? However, they have grave anxiety that inevitably the NHS will cost more. They welcome examination of the issue in order that vital changes should be made. However, despite the additional expenses that may be imposed, they would like reassurance that a fundamental element of the defence of the nation's health will be an adequate supply of finance to the National Health Service at all times.

§ Baroness Blatch
My Lords, I am somewhat relieved that I may be encouraging to the BMA. I believe that the BMA have done more to talk down the National Health Service than almost any other organisation.

Noble Lords
Oh!

§ Baroness Blatch
My Lords, however, the noble Lord made the case for the reforms almost as well as I did. If we are to spend large sums of money, we wish to see them spent in the most cost effective way so that they will benefit the patients.

§ Lord Ennals
My Lords, will the noble Baroness reconsider the words that she has just spoken? The British Medical Association represents the vast majority of consultants, hospital doctors and general practitioners in this country. To speak of them in such a way on behalf of the Government in your Lordships' House is surely a disgraceful way to treat the profession? Does she agree that it is absolutely vital that the medical profession enjoin with the Government in what they are trying to do? Is not such an intervention likely to do damage to the relationship with the medical profession?

§ Baroness Blatch
My Lords, I have no hesitation in paying a tribute to all who work in the National Health Service. I wish to make the distinction between those who work in the National Health Service and some of the quite overt and very public scaremongering that has been done in the name of the BMA and which, frankly, has let down many professional colleagues.

§ Lord Whaddon
My Lords, will the noble Baroness bear in mind that cost analyses of the treatment of illness by the NHS and by the private sector health services, both here and abroad, have shown time and again that the NHS is a very cost effective way of treating illness and that it is public money very well spent?

§ Baroness Blatch
My Lords, I absolutely agree. I add one factor. I believe that money spent on prevention is also money very well spent.