National Health Service: Funding (Hansard, 5 December 2001)

§ Lord McIntosh of Haringey
My Lords, the Chancellor has made it clear that decisions on tax will he taken as part of the normal Budget process. New budgets and targets for health spending for 2004–05 and 2005–06 will be announced when the Spending Review 2002 reports next year.

Baroness Sharpies
My Lords, I thank the noble Lord for that reply. Given that the Health Secretary described the National Health Service on television as a command and control system, what plans do the Government have to make the NHS more locally accountable and user friendly to both staff and patients? Should not the discussions centre around how to facilitate medical practice rather than how funding constraints may be applied?

§ Lord McIntosh of Haringey
My Lords, in the approach to the 2002 Spending Review, we have done something that has not been done in the health service since 1948. We have commissioned Mr Derek Wanless, from outside the health service, to produce an independent review on the funding of the health service. He has given his preliminary results, which were previewed by the Chancellor of the Exchequer last week, but his major analytical report will be published in April next year and will be an input to the spending review. The issues raised by the noble Baroness, Lady Sharpies, will, of course, form part of that review.

§ Lord Crickhowell
My Lords, does the noble Lord agree that the Chancellor of the Exchequer previewed only a small part of Mr Wanless's report, which also contained a damning indictment of the present condition of the National Health Service?

§ Lord McIntosh of Haringey
My Lords, I had hoped that we would not talk about the damning indictment of the condition of the health service because that goes back over many years, including the period of the previous government. It is certainly true that at the present time the health service is under financed. That has been the situation for very many years and action is required in terms of both resources and reforms of the health service itself.

§ The Earl of Onslow
My Lords, I congratulate the Government on realising, after five years in office, that there is something wrong with the National Health Service. Why is it necessary to increase funding when it cannot spend the money it has at the moment?

§ Lord McIntosh of Haringey
My Lords, I shall have to throw the noble Earl's congratulations back in his teeth. An understanding of the problems of the health service has been evident in this Government ever since we took office—and, indeed, for a long time before. A major part of the problem—but not all of it—has been underfunding. Spending on health services in this country under the previous government was 6.2 per cent of GDP. That has gone up from 6.9 per cent, to 7.2 per cent, to 7.4 per cent this year, with plans for 7.6 per cent and 7.7 per cent in the next two years. I think we can see the difference.

§ Lord Clement-Jones
My Lords, is the Secretary of State for Health correct in saying that a hypothecated health tax would be desirable?

§ Lord McIntosh of Haringey
My Lords, the Secretary of State has not said that a hypothecated health tax would be desirable. Clearly there are arguments for a hypothecated health tax—there are presentational arguments for a hypothecated health tax—but we have to look at what would happen if the revenue from a particular hypothecated tax was to go down rather than go up, and whether that would be desirable for the health service. That is another consideration to be taken into account.

§ Lord Boardman
My Lords, in the other place, the Prime Minister committed the Government to substantial additional expenditure on health services. Would it not be responsible for the Government to give some indication of how this very large sum of money is to be provided within the time span?

§ Lord McIntosh of Haringey
My Lords, our existing plans for expenditure on the health service within the period of the spending review are set out in the Pre-Budget Report and in previous Budget documents. There is no doubt about the capability of public finances to meet those demands. As to the future, after the next two years—in other words, under the next spending review—I have made it clear that the judgments to be made next summer will be based on extensive and independent analysis.

§ Lord Lea of Crondall
My Lords, although many of us welcome the conversion of the Opposition to EU benchmarking, would it not be logical to ask Members opposite the following: if they find that we are trailing behind on a particular benchmark, what financial proposals will they make to correct that?

§ Lord McIntosh of Haringey
My Lords, my noble friend is absolutely wrong—and it is seldom that I have to say that. The Opposition have not been converted to EU benchmarking in any sense. The Opposition are continuing to run two horses which are running off in opposite directions. On the one hand they are still residually attempting to claim that there will be tax cuts—indeed, Mr Michael Howard said only on Monday that the Conservatives would reduce the so-called tax burden to 35 per cent, which would mean a 835 £50 billion a year cut in public expenditure. On the other hand, they are attempting, not very convincingly, to match the commitments that this Government have made to the proper funding of the health service.

§ Baroness Cumberlege
My Lords, does the Minister agree that waiting times are now longer than they were when the Conservative government left office?

§ Lord McIntosh of Haringey
My Lords, there are many definitions of waiting times.

Noble Lords
Oh!

§ Lord McIntosh of Haringey
My Lords, that is a matter of fact. Waiting lists are down by 100,000, and the noble Baroness can take any other measure that she cares to choose.

§ The Countess of Mar
My Lords, first, will the noble Lord confirm that the Opposition are not responsible for answering Questions at Question Time? Secondly, why is it that in our small rural locality in Worcestershire you now have to wait up to a month to see a general practitioner? You can be dead by then!

§ Lord McIntosh of Haringey
My Lords, I do not know about rural Worcestershire, but in my part of north London you cannot get to see your GP as quickly as you ought to be able to do. Of course, there are defects in many parts of the country. That is why we have set targets for the specific question raised by the noble Countess; namely, the issue of waiting times to see a general practitioner.

§ Lord Saatchi
My Lords, on the crucial question of public health, would not people be more willing to forgive the Government for all their splits at the top between the Prime Minister and the Chancellor, their wriggling from pledge to aspiration, and their twists and turns over dates and amounts, were it not for the fact that this is the Government who rose to power under the cynical and ruthless banner "24 hours to save the NHS"?

§ Lord McIntosh of Haringey
My Lords, I have always found that scripted abuse goes down very badly in this House. The noble Lord has not added very much to the debate.

§ Lord Renton of Mount Harry
My Lords, does the Minister agree that in almost every European country the percentage of health spending that comes through private health insurance is higher than it is in this country? Furthermore, Mr Wanless has said that he did not look in any great detail at the operation of private health insurance in France and Germany. Surely it would make sense for the Government to look more closely at the effectiveness of private health insurance and what contribution it can make before taking any final decisions on how the NHS should be financed.

§ Lord McIntosh of Haringey
My Lords, I agree with part of the noble Lord's premise. I do not agree with the conclusion that he draws. Yes, it is true that in many other European countries expenditure on private health insurance is substantially greater than it is in this country. The preliminary report by Mr Wanless—which is a serious report of 222 pages—states that there is no evidence that to extend the role of private insurance in this country would improve the efficiency of our health service. Indeed, the evidence is in the other direction. In this country we have—I am not saying that this is the only judgment—probably the most efficient health service in Europe. We have better bed use. We have better equity, in the sense that fewer people are being deprived of treatment because of the cost. Of course, there are other considerations. However, the importation wholesale of other people's solutions, when they themselves are questioning them, is slightly dubious.

§ Lord Walton of Detchant
My Lords, does the Minister recall that, in a major debate on the National Health Service in this House on 21st November, one of the problems highlighted was that we have approximately half the number of GPs and consultants, in all specialties, compared with our European competitors? Is that not one of the major problems causing the difficulties that we are presently encountering in the NHS?

§ Lord McIntosh of Haringey
My Lords, I do riot know that one-half of the European average is the correct figure. I do not have exactly that figure. But we have increased the number of nurses since 1997 by 17,000 and an additional 5,000 are in training. That is huge increase. We have also increased the number of doctors by 7,000 since 1997. Those are real achievements.

§ Lord Mackie of Benshie
My Lords, will the Minister—whom we all hold in high regard—tell the House whether the NHS could afford some throat pastilles for him?

§ Baroness Noakes
My Lords, can the noble Lord shed any light on the Government's target for NHS spending compared to the European average? Is that target to be achieved in 2005 or, as we now understand, 2006? How is the average to be calculated?

§ Lord McIntosh of Haringey
My Lords, the most recent figure for the European average is 7.9 per cent of GDP. Clearly, the figures are not immutable. Governments will make changes in their decisions on health spending, and changes in GDP will affect the average. The Prime Minister and the Chancellor have highlighted, very effectively and in vivid terms, the extent to which our health service does in some respects fall behind the best in Europe and the extent to which, in order to correct the position, the NHS needs additional resources which were denied to it by the previous government.