HL Deb 03 March 2003 vol 645 cc597-600

2.44 p.m.

Lord Sheldon

asked Her Majesty's Government:

In view of the speech by the Chancellor of the Exchequer to the Social Market Foundation on 3rd February, what are those areas where they consider markets cannot deliver the long-term returns required.

Lord McIntosh of Haringey

My Lords, the Government's central objective is to create a more prosperous Britain, with opportunity and security for all. In many areas, private firms operating in well-functioning markets can help to achieve this objective, by efficiently providing high-quality goods and services to consumers. But for certain key public services, such as healthcare, schools and national defence, a range of market failures can make public provision a more efficient and equitable means of delivery.

Lord Sheldon

My Lords, I thank my noble friend for that reply. The speech was a remarkable personal comment on those areas of public policy where markets are not appropriate and where public action is required. I know that my noble friend will have read this most important speech. Will he comment on the implications of the speech in the light of the current debate on the future of the National Health Service?

Lord McIntosh of Haringey

My Lords, I agree about the importance of the speech. I rather think that it will be referred to in economics textbooks and in studies of public policy for many years to come. As to the National Health Service, the Chancellor spent a considerable part of the speech describing the particular characteristics of the National Health Service which make public provision necessary: for example, the difficulty of specifying contracts, the fact that there are local monopolies in various specialisms in health, and in particular that there is very poor—too poor—consumer information. But at the same time, it is government policy to devolve responsibility for healthcare matters to the front-line organisations.

Lord Saatchi

My Lords, is not one of the most attractive aspects of the party opposite its belief in universal provision free at the point of use? Is it not a sad end of that romantic dream that now the Government intend to charge people for public services as well as taxing them? Does the Minister appreciate the scale of public disquiet about what that means—as in these findings: 37 per cent of people think that most people will end up paying for private schools; 56 per cent think the same about private healthcare; 59 per cent say that about private welfare insurance; and 66 per cent say that most people will end up paying for private pensions?

Lord McIntosh of Haringey

My Lords, I am sorry that the noble Lord thinks it more important to report to the House on opinion research findings than to read the speech. Had he read the speech, he would have realised that the principle of public service provision free at the point of delivery is exactly the thrust of the Chancellor's argument about healthcare. I referred also to schools and to national defence. I should have to know the provenance of the noble Lord's figures relating to public opinion in order to comment on them. As a market researcher, I am sorry to say that far too many dubious polls have been published in the past few years and months.

Lord Barnett

My Lords, I am sure that the researcher for the noble Lord, Lord Saatchi, will have read the speech—as will my noble friend; I know how assiduous he is. Perhaps I may draw my noble friend's attention to a particular point in the speech. My right honourable friend the Chancellor said: in those areas where markets failures are chronic, I am suggesting that we step up our efforts to pioneer more decentralised systems of public service delivery". Can my noble friend tell the House what exactly he had in mind?

Lord McIntosh of Haringey

My Lords, I have already volunteered an answer to that question in referring to the National Health Service and to the Chancellor's statement that in the NHS we would be devolving responsibility to front-line health organisations. The Secretary of State for Health is very keen on that. If that is allied to what the Department of Health has been doing in improving and establishing inspection facilities, it will be seen that the organisation of the National Health Service is very much in line with what the Chancellor is describing.

Lord Lamont of Lerwick

My Lords, what philosophical distinction does the Minister draw between, on the one hand, charging for prescriptions and charging for road use in London, and not charging for other public services?

Lord McIntosh of Haringey

My Lords, prescription charging goes back a very long way and has not been challenged by governments of either political persuasion for more than 50 years. That is an accepted variation on the principle of free delivery at point of use. As for congestion charging, because of the growth of traffic, it is no longer acceptable to say that all roads shall be available to all types of traffic at all times without some sort of charge. The introduction of the congestion charge in London is a good example of how that is both necessary and correctable.

Lord Newby

My Lords, in the speech, the Chancellor says that achieving the Government's economic objectives, demands the courage to push forward with all the radical long term reforms necessary to enhance productivity". Given the Government's extremely patchy record on productivity, what courageous measures did the Chancellor have in mind?

Lord McIntosh of Haringey

My Lords, I do not accept that the record is patchy unless the noble Lord, Lord Newby, means by patchy that he cannot claim that it is a bad record. I suspect that that is the case, because, as he very well knows, there have been significant improvements in productivity during the lifetime of the Government.

Lord Naseby

My Lords, although the Minister derides the view of my noble friend Lord Saatchi on opinion polls, is not the Chancellor's speech an opinion in itself? Does the Minister recognise that there really has not been any progress on the health service in the last seven years? Waiting lists are as long as they have ever been—probably longer. If there is to be devolved power to the front line—to the GPs, in other words does—that mean we can hope to have fundholding back again?

Lord McIntosh of Haringey

My Lords, I do not know what the noble Lord heard of what I said about opinion polls. As a survey researcher myself, I am not one to criticise opinion polls as such. However, I am one to criticise bad opinion polls, and I would need to know more about the sources of the noble Lord, Lord Saatchi, to comment on them. As for the point about delivery in the health service, the noble Lord, Lord Naseby, is plain wrong. Since 1997, we have 10,000 more doctors, 30,000 more nurses and 750,000 elective admissions—that is, 16 per cent—and waiting lists are down by 116,000.