| Previous Section | Home Page |
Madam Deputy Speaker : Order. I am sorry to stop the hon. Member, but he is attempting to divert the hon. Member for Wakefield (Mr. Hinchliffe) from the provisions that are set out in the Bill. Perhaps the hon. Member for Wakefield will speak to the Bill.
Mr. Hinchliffe : My hon. Friend the Member for Makerfield (Mr. McCartney) has read my mind completely. He said exactly what I intended to say.
Madam Deputy Speaker : I am pleased that the hon. Member for Makerfield (Mr. McCartney) has read the mind of the hon. Member for Wakefield. That means that the hon. Member for Wakefield does not have to repeat what his colleague said.
Mr. Hinchliffe : I want to see the development of options to the model that we have been promised by the Government. It is a conservative model of what we have had for far too long. Other countries have developed options. They do not believe that when a person reaches a certain age or has a certain degree of incapacity he or she must leave the family home and go into an institution. We must have more sheltered housing. We need very sheltered housing. My hon. Friend the Member for Makerfield has described the domiciliary support that is needed. There should be support seven days a week in a person's own home if that is needed. Why should not the person to whom my hon. Friend the Member for Bow and Poplar (Ms. Gordon) referred have that sort of support? In many instances it would be cheaper for the public purse to provide it instead of shunting such people into an institution. We should be thinking of transforming
Column 709
residential care into a completely different model. We should facilitate community care and stop incarcerating people.The Government have ducked the challenge of having a completely different vision of community care. They have failed to meet the challenge of keeping people in the community. We should look to future provision and ensure that community care means care in the community, not away from it. On that basis, the Government have failed completely.
6.6 pm
Sir Michael McNair-Wilson (Newbury) : I shall not take up the remarks of the hon. Member for Wakefield (Mr. Hinchliffe), who has an enviable knowledge of the community care part of the Bill. I begin by saying that I support the Bill and the concept behind it, which is to open all the facilities in the National Health Service to all the patients within it. Such a concept is long overdue. It will enable a measure of choice to be introduced in the care of patients. The patient will be able to choose whether he is cared for locally or at a distance, and that will have a bearing on the time that he may be asked to wait for an operation. That choice should have been there all along.
I must, however, chide my Front Bench colleagues. They keep telling me that the Bill is a patients' charter. It may be that I am sensitive because I helped to produce a patients' charter, as the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) kindly reminded us last night, with the Association of Community Health Councils. A patients' charter can be produced only by patients and patients' organisations. The best that the Bill can do is be a patients' charter produced by a Government who think that they know what patients want. I assure my right hon. and hon. Friends that what the patient wants and what he gets may be rather different things. I regret that to some extent CHCs have been downgraded as a result of the Bill. We have not put an institution in their place that will speak for patients as I think the voice of the patient should be heard. I hope to return to that subject in later debates. In the end, what is the Bill about? It is about better service for the patient or it is about nothing. It is about better care from the general practitioner, and an extension of the service that the GP can offer his patient. It is about better hospital care, more consultants in the NHS and making better use of resources. Some may say that if I make such a statement I imply that the Health Service is of a poor standard. It is not. I know that the NHS is a political hot potato that we like to kick around in the Chamber, but the NHS is doing a superbly good job. I can say so because, as I think everybody knows, I am dependent on the Health Service for my life. I declare my interest : I am a kidney dialysis patient. I receive kidney dialysis three times a week through the NHS. I am the president of a kidney patients' charity. I have, therefore, considerable experience of the Health Service.
I listened to the hon. Member for Pontypridd (Dr. Howells) telling us about the hospital in which his son, sadly, is being treated. He referred to broken windows, peeling wallpaper and so on, and he placed the blame for that on the Government. I have been in many NHS hospitals, and some are good and some are bad. Some are well decorated and some are not. It amounts to good management or bad management. In some instances those
Column 710
who run a hospital notice such things and in others they do not. We are all guilty because we often find that we live in shabbier surroundings than we imagined when we compare those circumstances with others elsewhere. Let us not imagine that the Government decide whether a ward is painted or whether someone hangs pictures and makes the place more attractive for patients. Very often such matters are for the people who run our hospitals.Mr. Martin Flannery (Sheffield, Hillsborough) : Will the hon. Gentleman give way?
Sir Michael McNair-Wilson : I shall not give way because time is short and I know that others wish to contribute to the debate. I am sorry that the Government do not appear to want to follow through my next point. If we are to decide whether our hospitals are coming up to the standard that we expect, we must consider whether there should be a separate hospitals inspectorate. Although it may be a bureaucratic concept that may not find favour on the Treasury Bench at the moment, I ask my right hon. and hon. Friends to give it a little more thought. Perhaps a third body, such as the Health Advisory Society, which looks at mental hospitals, could be applied to the overall realm of the National Health Service and might help to raise standards and to identify the sort of problems that some of us notice when we go round hospitals and wonder why they are not as we would wish them to be.
If the Bill is about treating patients, in the end it is also about creating a form of accountability for the resources used to treat patients. Therefore, I welcome the idea of clinical audit and the fact that the Audit Commission is to have a say. By definition, all resources in the National Health Service are precious. It is a demand-led service, where the demand is infinite. If the demand is infinite, clearly the resources available to us will always be limited. No hon. Member should imagine that somebody somewhere in this or any other political party will be able to find all the resources that the Health Service will need one day. They will not. I have heard the hon. Member for Livingston (Mr. Cook) say just that. Whichever Government are in office, they will have to impose some limits on the resources that are available.
The important point, which I believe the Bill addresses, is getting the most out of resources and making all those who spend the resources conscious of the fact that they are spending something precious. Therefore, I welcome the cash-limiting of the drugs budgets. That must be right. I also welcome hospital trusts, and budget-holding practices. I welcome anything that makes those who are spending public money ask themselves whether they are getting the most from the money that they are spending. No practitioner, no matter what he is doing, who handles public money can divorce himself from the cost of the treatment that he intends to provide. Of couse, the cost is not, and should not be, the dominant consideration, but it must play a part.
As I have said, resources are the one thing that must be treated as what they are--precious gold. They must be used as prudently and as economically as possible, so that the greatest number of people can benefit from them. To that extent, the concept that now appears to have all-party support-- although I did not know that until this evening--of the money travelling with the patient is of the greatest significance. If the money travels with the patient, that
Column 711
means that the money goes with the treatment. That has the corollary that once the Bill becomes law, a patient who goes outside his region for treatment will take the resources with him, out of the district. That must introduce a new thinking into the minds of district health authorities.Perhaps the House will allow me to illustrate what I am trying to say in terms of kidney dialysis facilities. In the United Kingdom, we have 1.2 kidney dialysis units per1 million of population, whereas in the Federal Republic of Germany there are 5.8 such units ; in France there are 4.1 ; in Italy there are seven ; and in Spain there are five units per 1 million of population. Even in the German Democratic Republic, there are 3.5 units. The fact that those countries have more centres per 1 million of population also discloses that they also have more kidney specialists for their populations. Because of the small number of centres in this country, many patients must travel long distances. Plenty of Health Service studies show that both acceptance of new patients and treatment rates are inversely proportional to the distance of the patient's home from the treatment facility.
A renal consultant has written to me stating that the ethos of the Bill
"may promote change One would expect that a District exporting all its (valuable) renal patients might wonder why it does not keep those patients and treat them for itself. In addition, the District might also look at the cost of ambulance services required for shipping patients to the remote centre"
that is the kidney dialysis centre--
"and decide that these charges could be turned into a clear saving. It is thus possible that a certain number of patients would between them generate sufficient funds to establish a new Unit and pay for a new Consultant Nephrologist.
I am hearing from the patient organisations that British patients would prefer to be treated in small centres where relationships with individual doctors and nurses are maintained rather than in vast centres where they are lost in anonymity."
I suggest that as a result of the Bill that renal consultant's hopes will become a reality. I admit that that is a small example, but it underlines the potential of the Bill. Therefore, for that reason as well as for the others that I have given, I shall support the Bill on Third Reading. However, I add just one caveat. Perhaps it was a good idea to take the Health Service and the community care elements together in the same Bill, although I am one of those who believe that they should have been in two different Bills. But I am still worried about the co-ordination between health and community care. I believe that we shall have to return to that subject and I shall look forward to suggestions made in another place which may return to us as an amendment at some future date.
6.15 pm
Mr. Charles Kennedy (Ross, Cromarty and Skye) : Over the past decade --and longer--this has been a Government of reforming zeal on so many fronts. Much of that zeal has been well placed, such as the sale of council houses and the encouragement of democracy in trade unionism. However, the zealotry has now begun to blind common sense, not least in relation to the National Health Service. Ten years in office can cocoon a Government from reality.
Column 712
To paraphrase the earlier critical speech from the Government Back Benches, the hon. Member for Northampton, South (Mr. Morris) pointed out what is manifestly the case, yet the public are not behind the Bill one iota. At times the Government would do well to remember the Churchillian dictum of trusting the people. They may well find that, when the people next have an opportunity to give a national verdict on the Government's continuing reforming thrust, not least in relation to health and welfare services, they will lose badly, but deservedly.My fundamental objection to the Bill is its lack of intellectual honesty. There are two reasons why the Government have felt it necessary to introduce a Bill to reform the National Health Service. The first is straightforward : the Health Service is both big and bureaucratic. It is the biggest civilian employer in western Europe. Anything like that is bound to attract the disdain of a Government such as this, who do not like to respond to, or to have to deal with, any group in society that can wield the kind of power that the National Health Service can.
Secondly, and derived from that, the Bill is a response to political frustration. After 10 years of being told that the Government are spending more, employing more, treating more and building more, the public do not believe them. From the evidence in their own communities, the public do not believe the rhetoric of Ministers at the Dispatch Box. Largely out of the sense of frustration, the Prime Minister insisted on a political and legislative response. She split the Department of Health from the Department of Social Security, downgrading the then Secretary of State for Health and Social Security. She then dismissed him and brought back the previous Minister for Health, who has had to pull together this ill- assorted ragbag of ideas and try to present it as a coherent political philosophy when, in its basic analysis, it is not, because it is a response to political rather than patient needs. My principal objection to the Bill is that it seeks to impose on the main providers of health care a costly and untried administrative structure, which is designed in the first instance not to improve health care or to increase the resources given to health care, but to impose a sense of structured competition in a totally inappropriate form and setting. In so doing, Ministers have made it clear that they do not have sufficient regard for the professionals who are the Health Service or, indeed, for the patients who are dependent upon it. If they had, they would have built in throughout the Bill far more consultation and far more guaranteed representation for both those groups. At every stage at which these arguments have been raised--at times they have not just been Opposition arguments but have been supported by Government Back Benchers--they have been resisted throughout the Committee stage and the truncated Report stage in the last few days. I shall touch very briefly on a few of the issues that arise.
The National Health Service contracts will remove clinical responsibility from doctors. They will remove the proper voice in health care that I believe patients should have--I agree with the hon. Member for Newbury (Sir Michael McNair-Wilson), who has done so much in this field--and at the end of the day they will hand over final control and major decisions to administrators. That will create monopolies, which I suggest will add to costs.
Self-governing trusts will break the link between the community and the hospital, undermine planning in terms
Column 713
of both health care and staffing, and force people to travel for treatment that they should rightly expect in their locality, not least in rural areas, without giving them or the staff any direct democratic say in the decisions.General practitioner budgets, particularly in the light of the new GP contract, can only undermine the essence of the relationship between patient and doctor, which has been one of the greatest strengths of the NHS and is the interface--horrible word--between the vast bulk of the population and the family doctor service. I agree with Government Back- Benchers that the Government have refused to write in a guarantee that drug budgets will never be used to reduce expenditure on drugs. The Minister gave some assurances at the Dispatch Box on this matter, but they do not appear in the Bill. The Minister makes a face. I know the reason that the Secretary of State enunciated why they have been unwilling to write things in at certain times, but let us go beyond that on this question of drug budgets. This was a major opportunity to take a significant step forward down the line of generic substitution, of looking at patent life in a European Community context with a view to a better deal for the United Kingdom pharmaceutical industry, which, at a time when our balance of trade is disappearing over the cliff, is one of the major net contributors to British exports. But, unfortunately, the Government have not chosen to go sufficiently down that road. This is an extremely sad missed opportunity.
On health authority membership, the Government announced earlier this week a shake-up in the membership of health authorities throughout England and Wales. It was a disgraceful announcement in terms of the number of people with proven links to the Conservative party--we have been over this before in the course of the Bill--and business backgrounds. I do not object to business backgrounds, but all too often the criterion for appointment, or, more important, the criterion for not reappointing somebody who has served on a health authority, is, first and foremost, their political orientation rather than their professional commitment to a good National Health Service.
Mr. McCartney : The position is that a majority of the members of our health authority do not live in, work in or belong to the community for which they are the authority. After this Bill is passed and local authority representation is removed, there will be a majority of people on that body who do not live or work in or have any connection with the community to which they are appointed.
Mr. Kennedy : I am grateful to the hon. Gentleman. That is a serious and genuine complaint, which has been repeated in many other parts of the country. I can only say, given the difference in geography and demography between our two parts of the country, that I hope it does not begin to happen in the Scottish Highlands, because it would be farcical to have somebody sitting in Glasgow on the Highlands health board.
Mr. McCartney : A modern-day Highland clearance.
Mr. Kennedy : That is one way of putting it.
On the question of medical teaching--sadly, we were not able to come back to an all-party amendment on this matter on Report--there is, as the Minister knows, continuing concern and anxiety, particularly for the big teaching hospitals attached to and aligned with some of
Column 714
our great universities, about the role of those who are both in the academic sector and aligned or attached to the National Health Service. The Committee of Vice Chancellors and Principals has expressed particular concern about this. Given the educational lobby in another place, this is a matter on which the Government will be subjected to significant scrutiny, and I hope that there will be constructive amendment at that stage in the Bill.I come to medical practice committees. The hon. Member for Northampton, South had some caustic remarks to make about this and I quite agree with him that it is gratuitous and unnecessary to take powers to reduce the number of doctors, if necessary by imposing directions on the MPCs. In particular, it will be disadvantageous to both the inner cities and the rural areas. It is striking at one of the real success stories in the British Health Service since 1947, which is the growth in the number of general practitioners and the expansion of the family doctor service in accessible areas in every community.
Rural dispensing committees are also abolished--a decision made by the House with hardly any discussion, which is not at all a good way to go about legislation.
Coming, finally, to the community care section, while the principles behind it are welcome, even though the Government had to be dragged kicking and screaming over the Rubicon, not least where local authority input is concerned, and only after excessive delay, there is no provision, as the hon. Member for Eastleigh (Sir D. Price), the distinguished Vice-Chairman of the Select Committee on Social Services, made clear, for ring fencing, an essential concept of the Griffiths report. There are no national standards. The provision for the funding of residential homes is known by all--indeed, at one stage earlier this week, for a few magic moments, by a majority of the House--to be inadequate. There is no proper provision for carers and, in the context of one of the admittedly more minor amendments that was moved last night, no proper protection yet for residents in homes of four people or fewer through their being subject to proper scrutiny by the inspectorate. Within Scotland, there are no moves to introduce a proper inspectorate.
This Bill has been a response to political pressure. It has been born out of governmental frustration rather than a genuine, formative effort to improve the National Health Service. It did not feature as a manifesto commitment. I think that the Government are wildly out of touch with so much connected with this measure, and that they will reap the return from that at the ballot box in the next election. 6.27 pm
Mr. Quentin Davies (Stamford and Spalding) : I felt very privileged to take part in the work of the Committee that considered this Bill because I believe that it is one of the most important Bills going through the House in this Parliament, in the essential sense that it will have an enormous impact on the welfare and, indeed, the lives of our constituents.
I paid great attention to the Report stage and it is now clear to the House, and will be clear to the country, that the essential political difference between the parties in this House on the Bill is extremely simple. On the one side, the Government have decided that, after 40 years, it would be sensible to introduce a number of radical reforms into the
Column 715
NHS, not merely or even largely to improve the efficiency of the service, although improving value for money becomes ever more important the more money is allocated to the NHS and the greater the share of the Government's budget and of national income is absorbed by the NHS. But it is also necessary to get rid of some of the major perversities that have emerged within the operations of the NHS. Those perversities have, for example, led to a number of hospital managers having an incentive to reduce the throughput of their hospitals and to local authorities feeling that there is an incentive to dump people into institutional care as a first, rather than a last, resort.One of the great human benefits of this Bill will be that, for the first time, an attempt will be made to assess individual needs and, wherever possible, to support people in their own homes rather than consign them to institutional care, however dedicated and competent that care may be. The Government believe that it is now possible to introduce into the National Health Service a greater measure of patient choice and to make the system fundamentally more responsive to patient needs and demands.
The Opposition's position has been equally clear. Throughout the discussion on this Bill, in Committee and on Report, the Opposition have opposed, almost in every particular, any change in the 1948 structure--as though it were a crime even to touch that structure, and as though that structure represented a sacred totem. Perhaps to certain hon. Gentlemen and hon. Ladies of the Opposition it is a sacred totem. To a visitor unfamiliar with the British political debate it might seem that such blind defence of the NHS reflected a very large measure of satisfaction with the workings of the service. Of course, we know that nothing could be further from the truth. Throughout this Parliament the Opposition have subjected us to an endless litany of complaints about its operation. How does the Labour party explain this fundamental contradiction--on the one side, defence of the NHS in its present form, and on the other, the most serious, and often vituperative, complaints against its operation?
Mrs. Alice Mahon (Halifax) : In respect of the complaints against the NHS, we say to the Government quite simply, "Fund it properly."
Mr. Davies : I am glad that the hon. Lady mentioned funding. That is precisely how the Labour party, at least during the first two years of this Parliament, attempted to reconcile the contradiction to which I have drawn attention. We all remember how, in 1987, 1988 and 1989, we continually heard from the Opposition the suggestion that there was nothing wrong with the NHS except that it needed more money--as though throwing more money at it would solve its problems. Over the past two years something very interesting has happened. In 1988 Opposition leaders were regularly calling for the expenditure of another £1 billion or another £2 billion on the service--some Opposition Members seem to like multiplying round figures. In fact, the Government have come forward with £3 billion, £4 billion and £5 billion more.
Mr. Chris Mullin (Sunderland, South) rose --
Column 716
Mr. Davies : I will give way to the hon. Gentleman in a moment. I have observed--I hope that the hon. Gentleman who is about to intervene will show that I am right--that recently the Opposition have ceased their attempts to outbid the Government in respect of financial plans for the NHS.
Mr. Mullin : It is not just the Opposition who have been saying that the Health Service is underfunded. According to the local Tory newspaper in Sunderland, the chairman of the Northern regional health authority, who was appointed by the Government, said last week : "Fundamentally we are underfunded consistently. It is absolutely frustrating to feel so useless."
The person who made that comment is not a supporter of the Labour party.
Mr. Davies : Had the Government accepted the funding arrangements that the Labour party suggested for the NHS two years ago, the service would be funded at a lower rate today than is actually the case. The increase in expenditure on the service has been considerably greater than was demanded by the Opposition only two years ago.
Throughout the Committee stage and Report stage debates I listened with great attention, but entirely in vain, for the slightest suggestion by Opposition Members that if, by mischance, they were to come to power they would spend more on the NHS than the Government are planning to spend. I will give way to any hon. Member who is prepared to give a specific commitment to spend on the NHS more than the Government are currently planning to spend. I notice that not a single Opposition Member--least of all, the hon. Member for Monklands, West (Mr. Clarke)--is attempting to catch your eye, Mr. Speaker, or mine with a view to answering that challenge.
The hon. Member for Halifax (Mrs. Mahon) drew attention to the ruse by which the Labour party attempts to cover the contradiction in its attitude towards the NHS. That party gives the impression that, somehow, it will come up with more money than the Government have provided. That notion has been exploded, and, against this background, the Labour party's opposition to every element of the reforms being suggested by the Government is fundamentally mindless.
Mr. Frank Field (Birkenhead) : If even half of the hon. Gentleman's assertions are true, it must be galling for him. He is telling us how much the Government are spending on the NHS, but no one outside believes him. It is absurd to try to get the Opposition to outbid the Government on the question of funding arrangements. This Bill is about the delivery of health care. Our stance is that the Health Service has been a tremendous success story. Let us set the proportion of GNP spent on the Health Service against mortality and morbidity rates. Britain gets a good deal, and the electorate understands that. Surely it would be sensible to ask in what ways we can improve the service. Instead, what we have is a pig-headed decision that certain schemes, without even having been tried out, are to be introduced on a massive scale. I am therefore grateful for the hon. Gentleman's contribution. I hope that many people outside are listening, because the more he says, the fewer there will be who think that the Health Service is safe in his and his hon. Friends' hands.
Mr. Davies : The hon. Gentleman has raised a number of important points which I am only too pleased to address. I am glad that he, too, has come to the conclusion
Column 717
that it would be pointless to conduct this debate on the basis of the two sides trying to outbid each other in terms of promised NHS expenditure. That would indeed be futile. I believe that the Labour party's commitments have lost all credibility. Nevertheless, I repeat that there is a fundamental contradiction between the Opposition's defence of the NHS in its present form and their continuing complaints about the workings of the service. The only answer that the Opposition can give is to say that the problem is one of funding and that they are in a special position to resolve that problem. Now that the Labour party has dropped the claim that it will spend more money on the NHS, that means of reconciling the contradiction falls away. Thus is exposed the hollowness of the arguments that we have heard throughout this debate.I have the highest regard for the hon. Member for Birkenhead (Mr. Field), but I hope that, before we next have a debate on Health Service matters, he will spend a little time in the Library. I urge him in particular to look at the OECD figures on life expectancy and infant mortality of which, obviously, he is unaware. In 1948, when the National Health Service was introduced, this country was in the OECD's top quartile for life expectancy, for men and women, and in the bottom quartile for infant mortality. We are now in one of the two most unfavourable quartiles in respect of both. That is a serious relative deterioration in the general health of the British population. I say "relative" because, in absolute terms, the health of the population has improved greatly.
Mr. Frank Field : It is slightly barmy to make such comparisons. In the period after the second world war much of Europe was starving. Therefore, we would expect that to show up, particularly in the infant mortality figures. It is not comparing like with like to compare us with the rest of Europe in that period and then at present.
Mr. Davies : It is a good rule that one should attempt to display elementary familiarity with figures before one quotes them in the House.
Dame Elaine Kellett-Bowman (Lancaster) : Is my hon. Friend aware of the startling discrepancy in expectation of life within quite a small region? For example, the expectation of life in the north-west as a whole is well below the national average, whereas in Lancaster it is above the national average because we run our affairs properly. That is one of the fallacies of the National Health Service. There are enormous discrepancies even between adjoining districts. That is one problem which the Bill will address and cure.
Mr. Davies : I congratulate my hon. Friend on health achievements in her constituency.
I welcome the Bill not because it enshrines some useful reforms but because the Government have resisted the temptation to replace one monolithic, global, systematic structure, introduced in 1948 and apparently valid for all time, with another monolithic, global, systematic structure, also apparently valid for all time. The Government have adopted an extremely pragmatic approach and have introduced a number of radical but specific reforms into a structure that continues to enshrine the basic principles of the NHS. The Government have not been afraid to look round the world and to learn from foreign experience when it had something to teach us. To a certain extent, the
Column 718
fund-holding practice concept owes something to the system of health management organisations in the United States. Clearly, the introduction of self-governing hospitals will produce a structure more akin to that in continental countries such as France and Germany.The Government have also learnt from analyses over many years of the experience of the NHS. Elements of the Bill reflect some of the thinking of Professor Enthoven in his famous report and reflect his concept of an internal market. They also reflect much of the thinking which that report inspired.
The Bill brings in useful and vital reforms. I have already mentioned some. If their operation is properly monitored and controlled, they should provide a basis for continuing uprating of the National Health Service. That is vital because we cannot legislate for the NHS once and for all and then forget about it for the next 40 years. It deserves, and will receive, detailed continuing attention. The Government did a good day's work for the country when they introduced the Bill, and I am proud to support it.
6.42 pm
Mr. Ieuan Wyn Jones (Ynys Mo n) : The debate has demonstrated graphically the ideological gulf between the Government and the Opposition. Unfortunately, the Minister, the hon. Member for Stirling (Mr. Forsyth), used the debate simply as debating practice. It seemed as though he wanted to earn brownie points from his friends on the Front Bench rather than tell us about the merits or demerits of the measure. I contrast that speech--34 minutes of doing nothing other than baiting the Labour party--with the compassionate speech of the hon. Member for Pontypridd (Dr. Howells). He and I share a background from which we can say that the National Health Service is part of our heritage. We are conscious that the Bill will undermine the philosophy upon which the Health Service was founded.
One reason why the hon. Member for Stirling refused to give way to Opposition Members was that he forgot to tell the House that, despite the fact that the Government have introduced a number of sweeteners to persuade doctors to accept budgets, we still get letters from the British Medical Association telling us that the proposals for budgets are flawed. The BMA also tells us that support for the Bill, even among Conservative voters, is declining dramatically and that a majority of Conservative voters do not believe the Government's rhetoric.
In Committee I was concerned about the way in which Ministers defended the principle of setting up NHS trusts. The Government referred to them as centres of excellence. None of us wants any hospital to be other than a centre of excellence. If hospitals are compared, and one is regarded as a centre of excellence, it must mean that the others are not. We are worried because the principle enshrined in the Bill will create two tiers of hospitals. The hospitals which become trusts will become centrepieces of the Government's new philosophy, while other hospitals will be starved of cash.
The desperate shortages in key services and key personnel within the Health Service have not yet been addressed on Third Reading. There is a shortage of physiotherapists, clinicians, speech therapists, occupational therapists, community psychiatric nurses and pharmacists. The position in speech therapy is disgraceful.
Column 719
Speech therapists are paid less than almost every other similar profession. Speech therapists are despondent because, after four, five or six years of training, they have no proper career structure and their work is not properly valued by the Government, because they are grossly underpaid.In recent months I have spoken to speech therapists who are so disgruntled about their pay that they are changing profession and becoming teachers. How can that be in the interests of the Health Service? Teachers are underpaid, yet speech therapists are moving to that profession. I urge the Government to do something about rates of pay for speech therapists. Many health authorities are in a Catch 22 position. Even if they had the cash to employ more speech therapists, not enough people are going into training. I urge the Government to consider that.
On the NHS side of the Bill, the philosophy of contracting within the new Health Service after 1991 will be meaningless in rural areas. Even if NHS trusts are established, there will be no opportunity for a meaningful relationship between a hospital and the provision of services by contract. By their very nature, hospitals in rural areas are monopolistic. There cannot be competition between them. The provisions on the setting up of NHS trusts are irrelevant to the people of Wales.
I know that other hon. Members want to speak, but I wish to touch briefly on community care. Although I welcome in principle the provision transferring assessment procedures to local authorities, I am concerned whether there will be proper funding for the service. I commend to the House the words of the hon. Member for Eastleigh (Sir D. Price) who is the Vice-Chairman of the Social Services Select Committee. He quoted from Sir Roy Griffiths's report on ring fencing. I would also like to quote from the social services inspectorate report on the implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986. The summary of the report says of funding :
"The lack of resources made available by Central Government (despite provision for the Act being made in recent Rate Support Grant settlements) was a reason given by a number of SSDs to explain why they had allocated little, or not as much as they would have liked, to the operation of the Act."
That must be a case for ring fencing. Although the Government have made general provision, under the rate support grant, for allocation of funds, local authorities have found themselves constrained and have failed to send the resources where they should have gone--to implement the 1986 Act. The only answer to that is ring fencing. I appreciate the point made by the Minister in Committee about the danger of eroding the independence of social services departments and local authorities in how they allocate their funds. However, the other cases are unanswerable. The rate support grant system means that local authorities will have to prioritise their spending. I urge the Government to think again to ensure that the grants for social services departments are ring-fenced for community care.
Column 720
6.52 pmMr. Edward Leigh (Gainsborough and Horncastle) : Unlike the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), I do not believe that the genesis of the Bill came from the desk of some Right-wing ideologue in the Adam Smith Institute.
Mr. Robin Cook : You know them all.
Mr. Leigh : I do not know them all. With my hon. Friend the Member for Stirling (Mr. Forsyth), I wrote a booklet for the No Turning Back group. We were the first to talk about the principle of money following the patient. That was not the genesis of the Bill ; that lies in the creation of the National Health Service.
No one doubts the sincerity of the Labour party's defence of the NHS. It views the NHS as a monument to Socialism--and there are precious few left. I am pleased to see the right hon. Member for Blaenau Gwent (Mr. Foot) in his seat. I remember him saying that he wished that the wartime spirit could return. Actually, the creation of the NHS was less the work of the Attlee Government than that of the wartime coalition and the Beveridge report.
I say that the genesis of the Bill lies in those days, and not in the work of some ideologue, because the NHS badly needs reforming and modernisation.
Mr. Flannery : Will the hon. Gentleman give way?
Mr. Leigh : I will not give way ; I have only two or three minutes.
The principle of the NHS is based on a highly centralised structure, which was common in those days in all our nationalised industries and, indeed, in Government Departments. That structure has developed into the regional and district health authorities that we know so well, and it is now creaking at the joints. I suspect that, if we were now faced with a Labour Government, they would be implementing many of the reforms that we are discussing today. No one who looked into a crystal ball in 1979 would have believed that, 10 years later, a Conservative Government would be spending £28 billion on the NHS--more than they spend on defence. No one would have believed it possible that we would now be treating 30,000 more patients every week than 10 years ago. However, those are the facts.
This debate is not about ideology, but about balancing priorities with resources. The Bill is--I hope the phrase is appropriate--a fundamentally and gradualist and Fabian measure. It is not a radical privatising measure, by any stretch of the imagination. Let us look at the core elements of the Bill--for instance, indicative drug budgets. The genesis of that proposal lies in the cash limits that the last Labour Government placed on health authorities, but these are not even cash limits. Is it unreasonable for the House--the guardian of the £28 billion that we give on behalf of our constituents to the providers of the NHS--to insist on accountability and cost control? That is the essence of indicative drug budgets. Nor do I think it unreasonable for us to seek to modernise the NHS by bringing more choice and accountability down to the grass roots and away from the centralised structures to which I have referred. That is the basis of self- governing hospitals and of fund-holding practices. There is nothing radical in the Bill, in the sense
Column 721
of NHS privatisation. The Bill will introduce a more businesslike approach, but it is not about making the NHS into a business. I regret the phrase "internal market", because it sets the alarm bells ringing on the Opposition Benches. We were not talking about an internal market ; in a sense, that is a contradiction in terms. We were talking about providing a better service for the public. The Bill will achieve that, and that is why I will support it tonight. 6.57 pmMr. Tom Clarke (Monklands, West) : The hon. Member for Gainsborough and Horncastle (Mr. Leigh) has confirmed my conviction that all Conservative Members who made serious speeches either had strong reservations about the Bill or--in at least in one case--opposed it. In a telling withering speech, the hon. Member for Northampton, South (Mr. Morris)--who was interrupted by several hon. Members who had not even heard the speech--gave an analysis of the Bill that I considered profound. He said that the Government have failed to take the people with them : surely that is self-evident. It is one of the problems that we have in trying to ensure a reasonable debate on the Bill.
The Bill is the baby--many would say the folly--of the Secretary of State for Health. We attempted in Committee --whatever he has said since--to be constructive and helpful, and to offer alternatives. However, none of our amendments was accepted. That is not surprising because of the self-imposed infallibility of the Secretary of State, which is--so far as I know--shared only by the hon. Member for Stirling (Mr. Forsyth). However, we in Scotland understand that aberration, even if we do not agree with it.
The Secretary of State's obsession is not surprising. After all, he told The Independent on 25 September 1989 :
"I have been spectacularly more successful than any of my predecessors."
When a Gallup poll commissioned by the British Medical Association suggested--
Mr. Tom Clarke : I will be even fairer to the right hon. and learned Gentleman by quoting what he told The Daily Telegraph -- Mr. Kenneth Clarke rose --
| Next Section
| Home Page |