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The right hon. Member for Sedgefield, with his £60 haircuts and his £500 suits--sponsored by the Transport and General Workers Union--has indicated that, under a Labour Government, he will be prepared to see the clock turned back on the NHS reforms. That means that the management of the health service will be taken away from the health professionals, and returned to the claws of the unions. It is hardly surprising, given that 156 Labour Members are sponsored by unions--including all Opposition Front Benchers.
The 1978-79 winter of discontent is indelibly printed on the minds of the public--so much so that that lot over there received four red cards in the last four elections. They lost in 1979; they lost in 1983; they lost in 1987; they lost in 1992; and they will lose again in 1997. How could the British public put the health service into the hands of the right hon. Member for Kingston upon Hull, East (Mr. Prescott)? He cannot even remember where he parked his car, let alone cast his memory back to the appalling way in which the Labour Government bungled the health service in the 1970s.
In 1974 the Labour party manifesto promised:
"A Labour Government will . . . expand the National Health Service".
Three years later Mr. David Ennals, Labour's Secretary of State for Health, was forced to concede:
"In the present economic climate, the Government could do little more than provide for the increasing number of old, leaving a small margin for improvements in methods of treatment".
In 1978, the health budget was cut by 3 per cent. in real terms. Capital spending was cut by one third in real terms--the largest cut ever inflicted on the NHS capital
Column 918programme. Aneurin Bevan, eat your heart out. Between 1974 and 1979, in real terms, nurses' pay fell by 21 per cent., doctors' pay fell by 16 per cent. and surgeons' pay fell by 25 per cent. Waiting lists rose by 48 per cent.
Dr. James Cameron, chairman of the British Medical Association, described in 1978 how
"the national health service is sick in Britain, it is inadequate and impersonal and is losing the confidence of the medical profession and the public".
The Royal College of Nursing congress at Harrogate in 1978 talked of
"a crisis of manpower, finance and morale in the service". In 1978-79, the national health service went on strike, led by the Confederation of Health Service Employees and by the National Union of Public Employees. Telephonists were on strike and clinical staff were manning public call boxes to get calls into hospitals. Clean linen was not allowed though picket lines. Foul linen was destroyed because the unions would not even let it out of the hospital. Meals were provided by volunteers and cleaning was non-existent. Let us cast our minds back to the news stories of the time. They did not reveal a health service nurtured by a caring, sharing Labour Government--quite the opposite. An article in The Times in 1978 with the headline
"Hospital is to turn away patients with cancer"
"patients with breast, lung and other cancers, and abortion cases are to be turned away from the Kingston hospital, Surrey, because of industrial action by health service workers and supervisors, the hospital said yesterday. From midnight next Tuesday, even known cancer cases will be denied admission and lives immediately threatened. Investigative surgery, even where there is a strong suspicion of a life threatening condition, will not take place." That was the national health service under that lot. That is what it was like--a total nightmare. If loved ones died, one could not even bury them because the picket line would not let the grave-diggers through to dig the grave to put them in. That is what it was like. Mr. Nicholas Brown rose --
Finally, we come to the confessions of the former Secretary of State for Health, Barbara Castle. During the winter of discontent, she described her attack on pay beds as an "essential political sweetener" for the trade unions. The Labour party is still committed to tossing political sweeteners to unions. In return, the unions toss financial sweeteners to the Labour party. As the leader of the Transport and General Workers Union said last year, "No say, no pay."
So Bambi intends to turn the clock back to those bad old days of the "savage seventies". As if that were not bad enough, he intends to strip power from the health professionals--the doctors and general practitioners- -and to put it in the hands of his new regional assemblies. What a recipe for disaster. Yet again, the Labour party refuses to listen to the views of the profession. Instead, it wants to play politics with the health service. Just who does the right hon. Member for Sedgefield think he is--the Milky Bar kid? If Labour had its way, the NHS as we know it would be destroyed. Decision making would be stripped from health care professionals and given to shop stewards, who would ultimately tear it apart as a result of regional and industrial political battles.
Column 919Labour should listen to its friends at The Guardian . In an article on 4 January this year, The Guardian argued that "the problem with trying to restore the NHS is twofold: first, the disruption which yet another organisational change would make and, second, the danger of re-introducing the old inequalities and inefficiencies."
Perhaps the lot opposite should turn the clock right back to go back and truly to understand Nye Bevan's intentions' for the NHS. Back in 1946, he said:
"I believe that democracy exists in the active participation in administration and policy. Therefore, I believe that it is a wise thing to give the doctors full participation in the administration of their own professions."
Going by that statement, if Nye Bevan were still an hon. Member today, and if he reflected on the Conservative reforms and Labour plans, I am pretty sure that he would vote for the Government's amendment at the end of today's debate.
Mr. Kevin Hughes (Doncaster, North): There we have it from the historical and intellectual wing of the Tory party. The lack of understanding of the hon. Member for Welwyn Hatfield (Mr. Evans) on this issue is surpassed only by his lack of understanding on every other issue that he speaks about in the Chamber.
The national health service is the most important of our public services, but we know that the Government's reforms have created a two-tier system, with treatment decided by ability to pay, by whoever one's doctor happens to be, or by the performance of a contract. The service, as we know it, has been split into small, competing health businesses--the internal market. It implies competition between those businesses, purchasing on the basis of cost, and making local hospitals work against each other rather than together. One unit poaches patients from another in a war that is fought and won primarily on the basis of cost. Patients are the losers on that commercial battlefield.
The trend is towards not localisation but a health service where people are shipped around for the cheapest treatment. That is the logic of the Government's reforms. Some hospitals, of course, will always have to buy specialty services that they cannot provide and have never been able to provide, but it goes beyond that. The results are only just beginning to be shown, but I know from my discussions with health managers in my region that that is the way in which trust managers think.
Doncaster Royal infirmary is being forced to develop plans to treat patients from other areas. Although that might be good news for the hospital's staff, it is not such good news for facilities elsewhere. They will be run down as they lose patients, who will be forced to travel for treatment.
The Government's sleight of hand, to put it mildly, with statistics on the NHS is evidence of how far they are prepared to go to cover up their failures. Patients are no longer people. They have become episodes, to be counted not once, not twice, but sometimes even three times by administrators. It is convenient for the Government that they have decided on finished consultant episodes as the best means of measuring the amount of work undertaken in our hospitals. The Government can con their Back Benchers, but they cannot con the people, who know how long they have been waiting for treatment.
Column 920The Government claim that waiting times are improving, but the people who are waiting know that that is not true. More and more people--more than 1 million--are waiting for treatment in today's NHS. Patients are waiting for an appointment to be granted, waiting once an appointment has been given, and waiting for treatment after their initial consultation--three waiting lists for the price of one. The market makes it expedient for trusts to cook the books and it is politically convenient for the Secretary of State for Health to sit idly by while they do so, and then to quote the distorted figures. That distorted picture makes it hard to determine what is happening in the NHS.
My constituents have been made to wait for months for an appointment, or they have had to pay to jump the queue for a consultation, because if they do not receive the treatment, they could lose their job. It is becoming a pay-as-you-go health service.
The Government have not given an adequate reply on the concerns expressed about the extent of the work done privately by consultants. An extension of private work can only mean a retraction in national health services and longer waits for patients who do not have the means to pay. The two-tier system is emphasised by GP fundholding, which gives some patients a fast track to hospital care while others lose out. Again, that can mean only that clinical need has gone out the window as a basis on which to decide who gets treatment. Finally, there is a problem of contracts being completed while there are patients still needing treatment. These people have to wait for treatment because the year's money has run out. Health care is being turned into a lottery, and everywhere we look we see the same signs.
The Government have managed to upset dentists so much that many are refusing to treat NHS patients. A dentist in my constituency has stopped treating them and is instead asking patients to take out Denplan insurance. In response to a letter to me, he wrote: "To remain wholly within the Health Service is like having all your eggs in one basket . . . with the person holding the basket intent on emptying it".
The Government have turned dentists away from the NHS and have, in the process, fragmented and commercialised the services that they provide.
Less than two months ago, the Secretary of State claimed that the reforms had
"effected a fundamental and irreversible shift in favour of the patient."-- [ Official Report , 12 December 1994; Vol. 251, c. 632.] The evidence says not; the evidence says that it is the insurance companies and private sector that stand to gain the most and the patient who has gained the least.
The Government's claims for patients do not fit very well with the facts. The Government's aim is to privatise our health service by taking away its truly national meaning, introducing inappropriate competition and making patients pay for more of what they get. The inevitable conclusion is that the NHS is not, and never has been, safe in their hands.
The Government have systematically excluded the voice of professionals and that of local people and replaced them with the voice of business, with more than half the chairs of family and district health authorities appointed by the Secretary of State having a business background. We can see where the Government's priorities lie--with the commercialisation and
Column 921privatisation of health care rather than democratic decision making about the allocation of resources within the NHS.
Mrs. Virginia Bottomley: Does the hon. Gentleman think that there was a better state of affairs when Greenwich local authority placed on its health authority three prospective Labour parliamentary candidates, or when Lambeth health authority had placed on it someone who was not fit to serve on the local authority and who was a disqualified councillor? We are in a very much better position now that we have people committed to the delivery of health care to which they bring a range of skills. They are not politically motivated and making ludicrous points and undermining the institutions that they should be protecting.
Mr. Hughes: Through the Secretary of State, the Government have systematically replaced local people with business people, usually those who have connections with the Tory party or those who, if they are not members of the party, undoubtedly make donations. Often, such people do not live in the areas on whose boards they serve. The Government are reducing democracy in the health service at the local level.
Dr. Norman A. Godman (Greenock and Port Glasgow): I hesitate to interrupt this English exchange, but may I point out that we in Scotland have experienced the same thing? Literally hundreds of Tory placemen and women, including failed candidates, have been put on NHS trusts the length and breadth of Scotland and its islands.
The inescapable conclusion is that the Government are edging towards privatisation of the health service by a process of fragmentation and commercialisation. They are filtering more public funds into the private sector and their ultimate aim is a small public sector element dealing with residual purchasing and strategic planning. It is privatisation by the back door, but with denials issued every step along the way; but that is the logic and the effect of the Government's reforms, which is why we shall continue to oppose them.
Mr. Jerry Hayes (Harlow): I must first declare an interest in that I am an adviser to the Western Provident Association which, as everyone who knows anything about health is aware, is a non-profit-making organisation.
I read the motion most carefully and I was amazed because I had thought that the right hon. Member for Sedgefield (Mr. Blair) was turning--or trying to turn--the Labour party into the acceptable face of Channel 4. He is clearly failing, because, to judge from the motion, this is the same old Labour party. The motion could have been drafted by Dave and Deirdre Spart; it is full of spite and envy and, of course, full of jobs for the boys.
The Labour party has drifted to the left. [Interruption.] I was going to congratulate the hon. Member for Doncaster, North (Mr. Hughes) on a swash-buckling speech, but it contained more buckle than swash. He
Column 922asked what evidence there was for the reforms' success, so I shall tell him. He should read what the Organisation for Economic Co-operation and Development said about the Government's reforms. Its July 1994 report criticised the command and control system-- the Labour party should know about that as it almost invented it--inherent in the pre-reform national health service. It said that the pre-reform NHS lacked
"flexibility, incentives for efficiency, financial information (and hence accountability) and choice of providers of secondary care".
It went on to highlight the "possibilities" opened by the reforms and the improvements introduced by national health service trusts and GP fundholders who
"seem to have done a better job of purchasing than district health authorities".
Mr. Nicholas Brown rose --
Mr. Brown: The National Audit Office, to test the efficiency of the exercise, did its best to ascertain what resources had gone to GP fundholders and what was therefore left for non-fundholders. However, it was unable to draw any conclusions because, as I am sure the hon. Gentleman knows, not a single region could provide it with statistics for non- fundholders. How does the hon. Gentleman arrive at the conclusions to which he is treating the House?
Mr. Hayes: If the hon. Gentleman had read the report, he would know that it commended the purchaser and fundholder. He should remember that it was the Conservative Government who created the Audit Commission, thus leading to the financial profiles of every single health authority being given for the first time.
Mr. Hayes: I have done my best to answer the hon. Gentleman by saying that the reforms were commended by the OECD and the National Audit Office. I was drawing his attention to the fact that, for the first time, the Audit Commission has given a financial profile of every health authority. That is a very good thing and I hope that the Labour party will accept it as such.
The hon. Member for Doncaster, North asked what the people thought. We know from the survey of attitudes that the overwhelming majority of people are satisfied with the service that they receive from the NHS.
Mr. Kevin Hughes rose --
Why are the majority of people satisfied? Because far more money is put into the health service than ever before--66 per cent. more than the rate of inflation since 1979. There is far more choice than ever before. Waiting lists have gone down way beyond anybody's dreams and are continuing to go down. As well, as my right hon. Friend the Secretary of State said, there are patients charters that deal with referrals from consultants to hospitals, which was a major bone of contention.
Column 923I am not suggesting for one moment that everything is perfect in the health service. It never will be. But a few years ago, before the reforms, no one knew the cost of anything in the health service. If people do not know their unit costs, they cannot plan for the future. That is the essence of the reforms.
Mr. Hayes: They are getting it far more quickly than they ever did under a Labour Government. It is all very well for Labour Members to sit there as if polyunsaturated butter would not melt in their mouths, but they were responsible, as my hon. Friend the Member for Welwyn Hatfield (Mr. Evans) said, for the largest cut in revenue in real terms in the history of the health service. They cut capital expenditure by 27 per cent. Do Labour Members live in the real world? Do they understand that, every eight days, there is a multi-million pound capital project in the health service? Oh, no. All they talk about is the closure of hospitals. They do not say that, for every closure, a new day surgery opens.
Mr. Nicholas Brown rose --
Mr. Hayes: The hon. Gentleman should not get too excited. He should come to Harlow, where we have just had a £10 million extension of our accident and emergency facility. He would be more than welcome to come to Harlow to see our two new trusts, which are very popular. Mr. Brown rose --
Mr. Hayes: I shall give way in a moment because I am building up for the hon. Gentleman's state tour of Harlow. He ought to see our new computer -aided tomography scanner. He ought to see our new magnetic resonance imaging scanner. He ought to know, before he suggests that we are stuffing the trusts full of Tory placemen, that I proposed two candidates. Guess what, they were not Conservatives, they have never voted Conservative in their life and they probably never will.
The fact is that those people believe in the policy and they are competent. That is what the appointment system is all about. That is why those who sit on trusts include people such as Helene Hayman, a former Labour Member of Parliament. She runs a trust. She is a socialist. She does not vote Conservative, but she believes in the policy because she believes in patients. Rabbi Julia Neuberger is not a Conservative. She probably never will be. Why was she appointed? Because she is competent and believes in the best possible care for patients.
Last night, we had a little time to spare because of the Liberal Democrats, as often happens, so I went into the Library. [Hon. Members:-- "Where are they?"] Looking, I suspect, for policies. I found some policies last night. I had the misfortune of looking through every single policy and consultation document that Labour has published in the past two years. It was not an edifying experience,
Column 924because every other document had a glossy picture of the Front-Bench team smiling like snake-oil salesmen. There is a picture of the hon. Member for Newcastle upon Tyne, East (Mr. Brown). I shall show it to him later, as he probably does not want it to be shown on the television here.
Labour Members are pretending that they are consulting, because they do have the nerve to put their policies to the British public. They do not want to upset the beautiful luvvie view of the Labour party. We all know that it is a mirage.
"Health 2000" is well worth a look. What will Labour Members do about compulsory competitive tendering? They say:
"We are already committed to ending CCT for hospital services. This, plus the maintenance of a national framework for bargaining including a minimum wage, the retention of Pay Review Bodies and a full acceptance of T.U.P.E." --
I suppose that should be NUPE--
"will do much to raise morale and develop increasing commitment to the service."
That is absolute codswallop. The minimum wage will cost at least £500 million, according to the hon. Member for Livingston (Mr. Cook). He is on record as saying that. We know that ending CCT will probably cost patient care more than £100 million.
What about the internal market? I would love to give Labour Members an opportunity to explain their next proposal. "Health 2000" says: "We propose"--
I hope that the hon. Member for Newcastle upon Tyne, East is paying attention, because I shall test him on this in a second. It says: "We propose an alternative to the `internal market' which would allow funding for agreed minimum programmes of work within a given period of time (service-level agreements). These programmes could be continually updated so that long-term planning of hospital and community services would be possible. This would also avoid treatment being cancelled because the workload had been under-estimated and the budget contract"--
"had been exhausted."
What on earth does that mean? The hon. Gentleman does not know, and it is his policy.
What about general practitioners? The consultation document says: "We will" --
this is very important, this is a real debate--
"abolish fundholding and replace it with a system which brings GPs and their local health authority together to provide the best possible care for their patients and the community they serve. Easing the burden of running a business will allow GPs to spend more time with their patients and less time on paper-work."
The very fact that we give them a grant for doing that and the fact that doctors' lists are going down--
Column 925fundholders. What are Labour Members going to do? Will there be a massive upheaval of a policy which is popular at the moment, as all the opinion polls show?
Let us move on to the trusts. "Health 2000" says:
"As a priority we would remove the unaccountable self-governing and self- perpetuating Trusts which run hospitals and community health services. The non-executive members of trusts are currently Tory Government appointees-- this is unacceptable. Drawing together those with a commitment to the NHS would offer a forum for the involvement of local people in their hospitals and community facilities as set out in Health 2000. "
The fact that 96 per cent. of hospitals are national health service trusts and that at least 99 per cent. of them will shortly be trusts would mean another massive upheaval for the people who are working so hard on behalf of patients in the health service. The very fact that trusts are far more efficient than directly managed unions ever were is totally ignored by the Labour party.
Probably the most important proposal of all concerns accountability, about which "Health 2000" says:
"There are a number of ways of achieving this. Possible options include some form of nomination"--
now there is a surprise--
there is a surprise--
"or integration with local government."
There is no surprise there at all. It goes on:
"We will consult closely with patients and health service workers to establish real democracy and accountability."
We all know what this means--jobs for the boys. It means trade unions and health authorities, which are more interested in politics than in patients, and it means regional authorities dealing with health.
Mr. Nicholas Brown indicated dissent .