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House of Commons

Friday 17 November 1995

The House met at half-past Nine o'clock


[Madam Speaker in the Chair]


Education (Student Loans)

Mrs. Secretary Shephard, supported by the Prime Minister, the Chancellor of the Exchequer, Secretary Sir Patrick Mayhew, Mr. Secretary Forsyth, Mr. Secretary Hague and Mr. Eric Forth, presented a Bill to make provision for, and in consequence of, the payment of subsidy in respect of private sector student loans: And the same was read the First time; and ordered to be read a Second time upon Monday next and to be printed. [Bill 4.]

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Orders of the Day

Debate on the Address

[Third Day]

Order read for resuming adjourned debate on Question,

Question again proposed.


9.34 am

The Secretary of State for Health (Mr. Stephen Dorrell): Some parts of the parliamentary year and the parliamentary ritual are completely predictable. That is particularly true of the events surrounding the State Opening of Parliament. We have become familiar down the centuries with the arrival in the Chamber of Black Rod, the procession of Members of the House of Commons to the House of Lords and hearing the Queen's Speech. Another predictable ritual is that the Leader of the Opposition returns to the House the afternoon after hearing the Queen's Speech and declares it to be a mouse.

The Leader of the Opposition is a deeply conservative person. He has performed his role with his usual aplomb and spoken the lines allotted to him. Like him, I attended a public school and I know the atmosphere in which we were both educated. The public schools of the 1960s rather frowned upon individuality and did not encourage originality. Fettes certainly left its mark on the speech of the Leader of the Opposition this week.

The speech of the Leader of the Opposition was deeply disappointing and unoriginal. The right hon. Gentleman clearly failed to rise to the challenge facing him as Leader of the Opposition at that moment: to set out to the House and the country what Labour considers to be the priorities facing the nation and, more importantly, how it would address them. The right hon. Gentleman's speech contained no suggestions, no policies and no proposals. I shall be listening with interest to the speech of the hon. Member for Peckham (Ms Harman), assuming that she catches your eye, Madam Speaker, to hear what she argues should be done in the national health service. I look forward to hearing her proposals and specific suggestions.

Ms Harriet Harman (Peckham): Getting the Tories out of Government.

Mr. Dorrell: The British people will not regard that as a remotely satisfactory answer to the challenge that faces the Opposition, that is, to tell them how, if they were elected to office, they would address the problems affecting the national health service or any other aspects of Government.

By contrast, the Government have set out consistently--it was reaffirmed in the Queen's Speech earlier this week--a coherent strategy for dealing with the

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issues facing the Government and the people of Britain. My right hon. Friend the Prime Minister made it clear in his speech that the Government attach prime importance to three clear priorities that face the country.

First, and overwhelmingly most importantly, we must ensure that the United Kingdom is internationally competitive and able to earn its living in the world. Unless we have an answer to the problem as to how we earn our living in the next 10 years, our debate on the national health service today is mere hot air. What pays for the national health service is the competitiveness of the British economy.

The Opposition are full of soundbites but they have no proposals at all which rise to the challenge of showing how Britain will earn its living in the world over the next 10 or 15 years. That is the first leg that the Prime Minister made clear underlies the Government's strategy, which is set out in the Queen's Speech and which reaffirms the strategy that we have been developing for a considerable time.

Secondly, the Government have shown themselves determined to address the problems of individual rights, stability and the maintenance of law and order in Britain to ensure that the people of Britain can be confident that the Government will carry out their most basic responsibility, which is to provide an atmosphere of stability that respects the rights and obligations of individual citizens. That, again, is something in which the Opposition are utterly uninterested. Over the past 16 years, the Government have consistently introduced proposals to deal with the problem of rising crime and to reassert individual rights and responsibilities. The Opposition have fought those proposals.

The third leg of the Government's strategy, to which my right hon. Friend the Prime Minister and the Government attach great importance, is the improvement of public services. That is what we are debating today. It is an area where the Opposition face a specific and focused challenge. Instead of soundbites and press releases bemoaning this or that failure in a public service, how would they improve the management of public services, if they were ever to find themselves in Government? How would they increase the resources of public services? How would they change the culture of public services--in particular the national health service so that it can deliver better quality health care to the people of this country?

Mr. Nigel Spearing (Newham, South): A fundamental is implicit in the right hon. Gentleman's remarks about public service, and in the health service that fundamental is care. Does the right hon. Gentleman really believe that care is a marketable commodity?

Mr. Dorrell: What I believe in passionately, and it is a shared commitment across the parties, is the principle that health care should be available to those who need it without being asked whether they can afford to pay for it. That is the simple idea on which the health service is founded. Our health service has been more successful in delivering that principle, under Governments of both political complexions, than have equivalent health care systems in other countries. That much is agreed between the parties.

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What is not agreed is whether, as we face the day-to-day implementation and delivery of that shared commitment, the Opposition are man and woman enough to face the hard issues that must be faced if they are to turn high-flown rhetoric into hard reality.

Mr. John Austin-Walker (Woolwich): Does the right hon. Gentleman accept that, under his community care proposals, many elderly people are now being means tested and are paying for services that previously they would have received free under the NHS?

Mr. Dorrell: There are now about a quarter of a million more beds for elderly people--ensuring the provision of care at public expense--than was the case in 1979. That has been part of the growing improvement in community care over the past 16 years. Indeed, it has been one of the fastest growing aspects of public service.

Mr. Tom Clarke (Monklands, West): Only because there are more elderly people.

Mr. Dorrell: That is certainly one factor, but it is true to say that the public service now much better meets that demand than it did in 1979. I recall that when I was first elected to this place, one of the tasks that used to face hon. Members week by week was finding places in part III accommodation for elderly people clearly incapable of looking after, and providing for, themselves at home. The only option available to them was to go on a waiting list for part III accommodation. This Government have abolished that waiting list. I do not think that any hon. Member has had to engage in that activity for several years, yet it used to employ a substantial part of our time.

I want to deal with the specific proposals for which I am departmentally responsible and which were included in the Gracious Speech. I believe that both are welcomed by all parties. The first is the Bill relating to the health service commissioner, which will implement a key proposal of the Wilson committee, which examined the reform of the handling of complaints within the NHS. Both sides of the House agree that the committee produced proposals that will substantially improve the handling of complaints. It suggested a three-tier approach. The first is to encourage complainants and the local health care deliverer to resolve their difficulties informally. If that fails, the second is the establishment of a three-person lay panel at local level, with the majority of its members being independent of the trust or health care provider, to consider the complaint. If both those fail, the third tier is for the complaint to be examined by the health service commissioner.

If we are to deliver that system, which the Government accept and endorse, we need to extend the commissioner's powers to allow him to examine both the activities of the family health services and the clinical questions and complaints put to him. The Bill will provide for that. It is an important step forward in ensuring that the health service respects its obligation to listen to its patients and to their complaints and to learn from them. It will ensure that the health service treats its patients as human beings as well as as patients.

The other Bill for which I am directly responsible is the Community Care (Direct Payments) Bill, which was introduced in the other place yesterday. It will give local authorities the power to pay cash to certain people entitled to community care services--that is, cash in lieu of

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services--so that individual recipients will be able to take the cash and buy their community care in the way that they choose, rather than having to accept the direct provision from a local authority. The disabled groups have pressed for that change for a long time. It is ironic that one of the most ardent supporters of the proposal has been the hon. Member for Stratford-on-Avon (Mr. Howarth). I look forward to his endorsement of at least that aspect of the Gracious Speech.

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