| Previous Section | Index | Home Page |
Mr. Lilley: The hon. Lady just told the House that information about the amount of money that Front-Bench Members receive from Unison was in the Register of Members' Interests. I have it before me and that information is not there. Perhaps she would inform the House just how much they do receive.
Ms Harman: The House voted for a change in the procedure for declaration of interests. We propelled that change, which the Tories tried to prevent. It is now through and the information will all be placed in the Register of Members' Interests.
Ms Harman: No, I will not give way on that point. I have made it clear. The Secretary of State for Health did not want to discuss what is going on in the national health service. All he wants to do is smear Labour and attack what we are trying to do. He has failed to deal with the real question of what is going on in the NHS, so I and my colleagues will do that in this debate and ignore Tory Members' disruptions.
Mr. Dorrell: Will the hon. Lady give way?
Ms Harman: No. I have made it clear. The Government are not prepared to talk about what is going
on in the national health service and are resorting to tactics of distracting and cutting across in this debate. Their agenda is clear and I will not give way on that basis. I shall continue my speech because I am talking about what the British people are concerned about, which is the destruction of the NHS by this Conservative Government.
Mr. Piers Merchant (Beckenham): On a point of order, Mr. Deputy Speaker. Will you clarify a point? I was under the impression that hon. Members should declare an interest if they are to make a speech on a subject. As an interest is clearly involved here and no declaration has been made, will you guide us as to whether that is correct?
Mr. Deputy Speaker: It is entirely up to each hon. Member to decide whether they have an interest to declare: it is not for the occupant of the Chair to rule on that. Before we go any further down this route, I say to hon. Members that, in the Table Office, there is a published document, which I have before me, which outlines the new rules specifically.
Ms Harman: It is absolutely clear that the Conservatives' interest is in covering up their destruction of the national health service and the effect that it is having on patients. I have mentioned dentistry. Charges were pushed up so high that people could hardly tell whether they were receiving NHS or private dentistry. Then fewer and fewer dentists did NHS work so more and more patients went private. There are 2.3 million fewer people on NHS dentist lists than there were 18 months ago: 2.3 million more people have to pay because they cannot receive NHS treatment. The Tories can deny that it is privatisation--indeed, they do--but the British people know that it is. They used to receive their dental treatment on the NHS; then they had to go private.
Mr. Dorrell: The numbers are the same.
Ms Harman: The Secretary of State has not read the answers to the parliamentary questions that I asked him. There are 2.3 million fewer people on NHS dentist lists than there were 18 months ago and, month by month, family health services authorities register an increase in people who apply to them for help in finding an NHS dentist.
The British people know that this is privatisation. They used to expect that, if they needed long-term nursing care, it would be provided on the NHS. Now it must be provided privately. A new engine of privatisation is being driven into the heart of the national health service: rationing. An increasing number of health authorities are chopping, bit by bit, the services available on the national health service. The Government pretend that it is not happening, but the evidence is absolutely clear.
It is clear from local health purchasing plans that treatment on the NHS is becoming a lottery: what one can get depends on where one lives. District by district, lists are emerging of what one cannot get on the national health service.
Mr. Dorrell:
Will the hon. Lady give way on that point?
Ms Harman:
I shall not give way to the Secretary of State. He failed to set out what the Government seek to do and simply attacked the Labour party. I shall not allow
Mr. Deputy Speaker:
Order. I heard the word "lying". That is not an acceptable word.
Mr. Dorrell:
I apologise for the use of that word, Mr. Deputy Speaker, which I withdraw. But it makes me angry to hear people clearly misrepresenting what is going on in the health service. When patients go to the health service for treatment, the doctor's opinion determines what treatment they get.
Mr. Thomas McAvoy (Glasgow, Rutherglen):
On a point of order, Mr. Deputy Speaker. The Secretary of State has apologised for saying, "You are lying". Is he then entitled to go on and make the false accusation that he made in the first place?
Mr. Deputy Speaker:
Order. I must be the judge of that.
Ms Harman:
It is no misrepresentation to say that what people can get depends on where they live. District by district, lists are emerging of what people cannot get on the national health service. Two years ago, only four local health authorities were rationing--excluding treatment from the NHS. Now, using the Blackwell Masters database, we have shown that 40 health authorities--a third of all authorities in the country--are rationing. It is no good the Conservatives objecting to the word
"rationing", because that is what health authorities themselves call it.
One must be careful where one falls ill as this rationing sweeps through the national health service. Do not get the menopause in west Kent as no specialist menopause services will be provided there. Do not get brittle bones in Dorset as no more screening for osteoporosis will be provided there. Do not get infected wisdom teeth in Hertfordshire or Kingston and Richmond. Do not get a glue ear in the Isle of Wight or the other authorities that have declared themselves to be grommet-free zones. Do not have a stroke in Buckingham as savings in stroke management are being sought in that area. Do not have difficulty having a baby in the former Health Secretary's constituency of South-West Surrey, as no NHS fertility treatment will be provided there. However, west Kent seems to be pursuing a policy to increase the birth rate: no block contracts for male or female sterilisation; and no contracts for abortion.
Those excluded treatments are the thin end of the wedge. Yesterday it was grommets and fertility treatment; today it is varicose veins and osteoporosis screening; tomorrow, it will be hernias and hip replacements. Concern about rationing is mounting in the medical profession. Dr. Sandy Macara, chairman of the BMA, said in a speech this week:
The Secretary of State must come clean. He has just had an opportunity to do so but he failed to take it. The Government pretend that they know nothing about this. I asked the Secretary of State to place copies of all the health authorities' and commissions' purchasing plans in the Library and the Minister answered that copies of the plans were not available centrally. I asked the Secretary of State to specify where some treatments were not available on the NHS and his Minister replied that the information was not available. He did not say that it was not happening or admit that it was happening, but simply said that the Government did not know. Well, the Labour party does know, and we are telling the country today that rationing is sweeping through the national health service.
I asked the Secretary of State for Health what plans he had to establish a national database that lists by health authority which treatments are available on the NHS and which are excluded and available only privately. The answer from his Minister was no, they had no such plans. That is not knowing on purpose--a feigned, calculating ignorance--so that the Secretary of State can pretend that the effect at local level of the decisions that he has taken nationally will be blamed on local health authorities but not on him. He must admit what is going on and, unless he is prepared to condemn the wholesale removal by managers' edict of treatments from the NHS, it will be clear that he secretly endorses it.
For all his denials in those parliamentary answers, we know that the Secretary of State is up to his neck in it. Of course he knows what is going on. How could I possibly believe the answers to those parliamentary questions saying that the Government do not collect the information centrally? They must collect it, for they drive it. They are driving rationing because it leads to privatisation. If people cannot get what they need on the NHS, they must either go without treatment or go private. Private health care is booming, contrary to what the Secretary of State said, and rationing is set to give it another boost.
The private sector is encroaching on the NHS. The Secretary of State says that the NHS needs fewer hospital beds. He derides our complaint about hospital beds, saying that NHS hospital beds are an old-fashioned issue for discussion. Let us look at what is happening. There are 28 per cent. fewer NHS acute hospital beds than there were 15 years ago, but there are 68 per cent. more private beds than there were 15 years ago. The Secretary of State said that fewer beds are a sign of improvement in the NHS. Can it be that more beds are a sign of improvement in the private sector?
It is the same story with hospitals. There are 28 per cent. fewer NHS hospitals but 47 per cent. more private hospitals than there were 15 years ago. That shows the relentless advance of privatisation. People fear and dread the privatisation of health care because they know what it means: unfairness and a massive increase in costs. People fear and dread the commercialisation of the NHS because they know what it means: fewer nurses and more managers.
The Tory alibi for slicing acute services out of the NHS is that we cannot afford it. They say that the demand for health care is infinite, there is a bottomless pit and we simply cannot do it. They grossly overstate the growth in demand for health care in order to use it cynically as an excuse to promote the argument that more and more services must go into the private sector. With an ageing population and new techniques there is obviously an
increasing demand, but demand for health care is not infinite. It is more expensive as well as more unfair to push that demand out of the NHS and into the private sector. The evidence from around the world is overwhelming: private health care is more costly and more unfair.
Competition in health care does not reduce costs, it increases them. In the United States, where all health care is privately delivered and there is a well-developed private health care market, total expenditure on health is equivalent to nearly 16 per cent. of gross domestic product. In this country, with the NHS, total spending on health is under 7 per cent. of GDP.
No doubt, the Government will label our complaints about rationing as scaremongering. [Hon. Members:
"Yes."] Conservative Members say yes. They accused us of scaremongering when we warned that the consequences of an internal market would be huge increases in the cost of administration, but we were right. Every year, an extra
£1.5 billion is spent on administration, on managers and accountants.
There has been some discussion about extra resources, but look where they are going. In 1986, there were 500 general and senior managers in the NHS. In 1993, there were 20,000--an increase of nearly 4,000 per cent. Over the same period, the number of nurses and midwives in the NHS dropped by 9 per cent. We want more resources in patient care and fewer resources for managers and accountants.
The result of the Government's actions is that there are more people to count the cost of treatment, and fewer people to provide the treatment. They have put cost before care and profit before patients.
The Secretary of State has recently said that he is a
"bureau-sceptic". He is criticising the administration that he has created. If I was a health service manager, I would think it was pretty cheap for the Government to create so much bureaucracy and then attack it. But that is their style. The Secretary of State now says that he is a
"bureau-septic" and he attacks all the managers. That is a surprise to those of us who remember what he said at the time of the NHS reforms, when he was a junior Health Minister. I know what he said then because I read the debates last night. He was what I can only describe as a
"bureau-fanatic". In a debate in March 1991, he extolled the virtues of more and more management in the NHS.
"Health care management" he enthused
--it is hard to see how that is the case--
The Secretary of State dealt with primary care services. We warned that giving control over their own funds to some GPs, but not to others, as my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) mentioned, would mean that purchasing power, and not clinical need, dictated priorities for treatment. That was
our accusation, and that is what is happening. The Government accused us then of scaremongering, but we were right.
In the Minister for Health's constituency, the Winchester and Eastleigh Health Care NHS trust and the North and Mid-Hampshire health commission announced that, because the commission had no further cash, the trust was not going to take any non-urgent cases from non-fundholding GPs until the end of the financial year in March 1996. Fundholding GPs on the local purchasing group, non-fundholding GPs, the trust and the commission are trying to club together to buy the hip replacement operations for the patients of non-fundholders who would lose out. They are trying at local level to make an unfair system fair. They are trying to make sense out of a senseless system. There is a two-tier waiting list, as we warned that there would be. Patients of fundholding GPs wait for no more than 10 months for hip replacements. Patients of other GPs wait for anything up to 18 months. Admission to hospital is based on purchasing power, not on clinical need.
We also warned that to close hospitals in London without improving primary and community care services would cause a crisis. We were accused of scaremongering, but we were right. Patients at King's College hospital spend up to 18 hours on trolleys in the accident and emergency department.
Let me tell the House what happened to my constituent, Mrs. Foster, who was rushed to the A and E department at King's at 8.40 pm on 3 October with a suspected heart attack. She was seen quickly by a doctor and put on a trolley in A and E. She waited for 19 hours on that trolley in a room with 10 other people on trolleys, including stab victims, one of whom died while she was waiting. Mrs. Foster asked for a bed pan, and she was given one--an hour later. She asked for a pillow and was given one-- four hours later. She was finally moved to a bed in a ward at 3.40 on the following afternoon.
Let me make it absolutely clear that Mr. and Mrs. Foster have no complaints about the excellent staff, but they are unhappy to see a situation in which bed shortages mean that the staff cannot provide the services that they want to provide, and which patients need.
We warned that hospitals would compete instead of co-operating and that planning would give way to market forces. The Secretary of State mentioned that this morning, when he spoke about rivalry and friendly competition. Let me tell him how the internal market is working in practice.
The Government accused the Opposition of scaremongering when we said that hospitals would stop co-operating and would fight against each other. The House should note the example of Sue Snowdon, a consultant kidney specialist at Dulwich hospital. She has been told to take three months leave from her job rather than work her notice before she moves to her new job at St. George's hospital. Dulwich hospital is paying her to work in her garden, but not on its wards, because it fears that if she continued to treat her patients at Dulwich they would follow her to St. George's, and Dulwich would lose money.
We warned that the Government were privatising the NHS bit by bit, and we were right. We warned that they are making the NHS more like the private sector, and that
is what they are doing. The market-testing of clinical services, which is now sweeping through the NHS, is taking that strategy forward.
The British people want two things from their health care services--excellent care and fairness. One cannot achieve fairness in a privatised, commercialised system. It is particularly important that the NHS gives equal access to everyone because of the health inequalities that mar our country, which the Secretary of State did not even mention. How long one lives and how good one's health remains is determined by one's income and social status--whether one is rich or poor. "The Health of the Nation" and numerous other reports have charted the gross social and economic inequalities of divided Britain, which lead to health inequalities.
It is vital that the Department of Health should take the lead in ensuring that other Departments and local government work together to end the inequalities that lead to the gap in people's relative health. It is also vital that the NHS is able to provide that equal access to health care; otherwise we will have an unequal NHS, and that will worsen rather than redress health inequality.
The Gracious Speech contains two specific health measures. We welcome the Bill to strengthen complaints procedures and look forward to studying its detail. I know that my hon. Friend the Member for Monklands, West (Mr. Clarke) would like to mention the important issue of direct payments for people with disabilities, should he manage to catch your eye, Mr. Deputy Speaker.
We also welcome the measure to empower the users of services, but we seek an assurance that that legislation will not contain any perverse incentive to compel users to buy purely from the private sector. We want the Bill to provide a genuine extension of choice, but for that to happen there must be a level playing field between public and private provision; otherwise choice will be extinguished as the public sector is simply driven out of the market.
We want genuine choice for users of community care, but we also want to ensure that those who receive such care are afforded proper protection against low-quality and substandard services. Now is the time for the Government to act on Labour's call for a proper system of regulation and inspection of the whole range of community care services, public and private, residential and domiciliary. Perhaps the proposed Bill will give them the opportunity to do so.
The Tories never had any mandate from the British people for their health reforms. Remember all their consultations on opting out hospitals? Those were a complete sham. The reforms have never won the support of the British people, and the NHS must be freed from crude Tory free-market dogma. Labour will take it forward to meet the new and great challenges of the next century.
"I deeply regret the passive endorsement of the perceived inevitability of rationing. It is tantamount to telling our paymasters that we do not require more adequate resources, that we will get together to agree which of our patients' needs will not be met, that we will, in Shakespeare's words, 'bend with the remover to remove'."
"is good quality health care for the patient"
"and good value for money for the taxpayer. That is what the investment in management is designed to achieve".
The Government went on to invest £1.5 billion extra. Does the Secretary of State think that that £1.5 billion extra provides good-quality health care for patients? Does he think that £1.5 billion extra spent every year on accountants and managers is good value for money for taxpayers? The patients do not. They would rather it was spent on the people providing the care.
| Next Section
| Index | Home Page |