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Mr. Hughes: The hon. Gentleman who speaks on these matters for the Labour party wants to intervene. I hope that I am getting time out for this. I give way one more time.
Mr. Clarke: I am grateful to the hon. Gentleman, but although he is a usually generous person, on this occasion he should be really careful. My hon. Friend the Member for Newham, South (Mr. Spearing) is much nearer the point. If the hon. Gentleman reads the small print of the Bill that was published in another place yesterday, he will see that my hon. Friend is right on the ball.
Mr. Hughes: I have seen the Bill, including the small print. I did not mean to indicate to the hon. Member for Monklands, West that I, like he, will not give the Bill particular care and scrutiny when it is before us to ensure that it delivers what it was intended to deliver and responds to the requests that were properly made by disabled people and others for a more flexible system. We shall come back to that. The Bill will probably be before us fairly soon--perhaps in the new year--given its start in another place yesterday.
I think that we all know that behind the debate about structure is the debate about the Budget, and that is the key issue. That is why I asked the Secretary of State about real-value increases in funds. Yes, we have increased considerably, as the hon. Member for Chipping Barnet said when he intervened, the proportion of our GDP that we spend on health, but we are still significantly below the average of our neighbours and comparable countries, both in Europe and the European Union, and across the Atlantic, too. In countries such as the United States, the balance between public and private contribution is different. We all know that.
The test of the health service and how well it does is the user--the public--rather than those who work in it, important though they are. It is important that, as we plan the future of the health service, we use the test: are the public getting the health service that they want? So that there cannot be any misunderstanding, I shall briefly set out my party's priorities for the health service. If anybody is interested, they can buy the booklet, which was the policy passed at our conference. It is called "Building on the Best of the NHS". We had a full and frank debate this year, including one controversial item, to which I shall return in a second.
First, we have to put the money where most people will benefit most easily to the maximum benefit. That is why we argue that it is good to hypothecate some of the revenue collected--I dissent from the Secretary of State on this point--and put it specifically into health uses. We would put an extra 5p on tobacco duty, which we would use to make eye tests and dental checks free again and to freeze prescription charges. We think that that is a good idea. We think that the public would benefit considerably from it and that it is the right way to proceed. A further 1p on tobacco duty would allow some extra money to go into community care. The beneficial consequence of those
proposals is that by reducing smoking we considerably reduce the bill to the health service, because smoking costs the health service a considerable amount--an estimated £600 million a year.
The next area that needs reform is the undemocratic mess of the structure of the health service. The Nolan committee made it clear that there needs to be much better scrutiny of those who are appointed. Many of us would say that we need to reduce the number of people who are appointed and have considerably more people elected. The Secretary of State personally appoints more than 5,000 people to NHS jobs. The reality, therefore, is that decisions are taken by nominees of the Secretary of State, not by representatives of the local community, and thus not in a way that is accountable in any real sense of the word. I agree with the Secretary of State that there will be difficult decisions about priorities, but they are currently taken by placemen and placewomen, often by their medical advisers and not by community representatives, who are the best people to make those judgments, just as in Parliament we have to make priority decisions for the nation as a whole. We must have more consultation about the setting of priorities. We must have far greater accountability for appointments to trusts, the constitution of NHS trusts, health authorities and community health councils.
As local government becomes more accountable and is reformed, health commissioning should be passed to local authorities. There is debate about that in the profession, but our party has supported the concept. The link between social services and health is becoming ever closer; logically, they should be united in the context of commissioning at local level.
We must also consider the long term. I have always believed that, despite all the efforts of bodies such as the Health Education Authority, the country still spends too much time, effort and money in concentrating on building the best health-care system rather than ensuring that we have the best health. We need social policies that reduce inequality and improve health.
We must not continue to allow the rich to get richer and the poor to get poorer; we must not continue--in 1995--to condemn large numbers of people to living in overcrowded, unsatisfactory accommodation. We must not continue to allow so many people to be out of work, and thus unable to earn a decent income enabling them to be warm and well looked after. We must not allow education to be so poor that people cannot take the decisions that are best for their health. Nowadays the pollution of the environment--particularly in urban areas, and particularly as a result of vehicle emissions--induces, directly or indirectly, additional disease. We must concentrate on the health promotion agenda if we are to secure the health in the nation that will allow us to meet the bills that the NHS will always demand.
The public are as committed to the NHS as they have ever been, but they are aware that we still spend less than they would wish. They are aware that many needs are still unmet in health and community care. As all the surveys show, they would prefer additional investment in those services to a cheap, short-term cut of a penny or two in income tax. We need directly beneficial investment in the health service. For instance, the public would welcome a reinstatement of free eye checks.
We must reclaim the NHS from the bureaucrats, administrators and appointees, and give it back to real people. We must also keep an eye on the long-term bills: by investing in a healthier nation, we shall both reduce our bills and manage our resources better.
Mr. Hartley Booth (Finchley):
It is a pleasure to follow the hon. Member for Southwark and Bermondsey (Mr. Hughes), with whom I have been debating for 20 years or more. The hon. Gentleman is still wrong in various respects: for instance, his suggestion that it is possible to finance all sorts of wonderful improvements in the NHS by increasing the tax on tobacco by 5p is simply wrong. The hon. Gentleman knows what happens in the European free market about which he is so enthusiastic; he knows that we would lose rather than gain by hiking up tobacco prices in the way that he suggests. People would buy tobacco in other countries such as France.
I pay tribute to my hon. Friend the Member for Chipping Barnet (Sir S. Chapman). He served his term on the Front Bench for nearly seven years, and has now broken his Trappist vow. We are glad to reclaim what we lost during those years: my hon. Friend need no longer be taciturn.
The Queen's speech requires us to look beyond the proposals that it contains. It should focus our minds on the very purpose of government. I have always believed that Government's aim should be to transcend the immediate--to view long-term objectives, to rise above self-interest and to bring prosperity of body, mind and spirit to all our people. According to the hon. Member for Peckham (Ms Harman), the Queen's Speech merely laid out the road to a privatised health service. There is, to say the least, a vast chasm between what I would define as the Government's aims and the hon. Lady's limited perception of those aims.
Testing the wider perception of Labour's view of our aims does not produce much more illumination. The right hon. Member for Sedgefield (Mr. Blair) said that our proposals in the Queen's speech were a rag-bag and right-wing; he described them as "a mouse". That was how he described excellent proposals that will improve education, tackle organised crime and improve our housing stock, as well as dealing with problems in transport and broadcasting and the complaints of NHS patients. Those proposals do not constitute a mouse; they certainly do not constitute a rag-bag. And the stuff about right-wing is all talk.
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