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6.39 pm
Dr. Charles Goodson-Wickes (Wimbledon): As the general election approaches, debates on health care become ever more bemusing and intriguing. Opposition Members' speeches today have demonstrated all too well the increasing contradictions and anomalies in the Opposition's policies, which have been so well exploited by my right hon. Friend the Secretary of State. I have no doubt that my hon. Friend the Minister for Health will probe further when he replies.
I begin by deploring the fact that, at this time of year, the chairman of council of the British Medical Association seeks to provide emotive headlines at the BMA's annual conference. I had better declare an interest straight away, as the BMA is my trade union. The sort of language he has used, which is translated into the headlines we read, is reminiscent of the worst days of the old TUC conferences: "Health service heading for disaster"; "NHS sinking like the Titanic". Such headlines are not only singularly unhelpful--indeed, untrue--but totally out of keeping with the medical profession and all it stands for.
The ethos of the medical profession is surely to reassure and to act in the best interests of patients. It must adapt to changing times, but in that adaptation and change, must assist, with the prime object always in view--the welfare of the patients it is looking after.
When on earth were there not politicians bemoaning chaos and crisis in the NHS, combined with limited resources? "Underfunding" is an emotive left-wing word which has got into the Opposition's vocabulary as a cover-all description which completely fudges everything that we are in politics for--to make decisions about priorities, within limited resources. It is nonsense to talk about underfunding.
Our job here, on whichever side of the House we sit, is to decide where best we can use the taxpayers' money. It is a fundamental naivety for the Opposition always to go on about underfunding, when we should be talking about efficiency and patient care.
Mr. Martlew:
Does the hon. Gentleman think that the NHS is underfunded?
Dr. Goodson-Wickes:
I certainly do not. The hon. Gentleman has not been following my train of thought. In an ideal world, every Secretary of State would have an unlimited budget, and the world would be a lot better for that. But that is not the sort of utopia in which we live. I am sure that the hon. Gentleman recognises that. I welcome the fact that his right hon. Friends on the Opposition Front Bench increasingly recognise that, and are beginning to see the realities of life. I look forward to the hon. Gentleman joining that club in due course.
After all, Nye Bevan himself wholly failed, in all his admirable work in setting up the NHS, with all-party backing--the Conservative and Liberal parties, Beveridge, all worked together in the all-party tradition to set up the NHS--[Interruption.] If anyone disagrees, they have only to read the history books. I will send them the bumf whenever they like.
But in setting up the NHS, Nye Bevan himself wholly failed to recognise the infinite demand which would result thereafter. He thought that ill health would, to coin a phrase, at a stroke be eradicable, that everyone would be cured instantly, and that people thereafter would not become ill. I forgive him for that. He could not possibly have foretold the developments in medical technology and so on, which have now opened unforeseen areas of expertise for the benefit of patients and populations.
Mr. Simon Hughes:
Without getting into a debate about Nye Bevan, I have one factual point to make. I hope that the hon. Gentleman will not deny that, in the 1945-50 Parliament, the Labour and Liberal parties voted for the NHS legislation, and the Tory party voted against it.
Dr. Goodson-Wickes:
I said that I was perfectly prepared to send hon. Members the exact basis on which the Conservative party did that. But the hon. Gentleman, being a fair-minded man, will acknowledge that the Conservative party had a considerable input in the setting up of the NHS. We go back to 1911 and Lloyd George. I hope that the hon. Gentleman will be happier now that I have mentioned Lloyd George.
The hon. Gentleman knows perfectly well that the workings of this place are such that, for bizarre reasons, particular parties go into particular Lobbies, and then the reasons are dissected. We all know the truth. I am sure that the hon. Gentleman and Opposition Members will
acknowledge the Conservative party's input. However, I give Nye Bevan the credit for getting the NHS legislation on to the statute book.
The perfect must never be the enemy of the good. One of the uncomfortable messages we must all address on a non-party political basis is well set out in a leading article in this week's British Medical Journal. I was critical about that publication earlier this week, so I had better be polite about it today. The article, headed "Rationing health care: moving the debate forward", says:
The article continues:
Five years on from the NHS reforms, it is an appropriate time to take stock. Having spent most of my career in the NHS, I have had ample opportunity to see bureaucray at first hand, and bureacracy is the subject of the motion today. I have seen the appallingly long waiting lists for admission, the inadequate administration of case notes, the lack of a proper appointment system in out-patient departments with either no appointment system at all or multiple bookings, and the lack of liaison with investigation results coming back after patients have been seen.
On top of all that--I say this with humility about my profession--all too often in the past, superimposed upon all those inadequacies has been an air of condescension and old-fashioned paternalism which suits this day and age particularly badly. Any reform which helps to remedy some of those problems, and which the Government have been so conspicuously successful in achieving, is warmly to be welcomed--I imagine, on both sides of the House.
Where do we go from here? I believe that the Government's record stands up to the closest scrutiny. I welcome the shift from secondary care to primary care, with all that that involves for GPs and their close involvement with patients. I want to quote a letter sent to all Members of this House from the BMA, dated 2 November of last year:
There is no district general hospital in my constituency, but the borough of Merton's is arguably the best served population in the country, in that it contains three superb district general hospitals which serve my constituency: St. George's Hospital NHS trust, Kingston Hospital NHS trust and St. Helier Hospital NHS trust. I keep in close touch with all of them to find out how they are dealing with the Government's reforms, particularly in respect of bureaucracy.
The St. George's Hospital trust warmly welcomes the efficiency scrutiny exercise now under way, and believes that it will offer scope to allow the hospital to reduce administrative effort--for instance, in invoicing each month, as mentioned by the Chairman of the Select Committee. The hospital will also be able to simplify contract payments with purchasers and to reduce the need for pre-authorisation from purchasers. That will lead to reduced bureaucracy in the internal market.
My hon. Friend the Member for Broxbourne (Mrs. Roe) and I would do anything to reduce the bureaucracy that inevitably arises during any administrative change. The fact that St. George's is reacting so positively to the initiative is a good omen for the future.
The hospital has already speeded up communications within the trust by using e-mail technology. It has developed an integrated information support scheme that speeds up patient results to doctors, reduces the time spent chasing medical records and generally reduces bureaucracy and paper chasing, thereby allowing more time for hands-on patient care. It is important to eliminate the sort of problems which I said at the beginning I had seen at first hand.
Information links to GP practices have been greatly enhanced, allowing laboratory and radiology results to be passed on quickly and permitting GPs' letters and discharge statements to be electronically mailed. This, too, will alleviate the old problem of time spent chasing paper. I believe that all hon. Members would endorse such an objective.
I tried earlier to intervene on the hon. Member for Peckham (Ms Harman) while she was waxing lyrical about the bureaucracy surrounding fundholding practices. The House will have noted that she declined to give way, despite my trying to intervene several times. I have specific examples that rebut what she alleged is happening to increasing numbers of GP fundholders.
The Kingston Hospital trust document explains exactly what I mean. It has set up a so-called GP multi-fund, which, although it consists of about 40 practices, enables the hospital to deal with a single management group. I do not know whether that pattern is followed around the country; if not, it should be, because it is eminently sensible. I hope that the hon. Member for Peckham will visit Kingston hospital and find out at first hand how well the system is working--instead of waffling on about thousands of GP fundholding practices and the bumf that she says they generate. It simply does not work like that.
Kingston is also talking to the district health authority and to the multi-fund group about providing electronic data transfer between GPs and the hospital, thereby reducing administrative costs. The hospital's management structure is flat, with authority and responsibility delegated close to the point of patient contact.
Kingston Hospital trust is set to achieve the target of management cost savings of 5 per cent., a reduction of more than £150,000. It is all very well to swap insults across the Floor of the House, but it is more sensible to look at the figures and see what is actually happening.
The same good developments are to be found at St. Helier NHS trust and at Queen Mary's NHS trust in Roehampton, which also serves a few people from my constituency. Furthermore, I have good news about the Nelson hospital--one of the old cottage-type hospitals which had been virtually condemned to closure. Thanks to efforts at local and national level, it will now have a future, providing the Labour-controlled council is co-operative, offering enhanced day care facilities, physiotherapy, occupational therapy and radiology--all in the heart of my constituency: a most welcome development.
I pay tribute to the community health council in my constituency. My first contact with such councils was in Islington, where I was the prospective parliamentary candidate in 1979. I do not know whether things have changed in Islington, in line with the change of attitude represented by the Leader of the Opposition, but at the time its CHC was a politically motivated left-wing pressure group. Nevertheless I pay tribute to the community health council in my area, which could not be less politically motivated. I have not the slightest idea of the politics of those who serve on it, whom I meet regularly and who offer a uniformly constructive and helpful analysis of what is going on. I congratulate them on that.
The Secretary of State extolled the virtues of removing unnecessary tiers of administration throughout the NHS. I vividly remember the time I sat in the office of the chief executive of the South-West Thames regional health authority, in Paddington. On the wall was an idiotic map, showing his area of responsibility, stretching from Wandsworth to the south coast of Sussex. At the time, my elder son was a patient in an NHS Chichester hospital. I could discern nothing--apart from excellent medical care--linking Paddington, Wandsworth and the southern reaches of Sussex, however. It was ludicrous, and it just showed what a good idea it was to abolish the regional health authorities and put in hand the subsequent reorganisation.
Not only has Merton and Sutton health authority merged with the local family planning committee; we have gone further and merged the Merton, Sutton and Wandsworth health authority with the family planning committee. That will lead to financial savings, and give my constituents a much better service.
I do not want my speech to be a litany of good news and congratulations for the Government. There have been problems in my constituency--in fact, I am surprised that Labour Members have not intervened in this regard. For example, there has been national publicity about accident and emergency facilities at St. Helier hospital, which serves my constituents who live in the southern part of the borough. I have had regular meetings with the management of St. Helier hospital, and I have every confidence that it will tackle what is an uncomfortable situation--patients have been left, inappropriately, in corridors. That is unacceptable.
The management at St. Helier hospital has told me that the main problem is the phenomenon known as bed blocking--I suppose that we will get used to the term.
Apparently, "bed blocking" means that patients who are perfectly fit to be discharged from hospital do not have the facilities to be so discharged and thus take up beds that could be used for emergency admissions. This is unacceptable.
I offer my hon. Friend the Minister a radical solution to the problem--I do not know how receptive he is to radical solutions. If he is in a tier-abolishing and streamlining mood, he might examine the merits of looking at the roles of the community NHS trusts in relation to local authority social service departments to see whether the liaison between the two is good enough. If it is not, would he consider talking to his colleague in the Department of Social Security? There could be scope for further amalgamations and abolitions of tiers.
The Labour party is coy about its plans for the future. I do not wish to jeopardise the hon. Member for Peckham's chances of re-election to the Labour shadow Cabinet--if such an election takes place--but some of the semantics we heard from her today were quite extraordinary. She was asked whether fundholding will be abolished, or whether it will re-emerge as general practitioner commissioning.
If the Labour party believes in choice and diversity, will it say whether new Labour believes in a mixed economy in health care? The hon. Member for Stockport (Ms Coffey) is shaking her head--but I do not know whether it is in response to my argument. I hope that the hon. Member for Fife, Central (Mr. Mc Leish) will clarify the situation in winding up.
The former research director of the Fabian Society, Stephen Pollard, stated:
I was once a consultant to BUPA. When Frank Chapple was the general secretary of the Electrical, Electronic, Telecommunication and Plumbing Union, the union joined BUPA. He wanted to ensure that his members had the best possible health care available. I am not carping from a purist point of view, because, as a Conservative, I believe that everyone has the right to the best possible treatment available. If the general secretary of the EETPU chose to sign up all his members for private health care, well and good. I congratulate him, and I hope that they all benefited from it.
As I said in an intervention, there has been a long tradition of the trade union movement looking after its members with private health care outside the national health service--I refer to the Manor House hospital and to the Benenden hospital, one of the largest independent hospitals in the country.
The Labour party's argument is riddled with hypocrisy, and it is about time it came clean and told us what it stands for and what its plans are for the future. Does it believe in a mixed economy in health care?
In years to come, the most important thing will be getting value for money. The right hon. Member for Sedgefield (Mr. Blair) made a speech in this regard earlier in the week. The Times refers to his speech, and states:
"In Britain neither the Government nor the main opposition party will openly acknowledge the inevitability of rationing health care."
That is at the nub of every debate that we have about health care. Commentators believe that the Government should lead a debate on how best to ration health care. We are talking not about whether one should or should not ration health care, but about how best to do it. Anyone who says otherwise is living in the utopian world to which I referred earlier in reply to the hon. Member for Carlisle (Mr. Martlew).
"Many people in the health service think that more funds should be available for health care, and many members of the public support such a proposal. But these are separate debates. More effectiveness and more money will not"--
I repeat, not--
"remove the need to deny effective treatments."
In other words, to go back to the hon. Gentleman's intervention, however much money one has, the resources will never be available to give effective treatment to all patients regardless of need. That is an entirely non-political argument.
"The Government's reforms offer improved services to patients, both in quality and range".
Of course, resources must mirror these changes--although they are not infinite. I certainly hope that GPs' careers will be further enhanced; likewise their job and clinical satisfaction.
"For Labour to put forward a credible social and economic policy--with specific costings for healthcare--it should examine the approach adopted by its Socialist colleagues abroad and embrace the benefits that can be derived from an enhanced British independent healthcare sector."
What is the Labour party's official view in that regard? Geoff Mulgan, the director of Demos, stated:
"Mutual help can fill the gaps in provision of everything from money, to food shops and housing."
Does the Labour party endorse a trend towards the great mutuals of the past and of the present, such as the John Lewis Partnership, the Co-op and BUPA? The Labour party should let the House and the country know its views in this regard.
"If Labour won the general election there would be no unnecessary reorganisation in the NHS. He said also that he had no intention of pumping in more money until it had been established whether the present budget was being well spent."
Hear, hear, to that. I wonder whether he has told the hon. Member for Peckham. Why should we look in a crystal ball when we can read the book? I have read the book according to the Leader of the Opposition.
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