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Dr. Goodson-Wickes: I shall conclude my speech--if hon. Members do not wish to intervene.
I refer to a saying of Sir Richard Doll, which I used to have framed in my consulting room--I used to get my patients to read it. He is well known by hon. Members as one of the supreme epidemiologists--and he was suitably honoured in a recent honours list. He first came to prominence when he demonstrated the causal link between smoking and carcinoma bronchus. He said:
Madam Speaker:
The 10-minute limit on speeches now applies.
"It is not for doctors to advise people to live their lives as invalids in order to die healthy."
I suggest that the essence of Labour policy is to spread alarm among patients, when all the trends--while far from perfect--are for the better and in the interests of patients. I have the greatest confidence in the reforms proposed by the Government. They have been tackled in a practical and robust way. I suggest that the Labour party offers only uncertainty--and uncertainty is one of the worst things in this life. A patient, by definition, feels unwell, uneasy and uncertain. The last thing a patient wants is uncertainty about what the Labour party is going to do to the national health service, which we all value.
7.9 pm
Mr. Don Touhig (Islwyn): The hon. Member for Wimbledon (Dr. Goodson-Wickes) spoke for about 27 minutes--but I do not know whether hon. Members are any wiser. We know that history is not his strong point because he spoke about the Tories supporting the foundation of the national health service. I wonder what Aneurin Bevan, the architect of the national health service, would say if he knew that this week the British Medical Association has said that the health service is being cut to the bone. No one should pretend that today's national health service is the one that Nye Bevan and the Labour party created. The task of providing health care is as great a challenge now as it has ever been. Health care systems across Europe face conflicting demands, from the political pressure to provide every citizen with better access to care to the need to keep costs at a level that the nation and its taxpayers are prepared to pay and can
afford. Added to that political juggling are the pressures of modern health care--the mounting costs of care, a general aging of the population, changing disease patterns, increased expectations and advances in medical science and technology.
Health care in Europe has developed from the two basic models of a system of mandatory insurance supplemented by public funds and a universal system of state-funded health care. Rising public expectations set against the difficulties of financing health care inevitably lead us to examine how we fund health care, but that is a subject for another debate. Today, we are addressing the issue of bureaucracy in the health service.
The task of providing an adequate health service for the next millennium is not an easy one. We need to consider carefully how we will rise to the challenge. The Government's response has been to increase bureaucracy and to pour resources into an ever-growing army of administrators, rather than into primary health care. That is not the way to meet the challenge. Bureaucracy has risen to ridiculous levels in the health service. In 1993-94, the Government put an extra £1.4 billion into the NHS and every penny went on bureaucracy, not on patient care. As my hon. Friend the Member for Peckham (Ms Harman) said earlier--she is not in her place at the moment--the health service now has 50,000 fewer nurses compared with 1989, but it has 20,000 extra managers. The cost of administering the NHS has increased from 9.2 per cent. of the total expenditure on the NHS to 15.6 per cent.
While all that is happening, hospitals are refusing people who need treatment because of problems with funding. That is a scandal that cannot be tolerated in a civilised society on the eve of the new millennium, but it is being repeated across the country. I was in Hamburg recently and I learned about some initiatives that the German health service has taken to overcome the problems of meeting public aspirations for health care at the same time as controlling costs. The cost of some 25 per cent. of hospital procedures has been agreed between the Government, the medical profession and others by identifying diagnostic related groups. Those patient management categories have been negotiated between the hospital association and the insurance funds in all state hospitals to ensure quality and good care. It is intended that that practice will apply to 80 per cent. of hospital procedures.
Meanwhile, the Government continue with their obsession to develop the market in the NHS, instead of balancing costs against expectations. That obsession means that young diabetics, in my county of Gwent, have to pay for special insulin syringes because the local hospital cannot afford the £4,000 yearly cost of the service. In my constituency, a group of local women provide a cancer advice surgery. Last year, the bulk of its funding came from the mayor's charity appeal and it operates from a portakabin in a car park behind the high street. The group is sustained by volunteers and they are doing the work that should be done by the NHS. Such gaps are all too common.
Another reason why today's national health service is not the one that Bevan created is the element of commercialisation that has been allowed to sweep in like the incoming tide. While it might be appropriate to market-test for some services in a hospital--portering, catering and cleaning--it is not acceptable or effective to
privatise clinical services that directly affect patient care. Already sterile supplies, dental care, ophthalmology, pathology and pharmacy services have been handed to the private sector. Abortion services, psychology, speech therapy, physiotherapy and occupational therapy services have been market-tested as the inevitable consequence of an NHS that operates with a blind faith in market forces. No balance has been sought or achieved.
The markets may do many things well, but left to themselves the markets will not educate our children, they will not provide the infrastructure that the country needs and they will not provide an acceptable level of health care for our people. Health care is not a product that can be packaged, marketed and sold by formula, at least not in a civilised society which, while valuing the individual, cares for the whole community. Health care is not simply an economic question of supply and demand: it has a human element that makes it unique. Health care is about curing the sick, relieving pain and caring for the young, old and infirm. For most of us, the possession of all the wealth in the world would be no substitute for good health. We must bear that unique element of health care in mind when we consider the subject of effective management.
We need effective management in the NHS. We already have some good and effective managers in the NHS--some of the managers working in my area do a splendid job--but we do not need managers who are fixated on market testing and contracting out. The NHS needs skilled managers who can develop strategies and schemes, balance budgets and control costs properly, but who also appreciate that they run a unique service of health care. Those who are active and working in health care need to have a say in the management of the health service.
I recommend to the House the United Kingdom nursing leadership programme, which is sponsored by Johnson and Johnson and the King's Fund. The programme seeks to tap into the unrealised potential of nurses to produce leaders who can make vital contributions to the development of health care. It operates over two years and nurses have a non-nurse, board-level mentor and undertake relevant secondments to improve their knowledge and skills. That break with the traditional career paths for nurses is to be applauded because it is one way in which experienced health care staff can move to board level, thus aiding their personal development and, most importantly, providing a much needed health care perspective at board level. We should welcome that major new learning opportunity.
Nurse leaders will need to be strategists, environmentalists, slick political operators and confident leaders and they will need to show a sense of purpose. The programme will help them develop those skills. There is a need
Mr. Peter Luff (Worcester):
Stakeholders!
Mr. Touhig:
The word "stake-holders" was a quotation from the programme set out by the King's Fund.
The rub is that the participants have to contribute £1,000 towards the cost of the programme. The Government are prepared to put £1.4 billion a year into the bureaucracy of health service, but they have not invested in that programme. They are concerned about bureaucracy and administration, but they are not concerned about the nurses--those at what my father would call "the coal face".
"for nurses to work with the whole system"
so that they too are
"stake-holders",
and can contribute fully to the development of new approaches to health care.
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