House of Commons Hansard Debates for 20 Nov 1996 (pt 48)

Ms Jowell: The hon. Gentleman makes my point. There is a view of reality that is shared by Conservative Members, and there is the real world outside, across the bridge at St. Thomas's hospital, at King's College hospital, Guy's hospital and Chase Farm hospital.

At the root of all that is the fact that the Tories do not really believe in the national health service. They voted against it 50 years ago. They have come to see it as inevitable, but they do not see it as desirable. The Secretary of State continues to protest that his intentions are good. Perhaps they are; let us give him the benefit of the doubt. But the truth is that his heart is not in it. For the Conservatives, state medicine is like state education: the odd hon. Member may use it, but most do not.

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At Richmond house, where the Secretary of State sits, in a world where the raw pain and hard choices are sanitised, and where management-speak has taken over from patient care, a particular language is spoken. Nasty words such as "patients", "pain" and "waiting lists" have been eliminated from the vocabulary.

I was recently sent a copy of the minutes of the management board, the most senior board responsible for the NHS. One need read no further than those minutes to understand that patients have simply been written out of the script. Nowhere in the long deliberations of that meeting are patients mentioned. My hon. Friend the Member for Preston made the point that the Government no longer speak about patients, but speak instead about finished consultant episodes.

To give the House a flavour of the way in which the board speaks, I quote from the document. It states:

"The Board considered the areas of the country which faced the most difficulties. It agreed that support must be given to the NHS to manage through these problems without impacting on the many improvements already achieved. . . A more open position on prioritising was inevitable."

What on earth does that mean?

There is no mention of patients in the letters sent to trusts and health authorities about the winter crisis. The NHS is aping the culture of a commercial organisation and failing both patients and staff in the process.

I received a letter today from the Royal College of Midwives expressing great concern at the fact that "Changing Childbirth" was becoming less viable. That is supported by both sides of the House as the way forward in maternity care. "Changing Childbirth" is threatened by the recruitment and retention crisis hitting midwifery.

The people of this country will have to get through this winter. There will be heartache and anger as clinical priorities are determined by the crude mechanisms of a false market. In the spring there will be a general election. That will be the last chance for our national health service.

Labour will rid the health service of the dogma-driven reforms foisted on it by the Government. It will mend the fractures that have shattered the NHS into hundreds of small businesses. We will rebuild a health service in which our constituents can have confidence and of which the country can again be proud.

9.38 pm

The Minister for Health (Mr. Gerald Malone): The hon. Member for Dulwich (Ms Jowell) had an opportunity to set out some of her party's policies, as the country approaches an election, about the future of the national health service, but we heard absolutely nothing about what the Labour party would do. The same was also true of the hon. Member for Islington, South and Finsbury (Mr. Smith), who opened the debate.

The emptiness of the Labour party and its policies on the national health service characterised the debate. All that the hon. Lady did in winding up the debate was to reiterate threats about the privatisation of the NHS and the hidden agenda for the NHS that the Government were supposed to have in 1979, 1983, 1987, 1992 and 1997. The hon. Lady will doubtless make the same speech about our hidden agenda when we come up for re-election again in 2002, still supporters of our national health service.

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Our future for the NHS is contained in "secret documents" called White Papers, which appear in public and are debated. It also appears in things called Bills, which come before the House--currently before the House of Lords--in terms of bringing forward primary care. It is astonishing that not one Opposition Member even bothered during the debate to mention what is at the centre of the debate on our health service today--the future of a primary care-led NHS--and that a Bill has been presented to Parliament. Not a word did we hear from Labour Members about that, what their thoughts about it were and how they would take it forward. We will talk about that later in my speech, I promise.

We also failed to hear the Labour party's pledge on spending. Again, the hon. Member for Islington, South and Finsbury totally refused to match the promise that made by my right hon. Friend the Prime Minister and repeated by my right hon. Friend the Secretary of State.

Mr. Chris Smith: How much?

Mr. Malone: It is a real-terms increase year on year on year on year for the next Parliament, just as we have done in this Parliament and in the Parliaments before that. If the hon. Gentleman thinks that getting down to specifics on health spending will do him any good, he should look at the record of the last Labour Government. Not only was that pledge not honoured in its final years, but--for the first time in the history of the health service, I believe--the percentage of gross domestic product spent on health care in this country slipped from 4.8 per cent. to 4.7 per cent. The figure has now been increased to 5.9 per cent.

Mr. Smith: Can the Minister confirm two things? First, will he confirm that the percentage of GDP currently spent on the national health service is less than it was at the general election in 1992? Secondly, will he confirm that the last Labour Government raised national health service spending by more in real terms in its five years than has happened in the past five years?

Mr. Malone: The hon. Gentleman made much of his party's custody of the health service while Labour was in Government. In Government, we have gone from 4.7 per cent. of GDP to 5.9 per cent. The hon. Gentleman cannot fudge that.

It beggars belief that, even in the winding up of the debate, when the hon. Gentleman intervenes he does not take the opportunity to repeat or match the pledge that the Prime Minister has given. The hon. Gentleman made much of Red Book figures--outline figures--and the House knows that they are not normally the figures lit upon at the end of the day. He said that a 0.1 per cent. increase in health spending in real terms was tiny. If that is so, will he now pledge to match even that minimalist amount in real terms spending on the health service if he were in Government? I invite him to do so now, but he will not, as I am sure that the House will have recognised.

The truth is that the Tories are now running the agenda on the NHS. That is what I believe that the hon. Member for Hartlepool (Mr. Mandelson), Labour's spin doctor, may well have said. I can hear it characterising the debate. "Come on, Chris. The Tories are running the agenda on the NHS. Even if we can't promise anything--and you

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can't promise anything--let's simply declare a crisis." After all, that is what the Labour party has done for 17 years, but I can tell the hon. Gentleman that it has not done the Labour party any good.

Many right hon. and hon. Members have participated in the debate. I shall refer to a number of the contributions and try to answer the points that were made.

My right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) was Secretary of State for Social Services for six years and he drew on that extensive experience in his speech. He pointed out that trust hospitals are able to respond to problems, and he used a constituency example to illustrate very clearly how trusts can make rapid changes in order to improve service provision.

The hon. Member for Southwark and Bermondsey (Mr. Hughes) raised two points. First, he referred to mental health and asked whether the Government consider it a priority. I assure him that we do. In the current year, £95 million in additional revenue has been devoted to improving mental health services--£53 million from health authorities, £10 million from the mental health challenge fund, £10 million in matching health authority funding, and £20 million from the mental illness specific grant, plus a £2 million contribution from local authorities. I hope that he will accept that as proof of our earnest intentions and our acceptance of mental health as a priority.

The hon. Gentleman also mentioned backlog maintenance. That figure must be put in perspective, as it represents only 3 per cent. of the replacement cost of NHS estates. He should bear in mind also the fact that the NHS is responsible for more than 700 listed buildings, which is more than the National Trust.

The hon. Member for Blaenau Gwent (Mr. Smith) highlighted problems with the South and East Wales Ambulance NHS trust. I assure him that my right hon. Friend the Secretary of State for Wales is taking a close interest in the matter.

My hon. Friend the Member for Broxbourne (Mrs. Rowe) mentioned a primary care-led NHS and set out the improvements that that will bring--including quicker access and new clinics located closer to patients. The legislation that is currently before Parliament will encourage further developments in that area. It embraces the principle that patient care should take place closer to the patient where that is clinically appropriate. Although Labour Members said nothing about it, the move is welcomed by the medical profession and by those who are involved in primary care delivery.

The hon. Member for Nottingham, East (Mr. Heppell) raised two points. First, he asked what was happening at the Queens Medical Centre NHS trust. That trust is increasing the treatment that it provides, and the number of cases rose by 2.2 per cent. last year. Trusts up and down the country are facing pressures and difficulties, but I hope that the hon. Gentleman will view current events in the context of an overall increase in treatment. Secondly, the allocation for his local health authority increased by £15 million last year--which is the largest percentage increase in the Trent region.

The hon. Member for Mid-Ulster (Rev. William McCrea) made the very good point that we must follow policies with real finance. In so doing, he put the Labour party on the spot as he clearly understands that there can be no pledges regarding the health service unless they are