House of Commons Hansard Debates for 5 Feb 1997 (pt 27)

Mr. Robert Maclennan (Caithness and Sutherland): Is it not unlikely that, by absenting himself from the debate, the Secretary of State will promote consensus?

Mr. Hughes: I find the Secretary of State's absence surprising. I am glad that the Minister of State and the Under-Secretary of State are present, but, if the Secretary of State thinks the NHS as important as he claims, he should be here. This may well be the last debate on the NHS before the general election, which is another reason why the person in charge--in a system that I must say is very undemocratic: no other elected person can be in charge even locally--ought to be present.

Politicians will need to be bold. It is widely recognised that the Tory and Labour parties are not yet rising to the challenge. I am not the only one who says that: it was said the other day on a Radio 4 programme in the "Analysis" series, presented by Andrew Dilnot, entitled

5 Feb 1997 : Column 1016

"Free for All". Let me briefly quote from what he and Chris Ham, professor of health policy at Birmingham, said in the programme. Andrew Dilnot said:

"Clearly and unambiguously committed"--

the Secretary of State, apparently, is so committed--

"to high quality, universal, tax-funded healthcare . . . With both major parties so firm in their backing of the NHS, surely we can just relax in the security of knowing that it will be all right.

No, we cannot. In fact there is now a real risk that over the next five years the NHS will cease to be a universal, comprehensive, free service, without any real debate, because neither party"--

neither of the main parties, that is--

"is prepared to promise anything like the rate of growth in spending seen throughout the life of the NHS."

Professor Chris Ham said:

"This year is the toughest year for the Health Service in the last decade. There's always been a funding problem in healthcare because demand exceeds supply of resources, but in the current year that's a particularly acute problem. We're finding that hospitals all around the country, health authorities and GPs, are finding it very hard to make ends meet. In that sense the wheel has come full circle because a decade ago Mrs. Thatcher, when she was the Prime Minister, was forced to set up a review of the Health Service because of the funding problems. That review has led to increased efficiency and greater responsiveness but it's not really tackled the long-term underfunding of the NHS and it's that problem that the NHS continues to grapple with."

Mr. Phil Gallie (Ayr): Will the hon. Gentleman give way?

Mr. Hughes: Not for the moment: I want to proceed.

Therefore, there is no dispute that there is a long-term problem or that we owe an enormous, probably unspeakable, amount to the work of the people who are in the NHS locally in our constituencies, regionally and nationally. There is no doubt that many of them work under perpetual pressure and often regular crisis in the frontline, saving and extending lives and alleviating pain every day.

The predicted winter difficulties have, in large measure, come to pass. Hon. Members do not have to take my word for it. They just have to read reports in the past couple of days from the Greater London Assn of Community Health Councils and the British Medical Association, or a briefing from the Royal College of Nursing for today's debate. I did not know that it was going to be on, but last night I watched a report on "Newsnight" by Alexis Rowell on the health service in Whipps Cross hospital in north London. The report confirmed the crisis and acute difficulties of coping with people, some of whom testified to spending two days waiting in the casualty department before admission to a ward, and to not being able to get a moment's sleep--understandably, because it is a busy place and that is not where they should have been cared for.

Above all, hon. Members do not have to take the word of politicians or journalists if they talk to people in the health service. This morning, my right hon. Friend the Member for Yeovil (Mr. Ashdown) and I met a nursing student and three nurses: Jerry, an accident and emergency nurse from Homerton hospital in Hackney; Tracey, an HIV and AIDS staff nurse from just across the river in St. Thomas's hospital; and Richard, a senior staff nurse working with older people who are acutely ill. They all confirmed that there is a need for more staff, for better

5 Feb 1997 : Column 1017

training and for urgent provision of methods to ensure that we keep staff--who, at the moment, often choose to leave. They also confirmed that we have the facilities for patients, who are just not receiving them.

Mr. Matthew Banks (Southport): Will the hon. Gentleman give way?

Mr. Hughes: Yes, but this is the last intervention.

Mr. Banks: I just wonder whether I could ask the hon. Gentleman, in view of that visit, where the right hon. Member for Yeovil (Mr. Ashdown) is at present?

Mr. Hughes: I do not know the answer to that question, but I assume that my right hon. Friend will be here shortly and certainly he has spent a lot of time in recent days on health service matters.

On the motion and the Government amendment, the big questions are these. Is the NHS doing enough, which in Government-speak is a question about volumes? Is the NHS doing it well, which in Government-speak is a question about quality of care; and has the NHS been given adequate resources, which in Government-speak is a question of NHS spend? My party's view is that, sadly, we are not doing enough, and we are not always doing it well enough; and those two conclusions are not surprising because we are not spending enough.

We have real concerns about the volumes. Where we used to count patients, we now count episodes of treatment. People whom we used not to count as admissions--for example, newborn babies--are now additional parts of the statistics. There is now widespread, probably universal, public and professional scepticism about the Government figures on increased volumes. In terms of separate individuals being treated by the NHS, those figures no longer accurately add up. We believe that the NHS statistics must be collected, verified and reported by a body independent of Government and of party politics. We propose a practical way of doing that. We are worried about the fact that no one independent of the authorities vouches, when people are discharged from treatment, for the fact that that treatment has been properly administered. We believe that the quality of work done in the NHS by the NHS should be checked, verified and reported by a body independent of the Government of the day and of the authorities, and independent of party politics in general. We propose a practical way of doing that.

We also have real concerns about costs. Again, no one independent of the authorities vouches for whether the NHS is given enough resources to do even the minimum amount of work that we expect it to carry out. An assessment of what the NHS needs should be done by a body independent of Government and party politics. Here too we propose a practical way of achieving that. The NHS needs an independent assessment of supply and demand, of the quality of its care and of what we should spend on it.

How we pay for the NHS is a separate question. I suspect that the debate over the next few years will develop our idea of hypothecating taxes instead of simply assuming that the NHS can always win its share from general tax and revenue held by the Treasury.

5 Feb 1997 : Column 1018

For us, therefore, three issues must be dealt with: investment, planning and accountability. For us, investment means--above all--investment in staff: doctors, midwives, nurses and allied professions. We are committed to spending an amount equivalent to the cost of 10,000 nurses or 5,000 doctors to get the NHS back to a state in which it can do the job.

Waiting lists must be reduced; they are currently rising. The public should not have to wait, as they often do, for 18 months for routine operations. That requires investment; we have identified the money that can go into reducing those waiting lists. We believe that, over a three-year programme, waiting times could be reduced to six months.

Mr. Gallie rose--

Mr. Hughes: I have already said no. This is a half-day debate, and I want to give colleagues a chance to speak.

We must also make sure--careful language is called for here--that NHS expenditure keeps pace with inflation. The Government say that they are committed to year-on-year real-terms growth--referring to general inflation--but everyone knows that the NHS costs a bit more, and that, unless expenditure on the NHS keeps pace with NHS inflation, a real reduction in funding will occur.

There has been some debate this week about public sector pay. Last year, the nurses were awarded a flat rate--sometimes topped up locally--increase of 2 per cent., which was below the rate of inflation. This year, according to Red Book projected expenditure on health and community services, and if the award recommended by the review committee, when it is announced tomorrow after the Cabinet meets, is about 3.3 per cent., that amount can, we believe, be afforded.

An analysis of the real-terms growth in the budget for health and community services shows that the 3.3 per cent. increase anticipated by the Government for next year leaves money to spare to allow the Government to agree the recommended increase. We believe that the Government should tomorrow, without demur and without phasing, agree to implement the recommended award; and we would expect the Labour party to agree with us that the money should be paid straight away.