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4.46 pm
Rev. Martin Smyth (Belfast, South): I am aware of the positive role of the national health service. I remember that, some years ago, when we were considering
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long-term financing, we had before us a person who had been in private medicine in the United States and in England. He was asked which was the most effective health management organisation, and his response was, "Yours--the NHS." I accept that, but there is room for improvement in everything.
When the Minister spoke about waiting lists, my mind went back to a little family discussion a good number of years ago, when I had asked my wife whether she would be able to join me on a certain occasion, and she had said no. I turned to my eldest girl and said, "What about you, Rosemary?", to which she replied, "Yes",
whereupon my younger daughter immediately said, "Ha! Using a big word when a small one would be sufficient!" The younger daughter had worked out that if Rosemary had said no--a smaller word than yes--I would have invited her instead. The Minister gave us a long, wandering explanation of the waiting list problem, when the simple reality is that waiting lists are growing. It would have been much easier to say that on the record.
It is not sufficient for Ministers to be on the defensive in the House, even when some hon. Members may be on the offensive, asking questions and putting things on the record. A senior civil servant put on the record the role, at times, of civil servants, when he said in a famous court case that they were economical with the truth. Figures can be used in different ways.
Mr. Gallie:
Given the hon. Gentleman's comments on waiting lists, is he aware of the service offered by hospitals in Ayrshire to patients from Northern Ireland for orthopaedic surgery, aimed at reducing waiting lists in Northern Ireland, and does he feel that that strengthens the bond between Scotland and Northern Ireland?
Rev. Martin Smyth:
I have no difficulty with that, because it is part of the system. If people who need treatment can receive it in other places, that is fine. The tragedy is that some purchasing bodies are not prepared to go elsewhere, even if, as in the case of Ayrshire and some London providers, the service is offered as a loss leader, to try to fill spare places. If patients who need treatment can be treated anywhere in the NHS, I would support it. Certainly there is a bond, and it will be strengthened when Musgrave Park hospital starts competing and tendering abroad. It, too, has the facility to do that but, unfortunately, it has tried to treat people in Northern Ireland as first priority when the boards in Northern Ireland have not been able to purchase places there.
I am concerned by the phrase
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I generally support the motion. It is the way of all Governments, of whatever ilk, that they bring in people from outside to try to resolve problems--to kick them into touch, to use a rugby analogy. They might call it a royal commission but someone else has to take the responsibility. Why did the Minister try to shoot down a mere Opposition spokesperson who suggested using a body, such as the King's Fund, which the Government have used often? As a Member of Parliament, I have found its services very helpful. My constituency has at least two medical facilities that have benefited from assessment by it. I support its use.
Mr. Simon Hughes:
The Minister's response to our suggestion was to ask why we should not use the Audit Commission. Many hon. Members would rather have the Audit Commission perform independent assessment of statistics than the Government. If they have some problem with using the King's Fund for this job and the Minister were offering that, it would be an acceptable middle way that the hon. Gentleman might encourage the Government to adopt.
Rev. Martin Smyth:
I have no difficulty with the Audit Commission doing the work, but I am concerned about the pressure of work on it. Often, when Select Committees are asked to consider its reports, civil servants or officers come before us to answer our queries and we discover that they are doing their best to kick into touch. They say that were not involved in the misdemeanours of previous years and assure us that they will do better in future. In the end, the same mistakes are perpetrated. However, I have no difficulty with the examination being carried by the Audit Commission.
I am not sure that the Minister fully understood what he was saying in talking about free dental and eye checks. He said that they would mean that there would be less money for patient care. I have a suspicion that the people we are talking about are patients who need care. Some people have found that they can benefit from routine check-ups because other diseases are immediately discovered and helped on their way. We are arguing for something that experts have been asking for.
Only recently I went in to have my eyes tested--admittedly, a year after I should have done, not because of the expense, but merely because I put off until tomorrow what I should have done yesterday--and asked about the figures. I was interested in the Minister's answer. There was a decisive drop in the number of people coming for eye tests when the change took place; the numbers have now begun to rise again.
I am not so sure that they are rising again simply because more people need the tests. It may reflect the fact that some sections of our society are better off financially and are ready to have check-ups earlier. However, elderly people who have to balance their budgets think twice before having a routine eye test. They wait until something affects their eyesight before going for a test. We might save pounds in the long run if we treated patients earlier.
Mr. Simon Hughes:
Can the hon. Gentleman confirm that there is now evidence--I think that we have all seen it--from the Royal National Institute for the Blind which confirms that there has been a deterioration in the sight of some of those who are now not being tested? It is not a
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Rev. Martin Smyth:
The motion deals specifically with that matter. I accept that the Government of the day may have to find some money from another sphere.
I know that we do not want to make political points; there are those who fear that, the nearer we come to an election, the more likely it is that political points will be made. All I shall say by way of guidance to the Government is that the recommended increase for nurses of about 3.3 per cent. might be their best vote winner and it may embarrass others if the Government opt for it. Only yesterday, those close to the core of the matter claimed to me that the money is available for such an increase. That may relate to the argument that the hon. Member for Southwark and Bermondsey (Mr. Hughes) was advancing.
People throughout the nation still believe that those in the front line of medical care at every level, community or otherwise, are those in the nursing profession. Unfortunately, even now, some people have not received last year's increase because the discussions are still continuing. There is something wrong with that. I cannot understand how those who manage different health provisions can argue that they have been wrong-footed and that, if the Government give the increase, they will be short of money because they have already allocated their funds in a different way.
When we discuss financing the health service, we must watch out for what I constantly call medical politics, where each group--whether managers, community groups or elsewhere--argue specifically for themselves. They may bring in patients as an added bonus, but there is undoubtedly a need in the nation. I am discovering that Northern Ireland is being robbed of some of the advantages that it had when it governed itself.
Lest anyone should misunderstand, I shall put the record straight. There is no Minister responsible for Northern Ireland present on the Front Bench. I know that the House will sympathise with the Under-Secretary of State for Northern Ireland, the hon. Member for North-East Cambridgeshire (Mr. Moss), who lost his wife yesterday. I felt a great sense of sympathy when I was told about his bereavement at the conference of the Royal College of Student Nurses in Belfast. That is why the Minister is not on the Government Bench today.
Mr. Matthew Banks (Southport):
Thank you, Madam Deputy Speaker, for calling me so early in this important debate on the national health service. Before coming to the substance of my remarks, I shall take a moment to join the hon. Member for Belfast, South (Rev. Martin Smyth) in his expression of sorrow. We were all sorry to hear of the family bereavement of the Under-Secretary of State for Northern Ireland, my hon. Friend the Member for North-East Cambridgeshire (Mr. Moss).
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The hon. Gentleman also drew attention to the attendance at the debate. I am pleased to see my hon. Friend the Minister for Health on the Front Bench, and also the Minister of State, Scottish Office, who is representing the Scottish component of this important debate, if I may put it that way. As I commence my remarks, I am sorry to see that not a single Labour Back Bencher is present. I get the feeling that the Labour party is trying to make the debate collapse early, in the hope that insufficient Conservative Members will be present to out-vote the Liberal Democrats. No doubt the hon. Member for Warley, East (Mr. Faulds) will be here later, because, as a member of old Labour, he is hardly likely to pay any attention to the antics of the new Labour Whips Office.
"on the basis of need regardless of the ability to pay"
in the Government's amendment. I accept that, but the harsh reality is that that does not always happen in the national health service. We will be told that we offer only anecdotal evidence, but if only one person in a hospital, having been examined by a cardiac specialist, is told, "You need a cardiac operation. I will have to put you on the waiting list. If you can afford £10,000 or £12,000, we can do it in three weeks," something is wrong. Those surgeons are employed in the national health service rather than in private practice: it would different if the patient had gone to a private practice for treatment. If that happens to one person, it is one person too many.
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