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5.20 pm
Sir Geoffrey Johnson Smith (Wealden): It is a pleasure to follow the right hon. Member for Manchester, Wythenshawe (Mr. Morris), especially as I have also been involved in the past few years in both the campaigns that he mentioned for haemophiliacs. I agree that disastrous, unwanted and unlooked-for damage was done to their health, which none of us could have foreseen. I hope that eventually the case will be accepted, but there are financial implications and the question of apportioning blame. Those are difficult legal matters that have yet to be settled. The issue is approached in a non-partisan way, which shows that on health matters it is possible for both sides of the House to work together.
It is therefore all the more regrettable that today the speech by the hon. Member for Islington, South and Finsbury (Mr. Smith) was nothing but a brawl. Time and again he initiates these debates, motivated by the approaching general election, but he has little regard for the facts of the case in terms of the development of the health service and the difficulties that it faces: he merely tries to rubbish all that goes on in the health service. That just will not do. If the Labour party were elected, it has already pledged not to increase public expenditure. When the hon. Gentleman was challenged by my right hon. Friend the Secretary of State for Health, he could not give a single example of how he would heal what he calls the wounds of the health service.
We had a simple, stupid brawl from the hon. Member for Islington, South and Finsbury. No one would imagine, from what he said, that people in the health service are working to the highest standard of excellence that can be found anywhere in the world. No one would imagine that the Government had funded such a huge increase in expenditure over many years. In real terms, we have seen an increase in funding from £7 billion in 1979 to more than £43 billion for next year. How dare the hon. Gentleman, aided and abetted by his hon. Friends who know that the election is coming, denigrate a Government who have funded that increase in expenditure? The increase has been nearly 70 per cent., allowing for inflation. I doubt whether any Labour Member would have the guts to make such attacks, were it not for the general election and their wish to make party political capital.
The damage done to people who work in the health service is appalling. Morale can be seriously affected, and the trust of the wider public in the health service is also damaged. Overwhelmingly, people receive magnificent treatment from the NHS which is unrivalled anywhere else in the world. We stand high in the estimation of
people who observe our health service. I know people from the United States who have come to study our methods. They do not go home and rubbish the health service: they recognise its positive and solid values.
I do not claim that all is well, and I will come to the problems in a moment, but I ask why the doctors, the nurses, the specialists and the people who clean the wards cannot be taken out of the horrible cockpit of politics. It is not necessary to drag them into it, and it demeans Parliament to do so. I am fed up to the back teeth with that tactic, and I dare say the health workers are too.
In my constituency, the local hospital has developed its services over the years. When I was first elected, it was unusual to speak to a constituent who had had a hip operation. Now when I go canvassing, I meet people who have had operations on both hips. Life expectancy has been prolonged and many services have been improved while I have been in Parliament. We do not hear about that from the Opposition: instead, we get constant bitching as they continually demean the high quality service that we get from the NHS.
We know that there are difficulties, including an aging population, rising expectations, and improvements in technology. All those factors add millions of pounds to the NHS budget. I remember a time, shortly before I entered the House, when we thought that all was well with the health service. It was cheap to run and none of the life-prolonging technologies were in use. We were living in the post-war illusion that the country's health would be improved as time went by and that costs would therefore go down.
Mrs. Jane Kennedy:
I resent the suggestion that complaints about the current state of the health service are, in the hon. Gentleman's words, bitching. Does the hon. Gentleman accept the words of Robert Tinston, who works for the North-West Regional Executive, in the introduction to his report to Alan Langlands:
Sir Geoffrey Johnson Smith:
It has not collapsed. I am not talking about people in the health service, who are bound to know what the pressures are. I do not deny that there are pressures and I have already given three reasons for them. We have had a winter surge in elderly people seeking hospital beds, because there are more elderly people around than when we started the health service.
It was thought when the health service was introduced that costs would steadily go down, but it was not many years before people started complaining about the cascade of medicine that was poured down patients' throats. That led to the introduction of prescription charges. Who introduced them? The Labour Government of the time introduced them, and one of their Ministers resigned over it. For years, Labour Members have complained about
prescription charges, although there is plenty of protection for the chronically sick and those in vulnerable age groups.
The key issue is the efficient use of resources. The Labour party's policy does not promise extra resources for the NHS. Why cannot the Labour party spokesmen be constructive? My right hon. Friend the Secretary of State made a most able speech and he confronted and challenged the hon. Member for Islington, South and Finsbury, who had no answers. In the Secretary of State, we have a man who fully understands the complexity of the health service, the pressures on it and, more importantly, the ways in which we can surmount the difficulties and gradually eliminate them. That is the constructive way to look at the problem.
An article by Kathy Jones in the Fabian Review suggested that the Labour party has taken a paternal interest in the health service. The article continued:
Mr. Kevin Barron (Rother Valley):
The hon. Gentleman started by saying that we should keep party politics out of health, but he has gone into that subject. Is there not a contradiction in that?
Sir Geoffrey Johnson Smith:
The Opposition have been rumbled. I wanted to establish that the approach of Opposition Members is wrong and that people in the NHS resent it enormously. It is about time that Opposition Members realised that we know what they are doing and that their reasons for doing so do not stand up. I am making a point that I am entitled to make.
Other countries spend no more money on health than the UK--despite what Opposition Members think--and extra funding comes not from the state, but through private provision. Before any Opposition Member comments on the need for increased private provision as a crucial supplement to Government funding, I stress that independent health care is particularly encouraged by socialist countries in the European Union.
In Spain, the socialist Government have a public-private mix in which 31 per cent. of hospital beds are privately owned. In Belgium, there are 48,000 private beds out of a total of 77,000. In France, 33 per cent. of hospital care comes from the private sector. I could go on, as this is the story across the continent. Co-operation between the state and the private sector is now normal, and I am not alone in believing that there is a need in the UK for private provision to be developed.
My right hon. Friend the Secretary of State quoted Stephen Pollard, a former research director of the Fabian Society, who has written about this matter. He said:
The Netherlands has also had problems with increases in expenditure and demand, and reforms have had to be made. At the moment, GP services are mostly private, but the system of health care provided by hospitals is mostly public. That is a problem that they must address, and it has caused political divisions in the Netherlands, where there is a larger number of parties than in this country. As a consequence, no decision has yet been made on how far they can improve the use of the private sector.
In France, the characteristic of the system is free choice for the patient with no restriction of access to a general practitioner or specialist. A report from the French embassy on health care states:
"Over recent years there has been a steady increasing pressure placed on secondary care"--
in other words, hospital services--
"to handle emergency admissions over the winter period. The pressure became so intense at times, during 1995-96"--
when the report was written--
"that the system was in danger of collapsing."
Is that bitching?
"But the fact that the NHS is Labour's issue has frequently led to laziness, both in developing policy and in presenting it. 'Jennifer's Ear' is perhaps the best known example."
The article went on to say that the
"soundbite approach to NHS policy may help Labour to win the election but it will not help the party run the NHS when in power."
Instead of concentrating on tackling the problems in the NHS, the Labour party concentrates on ownership. The article continued:
"Most Labour front bench speeches refer to creeping privatisation. They argue that the introduction of market mechanisms in the NHS is the forerunner of privatisation of NHS providers. They regard Trust status for NHS providers with the same suspicion. I would argue that, first, this is not true and second, it is not important."
She is absolutely right, and that is one reason why the negative carping approach of the hon. Member for Islington, South and Finsbury and others is thoroughly wrong.
"With the electorate unwilling to support a return to the old 'top-down' approach to welfare provision, it is now time to examine how the independent sector can . . . augment the state system".
Let us look at other countries. In Sweden, the health care system is going through a rapid transitional phase, and is moving from a traditional budget-based and steered scheme to an internal market model with a separation of purchasers and providers. The changes are running in parallel with developments in Britain, although the Swedish system is more decentralised. Doctors in Sweden have been asked whether the new system is motivating them to become less concerned about their patients, but it is recognised that they have acquired a new attitude and an awareness of the resource aspects of health care. A report on the matter states:
"So far there are no indications that these changes of behaviour have led to a decreased quality of medical care (that is withdrawal of necessary and meaningful treatments). There are some indications of an increased quality in the service component of the care."
How many times have I heard Labour spokesmen state that "creeping privatisation" would lead to doctors being interested only in money and not in the care of their patients?
"It might seem strange to someone used to the NHS that a person can go to one specialist in the morning and if not satisfied see another in the afternoon . . . In France most people expect to go out from the doctor's with a prescription. It is difficult for a doctor to refuse when a patient asks for a particular treatment, since the doctor might lose that client who could go to other doctors to find one who does not refuse."
France faces the problems of rising expenditure and an increasing debt that the Government cannot fund, and these are not unique to France. For years, some were convinced that the French system was the best in the world, but they ignored the fact that it had become too expensive and not as efficient as it should be. The report continues:
"However, despite all this, it will still be possible to survive under the present system, even if one is not rich!"
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