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Mr. William Cash (Stafford): Will the hon. Gentleman take sides on rural dispensing from surgeries and the provision of such services by prescription? Would the Liberals abolish the monopoly in a one-mile radius around existing provision of prescriptions in rural areas? What is the Liberal position on cloning and genetic engineering?
Mr. Hughes: I shall not deal with the second, complicated issue that the hon. Gentleman raises; I could not in a sentence do justice to it. On the first issue, the presumption should be that the present dispensing system should continue. However, it must be patient-determined. Where there is not local access to a service provided by an existing practitioner, there needs to be some liberalisation of the service. I am willing to give the hon. Gentleman a copy of the considered, lengthier statement of our position. It is on record and is not a secret, but it is obviously controversial. I have heard the hon. Gentleman speak about the matter in the House before and I am aware of his regular interest.
There are clearly things wrong with the system that the Government have introduced. First, all general practitioners should be treated equally and funded in the same way. There should be no differential according to whether or not they are in a fundholding practice. They should be funded according to their number of patients and the make-up of their practice in terms of local statistical factors such as morbidity, ethnicity and mortality.
Secondly, we should not have a system whereby a patient who goes through the door of one GP receives speedier treatment from the local trust than the patient of another doctor by virtue of the former GP's status as a fundholder. That is evidence of a two-tier health service--it is not worth arguing about that--which is not a national health service available to all.
Other inequalities must also be dealt with. Depending on where one lives, one may not be able to get a dentist on the NHS. Again, there is no longer an equal health service. Depending on where one lives, the chances of being operated on speedily vary hugely because waiting lists are different. Depending on where one lives, one may have a much higher chance of having one's operation cancelled.
As I said in the context of community care, we believe that it is important to establish a national inspectorate of health and social care. Its work would be complementary to that of the Audit Commission and it could check independently to ensure that good practice exists whether in the surgery, clinic, hospital or wherever. The education service benefits from the existence of Ofsted. We need a similar body in the health service which can say, "That is not good enough; you must improve."
The last and most crucial issue is funding, which the right hon. Member for Wealden has already discussed. We must address fundamentally where we will get the money for the NHS. We have a cheap health service, which costs us 7p in the pound--we pay less than nearly every other comparable country. The Americans pay the equivalent of 14p in the pound for a far less good health service. We must debate whether more public sector money and more taxes should be devoted to our health service. My party has debated that for the past two years and we have come to the conclusion that, certainly in the short and medium term, the NHS should be funded more from taxation and from public funds. That is why we have made various commitments. I know that that promise may prove unpopular at the general election, but that is the risk we take. In fact, I do not think that that commitment will be unpopular, because I believe that the public want more public money spent on their public health service.
We have made five commitments. First, NHS funding should be guaranteed year on year on year on year on year, but our policy is different from that of the Tories, because we believe that funding should keep pace with NHS inflation not national inflation, which is running at a lower rate. It is no good giving a year on year increase if, in real terms, it does not keep pace with the cost of running the service.
Secondly, we must remove the most bureaucratic elements from the system. I am not slating managers. We need good health service managers, but we do not need people to manage a system when one does not need that part of the system. Money can be saved from bureaucracy. We are not, however, at the beginning of a five-year programme, committed to spending money to be derived from that saving. Unlike the Labour party, I do not believe that one can obtain £100 million overnight from a pot marked "bureaucracy savings". [Interruption.] It is completely impossible to save £100 million overnight after the general election from bureaucracy savings. It is a figment of imagination, and that money will not immediately exist.
Sir Geoffrey Johnson Smith:
As the hon. Gentleman has rightly pointed out, we are in agreement on certain facts. I should like to question his desire that we should look to the taxpayer to fund the ever-growing gap between resources and people's needs. That gap is apparent in this country and others and nearly all countries are considering how far private provision can play a role even though the main bulk of the expenditure provided will come from public funds. That possibility must be addressed, otherwise expenditure of £150 million year on year on year will be just peanuts.
Mr. Hughes:
I understand that. Let me clarify that our £150 million yearly commitment is just to reduce the waiting lists. We have committed in total £550 million each year for five years above the inflation-linked amount. I disagree with the right hon. Gentleman that we need to change fundamentally the funding of the health service and opt for an increasingly privately funded one. I am happy to be honest with the right hon. Gentleman because we need to look beyond our manifestos and the general election. The health service in Britain provides a huge amount of fee-paying treatment for people from abroad.
I believe that in the next Parliament we will also have a debate about whether we should abolish national insurance in favour of a separate health and social care tax. The right hon. Gentleman is aware that national insurance contributions no longer fund pensions. They are not directly related to pensions; instead they go into the great Government kitty over the road at the Treasury. I understand that the right hon. Gentleman hopes to be a Member of the next Parliament--with a majority of 20,000 he should be, otherwise the Tories will be in trouble--and on that assumption I look forward to debating that issue with him. We need an urgent debate on the longer-term issues.
Returning to the present funding commitments, the specific list of changes from which the health service would benefit desperately also includes the provision of its funds three years at a time and a move to a minimum of three-year contracts between health authorities and trusts. As the hon. Member for Morley and Leeds, South (Mr. Gunnell) has already said, it should also benefit from a fair allocation policy, according to which the capitation formula should apply fully across the country. That would mean that that formula is not applied partially, according to local criteria. We must correct the current inequity governing the application of the funding formula throughout the country.
Today's great debate has been about waiting lists. The Secretary of State admitted to me that it is unarguable that waiting lists are at their highest level. That is not the end of the story. It matters to the individual more how long he or she waits than how many people have to wait. A study of the relevant table of figures since 1974 reveals two things which are pertinent and interesting. First, according to the figures as they were compiled then, I am afraid to say that from 1974 to 1979, when the Labour party was last in Government, waiting lists consistently went up. That is according to figures provided by the Library, which record that in every quarter of every year the number of patients waiting increased. Secondly, the figures started to come down only in September 1979. They then bounced around and went up and down, but in recent years the number of patients waiting for treatment went down. Those figures have however, started to increase in the past year.
I have tried to persuade the Secretary of State and the Labour spokesman that we must collect independently the relevant statistics. I am not impugning the integrity of the statisticians, but these sorts of figures should be produced independently so that the relevant factual information is taken out of the political debate. Statistics change, as does the assessment of them. We now include the number of day cases treated, as well as all sorts of other information. The key thing that people outside are aware of, however, is that in recent times waiting lists have started to go up. Now, people are not even being treated within 18 months, as stipulated in the patients charter.
The figures relating to the time between one's first consultation and treatment also provide just half the story, because one must often wait a hell of a long time between the first appointment and the consultation. We therefore need to study two sets of figures.
We have all studied the current figures. I did the same thing when I did my duty in the Wirral last week--incidentally, I was born in Cheshire and have family in that part of the world. I visited Clatterbridge hospital; it is brilliant and offers an extremely good service. That hospital has done well although there remains a debate about whether it should provide accident and emergency facilities. According to Government figures, however, in the past year, more than 200 operations were cancelled at the last minute in the Wirral. Figures are set out for every quarter. Some patients are not being readmitted to hospital for operations within the one month waiting time stipulated by the patients charter.
We must establish standards that are met. If we have a patients charter that says that if one's operation is cancelled, one will be admitted within a month of that cancellation, that must happen. If not, the charter is a paper tiger and there is no use having it. If the patients charter states that a patient should be seen and admitted within a maximum of 18 months, we must honour that commitment. People must have a right to enforce it--their inability to do so is one of the weaknesses of the current system.
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