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Mr. Eric Forth (Bromley and Chislehurst): Will the Secretary of State give way?
I explained that the review was to be intellectually honest and thorough, and that therefore nothing was ruled out and nothing was ruled in. Of course that included charges, as the Chief Secretary to the Treasury told the House on 11 June.
Mr. Forth:
Before the right hon. Gentleman leaves the subject of truth, perhaps I may give him another opportunity to indulge in the use of that commodity. On Wednesday the Prime Minister said:
Mr. Dobson:
The right hon. Gentleman ought to know that there are currently charges for treatment at the point of receipt. Our election manifesto included other promises relating to the national health service. We promised:
Mr. Simon Hughes (Southwark, North and Bermondsey):
The Secretary of State knows, because I have said it in the House, that it is perfectly proper for an incoming Government to look at Government spending and the spending of each Department. There is no argument about that. However, the debate is about the raising of money, and it would be helpful if the Secretary of State could answer a simple question. Why have the Government decided, according to what we have heard about the review, that charging is ruled in as a way to raise money for the health service while further taxes are ruled out?
Mr. Dobson:
We intend to keep all our manifesto pledges, some of which relate to income tax. I know that the hon. Gentleman's party has made some manifesto pledges in the opposite direction about tax, but as we won the election we have to keep our election promises and not his.
There is no point in the Tories bleating about prescription and other charges. They increased prescription charges tenfold and top dental charges elevenfold. They pushed through the House laws that forced pensioners to pay for eye tests and dental examinations. They also failed to deal with the unfairness and the anomalies in the current charging arrangements. As the Chief Secretary to the Treasury has told the House, we will not ignore that unfairness and the review will look at the anomalies.
I shall give some examples of anomalies that the Conservative Government were apparently quite happy to put up with. The present exemptions from charges were agreed in 1968 but much has happened since then. There is now transplant surgery. Under the 1968 arrangements, people who needed lifelong medication were supposed to get free prescriptions, but transplant patients do not even get free prescriptions for their anti-rejection drugs. Another example is that people who receive chemotherapy for cancer and who have lost their hair can get free wigs if they are in-patients but must pay for them if they are day patients.
There is also the ridiculous case of elastic support stockings. Those who need two such stockings have to pay for two prescriptions, one for each leg. That is the anomalous charging system with which the Conservative Government were apparently quite content. As we know, that system is wide open to fraud, about which the Tory Government did next to nothing. What can one say about a system about which the official report stated that more than one pharmacist conceded that they had accepted forms from men who claimed exemption on the ground of pregnancy? That is the system that the Tory Government were happy to run and which the Tory party would like to protect.
Unlike the Conservative Government, we are prepared to take action to stop the fraud that is haemorrhaging £85 million a year from the NHS. We shall incorporate anti-theft and anti-counterfeiting devices in the printing of prescription forms. We shall have a scheme to reward pharmacies which detect stolen or counterfeit prescription forms. We are working on a new criminal offence of evading a prescription charge and on a fixed penalty for non-payment. We are examining the use of an electronic data interchange system for transferring prescription information, and we want to make more effective use of information technology by the fraud investigation unit.
Mr. Maples:
Will the new criminal offence apply to people who try to get out of paying their GPs for going to see them?
Mr. Dobson:
If Opposition Members who were in government, one at the Treasury and the other a Secretary of State, had done anything about fraud, this year the NHS would have £85 million more to spend on patients.
Every aspect of the NHS will be carefully examined in our comprehensive review. It will be careful and thorough and will involve Health Department officials, NHS staff and people from outside both services. I and other Ministers will be involved at all stages. As I have said, we shall judge all the propositions that are put to us against the need to keep our promise that access to the national health service will be based on need and need alone and not on the ability to pay.
Mr. Dobson:
I shall finish this point before giving way.
I say to hon. Members, those in the health service and others, do not judge our review by what other people say is going into it. Judge it by what comes out of it. It is a bit like judging an operation, because it is the outcome that counts.
Mr. Michael Jack (Fylde):
I am grateful to the Secretary of State for outlining how we should judge the
Mr. Dobson:
As I have said about three times and as I have said outside the House--causing a fracas--we shall consider everything in the review and publish such information as we think proper when we publish the outcome. I understand that every Department will publish the terms of reference of each review. That in itself will be a giant step in terms of public information about Government reviews of spending, because the Conservative Government never did that.
Mr. Dobson:
I shall not give way.
I shall accept no Tory criticism of our review. The systematic way in which we are going about the review is in marked contrast to the way that the Tory Government formulated their health policy. Their reorganisation of primary care was based on advice from a Tory doctor who was a smackhead, Dr Clive Froggatt. He advised Margaret Thatcher and successive Tory Health Secretaries, ending up with the right hon. Member for South-West Surrey (Mrs. Bottomley). He told the Observer that he was taking heroin every day
Let me emphasise that the NHS is not going to stand still while the review is going on. We are getting on with keeping our election promises. We have already started cutting paperwork and unnecessary management costs, shifting the money instead into patient care. We have deferred the eighth round of fundholding and that has released £20 million from the NHS budget. That money has been redeployed. The first £10 million has gone into breast cancer diagnosis and treatment. Another £5 million is going into improving children's intensive care.
Surely everyone has to accept that that money is better spent on women and children in need than on the paperwork of fundholding, which is where the previous Government were going to spend it.
Mr. Forth:
Will the Secretary of State give way?
Mr. Dobson:
Because I do not want to. Other hon. Members want to speak and this is a short debate.
We are following that up by taking further steps to reduce the flow of invoices and other costly paperwork. To end the two-tier system, we will introduce a system of common waiting lists so that people are treated on the basis of need and need alone. That was our promise in our election manifesto and we will keep it.
With the support of clinical professionals, we are encouraging new ways of improving primary care and we are developing pilot schemes for local commissioning to take the place of fundholding and health authority contracting. The Minister of State, Department of Health, my hon. Friend the Member for Darlington (Mr. Milburn), will make an announcement about that shortly.
We have been sorting out the shambles that the Tory Government used to grace with the title "private finance initiative". They could have been prosecuted under the Trade Descriptions Act 1968, because they displayed no initiative and raised no finance. Far from keeping things private, they repeatedly made misleading public statements. They boasted about using the PFI to build hospitals and never built any. We will get them built using the PFI.
As our manifesto also promised, we are taking action against tobacco advertising. On 14 July, we are hosting an international summit on tobacco, which is being organised by the Minister of State, Department of Health, my hon. Friend the Member for Dulwich and West Norwood (Ms Jowell). We are also keeping our promise to establish an independent food standards agency.
We have commenced a drive to reduce inequalities in health. Poor people are ill more often and die sooner, and the ultimate inequality is the difference between being alive and being dead. Under the previous Government, the words "inequalities in health" were described as politically incorrect and the only phrase that civil servants were allowed to use in the Department of Health was "variations in health". The previous Government could not even stand the truth on that.
We have established an NHS efficiency task force to root out inefficiency and to identify savings throughout the NHS. The Under-Secretary of State for Health, my hon. Friend the Member for Brent, South (Mr. Boateng), is reviewing long-term care for elderly people and other groups, and he is making a series of visits throughout the country to promote more and better co-operation between health authorities, trusts and local authorities.
"We will have a national health service restored to the basic principles of the British NHS--the health service that we founded".--[Official Report, 18 June 1997; Vol. 296, c. 304.]
Is one of the principles of the NHS to which the Prime Minister alluded that no patient should ever be charged at the point of treatment?
"If you are ill or injured there will be an NHS there to help . . . access to it will be based on need and need alone, not on your ability to pay or who your GP happens to be or where you live".
Every aspect of our spending review will be judged against those criteria. The questions will be: would a particular proposal mean that access remained based on need alone or would it mean that access became related to the ability to pay? Would the introduction or the increase of a charge put people off seeking the treatment or care that they need? We intend to keep our promises, and they are the criteria that we shall use to make judgments in the review.
"shooting up before meetings with Ministers".
He added:
"no-one in Westminster noticed anything wrong".
Conservative Members may be interested to know how he financed his heroin habit. He did it through prescription fraud, obtaining pure heroin in the names of dead or terminally ill patients. He ended up being convicted for fraud. Therefore, the Tories were advised on their major reorganisation of the NHS by a junkie and a fraudster. No wonder it is in such an organisational mess. No wonder we need a review.
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