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Mr. Forth: Will the Secretary of State give way?
I do not have time this evening to spell out all we have been doing to change the health service, to change it for the better and--unlike the previous Government--to change it with the agreement and enthusiasm of the staff involved, but that is what we are determined to do and what we are doing.
It is nearly 50 years since the Labour Government founded the national health service, in the teeth of opposition from the Tory party. They founded it on the basis that the best health services should be available to all: that quality and equality should be available to all. Those principles were put into practice. The NHS worked--until recently--exceptionally well.
The system was fair to patients and, because of that, it was comfortable for staff to run it. It was based on need, so it was clinically sound; people were treated because they needed to be treated. It was managerially straightforward because such a system kept paperwork to a minimum. As a result of the Tory changes, the NHS developed into a two-tier system that was unfair to patients, repugnant to the staff who had to run it and managerially complex and wasteful. That is why we are ending the internal market, as we promised in our manifesto.
Next year will mark the 50th anniversary of the national health service, which has served our country so well for so long. People everywhere will want to celebrate that anniversary; so we should and so we will. We will pay tribute to the founders of the NHS and to the generations of dedicated people who have made it work, but we must resist the temptation to spend the coming year looking back.
That is not what the founders of the health service did. They looked forward. They drew on their experience of what had gone before and they married that experience to their hopes of better things to come. That is what we must do: take stock of what we have, discard what does not work and build on what does. It is our job to fashion a health service for the future--for the next 50 years.
Sir Geoffrey Johnson Smith (Wealden):
I heard an interesting speech from my hon. Friend the Member for Stratford-on-Avon (Mr. Maples) and I expected something better from the Secretary of State for Health. After all, what he suggested--the sum of the reviews that are likely to come up--is that £80 million should be saved here and that £300 million should be saved somewhere else. Obviously, it is useful to be able to save some money, but what he has announced so far is peanuts in comparison with the NHS's total bill, of about £43.5 billion.
The Secretary of State's words would have carried more conviction if, when he said that nothing would be ruled out, he had outlined the sort of philosophical approach that he would bring to that phrase "nothing is ruled out". I should like to suggest to him some of the things that we would expect to come out of the review.
Frankly, the Secretary of State's speech was a disgrace to the House and to the way in which we run our health service. It was based on the same old party political battle. We claim to have made some progress in the pursuit of better health standards and of an improved health service. Anyone considering the standards that we have today, with the variety of operations, surgical techniques and the rest of it, would agree that we have made enormous strides, but, despite the innovations and improvements that have been made over many years, all we have had is an attack on what was achieved by the previous Government.
Basically, the attack has been based on the concept that what was introduced when the health service first came into being in this country, the principles that motivated it and the manner in which we financed it, could not in any sense be sacrificed.
The principles are fine--a service free at the point of demand. But do the Government really expect to be able to finance the further expectations of Britain's patients without changing the way in which those services are delivered? No country that examines the way in which we finance health care regards ours as the envy of the world. We know that, when the NHS started, patients' needs were simple compared with those of today. That is one reason why there has been such a huge escalation in costs.
The NHS had a budget of some £9 billion in 1979 when the Conservative Government took office and it is now spending £43.5 billion. Do the Government really expect to continue to meet some of their targets under the present system of financing the NHS? Do any of members of the Government believe that it can be done? Neither the Secretary of State nor his colleagues have accepted that there might be some need to reassess the financing of the NHS; on the contrary, they have consistently rubbished every achievement of the previous Government.
We know why the NHS, as financed, forces any Chancellor of the Exchequer to face up to enormous financial difficulties. First, there are more elderly people. The cost of providing care for elderly people has escalated beyond the imagination of those who founded the NHS. Secondly, the explosion of modern medical technology and diagnostic techniques has far surpassed anything that many envisaged when the NHS was introduced. Thirdly, as I have mentioned, as a consequence of the progress that has been made, expectations have risen.
Nothing that I have heard today has given me reason to believe that the Government understand that there is no point in trying to rubbish the previous Government's record at a time when there was a massive explosion in health expenditure in Britain unless nothing really is to be ruled out.
I can remember when there were cuts in the hospital building programme, not the increases that we have seen since 1979. I can remember when prescription charges were first introduced. I have seen not cuts but an increase in real terms in public expenditure on the NHS, the like of which was never achieved by a Labour Administration.
Mr. Hugh Bayley (City of York):
That is rubbish. It is not true.
Sir Geoffrey Johnson Smith:
It is not rubbish. There may have been the odd year when there were cuts. I have heard the hon. Gentleman speak on this subject, but he
Not one country that has sent an expert to Britain has followed our example of trying to finance the huge explosion in medical expenditure almost exclusively out of public funding. I would take more heart if the Secretary of State showed a little more humility as he approached his task, rather than trying to kid us that nothing will really change.
The right hon. Gentleman, like his predecessors, accuses us of not spending as much on health care as other countries, but he knows very well that, unlike us, other countries have not accepted that there should be a gap between private and public expenditure. They have managed to bring the private sector into the funding of their public health service, either through non-profit organisations or through private insurance and a raft of other methods. There is not the divide that exists in Britain.
I hope that, when the right hon. Gentleman comes to rule nothing out, he will examine the role of the friendly societies, the mutual societies and non-profit organisations and groups that try to run some of our hospitals. In the 19th century, they and the trade unions played their part, and they are only too willing to try to play their part today in bringing additional funding to the NHS.
Instead of denying to elderly people the right to some tax relief from the age of 60, the Government should encourage people through the tax system to take on some responsibility for their own health care. Unless people take on that responsibility, as people do in France, Holland, Spain and throughout the western world, the only way in which the needs of modern health care can be met will be through the taxpayer, and I do not believe that that will work.
The right hon. Gentleman knows that, despite the huge increase in expenditure, we face a serious problem. Britain has fewer consultants than Holland. The Government might try to discover why we go through so many GPs and why, compared with America and elsewhere in Europe, we do not have enough specialists. That is a problem that needs tackling face to face with the medical profession.
The Government might wonder why there are recruitment problems in the NHS. That might have something to do with the pay structure and doctors' working hours. They might also consider the disproportionate influx of doctors from overseas. When those doctors now in their 50s retire, the Government will have to find replacements for them. Will they come from overseas or will the Government increase expenditure on the training of medical students and attract more people to the profession? There are weaknesses in today's NHS, and I have heard nothing from the right hon. Gentleman about that.
I come now to a matter that I hope the Government will recognise deserves their attention as well as that of anyone else with an interest in the NHS. Why has the Labour party always regarded any form of health provision outside the NHS as, by definition, tainted with capitalism or private profit? That could not be further from the truth. I have here a document giving instances of how it is possible today for people, although on a
smaller scale than one would like, to give professional and financial help to the health service. It is a document written by Fabians called "Towards a More Cooperative Society: Ideas on the Future of the British Labour Movement and Independent Healthcare".
Why does the right hon. Gentleman not give some obeisance to such a document? Perhaps he wants to discard it, or perhaps it is the sort of approach that he would like to see introduced. It would have been better if he had shown some humility instead of indulging in the usual rabble rousing, saying how everything is rotten under the present system. It can be improved, and he knows how. I assume that some Labour Members believe that something of that nature can be done.
The Secretary of State for National Heritage, the right hon. Member for Islington, South and Finsbury (Mr. Smith), welcomed participation by the private sector. In The Times of 8 May 1996, he said:
"Surely it is time to get away from the sterile battle lines of public and private and instead look to how the two can best work together in the interests of the citizen--and in the interests of all citizens, at that."
The hon. Member for Hartlepool (Mr. Mandelson) and Mr. Roger Liddell claimed in their book "The Blair Revolution":
"New Labour's objective should be efficiency, diversity and innovation in the provision of public services--not privatisation for its own sake. Service providers will not necessarily be conventional private companies. They might be employee-owned or they might be co-operatives. Many will be in the voluntary sector . . . what is most desirable is the emergence of a new generation of 'social entrepreneurs'."
In other words, the distinction between private and public becomes irrelevant. That, I hope, is part of the thinking that leads the Secretary of State for Health to say that nothing is ruled out.
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