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Sir Geoffrey Johnson Smith: Why not?
Mr. Hughes: Because for a long time, certainly until about three years ago, the NHS was not regarded as safe in the hands of the Tory party. Lady Thatcher's actions gave no great credibility to the claim that the health service would be safe in Tory hands. To his credit, her successor as Prime Minister tried hard to ensure that the NHS was seen to be as strongly supported and cared for by the Tories as by other parties.
Although there were many reasons for us to criticise the Tory Government on health--the two-tier system, the differing speed of treatment depending on who a patient's general practitioner was and the differing access to the health service depending on where a patient lived--I have never alleged that the right hon. Member for Huntingdon (Mr. Major) sought to do other than to preserve the NHS as a service paid for through taxation, or that he intended to privatise it. That was another unjustifiable allegation.
I did not know the precise date until my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) went round the corner just now to check, but I can now confirm that it was on 10 May 1951--seven days before I was born--that the then Labour Government passed
Let us strip away the pretence. There have been charges in the health service since its inception. That is why it is perfectly proper for a new Government to consider charges. As one of the authors of the health section of our manifesto and a member of our policy committee, I made sure that our policies on health were worded correctly. We had a manifesto commitment at the election to freeze prescription charges, but then to review them. There are clearly all sorts of anomalies in the system of prescription charges. I have been in Committees that have addressed the matter, but never dealt with it.
Having also considered charges for eye tests and dental checks, we went into the election with the clear view that, on balance, they ought to go. People understood that we made a costed commitment to abolish charges for dental and eye checks. There may be a debate about whether that was right, but we carried out a review and came to that conclusion.
Mr. Paul Burstow (Sutton and Cheam):
I want to draw my hon. Friend's attention to an interesting answer to a written question that I received today, which is relevant to the debate. Does he agree that eye test charges deter people from taking the opportunity of having a regular eye check and therefore from gaining the health benefit that they would derive from it, and that free eye tests are a sound investment in preventive health care? Does he therefore share my surprise that, in the written answer that I received today, Ministers admitted that they have not even drawn up the terms of reference for a review of eye test charges and that no research has been commissioned? That seems strange.
Does my hon. Friend agree that the charges should be ended now, not later? More than 500,000 people over the age of 60 are not having regular eye tests. They are running the risk of losing their sight and will cost the health service far more as a consequence.
Mr. Deputy Speaker (Mr. Michael Lord):
Order. I remind the House that interventions must be brief and to the point.
Mr. Hughes:
My hon. Friend was getting carried away by the novelty of being able to make an intervention, but his point was valid. [Hon. Members: "But long-winded."] No. He was referring to a ministerial answer. I do not know and the Minister on the Front Bench now may not know precisely what the Chancellor will say next week. Indeed, I hope for his sake that he does not, because such matters are meant to be kept in the Treasury. However, the Chancellor has the option to deal with some of those matters next week.
One of the valid criticisms of the Government's review is that it appears to have no terms of reference apart from the generic phrase, "Nothing is ruled in and nothing is ruled out." There is a problem with that--it is not true. Of course it is appropriate to review spending in the NHS. I sought to put that point to the Secretary of State earlier and the Minister knows that I share his view. Money may be wastefully spent on all sorts of things, although I believe that the NHS is pretty well squeezed down because the Tory Government required it to cut costs year on year. However, we are talking not about expenditure but about raising revenue, and I have to tell Ministers on the Treasury Bench that they are different things.
Revenue is raised for the health service traditionally from only two sources--taxes or charges. I am not aware that significant amounts of money come in in any other way. The NHS can of course sell land if it is surplus to requirements and charge for private services that it contracts out, but the fundamental sources of revenue are taxes and charges. So today we need to hear where the Government stand on both those things. Sadly, and unfortunately for the Government, they have fudged the issue on both.
The argument is made even easier for Opposition Members. When the Labour party was in opposition only a year ago, it knew the score as well as it knows the score now. The right hon. Member for Edinburgh, Central (Mr. Darling), now the Chief Secretary to the Treasury, said in the Budget debate last November:
I do not believe that hon. Members from any party will find a single constituent who believes that a projected increase in health service spending of 0.2 per cent. per year for the next two years is enough when we have had 3 per cent. per year for the past five years. So someone has to grasp the nettle and say that more money must be collected from somewhere. It is no good waiting until the year after the year after next.
We have a deficit this year in the health service of about £300 million. The Minister of State, Department of Health, the hon. Member for Darlington (Mr. Milburn), has admitted it. He asked the questions when he was shadowing the health team in the previous Government.
The Minister of State, Department of Health (Mr. Alan Milburn):
No.
Mr. Hughes:
I shall give way to the Minister if he wishes. The figures on trusts and authorities at the end of the last financial year show a deficit of £300 million. If the Minister wants to correct me, I stand to be corrected. There has been a cumulative pattern. In the past few years, by all sorts of funny dealings, health authorities and trusts have had to borrow against the money ahead of them to keep themselves afloat. They have a duty to balance their budgets. That money could be found now and the debts could be paid off, but it can be found only from charges or from taxes.
My colleagues and I have said today, as we said before the election, that the money ought to be found by increasing taxes. Even if the Government want to hold to their commitment not to increase income tax, when the Chancellor comes to the House next week, he ought to find other taxes by which he can raise money for the health service. We offered to the Government and we offer them again the suggestion of an increase in employers' national insurance contributions, so that everything given to an employee as a perk as opposed to salary is chargeable. That would raise about £250 million
according to Treasury figures and more than £300 million according to our figures. The Government could put extra tax on cigarettes. According to the last Government figures, 5p on a packet of cigarettes produced about £200 million. That could make free dental and eye checks available again.
I am not telling the Chancellor to do either of the specific things that I have suggested, but the immediate need is not for the end-product of a review with no terms of reference, but to bring some money into the health service. If that does not happen, the Government can have a wonderful review. They can save money and in two or three years we may get the benefit of those savings. But the review will not benefit now the people who are waiting for 18 months between seeing a consultant and being treated. It will not deliver for the many people who are not being treated by the NHS today.
Another nonsense was again confirmed by the Chief Secretary to the Treasury the other day. There was a bit of a wobble in the Government at the weekend because it looked for a while as if they might change their position. Even if Government policy is successful--I hope that it is--and the social security bill goes down and more people go back to work--I hope that they do--we shall not be able to transfer the money saved from the Department of Social Security to the Department of Health. That is lunacy. Even if one is being the iron Chancellor and saying that the Government will not increase public expenditure overall above the Tory planned levels, it is nonsense not to be willing to spend the £30 million, £40 million or £50 million saved from one Department when people are knocking at the door of another.
I remember when the Prime Minister said that Labour would never put dogma before children's education. I ask the Minister to pass on personally, before Wednesday, my request to the Prime Minister and to the Chancellor that they should say that Labour will never put dogma before patients' health. It is dogma, and dogma alone, which prevents the Labour party from saying to the House, "We have inherited certain conditions, but patients and youngsters at school are the priority for the country, and we must produce some more money for them." Political U-turns can be popular. To say that one is wrong and to change before it is too late is better done early, before the winter comes and people are waiting on trolleys, and the Government find themselves under attacks similar to those made against the previous Government. I hope that the Government undertake that change.
I have a few questions that relate to where the necessary money will come from. The Government have made an honourable commitment to reduce the number of people on waiting lists by 100,000. How will we know when that is achieved? If the waiting lists go up by 500,000, will the Government then say, "Ah, that figure should have been 600,000." We need a few rules to judge how Government money will reduce the waiting list by 100,000 people.
The Government have also said that they will get rid of the Tory internal market. The Minister knows that I share his view about that, but I want to know when and how it will be possible for the constituents of Southwark, Darlington, Dartford and all the rest to receive the same treatment from their GPs, irrespective of whether they are fundholders.
There is also the mystery about the private finance initiative. First of all the Government said that they were against it, then they were for it and now they do not know. Eventually, the Government will have to come up with a clear view about a proper policy of public-private partnership in the health service. I am absolutely convinced that the Minister does not think that the PFI is wonderful, although I know that he will have to let a couple of schemes through on the nod, because some are banging at the door to be agreed. We must have a stable system that provides secure finance for capital expenditure in the health service, and that will not achieved by the PFI.
As for charges, I want to put my cards on the table. The Government have quoted their manifesto commitment, so let me do the same:
The Government have also not addressed what will happen to a person who needs a particular drug, which he normally has to pay for on prescription. According to the Labour manifesto statement, if that person has a clinical need or a health need for that drug, it should be free. According to the press release of 13 June, the Labour party pledged that NHS care would be available to all according to need and would be free at the point of use.
If the NHS was bizarre enough to plan for someone to stay on a water bed in a five-star hotel while waiting for an operation, there is all the difference in the world between charging for that, which has nothing to do with health need, or charging for cosmetic treatment in terms of the surgery involved or the appliances used--again, nothing to do with health need--and charging people for things that they need because of a clinical condition. That is the test.
We believe that the Labour Government should have been able to say that there would a review of spending and charging, but that they had some principles to which they would adhere. They should make it clear now that they will not charge for the health care that the NHS provides, because that will be funded by taxation.
We thought about those matters before the election. I agree with the hon. Member for Stratford-on-Avon (Mr. Maples): the Labour party has had 18 years to think about what it would do when in government and, having arrived after 18 years' preparation, it is a bit thin, weak and inadequate for it to come to the country and say, "We know there is a problem and we know we need the money, but we haven't got a clue yet about how we're going to raise it." That just ain't no answer. It really is inadequate.
Two thirds of my constituents are on welfare benefits; 25 per cent. are out of work; and I probably represent fewer people with private health care--apart from those in the new riverside developments--than any other Member of Parliament. My constituents are troubled by
the thought that the Labour party has not sorted out its line on those matters and is now introducing an agenda item that had not previously been thought of.
In conclusion, I offer the Minister some suggestions. Tell the Chancellor to raise some taxes in the Budget next week. For example, about £500 million would be relatively painless, and I gave two suggestions earlier on how that could be done. Fund a moratorium on London and outside London reductions in service, so that we can see what is going on before planning what we do next. [Interruption.] I am asked how much that would cost; the answer is that it would cost about £185 million. Merge trusts in the many places around the country where separate community and acute trusts are not needed and we shall save a lot of money.
"An Act to authorise the making and recovery of charges in respect of certain dental and optical appliances under the National Health Service Act, 1946, and the National Health Service (Scotland) Act, 1947".
There have been charges in the NHS since the first post-war Labour Government. They were fought about in the post-war Labour party, but in the end the Labour Government introduced both the facility to charge and some charges. Of course they have been extended. They were supported and retained by the Labour Government in the 1970s and then extended again--in our view unacceptably--by the Tory Government under Lady Thatcher, who introduced charges for dental checks and optical tests for people who wanted to check whether they needed treatment.
"a year after the general election"--
he was looking at the Red Book for the coming year--
"we find that spending on health is set to be reduced in real terms. . . . It is abundantly clear in the Red Book that public spending on the health service is due to be reduced in real terms."--[Official Report, 3 December 1996; Vol. 286, c. 896.]
The present Prime Minister, then the Leader of the Opposition, said earlier in the Budget debates:
"the Department of Health's actual total spending in the year after next . . . will in fact fall by 0.7 per cent."--[Official Report, 26 November 1996; Vol. 286, c. 176.]
If that was true then, to some of us it was bizarre that, until about a week before the election campaign began, the Labour party was committed to spending on the health service that was below even that of the then Tory Government. In a belated conversion--in Essex, if I remember correctly--the present Chancellor decided that he would up the amount of tax and spending to which the Labour party was committed to the same as that to which the Tories were committed. It is clearly not enough.
"Labour commits itself anew to the historic principle: that if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone--not on your ability to pay, or on who your GP happens to be or on where you live."
That pledge has some significant implications. It means that the Government should rule out now that people would be charged to see their GP or hospital doctor. If one was charged, by definition the NHS would be governed by payment at the point of access, and would not be free.
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