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11.23 am

Sir Geoffrey Johnson Smith (Wealden): It is a pleasure to follow the hon. Member for Blaenau Gwent (Mr. Smith), who represents a constituency that, as he said, was once represented by the right hon. Gentleman who is associated with the founding of the national health service, the 50th anniversary of which we are celebrating.

Let me say en passant that I understand the philosophy behind the primary care groups, but we do not contemplate anything in my part of England that would be as large as the hon. Gentleman suggested for his part of Wales. The group that has been proposed for my health authority would involve 50-odd general practitioners and cover a population of 80,000.

I know a little about the medical profession, and I find that GPs have their own way of doing things: they and other members of the medical profession rightly have an independence of attitude towards the way in which they carry out their duties and ply their skills. There are those in rural practices who have developed particular attitudes to fit the needs of their patients, and if we amalgamate all those people with their different priorities, combining urban and rural areas, I fancy that it will not always be easy to find the harmony that one would expect among professional people carrying out their duties on behalf of the public.

I do not want to go into great detail, because I want to cover a wider canvas on the question of the national health service, but I want to fire a warning shot across the Minister's bows--I welcome his presence, because I know that he takes a keen and practical interest in these matters--to show that I hope to get an assurance, at some future date, that my worst fears are not well founded.

It is an honour to speak in this debate and to pay tribute to the national health service and to all those who work or have worked in it, giving of their time, skill and dedication--bywords among many of us who have had the opportunity to meet at their work those who have given such excellent service to the public.

I was almost in at the birth of the national health service, as I am one of the few Members of Parliament who was alive and well at the time of its introduction. Little did I know that, some years later, I would represent the constituency now represented by the Secretary of State for Health--Holborn and St. Pancras, South, as it then was--which contains some of the finest teaching hospitals in the world. I got to know members of the medical profession, nursing staff and administrators extremely well. I pay a warm tribute to them, as they carry on the best traditions of medicine to be found anywhere on the globe.

I also compliment those who give service in my health authority area--they are dedicated, as one would expect, and try to observe the highest standards, although it is not always easy for them so to do--and especially those who give of their time and money to help out the smaller hospitals.

We are fortunate enough to have two community hospitals. It took two deputations to persuade the previous Government not to close the community hospital at Crowborough, which, like so many in the 19th century, was founded by voluntary contributions. Today, it is still charged with raising £2 million--it has raised £1 million--to ensure, with help from the health authority, that it can be modernised and fulfil the

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important function of allowing elderly people and women with babies not to have to travel to the district general hospital in a congested town far away. I pay an especially warm tribute to the voluntary side, which has spent so much time trying to raise money, with some success, although there is still a long way to go.

I also congratulate the previous Government, whom I have heard rubbished on more than one occasion, including at yesterday's Question Time. It is now part of the ritual to say, "No, we spent more than you did," "No, you didn't, you spent less," "You destroyed what we tried to build up," and so on. All new Governments say such things. The previous Government did the same after the cuts in the health service imposed by the previous Labour Government during the stormy economic days of 1976 to 1979.

I wish to goodness that we could get rid of some of the ridiculous party politics. One reason why the national health service is failing us--not in terms of health, but in terms of its structure--is that the concept of it leads to too much low-grade politicking. I try to avoid that, but I do not think that it was pointed out yesterday that, overall, we increased expenditure on the health service by 3 per cent. in real terms. Of course, the amount varied from one year to another; we would have liked a smoother financial passage.

When the last Conservative Government came to office in 1979, expenditure on the NHS in England, as opposed to the United Kingdom as a whole, was some £9 billion. When we left office, it was well over £35 billion--and that was not small beer. We spent more, standards improved, and so it went on. I do not think that that record should be rubbished.

Nor should our record be rubbished in respect of the birth of the national health service. It is true that Conservative Members of Parliament opposed it, but so did doctors. It should not be assumed that a politician who opposes the NHS does not care for the people, any more than doctors who opposed it should be accused of not caring for the people. What they did not like was state control over health matters, which they saw as socialism.

Even Lord Beveridge, the architect of the modern welfare state, was not keen on the creation of a national health service. He had certain things to say about it. They may sound rather old-fashioned now, but I think that they are worth repeating. He said:

That is, perhaps, a rather Victorian concept.

Beveridge went on to say:

He referred to

    "the importance of securing that suitable hospital treatment is available for every citizen and that recourse to it, at the earliest moment when it becomes desirable, is not delayed by any financial considerations. From this point of view, previous contribution"--

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    through the insurance system, I assume--

    "is . . . better even than the free service supported by the tax-payer. People will take what they have already paid for without delay when they need it, and they pay for it more directly as contributors than as tax-payers."

It is possible that, because it is free at the point of demand, the NHS has weakened that link--weakened the citizen's feeling that he should take responsibility for his own health, and his awareness of the connection between his treatment and the cost to the nation, as well as to his family. That point is ripe for debate, because it cuts right across the concept of the service being free at the point of demand. I am merely quoting the views of someone who was not cruel or hard-hearted, and who recognised the importance of health treatment to the poorer members of the community, but who thought that there was another way--perhaps a more responsible way--of ensuring that there was a link between the insurance taken out by a citizen and the service that he received as a consequence.

The hon. Member for Blaenau Gwent spoke of Aneurin Bevan's dedication to the health service. Bevan, however, realised that he was opening the floodgates. He referred to the cascade of medicine that would flow down the throats of the British people. Even at that time, he was aware of the mounting costs of the health service. Although he did not want to, Bevan--and the House of Commons--had to accept that prescription charges would have to be introduced. Then came the question of paying for spectacles, and so on.

Bevan was clearly disappointed, because he resigned, but he understood what had happened. He is on record as saying that costs were increasing at an alarming rate--more than he had ever imagined.

Mr. Llew Smith: If the right hon. Gentleman reads Nye Bevan's resignation speech, he will see that Bevan resigned not just over prescription charges, but over such issues as defence spending. He thought that one area of spending was causing problems to another. It is interesting to read that speech.

Sir Geoffrey Johnson Smith: I am sure it is, but I do not think it can be denied that Bevan realised that the floodgates had been opened to heavy expenditure that he had not envisaged. I lived through it, and I know that, at the time, many people said that the health of the nation would improve and that costs would therefore fall. How wrong they were. I cannot criticise them, because that was the received wisdom at the time; but they did not realise that the health service was not the only vehicle for improving the health of the nation. Health can be improved by a better standard of living--by a better diet, better housing and better education. The health of the nation does not improve markedly more than that of any other nation because we have a national health service.

Although I admire what has been done and what is still being done, I think that we must face up to the reality of the NHS and what it has achieved. We should not just look back; we need to look forward, and ask ourselves how we can provide a better and more affordable health service. The present system is not good enough, for many reasons. It can be improved.

Since 1948, most countries have looked at their own health services. Germany, for instance, has continued with a system that was introduced years ago by Bismarck.

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Its system of compulsory insurance for health treatment must have influenced Beveridge; otherwise, he would not have made the comments that I quoted. New Zealand, Canada and Holland have looked at their health services in recent years, and have introduced reforms on the principle to which most of us adhere: that the door should not be closed to people who happen to be poor. Such people should not be deprived of decent medical care.

Interestingly, not one country that has examined our system has adopted it. That should make us, on this 50th anniversary, take stock of the present situation, and ask ourselves what we can do to improve our service in the face of rising costs--costs that I cannot see declining, for several reasons.

First, the health service is labour intensive. As the Minister knows, a fair proportion of low-paid people work for the NHS. One reason why they put up with low pay is their feeling that they are doing something for others: that voluntary spirit is very strong in the health service. Those workers are better paid than many others, but, given the range of skills that they possess, and the salaries that such skills would command in other walks of life, they are not overpaid, by a long chalk. If we want to improve recruitment and reduce the notorious wastage in the NHS--especially among nurses--we must consider that point.

Secondly, there is the problem of the aging population, but I shall not dwell on that. Then there are the sensational advances in medical care and diagnostic technology. We all know how expensive that technology is. Someone was telling me the other day--I do not know whether it is true--that a little drip feed that could once be bought for very little now costs £140. Why is it so expensive? It is computerised, so doctors do not need to attend to it. They know what is going into the patient, and whether the mixture is right. That is a great advance, but it is expensive.

Expectations are always rising. I will never forget being absolutely astonished to meet a woman who I thought had gone into hospital, but who was back and walking after her hip operation. It is not uncommon to meet people who have had two hip operations. Expectations are rising because people know that a wide range of surgical techniques hitherto undreamt of--and certainly unthought of by the medical profession at the foundation of the health service--are now available, and might improve the quality of their lives.

Dr. Chris Adams, a consultant to the department of neurosurgery at the Radcliffe infirmary, Oxford, is not regarded as a wild, radical doctor who runs ahead of the pack. In the November edition of Parliamentary Review, whose editorial judgment would, one assumes, lead it to employ only those whom it believes to be reasonably rational, Dr. Adams said:

However, we need not feel guilty about that,

    "Because each year advances make medicine more expensive--and that trend will accelerate. This country cannot afford a comprehensive free health service, and it is not providing one."

He went on to say, as others do, that we should not put up with the present system of rationing. It is, of course, not always called "rationing", but there are long waiting lists for certain treatments for which there is great demand. If one believes that the health service should be free at the point of demand, one might argue that that is immoral.

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I do not want to generate party political heat, so I recognise that the Government do not accept that gloomy prognosis. The White Paper takes a different view, saying that, at its best, the NHS is the envy of the world. I do not use the word "envy"; I have seen too often how other countries employ the best techniques. I do not envy them that; they are pretty good, and we are pretty good, too, and have institutions and practices that are as good as any. However, as the hon. Member for Blaenau Gwent said, we are a rich country, so that might be expected.

The White Paper also says that the Government reject arguments that the NHS cannot cope with the pressure of public expenditure without a huge increase in taxation or charges for services or radical restriction in patient care. It states:

It also says that the NHS has met past challenges and will rise to future ones. It is not my purpose to say dogmatically that the Government are wrong, but hon. Members may have gathered that I have my doubts. They are not irrational doubts, and they are not motivated by emotion, but I have practical doubts about whether the Government's worthy aims can be met.

Funding the NHS by taxation always involves the menacing figure of the Chancellor. Chancellors are not cold-blooded men; even the present one has decent feelings, just as his predecessors did. However, Chancellors have a duty to the nation. They must consider defence, and there may be arguments about why defence should have more money. The hon. Member for Blaenau Gwent mentioned that Nye Bevan was concerned not only about the increasing costs of the health service and charges, but about the cost of defence. Chancellors are always concerned about rising costs. There are always battles between one Department and another.

Perhaps that is one reason why we are more politically conscious of the health service than virtually every country that I have visited. The politics of health in the United Kingdom stem largely from the fact that so much decision making lies here because we--rather, Chancellors--control the purse. The Chancellor has more control over decisions balancing how much should go to defence or other parts of public expenditure than any other Minister. Although the economy does not have to go from boom to bust, we all know that no economy can sail along year after year in the assumption that things will get better and better. There may be a world economic crisis from which we cannot be insulated, especially now that there is a global economy. That would have a profound effect on the Government's ability to deliver from taxation all the services that they want. That is one reason why people think it would be a good idea if the Government were to consider additional ways to finance health.

The Government should not underestimate the serious defects of the NHS. First, there is the money problem. In a few days, the Government will announce an extra injection of money, and I have read that it will be a greater real-terms per annum increase than has been accomplished before. I do not know if that is so, but there will be a substantial increase. All will look good for three years, but the Government cannot guarantee that there will not be some change in the economy that will leave the Chancellor having to tell a Secretary of State for Health that the belt has to be tightened. One of the service's problems is that it is wholly dependent on money from taxation.

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There is an acute shortage of personnel--a particularly serious problem among nurses, doctors and specialists. One reason why there is a waiting list is that there are appallingly few consultants. According to 1994 figures, not very out of date, and still true, we have 9.5 consultants per 10,000 of the population. Sweden has 20 consultants, Germany 19, France 14, Finland 15 and the Czech Republic 20. We are not quite as badly off for general practitioners, but France has 14 per 10,000 of the population, while Great Britain has six. Germany has 11, and I could list other countries. The simple message is that the people on whom we rely for skilled advice and knowledge are in short supply. The NHS executive has also mentioned that we are short of modern equipment. We simply do not have enough of it. I visited the United States recently, and found that magnetic resonance imaging was everywhere. Here, we have made a start, but there is much to do.

I should like the Minister to pay attention to training--a difficult problem. The training of our medical profession is too unstructured and is inefficient. What happened at Bristol would not have happened if training and qualifications had been more specific. Junior doctors spend hours walking round wards looking after patients, but those hours are out of all proportion to the time when they should be provided with specific teaching. Our emphasis on teaching is not high enough. Of course, more teaching will not come cheap.

It is difficult to understand why the Government refuse to consider topping up revenues for the NHS, as happens in the European Union. Stephen Pollard, a former director of the Fabian Society, has said:

The socialist Government in France have no problem about topping up their taxpayers' contribution in that way. Other international comparisons also show the use of additional sums from, for example, non-profit mutual societies--an old Labour concept--and friendly societies. I cannot think why we do not make better use of them. For those reasons, the time has come for us, and especially the Government, to examine the matter and perhaps to go back to some of their old Labour roots to find how much we can better use our resources to ensure that the NHS is better funded and well funded.

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