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12.5 pm

Ms Julie Morgan (Cardiff, North): I am pleased to speak in this historic debate on the national health service. I congratulate my hon. Friend the Member for Blaenau Gwent (Mr. Smith) on securing a debate this week on the anniversary of the NHS. I represent a Cardiff seat but, like my hon. Friend, I come from the south Wales valleys. I am proud of the fact that the NHS was born in Wales. I strongly support the principle behind it--that it should be free at the point of delivery--which has been covered in many of the speeches today.

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I want to focus briefly on some of the key issues that face the NHS today, all of which have arisen in my constituency. I represent a constituency in which there is an excessive number of hospitals. We have three major hospitals in Cardiff, North--Velindre, which is the major cancer hospital in Wales, the University Hospital of Wales, a major teaching hospital, and Whitchurch hospital, a psychiatric hospital. The nature of the first two hospitals means that many of the issues that are brought to me are of an acute nature, involving people who are very sick, their families, or their doctors. They are about treatment for very sick people. The Government's emphasis on public health, preventive care and the links with bad housing, poverty and the minimum wage--all those issues that have been raised today--is of tremendous importance, but we have to deal with, and debate in public, the provision of acute services. Some of those issues have been aired today.

Although some of the problems of the purchaser- provider split are being tackled, we probably still have to take further steps to reintegrate the NHS, especially in relation to acute services. Can the NHS operate properly with a split between commissioners and providers of very acute services when it is dealing with the advances in medical science that have been mentioned this morning? With advances in drug therapy for cancer, for example, is it reasonable to think that decisions about new drugs can be dealt with at a local commissioner-provider level? Will the health care commissioners have sufficient knowledge to decide which drugs to buy?

There has been much publicity lately about the improvement in cancer care in the United Kingdom, but also about how much it lags behind that in other countries. The figures are sometimes dramatic. Survival rates for different cancers vary enormously throughout the world. The publicity around cancer care raises public expectations. I believe that it is right that they are raised and that people should know about advances and treatments that might be available. However, that presents a dilemma about how to deal with that knowledge and deliver the service.

One problem, especially in relation to cancer treatment, is that much of the research is in the hands of the pharmaceutical companies, as my hon. Friend the Member for Newport, West (Mr. Flynn) said. It is a big issue--and a big debate, which we must have. We have to decide who is to have treatment and what treatment should be made available.

The other big issue that has come up in my constituency is acute heart surgery. The proposed heart transplant unit in Wales has been on then off, on then off, for the past three years. Before the Welsh Office and the University Hospital of Wales Healthcare NHS trust commit to it, the views of all the health areas in south Wales have to be taken.

In 1996, the right hon. Member for Wokingham (Mr. Redwood) changed the health authority boundaries and removed the central planning capacity of the NHS in Wales to take strategic decisions about the provision of services such as the heart transplant unit for Wales and the ability to top-slice health authorities. That meant that the planning mechanism for those acute services had gone. There have been about three years of discussion and

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waiting to see whether the heart transplant unit will be provided in Wales. Wales should have such a unit. There is much discussion about the rebranding of Wales, and a top heart transplant unit is one of the greatest services that could be provided: heart transplantation is becoming common and should be available locally.

In September, the paediatric heart surgeon at the University Hospital of Wales in my constituency, who has had tremendous success in treating children with severe heart problems and has built up the unit, is to return to Italy. He has an empty theatre in which to operate, but he does not have the nurses and the paediatric intensive care beds to do the amount of surgery that he wants to do. It is frustrating not to have the ability to develop that work at the hospital. At the same time as that surgeon is leaving for Italy, the cardiologist is leaving to go to Bristol. Bristol's gain is Wales's loss. The chair of cardiology in that same teaching hospital remains vacant while a decision is awaited on whether there will be transplant surgery in Wales. Everybody is waiting for everybody else, and the result is the loss of a first-class service in Wales. I appeal to the UHW and the Welsh Office to ensure that we can continue as before with paediatric cardiac work in Wales.

The same is true of other advanced treatments. The UHW has the capacity to develop advanced in vitro fertilisation treatments, but consultants have to visit health authorities to see whether people will buy their product. There must be a simpler way. The purchaser-provider split is not effective in such acute, expensive areas of medicine, but it is important to make them available.

There must be a debate on how to fund and decide health service priorities. Advanced developments must be examined strategically. The health service may face huge challenges, but this week we must celebrate 50 years of the NHS. I am proud that it was born in Wales. Health provision must continue to be free at the point of delivery, but we must find a way to make available to people the tremendous advances in health care.

12.13 pm

Mr. Elfyn Llwyd (Meirionnydd Nant Conwy): I congratulate the hon. Member for Blaenau Gwent (Mr. Smith) on securing time to debate the important issue of the 50th anniversary of the NHS. The service is under great pressure, especially in Wales, and I hope that the Welsh assembly will formulate a policy to serve the needs of Wales. There are many reasons for differences in Wales, where there are more heart complaints and more premature deaths, and where a host of other problems are endemic. Those problems need to be addressed, and I hope that the assembly will do just that.

I have been brief, because I know that other hon. Members wish to contribute to the debate. I have jettisoned most of my speech but I am pleased, none the less, to take part in the debate.

12.14 pm

Mr. Philip Hammond (Runnymede and Weybridge): We welcome the debate and I congratulate the hon. Member for Blaenau Gwent (Mr. Smith) on securing it. I join other hon. Members in paying tribute to those who have built the health service over the past 50 years and who continue to give dedicated service. The service's 50th anniversary is the time to celebrate past

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achievements, to take stock of the present and to look forward to the future. The hon. Member for Blaenau Gwent ranged fairly widely in an attack on Government policy. He spoke about the minimum wage, the private finance initiative and education zones. We sympathise with what he said about the situation in Wales and I assure him that the Opposition will listen to what the people of Wales have to say over the next few months. Other hon. Members struck a more consensual tone. I was delighted to listen to my right hon. Friend the Member for Wealden (Sir G. Johnson Smith) and to the hon. Members for Newport, West (Mr. Flynn), for Southwark, North and Bermondsey (Mr. Hughes) and for Cardiff, North (Ms Morgan).

The national health service is a truly national institution. It enjoys universal public appeal and no party or faction can claim ownership of it. The Beveridge report was commissioned by the wartime coalition Government, and in the 1945 general election both main parties were committed to the introduction of a universal health service that was available to all. It fell to a Labour Government to introduce the NHS in 1948, and Labour is rightly proud of that achievement. We in the Conservative party had control of the NHS for 35 of the past 50 years and we are proud of our stewardship of the service.

The NHS has prospered and grown under Conservative Governments. In the period between 1979 and 1997, NHS spending grew by 3.1 per cent. in real terms on average. Treatments went up by 3 million and the number of nurses, doctors, dentists and midwives increased. Capital spending increased by 50 per cent. in real terms in that time. I hope that we shall not hear from Labour Members the old, tired mythology that the NHS is somehow a product of the Labour party and that only it holds the NHS dear.

There is broad, cross-party consensus on the objectives for the modern NHS. They are to provide cost-effective, state-of-the-art health care that is free at the point of delivery and based on clinical need. There is political debate on the NHS but it is not about the objectives of the service: it is about differences in view on how best to achieve those objectives. There is an urgent need for debate on innovative and imaginative ways of ensuring the provision of the extra resources that the NHS will need to flourish and prosper in future. As medical technology develops and demography changes, the demand for more resources will increase. New technologies will allow better prediction of genetic predisposition to diseases, and that will allow preventive medicine to be better targeted. That will lead to long-term savings but it will demand greater short-term investment.

It is important to begin that innovative debate about the means of ensuring the availability of resources that the service will need in future. If the debate is to be meaningful, it is important to determine the underlying core principles that are important to patients--the users of the service--and to distinguish them from the sacred cows. The principle of universal availability on the basis of clinical need, free at the point of delivery, should be inviolable. Beyond that, the resourcing of the service should be based not on political dogma but on the determination to deliver the best possible service to users within the constraints of prudent fiscal policy.

Hon. Members on both sides of the House are proud to join in the celebration of the 50th anniversary of the NHS. The best birthday present that we, as politicians, can give

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the NHS is to break out of the sterile debates of the past and launch a real debate on future resourcing of the service so that it can effectively deliver a modern national health service offering the level of service that the British people are entitled to expect in the new millennium. We need a debate that acknowledges the consensus on objectives that exists across the political divide, the commitment among hon. Members on both sides of the House to the future of the NHS and the real issues of escalating demand and finite tax-based resources; recognises the reality of rationing that exists now in the system; and does not shrink from hard questions in seeking to ensure the proper resourcing of our health service.

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