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12.19 pm

The Minister of State, Department of Health (Mr. Alan Milburn): I am delighted to have the opportunity to respond to the debate, which has been initiated by my hon. Friend the Member for Blaenau Gwent (Mr. Smith). He has secured it at an appropriate time not just for his constituents, but for the whole nation. It is particularly appropriate that it should fall to my hon. Friend to open the debate on the 50th anniversary of the NHS as one of his predecessors, Aneurin Bevan, was the founding father of our NHS. I think all hon. Members would want to pay tribute to Nye Bevan for his work, in the 1940s and subsequently, in giving the nation the sort of NHS that we have now.

This has largely not been a party political occasion, but I must point out that the hon. Member for Runnymede and Weybridge (Mr. Hammond) seemed to be suffering from a slight case of selective amnesia. In 1946, when we debated this issue in the House, his party opposed the National Health Service Bill tooth and nail. It fought it throughout--on Second Reading, Third Reading, Report and subsequently.

Mr. Nicholas Soames (Mid-Sussex): I am sorry that I was not here for the whole debate. Will the Minister acknowledge that the doctors opposed the establishment of the NHS, too? It is not a matter of pride for anyone that they should have opposed the creation of the NHS. The fact is that it is a truly wonderful service. All parties in the House should acknowledge that, and try to minimise, not maximise, the amount of politics involved.

Mr. Milburn: As the hon. Gentleman knows, I am all for keeping politics out of this place. I remind him that 90 per cent. of doctors voted in favour of the NHS in their ballot. There are interesting parallels with the situation today because, at their conference last week, 85 to 90 per cent. of general practitioners voted in favour of this Government's policy on NHS modernisation.

The NHS was founded on a simple principle: the best health services should be available to all--quality and equality. That appealed to the fair-minded people of our country then and it still appeals to them now. No one dares challenge those principles. No one says that the best health services should not be available to all. Indeed, the NHS embodies the principles in which the Government and my party believe.

We achieve more together than we do alone, and we have a duty to look after the weak as well as the strong. The NHS not only binds the nation's wounds, but binds

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the nation together. Each and every family in the land has a stake in the NHS and in its future. This Government were elected on the principle that the best health services should be available to all on the basis of need--not according to ability to pay or, indeed, who one's GP happens to be.

My right hon. Friend the Secretary of State recently had the honour to meet one of the first patients to be treated in the NHS, a lady called Sylvia Diggory, who summed it up far more eloquently than perhaps any hon. Member--including me--has been able to do in this debate. She said:

That is a lasting testimony to the sort of national health service that Nye Bevan wanted to create.

It is a privilege to be a Minister with responsibility for health in the 50th year of the health service. As hon. Members will know, this Sunday, we celebrate the 50th anniversary of the founding of the NHS. My hon. Friend the Member for Blaenau Gwent reminded the House that, during the passage of the Bill, Nye Bevan talked of how the new NHS would lift the shadow from millions of homes. He was right. It is now impossible to imagine life in Britain without the NHS. Its achievements in those 50 years have been immense.

The NHS has banished the fear of being ill and becoming ill for millions of our fellow citizens. It is our country's greatest institution and it is my party's proudest achievement in government. It is living proof that public services can be both efficient and popular. Quite simply, the NHS has delivered the goods, as Nye Bevan promised it would.

I pay tribute in particular to all the people who work in the health service and who have given so much day in, day out over the past 50 years in the service of others. Without them, the achievements of the NHS simply would not happen.

Some people said in 1946, 1947 and 1948, and some people still say, that we cannot afford the best--that the principles of the NHS are not practicable, that they cannot be delivered. The past 50 years have proved those prophets of doom and gloom wrong because our NHS has served this country well for the vast majority of the time. The vast majority of patients over the vast majority of the country have received top-quality treatment and care, and the NHS has proved to be the cheapest and most cost-effective health care system in the developed world.

That is not despite the principles on which the NHS was based; it is because of those principles. Fairness and cost-effectiveness have gone together. They are two sides of the same coin. The basic financial principle of the NHS is that it is paid for out of taxation and free to people when they use it. That is a fine principle and, contrary to what the right hon. Member for Wealden (Sir G. Johnson Smith) said, it is also phenomenally efficient because it avoids the horrendous costs of paperwork that are inevitable in any system where patients have to pay for treatment.

That is the main reason why our system is so cost-effective. It puts a bigger proportion of resources into patient care, and a lower proportion into paperwork,

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than any other system. That is true even now, when we still suffer from the after-effects of the competitive internal market. It is one of the reasons why the Government are sweeping away the internal market, but it is not the only reason. The internal market introduced a new competitive ethos into the NHS that was anathema to the basic principles of the NHS. It was also deeply inefficient.

Our NHS is based on the basic common-sense idea that we achieve more together in partnership than if we compete. It is that idea of partnership and co-operation--helping each other out--that is at the heart of the NHS. Indeed, it is one of the reasons why my right hon. Friend the Secretary of State for Wales has proposed a series of trust mergers to cover the Principality.

I know that my hon. Friend the Member for Blaenau Gwent has concerns about those issues. My right hon. Friend has been here to listen to those concerns. He has listened to them in the past. My understanding is that what is taking place is a genuine consultation, where the views that my hon. Friend and his constituents have expressed will be taken into account when final decisions are taken.

Mr. Huw Edwards (Monmouth): On the issue of the trust merger in Gwent, may I assure my hon. Friend that all the Government's priorities and policies will be fulfilled if we have a separate trust for north Gwent?

Mr. Milburn: I am sure that my right hon. Friend the Secretary of State for Wales was listening to that intervention, and that those considerations will be taken into account when final decisions are taken.

As hon. Members have said, this is a great time for looking back and celebrating what we have achieved, but it is important also that we look forward and that, in particular, we look to build the sort of modern and dependable health service that people want. That is what the Government are committed to doing. That is why we are intent on cutting waiting lists, and are now achieving that. That is why we are intent on enshrining quality at the heart of the NHS; my right hon. Friend the Secretary of State for Health has launched a consultation on how we better ensure quality and transparency for all patients in the NHS. That is why we want a much more integrated form of care than was ever possible under the internal market. We want to break down barriers between services--between health care, social care and housing care--so that patients receive the benefit of all those services. The patient should be at the heart of the national health service.

We also realise, as my hon. Friend the Member for Blaenau Gwent asked us to do, that--if we are to improve the health of the nation, and, more important, if we are to improve the health of the poorest at a faster rate than the health of the overall population--we will have to tackle the root causes of ill health, which means tackling poverty, creating jobs, building homes and greening the environment.

The Government have embarked on the biggest anti-poverty, pro-health crusade that the United Kingdom has seen in two decades. To underpin that crusade, we shall annually invest more in the national health service, as we promised to do. We have embarked on the biggest new hospital building programme that the national health service has ever seen.

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On the private finance initiative, I remind my hon. Friend the Member for Blaenau Gwent that the Government were elected--

Mr. Deputy Speaker (Sir Alan Haselhurst): Order.

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12.30 pm

Dr. Peter Brand (Isle of Wight): I am grateful for the opportunity of raising the issue of pedlars. I have been supported on the issue in an early-day motion that has been signed by hon. Members on both sides of the House. We have also tabled questions on the issue to the Under-Secretary of State for the Home Department, the hon. Member for Knowsley, North and Sefton, East (Mr. Howarth). I am grateful that he will respond to this debate.

There are significant problems associated with people who trade on the streets, whether they are pedlars or street traders. I should like to concentrate particularly on the issue of pedlars. I believe that they create unfair competition, are poorly controlled, cause great problems for local police forces and are certainly a major headache for environmental health, trading standards and local government licensing officers.

I am sure that pedlars once served an extremely useful function in spreading goods round rural communities, such as my own. However, they used to work on foot within a local district, and the fact that they were licensed by a local police authority was entirely appropriate if they restricted their activity to within that authority. Unfortunately, now any pedlar can get a licence from his or her own local police force and operate anywhere within England and Wales. Although I am sure that the Pedlars Act 1871 was entirely relevant to its time, I am not quite sure whether it is entirely appropriate now, especially as we move towards the millennium.

I have received considerable representations on the issue. I am particularly grateful to my colleague, Alan Hersey, a local councillor on the Isle of Wight, who first brought it to my attention. Concern about the matter has been very strongly expressed by carnival committees, bonfire societies and other organisers of voluntary events.

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