| Previous Section | Index | Home Page |
5.8 pm
Mr. Simon Hughes (Southwark, North and Bermondsey): I should like to take up two of the comments of the hon. Member for Lewisham, East (Ms Prentice), who is a near parliamentary neighbour. I support her plea for speedy youth justice, and I hope that it is heeded. I, like her, have some experience of the failure of the system. Young people understand far more if they are dealt with quickly. I disagree profoundly, however, with her motto, "Come to Labour authorities to see good value". Lewisham may be wonderful, but if Southwark were ever held up as a model local authority, many in this Chamber would be hugely surprised. Sadly, in many respects, Southwark is not yet a good Labour authority--or a good authority at all. The sooner that we have good quality services in Southwark, the sooner that my constituents will be happy.
When William Beveridge produced his report in 1942, he made it clear that a national health service was the precondition of a good welfare state. It is therefore appropriate that this debate links welfare and the health service--and logical that we debate health first and welfare later. I am sad to note that no health Minister is currently present, although the Secretary of State for Social Security is here.
Today is Thanksgiving day in the United States. We all give thanks for our good health, and hon. Members have often joined hands in giving thanks for the national health service. As the 50th anniversary year nears its close, we give thanks as loudly as ever. Let me say to the Secretary of State for Health--although he is not present--that none of us intend to criticise those in the health service who are trying to do a very good job.
The Minister for Public Health has just arrived. May I ask her to convey some information to the Secretary of State? On one occasion during the past year and a half,
I have misrepresented someone's position. Two weeks ago, we had an exchange about South Devon healthcare trust. The trust used the phrase "pending lists" rather than referring to waiting lists, and I suggested that people on pending lists were not included in waiting-list figures. I was corrected, and I apologise to the trust and those who work for it. I say, unreservedly, that we should always give accurate information, and if we make mistakes we should admit to them.
I hope, however, that, as a consequence of our debates about waiting lists and waiting times, a common form of wording will be introduced. I also hope that a common system will be introduced for the publication of figures relating to out-patient and in-patient waiting times, so that the statistics are objectively valid and can be checked and there is no massaging of statistics, either by Government or by those trying to criticise Government. A senior member of the staff of the King's Fund called for such a system only earlier this week.
Today's debate coincides with the launch of the Acheson report, whose commissioning by the Government we welcomed. Like the Black report before it, it sets out a range of measures--thirty-nine steps--to reduce health inequality and improve public health. It is important for the nations of the United Kingdom to understand that, even with the best health service in the world, the sickness service--for that is what the NHS is--will be of relative rather than better worth unless we improve public health.
I applaud the appointment of a Minister for Public Health, and, like the current Minister, I want us to have a public health service that is as effective and integrated as possible. I shall make a couple of positive observations first, and then issue a couple of promptings that will be constructively critical of the position that the Government have reached over their first 18 months in office.
We all remember the section of the Labour manifesto entitled "We will save the NHS", in which the Labour party made a welcome commitment. It stated:
The manifesto made another commitment in the next sentence: to
It is a case of "not yet" for the banning of tobacco advertising, and for the food standards agency; and, sadly, there are to be free eye tests--but not dental checks--but not for all. Both used to be available to all, but the Tories abolished that, and the Labour Government are reintroducing free eye tests only for pensioners. That is a shortfall, and I hope that the Government will think again.
As my hon. Friend the Member for Newbury (Mr. Rendel) pointed out in an intervention--I hope that he will catch your eye later, Mr. Deputy Speaker--less help
will be given to widows and disabled people. It was announced in the Queen's Speech that their benefits would be cut. We shall have further debates about that, but it clearly will not help to reduce inequality for those in these categories concerned.
The commitment to reduce inequality also contains no commitment to redistribute wealth, which means taking from the well-off as well as giving to the less well off. The Government have policies to improve the conditions and wealth of the less well off, but they have resolutely set their face against collecting more from the better-off. Some of us believe--and our party voted to this effect at its conference--that there should be redistribution of wealth as well as an increase in the wealth of those at the bottom of the league.
These are important issues. I am glad that the debate has begun again, 20 years after the Black report. I hope also that the Minister will persuade her colleagues that we should debate public health and inequalities in health,on the basis of Sir Donald Acheson's excellent recommendations, in Government time and relatively soon, after we have all had time to read the report.
I want to raise a couple of other matters that do not relate to the NHS Bill. I know that the Minister, like me, is committed to ensuring that our efforts and resources are directed as much towards mental as towards physical health. I look forward greatly to the Government's announcement about its mental health policy. My health authority, Lambeth, Southwark and Lewisham--the largest in the country in terms of population--gave me its figures this morning. In a population of about 750,000, 100,000 people suffer from mental illness--roughly one in seven. That is not unusual in urban areas, and, indeed, other parts of the country.
In terms of mental health, a person may be fine one year, but not the next. It might be us one day, and someone else the following day. People need to know that resources, support and, where appropriate, drugs that they may need are considered a priority by the Government. I am not saying that the Government do not understand that, but we must continue to remind each other that our duty to those with mental illness is as great as our duty to those with physical illness.
Let me now raise a matter that is also in the domain of the Minister for Public Health. It is appropriate that it should be raised this week. There is still a battle to be waged against HIV and AIDS. We have been waging that battle, but we have not won it. The Terrence Higgins trust has told the Minister, who responded in a recent interview, that although the prevalence of HIV in this country is relatively low--22,000 cases--there are still 2,500 new diagnoses each year. Of those cases, about 1,500 are men--often gay men--and young people form a high proportion.
We must spare no effort. Perhaps there is some complacency because, owing to vaccines and therapies, people with HIV do not necessarily look as though they will automatically die of AIDS. Unless we continue the attack with publicity, information and education, as well as funds--an attack that may have to be very hard-hitting--we may not be able to win the battle. I hope that winning it will remain a high priority, and that we realise that such action is our duty in this country as much as in other parts of the world.
Two Bills were proposed in the Queen's Speech, the NHS Bill and a supplementary Bill relating to charges. I believe that services and staff in the NHS are more important to people outside than structures. The Government say that they will abolish the two-tier NHS. Under the Tories, people were given either fast or slow treatment, depending on who their GPs were. That practice is to be abolished, which we welcome; but in some areas there will be a three-tier NHS caused by rationing. There will be some treatment for some people, and private treatment, or no treatment, for others. The Government have yet to grasp that nettle.
The Government say that they will abolish the internal market. They must be careful, because that is not actually true. The purchaser-provider split will remain--we accept and support that--but the internal market will also remain: reduced, yes, remaining yes, and abolished, no. Let me give an example. If a primary care group is able to choose where to send its patient, there is choice and therefore, to an extent, a market. What will happen to what were called extra-contractual referrals? I understand that they are not being abolished, but are merely being renamed. Let us not delude people into believing that the system has been completely changed.
The Government say that they will reduce bureaucracy. That may happen, and the Government say that they will maintain their £1 billion cost reduction target; but it is another case of "not yet". According to this week's newspapers, 500 new managers will be appointed under the new proposals. I am not against additional managers but let us not pretend that bureaucracy will be reduced if there are to be more.
The Government talk about established primary care groups. We think that that is a flawed and second-best proposal, which we shall seek to amend and improve. A radical and sensible Government would have merged health and social services authorities, and would have done so under democratic control. A radical and self-confident Government would not have given in to doctor influence over the composition of primary care groups, which delivered them a majority and the chair in every instance. A sensible and democratic Government would not try to rush changes through now. They would have a start date later than next April to enable proper scrutiny of the proposals and the concept embodied in the proposed legislation to ensure that it is up and running properly and not rushed to meet an artificial target.
We are in favour of health improvement plans, but they should be led by democratic local health authorities and social services authorities. That is where the debate can take place.
We support the raising of standards as we support the health improvement commission. It is not as radical a concept as that which we have proposed in the past, when we said that there should be a national inspectorate of health and social care.
We support the idea that it is necessary to deal with people who are not up to the job. However, let us not confuse having a go at people who are not up to the job with having a go at those who are overstretched in trying to do their job because there are not others to help them do the job. The patient needs an NHS contract to know what service, standard and speed he can expect, but there must be the staff to deliver the service and the money to deliver the staff.
"Smoking is the greatest single cause of preventable illness and premature death in the UK. We will therefore ban tobacco advertising."
Sadly, there was a blip--a glitch, or hiatus--last year. Regrettably, unless the Government bring the date forward, the manifesto commitment will not be fully implemented until 2006, which, especially in the light of the Acheson report, may be far too late. I hope that tobacco advertising will be banned much earlier than that.
"establish an independent food standards agency."
Many people, not just politicians, regret the absence of a measure for that purpose in the Queen's Speech. The public regularly express strong views about the need for better food standards.
| Next Section
| Index | Home Page |