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6.7 pm

Mr. Oliver Letwin (West Dorset): With your eagle eye, Mr. Deputy Speaker, you will have noticed that I have been translated not merely from the Front to the Back Bench--I hope temporarily, for the purposes of this debate--but to the very Back Bench, as I would not want my remarks to constrain or embarrass my right hon. and hon. Friends on the Opposition Front Bench in any way.

I must begin by admitting that I am becoming something of a "Dobsonist", or perhaps, a "Dobsonite". I am startled by the magisterial way in which the Secretary of State is gradually building the case for the privatisation of the national health service--a case that he and his colleagues spent their time in opposition explaining that they regarded as an abomination.

When I was new to the House, my first parliamentary question was to the Secretary of State. I wanted to know whether he recognised that, in the first measure proposed by the Government for the NHS, he was paving the way for the privatisation of clinical services. The right hon. Gentleman, with his usual charm, grinned slightly and evaded the question wholly, since when it has become evident in the popular press and elsewhere that that was indeed the tenor of the measure concerned.

The Bill was presented as entirely uninteresting by the Secretary of State, who went out of his way to diminish the interest and importance of his own measure. I have not been long in the House, but I cannot recall an occasion on which a Secretary of State made so brief and so

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low-toned a speech on Second Reading--a speech so calculated to induce silence, and possibly sleep, on the Benches behind and opposite him. He intended to put us to sleep so that we should be pleasantly anaesthetised, to use a health service metaphor, and should not notice that there was anything remotely interesting in this legislation.

Ms Drown: Does the hon. Gentleman recognise that the Bill is relatively simple and involves simple principles? Is my right hon. Friend the Secretary of State not to be highly commended for not speaking longer than necessary, since we have many matters to discuss in the House?

Mr. Letwin: As I said at the beginning of my speech, I am increasingly an admirer of the Secretary of State and I certainly do not want my remarks to be taken as an accusation against his acumen. I hope that by the end of my speech, the hon. Lady may be persuaded that, although the Bill is simple in the sense that it is short, it does not by any means involve simple principles. In fact, it probably involves the most subtle principle to be connected with the NHS and it constitutes one of the more important measures to come before the House this Session, as will probably come to light gradually in the next five, 10 or 20 years.

I shall explain. The fundamental question about health payment--not the administration of the NHS or the way in which people are cured--which has been a vexed political issue for almost half a century, is not whether there should be charges at the point of use. No major political party has advocated that since the war and, in large part, no party has advocated it since the 1920s. Everyone has aimed at a health service that is free at the point of use. The great debate--sometimes open and sometimes covert, sometimes pursued intelligently and sometimes with partisan zeal and much less intelligence--has concerned whether the health service should be insurance or tax based. Members on both sides of the House will recognise that that has been the serious issue that people have pondered, debated and failed to resolve.

The measure before the House is extremely interesting. It appears to extend the tax base for payment for NHS services. It has that appearance because it so happens that under the laws governing motoring, insurance for motorists is compulsory, so Labour Members have been able to argue that this is a special case--the Secretary of State did not bother to do so, so keen was he to avoid the issue altogether--and have salved their consciences, so to speak. The hon. Member for Crawley (Laura Moffatt) salved her conscience by explaining that this was a special case, quite unlike all the other cases that she did not want to see flow from it, because motoring insurance is compulsory.

Laura Moffatt: The hon. Gentleman says that we are salving our consciences by saying that because compulsory insurance is involved, the Bill is easy to justify. Can he cite any other compulsory personal insurances in the United Kingdom that might relate to the Bill?

Mr. Letwin: No, but I fear that I will alarm the hon. Lady a little by explaining that the distinction that she has erected will be subject to an onslaught from the Secretary of State.

Mr. Duncan: I suggest that my hon. Friend start his list with employer liability and local authority liability.

Mr. Letwin: With his customary acuity, my hon. Friend is right. There are other such cases, but my argument goes well beyond the cases where there is already compulsion.

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The hon. Member for Crawley argues that this is a special case. My hon. Friend the Member for Rutland and Melton (Mr. Duncan) pointed out that it is not so special, but there is a restricted set of cases that involve compulsory insurance. Labour Members have effectively argued that compulsory insurance schemes through which the NHS seeks to recover its costs from insurers are de facto taxes. This is another sort of tax, but one that happens not to pass into the Consolidated Fund but directly to the NHS, if that is indeed the case; I plead ignorance on the point. I find it a little odd in terms of Treasury theology that it should be so designated but perhaps it is. If so, it is all the more interesting because that would suggest that it is not quite a tax. If it were seen by the Treasury as a tax, it would enter the Consolidated Fund. The Treasury therefore regards it as a charge, but the hon. Member for Crawley and others would argue that it is a de facto tax because it is raised from an insurance company in a case where the insurance is compulsory.

The problem with that line of argument from the Government's point of view is striking because we must ask why compulsory insurance is applied only in a very select group of cases, in particular, motoring and the two others that my hon. Friend the Member for Rutland and Melton mentioned. Why is compulsory insurance so restricted in its application? The answer is that it happens by historical accident to be rather restricted. Now enters upon the scene the majestic figure of the Secretary of State, with his logic and his needs.

The Secretary of State intends to pile large sums that the Chancellor of the Exchequer does not have, and will have less of in due course, into the NHS. He argues--and has introduced a Bill to this effect--that it is legitimate for the NHS to charge the insurers of people who suffer from accidents the cost of caring for them because the insurance involved is compulsory. It is at that point that he will ask the Home Secretary to do something that is perfectly rational under that rubric or logic--to expand the scope of compulsory insurance.

It is rational to propose that anyone engaging in an activity with a high chance of leading to medical care costs should by compulsion be insured. It is rational because it covers a social inequity. If they are honest, Labour Members will admit that as much as would Conservative Members. It is equitable to suggest that people who decide to do something dangerous should not impose additional costs on the rest of the community. It follows that if the Secretary of State believes that the right way for the NHS to recapture the costs from the right people is to make insurance compulsory, the Government will argue for making such insurance compulsory for a wide range of activities.

The more I think about the matter, the less I can see the slightest objection on the part of the Governmentto the widening of compulsory insurance. Some Conservative Members would object to a vast widening of compulsory insurance on libertarian grounds. It may well be that my hon. Friend the Member for Rutland and Melton would, because he is one of the most noted of the libertarian tendency of Conservative Members--perhaps its most distinguished exponent in print. Among Labour Members, I see no libertarians. I have heard no such logic or rhetoric from them so far, and do not expect to hear

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any before the Government's period in office ends, to suggest any objection to a vast application of compulsory insurance across a wide range of activities.

Such a course would be consonant with Ministers' desperate efforts to prevent people from killing themselves by smoking. The Government specialise in trying to deal with what they regard as the problem of individuals taking risks that they should not take. Why else spend large amounts of public money trying to persuade people not to smoke? Why else does the Minister for Public Health spend her time circulating the heads of the royal colleges and desperately assuring them that the single most important thing in the health service is preventing people from smoking? Why would it not be a natural extension from that to get the Secretary of State to agree to something that would be introduced as an unimportant, obvious little Bill to which we need not pay much attention, and would create a compulsory insurance scheme for smokers? Labour Members could argue that, de facto, it was a tax if the NHS could recover the cost of cancer treatment from a compulsory insurance scheme for people who smoke. I believe that treating cancer is one of the major costs of the NHS, although I am not an expert. That logic could be extended across a vast range of activities.


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