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Dr. Peter Brand (Isle of Wight): Does the Secretary of State accept that, in the past, rationing as he is describing it--for the individual--occurred mainly because of the uneven availability of expertise and expected outcomes, whereas today rationing, as I see it, is determined by the availability of resources for people with the expertise to carry out procedures that we know have an effective outcome? There is financial rationing, rather than rationing of ability.
Mr. Dobson: I certainly do not entirely agree with that point, because in many cases there is the question of the necessary spread of expertise. For instance, any old doctor cannot carry out a cochlear implant, so we need doctors with the necessary skills before expertise can be spread as widely, effectively and quickly as we should like.
Miss Julie Kirkbride (Bromsgrove): I thank the Secretary of State for giving way on that point. A constituent of mine is in the early stages of multiple sclerosis and, as the Secretary of State knows, treatment for multiple sclerosis with beta-interferon is carried out on a regional basis. In the west midlands, 47 patients who attend the same centre have been given beta-interferon for multiple sclerosis. On the same waiting list, with the same doctors, are a further 60 patients--sadly, including my constituent--who have been clinically assessed as needing that treatment, but who are not receiving beta-interferon because the region's health authorities cannot afford it. Will the right hon. Gentleman address that question, which follows up the point made a moment ago by the hon. Member for Isle of Wight (Dr. Brand)?
Mr. Dobson: I shall address that point, because the whole basis of my speech is to explain what we are doing to change the national health service so that we get away from the lottery system that we inherited from the previous Government.
The take-up rate of new treatments, such as Taxol, has been too slow and needs to be speeded up. That time lag is nothing new--it has always existed: there is no new crisis. This is all about how fast patients get extra and better treatments, not about cuts and reductions.
What is new is that the Government are doing something about the problem by putting in place a better-quality system that is better organised for assessing new developments and spreading their use. The speech that we have just heard from the right hon. Lady was the latest round in the endless efforts of the Tory right wing to decry and denigrate the national health service. The Tories have always opposed it. They voted against setting up a national health service, and since then the right wing of the Tory party has taken every opportunity it can to run it down and to suggest that the people of this country would be better off with a different system. The right hon. Lady was at it again today.
The national health service was based on the idea that the best health services should be available to all--the best for all: quality and equality. Despite the damaging reforms of the Tories, the NHS has delivered. Most people
in most parts of the country get a good service from the health service. That is why it is popular. It is the most popular health care system in the English-speaking world.
I believe that the NHS is also popular because the people of this country like the idea that it is fair, that it is there not just to look after them but to look after everybody without fear or favour, and that nobody will miss out because he or she cannot afford to pay. They like the idea that, under the NHS, people qualify for treatment because they need it, not because they can pay for it. The people of this country prefer to pay for health care through their taxes rather than pay each time they see the doctor or have a test or go into hospital. Unlike the Tories, the people of this country do not want to abandon that principle, and nor do we.
There is another good reason why our NHS is so popular. It is much more cost-effective and less wasteful than any other system. That relates back directly to the principles on which it was based. Systems in which patients have to pay each time they are treated put off people who cannot afford it. That is not the end of it; those systems cost a fortune to run. Every item must be separately logged so that it can be included in the bill, invoices have to be sent, payments collected and debts pursued. All that paperwork is very wasteful and costly. By not charging patients each time they are treated, our health service is both more fair and more cost-effective. Fairness and efficiency go together.
When the Tories talk about alternatives to the NHS--as they were today--they want to lumber the people of this country with health systems that are less fair, less efficient and more expensive. That is just what one would expect from the party that gave Britain the poll tax and privatised the railways.
No one can deny that the NHS could always do with more resources than it is getting. That has been true for the past 50 years, but it is equally true of every other health care system, which can always do with more. Replacing our system would not eliminate that problem: it would merely add unfairness and extra costs.
The question that every system must address is how to provide a reasonable level of resources for health care and ensure that the services are top quality and are shared out fairly. Unlike the previous Government, the new Labour Government are tackling those issues. From 1 April this year, we will be investing an extra £21 billion in the NHS--£18 billion in England. We have already made a start on the biggest hospital building programme in the history of the NHS. Not a single private finance initiative hospital was started under the previous Government. Under Labour, work has already started on new hospitals at Dartford and Gravesham, Norfolk and Norwich, Carlisle, Durham, South Manchester, Greenwich, Bromley, High Wycombe, Amersham, Sheffield, Rochdale, Halifax and Reading, and many more are to follow. Smaller schemes will replace unreliable plant and equipment.
Mr. John Horam (Orpington):
We started all those hospitals.
Mr. Dobson:
I am getting some stick from the hon. Gentleman at the back. The last time I saw him was at the sod-cutting ceremony for the hospital that his area is getting.
Starting in April, one quarter of all accident and emergency departments are to be renewed, which will make them better for patients and safer for staff. Much more is to be invested in equipment to detect and treat cancer, partly using lottery money from the new opportunities fund. That investment will ensure that more and more people in every part of the country will have access to top-quality hospitals, plant and equipment. The Government are determined to end the health lottery that results in some people in some parts of the country not being treated as promptly or as well as people in other areas.
Poor people are ill more often than others and die sooner. When somebody's span of life is cut short by poverty, that is real rationing. The Tories never talk about that sort of rationing. By opening up greater inequalities in wealth, they opened up greater inequalities in health. We are determined to change all that as part of our commitment to reducing inequalities in health and in health care. That is why, with the support of the health care professions--doctors, nurses, midwives, therapists, laboratory scientists--we are starting to change the NHS for the better by making it easier for the professionals to do their jobs, and to do them as well as they want to do them.
The NHS that we inherited has little or no machinery for identifying best practice and spreading it. That is one reason for the problems over new drugs such as Taxol, beta-interferon and Aricept. We are establishing--with, I emphasise, the full support of the professions--the national institute for clinical excellence. Its chairman designate is Sir Michael Rawlins, professor of clinical pharmacology at the university of Newcastle and consultant at the Freeman hospital and the Royal Victoria infirmary, Newcastle. He is the former chairman of the Committee on Safety of Medicines. His appointment was publicly welcomed by the British Medical Association on the day that I announced it.
The job of NICE will be to appraise new treatments, new drugs and new medical devices, and to issue authoritative guidance to the professionals who wish to use them. That will give individual clinicians more help than they have ever had before when they have to make decisions about the treatment of individual patients. As a result, best practice should be spread much more quickly, and ineffective treatments discouraged. Standards should rise and the same top-quality treatment should be available in every part of the country. NICE will take responsibility for providing the best advice, but each doctor will retain responsibility for the treatment that he or she gives to each individual patient.
Dr. Evan Harris (Oxford, West and Abingdon):
I was interested to hear the details about NICE. Will it consider cost-effectiveness as part of its remit? That may not be unreasonable, because there are limited resources. If so, will it ensure that the Government are associated with advice which it gives to clinicians not to prescribe or treat in a certain way because of problems of cost and not of effectiveness, so that politicians take responsibility for the limitation of treatments because of limited resources?
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