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6.10 pm
Mr. David Hinchliffe (Wakefield): I should like very warmly to welcome the main thrust of the Health Bill, particularly its three key provisions on quality of provision, emphasising the role of primary care, and especially the long-overdue abolition of the internal market.
When the history of this phase of the national health service is written, the Bill will be remembered as the end of the privatisation by stealth attempted by the Tories over the past 25 years. I say 25 years because I was working in social services 25 years ago, when Sir Keith Joseph was the Secretary of State and introduced the changes removing the democratic element in health provision from local government to health authorities. His view was that the market had an important role in health provision. Gradually, over the past 25 years, when the Tories were in power, they moved increasingly in the direction of allowing the market to run health care. Current Tory Front Benchers have made it quite clear that they are firmly wedded to the market in health--which is profoundly opposed by most civilised people in the United Kingdom, whatever their politics.
When the Thatcher Government were elected, in 1979, they realised that the British people would not vote for privatisation of the health service--because a vast, cross-party majority of the British electorate support the central tenets of the national health service, as they have done since the service was started in the 1940s. The Tories therefore began the process of privatisation by stealth, with a range of measures that I should like to mention briefly.
The first measure to be introduced, in the early 1980s, was general management. Management concepts were wheeled into the national health service that were totally alien to it. More importantly, people from business were wheeled in, although they had absolutely no knowledge of the NHS. A biscuit manager was brought in as the general manager of my health authority, and the right hon. and learned Member for Rushcliffe (Mr. Clarke) may well recall the consequent problems that we had in Wakefield.
The previous Government created a culture of paying for care. Year after year, prescription charges were hiked way above inflation. The Health and Medicines Act 1988 introduced charges for eyesight and dental checks and for preventive health checks. For older people, there were also tax concessions on private medicine, as the previous Government believed that such an incentive should be
introduced to encourage ever more people into the private sector. The hon. Member for Rutland and Melton (Mr. Duncan) nods. He is in favour of people using the private sector.
The previous Government also instituted the wholesale privatisation of community care. I have received computations from the Library showing that, in the 10 years before introduction of the 1993 community care changes, £10 billion of social security resources were pumped into the private residential and nursing home sector. At the same time as there was a huge expansion in construction of private nursing and care homes, there was a deliberate run down of NHS provision for older people.
The Bill will reverse that privatisation process. I therefore believe that, in many respects, the Bill's passage will be a major landmark in making the NHS once again conform to Bevan's vision for it.
The National Health Service and Community Care Act 1990 introduced the internal market. During its passage, several Conservative Members made it clear that they believed that the internal market was only a prelude to moving further towards a market system, in which the vast majority of patients would be expected to have private insurance, with only a state safety net for those without it, as in the United States.
The end result--regardless of what the Tories' reasoned amendment to this Bill states about fundholding--was a two-tier system. In my constituency, I had peoplewho were life-long Tory voters but who objected fundamentally to the fundholding system, which provided them with second-class treatment. The names and addresses of those who came to see me about the way in which the fundholding system operated and impacted on their specific treatment needs are on record.
I praise the Tories for knowing what they believe in and pursuing those beliefs. Although they were absolutely hammered on the NHS at the general election, they still believe in moving us ever closer towards private health care. In every one of her speeches and interviews, the right hon. Member for Maidstone and The Weald (Miss Widdecombe) has said, "Make more use of the private sector." A couple of weeks ago, the hon. Member for Rutland and Melton made a major speech--in which I was given the great honour of a mention or two--the central thrust of which was that, "We can't afford to pay for a national health service. Get people into the private sector."
When talking about moving NHS patients into the private sector, Tory Members fail to deal with one specific difficulty: the private sector is staffed entirely by those who were trained in the NHS. Therefore, the more the private sector develops, the more that the NHS will be denuded of staff. They fail also to appreciate--as the Health Committee is discovering in its inquiries--that the quality of care in the private sector sometimes leaves much to be desired.
I am sorry that the right hon. Member for Maidstone and The Weald has left the Chamber. She mentioned three categories of the dispossessed, but failed to mention a fourth one--NHS patients who wait patiently on a NHS waiting list, until someone from the private sector queue
jumps, putting everyone back a place. Those people do not have access to the treatment that they need because of queue jumping by people from the private sector.
Mr. Alan Duncan (Rutland and Melton):
Where does that happen?
Mr. Hinchliffe:
There is plenty of evidence of it. The hon. Gentleman need not worry, as I could give him plenty of examples.
In the few minutes that I have left to speak, I should like to concentrate on a few key matters. As I said,I welcome the Bill's concentration on the quality of provision. In my own constituency, I have been concerned that, in a minority of cases, patients have had a very raw deal from the health service and not received answers to some of their medical problems.
As I also said, I welcome the Bill's emphasis on primary care. However, I should like to mention one specific concern. I believe that the Bill's vision of involving the social services should go much further, and follow the model provided by Northern Ireland, where there are one-stop shops in general practitioners' surgeries. Northern Ireland's health centres genuinely offer access to child protection, home care, district nurses and various professionals other than GPs. I worked, 25 years ago, as a GP-attached social worker. Gradually, we are returning to that system, which worked so well but was damaged by the reforms introduced in 1974 by the Conservatives.
I hope that one specific aspect of the Bill--on governance of the NHS--will be dealt with in Committee. I have previously raised concerns about the democratic deficit in the health service, and believe that one reason why some patients sometimes misuse the NHS--by not turning up for appointments, for example--is that they lack a feeling of personal ownership of the service. Within the primary care groups, trusts and the overall service, we shall have to consider how to involve patients in the service, as they currently are not.
I have also previously expressed my disappointment at the continuation of the system of appointment of officials which was so discredited under the previous Government. Although those who currently hold appointments usually believe in the health service, we still have to ensure that local people who use the service are involved in decisions on the service's direction.
Mr. Simon Hughes (Southwark, North and Bermondsey):
Almost two years ago today--when we were about 14 days out from the general election--the Labour leader and Labour spokespeople said that there were only 14 days left for the country to decide whether it wanted to save the national health service. Many of us thought then that we could be well disposed towards Labour's commitment to the NHS. We would rather have
Mr. Patrick Hall (Bedford):
Correct.
Mr. Hughes:
If the Bill is supposed to be the great, bold, dramatic flagship that the hon. Gentleman implies, he should be sorely disappointed. It is a timid little measure. Although some things in it are timely and welcome--as my colleagues in the other place have said, we support those--there is much more that the Government should and could do. Sadly, none of that is in the Bill.
The Government started off on the wrong tack by saying that their first priority, before any legislation, would be the reduction of waiting lists. There is nothing about that in the Bill, perhaps because the target was wrong anyway. Even if it had been the right target, the bold promise of a 100,000 reduction is still some way off. The figure is down by 50,000 in England, so one in 23 people fewer are waiting; really successful! One in 14 people fewer are waiting in Scotland, and in Wales more people are waiting than when Labour came to office. So far, therefore, there has hardly been a dramatic change.
The Secretary of State said that the Government inherited a health service in deficit, but if we look round the country we see plenty of health authorities that have started the new financial year this month in deficit.
The Secretary of State also said that Labour had inherited a health service in which there were many parts of the country where one could not find a dentist. I was in Cornwall the other day with my hon. Friend the Member for South-East Cornwall (Mr. Breed), and my colleagues there have just launched a campaign to try to get a decent number of dentists almost anywhere in the country. My hon. Friend the Member for Taunton (Jackie Ballard) keeps trying to make it clear to the Government that although everybody identified the lack of dentists as a major issue, there has hardly been any significant change in numbers.
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