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Mr. Mike Gapes (Ilford, South): What does the hon. Gentleman think that the national health service should not provide, and for what should people be forced to pay?

Mr. Duncan: The Government should consider exactly that in recognising that the national health service cannot do it all. There is no prospect--no chance, even--of starting a sensible discussion on the national health service's limitations and capabilities without first admitting that the health service cannot do it all. As I said the other week, in a lecture, if the national health service cannot do it all, it is immoral for anyone to stand up and say that it should--unless they are prepared to say clearly from where the resources will come.

Our vision of health care in Britain is for the overall health care sector to be expanded when possible. In other countries, a private sector larger than ours works in harmony with the public sector. We want the United Kingdom to develop such a mutually supportive private-public mix. Those who say that the national health service can and should do it all are only trapping us in an unreal world in which patients will suffer.

The Opposition's position on the national health service is clear, whereas the Government, who are responsible for the health service, have not made their position clear. The Government gained office by stirring up grievance and campaigning against almost every hospital closure. In some cases, they won a seat in this place by promising that they would keep a hospital open. They also continue to enjoy blaming the previous Government for every possible problem in the national health service, although they refuse to come to terms with the basic fact that the national health service cannot do it all.

One has only to consider the Secretary of State's comments on the minimum wage to realise that the Government's campaign promises do not marry with their statements in government. The Opposition's task is to

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ensure that the Government are held to account, so that their actions since being elected to government may be judged by their statements before the general election.

There is rationing in London, as there is in the whole country. The Secretary of State attended the London school of economics--albeit at a time when it was teaching some pretty funny things--and studied economics. He should therefore know the definition of rationing--[Interruption.] I hear him pleading guilty, and I join him in that verdict.

There is rationing. By what definition is there not rationing in the national health service? If there is a limit to what the national health service can do, if everything that is demanded is not supplied, and if a monopoly supplier is deciding for patients what they can or cannot have, what is it, if not rationing?

I ask the Secretary of State--who, even on Tuesday, denied that there was rationing--and the Minister for Public Health, who answered no when asked point-blank whether there was rationing in the health service, to define rationing. If the national health service is determining what people can or cannot have in the face of scarce resources, what is it, if not rationing?

Mr. Dobson: By the normal definition of rationing, the only rationing of health care in the United Kingdom is occurring in some parts of the private sector, which provide insurance cover only up to a certain sum, after which people must pay for care themselves. That is rationing. Every definition of rationing--I refer the hon. Gentleman to the "Oxford English Dictionary"--

Mr. Duncan: Answer the question.

Mr. Dobson: I refer the hon. Gentleman to the "Oxford English Dictionary", as it might be a good idea for him to base his arguments on something sound. All dictionary definitions of rationing describe limits to what is available to an individual--but that situation does not apply in the national health service at all. Everyone knows that there are limits to available resources. However, suggesting that we have rationing in the national health service is like saying that, because there are no more seats on the jumbo jet that one wanted to go on to New York, for example, flights are being rationed. No one thinks that that is a sensible definition of rationing.

Mr. Duncan: That is an extraordinary statement. The Secretary of State has just said that there are no limits to what an individual can get on the national health service. If that is his defence against my charge that there is rationing, he is in a very peculiar position and his comments will not bear scrutiny.

Let us consider daily life in the national health service in London and throughout the country. Waiting lists are a form of rationing. Patients want and need treatment, but they cannot have it yet. They have to wait. It was the same during the war when there was a shortage of food. People could not have their sausages until new supplies came in. Delays for treatment are a form of rationing.

The situation is not even improving, as the Secretary of State claims. It remains as bad as ever. For every fall in the waiting list that he publishes, he knows that there is a pretty well equal rise in the number of people trying to get on the waiting list. We have continuous, unimproved

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rationing by making people wait not just to get the treatment that they need, but--this is worse--to get the diagnosis that they need to work out whether they need treatment.

Mr. Dobson: The hon. Gentleman apparently sees a parallel between the national health service and wartime rationing of food. Under wartime rationing, people got a specific amount of bacon a week and nobody got more. That is rationing. We do not have that in the national health service. We do not say, "You can have £50 of treatment and then that's your lot." That would be rationing.

Mr. Duncan: The situation is even worse. Such is rationing in the national health service that someone who needs beta interferon for multiple sclerosis might not get it at all, depending on where they live. Some people get it and others do not. That is another form of rationing.

If even those logical arguments have not persuaded the Secretary of State that rationing exists and that he has yet to treat this massive issue with the honesty that it deserves, let me refer to Viagra.

Mr. Roger Casale (Wimbledon) rose--

Mr. Duncan: Before I do so, I shall give way to the hon. Member for Wimbledon (Mr. Casale).

Mr. Casale: Does the hon. Gentleman accept that the introduction of nursery vouchers was a form of rationing? Is his party proposing something similar for access to the national health service?

Mr. Duncan: I am trying to explain to the Secretary of State that there is a difference between the resources put into the health service and the demand that is put on it, but he seems impervious to that point. The shortfall leads to rationing, but he is not prepared to admit to that form of rationing.

Viagra is the perfect example to fit in with the Secretary of State's narrow and peculiar definition. There is a lawsuit under way about the manner in which the Secretary of State has taken a decision about Viagra and I would not dream of straying into any details that might be deemed sub judice. The more general point, which is evident from the statements that he has made in the House and to the press, is that he intends to ration Viagra. It will not be freely available on prescription in the national health service, even if GPs, using their clinical judgment, assess a patient to be in need of the drug. Instead, the Secretary of State intends to restrict it to the narrowest possible form of availability, thereby paradoxically forcing anyone else who might otherwise be prescribed it within the national health service into the private sector--which the Secretary of State so loathes and reviles--where they have to pay double or even more.

So we have a new drug which can do a lot of good to people who clearly need it, which is recognised by clinicians throughout the health service and which will not be available from the national health service. Its availability is restricted. That is rationing and it applies in London and everywhere else. We need some transparency as to the rationale behind the Secretary of State's decision about what is available on the national health service, what is rationed and what is not available at all.

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Unless we have a realistic, grown-up, responsible debate about what the health service can and cannot do, London will suffer, the future of health service care throughout the country will suffer and the Secretary of State will not go down in history as someone who has met the responsibilities that have been entrusted to him. The debate has become puerile and deceitful. It has become a nasty form of politics of which the Secretary of State cannot be proud.

Let me turn to deficits in London. The Secretary of State has paraded no end of generosity about the spending round. He came to office two years ago--that is, two financial years. If he thought there was a great problem, he has had time enough to sort it out. However, a recent article in the Health Service Journal reported that London trusts and health authorities have a deficit of £74.74 million. That figure does not include mental health trusts or Lambeth, Southwark and Lewisham health authorities. It is estimated that the total deficit in London is probably in excess of £100 million. I am not sure whether the Secretary of State is snoozing or smiling, but he does not seem to want to address the fact that £100 million is a large deficit, which he used to criticise in opposition. Given what he said in opposition and what he claims to be doing in government, what does he propose to do about the £100 million deficit in our health service?

How can the Secretary of State reconcile everything that his party campaigned for in opposition with what has subsequently happened in respect of closures? When we were in government, we had the honesty to admit that, as old buildings decay and patterns of health service demand change and the requirements of technology and population shift, some hospitals will close, others will provide different services, others will take on different responsibilities and new hospitals will have to be built. That is a fair-minded, sensible view of how a developing health service should operate. However, that was not Labour's opinion in opposition. According to Labour, every closure was bad, every change was bad and no hospital was doing enough. Some Labour Members even had the deceit to put out election literature promising that certain wards or hospitals would remain open in order to grub for votes, only to collude with the new Government on their subsequent closure. Does the Secretary of State have any qualms about that? Is he worried that his reputation might sink? He seems impervious to accusations that such deceitful politics harm the reputation of his own party and the health service.

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