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Mr. Christopher Leslie (Shipley): The hon. Gentleman talks about taking pressures off the NHS. Would he advise people who can afford it to take out private medical insurance?

Dr. Fox: I shall deal with the private sector in a moment--it is essential that we do so as part of a rational debate. I want to ensure that people take their appropriate place in the queue, that there is no queue jumping and that some people are not pushed up the queue ahead of those with greater clinical need because some political priority is being forced on hospital managers.

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We have said that we would continue to increase funding for the NHS in real terms year on year, as we did during our period in office. However, we believe that there is a place in health provision for the independent sector and that we should have more mixed provision. The biggest difference between what this country spends on health and what comparable European countries spend is that while our state spend is similar, people in other countries spend rather more from their post-taxation income.

The hon. Member for Shipley (Mr. Leslie) implied that it is bad to take out private health insurance. That is strange logic for any Government who rake in money from tobacco sales but tell us that we should not buy private health insurance; in other words, people can buy ill health but they must not buy health--what a twisted sense of morality.

I want to make one or two things absolutely clear for the sake of this debate. My party does not want an entirely private system. I have had experience of such a system in the United States, and I find the idea of a health care system that is not free at the point of use absolutely repugnant, and would not support such a system. Given that the culture in this country has developed from our experience of the national health service, we have the chance to get the best of both worlds. A Government who talk about partnership and mixed provision show how Luddite they are on health when they totally deprecate individuals who want to take out private health provision for themselves or their families.

Certain conditions must be attached to any independent sector involvement. It must augment NHS provision, not seek to replace it, and it must increase the total capacity of available health care. It must be uniformly regulated, because it would be unacceptable for a Health Secretary to use public money to buy private health care that was not regulated and did not guarantee certain minimum standards that we take for granted in the NHS.

The most important change needs to come from the insurance industry. I have no private health insurance because, like many people, I believe that the private health insurance products on offer are too inflexible and heavily loaded, have too many exemptions and are too expensive. We need far cheaper and more flexible products which are accessible to a much wider range of our fellow citizens at all income levels. The restriction in that market holds people back from helping to augment the spend on health, which would relieve some of the burden on the NHS.

Dr. Peter Brand (Isle of Wight): In continental Europe, there are compulsory insurance-based systems. Does the hon. Gentleman accept that that is not dissimilar to raising money through taxation, because people have no choice--they have to insure privately? What he advocates would work only if standards in the NHS--the publicly provided service--were such that people had an incentive to go private. What does he think might attract people to pay extra money on top of their taxes?

Dr. Fox: The hon. Gentleman confuses two issues: access and quality. What we should be able to have from the NHS is an absolute assurance that, if we or members of our family are ill, the most serious complaints will be treated first and within a reasonable time, and there will be no distortion of clinical priorities. However, it is

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perfectly acceptable that people may choose to spend their private incomes on any product that they choose, to buy convenience in health care with their post-taxation income, thereby relieving the burden on the NHS. What is wrong with a system that buys everybody the best of every possible world, while allowing us to get better value from the NHS?

Several hon. Members rose--

Dr. Fox: I am conscious of the time and the fact that many hon. Members want to speak.

Our motion begins by discussing the first-class staff in the NHS. Sadly, however, they are increasingly first-class staff in a second-class service. Morale is very low, from GP recruitment to early retirement for consultants. Despite the Government's attempts to increase recruitment, we are short of midwives and nurses because we cannot retain them. We must increase the total amount that we spend on health. Some money can come from the Treasury, but not enough. We must encourage people to spend more on getting good health through prevention and other products--some 15.5 million of us buy private health insurance for overseas travel every year, and the ground does not open up and swallow us.

We need more doctors, not more spin doctors. The Government say that they want to think the unthinkable, but now they will not even think the thinkable. They are obsessed with monopoly provision in health, whereas in everything else they claim partnership and mixed provision. It is not the British Medical Association or the royal colleges that are bound by the dark forces of conservatism, but the Government through their health policies. Just as they resisted people's right to buy their council homes and to have their own pension funds, so they seek to deny us choice in the provision of our own health care. The Conservative party, not the Government, will genuinely set the people free.

7.37 pm

The Secretary of State for Health (Mr. Alan Milburn): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:


It is a privilege to stand here as a Labour Secretary of State for Health in a Labour Government committed to modernising the national health service, which a Labour Government created in the first place. Incidentally, the Conservative party voted against it not once, not twice, but 51 times.

The hon. Member for Woodspring (Dr. Fox) promised a mature debate. I am still looking forward to precisely that. What we heard tonight was a Conservative party committed not to the future of the NHS or to modernising

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it, but to demoralising it. It is committed to demoralising the public who use it and the dedicated staff who provide treatment and care day in, day out.

Sir Raymond Whitney (Wycombe): The right hon. Gentleman started his career as Secretary of State for Health with the hoary old myth to which Labour politicians cling. Is he aware that the structure of the NHS was set out in the 1944 White Paper produced by the coalition Government led by a Conservative Minister of State for Health?

Mr. Milburn: I am aware of how the Conservative party voted when it came to push and shove: it voted against the NHS. Conservative Members entered the No Lobby 51 times. Indeed, some Conservative Members--[Interruption.]

Mr. Deputy Speaker: Order. Hon. Members must not shout across the Chamber.

Mr. Milburn: At that time, some Conservative Members warned that the coming of the national health service would bring about the demise of civilisation as we had known it. I believe, as do the staff and the public, that it has been the greatest civilising force this century.

Mr. Andrew Robathan (Blaby): The Secretary of State talked about the future of the national health service. The debates to which he refers took place before I was born, and I am not young. He may be a little younger than I am, but it was before he and most of the people in this Chamber were born. Let us talk about the future instead of the past.

Mr. Milburn: I am happy to rise to the hon. Gentleman's challenge. It is our intention to build up the national health service, whereas the mantra that we have just heard from the hon. Member for Woodspring (Dr. Fox) is the new Conservative mantra for the NHS: talk it down, run it down, deny it can ever succeed. We all know that the national health service must change and improve--staff and patients also know that. It must be fairer, faster and more convenient. Yes, it must modernise, but no, it does not have to privatise. That is the difference between the Labour party and the Conservatives.


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