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Mr. Hammond: For the record, will the hon. Gentleman clarify his party's current estimate of the amount that would have to be added to income tax to deliver, from taxation, the NHS that he feels that the British people deserve in the 21st century?

Mr. Harvey: One cannot bring about the service that one wants to build in the longer term on the basis of this year's or next year's income tax revenues. We have to invest over time to make good the underinvestment that has been going on for decades. Over time, we have to move towards the proportion of gross domestic product that other European countries spend on health. I agree that the private sector must be counted in that. We have to make progress towards the European average if we are to have health provision comparable with that in our competitor countries and put right the problems to which the right hon. Member for South-West Surrey(Mrs. Bottomley) referred in her comments about travel agent's brochures.

Sir Geoffrey Johnson Smith (Wealden): The proportion of GDP spent on health care through the national health service is about the same as that spent

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on the continent. The difference between spending on the continent and spending here is accounted for by the private sector.

Mr. Harvey: That is simply not true. Our spending is about 2 per cent. lower than the average of other European Union members. The split between public and private provision differs from country to country, but on the total spent we are trailing well behind our competitor nations. I am sorry to disagree with the right hon. Gentleman, but that is the fact.

The Secretary of State asked the Opposition to say whether they welcomed the new focus that he has adopted in the past couple of weeks. I should like to make it clear that I do. I hope that he will address the worrying gap between the level of care for cancer patients in this country and that in our competitor nations. Patients and the general public will welcome having those priorities mapped out clearly. If the new cancer tsar, Professor Richards, is to make the progress that we all want, he will need a full increase of resources behind the surgeons to whom the Secretary of State has already referred. That includes nursing staff and equipment. I agree with the comments from the Conservative Front Bench. There have been many representations from health service professionals about the state of the equipment used for cancer care. That will all be important to the work that the Secretary of State is trying to do, and I fear that there will be no scope for recycling any money already committed; the money will need to be genuinely new. Indeed, in planning a work force capable of delivering the new priorities, we must consider what staffing levels throughout the profession will be required.

The Secretary of State talked about the increase in nursing salaries. Certainly the sharp increase in salaries for new nurses is welcome. As the right hon. Gentleman rightly said, that is beginning to have an impact on recruitment into the profession. However, retention is equally important. If we are to solve that problem, we must do something about salaries for existing nursing staff. There have been some examples of new staff earning almost the same as experienced staff. It costs about £33,000 to train a nurse, and £5,000 to replace one who leaves the profession; that figure covers recruitment costs, agency costs and so on. We must think about cost-effectiveness in a broader sense, because spending on nurses can save money.

We also need more nurse-led care, more prescribing by nurses and more specialist nurses. In addition to the impact that that would have on efficiency and on the economics of the national health service, it would also encourage nurses to stay in the profession and relieve some of the pressure on doctors. I was pleased to hear about the GP practice in Derbyshire that is run entirely by a nurse, who sees the patients first and employs a GP to whom she passes them if she thinks it is appropriate and necessary.

Ultimately, without additional funding the NHS cannot remain comprehensive, high quality and free at the point of entry. In the longer run, however, funding the NHS could save other Departments money. When we think about the winter ahead, and the sort of problems that are piling up, including the fact that one quarter of the trusts say that their financial position means that they will have to postpone or cancel developments in the Government's priority area of mental health, we realise that the immediate problems are very serious.

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Expecting trusts and authorities to go through the process of efficiency gain and to continue to come up with savings year on year on year is simply causing additional problems, and adding to the problems that we already have is no solution to the headaches that those who try to provide our health service are already experiencing.

8.38 pm

Mr. Stephen Hesford (Wirral, West): Having heard the hon. Member for North Devon (Mr. Harvey) speaking on behalf of the Liberal Democrats, I cannot help observing--this is an old one but a good one--that in the health debate, the Liberal Democrats have bladder trouble again. I am talking about a continuation of the longest "pee"--[Interruption.] I shall take no lessons from them when they talk about funding.

The Conservatives, as well as the Liberal Democrats, have a problem. We heard nothing from their Front-Bench spokesman about spending--nothing about the £21 billion that the Government have placed before the nation to be spent on the national health service over three years. The Conservatives do not talk about that, because they cannot say what they would do.

We heard nothing about the Health Act 1999, either. I had the honour and good fortune to serve on the Standing Committee on that Bill, so I know that one of the reasons why the Conservatives will not talk about it is that they have lost the argument about the structure. In Committee, they talked for hour upon hour about how abolishing fundholding would be the ruin of the health service. Yet we have heard nothing about that today. The Conservatives do not mention it any more, because they lost the argument, and the argument has now moved on.

We heard nothing from the hon. Member for Woodspring (Dr. Fox) about mental health services. He said that he wanted a mature debate, so why did he not welcome the national frameworks that the Government have recently introduced for major sectors of the health service? My right hon. Friend the Secretary of State for Health mentioned public health. If we are having a mature debate, why did the Opposition not welcome "Saving Lives: Our Healthier Nation", the White Paper that addressed that very issue?

The present Government are the first to consider the effects of ill health when determining health policy. Why do we hear nothing from the Opposition about the wider health debate, including the effect of the new deal on poverty? We hear nothing about the national minimum wage, because the Opposition have lost the argument. We hear nothing about the working families tax credit, which will make work pay for families and do much to reduce ill health.

Shamefully, we heard nothing from the hon. Member for Woodspring about staff. In a debate on the health service, he failed to welcome the commitment and dedication of the staff. The Opposition are too churlish to welcome the Government's investment programme which will provide more nurses after years of cuts in nurse numbers under the Tories' regime.

The hon. Member for Woodspring mentioned his theory that private health insurance would get extra money into the national health service. Several powerful criticisms of that approach have been made already, but they are worthy of reiteration. Private health insurance

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would mean a massive boost for the Tories' friends in the City in the health insurance market. That is one of the byproducts of that approach.

Mr. Brady: Will the hon. Gentleman give way?

Mr. Hesford: No, because I have only 10 minutes. My right hon. Friend the Secretary of State made the powerful point that the Tories were not trusted after the mis-selling of private pensions, so why should they be trusted on the idea of health insurance?

The hon. Member for Woodspring did not mention what it would take to attract people to private health insurance. One curious theory, expounded by the hon. Member for North Devon, was that waiting times would be lengthened to force people into it. That is one potential method, but what else could be done?

The method that dare not speak its name was revealed by the hon. Member for Rutland and Melton (Mr. Duncan) when he made a speech in March 1999 to the Social Market Foundation as a shadow Health Minister. He gave the game away about using tax relief to encourage people to take out private health insurance, although the Opposition seem since to have suffered collective amnesia on the issue. They do not talk about it because of the cost implications. It would cost between £500 million and £1 billion a year to achieve the take-up of private health insurance that the hon. Gentleman talked about.

I would be grateful if the hon. Member for Runnymede and Weybridge (Mr. Hammond), who is to reply for the Opposition, could deal with that sort of costing. It flies in the face of the tax-cutting agenda that his hon. Friend the shadow Chancellor discussed. So much for the Opposition.

The right hon. Member for South-West Surrey(Mrs. Bottomley) described what goes on in her constituency, but I will not take from her that doom-and-gloom-merchant view of the health service. I visit my local hospitals, see my local primary care groups and talk to the local trusts. I know what the health service is achieving in my constituency and how the Government's agenda sits very well with the people with whom I speak. I very much welcome the Government's modernising agenda.

In the Wirral, we will get a walk-in centre, which will reduce waiting times and lists for patients. We have been allocated £800,000 to modernise our accident and emergency unit. The Opposition do not mention that. Waiting lists are down in my constituency and I have received no letters from constituents complaining about shorter waiting lists. It is nonsense to say that we should not honour that commitment, as has been said rightly and powerfully in this debate.

My local hospital, Arrowe Park, which does an excellent job, is to get a new 12-bed unit to help deal with winter pressures. We are part of the Merseyside health action zone, which returns me to the public health agenda. On the Wirral, we are considering occupational therapies to get those who are suffering from long-term ill health back into employment.

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I will end on this note. My right hon. Friend the Secretary of State for Health said that this debate is fashioned around the idea of year zero--the idea that the Conservatives were not in power for 18 years. Their collective amnesia is--


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