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5.23 pm

Sir Norman Fowler (Sutton Coldfield): The hon. Member for Wakefield (Mr. Hinchliffe) rather wrecked his credibility with his display of ignorance about Lord Winston. However, I shall follow his example and be brief.

The trouble with the speech by the Secretary of State was that it offered nothing to the public. The House should recognise that people are genuinely worried about the present state of the health service. The right hon. Gentleman rejected all new thinking and ideas--a ridiculous approach to adopt. The Government must accept that they alone are to blame for the criticism heaped on them in the past few weeks.

No party could have done more to exploit the inevitable difficulties that occur in the health service than the Labour party in opposition. I was Secretary of State for Health and Social Security for six years. My abiding memory is that the Labour Opposition opposed all changes in the service--even the introduction of general managers, which the Labour Government have now adopted. It is a bit rich, therefore, for the Secretary of State to say that he believes in good management of the national health service.

However, that Labour Opposition did more than just attack the then Conservative Government. They also raised the public's expectations. Their promise was specific: vote Labour, and the problems of the health service would be ended. That message has now been radically altered. The promise is that if people vote Labour, the problems may be over in 10 years' time. The angry reaction to that change of position is not surprising.

The issue today is whether we continue down this dismal road of political recrimination and simply continue the party battle of slogans, or whether we have a serious debate on a better way forward for the health service. I have no doubt that that is what the public want us to do. There may be some very important interest groups in the health service, but what the public--the patients--want should be crucial. I think that the public want a serious debate about how to achieve better health care.

I should mention that I am chairman of Numark, an industrial provident society with more than 1,300 community pharmacies. Having declared that interest, I intend to speak not about pharmacy, however tempting it may be, but more generally.

In the years since 1947, the health service has developed steadily under Governments of both colours. When the Prime Minister says that today more patients are being treated, more operations are being carried out and more hospitals are being built, that is precisely the case that I put forward 15 years ago. It was the case that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) put forward when he was Secretary of State for Health, as, I am sure, did my hon. Friend the Member for Wycombe (Sir R. Whitney) when he was Under-Secretary of State for Health. It was true then and it is true today. However, it does not answer the fundamental question of whether enough patients are being treated or enough operations carried out.

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This country has the best-value health service in Europe. By that I mean that we get more value for the money that we use than any other health service that I know of. That is a tribute to the doctors, nurses, staff and managers of the national health service. However, running a cost-effective health service is no longer enough. The public expect more, and I think that they are right to do so. The most important principle of the health service is that no one should be deprived of health care because of lack of income. Whatever other judgments are used on who will have health care, the question of a man or woman's income does not enter the equation. That remains fundamental. No one wants a system in which people are excluded from health care provision because of lack of income.

Increasingly, people feel that in addition they should not be deprived of self-evidently important health care because of a lack of resources in the health service. The dilemma was most famously put by Enoch Powell, who said that any health service faces the problem of infinite demand meeting finite resources. That is the dilemma of the health service in this country and anywhere else. No system is perfect; equally, it does not have to be as imperfect as ours. It is clear from the cases that have been widely reported over the past few weeks that people who should be treated are not being treated. No one, whatever their political party, wants that.

The real question is how to bring those extra resources into the health service. How do we ensure that those resources are best used? The issue should be about how to achieve the best possible health care for the maximum number of people. In achieving that, we should consider all the options. That is where I quarrel with the Government. It is not written in stone that general taxation is the only means whereby money can be raised for the health service. That is not a fundamental principle of the health service--it is simply the way that it has always been.

I remember talking to Margaret Thatcher about the health issue before the 1987 election. She thought that a royal commission on health was the way forward. That was unusual, because Margaret Thatcher was not renowned for appointing royal commissions--I could put it more strongly than that. In the event, no commission was appointed, but today, three years after the 1997 election, the case for an inquiry--at least--into the financing of the health service is overwhelming. A royal commission or some other independent and authoritative inquiry would allow us to consider all the options by which we could bring extra resources to health.

We can continue to make the health service entirely dependent on general taxation. That seems to be the approach taken by the Prime Minister, and by the Secretary of State, who says that there is no alternative to public spending, which will bring us up to European standards, not now, but in six to eight years' time. There are strong arguments against that course. Of all the health slogans that I can think of, "The health service is safe in the hands of the Treasury" would certainly be the oddest. My right hon. and learned Friend the Member for Rushcliffe is sitting behind me, so I shall be gentle, but the idea that the Treasury is populated by kindly Ministers and officials eager to resource health care is somewhat fanciful. Public spending has not resourced the health service adequately to date. That fact is a commentary not on the present or the previous Governments, but on all the Governments of the past half century.

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If we make health an overwhelming public spending priority, other priorities such as education, law and order, defence and pensions will suffer. To rely exclusively on general public spending is a triumph of hope over experience. We should look at other options. One possibility is a health tax, which might have the advantage of creating some connection between the taxpayer and the health provider. Another option is to raise revenue by some form of personal insurance to add to public funding from tax. Many European countries already use that system, and it is both foolish and depressing to reject that prospect out of hand. It is wrong to suggest that that system would Americanise--or even privatise--the health service.

In Germany, I am told, there have been many television pictures of patients in Britain lying on trolleys and so on. Newspaper comment in Germany has been not about how wonderful the British health service is, but about how the Germans do not want our system of shortages. We deceive ourselves if we think that the rest of the world regards the method by which we finance our health service as the way it should be done. People in other countries may well say that our doctors, nurses and other staff are dedicated professionals who make the most of every penny. I hope that they do, and they would be right to say so, but no one advocates moving towards our system of finance.

I fear that, if we do not seek new paths, in 10 years' time we shall still be debating these problems in the same depressing way. There is no doubt that the old national health service has achieved a vast amount and, having served as Health Minister for six years, I certainly applaud that. But we need change. We need a new national health service, possibly run as a separate commission, but certainly receiving new and consistent streams of income. Such a service could achieve so much more. The Government have turned their face against change, and I deplore that. If they do not alter that stance, my party will rise to the challenge. The present crisis, following past crises, provides an opportunity to think anew.

5.34 pm

Mr. Kevin Barron (Rother Valley): In view of the remarks made by my hon. Friend the Member for Wakefield (Mr. Hinchliffe) and by the right hon. Member for Sutton Coldfield (Sir N. Fowler), perhaps I should point out that I have known Lord Winston for many years. I first met him in 1984, when he was Robert Winston and I was a Member of the House, helping to talk out a Bill sponsored by Enoch Powell, which would have stopped research into the human embryo and thus into infertility. At that time, I thought that Robert Winston was a brilliant clinician and, having considered the events of the past few days, I still think so, although he is now a politician--we are led to believe.

I am sorry that the hon. Member for Woodspring (Dr. Fox) has left the Chamber, because I quite enjoyed the earlier knockabout over his and the Opposition's perceptions of NHS funding. When he got down to his three ways to save the NHS, which I understand have been expressed in a letter from the Conservative party to my right hon. Friend the Secretary of State and Members in other parties, he mentioned two points in particular. The first was that the Conservatives wanted long-term

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funding of the NHS. The second was that they wanted increased funding year by year. That was not our experience during the last five years of the previous, Conservative Government. [Hon. Members: "Yes, it was."]

The right hon. Member for Sutton Coldfield said that the Conservatives had built hospitals every year. Under the Tory Government, they did not build hospitals for many years. What really happened was that they cut back savagely on capital expenditure in the NHS--not £10 million or £15 million but hundreds of millions of pounds. That was the amount that they cut from capital expenditure during their last three years in office. Consequently, my right hon. Friends who have held the position of Secretary of State for Health have had to use the private finance initiative to restore some of the savage cuts to building in the NHS. For the Conservatives to say that they built hospitals is absolute nonsense.

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