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Dr. Howard Stoate (Dartford): It always gives me great pleasure to take part in health debates: I am one of the few Members who still has personal contact with the NHS, as I still do some medical surgeries in general practice.

We have heard some extraordinary statements today. The one from the right hon. and learned Member for Rushcliffe (Mr. Clarke) takes the biscuit. He tried to explain that he phased in the pay awards when he was Secretary of State because the health authorities could not afford to pay them. Of course they could not--the previous Government did not give them the money. Had the Government given health authorities the 6.8 per cent. average that we have given, they would have been able to afford decent pay awards for decent staff.

Mr. Brady rose--

Dr. Stoate: I shall give way in a moment.

To cool the temper of the debate, I shall try to establish whether there is a genuine crisis in the NHS. I shall do so by reference to my own experience. As the House knows, I am a general practitioner. This morning I contacted my local health trust to find out what was happening. It is indeed under severe strain, among other reasons because it is 92 nurses--about 13 per cent. of the nurse complement--short.

Why are health trusts short of nurses? Because they cannot get trained nurses. Why can they not get trained nurses? Because there are not enough trained nurses in the health service. They are doing their best to put that right, as are the Government, but it is nonsense to suppose that we can produce trained nurses out of a hat.

The idea that complementing the health service by using the private sector would solve the problem is even greater nonsense. The same number of trained nurses would be split between two hospitals--the national health hospital, which would be struggling to keep them, and the private hospital, which would be struggling to poach them. It is fairly obvious that there would be winners and losers, but we cannot stretch the number of nurses, unless we want them to do double shifts and work 16 hours a day.

Mrs. Gillan rose--

Dr. Stoate: I shall give way later, but I want to make progress first.

It is impossible to get more out of our dedicated staff. That applies not just to nurses, but to professions allied to medicine, including technicians, and of course doctors. If doctors are doing coronary artery bypass grafts down the road at the private hospital, they are not doing them in the NHS hospital. The idea that twice as many coronary artery

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bypass grafts could be done if the private ward down the road were opened does not accord with the facts, because the same surgeons work in both the private sector and the NHS.

When I refer patients for surgery, they often ask me whether they can go privately. The answer is yes, they can go privately, but they will see the same consultant and get the same treatment. And guess what? If they get the treatment privately, the consultant whom they see will not be in the NHS hospital. We cannot have it both ways. The idea of expanding the private sector as some miraculous panacea will not do the business.

We heard tell of Lord Winston's comments. Lord Winston is an honourable and decent physician, and he has a point of view, but I cannot agree with it. Consultants are feeling frustrated and let down. As has been pointed out, the reason is that the Government's health reforms, putting primary care in the driving seat, threaten some interest groups. The reforms threaten the monopolies of certain physicians and specialists, who are seeing some of their power put back into primary care, where doctors, nurses, social service staff and others are making decisions on what constitutes the best health care for their area, in conjunction with health improvement programmes, the Commission for Health Improvement and the work of the National Institute for Clinical Excellence. All that will improve health care, but may well damage some personal empires and private interests in the health service. I understand that view, although I disagree with it, but to sensationalise the position is quite wrong.

We also heard it said that we need to increase health resources to the European average. That is certainly a target, but we must be careful to compare like with like. In the UK, NHS spending and private health spending together represent about 6.8 per cent. of gross domestic product. The European average is about 8.8 per cent. of GDP--about 2 per cent. more. However, if we analyse those systems, we find that they are much more bureaucratic than ours.

In the 1960s and 1970s the NHS used to spend 3 to 4 per cent. of its total budget on administration and bureaucracy. The Conservatives managed to increase that to 6 per cent. by introducing their market reforms, which increased administration costs, if not clinical costs. In most European systems, the administration costs are far higher--10 per cent. in some cases. In America, administration costs are even higher, and can reach 12 or 15 per cent. If that money is stripped out, the European average of 8.8 per cent. of GDP is closer to 7.8 per cent, which is not so very far above our 6.8 per cent.

I am not arguing that the NHS has enough money. No hon. Member believes that--it clearly does not have enough money. Everyone in the House believes that we need to spend more. There is no argument about that. The question is how we do it.

I listened closely to suggestions from the Opposition about how we could increase the contribution of the private sector. Let us assume that there are enough doctors and nurses, and concentrate on funding. Various alternatives have been proposed, and it is unfair for the Opposition to claim that the Government have not thought them through. The Government have considered them carefully.

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The alternatives are compulsory insurance or voluntary insurance. Both have costs. Compulsory insurance is merely a stealth tax. If people are told that they must have private insurance, that is the same as taxation. Where is the advantage in that? We might as well pay for the service out of general taxation. If people are urged to have voluntary insurance, something different will happen. People will say, "If I'm going to pay voluntarily for health insurance, I want something more in return than the bloke down the road, who doesn't have it."

That will create a huge split in the service and a massive two-tier system. I do not believe that the British people's sense of fair play would allow that. There are far greater problems. As my right hon. Friend the Secretary of State said, the people who need health insurance--those with chronic illnesses and pre-existing conditions--will not get health insurance.

I should like to see the health insurance company that would take on someone with chronic diabetes, renal failure and eye problems. It would be crazy if it did, and I am sure that actuarial advisers would say that that was a bad bet, in the same way as insurance companies will not take on a young driver with four convictions for drunk driving. They do not want to know such people, and they will not want to know people with chronic health problems. If, however, private health insurance companies were forced to take those people on, it would merely force up the premiums for everyone else, and we would be back where we started. People will not want to pay hugely inflated premiums. Private health insurance simply does not cut the mustard. It is not fair for Conservative Members to claim that we have not thought the matter through. We have considered it for many years.

I want to comment on the suggestion that the health service has deteriorated rapidly since the Labour party took office. When I qualified in medicine 20 years ago, our health service was the envy of the world. Nobody challenged that slogan. Twenty years on, however, we are led to believe that we have the worst system in Europe--a health service that is even worse than Poland's. For 18 of those 20 years, the national health service was in the hands of the Tory party; it has been in the hands of the Labour party for only two years or so. That sets alarm bells ringing and makes people wonder what happened. Could it be that the previous Government were not especially interested in preserving the health service? Perhaps they liked the idea of the slow decline of the NHS into a second-rate service; perhaps it served their purpose. When my hon. Friend the Member for Wakefield (Mr. Hinchliffe) read out The Sunday Times article, which outlined the wishes of the hon. Member for Woodspring (Dr. Fox) for the NHS, the matter began to become clear. Perhaps the hon. Member for Woodspring does not want the NHS to be the primary provider in the new century.

I want to consider the flu epidemic. I shall not speak for too long because other hon. Members want to contribute, but most of the media interest has sprung from the so-called flu epidemic. Frankly, I am not sure whether there is a flu epidemic--and I do not even care, because the answer depends on the way in which one measures an epidemic. A traditional measurement is 400 sufferers per 10,000 visiting a general practitioner in one week. However, nowadays, more options are open to those who suffer from flu. They can visit their pharmacist, phone NHS Direct, go to casualty, speak to a neighbour or take

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home remedies. Many people are far better informed and do not go to their GP. However, the people who visit their doctor with flu are more ill than in previous years. There are far more cases of genuine flu rather than the flu-like symptoms of previous years. Patients are more ill, need far more treatment and take longer to get over the illness. Some people have taken three or four weeks to recover.

This morning, I saw a lady who was very ill through flu complications. In previous years, I would have sent her to hospital. However, the Government have made a real advance: for the first time, I had an option. I could tell that lady that she did not need to go to hospital because we could manage her condition at home with proper nursing, physiotherapy, and through involving social services. For the first winter I can remember, we can manage that patient at home on an acute basis. The NHS is well prepared for the crisis. I turned up and said what needed to be done. In a few minutes, we took action, the services were provided and the lady could be looked after at home, where she wanted to be. The NHS is thus more modern and better prepared than some hon. Members claim.

I want to consider flu injections. Much research shows that flu injections work, although they are not perfect. However, there are two provisos. The injections need to be targeted at vulnerable groups and we need to increase the herd immunity of the population. I hate to refer to hon. Members as a herd, but the description fits the concept of immunity. Those needs mean vaccinating more widely. The Government should consider carefully widening the net for flu jabs in an epidemic year. That means targeting not only all those who are at risk but their carers. I suggest targeting those who are over 65 rather than over 75, and injecting crucial care workers and others who perform an essential service in society. If a carer is sick with flu, it is a tragedy not only for the carer but the person who is cared for. The Government should consider widening the availability of flu immunisation to cover far more people. We can thus spare the NHS significant strain. If it is true that the NHS is under strain as a result of the flu bug, it is also true that much of the problem would disappear if it was controlled.

The NHS ain't broke, but it needs fixing. It comprises a dedicated group of staff: doctors, nurses, staff in the professions allied to medicine, managers and others do a splendid job in difficult circumstances. We should pay tribute to them because they keep the NHS going. Clearly, we must do something to provide more resources for the NHS. The Government are honest and open in admitting that we need more money and in holding a debate on the source of the funding. For all the reasons that I and other hon. Members have given, privatising more of the health service or increasing private insurance will not provide what we want. We need a modern health service for this century. Privatisation and private health insurance are not the answer; we require a better-funded public health service. I will leave the calculations to the Chancellor and his colleagues because that is their field, but I call for greater funding in future.

If Conservative Members want to reform a bankrupt and outdated institution, they need look no further than their party. I wonder whether the private sector would be interested in buying it from them.

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6.16 pm

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