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6.30 pm
Mr. Philip Hammond (Runnymede and Weybridge): I have listened carefully to all that has been said, some of which has been very interesting. The hon. Member for North Devon (Mr. Harvey) agreed with my hon. Friend the Member for Woodspring (Dr. Fox) that the growth of the private sector would complement the national health service. I welcome that uncharacteristic display of openness from a Liberal Democrat.
The hon. Member for Wakefield (Mr. Hinchliffe), who is not present, is at least consistent, and I would not expect him to move an inch. I disagree with him entirely, but I respect his consistency: he is one of the few Labour Members who have stuck to a position that they have maintained for many years. He did, however, manage to ignore the experience of the rest of Europe and, indeed, the rest of the world.
My right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) helpfully drew attention to the sterility of much of the political debate about the NHS. He referred to longer-term trends extending over periods exceeding any Government's time in office. The conclusions that we must draw from those longer-term trends underline that,
notwithstanding the rhetoric, all Governments over the past 20 years or so have spent more on the NHS, and the problems have not gone away. That emphasises the need for serious consideration of strategic approaches to those problems.
The hon. Member for Rother Valley (Mr. Barron) seemed to suggest that doctors were to blame, because they are building and defending their empires. He apparently supports the idea that the Government should tell doctors how to spend their resources. He calls it modernisation; I suspect that most people in the health service would call it meddling. Most telling of all, after his condemnation of the internal market, he gave figures relating to the differing costs of certain procedures in different hospitals. He was right to draw attention to the disparities, but had it not been for the internal market he would not have had the figures.
Mr. Barron:
According to the hon. Gentleman, I said that doctors were to blame. In fact, he has answered his own point. The figures that I gave relate to the practices of clinicians in the NHS. I asked why some clinical interventions cost three times as much as others. Surely he accepts that ensuring that our money is used in a resourceful way should be a priority.
Mr. Hammond:
It is an important issue, and the hon. Gentleman is entirely right; but without the internal market he would not have the figures that he has been quoting at us, and we could not pursue his argument and, hopefully, make the necessary savings.
In our last health debate, my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) warned the Secretary of State that winter crises would inevitably recur unless the fundamental issues were addressed. I remember that very well. My right hon. and learned Friend is eminently qualified to draw attention to the myth continually promoted by the Government that a re-elected Conservative Administration would have stuck to the draft spending plans. Everyone knows that we had annual spending rounds, and spending on the NHS would--as it always had--have increased year on year. By pretending that they would follow the Conservative spending plans, the Government starved the NHS for the first two years; now they wonder why the patient is not responding to force feeding.
My right hon. and learned Friend spoke of the discredited £21 billion slogan. As he said, it has now been replaced by a new slogan referring to a "five years ahead" target to match a European spending average that has not been defined for us. It is not even clear to me that that constitutes a pledge. I hope that the Minister can tell us whether the Prime Minister gave a clear commitment on Sunday.
The hon. Member for Dartford (Dr. Stoate), who often speaks on these matters, said that the NHS wasn't broke, but did need fixing. He seemed to miss an important point about additional resources. He said that expanding private spending would simply denude the NHS of resources. Let me tell him that, whether financial resources come from the private sector or the public sector, they will contribute exactly the same to the pot, and the problem will be exactly the same: how to turn financial resources into real
resources. The Secretary of State may say that that problem can be solved by injecting more public money, but it can equally be solved by finding other financial resources.
Dr. Stoate:
It is generous of the hon. Gentleman to give way to me in his winding-up speech. In fact, I was referring to NHS staff. There are not enough doctors, not enough nurses and not enough members of professions allied to medicine. Until we have trained more people--as the Government are doing--reapportioning the same number of staff between the private and public sectors will not improve the situation.
Mr. Hammond:
What the hon. Gentleman said was that more private spending would denude the NHS of resources. More needs to be spent on health care, but the problem of translating financial resources into real resources--doctors and nurses--will be the same whether the money comes through additional private spending, a mixed model or more state expenditure.
My right hon. Friend the Member for Kensington and Chelsea (Mr. Portillo) drew our attention to the important fact that it is largely through historical accident that our national health service is funded as it is. He posed a good question: why is it, outside the eastern bloc, a unique model for the delivery of health care? If it had so much to recommend it, why did not other countries in western Europe copy it when rebuilding their economies in the 1950s and 1960s? He also drew attention to the insularity of the Labour party. The party that does not want to be isolated in Europe has refused to learn anything from the lessons of all our European neighbours over 30 or 40 years.
I am delighted that the Under-Secretary of State for Wales is to wind up the debate, but I find it odd that, with four junior health Ministers in the House, it was not possible to find one who was willing and able to do so.
We have heard from Labour Members--not least the hon. Member for Crawley (Laura Moffatt)--a catalogue of complacency, in the face of the worst short-term crisis that the NHS has faced in living memory and against a backdrop of growing discontent with the state of our health system overall. The Government stand exposed as complacent, ill-prepared, shifty and manipulative when under pressure, and simply not credible when attempting to formulate a policy response to the longer-term strategic questions that face health services, while refusing to abandon any of their dogmatic baggage.
I thought it a telling insight into new Labour's priorities that, at the beginning of last week, with patients dying for want of intensive-care beds, staff working at breaking point and hospitals bursting at the seams, there was, according to the Secretary of State, "not a crisis". But by the end of the week, one doctor speaking his mind and telling the truth about Labour's national health service had become a crisis of such proportions that it required the direct involvement of the Prime Minister.
Labour has no credible policy solution to the problems of the NHS: the Prime Minister's intervention confirmed that. We have no clue about how the Government would deal with the real problems in the long term. Their prescription is "more of the same"--although it is obvious to every qualified observer that, after nearly three years, the new Labour medicine simply is not working.
As my right hon. Friend the Member for Sutton Coldfield commented, in the Secretary of State's whole rambling speech, there was not a single new idea for the resourcing of our national health service.
The Secretary of State said that he had an open mind, but it was abundantly clear during his speech that he has not. As my right hon. Friend the Member for Sutton Coldfield said, it is unbelievably depressing. The Secretary of State's dogmatic hostility to the private sector was tangible throughout his speech.
Many hon. Members paid tribute to the valiant efforts of the dedicated staff--just about the only thing holding the health service together. I associate myself with those remarks, but the fact is that, despite those efforts, the NHS is not providing a basic acceptable level of service to all. The Prime Minister has acknowledged as much, snatching the rug as he did so from under the Secretary of State, who just a few days earlier had denied that that was the case.
As it is currently managed and run, the NHS clearly cannot cope when faced with a sudden surge in demand. People living in an advanced, affluent democracy--the world's fifth largest economy--at the outset of the 21st century should not have to ask themselves, "If I fall sick, will there be a hospital bed available for me?" or, "If I need an intensive care bed, how many hundreds of miles will I have to be transported to get it?"
Our neighbours in France, Germany, Belgium and the Netherlands take such a service for granted. It is increasingly clear that the British public are no longer willing to be denied the levels of health care that their neighbours enjoy simply because of the Government's dogmatic political ideology.
The current crisis in the NHS is a catalyst that demands a triple response. First, we need an immediate short-term response from the Government. On that count, they have clearly failed. They failed to give a clear undertaking to hospitals that they could devote resources to medical priorities without risking penalisation under the Government's waiting list scheme. They have failed to take the lead in encouraging NHS hospitals to use the private sector where that is sensible. Instead, they have ducked and weaved, relying on spin, rather than looking for real solutions.
The Government tried to exaggerate the status of the flu epidemic outbreak. They then misled us over the number of intensive care beds that had been created and suppressed the report of the inquiry into NHS beds, which will show that, despite their rhetoric, bed numbers have fallen under Labour.
Secondly, in the medium term, we need an end to the system of initiatives that is doing so much to damage the NHS, particularly the Government's waiting list pledge, which has grotesquely distorted clinical priorities throughout the service in favour of Labour's political priorities. Since they came to office, they have doubled the number of in-patients waiting more than 13 weeks and doubled the number of people waiting for an out-patient consultation. We need an end to that distorting system immediately.
Thirdly and perhaps most importantly, the crisis shows the need for a longer-term, more measured response to the underlying problems of the NHS: not a panic reaction such as the one that has occurred in the past couple of
days, with wild half promises and vague commitments, but a measured, serious review of the options for future delivery of health care.
We have invited the Government to join in such a review, starting without any ideological baggage and looking at all the options with the open mind that the Secretary of State claimed he had. It has been made abundantly clear from the things that he has said that he rejects that opportunity to take the NHS off the political battlefield and to deal with it rationally.
So far, the Government's only response to serious debate on the future of the health service is to level the rather pathetic charge that anyone who dares to question the sustainability of the present model--which is now almost all serious commentators--wants to privatise the NHS. That seems to be the only argument that the Government can deploy in defence of the status quo. They do not deploy reasoned arguments, call for open discussion of the options, or review experience elsewhere. It is simply a knee-jerk reaction. That strikes me as the position of a Government who are not confident of their case, but have a bunker-style mentality, are increasingly isolated at home on the issue and are in a minority of one, even among their socialist colleagues in Europe.
The Conservative position could not be clearer. The Leader of the Opposition has made it clear, as did my hon. Friend the Member for Woodspring again today. We are committed absolutely to the NHS, free at the point of delivery. We are committed to increases year on year in real terms in NHS funding under the next Conservative Government. However, we recognise that, even with that commitment to tax-funded NHS spending, it will not be enough in the face of the explosion in medical technology and the imminent genetics revolution. All serious commentators now agree that what is needed is strategic and innovative thinking about the NHS. We have seen that there is no appetite on the Government Benches for such a debate.
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