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Dr. Fox: It is a very important point that there is a distinction between cost-effectiveness and affordability. Although it might be a legitimate role of NICE or any similar body to examine the cost-effectiveness of any treatment--an aim which I am sure is widely shared--the decision on affordability should not be left at arm's length, but should rest with Ministers. Will the right hon. Gentleman confirm that if NICE agreed that beta interferon was a cost-effective treatment--especially, as seems increasingly likely, in the early stages of multiple sclerosis--Ministers would not stand in the way by saying that it was not affordable to the NHS?
Mr. Milburn: There are clearly two separate sets of decisions to be made. One is about effectiveness. It is right and proper that NICE should look at clinical and cost-effectiveness side by side. That is the right thing for it to do; and it is best equipped to do it. The national health service has never had an independent means of considering those matters and it seems sensible to have one if, as Conservative Members claim--I am sure they are genuine in this--they want to deal with these problems.
There is a separate set of decisions which, in the end, I take. I take decisions about affordability. Those are my decisions. That is right and appropriate, and I will be held to account for them. When NICE comes up with its recommendations, we will of course consider what it says. That is the right thing to do.
I can tell the House that there has been no greater clinical distortion than allowing the NHS, as the previous Government did, to provide the lowest level of cardiac services in precisely the areas where coronary heart disease is highest. That is what we inherited, and that is
what we are trying to change. We shall improve the health of the population as a whole, but we shall improve the health of the poorest fastest.
Yes, there are many things wrong in the health service, but there are many things that are going right. Slowly but surely the expansion of the NHS is under way. It is underpinned by the extra resources that we have committed to the service. Of course, it takes time to deliver results and they are always dependent on what we can afford, but we have achieved 5 per cent. funding increases on average during the current spending review. If we continue to manage the economy successfully, we can be confident that we will be able to make the sustained increases in funding that our health service needs, and get up to the European Union average.
The hon. Member for Meriden (Mrs. Spelman) has said that none of that is certain. One thing is certain--the Conservatives would not and could not match our commitment to the NHS. The first reason for that is that Conservative Front-Bench Members have already condemned Labour's investment levels as reckless and irresponsible and as madness. Secondly, the Conservatives' tax guarantee, far from delivering the growth in NHS capacity that the service needs, would result in
Opposition Front-Bench Members cannot have it both ways. They cannot bemoan the improving financial position of the health service while proposing swingeing cuts. They cannot complain about NHS deficits while threatening to make them worse. What the Conservatives propose is not so much a tax guarantee as guaranteed attacks on the future of the NHS.
That is not what the NHS needs. It needs more investment and more reform. The only guarantee is that it will get neither from the Conservative party. The hon. Member for Woodspring says that, philosophically, the Conservatives have moved on from the NHS. The Government believe that the principles of the NHS are right, but we believe with equal passion that its practices have to change fundamentally.
Mr. Geraint Davies:
Does my right hon. Friend agree that to say that waiting lists are unethical is to say that minor ailments should always be trumped by major ailments, and that under Tory rule someone with a cataract would never have treatment? Does he agree also that to say that a 6.8 per cent. funding increase is not sufficient and yet not to pledge any more is to open up the hidden agenda of privatisation behind the tax guarantee?
Mr. Milburn:
My hon. Friend is absolutely right, and I am coming to precisely those points.
The Conservatives cannot have their cake and eat it. They cannot have the tax guarantee and then complain about lack of investment in the NHS. That will open them up to the charge of hypocrisy, and that charge will stick as we go into future general elections. The hon. Member for Bromsgrove (Miss Kirkbride) and her colleagues on the Back Benches, who complain that there is not enough
money going into the NHS, ought to take up their complaint with the new shadow Chancellor and the Leader of the Opposition because their policy, the tax guarantee, places an artificial straitjacket around NHS spending.
Our view is straightforward: we want to invest more in the NHS. We know that more investment is needed in the NHS, and that is precisely what we intend to provide.
Dr. Fox:
Will the right hon. Gentleman give way?
Mr. Milburn:
One more time, and then I want to get on to clinical distortion.
Dr. Fox:
It surprises me that the Secretary of State wants to get on to that subject. On taxation, he makes the ridiculously simplistic argument that it is impossible to reduce the burden of taxation and increase expenditure on the health service. In the 1980s, the NHS saw its biggest funding expansion in history, at the same time as the tax burden diminished. If the right hon. Gentleman asserts that that is impossible, how does he reconcile his two statements today about increasing and improving NHS funding and the Government's reduction in the standard rate of tax by 1p next month?
Mr. Milburn:
I presume, therefore, that the hon. Gentleman disagrees with the right hon. Member for Huntingdon. Is that right? Does he agree or disagree with what the former Prime Minister had to say about the tax guarantee?
As the Prime Minister has said many times, cutting income tax rates is the right thing to do--not least to compensate for other changes in the tax system. We can do that precisely because we are giving the NHS the biggest cash injection in its entire history. Let us not forget that the hon. Gentleman and his party opposed that at the time, and do so now, but do not have the guts to say so.
On the question raised by my hon. Friend the Member for Croydon, Central (Mr. Davies), clinical need drives our determination to speed up care. Faster care means better health. Let us be clear: the NHS is expected to treat all patients according to their clinical priority. Emergencies should be treated immediately, and urgent cases should rightly be given top priority. Our determination to get waiting lists down has not changed that one bit, and the figures prove it.
Compared with 1997-98--these are complex procedures; precisely the sort that the hon. Member for Woodspring says are not happening in the NHS because of all the toes and nails that are being done--last year, there were more than 6,400 additional hip replacement operations, more than 4,700 additional knee replacements and more than 1,400 additional coronary heart bypass grafts. Let us have no more of the argument that clinical priorities are distorted by waiting lists. Waiting lists are down, and we will go on to meet our manifesto commitment. What is more, we have turned the corner on out-patient waiting, too.
The hon. Member for Woodspring says that the lists are not coming down. Over Christmas and new year, hospitals rightly prepare to deal with the inevitable rise in attendance that extra winter pressures cause. This winter
was no exception. We saw a rise in the number of people waiting for in-patient treatment in December. We will probably see a further rise in the January figures.
Imagine what a performance there would have been from the hon. Gentleman if those waiting lists had not risen this winter. He would have endlessly repeated the charge that waiting lists had distorted clinical priorities. Indeed, December must have been the only month of the year when he wanted waiting lists to go down. I am sorry to have disappointed him. The NHS did the right thing this winter. It put emergencies before elective cases. In the process, it has given the lie to those who claim that cutting waiting lists distorts clinical priorities. It has not, it does not and it will not in the future either.
Mr. John Bercow (Buckingham):
In responding to my hon. Friends the Members for North Wiltshire (Mr. Gray) and for Bromsgrove (Miss Kirkbride), the Secretary of State wriggled like a belly dancer. For the benefit of the 1,000 multiple sclerosis sufferers and their supporters congregating this afternoon in Westminster Hall, will he tell the House in the form of a simple yes or no answer whether he stands by his statement that
Mr. Milburn:
That is precisely what we want to do and that is precisely why we have established the National Institute for Clinical Excellence, which the hon. Gentleman opposed. I can therefore only presume that he and his hon. Friends are quite content, apart from specific instances of drugs and treatment, to let the lottery of care continue. I say one thing to him: we are not. Yes, we want to ensure that people receive the treatment that benefits them most. That is precisely what NICE will do.
swingeing cuts in the health service.
Opposition Members shake their heads, but those are not my words; they are the words of the former Prime Minister, the right hon. Member for Huntingdon (Mr. Major).
No one will be denied the drugs they need. That is guaranteed . . . ?--[Official Report, 30 June 1998; Vol. 315, c. 143.]
Yes, in all circumstances, or no?
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