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Mrs. Caroline Spelman (Meriden): On a point of order, Mr. Deputy Speaker. I did not want to cut into the
time of the hon. Member for Rother Valley (Mr. Barron) because I wanted to be courteous. However, page 386 of Erskine May states:
- Expressions which are unparliamentary and call for prompt interference include:
The imputation of false or unavowed motives.
The misrepresentation of the language of another and the accusation of misrepresentation.
Mr. Deputy Speaker: Perhaps the hon. Lady did not hear me, but when there was much excitement earlier in the debate about the hon. Gentleman's comments, I said that there would be an opportunity for Opposition Members to rebut his case. All that needs to happen to put the record straight is for an hon. Member to say, "Hospitals were built at that time". That is why we have debates.
5 pm
Sir Raymond Whitney (Wycombe): In response to the misapprehensions about hospital building that have been distributed by Labour Members, let me advise the hon. Member for Rother Valley (Mr. Barron) that the hospital building programme has been cut back only once in the 50-year history of the national health service and that was in 1976 under the Labour Government on the orders of the International Monetary Fund, when the accounts of this country were effectively under foreign control.
I begin by offering the House two predictions. First, just as we have heard nothing new yet from the Government on the future development of the health service, I predict that by the end of this debate, including the wind-up by the Minister of State, we shall have heard nothing new. For 50 years, Labour Members have had nothing new to say about the health service, so they are certainly not about to start now. My second prediction may seem a little presumptuous as it concerns my remarks. Either they will be totally ignored because the facts that I am about to offer will be too uncomfortable, or they will be deliberately and wilfully misconstrued.
For half a century there has been an intellectual blight on how we treat health care. We have heard it again today. It all starts from the assumption that, allegedly, the Conservative party was against the national health service. Hon. Members ought to know that that is absolute nonsense. During the Second Reading debate on the National Health Service Bill in the House of Lords, the then Labour spokesman said that the Bill was not the product of any single party or any single Government. He said that it was in fact the outcome of a concerted effort, extending over a long period of years and involving doctors, laymen and Government to improve the efficiency of our medical services. There is no doubt that it was a joint effort.
The health service was based on the 1944 White Paper which was produced by Henry Willink, a Conservative, who was Health Minister in the coalition Government at the time. Although Conservative Members, perhaps misguidedly, voted against Aneurin Bevan's Bill--just weeks earlier Herbert Morrison had spoken against its content--the Conservative health spokesman said in the
Second Reading debate that he was anxious to clarify the position of the Conservative party with regard to the principle of the national, comprehensive, 100 per cent. health service. He said that the Conservatives accepted that principle, as they had in 1944. Labour Members should accept those realities instead of continuing to perpetrate misinformation.The intellectual blight that I mentioned occurred because we became used to persuading ourselves that the national health service was the envy of the world. I wish that it were. Sadly, that has seldom been the case. Had our national health service been the envy of the world, one would have expected country after country to have adopted the same system. As we know, that has not happened.
Sadly, evidence has steadily mounted that the structure that was put together in 1946 has not met modern conditions. Indeed, as long ago as 1967, the British Medical Association recognised that it was falling short and set up a committee under Dr. Ivor Jones. It reported in 1970 that
- performance . . . is shown to compare unfavourably with that of many other countries in several respects . . . there is inadequate finance both in regard to capital and running costs . . . the imperfections of our health service are clearly visible . . . staffing is deficient at all levels and many sections are underpaid . . . it appears probable that Britain must think in terms of additional expenditure on medical care of an order which no government has ever contemplated . . .
When I became a junior Health Minister in 1984, I did not accept that point of view. I took the point of view of every other Health Minister of both parties--that we had two jobs. One was to get as much money out of the Treasury as we could and the other was to spend it as sensibly as possible. At the time, I did not consider that there was any possibility of changing the basic 1946 structure. After one year of wrestling with the problem, I concluded that it had to change. That conclusion is increasingly being reached by people who know about the health service. As hon. Members may recall, it was voiced by Lord Winston for 24 hours before he was silenced by the Government machine.
There is now overwhelming evidence that our health service is not up to international standards. The latest league table puts us in 18th position. Let me offer hon. Members a few more statistics. I hope that they do not find them too unpalatable. On the basic challenge of mortality, in respect of life expectancy at the age of 60, the United Kingdom came 19th out of the 23 countries examined by the Organisation for Economic Co-operation and Development. We are on a level with Turkey.
On health outcomes, in respect of heart disease and cancer survival rates we are at or near the bottom of the European league table. In the United Kingdom a person with stomach cancer has an 8 per cent. chance of surviving five years. In France, his chances are three times greater. In the United States, his chances are four times greater.
Mr. Hesford: Will the hon. Gentleman give way?
Sir Raymond Whitney: No. There is a time limit on speeches and I need to make progress. If there is time, I shall give way later in my speech.
In December 1998, the Economist Intelligence Unit survey placed us 14th out of 25 nations. It assessed that we were losing 200 million working days a year due to sickness, much of which was due to the deficiencies of the national health service. It estimated that that was costing the nation some £12 billion in lost production.
Those are the facts. In debate after debate in the House hon. Members representing all three major parties resolutely refuse to face up to them. In the United Kingdom we have 4.5 nurses per 1,000 people. The figure for Germany is twice that. We have 0.4 dentists per 1,000 people--half what they have in Germany. Of all the OECD countries only Albania and Turkey have fewer doctors per head of population than we have.
We all know that health service morale has never been lower. The medical profession especially feels under attack, and it is alarming to see the sensitivity among doctors. Some of my hon. Friends have already mentioned the deep damage that the juggling of the waiting lists has done to clinical priorities.
Those are the problems and we have to open our minds to them, instead of dwelling on misinformation about what happened in 1946. As my right hon. Friend the Member for Wealden (Sir G. Johnson Smith) said, under the previous Conservative Government, the budget went from £9 billion when we took over to £40 billion by the time we left office, so we have all tried. For example, we increased the number of people treated in hospital by 80 per cent. and the budget went up by 75 per cent. in real terms. The present Government are also trying, but the question is whether we can ever get the results we want using public finance.
In terms of total expenditure on health, the most recent figures available show that we spend 6.9 per cent. of our GDP on health, and of all the OECD countries, only Ireland spends less. The claim is that we will catch up with the Germans' spending. To do so, the Chancellor of the Exchequer would have to find a further £45 billion. That is an inconceivable figure. However, even if we did achieve that over five years, by that time the Germans would have moved on. They are not satisfied with their level of health care, even though they spend some $2,000 per person and we spend $1,200 per person.
Cash is not everything, and we can achieve more through our NHS than the Americans do with their vast expenditure. Even my hon. Friends on the Front Bench are, understandably--because of the rubbish we hear from Labour--scared of dealing with the facts that I am setting before the House. Many people do not realise what they are being deprived of, compared with what other societies--comparable to us in wealth and economic structure--provide for their people. For example, our waiting times are unheard of in continental countries. They would laugh at such waiting times.
We must ask, therefore, whether there is another way to run the NHS. I mentioned the BMA committee that reported in 1970, and it concluded that the answer was an insurance-based system. That does not mean pushing some of the work on to the private sector. Some of the arguments that we hear from the Government against giving greater emphasis to private insurance are valid. In my opinion, we need a totally new structure. It would not be revolutionary, because I could name 20 countries that have similar structures, and they provide much better health outcomes than we do.
An average of £915 is spent for every man, woman and child in the country. Under the insurance-based system that the Jones committee advocated in April 1970, we could offer everybody an insurance voucher of £700. I support that system and, indeed, I wrote a little book on it in 1988. The system would give us all the chance to contribute for ourselves, and that is the way forward. No Chancellor will ever be able to find that astronomical sum of £45 billion, and therefore we must have a new system.
That new system is obvious, when we consider society now and how much better it is than the one for which the NHS was constructed in 1946, when the decisions were taken. Then, we were impoverished, worn out and on our knees. Now, the average family is four times better off in real terms. It spends some £2,000 to £3,000 a year on its holidays and Christmas presents. Most people would want to supplement their health cover. If they did, they would feel involved in the health system, and that they had some ownership of it.
I realise that that is a difficult pill to swallow. Most of us have said for 50 years that the national health service would be wonderful if only we could spend another few billion. That is what the House and the Labour Government are saying again now, but it will not work.
There is money in the Exchequer. Of the £915 per head of population that is spent on the NHS every year, we could spend £700 on insurance vouchers. That would leave £215 for those who really need protecting--
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