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The Prime Minister: The right hon. Gentleman said that I conceded yesterday that the Conservatives would match us on health spending. They will not match us on health spending. The right hon. Gentleman has £16 billion worth of cuts to find. He has £1 billion more to find for private medical insurance. He has to find the extra money on tobacco duty, which he refused to support, which makes a £300 million hole in his funds straight away.
What is clear from everything that the right hon. Gentleman has said today, and from what his health spokesman has said, is that on the NHS, the Conservatives are more extreme than ever. They do not believe in the health service--they never did. They would not invest in the health service--they never did. They do not understand the health service--they never did. [Interruption.]
The Prime Minister: I will repeat what I said. Conservatives do not believe in the health service--they never did. They would not invest in the health service--they never did. They do not understand the health service--they never did. [Interruption.] The problem with the service is that, for 35 of its 52 years, it was run by a
Mr. Charles Kennedy (Ross, Skye and Inverness, West): There is great symbolism in the fact of this prime ministerial statement today, and the House of Commons, as a whole, should welcome that fact. Is it fair, therefore, to acknowledge that, in the carefully crafted words of the Prime Minister today early in his statement--when he said that the plan shows how the money will make up for years of underinvestment--those years of underinvestment included the first three years of his Administration?
Secondly, when the Prime Minister says--[Interruption.] I hope that Labour Back Benchers will give me the courtesy of attention, because I am attempting to question the Prime Minister on what he said, as opposed to coming up with a pile of pre-prepared, jingoist and simplistic soundbites, paying no attention to the detail involved.
When the Prime Minister says that, for decades, the NHS has failed to invest sufficiently in modern building and equipment, he should say not that the NHS has failed to invest, but that we have failed to invest. It is the responsibility of the public in terms of the decisions taken at the ballot box, as well as of the Government of the day. Having listened to the Leader of the Conservative party, I am sure that we will have our legitimate differences across the Floor of the House when it comes to public services generally and the health service in particular, but none of us wants to return to the 18 years that preceded the development that we are acknowledging today.
Can the Prime Minister properly clarify whether the national plan includes the provision of personal care for those in long-term care, as was recommended by the royal commission? If it does not, let us be clear what that means in human terms. It means, for example, that a person suffering from dementia would be expected to pay for being bathed, fed and clothed. That is an issue of basic dignity that should be of concern to us all. It is vital that the Prime Minister should be able to confirm that.
In passing, could the Prime Minister confirm how many of those groups--including, for example, those concerned with Alzheimer's--who put their names to the NHS plan have not put their names to the Government's response to the royal commission on long-term care? That is a significant consideration, and one that the House needs to hear about. Will every mental health patient be given an absolute right to an assessment of their needs and treatment?
The Prime Minister was silent today on the issue of dentistry. What, if anything, are the Government proposing later this year with regard to that? All of us know, at a constituency level, the real difficulties people are having in even getting registered with a dentist, never mind getting or affording the treatment that follows.
Finally, Mr. Deputy Speaker, Sir, I welcome the report and confirm the commitment of my party--and our whole political and philosophical tradition--to the thinking that led to the formation of the national health service. We want the national plan to succeed: that is in all our interests. If the promises it contains are delivered, there will be better to come for the health service. I share the Prime Minister's hope that better is to come. The whole nation wants that.
The Prime Minister: On the right hon. Gentleman's point about underinvestment, I accept that we did not get as much money into the health service as we should have liked during our first two years. However, that happened for the simple, clear reason that we had to make sure that we reduced the enormous deficit in the public finances. If we had not done that, we would not have stabilised the economy, achieved growth and avoided the recession that many predicted. We would not, in fact, have been in a position now to achieve sustainable increases. The right hon. Gentleman is also, of course, right to refer to a failure by Government to invest.
On personal care, the right hon. Gentleman is right. We have committed ourselves to nursing care, but have decided that it is better to spend £900 million on intermediate care rather than making all personal care free. It will be up to the nurse on the ground to decide the difference between nursing and personal care. I am informed--but will get the precise details for the right hon. Gentleman--that seven out of 10 of those who receive personal care will also receive some support.
I will also check the details on mental health, but think it correct to say that people will have the right to have their needs assessed. On dentistry, the position is as I set it out last year. By the end of September 2001, everyone will have access to an NHS dentist.
There are many elements in the plan, and to list them all would detain the House even longer than I have done. I thank the right hon. Gentleman for his general support, and for the constructive way in which he has approached the issue. To Conservative Members, particularly those who object to what I have said, I say that it would have been easier if we had had something of the same constructive approach from the right hon. Member for Richmond, Yorks (Mr. Hague).
Mr. David Hinchliffe (Wakefield): I warmly welcome the Prime Minister's statement. The strategy that he has outlined is in marked contrast with the ragbag of a fragmented internal market that we were left by the
I have one or two detailed questions about the statement. My right hon. Friend will understand that there is some unease on the Labour Benches about the proposed relationship with a private health care sector that has consistently undermined the NHS's basic principles since 1948. Will he say a little more about the proposed concordat? Is it a temporary arrangement, and will it last as long as some of the mental health arrangements with the private sector? If the NHS is short of capacity, why do we not buy capacity on a long-term basis from the private market?
Picking up on the point made by the leader of the Liberal Democrats, my right hon. Friend answered the question about the definitions of social care and nursing care by saying that the decision would be left to the individual nurse. Does the plan offer a clear definition of those two areas, one of which is means-tested and one of which is free? Otherwise, will there not be some inconsistency in the interpretation of that division?
The Prime Minister: On the last point, I will write to my hon. Friend as I do not want to mislead him in any answer I might give about some of the distinctions, which are complicated. Essentially, we had to choose whether we would fund all personal care in the way that the Sutherland commission anticipated, or whether it was better to use the same amount of money for a range of intermediate care projects. We decided that it was better to do it in the latter way.
I have no doubt that the debate and discussion will continue on the matter, but the commitment of £1.4 billion overall is significant. Of course, the commitment to free nursing care is intended to remove what otherwise has been a basic anomaly in the way in which we have dealt with the long-term care system.
As for the private health care sector, for me the key distinction is between that sector developing or delivering a service within the national health service and people being forced out of the NHS altogether. It would probably be prohibitively expensive to buy out all the private care as my hon. Friend suggests. However, it is also clear that if hospitals can buy in some capacity for the treatment of particular patients--obviously, this happens now to an extent--it is important to have that flexibility for the patient.
On consultants' contracts, the important thing is that, obviously, consultants will carry on with their private practice, but it is right that we contract new consultants to the national health service for the early stages of their careers, provided that we ensure that they are properly and adequately rewarded--[Hon. Members: "How long?"] As to the number of years, that is precisely what we can now sit down and discuss with them. [Interruption.]