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9.45 pm
The Chief Secretary to the Treasury (Mr. Andrew Smith): I have been here throughout the debate and heard the hon. Member for Buckingham (Mr. Bercow) as well
as the right hon. and learned Member for Folkestone and Hythe (Mr. Howard). The hon. Member for Buckingham has a thing or two to learn about monkeys and organ grinders. Never could we have heard a better example of someone's eloquence outrunning his judgment than in the hon. Gentleman's speech.The hon. Gentleman refers to the fund raising for the Nuffield orthopaedic hospital in my constituency. I am proud of that fund-raising effort. I commend the energy and support that Lord Tebbit has put into that out of personal commitment. I would not seek to use that for political purposes, here or anywhere else. [Interruption.]
Mr. Speaker: Order. We must be able to hear the Minister.
Mr. Smith rose—[Interruption.]
Mr. Speaker: Order. We must have some calmness.
Mr. Smith: There are two striking things about this debate. The first is that the shadow Chancellor described our national health service, a proud creation of this country and something of which we are all proud, as a Stalinist creation. The second is that he refused conspicuously when challenged by my hon. Friend the Member for Dumbarton (Mr. McFall) and others to rule out charging. He gave the game away as to what the Tory agenda is. It is an agenda of privatisation and of charging for the health service.
It is clear where the dividing lines are in the debate. Where we will invest in the NHS, reform it and work with staff to raise its performance, the Conservative Front-Bench team will not commit to NHS investment, it has no ideas for NHS reform and, as it toys with half-baked ideas for private insurance, it would destroy the principles of the NHS, just as the Conservatives opposed its foundation.
As my right hon. and hon. Friends have pointed out, a key principle is at stake. We believe in an NHS free at the point of need, so that patients receive care on the basis of clinical need and not ability to pay. I believe that that principle is strongly supported by the British people. After all, it is about fairness. In walking away from it, as my hon. Friend the Member for Halton (Derek Twigg) pointed out speaking on behalf of his constituents, the Conservative leadership would threaten millions of people with insecurity, with costs that they cannot afford, and with health care being unavailable when they need it most. In promoting their private health agenda for what they describe as the Stalinist NHS, Conservative Members would land a body blow on NHS staff, whose skills and dedication we depend on for better health care. Conservative Members will rue the day that their leaders set off down that road—just as they already regret initiating this debate in which only two Tory Back Benchers spoke after the shadow Chancellor, who could not get out of the Chamber fast enough. They have not one thought-out policy to offer.
I shall reply to some of the speeches. If I followed him correctly, the right hon. Member for North-West Hampshire (Sir G. Young) was urging a supplementary social insurance model. I took his comments in the spirit in which they were made, which was certainly not the spirit of the shadow Chancellor. I think that the right hon.
Gentleman believes in a national health service that is free at the point of need, as he promised in his manifesto. He is nodding his agreement. He clearly disagrees with the shadow Chancellor and recognises that charges would be a disaster.The danger of such schemes is not only that employers and employees have to pay more, but that, as has happened in France, they often increasingly require top-up contributions. Moreover, the administrative burden of such schemes frequently grows—as it did in Germany, where the Government were forced to intervene when administrative charges exceeded 4.8 per cent. of health spending, compared with the 3.8 per cent. of health spending to which we keep administrative charges in the cost-effective NHS.
Mr. Edward Davey (Kingston and Surbiton): Will the right hon. Gentleman give way?
Mr. Smith: No; if I may, I shall reply to the debate.
In a characteristically thoughtful speech, my right hon. Friend the Member for Birkenhead (Mr. Field) pointed out that, in contrast to most European countries, the key issue for the United Kingdom is that, without a surplus of nurses and doctors, expansion of the private sector would be at the expense of the NHS and those who depend on it. He also pointed out the ever-present danger for politicians of grappling with what he called the "live rail" of the NHS. Today, the shadow Chancellor jumped down on the tracks and grabbed that live rail when he threatened the British people with charges.
My right hon. Friend the Member for Birkenhead also urged that the NHS be funded only with national insurance contributions levied on employees. I am sure that he will understand it if I say that I shall take that as a Budget representation.
The hon. Member for Sutton Coldfield (Mr. Mitchell) said that a lot of things are wrong with the NHS, but, although I listened carefully to his speech, he made not one positive suggestion about what to do about them. He said that there are not enough nurses and doctors, but the Government have already recruited an extra 17,000 nurses and an extra 6,700 doctors. Moreover, what was the position before we entered office? Furthermore, with the funding that we are making available, which would not be made available if Conservative Members were in government, we are bringing forward 20,000 extra nurses and 10,000 extra doctors. We shall achieve that because we are increasing the resources and share of GDP provided to the national health service, not introducing charges or cutting public spending to 35 per cent. of GDP as advocated by the shadow Chancellor.
We believe in the NHS and are ambitious for what it can and must achieve. Moreover, as the interim Wanless report points out, United Kingdom health outcomes have not been good enough, public expectations are increasing, and over a long period we have not invested enough to get the health services that the British people want. As my right hon. Friend the Chancellor of the Exchequer spelled out in the pre-Budget report, we need to spend a higher proportion of national income on health, coupled with reform to improve delivery. If hon. Members accept that, they will accept that the money can come from only three main sources: general taxation, social insurance, or private payments.
We say that it is right that it should come principally from general taxation. We say that because, as the Wanless report states:
- "The main disadvantage of a predominantly social insurance based model is that the revenue base is more concentrated, falling on employment to a greater extent than in countries with a higher proportion of general taxation funding. As a result, many countries such as France with a tradition of social insurance, have been shifting the balance in their funding towards general taxation."
- "Private funding mechanisms tend to be inequitable, regressive . . . have weak incentives for cost control, high administration costs and can deter appropriate use."
Mr. Edward Davey: Given that Ministers have been so against charges in the NHS tonight, will the right hon. Gentleman commit the Government to ending charges for eye tests and dental check-ups?
Mr. Smith: It was this Government who ended charges for eye tests for people over 60. If it were not for our commitment to resourcing public services, which would never have been possible with Liberal Democrat policies, that would not have happened. Of course we reject charging for clinical services.
As we have seen in the months since the general election, it is our party and our Government who are reaffirming a commitment to the principles of the national health service, hugely increasing health spending and matching that expenditure with reform, putting 75 per cent. of the funding through the primary care trust, devolving responsibility and empowering front-line staff.
The Conservative party, having promised that no one would be forced to take out private insurance, now wants to introduce charging for health care services but will not say who will be charged how much for what.
Mr. Bercow: The Chief Secretary has already gone one better than the Chancellor: he has so far provided half an answer to one of the 16 questions put by my right hon. and learned Friend. In the remaining three minutes, will he answer some of the other 15 and a half?
Mr. Smith: There is a lot to debate as we decide how to develop the NHS, but that contribution is barely worthy of our attention.
The public want a publicly funded, comprehensive, high-quality service, available on the basis of clinical need, not ability to pay. One thing is clear: the shadow Chancellor did his party, and indeed many decent Conservative voters, a great disservice last week and again tonight, when he derided this as a Labour question. The truth is that it used to be a Conservative question, too, and perhaps still is for those of his more moderate colleagues who are able to resist the ever increasing power of the fundamentalists in their constituency associations.
The shadow Chancellor and the Leader of the Opposition have confirmed that they are more extreme than ever. Their abandonment of a one nation health service is a final nail in the coffin of one nation Conservatism.
We are determined to secure comprehensive, high-quality services available on the basis of clinical need, not ability to pay. That is not just a Labour question: it is the British people's question. It is in applying the best values and instincts of the British people for fairness and mutual support that we, and not the Conservative party, will provide the answer: a properly resourced national health service that delivers for all the people.
Question put, That the original words stand part of the Question:—
The House divided: Ayes 169, Noes 297.
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