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Linda Gilroy (Plymouth, Sutton): Will the hon. Gentleman give way?
Dr. Fox: If I may, I shall quote from a letter that appeared on the letter page of The Times yesterday. A GP wrote:
- "I am also self-employed within the NHS. As a result (in common with other GPs) some of my staff costs are reimbursed. In 1990 the Government paid 70 per cent. of these costs, now this figure is creeping below 50 per cent. To add insult to injury, not only am I being penalised personally to fund my employer but I will have to pay more on behalf of my staff as well."
Linda Gilroy: As the hon. Gentleman is highlighting the shortage of doctors, will he apologise to his constituents, my constituents and those of all hon. Members, given that it takes seven years to train one?
Dr. Fox: The logic of the hon. Lady's question is rather dubious, as the Government constantly trumpet the increased number of GP trainees. By her definition, all of them must have started their medical education under the last Conservative Government. If there is an increase in the number of trainees, that is nothing to do with the Government. The problem with the Government is that those trainees do not want a career in general practice because morale is constantly undermined by interference from politicians in clinical freedom. GPs have less ability to do what they think is right, and they are now being taxed more into the bargain, notwithstanding the fact that they are more likely to be sued. All those elements contribute to general practice being much less attractive as a career, and responsibility for most of them lies at the door of the Secretary of State. I suggest that the hon. Lady saves her questions for the wind-up this evening.
The Secretary of State told us this afternoon about the Government's closed mind. We have had many indications of what he described as their closed mind. That is perhaps the most disappointing aspect of the Government's policy. To make matters worse, the Chancellor's closed mind was forced on the Department
of Health. The Wanless report, which was held up as a great independently minded tome, was simply used as a smokescreen to raise our taxes. Its conclusions could have been written in advance, and its contribution to the health debate was minimal at best.That closed mind, which the Secretary of State mentioned, prevents the Government from dealing with four of the biggest problems in the national health service. For all the talk, it remains hugely centralised. Devolution, which was written and directed in Whitehall, is a sham. The primary care trusts will have their budgets decided by the Secretary of State. He will set the budgets, decide the performance targets and withhold funding as he sees fit. Labour's concept of earned autonomy is an oxymoron; it means that people can do what they like, but only if it is what Labour likes. The system also remains hugely politicised. Far too many appointments are made according to political allegiance rather than health expertise. Since the introduction of the so-called independent Appointments Commission, the number of appointments given to those who expressed an allegiance to the Labour party has gone up. The system is becoming even more politicised than it was when it was being criticised by Dame Rennie Fritchie only a couple of years ago.
The system also remains hugely wasteful. In case hon. Members think that I am bigoted in terms of what newspapers I read, the Sunday Mirror—the Chancellor's fanzine—pointed out this week the loss of
- "£9 billion down the drain every year in the NHS . . . £2 billion because of bedblocking or late-cancelled operations . . . £1 billion because of infections caught in hospitals; £400 million on clinical negligence; £300–£600 million on wasteful prescribing and over-priced drugs; £100 million on avoidable management costs."
Perhaps most worrying is the Government's failure to deal with lack of choice in the NHS. All too often in the NHS, patients are seen to service the system, rather than the system being seen to exist to service the patients. What the Government mean by choice is extremely unclear. The Secretary of State told the House:
- "Within three years, all patients, with their GPs, will be able to book hospital appointments at a time and a place that is convenient to them."—[Official Report, 18 April 2002; Vol. 383, c. 716.]
- "if the Primary Care Trust and if your local GP and you yourself as a patient decide . . . There are a lot of ifs about this—decide that what you want to do is to be treated in that hospital, then providing it's got the capacity that's fine."
Since the Budget, desperate Ministers have described the NHS as the world's best insurance policy, so let us examine the case for that assertion. The first reason why the NHS is not the world's best insurance policy is that consumers cannot tell whether they are getting value for money. In Germany, whose system the Secretary of State
so deprecates, consumers can compare the prices of sickness funds and if they do not like what they see in one, they can choose another. We in this country have no idea how much of our tax goes to the NHS because of the Chancellor's rejection of hypothecation. Secondly, people on middle incomes cannot tell whether they are paying enough to assist the poor because we know too little about access and outcomes. Thirdly, the payment we make to the Treasury does not guarantee us any power of choice. Fourthly, the NHS is a state-run monopoly with no real competition.Let us imagine telephoning the world's best insurance company for car insurance. We might be told, "We can't say how much it will cost you—we'll take an unspecified sum directly from your pay packet each month. Although we will promise you fully comprehensive, high-quality, universal coverage, we won't detail what rights you have to expect that, and if you make a claim, we might not get around to the repair for 15 months, especially if your car's an older model, and even then you'll have no choice of repairer." How long would such a company stay in business?
Clive Efford (Eltham): The hon. Gentleman is fixated on people on low incomes, but when we talk about a universal insurance policy, we have chronic illnesses in mind as well. Can he tell me about one insurance policy that covers chronic illnesses?
Dr. Fox: The German social insurance policy ensures that people get access to chronic disease management far better than they get in the United Kingdom. The Chancellor says that we cannot even consider other systems because of the effect that they would have on the poor and vulnerable. I say to him, go to France, Holland or Germany and see what happens to the poor and vulnerable of those countries—they get far better quality care than people in many parts of the United Kingdom.
Clive Efford: Will the hon. Gentleman give way?
Dr. Fox: No. The hon. Gentleman had his chance and he blew it.
We will, no doubt, engage in much further debate on how we finance health care, but the way in which money is spent must take priority.
Helen Jones (Warrington, North): Will the hon. Gentleman give way?
Dr. Fox: No. I will not give way again.
There are real doubts about the NHS's ability properly to absorb spending increases of such magnitude within such a time scale. The Conservatives will continue to examine the ways in which other countries organise and fund their health care, to see what lessons we can learn for the sake of the people of the United Kingdom. As the King's Fund puts it:
- "It is time to stop making heroic promises, and buckle down to the unglamorous detail of building a good-enough health system for the 21st century."
Mr. Deputy Speaker (Sir Alan Haslehurst): Order. I am sorry to interrupt the hon. Gentleman. It is no good
hon. Members baying at a Member addressing the House; the hon. Gentleman will indicate if he is prepared to give way. He has said that for the moment he is not.
Dr. Fox: It is entirely characteristic of the party with no arguments but lots of volume to adopt such an approach in the House. It knows, as do the voters of this country, that the Government will ultimately live or die as a result of the success or failure of producing not good, not better, but world-class health services by the next election. We will monitor their performance; we will support them when we think that they are right, and produce alternatives when we think that they are wrong. The push for deeper reform must continue. The life and death of the Government is one thing, but failure to reform is a matter of life and death for our fellow citizens and is of a completely different order of magnitude.
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