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John Mann: I would not dream of putting words into the mouth of my hon. Friend the Member for Bolsover (Mr. Skinner), but our constituencies share quite a long border and very similar characteristics, having both been mining constituencies. I want to ask the hon. Gentleman
a question about pensioners in my constituency, who have the same characteristics as those of my hon. Friend. The vast majority of pensioners in mining areas have a second pension from British Coal and—because of the scandal of health and safety in the coal industry—now receive industrial injuries compensation to the tune of £6 billion. They are precisely the pensioners who would lose out if this increase were to be funded through income tax rather than national insurance contributions. How would the hon. Gentleman answer that point?
Dr. Harris: I refer the hon. Gentleman to the answer that my hon. Friend the Member for Truro and St. Austell gave to his almost identical, but more briefly expressed, question at column 975 on 1 May. I suggest that he picks up a copy of Hansard.
The point that the hon. Gentleman's pensioners will make clear to him, as mine do to me, is that pensioners rely on the health service and on adequate funding being given to it. They are of one voice in wishing that these increases had been introduced five years ago. By now, we could be five years into a 10-year plan, instead of one year into it. We could be watching the first newly qualified medical students emerging at the end of their training, rather than seeing new medical schools being set up only this year. Nurses whose training places had been funded by increased resources could already be on the wards by now. Five years have been wasted. For the many pensioners who cannot write to the hon. Gentleman because, sadly, they have passed away, this increase has come too late, as has the delivery that the Labour party promised.
The Government published the NHS plan in 2000. In the following year, and in this one, they have published details of the delivery of the NHS plan. Perhaps, in 10 years' time, we shall see a new document outlining how they will deliver the delivery of the NHS plan. The Government's history on the management of health service funding consists of a series of comprehensive spending reviews that have not been comprehensive and in which the money has sometimes not been spent. The only thing in their favour is that they have constantly been reviewed and revised. In 1997, this Government hit the ground reviewing, rather than running. They have not dealt with the health service in the way that it needed to be dealt with.
Dr. Harris: I shall give the hon. Gentleman one more chance.
Mr. Rammell: One of the difficulties with these debates with the Liberal Democrats is that we hear spending commitments sprayed around like confetti, but when we analyse them they do not add up. Will the hon. Gentleman tell the House clearly and precisely what net additional health service spending—above and beyond the Government's current plans—the Liberal Democrats are committed to, and how they would finance it?
Dr. Harris: As I said earlier, we welcome the current plans. The level of resources that the Government are now talking about for the NHS—social services are still to be the poor relation—is about the level that we would wish to see spent. Indeed, the hon. Gentleman can look at our
manifesto and our alternative Budget to see that we were the only party at the time to be honest with the electorate about what these resources would be. I know that the hon. Gentleman is not used to straight counting and straight figures, because of the triple counting and re-announcing that he is used to from his own side, but I think, in all modesty, that he should give us credit for announcing our spending plans to the public before the election.The 1 per cent. rise in employers' national insurance contributions is a stealth tax, and is a potential significant burden for industry. Indeed, the Government recognised that when they announced, in their March 1999 Budget, that they were going to tax the "bads" and not the "goods", and cut tax on employment to encourage employment opportunities. That was in reference to, yes, a cut in employers' national insurance contributions. What applied in 1999 to employers—particularly those in manufacturing industry, faced with the problems of a high pound and the decline in manufacturing—should really apply now if this really is a Government of stability, at least in terms of policy.
The proposal is also self-defeating, because the local authorities will have to pay in NICs about the same amount extra that they will receive to fund care of the elderly, even before the ridiculous and punitive fines system is imposed. It has been estimated that the additional costs for the care homes sector will be £50 million in NICs. That has not been factored in. If it has been factored in by the Government, they must give a net figure for an increase in funding in those important care sectors. They have not done so, because they fear that there may be a negative net figure in certain areas—a cut in the money available to social services.
The Government want to spend the money on the health service and they have set out examples of how in a Department of Health document. Some issues are worrying, and I would be grateful if the Minister addressed our concerns when she winds up the debate. The idea that those moneys should be spent on financial incentives for hospitals wholly misunderstands the basis on which people in the health service work. They work because of a public service ethos to treat patients to the best of their abilities.
The idea that we can wring more out of those dedicated professionals by giving hospitals financial incentives to get people in, to get people out and to treat them as day cases or not as day cases suggests that their inspiration is mercenary rather than professional and dedicated. It also runs the risk of significantly distorting clinical priorities and makes the health service more of an accountants' paradise, moving to a bottom-line analysis of health care delivery rather than one based on consideration of the patient's needs.
The Government say that they will establish a new commission to reassure us on how the extra funding is spent. The first place to which a new commission examining whether funding is spent correctly should look is its own creation. Remember, the Government rightly set up the Commission for Health Improvement under the Health Act 1999. They followed that with a refusal to allow it to consider the private sector, setting up the National Care Standards Commission a couple of years later, to begin functioning this April.
Then, while debating the latest NHS deform Bill on Report, we heard about another structural reform, as the Government said that they would merge the CHI and the newly established NCSC after all, despite saying that they would not when we advocated it during consideration of the previous legislation. All that money was spent on establishing a commission that was dissolved shortly afterwards. We heard nothing more until another announcement of a new health commission—this time, merged with Audit Commission functions and the NCSC. How much money has been wasted on the failed attempts to get this right?
We also hear that the Government are to insist that primary care trusts send patients prospectuses to tell them what services are available. That would be even more worth while if the Government insisted that PCTs openly and explicitly tell patients what services are not available. I return to the point about rationing: we should consider not the question whether there is rationing for the health service, but how explicit we are, so that people who are deciding whether to vote for the resources to go to the health service know that some services will not be available if they do not vote for those resources.
The major concern, and our biggest problem with the Government's proposals for spending the money, is how social services are being treated. The Government must recognise that, across the country, local authorities are spending £1 billion more—taken from council tax and other services—than what the Government say they should spend on social services. So, the Government are saying that there is £1 billion of cuts to be had from social services spending or they are happy for education or, more likely, environmental budgets, as education is protected, to be cut to pay for the care of the vulnerable.
Perhaps the Government want council tax to rise. Whatever we say about NICs and income tax for pensioners, Labour Members must accept that council tax is much more regressive, particularly for pensioners on a fixed income. The failure of the standard spending assessment to match need means that the most vulnerable—pensioners paying council tax or children who want funding for education or special needs provision—have to pay for the vulnerable users of social services.
The Government have not only failed to fund social services adequately, but they now say that social services will be fined if funding is not provided to deal with bed blocking and the problem of delayed discharge. We know what that means—not that social services and local authorities will pay the fines, but that they will cut other social services funding on which they will not be fined to avoid those fines. Spending on responsibilities without statutory protection, including vulnerable children, the mentally ill and the disabled, as well as some where statutory duties apply, will be cut.
Indeed, pressures on social service spending come not only from the elderly, but from the vulnerable young and the huge increase in the number of looked-after children who need those resources. Forcing local authorities to rob Peter to pay Paul or to rob Darren to pay Dora to avoid those fines is low politics of the worst kind.
The Government should ensure that their social services funding matches if not exceeds NHS funding. The Wanless report is revealing in that respect. Table 5.4 shows personal social services spending in England and
every column covers four years of projected increase, except that for the current spending review period. Instead of covering the years 1998–99 to 2002–03, it covers the three years from 1999–2000 to 2002–03. Every projection in that column lists average real-terms growth of only 1.2 per cent. compared with about 7 per cent. for the NHS. That shows the low priority that the Government plan to give to social services.
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