| Previous Section | Index | Home Page |
5.42 pm
Mr. Jon Owen Jones (Cardiff, Central): It has been a privilege to hear today's debate and to have the opportunity to speak in it, particularly after my hon. Friend the Member for City of York (Hugh Bayley), who spoke from his experience in the health service. My right hon. Friend the Member for Birkenhead (Mr. Field) and my hon. Friend the Member for Wallasey (Angela Eagle) ably summarised the debate for and against reform, and I want to examine some of the evidence to help come down on one side or the other.
In 1997, Labour inherited a health service that was slower and less responsive than that of any other western European nation, but it was also cheaper. That year, the NHS cost us only 5.2 per cent. of our gross domestic product—£32 billion—which was less than that of every other developed nation. With decades of under-investment, it is not surprising that the performance of our health service lagged behind that of others. The scale of the underfunding was tellingly brought to the Prime Minister's attention by the knowledgeable comments of Lord Winston in the new year of 2000. The Prime Minister responded by committing our party and Government to the ambitious objective of matching European levels of investment, a commitment that was repeated in our manifesto of 2001. As we build capacity, and train and recruit more health workers, we will gradually see our health service become once again, if not the envy of the world, at least a service in which no British citizen has to wait months or years for treatment.
There can be no serious argument against the need for investment, though how the Conservative party can support both health investment and a 20 per cent. cut in public spending is a difficult equation, which I am glad to leave them to solve. For most of us, the argument is not about investment, but about the extent to which reform is also necessary.
The critics of this Bill will, of course, deny being against reform. There are some who genuinely support reform but who have concerns about this particular policy. In general, however, the opposition to
foundation hospitals comes from a belief that not much is wrong with the national health service that more money will not cure. Our national health service is one of the few institutions, as my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) has said, that can claim to be loved by the public. It is valued and respected, particularly on the left and in the Labour party. It is viewed rightly as the greatest achievement of Labour, and any Labour politician who might suggest that Aneurin Bevan did not design a perfect system, fit not only for the 1950s but for the 21st century and in perpetuity, does so at his peril.How true, therefore, is it that if we give the national health service more money it will deliver a correspondingly better service? Funding is easy to measure but it is less easy to quantify the level of service. I put together the following statistics that give a broad, and, I believe, accurate picture. Between 1997 and 2001, national health service funding increased from £32.9 billion to £43.8 billion—a 33 per cent. increase. During the same period, however, out-patient attendances rose by just 6 per cent. Between 1997 and 2001, funding increased from £36.5 billion to £51.2 billion. During the same period, however, consultant episodes rose by 3.1 per cent. a day, and day cases rose by 5 per cent. Between 1996–97 and 2001–02, funding rose by 55 per cent. Out-patient attendances, however, rose by only 7.7 per cent. For the years for which the figures that I have found are available, therefore, it is clear that the national health service has failed to match investment with service delivery, and that its productivity is declining.
We should accept, however, that increased activity will lag behind investment, and that it takes time to build capacity and train staff. That is a fair argument for the steady-as-you-go believers. That argument predicts, however, a steep increase in activity as capacity is built. As yet, in this evening's debate, I have heard no analysis of when and how that steep increase in activity is to occur. On the contrary, evidence exists that activity is not rising even when capacity is installed. We have 4,320 more consultants than in 1997—a 20 per cent. increase in capacity, but, as I said, consultant episodes have increased far more slowly than that. That means that, on average, a consultant does less today than his or her counterpart did in 1997. They are roughly 85 per cent. as productive as they were in the mid-1990s. Those statistics lead me to reject the steady-as-you-go argument, and to urge the Government to speed reform. Without reform, this historic investment will be used inefficiently and wasted.
I believe that the 21st-century health service should be patient-driven, offering a high degree of choice and convenience for its customers. Health information should be widely available to inform choice. Health service providers should be given freedom to innovate and to respond to local needs. Success should be rewarded and productivity and efficiency improvements encouraged.
The present system does none of those things. It denies choice. It seeks its own convenience rather than that of patients. It conceals information. It operates on central direction rather than on devolved responsibility. It tolerates, and even rewards, failure and inefficiency.
For those reasons, I support reform—
Mr. Deputy Speaker (Sir Alan Haselhurst): Order.
5.50 pm
Mr. Geoffrey Robinson (Coventry, North-West): The whole House shares the deep frustration expressed by my hon. Friend the Member for Cardiff, Central (Mr. Jones) that, despite the large resources going into the health service, there is not a proportionate and commensurate response in productivity and efficiency. I do not draw his negative conclusions, but we all need to ask why that is the case.
There also seems to be general agreement in the House that the monolithic bureaucratic structure of the NHS, especially at the centre, which the Secretary of State himself described as the dead hand of central control, is one of the factors that is holding back local managements and preventing them from getting ahead as they want to do. That is certainly what I hear in all my discussions with trust chairmen and chief executives. When we hear about the stream of e-mails that they receive and the restrictions placed on them, we can all share their natural sense of frustration.
The immediate reaction to the foundation proposals is that 50 hospitals will be taken outside that bureaucratic structure, so that will, we think, solve the problem. However, in effect, all it means is that 250 hospitals will be left with increased bureaucratic overheads and all the restrictions and difficulties that that will impose on them. The Government have to come to terms with the problem: it is not that we must set up foundation hospitals, but that we must scale down the bureaucratic burden and the central planning and control of the health service.
Because of the specific proposals on foundation hospitals, I shall abstain on Second Reading. I shall explain some of the reasons, as I have done on previous occasions. The regulator's role is not clear; there is a muddle about the extent of his independence. Why was it proposed that certain hospitals should be allowed to borrow, then that they should not be allowed to borrow or that their borrowing should be capped? None of those points are clear. I agree with Members on both sides of the House who say that if we want to take the democratisation route—as we all do—we should start with the primary care trusts. That seems logical. The whole interface between them and the new foundation hospitals is unclear.
My biggest problem with the Bill has been set out by many Members: it is yet another reorganisation. The Government can call it reform if they want, but reorganisation and reform do not give us what the measure should be about: improvement. For the first time in a generation, real resources are going into an organisation. If we take the right decisions and ensure that those resources get down to the local hospitals where they can be used, we can expect them to produce really effective results.
I listened with great interest to the speech made by my right hon. Friend the Member for Birkenhead (Mr. Field). Like him, I read the debates held in the early days, in the late 1940s. Perhaps we took the wrong route by going national instead of local. I have much sympathy for that view, but we must deal with the situation that exists. Given the resources that we are putting in, we need a big increase in the level of service and in its responsiveness.
The foundation route will make no significant difference over the next five years. I am sure that the Bill will receive a Second Reading, but I urge the Government to introduce it as a pilot; for example, in two health regions. We could then monitor the process and learn the lessons, to see how to make it work. We should not blindly take that route, thinking that we have found the solution—a new deus ex machina—when all we have is a vague idea.
There are several reasons—I have mentioned one already—why the foundation hospitals concept could, in general, produce much better results: new local management; local autonomy, which would be welcome and have a very good effect; democratisation and the involvement of the public, which, over time, would also have an effect; a flexible wage policy for different areas of the country, which I would not necessarily oppose in principle; and preferential or increased access to capital.
I have just listed five criteria, the development of which we could consider through two pilot areas. I assure my right hon. Friend the Secretary of State that if that were the proposal, I would be joining him in the Lobby, but unfortunately it is not. Worse than that, there is no proposal to improve the lot of the 250 hospitals that will be left out of this initial reorganisation. We are putting the cart before the horse. It is underperforming or average hospitals that should be the focus of our attentions and energies; instead, efforts will go into setting up complicated new structures, which will mean millions for lawyers, accountants and consultants. That is where the £200 million that those hospitals can spend preparing to become trusts will go; it will not be spent on front-line services.
I am sad to see that, in the absence of such a proposal, we are going down the route of another uncontrolled experiment, thinking that we have got it right. Instead, we could conduct this reform in such a way that it did not take up the entire focus of the energies of this House and of the national health service itself, and thereby get to grips with the real problems that we face. As many Members have said, we have the resources: real money; management, professionals, nurses and auxiliaries working together; and the necessary time. We do not have to rush into this particular solution now.
I am told that we can expect the Bill to come back on Report substantially modified by the other place. I hope that it does and, although I shall abstain tonight, I look forward to perhaps finding it more favourable then. Above all, in the interim, I should like the Government to say what they will do to improve the overall situation, given that they have at their disposal the means to do so.
| Next Section
| Index | Home Page |