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A huge degree of inefficiency would be unleashed in the public sector if that money were poured in without some direct targeted control. It is almost as though the Conservatives want the NHS to failas though they want to produce a complete recipe for inefficiency in the public sector in order to illustrate that they can never provide high-quality and efficient services.
I have been listening to the right hon. Gentleman's argument very carefully. Earlier, he spent some time praising the management and staff of the NHS, and rightly so, but he now seems to be saying that if they are given the opportunity to use resources they will be so uncaring of them, and so hopeless, that they will not be able to drive the NHS in the direction that they need locally where they have made
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decisions in consultation with others who work for the NHS. I cannot see where the two parts of the argument meet. Is he saying that he has no confidence in the ability of local NHS staff and management to handle resources well?
Dr. Reid: No. I have great respect for the hon. Gentleman, but he is clearly having difficulty holding two ideas in his head at the same time. We will have a managed transition from centrally driven targets while we simultaneously change the system, making the driving and navigation force patient power, not providers' power. That is a sensible balance between two extremes. One extreme is to micro-manage everything in great detail from the centre, so that every time a bedpan falls in Tredegar it resounds in Whitehallthat is where we started from, although Nye Bevan himself never regarded that as the ultimate or the optimum structure for the NHS, because he desperately wanted to decentraliseand the other extreme is the happy-clappy friendship society that the hon. Member for North-East Bedfordshire (Alistair Burt) seems to be suggesting. That is to say that
so here is £62 billion, go away and do something, and we won't exert any scrutiny or ask for accountability on behalf of the taxpayers." Both positions are extreme and both are silly. We want to reach a position that is in between.
If we suddenly decided to spend £110 billion on the NHS, without managed transition of the system so that it was driven by patients, and announced that we would be the only business in Britain that had no objectives, targets or aimsthe official policy of the Conservative partyit would be absurd. It would unleash huge inefficiency. Hon. Members should not take my word for it but simply check the leaders of the Financial Times in May or June this year, which made that very point.
Matters are even worse, because the Conservatives plan to render more inefficient not only our public services but the private health care sector. The NHS used to buy operations from the private sector, but as one-off purchases, and often at high spot prices.
Mr. Dorrell: The Secretary of State is obviously enjoying himself, but he should base some of his comments, at least tangentially, on the truth. Does he genuinely believe that the idea of block purchase by the NHS from the private sector was revealed to an unsuspecting world on 1 May 1997? Is that his view of how the world worked before that date?
I did not say that no one had ever used block purchase previously. I said that the NHS used to make purchases from the private sector, often as one-offs and at high spot prices. I know what the right hon. Member for Charnwood did because we carried out a study for the Select Committee on Health, which my hon. Friend the Member for Wakefield (Mr. Hinchliffe) chairs. The average price that the right hon. Gentleman paid was about 150 per cent. of the NHS price, because the purchases were not made systematically in huge bulk. I hope that he accepts that that is truthful because it is a fact. In general, if we can agree on the facts, we get to the truth.
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Mr. Dorrell: I am all in favour of agreeing the facts. I am delighted if the Government now realise, as they did not in 1997, the importance of establishing a proper partnership between the public and private sectors. The great shame is that the incoming Government on 1 May 1997 did not develop that policy from the roots that they inherited. Instead, they spent five years going off in the opposite direction. Only now is the Secretary of State for Health, like the Secretary of State for Education and Skills, returning us to a policy that he inherited on 1 May 1997.
Dr. Reid: That is interesting. I hope that the right hon. Gentleman does not suggest that there is any difference between my right hon. Friend the Secretary of State for Education and Skills and me. We are the vanguard of revolutionary transformation of public services. I am proud to march shoulder to shoulder with him.
If the right hon. Member for Charnwood finds himself in a positionas he has just doneof congratulating us on our actions, he must simultaneously condemn Conservative Front Benchers for their proposals.
Dr. Reid: Let me explain their proposals to the right hon. Gentleman. Having unleashed inefficiency in the public sector, they would do the same, if they ever got their hands on the reins of power, in the private health care sector. Let us remember the dog that did not bark, the elephant that no one mentionedthe patient's passportwhich featured in the 40-minute contribution of the hon. Member for South Cambridgeshire. The Conservative Government would let anyone who could afford it buy any operation at any price from any private sector provider. Whatever the price or value, the Conservatives would provide an automatic public subsidy for such operations. That is a combination of the inefficiency of the worst 20th century subsidy-junkie thinking and the worst 19th century Conservative iniquities and inequalities. The Conservatives have managed to combine the grossest inefficiency with the grossest unfairness. They do that with so much embarrassment that they do not dare mention the policy during a major debate in the House of Commons.
The Secretary of State talks about unfairness. Apart from the unfairness of ascribing to us policies that we do not have, let me give him an example of terrible unfairness. What does he say to my constituentwhose name I am happy to provide to hima young, fit guy who went jogging recently and had a heart attack? He did not realise that he was having a heart attack. The ambulance service in Staffordshire arrived within six minutes, so congratulations are due there, and staff gave him a decoagulant injection. He went to hospital for a week. He was told that he needed an angiogram to determine the precise damage that had been done. He was told that he would have to wait three months before he could be put on a waiting list and subsequently a further three to four months. However, he was then told that he could have it done tomorrow if he paid for it. He paid out of his own pocket£1,800. Is not that inequity?
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Dr. Reid: If that happened, it is a disgrace. That is why long waiting lists are a disgrace. Long waiting lists and times create demand in the private sector by those who sometimes cannot afford to use it. I have no objection to anyone going private if they wish, for reasons of celebrity, money, taste and so on, but I object to the placing of people in a position whereby they or their loved ones are forced to pay for primary and secondary health care because the quality, and the time that they have to wait, in the NHS is a problem. Tragically, year on year, that was increasingly the position under the Conservative Government.
Dr. Reid: If it is happening, and the hon. Gentleman gives me the name of his constituent, I will look into the matter. However, I stress that one of the reasons for the 27.1 per cent. reduction in premature deaths from heart-related diseases is the provision of thrombylosis and other treatment within 30 minutes. Survival rates for those who have suffered heart attacks and get treatment in 30 minutes of their arrival in hospital are huge compared with those that previously pertained. I shall revert to waiting lists shortly.
Mr. Tim Collins (Westmorland and Lonsdale) (Con): I am sure that the Secretary of State is sincere when he says that he regards it as disgraceful that people feel that they must go private to make up for the problems that they find in the NHS. However, he said that the problem worsened under the previous Government. Will he confirm that the numbers forced to do that under the Labour Government have tripled since 1997?
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