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“The discoveries of healing science must be the inheritance of all. That is clear. Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion... Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”
The Prime Minister of the day, Winston Churchill, said that on 2 March 1944, anticipating the establishment of a national health service.
In a spirit of consensus, I will acknowledge that the NHS was inspired by the work of a Liberal, William Beveridge, designed by a Conservative, Henry Willink, and implemented by a socialist, Aneurin Bevan. [Hon. Members: “Oh!”] I was talking to a nurse; my right hon. Friend the Member for Witney (Mr. Cameron) and I have met a number of—[ Interruption.] Is the hon. Member for Livingston (Mr. Devine) seeking to intervene?
Mr. Devine: I have the record of Second Reading of the Bill that introduced the national health service, in which the hon. Gentleman’s predecessor, the then shadow Health Minister, started by saying:
“The right hon. Gentleman the Minister of Health has received an ovation from the Benches behind him for a speech as eloquent,
as unconvincing, and as disingenuous as any I have ever heard from him.”—[ Official Report, 30 April 1946; Vol. 422, c. 63.]
When did the Conservative party start supporting the NHS?
Mr. Lansley: Considering the occasion, the purpose of the debate, the nature of the motion that we have tabled and the way in which I am introducing it, that was a wholly inappropriate response. As far as I could tell from listening to it, it was probably inaccurate, but it was difficult to say.
In the 60 years since the establishment of the national health service, it has been under the stewardship of Conservative and Labour Governments—Conservative Governments for 35 years and Labour Governments for 25 years. In that time, the NHS, for all its vicissitudes and the ups and downs that it has suffered, has none the less exhibited continuous gain, from the point of view of the people of this country. It has benefited us individually and collectively and remains part of the glue that holds society together. From the point of social solidarity and a sense of security in this country, it is immensely important to people.
Conservative Members know—as do all hon. Members—how much we rely on the NHS. I suspect that many of us, from all parties, have occasion to visit other countries—I am thinking especially of America—where the experience of people visiting their health services is too often of worrying about whether they can pay for their care, what the circumstances will be if they become chronically ill and whether, if they visit an accident and emergency department, they might first be asked for their insurance policy or visa number. We do not have those experiences in this country. We have a sense of equity and an understanding that, as part of our social solidarity, we are collectively committed, through taxation, to providing a comprehensive health care service, free at the point of delivery and based on people’s need, not their ability to pay. Those principles are unchanging, even though policies may change or be debated. I do not believe that we disagree about the principles.
Mr. Graham Stuart (Beverley and Holderness) (Con): I congratulate my hon. Friend on the tone with which he has begun the debate, in which hon. Members of all parties will celebrate the foundation of the national health service. There have been huge increases in spending on the NHS, for which the Labour party deserves some credit, but a focus on outcomes rather than false targets will end the distortion of clinical priorities and of the value for money and excellent health care to which the expenditure should lead.
Mr. Lansley:
I am grateful for that intervention and it will not surprise my hon. Friend to know that I feel strongly that the NHS needs to become much more focused on outcomes for patients. That policy does not derive from our thinking alone, but is the product of speaking to literally thousands of people in the national health service. They say that they want to care for the patient and determine their actions on the basis of the patient’s need in a framework where policy is geared to that. Unfortunately, although the Government have been talking about outcomes since my right hon. Friend
the Member for Witney and I started to make it clear that we would move in that direction, they are not designing health outcomes into the policy of the NHS. The policy, as dictated by the Government through national targets, is still geared towards processes and targets rather than health outcomes for patients. A change of direction is vital.
Chris Ruane (Vale of Clwyd) (Lab): The hon. Gentleman started with a brief synopsis of the Conservative party’s position in the 1940s. Will he remind the House of how the Conservative party voted in 1948? Did it vote for or against establishing the national health service? It is a simple question.
Mr. Lansley: I have not looked back—[Hon. Members: “Oh!”] However, my recollection is that Conservative Members at the time, in opposition, took a view about the specific proposals that the Labour Government presented and objected to aspects of them. Labour Members appear to believe that the British Medical Association’s difficulties at the time were a measure of its opposition to the NHS. It is no more true to say that the Conservative party since 1948 or today opposes the NHS than it is to say that the BMA opposes it. Neither statement is true and it is absurd to claim either.
Mr. Jeremy Browne (Taunton) (LD): I am grateful to the hon. Gentleman for giving way because I want to make a helpful intervention. In these straitened economic times, will he reaffirm his personal commitment to increasing NHS spending by £28 billion a year over and above the current Government figure?
Mr. Lansley: The hon. Gentleman must not believe everything that he reads in the newspapers. I made no such commitment. Our commitments are clear: we are committed to the same increases in NHS spending up to 2010-11 as those in the Government’s spending plan. Beyond 2010-11, my colleagues are committed to further real-terms increases in NHS spending.
Mr. Greg Knight (East Yorkshire) (Con): Is my hon. Friend aware that, although most people recognise the anniversary, it is not being celebrated everywhere? For example, in Bridlington in my constituency, there is genuine concern that a relatively new hospital, which a Conservative Government built, maintained and sustained, is under threat from the Labour Government, with services being cut.
Mr. Lansley: Labour Members should listen to my right hon. Friend because attachment to the NHS is often expressed through support for one’s local health service. It should be no surprise that, as I know from my visit to my right hon. Friend’s constituency, many thousands of local people have signed a petition to maintain services at their local hospital. Instead of carping, Labour Members would be well advised to acknowledge that that is true not only in Bridlington but in many places throughout the country.
People are signing petitions not in contravention of medical evidence, but with clinicians’ support and on the basis of evidence for the desirability of maintaining care closer to home. Labour Ministers have adopted that policy, which my former right hon. Friend, Virginia Bottomley, began. She started the process of providing care closer to home, and that care is being lost too often under a Labour Government.
Mr. Lansley: I want to make progress and I do not want to take much time because I want as many Members as possible to have a chance to express their views about the NHS. It is not an occasion for me to make many—or, indeed, any—party political points or to talk about policy in great detail.
However, when one considers the current position in the NHS, we should take account of some things from the past. A couple of years ago, I was at Papworth hospital, which was celebrating the 25th anniversary of the first heart transplant. I was surprised to hear Sir Terence English, who carried out that transplant, say that the 1980s was a golden age in the NHS. That is not a phrase that I normally hear applied to the 1980s, so I asked him what he meant by it. He replied that, in those days, if he could convince the board of governors at Papworth hospital that he should innovate through undertaking something groundbreaking, there was nothing to stop him. We need to consider that carefully. The Conservative party is geared towards health outcomes because the structures of targets and micro-management in the NHS have made many NHS staff believe that they are no longer in a position to innovate or have the freedom to deliver high quality care in the way they should.
Clive Efford (Eltham) (Lab): Will the hon. Gentleman give way?
Mr. Lansley: No, I am making progress and I want other hon. Members to be able to speak.
Hon. Members of all parties should ensure that there are opportunities for innovation.
As we understand from Derek Wanless’s reports and his revisions to them, there are substantial risks to the future of the NHS, not least those that arise from demographic change, the impact of new technologies and the costs associated with implementing them, and rising expectations and demand. However, central among those risks are the impacts of public health demands, if we are unable to achieve what he describes as a fully engaged scenario, whereby the public understand the health implications, including obesity and sexually transmitted infections, of behaviour such as alcohol abuse, substance misuse and the like. Unless the public recognise that, it will be very difficult for the NHS to cope with the disease consequences that will arise.
When Ministers publish the review next week, I hope that they will make it clear that it is outrageous that in London, for example, as Lord Darzi set out in “A Framework for Action”, there is an inverse relationship between the relative deprivation of primary care trusts and the amount spent on preventive health care. Indeed, we have set out clearly how our public health infrastructure should be geared to that, and how we should have separate public health spending. Right across the country, there is no positive relationship; indeed, the average spend per head in primary care trusts on preventive health care spending is just £20, from an average allocation to PCTs of well over £1,000 per head. That is the second lesson.
The third lesson that we must learn is about giving the NHS organisational stability. My right hon. Friend the Leader of the Opposition happily said that, and the
Secretary of State repeated what he said when he took office—that there should be no further major organisational upheavals. I will not dwell on all the things that have happened, but even now the NHS does not know whether it is working to the NHS plan from 2000, to “Keeping the NHS local” from 2004, to “Commissioning a patient-led NHS” from 2005, to “Your health, your care, your say” from 2006 or to whatever is contained in the document to be published next week.
There is no thread of consistency and stability in either the structures or the policy being pursued in the NHS. One of the first things that many people working in the service would say to us, as we collectively discuss the NHS after 60 years, is that they will be able to deliver so much more in the future if they are given the stability of a framework in which to do so and the freedom to respond to the needs of patients.
Mr. Philip Hollobone (Kettering) (Con): Local people in Kettering are rightly proud of their district general hospital, which this year celebrates the 111th year since its foundation. Although they are positive about the NHS in respect of the local hospital, they are negative about it in respect of NHS dentistry. Local people have never had such limited access to an NHS dentist as they do now.
Mr. Lansley: I am grateful to my hon. Friend, who makes an important point. If my memory serves, over the past year we have seen a reduction of about 1 million in the number of people accessing NHS dentistry. We must recognise that the experience of dentistry that many people throughout the country have is genuinely one of a two-tier system. There are people in some areas who can access NHS dentistry or receive it free, because there are still contracts and dentists available, yet in other places it is simply not available or people pay so much that, frankly, they might as well be in the private sector, because of the costs that they have to meet.
My hon. Friend makes an important point, and we need to be realistic. This is a debate not just to say thank you, although that is an important part of it, but to listen to the staff of the NHS. Last week, the Government published the annual survey of NHS staff, “What Matters to Staff in the NHS”. There was much in it about NHS staff feeling positive about their hospitals or surgeries, and they were very supportive of what the NHS stands for.
However, staff were asked, by Ipsos MORI on behalf of the Government, whether they would praise the NHS as it currently stands. Unhappily, those figures were not as good. Forty-three per cent. of staff overall said that they would speak critically of the NHS as it now stands and only 27 per cent. said that they would speak highly of the NHS as it now stands. That is very depressing. Any organisation—public, private or whatever—in which more staff would, unprompted, speak critically of that organisation as it stands today than would spontaneously speak highly of it has serious problems with staff morale and motivation, which needs to be changed.
The Secretary of State for Health (Alan Johnson):
Staff views are very important. NHS staff were concerned about changes to their normal pension age. I negotiated an agreement whereby all NHS staff in post at the time
would continue to have a normal pension age of 60. The hon. Member for Tatton (Mr. Osborne), the shadow Chancellor, said that that agreement should be reviewed. Will the hon. Gentleman confirm that NHS staff, about whom he is rightly concerned, can rest assured that the Conservative party will not reopen that deal and that all staff in the NHS will continue to have a normal pension of 60, if those were the terms on which they were recruited?
Mr. Lansley: Yes, I did not have the opportunity, I am afraid, to listen to my hon. Friend on “Newsnight”, but I understand that he made it clear subsequently that he had not been correctly quoted. I thought that the Secretary of State was rising to respond—I hoped positively—to the fact that 43 per cent. of NHS staff, including 54 per cent. of medical and dental staff and 49 per cent. of junior managers, said that they would speak critically of the NHS as it is now. That needs to change, and if that is not critically important to the Secretary of State, it ought to be.
People in the NHS listening to our debate this evening would say, “Don’t just say thank you to us or express appreciation for what has been achieved. We know that the public support us, but at the same time they know that we are not allowed to achieve what we should achieve, and that although we’ve seen a doubling of resources in the NHS in the last 10 years, this hasn’t reached the front line and it isn’t delivering the patient gain that it should. From our point of view, not only do we need organisational stability, empowerment of professionals and freedom to deliver for patients, but we are prepared to be held to account for the outcomes that we achieve and held to account by patients for the services that we provide.” Patients should be able to access choice and control over their health care and, to an extent, those with long-term conditions should even, where possible, be able to manage personalised budgets.
Joan Ryan (Enfield, North) (Lab): It is important to talk to staff, and I have talked to the staff at my local hospital. They are users of that service, too, and they have said to me that they are not willing to wait more than four hours in A and E. They do not want to wait more than 18 months for operations and are pleased about everybody getting 18 weeks, end to end. What does the hon. Gentleman think is the difference between the target and the outcome? If the target is that everybody gets their operation and gets better, the outcome is better health for everybody. It is misleading to mix up targets and outcomes.
Mr. Lansley: Let me say two things to the right hon. Lady. First, I do not think that she has talked to many NHS staff, if that is the view that she reaches.
Joan Ryan: On a point of order, Mr. Deputy Speaker. I do not understand the basis on which the hon. Gentleman can contradict me when I say that I have spoken to NHS staff.
Mr. Deputy Speaker: Order. If that had not been in order, I would not have let the hon. Gentleman say it. These are matters for debate, not matters for the Chair.
Mr. Lansley: Let me explain two things to the hon. Lady. First, many clinicians to whom I have spoken over many years, as well as their representative organisations, have made it clear that the impact of a waiting time target is less about delivering reductions in waiting times than it is about distorting clinical practice and the clinical judgments that have to be made. Waiting time targets can thereby have a damaging overall impact on health outcomes.
Clinicians want to focus on outcomes and be held to account for some of the performance measures that go into delivering high-quality care for patients. There is no doubt that clinicians know that their local hospital should be responsible for publishing referral-to-treatment times and that patients and commissioners should hold them to account for that. That is performance management; it is part of the contract and nobody is proposing that we get rid of it. However, the hon. Lady must recognise the truth about imposing a national, one-size-fits-all, 18-week referral-to-treatment target. Almost every clinician to whom I have spoken says, “This is nonsense. There is no clinical evidence for this and it distorts.” Indeed, we can see that happening already, with hospitals having to pay well over the tariff to access private sector providers and deliver the target.
Another thing that I would like to say to the hon. Lady is that the staff at her local hospital, Chase Farm, are saying, “Don’t take away our maternity services and our A and E services”. The people of Enfield care about services at Chase Farm, and I wish that she had got up to tell the House about that, instead of making a party political point.
Clive Efford: Will the hon. Gentleman give way?
Let us be very clear about this. International benchmarking—
Barry Gardiner (Brent, North) (Lab): Will the hon. Gentleman give way?
International benchmarking is absolutely critical. Let us look at a simple example. The Government rightly say that, over the past decade, we have seen reductions in premature mortality from cardiovascular disease and stroke. However, they never go on to say that that has been true not for 10 years but for 20 years. They never go on to say that, when we compare our data with those of other countries, we see that we have not narrowed the gap. They do not go on to say that studies suggest that we have the worst outcomes for stroke among the European countries. They do not go on to say that there are routine procedures in other countries for stroke services and heart care services—for people having a heart attack—under which people are treated as an emergency when they have a stroke or when they are taken for primary angioplasty when they have a heart attack. Those services have routinely been offered for years in those other countries but they are not being offered here.
International comparison is essential in this regard. How can we know how well the NHS is performing unless we look at countries with equally developed health economies to see how well they are doing by comparison?
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