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Mr. Stephen Dorrell (Charnwood) (Con): Is not the situation actually worse than my hon. Friend describes? Some years ago, there were two gaps. We spent less per head on health care than our European comparator countries, and we had worse health outcomes. Now, our spending is broadly in line with our European comparator countries, but we have not eliminated the gap on health outcomes. That is the core challenge, and the Government have failed to deliver on it.
Mr. Lansley: I am afraid that it is, and this takes us back to one of the central issues that most depresses people who work in the national health service, and those whom they look after. They want to see those resources, and they want to use them productively. Unfortunately, however, the nature of the system means that when spending was rising fastest, productivity in the NHS was falling by 2.5 per cent. a year, according to the Office for National Statistics. In those circumstances, they cannot deliver the quality of health care that they should.
Last year, the Government were fond of quoting the Commonwealth Fund, but I am afraid that that study presents an unhappy picture of an international comparison that does not even include some of the most positive comparators, such as France. The Commonwealth Fund, from New York, which Ministers like to quote, states that the UK health care system is the worst for waiting times, for mortality rates, for hospital-acquired infections, for preventive care such as breast cancer screening, for caring for those with long-term conditions and for GP access out of hours. So, precisely—[ Interruption.] Hon. Members laugh, but this is not a matter for amusement. The Commonwealth Fund is quoted by Ministers, and I have just quoted it as well. They should recognise this. We should look at outcomes, at the overall benefit for patients and at international comparisons. The Government—and any future Government—must focus on overall outcomes for patients and not on trying to micro-manage the way in which they are achieved. We should focus on what we are trying to achieve, and we should be rigorous, challenging and ambitious about that, but we should not try to dictate how it is done.
Anne Moffat (East Lothian) (Lab): The hon. Gentleman was talking about what NHS staff actually thought. Does he remember—as I do from when I worked in the NHS—that this Government are not frightened to ask the staff what they think about the health service and about what measures can be taken to improve it? When the Conservative Government were in power, if whistleblowers told the public what was going on in the national health service, they were sacked for telling the truth. Does the hon. Gentleman think that that is a good record?
Mr. Lansley: I am sorry that the hon. Lady thinks that that was true in the past, and that it is not true today. I am afraid that I have met many people who still feel that the culture in the NHS is such that they cannot speak out openly about what is happening. That should not be true, but unfortunately it still is.
Clive Efford: Will the hon. Gentleman give way?
Mr. Lansley: No, I am going to finish my speech in a moment. I want everyone to have a chance to speak.
The national health service is something we can applaud and something to which we attach enormous importance locally. In my own constituency, the Addenbrooke’s and Papworth hospitals are excellent examples of innovation and high quality care, and we attach enormous importance to them. But the NHS knows, and we know, that the route for the future is not just about things as they are. It is about achieving a stable organisational framework for the NHS that will allow real dynamism for reform and change. Under the twin levers of patient choice and a competitive environment among health care providers, information based on health outcomes, rather than on micro-management, will deliver the framework within which those levers can work most effectively.
Internationally, we can see that we have a treasure in the NHS. When I go to America or, as I did recently, to the Netherlands, I see that people are seeking to achieve a structure that will provide universal coverage, or a maximum risk pool, as they put it. They want to achieve the combination of equity and efficiency that everyone is looking for in health care. The scale of spending on health care in many of those countries is similar to our own or even higher. In America, for example, the scale of public spending on health care as a proportion of gross domestic product is almost exactly the same as it is in this country, but there is an additional 7 per cent. of gross domestic product on top of that in private contributions. That is not a situation that anyone could contemplate. The inefficiencies involved are not to be contemplated.
In the national health service, which is funded through general taxation, we have a vehicle that is highly efficient at raising resources for health care and highly equitable in regard to the potential distribution of, and access to, that health care. Unfortunately, over recent years in particular, it has become bureaucratic and monolithic. It does not exhibit the characteristics towards which all those other health care systems are moving in regard to exposure to efficiency. That exposure to efficiency, through choice and competition, is essential for the future, and I believe that NHS staff are happy to contemplate that. They are prepared for it, as long as the competition is fair and they are judged on genuine outcomes, and as long as they are given the opportunity to do the best for patients in a framework that continues to be supportive and true to the principles of the national health service.
In supporting the motion this evening in a non-partisan fashion—[ Interruption.] It is entirely non-partisan. I hope that my colleagues and I will make it clear that its purpose is to give hon. Members on both sides of the House the opportunity to express differing views on the policy direction of the NHS, as well as a clear and unanimous commitment to its principles, its values and its future.
7.47 pm
The Secretary of State for Health (Alan Johnson): I beg to move, To leave out from “all;” to the end of the Question, and to add instead thereof:
“recognises an opportunity to make the NHS more patient-centred by focussing on outcomes; further recognises the defining contribution the NHS has made to the health and wellbeing of the nation since 1948; acknowledges that the principles upon which the NHS was established, funded by general taxation and free at the point of delivery, are immutable; accepts that target reductions in waiting times have significantly improved services to patients; and looks
forward to the next 60 years of the NHS characterised by world-class quality healthcare as well as greater personalisation, individual choice and easier access to services.”.
There is nothing in the Opposition’s motion that we find objectionable. There is one minor quibble, which I will come to in a second—and there is a very major quibble sitting next to the hon. Member for South Cambridgeshire (Mr. Lansley); I will deal with the minor quibble later. The claim in the motion that the Conservatives recognise
“the support from all political parties for the NHS”
crept in at the last minute. It was not there yesterday—but I will even let that pass. I might come back to it later.
We are genuinely pleased that the Opposition have dedicated some of their time to discussing the important occasion of the 60th anniversary—the diamond anniversary, indeed—of the national health service. We should not forget the many and varied ways in which it has improved the lives of individuals in this country, and improved the nation as a whole.
I was at an event earlier today with the Prime Minister to celebrate 60 years of NHS research. When the NHS was established, the opportunities for medical advances were greatly expanded because it gave researchers access to vast numbers of patients and staff in a clinical setting for the first time. For example, the discovery in the UK in 1950 by Professors Hill and Doll that there was link between lung cancer and smoking could not have happened without the collaboration between the NHS and the Medical Research Council. That discovery was followed by breakthroughs in hip replacements, in detecting osteoporosis, in bio-engineering, in heart valves and in the word’s first test tube baby, along with many other breakthroughs.
The UK is a world leader in health research, responsible for 3 per cent. of the world market in medicine, but funding 11 per cent. of the world’s medical research. We will continue to invest in science, innovation and research to ensure that we maintain this country’s pre-eminence. Following today’s summit, we will forge even closer links between universities and the NHS.
Medical research is just one of the many advantages bequeathed by our predecessors in 1946, when the National Health Service Bill was approved in this House. It can hardly be said that the NHS emerged from deep political consensus and professional support. The historian Kenneth Morgan pointed out that the conflict between the BMA and the Government lasted longer than the second world war— [Interruption.] The hon. Member for North Norfolk (Norman Lamb) says that it is still going on, and I shall come back to that in a few moments. My hon. Friend the Member for Livingston (Mr. Devine) cited a reference from a debate in this House 60 years ago. This was April 1948— [Interruption.] No, my hon. Friend was not there at the time! The Bill had become an Act, having received Royal Assent, and Bevan and the Government were forced to provide time to debate the NHS because of the huge opposition that had emerged from the BMA and the Conservative party. Let me read one quote from Nye Bevan. There are loads of quotes in these debates, but this one struck me as being perfect for the occasion. Bevan said:
“It can hardly be suggested that conflict between the BMA and the Minister of the day is a consequence of any deficiencies I
possess, because we have never been able yet to appoint a Minister of Health with whom the BMA agreed.”
No change there. I am sticking to the tradition established by Nye Bevan.
Mr. Fraser Kemp (Houghton and Washington, East) (Lab): A constituent, Mrs. Elizabeth Porter, celebrates her 100th birthday next year. She spoke to me recently about what happened 60 years ago when she travelled on a bus from where she still lives in Shiney Row, Durham to hear Nye Bevan speak about the creation of the health service. She said to me that it was the greatest decision ever taken by any Government in the last century, because it took away the fear that she had in the 1930s of having to make a decision on health on the basis of whether she had £2 to call a doctor, rather than whether she needed help. Does my right hon. Friend agree with Mrs. Porter’s analysis?
Alan Johnson: I entirely agree, and I cordially invite my hon. Friend’s constituent to come to Westminster Abbey next Wednesday to celebrate the 60th anniversary of the NHS, as there will be many more NHS workers there and people who have benefited from it over the years.
Mr. Charles Walker (Broxbourne) (Con): I am not one for celebrating institutions, but I am one for celebrating the people who work in them, particularly nurses, who make a massive and important contribution to the NHS. My concern is that too many district and community nurses are now subsidising the NHS because their mileage allowance was fixed in 2001 and has not risen since. Will the Secretary of State take a look at that and give the nurses a real present for their 60th anniversary?
Alan Johnson: Of course I will look at that, but today’s occasion should not get bogged down in mileage allowances: let us look at the bigger picture— [Interruption.] I know that there are three or four ex-nurses in their places around me now. As I said, I will look at the issue, but let us move on from mileage allowances to the big debate in 1948 about whether we should establish a national health service.
I am unsure how the Liberals voted in 1946 —[Interruption.] Well, there were only a dozen of them in the House at the time. But I do know how the Conservatives voted, and the hon. Member for South Cambridgeshire (Mr. Lansley) might like to know that the Conservatives voted against the Bill at every stage. There was a three-day Second Reading debate, at the end of which the Conservative Opposition voted against it. There were no rebels going through the Labour Lobbies. For us, it was unanimous. Again on Third Reading, however—
Mr. Simon Burns (West Chelmsford) (Con): Will the Secretary of State give way?
Alan Johnson: Let me finish my point. The Conservatives voted against Third Reading, proving that this was an absolute point of principle for them. As I have already explained, two years later, Bevan had to come to the House with another debate because of the coalition between the BMA and the Conservative party, which was in fierce opposition to the establishment of the national health service.
Alan Johnson: I give way to the former and very distinguished Secretary of State for Health.
Mr. Dorrell: I am grateful to the Secretary of State. One of his achievements in office is that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Tory spokesman, is ahead of him in terms of public trust in handling health policy. That is an important event for the Conservative party, but I wonder whether the Secretary of State thinks he is likely to get himself ahead of my hon. Friend in terms of public ratings by digging up the history of who said what in the House of Commons in 1946?
Alan Johnson: Every poll I read puts us in the lead; I suppose it all depends which ones, but let that pass.
Mr. Devine: Will my right hon. Friend give way?
Alan Johnson: In a few moments.
I think that it would be really strange if, in debating an Opposition motion celebrating 60 years of the NHS, I did not point out the consistent support or otherwise of all political parties for it. I realise Conservative Members do not want to go over the history, but it would be perverse if we did not at least mention some of that history. Indeed, the hon. Member for South Cambridgeshire mentioned it himself.
Mr. Devine: It might be helpful to the debate if Conservative Members in making their contributions or interjections told us whether they are covered by private medical insurance. The difference between Conservative and Labour Members is not only that we created the national health service, but that we actually use it, too.
Alan Johnson: The hon. Member for West Chelmsford (Mr. Burns) cannot intervene before I have risen to respond to the previous intervention. All we know is that an analysis of the Cabinet of which the right hon. Member for Charnwood (Mr. Dorrell) was a member showed that none of them used either the NHS or, indeed, the state school system—but we will draw a veil over that period of history.
Mr. Burns: Interesting as it is for the right hon. Gentleman to give us a history lesson, does he accept that many Conservative Members, including myself, were not born in 1946 or 1948, and that we have supported the principle and the exclusive use of the health service ever since we were born?
Alan Johnson: I accept that point entirely. However, the hon. Member for South Cambridgeshire began his speech by quoting Winston Churchill in 1944, and went on to talk about Henry Willink, the shadow Health Secretary at the time and Health Secretary during the coalition Government, so perhaps we can be allowed to enter the same debate and talk about the history as well.
Norman Lamb (North Norfolk) (LD): I am still waiting for the right hon. Gentleman to mention who laid the foundation stones of the NHS—the great Liberal, Beveridge. Will he please get on with that?
Alan Johnson: I will. Beveridge’s contribution should be recognised, as indeed should that of Lloyd George, who introduced the insurance-based system that the BMA vehemently opposed in 1911 and then sought to protect in 1946—so what goes around, comes around.
Joan Ryan: May I suggest that my right hon. Friend might get quite a long way ahead in the ratings if he told the House about the difference targets have made to cardiac mortality and death rates from cancer? Those issues are important to this evening’s debate. May I also say to my right hon. Friend that despite the many discussions I have had with him and other Ministers about Chase Farm hospital, one thing I am absolutely certain of is that that hospital, as a result of all the efforts made locally and here, has a very bright future ahead?
Alan Johnson: I agree with my right hon. Friend, and I will come on to targets and outcomes a little later.
The Conservative party voted against the National Health Service Bill at every stage, so has the NHS really had
“support from all political parties”?
Has this great achievement of a Labour Government been equally cherished by the Conservative party? I think the hon. Member for South Cambridgeshire may blush a little at that suggestion. The NHS was certainly not supported at birth—in its infant and teenage years, perhaps.
Moving on to the ’80s, Baroness Thatcher, who famously went to a private hospital in Windsor rather than use the NHS, said as Prime Minister that the NHS was “safe in her hands”, rather as the Leader of the Opposition was saying earlier today. However, as Rudolf Klein, historian of the NHS, points out, in 1982 the Government’s think-tank, the central policy review staff, produced a paper proposing the replacement of a tax-financed NHS by a system of private insurance. That was presented to Ministers by the Chancellor and promptly leaked to The Economist, so it became a big scandal. History records that we can thank Lord Fowler, who was Secretary of State for Social Services, for killing off that proposal.
We should also remember that every single— [Interruption.] Just one second. We are coming up to recent history, which will be much more interesting to the hon. Member for Hemel Hempstead (Mike Penning). Coming up to recent history, we should remember that every—
Mr. Lansley: Will the Secretary of State give way?
Alan Johnson: In a second. Every single Conservative Member won their seat on a manifesto that supported the NHS to such an extent that they would have paid people to leave it.
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