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Baroness Flather: Will the noble Baroness give way?

Baroness Hayman: The debate is timed, and time is short.

Baroness Flather: That is an unjustified attack by the noble Baroness. I recommend that she look into the case properly.

Baroness Hayman: I understand the feelings of the noble Baroness. I know the difficulties--

Baroness Flather: The facts, my Lords.

Baroness Hayman: There are facts here, but some of the facts show that the changes in contracting arrangements between hospitals resulted in a situation where we, as the NHS, did not serve those patients well. Those patients who, 50 years ago, thought that the NHS would give them security in old age had that feeling of security taken away from them.

Noble Lords opposite and Ministers do not understand how public confidence in the NHS has been destroyed by the attempt to commercialise the

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culture within the NHS. It means that where the best may be being done, people feel that financial considerations and market considerations are not considerations of patient care. The language of the market has itself had a corrupting effect. Talk of purchasing, contracts and of calling patients "customers" has undermined confidence that the decisions that will face any government dealing with the health service are not being taken on the basis of patient need.

The right reverend Prelate the Bishop of Exeter talked about hospital chaplaincy services. I knew that we had gone too far when I met a hospital chaplain the other day who told me that he was terribly busy. I asked whether there had been a particularly harrowing event. He said that there had not; it was just that he was having trouble adding up the figures in his business plan for next year.

One of the other public service values we have lost, and which in some way is threatened in the health service, is that of openness. There is concern that people are unable to speak out. The BMA sent me two examples--two anonymous letters. I have no idea from where they came. One was from a doctor who wrote:

    "I am concerned that if these were to get into the public domain in the present day NHS they would cause problems for me and particularly my trust ... despite the serious risks it seemed a duty to inform someone".

Another wrote:

    "Please feel free to quote the content--but please not the trust, nor the writer, nor me".

It is important that we are open about the issues within the NHS, because they are challenging issues. There are no easy answers. There are big issues that any government will have to tackle. What makes me so sad is that during the past five years the improvements that have been made have not occurred as a result of the introduction of the internal market but often despite its introduction. My noble friends Lord Haskel, Lord Desai and others spoke about the difficulties and damage inflicted upon the planning processes and of the throwing away of some of the tremendous benefits that the NHS brought to us--low administrative costs, the saving of transaction costs, and collaboration rather than competition--which were so important in delivering the service that we had.

I have no desire to talk down the achievements of staff within the NHS or to make patients unnecessarily worried but everyone who works within the NHS--it is clear from the messages that come from the NHS Executive about arranging emergency care this year--knows how severe the situation is. It is fascinating to see what has happened to waiting lists. For five years we have heard, "Waiting lists, waiting lists, waiting lists performance". This year waiting lists are not the dog that did not bark in the night. It

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is the junior Minister who did not crow at dawn, because we all know that waiting lists will go up this year--

Lord Winston: They are going up.

Baroness Hayman: They are going up, as we struggle to meet pressures on the emergency services.

There is an enormous amount to do, not just in terms of obtaining more resources, rebuilding medical morale, particularly in academic medicine, and in general practice. There is also a recruitment and retention crisis within the nursing profession. We can hope that this Government do something about the short-term funding. In the long term, for the reinvigoration of public confidence in a government who will support, sustain and change the NHS for the future, only a general election can provide the answer.

7.38 p.m.

Baroness Cumberlege: My Lords, I, too, would like to thank the noble Baroness, Lady Jay, for initiating this debate. As a distinguished member of a health authority she, with other members of your Lordships' House who serve on health authority and trust boards, who work or have worked in the NHS, who have given so much in a voluntary capacity, speaks with knowledge and authority; and that is my first point.

The NHS is unique in many ways but what makes it exceptional, outstanding and quite different from other health care systems around the world is the involvement of millions of people. People give willingly to research, to leagues of friends, to special interest groups. They give their blood, their organs, their time, energy and cash. The NHS quite literally belongs to the people and I am always conscious that any government, whatever their political persuasion, are merely stewards--custodians--of this remarkable national institution. But as my noble friend Lord Astor of Hever reminded us, Conservative Governments have been the custodians of the NHS for two-thirds of its 48 year existence. It has been Conservative Governments who have taken it from strength to strength. It has been Conservative Governments who have ensured that the NHS can meet its ambitions. In the 1950s it was Conservatives who established the Pay Review Body and conducted a thorough review of NHS finances.

In the 1960s it was Conservatives who published the first hospital plan for England. In the 1970s it was Conservatives who introduced structural changes in order to plug gaps in the NHS and who created community health councils. In the 1980s it was Conservatives who introduced reforms that have provided a firm foundation for the modern NHS and enabled the majority of GPs to take charge of funds for the care of their own patients. And in the 1990s not only have Conservatives produced the first comprehensive strategy for public health, The Health of the Nation, described by the World Health Organisation as a model for other countries to follow, as my noble friend Lady Brigstocke said; not only

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have we involved patients through the Patient's Charter, mentioned by my noble friend Lord Bridgeman, setting out their rights and responsibilities, but we have worked with the professions most recently in drawing up the White Paper on primary care. Our new Bill will reflect those views, a direction which I believe will please the noble Viscount, Lord Waverley.

This is a consistent record over many decades of which Conservatives can be proud. It upholds the promise of a Conservative Health Minister, who in 1944 published the White Paper on the NHS declaring that the new National Health Service would be available to all on the basis of need, and also that:

    "they shall get the best medical and other facilities available".

I believe that we have more than honoured that promise.

As well as providing the best service for patients, the NHS must also provide rewarding careers for the million committed people who work in it. That is why we established the pay review bodies. For the most part these have ensured that, whatever the pressures on the health service, its professional staff have seen real investment in their careers and incomes. I say "for the most part" because the incomes of doctors and nurses suffered badly in the economic chaos of the late 1970s, when the Labour Party was in power and the IMF dictated this country's fiscal policy.

My father joined the NHS in 1948. Patients came to the house, and in my home we literally had blood on the carpet. The ethic of the NHS was imprinted on me at an early stage. Whether young, old, black, white, rich or poor, people should have access to health care according to clinical need and not ability to pay. As the noble Baroness, Lady Robson, and other noble Lords have said, it is an ethic which is prized and cherished by the British people.

But the maintenance of this ethic depends upon proper funding. That is where rhetoric and reality divide. As my noble friend Lady Seccombe said, the NHS has never had more resources. Whereas my right honourable friend the Prime Minister has renewed his health service guarantee to the British people--that year on year the NHS budget will continue to grow--once again, no such pledge has come from the party opposite.

Indeed, only on Monday of this week, when pressed for an assurance that any incoming Labour Government would increase resources, the Shadow Health Secretary said on the "Today" programme, "That would obviously be my aim". We all have aims, but the NHS deserves more than that. Our commitment to the NHS has been demonstrated for 17 years and the Prime Minister has made it clear that this will continue. This puts in context the criticisms which have been made about the current level of resources.

The noble Baronesses, Lady Robson and Lady Jay, the noble Lords, Lord Monkswell and Lord Prys-Davies, and the noble Viscount, Lord Waverley, have said that the NHS is short of resources. However,

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I believe that we should see it in the context that I have outlined. The majority of trusts and health authorities are not facing bankruptcy. In a budget of £41 billion, a forecast of less than 1 per cent. overspend halfway through the year is not an insurmountable problem. In fact, any commercial organisation would be proud to achieve a result so close to its target. The NHS has an extremely good record in balancing its books. I am sure that, as in other years and with a little flexibility, it will achieve the desired result because it has a carry-forward facility. Perhaps I may say in parenthesis that I agree with the noble Baroness, Lady Robson, that three-year contracts are sensible and we are encouraging health authorities to follow that advice where appropriate.

I agree also with the noble Lord, Lord Rea, and my noble friend Lord Colwyn that the important criterion is not simply the amount of GDP which a country spends on healthcare but the value which it gets from that expenditure. The reformed NHS is one of the most efficient in the world and we know through OECD and other independent reports that it provides excellent value for money.

The noble Baroness, Lady Jay, gave an undertaking that in the event of a Labour government coming to power they would abolish the internal market. I believe that that call was welcomed by the noble Lord, Lord Monkswell. However, Renewing the NHS, which I understand is still the Labour Party's main health policy statement, states on page 20:

    "We believe there should be a separation in the planning and delivery of healthcare. We want health authorities to commission care but we do not want them to run hospitals on a day-to-day basis".

I was not sure whether the noble Lord, Lord Winston, was slightly embarrassed or slightly elated at being quoted by my right honourable friend the Prime Minister in another place--

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