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Lord Prys-Davies: My Lords, I, too, welcome the timely initiative of my noble friend Lord Hunt. I thank him for having set the scene in a comprehensive, well-informed and sensitive speech. It was a speech of high quality, if I may humbly say so. It is clear that the whole House was impressed by some of the points made by the noble Baroness, Lady Knight, in her maiden speech. I hope that my noble friend the Minister will take note of her contribution.

The whole country has every reason to be grateful for Labour's finest and most enduring achievement--the NHS. There were other achievements, but this has been an enduring achievement. It has directly improved the quality of life. Those of my generation in your Lordships' House can testify that it has increased the length of life. Fifty years ago, the NHS brought a fundamental freedom to the vast majority of the British population; the freedom of access to health services.

For me, it was Nurse Grace Owen, a district nurse at the time, who best expressed the feelings of millions of people in 1948 when the NHS hospitals first opened their doors. She said of that occasion:

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Access to those hospitals was founded on two basic principles: the provision of healthcare for all, free at the point of treatment, which would be funded largely out of public taxation. Fifty years on, the enthusiasm for those principles remains.

Looking back to 1948, there have been many changes in working conditions within the service and there have been many reorganisations. But the essence of the health service still lies in the transactions between doctors, nurses and other health professionals and patients. This essence also remains untouched.

Probably the most profound change in the NHS structure occurred in 1991 after the Prime Minister of the day, the noble Baroness, Lady Thatcher, took personal charge of her government's response to the needs of the NHS. That led to the purchaser-provider split and the creation of the internal market. A new business ethos was introduced which shifted emphasis to value for money and competition. It was argued that what was principally at fault with the NHS could best be solved by competition between competent managers. Giving due credit to the government of day, they believed that that would stimulate greater enterprise and commitment, which in turn would improve services to patients. The general evidence is that that did not happen.

Looking to the future, I suggest that what we should expect of the NHS is: first, that the hospital system is able to deal with urgent cases urgently; secondly, that waiting lists will be shortened; thirdly, that patients will not be discharged from mental hospitals to the outside world unless proper support facilities are available for decent community care; fourthly, that the service provides a high standard of care to all patients, whether in hospitals, surgeries, clinics or their own homes; fifthly, that the devotion of the staff will not be taken for granted or exploited; sixthly, that the Government take steps to reduce the cause of inequalities in health. How likely is all that to come about? Will it be in 10 or 25 years' time?

From time to time, I am obliged to attend the busy outpatient departments of a major district hospital in South Wales and of a leading teaching hospital here in London, St. Bartholomew's. Those hospitals are working at their maximum capacities. I believe that the new Government start with a store of good will in the NHS. There is a feeling that their problems have a prospect of receiving full consideration by the Government. But this also means that health professionals and ancillary staff, as well as the general public, expect great things from the new Government.

It is agreed that the problems facing the NHS cannot be addressed overnight. However, the policy statements issued by the department since last May show that they are being identified and tackled. On 9th May, the Secretary of State confirmed that the internal market would end and that the service would be developed on the basis of co-operation, team work and competence. Since then, the department has announced a series of major initiatives. I wish to welcome six of those initiatives because I have an interest in them

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I welcome the independent review of health inequalities by Sir Donald Acheson which was set up last July and is to report this year. Given the personal interest of my noble friend Lady Jay in this area of policy, I am confident that she will use her influence to ensure that its findings will be speedily acted on. In September, an advisory committee on resource allocation was set up to advise how inequalities can be tackled through resource allocation. That could have a profound effect on the allocation not only between districts but also between priorities. I find that there is widespread support for the Royal Commission on the funding of long-term care for elderly people and also for the independent reference group to give independent advice to Ministers about psychiatric hospital closures. I welcome the appointment of an additional 390 junior hospital doctors, from whose ranks will come the consultants and GPs of the future. If the NHS is to work as well as we hope for in the new century, those initiatives are significant steps in the right direction.

I was interested to hear the speech of my noble friend Lord Winston and I hope that my noble friend the Minister will deal with the two issues which he raised. Can my noble friend please explain the remit of the independent reference group which will give independent advice to Ministers about psychiatric hospital closures? I have read that in future the closure proposals will be measured against new criteria. Who will draw up such criteria? Will the voluntary organisations with a special interest in the mentally ill be consulted on their formulation? Ministers will know that public confidence in the policy of running down and eventually closing Britain's long-stay hospitals and substituting care in the community, which has been a policy of every government since the early 1960s, is now increasingly fragile. I therefore hope that this independent reference group will address the issues effectively and realistically.

5.38 p.m.

Lord Butterfield: My Lords, I wonder whether the noble Lord, Lord Hunt of Kings Heath, will accept the thanks of a man from Stechford for introducing the debate. We are grateful to the noble Lord and there are a few Brummagem folk around who have spoken in support of his ideas.

On the 50th anniversary of the NHS, we were delighted to discover that the Secretary of State had managed to raise an additional £2 billion a year for the service. When I mentioned that to my folk in Cambridge, they said, "Well done Dobson, but keep going". Your Lordships will realise that some people wonder whether £2 billion will be enough to provide everything that is needed. Many needs were outlined by the noble Lord, Lord Prys-Davies.

Looking back, I want your Lordships to know that I first became wedded to the philosophy behind the NHS in 1941, when, as a medical student at Johns Hopkins, Baltimore, I read and proselytised the Beveridge report. I was not particularly popular or politically correct among the Americans. The American medical profession has always resolutely resisted any political intervention in the doctor/patient relationship. We have

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heard something about the tensions at the beginning of the health service; but as things went on, I even felt compelled to resign from my trade union, the British Medical Association, over its policy of opposing the NHS back in the 1946-47 era.

However, we can all see what a remarkable success the NHS has been, although not in every way. Many points have been raised this afternoon which show that we must continue with our efforts. But overall, it has been a remarkable performance and I have been proud of it, going around the world as a professor giving lectures, because I have realised that we have been able to stimulate the development of health services throughout Europe and in many parts of the world, although not perhaps the USA as we all might have hoped.

We all recognise that the service has faults but on its 50th anniversary, we can be proud of that extremely British, flexible and transparent organisation. That is becoming clearer and clearer. It was not transparent a few years ago but it is becoming increasingly transparent now. Today we have been discussing how patients may look into the whole question of rationing. That is a terrific step forward.

Many of the original flaws of the NHS have been corrected. When I became a medical student, there was a serious maldistribution of medical expertise around the country. It was rather top-heavy in London. But all that has been largely smoothed out and I believe that London has the status and potential to be a world-leading medical centre.

That will be especially true if its support is maintained from its many traditional sources of guidance and help. I mean by that, for example, the historic links with the royal colleges concerning excellence, with the universities concerning research and teaching and with the wonderfully balanced and remarkably unselfish professions which served the NHS.

There is no doubt that since Aneurin Bevan first shocked the medical profession by incorporating all our hospitals--teaching, charity, municipal and so on--into a single service, we have not only seen a much more uniform spread of medical specialties but also, rather more gradually as I see it, the development of a service which puts first patients' health rather than the interests of the professions or institutions.

The NHS is not, we know, a national disease service. In the more recent years of its life, the idea of the health of the people has caught on with the public in a most remarkable way. Health promotion is widely recognised and practised. We have much better health behaviour. It is not perfect but we know about diet and are taking more exercise; for example, people here walk up and down the stairs rather than use the lift. It is interesting that it is unusual now to see people smoking in our dining room. We should reflect on those matters and be grateful that the health promotion drive is getting through. Of course, there has been the acceptance by mothers and children of our vaccination programmes. Breast and cervical cancer screening services have been developed. I am intrigued that there is growing concern

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about the amount of cancer of the prostate in men which appears to be developing in the country. We should be helping to track that down.

I have been very impressed, as an old grey man who has lived as a doctor throughout the time of the NHS, by the people of the various professions and those who work in the service side of the NHS and in the remarkable charities which take care of the interests of different people--the British Heart Foundation, the British Diabetic Association, the cancer charities and so on. They have all had a beneficial effect on the service not only by raising incredible sums of money from the public for research projects, but also by the way in which they have been watching the health service and its performance in relation to the very people with whom they are mainly concerned.

I have always been interested in diabetes. I have been fascinated by the way in which the British Diabetic Association has been watching the way in which different insulins and different measuring devices for blood sugar have been introduced and so on. We must realise that part of the achievement of the NHS must be attributed to us all--all the people who use it and have worked for it. They have all been keeping an eye on it and making observations which have had a profound effect on its quality.

Before I came here to speak today, my wife, who is an American, said, "Don't make it sound too good because there are still things to do". I wish to make it clear that I realise that. But we can be proud of the first 50 years.

I wish to look briefly at our future prospects. I am delighted that more effort and resources are going into management in the NHS. It has been said, and it is true, that hardly anybody knows what anything costs in the NHS. That is a great tribute to the original philosophy but it has its disadvantages.

I am delighted at the way in which we have built up a research and development department with very good leadership. Moreover, I am astonished and amazed by the remarkable efforts of our pharmaceutical industry and its allied industries in the development of new and safe therapies and drugs. It is not to be forgotten that the NHS has developed research into the activity of medicine so that we can now prescribe on the basis of research evidence rather than hope. We have also produced a remarkable general practice service in the community.

I wish to end quickly with three other remarks. I remember speaking in this House when we were all worrying about fetal research. Since those years when IVF was being introduced, the work which has gone forward in fetal research has been astonishing. There is fast-growing interest in the possibility that diabetes and many other chronic conditions may arise from things which happen to the fetus.

Lastly, I pay two personal tributes. First, 90 year-old Professor Reginald Revans of Manchester did the NHS a great service when he studied action learning in London hospitals. He really showed that if managers share their difficulties and help each other in their diversities, hospital performance statistics improve.

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More recently, a former director of mine in the army operational research group, 88 year-old Stanley Hey, of all things a radio astronomer, is leading a personal campaign from Eastbourne, to measure the pressure points in the skin as people lie immobile in bed. He has found ways to relieve them. To my mind, that is more evidence of the way in which people are joining in with the drive and philosophy of the National Health Service.

5.50 p.m.

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