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Lord Monkswell: My Lords, I thank my noble friend Lord Hunt of Kings Heath for introducing this celebratory debate on the 50th anniversary of the National Health Service. I am also pleased that the terms of the debate are drawn to highlight the contribution that the National Health Service has made to the health of the nation. In that context we need to be aware of the health of the nation not merely as the health of individuals. It is that cohesiveness of society which comes from recognising the importance of every individual and treating people fairly. In the context of the National Health Service it means treating people on the basis of clinical need rather than any other basis, such as income, wealth or perceived status in society.
We also need to recognise that in the post-War consensus, so cruelly torn apart by Thatcherism, the National Health Service was only one facet. The others were a commitment to public education, a commitment to decent housing and a commitment to full employment--in other words, the whole panoply of the welfare state from cradle to grave.
Over half the speakers in today's debate are in their late 40s or early 50s. In other words, they are "baby boomers"--those who have lived all their lives under the National Health Service. I am very pleased to have been present to hear my noble friend Lady Jeger making her contribution.
We do not honour enough our fathers and mothers who brought forth the National Health Service. In this celebration it would be remiss not to speak in the most glowing terms of the role played by Nye Bevan, rightly seen as the father of the National Health Service. But in doing so, we must not forget the role played by countless others in the formation of the National Health Service.
We must not forget the misery experienced by so many in the period before the National Health Service was set up who did not receive treatment, or the right treatment, either because they were too poor and could not afford it or were too rich and were therefore easy targets for unscrupulous doctors prepared to engage in unnecessary procedures.
We must not forget, in the fight for the National Health Service, the contribution of doctors, nurses and other health professionals who were ostracised by their colleagues and pilloried by Conservative politicians for the stand which they took.
This debate gives us the opportunity to restate the reasons why the principles underlying the National Health Service that treatment should be based on clinical need, free to the patient and funded from general taxation are so important. First, the National Health Service is cheaper than the alternative because it does away with private insurance, billing, management, marketing and legal costs associated with market-driven systems. Secondly, because it is based on clinical need, there is a greater chance of the right treatment being provided. Other systems lead to poor or under-insured people not receiving treatment or to rich people being over-treated.
It would be remiss not to point out that the National Health Service is currently under severe pressure, which is not surprising after 18 years of sustained Conservative government attack. I hope that from this debate will come a message that we now have a strong Government committed to the rejuvenation of the National Health Service but a warning that the service is very sick because of previous wrong treatment and will take some time to improve.
I am sure that it may take some time to get rid of prescription charges, to bring back free dental treatment and spectacles and to bring back chiropody into the National Health Service. Free feet care, my Lords!
We must challenge over-treatment in the National Health Service. Many elderly people are terrified of being cared for to the extent that they will live too long in a state of complete physical and mental deterioration, locked into their frail bodies. Why should small children who are likely to die be treated by American doctors for their own personal gain? We should question such practices and find solutions to the problems they cause.
I return to my theme of the National Health Service as a major contributor to the health of our nation. Should we not have the courage of our convictions, made strong by our experience of the health service over the 50 years of its existence, and argue with our colleagues in Europe and the United States that they should follow our example and develop free health services? We have a vested interest in Europe. We are now citizens of the European Union and can travel and work freely within it. Why should we not expect the same kind of medical treatment as we receive in this country if we live and work in France, Germany, Italy or Spain? We also have a vested interest in the future of the United States. I hope that during Tony Blair's visit to Bill Clinton he may give the President advice on how to set up a national health service for the United States of America, an achievement which would surely make him one of the greatest presidents the United States has ever had.
We now live in a global village. Surely we have a right to expect the same kind of healthcare as we receive at home anywhere we travel in the globe? Surely we should recognise that every other citizen of the global village should be entitled to the same healthcare treatment as we expect and to which we are entitled? Let us set our sights high. Let us think in terms of a global health service for the 21st century.
Viscount Bridgeman: My Lords, I add my thanks to the noble Lord, Lord Hunt, for initiating this debate. I must declare an interest as a special trustee of the Hammersmith Hospital, a post created, I believe, by my noble friend Lord Jenkin of Roding. As such, I have the privilege to be a colleague of the noble Lord, Lord Winston.
Speakers from all sides of the House have been broadly supportive of many of the steps which the Government are taking. At the same time, we can look back over the 50 years of the National Health Service and recall some of its achievements. My noble friend Lady Gardner of Parkes, the noble Baroness, Lady Jeger, and the noble Lord, Lord Davies, all spoke about the early days of the National Health Service. It is worth recalling two assumptions made in good faith at the time of its creation but which were not in the event fulfilled.
The first was that the health of the nation would be brought up to an acceptable level and that thereafter the health service would be on a kind of care and maintenance basis. The reality is that, as facilities and treatment improved, so did people's expectations. The second, perfectly understandable, error of judgment was the failure to appreciate the enormous costs of advancing medical and related technology and of pharmaceuticals. The result is a massive problem which has confronted all successive governments of balancing the NHS budget. That point should be borne in mind in view of the remarks made by the noble Lord, Lord Davies, about my party's record over the past 17 years.
In his admirable speech the noble Lord, Lord Hunt, endorsed the White Paper's proposals with regard to the removal of competition, creating a team spirit at national level. More than one trust manager has said to me how much the team spirit at trust level, from consultant to porter, has increased with the creation of trusts. One has to say that this is due to the sharp tang of competition. Are we to have a team spirit, which is so important for the effectiveness of the service, at national level, trust level or both? We shall see.
Associated with this market discipline is the Patient's Charter. My noble friend Lord Butterfield talked about transparency. The significance of the Patient's Charter is that for the first time there is the assessment for all to see of performance, openly analysed, both in absolute terms and, by means of the much feared league tables, in relative terms too. Patients now have identifiable yardsticks for what their expectations should be. There can be no better way, through this totally transparent monitoring, of getting rid of managerial fat.
Nowhere can its effects be more felt than in the trusts themselves. The current trend of political appointments of non-executive trust directors must be regretted, but I am pleased to note a welcome continuity in the existing executive managements which overall are of a very high level. The reference in the White Paper to making NHS trusts more accountable sits easily with this.
I wish to make two further points. I am pleased to note that the Secretary of State has stated his intention to knock down the "Berlin wall" between the health service and care in the community. The noble Baroness, Lady Pitkeathley, spoke of her considerable experience of that matter. Having formerly been a director of a company providing both agency carers to social services and agency nurses to the National Health Service, I know the problem and I applaud his intentions. But we all wait with interest to see how the Treasury determines which way that wall will fall.
Finally, perhaps I may refer to something which is all that is best in the continuity of the health service through successive administrations. The NHS (Primary Care) Act was a creation last year of the previous government and came into force, I believe, before the general election. That will transform the primary care treatment in the community. I note that the speaker following me is the noble Lord, Lord Rea, and nobody could be better qualified to speak on that subject with its emphasis on relations with GPs in deprived areas. I am pleased to note that Mr. Alan Milburn in another place announced the creation under that Act of the first 94 personal medical service pilot schemes, predominantly in deprived areas. I am sure that from these Benches we wish them every success.
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