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Mr. Milburn: No, that is not the position. A proper assessment will be made by the nurse. Who can make the assessment for free nursing, other than the nurse? My hon. Friend the Minister of State is not going to do it; I am not going to do it; officials and bureaucrats are not going to do it--nurses are going to do it. If I know nurses, they will make an assessment based on the health needs of the patient. That is precisely what we shall have. Where a nurse makes an assessment, it will be properly funded by the local health service. I gave that commitment before the Select Committee on Health and I give it before the House.

I read with some amazement the Opposition's reasoned amendment and its reference to free nursing care as a "modest" change. That change that will benefit 35,000 people. It will save them on average £5,000 a year. It is a change so modest that it was resisted year after year by the Conservatives when they were in government.

The truth about today's Conservative party is that it has neither the inclination nor the conviction to support such changes in the NHS. The Conservatives do not have a credible programme either for reform of health and social care services or for investment in health and social care services. Instead, they have a programme of cuts to damage public services.

Mr. Burns: Rubbish.

Mr. Milburn: The hon. Gentleman says that is rubbish. The Conservatives' programme would repeat the decades of damage to social services that they inflicted during the 1980s and the 1990s.

Mr. Burns: Rubbish.

Mr. Milburn: I have questioned the hon. Member for Woodspring on this matter before and he has refused to

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answer. I shall give him another opportunity to answer. In a moment or two, when he speaks, will he give a clear commitment to match our spending on social services? If he does not--if he cannot--his crocodile tears on bed blocking and care homes will be clear to the whole House.

Health and social services--as the Bill makes clear--go hand in hand; we cannot have one without the other. Any failure to match our increases in social services spending will bring more bed blocking in hospital, less rehabilitation in the community and more old people once again paying the price for the Conservatives' failure to invest.

The Bill is about investment in and reform of health and social services--after decades of under-investment and failed reforms in those services. Just as the first post-war Labour Government in the last century created the NHS, so the first Labour Government in this new century are now busy rebuilding it. Just as the Conservatives opposed the creation of the NHS then, so they oppose its modernisation now.

Today, with this Bill, we make progress on free nursing care, progress on patient power, progress on primary care and progress on patient protection. We make progress on implementing the NHS plan--not just to save the NHS from its enemies, but to secure it for a whole new generation.

The Labour party stands firmly on the side of the NHS. We are on the side of its principles and on the side of its staff. In our heads and in our hearts, we know that care based on need and not on the ability to pay is the right way forward for Britain. Today, with this Bill, we modernise the NHS so that it can improve the health of our nation--all of our nation--across the whole nation. I commend the Bill to the House.

4.24 pm

Dr. Liam Fox (Woodspring): I beg to move, To leave out from "That" to the end of the Question, and to add instead thereof:


I begin by making a personal apology to the House. No Member would purposely mislead the House, but I did so inadvertently at Question Time yesterday and I want to correct the record. Yesterday, I said that the number of patients waiting for appointments--the waiting list for the waiting list--had gone up by 55,000 under the Labour Government. I should have corrected that, because the number has gone up by 188,000 under the Government--[Hon. Members: "Ah!"] I do not want the record to underestimate the amount of misery caused to patients by the Government.

That is the background to the current debate. The Secretary of State said that the Government came to office to stabilise the NHS. In fact, more people are waiting than were waiting previously and clinical priorities have been

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distorted through the waiting list initiative. Last week, a consultant from a major London hospital told me that he had been told to stop carrying out so many hip replacements and start completing more minor procedures that would bring down the waiting list more quickly. That is ethically unacceptable.

There is greater public dissatisfaction with the lack of cleanliness in our wards. There has been an increased number of hospital-acquired infections and consequent unnecessary deaths. There are failures in public health policy--in tuberculosis--and there is an unacceptably and dangerously low level of immunisation against common illnesses such as measles. The Government say that they are proud of "The NHS Plan", but it took them six months to bring it to the House of Commons to have it debated. It is part smokescreen, and only part reform.

Dr. Stoate rose--

Dr. Fox: I shall give way to the hon. Gentleman, but must warn him that I shall do so only once, so he had better make use of it.

Dr. Stoate: I am grateful. The hon. Gentleman talked of clinical priorities. Does he believe that the fast-tracking of suspected cancer patients, who can now see a consultant within two weeks, is a distortion of clinical priorities?

Dr. Fox: It is obviously right to treat the sickest patients first. Quite wrong, however, are the examples of which we have heard from up and down the country of patients whose cancer surgery has been postponed because more minor cases are being treated. That is an unacceptable ethical distortion, and it happens up and down the country regularly.

The Bill is aspirational, if undeliverable in many ways, but it is, fundamentally, the wrong approach to the problems. Despite what the Secretary of State has said, the Bill is not a decentralising, but a centralising Bill. It is all about micromanagement of the NHS from Whitehall. It is impossible to run an organisation that employs almost 1 million people from behind a single Minister's desk. The more micromanagement that we attempt, the poorer morale becomes for those at the front line in the national health service.

The Bill perpetuates the myth of a one-size-fits-all structure for health care. There is no single blueprint. Forcing primary care groups to become primary care trusts, and then forcing them into being care trusts implies that some magical Whitehall blueprint can work in all parts of the country. It will not. We must allow systems to develop that are fit for the purpose required in their locality. We need to move from a managed health care system to a regulated one. We need an outcome-based system with investment directed accordingly.

We need less power in the hands of the Secretary of State. We need depoliticisation with an independent appointments body established in legislation. We need more decisions to be made by doctors, not taken by hospital managers on the orders of Ministers. We need authority to match responsibility for the nurses on our wards, and a return to what we might call matron's values of discipline and cleanliness. We need an expansion of the private sector, with incentives to create more capacity.

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We need to maximise the use of the voluntary sector, and patient choice and competition between providers must be recognised as good, not something to be deprecated.

In considering the effectiveness of the Bill, we must return to first principles. We need to examine the functions of the NHS and whether the Bill will improve them. The first function of the NHS is as a funding mechanism for the provision of health care free at the point of use. By any measure, the NHS must be regarded as, at the least, a highly qualified success in that area. Costs are controlled, it is relatively efficient and there is no wealth barrier to access. Funding is relatively even across the country; we could all name areas in which it is slightly higher or lower, but it is relatively even.

The Government, to their credit, have shown commitment to funding the NHS. United Kingdom spending on health fell behind what was then the common market average in 1963, so that during almost my entire life--and certainly my life as a working doctor--our spending had been historically behind that of continental Europe. The simple truth is that we only get what we pay for, irrespective of whether funding comes via taxation or insurance. I do not believe that there is any benefit in shifting the funding basis of the NHS to insurance.

The second function of the NHS is that of the delivery of health care, which is where the NHS falls down. Its delivery is poor. Our outcomes are unacceptable. The chance of surviving stomach cancer in the United Kingdom for five years is only about a quarter of the chance in Germany and the chance of surviving lung cancer for five years in the United Kingdom is half of the chance in Germany. Life expectancy in this country--the world's fourth biggest economy--is 19th in the world, similar to that in Turkey.

There is widespread public dissatisfaction with the delivery of health care under the NHS. That is why, since the Government came to power, 450,000 uninsured people have paid directly for procedures to be carried out privately. I have no problem with that if they can afford it and it is their choice. Choice is a good thing; in addition, the burden on the NHS is off-loaded, which is welcome. However, people should not have to pay with their life savings for life-saving surgery. Until we tackle the deficits in NHS delivery, the problem will remain, but I do not believe that the measures described by the Secretary of State will necessarily improve matters.


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