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Mr. John Maples (Stratford-on-Avon): It is always interesting to listen to somebody describing one's party's policy when they are getting it so comprehensively wrong. If the Conservatives wanted to do as much damage to the NHS as the hon. Member for Corby (Phil Hope) says, why did we not privatise it or start charging people when we were in charge? The fact is that we did not.
The hon. Member for Gedling (Vernon Coaker) put his finger on what the debate is all about. Will the Government's dramatic increase in health spendingfrom £60 billion to £100 billionshow up in better health outcomes? He said that it will, as though it were a given. I would say that the crucial test is whether it does or does not.
The issue within the health service is clearly a lack of capacity. We see that in waiting lists, rationing and poor health outcomes compared with a lot of other countries. That is partly due to the fact that we spend less money than comparable countries, but it may have something to do with the model or the system by which we turn that money into health care.
The Government ought to think about the example of Scotland. In Scotland, health spending is at the level of our main European competitors in this regard, but the outcomes and waiting lists are not that much better. One must ask what is going wrong there; why is that extra money not being turned into better health outcomes? Will our model use this enormous increase in spending efficiently? If it does, we will have as good a health service as France, Germany and Holland, which are the most interesting countries to compare us with. If it does not, it will throw into question whether the model to which we have been wedded for many years is the right one.
The Government have produced an interesting combination of a massive increase in money and a reform of the way in which that money is spent within the health service. It is a change from when I used to shadow on this subject for the Opposition in the first years of the Government, when they were doing exactly the opposite of what they are proposing to do now, in terms of the using the driver of the internal market. It is an interesting combination and, I say to my hon. Friends, it may work. We all have doubts about whether the system can deliver, but it may work.
My belief is that the jury is out and will not be back for three years or so. We have had three years of quite large increases in health spending. By the next election, we will have had another three, making six. If at that time we are seeing far better outcomes, the Government will have been proved substantially right in the way in which they have handled the issue. But if, by the next election, we are not seeing dramatically lower waiting times, better health outcomes and less rationing, the Government and their supporters will have to examine whether the model they are using to turn the money into health outcomes is the right one. It is an interesting experiment, but I have my doubts.
One problem is that there are huge supply-side constraints within the health service, at least in the short term. In the long term, one can train more doctors and nurses and build more hospitals. In the short term, one cannot. The proposal could lead to health sector inflation, about which the Government must be careful. They could spend all the money on increasing everybody's pay and have no additional outcomes. They could also introduce an enhanced role for the private sector on the supply side of health care. There may well be greater flexibility and less short-term constraint there than in the public sector.
Dr. Ladyman: The hon. Gentleman is one of the more thoughtful Conservative Members and I accept his goodwill in this matter. But does he agree that the logical conclusion of what he is saying is that the Opposition should support the Bill, to give us the money to see if our modernisation programme works, while possibly making proposals to amend the modernisation programme? To deny us both the opportunity to modernise and the money to do it with is nonsensical.
Mr. Maples: The Government will get a lot of support for what they call their modernisation proposals. But it is a bit much to expect the Opposition to support the Government over a stonking great tax rise that is in breach of their own manifesto. There is only so far I am prepared to go in helping the Government to make their case.
There is little choice within the NHS for patients or GPs. In the private sector, choice is what drives efficiency and quality because it produces competition. That cannot happen in the NHS, so we try to create proxies for it. The Government have created some interesting proxies that are similar to what we did some time ago; their supporters will argue that they are different. They are trying to create proxy drivers for efficiency and quality in outcomes, which are missing, by definition, from a nationalised and Government-run service.
One other concern that I have is what in the jargon is called "turbulence". The Government are trying to get a hugely increased amount of money turned into health care: something that has never been done before. Very senior civil servants who are friends of mine say that they have never done it before, and that it is difficult to get 7 per cent. real terms increases in spending through into the front line. At the same time as doing thisand while introducing a new way in which money moves around the system to create incentivesthere has been a huge
At the moment, health authorities are being abolished and strategic health authorities and primary care trusts are being created. In my constituencyother Members will have noticed this as wellfor the last six months, people have been concerned about what job they will do and whether they will still have a job when the authority is abolished. When they do get a job, they spend the next six months setting up the organisation, hiring the staff and ensuring that the working methods and protocols are in place. Those very peopleparticularly the senior managers in the health servicewho will be responsible for driving the money through into health care have been massively distracted over the last six months and are likely to be so distracted over the next six months.
Phil Hope: Like my hon. Friend the Member for South Thanet (Dr. Ladyman), I welcome the thoughtful approach of the hon. Gentleman. Our dilemma is that if we are to achieve the increases in spending needed to deliver real health care, we require leadership. He has given an academic view; he stands back and says it will be interesting to see whether the model works or not, and we will decide in three years' time. Does he agree that we have to show leadership, and that we as a country must show that we want the spending and that we want those NHS managers to deliver? We need the managerial ability to drive the measure through. It is not an academic exercise in which we can make our minds up at some point in the future. It requires real leadership, which the Government are giving to the NHS.
Mr. Maples: I agree that we will require effective management to turn the money into health care. That is what I have been tryingperhaps rather laboriouslyto say. I am concerned that those very managers will be distracted by the change in the bureaucracy and the structure of the health service that has been going on for the past six months and which is likely to take another six months, or longer, to bed down. However, I agree completely that management may well be the key.
I want to refer to the "but if". If the plan does not work, people will have to be prepared to look at other ways of working. Ours is the only OECD country of which I am awarecertainly the only advanced European economythat uses this model for funding and running a national health service. Clearly, it has attractions; the primary attribute, of which we are all in favour, is that it provides care free at the point of use on the basis of need. But anyone who pretends that there are no problems with the system, that some people's needs are not more easily met than others, or that some of the rationing is not very arbitrary, is pretending that there are not flaws in the system, which there are.
My friends and colleagues who are Members of Parliament in Germany, Holland or France do not have weekend surgeries and postbags full of complaints from people about the time they are waiting. It is worth looking at how others do these things. We ought not to treat this subject like religionsomething that you either believe in or not. We are looking for an effective way of turning a citizen's money, however it is paidwhether through taxes, social insurance or whateverinto the best possible health outcomes.
There has been much trashing of the United States system, and I do not advocate it. What is wrong with the US system is that it is very bad for the poorest third of the population, but it is jolly good for the other two thirds. If you are rich, there is no question but that the United States is where you would choose to be if you fell ill. The US has a self-funding and classic insurance system that wealthy people tend to use. In the middle, they have developed health maintenance organisations, which are extremely interesting. They ration health care, but do so openly. The system involves the money that a family spends as an insurance premium; whether one pays it as a premium or in tax seems a relatively minor detail. However, health maintenance organisations are interesting. They present the health care that they are going to provide openly and honestly.
That model is worth looking at, but a yet more interesting one is the social insurance model that Holland, France and Germany use in one way or another. In those countries, such issues seem not to be as political as in Britain, in that they do not bother their elected representatives quite so much. The model allows some choice and gets more money into the system. When people can see money going directly into health care, they are willing to pay more than if the Chancellor takes the money in tax and then decides how much he is going to spend on health care. In other words, when the arrangement is more direct, people are prepared to pay more, and the service can still remain free at the point of use. That said, it should be pointed out that our health care systemand those of other countriesdoes make charges, but basically it is free at the point of use.
Under that model, rationing does not disappear, but it is more open. Other things being equal, the more money spent, the less rationing there will be. However, it is a fallacy to imagine that it will disappear altogether, and that we can eliminate waiting times completely and create a health service that is prepared to provide any drug that anybody wants. Drugs are becoming incredibly expensive.
If we are to go down this routeI agree that it is worth looking atI should like to adopt the model used by Germany and Holland, in which people can contribute to several social health funds. At the moment, we spend about £60 billion a year on health carea 10 per cent. levy on everybody's taxable income produces roughly that sumbut we should consider a system in which people's taxes are reduced by 10 per cent. Here, the "straw man" of the £60 or £100 a week cost arises. The idea is that, if the sum is being paid as an insurance premium, it is not being paid in tax, but we should consider a system similar to that suggested by the Liberal Democrats, under which a 10 per cent. levy on people's taxable income is put into the health fund of their choice. It is at this point that I part company with the Government's thinking. Under my suggested model, the national health service would become one such health fund, and other organisationsthe Confederation of British Industry, the Trades Union Congress, insurance companiescould set up others. People would have a choice. The Government would lay down the minimum standard of care to be provided, but people could top it up if they wanted to. Again, that should be done as a percentage of one's income, so that equality can be maintained.
One thing that I do not like about the health service is that, although we pay a lot of money in tax for our families' health care, we cannot choose to pay a little more in order to get a bit more of a service; we must either take it, or leave it. If we leave it, we have to pay for the whole thing over again out of private resources, while not getting anything for the taxes we have paid. A social insurance system would combine the two incentives. The Prime Minister and the Minister have mentioned scare stories about the £60 a week that employers pay under such a system, but as I have pointed out, projected health spending of £100 billion a year will amount to about £1,700 per person per year, or about £7,500 for a family of four. In other words, we are paying a hell of a lot of money for health care, and we want to know that the existing system for delivering it will use the money to maximum effect. Describing the costs of other health care methods as additional to, rather than a substitute for, current costs, is a straw man. It is not an honest way to argue.