I must remind the House that Mr. Speaker has selected the amendment standing in the name of the Prime Minister.
I beg to move,
That this House celebrates 60 years of the NHS; recognises the support from all political parties for the NHS during that time; is grateful to NHS staff, past and present, who are the key to its success; commends their commitment and expertise in delivering patient care in often difficult circumstances; acknowledges the unique contribution of volunteers and charitable organisations; is committed to providing the NHS with the funding it needs to deliver European standards of healthcare to all; and recognises an opportunity in future to make the NHS more patient-centred by focusing on outcomes.
On Saturday week, it will be the 60th anniversary of the national health service, and my right hon. Friends and I felt that the House should have the opportunity, in anticipation of that day, to record our appreciation of all that the NHS has achieved and all that it has meant to the people of this country over the course of those 60 years. We do so this evening entirely in the spirit—
When I have made a little progress.
We do so entirely in the spirit in which the national health service was created. I shall let the House have a quotation:
“The discoveries of healing science must be the inheritance of all. That is clear. Disease must be attacked, whether it occurs in the poorest or the richest man or woman simply on the ground that it is the enemy; and it must be attacked just in the same way as the fire brigade will give its full assistance to the humblest cottage as readily as to the most important mansion… Our policy is to create a national health service in order to ensure that everybody in the country, irrespective of means, age, sex, or occupation, shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”
The Prime Minister of the day, Winston Churchill, said that on 2 March 1944, anticipating the establishment of a national health service.
In a spirit of consensus, I will acknowledge that the NHS was inspired by the work of a Liberal, William Beveridge, designed by a Conservative, Henry Willink, and implemented by a socialist, Aneurin Bevan. [Hon. Members: “Oh!”] I was talking to a nurse; my right hon. Friend the Member for Witney (Mr. Cameron) and I have met a number of—[Interruption.] Is the hon. Member for Livingston (Mr. Devine) seeking to intervene?
I have the record of Second Reading of the Bill that introduced the national health service, in which the hon. Gentleman’s predecessor, the then shadow Health Minister, started by saying:
“The right hon. Gentleman the Minister of Health has received an ovation from the Benches behind him for a speech as eloquent, as unconvincing, and as disingenuous as any I have ever heard from him.”—[Official Report, 30 April 1946; Vol. 422, c. 63.]
When did the Conservative party start supporting the NHS?
Considering the occasion, the purpose of the debate, the nature of the motion that we have tabled and the way in which I am introducing it, that was a wholly inappropriate response. As far as I could tell from listening to it, it was probably inaccurate, but it was difficult to say.
In the 60 years since the establishment of the national health service, it has been under the stewardship of Conservative and Labour Governments—Conservative Governments for 35 years and Labour Governments for 25 years. In that time, the NHS, for all its vicissitudes and the ups and downs that it has suffered, has none the less exhibited continuous gain, from the point of view of the people of this country. It has benefited us individually and collectively and remains part of the glue that holds society together. From the point of social solidarity and a sense of security in this country, it is immensely important to people.
Conservative Members know—as do all hon. Members—how much we rely on the NHS. I suspect that many of us, from all parties, have occasion to visit other countries—I am thinking especially of America—where the experience of people visiting their health services is too often of worrying about whether they can pay for their care, what the circumstances will be if they become chronically ill and whether, if they visit an accident and emergency department, they might first be asked for their insurance policy or visa number. We do not have those experiences in this country. We have a sense of equity and an understanding that, as part of our social solidarity, we are collectively committed, through taxation, to providing a comprehensive health care service, free at the point of delivery and based on people’s need, not their ability to pay. Those principles are unchanging, even though policies may change or be debated. I do not believe that we disagree about the principles.
I congratulate my hon. Friend on the tone with which he has begun the debate, in which hon. Members of all parties will celebrate the foundation of the national health service. There have been huge increases in spending on the NHS, for which the Labour party deserves some credit, but a focus on outcomes rather than false targets will end the distortion of clinical priorities and of the value for money and excellent health care to which the expenditure should lead.
I am grateful for that intervention and it will not surprise my hon. Friend to know that I feel strongly that the NHS needs to become much more focused on outcomes for patients. That policy does not derive from our thinking alone, but is the product of speaking to literally thousands of people in the national health service. They say that they want to care for the patient and determine their actions on the basis of the patient’s need in a framework where policy is geared to that. Unfortunately, although the Government have been talking about outcomes since my right hon. Friend the Member for Witney and I started to make it clear that we would move in that direction, they are not designing health outcomes into the policy of the NHS. The policy, as dictated by the Government through national targets, is still geared towards processes and targets rather than health outcomes for patients. A change of direction is vital.
The hon. Gentleman started with a brief synopsis of the Conservative party’s position in the 1940s. Will he remind the House of how the Conservative party voted in 1948? Did it vote for or against establishing the national health service? It is a simple question.
I have not looked back—[Hon. Members: “Oh!”] However, my recollection is that Conservative Members at the time, in opposition, took a view about the specific proposals that the Labour Government presented and objected to aspects of them. Labour Members appear to believe that the British Medical Association’s difficulties at the time were a measure of its opposition to the NHS. It is no more true to say that the Conservative party since 1948 or today opposes the NHS than it is to say that the BMA opposes it. Neither statement is true and it is absurd to claim either.
I am grateful to the hon. Gentleman for giving way because I want to make a helpful intervention. In these straitened economic times, will he reaffirm his personal commitment to increasing NHS spending by £28 billion a year over and above the current Government figure?
The hon. Gentleman must not believe everything that he reads in the newspapers. I made no such commitment. Our commitments are clear: we are committed to the same increases in NHS spending up to 2010-11 as those in the Government’s spending plan. Beyond 2010-11, my colleagues are committed to further real-terms increases in NHS spending.
Is my hon. Friend aware that, although most people recognise the anniversary, it is not being celebrated everywhere? For example, in Bridlington in my constituency, there is genuine concern that a relatively new hospital, which a Conservative Government built, maintained and sustained, is under threat from the Labour Government, with services being cut.
Labour Members should listen to my right hon. Friend because attachment to the NHS is often expressed through support for one’s local health service. It should be no surprise that, as I know from my visit to my right hon. Friend’s constituency, many thousands of local people have signed a petition to maintain services at their local hospital. Instead of carping, Labour Members would be well advised to acknowledge that that is true not only in Bridlington but in many places throughout the country.
People are signing petitions not in contravention of medical evidence, but with clinicians’ support and on the basis of evidence for the desirability of maintaining care closer to home. Labour Ministers have adopted that policy, which my former right hon. Friend, Virginia Bottomley, began. She started the process of providing care closer to home, and that care is being lost too often under a Labour Government.
I want to make progress and I do not want to take much time because I want as many Members as possible to have a chance to express their views about the NHS. It is not an occasion for me to make many—or, indeed, any—party political points or to talk about policy in great detail.
However, when one considers the current position in the NHS, we should take account of some things from the past. A couple of years ago, I was at Papworth hospital, which was celebrating the 25th anniversary of the first heart transplant. I was surprised to hear Sir Terence English, who carried out that transplant, say that the 1980s was a golden age in the NHS. That is not a phrase that I normally hear applied to the 1980s, so I asked him what he meant by it. He replied that, in those days, if he could convince the board of governors at Papworth hospital that he should innovate through undertaking something groundbreaking, there was nothing to stop him. We need to consider that carefully. The Conservative party is geared towards health outcomes because the structures of targets and micro-management in the NHS have made many NHS staff believe that they are no longer in a position to innovate or have the freedom to deliver high quality care in the way they should.
No, I am making progress and I want other hon. Members to be able to speak.
Hon. Members of all parties should ensure that there are opportunities for innovation.
As we understand from Derek Wanless’s reports and his revisions to them, there are substantial risks to the future of the NHS, not least those that arise from demographic change, the impact of new technologies and the costs associated with implementing them, and rising expectations and demand. However, central among those risks are the impacts of public health demands, if we are unable to achieve what he describes as a fully engaged scenario, whereby the public understand the health implications, including obesity and sexually transmitted infections, of behaviour such as alcohol abuse, substance misuse and the like. Unless the public recognise that, it will be very difficult for the NHS to cope with the disease consequences that will arise.
When Ministers publish the review next week, I hope that they will make it clear that it is outrageous that in London, for example, as Lord Darzi set out in “A Framework for Action”, there is an inverse relationship between the relative deprivation of primary care trusts and the amount spent on preventive health care. Indeed, we have set out clearly how our public health infrastructure should be geared to that, and how we should have separate public health spending. Right across the country, there is no positive relationship; indeed, the average spend per head in primary care trusts on preventive health care spending is just £20, from an average allocation to PCTs of well over £1,000 per head. That is the second lesson.
The third lesson that we must learn is about giving the NHS organisational stability. My right hon. Friend the Leader of the Opposition happily said that, and the Secretary of State repeated what he said when he took office—that there should be no further major organisational upheavals. I will not dwell on all the things that have happened, but even now the NHS does not know whether it is working to the NHS plan from 2000, to “Keeping the NHS local” from 2004, to “Commissioning a patient-led NHS” from 2005, to “Your health, your care, your say” from 2006 or to whatever is contained in the document to be published next week.
There is no thread of consistency and stability in either the structures or the policy being pursued in the NHS. One of the first things that many people working in the service would say to us, as we collectively discuss the NHS after 60 years, is that they will be able to deliver so much more in the future if they are given the stability of a framework in which to do so and the freedom to respond to the needs of patients.
Local people in Kettering are rightly proud of their district general hospital, which this year celebrates the 111th year since its foundation. Although they are positive about the NHS in respect of the local hospital, they are negative about it in respect of NHS dentistry. Local people have never had such limited access to an NHS dentist as they do now.
I am grateful to my hon. Friend, who makes an important point. If my memory serves, over the past year we have seen a reduction of about 1 million in the number of people accessing NHS dentistry. We must recognise that the experience of dentistry that many people throughout the country have is genuinely one of a two-tier system. There are people in some areas who can access NHS dentistry or receive it free, because there are still contracts and dentists available, yet in other places it is simply not available or people pay so much that, frankly, they might as well be in the private sector, because of the costs that they have to meet.
My hon. Friend makes an important point, and we need to be realistic. This is a debate not just to say thank you, although that is an important part of it, but to listen to the staff of the NHS. Last week, the Government published the annual survey of NHS staff, “What Matters to Staff in the NHS”. There was much in it about NHS staff feeling positive about their hospitals or surgeries, and they were very supportive of what the NHS stands for.
However, staff were asked, by Ipsos MORI on behalf of the Government, whether they would praise the NHS as it currently stands. Unhappily, those figures were not as good. Forty-three per cent. of staff overall said that they would speak critically of the NHS as it now stands and only 27 per cent. said that they would speak highly of the NHS as it now stands. That is very depressing. Any organisation—public, private or whatever—in which more staff would, unprompted, speak critically of that organisation as it stands today than would spontaneously speak highly of it has serious problems with staff morale and motivation, which needs to be changed.
Staff views are very important. NHS staff were concerned about changes to their normal pension age. I negotiated an agreement whereby all NHS staff in post at the time would continue to have a normal pension age of 60. The hon. Member for Tatton (Mr. Osborne), the shadow Chancellor, said that that agreement should be reviewed. Will the hon. Gentleman confirm that NHS staff, about whom he is rightly concerned, can rest assured that the Conservative party will not reopen that deal and that all staff in the NHS will continue to have a normal pension of 60, if those were the terms on which they were recruited?
Yes, I did not have the opportunity, I am afraid, to listen to my hon. Friend on “Newsnight”, but I understand that he made it clear subsequently that he had not been correctly quoted. I thought that the Secretary of State was rising to respond—I hoped positively—to the fact that 43 per cent. of NHS staff, including 54 per cent. of medical and dental staff and 49 per cent. of junior managers, said that they would speak critically of the NHS as it is now. That needs to change, and if that is not critically important to the Secretary of State, it ought to be.
People in the NHS listening to our debate this evening would say, “Don’t just say thank you to us or express appreciation for what has been achieved. We know that the public support us, but at the same time they know that we are not allowed to achieve what we should achieve, and that although we’ve seen a doubling of resources in the NHS in the last 10 years, this hasn’t reached the front line and it isn’t delivering the patient gain that it should. From our point of view, not only do we need organisational stability, empowerment of professionals and freedom to deliver for patients, but we are prepared to be held to account for the outcomes that we achieve and held to account by patients for the services that we provide.” Patients should be able to access choice and control over their health care and, to an extent, those with long-term conditions should even, where possible, be able to manage personalised budgets.
It is important to talk to staff, and I have talked to the staff at my local hospital. They are users of that service, too, and they have said to me that they are not willing to wait more than four hours in A and E. They do not want to wait more than 18 months for operations and are pleased about everybody getting 18 weeks, end to end. What does the hon. Gentleman think is the difference between the target and the outcome? If the target is that everybody gets their operation and gets better, the outcome is better health for everybody. It is misleading to mix up targets and outcomes.
Order. If that had not been in order, I would not have let the hon. Gentleman say it. These are matters for debate, not matters for the Chair.
Let me explain two things to the hon. Lady. First, many clinicians to whom I have spoken over many years, as well as their representative organisations, have made it clear that the impact of a waiting time target is less about delivering reductions in waiting times than it is about distorting clinical practice and the clinical judgments that have to be made. Waiting time targets can thereby have a damaging overall impact on health outcomes.
Clinicians want to focus on outcomes and be held to account for some of the performance measures that go into delivering high-quality care for patients. There is no doubt that clinicians know that their local hospital should be responsible for publishing referral-to-treatment times and that patients and commissioners should hold them to account for that. That is performance management; it is part of the contract and nobody is proposing that we get rid of it. However, the hon. Lady must recognise the truth about imposing a national, one-size-fits-all, 18-week referral-to-treatment target. Almost every clinician to whom I have spoken says, “This is nonsense. There is no clinical evidence for this and it distorts.” Indeed, we can see that happening already, with hospitals having to pay well over the tariff to access private sector providers and deliver the target.
Another thing that I would like to say to the hon. Lady is that the staff at her local hospital, Chase Farm, are saying, “Don’t take away our maternity services and our A and E services”. The people of Enfield care about services at Chase Farm, and I wish that she had got up to tell the House about that, instead of making a party political point.
International benchmarking is absolutely critical. Let us look at a simple example. The Government rightly say that, over the past decade, we have seen reductions in premature mortality from cardiovascular disease and stroke. However, they never go on to say that that has been true not for 10 years but for 20 years. They never go on to say that, when we compare our data with those of other countries, we see that we have not narrowed the gap. They do not go on to say that studies suggest that we have the worst outcomes for stroke among the European countries. They do not go on to say that there are routine procedures in other countries for stroke services and heart care services—for people having a heart attack—under which people are treated as an emergency when they have a stroke or when they are taken for primary angioplasty when they have a heart attack. Those services have routinely been offered for years in those other countries but they are not being offered here.
International comparison is essential in this regard. How can we know how well the NHS is performing unless we look at countries with equally developed health economies to see how well they are doing by comparison?
Is not the situation actually worse than my hon. Friend describes? Some years ago, there were two gaps. We spent less per head on health care than our European comparator countries, and we had worse health outcomes. Now, our spending is broadly in line with our European comparator countries, but we have not eliminated the gap on health outcomes. That is the core challenge, and the Government have failed to deliver on it.
I am afraid that it is, and this takes us back to one of the central issues that most depresses people who work in the national health service, and those whom they look after. They want to see those resources, and they want to use them productively. Unfortunately, however, the nature of the system means that when spending was rising fastest, productivity in the NHS was falling by 2.5 per cent. a year, according to the Office for National Statistics. In those circumstances, they cannot deliver the quality of health care that they should.
Last year, the Government were fond of quoting the Commonwealth Fund, but I am afraid that that study presents an unhappy picture of an international comparison that does not even include some of the most positive comparators, such as France. The Commonwealth Fund, from New York, which Ministers like to quote, states that the UK health care system is the worst for waiting times, for mortality rates, for hospital-acquired infections, for preventive care such as breast cancer screening, for caring for those with long-term conditions and for GP access out of hours. So, precisely—[Interruption.] Hon. Members laugh, but this is not a matter for amusement. The Commonwealth Fund is quoted by Ministers, and I have just quoted it as well. They should recognise this. We should look at outcomes, at the overall benefit for patients and at international comparisons. The Government—and any future Government—must focus on overall outcomes for patients and not on trying to micro-manage the way in which they are achieved. We should focus on what we are trying to achieve, and we should be rigorous, challenging and ambitious about that, but we should not try to dictate how it is done.
The hon. Gentleman was talking about what NHS staff actually thought. Does he remember—as I do from when I worked in the NHS—that this Government are not frightened to ask the staff what they think about the health service and about what measures can be taken to improve it? When the Conservative Government were in power, if whistleblowers told the public what was going on in the national health service, they were sacked for telling the truth. Does the hon. Gentleman think that that is a good record?
I am sorry that the hon. Lady thinks that that was true in the past, and that it is not true today. I am afraid that I have met many people who still feel that the culture in the NHS is such that they cannot speak out openly about what is happening. That should not be true, but unfortunately it still is.
No, I am going to finish my speech in a moment. I want everyone to have a chance to speak.
The national health service is something we can applaud and something to which we attach enormous importance locally. In my own constituency, the Addenbrooke’s and Papworth hospitals are excellent examples of innovation and high quality care, and we attach enormous importance to them. But the NHS knows, and we know, that the route for the future is not just about things as they are. It is about achieving a stable organisational framework for the NHS that will allow real dynamism for reform and change. Under the twin levers of patient choice and a competitive environment among health care providers, information based on health outcomes, rather than on micro-management, will deliver the framework within which those levers can work most effectively.
Internationally, we can see that we have a treasure in the NHS. When I go to America or, as I did recently, to the Netherlands, I see that people are seeking to achieve a structure that will provide universal coverage, or a maximum risk pool, as they put it. They want to achieve the combination of equity and efficiency that everyone is looking for in health care. The scale of spending on health care in many of those countries is similar to our own or even higher. In America, for example, the scale of public spending on health care as a proportion of gross domestic product is almost exactly the same as it is in this country, but there is an additional 7 per cent. of gross domestic product on top of that in private contributions. That is not a situation that anyone could contemplate. The inefficiencies involved are not to be contemplated.
In the national health service, which is funded through general taxation, we have a vehicle that is highly efficient at raising resources for health care and highly equitable in regard to the potential distribution of, and access to, that health care. Unfortunately, over recent years in particular, it has become bureaucratic and monolithic. It does not exhibit the characteristics towards which all those other health care systems are moving in regard to exposure to efficiency. That exposure to efficiency, through choice and competition, is essential for the future, and I believe that NHS staff are happy to contemplate that. They are prepared for it, as long as the competition is fair and they are judged on genuine outcomes, and as long as they are given the opportunity to do the best for patients in a framework that continues to be supportive and true to the principles of the national health service.
In supporting the motion this evening in a non-partisan fashion—[Interruption.] It is entirely non-partisan. I hope that my colleagues and I will make it clear that its purpose is to give hon. Members on both sides of the House the opportunity to express differing views on the policy direction of the NHS, as well as a clear and unanimous commitment to its principles, its values and its future.
I beg to move, To leave out from “all;” to the end of the Question, and to add instead thereof:
“recognises an opportunity to make the NHS more patient-centred by focussing on outcomes; further recognises the defining contribution the NHS has made to the health and wellbeing of the nation since 1948; acknowledges that the principles upon which the NHS was established, funded by general taxation and free at the point of delivery, are immutable; accepts that target reductions in waiting times have significantly improved services to patients; and looks forward to the next 60 years of the NHS characterised by world-class quality healthcare as well as greater personalisation, individual choice and easier access to services.”.
There is nothing in the Opposition’s motion that we find objectionable. There is one minor quibble, which I will come to in a second—and there is a very major quibble sitting next to the hon. Member for South Cambridgeshire (Mr. Lansley); I will deal with the minor quibble later. The claim in the motion that the Conservatives recognise
“the support from all political parties for the NHS”
crept in at the last minute. It was not there yesterday—but I will even let that pass. I might come back to it later.
We are genuinely pleased that the Opposition have dedicated some of their time to discussing the important occasion of the 60th anniversary—the diamond anniversary, indeed—of the national health service. We should not forget the many and varied ways in which it has improved the lives of individuals in this country, and improved the nation as a whole.
I was at an event earlier today with the Prime Minister to celebrate 60 years of NHS research. When the NHS was established, the opportunities for medical advances were greatly expanded because it gave researchers access to vast numbers of patients and staff in a clinical setting for the first time. For example, the discovery in the UK in 1950 by Professors Hill and Doll that there was link between lung cancer and smoking could not have happened without the collaboration between the NHS and the Medical Research Council. That discovery was followed by breakthroughs in hip replacements, in detecting osteoporosis, in bio-engineering, in heart valves and in the word’s first test tube baby, along with many other breakthroughs.
The UK is a world leader in health research, responsible for 3 per cent. of the world market in medicine, but funding 11 per cent. of the world’s medical research. We will continue to invest in science, innovation and research to ensure that we maintain this country’s pre-eminence. Following today’s summit, we will forge even closer links between universities and the NHS.
Medical research is just one of the many advantages bequeathed by our predecessors in 1946, when the National Health Service Bill was approved in this House. It can hardly be said that the NHS emerged from deep political consensus and professional support. The historian Kenneth Morgan pointed out that the conflict between the BMA and the Government lasted longer than the second world war—[Interruption.] The hon. Member for North Norfolk (Norman Lamb) says that it is still going on, and I shall come back to that in a few moments. My hon. Friend the Member for Livingston (Mr. Devine) cited a reference from a debate in this House 60 years ago. This was April 1948—[Interruption.] No, my hon. Friend was not there at the time! The Bill had become an Act, having received Royal Assent, and Bevan and the Government were forced to provide time to debate the NHS because of the huge opposition that had emerged from the BMA and the Conservative party. Let me read one quote from Nye Bevan. There are loads of quotes in these debates, but this one struck me as being perfect for the occasion. Bevan said:
“It can hardly be suggested that conflict between the BMA and the Minister of the day is a consequence of any deficiencies I possess, because we have never been able yet to appoint a Minister of Health with whom the BMA agreed.”
No change there. I am sticking to the tradition established by Nye Bevan.
A constituent, Mrs. Elizabeth Porter, celebrates her 100th birthday next year. She spoke to me recently about what happened 60 years ago when she travelled on a bus from where she still lives in Shiney Row, Durham to hear Nye Bevan speak about the creation of the health service. She said to me that it was the greatest decision ever taken by any Government in the last century, because it took away the fear that she had in the 1930s of having to make a decision on health on the basis of whether she had £2 to call a doctor, rather than whether she needed help. Does my right hon. Friend agree with Mrs. Porter’s analysis?
I entirely agree, and I cordially invite my hon. Friend’s constituent to come to Westminster Abbey next Wednesday to celebrate the 60th anniversary of the NHS, as there will be many more NHS workers there and people who have benefited from it over the years.
I am not one for celebrating institutions, but I am one for celebrating the people who work in them, particularly nurses, who make a massive and important contribution to the NHS. My concern is that too many district and community nurses are now subsidising the NHS because their mileage allowance was fixed in 2001 and has not risen since. Will the Secretary of State take a look at that and give the nurses a real present for their 60th anniversary?
Of course I will look at that, but today’s occasion should not get bogged down in mileage allowances: let us look at the bigger picture—[Interruption.] I know that there are three or four ex-nurses in their places around me now. As I said, I will look at the issue, but let us move on from mileage allowances to the big debate in 1948 about whether we should establish a national health service.
I am unsure how the Liberals voted in 1946—[Interruption.] Well, there were only a dozen of them in the House at the time. But I do know how the Conservatives voted, and the hon. Member for South Cambridgeshire (Mr. Lansley) might like to know that the Conservatives voted against the Bill at every stage. There was a three-day Second Reading debate, at the end of which the Conservative Opposition voted against it. There were no rebels going through the Labour Lobbies. For us, it was unanimous. Again on Third Reading, however—
Let me finish my point. The Conservatives voted against Third Reading, proving that this was an absolute point of principle for them. As I have already explained, two years later, Bevan had to come to the House with another debate because of the coalition between the BMA and the Conservative party, which was in fierce opposition to the establishment of the national health service.
I am grateful to the Secretary of State. One of his achievements in office is that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Tory spokesman, is ahead of him in terms of public trust in handling health policy. That is an important event for the Conservative party, but I wonder whether the Secretary of State thinks he is likely to get himself ahead of my hon. Friend in terms of public ratings by digging up the history of who said what in the House of Commons in 1946?
In a few moments.
I think that it would be really strange if, in debating an Opposition motion celebrating 60 years of the NHS, I did not point out the consistent support or otherwise of all political parties for it. I realise Conservative Members do not want to go over the history, but it would be perverse if we did not at least mention some of that history. Indeed, the hon. Member for South Cambridgeshire mentioned it himself.
It might be helpful to the debate if Conservative Members in making their contributions or interjections told us whether they are covered by private medical insurance. The difference between Conservative and Labour Members is not only that we created the national health service, but that we actually use it, too.
The hon. Member for West Chelmsford (Mr. Burns) cannot intervene before I have risen to respond to the previous intervention. All we know is that an analysis of the Cabinet of which the right hon. Member for Charnwood (Mr. Dorrell) was a member showed that none of them used either the NHS or, indeed, the state school system—but we will draw a veil over that period of history.
Interesting as it is for the right hon. Gentleman to give us a history lesson, does he accept that many Conservative Members, including myself, were not born in 1946 or 1948, and that we have supported the principle and the exclusive use of the health service ever since we were born?
I accept that point entirely. However, the hon. Member for South Cambridgeshire began his speech by quoting Winston Churchill in 1944, and went on to talk about Henry Willink, the shadow Health Secretary at the time and Health Secretary during the coalition Government, so perhaps we can be allowed to enter the same debate and talk about the history as well.
May I suggest that my right hon. Friend might get quite a long way ahead in the ratings if he told the House about the difference targets have made to cardiac mortality and death rates from cancer? Those issues are important to this evening’s debate. May I also say to my right hon. Friend that despite the many discussions I have had with him and other Ministers about Chase Farm hospital, one thing I am absolutely certain of is that that hospital, as a result of all the efforts made locally and here, has a very bright future ahead?
I agree with my right hon. Friend, and I will come on to targets and outcomes a little later.
The Conservative party voted against the National Health Service Bill at every stage, so has the NHS really had
“support from all political parties”?
Has this great achievement of a Labour Government been equally cherished by the Conservative party? I think the hon. Member for South Cambridgeshire may blush a little at that suggestion. The NHS was certainly not supported at birth—in its infant and teenage years, perhaps.
Moving on to the ’80s, Baroness Thatcher, who famously went to a private hospital in Windsor rather than use the NHS, said as Prime Minister that the NHS was “safe in her hands”, rather as the Leader of the Opposition was saying earlier today. However, as Rudolf Klein, historian of the NHS, points out, in 1982 the Government’s think-tank, the central policy review staff, produced a paper proposing the replacement of a tax-financed NHS by a system of private insurance. That was presented to Ministers by the Chancellor and promptly leaked to The Economist, so it became a big scandal. History records that we can thank Lord Fowler, who was Secretary of State for Social Services, for killing off that proposal.
We should also remember that every single—[Interruption.] Just one second. We are coming up to recent history, which will be much more interesting to the hon. Member for Hemel Hempstead (Mike Penning). Coming up to recent history, we should remember that every—
Is the Secretary of State interested in history, as he seems to have glossed over the fact that since the 1950s, the year in which the largest reduction in NHS spending took place—a reduction of 2.9 per cent. in real terms—was 1977-78, under a Labour Government? Perhaps he will confirm that that is correct. Will he acknowledge that Governments both Labour and Conservative have sought to support the NHS, but that the year in which there was the least financial support for the NHS occurred under a Labour Government?
The Conservative party has tabled a motion saying that “all political parties” have supported the NHS. I am not dealing with the vagaries of finance; I am saying that the Conservatives opposed the NHS when it was founded, and came up with a plan to move to a national insurance system, which thankfully was scuppered, and that as recently as the last general election, every single Conservative Member stood on a manifesto that said that people could take money out of the NHS to go private. I point that out merely because of the terms of the motion.
The hon. Member for South Cambridgeshire has tried to put all that in the past, primarily to try to encourage the public to forget what the Tories did to the NHS when they were last in government. That was an era of 18-month and sometimes two-year waits for life-saving operations. It could take weeks to get a GP appointment. As the chief medical officer tells us, when he was working in the north-east an 81-year-old man wrote to him to ask whether he could bequeath his place on the waiting list for a cataract operation to his nephew, who was 60 and developing eye problems. That man had been on that waiting list for 11 years. Waits in accident and emergency were sometimes 24 hours, and infection rates in hospitals soared.
Such was the public anger that the debate was not always about how we could save the NHS, but about whether we should abandon it altogether. Now, thankfully, the debate is about how we take the NHS from good to great, and from world class in some aspects to world class in all. Here I come to my quibble with the Conservative motion. While it rightly mentions the need to focus on outcomes, as we are doing, it implies—this point was referred to by my right hon. Friend the Member for Enfield, North (Joan Ryan)—that targets have had no role to play in rescuing the NHS from years of neglect and underfunding.
This is an area where the Tories have created more than a bit of confusion for me. Heaven forbid that we should ever have a Conservative in charge of the NHS again, but exactly what would a future Conservative Government be responsible for? Three issues have been raised—Chase Farm hospital, which was mentioned by my right hon. Friend the Member for Enfield, North (Joan Ryan), and two others, which were raised by Labour Back Benchers—on which local decisions were made to change the NHS to try to improve it and make it ready for the 21st century, but the hon. Member for South Cambridgeshire has prayed them in aid to attack the Government. There is localism and decisions are being made, but the hon. Gentleman brings them here to attack the Government. Exactly what would a Conservative Government do for the NHS, and who would be responsible for what?
That is a very good question. [Interruption.] It is a very good question. Last week we had a debate on polyclinics. The argument about GP-led health centres—[Interruption.] I will say it in words of one syllable: we had a debate last week about health centres. We heard that the argument against putting GP-led health centres in every part of the country—open from 8 am to 8 pm, 365 days a year, with access for people whether they are registered or not; they can walk in—was that we were determining things from the centre.
When it was pointed out that in London the proposals for polyclinics had come from a consultation involving clinicians and the population, that was opposed. When it was pointed out that there were proposals for a further three centres in Hull, in my own constituency, that was opposed. My hon. Friend the Member for Eltham (Clive Efford) is right to be confused: the Conservatives oppose what is driven from the centre, and oppose what comes from the local level as well.
Does my right hon. Friend agree that quality and dignity go hand in hand in the NHS, and that our target to ensure that all A and E patients are seen within four hours of entry to hospital is a massive improvement on patients spending the night on trolleys, as they used to in my local hospital, Pinderfields, 10 years ago? Does he also agree that the debate about targets and outcomes represents a semantic difference, and that we should all be working together to improve health care?
The public will be bemused by all this discussion about outcomes. They want to get through A and E in a reasonable time. They want not to wait years for an operation. Samia al Qadhi, chief executive of Breast Cancer Care, said this morning that targets had their uses. She certainly thinks that it is important that there are targets for the timing of cancer care in particular, not only because of the emotional distress of waiting for a diagnosis or for information, which should certainly not be underestimated as it is considerable, but because there is plenty of evidence that early diagnosis saves lives with breast cancer and other cancers. So there was no support there for this weird argument that we concentrate just on outcomes and there is no place for targets at all.
I have referred to this before, but it is a key point about cervical cancer screening. We know we have a problem, which has developed more recently, with young women in their 20s and 30s falling away and not attending screening. There have been some wonderful initiatives, including one at Salford PCT, which has studied the process, worked with GPs and improved our uptake of screening in Salford by 7 per cent. It is true that we have to focus on process and on targets to achieve those different outcomes.
I saw what is happening in Salford when I was there a couple of weeks ago. When I went to King’s, I also saw how the areas of south-east London where the most deprived communities live are being targeted to ensure that they get the breast cancer screening programme to reach the parts of the community that are most difficult to reach. Those are very important local initiatives. We reject totally the Opposition proposal that we should abandon targets. In achieving reduced waiting times and in tackling health care acquired infections, they remain important.
The transformation of the NHS is due to the hard work and dedication of its staff, but national targets, together with sustained growth in resources, delivered significant progress: better access, improved treatment in A and E, better treatment for cancer patients and significant reductions in mortality rates from the major killer diseases. From December, no patient will be waiting more than 18 weeks for an operation following referral to treatment.
I shall quote Professor John Appleby, chief economist—[Interruption.] I mean that no patient would wait that long apart from those who book an appointment but decide that they do not want to have their operation yet, and those who decide that they are going on holiday.
It is quite important that we are clear about that. For example, the Government will say that nobody waits beyond four hours in A and E, but last year 129,000 people waited more than four hours. There is a tolerance. I understood that Ministers were proposing an 85 per cent. target for the 18-week referral to treatment, so hundreds of thousands of people will wait beyond 18 weeks.
Why did the hon. Gentleman have to intervene? I was just mentioning the tolerance: the figure is 10 per cent., so there is a 90 per cent. target because of the fact that there is a tolerance and—[Interruption.] The hon. Member for Guildford (Anne Milton) says from a sedentary position that I said “nobody”. Before the hon. Member for South Cambridgeshire intervened, I made it clear that there is a tolerance level, as there is for all targets.
Let me quote Professor John Appleby, chief economist at the King’s Fund:
“Every opinion poll and headline ten years ago said that if there was one thing the public wanted fixed in the NHS it was waiting times, and they’ve done it.”
“It is quite staggering.”
That is from the independent King’s Fund. He continues by saying that
“the whole point of the targets was to change clinical priorities, because doctors seemed content to put up with long waits for their patients—while patients were not content…There is no evidence that vital priorities such as urgent cases have been delayed.”
Patients do not want to see a return to perilous waiting times, and we will continue to be their advocates.
We are now coming through the necessary era of top-down targets, and are refining and improving how we measure performance. As my noble Friend Lord Darzi of Denham has made clear, quality must be the organising principle of the service. We have already proved by our actions our commitment to letting go from the centre. In 1999 we relinquished power to determine which new drugs and technologies the NHS should adopt, and put it in the hands of a new independent body, the National Institute for Health and Clinical Excellence. In the same year, we established the Healthcare Commission and the other commissions, making them responsible for setting standards, and inspecting and reporting on every hospital, mental health and social care provider in England—completely beyond the influence of politicians. Four years ago, we established NHS foundation trusts—independent of Whitehall, accountable to their members and making their own decisions on how best to serve their patients.
The NHS is in rude health: we no longer debate its survival, but its continuing success. On Monday, we will publish our next stage review. From the NHS plan in 2000 right up to now, there has been consistency: first the resources; then the mechanisms for reform; and now a fundamental concentration on improving quality. A national, enabling framework will be driven by the local priorities set out by thousands of clinicians, patients and members of the public; they drove the process that set the direction of the health service in every region of the country. It was developed locally because local clinicians, patients and managers are best acquainted with the specifics of improving patient care, and are best equipped with the knowledge and ideas necessary to shape the future of the service.
Unlike the situation in 1948, we are no longer in the age of infectious and acute disease, but in the age of chronic and lifestyle disease. The burden of modern and future health care systems will be to support an ageing population, to help those with long-term conditions to manage their care better, to promote health and well-being so that we can ward off disease, and to keep up with the astonishing advances in medicine and technology. Only through universal health care, free at the point of need, can we make sure that all citizens benefit from those advances. Whereas our national health service makes screening and vaccination programmes available to all, an insurance-based system could use what we discover about disease to increase premiums. Under such a system, the scientific knowledge that could liberate a patient from the threat of disease and early death would instead remove their right to treatment.
At the beginning of the 21st century, therefore, the value of the NHS is even more important than at any time in the past 60 years. Only because of the attention and care that the Labour party has shown the NHS—running beyond a mere expression of support, welcome though that is—can we address the challenge of today’s health requirements. Massive increases in investment put us in touching distance of European spending levels. There have been huge gains in staff numbers—80,000 more nurses and 38,000 more doctors. Every week another new building to host primary and social care services opens, and 125 new hospitals will be open by 2010.
For today’s NHS, the way ahead is through a greater emphasis on prevention, personalisation, individual choice and easier access to even safer services. It is right that we pay tribute to the NHS as we approach its 60th anniversary. Nobody would claim that it is perfect, but it is deeply cherished by the British public because of its enduring values, and because it epitomises the social solidarity that is as important today as it was 60 years ago. I commend the amendment to the House.
I am pleased to join in celebrating the 60th anniversary of the NHS. It is right to acknowledge and express appreciation for the massive contribution of the staff in the NHS, from those at the bottom of the organisation to the most specialist clinicians. The motion also rightly identifies the role of volunteers and charitable organisations, which often work in partnership with the NHS. They play a vital role, and are often staffed by people who have had a particular experience, or whose loved ones have, and who demonstrate a real commitment to the care provided.
It is also right to acknowledge and celebrate the extraordinary founding principle of the NHS—that everyone, irrespective of income, should have the same access to care, based on need, not on ability to pay. As the other two Members who have spoken have acknowledged, it was a Liberal, William Beveridge, who laid the foundation stones of the NHS. It is a pity that the Liberal Democrats have not yet had the opportunity to administer the national health service, but one day our turn will come.
We should never be complacent about the future of the NHS, its safety and security. It could be undermined by two factors: first, funding levels; and secondly, the way in which the money is spent.
Back in 1997, at the end of the Conservative Government, this country was spending a third less than the average European spend on health. The consequences were there for all to see. Hospitals were decaying, and not enough doctors, nurses or other health professionals were being trained or recruited. There were real weaknesses. At the end of the Conservative years in government, whether we look at cancer, heart disease or stroke care, the outcomes—the issue on which the Conservative spokesman focused—for people in this country were poor compared with those in other European Union countries.
Today, a difference has been made to funding. This country now spends about £100 billion a year, which is a dramatic increase in investment in the health service. We supported that all the way through. We called for it in 1997, and when it came we supported it in votes in this Parliament. Given that funding has increased, however, we must ask, first, whether we are getting enough out of the investment, and secondly, how the NHS will cope with the challenges of the future.
As has been said, the current spend is at about the European average. Yet, as the Conservative spokesman has said, our outcomes still lag behind Europe’s on heart disease, cancer, stroke care—
This country has gross inequalities in health outcomes. That issue has not been focused on particularly in this debate, but we ought to focus on it. Health inequalities in this country continue to be completely unacceptable, and indicators suggest that they are getting worse, not better. I fully recognise that the causes of those inequalities are often well beyond the remit of the national health service, but the NHS has a role to play. Part of that role is to ensure equal access to health care, which we simply do not have at the moment, and that should be addressed. In some areas of health care, particularly those which are not subject to targets, access is still poor. I want to focus on mental health.
Under the Freedom of Information Act, we did a survey asking mental health trusts across the country how long people have to wait for access to cognitive behavioural therapy. In some parts of the country, people have to wait more than two years; in many areas, the wait is more than one year. Given the view of clinicians that outcomes improve significantly as a result of early access to such treatment, it remains a scandal that people are having to wait so long for something that could make a real difference to them. One of the themes on which I want my party to continue to focus is the inequality between the treatment of patients suffering from mental health problems and the treatment of those suffering from physical health problems. That disparity cannot be justified, and must be remedied.
In recent years, when trusts throughout the country got into financial difficulties and trusts were forced to deal with their balances, it was public health budgets that suffered, although they can do so much to prevent health problems from developing in the first place. The experiment that has taken place over the past decade, involving top-down command and control and big government, has clearly been found wanting. It has failed in so many respects.
We see gross waste and inefficiency, and a dependency culture in which no innovation takes place at local level because the Government dictate everything to primary care trusts and hospitals. We see funding that always has strings attached, because the Government know best how the money should be spent. We see micro-management from Whitehall: the Government tell every hospital in the country to undertake a deep clean, at vast expense. The clinicians tell us that that is not the best way to tackle hospital-acquired infections; but the Government know best. Then there is the debacle of the Medical Training Application Service—[Interruption.] Does the hon. Member for Cleethorpes (Shona McIsaac) wish to intervene? It appears that she does not.
I was talking about the MTAS debacle. The Government sought to impose an entirely new system for the recruitment and selection of junior doctors throughout the country without piloting it first to establish whether it would work, leaving chaos in its wake. Similarly, we have an IT system that has been imposed from the centre.
The crux of the problem is that, as my hon. Friend says, we do not have an IT system. It was a system designed in Whitehall, a political imperative. No cost-benefit analysis was undertaken. There was no proper review to ensure that people who were building the system, the people who were paying for it and the people who were using it understood the same thing. Nothing like that happened; all that was undertaken was a massive commitment to spend over very many years. What do we see now? We see the whole scheme running years behind schedule, according to the National Audit Office, and we see the total cost massively above budget.
We see polyclinics—sorry, GP-led health centres—being imposed on every primary care trust in the country. The Secretary of State sought to defend that, but it is indefensible. It is not sensible to tell every primary care trust that it must have a GP-led health centre and that contracts must be concluded before the end of this year. Again, that is dictating to the health service because of political priorities and political imperatives rather than sound clinical judgment.
Does the hon. Gentleman not understand that without some form of direction from the centre, without someone trying to organise what should happen around the country for equity’s sake, the postcode lottery would come into the picture?
The remarkable answer to that is that we have a postcode lottery now. It is alive and kicking, and we have no accountability for it. Around the country, bureaucrats and people appointed centrally are making the decisions about access to health care. They are not accountable to the communities that they serve. We have the very problem to which the hon. Gentleman refers under our existing highly centralised system. The hon. Gentleman shakes his head, but we have it: it is there for everyone to see.
We have myriad bureaucratic targets, which are often contradictory and have unintended consequences. Unlike the Conservatives, I see a role for targets. Every well-run organisation has targets to improve its performance. In the private sector every good organisation has targets, and for the Conservatives to speak of getting rid of all targets seems utterly bizarre to me.
Despite that suggestion, I will not leave it out, because it is a central issue that needs to be addressed.
We see endless botched reorganisations, and with every reorganisation come more payoffs to senior executives. They drive clinicians crazy, and they certainly drive the public crazy. A recent example is the enormous payoff—£700,000—to a chief executive of a hospital trust in Leicester, aged 52, who now receives a pension of some £60,000 a year while also working as a consultant for the Healthcare Commission. That sort of waste of money drives people mad.
We are not the only people who say that the health service is ludicrously over-centralised. As she reached the end of her troubled tenure last year, the former Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), made a speech to the London School of Economics in which she described the NHS as
“four times the size of the Cuban economy and more centralised.”
That seems to me to describe it rather well, and I suspect that the right hon. Lady was in the best position to make the judgment, having tried to control the beast for so long.
This, then, is Labour’s NHS: loads of cash, the right instincts certainly, but dreadful waste and inefficiency and an absolute failure to let go. Interestingly, the Labour manifesto at the last general election made a bold claim—promise, indeed—to cut the number of staff in the Department of Health by a third, and to halve the number of quangos. Neither, of course, has happened. When we asked a question about the number of people working in the Department, the answer suggested that it was pretty much the same as the number three years ago.
How can we meet the challenges of the future better than the top-down, command-and-control approach that has proved so wasteful over the past 10 years? We face enormous cost pressures in a modern health service. New technologies are emerging, and new drugs are constantly being developed. There is a continuing debate about top-ups and about how on earth we are to fund new drugs which, in many cases, can provide good clinical benefits but may not meet the NICE criteria for public funding. We face all the challenges posed by lifestyle conditions such as obesity, alcohol consumption and smoking; and, critically, we have a massively ageing population.
I recently met a specialist in mental illness among the elderly in Liverpool. He showed me a graph showing the number of centenarians in our society over the next 50 years. It was frightening to observe the growth in the number of people who will reach the age of 100. At the same time, the ratio of people of working age to older people will change dramatically, so we are losing the work force that will provide the care for older people. Therefore, we face massive challenges. As well as all the extra cost pressures, we have to recognise that patients now expect something different. Nowadays, in all aspects of life, people behave as consumers—they want to make their own decisions and to have control over their lives. That is the case in health care as well, and the NHS must adapt to that. On top of all these matters, tackling the gross health inequalities that continue to afflict our country must be a priority in the years ahead.
What is the Conservatives’ solution? First, let me say that they are right to focus on outcomes. There can only be any point in all of this vast amount of public spending if we manage to make people stay healthier and live healthy, longer lives; that is the aim. However, that focus is only a partial solution, as willing the end does not always achieve delivery. We must always ask how we are going to achieve the improved outcomes that today’s Conservative paper rightly points to the value of trying to achieve. Its approach is to scrap all national targets—to have no access incentives at all, as far as I can see. Under its plans, there will be no entitlements for individual patients across the country, wherever they live, to ensure that they get access to the health care they need.
It is worth remembering the origins of targets. They emerged when the new Government came to power in 1997 because of the dreadful and unacceptable waste under the previous Conservative Government. The political debate in 1997 focused particularly on the fact that people were waiting so long for treatment. I remember when I was first elected to Parliament in 2001 taking up cases on behalf of constituents who were waiting three or four years for orthopaedic operations—for hip and knee-joint operations. It is worth remembering what it was like; it was dreadful.
Therefore, I believe that access is an important issue in its own right. While waiting for treatment, people often suffer from anxiety and trauma. If they are waiting for a hip or knee-joint operation, when it finally takes place the outcome might demonstrate that the operation has been performed well, but if they have waited two years to have the operation, they will probably have waited in severe pain and will also probably have had a carer who had to cope with them in that condition during that period.
The document we published today is expressly a follow-up to the autonomy and accountability paper that we published last year. It sets out to define the basis on which the Government agree with the NHS board—a more autonomous board—the structure of national objectives. That is not to say that the NHS board will not be responsible for issuing commissioning guidelines. It will be responsible for the contracting process between commissioners and providers. For services such as accident and emergency, there will be contractual conditions for the necessary quality. Patients’ referral to treatment times will still be measured, and patients will still be able to exercise choice, and that choice will drive continuous improvement. It is important to be aware that what we are talking about is the national relationship between Governments and the NHS.
That suggests to me that waiting time targets might re-emerge, either locally or through the independent board. [Interruption.] Well, if the Conservatives’ conclusion is that they will not have either national or local targets or entitlements, I think there is a severe flaw in their overall package.
We must never take access for granted. To focus on outcomes almost assumes that access is a given, but we can never assume that that is the case. Just as we have managed to improve waiting times, they can easily slip—and we must remember those areas such as mental health where waiting times are horrendous. To abandon targets, and to have no access incentives and no entitlements for patients, will have potentially disastrous consequences. I also think it will run the real risk of worsening health inequalities. Our approach focuses on entitlements for patients and recognises entitlements to access treatment. It recognises that many people, who might not be articulate and understand how to play the system, will need help in exercising their choice and in making the right informed judgment. That is why we think that a network of patient advocates can help people in making the right decisions about their own health care.
Let me now turn to what I think the priorities should be for the future of the health service, and to what the Liberal Democrats’ approach would be. Let me deal with the question of pruning back the role of the central state. I have made the case against the Government’s approach, which stands alone, if one makes international comparisons, in the extent to which it seeks to control the delivery of health care from Government offices in the centre. It seems to me that the Government should focus on key functions such as, first, the fair distribution of resources around the country, so as to ensure—without political interference, incidentally—that the resources get to where the need is greatest. Secondly, it is right nationally to focus on high professional standards within the NHS. Yes, the Conservatives are right to focus on setting a framework for the delivery of improved outcomes, but it is also right to focus on the right to access to health care wherever people live in the country, and irrespective of their means.
So yes, our approach is to recognise that access is important and to introduce the idea of an entitlement to access treatment within a defined period. The system in Denmark works well there. The idea is that people get access to condition-specific treatment within a defined period, and if they do not receive the treatment, it is paid for by the locally elected health board, if necessary in the private sector. Interestingly, it has not led in Denmark to a haemorrhaging of patients to the private sector; rather, it has been the biggest single driver of improved efficiencies within the state hospital system. [Interruption.] It is absolutely not the patient passport, and the hon. Member is either being disingenuous or not understanding. The patient passport was a subsidy for people who could afford to top up the rest of their care for private treatment in the private sector. This system pays for a person’s operation in its entirety. Crucially, in mental health, the person who has no resources to go to the private sector to circumvent the one-year wait for cognitive behavioural therapy would also be entitled to their treatment within that defined period, and if they did not get it, it would be paid for privately. That is giving real power to individuals, irrespective of their needs.
We also believe that we should be empowering local communities, democratising primary care trusts and imposing on all PCTs—locally elected health boards, as we would call them—a duty to ensure the efficient use of resources. The health think-tank Reform has talked about an economic constitution for the NHS. That is the right approach, ensuring that money is used most effectively. Compare that approach—empowering communities—with that of the Conservatives. At the moment, one person is democratically elected within the health service: the Secretary of State. The Conservatives would lose that one person and have an independent board that was not democratically accountable in any shape or form. Just imagine: when a local community faced the loss of their hospital, they would have no right to decide locally whether that hospital would close. Decisions would be made by unaccountable, unelected bodies nationally. At that stage, in my view, the wheels would come off.
The Secretary of State recognises that there is a democratic deficit within the health service but he appears unwilling to do anything about it. The Minister may well want to address that issue when he winds up the debate. We recognise that there must be democratic accountability within the health service. The Government recognise that there is a problem; what are they prepared to do about it?
Thirdly, we want to empower patients far more than they are at the moment. No longer can we accept the idea of care delivered from on high to grateful, passive recipients. People want to take charge of their care and they need, as the Conservative spokesman said, access to information so that they can make the right choices; but as I have said, they also need access to support in guiding them in making the right decision. We also support the idea of individual budgets being piloted in the NHS and of seeking to give people more control in coping with long-term chronic conditions and so on.
Our fourth principle is fairness, equity and addressing those health inequalities that scar our society. One of the issues that must be addressed is the fact that there is less access to primary care in poorer areas than in wealthier suburbs. The mechanism that the Government use is the central imposition of GP-led health centres, and they are also promising to bring more GP practices to impoverished areas, but surely the financial incentives to undertake primary care must also be addressed. At the moment, a GP receives more money if they practise in a wealthier area than they do if they practise in a poorer area. There should be financial incentives to encourage GPs to practise in those more challenging areas. We are developing the idea of a patient premium, whereby extra funding is attached to patients from deprived backgrounds to encourage GPs to provide support for those communities.
As the NHS reaches its 60th birthday, it is time for an injection of Liberal thinking, as there was at its very beginning. The NHS can adapt, evolve and prosper. I am passionate about giving power to those people who have no power in our system. That is as important a principle in health care as it is in any other walk of life. Communities, not Government, should be in the driving seat in shaping the delivery of local health services; patients should take control. Fast, efficient, high quality care should be guaranteed to patients, putting individuals before institutions. That is how we should build on the past successes of the NHS as we look ahead to the next 60 years.
I congratulate my right hon. Friend the Secretary of State for Health on setting out his case. I recognised more of a celebration of the national health service, which is supposed to be the theme of this debate, from the tone of his remarks than from those of the hon. Member for South Cambridgeshire (Mr. Lansley), who set out the case for the Conservatives—I heard more carping than celebration from him.
May I add to what my right hon. Friend said on the short history of the origins of the NHS? In the 1940s, not only did the Opposition vote against the principle of the national health service, but the Conservative Government, led by Winston Churchill, who took over from the splendid Attlee Government of the 1940s and 1950, were still so dischuffed with the NHS that they set up the Guillebaud committee in the early 1950s. The specific remit of that committee was to review NHS spending and the then Conservative Government hoped it would say that the NHS, as a publicly funded institution free at the point of use, was too expensive. In fact, the Tory Guillebaud committee said that the NHS was very good value for money, and so the Tories, at that stage, were stuck with the NHS. I submit that they have never properly digested that lesson.
Let me make one further point, although I always enjoy the hon. Gentleman’s interventions and I am looking forward to this one.
As I was saying, that is why, at the last election, the Tories were still toying with the idea of the patient passport, which would undermine the principle of NHS financing—that it is free at the point of use.
As the hon. Gentleman rambles down the roads of history and recalls a committee that recommended that the then Conservative Government continued to increase spending on the health service each year, to which they adhered, he has conveniently forgotten that three years earlier it was Hugh Gaitskell as Chancellor who introduced the charges for prescriptions and dental and eye care, which led to Wilson, Freeman and Bevan resigning from the then Labour Government.
My point was that the Conservatives may have set up a committee to get outsiders’ views on the way forward, but they then continued to increase the funding for the health service each year. The previous Labour Government may have set up the health service, but they brought in financial cuts that led to three Cabinet Ministers resigning.
The hon. Gentleman makes his point.
I now want to come up to date. I have some sympathy with the hon. Member for South Cambridgeshire —[Interruption.] Yes, I do. We both entered Parliament in 1997 and I have watched his career with interest. I hope that that is not too much of a bar to his future progress, if any. I have always thought that his personal position is sympathetic towards the NHS. His problem—and his party must address it—is that the instincts of his party and his leader do not align with his. The hon. Gentleman is forced to be a cheap and shallow salesman for the NHS. On closer examination, Conservative policy is smoke and mirrors. As we get closer to the election, in 18 or 24 months, we will want to return to that argument.
The hon. Gentleman is also a roadblock to reform. He and his party will not support the necessary reforms to take the NHS into the 21st century, and I shall give a couple of examples of that. The Conservative leader has promised to scrap extended hours for GP surgeries. That is not taking GP practices into the 21st century: it is going backwards. The hon. Gentleman well knows that most people’s experience of the NHS is through general practice and primary care. If his party scraps extended hours as it has promised to do, it will reduce people’s access to primary care. That is the charge that he must answer, and on which the House must decide today by voting for either the motion or the amendment.
A further roadblock to reform is that the Conservatives would scrap the guaranteed two-week treatment wait for those with suspected cancer. They would scrap the guarantee that all patients should be seen within 18 weeks, from their first visit to the GP to their operation. The Conservatives do not seem to like that target or that guarantee. Why not? When they come to power, if they ever do, they do not want to be put on the spot and to be expected to deliver an NHS run on such guidelines.
I hesitate to interrupt the hon. Gentleman, because he is making such a helpful speech from our point of view, but I must tell him that the 18-week target does not apply to cancer. Different targets apply specifically to waiting times for cancer. Perhaps the hon. Gentleman would care to visit Clatterbridge and discuss the matter with patients there? They will tell him that a target geared towards the time to first treatment that fails to take account of the time lapse before subsequent treatment or to consider the holistic outcomes is not a target that works in the best interests of patients.
The hon. Gentleman mentions Clatterbridge, which is one of my local hospitals. I shall come back to it because I want to talk in detail about some of the work it does, so I am grateful that he mentioned it.
I have mentioned salesmanship and smoke and mirrors, as well as the roadblock to reform. The right hon. Member for Witney (Mr. Cameron) has made empty promises on hospital closures, but the Liberal Democrat spokesperson, the hon. Member for North Norfolk (Norman Lamb), has already identified the problem: closures will be made without any political accountability, unlike at the moment. The Conservatives say that in effect there will be no local closures, but how on earth will the system be regulated when the service must modernise and new facilities, operation procedures and the like must be implemented—[Interruption.] The hon. Member for South Cambridgeshire is chuntering from a sedentary position, but he does not want to intervene.
The Conservatives would also put NHS finances at risk and, as I have said, finance has been a contention between the parties down the years. The right hon. Member for Witney is on record as saying that his party would allow hospitals to borrow against building and equipment, but that would put the financial stability of local hospitals at risk. Who would bail them out if they went wrong? Would they be allowed to close under the independent board? The Conservative party must explain to my constituents why such financial instability would exist.
I suspect that the reason why the Leader of the Opposition is considering the idea of local hospitals’ borrowing against their capital is that an element of central funding would be cut, so local hospitals would be required to consider raising their budgets. That policy would reduce central responsibility and create local responsibility, but run the risk of creating a postcode lottery and financial insecurity for local hospitals.
The final element of the roadblock to reform is that the Conservatives are against GP-led health centres. Again, if there was a 21st century, forward-looking Conservative programme, I cannot see why they would be against them. In my constituency, for example, there will be a GP-led health centre. It will not destabilise local GPs. That entirely new facility will be open from 8 am to 8 pm and will bring new doctors into the Wirral. My working constituents’ busy lives will be enhanced, as they will be able to choose between dropping in at the new centre when that is appropriate or convenient or going to see their own GP. That is a significant reform and improvement of the service in my constituency.
At the request of my colleague MPs on the Wirral, since 1997 I have had the lead responsibility for dealing with local NHS matters. For the past 11 years, I have been in constant touch with the PCT and all other health local providers in the area, and I should like to take this opportunity to review the improvements that have taken place.
The hon. Member for South Cambridgeshire said that the target-driven system left no room for innovation at a local level. That is utterly wrong, and completely outside my experience over the past 11 years. A few months ago, I visited the Wirral University Teaching Hospital NHS Foundation Trust. That is my local hospital, and I was shown an example of innovation—a new machine in the urology department that enables the consultant to look at prostate trouble using a laser, thus eradicating the need for invasive surgery or investigation. The procedure takes only about two hours, as opposed to the overnight stay that used to be required.
The machine is one of only two in the area, and I am pleased that my constituents have access to such an innovation. The urology consultant had read about it on the internet and then had a word with the hospital’s chief executive and board of governors, who decided to buy it. That is a perfect example of how local innovation can make a new service available, and I simply do not understand how a system of targets designed to raise national standards and provide equity across the country can be said to be inimical to local innovation. Targets and local innovation can—and do—work side by side across the country.
I am delighted that the hon. Member for South Cambridgeshire mentioned Clatterbridge, a specialist cancer trust and a world-class oncology centre that provides excellent and timely treatment for people in the north-west and the Isle of Man. A recent Healthcare Commission described it as “excellent”, and Clatterbridge is a trust going forward into the 21st century.
Again, the hon. Gentleman says, almost as a scaremongering tactic, that somehow the NHS is sclerotic in terms of its innovation. That trust has taken the courageous decision to spend £15 million to £30 million over the next five years on a linear accelerator across the water in Liverpool; that is a huge investment for a relatively small trust. It is doing that to save patients the trouble of having to come across the Mersey for treatment. That decision was taken at a local level—not through some strategic health authority or diktat from Whitehall. It will immeasurably improve patients’ experiences. The families who come from Liverpool and points north of it will not have to travel so far.
I was interested to note that the hon. Gentleman holds an important leadership position across the Wirral in respect of all the hospitals. No doubt he has had the same conversations as I have had with the people at Clatterbridge, who also serve my constituents. One of their biggest problems relates to tertiary referral. Owing to the Government’s target regime, oncology centres are penalised because so many of the targets for which they are forced to try to qualify are so far outside their control, at the tertiary end of the process, that they find themselves struggling with financial penalties that they could do without.
The hon. Gentleman has a point in that that was a problem historically. It is a perfectly serious point. When some of the targets were first introduced, they were clearly not designed for oncology trusts of that kind. They were designed more to relate to a district general hospital. There was some tension around that. I have investigated the matter on the centres’ behalf to some extent, and my understanding is that that tension is now more historic and that accommodation has been made for such trusts in respect of those targets.
I see that the Minister is nodding; I think that I have described the up-to-date position. However, I acknowledge that there was a serious point to be made a few years ago.
In a recent Healthcare Commission report, Cheshire and Wirral Partnership NHS Trust, the local mental health trust, was described as “excellent”; that trust is also innovating hugely in its outreach provision. Certainly the number of consultant psychiatrists that it has brought on board in the past five or six years has transformed its provision to my constituents and others in Cheshire and Merseyside.
The hon. Member for North Norfolk rightly pointed out that the NHS has not always got mental health services right. However, I can honestly say that Cheshire and Wirral Partnership is innovating and making good progress—
He does not.
I have mentioned my local district general hospital in passing. Two things happened to it. Under the old system, it was a three-star hospital. It became a foundation hospital and is going from strength to strength, I am delighted to say. I do not recognise the stifling of innovation at a local level that has been mentioned. The institution that I have mentioned used to be the second largest non-teaching hospital in the country. It is now a teaching hospital because it was able to innovate with local universities to provide a £7 million education centre on the hospital campus. That decision was made locally by the hospital with the aim of upskilling its staff, and I welcome that.
The final local organisation that I want to mention is the Wirral primary care trust. I am proud to be able to say, as I have said in the House on a previous occasion, that my local PCT has been recognised for its innovations in the Wirral, not least on public health. Towards the end of last year, it was voted the best primary care organisation in the country for 2007-08.
It may be that those excellent, innovative organisations on the Wirral peninsula are unique. Of course I am proud of my constituency and proud of the Wirral, but I do not believe that that is the case—they are exemplars of what is going on around the country. It would be a huge coincidence if I just happened to be the lead MP for health in the Wirral and we had uniquely good health services. I would like to think that, but it is not so.
I pay tribute to the staff in my local health service, which is the second largest employer in the Wirral. Some of the local practices have been innovative in working with part-time workers, ensuring that public transport is available, and advancing green issues by making imaginative use of the local Sainsbury’s car park. Such arrangements have enabled staff and patients to use the hospital in different, innovative ways.
I am proud that the local NHS in my constituency is in such good shape for the future. I commend the work of this Government and look forward to working with my hon. Friends as we take matters forward for another 60 years.
I begin by congratulating my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on tabling the motion and on the tone in which he introduced it. The key point that he wanted to draw out—I wholeheartedly agree with him—is that the political fact in 2008, as opposed to 1946, is that the national health service is built on a political consensus that includes every single Member of this House from every party.
A key element of the background to my hon. Friend’s initiative in introducing the debate is that it is a relatively unusual experience over the 60 years of the NHS for a Conservative spokesman to be able to point to opinion polls saying that the Conservative party is the most trusted party on health policy issues. I congratulate him on achieving that as our health spokesman; I certainly never achieved it when I held that post some years ago. The important point is not to luxuriate in the fact that we are more trusted than the Government on health care, but to draw a political conclusion about the fact that Labour spokesmen go round the country saying that because the Conservative party voted against the national health service in 1946, it is somehow not committed to the principles of the health service—despite the fact that we have been responsible for it over 35 of its 60 years of history and have never taken action that undermined the principles of the health service.
I say to my hon. Friend the Member for South Cambridgeshire that the more often he can create opportunities for that argument to be developed, the more it suits our purpose, because it demonstrates that the arguments used by our political opponents cut no ice with the voters. The voters regard us as the more trusted party because they accept that there is no point of difference on the matter in the House of Commons. There is an all-party consensus on the principles of the national health service, and the true debate in politics is not who is committed to it and who is not, but who can deliver. On the 60th anniversary of the NHS, we should focus on that argument.
The charge against the Government is the one I mentioned during a brief intervention on my hon. Friend. The Government have hugely increased the budget of the national health service over the past 11 years. I applaud them for that—it is the right thing to have done—but they have not brought about the improvements in the delivery of health outcomes and health care that we should have expected for that scale of resource increase. One or two of our more partisan supporters say that all that money has been spent, but that there has been no improvement. That is not true. Of course there has been an improvement in the delivery of health care in Britain over the past 11 years, just as there was during the previous 49 years. A year-by-year improvement in the delivery of health care is the consistent story of the NHS since 1948.
If we are to be reflective on the 60th anniversary of the health service, what should disappoint us is that over the past 11 years there has been a huge increase in resources, but no improvement of performance commensurate with that increase. The question is, why is that true? Ironically, some analysis of the reasons for that failure is implicitly shared by those on the Opposition Front Bench and those on the Government Front Bench. If we look at what happened to health policy during the past 11 years, we see that the truth is that, in some important respects, it has gone round in a huge circle.
The neatest way of encapsulating that is to refer to a speech I heard made in the summer of 2006 by Paul Corrigan, the health adviser to the former Prime Minister, Tony Blair. He explained that as a result of the insights of Mr. Blair, a new idea had been introduced into the health service—commissioning. By empowering commissioners, we would introduce conditionality about the use of resources, and we would ensure better value in terms of efficiencies and health outcomes for the money provided by the taxpayer. I am afraid that when I heard that speech, I could not resist observing that its sentiments were precisely the same as those in the comments made by Professor Sir Donald Acheson, who was the chief medical officer when I first became a Health Minister in 1990 and my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) was Secretary of State for Health.
The truth is that we introduced what we called purchasing and it has now been relabelled commissioning. We introduced trusts; the hon. Member for Wirral, West (Stephen Hesford) referred to the importance of local decision making and trusts and I entirely agree. We introduced what we called GP fundholding, and the Government introduced practice-based commissioning. A gigantic circle has been drawn and the health service’s institutional framework today bears a sharp resemblance to the one that we left in 1997. The regret is that it has taken so much money and such a long time—wasted time and money—to get back to the point that we had reached in 1997, not in resources, for which I give the Government credit, but in their use and the management of health service institutions.
Will the right hon. Gentleman comment on waiting lists? What was happening to waiting lists—for cancer, hip and heart operations—in 1997? People died on those waiting lists, as he knows.
I shall now inveigh against a slight conspiracy between Conservative and Labour Front Benchers. It suits both sides to say that the Government invented national targets for waiting times in 1997. That is untrue—they were invented by Virginia Bottomley before I became Secretary of State. Waiting times were reducing well before I became Secretary of State. They continued to decrease during my time in post and reduced further after 1997 as a result of national waiting time targets.
The point that my hon. Friend the Member for South Cambridgeshire makes about national targets, with which I wholeheartedly agree, is that they were introduced in the early 1990s to tackle precisely the problem to which the Under-Secretary referred. They were effective before 1997 and became more effective afterwards, but the commitment to national targets has now become obsessive, distorting the use of resources.
I accept that there is some cross-fertilisation of ideas about the future of the NHS. However, on commissioning, the right hon. Gentleman needs to explain how the choice in the manifesto on which he stood to allow patients to opt out of the NHS fits into the framework that he describes.
May we debate election manifestos for previous elections on another day?
I believe that targets are symptomatic of a deeper malaise, which has been the focus of some work that the Local Government Association initiated on a commission on which the hon. Member for Wyre Forest (Dr. Taylor) and I had the honour of serving. It examined the national-local balance in the NHS. I believe that the Government have got that wrong, and it is vital to tackle that as we look forward, beyond the 60th anniversary of the NHS.
The former Health Secretary described our current health system as being more centralised than Cuba. I used to say laughingly to my colleagues in the Division Lobby that I was the last manifestation on earth of Marxist-Leninist ideas. We were both saying the same thing in different ways: the culture of the NHS attributes too much authority and power to the centre and inadequate authority and influence to the local view. The result of that is the current debate on polyclinics. In some circumstances, they are a good idea. What is wrong is that Department insists that, because it is a good idea, everybody do it.
The Under-Secretary shakes her head but it is deeply imbued in the culture that, when a good idea is proposed, the immediate question follows, “Why can’t everybody have one?”
We need a stronger local influence in shaping the NHS around targets and polyclinics and dealing with one of the consequences of over-centralised health care provision: too much concentration on the issues that grab the headlines, acute medicine, and too little on community medicine, mental health—all the Cinderella services that always lose out when a high profile debate goes on in the national newspapers.
Of course there needs to be a national view in the national health service. When people observe differences in different parts of the country, they will ask why they exist and whether they should exist. However, I invite the House to recognise that one perverse consequence of an over-centralised culture is precisely those health inequalities in different parts of the country that the hon. Member for North Norfolk (Norman Lamb), the Liberal Democrats’ spokesman, referred to earlier.
We have an over-centralised culture that delivers, at the local level, an unacceptably wide variety of health outcomes. What my hon. Friend the Member for South Cambridgeshire is rightly seeking, and what we were arguing for through the Local Government Association commission, is to empower local people. If we do that, we will find, ironically, a greater similarity of outcomes, because by decentralising management we empower people to address the inadequacies of the health care delivery that they experience locally.
As we look forward to the next 60 years of the health service, I hope that we can move on from silly arguments about who is committed to it. Over 60 years, we have all been committed to it, and we all remain committed to it. However, if we are going to deliver the objectives that our constituents have for it, we have to move away from a model of over-centralised management that has failed in all its other manifestations on earth, empower local people, local management and professionals, and learn to let go. By letting go of over-centralised controls, we will deliver better health outcomes and, ironically, a more common experience of health outcomes in different parts of the country.
I join the Secretary of State in congratulating my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on calling this debate. I am delighted and privileged to be taking part in a debate celebrating 60 years of the national health service.
I have heard many history lessons this evening. I was not even born in 1946, when the legislation went through the House, or in 1948, when the health service was established. However, I know from experience, throughout my life as a user of the health service, that in principle it is second to none. The national health service is what this country wants, and it is what I passionately believe in. It is ludicrous—indeed, I find it quite baffling—to try to make complaints about an era in which we were not alive. If one worked on that argument, one could say that the Labour party still wanted to take us out of Europe, that it supported CND or that it did not believe in war, as George Lansbury, its pacifist leader in the 1930s, proclaimed. However, that is nonsense, because life has moved on, and so have circumstances.
As my right hon. Friend the Member for Charnwood (Mr. Dorrell) and other hon. Members said, it is right that we should all be united on the basic premises and principles of the national health service, even though we may argue and have differences of opinion about how it should be organised and how it should evolve to continue providing a first-class health service for the people of this country.
Why is the NHS so important? Why is this national institution so popular with the vast majority of people in this country, who are more than happy, as I am, to pay their tax pounds to have free health care at the point of use for all who are entitled to use it? One of the reasons is this. In the 1930s, Franklin Roosevelt talked of the four freedoms: freedom from fear, freedom from want, freedom of speech and freedom of worship. I believe that there is a fifth freedom. Some hon. Members have talked about the American experience. If we exclude those people who qualify for Medicaid and Medicare, because of their financial poverty or their age, there are more than 40 million people in the United States—working families—who cannot afford health insurance. They do not have the freedom from fear of the next health bill landing on the mat, which might financially destroy their family. They do not have the freedom from fear that illness might come into the family, either to a child or to a parent, which might financially cripple them. Since 1948, because of our national health service, everyone in this country has had the freedom from those fears.
I passionately believe in and support the national health service, whether it is under a Labour Government or a Conservative Government. Let those people who say that Conservatives are not committed to the health service look back over the past 60 years. They will see that Conservative Governments were in office for 35 of those 60 years, and nothing was done under those Governments to undermine the principles of the national health service or to seek to destroy it—[Interruption.] I resent people taking cheap opportunities to try to score party political points when there is no basis in fact for that argument.
I will not give way, because there is not much time.
We have differed in our approaches over the way in which we believe the health service should operate. There has been too much of a propensity—certainly under this Government, but also under Conservative Governments in the past—for politicians to interfere when they come into office, and to feel that they have to prove their stamina and machismo by making changes, sometimes, it seems, just for the sake of it. The national health service has had too many changes and reorganisations under successive Governments. It is suffering from a surfeit of change and from fatigue. It needs to be able to settle in with what it has, and to get on with the job that it is meant to be doing—providing first class health care for all.
That is the challenge to politicians of all political parties. The reorganisations and changes have inevitably led to money being wasted and, certainly over the past 11 years, in certain areas, to almost going full circle and coming back to square one, with upheaval and waste of resources in between. That, too, has to stop. We need a health system in which the medical practitioners, who are the best qualified to make the judgments, make those judgments for the furtherance of patient care, rather than one in which politicians dictate from Whitehall what they believe should be happening. To give the health service that freedom, within its existing principles, would be a tremendous step forward that would benefit patient care and the working of the health service, as well as saving money from waste that could then be reinvested in patient care, which is the most important thing.
We can all find problems in the health service in our constituencies, but this debate is not an appropriate time to express those criticisms. There are other opportunities to make those speeches in the House. Today, we are celebrating the health service. We must celebrate the tremendous people who work day and night to look after patients and to provide patient care: the nurses, the doctors, the consultants and the often-forgotten ancillary workers who are so crucial to the delivery of health care and the working of our hospitals. They are the unsung heroes of the national health service; they are the people at the front line of patient care and health care, who do so much that is too often unrecognised—not through ingratitude, but because they do their job so well that they become seamless in the whole provision of health care. To them, we owe our thanks and a debt of gratitude for all they do; we should not forget that.
We must also ensure that our local communities have the best facilities and the finest equipment that money can buy to provide health care within the budgets that Governments provide. As my right hon. Friend the Member for Charnwood said, it is no secret that this Government have substantially and significantly increased health spending over the last eight years. I, of course, welcome that. I have to say, however, that they have been in an extremely fortunate position because the strength of the economy over the last 15 years has enabled them to generate the revenue to invest in health care. That is a benefit for all of us. The sadness has been that not enough of it has gone to front-line services. That is why it is crucial that we have mechanisms in an ever-evolving health care system to ensure that we get the maximum amount of money that the state makes available to the health service to front-line services in order to continue to improve and advance the treatment of our patients.
I conclude—I know that others want to participate in the debate—by saying that we should stop the nonsense of Labour Members trying to accuse Conservative Members of not believing in the health service. Government Members may not like it, but we do believe in it. There is no monopoly of caring and belief in the health service on the Government side: we all share an affection, a loyalty and a devotion to the health service. What we all want to do is ensure that it works at its finest, providing the greatest health care. We may have differences, which we can argue about until the cows come home, but no one should question the motives or the honourable intentions of Conservative Members just because it suits the political agenda of Government Members at election time.
With some exceptions, I have been desperately disappointed with this debate, which instead of being a celebration of 60 years of the health service, has descended into party political bickering. I was hoping, as there was no time limit, to devote a little time to reminiscing. I have been in the health service more than 50 years—much longer than most other people here—so I can remember the days when we had precisely three antibiotics: streptomycin, penicillin and tetracycline. We did not have MRSA because there were so few antibiotics that the bugs could not get used to them. We had aspirin, morphine and digoxin. We had largactil and the barbiturates, but no antidepressants, no tranquillisers, no beta blockers, no ulcer healing drugs, no ACE inhibitors, no statins—and I could go on for a long time. The “British National Formulary” in those days was absolutely useless, because there were no drugs to put in it.
We did not know how to do endoscopy, ultrasound had not come in, computerised tomography scans had not been introduced, and magnetic resonance imaging was a long way off. Diagnoses were still made the proper way by taking a careful history, making a careful examination and carrying out a few investigations to prove what a doctor was already pretty sure of. We were still in the days of William Osler, who wrote:
“One finger in the throat and one in the rectum makes a good diagnostician”.
I do not think that he expected both fingers to be in those places at the same time, because one would have had to be something of a contortionist, but that phrase makes the point that clinical skills were necessary.
There is not much time to reminisce, but let us remember what used to happen with heart attacks. All we did when I qualified was to put the patient to bed and hope. Patients were kept in bed for four to six weeks, and if they did not get a pulmonary embolism, the doctor was really lucky.
I was working at the London chest hospital when external cardiac massage was discovered. We were staggered by its effectiveness; people were awake when we did it. I was involved with the very first pacemakers used. Since then, the first major cardiac care breakthrough came in the 1980s with the invention of the clot-busting drugs and the ACE—angiotensin converting enzyme—inhibitors, which transformed the treatment.
We have come a vast distance with the treatment of heart attacks, with the immediate reboring of the arteries when necessary. We know how to prevent heart attacks, at least by attacking smoking, diet and high blood pressure and by using the statins. Now, the “British National Formulary” is the most prized document that any doctor carries with him, because if doctors use it well they cannot really make any mistakes with prescribing.
Any celebration has to give credit to the staff, the doctors, the nurses, the secretaries and the volunteers in the charities. Above all, credit must go to the patients, who are so tough, stoical and co-operative with the staff. I worked with patients with rheumatoid arthritis for a long time; it is a most painful, disabling disease. Until very recently it was uncontrollable, yet those patients remained cheerful.
Looking briefly to the future, what are the challenges? They have been mentioned—vastly increasing longevity, the incidence of dementia, and vastly increasing costs—and resources are crucial. We must optimise the use of resources. Economies must be made. The Government are to be congratulated on the better care, better value indicators, which at least make a start on making appropriate use of so many resources.
We must eliminate the medical errors, along with the immense costs associated with them, and we must get prioritisation correct. I was not allowed to use the word “rationing” in a debate not long ago, but health care rationing is crucial, and it demands an open, honest and widespread debate. If there was more money available—not by getting more, but by making better use of what we have—perhaps the National Institute for Health and Clinical Excellence would allow us to afford more drugs. If NICE were able to assess new drugs much more quickly, we might not have the huge problems of co-payments, which have been raised so frequently recently.
Reorganisations have been mentioned many times. When the Health Committee undertook an inquiry on foundation trusts, we listed the reorganisations between 1982 and 2003. There were 18 in those 20 years, and the pace of reorganisation has continued. We face perhaps the biggest change and reorganisation of all with Lord Darzi’s review. The one comfort is that he has said clearly that no changes are to be made until the replacement service is up and running. I hope that that happens.
I am grateful that the Government have reaffirmed the principles of the NHS—that it is funded by general taxation and free at the point of delivery—and that those are immutable, but there is one vital bit of Bevan’s work that is missing. Bevan realised that we had to pay doctors and nurses the same across the country to get universality of providers and a real national health service. So a consultant working in London was paid the same as a consultant working out in the country. That achieved a real NHS. My sadness is that with the internal market and the purchaser-provider split, as well as the interests of shareholders in the large commercial organisations tendering for parts of the core NHS, there is a risk of seeing the NHS as we know it disappear.
I shall finish by talking about quality of care. I am delighted that the Secretary of State must have read the old proverb,
“A merry heart doeth good like a medicine”,
because he is persuading the nurses to smile. There is no doubt that cheerful, kind and sympathetic caring by doctors and others, and doctors and nurses who communicate with each other and with patients, will do away with most of the complaints that I receive. My problem is to know which to vote for: the motion or the amendment. Both have good points. If we have votes on both, I will have the greatest pleasure in voting for both.
It is a genuine pleasure to wind up this debate to mark the 60th anniversary of our national health service. The debate has allowed contributions from all parts of the House expressing both personal and national gratitude for the unparalleled institution that we call our national health service, and above all for its staff.
The NHS is the Conservative party’s No. 1 priority. We are not unique in that—it is the No. 1 priority of the people of this country. We have committed ourselves to it financially, and have laid out foundational policy to preserve and enhance its strength. We have the determination to trust front-line staff with decisions, and to set our NHS free from politically inspired micro-management. We have brought forward this motion to celebrate our NHS, and we are glad to use our Opposition time in that way.
As is the case with Members on both sides of the House, Conservative Members are unequivocal advocates for and supporters of the NHS. I am proud that my mother was an NHS nurse who started her training in the late 1940s, shortly after the founding of the NHS, and retired in the late 1980s. I am also married to a nurse; by that stage, the qualification was no longer as a state enrolled nurse, but as a registered general nurse. My family also uses the NHS, and I am glad that we have had excellent treatment and outcomes.
In this 60th anniversary year, I pay tribute to the hard-working front-line staff in the NHS, and the volunteers who, together with the many charitable organisations, support and care for patients, day in and day out. As my hon. Friend the Member for West Chelmsford (Mr. Burns) said in a powerful and impassioned speech—I am sure that the House will turn to it, and that his constituents will be proud—the Conservative party, among many others, has supported the principles of the NHS from its outset. There is a strong national consensus on the values of the NHS. The British people are rightly proud of it as an institution of whose values we can be proud internationally. We are rightly proud that everyone has access to high-quality care on the basis of need, regardless of their ability to pay.
We all have stories of the hard work of front-line professionals when both we and our families have been under the care of the NHS, and will have heard similar stories from our constituents. We also take up those times when the NHS, for all its great benefits and values that we are keen to celebrate, occasionally fails to meet its own standards.
The debate has been interesting and wide-ranging. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) set the tone in a way that accorded with how the House sees the NHS. He sought to ensure that we celebrated an NHS that is and should be, in many respects, above party politics. In a relatively short debate, he did not necessarily delve down into the policy and detail, but painted a clear, optimistic, enthusiastic vision for the future. It was heartening to note that the hon. Member for North Norfolk (Norman Lamb), whose opening remarks also celebrated the staff of the NHS, largely supported my hon. Friend. [Interruption.] Indeed he did. I am glad that we had the chance to put him right on the question of national targets, and that he can now enter that debate in the right spirit.
The Secretary of State, who has not been able to return to the Chamber, observed that he agreed with every single word of the Opposition motion. Indeed, all that the Government chose to do in their amendment was add to the motion. That set a tone that I think we all hoped could be sustained, but to everyone’s surprise it took the Secretary of State a further 15 minutes to deal with an historical obsession with 1948, and perhaps with 1946 as well.
If we are honest, all of us—Members throughout the House—will admit that when we talk to our constituents, it is clear that one thing that does not concern them is what took place in this Chamber in 1948. What does concern them is what will happen to their health service in years to come. That is why it is so important for us to demonstrate our ability to criticise what is happening, and to ensure that we are committed to the future.
Despite what struck me as unnecessary, somewhat inappropriate and disappointing partisanship on that score, one certainty emerged from all the speeches. It was articulated by the Secretary of State, and again by Conservative Members. What is clear is that there is no dispute but a total, not even qualified, consensus among Members throughout the House, on behalf of all the people of this nation, that we are committed to the operation and values of the NHS.
I was delighted that a former Secretary of State—my right hon. Friend the Member for Charnwood (Mr. Dorrell), who spoke with great authority and knowledge—was able to confirm the existence of that total consensus, and the adherence to those principles by all who represent the people of this country in the House. He rightly urged us to move on from what has, at times, been a sterile debate that has not resonated with what people think about the real issues, and to deal with the true debate on who is best placed to deliver what everyone wants to achieve: improving health outcomes in a way commensurate with the huge resources that the country is willing to commit to the NHS in which we all believe.
My right hon. Friend was also able to demonstrate that we have come full circle. He gave the example of the introduction by the current Government of commissioning, which had remarkable resonances with procedures and challenges that he and his immediate predecessor had experienced. There have been some wasted years, but we can move on. What my right hon. Friend urged the House to do, above all, was ensure that we retain our confidence in the NHS and learn to let go so that we—the politicians who are accountable in the House for the resources that are committed—can feel confident that the NHS, clinical and non-clinical, can deliver the outcomes that we want.
My hon. Friend has made an important point. This is not a question of party political partisanship; it is a question of the accountability involved in trying to make the resources committed commensurate with the results that we are all trying to achieve. That is to do with the operation of the NHS, and that is why—as my right hon. Friend the Member for Charnwood pointed out—it is right for us to have debates such as this in order to decide how best we can deliver the results that we all want.
The hon. Member for Wirral, West (Stephen Hesford) made a long speech that went round the houses and a number of parts of the Wirral. It left us wondering what debate he was contributing to, because it did not seem to relate to anything else that was going on. As for the all too short contribution by the hon. Member for Wyre Forest (Dr. Taylor), I think that while many us shared his disappointment that the debate had been diverted by some chippy approaches and contributions, we were grateful for the opportunity to hear his reminiscences, not least because he is probably the Member with the most experience of the NHS over a long period. He has committed himself to the health service throughout his life, and we salute him for that.
Staff, volunteers and charities support the increasing improvements in health outcomes that we all want to see in the NHS, and we should not lose sight of the importance of research and development, either. I pay tribute to the Secretary of State for emphasising that in his speech, as it is vital.
In today’s debate, not only has the need to move from a target-driven NHS to a health outcomes-driven NHS been spelt out, but so, too, has the means by which we can achieve that, which is what people want. I hope that the Government, who no doubt had their eyes and ears officially at the launch of our document today, are listening carefully, because our proposals—and this document—are there for them to pick up. We do not just have pride of authorship in the document; we hope that they will pick up on it, as it will lead to better health outcomes for our constituents and give a proper chance for the NHS to develop over the next 60 years in the way that we all wish, particularly as we celebrate its first 60 years.
In congratulating the NHS on its 60th anniversary, we thank, celebrate and encourage all the staff, past and present and clinical and non-clinical alike. They can be assured of our support on behalf of our constituents, and know that all of us draw inspiration from the very idea of the NHS. All we want is for it to reach the levels of improvement that we know it can achieve when the people in it are trusted to deliver the improved health outcomes we all want. I commend the motion to the House.
I, too, am exceptionally proud and very pleased to wind up in this debate on 60 years of the health service. First, let me say to the hon. Member for Eddisbury (Mr. O'Brien) on his history of family nursing, I think it is time I met Mrs. O’Brien.
This July, we celebrate the 60th anniversary of the NHS, which is not only a great institution but a great, unique and very British expression of the ideal that health care is not a privilege to be purchased, but a moral right secured for all. Opposition Members have made much about references to history. They might have a point if they were talking about 1946 and 1948, but I cannot see how history can start as recently as 2005—that is not long ago—when the Conservative election manifesto proposed patient passports, and not all Conservative Members agreed with the funding of the NHS in that way. Surely, 2005 cannot be described as history?
Much has been said in particular about the NHS founder, Aneurin Bevan, but also about Sir William Beveridge, who looked at the five giants. However, since I was first elected as a Member of this House in 1997 the main Opposition parties have voted against anything that would actually bring about the defeat of the five giants of want, disease, squalor, ignorance and idleness. That is not history; that is 1997, when the greatest inequality addressed in the House was to do with the minimum wage, and the Opposition parties voted against that.
I therefore feel that history is not, perhaps, what we should be discussing, but I can certainly give a lesson in “herstory”, because “herstory” worked in the NHS throughout most of the time that the Conservatives were in government. I visited the north-east today, and met staff who were born in 1948 and who are working in the NHS today. I particularly want to mention Irene Lerche, who is an appointment and records officer, and Agnes Donoghey, who works for domestic services. I also met up with an old friend: an ambulance driver who was in Chester.
Ten years ago, people questioned whether the British NHS could survive. It is a testimony to the extraordinary work done by nurses, doctors and all NHS staff—[Interruption.] I ask Opposition Members just to take a lesson from “herstory”; she only has a few minutes. In the 10 years since I have been in this House, the NHS is more firmly than ever part of the fabric of British national life.
Deaths from cancer and heart disease have fallen dramatically and Britain is one of the safest places in the world to give birth. The NHS is the largest employer in Europe. Its staff both past and present have helped to care for tens of millions of people and saved many hundreds of thousands of lives. We acknowledge that the NHS has come through difficult times, and it is a testimony to the hard work and dedication of its staff that it has turned a £547 million deficit in 2005-06 into a £515 million net surplus at 2006-07. All are to be congratulated.
Tonight, we also need to recognise the volunteers and charitable organisations that have made a huge contribution to the success of the NHS and to the health and well-being of patients. We would particularly like to thank charities not only for their contribution to patients’ and their families’ lives, but also for their support and ongoing partnership with the Government, which is so valuable in determining the best outcomes for patients. Be it our cancer strategy or our stroke strategy, all have contributed; everybody feels part of this NHS. Stakeholders are constantly consulted and their documents shared, and they are proud of the documents that they have produced. Not acknowledging the organisations that praise the national stroke strategy in particular does nothing for the Conservative party. The chief executive of the Stroke Association has highlighted that strategy, which I believe it is celebrating this week.
One million more operations a year are performed, and heart operations have more than doubled, so I am pleased to say that we do more than hope; we are really meeting our targets on heart disease, which should be welcomed by the Opposition parties. If this is a true debate on really acknowledging the changes that have taken place, we should have the acknowledgment that the targets have made a difference. The difference that they have made is that people are alive, and their quality of life is better. They are not in pain or worried about whether they will see the end of the year out, until the next waiting list figures are produced. They are alive and well and their quality of life has increased dramatically. That is thanks to the dedication and commitment of staff. A number of NHS trusts around the country have already delivered on the 18-week target—nine months early.
Next week, the NHS “next stage” review will build on the progress that it has made with a new vision for the NHS based on care that is fair, personalised, effective and safe. We commend our noble Friend and colleague Lord Darzi and his work. The major review that he has led will inevitably result in a significant improvement in patient-centred care. I am quite clear that the NHS must continue to change. To quote Sister Wendy Larmouth, the sister in charge, along with Professor Andrew Cant, of the northern regional bone marrow transplant unit,
“we no longer do ordinary, we now regularly do extraordinary”.
That is a truly remarkable team, and the unit is ranked No. 3 in Europe. We must continue to organise medical expertise so that the highest standards of care are available to all patients. If we can achieve all this—I hope Members throughout the House agree that this should be a shared objective—we will make the NHS safe for future generations.
At the last election, we fought battles on the NHS. We have constantly been reminded in the House of the history. “Are you thinking what we’re thinking?” was a slogan at the time. Well, the British people knew what to think. They re-elected a Labour Government to secure the NHS. I believe that the NHS is the best insurance system for the long term, and even more relevant to Britain today than it was in 1948. I commend our amendment to the House.
Question put, That the original words stand part of the Question:—
Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
Main Question, as amended, agreed to.
That this House celebrates 60 years of the NHS; recognises the support from all political parties for the NHS during that time; is grateful to NHS staff, past and present, who are the key to its success; commends their commitment and expertise in delivering patient care in often difficult circumstances; acknowledges the unique contribution of volunteers and charitable organisations; is committed to providing the NHS with the funding it needs to deliver European standards of healthcare to all; recognises an opportunity to make the NHS more patient-centred by focussing on outcomes; further recognises the defining contribution the NHS has made to the health and wellbeing of the nation since 1948; acknowledges that the principles upon which the NHS was established, funded by general taxation and free at the point of delivery, are immutable; accepts that target reductions in waiting times have significantly improved services to patients; and looks forward to the next 60 years of the NHS characterised by world-class quality healthcare as well as greater personalisation, individual choice and easier access to services.’.
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Delegated Legislation Committees),
That the draft Political Parties, Elections and Referendums Act 2000 (Northern Ireland Political Parties) Order 2008, which was laid before this House on 16th May, be approved.—[Mr. Khan.]
Question agreed to.
Speaker: If it is convenient for the House, I propose to put together motions 4, 5, 6 and 7.
Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Delegated Legislation Committees),
That the draft Ministerial and other Salaries Order 2008, which was laid before this House on 2nd June, be approved.
That the draft Armed Forces, Army, Air Force and Naval Discipline Acts (Continuation) Order 2008, which was laid before this House on 21st May, be approved.
That the draft Armed Forces (Service Complaints) (Consequential Amendments) Order 2008, which was laid before this House on 21st May, be approved.
That the draft Armed Forces (Alignment of Service Discipline Acts) Order 2008, which was laid before this House on 21st May, be approved.—[Mr. Khan.]
Question agreed to.
Motion made, and Question put forthwith, pursuant to Standing Order No. 119(9)(European Committees),
Diplomatic and Consular Protection of Union Citizens in Third Countries
That this House takes note of European Union Document No. 5947/08 and Addenda 1 and 2, European Commission Communication, Diplomatic and consular protection of union citizens in third countries; recalls that such Communications are not legally binding; underlines that the provision of consular assistance remains a matter for Member States; and in this context, welcomes the Commission’s Communication as a contribution to continuing reflections on promoting consular co-operation among EU Member States.—[Mr. Khan.]
Division deferred till Wednesday 25 June, pursuant to Standing Order No. 41A (Deferred divisions).