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7.11 pm
Mr. Robert Syms (Poole): This debate excites many passions, particularly when discussing health, for the simple reason that most of our constituents care deeply about these subjects. They value the national health service and the people who work in it. It is fair to say that, apart from a few cases, the vast majority of people receive good treatment from conscientious staff who work extremely hard. This year, as we celebrate the 50th anniversary of the national health service, it is worth reflecting on the prosperity of the nation, the national diet and the contribution of the NHS. Its founders would be surprised by how healthy, robust and successful we are as a nation.
As a Conservative, I am perfectly prepared to give credit to the Attlee Government for founding the NHS, if the Labour party is equally prepared to acknowledge that Conservative Governments have administered and nurtured it for 35 of its 50 years--or nearly 70 per cent. of its history. If all the dire headlines and the jibes thrown across the Chamber during the last Government and previous Governments had been true, we would not now be valuing what many hon. Members on both sides of the House have called the "jewel in the crown".
My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) made a very good point: total health spending is vital. The Government started off badly by abolishing tax relief for over-60s private health insurance--a measure which encouraged people to put a little more of their own money into their health care. There is a real problem with public expectations that cannot be addressed through the Exchequer. If we can use the tax system to encourage people to invest a little more of their own money in their health care--and there is every evidence that they will do that--we will be able to provide a better service for all.
I do not intend to go into the details of the Government's proposals, because I have a feeling that I may spend many hours doing so later this Session. However, I must mention GP fundholding. That system has been in place for seven years, and nearly 60 per cent. of patients are covered by some 15,000 fundholders. GP fundholding has proved a success, because, by and large, decisions are taken nearer to the patients. It has empowered many GPs. I accept that there were no GP fundholders in many areas, but I believe that the solution was encouraging more GPs into fundholding rather than abolishing the system.
GP fundholding was voluntary, and, as many of my hon. Friends have pointed out, the system of primary care groups is coercive because people have no choice: it is a form of conscription. For that reason, the Government's proposals contain deficiencies--many of which we will undoubtedly test later this Session. One of the key differences is size. The Government propose increasing the size of groups to hundreds of thousands of people, or to 30,000 or 35,000 in rural areas. Frankly, that structure is too large.
Grouping together 50 or 100 doctors will cause difficulties. It is often hard to encourage doctors to work together--although they are very worthy people. I questioned a Yorkshire GP about this matter when the Select Committee on Health considered it, and he said that the regional groups would subdivide. That is perhaps an acknowledgement that, in rural areas, the Government are trying to create an edifice that is far too big.
I turn now to issues involving the national institute for clinical excellence. We are moving towards evidence- based medicine, which is good. However, doctors sometimes prescribe treatments that are not fully tested; some trial and error is involved. I think that we will get into difficulty if the institute provides guidance that doctors do not wish to take in the interests of their patients. Doctors may be put under professional or financial pressure to follow those guidelines. There must be a balance in this area between sensible guidance and audit, and sensible conduct on the part of medical professionals.
Earlier in the debate, we discussed moving away from self-regulation to more intervention by Government. The British Medical Association is aware of terrible abuses within the medical profession. Mention has been made of the fact that it is difficult to get rid of bad doctors and consultants, because their colleagues in the profession are not always prepared to stand up and be counted.
I served on a regional health authority some years ago that forced a particular consultant to take early retirement. Although other doctors refused to work with him, they would not put anything in writing, because he was
a colleague. Actions such as forced early retirement benefit the patients, but cost the national health service a lot of money. It is a question of balance. I shall be interested to examine the Government's proposals in detail when they introduce a Bill.
Mention has been made of reclaiming sums from insurance for accident victims. Like many other hon. Members, I have constituents who have suffered accidents and, as a consequence, cannot work. That often leads to financial problems, such as falling behind with the mortgage. That is not always the best time to try to get money from people, unless it can be done efficiently and cost-effectively. If a new agency is to be established to try to get money from insurance companies via patients, it must do so efficiently and effectively. We must test its success pound for pound.
In their publication "Our Healthier Nation", the Government stated that stroke and heart disease would be one of their four main priorities. However, the Stroke Association was a little exercised when the "national priorities for health" guidance, which was sent to chief executives of health authorities, failed to mention it. The Stroke Association viewed that as either simply an omission or a change in the Government's priorities.
The association is concerned because stroke is the third largest killer in this country, and the main cause of severe disability. Some £2.3 billion of resources from the health and social services budget is devoted to addressing that problem. It is not an exciting side of medicine--there is no fancy machinery--but the Stroke Association does valuable work improving people's thought processes and encouraging them to talk again and holding group sessions for stroke victims two or three times a week. That provides some respite for partners and carers who bear the brunt of caring for stroke victims.
Lord Skelmersdale issued a press release a few weeks ago to the effect that he would seek a meeting with the Secretary of State in order to gain a reassurance that strokes remain a high priority within the NHS. I hope that the message has got through to Richmond house, and that that assurance will be provided. My constituency on the beautiful south coast is rather more elderly than some, and, although there are young stroke victims these days, the elderly are particularly vulnerable to strokes.
Because it is reliant on blood products, the haemophiliac community gets really scythed down whenever anything goes wrong with them. In the last Parliament, the Government took the correct decision to compensate haemophiliacs with HIV.
As the Minister of State no doubt knows, there has been a campaign for compensation for the many haemophiliacs who contracted hepatitis C through NHS blood products. It is a great pity that, despite the campaign, the Secretary of State provided a written answer in July, only two days before the beginning of the summer recess, to say that the Government were not persuaded of the argument for compensating people with hepatitis C. Some of them will die, and they are concerned about looking after their families. They are finding life difficult. That issue needs to be reconsidered.
There has recently been a statement about Creutzfeldt- Jakob disease. If that is causing problems with blood products, it will affect haemophiliacs more than any other group, and they will experience problems first. I welcome the Government's decision to spend £30 million on blood
products, of which I know there is a shortage. That is a belt-and-braces approach, but we cannot take any risks with blood products, particularly for communities such as haemophiliacs.
Helen Jones (Warrington, North):
I shall address my remarks to the decisions on the health service and the announcements about that in the Gracious Speech.
I am conscious that I and others of my generation are children of the NHS; I was born into the NHS and I have never known anything else. We are therefore probably the most fortunate generation in this country's history. We have never had to fear the consequences of illness or worry about how to pay the doctor, as our mothers and grandmothers did. We have been able to benefit from huge advances in medicine and surgery without worrying about the size of our pay packets. It is precisely because my generation has benefited so much from the health service that we have a duty to protect and extend it so that others might benefit in their turn. That is our aim in this Session. We are working for nothing less than the modernisation and improvement of the health service to make it, once again, the envy of the world, because for the people whom we represent, nothing less is good enough.
The previous Government paid lip service to that duty but did not carry it out. We all remember them saying that the NHS was safe in their hands. I am sure that General Custer said the same to the 7th Cavalry. He probably said, "Stick with me boys and you'll be all right." Far from safeguarding the NHS, the Conservatives set about damaging it. They introduced a two-tier health service in which doctors and nurses were competing against one another not for patients' benefit but to satisfy their accountants. When the Conservatives left office, inequalities in health had grown so much that people in social class V had a mortality rate three times as high as those in social class I. So much for one-nation Conservatism.
The Conservative party's response--which we heard again today--was not to consider how those problems could be tackled, but to encourage more and more people to use private medicine and to subsidise that through the tax system. This afternoon, Conservative Members have talked not about providing good public services, but about how they could provide a route out of such services for those who could afford it.
The right hon. Member for Maidstone and The Weald (Miss Widdecombe) would no doubt tell us that such measures provide freedom of choice. They do, but what freedom is there for people in Bewsey in my constituency, which is the most deprived ward in north Cheshire, who, however hard they worked and saved, would never in a million years be able to afford private medicine? What choice is there for people who require geriatric nursing, long-term mental health care or other services that the private sector hardly touches? Those people rely, and always will, on good public services. We are determined that we will meet their needs and tackle the health inequalities that so disfigure this country.
In common with some of my hon. Friends, I still have on my bookshelf a samizdat copy of the Black report. The then Prime Minister, now Baroness Thatcher, did not like its conclusions, so she sought to suppress it, but health inequalities do not go away if we ignore them. They have got worse, as the Acheson report has revealed today. We are tackling those inequalities. We have appointed the first Minister for Public Health and changed the direction of the NHS so that it will not only treat illness but promote good health.
The north-west needs that change of direction more than most regions. Its mortality figures are the worst of any regional office area and they are much higher than those for England and Wales as a whole. In 1995, the last year for which I have complete figures, two thirds of all deaths were from circulatory problems and cancers, many of which were preventable. Those are not only figures on a balance sheet; they represent people suffering pain. It is the duty of Governments to tackle that.
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