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Mr. Quentin Davies (Grantham and Stamford): Will the hon. Gentleman give way?
Mr. Hesford: No, I want to make progress.
To the surprise of the then Tory Government, the committee said that funding out of general taxation was the best form of funding and that the health service gave very good value for money. Let us fast forward to 1997. What was the state of affairs on funding? The figures that we inherited show that in 1999-2000--[Interruption.] Conservative Members may laugh, but these are their figures, showing that there would have been a real cut in NHS funding if the Tories had returned to power.
The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) asked the right hon. Member for Maidstone and The Weald about funding the NHS with private money, and the hon. Member for Poole (Mr. Syms) seemed to say that it was Tory policy. If my analysis is at all correct, the divide between the Conservative and Labour parties is such that, if the Tories had won at the general election or were--inconceivably--to win at the next one, there would be only a safety net. The NHS would not be funded out of general taxation to be there at the point of need, without requiring payment. My constituents--they realised this at the general election--would be left with a safety net that dealt only with emergencies, geriatric care and mental health: the services that the private sector does not like.
Dr. Peter Brand (Isle of Wight):
We have been promised changes in the benefits system. I make a plea for a change in attitude in the benefits system delivery. As a GP, and now as a Member of Parliament, I have been amazed by the insensitivity shown by some of those who administer the system. The medical division of the Benefits Agency seems hellbent on giving people just one point less than they need to qualify on the all work test. The staff should realise not only the anxiety that is created for their clients--and my patients--but the danger into which they sometimes put them.
Over the past 18 months, I have seen three cases of that. One was a man who used to work as a builder's labourer, who had no other qualifications. He had had one heart attack and coronary grafting, and he still had unstable angina. A doctor from the medical department of the Benefits Agency found him fit for some sort of work. The agency withdrew that classification only when I asked it which doctor would represent it at a coroner's court should the man drop dead because of the advice given by the agency.
The same happened to a man who had worked as a gas fitter. He had an unstable neck, surgery had failed, and he was becoming paralysed from the waist down, but he was considered to be fit for work. That is clearly nonsense, and shows the insensitivity and the poor clinical skills of some of the doctors employed.
Most recently, last week, I saw the husband of a lady who suffered from Alzheimer's disease, who had just had an application for night-time attendance allowance
turned down. The lady became severely confused day and night, and she was taking a small dose of tranquilliser four times a day. The written report from the adjudication officer suggested that she could be adequately sedated at night so that she would not be a problem. That report was written by someone without medical or nursing qualifications, as far as I could see, and it is not their role to give advice that is dangerous as well as incorrect.
I am concerned that the trend in the medical division of the Benefits Agency seems to have worsened since it has been externalised. I urge the Government to review the decision to privatise that aspect of the agency's work. We have heard much today from Labour Members about the dangers of private medicine and privatisation, but I was surprised that the Government have continued the policy of externalising an important medical input into many people's lives.
I am not against private medical services, because they have a role to play. However, I am concerned that the development of an NHS with core services that excludes certain aspects of medical care may, overtly or more subtly, drive people to the currently unregulated private sector. Examples of such services include cosmetic surgery, counselling and psychotherapy, slimming clinics and infertility clinics. The best recent example is probably the treatment of erectile dysfunction--the great Viagra story--which is a wonderful illustration of the fact that the present regulations do not make sense if we want to deliver the best treatment for patients in the NHS.
The Secretary of State for Health has issued an edict, not backed by any regulation, that Viagra shall not be available on the NHS. The people who execute his edicts have taken it a stage further. For example, my local director of public health wrote me a letter saying that, if I prescribed Viagra on the NHS, he would take every step possible to recover the cost of the prescription from me personally. No regulations exist that allow him to do that. He could take me to a tribunal only for irresponsible prescribing, but Viagra is a licensed drug with a proper purpose.
We are dealing with a bit of bullying and bluffing, but that story illustrates an important point. Technically, I cannot prescribe Viagra, which is a useful drug, on a private prescription for my patients. The official advice is that I should see the patients, and then send them to see someone else to get the prescription. That is not in the interests of the patients or of efficiency.
It is hard enough for patients to come and explain that they have a problem, and they want to sort it out with a doctor they know. If we drive them into the private sector, we will cause problems. We have seen how awful some of the clinical outcomes of cosmetic surgery are, and we have seen the irresponsible behaviour by many slimming clinics. We must consider the regulations, and, even if the NHS is not prepared to pay for certain treatments, ensure that those treatments are still available through the NHS, so that patients are supported while their treatment is carried out.
It is not a problem to suggest that some treatments, such as life-style drugs, should be paid for. People are prepared to pay for such treatment, as the clinic at Euston
station shows. One can get Viagra from the Euston clinic if one is prepared to pay £120 for a consultation and a few pills.
Mr. Coaker:
It is more than that.
Dr. Brand:
I hear it is more expensive. People used to go to King's Cross to get advice on erectile dysfunction from the shops round there, but they now go to Euston station. The present regulations do not make sense, and I hope that the forthcoming legislation will address the issue of what may be prescribed through the NHS, even if the NHS does not pay for it.
Mr. Vernon Coaker (Gedling):
It is a good job that we do not always take everything that happens in the House personally. I saw the Whip talking to you, Mr. Deputy Speaker, and I thought that I would be told that I was no longer needed.
The Gracious Speech contained much to be commended on health and welfare. Although we all recognise that the primary care group proposals present certain problems, they are radical because they will bring together doctors and nurses with health visitors, community workers and housing workers to tackle health inequality. That will be complemented by the setting up of health action zones.
The hon. Member for West Chelmsford (Mr. Burns) made some good points about mental health. He is not in his place at present, and I should be grateful if his hon. Friends could pass on my remarks to him. Families find it difficult to seek help, but the individuals who suffer from mental health problems often wish to hide the fact. The more all of us--this is not a party political issue--can talk about some of the difficulties that mental health problems cause many people, the better. All ages, from young people--as I know from my teaching experience--to old people, can suddenly develop a mental illness. It is a huge problem. Everyone will agree with the points that have been made about mental health.
I will focus on welfare reform, which is a huge issue. I was pleased to see the Chairman of the Select Committee on Social Security here, as I very much enjoyed my first meeting yesterday. It was a purposeful meeting, at which we tried to build a consensus, which is often more helpful than the inevitable ping-pong--in which, no doubt, I shall myself engage later. I commend the Government for grasping the nettle of welfare reform. Ask anyone whether the welfare state works. Few people, if any, would answer that it does. Most accept that reform is needed.
The problem, of course, is identifying what reform we need, and how to go about it. That is difficult. The welfare state was set up 50 years ago, and longer ago in some parts of the system. During that time, there have been huge changes. People live longer now. The retirement ages are 60 and 65, and people often stop work before that. Working patterns have changed, and people move in and out of work. More women work. Many people care at home for long periods, and they are unable to contribute towards benefits. The welfare state is important to us all, but it needs fundamental change.
The welfare state was not initially set up as anything more than a safety net. Now, however, some people live off the welfare state. That has become a life style. I do
not believe that that sort of dependency was what the architects of the welfare state wanted, or thought desirable. Without engaging in fundamental change, we may damage some of the central planks of society.
Change, of course, is difficult. Modernisation is difficult. The Government are often accused, even by people who support me in my constituency, of not modernising with principle, but I think that they have very clear principles. They are grappling with difficult issues in trying to modernise according to those principles. That is not easy.
I do not believe that the Secretary of State sets out to make people poorer. I do not believe that he sets out to make life worse for disabled people, or that he sets out to attack the sick. However, when we listen to some of the debate on welfare reform, those accusations seem to be made. In my view, people who want no change, and who have a vested interest in keeping things as they are, attack my right hon. Friend and those who try to change the system in order to undermine the real changes that are needed.
The Gracious Speech offered a beginning. It did not cover everything. I accept that, and the hon. Member for Chingford and Woodford Green (Mr. Duncan Smith) may well say in a moment that some matters were missed out. However, the Queen's Speech contained a large number of measures, others have already been enacted, and more are on their way. The important thing is that the Government are determined to reform the welfare state in a principled way.
We must ensure that those who need help receive it, but we must also face the fact that, without fundamental change, the people who are poor now will be poor in 20 or 30 years' time. One of the most depressing things at my surgeries--this must be so for all of us, of whatever party--is that I see people who are desperately poor, and I know that their children will be in exactly the same situation in 20 years' time. That is immensely frustrating and emotionally sad, for want of a better way of putting it. If we continue to defend the welfare state as it is, we condemn those people to that future. In reality, the welfare state fails them.
We must have a more mature debate on many of these issues. Otherwise, we are arguing about defending the poor, the sick and the disabled, but using them as party political pawns, and doing nothing to help them. My right hon. Friend the Secretary of State and the Government have started to grasp some of those very real nettles, in the face of determined opposition even from some Labour Back Benchers. That nettle has to be grasped.
A number of other measures mentioned in the Gracious Speech are important, and should command widespread support. The establishment of a disability rights commission is long overdue, and I think that everyone will welcome it. We look forward to finding out exactly how it will work, and the way in which the idea will be developed.
The shake-up of disability benefits is also important. We have enacted legislation to ensure that people with disability must be included. We must try to encourage them and consider what they can do. The fact that someone is in a wheelchair or has a disability doesnot mean that he or she cannot contribute. Indeed,
their contributions are often fantastic. I am sure that many people with disabilities could floor me when it comes to using information technology and such like.
Surely we should be asking how we can use their talents and abilities, and bring them into work, so that we can create a better society. It is a shame that, when we talk about such matters, the debate often degenerates into an argument about whether the Government are trying to force people who are terminally ill or can do hardly anything to go out to work, as if that were the real aim of the reform, when it is nothing of the kind.
The single gateway--the idea of compulsory interviews for benefit--is another important reform. For too long, people have got benefits passively. If they have fitted set criteria, they have received benefit. The gateway is a means of making the system more proactive. It will be concerned with the totality of someone's needs, whether those are child care or training, as well as with benefit. That is a positive way forward.
The measures to try to make work more rewarding and to show that going to work can be attractive, both for the individual and for the pay packet, are important. The working families and disabled persons tax credits, as well as the child care tax credits that go with them, are important ways to move the debate forward and they will help more people.
8.56 pm
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