Orders of the Day — National Health Service

Part of the debate – in the House of Commons at 12:00 am on 20th April 1978.

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Photo of Mr Timothy Raison Mr Timothy Raison , Aylesbury 12:00 am, 20th April 1978

This debate has largely hinged upon resources. I shall not try to elaborate on that matter, important though it is, except to say that one of the great problems of resources in medicine that we face—and I imagine that in a sense this is what a number of my hon. Friends have been saying—is that, whereas there is an understandable inclination on the part of the Government to pour additional resources into the deprived areas—the inner cities, and so on—it is, nevertheless, a fact that in the areas of growing population in this country there are inevitably very great problems.

The Minister of State knows a certain amount about the problems in my constituency of Aylesbury. We have exactly that problem. We have the new town of Milton Keynes in North Buckinghamshire, and we have Aylesbury, which is still growing pretty rapidly. Inescapably, we have a very difficult situation. Frankly, there is a sense of disbelief when Ministers claim that we are still raising standards overall in the Health Service when we see in our own hospitals the harsh necessity of cutting back on beds and, indeed, of scrapping hospitals.

I do not blame the Government for being concerned about the inner cities and the older areas, but I hope that they will never forget that they have a basic duty to provide a sufficiency of beds for everyone and that a poor person, a mentally handicapped person, a disabled person or a person with any kind of sickness is just as much entitled to service if he lives in Buckinghamshire as he is if he lives in the North-East or some other area of that kind.

Secondly, the Government must accept that under the present Administration morale in the Health Service has sunk to a level that has never previously existed. They cannot duck that. Under the present Secretary of State and under his disastrous predecessor we have had an appalling loss of morale. Of course, some of that is to do with factors beyond the Government's control. It is to do with the change in the economic situation which followed the oil crisis in 1973, so there would always have been problems.

But the Government have unquestionably aggravated those problems. They have aggravated them by the war against pay beds. I declare an interest as a director of Private Patients Plan. The Government are doing the very damaging thing of creating two quite separate health services in this country. It is they who are creating separate health services as a result of their policy, and that is damaging.

The feeble line that the Government took over the early signs of industrial action in the hospitals about three years ago has led to a lot of trouble since then. I acknowledge that industrial relations in the hospital service are difficult and that there has been very little experience of dealing with industrial relations in the hospitals over preceding decades. In a sense, I think that the hospitals have been taken unawares by this new phenomenon and have not known how to respond. However, I believe that, because of their irresolution three years ago, the Government must accept some of the blame for what has been going on.

I want to touch lastly on the difficult question of the administrative structure. The 1944 White Paper on the creation of a National Health Service said: There is a certain danger in making personal health the subject of a national service at all. It is the danger of over-organisation, of letting a machine designed to ensure a better service itself stifle the chances of getting on. Although it went on nevertheless to advocate a national service, that warning has had echoes in succeeding years.

The Royal Commission is looking at structure, and I hope that no one will form a final view. I hope, in particular, that my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), who opened this debate so ably, has not come to a final view.

It is still an open question whether it is realistic to switch to a much more insurance-based Service. I should want to see that much more fully argued before we took a strong line. There is a place for insurance in the Service—I have an interest in it, as I said—but I am not yet persuaded that a basically insurance-based Service would be the right approach.

I also think—I know that here I am in very much of a minority—that the right organisation is not a three-tier or even a two-tier system but a one-tier system. I should like to see the area retained and the region and the district in due course disappear. My fundamental reason is that at the end of the day—I know that it is a long way off—health and local government should merge. The only effective basis for that is the area-county basis or, in the case of metropolitan areas, the metropolitan districts. I therefore hope that, in any kind of new reorganisation, we do not lose the area and thereby lose the chance of what I believe to be ultimately the right solution to this whole problem.

In the interests of better administration and saving money, I suspect that we should abolish the community health councils, but I think that we should give them a little longer before taking such a drastic step.

To cast a final bombshell, I think that there is a very good case for splitting up the DHSS once again. The business of running health and the local authority personal social services, on the one hand, and the enormous social security element in Government today, on the other, is too much. There are two Cabinet Ministers in the Department, but that is not the right way to tackle the problem. I seriously question whether this leviathan can do as good a job as two separate Departments.