Orders of the Day — National Health Service

Part of the debate – in the House of Commons at 12:00 am on 2nd November 1978.

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Photo of Mr David Crouch Mr David Crouch , Canterbury 12:00 am, 2nd November 1978

Of course I shall read it very carefully. I am glad that my right hon. Friend did not start intervening in the Secretary of State's speech, because that might have delayed this debate and we want to get on. I have no doubt that my hon. Friend the Member for Reading. South (Dr. Vaughan) will be making some comments on those points at the end. But enough of that.

The Secretary of State took three subjects as his text—resources and priorities, organisation and, finally, industrial relations. We are grateful to him for having singled out the three major areas where problems exist in the NHS. There are other areas, but those are the three major ones. In the main, I should like to comment on two of them. I shall leave out industrial relations, because what I would say would not really help the situation at this stage.

It is revealing to learn that we are today spending £8,000 million a year on resources and priorities—more than we spend on defence. Such is the priority of health care in this country. In my view it is not a penny too much. But spending is not unlimited, as I said to the Secretary of State in an intervention. I was glad that the Prime Minister could hear that intervention, because spending is not unlimited. In April 1976, cash limits came into operation. I not only sit on a regional health authority, but I am also a member of the Public Accounts Committee. It is very revealing to sit on that Committee and see behind the scenes and discover exactly what happens.

Outside this House, I am a business man. Only this week I said to some industrialists "I have never seen in private business of the biggest kind the operation of such stringent control of expenditure as now exists in the operation of the cash limits". It is so stringent that I do not think it is realised by those down the line who have a delegated responsibility for spending that money. The Secretary of State knows what I am thinking about. I am thinking of people in some areas in the country who are reluctant to accept the figures given to them for their budgets for the year and who even turn to him and say "We shall not accept the figures". The Secretary of State is thus put in a very difficult spot. But he has no freedom, because it is the Treasury which has set those cash limits. If those cash limits are exceeded the matter will be reported to the Public Accounts Committee. Such is the way that we work our democracy today, and it is right that we should.

Even with £8,000 million a year not being a penny too much—it is strictly controlled to that amount—in my view it is still not enough. We lack resources for the provision of care for 54 million people in this country. Why? Perhaps because we use the most expensive part of the Service too readily. We use the hospitals too readily. They are the most expensive part, and, let us face it, people are living a lot longer than used to be the case. Although there are not all that many people between the ages of 75 and 85, that is where there is a major expense in the Health Service today, because such people need the expensive health care which only a hospital can provide.

The crisis in the Health Service—at £8,000 million a year—means that the Service is dragging its feet in the development of new techniques in medicine. Some of these techniques have been invented in this country. Some of our major teaching hospitals do not even have a brain scanner, which was invented by EMI. One can go to hospitals in America and find five scanners in one hospital. These have been exported from Britain, earning us foreign currency, but we cannot afford the privilege of having them in this country. We have had to close down neurological and neurosurgical units in this country because we can only afford to have them in certain places. It is expensive to have the modern techniques that can save lives and save suffering.

That is why the Service is in such a crisis. But it is not just a matter of money. Of the £8,000 million, about 70 per cent. goes in wages and salaries. That means that pay demands and pay awards will have an enormous effect on the provision of resources for the whole of the National Health Service. In short, the operation of a pay policy, however it is determined and structured, is crucial in the effect that it has on the resources available for health care.

I turn to the question of priorities. It is not for me to say where we should get the extra money. I can only say, as a Back Bencher, that I do not think we can spend any less.