National Health Service

Part of Opposition Day – in the House of Commons at 3:43 pm on 19th January 1988.

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Photo of Robin Cook Robin Cook , Livingston 3:43 pm, 19th January 1988

If the hon. Gentleman wishes to talk about dogma, let us consider dogma. Let us look at the instruction from the Minister of State to the West Midlands regional health authority that it can have £250,000 to buy private operations in private hospitals, but only to buy private operations and not to spend in its own hospitals. It is a sort of Health Service parallel to the assisted places scheme. On inquiring of BUPA, the health authority discovered that a hip replacement operation in a private hospital would cost £700 more than in its own hospitals and that a hysterectomy would cost £400 more.

Meanwhile, in Wolverhampton the regional health authority has so starved the district that it has closed the operating theatre for the orthopaedic ward. All hip replacements in Wolverhampton have ceased. To save what? To save a sum that is actually less than the amount that the Minister of State offered to the west midlands, earmarked for the purchase of orthopaedic operations in the private sector.

If the hon. Gentleman wants a little dogma, I can think of no clearer and finer illustration than paying over the odds to subsidise the private sector while forcing the closure of identical facilities in the NHS. That has nothing to do with cost-effectiveness but it has everything to do with political dogma.

That brings us to the heart of the debate between ourselves and those on the Government Benches. In truth, this is not a debate about public spending priorities; it is a debate about political values. The reason the NHS is under siege is that the Government's vision of a private enterprise society cannot tolerate the contradiction of a public health system that is more efficient and more comprehensive than its private sector competitor.

Those who sit on this side of the Chamber have the advantage of being able to see the Prime Minister's face, so we notice a revealing feature that may be lost on those who sit behind her. Whenever the Prime Minister recites the extra spending on the NHS under her Government, she does not do it with pride, satisfaction or relish; she does it with self-evident resentment. In her eyes, the NHS commits two fatal offences. The first is that everyone is equal, regardless of ability to pay. The second is even worse than the first: the service is actually popular because of that.

I do not know whether the right hon. Member for Brent, North (Sir R. Boyson) is with us today. The right hon. Gentleman has participated in exchanges on this subject outside the House. I particularly relished his speech on the fringe of the Conservative party conference last autumn, when he advocated an insurance system, with the Church of England catering for those who could not afford insurance. That does not seem an adequate solution for those who live in Scotland.

The right hon. Gentleman expressed the difference between our parties very well, I thought. He is on record as saying: The problem with the National Health Service is that there is no link between what people pay and what they receive, and no way of influencing what they receive by what they are prepared to pay. The right hon. Gentleman sees that as a problem. We see it as a strength of the NHS. Having glimpsed that gulf of political values between us, I think we can understand why the NHS is in financial crisis and why it will be kept in financial crisis. What we see as a crisis of the NHS some Conservative Members see as an opportunity to claim that the NHS cannot deliver and as an excuse to dismantle a service that they never liked. How else can we explain the persistent refusal to give it more funds, when we all know that the Chancellor's wallets are as ample as his presence?

That brings me to the third reason why it is important that the House debate the matter again. It is more than ever transparent that the Government can afford to fund the NHS. I note that The Times today quotes a Whitehall source as saying that the Secretary of State's argument will be If you haven't got it, you cannot spend it. Possibly the Whitehall source, who may be with us, would stand up and disclose himself so that we may see who is responsible for that wonderful observation.

The fact is that, in terms of financial resources, the Government have got the necessary funds. The Chancellor would need a JCB to cart the current Treasury surplus around Whitehall. Only today the Treasury, with impeccable timing, released the public sector borrowing requirement figures, which show that the PSBR is now a minus figure; that is Treasury language for being in surplus. There is a surplus of £400 million rather than a planned deficit of £4,000 million. Greenwell Montagu estimates that next year the surplus could be £11,000 million.

Perhaps I may dampen the enthusiasm of hon. Members on the Government Benches. Greenwell Montagu might not be spot on. Suppose it is wildly wrong. Suppose it is only half right. Suppose the surplus is only £5,000 million. That would still be enough to cut tax by the 2p beloved by the Chancellor and to give £2,000 million more to hospitals.

We saw on "Weekend World" that the Harris poll discovered that 68 per cent. of Conservative Back Benchers would rather see tax cuts than increased spending on the NHS. Those hon. Members need agonise no more. They can have both their passion for tax cuts, without any nagging doubts as to whether they are being faithful to the wards back home, and more expenditure o n the NHS. If Greenwell Montagu is more wrong and if there is only a quarter of that sum, there can be no serious doubt that if the Government have to choose, this year the priority must be not tax handouts but rescuing the NHS.