National Health Service

Part of Opposition Day – in the House of Commons at 7:04 pm on 19th January 1988.

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Photo of Dr Rhodes Boyson Dr Rhodes Boyson , Brent North 7:04 pm, 19th January 1988

The genesis of the Health Service came in the Labour Government after 1945 at a time when, after total war, there was a feeling on both sides — more strongly on the Socialist side than the Conservative side — that, having won the war by a concentration of resources and people, one should win the peace in the same way. The National Health Service represented that.

The National Health Service is a nationalised, not a national service. I shall define the difference between the two shortly. The Health Service was nationalised at the same time as the railways, the coal mines and all the rest. It involved the nationalisation of 1,000 voluntary hospitals, 500 municipal hospitals and many private hospitals.

At the time, nationalisation was popular. The general climate of opinion in Britain among Socialists was strongly in favour of it and the Conservative party was halfheartedly in favour of it, if I may put it that way after reading speeches of the time. The National Health Service grew out of a time when nationalisation was a popular policy in Britain.

Since 1948, 40 years have passed and three things have happened which have led to the crisis in the Health Service. This is a crisis not just of resources, but of design—whether the service now meets the needs of the present time. That must be said to Opposition Members, each of whom I respect.

It is interesting that no other country has followed our example. If ours was the best service in the world, people would be coming here to see it. The NHS grew out of a general belief at that time and out of the Beveridge report, as all of us know.

Nationalisation, in the view of the general public, is entirely different now from what it was between 1945 and 1951. That is why the Conservative party has fought three elections on denationalisation and has won with votes from all classes in our society. Nationalisation is no longer seen as a great frontier advance. It is now seen as something to be rid of, so that we can return to some form of competitive enterprise for the benefit of all classes and groups in our society.

The second difference is the rising standard of living. Rationing was all around us between 1945 and 1951. That has gone. People then were used to waiting. I am not making a virtue of that, but people were used to waiting. The war meant that rationing continued for a considerable time.

That time has gone. Now, 16 million people holiday abroad. People buy videos and cars. They do not expect to wait. They do not go to the travel agency to be told that there is a queue and that they should come back in two years' time when they may get a holiday in the back streets of Turkey. People read their brochures, save their money and go away when they want for as long as they want.

The outcry about queues in the NHS is because queues do not exist in any other area. People realise how important health is. All hon. Members do. That is why so many have been present for the debate today. The Government must be given credit for the change in people's expectations. The Government are responsible for the economic advance and, in particular, for how much better off those in work are now than ever before. People are no longer willing to join queues for a long period.

Thirdly, great technical advances have been made and the cost of medicine has increased. Many of those advances were unheard of 40 years ago. It is always well to go back to first principles, and one reads in the Beveridge report an estimate of what the NHS was expected to cost. In 1945 it was estimated as £170 million. Index that for inflation and we now are spending 10 times more in real terms than Aneurin Bevan—all credit to those who brought it in—thought it would cost at that time.

First, nationalisation is no longer popular. We live in a denationalising age. Secondly, people are not prepared to queue because the consumer goods society has given people a taste of getting things when they want them. Thirdly, technical medicine has become very expensive.

Let me define the difference between a nationalised and a national Health Service. A National Health Service is one in which the Government somehow ensure that all parts of society, including the poorest, get health care. No one in this House would disagree with that. However, the Government do not need to provide that health care; they need to ensure that it is available to everyone. Local authorities now use competitive tendering for their services, and they do not provide them. They ensure and expect that the best service available is obtained. No longer do we need a nationalised Health Service.

My right hon. and hon. Friends and I differ in this continuing debate. Often, these days, we Conservatives have to provide our own debate within the party, which is sad, but I am glad to contribute to that debate. There is something wrong with the design of the system. I shall not throw figures around; I shall be brief. We now know that we have more than twice as many nurses as we had in 1960 — 480,000 as against 236,000. We have fewer hospital beds, and a shortage of nurses that we did not have then. The ordinary man or woman in the street might say that that looked odd, and he or she might have a point. I have some odd figures to illustrate this, which are interesting but do not require deep analysis. On one set of figures—many are going around—510,000 more people are employed in the Health Service now than were employed in 1970. Since 1970, the population of this country has risen by 500,000. So we are employing 510,000 more staff for a population that has grown by 500,000. Thus, on a straight-line graph projection, there will come a time when more people are employed in the Health Service than live in this country. It will not happen in our lifetimes, but the man or woman in the street or in the public bar—on second thoughts, we are all in the saloon bar now, thank goodness — may say that that is odd. And I say that he or she may have a point.

Because of the lack of time, I cannot advance a detailed scheme now; nor do I have one ready. Bright lights in dark corners, I always say, and one must start looking at what must be done to improve things now. Money must follow the patient. Wherever there is a service in which the money drips down from the top there will be massive numbers of administrators, and a lot of the money will go to the wrong places. Money following the consumer is the basis of denationalisation, and consumer control has transformed so much of the economy of this country which before was an economic dinosaur.

Some form of insurance will have to come. The Government's job will be to ensure that all the people can properly insure themselves. It will cost somewhere between £300 and £500 per person. Three booklets that have come out recently — the author of one is sitting on the Conservative Benches now— on the subject all give different figures, so if I average the lot, we shall say that it will cost £400. Every person in the country could be given a voucher for £400 for health insurance. It is the same system as we have for car insurance, which is not done by the Government. One insures the car, and the insurance company has to provide the service so that one is not bankrupted. That is one way of doing things.

The trade unions began as benevolent—