National Health Service

Part of Opposition Day – in the House of Commons at 3:52 pm on 5 July 1988.

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Photo of Robin Cook Robin Cook , Livingston 3:52, 5 July 1988

I have clearly said that I shall not give way to the hon. Gentleman. I have already been obliged to give way on four occasions to Conservative Members.

The Secretary of State has seen the problems spelt out in several reports, the latest of which was that of Sir Roy Griffiths, who had the bad taste to point out that community care will work only if we give a much wider role and much greater resources to local authorities. That view was so unpopular in Downing street that Sir Roy's report was smuggled out with no statement being made to the House and with no press conference for the media, and it was published on the day on which Sir Roy was under an anaesthetic in an operating theatre. The Secretary of State may have buried the report, but he cannot bury the issue.

If the Secretary of State takes community care seriously, he must spell out how the Government intend to make a reality of their rhetoric about community care. I am sorry to say that, judging by the leaks trickling out, it does not look as though that is what the review will tackle, but rather that it will fit neatly with the Government's social priorities. Press reports suggest that the only help provided will not be for the poor or for those in need of health care, but will take the form of tax concessions and subsidies in respect of private medical insurance. Not many of the mentally handicapped will pick much out of that.

The Secretary of State, wearing his social security hat, is fond of advising us that an important aspect of Government policy is to target health. Tax concessions are an odd form of targeting. They target help on the wealthy, who will benefit most because of the higher taxes they pay, and on the healthy, because the private insurance companies claim the right to screen and to reject the unhealthy. I saw that principle defended last week by the managing director of WPA, which is Britain's third largest medical insurance company, on the ground that it enables essentially healthy people to avoid being penalised by unhealthy people. That statement at least has the originality of identifying the healthy as the vulnerable group, to be protected against the unreasonable costs of the unhealthy. The truth is that any sum spent on indirectly subsidising private health insurance will achieve a much larger and more immediate impact on health resources than if it is spent directly on the NHS.

That returns us to the origins of the review, because it was not undertaken because the Government are anxious to set about improving the NHS. Only a fortnight before the Secretary of State announced in a letter to me that there would not be a review of the NHS. The review was born out of panic, as the Government reeled from the publicity last winter about the underfunding crisis in our hospitals. That crisis remains.

Last week Bloomsbury district health authority approved a package of cuts that will shed another 80 beds at University College hospital. The Secretary of State will be aware that he has received an internal report from the DHSS pointing out that, in the last three years alone, London has lost acute beds equivalent to six entire district general hospitals.