There has been attack, counter-attack, accusation following accusation, words spoken, written and shouted about the National Health Service review and its implications, which has led to the burying of the reasons for that review in the first place. Not long ago, the House was in the throes of a debate about the Health Service crisis in response to the almost nightly scenes of young children, the elderly, and other seriously ill and chronically sick patients being refused admission to our hospitals and to the life-saving treatment that they desperately needed. All that was the result of a lack of beds and resources. We all agree that that situation was brought about by systematic and chronic underfunding. A consequence of those debates and of the general furore over the crisis in the hospital services was that the Prime Minister announced a thorough and extensive review of NHS resources.
One year later, we find not only a White Paper full of holes and omissions that are not filled by the working papers, but one that fails to examine in any detail the financing and funding of the country's Health Service. There is no commitment to inject new resources; merely a tinkering at the edges with the old by transferring them from one area to another, including in and out of the private sector, in the hope that this will in some way cut costs while improving services. This purely a pipe dream.
The Health Service needs more hard and ready cash. Just this week, the National Association of Health Authorities has provided evidence that the review completely ignores. Its report shows an underfunding in England alone of £490 million this year with cumulative underfunding of £billion. Those figures show that the pressures on the National Health Service are continuing at an alarming rate and are likely to do so in the foreseeable future—something of which those who work in and those who use the service are very well aware.
It is hardly surprising, therefore, that the lack of any commitment to the adequate funding of these services is clear from the Government's White Paper. This has led patients and professionals to believe that the review was designed not to improve care but to cut costs.
Mr. Philip Hunt of the National Association of Health Authorities, which is by no means a blanket critic of the review, is reported to have said:
It is very vital for the government to recognise and understand this history of financial pressures on health authorities if the reforms proposed by the white paper are to be successful or for the benefit of patients.
There has been much publicity over the opposition by doctors to the Government White Paper. I know that many of my hon. Friends have received very many letters and have been besieged by general practitioners and hospital doctors all expressing their concerns. But perhaps Dr. F. J. Parkinson of Redditch, who is not at all impressed by the Government's commitment to funding, is the best example. In a letter to the newspaper Pulse on 6 May this year, he wrote:
I believe that the NHS review is a smokescreen for the underlying problem with the NHS. As the Commons Select Committee so rightly stated, the service is grossly underfunded. The proposals do nothing to tackle this problem and offer little that will benefit ordinary patients.
The writer describes himself as a member of the Conservative Medical Society. He continues:
As a Conservative I feel very ashamed at the manner in which the review has been presented—the white paper is a thoroughly bad document. The schemes outlined are vague, untried and really do not seem likely to benefit patients.
It is not very often that I find myself in agreement with a Conservative gentleman, but in this case I am in complete agreement.
My own stand on the matter of resources for the NHS has never been in doubt. I have often said, and said in the House, that how much a country can afford to pay for its health service is a matter of political will. We can afford a lot more than we are paying now and I would like to see a minimum of 2 per cent. increase over and above the NHS pay and price inflator on a long-term plan. I would like to see pay awards fully funded and proper provision made for any reforms or projects that the Government introduce. For instance, I would have no hesitation in committing Social and Liberal Democrats to fully funding the restructuring of the nurses' profession along the lines of Project 2000.
While on the subject of funding, I want to make it clear that Social and Liberal Democrats continue to oppose and would like to see abolished the recent tax relief to the elderly for private health insurance. We would also like to see the charges for eye tests and teeth checks abolished immediately and, in the long term, all such charges dispensed with.
One of the biggest failures of the White Paper is the total lack of costing of any of the proposals. This is very odd coming from a Government which prides itself on the use of marketplace methods. It is even more strange to watch the full-blown attempts to sell the product when the Government have no idea of the cost of the product, whether there is a market for it or, worse still, if the product is capable of working at all. It is even more disconcerting when I realise that it is my and other taxpayers' money that is paying for this folly.
I cannot understand why the Government did not attempt to test this product first. Is the Prime Minister concerned that pilot projects may show too many faults in the design, or is it due to sheer arrogance that pilot schemes have not been introduced? Worse still—I hesitate to make such a suggestion—is it that the proposals are all part and parcel of the Prime Minister's proclaimed aim to roll back the state, and will it therefore be implemented whatever the cost, in both financial and human terms?
Ministers justify these proposals with claims that they will improve patient choice and patient care. I agree that it may be easier for patients to change doctors but, with doctors rushing to increase their list sizes and incentives given to encourage them to form large group practices, how much choice will the average patient have? How many doctors will be within easy reach? How many of them will be women? There are patients who prefer to see a women doctor but, with the pressures to increase list sizes, many women will find it difficult to run or even join a practice, as has been mentioned already. In rural areas—this was referred to in the debate the other night—where doctors are few and far between, choice is already limited and will remain so.
In 1983, the Social Services Committee recommended an optimum list size of 1,700. Will the Minister tell me what has changed since that time? Social and Liberal Democrats believe that doctors need to spend time with their patients, and we would seek to lower the list size at present proposed.
Primary health teams with greater involvement for district and practice nurses, midwives and health visitors would free the doctor for more active diagnostic and preventive medicine and create a real community health service—a concept obviously alien to the authors of the present proposals.
The White Paper makes little provision for particular groups, such as the elderly, many of whom rely on community-based health services. Where is the guarantee of choice and improved care for them? In many respects the proposals may lead to a reduction in services as a result of hospitals becoming self-governing trusts.
These proposals will diminish health care in the hospital catchment area. Core services are imprecise and the term "local area" is not defined, making it very difficult to know whether people will have access to a full range of services within their own area. As the market and profit play a vital part in the Government's view of the Health Service, it is doubtful whether the present range of services will stay intact. This is even more doubtful when it comes to resource-draining services such as geriatric arid long-stay care.
The White Paper takes very little account of discharge procedures, after-care services, ambulance and transport services and many other aspects of patient care.
Major hospitals opting to become self-governing trusts will have a knock-on effect on other hospitals and services. The problems of lack of funding, lack of staff and poor pay will be shifted round the country, which will merely exacerbate them. Already many hospitals are suffering not only from a shortage of nursing staff but from shortages in all staff groups. The private sector, as well as other industries, contribute to this shortage. Obviously, hospitals not restricted by national pay agreements will attract the most qualified staff, making it very difficult for other hospitals in the same area or adjoining areas to attract the necessary personnel.
I know that the university medical schools are very concerned about how this proposal will affect their interrelations and responsibilities. They, of course, play a very important part in teaching, training and research. Centres of excellence will destroy the aim of universal provision of health care and the concept of a community-based comprehensive Health Service.