National Health Service

Oral Answers to Questions — Treasury – in the House of Commons at 11:30 am on 11th April 2002.

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Photo of Desmond Swayne Desmond Swayne Shadow Spokesperson (Defence) 11:30 am, 11th April 2002

If he will make a statement on the conclusions of the final Wanless report.

Photo of David Laws David Laws Shadow Spokesperson (Defence)

When he plans to publish the final report by Mr. Derek Wanless on the future funding of the national health service.

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

On Mr. Wanless's conclusions, his interim report states that there is no evidence that any alternative financing method to that of the UK would deliver a given quality of health care at a lower cost to the economy. Indeed, he says that other systems seem likely to prove more costly. His final report will be submitted to me shortly, and he will also publish a study commissioned by his review on international health care systems, considering health systems in individual countries around the world.

Photo of Desmond Swayne Desmond Swayne Shadow Spokesperson (Defence)

Given that expenditure on the NHS in Scotland has already reached the Prime Minister's target of the EU average without providing noticeably better services than are to be found elsewhere in the United Kingdom, what reforms does the Chancellor think will be necessary to ensure that greater expenditure leads to a better service?

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

Reforms have already been put in place and are being implemented now. Only a few days ago, the primary care trusts were implemented in England, and we have also established the National Institute for Clinical Excellence, which deals with standards. There is now greater provision for audit and inspection, and around the country, hospitals have more autonomy. Money was paid directly to health trusts. Those measures are making a difference: waiting lists are down; half a million more operations are being done; and there are 10,000 more nurses in the system and 7,000 more doctors. As a result, for example, in relation to cancer, 10,000 more operations a year are being done, and in accident and emergency, 200,000 more people are being seen.

The question posed by the hon. Gentleman is this: what is the best system for funding health care for the future? I have asked people in the past few months to put their views to us about what they believe would be the best system for the future. The Conservative party has not yet put its views to us in detail. The hon, Gentleman signed a motion in the House some years ago saying that it was time to think the unthinkable and go for private health care insurance systems. We now find this morning that the Conservative party is planning the dismantling of the national health service. It is time that it was honest with the House.

Photo of David Laws David Laws Shadow Spokesperson (Defence)

In the Chancellor's speech on 20 March, he undertook to use his Budget statement next week to put the national health service on a long-term stable financial footing. In an environment in which Governments come and go, is not the only way of achieving that goal for the long term to introduce either a dedicated health tax or a system of social insurance for the national health service?

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

I am interested in the hon. Gentleman's views, but they are clearly not those of his party. They are distinct from those advanced earlier this week by his shadow Chancellor, who urged continued funding of the existing health care system. It is right that we need a long-term system of funding for health care in this country. That is why the Wanless review was asked to deal with a 20-year perspective and is considering technology, demography and rising expectations—issues that, as he will agree, must be looked at so that we can find the basis for a long-term system of funding.

I return to the issue raised by both questions: what is the best system of funding health care for the future? We have looked at private health insurance. In America, it covers some people some of the time, but it certainly does not cover all the people all the time. We have also looked at charging, which is called "self pay" in the document in which we find this morning that the Conservative health spokesman has been involved.

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

The hon. Gentleman should read the transcript of the tape. [Interruption.] Indeed he has; and he will agree that when the issue of charging arises, it is called "self pay". It is a new term that the Conservatives have invented, just as they used to call private medicine personal medicine when they were trying to make it a softer version for the public.

I come back to this question: does not a system of charging or self-pay mean that the sick pay for being sick, and that they pay more when they are sick? We have looked at health care systems around the world, and at social—

Photo of Mr Nigel Beard Mr Nigel Beard Labour, Bexleyheath and Crayford

Does my right hon. Friend agree that the interim conclusion of the Wanless report—that anything other than general taxation is likely to constitute a more expensive way of providing a given level of health care—should eliminate political controversy from this issue? Does it not illustrate the absurdity of statements such as that of Mr. Howard, who said that the national health service is a Stalinist creation, and of Mr. Bercow, who described the health service thus:

"An unreformed, Stalinist structure now in crisis"?

Photo of Michael Martin Michael Martin Speaker of the House of Commons

Order. The question is not in order. I call Mr. McFall.

Photo of John McFall John McFall Chair, Treasury Committee, Chair, Treasury Committee

May I ask the Chancellor to use next week's Budget to invest more money in the national health service, and to convince people that a publicly funded NHS is the only way forward for the well-being of everyone in this country? Does he have some sympathy for the shadow Chancellor, who wants to cut public spending to 35 per cent. of gross domestic product, while the shadow Health Secretary

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

I am grateful to my hon. Friend, who points out that the decision that must be taken is whether we invest more in health care to get the doctors, the nurses and the improvement in the service, backed up by reforms, or whether we invest less. If we go with the proposals that this Government have put forward, we will invest more. The prior question that must be addressed by those who want to put forward alternative systems is whether they are more efficient and equitable than the current funding system. On charging, such alternative systems would involve the sick paying for being sick, and in terms of social insurance, employers would pay an average of £60 a week for an employee, as happens in France. Such systems would not provide the full coverage that the health service in this country provides. The issue that the Opposition will have to address at some point is that we want to invest more and they want to invest less.

Photo of Matthew Taylor Matthew Taylor Liberal Democrat Spokesperson (Treasury)

Before the Chancellor is cut off again, perhaps he could tell the House whether he regrets the fact that it took six years and two general election campaigns before he was prepared to ask an expert to tell him what was staring everybody else in the face: that if the NHS is to be put on a healthy footing, a tax increase is necessary to raise the money for the doctors and nurses who are obviously still missing from the NHS. According to the Wanless report, they are still not being trained to fill the gaps.

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

In 1997, the Liberal party advocated the spending of an extra £500 million a year for the national health service, but we are spending an extra £5,000 million a year. Since 1997, we have taken tough and difficult decisions that the Liberal party never supported. We raised interest rates, cut back on the national debt and initiated a welfare-to-work programme. Those decisions were taken to reduce debt interest payment and unemployment, and they have enabled us to pay more for health care in this country. However, if we want a health care system for the next 20 years that is worthy of our country, we must also take long-term decisions on funding. I hope that, for once, the Liberals will face up to some long-term decisions.

Photo of Barry Sheerman Barry Sheerman Chair, Education & Skills Committee, Chair, Education & Skills Committee

May I urge my right hon. Friend to carry on, regardless of those who think the unthinkable or speak the unspeakable, and not to be deterred from accepting the fact that, as we all know, long-term, sustainable investment and good management is the right answer for the health service? At a convenient time, will he find extra resources to establish centres of excellence, which can train managers who care and who are engaged not just in the private sector, but in the public sector?

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

I agree with my hon. Friend. A public sector leadership programme is being run for the health service and, indeed, for education authorities. He is absolutely right that resources need to be matched with proper reform. Many reforms are already in place, some are being introduced this month and many will have to be introduced in future years. Matching money to modernisation is the way forward, but the question that we must resolve is this: what is to be that long-term system of funding for the health care system? It is no good people three, five or 10 years down the line saying that they thought that they might have had a good idea if they have not put it forward. We must resolve those questions over the next few months for the sake of the health service.

Photo of Michael Howard Michael Howard Shadow Chancellor of the Exchequer

The Chancellor's reply to my hon. Friend Mr. Swayne was astonishingly complacent. Is the right hon. Gentleman not aware that lung cancer survival rates are lower in England than in France and Germany; that 25,000 lives could be saved every year if the United Kingdom were as good at treating cancer as the best in Europe; and that in Germany waiting lists do not exist? Does he still think, as he told the Social Market Foundation last month, that we have no lessons to learn from the way in which health care is provided elsewhere?

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

I did not say that. What I did say was that I reject the social insurance system as proposed for France and Germany, I reject private insurance as in the United States of America and I reject the policy that the Conservative health spokesman is now putting forward—it is called self-pay, which is, effectively, charging for medical services.

If the shadow Chancellor wants to achieve improvements in the health service, he has to support the additional doctors, he has to support the additional nurses and he has to support the investment in new hospitals. He cannot support that if at one and the same time he wants to cut public spending to 35 per cent. of national income—a £50 billion cut in public spending, which the public find unacceptable.

Photo of Michael Howard Michael Howard Shadow Chancellor of the Exchequer

The Chancellor continues to misrepresent and distort our position. We have no target along the lines that he falsely suggests, but we do need a proper debate on those issues. It is already clear that we have an open mind on them; he has a closed mind. His idea of the debate is the speech that he makes when he looks at himself in the mirror.

Photo of Gordon Brown Gordon Brown The Chancellor of the Exchequer

First, the shadow Chancellor cannot get off with the fact that in 1997 he said:

"I believe that our aim should now be to reduce the proportion of national output now taken by the state towards 35 per cent.".

That represents a £50 billion cut in public spending. He also cannot get out of the fact that the shadow health spokesman has been quoted this morning as saying that he wants to replace the national health care system by charging and private insurance. As long as the Conservative party supports those privatisation measures, it will have no chance of support from the British public.