The Government believe in upholding the founding principle of the national health service: a service free to all at the point of need and equally available to all, because access to treatment is determined by clinical need, not by the ability to pay. That is why we have no plans to introduce charges for hospital operations.
Has any work been done within the Department on extending the scope for charges? If so, what are the implications of that approach?
We have considered the whole set of proposals to charge patients for basic operations, but have rejected them completely. One of the reasons is that it would be grossly unfair to ask people, particularly old people, to pay about £2,500 for a cataract operation or up to £11,500 for a heart bypass. We have considered and rejected completely such proposals, as they would be unfair, immoral and, as it happens, illegal.
The Secretary of State said, and I agree with him, that the national health service should be free to all and equally available to all. One of the problems that we have found in my area, which is covered by the Melton, Rutland and Harborough primary care trust, is that it has a deficit of £2.3 million, and it will be asked to take on the health provision for HMP Ashwell and HMP Gartree, which will only add to the burden. How will the Secretary of State prevent my constituents from being further taxed, if not further directly charged, for access to the national health service, when the PCT, and particularly its out-of-hours service, is running at a massive deficit?
On one of the hon. and learned Gentleman's points, additional funding will go with the new arrangements. Secondly, we offer equal access to everyone in a faster and comprehensive fashion by increasing investment year on year. Thirdly, it would be a disaster to reverse that, since he believes, as I do, that equal access to health care means that access to speed of treatment should depend entirely on clinical need and not on the amount that one can afford to pay. It would therefore be a disaster to withdraw investment and ask patients to pay to get quicker operations, and we have no intention of doing that.
My hon. Friend is right on both points. First, Secretaries of State do come and go—some more rapidly than others, I must say, from my career. Secondly, he is right that the founding principle of the NHS stays: it is enshrined in the National Health Service Act 1946 and the National Health Service Act 1977, which states:
"the services so provided shall be free of charge except in so far as the making and recovery of charges is expressly provided for".
There is absolutely no provision under the law for any charges or co-payment for basic hospital operations. That is why I say that any plans to introduce such charges would be unfair, immoral and illegal.
Will the Secretary of State explain to the House how NHS income from patient charges has increased by almost £500 million to £1.5 billion a year since Labour came to power? If the Labour party wins the next general election, will he guarantee that it will not increase patient charges by another £500 million?
Yes, I can explain that to the hon. Lady. There are express provisions in the 1946 Act and the 1977 amendment for certain charges such as prescription charges, dental charges and the recovery of compensation not from the patient but from those who have been negligent, as a result of which the patient has suffered injury. However, charges for basic operations are expressly prohibited under the law. Therefore, it is not legal to charge £7,550, for instance, for a knee replacement, or £3,800 for a hysterectomy. That is contrary to the basic founding principle of the national health service. If I can be courteous to her, since I believe that this may be her last Health questions, may I say how much we have enjoyed her contributions at Health questions over the years?
May I tell my right hon. Friend about a constituent of mine who told me on Friday that he needs knee surgery and is to be admitted into a Nuffield hospital for treatment paid for by the NHS? Has my right hon. Friend considered, given that the Wanless report recommended that treatment free at the point of need was the most effective and efficient way of delivering health services, how we can expand capacity while not burdening people with an unexpected charge beyond the national insurance that they have already paid?
I am glad that my hon. Friend's constituent is getting quick access to health care. We have broken down the old dogma that says that we will never use anything except directly provided services, but we have maintained the old principle that any such services—even if purchased in bulk from the independent sector—will be delivered free at the point of need. For instance, that means that her constituent does not have to pay some £7,550 for a knee replacement, and it is one reason why the NHS is getting more and more commendations throughout the country.
So far as I am aware, the only party in this House that proposes to levy charges for NHS treatment is Labour. [Interruption.] It is a question. Let us consider section 150 of the Health and Social Care (Community Health and Standards) Act 2003, which is entitled "Liability to pay NHS charges"—a provision introduced by this Government 18 months ago. Following the consultation started by the Minister of State, Department of Health, Ms Winterton on
Mr. Speaker, the House and you in particular, will be interested to know that the hon. Gentleman is talking not about charges and patients but about the recovery of costs from third parties whose negligence has resulted in people being admitted to hospital. On the other hand, since he seems unaware of the subject of charges, let me point out to him the following:
"If an independent hospital charges more for an operation than the NHS, patients will be entitled to 50 per cent. of the NHS cost as a contribution towards their bill."
That quote is from page 6 of the hon. Gentleman's own party's manifesto, which he clearly has not even read. However, I will stay within order, Mr. Speaker, and merely repeat that we will not introduce charges for basic hospital operations. We are delighted that the hon. Gentleman is putting his policy to the country.
Many of my constituents have to use dentists operating in the private sector and such dentists are increasingly requesting that their patients take out nominated insurance policies. Has my right hon. Friend received any complaints about this practice and if not will he examine these nice little earners for dentists in the private sector?
I will examine them because, given all the difficulties that we face in dentistry, we want to ensure that, by bringing in 1,000 more dentists in the short term and by replacing the two dental schools closed by the last Conservative Government, we increase the number of dentists available. I should point out to my hon. Friend that such experience is not typical, according to the many surveys of people's experience of NHS services throughout the country. Indeed, a recent survey showed that 30 per cent. of people categorised the NHS as "excellent", 40 per cent. rated it "good" and 18.5 per cent. rate it "adequate". So 88.5 per cent. of people rated the NHS as "excellent", "good" or "adequate", and I thank the shadow Chancellor, Mr. Letwin, for carrying out that survey in his own constituency, and for publishing it for our benefit.