Amendment of the Law

Part of the debate – in the House of Commons at 3:22 pm on 8th March 2017.

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Photo of Andrew Murrison Andrew Murrison Conservative, South West Wiltshire 3:22 pm, 8th March 2017

It is a great pleasure to follow Chris Leslie. It is also a pleasure to support the statement and the OBR’s “Economic and fiscal outlook”, which supports it and gives generally very good news and confounds many of the doomsayers who have been prognosticating so luridly over the past several months.

I say from the outset that, although I agree with the statement and some of the things that were announced, I have some small concerns about national insurance. On that matter, I find myself in agreement with the concerns expressed by the hon. Members for Nottingham East and for Leeds West (Rachel Reeves). It is very important to ensure that we do not disadvantage self-employed people. The Conservative party always has been and, I hope, always will be the party that supports white van man and—may I say on this particular day?—white van woman.

It is vital that in abolishing class 2 NICs and instituting class 4 NICs for those who were covered by them, we do not disadvantage those individuals. My back of a cigarette packet calculations support the concerns expressed by the hon. Lady. Her figures were more or less the same as mine. I hope very much that we will have some reassurance from Treasury Ministers that plumbers, electricians, plasterers and people of that sort will not be disadvantaged, particularly as we consider further measures to equilibrate them with employed people, such as those who have been described on paternity benefits and the like, which of course ignore the fact that employed people have advantages that the self-employed very often do not.

I do not have a university in my constituency, but I do have a further education college. I know that the principal of Wiltshire College will warmly welcome today’s announcement on T-levels. We have long ignored technical education in this country, to our great disadvantage, and I suspect that our poor productivity compared with our European competitors is in large part due to the fact that we have not skilled our workforce in the way we should since 1945. I therefore very much welcome this development.

I also welcome the funding for children who wish to access selective education. I think that the hon. Lady missed the point that it is money for children on free school meals, so it is not generally available. It is a measure that seeks to improve the chances of the poorest. I would have thought that the Labour party welcomed that. However, I oppose further grammar schools. They would not be good for areas like mine. I fear this development because its flipside is an increase in the number of secondary modern schools. That has not been positive in the past and I would not like to see it visited on areas such as mine in the future. I would be concerned if the measures announced today, which appear to advantage disproportionately free schools seeking to select their intake, introduced grammar schools by the back door.

I am particularly concerned for health and social care. I very much welcome the positive announcements that have been made today. By my reckoning, they mean £2.4 billion over three years for health and social care, which will be very helpful, over and above the announcements that have been made previously—in particular, the increase in the social care precept to 3%. To sound a cautionary note, I think that it would be wrong in principle if we were to shift from raising money for social care from general taxation, which is the current situation, to a system based on property. The reason for that is very obvious: the most disadvantaged areas are the least capable of sustaining that kind of tax burden. However, £3.4 billion over three years is a great deal of money.

I am particularly pleased that the Chancellor suggested in his statement that there will be more in his autumn statement, in particular to fund the capital costs of sustainability and transformation plans. Many of us in areas that will be profoundly affected by STPs are concerned that those capital costs simply are not being met. The revenue savings that are necessary over the years to guarantee the five year forward view will not be possible without the injection of significant sums, of which I hope this is the start. I therefore very much welcome the £300 million announced for those capital costs and look forward to even more in the autumn statement.

The £100 million announced for accident and emergency is extremely welcome. We have got off relatively lightly this winter—it has been a relatively mild winter—but we cannot expect that to be the case in future. I welcome the Chancellor’s ambition to get the money in place to deal with next winter’s winter pressures. That is ambitious and I hope that he can achieve that and a system of triage to ensure that people are treated appropriately and by the right practitioner. Luton and Dunstable hospital is an example of very best practice in that respect, and one that should be mirrored, copied and emulated elsewhere.

We are still left with a big problem: the future funding of our national health service. When William Beveridge made his report in the mid-1940s, he tried to address society’s five great evils as best he could and suggested that spending on healthcare would reduce over time the costs of the NHS. How wrong he was. That is an example of how we can get our predictions so badly wrong with devastating consequences. Clem Attlee’s Government rapidly realised that that was wrong, which led to Nye Bevan’s resignation in fairly short order over what became known as teeth and specs.

The fact of the matter is that the burden of disease is going up because of our ageing population, as are patients’ expectations. We welcome the ageing population and the increase in patient expectations. Innovations and medical advances are also increasing, but all that costs a great deal of money, which the OBR makes clear. It makes it clear that we need to find a great deal of money over the next several years—eye-watering sums—but what is happening now is important as well as the future. Compared with countries such as Germany, France and the Netherlands—countries with which most people in this country would wish to be compared—our healthcare outcomes are significantly worse. In my view, there is a causal link between the amount of money we are prepared to spend on healthcare and the outcomes we will eventually get. The amount of money we spend on healthcare is very much less than the amount spent in the aforementioned countries.

Ministers will rely on the OECD average and say that we are doing relatively well in that respect, which is perfectly true. However, the OECD contains countries such as Mexico, Turkey, Hungary and Poland. They are great countries but have healthcare economies that are surely less advanced than ours and that do not therefore present reasonable comparators. We find that poor little five-year-old Ashya King had to go to the Czech Republic for his proton beam therapy for medulloblastoma. That would strike most people in this country as being distinctly odd. We find that cancer drugs that are routinely available on the continent are not available here or, if they are available, that they take much longer to appear on the market than they take in comparable countries. We find that cancer staging is delayed in this country, with obvious consequences for people’s chances of survival. It is hardly surprising that the much-cited Commonwealth Fund puts the UK 10th out of 11 in terms of healthcare outcomes for conditions amenable to healthcare.

Last year, the Office for National Statistics perfectly reasonably tweaked the figures so that the UK health spend related better to the OECD methodology. That rolled in publicly funded social care costs, which is also perfectly reasonable, but it bumped up the UK spend on healthcare a few notches in the international league table—it went from 8.7% to 9.9%, and meant we overtook Spain, Portugal and Greece, but we are still well behind France, Germany and the Netherlands.

The question for me is how on earth we close that gap. Many right hon. and hon. Members have suggested that we ask a commission to examine the long-term future funding. We need that level of public conversation to enable us to examine how we will lever in the significant funds necessary to close that gap. I hope that just as we are having a Green Paper on social care, which is welcome, the Government are open to suggestions from the public on how we can fund healthcare through hypothecated taxation or the various other mechanisms open to them.