National Health Service

Part of the debate – in the House of Lords at 12:18 pm on 9th March 2006.

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Photo of Lord Fowler Lord Fowler Conservative 12:18 pm, 9th March 2006

My Lords, it is a pleasure to follow the noble Lord and particularly to congratulate my noble friend Lady Cumberlege on securing this debate, which could not have been better timed. I praise not just her speech, which was exceptional, but her dedicated interest in healthcare over the years.

When I was Secretary of State for Health, my noble friend was one of my health authority chairmen, before she went on to higher and bigger things. That is rather different from the noble Lord, Lord Warner, who was previously a distinguished civil servant at the Department of Health. When I became Secretary of State and arrived at Elephant and Castle, he promptly handed in his cards and moved away. So there we are.

I have three swift points to make. The first is to pinpoint a puzzle about the present-day health service. There is no doubt that the Government are spending more on the health service. I say that with a certain amount of envy, because I once did a waiting list initiative on £25 million. However, the real test is whether the extra resources are being used to best effect. If, for example, you spend a disproportionate amount on pay increases, the benefit to patient services is limited.

What seems to be beyond doubt is that the public themselves do not always believe that the money is reaching the services. I saw a poll last week which asked whether people thought that the quality of the National Health Service had improved; 23 per cent said yes and 77 per cent said no. I recognise, as the noble Baroness, Lady Pitkeathley, pointed out, that when people are asked about their personal experience, those results are undoubtedly different, but that has always been the case—it was my defence when I was Secretary of State for Health.

Add public concern to the big financial deficit and the resignation of Sir Nigel Crisp—to the discomfort of Ministers—and the press are writing not about success but about crisis in the health service. Perhaps the lesson here is that, whatever else, good management is of the essence in the health service. I remember that when I introduced general managers into the health service, it was fiercely opposed. My opponents said, "We do not want to see the health service run like Tesco". I am tempted to say, "If only", because the health service is like any other big organisation—it needs strong and skilled management locally and nationally.

It always seemed to me, and seems to me particularly today, that at the centre one of the obstacles to good management—perhaps this lies behind the demise of Sir Nigel Crisp—is that there are far too many people intervening and double-guessing. Ministers, civil servants and politicians may sign up to the general proposition of moving resources north, but not if it affects their own area. I see also that the Prime Minister now has his own No. 10 health adviser. Why does the Prime Minister need his own health adviser? Surely his adviser is the health secretary. That was certainly my view when a similar proposition was put to me. If you go the other way, people do not know to whom they are answering. It blurs the lines of responsibility and is certainly not good management.

As I went on in the health service, my view became that we would be better served if we could in some way separate policy development—properly the function of the Department of Health—from implementation and management of the service. My concept was for a health commission managing the service at arm's length from government, accountable to government but not run by it. I remember putting that to my noble friend Lady Thatcher. She thought for a little and then said, "No, they would say this was just a prelude to privatising it". There was no doubt that, at the time, that was exactly what would have been said, although I now note that the idea has the support of organisations such as the King's Fund.

That brings me to my second point. No issue is more bedevilled by party politics than the health service. In my view nothing has done more harm over the years and stood more in the way of progress than that. I remember in 1983 publishing a circular entitled, Co-operation between the NHS and the private sector at district level—not exactly a threatening title. The idea was that, to reduce waiting lists, health service patients should have the opportunity of treatment in private hospitals, and health authorities should explore the potential of placing contracts with private nursing homes. That was described by Michael Foot as,

"the most serious attack on the National Health Service since it was originally started".

I am delighted that 20 years later it is now a mainstream policy of this Government. They rightly support co-operation between the private and voluntary sectors, because what matters is not what badge is being worn by the provider of healthcare but the quality and cost-effectiveness of that healthcare. Many people—some with vested interests—will snipe at that policy of co-operation, but I hope very much that the Government persist with it. In passing, I congratulate David Cameron on making it crystal clear that this party is not interested in introducing some new form of insurance system but is intent on developing the National Health Service. I hope therefore that there will be an end to all this nonsense about privatising the health service.

My last point concerns an area where there is no doubt that the service has gone backwards—sexual health. We should remember that the sexual health clinics—the GUM clinics—pre-dated the National Health Service. They came out of a royal commission in the First World War and their purpose and achievement was to provide a free, anonymous walk-in service. Their justification was not just to help the individual, but to prevent the spread of disease. Today, 60 years after the inception of the National Health Service, we have delays before patients can be seen, and we have crowded waiting rooms and run-down premises.

I am a trustee of the Terrence Higgins Trust, which, together with a number of other organisations, has just carried out a survey of provision, of which one section was devoted to the views of clinicians. I shall give one extract from it. The clinicians were asked:

"Are HIV and sexual health sufficiently prioritised within your local health services?"

Nineteen per cent said yes and 73 per cent said no. Yet we are in a position where sexually transmitted infections, including HIV, are the greatest infectious disease problem in the United Kingdom today: 1.5 million new episodes are seen in sexual disease clinics, over 60,000 people are living with HIV, and chlamydia is doing a great deal of damage, particularly to young women.

Here you can correctly talk of crisis, for not only is our treatment falling short, but our prevention effort has been inadequate over the past 10 years. This is not a fashionable subject; politicians tend to be embarrassed by it or to avoid it. Something like HIV/AIDS does not come high up in the usual list of public concerns, yet it is a disease like other diseases, which is causing real damage to thousands of people. One test of the National Health Service is whether it deals with such challenges. I fear at present that this challenge has not been met. I urge the Government to put new energy and new purpose into bringing help here.