Maurice Miller – 1978 Speech on the NHS

Below is the text of the speech made by Maurice Miller, the then Labour MP for East Kilbride, in the House of Commons on 2 November 1978.

I am sorry that the hon. Member for Canterbury (Mr. Crouch) has taken 25 minutes to tell the House that there is a crisis in the National Health Service, and has told us nothing else.

I wish to add my welcome to the Government’s commitment to fresh support for the NHS. I was sorry that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) devoted the major part of his speech to a post mortem examination of the recent industrial action which upset the Health Service. I am not saying that we should not discuss the problems in the NHS, but I wish that the right hon. Gentleman had stuck to the theme of today’s debate, namely, what is to be done in this Session of Parliament about the Health Service.

Having listened to the right hon. Gentleman, and having heard press and television reports, one would imagine that the problems in the NHS were new, and that there was once a golden era in ​ medicine before the establishment of the NHS. Nothing could be further from the truth, as those of us who remember the days before 1948 can testify.

The fact of the matter—and I say this with a good deal of regret—is that at present another battle is being fought in the long war against the NHS, a war which unfortunately has been going on for 30 years. It is all very well for the Opposition to pledge their support now for the Health Service. Their predecessors did not take that view in 1947 and 1948. There has been stubborn opposition to the development and continuation of the Health Service which has followed on from the stubborn opposition which occurred when the idea of the Health Service was first mooted in 1946 and 1947 during the long debates that then took place. That opposition has not disappeared.

Yet if we face the situation honestly—and this was a matter on which the hon. Member for Canterbury was totally wrong—we must take the view that a Health Service is needed even more today than it was 30 years ago. It is all very well for the hon. Gentleman to say that people should make a contribution. Costs in the Health Service are growing in geometric progression. Not only do we have to pay much more for old-established, well-tried services, but in addition advances in science and in technology have yielded diagnostic and therapeutic procedures unheard of, indeed undreamed of, 25 or 30 years ago.

All branches of medicine and surgery have made enormous strides enabling those with kidney failure, heart conditions and blood disorders, to mention only a few examples, which used to have rapidly fatal consequences, to lead useful and even completely normal lives. Orthopaedic procedures for hips and knees have literally transformed a generation of sufferers, who a short time ago would have been confined to wheel-chairs, into fully ambulant members of the community.

Even in conditions which as yet are not amenable to cure, the Health Service is the great saviour. I have a constituent who suffers from a relatively rare disease of the nervous system known as Hunting-ton’s chorea. Recently I had a long discussion with the secretary of an organisation which is striving valiantly to combat ​ this genetic disease. Although the disease is incurable, the Health Service provides a great deal of support for the victims—support which has bankrupted families in the United States, for example, where there is no National Health Service. There the very rich can afford the enormous amount of money necessary to sustain the sufferer over many years, and the poor can obtain institutional care. But the vast majority of the population who are in the middle have to pay and pay and pay. This is also true of many other long-term illnesses.

The point I am making is that this enormous expense must be met on a national and not on an individual basis. The Health Service must be free at the time of use. But I do not think that shortage of money alone lies at the root of present unrest in the Health Service. Part of the problem is of our own creation. I am referring to the greater and greater expectations which the nation now has in respect of the part which the Health Service can play in our lives. This applies to all the workers in the Health Service. It applies to doctors, nurses, medical laboratory scientists and all the staff, as well as to the patients.

This is a good thing, but it imposes an enormous strain on our resources of skill. This is an important aspect of the matter. There is a limit to the total amount of skill upon which we can call. This is one of the great problems that face us in the Health Service. There is no panacea, no overall speedy cure for all the problems, no shibboleths to be mouthed as passwords to perfection.

There is no lack of suggestions. Indeed, the suggestions are so numerous that it is obvious that we need a rethink of how to dispose of NHS income. But—and this is important—there can be no question of going back or of nibbling away at the Health Service until it is completely eroded. Perhaps the Royal Commission will come up with some answers.

Is there, for example, a surfeit of organisation? If so, we know where the responsibility for that lies. It is interesting to note that Scotland has a different structure from that in England and Wales and, in addition, Scotland has a much higher proportion of consultants who are full time in the National Health Service. This is a mode of action which my right ​ hon. Friend the Secretary of State for Social Services would do well to examine carefully, and perhaps copy.

Should we, for example, encourage even greater authority to the doctors in the Health Service? Would this help? One eminent medical journalist put the matter this way only a few days ago:

“Doctors are the sine qua non of this or any other health service. We know that we are indispensable, or at any rate most of us believe it, and so do most of our patients.”

He continues in the following vein:

“The solution to the problems of the NHS, I suggest, is to restore doctors openly to the position of authority which they once held. There is no point in pretending that medicine is a democratic profession, for it is not. It is a profession where vital decisions often have to be made quickly and clearly and democracy is not a very good way of doing that, whatever advantages it may have in other fields.”

He then concludes:

“Doctors are despots, but they are on the whole benevolent and enlightened despots. Furthermore, they are elected despots, for the patient has—or at any rate should have—the right to tell his doctor to go to hell, and to seek another one.”

I mention this at some length because there is no use denying that it is a widely held view in the medical profession, but I hasten to add that it is not my view. However, we must examine whether over-organisation has not given doctors the feeling that professional freedom has been seriously eroded. But doctors must realise that accountability must accompany the very real freedom which they enjoy.

I make only one suggestion which, in my opinion, would go a long way towards accomplishing what the Government describe as:

“Fresh support … to enable the National Health Service to fulfil and extend its services to the public.”

I advocate a considerable switch of funds to the family doctor sector. It is not good enough that this sector should command only 8 per cent. of the total budget. General practitioner services are the vital element and the GP is the first, and for most people the only, contact with the NHS. An increase in resources in this area would pay handsomely in fewer referrals to hospital and consequently more time being available to surgeons to carry out operations and reduce waiting lists. It would also reduce the enormous drug bill and have other benefits on ​ which time does not permit me to elaborate. To accept the family doctor as the linchpin of the whole Service and to allocate funds accordingly would have a snowballing effect on the whole Service.

I am not being complacent, because I know that there are problems, but I should like to move on to a serious omission from the Gracious Speech, namely, that we should have had a complete revision of the conditions that have to be satisfied before a pension is paid for industrial deafness. Unfortunately, deafness is regarded as something to poke fun at or, at least, as something not to be taken as seriously as blindness, and this is not so. The Secretary of State can be assured that those of us involved in this area will continue to press for legislation.

Today’s debate concentrates on the NHS and, according to my calculations, should occupy about 5 per cent. of the total time allotted for the debate on the Gracious Speech. However, I know that you, Mr. Deputy Speaker, do not have a rigid 5 per cent. fixation and I should therefore like to mention briefly one other matter that is related to health, if not directly. I refer to housing. Proposed legislation for a new charter of rights for public sector tenants is included in the Queen’s Speech. Nothing could be more welcome, but I conclude with one question directed to my right hon. Friend the Secretary of State for Scotland and of which I have given him notice. Will the provisions envisaged in the Queen’s Speech apply to the development corporations of new towns in Scotland?