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Category: Health

  • Patrick Jenkin – 1978 Speech on the NHS

    Below is the text of the speech made by Patrick Jenkin, the then Conservative MP for Wanstead and Woodford, in the House of Commons on 2 November 1978.

    May I begin with a word of welcome to the right hon. Gentleman? This. I think, is the first occasion on which he has addressed the House since he was struck down and whipped off to hospital in July. We very much welcome his return to health and hope that this time it will be lasting.

    I can agree with the right hon. Gentleman on two of the matters to which he ​ referred. First, he said at the outset of his speech that there is real concern in the country about the state of our Health Service. That is correct, and it is why we have chosen to devote the second day of the debate on the Queen’s Speech to the subject of health.

    Secondly, I agree with the right hon. Gentleman’s expression of the thanks of the House, and indeed of the whole country, to those who work in the Health Service. He singled out the nurses. That was certainly justified, and one can add all the other professional, para-medical and non-professional people who work and strive to give of their best, often in extremely difficult circumstances.

    The Prime Minister has intimated to me that he must depart very soon, so, if I may, I shall break the natural order of my speech and make one point now in his presence—and may I say how grateful I am to him that he has chosen to wait.
    One of the things that we expected to hear about in the Queen’s Speech was a Bill to reorganise the Health Service. The right hon. Gentleman made a powerful statement at Blackpool—in fact, I think that he startled his right hon. Friend. He certainly startled the Health Service when he said that it was to be further reorganised.

    Naturally enough, the press, caught a little unawares by this, tried to find out what was happening. There was an interesting article in The Times. After referring to the Prime Minister’s words, Mr. George Clark, whom we all know well and greatly respect, wrote:

    “According to the ministers closely involved, the area health boards will disappear in the reorganisation and there will be greater democratic control of the hospital service.”

    Mr. George Clark contacted me and asked me what were the implications of that statement—he was obviously making his inquiries. He is not a man who writes the words

    “According to the ministers closely involved”

    unless he has had some contact with Ministers closely involved. So there it was. Presumably, this was what the Prime Minister was referring to, and it is interesting because it is exactly what we have been advocating. We believe that there needs to be a slimming down of the ​ structure, the merging of a tier, and, in most of the country—although there must be flexibility about this—it is the area tier which must be merged into the others.

    But, alas, it was all wrong. That was not what the Prime Minister meant—or certainly not what the Secretary of State meant—because apparently a letter was written on behalf of the Secretary of State to administrators of regional and area health authorities of which, Mr. Speaker, for greater accuracy, I have obtained a copy. This was a little difficult because, despite the great importance of the Prime Minister’s remarks as interpreted by Ministers, and the very wide interest they had aroused, no publicity at all was given to the letter. There was no press release, no press guidance, no private briefings, not even one of the Secretary of State’s many speeches.

    But the letter is clear beyond peradventure. It is short, blunt and to the point. It reads:

    “Dear Administrator,

    In view of some of the misleading press comments on what the Prime Minister said at the Labour Party Conference on 3 October you may like to know that the Secretary of State has given an assurance that there is no commitment on the part of the Government to introduce legislation on the organisation of the National Health Service in advance of receiving and considering the Report of the Royal Commission.”

    The Prime Minister (Mr. James Callaghan)

    Hear, hear.

    Mr. Jenkin

    The Prime Minister said “Hear, hear.” What, then, are we to make of Mr. George Clark’s statement beginning:

    “According to the Ministers closely involved”?

    Mr. Ennals

    The right hon. Gentleman should not allow himself to be fooled by everything that he reads in the press. I can assure him that no such statement was made by any Minister in the Department. Perhaps the right hon. Gentleman should have taken the trouble to read what the Prime Minister actually said, which was:

    “Subject to the recommendations of the Royal Commission on the Health Service, we intend to undo much of the damage caused by the Tory reorganisation and make the management of the Health Service more responsive to the patients and to the dedicated people at all levels who work in the Service.”

    I hope that the right hon. Gentleman will warmly congratulate my right hon. Friend on setting that lead.

    Mr. Jenkin

    Yes, if I knew what the Government’s intentions were. What we have in this episide is that on Tuesday 3rd October the Prime Minister goes to Blackpool and cheers up the Labour troops by telling them that it is all going to be changed. On Friday 6th October, quietly and surreptitiously and without any publicity at all, the Secretary of State reassures the managers principally concerned that, of course, it is all nonsense and that nothing whatever will happen. All I can say is that it is one hell of a way to run a health service.

    I am grateful to the Prime Minister for staying in the Chamber, but he must realise that he caused great dismay by his talk of a major reorganisation at this stage. This most emphatically is not our policy.

    The Prime Minister

    I am not sure that it was worth staying. I have the very highest opinion of Mr. George Clark, as of every other journalist, as we all have; we all know how splendid they all are. But I think that the misapprehension could have been avoided if the initial words of my statement had been quoted, but, alas, they were left out of a number of the press documents.

    They were

    “subject to the recommendations of the Royal Commission”,

    which, I understand, we shall not have until several months from now. Anybody who really studied these matters would therefore know very well indeed that we could not possibly legislate in the current Session, so there was no need for the apprehensions.

    I would just say this in conclusion. Every morning I say to myself “Shall I really correct this error that is in the newspapers?”, and then I decide “No. If I spend my day correcting all the things that are wrong which are written about me I shall never do anything else”.

    Mr. Jenkin

    Perhaps we can leave it at that. I accept the Prime Minister’s bona fides on this. Apparently, he did not mean what was attributed. But it seems to me that with a matter of this importance—and the Secretary of State had a very strong letter from John Bettinson, the chairman of the National Association of Health Authorities—a little more publicity might have been given to the denial, as a good deal of publicity had ​ been given to the original misapprehensions.

    I said that we selected the subject of health for debate today because of the real concern of the people over the state of the National Health Service—not just because of the appalling damage done by the recent dispute, or even on account of the evidence that we have recently had from the Royal College of Nursing about falling standards and collapsing morale, but because as I go round and talk to people in the hospitals and in the constituencies I detect a growing fear that the NHS is rapidly sliding out of control while the Secretary of State stands, as it were, feebly expostulating on the sidelines and quite powerless to halt the slide.

    We read in the Queen’s Speech about “fresh support”. I come straight away to the points that the Secretary of State has made about the financial support. I thought that today he might be announcing additional spending for the Health Service. Certainly that is what I read into his remarks in his reply to the nurses’ deputation. He has said that this will come. May I put this to him? We would welcome this. It would be a step to get back to the rates of growth which the Health Service enjoyed under the last Conservative Government. Let me repeat the figures to get it clear. On capital expenditure alone, in real terms, for every £2 that is being spent now on Health Service capital spending, £3 was being spent when we left office—I am talking about real terms, taking account of inflation. After a prolonged period of more than 3 per cent. growth per year, the growth rate has been cut back to 2 per cent. over the last four years, and the figures in the public expenditure White Paper, even taking account of the £50 million, made it 1·8 per cent. over the next four years. There was a suggestion in one of the medical magazines that the Government were aiming to get back to the long run rate of growth of spending. That would involve very substantial sums indeed. We shall wait and see what comes.

    A more general point is that in the Health Service local health authorities are large and complex organisations. If they are asked to change speed and direction at short notice and suddenly, as, for ​ instance, with the extra £50 million in the Budget coming only three months after the public expenditure White Paper, this makes rational planning of health services for the future almost impossible. It is bound to lead to a waste of resources. Of course people welcome the extra money. But one does not get the best value for money if one is constantly chopping and changing; sensible planning is made almost impossible.

    Mr. William Molloy (Ealing, North)

    The right hon. Gentleman should have told the right hon. Member for Leeds, North-East (Sir K. Joseph) that.

    Mr. Jenkin

    On the contrary. When we were publishing White Papers on public expenditure and health expenditures over a prolonged period, we tended to stick to the projections. If more money is to be spent on the Health Service, the sooner that people know when it will be available so that they can incorporate it into their plans the better value we shall get for the money.

    Mr. Ennals

    I gave an assurance without giving the figures. However, the right hon. Gentleman is clearly dedicated to George Clark and what he writes in the columns of The Times. I read on 16th May:

    “Mr. Jenkin explained the scheme when he was asked whether the Conservatives, if returned to office, would provide extra resources for the National Health Service. He said the Conservatives would adopt the projections for spending contained in the present White Paper on public expenditure.

    ‘We have to live within that, and there is no possibility of extra money’.”

    Did George Clark get that wrong, too?

    Mr. Jenkin

    I was asked on that occasion whether we were proposing to cut the money for the Health Service. I gave an absolute commitment then, and have repeated it since on a number of occasions. We have no plans for cutting the Health Service below what we shall inherit. That is the phrase I am using. I made that statement soon after the publication of the White Paper on public expenditure. The phrase I have used, which I stand by and repeat today, is that we shall not cut spending on the Health Service below the figures that we shall inherit. How far and how fast we shall be able to increase spending will depend, as is common ground between the two parties, ​ on how successful we are at managing the economy and restarting economic growth. It will be our aim, when we can, to get back to the rate of growth and spending on health that we had under the last Conservative Government.

    Dr. M. S. Miller (East Kilbride)

    It is not the same thing for the Conservative Party to say that, if elected, it will not cut expenditure. Other allegations have been made about increasing the money going into the Health Service by charges which are to be levied.

    Mr. Jenkin

    I have nothing to add to what I said in the earlier debate. The Secretary of State played the same old tune and perhaps I may be allowed to: we must wait for the advice of the Royal Commission. Listening to the Secretary of State fiddling his old tune, one might have thought that everything had stood still in the meantime. The fact is that we are expecting the report of the Royal Commission in a few months and it would be foolish now to make pledges in advance of that.

    I turn briefly to the subject of the nurses, because they have made a long and detailed critique of the Health Service.

    They talk of the falling standards in the Health Service, of the collapse in morale, and use very serious language about “continuing deterioration” and

    “the serious threat to the maintenance of standards of care.”

    In describing clinical areas, they talk of the resulting

    “positively dangerous standards of care.”

    We need to take those criticisms very seriously indeed. I do not know whether the nurses’ complaints are to be included in the right hon. Gentleman’s description of “carping criticism” which he made in his speech, but I take the memorandum, which I have carefully studied, extremely seriously.

    I take no part more seriously than the figures given of the rapidly declining number of learner nurses in the Health Service. Initial entrants from March 1977 to March 1978 are down 17 per cent. and learners down 13 per cent. That is very bad news for the country and for the Health Service. We did not hear anything from the Secretary of State on what is to be done about that.

    In many parts of the country—and this is true in my own area—it is not possible to fill those posts for which funds exist and they are below the regional norms. What the future position will be like fills one with great despondency. We are in the grip of a vicious circle, with falling numbers that result in overwork, leading to lower standards and increasing job dissatisfaction for the nurses. Consequently, many leave early, many do not complete their period of training, and the situation deteriorates further.

    Job satisfaction for nurses is the absolute key. They want to feel that their work is up to the highest standards that they were taught in their nursing schools. There is nothing more demoralising for people in that kind of work to know that they are giving only second or third-rate service.

    Mr. Molloy

    I agree with much of what the right hon. Gentleman is saying. Indeed, I think that the whole House agrees with it. However, we should like to know whether he will also agree that there must be a massive resurgence of resources to put right the matters about which the nurses have been complaining.

    Mr. Jenkin

    I made the point that we could afford a substantial increase in money spent on health only when the economy is once again producing the resources to enable that to be done. That is common ground between the parties. I do not think that there is any point in calling for a huge influx of funds at this stage, because we know that that cannot be done.

    I turn to the Briggs report, which was referred to in the Gracious Speech. We shall debate that, I believe, on Monday week, so I need say little now about it. It has been a long time coming, and we welcome it. I know of the lengthy consultations that have taken place, because of the understandable desire on the part of professional groups who wish to preserve their separate identities within the profession, bearing in mind their long and honourable records of service to the community. At the same time, we must avoid—and this is a question of balance—creating an over-rigid, over-cumbersome structure. We support the general aims of the Bill, but we shall ​ certainly wish to study the details very carefully.

    The Gracious Speech referred to vaccine compensation. We also welcome that. May we ask the Under-Secretary to state whether that will be taken into account in the calculation of supplementary benefits for affected families? When the Government were last asked that question, they reserved their position, but we now need to know. I do not know whether the Under-Secretary intends to say something on the future of the Pearson report and where the Government stand on that. These subjects are clearly interrelated.

    I turn next to the Bill to pay attendance allowance to kidney patients. The conduct of Ministers here has been a good deal less admirable. The sad thing is that those payments could now be being made if the Government had had the sense to adopt the Private Member’s Bill presented by my hon. Friend the Member for Ealing, Acton (Sir G. Young) in the last Session. I have been singularly unimpressed by the excuses why that did not happen. The Government said that the Bill was not properly worded and did not cover the subject adequately. My hon. Friend—indeed, the whole House—would have been ready to accept any amendments that could have been made to the Bill, either here or in another place, to enable those payments to be made to kidney dialysis patients as rapidly as possible.

    I have a horrid suspicion that the reason we have not had that Bill is that the right hon. Gentleman has an almost obsessive compulsion to take the credit for everything that happens. Why cannot he have a little grace and give credit where credit is due? Why could he not have allowed my hon. Friend’s Bill to reach the statute book? The right hon. Gentleman has not enhanced his reputation in this affair.

    Important though all this is, it is overshadowed by recent events in the Health Service—the maintenance supervisors’ strike. I should like to examine in some detail the arguments which the right hon. Gentleman has put to the House and those which were advanced during the strike. By common consent, this has been the most damaging strike—although it should not be described as a strike but a ​ dispute; the supervisors were being paid all the time—in the history of the NHS. That point has been raised by my hon. Friend the Member for Aylesbury (Mr. Raison) on a number of occasions.

    We cannot know whether deaths actually resulted from it, but we certainly may assume that deaths may have been hastened and that some who could have been cured will not now be cured. A total of 9,000 beds were closed, 300 hospitals were on emergencies only and waiting lists are now up by 60,000—a 10 per cent. increase—with untold misery and despair for patients. The dispute certainly dealt a further blow to morale in the NHS.

    The Secretary of State’s explanation has left a whole raft of questions unanswered. It needs to be made clear why the dispute was left outstanding for so long. That point was made by the hon. Member for Nelson and Colne (Mr. Hoyle).

    The dispute dates back to 1974. For all the criticisms of this party, the Government have been in office for four and a half years; they have been in charge of matters. They really cannot put the responsibility back on the last Conservative Government.

    The pay structure was settled for senior work staff in grades 1, 2 and 3 but not for grades 4 and 5. Yet it was only two months ago that management got round to putting forward pay scales for grades 4 and 5. Why was the grievance allowed to fester for over four years?

    By his inaction on this matter alone, the Secretary of State deserves severe censure. However, a much more serious question that he must answer—he has not yet done so to my satisfaction—is why this dispute was not settled within the first few days. His case, as he presented it to the public throughout and as he presented it again today, was that the Government were standing firm in defence of their pay policy. In his letter of 9th October to Allan Black, the chief staff side negotiator, he wrote

    “The Government would not be prepared to authorise any offers which would involve further increase in cost … we must ensure that any agreement is consistent with pay policy.”

    He has maintained that attitude throughout, including his phrase, repeated this afternoon, that what the staff side was demanding was “just not on”.

    The Daily Mirror quoted him as saying on 26th October, that

    “…we mustn’t create a situation which makes such a hole in the pay policy that there is nothing left.”

    Yet there has now been substantial evidence, from authoritative sources, that pay policy had nothing whatever to do with it. The Sunday Times quoted one of the staff side negotiators, Mr. Ray Harris—[Interruption.] I am quoting what the paper reported him as saying, and I believe it to be true that he said it. He said:

    “he … first realised that pay policy was an issue when they met Ennals two days after their action began. We were amazed at his attitude.… until then, and from our meeting with the Secretary’s junior colleagues at the ministry,”—
    that will be the Under-Secretaries—

    “we had been led to believe that pay policy had nothing whatsoever to do with our dispute.”

    Mr. Len Murray, whom the Secretary of State praised—and to whom we pay tribute for his part in settling the dispute—said:

    “‘Whatever the merits of the pay policy this dispute was concerned with the relationship between supervisors and related grades on the one hand, and electricians on the other. In no sense did the works staff concerned, or their unions, regard this as an attempt to break the pay policy.’”.

    This is a powerful case, which the right hon. Gentleman must answer. Yet he later went on the radio simply repeating that it was a matter of pay policy. As I understand it—and I have made my own inquiries—the issue, at the end, was relatively simple. It was whether all supervisors should share in the productivity bonuses, or only where a productivity scheme was in operation. The unions were insisting “all”. The management side was insisting “No. A productivity scheme must be financially viable”. That is common form when anyone introduces a productivity scheme. It must pay its way. There were also arguments about the lead-in time.

    But does not this mean that all we had here was not a dispute that put at stake the whole Government pay policy but a haggle over the small print of a productivity deal? That was the view of The Times, which said:

    “… the immediate issues are small beer to both sides.”

    ​The Guardian, in one of the strongest worded leaders that I have seen on the issue, said that it was

    “a snivelling pay anomaly of the most petty nature … It was foolish to try to construe the present dispute as a challenge to pay policy. We may be in Stage Four, but the supervisors’ grievance, hoary with age, predates even this Government’s long-running incomes policy.”

    The House needs to know which was right. Was it the view of management? The management told me that at no stage in the negotiations was pay policy even mentioned. Was that right? Were the unions right—Mr. Harris and Mr. Murray? Were the junior Ministers right, when they gave their indications earlier that pay policy was not involved? Or are we now to believe the Secretary of State that it was all a matter of pay policy?

    I am bound to tell the right hon. Gentleman that he has not emerged from this episode with any credit at all.

    Throughout he has given the impression of thrashing about in frenzied futility, blaming everyone and everything except his own dilatoriness in settling the matter years ago, and one of the reasons for his ineffectiveness has been his total confusion about whether pay policy was or was not at the back of it.

    Mr. Ennals

    Of course I can well understand the right hon. Gentleman, who represents a party which does not believe in pay policy—well, part of it dots and part of it does not; the Front Bench does not. I can well understand that The Times or The Sunday Times, or all sorts of other spokesmen, would wish to say that it was not a pay policy issue. The people who have to decide whether it is a pay policy issue are those who have responsibility for pay policy. That is Her Majesty’s Government. I say straight away that my hon. Friends did not give that impression. That was incorrect. When I spoke, I spoke not just for myself. I spoke for my Government—our Government—who have responsibility for pay policy. I have spelt out in detail the two clear roles in which this was a breach of pay policy. I can understand that people would say “No, we are not trying to break the pay policy”. The Government have to decide whether the pay policy is being challenged.

    Mr. Jenkin

    I wish that I had not given way to the right hon. Gentleman because ​ I am coming to these points. I think there was throughout a confusion as to whether it was pay policy or not. But I should like to take the argument a little wider and look at it in the context of the discussion that took place here yesterday between the Prime Minister and my right hon. Friend.

    Let us suppose, in the first instance, that the negotiators were right and the Secretary of State was wrong—that the junior Ministers were right and that pay policy was not the issue. Where does the case stand then? Surely, it is that this episode demonstrated, as starkly as could be imagined, that if one has a rigid pay limit it can foul up negotiations even where it is not relevant at all.

    Alternatively, let us take the other way. Let us assume that the Secretary State was right—and there may be some grounds for saying that at the later stage, when the 25 per cent. claim across the board for productivity bonus was made—and pay policy did by then become an issue. Does not this, too, demonstrate the folly of brandishing about a fixed limit at this stage in a pay cycle in that one sets up an Aunt Sally for the trade unions? We know that there are unions which are prepared to have it as their objective to smash the limit, irrespective of the merits of the particular case. None of the unions which are used to negotiating in this Whitley Council can have believed for one moment that a 25 per cent. across the board productivity payment irrespective of financial viability was a starter at all; but it was as good a way as any of trying to smash the Government’s pay limit.

    Mr. Ennals

    That is right.

    Mr. Jenkin

    Yes, but let us see where it takes the right hon. Gentleman. This was the view of a person who perhaps should know, the chairman of the area works officers’ association, West Midlands region, who has written an extremely interesting letter in this week’s Health and Social Service Journal. I quote:

    “It is only within the past week that both the media and our colleagues within the Service have considered that this is a direct confrontation with the Government pay policy. There appears to be evidence that this dispute is being used as an attack on the Government pay policy by unions and preventing a reasonable settlement.”

    I have no doubt that the Under-Secretary was right when he saw the staff side some time ago and said that to settle this dispute need not involve pay policy at all.

    Mr. Ennals

    Absolute nonsense.

    Mr. Jenkin

    What has happened by having the Prime Minister’s 5 per cent. pay policy is that it provoked the unions into putting forward a totally unreasonable claim which the Secretary of State then had to say was in breach of pay policy.

    Mr. Ennals rose—

    Mr. Jenkin

    Let me just finish my case. Whichever way one looks at it, whether pay policy was involved or whether it was not, the fact of the matter is that this dispute has taken us right to the heart of the argument which we had yesterday. At this stage of a pay policy, does it help to have a rigid 5 per cent. figure, which either gets fouled up with negotiations which are not relevant or else is used as a target by the unions to try to smash?

    Mr. Ennals

    I did not wish to intervene again, but the right hon. Gentleman has made an accusation against my hon. Friends which I have already denied. I made it absolutely clear that my hon. Friends in their discussions said no such thing. The right hon. Gentleman really cannot do this in the House. It is quite wrong. I have given him an assurance that no such statement was made by Ministers, and if he wishes to turn this into an economic debate, let him do so.

    Mr. Jenkin

    I accept what the right hon. Gentleman says. If he gives me an assurance, of course I accept it. The fact of the matter is that we are in the heart of an economic debate, and as a result of the way in which the situation has been handled we have had now the worst dispute in the history of the National Health Service. It is well known that the 5 per cent. figure was plucked from the air by the Prime Minister in the course of a television interview, much to the dismay of many of his colleagues. They knew what the consequences would be. In 1974, a rigid limit plunged the country into the three-day week and brought down the Government. Now, in 1978, another rigid figure has hit the National Health ​ Service with the worst dispute in its history and may well have led to loss of life.

    In his speech yesterday the Prime Minister asked:

    “Are we to have a winter of strikes?”

    It means, he continued:

    “that life could seize up in a closely-knit industrial society such as our own.”[Official Report, 1st November 1978; Vol. 957, c. 53.]

    In the National Health Service it is not just that life seizes up, it is that lives are snuffed out. That is the price that we are now paying for an over-rigid pay policy.

    Of course, this would not be so if it were not for the activities of those in the National Health Service who use patients as weapons in their disputes, by taking industrial action. We debated this subject last July, but it has now become one of even more intense public concern.

    People have been horrified by what they have seen and read in recent weeks. In a straightforward battle for more money, the unions involved have not hesitated to use the torment of patients as a weapon in their struggle—and “torment” is the right word. There was the lady sent home with a fractured knee joint, in agony and untreated; the 85-year-old man with a broken shoulder joint, sent home in agony and untreated; cancer patients, where surgeons reported that cases which were operable were now becoming inoperable. The list is very long.

    My hon. Friend the Member for Aylesbury received a letter last week from an elderly lady of 77 with polio in one leg who needs an operation on an arthritic knee in the other. She has already been waiting over 10 months. She wrote:

    “Mr. Taylor the consultant has told me that owing to the industrial dispute the waiting list will now be much longer and as I live alone and am not able to get out life is becoming very depressing. When working before retirement I worked 10 years in the hospital service including the Royal Bucks.”

    What does she think of what has been going on during the past few weeks? All over the country there were similar stories, and 60,000 cases were added to the waiting list.

    I have to ask this—have we all gone mad? How can one justify using the sick and injured in this callous and inhuman ​ way? Have we reached such a level of moral bankruptcy that we accept with a resigned shrug that one man’s pay claim may be another man’s coffin? [Interruption.] I have said many times that I condemn all those who strike in the Health Service. We were very firm about that when we were faced with strikes in the medical profession.

    Look at the defences we have heard. First, there was the flat denial that anything at all was going wrong. COHSE’s spokesman, Nick Grant, said:

    “It is extremely doubtful whether there’s a cause-and-effect relationship between the patients being turned away and the supervisors’ action.”

    Further on he said:

    “The difficulty we always have in disputes is that certain consultants tend to exaggerate and make some sort of capital out of them.”

    We can treat that statement with the contempt it deserves.

    Then there was the counter-attack. The right hon. Gentleman felt its blast when he finally, from Norwich, made his appeal to the men to go back and pointed out what the consultants there had told him. Of what was he accused? He was accused of “blackmailing the union” which, when one considers what was going on really makes one puke.

    Perhaps almost more offensive than the other defences was the mealy-mouthed excuse “Yes, we know. We are very sorry, but it is not our fault.” I have said that I thought the men had a case that should have been dealt with years ago, but it seems to me absolutely outrageous that the sums of money involved should have given rise to the hardship which we have been facing.

    Geoffrey Drain, in his letter to The Times, which aroused a pretty fierce riposte from a number of people, said:

    “NALGO joins … in feeling sympathy for patients caught up in the effects of the industrial action currently being undertaken by hospital engineers and building supervisors. Mr. Rodger “—

    who had written earlier—

    “however, is misinformed. These NALGO members are not on strike. They are refusing to undertake tasks for which they are not being paid; additionally they are not carrying out certain maintenance work.”

    In law a man is presumed to intend the natural and probable consequences of his act. If a union orders men not to service ​ essential equipment and as a result patients have to be sent home in pain and untreated, it does not lie in the mouths of the union leaders to claim that that consequence is unintended. However we look at it, the object, the purpose, is to put the screws on management, but the result is to punish the patient.

    None of the men concerned would, individually, set out to cause suffering to a sick or injured person to secure a private gain. I must again ask the question that I asked on 3rd July, to which I have never had an answer: why does it apparently become quite acceptable to do so collectively in order to secure a collective gain? What is it about trade union morality which seems to blunt individual consciences?

    When I asked that question in July Albert Spanswick, the general secretary of COHSE, in reply to the debate, wrote a very intemperate article in the COHSE journal, accusing me of “an extraordinary display of Tory prejudice.” On some matters I admit to prejudice. I am prejudiced against depriving patients of urgent medical care as a weapon in a dispute over more money. That is one of the matters on which I shall maintain my prejudice, because I believe that that is totally wrong.

    Therefore, I ask—and I was half encouraged by what the Secretary of State said—that we now work towards what I have called a patients’ charter. Of course, that must mean improved negotiating procedures. The Secretary of State said that the Whitley machinery existed to avoid such disruption when difficulties arose. It is clearly not working. Four and a half years have passed without this grievance being dealt with.

    The action announced last week was a small step in the right direction, but, as the Secretary of State conceded, it does not deal with major issues. It may deal with the kind of case that occurred in the constituency of my hon. Friend the Member for Kingston upon Thames (Mr. Lamont), where, because of a keen and efficient security manager, thefts totalling £100,000 a year were traced and stopped, but the unions have walked out on strike because they think they are being victimised. I hope that the right hon. ​ Gentleman’s new procedure will stop that sort of scandal. It makes me very angry. That security manager has now been suspended because of union pressure pending the inquiry. It is absolutely outrageous.

    Mr. David Price

    Will my right hon. Friend answer the question that I wished to put to the Secretary of State? Surely, at the non-pay level we must have a more effective consultative industrial relations machine in the Health Service. I do not wish to be pompous, but I have had much experience in industry. Although one may have national agreements, a great deal of detail is filled in at work level. That is what participation is about. I do not wish to mention particular cases from my part of the country—I am speaking as one who was once a governor of a London teaching hospital—but surely we must have better machinery whereby more matters can be settled in the hospitals and not have to go higher.

    Mr. Jenkin

    I agree. We want more than just the short-term brush-fire operation which the Secretary of State announced last week. My hon. Friend is saying that there must be a greater capacity to deal with industrial relations problems at the working level. I am sure of that. The right hon. Gentleman has had the McCarthy report; practically nothing has happened—

    Mr. Ennals

    Oh.

    Mr. Jenkin

    No doubt, the Under-Secretary will tell us what has happened. Consideration of the McCarthy report, which dealt with the structure of the staff side, seems to be grinding exceedingly slowly. Meanwhile, the nation is having to suffer as we suffered over the past few weeks. It is already clear that we are to suffer again in the future. Other unions are threatening to follow the supervisors down the same road. The National Union of Public Employees has tabled a 40 per cent. pay claim for hospital ancillary workers, as reported in the Financial Times, warning that it has

    “completed detailed contingency plans for industrial action against the Government’s 5 per cent. pay policy.”

    The Financial Times gave an account of what is envisaged:

    “The plans are aimed at identifying areas of maximum disruption to the Health Service ​ and the effects could be similar to—and possibly worse than—the crippling action taken by hospital works supervisors over the last five weeks.”

    That is a grim outlook, which is already casting dark shadows over the next few months in the life of our hospitals. Yet against that background all that we have had is the bland and reassuring words of the Queen’s Speech that more resources will be made available. Against that kind of background it is empty rhetoric.

    The Government have presided over the Health Service for four and a half years and the result is now rock-bottom morale, falling standards and growing public disillusion with the whole concept of the NHS. It is time for a fresh start—the kind of start that only a General Election can bring.

    Mr. Laurie Pavitt (Brent, South)

    You must have heard hundreds of speeches, Mr. Speaker, in which an hon. Member has apologised to his predecessor, saying “I shall not be following you”. I want to reassure the right hon. Member for Wanstead and Woodford (Mr. Jenkin) that I shall be following him very closely because, somehow or other, without straying very far from my own notes, I seem to be moving step by step in the same framework.

    I wish to pick up three points which arose earlier. First, may I dispose of the intervention about Mr. George Clark? Mr. George Clark came to see me on the Friday after the Labour Party conference, and we had a chat. I assure the right hon. Gentleman that, although my right hon. Friend the Secretary of State has affection and respect for me, I have never been close enough to be able to influence what he says or what the Department does. So I am afraid that, as the right hon. Gentleman knows, the idea that someone could have direct access to the DHSS by talking to a Back-Bench Member is not feasible.

    The second point that I should like to take from the right hon. Gentleman’s comments is the challenge put to him by the Government Front Bench. He made the categorical statement that a Conservative Government will not in any way allow less expenditure than that which they inherit on the NHS budget. Secondly, he believes that public expenditure must ​ be contained. Thirdly, I accept that he sincerely believes that resources for the Health Service must be improved.

    If we take those three propositions together, we reach the inescapable conclusion that the only way in which he can get fresh resources without increasing public expenditure—while maintaining the expenditure which he inherits—is by some form of charging. I hope that whoever winds up the debate from the Opposition Front Bench will tell us whether there will be increased prescription charges, board and lodgings charges, increased charges for spectacles or teeth, a fee for an interview with a general practitioner, or any of the other kites that have been flown.

    The right hon. Gentleman concluded by expressing anger and concern. For every case that he has put to the House—and I know of these cases, too, in the past few weeks—I know from personal experience of cases where, in spite of difficulties, devoted Health Service workers—including some in the grades that we have been discussing—have managed to clear the lines, do a job of work and save people from going on the waiting list. I speak from personal knowledge.

    Why do we always hear this jeremiad about all that is wrong and how the trade unions do not do the job, yet never hear the compensating points? I hear both sides. It would be helpful if the House sometimes heard both sides as well.

    The right hon. Gentleman said nothing about the attitude of the Tory Party when industrial action by doctors raised the waiting list from 500,000 to 600,000. That was the time when he should have spoken out about industrial action being harmful to patients.

    Mr. Patrick Jenkin

    I have not checked back through Hansard, but the conduct of my hon. Friend the Member for Sutton Coldfield (Mr. Fowler), who was then our spokesman, was in marked contrast to the attitude of Labour Ministers when we were facing strikes not only in the Health Service but elsewhere. My hon. Friend made it abundantly clear that in no way could we support industrial action aimed at disrupting the Health Service or indeed at breaking the Government’s pay policy.

    That has been our consistent and responsible view throughout. I held my ​ peace entirely during this last dispute because I did not think that an Opposition spokesman not privy to the negotiations could make a comment upon it.

    Mr. Ennals

    What about the hon. Member for Reading, South (Dr. Vaughan)?

    Mr. Jenkin

    The natural revulsion of my hon. Friend the Member for Reading, South (Dr. Vaughan) stems from the fact that he is a doctor and perhaps feels more passionately than most of us what doctors feel when they are unable to treat patients whom they are asked to see.

  • Peter Hardy – 1978 Speech on Lawrence-Moon-Biedl Syndrome

    Below is the text of the speech made by Peter Hardy, the then Labour MP for Rother Valley, in the House of Commons on 6 July 1978.

    Many hon. Members are well acquainted with tragedy. Each day we learn of the griefs and tribulations which affect our constituents or ourselves. That is why I understand why the Under-Secretary of State is replying to the debate. Perhaps we become so accustomed to responding that the response becomes habitual. But sometimes we encounter circumstances which are particularly dreadful.

    This has certainly been the case with my experience of the Hoden family of East Hellingthorpe, Rotherham. The first I learned of this family’s problems was through the local papers. I checked that Mr. and Mrs. Hoden were my constituents and then commenced inquiries into what seemed to be an alarming story. The inquiries convinced me that the alarm was justified.

    I called to see the Hodens at their home in the company of Mr Payne, the secretary of the Rotherham community health council, on 29th April. Before I made that call Mr. Payne furnished me with a moving account of the family’s experiences. I wrote to the Minister and the Rotherham health authority and conveyed the Hodens’ strong belief that a thorough inquiry should be held. Mrs. Hoden had written in similar terms to the authority on 3rd February this year.

    The area administrator wrote to me on 26th May to say that the chairman had instructed his officials to assemble all the known facts in order to assist the authority to decide whether to hold an inquiry. I understand that the information is still being compiled. I believe, however, that sufficient information is known to allow a decision to be made. But that question has not yet been resolved.

    I received a letter from the chairman dated 23rd June which informed me that the information was not yet ready for decision. The Minister might say that I should have awaited a decision. But I did not feel that I could let further months elapse. The pace of administration must not be allowed to determine the speed of representative response.

    I regret that matters have not proceeded more urgently. I hope that the Minister will not seek to shelter behind the authority. I hope that what he knows already and what I shall say will convince him of the need to urge that an inquiry is held. It is necessary not to blame individuals or pillory the service but to ensure that lessons are learned.

    Mr. and Mrs. Hoden are good and respectable people. Mr. Hoden is a strong clean man and is a mains layer in the civil engineering industry. He is quiet and decent and is an anchor in the storms which have assailed his home. Mrs. Hoden is more articulate, a good ​ South Yorkshire housewife and, as the authority is learning, a determined mother. She has a passionate concern for her children. I am not surprised, just as I am not critical, about the insistent questions which she is asking about her children. The replies she has received have not satisfied her.

    The three children are said to be affected by the Lawrence-Moon-Biedl syndrome. Tina is the eldest, born in December 1961. Diane was born in May 1963 and Barry in January 1965. They have been receiving attention for visual difficulty almost since infancy. Tina was born in Listerdale Hospital, Rotherham with extra digits which were removed at Lodge Moor hospital, Sheffield when she was a baby. She was then a patient at the children’s hospital in Sheffield. Both Diane and Barry had similar experience.

    Just before Barry was born in 1965, the two girls contracted measles and Diane seemed to develop an eye condition. She was seen at the Doncaster Gate hospital, Rotherham, and was referred for eye exercises and treatment, which included wearing a patch to correct a lazy eye. Later records suggest that nystagmus was diagnosed.

    Barry was born in similar condition, again with extra digits, but with the addition of talipes foot. Surgery to remedy this was carried out before he was 11 months old. He then developed cerebrospinal meningitis and was in hospital at Moorgate in Rotherham. Barry was classed as ineducable while in his fourth year. Tina started school at five in the normal way. Eye tests were carried out, but Mrs. Hoden was told little except that the girl was short-sighted.

    From about this time Mr. and Mrs. Hoden found that accidents were happening and they could not let the girls out after dark. Questions were asked at the eye clinic but these are said to have brought merely a brisk and officious response.

    At the age of seven Tina was said to be falling behind at school and she was later classified as backward and sent to the Abbey special school in Rotherham. Diane was given a similar classification and attended this school from the age of six. Barry, classed earlier as ineducable, made progress and also arrived at the Abbey school.

    The children had regular eye tests but the parents were never given any idea that a serious position was developing, until retinitis pigmentosa was simultaneously diagnosed in all three children late last year. Certainly from the period when the eldest girl, Tina, was about nine, the children were often having accidents, slipping off kerbs, bumping into posts, walls, and so on. The attention of the medical authorities was drawn to these incidents but they were told that it was because the children were backward.

    Eventually Mr. and Mrs. Hoden requested that the children see another consultant. This consultant, so Mrs. Hoden tells me, said simply that both girls had bad right eyes and that the optic nerve was withering.

    By 1977 the Abbey school had become worried since the children were experiencing serious difficulty. Unbeknown to the parents, the school is said to have expressed anxiety. I have spoken to the headmaster and he confirms that the anxiety was serious enough for him to feel that needs seemed to be going unresolved.

    In early 1977, the school medical officer was asked to assist. At about the same time I understand that a doctor from the department visited the school for another purpose and met these children. Apparently he is said to have urged that further steps were needed.

    In April 1977, Mrs. Hoden learned that the school authorities had contacted the medical authorities, and in June these children saw another consultant. They were told that the right optic nerve had withered and they had night blindness. The case was referred to another consultant. Five months elapsed before this was arranged.

    On 1st November last year the consultant, Mr. Maw, saw the three children with their parents. There was great distress when the parents learned that all three were going to be totally blind. Mr. and Mrs. Hoden then discussed the matter with Mr. Maw, who explained the nature of the condition. I understand that Mr. Maw was unaware that no earlier explanation had been given. Perhaps I should add that I am not critical of Mr. Maw. He is an experienced consultant of high standing in our area and he faced a dreadful situation. To have ​ to break such news must have been an ordeal. The ground should have been prepared before.

    Mrs. Hoden has asked if the eye condition could be the cause of other difficulties and anxieties and of the series of trials and tribulations which had been experienced.

    The Lawrence-Moon-Biedl syndrome was at least suspected by Mr. Maw, as soon as he saw the children together. He observed common characteristics, not merely the visual difficulties. I believe that he wondered whether retinitis pigmentosa was not primary but part of another condition or syndrome, a distinct group of symptoms which form a whole.

    The case was then referred to Dr. Hosking, a consultant at the Reigate centre for children in Sheffield. Dr. Hosking confirmed Mr. Maw’s suspicions. Aspects of the syndrome are or were to be observed in each of the Hoden children—extra digits at birth, obesity, the dreadful handicap of retinitis pigmentosa, some deafness, and mental retardation, although as far as deafness is concerned, the girl’s problems appear to be eased now, for only Barry wears a hearing aid.

    The Hodens therefore know the worst. As I said, that was very long after the first symptoms were to be observed. To be fair, this syndrome is rare. Dr. Hosking had encountered only two previous cases, but it is a well documented condition, first described a century ago, and I know that one child—one, not three—sadly has had it diagnosed in another area of Yorkshire recently. That child is only seven years of age.

    Mr. and Mrs. Hoden do not seem to be critical of the education authority, for they were told that on the children’s records—records which clearly ought to have been more adequate—there was only reference to eye difficulty. That is an example of unsatisfactory communication which my hon. Friend should note.

    Early this year the Hodens visited the Henshaw school for the visually handicapped in Harrogate. It was pointed out quite properly that the elder girl, Tina, by now aged 16, should be leaving school, not starting it. I understand that one official present remarked that something had gone wrong somewhere. Something ​ very clearly has gone wrong. The condition—if I may use Mr. Payne’s words, the approach to eventual darkness—had been disregarded.

    Since the diagnosis Mr. and Mrs. Hoden have attempted to ascertain the facts. As far as they are concerned there was no hint of gravity of vision until June 1977. There should not have been such delay, such slowness of response, or such inadequacy of communication, before the consultation on 1st November. Perhaps my hon. Friend will bear this in mind when the authority considers its decision.

    I know that the Trent region health authority, and our South Yorkshire part of it especially, has been the least favoured area for health provision for a century or more. I know that the Government are set on a course to put that right. But the fact is that while we have below-average waiting lists at our hospitals the Trent authority has 17·4 consultants per 100,000 population, as I learnt from a Question this week, and that compares unfavourably with the highest provision, at North-East Thames, of 26·19 per 100,000. I know that my hon. Friend is determined to get the balance right, but I should like him to be rather less gradual in his approach. Certainly, I hope that inadequacies in consultant establishment have not proved a factor in this case. He might care to comment on that.

    The children, all three, commenced attendance at the Henshaw school in February. I have spoken to Mr. Seed, the head, this week. The latest position is interesting. Given earlier classification of Tina as educationally sub-normal, I was surprised when Mrs. Hoden told me that Tina had asked her the other day “Mother, what do I have to do to prove that I am not stupid?” That is not a question an educationally sub-normal child would ask.

    Tina is not now classified as ESN. An educational psychologist assessed her earlier this year and said that were it not for Tina’s sight she would have no hesitation in sending her to a normal school. This view seems substantiated by the fact that after 11 weeks at the Henshaw school, Tina obtained a certificate of merit for successfully passing her first ​ Braille test. She can now manage to read simple language in Braille. Clearly, there was a dreadful error in her early classification. That needs to be considered, too. I regret that I cannot say that there is obvious error in educational classification of the siblings, but clearly Tina was wrongly labelled.

    Certainly, one can well understand Mrs. Hoden’s anguished cry “Can anyone tell me how in the name of God did three children escape the diagnostic and registration net?” Mr. and Mrs. Hoden insist that they should know, and I believe they have that right. As their Member of Parliament, I feel that investigation is needed.

    I have it on authority—and my own observation bears this out—that Mr. and Mrs. Hoden are caring parents. I am not convinced that society has shown sufficient care. I consider that we need to know whether medical, social and educational diagnoses, treatment and arrangements have been sufficiently careful. We also need to know whether there has been adequate communication between the individuals and agencies involved.

    Until Mr. Maw’s consultation there was grossly inadequate communication to the parents. Mrs. Hoden maintains her belief that the diagnosis was noted earlier, and does not seem to accept the explanation of the reference to the condition on an attendance allowance application form.

    I have already raised serious questions. As I first wrote to my hon. Friend some time ago to express my concern, I hope that he is able to offer comment. Before he does, let me say that South Yorkshire places great store on good neighbourliness. That is shown in this case. In various parts of our area the people have been touched by the Hodens’ experience, and widespread effort is being put into aid for the children. I welcome this evidence of kindness.

    It is good to know that there are many Samaritans in South Yorkshire. But, as my hon. Friend will realise, we in South Yorkshire, above all, are entitled to expect that official provision is sufficient. We are not so given to the parrot cry of cutting taxes above everything, for our history leads us to recognise that civilised arrangements are necessary and must be paid for. We are offended by the reality ​ of Mrs. Hoden’s comment of 3rd February to the health authority, “If someone had spoken years ago, my children would have received years ago the help they will now get”. We wish to know why they did not get it.

    My hon. Friend the Member for Grimsby (Mr. Mitchell) recently raised the question of treatment for retinitis pigmentosa. I shall not repeat his arguments, but I welcome the Minister’s promise to several of us on the Labour Benches that he will study the cases of people who believe that they have benefited from the Oops clinic treatment. May I ask that this study be carried out with urgency? May I ask that if it reveals that benefit has been conferred, provision of this treatment will be rapidly encouraged? That may offend orthodoxy. However, until the study is complete one cannot ignore the claims of people who feel that their condition is noticeably improved by the treatment. I am uneasy about their claims, for I understand that spontaneous improvement is anyway possible. I understand the official response, but, given their experience, the Hodens cannot be easily reassured.

    My hon. Friend may be able to tell me that every possible help will be given to these children in the future. I shall be pleased to hear that. However, I should also like to be assured that the failure in communication, the inadequacies in response and the possible misinterpretations and inaccurate classification apparent in this family’s experience will not be repeated on the scale that has apparently occurred here.

    Certainly authority should consider whether it fully understands the public response, for, as I have shown, this case has moved many people in my area.

    With my hon. Friend the Member for Rotherham (Mr. Crowther), I attended the East Herringthorpe club on Friday night, when one of the efforts to support this family was under way. I met Mr. and Mrs. Hoden again there. Hundreds of people had come to show their support. Seven hundred pounds was raised in a very short time. The widespread kindness which was exhibited was memorable. But more important and more obvious was the cry that this must not ​ happen again. There was very genuine and very welcome concern.

    I trust that my hon. Friend will be able to satisfy those people, will be able to respond to the Hodens’ needs, and will be able to comment appropriately on my questions.

  • John Eden – 1978 Speech on Hospital Beds in Bournemouth

    Below is the text of the speech made by John Eden, the then Conservative MP for Bournemouth West, in the House of Commons on 28 June 1978.

    I congratulate my hon. Friend the Member for Beeston (Mr. Lester) on bringing to the House the petition which he has just presented. On behalf of the pharmacists in my constituency, I endorse every word that my hon. Friend said about the strength of feeling which he has so adequately represented. Those who have been responsible for organising the petition and collecting the signatures have done extremely well. They are to be congratulated on having amassed so many names and on having made clear to us in the House, and hopefully to the Government, too, what action needs to be taken in the interests of the pharmacists of England and Wales.

    Before the House adjourns I wish to draw attention to a matter of considerable importance to the people of Bournemouth—the shortage of hospital beds in that area. I hope that my hon. Friend the Member for Bournemouth, East (Mr. Atkinson) will have the opportunity of catching your eye, Mr. Deputy Speaker, to support what I say.

    There is a serious shortage of hospital beds in the Bournemouth area. That is, however, not a new situation. It has existed for some years. I have seen the lists kept by one consultant that give details of every patient who was waiting on the emergency bed service for over 48 hours during the past three years to four years. It happens—this is not to ​ dramatise but to make a point of fact—that some of the patients died before they were found a bed in hospital.

    The consultants in the Bournemouth area have for long been worried about the shortage of hospital beds. Two of them—the chairman and the vice-chairman of the medical staff committee of the Bournemouth and East Dorset Group Pathology Service attached to the Royal Victoria Hospital in Bournemouth —recently wrote a letter to the local Press in which they stated:

    “While patients in hospitals are receiving adequate care there is no doubt that too many patients wait too long to get into hospital because of an acute shortage of beds.”

    These are responsible people who write such things. They are not given to hyperbole. They weigh their words with care and speak with deep anxiety.

    The consultant representative on the East Dorset district management team, Dr. Christian Loehry, has played a leading part in drawing attention to the seriousness of the shortage. He has given me details of waiting time for in-patient treatment that fully justify all the expressions of anxiety and concern. The records have also been shown to the community health council, which I understand now fully supports the views of consultants that early and effective action is most necessary. I see that in a recent statement in the Evening Echo it recommended that

    “every effort be made to co-ordinate efforts to effect a long-overdue improvement in the situation regarding emergency admissions.”

    The figures that I have seen indicate that in the first week of February 1978 the aggregate number on waiting lists for in-patient treatment in the East Dorset district was just under 5,000. In some specialities—notably general surgery, ENT and orthopaedic—the numbers were especially high.

    I know that orthopaedic waiting lists have been eased slightly by the opening of the Christchurch facility. That is extremely welcome, but the situation is still very serious, especially for those who are waiting for hip operations. That information comes to me not only from my constituency but from the two constituencies on either side of mine. It bears out the difficulties and personal ​ problems that are being experienced in the whole of the region—I have an interest to declare because tomorrow morning I have to go to an orthopaedic surgeon to have my hip checked. I hope that something will be done in that regard. It is a serious matter which for far too long has been attended by waiting lists which are totally indefensible.

    There is another matter which should be discussed. When speaking of the Bournemouth area we are speaking of a holiday resort. There is a substantial influx during the holiday months which, at its peak, doubles the population. This causes additional problems for the existing services and no special regard seems to be paid to them. It places extra demands on consultants and doctors and obviously puts new pressures on the beds that are available.

    In this area there is also a marked shortage of assessment beds for geriatric cases. Not surprisingly, Bournemouth has a large number of elderly people. We welcome them. Many of them come to Bournemouth to retire and to spend the remaining years of their lives in this attractive area. But this means that they have special requirements which are not being met adequately. Because of the many elderly people in the area, the need for more geriatric beds is urgent. This applies not only to Bournemouth but also to Poole.

    In answer to a case with which I have been dealing, the district administrator at the hospital wrote to me and said:

    “Facilities for psychogeriatric patients are grossly inadequate in this district”

    —that is the East Dorset health care district. He explained that because of this very difficult decisions on priorities had to be reached.

    It is appalling that that should be so. It is appalling that people should have to take decisions of that kind. Of course as I know the Minister understands, it is far more serious for the patients themselves.

    It is clear that there is widespread concern amongst informed and responsible people about the inadequate number of beds in the Bournemouth area and about the difficulties experienced in admitting patients through the emergency bed service.

    For these reasons I and my hon. Friend the Member for Bournemouth, East feel fully justified in raising the subject in Parliament and in pressing the Minister to authorise early action to ease the intolerable situation. Our constituents want action.

    We welcome that in August 1982 a start is to be made on phase 1 of the new 900-bed district general hospital. When phase 1 is completed—and that is planned to be in August 1985—the hospital will provide 281 beds. The net increase in beds, however, depends upon what else is done in the meantime and what else is done when phase 1 is completed. For example, if it is planned to close the Royal National Chest Hospital, some beds will be taken away and the net position will not be as good. We must be careful to ensure that by the end of this exercise we are better off than before.

    My anxieties in this regard are aroused by the fact that we are not to get a complete hospital in 1985. We are to get phase 1 of a complete hospital. Phase 1 is, in fact, a unit package, with many of the essential specialities omitted from it. I am not disappointed that we are getting phase 1; believe me, it is far better than nothing at all. But what would be better still would be a complete hospital, with all the facilities, all the specialities and all the services provided there.
    When is that to happen? When is phase 2 to begin, to complete the hospital that has been planned and talked about for such a long time? When is phase 2 to start? Will the Minister assure me this evening that there will be no gap between the completion of phase 1 and the start of phase 2?

    Meanwhile, it is most urgent that we press ahead with the building of a new 30-bed ward at Boscombe Hospital. This has also been under discussion for years, but for some reason no decision has been taken until just recently. For some reason, the Wessex regional health authority seems to have been sitting on this proposition. I have seen letters from the authority to consultants in my constituency which left me speechless, since they seem to be unaware of the urgency of the situation. Now, at last, it seems that it will go ahead, but exactly when I am not absolutely sure.

    I want to know exactly when this new 30-bed ward is to be built. I want to know when it is to be started and when it is to be completed. If the Wessex regional health authority does not understand the urgency of the situation, it should give itself a holiday from its paper work and come to Bournemouth to ascertain the facts on the spot.

    I want to make two other points. The first is related to this, although not directly concerned with the in-patient aspect. I refer to the out-patient problem. There is an acute waiting time for new out-patient appointments with consultants. In some cases this is grotesquely long. In neurology, it is as much as 35 weeks. There seems to be a grave shortage of neurologists. I do not know what steps are being taken to try to overcome it. I do not suppose that it is peculiar to the area I represent, but this seems to me to be a problem which deserves close attention. A period as long as 35 weeks must be wrong. In surgery, the period is anything from 10 to 31 weeks. In orthopaedics, it is anything from 10 to 29 weeks. In ENT it is 21 weeks, and in urology, 20 weeks.

    It is wrong that we should have to contemplate figures of this order of magnitude. I am certain that the Minister would like to see them shortened. We would all wish to see them shortened. What worries me is that they have been going on like this for far too many years. I had a letter the other day from a leading doctor in my own constituency who has said that over the last seven or eight years, far from getting better the situation has been getting worse. No wonder doctors are worried and frustrated.

    Finally, I should like to make one general point. It is that by comparison with other areas, Dorset is seriously under-funded. Will the Minister please undertake to look at this, and will he tonight give firm answers to the two questions that I have put to him?

  • Eric Deakins – 1978 Speech on Multiple Sclerosis and the Naudicelle Treatment

    Below is the text of the speech made by Eric Deakins, the then Under-Secretary of State for Health and Social Security, in the House of Commons on 5 May 1978.

    I am glad to have this opportunity of replying to the points raised this afternoon by my hon. Friend the Member for Derby, North (Mr. Whitehead). I know that his interest in this subject—which goes back a number of years—is shared by other hon. Members. Let me say frankly at the outset that there is very little I can add to what my right hon. Friend the Minister has already said on this matter in reply to hon. Members who have written to him and put down Questions in the House.

    The reason for this is that in all fields of treatment and prescribing of medicines one must tread most carefully and cautiously and, as I hope I can show to the satisfaction of my hon. Friend that, in this area particularly, there is very good reason indeed for slow progress. Let me first explain something of the general context in which treatment under the National Health Service occurs.

    Family doctors, under the National Health Service, are free to prescribe any drug or medicine they consider necessary for the proper treatment of their patients, though they may be asked to justify their prescribing decisions, if the cost appears excessive, or if the substance may not be a drug. Only the doctor concerned can decide whether something is necessary for the treatment of his patient and whether that substance is something that should properly be prescribed as a charge on the National Health Service.

    If there is any doubt on the latter point, the doctor will consider carefully whether he would feel able to justify the ​ decision to prescribe a substance if called upon to do so. If he is satisfied on this point, there is nothing to prevent him from issuing the prescription and it being dispensed in the normal way.

    I emphasise that it is the doctor, and only the doctor, who can determine which medicines or drugs should or should not be prescribed for a patient. It is certainly not the Department’s job and it would be quite wrong for it or anyone else—including the patient—to attempt to influence the doctor’s decision.

    My hon. Friend asked about representations from doctors. Over the course of some three years there have been 69 cases of family doctors who have defended their decision to prescribe Naudicelle for multiple sclerosis before their professional colleagues on the local medical committee. In 25 of these cases the doctor concerned was about to satisfy his colleagues that the substance had been properly prescribed in the circumstances.

    National Health Service legislation does not define a “drug”. The question of which items or substances should or should not be regarded as drugs, which form part of the pharmaceutical services under the National Health Service Act, has been considered on several occasions by independent professional committees. Precise terminology has varied, but the basic conclusion of each committee has been that substances of a primarily nutritional nature cannot be regarded as drugs and, because they are therefore “foods”, cannot be provided on National Health Service prescription.

    Often the question whether a particular substance is a drug depends upon the circumstances, and no definition could hold good for every case. However, for practical medical purposes, it is reasonable to expect that, where a substance is prescribed for a patient, the substance will have both pharmacological and therapeutic effect on the condition being treated.

    In certain conditions, a “food” may have the characteristics of a “drug”. To advise on the circumstances in which items may be regarded as “drugs”—and therefore prescribable at National Health Service expense—the Department and the profession are very fortunate to have the services of an independent professional body chaired by Professor Barbara ​ Clayton of the Hospital for Sick Children. This body is known as the advisory committee on borderline substances.

    The advisory committee plays a continuing role in examining claims of therapeutic efficacy for individual substances and preparations in relation to particular conditions—that is, whether in particular conditions they may be regarded as having the effect of a drug. Such is the prestige of this independent committee of experts among their professional colleagues that any recommendation which is made is usually acceptable to all concerned. However, I must point out again that whatever the committee’s recommendations, the final decision whether a substance should be prescribed for a patient’s condition rests with the doctor.

    The practical effect of this is that if the committee recommends that a substance acts like a drug for a particular condition then, if the doctor prescribes it for that condition, the National Health Service pays for it. If the committee does not so recommend, decisions to prescribe that substance may be challenged, but—and to re-emphasise the point that I made at the beginning about the prescribing freedom of the family doctor—doctors can and often do successfully defend their prescribing decisions, through the machinery laid down in regulations for this purpose, notwithstanding an advisory committee recommendation.

    I have described this framework in some detail, because it is germane to the fundamental question raised by my hon. Friend why the substance known as Naudicelle cannot at present be provided at National Health Service expense in the treatment of multiple sclerosis at home. I say “at home” deliberately, because a patient in hospital is provided with all his daily needs. These include whatever food and toilet preparations may be considered advisable for him and which he would be expected to provide for himself as necessities of normal life if he were living at home.

    As those who have had anything to do with the disease will know—my hon. Friend stressed this matter—multiple sclerosis is a very distressing disease and one which is most difficult to treat. I understand its effects are so variable between individual patients and that the ​ course the disease follows is so erratic that often it is difficult for a layman to appreciate that a multiple sclerosis patient in remission is ill. I am told that many of the features of multiple sclerosis can present—variability, erratic and unpredictable developments—make every patient’s case uniquely individual.
    That being so, formidable barriers are presented to those evaluating the efficacy of particular types of treatment. At any time patients may experience spontaneous remissions of the condition, sometimes of long duration, so that it can be most difficult to know whether encouraging changes are in fact due to treatment.

    Multiple sclerosis is the general term given to cover many symptoms of weakness and loss of use occurring in different parts of the body. Experts differ in their views on the disease, and for this reason no single method to treat the condition or alleviate the symptoms has been arrived at. One view is that if the proportion of saturated fat in the diet were reduced relative to unsaturated fat, it might help a patient’s nervous system function more effectively. To explore the validity of this theory, multiple sclerosis patients have been given oils such as sunflower seed oil which contain the unsaturated fat, linoleic acid. An even less saturated fat, gamma linoleic acid is, I understand, found in the oil of the evening primrose, as my hon. Friend pointed out, and it is this oil which is contained in Naudicelle capsules.

    The capsules are a proprietary preparation manufactured by Bio-Oils Research Limited of Nantwich, Cheshire. From the outset it has claimed that the Naudicelle capsules contain a pre-digested form of linoleic acid which acts more directly and more quickly than other linoleic acid derivatives.

    This claim was included in the evidence submitted to the advisory committee on borderline substances in July 1974. At that time the committee convened a special meeting to consider in detail the whole question of the use of dietary supplements and linoleic acid and its derivatives in the management of multiple sclerosis. The committee examined in great detail all the available evidence published during the preceding years. In addition, it considered the written evidence from several consultants—some of ​ whom participated at the meeting—who were either known to the chairman or who had been recommended by the Medical Research Council as being or having recently been engaged in research into the problem. I am advised that the research for the meeting, the trouble taken to canvass informed opinion and members’ keen interest and sympathy combined to make this probably the most carefully prepared exercise the advisory committee on borderline substances had ever undertaken.

    Reluctantly, after much deliberation, the committee decided that there was no evidence which could justify recommending that linoleic acid or its derivatives should be regarded as a drug in the management of multiple sclerosis. The committee was particularly concerned that any advice offered should be founded firmly on scientific evidence. It felt that it would be wrong to offer advice that might raise false hopes among multiple sclerosis patients, their families or friends, that an effective palliative or cure was close at hand—a point emphasised by my hon. Friend. Members noted that research into the value of unsaturated fats in the management of multiple sclerosis was continuing and expressed their readiness to reconsider their decision if and when fresh scientific evidence became available.

    Moreover, in October 1974 a conference on multiple sclerosis, arranged jointly by the Medical Research Council and the Multiple Sclerosis Society of Great Britain and Northern Ireland, reached broadly the same conclusion on the question of dietary supplements as the advisory committee on borderline substances. Furthermore, it is worth pointing out that the Medical Research Council’s annual report for 1975–76 stated:

    “The evidence for a beneficial effect of linoleic acid supplements in the diet is unconvincing but the existing studies should be continued; meanwhile no further trials should be supported.”

    I must take serious note of this view. It is an expert one and is endorsed by my medical advisers in the Department.

    To give the House further evidence of the Government’s constant concern to leave no stone unturned in this matter, I should like to point to my right hon. Friend’s meeting with a deputation from the Multiple Sclerosis Action Group early ​ last year. Particular attention was paid at that meeting to the claims that were being made for Naudicelle capsules and the superior virtues of their active ingredient, gamma-linolenate as compared with those of linoleic acid and to the need for further research. The deputation included a distinguished research scientist who, I understand, is engaged in the field of multiple sclerosis research and who explained the claims for gamma-linolenate very lucidly. However, my right hon. Friend had to tell the deputation that, having consulted the Department’s medical advisers afresh about these claims and the value of further research, he felt that he would not be justified in initiating or supporting more research. He promised to ensure that any new scientific evidence that may appear is placed before the advisory committee without delay.

    I understand that, in addition to the research mentioned in the MRC report that I quoted earlier, a trial financed by the Multiple Sclerosis Society of Great Britain and Northern Ireland of dietary supplements, including Naudicelle capsules, has been undertaken at a hospital in the North-East. The results are expected shortly. The chairman of the advisory committee is in touch with the research teams concerned and hopes to convene at an early date a meeting of the committee, augmented by other experts invited for the occasion to consider these results. Of course, we can make no assumptions yet about the outcome of the trials.

    Since the submission to the advisory committee in 1974, Bio-Oils Research Limited has applied for and been granted a product licence for Naudicelle capsules under the Medicines Act 1968 as

    “dietary supplements where unsaturated fatty acids are needed”.

    Aside from the researches sponsored by MRC and the Multiple Sclerosis Society, I understand that Bio-Oils Research Ltd. has been granted a clinical trial certificate to enable it to have its product tested in relation to multiple sclerosis. The certificate is valid until November this year. Naturally, if the firm were then to produce evidence of the efficacy of its product in relation to multiple sclerosis, it would be open to it to apply for its existing product licence to be varied so as to specify the disease.

    If such a variation were granted there would be no question that Naudicelle might be regarded as a drug in the management of multiple sclerosis.

    The Government regard the promotion of health and the prevention and eradication of disease as a prime responsibility of my Department. However, we cannot will the results or the developments that we desire. I know of nobody who does not wish that a drug that would cure or alleviate multiple sclerosis were available.

    Certainly the moment any substance or preparation is shown scientifically to have a beneficial effect, then, whatever it is, it will be made available as soon as possible as a drug for the treatment of the disease. However, I am bound to remind the House, as I implied at the outset, that ​ the history of research into multiple sclerosis is one of repeated disappointments.

    My hon. Friend has raised a number of issues including early diagnosis and the possibility of the Department having field trials about which I shall write to him. In the meantime, let me repeat that the reason why Naudicelle would be challenged if prescribed by a family doctor at National Health Service expense is that we are advised that the only scientifically reliable evidence that we have does not justify the belief that dietary supplements such as Naudicelle capsules are helpful in the management of multiple sclerosis.

  • Phillip Whitehead – 1978 Speech on Multiple Sclerosis and the Naudicelle Treatment

    Below is the text of the speech made by Phillip Whitehead, the then Labour MP for Derby North, in the House of Commons on 5 May 1978.

    In raising this subject, I do not want to be thought to be plugging a particular brand name or suggesting that Naudicelle is a catch-all cure for the scourge of multiple sclerosis. However, I believe that it is of fundamental importance that we and the Department of Health and Social Security give the closest attention to the dietary supplement containing a ​ committee on borderline substances and derived from the evening primrose, which is sold in this country under the name of Naudicelle, as I shall refer to it. We should look at reasons why an increasing number of multiple sclerosis sufferers are, in a sense, conducting their own trial and marking their own personal results by the money they have to spend on the preparation as well as the testimony they almost all give to it.

    I was first interested in the properties of Naudicelle by my constituent and friend, Mrs. Josephine de la Mare, secretary of the Derby Multiple Sclerosis Society. I regret to say that after a long illness, which was fought every inch of the way, she died last week. It is right that I should pay my own tribute today to this brave lady. She led me, in early discussions about dietary supplements, both to Mr. Joe Osborne of Newhall in Staffordshire, who has been working in the Burton-on-Trent area, linking Naudicelle dietary supplements with a proper regime of exercise, and to ARMS, the action group for research into multiple sclerosis.

    Mr. Osborne, through his own Member of Parliament, the hon. Member for Burton (Mr. Lawrence)—who has taken up his case energetically and who, I know, would have wished to be present today had he not been prevented by a prior engagement—and the ARMS group, in direct correspondence with the Department of Health and Social Security and the Medical Research Council, have been pressing for early publication of the results of recent trials at Newcastle, for further and wider trials of this substance and for support for the screening of close relatives of multiple sclerosis sufferers who may, it seems possible, be at greater risk, so that there shall be an early diagnosis of the disease.

    I shall argue that such wider study of a substance with no known harmful side effects and for which much is claimed, would be helped by the availability of Naudicelle on prescription at the discretion of the local general practitioner. Professor Field at Newcastle, who has been a pioneer of research into demyelinating diseases and in the screening of young people who may be at risk, is strongly of the opinion that Naudicelle can be of help to acute sufferers from ​ multiple sclerosis in reducing the number, severity and duration of the attacks which they incur.

    There have been earlier experiments by Professor Millar and others into the effects of linoleic acids which principally derive from sunflower seed oils as a dietary supplement. The test which is most eagerly awaited now is the double-blind trial carried out by Professor Shaw, also at Newcastle upon Tyne. This, I understand, covers two groups of patients, the old chronic and acute relapsing patients respectively. Professor Shaw wrote to the hon. Member for Burton on 13th February to say:

    “Our clinical trial has been completed but the results have not yet been fully analysed. Much of the statistical work has been done but there are still a few more calculations to be made before final conclusions can be drawn …. As you may recall, the results of the first part of the trial which were published in the British Medical Journal in October showed that Naudicelle had conferred no benefit on the treated patients. The part of the trial now under analysis deals with a different group of patients but I hope that no assumptions will be made about the outcome of the trial until the calculations have been completed. I am distressed to learn that in Italy Naudicelle has received wide publicity as an effective treatment for multiple sclerosis. This has raised hopes to a degree that is not in my view justified by the scientific information at present available.”

    I include that last rider because it is important to stress very strongly that no one seriously asking for a wider study of the substance ought to claim, or ought to lead multiple sclerosis suffers to believe, that it is a cure for the disease. That is not what is claimed by those who have taken the greatest interest in it and, indeed, by the patients who claim, as I shall show, that it has many beneficial effects for them. It can, it is claimed, control the onset and severity of the attacks incurred by multiple sclerosis sufferers.

    The earlier the disease is diagnosed and caught, the greater the beneficial effects have been, it is claimed, in nonscientific trials. That is why we are all anxious to see the early publication of the second series of tests on acute relapsing patients being conducted by Professor Shaw. I spoke earlier this week to Professor Shaw. He told me that he will be calling together in London a group of his learned colleagues in the next few days to evaluate the results that ​ he has achieved in the second test, prior to publication.

    In the nature of balloting for debates on the Adjournment, Mr. Deputy Speaker, it is not always possible to predict precisely when the debate will come. In a sense, it might have been better had we been able to have this debate a week or two after the publication of Professor Shaw’s finding. However, what I shall be saying today will be argued ex hypothesi on the basis that if we learn something from the second series of tests conducted by Professor Shaw, that will be an additional reason and, I submit, an urgent reason for the Department’s taking a fresh look at the claims which have been made so widely for this substance Naudicelle.

    Hon. Members who have communicated with the Department of Health and Social Security—as I know many of them have—have had to rely upon the testimony of those already using the substance, and the many doctors and others who have been working in this field, such as Mr. Osborne, to whom I referred earlier, who have used it often in conjunction with concentrated programmes of exercise and physiotherapy.

    I think that in this short debate it would be right to quote from at least some of the testimony which is typical of that which so many hon. Members have received from individual sufferers from multiple sclerosis. I shall mention one or two of the letters as an example of the pressure which has rightly been brought to bear upon Members of Parliament to make the DHSS look again very carefully at this matter.

    I have a number of letters here from which I shall quote very briefly. First, I have a letter from Mrs. Williams of Burton-on-Trent, who has had the disease for a long time and whose husband has worked closely with Mr. Osborne in that area. She says:

    “In the space of 12 months—from 10th May 1977 to the present day, 4th May 1978—there has been no need for me to visit my GP from either attacks due to MS or, indeed, any other ailment. In fact, I have not lost one working day from my employment … Of course, there have been those days when I felt a little below par, but I think one would agree all normal people experience those. Looking back over these 12 months on Naudicelle, I will now stress more strongly where the greatest stability has been created. Firstly, there has been a tremendous improvement in my vision ​ … and a marked improvement in my circulation.”

    Mrs. Williams then goes on to describe other beneficial effects of the treatment. She has had the disease for a longer period of time, and her letter is typical of many that we get expressing the general view that this substance is very beneficial indeed as a dietary supplement.

    The next letter is from a constituent of mine, Mrs. Mason, in Allestree, in Derby, who is talking of her husband. With this case, as with the previous one, I am following up a case which has been mentioned in the book published on the subject by Mr. Osborne. Clearly one wanted to look at such cases some months or a year later, to see whether this had been a false dawn in the case of the sufferers concerned. In each case that I have followed up it would appear that the improvement—or what they believe to be an improvement—has been sustained.

    Mrs. Mason, in talking of her husband, writes:

    “His wheelchair is now a thing of the past, now walking with either one elbow crutch or one walking stick, in the home on a very smooth surface he needs no aid at all, his arms are much stronger, his eyesight is better than it has been for years.”

    She goes on to say that the doctor is very pleased by this improvement. To the amazement of the local Press, her husband entered the sports for the disabled recently and was able to win the discus competition, the shot put and the 60 metres freestyle walk. He will go on to compete at Stoke Mandeville in September.

    Mrs. Mason says in the course of her letter that she thinks that the capsules should be available to multiple sclerosis patients on the National Health Service. She adds:

    “It is cruel to deprive them of it. They are like insulin is to a diabetic, and where would they be without their insulin, and yet that is free for diabetics.”

    I appreciate that there are very great differences between the need to provide insulin for diabetic sufferers and what is claimed and what is so far known of the gamma-linolenic concentrates. However, I feel that when people speak in those terms, although they may be using a figure of speech, they are expressing, in what is to them the clearest possible ​ way, the amazing effect that the treatment has had on them and on their own lives. They are lives which, I remind my hon. Friend, have been largely without hope because one of the cruellest features of the disease multiple sclerosis is that when it is initially diagnosed all too often in the past people have been told “I am sorry. There is no effective treatment.

    We can ease the downward progression of the disease, perhaps. We can make you comfortable for long periods of time. You will enjoy periods of remission. But the overall prognosis is pretty hopeless.” That is what has caused so much despair and dismay amongst those who have had the disease diagnosed and why it is so important that we should look at every possible way of helping them.

    I have a number of other letters which it is perhaps unnecessary to quote at length because they all make the same basic point that their condition has stabilised and that some at least of the symptoms of this dreadful disease have been very much ameliorated over the course of months and years during which they have been taking this preparation as a dietary supplement.

    This is no scientific trial. I accept that. It could not possibly be. But it is of importance that we have the widest possible knowledge of these case histories, and I want to ask my hon. Friend to say how many submissions there have been from general practitioners about Naudicelle and about the beneficial effects of linoleic and gamma-linolenic concentrates of this kind, whether based on the evening primrose, sunflower or safflower oils.

    We need to know what the medical profession, directly in touch as GPs are with the average MS sufferer, is now saying about this, and I think that we also sould know whether there are any known harmful side effects to this preparation. I know of none, and I have been told of none. It is important that this should be established. If we argue, as I am in this debate, that it would be greatly in the interest of arriving at some kind of conclusion about the possible beneficial effects of Naudicelle if we were to have it more widely available so that there could be a test within the general population, we need to know whether it ​ has harmful side effects. I believe and I submit that it has none.

    The Department has said in letters to me, to the hon. Member for Burton and to a number of other hon. Members that Naudicelle is a food and not a medicine, that it will keep a benign eye on tests into the efficiency of dietary supplements, and that it has allowed Naudicelle a Medicines Act licence under the 1968 Act with all the usual limitations, but no more than that.

    The problem is that for the many thousands of multiple sclerosis sufferers time is very precious and hope is rationed. Many of the letters that I have mentioned speak of the utter despair of those who have had multiple sclerosis diagnosed. This is why, in terms of those who have it at the moment and even more so in terms of those many thousands who will have it diagnosed in the next few years, it is important that we should now have from the Department a promise of early action.

    With that in mind, the questions which I wish to ask are these. Will the Department undertake to act on the results of the Newcastle tests if these happen to show beneficial results for acute relapsing patients? Will it, in those circumstances, be prepared to go back to the advisory committee on bordering substances and to the MRC and to consider once more the possibility of putting Naudicelle on the National Health Service at the discretion of the general practitioner concerned? Will it further extend the field trials under its own auspices prior to such reconsideration? At the moment we know of the double-blind trial which is going on at Newcastle and we know of the immense random sampling, if it can be so described, which has come to the surface as a result of the work of laymen such as Mr. Osborne and many individual branches and arms of the Multiple Sclerosis Society. We should like to see the Department itself intervening and taking a hand.

    Finally, I wish to go slightly wide of the subject of this debate and ask my hon. Friend whether the Department will undertake to extend and further investigate the system of diagnostic blood testing which has been developed by Professor Field. It is in this area that there is the most hope for combating those forces which appear to act early on the ​ acute multiple sclerosis sufferer. If any of the claims for these dietary supplements have been justified, it is obviously in cases where the disease has not progressed through all its acute stages. In that stage most can be done by the dietary supplements.

    The badge of the Multiple Sclerosis Society is a key. We are all looking for the key which will unlock the mysteries of this disease. The most curious thing about the disease itself is that perhaps that key might be found in the seeds of that equally mysterious flower, the evening primrose.

  • Alan Milburn – 2002 Speech on Healthcare

    Alan Milburn – 2002 Speech on Healthcare

    Below is the text of the speech made by the then Health Secretary, Alan Milburn, on 15th April 2002.

    The debate in the country about the future of our public services is crystalising. The Budget this week will make those dividing lines even clearer. As the Prime Minister, Chancellor and myself have all made clear in recent weeks, the biggest political issue today is whether we are prepared as a country to provide the resources and make the reforms necessary to bring about improvements to our key public services, in particular to the National Health Service

    As a party and as a government we believe that we should be prepared to do so. Our formula is simple: investment + reform = results.

    The debate is now sharpening, not just because of the imminence of the Budget and the progress of the Spending Review, but also because of the position now being taken by our political opponents.

    Today I want to set out both our analysis of the position being taken by the Conservatives and our own analysis that we have made of why a reformed NHS – funded through general taxation – is the right way forward for Britain.

    Our report – The Right’s Remedy – which we are publishing today, highlights where the Conservatives have got it wrong.

    Within the last week we have heard twice from the Conservative Party about the future of health care in our country.

    First, Liam Fox spelling out – in his Secret Speech – the Conservatives’ strategy on the NHS seeking to “persuade the public that the NHS is not working…it has never worked before and will never work” as a prelude to what he called more people having to “self-pay”.

    Second, yesterday the Conservative’s publication outlining what they call “Alternative Prescriptions” for health care in our country. Whilst this second publication avoids plumping for any specific solution – that as Liam Fox makes clear will come later and is dependent upon first undermining public confidence in the NHS – it does now illustrate the clear direction both of Conservative thinking and the Conservative’s strategy.

    They are in the first stage of their approach: undermining the NHS and suggesting there is a better alternative to it. This is a cynical and destructive softening up operation that should be seen for what it is.

    For them the NHS, as Liam Fox puts it “cannot work and won’t work”, and as IDS puts it in today’s publication, “the system is not working.”

    They quote approvingly in their document (page 54) those countries with up to 30% of spending undertaken in the private sector as offering an acceptable level of fairness. This sits interestingly with Liam Fox’s determination to encourage more people to “self-pay” and is the equivalent of up to £20 billion of UK NHS spending.

    What this all points to is that for all their grand study tours of Europe the Conservatives are opting for an American-style solution. A two-tier health care system – for the poor a Medicaid style NHS and “self-pay” solutions for middle income families with top-up services having to be paid for privately. Low income Britain would pay the price through second rate services that are poor because they only serve the poor. Middle income Britain would pay the price through increased costs and extra charges.

    The Conservatives have brought the post war consensus on health to an end. Indeed it is revealing that no-one reading their document could believe they remain committed to a universal NHS that is free to all and accessible to all. Instead they talk up the advantages of other health care systems.

    Their examination of the supposed superiority of other systems for funding health care tells is partial and selective. We too have examined the case for other systems of funding. But, like the BMA who conducted a similar examination last year, we have found these other systems wanting.

    The report we are publishing today contains analysis from a range of academic sources across the world about the fault lines in different systems of health care funding.

    In essence, the problem with social insurance systems is who bears the majority of the costs of the total health care budget. It is estimated that at 2003-4 levels of funding the additional costs of a wholesale move to a social insurance system here would be the equivalent of an extra £1,500 per worker per year using the French model and an extra £1,000 per worker per year using the German model without a single extra penny to currently planned NHS funding.

    In essence the problem with private health insurance – whether compulsory or voluntary – is that it would increase bureaucracy and decrease efficiency. Compulsory private insurance is simply replacing a single state-managed risk pool with numerous, complicated, less efficient private risk pools. Tax incentives to encourage voluntary private insurance are costly, inefficient and inequitable. They tie up millions in dead-weight tax breaks for people who already have insurance before a single extra person takes out private cover. Tax incentives have a cost to the Exchequer and thereby, reduce the levels of investment available to the NHS.

    The truth is there is no perfect health care system in the world. All have strengths. All contain weaknesses. What is wrong is to pretend that the only way to address the weaknesses is to move hook line and sinker to a new system. When the Conservative Party says the NHS should be reformed, what they really mean is that it should be adandoned.

    From a pragmatic point of view the disruption in doing so – not to say the costs of doing so – would delay precisely the improvements in services that people long to see. From a principle point of view we would end up throwing out the baby with the bath water.

    There are many things wrong with the NHS but it does have great strengths. It should be a cause of national pride in our country that no-one asks for your insurance policy or credit card before you get the care you need.

    Without the NHS the sophistication of modern treatments – and of course their cost – would put individual provision of health care beyond all but the very wealthiest in society. Without it the sick would end up paying for the privilege of being sick. In a world where health care can do more and costs more than ever before having an NHS based on need not ability to pay, with services that are free and comprehensive, is a real source of strength for our country and security for our people. So the NHS should be supported with our heads as well as our hearts. The relevance of its values make it the best insurance policy in the world.

    Where it is weak is on two counts

    First, while its values are right its structure is wrong. For decades it has been run as a top down, centralised, monopoly service where patients interests have too often played second fiddle to the system’s interests. It is these faultlines in the system that the NHS Plan seeks to address. By devolving power so that locally run primary care trusts control NHS resources.

    By introducing new incentives so that the best hospitals get more freedoms and the poorest are helped to change or else are taken over. By securing greater diversity with better co-operation between the public, private and voluntary sectors. By giving patients more choice over when and where they are treated. These reforms address precisely the structural weaknesses that the critics of the NHS pretend can only be delivered by rejecting the health service.

    Second, the shortages of capacity that are the cumulative effect of decades of under-investment. On any count comparing health care investment in this country with investment in other developed countries shows that the NHS has been short-changed for decades. It is not a superior system of funding which France and Germany have enjoyed. It is a superior level of funding. The gap on public spending between France and Germany and the UK has been substantial: according to latest OECD figures French per capita public spending on health as a precentage of GDP stood at 7.1%. German public spending at 7.8%. The UK figure was 5.7%. It is this gap that is now being closed. Indeed in the last few years while in France and Germany health spending as a proportion of GDP has been falling, since 1997 in Britain it has been rising.

    The point is this: the NHS can be fixed providing there is the right level of resources and the right programme of reform. The reforms are as important as the resources. Indeed the more cash goes in the more the public have a right to expect they get out. The greater the programme of investment, the bolder the programme of reform. It will take time – the NHS Plan is for 10 years – but what we have started we should now finish.

    This week the battle lines for this Parliament will become clear. Labour committed to building up and reforming the NHS and the Conservatives committed to talking it down, as a prelude to forcing more people into paying for their own care.