19 May 2004

S2M-1326 Health Services

Scottish Parliament

Wednesday 19 May 2004


[THE PRESIDING OFFICER opened the meeting at 09:30]

Health Services

... ... ...


Stewart Stevenson (Banff and Buchan) (SNP): Too much of today's debate has been a flight from reality, but at least it is on the record that the representatives of the Fourth International are for public confiscation rather than public ownership. There is more in the SSP amendment, which demands that contracting from public providers be stopped. So we will have NHS brickies, NHS equipment designers and builders and NHS farms on which to grow food. I am so glad that I was awake when I was listening to the Trots sitting behind me.

However, numbers are not something that the Trots are terribly good at. They would spend 157 years' worth of the Scottish health service's drugs expenditure to nationalise two companies alone. Is that a return on investment that anyone in the chamber would be comfortable with? No, of course it is not.

Let us return to principles. The 1942 Beveridge report, which was entitled "The Way to Freedom from Want", stated that the aim was to abolish want, squalor, ignorance, idleness and disease. I believe that the greatest of those aims was to achieve freedom from disease. Beveridge wrote:

"Proposals for the future ... should use to the full experience gathered in the past, not restricted by consideration of sectional interests."

He also wrote:

"The state should offer security for service and contribution"

but not

"stifle incentive, opportunity and responsibility."

A Gallup poll from 1943 shows that an overwhelming majority of the public endorsed a proposal to include everyone in a comprehensive scheme of medical services. That remains as true today as it was 61 years ago.

Vested interests that run against the grain of public opinion have to be confronted today as they were before the NHS started on 5 July 1948—not 1947, I point out to Mike Rumbles. On 19 February 1948, a BMA press release showed that 40,814 medical practitioners disapproved of the National Health Service Act 1946 and that a mere 4,900 of them—or just over 10 per cent—approved. The figure in Scotland was slightly higher at 12 per cent in favour. The objectors were largely, but not totally, faced down before the health service started.

The question is, what should the NHS credo be today? I make three suggestions. First, access to health care should be based solely on need. Secondly, there must be respect for the public service ideal and the contribution that public service makes to wider society. The third ideal should be value for money.

I will test the Tory plans against those ideals. The Tories want preferential access for those who can afford to pay; the passport needs to be topped up, so its operation would be denied to those who could not afford to top it up. The result would be a move away from access by health need towards access based on greed.

Respect for the public service ideal is not in great supply on the Tory benches. The Tories must accept that the private sector does not have a monopoly on succeeding and that failure is not the sole prerogative of the public service. For example, Capita Group plc and a number of its public service contracts can be considered. There is a history of failure and hardly a success in a contract in which it has been involved. One benefit of PFI—the only benefit that I have found so far—is that it shows that private companies can and do fail when they try to deliver public services.

On value for money, a number of members have referred to expensive operations. NHS surgeons moonlight at weekends and in the evenings—

Often, NHS hospitals charge more for operations simply to provide people who have money with early access to a system in which access should be provided on the basis of health, not on anything else.

The Tory motion refers to international examples. The most recent edition of The Economist examines the French health service, which is largely privately provided and largely publicly funded. The service is excellent, but it is not delivering value for money and is probably heading for bankruptcy very soon. David McLetchie should read page 40 of The Economist—he will see what I mean.

Almost every member supports choice for all, rather than merely for the few. I have a challenge for the Tories, whose motion mentions supporting and developing the private sector. Which hospital in Glasgow would they close in order to develop the private sector to replace what is provided by the public sector in Glasgow?

We should not let Labour escape. In 1969, the Socialist Medical Association provided a report to Richard Crossman, who was a secretary of state, which focused on the long hours and poor pay of junior hospital doctors. That was many years ago and the argument has hardly moved an inch. Hospital services and young doctors are overworked and underpaid.

The health service is a great ideal. By all means, the service needs to be revisited and refurbished, but the ideals continue as they did before. I am happy to support the amendment in my colleague's name.


Stewart Stevenson
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