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Health and Education

I begin by joining the hon. Member for Huddersfield (Mr. Sheerman) in congratulating my hon. Friend the Member for Lancaster and Wyre (Mr. Wallace) and the hon. Member for Swansea, East (Mrs. James) on their maiden speeches. Sadly, it is some time since I made my maiden speech, but one’s first contribution in a new Parliament is an opportunity to reflect at least briefly on the vote of confidence received from the constituents. As the hon. Member for Swansea, East noted, being elected to this House should always be a humbling experience, whether it be for the first time or, as in my case, for rather more than the first time. In congratulating my hon. Friend the Member for Lancaster and Wyre, I must say that I detected a certain robustness of tone which I think that we shall come to enjoy in the years ahead. I look forward to his contributions to other debates, in particular in respect of matters to do with law and order and other topics for which the necessary traditions and expertise apparently still reside in Lancaster. It is a cliché that public services lie at the heart of modern political debate, but anyone who doubted that had only to listen to the reaction on the doorstep during the recent general election campaign. That reaction, and the evidence from opinion polls, made it clear that electors considering the performance of a modern Government put the delivery of health care and education services that match their aspirations at the very heart of their choice at the ballot box. Hon. Members of all parties must take that very seriously. The signal from voters also reflects a growing disparity between what they expect to receive from the core public services of health and education and what they receive in reality when they visit a school, hospital or GP surgery. That is not unlike what happened in the British economy in the 1970s, when a dangerous disparity developed between what we wanted to achieve and what we managed to achieve. As every hon. Member knows, that led to a radical reform of the way in which the economy works—a reform that is now common ground across the House. It is no exaggeration to say that a similar process of rethinking the delivery of health and education in the modern world now faces the Government and all political parties if we in this House are to be seen to take this matter as seriously as our voters take it at election time. I shall deal with two sectors of the public service, apart from schools and hospitals, that illustrate some of the more difficult and uncomfortable choices that we will have to face up to. The first sector is the universities. We heard a lot during the election campaign from the Government, and a little from the Lib Dems, about how the Conservative party planned to introduce new charging regimes for public services. It is a matter of history that the NHS has three charging regimes, one for dentistry, one for opticians and one for prescriptions. Two of those three charging systems were introduced not by Conservative Governments but by Labour Governments. More importantly, and much more recently, the core public service of the delivery of university education was subjected to a new charging regime for tuition, introduced in the last Parliament by the present Government. Therefore, I accept no lectures from the Government on charging regimes in public services. Across those four specific examples, the score for introducing new charging regimes is 3–1 to Labour. That is a convenient party political point, but it has some uncomfortable lessons that need to be taken more generally into account. We must recognise that some difficult issues must be addressed in the university sector. The British university system has fallen behind other comparative systems, in particular that in north America, in terms of available resources and the degree of comfort with which university staff work within that sector. If we wanted a university system in which professional people felt that their professionalism was undervalued and subject to too many targets, it would be hard to find a better example than our present system. That is not a party political point, because the target setting started under the last Conservative Government. We have to develop a system in which universities trust more in the professionalism of those who work in them. We need to see universities more as private sector institutions, which—strictly speaking—they are—delivering a service to their students. I must say to my right hon. and hon. Friends on the Front Bench that I think that the Conservative party went up a dead end when it opposed the introduction of tuition fees. Reform of the public services involves reassessing the balance between individual and collective responsibility, and accepting that some matters that were regarded in the post-war world as the responsibilities of the taxpayer will increasingly have to be regarded as responsibilities that the individual at least shares with the taxpayer. The Government were right to conclude that the university sector was a good place to start. The universities are one area of public service that needs to work through difficult issues. The other area that I wish to mention is NHS dentistry, for which I used to be responsible. Nobody can surely believe that the model for the provision of NHS dentistry is one that we should admire or claim great credit for. The fact is that access to public services should be one of the key determinants of whether our policy mix is right. Access to NHS dentistry is too often denied to people who should—we would all agree—have ready access to those services. NHS dentistry is another area where the issue of charging for public services arises. It has an appalling charging regime, not because charges are always wrong but because, unlike private sector insurance schemes for the provision of medical or clinical care, the charges are imposed on the patient at the time of clinical need—despite the formulation that the hon. Member for Northavon (Steve Webb) used. If we are to introduce further charging, we must think about establishing a way for the patient to accept shared responsibility without imposing the charge at the moment that they might be put off from accepting care that they need by the financial consequences. I raise those two services—universities and dentistry—because I do not believe that any party in the House will accept the suggestion that we should abolish all charges for them and go back to total state funding. We need to think through how we can make co-payment—that dreadful jargon word—consistent with the core principle everyone should accept: equitable access to those services for all who should have access to them, when they need them and without regard to the financial consequences. I end with a rhetorical question: does anybody seriously believe that the issues I have raised in connection with dentistry and universities are unique to those services?