May Adjournment

Debate between Thangam Debbonaire and Edward Leigh

Thursday 3rd May 2018 Commons Chamber

[Sir Edward Leigh (Gainsborough) (Con)]

I am glad that I am following my hon. Friend the Member for Beckenham (Bob Stewart). He spoke about pressure on one part of the public service sector and, in particular, about the cuts in legal aid. He made the very fair point that the criminal justice system relies crucially on talented young people wanting to enter it and receiving appropriate remuneration. I want to make a similar point about the whole public sector.

I shall argue that spending is overstressed in large parts of the public sector. I shall talk about defence for a short time, and then about transport and police funding in my own constituency. This will not—I hope—be just one of a series of speeches in which Members ask for more and more public spending, because I am also committed to lower public spending. I am going to take it on the chin and argue that we cannot devote an ever-increasing part of public sector spending to overseas aid, health and social security.

Let me start with defence. I am going to make some political points. They may not be points with which everyone will agree, but I feel that they need to be made. The fact is that the Ministry of Defence is underfunded. During the cold war, we were spending 5% of our national wealth on defence; even after the peace dividend, following the collapse of the Soviet Union, we were still spending 3%; and we continued to do so until the advent of the Labour Government in 1997. We are now hovering around 2%, and there is a general consensus that we must increase that percentage. That will, of course, involve difficult decisions.

We cannot increase spending on defence unless we are prepared not to spend as much as we would like in other areas, such as health. I understand that certain senior people in the Government may well question whether that is politically possible—whether we could argue the case before a general election. I would argue that not only is spending more on defence in an increasingly dangerous world the right thing to do, but it is a politically sensible and popular thing to do.

[Thangam Debbonaire]

I thank the hon. Gentleman for being so courteous with his time. He is making some interesting points, but I ask him to reflect on this. Does he not agree that cutting the spending of the Department for International Development, which he has mentioned, would be counterproductive? Would it not increase the potential reason to spend more on defence? One of the ways in which we reduce our security concerns about other countries is investing in those countries. That is in our interest, as well as being altruistic.

[Sir Edward Leigh]

The hon. Lady leapt to her feet too soon. I am not going to argue that DFID’s spending should be cut; I am going to argue that we should spend on DFID what we can afford to spend, and what we need to spend. We should not link the arbitrary aim to spend 0.7% of GNP on aid, which is now enshrined in law, with the very different aim in respect of defence spending.

--- Later in debate ---

[Sir Edward Leigh]

I will not join the hon. Gentleman in advocating ever-increasing levels of the tartan tax. I remain a strong Conservative, and I believe in the value of deregulation and a low-tax system. Earlier in my speech I made pleas for higher Government spending, both in Lincolnshire and on defence, so—to be fair to Treasury Ministers—how is all that going to be paid for? We cannot increase borrowing, and I would not argue that it is right to increase taxes.

There is another matter that I am really concerned about. I understand that the Government are now looking closely at a significant increase in real-terms spending on the NHS. I am of an age at which the NHS is terribly important to me and my family. I have no private health insurance. Indeed, earlier this week, I had a small procedure on my face under the NHS, which was beautifully carried out. I have no complaints against the staff, but I am very worried about this proposal, which Ministers are apparently considering, to dramatically increase the amount of money spent on the NHS in real terms.

I remember what happened during the period of the Labour Government. Of course such measures are popular in the short term, but the more we increase spending on the NHS in real terms, the lower the productivity becomes. I have spent quite a lot of time talking to consultants and doctors—I am at the age where I do that—and they all, to a man and a woman, bewail the level of bureaucracy and incompetence in the NHS. They are not arguing for more public funding in real terms, although it has to increase by a certain amount in real terms every year because we are an ageing population and we understand all the pressures. They all say that what drives them mad is the level of bureaucracy in the NHS, and it worries me that if we substantially increase NHS spending in real terms, we will simply add to that level of bureaucracy, even though Ministers assure us that that is not their aim.

[Thangam Debbonaire]

rose—

[Sir Edward Leigh]

I will give way to the hon. Lady. Nobody else has a solution, but perhaps she does.

[Thangam Debbonaire]

The hon. Gentleman is being extremely generous. I do not have a solution, but I caution him to be careful what he wishes for, because that so-called bureaucracy includes data, IT and back-office functions. We heard from the Secretary of State for Health and Social Care only yesterday about what happens when an IT system does not have good scrutiny or governance. We must be careful what we wish for.

[Sir Edward Leigh]

It is a question of quality. Is it really necessary to have 30,000 people employed by the NHS, who have never been doctors or nurses and who have never met a single patient, earning over £100,000 a year? We of course need a level of good-quality management, but we must trust the people on the frontline. Whenever we talk to doctors and nurses they say, “Trust us. We are professionals.” They are the people that members of the public want to see. They are the ones with the vocation and the professionalism to look after us.

The hon. Lady makes a fair point and, like all arguments, we could take it to extremes, but in my view there are two models for the NHS. There is the traditional model that I grew up with in the 1950s and 1960s, and there is a newer model with evermore systems, targets, internal markets and the rest. My personal view—this may surprise the hon. Lady—is that the old-fashioned model probably worked better, because it put more competence and more control in the hands of nurses, doctors and consultants.

I am now going to say something that will probably be even more unpopular. I wonder why our Government are not prepared to bite the bullet and consider alternative funding for the NHS. With an ageing population, we must encourage people to put more of their own resources into their health. How are we going to do that? We could do it through general taxation and increase overall spending, but I have argued against that, or we could do what previous Conservative Governments have done. The Major Government and the Thatcher Government—I do not think the Major Government were particularly right wing—gave tax relief for people of pensionable age towards private health insurance. That is anathema to the Labour party, but it would actually put more resources into health. Most people of retirement age simply cannot afford private health insurance, because they pay for it from their taxed income. However, if we gave tax relief for private health insurance, as previous Conservative Governments have done, we would not be saying that we are against the NHS or devaluing it; we would be trying to encourage the people who are going to use healthcare more often to put more of their own resources into healthcare.

I am worried that if this massive real-terms increase in healthcare spending happens, we will be approaching the levels of health spending per head that we see in Germany or France. The fact is—let us be honest about this—that if we are going to be ill, we would much rather be ill in Germany or France. I know that the NHS is a kind of religion for many people, but the health services under the social insurance systems of France and Germany do work better. They cost more, but the people feel that they have real control over their healthcare. They pay large amounts of tax, but they feel that they have some kind of ownership of their healthcare—some kind of right. When something goes wrong, they are not just enmeshed in a vast bureaucratic machine; they believe that they have some right to treatment through social insurance. Indeed, in Germany, they do get that.