Dear Mr. Kinnock
Thank you for your letter of 13 May about health service spending.
The Government stands by its record of support for the National Health Service. That can be measured in several ways—by the resources we have committed, the staff we have recruited and, most important of all for the public, the scale and quality of patient care we have provided.
First, resources. Spending has been increased from £7¾ billion under the Labour Government in 1978/79 to £17½ billion in 1985/86 and will increase to some £18¾ billion in 1986/87. That is an increase of 24 per cent in real terms. In other words, even after taking account of inflation, this Government is devoting £5 to health for every £4 committed by the last Labour Government. Further real terms increases are planned for the next two years. These increases among other things measure the extra cost to the taxpayer of financing the service. I accept that NHS pay and prices have increased substantially. That is partly because this Government has increased nurses' basic pay by 33 per cent more than inflation—worth £2,000 a year on the basic salary of a Ward Sister on the maximum of the scale—and improved their conditions of service. These included a 2½ hour reduction in the working week without loss of pay. I am surprised that you think that higher pay and better conditions should be excluded from calculations of spending [end p1] on the NHS: I am sure you would accept that the principal asset of the NHS is its staff. But even if such increases are excluded, the growth in expenditure between 1978/79 and 1985/86 has been very considerable, at about 9 per cent in real terms.
We have also given particular priority to building a modern health service. The last Labour Government cut back capital spending on new wards and new hospitals by over a third—the biggest capital cuts in health service history. We have restored those cuts. In Great Britain this year we will be spending well over £900 million. 159 new hospital projects each worth over £2 million are presently being planned, designed or built in England alone.
Second, staff. We have recruited substantially more key staff than the last Labour Government. None are more important to patients than doctors and nurses. In Great Britain in 1985 we had over 60,000 more nurses and midwives, 5,500 more hospital doctors and dentists and nearly 4,000 more general practitioners than under Labour in 1979. It is disappointing that you seek to talk down the great contribution they are making to the health service.
Third, patients. No measure of health service performance is more important than the number of patients given good treatment in our hospitals. Here, too, the record shows great progress.
In 1984 the health service in England treated over 800,000 more inpatient cases than in 1978, over one-third of a million more day cases and over 3 million more outpatient attendances. That is a remarkable record of service to the patient. You mention waiting lists. In fact hospital waiting lists have fallen since 1979 and they would have fallen by a great deal more without industrial action in the NHS, which your Party supported. And under Labour, hospital waiting lists rose by 250,000. [end p2]
This Government has indeed continued to redistribute resources in favour of the historically deprived regions and those with rapid population growth—as did the Labour Government before it. The facts speak for themselves. To take only those regions which you mention, Northern Region received a cash increase of 6.7 per cent in 1986/87, North Western Region 6.4 per cent and Trent Region 7.7 per cent. These figures compare with increases for the Thames Regions of 5.7 per cent to 5.8 per cent—and with an inflation rate which is now 4.2 per cent and falling sharply. All three regions have benefited very substantially indeed under this Government: in 1978/79 they were each more than 8 per cent below their target shares of the national resources, but by 1986/87 none is more than 4 per cent below target and indeed North Western Region is now within 1 per cent of its target. You suggested that a policy of resource reallocation was acceptable when NHS resources were increasing but not when they were contracting. There have been increases in resources in every single year of this Government. Contrast that with the last Labour Government which cut the NHS in real terms for two years in succession.
You quoted particular problems at district level. Of course health authorities have to control overspending so as to stay within budgets. Even the Labour Party would surely expect this basic financial discipline to be observed. But the picture you present of cuts and falling services ignores the facts. In Newcastle Health Authority, to which you refer, more patients are being treated now than ever before. Compared with the position in the last year of the Labour Government, 10,000 more inpatient cases are being treated, 100,000 more outpatients and 7,000 more day patients. Capital spending also has increased. To take just one example, more than £30 million has already been spent on the development of the Newcastle Royal Victoria Infirmary and a further £28 million spending on this hospital is planned. These improvements are reflected throughout the Northern Region: inpatient cases treated in that Region are up 60,000 [end p3] since 1978, outpatient cases are up 350,000 and day cases are up 30,000. Capital spending is substantially up: £43 million now compared with £24.2 million in 1978. Where are the cuts you talk of here?
Or take heart operations to which you also refer. The number of open heart operations nationally increased by two thirds from 10,160 to 16,874 between 1978 and 1983 and the numbers of coronary artery bypass grafts trebled, from 3,191 to 9,433 in the same period. The number of heart transplants carried out in 1985 was 169—compared with just 3 in 1979.
Of course we recognise that there are increased demands from, for example, greater numbers of elderly people and medical progress. Our response has been to provide extra resources. These improvements have been financed largely by increased funds from the taxpayer. But improved efficiency within the NHS has also—rightly-made its contribution. Improvements in efficiency are planned to release £150 million (1½ per cent of total spending) for the service this year. This target has not been imposed centrally. It is what health authorities themselves are achieving through better use of resources.
These are the facts. They show that the NHS is indeed safe in our hands.
Yours sincerely
Margaret Thatcher