The National Health Service

HC Deb 08 March 2000 vol 345 cc1010-65

Madam Speaker

I have selected the amendment in the name of the Prime Minister.

3.41 pm

Dr. Liam Fox (Woodspring)

I beg to move,

That this House deplores HM Government's clinical and financial mismanagement of the NHS; condemns the distortion of clinical priorities resulting from the Prime Minister's refusal to abandon the Government's flawed waiting list initiative, which is described by the medical profession as anathema to them and which has resulted in some of the sickest patients waiting longer than necessary for treatment; notes the financial chaos in Trusts and Health Authorities as a result of ministerial incompetence; and deprecates the misleading of the public about funding as a result of the Treasury's culture of repeatedly re-announcing financial decisions, and the practice of using the NHS as a means of providing publicity and photo opportunities for Ministers, putting political priorities before the morale of dedicated and hard-working NHS staff and to the detriment of patient care. When the Government came to office nearly three years ago, their message was that there was nothing essentially wrong with the model of the national health service, but that the Conservatives in government had not wanted it to work properly, and that therefore it had not worked properly. The message was "Vote Labour and save the NHS", and a great deal of the Prime Minister's personal prestige was invested in that pledge. Huge expectations were raised about what the Government would be able to do, and on what time scale they would be able to do it. Today, we shall ask where those expectations are now and what has become of the NHS under Labour management.

Most countries are grappling with the health care debate, and our debates here resonate throughout Europe and the rest of the western world. Most western countries generally accept some form of mixed health provision, and engage in relatively mature debate. Our Prime Minister says that he has no ideological problem with the private sector, but the Secretary of State has. We have financial mismanagement, with repeated announcements of funding to secure headlines for Ministers. We have, at the centre of the Government's plans, a waiting list initiative that is almost universally condemned by the medical profession, which considers that it distorts clinical priorities. We have a system of management and a culture that are corroding the system from within, eating away at morale in the NHS and destroying the considerable good will, which, it must be admitted, the Government enjoyed when they came to office.

We intend today to examine the questions of finance and the waiting list initiative in detail, but first I want to deal briefly with the Government's style of management and the organisational structures. The last Government abolished a tier of NHS management to give more autonomy to trusts. We now have, roughly, an 80:1 management ratio, with 80 trust chairmen reporting to one regional authority. This Government, however, have insisted on a highly centralised style of management, involving a flood of policies, targets and directives that are entirely beyond the capacity of trusts. The result is poor communication, with a devolved structure of management but centralised control of management from Whitehall.

We are seeing a non-stop series of knee-jerk reactions. It seems that, in the case of the present Government, the best way in which to get anything done—the best way in which to secure any new initiative—is to embarrass the Prime Minister, either in public or, especially, on television. The Prime Minister's embarrassment fund seems to be a bottomless pit: it is necessary only to ask him a difficult question on "Newsnight" and throw him a few embarrassing statistics, and he will have the Secretary of State running off to the next Department on Monday morning with a new initiative, pledging money—probably the same money that has been pledged before, but money none the less. We therefore have a fragmented finance process with arcane bidding mechanisms, in which no one really knows what is going on. The losers are the patients. Morale among staff is reduced. I hope that the Secretary of State will deal with the problem of morale among general practitioners.

Mr. Michael Fabricant (Lichfield)

My hon. Friend mentions problems of morale in the NHS. Is he aware that the head of staff recruitment at Victoria hospital in Lichfield has told me that it is virtually impossible to recruit nurses to the hospital as, for the first time, its future and its services are under threat? Does he agree that that is appalling? For 18 years, the future of the Victoria and Hammerwich hospitals was assured. Now, both hospitals and their services are under threat.

Dr. Fox

I am more than happy to take my hon. Friend's word about the problem of recruiting nurses. The more general problem is retaining them once they have been recruited. We have been over the factors involved in the House: pay; conditions; lack of professional esteem from other colleagues, and sometimes from the public; and shift patterns in the NHS, which do not entice many who would like to stay in nursing. I am sure that my hon. Friend is more than capable of making sufficient political capital out of the difficulties in his area.

GPs throughout the country have complained about their loss of status, the steady erosion of their position in the medical profession and, in particular, the loss of their role of gate-keeper, which many were developing very well, especially towards the end of the previous Government's term of office.

GPs feel, for example, that there is a complete lack of co-ordination between NHS Direct and the rest of the primary care system. The many problems with NHS Direct are increasingly showing up. It is expensive, and consultants have complained that it is stripping nursing staff, especially from accident and emergency departments. We are at the ridiculous stage where nurses who are part of NHS Direct are pretending to be answerphones and being caught out only because they happen to cough. That is indicative of the ridiculous system that the Secretary of State is forcing through at pace. However, the morale problem among GPs will inevitably result in reduced patient care if the Government do not address it. Will the Minister mention that in particular when he replies?

Let us look at finance. We have two questions to ask: what is really happening to finance in the NHS and how is it affecting health care? The NHS Confederation says that 2000–01 is likely to be one of the toughest years on record. There are several reasons for that. The first is the front-loading of the comprehensive spending review. The rise in NHS spending is 4.7 per cent. in real terms in 1999–2000, falling to 4.5 per cent. this year and to 3.9 per cent. next year. However, we then have the unfunded pay awards. Although those are entirely laudable and I am sure that no one would object to any NHS staff receiving higher remuneration, as the average trust pay bill is rising by about 4.2 per cent. this year—not the 3.5 per cent. that the Government predicted—and as funding is likely to go down, as predicted, over the next three years in real terms, the recurring cost of the awards can be met only by a reduction in patient care. That is not a political judgment, but simple arithmetic. The Government will have to tell health authorities and trusts how to deal with that; otherwise, there will be a reduction in patient services.

Health authorities and trusts are being asked to deal with additional financial burdens. The European Union working-time directive is one. Holiday pay, for example, will cost more. Nurses will have to be paid the average rather than basic pay for nursing leave. Again, no one would begrudge nursing staff that, but it will be an extra financial burden on health authorities. Prescribing budgets in primary care will rise, with the drugs budget perhaps up by 11 per cent. this year.

Structural deficits are carried over from year to year. They are increasing and make the first claim on funds that are available in April. For example, I shall randomly pick hon. Members and look at the deficits that their health authorities face. It is predicted that the deficit of the health authority that serves the constituency of the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), will be £8.5 million. The health authority in the constituency of the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), has a deficit of more than £1 million. The deficit for the health authority in the constituency of the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper) is predicted to be more than £5.5 million.

Those Ministers will be pleased to know that—by complete coincidence—the one member of their team whose health authority is not facing a deficit is that of the Secretary of State. Although I am sure that hon. Members will agree that the location of health authorities among constituencies is entirely coincidental, not all hon. Members—not even all health Ministers—have been able to obtain such privileged funding for our own health authorities.

What does the funding problem entail for a typical trust? Ministers say that they have been extremely generous in providing a 6.7 per cent. funding increase, which includes the extra allocation made at the end of last year, but basic inflation has been running at 2.6 per cent. If we add to the inflation figure the effects of superannuation, the working-time directive, reduced hours for junior doctors and capital charges excess, the 2.6 per cent. figure increases to about 5.78 per cent. If we add to that the costs of clinical governance and increases in drug costs, the figure increases by another 0.5 per cent. If we add to it the costs of dealing with the maintenance backlog, winter and ensuring a nursing skill mix, the figure increases by about another 1.8 per cent. Finally, if we add the 3 per cent. deficit, it becomes clear that, before we treat another patient or increase any type of patient care, there is 10.5 per cent. in extra costs. However, only 6.7 per cent. extra has been provided. That is not generous.

People will be wondering why the extra £21 billion that the Chancellor announced for NHS spending is not being spent on patient care. They will be wondering where all that money has gone. I am grateful to Peter Kellner for his very simple analysis of the matter. After inflation, the £21 billion—of which England is receiving £17.6 billion—yields a real increase, over three years, of £10.9 billion. We must then subtract from that figure the costs of unfunded wages, more elderly patients and the drug budget—in short, the costs of medical inflation—which yields an increase of only £5 billion over three years.

If we also take into account the deficits, we can appreciate why Lord Winston came to the view that the national health service was being starved of funds. Health authorities are beginning the year with negative funding.

Ministers try to pretend that they have provided much more money to the NHS than they have, but I caution them about that. In future, the public will not believe them when they promise—like the boy who cried wolf—more money for the NHS.

Miss Julie Kirkbride (Bromsgrove)

I have written to the chairman of Worcestershire health authority to raise precisely the point that my hon. Friend is making. Although she could not give me a substantive reply, when I asked her about all the costs that my hon. Friend has mentioned so far in his speech, she could not assure me that there would be one extra penny for improved patient care for anyone in Worcestershire. The situation is shameful. I am awaiting a further reply from the chairman.

Dr. Fox

The shame is not that the money is not available—although all hon. Members are worried about the lack of expansion in patient care—but that Ministers pretend that more money is being made available than they are providing. People find unacceptable the essential dishonesty of the process. My hon. Friend has described a part of the pattern of constant re-announcements and the distortion of information that is at the heart of the culture of the Government.

Helen Jones (Warrington, North)

rose—

Dr. Howard Stoate (Dartford)

A moment ago, the hon. Gentleman said that he thought that 6.7 per cent. was not generous. What sum would he consider to be generous, and what would Conservative Members do, if they were in power, to provide the increased funding for which he seems to be calling?

Dr. Fox

I did not say that the settlement was not generous, but that it was insufficient. I said that, given the added pressures that the Government have introduced—including the working time directive and all the other costs that I mentioned—extra pressure is being placed on the NHS budget. The Government are being dishonest with us. Although they say that they are providing a real increase, we all know that it is not a real increase. Across the country, people are asking why they are not seeing that extra money.

As I said, the Government came to power by raising expectations to a level that they themselves knew they could never fulfil. That promise of improving the situation far beyond what they knew they could accomplish has diminished the standing of politics in society and resulted in, for example, lower turnouts at elections.

Helen Jones

Will the hon. Gentleman give way?

Dr. Fox

I may give way in a moment.

There has been a pattern of distortion and reannouncements. For example, this week, the Secretary of State has talked about an increase in the number of cardiologists. On "On the Record", John Humphrys said: The point is they are there, they're waiting, they're registrars, senior registrars or whatever. Professor Alberti— the Government's adviser— himself the source on these matters says they are there, but there is not the money to create the consultancy posts. The Secretary of State replied But that isn't true … That simply isn't true. He has been taking lessons from the Prime Minister at Prime Minister's Question Time. When confronted with a fact that they do not like, they simply deny that it exists.

Yesterday, I received a letter from a cardiologist who wrote as a result of comments that the Secretary of State made on the BBC. The cardiologist wrote: He claimed that an expansion of consultant cardiologists could not take place immediately because it would take time to train such specialists. He stuck to this view despite the comments of Professor George Alberti to the contrary. As a trained cardiologist looking for a consultant position, I take great issue with these comments because they are incorrect. There is in fact a surfeit of trained cardiologists in this country compared to consultant posts arising and projected to arise. It is estimated that there are about 50 trained cardiologists currently seeking consultant posts. I am one of three fully trained cardiologists … who face unemployment in the next few months following termination of our training posts under the new Calman scheme hellip; On the 21st January, I met with my local MP— A Labour MP— … to discuss the situation. I provided her with the above information, which she immediately relayed to Alan Milburn's department for comments. One would assume therefore that he was aware of the situation when he made his comments on the Today programme. I do not know whether he was aware of that information or whether it was passed to him, but, as Secretary of State, I would expect him to know about it.

The Secretary of State for Health (Mr. Alan Milburn)

The hon. Gentleman mentioned Professor George Alberti. I wonder whether he has seen the statement issued, I think, today by the Royal College of Physicians. It says that the College does not expect there to be any fully-trained unemployed cardiologists by the end of 2000 and indeed there are several unfilled posts at present.

Dr. Fox

Time will tell what will come to pass. I take the Secretary of State's comment to be a pledge that all those who are trained in cardiology will be found consultant posts by the end of the year. If any trained cardiologists have not been given new consultant posts created by the end of the year, we will know that what he has just said are simply words to get him through the debate and not a serious matter of policy.

The Secretary of State told us to judge him on his record. In October 1999, he said that a £50 million boost to cardiac surgery was there to increase the number of operations by 10 per cent. over the next two years. However, of course, that was not new money as he was forced to admit later. He said that it was part of the extra £21 billion that the Government were putting into the NHS. It seems that the words "new" and "extra" in the Department of Health mean the same as the Home Office's use of the word "extra" in relation to policemen.

When the Secretary of State spoke about consultants, he said that there would be an increase in the number of heart specialists by more than 400 in the next six years. However, Dr. Peter Hawker of the British Medical Association's consultants committee said: The 400 additional heart specialists announced today are already in the NHS as specialist registrars on the training ladder. The Secretary of State is trying to create numbers that do not exist. That can lead only to the dashing of the expectations of those who work in the medical profession and the patients who would be treated by them.

The Government's greatest trick is to reannounce. When one makes one announcement, one might as well make it many times. Let me give the House an example. On 29 September 1998, the Government announced—it was a welcome announcement—£30 million to modernise 50 accident and emergency units. On 28 October, they announced that there would be £30 million extra for A and E and, on 17 November, that there would be £30 million extra to fund A and E. On 16 February in the following year, on 15 March, 15 April, 7 May and 28 May, they announced each time that an extra £30 million was being made available for accident and emergency units.

Anyone outside the House might believe that if one announces seven times that £30 million extra will be spent on A and E in the NHS, that means that one is spending more than £200 million. However, in fact, only £30 million will be provided. That is the elastic arithmetic of the Government and a total inversion of the truth.

Mr. Christopher Gill (Ludlow)

Is my hon. Friend aware that, on 21 July, the Prime Minister said: We are renovating every accident and emergency department in the country?—[Official Report, 21 July 1999; Vol. 335, c. 1188.] In reality, my constituents have found that the accident and emergency department serving them in south Shropshire is being scaled down.

Dr. Fox

If I may, just for once, be fair to the Prime Minister, I think that he said that every accident and emergency department that needs it will be upgraded. What beats me is where we can find the criteria by which "needs it" will be judged. Throughout Britain, many departments that I would regard as needing improvement do not seem to be eligible for the magical £30 million that the Government are bringing forward. It would be entirely justifiable if my hon. Friend were to table parliamentary questions to discover those criteria. I wish him good luck, because we have not been able to discover them.

Helen Jones

Will the hon. Gentleman give way?

Dr. Fox

I shall give way to the hon. Lady in a moment because she has already tried to intervene twice.

What we see in terms of waiting lists is probably the greatest deception of all. Again, in "On the Record" this week, the Secretary of State said that, as everyone knows, waiting lists had peaked but were coming down, yet last month his Department announced a 36,000 rise, and the waiting list for the waiting list has more than doubled since Labour took office. Only the Government, with their Alice in Wonderland interpretation of data, could regard such figures as going down.

Helen Jones

The hon. Gentleman talks about spending plans and the information given to the public, but who should the public believe—the hon. Gentleman when he says that Government spending plans are insufficient, or the former shadow Chancellor who said that they were reckless?

Dr. Fox

The lap dogs are all out today. I should have expected that, by now, the Labour Whips would have done a little work and got some new interventions.

The amount of money that has been made available, although described as "generous", is nothing of the sort. In fact, the money announced by the Government is not the amount that has been given to health authorities. It is becoming increasingly clear that the Government have perpetrated a con trick on the health authorities and the trusts, and on patients in Britain.

Miss Kirkbride

I share the accident and emergency department referred to by my hon. Friend the Member for Ludlow (Mr. Gill). The Government talk about changes and improvements to such departments, but at Kidderminster general hospital and the Alexandra hospital in Redditch, those departments are being downgraded to minor injuries units, which is why money is being spent on them.

Dr. Fox

That is an example of something else that the Government do continually: regrade things and give them a different title so that we are supposed not to notice that we are being given an inferior level of service. They must think that the public are as gullible as their own Back Benchers if they think they will get away with that for any length of time.

Mr. Geraint Davies (Croydon, Central)

Will the hon. Gentleman give way?

Dr. Fox

No, I have just given way three times.

I come to clinical priorities. This is probably the most serious part of today's debate. The Government were warned at the outset by the Conservative party and, to be fair, the Liberal Democrat—the hon. Member for North Devon (Mr. Harvey)—and the medical profession, that its waiting list initiative was dangerous. Last week, Dr. Peter Skolar described it as complete anathema to the medical profession. Increasingly, that is how it is. It is dangerous because, with its obsession with numbers, it treats all patients as having equal clinical weighting, which is unfair. It is a manipulation of clinical priorities because, by penalising health authorities for not bringing numbers down quickly enough, health authorities are being encouraged, within any one given budget, to treat more minor conditions to satisfy the political masters, rather than treat them according to clinical priority. That is an unethical, unfair and immoral way in which to run a health care system.

Dr. Peter Wilde confronted the Prime Minister last week on "Newsnight" and said that, as a cardiologist in Bristol, he believed that patients had died unnecessarily waiting for cardiac surgery. The scandal lies in the fact not simply that patients were waiting too long, but that the health authorities were still treating minor conditions while those patients were waiting for more serious surgery. That distortion of a simple clinical priority is the ethical flaw in the Government's policy.

There is still time for the Government to abandon that policy. I have no intention of raising individual cases of patients who have suffered, but surely we can all see that it cannot be right, in any medical system with finite funding, to ration on the basis of getting the numbers down quickly rather than treating the appropriate patients and ensuring that the sickest are treated first.

Surgeons throughout the country tell us that they are under pressure from their managers to get the numbers down quickly to avoid being penalised financially by the Government. We most object to the culture that is driving the process. There is a corrosive—and, I believe, disreputable and dishonest—code driving not only the policy but its presentation. That is partly because the Government have no coherent philosophy. The Secretary of State told managers when he was a junior Minister that he would come down like a ton of bricks on anyone who dealt with the private sector, but the Prime Minister said on "Newsnight" that he had no ideological problem with the private sector.

There was no adequate consultation to avert the winter crisis. From April, employers who dare to give private sector cover to their employees as a benefit will be subject to a new tax. Hon. Members may want to know that yesterday the Fees Office said: I am writing to confirm that there will be a National Insurance liability on Health Care payments … All such payments should go through the payroll and will incur Employer's NI at a rate of 12.2 per cent. Any Members of Parliament who dare to give their secretaries or researchers health perks will be taxed by a Government who do not have a problem with the private sector.

It goes to the root of the Government's culture that they say one thing and do another. They would say black was white if they thought they had to. They are so duplicitous that they would not ask for water if they were thirsty. What is more, they can never be wrong. The Secretary of State said last week that Professor Alberti—his own adviser—Stephen Thornton of the NHS Confederation, the Institute for Fiscal Studies and Rabbi Julia Neuberger of the King's Fund were all wrong. On "Newsnight", the Prime Minister said that the managers, the doctors and the public were wrong, and moreover that the media were to blame.

The Government have no core values and exist only to be in office. We have the sad spectacle of Back Benchers, rather than holding the Executive to account, worshipping at the altar of the Prime Minister's ego. If one statement said it all, it was when the Prime Minister was asked whether the distortion of clinical priorities by the waiting list initiative should be changed. He said: If we abandoned waiting lists, you guys— the press— would come down on us first and then patients would come down on us. That means that Ministers' reputations come first and patient care comes second.

We have a health care system run by politicians for politicians, not by doctors for their patients. On health care, the public expected much from the Government, but have been bitterly disappointed. The Government have replaced ethics with spin, hope with cynicism and dedication with dismay. The great Labour lie has turned into the great Labour betrayal.

4.9 pm

The Secretary of State for Health (Mr. Alan Milburn)

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

welcomes the Government's modernisation programme for the NHS and the reduction in waiting lists and times that are being achieved through the dedication and hard work of NHS staff; notes the progress being made on recruiting more doctors and more nurses, building more hospitals, treating more patients and modernising more services; applauds the Government's decision to make tackling cancer, coronary heart disease and mental illness a priority; believes that financial provision for the NHS would be reduced as a consequence of the Conservatives' Tax Guarantee and that clinical need would be abandoned in favour of ability to pay under the Conservatives' health plans. I apologise at the outset for the fact that I will not be here for the winding-up speeches, as I have a prior speaking engagement.

The Opposition have called for a debate on financial provision and clinical distortion in the NHS. I am pleased to tell the House that financial provision for the NHS has never been greater. The NHS is now benefiting from the largest cash injection it has ever seen. I am also pleased to tell the House that the assault on clinical distortion caused by the postcode lottery of care has never been greater either: the failed, disastrous, divisive internal market in the NHS has been consigned to the dustbin of history, where it belongs.

Mr. Simon Burns (West Chelmsford)

Will the right hon. Gentleman give way?

Mr. Milburn

Yes. I believe that the hon. Gentleman was a supporter of the internal market.

Mr. Burns

If everything is so wonderful for funding in the national health service, why is it that, this financial year, the Mid Essex hospital trust will have the largest deficit it has had in its history, and three wards, containing 84 beds, will be closed?

Mr. Milburn

I do not know about that particular case, but the hon. Gentleman was a Minister at the Department of Health in 1996–97 when the NHS ran up a combined deficit of £459 million. He shares at least some of the responsibility for that, as I am sure he accepts. By the beginning of this financial year, that deficit had come down to £18 million, so we will not take any lectures from the hon. Gentleman or the Conservative party on deficits in the NHS.

Mr. Edward Garnier (Harborough)

If the Secretary of State could not answer the previous question, perhaps he can answer mine. In November last year, his predecessor, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), opened a brand new breast cancer unit at the Glenfield hospital in Leicester. That unit was opened thanks to private subscriptions and was not funded by NHS money. It will now be closed. Why?

Mr. Milburn

The hon. and learned Gentleman is talking about the Leicestershire area and he will be aware that consultation is still taking place about some of the proposals. There are always difficult decisions to make about health care funding and services, and that is as true for this Government as it was for the previous Government. The consultation continues and I urge the hon. and learned Gentleman to take part in it.

The Conservatives' motion condemns financial mismanagement when the Conservatives are past masters of it. I remind the hon. Member for Woodspring (Mr. Fox), who was rattling on about financial mismanagement, that it was his Government who managed to spend a small fortune on financial mismanagement in the NHS, including more red tape and bureaucracy than it has had in its history. This Government are taking £1 billion out of red tape to put directly into front-line patient services. We are doing that because it is the patients' priority, the staff's priority and our priority. Needless to say, the hon. Gentleman and his party oppose it.

Mr. Gerald Howarth (Aldershot)

The Secretary of State referred a couple of moments ago to the ending of what he called the postcode lottery. Can he explain to me, so that I can explain to those of my constituents suffering from multiple sclerosis—some of whom are now in Westminster Hall—why one of my constituents from Hampshire is unable to obtain beta interferon and will have to wait 18 months, while another person from Surrey is able to obtain it immediately and tells me that it is down to the postcode lottery? Rather than going back to the past, will the Secretary of State recognise that people want to know what the Government whom they elected are going to do to improve their health care instead of making it worse?

Mr. Milburn

I shall tell the hon. Gentleman precisely what we will do about it. Every hon. Member is aware of the situation in relation to beta interferon, and the first thing to say is that nobody should hold out beta interferon or any such product as a cure for MS. It is not a cure, because there is no such cure. However, this Government recognise that there is a lottery of care—unlike the previous Government who denied it—and, what is more, we are taking action to tackle it. That is why the National Institute for Clinical Excellence is considering beta interferon. I want to see a fair system of care that does not depend on where someone lives, or who their GP happens to be. Care should be determined according to clinical need. As the hon. Gentleman will be aware, the current guidance on beta interferon, which will be superseded once NICE has reported, is guidance that the Tory Government issued in 1995.

Mr. James Gray (North Wiltshire)

My constituent Stephanie Millward will be keen to hear when NICE is to report. If the Secretary of State is happy about the treatment of MS, will he explain why the Government spend a laughable £640,000 a year on research into the causes of MS? That is a ridiculous sum, so will the Secretary of State commit himself to increasing it?

Mr. Milburn

There are always many demands on the NHS research and development budget—including for research into prostate cancer. We try to ensure that the R and D programme is best geared to meet patients' interests. We will, of course, look at the resources devoted to MS research. With regard to beta interferon, I can tell the House that we expect NICE to report in late summer or early autumn. We will try to make that report available to the national health service as quickly as possible, as we all have a shared interest in getting the matter right. I am afraid that, in the past, the problem has been swept under the carpet.

The Conservative motion also complains about using the NHS as a means of providing publicity and photo opportunities … The hon. Member for Woodspring has been caught short once already, so he ought to check his facts more carefully, especially with regard to photo opportunities. For some time, the BBC's "Panorama" programme has been contacting NHS hospitals up and down the land asking if filming could be conducted on their premises. At least 23 hospitals have been contacted, including Basildon hospital, Kettering general hospital, the Princess Royal hospital in Telford, the Royal Shrewsbury hospital, and Kidderminster general hospital. One might think that there is nothing unusual in that, but the filming is not for a factual programme. It is for a fictional programme—the story of one man's experience as a television extra.

I have a copy of the fax from the BBC about the programme, dated 20 January this year. Given the concern expressed in the motion about photo opportunities and the misuse of the national health service, I am sure that the House will be interested to know the proposed star of the extravaganza. The fax states: William Hague has agreed to be filmed in a variety of situations. There is more to the story than that. According to the fax, the Leader of the Opposition is to

take on a role in the hospital for half a day; a porter's job or something similar. I suppose that we should at least be grateful that he is not going to masquerade as a brain surgeon. So much for the Opposition's complaint about photo opportunities: the hon. Member for Woodspring should check his facts before he comes before the House.

Mr. Patrick McLoughlin (West Derbyshire)

Will the Secretary of State give way?

Mr. Milburn

In a moment, as I have given way six times already.

Mr. McLoughlin

Will the Secretary of State give way on this point?

Mr. Milburn

The hon. Gentleman, who is a Whip, should sit down. I might give way to him later—if he learns to behave himself.

I shall deal with each of the claims in the Opposition motion, and I shall start with the question of financial provision for the national health service—a subject that we are more than happy to debate.

Over the period of the comprehensive spending review—that is, this year, next year and the year after—the NHS is experiencing average real-terms growth of about 5 per cent. In the present financial year, real-terms growth is actually around 6 per cent. Health authorities are getting cash increases that average 6.8 per cent.

Let me put that in context. The average real-terms growth for the NHS over the full 18 years of the Conservative Government was around just 3 per cent—half the growth in this financial year. During the previous Conservative Government's final five years in office, they did not even manage 3 per cent. growth. They averaged growth of only 2.6 per cent. per year in that time.

It is little wonder, then, that the NHS that this Government inherited had too few doctors and too few nurses; that three quarters of accident and emergency units needed modernising; that the NHS was crying out for the biggest hospital building programme in its history; that waiting lists were too long and were rising; and that our country's record on coronary heart disease and cancer lagged so far behind that of other European nations.

It is also little wonder, after those 18 years of neglect and mismanagement, that we inherited an NHS that was on its knees. We intend to get it back on its feet, but of course that will take time. We will not be happy until it is up and running again as the pride of Britain and the envy of the world. Conservative Members want always to run down and talk down the national health service, but the Government are making progress towards "making political capital" out of the NHS, to borrow the graphic phrase used by the hon. Member for Woodspring.

There are 2,000 more doctors in the national health service than there were when we came to office. We are beginning to turn the corner, too, on nurse shortages. There are 4,500 more nurses in the NHS than there were a year ago, thanks in part to the largest real-terms increase in pay that nurses have had in a decade and a half. It was paid in full—without staging, as happened under the previous Government. The biggest hospital building programme that the NHS has ever seen is under way. Every casualty department that needs it is being modernised.

The hon. Gentleman was talking about difficult decisions. For the first time, we have a means of setting national standards, through the National Institute for Clinical Excellence, to tackle precisely the lottery of care that the Conservative created and connived at. We have also, for the first time, a means of monitoring and inspecting those standards through the Commission for Health Improvement.

Miss Kirkbride

The Secretary of State has mentioned NICE a number of times, and its views on beta interferon. He will be aware that many people in Westminster Hall right now are very concerned about that. In Worcestershire, only two people out of hundreds with multiple sclerosis are receiving beta interferon. If NICE agrees that beta interferon is a cost-effective treatment, as the right hon. Gentleman's Government would put it, does he promise that everybody in Worcestershire who is able to benefit from receiving beta interferon will have it, and will he make up the shortfall in Worcestershire health authority's budget as a result?

Mr. Milburn

We have NICE for a very simple and straightforward reason. As both the hon. Lady and I know, different health authorities take different decisions about prescribing important drugs and making available different forms of treatment and intervention. We want to put that right, because we believe in a fair system of health care in which care is made available according to clinical need and not any other factor. When NICE produces its guidance, we expect health authorities, primary care groups, doctors, nurses and others to take full account of what it says.

Mr. Nick Harvey (North Devon)

Does that mean that, should NICE decide that beta interferon is not cost-effective and clinically effective, patients who currently receive it can anticipate ceasing to have it in the future?

Mr. Milburn

That is not the position. We have discussed this issue with NICE, which is under an explicit instruction to look at the ramifications of any decision that it takes—for example, if it decides that in future a drug that patients currently receive is not cost-effective or clinically effective. The important thing about NICE is that it does not substitute for doctors or for other clinicians' decisions. It is there to help and support them and make their job easier. Ultimately, the individual clinician dealing with the individual patient will have to decide. Frankly, I cannot decide that; neither can the hon. Gentleman—and neither, with the best will in the world, can the NHS Executive or the National Institute for Clinical Excellence. It is a clinical decision, but it must be an informed clinical decision, based on what works and what does not, on what is effective and what is not.

Dr. Fox

It is a very important point that there is a distinction between cost-effectiveness and affordability. Although it might be a legitimate role of NICE or any similar body to examine the cost-effectiveness of any treatment—an aim which I am sure is widely shared—the decision on affordability should not be left at arm's length, but should rest with Ministers. Will the right hon. Gentleman confirm that if NICE agreed that beta interferon was a cost-effective treatment—especially, as seems increasingly likely, in the early stages of multiple sclerosis—Ministers would not stand in the way by saying that it was not affordable to the NHS?

Mr. Milburn

There are clearly two separate sets of decisions to be made. One is about effectiveness. It is right and proper that NICE should look at clinical and cost-effectiveness side by side. That is the right thing for it to do; and it is best equipped to do it. The national health service has never had an independent means of considering those matters and it seems sensible to have one if, as Conservative Members claim—I am sure they are genuine in this—they want to deal with these problems.

There is a separate set of decisions which, in the end, I take. I take decisions about affordability. Those are my decisions. That is right and appropriate, and I will be held to account for them. When NICE comes up with its recommendations, we will of course consider what it says. That is the right thing to do.

I can tell the House that there has been no greater clinical distortion than allowing the NHS, as the previous Government did, to provide the lowest level of cardiac services in precisely the areas where coronary heart disease is highest. That is what we inherited, and that is what we are trying to change. We shall improve the health of the population as a whole, but we shall improve the health of the poorest fastest.

Yes, there are many things wrong in the health service, but there are many things that are going right. Slowly but surely the expansion of the NHS is under way. It is underpinned by the extra resources that we have committed to the service. Of course, it takes time to deliver results and they are always dependent on what we can afford, but we have achieved 5 per cent. funding increases on average during the current spending review. If we continue to manage the economy successfully, we can be confident that we will be able to make the sustained increases in funding that our health service needs, and get up to the European Union average.

The hon. Member for Meriden (Mrs. Spelman) has said that none of that is certain. One thing is certain—the Conservatives would not and could not match our commitment to the NHS. The first reason for that is that Conservative Front-Bench Members have already condemned Labour's investment levels as reckless and irresponsible and as madness. Secondly, the Conservatives' tax guarantee, far from delivering the growth in NHS capacity that the service needs, would result in swingeing cuts in the health service. Opposition Members shake their heads, but those are not my words; they are the words of the former Prime Minister, the right hon. Member for Huntingdon (Mr. Major).

Opposition Front-Bench Members cannot have it both ways. They cannot bemoan the improving financial position of the health service while proposing swingeing cuts. They cannot complain about NHS deficits while threatening to make them worse. What the Conservatives propose is not so much a tax guarantee as guaranteed attacks on the future of the NHS.

That is not what the NHS needs. It needs more investment and more reform. The only guarantee is that it will get neither from the Conservative party. The hon. Member for Woodspring says that, philosophically, the Conservatives have moved on from the NHS. The Government believe that the principles of the NHS are right, but we believe with equal passion that its practices have to change fundamentally.

Mr. Geraint Davies

Does my right hon. Friend agree that to say that waiting lists are unethical is to say that minor ailments should always be trumped by major ailments, and that under Tory rule someone with a cataract would never have treatment? Does he agree also that to say that a 6.8 per cent. funding increase is not sufficient and yet not to pledge any more is to open up the hidden agenda of privatisation behind the tax guarantee?

Mr. Milburn

My hon. Friend is absolutely right, and I am coming to precisely those points.

The Conservatives cannot have their cake and eat it. They cannot have the tax guarantee and then complain about lack of investment in the NHS. That will open them up to the charge of hypocrisy, and that charge will stick as we go into future general elections. The hon. Member for Bromsgrove (Miss Kirkbride) and her colleagues on the Back Benches, who complain that there is not enough money going into the NHS, ought to take up their complaint with the new shadow Chancellor and the Leader of the Opposition because their policy, the tax guarantee, places an artificial straitjacket around NHS spending.

Our view is straightforward: we want to invest more in the NHS. We know that more investment is needed in the NHS, and that is precisely what we intend to provide.

Dr. Fox

Will the right hon. Gentleman give way?

Mr. Milburn

One more time, and then I want to get on to clinical distortion.

Dr. Fox

It surprises me that the Secretary of State wants to get on to that subject. On taxation, he makes the ridiculously simplistic argument that it is impossible to reduce the burden of taxation and increase expenditure on the health service. In the 1980s, the NHS saw its biggest funding expansion in history, at the same time as the tax burden diminished. If the right hon. Gentleman asserts that that is impossible, how does he reconcile his two statements today about increasing and improving NHS funding and the Government's reduction in the standard rate of tax by 1p next month?

Mr. Milburn

I presume, therefore, that the hon. Gentleman disagrees with the right hon. Member for Huntingdon. Is that right? Does he agree or disagree with what the former Prime Minister had to say about the tax guarantee?

As the Prime Minister has said many times, cutting income tax rates is the right thing to do—not least to compensate for other changes in the tax system. We can do that precisely because we are giving the NHS the biggest cash injection in its entire history. Let us not forget that the hon. Gentleman and his party opposed that at the time, and do so now, but do not have the guts to say so.

On the question raised by my hon. Friend the Member for Croydon, Central (Mr. Davies), clinical need drives our determination to speed up care. Faster care means better health. Let us be clear: the NHS is expected to treat all patients according to their clinical priority. Emergencies should be treated immediately, and urgent cases should rightly be given top priority. Our determination to get waiting lists down has not changed that one bit, and the figures prove it.

Compared with 1997–98—these are complex procedures; precisely the sort that the hon. Member for Woodspring says are not happening in the NHS because of all the toes and nails that are being done—last year, there were more than 6,400 additional hip replacement operations, more than 4,700 additional knee replacements and more than 1,400 additional coronary heart bypass grafts. Let us have no more of the argument that clinical priorities are distorted by waiting lists. Waiting lists are down, and we will go on to meet our manifesto commitment. What is more, we have turned the corner on out-patient waiting, too.

The hon. Member for Woodspring says that the lists are not coming down. Over Christmas and new year, hospitals rightly prepare to deal with the inevitable rise in attendance that extra winter pressures cause. This winter was no exception. We saw a rise in the number of people waiting for in-patient treatment in December. We will probably see a further rise in the January figures.

Imagine what a performance there would have been from the hon. Gentleman if those waiting lists had not risen this winter. He would have endlessly repeated the charge that waiting lists had distorted clinical priorities. Indeed, December must have been the only month of the year when he wanted waiting lists to go down. I am sorry to have disappointed him. The NHS did the right thing this winter. It put emergencies before elective cases. In the process, it has given the lie to those who claim that cutting waiting lists distorts clinical priorities. It has not, it does not and it will not in the future either.

Mr. John Bercow (Buckingham)

In responding to my hon. Friends the Members for North Wiltshire (Mr. Gray) and for Bromsgrove (Miss Kirkbride), the Secretary of State wriggled like a belly dancer. For the benefit of the 1,000 multiple sclerosis sufferers and their supporters congregating this afternoon in Westminster Hall, will he tell the House in the form of a simple yes or no answer whether he stands by his statement that No one will be denied the drugs they need. That is guaranteed … ?—[Official Report, 30 June 1998; Vol. 315, c. 143.] Yes, in all circumstances, or no?

Mr. Milburn

That is precisely what we want to do and that is precisely why we have established the National Institute for Clinical Excellence, which the hon. Gentleman opposed. I can therefore only presume that he and his hon. Friends are quite content, apart from specific instances of drugs and treatment, to let the lottery of care continue. I say one thing to him: we are not. Yes, we want to ensure that people receive the treatment that benefits them most. That is precisely what NICE will do.

What the NHS did not do was turn people away because they had the wrong sort of illness, or expect them to take out private medical insurance for a range of conditions deemed by politicians to be no longer necessary on the NHS. To do so would genuinely be to distort clinical priorities and put political priorities ahead of patient need. That is precisely what the hon. Member for Woodspring and the Conservative party propose to do.

Dr. Stoate

My right hon. Friend has told the House how many more hip and knee replacements were carried out on the NHS last year. Will he tell me what would have been the increased burden on an average family, especially a pensioner family, had those treatments been carried out in the private sector with private insurance?

Mr. Milburn

I was coming to precisely that point. I think that the average cost of a hip replacement on the NHS is about £5,000, and that of a cataract operation is about £2,000. Those are NHS costs, and the NHS is cheaper than the private sector.

My hon. Friend makes an extremely good point. To an overwhelming extent, cataract operations and hip and knee replacements are the operations of old age. Why, on 16 January, did the hon. Member for Woodspring tell The Sunday Times that private medical insurance companies should cover conditions such as hip and knee replacements, hernia and cataract operations leaving the NHS to do other things? It was not a slip of the tongue: later that month, on "Sky News", the hon. Member for Runnymede and Weybridge (Mr. Hammond) made it absolutely clear that, under Conservative plans, people would look to the NHS when they had serious life-threatening conditions and would look to their private insurance to help them with the rest.

There is no ambiguity and no weasel words—the message could not be clearer. Conservative policy is to reduce the NHS to a core service for life-threatening conditions, thereby leaving other conditions—such as hip and knee replacements and hernia and cataract operations—to the private sector. Surely, there can be no greater distortion of clinical priorities than the Conservatives writing off the 300,000 people—many of them pensioners—who rely on those operations every year. Pensioners are the people who most need health care and can least afford private health insurance. The Conservatives' policies amount to no more and no less than a new Tory tax on old age.

Dr. Fox

The right hon. Gentleman should read more than a few misquoted columns in The Sunday Times. Had he read this week's newspapers, he would know that I stated explicitly last week that, for many reasons, a core model NHS could not work in the United Kingdom. However, does he accept that if we do not have a core model, any rationing in the NHS has to be done by means of waiting times and proper prioritisation of cases? Does he also accept that if people were encouraged to take out greater private coverage, either individually or through their employer, it would reduce pressure on the NHS and produce an expansion of total health care, which would help to achieve the outcomes that everyone wants?

Mr. Milburn

The last time the hon. Gentleman and I had exchanges about The Sunday Times article, he said that he was going to write to the newspaper to demand a retraction.

Dr. Fox indicated dissent.

Mr. Milburn

Yes he did—it is in the Official Report. Has he written that letter or not? If he has not, I can only assume that the article was an accurate reflection of what he told The Sunday Times about Conservative party policy.

Dr. Fox

Ridiculous.

Mr. Milburn

If it is ridiculous, the hon. Gentleman should send The Sunday Times a letter demanding a retraction two months after the publication of the article in question. In fact, he knows that I am telling the truth—that is the Conservatives' policy.

If individuals want to take out private health insurance, that is a matter for them, but the idea that that could be a panacea for our health care system is fatuous. There is no army of unemployed oncologists—or, according to Sir George Alberti, unemployed cardiologists or cardiac surgeons—waiting for the private call to arms.

An expansion of the private sector must inevitably mean a contraction of the public sector. We have been down that route. We tried that model of care during the 1990s. The then Conservative Government spent £150 million a year subsidising old people to take out private medical insurance. It did not make a jot of difference to the numbers taking out private health insurance. The idea that that somehow acts as a safety valve for the national health service is simply wrong and fatuous.

Mr. Desmond Swayne (New Forest, West)

Will the Secretary of State give way?

Mr. Milburn

No, I am not giving way.

The contrast could not be clearer. Yes, the NHS needs modernising, which is what the Government are doing, but no, the NHS does not need privatising, which is what the Conservatives propose to do. Conservative health policy would indeed distort clinical priorities and mean financial under-provision for the NHS.

No one pretends that everything in the garden is rosy. It is not, but step by step we are making the NHS better. It takes time, but we are making real progress. The country and the service will recognise that. There are more doctors, treating more patients in the NHS; more nurses, training and working in the NHS; new hospitals beginning to be completed for the NHS; modern casualty units coming on-stream throughout the NHS; and fewer in-patients waiting and more out-patients being treated.

That is our record so far, but it is only the start. There is a lot more to do, but I say to the hon. Member for Woodspring and the Conservative party that we have only just begun and we intend to finish the job, because it is what patients and staff want. They want a national health service modernised and reformed, and that is what they will get with this Government.

4.42 pm

Mr. Nick Harvey (North Devon)

I congratulate the hon. Member for Woodspring (Dr. Fox) on securing an opportunity for another debate in the House about health care provision. I agreed with a number of the points that he made. As he explained, the arbitrary waiting list initiative and the targets that were set have in many instances distorted clinical priorities, despite the protestations to the contrary from the Government Front Bench.

Anyone who visits hospitals and speaks to representatives of the professional organisations in the NHS knows that every time hospital managers are called upon to make decisions and set priorities, they are not making the decisions or setting the targets that they would otherwise have done, because they have to meet the waiting list targets.

Mr. Geraint Davies

The hon. Gentleman makes much of priorities, but is he aware that the National Audit Office found that last year the NHS performed an extra half a million operations? Will he give a big clap to the NHS, irrespective of priorities, for the fact that the overall amount of treatment is escalating rapidly, and we are committed to keep it going up?

Mr. Harvey

I congratulate NHS staff on achieving the objective of performing more operations. It is entirely right that they should do so, and they deserve congratulation. However, there are still more people waiting longer for operations.

In its 1997 general election manifesto promise, the Labour party stated: The Conservatives have cut Government spending … by the equivalent of more than £3 billion as spending on the bills of economic and social failure has risen. We are committed to reversing this trend of spending. Over the course of a five-year Parliament, as we cut the costs of economic and social failure we will raise the proportion of national income that is spent on health.

That was a sensible and laudable aim, but, despite the fact that extra money has gone into the health service—a matter to which I shall return—it was clear that demand would continue to rise over time. It always does. If the Government did not anticipate that the number of people needing those extra operations would rise, it was extremely shortsighted of them to frame the policy commitment in that way. The hon. Member for Woodspring was right to say that, from the outset, warnings were given about that. In the Liberal Democrat manifesto our policy commitment was measured on the length of time that people had to wait, not on the number of people on the waiting list.

The number of other people on the list is of relatively little interest to people who are in the unfortunate position of waiting for an operation. They want to know for how long they will have to wait. It would have been more sensible of the Government to set themselves targets on the length of time that people have to wait. People are having to wait longer.

I am slightly puzzled by the Opposition's political objectives in choosing the subject of this afternoon's debate. They have made some important, serious points, but none are new. The ground has been fairly well covered. If the hon. Member for Woodspring hoped to secure news coverage, he would have aroused more news interest if he had told us more about the Conservative policies that he was distilling, and especially the role that he envisages for the private sector. I suspect that more journalists would have been in the Gallery, waiting to hear that. We await more information with interest.

In the rush to get people off in-patient waiting lists, the number of people on out-patient lists has increased. It has more or less doubled since the election from 250,000 to more than 500,000. Although a small downturn occurred recently, the number of people on those lists has increased massively. That more than compensates for the Government's limited progress on the objectives that they set themselves of trying to reduce in-patient waiting lists.

The Secretary of State made a fair point in his speech when he said that we should not be too carried away by figures that appear over a couple of months, especially if they cover the mid-winter period, because authorities and trusts will set different short-term priorities to cope with winter pressures. He is right. However, the overall trend has been upwards for the number of people who wait for unacceptable lengths of time.

It is interesting to consider regional variations. In the south-west—my region—there has been an overall increase in NHS in-patient lists, never mind out-patient waiting lists, since the general election. In the last quarter of last year, 159,000 patients waited more than 26 weeks for an appointment with a consultant after a written referral by their general practitioner, compared with 149,000 in the previous quarter. Even before the Christmas problems and the winter worries, matters were deteriorating.

It should be no surprise that the winter pressures caused such havoc in the health services. Despite promises, and the analysis made in the Labour party manifesto commitment that I quoted, the vast, generous allocation of funding that the Secretary of State describes is not being made to the health service. In a Liberal Democrat Opposition Supply day debate, I said that the Government's methods of accounting are, to put it mildly, unusual.

Those methods have never been used previously, in other walks of life or in other countries. However, as a doctor put it to me, "If my child grows 3 inches in the first year, 3 inches in the second year and 3 inches in the third year, surely the child has grown 9 inches, but under the Government's accounting methods, the child has grown 18 inches." That is the truth about the £18 billion that has gone into the NHS.

I listened with interest to the hon. Member for Woodspring, who, assisted by interventions from his colleagues, went through some of the difficulties that the health service faces. He referred to those that the NHS Confederation had mentioned, and explained how they wiped out some of the money that appears to have been put into the health service. The hon. Gentleman was right to say that several important points needed to be made, not least on pay awards and the costs of coping with improved working rights and conditions, among others, that managers have to tackle. However, as he went through the list and as Conservative Members referred to the difficulties that those issues cause, I could not help but think back to the number of delegations of which I was a member during the previous Parliament that pressed Ministers for more funds on behalf of local education authorities, local councils and health authorities.

In those presentations, we invariably said to the Conservative Ministers facing us, "Look at the terrible pressures that the authority will face, not least funding pay rises." Unfortunately, I do not recall the provision of more cash ever being part of the response. I recall their saying, "These are simply the facts of life and local education authorities and the like are no different from businesses. Everybody has to face those additional costs." Although I very much agree with what the Conservatives have said today, on that particular aspect there seems to be a marked distinction between what they are saying in opposition and what I recall even the kindliest Conservative Minister saying in government when one petitioned for more cash.

The Secretary of State made the point that part of Government policy has been to set about a modernisation programme. In general terms that must be right and, indeed, in some specific terms it has headed in the right direction. We have detailed points of dispute with them over a number of changes, but their reforms of primary care, the introduction of the National Institute for Clinical Excellence and the Commission for Health Improvement, and the development of national service frameworks are all sensible policies that move in the right direction. However, the danger is that they will convince themselves that modernisation is in some sense an alternative to putting additional funding into the national health service. The reality is probably the reverse.

If the modernisation policy works as well as I hope it will, it will result in an improving NHS that will probably cost even more to run. I remember the Conservative Government setting about the process of introducing care in the community. The only thing that was wrong with what otherwise seemed to be an entirely laudable policy objective was the belief that it would somehow cost less. Anybody could see that closing down those appalling old mental asylums and putting people into care in the community was entirely right, but it was a banking certainty to cost a lot more money. We have found precisely that in practice.

For the first two years of this Parliament, the Government decided to saddle themselves with the spending objectives left in place by the previous Conservative Administration. Only in the last three, under the comprehensive spending review, have they started to load significant sums into public services. The result will be that, by the end of this Parliament, they will struggle to convince the electorate that they have expanded health service funding by any more than their Conservative predecessors. Were the election to be called next spring, which seems to be a fashionable bet in some quarters, they would have had only a four-year Parliament of two lean and two slightly better funded years. They would not even have achieved a real-terms increase year on year as great as that managed by the previous Conservative Government.

Unless the Government take radical action pretty quickly, they will face the electorate in May next year having to explain why their increases in health service spending have not even kept up with those of the Conservatives. With the Budget only three weeks away and the comprehensive spending review to be published in July, I can only hope that they find extra money that goes some way to meeting the objective—which the Prime Minister seemed to come up with on the hoof a few weeks ago—of trying to achieve average European Union health spending within five years.

That commitment does not stand close scrutiny because the EU' s membership might change considerably over the next five years, the economic cycle could make average EU health spending a completely different proportion of gross domestic product in any or all EU countries and exchange rate fluctuations could completely distort the figures in any event. The United Kingdom, as one of the largest EU countries, will push the European average up as the situation here improves, so we would be chasing a target that got further and further away.

It would be helpful if the Government nailed down what the Prime Minister meant, what they are seeking to achieve and over what period. If they were seriously to achieve the objective of getting up to EU average spending within five years, it would begin to address the serious funding and resourcing problems in the health service. The measure of success will be whether they achieve the objective that has been set.

Mr. David Hinchliffe (Wakefield)

Bearing in mind the fact that this Opposition day debate was mounted by the Conservative party, does the hon. Gentleman share my surprise and concern that only two Back-Bench Tory MPs are present to discuss these issues?

Mr. Harvey

It seems surprising that, having chosen this subject for debate, there are not more Conservative Members wanting to participate in it. I am not sure how they will keep it going until 7 o'clock, but I suspect that some of them are frantically running round the Tea Room. I suspect that they are relying on me to keep it going. Other than that, we are looking forward to a long contribution from the hon. Member for Meriden (Mrs. Spelman). I shall see what I can do to help her.

Miss Kirkbride

Will the hon. Gentleman give way?

Mr. Harvey

I shall give way to help out in these circumstances.

Miss Kirkbride

In the interests of fairness, the hon. Gentleman may like to know that many of my hon. Friends who were present during the speeches of the Front-Bench spokesmen are now downstairs in Westminster Hall seeing off the multiple sclerosis sufferers who came to lobby Parliament. Labour Members were absent from that lobby.

Mr. Harvey

It is correct that a lobby on behalf of MS sufferers is taking place today, and I am sure that hon. Members from both sides of the House will want to hear what they have to say and to play a part in that.

Funding for the coming year will be hard for many authorities and trusts, which carry the deficits that have accumulated in previous years. The Government, the public and the media are expecting more and more of the national health service. If authorities and trusts are to achieve what everyone wants them to achieve, they will have to have more money than they are getting at the moment. We shall have to wait and see what the comprehensive spending review comes up with, but we hope that the method by which calculations are made in that review and the sums that the Government are able to announce will be clearer and more transparent than they have been to date.

The Secretary of State referred to spending announcements. I looked into 63 spending announcements during 1999, which emerged in the form of Department of Health press releases. Umpteen were already covered by earlier announcements—fair enough, we have got used to that—but several were straightforward repeats. The distance and time that the Government allowed to elapse before reheating the old spending announcements varied from two months at the cheekiest to about eight months, when they hoped that enough people had forgotten about it.

We need to see real money, calculated in a universal fashion that everyone understands and that bears historical and international comparison. When the comprehensive spending review comes out, it is essential that the laudable goal of getting up to the EU average within five years that the Prime Minister has mapped out can be achieved.

Dr. Stoate

The hon. Gentleman has made a number of comments about funding, and I share his concern that we must ensure that the health service is properly funded. He claimed that the £18 billion that we promised for England does not add up, but were we to put in £6 billion in each of three years, he would have to agree with me that that would mean no growth in the second and third years.

Time and again, the Liberal Democrats have asked for money for the health service—there is nothing wrong with that—but they have not explained how they would fund the NHS, and have not said how much money they would put in. I have heard nothing from the Liberal Democrats that makes me feel happy that they have a viable alternative to the vast sums of money that Labour is putting in and will to continue to make available in the future.

Mr. Harvey

I have a sneaking suspicion that the hon. Gentleman will never be entirely happy that the Liberal Democrats have a solution to the problems of the health service. Nevertheless, we shall continue to do our best to persuade him that that is so. We had a costed manifesto at the last election, which promised real-terms increases far in excess of what the Government have achieved, and we explained how those would be paid for.

Each time there has been a Budget we have produced an alternative Budget, and we shall do so again in a couple of weeks' time. After the July comprehensive spending review, both opposition parties will be able to take stock of the state of the nation's finances, and will begin the process of explaining to the nation before next spring's election what our spending priorities are and how we would pay for them. We will take those policies into an election next spring to try to convince the public that there is a better way of doing it. If the hon. Gentleman will hold his breath for a couple of weeks, he will be able to see our alternative Budget.

I remind the hon. Gentleman that last week we debated why the Government had decided on a tax cut this April, although all the polling evidence suggested that people did not want it. According to the polls, at least 80 per cent. said that they would prefer the money to be spent on public services. The Bank of England is raising interest rates almost every month because it is worried about a consumer boom, yet the Chancellor is considering putting the extra money into the pockets of consumers who do not even want it. It is a bit rich for the hon. Gentleman to claim that Liberal Democrats do not say how things should be paid for, just when we are saying that £2.6 billion could easily be found for the purpose.

The long and the short of it is that health service professionals, health authorities and trusts continue to struggle with adverse circumstances. Patients can see the state of hospitals: they can see that there is a lack of staff and that the staff who are there are so overworked that they are having to rush around like scalded cats, and they find it unacceptable that more people are still waiting for longer than they were at the time of the last election.

The Government have introduced some policy initiatives, which we applaud, but those initiatives are no substitute for adequate funding of the health service. The Prime Minister has now set an ambitious goal; we await the Budget and the July comprehensive spending review to see whether the Government are sincere and serious in their attempt to achieve it.

5.1 pm

Mr. David Hinchliffe (Wakefield)

I realise that not many Conservatives wish to speak—although their numbers have doubled in the past few moments: four Tory Back Benchers are now in the Chamber, which is encouraging—but several of my hon. Friends want to say a word, so I shall be brief.

This morning I read a piece in the paper—I cannot remember which one—by some learned professor who argued that the ablest Conservatives were now leading a move back to the centre ground. I have observed no move in that direction on the part of Conservative Front Benchers today. There has been no departure from the clear commitment to a move towards a privatised system that we have heard consistently from successive Tory health spokesmen since the election. Significantly, however, the motion makes no mention of the Tories' privatisation solutions.

Mr. Burns

That is because we are not going to privatise.

Mr. Hinchliffe

I have a degree of respect for the hon. Gentleman, who, like me, is a member of the Select Committee on Health. He works hard on the Committee, and understands some of the issues—not all, but some. However, I have read statements made by the hon. Member for Woodspring (Dr. Fox) in The Sunday Times, which we discussed during our last debate. Those statements make clear the direction in which the Conservatives intend to go, and, although this is not in the motion, it has been made clear again from the Front Bench that they see the NHS as a core service to deal with serious conditions, and expect people to seek private treatment for conditions that are less serious.

Mrs. Caroline Spelman (Meriden)

At 2.40 pm, the hon. Gentleman and I engaged in a debate on "Westminster Live", in which I plainly stated that both my right hon. Friend the Member for Richmond, Yorks (Mr. Hague) and my hon. Friend the Member for Woodspring (Dr. Fox) had said explicitly that the Conservative party would not privatise the NHS. My statement could hardly have been made more recently; I hope that it was clear.

Mr. Jon Trickett (Hemsworth)

Playing with words.

Mr. Hinchliffe

Indeed it is. The Conservatives say that they will not privatise the NHS, but the hon. Lady's colleagues say that a number of patients will be encouraged to seek a private alternative to the NHS. That is on the record, and has been on the record consistently throughout all our debates in the current Parliament. It is the Conservatives' clear commitment. The point that I am making is that their motion makes no mention of any of their policies. In a sense, it treats the House with contempt to table a motion that simply comments on Government policy and sets out no alternative whatever. It has happened before. More than halfway, possibly, through the Parliament, the public deserve some explanation of what the Opposition stand for. The picture that we get is that they stand for moving away from the state health care system.

Miss Kirkbride

Will the hon. Gentleman give way?

Mr. Hinchliffe

No. I want to make some progress.

As I have said, the debate on 18 January focused around the interview in the latest edition of The Sunday Times with the hon. Member for Woodspring and his detailed thinking on the future direction of health care under the Conservatives. I made a point of mentioning one specific part of the article. I did not quote his words out of context; I quoted them exactly within the context of the article. It quoted his views on the direction of Conservative policy: The Conservatives are no longer concerned with the maintenance of the NHS as the primary provider. There was a clear message there.

There was some mumbling from the Front-Bench team at that time. The Secretary of State said that the Conservative Front-Bench spokesman intended to write to The Sunday Times. I have read it every week since. I have seen no corrections. I have seen no suggestions from the Conservatives in the letters column or elsewhere that it was a misrepresentation, because it is exactly what the hon. Member for Woodspring said. The key point that the Secretary of State made is that the tax guarantee will reduce public funding. Clearly, the expansion of private health care is allied to that.

The problem that the Tories face—they have never answered the question, although I have raised it in every health debate since the last general election—is that, if they expand private health care, where will the staff come from? They will come directly from the NHS, so it is their policy to expand the private sector—whether we call it privatisation or peripheral—with people being encouraged, as they have been today, to take out private insurance and use the private sector for hip replacements, cataract operations or whatever. The purpose is to expand and increase use of the private sector.

The Tories do not seem to understand that the private sector does not train its own staff. It recruits them directly from the NHS, so their policy is all about robbing the NHS of its staff and skills.

Mr. Swayne

Will the hon. Gentleman give way?

Mr. Hinchliffe

No. I want to carry on because many Members want to take part in the debate. I have taken one intervention. I hope that I responded to the point that was made.

The simple political fact is that the Tory party has given up on the NHS. I made the point during the speech of the hon. Member for North Devon (Mr. Harvey): two Tory Back Benchers were in the Chamber for a Tory debate. That shows their commitment to discussing concerns about the NHS. If they are getting hammered by their constituents about problems in the NHS, look at the Tory Benches: there is no one there. That shows that they are doing nothing but going through the motions. They see the private sector as the way forward. It is no surprise because, as we all know, the Conservative party has never believed in the NHS.

Mr. Burns

May I try to put the hon. Gentleman out of his misery? I know that he is keeping to a script that he obviously wrote some hours ago, but just to reassure him: Conservative Members do believe in the NHS, free at the point of delivery. That is why we are so concerned on behalf of our constituents about what is happening with waiting lists, out-patient lists, ward closures and the lack of funding.

Mr. Hinchliffe

I am still mystified. If there is such concern, why do we constantly hear about the mixed economy? The first statement—I will check the record— of the hon. Member for Woodspring was about that. That gives a clear message: the Tories want not the state health care system, but the mixed economy.

Mr. Burns

Will the hon. Gentleman give way?

Mr. Hinchliffe

No. With the greatest respect, I have to make progress.

That has been the consistent message for nearly three years. It has not changed, so people understand the direction of Tory policy and will make up their own minds, as they did at the last general election.

I should like to deal specifically with the subject of this debate, as described on the Annunciator: the Government's waiting list pledge at the previous general election, and the alleged distortion of clinical priorities. I have long examined the issue, and I know that there are 101 ways of measuring activity and progress—or the lack of it—in the national health service. As I have said many times, I should not have chosen waiting lists as the best way of measuring progress made in the health service, but should have thought that progress in public health is the best overall guide in judging Government policy. Nevertheless, I accept that I was elected on that pledge, and I believe that I have a duty to ensure that the Government deliver it.

I recommend to hon. Members an exercise that I performed the other day—read the manifesto on which we stood at the general election. I re-read the manifesto that I issued at the election, and it included the pledge on waiting lists. It seems—looking at my picture on the manifesto cover—that I look younger now, under Labour, than I did then, but that is a separate issue. The point is that, with the exception of that one pledge, on waiting lists, we have delivered all of our promises, and I am damned proud of that. I also have a vested interest in ensuring that I can tick the last promise, on waiting lists. Although I had reservations about including the pledge, I believe that we have to deliver it, and that we will deliver it.

Is the pledge distorting priorities in the NHS? A couple of weeks ago, the Health Committee conducted a brief inquiry into the winter pressures initiative. The hon. Member for West Chelmsford (Mr. Burns) attended the inquiry, so I hope that he will concur on this.

At the inquiry, I asked a question of the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), which I couched in these terms: "If I were the chief executive of an NHS trust and I faced the dilemma of choosing between meeting the Government's waiting list target or treating people on the basis of clinical need, what should I do?" She was absolutely clear and categoric in her reply: "You treat people on the basis of need. The health service should treat urgent clinical needs first." The Secretary of State made precisely the same point today.

If hon. Members say that that is not happening in various parts of the country, I shall need to see the evidence of it. Although I have heard anecdotal evidence that urgent clinical priorities are not being treated first, I have not seen concrete evidence of it. I listen to people and, every day, I receive many letters from people who work across the NHS, but I have not yet received a concrete example of the practice. If I receive such an example, I shall examine it. I shall also say that the people in the health service who are involved in the practice have not been listening to the Government's statements, which have made it quite clear that urgent clinical needs should be treated first.

At that Health Committee inquiry, we also compared the performance of two acute NHS trusts, one of which was in the constituency of the hon. Member for West Chelmsford, in Essex, with the other in the north-west of England, in Cheshire. Allegedly, one of the trusts was failing, and the other was succeeding. What I learned in the inquiry—perhaps the hon. Member for West Chelmsford took from it a different message—is that, when we examined in depth the two trusts' figures, we were not comparing like with like. I also learned that one of the trusts was intervening earlier than the other trust in certain medical conditions, and that that practice was increasing its out-patient waiting list.

One trust gave the Committee the specific example of cataract operations. That trust tackled cataract cases earlier than it had before, on an out-patient basis, and did not leave them for the condition to worsen. However, the change in procedure increased the number of people on the out-patient waiting list. The size of waiting lists is, therefore, not the most reliable way of measuring local performance.

I hope that, at the next general election, we might consider including in our manifesto pledges on measurements other than waiting lists. Although I have no problem with including waiting lists, we should do so within the wider context of measuring progress, or lack of it, on other health issues, not only in the health service, but in public health.

As other hon. Members wish to speak in the debate, I shall make only one or two brief points on issues that the Government still have to address. I believe that the biggest distortion in clinical priorities has been caused by private medicine. Part-time NHS consultant status leads to a scandalous distortion, often placing treatment of those who are able to pay before treatment of those on NHS waiting lists who are in greater need. The same consultants are treating people in both sectors.

I ask my hon. Friend the Minister whether the Government will consider conducting a sample audit of NHS and private operating lists of part-time NHS consultants and comparing the clinical needs of patients in each sector. I know for a fact that the outcome of such an audit will show that the clinical needs of those who are on NHS waiting lists are far greater than those of people being treated in the private sector.

The message that I want to give the Government is that the waiting lists problems that we are facing will be dealt with seriously only when moonlighting in the private sector is ended once and for all. We have faced that problem ever since the inception of the national health service, and it is about time the Government dealt with it seriously, on behalf of those—the vast majority of people—who use the national health service.

We could fund that solution by using within the NHS the money that is currently being spent by the NHS on buying care in the private sector. A lot of money is being spent on buying private sector care that could be devoted to the NHS. I hope that Ministers will consider doing that, because such a change would fundamentally alter the treatment received by NHS patients waiting on NHS waiting lists.

I also hope that we shall make much better use of the scarce resources that we do have. When one has been an hon. Member as long as I have, one will—as the hon. Member for West Chelmsford is well aware—have heard it all before. We simply move to the Benches on the other side of the House and carry on dealing with the same matters as we dealt with before. The current Government are bolstering the health service with ever more money, just as the previous Government did. I am always mystified as to where all the money the Tories provided went. In my backyard, all I could see was things getting worse by the week. The money seemed to disappear into a black hole somewhere. There still seems, to some extent, to be a black hole.

We have talked about ending the internal market, which I fully accept. I have also commended the Government on ending competition, which is now officially gone, as the Health Act 1999 made absolutely clear. As an analogy, however, when I go to a market, I see various stalls selling similar products. In health provision, we still have a whole load of stalls that are selling very similar products. I should like some of those stalls to be combined.

I should also like us again to address the purchaser-provider split. I remain to be convinced, when I see what has happened in my own backyard, that such a split makes sense. I talk to people who know far more than I do about local operation of the NHS, and they think that there is huge duplication and a lot of money—which should be spent on patient care—being wasted. I hope that we will revisit that issue. I also urge Ministers to re-examine the framework, to make it more sensible and to cut more of the bureaucracy and waste still in the system.

It would not be a speech by me if I did not also argue that there has to be a much closer relationship between the NHS and local authority social services. I commend the Government on the way in which they have moved the two spheres much closer together. However, like many hon. Members, I fundamentally believe that there should be formal integration of the services. It does not make sense to keep the two systems separated.

I was struck by figures provided, a couple of weeks ago, in the conclusion to the national bed inquiry, showing that two thirds of NHS beds are occupied by over-65s. Since the mid-1990s, one half of the increase in emergency admissions has been of people over 75. Since the early 1990s, one half of the extra emergency admissions of over-75s have been for frailty, not medical need. The inquiry report, which was very comprehensive, provides concrete evidence showing that a substantial proportion of NHS admissions arise as a direct result of the failure to offer people alternative care in the community. In a previous health debate, my hon. Friend the Member for Dartford (Dr. Stoate) gave an example of how he was able to provide such alternative care. We have to provide it, and combining the NHS with local authority social services would make it much easier to do so.

I am very proud of my Government's achievements on the NHS. I am proud that they are addressing the issue of quality, and that they are re-establishing public health as a key public policy issue. I am proud that, so far, they have managed to increase NHS funding, although I look forward to more funding. However, as I said, improving the NHS is not only about money, but about organisation. I am proud also that the Government have ended competition and restored to the NHS the philosophy of collectivism.

The hon. Member for Woodspring said that the Government have no core values. For goodness' sake, we represent the values of the vast majority of people in the United Kingdom. We believe in the values of the NHS that have stood this country in good stead since the 1940s. The NHS has an excellent future in the hands of the Labour Government.

5.20 pm

Mr. Simon Burns (West Chelmsford)

It is a pleasure to follow the Chairman of the Select Committee on Health, the hon. Member for Wakefield (Mr. Hinchliffe). Like the Minister, I listened with great care—the Minister was probably a little aghast—to the hon. Gentleman's comments on what should happen to consultants. I hope that the Minister will fully answer the important points that the Chairman of the Select Committee made. Conservative Members will be fascinated to hear how much the Minister agrees with the hon. Gentleman.

It was also a pleasure in some ways to listen to the characteristically robust, but somewhat worn speech of the Secretary of State. In places, his speech was extremely interesting and non-partisan, and there were even points in it with which no fair-minded person could disagree. The trouble was that he, like many other Ministers in this Government, got hooked on the Millbank syndrome and had to repeat the same catch-phrases, buzz words and on-line messages that the Government try to get across to the country, regardless of whether they are based on fact. Sadly, the hon. Member for Wakefield could not resist clutching at the Secretary of State's coat tails. I refer in particular to the bogus argument about privatisation.

As the hon. Gentleman well knows, we were in government for 18 years. We did not, in any shape or form, in those 18 years seek to privatise the health service. In every year that we were in office, we increased the real-terms funding to the health service. Just to try to convince the hon. Gentleman, may I point out that I certainly believe passionately in the national health service? Under no circumstances would I tolerate its privatisation, in any shape or form.

Mr. Hinchliffe

I accept that the hon. Gentleman personally believes in the NHS. However, he supported and was a member of a Government who had a key fiscal policy of encouraging people to use the private health sector. His Government gave people tax breaks to do that. That does not suggest to me that they believed in the NHS. They wanted to get people out of the NHS and into the private sector, with a consequential drain on staff in the NHS.

Mr. Burns

The hon. Gentleman says that we encouraged people to use private health care. That may well be true in certain areas, such as tax relief on insurance premiums for the elderly, but it is not privatisation.

If one makes it attractive, through tax breaks for individuals, totally voluntarily to spend the money that they earn as they wish on private health care, that relieves the pressures on the national health service and must be beneficial to the people on waiting lists. I see no conflict between the principle of a free national health service and some members of the public wishing to spend their own money to make their own provision. There is nothing wrong with that and it is not privatisation.

I do not want to speak at great length on this subject, but shall make one final point about it. The Government are not averse to using the private health care sector to treat patients, albeit, rightly, free at the point of delivery to those patients. One of the Government's cherished promises—which was that no one would wait more than 18 months for hospital treatment—was broken in my constituency at the end of November and the beginning of December last year. Fourteen people had waited more than 18 months for treatment and the trust picked up on that problem. It was so terrified that it had embarrassed the Secretary of State and that the Government's cherished promise had been broken that it wrote to all those people to say that they could have their operations as quickly as possible whenever they liked, and the private sector carried out the operations. I am delighted for my constituents, because they quickly received their treatment, having waited longer than the Government said they would have to wait. That shows that the Government are not averse to using the private sector when there are problems.

Mr. Hinchliffe

I do not want to pursue this point, but I want to try to get one thing on the record. The hon. Gentleman is probably a good deal brighter than the average Conservative Front Bencher, so perhaps he can answer a fundamental question that none of his Front-Bench colleagues appear able to answer. When one pushes people into the private sector and expands it, where do the staff come from to service the private sector? They come directly from the NHS; that is the central point.

Mr. Burns

The hon. Gentleman's question suggested that people are forced into the private sector. No one forces people to take out private health insurance or to use private health care. As he has alluded to, there were in the past encouragements through the tax system for the elderly, but no one forced them to use the private sector.

There are two ways in which staff can be trained for health care in this country. The first—it trains the largest proportion—is through the health service and the second is through the private system, which trains a much smaller proportion.

Dr. Stoate

Will the hon. Gentleman give way?

Mr. Burns

No, I will not give way, because I want to finish my point.

The hon. Member for Wakefield raised the issue of consultants and seems to be obsessed by it. I think that I can anticipate the Minister's answer to his suggestion. He will say no, but the hon. Gentleman probably thought it was worth a try to raise the issue. It will reassure the profession and bring relief to the Government when the Minister says that he does not agree with him. Significantly, he did not mention general practitioners, who are all self-employed. It was interesting that he mentioned consultants, but did not, for some reason, refer to GPs. I assume that that was an omission and that he would like to include them in his system.

Mr. Hinchliffe

No.

Mr. Burns

The hon. Gentleman says no. That suggests that he has a contradictory view. However, I want to move on, or we shall get bogged down in what is a minor part of my speech.

I read the Government's motion with interest and I listened to the glowing picture that the Secretary of State painted of NHS funding. He suggested that everything was absolutely magnificent in the health service. I agree that some things are magnificent. The staff—the doctors, nurses, consultants and ancillary staff who deliver health care to all our constituents—are excellent. I also concede that the additional money that the Government, like the previous Government, have given to the NHS is welcome. As the country's financial position dictates, and when the economy is healthy and more money pours into the Treasury from tax receipts and other sources, I would like more investment in the health service. I hope that the Chancellor of the Exchequer's war chest for the general election is not squandered buying up different target groups of the electorate for polling day some time, presumably, next year. I hope that more money is given to the health service.

My hon. Friend the Member for Woodspring (Dr. Fox) said that the £21 billion over three years for the whole of the United Kingdom is not as spectacular as the headline figure suggests. He said that, once it is broken down and analysed, and if one takes into account the partial funding of pay awards and medical insurance, in effect, it works out at £5 billion. When the country can afford it—we are perhaps at a unique point in my lifetime because the country can afford it—I hope that substantially more money will be put into the health service. I say that because of what has happened in my constituency, which is causing grave concern to my constituents. Sadly, they have not enjoyed health care that is as good and glowing as the Secretary of State suggested was the case throughout the land.

I shall be fair and say from the outset that, under the Labour Government of the 1970s and my Government from 1979 until the early 1990s, health service spending was allocated under the resource allocation working party system down to the health authority, and what is now the health trust. RAWP was a crude and painful exercise for my constituents because we were part of the North-East Thames regional health authority, which lumped together places such as mid-Essex with Hackney, Tower Hamlets and other east London boroughs, which, to be frank, have worse social problems than mid-Essex. As a result, a disproportionate amount of health care funding, which, on a pound per head of the population basis would have gone to mid-Essex where the population was expanding, went to the east end of London. At the end of RAWP in 1990–91, it was calculated that mid-Essex alone had lost out to the tune of £15 million a year.

My right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) abolished RAWP and, in crude terms, introduced a pound per head system. From 1990–91 until 1997–98, mid-Essex did much better on a pro rata basis and started to recoup some of the £15 million lost as a result of RAWP. Unfortunately, one of the first things that the Secretary of State did as Minister of State when the Labour Government took office in 1997 was to tweak the funding formula. To be fair, it was only a small tweak, but it meant that more money went back into the east end of London and mid-Essex is losing about £1 million a year that it would have had under the system that existed in 1997–98. I regret that.

As I said in an intervention on the Secretary of State, at the end of this month the Mid Essex Hospital Services NHS trust will have the worst deficit that it has ever had—£4.2 million. Last summer, when the trust believed that the deficit would be £1.8 million by the end of this year, it closed three wards. Owing to the community health council's representations that autumn, it agreed to keep one ward open and, subsequently, due to the winter pressures, it was forced to use part of a second ward, but that was guaranteed only until March. Since then, the deficit has exploded from £1.8 million to £4.2 million. Even the closure of all three wards will not meet the trust's deficit, because that was expected to save only £900,000. One wonders how on earth that deficit would be removed in a recovery plan without even more adverse effects on health care, unless the Government were to provide more money.

The Government's amendment says that my constituents and those of my hon. Friends should welcome the Government's reduction in waiting lists and times that are being achieved through the dedication and hard work of NHS staff. I wholeheartedly concur with the second half of that sentence, but the first half causes me problems. Once again, it is Government spin, which bears little relation to reality.

As my hon. Friend the Member for Woodspring said, the waiting list to get on to the waiting list has increased during the past two and a half years from 250,000 to just over 500,000. The Government have pledged to reduce in-patient waiting lists by 100,000 in the lifetime of this Parliament. We may have only 12 or 14 months to go, so they have an uphill battle. In the Government's first year, waiting lists escalated almost out of control. They then started to come down—to be fair, they came down to 50,000—then they rose again. The Government will say, with some credibility and accuracy, that that was due to winter pressures, but it remains to be seen in the coming months how much of that rise was due to winter pressures and how much to financial pressures and demand on patient care.

Sadly, we in mid-Essex have not shared in that so-called improvement. If only we had, my constituents would not write to me so often about their problems. In mid-Essex in March 1997, 8,361 people were waiting for hospital treatment. In December 1999, the latest available figure, it was 9,851. In March 1997, 104 people, and falling, were waiting 12 months or more for treatment. In December 1999, the figure was 1,060, and rising. We have the added indignity that, at the end of November, early December, the Government's most cherished promise that no one would wait more than 18 months for treatment was also breached, yet we had no apology.

On out-patient lists, the Government thought that they had come up with a wonderful little wheeze. Some bright spark, realising the problems faced by the previous Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), because the figures were not falling and he had rashly said on the "Today" programme one morning that if they did not come down he would resign, decided to save the right hon. Gentleman's bacon—that was before the Prime Minister decided to save it for him by making him the Labour candidate for the mayor of London—by stringing out the length of time before anyone ever sees a consultant after having seen the GP, so creating a significant waiting list to get on to the waiting list for treatment. Nationally, that has been a disaster. The figure has risen from 250,000 to more than 500,000.

In my constituency, matters are even worse. In March 1997, a total of 555 people were waiting 13 weeks or more to see a consultant. Now, the figure is 3,699, which is unacceptable. That is why we need more money.

I come now to the distortion of clinical needs. The Secretary of State said that that does not exist and the hon. Member for Wakefield confirmed that. But, as Mandy Rice-Davies once said, they would say that wouldn't they? It is in their interests to try to spin that line. Unfortunately, to use a stockbroker term, what we are seeing is churning. If an operation is relatively minor, cheap and quick to do, it will be done more quickly than a non-emergency operation that is more complicated, expensive and time consuming, because of the pressures being placed on hospitals and trusts to deliver the Government's deadlines and targets.

As a general election approaches, the pressures will build even more, because the Government will have to show, by hook or by crook, that they have honoured their pledge on waiting lists. They may do it with mirrors or spin, but, whatever the real situation, they will claim to have achieved it because it would be too politically embarrassing for them to admit otherwise. People in the real world, waiting for treatment, will know what the Government are up to.

There is the further problem of trolley waits. Unison did a survey of my local hospital, Broomfield hospital, from 31 October to 5 December 1999. That end date is slightly before the problems of the winter pressures kicked in, so that cannot be used as an excuse. In that period, the number of people having to wait on a trolley from four to 12 hours for a hospital bed was 120. Even worse, the number waiting from 12 to 24 hours was 47. It is unacceptable to have people waiting around in A and E departments or elsewhere to get onto a ward.

Chelmsford has a problem that is shared throughout the country: the cancellation for non-clinical reasons of non-emergency treatment. A survey conducted at Broomfield between October and 22 December 1999—again, just before the winter pressures began to have a significant impact—showed that the number of people whose operations had been cancelled a month before admission was 118, but the number whose operations had been cancelled on the day of admission was 201.

Imagine being psychologically prepared for an operation, with the mental anguish and worry, and turning up at the hospital only to be told that, for non-clinical reasons, the operation has been cancelled. That is unacceptable. Everyone accepts that, if there is a major road accident or a disaster, operations will have to be cancelled to give precedence to emergency treatment, but for those 201 people, that was not the case. That is terrible.

The half-baked solution, which will not work, was to announce the closure of three wards in my constituency, with the loss of 84 beds. To be fair, part of the solution was to eliminate the problem of delayed discharge, and I welcome that, but the wards should not have been closed: they should have been used to bring down the waiting lists. I see the hon. Member for Harwich (Mr. Henderson) nodding in agreement. I wonder whether he knows that, six months after the introduction of the policy of working with social services to eliminate the problem of delayed discharge patients in hospitals, the number of people in Broomfield as delayed discharges is 89.

Mr. Trickett

On a point of order, Mr. Deputy Speaker. Is it in order for the hon. Gentleman to filibuster the debate when many Back Benchers want to take part in this very important discussion?

Mr. Deputy Speaker (Sir Alan Haselhurst)

That is not a point of order for the Chair, as the hon. Gentleman knows.

Mr. Burns

Thank you, Mr. Deputy Speaker. It is a sign of the hon. Gentleman's embarrassment that he has to call my speech a filibuster. He does not like to have to listen to what is going on in the real world, as it does not dovetail with the spin from Millbank. He should learn, because I cannot believe that his constituents do not write to him complaining about delays in their local hospital.

Everything is not as rosy in the NHS as the Secretary of State would have us believe. I am the first to wish him well, because we all want the most effective and efficient provision of health care for our constituents within the health service, for those who choose to use it. I only wish that, instead of trying to convey a situation that does not exist, the Government would be a little more honest and consider some of the tough decisions that will have to be taken to ensure that the health service continues to develop and improve, providing the health care that we all want for our constituents.

Several hon. Members

rose—

Mr. Deputy Speaker

Order. So far, there has been no speech shorter than 18 minutes in this debate. I appeal to hon. Members to realise that shorter speeches make more friends.

5.46 pm

Mr. Eric Martlew (Carlisle)

Thank you for calling me, Mr. Deputy Speaker. I have told my Whip that if I take more than 10 minutes he must pull me down.

The hon. Member for West Chelmsford (Mr. Burns) said that his party was in power for 18 years and did not privatise the national health service. The reality is that it did. Anyone who knows how difficult it is for a constituent to get on an NHS dentist's list will realise that the Tories deliberately and cynically pushed dentistry out of the national health service. The vast majority of people who need dental treatment now have to pay for it. I needed dental treatment and refused to go private, but I had to wait three months for an appointment. That is what the Tories did: they privatised the NHS and they would do even worse next time.

Miss Kirkbride

Dream on.

Mr. Martlew

The hon. Member for Woodspring (Dr. Fox) encouraged his colleagues to make political capital out of the problems. The Conservatives are too stupid to realise that they cannot make political capital out of the NHS, because the public will not forgive them for the state that they left it in: there is nothing in it for them. They are a bit like a—[Interruption.] They are a bit—

Mr. Deputy Speaker

Order. I have tried by silent entreaty to silence the hon. Member for Bromsgrove (Miss Kirkbride). I must now tell her that I have had enough of her sedentary comments. They are delaying the debate.

Mr. Martlew

The Conservatives are a bit like a punch-drunk boxer: they do not know why they have come here—and most of them have disappeared. Politically, on the health service, they are brain-damaged.

The benefits of the £21 billion—the increase in nurses' pay, the increase in the number of nurses, and the increase in the number of doctors—are starting to show through. That may be even more the case in my constituency than elsewhere. In a way, that has been easy, because although I would not say that the NHS in my constituency was decimated, it was certainly starved of investment in the 18 years of Conservative Government.

Since we have had a Labour Government, we have closed the Victorian mental asylum and opened the brand-new Carleton clinic, which has provided an excellent service since opening last year. At the beginning of April, we will have a brand-new district general hospital—which we have waited more than 20 years for—under a contract that was signed after the Labour Government took over. Five attempts to build a new hospital were aborted under the Conservatives.

It may take seven years to train a doctor and three years to train a nurse, but under the Labour Government we have got a brand-new hospital in less than three years. It will be an excellent hospital, providing services—especially maternity services—that used to be on a split site. We have heard about various factors—lack of cardiac surgeons, for instance—that have led to the loss of lives. The fact that the paediatricians were on one site and the maternity unit on another cost babies' lives year after year—under the previous Labour Government, too, it must be said. The new hospital is coming and people are certain to see an improvement. That is why people will say that the Labour Government are doing their best. The NHS is like a supertanker, and turning it round has not been easy, but we are now seeing the effect of a good health service in Carlisle and the rest of the country.

NHS Direct will also come on stream locally in the autumn and provide an extra facility for my constituents. The hon. Member for Bromsgrove (Miss Kirkbride) can pull faces about that, but the people who ring NHS Direct when they have a problem will be pleased by it.

There is no doubt that things are improving, but I cannot let the Secretary of State off completely. We still face challenges in North Cumbria. We have two district general hospitals, one in Whitehaven and one in Carlisle, which are separated by 40 miles of very bad roads. The population of the area dictates that we should have only one hospital, but that is not feasible, sensible or practical. However, the funding formula used takes no account of the fact that we need two district general hospitals. We need to keep the facilities of a district general hospital on both sites.

The two existing trusts will be merged in the near future, and we will have one acute trust and two district general hospitals. However, services will not improve as they should unless the Secretary of State is prepared to accept that there are rural areas whose needs the Conservatives did not address in the past and this Government need to address in future. We need to take account of the fact that North Cumbria is a massive area that includes the lake district, not an urban area in which everyone lives near the hospital.

The situation is improving, but we face many challenges. We need more nurses in our area. A recent scare put out by Unison claimed that a move to a single site would cost 180 jobs. That created much distress among the nursing staff and for my constituents. They thought, "Here we have a Labour Government who said that they were going to improve the NHS, but they are going to sack 180 nurses." The story was a fabrication, and in reality those 180 jobs are safe—and we will take on extra nurses in the future.

The people of Britain have a choice. Do they want partial privatisation of the NHS by the Conservatives—I suspect that even their focus groups are telling them that people do not want to pay for private insurance—or do they want the Prime Minister's pledge that if the economy is going right—and it would be stupid to commit to spending the extra money if there is a slump—spending will be brought up to the European average?

People who work in the NHS in my constituency are looking forward to that extra spending. For too long under the Conservatives, NHS staff did not know where the money was coming from. They have heard the platitudes—we heard them today from the hon. Member for West Chelmsford (Mr. Burns)—about how magnificent they are.

Mr. Burns

They are.

Mr. Martlew

In that case, it is a pity that the Conservatives did not pay them properly.

Under the Labour Government, the nurses will get the best increase that they have had for 10 years. It is easy to say that the staff are magnificent, but the Conservatives never provided the resources to match their magnificence. A Labour Government created the NHS and we are committed to it. We will modernise it and we will give the people of this country the health service that they deserve.

5.54 pm

Mr. John Hayes (South Holland and The Deepings)

Above all else, this debate is about expectations—the expectations by the people of Britain of a decent and healthy life, and a good quality of life, and the expectation that Governments will do what they say they will do.

Unlike many of those who have spoken, I wish to start with the common ground between hon. Members on both sides of the Chamber, which is that those expectations— the public perceptions of what they can expect out of life in terms of health—have changed and are changing. I do not want to become too philosophical in a debate on health—indeed, in any debate, that might be a disadvantage—but it may be true to say that as people have become less sure about their journey to the next life, they have become more interested in preserving this one for as long as possible. Certainly, the nature of people's expectations of their time on this planet is affected by whether they think they can look forward to going anywhere else.

It is also true that as ageing has changed—not just in terms of how long people live, but in terms of what they expect to do when they are older—that has altered people's expectations of health. It is said that in my grandparents' time people were regarded as old at the age of 50. Now my 83-year-old father looks forward to travelling across Europe at regular intervals—at considerably more regular intervals than I do—and expects to be able to do so in good heart and health.

All that is common ground because those problems would confront any Government of any political persuasion. My disagreement with Labour Members is that they do not seem to appreciate that Conservatives recognise that common ground and have, in their hearts, the same desire to see good health for all the people—not only for personal and familiar reasons, but because we care about the welfare and well-being of all our constituents. It is nonsense to pretend otherwise, and facile to have a debate about who does not care about public health standards. All hon. Members care about health—

Mr. Martlew

indicated dissent.

Mr. Hayes

The hon. Gentleman shakes his head, but the reason why I care about health is that before we had an NHS, my grandparents and great-grandparents had to buy their false teeth, let alone their spectacles, second-hand from Woolworths. When my father was a boy going to school in London, there were children there with no shoes on their feet and with rickets. Conservative Members do care about decent public health for all, including working-class people, because many of us come from such backgrounds.

The difference between the parties is that we understand that if we are to address the changing expectations, we must do so with a coherent strategy, and that is incompatible with short-term political stunts and spin. That is what the Government's waiting list priority smacks of, not a long-term strategic view of requirements.

The second type of expectation is the expectation that a Government will do what they say they will do. I mean specifically the mismanagement of expectations—the cynical business of making the electorate believe before the general election that the problems could be easily solved. I refer hon. Members to the Labour party manifesto, which makes no judgment about the difficulties and gives no preamble about how hard the problems will be to solve. It says, in clear and specific terms, that the new Labour Government will do better … We will restore the NHS as a public service. It pledges to spread best practice and ensure rising standards of care. Those are not guarded or considered words, but bold claims which—if they are not realised—will lead to disappointment and, ultimately, to despair.

Labour suggested to the electorate, many of whom were fooled into supporting that party at the general election, that the problems would be solved in a straightforward, fast and simple way. If one sows seeds of hope of that kind, one harvests despair. When the Government consider their record on health over five years—perhaps four—there will be no point in their saying to people, "We couldn't do what we hoped to do or what we said we were going to do. We couldn't deliver on the pledges that the electorate accepted as straightforward and honest. We need more time." No Government can say that unless they are straightforward and honest when they make the initial claims and promises.

If the Labour party election manifesto had talked about strategic difficulties, long-term plans and matters that would not be dealt with in the lifetime of a Parliament by straightforward means, we might have some sympathy. It is possible that we would be less critical than we are obliged to be today, in the interests of our constituents and of our country.

I hope that the Minister of State, when he replies to the debate, will respond to five specific points that I shall make very briefly. First, will he ensure that new NHS treatments are not introduced at the cost of cuts in the existing health service? For example, a new drug that treats a particular condition should be introduced without a parallel decline in a traditional service such as nursing. The resonance of the old truth that people are nursed back to health should not be lost in the push for ever more sophisticated solutions.

Secondly, we must look again at the variety of health needs that are not currently identified as separate and distinct problems. I have a particular interest in acquired brain injury—head injury. The problem with acquired brain injury is not that people are not treated well and properly when the accident that causes the injury—it usually is an accident and one that requires intensive care and emergency treatment—nor that their neurological problems are not dealt with. The problem is that the patient's subsequent needs and treatment are not considered to be worthy of separate attention.

Injuries to the brain and head are not identified as a discrete and separate subject, with the result that many of a patient's subsequent needs are left to haphazard, piecemeal provision. That provision depends on the particular policy of the health authority, hospital or professionals involved.

Thirdly, I hope that the Minister will ensure that, when NICE studies treatments with a view to recommending a policy on them, the people already receiving those treatments will not be disadvantaged. No better example of that problem exists than the case of beta interferon. A number of people receive that drug already, and we know that there is an inequality about the way in which it is provided. However, we do not want those already receiving the drug to be disadvantaged by a new policy.

Fourthly, I am sure that aftercare services, such as convalescence services, will increasingly be moved into the community. When that happens, the Government must ensure that resources follow the patient. It is often more expensive to look after a person at home than it is in hospital, where economies of scale can be made. The small hospitals in many of our smaller towns and rural communities are disappearing, in accordance with the strategy of moving aftercare services into the community.

I do not necessarily disagree with that strategy, but I worry that the resources will not follow the patient, with the result that the funds devoted to such care will decrease over time, and that the quality of care will diminish accordingly. We need good liaison between social services and other agencies involved in that care and health authorities. If necessary, the structure for that communication and liaison must be formalised.

Finally, I hope that the Minister will reconsider the impact of sparsity on the delivery of rural health services. We must take on board the complaints of people who live in remote communities, such as my constituency. The Minister will understand that there is a difference between a sparse population and a scattered one. The degree of sparsity and scatter affects the ability of emergency services to respond to need, but it also impacts on less "glamorous" difficulties, such as those faced by people visiting relatives in hospital. For example, if an elderly spouse is taken into hospital, the healthy partner may have to make a round trip of 50 miles to visit. That problem may not be glamorous, but it is important to those whom it affects.

I have a letter from my constituent Mrs. O'Toole of Spalding, in which she makes the point about rurality. She tells me that, since the provisions in Spalding were reduced, her family has been forced to travel to Peterborough for casualty facilities, a round trip of 50 miles.

Two still more fundamental problems remain with the Government's approach. The first was mentioned by my hon. Friend the Member for Woodspring (Dr. Fox) in his opening remarks, and it concerns the difference between clinical and political judgments. I shall elucidate by identifying the differences between efficacy and priority, and between cost-effectiveness and affordability.

The second fundamental problem concerns the measurement of outcomes, alluded to by the hon. Member for Wakefield (Mr. Hinchliffe). He made two or three very good points, but unfortunately shrouded them in a good deal of prejudice and bile.

Mr. Hinchliffe

I thought that the hon. Gentleman was pleased with me.

Mr. Hayes

My remark was kindly, an example of me at my most generous.

The Labour manifesto states: With Labour, the measure will be quality of outcome. However, all hon. Members know that there is a tendency to measure expenditure and the numbers of people passing through the service. Those measures may be perfectly appropriate, but they do not measure the quality of outcome. We must differentiate between discussions of waiting lists, numbers and the amounts of money being spent, and the need to investigate how effectively money is spent, and how that is being delivered in terms of outcome.

The harvest of disappointment is turning into a harvest of despair. The Secretary of State said that urgent cases had been given priority over the winter. That is not the experience of all of my constituents, however. The daughter of a Mrs. Wendy Allen wrote to me to tell me that her mother, who suffers from a serious condition, was admitted to Leicester royal infirmary on Tuesday 4 January to prepare for an operation to remove half of her liver the next day. However, on Wednesday morning, Mrs. Allen was informed that her operation could not go ahead due to a lack of intensive-care beds.

That is precisely the sort of case to which my hon. Friend the Member for West Chelmsford (Mr. Burns) referred in his remarks. It is not the experience of my constituents—and I believe that the same is true for the constituents of all hon. Members—that the prioritisation of urgent cases has been delivered in practice.

I do not fear what will happen politically if the Government do not address problems such as those I have described. However, as an honourable and dutiful Member of Parliament, I fear for my constituents, among whom not only cardiac patients will continue to regard the Government as heartless, and not only those seeking maternity care will consider them to be all mouth and no delivery.

6.8 pm

Mr. Stephen Hesford (Wirral, West)

I shall begin with a word about the position adopted by the Liberal Democrats. My hon. Friend the Member for Dartford (Dr. Stoate) asked the hon. Member for North Devon (Mr. Harvey) what the Liberal Democrats would do to fund their approach to the health service. As I sat in the Chamber listening to the debate, I noted the rather idiosyncratic response of the hon. Member for North Devon. Although he did not respond at the time, he wrote at least one cheque while the debate continued. That is a novel solution to the problem. I look forward to the cheque being cashed on behalf of the national health service, and I congratulate the hon. Gentleman on his contribution.

My hon. Friend the Member for Wakefield (Mr. Hinchliffe) deserves congratulation for raising the matter of public health—a vital matter that needs to be emphasised at every opportunity. One of the sadnesses of the cycle of debates is that we never get on to such issues.

I come now to the subjects that Conservative Members seem not to want to mention. The debate has been about financial provision, but they did not mention the pledge from my right hon. Friend the Prime Minister that, over five years, the proportion of gross domestic product devoted to the NHS would reach the European average. They never mentioned that, yet it is a key issue. One reason for not mentioning it is their crazy tax pledge, to which my right hon. Friend the Secretary of State referred.

The Prime Minister's pledge requires, year on year for five years, stable and effective growth in the economy. The Tories do not want to discuss the issue because they cannot promise that. Their handling of the economy over 18 years was a cycle of boom and bust. They cannot promise that steady growth, which is why they will not talk about the proportion of GDP matching European funding.

Mr. Swayne

Will the hon. Gentleman give way?

Mr. Hesford

If I must.

Mr. Swayne

Surely the hon. Gentleman recognises that the easiest way to achieve a proportion of GDP as a target would be to engineer an economic downturn. That would secure it quicker than any other method. Does the hon. Gentleman recognise that at the current growth rate of 5 per cent. per year, as claimed, it will take us 19 years to reach the level of funding enjoyed by France, and 25 years to reach that enjoyed by Germany?

Mr. Hesford

I wish that I had not given way, but I am generous to a fault.

The other matter that the Tories would not discuss today was their approach to health insurance. It seems surprising in a debate on financial provision that they should say nothing about that. I call it their "one club" approach, and I suspect that they have begun to realise that they have been beating themselves over the head with it. Whether they have abandoned the club, I do not know. If they finally put away the nonsense about privatisation and health insurance, I would be the first to welcome their conversion. I suspect, however, that that is not the case. They privately harbour that wish, but have not had the courtesy or decency to mention it in the debate.

I listened to the hon. Member for Woodspring (Dr. Fox) address a conference of general practitioners in Bristol. He was asked how far we could push the burden, and who would pay for the expansion of private health insurance. He said two strange things, which may explain why he will not talk now about this aspect. He was asked whether, if he were Secretary of State and he thought that people should take out private health insurance, he would he give all members of public sector services private health insurance. He burst out laughing and said no, he would not. Why would he not give that commitment if it is such a sensible way forward? The answer is cost.

More telling was the hon. Gentleman's remark that the burden should be put on to private business. That answer went against his own logic. Pressed on how far that could be taken, he said, "But not too much." He recognised the flaw in the argument—that lumping private health insurance on to private business would burden it with a cost that it does not now face. The Tories are seeking to impose burdens on the private sector business community. The hon. Gentleman had to say, in a lighthearted way, that the burden should not be put on too many companies. What does that mean? Who will pick up that bill? It is a chaotic approach.

Bearing in mind that the hon. Gentleman was addressing an audience of GPs, it is not surprising that he was asked from the floor, "If you want to bring private sector money into the health service, where does that leave us?" The hon. Gentleman said something like, "It's not for you; it would be too much trouble to introduce those arrangements for GPs." So GPs, who make up 90 per cent. or so of the health service in terms of seeing patients, would not be included in those insurance provisions.

When the right hon. Member for Maidstone and The Weald (Miss Widdecombe) spoke for the Opposition on health, she said: I think if someone wants to pay to see their GP, they should be encouraged to do so … The problem with the NHS is that we do not charge for much of what we do. Which is it? Do the Tories really have no intention of funding visits to the GP by imposing charges?

Dr. Fox

I will put the hon. Gentleman out of his misery for a moment while he gathers his thoughts. It is obvious that very few insurers offer any cover anywhere for general practice problems. It is common sense that any expansion of the non-NHS sector would be unlikely to focus on general practice. That is blindingly obvious to anyone—except, it seems, the hon. Gentleman.

Mr. Hesford

I am amazed by that intervention, which brings me to my next point.

Rather curiously, the hon. Gentleman also said at that meeting—and I have seen it reported elsewhere on a number of occasions—that the insurance sector, on his own estimation, is not up to the job. It is diabolical at the moment; it does not serve the public. When will it start serving the public? When will this be a credible policy? As the Prime Minister has said in Question Time, it is a Trojan horse. It is, as my hon. Friend the Member for Wakefield said, privatisation by any other name.

To paraphrase a former Member of this House, I say this to members of the public who take note of these debates, "Under the hon. Gentleman's regime, don't become elderly, don't need a hip operation, don't need a knee operation, don't need a hernia operation, don't need a cataract operation. If you do, they will make you pay for it, and if you can't afford it, you won't get it."

I want to discuss what is happening in my constituency. I cannot believe that Wirral is unique in this regard. It was interesting that in his opening remarks, the hon. Gentleman refused to go into detail or give any examples—I wonder why, considering that this is an Opposition debate. It may have been because of a lack of clear examples. I contacted the chief executives of my community trust, the health authority and the acute trust. I read them the title of the debate and asked them to comment on it in the light of their experience in Wirral.

The chief executive of the community trust said that he is satisfied with the current year's financial position. He went on to say that the trust has benefited considerably from the modernisation agenda, and gave the example of NHS Direct. I welcome the introduction of that in the Wirral.

The chief executive of the health authority said that there are sufficient resources to address the current programme and there is no evidence on the Wirral of a skewing of clinical priorities. He knows of no local consultants who are saying that such a distortion is happening. On the Wirral, local consultants with waiting lists and other priorities to take into account have been able to show sensitivity and flexibility and deal with each priority to the satisfaction of all concerned. The chief executive described that to me as a clinically sound case mix. Skewing clinical priorities is not an inherent part of the waiting list initiative, as is claimed by Conservative Members.

The chief executive of the acute trust, who is, perhaps, put on the spot more than anybody by the waiting list initiative, said that he has not been under any financial pressure at all in the current financial year, and in terms of capital investment this is the best year that the trust has had since its inception in 1991.

Mr. Hayes

As the hon. Gentleman is fond of quoting health professionals and their confidence in the Government's ability to deliver, will he reflect on the British Medical Association's view? It has written to the Prime Minister to tell him that the Government's habit of constantly reannouncing the same figures is making it impossible for the health professionals, whom the hon. Gentleman is quoting, to plan the effective delivery of the service. The BMA has not had a reply from the Prime Minister. Would the hon. Gentleman care to reply?

Mr. Hesford

If I may, I will leave that to the parties concerned.

I endorse the Secretary of State's remark in a recent speech in Birmingham: There is no funding system or health care system that is fairer or more efficient than the NHS.

Mr. Deputy Speaker

I call the hon. Lady—

Mr. Swayne

rose—

Mr. Deputy Speaker

I call the hon. Gentleman.

6.22 pm

Mr. Desmond Swayne (New Forest, West)

The greatest potential distortion of clinical priorities—[Interruption.]

Mr. Deputy Speaker

Order. Perhaps I might just say to hon. Members that it is as well to pay attention to the debate. If no one had risen on the Opposition Benches, an hon. Member on the Government Benches could have been called. I hope that hon. Members will concentrate and not spend too much time gossiping.

Mr. Swayne

I hope that your stricture was not aimed at me, Mr. Deputy Speaker, for I am bereft of anyone with whom to gossip.

It strikes me that the greatest potential for distortion of clinical priorities lies with the very mechanism that the Secretary of State has set up to do away with those distortions: the National Institute for Clinical Excellence. When the Health Act 1999 went through the House, we were assured that the institute's terms of reference would be merely clinical efficiency and effectiveness and cost-effectiveness. In Committee Room 16 last July, the Minister introduced a change to those terms of reference, under which the institute had to consider also the overall affordability to the health service of any decision that it made. In other words, the Secretary of State would be able to hide behind the implications of any decision by NICE.

I welcomed the Secretary of State's answer to my hon. Friend the Member for Woodspring (Dr. Fox), when he said, "No, I will make decisions on funding and on whether to make provision for certain treatments." The exchange was about beta interferon, which is appropriate given the lobby today. I am glad to hear that the Secretary of State will make those decisions, but it strikes me as rather odd that he introduced the change last July.

It is, of course, appropriate that the question of whether a treatment should be available is one of overall funding to the health service. We have flogged the question of funding this evening, but it is only the Government who are to blame for the general lack of confidence in their figures. The fact that they claim to have provided an additional £21 billion for the health service in this Parliament was interestingly questioned by Mr. Kellner's article in the Evening Standard on 14 January. He said that there had been a process of triple accounting, and the actual figure was nearer £5 billion. The fact that the Government's figures should be questioned in that way is a consequence of their own systematic spinning.

The hon. Member for Wirral, West (Mr. Hesford) referred to the Government's latest pledge. They aspire to spend on health care a percentage of gross domestic product equivalent to the European Union's average spend on health care. That begs one or two questions. It is estimated that it will take us eight years to get there, at an annual increase of 5 per cent. in real terms, but by then the European average may have significantly increased, and I do not doubt that it will.

Why do UK patients deserve a lower level of health care outcomes than that enjoyed by patients in France and Germany? Those countries enjoy a much higher proportion of health care expenditure than the European average. As I said to the hon. Gentleman, the current aim of increasing health care expenditure by 5 per cent. in real terms each year means that it will take many years to reach the levels of expenditure in France and Germany-19 and 25 years respectively.

Mr. Hayes

I do not want to indulge in gossip, but will my hon. Friend illustrate his point by reference to beta interferon? The number of multiple sclerosis sufferers prescribed beta interferon in France, Germany, Italy, Spain, Finland, Greece, Ireland and Turkey is considerably greater than in Great Britain. Perhaps that is why my constituent Mr. Kevin Keeble, of Roman Bank, Holbeach Bank, cannot get the drug.

Mr. Swayne

I have no need to illustrate the point because my hon. Friend has done it so effectively.

It is all very well saying that in a few years' or, indeed, in many years' time we will achieve European levels of expenditure on health care, because the crisis is happening now. It may be stretching the point to say that, in some respects, this country has a third-world level of health care, but anyone who read the series of articles in The Daily Telegraph just before Christmas about the level of treatment available to many of our elderly people would not think it an exaggeration. We have much lower levels of satisfactory health outcomes for critical diseases such as heart conditions and cancer care than in Germany, France, the Netherlands and Belgium, and that is not acceptable.

Returning to clinical distortion, we know that out-patient waiting lists have risen by 248,000 since the election. Even in-patient waiting lists—a higher priority target for the Government—rose by 36,000 in December alone. However, the greatest potential clinical distortion is the alarming growth in the number of patients waiting to get on to a waiting list, and who are awaiting their first appointment with a hospital consultant. That number has risen by some 500,000. Those people represent a clinical distortion because we do not know what is wrong with them and they have not been assessed by a consultant.

It is all very well the Secretary of State making a gibe at our proposals by saying about the winter crisis, "We wouldn't be guilty of turning people away because of the wrong sort of illness." The fact is that, at the moment, people with critical conditions are being turned away.

A constituency case was brought to my attention of an elderly lady who was seriously ill with bowel cancer. Her operation was cancelled because of the winter crisis. Last week, Dr. Peter Wilde, consultant cardiologist at the Bristol Royal infirmary, told the Prime Minister clearly that, if he had been able to operate on all the patients with heart conditions under his care, he would have saved the lives of half of them.

The Secretary of State and, indeed, the hon. Member for Wakefield (Mr. Hinchliffe) have made it clear that there is no certainty of any relief from the private health care sector. The Secretary of State said that there was not an army of under-employed surgeons who could suddenly take up the slack. That is, of course, true, because often enough—in fact, usually—the very same people operate in both the private and public sectors.

However, it is monstrous to suggest that the private sector cannot provide some capacity. We all know—I certainly know, and I doubt whether I am the only person who has had this brought to his attention—that NHS operations are being cancelled because of cash shortages. Such operations could take place using resources available in the private sector—and they ought to do so. That was the basis of the comments of my hon. Friend the Member for West Chelmsford (Mr. Burns), and it goes to the heart of our patients guarantee.

Our solution, which has of course been much criticised by the Secretary of State, is to provide a core NHS in which those with, let us say, Cinderella conditions such as hernias and in-growing toenails would be treated elsewhere and would pay for it. I reject any such suggestion. In fact, it strikes me as monstrous that any such health service could be devised. It is ridiculous to suggest that, for example, varicose veins would have to be treated outside the NHS because the condition was not critical or life threatening and therefore did not meet the criteria that might be devised for a core health service. Although a varicose vein might almost be a matter of cosmetic surgery to one person, it might be a life-threatening condition, causing severe ulcers, to another.

The Minister of State, Department of Health (Mr. John Denham)

Will the hon. Gentleman help me and other hon. Members by giving his interpretation of the comments of the hon. Member for Runnymede and Weybridge (Mr. Hammond), a Conservative Front-Bench spokesman, who told "Sky News" that, under the Conservatives, people would look to the NHS when they had serious life-threatening conditions and would look to their private insurance to help them with the rest? The hon. Gentleman seems to be arguing a rather different point.

Mr. Swayne

I do not think that that is so. I am not here to speak for my hon. Friend, but I shall honestly tell the Minister what I think my hon. Friend meant—I shall certainly tell him what I mean.

If we are honest and work within the same resource restraints, reprioritising the NHS so that the sickest patients are given the highest priority and treated first—I assume that that would be entirely reasonable to all people—will of necessity mean that people with less critical conditions will wait longer.

One problem that results from fixation with the overall size of the waiting list is that some people are not waiting long enough. Simple conditions are treated quickly to massage the overall figures while those with more critical conditions are waiting. If, as a result of a patients guarantee, the sickest patients are treated first, those with lower clinical priorities might consider other possibilities. That is, after all, the basis of freedom of choice. Such a structure would crystallise and focus the private insurance market, unlike the current position, and might result in the development of products that addressed many of our people's needs.

Mr. Trickett

Will the hon. Gentleman give way?

Mr. Swayne

No, I am afraid that I do not have the time to give way.

In addition to prioritisation of existing resources, we must of necessity seek to increase such resources. Labour Members believe that spending in the existing NHS model, almost alone in providing for the health care needs of the United Kingdom, can reach the European average. I suggest that they look elsewhere in the world—they are alone. In no other nation is such a proportion of gross national product spent without a much healthier contribution from the private sector.

There has been much criticism of our ability to continue to fund the health service as in the past owing to our overall tax guarantee.

Mr. Trickett

Will the hon. Gentleman give way?

Mr. Swayne

No, I will not give way; I have told the hon. Gentleman so.

It should have been obvious to anyone with experience of the 1980s that cutting the burden of taxation generates additional tax revenue.

6.36 pm

Dr. Howard Stoate (Dartford)

I appreciate that I do not have much time to speak, so I shall be brief and not indulge in too much rhetoric.

We have heard a great deal of rhetoric from Opposition Members—despite the fact that there have been only two to four of them in the Chamber throughout—but we have not heard anything approaching a policy. We have also heard much gloom, doom and despondency from them, which saddens me. Frankly, they need to get out more. They need to go to hospitals, to visit general practices, and to speak to nurses, doctors, health workers and, above all, patients. If they did so, they would find that most patients are very satisfied with the health service. Survey after survey has revealed a very high degree not only of satisfaction but of trust in those who provide health care—more than can be said of politicians.

It is obviously the job of the Opposition to rubbish the Government, and they are doing what they consider a good job—others may have other views and I could not possibly comment. However, it upsets me greatly when I hear the health service being run down. The hon. Member for Bromsgrove (Miss Kirkbride), who is no longer present, said several times that we have the worst health service in Europe. The hon. Member for New Forest, West (Mr. Swayne) talked about the third-world status of our health service. Those are disgraceful comments, which I deplore. They drive down public confidence, morale and the standards that the 1 million people working in the health service strive daily to achieve for their patients. I shall give an example of that.

I recently visited a very elderly patient, of whom I do not see much—I still do some GP work, as hon. Members know. She asked me to look at a lump in her breast. When I examined her at home, I found that she had a fungating breast cancer, which is a very advanced form of cancer, unpleasant to deal with, a nasty thing to have and medically very bad news. I asked her why she had waited so long before calling me, and she said that she had discovered the lump only the week before. I said, "That is not true, is it?" She said that it was not but that she did not want to trouble me. I told her that I had known her for many years and that she knew that she was not troubling me. The truth was that she had read in the paper that elderly people did not matter in the NHS, and concluded that there was no point in calling me because there was nothing much that I could do.

What saddens me is that I know that, within two weeks of seeing that lady, I could guarantee that she would be seen by a cancer specialist in the local hospital's breast unit, where she would receive expert care. She had read in the papers not the good news that this Government have made cancer treatment a priority, so that people can be seen within two weeks of their GP referring them, but that elderly people did not matter. If we talk down the health service and those who work in it, we drive down patient expectation. People expect bad treatment before they even start.

Another patient whom I saw recently told me not to bother referring her because she would never get to the top of the queue of those waiting to be seen. That is not true; I know that my health trust has relatively modest waiting lists for her condition.

Opposition Members have every right to rubbish the Government—that is what they do—but they have no right to drive down the NHS and the morale of its staff, or to frighten patients. If they are to rubbish us, they should at least have the goodness and decency to come up with their own policies—which are lacking.

6.40 pm

Mrs. Caroline Spelman (Meriden)

As a relatively new Member of Parliament, I am disappointed by the debate. We have again missed an opportunity to lay aside cheap political points and to debate health care in this country with honesty.

Criticisms of the Opposition motion overlook the fundamental point. The Opposition can, of course, choose what to put in their motion. Our last health debate, on 18 January, was held in close proximity to what the Government then described as a flu epidemic. I note that today the Secretary of State described the winter just passed as "no exception". That is what general practitioners told us at the time. The purpose of our motion on that occasion was to allow debate on the impact of the flu crisis. Today's debate is held very near the end of the financial year for health trusts and authorities, so it strikes me as perfectly sensible to make that the main focus of our debate. However, although the debate has ranged far and wide, it has not focused on the roots of the financial crisis facing the national health service, or on the impact on patients of the distortion of clinical practice.

Patients who have to wait and who have operations cancelled no longer feel that they come first. The Government's waiting list initiative has undermined clinical priorities; and to those who have to wait, it appears that the Government's priorities come first. That is anathema to health professionals who are trained to treat patients according to clinical need: they are trained to be able to rush into casualty in time of crisis and to decide within minutes who should be treated first. That is what prompted GP Sharon Bennett to tackle the Prime Minister on "Newsnight". She pointed out that Most managers are under extreme pressure to reach the targets. Waiting lists are being manipulated and as a doctor I find that completely unethical. Ask doctors to do the unethical and they soon become demoralised. Ask patients to submit to the unethical and they soon lose faith in the service.

My hon. Friend the Member for South Holland and The Deepings (Mr. Hayes) hit the nail on the head when he said that one of the main purposes of the debate was to tackle the issue of unrealistic expectations. The Government have raised expectations so high that they now fail even approximately to match people's experience. The extra billions that we have heard about mean nothing to the patients waiting anxiously for the treatment they need. It is as well if we as politicians remind ourselves of that. My hon. Friend the Member for West Chelmsford (Mr. Burns) told us of 14 people who have had to wait more than 18 months. The extra billions do not appear to have reached them. To his information about cancelled operations, I should like to add that, in the last financial year, 57,000 operations were cancelled, and 9,000 of those who suffered cancellation were not recalled within a month. To them, some of today's debate will have been meaningless; they just want to get their treatment.

We as politicians and as the Opposition have the job of asking questions about the money that has been spent. I pay tribute to the hon. Member for North Devon (Mr. Harvey) for having summed up as neatly as anyone could the problem with the Government's elastic arithmetic. He did so in inches; as I see my children grow, I can relate to his methods. He said that if three inches, three inches and three inches are added together, the result is nine inches. That is pretty easy. In simple mathematical terms, three times three is nine. My hon. Friend the Member for Woodspring (Dr. Fox) referred to Peter Kellner's article, which pointed out that the claimed £18 billion is more akin to £5 billion once general inflation has been stripped out. Lord Winston was right about that; he was also right to speak his mind.

From that £5 billion, we have to take the £500 million deficit accrued by trusts and health authorities. My constituency is sandwiched between Birmingham health authority, which, as we have already heard, has a deficit of £8.6 million, and Warwickshire health authority, which has a deficit of £8.2 million. Managers in both trusts have told me that the problem is not only money that is promised but never received or that fails to match spiralling costs, but the parcelling of money in a way that makes operating based on clinical priority far more difficult: attaching money to particular uses creates great inflexibility.

The hon. Member for Dartford (Dr. Stoate) is keen on surveys, so here is one for him. Last year, the NHS Confederation carried out a survey of trusts and health authorities. It showed that 64 per cent. of trusts were less confident about their financial position than they were 12 months ago, and the figures we have discussed today tell us why that is; 55 per cent. of trusts believed that income would exceed expenditure by up to £5 million—my hon. Friend the Member for Woodspring showed how costs increase; 37 per cent. of trusts believed that they would have to make cuts in direct service provision during the coming financial year to balance their budget; 24 per cent. of trusts said that their financial position meant that they would have to postpone or cancel developments in the Government's priority area, mental health; and 20 per cent. of trusts said that their financial position meant that they would have to postpone or cancel developments in the area of reducing health inequalities. That all makes unattractive reading, but we are debating the financing of the NHS and whether or not it is in crisis, and that is the right debate to be having at this point in the financial year.

It does not help public confidence one iota to re-announce money. We heard about an especially bad example, in which £30 million spent on accident and emergency facilities was announced seven times—that is right over the top. The Government appear to have reached the stage of believing their own rhetoric. In one breath, the Secretary of State said of the £50 million boost to cardiac surgery that it was new, extra money; with the next breath, he said that it was part of the extra £21 billion that the Government are putting into the NHS. I guess that, if it is said enough times, even a Minister believes it. That sort of thing has undermined confidence in the Government's pledges. On the question of matching European funding for health care, even the Prime Minister is caught between a firm pledge and an aspiration. Everything depends on a great "if'—if the economy performs well, and if the Government can afford it. That is the biggest "if' we have ever heard.

In a recent speech delivered in South Ribble, my hon. Friend the Member for Woodspring said: The British people want a system which guarantees that nobody ever has to endure the harrowing experience of someone whose treatment was postponed so often it became inoperable. They want a system that doesn't put half a million patients on the waiting list to get on the waiting list … a system in which doctors decide who should be treated, when and … no wait exceeds a clinical maximum. The Government has meddled with the system, making the sickest wait longest, which is … simply wrong. Staff are demoralised because they can't do what they were trained to do. The Government has raised expectations but they don't match people's experience. For the first time in a generation, we have a chance to hold an honest debate on how to buttress the NHS but the Government has closed its mind. The Prime Minister says there is "no alternative" to the Government's present strategy. What a missed opportunity! There is debate everywhere—in the press, in the professions and amongst the public. But the Government won't debate the options. Like my hon. Friend, I believe that the NHS deserves better.

6.49 pm

The Minister of State, Department of Health (Mr. John Denham)

This has been an Opposition-day debate on a topic chosen by the Opposition. It is therefore a shame for the Opposition that, from the opening speech of the hon. Member for Woodspring (Dr. Fox), the debate from the Opposition side has lacked focus, facts, policy alternatives, analysis and, for a good deal of the time, an audience. It speaks volumes that, for a considerable part of the afternoon, only two Members from the Opposition party bothered to turn up for an Opposition-day debate.

On the subjects covered in the motion under discussion—financial management and deficits—the worst that we could deduce from the facts that emerged in the debate was that the situation was at least twice as bad in the last two years of the Tory Government as the worst that has been projected for the current year, and that does not take into account the extra funds that we have put into the health service over the past couple of years.

Cancelled operations were raised by the hon. Members for Meriden (Mrs. Spelman) and for New Forest, West (Mr. Swayne), yet there was less chance of an operation being cancelled during the first two years of the present Government than during the last two years of the previous Government. That does not mean that the situation is good, or that we are happy that anyone's operation is cancelled, but the situation is better than it was before.

My hon. Friend the Member for Wakefield (Mr. Hinchliffe) raised a number of issues, principally private medicine. I understand his continuing concern, but the Government's view is that our priority should be to concentrate on the time for which consultants are contracted to work for the national health service, and to ensure that we get the best contribution during that time. That is where we are focusing our effort in our discussions with the British Medical Association about a new contract.

The hon. Member for West Chelmsford (Mr. Burns) had the same difficulty as other Opposition Members who spoke—he did not understand the policy of his own party, when he said that he did not want the privatisation of many services provided by the NHS.

My hon. Friend the Member for Carlisle (Mr. Martlew) is right to be proud of the new hospital that the NHS and the Government are delivering for his constituents. He raised the question of the funding formula, as did the hon. Member for South Holland and The Deepings (Mr. Hayes). A review of the funding formula is under way. There will be no changes, other than the statistical changes, until we have the findings of the review. A wide range of factors will be taken into account in the review, and I cannot prejudge the outcome.

My hon. Friend the Member for Wirral, West (Mr. Hesford) correctly pointed out the huge unanswered questions at the heart of what we know about current Opposition policy.

The hon. Member for New Forest, West made me wonder, as he always does, what the other candidates in his selection conference were like.

My hon. Friend the Member for Dartford (Dr. Stoate) rightly underlined the good work of the NHS. It is important to strike a balance between the proper discussion of issues that have yet to be resolved in the health service, and the presentation of a negative view that might persuade some patients not to take up the services on offer.

To the extent that there was any focus in the debate, it was the attack on the Government's pledge to reduce waiting lists and our determination to honour the promise that we made to voters at the last election. We will reduce waiting lists and honour that election promise, and we will do so for good reason. Fewer people on waiting lists means fewer people waiting for treatment. The main way in which we cut waiting lists is by treating more patients. It is as simple as that. More patients were treated last year, more are being treated this year and more will be treated next year. Those who say, as the Opposition do by implication, that we should let waiting lists rip are effectively saying that we should treat fewer patients.

Dr. Fox

That is not the case. The question is whether the correct patients are being treated, and whether patients are being treated in the right order. The Secretary of State said that under the waiting list initiative, there had been and would be no clinical distortion, but almost the entire medical profession says the opposite. When Dr. Wilde says that his patients died unnecessarily, having to wait because of clinical distortion, is he wrong or is he lying?

Mr. Denham

Let us look at the evidence. The charge that is made not infrequently is that the complex, difficult operations and those that are likely to require a stay in hospital are being reduced. The facts are as my right hon. Friend said earlier. There were 1,000 extra bypass operations last year. There were more hip operations and more knee replacement operations. There is no evidence that those complex, time-consuming operations have been cut to allow other operations to be carried out.

Mr. Burns

rose—

Mr. Denham

I shall make progress.

The hon. Member for Woodspring produced no evidence to sustain his charge. Those who say that we should not be reducing waiting lists ought to tell us which of the extra half a million people who had operations last year would not have had them had the Conservative party been in power.

To be fair to the hon. Gentleman, in the past there was always a deathly silence when we asked which patients should not be treated. The hon. Gentleman has changed all that. He has told us, through The Sunday Times, which operations should not be done, unless people can pay for them: hip replacements, knee replacements, cataracts and hernias. That is an outrageous attack on the rights of patients, mainly elderly patients, to the NHS treatment for which they have paid all their lives.

On 16 January, the hon. Gentleman told The Sunday Times that private medical insurance companies should cover such conditions as hip and knee replacements, hernia and cataract operations, and his hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond) told Sky News that the Conservatives wanted people to look to the NHS when they had serious life-threatening conditions, and . . . to their private insurance to help them with the rest.

The hon. Member for Woodspring should clarify the situation and get The Sunday Times to retract. He has had two months to do so, but he has not done so yet. He had the entire debate this afternoon during which to do so, but he did not.

Dr. Fox

rose—

Mr. Denham

Let us hear from the hon. Gentleman. It would be interesting to hear a quick retraction and an assurance that there will be no change in people's ability to get those operations on the NHS.

Dr. Fox

As I said this afternoon, if it is a question of maintaining the NHS as a comprehensive service, I absolutely accept that. What the Minister and his colleagues cannot conceive is that additionality is possible, and that an increase in capacity and more cases treated by the private sector would offload the NHS. That would be a total increase in capacity, and it is only the Government's ideological bigotry that prevents them from being able to accept the truth.

Mr. Denham

The entire House will have noted that I gave the hon. Gentleman time in my speech to reject the charge that we have made and to withdraw any misconstruction that we had put on what he said. The entire House now knows that he failed to reject the charge and failed to ask us to withdraw. He has confirmed the information. The 300,000 elderly people who had those operations last year and those who are waiting for them this year—for hips, cataracts, hernias and knees—now know that they would have to pay under a Tory Government.

We shall get waiting lists down not by trading in-patients against out-patients, not by doing one instead of the other, but by doing more of both. Clinical priority will continue to be the main determinant of who is treated.

Of course, we must do more, because the waiting list initiative alone is not enough to meet need. We acknowledge that, and we have therefore included in the waiting list initiative the two-week target for cancer waits. That will be introduced this year, because some people must be seen as quickly as possible. The Conservative party did not introduce such measures.

Although 1,000 extra heart operations will be done next year, we need more. We will therefore allocate £50 million so that 3,000 extra heart operations can be carried out. We give priority where it is needed.

The Conservative party chose the debate. Its members failed to score any points; they largely failed to turn up. They have confirmed that, under a Tory Government, many important procedures would no longer be available on the NHS. To that extent, the debate has been useful.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 179, Noes 307.

Division No. 97]	[7.1 pm
AYES
Ainsworth, Peter (E Surrey)	Brazier, Julian
Allan, Richard	Breed, Colin
Amess, David	Brooke, Rt Hon Peter
Ancram, Rt Hon Michael	Browning, Mrs Angela
Arbuthnot, Rt Hon James	Bruce, Ian (S Dorset)
Ashdown, Rt Hon Paddy	Burnett, John
Atkinson, Peter (Hexham)	Burns, Simon
Baker, Norman	Burstow, Paul
Baldry, Tony	Butterfill, John
Ballard, Jackie	Cable, Dr Vincent
Beggs, Roy	Campbell, Rt Hon Menzies (NE File)
Berth, Rt Hon A J
Bercow, John	Cash, William
Beresford, Sir Paul	Chapman, Sir Sydney (Chipping Barnet)
Blunt, Crispin
Boswell, Tim	Chope, Christopher
Bottomley, Peter (Worthing W)	Clappison, James
Bottomley, Rt Hon Mrs Virginia	Clark, Dr Michael (Rayleigh)
Brady, Graham	Clarke, Rt Hon Kenneth (Rushcliffe)
Brake, Tom

Clifton-Brown, Geoffrey	Maples, John
Cormack, Sir Patrick	Mates, Michael
Cotter, Brian	Maude, Rt Hon Francis
Cran, James	Mawhinney, Rt Hon Sir Brian
Davey, Edward (Kingston)	May, Mrs Theresa
Davis, Rt Hon David (Haltemprice)	Michie, Mrs Ray (Argyll & Bute)
Day, Stephen	Moore, Michael
Dorrell, Rt Hon Stephen	Nicholls, Patrick
Duncan, Alan	Norman, Archie
Duncan Smith, Iain	Oaten, Mark
Emery, Rt Hon Sir Peter	O'Brien, Stephen (Eddisbury)
Evans, Nigel	Öpik, Lembit
Faber, David	Ottaway, Richard
Fabricant, Michael	Paice, James
Fallon, Michael	Paterson, Owen
Feam, Ronnie	Pickles, Eric
Forsythe, Clifford	Portillo, Rt Hon Michael
Forth, Rt Hon Eric	Prior, David
Foster, Don (Bath)	Randall, John
Fox, Dr Liam	Redwood, Rt Hon John
Fraser, Christopher	Rendel, David
Gale, Roger	Robathan, Andrew
Garnier, Edward	Robertson, Laurence
George, Andrew (St Ives)	Roe Mrs Marion (Broxbourne)
Gibb, Nick	Rowe, Andrew (Faversham)
Gill, Christopher	Ruffley David
Gray, James	Russell, Bob (Colchester)
Green, Damian	St Aubyn, Nick
Greenway, John	Sanders, Adrian
Grieve, Dominic	Sayeed, Jonathan
Gummer Rt Hon john	Shepherd, Richard
Hague, Rt Hon William	Smith Sir Robert (W Ab'd'ns)
Hamilton Rt Hon Sir Archie	Smyth, Rev Maritn (Belfast S)
Hammond, Philip	Soames, Nicholas
Hancock.Mike	Spelman, Mrs Caroline
Harris, Dr Evan	Spicer, Sir Michel
Harvey, Nick	Spring, Richard
Hayes, John	Stanley, Rt Hon Sir John
Heald, Oliver	Steen, Anthony
Heath, David (Somerton & Frome)
Heath, Rt Hon Sir Edward	Streeter, Gary
Heathcoat-Amory, Rt Hon David	Stunell, Andrew
Heseltine, Rt Hon Michael	Swayne, Desmond
Hogg, Rt Hon Douglas	Syms, Robert
Horam, John	Tapsell, Sir Peter
Howarth, Gerald (Aldershot)	Taylon Ian (Esher & Watton)
Hughes, Simon (Southwark N)	Taylor, Rt Hon John D (Strangford)
Hunter, Andrew	Taylor, John M (Solihull)
Jackson, Robert (Wantage)	Taylor, Matthew (Truro)
Jenkin, Bernard	Taylor, Sir Teddy
Jones, Nigel (Cheltenham)	Thompson, William
Keetch, Paul	Townend, John
Kennedy, Rt Hon Charles (Ross Skye & Inverness W)	Tredinnick, David
	Trend, Michael
Key, Robert	Tyler, Paul
King, Rt Hon Tom (Bridgwater)	Tyrie, Andrew
Kirkbride, Miss Julie	Viggers, Peter
Lait, Mrs Jacqui	Walter, Robert
Lansley, Andrew	Waterson, Nigel
Leigh, Edward	Webb, Steve
Letwin, Oliver	Wells, Bowen
Lewis, Dr Julian (New Forest E)	Welsh, Andrew
Lidington, David	Whitney, Sir Raymond
Lilley, Rt Hon Peter	Whittingdale, John
Lloyd, Rt Hon Sir Peter (Fareham)	Widdecombe, Rt Hon Miss Ann
Loughton, Tim	Wilkinson, John
Luff, Peter	Willis, Phil
MacGregor, Rt Hon John	Winterton, Mrs Ann (Congleton)
McIntosh, Miss Anne	Winterton, Nicholas (Macclesfield)
MacKay, Rt Hon Andrew	Young, Rt Hon Sir George
Maclean, Rt Hon David
Maclennan, Rt Hon Robert	Tellers for the Ayes:
McLoughlin, Patrick	Mrs. Eleanor Laing and
Malins, Humfrey	Mr. Keith Simpson.

NOES
Ainger, Nick	Davies, Rt Hon Denzil (Llanelli)
Ainsworth, Robert (Cov'try NE)	Davies, Geraint (Croydon C)
Alexander, Douglas	Dawson, Hilton
Allen, Graham	Dean, Mrs Janet
Armstrong, Rt Hon Ms Hilary	Denham, John
Ashton, Joe	Dobbin, Jim
Atherton, Ms Candy	Doran, Frank
Atkins, Charlotte	Dunwoody, Mrs Gwyneth
Austin, John	Eagle, Angela (Wallasey)
Barnes, Harry	Efford, Clive
Battle, John	Ellman, Mrs Louise
Bayley, Hugh	Ennis, Jeff
Beard, Nigel	Etherington, Bill
Beckett, Rt Hon Mrs Margaret	Field, Rt Hon Frank
Begg, Miss Anne	Fisher, Mark
Benn, Hilary (Leeds C)	Fitzpatrick, Jim
Benn, Rt Hon Tony (Chesterfield)	Fitzsimons, Lorna
Bennett, Andrew F	Flint, Caroline
Benton, Joe	Flynn, Paul
Bermingham, Gerald	Follett, Barbara
Berry, Roger	Foster, Michael Jabez (Hastings)
Best, Harold	Foster, Michael J (Worcester)
Betts, Clive	Fyfe, Maria
Blackman, Liz	Galloway, George
Blears, Ms Hazel	Gardiner, Barry
Blizzard, Bob	George, Bruce (Walsall S)
Blunkett, Rt Hon David	Gerrard, Neil
Bradley, Keith (Withington)	Gibson, Dr Ian
Bradley, Peter (The Wrekin)	Gilroy, Mrs Linda
Bradshaw, Ben	Godsiff, Roger
Brinton, Mrs Helen	Goggins, Paul
Brown, Rt Hon Nick (Newcastle E)	Golding, Mrs Llin
Browne, Desmond	Gordon, Mrs Eileen
Buck, Ms Karen	Griffiths, Jane (Reading E)
Burden, Richard	Griffiths, Nigel (Edinburgh S)
Burgon, Colin	Griffiths, Win (Bridgend)
Butler, Mrs Christine	Grocott, Bruce
Byers, Rt Hon Stephen	Gunnell, John
Campbell, Alan (Tynemouth)	Hall, Mike (Weaver Vale)
Campbell, Mrs Anne (C'bridge)	Hall, Patrick (Bedford)
Campbell, Ronnie (Blyth V)	Hamilton, Fabian (Leeds NE)
Campbell—Savours, Dale	Hanson, David
Cann, Jamie	Heal, Mrs Sylvia
Caplin, Ivor	Healey, John
Casale, Roger	Henderson, Doug (Newcastle N)
Cawsey, Ian	Henderson, Ivan (Harwich)
Chapman, Ben (Wirral S)	Hepburn, Stephen
Chaytor, David	Heppell, John
Clapham, Michael	Hesford, Stephen
Clark, Dr Lynda (Edinburgh Pentlands)	Hewitt, Ms Patricia
	Hill, Keith
Clark, Paul (Gillingham)	Hinchliffe, David
Clarke, Charles (Norwich S)	Hoey, Kate
Clarke, Tony (Northampton S)	Hood, Jimmy
Clelland, David	Hope, Phil
Clwyd, Ann	Hopkins, Kelvin
Coffey, Ms Ann	Hoyle, Lindsay
Cohen, Harry	Hughes, Kevin (Doncaster N)
Colman, Tony	Humble, Mrs Joan
Connarty, Michael	Hurst, Alan
Cooper, Yvette	Hutton, John
Corbett, Robin	Iddon, Dr Brian
Corbyn, Jeremy	Jackson, Ms Glenda (Hampstead)
Corston, Jean	Jackson, Helen (Hillsborough)
Cousins, Jim	Jenkins, Brian
Cranston, Ross	Johnson, Alan (Hull W & Hessle)
Crausby, David	Johnson, Miss Melanie (Welwyn Hatfield)
Cryer, John (Hornchurch)
Cummings, John	Jones, Rt Hon Barry (Alyn)
Cunningham, Jim (Cov'try S)	Jones, Mrs Fiona (Newark)
Curtis—Thomas, Mrs Claire	Jones, Helen (Warrington N)
Dalyell, Tam	Jones, Ms Jenny (Wolverh'ton SW)
Darvill, Keith
Davey, Valerie (Bristol W)	Jones, Jon Owen (Cardiff C)
Davidson, Ian	Jones, Dr Lynne (Selly Oak)

Kaufman, Rt Hon Gerald	Prentice, Gordon (Pendle)
Keeble, Ms Sally	Prescott, Rt Hon John
Keen, Alan (Feltham & Heston)	Primarolo, Dawn
Kelly, Ms Ruth	Prosser, Gwyn
Kemp, Fraser	Purchase, Ken
Khabra, Piara S	Quin, Rt Hon Ms Joyce
Kidney, David	Quinn, Lawrie
Kilfoyle, Peter	Radice, Rt Hon Giles
King, Andy (Rugby & Kenilworth)	Rapson, Syd
Ladyman, Dr Stephen	Raynsford, Nick
Laxton, Bob	Reed, Andrew (Loughborough)
Lepper, David	Reid, Rt Hon Dr John (Hamilton N)
Leslie, Christopher	Robinson, Geoffrey (Cov'try NW)
Levitt, Tom	Roche, Mrs Barbara
Lewis, Ivan (Bury S)	Rooker, Rt Hon Jeff
Linton, Martin	Rooney, Terry
Lloyd, Tony (Manchester C)	Ross, Ernie (Dundee W)
Love, Andrew	Ruddock, Joan
McAvoy, Thomas	Russell, Ms Christine (Chester)
McCabe, Steve	Ryan, Ms Joan
McCafferty, Ms Chris	Salter, Martin
McCartney, Rt Hon Ian (Makerfield)	Sarwar, Mohammad
	Savidge, Malcolm
McDonagh, Siobhain	Sawford, Phil
Macdonald, Calum	Sedgemore, Brian
McDonnell, John	Sheerman, Barry
McFall, John	Simpson, Alan (Nottingham S)
McGuire, Mrs Anne	Singh, Marsha
McIsaac, Shona	Skinner, Dennis
McNamara, Kevin	Smith, Rt Hon Andrew (Oxford E)
McNulty, Tony	Smith, Angela (Basildon)
MacShane, Denis	Smith, Jacqui (Redditch)
McWalter, Tony	Smith, Llew (Blaenau Gwent)
McWilliam, John	Snape, Peter
Mahon, Mrs Alice	Soley, Clive
Mallaber, Judy	Southworth, Ms Helen
Marsden, Gordon (Blackpool S)	Spellar, John
Marsden, Paul (Shrewsbury)	Squire, Ms Rachel
Marshall, David (Shettleston)	Steinberg, Gerry
Marshall, Jim (Leicester S)	Stevenson, George
Marshall—Andrews, Robert	Stewart, Ian (Eccles)
Martlew, Eric	Stinchcombe, Paul
Maxton, John	Stoate, Dr Howard
Meacher, Rt Hon Michael	Strang, Rt Hon Dr Gavin
Meale, Alan	Straw, Rt Hon Jack
Merron, Gillian	Stringer, Graham
Michie, Bill (Shef'ld Heeley)	Stuart, Ms Gisela
Mitchell, Austin	Sutcliffe, Gerry
Moffatt, Laura	Taylor, Rt Hon Mrs Ann (Dewsbury)
Moonie, Dr Lewis
Morley, Elliot	Taylor, Ms Dari (Stockton S)
Morris, Rt Hon Ms Estelle (B'ham Yardley)	Taylor, David (NW Leics)
	Temple-Morris, Peter
Morris, Rt Hon Sir John (Aberavon)	Thomas, Gareth (Clwyd W)
	Thomas, Gareth R (Harrow W)
Mountford, Kali	Thomas, Simon (Ceredigion)
Mullin, Chris	Timms, Stephen
Murphy, Denis (Wansbeck)	Touhig, Don
Murphy, Rt Hon Paul (Torfaen)	Trickett, Jon
Naysmith, Dr Doug	Truswell, Paul
O'Brien, Bill (Normanton)	Turner, Dennis (Wolverh'ton SE)
O'Hara, Eddie	Turner, Dr Desmond (Kemptown)
Olner, Bill	Turner, Dr George (NW Norfolk)
O'Neill, Martin	Turner, Neil (Wigan)
Osborne, Ms Sandra	Twigg, Derek (Halton)
Palmer, Dr Nick	Twigg, Stephen (Enfield)
Pearson, Ian	Tynan, Bill
Pendry, Tom	Vis, Dr Rudi
Perham, Ms Linda	Ward, Ms Claire
Pickthall, Colin	Wareing, Robert N
Pike, Peter L	Watts, David
Plaskitt, James	White, Brian
Pollard, Kerry	Whitehead, Dr Alan
Pond, Chris	Wicks, Malcolm
Pound, Stephen	Williams, Rt Hon Alan (Swansea W)
Prentice, Ms Bridget (Lewisham E)

Williams, Alan W (E Carmarthen)	Worthington, Tony
Wills, Michael	Wray, James
Wilson, Brian	Wright, Anthony D (Gt Yarmouth)
Winnick David	Wright', Dr Tony (Cannock)
Winnick, David	Wyatt, Derek
Winterton, Ms Rosie (Doncaster C)
Wise, Audrey	Tellers for the Noes:
Woodward, Shaun	Mr. Jim Dowd and
Woolas, Phil	Mr. Greg Pope.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments) and agreed to.

MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved, That this House welcomes the Government's modernisation programme for the NHS and the reduction in waiting lists and times that are being achieved through the dedication and hard work of NHS staff; notes the progress being made on recruiting more doctors and more nurses, building more hospitals, treating more patients and modernising more services; applauds the Government's decision to make tackling cancer, coronary heart disease and mental illness a priority; believes that financial provision for the NHS would be reduced as a consequence of the Conservatives' Tax Guarantee and that clinical need would be abandoned in favour of ability to pay under the Conservatives' health plans.