Hospital Waiting Lists

HC Deb 16 June 1998 vol 314 cc136-93

Madam Speaker

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

3.41 pm

Miss Ann Widdecombe (Maidstone and The Weald)

I beg to move, That this House notes with regret the increase in National Health Service hospital waiting lists since May 1997; deplores the failure of Her Majesty's Government to achieve implementation of its promise of an early reduction of such lists; notes that current Government policies in respect of hospital closures and bed reductions are likely to increase the lists further; notes that the proposals to abolish fundholding and reduce flexibility for general practitioners in purchasing health care for their patients will also add to the lists; and urges the Government to reconsider these changes.

We have chosen to debate waiting lists because the Government's broken pledges are of massive concern throughout the country. I was almost encouraged when I switched on my radio this morning and heard that the Secretary of State had announced another 2,000 beds. I thought, "This is wonderful. Every time we have an Opposition day, we can get 2,000 beds out of the Government." We shall consider it a great triumph if, at any time over the next month, the Secretary of State responds to our concerns and announces more money to put into the national health service. We shall be watching for that, and we hope that he will take seriously our request that he should do so.

However, my enthusiasm for the 2,000 beds quickly dwindled when I realised that they were nothing more than the same 2,000 beds that had been announced on 2 June. For one wonderful moment I had thought that we were going to get 4,000 beds, and I am sure that, from the tone of the statements by the Secretary of State, the general public were meant to think that those were extra beds. However, they are not; they are the old beds.

What is more, there is not even any evidence that those 2,000 beds represent a net gain. Are they, for example, to be set against the programme of closures and bed reductions now going on in hospitals throughout the country? This morning, I was at Kent and Canterbury hospital, where a reduction of 400 beds is threatened. Do we assume that those 400 beds will be added back in addition to the 2,000, or are we now talking about a maximum of only 1,600 beds? I would be grateful if the Secretary of State would explain both the minuses and the pluses, and tell us either the net gain or—as I suspect—the net loss.

Before the general election, Labour promised to "save the NHS", and to cut waiting lists by 100,000. They called that their "early pledge". Labour has now been in government for 14 months and we are entitled to examine that early pledge. The Government now say that they will meet the pledge before the next election, so that early pledge has become a "better late than never" pledge. Let us recall what Labour told us when it was in opposition. Its posters told us that NHS waiting lists will be shorter"; its mugs—that is, the china sort—told us, "Treat more NHS patients"; and its election manifesto promised to cut health service waiting lists by 100,000. Then, the Secretary of State told us: This Government only makes promises we intend to keep. However, the truth is rather different: waiting lists are now 11.5 per cent. higher than when Labour took office and that early pledge has been comprehensively broken. There can be no doubt that those pre-election promises were deliberately designed to make the voters think that waiting lists would be reduced quickly; not only have waiting lists risen, but the Labour Government are deliberately adopting policies that will cause them to rise still further.

The Secretary of State has made various excuses. First, he deliberately put waiting list surgery on hold to cope with a winter crisis that did not, in fact, materialise. The Opposition have been told of cases where temporary nurses were hired at great expense, only for them to have nothing to do, because there was no winter crisis; and of waiting list surgery cancelled, only for the hospitals to have nothing with which to replace it, because there was no winter crisis—a catalogue of waste and inefficiency. I am not suggesting that the Secretary of State could have predicted exactly how mild the winter would be—after all, if he does not know how many hospitals he is responsible for closing, it is most unlikely that he would be in touch with the long-range weather forecasters. However, I am saying that he did not sufficiently think through, or keep sufficiently flexible, his priorities last winter.

Having said that, I give the Secretary of State a little bit of credit, because he accepted that it was his decision and, therefore, his fault. He bungled in his judgment, but at least he had the grace to admit that the record waiting lists were his own creation. He did so in the House, when he said: As top priority was given to emergencies, waiting lists have grown". He himself made the direct connection; he then said: I set that priority, and the health service met that priority".—[Official Report, 18 March 1998; Vol. 308, c. 1290.] That is more than the Prime Minister is able to do.

During Prime Minister's Question Time on 29 April, the Prime Minister flatly refused to take any responsibility whatsoever for increased waiting lists. I might add that it was not clear from his answer whether or not he held the Secretary of State directly responsible—I suppose that we shall have to wait for the forthcoming Cabinet reshuffle to discover the answer to that question. However, there now appears to be a rather interesting dichotomy, between a bungling Secretary of State for Health who admits that it is all his fault and a Prime Minister who cannot take responsibility for anything.

Despite the Secretary of State's flush of culpability over the winter pressures fiasco, it seems that he is not yet ready to make the ultimate sacrifice. Usually, if someone admits an error of judgment that causes untold misery to 133,000 people, one would not expect that person to say, as the Secretary of State said in his message to trust chairmen and chief executives, "Okay, I bungled, but you're the ones who may be fired." What makes the Secretary of State's response even more astonishing is that the people he has threatened with the boot are the Labour party's friends, whom he had appointed to trust boards barely four months before.

Let me remind the House of the figures: 79 per cent. of those appointees declaring political activity did so for the Labour party; and 84 per cent. of those appointees who are councillors are Labour councillors. That is what the Secretary of State calls making trust boards more representative of the people they serve", but most people would simply call it gerrymandering.

The reason for that preponderance of Labour activists is the result of a rather convenient oversight: the Department of Health wrote only to council leaders, not chief executives, when seeking nominations from local authorities. It appears that some Labour council leaders—inadvertently, it is said—failed to pass on the letter to their colleagues in other parties, so that only Labour activists were nominated in any significant number by that method.

Of course, it must be a little embarrassing for the Secretary of State. Having gone to all that trouble to ensure that trust boards were packed full of Labour supporters, he is now in the rather awkward position of being forced to sack them all as scapegoats for his Government's broken early pledge on waiting lists.

However, trust chairmen will not have to look pensively through their morning post just yet because it seems that the people's pledges are, in fact, portable pledges, to be moved around whenever it is most convenient to the Government. In March, the Secretary of State promised, to the House and in a press release, that waiting lists would be below 1.16 million within a year—by April 1999. Three months later, on 2 June, he said during Health questions that by this time next year waiting lists will be down to the level that we inherited."—[Official Report, 2 June 1998; Vol. 313, c. 159.]

Was that just another bungle by the Secretary of State or has he delayed the pledge by three months? Will he now set the record straight? Will the deadline for the first new clause of his revised waiting list pledge expire by 31 March 1999 or 30 June 1999, or will he extend it again? Which is the correct pledge? I look forward to hearing his answer.

The Secretary of State for Health (Mr. Frank Dobson)

I know that the right hon. Lady has not been doing her job for very long, but I should have thought that she would have understood by now that under the useless statistical system that we inherited from the previous Government, it takes the national health service about two and a half months to come up with the figures. That is the explanation for the discrepancy.

Miss Widdecombe

It is always somebody else's fault. This time, it is the fault not of the trust chairmen, but of the statisticians—the right hon. Gentleman's own civil servants. He still has not answered the question, but I take it that 30 June 1999 is the date to which we are all now working. If it is, that can go on the record and we can hold him to account. That is no way to run the health service. The convenient confusion over the Secretary of State's waiting list pledge and the treatment of health service staff is just part of the picture that we are beginning to see of a health service in turmoil. In one breath to tell people that they have done us proud, as the Secretary of State puts it, and in the next to threaten them with the sack when it is the same Secretary of State's decisions that have caused the record waiting lists merely demonstrates that Labour has never been fit to manage anything. That rather sad display of macho management will serve only to demoralise health service workers even further.

Mr. Paul Truswell (Pudsey)

Will the right hon. Lady give way?

Miss Widdecombe

In a moment.

The Secretary of State appears intent on alienating the most important workers in the health service. First, he alienated the nurses by giving them a staged pay rise. He said that he was embarrassed. So he should be—in July 1996, when the then Government proposed to stage the pay rises of Members of the House, the right hon. Gentleman voted against it. He voted to take his pay rise in one go. He was not embarrassed then, so no wonder he is embarrassed now, as should be the Under-Secretary of State for Health and the Minister for Public Health who also voted against staging then. Let the Secretary of State explain that to the nurses.

The Secretary of State should be embarrassed also that when he is closing hospitals across the country, there is to be a £1 billion hospital in his own back yard.

Mr. Roger Casale (Wimbledon)

I appreciate that the right hon. Lady is speaking on behalf of the Opposition, but is she aware that the Government have made over £5 million available to West Kent health authority in the area that she represents which will be used to create 132 new beds, which were cut under the previous Government? Will she take the opportunity at least to thank my right hon. Friend the Secretary of State for the extra resources that he has made available for her constituency?

Miss Widdecombe

I shall discuss the position in Kent presently, and the hon. Gentleman will not then be smiling so confidently as he is now. The situation in Kent is grievous, and it is entirely the result of decisions taken since May 1997. We shall hear about that in a moment.

Mr. Dale Campbell-Savours (Workington)

Will the right hon. Lady discuss what is going on in my health authority? It is getting an extra £1.8 million for these matters. Why is the right hon. Lady complaining, when every Member of the House of Commons represents a seat where millions of pounds has been allocated to shorten waiting lists? What is wrong with that? Labour is delivering.

Miss Widdecombe

First, that money must be allocated because the Government's policies are not working and waiting lists are lengthening. Secondly, when we discuss those millions, I shall show the hon. Gentleman that the money is not worth as much as he supposes.

I return to the demoralisation in the health service. The sources of increased pressure on waiting lists are not only the Secretary of State's bungled attempt at "tough management", as he calls it, but the pathetic financial settlement that the Government have seen fit to offer the health service. "Pathetic" is not my word; it is the word used by Dr. Sandy Macara, chairman of the British Medical Association—a group that has rarely criticised the Labour party in the past 19 years, and now says that its financial settlement is pathetic.

The BMA says that because, despite all the talk of extra money for the health service, we had an increase of 3.1 per cent. in real terms per annum, whereas the average increase under the present Government has been only 2 per cent. Of course they have made some extra sums available, but let us see what we have to remove from those extra sums. Perhaps the hon. Member for Workington (Mr. Campbell-Savours) will get out his calculator.

Mr. Campbell-Savours

I have it here.

Miss Widdecombe

We can remove higher-than-expected inflation. That is another broken pledge; Labour said that it would keep inflation low. We can remove health service inflation. We can remove the abolition of private medical insurance tax relief, deficit reduction, the phased pay award and other black holes in Labour's spending campaign, which render the additional money that they keep talking about only a fraction of its current worth. For example, if one removes the factors that I have suggested, the £417 million announced in the Budget becomes a paltry £32 million.

The effect that underfunding has had on the health service is now visible; what will be the cost to waiting lists of another year of short change? If underfunding and winter pressures were the only factors, the waiting lists situation might not look so desperate, but that is only half the story. The entire structure of Labour's health service reforms and its hospital closures programme will have an equally devastating effect on the future of the health service.

Labour's White Paper is a blueprint for increasing the people's waiting lists. The bureaucracy proposed in the White Paper will add substantially to health service running costs. The Government claim that they can save £1 billion from bureaucracy but, without saving anything, they have already added another £150 million a year from the cost of administering the primary care groups alone. Bureaucracy to co-ordinate health authorities and local authorities will be necessary within the structure of their reforms, but they have not accounted for any cost whatever. NICE, the national institute for clinical effectiveness, and CHIMP, the commission for health improvement—to name just two of their inventions —will also cost extra money, with no resultant administrative savings. The whole White Paper appears to be a return to the command-and-control structure for the health service, with all the associated running costs. There will be a raft of new quangos, none of which will keep the waiting list pledge afloat.

The Government have not, as they frequently claim, abolished the internal market. The purchaser-provider split remains. They have only clogged up its workings with unnecessary controls and bureaucratic mechanisms, requiring constant consultation before any decision is taken. That will reduce efficiency and lead to money being diverted from reducing waiting lists to unnecessary administration. There is reduced freedom for general practitioners because primary care groups, rather than fundholders, will choose between trusts, and that will reduce the flexibility of individual GPs to choose shorter waiting lists for their patients. The reduced efficiency caused—

Mr. Truswell

rose—

Mr. Ian Bruce (South Dorset)

Go on, read from your briefing.

Mr. Truswell

No, it is entirely of my own making; I have no briefing from anyone else.

I speak as a former member of a family health services authority, and that authority had some Tory nominees on it, none of whom subscribed to the concept of GP fundholders. Does the right hon. Lady think it was right that so much money accumulated in GP fundholder budgets while health authorities were running deficits? That money could have been used to treat patients and reduce waiting lists. Does she accept that while I was a member of a family health services authority, our auditors brought to our attention a number of cases where they thought that fundholders were not using the money efficiently, such as for the purchase of lavish oak furniture? Does she not think that those cases should have been dealt with, and that the money should have been spent on reducing waiting lists?

Miss Widdecombe

Fundholding increased flexibility and allowed doctors to choose what was best for their patients. Fundholding resulted in a vastly improved service, to such an extent that, although the early demand was cautious, there was later a huge demand for fundholding. I would have expanded fundholding, not got rid of it.

Even more disturbing than what I have described so far is the programme of hospital cuts and closures by stealth. Beds, wards and even whole hospitals are being shut down as Labour's lack of investment in our health service bites.

Mr. Nigel Beard (Bexleyheath and Crayford)

My constituency was marked by years of hospital closure on the promise of a new hospital corning, which was intended to be built under the private finance initiative. However, dither and delay prevented it from coming, and confidence in the health service lapsed. My right hon. Friend has redeemed the promise and we are to have a new Queen Elizabeth hospital in the area.

Miss Widdecombe

I am delighted to hear about the Secretary of State's U-turn in accepting the PFI, but in the month that the election was declared—in March last year—Labour said, "We have no plans to close hospitals." Labour deceived the electorate. [HON. MEMBERS: "Where?"] I shall give some examples.

In Oxfordshire, the outlook is especially bleak. Three community hospitals face the axe. One of those, Burford community hospital, contains a specialist Alzheimer's rehabilitation project. The unit is not replicable in the medium term, so if it goes, no substitute service will be provided. It will close when Burford shuts, despite being a centre of academic excellence for research into Alzheimer's. Patients using Burford will face a 40-mile round trip to out-patient facilities in Oxford.

The closure of the hospital will mean that elderly patients using Burford as a halfway stop when returning home from hospital stays will be forced to block beds for other patients waiting for treatment. I have heard that story from many community hospitals. One of their most important functions is to relieve acute beds by taking people who are no longer in need of acute beds, but who are not yet ready to return home, and rehabilitating and caring for them in the interim. If those hospitals close, that function will go with them. That can only result in longer waiting lists, as beds are blocked.

Mr. Oliver Letwin (West Dorset)

Is my right hon. Friend aware that the exact situation that she describes applies in Dorset? We have a massive bed-blocking problem, which has got much worse over the past year. [Laughter.]

Miss Widdecombe

Indeed. Dorset, Oxfordshire, Warminster and Wallingford are merely examples. We shall hear far more during the debate, but we should note that the response to my hon. Friend's intervention was laughter on the Labour Benches. I do not think that that laughter will be shared by the patients who fear that their hospital will be closed, or in my hon. Friend's constituency or throughout the country when people realise how deceived they were by the Government. The Labour Government said that there would be shorter waiting lists, but lists have risen to record levels. The Government said that there would be no closures, but they are now closing right, left and centre.

Mr. Bruce Grocott (Telford)

Will the right hon. Lady tell the House how much more money she wants spent on the health service?

Miss Widdecombe

We did not plan to close those hospitals, so we would have spent the money to keep them open. We spent 3.1 per cent. more every year, but the Government have spent 2 per cent. more. That is the answer to the hon. Gentleman's question.

Mr. Julian Brazier (Canterbury)

The point is that hospital reorganisation can be very expensive. The proposed rundown of Kent and Canterbury hospital in my constituency, which my right hon. Friend visited this morning, is a good example. The community health council has pointed out that Kent health authority's figures for the likely costs of the closure are wholly unaudited, unsupported and grossly understated.

Miss Widdecombe

My hon. Friend is absolutely right. I intended to make those very points when I turned to Kent, as there seems to be a misapprehension that all of Kent is swimming in new Government money.

As my hon. Friend said, I visited Kent and Canterbury hospital this morning. It is an acute —not a community—hospital with an award-winning cancer unit. Local people cannot believe that there is any question of that hospital being axed, with all the in-patient facilities scrapped. People will face a 100-mile round trip for radiotherapy if the oncology unit is scrapped, for example. I must admit that I am interested in that myself as the nearest oncology centre is Maidstone. If the oncology unit at Kent and Canterbury hospital is closed—I accept that it is only a proposal at present—I want to know what extra resources will be made available to Maidstone to enable it to cope with the people who will be forced to make that long round trip.

People feel let down and disillusioned. The 465 beds at the Kent and Canterbury are threatened with a reduction to 65. How does that square with anything that Labour said before the last election? People never believed that Labour would close their hospitals; they never believed that Labour would preside over record waiting lists. They were led to believe that there would be increased funding, reduced waiting lists and hospitals kept open. The Government have failed in each and every one of those areas—and they have failed dismally.

Let the Secretary of State now make several things clear and we shall listen very carefully —I shall not be ambitious and ask him to apologise. The Secretary of State needs to tell us if and when he will meet his pre-election pledge on waiting lists. He needs to tell us how much more than his original estimate of £100 million it will cost to meet that pledge, however late it may be. He needs to tell us—he has been asked this many times during Health questions, but has dodged the issue every time—whether he will guarantee that no other areas of our health service will suffer as a result of the Government's panic reaction to tackling the waiting list problem that they have created.

If the Government eventually reduce waiting lists at the expense of other investment in our health care system, they will not have delivered on their pledge. To cut back or to marginalise other core areas of health service activity would be to cheat all hospital users. The Government have fudged and bungled their early pledge: it has been broken and twisted beyond repair. There will come a point when the Secretary of State must realise that he cannot turn around his supertanker fast enough and that he is heading on to the rocks of Labour' s pre-election early pledge. When he reaches that point, I suggest that he considers whether he should follow the example of all decent captains and go down with his ship.

Mr. Ian Bruce

I must apologise, as my voice is going—I should obviously consult our wonderful national health service. Does my right hon. Friend realise that both the Department of Health and the Department of the Environment, Transport and the Regions have had to accept that money has been cut from social services budgets in places such as Dorset? The process of unblocking beds by putting people into community care is falling down completely in Dorset —it is not just a matter of its maintaining previous levels. The Secretary of State must tell us what he is doing to ensure that the other Departments' budgets are not being cut in that way.

Miss Widdecombe

Indeed. My hon. Friend gives a great deal of flavour to my point, which is that we are already receiving intelligence from various parts of the health service, from chairmen and chief executives, who are telling us—

Mr. Eric Martlew (Carlisle)

Labour chairmen.

Miss Widdecombe

If they are Labour chairmen, Labour Members should listen carefully to what they are telling us because it is not very helpful. They are telling us that there is such a frantic demand for statistics coming from the Government, and so much fear and panic over trying to make it look as if the Government can keep their waiting list pledge, that staff are being prevented from getting on with the job in hand. That information is coming not from politicians, but from those who are responsible for running the health service, and who are faced with the sack by the Secretary of State if they do not deliver.

Mr. Simon Hughes (Southwark, North and Bermondsey)

The right hon. Lady knows that I am sympathetic to her attack on the Government for postponing their early pledge on waiting lists—if not looking as if they are in great difficulty in delivering it. However, the implication of the right hon. Lady's attack is that her party would put in the money to ensure that waiting lists were reduced. If that is now her party's policy, will she explain why, last Thursday, the shadow Chancellor of the Exchequer accused the Chancellor, when he announced more money for the public services, of going soft on public spending?

Miss Widdecombe

The Labour party made twin promises, as the hon. Gentleman will know.

Mr. Campbell-Savours

Answer the question.

Miss Widdecombe

I am answering it. The first promise was, "We will stick to the previous Government's spending plans." The second promise was, "We will reduce waiting lists." The Labour party made twin promises at the same time. That being so, the Government cannot now blame keeping one promise for breaking the other.

How does the Secretary of State respond to the motion? He responds with exactly the same manipulation of fact—I put in no higher than that.

Mr. Campbell-Savours

Will the right hon. Lady give way?

Miss Widdecombe

No. I shall make some progress and I have given way to the hon. Gentleman once. It was not a particularly intelligent intervention last time, and I do not suppose that he has learnt anything in the short time between because he has not been listening. That being so, I am going on.

How did the Secretary of State react to the motion? He did so by making the statement that appears in the amendment, which is that the House notes that by March 1998 no-one in England was waiting over 18 months for treatment, meaning that this Government has already achieved what the Conservative Government never achieved". I say that again. The amendment states that

no-one in England was waiting over 18 months for treatment". Naturally we wondered what surveys had been done to establish this, and we asked. We were told that it was established through management intelligence. That is, I think, a ring-round. There is at least one case of a schoolboy who has been waiting not 18 months, but 19 months for a simple throat operation. His mother wrote: He can't sleep at night because his throat hurts and he can't eat properly. I know that he has got to wait his turn"— so this is a reasonable parent— but it has been 19 months and that is too long for a little boy. Two months ago I wrote to St. Thomas's because I hadn't heard anything since I took him to the doctor's in 1996. They came back saying that they had looked into my complaint and they gave him an appointment to have his tonsils out on 10 June. On 28 May I got a letter saying that he could not go in because there was an emergency case coming in, but how did they know that 12 days in advance? That is the situation, so the statement to which I have referred is untrue and I expect the Secretary of State to withdraw it.

Mr. Graham Brady (Altrincham and Sale, West)

Is my right hon. Friend further aware that when waiting lists in Salford and Trafford, in my health authority area, have risen by about 5 per cent. in only four months, there is the further scandal of operations being moved? People are not being moved through the system and then having operations, but being removed from waiting lists and going on to deferred lists, which do not count in the official figures. That is happening, but we are still seeing waiting lists increasing dramatically.

Miss Widdecombe

My hon. Friend is right, but I also want to ask the Secretary of State another simple question. The first was, will he acknowledge that the statement in his amendment is wrong, which means that he cannot press the amendment because it would mislead the House?

Mr. Dobson

No, I will not.

Miss Widdecombe

The Secretary of State is saying that that child has not waited 19 months. I shall read that into the record, and I am sure that the mother of that child will want to take it up. He is saying that she is not telling the truth, but he should be saying that the amendment is wrong and should be withdrawn, because to press it would be to mislead the House, which I am sure he would not want to do.

Let me ask the Secretary of State another simple question. He talks about 18-month waiting lists. That, of course, is for treatment. There is an easy way to make sure that no one waits more than 18 months for treatment, which is to make sure that they wait rather a long time for a consultation. Will he please publish lists of how long people have been waiting for consultations, and make them comparative, so that we can see the true state of affairs?

Mr. David Lock (Wyre Forest)

I of course accept that the right hon. Lady has managed to identify one person who has been waiting more than 18 months, but does she accept that, under the Conservative Government, a time was reached when 220,000 people had been waiting more than 18 months, and 92,000 people had been waiting more than two years? Would she apologise to those people, whom she let down year after year?

Miss Widdecombe

The Conservative Government cut the number waiting for more than a year from 200,000 to 15,000. Perhaps the hon. Gentleman would applaud that.

In considering this rather silly amendment, which contains an inaccuracy and which the Secretary of State, in all decency, should not press on the House, we should make a final survey of what we inherited, what they inherited and where we are now. In the last full year of the previous Labour Government, there was a 2.7 per cent. cut in the NHS. Under us, there were consistent rises, year on year. During our previous period in government, our spending rose 74 per cent. The Labour Government's capital investment fell; ours rose, by 66 per cent. Under us, pay for doctors and dentists went up 34.5 per cent.; under them, it went down 31 per cent. Under us, nurses' pay went up 67 per cent.; under them, it went down 3 per cent. Our lists of people waiting more than a year went down by 92 per cent.; theirs went up by 26 per cent. [Interruption.] I am wrong. I am sorry, but I thought that one of my hon. Friends wanted to intervene. I always value contributions from my hon. Friends, so I was prepared to give one of them a chance to speak.

Where are we, at the end of just over a year of the Labour Government being in power? They plan to reduce flexibility for doctors, they have closed hospitals and reduced spending year on year, and they put such an emphasis on statistics that we are being told that basic care is suffering. That can all be summed up easily: they spend less, they close more, they make people wait longer.

Mr. Ian Bruce

On a point of order, Madam Speaker. I crave your advice on something that is going on in the House—behind you, I am afraid, because of the people who are involved. The normal situation is that people in the Box send notes to Ministers. Those notes are being caught up by the parliamentary private secretaries and sent round to other people.

Madam Speaker

My only concern is that either a Minister or a PPS approaches the Box.

4.19 pm

The Secretary of State for Health (Mr. Frank Dobson)

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof: notes with pleasure the £2 billion increase in National Health Service spending since 1st May 1997; welcomes the allocation of £500 million to cut waiting lists by the end of this Parliament to 100,000 below the record levels inherited from the last Conservative Government; notes that as a result of record increases in waiting list surgery the National Health Service will be opening around 2,000 extra beds and keeping open around a further 1,000 in marked contrast to the cuts under the last Government; notes that by March 1998 no-one in England was waiting over 18 months for treatment, meaning that this Government has already achieved what the Conservative Government never achieved; and further welcomes the ending of two-tier care by the introduction of primary care groups which puts doctors and nurses in the driving seat of modernisation.".

The Tory attack on our handling of the national health service seems to me to be an unholy combination of barefaced cheek and amnesia.

Mr. Oliver Heald (North-East Hertfordshire)

Will the Secretary of State give way?

Mr. Dobson

No, I am not giving way for the time being. Many Back-Bench Members wish to speak. The shadow Secretary of State went on for a long time, and so that other people can contribute to the debate, I do not propose to take a large number of interventions. The motion tabled by the Leader of the Opposition begins by regretting the increase in waiting lists since May 1997. We welcome the Tories' new interest in waiting lists. I wonder why they regret only the increase since May 1997. They have expressed no views on the massive increases in waiting lists that took place before 1997. I have checked the records. Such has been the massive concern of the parliamentary Tory party about waiting lists that, during the previous Parliament, when more than 230,000 questions were tabled and answered, Conservative Members asked just 32 questions about waiting lists, which is six a year.

Miss Widdecombe

The reason for the concentration of interest on waiting lists as opposed to waiting times or capital spending is that Labour made the promise, and the Government are being held to account. The interest in waiting lists stems from Labour's rash promise.

Mr. Dobson

The Opposition spokeswoman has taken up more time in my speech than I have, and she has already had 40 minutes of her own.

Under the Tories, there was a relentless increase in hospital waiting lists. During the 1990s, after the reforms of the national health service of which the Tories were so proud, the figure exceeded 1 million. They seem to have forgotten that, when we took over in May last year we inherited from them record national health service waiting lists, which were rising faster than at any time in the history of the service. They have either forgotten that, or they are proud of their useless record when they were responsible for the health service.

Not only do we regret the rise in the waiting lists both before and after May last year, but we intend to do something about it. That is what we promised at the general election. It is worth remembering that, at that election, the Tories proposed to do nothing more about waiting lists: they were apparently satisfied with things as they were.

Mr. Heald

Will the Secretary of State give way?

Mr. Dobson

No, I shall not give way.

The people of this country want waiting lists to come down. For them, the worst aspect of the health service is the waiting: waiting for an ambulance, waiting in accident and emergency, waiting for an out-patient appointment, waiting to go into hospital, and, for God's sake, once they are in hospital, sometimes having to wait to get out again. We recognised that concern, and we promised to get waiting lists down. The Tory party was apparently quite satisfied with the situation that then prevailed.

It will not be easy to get the waiting lists down: no one ever suggested that it would be. As I said this time last year, they are like a supertanker: it will take time to slow them down, longer to stop them rising, and even longer to turn them around.

Mr. Alan Duncan (Rutland and Melton)

What was "early" about the Secretary of State's pledge?

Mr. Dobson

It was certainly an early pledge, and we are doing something about it. If we are to improve the health service, we must take account of the state it was in when we inherited it. It was in a very bad state. It was stretched almost to breaking point. Staff were run off their feet, and there was a lack of resources. The Tory Government used to pride themselves on the way in which they looked after public money. Sixty of the 100 health authorities–60 per cent.—were in debt.

A massive increase in the number of emergency cases had been taking place for some time. When we took office, we asked the officials what research had been done into the reasons for that increase, and what had been done to tackle it. Answer came there none. The idle, useless lot who had preceded us had not examined the problem at all; we have had to start doing so.

Last summer, I made it clear that, in the coming winter—last winter—the national health service should give priority to dealing with emergencies. We realised that, given the resources then available to the NHS, we could not ask it both to bring waiting lists down and to deal with emergencies. I took responsibility for that from the day on which I said it, and I continue to accept personal responsibility. I am not ashamed to do so. I said that emergencies should come first. I took substantial steps to promote joint working throughout the NHS and with social services all over the country, and my right hon. Friend the Chancellor of the Exchequer provided an additional £300 million to cope with emergencies during the winter.

Mr. Matthew Taylor (Truro and St. Austell)

Will the Secretary of State give way?

Mr. Dobson

I will in a moment.

That made 700 extra beds available during the winter to help the hard-pressed people in the health service to cope with emergencies. They achieved a brilliant success. I know that the weather was mild last winter, and that there was no flu epidemic; but last winter the NHS dealt with more emergencies than ever before, and there were none of the scandalous lists of people waiting on trolleys and mattresses in corridors that had characterised nearly every winter in the 1990s. That is immensely to the credit of those working in the NHS and local social services. It contributed to the rise in waiting lists, as I had said it would at the start, but I believe that the right priority was given.

Until recently, I had not heard one person object to that decision. Then the last shadow Secretary of State for Health said that it had been made to save my face. I possess my face, and I would not want to sacrifice anyone for the sake of my face. Nothing was done for the sake of my face.

Now the new shadow Secretary of State says that our action was a failed public relations exercise. Was what was done in the West Kent health authority area, part of which the right hon. Lady represents, a public relations exercise? Was it a public relations exercise to put £117,000 into flu vaccinations to protect the most exposed groups? Was it a public relations exercise to put an extra £1 million into 132 additional nursing and residential home placements and home care?

Mr. Brazier

Will the Secretary of State give way?

Mr. Dobson

No.

Was it a public relations exercise to spend £50,000 on extending district nurse cover in the right hon. Lady's area, to spend £200,000 on additional beds at Mid-Kent hospital, or to spend £150,000 on a minimum care ward and discharge lounge at Kent and Sussex Weald? Apparently so.

Mr. Matthew Taylor

Will the Secretary of State give way?

Mr. Dobson

I will in a moment.

Recently, at the invitation of the senior representative of the consultants in the British Medical Association, I visited Halton general hospital. That representative was proud to introduce me to a team of respiratory care nurses who had spent the winter using some of the money to visit old people and other people with chest complaints, and deal with them at home. Being in hospital would have put them in danger, owing to the nature of hospitals. That was not a public relations exercise; it was a brilliant effort on the part of people in the NHS, which was appreciated by everyone—except, apparently, the new shadow Secretary of State for Health, who would rather make cheap political points.

Mr. Brazier

rose—

Mr. Heald

rose—

Mr. Matthew Taylor

rose—

Mr. Dobson

I will give way to the hon. Member for Truro and St. Austell (Mr. Taylor).

Mr. Taylor

The Secretary of State has rightly referred to the brilliant effort by staff in the NHS. He is aware, of course, of the situation in Cornwall, where four hospitals and a maternity unit face closure. He has to accept that it is now his responsibility to say yes or no to the health authority proposal. He will understand that there is much concern among the staff themselves in those hospitals and the maternity unit about their future, and there has been substantial delay in making a decision. Can he give any indication as to whether there is any chance of an early decision, one way or the other, which will at least relieve the burden that they are under? I hope that the decision will be to keep the hospitals and maternity unit open.

Mr. Dobson

I am not supposed to adjudicate on individual decisions on the Floor of the House, because I could be challenged, whether my decision went one way or the other, and I have a quasi-judicial role in this matter. All I can say about the Cornwall situation is this: it is nothing to do with money. The chief executive of the Cornwall and Isles of Scilly health authority has said that, even if he had the money, he would close those hospitals.

I am dubious about that idea, as the hon. Gentleman and other Cornwall Members know, and I am looking at the objections to those closures extremely seriously. It is all right people saying, "Make up your mind quickly." If I had made up my mind a lot sooner, they might have got the wrong answer. If they hang on a bit, they might even get the right one.

Mr. Heald

In East and North Hertfordshire health authority, the number of people on the waiting list has gone up by a third in the past year, so will the Secretary of State apologise to the 4,000 extra people on the waiting list, and answer the question that my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) asked: what about Lee Bosley, who has been waiting for 19 months? How can the Secretary of State possibly say that people are not waiting for 18 months when here is someone who has been waiting for 19?

Mr. Dobson

I do not know the details of the case that has been raised across the Dispatch Box, but the statements that I have made are based on information that has been supplied through the normal statistical arrangements in the Department of Health. Indeed, I have so insisted on it getting things right that one of the reasons for the increase in waiting lists is that it has had to look around, and has found some people who, strangely, disappeared from the waiting list last year. They are now back on because I want the figures to be accurate. If they are not, I will follow that up and ensure that something is done about it.

Mr. Duncan

So will the Secretary of State withdraw the amendment?

Mr. Dobson

No, I certainly will not withdraw the amendment because, frankly, I would not take the word of the people sitting on the Conservative Front Bench if they were the last people on earth. The child's mother may be right, and I am prepared to find out what has been going on, but I am not prepared to accept any accusations that are hurled at me by people on the Conservative Front Bench. If they had really been interested in the interests of the child, they could have got in touch with my Department—and I would have sorted the matter out in advance—rather than trying to make cheap points at the Dispatch Box.

We are entering just our second year of government and, with the extra money, I am convinced that we can and will tackle waiting lists. In his first Budget, the Chancellor found for this year for the NHS £1.2 billion over and above what the Tory Government had intended. In his second Budget, which was announced fairly recently, he found an extra £500 million, specifically to tackle waiting lists. That takes to £2 billion the total extra funds that we have put into the NHS since we came to power.

Of the £500 million of waiting list money, £417 million extra will go to England—rightly, Scotland, Wales and Northern Ireland will get their share—to start getting waiting lists down. That is how it will be used. Today, I have published —anyone who reads it will be able to challenge the figures—a preliminary survey of what is happening with that money, which shows that more beds are being provided, that more wards are being opened, that more staff are being taken on, that there is more operating theatre time, and that there are more weekend and evening surgeries.

Let us look at what is happening with beds. The Opposition motion accuses us of reducing the number of beds, but, as a result of the availability of that £417 million—or, indeed, only part of it—this year 2,000 extra beds will be made available to the NHS, which would not otherwise be available. Moreover, 1,100 beds which were planned to be closed will not be closed. Therefore, this year, 3,000 extra beds—the equivalent of six new district general hospitals—will be in use to help bring down waiting lists. That action is being taken at a time when we are getting on with building another six district general hospitals, including the one in the constituency of my hon. Friend the Member for Carlisle (Mr. Martlew).

Several hon

Members rose—

Mr. David Faber (Westbury)

Will the right hon. Gentleman give way?

Mr. Dobson

I shall not give way for the moment.

Although the new Opposition health team have not been in the job very long, they should know that, between 1979 and 1997, the Tory Government—of whom they seem to be so proud —closed 43,000 acute beds in the national health service. This is our second year in government, and 3,000 extra beds will be available. Compare that with the 43,000 fewer beds that were available under the Tories. What a contrast!

Several hon. Members

rose—

Mr. Duncan

Will the right hon. Gentleman give way?

Mr. Dobson

I shall not. I shall mention the hon. Gentleman, after which he can intervene.

This morning, the hon. Member for Rutland and Melton (Mr. Duncan)—who keeps leaping to the Dispatch Box—said on radio that he wanted to see the lists of those beds. We have published the lists. However, to save him looking them up, I tell him that, because of the Government's action, there will be 30 extra acute beds in Leicestershire, which will serve his constituency. In west Kent—which includes the constituency represented by the shadow Secretary of State for Health–125 extra beds will be available. I know that the right hon. Lady is in favour of old-fashioned courtesies—so I am just leaning forward to hear the words, "Thank you." She should be grateful that she is getting that extra money.

I shall give some other examples.

Miss Widdecombe

rose—

Mr. Dobson

Let me finish the list.

There will be 450 extra beds in London; 60 in Birmingham; 75 in Leeds; 73 in Berkshire; 67 in Liverpool; 36 in east Norfolk; 89 in Suffolk; 60 in Bradford; 115 in Derbyshire—because we are as interested in rural areas as in big cities—and 48 in Durham. Extra staff will be taken on. Moreover, £65 million will go into primary mental health care and community services—all of which can make a contribution by looking after people at home, so that they do not place a demand on hospital beds.

The Government's action has been welcomed across the country—except by the Tories. The right hon. Member for Maidstone and The Weald said that people are moaning about the Government's action. However, I should tell her that, in May, Ruth Carnall, chief executive of the West Kent health authority, told the Gravesend Reporter: We welcome this money, particularly since we understand"— she is quite right— that it is not just a one-off but part of an intention nationally to enable health authorities to maintain lower lists. The Government have had such welcomes from the people who actually have to do the work across the country.

The Tory motion, out of date as it is—as the Tories usually are—mentions bed reductions. However, as I said, there will be 3,000 extra beds.

Miss Widdecombe

The right hon. Gentleman has quite consistently talked about extra beds. I therefore ask him again the question that I asked him earlier: will those extra beds be over and above complete restoration of all the beds that are now being cut and all the hospitals that are now being closed? Will the extra beds in Kent, for example, mean that we will not lose 400 beds at Kent and Canterbury? If we lose 400 beds at Kent and Canterbury, 63 extra beds somewhere else in Kent will be of minimal use.

Mr. Dobson

The 63 extra beds in Kent will be provided this year. Consultation is under way in Kent about proposals made by the East Kent health authority that involve changes and—if the authority has its way—bed reductions at the Kent and Canterbury hospital. That, if it is approved, may take place in future years. I am talking about this year. There is not going to be any reduction in beds in Canterbury this year.

In addition, the proposition for the changes in Kent to which the right hon. Member for Maidstone and The Weald objects comes from the members of the East Kent health authority, every single one of whom was appointed by a Tory Secretary of State, not by me. As I do not like to mislead the House, I must point out that I reappointed the woman who chairs that health authority because it seemed wrong to change horses in mid-stream. I believe that I have the support of the Tory Member for Thanet—the hon. Member for North Thanet (Mr. Gale— in so doing.

Several hon. Members

rose—

Mr. Dobson

I give way to the former Secretary of State for Health.

Mr. Stephen Dorrell (Charnwood)

The Secretary of State can clear up very simply the question whether there is to be a net increase in bed space. Will he give the House a clear undertaking that the published figures for this year will show that 3,000 more acute beds were available in the national health service than were available in the health service last year? Are the acute beds in the health service going to increase by 3,000? Is that the commitment that he is giving the House?

Mr. Dobson

As the right hon. Gentleman knows, under the present statistical arrangements in the Department of Health, over which he presided, we shall not get those figures until 1999. We are talking about practicalities, not crackpot statistics as provided by the Tories. The practicalities are that the hard-working staff in the NHS will this year have access to 3,000 more beds in which to treat patients. That is clearly a step forward.

The Tory motion also criticises our proposals for improving primary care and giving greater power and influence to general practitioners, community nurses and midwives. We are doing that because everyone recognises that the Tory reorganisation of the NHS was wrong. The Tories introduced a competitive internal market which produced a two-tier system. It set doctor against doctor and hospital against hospital, and it cost a fortune in bureaucracy. If anyone doubts the huge amount of waste in the bureaucracy, I shall give one simple example.

When we took office, we were faced with having to agree, or otherwise, what was called the eighth wave of fundholding. We decided not to go ahead with it. The previous Government had earmarked £20 million for last year just to pay for the bureaucracy involved in the eighth wave of fundholding. I stopped it. That released £20 million, £10 million of which was spent on improved breast cancer services across the country, including £194,000 in the health authority which serves the shadow Secretary of State and £183,000 in that which serves the shadow Minister of State.

We know from what she has said in the past that the shadow Secretary of State believes that the Tory reforms are now really delivering results, but the main result they delivered was untold harm. Talking to people in the NHS, I find it very difficult to find anyone who will admit to supporting the old system. Admittedly, the majority of people in the health service never did support it, but even some of its former advocates have publicly recanted. Even more disturbing is the fact that the odd one, well known for advocating the internal market years ago, has sidled up to me to whisper that he was a secret member of the resistance all along. Such people are not very convincing, but I give them the benefit of the doubt.

Our proposals will put doctors, nurses and midwives back in the driving seat, not only in primary care but right across the national health service. That is bad news for management consultants, but good news for the rest of us. Management consultants have done untold damage to the NHS.

GPs are rightly concerned about the future of general practice. It is natural that they should be, as it is their careers, their premises, their staff and their patients who are involved. They have raised practical concerns, and there have been talks between the British Medical Association and officials in my Department, and, more recently, between representatives of the BMA and the Minister of State, my hon. Friend the Member for Darlington (Mr. Milburn), whom I should like to thank for the amazing amount of hard work that he has put into those talks. I hope and expect that the talks will achieve a successful outcome.

We share the desire of the professions—not just the medical profession but the nursing profession—that they should have a bigger say, and the desire to raise standards. We want to carry the professions with us.

Mr. Hilton Dawson (Lancaster and Wyre)

Does my right hon. Friend agree that, although GPs raised with him issues such as recruitment to the service on his extremely successful visit to Over Wyre medical centre in my constituency yesterday, there was a real sense of optimism and a determination to provide services close to the patient, or customer, in rural areas? GPs want to provide services at the local, GP practice level, rather than having to rely on acute hospital trusts and becoming involved in waiting lists.

Mr. Dobson

I confirm that that was the reception I received. We want the health service to provide treatment much closer to home. Many of the procedures, treatments and operations which once had to be carried out in district general hospitals will, with new technology, be able to be delivered on GP premises, much closer to people's homes. That is one of the things that we are trying to develop.

I greatly welcome the strong support of the medical, nursing and midwifery professions for what we are trying to do to improve quality. I do not think that there has ever been a time in the history of medicine in this country when the medical profession has been so committed to trying to improve quality and standards.

Until now, there has been no national health service machinery setting clinical standards, spreading good medical practice or checking on standards of performance. We are putting that machinery in place, with the overt support of the professions. Like them, we are determined that there will be no more Bristols, no more Kent and Canterbury cervical screening scandals, and no more Devon and Exeter breast screening scandals. We are going to put in place machinery to set standards, and then ensure that they are met. [Interruption.] If we are to hear booing from the Opposition about standards, I have to say that machinery should have been in place to pick up what was going wrong in Kent and Canterbury and in Devon and Exeter, but there was not.

When I asked the Tory-appointed chair of the South Thames health region to conduct an inquiry into the scandal in Kent and Canterbury, which had not been cleared up by the previous Government, who had allowed the people who had got it wrong to produce a report and then keep it private, he said—the previous Government were responsible for some of this— that the reasons for failure were poor and confused management; there had been repeated warnings of understaffing, poor training and low morale which had gone unheeded for many years. He said that there was a lack of a clear line of accountability on both management and quality assurance for the national programme. He went on: I have been forcibly struck by the different ways in which the introduction of the internal market … exacerbated an already inherently weak situation … Many of the decisions which had an adverse effect on the cytology department were made … because of the perceived need to be free standing and competitive in the newly created market. That is why we are opposed to the internal market in the NHS.

Dr. Evan Harris (Oxford, West and Abingdon)

Will the Secretary of State give way?

Mr. Dobson

Not at the moment.

Unlike our Tory predecessors, we are doing something about quality, and about our waiting list commitment. We admit that it will be hard to achieve. In the last year that the Tories were in power, the increase in treatment of people on the waiting list was just 1.2 per cent. To achieve what we want this year will require an increase of 10 per cent. It is a huge increase, but, on the basis of the statistics supplied to me, there are no 18-month waiters—I shall look into that. There are fewer 12-month waiters than in the past two years, and there has been the biggest fall in cancelled operations since figures were first collected.

All that depends on the people working in the health service, and on more money. We have found an extra £2 billion for the health service since we came to power—that is £2 billion more than the Tories intended to spend, and £1 billion more than the Liberal Democrats promised to spend. Last week, my right hon. Friend the Chancellor set out the Government's disciplined framework for public spending and investment. I am confident that, when the outcome of the comprehensive spending review is revealed, there will be more money available to the national health service.

The interesting question about the comprehensive spending review is not for us, but for the Tories. What will they say? They have been calling for more money for the national health service today, but last week the shadow Chancellor was attacking my right hon. Friend the Chancellor for squandering public money. We think that more money should go to the health service. Do the Tories agree? If so, do they have the agreement of the shadow Chancellor to say so?

We have no doubt that the national health service was under-resourced under the Tories, and needs more resources. Under this Labour Government, it will get more resources, not just to get waiting lists down, but to raise standards and give the hard-working staff the quality of buildings, plant, equipment and pharmaceutical products that match their excellence and commitment, putting them in a position to respond to the changing needs of the people of our country. With Labour—the party that founded it—the national health service will be renewed. It will be fit for the 21st century, and it will not be in the hands of the Tory party.

Mr. Faber

On a point of order, Mr. Deputy Speaker. I know that Madam Speaker values the rights of Back Benchers. I have heard her speak about the speed with which Ministers should reply to letters, and she has said that, whenever possible, Ministers should offer the courtesy of hosting delegations from Back-Bench Members of whatever party who want to discuss issues. This morning, I visited Warminster hospital in my constituency, where the mental health ward is due to be closed by the local health authority because of the Government's policies—

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. I have heard enough to realise that that is not a point of order for the Chair.

Mr. Faber

Further to that point of order, Mr. Deputy Speaker.

Mr. Deputy Speaker

Order. I have ruled that there is no point of order, so the hon. Gentleman cannot raise anything further to it.

4.52 pm

Mrs. Marion Roe (Broxbourne)

I am grateful to you for calling me early in the debate, Mr. Deputy Speaker. I am required to chair a Select Committee in 15 minutes.

I apologise to you and to the House that my parliamentary duties will prevent me from remaining in the Chamber for the following speaker and for the winding-up speeches.

It is a great sadness that the 50th anniversary celebrations of the NHS are being marred by Labour's broken promises. At the general election, the public were misled into believing that NHS services would improve, not deteriorate. The reality is that acute hospitals and community hospitals are being closed, waiting lists are growing and waiting times are becoming ever longer. If the Labour party had matched the Conservative record on health service funding, the NHS would have £750 million more for next year than the Chancellor of the Exchequer has so far given it. I hope that the pressure from the Conservatives will persuade him to find additional funding.

In a recent Gallup poll on the two most urgent problems facing the country, 48 per cent. of respondents cited health, hospitals and medical services. No wonder the Prime Minister has been forced to postpone the publication of his first annual report on the Government's performance because of the growing criticism of Labour's failure to meet its key election pledges. The decision to postpone the launch of the report earlier this month has come as Ministers face embarrassment over a spate of official figures showing that the Government are encountering difficulty in achieving many of their five early pledges. The Secretary of State for Health has admitted to being embarrassed about waiting lists reaching 1.3 million—an increase of 133,300 since Labour came to power 14 months ago. He seems to be in a state of permanent blush.

Last February, I asked the Prime Minister whether he was aware that patients attending the Queen Elizabeth II hospital in Welwyn Garden City were waiting a maximum of 12 months for elective surgery in May 1997, but that nine months later they had to wait 18 months. The waiting lists have grown dramatically in every specialty. Needless to say, I did not receive a satisfactory reply from the Prime Minister.

The Labour party cannot claim naivety over the promises that it made at the general election. It must have been a calculated confidence trick on the British people. Those in the Labour leadership assessed how they could persuade electors to vote for them, produced the appropriate propaganda, inflicted it on the unsuspecting electors and are now pretending to us all that they really believed it.

Mrs. Louise Ellman (Liverpool, Riverside)

Will the hon. Lady give way?

Mrs. Roe

I cannot give way, because I have to chair a meeting in 10 minutes. I apologise, but I am afraid that 1 am under pressure of time.

Anybody who knows anything about health realises that Labour's health policies were never going to reduce waiting lists by 100,000 in the early years of its term of office. The Secretary of State for Health is using crisis money in a desperate attempt to achieve a short-term solution instead of identifying the fundamental problems of demand and need. His strategy will reward poor performance by throwing money at trusts with longer waiting lists. It will distort practice, undermine the development of a co-ordinated strategy and bail out the inefficient practitioner who does not make best use of his facilities.

The Government have fallen into a trap. They are trying to reduce waiting lists by treating more patients through a short-term burst of activity. History shows that to be a fundamentally flawed strategy. Waiting lists have risen inexorably since 1948. Despite an increase of more than 800,000 in the number of patients treated annually, waiting lists lengthened by 100,000 between 1991 and 1995 because more than 1 million extra people were referred to the waiting lists.

Since the election of the Labour Government, on their spurious health pledges, the rate of increase has accelerated because they have failed to recognise the underlying pressures: increased chronic illness in all age groups; greater understanding of the options available; greater expectation of medicine; increasing demands on the service; new technology; and new therapy. Evidence shows that there is an equilibrium between waiting lists and activity. Increases in activity will be met by increases in referrals, which puts further pressure on the waiting lists. The Secretary of State's shallow attempts to bail out media pledges cannot succeed. Like King Canute, he will discover that the tide of demand will inundate him.

Of course, money for waiting lists will result in extra people being treated. They will benefit and their quality of life will improve, but that political measure will do nothing for genuine clinical need. Managers under pressure to deliver the Government's requirements will target the simple and quick procedures. Cataracts, varicose veins and bunions will be treated. People will be pleased and the statistics will improve for a while, but what about the chronically ill—those with multi-system pathologies, waiting for complex, time-consuming and expensive procedures? They will continue to wait and to suffer. The Government's facile financial approach makes fiddlers out of managers and victims out of patients.

The Secretary of State should have invested the money in meeting genuine clinical need, targeting those most in need of treatment. He should also remember social need. Consider the elderly lady with a sore hip. She may not have the highest clinical need, but what if she lives four storeys up in a block of flats with a lift that hardly ever works? Such desperate social need is not recognised. She is a number on a list that is ever delayed because the resources that she requires are expensive.

If the Secretary of State were genuinely keen to achieve change rather than short-term political kudos, he would understand the folly of his approach to those requiring hospitalisation. If he put lists in the hands of primary care GPs, he could build on the unique clinical intimacy between British GPs and their patients. Operations would be done not because they were quick, cheap and easy but because they delivered the best results.

It is no coincidence that waiting lists have improved dramatically since GPs became personally involved, with doctors controlling when and where to provide an intervention and having a cheque-book to back up fulfilling the need. It is incontrovertible that one GP practice providing clinical care and managing resources will achieve more than 10 that do not—or more than 50-plus reluctant participants in one of the new Government-imposed primary care groups. Such PCGs will undoubtedly mean that the initiative taken by GPs in the past on behalf of their patients will be lost, thus damaging the opportunity to provide more services at a doctor's surgery rather than in hospital, as well as damaging general improvements in hospital services.

If the Government want the best for patients, they must recognise the skills of GPs at practice level in identifying need. Such GPs support not just a list or a number but the individual who is damaged by disease or disability—the person who needs the help of the medical profession, irrespective of whether they are first or 101st on some list. That is what a visionary Government, unhampered by bigotry, should support. Of course, such practice already exists. The Conservative Government were operating such forward-thinking, innovative policy after the introduction of their reforms.

My constituents are not concerned directly that 10, 100 or 100,000 other people are waiting for an admission or an operation. If they are distressed, in pain or incapacitated, they want treatment as soon as possible. The only way in which the Labour Government will truly benefit patients is to admit the magnitude of their folly and recognise that waiting lists are an irrelevance. They should focus on the true indicator of success: waiting times that meet the needs of the individual and not the statistician.

5.1 pm

Mr. Kevin Barron (Rother Valley)

I rise to support the amendment and to debate the motion.

Two words came to mind when I read the motion. One was "stones" and the other was "glass houses". The Tories seem to have some block—my right hon. Friend the Secretary of State brought this up—in wanting to refer only to waiting lists since May 1997. We know fine well where the seed of the recent surge in NHS waiting lists lies—back in the first quarter of 1991, when the right hon. and learned Member for Rushcliffe (Mr. Clarke) introduced his national health service reforms.

Before those reforms, there had never been NHS waiting lists of 1 million people. Over the two years following the reforms, we saw waiting lists rise in every quarter but two. The number went through the million mark and has remained in excess of that ever since. By the time Labour took office, waiting lists were at a record high and were rising faster than at any time in NHS history. I do not think that anybody is surprised at the fact that it will take time to stem the increase and bring the figures down.

I admire my right hon. Friend the Secretary of State and the Government for taking the challenge and stating publicly that we shall do something about NHS waiting lists. I should tell Opposition Front Benchers and the House that a timetable for the pledge on waiting lists was never set before the election. I know, because I was party to the writing of that pledge into the manifesto and on to our pledge cards.

Mr. Duncan

Will the hon. Gentleman give way?

Mr. Barron

The hon. Gentleman can get his fix a little later in the debate. A time was never set. In the past few months, my right hon. Friend the Secretary of State has set a time by which we shall reduce waiting lists to last year's level. Then we shall start reducing them further.

Mr. Simon Hughes

The hon. Gentleman is often very convincing, and is very nearly making a convincing point. He is failing to excuse one other thing. There cannot be a early pledge to do something as a first step in a Parliament—a manifesto applies only for one Parliament —if it is then announced that the pledge will be honoured only by the end of it.

Mr. Barron

I do not agree with that. The hon. Gentleman has covered health matters in the House long enough to recognise the reality of what has been happening in the NHS.

Mr. Brazier

Why pledge that waiting lists will be reduced?

Mr. Barron

Because we shall reduce them; that is why.

The motion notes that current Government policies in respect of hospital closures and bed reductions are likely to increase the lists further". About four weeks ago, Opposition Front Benchers did not know the Government's policy on hospital closures. Indeed, for a short time in the media, trust mergers became hospital closures. I was as confused as those in the Opposition Front-Bench team even before the first 24 hours of their trying to make that point were up.

If my right hon. Friend the Secretary of State is right in saying that there will be 3,000 more beds in the acute sector by the end of this financial year, it will be the first time that that has happened in the history of the NHS. We ought to be congratulating the Government on being prepared to take such action, given that, year on year, no matter who has been in office, there have been fewer beds at the end of each financial year than there were at the beginning ever since the NHS was brought into being.

In the Budget, the Chancellor provided an extra £500 million for health care, £ 417 million of which is to be spent on the Government's waiting lists initiative to provide those extra beds. About 850 schemes are being introduced by health authorities all over the country. Such schemes include the provision of more beds, the opening of more wards, more staff being taken on, more theatre time and the extension of treatment, and the introduction of weekend and evening surgeries. Those are not soundbites; they are clear and sensible ways of tackling the problems of NHS waiting lists.

I am sorry that the hon. Member for Broxbourne (Mrs. Roe) has had to leave the Chamber. Over the years, I have had a bit of time for her in her independent role as Chairman of the Health Committee. I wish that she had been a little more independent in her speech today. It is not true that the idea behind the waiting lists initiative is to introduce simple, quick and easy procedures. That is far from so. The hon. Lady said that we should target the most needy and not consider what is happening in the NHS. We can all consider individual need, but we must recognise the immediate impact that it has on waiting lists—whether for day surgery, in-patient surgery, or whatever. We must consider procedures inside the NHS, to ensure that we get things right. We must ensure that money goes to specifics and gets things done.

In the Rotherham borough, health service partnerships have already agreed a plan of action. The waiting lists initiative in Rotherham health authority will mean an additional 24 gynaecology sessions, covering 100 additional cases, including weekend cases, at a cost of more than £100,000. There will be additional theatre lists for orthopaedics, dealing with an extra 115 cases at a cost of £105,000. There will be two additional ear, nose and throat lists a week, covering 175 cases. Later this year, depending on how things pan out, it is likely that there will be a third ENT consultant, whom we have wanted for many years in my local health service. That additional ENT provision will cost £112,000. We shall get an ophthalmic consultant and extra work at a cost of £131,000; an additional colonoscopy session for 20 cases, costing more than £21,000; and an extra consultant to treat 500 orthopaedic patients annually. We have been after orthopaedic consultants in Rotherham for many years. Unfortunately, it is not the best place in the world to work. We have great problems getting people to come to our area to work in the health service. That will cost £250,000.

For general surgery, we shall get an extra arteriogram session each week to deal with 120 cases, and additional endoscopy will treat 50 cases at a cost of more than £67,000. We shall get an alternate Friday prosthetic list to deal with 25 orthopaedic cases, costing more than £79,000. An additional oral surgery theatre list for 150 cases will cost more than £99,000.

Nearly £1 million is going into Rotherham to help people. Those targets, when met, will benefit hundreds of people who have been waiting for far too long on our national health service lists. Such initiatives should result, not only locally but nationally, in the biggest increase in operations in the history of the NHS and the biggest ever cut in waiting lists. The money will be targeted to deliver what patients want most: shorter waiting lists.

In addition to the extra money, about £500,000 is available in Rotherham for innovative ways of clearing waiting lists. That money will also be invested in reducing waiting lists by maintaining the flow of operations, building on our success last winter. The right hon. Member for Maidstone and The Weald (Miss Widdecombe) said that the £300 million for the winter crisis was wasted, but it did exactly what it was planned to do. It avoided the winter crises that we had year on year under the previous Government. We could not acclaim something that was not there and get it into the media. It is nonsense. Rotherham got £769,000 extra last winter to avoid what we had suffered in years gone by.

Mr. Brady

Does the hon. Gentleman acknowledge that it was a mild winter and that pressure on the health service was less than it would have been in a normal winter?

Mr. Barron

I do not think that the facts prove that it was such a mild winter. The pressure was reduced by the initiatives mentioned by my right hon. Friend the Secretary of State, such as getting out into the community in Kent to stop flu epidemics. That was how the money was put to good use, to avoid the crises that we have had before. Better primary, community and mental health services are coming under this Government. I have a health action zone in one of the poorest areas of Britain. It will start to examine people's problems and the problems that the health service has in delivering. The Government are doing things that have been sadly neglected for many years.

We shall also start to modernise the waiting list system. Some of the extra money will go on pioneering new streamlined appointment systems, so that day patients can book the dates of their operations. It is extraordinary that people go to their general practitioner and then have to wait weeks and weeks before seeing a consultant at the hospital, and then wait weeks for treatment. I can go to one of three travel agents in my town, book holidays, hotels, car hire and everything else anywhere in the world, but people cannot book into a consultant's clinic in a hospital. The information technology that the Government have been getting on with will help us to do that. It is much to their credit that they done it when previous Governments have neglected it.

This is targeted investment, not just giving money to the NHS. The Opposition can say, "We've been giving more than you; aren't we better than you?" but this is about targeting investment, so that we know that it will get waiting lists down and improve the NHS. Good management and innovative change are important. The Government will do better than previous Governments. All Governments do better than their predecessors, because medical science moves on. We shall do better in areas where the previous Government failed, by organising and managing the health service properly.

The 18 years of Conservative government saw waiting lists rise by more than 400,000. In the next four months under Labour, they will begin to fall, and they will continue to fall. The Opposition did not ask the electorate to vote for them again in 1992 by promising to ensure that hospital waiting lists increased. This Government have the courage to do things that many thousands of people want. We have the courage to set targets. The electorate will hold us to account. When we get through this first Labour Government in many years, the Opposition will be sorry that they tabled such a motion, because they will have to eat their words.

5.14 pm

Mr. Simon Hughes (Southwark, North and Bermondsey)

The hon. Member for Rother Valley (Mr. Barron) gave his usual robust speech, but he did not answer the point that I put to him.

As always, we welcome the opportunity to debate health. We even welcome the opportunity to debate waiting lists, although, as I will explain, we think that the Government chose the wrong target, so this is the wrong focus for a debate.

When the Labour party was in opposition, it tried to think up a compact promise for what it would do for the national health service. Labour thought of a nice, tight soundbite, "We will save the NHS." I am happy about that, because the NHS was in some difficulty under that party's predecessors. The Labour party then tried to think what that would mean in substance. Despite all the sound advice that it will have received from professionals and from within its own ranks that people care far more about how long they wait for treatment than about how many people are in the queue with them, in the end, the Labour party chose the wrong target. Labour made only one early pledge on health and, unfortunately, it was the wrong one. The Government are hoist by their own petard. They must deliver, but they are now in difficulties.

Rumour has it that some Ministers, including senior Ministers, know that they are spending money on the wrong things. This is their bed and they must lie on it. The Secretary of State took few interventions and, in particular, refused one from my medical friend, the hon. Member for Oxford, West and Abingdon (Dr. Harris), who may know something about the matter.

The Minister of State, Department of Health (Mr. Alan Milburn)

My right hon. Friend knew what he was going to say.

Mr. Hughes

The difficulty may be that the Minister may not like what my hon. Friend was going to say. The Secretary of State listed things to do with waiting that mattered to patients. Every one was to do not with waiting lists but with waiting times—more clear evidence from him that the Government have got their target wrong.

That evidence is backed up by what the right hon. Member for Sedgefield (Mr. Blair) said when in opposition. In 1996, when he launched the document—to which the hon. Member for Rother Valley may have been referring—"New Labour, New Life for Britain", and gave the early pledge, his explanation was: waiting means misery for patients. They are often in pain or discomfort. I could not agree more. We all understand that the longer people wait, the longer, by definition, they are likely to be in pain or discomfort.

Having adopted waiting lists, not waiting times, the Government are in considerable difficulty. There was no hint that it would take five years, the whole Parliament, to get 100,000 people off the list. There was no such qualification. I challenge any Labour Member to produce one bit of evidence from any Labour candidate who said that it would take the whole Parliament. It was not even said immediately after the general election, but said some little time later. Someone must have told the Secretary of State that he had better qualify it. That is not surprising: if one makes the wrong pledge, one ends up in difficulty.

It is not only me, my party or the right hon. Member for Maidstone and The Weald (Miss Widdecombe), but the British Medical Association, the Health Service Journal, the British Medical Journal and the Government's advisers who say, "It's the wrong target, Government. We are sorry that you made that so clear."

The only problem is that, although the Secretary of State has said that he is embarrassed about the fact that the numbers waiting are rising, nobody has yet owned up to the fact that the Labour party is embarrassed because it chose the wrong target. I hope that the Minister of State will say, "I'm sorry, we were wrong;"—it makes a welcome change to hear Governments of any colour admit that they were wrong—"but we chose the wrong target. We will deliver, although it will take us longer than we said and longer than we planned —but actually it is waiting times, not waiting lists, that we should be talking about." If the great socialist Labour party nirvana can be reached by—

Jackie Ballard (Taunton)

Socialist?

Mr. Hughes

That is doubtful; let us assume that it is neo-socialist, or new Labour.

If the great nirvana can be reached by taking 100,000 people off a waiting list that now consists of 1,300,000 people, that is a pretty mean, poor target. I do not think that out there the people will be greatly rejoicing at the prospect held out by the Government: "By the end of this Parliament, one in 13 people on the NHS waiting list will not be waiting any more, but 12 out of 13 will still be waiting. Sorry about that, kids." At that rate, it would take 50 years of Labour Governments to get those people off the list. I do not think that that is an encouraging prospect. It is a pretty thin, mean, small, pathetic target.

Mr. Gareth R. Thomas (Harrow, West)

rose—

Mr. Hughes

No, I shall not give way.

If that is all that the one promise made about health before the election means, it is pretty thin gruel.

I shall not rehearse the fact—because we all know it, and it is recounted every three months—that waiting lists have gone up ever since the election. For the first few three-month periods, that was not Labour's fault; for the second few, it was more Labour's fault; and, if the numbers keep going up, it will be even more Labour's fault.

We all understand that supertankers take a long time to turn around. I hope that the Secretary of State is right and the figures come down. Indeed, I hope that they come down by much more than 100,000—by more than 200,000 or by more than 300,000—but there ain't much sign of that yet. I certainly hope that our colleagues on the Labour Benches do not say at the next election, "We've done wonders; we've taken one in 13 people off the waiting list, and that allows us to come before you and ask for re-election."

We are debating waiting lists on a Tory motion, so it would be unfair not to say a word about the motion, or about the Tory record, despite the fact that, as the Tories are not in power and the Labour party is, what the Government do is more relevant at the moment. My job as the spokesman for an Opposition party is to hold to account the Government, rather than Her Majesty's official—more official than us—Opposition. [Interruption.] They are not the only official Opposition, but they are the only technically registered official Opposition, even if they are not always the most effective Opposition.

It is a bit difficult for the Tories to launch an attack about waiting lists and waiting times, for three statistical reasons. First, between 1979 and 1997—their famous 18 years—waiting lists rose by 546,000, or more than half a million. Secondly, under the Tories, a record number of people were waiting for more than a year for operations—there were 200,000 of them in September 1987. Thirdly, under the Tories, a record number of people had been waiting for more than two years for operations—almost 50,000 of them.

The Tory record is therefore difficult to defend, despite the fact that, at the end, although there were many more people waiting, there were fewer people waiting for longer—[Interruption.]—which we welcomed. We have always welcomed that.

Miss Widdecombe

Thank you.

Mr. Hughes

The hon. Member for Rother Valley used a comparison that I had not thought of when he talked about stones and glass houses. I, on the other hand, was thinking about pots and kettles, which suggested to me the fact that there was "something of the night" about the Conservative attack—but I do not want to go further down that road.

The point made by the Secretary of State at the end of his speech, which I also made in an intervention to the right hon. Member for Maidstone and The Weald, needs answering. The Tory party cannot credibly attack the Government on waiting lists while the Conservative shadow Chancellor says that the Labour party is profligate with public spending.

Mr. Duncan

Yes, it can.

Mr. Hughes

All right; the Tory party can say that waiting lists are too high and should come down, but that the money that the Labour party is putting in is far too much. [Interruption.] I shall wait for the hon. Member for Rutland and Melton (Mr. Duncan) to explain how two apparently contradictory statements—

Miss Widdecombe

The pledges are contradictory.

Mr. Hughes

I agree. We always said that before the election. The Minister of State was shadowing the health portfolio for Labour before the election, and he and his hon. Friend the Member for Rother Valley will both know that we said then that Labour could not pledge to keep to Tory spending totals and still expect to save the NHS. Those pledges were incompatible, and have been proved to be incompatible. [Interruption.] There is not a punter out there who does not know that.

Saving the NHS needs more public money—[Interruption.]—as the Chancellor announced on Thursday.

Mr. Deputy Speaker

Order. There is far too much sedentary comment, and we cannot have a very coherent debate with that background noise.

Mr. Hughes

Thank you, Mr. Deputy Speaker.

I now want to deal with the announcement about beds which was remade today—"remade", because the announcement that there would be 2,000 more beds in the health service this year, and 1,000 beds saved that otherwise would have gone, was made a fortnight ago. It appeared in the Evening Standard, for example, on 2 June. I have the list of those beds here, and I already knew that Guy's and St. Thomas's, my local trust, would get 24 more beds. That is another example of one of the recycled announcements at which the Labour party in government is so good. I welcome the fact that more beds will be kept this year; of course I do. I welcome, and do not even doubt, the fact that there will be 2,000 of them— beds that would not have been kept or been reopened had it not been for waiting list money. I also welcome the fact that another 1,000 beds that would have been closed will be kept open.

However, I have not yet heard—I ask the Minister to tell us the answer in his winding-up speech—whether the money committed to doing that this year is guaranteed on a recurring basis for the three-year period that the Chancellor defined last Thursday. The Minister will understand that, if the money is not guaranteed, the beds may not be kept open after this year. There will then be a further crisis, and they will have to be reopened later using additional money. That is no way to run anything, let alone a health service.

My hon. Friends the Members for North Cornwall (Mr. Tyler), for Truro and St. Austell (Mr. Taylor) and for Oxford, West and Abingdon—in fact, probably all my English right hon. and hon. Friends—have told me that they know that the shortages in the health service, and the fact that we have so many people on waiting lists, are in part due to the fact that we do not have enough staff in the service. We have not had the money to recruit the 8,000-plus nurses that the health service is short of, or the 1,000-plus doctors, let alone the general practitioners.

Yesterday, I spoke to a recently retired very senior nurse manager who said that we were building up a huge crisis because staff did not want to come into the health service. I do not pretend that the Government do not understand that; I know that they are aware of the problem. It must be acknowledged, however, that we have to provide more than beds and operating theatres; we have to provide the staff.

I am not talking about existing staff working extra time–12 and 18-hour shifts—or about agency staff or staff on bank duty. I am talking about real permanent establishment staff who can supply all year the consistent teamwork to provide health care in the way that the NHS does best.

There have always been waiting lists. I suspect that doctors are keener on them than the rest of us, because they believe that lists are a good way of rationing. There has always been rationing, too, since the NHS was created—let us not delude ourselves about that. I rarely hear the fact admitted by either the Government or those on the official Opposition Front Bench.

I hope that, if not by the end of this Parliament—I see no sign of the present Government's delivering on the pledge—at least by the end of the next Parliament, we will have put enough money into the health service to reduce waiting times, and therefore waiting lists, to a reasonable level for everybody. In my book, "reasonable" means six months. I have worked out the figures and have explained them to colleagues in other places and at other times, and the Library has provided figures too. I cannot see why, with sufficient investment over five years, we cannot get waiting times down so that no one has to wait more than six months for any serious treatment.

People in many other countries do not have to wait longer than that. Longer lists are nonsense; they are evidence of the British queueing disease. When too many people are waiting for buses, once a few extra buses are provided to clear the backlog, one has to provide only enough to keep picking the people up from the bus stops.

If we provided a decent injection of money into the health service over the next five years, we could clear the backlog.

Of course demand rises, and of course we may have to put in a higher proportion of gross domestic product, but we could get waiting lists and times down to a reasonable level. There is a realistic difference between somebody with, say, an ingrowing toenail, who could reasonably be expected to wait 12 months, and somebody with a serious condition. If someone has a cataract, the longer the operation is delayed the more likely that person is to go blind. The longer a hip operation is delayed, the longer somebody is likely to be out of work. Some conditions are serious and need treatment soon, and some are less serious.

More people are waiting now than ever before, whatever the arguments about the detailed statistics. There is a crisis. Demand may have risen; expectations may have risen—but that is the position we are in. We need to respond to that, and the public want us to spend more money on health, to deal with those problems, than on any other part of the public service.

Mr. Gareth R. Thomas

The hon. Gentleman says that we are not spending enough money on the health service, but would he speculate on what the state of the NHS would be if his party's spending plans had been implemented and £1 billion less had been spent on the NHS?

Mr. Hughes

If that had been a less predictable question, it might have caught me unawares. [HON. MEMBERS: "Answer it."] Of course I shall answer it—unlike other hon. Members, I answer every question asked in the House. The reason why the hon. Gentleman makes that point is that he misunderstands that the Liberal Democrats argued for spending additional to inflation, not inclusive of inflation, as the Labour party's figures were. The debate between Labour and the Liberal Democrats has always been on that point.

Mr. Thomas

indicated dissent.

Mr. Hughes

The hon. Gentleman might not like the argument, but that is the difference. Before I sit down, I shall get rid of the history, because debates about what we said we would spend before the election are debates about history. I like history and am happy to debate historical points, but that is not what people outside think matters the most; they are concerned about what is to be spent now.

Mr. Andy King (Rugby and Kenilworth)

The hon. Gentleman should be supporting us.

Mr. Hughes

Of course I support money going into the NHS, but I want more, the nation wants more and there is more available to spend. Let me tell the House how.

In the document produced by the Chancellor last week accompanying the first stage of the announcements of the outcome of the comprehensive spending review, "Stability and Investment for the Long Term", a revealing section on page 41 shows that the Government have more in reserves this year than they had expected at the time of the Budget. In the Budget, it was announced that there was estimated to be a £1.5 billion undershoot in public spending—spare money in reserve for this year; the Chancellor announced last week that public spending last year undershot by £3 billion; therefore, there is in reserve an additional £0141.5 billion.

Mr. King

No.

Mr. Hughes

It is no good the hon. Gentleman saying no—that is what the Chancellor said last week.

Mr. King

It is what is done with it that counts.

Mr. Deputy Speaker

Order. I have already asked hon. Members to cut out the sedentary comments—they are not helping the debate.

Mr. Hughes

I apologise, Mr. Deputy Speaker. I agree that it is what one does with the money that matters.

There is £1.5 billion extra in the reserves—£3 billion in all, sitting unallocated, waiting. Whereas the Government have so far announced £500 million extra—this picks up on the intervention from the hon. Member for Harrow, West (Mr. Thomas)—we say that they should have allocated the health service £1.25 billion this year, to be spent on staff recruitment, the reduction of waiting lists and improvements to community care and social care, which help to prevent hospital bed blocking.

The 50th anniversary of the NHS is about to be celebrated. None of us is naive, so we do not doubt that there will be a bit of a song and dance and an announcement of more money for the health service. We are all ready for that and we shall welcome it, but the sum to be announced will have to be far greater if it is not to be misrepresented as largesse, when it is not very large at all. The reality is that there is £3 billion sitting in the reserves this year. The health service this year could easily have spent the money on funding the staff pay review all at once, instead of its having to be phased. That would have greatly helped morale and recruitment, but the Government have not done that; nor have they since increased pay for NHS staff, which hardly anyone in the House would resist.

The announcement that the Prime Minister should make is, at least, that real growth—not cash growth—this year should be 5 per cent. over that of last year and that, for the rest of this Parliament, it should be 4 per cent. a year. That is about another £1 billion this year coming out of the reserves and probably an additional £2 billion—real growth—each year for the remaining three years of this Parliament. We shall judge the Government by whether there is a real, significant and substantial increase in money for the health service, not by recycled announcements of a bit more money that will not go halfway toward meeting the shortfall accrued under the previous Government.

I leave the House with this reflection: despite the Chancellor's announcement last week and the fact that what should first be measured is quality, not quantity—the Secretary of State was right to say that what matters most is how good the health service is, not how much we put into it—there is not a single informed person in the country who does not believe that, unless we ratchet up considerably the relatively small amount that we put into the health service, our 6.5p in the pound, we shall not be able to sustain the health service at the level the public expect and need. The reason why the Labour Government's rating in terms of public confidence in their handling of the health service has slipped so badly from last year to this is that the public do not see the money being forthcoming. Our challenge to the Government for the 50th anniversary of the NHS is to announce money that will keep the beds open next year and the year after, money that will keep the health service growing at a decent rate throughout the lifetime of this Parliament and money that will catch up with the consistent underfunding of the past 18 years.

The pledge on waiting lists was an early pledge which, sadly, will be delivered late, if at all. It was a modest pledge that will hardly affect most of the people waiting for treatment. It was the wrong pledge. The Government now need to change their priorities. If they do that and come up with the money, the NHS and its patients will be grateful; but, if they do not, they will surely and justifiably be held to account by the electorate.

5.35 pm

Mr. Gareth R. Thomas (Harrow, West)

In the 18 months before the general election last May, my constituents had seen two thirds of their accident and emergency departments shut. All four local NHS trusts were in severe financial difficulty, staff morale was at a low ebb and, not surprisingly, local waiting lists were at record levels and set to rise further. In the years after the Tory reforms, the NHS had degenerated into a bureaucratic health market, kept going mainly by the commitment of NHS staff. It had become a patchwork of businesses competing with each other, dependent for their funding and for their very existence on their success in winning orders and making money.

On Second Reading of the National Health Service and Community Care Bill, the right hon. Member for Maidstone and The Weald (Miss Widdecombe) declared that the reforms would herald a new era for the National Health Service". How right she was, but the truth is that that era is one that my constituents are delighted to have seen consigned to history. The right hon. Lady also claimed that the reforms would turn the NHS into the thriving, expanding concern that it should be."—[Official Report, 11 December 1989; Vol. 163, c. 722.] She was entirely wrong on that point. The reality of the NHS at the time of the general election was one of rising waiting lists and record sums being spent on administration. The Conservative NHS reforms that she endorsed so enthusiastically turned access to health care into a lottery. People living in the same borough—even in the same street—were confronted with widely differing patterns of care and waiting times for operations. My constituents suffered particularly in respect of ophthalmology, as waiting times for the patients of GP fundholders were up to two and a half times shorter than those for patients of non-fundholding GPs.

The financial position inherited by the Labour Government was appalling: 59 out of 100 health authorities ended the last financial year under the Conservative Government in deficit, as did 128 NHS trusts. At the same time, huge sums were being wasted on bureaucracy and administration as, from 1989-90, annual spending on managerial and administrative staff almost doubled, from £1.2 billion to £2.3 billion. Indeed, in one year, spending on managers soared by 17 per cent., while spending on nurses rose by only 1 per cent. Those who were Ministers in the Conservative Government should admit that they took their eye off the ball. The Audit Commission found that senior management costs in some trusts were more than double those in others, for no comparable reason. Estimates put GP fundholding costs at £80,000 per practice per year, totalling more than £200 million spent each year administering fundholding— money that could, and should, have been put into patient care.

I can think of no other area of government that so encapsulates the way in which the Conservatives let down the people of this country, or that so epitomises the mismanagement and incompetence that riddled the previous Government. It is a story of Tory failure to embarrass and shame even the most senior figures in the party.

The predecessor of the right hon. Member for Maidstone and The Weald, the hon. Member for Stratford-on-Avon (Mr. Maples), said only recently: We had a very clear policy on health up until 1st May. It was rejected by the electorate. That policy was decisively rejected by the electorate. The hon. Member for Rutland and Melton (Mr. Duncan) owned up in his book to some embarrassment about the excessive cost in managerial overheads of GP fundholding". Perhaps, when he sums up the debate, he will tell us whether that remark will be in the paperback version.

I congratulate my hon. Friends on the Front Bench because, in contrast to the record of failure and mismanagement of the Conservative party, they have begun to tackle the deep-seated problems that the Conservatives bequeathed us. The NHS White Paper and the public health Green Paper hold out the prospect of a health service that truly works in co-operation to provide high-quality health care. Doctors, nurses and their management are genuinely beginning to put together a new health service, and are working much more closely with partners in local authorities and the voluntary sector.

In that context, the extra money allocated for the waiting lists initiative is extremely welcome. The extra 3,000 beds to treat patients, which the initiative will fund, are in stark contrast to the record of bed closures under the Conservative Government, as my right hon. Friend the Secretary of State said. I particularly welcome the 450 extra beds in London. My health authority is to receive an extra £3 million, over and above what the Government have already allocated to it. Some £1 million of that will be used to reduce waiting lists at Northwick Park hospital by an estimated 1,200 patients.

Mount Vernon hospital, which is located in the constituency of the hon. Member for Ruislip-Northwood (Mr. Wilkinson) but serves my constituents, suffered considerable speculation about its future under the previous Government, which was exacerbated when its accident and emergency department was closed. The extra 15 beds that will open at Mount Vernon and the £250,000 from Brent and Harrow health authority's allocation from the waiting lists initiative will offer confirmation of Mount Vernon's continuing viability and reassure my constituents, who felt let down by the previous Government's failure to stop cuts at that hospital.

I also welcome the plans to establish in my constituency a three-way partnership between Northwick Park, which is the district general hospital, Harrow and Hillingdon Healthcare NHS trust, which is the local community services trust, and Harrow social services to increase community nursing. In the first instance, that will facilitate discharges from hospital and, secondly, it will help to keep out of hospital people who would, perhaps, have been bed blockers, and who can be more appropriately cared for in their home. Reforms in the White and Green Papers will continue to promote that spirit of partnership.

Health improvement plans and the new duty to work in partnership with other care agencies will be essential in cementing effective joint working between local authority departments and health care agencies to continue to tackle waiting list reductions. I hope that Ministers will ensure the speedy dissemination of the lessons to be learned from the way in which health action zones and the pilots under the National Health Service (Primary Care) Act 1997 are working so that all patients can benefit.

The Government are tackling the waiting list problem. More beds are being provided; more wards are being opened; more staff are being recruited and more theatre time is becoming available. The Government should be congratulated on fulfilling their first waiting list promise, made last November, that by the end of last March nobody would be waiting more than 18 months for treatment. That target has been achieved by the work of health authorities and trusts, which is now being stepped up through the work of the waiting lists action team and the appointment of the chief executive of Leicester royal infirmary to reinforce the national drive to slash NHS waiting lists. The Government will fulfil our pledges to cut waiting lists.

It would be worth hearing from the Conservative party what exactly their policy is on the national health service. What actions and reforms would the party of the right hon. Member for Maidstone and The Weald and the hon. Member for Rutland and Melton implement if, God forbid, it were still in power? Do Conservative Members still cling to a belief in the discredited reforms that they so enthusiastically backed nine years ago, which produced a health service weighed down by bureaucracy? Do they support our reforms, but feel a little shy about owning up to that, or do they have something else in mind for the national health service?

I ask that question because, on 13 June in The Daily Telegraph, the right hon. Member for Maidstone and The Weald described the NHS as needing not just a little tinkering, but a radical overhaul. It would be worth while if Conservatives clarified what they mean by a radical overhaul. Do they mean, for example, that the national health service should be privatised? I am sorry that the right hon. Member for Charnwood (Mr. Dorrell) is no longer in his place, because I remember only too well his proposal to privatise many of the social care agencies. It would be interesting to know whether the Conservative party continues to support that proposal. Had that been implemented, it would have been disastrous for partnerships between social care agencies and the health service to reduce waiting lists.

The hon. Member for Stratford-on-Avon wrote in 1994, when he was working in Conservative central office, that it would be best for the Conservative party if there were absolutely no publicity about the national health service. I suspect that, if he were still working in Tory central office, he would be arguing that it would be better for the Conservative party if no publicity were given to the national health service for the next 10 years.

5.45 pm

Mr. John Horam (Orpington)

The famous NHS waiting list pledge, on which the hon. Member for Harrow, West (Mr. Thomas) and other Labour Members were elected, was quintessentially new Labour in that it was superficially impressive, would not cost very much and would make almost no difference even if it were implemented.

As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), who has just left the Chamber, said, it was a pretty thin pledge in the first place. I am sorry that I am agreeing with him—perhaps he is uncomfortable with that when his party is so close to the Labour party. The pledge was almost as thin as the hon. Gentleman's famous pledge to do something about the NHS by putting another 6p on a packet of cigarettes, which was the Liberal Democrats' funding suggestion at the general election.

From an ordinary person's perspective, a waiting list reduction of 100,000 is significant, but if we consider the total waiting list—of 1.3 million—it is not. It is even less significant if we remember that the pledge was to increase the number of patients treated, which is roughly 9 million in any year. That is a thin pledge.

The £100 million of savings on bureaucracy, which the Labour party pledged would pay for more patients to be treated and reduce waiting times, was equally thin. Again, to an ordinary person £100 million sounds like a lot, but it stands against the £40 billion spent on the NHS in England, Scotland and Wales in any one year. It is a meagre amount to achieve an insignificant objective, and it has made very little difference.

Dr. Jenny Tonge (Richmond Park)

Will the hon. Gentleman give way?

Mr. Horam

We have a relatively short time for the debate and I have already referred to the hon. Lady's colleague, the hon. Member for Southwark, North and Bermondsey, so I shall not give way.

The public have noticed that even Labour's meagre promise has not been fulfilled and that nothing has changed except that the problem is worse than when the Labour party was in opposition. In my area, for example, waiting lists have gone up to 8,500 over the past 12 months; they have gone up by 140,000 over the country as a whole. I accept that if one throws enough money at the problem the figure will begin to decrease. I expect that there will be cheers from the Labour Benches at some stage in this Parliament; I did not imagine that it would happen within one year, but perhaps within in two or three years the Government will say that they have reduced the number of patients not being treated compared with a figure when the Conservatives were in power.

How did the Government get into this situation? There is one simple reason—

Helen Jones (Warrington, North)

Will the hon. Gentleman give way?

Mr. Horam

Perhaps the hon. Lady will let me complete my sentence. It is because they have not continued the funding that we put into the NHS. They have reduced the steady increase of extra funding that the Conservative Government put into the NHS year after year. The present Government are now increasing it—as they did previously—by 2 per cent. a year; we increased it by more than 3 per cent. a year when we were in power. That is the difference between us.

All the recycled pledges, recycled beds and recycled figures do not add up to anything by comparison with the simple fact that the present Government are spending less than we achieved throughout our 18 years in power. They have cut the increase—

Mr. Dobson

The hon. Gentleman was voting against the Conservative Government for much of the time—he was a Liberal.

Mr. Horam

The present Government have cut the year-by-year increase in NHS funding achieved by the Conservative party. That is the simple fact. Even the Secretary of State's brusque interventions cannot conceal the fundamental facts about the NHS. The Government have cut spending. That is not what the public expected and none of the Government's recycled pledges can detract from that reality.

What are the Government trying to do to get out of the mess that, as the Secretary of State admitted, he created by his injudicious pledges? He is trying to bully managers throughout the country into giving priority to reducing waiting lists. That is not a sensible way to carry on.

Mrs. Ellman

Will the hon. Gentleman give way?

Mr. Horam

No.

As the Secretary of State should know, even he, as Secretary of State, cannot turn round this supertanker with his own hands. He counts on the 1 million people—he keeps quoting that figure—employed in the national health service to do the job for him. They are the people at the chalkface.

If he knows anything, the Secretary of State should know that one cannot declare that, in one six-month period, priority will be given to accident and emergency services and, in the next, to waiting lists; the people will have gone. If, in one period, priority is given to accident and emergency consultants and nurses, they cannot be switched to orthopaedics, gastroenterology or urology in the next six months. The people cannot be made to reappear out of the hedgerows of the national health service once they have gone. One cannot run a service that way.

I repeat the argument made by the hon. Member for Southwark, North and Bermondsey: the reduction of waiting lists is the wrong target. What matters to the ordinary person in the street is not waiting lists—whatever they may be—but waiting times. Under the previous Conservative Government, in the period after 1988, when the reforms were introduced, the average waiting time decreased from nine months to four months. That was one of the previous Government's major achievements. The average waiting time for treatment was reduced by more than half during those seven or eight years.

Labour failed to address that issue in its famous pledge. The Government are now failing to address it in their attempts to bring their pledges under control, and they will continue to fail to address it if they continue with the absurd reduction of waiting lists aim as a result of their pledge—a cross that they took up themselves.

What should the Government be doing? The hon. Member for Harrow, West asked what the Conservatives would do if we were once again in power. First, we would reintroduce Conservative levels of spending —as the Government should. We increased spending by 3 per cent. in real terms over 18 years.

Mr. Gareth R. Thomas

Under the spending plans that the hon. Gentleman must have agreed, my health authority would have received two and a half times less than the current Government are giving it.

Mr. Horam

The hon. Gentleman may talk about his authority until he is blue in the face. In the country as a whole, spending increased by 3 per cent. in real terms, on average, during the last 18 years of Conservative government. It has increased by only 2 per cent. in the first two years of the Labour Government. That is fact, and it is one reason why waiting lists have lengthened.

I hope, as a Conservative Back Bencher, that if we were returned to power we would increase spending to the levels that we achieved in the last period of Conservative power. If the Government were to do so over the next three years—they are approaching the end of their comprehensive spending review, so in a few weeks we shall know what health will receive—it would cost them approximately £10 billion over three years. If, at the end of July. the Department does not receive at least £10 billion for health spending, the Government will have failed, over the next three years—never mind over the Parliament—to match what the Conservatives achieved over 18 years in power. The Government cannot get away from the fact that they are cutting spending by comparison with what we achieved.

Above all, the NHS wants a regular increase in spending. No party in the history of the NHS has achieved that. The NHS wants to feel that it will not receive an increase of 5 per cent. one year, 2 per cent. the following year, 8 per cent. the year after and perhaps no increase the next. It does not want that because it leads to bad planning, as switching priority from accident and emergency one month to waiting lists the next does. The NHS needs a regular, sustained increase over three to five years—the period of one Parliament. It is time that we, as politicians, addressed ourselves to that point. The NHS is underfunded; at least we can achieve continuity and stability in its funding increases.

Finally, the Secretary of State should consider his macho management style. People are working as hard as they can to fulfil these ridiculous pledges; it will not do to say that people will be sacked just like that. As a result of the Conservative reforms, we have built up a considerable core of clinical directors who are both managers and clinicians and know what life is like at the chalkface in the NHS. It simply is not good enough to produce diktats from Whitehall, or the Kremlin in Leeds, and expect them to follow them. We should trust them to manage the NHS as it should be managed. The Secretary of State would receive a much better response by doing so than by coming out with these absurd proposals. I hope that we would do so if we were returned to power. That would produce a better NHS than the Government are likely to, on their present plans.

5.56 pm

Mrs. Alice Mahon (Halifax)

I support the Secretary of State's amendment to the Opposition motion.

I am pleased that the shadow Secretary of State is in her place. She made an inadequate but not surprising speech, given that she is on record as saying recently that Conservative policy isn't going anywhere, because we haven't actually worked out a policy. I understand that both she and her deputy—her sidekick—have very little experience of the NHS, as they both go private.

I should like to place on the record the fact that the shadow Secretary of State cannot escape her past. Not only is she inexperienced in the NHS; her most famous encounter with the NHS was when, as a Home Office Minister, she advocated shackling pregnant prisoners. She now pretends that she did not support the policy, but that is untrue—and I know, because I obtained an Adjournment debate on the subject during that period.

We need to explain how our policies will shorten waiting lists—they will shorten, because our approach is radically different from that of the Conservatives. As the Secretary of State outlined, we want to mould health services to meet patients' needs. That means modernising waiting lists. We want to increase public confidence in the NHS; shortening waiting lists is part of that process.

However, as the Secretary of State said, the national health service is a huge organisation. I accept that more than 1 million people work for it and that it will take some turning around. The national health service was neglected for 18 years; that is why we were returned with a landslide majority. The Conservatives seem to have learnt nothing from the state that they are in as a party, having been judged by the public on what they did to the national health service.

In the past 14 months, we have made a real start. As my hon. Friend the Member for Rother Valley (Mr. Barron) said, more than 850 schemes are now in place to shorten waiting lists. We have given an extra £2 billion for the national health service throughout the country and started the biggest hospital building programme in its history. One of the most important things we have done is publish a White Paper that sets out our far-reaching programme; it has some vision in it.

We have started to dismantle the internal market. Anyone who is still pleading in its favour has been silent today—I believe because Conservative Members have realised that it only produced a huge paper chase and increased administration and billing.

We are focusing on quality. I am pleased about the development of the national services framework to improve access and quality across the country. I am excited by the proposals for a commission for health improvement and the national institute for clinical excellence. Two recent scandals highlight the need for those initiatives. The Opposition were in charge when those scandals were occurring and being covered up. The Bristol case and the failure of cancer screening in Exeter and at Kent and Canterbury damaged public confidence in the NHS and demonstrate clearly the need for an added safeguard. Doctors from the commission will visit NHS trusts at least every three to four years. Where was such monitoring of quality and access when the Conservatives were in power? It was non-existent, and if hon. Members raised the matter in the House they were told to shut up because the Conservatives were doing everything right—but we know that they were not. That initiative is welcome if it will help to reduce waiting lists and wastefulness in the health service.

The figures that will be collected will cover various aspects of clinical care, including hospital deaths, complication rates after operations, death rates after heart attacks and death rates after fractured neck of femur. Such information can help a national health service that knows where it is going. Thanks to my right hon. Friend the Secretary of State, the health service does know where it is going.

The Green Paper on public health, with its proposals for tackling health inequalities and reducing avoidable death and illness, is one of the most radical initiatives since the inception of the national health service. By reducing health inequalities, waiting lists will be reduced. If people are not ill, they do not need hospital beds. The Green Paper is out for consultation now and will be a major step forward in breaking down barriers between health and social services.

I compliment my right hon. Friend on his honesty about care in the community. [Laughter.] The hon. Member for Rutland and Melton (Mr. Duncan) may laugh, but for the past 18 years his party used a concept on which we all agreed to close down wholesale care for the mentally ill. I hope that he is not laughing about what we read in the papers about the tragedies of mentally ill patients such as Christopher Edwards and Richard Linford. I hope that the hon. Gentleman feels a little guilty about that, because his party was in charge when the scandal took place.

The right hon. Member for Maidstone and The Weald (Miss Widdecombe) spoke about a little boy. I wonder whether she would like to speak to the parents of Christopher Edwards, who was not on a waiting list. There were no beds for him or Richard Linford and they ended up in a prison cell together. My right hon. Friend is to be commended on recognising that community care needs a good shake-up and that we did not get it right over the past 18 years.

The Green Paper is relevant to keeping down waiting lists. We must provide more access to treatment more quickly. We must recognise that health inequalities are tied into low income and that the income gap has widened massively under the Tories. We must recognise, as my right hon. Friend has done, that we need to do something about sex education, and about tackling drugs, smoking and bad housing. If we reduce bad health, people will not need to go into hospital.

The Green Paper proposes partnerships between local authorities and voluntary organisations and talks about going into schools to preach about preventable health problems. All that was anathema to the Conservatives when they were in power. They had their chance and they blew it. The right hon. Member for Maidstone and The Weald may laugh, but I thought that her speech was superficial.

The Opposition say that the Government have nothing to offer hon. Members by way of extra resources. Let me put on record what we have in Calderdale. We are on the verge of being signed up for a new hospital. I pleaded with the Conservative Government for 18 years for a new hospital and now we are about to get one. We have received extra money from the waiting list initiative, over and above inflation.

Our health authority received an extra £118,000 for breast cancer, which was extremely welcome. The previous Government neglected that area, even though many of us in the House pushed it for years. Twenty-seven beds that were due for closure under the previous Government are now to be kept open. The right hon. Member for Maidstone and The Weald tells us that we are getting less, but we have the facts at our fingertips so we know that we are getting more. It is there for all to see and it will be good for my constituents.

We are getting rid of the hated internal market and replacing it with integrated care. The idea of GP commissioning is far superior to GP fundholding. We do not want to continue with a system that wasted money—and we all know the scandals that arose from it.

The Leader of the Opposition has seen fit to appoint a rather intolerant and narrow-minded shadow Secretary of State. The British people will have noted that move. They have never trusted the Tories with the national health service and they never will again.

6.6 pm

Mr. Julian Brazier (Canterbury)

I welcome the opportunity to debate bed closures and to support the Opposition motion. I thank my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) for her support for my local hospital, Kent and Canterbury, which is faced with a rundown virtually to cottage hospital status if East Kent health authority's proposals are adopted. Just last week our community health council stated that those proposals were unacceptable in their present form.

East Kent health authority has repeatedly failed to identify the aim of its proposals. It keeps quoting a view with which everyone agrees—that working practices and configurations must change as patients' requirements and expectations rise—but nowhere has it identified a clear objective. In its consultation document it rules out money as the main driving force, and instead refers vaguely to factors involving the supply of doctors, the way they train and the new ways they need to work".

One of the two principal bodies responsible for policing doctors' training and working practices, the Royal College of Physicians, stated at the outset that it disagreed with the proposals, and local representatives of the Royal College of Surgeons have more recently given a clean bill of health to local acute hospitals and stated that they do not see the need for the proposals. Why does not the Department tell EKHA to go back and think again about proposals that have generated tens of thousands of objections from the community?

East Kent has recently suffered from bed shortages, so it beggars belief that the closure of nearly 400 beds at the hospital and a large number at Dover is proposed. Even meeting EKHA' s reduced bed totals under the proposal would mean expanding bed provision at Ashford and Thanet, despite recruiting shortages in Thanet.

Mr. Roger Gale (North Thanet)

My hon. Friend is aware that an almost certain consequence of Kent and Canterbury's proposals would be the transfer of cancer care to Canterbury and the closure of the unit at Maidstone. I cannot believe that my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) would welcome that on behalf of her constituents. More important, the proposal would lead inexorably to the closure of Faversham hospital, Whitstable and Tankerton hospital, Queen Victoria hospital, Herne Bay hospital and Deal hospital and the downgrading of the Buckland hospital in Dover—a town larger than Canterbury.

I do not believe that my constituents in Herne Bay would welcome the loss of beds in the Queen Victoria or Herne Bay, or the loss of facilities there and the potential for the development of telemedicine. Does my hon. Friend believe that his constituents would welcome such a loss at the Whitstable and Tankerton hospital?

Mr. Brazier

The Kent and Canterbury proposals—which I support—do not include downgrading the cancer facility in Maidstone. Rather, they make it quite clear that we need both facilities in Kent: one to cover the east and one to cover the west. They do not challenge any community hospitals and they certainly do not threaten the Whitstable and Tankerton hospital, whose support group is also championing the cause of Kent and Canterbury hospital.

As well as threatening a large reduction in bed numbers in East Kent at a time of bed shortages, East Kent health authority's proposals threaten our five regional specialties. The cancer care facility at Kent and Canterbury was one of only three last year to win a charter mark for excellence. If that unit were closed, it would move out of East Kent, resulting in some 20,000 patient visits each year for radiotherapy alone to Maidstone—which has the closest alternative unit. That would have knock-on effects for people awaiting treatment in Maidstone. Renal and haemophilia treatment, neurophysiology and neonatal intensive care would also have to leave Kent and Canterbury, and some services would leave East Kent. EKHA has admitted that the destruction and rebuilding of those teams elsewhere involves considerable risk. However, as the community health council points out, the health authority has done no proper risk analysis of its proposals.

The loss of access to a broad range of other acute medical services is also a cause of huge disquiet in the community. Almost all individual responses to EKHA's proposals from outside the Isle of Thanet—which comprises less than a quarter of the population—have opposed the changes. For the people who live in the Canterbury city council area, which on its own has a larger population and a larger elderly population than the Thanet district council area, and in the constituency of my hon. Friend the Member for Faversham and Mid-Kent (Mr. Rowe) and for the tens of thousands of people who live in small villages in other districts that are served by Kent and Canterbury—Canterbury is the hub of the bus system for the whole of east Kent—the proposals represent a serious threat.

Any private sector organisation that invested heavily in two sites—an acute hospital was built recently in Thanet and many millions of pounds have been invested in regional specialties at the Kent and Canterbury in the past few years—and then said that it had to close one or other of those facilities would be reasonably expected to take some trouble over its financial estimates.

East Kent health authority, however, submitted its estimates for changes in cancer care without consulting Maidstone, although Maidstone will be pivotal to the health authority's cancer proposals. EKHA appears to have ignored the costs of redundancy payments to consultants, nurses and other staff who may choose not to move to another location, and its proposals appear to have built in nothing for the extra ambulance costs involved in moving more people greater distances. Above all, the health authority's wholly unrealistic bed numbers make the financial side of the proposal laughable.

Closure of Kent and Canterbury would mean that East Kent would lose a hospital which, partly because of its proximity to the university and the extra educational and training facilities that it provides, has proved extremely effective in attracting talent to the region. It has proved possible to utilise talents across all three major acute sites by working together on the children's site. That would not be possible if we lost the middle site in the region; the extended distance and the additional time that it would take to travel between Ashford and Thanet would make joint working impractical.

I hope that East Kent health authority will see sense. I hope that, at its meeting in a few days' time, it will reconsider and not seek to drive through its proposal—and I am delighted that Canterbury and Thanet community health council has made clear its intention to refer the matter to the Secretary of State if EKHA persists. I hope that the Secretary of State will listen hard to the counsel not only of several Conservative Members but of the hon. Member for Sittingbourne and Sheppey (Mr. Wyatt), who participated in a recent delegation to Downing street on the subject. I hope that the Secretary of State will throw out this dreadful proposal that threatens to do much damage to the people of East Kent.

6.14 pm

Ms Rosie Winterton (Doncaster, Central)

I am grateful for the opportunity to participate in this debate. We all know from our postbags the anguish that is caused to people awaiting NHS treatment. I have personal experience of that as my father has been waiting some months for a knee operation, and I am aware of how waiting can put people's lives on hold. It affects not only the person awaiting treatment, but his or her family. That is why I think that the Government's commitment to reducing waiting lists is so important.

Doncaster health authority in my constituency has warmly welcomed the Government's initiative. Even though the health authority already has the smallest number of people waiting more than 12 months for treatment in the Trent region, the extra £1.7 million that the authority has been allocated has allowed it to agree a waiting list target of 4,600 to be achieved by the end of March next year.

My hon. Friend the Member for Rother Valley (Mr. Barron) referred to the importance of going back to 1991 when examining the whole picture regarding waiting lists, but I am happy to go back to 1997. In April of that year, the waiting list was 5,773. That means that, by next year, the waiting list will have been cut by 1,200. My health authority also expects that substantial progress will be made in reducing the waiting list by September this year. The built-in incentive of receiving £170,000 on top of the funds already allocated has concentrated minds on making real progress in reducing waiting lists. That can only benefit my constituents. We cannot look at the waiting lists initiative in isolation. My hon. Friend referred to the health action zones, and Doncaster is a part of one. The zones enable the health authority and local social services departments to work together on several initiatives, particularly tackling the effects of industrial diseases and the problem of teenage pregnancies. My hon. Friend the Member for Harrow, West (Mr. Thomas) referred to the partnership between social services and the health service. I believe that it is vital to get the balance right, as that is the way forward when it comes to improving health services.

Doncaster has also been awarded pilot status as part of the healthy schools initiative, which will allocate an extra £150,000 to schools to enable them to introduce health initiatives. We have made excellent progress with the establishment of primary care groups, which will reduce the fragmentation and division caused by the previous Government's policies and allow the greater planning of patient services by general practitioners in my area, who have welcomed the initiative. Substantial progress is being made in improving health care.

Operations will always be cancelled because of emergency cases, which are beyond the control of doctors and hospitals. However, I think that better information could be provided to patients about the reason for operation cancellations. Too often, the letters that are sent out are quite brusque and do not include further dates when people might expect their operations to be carried out. I hope that my right hon. Friend the Secretary of State will be able to give an assurance that we can address such matters.

I have received a number of complaints about general practitioners who, without giving any real reason, refuse to take pensioners on to their lists. People sometimes get the impression that there are GPs who cherry-pick their patients, refusing those who need what they think might be expensive care. Would my right hon. Friend consider some form of appeal system against that happening, or at least ensure that more information is given about why someone is refused treatment? People feel resentful when they are taken off a list or not taken on one without the reason being explained to them.

Before the general election last year, I visited my local hospital. Staff morale was at all-time low and the management was in despair. A few weeks ago, I returned to the hospital to present the staff awards. The atmosphere was completely different. The mood of the staff and of management was so much more upbeat. There was absolute certainty that the extra resources allocated to Doncaster health authority would have a great impact on reducing waiting lists. Having that as a long-term objective is something of which the Labour Government can be proud. It will make a real difference to many of my constituents and I am proud to be associated with any initiative in that regard, as I am proud to see a Secretary of State who has the guts to do something about reducing waiting lists.

6.22 pm

Mr. David Amess (Southend, West)

I congratulate my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) on her magnificent speech. It greatly cheered Conservative Members. I must be careful how I phrase my next sentence, but I am not sure that the Secretary of State for Health knows quite how to deal with my right hon. Friend. Certainly, we Conservative Members look forward to future battles.

I should say something kindly about Health Ministers. They are courteous, which is more than can be said of all Ministers. They reply reasonably quickly to letters, which again is more than can be said of all Ministers. However, their policies are deeply flawed.

The idea that the Minister of State can go ahead and press his amendment is bizarre. If he reads the amendment carefully, he will find that it states clearly that no one has had to wait more than 18 months for treatment. My right hon. Friend the Member for Maidstone and The Weald drew the attention of the Secretary of State to a case of someone who had waited 19 months. I think the right hon. Gentleman said that he would reflect on the matter. That being the case, it surely would not be right for the Minister of State to press ahead with the Government amendment.

A bizarre feature of the debate is that anyone would think that Labour had not won the election. I thought that the Labour party won the election and formed the Government over a year ago. As we reflect on what has taken place over the past two and a half hours, it seems that the Labour Government are responsible for nothing over the past year and that it is all the fault of the Conservatives. Time after time, Ministers have blamed Essex county council, which was Conservative for only a month, for everything that is wrong is the county. Yet the Government, who are now in their second year of office, apparently are to blame for absolutely nothing. That is bizarre.

I resent the insinuation from Labour Members that Conservatives do not care about the health service. We all know how cynical Labour is about the health service. We can all remember "Jennifer's Ear" and the other propaganda coups that went wrong. That is why I was drawn to read the Daily Mirror two weeks ago, when the headlines were less than flattering about the Secretary of State for Health. The right hon. Gentleman's relationship with the Daily Mirror now seems to be a little sour.

Mr. Keith Darvill (Upminster)

Will the hon. Gentleman give way?

Mr. Amess

I think the agreement is that the Minister of State will start his reply at 25 minutes to 7. That being so, I do not think that he would be too pleased if I gave way and took extra time. The shadow Minister, my hon. Friend the Member for Rutland and Melton (Mr. Duncan), will start the winding-up speeches soon. It would be unfair on the two remaining speakers if I took extra time.

The Labour party has been cynical in the way that it has used the health service. I and my family use the health service. We do not have private health care but, given the way that the Government are continuing, we shall need it. They have been cynical in so many ways. I was proud to be associated with Lord Moore and Mrs. Edwina Currie when they were involved in the Department of Health. I learned at first hand what an excellent national health service we have. That can be proved by the ages to which people are living now and the stage at which babies can be saved. Things thrived under 18 years of Conservative government.

I heard my previous constituency referred to in a seated observation. I was proud to be associated with the health service in my former constituency.

Helen Jones

Not proud enough to stay there.

Mr. Amess

I shall come to that in a moment.

When the accident and emergency unit in my former constituency was due to be closed, I joined the march. The unit was supposed to be closed on the Friday. I had a row, first, with one of the Conservative Health Ministers and, secondly, with the chairman of the health authority. After a meeting two days before the unit's proposed closure, the health authority decided to keep it open. The following year, it wished to remove the gynaecological section. I again did battle with the then Minister. That section is also still in my former constituency. I was proud to lay the foundation stone for the cancer unit and for the hospice in my former constituency.

I am pleased now to be associated with the various services in my new constituency. It is wrong for Labour Members to sneer and allege that Conservatives do not care about the national health service. Let us consider the record for which Labour Members are responsible since 1 May 1997. During the general election campaign, my opponent said: Cut NHS waiting lists by treating an extra 100,000 patients as a first step by releasing £100 million saved from NHS red tape. Labour Members know only too well that they misled people. They pretended that waiting lists would be reduced. They did not lead the British people to expect them to be increased, and the British people never understood that the new Secretary of State for Health would say, "They have gone up but we shall get it right eventually." Who is kidding whom on that issue? The Labour party misled the British people.

In my constituency, I am pleased that our hospital is a centre of excellence. It is the only hospital in Essex that has acquired associated university teaching hospital status. It is now a cancer treatment centre of excellence. It has received the King's Fund accreditation award. However, let us consider what has happened to hospital waiting lists in my constituency. Last year, there were 9,745 people on waiting lists. In only a year, the numbers have risen to more than 13,000. That is entirely the fault of a rotten Labour Government. The weasel words of the Secretary of State do not wash with me.

I draw the attention of the Minister of State to waiting lists because I have no doubt that, when he receives his brief, he will tell us that they do not really matter. I was very impressed by an article that appeared in the Health Service Journal, and I shall quote from it. The author wrote: Of course, some people claim waiting lists don't matter. I'm afraid they are badly out of touch with patients' priorities. Let's not forget the longest average waiting times are not for procedures of dubious effectiveness but for pain-easing, disability-reducing, highly cost-effective operations such as cataracts and joint replacements. Cutting waiting lists will cut average waiting times for these so-called non-urgent cases. As important, long waiting lists undermine public confidence in the NHS. They embody the sense of bureaucracy, slowness and inconvenience at the heart of declining satisfaction with the health service. Opinion polls consistently show that waiting lists are far and away patients' greatest concern about the NHS. By comparison with other countries' healthcare systems, they are our Achilles' heel. Like it or not, lengthening waiting lists are a powerful metaphor for the state of the health service. This remains stubbornly true despite the government's sustained attempts to divert attention to other aspects of waiting. I wonder whether my hon. Friends can guess who the author is. He is none other than the Minister of State, Department of Health who, in a few moments, will try to justify what the Government have done since 1 May 1997. I agree with every word that he wrote in that article on 26 March 1998.

We all know what is happening with waiting lists. Waiting list money is being spent on less serious cases, because other cases have an impact on social services, which themselves have insufficient funding. That means that seriously ill people, including those waiting for cardiac surgery, are not having their wait shortened and may die while on the waiting list. Day case surgery, which is relatively cheap and not life-threatening, but performance of which reduces waiting lists dramatically, is taking place under the new Labour Government—that is their priority. Patients often wait in excess of 12 months for joint replacements and have severely impaired quality of life in that time. Some are being forced into the private sector, using their life savings.

A year ago, Labour celebrated at the Royal Festival hall, with the clarion call, "Things can only get better." They are not getting better for people who are struggling to pay their mortgages with increasing interest rates, who send their children to schools with increasing class sizes or who are waiting to have operations. The Government have let the people down.

6.32 pm

Mr. David Lock (Wyre Forest)

First, may I reflect on why this subject has been chosen for debate? The right hon. Member for Maidstone and The Weald (Miss Widdecombe) inadvertently let the cat out of the bag. Was it chosen because Conservative Members are concerned about waiting lists, because people on waiting lists are suffering or because people on waiting lists pay taxes for the national health service without receiving treatment to which they are entitled? No. She said that waiting lists were the subject for the debate because the Labour party had msade them the subject. My party did that because they matter to people, to people in the NHS and to people who are suffering, which is why they were an election pledge and why they are important.

Mr. Christopher Gill (Ludlow)

Will the hon. Gentleman give way?

Mr. Lock

I shall not give way, because I do not have sufficient time.

Secondly, primary care groups, which have been criticised by Conservative Members, will at least mean that those people who are waiting will do so in an orderly and equitable queue, as opposed to fundholding being a charter for queue jumpers. People must be treated according to their health needs, not according to the status of their doctor.

Thirdly, we should reflect on the incompetence of the people who were put in charge of health services when the Conservatives were in power. For example, by last year, Worcestershire health authority was overspending by £8 million a year and had a cumulative deficit of about £20 million. Those serious problems are being addressed, and painful decisions are being taken, but it would have been better if they had been considered and difficult decisions taken before the general election.

Mr. Gill

Will the hon. Gentleman give way, on that point?

Mr. Lock

No, I shall not give way. The painful decisions that we are taking in Worcestershire will be considerably better for the extra £13 million, over and above spending figures that were published before the general election by the Conservatives, that has gone into the health authority as a result of decisions taken by the Government. There are options for the people of Wyre Forest, whom I represent, and the matter is with my hon. Friend the Minister, but if it were not for that extra money, there would be no options and there would be nothing for him to consider. Waiting lists in Worcestershire will come down, as they will come down elsewhere, as a result of decisions taken by the Government. For that reason, I shall support the amendment.

Mr. Amess

On a point of order, Mr. Deputy Speaker. Is it in order for a Minister to include in an amendment a statement that he has reason to believe is inaccurate?

Mr. Deputy Speaker (Mr. Michael Lord)

The Minister is entirely responsible for amendments that he tables or statements that he makes in the House.

6.36 pm

Mr. Alan Duncan (Rutland and Melton)

The terms of today's debate may have been set by our motion, but the climate in which it has been worded was entirely determined by the pledge made by the Labour party in the run-up to the general election. Labour promised to reduce waiting lists, which has caused us to draw to the attention of the House the way in which that pledge has been betrayed.

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) has covered—rumbustiously, as always—most of the arguments that I want to make, none of which, needless to say, was answered by the Secretary of State. First and foremost is the spending climate in which he pretends that he is beginning to fulfil his pledge. The key point is that spending under this Government is less than it would have been had the Conservative party stayed in office.

The Secretary of State is unable to fulfil his pledge because, in his naivety, he has boxed himself in by making two conflicting pledges. On the one hand, he said, bogusly, that his Government would stick to former spending plans, but, on the other, he said that he would reduce waiting lists. Those conflicting pledges explain the predicament that he and his colleagues find themselves in. Worse, it has been announced today that inflation has hit 4.2 per cent., so his spending plans will be further eaten into by the Government's inability to stick to their economic targets.

My hon. Friend the Member for Broxbourne (Mrs. Roe) clearly knows her stuff—she spoke cogently, as ever, and the Government should listen to her. The hon. Member for Rother Valley (Mr. Barron) clearly does not—he has become an apologist for something that will not please his voters in South Yorkshire. I doubt that he will honestly be able to hold his head high in the streets of Rother Valley again.

The hon. Member for Southwark, North and Bermondsey (Mr. Hughes) spoke a lot of sense. In discussing the deceit of this so-called early pledge, he joined us in pointing out the truth which Labour Members are not prepared to admit. The hon. Member for Harrow, West (Mr. Thomas) read his brief—he dwelt on the past, but seemed to have little vision of how his party will honour its pledge. My hon. Friend the Member for Orpington (Mr. Horam), as one would expect of a former Health Minister, brought expertise to the debate, helping us to understand the detail of waiting times and the importance of times rather than lists.

The hon. Member for Halifax (Mrs. Mahon) spoke as the House has come to expect of her. My hon. Friend the Member for Canterbury (Mr. Brazier) made a fluent and thoughtful contribution, which I trust Ministers will have noted. The hon. Member for Doncaster, Central (Ms Winterton) seemed reluctant to address the Government's failure. My hon. Friend the Member for Southend, West (Mr. Amess) was, as always, clear and to the point. The hon. Member for Wyre Forest (Mr. Lock) addressed the House with some gall. I wonder whether he campaigned on the Kidderminster hospital in the run-up to the general election. He is becoming an apologist for the reduction in services. Where does he stand with the voters now?

Miss Melanie Johnson (Welwyn Hatfield)

Will the hon. Gentleman give way?

Mr. Duncan

I shall not give way, because we are restricted on time.

The pledge on the health service—

Mr. Andy King

Does the hon. Gentleman use the health service?

Mr. Duncan

The hon. Gentleman has been barracking throughout the debate. The answer to his question is yes.

Given the Government's early pledge, 100,000 people should have been knocked off the waiting lists. Instead, they have gone up by 150,000. The Secretary of State and his chummy Minister are falling behind on their promise to the extent of almost a quarter of a million. To secure their fortunes and to recover from this panic—

Miss Johnson

Will the hon. Gentleman give way?

Mr. Duncan

I shall not give way.

Will the Secretary of State give a guarantee—which he failed to give the House when I asked him a week ago—that no other area of health provision will be pushed in the wrong direction to get the Government out of the hole they are in on their pledge? I see that the Minister is nodding. Let him put that on the record when he replies to the debate. Will he assure us that no other national health service indicator of performance will be pushed in the wrong direction to get the Minister and his team out of the hole that they have so deeply dug for themselves?

Miss Johnson

Will the hon. Gentleman give way?

Mr. Duncan

I have told the hon. Lady, and I shall not tell her again: I shall not give way, because we restricted on time. [Interruption.] If the hon. Lady had been here throughout the debate, I might have given way to her.

The White Paper reforms are likely to make the Minister's problems worse. He should listen to what doctors say about primary care groups. They are being compelled to form groups of 60 or 80 doctors covering about 100,000 patients. According to a recent poll by the British Medical Association, that is against the will of an absolute majority of practising GPs. We intend to listen to doctors, and it is time the Minister did so, too. What he proposes to do with GPs and with primary care groups will make matters worse.

Mr. Barron

The hon. Member says that the position of primary care groups will make matters worse. How can he defend the fundholding system, which only 50 per cent. of doctors were eventually cajoled into? It created a two-tier system of health care.

Mr. Duncan

If the Government are concerned about a two-tier system, they should endeavour to level up, not level down. It is typical of the Labour party and the socialist philosophy always to prefer to level down rather than to level up.

What is the point of an early pledge if it is continually postponed?

Miss Melanie Johnson

Will the hon. Gentleman give way?

Mr. Duncan

I have made myself clear.

What did the Secretary of State mean by "early"? He chooses to talk to his Minister in an attempt to ignore me. What was "early" about his pledge? The Government promised that they would bring down waiting lists as a first step, but it is becoming a bit of a last step. What does the Minister mean by "early"? Early in the morning, just as the sun is setting? [HON. MEMBERS: "Rising."] Morning has broken, blackbirds gone to bed? When the Minister replies, he should tell the House what he meant by "early".

Mr. Andrew Robathan (Blaby)

Perhaps I can help my hon. Friend. In the county of Leicestershire, waiting lists under Leicester health authority have gone up by 15 per cent. In two years—which will be "early"—they will be just the same as they were when we left office.

Mr. Duncan

My hon. Friend is absolutely right. Nowhere in the country has the early pledge been fulfilled.

Miss Johnson

Will the hon. Gentleman give way?

Mr. Duncan

No.

Mr. Deputy Speaker

Order. The hon. Gentleman has made it quite clear that he will not give way.

Mr. Duncan

I am grateful to you, Mr. Deputy Speaker.

In answer to a question from, I think, my hon. Friend the Member for Chesham and Amersham (Mrs. Gillan), the Prime Minister said that waiting lists will begin to fall by the end of this year.

Mr. Tony McNulty (Harrow, East)

Will the hon. Gentleman give way?

Mr. Duncan

No, I am running out of time.

We shall examine the figures on 1 January 1999 to see whether the Government's delayed fulfilment of this pledge will begin to happen. [Interruption.] The Minister is laughing. The only reason he is laughing is that he hopes that he will get out of this Department so that he does not have to pick up the pieces. I hope that the Prime Minister did not give him an early pledge that he would be promoted.

I look at the faces across the Chamber, and I wonder whether there is anyone left in the Labour party who is prepared to exercise his conscience. In due course, the Labour party will divide into old rebels and new robots. At least the old rebels have come into politics with an opinion, but they so despise their Prime Minister that it will take only a short time before they break ranks. The new robots, who have no idea why they are here, must look at their bleepers to know what they have to do. If there is a conscience left among Labour Members, some of them at least should join us in the Lobby tonight.

The Prime Minister's credibility is most at stake. He is not here: he never is. He spoke in almost Messianic terms: he talked about making a vow, making a pledge, making a covenant with the people, making a promise. He spoke like the Messiah, as if delivering a message from the mountain top. He promised a better health service. Where is he? He is never here. What would he say if he were here?

Mr. Bruce Grocott (Telford)

He would say, "This is rubbish."[Laughter.]

Mr. Deputy Speaker

Order. I remind the House that the hon. Gentleman is entitled to be heard.

Mr. Duncan

And I will be. Labour Members do not like hearing about what they will have to admit to their constituents. No manner of diversion will distract us from the fact that the Government have broken their pledge.

If the Prime Minister were here, he would say, "Suffer unto me little children, and I will make you wait. Come unto me all of you who are ill, and I will make you queue. Come unto me all who are old and ill, and I will make you go to the back of the line." This is a cruel betrayal of people who expected better. They were deceived, because they were led to believe that, as an early pledge, waiting lists would be brought down. If hon. Members have a conscience, they will vote with us tonight.

6.47 pm

The Minister of State, Department of Health (Mr. Alan Milburn)

I hope that the hon. Member for Rutland and Melton (Mr. Duncan) feels better for that. It is always better to get things off one's chest. Just a fortnight ago, when the hon. Gentleman made his debut at the Dispatch Box, he promised that the Conservative health team would be mature and constructive in debate-I think those were the words the hon. Gentleman used. I know that this debate is about waiting, but we are still waiting for that to happen. Thankfully, my hon. Friends have supplied the maturity and reflection that have been so sadly lacking from Conservative Members. As the subject of waiting lists has inevitably dominated the debate, I should make it clear at the outset that those who say that waiting lists do not matter—such as the hon. Members for Orpington (Mr. Horam), for Broxbourne (Mrs. Roe) and for Southwark, North and Bermondsey (Mr. Hughes)—have got it wrong, for two reasons. The hon. Member for Southend, West (Mr. Amess) kindly quoted from an article that I wrote in the Health Service Journal, in which I repeated what I had said on previous occasions: the longest average waiting times for treatment are for operations such as cataract and hip replacement operations.

As my hon. Friends the Members for Doncaster, Central (Ms Winterton) and for Wyre Forest (Mr. Lock) said, people who have to wait a long time for treatment have their lives put on hold.

Mr. Simon Hughes

That is because of waiting times.

Mr. Milburn

Cutting waiting lists will cut waiting times. The hon. Member for Southwark, North and Bermondsey, the Tory Front-Bench team and the hon. Member for Southend, West have not grasped that essential point.

We have already made progress on cutting waiting times, and we will continue to do so—especially for patients who are waiting for urgently needed cancer treatment. The hon. Member for Rutland and Melton, and, indeed, the right hon. Member for Maidstone and The Weald (Miss Widdecombe), raised the case of a boy who apparently waited 19 months for treatment. I wish that the right hon. Lady had checked the facts before coming to the Dispatch Box.

As our amendment rightly points out, on 31 March no patients were waiting more than 18 months for treatment, and that includes the boy who was mentioned. He will have an operation within the next few days, as the NHS trust had always planned. Had the right hon. Lady raised the matter sensibly with the Department, rather than trying, and failing, to make political capital out of it, we would have sorted it out immediately.

Mr. Duncan

Will the Minister give way?

Mr. Milburn

In a moment.

My right hon. Friend the Secretary of State has asked me to tell hon. Members on both sides of the House that, if there are any other such cases, we will gladly deal with them personally. When we say that we will cut the number of 18-month waiters, we mean it.

Mr. Duncan

Will the Minister confirm that the NHS is commissioning operations in private hospitals in order to bring down waiting lists?

Mr. Milburn

As the hon. Gentleman knows, the NHS has been doing that for years. What is new is that this Government have instructed health authority and other commissioners always to use NHS capacity first, if it is there.

There is a second reason why cutting waiting lists is important. The hon. Gentleman did not refer to that part of my article. The longer waiting lists are, the more people question the ability of the NHS to cope. It is no coincidence that, if hon. Members drive only a few hundred yards, they will see enormous posters advertising the wares of private health insurance companies. Those companies recruit on the basis of one simple fact: waiting for treatment. Long waiting lists are the recruiting sergeant of private medicine.

That may not matter to those on the Tory Front Bench, but I can tell the House that it matters to the millions of people who have to use the NHS day in, day out, and who want it to continue as a universal service funded from general taxation.

Dr. Harris

Waiting lists can be cut if operations are not offered. If the private health sector recruits by means of longer waiting lists, why is it recruiting through health authorities that no longer offer operations for uncomplicated varicose veins or for infertility after nought, one, two or three cycles? The Minister should think carefully about whether there is now a universal service for some of these so-called non-urgent procedures.

Mr. Milburn

The difference between my party and the hon. Gentleman's is that we want a universal health service that provides fair access to high-quality treatment in all parts of the country. I hope that, when we announce our proposals for improving quality and fair access—as we shortly will—the hon. Gentleman and his party will welcome them.

Cutting waiting lists will be the single most important way of rebuilding public confidence in the NHS after all the damage done to it by Tory Governments. As we heard from my hon. Friend the Member for Halifax (Mrs. Mahon), we will get waiting lists down by both investing and modernising. The two go together.

We have earmarked an extra £500 million so that waiting lists will be lower in April next year than the record level we inherited from April last year. The cash will pay for extra operations, extra staff and extra beds, and will mean the biggest annual increase in the number of hospital operations that the NHS has ever seen—as my hon. Friend the Member for Rother Valley (Mr. Barron) said—as well as an extra 3,000 hospital beds across the country. That includes 450 in this city, as my hon. Friend the Member for Harrow, West (Mr. Thomas) pointed out.

This morning, the hon. Member for Rutland and Melton issued a press release. I am afraid that he is rather prone to that. It demanded that we publish a full list of extra beds and extra activity. That list has been published. Let me ease the hon. Gentleman's doubts by telling him about some of the extra investment that is taking place—

Mr. Duncan

rose—

Mr. Milburn

I will give way in. a moment. First, I want to soothe the hon. Gentleman's fears and ease his suspicions. I want to bring him on side. He asked for the information this morning.

In Leicestershire, an extra £4.8 million will be provided. It will pay for an extra 30 beds; it will also pay for an extra 250 plastic surgery treatments, an extra 407 ear, nose and throat treatments, an additional consultant, 1,300 gastro-enterology treatments, two paediatric consultants and 150 extra paediatric treatments, additional staff for 200 extra ophthalmology treatments, one oral surgeon, 143 extra oral surgery treatments, one orthopaedic surgeon, 1,171 extra orthopaedic treatments, extra staff for general surgery and anaesthetic, Saturday opening at Leicester hospital, and 1,568 extra general surgery treatments.

Mr. Duncan

Will the Minister answer a question that he has not answered so far today? Are those 2,000 new beds the same 2,000 beds that the Secretary of State announced on 2 June?

Mr. Hugh Bayley (City of York)

They are the beds that the hon. Gentleman's Government closed.

Mr. Milburn

My hon. Friend has given the hon. Gentleman the answer. It is a terrible shame that he did not take the opportunity to be grateful on behalf of his constituents when it was offered.

Investing, however, is only part of the story. We are modernising the whole waiting list system. Unlike the Tories, who also launched waiting list initiatives, we recognise that getting waiting lists down and keeping them down needs more than just extra operations in hospitals.

The hon. Gentleman asked me for an assurance that no other sector of health care would suffer as a consequence of our getting NHS waiting lists down. I will give him that assurance, and I will also tell him that the Government will invest an extra £65 million to ensure that there are improvements in community, primary care and mental health services.

Those are all essential steps towards modernising the NHS. This Government were elected on the basis of a pledge not just to save the NHS, but to modernise it. We never said that it would be easy—we always said it would take time—but deliver the goods we will. We are a Government who keep the promises we make. Moreover, we are a Government who are not frightened of taking responsibility. When my right hon. Friend the Secretary of State took responsibility for rising waiting lists, he did something that no Tory Secretary of State for Health had ever done: he had the guts to take the blame. Tory Secretaries of State for Health always passed the buck; they always found an alibi; they always searched for an excuse. They never had the courage to take responsibility for their decisions.

This morning, the hon. Gentleman said on the radio that cutting waiting lists was the yardstick by which the Government's honesty would be judged. He is not right about much, but he is right about that. When we get those waiting lists down—as we will—the hon. Gentleman, too, will have to take responsibility, and admit that the Tories were wrong. He will have to admit that a Labour Government will have achieved something that a Tory Government never managed to achieve: getting waiting lists down, and enabling them to keep going down year after year after year.

Let us not forget that, for 18 years, the Tories put up waiting lists year after year after year. There were 400,000 more people waiting for hospital treatment at the end of their term of office than at the beginning. By the end of this Parliament, waiting lists will be at least 100,000 lower than the waiting lists that we inherited.

Given the Tories' record, I should have thought that the right hon. Member for Maidstone and The Weald would do well to heed the advice of her predecessor, the third shadow Health Secretary our health team has faced. He advised the Tories that the best policy for them was zero coverage. Tonight, we have learnt that the Tories cannot listen even to their own advice. After three hours of debate, no one is any the wiser about where they stand. Do they welcome our efforts to cut waiting lists? Do they welcome the extra cash? Do they want more cash for the NHS, which we do, or do they believe, like the shadow Chancellor, that the Government's plans for extra investment are a waste of public money?

The truth is that the Tories have no policies, they have no ideas, and they are out of touch with the 1 million people who work in the health service and the millions more who use it. They do not have even a credible position in opposition. Fifty years after opposing the very creation of the NHS, they are opposing its modernisation. They deserve to be rejected now, just as they were rejected then. I urge my hon. Friends to do just that.

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

The House divided: Ayes 133, Noes 327.

Division No. 304]	[7 pm
AYES
Ainsworth, Peter (E Surrey)	Forth, Rt Hon Eric
Amess, David	Fowler, Rt Hon Sir Norman
Arbuthnot, James	Fox, Dr Liam
Atkinson, David (Bour'mth E)	Fraser, Christopher
Atkinson, Peter (Hexham)	Gale, Roger
Baldry, Tony	Garnier, Edward
Bercow, John	Gibb, Nick
Beresford, Sir Paul	Gill, Christopher
Blunt, Crispin	Gillan, Mrs Cheryl
Body, Sir Richard	Gorman, Mrs Teresa
Boswell, Tim	Gray, James
Bottomley, Peter (Worthing W)	Green, Damian
Brady, Graham	Greenway, John
Brazier, Julian	Grieve, Dominic
Brooke, Rt Hon Peter	Hague, Rt Hon William
Browning, Mrs Angela	Hamilton, Rt Hon Sir Archie
Bruce, Ian (S Dorset)	Hammond, Philip
Burns, Simon	Hawkins, Nick
Butterfill, John	Hayes, John
Cash, William	Heald, Oliver
Chapman, Sir Sydney	Heathcoat-Amory, Rt Hon David
(Chipping Barnet)	Horam, John
Chope, Christopher	Howarth, Gerald (Aldershot)
Clappison, James	Hunter, Andrew
Clark, Rt Hon Alan (Kensington)	Jackson, Robert (Wantage)
Clark, Dr Michael (Rayleigh)	Jenkin, Bernard
Clarke, Rt Hon Kenneth	Johnson Smith,
(Rushcliffe)	Rt Hon Sir Geoffrey
Clifton-Brown, Geoffrey	Key, Robert
Collins, Tim	King, Rt Hon Tom (Bridgwater)
Colvin, Michael	Kirkbride, Miss Julie
Cormack, Sir Patrick	Laing, Mrs Eleanor
Cran, James	Lait, Mrs Jacqui
Curry, Rt Hon David	Lansley, Andrew
Day, Stephen	Leigh, Edward
Dorrell, Rt Hon Stephen	Letwin, Oliver
Duncan, Alan	Lewis, Dr Julian (New Forest E)
Duncan Smith, Iain	Lidington, David
Evans, Nigel	Lloyd, Rt Hon Sir Peter (Fareham)
Faber, David	Loughton, Tim
Fabricant, Michael	MacKay, Andrew
Fallon, Michael	McLoughlin, Patrick
Flight, Howard	Major, Rt Hon John

Malins, Humfrey	Spring, Richard
Maples, John	Streeter, Gary
Mates, Michael	Swayne, Desmond
Mawhinney, Rt Hon Sir Brian	Tapsell, Sir Peter
May, Mrs Theresa	Taylor, Ian (Esher & Walton)
Nicholls, Patrick	Taylor, John M (Solihull)
Norman, Archie	Taylor, Sir Teddy
Ottaway, Richard	Townend, John
Page, Richard	Tredinnick, David
Paice, James	Trend, Michael
Paterson, Owen	Tyrie, Andrew
Pickles, Eric	Viggers, Peter
Prior, David	Wardle, Charles
Randall, John	Waterson, Nigel
Redwood, Rt Hon John	Wells, Bowen
Robathan, Andrew	Whittingdale, John
Robertson, Laurence (Tewk'b'ry)	Widdecombe, Rt Hon Miss Ann
Roe, Mrs Marion (Broxbourne)	Willetts, David
Rowe, Andrew (Faversham)	Winterton, Mrs Ann (Congleton)
Ruffley, David	Winterton, Nicholas (Macclesfield)
Sayeed, Jonathan	Woodward, Shaun
Shephard, Rt Hon Mrs Gillian	Yeo, Tim
Shepherd, Richard	Young, Rt Hon Sir George
Simpson, Keith (Mid-Norfolk)
Smyth, Rev Martin (Belfast S)	Tellers for the Ayes:
Soames, Nicholas	Sir David Madel and
Spicer, Sir Michael	Mrs. Caroline Spelman.

NOES
Adams, Mrs Irene (Paisley N)	Cann, Jamie
Ainger, Nick	Casale, Roger
Ainsworth, Robert (Cov'try NE)	Caton, Martin
Alexander, Douglas	Cawsey, Ian
Allan, Richard	Chapman, Ben (Wirral S)
Allen, Graham	Chaytor, David
Anderson, Janet (Rossendale)	Chidgey, David
Armstrong, Ms Hilary	Chisholm, Malcolm
Ashdown, Rt Hon Paddy	Clark, Rt Hon Dr David (S Shields)
Ashton, Joe	Clark, Paul (Gillingham)
Atherton, Ms Candy	Clarke, Charles (Norwich S)
Baker, Norman	Clelland, David
Ballard, Jackie	Clwyd, Ann
Banks, Tony	Coaker, Vernon
Barron, Kevin	Coffey, Ms Ann
Bayley, Hugh	Coleman, Iain
Beard, Nigel	Colman, Tony
Beckett, Rt Hon Mrs Margaret	Connarty, Michael
Beith Rt Hon A J	Cooper, Yvette
Bell, Stuart (Middlesbrough)	Corbett, Robin
Benn, Rt Hon Tony	Corbyn, Jeremy
Bennett, Andrew F	Corston, Ms Jean
Best, Harold	Cousins, Jim
Betts, Clive	Cox, Tom
Blackman, Liz	Cranston, Ross
Blears, Ms Hazel	Cryer, John (Hornchurch)
Blunkett, Rt Hon David	Cummings, John
Borrow, David	Cunningham, Jim (Cov'try S)
Bradley, Keith (Withington)	Dalyell, Tam
Bradley, Peter (The Wrekin)	Darling, Rt Hon Alistair
Brake, Tom	Darvill, Keith
Brinton, Mrs Helen	Davidson, Ian
Brown, Rt Hon Gordon	Davies, Rt Hon Denzil (Llanelli)
(Dunfermline E)	Davies, Geraint (Croydon C)
Brown, Rt Hon Nick (Newcastle E)	Denham, John
Browne, Desmond	Dewar, Rt Hon Donald
Buck, Ms Karen	Dismore, Andrew
Burden, Richard	Dobson, Rt Hon Frank
Burgon, Colin	Donohoe, Brian H
Burnett, John	Doran, Frank
Butler, Mrs Christine	Dowd, Jim
Byers, Stephen	Drew, David
Caborn, Richard	Dunwoody, Mrs Gwyneth
Campbell, Alan (Tynemouth)	Edwards, Huw
Campbell, Ronnie (Blyth V)	Ellman, Mrs Louise
Campbell-Savours, Dale	Fatchett, Derek
Canavan, Dennis	Fearn, Ronnie

Field, Rt Hon Frank	King, Ms Oona (Bethnal Green)
Fitzpatrick, Jim	Kingham, Ms Tess
Fitzsimons, Lorna	Ladyman, Dr Stephen
Flynn, Paul	Lawrence, Ms Jackie
Follett, Barbara	Leslie, Christopher
Foster, Michael Jabez (Hastings)	Levitt, Tom
Foster, Michael J (Worcester)	Linton, Martin
Fyfe, Maria	Livingstone, Ken
Galbraith, Sam	Livsey, Richard
Galloway, George	Lloyd, Tony (Manchester C)
Gapes, Mike	Lock, David
Gardiner, Barry	Love, Andrew
George, Andrew (St Ives)	McAllion, John
George, Bruce (Walsall S)	McAvoy, Thomas
Gerrard, Neil	McCafferty, Ms Chris
Gibson, Dr Ian	Macdonald, Calum
Godsiff, Roger	McDonnell, John
Goggins, Paul	McFall, John
Gordon, Mrs Eileen	McGuire, Mrs Anne
Gorrie, Donald	McIsaac, Shona
Grant, Bernie	McKenna, Mrs Rosemary
Griffiths, Jane (Reading E)	Mackinlay, Andrew
Griffiths, Nigel (Edinburgh S)	McLeish, Henry
Griffiths, Win (Bridgend)	Maclennan, Rt Hon Robert
Grocott, Bruce	McNamara, Kevin
Grogan, John	McNulty, Tony
Hall, Mike (Weaver Vale)	MacShane, Denis
Hanson, David	Mactaggart, Fiona
Harris, Dr Evan	McWalter, Tony
Harvey, Nick	McWilliam, John
Heal, Mrs Sylvia	Mahon, Mrs Alice
Healey, John	Mallaber, Judy
Henderson, Doug (Newcasle N)	Mandelson, Peter
Henderson, Ivan (Harwich)	Marsden, Gordon (Blackpool S)
Hepburn, Stephen	Marshall, David (Shettleston)
Heppell, John	Marshall-Andrews, Robert
Hesford, Stephen	Martlew, Eric
Hewitt, Ms Patricia	Maxton, John
Hill, Keith	Meale, Alan
Hoey, Kate	Merron, Gillian
Home Robertson, John	Michael, Alun
Hoon, Geoffrey	Michie, Bill (Shef'ld Heeley)
Hope, Phil	Michie, Mrs Ray (Argyll & Bute)
Hopkins, Kelvin	Milburn, Alan
Howarth, Alan (Newport E)	Mitchell, Austin
Howarth, George (Knowsley N)	Moffatt, Laura
Howells, Dr Kim	Moonie, Dr Lewis
Hoyle, Lindsay	Moore, Michael
Hughes, Ms Beverley (Stretford)	Morgan, Ms Julie (Cardiff N)
Hughes, Kevin (Doncaster N)	Morley, Elliot
Hughes, Simon (Southwark N)	Morris, Ms Estelle (B'ham Yardley)
Humble, Mrs Joan	Morris, Rt Hon John (Aberavon)
Hurst, Alan	Mudie, George
Hutton, John	Mullin, Chris
Iddon, Dr Brian	Murphy, Denis (Wansbeck)
Ingram, Adam	Murphy, Paul (Torfaen)
Jamieson, David	Norris, Dan
Jenkins, Brian	Oaten, Mark
Johnson, Alan (Hull W & Hessle)	O'Brien, Bill (Normanton)
Johnson, Miss Melanie	O'Brien, Mike (N Warks)
(Welwyn Hatfield)	O'Hara, Eddie
Jones, Barry (Alyn & Deeside)	Olner, Bill
Jones, Helen (Warrington N)	O'Neill, Martin
Jones, Jon Owen (Cardiff C)	Organ, Mrs Diana
Jones, Dr Lynne (Selly Oak)	Osborne, Ms Sandra
Jones, Martyn (Clwyd S)	Pearson, Ian
Jones, Nigel (Cheltenham)	Pendry, Tom
Jowell, Ms Tessa	Perham, Ms Linda
Keeble, Ms Sally	Pickthall, Colin
Keen, Alan (Feltham & Heston)	Pike, Peter L
Keetch, Paul	Plaskitt, James
Kennedy, Charles (Ross Skye)	Pollard, Kerry
Kennedy, Jane (Wavertree)	Pound, Stephen
Khabra, Piara S	Powell, Sir Raymond
Kilfoyle, Peter	Prentice, Gordon (Pendle)
King, Andy (Rugby & Kenilworth)	Primarolo, Dawn

Prosser, Gwyn	Stringer, Graham
Quin, Ms Joyce	Stuart, Ms Gisela
Radice, Giles	Stunell, Andrew
Raynsford, Nick	Taylor, Rt Hon Mrs Ann
Reed, Andrew (Loughborough)	(Dewsbury)
Rendel, David	Taylor, David (NW Leics)
Robertson, Rt Hon George	Taylor, Matthew (Truro)
(Hamilton S)	Thomas, Gareth R (Harrow W)
Robinson, Geoffrey (Cov'try NW)	Timms, Stephen
Rogers, Allan	Tipping, Paddy
Rooney, Terry	Todd, Mark
Roy, Frank	Tonge, Dr Jenny
Ruane, Chris	Touhig, Don
Ruddock, Ms Joan	Truswell, Paul
Russell, Bob (Colchester)	Turner, Dennis (Wolverh'ton SE)
Russell, Ms Christine (Chester)	Turner, Dr Desmond (Kemptown)
Sanders, Adrian	Twigg, Derek (Halton)
Sarwar, Mohammad	Twigg, Stephen (Enfield)
Savidge, Malcolm	Tyler, Paul
Sawford, Phil	Vaz, Keith
Sedgemore, Brian	Wallace, James
Sheerman, Barry	Walley, Ms Joan
Sheldon, Rt Hon Robert	Ward, Ms Claire
Simpson, Alan (Nottingham S)	Wareing, Robert N
Skinner, Dennis	Watts, David
Smith, Angela (Basildon)	Webb, Steve
Smith, Rt Hon Chris (Islington S)	White, Brian
Smith, Miss Geraldine	Whitehead, Dr Alan
(Morecambe & Lunesdale)	Wicks, Malcolm
Smith, John (Glamorgan)	Wigley, Rt Hon Dafydd
Smith, Llew (Blaenau Gwent)	Williams, Rt Hon Alan
Smith, Sir Robert (W Ab'd'ns)	(Swansea W)
Snape, Peter	Williams, Alan W (E Carmarthen)
Soley, Clive	Williams, Mrs Betty (Conwy)
Southworth, Ms Helen	Willis, Phil
Spellar, John	Winnick, David
Squire, Ms Rachel	Winterton, Ms Rosie (Doncaster C)
Starkey, Dr Phyllis	Woolas, Phil
Steinberg, Gerry	Worthington, Tony
Stevenson, George	Wright, Anthony D (Gt Yarmouth)
Stewart, David (Inverness E)	Wright, Dr Tony (Cannock)
Stewart, Ian (Eccles)	Wyatt, Derek
Stinchcombe, Paul	Tellers for the Noes:
Stott, Roger	Ms Bridget Prentice and
Straw, Rt Hon Jack	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 notes with pleasure the £2 billion increase in National Health Service spending since 1st May 1997; welcomes the allocation of £500 million to cut waiting lists by the end of this Parliament to 100,000 below the record levels inherited from the last Conservative Government; notes that as a result of record increases in waiting list surgery the National Health Service will be opening around 2,000 extra beds and keeping open around a further 1,000 in marked contrast to the cuts under the last Government; notes that by March 1998 no-one in England was waiting over 18 months for treatment, meaning that this Government has already achieved what the Conservative Government never achieved; and further welcomes the ending of two-tier care by the introduction of primary care groups which puts doctors and nurses in the driving seat of modernisation.