Health Care

HC Deb 20 July 1999 vol 335 cc974-1032 3.50 pm

Madam Speaker

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

Dr. Liam Fox (Woodspring)

I beg to move, That this House notes the failure of the Government to deliver improvements in the provision of health care in the United Kingdom, resulting in increased waiting times for patients, plummeting morale in the medical and nursing professions, distortion of clinical priorities and the increasingly widespread rationing of drugs and treatments; and believes that repeated announcements, soundbites and photo opportunities are no substitute for a coherent and effective health policy. After more than two years, we can now start to compare new Labour's promises with what it has actually delivered. We can compare what it said that it would do, and often pretends that it is doing, with the reality of the health service that patients experience and within which doctors and nurses work every day.

As of this morning, two thirds of the trusts and half the health authorities expect underlying recurrent expenditure to exceed income by the end of the year. More than one third of trusts intend to cut direct service provision this year to balance their budgets.

The debate is about the widening gap between the growth in expectations and the ability of the service to deliver quick results.

Mr. Geraint Davies (Croydon, Central)

Will the hon. Gentleman give way?

Dr. Fox

I can deliver quick results, but not that quick. No thank you.

The debate is also about the competence of a Government who make announcements about the same spending over and over again and engage in gimmicks and soundbites to hide the intellectual vacuum in a Department that denies that rationing in our health care system even exists.

Mr. John Swinney (North Tayside)

Will the hon. Gentleman give way?

Dr. Fox

A surprise appearance. I shall give way to the hon. Gentleman.

Mr. Swinney

The hon. Gentleman has raised the issue of competence and I want to probe that issue further in the context of the motion. The motion is about health care provision in the United Kingdom, but with effect from 1 July, control of health policy was devolved from this Parliament to the Scottish Parliament. How competent is the Conservative party to move a motion about health care provision in the United Kingdom, when that is a matter over which this Parliament no longer has the power to exercise control?

Dr. Fox

I am sure that had the motion been out of order, you would have ruled it out of order, Madam Speaker. Besides, all citizens of the United Kingdom are entitled to free treatment wherever they go in the United Kingdom. Furthermore, this Parliament is responsible for making the money available for health care in all parts of the United Kingdom—and long may it remain so.

Mr. Dale Campbell-Savours (Workington)

Will the hon. Gentleman give way?

Dr. Fox

No, but I will in a little while.

It is interesting to note how the disappointment that now exists among large sections of the electorate came about. On 1 July 1996, in "The Road to the Manifesto"—which for her was to be a short road to the Back Benches—the right hon. Member for Camberwell and Peckham (Ms Harman) wrote: Labour will cut NHS waiting times". The facts are a little different. In March 1997, 30,100 patients had waited more than a year to be seen. By the end of May this year, 48,300 people were in that position—a 61 per cent. increase.

In December 1996, the Secretary of State for Culture, Media and Sport, who was then Labour health spokesman, said in a speech on "A Health Service for a New Century": I am particularly conscious of the need to avoid upheaval yet again within the Health Service. Change is needed, but it must happen in a sensible and phased way, and it must never become change for change's sake. However, not only has everyone who works in the national health service been avalanched with paper by the Government's attempts to make the system ever more centralised, but Dr. Ian Bogle, in his first speech as chairman of the British Medical Association, attacked the Government, saying that the pace of change was "frightening", and that doctors were apprehensive and fearful for their future". He continued: Congratulations, Mr. Blair, you have managed to alienate the whole profession. Then there is the question of political appointments. The then Labour spokesman also said: We want greater accountability and transparency for the planning and funding decisions made by health authorities, hospitals and GPs. Solely political appointments made to non-executive directorships on the boards of trusts and authorities must end. However, the figures show that 189 Labour councillors have been appointed as chairmen or non-executive directors on NHS trusts since the general election—posts that can boost their incomes by up to £19,000 a year. By contrast, only 25 of their allies in the Liberal Democrat party, 11 Tories and three independent councillors were chosen in the same period. What a bunch of phoneys the Government have turned out to be.

Far more important than the Government's broken promises is the plunge in morale in the national health service to which Ian Bogle referred in his speech. That plunge, which has happened throughout the country, is clearly evident to those of us who visit hospitals and is nowhere more visible than in the destruction of junior doctors' morale. Two weeks ago, the Prime Minister told the House that when the Government came to office, 6,500 junior doctors were working more than 56 hours a week—an unacceptable figure. He was correct. He then said: Now the figure is 4,800. That is wrong. The figure is now 8,508; 26 per cent. of junior doctors work beyond the new deal limits. The Prime Minister added: I am pleased to say that only one junior doctor in six works now for more than 56 hours a week"—[Official Report, 7 July 1999; Vol. 334, c. 1024.] That is incorrect. Only the Prime Minister's arithmetic can turn 26 per cent. into one in six. For the rest of us, the figure means that one in four of all junior doctors in this country are not complying with the new deal. That is an increase of 78 per cent. over the previous non-compliance figures of 30 September 1998. If the Minister thinks that those figures are wrong, I hope that he will give us the correct ones.

What do those figures tell us? They tell us either that the Prime Minister does not speak to the Secretary of State, or that the Secretary of State does not know the figures. Perhaps neither of them really cares about the figures.

The truth is that our junior doctors are starting to work more hours than they did before. Rules govern the length of time that a person can drive a lorry or fly an aeroplane, but the Government do not appear to mind the number of hours that people can guddle around with a scalpel in a patient's insides. The Government propose that there should be no limit on junior doctors' hours for the next four years and that the transition to 48 hours a week will take 13 years. When that was decided, the Secretary of State called it "good news for doctors".

Rev. Martin Smyth (Belfast, South)

Will the hon. Gentleman give way?

Dr. Fox

In a moment.

Padraig Flynn, the former European Union Employment and Social Affairs Commissioner, said that he was "very, very dismayed" at the decision. He said that it was unacceptable for patients to be treated by doctors who are exhausted, and that such a long transition period was not politically feasible or morally acceptable. It does not take 13 years to improve work organisation in European hospitals. Notwithstanding the interference that may come from Brussels on this matter, it is surely right that the Government should ensure that no junior doctor works more than 56 hours a week by the end of this Parliament. I look forward to the Secretary of State giving that commitment this afternoon.

Rev. Martin Smyth

At a time when a senior consultant has been accused of failing in his duty because of overwork, is it not even more dangerous that junior doctors, who are often a patient's first line of defence, work even longer hours than some consultants? Northern Ireland has the highest rate of junior doctors working hours that are too long.

Dr. Fox

When I was a senior house officer in obstetrics, I worked one weekend that began on Saturday morning and finished at the end of Sunday night. I had no sleep at all and managed to assist in nine emergency caesarean sections. I thought that those days were gone, and I expected that the progress made by the previous Conservative Government in reducing junior doctors' hours would continue. Apparently, however, the move is in the other direction. That is extremely demoralising for junior doctors and terrifying for patients.

Another worry is the rise in non-UK doctors in the national health service. I was surprised at the figures showing the proportion of our doctors who were born and trained here. [Interruption.] The Secretary of State laughs, but will the public laugh when they find out that 18 per cent. of consultants, 67 per cent. of staff grade personnel, 68 per cent. of associated specialists, 31 per cent. of registrars and 38 per cent. of SHOs come from overseas?

Mr. Campbell-Savours

On a point of order, Madam Speaker. Is the hon. Gentleman addressing the House or the Strangers Gallery?

Madam Speaker

I hope that he is addressing the House. That seems to be largely what he is up to.

Dr. Fox

Thank you, Madam Speaker. I am not so thin-skinned as to be deflected by spurious interruptions that are intended to prevent us from discussing the Government's appalling reputation.

All of us support training in the national health service, but we must hope that it does not become an increasingly international health service.

Lorna Fitzsimons (Rochdale)

May I offer the hon. Gentleman an opportunity to praise the rich contribution made in my constituency by overseas doctors, who invest in our health care and in saving lives, as well as contributing economically to our communities? Will the hon. Gentleman say that they are welcome, and that they would be mistaken if they heard any racist overtone in what he has said? I merely offer him an opportunity to clarify what could be seen as—I hope that it was not—a sad insult to the rich contribution of overseas doctors to our health care.

Dr. Fox

I have read a lot in the newspapers about the simplicity of the so-called Blair babes, but I have never heard the case better put.

One of the major problems facing us at present is compounding the drop in doctors' morale. In difficult times in the NHS, doctors and nurses used to be able to console themselves that no matter what resources they had to work with, they could properly prioritise patient care. That has changed fundamentally. My colleagues and I have travelled the country, speaking in particular to surgeons in hospitals. As a result of the Government's waiting list initiative, those surgeons are under increasing pressure to get the lists down, irrespective of what that means for patient care. If it means treating more varicose veins and ingrowing toenails, and keeping those who require cardiac surgery waiting, that must be done. If doctors do not act in that way, they face financial penalties.

Clinical priorities are being distorted. When one talks behind the scenes to sympathetic officials, or even—dare I say it—to sympathetic Ministers, one hears them say that they understand that that is happening, but that Tony's promise must be fulfilled. Party politics is being put before patient care. When caring medical professionals say that clinical judgment is being distorted, they are simply told that that is how it must be: the promise was in Labour's manifesto, and if those who are most sick must wait longer, so be it. That is a sad indictment of the way in which our health system is being run.

Mr. Nick St. Aubyn (Guildford)

Has my hon. Friend noticed a clear illustration of that point, which appeared in Hansard? During a statement on health on 6 July, at column 828, the Secretary of State for Health was told that a 90-year-old patient at the Royal Surrey hospital, Guildford, had been made to wait more than 24 hours before being given a bed on a ward, and he replied: "The craw can wait." Can my hon. Friend imagine such an insulting remark being made about a patient in a Labour area? Does that remark not prove that the Labour party's true feelings are for their own interest, and not for patients?

Dr. Fox

My hon. Friend—

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

rose—

Dr. Fox

Does the Secretary of State wish to make a point of order?

Mr. Dobson

Will the hon. Gentleman give way?

Dr. Fox

I am not giving way. I have to reply to my hon. Friend.

Mr. Dobson

rose—

Madam Speaker

Order. The hon. Member for Woodspring (Dr. Fox) is not giving way.

Dr. Fox

My hon. Friend must appreciate that clinical priority is no longer the deciding factor. What matters is what suits the opinion polls and how statistics can be reduced without their accidentally becoming individuals who have families and needs. If the Secretary of State wishes to put the record straight, I shall give way.

Mr. Dobson

I do want to put the record straight. If the hon. Member for Guildford (Mr. St. Aubyn) reads the corrected Hansard, he will find that I was referring to something said by the hon. Member for Mid-Sussex (Mr. Soames). Two newspapers managed correctly to record what I had said, even if Hansard did not.

Dr. Fox

I am none the wiser for that correction.

In dealing with clinical priorities, the downgrading of the opinions of medical staff is not in any way the fault of medical staff themselves. Hon. Members on both sides of the House have the very highest regard for doctors and nurses in our health service. I spent all my working time before entering politics working as a doctor in the health service. If the current trend continues, in which statistics are all-important and patients are downgraded, we shall shortly find ourselves with first-class staff working in a second-class service.

Mr. John Bercow (Buckingham)

My hon. Friend touched on the plight of heart patients. Is he aware that the patients charter specifies that no heart patient should be obliged to wait more than 12 months for cardiac surgery, but that a recent survey of 35 trusts showed that no fewer than 21 of them were failing to meet that target and that some people had to wait up to 17 months to receive the treatment to which they were entitled? Is that not an outrage?

Dr. Fox

It is an outrage and it is a tragedy. The outrage is that patients are being made to wait in order to manipulate the figures. Hernias and varicose veins are being pushed up the surgery list while serious cases that cost more money and take more time are being pushed down it. It is the distortion of clinical priorities that lies at the heart of our complaints about the Government's running of the NHS.

My hon. Friend's complaint about waiting times is mirrored by complaints about waiting lists. Despite all the rhetoric, waiting list figures have started to go up again. They have gone up by 21,197 since March this year. That, the Secretary of State would no doubt say, is an increase of merely 2 per cent., but it is worrying—and not only if one happens to be one of the 21,197. There is a seasonal factor. A rise in waiting lists at this time of year does not bode well for the second part of the year. Waiting times have gone up for many patients. In March 1997, 30,100 patients were waiting more than a year to be seen, but at the end of March this year, 48,300 were waiting—a 61 per cent. increase.

Mr. Geraint Davies

How can the hon. Gentleman reconcile his crocodile tears about alleged waiting lists with the fact that Conservative Members not only want to abolish the road fuel duty escalator, which would cause more asthma and would cost billions of pounds' worth of public money which could otherwise be put into health, but would abolish the escalator on duties on tobacco—a policy that would cost thousands of lives? There would be less money for health and more people would die as a result of the hon. Gentleman's stupid policies.

Dr. Fox

They are not alleged waiting lists. I am citing the Government's published figures for waiting lists. Perhaps the hon. Gentleman might want to have that argument with his Front-Bench team. In the seven years I have been in this place, I have heard some pretty poor red herrings to detract attention from an Opposition attack, but that one took the biscuit.

Waiting lists have started to rise again. The number of patients waiting for their first out-patient appointment following GP referral has increased. What matters to patients is that they get the appropriate treatment at the appropriate time. They do not care how many people are in front of or behind them in the queue. The Government believe that the people of this country will believe them when they put patients on a waiting list to go on a waiting list, say that waiting lists are coming down and pretend that the Government are doing well. Do they take people for fools? Patients care about the time between seeing their GP and getting their treatment. They are not bothered about what statistical measures and accounting procedures are put in place to ensure that the waiting list figures look right.

Department of Health statistics comparing March this year with March two years ago when the Government came to office show that, this year, 208,000 more patients were still waiting more than 13 weeks—an 84 per cent. increase—and 121,349 had waited more than 13 weeks—a 115 per cent. increase. Of those patients, 82,000 were still waiting more than 26 weeks—a 115 per cent. increase—and 50,968 had waited more than 26 weeks—a 92 per cent. increase. All the promises that waiting times and waiting lists would come down were nothing but meaningless hot air, but people know that health care has got worse under Labour.

One of the ways in which the system has got worse is that the Government refuse to accept that there is any rationing in our health care. We all know that there was, is, and will continue to be, rationing in health care as long as medical science is able to provide more than any publicly funded service can afford. That is a matter of fact. To pretend otherwise by entering the state of denial in which the Government find themselves does not help us to move the debate towards a better model of health care. My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe), the then shadow Secretary of State for Health, asked the Minister for Public Health: Is there rationing or is there not? The Minister replied, No".—[Official Report, 15 December 1998; Vol. 322, c. 746.] When I was a GP, health care was rationed; we had to decide whether to state in the referral letter that the case was an emergency, urgent, quite urgent, or not urgent. That is how health care was rationed. As we are told that there is now no rationing, I wonder whether patients with hepatitis C are being refused Ribavirin—a drug that would help them immensely. Is that not rationing? When multiple sclerosis patients in most parts of the country are told that they cannot have interferon, although patients in other parts of the country can have that drug, is that not rationing? That is rationing by postcode—the most unfair rationing of all. When some breast cancer patients pay £12,000 for a six-month course of Taxol, is that not rationing? Are the Government still going to have the nerve to tell the House today that there is no rationing in health care? There is rationing; we accept that. Why can the Government not have the intellectual courage to say what everyone in the medical profession and patients know is true? There is rationing.

Mr. Eric Illsley (Barnsley, Central)

Is it not true that the previous Government denied that there was rationing in the NHS? I am aware of that from a personal case. When my daughter was a patient at the Sheffield children's hospital, for month after month the doctors pleaded with me to try to get the Conservative Government to stop the rationing of various drugs in the NHS. Dr. Wales, a consultant at the hospital, was unable to provide drugs for his patients; he had to rely on the patients' GPs to use their own drugs budget to provide the drugs that he prescribed. I received letters from two previous Secretaries of State—one of whom is in the Chamber today—denying that any form of rationing on those lines took place.

Dr. Fox

The hon. Gentleman was not listening. I was just making the point that, as a practising doctor, I always realised that there was rationing—it takes place now and it will always take place as long as medical advances outstrip our ability to fund them. It does not take membership of Mensa to understand that equation. Perhaps the hon. Gentleman should have a word with Members on the Treasury Bench about the forms of rationing that he mentioned. Does he believe that the argument is progressing when those Members deny that there is any rationing at all in our health care? We cannot move to a more rational debate as long as we remain in this denial process—the intellectual vacuum and thought-free zone that pervades the Treasury Bench.

Mr. Campbell-Savours

Will the hon. Gentleman give way?

Dr. Fox

No, I do not think I shall. The hon. Gentleman has already interrupted—wholly fatuously—although he had the opportunity to make an interesting point for once.

When one has to go on a waiting list for a waiting list, that is all right because it is a people's waiting list. When one cannot receive cancer treatment free on the NHS, one must not worry because it is the new NHS. When the health service keeps people waiting for their heart surgery so that the Government can keep their election promises, that is okay because they are Tony's promises. What we have—dressed up as health policy—are broken promises dressed in gimmicks and delivered with incompetence. Labour said that Britain deserved better. Britain still does deserve better, but all that we have had is let-down Labour.

4.14 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: 'welcomes the action the Government has taken to turn around the National Health Service by finding £21 billion extra funds for the coming three years, starting building work on 13 new hospitals, modernising every Accident and Emergency Department that needs it, abolishing the unfair and divisive system of fundholding and replacing it with Primary Care Groups putting doctors and nurses in the driving seat, cutting waiting lists, ending 18 month waiting in the NHS, creating the National Institute for Clinical Excellence and National Service Frameworks to promote quality treatment, delivering the biggest real terms pay rise for nurses for 10 years, publishing the most comprehensive strategy ever produced for improving the status, training, pay and job opportunities for Britain's half a million nurses, midwives and health visitors, with 3,800 nurses returning to the NHS so far this year and 2,200 additional doctors in the Government's first year of office; further welcomes the 450,000 more waiting list operations carried out last year plus the 142,000 extra emergency cases treated, and half a million more outpatient cases dealt with; and congratulates the staff on providing record results in what remains the fairest and most efficient healthcare system in the world.'. Rather than make a statement on an important matter before the debate, it was agreed with Members of the Opposition Front Bench that I should make it before beginning my speech.

In recent years, the number of cases of meningitis has increased. The increase—

Mr. Simon Hughes (Southwark, North and Bermondsey)

On a point of order, Madam Speaker. Usually, a statement is advertised to the House. If the Secretary of State is to make a statement now, is it appropriate that parties other than the Conservative party were not notified, and should they have been notified?

Madam Speaker

I have no knowledge of who was notified of the statement—I was not notified myself. However, if the Secretary of State wishes to give information to the House, he should be allowed to do so. If he gave the information outside the House, Members of Parliament would be the first to complain.

Mr. Dobson

In recent years, the number of cases of meningitis has increased. The increase has been caused by meningococcal group C infection, which is often associated with outbreaks in schools and colleges. Last year, that group C infection affected around 1,530 people and caused 150 deaths, mainly among children and young people. I am sure that the House will be pleased to learn that a new vaccine against this infection has been developed, carefully tested and shown to be safe and effective. I am glad to be able to announce that it is now expected to become available on the national health service this autumn, a year earlier than was expected.

The vaccine is being developed by three companies, all of which expect to bring forward production of the vaccine. One company, Wyeth, expects to be the first, with supplies coming on stream this autumn. Following discussions I have had with the company, it has taken steps to increase production capacity and is now confident that it can supply substantially more doses by December than it had originally intended, and even more vaccine next year. The two other companies, Chiron Biocine and North American Vaccines, are expected to be able to supply the vaccine early next year. Therefore, providing the suppliers' timetables are kept to and licensing and procurement proceed smoothly, a new immunisation programme in this country should start in October this year and expand as rapidly as the manufacturers can supply more vaccine.

Because the new vaccine is being produced for the first time, there will not be enough to supply everyone from the start, so it will have to be targeted at the babies, children, and young people who are most at risk. It is proposed that, in the first instance, the new vaccine should be made available for: babies when they get their routine diphtheria-tetanus-whooping cough, polio and Hib vaccinations at two, three and four months; children receiving their first measles, mumps and rubella vaccination at around 13 months; children over four months and under one year who will be recalled specially for immunisation; and young people aged 15, 16 and 17. Children over one and under five will be covered in the second phase, and other age groups will follow as stocks of the vaccine become available. Those priorities have been endorsed by the members of the Joint Committee on Vaccination and Immunisation, the National Meningitis Trust and the Meningitis Research Foundation.

For the rest of this year, stocks of the new vaccine will not be large enough or available soon enough to cover young people going to college and university for the first time. However, this group, especially those in halls of residence, has proved to be vulnerable to meningitis C, especially in the first few weeks of their first term. To meet their needs, I have decided that the existing vaccine, which is effective only for about three years, should be made available to any people in that category who want it. It is recommended that they get vaccinated before they go to college or university this autumn. If they need it, they will be able to have access to the new vaccine at a later date.

I am making this announcement today so that the NHS can make the necessary preparations for the new immunisation programme. The chief medical officer, chief nursing officer and chief pharmacist are writing today to all those working in the NHS who will be responsible for implementing the programme. It would, of course, have been better if we could have had sufficient doses of the new vaccine to immunise everyone straight away, but that is simply not possible as this is a new vaccine and stocks are having to be manufactured from scratch.

Meningitis fills parents with fear because it can arrive out of the blue and bring a healthy child to death's door in a few hours. The brand new vaccine will help to reduce the incidence of meningitis but it will not bring it to an end. Sadly, the development of a vaccine to counter the remaining form of meningococcal infection is still some years away. A substantial number of people will contract meningitis even when the full immunisation programme is in place, and some will die from that disease. However, at least we are making a start, and my announcement today should give us a chance of almost halving the number of outbreaks and deaths among the children of this country each winter.

Providing everything proceeds as intended, the NHS will be the first health care system in the world to have the use of this new vaccine. I would like to pay tribute to the hard work of the companies and the staff of my Department, the Public Health Laboratory Service, the National Institute for Biological Standards and Control, the Centre for Applied Microbiology and Research and the Medicines Control Agency for all they have done, and are doing, to expedite the availability of this brand new weapon in the unending fight against illness and death.

Dr. Fox

I am grateful to the Secretary of State for giving way and for giving me notification of this information earlier. When does he intend to move to a universal programme rather than simply a targeted programme? How many people does he think will be involved? Will health authorities receive extra cash allocations to cover this new programme?

Mr. Dobson

There are two points. First, we are utterly dependent on how quickly the three manufacturers can provide sufficient doses of the vaccine. However, I hope that we will have virtually universal coverage by either the spring or summer of next year. Secondly, the programme will be funded centrally and the health authorities will not have to find a penny out of the money that they have been allocated already.

Mr. Simon Hughes

On the substance of his statement, can the Secretary of State tell the House what cost-effectiveness analysis has been conducted of the announcement and the vaccination? Why did he not make a statement in the usual way?

Mr. Dobson

My officials and the health economists have made their assessments. I looked at those assessments and I decided that it was a reasonable proposition. That is my judgment, whatever others may say. I offered to make a statement in the usual manner but the official Opposition asked me to make my statement in the course of my speech, and that is what I have done.

Madam Speaker

As the right hon. Gentleman has made the statement at the beginning of his speech, I will limit questions because I want him to proceed to the general debate and address the Opposition motion. I shall allow a few more interventions.

Mr. Kenneth Clarke (Rushcliffe)

The announcement is obviously welcome. The Secretary of State knows perfectly well that no one in the House will challenge that desirable outcome. However, is it not obvious why he has made this statement today? In line with the press relations machinery of this Government, when Labour is in trouble it finds a piece of readily accessible good news that it believes will divert the reporting. The Secretary of State could have made this statement yesterday or tomorrow. However, he has made it today because he is facing a difficult debate about general health policy and is seeking to divert attention from, among other things, the figures on waiting lists and waiting times about which my hon. Friend the Member for Woodspring (Dr. Fox) has challenged him.

Mr. Dobson

The right hon. and learned Gentleman has obviously tried to raise the tone of the debate.

Mr. Andrew Robathan (Blaby)

Answer the question.

Mr. Dobson

If there was a question. The fact is that we did not get everything nailed down until yesterday. I have a speaking engagement in Liverpool tomorrow and it was necessary to get this information to the national health service as soon as practicable so that it can get on with it.

I think that the Tories should abandon this obsession with spin doctoring. It was alleged in several newspapers and on television and radio by Lord knows who that we had timed the release of information about the people who tried to place a racial block on the use of organs donated from a relative. I was told about the incident and, within an hour, I had issued a denunciation of the practice and called for an inquiry. I did not consult anybody—spin doctors or anyone else. I simply thought that it was right to set the record straight. We are making this information public today because I think that it is the right thing to do.

Madam Speaker

Order. I shall call one more hon. Member, who represents the Ulster Unionist party, to put a question to the Secretary of State on his statement and then I shall expect the Secretary of State and other hon. Members to move on to the general debate on the Opposition motion. I call the hon. Member for Belfast, South (Rev. Martin Smyth).

Rev. Martin Smyth

This is an abstract debate on the national health service, but I believe that the national health service is concrete. I take it that the statement refers not only to England, Wales and Scotland but to all the regions.

Mr. Dobson

I can confirm that the statement is UK-wide, even if the Scottish National party Member who has now departed the Chamber would have wished it not to be so.

On the general debate, the national health service certainly needs improvement, and nobody is complacent about that. We recognise that the NHS needs to change, and we have made a start. Some say that we are going too fast, some say that we are going too slow, and some even manage to make both complaints at the same time.

I have to remind Conservative Members of the state of the health service when we took over. There were record waiting lists, and they were rising faster than ever before. The debts run up by the NHS in the year before we took over amounted to £450 million. The number of nurses in training had been cut. The number of doctors going into general practice had been reduced. The investment in new buildings, new plant and equipment was at its lowest for 10 years.

The system introduced by the right hon. and learned Member for Rushcliffe (Mr. Clarke), who accuses me of politicising a statement on meningitis, had set doctor against doctor and hospital against hospital. The pay system for almost all staff was archaic and inflexible. Expenditure on information technology systems had been a scandal almost from start to finish. There had been no preparation for the millennium. Violence against NHS staff was soaring. We have made a start on changing that.

Despite the increases in the past two months, the waiting lists are 60,000 lower than those that we inherited. Last year, 450,000 extra people from the waiting lists were treated, as well as 142,000 extra emergency cases and more than 500,000 extra out-patients. The debts accrued by the NHS last year totalled £12 million, compared with the £450 million run up in the Tories' last year in office.

We now have the highest number of nurses in training—15,000—for six years. The applicants for places in nurse training have doubled compared with the previous year. There are 481 primary care groups throughout the country, with doctors and nurses in the driving seat. It has been necessary to invest £300 million in dealing with the millennium problem. An extra £21 billion is going to the NHS over the next three years, and £18 billion of that is for England.

This year, £110 million is being invested in bringing every accident and emergency department up to scratch. An extra £350 million is being invested in new equipment, and £100 million is coming from the lottery for equipment to diagnose and deal with cancer. Thirty-seven new hospitals have been given the go-ahead, and 17 of them are already being built. Despite that, public capital is also being increased by 50 per cent. over the next three years.

I do not know what the hon. Member for Woodspring (Dr. Fox) was saying from the Front Bench about overseas doctors but I can tell him that, since we came to power, prejudice and discrimination against overseas doctors in the giving of distinction and merit awards has been stopped. There has been a 50 per cent. increase in the number of such doctors who have received those awards. We owe a great debt to them. The idea that if people do not graduate from medical school, we can expand the number of doctors without getting some from abroad is preposterous, and the hon. Gentleman knows it. He ought not to attack overseas doctors.

Mr. Crispin Blunt (Reigate)

rose—

Mr. Peter Viggers (Gosport)

Will the right hon. Gentleman give way?

Mr. Dobson

No, I shall not because I have to get on.

When Opposition Members talk about the appointment of chairpersons and non-executive directors of boards, I am very proud to stand here and say that for the first time in the history of the health service—and of any public body in this country—50 per cent. of its members are women and 12 per cent. are from black and ethnic minorities. I am proud of that and I am glad that I did it. We have reduced the number of mixed-sex wards. The nurses' pay increase this year was the best for 10 years. Two thirds of qualified nurses are now earning more than £20,000 a year.

Mr. Blunt

Will the right hon. Gentleman give way?

Mr. Dobson

No I shall not.

We are changing the grading system that held down the promotion of nurses. We have introduced nurse consultants so that the top pay for nurses will go up from £27,000 or £28,000 a year to £40,000 a year. As the Prime Minister announced, there is a new and expanded role for nurses, which was welcomed by the Royal College of Nursing, the Royal College of Midwives and Unison but denounced as a gimmick by the Tory Front-Bench team.

We are also trying to ensure better quality across the health service and that we get away from the postcode differences that have developed. With the support of the medical profession, we have set up the National Institute for Clinical Excellence to give authoritative and independent guidance to the health service. We are establishing national service frameworks to lay down what should be provided in the treatment of people with heart disease, old people, mentally ill people and those with diabetes across the country. We are also obliging all trusts to undertake a duty of clinical governance so that, for the first time, instead of just looking at the books, they will have to consider the clinical performance of their units to ensure that they are up to scratch. We are putting in place the Commission for Health Improvement to back them up.

Mr. Viggers

The Secretary of State's amendment says that the Government are modernising every Accident and Emergency Department that needs it". How dare he say that with what in anybody else would be bare-faced cheek when he knows perfectly well that he is closing the accident and emergency unit at the Haslar hospital in my constituency and, despite his bland assurances, making no effort to provide adequate accident and emergency cover for my constituents?

Mr. Dobson

The hon. Gentleman ought to know, for a start, that we have modernised the accident and emergency department at the Portsmouth hospital. The decision to close Haslar hospital was not for me but, as it is a military, naval and Air Force hospital, for the Ministry of Defence. I have said to his constituents—and meant it—that we must ensure that the arrangements implemented following the closure of Haslar meet the full needs of people who live in the area, and I shall ensure that that is done.

Several hon. Members

rose—

Mr. Dobson

No, I shall not give way.

We have also, partly at the behest of Tory Members—that is the truth—tried to ensure that, for the first time, standards are set and met for the provision of cervical and breast cancer screening services, which had been dispensed with under the previous Government. We have made sure that more effort is targeted on improving the health of people in the worst-off areas through investment in health action zones. We have provided an extra £700 million for mental health services over the next three years, largely to be spent on extra beds and new staff. We are already negotiating with consultants about a future consultant's contract, and more people are opting to become general practitioners.

The hon. Member for Woodspring knows that what he was saying about junior doctors is somewhat adjacent to the truth. We agreed with junior doctors much more rigorous standards for judging whether the new deal was being complied with. When we did that, we said that it would make the figures worse, and it has. However, comparing like with like, the number of junior doctors working longer hours has been coming down since we have been in office—and it will continue to come down.

Junior doctors have quite rightly been saying that they are concerned about their hours, their working conditions and the conditions in which they wait to work. We have been having meetings with them to try to improve matters. Of late, their approach at meetings has been to make a very substantial pay demand, and we have had to explain that the pay of junior doctors, like all other doctors, is a matter for the Doctors and Dentists Review Body. We either have review bodies or negotiation; we cannot use the review body decision as a starting point for negotiations. I hope that we can make some reasonable arrangements with junior doctors' representatives but, as the British Medical Association has recently reaffirmed that it wants to continue with the review body, I assume that they do.

Dr. Fox

So when the figures for junior doctors' working hours—published by the Government—show that they are increasing, they are actually decreasing. That is interesting newspeak, even from the Government. However, I wonder whether the Secretary of State would reconsider a figure that he just gave us. He says that the number of doctors entering general practice is increasing. There has actually been an 18 per cent. reduction in the past two years.

Mr. Dobson

Not according to the figures that I have. There is no point in disputing figures over the Dispatch Box; I shall sort this out with the hon. Gentleman later.

We have also made substantial efforts to make working in the national health service safer for all staff. There was a massive increase in the number of people who were assaulted and abused. We have been trying to improve the situation for nurses and ambulance staff—people working in accident and emergency. When I discussed that with people from the BMA, they said that the previous Government had said that nothing could be done about it—it was the sort of society that we live in these days. It may be the sort of society that the Conservatives want to live in, but we are not going to.

We have just completed successful negotiations with representatives of the pharmaceutical companies and brought about a 4.5 per cent. price reduction in the cost of drugs to the national health service, which will save the health service £200 million and has ensured that research-based British companies can continue to be research based.

Mr. Bercow

rose—

Mr. Dobson

We have introduced other new developments. NHS Direct, the 24-hour nurse-led helpline, now covers 40 per cent. of the country and will cover 60 per cent. by December. I assume that that will not be attacked by the Tory Front-Bench team because it was welcomed by them the last time that we announced it. It is working very well.

We are developing a limited number of pilot schemes for walk-in centres in city centres, shopping centres and city-centre hospitals. There has been some criticism of that idea on the grounds that the doctors do not like it, but we invited people to apply to run them, and 99 places in the country applied for the right to operate a walk-in centre. All 99 had to have the agreement of the GP-dominated primary care group in their area, and I am very sorry that I have had to disappoint 80 of them and announce only 19.

Walk-in centres are intended to modernise the provision of care in various areas. We shall consider their impact on other services in the areas, but they are popular with the doctors who have applied.

Mr. Bercow

rose—

Dr. Peter Brand (Isle of Wight)

rose—

Mr. Dobson

I give way to the hon. Member for Isle of Wight (Dr. Brand).

Dr. Brand

Is it not human nature, Mr. Deputy Speaker, that if you are offered a free good in addition to the work that you are already doing, you will say yes? However, that does not square the profession's problems, in that resources are being taken up and top-sliced from the core services of the NHS.

Mr. Dobson

They have not been top-sliced because the resources are taken from the modernisation fund and had not previously been allocated. Dr. James Kingsland, a GP from the Wirral who has been visiting and considering the various applicants, says: It is very much new money available for general practice, to complement the primary care services already in place. It is cash for primary care groups. By the very nature of their applications, they have to be PCG supported. It is a GP-led initiative. He is right, and it is working.

Mr. Bercow

rose—

Mr. Dobson

We are trying—although we fail at times, and we are not making as much progress as we should like—to modernise the national health service. We all know that the modern Tory party wants to undermine and privatise it. We have only to consider the history as it relates to the hon. Gentleman's predecessor, the right hon. Member for Maidstone and The Weald (Miss Widdecombe). As the third shadow Health Secretary since the general election, she advocated substituting private health insurance for large parts of the national health service, and has apparently been promoted.

The right hon. Member who was a deputy leader of the Tory party and who rejected the idea of health insurance as barmy has been sacked. If we look at what the hon. Gentleman who is now the Tories' representative has said in the past, it appears that he, too, has a fixation about shifting to the private funding of health. In 1993, it was reported that he had helped the Association of British Insurers with a document entitled "Transfer of Responsibility from the Public to the Private Sector", which urged an expansion of private medical insurance beyond the current policyholders, through tax incentives to the under-60s or through contracting out certain NHS benefits. That fundamentally undermines the concept of the NHS, but it is apparently the Tories' line.

Every time Conservative Members speak in their constituencies, they demand more money for their bit of the health service, but they do not vote for that in the House. The shadow Chancellor described our plans for spending on the NHS as "reckless", and said that when the Chancellor had been goaded on health and education, he had "gone soft on spending." What we say is decent investment in improving the health service, the Tories regard as reckless, stupid spending.

The NHS is far from perfect; it never will be perfect. It is improving, but it will take us a long time to turn things around. So much of it depends on new additional staff. It takes a long, long time to train a doctor. It takes three years to train a nurse or a midwife. We cannot turn things around in a day, but the NHS is getting better. It is not getting better as quickly as we would like. However, it is getting better, and it will get better still.

4.41 pm

Mr. Simon Hughes (Southwark, North and Bermondsey)

We welcome the debate. We welcome the announcement that, surprisingly, was made at the beginning of it, although it would have been better if the announcement had been made in the usual way. I do not attribute the fault entirely to the Secretary of State, but announcements on important specific matters should be separated from debates on the health service in general. This is a debate about the Government's record after two years in office.

We welcome the fact that the Conservative Opposition have flagged up a series of issues in the health service where the Government's record clearly has not lived up to expectation. Although the Secretary of State made the case that there have been some improvements in the health service—that is unarguable—it was noticeable that, on the assertions and allegations made by the Conservative party, he did not have an answer.

There has been increased waiting time for patients. There has been plummeting morale. There has been a distortion of clinical priorities. There certainly has been increasingly widespread rationing of drugs and treatment. One of the key propositions on which the Government came to office was that there would not be a difference of treatment for patients depending on where they lived. That is not the case now. The situation has not improved under the Government, and we still have postcode rationing, as we did two years ago.

Mr. Bercow

Will the hon. Gentleman give way?

Mr. Hughes

Not yet.

The Government came to office against the background of the public saying, first, that the NHS was the issue that mattered most to them, and secondly, that they wanted the Government to spend more on the NHS—not just more, but more as a share of our national wealth. That has not yet happened. More has been spent, but the Government have not yet made the commitment to spend more as a share of our national wealth.

When will the Government start delivering on the key promises that they made to the electorate two and a quarter years ago? We will save the NHS", they said in their manifesto. Their first promise was 100,000 people off waiting lists". Two and a quarter years later, in England, that figure still has not been achieved.

In its manifesto, the Labour party stated that it commits itself anew to the historic principle: that if you are ill or injured there will be a national health service there to help; and access to it will be based on need and need alone—not on your ability to pay, or on who your GP happens to be or on where you live. What one gets from the NHS still does depend on where one lives, and we want to know when that, too, will change.

The public feel that they have been betrayed or let down on a number of other matters. There are significantly fewer beds—more than 5,000 fewer in the major specialties in England. Nearly 100,000 operations have been cancelled on the day that the operation was booked. Up to April this year, investment was nearly £500 million lower each year than it would have been on the projections of the outgoing Conservative Government. This financial year, NHS trusts and health authorities in England started the year £163 million in debt. We read in the papers yesterday that Wales also now has a £72 million deficit, which means that, on the basis of the current United Kingdom allocation of money, the NHS there may have to close trusts and hospitals.

The Secretary of State has made progress on appointing more women and more members of minority ethnic communities to run health service boards and authorities, but he has not answered the allegation that, during the past two years, he has packed the NHS with more and more of his people. Given the accusations that he and his party levelled at the Tories in office, to increase the number of Labour appointees to NHS trusts' non-executive posts from eight to 226 Labour activists is a complete contradiction. If that is not cronyism, I do not know what the public think it is. Despite the number of women, members of ethnic minority communities and people with disabilities appointed, that record, good as it is, is tarnished by the fact that the Government have insisted on so many people coming from their party.

Some of the stories, apparently true, about the sort of people appointed in the Prime Minister's part of the world, in Sedgefield and round about, who appear to have been appointed simply because they were local party activists, just undermine the credibility of proper management of the NHS.

Mr. Dobson

Has it occurred to the hon. Gentleman that a considerable number of the Labour supporters appointed are women, black and Asian, who therefore make a big contribution to the increase in the number of women, who are up to 50 per cent., of appointees, and the number of black and Asian representatives, who are up to 12 per cent? That is a good thing, and I shall keep on saying that it is a good thing, whatever anybody else says.

Mr. Hughes

I have made it clear to the Secretary of State—I have said it to him privately as well as publicly—that to get a better gender and ethnic balance and a better inclusion of people with disabilities in NHS management is clearly a good thing. But if he is saying that he is willing to appoint those people, particularly or only if they are Labour supporters, that is not a good thing, and the sooner the Government seek an agreement across parties and beyond parties about appointments, rather than consulting and then ignoring what they are told, the better. I have practical experience of a consultation that was not followed, because Labour people were appointed against my advice.

Mr. Bercow

I hope that I do not fatally damage the hon. Gentleman's prospects by telling him what a good speech he is so far making. Given that the Secretary of State referred to the National Institute for Clinical Excellence and to the supply of drugs, does the hon. Gentleman agree that my constituents, Caroline Cripps and Marc Smith, and constituents of other right hon. and hon. Members, who are suffering from multiple sclerosis, are entitled now to ask the Secretary of State exactly how long they are supposed to wait and suffer before NICE issues definitive guidance? Does he further agree that the premise upon which that guidance, when it ultimately emerges, is based, should be that, where it is judged to be clinically appropriate to prescribe beta interferon, it should ordinarily be prescribed?

Mr. Hughes

I understand and accept the general premise of the hon. Gentleman's intervention, and if he bears with me for literally about a minute, he will see that, in my list of specific questions for the Secretary of State, there is one relating exactly to the equality of access to drugs, which was promised in Labour's manifesto when it sought office two years ago.

Lorna Fitzsimons

Will the hon. Gentleman give way?

Mr. Hughes

I will in a moment.

Labour has clearly failed on a final matter: it kept promising us that the famous waiting list targets would be met—not that there should have been such targets in the first place—but that great day has also not yet dawned. There has been not a reduction of 100,000 in the waiting lists—even if that had been the right target—but a considerable increase in the number of people waiting to get on to the waiting list, as the hon. Member for Woodspring (Dr. Fox) said.

I have to say that the recent extraordinary comments of the Prime Minister and the Secretary of State about the attitude of the public service in general have not helped. Only two weeks ago, the Prime Minister told the British Venture Capital Association: You try getting change in the public sector and public services". People in the NHS, who have been subject to change after change after change, did not take that kindly. I should have thought that the Secretary of State, who has traditionally been a good supporter of the public services, would have been well advised not to add fuel to the fire by accusing those in the NHS, and doctors in particular, of failing to keep pace with the expectations of the people". My hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) attended the British Medical Association conference in Belfast and doctors' leaders were clear about the fact that they respond to the Government's requests for change, but they want a bit more support from them and a bit more understanding of their position.

I shall list the questions that the Government must answer after two years in office and at the end of the parliamentary term. The Secretary of State may be being considered for a move in the reshuffle, or he may stay in his current post, so he could usefully give the answers to the Prime Minister as well as to the country and the House.

When will Labour deliver equality of treatment for patients in the NHS, wherever they live? That question was asked by the hon. Member for Buckingham (Mr. Bercow). When will it deliver equality of treatment for NHS staff, wherever they work and whatever their race? When will it deliver a reduction in the time that people have to wait for hospital treatment in the NHS after referral by GPs? When will it deliver its so-called early pledge to cut by 100,000 in England the waiting list for treatment in the NHS? When will it give up prioritising waiting lists over waiting times in the NHS? When will it make sure that we have enough consultants, hospital doctors, GPs, nurses, midwives, dentists and other professionals? What is the time scale? Is it a year, two years or 10 years? We have never been told the date. When will the Labour Government put an end to the reduction in the number of beds in the NHS? When will they reduce their commitment to use private finance for capital building in the NHS? When will they make a commitment to pay for all long-term nursing care in the NHS? That was expected from a Labour Government. Lastly, when will Labour increase the share of our national wealth that it commits itself to spend on the national health, including the NHS? We have never heard a word about that from them.

I do not want to elaborate on my first point, because equality of access has been discussed so often in the House, by my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) among others, that the case has been well made.

However, I shall elaborate on my second point—racial discrimination in the health service. Not many months ago, the House considered the Health Act 1999, and my hon. Friends and I tabled amendments in Committee and on Report that would have ruled out discrimination in the health service. They were rejected by the Government. The Secretary of State subsequently referred to the incident in Sheffield where it appeared that somebody had donated an organ for use on the basis that it could go only to a white person, and that was accepted. When that became public knowledge, the Secretary of State suddenly said, "Perhaps we need a change in the law to outlaw discrimination in the NHS." My hon. Friends and I, with the backing of the Commission for Racial Equality, argued for that some months ago and it would be helpful to know before the end of the debate whether the Secretary of State accepts that that is now the case.

Mr. Dobson

I am advised by our lawyers—the hon. Gentleman can give that whatever weight he likes—that the Race Relations Act 1976 applies in full to the NHS. If it does, why do we need to change that?

Mr. Hughes

I should be happy to debate that with the Secretary of State outside the Chamber, but my advice and understanding, and that of the CRE, is that not all matters relating to employment, which I shall come to, and to treatment, are governed by the 1976 Act. A general duty of non-discrimination would ensure that the Sheffield case did not arise, and would also cover events such as old people being turned down by the health service and discrimination on other grounds.

I have been approached by colleagues in Rochdale—this may interest the hon. Member for Rochdale (Lorna Fitzsimons)—about a severe case of racial discrimination in the health service. On 24 June last year, the Rochdale Healthcare trust was visited by representatives of the Royal College of Physicians, the Royal College of Paediatrics and Child Health and a dean from Manchester university, Professor Hayden, who was acting on behalf of the colleges to examine training in the Rochdale health service. At the end of her examination she said: finally I am disappointed not to find many UK graduates employed in your hospital. I am giving you a clear warning that when I come back in two years' time if this has not changed then I will remove some of the funding for training. That comment caused great distress to people working in the health service in Rochdale, where recruitment is on the basis of application and ability. Since then, the dean has made only a statement that her comments were misunderstood, and not a full apology. There is no confirmation that her comments will not have an adverse impact on the hospital's assessment in the future. I know that the Secretary of State has received a copy of at least some of the correspondence. One of the hon. Lady's predecessors, Sir Cyril Smith, was asked if he could intervene to ensure that we never have such a practice again.

Lorna Fitzsimons

Will the hon. Gentleman give way, as this matter involves my constituency?

Mr. Hughes

Of course, I shall give way in a second.

Will the Secretary of State investigate what happened? Will he ensure that that trust and all others are never again at risk because of the practice of recruiting more overseas graduates?

Given incidents such as those in Rochdale and Sheffield, will he agree to allow the CRE to undertake an investigation into racism in the health service? Will he bring to the House also the result of a further inquiry into how we can hold the royal colleges to account, because they tell the health service what to do with no accountability to Parliament or to the NHS? Some hospitals have been closed because the royal colleges have said that there was no suitable training. It is time that those professional organisations were held democratically accountable, because they have significant authority throughout the country.

Lorna Fitzsimons

I should have liked the courtesy that the hon. Gentleman asked of the Government Front-Bench team. He raised an issue with which I have been dealing. He waded in, I am sure with utter sincerity, but with political opportunism, which I have got to know well locally. If he cares so much about the health service in Rochdale, he should advise his colleagues that, rather than scaring old people during a council by-election by saying that the council was shutting a hospital, they should acknowledge the investment of £28 million in a new hospital, £15 million in a health action zone, and £27 million in new money for new services.

I have taken this case up with the British Medical Association and the Royal College of Surgeons. If the hon. Gentleman had cared to ask me about it, we could have fought together, because I agree with him about the problem of the Royal College of Surgeons and its intervention in the Bury and Rochdale health authority.

Mr. Hughes

The hon. Lady's comments speak for themselves.

Mrs. Virginia Bottomley (South-West Surrey)

Does the hon. Gentleman agree that it is important to distinguish between overseas doctors and UK graduates from black and ethnic minorities? It is completely unacceptable for UK doctors from black and ethnic minorities not to have exactly the same treatment as white UK graduates. There may be issues that affect overseas doctors, whether they are black or white. For those of us who care about race relations in the NHS, it is more helpful if we are clear on precisely what we are talking about. Moreover, as soon as the Overseas Doctors Association changes its name, the better.

Mr. Hughes

The right hon. Lady is right to make the point that there are two different issues. However, it is clear from the correspondence that it is as wrong to discriminate against somebody because they graduated from an overseas university as it is to discriminate on the basis that someone who graduated from a university in this country is a member of an ethnic minority community. The issue—which caused great offence—concerned discrimination, and a suggestion that the Rochdale trust might not be funded if it did not reduce the number of people whom it appointed from overseas universities. That cannot be acceptable. I hope that the Secretary of State will make that clear, and that he will deal with the person who said that that was appropriate policy.

The Government's surprising endorsement of the private finance initiative—contrary to all their arguments when in opposition—is not finding favour either within the NHS or, significantly, outside. It is no good pretending that there is a further £8 million for investment in the NHS when £1.5 million of that is new money and the rest is entirely arrived at by the selling of assets.

A letter that the Secretary of State may have seen—accompanying a BMA press release of 16 July—stated that, in Edinburgh, the Scottish Office had confirmed that the Government had rejected greater bed numbers for the PFI flagship hospital as not affordable. It is entirely on the basis of cost that PFI schemes are now being approved or not. I challenge the Government to make it clear where, if anywhere, a PFI scheme has resulted in more beds and more resources than previously, as opposed—as has happened in every case so far—to fewer beds and fewer resources.

The Liberal Democrats are clear that not just the public demand, but the need of the patients requires that a greater share of our national wealth is dedicated to national health. It is surprising to us that the Labour Government have never made that commitment. They have made it for education, but they have been silent on health. Some of the pressures that the NHS is under, some of the lack of morale among NHS staff and some of the failures set out in the motion could be addressed if the Government were brave enough to say that, to have a decent health service for the next century, rather than funding it just a bit more every year, we have to give it a significant boost in funding, so that we as a country spend on the health service what the country believes that it needs.

We look forward to the Secretary of State saying something like that, but two and a quarter years have passed and nothing has yet come from his lips.

5.2 pm

Mr. David Hinchliffe (Wakefield)

I welcome my right hon. Friend the Secretary of State's announcement on meningitis. As the representative of a constituency where there have been fatalities through this terrible problem, I know that his announcement will be widely welcomed. I know how anxious many parents are in my area and elsewhere about this problem.

I have had some difficulty in understanding the Conservative party's tactics over the past few hours. I was in the Chamber at 2 o'clock this morning on either the eighth or ninth totally pointless Division. I do not understand the purpose of such an exercise, where there is no debate. All that appears to be happening is that we are wasting huge amounts of public money in keeping in this place large numbers of people—the staff—who could be better off at home in their beds, preparing for the following day's work.

I do not understand those tactics, and I do not understand the tactics of the Tory motion which I read at 9.30 am—after half a night's sleep. [HON. MEMBERS: "Ah!"] Thank you for that sympathetic response. In drawing attention to the comparative health policies of the previous Conservative Government and the new Labour Government, the motion draws attention to the paucity of the Conservatives' thinking on health care.

I listened carefully to the Opposition spokesman, the hon. Member for Woodspring (Dr. Fox), who has now left the Chamber. I apologise for referring to him when he is not here, but it is not my fault that he has left the Chamber. He did not propose one policy of any type to deal with the concerns that he expressed. Today's official Opposition motion suggests not one idea of what they would do to address those issues if they were in government.

I was disappointed also with the speech of the hon. Member for Southwark, North and Bermondsey (Mr. Hughes)—for whom I have some respect; he has at least some knowledge of health issues, and some belief in what he says—as he was unable to offer any real policies on what he would do were he Secretary of State for Health.

The official Opposition's motion on health is the thinnest motion that I can remember debating in any of the numerous such debates that I have attended in my mere 13 years in this place. Their motion is petty, superficial and only a token attempt to imply that they have some interest in the concept of collective health care—which they have opposed since voting against establishment of the national health service in 1946.

The issue of collective health care highlights the ideological division between the Conservative party and the rest of the nation—the decent-thinking people who believe in collectivised health care, and who believe that we should have a system ensuring that those who are ill are appropriately cared for by the state.

For the Tories, health is essentially a matter for the individual, and a marketable commodity. I have listened carefully to the debate, to detect whether any contradictions are emerging in the Tories' policy commitments of the past two years on shifting patients into the private sector—which is the one health policy that they have proposed in that time.

Mr. Philip Hammond (Runnymede and Weybridge)

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) has made a very clear commitment that the next Conservative Government will increase, year on year, in real terms, spending on the national health service. That is the clearest possible policy commitment, and the clearest possible indication of the Conservative party's commitment to the NHS.

Mr. Hinchliffe

That does not square with the Tories' attack on the Chancellor of the Exchequer for diverting resources into the national health service. The shadow Chancellor attacked Labour for delivering £21 billion to the NHS.

The hon. Member for Runnymede and Weybridge (Mr. Hammond) has also not dealt with my key point. If he has attended our health debates, he will have heard the various statements that have been made. On a number of occasions in the Chamber, I have debated the private sector issue with the right hon. Member for Maidstone and The Weald (Miss Widdecombe)—who now shadows the Home Secretary—and she has quite categorically stated her belief that, to deal with what she perceives as a crisis in the national health service, we have to make greater use of the private sector and ensure that more NHS patients are sent to the private sector.

The right hon. Member for Maidstone and The Weald has, however, never been able to deal with the rather fundamental point about the source of private sector staff. The hon. Member for Runnymede and Weybridge knows as well as I do that private sector staff come entirely from the national health service—which trains people, many of whom we lose to the private sector. Therefore, if the Tories are pushing staff into the private sector, they are further denuding the NHS of staff. It is also nonsense for the Tories to express concern about junior doctors' hours and consultants' work loads. I should like briefly to deal with the previous Government's record.

Mr. Bercow

Will the hon. Gentleman give way?

Mr. Hinchliffe

No; I have given way once already.

We should consider what the previous Government's 18 years in office meant to people in my constituency and to people across the country. The previous Government introduced the internal market—and I served on the Bill that introduced it. I also remember the House's debates on that Bill. Nevertheless, whatever one's views on the internal market itself, the philosophy underlying it plunged the NHS into cut-throat competition. The idea behind the internal market was to encourage hospitals to compete against hospitals, and doctors against doctors.

The philosophy behind the internal market was fundamentally opposed to that of the national health service—which I had thought that almost everyone believed in. Over the years, even Conservatives in my area—but certainly not the previous Government—subscribed to the NHS philosophy.

On fundholding, I have provided facts, figures, names and addresses of my constituents who had been told that, as they were not patients of general practitioner fundholders, they could not gain access to certain hospital treatments in my area. That is on the record; the names of the people are known. I am not making this up. There was a two-tier system in my area.

Mr. Illsley

The Sheffield hospitals made no bones about it; when the previous Government were in power, they made a public statement that they would not accept patients whose funding might run out as they were not from fundholding practices.

Mr. Hinchliffe

The two-tier system was a fact of life, an inevitable consequence of the move to fundholding. The Conservatives cannot deny that, and they were not unduly worried about it, because in a market there are winners and losers, and they were more concerned about the winners.

My work background was in local authority social services, so it affected me personally when the Tory Government drove a wedge between the national health service and social services. The present Government are trying to repair the damage, and get the two back together.

When my right hon. Friend the Secretary of State made the announcement about the royal commission, the hon. Member for Runnymede and Weybridge, who is on the Opposition Front Bench today, had the brass neck to ask what the Government intended to do about the long-term care crisis. That crisis was entirely created by the Tory Government, who withdrew long-term NHS care from old people and, at the same time, shoved public money into the privatisation of community care. The massive expansion of private care and nursing homes created the crisis.

When I think about the people in my constituency and elsewhere, what particularly concerns me is the fact that that was a gross betrayal of the generation of people who delivered the national health service. They had paid tax and national insurance into the system all their lives, in the belief that when they needed care, they would get it free from the national health service, yet when they did need it, it had gone. They had to pay all over again for what they had already paid for throughout their lives.

For the Tories, public health is a politically inconvenient non-issue. It does their case no good to talk about inequalities in health, because then we get into the real politics and the real reasons why there are winners and losers. From their point of view, it is inconvenient to address such issues.

The Tories also shelved the Black report. One of the most crucial reports on public health this century was allowed to gather dust, although it contained so many significant proposals that could have been acted upon in the early 1980s. Disgracefully, those were ignored.

The Tory party made no attempt to curb smoking, either, because of its relations with the tobacco industry. The tobacco companies provided its poster sites free in 1992, and the right hon. and learned Member for Rushcliffe (Mr. Clarke), a former Secretary of State for Health, is openly connected with the tobacco industry.

The Tories' business connections are important. I know where they are coming from, and I know why they cannot address the problem of smoking—but thousands of people have died needlessly as a result of the 18 years in which they did nothing about people misusing tobacco in a way that affected their health, their children's health and the health of generations to come.

My area was drastically affected by the Tories' economic policies, too. Some of my hon. Friends from nearby areas are here today, and they, too, saw thousands of people kicked out of the coal industry and the industries connected with it. Twenty thousand people were sent down the road in my area, and that was a public health issue, too—one that was totally ignored by the Conservative Government.

In the short time that I have left, I shall contrast that record with what I believe are some of the key achievements of the Labour Government in the past two and a quarter years. There are three key elements that I believe are especially important. First, the abolition of the internal market is perhaps the most important step forward concerning the NHS that the Government have made. It represents a fundamental redirection of the service from competition back to co-operation, and to people working together to deliver a service that provides the best possible care for patients. The move from fundholding practices to primary care groups has put primary care back in the front line, where Nye Bevan envisaged it in the 1940s.

I welcome the idea of walk-in centres, especially as one of the first 19 of them is in Wakefield. I realise that there are debates about whether those centres represent an appropriate way forward, but there will be monitoring of their success or otherwise. The centre in Wakefield is targeted towards certain groups, such as middle-aged men, who tend not to go to see their doctors, and I welcome the accessibility that that will offer such people.

I also especially welcome the reacquaintance of the national health service with social services. The two disciplines are shaking hands again in a way that did not happen under the Tories. The winter pressures initiative was a great success, on which I hope that the Government will build. My hon. Friend the Minister of State knows that I favour going a good deal further, but I welcome the steps taken so far, and especially the public health White Paper that tackles health inequalities.

I also welcome the commitment of various Departments to the assessment of the health implications of Government policies. That makes a crucial connection between health and wider economic and industrial policies. The previous Government gave no thought to that at all.

The motion before the House today shows that the Conservatives have given up on health as an issue. Neither in the motion nor in the opening speech have they offered any concrete proposals. The warning in the Maples memorandum to keep out of health appears to hold sway in the Conservative party.

Dr. Howard Stoate (Dartford)

I take issue with my hon. Friend about the Opposition's tactics. I disagree with his contention that they have no tactics; their aim is to frighten people. Talking down the health service by saying how much worse it is becoming brings down the morale of doctors and nurses, and diverts attention from the good work that those people do. The result is lower morale and frightened people believing that the service is worse than it really is. As a doctor in the health service, I do not recognise the description of it given by Conservative Members.

Mr. Hinchliffe

My hon. Friend makes a valid point. People who are frightened of the health service will go to the private sector, which is what the Tories want.

Mr. Bercow

Will the hon. Gentleman give way?

Mr. Hinchliffe

No, I have already spoken for longer than I intended.

Perhaps Conservative Members might care to look at the report about private medical care by the Select Committee on Health, which will be published tomorrow. They want to push people into the private sector, but I hope that they will draw some conclusions from the report's investigations.

Mr. Bercow

Will the hon. Gentleman give way on that point?

Mr. Hinchliffe

No, I said that I intended to conclude.

The Tories have given up on health. I never thought that I would miss their previous spokesman, the right hon. Member for Maidstone and The Weald, but I do. What she lacked in knowledge of the health service she made up for in bluster when she banged around at the Dispatch Box. I miss her already, and this is only the first debate since her departure. She was good entertainment, and livened up debates such as this, even if there was not a lot of content in what she said.

I know that many issues remain to be resolved, and that many challenges remain for the Government to deal with. However, I believe that the Government have started to establish some firm foundations and are addressing the fundamental problems. Whatever happens in next week's reshuffle, I think that the team leading the Department has made a pretty good start in the past two years. I am sure that we can build on that in the years to come.

5.18 pm

Mr. Kenneth Clarke (Rushcliffe)

The hon. Member for Wakefield (Mr. Hinchliffe) has followed the pattern of many Labour Members by devoting most of his contribution to a speech that he could have made at the last general election. In the two years since then, I have debated most of the matters that he raised, so I shall not go over them all again.

The hon. Gentleman went back as far as the early 1980s, when he referred to the difference of opinion about the Black committee report. The Labour party turned to the left at that time, and it has accused Conservative Members of wishing to privatise the national health service ever since. That accusation often dominated the debate, and it is still being used today, by the hon. Gentleman and by the Secretary of State. However, the record over more than a decade of the previous Conservative Government shows that we had no such intention.

We have no such intention now, and my own commitment to the national health service is beyond doubt. The debate should be about making the health service better, rather than about exchanging empty slogans.

Mr. Hinchliffe

If what the right hon. and learned Gentleman says is true, what was the purpose of giving financial incentives to elderly people to insure themselves for private medical care? Was it not the Tory party's intention to move towards private medical care?

Mr. Clarke

Many people in private insurance found that, when they reached an age at which they were likely to make a demand on that insurance, there was a risk that the premiums would rise. The aim of the incentive was to ensure that those who chose private insurance when they were of working age would not have to give it up when they were most likely to make a claim. That perfectly defensible policy reduced the demands on the national health service. We otherwise concentrated on improving the national health service—paid for out of general taxation and free at the point of treatment—and I remain committed to improving that service.

The Secretary of State also devoted much of his time to his old election speech. I shall not go over all that he said, but I will attack his lack of policies. I wish the Secretary of State no personal ill will as he and I get on well and he has always been amiable and straightforward in our countless debates on policy on many subjects. I understand his much-publicised desire not to drink from the poisoned chalice by becoming Labour's candidate for mayor of London. But if he is moved, I shall not mind; as an Opposition Back Bencher, I am indifferent to who the Secretary of State is. What matters is that he or she has a coherent policy for a vital service. I have criticised the Secretary of State for having no such overall strategy, and he has merely reinforced that criticism today.

The Secretary of State has made a welcome statement on meningitis vaccines, but I have previously criticised the Government, and will do so again, for putting presentation where strategy should be. A stream of press releases and initiatives flows towards us. Often, the initiatives have already been reannounced, but they have to be reannounced yet again. Many are entirely beside the point when placed against the day-to-day problems confronting those responsible for delivering health care on the ground.

In the most striking recent example, the Secretary of State, as usual when he is under pressure for failing to deliver what he promised at the general election, grabbed for the headlines. He published targets for health standards well into the next century. I do not want to be accused of being against his worthy objectives, which included careful calculations to show that many lives would be saved if the targets were ever delivered. However, he produced not a scintilla of evidence of anything new being done to deliver them. He offered us, instead of policy today, desirable ambitions that he said would be delivered in a decade or more, long after the Government have gone. All that was intended to divert attention from pressing problems now all over the country.

Today's statement was welcome, but the Government's advisers ought to raise the Secretary of State's standards. On a bad news day, his diversion of attention was blatant. He began with a worthwhile statement on meningitis protection, but was unable to answer our complaints and allegations about the state of the NHS. In addition to his usual election address on the deficiencies of the Conservative party's performance on the health service, he reminded me of the Wilsonian speech-making process of using a stream of statistics to hold together the best bits of the press releases, while coming to no particular conclusion on the future.

I congratulate the Conservative Front Bench team on raising this debate, because the Government are failing to deliver on the expectations that they raised by setting specific targets—some of them unwise—at the last election. Service to our constituents is deteriorating, and the volume of complaints about the inability of the NHS to meet its obligations is growing.

Dr. Stoate

I entirely agree with the right hon. and learned Gentleman on one point. We need debates of substance on matters of policy. Why, then, when this should be an adult, grown-up debate about the running of the health service, is there no shred of policy in the Conservative motion? I should welcome a debate on policy, but there is none before us. The Conservatives offer only a stream of criticisms and no suggestions on how to improve the health service.

Mr. Clarke

I promise the hon. Gentleman that, by the conclusion of my speech, I shall be giving welcome advice to the Secretary of State and making suggestions on how he can move from here to make worthwhile progress towards the ambitions that he holds out for us as targets for the next century. He will not attain them if he continues to cause the damage to the service that he has in two years so far.

I have spoken in health debates before because I am so concerned about the health service. It is one of the weakest areas of performance by the Government. I could choose many others, but with the health service, they are at the greatest risk of getting into more and more political trouble as reality confronts their presentation of what they are doing.

I shall begin by briefly putting points that I have made before about why the Government are getting it so wrong and why we are worried about a crisis in the health service that appears to be looming even in the summer, when demands are not the greatest. I most fear a winter crisis after our experience of last winter. There are some clear reasons why the Government have got themselves into this position.

First, the Government have got the money for the NHS wrong. I am the first to admit that the problem of the health service is not only money. I often said that to Opposition spokesmen when I was in government myself. However, the Labour Government made a serious mistake in the first two years by imposing on the NHS two of the stiffest years that it has ever had. They used to justify that with the misleading claim that they were imposing Conservative spending plans. They know perfectly well that that is not sustainable. We never stuck to the second and third-year figures in our Red Books for the health service. We always had annual spending rounds, and we revised the spending targets in the light of the experience of the previous year. Everyone who works in the health service knows that it is a long time since it has had two such tough years.

As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) rightly said, the amount of debt being incurred throughout the service is enormous. All the great claims for how well the service is going sit ill alongside the serious financial crisis that rising demand and rising expectations have forced on health authorities, which have had two very severe years. As, to be fair, the Liberals warned us that they would, the Government hope that, in the run-up to the next election, they will be able to put more money into the health service to raise the feelgood factor in the next three years.

The Government have found a misleading and original way of presenting wholly unexceptional figures for those next three years. They are going back to the normal increases in spending roughly attained for most of the past 10 or 15 years. Those increases will not be good enough. The Government have locked themselves in for three years. They have said that they will not reopen the figures or review them in the light of each year's experience. I shall be surprised if they manage to stick to that.

The only good claim that the Government can make on resources is that they have a massive hospital-building programme. I cannot forbear to point out that that is entirely the result of the flow-through from the private finance initiative, which we initiated. The Labour Government inherited a great flow of schemes. The Labour party slowed up progress when we were in office, because its then spokesman kept opposing the PFI and saying that a Labour Government would scrap it, which made it more difficult to conclude the deals. I wish the hospital-building programme well. It is the one piece of good news on resources that the health service has.

To move on to policy, the Government are not distributing money properly throughout the service across the country. Staff, patients and the public read about the figures, but they know perfectly well that they have not got the money in local budgets. A great deal is being held back centrally for presentational purposes. The modernisation fund will be used to fund today's announcement. It is just one little pot of money kept safely under the Secretary of State's lock and key in London to feed the flow of popular announcements over the next three years. The one that we had today was, I suspect, fairly modest in cost and was a perfectly sensible choice of priorities. However, in some initiatives, the Government are obviously pursuing the presentational impact of going for some spectacular area for which the Prime Minister or the Secretary of State can announce that money is now available.

Meanwhile, at local level, people do not have at their disposal to tackle priorities at their discretion the money that they are constantly described as having. Their priorities are being distorted, for example, by the meaningless waiting list targets, which are not being achieved and should never have been set in the first place. Cutting waiting lists is not the best objective to set the health service. In addition, ever-increasing bureaucracy and strangling of local initiative will inhibit the ability of people to deliver the service. That is my indictment of where we are headed and of why things are going wrong. We have been short of money; now we are not distributing it properly and we are not allowing people to use it properly on local priorities. That is evident everywhere and the problem will get worse.

Both sides of the House are committed to the NHS, but when we come to defend it, we discover that it is a hard taskmaster; it requires especially high competence, a rigorous choice of priorities and absolute clarity about what is at the disposal of the people who have to make decisions at the sharp end. Demand always rises inexorably, and has itself to be addressed by those responsible for the health service. The choice of priorities should be clinical and never political; it should certainly never be purely presentational.

The Secretary of State is taking some curious steps. Comments have already been made about his appointments and the right hon. Gentleman gave a curious and slightly tangential explanation. I realise that he is no longer in the Chamber, but I must make it clear that I have no personal complaint to make against him on appointments. I recommended one appointment, which the Secretary of State made—despite the fact that I made it clear that the person was a supporter not of the Labour party, but of the Conservative party.

Apart from the political complexion of the appointments, the Secretary of State does not satisfy me that he appoints on merit, or for the special qualities required for the huge, demanding and stressful task of managing a health authority or an NHS trust. He misunderstands the nature of the appointments that he makes. When I was Secretary of State for Health, I did not make political appointments. I had rows with some of my Back-Bench Members because I refused to make the political appointments that they wanted. I appointed, or re-appointed, at least two ex-Labour Members of Parliament. I might even have appointed people who were Members of Parliament at the time, if they had had the time to combine the job—it is a pretty full-time one—with being a Member of Parliament.

However, I did appoint a much higher proportion of business men; that got me accused of political bias. I appointed professional people and people with managerial experience of running a large organisation that posed difficult challenges outside. It was said that many of those people were Tories. Indeed, in the good days for our party, it was probably true that a large number of business men were Tories, but that was not the reason for their appointment. It is no good removing people from NHS posts, as the Secretary of State does, because they are business men and because the quota of business men is too large.

Of course, people with professional, managerial and other skills can be found in local government, but it is a mistake to believe that one should appoint to those key management tasks a whole lot of elected, local representatives of one's party—elected for their democratic and political skills. The appointments are much more akin to non-executive appointments to large, complex organisations; people are needed who have the substance to sit alongside the executives, and who can share the responsibility for multi-million budgets and for agonising ethical and priority choices. They have to hold the executives to account and assist them in discharging their duties. Those huge lists of local authority or other Labour party activists and worthies completely miss the point.

Mr. Simon Hughes

It may be easier for the right hon. and learned Gentleman to answer my question now that he is in opposition than it would have been when he was in office. Does he agree that it is now sensible that we should move away from such appointments being entirely the responsibility of the Secretary of State of the day? They should be dealt with by a cross-party or all-party process and should be much less political appointments—as Neill has recommended for other public offices.

Mr. Clarke

I am a straightforward chap and I think that it is a pity that Secretaries of State cannot handle those matters. I fear that appointment-making will be taken over by quangos of the great and the good. I am not sure whether all the rules that have been introduced on public appointments have improved the quality of those appointments—all that results is a great paper chase and some curious appraisal methods. With great respect to the officials, more people tend to be appointed whom the officials know and less people whom the Ministers know. That is not an automatic advance. If it is any consolation to the hon. Member for Southwark, North and Bermondsey, when I was at the Home Office, I once made a senior appointment of a Social Democrat who had lost his seat. It should be possible to have clear guidance and the Secretary of State should be held to account. We try to hold him to account, but he offers us a rather unconvincing explanation of the ridiculous total of Labour party activists that he has appointed all over the place.

Even more serious are the bureaucracy, the constraints and the changes that are being imposed on the ground, largely to satisfy the Government's claims that they are reversing the Conservative reforms. I believe that those changes will inhibit the delivery of the service, and the aspect about which I feel most strongly is fundholding. I totally reject the slogan used by the hon. Member for Wakefield that the NHS was made a two-tier service. The whole idea of fundholding was to give incentives to GPs, who act as gatekeepers to the service, to raise the quality of service that they provide to their patients. We discovered that some could do that better than others, but it is no good turning around and saying that the whole system is unfair because some people cannot manage it and make a mess of it, so everything has to return to the level it was before.

I come now to what I trust will be the most eloquent part of my speech, in which I quote a letter I received from a doctor. The letter was entirely unsolicited, although I have expressed strong views on fundholding. I shall not name the doctor, who is a GP in my constituency; I have no idea what his political allegiance is. By chance, he summed up in his letter my fears about fundholding. He writes: It is clear that the end of fundholding means that our patients must return to the unacceptably, and in my view, dangerously long waiting times for both inpatient and outpatient appointments. So much for the 'levelling up' process proposed by the government. In addition to the above concerns, it is not at all clear that the Practice based services such as Physiotherapy, counselling and venepuncturist will be available in the future. Despite strenuous efforts on our part, Nottingham Health can not or will not give us any idea what the future holds for these services. I suspect that through a process of vacillation and procrastination they will wither on the vine … The innovation and local flexibility that fundholding brought to General Practice is being stifled by the plethora of administrative structures, PCGs, TCPs, Trusts etc. The only result of all this reorganisation has been to introduce yet more bureaucratic layers, costing money which could be available for patient care. You might be interested to discover that the approximate cost of each PCG"— primary care group— of which there are six in Nottingham, is £250,000—not a penny of which has been spent on patient care—and the complaint was that fundholding was expensive! I could go on and give other details of the threats to his practice that that doctor fears. Almost every doctor in my constituency was in a fundholding practice by the time the Conservatives left office. Many of them fought the system fiercely when it was first proposed, but discovered the benefits of it and now regret its loss.

One of the great strengths of the NHS is the primary care service, provided by the family doctor who knows at first hand the needs of his patients. The duty of the family doctor is to act as a gatekeeper to access to NHS services, such as hospital care and community care services in his locality, and to get his patients the best possible access for the public money available for their care. That is being threatened by the crisis in local services. I could give a plethora of examples from the rising number of submissions made to me—that the number is rising may be chance, but I think not—of people whom the service fails when they find they want it.

The hospital service is also breaking down. The waiting list initiative is being used shamelessly to distort the length of waiting lists. People are removed from waiting lists for reasons that are administrative and have nothing to do with their clinical need. I have examples of people who need a hip replacement being told that they will have to wait 16 months before they can have a first interview with a consultant, because they only go on to the waiting list figures after the first interview and their waiting time thereafter is thus shortened. I have also found that our health authority has stopped allowing GPs to refer out of area because waiting times are shorter elsewhere, which is one of the flexibilities that the previous system permitted. All that tells of a steady deterioration in what can be done on the ground, and the prospect of a stream of public announcements and initiatives is no substitute.

Dr. Stoate

Will the right hon. and learned Gentleman give way?

Mr. Clarke

No, because I shall answer the point the hon. Gentleman made about what should now be done.

Fortunately, the Government have not reversed the previous NHS reforms. They have kept the purchaser-provider divide. The NHS now has management information that was not at the disposal of anyone before the reforms were made. I used to compare the old unreformed national health service with the Indian state railways: no one was apparently in charge of anything and the system worked only because everyone knew that they had to do roughly what they had done the year before, while hoping that they did not run out of money before the year's end. We now have an altogether better system which is capable of being controlled.

We must release from the centre the great bulk of unallocated money and stop introducing central initiatives. The walk-in health centres sound like a good idea—although they will probably stimulate extra demand, which is a great misfortune. However, they are not a first priority when we consider the strains on the service and they run the risk of diverting resources from other areas. Local priorities will differ somewhat from place to place; that is why we have a postal list variation. Sometimes variations are inevitable and sometimes they should be addressed—especially when big items, such as beta interferon treatment for multiple sclerosis, are involved. People should be allowed to say that, because waiting times are quite good in their region, they want to tackle other areas of the health service.

Money should be distributed and responsibility should be returned to the authorities, the trusts, the doctors in the GP practices, the senior clinicians in the hospitals and trusts and the community services. Health policy must be redrawn on the basis that responsibility for the day-to-day handling of health service demands should be delegated as far as possible to those on the front line in the local hospitals and GP practices. The Secretary of State's job is to hold local service providers accountable centrally for their performance and to ensure that he has in place people who are competent to use the millions of pounds at their disposal for the best purposes.

There is no thread of policy of that kind running through the Government's activities. The Secretary of State delivered a worthwhile statement on meningitis today and, in a fortnight's time, there will be another statement. By autumn, the press will happily report on its front pages stories that we have heard before. I am sure that I have heard the nurse consultant salaries announcement several times—with slight alterations on each occasion. Statements are no substitute for guiding the health service.

It is foolish to believe that increased spending will solve all the problems. The Government must conduct an annual spending review. It is no good accusing the Opposition of attacking health spending. The Government have been far too generous across the field in Whitehall, but I have never heard anyone attack the Government's health spending. My guess is that, despite what they say, the Government will have to allocate more money to health next year. They should face up to their responsibilities, conduct a proper spending review and save money elsewhere in government in order to afford increased health expenditure.

At present, we have drift and no policy. We are halfway through this Parliament and the problems are piling up—and they threaten to get worse, winter by winter. I have listened to this debate and I still have no sense of the Government's direction. The Labour party is at home and content fighting the last election, but it is totally out of its depth when it comes to taking decisions about the most demanding public service of all.

5.43 pm

Mr. Eric Illsley (Barnsley, Central)

I welcome the Secretary of State's statement about meningitis. I, too, would have liked a separate statement about that issue as I wanted to question my right hon. Friend about the age ranges for which the vaccine will be available. When my hon. Friend the Minister of State winds up the debate, perhaps he will confirm whether the vaccine will be made available to students in halls of residence throughout the country where meningitis has been a problem.

I agreed wholeheartedly with the comments of my hon. Friend the Member for Wakefield (Mr. Hinchliffe)— except his remarks about the right hon. Member for Maidstone and The Weald (Miss Widdecombe). I agreed with my hon. Friend's views about policy, so I shall confine my remarks mainly to constituency points.

Before I do so, however, I want to take issue with the right hon. and learned Member for Rushcliffe (Mr. Clarke), who refused to accept that the introduction of fundholding resulted in a two-tier system. A few years ago, under the previous Government, the Central Sheffield University Hospitals NHS trust told all GPs in the South Yorkshire area, "We shall not accept any patients who are not from fundholding practices." When I took that up with the trust, it said that the reason for its decision was that fundholding practices' patients came with the money up front, whereas health authority patients did not, and the trust's perilous state at the time—it was, among other things, 9 per cent. over budget—meant that it could not afford to take anyone who did not come with the money in their hand, as it were.

Before I move on to my constituency points, I want also to deal with rationing, which is mentioned in the Opposition motion. As other hon. Members have pointed out, that motion, which claims that the system is deteriorating, is remarkably poor. Rationing existed under the previous Government to a large degree, but previous Secretaries of State refused to admit that.

Mr. Hammond

Does the hon. Gentleman believe that rationing exists under the present Government?

Mr. Illsley

I believe that rationing has existed in the national health service since it was formed. It is obvious that if there is an increasing demand for services and an increasing number of people want access to the system, the strains on the system will lead to some form of rationing. I disagree with the Opposition's accusation that we refuse to accept that rationing is happening. In government, they refused to accept that there was rationing and simply turned their back on the question.

Consultants in my area had to hope that GPs would prescribe to their patients the drugs that they wanted to prescribe because hospital trusts would not allow consultants to prescribe those drugs from the hospital's budget. I can quote chapter and verse on that matter because for many years my daughter was prescribed an expensive drug simply because we have a good, sympathetic general practitioner.

Some of the comments of Conservative Members about bureaucracy beggar belief. The previous Government introduced bureaucracy into the national health service by increasing management to the point where a previous Secretary of State had to remove 3 per cent. of the management staff who had been introduced because they cost too much.

There have been improvements in the national health service under this Government. For a start, there is the extra funding that is mentioned in the Prime Minister's amendment. That is a clear example of Labour's commitment to the NHS.

On funding, Barnsley health authority in my area has traditionally been the lowest-funded health authority in the country. We have been at the bottom of the list for a long time. Similarly, we were at the bottom of the list for the revenue support grant. When we queried our status with the previous Government, we received the scientific response, "Someone has to be at the bottom of the list, so why can't it be you?" There was no explanation of why the funding formula always discriminated against us when we had, and still have, some of the worst health indicators in the country.

I am pleased to say that under this Government my health authority received a funding increase of 7.85 per cent. this year, which is one of the highest increases for any health authority. That is very welcome. However, we still have considerable problems, one or two of which I shall outline, and we are still one of the lowest-funded health authorities.

Some colleagues and I recently attended a meeting with the Trent area health authorities and were shown a presentation in which almost every slide or indicator from the Trent region placed my health authority in the worst position and revealed problems with, among other things, coronary care and so on.

Mr. Jeff Ennis (Barnsley, East and Mexborough)

Mortality rates.

Mr. Illsley

I shall deal with those in a moment.

Every indicator that is highlighted by health authorities in the Trent region points to our authority being the worst, yet our funding does not allow us to tackle the problems.

Traditionally, my area has high levels of disability. It is a former coal mining area—sadly, the previous Government decided to close the mines—and we have a legacy of problems from such heavy industry. There is a high incidence of disability, coronary disease, stroke and cancer, most of which relate to poor life style, diet, and so forth as a result of living in a poor and economically disadvantaged area. This Government have recognised that: they have introduced health action zones and I am pleased to say that South Yorkshire is one such zone. The incidence of heart disease and stroke in particular will be dealt with, I hope, and we will see an improvement.

The standard mortality ratio in the Barnsley health authority area is the worst in the country. Apart from the incidence of heart disease, stroke and so on, I am not sure why, but it is a cause for concern. When the figure is broken down by ward, the difference between the highest and lowest is very small. In other words, no area covered by Barnsley health authority is good or bad; the figure is simply bad throughout. That needs to be tackled. I hope that the regional health authority and my hon. Friend the Minister will consider the matter for the future because in an area that has a history of heavy industry and which wants to regenerate and improve itself economically, such figures are not conducive to people settling.

Another recent indicator that caused concern is that for the prescription of anti-depressants, where again—and I am not sure why—our area is the worst in the country. I do not know whether it is simply a question of GPs prescribing such drugs to get people out of their surgeries, but it should be addressed. I was encouraged recently to hear that the new GP-led primary care group has appointed a GP from within the group to tackle the issue among GPs themselves. That GP can go to the worst offenders and find out why they are prescribing so many anti-depressants and whether their practices—either previous fundholding or single-handed GP practices—are up to scratch. The history of prescribing in my area may not be as good as it should be. Now that we have a PCG, we are able to address that.

For some reason, the highest number of deaths—albeit a low number—from breast cancer occurs in my area. Neither the health authority nor Trent executive region can identify the reason why—nobody knows. Some time ago, I went to the opening of the breast cancer unit in Barnsley district general hospital. It is a superb facility—nicely decorated and situated, and established to make patients feel comfortable and to encourage them to come forward with breast cancer problems and related issues. The unit is excellent, but no one can explain why we have the highest rate of deaths from breast cancer. Nobody has been able to identify whether it is because people are not coming forward early enough or at all.

There is a shortage of GPs in our area. Several are due to retire in the not-too-distant future, but we are not attracting people to replace them, so we may soon have a crisis in such provision. Also, for some reason, we have a large number of single-handed general practices. In fact, the primary care group GP who represents them is responsible for 148,000 patients in the Barnsley area, which appears to be a very high number. Perhaps that too ought to be addressed.

In Barnsley, waiting lists for two types of treatment are far too long. People must wait three years to see a consultant orthodontist. All concerned have acknowledged that, but no one appears to be doing anything about it. I would welcome the comments of my hon. Friend the Minister on whether the matter can be addressed.

Second only to one or two areas in the north-east and Northern Ireland, Barnsley has the highest rate of coronary heart disease in the country, yet patients must wait up to nine months for an angiogram. In one case, which was referred to me recently and is a cause for concern, a man aged 38 was required to wait nine months. He decided to obtain the angiogram privately, at quite some cost, only to find that he needed quadruple heart bypass surgery. He is fearful that, had he not taken the option of private treatment, he might not still be alive.

I welcome the private finance initiative to build new hospitals. The right hon. and learned Member for Rushcliffe referred to the PFI hospital programme, which he apparently started but never got off the ground—he never managed to get the buildings up and running. The PFI in Barnsley is very small: about £1 million to refurbish hospital kitchens. However, the privatisation of all kitchen area staff and of housekeeping on the wards appears to be coming in on the back of it, to the point where the only health service staff on the wards of Barnsley district general hospital will be nurses, and everyone else—from the bed to the door—will be contracted in from private companies. That is a great cause for concern.

I welcome the Government's amendment and totally oppose the Opposition motion. I welcome all the initiatives that my right hon. Friend the Secretary of State is taking and hope that some of the points that I have raised about my constituency will be taken on board.

Several hon. Members

rose—

Mr. Deputy Speaker (Mr. Michael Lord)

Order. Before I call the next speaker, I must inform the House that many hon. Members are still seeking to catch my eye. Unless speeches are considerably shorter, several of them will be disappointed.

5.58 pm

Mrs. Marion Roe (Broxbourne)

I congratulate the Secretary of State on his announcement concerning meningitis, which is very good news. I congratulate all those associated with the initiative.

It is with a sense of enormous sadness that I have watched the decline in the standards of health care provision in Britain since the Labour Government and the Secretary of State took control in 1997. I believe in a national health service and in the magnificent work of our doctors, nurses and other health professionals in the face of huge difficulties that have been generated by this Labour Government's policies.

My principal interest is in primary care. I have watched with pride over 14 years the innovative developments in practices in my constituency which have improved the quality and efficiency of their services.

I fully endorse the points that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) made about fundholding. I watched with pleasure as clinics were established by fundholders in local surgeries to provide convenient local and cost-effective care for the local population. They developed day-surgery clinics, cutting waiting times for surgical procedures. They employed medical professionals such as counsellors to reduce the demands on the mental health services. Since 1997, I have seen those clinics systematically destroyed as a result of the Government's reforms.

The Government seem to spurn innovation and entrepreneurialism. They seem to be working to the lowest common denominator in medicine. They fail to realise that all developments in medicine have always depended on the introduction of ideas in individual pioneering units, rolled out to all for the greater good. The current primary care reforms, corralling and coercing doctors into arbitrary groups and forcing them to work to confusing agendas in disparate environments, deride and destroy the progress that Conservative Governments for so long fostered and nurtured. Those groups, often working to impossibly tight budgets, are being forced to close those clinics and services as a niggardly cost-cutting exercise. The result is less good, less convenient services.

The doctors are being forced to act as Government hit-men, rationing services while the Secretary of State denies that rationing even exists. Indeed, he is setting up the National Institute for Clinical Excellence to intervene in the clinical care provided by doctors by imposing dubious guidelines and applying professional and financial pressures to force the withholding of some types of care. The Secretary of State has certainly caused chaos with Viagra, leaving practitioners unsure how to manage the often serious symptoms for which it is available.

The service will deteriorate further as other new drugs, possibly with life-saving actions, are allocated to patients arbitrarily by a Minister who seems more interested in named diseases and financial constraints than in the distress and morbidity resulting from the illnesses from which patients suffer.

I watch with sorrow as the primary care groups take clinicians out of their surgeries to try to manage the unmanageable. Half a million consultations a month are stolen from the system by their absence to attend committees. Half a million patients a month are deprived of their own doctor and are forced either to wait or to obtain medical advice from other practitioners in whom they may not have as much confidence.

I watch with sorrow as primary care is fragmented by this gung-ho Government, who are introducing NHS Direct and walk-in centres without proper evaluation, putting dogmatism before realism. Why can the royal colleges, the British Medical Association and the profession as a whole all see what the Government fail to see—that these new and gimmicky services will fuel demand, diluting care and consuming enormous financial resources? Worse, to use the words of Dr. John Chisholm, the BMA's general practice committee chairman, the Government could casually destroy or weaken our model of general practice.

Dr. Brand

We may be getting slightly carried away by dogma. Does the hon. Lady accept that single-practice fundholding was extremely costly on doctors' time, as they had to negotiate with every clinical department of every hospital with which they negotiated? Does she agree that the setting up of consortiums of fundholders was a great improvement? There is no reason why primary care groups cannot carry forward that effectiveness. It is up to the ex-fundholders to get stuck in to the new system and make it work instead of slagging it off.

Mrs. Roe

I take the hon. Gentleman's point, but the doctors to whom I have spoken feel that the freedom and flexibility that they had as fundholders gave a much better opportunity for appropriate patient care and certainly provided the adequate service that they felt was important within the national health service.

I am saddened to see the British Medical Association so concerned by the Labour Government's changes. Last week in Belfast, Dr. Ian Bogle, BMA council chairman, made an unprecedented attack on the Prime Minister. He pointed out that morale in the health service had never been so low. He offered mock congratulations to the Prime Minister on managing to alienate the whole medical profession. He attacked the Prime Minister's personal style of "spin and grin".

In my constituency, I have never had so many complaints. It is surrounded by deterioration in local hospital services. My constituents have access to three hospitals—the Chase Farm hospital in Enfield to the south, the Queen Elizabeth II hospital in Welwyn Garden City to the west and the Princess Alexandra hospital in Harlow to the east. All are faced with downgrading, closures and service reductions born out of financial stringencies and staff shortages. Up to 50 beds will go at the Princess Alexandra; the Queen Elizabeth II faces a merger with the Lister hospital at Stevenage with the loss of some of its key services; and the Chase Farm hospital has already been merged with Barnet general and, I believe, now faces a declining future.

Many of my constituents are infuriated by a Government who claim to be bountiful while cutting and cutting service after service. In the past 24 hours, I have received several tragic letters from constituents. One was about a frail, elderly and sick lady suffering an appallingly long wait in hospital with nursing and medical shortages, defective equipment and not even any refreshments.

I am hugely concerned about the future security of my local breast disease service, threatened with relocation in an inappropriate merger with another hospital.

Another constituent, a frail, elderly gentleman, experienced a five-and-a-half hour wait for an ambulance to take him home, resulting in his not arriving until late at night, long after his carer had left. If it had not been for the good will of the carer, who returned to help him to bed, he might have had to face a night in his wheelchair.

The Government have ridden roughshod over the health professions, imposing change of dubious benefit and doubtful efficacy. The real success, the jewel in the crown, are the health professionals, who have risen to meet this folly with dedication and vigour, challenging the steady deterioration in service with ever more commitment in time and energy.

I do not believe that this can go on. The Government must realise that they cannot expect dedicated health professionals to bail out unworkable and nonsensical policies. They must remove the coercion to join primary care groups. If they are so good, why are they compulsory? They should reconsider the roll-out of NHS Direct and walk-in centres until proper evaluations have been carried out and the results have been submitted to public scrutiny, and they must realise that GPs cannot subsidise in time and money the management of our vital service. Only then will our NHS start to recover from the ill-conceived and chaotic policies of this Labour Government.

6.8 pm

Dr. Howard Stoate (Dartford)

No one seems to have a good word to say for the national health service these days, so it behoves me, as one of the very few medically qualified Members of the House who still does a certain amount of practice, to answer some of the points that have been raised.

Mrs. Virginia Bottomley

Is the hon. Gentleman the Minister?

Dr. Stoate

In answer to the right hon. Lady's question from a sedentary position, I do have the right to answer the debate, even though I am not winding up for the Government. I still feel that I have arguments to make in answer to points that Labour Members and Opposition Members have raised in the debate so far.

Dr. Brand

rose—

Dr. Stoate

I shall give way in a minute.

In the interests of grown-up debate I decided to look back over the past 20 years, at my experience as a doctor, to see what I could glean from my experience in the health service. During the past 20 years, the health service has changed dramatically. There have been vast improvements all round. Social conditions for most people in this country have to a certain extent improved. Nowadays most people have telephones and many have cars. Most people can now get to the premises where their general practitioners and the primary care professionals work.

The role of the general practitioner has also changed dramatically over the past 20 years. Most people can come to much better equipped surgeries, where a far wider range of facilities is available. More can be done for them in primary care, without their having to be passed on to the secondary sector.

Dr. Brand

I am grateful to the hon. Gentleman for giving way. Is he not surprised that the Government amendment congratulates the staff on providing … the fairest and most efficient healthcare system in the world", and that we no longer speak of the best health care system in the world? Can he explain how we can go back to being comparable with the best—at present we are second or even third-rate in our outcomes—without putting in extra resources?

Dr. Stoate

I thank the hon. Gentleman for that contribution, although I do not agree with him. I believe that ours is still one of the best health services in the world. We have one of the most dedicated services available. We have notes that go from cradle to grave. We have a commitment to patients that is unsurpassed in most countries, which still envy us. For example, many people still come to visit the Royal College of General Practitioners, of which I am a fellow, to find out how British general practice can be rolled out into other parts of the world. I still take part to some extent in the college activities, and professors from foreign countries come over frequently to find out how British general practice can be used in their own countries for the benefit of their own people.

I simply do not recognise the idea that British general practice and the British national health service have slipped in their position in the world. I still believe that it is an excellent service, with much to offer people in Britain.

General practice has improved markedly over the past few years. That has not just happened recently. It has been going on over a long period. I shall surprise Opposition Members by saying that I do not believe that the service has become wonderful over the past two years having been dreadful before. I take a rather more grown-up approach and say that improvements have happened gradually, over a long period—and yes, some of those improvements have been due to the Conservatives. To a certain extent, I pay tribute to what the previous Government did.

Much of the debate this afternoon has centred on fundholding. Yes, there are aspects of fundholding that did a great deal of good. There was considerable innovation, and many entrepreneurial ideas came from certain general practitioners who were able to run with the ideas and introduce genuine change and improvements for patients in their surgeries. However, there was a problem, which the Opposition have never grasped and to which they have never owned up.

Every improvement that some GPs were able to glean for their patients was at the expense of other GPs who were unable to do so. The fact remained that if money was being top-sliced to be given to fundholders, less was left for the commissioning groups of other GPs who did not have those advantages. There was indeed a two-tier service. For every innovation from which some GPs benefited, others lost out. As someone who has been a GP for a long time—a non-fundholding GP—I felt that keenly in some aspects of patient care. I felt that on many occasions my patients were missing out, because of the activities of fundholders.

Many aspects of fundholding worked, but the problem was that it was unfair. Opposition Members like to speak about free choice and the right of people, including doctors, to make decisions for themselves. I agree with that, but there is a fundamental difference between my view of the world and theirs. In their view, choice and freedom must be right at any cost. In my view, choice and freedom are right only in so far as they do not impinge on the choice and freedom of others. Choice is good, but not at the expense of others. Fundholding undoubtedly reduced the choice of others.

Opposition Members look quizzical, so I shall give a simple example relating to economies of scale. If a fundholder top-sliced the budget for the family practitioners service, as it was then, that left far less money for the non-fundholding GPs. That meant that they were far less able to negotiate bulk contracts with their local providers. They got a worse service and the money ran out sooner. The money was not available for GPs in the non-fundholding practices to make the best of things for their practices.

Although some good things came out of fundholding, I believe that overall it created inequality, unfairness and a two-tier service.

Dr. Fox

I am grateful to the hon. Gentleman for giving way. If, as he says, fundholding created a two-tier system and there were advantages to fundholding, would it not have been logical to move everyone up to the top tier, not to drag everyone downwards by restricting freedom, as primary care groups have done?

Dr. Stoate

The hon. Gentleman raises an important point, but I cannot agree with it. If, as I believe and as many surveys have shown, fundholders were getting a greater proportion of the resources, those advantages would be lost if all GPs became fundholders, because they could not all have more than their share of resources. The only way that fundholding could turn out to be a great success was by reducing the resources available to non-fundholders.

Surely the way forward in that case is to amalgamate fundholding with non-fundholding to produce the best of all worlds. I shall give an example to Opposition Members, who may not believe me. In my constituency, Dartford, more than 100 GPs, fundholders and non-fundholders working together, formed a primary care pilot. About 70 of them were fundholders and 30 were non-fundholders. They voluntarily gave up that status to work together as 100 GPs. They reduced bureaucracy and achieved much better economies of scale and improvements in services.

Those GPs acted as a model for primary care groups. Now that they have become a primary care group, they are a year ahead of most other GPs and are providing genuine and sustained improvements in service for their patients. They have taken the best of fundholding and rolled those benefits out for all patients and all GPs in the community. They formed a primary care group, precisely as the Government intend, to reduce the inequality that was apparent under the previous system.

We have taken the best and ensured that it is available to all. Of course I accept some of the criticisms from some of my GP colleagues who say that things have happened very fast, that they are not sure what is happening and that there are gaps in service. Some PCGs have obviously been faster and more organised than others, and some are falling behind. However, that is more a matter of things settling down over time and the new service bedding in, rather than a fundamental problem with the service.

I genuinely believe that in a year's time, primary care groups will prove to be the best thing that we could have done under the circumstances. They will provide the maximum improvements for all patients in the community, not just for the favoured few. That is surely what is needed to improve health care for people in Britain.

It is right for this debate to take place and for the House to examine how the health service is working, but it is not right to table motions that run the health service down and frighten people into believing that the health service is getting worse, when it clearly is not. We should be talking up the best of the health service, improving aspects in which improvement is still needed, and most of all building on the successes of the past and ensuring that they benefit everyone.

I pay tribute to the enormous number of doctors, nurses and other health professionals who work extremely hard, who show such dedication, and who work long hours, sometimes at thankless tasks. We should pay tribute to those people, instead of making them look as though they are running a second-rate service of which no one wants to be part. That is not the case.

I have sat through the debate this afternoon and listened to the comments, and I do not recognise the health service that many hon. Members profess to know all about. I still work in the health service to a certain extent and I shall give Opposition Members three examples of patients whom I have seen in the past few weeks.

We talk about priorities and about whether people get the service that they want, when they need it. I saw a lady with breast cancer. It was in quite an advanced state. I picked up the phone and spoke to a surgeon. He said, "I am still here. How quickly can she get to see me?" She was seen that very morning. That is not a bad service.

I saw a patient recently who had come back from Thailand with a nasty tropical illness which clearly needed investigation. I picked up the phone and arranged for him to be seen by a consultant the same day. He was dealt with immediately with no problem and no queues.

I saw a patient a few weeks ago who was suffering from post-natal depression. I sent a fax to my local psychiatric hospital asking whether she could be seen as soon as convenient. I got a phone call from the consultant the same day, asking me to track the patient down so that she could be seen the same afternoon in the consultant's clinic. That is not a bad service.

The health service can still deliver the best. For every example that Opposition Members can list in which things have gone wrong, I can give examples in which things have gone very right indeed. We should pay tribute to the health service and talk it up, instead of talking it down. It is the best that we have, and I do not believe that the Opposition have any ideas about how the system that we have introduced could be improved on.

6.20 pm

Mrs. Virginia Bottomley (South-West Surrey)

Like the hon. Member for Dartford (Dr. Stoate), I can give three examples of what has happened to patients—a gentleman, Mr. Roger Humphreys, admitted to the Royal Surrey county hospital on Sunday lunchtime but not admitted to a ward until Monday evening; a lady, whom I shall not name, with cancer who was left in the accident and emergency department for more than 10 hours; and a young man, a schizophrenic, who should have been seen by either a social worker or a psychiatric nurse as he had just burned his parents' house to the ground—all suffering from the Government's blight on the home counties.

Undoubtedly, matters in South-West Surrey are worse than ever before. I have had more letters than ever before. The waiting lists are up. When I went to the Department of Health, I took the view that a one-year wait was too long to be acceptable. At that time, there were 270,000 one-year waiters. When I left, there were 30,000. When this Government came to power, there were still 30,000; there are now 48,000. How many more examples do the Government want of the fact that the rhetoric, the spin and the trivial nature of their approach to the health service are not delivering?

For the first six months, time and again every Minister said of the previous Government, "We keep our promises; they broke theirs." We have not heard that trite claim today, because it is so blatantly not being delivered. The Government were going to reduce waiting lists. As we know, that promise is costly—the Government are not delivering, and that promise is distorting priorities.

The Government have attacked managers. They have now reached the stage where managers apparently have to be appointed by the Secretary of State. Breaking all precedents, the chief executive of the National Institute for Clinical Excellence has to be appointed by the Government. I hope that the First Division Association will make its voice heard about that.

The Government are opposed to postcode prescribing. I take the view of my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) that postcode prescribing may not be desirable, but the alternative is centralisation, lack of innovation and the lowest common denominator. We see old Labour at work more in the health service than in any other area.

Professor Le Grand of the London School of Economics health unit—I declare an interest as a governor of LSE—has described how the third way has been adopted across the social agenda by the Labour party, but not in health. I urge the Government to look more pragmatically at the NHS, to have more of a partnership approach and to stop being so politically driven, because these endless irrelevant initiatives are irritating the professionals more and more and creating quite unrealistic expectations among patients.

Walk-in centres and NHS Direct are not bad ideas, but they are centralising. They are taking power to Ministers at exactly the time when, as my right hon. and learned Friend the Member for Rushcliffe said, we should be devolving power down to the levels closest to the patients and the professionals.

Today, we had a welcome announcement on meningitis C. I declare an interest, which appears in the Register of Members' Interests, because I work with Wyeth, which has been closely associated with that initiative. Despite all the rhetoric about health action zones and inequalities, let us consider what the previous Government delivered—please can this Government do better?

Let us take the example of MMR immunisation. In 1989–90 in west Birmingham, among the worst areas in the country, only 49 per cent. of children were immunised. Two years later, as a result of the changes put in place by the Conservative Government—rewarding general practitioners for immunisation, against which the Labour party voted—that figure had risen to 82 per cent. In Newham, again an area of great deprivation, the party which Labour always said did not care about inequalities was responsible for an increase in the number of children immunised from 50 per cent. in 1989 to 81 per cent. in 1991.

I urge the Government to take more seriously the delivery of results. Health care is not about initiatives; it is about implementation and the follow through. That is why I am so appalled by what is happening on junior doctors' hours. I was the Minister who signed the new deal. I was also the Secretary of State who signed up to the targets in the "Health of the Nation" White Paper. I hope that in "Our Healthier Nation", with many similar targets in many similar areas, the Government will deliver. The Government would gain more respect if they left party politics aside—they do not need it with such a big majority—quietened down and delivered.

All these trivial initiatives take the time and energy of senior managers, Ministers and others at a time when, with more humility and pragmatism, they should be asking what the NHS can deliver. My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) put the rationing issue well and truly on the agenda. The worry is that unless the Government are more truthful—this is why I so welcome the appointment of my hon. Friend the Member for Woodspring (Dr. Fox)—they will always give way to the articulate greedy as opposed to the inarticulate needy. The challenge will be the unfashionable causes and the inarticulate groups. The Government should say, "We cannot deliver everything for everybody."

Let us have some realism, integrity and honesty. The danger that the Government are storing up for themselves is that they will end up exactly like the previous Labour Government—expectations were massive, and the disillusionment and disappointment with the implementation was so great that people started to take industrial action and patients suffered.

We have had a welcome announcement but, please, now, two years into office, will the Government calm down and put the patients and the professionals, not the politicians, in the driving seat?

6.25 pm

Sir Raymond Whitney (Wycombe)

My right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) speaks with great knowledge and understanding of the health service and makes an extremely valid case. By nature, I am an optimist and I came here today thinking that, perhaps, for the first time in 53 years, we could have a sensible political debate on how to provide health services in Britain. I thought that because, after 26 months of the realities of office, I hoped that the Labour party might, as my right hon. Friend suggests, face up to the problems that we all share in providing a proper health service for Britain, but that was not to be.

The reason that we have not had a sensible debate for 53 years is the myths that surround what happened in 1946. Sure enough, the hon. Member for Wakefield (Mr. Hinchliffe) tried to resurrect those myths this afternoon. The fact is that all three major parties in Britain were, for many years before the health service was created, totally in favour of a health service which was comprehensive, universal and free at the point of delivery. There was great unanimity on that throughout the war, culminating in the 1944 White Paper introduced by a Conservative Minister. That White Paper was strongly endorsed by the Labour party at its Blackpool conference in October 1944.

The only difference—it was a significant difference—was that the majority of the Labour party, led in particular by the then Lord President of the Council, Mr. Herbert Morrison, the grandfather of the right hon. Member for Hartlepool (Mr. Mandelson)—and who, in the light of the problems that we have had since, would say that he was wrong?—said that we needed not the centralised and over-bureaucratic structure which Aneurin Bevan eventually put through the House, but a much more devolved structure with local autonomy and a great deal more freedom from bureaucracy. Let us therefore be clear that we should not be fobbed off with the myths that we have heard this afternoon, and have had—

Mr. Hinchliffe

rose—

Sir Raymond Whitney

No, sorry; no chance at all.

We have had those myths for 53 years. For 53 years, Health Ministers have had the same challenges. I was a junior Health Minister for a short time and, like every other Minister, junior or senior, I accepted the basic framework of the health service with the two overriding essentials of universal care free at the point of delivery and the need to get as much money as possible out of the Treasury and spend it as wisely as one can. Governments of both complexions have tried that. The previous Conservative Government had a great record. We had a 74 per cent. increase in expenditure in real terms, an 86 per cent. increase in hospital treatments, and we doubled the number of hip replacements. We can all swap such statistics.

We should concentrate on the hospital sector. The hon. Member for Dartford (Dr. Stoate) spoke about general practitioners. I accept that the level of GP provision in Britain is something of which we should be proud, but we should not be proud of the hospital problem, particularly the waiting times and all the ancillary services.

The Conservative Government tried hard with their massive increase in spending over 18 years. We produced a long list of improvements. We have now had two and a bit years of the Labour Government. In many ways, they have gone backwards. The previous Labour Government's record was appalling. Nurses' pay fell in real terms by 3 per cent. in one year, the hospital building programme was cut by a third, and doctors said that the health service was on the point of collapse. They are saying that again. I utter these words with care, but does not that suggest that the NHS is not the envy of the world? If it was, it would have been copied elsewhere.

The New Zealanders established a national health service for a short time and then walked away from it. The Swedes had something similar for a while, but they do not have such a service any more. There must be lessons that we can learn from other countries and it is about time that we, as responsible politicians, faced up to our responsibilities and accepted that reality. Instead, we always hear flannel from Labour spokesmen, and the Secretary of State gave us a prime example of that this afternoon.

Let us look to other countries. Of course they have great problems, but I am sure that there are things to learn from them. I believe that we have to go back to where Herbert Morrison was when he lost his battle with Aneurin Bevan 53 years ago, and look for a much higher degree of local autonomy and less of the centralisation that the Labour party by instinct enjoys so much.

We also have to look at additional sources of funding. We all know that money is not everything in respect of health care, but it is crucial. The latest figures available for per capita health spending in Britain are given in American dollars, which is usually the case with statistics. We spend $1,300 compared with $4,000 spent in the United States. I would not dream of suggesting that as an example, but we should look at our sister countries—the other advanced industrial countries such as Germany and France—where average per capita spending is $2,000. That is a difference of $700 per person.

Laura Moffatt (Crawley)

Will the hon. Gentleman give way?

Sir Raymond Whitney

I am sorry, but I cannot.

With such a difference in spending, no wonder we have these problems. We should therefore open our minds and tell ourselves that the health service will not be safe in the hands of Labour or any other party unless we consider new solutions.

6.32 pm

Sir Geoffrey Johnson Smith (Wealden)

I fear that only a few minutes remain, and one of my hon. Friends—

Dr. Julian Lewis (New Forest, East)

Two.

Sir Geoffrey Johnson Smith

Two of my hon. Friends wish to make further comment. I am relieved from discharging some of my duty, however, because the speech of my hon. Friend the Member for Wycombe (Sir R. Whitney) followed in thought, if not word by word, exactly what I have in mind.

Members of my family work in the national health service, and I have great admiration for such people and for the achievements of the NHS. I have no wish to scrap it but, like my hon. Friend, I have to recognise that no other country has copied us. The representatives of nation after nation have visited this country and rejected our solution, but they have suggested that there are ways of topping up public expenditure. They believe that that can be achieved through friendly societies and insurance, and we can do that in this country. A whole raft of measures has made it possible for a better service to be delivered in continental countries, with which we should compare this country.

In my judgment, it is disgraceful that, instead of recognising that, we indulge in the sort of political rhetoric that so often destroys the ability of the House to give some lead to the Government and the public and to help to explain to them why change is necessary. By doing that, we do a disservice to those who work in the health service. They suffer from some of the same frustrations as us and they do not want the health service to be destroyed, but we will not give them a pointer to ways in which the health service can be improved if we do not recognise that alternative sources of finance and training would enable them to discharge their duties more effectively.

I am not referring to creeping privatisation or anything of that kind, but I am concerned that we will lead people to ever declining standards of practice if we go on blindly assuming that we can continue to have a health service free at the point of demand and subsidised almost exclusively by the taxpayer.

6.34 pm

Mr. David Amess (Southend, West)

I am increasingly angry about the style and lack of substance of Her Majesty's Government. Frankly, they should be absolutely ashamed of the way in which they have let the British people down by mismanaging the national health service since 1 May 1997.

Mr. Eric Martlew (Carlisle)

Basildon!

Mr. Amess

From a sedentary position, the hon. Gentleman shouts the name of my former constituency. Yesterday, I visited a friend who is seriously ill in hospital and that gentleman has everything to thank the hospital for in respect of the treatment that he has received. This might take the smile off the hon. Gentleman's face: he might be interested to know that the staff who work at that particular hospital—

Mr. Martlew

Will the hon. Gentleman give way?

Mr. Amess

We have only five minutes to go, and if I gave way I should be abusing the procedures of the House.

Every hon. Member should thank the women and men who work in the NHS for the wonderful work that they do on behalf of our constituents. Many of us have relatives and friends whose lives have been saved by them. For example, the gentleman who runs my office has had two heart bypass operations and he is thankful for the skill of the surgeon concerned.

For 18 years, the Labour party politicised the health service. Day in, day out, it tried to blame the Conservative party for everything that was reported by the newspapers, but it is interesting that it is now a little bit uncomfortable with the headlines. This week, a leader in The Times headed "Patients and Patience" said: In health reforms outcomes are what matter". A headline in the Daily Mail, which the Labour party does not like, says: At 103, Amy King had a right to expect exemplary treatment when taken to hospital. Instead, she was left weeping on a trolley for 28 hours, just another victim of our crumbling health service". Day in, day out and week in, week out, headlines that are clearly criticising the Government appear in the newspapers.

It has sickened me to listen to Labour party apologists during this debate on an Opposition motion, which I believe has already been abused by combining it with a statement. Labour Members say, "What has been reported since 1 May 1997 is all wrong." The hon. Member for Dartford (Dr. Stoate) and others were not Members of the House in previous Parliaments, but we all remember Jennifer's ear and all that. I believe that Labour Members should be absolutely ashamed of the way that they politicised the health service for 18 years.

Who thinks that the Labour party is doing a good job? Labour MPs do, but the professionals and the people who work in the health service know that the Labour party has let them down. Last week, I had the privilege to meet representatives of the Royal College of Nursing, which has said: The NHS is facing its worst nursing shortage in 25 years. The RCN revealed in January 1999 that there are now up to 13,000 full-time nursing vacancies". Local medical committees in Essex have passed two motions. One said that the conference had no confidence in the present government's handling of the National Health Service and deplores the fragmentation of the structure of primary care delivery in the UK". Another motion was passed, also saying that conference has no confidence in this present government's handling of the National Health Service. We have already heard what the British Medical Association has had to say. Labour MPs quoted what it had to say for 18 years—it was their greatest comforter—but it has turned against the Labour party. I am not sure whether the Liberal party still supports it; we shall find out when it elects its new leader in the middle of August. Now that it has turned against Labour Members, they do not want to know about it. As far as I am concerned, no one is satisfied with the NHS reforms except Labour Members. Those of us who sat through 77 hours of Standing Committee sittings on the Health Act 1999 know at first hand what those reforms amount to.

Lorna Fitzsimons

Will the hon. Gentleman give way?

Mr. Amess

No. We know what those reforms amount to and the Minister of State, who was a member of that Committee, was responsible for overseeing a complete shambles. On Report, Labour Members had no idea what new clause 18 meant, and we did not have a satisfactory debate on the health service.

On 1 May 1997, the Labour party said, "Vote Labour and you will save the national health service." It should have said, "Vote Labour and you will have to save the national health service." The two people whom I blame for the mismanagement of affairs since 1 May 1997 are none other than the Prime Minister and the Secretary of State for Health. The sooner the pair of them go, the better.

6.40 pm

Mr. Philip Hammond (Runnymede and Weybridge)

I begin by expressing our support for the Secretary of State's statement on meningitis vaccination, which builds on the immunisation programme that was at the heart of the previous Government's public health programme. It is extremely good news for all of us, especially those with small children.

We had the familiar speech from the hon. Member for Wakefield (Mr. Hinchliffe). Many of us have heard it before, and I do not intend to address it point by point. However, it was interesting that he attacked the previous Government on their record on the funding of long-term care. I noticed that he did not ask his Front-Bench colleagues when they were going to respond to the recommendations of the royal commission on the long-term care of the elderly. I suspect that the answer is that they will not respond, and that we shall discover that that is just one of the many promises made in opposition that the Government have now broken.

I am extremely grateful to my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) for nailing the hon. Member for Wakefield and the Secretary of State for once again making the cheap and unfounded slur that the Tory party wants to privatise the NHS. That is their only response to health debates these days. It is untrue: the Government know it, and it is unworthy of them to keep repeating it.

I was interested to note that the hon. Member for Barnsley, Central (Mr. Illsley) acknowledges that rationing exists in the NHS. I look forward to hearing from the Minister whether his hon. Friend has got it right, or whether he has a pager defect.

I am also grateful to my hon. Friend the Member for Broxbourne (Mrs. Roe) for her eloquent exposé the weaknesses and pitfalls of the Government's primary care reform agenda, and to my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley), who drew attention to the problems of areas that are not among the Government's most favoured.

The focus of the debate is on the gap between the NHS that we were promised by the Government at the last general election and the NHS that is being delivered to us. It is about the deception that was practised on the British people by the party that posed as the saviour of our national health service, and about the betrayal of NHS staff, many of whom—of all political persuasions—placed their trust in the Government in May 1997. If the Secretary of State has achieved one thing unequivocally, it is, as the chairman of the BMA said, the alienation of the whole medical profession in just two years.

The Government are obsessed with style over substance. They believe that saying it is doing it, and they put politics before patients.

Lorna Fitzsimons

Will the hon. Gentleman give way?

Mr. Hammond

No, I shall not give way, because there is no time left in the debate.

No one doubts the Government's desire to achieve a better national health service, but wishful thinking is no substitute for policy competence. Spin doctors cannot deliver pain relief, and they cannot cure patients. Patients who are on waiting lists or waiting to get on those lists, or who cannot get the drugs that they need to prolong their lives or to relieve their pain, know that the Government have failed to deliver the better health service that they promised them at the general election. Their families, neighbours and friends know that.

The Government are presiding over an unprecedentedly centralised national health service. It is an NHS in crisis: clinical priorities are subordinated to political targets, and the nursing shortage is at its worst level for 25 years. We now have a year-round winter crisis, fewer beds; routine, same-day cancellations of operations; rising total waiting lists; and more people waiting longer for their treatment. The morale of the medical profession is at an all-time low, and we have creeping rationing of drugs and treatment across the system and across the country. The worst thing is that the Government deny that all that is happening. They will not address the issues because they do not even acknowledge them.

The contrast between the reality and the expectations that were deliberately, recklessly and irresponsibly raised by Labour's rhetoric at the last election could not be greater, and is already beginning to haunt the Secretary of State. I wish that I could say that that applies to the Secretary of State for Health alone, but it does not, because this admixture of deception, betrayal and incompetence is a common theme throughout the Government. It applies to taxation, transport, education, environment, welfare reform and law and order.

The Secretary of State is also not alone in being responsible for the problems of the NHS. His colleagues on the Government Front Bench have helped him with those. The working time directive has added £100 million to his problems. The extra pension contributions that are required have added another £0.5 billion. The minimum wage, higher taxes on fuel and social chapter costs have also compounded his problems.

However, the Secretary of State alone is personally responsible for impaling himself on his ludicrous assertion that there is no rationing in the NHS, thus singlehandedly stifling the most important debate that we need to have about the future of our national health service.

We are discussing the promises that the Government made and the promises that they have broken. They promised to cut waiting lists by 100,000 as a first step by saving £100 million on NHS red tape. How have they done on that? According to their own figures, they have spent almost £1 billion on the waiting list initiative. They have not cut red tape; they have increased it. People in the NHS tell us that they are drowning in policy initiatives, targets, circulars and executive letters. After spending all that money, the Government have utterly failed even to achieve the target of a 100,000 reduction. Two years on, the figure is only 40,000 lower than it was in May 1997, and that is if we accept the Government's figures at face value and take no account of the additional 200,000 people who are waiting to see a specialist to have the chance and the privilege of getting on the Secretary of State's waiting list for treatment.

The Government have done no better on waiting times. As my hon. Friend the Member for Woodspring (Dr. Fox) said, they have not achieved equality of treatment across the country. In opposition, they explicitly recognised the dangers of upheaval in the service, yet they have introduced wholesale change, which the BMA has called "frightening".

The Government have abolished GP fundholding, and have created a levelling down of expectations in primary care. They betrayed the nurses in their first year of office by staging the nurses's pay claim, which did irreparable damage to morale in the nursing profession. [Interruption.] The Secretary of State snickers. He has recently introduced an expensive initiative to lure nurses back to the profession. He has told us how many people have made inquiries, but we do not know how many people have rejoined the NHS. The Government's amendment says 3,800, but the Secretary of State may be interested to know that the Minister of State, in a written answer to me just last week, gave the figure of 1,223, so there must be more than one spin doctor working in the Department of Health giving us two separate answers.

The Secretary of State should beware. The last time, the electorate judged the Labour party on what it said it would do for our national health service. The next time, they will judge it on what it has achieved, not on what it says.

More immediately relevant to the Secretary of State is that others may be judging him on what he has achieved in the NHS. Perhaps, somewhere in Downing street, the Secretary of State's own end-of-term report—prepared by some faceless wonder—is gathering dust. The salient achievements that that report will list are: the alienation of the entire medical profession in just two years; the largest fall in public confidence rating of any Government Department since May 1997; and a failure to deliver on a single key pledge, despite a cynical manipulation of the system in an attempt to achieve that.

The Government will be judged on their competence to address the problems in the NHS, and not just on the sincerity of their aspirations for it. On that measure—competence—the sad but inevitable conclusion is that the Government have failed. The Secretary of State has failed, and Britain's health service is getting worse under Labour.

6.50 pm

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

It is quite clear from the debate that there is a difference between the Government and the Conservative party, but equally it is clear how the Tory party has changed. For years, the saving grace of the Conservative party—as it presided over the break-up and decline of the NHS—was that, at least, it felt that it should claim that the NHS was safe in its hands. We have seen in the past year, first under the leadership of the right hon. Member for Maidstone and The Weald (Miss Widdecombe), and now under the hon. Member for Woodspring (Dr. Fox), that the Conservatives have dropped that pretence.

It was explicit in the speeches by the hon. Member for Wycombe (Sir R. Whitney) and by the right hon. Member for Wealden (Sir G. Johnson Smith) that the NHS would not be safe in the hands of the Conservative party, and that will be on the record.

Sir Geoffrey Johnson Smith

The hon. Gentleman has no right to say that. The suggestions that I have made about the need for extra topping-up from the private sector have been proposed by the Fabian Society and others, including Front-Bench spokesmen. That does not signal the break-up of the NHS.

Mr. Denham

The story now is that, in the view of the Conservative party, the NHS cannot be saved. The aim of what we have heard today has been to undermine, to demoralise, and to persuade people to abandon the NHS for the private alternative. Some Opposition Members seem to be under the impression that private health insurance works by giving money to patients. We should explain to them that it works the other way round.

We were elected as a Government to modernise the health service. The people knew at the last election, as they still know, that we were the only party which had faith in the future of the NHS. We said that it would take 10 years to modernise the NHS—we said that when we published the White Paper, and it will. However, the right start has been made in every part of the NHS.

The NHS depends on its staff. We need more staff, who are better trained and fairly rewarded, and that is what we are doing. Already, more people want to go into careers in nursing. More than 31,000 people have applied for pre-registration nursing and midwifery training this year, compared with just over 18,000 last year. The recruitment campaign that we launched after this year's pay award has brought more than 1,200 trained nurses who had left the NHS back on to the wards in just five months, with more than 2,500 more in the process of returning. We are determined to tackle violence and harassment, and we will promote family-friendly employment to ensure that those nurses will want to stay in the NHS.

We implemented the pay review body awards for doctors and nurses for this year in full and without staging—for the first time in five years. There will be more doctors. The comprehensive spending review will allow the appointment of up to 15,000 extra nurses and 7,000 extra doctors. Some 2,200 more doctors joined the NHS in our first year, and there are more than 90,000 doctors for the first time in the history of the NHS.

I say to the hon. Member for Woodspring that I did not understand—I hope that I did not misinterpret—his comments about overseas doctors. A quarter of doctors in the NHS are overseas doctors today—about the same proportion as under the Conservative Government. His attack on the role of overseas doctors in the NHS will have alarmed many people in the House, and I hope that he will soon take the opportunity to make it clear what he meant.

Let me also point out to the hon. Gentleman that there is no evidence that the hours worked by junior doctors have risen. He should know that we agreed with the junior doctors to improve the conditions for the new deal on rest and other aspects, not the working hours, and that has led to an increased number of posts that do not comply with the "new" new deal. That is because we want tougher standards for junior doctors. I can assure the House, as we have on many occasions, that the hours worked by junior doctors have fallen since we came to office, and we will make sure that they continue to fall.

We have increased the number of nurse-training places. More than 1,500 extra pre-registration nurses will go into training in the next year, and we are on track to create an extra 6,000 training places by 2002. We are putting in an extra 1,000 medical school places for doctors. We are making sure that NHS staff will be properly trained and properly rewarded.

The NHS is changing, and all change can be disconcerting for some. However, right across the NHS there is a new leadership, which shares the Government's faith in the NHS and our vision, and which wants to make it work. We have abolished the internal market, which means that we will be able to put about £1 billion saved from bureaucracy back into patient care in this Parliament.

The managers have managed. With the doctors, nurses and other staff, they have delivered the biggest-ever fall in waiting lists. As my hon. Friend the Member for Dartford (Dr. Stoate) said, in 481 primary care groups, doctors and nurses are now in the driving seat, taking the responsibility for shaping the new NHS at local level. Some 170 primary care groups have expressed interest in becoming primary care trusts. Some 91 primary care groups, grass-roots GPs and GP co-operatives have applied to run the first NHS walk-in centres.

Primary care groups, and particularly GP co-operatives, are working closely with NHS Direct to bring about the new nurse-led helpline, and to bring services closer to patients. Over 400 doctors now work in personal medical service pilot schemes, and many hundreds more wish to do so.

Those people are taking part not because anyone told them to, but because they want to. They can see that the changes that we have introduced will be better for their patients and better for the services that they want to offer. The Royal College of Nursing described our new nursing strategy as a breakthrough document. There will be better careers and wider roles for nurses, and already we are training 23,500 nurses to take on the responsibility of nurse prescribing.

Doctors, nurses and other health professionals are developing new roles in the new NHS, building on the best of what is already there and tackling new needs in new ways. We have started the modernisation of the NHS and we will see it through. We promised to tackle waiting lists, and we are doing so. When we came into office, waiting lists were at record levels and rising. Now, waiting lists are falling and, as waiting lists fall, waiting times will fall.

In 1992, when the Conservative Government launched the patients charter, they said that no one should wait for more than two years. A bit later, they said that no one should wait for more than 18 months. However, they never achieved that target—not for one month in any year did they achieve the waiting target that they set themselves. In England, for the past nine months in a row, no one has been reported as waiting for more than 18 months.

We should all like waiting lists to be shorter; but for some conditions, waiting lists must be shorter. Therefore, we set out to ensure that, from April, any woman with suspected breast cancer needing urgent treatment is seen by a specialist within two weeks. In 2000, we want to extend that to cover all cancer conditions.

Across key health problems—such as coronary heart disease, mental health and the needs of older people—national service frameworks will state the service standards that we want the national health service to provide to everyone, everywhere—not with local, postcode prescribing—

Mr. Hammond

On a point of order, Mr. Deputy Speaker. The Government's amendment states quite clearly that 3,800 nurses have returned to the NHS "so far this year". In his speech, the Minister has just confirmed that the real number is 1,233—as he has confirmed to me in a written answer—

Mr. Deputy Speaker (Mr. Michael J. Martin)

Order. Perhaps I can help the hon. Gentleman by saying that that is a matter for debate.

Mr. Denham

An awful lot more nurses have returned to nursing under the current Government than under the previous one. Moreover, the amendment mentions nurses "returning" to the national health service. Nurses are returning to the national health service because they, like Labour Members, have confidence in the future of the national health service. If there is one lesson to be learned from this debate, it is that we have a choice not between the new and old NHS, but between the new NHS, represented by the Government, and no NHS, represented by Conservative Members.

Sir Patrick Cormack (South Staffordshire)

On a point of order, Mr. Deputy Speaker. I completely understand why you said what you did a few moments ago, but the 3,800 figure appears on today's Order Paper. Therefore, the House is being given—inadvertently, I trust—misleading information on which to vote. Surely that is a point that you can address, sir.

Mr. Deputy Speaker

That is a matter not for the occupant of the Chair, but for hon. Members in deciding how to vote on the motion.

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

The House divided: Ayes 169, Noes 327.

Division No. 260]	[7.1 pm
AYES
Ainsworth, Peter (E Surrey)	Day, Stephen
Allan, Richard	Donaldson, Jeffrey
Amess, David	Dorrell, Rt Hon Stephen
Arbuthnot, Rt Hon James	Duncan, Alan
Atkinson, David (Bour'mth E)	Duncan Smith, Iain
Atkinson, Peter (Hexham)	Evans, Nigel
Baker, Norman	Faber, David
Baldry, Tony	Fabricant, Michael
Ballard, Jackie	Fallon, Michael
Beith, Rt Hon A J	Fearn, Ronnie
Bercow, John	Flight, Howard
Beresford, Sir Paul	Forsythe, Clifford
Blunt, Crispin	Forth, Rt Hon Eric
Body, Sir Richard	Foster, Don (Bath)
Boswell, Tim	Fowler, Rt Hon Sir Norman
Bottomley, Rt Hon Mrs Virginia	Fox, Dr Liam
Brake, Tom	Fraser, Christopher
Brand, Dr Peter	Gale, Roger
Brazier, Julian	Garnier, Edward
Brooke, Rt Hon Peter	George, Andrew (St Ives)
Browning, Mrs Angela	Gibb, Nick
Bruce, Ian (S Dorset)	Gillan, Mrs Cheryl
Bruce, Malcolm (Gordon)	Gorman, Mrs Teresa
Burns, Simon	Gorrie, Donald
Cable, Dr Vincent	Gray, James
Cash, William	Green, Damian
Chapman, Sir Sydney (Chipping Barnet)	Greenway, John
	Grieve, Dominic
Chidgey, David	Gummer, Rt Hon John
Chope, Christopher	Hamilton, Rt Hon Sir Archie
Clappison, James	Hammond, Philip
Clarke, Rt Hon Kenneth (Rushcliffe)	Hancock, Mike
	Harris, Dr Evan
Collins, Tim	Harvey, Nick
Colvin, Michael	Hawkins, Nick
Cormack, Sir Patrick	Heath, David (Somerton &Frome)
Cotter, Brian	Heathcoat-Amory, Rt Hon David
Cran, James	Hogg, Rt Hon Douglas
Curry, Rt Hon David	Horam, John
Davey, Edward (Kingston)	Howard, Rt Hon Michael
Davies, Quentin (Grantham)	Hughes, Simon (Southwark N)
Davis, Rt Hon David (Haltemprice)	Hunter, Andrew

Jackson, Robert (Wantage)	Sanders, Adrian
Jenkin, Bernard	Sayeed, Jonathan
Johnson Smith, Rt Hon Sir Geoffrey	Shepherd, Richard
	Simpson, Keith (Mid-Norfolk)
Jones, Nigel (Cheltenham)	Smith, Sir Robert (W Ab'd'ns)
Keetch, Paul	Smyth, Rev Martin (Belfast S)
Key, Robert	Soames, Nicholas
King, Rt Hon Tom (Bridgwater)	Spelman, Mrs Caroline
Kirkbride, Miss Julie	Spring, Richard
Kirkwood, Archy	Stanley, Rt Hon Sir John
Lansley, Andrew	Steen, Anthony
Leigh, Edward	Streeter, Gary
Lewis, Dr Julian (New Forest E)	Stunell, Andrew
Lidington, David	Swayne, Desmond
Lloyd, Rt Hon Sir Peter (Fareham)	Syms, Robert
Llwyd, Elfyn	Tapsell, Sir Peter
Loughton, Tim	Taylor, Ian (Esher & Walton)
Luff, Peter	Taylor, John M (Solihull)
Lyell, Rt Hon Sir Nicholas	Taylor, Matthew (Truro)
MacGregor, Rt Hon John	Taylor, Sir Teddy
McIntosh, Miss Anne	Tonge, Dr Jenny
MacKay, Rt Hon Andrew	Townend, John
Maclean, Rt Hon David	Tredinnick, David
McLoughlin, Patrick	Trend, Michael
Major, Rt Hon John	Tyler, Paul
Malins, Humfrey	Tyrie, Andrew
Maples, John	Viggers, Peter
Maude, Rt Hon Francis	Walter, Robert
May, Mrs Theresa	Wardle, Charles
Michie, Mrs Ray (Argyll & Bute)	Waterson, Nigel
Moore, Michael	Webb, Steve
Nicholls, Patrick	Wells, Bowen
Norman, Archie	Whitney, Sir Raymond
Oaten, Mark	Whittingdale, John
Öpik, Lembit	Widdecombe, Rt Hon Miss Ann
Page, Richard	Wilkinson, John
Paice, James	Willetts, David
Pickles, Eric	Willis, Phil
Prior, David	Wilshire, David
Randall John	Winterton, Mrs Ann (Congleton)
	Woodward, Shaun
Redwood, Rt Hon John	Yeo, Tim
Rendel, David	Young, Rt Hon Sir George
Robathan, Andrew
Roe, Mrs Marion (Broxbourne)	Tellers for the Ayes:
Russell, Bob (Colchester)	Mrs. Jacqui Lait and
St Aubyn, Nick	Mr. Geoffrey Clifton-Brown.
NOES
Abbott, Ms Diane	Benn, Rt Hon Tony (Chesterfield)
Adams, Mrs Irene (Paisley N)	Bennett, Andrew F
Ainger, Nick	Benton, Joe
Ainsworth, Robert (Cov'tryNE)	Best, Harold
Alexander, Douglas	Betts, Clive
Allen, Graham	Blackman, Liz
Anderson, Janet (Rossendale)	Blizzard, Bob
Armstrong, Rt Hon Ms Hilary	Blunkett, Rt Hon David
Ashton, Joe	Borrow, David
Atkins, Charlotte	Bradley, Keith (Withington)
Banks, Tony	Bradley, Peter (The Wrekin)
Barron, Kevin	Brinton, Mrs Helen
Battle, John	Brown, Russell (Dumfries)
Bayley, Hugh	Browne, Desmond
Begg, Miss Anne	Buck, Ms Karen
Bell, Martin (Tatton)	Burden, Richard
Bell, Stuart (Middlesbrough)	Burgon, Colin

Butler, Mrs Christine	Fitzsimons, Lorna
Caborn, Rt Hon Richard	Flint, Caroline
Campbell, Alan (Tynemouth)	Flynn, Paul
Campbell, Mrs Anne (C'bridge)	Follett, Barbara
Campbell, Ronnie (Blyth V)	Foster, Rt Hon Derek
Campbell-Savours, Dale	Foster, Michael Jabez (Hastings)
Cann, Jamie	Foster, Michael J (Worcester)
Caplin, Ivor	Foulkes, George
Casale, Roger	Fyfe, Maria
Caton, Martin	Galloway, George
Chapman, Ben (Wirral S)	Gardiner, Barry
Chaytor, David	George, Bruce (Walsall S)
Chisholm, Malcolm	Gerrard, Neil
Clapham, Michael	Gibson, Dr Ian
Clark, Rt Hon Dr David (S Shields)	Gilroy, Mrs Linda
Clarke, Charles (Norwich S)	Godsiff, Roger
Clarke, Rt Hon Tom (Coatbridge)	Golding, Mrs Llin
Clarke, Tony (Northampton S)	Gordon, Mrs Eileen
Clwyd, Ann	Griffiths, Jane (Reading E)
Coaker, Vernon	Griffiths, Nigel (Edinburgh S)
Coffey, Ms Ann	Griffiths, Win (Bridgend)
Cohen, Harry	Grocott, Bruce
Coleman, Iain	Grogan, John
Colman, Tony	Gunnell, John
Connarty, Michael	Hain, Peter
Cook, Frank (Stockton N)	Hall, Patrick (Bedford)
Corbett, Robin	Hamilton, Fabian (Leeds NE)
Cousins, Jim	Hanson, David
Cox, Tom	Harman, Rt Hon Ms Harriet
Cranston, Ross	Heal, Mrs Sylvia
Crausby, David	Healey, John
Cryer, Mrs Ann (Keighley)	Henderson, Doug (Newcastle N)
Cryer, John (Hornchurch)	Heppell, John
Cummings, John	Hesford, Stephen
Cunliffe, Lawrence	Hewitt, Ms Patricia
Cunningham, Rt Hon Dr Jack (Copeland)	Hill, Keith
	Hinchliffe, David
Cunningham, Jim (Cov'try S)	Hodge, Ms Margaret
Dalyell, Tam	Hoey, Kate
Darling, Rt Hon Alistair	Hood, Jimmy
Darvill, Keith	Hoon, Geoffrey
Davey, Valerie (Bristol W)	Hope, Phil
Davidson, Ian	Hopkins, Kelvin
Davies, Rt Hon Denzil (Llanelli)	Howarth, George (Knowsley N)
Davies, Geraint (Croydon C)	Howells, Dr Kim
Davis, Terry (B'ham Hodge H)	Hoyle, Lindsay
Dean, Mrs Janet	Hughes, Ms Beverley (Stretford)
Denham, John	Hughes, Kevin (Doncaster N)
Dismore, Andrew	Humble, Mrs Joan
Dobbin, Jim	Hurst, Alan
Dobson, Rt Hon Frank	Hutton, John
Donohoe, Brian H	Iddon, Dr Brian
Doran, Frank	Illsley, Eric
Dowd, Jim	Jackson, Helen (Hillsborough)
Drew, David	Jenkins, Brian
Drown, Ms Julia	Johnson, Miss Melanie (Welwyn Hatfield)
Dunwoody, Mrs Gwyneth
Eagle, Angela (Wallasey)	Jones, Rt Hon Barry (Alyn)
Eagle, Maria (L'pool Garston)	Jones, Mrs Fiona (Newark)
Edwards, Huw	Jones, Helen (Warrington N)
Efford, Clive	Jones, Ms Jenny (Wolverh'ton SW)
Ellman, Mrs Louise
Ennis, Jeff	Jones, Jon Owen (Cardiff C)
Etherington, Bill	Jones, Dr Lynne (Selly Oak)
Field, Rt Hon Frank	Jones, Martyn (Clwyd S)
Fisher, Mark	Jowell, Rt Hon Ms Tessa
Fitzpatrick, Jim	Keeble, Ms Sally

Keen, Alan (Feltham & Heston)	Mudie, George
Keen, Ann (Brentford & Isleworth)	Mullin, Chris
Kelly, Ms Ruth	Murphy, Denis (Wansbeck)
Kemp, Fraser	Murphy, Jim (Eastwood)
Kennedy, Jane (Wavertree)	Naysmith, Dr Doug
Khabra, Piara S	Norris, Dan
Kidney, David	O'Brien, Bill (Normanton)
Kilfoyle, Peter	O'Brien, Mike (N Warks)
King, Ms Oona (Bethnal Green)	O'Hara, Eddie
Ladyman, Dr Stephen	Olner, Bill
Lawrence, Ms Jackie	Osborne, Ms Sandra
Laxton, Bob	Palmer, Dr Nick
Lepper, David	Pearson, Ian
Leslie, Christopher	Pendry, Tom
Levitt, Tom	Pickthall, Colin
Lewis, Terry (Worsley)	Pike, Peter L
Liddell, Rt Hon Mrs Helen	Plaskitt, James
Linton, Martin	Pollard, Kerry
Lock, David	Pond, Chris
McAllion, John	Pope, Greg
McAvoy, Thomas	Pound, Stephen
McCabe, Steve	Powell, Sir Raymond
McCafferty, Ms Chris	Prentice, Ms Bridget (Lewisham E)
McDonagh, Siobhain	Prentice, Gordon (Pendle)
Macdonald, Calum	Primarolo, Dawn
McDonnell, John	Prosser, Gwyn
McGuire, Mrs Anne	Purchase, Ken
McIsaac, Shona	Quin, Rt Hon Ms Joyce
McKenna, Mrs Rosemary	Quinn, Lawrie
Mackinlay, Andrew	Rapson, Syd
McNamara, Kevin	Raynsford, Nick
McNulty, Tony	Reed, Andrew (Loughborough)
MacShane, Denis	Reid, Rt Hon Dr John (Hamilton N)
Mactaggart, Fiona	Robertson, Rt Hon George (Hamilton S)
McWalter, Tony
McWilliam, John	Robinson, Geoffrey (Cov'try NW)
Mahon, Mrs Alice	Roche, Mrs Barbara
Mallaber, Judy	Rooker, Jeff
Mandelson, Rt Hon Peter	Rooney, Terry
Marsden, Gordon (Blackpool S)	Rowlands, Ted
Marsden, Paul (Shrewsbury)	Roy, Frank
Marshall, David (Shettleston)	Ruane, Chris
Marshall, Jim (Leicester S)	Ruddock, Joan
Marshall-Andrews, Robert	Salter, Martin
Martlew, Eric	Sarwar, Mohammad
Meale, Alan	Savidge, Malcolm
Merron, Gillian	Sawford, Phil
Michie, Bill (Shef'ld Heeley)	Sedgemore, Brian
Milburn, Rt Hon Alan	Sheerman, Barry
Mitchell, Austin	Sheldon, Rt Hon Robert
Moffatt, Laura	Simpson, Alan (Nottingham S)
Moonie, Dr Lewis	Singh, Marsha
Moran, Ms Margaret	Skinner, Dennis
Morgan, Ms Julie (Cardiff N)	Smith, Rt Hon Andrew (Oxford E)
Morley, Elliot	Smith, Rt Hon Chris (Islington S)
Morris, Ms Estelle (B'ham Yardley)	Smith, Jacqui (Redditch)

Smith, John (Glamorgan)	Trickett, Jon
Smith, Llew (Blaenau Gwent)	Turner, Dennis (Wolverh'ton SE)
Snape, Peter	Turner, Dr Desmond (Kemptown)
Soley, Clive	Turner, Dr George (NW Norfolk)
Spellar, John	Twigg, Derek (Halton)
Squire, Ms Rachel	Twigg, Stephen (Enfield)
Starkey, Dr Phyllis	Vaz, Keith
Steinberg, Gerry	Vis, Dr Rudi
Stevenson, George	Walley, Ms Joan
Stewart, David (Inverness E)	Ward, Ms Claire
Stewart, Ian (Eccles)	Wareing, Robert N
Stinchcombe, Paul	White, Brian
Stoate, Dr Howard	Whitehead, Dr Alan
Stott, Roger	Wicks, Malcolm
Strang, Rt Hon Dr Gavin	Williams, Rt Hon Alan (Swansea W)
Straw, Rt Hon Jack	Williams, Alan W (E Carmarthen)
Stringer, Graham	Wilson, Brian
Stuart, Ms Gisela	Winnick, David
Sutcliffe, Gerry	Wise, Audrey
Taylor, Rt Hon Mrs Ann (Dewsbury)	Worthington, Tony
Taylor, Ms Dari (Stockton S)	Wray, James
Taylor, David (NW Leics)	Wright, Anthony D (Gt Yarmouth)
Temple-Morris, Peter	Wright, Dr Tony (Cannock)
Thomas, Gareth (Clwyd W)	Wyatt, Derek
Timms, Stephen	Tellers for the Noes:
Tipping, Paddy	Mr. David Clelland and
Toutig Don	Mr. Mike Hall.

Question accordingly negatived.

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

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

Resolved, That this House welcomes the action the Government has taken to turn around the National Health Service by finding £21 billion extra funds for the coming three years, starting building work on 13 new hospitals, modernising every Accident and Emergency Department that needs it, abolishing the unfair and divisive system of fundholding and replacing it with Primary Care Groups putting doctors and nurses in the driving seat, cutting waiting lists, ending 18 month waiting in the NHS, creating the National Institute for Clinical Excellence and National Service Frameworks to promote quality treatment, delivering the biggest real terms pay rise for nurses for 10 years, publishing the most comprehensive strategy ever produced for improving the status, training, pay and job opportunities for Britain's half a million nurses, midwives and health visitors, with 3,800 nurses returning to the NHS so far this year and 2,200 additional doctors in the Government's first year of office; further welcomes the 450,000 more waiting list operations carried out last year plus the 142,000 extra emergency cases treated, and half a million more outpatient cases dealt with; and congratulates the staff on providing record results in what remains the fairest and most efficient healthcare system in the world.