National Health Service

HC Deb 26 October 1999 vol 336 cc869-920

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

We now come to the next motion. I inform the House that Madam Speaker has chosen the amendment in the name of the Prime Minister and has ruled that there will be a 10-minute limit on Back-Bench speeches.

7.15 pm

Dr. Liam Fox (Woodspring)

I beg to move—[Interruption.]

Mr. Deputy Speaker

Order. I ask hon. Members to leave the Chamber quietly as the hon. Gentleman is addressing the House.

Dr. Fox

That was a short soundbite, even for me.

I beg to move, That this House notes and applauds the dedication of those who work in the National Health Service but regrets the inadequacy of the support they receive from Her Majesty's Government in their efforts to deliver a first-class service; deplores the mismanagement of the National Health Service by Her Majesty's Government; regrets the continued distortion of clinical priorities in favour of political targets; urges the new Secretary of State to acknowledge the damage the waiting list initiative has caused to the National Health Service and to abandon waiting list targets as a measure of performance; calls on him to acknowledge the existence of rationing in the National Health Service and to ensure that in future such rationing takes place solely on the basis of clinical need; and calls for a fully informed and wide-ranging debate on the future of health care delivery to ensure that the people of this country have the health services they deserve. I hope that tonight's debate will be the first in a series of mature and incisive health care debates. However, given the amendment that has been tabled by Her Majesty's Government, I imagine that it will be a rather rhetorical conversation initiated by those on this side of the House, with Government Members advancing the usual simple, puerile arguments about how the Conservatives seek to privatise the national health service and so on. The Opposition will present reasonable, well thought out ideas about the future shape of health care, which I expect will be met with hissing and booing from the second-rate pantomime audience opposite.

We have three aims for health care in this country. We want a shift from throughput to outcome and from waiting lists to waiting times, and we want clinical priorities to replace political priorities. I say at the outset that I have some sympathy for the Secretary of State because he knows that we are absolutely right in those aims—he probably shares most of them. He must tonight defend not his waiting list initiative but that of his predecessor, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), and of the Prime Minister. The initiative has been condemned by almost every health care group, including the British Medical Association—that reactionary force which the Secretary of State loathes so much—the Royal College of Nursing, another reactionary group; the Royal College of Physicians; and the Royal College of Surgeons, each of which belongs to the forces of darkness that the Prime Minister sees around every corner. The Secretary of State is desperate to claim our territory, but he knows that he cannot dismiss the Prime Minister's pledge.

The Secretary of State is another of the Government's political prisoners: he is impotent in his Department because he cannot do what he knows to be right. He is desperate for a dose of political Viagra which, in this Government, is in as short supply as the real thing. The real problem that we face is not simply the Government's policy but the culture of the Government. As was revealed by the Home Office team in the previous debate, this Government engage not just in creative accountancy but in crooked accountancy. The Home Secretary's school of accountancy is applied in the Department of Health and in every other Government Department, so when the Secretary of State says that there will be an extra 410 cardiologists by 2005, he does not bother to add that those people are already in training and would be available to the NHS anyway.

The Government have a wonderful definition of "extra". Mr. Deputy Speaker, if you asked me to get you a sandwich from the Tea Room and I returned with an extra sandwich, you would expect to receive two sandwiches. However, if you sent the Secretary of State, you would get not only just one sandwich but an explanation that it was one more sandwich than you would have received if he had not gone in the first place. That is how the Government manage their accounting and their rhetoric.

More important is the Government's fundamental dishonesty. The Government promise things that they know they cannot deliver—it is part of the great Labour lie. While that is bad in other policy areas, to promise in health care things that one cannot deliver is to take advantage of the weakest and most vulnerable in our society when they are at their weakest and most vulnerable. The Government say that there will be extra consultants, but there are none. They say that there is no rationing when rationing is occurring. With Viagra and Relenza we have the most specific examples yet of health care rationing. The Secretary of State says that every drug that patients need will be made available—he should tell that to those whose consultants say that they would benefit from beta interferon. The Government, whose rhetoric does not match their actions, take cynicism to heights previously unknown in our politics.

Mr. Ronnie Campbell (Blyth Valley)

How does the hon. Gentleman square all that he is going to do for the health service with the fact that a Tory Government would cut taxes at the same time?

Dr. Fox

During the 18 years of Conservative government we made dramatic moves, not only in increasing the funding for health care available in this country but in reducing the burden of taxation, which was higher when we came into office in 1979 than when we left. It is entirely possible with economic growth, as we demonstrated, to increase health expenditure while reducing taxation. The two, of course, are not mutually exclusive.

The Government's cynicism is most apparent in their manipulation not only of money but of waiting list figures. There have been several examples recently of quite scandalous manipulation of statistics.

Mr. Hilton Dawson (Lancaster and Wyre)

Will the hon. Gentleman give way?

Dr. Fox

In a moment; I look forward to hearing the hon. Gentleman's defence.

In Bradford, for example, it was decided that patients who had previously had surgery to insert metal plates or screws in their bodies through various types of orthopaedic surgery and were waiting for them to be removed were not really waiting for treatment because they had received part of it. They could not get through an X-ray machine at Heathrow, but, according to the Government, they were not waiting for any treatment. They were put on a new list called 05 and are part of the Government's great disappeared of the health service.

In Derriford in Plymouth, those who reached the 18-month maximum waiting time for heart surgery were, strangely enough, subject to further investigation, after which the clock was stopped. They may have had chest pain or angina, and they may have been waiting in fear for the surgery, but, according to the official statistics, no one waited more than 18 months for surgery at those hospitals. That is a crude and repulsive manipulation of the data. At the Alexandra hospital in Redditch, 759 patients simply disappeared off the waiting list. That was called an administrative clean-up, which is a rather nice term for removing from the list patients who are still waiting for treatment.

Mr. Dawson

As we are talking about manipulation, can the hon. Gentleman explain why the previous Conservative Government totally failed to give any credence whatever to the Black report, to health inequalities or to the prime role of poverty as a precursor to ill health?

Dr. Fox

We are talking about patients who are waiting for surgery that could be life saving and who may die prematurely if it is denied to them. That argument demands more than a cheap, sixth-form debating point.

How many patients are living in pain and fear while awaiting surgery but are simply being removed from the statistics because it is awkward for the Government if they appear in them? Getting on the waiting list is in itself quite an achievement. People have first to get on the waiting list for the waiting list and then, if they are very good, they might get on the waiting list itself. The total number of such people—those who have seen their general practitioner but have not yet had treatment—has increased massively under this Government: 237,000 extra patients are waiting for treatment. They are the real waiters in the NHS, not those who are defined narrowly by the Government.

The problem of waiting lists lies at the heart of all the Government's troubles. The trouble with the waiting list initiative is that it treats all patients on the list in exactly the same way. Someone who is waiting for a coronary bypass graft is treated the same as someone with an ingrowing toenail. They matter, and are weighted, the same on that particular list, so within a finite budget there is inevitably pressure on clinicians from hospital managers and others to try to get the numbers down by using theatre time in a way that gets the maximum number off the list. That means that three inguinal hernias can be dealt with instead of a coronary bypass and in the same amount of theatre time. That is what has been happening.

People say, "Surely getting waiting lists down is a good thing?" It would be if the initiative were applied according to correct clinical priority, but clinical priority is being completely distorted to fit the Government's political priorities. That, if not unethical, is certainly an immoral way of running our health care system.

Since he took office, the Secretary of State has been willing to talk about a change of tack. I urge him to ditch the waiting list initiative, which is continuing to cause clinical distortion across the country. Surgeons and doctors are all complaining that their clinical freedom is being interfered with. He knows that the initiative is causing problems in the service—why does he not just ditch it? That might offend the Prime Minister's ego, but there would be plenty left if we lost a bit of it.

One matter that I want to concentrate on is the Government's attitude to cancer treatment. I did my junior doctor training in haematology and oncology, and I would be the first to agree that we need to improve our outcomes dramatically in respect of almost all cancers. I am right behind any Government of any political colour who seek to achieve that, but it has to be done in the proper way. The Government's cancer policy, as with everything else that they have tried to achieve, is not properly thought out and is run by gimmicks, headlines, crooked accountancy and incompetence.

Let us begin with some of the gimmicks. We have a drug tsar, so we have to have a cancer tsar. No doubt they will be joined by the gastroenterology tsar, the respiratory tsar, the cardiology tsar, the over-spending patient care group tsar and, when winter arrives, the winter crisis tsar. We may be short of consultants and have the smallest number per head of population of any comparable western country, but—my God—we will have the highest number of tsars per head of any western European country. What good will that do patients? None whatever. It is one of the many gimmicks employed by the Government, but what matters is the policies that follow.

The question of crooked accountancy comes up time and again. We hear great announcements of extra money and, before he deserted the sinking ship, the Secretary of State's predecessor sent all Members of the House a letter entitled "Cancer funding boost". It says: I wrote to you with details of £93 million … to provide the biggest ever investment in cancer equipment in England. However, sources in the profession tell us that exactly the same money had been earmarked for quite some time. Without extra funding, that money is enough to keep operating about only half the linear accelerators, which are an essential part of cancer treatment. It is a fraud and a sham. The whole thing is a complete charade.

On top of that, we have another example of Government incompetence. A serious point was put to the junior Minister at Question Time last week. We said that there was a grave danger—the point has today been echoed by the president of the Royal College of Surgeons—of swamping the system if every woman with a breast lump was to be referred within two weeks. I gave the Minister an example: neither the general surgeons nor the gynaecologists could cope if every woman with post-menopausal bleeding was referred within two weeks.

I asked: What level of clinical suspicion is required before the Government's time pledge comes into account. Is every patient with suspected cancer or only those with urgent referral for suspected cancer included? My understanding is that only urgent patients fall within the two-week time scale. I look to Ministers for clarification of the position, but I assume from the Secretary of State's silence is that my understanding is correct—only patients who are referred urgently will be seen. It is important to clarify that because the belief out there, and that which has been spun by Ministers to the press, is that every patient with suspected cancer would be seen within two weeks. Which is it? We look for clarification because it makes a huge difference to the real running of the system with real doctors, not spin doctors, and real patients.

When the Minister was asked that question, answer came there none. She said: We are working with GPs on the guidelines to ensure that referral takes place properly and according to appropriate clinical priorities."—[Official Report, 19 October 1999; Vol. 336, c. 244.] That was very interesting because the letter that we received from the British Medical Association said: I have checked with the GP Committee and discovered that they have not been involved in discussions with the Department of Health on any guidelines. Will the Minister clarify exactly whom she was talking to?

My hon. Friend the Member for New Forest, West (Mr. Swayne) has tabled a parliamentary question about what recent discussions have taken place between the Department and representatives of general practitioners regarding guidelines, the level of clinical suspicion in cancer diagnosis and when those discussions took place. Having had a week to consider her diary, the Minister said that she would let my hon: Friend have a reply as soon as possible. Despite all the extra special advisers and civil servants, Ministers cannot even look back in their diaries and decide when they met GP representatives. We suspect, therefore, that no such discussions have taken place, and that that is another part of the fantasy politics in which Ministers are engaged.

Ministers scoff at the potential overworking of the system, but the president of the Royal College of Surgeons said: Clinics are being snowed under with inappropriate referrals for breast cancer. Breast surgeons are coping, just, at the moment, but it could be at the expense of other things. The College is particularly concerned that when they bring on bowel cancer this is going to place an even greater load on hospital services. We need to know tonight with far greater clarity exactly what the Government's policies are and what the Government will do in response to those important criticisms from people at the cutting edge of the service.

We have made our priorities clear. We believe in instituting a patients guarantee, ensuring that the sickest patients will be treated first; and those with less urgent conditions will have to take their appropriate place in the queue.

Mr. Christopher Leslie (Shipley)

The hon. Gentleman talks about taking pressures off the NHS. Would he advise people who can afford it to take out private medical insurance?

Dr. Fox

I shall deal with the private sector in a moment—it is essential that we do so as part of a rational debate. I want to ensure that people take their appropriate place in the queue, that there is no queue jumping and that some people are not pushed up the queue ahead of those with greater clinical need because some political priority is being forced on hospital managers.

We have said that we would continue to increase funding for the NHS in real terms year on year, as we did during our period in office. However, we believe that there is a place in health provision for the independent sector and that we should have more mixed provision. The biggest difference between what this country spends on health and what comparable European countries spend is that while our state spend is similar, people in other countries spend rather more from their post-taxation income.

The hon. Member for Shipley (Mr. Leslie) implied that it is bad to take out private health insurance. That is strange logic for any Government who rake in money from tobacco sales but tell us that we should not buy private health insurance; in other words, people can buy ill health but they must not buy health—what a twisted sense of morality.

I want to make one or two things absolutely clear for the sake of this debate. My party does not want an entirely private system. I have had experience of such a system in the United States, and I find the idea of a health care system that is not free at the point of use absolutely repugnant, and would not support such a system. Given that the culture in this country has developed from our experience of the national health service, we have the chance to get the best of both worlds. A Government who talk about partnership and mixed provision show how Luddite they are on health when they totally deprecate individuals who want to take out private health provision for themselves or their families.

Certain conditions must be attached to any independent sector involvement. It must augment NHS provision, not seek to replace it, and it must increase the total capacity of available health care. It must be uniformly regulated, because it would be unacceptable for a Health Secretary to use public money to buy private health care that was not regulated and did not guarantee certain minimum standards that we take for granted in the NHS.

The most important change needs to come from the insurance industry. I have no private health insurance because, like many people, I believe that the private health insurance products on offer are too inflexible and heavily loaded, have too many exemptions and are too expensive. We need far cheaper and more flexible products which are accessible to a much wider range of our fellow citizens at all income levels. The restriction in that market holds people back from helping to augment the spend on health, which would relieve some of the burden on the NHS.

Dr. Peter Brand (Isle of Wight)

In continental Europe, there are compulsory insurance-based systems. Does the hon. Gentleman accept that that is not dissimilar to raising money through taxation, because people have no choice—they have to insure privately? What he advocates would work only if standards in the NHS—the publicly provided service—were such that people had an incentive to go private. What does he think might attract people to pay extra money on top of their taxes?

Dr. Fox

The hon. Gentleman confuses two issues: access and quality. What we should be able to have from the NHS is an absolute assurance that, if we or members of our family are ill, the most serious complaints will be treated first and within a reasonable time, and there will be no distortion of clinical priorities. However, it is perfectly acceptable that people may choose to spend their private incomes on any product that they choose, to buy convenience in health care with their post-taxation income, thereby relieving the burden on the NHS. What is wrong with a system that buys everybody the best of every possible world, while allowing us to get better value from the NHS?

Several hon. Members

rose—

Dr. Fox

I am conscious of the time and the fact that many hon. Members want to speak.

Our motion begins by discussing the first-class staff in the NHS. Sadly, however, they are increasingly first-class staff in a second-class service. Morale is very low, from GP recruitment to early retirement for consultants. Despite the Government's attempts to increase recruitment, we are short of midwives and nurses because we cannot retain them. We must increase the total amount that we spend on health. Some money can come from the Treasury, but not enough. We must encourage people to spend more on getting good health through prevention and other products—some 15.5 million of us buy private health insurance for overseas travel every year, and the ground does not open up and swallow us.

We need more doctors, not more spin doctors. The Government say that they want to think the unthinkable, but now they will not even think the thinkable. They are obsessed with monopoly provision in health, whereas in everything else they claim partnership and mixed provision. It is not the British Medical Association or the royal colleges that are bound by the dark forces of conservatism, but the Government through their health policies. Just as they resisted people's right to buy their council homes and to have their own pension funds, so they seek to deny us choice in the provision of our own health care. The Conservative party, not the Government, will genuinely set the people free.

7.37 pm

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

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof: applauds the dedication, skill and professionalism of the staff of the National Health Service but regrets that Her Majesty's Opposition seek to undermine the National Health Service at every turn; welcomes the Government's success in cutting waiting lists in line with its manifesto pledge and its programme to make services faster and more convenient; supports the Government's commitment to modernise cancer, heart disease and mental health services, and to ensure high standards of National Health Service care everywhere; notes that a modernised National Health Service funded through taxation and offering treatment according to need not ability to pay is both fairer and more efficient than private alternatives supported by the Opposition; and so believes that the National Health Service should be modernised not privatised.'. It is a privilege to stand here as a Labour Secretary of State for Health in a Labour Government committed to modernising the national health service, which a Labour Government created in the first place. Incidentally, the Conservative party voted against it not once, not twice, but 51 times.

The hon. Member for Woodspring (Dr. Fox) promised a mature debate. I am still looking forward to precisely that. What we heard tonight was a Conservative party committed not to the future of the NHS or to modernising it, but to demoralising it. It is committed to demoralising the public who use it and the dedicated staff who provide treatment and care day in, day out.

Sir Raymond Whitney (Wycombe)

The right hon. Gentleman started his career as Secretary of State for Health with the hoary old myth to which Labour politicians cling. Is he aware that the structure of the NHS was set out in the 1944 White Paper produced by the coalition Government led by a Conservative Minister of State for Health?

Mr. Milburn

I am aware of how the Conservative party voted when it came to push and shove: it voted against the NHS. Conservative Members entered the No Lobby 51 times. Indeed, some Conservative Members—[Interruption.]

Mr. Deputy Speaker

Order. Hon. Members must not shout across the Chamber.

Mr. Milburn

At that time, some Conservative Members warned that the coming of the national health service would bring about the demise of civilisation as we had known it. I believe, as do the staff and the public, that it has been the greatest civilising force this century.

Mr. Andrew Robathan (Blaby)

The Secretary of State talked about the future of the national health service. The debates to which he refers took place before I was born, and I am not young. He may be a little younger than I am, but it was before he and most of the people in this Chamber were born. Let us talk about the future instead of the past.

Mr. Milburn

I am happy to rise to the hon. Gentleman's challenge. It is our intention to build up the national health service, whereas the mantra that we have just heard from the hon. Member for Woodspring (Dr. Fox) is the new Conservative mantra for the NHS: talk it down, run it down, deny it can ever succeed. We all know that the national health service must change and improve—staff and patients also know that. It must be fairer, faster and more convenient. Yes, it must modernise, but no, it does not have to privatise. That is the difference between the Labour party and the Conservatives.

Mr. David Wilshire (Spelthorne)

The Secretary of State says that the NHS must be more convenient. In that case, why will my constituents be forced to travel further because our local accident and emergency department and 70 acute beds are to close? Services are being transferred out of the constituency. Does he consider that to be more convenient?

Mr. Milburn

The hon. Gentleman will recognise that changes in NHS structures and services are not a peculiar development of the past two years: they have been going on for the past 50 years or more, and will continue. We should welcome what is happening in the national health service. With the advent of new technology, such as telemedicine, and new treatments and drugs, more and more treatments are being brought closer to where people live. That is a welcome development.

I can give the hon. Gentleman a good example of that. Twenty or 30 years ago, patients with a stomach ulcer would have gone into hospital for invasive surgery, which would have been risky, and would sometimes have resulted in time off work or serious injury. Nowadays, such patients are treated with drugs. That is better, faster, more convenient and a good development. Those who say that we have an enormous problem with the NHS drugs budget and that it is growing exponentially forget that those new drug treatments are welcomed by patients and by staff. Such developments are not peculiar to the past couple of years. They have been part and parcel of the national health service for the past 50 years or more.

Mr. David Tredinnick (Bosworth)

Will the right hon. Gentleman give way?

Mr. Milburn

I shall make a little progress, and I shall allow the hon. Gentleman to intervene in a moment.

The hon. Member for Woodspring made allegations about fiddled figures. It is slightly galling to hear Conservative Members talk about fiddled figures, but I shall let that go for a moment. He made an allegation about Bradford, which was first raised in the House on 9 November 1998, and was repeated on 25 March this year. The hon. Gentleman knows that that allegation has no foundation in truth. He referred to metal plates. Patients go into hospital to have a plate inserted and subsequently have to have it removed. Of course they are not on a waiting list to have it taken out. On that logic, pregnant women would be on a nine-month waiting list. As the hon. Gentleman knows fine well, that is a planned admission.

The hon. Gentleman and his party seem to gain some perverse satisfaction from trying to convince people that the national health service is failing. What is worse, they try to convey the impression that it is bound to fail and can never succeed.

Mr. Gerald Howarth (Aldershot)

Will the right hon. Gentleman give way?

Mr. Milburn

In a moment.

The Conservatives present a catalogue of doom and a counsel of despair. There they are: Dr. Gloom on the Front Bench, and the doom merchants on the Back Benches. They are like some failed 1960s pop group. For each of the past 51 years, the NHS has proved the doom merchants wrong. It has coped with new ailments, new treatments, new drugs and an ageing population. It will go on coping for at least the next 51 years, but it will do that only by modernising and introducing new drugs and treatments.

There has been a lottery of care. The Conservatives were responsible for that when they created the divisive internal market. The uptake of treatments that work has been too slow, and the uptake of treatments that do not work has been too fast. We want fairer and more effective decision making in all parts of the national health service. That is why we established the National Institute for Clinical Excellence, new national health service frameworks and the Commission for Health Improvement. Our answer to those problems is not crude rationing decisions, but clear rational decisions. That is the difference between us and the Conservative party.

Mr. Howarth

rose—

Dr. Fox

rose—

Mr. Milburn

I shall first give way to the hon. Member for Aldershot (Mr. Howarth).

Mr. Howarth

The Secretary of State should not display such complacency. The Labour party is losing a lot of ground on this issue. How would he respond to my constituent who was diagnosed in February this year as requiring heart surgery? He was told that he would not be able to have that surgery until June or August next year. The reason given was that the Government have said that consultants should set themselves the objective of getting waiting lists down, not addressing clinical priorities. The Secretary of State had better beware, because the complacency that he has shown tonight will not go down well. He should respond to my hon. Friend the Member for Woodspring (Dr. Fox)

Mr. Deputy Speaker

Order. The hon. Member for Aldershot (Mr. Howarth) should not make a speech.

Mr. Milburn

There is no complacency on these issues. If the hon. Gentleman had bothered to listen, he would know fine well that one of the first things that I did when I became Secretary of State was to find new, extra money—

Mr. Philip Hammond (Runnymede and Weybridge)

It is not new money.

Mr. Milburn

It is new money. I made the first allocation from NHS budgets for next year. No money had been allocated for next year. I allocated extra money to speed up heart surgery—£50 million to pay for 3,000 extra heart operations. Surely the hon. Gentleman should have welcomed that, rather than run it down.

Dr. Fox

I counsel the Secretary of State against using the word "extra", because it has the same currency as "read my lips". He said that there was no rationing in the health care system. People would say that there is rationing if a new drug is not made available, and if some drugs are available in some parts of the country but not in others on the ground of cost. What is the right hon. Gentleman's view? Does he believe that there is rationing in the health care system?

Mr. Milburn

The national health service has always faced hard choices. That is the reality of life in the NHS. It is the reality for clinicians on the ground, and it is the reality for those of us who are charged with running the service. There has always been priority setting in the national health service, and there always will be. The issue is how priorities are set. We believe that priorities should be set on the grounds of effectiveness and what works. The difference between us and the Conservatives is that they want a system based not on what works, but on who can afford to pay for their care. That is the dividing line between Tories and Labour on health care. It is not about rationing: it is about rational decisions.

Dr. Fox

rose—

Dr. Brand

rose—

Mr. Milburn

I shall give way to a Liberal Democrat for a change.

Dr. Brand

The Liberal Democrats supported the National Institute for Clinical Excellence, and I support the Government's approach to rational decision making. However, hamstringing NICE by making affordability one of the criteria for NHS treatment is too restrictive. That decision should be made by politicians—the Secretary of State himself—rather than clinicians.

Mr. Milburn

Clinicians and managers throughout the national health service, whether in fundholding or other systems of care, have always had to decide how to align clinical and financial responsibility. What we are doing is helpful to clinicians. Doctors and managers on the ground want to know that when they take difficult decisions they have support from the centre. We are not abdicating responsibility—that is what happened under the previous lot. We take responsibility and make difficult decisions. I applaud my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), the previous Secretary of State, for the difficult decisions that he had to take on Viagra and Relenza. By and large, those decisions have been welcomed in the national health service.

Dr. Fox

rose—

Mr. Milburn

I shall make some progress, if the hon. Gentleman does not mind.

The truth is that, in the debate about rationing, the Conservatives' aim is to stimulate not a debate, but doubts. They do not believe that the national health service can cope, and they do not want the public to believe that it can cope. They want more people to be treated privately. The hon. Member for Woodspring was explicit about this, both today and in his speech yesterday, with which I shall deal in a moment. As the Prime Minister said in Bournemouth just a few weeks ago, we want a health care system that delivers care when people want it, where they want it—and we want it on the national health service.

The Opposition motion is the product of a strange Conservative form of selective amnesia. Since the Conservative party's visit to Blackpool, there seems to have been an outbreak of it. First, on that occasion, the Conservatives forgot even to mention their former Prime Minister, the right hon. Member for Huntingdon (Mr. Major). [Interruption.] It is true: they forgot to mention him. As you know, Mr. Deputy Speaker, slips are made in politics. These things can happen.

Secondly, the Conservatives managed to expunge from the record their former conference darling, the right hon. Member for Hitchin and Harpenden (Mr. Lilley)—he of the famous "little list". They now want to take that amnesiac approach to politics a stage further by conveniently ignoring their own record on the national health service. This must be the first occasion on which a political party has tried to airbrush itself out of politics. Well, the Conservatives may have forgotten what they did, but we have not—and neither have the staff of the national health service, or the public who rely on it.

Let me remind the Opposition of the Conservative record on health, and the difference that a Labour Government are making to the state of the NHS. When we came to office, the Tories had cut the number of nurses in training by more than 4,000. It is no use the hon. Member for Woodspring going on about the shortage of nurses; the Conservatives created that shortage in the first place. This year, following the biggest real-terms pay increase that nurses have had in a decade, the number of student nurses is at a six-year high.

When we came to office, investment in new buildings, plant and equipment was at a 10-year low. This year, the NHS capital budget is at an all-time high. The biggest new hospital building programme in the history of the NHS is now under way, and about 200 casualty departments and 1,000 GP surgeries are being modernised. When we came to office, the Tories had undermined the NHS and demoralised its staff by introducing the hated internal market. The motion deplores mismanagement; I deplore it too. That is why we have abolished the internal market in the national health service. That is why we have ended the two-tier system introduced by GP fundholding, and that is why we are putting doctors and nurses in the driving seat to share the task of providing health care in the future. In the process, we are freeing £1 billion from bureaucracy so that we can reinvest it in front-line patient services. Those are the public's priorities for the national health service, and they are our priorities too.

Dr. Fox

rose—

Mr. Milburn

I will give way to the hon. Gentleman, for the last time.

Dr. Fox

I am grateful to the Secretary of State.

As a matter of historical fact, can the Secretary of State tell us what proportion of this record capital spend on the NHS is due to PFI projects? Can he also tell us what was his party's attitude before the election?

Mr. Milburn

Let me tell the hon. Gentleman what my party promised in its manifesto at the last general election. We promised that we would rejuvenate the private finance initiative and make it work. The hon. Gentleman raises the issue of the private finance initiative in health at his peril, because the Conservatives had not done a single hospital deal by the time we came to office.

The hon. Gentleman talks of management consultants. The Conservatives spent £30 million on consultants' salaries and lawyers' salaries, and not a single hospital was built. We have the hospital building programme under way, through both the PFI and the public route. Communities throughout the country which have waited for decades are now seeing the building of new hospitals.

It is this Government, too, who have invested an extra £21 billion in the national health service. The hon. Gentleman skated over that today, which did not surprise me. After all, it was his party that described the extra spending as reckless, madness and irresponsible. Try as the hon. Gentleman might to rewrite history once again, his right hon. Friend the shadow Chancellor of the Exchequer gave the game away when he accused my right hon. Friend the Chancellor of being goaded on class sizes and waiting lists, and to have gone soft on spending. We are spending more; the Conservatives want us to spend less. We will take no lessons from them on the inadequacy of support for the health service.

Nor will we take any lessons on waiting lists. When we came to office, waiting lists were at a record level, and rising fast. Today, they are falling. They are already down by 69,000, and we will keep them going down. By the end of the current Parliament, they will be 100,000 lower than the level that we inherited. The hon. Gentleman says that I should abandon the promises that we made at the last election. That is the cavalier Conservative way with election promises. When we make promises, we keep them. Indeed, it is because of our success in getting waiting lists down that we are now able to move into the next phase of our modernisation programme.

Cutting waiting lists was always just the start. I want all aspects of NHS care to be modernised. We start with services dealing with our country's biggest killers, cancer and coronary heart disease. Those are my priorities for modernisation. In the last fortnight, I have been able to put more money into paying for extra heart operations, so that patients can gain quicker access to the surgery that they need.

The hon. Gentleman says that I did not announce the provision of 400 extra consultants. Let me tell him that I did. He should know that there is a difference between doctors in training and doctors in post. The Opposition are in training, while we are in post—and the same applies to my announcement.

Yesterday, I also announced more money for cancer services. The hon. Gentleman dismissed that as a gimmick, but it is £80 million of new, extra money, enabling cancer patients to obtain faster, fairer access to care. Let us hear no more from Conservative Members about the distortion of clinical priorities. The question for the hon. Gentleman is simple: does he support our efforts to modernise services dealing with the most severe clinical conditions, or does he not? The public support them; staff support them; patients with suspected cancer support them. They want faster, fairer care, and they know that it will be delivered by this Labour Government.

Miss Anne McIntosh (Vale of York)

Will the Secretary of State give way?

Mr. Milburn

I will give way one last time.

Miss McIntosh

Last week, the Secretary of State was kind enough to suggest, in reply to a question, that Shaun Johnstone should have had a brain tumour scan within two weeks. He was not given a scan within two months. The health service clearly failed him. Indeed, the photographer on the local newspaper in his home constituency—

Mr. Deputy Speaker

Order. Interventions should be brief; they should not be seen as opportunities to raise constituency matters at length.

Mr. Milburn

Let me repeat what I said to the hon. Lady last week at Question Time. I understand the circumstances surrounding the tragic case of Shaun Johnstone. I know that it has been looked into by the health authority, and I know that Shaun Johnstone' s parents have been advised that they should go to the health service commissioner, which is the right thing for them to do. Nevertheless, I repeat my promise to examine the case, and when I have had an opportunity to do so, I shall return to the hon. Lady.

Mr. Simon Burns (West Chelmsford)

Will the right hon. Gentleman give way?

Mr. Milburn

No, I will not.

It will take time, effort and investment to turn the national health service around, but, notwithstanding the allegation in the motion, the national health service is not getting worse; it is getting better. More patients are being treated, more doctors are being trained, more nurses are being recruited, more hospitals are being built and more services are being modernised. It will go on getting better each and every year that this Government are in office. No doubt, every step of the way, it will go on being talked down by the Conservative party. The Conservatives are determined to brand the NHS a failure.

Yesterday, we saw the clearest contrast between Conservative priorities for the NHS and Labour priorities. Yesterday, both the hon. Member for Woodspring and I visited NHS hospitals. I went to visit patients and staff in the cancer care unit at St. Thomas's hospital, which is opposite this place. He visited an NHS hospital in Burton-upon-Trent. I outlined plans for modernising England's cancer services. He outlined plans to get more people to buy private health insurance.

I talked about more money for the NHS. The hon. Member for Woodspring talked about pricing policy in private health care. I talked about national standards to end the lottery in health care. He talked about product standards in private medicine. What better contrast could there be—Labour creating a faster, fairer health service, available to all; the Tories encouraging a private, pay-as-you-go health system that is available only to a few.

The differences between Labour and the Conservatives on health have never before been clearer. They believe that improvements in health care can come only through an enhanced role for the private sector. We believe that improvements in health care have to come through the NHS. Only the NHS is capable of offering care on the basis of need, and need alone, not of ability to pay.

We now know what the next Conservative manifesto will mean for the national health service; the hon. Member for Woodspring has been explicit about that at least. He calls his approach the "silent revolution", although, as he told a conference fringe meeting just a few weeks ago: no one has really picked up on what it actually means". I can tell him. We have picked up on exactly what it means. I am determined that his secret revolution gets all the publicity that it deserves in communities throughout the land. He believes that the biggest problem we have in the NHS is that it is not a proper market". That will come as a bit of a surprise to NHS staff, who could not wait to get rid of the last market that the Conservatives introduced to the NHS.

The hon. Member for Woodspring says that the secret revolution could

revolutionise private insurance in the way we revolutionised pensions in the 1980s"— no doubt with the same impact. The Conservatives' secret revolution can be summed up in a simple phrase: not modernisation, but privatisation. It is a measure of how far today's Conservatives have moved from the political mainstream. They are prisoners of their own extremism.

Today's Conservatives have no ambition for the NHS. They do not feel comfortable with the NHS's values. They want market forces in a service that is founded on co-operative principles. Fifty years after they opposed the creation of the national health service, they oppose its modernisation. They deserve to be rejected now, just as they were rejected then. I invite my hon. Friends to do just that in the Division Lobby later.

Several hon. Members

rose—

Mr. Deputy Speaker

I remind the House that Madam Speaker has ruled that there will be a 10-minute limit on Back-Bench speeches.

8.3 pm

Mrs. Virginia Bottomley (South-West Surrey)

I congratulate the right hon. Member for Darlington (Mr. Milburn) on his appointment as Secretary of State for Health. For all the demands and pressures, I think that it is one of the most exciting and rewarding roles in government, but there is a profound difference between the way in which he sees the health service and the way in which many Conservative Members see it.

Behind the rhetoric, the Secretary of State knows the position. He consults the Organisation for Economic Co-operation and Development, the World Health Organisation and other international bodies, which believe that others are copying our changes in the health service over the past decade, the essence of which his party has endorsed. They include a focus on primary care, the introduction of a preventive strategy and greater efficiency: what is called corporatisation of hospitals. Those are all developments that, for all the rebranding and rebadging, his party has, with a lot of noise, endorsed. Evidence-based medicine was the labour of love, if we like, of my term of office. I am delighted to see it move forward with the service frameworks and the development of NICE.

Where the Secretary of State and Conservative Members differ is that he really believes that the service is getting better. It is a serious criticism of his party that, in office, he and his colleagues rarely visit constituencies of Members who do not belong to their party.

I spent many days in Darlington, Newcastle, Manchester and Leeds. I saw the investment in hospitals and primary care. I recognise the variations in health and the need for economic and social policies to address the problems, but I ask the Secretary of State and his colleagues to spend the same amount of time in South-West Surrey and other comparable constituencies. The degree of pessimism in the health service in my area and in those of many of my right hon. and hon. Friends is appalling.

I would have liked to have asked the hon. Member for Shipley (Mr. Leslie), who has now left the Chamber, an ethical question about private health services. If your child went to an accident and emergency department with a teacher or nurse—both have come to me in the past fortnight—was not seen after an hour and a half, and it was suggested that you took the child home, would you think that that was a good enough service? If mental health provision were so inadequate that a young man with developed schizophrenia burned his parents' house to the ground, even though they warned the services of his deteriorating condition, would you think that the service was good enough? If you spoke to a consultant, as I did today, who said that the situation has never been worse—

Mr. Deputy Speaker

Order. The right hon. Lady should not use the term "you" at such great length.

Mrs. Bottomley

I profoundly apologise, Mr. Deputy Speaker. The degree of emotion being generated in west Surrey is such that I want the Secretary of State to be aware of how desperate people feel.

The Royal Surrey county hospital has moved psycho-geriatric patients into surgical beds. Waiting lists are all rising. On the day that the Secretary of State's initiative on cancer was announced, a cancer specialist approached me saying, "Yes, we have to see people within a fortnight, but the surgery cases and chemotherapy waiting lists are both lengthening." On the day of the heart disease announcement, a doctor rang and said, "That is all very well, but the angiography waiting list has almost trebled in the past year."

The Secretary of State asks why I did not do anything. During my term as a Minister, I do not believe that I ever suggested that change would lead to a deterioration of services. No one in West Surrey health authority believes anything other than that services will deteriorate.

The ethical issue is: in those cases that I have identified, when a constituent says, "Should I go private if I can?", what is the appropriate response of the Member of Parliament? I have never believed that that situation would develop, but I have read the headlines of the local paper over the past month: Health chiefs must cut services by £20m by 2002. Anger at cuts in child health services. 'Blocked' beds put pressure on services. The funding raid on the home counties, which the Government describe as tackling inequalities, means that social services have lost £10 million. At the same time, the health service has a funding package that does not fund staff costs in an area with a high cost of living. It does not cover the cost of rents and all the other expenses in the area, which the Labour party dismisses as prosperous and treats in the same way as it treated the eight children from an independent school at its party conference. Other headlines state: A and E patients forced to wait up to 20 hours"; and: Hospital could be £1m in the red by March. I appreciate that Labour Members have little interest in areas such as the one that I represent. However, I wonder whether the right hon. Gentleman might have been concerned about recent newspaper reports that tour operators have been advising people visiting the United Kingdom to take out private health care insurance. When I held the right hon. Gentleman's office, a frequently heard quip—which no one ever challenged—ran, "If you're abroad and ill, what do you do? You come back to the use the NHS. If you're ill and a foreigner in Britain, what do you do? You use the NHS." Why, therefore, should tour operators, such as the German equivalent of the Automobile Association, now be advising people to take out private health insurance?

Nouvelles Frontieres states: People have had lots of problems seeing a doctor in Britain. With insurance they can see a doctor straight away. Portuguese tour operators have said that special health insurance was mandatory for the United Kingdom, but not for anywhere else in Europe. Elder Alves, of Top Tours, said: We always arrange health protection for people visiting London. We do not use NHS hospitals. The French Guide states: You have to have an appointment to see a doctor. Insist that it is urgent—otherwise you could end up being healed next week for this week's flu. Henri Menna said: I tell French parents to take out private medical insurance so they can have peace of mind. If the person contracts something serious or needs surgery while in England, it is better to get the person straight back to France, where the treatment and care are much better. Those comments should disturb Ministers and other Labour Members as much as they disturb Conservative Members.

If the reality is that the right hon. Gentleman cannot deliver services or provide adequate resources, it would be better to be courageous and say that there must be more co-payment and more explicit rationing, so that patients might know what is or is not available. Currently, however, people are being told to wait ever longer, and they are getting ever more worried about their inability to receive treatment. The situation is unacceptable.

Difficulties are being experienced not only by patients. The right hon. Gentleman will be aware that the problem of disillusioned doctors is bigger than ever before, partly because of the public sector salary structure compared with opportunities available for comparable graduates outside the public sector. However, the difficulties facing doctors, and Ministers' lack of realism, is causing doctors' frustration to become ever greater outrage.

Time and again, the Government's policy has been driven by the need to please No. 10 Downing street, with media initiatives such as supernurses, walk-in centres and NHS Direct. However, a telephone line will not help to cure the health service's problems. NHS Direct is perfectly all right, but it is essentially a trivial and marginal initiative. It is well known in the service that No. 10 Downing street drove that initiative, and imposed it on the previous Secretary of State for Health.

The right hon. Gentleman is about to encounter an extremely serious winter situation and all the problems caused by the new millennium. I do not know the accuracy of The Independent's report that the previous Secretary of State decided that seeking the office of London mayor would be preferable to facing the difficulties that he has left the right hon. Gentleman, but my—

Mr. Deputy Speaker

Order. Time is up.

8.14 pm

Mr. David Hinchliffe (Wakefield)

The Opposition motion demonstrates the remarkable narrowness of Conservative Members' views on health issues. In it, they make two key claims—first, that the waiting list initiative has damaged the national health service; and secondly, that there has been a

distortion of clinical priorities in favour of political targets". As the Secretary of State said, in their motion Conservative Members are sending a clear and quite profound message—that the Government's electoral promises do not matter. I accept that, for all political parties represented in the House, a sad fact of modern politics is that, frequently, hugely complex issues are slimmed down to one-line soundbites or pledges. Nevertheless, rightly or wrongly, an election pledge is an election pledge, and, like other Labour Members, I was elected on a waiting list pledge. Like my colleagues, I owe it to my constituents to ensure that the Government deliver that pledge.

Mr. Graham Brady (Altrincham and Sale, West)

Will the hon. Gentleman give way?

Mr. Hinchliffe

No, I shall not; I have only 10 minutes.

It is wrong for the Opposition to criticise the Government for trying to meet the commitments and promises that we made at the general election. None the less, politics seems to have reached that strange state.

What evidence has been presented to support the claims made in the Opposition motion? Supporting evidence from Opposition Members has been very thin. However, I am able to state that, in Health Committee sittings, I have seen evidence of distortions in the formulation of waiting list targets. I saw it in 1991, after the introduction of internal markets. The hon. Member for Macclesfield (Mr. Winterton)—who usually attends health debates, but is not here today—will recall evidence that we received from some trusts, which said that the internal market's emphasis on competition with neighbouring trusts had forced them into skewing their priorities. I am also able to state that I have seen distortion of clinical priorities in favour of political targets. It happened in my own constituency, when, under the previous Government, the two-tier fundholding system was operating and some of my constituents who were not patients of fundholders were denied operations.

It is remarkable that the Opposition motion makes absolutely no reference to wider health issues. Earlier, my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) raised the issue of public health—a fundamentally important issue, which, at long last, a Government are taking very seriously. In response, however, the shadow Secretary of State dismissed the public health issue as a sixth-form debating point. Nevertheless, the Government's amendment to the motion rightly mentions cancer and heart disease, which were dealt with at length by the Secretary of State.

Today's British Medical Journal report on the number of young women who die from heart attacks caused by smoking is also entirely relevant to the public health issue. Let us consider those figures, which the Tories have not bothered to quote today.

The fact is that, since 1950—during the lifetime of many hon. Members, including me—6 million people in the United Kingdom have died prematurely from smoking. The fact is that, every year, 120,000 people die from smoking-related illnesses. Smoking is the single most preventable cause of premature death.

In 18 years in government, what did the Tories do about those facts? They blocked successive attempts in the House to pass United Kingdom legislation preventing tobacco advertising. They also blocked European Union efforts to reach agreement on tobacco advertising. Why? They did so because they were paid to do so by the tobacco companies. They were in hock to the tobacco companies, and therefore have a direct responsibility for the vast numbers of people who have died prematurely in the United Kingdom. The Tories could have acted on tobacco in their years in government, but they regarded public health—the point that was raised by my hon. Friend the Member for Lancaster and Wyre—as a public school debating point.

I ask Conservative Members: who is calling the tune on their health policy? Who is paying for their policy? I have my own suspicions on that. Since the general election, implicit in every statement made by a Tory Front Bencher has been the desire to shift health care into the private sector. Their desire is now explicit, having been written into their document, "The Common Sense Revolution". In their proposal to shunt patients into the private sector, we have an explicit recipe for destruction of the national health service.

Mr. Brady

Will the hon. Gentleman give way?

Mr. Hinchliffe

I shall not give way.

I should like Opposition Members to answer one question that I have asked in probably every health debate since the general election. If people on a waiting list cannot be treated within the time set by whichever Government, possibly because there is a staff shortage in a particular hospital, what sense would it make to push them into the local private sector? That local private sector recruits entirely from the local NHS to treat those same patients. They will take the staff out of the NHS and shunt them into the private sector. It is a downward spiral that will lead to the destruction of a national health service in which the Tories do not believe and in which they have never believed.

The vast majority of the public, whatever their politics, believe in the basic principles of the NHS, as set out in the motion tonight. I wish the Government well in the process of rebuilding the NHS in accordance with those basic principles.

8.20 pm

Mr. Nick Harvey (North Devon)

I welcome the opportunity to participate in the debate this evening on the state of the NHS. When I looked at the motion, I could not help admiring the brass neck of the Conservatives in tabling it. As I listened to the entertaining and rhetorical speech of the hon. Member for Woodspring (Dr. Fox), I felt that one could have been forgiven for imagining that all the catalogue of problems—

Mr. Hammond

Will the hon. Gentleman give way?

Mr. Harvey

I have barely begun. The hon. Gentleman will have to give me a chance to get started.

I felt that one could have been forgiven for believing that the catalogue of problems that the Conservative spokesman ran through had magically commenced on 1 May 1997, and had come about in the last couple of years. Nothing could be further from the truth. The fact is that the Conservatives caused many of the problems that have been described this evening. Having passed them over—albeit reluctantly—to Labour two and a half years ago, their motion does not seem to have come up with any new solutions.

Apart from the idiosyncratic ideas of the hon. Member for Woodspring about private health care insurance policies, we heard nothing new tonight. I could have been forgiven for closing my eyes and thinking that this debate was indistinguishable from an Opposition day debate before the last election.

It all boils down to a question of resources. The NHS Confederation has been warning that the significant problems that authorities and trusts face in the coming winter will come about because there has been a history of ruthless year-on-year slicing and efficiency savings which has gradually stripped the system of flexibility and has eaten into service quality.

We hear from the Government that £21 billion is going into the NHS. That is a large sum of money which, on initial inspection, seems generous. However, when one looks more closely at the figures, one realises that it is not as much as it sounds. One must consider that, for the first two years of this Parliament, there was a freeze on public expenditure. The Government stuck to Tory spending plans—which it was highly improbable the Tories would have stuck to themselves.

As the £21 billion is measured out throughout the remainder of a four-year Parliament, we see that the Government will not even have increased spending on the NHS up to the same standard, year-on-year, as the Conservatives did during their 18 years in office. When we take out a few spoonfuls from the £21 billion pot to pay for the latest Government initiatives, we see that the pot shrinks even further.

The Government come up with eye-catching initiatives which keep the spin doctors happy, but do not result in improvements in the NHS. Some of the initiatives are good ideas. NHS Direct—although it would have been better to have done it on a local footing—undoubtedly contains the kernel of a good idea. However, the extra funding needs to go to the basic bread-and-butter service before we start having Government wheezes and initiatives which, frankly, amount to honey on top.

As we look forward to winter, reports are coming in that trusts are being forced to overspend, and many are running up deficits that are much bigger than expected. This news comes five months before the end of the financial year, and before we know the scale of the problems that the coming winter may bring with it. More resources are needed.

I agree with the call by the hon. Member for Woodspring for a rational debate on the issue of rationing, and I was depressed to hear the Secretary of State, yet again, dodge the questions about rationing. Of course there is rationing in the health service—there always has been and there always will be.

The Government should define clearly the constraints that are presently applied in the rationing of resources within the NHS, and they should take full responsibility for the decisions that have to be made within national guidelines. It may be a question of semantics or vocabulary but, in my opinion, that amounts to rationing. We need to have national policies that patients and members of the public understand—for example, on infertility, cosmetic and obesity treatments, and a variety of other issues.

I was depressed to hear the Secretary of State dodging this matter by hiding behind decisions that will be taken by the National Institute for Clinical Excellence. NICE should stick to the remit that it was given when it was set up—of looking at clinical effectiveness and cost-effectiveness. It may be semantics again but, in my view, there is a fundamental difference between cost-effectiveness and affordability. Some things can be cost-effective and yet very expensive. When the White Paper set up NICE, affordability was not included as one of the criteria for the body to consider. When the chairman of the body took up his task, he emphasised that point in response to questions put to him at the time.

This evening, the Secretary of State surprised us by saying clearly that it is already the role of NICE to consider issues of affordability. That is the Government dodging decisions that they ought to take. I disagree with the general thrust of some of the other remarks this evening—the Government should be making such decisions on a political basis, having received from NICE expert advice on clinical efficiency and cost-effectiveness. The issue is becoming confused.

I would welcome a broader look at what constitutes cost-effectiveness. It should not be a question simply of what the NHS's current budget can afford, but rather what UK plc will have to pay out as a result of decisions. For example, there may be a variety of treatments that would enable people to get back to work—and which would save money on benefit bills and housing provision by local authorities—which should be incorporated into any true consideration of what constitutes cost-effectiveness.

I welcome the fact that the Minister with responsibility for public health has a role in considering public health issues that will rove across Departments, but I cannot understand why the same cannot be true when we look at cost-effectiveness issues.

I wish to refer also to the tension that arises following the central diktats launched by the Department of Health, and the difficulties that these cause to the local providers who must carry them through. The Government are forcing health care suppliers to fund some of their well-spun schemes without providing adequate resources.

I listened with interest to the comments of the hon. Member for Woodspring. I agree with those who have suggested that the basic Conservative prescription for increasing health care provision seems to be an expansion of private health insurance. However, I was puzzled by the logic of the hon. Gentleman's case. Some of his comments about the shortcomings of private health insurance policies were right. I understand why they are unattractive for many people. However, I do not understand how a modification of those policies would suddenly make them vastly more attractive to great swathes of the population, unless the NHS was so unappealing and unattractive that people felt driven to go to such lengths. If we follow his logic, he was almost arguing—I am not suggesting that he said this—in favour of maintaining long waiting lists to encourage people to make provision for themselves in the private sector. As an hon. Friend said to me yesterday, that is replacing rationing by postcode with rationing by tax code, which is no more desirable than the current situation.

Mr. Brady

The hon. Gentleman is right to draw attention to the problem. However, that is what is happening under the current Government. I have a constituent who has paid from his life savings to have a life-saving operation because he could not put up with the ludicrous waiting lists that the Labour Government were inflicting on him.

Mr. Harvey

It is certainly true that with the current long waiting lists, some people are paying to go into the private sector. I do not query what the hon. Gentleman says about that. However, the thrust of his hon. Friend's case seemed to be that there needed to be a great increase in the extent to which people were making such provision for themselves. A better objective would be to run the NHS so well that such provision became less attractive.

I also congratulate the Conservatives on taking up the issue of waiting times. It is not an entirely original idea that they seem to have come up with over the past few weeks. The Scottish Administration formed in May after an election campaign that addressed those issues decided that their performance should be judged by waiting times, not by the number of people on waiting lists. It is common sense that the key issue for a patient awaiting care is how long they have to wait: first how long it takes to see a consultant; then perhaps how long it is before they can have a scan or some diagnostic measure; and then how long they spend on the waiting list that the Government measure. Although there have been some extreme comments this evening about the manipulation of figures, it is not a fair assessment of the performance of the NHS simply to look at waiting lists for in-patients and not to consider the growing waiting lists for out-patients.

Mr. Hammond

For the record, will the hon. Gentleman clarify his party's current estimate of the amount that would have to be added to income tax to deliver, from taxation, the NHS that he feels that the British people deserve in the 21st century?

Mr. Harvey

One cannot bring about the service that one wants to build in the longer term on the basis of this year's or next year's income tax revenues. We have to invest over time to make good the underinvestment that has been going on for decades. Over time, we have to move towards the proportion of gross domestic product that other European countries spend on health. I agree that the private sector must be counted in that. We have to make progress towards the European average if we are to have health provision comparable with that in our competitor countries and put right the problems to which the right hon. Member for South-West Surrey (Mrs. Bottomley) referred in her comments about travel agent's brochures.

Sir Geoffrey Johnson Smith (Wealden)

The proportion of GDP spent on health care through the national health service is about the same as that spent on the continent. The difference between spending on the continent and spending here is accounted for by the private sector.

Mr. Harvey

That is simply not true. Our spending is about 2 per cent. lower than the average of other European Union members. The split between public and private provision differs from country to country, but on the total spent we are trailing well behind our competitor nations. I am sorry to disagree with the right hon. Gentleman, but that is the fact.

The Secretary of State asked the Opposition to say whether they welcomed the new focus that he has adopted in the past couple of weeks. I should like to make it clear that I do. I hope that he will address the worrying gap between the level of care for cancer patients in this country and that in our competitor nations. Patients and the general public will welcome having those priorities mapped out clearly. If the new cancer tsar, Professor Richards, is to make the progress that we all want, he will need a full increase of resources behind the surgeons to whom the Secretary of State has already referred. That includes nursing staff and equipment. I agree with the comments from the Conservative Front Bench. There have been many representations from health service professionals about the state of the equipment used for cancer care. That will all be important to the work that the Secretary of State is trying to do, and I fear that there will be no scope for recycling any money already committed; the money will need to be genuinely new. Indeed, in planning a work force capable of delivering the new priorities, we must consider what staffing levels throughout the profession will be required.

The Secretary of State talked about the increase in nursing salaries. Certainly the sharp increase in salaries for new nurses is welcome. As the right hon. Gentleman rightly said, that is beginning to have an impact on recruitment into the profession. However, retention is equally important. If we are to solve that problem, we must do something about salaries for existing nursing staff. There have been some examples of new staff earning almost the same as experienced staff. It costs about £33,000 to train a nurse, and £5,000 to replace one who leaves the profession; that figure covers recruitment costs, agency costs and so on. We must think about cost-effectiveness in a broader sense, because spending on nurses can save money.

We also need more nurse-led care, more prescribing by nurses and more specialist nurses. In addition to the impact that that would have on efficiency and on the economics of the national health service, it would also encourage nurses to stay in the profession and relieve some of the pressure on doctors. I was pleased to hear about the GP practice in Derbyshire that is run entirely by a nurse, who sees the patients first and employs a GP to whom she passes them if she thinks it is appropriate and necessary.

Ultimately, without additional funding the NHS cannot remain comprehensive, high quality and free at the point of entry. In the longer run, however, funding the NHS could save other Departments money. When we think about the winter ahead, and the sort of problems that are piling up, including the fact that one quarter of the trusts say that their financial position means that they will have to postpone or cancel developments in the Government's priority area of mental health, we realise that the immediate problems are very serious.

Expecting trusts and authorities to go through the process of efficiency gain and to continue to come up with savings year on year on year is simply causing additional problems, and adding to the problems that we already have is no solution to the headaches that those who try to provide our health service are already experiencing.

8.38 pm

Mr. Stephen Hesford (Wirral, West)

Having heard the hon. Member for North Devon (Mr. Harvey) speaking on behalf of the Liberal Democrats, I cannot help observing—this is an old one but a good one—that in the health debate, the Liberal Democrats have bladder trouble again. I am talking about a continuation of the longest "pee"—[Interruption.] I shall take no lessons from them when they talk about funding.

The Conservatives, as well as the Liberal Democrats, have a problem. We heard nothing from their Front-Bench spokesman about spending—nothing about the £21 billion that the Government have placed before the nation to be spent on the national health service over three years. The Conservatives do not talk about that, because they cannot say what they would do.

We heard nothing about the Health Act 1999, either. I had the honour and good fortune to serve on the Standing Committee on that Bill, so I know that one of the reasons why the Conservatives will not talk about it is that they have lost the argument about the structure. In Committee, they talked for hour upon hour about how abolishing fundholding would be the ruin of the health service. Yet we have heard nothing about that today. The Conservatives do not mention it any more, because they lost the argument, and the argument has now moved on.

We heard nothing from the hon. Member for Woodspring (Dr. Fox) about mental health services. He said that he wanted a mature debate, so why did he not welcome the national frameworks that the Government have recently introduced for major sectors of the health service? My right hon. Friend the Secretary of State for Health mentioned public health. If we are having a mature debate, why did the Opposition not welcome "Saving Lives: Our Healthier Nation", the White Paper that addressed that very issue?

The present Government are the first to consider the effects of ill health when determining health policy. Why do we hear nothing from the Opposition about the wider health debate, including the effect of the new deal on poverty? We hear nothing about the national minimum wage, because the Opposition have lost the argument. We hear nothing about the working families tax credit, which will make work pay for families and do much to reduce ill health.

Shamefully, we heard nothing from the hon. Member for Woodspring about staff. In a debate on the health service, he failed to welcome the commitment and dedication of the staff. The Opposition are too churlish to welcome the Government's investment programme which will provide more nurses after years of cuts in nurse numbers under the Tories' regime.

The hon. Member for Woodspring mentioned his theory that private health insurance would get extra money into the national health service. Several powerful criticisms of that approach have been made already, but they are worthy of reiteration. Private health insurance would mean a massive boost for the Tories' friends in the City in the health insurance market. That is one of the byproducts of that approach.

Mr. Brady

Will the hon. Gentleman give way?

Mr. Hesford

No, because I have only 10 minutes. My right hon. Friend the Secretary of State made the powerful point that the Tories were not trusted after the mis-selling of private pensions, so why should they be trusted on the idea of health insurance?

The hon. Member for Woodspring did not mention what it would take to attract people to private health insurance. One curious theory, expounded by the hon. Member for North Devon, was that waiting times would be lengthened to force people into it. That is one potential method, but what else could be done?

The method that dare not speak its name was revealed by the hon. Member for Rutland and Melton (Mr. Duncan) when he made a speech in March 1999 to the Social Market Foundation as a shadow Health Minister. He gave the game away about using tax relief to encourage people to take out private health insurance, although the Opposition seem since to have suffered collective amnesia on the issue. They do not talk about it because of the cost implications. It would cost between £500 million arid £1 billion a year to achieve the take-up of private health insurance that the hon. Gentleman talked about.

I would be grateful if the hon. Member for Runnymede and Weybridge (Mr. Hammond), who is to reply for the Opposition, could deal with that sort of costing. It flies in the face of the tax-cutting agenda that his hon. Friend the shadow Chancellor discussed. So much for the Opposition.

The right hon. Member for South-West Surrey (Mrs. Bottomley) described what goes on in her constituency, but I will not take from her that doom-and-gloom-merchant view of the health service. I visit my local hospitals, see my local primary care groups and talk to the local trusts. I know what the health service is achieving in my constituency and how the Government's agenda sits very well with the people with whom I speak. I very much welcome the Government's modernising agenda.

In the Wirral, we will get a walk-in centre, which will reduce waiting times and lists for patients. We have been allocated £800,000 to modernise our accident and emergency unit. The Opposition do not mention that. Waiting lists are down in my constituency and I have received no letters from constituents complaining about shorter waiting lists. It is nonsense to say that we should not honour that commitment, as has been said rightly and powerfully in this debate.

My local hospital, Arrowe Park, which does an excellent job, is to get a new 12-bed unit to help deal with winter pressures. We are part of the Merseyside health action zone, which returns me to the public health agenda. On the Wirral, we are considering occupational therapies to get those who are suffering from long-term ill health back into employment.

I will end on this note. My right hon. Friend the Secretary of State for Health said that this debate is fashioned around the idea of year zero—the idea that the Conservatives were not in power for 18 years. Their collective amnesia is—

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. I am afraid that the hon. Gentleman must end now. I call the hon. Member for Spelthorne (Mr. Wilshire).

8.48 pm

Mr. David Wilshire (Spelthorne)

My constituents are growing weary of the NHS propaganda that this Government are pumping out. My constituents are getting less money, not more, they are getting a worse and not a better service, and their interests are being sacrificed on the altar of financial cuts and provider convenience.

The Government's propaganda machine drones on and on about more money for all, but the truth in Spelthorne is the exact opposite. West Surrey health authority's pro rata share of the much hyped £20 billion would be £5 million a year. Instead of getting that £5 million, the health authority has been ordered by the Government to make £20 million in cuts in the next three years. Those are real cuts—the ending of real services—and not merely getting £20 million less than the authority thought it needed. That is a total disgrace. So much for the propaganda about more money for the health service under Labour. Spelthorne is the victim of one of those Labour lies.

The Government's propaganda machine drones on and on about better services for all. Again, the truth in my constituency is very different. West Surrey health authority is savaging services in my constituency in order to cut expenditure. The total pay bill is being cut by 4.6 per cent. The hon. Member for Wirral, West (Mr. Hesford) said that he had heard nothing about staff from Conservative Members. However, I can tell him that in my constituency the cuts will mean fewer nurses and doctors. That is the truth about Labour's national health service. It is the real message about staff that the hon. Gentleman ought to hear.

West Surrey health authority is cutting spending on surgical, medical and intensive care services by £775,000 a year. It is also cutting spending on clinical support services by £1.6 million a year. I am talking not about savings through modernisation or through cutting overheads, but about cuts to front-line services. The consequences of those cuts for Ashford hospital in my constituency include the closure of the accident and emergency department, and the loss of all its intensive care beds and of 70 other acute care beds.

That is the truth of what is happening in my constituency. The House need not take my word for it. When one of the consultants in my constituency was asked what the cuts would mean, he said that they would lead to increased suffering and inconvenience for patients. He added that a few of those patients would die as a result of the cuts. So much for better services under Labour: Spelthorne is the victim of yet another Labour lie.

The Government's propaganda drones on and on about putting patients first, but once again, the truth in my constituency is very different. The Government say that services should be provided where patients want them, and the Secretary of State spoke today about convenience. However, the closure of local services in my local hospital—for purposes of saving money for the health service and of provider convenience—is forcing my constituents to travel ever further.

The Government say that patients will get the drugs that they want. There has been a lot of hype about that, but my patient care group has been told by my health authority to restrict prescribing in order to cut costs. The Government go on and on about how patients will be referred to the most suitable consultant. However, my PCG is being told to restrict referrals, again in order to cut costs. So much for Labour putting patients first: yet again, Spelthorne is the victim of another Labour lie.

One other truth needs to be taken very seriously, and my constituents know all about it. That truth is that the Labour Government are very willing to play party politics with the NHS in my constituency. Earlier this year, the proposals to cut £20 million worth of services were being drawn up. They were ready to be published when the edict from on high came down prohibiting their publication until after the European elections. We know why that happened, but I am happy to say that my constituents are sensible. They were able to rumble the Government's ploy to protect the Labour position in those elections. Fewer than 4,000 of the 70,000 electors in my constituency voted Labour, because they knew the truth about the Government.

On top of all that, my local health authority has told me that the Government were pressing it only last week not to make any concessions to the local opposition to the cuts that are being made. That is because when the matter reaches the Secretary of State, he will wish to disguise the cuts that he will make by offering sweeteners that he knows my health authority is thinking about. That sort of politicking disgusts me and my constituents.

The Labour party needs to understand another truth: however hard the Government spin and no matter how much propaganda they pump out about the health service, patients will always know the truth. The truth will out. The truth is that my constituency has less money than it did when the Government came to power. We have worse services than we did when the Government came to power. Once the cuts are made, Spelthorne will have fewer doctors and nurses than it did when the Government came to power.

It is time Ministers understood a few simple truths. I shall offer just two tonight: first, propaganda will not cure cancer; and secondly, it is time the Government stopped picking on people just because they vote Conservative.

8.56 pm

Ms Oona King (Bethnal Green and Bow)

I commend the Opposition for choosing the national health service for debate. If there is one thing on which both sides can agree, it is the importance of health.

I am afraid, however, that my conciliatory approach might have to end at that point. Those who know me know that I do not engage readily in party political point scoring, but I was astonished by the speech given by the shadow Health Secretary, who did nothing but score points. Frankly—if foolishly—I expected a tiny bit more of him. I was particularly shocked when he described the statement by my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) that poverty causes ill health as a cheap sixth form debating point. If that is the starting point taken by the hon. Member for Woodspring (Dr. Fox), I welcome this debate because it gives everyone the chance to see the Opposition score yet another spectacular own goal.

The debate also gives me the opportunity to challenge the Opposition on why they want to see an end to specific improvements to the quality of service that the Labour Government's actions of the past two and a half years have already brought about. I shall turn later to improvements in my constituency.

Meanwhile, what is the latest wheeze dreamed up by the free marketeers at Conservative central office? What do they have in store for the national health service? We have heard all about the patient's guarantee. When I first heard the Leader of the Opposition talk about that, I let my imagination run wild. Perhaps, I thought, the Tory party has undergone a collective conversion on the road to Damascus. But then I read the small print—which, incidentally, hundreds of thousands more of our pensioners are able to do because of the Labour Government's restoration of free eye tests for the over-60s—and found that the Conservatives are offering nothing but a massive expansion of private health care. The policy is simply a way of fanning out NHS treatment to the private health sector. It is back-door privatisation, an assisted places scheme in health care that will be used to subsidise private medicine for the privileged few.

The only guarantee that patients would receive from a Tory-run NHS would be a health service based on where the patient lives, who the general practitioner happens to be and—worst of all—the patient's ability to pay. Fortunately, while the Tories dream up ever more bizarre ways to flog off the NHS, the Labour Government are introducing modernising reforms alongside massive new investment that will underpin the quality of service. That fact cannot be disputed: my constituents are doing amazingly well out of the Government's commitment to the NHS—

Mr. Wilshire

Mine are not.

Ms King

If the hon. Gentleman wants to intervene, I shall be happy to give way. What is his point?

Mr. Wilshire

I wish that the hon. Lady had listened to what I said. My constituents are suffering as a result of her Government's actions.

Ms King

I find it astonishing that you say that your constituents can be suffering after a—

Mr. Deputy Speaker

Order. I remind the hon. Lady that she must speak in the third person.

Ms King

I find it astonishing that the hon. Gentleman says that his constituents are suffering under a Government programme that has put £21 billion extra into health, to which his party has objected.

Mr. Brady

Perhaps I can explain the situation both in a way that will please the hon. Lady's side and to my hon. Friend the Member for Spelthorne (Mr. Wilshire). The reason why my hon. Friend's constituents and mine are losing out although the hon. Lady's are gaining is precisely because the Government have changed the allocation formula. They are transferring money to less privileged areas from other parts of the country. The problem that I have with that is simply that the Labour party was not honest and did not say at the election that that was what it intended to do. It did not tell my constituents that they would lose health service resources.

Ms King

I find it amazing that the hon. Gentleman is pointing out the very well known fact that we believe that health resources should be allocated on the basis of need. Yes, we do, absolutely, and we are proud of it. I shall come to the funding allocation—[Interruption.] I have given way, if the hon. Member for Spelthorne will allow me to proceed.

Let us examine the improvements that my constituents have seen. Conservative Members will be aware of improvements up and down the country in Tory-controlled health authorities as well. They are well documented and they have shown a move away from the political engineering in which the previous Government were so quick to engage.

In Bethnal Green and Bow in Tower Hamlets, East London and the City health authority is receiving an additional £37 million to spend on local health services. That is an increase of 8 per cent.—something that could only have been dreamed of under the previous Administration. Yet all the increased funding is opposed by the Conservative party, with its blanket claim that the funding is reckless.

In Tower Hamlets we will get a brand new 900-bed hospital on the site of the Royal London hospital at Whitechapel. That is part of the largest hospital building programme ever known in this country. Again, it is opposed by the Conservative party.

The health action zone in Tower Hamlets is enabling health service professionals to introduce innovative approaches in partnership with other agencies to tackle ill health among our children and young people, to reduce deaths and illness from heart disease and strokes, and to improve the quality of life for those with mental health needs. Again, all of that is opposed by the Conservative party.

Basically, as far as I can work it out, the Tories do not have a policy to improve health. They have a policy of entrenching ill health among ordinary people. So I am rather less interested in what they have to say and instead I would like to look at how we can continue to deal with the health inequalities that the Government have so vigorously been tackling.

First, we need to increase access. That is high up the Government's agenda. Access to health care in the poorest areas is denied to many people. Some of my constituents have problems, whether cultural or language problems or just social exclusion pure and simple. Those problems prevent their access to health care.

A second point about which we do not often hear much is the need to link health care initiatives and regeneration. It is an important point, which the new deal for communities is tackling.

Thirdly, there is a need to break down health departmentalitis. That is one of the main aims of the health action zone. The best thing about the HAZ is that for the first time the Government have embraced, in a way the previous Government never could or would, the wider definition of ill health and its causes, such as poverty. That brings us back to the point made by my hon. Friend the Member for Lancaster and Wyre. I welcome the Government's approach. If we are to help the poorest people in the poorest areas, we must ensure that the amount of funding that the health authority attracts reflects the number of people who live in an area rather than the number included in the census. I hope that we can ensure that the index of deprivation plays a key part in the funding formula for health authorities.

Finally, the Government, and, indeed, the Prime Minister, have made it clear that these cash increases are not a one-off flash in the pan such as those that the Tories used to throw at us during the year before an election; rather they are sustainable, year on year, to increase access and quality of treatment, so that the NHS is once more the envy of the civilised world.

9.5 pm

Mr. David Amess (Southend, West)

Yes, there is a crisis in the national health service, but it is not only there. I must inform the hon. Member for Bethnal Green and Bow (Ms King) that there is also a crisis in education in Southend, where class sizes are growing and we do not have enough places for our secondary schoolchildren. There is a crisis in policing—[HON. MEMBERS: "What about the health service?"] I shall come to the health service in a moment. There is a crisis in foreign affairs, but, above all, there is a real crisis in the national health service. [Interruption.] Does the hon. Member for Harrow, East (Mr. McNulty) want to intervene from a sedentary position?

Last night, I spent a little time in the House of Commons Library, where I was referred to the comic section. There, I found the Labour party manifesto for the 1997 general election. After reading it, I felt physically sick. Obviously, many people have read that manifesto recently because it was well thumbed. It is headed: Britain will be better with new Labour. It states: Our case is simple: that Britain can and must be better. Turning to page 20, we read that Labour will "save the NHS". I hope that the Secretary of State for Health will soon return to the Chamber because he needs to read that manifesto. In a moment, I shall deal with both the present and the past ministerial teams.

It is garbage for Labour to claim to be saving the national health service. It should now be stated that after nearly three years of this wretched Labour Government, it will be left to the incoming Conservative Government to save the national health service. After all the drivel that the Secretary of State came out with about the Labour party being responsible for the NHS, I am extremely glad that my right hon. Friend the Member for Wealden (Sir G. Johnson Smith), who is somewhat older than the present Secretary of State, and my hon. Friend the Member for Witney (Mr. Woodward) were quietly able to put him right on precisely who was responsible for the national health service.

In the Labour manifesto, we were told that the NHS

is under threat from the Conservatives. We want to save and modernise the NHS. The document states that

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. There is much that I could say about that. When we turn to the next page, we see an attractive picture of some chap looking at X-rays, with the caption: We'll spend more on patient care and less on NHS red tape. There are also the five daft election pledges, which Labour tells everyone are being honoured, but they are not; it is merely that the goalposts are being completely changed.

Finally, the manifesto refers to our contract with the people and states "save the NHS". It continues: Over the five years of a Labour government … we will rebuild the NHS"— no; the Conservatives will have to rebuild it—

reducing spending on administration and increasing spending on patient care. The Labour party—new or old—should be thoroughly ashamed of all that nonsense.

As for the past ministerial team, I become extremely angry when Labour Members try to portray the Conservative party as never having any interest in the health service. I do not have private health insurance, although I wish I did. However, at present, I do not earn enough to afford it—I hope that I am not bombarded with application forms for it.

It is wicked for Labour Members to try to portray the Conservative party as uncaring. It is interesting to note that, after nearly three years in government, Labour Members are becoming annoyed for being blamed for things going wrong in the NHS. For 18 years—day in, day out; week in, week out; and month in, month out—as soon as someone died, it was all the fault of the Conservatives; Labour Members never worried about the effect on the relatives. Any problem in the national health service was the fault of the Conservative Government. After three years, Labour has been found out, and I do not believe a thing that Government Members say.

On 10 July, we were treated to an interview in The Daily Telegraph with the former Secretary of State for Health, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). When asked about his job, he said: I'm the Health Secretary, not Jeffrey Archer. I love my job and hope to have it for a very long time. At the end of the interview, he said: It's the only job I have ever wanted". When interviewed on live television about the Dick Whittington job, he had the cheek to say that he had been doing a rather good job as Health Secretary—in case you had not noticed, Mr. Deputy Speaker. I am a member of the Health Select Committee, and when the right hon. Gentleman and his Ministers appeared before us I found their so-called responses to our questions deeply disappointing. I am looking forward to dealing with the new ministerial team—I note that the Committee Chairman, the hon. Member for Wakefield (Mr. Hinchliffe), is in the Chamber.

My hon. Friends will be aware that the Government are seeking to present a new health care image. We have a new team and a softer, gentler image. There will be no distasteful jokes told at big functions, which was the habit of the previous incumbent. The Government's approach to health care will be more sophisticated in the future; this is a new start. However, I think that the new incumbent will find it difficult to distance himself from the original policy. He was a Health Minister after the general election, and I have pages and pages detailing his recent remarks as Health Secretary. I do not take anything that Government Members say at face value—I get the truth from the Library—and I think that the new Health Secretary will regret some of his comments.

Labour has undoubtedly broken many promises and let the public down. As shadow Health Secretary, the present Secretary of State for Culture, Media and Sport said that there would be no upheaval in the NHS. Yet Dr. Ian Bogle described the pace of the Government's health reforms as "frightening" and said that doctors were apprehensive and fearful for their future". The right hon. Member for Camberwell and Peckham (Ms Harman) said that Labour would cut NHS waiting times—that is a joke. In March 1997, 30,100 patients waited more than a year to be seen by a doctor, and that figure has now increased by 63 per cent. Many of my hon. Friends have described the growth in NHS waiting lists.

In Southend, we see the result of Labour's policies at first hand. Since Labour came to power, waiting times for radiology treatment, and particularly barium enemas, have increased dramatically. That is a serious matter. I am advised that the problem has arisen because the hospital has had to divert one radiologist from the barium list to mammogram sessions. That is a direct consequence of the two-week waiting time edict for breast cancer treatment and a good example of robbing Peter to pay Paul.

There are no secrets about the health service: unless Labour puts up taxes, which it is loth to do for popularity reasons, it will fall on its sword. I am concerned for Mrs. Sara Ashworth who, at 93, is awaiting a cataract operation. I am advised by my local hospital that she will have to wait between 15 and 18 months—which, at 93, is a hell of a long time. I am very concerned about Mrs. Ena Pluckrose who lives opposite me. She is in her eighties and looks after her husband who is in his nineties. She has been told that she is being moved to the "soon" category, which means that she will be waiting 12 to 15 months.

There is a crisis in the NHS and I blame the previous Secretary of State, the present Secretary of State and, most of all, the leader of the Labour party. The sooner he and this wretched Government lose the next general election, the better.

9.15 pm

Dr. Howard Stoate (Dartford)

I have listened to the debate with great attention and interest as this subject is dear to my heart. I am one of only two general practitioners who are Members of the House; the other, who is sitting opposite me, is listening closely as well.

The Opposition have played their usual tricks, which has rather disappointed me. I was hoping for an intelligent and adult debate, as billed by the Opposition spokesman, but unfortunately his words did not match his intentions and what we heard from them was not intelligent or enlightening discussion but a series of tricks to run down the NHS, demoralise staff and frighten patients into believing that the NHS is falling apart around their ears. The truth is exactly the opposite. I am becoming well versed in parliamentary ways, and I was afraid that that might happen, so I took the precaution of phoning around my health authority, my trust and my local primary care group yesterday and today to find out exactly what is happening in my patch, which is in the West Kent health authority area. It is not noted for its left-wing leanings or views and, in the main, is represented by Conservative Members, so the allegation that the Government are rigging the NHS in favour of Labour-controlled areas is nonsense. I shall give examples to back that up.

My local hospital told me that its waiting list stood at 4,395 on 31 March 1998. By 30 September 1999, the figure was 3,429, which is a 22 per cent. decrease, with no patients waiting more than 18 months and all Department of Health targets being met.

I asked about recruitment, which is often mentioned.

Mr. Brady

Will the hon. Gentleman give way?

Dr. Stoate

I am afraid that I do not have time. I have a lot to get through and, unfortunately, only 10 minutes in which to do it.

I was told that there was no problem in recruiting junior doctors and that consultant posts are generally well filled, apart from one in radiology. There is a national shortage of radiologists and the problem is being addressed by the trust as that post is currently covered by a locum. The trust is short of 70 nurses and has planned a recruitment drive for the new year, but it told me that that figure is considerably better than it was.

Today, West Kent health authority has published its annual report, which is entitled "West Kent's Health" and headlined "A Healthier West Kent". The area contains places such as Sevenoaks, Tunbridge Wells and Maidstone, which are not represented by Labour Members. Nevertheless, it is doing extremely well in terms of health care. I shall give an example from the document, which was sent to me this morning, concerning winter pressures. Time and again, we have heard that the health service is about to fall apart and that it disintegrates when winter comes on, but last year schemes were put in place across Dartford and Gravesham, Medway and Swale, Maidstone, and Tunbridge Wells to help community health teams to provide more services to enable people, particularly the elderly, to stay in their own homes. Over £1 million went to Social Services to provide more care packages for people in their own homes … Half a million pounds was spent on additional packages of care from Nursing Homes … Additional money was also made available for Community Hospital beds in the Livingstone Hospital, Dartford and Sittingboume Memorial Hospital … Some innovative schemes were developed, for example a Recuperative Care Scheme in Dartford". That is all well and good, but did it work?

The document says: The Hospitals and Community services were very busy over the winter period but this was managed and the effects of the additional pressures created by the flu epidemic and other seasonal demands were minimised. The success of the initiatives was seen in the Acute Trusts enabling them to achieve waiting list reductions and maintain bed availability for non-emergency admissions. That was during a so-called winter crisis. Obviously, the health authority coped very well indeed.

I contacted Dr. Alasdair Thomson—

Dr. Brand

Will the hon. Gentleman give way?

Dr. Stoate

Unfortunately, I do not have time.

Dr. Brand

On that point.

Dr. Stoate

Very well; I give way.

Dr. Brand

I believe that interventions are treated as injury time in these debates. Was the winter pressures money not a one-off arrangement, and does the hon. Gentleman agree that it is sad that there can be no consistent planning in the NHS? These schemes ought to be learned from and incorporated in the proper delivery of service.

Dr. Stoate

In answer to the hon. Gentleman, I shall continue to quote the article. It says that this winter The Health Authority is working with GPs and Trusts to repeat the successful plans of last winter and to improve them further. That is not my document, but a West Kent health authority document.

As I was saying, I contacted the chairman of my local primary health care group, Dr Alasdair Thomson, a GP in my constituency, about what the group was doing to progress to primary care trust status. A ballot has just been held and 116 ballot papers were sent to GPs in the area; 72.4 per cent. responded and 69 per cent. of those who voted, voted yes. That was an overwhelming majority in favour of proceeding to primary care trust status as soon as possible. Public consultation will begin next week and continue until January.

The group has also started partnership working in many areas, including mental health, and a new psychiatric unit will open in January in my constituency. It has also joined the partnership in action scheme, involving health, social services and user groups of mental health services, radically to improve mental health services in my patch. It is developing clinical pathways with consultants, the idea being that GPs will be able to carry out more investigations more quickly, thereby reducing the number of people passed on to consultants, which in turn will reduce waiting lists and waiting times to see specialists. That is all good, innovative stuff coming out of a primary care group that wants to become a primary care trust as soon as possible.

However, not everything in the health service is perfect. Many hon. Members have made some valuable points about the difficulties. I wish to raise a number of issues about what we can do to improve the health service yet further. Of course, the health service needs more money, and I am sure that the ministerial team will work hard with the Chancellor to free up resources for it as money becomes available in the economy.

Naturally, we must continue to increase efficiency in the health service. Will the Minister say how the Government are getting on with their task of cutting red tape and the money spent on bureaucracy? We must make best use of resources, ensuring that every penny is spent to best effect. That means cost-effectiveness as well as clinical effectiveness. It means looking at clinical outcomes to ensure that best practice is available everywhere, every time. We must also ensure that we get best value from goods and services. I am alarmed by the rise in the cost of generic drugs due to shortages and difficulties in obtaining them, and I am pleased that my colleagues on the Health Committee have agreed with my suggestion to meet to discuss that issue next week to see what we can do to improve the supply of generic drugs so that primary care groups do not overspend their budgets because of the unavailability of drugs.

We must also make best use of expertise in the health service. I am particularly concerned that community pharmacists are an under-used resource. They are highly trained and qualified and have much to offer. If there are extra winter pressures—for example, because of respiratory infections or flu—who better than community pharmacists to give good, sensible general advice and symptomatic treatment to people suffering from unpleasant, but generally not life-threatening conditions? That would free up clinicians, doctors and nurses to treat people who really need medical and nursing help and the few who may need hospital treatment. I am working with the hon. Member for Richmond Park (Dr. Tonge) to try to set up an all-party pharmacists group in this House. It will look at exactly that issue and try to raise awareness of how community pharmacists could be used to best effect within the health service.

Factors outside the health service can also affect health. We have already heard tonight that public health is a huge issue. It is not just about the NHS but includes many other aspects of society as we seek to improve the nation's health. We have heard about the smoking epidemic and the fact that every five minutes someone in this country dies from a smoking-related illness. We are beginning to find out that children are becoming fatter and less active because their diets do not necessarily suit them, and they are storing up the possibility of ill health in later life. That must be tackled. We must ensure that exercise programmes are geared to young people in schools so that they achieve maximum fitness.

We have heard that poor health is closely related to poverty, social circumstances, life chances and poor education. I know that the new Minister responsible for public health is working hard on that. All the different strands of government should be brought together to ensure that health is a matter not just for the health service but for the whole Government.

I believe that the NHS is under healthy pressure. Pressure is often a dynamic force for change. If properly harnessed, that pressure can be the driving engine of meaningful change, because we must respond to changing needs in society, changing expectations and the fact that people rightly expect more from the health service. They are entitled to more from the health service and, under this Government, they will get more from the health service.

9.24 pm

Mr. David Tredinnick (Bosworth)

I congratulate the Secretary of State and his colleagues on the Front Bench on their appointments. I wish them well, but I think that they are up against it. That became all too evident when I heard my hon. Friend the Member for Spelthorne (Mr. Wilshire) talk about the cuts in his constituency.

If hon. Members are in doubt about statistics, they tend to go to the House of Commons Library. I did just that before the debate. I discovered—there may be some comfort for the Minister—that, as at 31 March 1997, the waiting list for patient admissions to the NHS trusts in Leicestershire stood at 16,546 and, by the end of June 1999, the list was 16,539. The Government have achieved a reduction in the waiting list of seven patients. However, there had been an increase of 514, or 3.2 per cent., over the previous quarter, which covers the period since the ending of fundholding on 1 April this year.

The trend is upwards, and perhaps that is not surprising given what has happened at Hinckley Sunnyside hospital in my constituency. Owing to a lack of funding, 10 rehabilitation beds have been closed at Hinckley Sunnyside hospital, where staff have an excellent record of getting patients back into the community. Six of those beds have been moved to Hinckley and District hospital through the redesignation of six surgical beds for geriatric rehabilitation. That is a reduction in provision for the ever-increasing need for rehabilitation beds, and a reduction in the number of in-patient beds for local people to have operations locally without having to go to Leicester.

The Secretary of State said that the issue raised by my hon. Friend the Member for Spelthorne had to do with the need to move patients around. That is not the problem. The problem is to do with funding in Hinckley, where there is not enough money to go round. I have received a letter about a 45-year-old stroke victim who cannot get a rehabilitation bed at Sunnyside, and must go to Leicester general hospital, which involves a difficult journey on public transport. Is that what the Secretary of State meant, because it is not what we need? People will face considerable problems if they have to take a half-hour journey to Leicester.

I want to raise two key issues: the Government's central funding policy and the position of primary care groups post fundholding. The Government have pledged to provide equity in funding across the nation. The situation in Leicestershire is catastrophic. The hon. Member for Wakefield (Mr. Hinchliffe) will recognise that. We are right at the bottom of the heap, and suffer from an historic problem of underfunding.

For the financial year 1999–2000, Leicestershire health authority has a funding allocation of £517 million compared with a target funding allocation of £530 million, so there is a gap of £13 million. The Government will not be able to make their policy work in Leicestershire unless the Secretary of State can find more money. I have spoken to the chairman and chief executive of the health authority, and they are cobbling things together by shifting money around from the old fundholding budget, but that will not work in the long term. Leicestershire spends £4 million less on community services than the average health authority.

The second big issue is the transition to primary care groups. In Hinckley, doctors rightly refused to join the primary care group board, and instead are opting to advise through the medical advisory panel. The problem for doctors is that they are not being given any real authority, and are not being allowed to exercise control over financial decisions. They said from the outset that they knew that the funding of primary care groups entailed the handing over of their fundholding money, and that they would be asked to administer and, as members, give tacit approval to what would increasingly become inadequate funding.

I have been told privately that the Hinckley model is likely to become a model for the health service in the future. Doctors have refused to take on the burden that the Government wanted to impose on them, but are making a contribution through an advisory panel.

One of the problems that we have had in Hinckley since the demise of fundholding has been its impact on minor operations carried out by GPs at Hinckley and District hospital. General practitioners in my constituency have complained that the number of minor operations at Hinckley hospital has dried up. The Minister should take that on board. In April 1999, the waiting list stood at nil; since the cessation of fundholding, it has become fairly substantial, and there has been a tremendous knock-on effect, in that operations must now be performed at Leicester general hospital and the Leicester royal infirmary. The waiting list problem—the problem that the Minister and the Secretary of State want to solve—is being exacerbated by the reduction to zero in the number of minor operations at Hinckley hospital. We now have a six-month waiting list, which is growing.

Under the new arrangements for primary care groups, scheduled operations under fundholding have been stopped. The hon. Member for Bethnal Green and Bow (Ms King) referred to the policy of privatisation; I wonder how she will feel about this. A constituent of mine, Isabel Edgar, was due to have a second hip operation under the new primary care group arrangements. The operation had been scheduled under fundholding. She was told, "This is not possible: we will not do it." She has therefore had to have the operation done privately. Is that the kind of privatisation to which the hon. Member for Bethnal Green and Bow was referring?

One of the offices that I hold as a Back Bencher is treasurer of the parliamentary group for alternative and complementary medicine. In that capacity, I recently visited Bath to look at the new Bath spa project, which I commend to the Minister. Doctors whom I met there told me that, when they were fundholding, they were able to save 25 per cent. of their drug budgets through efficient management. That allowed them to offer a three-month wait for all operations, as well as to develop a full complementary medical team on their premises. They had homeopaths, hypnotherapists, herbalists, an osteopath and an acupuncturist.

Since the introduction of primary care groups—I beg the Minister to listen to this—complementary and alternative medical therapies are not being offered. There is a fundamental problem. People come to our surgeries saying that they can no longer benefit from homeopathy, herbal medicine, healing and other therapies. That represents a serious crisis for the Government. It will not be possible to meet the exponential increase in demand for complementary and alternative medicine, and the Minister must deal with that, because it is a vital issue.

At health questions last week, I raised the issue of how the prison service is dealing with complementary and alternative medicine. The Government have cut the list of services available from about 20 to about six. I visited Coldingley prison, and saw prisoners being treated there. One, a very violent man, had been treated by a cranial osteopath who had massaged and adjusted his skull plates. Another had received hands-on healing to channel energy. Both had responded well, but, although osteopathy remains on the list, cranial osteopathy is a different matter.

Let me draw the Government's attention to a newspaper cutting from The Times of 12 October in which someone is quoted as saying: I don't know how healing works, but it helped my son. The lady says: Sam spent his last 18 months at home, going to school, being a normal boy. The boy, a cancer patient, went into remission after someone channelled energy to him through the use of hands. Such services should be available not just to prisoners, but in the health service. If the Minister wants to cut his budgets and to secure a wider service, he should draw on the services of complementary practitioners, many of whom offer their services free.

What about the future? The level of confidence in the NHS can be measured by a leaflet that has been dropped in my constituency today advertising Nuneaton private hospital and asking "Why Wait?" The truth is out: the waiting time for first out-patient appointments is up, and the waiting time for operations is up. I ask the Minister to note that. We look forward to better funding in Leicestershire.

9.34 pm

Mr. Philip Hammond (Runnymede and Weybridge)

It has turned out to be a rather predictable debate. The Secretary of State for Health set the tone. He told us that waiting lists were down. That is clearly incorrect, given the total number of people who are waiting for treatment, or specialist consultation. He told us that the money that he has announced over the past couple of weeks is "new money." That is clearly incorrect as well. It is part of the £21 billion that was announced with so much fanfare last year. Again, he misrepresented Conservative policy. I find it odd that all the professions and patient organisations, and the great majority of informed commentators, agree with us that the waiting list initiative is a disaster.

My right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) and my hon. Friends the Members for Spelthorne (Mr. Wilshire) and for Bosworth (Mr. Tredinnick) gave a cameo of the position in many parts of the country: a funding crisis, services being cut and dissatisfaction among professionals and patients alike.

That was in stark contrast with the view of the world that was given by the hon. Member for Bethnal Green and Bow (Ms King), who seems to have a narrow, at best boroughwide, view of what is happening in the health service. All I can say to her—my right hon. and hon. Friends would echo it—is good luck to her constituents if they have been so lucky in the lottery of the Government's NHS funding formula.

The hon. Member for Wakefield (Mr. Hinchliffe) treated us to his usual review of history, with scarcely a glance to the future. On the only specific question that he asked, he based his position on the fallacy that there would be no complementarity between the private and public sectors.

The hon. Member for North Devon (Mr. Harvey) criticised the motion, but did not bother to table an amendment on behalf of the Liberal Democrats. He argued for greater health spending as a proportion of gross domestic product. We would agree with that, but he failed to tell us what split he would like between tax-funded and privately funded spending and, therefore, what income tax increase his party would propose at the next general election.

The hon. Member for Wirral, West (Mr. Hesford) accused us of not talking about the Government's additional spending plans for the NHS and challenged us to say what our approach would be. I am happy to confirm what it would be. My hon. Friend the Member for Woodspring (Dr. Fox) has already stated it, as did my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) when she was the shadow spokeswoman.

The next Conservative Government will increase tax-funded spending on the NHS in real terms year on year, but we do not believe that that is enough to deliver the health service that people need and deserve as we go into the 21st century. That is why we alone are looking for innovative solutions that will add to—supplement, not supplant—the NHS' s work.

As usual, my hon. Friend the Member for Southend, West (Mr. Amess) made a fine and rousing speech. The hon. Member for Dartford (Dr. Stoate) made at least one important point, which I am happy to endorse: community pharmacists are an under-used resource. I wish that he had put that point to the Government before they jumped in with both feet in support of NHS Direct, an untried and untested idea.

The overall picture that has been painted in the debate is depressing. We have shown the position after two and a half years of government by a party that, in opposition, posed as the NHS's saviour. It is a picture, too, of shocking complacency among Labour Members. Who would have believed just a couple of years ago that, in opinion polls, 41 per cent. of people would tell pollsters that the NHS had got worse under Labour; that staff morale would be at record lows; that waiting lists overall would be completely out of control; and that half the NHS trusts would face massive deficits? Almost all PCGs have overspent, with the likelihood of cuts in drug prescribing later this year, despite the Secretary of State's pledge when he was Minister of State, Department of Health that patients would not be denied the drugs that they needed.

Clinical priorities are being distorted throughout the system. Patients are being deceived and hospitals are struggling to meet targets, with the sickest people often being put at the back of the queue in consequence. Does it please the Minister to think that, this very week, one of the largest and greatest teaching hospitals in London is having a blitz on grommets, possibly the cheapest and certainly the least clinically proven surgical intervention available, simply to meet the numbers that they need to meet to access a bonus?

In the face of all that, we have a Government who have not a clue of what their policy or strategy should be. They have their head firmly in the sand. They are perpetuating the myth, in the face of evidence to the contrary, that the NHS can deliver both excellence and comprehensiveness across the range of all demands, and further still the myth that, if the NHS cannot afford something, that something is valueless and should not be available from any other source.

The Government cannot decide whether they are trying stimulate demand, with 24-hour access and walk-in centres, or manage demand by controlling referrals and banning drugs. Indeed, the collective mind of the Government has become so confused on the matter that the previous Secretary of State, in his speech to the Labour party conference, seemed to suggest that the main purpose of the NHS was to compete with the private sector.

The appointment of a new Secretary of State might have been an opportunity for genuine change—a chance to put behind us the failed policies of the past two and a half years, and embark on a new and coherent approach to mapping out the future of our national health service. However, the Secretary of State has arrived already shackled by the Prime Minister's political pledge, and hemmed in by an ideological refusal to learn from the examples of the health care delivery systems of our European neighbours.

We have learned from this debate that there will be no change in the old Labour approach to health care. The waiting list pledge subordinates clinical to political priorities, and makes the sickest wait the longest. It turns the ethic of the national health service on its head. However, far from delivering on the waiting list pledge, as the Prime Minister's amendment might suggest, and based on their own fiddled figures, the Government have presided over a 170,000 increase in the total number of people waiting both for treatment and for first specialist consultation in the national health service.

In opposition, Labour Members said that they would spend £100 million to achieve a 100,000 reduction in the waiting list. In government, they have already spent £780 million to achieve a 170,000 increase. It is no wonder perhaps that the previous Secretary of State was sacked. I only hope that he never gets the chance to inflict on the bus queues of London what he has inflicted on the waiting lists of the national health service.

The truth is that, as long as the waiting list pledge remains the Government's key target—the one on which they base the rewards and penalties that they levy on hospital trusts—all other announcements are a zero-sum game; the rhetorical equivalent of rearranging the deck chairs on the Titanic. The facts are simple, and the Secretary of State knows them, but he cannot respond to them because he is a hostage to the Prime Minister's political pledge.

The NHS has limited resources and cannot manage now on those resources. If the waiting list initiative continues, any other focus or initiative must be at the expense of something else. Therefore, when the Secretary of State tells us that he is focusing on coronary heart disease, cancer and mental health, he must tell us also, if the waiting list initiative is to remain, what will bear the burden—which services will be discontinued or cut to finance those initiatives?

In focusing on the killer diseases, the Secretary of State is cherry-picking from the Conservatives's patients guarantee. My hon. Friend the Member for Woodspring has proposed precisely that the most serious complaint should be treated first, and that clinical priority should be the sole basis of running the national health service. He has also said that he would scrap the damaging waiting list initiative. He has had the courage and honesty to acknowledge that shorter waiting times for those who are most seriously ill will mean that those with more trivial conditions will have to take their place in the queue for treatment in the national health service. Surely, the rational way to run a health service is to deal with the sickest people first, but that is not the way that it works under the waiting list initiative.

The Secretary of State ignores the evidence all around him of chaos and demoralisation, and piles on more targets without scrapping the old ones. He displayed a frightening complacency when he told us last year that we have the best health service in the world. That is a health service which produces twice as many coronary heart disease deaths per 100,000 population as France; delivers half the lung cancer survival rate of Germany; and is pipped only by Romania for bottom place in a Europewide league table on the availability of renal dialysis. It is a system that delivers us the lowest number of doctors per thousand of population of any country in the European Union, and the lowest health spending as a percentage of gross domestic product.

If that is the health care system that the Secretary of State thinks that Britain deserves in the 21st century, that is a measure of the contempt in which this Government holds the British people.

The Government's insistence that the NHS can meet every last demand of every last person is a cruel deception which induces a dangerous complacency and becomes apparent only when it is too late. People are discovering that the NHS is not there for them, and the increasing numbers of elderly people using their life savings to pay privately for drugs and operations will testify to that.

We have set out our policy—transparent and explicit about the resource constraints on the system, putting the sickest at the front of the queue and letting doctors, not politicians, decide the priorities. That is a commonsense approach.

The Secretary of State is trying to ride two bicycles at the same time. He is trying to pursue the contradictory agendas of the Prime Minister's failed waiting list initiative and his own well-meaning, but ultimately doomed, killer disease initiative. The Secretary of State is not stupid, and he knows that he can effectively refocus the NHS towards the killer diseases only if the Prime Minister's misguided and damaging pledge is dropped.

It is time for the Government to grasp that nettle and start the real debate on how to resource the NHS for the 21st century—something about which we heard nothing from the Government this evening. They should stop letting the British people and the staff of the NHS pay the price for the Prime Minister's refusal to acknowledge what every responsible body has told the Government—that the waiting list pledge was a grave error, the pursuit of which is causing serious and lasting damage to our national health service.

9.47 pm

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

The hon. Member for Runnymede and Weybridge (Mr. Hammond) described the debate as predictable. I would prefer to describe it as fairly comprehensive. We have heard nine Back-Bench speeches, beginning with the speech by the former Secretary of State, the right hon. Member for South-West Surrey (Mrs. Bottomley). Much to the surprise of my right hon. and hon. Friends, she began with an apology. It was not, however, the one that many patients and the public would have liked her to make. We would have preferred her to apologise for her stewardship of the NHS. Sadly, she declined to do so.

Much to our surprise, the right hon. Lady dismissed NHS Direct as trivial and marginal. She should say that to the 500,000 people who have used the service, and she could learn about the contribution that the nurse-led service has made for many people.

Mrs. Virginia Bottomley

Does the Minister believe that the two children with head injuries who were not seen within one and a half hours at the local accident and emergency department and finally went home could have been helped by NHS Direct?

Mr. Hutton

Obviously, I do not have the details of that case. If the right hon. Lady refers it to me, I will look into it. However, lives have been saved as a result of NHS Direct, and it was sad and unfortunate that she and her right hon. and hon. Friends declined to acknowledge that.

My hon. Friend the Member for Wakefield (Mr. Hinchliffe) mentioned the importance of public health—rightly so—and the importance that we have placed on tackling health inequalities. He referred also to "The Common Sense Revolution"—a document recently published by the official Opposition. It is true to say that only in the modern Tory party could common sense ever be described as revolutionary.

The hon. Member for North Devon (Mr. Harvey) made a thoughtful speech, but he was weak on the arithmetic and in his appreciation of the £21 billion of additional resources going into the NHS over the next three years. Like many Opposition Members, he called for more money to be spent on the national health service, but when asked by the hon. Member for Runnymede and Weybridge, he declined to say how much more he wanted to spend.

At the election, the Liberal Democrats promised to spend an extra £540 million per year on the national health service. The hon. Member for North Devon might want to contradict that. We have done significantly better, exceeding that target within the first two and a half years of the Parliament, even without taking into account the additional resources available to the NHS under the comprehensive spending review.

Mr. Harvey

The hon. Gentleman refers to pledges at the election. They were on top of NHS inflation. The Government have tried to dupe the nation by bundling up NHS inflation and holding it back until the second half of the Parliament to make people think that the money was on top of what they should have been expecting. The fact is that by the end of this Parliament, the Government will not have increased health service spending as much as the Conservatives did when they were in office.

Mr. Hutton

I repeat, I do not think that arithmetic is the hon. Gentleman's strong point. He is wrong about the figures.

However, the hon. Gentleman coined a good soundbite about the new Tory policies on the national health service, saying that they would replace the postcode lottery that we inherited with a new tax code lottery. That would be the effect of Conservative policies. They will be rumbled and rejected by the people of this country.

I welcome the support of my hon. Friend the Member for Wirral, West (Mr. Hesford) for the action that we have taken to improve mental health services, particularly his welcome for the national service framework that we published recently. It will help to drive up standards and improve the quality of care for millions of people who suffer from mental health problems and turn to the national health service for support. I am also grateful for his support for our initiative on health action zones.

The hon. Member for Spelthorne (Mr. Wilshire) complained about propaganda and then indulged in a serious dose of it. He has probably recently arrived in the Chamber with copies of the press release that I am sure he had written before he made his speech. We all look forward to reading that press release in his local papers.

Mr. Wilshire

That is yet another Labour lie. The Minister might care to know that I have with me a petition signed by 25,000 of my constituents and that his party in my constituency helped to organise it, because even the local Labour party thinks that he is wrong.

Mr. Hutton

I am sure that the hon. Gentleman will not mind if I do not take his word for that. I should like to point out some of the facts to which he conveniently failed to refer. The cash growth for West Surrey health authority this year is nearly £20 million, which is a 3 per cent. real terms increase. He and other Conservatives who referred to the situation in Surrey conveniently forgot to refer to the £9 million that is going into the new accident and emergency department at St. Peter's hospital, or the £4 million scheme that has now been approved to redevelop the Weybridge community hospital in the constituency of the hon. Member for Runnymede and Weybridge. It is unfortunate but predictable that the good news stories about the NHS always slip through the fingers of Conservative Members.

My hon. Friend the Member for Bethnal Green and Bow (Ms King) made a conciliatory speech, but she also skilfully shot the Tory fox, rumbling the real implications of their new policies on the national health service. We know what their intentions are and they have been made clear for everyone to see. Like my hon. Friend the Member for Wakefield, she was right to emphasise the importance of reducing health inequalities and the benefits of the health action zone in her constituency. We have not forgotten that the Conservatives were consistently unable to bring themselves to talk about the health inequalities that were the legacy of their policies. We are determined to tackle the problems.

The hon. Member for Southend, West (Mr. Amess), in a typical speech, covered a lot of ground very quickly. Intriguingly, he referred to a foreign affairs crisis in Southend. I am sure that we would all like to hear from him what he had in mind. He also kindly reminded the House of some of our election promises, and I can tell him, and all other hon. Members, that we are meeting those promises and will keep them.

My hon. Friend the Member for Dartford (Dr. Stoate), in a very good speech, referred to the improvements in the national health service in his county of Kent, putting some of the gloom and doom spread by the Conservative party into some sort of context. My hon. Friend asked how successful we had been at cutting red tape and transferring resources to front-line care, and I can tell him that nearly £200 million has already been transferred to front-line services.

The hon. Member for Runnymede and Weybridge said that he wanted to add to health spending by encouraging more private health care, but his sums simply do not add up. When we were debating the Health Bill in Standing Committee, he said that health spending in the United Kingdom would have to increase by 2, 3 or 4 per cent. of GDP. Current spending on health care in the United Kingdom is about £48 billion—5.8 per cent. of GDP—and an extra 3 to 4 per cent. of GDP spent on health would require at least an extra £24 billion.

If we assume, as we should, that currently 3.2 million people spend £1.7 million on private health insurance, at an average annual payment of £531, the hon. Gentleman's policy could be delivered only if we increased the number of people covered by private health insurance from 3.2 million to 45 million. That means almost every adult person in the United Kingdom.

The hon. Gentleman and his hon. Friends say that they do not intend their policies to result in compulsory private health insurance, but that does not add up. The only other way to meet the hon. Gentleman's promise to raise £24 billion would be to increase the average annual payment for private health insurance from £531 to £7,500.

Obviously, the Conservatives have lost some of the talents and skills necessary to run a country and be in government, but I suggest to the hon. Gentleman that, as a matter of urgency, he goes away, does his sums again and comes back with something slightly more credible. Throughout the debate we have heard nothing from the Conservative party that could be described as credible.

Mr. Hammond

rose—

Mr. Hutton

No; I have given way three times to Conservative Members, and I do not believe that the hon. Gentleman gave way once.

The debate has highlighted some important differences between the Government and the Opposition concerning the future of the national health service. We want a service in which everyone can have confidence, which provides first class treatment and care to all who need it. The Conservatives want the NHS to be a second-line service for those who cannot afford to buy private health care. We want to modernise the NHS so that it can provide faster and better services where and when people want them. The Conservatives oppose all those changes.

The Tories opposed the new primary care walk-in centres. They oppose the appointment of a senior specialist to direct our fight against cancer. They do not want the number of people on waiting lists to be cut, and they oppose putting doctors and nurses in the driving seat through primary care groups, which are now up and running. They oppose the new public health strategy, and they described our commitment to spend an extra £21 billion on the NHS as reckless. Their position on all those issues is as dishonest as it is untenable. They claim to support the NHS, but they undermine it at every available turn.

The Conservatives say that the NHS cannot do everything, yet they oppose all attempts to improve the ability of the service to respond more quickly and effectively to patients' needs. We say that the NHS needs to be modernised so that it can provide the fast, convenient, high quality service that people want—

Mr. James Arbuthnot (North-East Hampshire)

rose in his place and claimed to move,That the Question be now put.

Question, That the Question be now put, put and agreed to.

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

The House divided: Ayes 176, Noes 341.

Division No. 276]	[6.59 pm
AYES
Ainsworth, Peter (E Surrey)	Heald, Oliver
Amess, David	Heathcoat-Amory, Rt Hon David
Ancram, Rt Hon Michael	Heseltine, Rt Hon Michael
Arbuthnot, Rt Hon James	Horam, John
Atkinson, Peter (Hexham)	Howard, Rt Hon Michael
Baldry, Tony	Howarth, Gerald (Aldershot)
Beggs, Roy	Hunter, Andrew
Bercow, John	Jack, Rt Hon Michael
Beresford, Sir Paul	Jackson, Robert (Wantage)
Blunt, Crispin	Jenkin, Bernard
Body, Sir Richard	Johnson Smith, Rt Hon Sir Geoffrey
Boswell, Tim
Bottomley, Rt Hon Mrs Virginia	Key, Robert
Brady, Graham	King, Rt Hon Tom (Bridgwater)
Brazier, Julian	Kirkbride, Miss Julie
Brooke, Rt Hon Peter	Laing, Mrs Eleanor
Browning, Mrs Angela	Lansley, Andrew
Bruce, Ian (S Dorset)	Letwin, Oliver
Burns, Simon	Lewis, Dr Julian (New Forest E)
Butterfill, John	Lidington, David
Cash, William	Lilley, Rt Hon Peter
Chapman, Sir Sydney (Chipping Barnet)	Lloyd, Rt Hon Sir Peter (Fareham)
	Llwyd, Elfyn
Chope, Christopher	Loughton, Tim
Clappison, James	Luff, Peter
Clark, Dr Michael (Rayleigh)	Lyell, Rt Hon Sir Nicholas
Clarke, Rt Hon Kenneth (Rushcliffe)	MacGregor, Rt Hon John
	McIntosh, Miss Anne
Clifton-Brown, Geoffrey	MacKay, Rt Hon Andrew
Collins, Tim	Maclean, Rt Hon David
Colvin, Michael	McLoughlin, Patrick
Cran, James	Madel, Sir David
Curry, Rt Hon David	Malins, Humfrey
Davis, Rt Hon David (Haltemprice & Howden)	Maples, John
	Mates, Michael
Dorrell, Rt Hon Stephen	Mawhinney, Rt Hon Sir Brian
Duncan, Alan	May, Mrs Theresa
Duncan Smith, Iain	Moss, Malcolm
Emery, Rt Hon Sir Peter	Nicholls, Patrick
Evans, Nigel	Norman, Archie
Fabricant, Michael	O'Brien, Stephen (Eddisbury)
Fallon, Michael	Page, Richard
Flight, Howard	Paice, James
Forth, Rt Hon Eric	Paterson, Owen
Fowler, Rt Hon Sir Norman	Pickles, Eric
Fox, Dr Liam	Prior, David
Fraser, Christopher	Randall, John
Garnier, Edward	Redwood, Rt Hon John
Gibb, Nick	Robathan, Andrew
Gill, Christopher	Robertson, Laurence (Tewk'b'ry)
Gillan, Mrs Cheryl	Rowe, Andrew (Faversham)
Gray, James	Ruffley, David
Green, Damian	St Aubyn, Nick
Greenway, John	Sayeed, Jonathan
Grieve, Dominic	Shephard, Rt Hon Mrs Gillian
Hague, Rt Hon William	Shepherd, Richard
Hamilton, Rt Hon Sir Archie	Simpson, Keith (Mid-Norfolk)
Hammond, Philip	Smyth, Rev Martin (Belfast S)
Hawkins, Nick	Soames, Nicholas
Hayes, John	Spelman, Mrs Caroline
Spicer, Sir Michael	Wardle, Charles
Spring, Richard	Waterson, Nigel
Steen, Anthony	Wells, Bowen
Streeter, Gary	Whitney, Sir Raymond
Swayne, Desmond	Whittingdale, John
Syms, Robert	Widdecombe, Rt Hon Miss Ann
	Wilkinson, John
Tapsell, Sir Peter	Willetts, David
Taylor, Ian (Esher & Walton)	Wilshire, David
Taylor, John M (Solihull)	Winterton, Mrs Ann (Congleton)
Taylor, Sir Teddy	Winterton, Nicholas (Macclesfield)
Townend, John	Woodward, Shaun
Tredinnick, David	Young, Rt Hon Sir George
Trend, Michael
Tyrie, Andrew	Tellers for the Ayes:
Viggers, Peter	Mrs. Jacqui Lait and
Walter, Robert	Mr. Stephen Day.
NOES
Adams, Mrs Irene (Paisley N)	Chidgey, David
Ainger, Nick	Clapham, Michael
Ainsworth, Robert (Cov'try NE)	Clark, Rt Hon Dr David (S Shields)
Alexander, Douglas	Clark, Dr Lynda (Edinburgh Pentlands)
Allan, Richard
Allen, Graham	Clark, Paul (Gillingham)
Anderson, Donald (Swansea E)	Clarke, Charles (Norwich S)
Anderson, Janet (Rossendale)	Clarke, Eric (Midlothian)
Armstrong, Rt Hon Ms Hilary	Clarke, Rt Hon Tom (Coatbridge)
Atherton, Ms Candy	Clarke, Tony (Northampton S)
Austin, John	Clwyd, Ann
Ballard, Jackie	Coaker, Vernon
Barnes, Harry	Coffey, Ms Ann
Battle, John	Cohen, Harry
Bayley, Hugh	Coleman, Iain
Beard, Nigel	Colman, Tony
Begg, Miss Anne	Connarty, Michael
Beith, Rt Hon A J	Cook, Frank (Stockton N)
Bell, Martin (Tatton)	Cooper, Yvette
Bell, Stuart (Middlesbrough)	Corbyn, Jeremy
Benn, Hilary (Leeds C)	Corston, Ms Jean
Benn, Rt Hon Tony (Chesterfield)	Cotter, Brian
Bennett, Andrew F	Cousins, Jim
Benton, Joe	Cranston, Ross
Bermingham, Gerald	Crausby, David
Berry, Roger	Cryer, Mrs Ann (Keighley)
Best, Harold	Cryer, John (Hornchurch)
Betts, Clive	Cummings, John
Blackman, Liz	Cunningham, Rt Hon Dr Jack (Copeland)
Blears, Ms Hazel
Blizzard, Bob	Cunningham, Jim (Cov'try S)
Blunkett, Rt Hon David	Dalyell, Tam
Boateng, Paul	Darling, Rt Hon Alistair
Bradley, Keith (Withington)	Darvill, Keith
Bradley, Peter (The Wrekin)	Davey, Valerie (Bristol W)
Bradshaw, Ben	Davies, Rt Hon Denzil (Llanelli)
Brand, Dr Peter	Davies, Geraint (Croydon C)
Breed, Colin	Dawson, Hilton
Brinton, Mrs Helen	Dean, Mrs Janet
Brown, Rt Hon Nick (Newcastle E)	Dobbin, Jim
Browne, Desmond	Donohoe, Brian H
Bruce, Malcolm (Gordon)	Doran, Frank
Burgon, Colin	Dowd, Jim
Burstow, Paul	Drew, David
Butler, Mrs Christine	Dunwoody, Mrs Gwyneth
Byers, Rt Hon Stephen	Eagle, Angela (Wallasey)
Campbell, Alan (Tynemouth)	Eagle, Maria (L'pool Garston)
Campbell, Mrs Anne (C'bridge)	Edwards, Huw
Campbell, Ronnie (Blyth V)	Efford, Clive
Campbell-Savours, Dale	Ellman, Mrs Louise
Cann, Jamie	Ennis, Jeff
Caplin, Ivor	Etherington, Bill
Casale, Roger	Fearn, Ronnie
Caton, Martin	Field, Rt Hon Frank
Cawsey, Ian	Fisher, Mark
Chapman, Ben (Wirral S)	Fitzpatrick, Jim
Chaytor, David	Fitzsimons, Lorna
Flint, Caroline	Lawrence, Ms Jackie
Follett, Barbara	Laxton, Bob
Foster, Rt Hon Derek	Lepper, David
Foster, Don (Bath)	Leslie, Christopher
Foster, Michael J (Worcester)	Levitt, Tom
Fyfe, Maria	Lewis, Ivan (Bury S)
Gapes, Mike	Lewis, Terry (Worsley)
George, Andrew (St Ives)	Liddell, Rt Hon Mrs Helen
George, Bruce (Walsall S)	Linton, Martin
Gerrard, Neil	Livingstone, Ken
Gibson, Dr Ian	Livsey, Richard
Gilroy, Mrs Linda	Lloyd, Tony (Manchester C)
Godman, Dr Norman A	Lock, David
Godsiff, Roger	Love, Andrew
Goggins, Paul	McAvoy, Thomas
Golding, Mrs Llin	McCabe, Steve
Gordon, Mrs Eileen	McCafferty, Ms Chris
Grant, Bernie	McCartney, Rt Hon Ian (Makerfield)
Griffiths, Jane (Reading E)
Griffiths, Nigel (Edinburgh S)	McDonagh, Siobhain
Griffiths, Win (Bridgend)	Macdonald, Calum
Grocott, Bruce	McDonnell, John
Grogan, John	McIsaac, Shona
Gunnell, John	McKenna, Mrs Rosemary
Hall, Mike (Weaver Vale)	Mackinlay, Andrew
Hall, Patrick (Bedford)	Maclennan, Rt Hon Robert
Hancock, Mike	McNamara, Kevin
Hanson, David	McNulty, Tony
Harman, Rt Hon Ms Harriet	MacShane, Denis
Harvey, Nick	McWalter, Tony
Heal, Mrs Sylvia	McWilliam, John
Healey, John	Mahon, Mrs Alice
Henderson, Doug (Newcastle N)	Mallaber, Judy
Henderson, Ivan (Harwich)	Marsden, Gordon (Blackpool S)
Hepburn, Stephen	Marshall, David (Shettleston)
Heppell, John	Marshall, Jim (Leicester S)
Hesford, Stephen	Marshall-Andrews, Robert
Hill, Keith	Martlew, Eric
Hinchliffe, David	Maxton, John
Hood, Jimmy	Meale, Alan
Hoon, Geoffrey	Merron, Gillian
Hope, Phil	Michie, Bill (Shef'ld Heeley)
Hopkins, Kelvin	Michie, Mrs Ray (Argyll & Bute)
Howells, Dr Kim	Milburn, Rt Hon Alan
Hoyle, Lindsay	Miller, Andrew
Hughes, Ms Beverley (Stretford)	Mitchell, Austin
Hughes, Kevin (Doncaster N)	Moffatt, Laura
Hughes, Simon (Southwark N)	Moonie, Dr Lewis
Hurst, Alan	Moore, Michael
Hutton, John	Moran, Ms Margaret
Iddon, Dr Brian	Morgan, Ms Julie (Cardiff N)
Illsley, Eric	Morley, Elliot
Jackson, Helen (Hillsborough)	Morris, Ms Estelle (B'ham Yardley)
Jamieson, David	Morris, Rt Hon John (Aberavon)
Jenkins, Brian	Mudie, George
Johnson, Miss Melanie (Welwyn Hatfield)	Mullin, Chris
	Murphy, Denis (Wansbeck)
Jones, Rt Hon Barry (Alyn)	Murphy, Jim (Eastwood)
Jones, Mrs Fiona (Newark)	Murphy, Rt Hon Paul (Torfaen)
Jones, Helen (Warrington N)	Naysmith, Dr Doug
Jones, Ms Jenny (Wolverh'ton SW)	Oaten, Mark
	O'Brien, Bill (Normanton)
Jones, Jon Owen (Cardiff C)	O'Brien, Mike (N Warks)
Jones, Martyn (Clwyd S)	O'Hara, Eddie
Jones, Nigel (Cheltenham)	Olner, Bill
Keeble, Ms Sally	O'Neill, Martin
Keen, Alan (Feltham & Heston)	Osborne, Ms Sandra
Kelly, Ms Ruth	Palmer, Dr Nick
Kemp, Fraser	Pearson, Ian
Kennedy, Charles (Ross Skye)	Pendry, Tom
Kennedy, Jane (Wavertree)	Perham, Ms Linda
Khabra, Piara S	Pickthall, Colin
Kidney, David	Pike, Peter L
King, Ms Oona (Bethnal Green)	Plaskitt, James
Kumar, Dr Ashok	Pollard, Kerry
Ladyman, Dr Stephen	Pond, Chris
Pope, Greg	Smith, Miss Geraldine (Morecambe & Lunesdale)
Pound, Stephen
Powell, Sir Raymond	Smith, Jacqui (Redditch)
Prentice, Ms Bridget (Lewisham E)	Smith, John (Glamorgan)
Prentice, Gordon (Pendle)	Smith, Llew (Blaenau Gwent)
Prescott, Rt Hon John	Smith, Sir Robert (W Ab'd'ns)
Prosser, Gwyn	Snape, Peter
Purchase, Ken	Soley, Clive
Quin, Rt Hon Ms Joyce	Southworth, Ms Helen
Quinn, Lawrie	Spellar, John
Radice, Rt Hon Giles	Squire, Ms Rachel
Rammell, Bill	Starkey, Dr Phyllis
Rapson, Syd	Steinberg, Gerry
Raynsford, Nick	Stevenson, George
Reed, Andrew (Loughborough)	Stewart, David (Inverness E)
Reid, Rt Hon Dr John (Hamilton N)	Stinchcombe, Paul
Rendel, David	Stoate, Dr Howard
Robinson, Geoffrey (Cov'try NW)	Strang, Rt Hon Dr Gavin
Roche, Mrs Barbara	Straw, Rt Hon Jack
Rogers, Allan	Stringer, Graham
Rooker, Jeff	Stuart, Ms Gisela
Rooney, Terry	Sutcliffe, Gerry
Ross, Ernie (Dundee W)	Taylor, Rt Hon Mrs Ann (Dewsbury)
Rowlands, Ted
Roy, Frank	Taylor, Ms Dari (Stockton S)
Ruane, Chris	Taylor, David (NW Leics)
Ruddock, Joan	Taylor, Matthew (Truro)
Russell, Bob (Colchester)	Temple-Morris, Peter
Russell, Ms Christine (Chester)	Thomas, Gareth (Clwyd W)
Ryan, Ms Joan	Thomas, Gareth R (Harrow W)
Salter, Martin	Timms, Stephen
Sanders, Adrian	Tipping, Paddy
Sarwar, Mohammad	Todd, Mark
Savidge, Malcolm	Tonge, Dr Jenny
Sawford, Phil	Touhig, Don
Sedgemore, Brian	Trickett, Jon
Shaw, Jonathan	Truswell, Paul
Sheldon, Rt Hon Robert	Turner, Neil (Wigan)
Simpson, Alan (Nottingham S)	Turner, Dennis (Wolverh'ton SE)
Singh, Marsha	Turner, Dr Desmond (Kemptown)
Skinner, Dennis	Turner, Dr George (NW Norfolk)
Smith, Rt Hon Andrew (Oxford E)	Twigg, Derek (Halton)
Smith, Angela (Basildon)	Twigg, Stephen (Enfield)
Tyler, Paul	Williams, Mrs Betty (Conwy)
Tynan, Bill	Willis, Phil
Vaz, Keith	Wills, Michael
Vis, Dr Rudi	Winnick, David
Walley, Ms Joan	Winterton, Ms Rosie (Doncaster C)
Ward, Ms Claire	Wise, Audrey
Wareing, Robert N	Wood, Mike
Watts, David	Woolas, Phil
Webb, Steve	Worthington, Tony
White, Brian	Wright, Anthony D (Gt Yarmouth)
Whitehead, Dr Alan	Wright, Dr Tony (Cannock)
Wicks, Malcolm	Wyatt, Derek
Wigley, Rt Hon Dafydd
Williams, Rt Hon Alan (Swansea W)	Tellers for the Noes:
	Mr. David Clelland and
Williams, Alan W (E Carmarthen)	Mrs. Anne McGuire.

Division No. 277]	[9.59 pm
AYES
Ainsworth, Peter (E Surrey)	Fox, Dr Liam
Allan, Richard	Fraser, Christopher
Amess, David	Garnier, Edward
Ancram, Fit Hon Michael	George, Andrew (St Ives)
Arbuthnot, Rt Hon James	Gibb, Nick
Ashdown, Rt Hon Paddy	Gill, Christopher
Atkinson, Peter (Hexham)	Gillan, Mrs Cheryl
Baldry, Tony	Gray, James
Ballard, Jackie	Green, Damian
Beggs, Roy	Greenway, John
Beith, Rt Hon A J	Grieve, Dominic
Bercow, John	Hague, Rt Hon William
Beresford, Sir Paul	Hamilton, Rt Hon Sir Archie
Blunt, Crispin	Hammond, Philip
Body, Sir Richard	Hancock, Mike
Boswell, Tim	Harris, Dr Evan
Bottomley, Rt Hon Mrs Virginia	Harvey, Nick
Brady, Graham	Hawkins, Nick
Brand, Dr Peter	Hayes, John
Brazier, Julian	Heald, Oliver
Brooke, Rt Hon Peter	Heathcoat-Amory, Rt Hon David
Browning, Mrs Angela	Heseltine, Rt Hon Michael
Bruce, Ian (S Dorset)	Hogg, Rt Hon Douglas
Burns, Simon	Horam, John
Burstow, Paul	Howard, Rt Hon Michael
Butterfill, John	Howarth, Gerald (Aldershot)
Cash, William	Hughes, Simon (Southwark N)
Chapman, Sir Sydney (Chipping Barnet)	Jack, Rt Hon Michael
	Jackson, Robert (Wantage)
Chope, Christopher	Jenkin, Bernard
Clappison, James	Johnson Smith, Rt Hon Sir Geoffrey
Clark, Dr Michael (Rayleigh)
Clarke, Rt Hon Kenneth (Rushcliffe)	Jones, Nigel (Cheltenham)
	Kennedy, Charles (Ross Skye)
Clifton-Brown, Geoffrey	Key, Robert
Collins, Tim	King, Rt Hon Tom (Bridgwater)
Colvin, Michael	Kirkbride, Miss Julie
Cotter, Brian	Laing, Mrs Eleanor
Cran, James	Lansley, Andrew
Curry, Rt Hon David	Letwin, Oliver
Dafis, Cynog	Lewis, Dr Julian (New Forest E)
Davis, Rt Hon David (Haltemprice & Howden)	Lidington, David
	Lilley, Rt Hon Peter
Dorrell, Rt Hon Stephen	Livsey, Richard
Duncan, Alan	Lloyd, Rt Hon Sir Peter (Fareham)
Duncan Smith, Iain	Loughton, Tim
Emery, Rt Hon Sir Peter	Luff, Peter
Evans, Nigel	Lyell, Rt Hon Sir Nicholas
Fabricant, Michael	MacGregor, Rt Hon John
Fallon, Michael	McIntosh, Miss Anne
Feam, Ronnie	MacKay, Rt Hon Andrew:
Flight, Howard	Maclean, Rt Hon David
Forth, Rt Hon Eric	Maclennan, Rt Hon Robert
Foster, Don (Bath)	McLoughlin, Patrick
Fowler, Rt Hon Sir Norman	Madel, Sir David

Malins, Humfrey	Steen, Anthony
Maples, John	Streeter, Gary
Mates, Michael	Swayne, Desmond
Mawhinney, Rt Hon Sir Brian	Syms, Robert
May, Mrs Theresa	Tapsell, Sir Peter
Michie, Mrs Ray (Argyll & Bute)	Taylor, Ian (Esher & Walton)
Moss, Malcolm	Taylor, John M (Solihull)
Nicholls, Patrick	Taylor, Matthew (Truro)
Norman, Archie	Taylor, Sir Teddy
Oaten, Mark	Tonge, Dr Jenny
O'Brien, Stephen (Eddisbury)	Townend, John
Page, Richard	Tredinnick, David
Paice, James	Trend, Michael
Paterson, Owen	Tyler, Paul
Pickles, Eric	Tyrie, Andrew
Prior, David	Viggers, Peter
Randall, John	Walter, Robert
Redwood, Rt Hon John	Wardle, Charles
Rendel, David	Waterson, Nigel
Robathan, Andrew	Webb, Steve
Robertson, Laurence (Tewk'b'ry)	Wells, Bowen
Rowe, Andrew (Faversham)	Whitney, Sir Raymond
Ruffley, David	Whittingdale, John
Russell, Bob (Colchester)	Widdecombe, Rt Hon Miss Ann
St Aubyn, Nick	Wigley, Rt Hon Dafydd
Sanders, Adrian	Wilkinson, John
Sayeed, Jonathan	Willetts, David
Shephard, Rt Hon Mrs Gillian	Willis, Phil
Shepherd, Richard	Wilshire, David
Simpson, Keith (Mid-Norfolk)	Winterton, Mrs Ann (Congleton)
Smith, Sir Robert (W Ab'd'ns)	Winterton, Nicholas (Macclesfield)
Smyth, Rev Martin (Belfast S)	Woodward, Shaun
Soames, Nicholas	Young, Rt Hon Sir George
Spelman, Mrs Caroline
Spicer, Sir Michael	Tellers for the Ayes:
Spring, Richard	Mrs. Jacqui Lait and
Stanley, Rt Hon Sir John	Mr. Stephen Day.
NOES
Abbott, Ms Diane	Browne, Desmond
Adams, Mrs Irene (Paisley N)	Burden, Richard
Ainger, Nick	Burgon, Colin
Alexander, Douglas	Butler, Mrs Christine
Allen, Graham	Byers, Rt Hon Stephen
Armstrong, Rt Hon Ms Hilary	Campbell, Alan (Tynemouth)
Atherton, Ms Candy	Campbell, Mrs Anne (C'bridge)
Austin, John	Campbell, Ronnie (Blyth V)
Barnes, Harry	Campbell-Savours, Dale
Battle, John	Cann, Jamie
Bayley, Hugh	Caplin, Ivor
Begg, Miss Anne	Casale, Roger
Bell, Martin (Tatton)	Caton, Martin
Bell, Stuart (Middlesbrough)	Cawsey, Ian
Benn, Hilary (Leeds C)	Chapman, Ben (Wirral S)
	Chaytor, David
Benn, Rt Hon Tony (Chesterfield)	Clapham, Michael
Bennett, Andrew F	Clark, Rt Hon Dr David (S Shields)
Benton, Joe	Clark, Dr Lynda (Edinburgh Pentlands)
Bermingham, Gerald
Berry, Roger	Clark, Paul (Gillingham)
Best, Harold	Clarke, Charles (Norwich S)
Betts, Clive	Clarke, Eric (Midlothian)
Blackman, Liz	Clarke, Rt Hon Tom (Coatbridge)
Blears, Ms Hazel	Clarke, Tony (Northampton S)
Blizzard, Bob	Clelland, David
Blunkett, Rt Hon David	Clwyd, Ann
Boateng, Paul	Coaker, Vernon
Bradley, Keith (Withington)	Coffey, Ms Ann
Bradley, Peter (The Wrekin)	Cohen, Harry
Bradshaw, Ben	Coleman, Iain
Brinton, Mrs Helen	Colman, Tony
Brown, Rt Hon Nick (Newcastle E)	Connarty, Michael
Brown, Russell (Dumfries)	Cook, Frank (Stockton N)

Cooper, Yvette	Howarth, Alan (Newport E)
Corston, Ms Jean	Howells, Dr Kim
Cousins, Jim	Hoyle, Lindsay
Cranston, Ross	Hughes, Ms Beverley (Stretford)
Crausby, David	Hughes, Kevin (Doncaster N)
Cryer, Mrs Ann (Keighley)	Hurst Alan
Cryer, John (Hornchurch)	Hutton, John
Cummings, John	Iddon, Dr Brian
Cunningham, Rt Hon Dr Jack (Copeland)	Illsley, Eric
Cunningham, Jim (Cov'try S)	Jackson, Helen (Hillsborough)
Dalyell, Tam	Jenkins, Brian
Darling, Rt Hon Alistair	Johnson, Alan (Hull W & Hessle)
Darvill, Keith	Johnson, Miss Melanie (Welwyn Hatfield)
Davey, Valerie (Bristol W)
Davies, Rt Hon Denzil (Llanelli)	Jones, Rt Hon Barry (Alyn)
Davis, Terry (B'ham Hodge H)	Jones, Mrs Fiona (Newark)
Dawson, Hilton	Jones, Helen (Warrington N)
Dean, Mrs Janet	Jones, Ms Jenny (Wolverh'ton SW)
Dobbin, Jim
Donohoe, Brian H	Jones, Jon Owen (Cardiff C)
Doran, Frank	Jones, Martyn (Clwyd S)
Dowd, Jim
Drew David	Kaufman, Rt Hon Gerald
Dunwoody, Mrs Gwyneth	Keeble, Ms Sally
Eagle, Angela (Wallasey)	Keen, Alan (Feltham & Heston)
Eagle, Maria (L'pool Garston)	Kelly, Ms Ruth
Edwards, Huw	Kemp, Fraser
Efford, Clive	Kennedy, Jane (Wavertree)
Ellman, Mrs Louise	Khabra, Piara S
Ennis, Jeff	Kidney, David
Etherington, Bill	King, Ms Oona (Bethnal Green)
Field, Rt Hon Frank	Kumar, Dr Ashok
Fisher, Mark	Ladyman, Dr Stephen
Fitzpatrick, Jim	Lawrence, Ms Jackie
Fitzsimons, Lorna	Laxton, Bob
Flint, Caroline
Follett, Barbara	Lepper, David
Foster, Rt Hon Derek	Leslie, Christopher
Foster, Michael Jabez (Hastings)	Levitt, Tom
Foster, Michael J (Worcester)	Lewis, Ivan (Bury S)
Fyfe, Maria	Lewis, Terry (Worsley)
Gapes, Mike	Liddell, Rt Hon Mrs Helen
George, Bruce (Walsall S)	Linton, Martin
Gerrard, Neil	Lloyd, Tony (Manchester C)
Gibson, Dr Ian	Lock, David
Gilroy, Mrs Linda	Love, Andrew
Godman, Dr Norman A	McAllion, John
Goggins, Paul	McAvoy, Thomas
Gordon, Mrs Eileen	McCabe, Steve
Griffiths, Jane (Reading E)	McCafferty, Ms Chris
Griffiths, Nigel (Edinburgh S)	McCartney, Rt Hon Ian (Makerfield)
Griffiths, Win (Bridgend)
Grocott, Bruce
Grogan, John	Macdonald, Calum
Gunnell, John	McDonnell, John
Hall, Mike (Weaver Vale)	McGuire, Mrs Anne
Hall, Patrick (Bedford)	McIsaac, Shona
Hanson, David	McKenna, Mrs Rosemary
Hamnan, Rt Hon Ms Harriet	Mackinlay, Andrew
Heal, Mrs Sylvia	McNamara, Kevin
Healey, John	McNulty, Tony
Henderson, Doug (Newcastle N)	MacShane, Denis
Henderson, Ivan (Harwich)	McWalter, Tony
Hepburn, Stephen	McWilliam, John
Heppell, John	Mahon, Mrs Alice
Hesford, Stephen	Mallaber, Judy
Hewitt, Ms Patricia	Marsden, Gordon (Blackpool S)
Hill, Keith Hinchliffe, David	Marshall, David (Shettleston)
Hodge, Ms Margaret	Marshall, Jim (Leicester S)
Hoey, Kate	Marshall-Andrews, Robert
Hood, Jimmy	Martlew, Eric
Hoon, Geoffrey	Maxton, John
Hope, Phil	Meacher, Rt Hon Michael
Hopkins, Kelvin	Meale, Alan

Merron, Gillian	Skinner, Dennis
Michie, Bill (Shef'ld Heeley)	Smith, Rt Hon Andrew (Oxford E)
Milburn, Rt Hon Alan	Smith, Angela (Basildon)
Miller, Andrew	Smith, Rt Hon Chris (Islington S)
Mitchell, Austin	Smith, Miss Geraldine (Morecambe & Lunesdale)
Moffatt, Laura
Moonie, Dr Lewis	Smith, Jacqui (Redditch)
Moran, Ms Margaret	Smith, John (Glamorgan)
Morgan, Ms Julie (Cardiff N)	Smith, Llew (Blaenau Gwent)
Morgan, Rhodri (Cardiff W)	Snape, Peter
Morley, Elliot	Soley, Clive
Morris, Ms Estelle (B'ham Yardley)	Southworth, Ms Helen
Morris, Rt Hon John (Aberavon)	Squire, Ms Rachel
Mowlam, Rt Hon Marjorie	Starkey, Dr Phyllis
Mudie, George	Steinberg, Gerry
Mullin, Chris	Stevenson, George
Murphy, Denis (Wansbeck)	Stewart, David (Inverness E)
Murphy, Jim (Eastwood)	Stewart, Ian (Eccles)
Murphy, Rt Hon Paul (Torfaen)	Stinchcombe, Paul
Naysmith, Dr Doug	Stoate, Dr Howard
O'Brien, Bill (Normanton)	Strang, Rt Hon Dr Gavin
O'Brien, Mike (N Warks)	Straw, Rt Hon Jack
O'Hara, Eddie	Stringer, Graham
Olner, Bill	Stuart, Ms Gisela
O'Neill, Martin	Sutcliffe, Gerry
Osborne, Ms Sandra	Taylor, Rt Hon Mrs Ann (Dewsbury)
Palmer, Dr Nick
Pearson, Ian	Taylor, Ms Dan (Stockton S)
Pendry, Tom	Taylor, David (NW Leics)
Perham, Ms Linda	Thomas, Gareth (Clwyd W)
Pickthall, Colin	Thomas, Gareth R (Harrow W)
Pike, Peter L	Timms, Stephen
Plaskitt, James	Tipping, Paddy
Pollard, Kerry	Todd, Mark
Pond, Chris	Touhig, Don
Pope, Greg	Trickett, Jon
Powell, Sir Raymond	Truswell, Paul
Prentice, Ms Bridget (Lewisham E)	Turner, Neil (Wigan)
Prentice, Gordon (Pendle)	Turner, Dennis (Wotverh'ton SE)
	Turner, Dr Desmond (Kemptown)
Prescott, Rt Hon John	Turner, Dr George (NW Norfolk)
Prosser, Gwyn	Twigg, Derek (Halton)
Purchase Ken	Twigg, Stephen (Enfield)
Quin Rt Hon Ms Joyce	Tynan Bill
Quinn, Lawrie	Vis, Dr Rudi
Radice, Rt Hon Giles	Wallev Ms Joan
Rammell, Bill	Ward, Ms Claire
Rapson, Syd	Wareing, Robert N
Raynsford, Nick	Watts, David
Reed, Andrew (Loughborough)	White Brian
Reid, Rt Hon Dr John (Hamilton N)	Whitehead, Dr Alan
Roche, Mrs Barbara	Wicks, Malcolm
Rooker, Jeff	Williams, Rt Hon Alan (Swansea W)
Rooney, Terry
Ross, Ernie (Dundee W)	Williams, Alan W (E Carmarthen)
Rowlands, Ted	Williams, Mrs Betty (Conwy)
Roy, Frank	Wills, Michael
Ruane, Chris	Winnick, David
Ruddock, Joan	Winterton, Ms Rosie (Doncaster C)
Russell, Ms Christine (Chester)	Wise, Audrey
Ryan, Ms Joan	Wood, Mike
Salter, Martin	Woolas, Phil
Sarwar, Mohammad	Worthington, Tony
Savidge, Malcolm	Wright, Anthony D (Gt Yarmouth)
Sawford, Phil	Wright, Dr Tony (Cannock)
Sedgemore, Brian	Wyatt, Derek
Shaw, Jonathan
Sheldon, Rt Hon Robert	Tellers for the Noes:
Simpson, Alan (Nottingham S)	Mr. David Jamieson and
Singh, Marsha	Mr. Robert Ainsworth.

Question accordingly negatived.

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

The House divided: Ayes 330, Noes 167

Division No. 278]	[10.14 pm
AYES
Abbott, Ms Diane	Cryer, John (Hornchurch)
Adams, Mrs Irene (Paisley N)	Cummings, John
Ainger, Nick	Cunningham, Rt Hon Dr Jack (Copeland)
Alexander, Douglas
Allen, Graham	Cunningham, Jim (Cov'try S)
Armstrong, Rt Hon Ms Hilary	Dalyell, Tam
Atherton, Ms Candy	Darling, Rt Hon Alistair
Austin, John	Darvill, Keith
Barnes, Harry	Davey, Valerie (Bristol W)
Battle, John	Davies, Rt Hon Denzil (Llanelli)
Bayley, Hugh	Davis, Terry (B'ham Hodge H)
Begg, Miss Anne	Dawson, Hilton
Bell, Stuart (Middlesbrough)	Dean, Mrs Janet
Benn, Hilary (Leeds C)	Dobbin, Jim
Benn, Rt Hon Tony (Chesterfield)	Donohoe, Brian H
Bennett, Andrew F	Doran, Frank
Benton, Joe	Dowd, Jim
Berningham, Gerald	Drew, David
Berry, Roger	Eagle, Angela (Wallasey)
Best, Harold	Eagle, Maria (L'pool Garston)
Betts, Clive	Edwards, Huw
Blackman, Liz	Efford, Clive
Blears, Ms Hazel	Ellman, Mrs Louise
Blizzard, Bob	Ennis, Jeff
Blunkett, Rt Hon David	Etherington, Bill
Boateng, Paul	Field, Rt Hon Frank
Bradley, Keith (Withington)	Fisher, Mark
Bradley, Peter (The Wrekin)	Fitzpatrick, Jim
Bradshaw, Ben	Fitzsimons, Lorna
Brinton, Mrs Helen	Flint, Caroline
Brown, Rt Hon Nick (Newcastle E)	Follett, Barbara
Brown, Russell (Dumfries)	Foster, Rt Hon Derek
Browne, Desmond	Foster, Michael Jabez (Hastings)
Burden, Richard	Foster, Michael J (Worcester)
Burgon, Colin	Fyfe, Maria
Butler, Mrs Christine	Gapes, Mike
Byers, Rt Hon Stephen	George, Bruce (Walsall S)
Campbell, Alan (Tynemouth)	Gerrard, Neil
Campbell, Mrs Anne (C'bridge)	Gibson, Dr Ian
Campbell-Savours, Dale	Gilroy, Mrs Linda
Cann, Jamie	Godman, Dr Norman A
Caplin, Ivor	Goggins, Paul
Casale, Roger	Gordon, Mrs Eileen
Caton, Martin	Griffiths, Jane (Reading E)
Cawsey, Ian	Griffiths, Nigel (Edinburgh S)
Chapman, Ben (Wirral S)	Griffiths, Win (Bridgend)
Chaytor, David	Grogan, John
Clapham, Michael	Gunnell, John
Clark, Rt Hon Dr David (S Shields)	Hall, Mike (Weaver Vale)
Clark, Dr Lynda (Edinburgh Pentlands)	Hall, Patrick (Bedford)
	Hanson, David
Clark, Paul (Gillingham)	Harman, Rt Hon Ms Harriet
Clarke, Charles (Norwich S)	Heal, Mrs Sylvia
Clarke, Eric (Midlothian)	Healey, John
Clarke, Rt Hon Tom (Coatbridge)	Henderson, Doug (Newcastle N)
Clarke, Tony (Northampton S)	Henderson, Ivan (Harwich)
Clelland, David	Hepburn, Stephen
Clwyd, Ann	Heppell, John
Coaker, Vernon	Hesfond, Stephen
Coffey, Ms Ann	Hewitt, Ms Patricia
Cohen, Harry	Hill, Keith
Coleman, Iain	Hinchliffe, David
Colman, Tony	Hodge, Ms Margaret
Connarty, Michael	Hoey, Kate
Cook, Frank (Stockton N)	Hoon, Geoffrey
Cooper, Yvette	Hope, Phil
Corston, Ms Jean	Hopkins, Kelvin
Cousins, Jim	Howarth, Alan (Newport E)
Cranston, Ross	Howells, Dr Kim
Crausby, David	Hoyle, Lindsay
Cryer, Mrs Ann (Keighley)	Hughes, Ms Beverley (Stretford)

Hughes, Kevin (Doncaster N)	Morgan, Rhodri (Cardiff W)
Hurst, Alan	Morley, Elliot
Hutton, John	Morris, Ms Estelle (B'ham Yardley)
Iddon, Dr Brian	Morris, Rt Hon John (Aberavon)
Illsley, Eric	Mowlam, Rt Hon Marjorie
Jackson, Helen (Hillsborough)	Mudie, George
Jenkins, Brian	Mullin, Chris
Johnson, Alan (Hull W & Hessle)	Murphy, Denis (Wansbeck)
Johnson, Miss Melanie (Welwyn Hatfield)	Murphy, Jim (Eastwood)
	Murphy, Rt Hon Paul (Torfaen)
Jones, Rt Hon Barry (Alyn)	Naysmith, Dr Doug
Jones, Mrs Fiona (Newark)	O'Brien, Bill (Normanton)
Jones, Helen (Warrington N)	O'Brien, Mike (N Warks)
Jones, Ms Jenny (Wolverh'ton SW)	O'Hara, Eddie
	Olner, Bill
Jones, Jon Owen (Cardiff C)	O'Neill, Martin
Jones, Martyn (Clwyd S)	Osborne, Ms Sandra
Kaufman, Rt Hon Gerald	Palmer, Dr Nick
Keeble, Ms Sally	Pearson, Ian
Keen, Alan (Feltham & Heston)	Pendry, Tom
Kelly, Ms Ruth	Perham, Ms Linda
Kemp, Fraser	Pickthall, Colin
Kennedy, Jane (Wavertree)	Pike, Peter L
Khabra, Piara S	Plaskrtt, James
Kidney, David	Pond, Chris
King, Ms Oona (Bethnal Green)	Pope, Greg
Kumar, Dr Ashok	Prentice, Ms Bridget (Lewisham E)
Ladyman, Dr Stephen	Prentice, Gorton (Pendle)
Lawrence, Ms Jackie	Prescott, Rt Hon John
Laxton, Bob	Prosser, Gwyn
Lepper, David	Purchase, Ken
Leslie, Christopher	Quin, Rt Hon Ms Joyce
Levitt, Tom	Quinn, Lawrie
Lewis, Ivan (Bury S)	Radice, Rt Hon Giles
Lewis, Terry (Worsley)	Rammell, Bill
Liddell, Rt Hon Mrs Helen	Rapson, Syd
Linton, Martin	Raynsford, Nick
Lloyd, Tony (Manchester C)	Reed, Andrew (Loughborough)
Lock, David	Reid, Rt Hon Dr John (Hamilton N)
Love, Andrew	Rooker, Jeff
McAllion, John	Rooney, Terry
McAvoy, Thomas	Ross, Ernie (Dundee W)
McCabe, Steve	Rowlands, Ted
McCafferty, Ms Chris	Roy, Frank
McCartney, Rt Hon Ian (Makerfield)	Ruane, Chris
	Ruddock, Joan
Macdonald, Calum	Russell, Ms Christine (Chester)
McDonnell, John	Ryan, Ms Joan
McGuire, Mrs Anne	Salter, Martin
McIsaac, Shona	Sarwar, Mohammad
McKenna, Mrs Rosemary	Savidge, Malcolm
Mackinlay, Andrew	Sawford, Phil
McNamara, Kevin	Sedgemore, Brian
McNulty, Tony	Shaw, Jonathan
MacShane, Denis	Sheldon, Rt Hon Robert
McWalter, Tony	Simpson, Alan (Nottingham S)
McWilliam, John	Singh, Marsha
Mahon, Mrs Alice	Skinner, Dennis
Mallaber, Judy	Smith, Rt Hon Andrew (Oxford E)
Marsden, Gordon (Blackpool S)	Smith, Angela (Basildon)
Marshall, David (Shettleston)	Smith, Rt Hon Chris (Islington S)
Marshall, Jim (Leicester S)	Smith, Miss Geraldine (Morecambe & Lunesdale)
Marshall-Andrews, Robert
Martlew, Eric	Smith, Jacqui (Redditch)
Maxton, John	Smith, John (Glamorgan)
Meacher, Rt Hon Michael	Smith, Llew (Blaenau Gwent)
Meale, Alan	Soley, Clive
Merron, Gillian	Southworth, Ms Helen
Michie, Bill (Shef'ld Heeley)	Squire, Ms Rachel
Milburn, Rt Hon Alan	Starkey, Dr Phyllis
Miller, Andrew	Steinberg, Gerry
Mitchell, Austin	Stevenson, George
Moffatt, Laura	Stewart, David (Inverness E)
Moonie, Dr Lewis	Stewart, Ian (Eccles)
Moran, Ms Margaret	Stinchcombe, Paul
Morgan, Ms Julie (Cardiff N)	Stoate, Dr Howard

Strang, Rt Hon Dr Gavin	Vis, Dr Rudi
Straw, Rt Hon Jack	Walley, Ms Joan
Stringer, Graham	Ward, Ms Claire
Stuart, Ms Gisela	Wareing, Robert N
Sutcliffe, Gerry	Watts, David
Taylor, Rt Hon Mrs Ann (Dewsbury)	Whitehead, Dr Alan
	Wicks, Malcolm
Taylor, Ms Dari (Stockton S)	Williams, Rt Hon Alan (Swansea W)
Taylor, David (NW Leics)
Thomas, Gareth (Clwyd W)	Williams, Alan W (E Carmarthen)
Thomas, Gareth R (Harrow W)	Williams, Mrs Betty (Conwy)
Timms, Stephen	Wills, Michael
Tipping, Paddy	Winnick, David
Todd, Mark	Winterton, Ms Rosie (Doncaster C)
Touhig, Don	Wise, Audrey
Trickett, Jon	Wood, Mike
Truswell, Paul	Woolas, Phil
Turner, Neil (Wigan)	Worthington, Tony
Turner, Dennis (Wolverh'ton SE)	Wright, Anthony D (Gt Yarmouth)
Turner, Dr Desmond (Kemptown)	Wright, Dr Tony (Cannock)
Turner, Dr George (NW Norfolk)
Twigg, Derek (Halton)	Tellers for the Ayes:
Twigg, Stephen (Enfield)	Mr. David Jamieson and
Tynan, Bill	Mr. Robert Ainsworth.
NOES
Ainsworth, Peter (E Surrey)	Foster, Don (Bath)
Allan, Richard	Fowler, Rt Hon Sir Norman
Amess, David	Fox, Dr Liam
Ancram, Rt Hon Michael	Fraser, Christopher
Arbuthnot, Rt Hon James	Garnier, Edward
Ashdown, Rt Hon Paddy	George, Andrew (St Ives)
Atkinson, Peter (Hexham)	Gibb, Nick
Baldry, Tony	Gill, Christopher
Ballard, Jackie	Gillan, Mrs Cheryl
Beggs, Roy	Green, Damian
Beith, Rt Hon A J	Greenway, John
Bercow, John	Grieve, Dominic
Beresford, Sir Paul	Hague, Rt Hon William
Blunt, Crispin	Hamilton, Rt Hon Sir Archie
Boswell, Tim	Hammond, Philip
Bottomley, Rt Hon Mrs Virginia	Hancock, Mike
Brady, Graham	Harris, Dr Evan
Brand, Dr Peter	Harvey, Nick
Brazier, Julian	Hawkins, Nick
Brooke, Rt Hon Peter	Hayes, John
Browning, Mrs Angela	Heald, Oliver
Bruce, Ian (S Dorset)	Heathcoat-Amory, Rt Hon David
Burns, Simon	Heseltine, Rt Hon Michael
Burstow, Paul	Hogg, Rt Hon Douglas
Butterfill, John	Horam, John
Cash, William	Howard, Rt Hon Michael
Chapman, Sir Sydney (Chipping Barnet)	Howarth, Gerald (Aldershot)
	Hughes, Simon (Southwark N)
Chope, Christopher	Jack, Rt Hon Michael
Clappison, James	Jackson, Robert (Wantage)
Clark, Dr Michael (Rayleigh)	Jenkin, Bernard
Clarke, Rt Hon Kenneth (Rushcliffe)	Johnson Smith, Rt Hon Sir Geoffrey
Clifton-Brown, Geoffrey	Jones, Nigel (Cheltenham)
Collins, Tim	Kennedy, Charles (Ross Skye)
Colvin, Michael	Key, Robert
Cotter, Brian	King, Rt Hon Tom (Bridgwater)
Cran, James	Kirkbride, Miss Julie
Curry, Rt Hon David	Laing, Mrs Eleanor
Dafis, Cynog	Lansley, Andrew
Davis, Rt Hon David (Haltemprice & Howden)	Letwin, Oliver
	Lewis, Dr Julian (New Forest E)
Dorrell, Rt Hon Stephen	Lidington, David
Duncan, Alan	Lilley, Rt Hon Peter
Duncan Smith, Iain	Livsey, Richard
Emery, Rt Hon Sir Peter	Lloyd, Rt Hon Sir Peter (Fareham)
Evans, Nigel	Loughton, Tim
Fabricant, Michael	Luff, Peter
Fallon, Michael	Lyell, Rt Hon Sir Nicholas
Forth, Rt Hon Eric	MacGregor, Rt Hon John

McIntosh, Miss Anne	Spelman, Mrs Caroline
MacKay, Rt Hon Andrew	Spicer, Sir Michael
Maclean, Rt Hon David	Spring, Richard
McLoughlin, Patrick	Stanley, Rt Hon Sir John
Madel, Sir David	Steen, Anthony
Malins, Humfrey	Swayne, Desmond
Maples, John	Syms, Robert
Mates, Michael	Tapsell, Sir Peter
Mawhinney, Rt Hon Sir Brian	Taylor, Ian (Esher & Walton)
May, Mrs Theresa	Taylor, John M (Solihull)
Moss, Malcolm	Taylor, Matthew (Truro)
Nicholls, Patrick	Taylor, Sir Teddy
Oaten, Mark	Townend, John
O'Brien, Stephen (Eddisbury)	Tredinnick, David
Page, Richard	Trend, Michael
Paice, James	Tyler, Paul
Paterson, Owen	Tyrie, Andrew
Pickles, Eric	Viggers, Peter
Prior, David	Walter, Robert
Randall, John	Wardle, Charles
Redwood, Rt Hon John	Waterson, Nigel
Rendel, David	Webb, Steve
Robathan, Andrew	Whitney, Sir Raymond
	Whittingdale, John
Robertson, Laurence (Tewk'b'ry)	Widdecombe, Rt Hon Miss Ann
Ross, William (E Lond'y)	Wigley, Rt Hon Dafydd
Rowe, Andrew (Faversham)	Wilkinson, John
Ruffley, David	Willetts, David
Russell, Bob (Colchester)	Willis, Phil
St Aubyn, Nick	Wilshire, David
Sanders, Adrian	Winterton, Mrs Ann (Congleton)
Sayeed, Jonathan	Winterton, Nicholas (Macclesfield)
Shephard, Rt Hon Mrs Gillian	Woodward, Shaun
Shepherd, Richard	Young, Rt Hon Sir George
Simpson, Keith (Mid-Norfolk)
Smith, Sir Robert (W Ab'd'ns)	Tellers for the Noes:
Smyth, Rev Martin (Belfast S)	Mrs. Jacqui Lait and
Soames, Nicholas	Mr. Stephen Day.

Question accordingly agreed to.

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

Resolved, That this House applauds the dedication, skill and professionalism of the staff of the National Health Service but regrets that Her Majesty's Opposition seek to undermine the National Health Service at every turn; welcomes the Government's success in cutting waiting lists in line with its manifesto pledge and its programme to make services faster and more convenient; supports the Government's commitment to modernise cancer, heart disease and mental health services, and to ensure high standards of National Health Service care everywhere; notes that a modernised National Health Service funded through taxation and offering treatment according to need not ability to pay is both fairer and more efficient than private alternatives supported by the Opposition; and so believes that the National Health Service should be modernised not privatised.