HC Deb 29 June 2000 vol 352 cc1058-156
Madam Speaker

I have selected the amendment that stands in the name of the Prime Minister. Because of the number of Back-Bench Members who wish to take part in the debate, I have had to limit speeches to 15 minutes.

1.19 pm
Dr. Liam Fox

(Woodspring) rose

Hon. Members

Hear, hear.

Dr. Fox

I will be happier if my hon. Friends cheer when I have finished my speech, Madam Speaker.

I beg to move, That this House deplores the Government's continued distortion of priorities in the National Health Service through its focus on political targets rather than clinical outcomes, its waste of scarce NHS resources, which would be better spent treating patients, on propaganda exercises, the bogus "national consultation" and a new logo, its manipulation of the appointments system within the NHS and its continued political interference in day to day management, creating a climate of fear and frustration which is driving good NHS managers out of the Service, and its failure to live up to its promises to end post-code rationing and to put patients first; and notes the huge gap between Labour's promises on health at the last General Election and the reality today, which is that, for the great majority of the British people, the NHS has got worse, not better, under this Labour Government. If we want a clear example of the Government's priorities in their approach to running health care in the United Kingdom, we need to look no further than last night's edition of the Evening Standard. Its headline "NHS blocks shock report on killing" tells us all that we need to know about the culture in the Government and the attitudes of Ministers. The report states: Publication of a damning report into a care in the community patient who killed his girlfriend in London has been postponed in a Government attempt to control bad news. Independent experts were instructed by the Department of Health to delay the inquiry report, which was due out today, because it would clash with a "big news day" on health, with Health Secretary Alan Milburn expected to make a major announcement. The report continues:

The move has dismayed leading mental health charities, which believe reports are being systematically delayed and unpublicised in order to avoid damaging headlines about the failures of care in the community. Marjorie Wallace of SANE said: "We're concerned that, increasingly, inquiries are being treated as only bad news to be suppressed, rather than giving vital evidence to prevent future tragedies."
Mr. Dale Campbell-Savours (Workington)

On that very point—

Dr. Fox

I have hardly started, and shall take interventions later. [Interruption.] I shall not take the intervention of the hon. Member for Workington (Mr. Campbell-Savours). He may as well save his blood pressure and sit down for a moment.

Mr. Campbell-Savours

On a point of order, Madam Speaker. There is a tradition in the House of Commons that a Member who makes an allegation of that nature gives way to interventions. Is that not correct? What is wrong with the man?

Madam Speaker

The Member who has the Floor determines for himself whether to give way. I heard the hon. Member for Woodspring (Dr. Fox) say that he would give way in a moment or two. Is that correct?

Dr. Fox

Yes, Madam Speaker.

Madam Speaker

I hope that the hon. Gentleman will stand by that statement.

Dr. Fox

I did not say that I would give way to the hon. Member for Workington, only that I would give way. Some hon. Members, however long they have been here, are slow learners.

The Government exist only to be in office and are obsessed with their own image.

Mr. Andrew F. Bennett (Denton and Reddish)

On a point of order, Madam Speaker.

Madam Speaker

Is this a genuine point of order?

Mr. Bennett

Surely the hon. Gentleman's remark was an insult to you, Madam Speaker, and he should withdraw it.

Madam Speaker

I must have a particularly thick skin this Thursday morning, as I did not recognise it as an insult.

Dr. Fox

I do not feel too sorry, as I have been in the Whips Office and know a Whips' operation when I see one. I know what a badly rattled Government try to do when they are in trouble. If there are no more points of order for the time being, I shall continue with bad-mouthing the Government.

The Government are obsessed by their own image, PR and propaganda. They are devoid of substance and are willing to subjugate truth, public interest and individual well-being and care to their overwhelming desire to remain in power. Yesterday's incident was just another example of that. The Government's priority is prioritising good news for Labour politicians, which is underpinned by bullying, secrecy and manipulation. In 1995, the Labour party stated:

One particularly damaging development in the Conservative years has been the emergence of a culture of fear in the NHS … We believe that all staff should be able to speak their minds.
Mr. Campbell-Savours


Dr. Fox

True to my word, I shall give way to the hon. Member for Workington.

Mr. Campbell-Savours

I thank the hon. Gentleman. May I have the good fortune of telling him that yesterday's Evening Standard report that he read out is a total and utter fabrication. In the light of that, is he prepared to reconsider what he said and withdraw the text?

Dr. Fox

I refer the hon. Gentleman to the barrister involved in that report. I am sure that she would be very interested if he wished to repeat outside the House the allegation that the report is bogus.

Another example that comes to mind is the headline in this morning's edition of The Independent "Officials drew up plans for NHS cuts cover-up". The Independent reports that the Leader of the Liberal Democrat party raised the matter yesterday, and states: Substantial cuts in the budgets of health programmes for some of Britain's poorest communities apparently— have been agreed by Ministers. The Independent reports that a Department of Health letter written by an official said: We will in effect be announcing cuts to anticipated health action zone budgets this year. There is likely to be some negative financial management and political feedback from HAZ partners. The Independent reports that another letter said: There is an issue about whether you would want to write to MPs pre-empting any complaints about funding. Ministers have only previously written to MPs when announcing successful HAZs and on balance we feel a letter would probably draw attention to this issue and is not merited. That says everything about the Government's culture. More substantial comment on that aspect of the Government was made by Judy Jones in a revealing series of articles in the British Medical Journal. She said that when an NHS trust in Northern Ireland reneged on promised funding for a new 10-bed drug rehabilitation unit, a consultant psychiatrist expressed his concerns to a newspaper. How audacious of him! As a result, he was called to account by the trust chief executive, who told him that his actions were ill judged, ill advised and detrimental to the trust. The consultant construed the dressing down as a warning and asked the British Medical Association for advice; he was the first of a very large number of consultants to do so in recent months.

Dr. Peter Brand (Isle of Wight)

Does not the hon. Gentleman recognise, as I do as someone who has worked in the NHS for the last 20 years, that in such cases NHS servants are only exercising the skills—that they have honed over the last two decades?

Dr. Fox

We are discussing what, according to huge numbers of people who work in the service, has increasingly become a culture of fear, bullying, intimidation and the suppression of truth and of the interests of individuals. It is increasingly likely that managers of trusts and health authorities will be phoned by Ministers or senior civil servants and be given a dressing down and asked why they are not giving core good news stories to the newspapers instead of allowing bad news about what is happening in the NHS to filter out. In running our health service, the Government's culture is becoming increasingly corrupt, and the NHS is playing second fiddle to the interests of the Labour party's news machine. At last year's Labour party conference in Bournemouth, Victoria MacDonald, the health correspondent for "Channel 4 News", was confronted by Joe McCrea—at that time the special adviser to the Health Secretary—who unleashed a stream of abuse at her, at one point throwing a mobile phone. I shall not repeat his language because it would not be suitable for Hansard. Victoria MacDonald explained the reason for the attack to the British Medical Journal, saying that Mr. McCrea thought that she was off-message because of a film that she had made about the waiting lists initiative.

In the film, which was made as a result of several off-the-record briefings, Victoria MacDonald suggested that the then Health Secretary was keen to ditch the waiting list initiative because it was distorting priorities. She said that he did not like the word "ditch" because he thought that it was damaging to the Government, although he did say that Ministers had come round to the idea that waiting times were more important than waiting list numbers. She wanted to report what Ministers genuinely thought, while they wanted to maintain complete control because they thought that in the short term the spin would be wrong for the Government, even though the policy may be right. How twisted and perverse is it possible to be? [HON. MEMBERS: "You should know."] Labour Members may think that it is funny that professionals who work in the media or the NHS should be subjected to a culture of bullying, fear and intimidation. They may think that that is immaterial and that sitting on the Government Benches is more important than any respect for truth or for professionals. However, those outside the Chamber certainly will not think that, and they will note the attitude of Labour Members.

Another major priority for the Labour Government when they came to office was their desire to abolish the internal market and to reorganise the system. The current Secretary of State takes great credit for having abolished the internal market, but Lord Winston, in the other place, says that one of the Government's biggest failings is that they have not abolished the internal market. It is difficult to know who is in touch with reality. However, the effect on the system of Labour's ideological reorganisation matters more than the question of who is giving us the correct version—and, as ever, the effect is that we get less choice.

Just this week, 24 of the United Kingdom's leading neurosurgeons, neurologists and anaesthetists joined the Parkinson's Disease Society in calling for changes to the current mechanism. They explained: Since the abolition of Extra Contractual Referrals in 1999 many patients with conditions such as movement disorders, spinal injuries and severe chronic pain syndromes are no longer able to benefit from treatment outside their local area. The current funding arrangement, known as Out of Area Treatment Allocations … operates under a fixed annual budget regardless of demand for operations. No mechanism now exists for the transfer of funds from Local Health Authorities to specialist centres. They then said in a statement:

We are told that since the abolition of ECRs no mechanism exists for the transfer of funds to follow the patients that urgently need our help. Consequently our waiting lists continue to grow and we are unable to treat these patients with the procedures they need. We have gone backwards since last year and the year before. This is unacceptable.
Dr. Nick Palmer (Broxtowe)

Will the hon. Gentleman give way?

Dr. Fox

I shall give way to the hon. Gentleman if he thinks that that is acceptable.

Dr. Palmer

As the hon. Gentleman continues his review of the media, would he like to comment on the today's admirable editorial in The Daily Telegraph, headlined "Dr. Fox's good health", which examines his proposals in detail and states:

Those who continue to rely on the NHS for their health needs should not expect an analogous level of care. Does he accept that that would be the consequence of his approach to the health service?
Dr. Fox

I accept that that is the view of The Daily Telegraph editorial today. I shall deal with my views shortly. [Interruption.] Given that we are discussing the lack of treatment for people with Parkinson's disease, and the fact that neurosurgeons and neurologists cannot refer their patients for the treatment that they want when they say that they were able to do so only a short time ago, it is interesting that the hon. Gentleman puts the interests of the Whips Office before those of patients in the NHS.

Several hon. Members


Dr. Fox

I have given way several times already, and I shall do so again later.

Another priority in the Government's armoury is to make funding available for their pet proposals. We have had reports this week that hospital managers say that the Government's national changeover plan in preparation for Britain's entry to the European single currency is costing millions of pounds and increasing work loads dramatically. A trust manager said: The plans will require substantial extra work from staff at a time when we are facing disintegration through the loss of mental health services, community hospitals and community services. The report further states that computers, printers, financial forms and stationery will be changed and new equipment for cashiers, vending machines and car parks required. The trust manager continues: It is likely that management consultants may he needed to support the process. It has been reported that the Department of Health admitted that the costs of preparing for the euro were high for the NHS. A spokesman did not know whether central Government would provide financial help.

We received information this morning suggesting, from calculations made throughout the country, that the cost of preparing for the Government's changeover plan could be between £75 million and £95 million for this year alone in the NHS. Will the Secretary of State tell us whether those figures are accurate, too low or too high?

Dr. Howard Stoate (Dartford)

Will the hon. Gentleman give way?

Dr. Fox

If the hon. Gentleman—he has practised as a doctor, so I shall give way to him—thinks that spending £75 million to £95 million on preparing for the euro is a good use of NHS money, I look forward to hearing from him.

Dr. Stoate

The hon. Gentleman will know, as a doctor, that GPs find it impossible to refer out of area because the Government of which he was a member set up extra-contractual referrals in the first place to limit GPs' freedom to refer out of area. If he thinks that the ECR system delivered the goods, I am afraid that he needs to talk to some more GPs, because the GPs know that the ECR budget was so tight that it was almost impossible to get health authorities to agree to pay for ECRs in the first place.

Dr. Fox

Sometimes I really do despair. If the problem with extra-contractual referrals was that the budgetary constraints were too tight, the solution would have been to loosen them, not to abolish the system. That is typical of all that the Labour Government want to do; they want to level down to the lowest common denominator and deny choice to doctors and patients, which is exactly what they have done. The consultants, such as the neurosurgeons whom I have mentioned, have less freedom to refer. That is why their patients throughout the country get a worse quality of care under Labour than they did under the previous Conservative Government—when, although I confess there could have been fewer constraints on extra-contractual referrals, there was a big improvement for GPs. The hon. Gentleman and I know that that was a great move forward for GP choice, which this Government have denied because they do not like doctors to have increased freedom.

The next pet project to be given extra funding is the new NHS logo. Everything must say "new" on it. Of course, there was not room to say "modern new NHS" on the logo. I wonder whether the Secretary of State will give us an idea of how much that will cost.

Those are minor points, although they tell us much about the Government and about the rotten culture that is eating away at them. They have no concern for truth and are obsessed by their own image and spin. What really matters, however, is what they are doing to patient care.

As the previous Secretary of State's adviser intimated, the Government themselves know that the waiting list initiative, one of the central parts of their policy, is deeply flawed, and distorting clinical priorities in our health care system. We have been told repeatedly by doctors throughout the country—I am sure that hon. Members on both sides of the House have heard it, and we have raised it here on several occasions—that clinical priorities are being distorted, with some of the sickest patients being made to wait longer while minor cases are moved up the list simply so that a bigger number are treated to make the figures look good for the sake of the politicians in Whitehall.

To put that those remarks into context, I should like to focus on a single case. The wife of a patient in County Durham wrote that her husband had been having chest pains on the treadmill and when playing golf. He consulted his GP on 17 February 1999. When he first saw a consultant it was 28 April 1999, and he told him that he thought a bypass would be needed and referred him to South Cleveland hospital. He had an angiogram in September 1999. It was not until 22 March this year that he had a consultation with a consultant. In a letter dated 28 March, he was told the current waiting time for heart surgery is 12 months. Tragically, that lady's husband died on 26 May at the age of 53, still not having received any written confirmation of his operation.

There is no way of knowing what will happen in any particular case—we all understand that—but the most important factor is that last year, 450 fewer cardiac bypass operations were carried out in the NHS than the year before—the first time in 25 years of the NHS carrying out those operations that there has been a fall, according to the cardiac register.

Does it not say everything about the culture and the way in which the Government are running the NHS that they increase the number of minor procedures, yet the number of coronary bypasses is going down? It confirms everything that we have said about the Government's approach to health care, their lack of clinical priority and their obsession with political priority.

Ms Julia Drown (South Swindon)

The hon. Gentleman has outlined a sad case, but we could produce equally sad cases from when his party were in government. If he looks at what the Government have done, he will see a huge initiative on heart specialists. We know that there are not enough. The Secretary of State has talked to heart surgeons, has worked out what needs to be done and has said that the money and the beds will be there and that the medics will be trained, so that as soon as possible, we will get an NHS of the kind that the patients of this country need. Why does the hon. Gentleman not recognise that?

Dr. Fox

To paraphrase the hon. Lady, things have not got any worse under the present Government—they are just as bad as they were before. That will come as bad news to the people who put her into Westminster, who were told that there were 24 hours in which to save the NHS. I suppose that we should all feel very reassured and can sleep safely in our beds knowing that, while the NHS is cutting the number of bypass operations, the Secretary of State has spoken to a couple of heart surgeons so it is all going to be fine.

Several hon. Members

Will the hon. Gentleman give way?

Dr. Fox

It is hard to choose from the chorus. I give way to my hon. Friend the Member for Salisbury (Mr. Key).

Mr. Robert Key (Salisbury)

Does my hon. Friend agree that most of the problem is that the Government should not be running the NHS? They should be funding and regulating it. Most of the problem is interference the whole time. Four thousand people work in my constituency hospital. They are sick to death of the Labour party treating the NHS as the Labour party poodle.

Dr. Fox

I think that there is a role for politicians in regulating the NHS and deciding what we should get out of the service, but they should then allow managers and doctors to do what they are trained to do, which is manage the service and treat patients. To have politicians interfering at every level of the service, sending circulars minute by minute and meddling wherever conceivable, is the worst possible way to run any health care system. Ministers cannot micro-manage a system that employs 1 million people, and even if were possible for them to do so, it would not be desirable. Politicians should not be managing services; we have specially trained professionals to do that. It is up to the Secretary of State and his Ministers to regulate the system and allow people to get on with what they are trained to do.

We are concerned about the effect of Government policy not only on individual patients but on hospitals. I have here a typical letter on a subject that is raised time and again as we go around the country: the increasing prevalence of hospital-acquired infections. It states: To get to the point, my father recently died in Wycombe General Hospital of a hospital-acquired infection, MRSA septicaemia— methicillin-resistant staphylococcus aureus, or the "superbug" to which the tabloids refer. The letter continues: My mother … discovered my father's pillow had a long faeces stain on it. She asked the nurses to remove it and was horrified to later find it under my father's head … Nurses have described this infection as 'the silent epidemic' … One killer fact you can throw back in Tony Blair's face is that 5,000 people a year die from hospital-acquired infections and 15,000 a year (this figure is on the increase) get infected in hospital with an infection that significantly contributes to their death. MRSA is now responsible for 37 per cent. of all cases of fatal septicaemias … tragically my father was one of those government statistics—and this is directly attributable to the filthy state of hospital wards. The rate of infection in NHS hospitals is 10 per cent. and in private hospitals it is only 1 per cent. The letter concludes:

PS. The money spent on the recent NHS publicity stunt could have been better spent on some mops and disinfectant for hospitals.
The Minister of State, Department of Health (Mr. John Denham)

I share the hon. Gentleman's concern about hospital-acquired infection. Perhaps he can tell the House whether he supports or opposes our setting standards for infection control in hospitals, or does he stick by his assertion that the Government should not be sending hospitals circulars about cleaning?

Dr. Fox

Setting the quality of standards for all health care, in both the private and the state sector, is a legitimate role of Ministers. [Interruption.] If he could retain in his memory more than one line at a time, the Secretary of State would find that I said exactly that in another part of the speech that I gave yesterday in Glasgow.

Perhaps the Minister of State would like to tell us why, after Labour has been in office for three years, only 10 per cent. of NHS hospitals have proper infection control plans and only 15 per cent. have infection control budgets. What have Ministers been doing for the past three years?

Mr. Denham

We have been setting in place a system—[Interruption.] Calm down. In three years, we have ensured that every single hospital has an infection control team. That was not the case when we came to power three years ago. On the subject of setting standards, let me point out that the hon. Gentleman said: Ministers should not be issuing endless circulars on everything from cleaning to catering. He opposed having cleaning standards yesterday, but today he wants cleaning standards.

Dr. Fox

Even given the level of distortion that we are used to from current Health Ministers, that was a particularly pathetic intervention. Apparently, the Government have spent three years putting together a piece of paper that tells hospitals to establish an infection control team. Any monkey with a typewriter could have produced one as quickly as that.

Mr. Tony Baldry (Banbury)

The Government are hypersensitive because the World Health Organisation has found that the national health service ranks 18th in the league of health organisations. Under this Government, we have a health service that is worse than that in Greece.

Dr. Fox

I find no pleasure in the fact that the world's fourth largest economy has only the 18th best health care system. There are many reasons for that, far too many to go into now. I was rather surprised by the reaction of the Department of Health, which regarded the findings of the survey as something of a pleasant surprise. It seemed to believe that it would be further down the league than it was. That says a great deal about the Department's expectations for our health care system and its confidence in running the system.

Mr. John Bercow (Buckingham)

What assessment has my hon. Friend made of the letter to the Prime Minister from Mr. Tipu Aziz, an internationally distinguished surgeon, who declares that he has supported the Labour party for more than 25 years, but that he now feels betrayed by that party because, as he sees it, morale in the national health service is at a lower level than he has ever seen in his professional life?

Dr. Fox

My assessment is that Mr. Aziz will not be alone.

Mr. Hilton Dawson (Lancaster and Wyre)

Throughout health policy and social policy, is not the first tactic of the party which wants to destroy the health service to privatise it and to denigrate and destroy public services, reducing confidence in them and bringing them down in the eyes of the public?

Dr. Fox

Given the few interventions that the hon. Gentleman will have the opportunity to make, he could surely have thought of a better one than that.

Before coming to the House, I spent all my working life in the NHS, as a hospital doctor and as a general practitioner. In the days when the Secretary of State was running his "Days of Hope" bookshops supporting CND and selling Marxist international newspapers, I was one of those junior doctors working long hours for low pay. I do not need to be told by any Labour Member what dedication is like in the NHS and about the quality of members of the medical and nursing profession. I have seen that at first hand. I do not need to be changing my line on what works and does not in the NHS according to my level of preference for any political system.

Ann Keen (Brentford and Isleworth)

Will the hon. Gentleman give way?

Dr. Fox

I have given way nine or 10 times. Given the time constraints, I think that that is sufficient.

Ann Keen


Dr. Fox

Let me say it slowly for the hon. Lady; I am not giving way.

Next week, we are getting the Government's latest and greatest stunt so far—NHS week. We are told that there will be NHS Oscars and lots of good news stories. No doubt the press will be pinned down and subjugated to ensure that no one dares to utter a peep against the Government during that period. Ministers should understand that the Government's image is not the problem. Changing it, spending more money on PR and adding more spin will not improve the situation. The lack of substance is the problem.

I will repeat what I said yesterday, because it is time the Opposition said what we want to see. We will transform the culture of the NHS by redefining the relationship between politicians and the management of the system. We aim to take the politics out of health care by changing the role of politicians altogether.

We will maintain an NHS which is free at the point of use and which, as now, provides a comprehensive range of services, funded by the taxpayer. We reject the idea of an NHS core service alone on the grounds of equity.

We intend to diminish the barriers between primary and secondary care and between the independent and state sectors to maximise partnership in all areas. We believe there should be a single regulatory framework based on the needs of the patient and not the needs of the care provider. We must ensure the safety and well-being of all patients wherever they are in the health care delivery system. Our watchwords should be quality, access and choice.

We do not believe it is desirable for politicians to be involved in the detailed management of the state system. The Secretary of State's role will be to take a strategic view of total health care, to agree funding and guaranteed minimum standards of quality and to set public health priorities.

We will abolish the Government's flawed waiting list target and adopt targets based on cure rates and survival rates, to bring them up to the level of our European counterparts. We need to place less importance on input and throughput targets. In defined clinical areas we will give a guarantee to patients that they will be given—

Mr. Derek Twigg (Halton)

Which treatments does the hon. Gentleman want paid for privately, rather than being free on the NHS?

Mr. Deputy Speaker (Mr. Michael Lord)

Order. We have had sufficient sedentary interventions.

Dr. Fox

It hurts Government Back Benchers when they are forced to listen to the real words, rather than the distorted versions they get from their own Front Bench. I said that patients will be given a guaranteed specific maximum waiting time—

Mr. Twigg


Dr. Fox

I will not give way again. I said that patients will be given a specific maximum waiting time for treatment decided by their consultant. It will be set specifically for their individual cases, not arbitrarily by politicians for the average patient. Good medicine is about seeing patients—

Mr. Twigg


Mr. Andrew Miller (Ellesmere Port and Neston)


Mr. Ivan Lewis (Bury, South)


Mr. Deputy Speaker

Order. The hon. Gentleman has indicated that he will not give way again. Hon. Members must resume their seats.

Dr. Fox

Those of us who have been, and can expect to stay, in Parliament more than one term know what it means when Government Back Benchers feel that they have continually to heckle those on the Opposition Front Bench. That shows that they are rattled and know we are telling the truth. What is more, our claims chime with the real experience of the public—who know that health care has got worse under the current Government.

I thought that we were moving towards some sort of consensus on public-private partnership. On BBC's "Newsnight", no less a person than the man in charge of the health service—the Prime Minister—said: There is absolutely no ideological barrier to using private beds. If there is a policy which prevents this, it should be removed. I will look into this. That was interesting because it is not what we have been hearing from the Secretary of State this week. Two weeks ago, he took the same line when the soundbites were being dictated by No. 10, rather than Millbank. Rodney Bickerstaffe, the general secretary of one of the main unions, said on BBC's "Question Time":

We want to abolish the private sector altogether. I would love to see it go altogether
Mr. Russell Brown (Dumfries)


Dr. Fox

At least the hon. Gentleman is honest. He wants the private sector abolished. I applaud him for having the honesty to say what many of his colleagues believe.

If the private sector—in which 1 million surgical procedures, or 20 per cent. of the total, are carried out each year—were abolished and did not exist, it would cost between £8 billion and £10.5 billion to have all those procedures done by the NHS. Do Labour Members want everything done on the health service? If so, do they want to use all the extra money and more—or do they want NHS patients to wait longer?

Every country in the developed western world has a proper partnership between the state and private sectors. In all the countries of Europe in which the Prime Minister takes his free holidays, his socialist friends in charge of health services understand the need for partnership. My greatest problem with the Secretary of State is that he said in response to the World Health Organisation report: we are not prepared to trade off being free and fair for efficiency and responsiveness to the demands of patients. Leaving aside the fact that postcode rationing is hardly fair, who believes that one has to trade off a fair and free service for efficiency or responsiveness, or that the two are mutually exclusive? A free and fair service can be efficient and responsive. The Secretary of State was giving away the fact that he does not understand the concept of choice. He does not believe that doctors or patients should be free to choose. He thinks that they should stand in line like Dickensian paupers having gruel given out to them and be thankful, irrespective of the second-rate care they are getting.

We all remember it; voters remember it—"24 hours to save the NHS", "Things can only get better", "Modernise, not privatise". We have heard it a thousand times. It is meaningless, vacuous drivel.

This is a Government with no substance, scared of their own shadow, obsessed with their image, driven by ego, incapable of taking difficult decisions—a Government afraid to govern. Their twisted priorities mean that the sickest patients get pushed down the queue or die, while more minor cases get moved up to make the figures look better. The Government are spending money preparing for the euro, while our hospitals get filthier. They speak about a national plan, but have no moral authority to call themselves national in any sense.

The best way to expose the situation is to quote from a letter from a GP in Wolverhampton, who writes: I am a G.P. in Wolverhampton. I went straight from a State School to Cambridge University, much the same background as some of the Labour Government's M.P.s, though I gather some went from public school, a privilege my farming parents could not afford for me. The GP continues: I thought the Labour Government would reward our changes … I have never felt like resigning from the N.H.S. before. I knew that Labour would not change the N.H.S. and education as per election promise, but I never expected to be blamed myself for their failure. The letter goes on: I am disgusted with Mr. Milburn's lack of respect for me and my team. You have got to get this across to him, he has to stop bashing doctors and the N.H.S. just because Labour hasn't delivered. All our efforts … are rubbished by him. I met Mr. Dobson. I believe he was "passionately" committed to the N.H.S. which is why Mr. Blair got rid of him when he realised that Doctor-bashing was the political answer to their problems. I am now worried that I will leave the N.H.S. if Labour is returned at the next election. I fear that other forward-thinking practitioners who have that option will also go. This will wreck Primary Care. My patients and others need to know the consequence of voting Labour. Tell them. I will tell my patients. What an indictment. What a disgrace. What a betrayal! "New and modern"? Labour have been rumbled for the self-satisfied, smug, hypocritical, bullying, shallow, soundbite-ridden and vacuous scam of a Government that they are. They should start counting their days.

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

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof: `welcomes the decision to prepare a National Plan for the NHS in England, bringing together doctors, nurses, patients' organisations and others working in the NHS to set out priorities for the modernisation of the NHS; welcomes the largest sustained increase in funding in the history of the NHS; and rejects the use of taxpayers' money to subsidise private medical insurance.' I am glad that the hon. Member for Woodspring (Dr. Fox) has got that off his chest. This debate on priorities in the national health service is very welcome, for a simple reason: it will reveal the clearest of differences between the policies of the Government and those of the Conservative party. For two decades they ran the national health service. They failed to invest in it or to modernise it.

For three years, the Government's priority has been to lay the foundations for a modernised national health service. Let me tell the hon. Gentleman what our priorities have been. First, we have been getting more doctors into the NHS as a priority. That is why there are 4,780 more doctors since we came to office. We have almost 500 extra GPs and 4,300 more hospital doctors.

By 2005, we will have increased the number of medical school places by more than 1,100—a 20 per cent. increase, and the biggest for a generation—and established two new medical schools, the first for 25 years. The hon. Gentleman always says that he wants more real doctors, rather than more spin doctors. That is precisely what we are providing.

Dr. Fox

How many consultants took early retirement from the NHS last year, and was it a record?

Mr. Milburn

I do not know those figures, but I will be happy to write to the hon. Gentleman. I can tell him that we are getting more consultants working in the NHS, and there will be more consultants working in the NHS.

Secondly, we have made getting more nurses into the NHS a priority. That is why there are now 5,000 more nurse training places than when we came to office. I remind the Opposition that when we came to office, the number of nurse training places had been cut by them. Now the numbers are rising. There are 10,770 extra qualified nurses working in the NHS—an increase since we came to power. Last year, the increase in nurse numbers was the highest for seven years.

Thirdly, we have made treating more patients in the NHS a priority. The NHS now carries out 500,000 more operations each year, sees 400,000 more patients as first out-patient appointments and treats 300,000 more emergency cases.

In May 1997, waiting list figures were rising, and were at a record level. Today, the figures are down by more than 100,000. Last year, there was a fall in both in-patient and out-patient waiting list numbers for the first time ever.

Mr. Simon Burns (West Chelmsford)

Will the Secretary of State give way?

Mr. Milburn

I shall give way in a moment. The hon. Member for Woodspring made much of distorting numbers and distorting the truth. I wish that he would concentrate on the genuine figures, and the truth about the number of heart operations. He alleges that the number of heart operations decreased in the last year for which we have figures. That is not true. In 1997–98, there were 21,110 coronary artery bypass grafts. The following year—when the hon. Gentleman claims that the numbers fell—they increased by approximately 1,300 to 22,494. The hon. Member for Woodspring and other Conservative Members should give fewer lessons on distorting the truth.

Mr. Burns

On the Secretary of State's claims about falling waiting lists, will he tell me in straightforward language why 8,391 were waiting for hospital treatment in the Mid Essex hospital trust area on 31 March 1997, whereas the latest figures show sthat 9,953 people are waiting? Why have not the numbers on waiting lists fallen in the past three years?

Mr. Milburn

As the hon. Gentleman knows, the number for in-patients has fallen by 100,000. The number of out-patients waiting for treatment remains too high—that is undeniable—but it is falling. Last year, for the first time since records began, the number of in-patients and the number of out-patients waiting for treatment fell at the same time.

The hon. Gentleman knows that performance varies across the NHS. I cannot micro-manage the North Essex trust, if that is the relevant trust. Management is up to individual managers and clinicians. If the hon. Gentleman, as the local representative, is so worried about the matter, he should take up the trust's performance with the people who are responsible for it.

Dr. Stoate

My right hon. Friend promised to present a clear contrast between the Government's priorities and those of the Conservative party. How is that possible when the Conservative party has not yet identified its priorities?

Mr. Milburn

If my hon. Friend has a little patience, I shall come to the Conservative party's priorities. To give him a little taster, I can tell him now that Conservative Members' priorities are not to modernise the NHS. They want to spend public money on subsidising the costs of private health insurers. That is their priority; the hon. Member for Woodspring told John Humphrys that on "On the Record" on Sunday. He also told the NHS Confederation in Glasgow yesterday that that was Conservative policy.

The hon. Gentleman has trouble remembering what he said from one day to the next. Yesterday, he said in his speech in Glasgow that it was not right to send out health service circulars on clean hospitals; today, he claims that it is right. I assume that he abides by his comments on BBC television, and that Conservative party policy is to spend millions of pounds of taxpayers' money not on modernising the NHS, but on subsidising more and more people to go private. That is the Conservative party's priority, but it is not that of this party.

Mr. Roger Casale (Wimbledon)

Doubtless my right hon. Friend will agree with John Humphrys' remarks in The Sunday Times last week, when he described Conservative party polices as wishful thinking.

Mr. Milburn

I do not always agree with John Humphrys, and I did not see the article to which my hon. Friend refers. Whether the Conservative party's policy is wishful thinking is a secondary consideration. What counts is who can be trusted with this country's health service. People will decide that in the forthcoming general election.

Several hon. Members


Mr. Milburn

I shall give way in a moment. It is time not only to judge the Conservative party on its past record, but on its promises for the future.

Mr. Geoffrey Clifton-Brown (Cotswold)

Will the Secretary of State explain why he has changed the guidelines on hospital transport? The change means that an 84-year-old woman with angina was able to get an ambulance to take her to hospital, but was not allowed an ambulance to take her home. That is a disgraceful way in which to treat our elderly people. Will the Secretary of State examine the guidelines as a matter of urgency?

Mr. Milburn

I shall look at the guidelines, although I am not sure what the hon. Gentleman is talking about. As he and the hon. Member for Buckingham (Mr. Bercow)— who really ought to calm down as I may give way to him if he behaves himself—should be aware, the Government are investing extra money in patient transport. More money is going to improve and modernise ambulance services, to get response times down and to make sure that patient transport is available. Of course I will look into the hon. Gentleman's concerns if he writes to me with the details.

Mr. Ivan Lewis

Does my right hon. Friend agree that more interesting than the comments of John Humphrys are the comments of the right hon. Member for Hitchin and Harpenden (Mr. Lilley), the former Secretary of State for Social Security, when he said this month: My departure from the front bench followed a high-octane row about my affirmation that there are distinct limits to the scope for private provision in healthcare. I trust no-one suspects me of plotting wholesale privatisation. What does my right hon. Friend think that says about those who remain on the Opposition Front Bench?

Mr. Milburn

It says quite simply that they have won the argument within the Conservative party. There were one-nation Tories in charge of the Conservative party, but now they are all on the Back Benches or they have left this place. The people who are in charge of the Conservative party today are like the hon. Member for Woodspring, who rightly described himself as an ardent Thatcherite free-marketeer. That is what he is, and proud of it, and it is about time that the British people understood the implications of that sort of policy for the national health service.

Mr. Michael Fabricant (Lichfield)

I am grateful to the right hon. Gentleman for giving way. He said that the party will be judged at the time of the general election. He knows that a number of hospitals and services in my constituency are under threat. The South Staffordshire health authority is conducting a review. He knows that as we have discussed the matter at Health questions. Why has the regional health authority told the South Staffordshire health authority to delay any final decisions on closures of hospitals and services in my constituency until after the next general election?

Mr. Milburn

I do not know when the next general election will be, and I guess that the regional office of the NHS does not know when it will be. The hon. Gentleman has asked a question so I shall try to give him a helpful answer.

Mr. Fabricant

Think quickly.

Mr. Milburn

I shall heed that advice, which is always gratefully received. Perhaps it could apply to those on the Opposition Front Bench and other Opposition Members.

Consultation is taking place in the hon. Gentleman's area. It will continue and the hon. Gentleman should participate in it, as I expect that his views will be listened to. However, the Conservatives cannot have their cake and eat it. The hon. Member for Woodspring, who speaks for the Conservative party on these issues, is urging me not to micro-manage the national health service and not to get involved in local decisions. I agree with him on that. He is absolutely right. We want to make sure that the people on the ground have the tools and the resources to do the job. However, Conservative Members should not then ask me to intervene in each and every case. Those on the Conservative Front Bench, and those on the Conservative Back Benches, should really get their act together.

We have made rebuilding the fabric of the national health service a priority—[Interruption.] I wish that the hon. Member for South Dorset (Mr. Bruce) would stop chuntering to himself. Accident and emergency departments in 182 hospitals are being expanded and refurbished, 1,000 GP surgeries are being modernised—[Interruption.] Keep taking the tablets.

By the end of the year, 36 walk-in centres will be open, and by next April, we will have created nearly 500 additional secure beds for people with severe mental illness. A new hospital in Carlisle has already been opened.

Mr. Eric Martlew (Carlisle)

Is my right hon. Friend aware that under the previous Government, the new hospital in my constituency was cancelled four times even though the premises of one of our hospitals was the old Victorian workhouse? Within three months of the Labour Government coming to power, the project was given approval and the new hospital was opened in April on budget, and ahead of time. That is the difference between the Tory Government and the Labour Government.

Mr. Milburn

My hon. Friend is absolutely right.

Liz Blackman (Erewash)

Will my right hon. Friend give way on that point?

Mr. Milburn

Let me answer my hon. Friend the Member for Carlisle (Mr. Martlew) and then I shall give way. My hon. Friend is absolutely right. The people of Carlisle, the community in north Cumbria and, indeed, my hon. Friend have campaigned assiduously and put a very strong case for a new hospital in their city. I am very pleased that my right hon. Friend the Prime Minister was able to open the new hospital. I shall read out the list in a moment or two, but I can tell my hon. Friend that it will not be the last new hospital to be opened this year, next year or the year after.

Some 21 other major hospital developments are already under construction, and those in Dartford, Rochdale and south Buckinghamshire will be finished this year—the hon. Member for Buckingham might wish to jump up and congratulate the Government. Five more hospitals will be completed next year and nine more the year after. That is the biggest hospital building programme that the NHS has ever seen.

Liz Blackman

My right hon. Friend mentioned the new hospital in Carlisle. Some 40 years ago, I had my appendix out in that old Victorian workhouse, so the people of Carlisle have waited a long time for their new hospital—and this Government have delivered it.

Mr. Milburn

I am grateful for my hon. Friend's observations. It is true that communities up and down the country have waited many years for the new hospitals that are now coming on stream. I remind the House that when the Conservatives were in office, they managed to spend £30 million on lawyers' and accountants' fees for PFI hospitals, but they did not get a single new hospital built. We have changed that.

Dr. Brand

For the sake of completeness, can the Secretary of State tell us what has been the effective reduction in bed availability as a consequence of the PFI projects that have resulted in those new hospitals?

Mr. Milburn

The hon. Gentleman will be aware that when we announced the first wave of new hospital building under the PFI arrangements—including Carlisle and Dartford, I believe—we carried out a comparison between the public sector and the PFI option to get the best value for the taxpayer. Indeed, we will proceed with any of the schemes under the PFI option only if it offers better value for money. In some cases, we will not proceed with PFI on value for money grounds if we think that Exchequer capital can produce a better deal for the taxpayer than the private finance option.

When we compare the number of beds available under PFI with the number available under the public sector comparator option in the first wave schemes, the number barely differs. In fact, my recollection is that the number of beds overall is slightly higher under the PFI option than it is under the public sector comparator option. Therefore, the idea that PFI is reducing the number of beds in the system is wrong.

Over many years, especially under the previous Government, the number of hospital beds declined markedly. Some 40,000 beds disappeared in the Conservatives' last 10 years in office alone. I have said many times that that decline has gone too far, and we now need to see an increase in the number of beds in the system. We have an opportunity to achieve that, given the resources that we are making available.

Mr. Bercow


Mr. Milburn

I give way to the hon. Gentleman, and I realise that he does not represent south Buckinghamshire.

Mr. Bercow

I am glad that the Secretary of State recognises that, among other things, he needs a lesson in geography, because my constituency is in north, not south Buckinghamshire. Will he now explain why he is cowering behind NICE—the National Institute for Clinical Excellence? Why, in the consideration of the supply of beta interferon, is he refusing to take account of the cost of the domestic adaptations required in the absence of the supply of that drug, and why does he think that it is right and proper to deny the additional 50 patients each week who are diagnosed as suffering from a chronically debilitating disease the prospect of some alleviation through the supply of that crucial drug?

Mr. Milburn

There is no argument about multiple sclerosis being a deeply debilitating disease. Every hon. Member understands that, and also understands that there is no cure for MS. The hon. Gentleman knows that I am not sheltering behind NICE. As I understand the position from the speech by the hon. Member for Woodspring yesterday—if it is still Conservative policy today—the Conservatives now support the role of NICE in the assessment of both cost and clinical effectiveness.

The hon. Member for Buckingham knows that NICE is assessing beta interferon. It is supposed to be a confidential process, as the drug companies preferred. NICE conducts its own appraisals in the way that it decides is best. The appraisal committee has met and made a provisional appraisal which has been leaked, unfortunately. It is not, nor will it ever be, the Government's intention to comment on leaks or provisional assessments from the appraisal committee. We will see what NICE comes up with, and I do not doubt that it will take the views of MS sufferers and others fully into account in reaching a final decision and making recommendations.

Dr. Fox

I am grateful to the Secretary of State for allowing me to clarify the point. We believe that NICE has a role in exactly the areas he outlined—cost and clinical effectiveness. That was agreed by both sides of the House when the Bill was in Committee. The trouble is that the Government sneaked affordability in, by statutory instrument, as another criterion for NICE. It is not equipped to deal with that criterion, nor does it want to have to assess it, but that is the arm's-length rationing mechanism for Ministers who do not have the courage to take the decisions overtly and transparently.

Mr. Milburn

The hon. Gentleman knows well that that is not the case. There is the clearest of differences between an assessment of clinical effectiveness and cost-effectiveness—which, from his speech yesterday, he now supports—[Interruption.] NICE will make decisions based on clinical effectiveness and cost-effectiveness, and it will have to assess the drugs and treatments according to whether—for the amount of money available—they offer a clinical benefit to patients. Decisions on affordability are decisions for the NHS, not for NICE. That is precisely what the establishment order makes clear.

Mrs. Eleanor Laing (Epping Forest)

On the point that the Secretary of State has just explained so precisely, can he tell the House why, if affordability is not to be taken into consideration by NICE, the House passed a statutory instrument last year that made a change in the criteria to be applied by NICE? That change was sneaked in last August when the House was not sitting.

Mr. Milburn

Sometimes I wonder why I bother. [HON. MEMBERS: "Hear, hear."] Well, I am pleased that the Tories are glad about something. I have just explained why we made the amendment to the establishment order. It was precisely to clarify that NICE has a role in assessing not only for clinical effectiveness but—as the hon. Member for Woodspring and his party now agree—for cost-effectiveness. As I understand it, there is no argument about that. Decisions about affordability are a separate issue for the NHS. [Interruption.] I have tried to explain it twice and if the hon. Lady does not understand, that says more about her than about the explanation.

We have invested more money in the NHS as a priority, which will mean the largest sustained increase in funding in the history of the NHS. It will be twice the historic growth trend in NHS spending, up from 3 per cent. under the Conservatives to more than 6 per cent. under Labour. By 2004, the NHS will grow by more than one third in real terms, and more than 50 per cent. in cash terms.

Our immediate priorities for the NHS have been more doctors; more nurses; modern hospitals; more patients treated; and more money invested. Not every problem has been solved, but a start has been made on turning round the NHS after decades of neglect. Those priorities have been underpinned by the changes we have made to tackle the two-tier system of care that we inherited. First and foremost, we have abolished the hated and divisive internal market foisted on the NHS by the Conservatives. In its place, we have put the primary care groups and primary care trusts, with control of local health services now in the hands of the people who know patients' needs best.

This year alone, the primary care groups—front-line doctors and nurses—are in charge of a budget of over £20 billion. That is not what the hon. Member for Woodspring calls an act of centralisation: it is the biggest-ever decentralisation in the history of the health service.

The motion accuses the Government, as did the hon. Member for Woodspring, of day-to-day political interference in the management of the NHS. The hon. Gentleman cited the number of circulars issued by the Department of Health to the health service. For the benefit of the House, I shall describe what the circulars are. Essentially, they are instructions from Ministers to NHS trusts and primary care groups.

I have some interesting figures about the extent of so-called day-to-day political interference in the work of the local NHS. In 1996, the final year of the previous Conservative Government, the then Secretary of State for Health issued a grand total of 305 explicit instructions to the national health service. Since I have been Secretary of State, I have issued a total of 21 explicit instructions to the national health service. What is more, I have set a cap on the number of such instructions to be issued from Richmond house to local health services. This year, no more than 100 health service circulars will be issued by Ministers to the local health service—and I expect the total to be far lower than that. I hope that that puts an end to talk about political interference in the national health service. If any party was guilty of that, it was the Conservative party.

Mr. Nick St. Aubyn (Guildford)

Is not it correct that the modernisation fund, which is worth £0.5 billion a year, is entirely in the hands of Ministers, to be used at their discretion? A quarter of the beds at the Royal Surrey hospital have been cut over the past two and a half years. Senior civil servants recommended that £2.5 million be given to that hospital, but the Secretary of State personally cut that allocation to just £1 million. Will he say why he did that? If that is not political interference, what is?

Mr. Milburn

I shall deal with ring-fenced funding for coronary heart disease and cancer in a moment. I make no apology for setting tough national standards for the national health service. Anyone who takes even the most cursory look at the NHS will realise that, all too often, the care that people get and the services that they receive depend on where they live. That is unfair. It is unacceptable, and it has to change.

That is why we have created the first-ever independent inspectorate for the NHS, the Commission for Health Improvement, to drive up standards of care for all patients. It is also why we set up the National Institute for Clinical Excellence, and it is why we have been working with doctors, nurses and managers to draw up clear national standards to treat and prevent the biggest killers that our country faces—coronary heart disease and cancer. National standards for treatment have also been drawn up for mental health problems.

It is worth reminding the House that, when we came to office, there were no such standards for tackling heart disease, even though Britain has one of the worst records of heart disease in the developed world. Today, those standards are in place. A national service framework has been established which commands the confidence of the service and which sets out a clear, 10-year programme of reform and improvement. It is a blueprint for change which is backed by £100 million of ring-fenced cash. That money will be used to pay for 3,000 more heart operations, cut ambulance waiting times and set up fast-track chest pain clinics. In addition, smokers will be helped to give up smoking, rather than just being exhorted to do so.

Fiona Mactaggart (Slough)

May I take this opportunity to thank the Secretary of State for making a difference in my constituency, which has one of the highest rates of death from heart attacks and strokes in the country? In nearly 20 years under the Conservative Government, my district general was almost unique in having no dedicated coronary care unit. The hospital now has £800,000 to invest in a coronary care unit. It is moving its intensive care beds out of the portakabin that has housed them for years. It also has £3.5 million for a new accident and emergency department. Will not that deliver better help for the appalling health record of the people of Slough?

Mr. Milburn

My hon. Friend is absolutely right. Frankly, it is a bit rich of the Opposition to cry crocodile tears over heart patients. There is no argument but that waiting times for heart operations are too long, but we are going to get them down. The waiting lists are too long for a self-evident reason—under that lot, there was no national plan for coronary heart disease, and inadequate training meant that we had too few cardiologists and cardio-thoracic surgeons. As a result, in today's national health service, there are only 171 surgeons capable of doing heart operations.

That is the legacy of the previous Conservative Government, not of this Government. I can tell my hon. Friend the Member for Slough (Fiona Mactaggart) that, over the next five or six years, we will increase the number of doctors capable of carrying out heart operations by between 50 and 60 per cent. That will be an investment in the future. Like everyone else, I wish that the increase could be accomplished faster, but we must make no bones about who were responsible for today's long waiting times for heart operations. They are the people who failed to invest in heart surgery yesterday—the previous Conservative Government.

Mr. St. Aubyn

Will the Secretary of State give way?

Mr. Milburn

No, I have given way once to the hon. Gentleman, who should not point his finger at me like that. It is most rude.

I do not say that we have solved all the problems the NHS faces, but we have made a start. The policies of the Conservative party would take the NHS back instead of moving it forward. There could not be a clearer contrast between the priorities of this Government and those of the Opposition.

The hon. Member for Woodspring gave an infamous speech to his party conference which has become known as his "NHS plc" speech. He said: The biggest problem that we have in the NHS is that it is not a proper market. Given that the Opposition see that as the biggest problem, I can only assume that it is their biggest priority too. We know now that they intend to tackle it by using public money to subsidise and expand the private medical insurance market.

The hon. Member for Woodspring confirmed this week that the Conservatives would spend £468 million subsidising employer-based private medical insurance. That is their policy and it is on the record—but it is just the start. On at least four occasions this year—twice in January, once in March and once in April—the Leader of the Opposition has repeated his commitment to introducing tax relief for individuals in private medical insurance schemes, as well as for those in employer-based private schemes.

The total cost of that policy could come to £1 billion. That would more than dwarf this year's pay rise for nurses, and all the investment that the Government are making in casualty departments. The resources that we have prioritised for the NHS would be frittered away in tax perks for people who already have private medical insurance—and all in the name of creating what the hon. Member for Woodspring calls a "proper market".

It is no good for Conservative Members to claim that that spending would be additional to matching our commitment to big increases in the NHS budget. They are spending money that they have not got. The Opposition's tax guarantee, their refusal to support tobacco taxation being ring-fenced for the NHS and their extension of tax perks for private medical insurance mean that they could not even hope to match the Government's spending on the NHS.

The Opposition cannot match our commitment to modernisation, so they are forced to prioritise their real policy. That is not to modernise the national health service, but to privatise it. [HON. MEMBERS: "Rubbish."] Conservative Members say that that is rubbish, but the hon. Member for Woodspring has said that he wants more patients to be pushed into paying for treatment and for what he calls non-urgent operations.

Dr. Fox

indicated dissent.

Mr. Milburn

The hon. Gentleman shakes his head, but that is what he told The Sunday Times in January—

Mr. St. Aubyn

Will the Secretary of State give way?

Mrs. Laing

Will the right hon. Gentleman give way?

Mr. Deputy Speaker

Order. It is obvious that the Secretary of State is not giving way at the moment.

Mr. Milburn

If they stopped shouting at me, I might give way. In an interview with The Sunday Times in January, the hon. Member for Woodspring said that hip and knee replacements, and cataract and hernia operations were at the top of his hit list. Whenever I have challenged the hon. Gentleman about that interview, in the House and elsewhere, he has always denied it and said that he was misquoted. I give him the opportunity to put the record straight today.

Dr. Fox

I have made it perfectly clear that if people choose to go privately, it is up to them. Yesterday, I said explicitly: It is not important to us where treatment is carried out—simply that it is carried out in the appropriate time and of the appropriate quality. We must also ensure that the system works effectively to deal with debilitating if not life-threatening conditions such as patients requiring hip replacements or cataract surgery. One of the solutions is to have stand-alone surgical units dedicated to these procedures without the pressures of having to deal with emergencies. It is an attractive idea which I hope the Government might include in the national plan. It could not be much clearer.

Mr. Milburn

The House will note that despite the fact that the hon. Gentleman claims that he has been misquoted by The Sunday Times, he did not use that opportunity to say that he was misquoted. He does not withdraw what he told The Sunday Times, published on 18 January. The House will be interested in that—as will, I suspect, The Sunday Times.

If the hon. Member for Woodspring does not agree with himself, I wonder whether he agrees with his hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond). In January, the hon. Gentleman said on Sky News—live on air—that the system that the Conservatives were advocating meant people would look to the NHS to provide them with service when they had serious, life-threatening conditions— and we have no argument about that. He went on to say that people would look to their private insurance to help them with those things where the NHS has to ask them to wait a little bit longer. Is this another case of the hon. Gentleman being misquoted? Did he misquote himself? Does he stand by those remarks—yes or no?

Mr. Philip Hammond (Runnymede and Weybridge)

I stand by those remarks entirely. Even the Secretary of State acknowledges that people in this country have a right to buy private health insurance. That is their choice and their right. Does the Secretary of State prefer a model in which people try to opt out of the NHS, buying private medical insurance that will cover all their needs? Or does he think it is a better model to have private health insurance products that are complementary to the NHS, so that people will look to the NHS for their serious and life-threatening conditions and turn to private insurance, if they have it, for those conditions

where the NHS has to ask them to wait a little bit longer?
Mr. Milburn

I can feel a general election campaign coming on—I can feel it in my bones. I can see the leaflets and the party political broadcasts. There we have it, from the lips of the hon. Gentleman; the authentic voice of today's Conservative party. The Conservatives are no longer committed to getting waiting times down for everybody in the NHS; they are committed to extending waiting times in the NHS. They are committed to taking non-urgent operations out of the NHS altogether. [Interruption.] That is what the hon. Member for Runnymede and Weybridge said.

Let me tell the House exactly what those non-urgent operations are. Some 1.2 million took place in the NHS in England in 1998–99. More than 300,000 of them were carried out on pensioners. A quarter of a million were general surgery operations and a further quarter of a million were orthopaedics. Just under 200,000 were eye operations and more than 100,000 were gynaecological operations. The priority of the Conservative party could not be clearer: a two-tier health care system with fast-track treatment for those who can afford to pay and second-rate treatment for those who cannot. Those might be the Conservative party's priorities, but I tell the House that they are not the Government's priorities.

Dr. Fox

Will the Secretary of State tell us how many patients forced out of the NHS to buy their entire treatments in the private sector did not have private insurance last year?

Mr. Milburn

The hon. Gentleman knows that there are two trends in the private health care market. There is one trend for private health insurance that is basically flat, although I know that the hon. Gentleman wants to bump it up and spend taxpayers' money doing so. He would rather spend £400 million on subsidising people for their private medical insurance than invest it in precisely the areas that Labour Members would recognise as priorities.

There is a rise in the number of so-called "self-payers"; people who decide to pay for their own care. That is true. I was asked whether I thought people should have a choice. Fine—they should have a choice, but it should be a genuine choice with a first-class national health service, not just in some parts of the country, but in every part. That does not mean shorter waiting times for some treatments, but shorter waiting times for every treatment.

Mr. Burns

indicated assent.

Mr. Milburn

I am glad that the hon. Gentleman is nodding so enthusiastically, and I can let him into a little secret; that is not the position of his Front-Bench colleagues.

Dr. Fox

Does the Secretary of State think that those 160,000 patients who, last year, paid entirely for their own care—many from out of their life savings—for operations such as cardiac surgery or major orthopaedic procedures, did so because they wanted to have that choice or because they were forced to do so by the unacceptable waiting times in the NHS, for which the right hon. Gentleman is responsible?

Mr. Milburn

The hon. Gentleman assiduously quotes his own medical experience. He will know at least as well as I do how many years it takes to train a cardio-thoracic surgeon. Could he remind me? How many years is it? Is it three years? Or is it seven or 10 years? Who was in power seven or 10 years ago? I will let him into another little secret—it was not a Labour Government, but a Conservative Government. The failures that we see now in our heart surgery services have everything to do with the failure by the previous Conservative Government to invest, plan and modernise. That is the case and however much the hon. Gentleman may wish to dismiss it, he knows that as well as I do.

I have described the Opposition's priorities, but they are not our priorities. Within four weeks, the Government will publish our national plan for the NHS. It will set out our national priorities for reforming the national health service. The national plan will be both radical and reforming. It will make clear that the nation's priorities are more doctors and more nurses, not more markets. Our priority is to expand the national health service; the Conservative party's priority is to extend the private medical insurance market.

Mrs. Teresa Gorman (Billericay)

Will the Secretary of State give way?

Mr. Milburn

No, I will not give way. I have given way on countless occasions and, frankly, every one was a waste of time.

Our priority is to reduce waiting times for all conditions. The Conservatives' priority is to increase waiting times for many conditions. Our priority is the opportunity for all to have a decent health service. Their priority is to waste NHS resources on subsidising the private medical insurance industry.

The national plan will deliver on our priorities for a bigger, better NHS, treating more patients more quickly. Those are the priorities for the NHS. They are the priorities for Britain. I believe that they are the priorities of the British people. From what we have heard today, we now know that they are certainly not the priorities of the Conservative party.

2.38 pm
Mr. Nick Harvey (North Devon)

I congratulate the hon. Member for Woodspring (Dr. Fox) on securing this debate on priorities in the NHS. It is an important issue and a timely moment for the House to debate the matter, as we are a few weeks away from a national plan that will point the way for the NHS in years to come. Everybody in the Chamber will recognise that there is a still great deal to be done to improve our national health service and certainly that perception is shared by the general public.

The 1980s and 1990s saw a decline in the NHS, as it was starved of investment. The decline is demonstrated by the waiting culture which continues to bedevil the service. The public are increasingly aware and concerned about waiting lists and times, increases in the number of operations cancelled and poor access to appropriate drugs in certain areas. However, those are merely symptoms. The causes have been the dwindling number of health care professionals, too few staffed beds and the deteriorating state of equipment and buildings. At the start of the 21st century, the service is slow and often unresponsive to patients' needs.

The principal problem with the national health service is lack of capacity. There are too few doctors, too few nurses and other health professionals, too few hospitals, too few beds and not enough modern equipment. These are the problems that bedevil us, and which come to light all too clearly in circumstances such as the flu crisis last winter. Not having the capacity to cope with the sudden upsurge in the numbers needing to use the health service brought all sorts of problems.

In the midst of that crisis, the Prime Minister outlined his goal of seeing spending on health in the United Kingdom increase to the European average. In March, the Chancellor committed new sums of money to the health service. We welcome that money; in some cases, we feel that it comes with too many strings attached, but it is clear that, in committing these resources, the Government recognise the scale of the problems that need to be addressed.

Our criticism is that if the Government had started making such an investment, and had called together the stakeholders in the health service to formulate their national plan—which they are now doing—when they first came to office three years ago, the dividends from that investment would now be starting to show. At the most rudimentary level, if more nurses had started training in 1997, they would be qualifying this summer and could help tackle the problems. However, better late than never—I think that the Government have been absolutely right to sit the stakeholders in the NHS round a table to discuss what they believe to be the way forward.

When I listened to the hon. Member for Woodspring talk about political interference, I could not help but look at the contrast between the process in which the Government are currently engaged and the manner in which the previous Government's health reforms were steamrollered through in the early 1990s as they ignored all the warnings that were given and refused to carry out any pilot studies. The Government's stance is in marked contrast, and is a welcome change in approach and emphasis. It gives us an opportunity to consider what the basic principles of the NHS should be for the next 50 years. The NHS has been well served by the original founding principles outlined by the great Liberal, Beveridge, and implemented by the post-war Labour Government. The first of these principles, in my view, is that the NHS should remain free at the point of need and paid for out of general taxation. The principles have ensured that the NHS has survived 50 years in which it has often been deprived of the resources that it needed and has suffered all sorts of experimentation and tinkering. That the NHS still exists is testament to the fact that people in Britain still regard it as their most valued institution.

Let me nail the Liberal Democrat colours to the mast on this first key principle. We believe that a tax-based NHS is sustainable; we believe that a tax-based NHS should be the route to expanded health care, not increases in private health insurance. A tax-based system is fairer and more efficient than a system based on continental social insurance or on private health insurance. At its most basic, the British people will get more health bangs for their buck through the NHS than through privately funded health care.

Britain cannot afford to encourage cheap provision without the promise of quality. We cannot afford to promote health care predicated on profit, and we will not accept quality of life dictated by quantity of wealth. That is what private insurance would mean to the poor, the elderly and the disfranchised of this country.

Mrs. Gorman

What would the hon. Gentleman say to an elderly person going into one of our national health hospitals whose card is marked "not to be resuscitated" when, under the previous Government, that person could at least have taken out private medical back-up because tax relief was allowed on it? Such a situation is deplorable.

Mr. Harvey

I am sure that everybody deplores what the hon. Lady describes, but it is an issue of clinical practice and needs to be addressed as such. To suggest that it is pre-eminently a matter of resources is wrong. The situation that she describes is scandalous, but it is not principally driven by resources.

Let me make it clear that the Liberal Democrats have no difficulty with the private sector playing a growing role on the supply side. If those in the NHS who commission care or subcontract it think that they can, in particular circumstances, get better value for money from some element of private sector provision, or if there are temporary capacity problems with which they think that the private sector can help the national health service, so much the better. There is no problem with that. However, that is a world apart from diverting resources that could be used in the national health service into subsidising private insurance for those who, in most cases, already have it.

Over the past year, the Australian Government have offered a rebate to all those taking out private health insurance. In the first nine months, they spent $2.2 billion—nearly £1 billion—on a population a third the size of ours. At the end of that exercise, the number of people taking up private insurance went up by all of 0.9 per cent. For goodness sake, that money could have been used in the Australian health system. The Australian Government have done the equivalent of going into the street, picking up a drain hatch and pouring the money down it. If they had wanted to spend that money on health, they could have done it by subsidising the supply side of the private sector. At least they would then have had something to show for it.

The situation in Australia is no different from the situation here. During the 1990s, when the previous Government offered tax incentives to people above retirement age to take out insurance, that had barely any impact on the numbers doing so, and when this Government removed that provision, there was barely any drop-off. This is a dead-weight subsidy to people who already have the insurance.

The Conservatives maintain that that money would not come out of the national health service. I am not about to pre-empt or judge what their costed manifesto will say at the next election. However, wherever the money is coming from, it could have gone into the national health service. There is no way in which the British taxpayer or the NHS patient will get better value for that money by diverting it into private health insurance for people who already have it.

The Liberal Democrats are perfectly relaxed about private sector involvement on the supply side, but we do not believe that taxpayers' money should be used artificially to stimulate the growth of private health insurance. We do not believe that that will give the British taxpayer value for money.

Sir Raymond Whitney (Wycombe)

Is the hon. Gentleman aware that the majority of countries in western Europe and Organisation for Economic Co-operation and Development countries have health outcomes—as they are called in the jargon—that are significantly better than those that we achieve? If he accepts that, does he agree that it is worth considering the funding methods adopted by those other countries?

Mr. Harvey

It is fair to say that many other countries have better health outcomes. In our view, that is because they spend a greater proportion of their gross domestic product on health than we do. We believe, for the reasons that I have just outlined, that the way for us to get the British spend as a proportion of GDP up is through greater investment in the national health service. That will secure better value, pound for pound, than using it artificially to stimulate the private insurance market. That is our firm belief, and the hon. Gentleman is perfectly at liberty to disagree with it.

Dr. Stoate

Does the hon. Gentleman agree that America, the largest economy in the world, which spends almost twice as much of its GDP on health as we do but almost entirely in the private sector, has rather worse outcomes than us in most health measures? Does that not illustrate the point that he was making earlier?

Mr. Harvey

The amount that the Americans spend is extraordinary. They spend more even on their state-funded health system than we do, but the fact that so many people in the USA still choose to invest in the private market does not seem to bring about the improvement in outcomes that the hon. Member for Wycombe (Sir R. Whitney) suggested that it might.

Mr. Geraint Davies (Croydon, Central)

Will the hon. Gentleman confirm that the position of his party on value for money, as articulated by his leader, the right hon. Member for Ross, Skye and Inverness, West (Mr. Kennedy), is simply to pour more and more money into the health service, with no regard for modernisation or change? The right hon. Gentleman has made that clear on many occasions and the hon. Gentleman is making it clear now. Is he not simply talking about putting in more and more money, not about modernisation and change in terms of best delivery and equal access?

Mr. Harvey

I have never heard our party leader say anything of the kind. I have made it clear on innumerable occasions that Liberal Democrats want modernisation, investment and, indeed, reconstruction for the national health service. The consultation that is continuing and the formulation of a national plan are a sensible way to try to do that and Liberal Democrats are contributing ideas in a submission to the Government as to what the national plan ought to be about and ought to do. I will say something about that in a few minutes.

Dr. Brand

Does my hon. Friend agree that one reason why we criticised the Government was that they did not take an opportunity to evaluate what may or may not be useful initiatives. NHS Direct is a good example. There was no report on its pilot stage until it was rolled out across the country. We do not know the effectiveness of £80 million of public expenditure.

Mr. Harvey

That is right. Clearly, we need a combination of additional investment, modernisation and reform. As I have said, we are largely in agreement with many aspects of the modernisation that the Government have undertaken. We think that the reforms in primary care were basically right. We do not necessarily agree with some of the details—we might not have given doctors a majority on the boards—but nevertheless we agreed with the general thrust of the reorganisation.

Again, barring the point that the Conservatives made earlier about affordability seemingly being added to the criteria after the event, we were broadly in favour of the formation of the National Institute for Clinical Excellence, ditto the Commission for Health Improvement. Therefore, it is absolute nonsense to say that we have not been addressing modernisation, or that we are not willing to continue to do so.

Our principal argument is that it is investment that is needed, and that lack of capacity is the biggest single problem. As money goes into dealing with that, it is only right and proper to pay attention to modernisation.

Mr. Hammond

Does the hon. Gentleman also agree with his hon. Friend the hon. Member for Richmond Park (Dr. Tonge), who said in a debate in Westminster Hall two or three weeks ago that the national health service needs more money than the Liberal Democrats have ever proposed?

Mr. Harvey

The Liberal Democrats put forward a manifesto at the election with some commitments to moneys that we wanted to go into the health service, which we stipulated were over and above inflation. As the economic circumstances have improved three years into this Parliament, the state is clearly now able to afford a contribution that is greater than anyone would have thought possible at the time of that election. When we make a commitment at election time it is for the minimum that we think that we can do. It does not preclude our coming back later and identifying that, with rosier economic circumstances, more money can be put in.

The long and short of it is that, as we publish our alternative Budget each year and publish our costed manifesto, we will commit Liberal Democrats to putting extra funds into the health service and we will say how much and from where it will come. Like the Conservatives, we will no doubt be poring over the comprehensive spending review when it comes out shortly and taking stock of what we think that the nation can afford in the light of that.

Increasing capacity has to be the first priority. We also think that there are problems with accountability and transparency within the NHS and that those should also be part of the reform process. Patients ought to be able to expect a high quality of care on which they are well informed, and to have access to their medical notes and to the decisions made about them. Patients also have the right to expect prompt and safe treatment.

The complaints procedures need a considerable overhaul. Yesterday, in my speech to the conference of the NHS Confederation, I talked about the need for a review of the compensation procedures used in the NHS. At the moment, about 70 per cent. of the money that has to be spent on compensation is swallowed up in legal costs. Reforms there could also help.

Prevention and diagnosis are also worthy of attention. A huge technological advance is taking place in diagnostic equipment and early treatment procedures. In many cases, British science is at the forefront. We need as a matter of urgency to consider how the NHS can take advantage of that. We have been rather too slow and too luddite about adopting new technologies and have sometimes insisted on trialling things that have already been comprehensively trialled in other industrialised and developed countries. We ought to be more willing to move faster to put some of those procedures in place.

A modernising NHS faces many challenges that it has not had to meet before. A growing population with an increasing number of elderly patients presents new problems and opportunities for existing and prospective NHS facilities. It is crucial that many of the old challenges are met more effectively. Clearly, heart disease and cancer treatments and the provision of mental health services need to be radically modernised. It is right that the Government have identified those as priorities.

The development of primary-led care, joint budgets, cross-disciplinary initiatives and a focus on alternatives to hospitalisation are necessary features of a modernised and capable health service. Some are also aspects where private sector provision might reasonably play a part.

At this exciting and challenging time, it is disappointing and regrettable that there are those who wish to destroy the fabric of the NHS by encroachment and neglect. As the debate has progressed, it has become increasingly clear that the official Opposition no longer believe in the NHS as it has existed until now. It is all too obvious that the familiar reassurances belie a party that underfunded the NHS for 18 years and now wishes it to be sidelined—a last resort NHS for the uninsurable, the elderly, the chronically sick and the marginalised.

Mr. Hammond

Will the hon. Gentleman give way?

Mr. Harvey

I have already given way to the hon. Gentleman. Clearly, that policy would be a betrayal of the NHS, and the British people do not want it. Liberal Democrats will continue to expose those plans for what they are.

Conservative spokesmen have talked several times in recent months of the increasing role for private insurance and the fact that they want to divert funds into it. This very afternoon, the Conservative spokesman drew a distinction at the Dispatch Box between the services that one and the same patient might expect to get in the NHS and those that he or she might look to private insurance to provide.

I am sorry that the Conservatives do not see that policy for what it is. The debate underlines the principles of the NHS as they have always existed. We will continue to take on the Conservatives on that issue in the next few months and into the election. Those are the facts of the matter. The Conservatives may not like it, but that is the meaning of their policies and we will continue to explain that to the British people.

Mr. Hammond

Will the hon. Gentleman give way?

Mr. Harvey

I will not give way. The hon. Gentleman has already made his point at the Dispatch Box and we have heard enough of that.

Liberal Democrats remain committed to the NHS. Clearly, if sustainable reconstruction can improve the quality of health care, the funds ought to be made available to the NHS to do so. Our party remains committed to reform and modernisation, welcomes much of the general direction of what the Government are doing with the help of doctors, nurses, the professions allied to medicine, managers, patient groups and others. There are signs of the beginnings of an emerging consensus on the matter. The Liberal Democrats welcome that consensus of all the stakeholders in the NHS about its future and what it might achieve. Only by going forward on the basis of consensus can we deliver what the majority of the people want and all the people need.

Several hon. Members


Mr. Deputy Speaker

Order. Before I call the next speaker, I remind the House that Madam Speaker has placed a 15-minute limit on all Back-Bench speeches and that that will apply from now on.

2.58 pm
Mr. Eric Martlew (Carlisle)

I will try to be brief. There was little substance in the Opposition's attack today and more than a whiff of hypocrisy. The reality is that the Tories left us with a two-tier system—fundholding and non-fundholding—and now I am not sure whether they want a two or a three-tier system, with the private sector and, perhaps, a return to fundholding and non-fundholding too. They do not want a unified system; that is obvious.

We all know about the effects of the internal market. We all knew that it was unfair. I presume that all hon. Members have advice surgeries. In those, we learned of the problems that that market was creating. We also know that it was one reason why the Conservatives lost the election. We did not have enough staff in the health service, the buildings were poor and it lacked capital expenditure. I think that 50 per cent. of NHS buildings were built before the war, which is 50-odd years ago. Also, the number of doctors and nurses in training was at a record low.

The Tories believe that all that is forgotten. They believe that people have short memories, but that is not true. We had all those problems in my constituency. On top of that, we had been waiting for a brand new hospital for over 20 years. We were promised one in the late 1970s. We needed it for two reasons: first, our old one was in part of an old Victorian workhouse and was built at the beginning of the last century. It is now a listed building and will provide a very good campus for our new teacher training college, but it was inadequate as a hospital. Secondly and more seriously, the maternity unit was three miles away from the paediatricians and anaesthetists.

The Tory Government received a report saying that young babies in my constituency were dying because of the split site, but nothing was done. The right hon. Member for South"West Surrey (Mrs. Bottomley) is in her place. Perhaps she can explain why on one occasion when she was Secretary of State, her Government withdrew the contract for building Carlisle hospital a week before it was due to go out to tender. That is what my people remember about the Conservative Government's record.

Let us contrast that with what has happened under the Labour Government. They were elected on 1 May 1997. I went to see the Secretary of State in June and put the case for Carlisle being a priority. In July he agreed with me and announced the intention to build a new hospital. In September the contract was let. In November, on one of the happiest days of my life, I cut the sod to mark the start of the building of our new hospital.

It may take three years to train a nurse and five years to train a doctor, but it took fewer than three years to complete our brand new district hospital. It was delivered in April, on budget. One of the problems that we had with its funding was that it was delivered before time. There was not a precedent for that—nobody could remember a hospital being delivered before time. A fortnight ago my right hon. Friend the Prime Minister came to my constituency and opened the hospital.

The hospital was started under a Labour Government and completed under a Labour Government, and it is only the first of many. We are talking not just about a new building but about new operating theatres, new equipment, everything being brought on to the site, a new hydrotherapy pool and more intensive care beds—an extra £500,000 was invested in them. A new nurse consultant was announced during the Prime Minister's visit. That shows the contrast between what the Conservatives did not do and what a Labour Government have done in my constituency. I know hon. Members on both sides of the House are looking forward to the happy day when their new local hospitals are built.

Mr. David Hinchliffe (Wakefield)

We have been waiting since 1962.

Mr. Martlew

My hon. Friend, who is the Chairman of the Select Committee, has been waiting since 1962, and I am sure that his constituents believe that a Labour Government will deliver where the Conservatives never did in 18 years.

Everything appears to be improving. The Labour Government have delivered on more than a district general hospital: they have built a new psychiatric unit and closed the old Victorian asylum. The hon. Member for Isle of Wight (Dr. Brand) complained that NHS Direct had not been tested. We cannot win, can we? If we wait and double or treble check to see if everything works, we are accused of not delivering; when we go ahead with a good scheme, we are accused of being hasty. However, that is what we expect of the Liberal party.

We are looking forward to NHS Direct operating from my constituency from October. It will employ 30 nurses and provide a valuable 24-hour service to Cumbria and north Lancashire.

Mrs. Virginia Bottomley (South-West Surrey)

As the hon. Gentleman has such a splendid situation in his constituency, what advice could he give to a Member of Parliament who now has one in 10 constituents waiting more than a year for treatment, and where the number of one-year waiters has trebled since the general election?

Mr. Martlew

Is the right hon. Lady saying that that is what is happening in her constituency? If so, she should take some of the responsibility, as she was Secretary of State for many years.

Mr. Hinchliffe

Go private.

Mr. Martlew

As my hon. Friend says, the Conservatives' option is: go private.

There is still more. On Saturday the News and Star ran the headline: £345,000 to pay for GPs' late surgeries and wrote about a Government boost for Cumbria health teams. It has nothing to do with the Prime Minister's visit, although the local paper did him proud; it shows what the Labour Government are delivering. People will see developments. Perhaps my constituency is ahead, but the Government will deliver. Developments will take time to come through the system, but it is working. The difference is that in 18 years the Tory Government never delivered. They had the opportunity; the economy was right; they could have spent the money—but they refused, basically because they did not believe in the NHS.

Everything is improving, but not everything is right. Hon Members would not expect me to speak without reminding them of what needs to be done. I represent a constituency in a rural county and we have been pressing the Home Secretary to give us extra money for sparsity. It appears that we will get that extra money for police funding. If the case has been made for the police, it must be made for the health service, too.

We have two district general hospitals, although in terms of numbers we probably justify only one. However, they are 40 miles apart: one is in Whitehaven in the Copeland constituency and the other is in Carlisle. That difficulty needs to be addressed if we are to attract top-flight consultants and maintain a first-class service. I am sure that Ministers are looking at that.

I want next to raise my concern about reorganisation. In the late 1970s I was chairman of the health authority. Since then there have been about six or seven reorganisations. The present one is reconfiguration. I have reservations about it for our acute trusts. That is not the real issue, however—it is the primary care trusts that concern me. Although we have a relatively small population, it appears that a decision is being taken to go for three of these trusts. There is no justification for it. We will end up with duplication of management: we will have three sets of management where one or possibly two would be right. That will take money away from patient care and create all sorts of confusions for community services. I will write to my hon. Friend the Minister, but I hope that he has noted my concern.

The choice is clear: it is between a privatised NHS where—let us accept what the Tories say; we do not want to scare people—people who need life-saving operations will receive them, but people who need cataract operations or hip replacements will have to go on an extended waiting list. [HON. MEMBERS: "Who said that?] I thought that the hon. Member for Runnymede and Weybridge (Mr. Hammond) had made his speech. People will go on an extended waiting list—that is what the Tories said—unless they have private insurance. The Tories will give away taxpayers' money, probably £1 billion, to subsidise private insurance for those who are employed or can afford it. Poor people who cannot afford it will have to go on an extended waiting list. There is no argument about that. Of course, the vast majority of people who use the NHS are of retirement age—they are over 65. What is the Tory message to pensioners? It is to go on an extended list because, as we all know, they cannot afford private insurance.

We have the option of a privatised service—[Horn. MEMBERS: "No."]—or, under the Labour Government, our offer, in my constituency and throughout the country, of a modernised, well funded health service that will serve the old, the sick, the poor and everyone else.

3.10 pm
Mr. Peter Lilley (Hitchin and Harpenden)

I congratulate my Front-Bench colleagues on calling the debate—especially my hon. Friend the Member for Woodspring (Dr. Fox), who opened it by forcing the Government on to the defensive on health. The reason that he provoked such a weak, defensive and slightly irritable response from the Secretary of State was that my hon. Friend focused on positive proposals to improve the NHS, on which the vast majority of our constituents depend. He emphasised the importance of choice for patients in the NHS—a word not even mentioned by the Secretary of State in his contribution.

My hon. Friend brings to the debate the fact that he dedicated his professional life to working as a doctor in the NHS, treating patients. That gives us credibility as members of a party which cares for and wants to improve the NHS. We field real doctors; the Government field spin doctors on their Front Bench.

Over the years, it is strange that our debates on the NHS have tended to revolve exclusively around how much money is put into the service rather than how much health care comes out. That process was carried to its ultimate absurdity by the Chancellor in his Budget, when he set the target of matching the amount spent by our European partners. It would make sense to set as a target matching and surpassing the health standards achieved in other European countries, but it is bizarre to use their spending as a target, when there is little correlation between the amount a country spends and its performance in improving the health of its people.

Despite the Government's wish to focus on inputs, the debate increasingly turns—as it should—on the quality of care delivered by the NHS.

Dr. Stoate

Does the right hon. Gentleman belong to that section of the Tory party that believes that we are reckless to put extra money into the NHS, or does he believe that my right hon. Friend the Chancellor was right to allocate those extra billions of pounds? That money is undoubtedly improving patient outcomes throughout the country.

Mr. Lilley

The important thing is to target improvements in standards. That may well require extra money, but that is what the target should be—not spending money as an end in itself. Surely no one would want to spend money if it did not produce a good result. If we can improve quality without necessarily spending money, then surely we would all want that. That is certainly what our voters and constituents want; their concern about quality is growing.

Last year, there was a record number of complaints in the NHS. Patients have an increasingly consumerist attitude to health care—although that is good in the long run. There is a focus on the specific shortcomings of a minority of clinicians—sadly, misused and abused by the Government, who try to put on the medical profession blame that should rightly fall on the Government.

Our focus should be on improving quality. There are two broad approaches to that end. The first is that adopted by the Government: to focus exclusively on the command and control approach to managing the NHS. It is to focus on centralising the service; on sending out detailed circulars, like a shower of confetti; on micro-managing from Whitehall; on aiming for uniformity; on turning doctors into functionaries rather than professionals; and on treating patients as pawns rather than as people with a say in where and how they are treated.

The second approach is to try to modulate by more decentralisation those aspects of the NHS that must inevitably be centralised to some degree; to delegate responsibility to local hospitals and trusts; to encourage a greater diversity of provision within the service; and, above all, to harness the desire of patients and doctors to obtain the best treatment from the NHS. I want to focus on that aspect.

In every other service with which we deal—including those that are most important to us—when users have choice, it drives up quality of service. When users have choice, service providers know that, if they do not match the quality of the best provider, they will lose users and resources. As a result, they will not be able to expand or to provide more of the service to which they are dedicated—whether for charitable or commercial reasons.

Where choice exists, comparatively marginal movements of users between suppliers produce major improvements in quality, as providers respond.

Mr. Hinchliffe

I am interested in the points that the right hon. Gentleman makes about choice. I am concerned that when choice is afforded to certain people, it is denied to others. It is something of a myth to suggest that we all have free choice in health care. One person's choice to queue-jump to see a consultant denies someone else access to that consultant. Does the right hon. Gentleman accept that point?

Mr. Lilley

The hon. Gentleman will realise that I want to extend choice to everyone. I hope he believes that is right; it formed part of the original conception of the NHS.

Unfortunately, patient choice has progressively been largely eliminated in the NHS. I acknowledge that there were some restrictions as the unintended consequences of the otherwise desirable reforms that we introduced. However, at least we allowed choice through extra-contractual referrals in exceptional cases. Since April last year, the Government have, in effect, abolished the last vestiges of patient choice in the NHS.

A patient cannot, with a GP referral, choose to go to a hospital with a shorter waiting list than the hospital selected by the local health care bureaucracy—the primary care group. A patient cannot choose to be treated at a hospital with a better record of success, at a cleaner hospital, or at one with fewer avoidable referrals—information about which is available.

The Prime Minister has quite an instinct for what people want—I acknowledge that. No doubt many people heard and applauded his speech to the party conference. He said: I want to go to the hospital of my choice, on the day I want, at the time I want. And I want it on the NHS. That is what he said and he was right to offer it as a promise. The Conservatives should try to deliver that promise.

However—as is characteristic of the Prime Minister—he says one thing and does another, because his Government have abolished choice. It is not only I who realise that. The director of the College of Health said that, under the arrangements introduced last April: There is now less choice than ever in the history of the NHS. We should be moving in the opposite direction, for which there are three requirements. First, we must give patients and their GPs the right of referral to any hospital in the United Kingdom—in practice, not merely in theory. Secondly, we should publish information—on waiting times, success rates, specialisation and the availability of single-sex wards—in GP's surgeries and on the internet, so that patients can make informed choices.

Thirdly, we should ensure that money follows patient choice. That may seem the most remote requirement, but it is the most important. If money follows patient choice speedily and clearly, hospitals will be able to treat patients properly and we shall not simply lengthen waiting lists at the more popular hospitals.

Of course, that means that money will not go to the less popular hospitals. That will not tip them into a spiral of decline as some people imagine, but it will cause them to respond and ask why fewer patients want to go to them. 4 If that is because they have a poor track record for a particular treatment, they will undoubtedly take action to change personnel. Hospitals will reassign doctors to operations that they are good at and not to those that they are less good at, or they will replace them so that the hospitals regain the confidence of the people living in the area.

If we do that, it will have three beneficial effects. First, it will drive up quality throughout the NHS. In my pamphlet "Patient Power", published by the Prime Minister's favourite think-tank, Demos, I quote details of a study undertaken in New York state which analysed the performance of every surgeon carrying out heart bypass surgery, and assessed their success rates. Under the American Freedom of Information Act, the study was forced to publish detailed information and the consequence was a dramatic improvement in performance. People had the knowledge and could choose which hospital to go to. As hospitals responded to that knowledge and choice, a dramatic improvement in the success rate of surgeons took place. In particular, that happened in the hospitals that previously had the worse success rates.

That example demonstrates that when one has choice, information and a variety of suppliers of health care, one obtains an improvement in quality. I want such an improvement for the people who depend on the NHS.

Mr. Jeremy Corbyn (Islington, North)

Before the right hon. Gentleman gets completely carried away with the argument about the American model and freedom of information, will he address the fact that in the United States, which has a largely private health service, many people are denied access to any health care whatever for the type of surgery that he has highlighted? Does that study refer to the problem of social exclusion that is caused by the type of private health services that he appears to favour?

Mr. Lilley

I am not advocating those aspects of the American system. I simply propose that, within the NHS, patients should have choice. The hon. Gentleman may care to tell his constituents that he does not believe that they should have choice. He can try to argue that if he wishes, but it has nothing to do with whether there is a large private sector.

Mr. Ivan Lewis

Will the right hon. Gentleman give way?

Mr. Lilley

Not now, because I wish to make progress.

If we move in the direction that I have described, it will have three beneficial effects. First, it will drive up quality. Secondly, it will facilitate the optimal degree of specialisation within the health service. The abolition of extra-contractual referrals last April is causing a crisis in specialist care in the NHS. As my hon. Friend the Member for Woodspring said, 24 surgeons issued a press release to coincide with the publication of my pamphlet last week. [HON. MEMBERS: "Ah."] I had nothing to do with it; I did not know that they were going to issue it. However, I am flattered that drafts of my pamphlet have circulated so far round the medical profession that they chose to do so. They point out that since the abolition of extra-contractual referrals no mechanism exists to transfer funds to follow the patients that urgently need our help. Consequently, our waiting lists continue to grow and we are unable to treat these patients with the procedures they need. In the New Statesman, which may be read by Labour Members, the president of the Royal College of Surgeons criticised the consequences for the quality of care that resulted from the abolition of choice by this Government under their recent reforms.

The third beneficial effect of encouraging more choice and more information in the NHS is an improvement in its ethos. At present, the NHS is monolithic, centralised, secretive and producer-oriented. If there is more choice and information, the NHS will become more focused on satisfying patient needs and on providing the maximum quality of care. That must be in the interests of all of us who care for the NHS and the quality of service that it provides for our constituents.

Some people argue that we cannot have choice in the public sector, and they make the same argument about education. When money following pupil choice was introduced in the education system, that produced changes in schools, as I saw in my constituency. If we restore choice in the NHS and make money follow choice, not only will we bring about the degree of specialisation that people want and need, but we will see improvements develop in the future that have not occurred in the past.

We have had little specialisation in common treatments, such as for hernias and hip replacements. Specialisation has been limited to the most complex and difficult operations. If people had choice, some specialist centres would develop alongside general hospitals. People would have the option to go to those specialist centres or to go the general hospital.

A few days before my pamphlet was published, there was a leak that suggested that the Government were thinking of creating such centres—they wanted to get in first. However, what do they propose for the specialist centres? Will the Minister confirm that the leaks are authentic and that they are thinking of setting up such centres? If they do, who will decide which patients go to the specialist centre and which go to a local general hospital? Will it be the NHS bureaucracy? That would be wrong and improper. People should be given choice, and the proposal will work only if they are given choice. That will ensure that the specialist units stand and thrive alongside thriving general hospitals.

Mr. Lewis

The right hon. Gentleman has confined his remarks today and in the pamphlet that he published to the point that improvements to the NHS will improve the health care of the people of this country. Does he believe, as those on the Opposition Front Bench believe, that the expansion of the private health care sector has any place whatever in improving health care in this country?

Mr. Lilley

Yes, it has. However, my primary concern—like that of probably everyone in the House—is to improve the NHS. I do not suggest that choice within the NHS is the only solution, but if we introduce such choice it will reinforce all the other changes that Conservative Members have suggested and some of the changes that the Government have introduced.

People want choice; people have a right to choice; the NHS will benefit from choice, but only the Conservative party will give them more choice.

3.27 pm
Mr. David Hinchliffe (Wakefield)

I am grateful for the opportunity to speak in the debate. In every debate on this subject since the election, I have been on the record praising much of what the Government have achieved in a short period to restore a collectivised state national health service. I am proud of what we have been able to deliver so far.

Bearing in mind that this is probably the last debate on the issue before we have the announcement on the national plan, I want to concentrate on the key matters that the plan should examine and those that need to be resolved and addressed before the next election and during the term of the next Labour Government. The relationship between the NHS and the private sector is at the core of the debate. It is crucial. Most colleagues are aware of my strongly held views. I am a believer in the NHS, and I am a member of the Labour party because I believe in the NHS. The NHS is only safe in the hands of a Labour Government.

I am aware of the comments made by the Conservative party yesterday and its commitment to "dramatically extending" the private health sector. I am interested in the comments made by the Government in recent weeks about making use of what they term as under-used capacity in the private sector. I may refer to that shortly.

The relationship between the NHS and the private sector is one of the great unresolved issues of the NHS. It has not been sorted out in the 52 years for which we have had a state health care system. The fact that the issue has not been resolved is at the heart of the failure to achieve the principle of equity that was one of the central principles that the nation aimed to achieve when the NHS was set up in 1948. I was interested by the fact that the hon. Member for Woodspring (Dr. Fox) used the term "equity" in his arguments for the Conservative party's new proposals. I would like to hear—I have not heard it yet—how his suggestion for extending the use of the private sector squares with the principle of equity. I do not see how the two match.

I wish to take up the point made by the right hon. Member for Hitchin and Harpenden (Mr. Lilley) on the issue of choice. I intervened on him to make a point about choice on health. We all know that it is common practice for some people who are waiting to see an NHS consultant who also has a private practice to pay to see that consultant privately and queue-jump. They are exercising their right to free choice but, by doing so, they deny access to an NHS patient on that same waiting list. The concept of choice therefore needs to be considered in far more detail than was done in the right hon. Gentleman's superficial examination.

The right hon. Gentleman made a comparison with education and said that we all have a free choice of schools. Of course some people have a choice, but to get access to schools that are not immediately on their doorstep, people need a car or access to public transport, and perhaps assistance with picking up their children. It is not quite as simple as saying that free choice means that someone can go from one end of the country to the other. By suggesting that that is free choice, we are automatically denying opportunity to vast numbers of people who cannot have choice in the way the right hon. Gentleman envisages.

The principle of allowing queue jumping is fundamentally wrong and undermines the equity principle. I hope that the Government will look at that in the national plan. Access to treatment should be on the basis of need: that is an ethical and moral issue. I recall taking part in a radio debate chaired by Boris Johnson with the hon. Member for Rutland and Melton (Mr. Duncan), who was previously on Conservative Front Bench. Mr. Johnson and the hon. Member for Rutland and Melton did not understand why I thought that access to treatment was an ethical and moral issue. A situation in which some people in need are denied access to treatment on the basis that they are unable to pay for it is fundamentally wrong in principle. I cannot understand how anyone can defend that kind of injustice.

The hon. Member for Runnymede and Weybridge (Mr. Hammond) spoke about opting out of the NHS. The idea that people who opt out of the NHS somehow help others is utter nonsense, as they are all seeing the same doctors. Those doctors should be working in the NHS and dealing with waiting lists, which should be organised on the basis of clinical need, not ability to pay.

Mr. Hammond

The hon. Gentleman may be interested to know that, right now, under this Government, West Surrey health authority is circulating a consultation document which states: Everyone who has access to other forms of healthcare should be encouraged to use them. The authority, which faces an £18 million deficit, obviously believes that that will leave more resources available to deal with other patients.

Mr. Hinchliffe

I am sure that Wakefield health authority is not saying that. If it did, I would want to know. As the hon. Gentleman obviously understands, the thing does not add up, as the same people are involved. I hope that the Government will address that.

Another private sector issue that I have picked up time and time again is a grievance that I hear, especially from elderly people who come to me as their local Member of Parliament. They are on a waiting list, usually for a hip replacement or an orthopaedic problem, and have to wait a certain length of time. They are told that, if they pay a certain sum, they can be in that much sooner. A couple of years ago, a gentleman came to see me about his elderly wife, who could not walk and needed a hip replacement. He faced the choice of her suffering with the problem for about a year or paying the consultant money. He was selling his car to pay to get his 81-year-old wife in. At that time of life, people do not have a lot of time left. That is a disgraceful situation, and it is about time that we addressed it.

Mrs. Laing

Will the hon. Gentleman give way?

Mr. Hinchliffe

No, I am sorry, I must carry on.

The only way of addressing the problem is to believe in equity on principle. We talk blandly about that belief, but do not address it practically or deal with providing people with access to care in a fair, reasonable and decent way.

I am conscious that the Select Committee on Health is bringing out a report next week, and I do not want to stray into that. However, we in the Committee heard evidence that raised strong questions about whether it is appropriate for consultants with private practices to manage their own waiting lists. The evidence was along the lines that there are perverse incentives, as the Secretary of State said. One witness said that the arrangement was an "invitation to mischief." We should look at those areas.

Mr. Burns

I do not want to break the thread of the hon. Gentleman's speech. However, is it right for him to be telling the House about some of the evidence that we in the Health Committee received before the publication of the report next week?

Mr. Hinchliffe

The evidence is on the record. Written evidence was available when the Health Committee took evidence. Everyone has seen it, and it has been in the press and on television. I have not referred to anything in the Health Committee's conclusions. The hon. Gentleman knows what those conclusions are, and we can have a debate next week.

Our debate is about NHS priorities. Some weeks ago, when we last debated the NHS, I said that the biggest distortion of priorities in the NHS arose from private medicine. I stick by that and I strongly believe it. People may try to contradict me, but I believe that that is true and that, 50 years on, we should do something about it.

I have practical concerns about the relationship between the state and private sector which relate not only to what the Opposition have said today but to what the Government have said in recent weeks. The Opposition fail to understand the way in which the private sector recruits its staff entirely from the NHS. As we have said time and time again, expanding the private sector means that there is a contraction of NHS staff numbers, reducing the ability of the NHS to cope with the need that they are attempting to address.

The Government have talked about the possibility of entire NHS staff teams moving to use capacity in private hospitals. I appreciate that distinction, and my only problem with the suggestion is that the track record on the short-term use of the private sector is that short-term fixes lead to a long-term arrangement. We need only look at the pattern of mental health provision in different parts of the country to see that, where the private sector has been used as a temporary fix, the arrangements have stayed in place for many years. We must look at that area very carefully.

I am not giving away any secrets from the Health Committee's recent inquiry by saying that we received evidence of under-used capacity in the NHS. Witnesses told the Health Committee that there are empty operating theatres in the NHS, so I hope that, before we start going into the private sector, we will make appropriate use of that capacity.

In the time I have left, I want to touch briefly on other key areas with which I hope the national plan will deal. I have argued for many years that the fundamental problem in the NHS is the lack of a proper relationship between it and local government, especially local authority social services. I was around before 1974, when there were local government health departments, and I believe that that system worked much better than the system that succeeded it. The health and social care divide can be addressed by looking at organisational issues, as well as some of the issues that the royal commission has discussed.

Commendably, the Government have introduced the potential for common budgets under the Health Act 1999, and I welcome that. I honestly believe, though, that we must examine organisational integration in a way that the Government have not done so far. I hear whispers, and there is speculation in the press that there is a move to put local authority social services in the health service. That would not be going in the right direction, as public health is the other area that suffers from the lack of a connection.

I worked in local government as a young councillor at the time when public health was a local government responsibility. It makes much more sense to have public health in a local authority setting than to have it separated, as it currently is, in a health setting, remote from such policy drivers as health, environmental health and a range of other local government functions. I hope that the Government will examine that area carefully. The position of public health needs to be addressed alongside its relationship with social services.

I welcome the Government's emphasis on primary care. I certainly urge a much closer relationship to enhance the public health role within a primary care setting. At the moment, there is a distance between primary care and public health, which we must examine.

I shall conclude with a point made, I believe by the hon. Member for North Devon (Mr. Harvey), the Liberal Democrat spokesman. We need to make the system of NHS governance far more open. We have never had a democratic national health service. I am happy to argue that micro-management should take place on a local level, but it should be democratic. In areas such as mine, it would be possible to develop regional government by combining health and local government functions in a way that we have not yet properly thought through.

I hope that the Minister has listened carefully, and I wish him well in his work on the national plan. I am sure that it will be an exciting development, and I hope that some of my points will be taken on board.

3.40 pm
Mrs. Marion Roe (Broxbourne)

The most important priorities in the national health service are not those of the Government, health service managers or doctors and staff, but those of the patients themselves. The Government gained power at the last general election on the crest of many promises, one of which was to restore the confidence that they said had been lost in the NHS. Yet we cannot open a newspaper or hear a news broadcast without learning, almost every day, of the latest NHS catastrophe. All areas of the NHS seem to be affected: general practice, paediatrics, obstetrics and pathology, to name just a few of the specialties involved in recent high-profile cases.

We have to ask ourselves why. I believe that it is because the Government have set the wrong priorities. They have, for example, produced meaningless waiting list targets to tackle the wrong problems. As a result of inappropriate targets, priorities have been distorted. Hospital and primary care clinicians and managers have been told to focus on valueless directives and, as a result, they are failing to improve the services and care that really matter to NHS patients. The Government now stand indicted as the Government who destroyed NHS morale and snatched from patients the confidence that is so necessary to ensure that the patient-doctor relationship is effective and successful.

Primary care groups in general practice have disrupted the delivery of medical services to patients. Over a year ago, I warned the Government that the requirement that doctors should be involved in the management of primary care groups would have a devastating effect on patients' access to their own practitioner. There are estimates that 500,000 consultations by patients' own doctors are being lost every year, so the number of patients affected is equal to a population the size of Sheffield. That is a crucial reduction in the quality and availability of the service that patients demand and expect, and from which they benefit.

There are now greater administrative demands, with the Government focusing priorities on calling GPs away to lead ever more non-clinical activities. There are clinical governance leads, risk management leads, training leads, education leads, audit leads and more. It was reported recently that in one large general practice, the doctors have suggested that there should be a lead partner with the responsibility to see patients.

There are increasing examples of how the Government are full of hot air and waffle. The House should consider the report of the chief medical officer for England and Wales, Professor Liam Donaldson, which reveals spectacular failures in the NHS. It reports the deaths of 400 patients a year as a result of errors and failures in the health service. What uproar would there be if a jumbo jet crashed in the United Kingdom every year killing all the passengers and crew? The report goes on to say that there are 10,000 serious incidents in the health service every year. Can hon. Members imagine the Secretary of State or the Minister pontificating on all the actions that would have to be taken if, every year, every single passenger on a dozen rush-hour trains fell ill with a serious disease through no fault of their own?

Yet what has Professor Donaldson done? He has produced a complacent report that fails to set the necessary priorities. That goes hand in hand with a posturing Government who seek only froth without substance and who fail to solve, with encouragement and resources, the real problems that beset the NHS.

Dr. Stoate

I share the hon. Lady's concerns that there are far too many adverse and critical incidents in the NHS, many of which are due to poor training and to doctors failing to keep up to date. That is precisely why it is so important that GPs and hospital doctors take part in audit, training and continuous professional development. They must also take part in revalidation to ensure that the clinical skills that they learned when they were at medical school are maintained throughout their lives. Surely the hon. Lady is not arguing that GPs and others should spend less time in education, training and audit.

Mrs. Roe

The patients should also be considered in these matters, and their priorities must come first. I must tell the hon. Gentleman that my constituents are becoming a little sceptical about the word "modernisation", which the Government seem to use about every policy initiative. From my experience of the past three years, I believe that "modernisation" is being used instead of "destruction", and there is a destructive element to many policies that are being introduced without any new system to replace the old and to improve the service. Modernisation must equal making it better, and not destroying a system just for the sake of gimmick and political correctness.

Let us consider two Government targets; one is in community health and the other is in acute services. Unfortunately, mental health has always been a true Cinderella service, long starved of adequate funding. The Government propose the elimination of suicide by patients who have recently been within the mental health system by 2005. That tragic loss of life is entirely unnecessary now. Surely the Government can imagine the loneliness and despair of those who ultimately take their own lives. They can imagine the emptiness felt by those left behind, and the guilt and failure felt by the clinical staff who failed to provide patients with the support that they needed when they were desperate.

More than 3,500 people commit suicide every year, and a third have had recent contact with NHS mental health services. Little more than a fifth are women. Over the last 20 years, male suicides have risen by nearly 15 per cent. The average age of the victim has fallen. More men are killing themselves and more of those are young. The most common ages for suicide are adolescence and old age—the times when problems of loneliness, financial pressures, break-up of a relationship or loss of a partner, bullying and abuse of alcohol are rife. Mental illness is of high incidence and it is a key risk. A patient suffering from severe depression probably has a one in seven lifetime risk of killing him or herself.

This tragedy is not a problem for next month or next year; it is a huge priority now. Although I welcome the fact that the Secretary of State has decided to do something about the problem, I do not think that the Government can luxuriate in the provision of five years to grasp the tragic problem that affects those who were recently mental health patients. It needs to be sorted out now, and those people at risk of suicide and not identified by the health system need to be recognised and incorporated in it now.

Let us consider the Government's position on obstetric complications. Again, they have awarded themselves five years to reduce the incidence of complications in the specialty by 25 per cent. That seems unbelievably casual, particularly given the two high-profile cases concerning senior obstetricians in the last few weeks. There are more than 700,000 live births in the United Kingdom every year—700,000 opportunities for disaster or mismanagement. Yet what is the Government's approach? They have given themselves five years to make a modest reduction in the problem.

There will be more than 50 million obstetric consultations in hospital, surgery and clinic during the next five years in primary and secondary care. Such a relaxed and casual attitude is unacceptable. How many babies will have to die or be damaged before the Government realise the true urgency of the problem? To be pouring money into a health system with the objective of producing a headline about taking a few people off the waiting lists when there is real work to be done urgently to save life and reduce morbidity is, frankly, immoral. In any case, the Government priority of cutting waiting lists is a sham, and everyone knows it. They have simply rearranged the distribution of the patients waiting in that queue.

The number of patients at the front of the queue for their operation has declined a bit, but at the other end of the queue, patients in pain and discomfort with, for example, back, shoulder and hip problems are waiting longer and longer for their first visit to the specialist. In the past seven days, it has been reported that not only do those patients have to wait up to 18 months for surgery, but that they have to wait a year or more as well just to be seen by a consultant for the first time. That wait is nearly two years in Medway, well over a year at the Royal London, a year at the Royal Sussex and over six months at Guy's. Demand continues to rise and pressure in the system continues to increase.

I do not have time today to speak about the shambles that the Government have the effrontery to call an IT strategy. We listened intently as the strategy was announced in 1998. There was to be much progress in electronic records, data transfer and communication. The Government were to commit £5 billion and the programme was to have a seven-year roll-out. Yet it is now becoming clear that the IT strategy has collapsed and the likelihood of exciting electronic developments is receding into the distant future. A key priority is in ruins, and I look forward to a ministerial statement on that as a matter of urgency.

Those are the real priorities that the Secretary of State should address. He must not conceal unattractive features simply by applying more make-up. They must be addressed as the key priorities in the NHS. Sham must be replaced with substance so that the real losers in the NHS—the real sufferers from Labour's policies—have the opportunity to get the care that they need at the time that they need it.

3.52 pm
Ms Linda Perham (Ilford, North)

Thank you, Mr. Deputy Speaker, for calling me at this stage in the debate. As some hon. Members know, my father suffered a heart attack late on Tuesday, and although he is making progress, I may be called away in the next few hours, so I hope that the House will forgive me if I am unable to stay until the end of the debate.

I begin by paying tribute to all those dedicated people in the NHS who have been involved in my father's care in the past few days. His GP, the ambulance crew and nursing and medical staff at Queen Mary's hospital, Sidcup are a testament to the NHS working at its best to deliver for patients. Unlike Conservative Members, led by the hon. Member for Woodspring (Dr. Fox), I want to praise our NHS, not to run it down.

Today is my birthday. [HON. MEMBERS: "Happy birthday."] I am 53—almost exactly a year older than the NHS, so I have grown up and grown older shielded and supported by the availability of and access to public health care. I am proud and fortunate to have been born under the pioneering post-war Labour Government, whose greatest achievement was to realise the dream of so many British people who were denied health provision because they could not afford it. This Labour Government are passionately committed to retaining and supporting the NHS, which was set up in the teeth of Tory opposition. We are the party that the British people trust to preserve and improve the people's health service.

Health is the big issue in my constituency. The neglect and divisiveness of the policies of previous Conservative Governments was a large factor in the decision of the electorate of Ilford, North to turn out the Tories three years ago. Labour's priority for the NHS in the past three years, and for the years ahead, is for a first-class, properly funded service. In March, the Budget gave the NHS its biggest ever cash boost. After the Budget, the chairman of the British Medical Association, Dr. Ian Bogle, said: We see this as the first major step to putting the health service on a sound long-term funding basis. As a result of the funds made available in the Budget, my health authority, Redbridge and Waltham Forest, secured an extra £6 million. Although it is severely disadvantaged by the current funding formula for health authorities—a matter about which I and my hon. Friends the Members for Ilford, South (Mr. Gapes), for Leyton and Wanstead (Mr. Cohen) and for Walthamstow (Mr. Gerrard) continue to make representations to Ministers, as my hon. Friend the Minister well knows—the authority was pleased to receive that much needed extra cash to provide services for local people.

My health authority has also gained in the past three years from £800,000 and £1.1 million allocated respectively to King George and Whipps Cross hospitals to modernise their accident and emergency departments as part of a £15 million investment in London. It scooped further funding from the successful single regeneration budget bid, called the "Health ladder to social inclusion", creating or safeguarding 115 jobs and getting 300 people training or qualifications, 10 new business start-ups, 60 voluntary or community groups supported and 300 capacity-building initiatives to be carried out.

In addition, Redbridge and Waltham Forest health authority has benefited from the Government commitment to prioritising cancer treatment as part of their war against the killer diseases. Last May, I was pleased to join Baroness Hayman, then a Health Minister, when she opened the new breast screening and ultrasound department at Whipps Cross hospital, which also won part of the £93 million new opportunities fund award in September 1999 for replacement X-ray equipment for breast screening. In January, my health authority shared £91,000 of a £1.5 million boost to London health authorities, which funded a cancer referral co-ordinator and administrative support and systems management.

My own involvement in working for improvements in cancer treatment started with co-operation with Age Concern on age discrimination issues, pressing the Government to extend breast cancer screening to women over 65—the group most at risk. I am glad that, in March, the Government announced their commitment to extend that programme if the current pilot studies show that it would be beneficial. More recently, I have worked closely with the UK Breast Cancer Coalition, speaking at seminars and advising on its "advocacy in action" programme, in which volunteers from across the country share campaigning experiences and hear from experts.

I pay tribute to the hon. Member for Broxbourne (Mrs. Roe) for her involvement and work in the breast cancer campaigns, although I do not agree with anything that she said in her speech. I also pay tribute to several hon. Members who are active in those campaigns.

actively support other cancer campaigns, including the work of the Orchid Cancer Appeal, set up by Colin Osborne—a survivor of testicular cancer who lives a few streets away from me in my constituency. I am a member of the all-party group on male cancers, which is ably led by my hon. Friend the Member for Reading, East (Jane Griffiths).

Another local initiative is the HEAL cancer charity, which covers Hertfordshire, Essex and north and east London, including nine hospitals in the region. It was founded in 1993 by oncologist Dr. Neville Davidson, a Chigwell resident. HEAL is now focusing on raising funds for the Helen Rollason cancer care centre at the North Middlesex hospital. As some hon. Members will remember, Helen was the TV presenter and first woman to anchor "Grandstand", who tragically lost her fight against bowel cancer last August.

Mrs. Laing

I add my support to HEAL and all the work of Neville Davidson and his team; they do a lot of good in my constituency, too.

Ms Perham

I thank the hon. Lady for her support. Several hon. Members in our local area are involved with that charity; it has a particular resonance because of Helen's great fight against her disease, and I am pleased at the support it has gained locally.

I have also been involved in campaigns to raise awareness of human papillomavirus testing for cervical cancer and have added a personal contribution to the fight against ovarian cancer, which kills 4,000 women a year, by participating in the ovarian cancer screening programme at Bart's hospital. Therefore, I welcome the answer that the Under-Secretary of State for Health, my hon. Friend the Member for Pontefract and Castleford (Yvette Cooper), gave in February of this year showing that the Government spent £1 million in 1998–99 on directly commissioned research relating to ovarian cancer and another £1 million on supporting research councils and charities. She also promised the setting up of a major ovarian cancer screening study.

I am pleased that, as part of their overall commitment to modernising—if I can use that word—the NHS, the Government are prioritising patient care to ensure fast and convenient access and increased patient empowerment, which will give patients a greater say in their treatment.

I have been honoured, as a member of the all-party group on cancer, to be asked to chair one of the groups working on five pledges to develop a comprehensive cancer strategy. Those are to improve the prevention of cancer; to ensure equal access to higher standards of care; to provide patient-centred care through the NHS—the group with which I am involved is working on that—to increase Government spending on a national agenda for cancer research; and to develop better treatments and to implement them quickly. At a time when the world is coming to terms with the staggering potential of the human genome breakthrough, we cannot afford to wait for miracle cures while one in four people in the United Kingdom is dying of cancer now.

I have focused on the treatment of cancer because of my attempts to press for improvements in the fight against that killer disease, but I am equally determined, as are the Labour Government, to confront the challenges of providing health care to all our people in the new century, and vigorously to oppose the Tory party's agenda of privatisation and selection for certain services by the ability to pay. I want to protect, to support and to expand our NHS. That is what the British people want and that is what we are delivering.

4.1 pm

Sir Geoffrey Johnson Smith (Wealden)

First, may I say that I think that the hon. Member for Ilford, North (Ms Perham) has shown a great deal of courage? That demonstrates not just her keen personal interest, but her wider political and social interest in health. I hope that all goes well with her family.

There are one or two irritating factors in the debate. One is the view that the NHS was created by just one party. It was not. It came out of a coalition that was developed during the war and it was finally put into practice with the support of Governments of both parties—[Interruption.] I do not want to argue about that because it is a fact.

Secondly, the question of expenditure is very important. When the NHS started, it had a budget of about £170 million. After two or three months, it increased to £250 million. Then it went to £374 million. The structure of everything being free at the point of demand was demolished when Mr. Bevan accepted—reluctantly—that there would have to be prescription charges. In 1951, he had to resign because he could not stomach the Government's view that there should be charges for spectacles and dentures.

Many advances are being made in the medical profession and in modern technology. Some are life saving; others we could deal with ourselves. Of course, we could embrace every illness and ailment—any pill that we want we can have—but that is not the reality of modern medicine, or of the problems that Governments have to face.

There may be occasions when a Chancellor of the Exchequer comes to the Dispatch Box and does not give the NHS the extra money that we all think it should have, because he thinks that there is a greater demand for housing, that there is some problem to do with defence, or that the economy is not quite as robust as it was the previous year and the forecast is not so good either. If we demand that the health service should always be financed to meet every demand, we refuse to face up to the reality of modern medicine, modern needs and social responsibility; we fail to recognise financial prudence.

Those are points that I would have thought could unite the House. Having come into the House in 1959, I have sat through a great many debates. I am astonished that we go on year after year having the sort of fights that we have. It is not true to say that—

Mr. Stephen Hesford (Wirral, West)

Will the right hon. Gentleman give way?

Sir Geoffrey Johnson Smith

Let me finish the sentence and then I will give way to the hon. Gentleman. It is not true to say that the Opposition want to rely on the private sector totally and to demolish the health service; that is such rubbish. After all, when we came into office the NHS had a budget of £9 billion. We ended up with a budget of just over £40 billion.

Now we are told that there will be another increase of about £20 billion from the present Government. Why is it that we automatically assume that, having poured that money in, we will have solved the problem of increasing expenditure on health? Of course we will not. We all know that there are many reasons why the burdens on health—the demands that are put on us—are increasingly greater and cannot always be solved with taxation. Some people say that they should be, but as I have said, there will be other priorities; there always are.

We can argue that the health budget is not always the one that will create a healthier society—I mean in a physical sense. Better education and looking after oneself can help, as can a better sense of individual responsibility. It is not always the doctor to whom one must go. We might consult our own consciences about whether we can provide for some of our own health needs. That is why the debate is at times disappointing.

Has any other country followed us? Not one has done so. The socialist Governments of Europe studied our methods, but not one of them has copied us. I have heard no contradiction on that point from any Minister, either. I have been to see them; I have talked with them; I have seen them struggle with their problems. My heart bleeds for them at times, because there is a recognition that, somehow or other, we can meet those demands, as the hon. Member for Wakefield (Mr. Hinchliffe) said. I have heard him say it before and do not doubt his sincerity. I ask him to get out of the mould of his experience and try to broaden it a bit.

In 1959, I fully supported the health service. Members of my own family have been involved in it. I was the Member for Holborn and St. Pancras, South, and I knew all that went on there. I have enormous respect for those in the health service; I know that many of them have to put up with tremendously long working hours—that is not something of which we should be proud—but they do so with enormous good will. Why, then, should I tolerate the existing situation, when Minister after Minister says, "Let us spend more."? Then there is always someone who says, "You should have spent more and you should have done it the year before."

In Germany, the Netherlands and other countries—we have all the statistics—they have more doctors, more specialists, more nurses and far fewer waiting lists. I am treasurer of a NATO parliamentary assembly. I must ensure that the assembly pays sufficient money to help our employees to meet their bills because they have to pay so much to the Belgian Government. They can get many other things very cheaply and, as I say, they have a better service. Not one of those people, some of whom are British, goes across the sea and gets it all for free in Britain. They would not touch it. They know that they have a better deal. Why do not we accept that? We have a lot to be proud of, but we will not be proud of it if we always have a spat year in year out.

I do not see any reason why we should resent the private sector having some part in the health service. The Secretary of State for Culture, Media and Sport said in The Times on 8 May 1996: Surely it is time to get away from the sterile battle lines of public and private and instead look to how the two can best work together in the interests of the citizen—and in the interests of all citizens, at that. There are others. The Secretary of State for Northern Ireland and Mr. Roger Liddell claimed the same in their book "The Blair Revolution." I will not quote it, but anyone can see what it says. They also talked about the need for diversity and innovation in the provision of public services, so what are we arguing about today? Where is the consistency? Then there is that venerable figure Mr. Steven Pollard, former director of the Fabian Society, who in a document entitled "Towards a More Cooperative Society" said on the role of independent health care: There is a myth in the Labour movement that any form of health provision from outside the national health service is by definition tainted by with capitalism or private profit. There is more to it than that. He is right.

That brings us to the formidable problems that we have to face: rising demand for primary and secondary care, the rising number of elderly people, advances in medicine—one could go on and on. Ministers know about the shortage of consultants, but also that some who have been trained cannot find posts. In addition, as the BMA points out, it will take years for doctors currently attending medical school to emerge into general practice or senior hospital positions. Announcements that another 1,000 people are to be trained fill people with hope, as though the doctors will be turned out the next day, like rookies entering the Army, but that is not how medical training works. That is why we get disillusioned with Ministers—we know darned well that they cannot deliver just like that, but they give the impression that they can.

If we are to be true to ourselves, we have to recognise the facts, one of which is that private provision, in its place, has a role. It does not diminish the health service—after all, consultants and GPs work in both the NHS and the private sector. I know people who work under contract with the NHS and give of their time to the private sector, and why should they not? In my constituency, we have people who work in a charity-supported private hospital that takes NHS patients. Such skilled people are the strength of our health service. I see no reason why we should not examine the extent to which we can broaden that base, as those on the continent have done, with better results than we have achieved.

I welcome the comments of the right hon. Member for Birkenhead (Mr. Field) who, in a recent edition of our favourite House Magazine, advocated two longer-term reforms that might help: The first is to settle how the NHS raises its funds. We live in an age when most voters are not keen to increase income tax. Practically all voters see national insurance contributions as an insurance payment and not a tax. The Government should commit itself to transferring tax-based NHS expenditure to a national insurance base. That would certainly give buoyancy to NHS revenue. People do not mind paying insurance and, as Lord Beveridge pointed out, if a service has been paid for in advance—that is one way of seeing insurance—people are more likely to respect that service. They are also more likely to take more personal responsibility. When I see the many people in this country who eat far too much, become bloated and suffer from a heart attack or some other condition while they are relatively young, I wonder to what extent the problem was the result of natural causes, or whether it was self-inflicted. We know that we are not a healthy nation and that we do not take sufficient personal responsibility for our health.

I hope that the House will take note of the views that I have expressed, which are not mine alone. They are the views of those who are progressive—workers at all stages of the national health service who are dedicated to improving it. They recognise that team spirit in the NHS and the private sector, and among those with specialties and knowledge, is the answer. If we acknowledge that, we might have a better debate and, more important, we would, for the first time, be able to give the British people hope that they have a service that is manageable and meets their needs.

4.13 pm
Ms Julia Drown (South Swindon)

When introducing the debate, the Tories drew a wholly inaccurate picture of the NHS—one that gave no credit to the hard-working staff of the NHS throughout this country. I mean all NHS staff, not only the doctors and nurses on whom we often focus, but the huge teams of people working together in the interests of patients. A more accurate picture is the one that I see in my constituency—a positive picture of people working together in the interests of the population. A new hospital is being built. Local dentists now accept NHS patients and thousands of people have been added to their lists; by contrast, when Labour was elected, not a single dentist in Swindon took adult NHS patients. That shows how far we have come in three years.

I remember, very soon after Labour was elected—it was not because of any legislative change, but because of the way in which Ministers spoke and the direction in which we said we wanted the NHS to go—NHS staff came to me and said, "We are so thankful that we can now work together, the community trust with the acute trust, to sort out what we need to do in Swindon." Before that, a new hospital was being built but the trust managers at that hospital did not even speak to the community trust, even though they relied on the community trust to deliver some of the services that would be needed in future. The atmosphere of competition that had prevailed before did the patients and staff who wanted to work together no service.

Significant additional resources are now coming into the health service in Swindon. Staff now tell me, "We've got the money now." In part because of the pressure resulting from years of cuts under the Conservatives, it took time for the new money to come through and have an effect. A bit of slack is needed before people feel that there is new money and that they can start to do the new things that they wanted to do for years. Managers now tell me, "You have given us the money. Now it is up to us to deliver for your constituents." That is welcome news after what we heard in the past. Doctors—GPs and consultants alike—have welcomed the Government's actions, saying, "At last, we are looking at the real problems." For instance, we are examining the wider problems of public health, such as cancer, and focusing on cancer services, which were previously ignored.

In the motion, the Tories have, rightly, raised concerns about political pressure in the NHS. I share some of those concerns, but the pressures started under the Conservative Government. In that time, I worked in the NHS for 11 years. At meetings, I was told that specific political targets had to be delivered; when I looked purchasers in the eye and asked, "Even if it means that a patient will not get his operation soon enough and might suffer—for ever—because of that?", the reply was, "You have to deliver the outcome." That pressure must be removed.

One measure that might have given rise to such problems is the abolition of regional health authorities and their replacement by civil servants. I worry that, sometimes, civil servants focus on a particular political objective and do not listen to the broad spectrum of Ministers' remarks. It is clear to me that Ministers always say that clinical priorities must take precedence—I hear that time and again—yet people working on the ground in the NHS say that, sometimes, it does not feel like that to them. To them, I have two things to say: first, listen to Ministers—the Secretary of State has said on several occasions that clinical priority is the important thing; and secondly, look at the things that Labour Members of Parliament are doing in this country. We visit our local hospitals and community units and talk to staff working there—[HON. MEMBERS: "So do we."] Good—I am glad to hear that.

Mrs. Laing

We have families too.

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

Order. The hon. Lady must keep calm.

Ms Drown

Thank you, Mr. Deputy Speaker. Those remarks enable me to tell Conservative Members that if, during those visits, staff raise the concerns that I describe, they should tell them to listen to Ministers, because Ministers always say that clinical priority is important. In that way, we can get rid of the worry felt in the middle of the chain of command. I would hope that everyone in the House agrees that clinical priority must take precedence. In addition, the Government have said that they will protect whistleblowers in the NHS and elsewhere. Staff should raise their genuine concerns so that they can be properly addressed.

The Opposition have also criticised our national consultation exercise. I took the opportunity to meet people in my local hospital who were responding to that consultation. They welcomed the opportunity to say what they thought was important in the NHS. The hon. Member for Broxbourne (Mrs. Roe) referred to the importance of patients' views. If their views are important, surely we should support a consultation exercise that gives them the opportunity to make their views heard. It would be wrong and arrogant to say that doctors, nurses and other NHS staff have all the answers. Patients' views are important too.

Another accusation concerns the manipulation of appointment systems and of waiting lists. There was definitely pressure and manipulation of systems under the Conservatives. They have such a cheek to say that there were no out-patients waiting when they were in office.

Mr. Hammond

Will the hon. Lady tell me whether I have this right? I thought that she was elected on a manifesto pledge to save the NHS within 24 hours. Is she now saying that if she can point to certain things having happened before 1997, it is all right?

Ms Drown

No. I am saying that it shows a remarkable cheek for the Opposition to try to claim that no out-patients waited under the Conservative Government. It is clear that waiting lists grew under the Conservatives by hundreds of thousands.

Mr. Burns

I shall be cheeky, in the hon. Lady's terms. Will she tell me and my constituents what she thinks of the situation in mid-Essex? On 1 March 1997, 104 people in the area were waiting 12 months or more for hospital treatment. Today, 986 people are waiting. To be fair, I shall take the out-patient list. There were 555 people waiting more than 13 weeks in March 1997. There are now 2,946.

Ms Drown

I would say to the hon. Gentleman and his constituents that they should be glad that they have a Labour Government who are committed to reducing in-patient waiting lists, which was a manifesto pledge. However, we wish to go beyond that and to address out-patient waiting times, too. We will do more than the Labour party manifesto outlined because we believe that the NHS is important and that it is about in-patient treatment as well as out-patient treatment.

Nevertheless, it must be remembered that under the Conservative Government waiting lists grew by hundreds of thousands. That should not be forgotten.

Mr. Burns

My constituents who are waiting on out-patient and in-patient lists will be amazed and staggered by that reply. I have a weekly column in my local newspaper, so next Friday I shall be able to print her words. Will she answer the letters that will come to me as a result of her comments about what my constituents should think of having to wait for hospital treatment?

Ms Drown

I am sure that the hon. Gentleman is aware of the strict parliamentary convention that would limit me in replying to his constituents. However, I am happy to tell them that the Government are committed to having an NHS on which everyone can rely. The Conservative party wants to have an NHS to which people turn for urgent treatment. However, if the treatment is not urgent and if the individual can afford it, he or she will go to the private health sector. Many of the hon. Gentleman's constituents will not be able to afford that. They will thus be faced with a two-tier system, and they will be the sufferers.

It was remarkable cheek on the part of the Opposition to raise postcode rationing in their motion. Undoubtedly such rationing came into being under the Conservative Government. There has been much support throughout the House for the National Institute for Clinical Excellence to deal with this problem. The Conservatives have agreed that NICE should examine costs and clinical effectiveness. There is no doubt that that is needed.

I have a couple of quotes from general practitioners who have said that far too much is done in the NHS by habit rather than design. The co-ordinator of primary care in London, Dr. David Colin-Thome, a practising GP, has said that too many treatments are initiated more by habit than design. He claims that only 15 per cent. of treatments have been tested in randomised control trials. Dr. Tudor Hart has said: We've tended to take a pride in how idiosyncratic we are. This is a very doctor-centred view of our function—it's as though we are entertaining ourselves rather than providing care. In so far as that happens throughout the NHS in different specialties from time to time, there is a need to establish a national framework for all conditions so that all patients know what care and treatment has been properly tested and is the best for them and their families. NICE has been designed to do just that. We have had the leak over beta interferon. Possibly, it will be the first negative decision to be made by NICE. It will be a test of how a mature democracy can deal with that. It will be easy for Opposition parties to say, "We agree with NICE and we agree with the general proposals. We agree when it comes out with favourable results, but when there is something negative we will jump up and down and say, 'Let's not go along with this."" That is worrying because it will raise many fears and will not produce the NHS that we need, which is one where all patients know that they are receiving the best care, and care that has been properly tested.

We return to the idiosyncratic behaviour of some doctors. If patients have been told by their GP or another doctor that beta interferon, for example, might help them, or another drug or treatment might, they will want to go ahead with that treatment once they have been started on that path. That has led to expectations, and psychological effects can often have an impact on people's physical health. Against that background, it is important for the patient to start on his course of treatment and to ascertain whether it works for him as an individual.

I hope that NICE will in future lay out proper clinical pathways. If these care pathways can be agreed for everybody across the NHS, everybody will have the confidence to say, "Yes, this drug is right for me and I will have it;" or, "This drug is not, and I will not be given it." It is important to get the outlines of NICE known across the health service so that patients do not think different things when they see different doctors. We must ensure that there is confidence in the NHS. If we are to have a mature debate about NICE and about priorities in the NHS, we should move more towards trying to establish all-party agreement on NICE being the right way forward, and on supporting its decisions.

We must try to work as constructively as possible. Of course the Opposition will continue to try to make political points out of the health service. I regret that in so doing they often scare patients. We should take no lessons from the Opposition. When in government, they were destroying the NHS. There were 24 hours in which to save it simply because the Conservatives were doing nothing for it.

The internal market did not work. I spoke to finance director after finance director. One after the other told me, "This is not working. The Conservatives' internal market does not work. It does not help patients and it does not help staff." Labour is rebuilding the NHS with staff and with patients. I commend the Government on their work.

4.29 pm
Mr. Simon Burns (West Chelmsford)

I hope that the hon. Member for South Swindon (Ms Drown) will forgive me if I do not take up her remarks, except to say that having heard them I now fully understand the meaning of the expression "Blair's babe".

I congratulate my hon. Friend the Member for Woodspring (Dr. Fox) on raising this important issue for debate. First, I shall take up the point made by my right hon. Friend the Member for Wealden (Sir G. Johnson Smith) about the allegations that have been made throughout the debate and at other times that the Opposition, when in government, would want to privatise the national health service. That is not true and is deeply offensive to all of us who believe passionately in the NHS. We have been in government for more than 50 per cent. of the lifetime of the health service. I am fair-minded enough to pay full credit to the Labour party for the establishment of the NHS in 1948 but it is a bit rich for the Government to make cheap party political points by spreading fears around the country that my party would privatise the health service. We would not privatise the national health service.

We believe in the NHS, in the way that the vast majority of people do. They want the national health service and they are content to pay their taxes to finance it. I wish that Ministers, Labour Members and prospective parliamentary candidates would stop this nonsense of suggesting that we would not keep the NHS on the basic premise on which it was established.

Such strands of propaganda are not unique in history. It is thought by some that if a big enough lie is spread often enough, the drip, drip, drip effect will convince people that there is some truth in it. I was outraged by a document that was put through my constituents' letter boxes two months ago, "Labour Rose", published by the Labour party at Millbank. It categorically tells people that, under the Conservatives If you need a hip replacement or other major operations you will have to go private. If you need to see a GP you will be charged under the Conservatives. That is an outright lie. To show that Labour has learned the lessons of dishonest propaganda from others who are far better at it, Labour tries to give that document authenticity by incorporating a little box headed: This is how much the Tories want you to pay. Hip replacement, hernia and cataract removal operations are all included, with price bands presented as though they were factual. To add insult to injury, it says: Health Privatisation. Guaranteed. The Tories would make patients go private for hip and knee replacements and other major operations. That is a lie. There is no other word for it.

I assure Labour Members that the Tory party will not vote for privatisation because we do not believe in it.

Mr. Hesford

Which Tory party?

Mr. Burns

That was very funny. The hon. Gentleman tried to get a laugh but did not raise one.

The Conservative party believes in the national health service, as it has shown not only in every general election since 1948 but in the way that it put more and more money into the NHS during its stewardship and sought to raise standards of patient care.

Labour Members may, with total sincerity, disagree with some of the reforms that Conservative Governments have implemented, but they were introduced with the most sincere of motives—to improve and enhance patient care. Labour Members will say that we want an expanded private health sector to work with the NHS. If individuals wish to spend their money on private care, they are entitled to do so. I certainly do not believe that anyone should be made to do so and we have no such proposals. It causes me no problems if people want to spend their money on private health care—no more than if any Government, including the present Administration, want to spend some of the taxpayer's money on treatment in private hospitals because they want to deal with waiting lists. If that means that the patient will be treated more quickly, I have no problem with it, provided that treatment is free at the point of delivery to that patient and the NHS picks up the bill.

I hope that nonsensical claims about privatisation will stop, because we do not believe in it. Privatisation is not going to happen and it is not the sort of thing that hon. Members such as me would agree to or vote for in the Lobby in a month of Sundays.

Liz Blackman

The Opposition spokesperson on health stated in The Sunday Times: Insurance companies could cover conditions that are not high-tech or expensive, like hip and knee replacements, hernia and cataract operations, which currently involve long waiting times. We could then leave expensive treatments like cancer therapy to the NHS. That is on the record. Is the hon. Member for West Chelmsford (Mr. Burns) distancing himself from his party spokesperson? If so, is it not correct—as my hon. Friend the Member for Wirral, West (Mr. Hesford) suggested—that there are several Conservative parties?

Mr. Burns

I will answer the hon. Lady's question in my own way. She will have to ask my hon. Friend but, not wishing to duck the issue, I will give my interpretation and understanding of his remarks. If private health insurance companies covered such operations for people who have voluntarily taken out policies, it would relieve pressure on the NHS for the more expensive operations. That is very different from saying that my party insists that individuals take out private health insurance to cover cataract and other relatively minor, non-emergency treatment to relieve the financial pressures on the NHS and fund major operations.

Liz Blackman

Does the hon. Gentleman support his party's proclaimed policy of introducing tax relief on private medical care premiums?

Mr. Burns

It would be perverse of me not to because I voted for that policy when Margaret Thatcher's Government introduced it in the late 1980s.

Sir Geoffrey Johnson Smith

For elderly people.

Mr. Burns

For elderly people. I do not have a problem with that policy if it would help more elderly people, for whom tax relief would make all the difference by allowing them to afford private care. That is a matter of individual choice.

The bottom line is that I could not under any circumstances support or agree to the privatisation of the NHS. I do not doubt that my party has no intention whatever of seeking to privatise the health service. I hope that Labour—and the Liberal Democrats, who have always enjoyed getting into the gutter to attack both the Government and the official Opposition—will stop pursuing that tack, as the hon. Member for North Devon (Mr. Harvey) was doing this afternoon. There is no truth in it.

A matter of particular concern to my constituents is hospital waiting lists. Notwithstanding the national figures, there are problems in parts of the country. Waiting lists in my trust area are probably among the worst in Britain. My constituents are disappointed and confused when they hear that waiting lists have gone down elsewhere. They were promised by my opponents at the last general election that under a Labour Government, all waiting lists in mid-Essex would reduce dramatically. However, there has not been a single day since 2 May 1997 when the in-patient waiting list has dipped below the level at which it was on 31 March 1997. There are at present 1,600 more patients on the list than when the Government came to power, and the waiting list to get on to a waiting list has soared, as I said to the hon. Member for South Swindon, from 555 people waiting more than 13 weeks to 2,946 people waiting to see a consultant to get on to the waiting list.

That is unacceptable, particularly because of the promises that were made to my constituents by my Labour opponent, by Labour shadow Ministers at the time, and by the then Leader of the Opposition, the current Prime Minister. My constituents believed that the promised improvements would happen for them, but sadly, whatever is happening elsewhere seems to be passing them by.

I passionately hope that the Government are successful in getting the waiting list down in mid-Essex. I am sure that Ministers do not want my constituents to wait longer than most other people in the country for hospital treatment, if only because an improvement would shut me up and they would not have to listen to my speeches any more. I am united with them. I want the waiting list down because I do not want my constituents to have to wait so long.

Like the hon. Member for Wakefield (Mr. Hinchliffe), I hear tales at my surgery and in correspondence, of pensioner constituents of mine having to use their life savings for non-emergency private treatment of painful conditions, because they cannot face the pain while they wait nine months, 15 months or whatever for a hip replacement operation or other treatment on the NHS. It is unacceptable.

Mrs. Virginia Bottomley

Does my hon. Friend agree that the Government are enormously politically partisan and that there has been a vendetta against the home counties? The appalling situation that my hon. Friend describes is shared by my constituency and many others.

Mr. Hinchliffe

Come on!

Mrs. Bottomley

I am amused to hear the hon. Gentleman's merriment. I know that he does not have one in nine people waiting more than a year for in-patient treatment. I know that the figure is only one in 50 in the Prime Minister's constituency. However, there has been a severe deterioration in the home counties because of the squeeze on social services and the changes to the funding formula. The problems in the home counties are very severe indeed. Labour Members laugh or say how successful—

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

Order. The Deputy Speaker is not laughing.

Mr. Burns

Thank you, Mr. Deputy Speaker. I thank my right hon. Friend for her intervention. My constituents and many others in Essex were extremely grateful to her when she was the Secretary of State for Health. When the resource allocation working party was ended, she gave a commitment to the now Lord Newton of Braintree, my hon. Friend the Member for Maldon and East Chelmsford (Mr. Whittingdale) and me that she would start using a per capita basis for funding. For five years, we started to catch up, after the problems that had arisen from our finances being drained into the east end of London. Sadly, one of the first acts of the present Secretary of State as Minister of State when he took office in 1997 was to fine-tune what my right hon. Friend had done. That means that my health area gets £1 million less a year than it would have got without that fine-tuning.

In conclusion, I hope that hon. Members will stop the party political denigration of our position on the health service by misrepresenting it as privatisation. It is not privatisation. Many of us passionately disagree with the idea of a privatised health service and could never support it. I also hope that more is done to ensure, especially in mid-Essex, that waiting lists come down, and that a reduction in waiting times is the next step, so that my constituents can benefit.

4.44 pm
Mr. Kevin Barron (Rother Valley)

I must say to the hon. Member for West Chelmsford (Mr. Burns) that the history of the national health service over the past two decades and the debate about privatisation shows the Conservative party hoist by its own petard.

Everything that the Conservatives did when they were in office suggested that they would go down the road of privatisation. The introduction of the internal market and of fundholding made it clear what the line was at the time. Many speeches made from the Opposition Front Bench since May 1997, with talk of Trojan horses and assisting private health care, give every indication that if they could go down that road, they would.

The right hon. Member for Wealden (Sir G. Johnson Smith) said that the Conservative party had always been in favour of the NHS. He was rewriting history slightly. When the vote was taken in the House of Commons in 1948, the Conservatives voted against the NHS coming into being, but I give credit to all Opposition Members for the fact that for decades after 1948, there was a consensus in the country that the NHS should remain and continue to give the wonderful service that it has given to generations of people in Britain—until the 1980s and the Thatcher Government.

It was then that the consensus broke up, not just in the public sector and in relation to health, but in many other parts of the public sector. If that causes Opposition Members embarrassment, it serves them jolly well right for what they did to the public sector during all the years that they were in office.

Sir Geoffrey Johnson Smith

I do not want to peddle history, but I do not want it thought that I did not report it correctly. Yes, there was that vote, but it was not a matter of principle. The proposal was agreed by the coalition Government and agreed right up to the legislation. We had no real opposition to it. If we look back at the records, we will find how events happened as they did. As for the business of moving towards privatisation, I have tried to convince many in the Labour party to accept that there is a role for the private sector. That is shown by the social insurance polices that operate successfully in Europe.

Mr. Barron

I do not want to go down that road. The right hon. Gentleman said how wonderful the NHS was, then he listed six or seven countries where, I assume, he was arguing that the situation was better. On the question of social insurance, who uses our national health service? Elderly people and young children. How can the majority of people who use the NHS benefit from tax breaks—even if there are tax incentives, as there were in the past, which the Government rightly argued impacted badly on the NHS by taking resources away from where they were needed? That does not square, and it is time that the Opposition admitted it.

At the beginning of the debate, we heard from the Opposition Dispatch Box that the Government claimed to have dismantled the internal market, yet that Lord Winston said that it still exists. One or two of us shouted, "And what do you think?", but there was no reply.

Mr. Lilley

What do you think?

Mr. Barron

I think that the internal market has been dismantled, and a jolly good thing too. It was about time, because it was the vehicle whereby Baroness Thatcher's Government would have privatised the NHS, and it is about time that Conservative Members admitted it.

Mrs. Laing

Will the hon. Gentleman give way?

Mr. Barron

I will not give way; I must make progress. I have enjoyed listening to the debate, especially the opening speech of the hon. Member for Woodspring (Dr. Fox). It is a pity that he is not present. I thought that the first 10 minutes of his speech were quite good. It was like watching "What the Papers Say", with one quote after another. However, he then advanced the fantastic and incredible argument that the Labour Government send people round the NHS looking for good news stories so that they can get them out into the media.

That comes from someone who supported the previous Government. For the last 10 years of their term of office, not one new hospital was built in the NHS. Presumably, the hon. Gentleman will now say that the announcement last week of the opening of the new hospital in Carlisle, or the announcement that another 36 hospitals are to be built by the Labour Government—

Mrs. Virginia Bottomley

Will the hon. Gentleman give way?

Mr. Barron

No, let me finish my point. There is one of the culprits. I will give way to her in a moment.

The idea that the £3 billion to fund the 37 new hospitals is part of a Machiavellian plot by the Labour Government to try to pull the wool over people's eyes is nonsense, especially when we consider the previous Government's shameful record on hospital building. We ought to sing from the roof tops the Government's actions in improving the health service, and especially in building new hospitals.

Mrs. Bottomley

I invite the hon. Gentleman to come on a tour with me of the various plaques that I have opened.

Mr. Peter Luff (Mid-Worcestershire)


Mrs. Bottomley

Yes, I meant hospitals.

Mr. Barron

A plaque is not a hospital. The right hon. Lady well knows that new hospitals were not built under the previous Administration—[Interruption.]

Mr. Deputy Speaker

Order. Again, I appeal for calm. The points are matters of debate—[HON. MEMBERS: "Fiction."] Order. They are not fiction, but matters of debate. Opposition Members will be called to rebut the hon. Gentleman's case. We must have calm.

Dr. Brand


Mr. Barron

I shall give way to the hon. Gentleman.

Dr. Brand

The right hon. Member for South-West Surrey (Mrs. Bottomley) reminds me that the previous Government opened a hospital on the Isle of Wight. Unfortunately, it needed repairs worth £15 million because it was built so appallingly by the right hon. Lady's cronies in the region.

Mr. Barron

We are time limited, so I shall move on.

I fundamentally disagree with the motion's suggestion of political interference in the day-to-day management of the NHS. It is not true. Ministers are probably examining the NHS in greater detail than they have done in the past. There are good reasons for that.

I have sat on the General Medical Council since the middle of last year. This morning, the British Medical Association conference passed a resolution that was hitting the headlines as I came to the House. It relates to the Government's actions. The BMA has passed a motion of no confidence in the GMC. Given that many members of the GMC are also members of the medical profession, and that it is a statutory, self-regulating body, members of the BMA have virtually passed a motion of no confidence in themselves, especially when we consider the way in which people are elected to the GMC.

I agree with some of the comments about the need for structural changes in the GMC. An internal paper is circulating about its governance, and we are considering the matter. I understand that the BMA wants delays in disciplinary procedures to be tackled. Next week, the House will consider a regulation, which the Government are introducing, which will assist with that. More lay members will be elected on to the GMC. That will mean that we can speed up the disciplinary process and reduce waiting times. The BMA is also worried about more regular testing and revalidation.

Today's headlines suggest a conflict: the BMA versus the GMC. That does a disservice to the issues. The real issue is doctors and patients' confidence in them. Revalidation is led by the GMC, but it complements the work of the Committee on Health Improvement, and other plans that the Government have put in train since May 1997. I compliment the Government on their proposals for clinical governance and improvement. Improvements have to be made to help all our constituents to get better treatment from the NHS.

Revalidation was hotly debated in the GMC. A minority of people opposed it, but they were heavily defeated. I understand that a tiny minority opposed it at the BMA, but they, too, were defeated. My hon. Friend the Minister can take heart from that. We recognise the need for change. We also acknowledge that the Government's clinical governance and clinical appraisal proposals, and the GMC's changes, will ensure that patients have more confidence in doctors. In the majority of cases, such confidence is high; the proposals and changes will ensure that it is maintained.

Medical regulation must modernise to fulfil the public's changing requirements. The GMC, the Government, the BMA, the royal colleges and health service managers have a role to play in that. The public will not accept unnecessary delays by any of the parties. Modernisation is moving at a quick pace.

In view of media reports in the past few weeks, especially about one specific case, it is important to progress quickly. In years gone by—I do not place any party political blame on anyone—people in clinical practice have not been appraised. Sometimes they have run single-handed practices, and there has been no peer pressure to ensure that they keep up to date and provide a good service, as the majority of doctors do. Sadly, any shortcomings that come before the GMC are blazoned in the press, and people could be forgiven for believing that no control existed. The Government and the GMC are trying to put better systems in place for effective annual revalidation or reappraisal.

I hope that I have two minutes to mention not only the changes that have taken place in the past two years, but those that are imminent in primary care. My constituency has a primary care group; it is one of three in the borough of Rotherham. We are in a position to apply to become a primary care trust. A debate about that has taken place. It seems to most people that having one primary care trust is sensible. I do not know whether there are any guidelines about that.

I wonder whether there are guidelines about another issue that is up for heated debate in Rotherham: mental health services. Do the Government or the regional office of the NHS have any guidance about whether those services should remain in a primary care trust or whether they could be floated off into a bigger trust? There is a worry in our area that if we become a primary care trust, and mental health services are not part of it, they will go to a neighbouring trust somewhere in South Yorkshire and we shall lose our local influence on mental health services.

Earlier, the hon. Member for Broxbourne (Mrs. Roe) described mental health services as Cinderella services. That might have been true in the past, but such services are vital in our health service and our local communities. Will my hon. Friend the Minister tell us whether there is any guidance about including mental health services in primary care trusts?

Mrs. Caroline Spelman (Meriden)

On a point of order, Mr. Deputy Speaker. I did not want to cut into the time of the hon. Member for Rother Valley (Mr. Barron) because I wanted to be courteous. However, page 386 of Erskine May states: Expressions which are unparliamentary and call for prompt interference include: The imputation of false or unavowed motives. The misrepresentation of the language of another and the accusation of misrepresentation. The hon. Gentleman said that no hospitals were opened under the Conservative Government. Had we been given the opportunity, we would have given many examples of hospitals that had been opened.

Mr. Deputy Speaker

Perhaps the hon. Lady did not hear me, but when there was much excitement earlier in the debate about the hon. Gentleman's comments, I said that there would be an opportunity for Opposition Members to rebut his case. All that needs to happen to put the record straight is for an hon. Member to say, "Hospitals were built at that time". That is why we have debates.

5 pm

Sir Raymond Whitney (Wycombe)

In response to the misapprehensions about hospital building that have been distributed by Labour Members, let me advise the hon. Member for Rother Valley (Mr. Barron) that the hospital building programme has been cut back only once in the 50-year history of the national health service and that was in 1976 under the Labour Government on the orders of the International Monetary Fund, when the accounts of this country were effectively under foreign control.

I begin by offering the House two predictions. First, just as we have heard nothing new yet from the Government on the future development of the health service, I predict that by the end of this debate, including the wind-up by the Minister of State, we shall have heard nothing new. For 50 years, Labour Members have had nothing new to say about the health service, so they are certainly not about to start now. My second prediction may seem a little presumptuous as it concerns my remarks. Either they will be totally ignored because the facts that I am about to offer will be too uncomfortable, or they will be deliberately and wilfully misconstrued.

For half a century there has been an intellectual blight on how we treat health care. We have heard it again today. It all starts from the assumption that, allegedly, the Conservative party was against the national health service. Hon. Members ought to know that that is absolute nonsense. During the Second Reading debate on the National Health Service Bill in the House of Lords, the then Labour spokesman said that the Bill was not the product of any single party or any single Government. He said that it was in fact the outcome of a concerted effort, extending over a long period of years and involving doctors, laymen and Government to improve the efficiency of our medical services. There is no doubt that it was a joint effort.

The health service was based on the 1944 White Paper which was produced by Henry Willink, a Conservative, who was Health Minister in the coalition Government at the time. Although Conservative Members, perhaps misguidedly, voted against Aneurin Bevan's Bill—just weeks earlier Herbert Morrison had spoken against its content—the Conservative health spokesman said in the Second Reading debate that he was anxious to clarify the position of the Conservative party with regard to the principle of the national, comprehensive, 100 per cent. health service. He said that the Conservatives accepted that principle, as they had in 1944. Labour Members should accept those realities instead of continuing to perpetrate misinformation.

The intellectual blight that I mentioned occurred because we became used to persuading ourselves that the national health service was the envy of the world. I wish that it were. Sadly, that has seldom been the case. Had our national health service been the envy of the world, one would have expected country after country to have adopted the same system. As we know, that has not happened.

Sadly, evidence has steadily mounted that the structure that was put together in 1946 has not met modern conditions. Indeed, as long ago as 1967, the British Medical Association recognised that it was falling short and set up a committee under Dr. Ivor Jones. It reported in 1970 that performance … is shown to compare unfavourably with that of many other countries in several respects … there is inadequate finance both in regard to capital and running costs … the imperfections of our health service are clearly visible … staffing is deficient at all levels and many sections are underpaid … it appears probable that Britain must think in terms of additional expenditure on medical care of an order which no government has ever contemplated … That was written 30 years ago and it is true today.

When I became a junior Health Minister in 1984, I did not accept that point of view. I took the point of view of every other Health Minister of both parties—that we had two jobs. One was to get as much money out of the Treasury as we could and the other was to spend it as sensibly as possible. At the time, I did not consider that there was any possibility of changing the basic 1946 structure. After one year of wrestling with the problem, I concluded that it had to change. That conclusion is increasingly being reached by people who know about the health service. As hon. Members may recall, it was voiced by Lord Winston for 24 hours before he was silenced by the Government machine.

There is now overwhelming evidence that our health service is not up to international standards. The latest league table puts us in 18th position. Let me offer hon. Members a few more statistics. I hope that they do not find them too unpalatable. On the basic challenge of mortality, in respect of life expectancy at the age of 60, the United Kingdom came 19th out of the 23 countries examined by the Organisation for Economic Co-operation and Development. We are on a level with Turkey.

On health outcomes, in respect of heart disease and cancer survival rates we are at or near the bottom of the European league table. In the United Kingdom a person with stomach cancer has an 8 per cent. chance of surviving five years. In France, his chances are three times greater. In the United States, his chances are four times greater.

Mr. Hesford

Will the hon. Gentleman give way?

Sir Raymond Whitney

No. There is a time limit on speeches and I need to make progress. If there is time, I shall give way later in my speech.

In December 1998, the Economist Intelligence Unit survey placed us 14th out of 25 nations. It assessed that we were losing 200 million working days a year due to sickness, much of which was due to the deficiencies of the national health service. It estimated that that was costing the nation some £12 billion in lost production.

Those are the facts. In debate after debate in the House hon. Members representing all three major parties resolutely refuse to face up to them. In the United Kingdom we have 4.5 nurses per 1,000 people. The figure for Germany is twice that. We have 0.4 dentists per 1,000 people—half what they have in Germany. Of all the OECD countries only Albania and Turkey have fewer doctors per head of population than we have.

We all know that health service morale has never been lower. The medical profession especially feels under attack, and it is alarming to see the sensitivity among doctors. Some of my hon. Friends have already mentioned the deep damage that the juggling of the waiting lists has done to clinical priorities.

Those are the problems and we have to open our minds to them, instead of dwelling on misinformation about what happened in 1946. As my right hon. Friend the Member for Wealden (Sir G. Johnson Smith) said, under the previous Conservative Government, the budget went from £9 billion when we took over to £40 billion by the time we left office, so we have all tried. For example, we increased the number of people treated in hospital by 80 per cent. and the budget went up by 75 per cent. in real terms. The present Government are also trying, but the question is whether we can ever get the results we want using public finance.

In terms of total expenditure on health, the most recent figures available show that we spend 6.9 per cent. of our GDP on health, and of all the OECD countries, only Ireland spends less. The claim is that we will catch up with the Germans' spending. To do so, the Chancellor of the Exchequer would have to find a further £45 billion. That is an inconceivable figure. However, even if we did achieve that over five years, by that time the Germans would have moved on. They are not satisfied with their level of health care, even though they spend some $2,000 per person and we spend $1,200 per person.

Cash is not everything, and we can achieve more through our NHS than the Americans do with their vast expenditure. Even my hon. Friends on the Front Bench are, understandably—because of the rubbish we hear from Labour—scared of dealing with the facts that I am setting before the House. Many people do not realise what they are being deprived of, compared with what other societies—comparable to us in wealth and economic structure—provide for their people. For example, our waiting times are unheard of in continental countries. They would laugh at such waiting times.

We must ask, therefore, whether there is another way to run the NHS. I mentioned the BMA committee that reported in 1970, and it concluded that the answer was an insurance-based system. That does not mean pushing some of the work on to the private sector. Some of the arguments that we hear from the Government against giving greater emphasis to private insurance are valid. In my opinion, we need a totally new structure. It would not be revolutionary, because I could name 20 countries that have similar structures, and they provide much better health outcomes than we do. An average of £915 is spent for every man, woman and child in the country. Under the insurance-based system that the Jones committee advocated in April 1970, we could offer everybody an insurance voucher of £700. I support that system and, indeed, I wrote a little book on it in 1988. The system would give us all the chance to contribute for ourselves, and that is the way forward. No Chancellor will ever be able to find that astronomical sum of £45 billion, and therefore we must have a new system.

That new system is obvious, when we consider society now and how much better it is than the one for which the NHS was constructed in 1946, when the decisions were taken. Then, we were impoverished, worn out and on our knees. Now, the average family is four times better off in real terms. It spends some £2,000 to £3,000 a year on its holidays and Christmas presents. Most people would want to supplement their health cover. If they did, they would feel involved in the health system, and that they had some ownership of it.

I realise that that is a difficult pill to swallow. Most of us have said for 50 years that the national health service would be wonderful if only we could spend another few billion. That is what the House and the Labour Government are saying again now, but it will not work.

There is money in the Exchequer. Of the £915 per head of population that is spent on the NHS every year, we could spend £700 on insurance vouchers. That would leave £215 for those who really need protecting—

Mr. Deputy Speaker

Order. The hon. Gentleman's speech is time limited.

5.15 pm
Ann Keen (Brentford and Isleworth)

I shall begin by using my nursing skills, as a clinical diagnosis of the occupants of the Opposition Benches reveals that some Conservative Members are suffering from an outbreak of what I recognise as amnesia. Like the hon. Member for Woodspring (Dr. Fox), I too worked in the national health service. I was a nurse for 20 years, and I was working the afternoon shift in a medical ward on the day that Mrs. Thatcher was elected. Her Government promised that they would not privatise the health service in the same way as they privatised the electricity, gas and other services—they knew that the British people would not let them get away with it. Instead, they set up a clever framework that allowed them to dismantle the system gradually by chipping away at it bit by bit.

The hon. Member for Woodspring is not in his place, but he is very worried about the cleanliness of our hospitals. I am too, as was the ward domestic with whom I worked for some years. I was a ward sister, and she worked permanently on my ward. She worked there every day and looked after the ward as if it were her own home. The evening cleaning shift were not just cleaners: they were domestic staff and part of the ward team. They cleaned the wards, looked out for patients' needs and ran errands for them—until the contracting-out process began.

The guidelines set by the previous Conservative Government required that contracts were awarded to the lowest tender. That meant that many low-paid health service workers had to accept short-term contracts at even lower rates of pay. Those rates did not equal today's minimum wage—which the Conservative party voted against, just as it voted against the inception of the health service. The Conservative Government were prepared to have a hospital cleaning force who were low in skills and poorly paid. That is not acceptable: hospitals must be clean if infection is to be kept down.

Contrary to popular belief, I did not work with Florence Nightingale, but she said that hospitals should do the sick no harm. The truth, however, is that they can do the sick an awful lot of harm. I urge my hon. Friends on the Front Bench to take note of the problem and to put measures to correct it into immediate effect. Permanent domestic staff must be restored to wards and hospital clinics and given responsibility for cleanliness there on a daily basis. That would contrast with what happens with people working on a contractual basis, who move on once they have done their stint with the cleaning fluid in any particular area.

I was working in the health service when the right hon. and learned Member for Rushcliffe (Mr. Clarke) introduced his new version of the NHS. He travelled to the privatised Limehouse studios by boat along the Thames to make a video for NHS workers. The video's presenter was Nick Ross, who also presents a programme called "Crimewatch UK". I am sure that it is merely a coincidence, but I am convinced that the right hon. and learned Gentleman's innovations amounted to the biggest crime ever inflicted on the British people.

The internal market that was established set hospital against hospital. I worked in the London area, where research centres and famous hospitals competed with each other instead of doing what they do best—advancing knowledge by sharing results, which is the central ethos of research.

At my interview for the West Middlesex hospital in 1985, I was shown the plans for the new hospital in which I would be working in 1987. I am pleased to say that, under a Labour Government, we will at last have that new hospital. The project is on schedule, the contractors are in place, and work will commence at the end of this year or the beginning of next.

The sale of the South Middlesex hospital took place in 1985 and £12 million was raised to go towards the new building at the West Middlesex hospital. Alas, the then Government had got their figures wrong for the Chelsea and Westminster and seemed to be £12 million out—so the money was moved to that project. How interesting; markets have always produced winners and losers.

This time, I want the national plan to make sure that we are all winners. Much has been said about choice, but one does not choose to have appendicitis, to have cancer, to have an accident, to become frail or to have a chronic condition. People want a high standard of treatment in the hospital that is closest to them—unless it has a specialist element for which one may have to travel. We want the hospital to be of a high standard in terms of staff and resources.

Mr. Lilley

Does the hon. Lady accept that some people might want to go to a hospital that is some distance away, but is near their relatives; that some might want to go to a hospital that has single-sex rather than mixed-sex wards; that some might want to go to a hospital with a better success record than the local one; and that some might want to go to a hospital with a shorter waiting time than the local one? Should they be prevented, for ideological reasons, from exercising that choice?

Ann Keen

The right hon. Gentleman makes the point that, sometimes, we must look at particular aspects of individual patients. We always have done that and we will continue to do so. If specialist treatment is needed, there are specialist facilities.

Choice was not available under the internal market. The only time people had any choice was if they collapsed outside the hospital of their choice. However, one certainly did not enter the contractual system out of choice; that only ever worked for a small group of people. That fact is stated by professionals of no political persuasion.

For the future, we want everyone to have a national standard. Standards should be the same and there should be clinical governance throughout all professions. The hon. Member for West Chelmsford (Mr. Burns) is rightly interested in his constituency waiting list, but he should discuss with managers why that list exists. In my local hospital we have looked at modernising the systems.

A patient with a suspected hernia goes to the GP, and GPs are very capable of diagnosing a hernia. There is no need, in most instances, to refer that patient to a consultant to have the diagnosis confirmed, and then for the patient to wait again for the hernia to be repaired. The GP should be able to use information technology, and set up an appointment for the day of surgery. That is happening in parts of Isleworth and west London, so the hon. Gentleman needs to ask why it is not happening in his area. That is where the money is going and what modernization means.

Mr. Burns

I have meetings on a quarterly basis, and have done so now for two and a half years. As the situation is so bad, I have also had meetings with Ministers who, unfortunately, cannot tell me why my trust is worse than so many others. Part of the reason is lack of funding, despite the increases announced by the Chancellor.

Ann Keen

I cannot accept that funding is the reason. We must always look at the way in which we work.

I want to mention two aspects of care with regard to the national plan. The winter pressure, as it is described, can be felt at all times. So why are many older people admitted into hospital from accident and emergency departments when a skilled primary care team, along with people from social services, could care intensively for them at home? A 24-hour, community-led service is essential for many of our older people. They can have treatment at home as long as such a service is available. In that way, patients are not disorientated because they are not moved from their homes. They do not have to stay in hospital beds for weeks and then encounter difficulties in rehabilitating themselves when they are back home.

My final point about the plan is cancer care. We need to look at the prescribing of chemotherapy drugs. A professor at Hammersmith hospital has told me that the country's prescribing bill is higher for laxatives than it is for chemotherapy. We need to look into the causes of some of that prescribing, given that our position in the European league tables is very low for prescribing chemotherapy drugs, but our mortality rates are high. I want there to be a national cancer centre. There should be consensus on many of the cancer drugs, such as Taxol, about which the National Institute for Clinical Excellence has recently made an announcement.

I thank you for giving me the opportunity to speak in the debate, Mr. Deputy Speaker. I feel very positive about the health service. It will continue to be very demanding, and the skills of all the staff need to be taken into account. We should see a little more humility from Conservative Members because, without question, their short-term, market-led health service failed the people of this country. It will take all of us to ensure that we have a health service that we can be proud of in the future.

5.27 pm
Mr. Peter Viggers (Gosport)

One abiding memory of the previous election was of meeting some nurses at a charity fair in the town hall in my constituency. It was a couple of days before the election, and I was talking to half a dozen nurses, many of whom I had known for many years and many of whom I knew to be Conservative supporters. Their eyes were shining—they were so thrilled that, at last, the national health service was going to be saved.

The Labour party was incredibly successful in persuading people that it could save the national health service. It said in its manifesto: if the Conservatives are elected again there may well not be an NHS in five years' time—either national nor comprehensive. It went on: Our fundamental purpose is simple but hugely important: to restore the NHS as a public service working co-operatively for patients, not a commercial business driven by competition. We cannot let this debate pass without saying that the previous Government were extremely successful in reorganising the national health service. Nobody who studies the subject can doubt that, for the amount of resources that are put into the national health service, it is successful and efficient. We were successful in putting together a system of providers and purchasers; we introduced market forces, which were successful in producing a better national health service.

This Government, meanwhile, have imposed extra burdens on the health service. The pensions cost in the health service, for instance, is about £495 million more than it was when the Government came to power. The working time directive and the provisions of the Disability Discrimination Act 1995 will add extra burdens to the national health service too.

We all remember when, in July 1998, the Chancellor of the Exchequer announced the amount provided for health in the comprehensive spending review for 1998–99. He announced an extra £18 billion, by double and triple counting the amounts in question. He added the £3 billion increase to the £2 billion increase to the £2 billion increase, and instead of arriving at a figure of £8.7 billion, he arrived at a figure of £18 billion. There has been a lot of double counting in the NHS finances.

What has actually happened? Notably, Lord Winston said that the national health service was gradually deteriorating because we blame everything on the previous government. Another doctor working in the national health service—Margaret Cook, the former wife of the Foreign Secretary—said: The NHS is still grossly underfunded and Labour have done not a thing. The King's Fund, talking of the changes in clinical priorities, said that the national waiting list diverts attention away from the issues that matter most to patients. By focusing simply on the number of people waiting for treatment after seeing a hospital consultant, the list ignores the time people are waiting and the severity of their need. That is why, when the Government came to power, in June 1997, the percentage of people waiting more than a year for an operation was 3.9 and, after three years, it is now 4.9, which is a 1 per cent. increase. Those are the people who have to wait more than 12 months for their operation. They are in the same category as a constituent who came to see me about a year ago. She had been told in January 1999 that the waiting time for her triple heart bypass would be nine months. The operation took place 18 months later.

In my constituency, the waiting time for cardiac surgery has gone from nine to 18 months within a year. I see that the Minister of State, the hon. Member for Southampton, Itchen (Mr. Denham), has rejoined us in the Chamber. In a written answer recently, he told me that the waiting time for cardiac surgery in my area was 15 months, but that the Government's ambition was to get it down to 12. That answer was not correct, as the waiting time is 18 months. Therefore this Government in action have not been successful nationally.

What about the local situation in the area that I represent, the Portsmouth-Gosport area? The News, the local newspaper, reported in January 1999: Relatives and friends of patients in Portsmouth hospital are being asked to help wash and feed their loved ones because of a drastic shortage of nurses. Notices are being handed out at Queen Alexandra Hospital, Cosham, and St. Mary's Hospital, Milton, asking for help to wash, shave and feed patients. It is the first time Portsmouth Hospitals NHS Trust, which runs QA and St. Mary's, has approached relatives, friends and carers for help in this way. The newspaper also reported Doug Dann, the chairman of the patients' watchdog, the Portsmouth and South East Hampshire Community Health Council, as saying: This is the worst winter I remember in terms of pressure. In the article, one nurse, who asked not to be named, said: Everybody's thoroughly fed up. Staff are leaving in droves because they have had enough. Patients and their relatives keep moaning at us all the time when we're struggling to make the best of a bad job. A year later, in January 2000, The News reported: Earlier this week, there were only three beds free at QA and St. Mary's hospitals. Lin Kennett, operational director for medicine at the Portsmouth hospitals' trust, which runs both hospitals, said: "This is the worst I have known in the 25 years since I have been here. The newspaper reports Keith Murray, the Portsmouth branch convenor of the Royal College of Nursing union, as saying: Staff are absolutely exhausted. I don't know how they can carry on at the pace they are. Some nurses are going off-duty in tears because they can't give the care they want to give. In April, which is not a time of bad weather, The News reported a crisis in Portsmouth hospitals, saying: The news comes as new Patient's Charter figures for Portsmouth hospitals show the worst recorded performance in two-and-a-half years— an interesting period, as it happened to be the time the Labour Government had been in power. The article continued: There were 251 operations cancelled at Portsmouth hospitals from last December to March. Earlier this year The News reported Portsmouth hospitals were suffering their worst beds shortage for 25 years … spokeswoman … Mrs Forsyth, said both hospitals were still on red alert—an emergency status to show a lack of beds. They have been on red alert since mid-December which is a record. In January 2000 The News also reported that 50 patients had been transferred from the Portsmouth hospitals to the Royal Hospital Haslar because of a shortage of beds.

What are the Government doing about that? Colleagues will perhaps not believe this, but the Government propose to close my local hospital. The Royal Hospital Haslar serves as the district general for my area of Gosport. It is a defence medical hospital. In 1994, the Conservative Government chose Haslar as the only tri-service hospital and concentrated all the resources of Army, Navy and Air Force medicine there, together with small Ministry of Defence hospital units at three other locations in the south of England. Yet the Labour Government, to the disbelief of many people involved, in December 1998 announced the closure of Haslar and the intention to create a new centre of excellence elsewhere, at that time undefined.

Many people within defence medical services hoped that the new centre of medical excellence would be either at St. Thomas's and Guy's in London or possibly at the John Radcliffe hospital in Oxford. There was even some suggestion that it should be in Newcastle. It is going to be in Birmingham, which is probably the largest city with no particularly strong services connection. It has no strong connection with the Navy, the Army or the Air Force. The people in my area are incredulous that the Government are pressing ahead with this plan.

When the announcement was first made in December 1998, I announced a rally and march, thinking we might have a few hundred or, possibly, a few thousand people. I was staggered to find that we had 22,000 people marching to Haslar hospital, everyone dedicated and committed to maintaining its existence. That is just the civilian side of Haslar hospital—the demand by local civilians.

Within the armed forces there is a similar determination that the hospital must not close. Already defence medical services are losing many doctors and nurses who, in 1994–95, were told that they should move to the Gosport area to the only tri-service hospital and are now told that in the medium to long term they will have to move to Birmingham. They do not want to go; they are voting with their feet and leaving.

Sandra Gidley (Romsey)

Is the hon. Gentleman aware that owing to a closure of wards at Southampton general hospital people are being transferred to Haslar? Does he agree that is further evidence that Haslar should remain open?

Mr. Viggers

I am grateful to the hon. Lady for that important and effective argument. There are so many other arguments that one could make—for example, the links developed over the years between Haslar and Southampton and Portsmouth universities—that local people feel it is overwhelmingly important that the hospital should remain.

The alternative is to travel to Queen Alexandra hospital at Cosham, which is a journey of some 10 to 12 miles depending on which part of the constituency one lives in, along heavily congested roads. The A32 is the main road from Gosport to Fareham and is notoriously slow. There is deep concern that ambulances will not be able to get to Queen Alexandra hospital and that lives will be lost.

Admittedly, a minor accident treatment centre has been opened at Haslar, so to a certain extent the Haslar taskforce which I formed and chair has been successful in persuading the Government in all their manifestations to maintain an accident centre at Haslar. In addition, the Portsmouth and South-East Hampshire health authority has proposed that Haslar will remain open under NHS control, and that the main part of Haslar, which is called the crosslink block, will be transferred from the Ministry of Defence to the NHS and the local health authority will be able to run out-patient facilities there. That is good news. The number of out-patients will increase from the 55,000 currently treated to 60,000 in future.

That is not good enough. We in the Haslar taskforce are drawing up a paper which I have called, "Haslar hospital 2020—our vision for the future". We want to spell out what facilities can best be maintained at Haslar. Clearly, the world-leading MRI scanner and the world-leading hyperbaric unit should continue at Haslar. We also need beds. With the problems in Portsmouth hospitals that I have outlined, there is a dramatic shortage of beds which is not likely to improve.

There is a private finance initiative to expand Queen Alexandra hospital at Cosham and almost double it in size. During the time of its expansion, it will be a building site and top quality medical facilities cannot be run from there. Our proposal, therefore, will be that Haslar be given a surge capacity while Queen Alexandra hospital is being extended; and that having been increased in size to take the surge necessary to cope with the building work on a congested site, Haslar will stay "surged".

Nothing less than a continuation of the Haslar facilities will be satisfactory locally. My constituents feel strongly about that—as do a large number of people in the defence medical services and the armed forces. They believe that the Government have made a mistake and that it should be only a matter of time before the Government go back on their decision and keep Haslar open.

5.40 pm
Dr. Howard Stoate (Dartford)

I am grateful for the opportunity to speak in this important debate. I am pleased that the Opposition have chosen the subject of priorities in the national health service.

I have been in the Chamber for almost all of the debate and have listened with care and interest to the contributions. However, I am disappointed. The debate was supposed to be on priorities in the NHS, so I hoped that the Opposition would lay out their stall for their policies to further and improve the service, but I have heard only a litany of complaints and moans and groans about the state of the NHS—how run down it has become; how low morale is and how patients are suffering. We have heard that time and again. We have not heard what the Opposition propose to do about it.

It took an intervention from me on my right hon. Friend the Secretary of State to find out the true Tory intentions for the NHS. I was grateful to my right hon. Friend because, by quoting the statements of Opposition spokespersons, he was able to tell me what they had in mind. Perhaps the Opposition are embarrassed; perhaps they do not feel happy about what they are trying to do.

Mrs. Laing

Will the hon. Gentleman give way?

Dr. Stoate

I shall not give way just yet—I will do so if there is time.

Perhaps the Opposition do not want to tell the public what they have in mind. I am a charitable person, so I do not like to run people down unnecessarily. I am even prepared to admit that the Opposition have honourable intentions in that they really want improvements in patient care. I think they do. However, there is a real difference in the way that we seem to want to achieve that.

I believe that the health service needs improvement and that the Opposition want better patient care, but there is a fundamental difference—clear blue water—between the parties. Today's debate offers us an opportunity to examine that distinction. Both parties agree that the NHS is underfunded and that there are not enough doctors, nurses, hospital beds or facilities. Patients wait too long—waiting times and waiting lists are too great. Both sides of the House agree. I have no problem about that.

The problem arises over what the two parties intend to do about the matter. Labour have made it clear that we are wholly committed to a publicly funded NHS, improving every year as resources become available. We aim to meet the European average on health as soon as practically possible given the available resources. I am pleased that the Government are making real improvements in health care every year.

The Opposition, on the other hand, want to do something different. I do not accuse them of wanting to privatise the health service—I do not believe that is what they want to do. That is not on their agenda. However, they do want to increase resources by increasing the private element in the health service. They want to increase health resources, using private sector money, by encouraging people to take out private insurance. Even the Opposition probably agree that that is what they are trying to do.

Labour, however, want the health service to be almost completely publicly funded.

Mr. Hammond

I am grateful to the hon. Gentleman for his comments. Does he acknowledge that, in trying to reach average European health spending as a percentage of gross domestic product, there is a problem? In the European countries to which he refers, spending on privately financed health care is much higher than in the UK; on average, it is nearly double.

Dr. Stoate

I accept that we have a different philosophy from our European partners, but our philosophy is correct, as I shall explain. Let us consider the consequences of the Opposition's proposals to increase the number of people who take out private insurance to fund their so-called non-life-threatening, so-called non-urgent operations, such as hip or knee replacements, or treatment for cataracts or hernias.

The hon. Member for West Chelmsford (Mr. Burns) suggested tax relief on private health insurance; he said that he had voted for that under the Thatcher Government. What would happen if that were implemented? I quote the Baroness Thatcher. In her book, "The Downing Street Years", she stated: Tax relief for private health insurance would in many cases help those who could already afford private cover and so fail to deliver a net increase in private sector provision. Tax relief will not increase the number of people who take out private health insurance.

Mrs. Laing

Will the hon. Gentleman give way?

Dr. Stoate

I cannot give way at the moment; I have already given way once and there is not much time.

What other consequences would flow from the Opposition policy? Many people—indeed the majority—who need hip and knee replacements do not pay tax because they are pensioners. The Government have taken the majority of pensioners out of the tax system. What advantage is there to giving tax relief to people who do not pay tax? None, so that will not help pensioners very much.

If tax is removed from private health insurance, premiums go up. Lord Lawson says: If we simply boost demand, for example by tax concessions to the private sector, without improving supply, the result would not be so much growth in private health care, but higher prices. Those are not my words, but Lord Lawson's. Therefore, giving tax relief on private health insurance would not increase the number of people taking out insurance, but it would push up prices. I do not see the value of providing a huge public subsidy to the private sector if it does not even increase the number of people using private health insurance. There is no point in that.

Let us suppose that the policy worked and we managed to increase the number of people using the private sector. That would result in a scarcity of private facilities and resources. Where would the doctors, nurses and other staff in the private sector come from if not from the health service? The annual representatives meeting of the British Medical Association pointed out how overworked and overstretched doctors are. I know, having been closely involved in medicine, that doctors and nurses are overworked and overstretched. However, if those same doctors and nurses also work in the private sector, they will be even more overstretched and overtired. I do not understand how that will improve patient care. The only alternative is for doctors, nurses and others to leave the health service and work only in the private sector. Again, that would be to the detriment of the NHS and patient care.

So far, I have heard nothing in the Opposition's proposals that could conceivably improve patient care, improve the uptake of private insurance or improve the supply of medical care. The proposals would not work at all.

Pooled risk presents another problem. Private insurance companies do not want to take on high-risk patients. The principle behind the NHS is that it pools risk. Those with low risk effectively subsidise those with high risk and we have accepted that for 50 years. If insurance companies were to pool risk, people would rightly become upset by that. We would all be upset if we pooled risk on car insurance. If I paid the same premium as an 18-year-old driving a sports car, I would be fairly upset. I consider myself to be a lower-risk driver, so I do not want to cover the risk of someone who drives extremely badly and who is a very high risk. I do not believe that people would be prepared to pay enormously enhanced premiums for private health care to subsidise those at risk.

I can provide chapter and verse on what happens to medical care in the private sector. A friend of mine who is a consultant diabetologist had a patient who took out private health insurance in good faith. The patient developed diabetes and—fair enough—the private sector paid for his treatment. He then developed the common complication of eye problems; he needed laser surgery on his eyes. The private sector paid for his laser treatment, but he needed more laser treatment and—fair enough—the private sector paid for that. He returned a third time and the company paid again. However, when he returned the fourth time for treatment, the insurance company wrote to him to say, "We are sorry. Four episodes of treatment mean that you have a chronic condition by definition. Chronic conditions are not covered under your policy. We ain't paying no more." That is precisely what happened.

That patient took out private health insurance in good faith, but found that the treatment was ruled out of order because he had the bad luck and the temerity to develop a chronic condition. I do not see how such insurance benefits anyone.

Mrs. Laing

Will the hon. Gentleman give way?

Dr. Stoate

I am sorry, but I do not have time to give way. I apologise to the hon. Lady.

There is a way forward. There are enormous opportunities in the health service for the prioritisation and improvement of patient care. I have been working hard with my local health authority, local trust and local primary care group on how we can improve patient care. I want to give one or two examples of what can be achieved in the NHS by prioritising care to improve patient outcomes.

Many people do not need to be in hospital. They do not want to be in hospital; they would rather be at home. Among that group are people with chronic illnesses, and the Dartford, Gravesham and Swanley health care partnerships primary care group has provided an extra multiple sclerosis nurse as well as an extra epilepsy nurse. It is also currently considering providing an extra Parkinson's disease nurse.

Those nurses are able to care for people in their homes and it has been demonstrated that they reduce costs, improve patient compliance and reduce the risk of admissions. They give much better patient satisfaction. The nurses are excellent news for the sufferers of long-term illnesses in West Kent and reduce pressure on the acute sector. Nurses can make a real difference to the quality of care and they play an important role in keeping people out of hospitals where they do not wish to be.

I am also working with a group in my constituency that is trying to encourage telemedicine, which is medicine at a distance, and allows my local hospice to link up with a hospital 300 miles away and receive, three times a week, expert guidance from a consultant many hundreds of miles away who is able to manage the patients and give advice and help to nurses who run the wards day by day. The Lions hospice has managed to get that video-conferencing system running and has made excellent improvements in patient care.

That sort of initiative should be applauded, as it is the way forward. It demonstrates prioritisation in the NHS, which involves setting priorities, using money to the best advantage and making sure that the available money goes to the best possible patient benefit. The Kent cancer network, managed by the Mid Kent healthcare trust, is driving forward modernisation of the NHS to make cancer services fairer, faster and more convenient. It is at the forefront of creating an NHS better attuned to the needs of patients by reshaping services for people with suspected or diagnosed cancer. The Kent cancer network is the first such collaboration of health authorities and hospitals in the south-east, and will speed up cancer treatment and keep patients fully informed at all stages about what happens next.

The modernising cancer care projects streamline care of patients with suspected and diagnosed breast, lung, bowel, ovarian and prostate cancer, and provide patients with any suspected cancer who need to be seen urgently with an appointment with a specialist within two weeks, thus reducing waiting times for those with real illnesses. The Kent cancer care network enables patients to pre-book appointments, offering them a choice of dates and times, which takes away the uncertainty of not knowing when and by whom they will be seen. It also co-ordinates surgery with follow-up therapy so that patients know in advance what will happen after surgery. That will minimise delays, reduce patient anxiety and improve care.

Kent was chosen from 26 applicants to be one of nine networks running 43 projects covering 14 million people, which will modernise cancer projects from top to bottom as part of the Government's pledge to change the way in which the NHS organises care, and radically to change people's relationship with the NHS. About 250,000 cases of cancer are diagnosed in the UK every year, and there are 156,000 deaths from the illness. The Government have pledged to cut the death rate from cancer in people under 75 by at least a fifth by 2010. We should be carrying out that sort of initiative, which is about priorities in the NHS that really make a difference. Opposition Members go on about dissatisfied doctors and nurses and rundown services, but that does not equate with the health service that I am helping to shape and with which I work. I genuinely see improvements in patient care and reductions in waiting lists.

Mrs. Virginia Bottomley

The reason for that is self-evident. The hon. Gentleman represents a Labour area, and there is a distortion in the allocation of funding.

Dr. Stoate

I would love to believe that that was true and, of course, I look forward to the time when I am re-elected to represent the area that I serve. However, the truth is that West Kent has largely been a Tory-controlled area for many years. Kent county council is Tory controlled and all the constituencies in my area were controlled by the Tories until the election. Since then, however, there has been a real improvement in service under the Labour Government. That is a fact, and patients are benefiting accordingly.

I wish the same improvements to be seen across the country, and look forward to a time when the Government can continue to improve the NHS year on year, making a health service different from the one that we had previously. I am not accusing Opposition Members of privatisation, but of lack of vision, foresight and initiative. I was hoping that today they would give a coherent, rational strategy for their view of the health service. However, they said that they wanted more and that that should come from the private sector. I believe that that is a redundant policy that will not achieve the results that they desire. It will certainly not be very popular in my constituency or throughout the country.

Mr. Deputy Speaker (Sir Alan Haselhurst)

Order. May I tell hon. Members that, in the short time that is left, if they take the full extent of the allocation to which they are entitled, there will barely be scope for two more speeches before the winding-up speeches? I therefore hope that we try to have short speeches in order to get as many Members in as possible.

5.54 pm
Mr. David Tredinnick (Bosworth)

I have heard what you said, Mr. Deputy Speaker.

Many Labour Members—in particular, the hon. Members for Wakefield (Mr. Hinchliffe), for Carlisle (Mr. Martlew) and for Brentford and Isleworth (Ann Keen)—have spoken of the evils of a two-tier system, but I suggest that a two-tier system now operates in the health service. The problem to which I shall refer has not been mentioned this afternoon, but it has got worse since the election of the Labour Government and the introduction of primary care groups. In fact, we are really talking about a three-tier system, because there is no such NHS cover in some parts of the country. I refer to complementary and alternative medicine, which includes homeopathy, herbal medicines, osteopathy, chiropractic medicine and healing.

I shall declare an interest: for the past 14 years, I have been an officer of the all-party group on alternative and complementary medicine, during which time I have seen a sea change in attitudes to complementary therapy. Many therapies, such as osteopathy and chiropractic medicine, have come in from the cold and become mainstream. In fact, £1.6 billion is spent annually on complementary medicine; 75 per cent. of the public want complementary medicine on the NHS, and 20 per cent. of people use complementary and alternative medicine now. Excluding those who channel energy—the healers—there are nearly 50,000 complementary and alternative practitioners in Britain.

One of those practitioners works in the House of Commons gym, offering Members acupressure treatments, using the thumb. Hon. Members on both sides of the House may be interested to hear the endorsement of "a satisfied MP", who wrote last year: It's the only thing I've found that really unwinds me. So there we are. That treatment is available in the House of Commons, but not in the nation as whole. I am glad to see the hon. Member for Rother Valley (Mr. Barron) nodding; I do not think that he has ever nodded in favour of any of my speeches in the past.

Mr. Barron

What the hon. Gentleman says about his previous speeches is quite right. Did he see the BMA report on acupuncture? Perhaps we could hold a debate in the House on why that is not available on the NHS. I have paid for acupuncture privately for several years, and it is an excellent way of making people better.

Mr. Tredinnick

I have seen that report, and the hon. Member is absolutely right. The problem is that complementary medicine is not available on the NHS, despite the fact that 75 per cent. of people want it to be.

The situation has deteriorated since the Government came to power. The previous Conservative Government introduced GP fundholding, and many doctors worked in small units of two or three and understood complementary therapies. They could start to offer complementary therapies as part of their NHS budget. That initiative was approved by my right hon. Friend the Member for Charnwood (Mr. Dorrell). Primary care groups have a larger management structure and many of the doctors have no interest in complementary medicine.

Representatives of Glastonbury health centre in the west country recently held a presentation in the House to explain how they use different therapies, such as herbal medicine, homeopathy, massage therapy and osteopathy, in an integrated service. They explained how that reduces health service costs. I hope that officials in the Treasury health team are listening. The problem is that, under the primary care group regime, their funding is being reduced and they are seriously thinking of having to shut down. I know from the letters that I receive that that is a serious problem right across the country, and the Minister must address it.

There is a welcome development: the Government initiative, together with the Foundation for Integrated Medicine, the NHS Alliance and the National Association of Primary Care, to produce a complementary medicine information pack for primary care groups. That has gone quite a way towards developing knowledge in those groups. However, the Minister has not resolved a fundamental problem: there are no guidelines. We need guidelines, and the Department must set some. People expect that of this Government. I encourage colleagues to sign my early-day motion, which has attracted the support of 50 hon. Members. They support the publication of that booklet, but it is important to have guidelines.

I draw the Minister's attention to the fact that complementary and alternative medicine has been effective in prisons. Recently, I have visited Coldingley and Hollesley Bay, both of which use meditation and Reiki techniques and other types of healing to reduce the problems with disturbed prisoners and young offenders. The Prison Service is offering a useful measure of what is possible, and many of the therapies of which it has made use should be extended into the health service.

Finally, I should like to draw the Minister's attention to a problem that arose last week: the decision of the Charity Commissioners to remove the charity status of the National Federation of Spiritual Healers and to deny the UK Reiki Federation's request for that status. Both decisions are fundamentally wrong. The NFSH has always had charity status and many people involved in the healing professions give their time for free. It is also wrong that the Charity Commissioners have no clear guidelines about alternative medicines, what they are and how they should be categorised.

I understand that the Government are responsible only for the funding of the Charity Commissioners, but I urge the Minister to write a letter—perhaps marked "Private and Confidential"—setting out the Government's objectives and pointing out to the commissioners that the therapies that they are "derating" were listed in the Government's own advice to primary care groups, published only last week. We must secure a common approach throughout the country. We need joined-up government: the Prison Service, the Department of Health and the Charity Commissioners should all be working to the same guidelines.

Complementary and alternative medicine has grown exponentially and it is here to stay. Let us have greater support for it. I look to the smiling Minister of State to do something about it.

6.1 pm

Mr. Jeremy Corbyn (Islington, North)

I have listened to your entreaties, Mr. Deputy Speaker, and I shall be as brief as possible.

The debate is welcome, because it gives us a chance to debate the fundamentals of the NHS. The speech of the hon. Member for Woodspring (Dr. Fox) makes it clear that the Conservatives now prefer the American model of bargain basement public provision, with everybody else paying for their treatment. In the long run, that would inevitably lead to a decline in the national health service and, therefore, a diminution in the opportunities for good quality health care for those who cannot afford to buy privately. It is essential that we continue to adhere to the principle of a national health service that is universally available and free at the point of use.

Not mentioned much during the debate are inequalities in illness and ill health. The outgoing 1974–79 Labour Government commissioned Sir Douglas Black to produce a report on inequalities in health care treatment and in health and life expectancy. It was suppressed by the incoming Conservative Government and later emerged as a Penguin book, which sold extremely well. It is to the credit of the current Government that they have taken an interest in and adopted many initiatives designed to tackle the problems of ill health in our poorer communities.

Like my right hon. Friend the Member for Islington, South and Finsbury (Mr. Smith), I represent an inner-city constituency. Our constituencies, compared with the rest of the country, have the dubious distinction of having higher infant mortality and shorter life expectancy, and a much greater incidence of mental illness and of notifiable diseases. In addition, to take up the remarks of the hon. Member for Broxbourne (Mrs. Roe), we have the highest incidence of suicide in the country. There are many reasons for those tragedies, including a combination of poor housing, unemployment, stress, living in complicated inner-city communities and social exclusion. I have always been fascinated by the reports of the medical officer of health for my district, because they reveal a direct link between ill health and poverty.

I was pleased when, in the second round of announcements of health action zones, the Government declared Camden and Islington to be a health action zone. That programme is under way, focusing on Early life … Social inclusion … Addiction. Objectives include: Improving and integrating services, to increase their effectiveness efficiency and responsiveness; and Developing the infrastructure to underpin the HAZ. I welcome all those objectives and applaud and admire the work being done by those working within the HAZ, but I ask my hon. Friend the Minister to think further down the line. The HAZ does not currently have much money to spend; is there any proposal to increase the funding available to HAZs, or is there a proposal in the long term to integrate the undoubted enthusiasm of many local agencies in support of HAZs into the health service itself?

We obviously welcome any improvement in the health service, but it is important that that links in with the enthusiasm of ordinary people who are participating in trying to reduce smoking and improve fitness, travel-to-work areas, safety and school safety especially. There are many issues that need to be considered.

I hope that the health action zones will continue for some time. I hope also that in the examination of community health and future structures and configurations, the Minister will think extremely carefully about the size of the areas proposed, and especially the size of those proposed for mental health trusts.

I and my colleagues with constituencies in Camden and Islington represent an area with serious and acute problems, very different from the problems faced in suburban London, outer London or the rural hinterland surrounding London. If we have good working relationships developing between community groups, the local authority, the health authority, hospitals and many voluntary organisations, it is essential that we do not break them apart.

I hope that the Minister will thoroughly consider these issues before approving any reorganisation that could end up being detrimental to the interests of people in the poorest parts of inner London. It could lead in some instances to a flow of resources out of inner London. I am sure that my hon. Friend understands my argument because he must be well aware of the issues that have arisen.

The Government's amendment rightly refers to the need to continue the hospital building programme and expand it. That is something that we all welcome. Anyone who represents an area that has inadequate hospital provision will be well aware of the problems. The incoming Labour Government inherited a backlog of maintenance alone of more than £2.5 billion. A great deal has to be done in terms of capital programmes within the NHS.

The use of private finance initiatives in the funding of the future expansion of the health service has a number of effects, and not all of them are particularly good. I hope that the Minister will take that remark in the spirit in which it is intended. A trilogy of articles has been put forward by the health policy and health services research unit of the school of public policy at University college, London. It includes a contribution by Professor Allyson Pollock and others. It outlines the way in which hospitals funded through a PFI have been planned on the basis of financial and not clinical needs. In many areas, PFI hospitals will need to generate income from private patients. As a result, some hospitals have increased the proportion of private beds to pay the costs of PFI.

I ask the Minister to take seriously the concerns that many people have expressed about PFI and the long-term costs. I have an inadequate hospital in my constituency, as do many other Members. It needs rebuilding, expanding and new units, and all that goes with that. However, PFI can be regarded as a form of candyfloss. A shiny new building is provided quickly with PFI, but the long-term costs are extremely great.

The experience of PFI in many parts of the country has been that long-term costs for the local hospital and for the NHS itself have been considerable. For example, the fees charged on construction costs are much higher under PFI than they would be if the hospital were funded and built directly by public finance through the Department of Health, as I believe it should be. Also, when PFI hospitals are constructed, they tend to be somewhat smaller than existing hospitals. Research has borne out the fact that there tends to be a reduction in the number of beds in total because of the use of PFI.

The British Medical Journal states that the programme of hospital expansion is associated with reductions in acute bed provision of about 30% and cuts in operating and staff numbers of up to 25%. In the 11 first-wave schemes financed through the initiative over 2,500 beds will be lost over the next five years. I welcome more money for the NHS and recognition of the needs of the poorest people in inner-urban areas. I look forward to a continuing increase in levels of expenditure and welcome any examination of the causes of poverty. I represent an area in which about half the population live in council or housing association property. Many households are grossly overcrowded and children miss school as they pick up illnesses from their brothers and sisters because they have to share a bedroom. We need to improve the health, housing and education of inner-city communities, and to cut air pollution.

I am glad that we have a sense of joined-up thinking, but it worries me that the use of the PFI in the Government's expansion programme will cost more in the long run. It is cheaper for central Government to borrow money for hospital building than to use the PFI—which gives rise to a democratic deficit as some control is lost over the building, running and management of hospitals. Many of us are deeply concerned and will continue pursuing that argument.

6.11 pm
Mrs. Virginia Bottomley (South-West Surrey)

I apologise profusely to the House for not being present for the opening speeches. I was attending a key governors meeting for the London Institute. The noble Lord Puttnam and I were equally late back for our parliamentary engagements. I shall read the Minister's comments with care.

As a former Secretary of State for Health, I find it extraordinarily exasperating to hear so many of the programmes that were lovingly delivered traduced in a parliamentary debate—but that is inevitable. I know that in the constituency of the hon. Member for Islington, North (Mr. Corbyn), giving GPs deprivation payments and extra payments for child immunisation and cancer screening, among many other measures, were part of a real effort to improve primary care in inner cities. It is difficult to tolerate the hon. Member for Rother Valley (Mr. Barron)—with whom I agree on many points concerning the General Medical Council—when he says that no new hospitals were built under the last Administration, although the Prime Minister was at Chelsea and Westminster hospital for the birth of his son, and that hospital was built during the time of the last Conservative Government.

The Economist Intelligence Unit's magnificent documents about health care, the King's Fund history of the NHS and Chris Ham's account of the past 10 years of change in the NHS show that the previous Government introduced many ways of making health care more efficient, effective and patient focused. The last Administration's patients charter, "The Health of the Nation" and mental health strategy—with almost the same targets as now—were first vilified but were then rebranded and incorporated into the present's Government's strategy.

The 1948 NHS model had a great many advantages and held its own on health outcomes; changes during the years of Conservative government brought a boost of efficiency gains—but that model is not good enough today. The UK is falling in all the international league tables. It is crazy for Labour, with its huge majority, to cling to reactionary policies that disappoint many people in the NHS. The worse the situation gets, the louder the Government's rhetoric.

My right hon. and hon. Friends are seeking to help the Government to be more constructive, responsible and realistic. In every debate on the NHS, Labour Members claim that the service has never before been so wonderful. My colleagues are telling the Government, who listen to no one, that the situation is not good enough.

I speak with great emotion about my constituency, because I have one in nine people now waiting more than a year for treatment. The number trebled after the election. In the Prime Minister's constituency, the figure is only one in 50. I understand why he might think that everything is all right, Jack, but it is not all right in my part of the world. One in nine people are waiting more than a year, even after all the Government's efforts to increase the waiting list to be on the waiting list, and the rise in the out-patient waiting list.

Week after week I deal with cases that are unacceptable. Many hon. Members despise the private sector, but I defy them not to ask people, as I have never previously done, whether they have private cover. I cannot tell them that I can do anything for them, because the situation is so bad. There is a crisis in the acute hospitals. What is the health authority doing?

I am delighted that the Minister of State, Department of Health, the hon. Member for Southampton, Itchen (Mr. Denham), is winding up. I ask him to help me again, as he did before. Two years ago, in a debate, I told him that after months—indeed, years—of discussion and decision about Farnham hospital, a plan had been agreed for 42 beds for a day hospital and for stroke rehabilitation. That had been agreed by both trusts—it is a complex area on the fringe of two health authorities.

The plan was presented to local people as a good way through. I had worked hard to lower expectations to the minimum. Since then, according to Government rhetoric, there are too few beds, there should be intermediate beds, there is masses more money, and people have never been so lucky in their lives.

The health authority has now come up with proposals under which there would be no beds in Farnham and no beds in Haslemere, which is the town in Surrey with the highest elderly population. The health authority proposal comes at a time when there have never been more examples of inadequate care. In three cases at least—I say this particularly to the hon. Member for Dartford (Dr. Stoate), with whom I often discuss such matters—if the people involved had been treated in the private sector, I would have advised the family to sue, because in all three cases, the people lost their lives.

Under the new proposals, £900,000 is to be taken out of the mental health budget in the Waverley area, and—surprise, surprise—£100,000 is to come out of the community nursing budget. The reason behind all that is that it is a costly area. There are 300 nurse vacancies because nurses do not get London weighting.

The changes introduced by the Government have meant more top-slicing. There are ministerial back-pockets for health action zones, accident and emergency departments and all sorts of other modernisation projects, but such projects do not come to areas like mine because the basic population is healthy. It may be healthy, but it is enormously needy and demand is high. It is wrong for a poor person in my area to have a worse service than a poor person in the constituency of the hon. Member for Islington, North.

Why should one in nine people in my area wait more than a year, when only one in 50 has to wait more than a year in the Prime Minister's constituency? In his area, for every man, woman and child, £115 more is spent on health care every year. I support programmes for additional health visitors and midwives, and prevention programmes, but the gap has become too great. Not only have the Government top-sliced more, but they have squeezed the formula to make it even harder for people in wealthy areas, and they have raided the social services budget and taken away the specific grant.

The cost of care is massive in an area such as Surrey. There are few volunteers because there is high employment. Public transport is poor because there is such high car ownership.

Mr. Denham

Does the right hon. Lady at least accept that this year her health authority has had an increase in funding of more than £30 million—a real increase of 5.7 per cent.—plus additional special funding? Will she tell me how long ago it was, under her Government, that her health authority received a real increase of 5.7 per cent?

Mrs. Bottomley

The Government have penalised Surrey when allocating resources. Durham has done much better. The position is deteriorating. It would help if the Government said that they were providing an increasingly unacceptable health service, and asked people—as my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond)—suggested, to use private health care if they could. If the Government were frank, open and responsible, they would do that.

It is distressing for my constituents, my doctors, my nurses and my managers that the problem is worse than it has ever been. There has been a threefold increase in one-year waiters. That category affords one of the greatest tests for the health service. I have often been challenged by Labour Members about that. When I became a Health Minister, there were 200,000 one-year waiters; when I left the Department of Health, there were 4,000. I wish that none had been left. Waiting more than a year for treatment is the ultimate sign of an unacceptable service. I ask the Minister to step in and tell the people of West Surrey that the problem is out of hand. One in nine people wait more than a year for treatment in my area, whereas one in 50 wait more than a year for treatment in the Prime Minister's constituency. That is not equity.

I have made the local points, and I wish briefly to make a few general points about the motion and the Government's stewardship of the health service. An important development, which has been commended by almost every independent commentator, was the attempt by Ministers in the previous Government to distance the political process from the management of the service. The establishment of NHS headquarters in Leeds was a means of saying that, while the NHS could not be a separate agency, the chief executive should have the stature, dignity and independence to exercise authority in his own right, and not be at Ministers' beck and call.

It is widely understood that not only is NHS management too much under the political control of Ministers but, worse than that, No. 10 has undertaken a role that is out of all proportion to the role it has played in living memory. To anyone who saw the Prime Minister's performance on "Newsnight", the idea that the Prime Minister should chair a health committee is nonsense. I do not blame him for not being an expert on health care, but doctors, nurses and managers know that it is not a subject with which the Prime Minister is remotely comfortable.

Politicising the process, producing extra money and saying that it must be used in a programme about "partnership", "professions", "performance", "prevention", "patient access" and "patient empowerment" is trivial and insulting to serious people in the health service.

We now face a serious problem. It is proposed that the roles of the permanent secretary at the Department and the chief executive of the health service should be combined. I hope that the Select Committee on Public Administration will examine the matter and that Sir Richard Wilson will reconsider it. The role of the permanent secretary is to maintain the independence of the civil service, ensure propriety, and handle all Whitehall activities and overseas elements such as European Union and Council of Ministers affairs. A permanent secretary at the Department of Health therefore has a huge agenda.

I hope that my Front-Bench colleagues will be taking over as Ministers in future and I speak from that point of view. The permanent secretary maintains the independence and integrity of the civil service. That role is unlike that of the chief executive, who needs to be a hands-on person and a team builder. The chief executive must fulfil targets, set objectives, travel around the country, be seen in the hospitals and talk to the health authorities.

I am pleased that the Secretary of State is here. I want to give a small example that means a lot to somebody who has held his office.

My hon. Friend the Member for Worthing, West (Mr. Bottomley) telephoned the Secretary of State's office to ask whether Members of Parliament would be part of the consultation on "whither the NHS?"—with a costly £500,000, according to the King's Fund, going into an exercise in which the envelopes arrive too late to be returned by the due date. The person in the right hon. Gentleman's office knew nothing about the consultation exercise. My hon. Friend replied, "It has been in all the papers. Perhaps you could investigate it." He was then told that the special adviser was responsible for that.

Anyone who has been in government appreciates why Conservative Members are so sensitive about the degree to which the Government are not sufficiently respectful of the distinction between the political process and the independent process which has been safeguarded by having a permanent secretary.

As the Secretary of State is now in his place, let me stress that an equitable service does not have one in nine people waiting for more than a year in Surrey and only one in 50 people waiting for more than a year in Durham. Will he please reduce the rhetoric, improve the reality and engage in debate which achieves solutions that can be delivered? Will he please consider NHS managers, whom the Prime Minister would cross the road to insult for two years before the election and for one year afterwards? We now understand that the Prime Minister has read an article by the British Association of Medical Managers and now thinks that managers might be a good idea.

Combining the roles of the chief executive and the permanent secretary will make it very hard for anyone in the health service to believe that the independence, stature and dignity that Sir Alan Langlands has had will be reflected in his successor. This is my last opportunity to pay tribute to Sir Alan Langlands, who has been a remarkably distinguished, able, talented and honourable chief executive of the most important and complex, and the largest, organisation in this country.

6.26 pm
Liz Blackman (Erewash)

I shall be as brief as possible. I am not philosophically opposed to private health care. We live in a free and democratic society and people have a right to make that choice. However, I am opposed to the Opposition making private health care central to their desire to expand health provision through what the hon. Member for Woodspring (Dr. Fox) described as less expensive, non-serious, low-tech operations which he defined as hip replacements, knee replacements, cataract operations and hernia operations. I am also against his proposal to use taxpayers' money to provide tax breaks to encourage that. Their policy is economically illiterate and grossly unfair.

Between 1990, when the Conservative Government introduced a relief for the over-60s, and 1997, when the Labour Government abolished it, the number of people with private health care insurance fell. It was a deadweight relief aimed at altering behaviour and it did not work. As my hon. Friend the Member for Dartford (Dr. Stoate) pointed out, even Lady Thatcher and Lord Lawson have now reached that conclusion. In her post-Government reflective period, Lady Thatcher has realised that that logic is flawed. To introduce a relief funded by taxpayers for people who have already chosen private health care insurance is wasteful and will not alter behaviour, as has proved to be the case. It would cost £350 million to provide relief on existing employer health insurance before one extra person gained relief, and the total cost could be as much as £1 billion.

The Opposition have promised to maintain the investment that the Government have put into NHS services, but they have not said where the extra money would come from. They need to come clean on that. Pensioners are clearly the target audience for the Opposition's proposal as they represent a significant proportion of the population who are least able to afford health insurance premiums, as many of them are on fixed disposable incomes. They have paid taxes all their lives and they have paid for a national health service, and it is they who will need hip replacements, knee replacements, cataract operations and hernia operations. Such operations are essential and they deal with conditions that cause sufferers misery and distress.

The thrust of Tory policy would force them to do one of three things: to pay up, to take out insurance or to wait longer. It is worth reminding the House that a hip operation costs between £5,000 and £7,000, a knee operation costs a similar amount, a hernia operation costs between £1,000 and £1,500 and a cataract operation costs between £1,800 and £2,400. We should also remember that premiums for a pensioner couple are between £3,500 and £4,500. In the past 10 years, those premiums have risen on average by 10 per cent., and they are rising on average by 3.5 per cent. a year. Some insurance companies' premiums are rising by between 30 per cent. and 50 per cent.

It is also important to read the small print on insurance policies, because they have many exemptions. People are caught out because they believe that they are entitled to a level of health care that they are disappointed not to receive.

Finally, I wish to draw the House's attention to an evolving scam called dual pricing, which operates in health care insurance. A hospital will quote one price for someone who does not have medical insurance and another—up to 50 per cent. more—for someone who does. Some insurance companies suggest that their customers get round the disparity by initially paying for their own operations. Julian Stainton, the chief executive of the Western Provident Association, has said: We'll reimburse them within 24 hours and also split the difference with them of the higher insurance price we'd expect to be charged. But it's ridiculous that this system occurs. There's no doubt in my mind that many charges rendered for private medicine are excessive. That quotation comes from Good Housekeeping. If private hospitals can afford to do the same operation at half the price, they are ripping off the health care insurers and, more importantly, the patients themselves through the premiums they pay. If tax relief were to be given, it would simply bump up the premiums. I urge the Government to look carefully at that practice, because further regulation would appear to be required.

6.32 pm
Mr. Philip Hammond (Runnymede and Weybridge)

We have had many contributions from Back Benchers and I shall pick up some of the key points. I hope that hon. Members will forgive me if I do not mention every contribution, but I need some time to respond to the Secretary of State's misinformation campaign in his speech.

The hon. Member for North Devon (Mr. Harvey) seemed to be parroting the Government line, and claimed that the Conservatives see the NHS as a residual service only. He ignored totally the explicit commitment we made on funding—to match the comprehensive spending review figures that the Government have produced. I can state categorically to the hon. Gentleman that the NHS will be at the heart of the system that we intend to put in place.

My right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) usefully drew the House's attention to the Government's attack on doctors. When the right hon. Member for Holborn and St. Pancras (Mr. Dobson) was Secretary of State, managers were responsible for all the problems in the health service. Now it is the doctors who are responsible. Perhaps the next Secretary of State will tell us that it is the patients who are responsible for all the problems in the health service. My right hon. Friend is passionately committed to the NHS and to the need for choice as well as access in the health service. He drew attention to the fact that my hon. Friend the Member for Woodspring (Dr. Fox) devoted the lion's share of his speech in Glasgow, which has been mentioned in the debate, to how we would improve the NHS. It is the Secretary of State who focused this debate on private health insurance.

The hon. Member for Wakefield (Mr. Hinchliffe) has the great benefit of consistency in his views and I know that his beliefs are genuinely held. He would like to ban independent health insurance and all forms of independent health care. However, I would be grateful if the Minister would reaffirm, when he winds up, that it is not the Government's plan to ban private health insurance or private treatment in the NHS. After all, as Lord Winston helpfully pointed out yesterday, it makes a significant contribution to the NHS. I agree with the hon. Member for Wakefield on one point: if there is any expansion of health care, whether public or private, it must be accompanied by an expansion of the real resources—the people who deliver the care, as well as the money. The two must go hand in hand if we are to achieve the effect that we desire.

My hon. Friend the hon. Member for Wycombe (Sir R. Whitney) gave us some telling and chilling statistics on where Britain stands in the world league of health outcomes. He said that no Government of either party would be ready to impose the tax burden necessary if, using taxation alone, we were to catch up with the amount spent on health in Germany. That example raises a pertinent question: should we therefore accept second best for the British people, or should we look for ways to supplement our national health service spending, while continuing to raise that tax-financed spending as economic conditions allow?

My hon. Friend the Member for West Chelmsford (Mr. Burns) spoke passionately about his commitment to the NHS, and in doing so he spoke for the Conservative party. He nailed the lie that the Conservative party wants to privatise or abolish the NHS. He referred to the Labour allegation that we would charge for visits to general practitioners—a possibility that we have explicitly ruled out.

My hon. Friend the Member for West Chelmsford also made the important point that the lie that we would privatise the NHS is not new. The Labour party has said that for years. They said it before the general election in 1987, but the Conservative Government then elected went on to spend more than ever before on the NHS. They said it again before the 1992 election, and the Conservative Government that followed that spent even more than their predecessor.

The Labour party's cheap slur cuts no ice with anyone. If the Secretary of State thinks otherwise, he should look at the comments in the press.

The hon. Member for South Swindon (Ms Drown) said that whistleblowers in the national health service were guaranteed a fair hearing and protection. I think that she lives on a different planet from the one that we inhabit. There is a climate of fear and a palpable atmosphere of oppression in the NHS. Earlier this week, an official of the NHS Confederation told me: I've got to confess to you. In 1996, we really thought that things couldn't get any worse, but we found out we were wrong. The hon. Member for South Swindon also mentioned the National Institute for Clinical Excellence. Its decision about beta interferon has exposed it for what we always said that it would be—a mechanism for levelling down, not levelling up.

In addition, the hon. Lady missed the point about Conservative policy. We are quite prepared to support an institute that looks at clinical effectiveness and cost effectiveness, but affordability must be an issue for politicians, based on the overall resourcing of the service.

The hon. Member for Dartford (Dr. Stoate) gave the lie to the Secretary of State's position. He knows my colleagues and me better than the Secretary of State does. He knows that the privatisation lie is just that—a lie. My right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) reinforced the point that the NHS depends on a consensus, which itself depends on the fact that the great majority of people in all parts of the country have confidence in the service.

However, the tone of the debate was set by the speech of my hon. Friend the Member for Woodspring (Dr. Fox), and the response from the Secretary of State. My hon. Friend set out a catalogue of the distortions that the Government have imposed on the NHS. He talked about the waiting list initiative, and spoke of spin and information management. He mentioned the threat to tertiary referral centres of excellence through the abolition of extra-contractual referrals. He described the systematic denial of choice, the bullying and the culture of fear that pervades the service, in which clinical needs are subordinated to political ones. He also recorded this country's dismal relative position in international league tables.

My hon. Friend the Member for Woodspring continued on a more positive note, however. He told the House about the speech that he made yesterday, in which he set out a vision for health care delivery in the 21st century. He mapped out his objective of a patient-focused system appropriate to a modern consumer society. That system would draw inspiration not only from the traditional NHS values of comprehensive service and universality of access, but from the examples of our European neighbours.

The system outlined by my hon. Friend the Member for Woodspring would be a mixed economy of health care, with the national health service at its heart, offering choice as well as access. We will have a national health service that is stripped of ideological baggage, puts the patient first and is determined to get the best health-care value for every pound that the taxpayer entrusts to it. Purchasing in the independent sector for the benefit of NHS patients, where that is the best-value decision, is a rubicon that the Secretary of State himself—at least in word, if not yet in deed—has crossed. We are delighted to endorse that step in the right direction.

We will have an NHS that acknowledges the finite nature of the resources available to it and the limits on its ability to deliver every want, instead of sticking its head in the sand. We will have an NHS that recognises that, in international comparisons, we do poorly; a service that prioritises according to clinical needs, not political ones. We will put the sickest first. Those with the most serious life-threatening conditions will be put at the top of the list and we will recognise that their needs must have the first call on the NHS's resources. That is common sense.

We are offering a guarantee—the patients guarantee—that, for the most important conditions—those which, in Bevan's words cast a shadow of fear over millions of homes the NHS will respond with the necessary treatment, using the best techniques and drugs available in a time frame that is clinically appropriate for the patient. That will allow the people of this country to be confident that, in cases of real need, they can be sure that the NHS will be there for them and their families.

The Secretary of State would have the world believe that priority for the most serious conditions means non-availability for others. That is just plain wrong. My hon. Friend the Member for Woodspring and my right hon. Friend the Leader of the Opposition have both made it clear that we have a commitment to a comprehensive national health service, free at the point of use. We have a commitment also to matching the Government's announced spending plans. There will be the same pot of money, the same total purchasing power for the national health service.

The question we are addressing is how we prioritise that spending. The Secretary of State's answer has been: according to his political agenda. He has played the numbers game, treating the hernias before the heart diseases because they are cheaper, easier and boost the throughput. Our answer is to allow doctors and NHS managers to prioritise according to clinical need and without political interference; without the dead hand of Richmond house on every decision and without the Secretary of State looking over their shoulders. That means treating the sickest first—those whose lives, livelihoods or life styles are threatened by disease—and asking those with minor conditions to wait, just as we do now. Indeed, we do that for some not-so-minor conditions.

Perhaps my hon. Friend the Member for Woodspring's most important point is the strategic one; the role of the Secretary of State. What happens now is truly incredible. From Richmond house, the Secretary of State seeks to run centrally the largest organisation in Europe, with a command-and-control structure that would not have looked out of place in the old Soviet Union. His NHS is subject to no independent or external inspection or checks to ensure quality and compliance with minimum standards. Instead, we have to rely on the organisation to police itself, and we all know what the result of that has been. We would redefine the role of the Secretary of State.

What was the Secretary of State's response? It was rather churlish, given our acknowledgment of the strides that the right hon. Gentleman has taken in our direction, in recognising at last the need for a partnership with private sector providers to deliver NHS objectives. He has come a long way since 1998 when, as Minister of State, he reportedly threatened NHS trust chairmen that he would come down like a ton of bricks on anyone who co-operated with the private sector. The Secretary of State does not want to draw attention to that recent development in his policy because not all of his hon. Friends are entirely on side with it. Instead, he decided to make the cheap points, working on the principle of "the bigger the lie". He repeated the tedious and offensive lie that the Tory party wants to privatise the NHS. Who in the Tory party? Not me; not my hon. Friend the Member for Woodspring; not my right hon. Friend the Leader of the Opposition; not any of the Conservative Members who have spoken in the Chamber tonight.

The Secretary of State used his old familiar quotes, out of context as usual. However, if he looks at the press, he will see that, by and large, his campaign is not succeeding. The press and the people of this country want to talk about the real issues and about the future of the NHS. They recognise the reality of the mixed economy in which we live and operate, and they want to see a positive view of the future of the national health service.

The greatest threat facing the national health service today is the threat to the consensus that supports it. Many hard-working, relatively affluent taxpayers up and down the country are no longer confident that the national health service can provide for them and their families. The Labour party is forcing them into taking up private insurance or being self-payers—they are afraid that the NHS will not be able to help them quickly and effectively because of the distortions of priorities within it.

I will give an example from my constituency. A patient goes to the local hospital; he is told that he may have cancer and that he needs a diagnostic procedure. They cannot tell him when that will be—it could be at least two months, because the bit of kit that they need to do it is broken. So he spends his savings—£700—to find out that he does not have cancer.

Such situations are being repeated up and down the country, day after day. They damage the consensus that underlies the national health service. Our vision is of a national health service in which everyone can feel confident of prompt, first-class treatment for the most serious conditions. That is a cohesive principle, not a divisive one.

What we have heard from the Secretary of State today is a smokescreen of misrepresentations, designed to distract attention from the changes that he is making—some of which do not enjoy support from his hon. Friends—and the embarrassing fact that the majority of the British people believe that the national health service has got worse, not better, since 1 May 1997. The Secretary of State will know that, because his private polling will tell him.

The Government are obviously not prepared to fight this battle on the basis of a defence of their own record. Instead, the Secretary of State wants to fabricate a policy that he attributes to us and then shoots down. So let me spell it out unambiguously: we are committed to a comprehensive national health service, free at the point of need. We are committed to matching the comprehensive spending review funding plans for the NHS which the Government have announced. We are committed to a system that has the national health service at its heart, but that commitment alone is not enough. We need to prioritise the way in which the NHS works on the basis of clinical priorities. We will guarantee access times, through our patients' guarantee, on the basis of clinical need. In that way, we will restore the confidence of the great majority of the British people in the way our health service works, after the cynical manipulations of this Government.

Mrs. Laing

On a point of order, Mr. Deputy Speaker. I wonder whether you have had notice that the Secretary of State wishes to correct an error that he made earlier this afternoon, undoubtedly inadvertently, as I am sure that he would not wish to mislead the House deliberately.

Mr. Deputy Speaker

Order. I do not think that the hon. Lady is doing the House a service. She will know that this is a matter for debate and not a matter of order for the Chair.

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

I apologise, in view of the time, that I, too, will not be able to refer to all the speeches made in the debate, including the many excellent speeches made by my right hon. and hon. Friends.

Unlike my hon. Friend the Member for Brentford and Isleworth (Ann Keen), I have no clinical training. Although I am quite sure that she is clinically able to diagnose a state of amnesia among Conservative Members, my observation that they are in a state of denial must be purely a layman's point of view.

Let us take, for example, the hon. Member for Wycombe (Sir R. Whitney). If I had been a junior Health Minister in 1985 and I came here in the year 2000 and said that we do not have enough doctors in the United Kingdom, I might have made some connection between that and the decisions that I took in 1985. For the record, I say here and now that, should I still be a Member of this House in the year 2015, and should I wander into the Chamber and make a speech saying that there are not enough doctors in England, I hope that someone will feel free to point out that I, along with my right hon. Friend the Secretary of State and our ministerial colleagues, were taking the decisions about how many doctors to train.

Sir Raymond Whitney

The Minister may recall that in my speech I predicted that what I said would be wilfully and grossly misrepresented. He has proved the accuracy of that prediction.

Mr. Denham

If the hon. Gentleman checks the record, he will find that he referred to the number of doctors in this country.

The right hon. Member for Hitchin and Harpenden (Mr. Lilley) spoke about the wonders of the reforms of the previous Government although, to be fair, he accepted that there had been some mistakes. However, the idea that the system of extra-contractual referrals allowed all patients to see whichever doctor they wanted is simply not true. For 15,000 GPs, if they wanted to refer to anyone outside their area they had to go through a set of bureaucrats in the health authority—bureaucrats imposed on those patients by the Conservative party. By getting rid of extra-contractual referrals we have restored to GPs the freedom to refer. Doctors collectively decide where their patients are treated and the health authority no longer has the veto power. That is a significant and important change.

Although I cannot develop the argument about neurological services today, those issues are important. However, a closer look will show that they are fundamentally to do not with the system of extra-contractual referrals, but with uncertainty about the clinical and cost-effectiveness of some of those treatments. It is an important issue and a number of hon. Members raised it. We need to resolve it as quickly as possible and I am determined that we should do so.

Finally, in a debate about responsibility, the right hon. Member for South-West Surrey (Mrs. Bottomley), knows as well as I do that while there has been a record of increases in funding for her health authority, her area has a major problem—the debts of £18 million that were run up under the stewardship of the previous Government. That problem has to be resolved, but there comes a point when those who were in government a few years ago have to take responsibility for the things that happened then.

I do not think that anyone here would describe Dr. Ian Bogle, the president of the British Medical Association, as a poodle of the Government. He has criticised Ministers and the Prime Minister. This week, however, when opening the BMA conference across the road from here he said: Following the Budget announcement in March, the Prime Minister offered to include us in the policy-making process … He continued by saying that there had been a fundamental shift in government thinking that has given us the opportunity to help shape policy and have a say in how the significant extra investment in the NHS pledged in the Budget will be spent. Tony Blair has challenged us to deliver change in return for extra investment. We are more than willing to meet that challenge. Mr. Blair, your plan is eagerly awaited by every doctor in this conference hall and every doctor on the NHS frontline. The picture that hon. Members have tried to portray of an entirely alienated national health service—an alienated profession—is simply not true. People are working astonishingly hard and giving an enormous amount to the NHS, I recognise that, and they are stressed and tired through doing so. However, it is not merely the BMA that is involved in drawing up the national plan; it is the royal colleges, the trades unions, the professional organisations of other staff, NHS management, patients organisations and thousands of NHS staff at local, regional and national level, as well as patients and users of the NHS.

Whether or not those people support the Government as voters, they all believe that this Government are right on two key issues. The NHS needs more money, and they know and believe that this Government are doing what the Conservative party never did, never wanted to do, never dreamed of or believed was right, which is to deliver more money to the NHS at unprecedented levels. Those people also agree with us that money alone is not enough. We have to change the way the NHS operates, the way we organise our services around the needs of patients, the way we train and use our staff, and the way we manage the NHS.

A huge national debate is taking place on the future of the NHS and all that debate is shaping the national plan, which we are drawing up. What gets up the nose of the Conservative party is that it has chosen to be outside that debate—because of its past record, its opportunistic attacks and its obsession with private medical insurance, and because Conservatives are more interested in drumming up business for Abbey National than in facing up to the challenges of delivering a better national health service.

Not everyone who is taking part in that debate supports the Government. The hon. Member for North Devon (Mr. Harvey), who made an excellent speech, is not a supporter of the Government, but he made it clear that he wants to be part of the national debate and his views should be listened to. We have listened to patients, we are listening to staff. Many Opposition Members have attacked us for waste in doing so. They say that listening to patients' views is not a good idea. If they want to talk about waste, let us talk about waste. One of our first actions when we came to power was to abolish the internal market—the bureaucratic, inefficient, unfair, internal market. By doing so, we will save £1 billion; £1,000 million will be saved over the lifetime of the full Parliament and spent on patients because we abolished the ideological, wrong-headed waste created by the previous Government. So let us not have any debates about waste and inefficiency in the NHS.

The hon. Member for Woodspring (Dr. Fox) is a pleasant gentleman. I understand that by repute he has an excellent bedside manner. He is, of course, a doctor. But when I look at him he strikes me not so much as a 21st century doctor as a 19th century quack, touring country fairs on the back of a wagon and looking for gullible people.

Mr. Owen Paterson (North Shropshire)

Will the Minister give way?

Mr. Denham

No, I will not give way to somebody who has just wandered in off the street.

I say that the Opposition spokesman is like a 19th century quack, because whatever symptoms and problems the NHS patient faces, the prescription is always the same: a strong dose of Doctor Fox's patent private medical insurance. [Laughter.] A bad knee? Better buy some insurance. Bad hips? Better buy some insurance. Trouble with the eyes? Better buy some more insurance.

This evening the hon. Member for Runnymede and Weybridge (Mr. Hammond) tried to put all this behind the Tories and say that what he had said on Sky television or what the hon. Member for Woodspring had said in The Sunday Times was all in the past. I have sat here, as have several of my colleagues, and listened to speech after speech from Opposition Members, every one of whom has said that the only answer to the problem is more private medical insurance. It is no use the hon. Gentleman saying that that is not their strategy. Clearly, back in January he convinced all his colleagues that it was, and they are continuing to say that it is. I believe them rather more than I give credence to the hon. Member for Runnymede and Weybridge.

One of the flaws in what we have heard this evening is the Tories' claim that they will match our spending plans. The final judgment about whether they are telling us the truth should rest with the voters, who are a good deal less stupid than the Opposition hope. Before the Budget, when my right hon. Friend the Chancellor of the Exchequer announced record increases in NHS spending, not once had there been a single indication that any Tory Member thought that an increase in spending at the level that we are proposing was either possible or desirable.

In the middle of the winter flu epidemic, did we hear calls for more money? In our debate in early January, did hon. Gentlemen call for money for the NHS? No, they called for more private medical insurance. What did we hear on the eve of the Budget from the shadow Chancellor on "The Money Programme"? Did he say, "If I were the Chancellor, I would put a bucketload of money in the NHS"? Did he say, "The NHS needs more money. That must be the Chancellor's top priority"? Did he say, "Give them the money, Gordon"? No, he said: He—the Chancellor—can either reduce taxes or he can increase public spending. What I would recommend is that he use the money to reduce taxes. Not once, not ever, did the Tory party call for the sort of increases in spending which we will deliver.

The Tories have made a claim born, as always, of opportunism and expediency. Voters will know that that type of promise has less value than commitments that are made from conviction and determination. It is worse than that, because the promise has a gaping hole in it: this afternoon, £500 million for private medical insurance, and a year-on-year tax guarantee that means cuts in health expenditure to pay for tax breaks for the rich—

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 122, Noes 278.

Division No. 243] [6.59 pm
Ainsworth, Peter (E Surrey) Bruce, Ian (S Dorset)
Amess, David Burns, Simon
Arbuthnot, Rt Hon James Cash, William
Baldry, Tony Chope, Christopher
Bercow, John Clappison, James
Beresford, Sir Paul Clark, Dr Michael (Rayleigh)
Blunt, Crispin Clifton-Brown, Geoffrey
Body, Sir Richard Collins, Tim
Boswell, Tim Cormack, Sir Patrick
Bottomley, Peter (Worthing W) Cran, James
Bottomley, Rt Hon Mrs Virginia Curry, Rt Hon David
Brady, Graham Davis, Rt Hon David (Haltemprice)
Brazier, Julian Day, Stephen
Brooke, Rt Hon Peter Dorrell, Rt Hon Stephen
Browning, Mrs Angela Duncan Smith, Iain
Evans, Nigel Maples, John
Faber, David Mawhinney, Rt Hon Sir Brian
Fabricant, Michael May, Mrs Theresa
Fallon, Michael Moss, Malcolm
Flight, Howard Nicholls, Patrick
Forth, Rt Hon Eric O'Brien, Stephen (Eddisbury)
Fox, Dr Liam Ottaway, Richard
Fraser, Christopher Page, Richard
Gale, Roger Pace, James
Garnier, Edward Paterson, Owen
Gibb, Nick Pickles, Eric
Gill, Christopher Prior, David
Gorman, Mrs Teresa Randall, John
Gray, James Redwood, Rt Hon John
Green, Damian Robathan, Andrew
Grieve, Dominic Robertson, Laurence
Hamilton, Rt Hon Sir Archie Roe, Mrs Marion (Broxbourne)
Hammond, Philip Rowe, Andrew (Faversham)
Hawkins, Nick Ruffley, David
Hayes, John St Aubyn, Nick
Heald, Oliver Shepherd Richard
Heathcoat-Amory, Rt Hon David Soames, Nicholas
Hogg, Rt Hon Douglas Spelman, Mrs Caroline
Horam, John Spicer, Sir Michael
Howard, Rt Hon Michael Spring, Richard
Howarth Gerald (Aldershot) Stanley, Rt Hon Sir John
Steen, Anthony
Hunter, Andrew Swayne, Desmond
Jenkin, Bernard Syms, Robert
Johnson Smith Rt Hon Sir Geoffrey Tapsell, Sir Peter
Taylor, Ian (Esher & Walton)
Key, Robert Taylor John M (Solihull)
King, Rt Hon Tom (Bridgwater) Taylor Sir Teddy
Kirkbride, Miss Julie Tredinnick, David
Laing, Mrs Eleanor Trend, Michael
Lait, Mrs Jacqui Tyrie, Andrew
Leigh, Edward Viggers, Peter
Letwin, Oliver Walter, Robert
Lewis, Dr Julian (New Forest E) Waterson, Nigel
Lidington, David Wells, Bowen
Lilley, Rt Hon Peter Whitney, Sir Raymond
Lloyd, Rt Hon Sir Peter (Fareham) Whittingdale, John
Loughton, Tim Willetts, David
Luff, Peter Winterton, Mrs Ann (Congleton)
MacGregor, Rt Hon John Yeo, Tim
McIntosh, Miss Anne
MacKay, Rt Hon Andrew Tellers for the Ayes:
Maclean, Rt Hon David Mr. Peter Atkinson and
Malins, Humfrey Mr. Keith Simpson.
Abbott, Ms Diane Brown, Rt Hon Nick (Newcastle E)
Adams, Mrs Irene (Paisley N) Buck, Ms Karen
Ainsworth, Robert (Cov"try NE) Burden, Richard
Alexander, Douglas Burgon, Colin
Anderson, Donald (Swansea E) Butler, Mrs Christine
Ashton, Joe Byers, Rt Hon Stephen
Atkins, Charlotte Cable, Dr Vincent
Austin, John Caborn, Rt Hon Richard
Barron, Kevin Campbell, Rt Hon Menzies (NE Fife)
Beckett, Rt Hon Mrs Margaret
Begg, Miss Anne Campbell, Ronnie (Blyth V)
Benn, Hilary (Leeds C) Casale, Roger
Benn, Rt Hon Tony (Chesterfield) Caton, Martin
Bennett, Andrew F Cawsey, Ian
Benton, Joe Chaytor, David
Bermingham, Gerald Chidgey, David
Best, Harold Clapham, Michael
Blackman, Liz Clark, Rt Hon Dr David (S Shields)
Blears, Ms Hazel Clark, Dr Lynda (Edinburgh Pentlands)
Blizzard, Bob
Bradley, Keith (Withington) Clark, Paul (Gillingham)
Bradshaw, Ben Clarke, Eric (Midlothian)
Brand, Dr Peter Clarke, Tony (Northampton S)
Breed, Colin Clelland, David
Brinton, Mrs Helen Clwyd, Ann
Coaker, Vernon Howarth, George (Knowsley N)
Coffey, Ms Ann Hughes, Ms Beverley (Stretford)
Cohen, Harry Hughes, Kevin (Doncaster N)
Coleman, Iain Hurst, Alan
Colman, Tony Hutton, John
Connarty, Michael Illsley, Eric
Cook, Frank (Stockton N) Ingram, Rt Hon Adam
Cooper, Yvette Jackson, Ms Glenda (Hampstead)
Corbett, Robin Jackson, Helen (Hillsborough)
Corbyn, Jeremy Jamieson, David
Cotter, Brian Jenkins, Brian
Cousins, Jim Johnson, Alan (Hull W & Hessle)
Cranston, Ross Johnson, Miss Melanie (Welwyn Hatfield)
Crausby, David
Cryer, Mrs Ann (Keighley) Jones, Helen (Warrington N)
Cryer, John (Hornchurch) Jones, Jon Owen (Cardiff C)
Cummings, John Jones, Martyn (Clwyd S)
Cunningham, Jim (Cov'try S) Jones, Nigel (Cheltenham)
Darvill, Keith Keeble, Ms Sally
Davey, Edward (Kingston) Keen, Alan (Feltham & Heston)
Davey, Valerie (Bristol W) Keen, Ann (Brentford & Isleworth)
Davidson, Ian Kelly, Ms Ruth
Davies, Rt Hon Denzil (Llanelli) Kemp, Fraser
Davies, Geraint (Croydon C) Kennedy, Jane (Wavertree)
Dawson, Hilton Khabra, Piara S
Dean, Mrs Janet Kidney, David
Denham, John Kilfoyle, Peter
Dismore, Andrew King, Andy (Rugby & Kenilworth)
Dobson, Rt Hon Frank King, Ms Oona (Bethnal Green)
Donohoe, Brian H Kirkwood, Archy
Doran, Frank Ladyman, Dr Stephen
Dowd, Jim Lawrence, Mrs Jackie
Drown, Ms Julia Laxton, Bob
Dunwoody, Mrs Gwyneth Lewis, Ivan (Bury S)
Eagle, Angela (Wallasey) Lewis, Terry (Worsley)
Eagle, Maria (L'pool Garston) Linton, Martin
Efford, Clive Livsey, Richard
Ennis, Jeff Lloyd, Tony (Manchester C)
Feam, Ronnie Lock, David
Field, Rt Hon Frank McAvoy, Thomas
Fisher, Mark McCabe, Steve
Fitzpatrick, Jim McDonagh, Siobhain
Flint, Caroline McDonnell, John
Follett, Barbara McFall, John
Foster, Michael Jabez (Hastings) McIsaac, Shona
Foster, Michael J (Worcester) Mackinlay, Andrew
Galloway, George Mactaggart, Fiona
Gardiner, Barry McWalter, Tony
George, Bruce (Walsall S) McWilliam, John
Gerrard, Neil Mandelson, Rt Hon Peter
Gidley, Sandra Marsden, Gordon (Blackpool S)
Godman, Dr Norman A Marshall, David (Shettleston)
Godsiff, Roger Marshall, Jim (Leicester S)
Goggins, Paul Marshall-Andrews, Robert
Golding, Mrs Llin Martlew, Eric
Gordon, Mrs Eileen Maxton, John
Griffiths, Nigel (Edinburgh S) Merron, Gillian
Grogan, John Michael, Rt Hon Alun
Hain, Peter Michie, Bill (Shef'ld Heeley)
Hall, Mike (Weaver Vale) Milburn, Rt Hon Alan
Hall, Patrick (Bedford) Miller, Andrew
Hamilton, Fabian (Leeds NE) Mitchell, Austin
Harman, Rt Hon Ms Harriet Moffatt, Laura
Harris, Dr Evan Moonie, Dr Lewis
Harvey, Nick Moore, Michael
Healey, John Moran, Ms Margaret
Heath, David (Somerton & Frome) Morris, Rt Hon Ms Estelle (B'ham Yardley)
Hepburn, Stephen
Heppell, John Mudie, George
Hesford, Stephen Murphy, Denis (Wansbeck)
Hinchliffe, David Murphy, Jim (Eastwood)
Hodge, Ms Margaret Naysmith, Dr Doug
Hood, Jimmy Norris, Dan
Hope, Phil O'Brien, Mike (N Warks)
Hopkins, Kelvin Olner, Bill
Howarth, Alan (Newport E) O'Neill, Martin
Palmer, Dr Nick Stevenson, George
Pendry, Tom Stewart, Ian (Eccles)
Perham, Ms Linda Stinchcombe, Paul
Pickthall, Colin Stoate, Dr Howard
Pike, Peter L Straw, Rt Hon Jack
Plaskitt, James Stringer, Graham
Pollard, Kerry Stunell, Andrew
Pond, Chris Sutcliffe, Gerry
Pope, Greg Taylor, Rt Hon Mrs Ann (Dewsbury)
Pound, Stephen
Prentice, Ms Bridget (Lewisham E) Temple-Morris, Peter
Prentice, Gordon (Pendle) Thomas, Gareth R (Harrow W)
Primarolo, Dawn Timms, Stephen
Purchase, Ken Tipping, Paddy
Quin, Rt Hon Ms Joyce Todd, Mark
Radice, Rt Hon Giles Touhig, Don
Rammell, Bill Trickett, Jon
Raynsford, Nick Turner, Dennis (Wolverh'ton SE)
Rendel, David Twigg, Derek (Halton)
Robinson, Geoffrey (Cov'try NW) Tyler, Paul
Rogers, Allan Tynan, Bill
Rooker, Rt Hon Jeff Walley, Ms Joan
Rooney, Terry Ward, Ms Claire
Roy, Frank Wareing, Robert N
Ruane, Chris Watts, David
Ruddock, Joan White, Brian
Russell, Bob (Colchester) Whitehead, Dr Alan
Russell, Ms Christine (Chester) Williams, Rt Hon Alan (Swansea W)
Ryan, Ms Joan
Savidge, Malcolm Williams, Alan W (E Carmarthen)
Sawford, Phil Williams, Mrs Betty (Conwy)
Sedgemore, Brian Winnick, David
Shaw, Jonathan Winterton, Ms Rosie (Doncaster C)
Sheerman, Barry Wood, Mike
Sheldon, Rt Hon Robert Woodward, Shaun
Simpson, Alan (Nottingham S) Woolas, Phil
Skinner, Dennis Worthington, Tony
Smith, Jacqui (Redditch) Wright, Tony (Cannock)
Smith, John (Glamorgan) Wyatt, Derek
Smith, Llew (Blaenau Gwent)
Southworth, Ms Helen Tellers for the Noes:
Squire, Ms Rachel Mr. Graham Allen and
Steinberg, Gerry Mr. Tony McNulty.

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 261, Noes 97.

Division No. 244] [7.11pm
Abbott, Ms Diane Brand, Dr Peter
Adams, Mrs Irene (Paisley N) Breed, Colin
Ainsworth, Robert (Cov'try NE) Brinton, Mrs Helen
Alexander, Douglas Brown, Rt Hon Nick (Newcastle E)
Anderson, Donald (Swansea E) Buck, Ms Karen
Atkins, Charlotte Burden, Richard
Austin, John Burgon, Colin
Barron, Kevin Butler, Mrs Christine
Beckett, Rt Hon Mrs Margaret Byers, Rt Hon Stephen
Begg, Miss Anne Cable, Dr Vincent
Benn, Hilary (Leeds C) Caborn, Rt Hon Richard
Benn, Rt Hon Tony (Chesterfield) Campbell, Ronnie (Blyth V)
Bennett, Andrew F Casale, Roger
Benton, Joe Caton, Martin
Bermingham, Gerald Cawsey, Ian
Best, Harold Chaytor, David
Blackman, Liz Chidgey, David
Blears, Ms Hazel Clapham, Michael
Blizzard, Bob Clark, Rt Hon Dr David (S Shields)
Bradley, Keith (Withington) Clark, Paul (Gillingham)
Bradshaw, Ben Clarke, Tony (Northampton S)
Clelland, David Hughes, Ms Beverley (Stretford)
Clwyd, Ann Hughes, Kevin (Doncaster N)
Coaker, Vernon Hughes, Simon (Southwark N)
Coffey, Ms Ann Hurst, Alan
Cohen, Harry Hutton, John
Coleman, Iain Illsley, Eric
Colman, Tony Ingram, Rt Hon Adam
Connarty, Michael Jackson, Helen (Hillsborough)
Cook, Frank (Stockton N) Jamieson, David
Cooper, Yvette Jenkins, Brian
Corbett, Robin Johnson, Alan (Hull W & Hessle)
Corbyn, Jeremy Johnson, Miss Melanie (Welwyn Hatfield)
Cotter, Brian
Cousins, Jim Jones, Jon Owen (Cardiff C)
Cranston, Ross Jones, Martyn (Clwyd S)
Crausby, David Jones, Nigel (Cheltenham)
Cryer, Mrs Ann (Keighley) Keeble, Ms Sally
Cryer, John (Hornchurch) Keen, Alan (Feltham & Heston)
Cummings, John Keen, Ann (Brentford & Isleworth)
Cunningham, Jim (Cov"try S) Kelly, Ms Ruth
Darvill, Keith Kemp, Fraser
Davey, Edward (Kingston) Kennedy, Jane (Wavertree)
Davey, Valerie (Bristol W) Khabra, Piara S
Davidson, Ian Kidney, David
Davies, Rt Hon Denzil (Llanelli) Kilfoyle, Peter
Davies, Geraint (Croydon C) King, Andy (Rugby & Kenilworth)
Dawson, Hilton King, Ms Oona (Bethnal Green)
Dean, Mrs Janet Kirkwood, Archy
Denham, John Ladyman, Dr Stephen
Dismore, Andrew Lammy, David
Dobson, Rt Hon Frank Lawrence, Mrs Jackie
Doran, Frank Laxton, Bob
Dowd, Jim Lewis, Ivan (Bury S)
Drown, Ms Julia Linton, Martin
Dunwoody, Mrs Gwyneth Livsey, Richard
Eagle, Angela (Wallasey) Lloyd, Tony (Manchester C)
Eagle, Maria (L'pool Garston) Lock, David
Efford, Clive McAvoy, Thomas
Ennis, Jeff McCabe, Steve
Field, Rt Hon Frank McDonagh, Siobhain
Fisher, Mark McDonnell, John
Fitzpatrick, Jim McFall, John
Flint, Caroline McIsaac, Shona
Follett, Barbara Mactaggart, Fiona
Foster, Michael Jabez (Hastings) McWalter, Tony
Foster, Michael J (Worcester) McWilliam, John
Galloway, George Mandelson, Rt Hon Peter
Gardiner, Barry Marsden, Gordon (Blackpool S)
George, Bruce (Walsall S) Marshall, David (Shettleston)
Gerrard, Neil Marshall-Andrews, Robert
Gidley, Sandra Maxton, John
Godman, Dr Norman A Merron, Gillian
Godsiff, Roger Michael, Rt Hon Alun
Goggins, Paul Michie, Bill (Shef'ld Heeley)
Golding, Mrs Llin Milburn, Rt Hon Alan
Gordon, Mrs Eileen Miller, Andrew
Griffiths, Nigel (Edinburgh S) Mitchell, Austin
Grogan, John Moffatt, Laura
Hain, Peter Moore, Michael
Hall, Mike (Weaver Vale) Moran, Ms Margaret
Hall, Patrick (Bedford) Morris, Rt Hon Ms Estelle (B'ham Yardley)
Harman, Rt Hon Ms Harriet
Harris, Dr Evan Murphy, Denis (Wansbeck)
Harvey, Nick Murphy, Jim (Eastwood)
Healey, John Naysmith, Dr Doug
Heath, David (Somerton & Frome) Norris, Dan
Hepburn, Stephen O'Brien, Mike (N Warks)
Heppell, John Olner, Bill
Hesford, Stephen O'Neill, Martin
Hill, Keith Palmer, Dr Nick
Hinchliffe, David Pendry, Tom
Hodge, Ms Margaret Perham, Ms Linda
Hope, Phil Pickthall, Colin
Hopkins, Kelvin Pike, Peter L
Howarth, Alan (Newport E) Plaskitt, James
Howarth, George (Knowsley N) Pollard, Kerry
Pond, Chris Stringer, Graham
Pound, Stephen Stunell, Andrew
Prentice, Ms Bridget (Lewisham E) Sutcliffe, Gerry
Prentice, Gordon (Pendle) Taylor, Rt Hon Mrs Ann (Dewsbury)
Primarolo, Dawn
Purchase, Ken Temple-Morris, Peter
Quin, Rt Hon Ms Joyce Thomas, Gareth R (Harrow W)
Rammell, Bill Timms, Stephen
Raynsford, Nick Tipping, Paddy
Rendel, David Todd, Mark
Robinson, Geoffrey (Cov'try NW) Touhig, Don
Rogers, Allan Trickett, Jon
Rooker Rt Hon Jeff Turner, Dennis (Wolverh'ton SE)
Rooney Terry Twigg, Derek (Halton)
Roy, Frank Tyler, Paul
Ruane, Chris Tynan, Bill
Ruddock, Joan Walley, Ms Joan
Russell, Bob (Colchester) Ward, Ms Claire
Russell, Ms Christine (Chester) Wareing, Robert N
Ryan, Ms Joan Watts, David
Savidge, Malcolm White, Brian
Sawford, Phil Whitehead, Dr Alan
Sedgemore, Brian Williams, Rt Hon Alan (Swansea W)
Shaw, Jonathan
Sheerman, Barry Williams, Alan W (E Carmarthen)
Simpson, Alan (Nottingham S) Williams, Mrs Betty (Conwy)
Winnick, David
Skinner, Dennis Winterton, Ms Rosie (Doncaster C)
Smith, Jacqui (Redditch) Wood, Mike
Smith, John (Glamorgan) Woodward, Shaun
Smith, Llew (Blaenau Gwent) Woolas, Phil
Southworth, Ms Helen Worthington, Tony
Steinberg, Gerry Wright, Tony (Cannock)
Stevenson, George Wyatt, Derek
Stewart, Ian (Eccles)
Stinchcombe, Paul Tellers for the Ayes:
Stoate, Dr Howard Mr. Graham Allen and
Straw, Rt Hon Jack Mr. Tony McNulty.
Ainsworth, Peter (E Surrey) Gorman, Mrs Teresa
Amess, David Gray, James
Arbuthnot, Rt Hon James Green, Damian
Atkinson, Peter (Hexham) Gummer, Rt Hon John
Baldry, Tony Hamilton, Rt Hon Sir Archie
Bercow, John Hammond, Philip
Beresford, Sir Paul Hawkins, Nick
Blunt, Crispin Hayes, John
Boswell, Tim Heald, Oliver
Bottomley, Peter (Worthing W) Heathcoat-Amory, Rt Hon David
Bottomley, Rt Hon Mrs Virginia Hogg, Rt Hon Douglas
Brady, Graham Howard, Rt Hon Michael
Brazier, Julian Howarth, Gerald (Aldershot)
Browning, Mrs Angela Hunter, Andrew
Bruce, Ian (S Dorset) Johnson Smith, Rt Hon Sir Geoffrey
Burns, Simon
Cash, William Key, Robert
Chope, Christopher King, Rt Hon Tom (Bridgwater)
Clappison, James Kirkbride, Miss Julie
Clark, Dr Michael (Rayleigh) Laing, Mrs Eleanor
Collins, Tim Lait, Mrs Jacqui
Cran, James Leigh, Edward
Davey, Edward (Kingston) Letwin, Oliver
Day, Stephen Lewis, Dr Julian (New Forest E)
Duncan Smith, Iain Lidington, David
Evans, Nigel Lilley, Rt Hon Peter
Faber, David Lloyd, Rt Hon Sir Peter (Fareham)
Fabricant, Michael Loughton, Tim
Fallon, Michael Luff, Peter
Flight, Howard MacGregor, Rt Hon John
Forth, Rt Hon Eric McIntosh, Miss Anne
Fox, Dr Liam MacKay, Rt Hon Andrew
Fraser, Christopher Malins, Humfrey
Gale, Roger Mawhinney, Rt Hon Sir Brian
Garnier, Edward May, Mrs Theresa
Gibb, Nick Moss, Malcolm
O'Brien, Stephen (Eddisbury) Swayne, Desmond
Page, Richard Syms, Robert
Paice, James Taylor, Ian (Esher & Walton)
Paterson, Owen Taylor, Sir Teddy
Pickles, Eric Tredinnick, David
Prior, David Trend, Michael
Redwood, Rt Hon John Tyrie, Andrew
Robathan, Andrew Viggers, Peter
Robertson, Laurence Walter, Robert
Roe, Mrs Marion (Broxbourne) Waterson, Nigel
Rowe, Andrew (Faversham) Wells, Bowen
Ruffley, David Whitney, Sir Raymond
St Aubyn, Nick Whittingdale, John
Shepherd, Richard Willetts, David
Simpson, Keith (Mid-Norfolk) Winterton, Mrs Ann (Congleton)
Soames, Nicholas Yeo, Tim
Spicer, Sir Michael
Spring, Richard Tellers for the Noes:
Stanley, Rt Hon Sir John Mr. John Randall and
Steen, Anthony Mr. Geoffrey Clifton-Brown.

Question accordingly agreed to.

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

Resolved, That this House welcomes the decision to prepare a National Plan for the NHS in England, bringing together doctors, nurses, patients' organisations and others working in the NHS to set out priorities for the modernisation of the NHS; welcomes the largest sustained increase in funding in the history of the NHS; and rejects the use of taxpayers' money to subsidise private medical insurance.

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