Health and Education

– in the House of Commons at 1:20 pm on 30th November 2004.

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Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 1:21 pm, 30th November 2004

I beg to move, as an amendment to the Address, at the end of the Question to add:—

"but deplore the absence of any measures in the Gracious Speech which would reduce the burden of centrally-imposed targets, bureaucracy and regulation on the NHS and the Education Service;
call on Ministers to implement urgently the action needed to deliver cleaner hospitals and to strengthen school discipline;
regret the omission of measures to abolish top-up fees;
note that legislation to reduce the size of Ofsted will merely reverse part of the huge increases in its staffing levels since 1997;
reject the Government's intention to impose additional fees on those attending further education colleges and deprecate the damage this will cause to adult and vocational education;
further regret the carry-over of the School Transport Bill, which will impose extra financial burdens on hard-working families;
are concerned at the failure to take forward legislation on mental health in a form that would protect the rights of people with mental health problems and promote their access to treatment;
further regret the lack of any proposals in the Gracious Speech to provide effective public health services;
and further deplore the absence of measures to promote freedom and independence for health and education professionals or effective choice of patients and parents.".

Today we move on to debate health and education. My hon. Friend Mr. Collins will later address in detail the education measures—or perhaps the lack of them—in the Queen's Speech.

The Queen's Speech offered no forward momentum to raise standards in the NHS or our schools. Three years ago, Labour said that it put schools and hospitals first, but they are now being pushed to the back of the queue by Home Office measures prompted by the Government's failure on law and order. We have no health Bills and nothing that would help to raise standards in our schools. There is no vision for our NHS or any room for the politics of hope in the Queen's Speech.

At the heart of the reforms for which the NHS is crying out is the reduction of centrally imposed targets, bureaucracy and the burden of regulation, but the Queen's Speech contains no measures from the Secretary of State for Health to move us in that direction. Indeed, in the few days since the Queen's Speech, we have heard from the Healthcare Commission that it proposes the abolition of star ratings, for which Conservative Members have been calling for a long time. We demonstrated, and many people throughout the NHS entirely agreed, that star ratings were a crude and misleading measure of performance in the NHS. They were centrally imposed by Ministers, but as soon as the scheme was taken out of the hands of Ministers and put into the hands of those who are genuinely charged with delivering improvements to the NHS, the conclusion has been reached that star ratings must be abolished.

The Government have offered nothing in the Queen's Speech to reduce the burden of targets. People throughout the NHS know that they distort priorities, and we have discussed this many times. Indeed, my right hon. and learned Friend the Leader of the Opposition has stood at the Dispatch Box and challenged the Prime Minister to get rid of targets that force those responsible for infection control measures in hospitals to keep beds and wards open when they should be cleaned for infection control purposes. The National Audit Office has made it clear that those people are overruled by managers in pursuit of the Government's centrally imposed targets. That is a disgrace, but it is only one of a range of illustrations of how targets that are centrally imposed by Whitehall are distorting the national health service's priorities.

The Government told the National Audit Office that by 2003–04, their NHS plan would bring bed occupancy down to 82 per cent., but that has not happened in practice. All the trusts throughout the country with the top 20 rates of methicillin-resistant Staphylococcus aureus have a bed occupancy higher than 82 per cent., and it is more than 90 per cent. in several. We will not get cleaner hospitals by using the Government's central targets; we will only achieve that in the absence of their interference.

Even the Government do not believe in their targets. They set a target for reducing the backlog of maintenance in the NHS. The target was the reduction by a quarter of a backlog measured at £3.1 billion by the end of 2004—the end of next month. Last Thursday, however, the Department of Health concluded that it was measuring the target using a flawed methodology, so rather than adhering to the target, it said that it would recalculate the figures. In place of the backlog of maintenance, which would now be not £3.1 billion but £3.2 billion, it has arrived at what it calls, using typical jargon,

"estimated risk adjusted backlog maintenance"—

I suppose that the risk in mind was that the target might not be hit. The Department would have had to announce its failure to make any progress towards addressing the £3.1 billion backlog, but instead—lo and behold—its estimated risk adjusted backlog has become £638 million. How interesting.

The Government do not believe their own targets, but neither do people who work in the NHS. The Government trumpeted the fact that four-hour waiting targets for accident and emergency departments had been met, but only last week, the Nursing Standard carried a report of the Royal College of Nursing Emergency Care Association annual conference. It said:

"nurses speaking from the floor claimed there was widespread misreporting of the figures that are signed off by chief executives. Some endorse so-called 'gaming', the practice by which patients are transferred only in the final minutes before breaching the target . . . One delegate, who wanted to remain anonymous, won applause from nurses for saying that her trust 'lied' over the A&E waiting time figures it presented."

The charitable view is that the Department does not know what is going on in the NHS, but the uncharitable view is that it would rather present figures than understand and be honest about what is happening.

We need fewer targets and less bureaucracy. The cost of bureaucracy in the NHS has increased from £3 billion in 1997 to £5 billion. The number of central administrators in the NHS is rising three times faster than the number of doctors and nurses. I recently visited a hospital at which I was given a list of the inspection bodies that visit it. It is visited by 42 inspection bodies. I referred to that during a meeting at which the Healthcare Commission was represented, but its chief executive said, "No, it isn't 42. We've been counting them and it's 102." Of course the Secretary of State does not believe that, but the Healthcare Commission seems to be more in tune than he is with what is going on in the NHS.

Photo of Henry Bellingham Henry Bellingham Shadow Minister (Business, Innovation and Skills), Shadow Minister

Is my hon. Friend aware that an increasing number of NHS trusts are reporting that they are moving heavily into debt? What is his explanation for that? Might the reason be that bureaucracy is stopping money from getting to the front line?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

My hon. Friend is right, and I shall come to that.

The extent to which hospitals have to comply with information requirements is a key consideration. A survey by the NHS Confederation identified that 50 per cent. of the data and information requests made to hospitals play no direct part in the performance management of those hospitals. We have to get rid of that and not only achieve a reduction in compliance costs for front-line services, but ensure that the resources get to the front line, as my hon. Friend said.

As always, the Secretary of State is all talk about cutting bureaucracy. He does it again today in a written statement, which says how he will cut the number of quangos and save money. Let us take one example. As a result of a public health White Paper five years ago, which the Government have conveniently ignored because they have made no progress on public health, they set up the Health Development Agency. They are now proposing to get rid of it by April 2005. The Government documents published today say that they will abolish it as one of their reductions in the number of quangos. What the documents do not tell us is that the public health White Paper published just a couple of weeks ago says that they will establish a new independent body to implement strategy on their behalf which will, in effect, have the same responsibilities as the HDA. Most of the quangos that the Government are getting rid of, they set up—and they are not really getting rid of them, but redeploying the staff and incorporating them into larger bodies, so there will be fewer quangos with wider responsibilities and more staff. At the same time, however, they are creating new bodies to take over the functions of existing bodies.

Just the other day, the chief executive of the NHS gave the game away when he said:

"The department has not been massively affected by either the Gershon or Lyons reports."

So the Gershon report, for all its vaunted reduction in the cost of bureaucracy across Whitehall, is not having much effect on the Department of Health. The implementation of the changes to taxpayer value that we are discussing with the James committee will affect the Department. As my right hon. Friend the shadow Chancellor of the Exchequer set out just 10 days ago, we now envisage more than £7 billion of savings from greater NHS efficiency, reductions in procurement costs, productivity improvements, reductions in the controls exercised by the central Department of Health, and a reduction in the number of quangos and the amount of bureaucracy in strategic health authorities and primary care trusts.

Photo of Nick Gibb Nick Gibb Conservative, Bognor Regis and Littlehampton

I am listening carefully to my hon. Friend's interesting speech. Is he also aware of the Office for National Statistics survey, that shows that rising inefficiency consumes as much as 9 per cent. of the extra cash put into the NHS? That amounts to a staggering £6 billion a year in inefficiency and waste.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

My hon. Friend is right, and knows much about such matters. The latest ONS productivity data show that the NHS had an increase in inputs of 80 per cent. and an increase in outputs of just 28 per cent. When the figures are deflated not for gross domestic product but for an NHS inflation factor, they show an 8 per cent. reduction in productivity over the Government's lifetime—which is probably an underestimate, because internal Government documents suggest that there is more like a 15 to 20 per cent. reduction.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

In the figures, what allowance is made for improvements in the quality of care?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Let me give an example. I am sure that the hon. Gentleman knows that finished consultant episodes are a measure of activity levels in hospitals—

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

The right hon. Gentleman will have to wait until I have answered Mr. Hinchliffe.

Hospital activity from 1998 to 2003 cost an extra 28 per cent. in real terms. The number of finished consultant episodes increased by 5 per cent. in hospitals. I am not talking about what happened outside hospitals. The rate of increase in finished consultant episodes after 1997 was slower than the rate of increase in activity in hospitals prior to 1997. Perhaps the Secretary of State will explain why NHS productivity has fallen rather than risen under this Government.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

The problem relates to the position that the hon. Gentleman accepts, which is incorporated in the calculations. When he says that he is not talking about what happens outside hospitals, he makes the very point. The number of people who are living longer and better lives, and who are not coming into hospital, includes the 125,000 people who are saved in the primary sector, and by better drugs. Will he confirm that those 125,000 lives are regarded not as an increase in productivity, but as a decrease in productivity?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

No. The Secretary of State does not understand—[Interruption.] If he will forgive me, I shall attempt to answer his question before he shouts at me. I am not ignoring what is happening outside hospitals. The Secretary of State previously said that we cannot compare the increase in activity in hospitals with expenditure in the NHS as a whole because some activity has shifted out of hospitals into the primary care context. My point is that we should at least look at what has happened in hospitals in direct response to the increase in expenditure in hospitals.

As for the wider circumstances beyond hospitals, the purpose of the ONS study was to capture changes in productivity. It made certain assumptions. For example, it assumed that productivity in Scotland and Wales matched productivity in England, because it had no separate figures. Most of us would say that that was not justified. None the less, its assumptions, which are favourable to the Government, still end up with an 8 per cent. reduction in productivity, which the Secretary of State cannot explain.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

In fairness to NHS staff, will the hon. Gentleman be good enough to note that the ONS press release explains that it failed to capture those things that it had tried to capture? Will he accept, and admit to the House, that if 125,000 people, who 10 years ago would have died, are saved today by the people who work in the NHS, it is absurd that that does not count as an increase in productivity for our health care system? Will he please stop running down the staff of the NHS, who have saved those very lives?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

That is a bit rich coming from the Secretary of State. People across the NHS know perfectly well that the bureaucracy, the central controls and the extent to which money is leached out of the system by administration instead of getting to the front line are the reasons why people in hospitals are unable to deliver increases in productivity commensurate with the increases in resources. That is what is going on, and he simply will not admit it.

Photo of Phyllis Starkey Phyllis Starkey PPS (Dr Denis MacShane, Minister of State), Foreign & Commonwealth Office

Does the hon. Gentleman accept that much of the increased spending has gone to improve the salaries of nurses, doctors and others within the NHS? That means that my area has the doctors, nurses, physiotherapists, occupational therapists and speech therapists for whom we receive funding, because they are staying in the NHS—and, in particular, in the NHS in the south-east.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Of course there are changes in costs inside the NHS, but incorporated into the calculation of the ONS statistics is a deflator for NHS prices of something like 6 per cent. The figures would have been different had a GDP deflator been applied. An allowance is made for that. The hon. Lady and I know—and I think that my hon. Friend Mr. Gibb, too, made this point—that this year hospitals are experiencing increases in costs well in excess of that. Part of that is due to increases in contracts and changes in pay, whether they result from "Agenda for Change" or from the consultants contract.

Hospitals, rightly, are saying that it is all very well Ministers talking about 9 per cent. increases in expenditure, but if costs are rising by more than 9 per cent., how can increases in activity throughout the NHS be delivered? They are asking how that will be possible. There must come a point when people in the NHS find that they have centrally imposed costs from the Government that exceed the willingness of the Government to provide resources. They must arrive at the point where they get the resources, and there are free resources that can deliver growth in the service.

As we discussed during the debate on the Queen's Speech yesterday, the people's priorities would have been, for example, strengthening school discipline or promoting cleaner hospitals. I will not dwell on promoting cleaner hospitals because we have had debates during which we have challenged the Secretary of State to come forward with the urgent action that is necessary. That is not happening. Perhaps he can tell us why we do not have information from clinical departments that will enable people working in the NHS and those who might be referred for operations to judge where there are cleaner infection-free hospitals and where there are not.

If there is to be a matrons charter, which the Government have announced, where is the model cleaning contract referred to in that charter but not yet published? It is almost a year to the day since the chief medical officer's report entitled "Winning Ways", which said that there would be a rapid review panel for products and processes. Nothing happened for nine months, and even today, nearly a year on, the so-called rapid review has delivered no additional advice to the NHS.

The National Audit Office said that four years ago the Department began working on a national infection control manual. I met staff through a Patients Association meeting that I hosted in the House last week, and they said that it would be extremely helpful for infection control teams to have access to such a manual in providing guidance to their hospitals. It is not available, and the NAO found that no substantive action had been taken. "Winning Ways", published a year ago, referred to hazard analysis critical control point methodology, and said:

"The . . . Inspector of Microbiology and the National Patient Safety Agency will work jointly to ensure that the techniques of . . . (HACCP) are developed for healthcare associated infection".

A year later, I can find no evidence that that work has been taken forward. Even pilot operations are not under way.

The Secretary of State's response to all the pressure that we have put on him to deliver action is typical. He talks about nothing more than the importance of dealing with infection, and promises one more target. That target is to reduce the level of MRSA—only the bit that he measures, not the whole of MRSA infection—by half by 2008, as if there is an acceptable level of MRSA infection, equivalent to the level that the Government inherited in 1997. The chief medical officer's report stated, as was made clear in the document published a year ago, that the proportion of staphylococcus aureus in this country that is MRSA is 44 per cent. The proportion in Demark and the Netherlands is just 1 per cent. The Secretary of State's ambitious and challenging target, as he describes it, is to bring the percentage down by half. That is not good enough.

The chief medical officer said that it was known how the Dutch had been able to achieve such a proportion. They did so through a search-and-destroy mechanism. It is about time there was a search-and-destroy philosophy inside the NHS to identify outbreaks of MRSA infection and destroy it to deliver cleaner hospitals, which is not happening under this Government.

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs)

Is my hon. Friend aware that a nursing sister in my constituency was telling me that in a major hospital in Birmingham there is no clear guidance to ancillary staff? She gave the example of water jugs and other crockery being taken from an isolation unit and mixed with crockery—[Interruption.] The Secretary of State laughs, probably because he does not care about MRSA infection. Does my hon. Friend agree with me that, if crockery and jugs from an isolation unit that is known to have MRSA, are mixed with crockery that was previously sterile, it too will become infected, and so in turn will infect other patients?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Yes. My hon. Friend makes a good point. If there is to be infection control in hospitals, there must be clear guidance about the standards that need to be maintained, whether in terms of cleaning—such as a model cleaning contract—or of the role of the infection control teams and staff. But the fact is that the manual has not been published. The Government have not given it the priority that is necessary.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

No, I will move on.

My hon. Friend Mr. Bellingham asked me about deficits. The Labour party is always parading the fact that it is providing additional money for the NHS, but we know what is happening because the strategic health authorities tell us exactly that in their latest document. South-west London is reporting a projected total deficit for the year end of £79 million. Norfolk, Suffolk and Cambridgeshire strategic health authority, in my area, is projecting a year-end deficit of £51 million. Avon, Gloucestershire and Wiltshire SHA, in the area of my hon. Friend Dr. Murrison, is projecting a deficit of £27 million. The projection of Surrey and Sussex is £22 million. Throughout the country, 75 primary care trusts and 73 NHS trusts are forecasting deficit. The total across—[Interruption.] From a sedentary position, the Minister of State, Department of Health, tells us that we should go back to the last century and try to examine what the comparison would be. That is terrific.

I thought that the Government pretended that in the past seven years things had changed. It seems that their argument is that things are the same now as they were in 1996. If the public believe that nothing has changed since 1996, they will look to us for the change that is necessary and not to the Government, who have achieved nothing. If the Minister of State is happy that half way through a financial year 75 PCTs and 73 NHS hospital trusts are forecasting deficits because he and his colleagues have imposed costs on the NHS that are far in excess of the financial resources that are made available, along with unfunded GP contracts, unfunded consultant contracts and risks associated with "Agenda for Change"—[Interruption.]

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Thank you, Mr. Deputy Speaker. Perhaps I should contain myself as well, or I shall raise my blood pressure, which would not be good for me, and the Secretary of State would tell me off.

Photo of Laura Moffatt Laura Moffatt PPS (Rt Hon Lord Falconer of Thoroton, Secretary of State), Department for Constitutional Affairs

The hon. Gentleman mentioned the trust that covers the area in my constituency, and he is making a point about deficits. I am very much aware that the extra funding in the Surrey and Sussex trust has expanded services enormously. If he is trying to make an important point about deficits, can he tell us how much the deficit would be had the Conservatives still been in power without the spending commitment that we now have?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

For goodness' sake. I do not think that the hon. Lady can reasonably expect me to reconstruct history from 1996. Let us deal with the world as it is, not the world as it might have been. In the world as it is, Surrey and Sussex SHA is forecasting a £22.6 million deficit resulting from delayed transfers of care and the discovery of a significant number of patients on its orthopaedic register whom it has had to pay to have treated by other providers. There is also the increasing costs of drugs consequent upon the guidance of the National Institute for Clinical Excellence. In addition, there has been a 5 per cent. increase in in-patient activity. There are deficits, and the hon. Lady will have to accept that many NHS trusts throughout the country are finding that they are not resourced to meet the objectives that the Government are proposing for them.

We and the Government might at least enjoy ourselves together for a moment. I accept that the Government are committed to increasing resources for the national health service in the next two years, but in talking about finances we should have regard to the position of the Liberal Democrats. I do not know what Mr. Burstow will tell us about their policy, but it will not wash. When I discussed Liberal Democrat policy with the hon. Gentleman, he said that everything would be all right because over the economic cycle—he sounded a bit like the Chancellor of the Exchequer—national insurance contributions would provide sufficient money for the NHS. Having looked at the detail of the Liberal Democrat proposals, however, I discovered that this financial year there would be a shortfall of £4.5 billion between national insurance contributions and NHS expenditure across the country. Next year it would be £8.2 billion, and the year after, £12.2 billion. In 2007–08, it would be £17.1 billion. If the Liberal Democrats believe in hypothecation of national insurance to the NHS they must aim for a 5 per cent. increase in NICs to pay for the shortfall. Perhaps the hon. Gentleman will tell us later whether he will cut funding for the NHS by £17 billion in the next three financial years or increase national insurance by 5 per cent.

The Queen's Speech is lacking in health provisions. We had exchanges on public health a couple of weeks ago, but in the past week the Secretary of State has treated the issue as if it were year zero and nothing had happened in the past seven years. He published a sexual health strategy which, in some respects, simply followed our suggestions about the need for a national awareness campaign on the consequences of poor sexual health. However, I must challenge him, because his strategy simply produced more evidence that the Government cannot co-ordinate their efforts in this arena. He proposes to initiate a public awareness campaign in the coming months about the risks of unprotected sex and poor sexual health. Waiting times for genito-urinary clinics are 12 days on average for men and 10 for women, but his 48-hour target—this is all about targets—will not apply until 2008. If, in the next few months, he seeks to encourage young people in particular to attend clinics—there are no more clinics today than in 1997—that will not be consistent with the delivery of services.

In our amendment, we once again express disappointment that the Government have failed to introduce mental health legislation. One in four people are affected by some form of mental illness. In the debate on last year's Queen's Speech, we called for the introduction of legislation on mental health services.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

We have got that legislation.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

The hon. Gentleman knows perfectly well that it is undergoing pre-legislative scrutiny. The Government have simply promised to undertake that process, even though they said that they would introduce legislation. We could have introduced mental health legislation that would deliver the framework that people who work in mental health services want.

Photo of Mr David Hinchliffe Mr David Hinchliffe Labour, Wakefield

The hon. Gentleman is being rather unfair, as he knows that this is a hugely complex area. The Government are right to be careful, so that the legislation will be introduced in a workable form. There are many conflicting views about the way forward on mental health legislation, so it is proper that both Houses spend time on scrutiny. That will ensure that the Bill is right and enjoys a consensus of support from people across the community.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Of course we need a Bill that is right, which is why we called for one in our amendment to last year's Loyal Address. We did not want a Bill that locked people up to satisfy the Home Secretary but one that gave them the health care that they needed and the access that they were entitled to expect. We do not need a Bill that introduces fear and coercion into what ought to be a therapeutic relationship. The legislation should provide quality care for patients, and compulsion should be a tool of last, not first, resort.

Before concluding, I shall put some questions to the Secretary of State. The Queen's Speech presages the introduction of legislation on identity cards. Indeed, the Identity Cards Bill has just been published. I do not understand the relationship between the ID card and the NHS, so perhaps he will enlighten us. We are told that the card will be used to facilitate access to NHS services. According to the Bill, however, it could not be used for that purpose until holding such a card is compulsory—according to the Home Secretary, that will be in 2013. In terms of action, therefore, the card is irrelevant, because it will not become obligatory for another decade. However, the NHS improvement plan that the Secretary of State for Health published in June says on page 30:

"The Department of Health is currently considering the development of an NHS Card, which could support smart access to personal data and speed confirmation of access to appropriate care."

Are there going to be two cards—the NHS card and, later, the ID card—and what will be the relationship between them? Quite separately, the European Union requires us to replace the E111 system. A number of EU member states have already introduced a card for access to their health services that serves as an E111 entitlement when one visits those countries. Surely we will have one of those cards, so where does the ID card fit in?

Children would not have an ID card but, presumably, to access NHS services they will need an identifier for personal patient records and so on. Whether or not they have an ID card, they will have an identifier already, so what is the point of the identifier on the ID card? Entitlement to NHS services is based on ordinary residence, but the ID card will be based on citizenship. All those problems illustrate the fact that many of the Government's proposals are ill thought-out. There are questions about the NHS and ID cards to which no one seems to know the answer. Perhaps the Secretary of State will tell us later whether he has any answers.

Our amendment expresses the hope that we will soon have a chance to deliver an NHS that is geared towards patients, not the Department of Health. It will be exclusively concerned with clinical standards, priorities and the needs and wishes of patients, not central targets and the demands of bureaucracy and administrators. It will be geared to give information to patients, with all the positive impacts on quality that that can deliver. It will give choice to patients, because in an era of added consumer pressure that will deliver quality and incentivise people across the NHS to deliver services and ensure that when staff treat patients, they receive the resources that they are clearly not receiving at the moment. It will give people suffering from chronic diseases control of their care, and will increasingly empower them to manage their care to meet their needs. It will give GPs control of their budgets through fundholding. The total purchasing pilots introduced in the latter stages of the last Conservative Government were a great success, but they were abandoned by the present Government who, however, proposed to reintroduce them in a distorted, cut-down form following the failure of their measures.

Once again, in our amendment we are demonstrating that there is a forward agenda for the health service that will provide freedom and independence for the NHS, choice for patients, and opportunities for the NHS to deliver the care that its staff work hard to deliver. That is our objective, and we will seek to achieve it as soon as the election gives us an opportunity to do so. On that basis, I urge colleagues to support our amendment.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health 1:59 pm, 30th November 2004

First, I congratulate Mr. Lansley on his belated stakhanovite use of the word "patient" six times in the past minute. Unfortunately, for the first 37 minutes of his speech, patients did not feature once. That is indicative of his approach—always on the side of the providers, never on the side of the patients—until at the end of his speech he digs out the peroration written for him by someone, which says, "Mention patients several times."

Secondly, I entirely accept that the hon. Gentleman does not understand every nuance of the Government's policy on, for example, NHS entitlement cards. I find it less explicable that he did not seem to know that the Conservatives were committed by his predecessor, Dr. Fox, to an NHS entitlement and identification card. However, I will let him study that and perhaps he can explain to us next time whether the proposal has been abandoned.

For 38 minutes, the hon. Member for South Cambridgeshire managed not to notice the elephant in the room. At no stage, even in those last repetitive uses of the word "patient", was it followed by the word "passport". The central policy of the Conservative party, the patient's passport, which received accolade after accolade from his own leader, was not mentioned once in the 38 minutes of his speech. That speaks volumes about the albatross hanging round his neck. He spent 38 minutes trying to hide the patient's passport. Perhaps that is why he did not mention patients.

Finally, I am sorry that the hon. Gentleman feels, as he said in his opening remarks, that health and education have not been given the priority that the Government promised them and have been pushed to the back of the queue in all our considerations. It is therefore with particular pleasure that I approach the Dispatch Box for the 297th debate on health in this Parliament and for the 64th debate on health in the past 12 months alone. The complete lack of priority will be obvious from the figures.

The truth is that health and education have been given every priority by the Government. That is as it should be, because there are few issues that affect people's lives so directly and so crucially as health, where everyone is potentially a patient—the word missing from the hon. Gentleman's speech—and education, where not only parents and pupils have an interest, but we all have an interest as a country.

My right hon. Friend the Secretary of State for Education and Skills and I welcome the debate today. For the past few years we have been privileged to be involved in travelling a journey in public services—a journey of modernisation and improvement. Opposition Members, who spent most of their time in government moving backwards on public services, find it difficult to understand the concept of moving forward on a journey of modernisation and improvement. We do not underestimate the challenges that remain. The view to the horizon leaves us in no doubt about the extent of those challenges, some of which were mentioned by the hon. Member for South Cambridgeshire and some of which were not. There are still staff shortages—for example, of radiologists, midwives and nurses. Admittedly, we have 80,000 more nurses than under the previous Government, but we still feel that there is a shortage. Combating MRSA is a big challenge for us.

The hon. Gentleman continually asks us from the Dispatch Box to pursue the search for truth. He should remember the old adage—"When you keep asking for something, be very careful. You might get it." Next week, I will publish a factual history of the increase in rates of MRSA over the past 12 years, and it will make very interesting reading, especially for Opposition Members, who seem to feel that the great increase in MRSA rates occurred under the present Government. As we look to the horizon, we know the great challenges that remain.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

When the Secretary of State publishes those figures next week, will he also publish the Government's plans for bringing the incidence of MRSA in British hospitals down to the levels recorded in the Netherlands and Denmark?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

Almost every month, we take another step in that direction. I do not pretend, as is sometimes implied from the Opposition Benches, that there is some magic wand that will achieve that. The hon. Member for South Cambridgeshire seems to be incapable of holding two ideas at the same time. He complains that we have any targets at all, then he complains that the target we have set for MRSA is not ambitious enough. He wants a bigger and better target.

I know that that is not the view of Mr. Dorrell, who has held a responsible post in government. We may be forgiven for encouraging some of the younger Members on the Front Bench, who have not held such responsible posts, but the right hon. Gentleman knows that these are difficult and complex issues. He is right that there are lessons that we can learn from abroad, as well as lessons that we ought to develop internally in this country. Month on month, we are taking further steps. Next month, we are bringing some of the world's leading scientists to this country in pursuit of research on immunity to MRSA. We are examining a range of measures.

We do not regard the matter as a party political issue, and I thought it was slightly churlish of the hon. Member for South Cambridgeshire not to mention that we invited him and Mr. Burstow, the Front-Bench spokesman for the Liberals, to put to us ideas that, if we find that they are practical and would achieve an advance for us, we will willingly adopt. I have never regarded methicillin-resistant Staphylococcus aureus as intrinsically related to either the Labour party or the Conservative party. The figures next week may show that it has crossed party politics.

Photo of Paul Burstow Paul Burstow Shadow Secretary of State for Health

On further steps to deal with MRSA infections in our hospitals, will the Secretary of State look again at the way in which the Government collect the statistics? They collect them on a hospital by hospital basis rather than on a specialty basis, in order that decisions can be made about targeting particular problems in particular hospitals. Is it not time to produce specialty-level data so that we can start to target the problem more specifically?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

We will look at all these matters. We will examine whether collecting data hospital by hospital is sensible, or whether we need to identify particular areas within hospitals where the vulnerable are and operations are carried out. It is a cruel deceit to pretend that it will not be a continual struggle. When I said that within roughly three years I wanted to halve the rate of MRSA, I did not propose that as a ceiling; that is a floor. I hope that we can make more progress, but for the sake of some party political populist slogan, I am not prepared to pluck any target out of the air and demand that it be accomplished. That is not responsible politics.

Looking forward, we can see huge challenges ahead in our attempts to improve and modernise the national health service. However, the retrospective view from the point that we have reached leaves me and most objective observers in no doubt about the significant progress that we have made so far on that journey of improvement.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

The Secretary of State knows that the measures that I outlined to the House are a subset of those that I have suggested to him should be undertaken in the fight against MRSA infection. If he did not pluck a target out of the air, will he tell the House where the evidence base is for his assertion that by 2008 the NHS should aim to halve the current rate of MRSA?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

It is not an assertion in the sense that I am saying that that is where we will be without a shadow of a doubt. A target is just that—an aim and objective. Where did I get that target? I got it on official advice as to what would be possible if we continued to combat MRSA. The advice was that, within three years, with the measures that we have now taken in our continual struggle, it would be possible first to stop the growth of MRSA, which has happened under both Governments, then to achieve a decline, and then a decline of significant proportions. That was done in the way in which any Minister would do it. It was done after consultation, discussion, testing and inquiry from officials.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

The evidence on what? What evidence does the hon. Gentleman want me to publish?

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

If the Secretary of State has received advice based on evidence about what measures will be taken to deliver the specific target, he can publish it. As he knows, there has been a string of reports, including the chief medical officer's report in December last year, which did not propose such a target or suggest that there was a particular path for the reduction of MRSA infection. The point that we are making is that the target may prove not to be challenging. The chief medical officer set out how a search and destroy strategy achieves substantially lower levels of MRSA infection. We need to know what the Secretary of State intends to do that he believes will deliver his target, as distinct from any other.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

First, the target should be clear. Secondly, with every month that passes, we announce some further measure, and we continue to examine other measures, so what I am doing on this issue is as clear as it can be to anyone. Thirdly, the chief medical officer and chief nursing officer have been as open as they can about their advice, including in publications. Fourthly, I keep making excuses for the hon. Gentleman, who has never been in government, but I may say that officials' advice has not conventionally been made available externally. I am doing nothing more than any other Minister has ever done in this position.

The hon. Gentleman is entitled to criticise me if he feels that there are failings in what I am doing, but he is not entitled to imply that the figures have somehow been plucked out of the air with the connivance of leading officials in my Department, including some people who I dare say are as qualified as him, although I know that he brings an esteemed civil service background to this matter. He knows about officialdom and has held official positions, so it is a pretence for him to say that the advice that he gave to Ministers would be randomly issued or made public even on rare occasions. That is not the convention.

Photo of Patsy Calton Patsy Calton Shadow Minister (Health), Health

Perhaps I can help the Secretary of State. What we are looking for is some practical measures that would lead to a reduction in MRSA, apart from the obvious measures on hand cleanliness and so on. What steps are he and his Department taking on bed occupancy rates, which the medical profession believes have an impact on MRSA, and on the availability of single rooms, which enable isolation?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

Half of all the new private finance initiative projects have single rooms in a far greater percentage than anything that we have had previously.

I do not want to spend all day on this matter, as I thought that most of the problems were known to everybody. They include old and crumbling buildings, lack of hygiene, shortage of staff, high throughput and the increasing immunity of methicillin-resistant Staphylococcus aureus itself. I could go on and on about the individual items that are part of this complex problem. What are we doing? We are building new hospitals, employing new staff and banning the two-tier contracting out of cheap cleaning services. We have gone through a range of such issues one by one. Having identified potential causes, we are going through them and applying a remedy to each. People are perfectly entitled to think that MRSA is a tragedy and a huge problem, as it is, and they may even think that the Government have not been doing enough about it, but it is not right to imply that one party or another has a particular solution or that the Government are unwilling to listen to or act upon any sensible advice.

That is why I start my speech by saying that we know of the many challenges that we face. MRSA is one of them, but it is by no means the only one. As I said, we recognise that there is more to do, but it is also a matter of pride to all Labour Members that the nation's direction in both health and education is clear. In both, we will provide a future for our people that is fair for all of us and personal to each of us.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

I should like to make a little progress. I shall certainly let the hon. Gentleman in, and I think that I have been fair up to this point.

In the past few years, after several decades of what I consider to be a lack of ambition, we have started to make considerable progress in service delivery in both health and education. Even our worst enemy would accept that there has been significant progress. In health, cancer and coronary heart disease survival rates are only the clearest indicator of success. That is how we should judge our health service; not on the inputs, but on whether lives are saved and are being improved. All those things, incidentally, are missing from the present way of analysing efficiency in the national health service.

Let me mention two of the most obvious improvements, which are due to the efforts of national health service staff—people who are continually run down as being inefficient, unproductive and uncaring, and who feature on the front pages of some newspapers every time something goes wrong. Let me give two figures that are to the credit of those staff. There has been a fall in the premature death rate from cancer of 12.2 per cent. in the first six years of this Government.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

It may be, but is it not a good one and should we not celebrate it? If we celebrate a 12.2 per cent. fall in the premature death rate from cancer, should not all of us, including those on the Opposition Front Bench, doubly celebrate a 23.4 per cent. fall in premature coronary heart disease-related deaths, as it was six months ago? If we celebrate that astounding reduction in premature deaths, should we not also celebrate today when I tell the House that that reduction is no longer 23.4 per cent., as in the first six years of this Government, it is now 27.1 per cent.? I can hear the cheers from the Conservative Benches.

Those figures alone mean that 125,000 people are walking the streets of this country who would not have been doing so only 10 years ago. That is not some abstract statistic; 125,000 more people are alive, and do you know what, Mr. Deputy Speaker? That counts as a fall in productivity in the national health service, as those people are not going into hospital for full consultant episodes. Would it not be nice if Conservative spokesmen occasionally explained that, and explained that better health for people outside should be included in the figures? Rather than running down NHS staff, they should say that they will continue to campaign with us to remedy the measurement of good health care.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

I am sure that all my hon. and right hon. Friends welcome, as the Secretary of State does, the improvements in public health outcomes that have occurred since 1997, but in the interests of avoiding party political game playing, perhaps he would also like to repeat to the House that there were sharp reductions in perinatal mortality during the period when the previous Government were in office, as a result not of what that Government did, but of improved medical practice in the national health service. Perhaps he will remind the House that, by 1997, average life expectancy in Britain was two years longer than in 1979. I do not remember ever claiming in public that one lived two years longer under the Tories.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

The right hon. Gentleman may have missed it, but I did not once claim—I repeated the point three times—that the achievement was down to the Government; I claimed that it was down to NHS staff. I ask Conservative Members to do what the right hon. Gentleman did in 30 seconds and what Conservative Front Benchers were unable to do in 38 minutes—pay credit to the NHS. That is what I object to.

I celebrate when lives are saved through the NHS. All Labour Members celebrate the fact that, 60 years after the formation of the NHS, a young child born in this country will live nine years longer than they would have done before the NHS was founded. Although the right hon. Gentleman is never churlish—he has led that vast organisation, with all its faults and virtues—I cannot hear roars of celebration from Conservative Front Benchers,

Conservative Front Benchers do not celebrate the fact that, compared with the peak, 456,000 fewer people are on waiting lists. Waits of more than nine months for hospital admission have reduced from more than 118,000, which was the last Government's legacy, to virtually nil today. Nineteen out 20 people are seen, diagnosed and treated by our NHS staff within four hours—a world record. I cannot hear roars of applause from Conservative Members.

None of those achievements is reflected in the efficiency gains. If one waits three months, three weeks, three days or three years, it makes no difference to the present method of calculating efficiency, which is why I have said that the current method is absurd. Rather than using those calculations to beat NHS staff over the head, let us point out that the practical improvements carried out by NHS staff are not currently represented in those statistics.

Managers are the bête noire of the hon. Member for South Cambridgeshire. The NHS has about 38,000 senior managers, which is a ratio of about 3 per cent. to other staff and about one quarter of the figure in private health care. The 38,000 senior managers compares with about 400,000 nurses and about 130,000 doctors. Let us not use the weasel words that the number of managers has increased at three times the rate for doctors, because, although that might be statistically accurate, like damned lies, statistics can be misleading. It would be better to say, "However, that means an increase from 25,000 to 38,000 senior managers out of 1.3 million staff. The 38,000 figure compares with about 500,000 doctors and nurses and another 500,000 people who work in the other 71 professions in the NHS, 84 per cent. of whom provide front-line care." That is a balanced summary of what the NHS has achieved on manpower.

The hon. Member for South Cambridgeshire did not mention the huge improvements in health or, indeed, the huge improvements carried out under my right hon. Friend the Secretary of State for Education and Skills. Spending is up: since 1997–98, schools' recurrent funding has risen in real terms by £870, which represents a 30 per cent. increase per pupil to £3,740 in 2004–05. Class sizes are down: the overall pupil-teacher ratio in nursery, primary and secondary schools has fallen from 18.6:1 in January 1998 to 17.7:1 in January 2004, and hundreds of thousands of children are now in smaller classes. Teaching numbers are up: there are 28,500 more teachers since 1997. Teacher vacancies are down: they have been cut to 0.7 per cent. Most importantly for parents, standards are up. This year, the best ever primary results were achieved, with 53.4 per cent. of pupils achieving five or more GCSEs or GNVQs, and the highest ever number of students has been accepted at university.

Lives have been saved and improved. Yesterday's generation is living longer, today's generation is learning better and tomorrow's generation has a brighter future. That is not perfection, but, by any standards, it is substantial progress.

Photo of Nick Gibb Nick Gibb Conservative, Bognor Regis and Littlehampton

I know that this is not the direct field of the Secretary of State for Health, but he may be aware of Professor Timms's study of primary education. Professor Timms conducts huge amounts of random testing on primary schools, the results of which are not published. His conclusion is that the real improvement is only one third of what the Government claim for English in primary schools and only two thirds of what the Government claim for maths in primary schools.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

The hon. Gentleman plays a prominent role on the Education and Skills Committee, in which I think that matter will be discussed in the next 48 hours. I am not an expert, but I know that a discussion, in which he is no doubt involved, is taking place about the statistics. Importantly, nobody has said that substantial improvement has not occurred, and we are arguing about the rate of improvement. That is a legitimate argument, but that is not always reflected in some of the comments made by Conservative Front Benchers.

Those real, practical changes are a product of our core values. The matter means something to Labour Members given our commitment to fairness, about which we feel passionately. However, the improvements are more than that, and I want to address head on the remarks made by the hon. Member for South Cambridgeshire. Those improvements are also the product of determined, driven, systematically sustained reform programmes. We know that every pound wasted on health expenditure means that someone waits in pain longer or someone dies earlier than they should do.

We know that every pound wasted in education expenditure is a life's chance wasted for somebody, which is why we have been so committed to matching the investment of money with driving forward efficiency and reforms. I want to examine some of those reforms, which the hon. Member for South Cambridgeshire threw aside as immaterial in rather a churlish fashion. We have become more efficient. For instance, last year I announced that we would cut the number of posts in the Department of Health by 38 per cent., which involves 1,400 posts, and we are now well through that process.

I listened carefully to the comments made by the hon. Member for South Cambridgeshire about how to run an efficient organisation. He said that the percentage of top managers should not be too high, but a little modesty and humility would not be out of place: some 3 per cent. of the NHS work force is top management, but, as far as I can see by counting the number of Front-Bench posts in the Conservative party, 53 per cent. of the Conservative parliamentary party are senior managers—Front Benchers.

We will certainly do our best to reduce the number of Conservative MPs at the next election, but I have gone a huge way to reducing the number of people in the Department of Health by 38 per cent. We are already well into that process and a lot of money, which can be invested in the front line, has been saved. In May this year, I followed that up by announcing that we aim to halve the number of arm's-length bodies that support the NHS.

That was the target, but I do not know whether the hon. Member for South Cambridgeshire thinks it worthwhile. Should we not have had a target? Should we have wandered around talking about the matter, without any objectives whatsoever? [Interruption.] We will reduce Department of Health staff by about 5,000, expenditure by about £500 million and the number of arm's-length bodies from 38 to 20. All that money will go into front-line care.

Today, I have gone further, by publishing exactly how that will be done. I have published the next steps—the hon. Member for South Cambridgeshire referred to them—in implementing the review of NHS arm's-length bodies to ensure that the NHS gets most of the money locally and an efficient central service that offers value for money. The aim of the cuts in bureaucracy that we, the Labour Government, are implementing is to ensure that every spare penny that can be spent on the front line is thus spent.

I used the word "cuts", but there is a difference between us and the Tories. When the Tories cut health spending, they cut training places for doctors and nurses. Mr. Burns looks astounded. Let me remind him of his party's history. Those who do not know their own history are obliged to wander aimlessly in the dark, so I will enlighten him about the last Conservative Government. Under the Tories, nurse training places were cut—I wonder how much Conservative Front Benchers can recall of their slash and burn—by 25 per cent. We are constantly told that we need more GPs. Under the Conservatives, GP training places were cut by 20 per cent. And what is the deepest personal concern expressed by Conservative Front Benchers every time they stand up? It is dentistry. No one will be surprised to hear, however, that the last Conservative Government closed two dental schools, which led directly to the staff crisis that we inherited and the requirement that this Government reinstate those places.

When the Conservatives cut, they cut training places, front-line staff and the essential provision of care. When we restrict the budget on bureaucracy, we increase the number of nurses caring for the public—there are now 77,500 more than under the Conservatives. That is not enough, by the way, so God knows how understaffed we were when that lot left office. When we cut bureaucracy, we put it towards increases in training. Another 178 dentists per annum will be trained, more GPs than ever will be in practice and in training and more nurses than ever will be employed by the national health service.

Above all, we shift the emphasis and the benefit from providers to consumers—the patients themselves. Through the bulk buying of drugs, for example, we will use the power of the NHS to do what the Conservatives used to take a pride in—run an efficient business.

Photo of John Pugh John Pugh Shadow Spokesperson (Education)

If I follow the Secretary of State's argument, he seems to be saying that it is not necessarily a good thing to cut administrators in hospitals, but it is necessarily a good thing to cut administrators in the Department of Health? Why is that, and are those two points of view congruent?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

I have great respect for administrators, officials and managers. I have never been one of those who say that administrators do not add value. The idea that doctors would run their surgeries without receptionists or that surgeons and consultants would spend their valuable time not operating on and treating patients but on doing all their typing is absurd—it could come only from the mind of a Conservative Front Bencher. [Hon. Members: "What mind?"] Indeed, that is a contradiction in terms. It is absurd to suggest that a national health service, especially one of our size, can be run with much less than 3 to 4 per cent. senior management given that organisations in the private sector, including in private health, are running at three or four times that level.

If one is prepared to throw away the dogmatic obstructions that have sometimes curtailed those of us on the left of politics, one can use the size and power of the NHS to enhance efficiency inside and outside it—for instance, through the bulk buying of drugs. The recent pharmaceutical pricing regulation scheme agreement with the drug companies will save the NHS nearly £2 billion over five years. That money is going not to the drug companies but to the front line of services for the patients of this country. Through the bulk buying of private sector health care, the NHS has succeeded in driving down not only the price of private operations for the NHS itself, delivered free at the point of need, but the price of private health care provided to insurance companies. We are leaving more operations for the NHS at the same time as driving efficiency in the private sector. Conservative Members know that, which is why they are sitting bemused, asking, "Why weren't we doing this?"

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

Let me tell the hon. Gentleman what they did. They bought from the private sector at one-off spot prices of 150 per cent. of the price of NHS operations. The average price of our bulk buying at the moment—it is still going down—is about 108 per cent., including a start-up premium. As a result of judicious buying from the private sector, we are being given roughly the same as NHS prices.

If the hon. Gentleman wants to make contrasts in efficiency, that is a fair point—let us do it. Everyone knows that the Conservatives' policies are unfair, but they have an air of efficient business men about them. That is an illusion. Their plans are grossly inefficient, apart from being unfair. Let me tackle this head on. They believe that we should spend billions of pounds of taxpayers' money—currently £65 billion, rising to £110 billion—throughout the United Kingdom with no targets whatsoever: no objectives, no aims, no management targets, no concrete expression of their ambition. "Abolish all targets", they shout—not, "Let's have a managed transition" or "Let's have centrally driven objectives, as any business would, while we change the system", but the instant abolition of all targets. They would pour more than £60 billion of taxpayers' money into the NHS with no targets, no objectives and no drive for reform. That is today's Conservatives. They are economic anarchists throwing out billions of pounds of taxpayers' money and hoping that it will arrange itself on the floor in neat patterns and with some degree of productivity. The NHS would be the only service organisation in western Europe, public or private, to be spending billions of pounds with no objectives. How absurd can a political party become?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

I have not finished yet.

A huge degree of inefficiency would be unleashed in the public sector if that money were poured in without some direct targeted control. It is almost as though the Conservatives want the NHS to fail—as though they want to produce a complete recipe for inefficiency in the public sector in order to illustrate that they can never provide high-quality and efficient services.

Photo of Alistair Burt Alistair Burt Parliamentary Private Secretaries To Leader of the Opposition

I have been listening to the right hon. Gentleman's argument very carefully. Earlier, he spent some time praising the management and staff of the NHS, and rightly so, but he now seems to be saying that if they are given the opportunity to use resources they will be so uncaring of them, and so hopeless, that they will not be able to drive the NHS in the direction that they need locally where they have made decisions in consultation with others who work for the NHS. I cannot see where the two parts of the argument meet. Is he saying that he has no confidence in the ability of local NHS staff and management to handle resources well?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

No. I have great respect for the hon. Gentleman, but he is clearly having difficulty holding two ideas in his head at the same time. We will have a managed transition from centrally driven targets while we simultaneously change the system, making the driving and navigation force patient power, not providers' power. That is a sensible balance between two extremes. One extreme is to micro-manage everything in great detail from the centre, so that every time a bedpan falls in Tredegar it resounds in Whitehall—that is where we started from, although Nye Bevan himself never regarded that as the ultimate or the optimum structure for the NHS, because he desperately wanted to decentralise—and the other extreme is the happy-clappy friendship society that Alistair Burt seems to be suggesting. That is to say that

"'in this best of possible worlds . . . all is for the best', so here is £62 billion, go away and do something, and we won't exert any scrutiny or ask for accountability on behalf of the taxpayers." Both positions are extreme and both are silly. We want to reach a position that is in between.

If we suddenly decided to spend £110 billion on the NHS, without managed transition of the system so that it was driven by patients, and announced that we would be the only business in Britain that had no objectives, targets or aims—the official policy of the Conservative party—it would be absurd. It would unleash huge inefficiency. Hon. Members should not take my word for it but simply check the leaders of the Financial Times in May or June this year, which made that very point.

Matters are even worse, because the Conservatives plan to render more inefficient not only our public services but the private health care sector. The NHS used to buy operations from the private sector, but as one-off purchases, and often at high spot prices.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

The Secretary of State is obviously enjoying himself, but he should base some of his comments, at least tangentially, on the truth. Does he genuinely believe that the idea of block purchase by the NHS from the private sector was revealed to an unsuspecting world on 1 May 1997? Is that his view of how the world worked before that date?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

I did not say that no one had ever used block purchase previously. I said that the NHS used to make purchases from the private sector, often as one-offs and at high spot prices. I know what the right hon. Member for Charnwood did because we carried out a study for the Select Committee on Health, which my hon. Friend Mr. Hinchliffe chairs. The average price that the right hon. Gentleman paid was about 150 per cent. of the NHS price, because the purchases were not made systematically in huge bulk. I hope that he accepts that that is truthful because it is a fact. In general, if we can agree on the facts, we get to the truth.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

I am all in favour of agreeing the facts. I am delighted if the Government now realise, as they did not in 1997, the importance of establishing a proper partnership between the public and private sectors. The great shame is that the incoming Government on 1 May 1997 did not develop that policy from the roots that they inherited. Instead, they spent five years going off in the opposite direction. Only now is the Secretary of State for Health, like the Secretary of State for Education and Skills, returning us to a policy that he inherited on 1 May 1997.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

That is interesting. I hope that the right hon. Gentleman does not suggest that there is any difference between my right hon. Friend the Secretary of State for Education and Skills and me. We are the vanguard of revolutionary transformation of public services. I am proud to march shoulder to shoulder with him.

If the right hon. Member for Charnwood finds himself in a position—as he has just done—of congratulating us on our actions, he must simultaneously condemn Conservative Front Benchers for their proposals.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

Let me explain their proposals to the right hon. Gentleman. Having unleashed inefficiency in the public sector, they would do the same, if they ever got their hands on the reins of power, in the private health care sector. Let us remember the dog that did not bark, the elephant that no one mentioned—the patient's passport—which featured in the 40-minute contribution of the hon. Member for South Cambridgeshire. The Conservative Government would let anyone who could afford it buy any operation at any price from any private sector provider. Whatever the price or value, the Conservatives would provide an automatic public subsidy for such operations. That is a combination of the inefficiency of the worst 20th century subsidy-junkie thinking and the worst 19th century Conservative iniquities and inequalities. The Conservatives have managed to combine the grossest inefficiency with the grossest unfairness. They do that with so much embarrassment that they do not dare mention the policy during a major debate in the House of Commons.

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs)

The Secretary of State talks about unfairness. Apart from the unfairness of ascribing to us policies that we do not have, let me give him an example of terrible unfairness. What does he say to my constituent—whose name I am happy to provide to him—a young, fit guy who went jogging recently and had a heart attack? He did not realise that he was having a heart attack. The ambulance service in Staffordshire arrived within six minutes, so congratulations are due there, and staff gave him a decoagulant injection. He went to hospital for a week. He was told that he needed an angiogram to determine the precise damage that had been done. He was told that he would have to wait three months before he could be put on a waiting list and subsequently a further three to four months. However, he was then told that he could have it done tomorrow if he paid for it. He paid out of his own pocket—£1,800. Is not that inequity?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

If that happened, it is a disgrace. That is why long waiting lists are a disgrace. Long waiting lists and times create demand in the private sector by those who sometimes cannot afford to use it. I have no objection to anyone going private if they wish, for reasons of celebrity, money, taste and so on, but I object to the placing of people in a position whereby they or their loved ones are forced to pay for primary and secondary health care because the quality, and the time that they have to wait, in the NHS is a problem. Tragically, year on year, that was increasingly the position under the Conservative Government.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

If it is happening, and the hon. Gentleman gives me the name of his constituent, I will look into the matter. However, I stress that one of the reasons for the 27.1 per cent. reduction in premature deaths from heart-related diseases is the provision of thrombylosis and other treatment within 30 minutes. Survival rates for those who have suffered heart attacks and get treatment in 30 minutes of their arrival in hospital are huge compared with those that previously pertained. I shall revert to waiting lists shortly.

Photo of Mr Tim Collins Mr Tim Collins Shadow Secretary of State for Education, Education

I am sure that the Secretary of State is sincere when he says that he regards it as disgraceful that people feel that they must go private to make up for the problems that they find in the NHS. However, he said that the problem worsened under the previous Government. Will he confirm that the numbers forced to do that under the Labour Government have tripled since 1997?

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

I cannot confirm that the numbers have tripled. They increased in the first few years of the Government. However, given the lead time, as we reduce the waiting time for an operation from a couple of years to a maximum of 18 months, then 15 months, then 12 months, and, from three months ago, nine months—next year, no one will wait more than six months—the compulsion to go private is also reduced. People can continue to choose to go private—I have no problem with that if it is people's genuine choice. However, it must be a real choice; people must not be forced to go private because of inadequacies in the NHS. The more we address the quality, waiting times and waiting lists in the NHS, the less the compulsion for anyone, inside or outside the House, to go private.

Let me conclude the point about efficiency. We reject the inefficiency in the public sector through lack of targets and in the private sector through individual rather than collective purchase, which constitutes the Conservative party's policy. That policy is inefficient as well as unfair. Therefore, we have an entirely different philosophy from the Conservatives. Their policy would mean patients waiting in pain—the very subject that Michael Fabricant mentioned—because they would get rid of targets, waiting times would go up and about £1.5 billion a year of the capacity that reduces waiting time would be taken out of the NHS and put into a subsidy to enable those who are better off to jump the queue. It is as simple as that.

Across the centuries in which the Conservative party has been around, an enormous amount of work has been put into intellectually justifying selfishness and greed—that is a matter of historical fact—but I have never seen anything that enshrines that as much as the patient's passport. It does not surprise me that the hon. Member for South Cambridgeshire could not bring himself to mention it once in his 40-minute speech, because the idea that people have either to wait endlessly in a queue, in pain for years, or to find £6,500 for their knee replacement is abhorrent to people in this country. I truly believe that. The Conservatives are not interested in a patient's passport unless it can be supplemented by another book—the cheque book. That is totally at odds with the philosophy of this country.

So, for our part, we claim not perfection, but solid, significant progress. We will continue that in sustaining our record investment and in transforming the way in which patients experience the health service with this increased capacity. In our health improvement plans, we build on what we have already done.

In education, my right hon. Friend the Secretary of State for Education and Skills has already produced more than 45,000 new day care places, which have been opened in disadvantaged areas as part of the biggest ever single investment to expand child care. That is also why 90,000 more 11-year-olds are achieving the expected level for their age in maths than in 1997 and why fully 8 per cent. more pupils achieve five A grades at GCSE than in 1997. Real opportunities are now being taken by so many of our young people. These achievements, efforts and energies are theirs, not the Government's.

I return to what I said to the right hon. Member for Charnwood: I do not claim this for the Government. I have said constantly, on and off the record, for 25 years that the biggest driver of social change in this country is people's ambitions—parents, pupils and those who take themselves out of disadvantage. It is the Government's role to give them the opportunity to do that and to reduce the barriers that prevent them from doing it and that make it more difficult to achieve for some people who are in different circumstances from others.

So, we will do that and go further. Under the previous Government, people sometimes had to wait years for an operation. This, again, is the subject that the hon. Member for Lichfield brought up. In 1997, the maximum waiting time that we inherited was over 18 months. That was scandalous—18 months for just a third of the patient journey from final diagnosis to treatment; it included nothing before final diagnosis. My aim is to speed up the whole patient journey from GP referral—first contact—right through out-patients, diagnostic tests and, finally, treatment.

That is why by 2008, from the time of referral to a family doctor to the door of the operating theatre, no one in England will wait more than 18 weeks—

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

Thus far, we have met every pledge and every target we have made. We will make this one as well, because NHS staff will respond to the challenge as they have in the past. This should ensure an average wait of about nine or 10 weeks. When the hon. Gentleman says he hopes that will be the case, I hope he is not implying that he and his colleagues hope it will not, because this would be a marvellous boon for people in this country—a maximum waiting time of 18 months for just part of the patient journey under the last Conservative Government and a maximum waiting time for the whole patient journey of 18 weeks under the Labour Government due to the efforts of NHS staff and investment from the taxpayer.

Our choice is for everyone, and we welcome today's chance to compare our records. This has been an enjoyable debate for me; I hope it has been enjoyable for our colleagues on the Opposition Benches. More than that, it has been informative. We now know that, under the Conservatives, waiting lists rose by 400,000; under Labour, they have come down by 300,000. Under the Tories, nursing places were cut by 25 per cent.; under Labour, they have increased by 62 per cent. Under the Conservatives, GP training places were cut by 20 per cent.; under Labour, the number of doctors training to be GPs has reached a record level in the past few months and there are 80 per cent. more doctors—that is eight-zero, Mr. Deputy Speaker, in case anyone thinks it is an exaggeration—training than only seven years ago.

The hospital building programme, which ground to a halt under the Tories, is now the biggest in the history of the NHS, but the Tories want to abandon the first principle of the NHS, which is that treatment will be free at the point of need—once more, a policy for the few against the interests of the many.

The dividing lines for the next general election are clear. With Labour, access to operations will remain based on need, not on ability to pay; under the Tory plan, there would be charges for operations. With Labour, investment in the NHS will continue; under the Conservatives, there will be cuts and the diversion of money from the mainstream to subsidise the rich in jumping the queue. With Labour, guaranteed waiting times; under the Conservatives, unlimited waiting times once more. With Labour, queues cut; with the Conservatives, queues jumped, but only by the rich few. With Labour, an NHS fair to everyone and personal to each of us, not as the Tories want—timely health care only for those who can afford it.

That will be the choice when the time comes for the election. That time cannot come soon enough for me. I commend the Queen's Speech to the House.

Photo of Paul Burstow Paul Burstow Shadow Secretary of State for Health 2:57 pm, 30th November 2004

Indeed, the election cannot come soon enough. The sooner the better we can get on with it and dispose of the Queen's Speech and the legislation it contains, so much of which is about promoting fear rather than aspiring to hope and meeting the aspirations of this country.

This debate is about the inextricable links between health and education. As I listened to the Secretary of State rightly celebrate the significant improvements in survival rates in respect of cancer and coronary heart disease, I was thinking just how much that link comes into play. While undoubtedly it is right to celebrate and applaud the contribution that NHS staff have made to those successes with increased survival rates, the fact is that education messages over many decades that have resulted in more and more people giving up smoking have probably contributed even more significantly to those survival rates than anything else.

That is why we on the Liberal Democrat Benches take the view that education has a key part to play in the health of the nation—unlocking people's potential and enabling them to have opportunities to improve themselves and their lives. Education has a vital part to play in equipping people with the skills and knowledge they need to exercise an informed choice on their health, to take control of their health and, when necessary, take control of their own health care.

A number of Bills in the Queen's Speech relate to education, and I hope that my hon. Friend Mr. Rendel might catch your eye, Mr. Deputy Speaker, so that he can address some of them in more detail than I propose to do. However, I want to make one or two comments. The Secretary of State referred in his peroration to the dividing lines between the parties. This Queen's Speech contains a number of dividing lines, one of which is the Government's tendency to concentrate power in Whitehall, to centralise, to undermine locally elected authorities, and to set appointed and unaccountable quangos in place of democratically accountable local bodies. The education and schools Bill is just one of a succession of local government, health, education and policing Bills that have reduced local accountability and imposed national priorities.

Local authorities should have an enhanced role in co-ordinating services for school-age children. Is that not what children's trusts are meant to be all about? It makes no sense for the Government to champion integrated services with the Sure Start programme, which the Liberal Democrats support, only to abandon that principle when children reach the age of five. Local authorities should be given the opportunity to champion the co-ordination of services to ensure that no child is left behind.

On the issue of school inspections, which will also, I believe, be covered in that Bill, it is welcome that the Government are at last beginning to recognise that endless inspections are not the key to higher standards—that does not just apply to schools and education but to the health and care sectors. Instead, such inspections in schools increase the stress on teachers and pupils and take away valuable time from teaching. We hope that Ofsted will be able to move towards a more constructive role, auditing school improvement and offering advice about best practice, and that this legislation will therefore pave the way for that. But it is disappointing that the Queen's Speech does not provide similar opportunities with respect to the role of the Healthcare Commission and Commission for Social Care Inspection and, indeed, does not provide the opportunity to bring those two bodies together, so that, for the first time, we have one agency responsible for setting the framework of standards and regulation for the whole health and care sector.

The child welfare Bill, which is in its draft form for scrutiny in the House, appears to refer only to enforcement of rules after a settlement has been agreed. Our initial thoughts are that the changes are necessary but should occur before that point, to ensure that children do not get involved in long-running and emotionally damaging legal disputes. Indeed, figures from the Office for National Statistics show that 88 per cent. of non-resident parents are satisfied with informal arrangements reached outside the court, and that only 35 per cent. are satisfied with the outcome once they get to the courts. Surely that makes the case for far more pre-legal mediation and support services.

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

Would the hon. Gentleman concede that our Green Paper on this subject sets out policies to do precisely what he suggests in terms of developing and changing the role of the Children and Family Court Advisory and Support Service? The proposal announced in the Queen's Speech relates to the court aspects of that, but what he proposes is set out clearly in the Green Paper that we published a few months ago.

Photo of Paul Burstow Paul Burstow Shadow Secretary of State for Health

That is helpful, and we would certainly acknowledge that. We look forward to seeing the detail of the Bill and working with the Government to ensure the best outcomes for children. We share the sentiment in the Queen's Speech that the welfare of children is paramount, which is made clear in the Children Act 1989. However, an alternative view seems to be advanced in some corners, not least by the Conservatives, in which perhaps the interests of parents should be paramount, and that 50:50 access should be statutory, regardless of whether that is in the best interests of the child.

The Conservatives also propose the abolition of CAFCASS. The Liberal Democrats hope that the Government—from what we have just heard, we are reassured—will take a more measured view and not simply play to the gallery, particularly a gallery that is often filled with people wearing Batman costumes. We need to ensure that the needs and interests of the child really are placed first, and if that means that both parents have 50:50 access, that is right, but if it means that the interests of the child are not central, it is not right.

I said that education and health are inextricably linked. One area in which there is a need for rapid progress is school meals, and I note that the public health White Paper says that the Government plan a three-year review of school meal standards in England. That is a devolved matter, and one might think that school meals standards would not vary much between Scotland and England. On the face of it, one would expect them to do the same thing. On closer examination, however, there is a clear difference between Scotland and England in the emphasis given to nutrient guidelines, for example. In Scotland, the guidance on school meal standards talks about achieving nutrient requirements as "essential", and the overall tone is set by words like "should" and "required". Compliance in relation to nutrition is clearly expected. By contrast, England's guidance specifically says that only the regulations are compulsory and that the guidance on good practice, which includes nutrient levels, is "not required by law". The net effect of putting the nutrient recommendations at the end, pointing out that the guidance is not compulsory, and using words such as "aim" and "try" is that the specific nutrient content of school meals is marginalised.

The Health Committee was therefore absolutely right to recommend that England should shift as soon as possible from the current food-based standards to the Scottish nutrient-based standards. The White Paper is disappointing, as it simply states that the Government will consider such a change—and, in a leisurely fashion, over the next three years. Yet good-quality, nutritious food has a key part to play both in the academic attainment and performance of children and in shaping healthy diet habits that will last a lifetime.

Photo of Barry Sheerman Barry Sheerman Chair, Education & Skills Committee

I hate to score points against the Health Committee, as its Chairman is a good friend, but three years ago, the Education Committee, in its inquiry into school meals, also strongly recommended that. We are still waiting for the Secretary of State to act on it.

Photo of Paul Burstow Paul Burstow Shadow Secretary of State for Health

The hon. Gentleman has not so much scored a point off his hon. Friend the Chairman of the Health Committee, but made a useful point about the fact that this issue has been hanging around for a long time. The evidence is compelling that, in England, the school meals service suffers from poor standards and underinvestment, and that it is doing a disservice in many parts of the country, despite the noble efforts of the many catering staff who try to provide meals.

The same delay, hesitation and further consultation in relation to the public health White Paper's proposals also applies to alcohol, smoking and food labelling. The Queen's Speech included a drugs and alcohol abuse Bill. Although that is a Home Office Bill, drug and alcohol abuse have far-reaching public health consequences, which turn up in our accident and emergency departments on Thursday, Friday and Saturday night, almost every weekend, in every city centre up and down the country. While the Liberal Democrats welcome the Government's commitment to increase the number of addicts going into treatment, we will examine closely the details of the Government's proposals.

The Government rightly talk about the need to expand treatment, yet their own figures on the numbers in treatment are misleading. They claim that 154,000 problem drug users underwent treatment in 2003–04, with an expansion in treatment places of 55 per cent. in the past five years. But if we examine the figures in more detail, we see that that was an estimate. What the National Treatment Agency for Substance Misuse goes on to say is that 125,900 individuals were "in contact with treatment". Precisely what that means is perhaps the subject for an Adjournment debate, but it suggests that the Government have claimed too much.

In relation to tackling the alarming rise in alcohol abuse, this Bill, in line with the Government's alcohol strategy, appears to be focused on containment and punishment rather than on treatment and prevention. While we welcome a clampdown on alcohol-fuelled rowdiness, which makes such a mess of our streets, blights the lives of many in our town centres and certainly does not make those in our communities feel safer, that is only half the equation. The Government are failing to address the health consequences of Britain's binge drinking culture, which is a ticking health time bomb. There has been a 75 per cent. increase in hospital treatment for alcoholic liver disease since 1996. Alcohol-related deaths have hit a new record, and have more than doubled over the past 20 years. The Government must focus on more than just containment of the problem; they need to deal with the causes.

Alcohol abuse among teenagers is storing up huge long-term health consequences. Every day, nine children are admitted to hospital because of alcohol- related problems—a shocking statistic. The public health White Paper was hopelessly weak on this issue. Last year, a MORI poll revealed that only 7 per cent. of men and 22 per cent. of women knew what the Government's recommended alcohol consumption was for them. Clear labelling with the numbers of units should be mandatory, and linked to a major public information initiative to publicise the recommended intake limits.

Improving training of health care workers is also vital, particularly in primary care, as identifying and tackling alcohol dependence problems at an early stage is key. According to research by Alcohol Concern, of an average 360 hazardous and harmful drinkers who visit a GP every year, seven or fewer will have their drinking addressed by their doctor. Alcohol problems are treated more easily and more cheaply if caught early, yet only 7 per cent. of all NHS spending on alcohol misuse is spent by GPs. The Government must ensure that this Bill begins to deal with alcohol problems, and does not just deal with drug problems, and that treatment for dependency is extended to people with alcohol problems as well as those with drug problems.

The Government's White Paper on public health also falls short in terms of protecting people from harm caused by passive smoking, and the Queen's Speech contains no Bill to do something about it. If the Secretary of State for Health admits, as he does, that passive smoking harms, that passive smoking kills and that there is no safe level of smoke, how can there be any exceptions from a ban on smoking in enclosed public places? The idea of exempting pubs that do not serve food is strange: the distinction seems to me to be born of administrative convenience rather than any real logic. Why should the health of someone eating a ploughman's lunch with a pint in a pub be more important than that of someone drinking a pint on its own?

Guidance on the health and safety responsibilities of employers to their employees makes it very clear that current evidence of second-hand smoke doing harm and killing people is so compelling that failure to protect staff from that risk puts employers at risk of legal action. Research makes it plain that ventilation systems cannot guarantee a safe working environment. I am told that as many as 10,000 air changes an hour, equivalent to a mini-tornado, blowing through a pub would be necessary to achieve anything like the necessary risk reduction. The Government's proposal to ban smoking in bar areas is unworkable and cannot ensure the safety of bar workers, let alone anyone else.

Just where is the sense of urgency? No legislation has been announced in the Queen's Speech, and we have a timetable that is content with a three-year delay before even a partial ban on smoking in enclosed public places comes into effect. Why are the Government putting off giving a lead for two years? Despite the chief medical officer's recommendation in his 2003 report "Going Smoke Free" that NHS premises should be smoke-free by 2004, we must wait until 2006 for even that fairly modest step to be taken. Just where is the leadership?

Then there is the question of labelling. Delaying action until 2006 and leaving everything to voluntary labelling codes fails to give consumers the information that they need to make health choices now. I hope that the Government will think again about introducing such measures earlier, not least given the clear public support that the Food Standards Agency has found.

The Queen's Speech also states that the Government want to continue their reform of the NHS, offering more information, power and choice to patients, with equal access for all and a service that is free at the point of delivery. It is a wonderful motherhood and apple pie moment but how real is choice when so many people struggle to get on to the list of a local GP or NHS dentist in the first place? People in many areas are struggling to gain access to local GPs. According to the Audit Commission, as many as 250,000 people each year cannot find a GP because of list closures and other problems, and find themselves being assigned to a GP as a consequence.

In its rather understated way, the Audit Commission described that as

"a significant issue for patients."

It certainly is a significant issue for many of our constituents. People should be able to choose their GPs and obtain care closer to their homes; they should not be allocated GPs on a basis that might entail longer journeys from where they live. Where is the choice for those 250,000 people each year? Where, indeed, is the choice for my constituents? Recently one of them, Miss Jean Duncanson, wrote to me about the difficulty that she and two of her neighbours in Elizabeth house—local authority sheltered housing—had experienced in registering with the local GP in Cheam village. Neither she nor her neighbours were able to do so; instead, they were told that they must travel by bus to practices in Sutton. My constituent felt discriminated against and let down. There was a surgery just around the corner, close to her home, to which she could not gain access.

It is not just a question of access to GPs, however. Only last week the National Audit Office expressed concern that the new dentists' contract might result in dentists reducing their NHS commitments further owing to lack of detail about the changes. Clearly the move away from a piecemeal, piece-rate approach makes sense, but the NAO has tapped an anxiety that needs to be addressed. The situation is indeed very worrying, given that only half the population are currently registered with NHS dentists. We need to make significant progress. The Government's dental work force review, which it took the Government over two years to publish, found that there is currently a shortfall of nearly 2,000 dentists—whole time equivalent—and that the number is set to rise to up to 5,000 by 2011. The Government say that there will be 1,000 extra dentists, but that is fewer than the forecast shortfall. Again, there does not seem to be enough urgency in the face of what is a massive problem of dental failure. It was inherited from the Conservatives, but it has not been addressed adequately in seven years of Labour government. Ministers are for ever talking about patient choice, but when it comes to finding a dentist millions of people throughout the country have no choice at all.

The Secretary of State spoke of the need to move from the current waiting-time targets to an 18-week end-to-end journey time for the patient. That may be a welcome goal of which we all approve, but just when will the Government make available information on diagnostic waiting times? In June, when the Secretary of State made a statement on the NHS improvement plan, he accepted that diagnostic waiting lists were the NHS's hidden waiting lists. Many of my constituents feel that they are stuck and lost in limbo, waiting for diagnostic appointments and the right scans so that they have the diagnosis that will enable them to secure the treatment that they need. It cannot be right for the information not to be collected and published, when that would allow everyone to see just how well their own NHS trust is performing and would help us to see how waiting times can be cut.

People are waiting for months in hospitals across the country for vital computerised tomography, magnetic resonance imaging and other diagnostic scans. As I have said, the Government have announced that they will cut the waiting times, but they themselves do not know how many patients are waiting for diagnostic tests or how long they are waiting; and they have failed to introduce a system for the routine collection of data from hospitals which would provide a clear picture. Without reliable and accurate data, how on earth do the Government expect anyone to plan properly to reduce diagnostic waiting times in the first place?

Mr. Lansley raised the question of my party's commitment to hypothecation of national insurance to fund the NHS. While not wishing to talk about his own policy on many matters, he was quite happy to talk about ours. I too am happy to say a little more about our policy. I certainly want to make it clear that we are committed to matching the Government's spending plans in full, and to achieving the staffing improvements that have been proposed for the next four or five years.

The aim, first and foremost, of our proposal for an NHS contribution is to make clearer to people just how much they are spending on the NHS from their taxes, as an aid to accountability and transparency. We are committed to hypothecating national insurance for that purpose. The figures given by the hon. Gentleman are the sort that one should look at closely before foolishly stepping into the big hole that he was trying to dig for me. If he writes to me setting out the basis of his calculations and assumptions, I shall be more than happy to write back explaining where he is confused and wrong about our policy. Perhaps when he writes to me he will also explain how the Conservatives justify spending £1.2 billion to fund a policy that used to be called the patient's passport policy, but is now a policy without a name—but with a deadweight cost of £1.2 billion for the NHS, without a single extra operation being performed as a result. If the hon. Gentleman is prepared to write to me about that, I shall be more than prepared to respond to him further on other matters.

The Queen's Speech also referred to the Government's intention to continue pre-legislative scrutiny of the draft Mental Health Bill. I have had an opportunity, as I am sure others have, to dip into some of the evidence sessions—to hear some of what has been said, and to read many of the transcripts. It appears from the evidence taken to date by a Joint Committee that has examined the draft Bill in detail that it has a long way to go before being anywhere near acceptable to those with an interest in mental health services and problems. It strikes one as a Bill that was drafted in the Home Office rather than one that was conceived to meet the needs of people with mental health problems. That concern is shared by the Law Society, by nearly all—if not all—mental health charities, and by professional groups.

The Government have performed a unique act. They have managed to construct a coalition of interested parties across the board, all of whom say one thing: that the Bill is the wrong Bill. Compulsion is not the right way in which to deal with mental health problems. Indeed, Cliff Prior, chief executive and chairman of the mental health charity Rethink, said the following in giving evidence to the Committee:

"When this long drawn out process began in 1999, the government's stated aim was to reduce compulsion. It was told that its plans would do just the opposite. Despite a few concessions, nothing has been done to address this fundamental flaw."

Indeed, I understand that when, during some of the visits carried out so far, people were asked whether they preferred prison or a mental health institution, many opted for prison because there is a guaranteed release date and the guarantee of spending a certain amount of time each day in the fresh air. Those two guarantees do not seem to apply to people who languish under restraint in mental health institutions.

Finally, the Queen's Speech talks about health care free at the point of delivery. We Liberal Democrats are entirely signed up to that principle, but if it is indeed to be free and available at the point of delivery, why, for example, does a person with advanced dementia who requires catheterisation, help with feeding—even peg feeding—and intimate personal care have to pay for such care? How can that be fair? The Queen's Speech should have included a Bill to end the arbitrary divide between health care, nursing care and personal care—a divide that is defined more by who provides the care than by the nature of the care itself.

This is a Home Office Queen's Speech and a programme with one date in mind: polling day. Health and education are the poor relations in the legislative programme that this Queen's Speech sets out. That programme places fear ahead of hope, and we Liberal Democrats will continue to provide an effective opposition to it.

Photo of Barry Sheerman Barry Sheerman Chair, Education & Skills Committee 3:21 pm, 30th November 2004

It gives me great pleasure to contribute to this debate. Most of my remarks will focus on education, but as is our privilege in this debate, I shall start by commenting on the broader context of the Queen's Speech. We do indeed have the opportunity to take a longer view, and the comments of the Opposition spokesmen—both of whom dealt mainly with health—perhaps reflect the fact that we are getting close to a general election that everyone seems to think will take place next May.

Time and again, my constituents come to my advice surgeries, or write to me, to say how much the health system has improved for them, and genuinely to thank me as a Labour Member of Parliament. No reasonably fair-minded person can doubt that consumer satisfaction with the health service has gone up astronomically in the past seven years. The picture with education is also very encouraging. When the Education and Skills Committee recently went to Norway, the permanent secretary in Norway's department of education said, "I am perhaps going to make you feel uncomfortable. Normally, you seek information on these visits, but I want to ask you some questions. We spend far more on education than you do, but the reforms that you have introduced seem to be producing outstanding results and pushing up standards. We want to learn how to do what you're doing, because in Norway we spend far more per head on education."

In the context of the real world, I am now going to be slightly unkind about the Government, even though I honestly feel that there has been a great increase in the quality of health care and a great improvement in many aspects of the education service. I have always been interested in preventive health care. As most people who know me realise, I am not a health expert, but early in my career in the House, I and others formed a group called the Parliamentary Advisory Council for Transport Safety. We campaigned for seat belt legislation, and for many other reforms that have saved countless lives over the years during which we have energetically pursued these issues. In that time, PACTS has made a real difference, and I welcome the measures on road safety in the Queen's Speech, because they will save many lives.

It is important to strike a balance on these issues. We all know that the safest way to travel is by aeroplane, the second safest is by train, and the most dangerous is by bicycle or motorcycle. So when there is an accident on the railway, let us please see it in that context. Before spending billions of pounds of taxpayers' money on saving a tiny number of lives a year, we should consider how many people are killed on our roads every day.

I am sorry that the Secretary of State for Health is not in his place, because if he were I would say to him in public what I have said to him in private. I came to this House to protect people in the workplace, and the evidence shows that passive smoking not only kills but causes dreadful ill health and means a much shorter life for the many people who have to breathe in other people's smoke while at work. I have always believed that if we approach this issue in terms of protecting workers' health there is an indisputable case for rapid change, so it grieves me that no measure has been introduced. We have a White Paper, we have had the discussion and the arguments have been made. There is no reason why the Queen's Speech should not have included a commitment to enabling this House to introduce a Bill similar to those introduced in Norway and in the Republic of Ireland a year ago. Two of our European Union colleagues have introduced such legislation, and it is already working very successfully in both those countries.

Let us consider the deep shame of what happened to the miners. It was not until the mid-1960s that legislation was introduced to protect miners from breathing in the filth of the mine debris and dust that caused so many dreadful diseases. What a shameful record. Yet now we are lingering—waiting to introduce a measure that everybody knows needs to be introduced. The White Paper is a step in the right direction, but it gets a critical point wrong. If we believe in protecting workers' health, we cannot exclude 20 per cent. of establishments from the smoke-free provision. Are we going to say that workers in those establishments should not have to care about their health, and neither do we? What sort of legislation would that lead to?

I have a warning for the Secretary of State for Health and for those on the Front Bench. Why should this be a party political measure? I believe that when a Bill on this subject comes before the House of Commons—it is a pity that that will not be sooner rather than later—on a free vote, there will be an overwhelming majority for a measure along the lines of the Irish legislation. That is my clear view, and if I were lucky enough to secure a slot for a private Member's Bill this week, I would introduce such legislation myself, and hope that the Government would give it fair wind. That gets that particular concern off my chest.

I will say in passing that I have been a long-term advocate and passionate believer in a system of identity cards. I cannot believe some of things that I have heard about the identity card scheme—I see my colleague on the Select Committee, Mr. Gibb disagreeing with me, as I would expect. If we are going to have a decent system of law and order in this country and be able to catch the criminals who plague the lives of some of my constituents, identity cards are crucial. I am not convinced by the arguments of Conservative and Liberal Democrat Members against the scheme.

Having now alienated most hon. Members with my views on what should and should not have been in the Queen's Speech, may I quickly run through two or three concerns about the long-term implications of aspects of the education proposals? I have already said that I believe that there has been a profound positive improvement in the quality of education in our country, but what worries me most is that, as Chairman of the Education and Skills Committee, I am aware of areas where we are not applying the views that the Government have enunciated.

For example, we as a Government believe in evidence-based policy—we hear Ministers telling us that all the time. That is a very good rule: finding evidence and introducing policies on the basis of it. No Government or Administration get it right all the time, but since 1997 this Government have introduced many interesting, innovative measures and, even more importantly, put substantial resources behind them. There has never been as much money invested in education in this country as has been invested since 1997. That is good news.

However, I have to say to the Secretary of State and the Government that they must evaluate their measures carefully and respond quickly. Some will work and some will not; some will become something of a disaster. As Chairman of the Select Committee, I know about individual learning accounts and attempts to establish a UK e-university. Those were brave experiments and good ideas, but they did not work out in practice. We have to dust ourselves off, evaluate what went wrong and then get it right next time. If there is a general systemic failure across a range of issues—perhaps in some of the public-private partnerships that the Department has implemented—we have to learn from it. The Select Committee's role, at its best, is to advise the Government how to put problems right.

Sure Start policy is another important issue. I have been a devoted supporter of it, and all the research and modelling from the best think-tanks shows that the best possible spend that can be made is on early years education. That is where the best value for money is. Stimulating children's imagination and giving them the chance to change their lives very early on is important, as is giving parents the opportunity to stimulate their children in the right way. I am wholly convinced by that, but the early research into Sure Start seems to show that only about 28 per cent. of it is effective. The Secretary of State needs to be aware that very good programmes sometimes yield results that are not 100 per cent. effective. Sure Start-type programmes need to be modified and built on in the future.

On the other hand, I can say that our policy on free nursery places has proved magnificent. The recent research of Cathy Silver and her team showed how excellent pre-school experience is. What a fantastic investment it has been for the taxpayer. It is important to get the balance right and understand the need to monitor the evidence closely and respond quickly to modify policy.

The Government will probably not like to hear another criticism, but the Queen's Speech refers to Ofsted and the need to modify it. It is my Committee's job to hold Ofsted, as well as the Government and the Department, to account, and Ofsted has appeared regularly before our Committee.

We have consistently argued for lighter-touch inspection. I am delighted that the Government are introducing such a system, although I have some concerns about using lighter-touch inspection across the piece as a rule. Some schools—perhaps between 10 and 20 per cent., although I do not know the exact figure—may need a much longer inspection. They may need a longer inspection, but they do not need inspectors to come in, tell them what is wrong with the school and then walk away without providing any help to sort out the problems and get the system right. That has always been my criticism of Ofsted: too often, it goes into a school setting, tells the school that it is not performing in a range of areas and then walks away.

When we press the chief inspector of schools, David Bell, and ask him, "But surely if you find that a number of schools in one town or city all have a similar problem"—in other words, systemic failure—"do you mean to say that you would not pick up the phone to the LEA's director and say 'you've got some problems here, and it's not just one school—it's a cluster of schools—and if you don't do something about it, when we evaluate you, as the LEA, you will have problems?"' The two things are not really in sync. Yes, Ofsted evaluates LEAs and yes, it evaluates schools, but it fails in the systemic evaluation of schools in certain areas, and the Government must be very careful about that problem, especially when it is linked to my second point.

My second point is that, in the Queen's Speech, we have yet another step towards schools becoming more independent and more in control of their own destinies than ever before. That journey has been going for a long time, but I tell the Secretary of State for Education and Skills that it is perilous. We took the Select Committee to look at the system in New Zealand, where a Labour Government gave absolute independence to their schools 10 years ago. There are no local education authorities and there is no council interference—local councils no longer have an education remit or role—but the people who had experienced that system for some time found it very difficult. The independence was such that, where systemic failure was found, there was no one between the department of education and what was happening in the schools, so it became extremely difficult to achieve systemic change in the education system and process.

C

It is marginally more dangerous to travel by car than by bicycle per million kilometers travelled:
Source: Dekoster J, Schollaert U. Cycling; the way ahead for towns and cities. European Commission DG XI. 1999

Submitted by Chris Beazer

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs)

The hon. Gentleman is raising an interesting issue. Does he think that a comparison can be made between education and health? The point that he makes about systemic problems is almost a study of epidemiology. Is the problem in New Zealand not so much that the schools are independent but that there is no proper study of what might be going wrong? Does he not think that, if there were greater independence for schools in the UK, combined with a better Ofsted system similar to that which he espoused earlier, one could get the best of both worlds?

Photo of Barry Sheerman Barry Sheerman Chair, Education & Skills Committee

No, that is not the answer. My analysis of the situation—I take a lot of evidence and look at many other countries' experience—shows that real problems are involved in giving up the ability of local authorities to take an overview and knit together a process. I shall give an example, and in doing so, I shall come to my third point: 14-to-19 reform.

Most enlightened people in the education world in this country passionately believe that it is right to introduce 14-to-19 reform—in fact, all the major parties in the House are still in favour of reforming 14-to-19 education—and Mike Tomlinson gave evidence before our Committee only last week. However, if we introduce a major 14-to-19 reform— of course, that bridges 11-to-16 education and post-16 education, which are very different systems; one has an LEA input, while post-16 education largely does not—who organises the system? Who knits it together? It is a magnificent challenge to get 14-to-19 education right, because if we do, it will start to deliver proper education and a parity of esteem between the people who have taken an academic route and those who have taken a more practical and vocational route. We are on a wonderful journey, and I admire the Government for leading in that direction.

I do not see anyone other than the local education authorities with any democratic roots. I do not count the Learning and Skills Council, because it is a quango even though it reports to our Committee. Therefore, if there is no other system builder that is capable of knitting together 14-to-19 education reform, the local education authorities will have to take on that important role.

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office

I thank my hon. Friend and good neighbour for giving way on this point. In his analysis and from the experience that we have in west Yorkshire, what contribution does he feel can be made to bringing out the best qualities of each school and each individual by schools collaborating across a whole area? They can contribute to what he says about knitting across the system of post-16 education.

Photo of Barry Sheerman Barry Sheerman Chair, Education & Skills Committee

That is absolutely typical of my good neighbour. She steals my next line, which I hoped was going to be my best one. I am making the case for being very careful about getting rid of the one agent for systemic change. I am worried about that in terms of what I have said about Ofsted and inspection and what I have said about the diminished role of education authorities.

It is not just the Queen's Speech that counts, and the Secretary of State knows that very well. There is a five-year plan and, if we want to know how independent schools will be, we should look at the five-year plan, at what will happen to foundation schools and at how easy it will be to become a totally independent school that owns the land and everything else. Such schools will be totally independent and all they have to do is have one vote through the governors.

I hope that the Secretary of State will compare that with what we said in our admission inquiry report. We pointed out that the vote in such cases was nonsense. Whatever view one takes about grammar schools and the 11-plus in parts of the country, no one can defend the basis on which the ballot takes place. It does not work. I almost said that it was crooked, but it is not. However, it is totally distorted to get one answer, and that answer will always be no. That is not a fair basis for consultation. We said that on an all-party basis in the Select Committee and it is absolutely true. Let us compare that with the vote on becoming a foundation school. One vote take places in one room in the school and then it becomes a foundation school.

I return to the point made by my neighbour, my hon. Friend Kali Mountford. A bit of the Government is always saying that the only way that we will knit together 11-to-16 and perhaps 14-to-19 education is through a greater degree of collaboration across schools. All the specialist schools in, let us say, Huddersfield, Colne Valley or Birmingham, where the Select Committee spent a week looking at education, have to work co-operatively together. That is the best way of getting the most out of the education system.

A senior adviser to the Government on London schools, Tim Brighouse—he was the chief education officer in Birmingham—has a notion of collegiates of schools operating together across the piece. That is a magnificent vision. However, if the Secretary of State really thinks that he will get that level of co-operation from individual barons or baronesses running their own schools, he should talk to any head about co-operation and collegiates of schools. They will say, "It is a wonderful idea, but I wish I had the time to do it." It is a complicated thing to achieve. If we want such participation and co-operation, head teachers will need someone to help them, and from my experience that will be their local education authorities. The Secretary of State should be cautious about riding the horse of greater independence for schools and diminishing the power of local education authorities while desiring more co-operation across the piece, because it will probably end in tears.

I shall make a final point because I have taken up far too much time, albeit only half that taken by anyone else who has spoken. It is proven that the best target for great investment in education is the early years, but another aspect of education comes close and is important to the future of our country. I shall again be nice to the Government. They have run the most successful economy in the developed world for the past seven and a half years—brilliant! Thanks to the Prime Minister and the Chancellor working as a close-knit team, they have delivered the wonderful economic situation in which we have found ourselves that has allowed us to afford the investment that we have ploughed into health and education. However, the future of the way in which our country innovates, produces new enterprises and becomes more successful as an entrepreneurial culture depends to a great extent on our higher education and the research carried out in our universities.

When the Education and Skills Committee reported on the Government's White Paper, we said—albeit slightly as a subtext—that the most important aspect was the recommendation on research funding. We thought that flexible fees, or top-up fees—whatever one wants to call them—were a secondary issue. The amount invested in research and the places in which the investment is made is the most important matter for the long-term future of our country. We warned the Government about concentrating too much big science research in a handful of institutions.

I discussed the matter with Sir Richard Sykes. I asked him whether his suggestion covered only five universities, and he said, "Yes, only five." I told him that that would mean that all the science-rich research universities would be in London and the south-east, and he said, "Yes, so what?" I tell you, Madam Deputy Speaker, that that proposal would exclude your constituency and mine. It would exclude the regions of England and the rest of the UK. Research would be focused in London and the south-east to too great an extent. If we are a country of all the regions, each region should have at least one big science research university, and it would be appalling to aim for anything less. The research assessment exercise has been driven by picking only five and five-star rated departments to get the riches from the Higher Education Funding Council, but that is plain wrong. Departments that are three or four-star rated are those in which hungry men and women are researching away because they want their departments to have a five or five-star rating. Many of the great inventions and breakthroughs have come from departments with ratings of three or four.

Four chemistry departments have closed in our universities in recent times, including one in Exeter, but that cannot be right. Lord Lewis has consistently made the case that a critical mass of departments is required to retain sufficient scientists in a country such as the United Kingdom and thus keep a subject alive. That is how people continue to innovate and get the highest prizes that the world has to offer.

I hope that the Government will go back to our Committee's evaluation of their higher education proposals and think carefully about what they will do in the months running up to the general election to promote fair investment in our universities' research departments. If that means shaking up the HEFC a bit, I am sure that the Committee will help them. If it means examining clearly the assumptions underlying the research assessment exercise, we will help with that, too.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood 3:49 pm, 30th November 2004

Like everyone else, I enjoyed the Secretary of State's speech—perhaps even as much as he enjoyed making it. However, I have one or two comments to make that arise from it.

The right hon. Gentleman delivered a Jekyll and Hyde speech. The Dr. Jekyll personality gave a presentation of the Government's health record that, broadly speaking, I sign up to. He offered the view that the NHS is not perfect, but invited us to appreciate the fact that it has made solid progress since 1997. I freely concede that it has done so. Indeed, I made the same speech on the NHS, inviting people to recognise that it was not perfect before 1997, but that it made substantial progress between 1979 and 1997, as it has done since its foundation in 1948.

It is possible to have a debate that recognises that every party in the House is committed to developing the NHS. We have all played a part in that development. We are all responsible for some of its failings and we can all claim some credit for some of its successes, but we should always recognise that the real successes are the result of the contribution by the professional staff, not of the politicians who are briefly responsible for it.

That was one personality that the Secretary of State presented. Although I disagree with aspects of his record and the Government's record—I shall say a bit about that later—I gladly sign up to some of the things that he said. However, it was not just Dr. Jekyll who was on display. In Mr. Hyde mode, the right hon. Gentleman offered us straightforward party political knockabout. We know that an election is coming when a Labour health spokesman says that the Conservative party is secretly planning to extend charging in the NHS, like all Conservative Oppositions and Governments have secretly done since 1948. It is worth reminding ourselves that there are three charging regimes in the NHS—for prescriptions, eyes and teeth. The historical fact of the matter is that two of the three charging regimes were introduced by Labour Governments.

The first stage of the argument is that we will introduce charges; the second is that the Conservative party is planning to cut NHS spending.

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

Would the right hon. Gentleman be good enough to set out his view of the patient's passport and how it relates to the charging discussion?

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

I shall come to that in due course. Before I do so, I want to respond to the charges made from the Dispatch Box. The first was that we would extend charging—an accusation that is always made in the run-up to an election. The second was that we would cut NHS spending, blind to the fact that no Conservative Government have cut NHS spending during their period office and that the shadow Chancellor made it crystal clear that we intend to carry through the spending plans published by the Government.

The third and most absurd proposition that Labour spokesmen advance is that the Conservative party is not committed to the principles of the NHS. As always when I hear that charge, I get out my calculator to remind myself of how many years there have been since the foundation of the NHS in 1948 and of how many years there have been of Conservative government and of Labour government during that period. When I do so, I find that the Conservatives have been in government for 35 of those 56 years.

I invite the House and, more importantly, the voters and anyone who might be interested in the arguments to reflect on the fact that if it were true, as Labour spokesmen have said consistently throughout those 56 years, that the Conservative party was not committed to developing the principle of the NHS, would it not have been likely that at some point during its 35 years in government it might have done something about it?

When the Secretary of State presents what I have called his Dr. Jekyll personality, he is realistic; I do not agree with everything he says, but we can have a sensible debate. When he presents the other side of his personality, it is a sign that an election is coming. When Labour spokesmen advance an analysis of Tory threats to the health service, it is one of the most sure bell-wethers of British politics that an election is not far around the corner. I guess that that confirms what most of us know.

The reality, and by far the most important point that emerged from the Secretary of State's speech, for which I give him some credit, is that to be committed to the principle of the NHS is to be committed to making difficult decisions about its evolution. Those who are genuinely committed to the development of the service and those who are genuinely committed to the development of maintained schools and the broader education sector are not and cannot at the same time be committed to no change in those sectors. The difficult argument—the interesting argument—involves the nature of the changes that need to be made to ensure that the commitment that we all have to the principles that lie behind them is delivered in reality in the years ahead, and that we continue to see regular improvements for children and patients.

I should like to address the nature of the changes that are taking place in our key public services, the rate at which the Government are introducing changes and the faltering nature, as I see it, of the process of change in health and education services.

It is one of the oddities of Queen's Speeches under this Government that they provide us, in the sense of a Kremlinologist, with a barometer that tells us about the current state of the relationship between the Prime Minister and the Chancellor of the Exchequer. It is—[Interruption.] The Secretary of State for Education and Skills should listen. I shall develop the argument, and the right hon. Gentleman will be hard put to deny its different elements. When we read the Queen's Speech, we find that the areas in which the Government will act are those where the Prime Minister and the Chancellor agree. The areas where the Government are introducing some generally fine-sounding words but nothing very radical are those where the Prime Minister would like to do more but the Chancellor will not let him. That is the argument around the evolution of public services that lies at the heart of the Government.

We all know what the Prime Minister's instincts are on this subject, and he loses no opportunity to tell us. We remember him telling us that he bears the scars on his back from those who oppose reform in the public services. We saw some of those responsible for inflicting those scars sitting behind the Secretary of State for Health.

The Prime Minister railed famously against the forces of conservatism, which in the press release was conveniently spelt with a capital C. The reality is that many of the most difficult opponents that the Prime Minister faces in the political arena are in his own party. They are relentless opponents of change within the public services.

The Prime Minister and I would number the Secretaries of State for Education and Skills and for Health among his friends on this subject. They understand the need for radical reform, but they are repeatedly blocked by internal opposition within the Labour party, led by the Chancellor. The most prominent example, foundation hospitals, arose in the previous Session, when the then Secretary of State for Health wanted to return to an agenda that we set out in the 1990s to create more independent and flexible management for major hospitals to allow them to respond more effectively to local needs—the needs of their patients and the priorities of the local communities that they are there to serve. It is well documented that the then Health Secretary repeatedly lost arguments with the Treasury and the Chancellor of the Exchequer. The Bill on foundation hospitals that was finally introduced did not deliver the measure of reform required to make the health service the flexible, responsive and efficient service that we all want in the coming years. It did not provide local hospital management with the capacity to evolve their own local employment terms for staff and gave them an absurdly politicised management structure. It did not give them freedom to borrow and thus access the resources that they need to develop their hospitals. The Chancellor obstructed reform by the Prime Minister and the then Health Secretary—now Cabinet supremo for policy development and winning elections and, I am sorry to tell the Secretary of State for Education and Skills, heir apparent.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

Indeed. The Treasury obstructed the drive to reform. I believe that the agenda for reform of the public services lies at the heart of political debate and will be the key domestic priority in the years ahead, so I approach the Queen's Speech with a sinking sense of disappointment. It is clear that the Prime Minister has largely left the field, and there are no major proposals that will continue the reform of health care and education that is needed if we are to deliver our objectives for those services.

That does not mean, however, that there is nothing of value in the Queen's Speech. I shall begin my examination of the proposals for the year ahead by looking at a measure that is not in the Queen's Speech because, I suspect, it does not need to be. In the middle of our party conference this year, the Government published a paper that I was pleased to welcome in a later question to the Prime Minister. He would not accept this description—indeed, he did not do so—but the paper outlines the Government's plan to reintroduce GP fundholding. I am delighted, however, that they aim to do so. They have, of course, changed the name—they call it practice-based commissioning, but they give the game away in the opening line of the paper which states:

"There is nothing new in the concept of Practice Based Commissioning."

You can say that again! From April 2005, GP practices can, if they so wish, be given indicative commissioning budgets, which is exactly what GP fundholding was about. I take a particular interest in the subject, because it was the first major issue for which I took ministerial responsibility when I was appointed junior Minister in the Department of Health in 1990. I read the document and almost wrote to the Secretary of State in the belief that I could offer my services as someone who has been here before. There are a number of things that I would have worded differently. The Government have fallen into a number of traps, which could have been avoided if they had been prepared to learn some of the lessons of experience. We could have made quicker progress towards a shared objective.

Photo of Alistair Burt Alistair Burt Parliamentary Private Secretaries To Leader of the Opposition

Does my right hon. Friend think that if he called himself Capita and charged £10 million for his advice he would probably have got the contract?

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

My hon. Friend and I should go into business together.

I wholeheartedly endorse the Government's objectives for what they call practice-based commissioning—they are exactly what we sought to achieve with GP fundholding. The Government say:

"By promoting practice level budgets for commissioning the Department envisages a number of ways in which patients will benefit".

The benefits include a greater variety of services and a greater number of providers

"in settings that are closer to home and more convenient to patients. Further, there are ways that the NHS as a whole . . . will benefit from more efficient use of services and greater involvement of front line doctors and nurses in commissioning decisions."

The passage continues:

"There is good reason to be confident in these expectations because of the evidence supporting Practice Based Commissioning"— in other words, the track record of GP fundholding between 1990 and 1997. I am delighted to be able to endorse the Government's returning to a sensible policy, although I have some questions to ask about it.

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs)

Does my right hon. Friend understand the frustration of patients and doctors in Staffordshire, where every GP was a fundholder? It is felt that six years have been wasted in going full circle and returning to the original position, where money followed the patient, rather than poor old patients constantly having to follow contracts and money.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

My hon. Friend took my next words out of my mouth. At one level, it is slightly humorous in a party political sense that I am reading words that are virtually the same as—in truth, they could be identical to—the words I used 15 years ago to describe the introduction of the policy. At another level, however, we are speaking about real people treating real patients in the health service and about 15 wasted years. The point that my hon. Friend makes is a serious one.

It is worth reflecting that if, instead of going down the dead end that was signposted by Mr. Dobson in 1997, we had continued with the development of the policy that the Government now recognise is right, every GP in the NHS would by now, if they so wanted, be engaged in practice-based commissioning, to use the jargon.

My hon. Friend Mr. Lansley referred to the total purchasing pilots that we were working on before 1997, which showed that this does not have to be a minimalist idea dealing with a few relatively minor patient routines. It can be at the heart of commissioning in the health service in order to make it flexible and responsive to the needs of communities and individual patients. It is not a joke; it is a scandal that we are now back at the starting blocks 15 years on, having to go through the same performance all over again.

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs)

Does my right hon. Friend also recall that fundholding GP practices were able to perform minor surgery, thereby taking the burden off cottage hospitals and larger district hospitals? That was abandoned, too, causing the problems that I raised earlier with the Secretary of State for Health.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

I caution my hon. Friend against overstating a powerful case. It would be wrong to suggest that all the minor surgery performed by GPs was unravelled with the end of fundholding. It is true to say that fundholding drove that change process, but quite a lot of it still goes on. What we have lacked in the meantime is the driver for further change to take the process on at the rate at which it was proceeding while the fundholding scheme was in place and driving it.

I have welcomed the fact that, albeit belatedly, we are again using the idea to drive change in the health service. I hope that when he responds to the debate, the Secretary of State for Education and Skills will deal with these matters, or perhaps he will arrange for someone else to do so. Given that we have wasted 15 years, it is important that we have a plan to make this opportunity available to all general practitioners in the national health service. It is important that we have flexible plans that allow GPs to group together, rather in the way that Mr. Sheerman suggested schools should, to allow GPs to create their own informal bodies to operate the commissioning approach, as they were before 1997.

It is important that we develop the concept of practice-based commissioning and that we get back to the concept of total purchasing pilots to allow that idea to develop. It is important that there is a target in the Department of Health—with due apology to my hon. Friend the Member for South Cambridgeshire for my mentioning targets—for achieving savings out of the primary care trusts that were the more bureaucratic version introduced to supplant fundholding. If we are going down the road of practice-based commissioning and, rightly, committing resources to that idea, let us score the efficiency savings that should be available from PCTs as a consequence.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health

Happily, my right hon. Friend does not have to apologise to me. We wish to remove Whitehall targets imposed on hospitals, but that does not mean that we will not set ourselves targets for efficiency savings. Indeed, with the James committee, we estimate that changing commissioning roles towards what is in effect practice-based GP fundholding and patient choice for elective treatments will mean that more than £600 million is saved from PCT administration.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

I am grateful to my hon. Friend for setting himself a fairly ambitious target. I hope that the Government will embrace that £600 million target; if they do not do so, they will need to explain why.

One of the oddities about the Government's paper on this matter is their statement that, if a practice achieves savings as a result of innovative commissioning—that is clearly the idea of the exercise—only 50 per cent. of the savings achieved will be available for the benefit of its patients. I do not understand why there should be a 50 per cent. limit, because its effect is that the other 50 per cent. of the savings achieved by innovative commissioning in one practice area will go to the benefit of patients in an unrelated practice area.

I do not see the logic of that approach. If a practice achieves savings and more efficient commissioning for its own patients, surely the people who should get the benefit of that resource, which will be more efficiently used, are the patients of that practice. I would be grateful if somebody explained to me why 50 per cent. of the savings should disappear into the ether. Why should not 100 per cent. be available to improve the health care of the patients of the practice in question?

In developing the idea of practice-based commissioning, I hope that the Secretary of State for Education will convey to the Secretary of State for Health my heartfelt good wishes for him in his no doubt upcoming battles with the Chancellor of the Exchequer and the Chancellor's friends on the Back Benches. The Health Secretary will have to do better this year than he did last year on foundation hospitals if we are to secure the real benefits that will be available for health service patients and if this idea is to be allowed to run properly. I wish to turn now to the Education Secretary's responsibilities.

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

Before the right hon. Gentleman moves on, I remind the House that he said that he would comment on the patient's passport. I hope that he will do so before he moves on to education, as I think the whole House would be interested in his analysis of that policy proposal.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

I am sure that the whole House is waiting for that with bated breath, but hon. Members are probably waiting with even more bated breath for me to sit down so that they can make their own contributions. I would not wish to deny the Education Secretary my thoughts on his departmental responsibilities, so I shall move on, if I may.

Turning to the relaunch of what I would describe as the city technology college programme, I am grateful to the Education Secretary for his hospitality, as he very kindly gave me a dinner in the company of 200 or 300 others at a promotion of his city academies programme. I was glad to go to the city academies dinner, as I thought that it felt very like dinners that I attended before 1997 to promote the development of what used to be called, as hon. Members will remember, city technology colleges. Indeed, so like city technology colleges are the academies that the Secretary of State quoted in his departmental plan of July the example of a very successful academy. I do not know the details, but I am prepared to believe that this is an admirable story, and I would like to read it to the House:

"Walsall Academy opened in September 2003 . . . Its sponsors are Thomas Telford School in Shropshire—one of the original City Technology Colleges, with an outstanding record of pupil achievement and innovation in the application of information technology . . . in partnership with the Mercers' Company, a City of London charitable livery company".

Members should bear it in mind that Walsall academy opened in September 2003, so this record is startling. Since it opened, it

"has already raised the proportion of students gaining five good GCSEs from 13 per cent. in 2001 to 49 per cent. in 2003. There are now ten times as many students applying for a place at the school than before—with 608 applications for September 2004 compared to just 57 students in" the predecessor school's last intake.

That is a huge success story, and I give the Secretary of State for Education and Skills credit for promoting the city academy programme, which is a relaunched city technology college programme. However, the same comment applies: if it is such a good idea—it is plainly a good idea—why did it have a seven-year sabbatical? Why could the reinvigorated Government post-1997 not follow through on the idea, instead of taking a great historical loop around a dead end? It is to the credit of the Prime Minister and the Secretary of State for Education and Skills that, if the newspapers are to be believed—I think that they are largely to be believed on this subject—they won their battle with the Chancellor on the target of 200 city academies. The policy is good, and I hope that that target is achieved.

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

Does the right hon. Gentleman accept that the lineal descendant of the CTC is the specialist school? Some 60 per cent. of secondary schools in the country are specialist schools and the growth has been consistent. When I became Secretary of State, one of my first steps was to remove the cap, so that every secondary school might become a specialist school and achieve the dramatic improvements in results to which he refers. His criticism simply has no foundation.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

No, I do not accept that independent schools, which I shall discuss in a moment, are the lineal descendents of the CTCs. The key thing about the CTCs is that they introduced major private sector partners, which the city academy programme is also designed to do. I am surprised that the Secretary of State for Education and Skills is so bashful about his policy, which is very good.

I shall read out another element of the policy:

"Academies are promoted and managed by independent sponsors . . . They are free to innovate as they wish, within the law and requirements on admissions"—

I shall have something to say about that in a moment—

"in order to transform standards in areas that have been persistently ill-served in the past."

That is precisely what CTCs were designed to do. It continues:

"Sponsors contribute up to £2 million towards the initial capital cost".

One again, the policy is a straight lift from the CTC programme. However, it is welcome, and the Secretary of State for Education and Skills should not be so bashful.

Photo of Mr David Rendel Mr David Rendel Shadow Minister (Higher Education), Education & Skills

Although the Secretary of State for Education and Skills seems to be fighting hard against the idea that he has taken over some of the previous Conservative Government's policies, does the right hon. Gentleman agree that he is arguing—a number of people in the media have argued this recently—that there is very little point in voting Tory at the next election, because the Labour party has taken over all the Tories' policies?

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

The hon. Gentleman has focused on one policy—city academies. He has forgotten what I have said about foundation hospitals and fundholding and has not yet heard what I am about to say about independent specialist schools, which are not, as the Secretary of State for Education and Skills proposed, the lineal descendants of CTCs. The parentage of the independent specialist schools is much closer to grant maintained schools, which is another programme that the Government have abolished. In the rubric that I have quoted, the Government have brought out of retirement all the arguments that were used to develop the grant maintained schools programme, to which Mr. Sheerman has referred.

The hon. Member for Huddersfield is worried about the implications of the policy, and he is not entirely signed up to the policy of the Secretary of State for Education and Skills. I am on the side of the Secretary of State for Education and Skills, who has got a good idea. I am concerned, however, that he, like the previous Secretary of State for Health, will be unable to carry this policy past Members such as the hon. Member for Huddersfield, with all respect to him, and, indeed, the Chancellor of the Exchequer. Winning the battle for independent specialist schools to ensure that they have genuine per capita funding and are allowed to own their own buildings and employ their own staff is absolutely central to the success of the Secretary of State's policy. I regret that he has already, in a pre-emptive cringe to the Treasury, had to concede the politically correct line on the law on admissions.

Perhaps when the Secretary of State winds up, he will be able to explain to the House how we distinguish between the dictionary words "aptitude" and "ability". We have specialist schools in science, music and other subjects, which is very good, and they are allowed to select up to 10 per cent. of pupils on the basis of aptitude, not ability. When I briefly did the Front-Bench job of my hon. Friend Mr. Collins at the beginning of the 1997 Parliament, I devoted a lot of time, with the present Home Secretary, to teasing out how we distinguish tests for aptitude from tests for ability. I look forward to hearing the Secretary of State, with his superior intellect, clarify that.

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

We set that out clearly in our response to the Select Committee, to which I refer the right hon. Gentleman. Does he agree with Conservative Front-Bench policy, which is completely to abolish any control of selection at the ages of five and 11, to establish a five-plus and an 11-plus for every school, and to abolish the requirement of proximity to the school?

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

As my hon. Friend the Member for Westmorland and Lonsdale is indicating disagreement with that representation of our policy, I feel under no compulsion to agree with it.

The Secretary of State is on to a genuinely good idea as regards city academies and independent schools, but I am worried about his pre-emptive cringe to the Treasury. I am also worried, as the Health Secretary has now rejoined us, about the track record of his predecessor in getting similar policies through the Treasury in the guise of foundation hospitals.

I cited three specific examples and I could add others. The key issue is how we reform the public services to deliver the commitments that are shared by Members across the House, including the hon. Member for Huddersfield, with whom I disagree on methods but agree on objectives. Whether in health care or education, the objective should be high-quality services that are available on the basis of need. It is to the Prime Minister's credit that when he makes speeches he appears to be clear that who provides the service is not the key issue. Indeed, he seems to think that there is an advantage in plural provision: let a thousand flowers bloom; let a number of different approaches be tried.

The key factor in our concept of public services is equitable access. That is a genuinely attractive vision for the future of public services that sets out to break down the accursed distinction between those who "go private" and those who rely on the state sector. We want to provide equitable access to a variety of institutions, both public and private, with access to a single system rather than allowing education and health care provision to continue to develop as two separate systems. Separate development is not an idea with a happy historical provenance. There is a dawning realisation in some parts of the Labour party—although none at all, from what I can make out, in the Liberal Democrat party—of the importance of that idea, but the problem is that every time we come to the crunch those with that dawning realisation appear to lose their battle.

We all know that the Queen's Speech is likely to be the last of the Parliament. I have no doubt that the Prime Minister and the Chancellor can keep the show on the road between now and the general election. However, the contradictions in the approach of the Secretary of State for Health and that of the Secretary of State for Education and Skills become clearer daily. The most important question at the next general election will be whether we continue with a team whose members do not agree about the most fundamental issue that faces Britain in the years ahead or accept the logic of the Prime Minister's occasional rhetoric on the subject, and elect a Government who can do something about it rather than simply talk.

Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. Several hon. Members hope to catch my eye. I remind hon. Members that the debate is time-limited—perhaps they will bear that in mind when they make their contributions.

Photo of Laura Moffatt Laura Moffatt PPS (Rt Hon Lord Falconer of Thoroton, Secretary of State), Department for Constitutional Affairs 4:25 pm, 30th November 2004

I am pleased to follow Mr. Dorrell because I listened carefully to his comments and I want to respond to some of his assertions.

I want to deal with both aspects of the debate—education and health—because I firmly believe that few other subjects affect our constituents more. They are greatly involved in them and feel that they will affect their families in future. We should therefore take any action in these areas, especially in connection with the Queen's Speech, extremely seriously.

If hon. Members visited Crawley—which they are welcome to do—it would be obvious to them that the education landscape had been transformed. One can enter the town from the south and look at all the new build. Astonishingly, we have three new secondary schools, one of which is completely new, and not rebuilt. People in the part of town where it is situated had been calling for that for many years. We have state-of-the-art special schools that deliver education to children and young people of hugely varying abilities in a way that we did not believe was possible. We also have new-build primary provision and an explosion in nursery care. The landscape is therefore very different from that of 1997.

I want to ensure that we understand how the difference came about. There is no magic to it. Crawley was once a new town, and the new build of 60 years ago had not been renewed or refurbished. The only way we could get money for education was by selling a bit of playing field: that was the only way that any schools managed to get rebuilt. However, in 1997 there was an explosion in building, and new confidence in education provision in Crawley.

I say to the right hon. Member for Charnwood that we could hold great debates about approaches to education, but without the resources we would simply be wasting our time. The aims and objectives of our teachers are now properly supported, which means that we can produce the sort of building that they want to work in and children find attractive. Circumstances are now completely different, which allows children to raise their game at school. They now have a different attitude towards staying on. They desperately want to do that, and I believe that education maintenance grants have made an enormous contribution to that change.

Let me consider the aspects of the Queen's Speech that are relevant to education. I was delighted to hear from my hon. Friend Mr. Sheerman, the Chairman of the Education and Skills Committee, as he spoke for many Members—certainly those who have been corresponding and raising the issue of having a light touch where we need to, while retaining an overarching authority that can get the family of schools working together, sharing experiences and also sharing what often cannot be done in one school. Hearing my hon. Friend speak in that way was music to the ears of people in Crawley, and we will certainly watch the Bill with great interest as it makes its way through Parliament. I will be an active supporter of it.

I have said something about education, which I believe has gone extremely well in Crawley, and few of us would argue that the reforms and the resources have not produced something that we can be incredibly proud of. The election of the Labour Government in 1997 was key to that. However, I now turn to an issue that has been quite difficult to deal with: modernisation, and ensuring that our health services can react to today's needs. Again, few of us would argue that enormous strides have not been made in the development of our health services.

Again I am thinking about what is happening in my own town, and considering the development of primary care. I firmly believe that bringing our GP practices to work together and think about the whole town, rather than just the little bit of it that each one happens to be serving, has been hugely beneficial to us all. Our GPs come together to discuss how we can ensure that health care is delivered throughout the town equally and co-operatively, not in the sense that one practice may be able to save some money and reinvest in some other way. I firmly believe that that has completely changed how GPs function.

This has not been an easy process—indeed, it has been a difficult one—but the ability to share information and expertise has borne an enormous amount of fruit. That will always be there for us now. We have encouraged people to work co-operatively, and that is a learned experience. People have learned to do it, and to respect their colleagues.

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office

I am interested in the development of the argument about sharing knowledge and practice among GPs under the primary care trust system. Will my hon. Friend compare that argument with the assertions made by Conservative Members about their policy of GP fundholding, and say whether what she is welcoming would have been possible under such a method of funding and running practices?

Photo of Laura Moffatt Laura Moffatt PPS (Rt Hon Lord Falconer of Thoroton, Secretary of State), Department for Constitutional Affairs

I thank my hon. Friend for that intervention, and she will not be surprised to hear me say that I do not believe that that would have been possible. There is a sense of having respect for colleagues, of sharing information and of sharing practice and expertise, which develops those services throughout the town. I believe that that has been hugely successful.

However, I also firmly believe that we have great difficulties when we face reconfiguration of major services, particularly the acute services. We know that 80 per cent. of health care is delivered through our GP practices and nurses, and I am glad to say that most of us do not have to go near a hospital, but it is extremely difficult for local people to accept that change is needed. That relates particularly to accident and emergency care.

As a Member who has attempted to think carefully about some suggestions from senior clinicians about how best to deliver emergency care, I want to share some of my experiences. As I was a nurse for 25 years, I have tried hard not to be just an oppositionist Member of Parliament who says no to everything suggested, just in case it might be damaging. I decided that I would listen to everything that was being said, and challenge it at every point, and I have done so since 1995—since before I was elected.

Being faced with very difficult arguments demonstrates to me that it is hard for those involved in the profession to be brave about those decisions, and to say that they feel that such things need to happen, and that they are going to make changes because they will make the service safer and more efficient. It is also difficult to set that against the background of what our constituents feel about the service, because, on the whole, they have not had any experience of it—thank goodness.

Given the modernising process, and the way in which we continue to ensure that the NHS is fit for the times in which we live, the relationship between Members of Parliament and the health service is an interesting one. We need a grown-up debate. For political parties to divide and say, "We don't like it because you look as if you're supporting it," does not do our constituents any good whatever. As we continue to develop our services and change the way in which we do business, it is my dearest wish that, in this House and outside, we can have a grown-up debate, be decent, and understand that the reason why decisions are devolved to senior clinicians is that they know what they are doing. We have the right to challenge, but they understand how best to deliver services.

The Queen's Speech contains quite enough proposals in relation to health, because our professionals are saying that the component parts are in place, particularly in acute care, and they now want to get on and do the job, and be left alone to show that they can deliver. I firmly believe that the one thing that has driven those improvements is targets. Without question those targets have put staff under pressure, but they have also given us excellent results in our health service. Long may that continue.

Photo of Nick Gibb Nick Gibb Conservative, Bognor Regis and Littlehampton 4:38 pm, 30th November 2004

It is a pleasure to follow Laura Moffatt, who is a fellow West Sussex Member. I agree fully with her call for a non-partisan debate by Members of Parliament on public services and the health service in particular. I endorse her comments on that particularly.

The Chairman of the Select Committee on Education and Skills made some comments about identity cards, on which I want to touch briefly before moving on to education policy. If the Government go ahead with the introduction of identity cards, I think that they will regret it deeply. It would be a huge extension of state power into the lives of ordinary people. ID cards always start off as popular, and then become hugely unpopular—they started off very popular in Australia, and then almost brought down the Government at one stage. Identity cards pose a danger, especially with today's technology, of aggregating in one place, around one identification number, all the personal information that is held by the state. That gives rise to a real danger that an unauthorised official will have access to information to which he is not entitled.

Neither do I believe that identity cards will work to deliver that which is claimed for them. They must be carried all the time to be effective—

Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. An amendment has been moved to the motion today, so we are restricted to discussing matters related to health or education.

Photo of Nick Gibb Nick Gibb Conservative, Bognor Regis and Littlehampton

I will obey your strictures, Madam Deputy Speaker.

The Queen's Speech talks of the high importance that the Government attach to educational opportunities enabling all individuals to realise their full potential. Who could disagree with that? I wonder, however, whether the Government are doing enough to achieve that aim.

On a number of occasions, I have raised in the House the issues of phonics in the teaching of reading in primary schools, the teaching of multiplication tables by rote—which I do not think happens in many primary schools—and mixed-ability teaching in secondary schools. I have raised those issues not just because they are important in themselves, although they are. Ours is one of the worst literacy rates in the developed world, with 23 per cent. of adults unable to read a simple instruction on the side of an aspirin bottle, 17 per cent. of 11-year-olds leaving primary school for secondary school still unable to read properly, and 37 per cent. of 11-year-olds leaving primary school unable to write properly—and they will never catch up, or recover from that bad start to their secondary school education.

Employers complain that school leavers do not have a basic knowledge of maths or English. According to the most authoritative international survey of education systems around the world, the TIMSS—third international mathematics and science—study, our state education system comes a poor 20th among those in 41 developed countries. The parents of one in four state pupils now think it necessary for their child to have private tuition, particularly in maths.

As I said, I have not raised those issues just because they are important in themselves but because they relate to the political and philosophical debate about who runs our state-sector public services. The hon. Member for Crawley touched on that when she said that Members of Parliament had a right to challenge experts on the conduct of the provision of public services. My question is this: is it the professional bodies who run and determine policy in our public services, or is it elected politicians? Does the Association of Chief Police Officers decide policing policy, or does the Home Secretary? Does the NHS Confederation or the Secretary of State for Health decide health policy? Do the education academics in our universities decide education policy, or does the Secretary of State for Education and Skills?

The public are quite clear about who is responsible. They understand our constitution, and they believe that the politicians are responsible. When things go wrong, they blame the politicians. Politicians, however, actually have very little say in key policy areas in education, health and policing. I believe that that is one of the main reasons why Governments of both parties have failed to deliver the improvements and reforms that were promised so faithfully. As a result, people have become disillusioned with politicians and the whole political process.

When I raised the issue of mixed-ability teaching with the Secretary of State and the Minister for School Standards, I pointed out that 60 per cent. of all lessons in comprehensive schools took place in mixed-ability classes. That came as a surprise to many, but the figures were from Ofsted and had emerged in parliamentary questions.

The Minister's initial response was that there was no evidence that teaching in a mixed-ability class was any less effective than streaming or setting according to ability. Labour's 1997 manifesto, however, contained an explicit promise to increase the amount of setting. It said:

"Children are not all of the same ability, nor do they learn at the same speed. That means 'setting' children in classes to maximise progress, for the benefit of high-fliers and slower learners alike. The focus must be on levelling up, not levelling down."

To the Minister's credit, he was happy to engage in a constructive discussion with me on the academic evidence that he had been given in the Department. The key document is a report by Laura Sukhnandan and Barbara Lee from the National Foundation for Educational Research. It is a publicly available document. The West Sussex director of education has also used it as a basis for our discussions about streaming in schools in that area. It is a summary of the literature on streaming and setting by ability, and it concludes that there was insufficient evidence that setting resulted in higher educational achievement, and that setting had a negative impact on those belonging to particular social groups.

On examining the report in more detail and looking at the underlying research that it claims to summarise, it is clear that it is tendentious and does not accurately reflect that research. It says that research by Kulik and Kulik, two American academics, concludes that

"although students in streamed settings outperform students in mixed ability settings by a small amount, the differences are not significantly different."

But reading Kulik and Kulik's research reveals that they say that only in respect of cases where the curriculum is not tailored to the particular ability level. The curriculum should of course be tailored to the particular ability level when setting is introduced, and Kulik and Kulik concluded that when it is, very significant gains are made in educational attainment at the top level, strong gains are made in the middle, and there is a neutral result—in other words, no loss—at the bottom. They also concluded that those at the bottom experience a small increase in self-esteem, and that the very bright pupils at the top experience a small decrease in self-esteem as they are confronted with competition for the first time.

On further reading the research of the proponents of mixed-ability teaching—the key proponent is R.E. Slavin—it is clear that their main motivation is social equality rather than higher educational standards. I have no complaint about those who are motivated by that point of view, which is a perfectly respectable one to hold. Slavin believes that one breaks down social division by deliberately mixing different abilities in a classroom, but in my view, that method perpetuates social division. It damages the educational achievement of those from lower socio-economic groups in particular, who do not have the background to counter the poor educational achievement that results from mixed-ability teaching. The consequence of such teaching is the opposite of what Slavin wants: social division is perpetuated, rather than ended. I strongly believe that Members who look at the research will conclude that setting results in significantly higher educational achievement, even if common sense does not already lead them to that conclusion.

During my friendly discussions with the Minister, and in answer to a parliamentary question, the Department for Education and Skills offered its next defence of the status quo. It accepted that overall, 60 per cent. of lessons take place in mixed-ability classes, but it argued that there is setting in the core subjects and that the 60 per cent. figure includes lots of peripheral, non-core subjects. So I tabled some more parliamentary questions to test that argument. They were answered by Ofsted, which showed that there was setting in 80 per cent. of maths lessons—a core subject. That supports the Government's contention, but it still means that that there is no setting in one in five maths lessons in our comprehensives. Only 54 per cent. of lessons in English—another core subject—are in sets, which means that nearly half of all such lessons in our secondary schools take place in mixed-ability classes. There is setting in only 20 per cent. of history lessons and 36 per cent. of geography lessons. That knocks on the head the argument that the 60 per cent. figure relates to non-core subjects; rather, it relates to the core, principal subjects.

Once that argument had been conceded, the next response was that that this is a matter for heads and teachers, rather than for Ministers. That brings me back to the core question. Should the decision about whether to stream secondary schoolchildren be a matter for the professions, or for elected politicians? That is an important philosophical issue, which we should consider. If every secondary school in this country were the envy of the world, if our schools filled parents with confidence, and if education were not the number two political concern in almost every opinion survey, I would agree that these matters should be left to teachers and heads. But if it is clear that one of the root causes of underperformance in our schools is mixed-ability teaching—it is a matter for debate, but I believe that it is—Ministers and Parliament have a right and a duty to intervene, or at the very least to engage in the debate with the professions about that particular policy.

Speaking as someone who was a chartered accountant by profession before I entered the House, I know that we were continually being told by the Department of Trade and Industry how to go about doing our job as auditors. We were told how to audit and what to put in companies' accounts, but I never felt that my professionalism was being undermined. Is not our children's education more important than the presentation of a profit figure for a company?

I think that the Government agree with me on this matter. Earlier this month the Minister for School Standards spoke to the annual meeting of the Girls Schools Association and reported the "startling" findings of a four-year study conducted by academics at Cambridge university into the differences in educational achievement of boys and girls. Revealing the evidence from that study to the world, he said that the research

"looked at a co-educational comprehensive school where single-sex teaching was used in subjects where gender is sometimes seen as influencing underperformance, such as languages for boys and maths for girls."

He continued:

"The number of boys who got five good GCSEs went up from 68 per cent. in 1997 to 81 per cent. in 2004. The number of girls went up from 68 per cent. in 1997 to 82 per cent. in 2004."

By segregating pupils into boys-only classes for languages and girls-only classes for maths and by arranging the seating into girl-boy, girl-boy throughout the classroom for all other subjects, those results were achieved. That is what this particular co-ed comprehensive did during this experiment over a particular period, and the results were startling with increases from 61 per cent. in 1997 to 81 or 82 per cent. by 2004. The reasons for the success were discussed in interviews and it was felt that pupils suffered from fewer distractions and that boys and girls did not feel the need to show off to each other.

Those remarks are very revealing for a number of reasons. First, it shows that there is an enormous amount of underachievement in our secondary schools. If making simple changes in classroom configuration can bring about such improvements in educational attainment in GCSEs, it is clear that in most schools where those changes have not been made—clearly the overwhelming majority of schools—pupils are performing way below their potential.

That research and the speech made by the Minister for School Standards directly contradict the Government's claims that secondary education in this country is doing fine. The Government cite surveys such as those conducted by the Programme for International Student Assessment to prove that everything is fine in our secondary schools, which they follow up by saying that they would still like to do a little bit more. I believe that the research that I have cited shows huge underachievement in Britain's secondary schools. It also shows that the move towards co-education was not based on any research or evidence that better results could be achieved. Too much of what happens in education is based on assertion rather than evidence-based policy making. That must be changed and I hope that the Government will ensure that policy changes are based on evidence rather than on the assertion of education academics.

The most revealing aspect of the speech by the Minister for School Standards is the acknowledgement that politicians can be involved in the debate about how the teaching profession goes about its business. He was directly engaging in debate about classroom configuration, so if he can engage with the issue of gender in classroom configuration, why cannot he engage on the issue of ability grouping? Why should setting be a matter for teachers, heads and the profession while gender can be influenced by politicians? The truth is that there is no distinction and the Minister was right to engage in the debate about gender, as he would be right to engage publicly in the debate about setting.

The next issue then becomes how much notice schools take of the research and the Minister's comments on it. If the research were replicated and the startling results repeated, would it not be a disgrace if it were not instantly taken up by every co-ed comprehensive in Britain to make huge improvements in educational attainment? What will be the result if that does not happen and the assertion-based policy emanating from education academics and disseminated by teacher training colleges continues to ignore that research, just as the research on mixed-ability teaching has been ignored? What should hon. Members do about it? What should the Government do about it? More importantly, what can the public, particularly the parents, do about it? When those questions have been considered, we should apply the answers to mixed-ability teaching and phonics versus whole language methods in the teaching of reading in primary schools.

I hope that all hon. Members who are interested in education will start to address some of the real issues that cause underperformance in our schools, put aside the ideology and the party pre-positioning and have the confidence, as democratically elected politicians, to challenge the comfortable and complacent educational orthodoxies that, for 30 or 40 years, have led to the gradual decline of our state education system.

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office 4:55 pm, 30th November 2004

I should like to take up where Mr. Gibb left off, to some extent, because I found his speech fascinating. It behoves hon. Members who did not hear his comments, some of which illuminated the whole education debate, to read them later. I, for one, will study hard what he said because there is great merit in extending the argument in education to consider issues that we do not traditionally look at as politicians and tend to leave to the teaching professions.

The hon. Gentleman's contribution was very worthwhile indeed, and it pointed me towards some other issues. Year in, year out, we debate the attainment of young people in secondary education and their ability to do more, and the outcry is always that we must have lowered standards. There is no acceptance of the fact that there is hidden, untapped potential, but the findings that he pointed to reveal an untapped potential that we ought to reach and show that there is great merit in looking at ways to reach it that we may not have looked at previously.

I hope that the answer is as simple as streaming. In my constituency, where streaming is common, school results are extremely good. I recently visited one school that, when we took office in 1997, already enjoyed high attainment on which it would be difficult to improve. The main thrust of my speech will be about, for example, the healthy schools initiative, and one thing that I noticed on my visit was the fact that it was a healthy school. Although its pupils were criticised for their exam results that year, the fact that the school's high standards of achievement have improved time and again shows that that it is an outstandingly good school.

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office

The hon. Gentleman has been very patient during the debate, so I can hardly resist him.

Photo of Richard Bacon Richard Bacon Conservative, South Norfolk

I am grateful to the hon. Lady for giving way. Before she moves on to the main substance of her speech, I should like to agree with her about my hon. Friend Mr. Gibb. Will she encourage him to publish the extremely good pamphlet that he has written on this subject—I have read it, but he has not yet published it—because it goes into greater detail on precisely the points that she is making?

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office

It would ill behove me to add to the hon. Gentleman's embarrassment, which hon. Members will see if they look at him now.

Photo of Richard Bacon Richard Bacon Conservative, South Norfolk

My hon. Friend is going bright red.

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office

The hon. Gentleman is squirming a little and his colour makes me think that he perhaps needs attention very quickly.

If what Mr. Bacon says about the pamphlet is correct, it should be published. Given that the debate is about how we achieve yet better standards, even for those who are already doing well, it would ill behove us not to read the pamphlet, and I would encourage the hon. Member for Bognor Regis and Littlehampton to publish it. New ideas are welcome in any debate—it would be madness not to consider them—but that one in particular has a core value about it and struck a chord with me. I congratulate him on his speech, and I hope that he publishes the pamphlet.

I want to combine education and health in my remarks. Most of my political life has been about how we take people from the position in which they feel that they are at the bottom to take them to the top. One of the issues that we examined many years ago was the relationship between health and poverty and then between health, poverty and education. How do we square that triangle, as I suppose we should call it, and make sure that people become better in themselves, better in their lives and have better attainments all round?

When we consider the issue in a growing and healthy economy, we have a particular duty to make sure that everyone shares in economic growth and wealth and also shares in better health. Many of our debates and the Bills that we consider deal with how we look after people when they are already ill. How do we invest in hospitals and GPs' practices? How do we manage the money? There is nothing wrong with such debates, and the outcomes of surgery, operations, health practices and new methods of achieving better health are all to the good. I would prefer it, however, if we focused even more on the health message. The age on which we focus that message must be very young.

I have seen families, especially families in which long-term unemployment has been the history for some time, where the health message is even more necessary for the very young. If the young start out in life not only not achieving as much educationally as they can, but with poorer health expectations and experiences, their hopes for the future are equally diminished.

How do we get to those young people? For the very young, we obviously need to get the health messages to their mothers. I believe that 1 per cent. of drug users who become pregnant pass on their addiction to their unborn child. However, more important is the fact that drug users pass on the drug experience to children as they grow up. We need to do more about getting the health message over to those young mothers so that they understand what they are doing to their children, their future health and their prospects for education and life expectancy. That is not simply because the mothers may pass on the addiction through the womb in pregnancy, but because of the effect on their children's childhood and education. Those messages are vital.

We must not consider just the role of the Department for Education and Skills and the Department of Health, but the role of the Home Office and what it is doing in the drugs Bill. That is a vital part of the healthy nation initiative.

I also consider what is happening to the young people who turn to drink earlier and earlier than was my experience when I was growing up. I always hesitate to talk about health issues as a fairly robust woman of certain years and not necessarily in the prime of my life. People attract attention to themselves in an unwarranted way in these debates, but I would say do not necessarily do everything that I have done. However, I did not start drinking when I was 12 or even by the age of 21, but that is another matter. However, if people start drinking regularly at the age of 12, they are not only damaging their health but their chance to learn and to do anything constructive. I was 21 before anyone would serve me with a drink.

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office

I give way to my hon. Friend, who will save me from my embarrassment.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

My hon. Friend is making a very good speech with which I agree. However, does she agree that a great danger for mothers is drinking while they are pregnant? That brings a high risk of foetal damage that affects children for the rest of their lives. We have not paid sufficient attention to that issue so far.

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office

My hon. Friend is right. Babies might be underweight at birth due to drug abuse or under-nourishment. Under-nourishment in babies often goes alongside their mother's drinking because that can have an effect on their mother's normal nutrition and diet. He is right to point out the huge impact of a mother's drinking on her unborn child.

I would like a campaign to encourage all pregnant mums to be more careful without having to enter into the debate of whether we are being a nanny state and failing to accept that all people have individuality and their own responsibilities. Of course we must strike a balance between the two. However, if a mother acts irresponsibly, what is our responsibility? Should we let her continue her actions, or intervene when her child is born, which used to happen a lot, but is now not encouraged?

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

My hon. Friend is correct that we have the right to make decisions about our own lives, but when behaviour such as passive smoking affects others—perhaps a foetus—choices are being made about other people's freedom.

Photo of Kali Mountford Kali Mountford PPS (Mr Des Browne, Minister of State), Home Office

I was coming on to that point, and it is where the rights and responsibilities argument is the crux of the matter. We must take responsibility on behalf of the community to care for such unborn children, so the most obvious thing to do is to educate mothers about the effects of their behaviour so that they can choose not to behave in such a way. It is more difficult to treat babies who are sickly due to their mothers' alcohol or drug abuse, under-nourishment, or any other behaviour than to encourage mothers not to behave in such a way.

It is now almost unknown for mums to smoke during pregnancy, so that campaign has started to hit home. Any pregnant mum who lights up in the street or a bus shelter is frowned upon or causes people to raise an eyebrow. Everyone would have a word with such a person and say, "You know, this really isn't on." However, other health messages have not been conveyed to such an extent that we will collectively encourage and admonish young mums for other behaviours. I would prefer to encourage them, because if people are constantly admonished by society, it becomes more difficult to change behaviour. If we encourage and inform people, we empower them to change what they are doing.

The whole of this health debate, which is extremely welcome, is centred on setting individual freedoms against our rights and responsibilities. The Government have the responsibility to act on behalf of everyone, because we all pay for the results of people's behaviour in the end. We pay through our own health when we breathe the smoke of others. We pay if we pick up the pieces for someone whose health has failed because of alcohol abuse. If a person is completely out of control in the street, we pick up the pieces and pick up the tab, so we take on extra responsibilities.

The right place to start to address the matter is in our schools, which takes me back to the healthy schools initiative. I was extremely impressed by teachers' enthusiasm for the scheme in a school that I visited. They were initially cynical about it and thought that it was another gimmick, or a ploy to engage them so that it would look as though people were doing something. However, they told me that when they got into the scheme, started to push the agenda along and realised their power to make a difference, their attitude to it changed, as did that of the young people in the school. The young people started to learn about more than just eating five portions of fruit and vegetables a day. I assure the House that I do that, despite my appearance—[Hon. Members: "You look very nice".] I suggest that hon. Members stop there.

We should consider not only what people eat, but the more intimate aspects of people's lives that some parents would perhaps prefer us not to discuss in detail. People have got used to the idea of sex education in schools and are beginning to accept that even quite young children can understand complicated messages about sexual relationships and what they mean. The messages rightly focus on the nature of love in a relationship and the responsibility that two people have to each other. However, we need to go much further and talk about the dangers of sexual activity, but not in a frightening way. We cannot say, "No. Don't do any of that. It's not a nice thing to do, so don't do it at all because you'll get sick." Children are not going to believe us if every time they try anything that we say they should not do, they find it fun. Even if they do believe us about the risks, they will carry on because the fun outweighs the message.

We have to get around that problem in an intelligent way. We need to reach young people in a way that makes sense to them, which is not by hectoring and lecturing them. We also need to provide support if they become frightened by the message. The problem is that if they think that they have contracted a disease, instead of telling us about it, as is often the case, they might withdraw into themselves because of the fear they encounter. They would rather run away from the problem.

In my view, young people are certainly too young to engage in sexual activity if they are in secondary school, but we know that they do. They will not admit that that is what they are doing because they think that they will be told off. They say, "Me Dad'll kill me. You can't tell me Mum. She'll go mad", but it is better that mum and dad go mad than some time down the line infertility sets in, which happens to some young women with chlamydia. Other long-term health problems could also set in. Irreversible damage can be done, but they cannot envisage that at that young age and cannot believe that that could be the consequence of their actions.

We need to find ways to get the message over. Sometimes that needs to be done on a one-to-one basis. The healthy schools initiative is an important part of that, but it needs more investment, especially for school counselling services. Proper places have to be set up. The ones that I visited in my constituency are nice places to be in. They are in the colours that create an environment in which young people feel comfortable and at home. They do not feel threatened by those places. However, there are always two or three other chairs in case someone wants to bring their mum or dad along. I find that young people would rather bring another 13 or 14-year-old along with them. We need to get around the fears about bringing mum or dad along. It should be a partnership across the community so that the feeling of safety that they need to tell us about their problems is engendered in the school.

I applaud the schools in my constituency that have embarked on the healthy schools initiative because it has made a difference to some aspects of health. What they have dealt with is laudable. I have no complaint about educating people about not smoking, not drinking, eating properly and having proper exercise. All those things are good, but we are still a little squeamish about saying to young people, "These are the things that could happen to you if you don't protect yourself."

The House might think it a little mad of me to reveal this, but I sent two 30-year-olds into my constituency to buy condoms. I thought that a woman of my advanced years would not be credible, and perhaps I should have found someone younger, but those people went for me. They could not find them on display anywhere. They went into chemists, the local pharmacy, pubs and supermarkets and found that they had to ask someone for them. I should explain that it is a semi-rural constituency, and there is only one smallish supermarket that has them in stock, which says something about the supply in areas such as mine.It was of great concern to me that when they came back they said that they could not find one place where they could pick up condoms, take them to a counter and pay for them. What are we saying to young people about the availability of one of the best methods of protecting themselves? We are making it extremely difficult for them to protect themselves. I put the matter to the primary care trust in my constituency and asked it what is being done. We have a good teenage pregnancy strategy, and that obviously goes a long way to dealing with some of the sexual health problems that come from sexual encounters, especially if the core message is the use of condoms.

It seemed to me that the sexual programme was not complete. In some places, counselling services are provided by GPs on top of what is available at a minority of schools. There seems to be a need to make more available the very means that young people require to protect themselves. If they cannot pick up a packet of condoms from the counter, they have to go to somebody and ask for help. That may be somebody whom they trust—for example, the school nurse, their local GP or someone at one of the new centres that is being set up around some of the new GP practices, with the help of the PCT. However, with all the new services that are available, young people have to pluck up the courage to ask.

I send out a plea not only to the manufacturers and distributors of condoms but to all retailers as well to think again about their policies about where they place condoms. The reason I have been given about their placing of these products is the risk of pilfering. As a result, they make them difficult to pick up. They may consider pilfering a high price to pay but it is a higher price to see some young people whose lives are devastated by an early sexual encounter. My plea may not be best placed with the Secretary of State, but I hope that my words are heard by those outside the House who can help us in a collaboration between medicine producers, condom producers, all pharmacies, all suppliers and all the efforts that we are putting in through the House, local education authorities and health services so that people's lives are not endangered in future and people can have the future that they richly deserve.

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs) 5:17 pm, 30th November 2004

There are times when it is a real pleasure to be in the Chamber. The previous two contributions were especially powerful and extremely interesting. Although the hon. Member for Colne Valley (Kari Mountford) said that she was not addressing her comments so much to the Secretary of State, I am sure that he was listening and will have heard her wise words.

I applaud all those who work in the national health service and in education. As right hon. and hon. Members have said, those people work hard for themselves and, more importantly, for those whom they serve—children, students, parents and patients. We should never forget the contribution that they make and, in many instances, what they have to put up with. It is a great shame that the Secretary of State for Education and Skills has just left the Chamber because I was about to talk about the things that teachers have to put up with, but no doubt the Minister for Children, Young People and Families will be taking copious notes and will pass them on to the right hon. Gentleman.

I shall take up three particular issues. The first is medical research, which affects health and science, so it straddles both health and education. It also straddles the responsibilities of the Home Office, because I shall talk about a problem in my constituency involving animal rights activists. Secondly, I shall speak about the real problem of there being a two-tier health service. In an earlier intervention, I think that the Secretary of State for Health accepted that it exists, although he deplores it. Thirdly, I shall speak about an issue that the hon. Member for Colne Valley raised, which is smoking and health. I suspect that we share similar views.

In my constituency, there is a farm that breeds guinea pigs primarily for medical research.

Photo of Michael Lord Michael Lord Deputy Speaker (Second Deputy Chairman of Ways and Means)

Order. Today's debate is principally about health and education. The hon. Gentleman perhaps understands that. It is in order briefly to mention other topics, but basically the debate is about health and education. If he cares to do so, I will allow the hon. Gentleman to mention the issue he has just raised, but I would like him to come back to health and education pretty quickly.

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs)

Of course, I take your guidance, Mr. Deputy Speaker. I was not aware that one had to stick to that particular topic.

Photo of Michael Lord Michael Lord Deputy Speaker (Second Deputy Chairman of Ways and Means)

I am not responsible for Members' awareness of these matters, but that is the position. The hon. Gentleman should talk about health and education. As I said, he may briefly mention the topic that he raised, but he should turn to health and education thereafter.

Photo of Richard Bacon Richard Bacon Conservative, South Norfolk

Perhaps my hon. Friend Michael Fabricant could talk about the health of his guinea pigs. [Laughter.]

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs)

Indeed. It is, however, a serious issue. I asked the Under-Secretary of State for the Home Department, Caroline Flint how many animals are used for research on things such as household products. It turns out that 99.9916 per cent. of all research on animals is done for scientific purposes, primarily for the benefit of people suffering from diseases and to develop new vaccines and treatments in the health sector.

As I said, villagers in my constituency have been terrorised for five years. It is not just the people who breed the guinea pigs who are affected but newsagents and people who run a tennis club, where a member was threatened. I very much welcome the proposal in the Queen's Speech to introduce Home Office legislation to try and control the problem. However, existing laws such as the Police and Criminal Evidence Act 1984 and the Public Order Act 1986—I could list more legislation—enable the police to control the activities of animal rights terrorists. It is right to call them terrorists because they terrorise people. The police, however, cannot be everywhere, and I am concerned that the new legislation will not be sufficient to control the activities of animal rights extremists either because there are gaps in the legislation—the devil is always in the detail—or because there are not enough police officers. I note, incidentally, the Conservative commitment to increase the number of police in Staffordshire by 670, which would certainly make a real difference.

Establishments that breed and supply animals such as guinea pigs are required to comply with standards of housing, welfare and care in codes of practice that specifically address the needs of breeding animals. The codes require that suitable environmental conditions are provided for different species and for different stages of development. Temperature, ventilation, and light and noise levels must be appropriate. The astonishing thing is that if the animal rights extremists were successful, the guinea pigs would have to be imported from countries that do not have such controls. It is important that animals are supplied from within the United Kingdom, because we have strict controls on the way in which they are bred.

Recently, I attended a Royal Society conference to hear about the genome project, with which the Department of Health is very much involved. The project has analysed every single gene in the human body, but researchers do not know precisely what individual genes and combination of genes do. Apparently, 80 per cent. of human genes are similar to guinea pig genes, so there is a clear overlap in the research needed to benefit mankind.

I am speaking about diseases that at present are incurable, such as diabetes, where we can treat only the symptoms. There is a real possibility of a cure for diabetes, whereby the islets of Langerhans could be injected into the pancreas and people would no longer need to take insulin regularly. I intended to speak at greater length on the subject, but I know that I would be trying the patience of Mr. Deputy Speaker and I would never wish to do that.

Let me move on to a second issue. In an intervention, I raised with the Secretary of State for Health the matter of my constituent who had a heart attack and found, after going to hospital, that he needed an angiogram. He was told that it would take three months before he could get on to a waiting list, and he would then have to wait a further three or four months for his angiogram. The angiogram was necessary to determine what damage there had been to the blood vessels supplying his heart and whether there was any damage to his heart itself. Waiting and worrying for such a long time might have brought on a second heart attack. He was advised that if he chose to have it done privately, he could have the angiogram in the next few days. So he chose to have the angiogram done privately and it cost him £1,800 because he did not have private health insurance.

I can give another example of someone I know in Wales, who had a tumour behind his eye. Again, he was advised to have an examination done privately, so that the diagnosis could be made quickly and treatment could start sooner. That cost him in the region of £2,000, and again he had to pay out of his own pocket. Last year there were 250,000 such procedures, where people were told that if they wanted to be diagnosed or treated quickly, they would have to pay for it themselves. It does not behove those on the Government Front Bench to say that it is the Conservatives who want a two-tier health system. We do not, but the sad fact is that we have a two-tier health system already.

Photo of Kelvin Hopkins Kelvin Hopkins Labour, Luton North

Is not the hon. Gentleman's argument just a symptom of the fact that we have an under-resourced health service? If it had been fully resourced by his party when it was in office, the private sector would have dwindled away because nobody would have needed to pay for private treatment. They could have had their operations done publicly, free of charge. That is the position in France, where there are twice as many doctors and twice as many beds.

Photo of Michael Fabricant Michael Fabricant Shadow Minister (Trade and Industry) (Trade and Economic Affairs)

It is fallacious to say, as the hon. Gentleman claims, that demand will always be met by any health service in any country. I can tell him that there certainly are waiting lists in France, despite the fact that, as he rightly points out, more money is spent on the health service there—considerably more than in the United Kingdom.

I was with someone last night from Iceland, which has a population of only 280,000. He explained to me that they have a voucher system. I am not advocating that—it is certainly not Conservative party policy—but it is interesting. In Iceland one has to pay £3 every time one sees a doctor. That teaches people to respect doctors' appointments. All the rest is subsidised by the state. Once one has seen the doctor and is referred, the treatment is free. But there are waiting lists even in Iceland, as there are in France.

I do not think any Government will ever provide sufficient money for people to be treated instantly, but there is a huge discrepancy between the types of treatment available. We need honesty among all parties on questions such as where a private health care system is or is not appropriate. I was rather pleased with what the Secretary of State for Health said. He ended up by espousing much of what the Conservative Government were saying in 1996 and 1997—that there is a role for private health care and there should be that choice. As the right hon. Gentleman said to me after my intervention, the choice should be whether one wants to have the treatment privately for convenience or whether one does not mind waiting for the NHS. When it comes to a matter of life and death, however, or at least of being treated in the NHS within a reasonable time, it is wrong for NHS people to say "Look, you will have to go to private health care."

The person whom I mentioned was also told that he would not be put on the waiting list for a good three months. The fact that that happens time and again demonstrates how the waiting list figures are fiddled. If somebody is not included on the waiting list, the overall time that they have waited is not counted in the total waiting time. That is a real problem that I know both main parties would wish to address, but we have to be honest about this matter, and I feel that we are not at times.

Let me now move on briskly to smoking and health. I am disappointed that the Queen's Speech does not announce legislation on the control of smoking. Many hon. Members on both sides of the House— I suspect that they are on the Opposition Benches in particular—will disagree, and say that there should be freedom of choice as to whether people smoke. I argue, however, that there should also be freedom to decide whether one can breathe clean air. The hon. Member for Colne Valley rightly pointed out that individuals must exercise responsibility, as well as the Government.

We have a duty of care, and there is no doubt whatever that smoking kills. I could be cruel and say that if somebody continues to smoke despite an excellent television and radio campaign by the Department of Health, it is up to them to make the decision. If the activity kills others through passive smoking, however, it has to be wrong, and I do not understand how people can argue that the state should not intervene in this instance. Indeed, I well remember that, when I worked in broadcasting, it was a Conservative Government who introduced legislation through the Independent Broadcasting Authority, as it then was, to ban cigarette advertising on radio and television. So there is nothing inconsistent with Conservative policy in saying that that approach should be extended elsewhere.

The issue needs to be addressed; indeed, it is a popular issue as well. Recently, research was undertaken to determine whether people would oppose a proposal to introduce anti-smoking laws in this country. Some 54 per cent. of respondents said that they strongly supported a smoke-free law, as they called it, while a further 35 per cent. said that they would tend to support such law if they knew more about the detail. In other words, 89 per cent. of the population believe that it is right that people should be allowed to eat in restaurants or work in an environment where they are not forced to breathe in other people's smoke. I believe that it is right and proper for any Government to introduce legislation of this type.

There are those who say that such legislation would not work, but that is plain nonsense. Studies in the United States have shown that banning smoking in restaurants has either a neutral or a beneficial effect on the economy and, indeed, increases tourist business. We would not be doing anything new in introducing such measures. There is smoke control in Australia, Canada, Iceland, Ireland, the Netherlands and the states of California and Minnesota. Anybody who has visited New York city will know that it has very strict rules on smoking, but they certainly do not stop people going to restaurants.

I am going to stop speaking now because of your advice, Mr. Deputy Speaker, that I could not speak on my main subject, which would have been animal rights activists. I welcome the Home Secretary's legislation, although the devil will be in the detail, but I believe that it could be better enforced with the 40,000 extra police officers that are being promised from a Conservative Administration.

Photo of Brian Jenkins Brian Jenkins Labour, Tamworth 5:34 pm, 30th November 2004

It is a pleasure to participate in the Queen's Speech debate. It is also a pleasure to follow my next door neighbour, Michael Fabricant. Ironically and coincidentally, we are both covered by the same PCT, but he thinks the glass half-empty, whereas I think it half-full.

I have looked at my constituency in the context of the measures in a number of Queen's Speeches, and I shall outline one or two areas into which we have put a lot of money for new buildings, new equipment and extra staff, leading to falling waiting lists for treatment. I shall consider the sickness service first, rather than overall health.

I was first elected to this House in 1996. Not many months afterwards, the front page of my local paper reported that one of my constituents had had to remortgage his home to pay for his heart bypass operation—a shocking story. However, not one similar story has appeared in the past five years. The system had fallen into an awful state, and it has taken money, and the involvement of the professionals who work unstintingly in the health service, to get us to our present position.

We now treat more people better and faster, and people who have gone through the system tell me about the state that it is in today. Our difficulty is to catch the urban myths and legends, because people reiterate stories about things that took place some 10 years ago. When my right hon. Friend the Secretary of State for Health visits the Sir Robert Peel hospital, Tamworth, tomorrow, he will see an excellent little hospital, run by a professional team who have provided new services and innovations.

In this afternoon's debate, one or two hon. Members have mentioned the private-public gap. They seem to think that the private initiatives in health come only from one side. I keep telling people this: when I visit my GP, which I do fairly regularly, I park my car in a car park that is private and belongs to the private buildings of a privately run practice. The GPs own the buildings. When I walk in and I see the girl or woman behind the counter—it is a very nice place, and I am treated professionally—she is an employee of the practice. I then see a doctor who is a contractor to the health service.

So far I have not seen or been in one publicly owned facility. When my GP writes out a prescription, it is on a form printed by a private practice. I take it down to a local shop, where the shopkeeper gets me some tablets made by a private drug company—and we think that we have a problem with private involvement in the health service. The NHS has always been privately provided and publicly funded. It is about time we got away from the hang-up of opposing any private involvement in the health service.

My right hon. Friend the Secretary of State for Health knows that the ambulance service in Staffordshire is second to none. We are currently using extra facilities in our ambulance service. When an ambulance attends a location, paramedics can treat people on the spot; there is often no need to take people to hospital in an ambulance. Admittance to hospital by ambulance occurs at a far higher rate than admittance of people who turn up by themselves. I hope that hospitals will stop being blocked and resources wasted in that manner. That is a priority in Staffordshire today, and it works well. The hospitals that serve my area are very good.

I am amazed when I hear people debate hospital-acquired infections in the public arena. They discuss the matter with great sincerity, but it is a pity that they have not read the Public Accounts Committee report. The PAC went through the matter religiously, and we identified the problems.

I do not want to say, "Privatise hospital cleaning," because that would not advance the situation one iota. We know that all hospitals should be kept clean and free from debris and dust. That is not the problem, because what looks like the cleanest hospital in the world can still have an infection problem. Across the world, different infections spring up in different countries. The key point is the culture of people not washing their hands and transmitting the infection from patient to patient.

Photo of David Taylor David Taylor Labour/Co-operative, North West Leicestershire

I am grateful to my hon. Friend and constituency neighbour for highlighting the improvements being made in general hospitals. Does he agree that no part whatever has been played in that by the rightly maligned star rating system, and that the Secretary of State for Health is to be warmly applauded for at last abandoning what has been a disaster from day one?

Photo of Brian Jenkins Brian Jenkins Labour, Tamworth

My hon. Friend is welcome to say that, but I could not possibly comment.

After months of trials to find the best anti-bacterial agent, we now have a system whereby doctors always carry syringes at their sides so that they can wash their hands as they go from patient to patient. Everyone who enters a ward now uses that facility, which may be the best option for reducing infection rates in our hospitals.

I want to move on to the broader concepts of health. Many years ago, I took health to mean stopping people getting sick, but one of the reasons why our primary care trust has spent so much time and effort is that people go out into the community and visit patients at home—mental health patients or elderly patients, for example—to ensure that they stay healthy. We should move that up the agenda, because when people are treated at home they must be kept in reasonable conditions.

In January 1985, I was involved in a local council by-election, and I went to a row of old people's bungalows and knocked on the first door. The person who answered had his coat, hat and scarf on, so I said, "I'm terribly sorry, sir—I shan't be a moment," because I thought that he was going out. I asked him my question and moved on to the second house, where again, the occupant had his hat, coat and scarf on. I thought that the two of them must be going out together, so I said, "Shan't be a moment, sir," asked him my question, and moved on. When the third person came to the door with his hat, coat and scarf on, I thought, "There must be a bus around here somewhere." Then it dawned on me. I asked him if he was going out, and he said no—he was sitting like that by his fire, which was switched down to one bar. He had to choose between keeping the house warm or eating. We had turned into a miserable society.

Thankfully, when we introduced the £200 winter allowance, those people could switch the other bar of the fire on, to keep the place warm as well as eating. Our warm front programme should be applauded for putting millions of pounds into targeting those vulnerable people to ensure that they double glaze and insulate their homes to keep them warm in the cold months. If that is not done, the health service has to pick up the tab, and it is a losing battle on both fronts.

Sure Start is a brilliant programme. The other week I went along to one in my area, where mothers were being shown how to prepare food and cook. I hope that my right hon. Friend the Health Secretary will speak to his pal the Education Secretary and ask him to get food preparation and cooking back into our schools where it belongs, because children, male and female, leave school with no concept of food preparation other than reaching for a can and a tin-opener, and given the high levels of sugar and salt in those cans, it is no surprise that they become obese.

When my right hon. Friend talks to the Education Secretary, will he also congratulate him from me, and from Tamworth, and tell him to keep up the good work? There is a lot done, but a lot more to do. We have some excellent schools with good and dedicated professionals who are turning out children with higher qualifications and more aspirations than we have ever had in our town. Our secondary schools work together in concert so that children can be transferred from one sixth form to another, because one specialises in music while another specialises in sport or in science.

Nevertheless, I enter a plea to the Education Secretary on behalf of Staffordshire. If we are to send money to each individual school—an idea that would find favour with certain Members, including me—will he ensure that the formula employed is not the malign and discredited one used by the Department for Education and Skills, but the one used by the Office of the Deputy Prime Minister, which shows us where deprivation and poverty are? In Staffordshire we suffer from pockets of deprivation that a wealthy county masks. I look forward to the response on that subject.

More youngsters than ever now enter higher education and training. Will my right hon. Friend the Secretary of State for Education and Skills, who is about to resume his seat, answer a question? The Opposition amendment states that they are appalled that we have taken no action to abolish tuition fees. After research and consultation with universities, will my right hon. Friend tell us how the universities would make up the shortfall, and how many United Kingdom students would find that the place that they believed was allocated to them had disappeared because the universities could not fund it? Parents and youngsters would like to know that, because it would present them with a choice about the direction to take.

My right hon. Friend the Secretary of State for Health knows that when I was first elected in 1996, there was mass unemployment, and an alarming and increasing number of people were registered as disabled. I realised that the two went hand in hand. A person who is unemployed and feeling depressed will look for an option, and disability can be such an option. A hard core of individuals believe that they are actually disabled and cannot work any more—and they would find it difficult to get back into the work force. Employment can play as great a role as keeping homes warm in the health of a nation. We should therefore consider it seriously.

Today, more people than ever are in work. We have eliminated long-term youth unemployment but we still need more trained people. After years of boom and bust in engineering, fathers advise their sons and daughters not to go into it. Although some of us believe that engineering and manufacturing still have a part to play in creating this country's wealth, we struggle to get people into education and training for them and to view industry and manufacturing as a career opportunity.

There are some excellent small firms in my constituency. They approach me regularly and bemoan the fact that they cannot get the trained skilled personnel that they need. They cannot get our bright youngsters, who have been siphoned off to do courses at university that will not provide them with a future, when they could have been trained in skilled work in our factories. Small firms acknowledge the Government's role in maintaining low interest rates and stability, but they feel lonely and a little unloved. They do not believe that they are the Government's favourite sons. Can we please send them a few warm words to ensure that they know that we acknowledge the major contribution that they make to our country?

I shall not discuss identity cards, or you would rule me out of order, Mr. Deputy Speaker. I simply say that much more work must be done to explain exactly what we would do with them.

The Opposition amendment calls for effective choice. Given our record over the past seven years, I believe that our people must have the information to make an effective choice. When they do that, I know that they will stick to the Government, who have done so much but have much more to do.

Photo of Alistair Burt Alistair Burt Parliamentary Private Secretaries To Leader of the Opposition 5:49 pm, 30th November 2004

I welcome the chance to participate again in an important debate on the Queen's Speech. I want to make a couple of general comments before focusing on the issues of the day.

As a former Minister with responsibility for people with disabilities, I welcome and thank the Government for the further steps to reduce discrimination against disabled people. As the Minister for Children, Young People and Families knows, being a Minister for disabled people is one of the best jobs in Government. It provides a unique opportunity to see life from a rather different perspective and to learn from that. Spending any time with disabled people tells us of a number of frustrations and distractions, which can be dealt with only by the change of attitude that is at the heart of anti-discrimination legislation. I stress that that change of attitude in society is much the most important thing.

Before dealing with the topics of the day, may I say a brief word in response to the Home Secretary's attempt to persuade us all that the policies and targets that he advocates will lead to a safer Britain? I might be forgiven for feeling that that has a rather hollow ring in North-East Bedfordshire, particularly around Yarl's Wood, as last week the Prison Service ombudsman produced a report that specifically blamed ill-thought-through policies and the pursuit of unachievable targets for the near disaster that engulfed the Yarl's Wood removal centre on 14 February 2002.

The Government's attempt then to deal with security issues set in train a series of consequences that cost more than £100 million and which, but for the individual heroism of many people on the night, could have led to scores of deaths. I was disappointed that the Home Secretary could not come to the Dispatch Box to introduce that report personally and to answer questions as to which parts of this particular policy fiasco have contributed most to the concept of a safer Britain, but come to the Dispatch Box in due course he will.

I give my wholehearted support to the amendment moved by my hon. Friend Mr. Lansley and contribute to the debate by again reinforcing the commitment to the NHS that my colleagues and I share. My father was a GP for nearly 50 years and my brother is a consultant anaesthetist at St. Thomas's. My wife and I have no private health insurance and our children were born in the NHS facilities at the wonderful Fairfield hospital in Bury, so let no one say there is a lack of commitment to the health service on this side of the House.

The big issues for my constituents are not addressed by the Queen's Speech or by what the Secretary of State had to say, despite his valiant efforts. My constituency, like a number of others in the south-east, faces an enormous housing increase: there will be 80,000 more houses in Bedfordshire over the next 25 years. Our facilities and infrastructure are already stretched, so how will they cope with this pressure on resources? We are stretched in relation to GPs: 330 are needed in Hertfordshire and Bedfordshire over the next three years, even before all this building takes place. That has not been addressed and I am worried about it, as are my constituents.

On education, the Government's determination, as stated in the Queen's Speech, to ensure that children fulfil all their talents and abilities is devoid of meaning without ensuring the right environment for teaching and learning. Despite the Government's avowed emphasis on education, is it not, after seven years, a matter of shame for them that one in three 11-year-olds leave school unable to write properly, 1 million children play truant every year and there is an assault on a teacher every seven minutes? If those issues are not addressed, the Government's rhetoric is as nothing.

In my constituency, parents of children in special schools feel threatened. The Government's pressure towards an inclusionist policy, which has its good points, runs the risk, by being pushed too far, of going beyond the aspiration of parents and the assessments of professionals in those schools, thus changing their character, not necessarily in the interests of each and every child. Those interests must be paramount. I urge the Secretary of State to include in the education Bill some measure on the further protection of special schools.

Schools in my constituency also tend to feel that the Government are all talk in terms of their commitment to improve children's sport in schools. In 2001, the lottery—not the Government—set up the fund for sport and physical education with a balance of more than £500 million. Schools attempted to access it, but got caught up in extraordinary bureaucracy to such an extent that by the middle of this year only £10 million of £500 million committed in 2001 had been spent.

Sharnbrook upper school in my constituency, with its excellent head teacher Peter Barnard, was caught up in this. He reckons that it has cost him some 18 months—nearly £40,000 worth of time—to seek to access £250,000 from the fund. A Government who were really committed to sport in schools would have sorted out such nonsense a long time ago. How much more the Queen's Speech could have achieved if it had recognised the people's priorities of cleaner hospitals and school discipline, and made people truly feel safer, not by frightening them, and putting forward half-baked policies and targets, but by matching our commitment for 40,000 more police over the next eight years.

I want to turn to my substantive remarks on chlamydia. I am sorry that Kali Mountford is not in her place, because I enjoyed what she said, which was helpful and significant. I am not sure whether an education Bill will examine this issue, as it may not be the place to do so, but can I urge the Government to conduct a serious review of sex education in schools? The information given to the House last week by the Secretary of State for Health that perhaps one in 10 sexually active women under the age of 25 are infected with chlamydia is perhaps one of the saddest statistics of our age. For whatever reason, we have surely failed our children if the demystification of sex over the past 40 years or so has resulted in the sort of unhappiness that comes from the picking up of a sexually transmitted disease or infection.

A fascinating exchange took place last week on BBC television's "Question Time". A questioner from the audience asked about the rate of increase of chlamydia and whether we were therefore losing the battle for safe sex. Bishop James Jones of Liverpool then questioned the conventional wisdom that nothing much could done about young people having sex, by saying that growing numbers of young people of faith backgrounds—Christian, Jewish and Muslim—wanted their faith reservations on early sex to be backed up by a society that encouraged and supported them if they wished to say no. The Liverpool audience gave the bishop strong support for such a view. That is worth exploring further, and it is a matter of great urgency to do so.

First, there is plenty of evidence that whatever we have been doing up to now has not really worked well enough. Secondly, the impact of such diseases and infections on young people can be catastrophic, and it is unacceptable to leave things as they are. Thirdly, to take a different tack, the cost to the NHS both of dealing with such diseases and infections, and future infertility, is great and growing. Fourthly, we must be honest about how we have got to where we are. There is a significant danger of the polarisation of views on this sensitive topic not being in anyone's best interest.

As a practising Christian, I reject a view that sex education is wrong, and that the more that is learned, the more harmful it is. Dutch and Swedish experience suggests the contrary. But such education should be considered in the context of the teaching of relationships and values accompanying the learning of the technicalities. Equally, those who condemn abstinence education out of hand should examine it again, not because it is the only answer, but because children are not uniform, and different teaching and different ideas will strike young people differently.

There is a further point. Forty years ago, those who spoke from a position of faith—often Christian—on these matters, and who tried to make an abstinence case, were often derided. They were, they were told, backward, against feminism, morally judgmental, and representing a finger-wagging authoritarian God whose nature was to condemn. Whether or not some took such a view, there was no evidence then available of where a society changing its moral and commercial attitudes to sex would go. The arguments could therefore rage in some form of vacuum.

But now things are different. There is evidence of genuine harm being done to our young people. Anecdotal stories of peer pressure to have sex early, encouraged by a far more sexualised society, can now be accompanied by information on rises in disease and infection and, as Bishop Jones said on "Question Time", sheer unhappiness.

That is not what we want for our children, and what we may be able to cope with as adults may not be right for them. I suggest to the House that the Christian response might now be seen in a different light. God gave his rules for our lives not because he wishes to condemn but because he loves us, and wants us to fulfil all that we can be. He warns against things that might hurt us. There is no condemnation.

Contrary to popular myth, the overwhelming characteristic is not that we are unabridged successes working in a context of self-righteousness but that we have all messed up, and we all have experience of a loving God reaching out to pick us up out of our mess and take us somewhere better. Let us adopt a balanced approach to sex education. Children must have knowledge—not to give them that would be to leave them unarmed in the world—but it must be put in a context of value and relationships. Those who feel unready, and do not want to take a relationship that far, should be encouraged to feel that saying no is powerful and right. Good medical back-up and professional services should also be available to deal with physical issues unambiguously and unashamedly. Let us not assume that, with such an approach, we cannot aspire to alter behaviour, and to enhance children's sense of self-esteem and self-respect in the avoidance of sexual activity.

We are so open about almost everything else to do with sex, but listening to youngsters on that programme and reading their comments on the BBC website makes one appreciate how hit-and-miss our sex education really is. Let us pick up the best ideas in the world. Let us talk to faith groups about their contributions. Let us also recognise a worry among people that years of licence, while helping us come to terms with many sexual matters and avoid misery, have also caused unwitting harm to others. I hope that the Government will consider an urgent review of sex education in the current Session.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest 6:01 pm, 30th November 2004

I find myself in a very privileged position in debates such as this. I can congratulate the Government when I think they are getting things right, and warn them when I think they are getting things wrong.

I was going to spend the first half of my speech congratulating the Secretary of State for Health, but he has had his enjoyment for today, and time is limited. Tribute has already been paid to improvements in cardiac surgery and cancer care; I add my tribute to the improvements in consultation, the forming of overview and scrutiny committees, patients forums and the independent reconfiguration panel, and above all the paper "Keeping the NHS local", which paints a good picture for the future of patient and public involvement.

Let me now make some rather more critical comments. As the Secretary of State knows, I welcome the public health White Paper. I particularly welcome its emphasis on sexual health, which has been discussed many times. It reinforces warnings of the risks of unprotected sex, which have faded into the background since the first HIV scares. The current goal is that by 2008 waiting time for an appointment in a genito-urinary clinic will be down to 48 hours. I hope that that will not lead to what has happened in primary care. The goal of 48 hours has sometimes been taken to represent the time by which appointments must be made, and poor unsuspecting patients have telephoned at 8.30 am hoping that they can secure an appointment because they are unable to make one further in advance.

The Department of Health has certainly taken on board many of the concerns about obesity reported by our Health Committee. I am delighted with the promise of clear and effective food labelling, and I am pleased that the food industry seems to be beginning to realise that it has a part to play. Although I must admit that I enjoy the occasional Burger King, representatives from both Burger King and Pepsi-Cola are coming to see me later in the week, when I hope to persuade them that they are part of the solution.

Photo of David Taylor David Taylor Labour/Co-operative, North West Leicestershire

Does the hon. Gentleman agree with me, and with a constituent who approached me this week in my Coalville office, that we risk condemning out of hand all who are obese for their unsatisfactory diet or lack of exercise although the reasons are sometimes genetic or medical?

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

I thank the hon. Gentleman for that intervention. The Health Committee report virtually bent over backwards in its efforts not to condemn such people for what had happened to them. It is increasingly recognised that obesity is not in all cases simply a question of diet and exercise; some people have definite medical conditions that make matters more difficult for them.

I turn to exercise, which is also terribly important. The Department of Health recognised in its White Paper the importance of walking to school, which, along with walking to work, is by far the most effective way to get people to exercise. I hope that the teaching of health economics and food technology, which is currently limited to cooking clubs and such like, will become part of the curriculum.

While I welcome the White Paper on health, I fear that it could be just words, but I am certainly hoping that it will lead to action. The Secretary of State himself said that it is the start of the journey, not its end, and that it is the vision of the future. There are some milestones by which we can judge whether success is coming. First, will the target concerning the provision of fruit in school for four to six-year-olds be achieved by the end of this year? The new rules on alcohol advertising are supposed to be introduced by the beginning of 2005, so we will be able to see whether they have an effect. On salt reduction, Sir John Krebs says:

"The food industry is about two-thirds of the way to reaching our target of a 1g reduction in processed foods by the end of 2005."

Will the industry achieve that reduction completely by that date? On food labelling, the recommendation is that the effective new system of "traffic light" identification of good foods and less healthy foods be in place by early 2006. We will watch very closely to see whether the targets are met, and whether the achievements match the Government's hopes and aspirations.

I have some other concerns, the major ones being the Government's review of arm's-length bodies and the abolition of the Commission for Patient and Public Involvement in Health, which has been in place for only a very short time. My worry is that this body, which supports the vital patients forums, is being taken away before the proper follow-up arrangements have been made. Such arrangements are crucial. The commission itself is fading away—its chief executive has already moved—so it is vital that we get alternative plans in place quickly.

I am very anxious about two other vital arm's-length bodies: the Healthcare Commission and the Commission for Social Care Inspection, which are crucial to the Government's monitoring of developments. I met the chair of the CSCI just last week, and I was delighted to hear that she is re-examining its method of inspecting facilities. She is determined that most future visits will be unannounced, and she intends to concentrate on the views of users of the services that the CSCI inspects. But will she be able to do so? Are the Government going to grant her the extra funds that the CSCI will need to carry out the extra duties that it will have to take on?

I have always been a critic of star ratings, and particularly of that ridiculous thing called the "balanced score-card approach". It simply eroded patients' opinions of the health service and did not allow their views to be taken into account in the star ratings. I am delighted, therefore, that the Healthcare Commission is also planning unannounced visits. It plans fewer visits, but wants to co-ordinate them with other visiting bodies, which is absolutely crucial.

Photo of John Reid John Reid Secretary of State, Department of Health, The Secretary of State for Health

I thank the hon. Gentleman for his comments; I know that he is an experienced and acute observer of these matters. I just wanted to take the opportunity of saying to the hon. Gentleman, who has been in exchanges with me on a number of occasions, how much I welcome the development of a more sophisticated assessment process and the publication of results both by the Commission for Social Care Inspection and the Healthcare Commission. I want to put that on the record because there have been some reports that I am at odds with what has been done. That is not the case. It was always envisaged that once we started assessments on a simplified basis, they would be handed over to more independent bodies, which would fashion them in a more sophisticated, though relatively simple, way. The key thing for all of us is that the public know—

Photo of Michael Lord Michael Lord Deputy Speaker (Second Deputy Chairman of Ways and Means)

Order. That is a very long intervention from the Secretary of State. Time is very short and he spoke for nearly an hour earlier.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest

Thank you, Mr. Deputy Speaker, though I warmly welcome the Secretary of State's intervention. Today's newspapers implied that he was indeed against these developments, so I am very reassured by what he just said.

My next concern—the Secretary of State is aware of it—is about NHS treatment centres, which have spare capacity but are not used to the full because primary care trusts do not have enough money. That results from the Government giving the money directly to the private-sector and independent-sector treatment centres. Inexplicably, instead of using the capacity available in the NHS sector, capacity in the independent sector is being called in when it is not really needed. Despite bulk purchasing, it remains more expensive to do things that way.

Some other concerns about independent-sector treatment centres were relayed to me only yesterday by a consultant orthopaedic surgeon. The selection of low-risk cases by the independent sector leaves the NHS to concentrate on the complex cases with longer periods of admission. The independent-sector surgeons may be on the specialist register, but may not have gone through the independent appointments process that is so important for NHS consultants. Concern was also expressed about follow-up arrangements.

I shall be brief in expressing my concern about out-of-hours care. When PCTs take over certain responsibilities this weekend, our constituents are going to be hit by the sudden loss of Saturday morning clinics, which have been run by many practices on behalf of the people who work all week and find it difficult to see a doctor. In the Health Committee report on out-of-hours care, we wrote:

"We deplore the loss of GP Saturday morning surgeries which will limit access to their GP for many working people, and we recommend that PCTs should provide such clinics in primary care centres or co-located emergency departments."

In its response, the Department said that

"routine appointments on Saturday mornings can be provided to patients . . . PCTs can commission Saturday morning GP surgeries as a Locally Enhanced Service, the cost of which is negotiated locally with the practice, and funding for which is included within the new GMS Enhanced Services Floor."

I shall certainly press my primary care trust to ensure that it provides some Saturday morning surgeries.

Finally, I am seriously concerned about the weaknesses of the Standing Committee system on recent health-related Bills. The Human Tissue Bill was certainly in desperate need of amendment, which was not achieved in Committee. Thank goodness, sensible Ministers actually changed it before Report and, in conjunction with further House of Lords amendments, it became an acceptable Bill. I am told that the Mental Capacity Bill, which will come before us very soon, was again not amended in Committee. In the debate on Second Reading, which was excellent because it did not take on party political lines at all, it was suggested that the Bill will open the door to euthanasia by neglect. There is widespread fear about that, so I hope that Ministers have listened and that perhaps the Government will table some amendments at the eleventh hour.

The Government have a vision for the future, and they will be judged on its achievement. Let us hope that it is unlike Prospero's vision in "The Tempest":

"And, like the baseless fabric of this vision,The cloud-capped towers, the gorgeous palaces . . .shall dissolve . . . and . . .Leave not a rack behind".

Photo of Martin Smyth Martin Smyth UUP, Belfast South 6:15 pm, 30th November 2004

I am happy to be able to share in the debate on the Loyal Address because I was beginning to think that it was actually just a little England debate, bearing it in mind that the NHS stretches across the country and that standards will affect different levels. Last Thursday, I drew attention during business questions to the problems of waiting lists, and the Leader of the House said that we could learn from England. I should be happy if those in England could help us by telling us how they have managed to reduce their waiting lists so well.

I acknowledge the fact that there has been a reduction of about 2,000 in our waiting lists in the past two years, but the Secretary of State for Health was on the watch when they were rising in Northern Ireland. Whereas waiting lists in England are down—552 people have had to wait for 12 months, according to the information given to us—we must face the fact that, in Northern Ireland, about 3,500 people have waited for between 12 and 18 months, and even beyond. On that aspect, I should like to have some guidance so that we might learn from England; or are Northern Ireland Ministers not getting the proper advice from their departmental officials, so that they can act accordingly?

I wish to raise again the issue of our primary care provision in the light of the comments made by Dr. Taylor. Throughout Northern Ireland, we are trying to return primary care to the front line, yet some general practices are not properly equipped even to meet the required standards in terms of insurance and health and safety. I understand that, as money is not ring-fenced, the health boards can decide to do what they want with it and that, at the end of the day, we may be hindering the advances in the care in the community, which was one of the key factors of the Government's activity.

I wish to raise a personal issue that affects one of my constituents—a young lady who was born with a certain problem that ultimately affected her physical aspect and her vision. She attended Jordanstown school and was supposed to be statemented each year. It would appear that, somewhere along the line, the Belfast education and library board did not do its work—it claimed that it was not invited to do so, but it was always advised when the statementing was done.

My constituent was advised that she should attend the Royal National College of the Blind in Hereford, and she has done so and that will be paid for until December, but because she will be 19 years old in December, there can be no further funding from the Belfast education and library board, nor from the Department. I understand that, if she were from England, her education could be funded by different means. There is a method of doing so because the principal of the royal college in Hereford has been in touch with me on that very point.

The Belfast education and library board says that my constituent could be funded for vocational training, but not for academic training. I understand that training for her physical condition means that she is now mobile after being wheelchair-bound. With the Department of Health and the Department for Education and Skills supposedly working together, there should be a way forward. It is discrimination of the worst kind if a person with a physical handicap who could take the academic route is not allowed to take it because they have been shunted off into another siding.

I have raised on the Floor of the House in the past the issue of the Departments working together, and I have followed the contributions made this afternoon that dealt with sex education in schools. Love for Life, which was founded as a charity by a medical doctor to do something positive, was funded by grants particularly from the Southern education and library Board to work in schools. It met a tremendous response from teachers, children and parents but, unfortunately, the Department of Health says that it now cannot fund it because the charity deals with education issues, and the Department for Education and Skills says that it cannot fund it because it deals with health issues. A Government who pride themselves on being seamless should begin to get their act together so that youngsters are taught not simply the mechanics but all aspects of relationships. That will help them through life and save on wasteful expenditure. They may get into trouble by contracting sexually transmitted diseases because we failed them in the early days.

There are many other subjects that I would like to raise, but I think that I have said enough. However, I want to make one final simple point. Gulf war syndrome has now been recognised as an illness. I have fought on the issue for a long time, and I trust that we will no longer withhold the financial aid and help so that soldiers who served this country faithfully in the Gulf war now receive the treatment that they deserve.

Photo of Mr David Rendel Mr David Rendel Shadow Minister (Higher Education), Education & Skills 6:22 pm, 30th November 2004

The themes of this Queen's Speech are "opportunity" and "security", and education is primarily seen in terms of opportunity. We are no strangers to this idea. In the prelude to the party's constitution, we make it clear that "freedom from ignorance" is critical to the liberty of the individual. Education, however, is also of critical importance to security, and I intend to spend a few moments talking about that.

The other evening following the Gracious Speech, I co-sponsored a House of Commons reception to celebrate the 10th anniversary of a small non-governmental organisation, Development in Action. It is run by young volunteers who have been to India on various projects and who have returned to this country to encourage interest in global issues. They produce a quarterly magazine that goes to students, teachers and careers offices and have created a development education resource base.When I talked to some of the volunteers, I was struck by the vital links that exist between education, the idea of global citizenship and the prospects for greater tolerance and understanding across the borders of geography, imagination and economic opportunity that divide our world.

On 15 November, the Secretary of State for Education and Skills announced the international strategy for education, skills and children's services. In doing so, he said:

"One cannot truly educate young people in this country without the international dimension being a very significant and real part of their learning experience."

Proposals include twinning every school in England with a school overseas within the next five years, and sharing Britain's educational expertise and resources with the developing world. This is all very welcome, and I congratulate him on his initiative. However, it risks being little more than a public relations stunt unless there is a genuine drive to expand foreign languages provision, as proposed by Tomlinson, and to ensure that the "international dimension" becomes a fundamental part of the education reform agenda. Too much of Government policy at present seems to run counter to those principles. One example is the Home Office policy of charging international students for visas despite the fact that fees income from non-European Union students already makes up 7 per cent. of the UK higher education sector's budget.

A second example is the decline of modern language teaching, and especially—this brings us back to security—a recent report by the British Society for Middle Eastern Studies that argues that we are not training sufficient people with knowledge of the middle east and competence in Arabic languages. Clive Holes, professor for the study of the contemporary Arab world at the university of Oxford, argues that we are seeing

"the gradual loss of a national resource for teaching Arabic and other Middle Eastern languages, and . . . because of the concomitant staff cuts, the loss of expert advice which should be available to government, the diplomatic and intelligence communities, and business."

I hope that the Secretary of State will comment on the report in his winding-up speech and give us his assessment of the likely impact of the Higher Education Act 2004 on the situation that Professor Holes describes.

I turn to the theme of opportunity. The Gracious Speech says:

"My Government attaches the highest importance to extending educational opportunity so that all individuals can realise their full potential and the country can benefit from the talents of all its people"— hear, hear. However, why then do the Government seem intent on erecting barriers to that opportunity? Liberal Democrats deeply regret that the Government have not used the Queen's Speech to announce a rethink on tuition and top-up fees. It was their last chance to do so before we take the issue to the country. The Liberal Democrats' alternative Queen's Speech proposed a Bill to scrap the tax on learning. The electorate face a clear choice: top-up fees under Labour, commercial interest rates on student loans under the Tories—in both cases, of course, that means that students will pay for their own education—or an end to all charges for university tuition under the Liberal Democrats, with the cost borne by the richest taxpayers.

Let us remember what happened at the last general election. Such was the hostility to tuition fees on the doorstep that the Prime Minister ordered a review of student finance, with the aim of

"tackling the problems of debt and the perception of debt".

Quite how Ministers, proceeding from that starting point, came up with top-up fees as the answer to our woes will no doubt make an interesting case study in university politics seminars for many years to come. I hope that at least some students will enjoy spending £3,000 to discuss it. Following the by-elections in Brent, East and Leicester, South, Liberal Democrats look forward with anticipation to the doorstep reaction that the Prime Minister's loyal servants will receive from voters next spring.

One measure that Liberal Democrats very much welcome is the proposed child benefit Bill. The Gracious Speech told us that that will

"extend financial support for 16 to 19 year olds engaged in training and education."

That will be a step, at least, towards a more equitable system. Liberal Democrats have long championed the needs of part-time students, not least by ensuring that they are covered by the fair access arrangements in the Higher Education Act 2004. We hope that the Government will move towards activity funding so that we can end the funding anomalies that disadvantage students in colleges. We regret that the recently published grant letter to the Learning and Skills Council failed to move us in that direction. The Government's preparedness to support the further education sector will be a key test of their commitment to the principle of opportunity.

We also welcome the proposal to ensure that the charitable status of independent schools will be dependent on whether they actually do work that is commensurate with that status. We have long argued that charitable status should not simply be a means by which fees can be held down for parents who can afford private education for their children. It should be about opening services and facilities for the benefit of the wider community.

Liberal Democrats' disappointment with the Queen's Speech stems not only from the fact that it contains measures with which we disagree and fails to contain others with which we would agree, but from the more profound fact that it shows a lack of philosophical direction—a sense of what the Government want our country to look like. Instead we have a mix of reactionary illiberalism and mean-spiritedness, and one or two sticking-plaster-type measures that are welcome, but will do little to help to clean up the mess.

In education, after three years of debate and a radical Act of Parliament, we are yet to see any real analysis of what the Government think that higher education is for, beyond performing a service role for business. Moreover, the Government may be tough on insecurity, but they are certainly not tough on the causes of insecurity. We live in a world in which 115 million children have no access to education, but providing that for them would cost $5.6 billion dollars, which is comparable to the £3 billion cost to this country of the Iraq war. Was bombing Iraq a sensible priority to set if we are interested in security, let alone opportunity? Which of those priorities would have been a better investment to fight the war on terror?

Perhaps it says it all that the international agenda for education that I praised, which strikes at the heart of our shared aspirations for a world of security and opportunity, has found no place in the Queen's Speech in the run-up to the general election campaign. The Government have made their choice: they will run with the politics of fear, but not the politics of hope.

Photo of Mr Tim Collins Mr Tim Collins Shadow Secretary of State for Education, Education 6:30 pm, 30th November 2004

I start on a sober note. I am sure that the House will share a sense of shock and deep sadness at today's horrifying news that a 15-year-old schoolboy has died, apparently after a fight involving another pupil at his school. The thoughts and prayers of every hon. Member will be with the family and friends of all those affected. I hope that all parties in Parliament will come together to act on the persistent calls from teachers for new legal protections and powers to help them in their vital task of upholding discipline in our schools.

Let me respond to the words of the Health Secretary straight away, because some of the things that he mentioned, too, are above party politics. All of us, without exception, pay tribute to the dedication, professionalism and sheer hard work of those in our public services—our nurses, doctors, teachers and others. All of us admire them, praise them and support them. As my right hon. Friend Mr. Dorrell said in his superb speech, we all celebrate the genuine progress that they have made since 1997, as we do the achievements that they secured between 1979 and 1997. There should be nothing between any of us on that subject.

The question is not whether we back our NHS and education professionals, but how we do so. The Secretary of State came up with an interesting phrase. He said that we have been on a journey with our public services since 1997. He will forgive me if I observe that parts of the journey have been circular in nature. We started by moving away from GP fundholding, and we are now moving back towards it. We started by moving away from grant-maintained schools, and now we seem to moving back towards those as well. As my right hon. Friend explained, we started by moving away from city technology colleges, and now we are moving close to them again, with city academies. We started by increasing the size of the Department for Education and Skills and the Department of Health, and now the Government say that they want to slim them down again. We have had an interesting journey, but the start and end points have not been terribly different.

The Secretary of State also said—I think that I am quoting him accurately; I am sure he will correct me if I am not—that the Government had met every target and every pledge. That will come as news to those who are still waiting for access to an NHS dentist, which the Prime Minister told them in a speech in 1999 they would get throughout the country by 2001. The Secretary of State said that many of the problems that have occurred in 2004 are the results of decisions taken by past Conservative Governments 10 or more years ago. However, I am sure that he would not expect the Prime Minister to have made his pledge in 1999—two and a half years after Labour came to office—unless he had properly researched it. The Prime Minister obviously believed in 1999 that he could secure universal NHS access by 2001. When he made that pledge, he was fully aware of exactly what capacity was in place and what was not.

My hon. Friends scored a bull's eye against the Secretary of State when they pointed out that he rightly said that we should praise NHS staff, but seemed alarmed by the prospect of allowing them to decide their own budgets and run the NHS in their own way.

One of the things that happens in the House is that we are tempted to oppose the party that we would like to be up against, rather than the party that we are up against. I put that gently to the right hon. Gentleman, because I have been guilty of it at times. Some years ago, the Secretaries of State for Health and for Education and Skills were considerably to the left of where they are now. I admit, politically inconvenient though it is, that they have moved and that I cannot make that charge against them. On the same basis, however, the Secretary of State for Health cannot make the accusation that the Conservative party stands for charging people for operations, that we would cut NHS spending or that we would introduce the black death—which I think was the next thing that he would have come to in his litany.

Nor is it the case that the Conservative party will introduce a five-plus for every primary school, as the Secretary of State for Education said we would, or that we would forbid schools from taking postcodes or geography into account in their admissions policies. I understand why he believes that that might have been our policy but I assure him that it is not. I wish to make it absolutely clear that that is not the Conservative party's policy.

Let us consider what has been said in this constructive debate. It is—

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

It would be helpful to the House if the hon. Gentleman would say whether it is or is not Conservative party policy to abolish codes of admission, and therefore enable every school, primary or secondary, to determine its own admissions policy without any guidance.

Photo of Mr Tim Collins Mr Tim Collins Shadow Secretary of State for Education, Education

It is clear that giving schools complete freedom to decide their own admissions policy does not involve banning them from taking into account the postcode—[Interruption.] It is all very well for the Minister for School Standards to make a sedentary intervention, but the Secretary of State made two charges, and he has now withdrawn one charge, so we have made progress.

The policy on schools having freedom means that head teachers will be able to decide for themselves the admissions criteria that they wish to apply. If the Secretary of State believes that there are many state school head teachers who want to introduce either a five-plus or 11-plus examination, he is even more out of touch with teachers than I thought he was. Of course that is not what they want to do. It is another Labour scare story suggesting that professionals should not be trusted to take decisions themselves.

Mr. Sheerman, who chairs the Education Committee and who is not in his place at the moment, made an extremely good speech in which he talked about the need to build on and learn lessons from Sure Start—both its successes and its failures. That is certainly something that we would like to do. He welcomed the Government's proposals to reduce the amount of bureaucracy in Ofsted. At the same time, he expressed some interesting concerns about light-touch regulation. Interestingly, he was also quite cautious about reducing the role of local education authorities. Similarly, it will be interesting to see whether the Secretary of State will go as far as the Chancellor of the Duchy of Lancaster has in advocating cutting LEAs out of education entirely.

The hon. Member for Huddersfield said that he thought that the ballot arrangements for abolishing grammar schools were unfair. The Opposition would agree with that. The conclusion that we would reach is to abolish the balloting mechanism and leave grammar schools to continue with their work, not threaten them all the time.

The most amusing comment made by the hon. Gentleman was that the Prime Minister and the Chancellor of the Exchequer are a close-knit team. That is not exactly the phrase that would come from most of our lips.

My right hon. Friend the Member for Charnwood made an extremely good speech, parts of which I have already looted in some of my remarks. He talked about the way in which the Government are bringing back GP fundholding and implementing our policies on city academies policies, albeit that they are doing it under a different name. His central theme, which was absolutely right, was that the Government have now decided that it is electorally popular to talk about choice in education. However, people know that they will not get choice from a Government who at best have a half-hearted belief in choice, and are divided about it. They support the word but not the idea. People will get choice only from a Government formed by the Opposition, who are determined to make choice a reality.

Laura Moffatt said that a great deal of money had been spent in her constituency. I am sure that that is entirely true. She said that she believed that ideas and concepts were not relevant unless there were the resources to implement them. We, the Opposition, would say that resources alone will not achieve much without the right structures or the correct empowerment of parents or pupils—and that, sadly, has been the story of much of the past seven and a half years.

My hon. Friend Mr. Gibb, in a typically thoughtful and wide-ranging speech, made some extremely powerful comments about the need to move towards the use of phonics, a return to teaching by rote, setting and less use of mixed-ability teaching. In response to his comment that he thought that this is something about which politicians should express preferences and views, I hope that he will have noticed that my right hon. and learned Friend the Leader of the Opposition, in his speech on education yesterday, specifically committed our party to sponsoring the expansion of all those things, for precisely the reasons that my hon. Friend addressed.

Kali Mountford rightly praised my hon. Friend the Member for Bognor Regis and Littlehampton for his speech, and made an excellent speech herself about the need to focus on the prevention as well as the cure of illness, and to develop the healthy schools initiative. I am sure that she shares my disappointment that the Prime Minister, in his party conference speeches in 1999 and 2000, made promises that were not kept. In 2000, he said that £750 million of lottery money would be spent on new school sports facilities in the succeeding three years. By February this year, however, of that £750 million a total of only £8.5 million had been spent. That is disappointing, and I agree with the hon. Lady about the importance of the issue.

My hon. Friend Michael Fabricant said that 200,000 people have had to go private because they cannot wait for their operation on the NHS. He also made powerful constituency points about animal rights protestors. My hon. Friend Alistair Burt made some sensible comments about school sport. He also made some strong points about the need to get the balance right in sex education. He is right to say that we should all review the balance and scope of sex education in our schools, and can learn lessons from European countries that have been more successful in this field for many years under successive Governments. He also spoke about the wisdom of listening to people who represent different faith groups and people who, like my hon. Friend, practise a faith.

Dr. Taylor talked about the food industry and food labelling, and secured an important clarification from the Health Secretary about his position which, I understand, was misrepresented in some of this morning's newspapers. Rev. Martin Smyth made an interesting observation about the reason why waiting lists in Northern Ireland are much longer than in England. Lessons certainly need to be learned, and I strongly agreed with his conclusion about the need to provide support for people suffering from what is called Gulf war syndrome. Mr. Rendel rightly highlighted the distinction between the Government's words about opportunity and their action in introducing top-up fees.

The contents of the Queen's Speech are, in many respects, disappointing. The School Transport Bill is carried over and will strip parents of a 60-year-old statutory entitlement to free school transport. That will permit, then encourage and ultimately, we fear, require local authorities to charge for that service. Two thirds of current subsidies for school transport benefit special needs children, who will lose out, as will parents who are far from wealthy, and people in rural areas.

The child benefit Bill, on the other hand, will address a genuine and long-standing anomaly, so we welcome it. Unfortunately, it has been packaged with measures that will result in the introduction of new and higher charges for adult learners in further education colleges. I would be grateful if the Secretary of State for Education and Skills commented on something that my hon. Friend Chris Grayling told me this afternoon—that the Association of Colleges has been told by the Learning and Skills Council that any revenues that it raises through the extra charging regime will be clawed back by the Treasury. In other words, the money would not be additional, which is a deeply disturbing development.

The schools Bill will include a number of measures that the Opposition do not find any difficulty in supporting, as they will make it easier and quicker for schools to achieve foundation status. They will also establish a three-year rolling budget and slim down Ofsted. We support those excellent measures, having called for them for a considerable period. However, we believe that the Bill is uncontroversial not because it is perfect, but because it is a half-hearted stab at what is necessary. Foundation schools have limited freedoms: they do not have control over admissions, have no final say over expulsions, and cannot commission or control all works on their site. They do not have the right to decide entirely for themselves whether to expand, alter working conditions or impose home-school contracts as a condition of admission. Schools need those freedoms, but they are not granted in the Queen's Speech.

The Queen's Speech that we should have had would involve a right to choose Bill, scrapping the surplus places rule, encouraging and funding good schools to expand, allowing parents to take state funding to any school of their choice, and ensuring that an extra 600,000 parents get their first choice of school in the lifetime of the next Parliament. We should have had a teacher protection Bill, giving teachers accused of misbehaviour a guarantee of anonymity until they are charged, giving head teachers the final say on exclusions by abolishing independent appeals panels, and providing for a massive expansion of high-quality separate provision for pupils who end up excluded.

We should have had a higher education Bill to scrap tuition and top-up fees, to transfer the huge asset of the student loan book to universities to make a massive improvement in their finances, and to scrap outright the disgraceful post of university access regulator, because access to university should not be politically determined.

As ever, we must judge the Government not on what they say, but on what they do. What we got in the Queen's Speech was more spin and all talk. What we needed was more choice, more discipline and higher standards. After seven and a half years, it is clear that we will not get any of that from more Queen's Speeches from Labour. We will get it only from the first Queen's Speech of the next Conservative Government.

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills 6:45 pm, 30th November 2004

The whole House will share the shock at the death of a 15-year-old boy at Broadoak in Trafford. It is an appalling incident. We do not know the details yet. The police are considering the situation and will report to us. It is incumbent on all of us to wait for their analysis before deciding on the best way to proceed. I send the feelings of the whole House, as Mr. Collins said, to the family and friends of the boy who has died.

Together with my right hon. Friend the Secretary of State for Health, I welcome the debate. I shall not deal in detail with the range of health issues raised, in particular by the hon. Members for Lichfield (Michael Fabricant), for Wyre Forest (Dr. Taylor), for Belfast, South (Rev. Martin Smyth) and for North-East Bedfordshire (Alistair Burt), my hon. Friend Laura Moffatt and Mr. Dorrell, though I notice the absence of any preparedness to discuss the patient's passport despite various invitations from my right hon. Friend the Secretary of State for Health and myself. I was a little surprised that the pupil passport also got so little mention throughout the debate, keynote measures as those are.

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

Not at the moment.

I was disappointed that Mr. Lansley said that there were no Bills on education in the Queen's Speech. In fact, there are four, and I shall summarise them for the House. First, we will publish an education Bill later this week, which aims to help schools raise standards through a more effective inspection regime—I appreciate the comments of my hon. Friend the Member for Crawley on those proposals—and by aligning the cycle of early years inspections, training the school work force more effectively with continuous professional development, establishing three-year budgets and school funding, and developing the ability of schools to run themselves more effectively.

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

Not at the moment.

I shall respond to a point made by colleagues in the debate, particularly my hon. Friends the Members for Huddersfield (Mr. Sheerman) and for Tamworth (Mr. Jenkins) and the right hon. Member for Charnwood on the role of the local authority. For us, that is exceptionally important in relation to children's trusts, as Mr. Burstow mentioned in his speech, as well as in the delivery of the whole 14 to 19 agenda, and in relation to the school improvement responsibilities mentioned by my hon. Friend the Member for Huddersfield and the various ways in which school performance can be raised, as set out by Mr. Gibb. I cite particularly to my hon. Friend the Member for Tamworth the importance of the vocational pathways which, following the Tomlinson report, will be critical to the 14 to 19 group and in which the local education authority will have an essential role. I was glad to hear that the official Opposition will give general support to the Bill, and I hope that we can make progress on it.

The second Bill is the School Transport Bill. Given the comments of the hon. Member for Wyre Forest, I hope that we can rely on his support. I ask both main Opposition parties to consider reversing their blind opposition to the proposals. As their colleagues in local government, Conservative and Liberal Democrat, well know, those proposals are supported by councils that want to be freed in the way that our pilots propose, that want to deal with congestion and the school run and that want to achieve healthier approaches. I urge Opposition Members not to persist in opposing the Bill.

The third Bill that I shall refer to is the draft Bill on contact and inter-country adoption—a key measure that follows the Green Paper to which I referred in an exchange with the hon. Member for Sutton and Cheam. It is a very important measure for a variety of reasons, but it is intended to give the courts more flexibility and powers to underpin and enforce contact orders in cases of parental separation. The measures in the draft Bill are very important and substantial. They will help to encourage and underpin productive contact arrangements in the best interests of the child. I say to every Member of the House that it is the best interests of the child that must be paramount in these considerations. There have been one or two knee-jerk posturings on this matter, not least from Mrs. May, which I think need to be addressed directly. I hope that we will have a proper debate on the draft Bill and agree that getting it right is important.

The final Bill that I want to mention is the one on child benefit. I was glad to hear the comments of Mr. Rendel and of the official Opposition in giving general support to this measure, which is also very important.

This is a substantial legislative programme for education that is part of the reform component of our overall strategy of investment and reform, which is central to everything we do. In July, we published our five-year programme for under-fives, schools, skills and lifelong learning, and the measures provide a substantial commitment in those areas. In the context of this debate, it is perhaps worth adding that health in schools and the public health White Paper published by my right hon. Friend the Secretary of State for Health are a key component in that joint work.

I noticed that a number of contributors—in particular, my hon. Friend Kali Mountford, who made an outstanding speech, as well as the hon. Members for North-East Bedfordshire, for Lichfield and others—focused on the health education element of the proposals. I think that that reflects joint working between the Department of Health, my Department and all our agencies to deliver high-quality education and health in every school in the country. That is done through information, integrating services through children's centres and children's trust arrangements, developing extended schools everywhere in the country, extending the school nursing service, establishing healthy schools in every area, investing to improve nutrition in school meals, active travel plans, school sports partnerships and funding through the whole range. That is a key element in our overall programme—a health and education programme that takes us forward.

In truth, reform is not enough in these areas; it is investment and reform that are needed, and the investment story too is immensely substantial. Today, my hon. Friend the Minister for School Standards announced our building schools for the future programme. It is worth setting out the figures, because they are so stark and impressive. We inherited total capital spending of £683 million in 1996–97. By 2005–06, the next academic year from now, the amount will have increased to £5.5 billion—a massive increase in spending.

Photo of Richard Bacon Richard Bacon Conservative, South Norfolk

While the Secretary of State is on the subject of investment and today's written statement made by the Minister for School Standards, which says that every maintained school will benefit from capital programmes, can the Secretary of State confirm that that statement includes all the 37 schools in Norfolk that would have been included in the PFI until it collapsed?

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

Yes, I can, and in two ways. First, every school will benefit, whatever its situation and whatever the PFI project. By next year, the amount will be £25,500 in a typical 250-pupil primary school, or in a typical 1,000-pupil secondary, there will be £87,250 in devolved capital for what the school has to do. Beyond that, whatever the particular programmes, such as the PFI in Norfolk to which the hon. Gentleman referred, and despite the difficulties, the commitment will remain precisely as it has been in the past.

The central point that I am making is that the financial commitment to the proposal is overwhelming. The building schools for the future programme that we have set out today is a transformation of education in this country that will enable improvements in every community in every part of the country.

Both on investment and on reform, there is a straightforward, clear choice between the Opposition and the Government. The choice on money is whether more money should go into education, as we propose, or whether money should be taken out of education, as the Opposition propose. The shadow Chancellor made it clear that spending outside schools, which means under-fives, skills, universities and all those other areas, will be frozen at 2005–06 levels. That was his clear commitment, which means real terms cuts in every other area.

The Opposition's proposed pupil passport would mean at least £1 billion going from state schools to private schools. In contrast, this party will continue to increase spending by at least 6 per cent. per year. from 2005–06 to 2007–08 and provide high-quality, flexible, affordable child care for all parents. That is one dividing line: more money from us; less money from the Opposition.

The second dividing line is opportunity for all, which we offer, versus selection for the few, which the Opposition offer. We require the strict application of the admissions code of practice for all schools and no extension to selection by ability. As the hon. Member for Westmorland and Lonsdale confirmed in an exchange a few moments ago, under the Opposition, every school would be able to decide its own admissions, opening the door to five-plus and 11-plus selection. Above and beyond that, the hon. Gentleman, speaking in March this year to the Secondary Heads Association, said that he wanted to get rid of catchment areas for schools. Again, there is a direct choice: opportunity for all, which we offer; selection for the few, which the Opposition offer.

The same dividing lines arise on standards. We say, "High ambitions for every school and pupil"; the Opposition say, "No ambitions for schools and pupils." Targets have been established, and schools are responsible for local target setting to encourage all young people to achieve the top grades. The Opposition would scrap the targets and limit the number of children who can achieve the top grades by introducing quotas.

Photo of Mr Tim Collins Mr Tim Collins Shadow Secretary of State for Education, Education

The Secretary of State has said something extremely important and, indeed, illuminating. He has just said that he wants to make sure that all young people get the top grades. Does he really think that it will achieve anything if everybody gets the same A grade? That is nonsense. Our top universities have a finite number of places and need to know who is the very best. Why will the Secretary of State not accept the Tomlinson recommendation to limit the numbers who get the very top grade?

Photo of Charles Clarke Charles Clarke Secretary of State, Department for Education and Skills

Sir Keith Joseph, holding the office that I now hold, recognised the lunacy of what the hon. Gentleman has just said by abolishing such a proposal. The hon. Gentleman wants to go to the right of Sir Keith Joseph, when Sir Keith Joseph was Secretary of State for Education, by failing to recognise everybody's ability to do better for themselves.

There is a dividing line on freedoms. We say, "More freedoms for all schools"; the Opposition say, "A free-for-all." We want freedom for secondary heads and governors to improve their governing bodies, set three-year budgets and create a framework for fair admissions; they want to create chaos by abolishing the codes of practice on admissions and by scrapping appeal panels, which would create a charter for lawyers.

On local education authorities, the division is clear too. We want a new role for local authorities in the areas that I have set out—children's trusts, those aged 14 to 19, child care and strategic leadership for education and school improvement. The Opposition want to abolish local authorities, funding schools directly by bypassing local government entirely. They are also considering the outright abolition of LEAs.

The Queen's Speech clearly sums up the choice in each of those areas: more money for us, less money for them; more freedoms for us, a free-for-all for them; high ambitions for us, no ambitions for them; and opportunity for all for us, selection for a few for them. In conclusion, we say, "Every child matters"; the Opposition say, "Only a few children matter."

Question put, That the amendment be made:—

The House divided: Ayes 178, Noes 305.

Division number 1 Health and Education

Aye: 178 MPs

No: 305 MPs

Ayes: A-Z by last name

Tellers

Nos: A-Z by last name

Tellers

Question accordingly negatived.

It being after Seven o'clock, the debate stood adjourned.

Debate to be resumed tomorrow.