NHS Workforce and Service Development

Opposition Day — [18th Allotted Day] – in the House of Commons at 12:33 pm on 11th October 2006.

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Photo of Michael Martin Michael Martin Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons 12:33 pm, 11th October 2006

We now come to the main business: the 18th allotted Opposition day, which is a debate on NHS work force and service development. I inform the House that I have selected the amendment in the name of the Prime Minister.

Photo of Andrew Lansley Andrew Lansley Shadow Secretary of State for Health 12:44 pm, 11th October 2006

I beg to move,

That this House, while welcoming past increases in the number of doctors, nurses and other health professionals working in the NHS, is alarmed at the recent reports of up to 20,000 posts to be lost in NHS hospitals and cuts in training budgets;
is deeply concerned about the lack of training posts for junior doctors;
condemns the severe shortage of posts for nurses and physiotherapists leaving training;
regrets the complete failure of the Government to remedy flaws in the implementation of the European Working Time Directive in its application to doctors' hours;
further regrets the unemployment of specialist medical staff;
believes NHS services are being cut back as a result of both financial deficits and staffing shortages rather than in the interests of patient safety;
and calls on the Government to ensure that the NHS fully utilises the potential of healthcare professionals available to the service.

The purpose of this debate is straightforward. The NHS is, in a real sense, its staff. The number and quality of health care professionals in the NHS is key to the quality of health care provided, and I am sure that Members on both sides of the House share a deep gratitude to doctors, nurses, therapists, scientists and health care professionals of all types across the NHS for their tremendous work. Improving the number of NHS staff is central to improving services.

Under the Conservative Government, the number of doctors increased by 23,000 and the number of nurses by 55,000. Under the present Government, according to the work force census, there are 33,368 more doctors, contrary to what the Government amendment says. There are 85,305 more qualified nurses and midwives than in 1997. The number of administrators has, of course, increased by 107,000. Under Labour, not only have the resources been badly used—according to the Office for National Statistics, productivity has fallen by 1 per cent. a year during the life of this Government—but now deficits are hitting those very staff. We know, and have debated, the scale of the deficits—today's debate is not primarily about that subject—and the Secretary of State has had to admit not only that the deficit last year was £1.3 billion gross, but that it was higher than she had previously estimated. It is now £547 million net.

Those deficits across the country are directly impacting on services. Decisions being made for short-term financial expediency have a direct impact on those staff. It is on that issue that we want to focus today—the impact on the staff of the NHS and, by extension, on the services that they provide, of the mismanagement of finances across the NHS.

Photo of Bob Blizzard Bob Blizzard PPS (Rt Hon Douglas Alexander, Secretary of State), Department for Transport, PPS (Rt Hon Douglas Alexander, Secretary of State), Scotland Office

There is one Opposition policy of which we are aware—their wish, as they say, to share the proceeds of growth between investment in public services and tax cuts. Can the hon. Gentleman tell us how much money will be removed from the NHS budget as a result?

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

The answer is straightforward: no money would be removed from the NHS. On the contrary, what my right hon. and hon. Friends have said means that the NHS will be able to participate in the enhanced economic growth that will be the product of our economic policies, and so can deliver more resources for the NHS in the future. I know that it depresses Labour Members that the Leader of the Opposition has frequently said that he will give priority to the NHS and has expressed his determination not only to increase its resources but to give it freedom from day-to-day political interference. We have said all of those things, and the public agree with them. The hon. Gentleman has to understand that we are putting that forward not on the basis of political advantage, but because it is in the interests of the national health service.

Photo of Sadiq Khan Sadiq Khan Labour, Tooting

Can the hon. Gentleman confirm that, despite all the cuts that he claims will be made, staff will be safe and no jobs will be lost under a Conservative Government?

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

I am interested in what the hon. Gentleman says. He will forgive me if I am wrong, but I think that his local hospital is part of the Mid Yorkshire Hospitals NHS Trust. Is that right? [Hon. Members: "Tooting."] I beg his pardon. I will give way to him again if he cares to tell us how he thinks that the deficits at St. George's hospital, Tooting, will be resolved other than by giving the NHS, including hospitals such as St. George's, much greater freedom to enable them to use resources more effectively. Frankly, under this Government, that is not happening. Hospitals such as St. George's are living under a regime of regulation and control, and the financial imposition of costs by the Secretary of State is causing them enormous damage. Perhaps he can comment on the fact that the Government admit that a 25 per cent. increase in the cost of hospital services in the past three years has eaten up all the money that has been provided to hospitals such as his.

Photo of Sadiq Khan Sadiq Khan Labour, Tooting

The hon. Gentleman mentioned money at St. George's. He will be aware of our new walk-in centre and our new Atkinson Morley wing, which is preventing deaths by cancer, and he will also be aware that we have doubled the number of nurses in the past nine years and have 500 more doctors. Can he now answer my question? Will all the staff that might be cut throughout the country because of the devolved powers of their trusts be saved by a Conservative Government?

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

I cannot, of course, make that promise. How could I make it? If the Secretary of State and the Government would care to call an election tomorrow and disappear—[ Interruption.]

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

If the Labour party would vacate the Government Benches and give us the opportunity to take up the responsibilities of government, we would ensure that NHS resources are used more effectively to deliver services for patients, that the staff the NHS recruit are front-line staff who deliver those services for patients, that accessible services—which are demanded by patients and GPs—can be commissioned by GPs on their patients' behalf, and that the threat that is the consequence of the Government's policies is lifted. Unfortunately, I cannot promise that, because the Government are not going to disappear tomorrow and Mr. Khan is asking me about jobs that are under threat now. I cannot promise that I can restore those jobs—of course I cannot. But I can promise that we will have policies that never lead, through gross mismanagement, to the problems that we face today and for which the current Government are responsible.

Let me tell the House how many jobs we are talking about: 20,000. I heard what the Prime Minister said; he had the effrontery to stand up at the Dispatch Box at Prime Minister's questions and say that there is no such threat of 20,000 job losses. He might like to look at some information I have, namely, that 64 NHS trusts have announced up to 20,000 posts that will be cut in the hospital sector alone. If the Prime Minister tries to deny that, let me refer him to the NHS Confederation, which is in no mood simply to support my party on this matter. It wants to minimise the effect of what might happen and it has issued a briefing. Labour Members seem to be reading only from the Labour Whip crib sheet, when what they should be doing is reading the briefings they have been receiving from organisations that know something about this matter. [Interruption.]

Photo of Michael Martin Michael Martin Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons

Order. Ms. McIsaac, I have already asked for some calmness in the Chamber and you are not helping me. You are not being as helpful as you usually are in such situations.

Photo of Mike Penning Mike Penning Conservative, Hemel Hempstead

There is a lot of laughter on the Labour Benches, but there is not much laughter in my constituency, where 750 doctors, nurses and key medical workers are being sacked by this Government.

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

I understand exactly what my hon. Friend says. When the casualties of the Buncefield oil depot incident—happily, there were very few—were taken to an accident and emergency department, it was the one at my hon. Friend's Hemel Hempstead hospital, and that accident and emergency department could have shut under this Government. Labour Members might like to explain why such things are happening. Indeed, they might like to explain—

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

I will in a moment, but to my hon. Friend Mr. Chope.

Labour Members might like to explain why the Prime Minister gets up and issues a denial in this, when the NHS Confederation says:

"The figures being widely quoted of up to 20,000 may turn out to not be too far off the total reduction in workforce numbers this year".

In fact, what the NHS Confederation is saying is worse than I thought because it is talking about an overall reduction of 20,000, whereas I am talking only about an announced 20,000 posts to be cut in the hospital sector. One might have imagined that there would be at least some compensating increase in posts in the community sector, but that is not, apparently, the experience of the NHS Confederation.

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

I am grateful to my hon. Friend for giving way. He is making some excellent points— [Laughter.]

Photo of Christopher Chope Christopher Chope Conservative, Christchurch

When I attend the Conservative NHS action day stalls in Christchurch on Saturday, I know that I am likely to be asked what our policy is in response to the National Institute for Health and Clinical Excellence decision to deprive those in the early stages of Alzheimer's of much needed medication. Can my hon. Friend assure me that we will overrule that decision by NICE when we get into government?

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

I am happy to be able to agree with my hon. Friend's first sentiment, but on Alzheimer's drugs I cannot give him the assurance for which he asks. [Interruption.]

Photo of Michael Martin Michael Martin Chair, Speaker's Committee on the Electoral Commission, Speaker of the House of Commons

Order, this behaviour certainly will not help the debate. Those who are listening to our proceedings will wonder why we are behaving in this way in a debate on such an important issue. I know that there is some excitement around, but things are getting to a stage where we are having a bawling or shouting match. Labour Members should understand that the Secretary of State's turn to speak will come, and I will seek the same courtesies for her as I seek for the spokesman for the Opposition. I know that the Speaker should not intervene for so long, but the Chamber is getting far too noisy—and perhaps one Member will be disciplined if we continue in this way.

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

Thank you very much, Mr. Speaker.

I was endeavouring to explain something to my hon. Friend the Member for Christchurch, with which he may or may not agree. NICE has to do an exhaustive job of trying to assess whether it is in the interests of the NHS that a treatment be provided because it is both clinically effective and cost-effective. That process has been extremely useful because it has increasingly exposed what is cost-effective and clinically effective about Alzheimer's drugs. They are effective for patients, especially for those with moderate and severe Alzheimer's—dementia. However, in respect of mild dementia, they are not regarded as sufficiently effective to be a treatment that should be recommended on the NHS. Frankly, it is my opinion that in an independent national health service such decisions must be made independently and we must ensure that there is a correct statutory framework. On this matter, one important issue remains in my mind. Because of the nature of the regulations prescribed by the Government, the benefits that NICE can take into account apply only to the national health service and to publicly funded social care. The benefits to carers and their families beyond that point cannot be taken into account. We must look into that—and that might, of course, have a bearing on the outcome of any appraisal undertaken by NICE.

a

Andrew Lansley's statement is factually incorrect. NICE found that the dementia drugs are effective for mild dementia. NICE does measure quality of life ('QALY' measurement) and it also has a remit to impact on carers and familiy, who may be ill themselves. The only reason the drugs were not found to be cost effective was that the QALY scores were unfairly biased.
I do agree that somebody needs to investigate the QALY scoring, taking into acount the patient's improved cognition and personality as well as the impact on familly.

Submitted by andy saul Read 1 more annotation

Photo of Jonathan Djanogly Jonathan Djanogly Shadow Minister (Business, Innovation and Skills), Shadow Solicitor General, Shadow Minister (Justice)

As my hon. Friend knows, hundreds of jobs have gone at Hinchingbrooke hospital, with hundreds more likely to go, and the hospital is now subject to a closure threat. It seems to me that the strategic health authority's review is in fact cover for a slash-and-burn policy conducted by this Government. What does my hon. Friend have to say about that?

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

To some extent, my hon. Friend and I share that hospital. Patients from my constituency go to Hinchingbrooke hospital. That anticipates something that I was going to say. It is disgraceful that "reviews"—in inverted commas—should be taking place that are in fact driven by finance. The implication— [Interruption.] Members might like to listen to this point. The implication of that for staff working at Hinchingbrooke is that the maternity unit has to be closed because it is not safe, but that is not true as it has one of the finest patient safety records in the country. That is financially driven.

Frankly, I do not think that the strategic health authority should be the body doing that. We are supposed to be moving—this is what the Government say—towards a structure in the health service that is increasingly geared towards the decisions of local commissioners such as primary care trusts, practices through practice-based commissioning, and patient choice. However, on the contrary, we have a strategic health authority that has just been established and that has inherited a financial problem—many of my colleagues right across the east of England are in the same position. Because of a £233 million deficit, it will decide which hospitals stay open and which are shut. That is a disgrace. In a year or two services will be shut down by the strategic health authority, but in subsequent years we will have to re-establish them because they are required to meet the needs of patients.

Photo of Kevin Barron Kevin Barron Chair, Health Committee

May I ask the hon. Gentleman about a news story that I read on the Conservative party website? Does he agree with the Leader of the Opposition when he says that

"the NHS matters too much to be treated like a political football"?

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

Absolutely, and that is exactly why my right hon. Friend and I explained on Monday how we could take politicians out of the day-to-day management of the NHS. However, as we heard from the Prime Minister at lunchtime, he is so keen on having the NHS as a political football that he is not prepared to allow it greater independence. I am sure that when the time comes, the Chairman of the Health Committee will want to ask the Secretary of State what the NHS political football game looked like on 3 July, when she sat down with the chairman of the Labour party, Ministers and political advisers, including Labour party staff, in order to debate their "heat maps" and to decide where in the country hospitals were to be shut. Frankly, that is not acceptable. It is the Government who are indulging in that political football game, not us.

Several hon. Members:

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

I will carry on for a minute. I have taken an intervention and I have yet to get on to the issues that we really need to reach.

We need to understand that all the deficits are having major consequences for staff. As I said, we might have imagined that, at the same time as jobs in hospitals were being cut, they were being created in the community. Members will recall that back in January, a White Paper was published the purpose of which was to state that precisely that shift of patients would happen. Well, what do we find? The work force census showed that in the last year for which figures were available, there were 485 fewer health visitors, 760 fewer district nurses, and even 36 fewer midwives. Yet the Government seem to think that those people are somehow magically going to increase in number and be available to provide services.

The Prime Minister made a speech on this issue last month. The action plan for social exclusion says that all additional health visitors and community midwives will be upskilled in order to undertake early interventions with families. Health visitors in my constituency used to visit every family, but that service disappeared about seven years ago. There simply is not the number of health visitors to enable that to happen.

Photo of Graham Stuart Graham Stuart Conservative, Beverley and Holderness

I am grateful to my hon. Friend for giving way. Is he aware that in the first six months of this year—in other words, almost from the moment that the Secretary of State sat down after presenting the White Paper in this House—10 community hospitals across England were closed under this Administration, with devastating effect? That is the exact reversal of the Government policy set out in that White Paper—a vision that many Conservative Members shared, but which has not been delivered on the ground. It is that sense of betrayal—the difference between the words and the reality—that is so undermining confidence in this Government.

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

I entirely agree with my hon. Friend. Let me give an example. If the Government were serious about supporting community hospitals, they would have taken the technical step that would have helped: unbundling the tariff to enable patients to be discharged from acute hospitals and transferred to community hospitals, with the money going with them. The Government keep talking about it and saying that it will happen, but they have not done it.

Several hon. Members:

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Photo of Howard Stoate Howard Stoate Labour, Dartford

I am most grateful to the hon. Gentleman for giving way. I cannot help thinking that we might be losing the focus of this debate. Surely what matters in the health service is patient outcomes and patient care. As I still work as a GP, I can point to the fact that it now takes only two weeks to see a cancer consultant and to the fact that waiting lists are falling and GPs are providing much more care in their own practices, thereby significantly reducing the need to refer people to secondary care. Those are significant improvements in patient care, which surely is the purpose of the health service.

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

I am grateful to the hon. Gentleman. Patient care does indeed matter tremendously, and in pursuit of that, patients in his practice will no doubt find things improving when he returns to full-time work in the NHS after the next election.

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

May I just answer Dr. Stoate, because there is an important point here? In their amendment to this motion, the Government say that

"death rates from cancer and heart disease are falling faster than ever before", and the Prime Minister said at Prime Minister's questions that deaths from coronary heart disease had fallen since 1997. Indeed they have, but as it happens they have not fallen faster than ever before. In the seven years before 1997, the death rate for circulatory diseases and the cancer death rate fell slightly faster than in the seven years since that date. Mr. Barron, the Chairman of the Health Committee, made a point earlier about the use of the health service as a political football. Well, a good starting point would be to tell the whole truth about what is going on.

Yesterday, the Government —[Interruption.] Let me finish this point. Yesterday, the Government published health profiles across England and said that cardio-vascular disease death rates have been falling since the mid-1990s. They have not—in fact, they had been falling for at least a decade before that. Let us be honest about what is going on. There is a long-term secular reduction in both coronary heart disease and cancer death rates, which is very much to be welcomed. That has not happened simply as the consequence of the 1997 election, or of additional money. It has happened in virtually every developed country across the world, so let us be honest about these things.

Several hon. Members:

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Photo of Chris Grayling Chris Grayling Shadow Secretary of State for Transport

I am very grateful to my hon. Friend. In my view, Labour Members simply do not understand the reality of what is going on. Two weeks ago, there were thousands of people on the streets of Epsom protesting against the loss of services at our local hospital. We now face the loss of services not only there but in Guildford—ironically, given the Secretary of State's clumsy party political intervention at St. Helier before last year's local elections—and we are losing community services and district nurses. The podiatry service is now being provided by Age Concern, and it looks as though we are going to lose sexual health advice for teenagers. What is going wrong? Labour Members seem not to understand the reality of our health service today.

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

Frankly, the quality of management at the top of the health service is what is going wrong, and that stems from Ministers. I hope that the Secretary of State will have the grace to apologise for trying, for political reasons, to steer a capital project to St. Helier, rather than to where the evidence pointed to. She had to backtrack on that in August.

Several hon. Members:

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

I am going to carry on because, as the hon. Member for Dartford rightly said, we have got to get to the points that really matter. There are a lot of NHS staff out there who want to know what the Government are actually going to do now about these problems. There are junior doctors worrying about whether they will find training places. I am glad that the Government said that they are going to find between 22,000 and 23,000 places in August 2007; indeed, I raised precisely that issue with the Secretary of State back in January. Of course, and as I recall from last year's flu statistics, she has always had problems understanding what is England and what is the United Kingdom. In this instance, she has gone for 22,000 to 23,000 training posts in the UK, in order to meet a demand for 22,000 such posts in England, so the figures do not quite add up.

Photo of Chris Bryant Chris Bryant Labour, Rhondda

Will the hon. Gentleman give way?

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

No; I am carrying on for a bit.

I do hope that the Secretary of State will also make it clear that, wherever possible, such posts will be run-through training posts that give the junior doctors concerned greater assurance that they can qualify and get their certificate of completion of specialist training in due course.

It is not only doctors who have problems. As the Royal College of Nursing made clear in its surveys, many nurses are leaving college unsure that they will find jobs; indeed, many do not find jobs. In some cases, half or more of the graduate output do not find jobs. Some 100,000 nurses are due to retire in the next five years, and over the next three years there will be a 20 per cent. reduction in the number of nursing training places. What are the prospects for nurses? I met a nurse in my surgery just last Friday, who said:

"I have just qualified as a nurse, and finished my degree in children's nursing at the beginning of July. I have been applying for jobs since May and am still unemployed...for one interview I attended, 45 candidates were being interviewed from over 120 applications. I am at a loss to know what to do."

I also received a copy of the following letter from a lady, who writes:

"My daughter will qualify as a psychiatric nurse in August after three years of training...She and her fellow students have been informed that there will be no training posts for them in Cornwall on qualification...The situation now is that she will not have a job in the Health Service within her chosen profession. And she will not be able to find employment abroad without one year of post qualification training."

Let us consider physiotherapists. How many Members present met members of the Chartered Society of Physiotherapy when they came here in July? Well, I met the students from the Royal London: 99 students completed the course, but only one has a job.

A lady writes to me:

"My daughter is one of hundreds of newly qualified physiotherapists unable to get a job because of the crisis in the NHS...My local hospital has a waiting list of 10 months to see a physiotherapist."

Somebody writes from Norwich that of 96 students leaving physiotherapy training only five found jobs. A letter from Lincolnshire states:

"Not one student from Nottingham (which is a centre of excellence for physiotherapy) has been able to find employment as a physiotherapist in the NHS. This abysmal situation appears to be directly due to the budget deficits across the NHS."

I have a question for the Secretary of State, because a practical issue is involved. In Scotland, as she knows, the Scottish NHS guarantees nurses and physiotherapists a year of employment following their graduation. Will she say that the same thing will happen in England?

Photo of Dawn Butler Dawn Butler Labour, Brent South

I agree that we should be honest about the debate. Part of the reason why death rates for cancer and heart disease are falling is that our Government have set targets—[Hon. Members: "Ah."]—Yes, targets. There is faster treatment: 99 per cent. of people diagnosed with cancer receive treatment within four weeks of diagnosis. Will the hon. Gentleman tell us whether his policies will reflect that or whether their NHS plan stands for no honest solution from the Opposition?

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

I am sorry that the hon. Lady was clearly not even listening to what I was saying. As yet, there is no discernible change in the trend reduction in deaths from cancer, even as a consequence of the additional investment in the NHS cancer plan. We might wish it otherwise, but that is the case. The fact that death rates continue to go down is much to be welcomed, but it has much more to do with things such as the reduction of smoking, as well as with the quality of service. When we compare our cancer death rates to those in other countries, we see that early identification of tumours will be absolutely instrumental in their further reduction. The cancer plan said that there needed to be awareness of symptoms and up-front investment for prevention, but that has not happened.

Photo of Edward Leigh Edward Leigh Chair, Public Accounts Committee

Ultimately the question is one of money and value for money. If we are to have more local control and accountability, can my hon. Friend give the House an assurance that, through Parliament's Committees—especially the Health Committee and the Public Accounts Committee—we will still be able to follow the money? Ultimately, the House must remain responsible for all public money spent.

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

I am grateful to my hon. Friend, who properly defends that important interest. Nothing we have said would deflect from it. The service would be publicly funded, where propriety and value-for-money considerations would remain the responsibility of the inspection bodies throughout the process, all the way down to the point where GPs exercise commissioning responsibilities. It needs to be so, because the service uses public money.

Several hon. Members:

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

I do not want to take more than about half an hour, as many Members want to speak.

Deficits do not affect only trainees; they have a direct impact on existing specialists. A report suggests that, by December, 61 cardio-thoracic surgeons will be without a consultant appointment in the NHS. I am advised that 37 ear, nose and throat specialists do not have posts at present. The Royal College of Anaesthetists tells me that whereas in previous years there have almost always been about 30 advertisements a month for new anaesthetist posts—last year there were 31 in July and 29 in August—only 17 were advertised in July this year and only four in August. The president of the royal college rightly says that a great number of people in other countries are looking for anaesthetists. My concern is that if we make life difficult for too long, they will go; we will lose the specialists we need.

The Government should note that the British Orthopaedic Association has already told them that the average retirement age of orthopaedic surgeons has gone down by three years over the past seven years. Such is the extent to which we are losing services.

Photo of Anne Milton Anne Milton Conservative, Guildford

To go back to my hon. Friend's comments about physiotherapists, does he agree that with the Government's drive for more people to be looked after at home and closer to their homes, physiotherapy services, and physiotherapists, are absolutely crucial to ensure well-being and treatment, especially of an older population?

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

My hon. Friend is absolutely right. The situation for stroke patients, for example, is utterly depressing. Even if they are able to secure early and intensive rehabilitation, sometimes treatment cannot be followed up to maximise their chances of recovery, owing to the lack of physiotherapists in post. We must have more physiotherapists. The Government said that we needed more physiotherapists and that there would be 60 per cent. more. People went into the profession as a result. A physiotherapist told me: "I knew what was intended so I went into the course. Now there are no jobs." That is a deeply depressing fact; it is a cruel irony played on people who took up such courses.

Several hon. Members:

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

I really should try to reach the end of my speech.

Photo of John Bercow John Bercow Conservative, Buckingham

Will my hon. Friend be generous?

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

No, I am sorry.

Not only have we lost specialist posts but training budgets are being cut. The Secretary of State might like to tell us whether it is the case that, as reported, training budgets across the country will be cut by 10 per cent. this year. She might like to consider the example of Leicester, where the strategic health authority says that it will cut £52 million from the training budget. The University Hospitals of Leicester NHS Trust told Leicester university that it will cut clinical academic funding by 20 per cent. That will mean the loss of 15 per cent. of the medical school staff, who spend more than half their time treating patients. Some of the senior staff, who are integral to the trust's delivery of service, will be lost.

To be fair to the Government, in 2002, they introduced the GP returner scheme and 550 GPs used it, but the money has disappeared. In 2006-07, there will be no money for the scheme; it is disappearing across the country.

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

No.

I want to mention one more important issue. The problem is not just deficits. In April 2004, Members may recall that we warned the Government about the impact of the European working time directive. I shall not rehearse all the arguments, but it was clear that if the Government did not secure an amendment to the directive there would be serious consequences for services. The Government claimed that would not be the case. Mr. Hutton, now the Secretary of State for Work and Pensions, said that they would maintain access to services despite the working time directive. But what has happened?

I shall quote from a document about changing maternity and paediatric services produced by the Manchester SHA. Manchester itself—not the whole north-west—is a good example, as it is not generally driven by deficits and ended last year with a health economy in surplus. The document states:

"Staffing pressures on the 13 units providing in-patient care are getting worse. Already children's wards and maternity units have to close on occasions because there are not enough staff to cover them safely. We will not be able to staff all these units by 2009 when the European Working Time Directive becomes law and doctors are not allowed to work the hours they currently work. This is already resulting in units being closed frequently. In 2002 there were over 200 closures to the admission of children and young people across 13 hospitals, due to either a shortage of doctors or a shortage of specialist nurses."

If the Government had done what they said would do, they would have secured an amendment to the directive. Their replies to me make it clear that they tried to do so when they held the presidency. They took the matter to the Employment Council in December 2005 but they failed, and they have not attempted to do anything since. They must do something.

Will the Government do what Lord Hunt—then a Health Minister—said he would do on 4 March 2003? He said that if there were difficulties, the further extension of the working time directive, due in 2009, could be deferred until 2012 and that instead of a 48-hour week, it would be possible to go up to 52 hours. Will the Secretary of State do that?

Several hon. Members:

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

No, I am not giving way, as I am moving towards my conclusion, but before I do so, I want to be fair to the Government. We are talking about work force planning and because I wanted to understand the Government's approach towards it, I looked at their evidence submitted to the Health Committee, which is currently investigating the matter. Here it is. The Government say that there is now "a streamlined framework" for work force planning. There are workforce directorates within strategic health authorities and they work with the social partnership forum, with the workforce programme board, with the national workforce group, with the workforce review team, with NHS national workforce projects, with Skills for Health and with NHS employers. There is even a diagram to explain it all—and all that is supposed to be the "streamlined" framework! Whatever it is, it is certainly not yet streamlined enough. We need a much better system because out there in the NHS, staff have no idea what the work force plans look like, as even now, posts are being cut.

The staff of the NHS are, as we have said, its greatest asset. They work miracles daily and we need them to be motivated and inspired, but at the moment they are demoralised. The Secretary of State has gone from her "best year ever" in May to a "very difficult year" by September. NHS staff are seeing a feast turn into a famine. They see promises of expansion turn into cutbacks and they see the advertising campaigns of three or four years ago to recruit new nurses and therapists turning into the cruel irony of people leaving training unable to pursue their vocations and find jobs. They see sham consultations over service reconfigurations driven by short-term financial expedients.

The staff also note how the effects of the European working time directive are dressed up to suggest that services have to be shut down because they are deemed unsafe. Frankly, that is a slur on NHS staff. People are working across the country to save their local NHS services. Labour Members should not decry that as a Tory conspiracy; it is happening because people are angry about the loss of their local NHS services. They do not want to block changes, but they want them to be guided by evidence and to take account of needs for accessible services.

The new chief executive of the NHS says that more than one in four of district general hospitals have to be downgraded. He then tells us, in an interview in The Guardian, that he "understands the politics" of it. Well, we do not need an NHS chief executive who understands politics, but one who is focused on patients. We need a chief executive who is not spending all his time trying to work out what Ministers want him to do, but assessing what is in the best interests of patients and the NHS. We need an NHS free of the Secretary of State and the chairman of the Labour party sitting down with their advisers, trying to decide which hospitals to close.

I am an optimist. I believe in the NHS and I believe in what NHS staff can achieve, but they can do so only if we give them the framework, the resources and the freedom to deliver. That is our objective, so I commend the motion to the House.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health 1:23 pm, 11th October 2006

I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

"welcomes the Government's historic investment in the NHS since 1997, trebling funding by 2008;
pays tribute to the commitment of NHS staff;
recognises the ongoing investment in their training and development;
notes that there are now 32,000 more doctors and 85,000 more nurses, and that overall there are over 300,000 more staff working in the NHS;
acknowledges that as a result of the Government's investment and reforms and the hard work and dedication of NHS staff, virtually no-one now waits more than six months for their operation whereas in 1997, 284,000 people waited longer than six months with some patients waiting up to two years;
further notes that over 99 per cent. of people with suspected cancer are now seen by a specialist within two weeks of being referred by their general practitioner, up from 63 per cent. in 1997, and that death rates from cancer and heart disease are falling faster than ever before;
and further recognises the need to ensure NHS services continue to change to benefit from new medical technologies and treatments which mean more care can be delivered in local communities and people's homes."

Mr. Speaker, Mr. Lansley has spent nearly 40 minutes telling us, as he always does, what is wrong with the NHS. I want to start by congratulating the staff of the NHS—more than 1.3 million committed and dedicated men and women, many working in very difficult circumstances. There are more than 300,000 extra staff—my right hon. Friend the Prime Minister slightly understated the increase in Prime Minister's questions—than there were in 1997. I particularly want to thank them for the improvements that they have made in looking after patients in recent years. We have seen dramatic improvements in waiting times, for example.

Photo of Andrew Gwynne Andrew Gwynne PPS (Rt Hon Baroness Scotland of Asthal QC, Minister of State), Home Office

With additional new money, the NHS has improved dramatically. We have perhaps forgotten that in the 1990s we used to worry about the number of years that patients had to wait for treatment, whereas today we worry about the number of weeks. That is not from the Whip's brief, as the point comes from the director of public health at Stockport primary care trust. Does my right hon. Friend recognise that that professional view represents the reality of what is happening out there?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend is absolutely right: he is in touch with what is happening in his local NHS.

Several hon. Members:

rose—

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

I shall give way again in a few moments.

In 1997, 284,000 people were waiting more than six months—some for more than two years—whereas today almost nobody waits more than six months and the vast majority are treated far more quickly than that.

Photo of Lindsay Hoyle Lindsay Hoyle Labour, Chorley

I am sure that my right hon. Friend would want to congratulate workers at Lancashire teaching hospitals on their dedicated work in ensuring that the quality of lives in Lancashire continues to improve. Does she support the continuation of the work at those hospitals and will she ensure that it does not go to the private sector, which would put them at risk?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

I join my hon. Friend in congratulating the staff at those hospitals. As he well knows, the Government and I have supported both investment and reform from the outset, including, where it will help cut waiting times and secure even better care for NHS patients, the use of the independent sector.

Photo of Michael Fallon Michael Fallon Chair, Treasury Sub-Committee

While she rightly congratulates existing staff, what does the Secretary of State say to those newly qualified midwives and physiotherapists who were promised a job in the NHS only to find that they cannot get one? Why has she made such a mess of work force planning?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

We have never made promises to NHS staff that either we or the Opposition could not keep. What we are saying to newly qualified staff, some of whom are indeed struggling to find a job, is that we will do everything possible to ensure that they get one. In some parts of the country, NHS hospitals are working with other organisations to ensure that, if a permanent job is not available for newly qualified nurses and midwives, they are at least taken on temporarily so that they can continue to build their skills and contribute to the NHS.

Several hon. Members:

rose—

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

I want to make some progress before giving way again.

I also want to thank NHS staff for dramatic improvements—belittled, I have to say, by the hon. Member for South Cambridgeshire—in cancer care. I do not think that any of the 50,000 cancer patients who are alive today because of improvements in cancer care would want to belittle them and neither would the hon. Gentleman's view be shared by cancer patients who have seen dramatic improvements over the last 12 months. Just 12 months ago, fewer than seven out of 10 patients with most suspected cancers could count on being seen, diagnosed and then beginning their treatment within two months. Today, nearly 95 per cent. of patients are doing so. That is the result of the incredibly hard work of staff, more money, which the Conservatives voted against, and the targets set for cancer care that the Conservatives would abolish.

Photo of Dari Taylor Dari Taylor Labour, Stockton South

On that very point, I would greatly appreciate it if my right hon. Friend would keep certain facts to the forefront of the debate. In North Tees hospital, for example, 100 per cent. of all breast cancer patients are seen and treated within 62 days. That is a superb achievement, which no one in the House should ever do anything other than congratulate.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend is absolutely right. It is a superb achievement when 100 per cent.—well beyond the target that we set—are being seen, diagnosed and beginning their treatment. That is one of the ways in which survival rates from cancer will be improved.

Several hon. Members:

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Photo of John Bercow John Bercow Conservative, Buckingham

Ministers have frequently asserted—they are right to do so—that early intervention is vital to help children with speech and language difficulties. As the Secretary of State knows, I have a strong and continuing personal interest in that subject. Given that the Vale of Aylesbury primary care trust is now turning away new referrals and inviting hard-pressed parents to seek help privately, what does the Secretary of State say to those parents who, in a million years, cannot afford to do so and who, without immediate and practical help, will find that their children's future prospects are permanently damaged?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

First, as the hon. Gentleman knows because I have written to him on this point, I have already ensured that the Nuffield speech and language unit—an issue that he has specifically raised on many occasions—will continue to treat patients. [Hon. Members: "What about the Vale of Aylesbury?] Funding for the Vale of Aylesbury primary care trust has increased by more than 30 per cent. over the past three years, by £40 million. In Buckinghamshire PCT, over the next two years, there will be an additional £91.5 million. However, what we must do—Opposition Members refuse to accept this—is support the NHS in making decisions that are often difficult, to get better value for that money, to release the savings that it needs to pay for more speech and language therapists, for new drugs and for all the other services that need improving. The hon. Gentleman is not willing to accept that, any more than are other members of the Conservative party.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

Although I do not doubt the Secretary of State's sincerity, I hope that she will visit Cornwall to see for herself the impact of the reforms that she and others have been implementing in areas such as my constituency. Despite the protestations that her Department is not enforcing the diversion by local trusts of NHS resources into the private sector, is she aware that, in fact, patients who are facing unnecessary, enforced minimum waits, including waits of more than nine weeks for breast care at the moment, receive unsolicited calls from NHS managers inviting them to be seen sooner in the private sector? Will she come to Cornwall to see the results of those reforms and their impact on the financially hard-pressed service there at present? In fact, it is a financial mess. People are waiting unnecessarily and the money is going into the private sector instead.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend the Under-Secretary of State for Health will indeed shortly visit Cornwall; I hope to do so in the near future. There are indeed some real challenges not only in the hon. Gentleman's constituency, but across Cornwall, in ensuring that the enormous amounts of extra money that we have put into the NHS in his part of the country are used to the best possible effect to ensure that patients get the best and fastest care everywhere. However, the NHS in the south-west has made superb use of the independent sector—for instance, at the Shepton Mallet treatment centre—to speed up the treatment of patients who need orthopaedic operations and to do so in co-operation with the rest of the NHS in an integrated fashion.

Several hon. Members:

rose—

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

No, I am going to make some progress before I give way again.

Every debate about the NHS is important to all of us, but I was looking forward to this one with particular anticipation. This week, we have had the first sighting of a rare bird—Conservative policy on the NHS—but what a disappointment. What we heard from the hon. Member for South Cambridgeshire today and from Mr. Cameron earlier this week was the mishmash of confusion and contradiction that we have come to expect from the modern Conservative party.

The leader of the Conservative party says that he will guarantee the NHS the money that it needs—a guarantee from the party that starved the NHS of funds for 18 years and a guarantee from the party and the leader who voted against the increased, record funding that we have put in? Conservative Members pretend, and they do so to NHS staff, that they can promise a blank cheque, but they also promised a new economic policy—a new fiscal rule, no less—that would mean £17 billion less for public services, including the NHS, this year. On top of that, their policy commission on taxation wants £90 billion of tax cuts. It does not begin to add up to a policy.

Photo of Charlotte Atkins Charlotte Atkins Labour, Staffordshire Moorlands

Hon. Members on both sides of the House are unanimous in praising NHS staff for their achievements, but are they unanimous in their views on funding "Agenda for Change", particularly NHS staff pensions?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend makes a very important point. Of course, what the hon. Member for South Cambridgeshire did not bother to mention, as he talked about NHS staff, was that he is against the agreement that we have just entered into on public service pensions. He is against it, just as he was against proper funding for "Agenda for Change".

Photo of Geraldine Smith Geraldine Smith Labour, Morecambe and Lunesdale

Does my right hon. Friend agree that the British people might remember what the state of the NHS was before 1997, when people lay dying on trolleys in hospitals, when people sometimes had to wait five years for cataract surgery and many years for operations and when the Conservatives would not put the necessary resources into the health service? They are a disgrace and an embarrassment when they talk about the national health service.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend is absolutely right, and the position is in fact even worse than she and I have described. The Conservatives now say that they want fair funding in the NHS—fairness from the Conservative party?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

Not yet; in a moment.

I, too, have a copy of the Conservative party's campaign pack. The Conservatives claim that

"some areas with a low disease burden, but deemed to be socially deprived, receive much more funding than areas deemed to be affluent but with a high burden of disease."

They go on to complain that

"some areas of Manchester receive 66 per cent. more NHS funding per head than some areas of Bedfordshire and Hertfordshire".

Let me tell the House about some areas of Manchester—north Manchester, for instance, where a baby is twice as likely to be stillborn and 10 times more likely to die before the age of one as a baby in south-east Hertfordshire or South Cambridgeshire. [ Interruption. ] Mr. Stuart, from a sedentary position, and the hon. Member for South Cambridgeshire complain that inequality in infant mortality is widening, but they want to take the money away from areas where infant mortality is worst —[ Interruption ]—north Manchester, where an adult is 50 per cent. more likely to die prematurely of cancer than one in St. Albans, South Cambridgeshire or south Oxfordshire.

In north Manchester, every GP has to look after about 2,500 patients; a GP in South Cambridgeshire has, on average, about half that number. That is why NHS funding this year is £1,600 per person in north Manchester and £1,000 per person in St. Albans, south-east Hertfordshire, South Cambridge and south Oxfordshire.

Several hon. Members:

rose—

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

I shall give way to Mr. Blunt on St. Helier; he has been very persistent.

Photo of Crispin Blunt Crispin Blunt Opposition Whip (Commons)

Since we were last here, the Secretary of State has had to reverse the quite disgraceful decision that she took on 19 December 2005, to overrule a consultation that had the full support of the local medical community to build a new hospital at Sutton, not at St. Helier, and to site the thing at St. Helier, at the request of Siobhain McDonagh. The Secretary of State was then taken to judicial review by Reigate and Banstead council and Surrey county council. The case would have gone to court in about a month's time; but, in August, she gave in. Will she repay the costs of the legal action that had to be taken, because her action was so unreasonable, to Reigate and Banstead council and Surrey county council?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My decision was made precisely on the grounds of health inequalities and fairness, in which the hon. Gentleman and the Conservative party simply are not interested. The reason why things have moved on is that, unfortunately, the financial situation in south London, in that part of the NHS, is worse than those involved believed it to be when they came up with the plan for a new hospital. It is, I am afraid, no longer clear that the proposal for a new critical care hospital and nine new community hospitals is affordable in the way that the local NHS originally planned it. It therefore makes sense to look afresh at that model of care—which, in principle, is the right one—to ensure that it is affordable before any further decisions or arguments take place about where the hospital is sited.

Several hon. Members:

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Photo of Helen Jones Helen Jones Labour, Warrington North

May I suggest that my right hon. Friend has omitted another strand of Tory party policy that is very clear? The Leader of the Opposition made it clear on "Any Questions?" in 2001 that he did not want to fund the NHS in the same way that it is funded now. He said that we should have more social insurance schemes, and he has never resiled from that comment. What effect does my right hon. Friend believe that that policy would have on our most deprived areas?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend is absolutely right about the views of the right hon. Member for Witney. Indeed, let us remember that only last year he wrote the Conservative party manifesto that proposed to take millions of pounds out of the NHS for everybody and put it into subsidising private care for a few. That is what the Conservative party means by fairness.

Several hon. Members:

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Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

No, I want to make some progress.

Conservative Members and the Conservative party refuse to accept that overspending has to be put right where it has taken place. They refuse to accept that it is wrong that a minority of hospitals and other organisations have overspent—some of them, I am afraid, for many years—at the expense of the majority who have been in balance or in surplus. Conservative Members have a simple solution to the overspending that has taken place in Bedfordshire and Hertfordshire even though the hon. Member for South Cambridgeshire did not come clean about it today. They want to take the money away from north Manchester and all the other parts of the country with the worst health needs and the worst health inequalities.

Photo of Mark Prisk Mark Prisk Shadow Minister (Business, Enterprise and Regulatory Reform)

What does the Secretary of State say to the excellent staff at the QEII hospital? Two weeks ago, she met the senior management in Bedfordshire and Hertfordshire and two senior clinicians have now told me that she made it perfectly clear that the QEII will go, Hemel will go and our new hospital at Hatfield will go. Will she now put it on record that that is not her view and that that will not be the end result? The irony is that the end result would be one hospital in Stevenage, which is Labour, and one hospital in Watford, which is Labour.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

The hon. Gentleman should know because everybody who has looked at this—

Photo of Michael Lord Michael Lord Second Deputy Chairman of Ways and Means

Order. The hon. Gentleman has asked a question and the least that he can do is let the Secretary of State answer.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

I am most grateful to you, Mr. Deputy Speaker. The hon. Gentleman should know—everybody in the NHS in Hertfordshire who has looked at the issue knows—that there needs to be a reorganisation of hospital services in that county. There needs to be a reorganisation of hospital services in order to keep up with modern medicine, to give patients better and safer care and to ensure that Hertfordshire does not go on overspending at the expense of other parts of the country that are far worse off. Those decisions will be made only after full and proper consultation with his constituents and everybody else in Hertfordshire and they will be made on the basis of what is clinically right for patients and not on the basis of party politics of any kind.

Photo of Barbara Keeley Barbara Keeley PPS (Mr Jim Murphy, Minister of State), Department for Work and Pensions

Conservative Members might have understood the issue of health inequalities a little better if they had bothered to turn up to the excellent event put on by the Minister of State, Department of Health, my hon. Friend Caroline Flint. It gave profiles for areas so that I and my hon. Friend Mr. Turner—we were the only two Members there—understood that Salford and Wigan, which are the areas closest to us, had very severe health inequalities and health needs. Does my right hon. Friend agree that given the resources that were needed to put on that event, it was a pity that Conservative Members, who do not understand the issue, did not bother to turn up?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

I absolutely agree. The Conservative party's policy of taking from the poor and giving to the rich, which is precisely what they are campaigning for, just shows that it has not changed an inch.

Photo of Howard Stoate Howard Stoate Labour, Dartford

Conservative Members are missing the point of what patients want. Patients want three things: they want greater preventive services, they want services nearer to the community in which they live and, when they need expensive, high-tech services, they want them quickly and efficiently. What they want as the result of the new GP contract is to have more pharmacists and GPs working together to provide far more screening, far more care closer to home and far more preventive medicine with greater use of statins and ACE inhibitors. All that reduces the need for people to go to hospital at all and that is what patients are calling for—greater prevention, more care in the community and, when they need high-tech care, that care being available swiftly and in a centre that has all the expertise that it needs.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend is a GP and serves on the Health Committee and he is absolutely right. The contradictions that we have been pointing out in Conservative health policy do not end there.

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

The Secretary of State is not addressing the questions in the debate, but the issue is simple and we take exactly the same view as the NHS Confederation. Resources that are being allocated across the country to deal with health inequalities and that should be directed towards public health measures should be in separate budgets from resources allocated in relation to the burden of disease in an area in order to ensure that there is equitable access to care.

The principles that we set out on Monday are very clear and involve equitable access to service delivery so that we do not arrive at the position—it happens now—whereby I can stand in the stroke ward in Luton and Dunstable hospital and be told that there are two kinds of discharge arrangements. The first is for patients going to Luton, where the PCT has enough money to provide follow-up and rehab, and the other is for Bedfordshire Heartlands, which is in deficit and cannot provide those services. That is not fair to patients.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

It is not fair to patients, but the answer is not to take money from the poorest areas with the worst problems and to give it to Bedfordshire, which has been overspending. The answer is to reorganise services in Bedfordshire. I spent a day a couple of weeks ago with community matrons in Bedford and they support patients with long-term conditions in their own homes and that slashes the need for those patients to go into emergency care. That is the kind of change that we want to lead.

Several hon. Members:

rose—

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

I will not give way, as I want to make progress.

The Conservative party has told us this week that it wants an independent commissioning board completely free to decide where patients should be treated, but it opposes any change in NHS provision, including, it appears from one Conservative Member, the involvement of Age Concern in providing some services. It says that it wants to put decisions in the hands of NHS professionals but, every time the local NHS proposes to make a change in the organisation of services, members of the Conservative party are out marching in the streets to oppose it. They protest—they have been doing it again this afternoon—against every closure of a community hospital.

Conservative Members should go to Norwich and talk to Tony Hadley, the brilliant nurse manager whom I met recently who worked with his nursing and community team to reorganise community hospital services. They cut the number of community hospital beds, they closed some wards and closed two community hospitals and centralised them in a third. Conservative Members are out on the picket lines when anything like that is proposed in their constituencies, but what Tony Hadley and his team did in Norwich was to listen to patients who want to be cared for at home rather than in hospital and they put half the staff out of the community hospital and into the community itself. They doubled the number of patients that they could care for, they slashed the number of emergency admissions and they saved £1 million a year that can go into better care for other patients. The Conservative party has to decide whether it is for or against that.

Photo of Graham Stuart Graham Stuart Conservative, Beverley and Holderness

I hope that the Secretary of State will recognise that no one on the Conservative Benches wishes to set community hospitals or other health services in aspic. We are perfectly happy to welcome change, but we do object to the cuts in local services that are precisely against the vision that she set out in January this year. That is what we are protesting against, and it is the cuts right across the country that upset not just Conservative Members but, if she cares to look behind her, those on the Labour Benches as well.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

I am afraid that the hon. Gentleman is simply incoherent on this point. It is not possible to take advantage of all the changes in modern medicine that make it possible to take tests and treatments out of acute and community hospitals and into GP surgeries, health centres and patients' own homes, which is where patients would rather be, without making difficult decisions about the numbers of beds, wards and cottage hospitals that we have. The hon. Gentleman and the Conservative party need to be willing, for once, to support the NHS in making difficult decisions that will improve care for patients.

Photo of Rob Marris Rob Marris Labour, Wolverhampton South West

Does my right hon. Friend share my dismay at the fact that Mr. Lansley wants to stop the NHS being a political football, yet the Conservatives seem to be obsessed with the number of posts in the NHS rather than the quality and quantity of output? Does she agree that it is somewhat hypocritical of the Conservatives to bang on every year in Finance Bill debates about productivity in the NHS, but to criticise her all the time for trying to address some of those issues and the configuration and suitability of services?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend is right. The Conservative party says one thing to one group and a completely different thing to a different group. Conservatives say that they are in favour of more health care close to people's homes—we have just heard it again—but when emergency admissions are cut, as community staff are doing all around the country, when there is more day-case surgery, and some hospitals are not doing enough, and when the average length of stay is reduced, as all the best hospitals are doing, we do not need as many acute beds in some hospitals and we do not need as many staff in those hospitals. When a hospital makes such difficult decisions, and when it makes difficult decisions to bring the NHS back into financial balance instead of allowing the problems to build up over and again and to get worse and worse, the Conservative party completely refuses to support them.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

We keep hearing the mantra that services are being reconfigured and moved into the community, which many would regard as quite a good thing, but will the Secretary of State explain why the Council of Deans and Heads of UK University Faculties for Nursing and Health Professions has stated that the cuts in training budgets have had a

"particularly severe effect in community nursing"?

If the Government are keen on realising what they state regularly, surely we should be increasing such budgets.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

As the hon. Lady will know from the NHS work force figures, despite the fact that there has been a decrease, as the hon. Member for South Cambridgeshire was saying, in the number of health visitors, there has overall been a significant increase—of about 27,000, I think—in the number of nurses working in the community. We should expect to see that trend continue. One thing that we need to do, which I have asked our chief nursing officer to take charge of, is to modernise nursing careers so that we can support more nurses in the community.

Photo of Paddy Tipping Paddy Tipping PPS (Rt Hon Jack Straw, Lord Privy Seal), Leader of the House of Commons

The Secretary of State has talked about change and difficult decisions. She knows the position in Nottingham well. She recently visited the new Nottingham University Hospitals NHS Trust and she knows that services are being reconfigured there, and it is difficult and painful. Does she accept that it takes time to make those changes and will she give the new trust time to put those changes into place?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend makes an important point. As he says, I spent quite a lot of time recently with staff at Nottingham University Hospitals NHS Trust. It is indeed in a very difficult position, as is the partnership trust, as I know he will accept. The latter has massively improved services for mentally ill patients but has had over many years to give up some of its urgently needed funding to bail out the acute hospital. I have already asked the NHS in the east midlands to look at the length of time needed for the Nottingham acute trust to make the necessary changes.

Given that both my hon. Friend and the hon. Member for South Cambridgeshire have raised the issue of risk to significant numbers of jobs in some places, I draw the attention of the House to the fact that Mid Yorkshire Hospitals NHS Trust, for instance, which notified the Government of up to 400 jobs at risk—a matter of considerable concern and great anxiety for the staff—has in reality had to make only six staff compulsorily redundant. We would all wish that there had been none at all, but that is very different from the headlines.

Worcestershire Acute Hospitals NHS Trust identified that it needed to lose the equivalent of 670 jobs, including of course agency workers and so on. It notified the Department of Trade and Industry of 250 jobs at risk. It has made only 19 redundancies. We will support any staff member who loses their job or needs to move to a new one; none the less, those hospitals like every other have continued to reduce waiting times. It is essential—the hon. Member for South Cambridgeshire continues to refuse to accept this point—that hospitals continue to become more effective in their use of resources in order to give even better value for money, so that we can free up the money to pay for extra treatments and extra drugs for other staff to use.

Photo of Greg Hands Greg Hands Conservative, Hammersmith and Fulham

Two months ago, it was announced that Ravenscourt Park hospital in my constituency will close in November. It was opened only three years ago. The then Health Minister, Mr. Hutton, said at the time:

"We have spent £10 million on improving Ravenscourt Park Hospital. When the NHS took over this hospital, it had 16 beds; now it has 106, and is treating upwards of 3,000 patients a year. That means improved quality of service for NHS patients, who are being treated in state of the art facilities. That is what investment and reform of the NHS is helping to bring about."

Only three years later to the very month, the hospital is to close. Will the Secretary of State explain that, and will she be sending one of her Ministers to the closing ceremony next month and apologising?

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

Ravenscourt Park hospital was an investment from the private sector. It went bankrupt—or pretty nearly so. We bought it for a very small amount of money and we did put some investment in it. It has treated a relatively small number of patients. I do not have the figures to hand, but it has never had anything like an acceptable level of bed use, because there are in fact enough beds and still some efficiency gains to be made in other hospitals that serve the hon. Gentleman's constituents and other parts of west London. The Conservative party has clearly given up completely on economic stability and sound finances. I take an old-fashioned view of these matters: I believe in prudent use of public money. I believe that we hold taxpayers' money in trust. I do not believe in keeping a hospital open if there are not enough patients to use it when they can be very well treated in other hospitals in that part of London.

Photo of Patrick Hall Patrick Hall Labour, Bedford

From recently visiting Bedford hospital and talking to staff, my right hon. Friend will know that they and others in the community have concerns about what is called "reconfiguration". Does she agree that the best thing to do in that circumstance is to wait for the proposals to be made by a strategic health authority and hospital trusts and others, so that people can then have a measured, informed, balanced debate about the future shape of health services? Did she notice that Mr. Lansley anticipated the outcome of the acute services review, the results of which have not yet been published, and is stirring up fears and unhappiness? That is not the way to improve the future of our health service. We should wait for the proposals and then have a proper debate about them.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend is right. Having met him twice recently in Bedford, I compliment him on the fact that he is indeed trying to ensure that there is a measured debate involving clinicians as well as patients and the public on the best way of organising services for patients in his constituency and other parts of Bedfordshire. It is absurd and unfair to patients for people to be campaigning to save a hospital when there is no proposal to close it and there is to be no proposal to close it.

Photo of Nick Palmer Nick Palmer PPS (Malcolm Wicks, Minister of State), Department of Trade and Industry

I concur with the point made by my hon. Friend Paddy Tipping. It is important in a difficult merger situation in Nottingham that we have time to ensure that the process is efficient and effective for patients. Does my right hon. Friend agree that Opposition parties' campaigning on the structure of the NHS is unnecessarily alarming patients? Although it is entirely understandable that staff are worried over mergers, patient care is better than it has been for many years.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

My hon. Friend is correct. The truth is that the Conservatives simply will not face up to any difficult decisions. They want theirs to be the party of economic stability, but they pretend that the NHS can have a blank cheque and they promise their business friends a tax cut. They say that they support the staff, but they promise to scrap the agreement on public sector pensions and the hon. Member for South Cambridgeshire has the nerve to attack the new chief executive of the NHS, a distinguished public servant whose appointment has been welcomed across the NHS. They say that they want to devolve decision making to the front line, but they oppose the local NHS every time it makes a proposal to get better value for money and improve patient care. They say that they have been converted to the cause of fairness, but they want to rob the poorest communities in our country.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

No, I will not.

The Conservatives want to be all things to all people—old Tory, new Tory, left, right and centre Tory—but they are being found out, because the more the British people hear from the Conservative party, the more they see the contradictions, confusion and intellectual dishonesty, the more they realise that, try as the Tories might, they cannot take the con out of Conservative. That is why the British people will never trust the Conservative party with the NHS. I commend our amendment to the House.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon 2:01 pm, 11th October 2006

Let me join in the one note of consensus between the Government and Conservative Front Benchers by recognising and valuing the work that is done by almost 1.4 million people in the NHS. They are, rightly, the focus of today's debate.

When we heard that the Conservatives proposed to spend a whole day talking about the NHS, we looked forward to seeing the motion for debate. We imagined—rather naively, I accept—that it might contain some answers. Given that, on Monday, the Conservative leader, Mr. Cameron, made a big speech about the NHS to tell us about his plans, I hoped that we would have the opportunity to see some more detail of those plans in the motion and to debate them. I was therefore startled to read the motion. I looked for something that was actually being called for, but first I found that the House "is alarmed" in line 2, "is deeply concerned" in line 3, "condemns" in line 4, "regrets" in line 5, and "further regrets" in line 7. We have to go to the penultimate line to find something that the Conservatives are calling for, which is "the potential" of health care staff to be used. I cannot disagree with that. We considered tabling an amendment that would simply add "and regrets the inability of Her Majesty's official Opposition to have anything to say on the subject", but, as a responsible and effective Opposition, we decided to table a substantive amendment.

Several hon. Members have waved around the "Stop Brown's NHS Cuts" campaign document, which is being circulated widely. At the bottom of the page, we have a picture of the Chancellor with his scissors out, but we have heard the Conservative leader say that he cannot guarantee that any of the cuts planned would not happen if he were in charge. The "Stop Brown's NHS Cuts" campaign should therefore be called the "Stop some of the cuts, but we can't tell you which ones" campaign. Something tells me that, in every locality where the Conservatives are campaigning against a cut, they will say that that cut is one that they would stop and it is one of the others that they might not.

Photo of Graham Stuart Graham Stuart Conservative, Beverley and Holderness

As the hon. Gentleman is aware, the Conservative party, unlike his own, has a prospect of entering government, so it tends not to make promises on expenditure without being wholly sure of what it can do. However, every Conservative Member knows full well—I hope that he accepts this—that the financially driven changes and cuts in staff and services would not happen in an independent NHS, freed from the political interference and control of both the chairman of the Labour party and the Chancellor of the Exchequer.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

That is very interesting. If an independent NHS is central to fighting the cuts against which the Conservatives have started to campaign, why is it not mentioned in the motion? I just wondered.

The hon. Gentleman suggests that, if the Conservatives were in charge, we would not see "financially driven cuts". I have to exempt him from blame, because he was not a Member of Parliament when the right hon. Member for Witney, now the leader of his party, opposed £8 billion for the NHS in the National Insurance Contributions Act 2002. I read the Conservative Q and A document on that subject, and this is what I found. The question asked is:

"Didn't the Conservatives vote against every penny of the extra investment the Labour Government has put into the NHS?"

The answer is:

"This is just classic spin".

Classic spin it may be, but I have here the Division lists from the Second Reading of the National Insurance Contributions Bill. John Bercow led for the Opposition in that debate, and he took an intervention from a little known Back Bencher representing Witney. That Back Bencher attacked the national insurance rise for the NHS, asking

"Has my hon. Friend calculated the effect of increased national insurance contributions on trying to hire badly needed staff in our hospitals?"

Whatever happened to him? The reply from the hon. Member for Buckingham was:

"the bull-headed and short-sighted policy on which the Government seem intent will make a difficult task much more difficult."—[ Hansard, 13 May 2002; Vol. 385, c. 543.]

In other words, when it came to the crunch—when it came to putting their money where their mouth was—where were the Tories? In the opposing Lobby.

Were that an isolated incident, a one-off, I might forgive the Tories—I am a very forgiving chap. Unfortunately, however, they have form. I asked the House of Commons Library for figures on real spending on the NHS. I was only interested in what had happened under Labour, but the Library staff inadvertently included on the chart the final year of Tory Government, which showed a real-terms cut. The last time the Tories controlled the purse strings, they cut NHS spending.

Photo of Stewart Jackson Stewart Jackson Conservative, Peterborough

I am glad that, true to form, the Liberal Democrats have not risen above the student union politics that we expect from them. As long as "discouraging intellectual argument" can fit on the back of a "Focus" leaflet, that is fine. The hon. Gentleman should know that, in fact, in the period between 1979 and 1997, under Conservative Governments, real capital expenditure on the NHS increased by 60 per cent. above the rate of inflation. I am happy to correct him.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

I am delighted to hear that. I wonder whether the hon. Gentleman can explain the following: if £8 billion of the approximately £80 billion currently being spent on the NHS is paid for by the 1p on national insurance contributions, which £8 billion does he think should not be being spent? A campaign against cuts is being run by a party that said that we should be spending 10 per cent. less than we are now. It is hard to reconcile those statements.

I would be prepared to forgive the Conservatives twice, in fact. I would forgive them real-terms cuts in the run-up to an election and I would forgive their later voting against the money. We therefore have to look at the manifesto on which every single Tory Member of Parliament was elected.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

I shall in a moment—perhaps the right hon. Gentleman will be able to explain what his manifesto called for. For those who could afford from their own resources to buy their way out of the NHS, the manifesto called for a subsidy from the taxpayer to enable them to do so. That is at the core of the Tory vision of public services: not "excellence for the many", but "enable the few to buy their way out."

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

May I suggest to the hon. Gentleman, with respect, that he leave the Government's propaganda to the Government? He is looking at the Division list on a national insurance tax increase and linking the £8 billion that was the result of that tax increase to increased NHS expenditure. That is the Government's line, but it does not need to be the Lib Dems'. If he looks at the Budget for that year, he will find that the biggest single increase in public expenditure in the year in which that Bill raising the money to pay for it went through, was not for the national health service at all. The biggest single increase in public expenditure that year went into the social security budget, so why does the hon. Gentleman feel it necessary to accept the branding that the Chancellor of the Exchequer attached to a tax increase in order to make a spending increase on social security sound more acceptable by saying that it went into the national health service, when it did not?

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

I must be fair to the right hon. Gentleman. I checked the Division list while he was speaking and he is not guilty. He was obviously otherwise engaged at the time. I have some sympathy with the point that he makes. Simply because the Chancellor labels something does not automatically mean that it is so. I am very much of that view, but if we did not have the 1p on national insurance, which we supported and which we warned before the 2001general election would be required but which Labour never quite got round to mentioning, we would have £8 billion less of total Government revenue. We can argue about where that would come from, but clearly it is ring-fenced and earmarked for the NHS by statute, and that is the right place for it.

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

As my right hon. Friend Mr. Dorrell rightly points out, it is a fiction that the change in national insurance directly determined the level of NHS expenditure. If the hon. Gentleman looks at the accounts for last year, as I am sure he has done, since he is a professor, he will find that national insurance provided £1.5 billion less to the national health service than it was expected to provide. Did that change the amount spent by the NHS? That is separately determined in public expenditure through the vote. The point that we were making in 2002 related to the economic consequences of the way in which the Chancellor would raise the money. That is why, at the subsequent election, we committed ourselves to maintain that level of expenditure, but of course my right hon. Friend might have chosen to raise the money in a different way.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

I am interested in the hon. Gentleman's claim that the Conservatives would maintain the expenditure. If the patients' passport that his leader wrote into the manifesto had been implemented, money would have had to be found to subsidise people to buy their way out of the NHS. Where would that money have come from?

Photo of Chris Ruane Chris Ruane PPS (Rt Hon Peter Hain, Secretary of State), Wales Office

I thank the hon. Gentleman for raising the crucial issue of financing the NHS. Mr. Jackson referred to the period between 1979 to 1997, when expenditure under the Tories went up by 60 per cent. May I remind the House that from 1997 to 2008, under Labour, the budget will be going up by 300 per cent.?

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

Nobody could dispute that the rate of increase in spending under the present Administration since 1997 has been substantially in excess of what the Conservatives did or would have done, had they been in office. I am glad the hon. Gentleman mentions 1997. Part of the reason why I am addressing the House now is the record of the Tories on the NHS. In 1997, I had people coming to see me at my surgery with letters from their hospital stating that it would be two years before they could see an orthopaedic consultant to be put on the waiting list.

The reason Conservative Members object to my raising that and think we should be attacking solely the Government is that the Conservatives are portraying themselves now as the friends of the NHS. I find that laughable. They have form. They have form in cuts in their final year in office, they have form in voting against money for the NHS, they have form in the patients' passport, and only last month the Conservative leader took out from the first draft of his speech a line that pledged to match Labour's spending on the NHS. What was that about? If Mr. Lansley wants to reinsert that pledge on the record, I will give way to him.

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

It is clear that we were all elected on the basis that we would match Labour's planned spending to 2008-09. We have no idea what Labour's planned spending is after 2008-09.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

So the hon. Gentleman does not rule out spending less than Labour on the NHS.

The hon. Gentleman said at the start that the debate was not principally about finance. One of the reasons why there are 90 per cent. unemployment rates among physiotherapists when they graduate, and one of the reasons that we are seeing redundancies, including of front-line medical staff, is the Government's mismanagement of the finances of the NHS.

A recurrent problem throughout the debate is the issue of reconfiguration and who should decide when health services need changing for greater efficiency. At Prime Minister's questions earlier today, Michael Jabez Foster said that, if we do not like what is to happen to our accident and emergency department, whom do we ask? What do we do about it? There is only one person who has been anywhere near a ballot box whom people can ask, and she is sitting on the Government Front Bench. [Interruption.] The Secretary of State says overview and scrutiny. The local authority can scrutinise. What does it have the power to do? It has the power to go and ask her, and if she wishes and deigns to do so, she can refer the matter to an independent body.

My overview and scrutiny committee asked the Secretary of State to review the closure of Frenshay hospital in my constituency. Guess what? She refused. All three parties on the council, not just the Liberal Democrats, wanted a referral. I want a referral. Anyone who had ever been elected in the area wants a referral, but the Secretary of State blocks it, so she is the one who controls these matters centrally. How is that a democratic and accountable national health service?

Photo of Simon Hughes Simon Hughes Shadow Attorney General, Shadow Lord Chancellor and Shadow Secretary of State for Justice, Party Chair, Liberal Democrats

Does my hon. Friend accept—the Secretary of State may anticipate this—that that must be right because, two nights ago, I went with four Labour colleagues to see her and the Minister of State Lord Warner to ask her to reinstate some of the cuts in south London for the most vulnerable this year and to look again at some of the prospective cuts for those with mental illness? The Secretary of State very reasonably said that she would reconsider because she believed that the formula that had been arrived at in London was unfair and she would seek to have it recast to reinstate some of the funding. We hope that that will be successful. We would not have gone to see her if it were not the case that the Secretary of State for Health is able to decide what happens. In the end, she calls the shots.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

Indeed, except when there is bad news. When there is bad news, it is a local decision. The right hon. Lady is the Secretary of State for good news in the health service. Whenever a community hospital opens, it is because of a Government promise. Whenever a community hospital closes, it is because of local decision making.

Photo of Patricia Hewitt Patricia Hewitt Secretary of State, Department of Health

Does the hon. Gentleman accept that I have been assiduous in going round the country to talk to staff in hospitals and local areas that are facing extremely difficult decisions, including Nottingham, about which we heard recently, and that I meet those staff privately to discuss the difficulties that they are facing? I do not go only to areas where everything is excellent. In the real world, most areas have to make difficult decisions to achieve the best use of their resources. Rather than continuing to sit on the fence, the hon. Gentleman must decide whether he is in favour of difficult decisions being made to get the best value, to take advantage of modern medicine and to get the best care for patients, even when that means, in his constituency or elsewhere, difficult changes.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

At the risk of being parochial, there is the strange coincidence that the hospital in my Liberal Democrat-held constituency closed so that a new one could be built in the neighbouring Labour-controlled constituency. We need to know that the difficult decisions that have to be made are being made on clinical grounds. All too often, it seems blindingly obvious that other factors, shall we say, come into play.

The Government and the health service must treat the public as adults and give them the necessary information and the opportunity not to be consulted and ignored, but consulted and listened to and for their views to be acted upon. I have discovered a new word in the English language—it is sham-consultation. We cannot have the word "consultation" any more without the adjective "sham" in front of it. Throughout the country when I, like the Secretary of State, visit local people, they say, "Yes, we went to endless consultation meetings, we had engagement, then consultation, then review, and then all the rest, but in the end they did what they were always going to do."

If people are making decisions against the will of the local people, they should be people whom local people can get rid of. How can it be right that decisions affecting hon. Members' health services are made by people whom they never elected, whom they can never get rid of, and whose only right of appeal is to the Secretary of State—who has total discretion to ignore the appeal and, if she hears the appeal, can refer it to a quango, which we also did not elect? Where is the democratic accountability in that?

I have some sympathy with the idea of getting rid of centralised meddling, so to that extent I am with the Conservatives on the idea of independence, but it falls down because there is no democratic accountability, particularly at the local level. Local communities are frustrated because they feel that the decisions are being made for them, rather than with them. Lots of meetings take place, but how often do they change anything? That is one of the things in the health service that must be changed.

The Secretary of State met the press this morning. She is anticipating whatever the Healthcare Commission might find tomorrow about the health service's performance. She said that we need action plans. In other words, where PCTs are found to be weak we urgently need action plans to start within a month. That typifies the Government's mismanagement of the NHS. She does not say that we need long-term strategic thinking for efficiency over a period of years or that we need deep-seated financial problems sorted out in the medium term, but that we anticipate a bad headline tomorrow, so we need an action plan and we have a month—a month—to do things that presumably have not been done for the last nine years. Is that a month to put long-term plans in place; a month to consult and listen and refine? No, just a month to get them out of the mess they are in this month.

What is happening with NHS finances is that problems that have built up over years, decades in some cases, have to be sorted out by Wednesday week. How can that be a rational way to run the health service? We have huge financial instability. The Secretary of State complained that the Tories wanted to spend taxpayers' money subsidising the private sector. The words "pot", "kettle" and "black" spring to mind. Independent sector treatment centres are being given better prices than the NHS, guaranteed volumes of delivery, the chance to cherry-pick the easy hips, cataracts and scans, but at the expense of what? She mentioned the ISCT at Shepton Mallet, but that has resulted in job cuts at the Royal United hospital in Bath just up the road. Frenshay hospital will virtually close and the chances are that an ISTC will be built on the site, so the same people will be having the same procedures on the same site but done by the private sector instead of the public sector, probably at greater cost—and that is not privatising the NHS? I wonder what would be.

Photo of Sandra Gidley Sandra Gidley Shadow Minister, Health

My hon. Friend has probably also seen the predictions that many of the ISTCs will not fulfil their full contracts, so they make more money. Does he share my concern that, for example, in Southampton we are faced with a treatment centre that will take cataract operations out of the system and threaten the viability of the extremely good and useful eye unit that we have?

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

My hon. Friend's experience is absolutely typical. It is hard to see what was wrong with the eye unit at her local hospital, yet because the Government are obsessed with marketisation, with trying to create a fake market and with trying to shake up the NHS by subsidised private competition, good quality NHS facilities are being undermined throughout the country.

Photo of Ed Vaizey Ed Vaizey Shadow Minister (Culture, Media and Sport)

Will the hon. Gentleman therefore confirm that it is Liberal Democrat policy to close the existing ISTCs and not to open any more, or is it their policy to fund them in a different way?

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

I can give a straight answer to that—it is Liberal Democrat policy not to subsidise ISTCs, which is what has been happening. One question that I would ask the hon. Gentleman is where is the value-added coming from? As my hon. Friend Sandra Gidley said, some of the ISTCs have block contracts, so they are paid for work that they do not do. The hon. Gentleman's party complains about low productivity in the NHS, whereas here the private sector is creaming it at the expense of the NHS.

Photo of Meg Hillier Meg Hillier PPS (Rt Hon Ruth Kelly, Secretary of State), Department for Communities and Local Government

Most patients go to their GP, in the vast majority of cases a private partnership, are given a prescription that they take to their local high street pharmacy, a private business, and are then given a drug from a private drug company. That is accessed free at the point of delivery, funded by the public purse, but provided by a range of providers—so I am not quite sure what his argument is.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

The origin of the cheers says it all. The GPs are not providing services to make a profit, although the drug companies might be trying to do that. The critical point is why should the private sector have to be subsidised and bribed in order to bring it in. Does the hon. Lady support that? Does she really believe that the private sector should get more than the NHS for providing the same treatment? That is Government policy.

Photo of Andrew George Andrew George Liberal Democrat, St Ives

Is my hon. Friend aware that in Cornwall at the moment, despite the fact that GPs refer patients to NHS consultants, who have to operate with one arm tied behind their back, constrained by minimum waiting times, NHS managers intervene with unsolicited phone calls to offer the possibility of those patients being seen earlier in the private sector?

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

My hon. Friend raises some very strange matters that are occurring in the NHS. I assume that the Secretary of State knows what is happening. We are supposed to have patient choice. The patient is supposed to see the GP, go through a list on the screen, pick one, and then a booking is made—except that someone is tapping the phone line. Someone intercepts the call, second-guessing the GP's referral, and in some cases saying, "Are you sure you want to do that? Let's try to refer them somewhere else." How that squares with patient choice I am not sure. If the GP and patient jointly decide one course of action and that is second-guessed, I do not see how that is patient choice.

My hon. Friend referred to minimum—not maximum—waiting times. We have examples all over the country—my hon. Friend Dr. Cable has raised the matter with me—of people being told that they have to wait longer because there is no target at the bottom end. The people right up against the target will have priority, even if the others could be treated sooner because there is no target. Those are the sort of distortions that the Government's obsession with targets are creating in the NHS.

Photo of Howard Stoate Howard Stoate Labour, Dartford

I have great sympathy with what the hon. Gentleman says, but he is in danger of confusing one or two issues. I work part-time as a GP and I refer people on the choose-and-book system. I bring up the list of possibilities on the screen for the patient, given his condition, and the patient then chooses the hospital and makes the appointment to suit themselves. Waiting times on choose and book are very good indeed. On occasion, a patient may choose a private sector deliverer if there is one on the list within the NHS tariff, but in my area nine times out of 10 the patient will choose a local general hospital that they have had contact with before. I do not quite understand where he sees the confusion.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

Perhaps the hon. Gentleman does not have referral managers in his PCT. Those are people who come between him and his referral to the consultant and suggest sending the patient somewhere cheaper. That is what happens.

Photo of Susan Kramer Susan Kramer Shadow Secretary of State for International Development, International Development, Shadow Secretary of State

Just to confirm the cases that have been brought up by my hon. Friend Dr. Cable, about a week ago my local GP complained to me that, having called up various consultants for treatment of his patients and been told that they and the operating theatre were available, when he tried to book in the patients he was told that there must be a 10-week delay until they are right up against the target barrier. That, presumably, is a mechanism for pushing costs, certainly within the London area, into the next financial year by delaying treatment as long as possible. My GP is very concerned about the deteriorating condition of his patients. I am now asking patients if they are willing to give me their names so that we can bring those cases forward.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

My hon. Friend has illustrated the consequences of the financial squeeze in the NHS. Ministers seem to think that they are running a different health service in which such things do not take place, and, as my hon. Friend has said, sometimes they do not seem in touch with what is happening on the ground.

The focus of today's debate is the work force, and the Council of Heads of Medical Schools has rightly criticised what is going on:

"Coherence is required—and this is sadly lacking at present—to the detriment of the entire nation."

It is talking about the Government's failure to ensure proper work force planning. Whenever I have asked written questions about that matter, I have been told, "That is the responsibility of trusts or health authorities." I sometimes think that this Government are the "Not me, guv" Government, because they always say that it is someone else's problem.

Where things need to be done strategically and nationally, the Government should be planning—I know that "planning" is a dirty word in new Labour—so that people who commit their lives to the NHS by undertaking three, five or seven years of training have a good prospect of obtaining a job when they complete their training. The Secretary of State has no answer to why 90 per cent. of recently graduated physiotherapists are unemployed. Is that acceptable? Has the right hon. Lady got anything to say on the subject? All she has said is, "We are trying to help. We will do what we can." The situation is totally unacceptable; it is the result of mismanagement; and the buck must stop on the Government Front Bench.

Some things in the NHS must be done nationally, strategically and with accountability to Parliament. However, as much as possible should be done locally by local people, who should be engaged early in the decision-making process to allow them to face the difficult choices, to express their priorities and to have those priorities respected, which is not happening in the NHS at the moment.

One important issue that has arisen in the debate is that of switching money from people with longer life expectancy to people with shorter life expectancy. There is the question whether enough money is going into the system in the south and whether too much money is going into the system in the north. How can the Conservative party run a "no cuts" campaign without promising to spend any extra money? It is difficult to work that one out, until one realises that, with one or two exceptions, it does not intend to win any seats north of the Watford gap. Conservative candidates in seats south of the Watford gap will say, "We will spend more money in this area." If, however, we were to have a parliamentary by-election north of the Watford gap, the Conservative candidate would not mention spending less in that area.

Photo of Graham Stuart Graham Stuart Conservative, Beverley and Holderness

Does the hon. Gentleman accept that the economics of the issue and health outputs both involve using the money wisely and both concern productivity, which lies at the root of the Government's failure? By reducing centralising bureaucracy and, as he has wisely pointed out, distortions caused by target setting, it would be possible to use the existing money to deliver more care. As the Labour party used to say before it got into power, which it has wasted, it is not only about money.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

The hon. Gentleman represents a seat north of the Watford gap, and he is right that we need to spend every penny wisely. Every incoming Government say, "Vote for us and we will spend the money more wisely", but the issue goes deeper than that. The Conservative party is saying that it would spend more money in the south of England without ever saying that it would spend less in the north. The shadow Secretary of State has said that the Conservative party should regard public health money as one pot and money for illness as another pot. Those two areas are clearly separate, but the total will not change—if one area gets more, another area must get less.

Photo of Chris Mole Chris Mole Labour, Ipswich

Will the hon. Gentleman clarify that the Liberal Democrats would not change the national distribution formula for the NHS one iota, which would help to rebut local Liberal Democrats who say, "We will get back the 10 per cent. that Labour has sent to the north"?

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

The hon. Gentleman will find that his Government have reviewed the formula in the past few years. It is wrong systematically to say across the south of the England that more money will be spent there without accepting the corollary of that choice. The Conservative party is saying, "Health cuts for the north", which is official Conservative party policy. [ Interruption. ] The shadow Secretary of State has said that the board would be independent, which means that he cannot guarantee delivery. His argument is: "Vote for me, and we will give more money to the south, but only if the independent board agrees to do so." Will he clarify the situation? [ Interruption. ] Would more be spent in the south because of the formula or would the independent board decide the matter?

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

It would be up to an independent board to arrive at a fair allocation of resources in relation to the burden of disease.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

Tory candidates who are campaigning for a change to the formula to give more money to the south cannot be sure that it would happen. [ Interruption. ] If the independent board did not give more money to certain areas, no one could do anything about it because it would be unaccountable.

Photo of Andy Burnham Andy Burnham Minister of State (Department of Health) (Delivery and Quality)

The shadow Secretary of State has said from a sedentary position that the independent board would allocate independently of Ministers the funding for each PCT.

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

That was my exact understanding of the shadow Secretary of State's remark. At the next election, people will be asked to vote Conservative on the basis of a set of promises on the health service that will be entirely undeliverable because the health service would be run by an unelected board.

Today's debate has provided a valuable opportunity to consider the NHS work force, but we have heard nothing from the Government about the lack of opportunities, which is due to the lack of planning for the work force. There is a place for central planning in the NHS—I know that that is a lefty thing to say—but it is not happening in the marketised NHS. Physiotherapists cannot find jobs because of the lack of planning.

More than anything else, we need an end to centralised meddling, which involves the centre dabbling, fiddling and changing when it should not do so. Every few months, managers must respond to the latest initiative and meet the next target. Unlike some, we have welcomed the money that has gone into the NHS, but we oppose the constant fiddling and meddling, without which the NHS would not face many of the pressures mentioned in the motion.

Photo of Michael Lord Michael Lord Second Deputy Chairman of Ways and Means

Order. Before I call the next speaker, I remind hon. Members that a 10-minute limit has been placed on speeches by Back Benchers, and it applies from now on.

Photo of Kevin Barron Kevin Barron Chair, Health Committee 2:39 pm, 11th October 2006

I want to pick up a point raised by Steve Webb about independent sector treatment centres. The Health Committee submitted a report to the House and the Government in July this year—we expect a reply to that report, which we may debate at some stage, in the next few weeks. The hon. Gentleman has stated that ISTCs are cherry-picking, but the Health Committee found no evidence on that point other than anecdotal, although I hope that hon. Members will provide evidence in this debate.

Photo of Tony Baldry Tony Baldry Conservative, Banbury

The orthopaedic treatment centre in Banbury is refusing to treat anyone under 18, anyone who lives on their own, anyone who does not have a telephone, and anyone who is overweight—in other words, anyone who presents any difficulties at all. I invite the Chairman of the Select Committee to come to that centre to see exactly how it is cherry-picking.

Photo of Kevin Barron Kevin Barron Chair, Health Committee

I will have a chat with the hon. Gentleman a bit later, but if what he says is the case, it is a great pity that those findings were not at least submitted as written evidence during the Committee's inquiry, because that would have enabled us to comment on it.

On the motion—

Photo of John Pugh John Pugh Shadow Minister (Health)

Will the right hon. Gentleman give way?

Photo of Kevin Barron Kevin Barron Chair, Health Committee

No, I will start my speech, if the hon. Gentleman does not mind.

The events of this week involving the main Opposition party leave me a little confused. On Monday, as I drove down from Yorkshire, I heard about the Leader of the Opposition's conversion in relation to the national health service, so I looked at the Conservative party's website. Two comments somewhat confused me. First, the right hon. Gentleman says that he is

"committed to the NHS idea, ruling out any move towards an insurance-based system."

I thought that he would have flagged that up at his party conference, assuming that it agreed with that, as just a few years ago, in 2001, he said in the Oxford Journal:

"We also need to look at a massive expansion of social insurance schemes, so that our health spending and outcomes can match that of other European countries. We want to keep and expand the NHS, but on its own it is simply not enough."

Perhaps the Conservatives should have put that idea down for debate today.

Photo of Kevin Barron Kevin Barron Chair, Health Committee

Not just yet.

We could then have had a discussion about the apparent conversion that has taken place in the past six years in terms of the money spent in the national health service, and how services have kept expanding while being paid for out of the public purse and not through private insurance.

I intervened on Mr. Lansley to draw attention to the extraordinary statement by the Leader of the Opposition on Monday, quoted again in the Conservative website news story:

"So my message to the Government is clear: the NHS matters too much to be treated like a political football."

Wonderful stuff, is it not? I also have the Conservative party's NHS campaign pack, which, I understand, is about to appear on its website— [Interruption.] It is not entitled "save the NHS", although I may sign up to one or two things in it, and I am prepared to share a few views about it with hon. Gentlemen. It is to be launched on Saturday by the Conservative party—I presume that it will be the non-political health service football that will be launched. That pack is very good and includes materials that can be purchased for action day, graphics to download and a template press release. All people have to do is take out the italics and put in how awful the NHS is in their part of the country. [Interruption.] Conservative Members who are making noises will find it very difficult to come to my part of the United Kingdom and fill in any type of press release saying that about the NHS there. I challenge them to come and do that on Saturday, although I will be holding a surgery.

Photo of Linda Riordan Linda Riordan Labour, Halifax

If the Conservatives intend to launch that campaign in Halifax, may I remind them that we waited 20 years for a new hospital, and we got it in 2000 under a Labour Government?

Photo of Kevin Barron Kevin Barron Chair, Health Committee

Again, people would have difficulty taking out the italics and filling in the press release with details from my hon. Friend's area.

Photo of Kevin Barron Kevin Barron Chair, Health Committee

Further to that press release—[ Interruption.] I will let its author speak in a few minutes. It is different from the motion in subtle ways. It includes a template for a council motion to be tabled at local government level, again to try to get everybody to agree how awful the NHS is. Once again, it will be a struggle to fill that in in south Yorkshire. None the less, although that press release says that almost 20,000 jobs have been lost from the national health service, the motion does not do so—it refers to posts. All of us who want to share the truth about such matters know that nowhere near 20,000 jobs are being lost in the national health service—not in the last 12 months, two years, three years or anything else. There are more than 80,000 additional nursing jobs in comparison with 10 years ago, and many other grades have more people working in them.

We received an e-mail from NHS Employers alluding to this matter, some of which was quoted by the hon. Member for South Cambridgeshire. That e-mail stated:

"Last week, NHS Employers contacted 18 trusts which had identified potential redundancies. Across all the organisations, the original estimate of the number of posts to be lost was 7,900, with the DTI subsequently notified of 3,999 jobs at risk. The number of actual redundancies (voluntary and compulsory) is 766. Of these 540 are in two organisations"—[ Interruption .]

I will go on, because the hon. Member for South Cambridgeshire missed all that out—clearly, he just picked up the second page when it came out of his printer. The document continued:

"The figures being widely quoted of up to 20,000 may turn out to be not too far off the total reduction in workforce numbers this year. This applies, however, not to people being made redundant but to the number of posts being taken out of the system in a total workforce of some 1.3 million which experienced an increase of 268,000 during the previous six years."

That has not stopped the Conservatives saying in their petition to councils that there have been 20,000 job losses in the national health service. I shall ask my party if it will produce a motion for our councillors to take to their council chambers, which says that those are not job losses in the real sense.

Photo of Kevin Barron Kevin Barron Chair, Health Committee

I note what the hon. Gentleman says from a sedentary position. The Conservative motion alludes to nurses in training who will not be able to get jobs, as was reported on the front page of my local newspaper earlier this year about those who do their practical work in Rotherham and then go to the medical school in Sheffield for nurse training. But what happened to them? They all got jobs. The only redundancies made at Rotherham district general hospital this year were three compulsory redundancies among administrative staff. To read the local press, one would have believed that hundreds of staff at our local district general hospital would be out of work.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

If the University Hospitals of Leicester NHS Trust employs fewer people next year than this year, I call that job losses. What does the right hon. Gentleman call it?

Photo of Kevin Barron Kevin Barron Chair, Health Committee

In my view, posts unfilled are not job losses. When the right hon. Gentleman was Secretary of State, I accept that there were job losses throughout the national health service. Unfilled posts, however, are not people being made redundant or people being added to unemployment statistics in this country; they are merely jobs not filled.

If Conservative Members want to listen, the Health Committee currently has two ongoing inquiries, one of which is on deficits, which we are trying to bottom. My voice is going hoarse from talking to organisations such as the Royal College of Nurses, which keeps saying to the media that there are hundreds if not thousands of job losses. I keep asking it to send me the evidence of people being made redundant from the national health service. I said that months ago, and again two weeks ago, and the evidence has still not arrived The inquiries on both deficits and work force planning are still ongoing, and as Chairman, I and other Committee members would be more than happy to receive that evidence if it exists. Putting out press releases about the work force that do not represent the reality on the ground does no one any good in this debate.

Photo of Martin Horwood Martin Horwood Shadow Minister (Environment, Food and Rural Affairs)

One of the problems for the Royal College of Nursing and the Royal College of Midwives is that they cannot extract the numbers from local NHS trusts and hospitals, or from the Department of Health. Surely the right hon. Gentleman should expect the Department to provide the numbers, not the RCN.

Photo of Kevin Barron Kevin Barron Chair, Health Committee

We are doing that, and we are asking witnesses. I did not have any difficulty finding out what is happening in my local health community, in the primary and acute sectors. Together with other Members who represent constituencies in the Rotherham borough, I have annual meetings on the issue. The reality is that this year there are three redundancies of administrative staff.

Photo of Andy Burnham Andy Burnham Minister of State (Department of Health) (Delivery and Quality)

As a Yorkshire MP, my right hon. Friend may wish to comment on annex E of the Conservative campaign pack, which has a list of "job losses", as they are called. It claims that 1,100 jobs will be lost in the Mid Yorkshire NHS trust. The information that the Department has is that although up to 400 jobs could be at risk, only six people will be made compulsorily redundant—though even six is too many. Does my right hon. Friend agree that the campaign pack includes such misleading information that it should be withdrawn immediately and not used as the basis for a national campaign this weekend?

Photo of Kevin Barron Kevin Barron Chair, Health Committee

Yes, I do, because it is wrong, false and misleading. This is no conversion to the national health service. They say on a Monday that they will not use the NHS as a political football and, before the ink is dry on that speech, they table a motion that does exactly that, with a campaign to be launched on Saturday morning. The people who work in the health service remember what happened between 1979 and 1997. Their memories are not as short as some people would believe. They know that the NHS has been a political football for far too long and they also know the improvements, for patients and the work force, that have taken place in the past few years.

Photo of Kenneth Clarke Kenneth Clarke Chair, Tax Law Rewrite Bills (Joint Committee) 2:51 pm, 11th October 2006

When my hon. Friend Mr. Lansley began his excellent and thoughtful speech at the start of this debate, he was accompanied by the usual cacophony of noise that we hear in every debate we have on the health service, with people briefed by the Government Whips Office denouncing us for treating the health service as a political football. I find that recurrent atmosphere ever more remarkable, because we are steadily moving towards a consensus in principle on the health service, of a kind that I never thought I would live to see.

We are all in agreement about the principles of the national health service. I have consistently believed that it should be provided free at the point of treatment, according to clinical need and largely funded out of taxation. The final loophole is only for prescription charges and so on, which we have always had in the system. I actually agree in principle with the reforms that the Government are introducing, because they are remarkably like the reforms that have been embarked on for the past 20 years.

I was delighted to hear Meg Hillier give an explanation of how the health service has always been a partnership between the private sector and the public sector. Her views would have seen her drummed out of the Brownies 10 years ago if she had said anything of the kind from the Labour Benches. Her predecessor, who was a very left-wing Labour MP, has now joined the Liberal Democrats, who are the last defenders of the view of the old left opinion that provision by the state of the buildings, staff and everything else is a key part of the system.

We are all embarked on what I never really thought was a market system, but has been called the internal market. It is a market-influenced approach, in which there will be a wider variety of suppliers, including the independent sector with the state-owned and provided hospitals, and in which patient choice is brought into play because it gives rise to competition and cost control and directs taxpayers' money to those places with greatest public demand because of the quality of service provided. In that way, the system reflects public need. That is our destination, but we are now in the middle of a familiar debate in which each side hurls at the other allegations about the acute crisis that we are in.

My principal complaint about the Government is that having had their miraculous Pauline conversion about four years ago, they have so far embarked on the process of reform in such an incompetent fashion that they are in danger of giving it a very bad name. They are in the middle of a classic crisis of the sort that my right hon. Friend Mr. Dorrell and I are only too familiar with. The Government do not even understand how they got there and they are in denial about the financial problems underlying the present situation.

Photo of Patrick Hall Patrick Hall Labour, Bedford

Will the right hon. and learned Gentleman give way?

Photo of Kenneth Clarke Kenneth Clarke Chair, Tax Law Rewrite Bills (Joint Committee)

In a moment.

I heard the Secretary of State using phrases that I remember using frequently when I was closing hospitals that we did not need. In my day, they were often Victorian workhouses. I would explain how we had to strive for more day surgery, shorter stays in hospital and more use of community services. That is all common sense when running any health care system. The snag is, as has been illustrated over and over, that that is not at the root of the present bad crisis. At the moment, many parts of the country—including mine—are being driven to short-term expedients to address financial deficits. They are saving money wherever they can. The failure to offer jobs to physiotherapists has nothing to do with a movement towards a more rational service. Student nurses are having more difficulty finding jobs and clinical staff are being shed because the NHS is in a total shambles. If the Secretary of State will not acknowledge that, we do not have much chance of curing it. I preferred my hon. Friend's approach.

The crisis is caused, as crises in health care systems throughout the world are caused, by a complete inability to control costs; the complete lack of a financial management system for most of the NHS; and an inability to localise the services sufficiently and give enough discretion to the people with the competence to sort them out, if that is what they wish to do.

I accept that there is no shortage of resources. The tragedy is that the crisis has occurred after the Government have poured money into the NHS for the past 10 years. That is not a matter of pride. How can they have trebled the expenditure in cash terms and doubled it in real terms, but still need to sack staff or close hospitals all over the place because costs have not been controlled? The Government cannot answer that question.

Photo of Tom Levitt Tom Levitt PPS (Rt Hon Hilary Benn, Secretary of State), Department for International Development

I am grateful to the right hon. and learned Gentleman for reminding the House that we have trebled spending on the health service. Does he agree that in percentage terms this year's deficit is less than it was for several years under the Tories?

Photo of Kenneth Clarke Kenneth Clarke Chair, Tax Law Rewrite Bills (Joint Committee)

Well, I could retaliate with a list of the years in which we increased growth by 5 per cent. in real terms, but this is corny stuff. Expenditure on the health service has always gone up. We increased spending on health by 1 per cent. of GDP. Every developed country increases its spending on health care and, given today's demography, will continue to do so. It is corny nonsense to say, "Aha, the Conservatives spent less than we did".

I would point out that the rate of increase of recent years cannot be maintained. A fundamental spending review is on its way and it will be impossible to maintain 7 per cent. real-terms growth in health spending, without doing fantastic things to the budget of every other part of the public sector. The public spending review towards which the Government are just beginning painfully to creep cannot maintain that rate of growth. It will shrink, and the failure to tackle the present problems will produce more crises, unless the Government face up to the fact that they are going nowhere fast. They must face the fact that just spending money has not delivered what they wanted and expected.

Where has all the money gone? It has gone in costs, including—as it is bound to do in a health care system—payroll costs. Of course, there have been improvements. It would have been impossible to spend all that money without seeing some improvements, but the health service has always improved, year on year, ever since it was created. People cite the problems in 1997, but I say that they should have seen what it was like in 1979. Those are hopeless historic comparisons.

The health service has got better, but most of the money has gone on enormous payroll increases and pay rises for the staff, on a scale that has not been matched by increased activity. The productivity performance of the health service has, as everybody has pointed out, steadily deteriorated. If one thinks that the health service is important, that is no way to run it. Ministers take pride in the 300,000 extra staff employed in the NHS, but what do they cost?

Photo of Kenneth Clarke Kenneth Clarke Chair, Tax Law Rewrite Bills (Joint Committee)

No, as I am afraid that I have a time limit.

The NHS is the largest employer in western Europe, but Ministers must resist the temptation to make political claims about how many new jobs are being created. They must have regard to what the extra staff are being employed to do, whether they can be afforded, and how the system is being allowed to proceed.

In my day, pay negotiations were very difficult. Ministers of State used to have to get stuck in, because no one on either side of the House could be persuaded that the affordability of pay increases was something that had to be borne in mind. What has happened since then? The working time directive has been allowed to go through, and there has been a huge increase in the number of doctors. The 24-hour commitment of GPs has been abolished, and all nursing grades have been raised as a result of people writing their own descriptions of their responsibilities. Lots of other staff are now employed, and we have the best paid clinical professions in western Europe. I congratulate the BMA and the RCN: as usual, they have taken the Department of Health to the cleaners, but what were Ministers doing when all that was happening?

The NHS has no system of proper financial control. We all believe in a giant NHS run on principles that everyone accepts, but there must be a system of financial control. All other giant organisations—such as Marks and Spencer and BP, although they are smaller than the NHS—have that. I can think of no other business-like activity whose first thought is to cut back its service, or product. The health service goes running around closing wards because it cannot afford the staff to keep them open. It closes community hospitals and stops recruiting the necessary trainee staff, but none of those problems has been addressed.

Of course, those are not comfortable things for me to say. I might have to mute some of it at the next election, as the news that not all problems will be solved merely by getting rid of the present Government is not always welcome to a general audience. However, my hon. Friend the Member for South Cambridgeshire is trying to depoliticise and localise the argument, and that approach is absolutely essential.

The only way to manage the NHS is through more, and genuine, local budgeting and financial control. People will have to stick to their local budgets, but they will have discretion about how they spend the money. We are getting GP fundholders back, but I have yet to discover whether they will have real budgets and total discretion over where they spend their patients' money in the service. All that has to be tackled, but what we do not need is more mad structural change all the time.

The Government have failed to manage the changes that their reforms require—of course the pattern of service has to change, but they are not even controlling the pace of change. It is crazy to go backwards and forwards on PCTs, commissioning, budgeting and so on, because that just demoralises the people who should control things. That is a failure on the Government's part. They are in a crisis, and they need to start again and decide how they are going to reform the NHS.

Photo of Neil Turner Neil Turner PPS (Rt Hon Ian McCartney, Minister of State), Foreign & Commonwealth Office, PPS (Rt Hon Ian McCartney, Minister of State), Department of Trade and Industry 3:03 pm, 11th October 2006

I begin by declaring an interest, in that my wife is a member of the Wigan and Leigh hospital trust board. I am amazed at the brass neck displayed by Opposition Members in holding a debate on the NHS. They seem to forget some of the problems that existed in 1997. They do not like to hear what they were, but it is important to put what is happening in context.

I remember workers throughout the country holding a one-day strike to support nurses, who did not want to go on strike and therefore disrupt the services that they were providing. Other workers were prepared to give up a day's work to support the nurses, to whom the then Conservative Government did not want to pay a proper wage.

I also recall the winter beds crises that arose year after year. Patients were forced to use trolleys in hospital corridors or were bused all over the country in ambulances. People were even treated in ambulances in those days, but such things do not happen now.

Two years was the norm for waiting lists throughout the country in 1997, but nowadays the maximum wait in Wigan in six months, and the vast majority of cases are dealt with in three months or less. I remember having to wait in an accident and emergency department in Wigan for more than eight hours before I was seen, but every patient is now dealt with inside a maximum of four hours.

All that represents a dramatic change from what was happening in 1997, and it would have been nice to hear an apology from Opposition Members for that. Given where the Leader of the Opposition was on Black Wednesday, I suppose we should expect him to say, "Je ne regrette rien." However, instead of saying, "We regret nothing," what we get is the Opposition saying, "We forget everything." Well, neither I nor the people of Wigan have forgotten, and we will make sure that the people of Britain do not forget when the next election comes around.

What are the Opposition's policies now? In 2005, as we have heard, we had the patient passport, which would have put wads of money into the private sector. In 2006, we have the Leader of the Opposition on his webcam telling us how good it is to wash up dishes, although I not sure what that says about him. The Conservative spokesperson on health says that his party does not want any more reorganisation, but that there will be a new organisation to reorganise things. He also says that there will be no more targets, but that his party will introduce protocols instead. The Opposition are all over the place: we have gone from flog it to blog it to blag it, but not one Conservative Member has shown any sign of embarrassment.

I want to tell the House what is happening in Wigan. The Wigan PCT and acute hospital trust covers Wigan and the constituencies of Makerfield and of Leigh, and parts of Worsley and West Lancashire. I am sure that my right hon. and hon. Friends who represent those areas—and they are friends as well as parliamentary colleagues—will not mind too much if I stray into their territories.

Since 1979, we have some 400 extra nurses and 100 extra doctors in Wigan. In the past two years, we have recruited 20 extra GPs, and 14 extra matrons are working in the community. Just as importantly, huge capital investment has been made. There are new maternity, neonatal and intensive care units at the Royal Albert and Edward infirmary, as well as a new X-ray department with a magnetic resonance imaging facility. The hospital has a new endoscopy unit, and extra beds. In case some of what I have listed does not work, the hospital also has a new mortuary.

At the Wrightington hospital in the Wigan area—where hip replacements were originally pioneered—there are two new clean-air orthopaedic clinics, while other wards have been refurbished and upgraded. Moreover, the Thomas Linacre centre is a brand-new outpatient facility in the centre of the town.

Over the recess, I visited the new cardiac catheter laboratory that has opened in the Royal Albert and Edward infirmary, and the new patients information centre at Wrightington. I also went to the renal unit opened under Wigan's LIFT—local improvement finance trust——programme. Never has one so well gone to so many health units in so short a time.

Photo of Grant Shapps Grant Shapps Co-Chair, Conservative Party

We are all delighted for the hon. Gentleman's constituents in Wigan, but how does he think that my constituents in Hertfordshire will feel? They were promised a hospital worth £500 million before the election, when a health Minister represented the seat that I now occupy, but the hospital has been withdrawn now that the election has passed. I understand the party political points that he makes, but how does he explain the fact that 18 years of so-called Tory cuts in the NHS meant that my constituency had the QE2 hospital, with accident and emergency, maternity, paediatric and other services? They have all been stripped away. The news is good for people who happen to live in Labour constituencies, but blooming bad for those who did not vote Labour. The Government's policies are a punishment, are they not?

Photo of Neil Turner Neil Turner PPS (Rt Hon Ian McCartney, Minister of State), Foreign & Commonwealth Office, PPS (Rt Hon Ian McCartney, Minister of State), Department of Trade and Industry

That is exactly my point: what happened in those 18 years is that we were not getting the service improvements that we needed, because you were gerrymandering so much of the money into your own areas. We have a new system now, in which money follows the needs of patients. What you have to ask your people—

Photo of Michael Lord Michael Lord Second Deputy Chairman of Ways and Means

Order. I think that the hon. Gentleman knows what I was about to say.

Photo of Neil Turner Neil Turner PPS (Rt Hon Ian McCartney, Minister of State), Foreign & Commonwealth Office, PPS (Rt Hon Ian McCartney, Minister of State), Department of Trade and Industry

I apologise, Mr. Deputy Speaker. The hon. Gentleman should ask why his PCT is getting more money than the formula prescribes. Why does it get extra money through the market forces factor, yet remain incapable of running its service properly? In contrast, my PCT is underfunded under the formula and gets less money through the market forces factor, yet is able to budget properly. Our PCT is three star, and we also have a three-star hospital. They keep to their budgets. If the hon. Gentleman cannot make sure that his PCT keeps to its budget, that is a matter for him.

The cardiac catheter laboratory makes sure that there is early diagnosis of heart trouble so that people can be treated and kept out of hospital. The patient information centre makes sure that patients who go for difficult operations understand what is going on. In that extremely anxious period, they will be given the kind of reassurances that they want. The renal unit means that, instead of patients trawling all over Greater Manchester looking for somewhere to have kidney dialysis, they can now have that treatment in the centre of Wigan. That takes an incredible amount of stress off not just the patient, but the families and friends who have to drive them there.

Those last points illustrate the huge changes that are being made and that need to be made if we are going to deliver health care properly in this country. I am talking about a massive shift from secondary to primary care. The Minister of State, Department of Health, my hon. Friend Andy Burnham will know of the doctors surgeries in two-ups and two-downs in Leigh, and up and down the Wigan area. They provided a poor service, not because the doctors were bad, but because the facilities were. In Wigan, we now have a refurbished clinic at Tyldesley and new clinics at Atherton, Ince, Worsley Mesnes, and Golborne. Platt Bridge is being built. Pemberton is being extended. More clinics are planned at Standish, Shevington, Whelley, Wigan, Ashton and Leigh—all with a huge range of facilities and with brand new treatments. What is the result of that? As I said, there is local delivery of renal care.

Photo of John Bercow John Bercow Conservative, Buckingham

The hon. Gentleman is positively triumphalist about the position in Wigan, but how does he explain the contradiction between the fact of greatly increasing expenditure nation wide on the one hand and no comparable increase in national health service productivity on the other?

Photo of Neil Turner Neil Turner PPS (Rt Hon Ian McCartney, Minister of State), Foreign & Commonwealth Office, PPS (Rt Hon Ian McCartney, Minister of State), Department of Trade and Industry

I am not a statistician, but I suspect that one of the problems is that if a lot of money is put into making sure that people do not get ill, the productivity end—that is to say, the measurement of how many people are treated and how they are treated—will be difficult, because the reality is that one makes sure that people do not get ill and that means that one is less productive. That is nonsense. There needs to be a way to look at the statistics to make sure that they properly reflect what is going in.

Photo of Neil Turner Neil Turner PPS (Rt Hon Ian McCartney, Minister of State), Foreign & Commonwealth Office, PPS (Rt Hon Ian McCartney, Minister of State), Department of Trade and Industry

Thank you. I thought that it was fairly successful, as well.

Not only do we have renal units, but diabetes is being treated in the community. People who have heart disease are being treated in their own homes, although obviously not while they are having their operation—I would not suggest that for one minute. The post and pre-operative aspects are being dealt with in people's own homes. Cancer therapy is being delivered at home. There are smoking cessation clinics in the clinics that I mentioned. In the case of dental treatment, there is an emergency line that operates 24/7 for the whole of the borough. That shows a shift from secondary care to primary care when dealing with health. It is not just a matter of some kind of organisational shift; it is what patients need and want, and what we are delivering.

I will finish—I am well aware that many people want to speak in the debate—by giving my constituents a strong warning. What we heard from a number of Members, and particularly Steve Webb and others who talked about the campaign pack from the Conservatives, was that that pack provides a stark warning. The Conservatives will move resources from Wigan to Windsor, from South Kirklees to south Cambridgeshire, and from Leicester to Leominster—from places that need those resources, because health there is poorer, to places that do not need them, because health there is better. Resources will no longer be based on health needs. They will be gerrymandered yet again to Tory areas. If anybody in Wigan votes for the Conservative party at the next election, they should know what they are voting for.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood 3:14 pm, 11th October 2006

I want to respond briefly to the point with which the hon. Gentleman closed. It has been apparent several times in the course of the debate, listening to Members on the Front Bench, as well as the Back Benches, that the charge now being levelled against the announcements that were made by my right hon. Friend the Leader of the Opposition on Monday is that they represent at attempt to gerrymander resources. The truth is precisely the opposite. The announcements are a response to the Government's gerrymandering of resources. We seek to set up an established authoritative body that can provide an independent assessment of where health resources ought to go. We want to do that in order to ensure that the national health service is in a position to deliver the objective that my right hon. and learned Friend Mr. Clarke made clear is shared explicitly right across the House: we want to have a largely tax-funded health care system that is available to people on the basis on need—on the principle of equitable access to those who need it, without regard to ability to pay. Attempts by Labour Members to undermine, or eliminate, that political consensus across the House are doomed to fail. I want to return to some of those themes in a moment.

I congratulate my hon. Friend Mr. Lansley on the fact that he has focused the debate on the key resource of the national health service. The message coming back right across the health service is that, although Ministers repeatedly say that the delivery of health care depends on the professionalism and commitment of health service staff, which we all know to be true, the message that is received by national health service staff themselves is that their professionalism and their commitment to the service is being systematically undervalued by the Government who are supposed to be their employer. Staff feel that their commitment is undervalued because—despite the huge increase in resources committed to the health service, which commands support right across the House—they find themselves in the too familiar situation of being caught up in the management of short-term crises that are repeating themselves right through the national health service. In any organisation, when people find themselves responding to firefighting initiatives and short-term crisis management measures, that undermines morale and that is precisely what is happening right through the national health service today.

Like my right hon. and learned Friend the Member for Rushcliffe, I think that it is fundamental that we understand why that situation has arisen despite the huge increase in resources committed to the national health service. I was struck by the fact that the Secretary of State was lecturing the House from the Dispatch Box on the importance of Ministers and managers in the national health service facing hard truths about the requirement to use resources efficiently if the health service is to deliver its objective of equitable access to high quality health care. As my right hon. and learned Friend said, he has made that speech, as have I—every Secretary of State for Health has made it. The problem is that this generation of Ministers had a once-in-a-lifetime opportunity to use resources to address some of those fundamental problems of efficiency in health care delivery in the health service and they fluffed it. They had an opportunity that was not available to my right hon. and learned Friend when he was Secretary of State for Health and that he made certain, when he was Chancellor, was not available to me when I was Secretary of State for Health—an opportunity to use that huge increase in resources to oil the wheels of change. The present Government had the opportunity to use those resources to provide a step change in the efficiency and quality of service that is being delivered by the health service. The present generation of Ministers has missed that opportunity and the result is that we are back with short-term responses and crisis management.

Let me give the House three specific examples of what that means in practice for people who deliver care to patients on a day-by-day basis, rather than make speeches about the health service. First, we have what are often called in health service-speak the priority services. There is an unintended irony in that phrase. I am talking about community services, therapies and the low-tech services that are delivered at community level that often bring a quite disproportionate benefit to the quality of life of patients. However, they are the easy targets every time a health service manager faces the need to make short-term cuts so that the books can be balanced. That is why we have unemployed physiotherapists throughout the country—the health service cannot afford to employ them—why occupational therapists are looking for jobs and why social services are complaining about their inability to get local partnership arrangements out of the health service.

The effect of such short-term cuts in community-based services throughout the health service is twofold. First, they undermine morale because those who are delivering the service know that it is not as good as it could be. Secondly, and absurdly, they mean that we are building up long-term costs in the health service because people are being trapped in hospital, rather than released to properly funded and resourced community services.

Photo of David Burrowes David Burrowes Conservative, Enfield, Southgate

Will my right hon. Friend add to his concerns the example from my constituency of the effective cuts that have led to unfilled health visitor posts and caused the closure of baby clinics and the suspension of routine developmental checks? That, together with the danger that our children and maternity services will be transferred, has led to profound concern that services are being hit where it hurts most. We have the agenda for "Every Child Matters", but that certainly does not matter in Enfield, Southgate.

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

My hon. Friend is entirely right. He cites a perfect example of the trend about which I am talking, which exists throughout the health service. Resources are being taken out of the community services because they are an easy hit.

The second example of short-term crisis management is the difference between the rate of inflation of health care costs in the system and the change that the Government have made to the tariff charged by secondary care to PCTs and commissioners. We all know that health care costs are rising very quickly—my right hon. and learned Friend the Member for Rushcliffe referred to that—and the latest estimate from the Office for National Statistics, which was published in August, is that they are rising by 6 per cent. a year. Given that the costs are rising at such a rate and the tariff that the Government published on 26 January increased by 1.5 per cent. a year, one does not need to be a statistician to work out that that represents a 4.5 per cent. cut in the real resources available for the delivery of individual procedures by NHS providers.

The situation shows that Ministers are not facing up to the consequences of their actions. If costs are rising by 6 per cent., yet Ministers fund them to the tune of 1.5 per cent., Ministers are effectively hoping that all the people in the national health service will somehow cover up the 4.5 per cent. gap so that they can avoid political embarrassment. It is not surprising that those people find their morale undermined if Ministers apparently believe that they are employed to do such a job. Those people think that they are employed to deliver high-quality health care to patients, as they should be. However, their experience is one of being asked to cover up the consequences of ministerial unwillingness to face precisely the kind of tough decisions about which the Secretary of State talked.

The development of training policy in the NHS, which is my third example of the short-term responses, has already been referred to during the debate. I have previously welcomed in the House the fact that we now spend more on training doctors and nurses in medical and nursing schools than we did when I was Secretary of State. I have reminded Ministers on previous occasions that that has happened partly because of carrying through plans that started to be generated when I was Secretary of State, but the big increase is welcome. However, it is not welcome that people who leave medical schools, and especially nursing schools, find that they cannot be employed in the national health service because Ministers have not faced up to the need to improve the efficiency with which health care is delivered. Furthermore, not only do we have unemployed nurses and doctors coming out of the growing medical and nursing schools, but the operators of the schools anticipate a 10 per cent. cut in the budgets available for training future doctors and nurses for the national health service. The Government have created a growing training sector, but they are not employing the people whom it produces, and they are also preparing a substantial cut to the increased training budget for which they are claiming credit.

Photo of John Bercow John Bercow Conservative, Buckingham

Of course, that is true not only of doctors and nurses. Is it not particularly absurd that whereas there is a substantial increase in the number of trained and qualified speech and language therapists, there is also a substantial increase in the unmet need among children who require the service, but for whom the employed personnel to provide it do not exist?

Photo of Stephen Dorrell Stephen Dorrell Conservative, Charnwood

My hon. Friend is right. Why does that undermine morale? It is partly because it results in unemployed people with training that they want to use and partly because the people in the service know better than the politicians the impact of the failures on the service delivered to patients from day to day. They can compare that service with what they want to deliver and what they know could be delivered if only the health service was led in a way that faced up to the real choices about which the Secretary of State likes to talk.

I agree with the Secretary of State when she talks about the importance of facing hard choices to deliver real improvements in health care. However, I look for a Minister who not only talks the talk, but walks the walk. I want to link the situation to the seven or eight rounds of bureaucratic change that we have had in the health service since 1997. The Government have brought us back round to virtually the same point at which they started nine years ago. Not only has that process led to a huge waste of resources—I have seen estimates suggesting that the whole rigmarole has cost roughly £1 billion—but more fundamentally and importantly, it has meant that the kaleidoscope of changing management structures simply has not addressed the real choices about which the Secretary of State has talked. That is the link between the bureaucratic changes for which the Government are responsible and their fundamental failure to deliver improvements in health care, which is what hon. Members on both sides of the House want.

Photo of Gordon Prentice Gordon Prentice Labour, Pendle 3:27 pm, 11th October 2006

Mr. Clarke gently mocked Labour Members for hyperventilating when it comes to the Conservative record of all those years ago. I agree with him that policy convergence is taking place. In fact, the Prime Minister is on record as saying that a lot of policy cross-dressing is going on, yet we have these debates that are full of sound and fury about what the Conservatives did in their 18 years, and I think that it is just a big yawn.

The Prime Minister can be very tribal. At Monday's meeting of the parliamentary Labour party, he told us—jacket off; gleaming white shirt—"The Conservatives have a marketisation agenda, you know. Get in there on Wednesday." Goodness me, I thought. I will come on to the business of new Labour and the market in a minute.

I also wanted to pick up on the point made about structural change, which has been hugely debilitating. In the time that I have been a Member of Parliament, strategic health authorities have changed massively. We have a huge strategic health authority in the north-west. In east Lancashire, which is where my constituency is, East Lancashire health authority morphed into Burnley, Pendle and Rossendale primary care trust, which has morphed into an even bigger PCT. We had two hospital trusts—Burnley hospital trust and Blackburn hospital trust—but they have been merged. The Lancashire ambulance service has been abolished and we now have a regional ambulance service. Community health councils have been abolished and we now have public and patient involvement forums, which are about to be abolished and replaced by patient links.

Photo of Tony Baldry Tony Baldry Conservative, Banbury

Is it not especially tragic that while we started off with community health councils that people understood, no one now understands how patients or the general public have a voice in NHS change?

Photo of Gordon Prentice Gordon Prentice Labour, Pendle

I agree entirely. Last year, there was a lunatic proposal from Lord Warner to transfer 250,000 people directly employed by primary care trusts from the NHS into the private, voluntary and not-for-profit sectors. That was stopped only because of the huge outcry from Labour Members. The announcement was made on 28 July, and it was finally overturned by my friend the Secretary of State last November.

Debilitating change has taken place. The Prime Minister tells us that we are the change makers, but every time that we change the organisation, it is set back a year, or perhaps 18 months. It takes time to recover, and as soon as it has recovered, we slap it in the face again and reorganise. The way in which we endlessly reorganise the health service is Maoist, which is why people in the health service are so antagonistic towards us, why the platform lost an important conference motion moved by Unison in Manchester, and why a statement by the national executive committee, saying that more work had to be done to engage people working in the health service, was rejected by the conference. We regard people working in the health service as pawns that can be moved about, but they are finally saying, "No, we are not having it."

The private sector is moving into the health service in a big way, but that is being done surreptitiously. Ministers do not say that it is taking place, although they should do so. All the arguments are wrapped up in issues such as contestability; instead, we should just play it with a straight bat and say, "There are too many people sleeping at their desks in the national health service; we will put 20,000 volts through the NHS and bring in the private sector."

That is what is happening in my constituency, where Netcare, a South African firm, has become involved. I have a letter from my primary care trust that reminds me that Netcare runs a local mobile ophthalmology unit at Rossendale hospital, but I am told that Netcare is coming to Lancashire in a big way. The contract will be signed by the end of the year. I am told that Netcare services

"will be established in the following specialities"—

I thought that it would just deal with the odd cataract, so that we process ophthalmology patients quickly, but it will be involved in work on ear, nose and throat, general surgery, trauma, orthopaedics and rheumatology. Urology and gynaecology, too, may be included, which does not leave much. Let us not kid people outside. The Prime Minister and the Government have a pro-market agenda, and they are pursuing it.

Photo of Meg Hillier Meg Hillier PPS (Rt Hon Ruth Kelly, Secretary of State), Department for Communities and Local Government

Does my hon. Friend agree that although the vast majority of NHS services in this country are provided in NHS facilities by NHS-employed staff, there are examples of cases in which it is not the best provider? I can give a personal example of a family member who was waiting for a wheelchair. She received it free at the point of delivery, but it was made by a private company, and private companies undertook the fitting. She was glad to receive the wheelchair. Is my hon. Friend suggesting that the NHS should open a wheelchair factory and make all the component parts, and provide the wheelchairs as well as the free service at the point of delivery?

Photo of Gordon Prentice Gordon Prentice Labour, Pendle

That is the argument about NHS Logistics. We can deconstruct organisations such as the police service. One might say that police officers should be fighting crime, not patrolling motorways, so we should take that responsibility away from them. The same could apply to the national health service. There are many people who want to be in the national health service family, and I agree that they should be part of it.

Photo of John Pugh John Pugh Shadow Minister (Health)

Were service users consulted about the change in the ophthalmology department?

Photo of Gordon Prentice Gordon Prentice Labour, Pendle

I very much doubt it, because there are no consultation procedures when services are moved from the NHS into the private sector. There was no consultation—it just happened. I got my information from the PCT; I did not have an opportunity to say that I do not want Netcare to be responsibly for urology, gynaecology, and ear, nose and throat procedures. I do not want that South African company to be responsible, but I was not asked, and nor was anyone else.

Photo of Patrick Hall Patrick Hall Labour, Bedford

I shall be brief. May I give my hon. Friend an opportunity to return to his characteristic loyalty to the Government by at least agreeing that the difference between the Conservative and Labour parties is that we do not pretend that we can grow the NHS while cutting tax?

Photo of Gordon Prentice Gordon Prentice Labour, Pendle

I would prefer to return to my own agenda in the five minutes left to me.

I am glad that my friend Kitty Ussher is here, because the latest shock to the system is that we may be losing the blue-light accident and emergency department at Burnley general hospital, which serves my Pendle constituency, too. Those services may be moved to Blackburn on the other side of east Lancashire. I do not believe that a proposal to close the blue-light accident and emergency services in Blackburn and transfer them to my friend's constituency would see the light of day. Tomorrow, the council's overview and scrutiny committee will make a decision on whether or not to refer the issue to the Secretary of State for Health. My friend and I are against it, the patient and public involvement forum is against it, general practitioners and others in the medical community are against it, and local people are against it, yet there is a possibility that tomorrow the overview and scrutiny committee may not recognise the strength of public opinion. That is why my friend and I will go up to Blackburn to speak to that committee, regardless of what the Whip says here. [Interruption.] I am speaking for my friend, and I think that I am doing so very well.

The issue of ambulance times is critical. In my PCT area, it takes an average of 38.57 minutes to take someone to the nearest accident and emergency department. In West Craven, where I live, it takes 54.48 minutes, and that is before the possible closure of blue-light accident and emergency services in Burnley. The ambulance will shoot past Burnley general hospital to reach Blackburn, way over the horizon.

Photo of Gordon Prentice Gordon Prentice Labour, Pendle

Indeed, it is an absurdity. I do not know how many times I have driven down the M65 only to find the junction for Blackburn clogged with traffic.

Photo of Gordon Prentice Gordon Prentice Labour, Pendle

No, I will not.

We hear from Ministers all the time about the need to listen to people—we heard about it today from the Prime Minister and from the Secretary of State—and if decisions on the NHS are to be made locally, the overview and scrutiny committee ought to listen to their voice.

Photo of Gordon Prentice Gordon Prentice Labour, Pendle

Would my friend like to intervene?

Photo of Ian Austin Ian Austin Labour, Dudley North

I am grateful that, finally, my hon. Friend has allowed me to intervene. I would like to ask him whether anything that the Government have done since 1997 has been welcomed by the people of Pendle and whether he can present a rather more balanced picture. Does he welcome the extra resources that have gone into the NHS in his constituency, and does he welcome the increased number of people who have been treated there? Does he welcome the financial position in his constituency, as I understand that both the hospital trust and the PCT have a surplus?

Photo of Gordon Prentice Gordon Prentice Labour, Pendle

My friend has abused the generosity that I demonstrated when I allowed him to intervene. There are plenty of opportunities for balanced discussion at the meetings of the parliamentary Labour party. I am trying to save my local accident and emergency department, as the decision will be made tomorrow.

The overview and scrutiny committee reports to my friend the Secretary of State, who has the power to refer the proposal to the independent reconfiguration panel, which consists of independent clinicians from across the United Kingdom who do not know east Lancashire. If they say that the department has to be closed—I say this to my friend Mr. Turner, who takes great delight in interrupting me all the time—we can live with that, because independent clinicians will have made that recommendation, not the director of accident and emergency services, who will speak at the overview and scrutiny committee minutes before the councillors are invited to make a decision.

There have been 13 recommendations from overview and scrutiny committees to the Secretary of State but she has passed only two of them on to the independent reconfiguration panel; that is not good enough. I had a meeting yesterday with Dr. Peter Barrett, who chairs the independent reconfiguration panel, and I told him that I hoped that there would be a reference through the overview and scrutiny committee to the Secretary of State, and that she would not throw it in the wastepaper basket, but that she would pass it on to that panel, which we on the Labour Benches set up to make recommendations that would carry public confidence—in this case in my constituency and the neighbouring constituency of my friend the Member for Burnley.

Photo of Michael Mates Michael Mates Conservative, East Hampshire 3:40 pm, 11th October 2006

It is often what happens to individuals, rather than what happens to institutions, that tells us when something is going badly wrong. Over the past two years, I have read with mounting disbelief letters from my constituents about the NHS in Hampshire. In case after case, they complain that they cannot get the treatment that they need. They tell me that national policies, such as cancer treatment within four weeks of diagnosis or the provision of services in community hospitals, are not being delivered on the ground.

When I take up these problems with the relevant authorities, I am sent from one to another, on a bewildering journey around an amazing merry-go-round of bureaucracies, none of whom seems to be wholly responsible for what has happened. Is it the hospital trust that is responsible, or the primary care trust, or the National Institute for Health and Clinical Excellence—or even, perhaps, the ambulance service? The space between the various bodies is not so much a gap as a swamp into which my queries sink into boggy depths, with all too often no satisfactory explanation for what has gone wrong.

Let me say something else—by way of light relief, perhaps. The new Hampshire strategic health authority started on 1 October. Its chief executive was the chief executive of one of the major trusts in the county; he has moved up the ladder, as so often happens in such situations, and I do not knock him for that. However, when I wrote to him about a problem at the beginning of September, he replied—very promptly—that he could not help me until 1 October because he did not exist until then. Such bureaucratic problems make a bad situation even worse.

Only yesterday, I received a letter from a constituent whose wife was diagnosed with a brain tumour on 9 June at Queen Alexandra hospital in Portsmouth, and it is that that has prompted me to take part in a health debate, which I do only very infrequently. Despite continuing pressure from her husband and her GP, no treatment began within the target time of four weeks. Indeed, they had to wait nine weeks for treatment at the other hospital in Portsmouth, St. Mary's. During the intervening period, her condition deteriorated, so that in the end radiotherapy treatment was too much for her to bear and had to be stopped. She died six weeks later.

Why did she not receive treatment within the stated time? I shall seek an explanation from the two hospitals involved. One of the things that my constituent simply cannot believe is that it takes two weeks for medical records to travel the two miles from one hospital to the other, because they are sent by second-class post.

But it is not just in headline grabbing areas such as cancer treatment that the NHS has problems. The Government say that they are committed to community hospitals, but both of the community hospitals in my constituency have experienced significant service reductions at a time when, as everybody agrees, the NHS budget has been expanding. At the Alton community hospital, the Inwood ward was closed for many months. Happily, it will now reopen. At Petersfield hospital, the Grange maternity suite was closed at two weeks' notice because of staff shortages, and it has stayed closed for 16 months. Happily, that is also now reopening. But how could the planning go so awry that those closures were necessary in the first place?

The trouble is that the NHS—particularly in Hampshire—is suffering from a stop-go policy. Sudden staff shortages or budget crises cause the withdrawal of a service. That sets off an understandable public row. Health service managers promise to reopen the facility, but are vague about when that will happen. After many months—often over a year—it is necessary to launch a recruitment drive to find the staff to run the service so that it can be reopened. Meanwhile, other parts of the NHS are making people redundant. The facility then reopens, but often—as at Petersfield—with a reduction in services.

That stop-go approach is deeply debilitating. It undermines morale in the NHS, wastes resources as facilities have to be closed and then reopened, and, worst of all, it bewilders patients. It is the most vulnerable patients who suffer from the closure of community hospital facilities, as they are the ones who are unable to travel to the nearest district general hospital.

This mismanagement—that is what it is—results from the total absence of stability within the service, as my right hon. and hon. Friends, whose knowledge is greater than mine, have mentioned. When my right hon. Friend the Leader of the Opposition spoke about taking politicians out of the NHS, he did not mean for us to walk away from our ultimate responsibility to provide health care; he meant that the constant chopping and changing brought about by the pressure of party politics has to stop.

Somebody said that there have been seven reorganisations of NHS bureaucracy since 1997, but I make it 10. I am not trying to dismiss the value of managers—good managers save lives by making the best use of inevitably limited resources—but it is no good Ministers trying to pretend that constant changes in management and structures do not adversely affect patients, because they do. An estimated £320 million is being spent on the current reorganisation of PCTs, and many of my constituents want to know why that money is not being spent on patient care.

Another constituent of mine has kidney cancer, and his consultant at Southampton general hospital wants to treat him with a new drug called Sunitinib. Clinical trials of the drug have been conducted for about six months and it has proved extraordinarily effective, to the extent that another of my constituents—a 38-year-old woman—is back home with her family. Yet before the trials began, it was thought that she had only weeks to live.

My constituent's kidney cancer was diagnosed two days after the trials officially ended, and although the treatment has been proven to be highly effective, it is not available any more, the argument being that it has not been approved by NICE. Indeed, according to a written answer in June from the Minister of State, Department of Health, Andy Burnham, the Department of Health is still deciding whether to refer the drug to NICE for consideration. When I asked about this, Lord Warner replied that it was for hospitals and PCTs to decide whether to prescribe new treatments. He went further, saying that

"PCTs cannot refuse to fund drugs simply because NICE guidance is not available".

He added that PCTs

"should not refuse to fund treatment solely on the grounds of cost but should consider all the circumstances before making a decision."

So what is the problem? The drug is the treatment of choice of the consultant, who is thrilled with the success of the trials. It is available, but it is not allowed to be prescribed and my constituent cannot have it.

The reality is that health rationing is going on all over Britain, and it is a complete lottery as to whether a particular treatment is available in a particular area. That does not add up to a national health service. I do not doubt the personal commitment of Ministers to solving some of the problems, but they do not seem to recognise that it is their making constant changes, the expansion in the number of managers and the obsession with targets that is denying patients the choice that they should properly have. If the focus of the national health service should be on anything, it should be on nothing more than patient care.

Photo of Ian Austin Ian Austin Labour, Dudley North 3:48 pm, 11th October 2006

I want to thank the Opposition for calling this debate, although the picture of the NHS painted by Mr. Lansley is not one that my constituents would recognise. Investment has doubled nationally since 1997, and it will treble by 2008. There are 32,000 more doctors and 85,000 more nurses, and by 2010 there will be 100 new hospitals. As you know only too well, Madam Deputy Speaker, my constituency has a brand new hospital that is treating more of your and my constituents more quickly than ever before. The real reason, however, why I welcome today's debate is that it gives us the opportunity to show that when it comes to the NHS work force and service development, the only party that can be trusted is ours. Whatever they may say in their motion on today's Order Paper, the Opposition still do not believe in the NHS.

Last week, we were told by the Leader of the Opposition how much he now cares about the health service. This remarkable conversion follows earlier eye-catching statements in which he said, for example, that he is not a Thatcherite and that he now cares about poverty. He and his party have chosen "change to win" as their slogan, because they know that their brand was discredited and distrusted and associated with the failures and betrayals of the past. That is why they are trying to show that they now care about issues such as the NHS, on which they have never been trusted before. They might be doing a decent job on public relations, but they face much stricter tests—vague claims about intent are not enough. I am not one of those people who say that the Tories believe in nothing and that they have no policies—quite the reverse. It is because of their beliefs and values that they cannot be trusted with the health service.

The Opposition motion says that they want more staff, but the Leader of the Opposition says that the investment to pay for them is "fiscal irresponsibility". He has committed his party to the so-called proceeds of growth rule, which—whatever the Tories say—commits their party to cuts, year in, year out. As my right hon. Friend the Secretary of State said earlier, if the Tories were in power this year, the new rule would mean expenditure at a slower rate of growth than under the Government's plans. This year, the difference between the Opposition's plans and the Government's plans would be £17 billion, and it would be bigger in the future.

NHS expenditure is almost a fifth of total managed expenditure, so a £17 billion cut in public spending applied across the board would mean cuts to the NHS of at least £3 billion this year—[ Interruption.] The Tories may not like it—

Photo of Ian Austin Ian Austin Labour, Dudley North

The hon. Gentleman can listen for a while. Let him listen to what the Leader of the Opposition said about the proceeds of growth rule this year—his words, not mine. He said:

"As that money comes in let's share that between additional public spending and reductions in taxes. That is a dramatic difference. It would be dramatically different after five years of a Conservative Government."

He also said that he wants to replace public services for the poor with

"a profound increase in voluntary and community support".

It is the same old Conservative ideology: a small state and spending cuts, leaving the most vulnerable relying on charity. That is why the Tories cannot promise that they will not cut funding for the NHS.

Before the Leader of the Opposition's conference speech last week, the Conservative party website said that it would promise:

"We will never jeopardise the NHS by cutting its funding."

That line also appeared in the extracts released to the media before the right hon. Gentleman delivered the speech, but it did not appear in the final version or the published version.

The Tory motion claims that the NHS is being cut, but the Opposition voted against the extra funds we invested. In fact, not only did the right hon. Gentleman oppose the national insurance increase at the time, he called for a social insurance system for health care instead. The Tories cannot say that they have changed that position, because only this week the shadow Secretary of State repeated his opposition to the tax increases that paid for the improvements. Time and again, they use moderate, compassionate language to mask traditional Tory positions.

Today's Tories claim to support the NHS, yet they run it down at every opportunity. They tell us that they believe in the health service, yet they are still committed to massive cuts. They say the NHS is underfunded, yet they vote against extra spending. It is absolutely clear that when it comes to the health service—just like everything else—they do not have even one centre-ground policy.

There is no huge secret about the so-called new Conservative party. Every speech makes it absolutely clear: the Tories may not spell out the lower taxes they want, or the precise parts of the so-called "big state" they want to cut down to size, but anyone who looks beyond the rebranding will see the same old Tories committed to the same old spending cuts. Instead of greeting their so-called changes with warm words of approval, we should expose the fact that they are not really changing anything at all. We should demonstrate that they will claim anything to win, but that they do not believe a word of it.

Photo of Grant Shapps Grant Shapps Co-Chair, Conservative Party

Much of what the hon. Gentleman says will ring hollow to my constituents and those of many Members on the Opposition Benches whose hospital services—unlike those in Dudley—are being cut, not expanded. How can the hon. Gentleman stand in the Chamber and say things that are not a reality for the whole of the country?

Photo of Ian Austin Ian Austin Labour, Dudley North

The reality for the whole of the country is that no one now waits longer than six months for an operation, down from 284,000 when we came to power. Ninety-nine per cent. of cancer patients are seen by a specialist within two weeks. Almost 99 per cent. of people with cancer are treated within 31 days of diagnosis, and 19 in 20 patients are seen, treated and discharged from accident and emergency departments within four hours.

Those things did not happen by chance; they happened because we set targets to achieve them. Eradicating targets, as the Opposition propose, may sound alluring, but can they imagine a patient turning up at BUPA—as they probably do—and saying, "I'll pay the charges and sign the contract but I don't care when you treat me, just do it in your own time. I don't want targets, I'm not that bothered"? Of course not.

It is not possible to say that everything is perfect in every case in the modern NHS, but no one prepared to look at the issues dispassionately can fail to deny that the NHS has been transformed. Come to Dudley and a brand new, £160 million hospital can be seen with more doctors, more nurses and more other staff treating more patients more quickly than ever before. There are new community facilities treating patients in their own homes in ways that could not have been dreamed of just a few years ago. That is not to deny that there are issues in Dudley. We have problems with car parking charges and we have a shortage of chiropodists—I hope that the Minister will help on that—but the new facilities and low waiting lists in Dudley show the improvements that extra spending and modern ways of working can bring to the NHS.

One does not have to accept my word on all that. Let me conclude by reading a letter from my constituent, Mr. Albert Williams, a 79-year-old gentleman suffering from two terminal illnesses. He wrote to the Secretary of State to say that

"the new hospital, the extra nurses and doctors and the new technologies I have seen at first hand have made a huge difference to me... The care that I have received in my home is a great example of the way the health service can treat people in the community, be visited by nurses, enabling them to live at home and free up hospital beds for other patients. Send people who spend their whole time complaining about our health service to talk to me. I can remember what people had to rely on before the NHS existed to treat people regardless of their income or ability to pay. It is our country's greatest invention and you", he wrote to the Secretary of State,

"should be proud of the work your government is doing to strengthen it for the future."

That, Madam Deputy Speaker, is the truth about the modern NHS that the Government are building.

Photo of Nicholas Soames Nicholas Soames Conservative, Mid Sussex 3:56 pm, 11th October 2006

First, I congratulate NHS staff in my constituency on delivering a wonderful service in a very good hospital. They are nervous and anxious about the future. I also warmly congratulate the shadow Secretary of State on the excellent way in which he moved the motion. I hope that the House listened carefully to the speeches of the two former Secretaries of State for Health, my right hon. Friend the Members for Charnwood (Mr. Dorrell) and my right hon. and learned Friend Mr. Clarke, which were full of wisdom and clarity about the way ahead. I wholly agree with the picture painted by my right hon. and learned Friend the Member for Rushcliffe, who took a tremendously national view of the NHS, to which I wholly and unreservedly subscribe.

In 23 years as an MP, I have never known such anger and anxiety directed at the Government as is now being generated on national health issues. Since I became the Member for Mid-Sussex in 1997, there have been four reviews of hospital services—nothing like as many as experienced by my right hon. Friend Mr. Mates—in my constituency and local area. We have had "Modern Hospital Services for Central Sussex—A challenge for us all" in 2000, and even more ridiculous names such as "Strengthening Hospital Services in Central Sussex" in 2001 and the "Best Care, Best Place" consultation in 2004. Now, 18 months on, we have a new document that sweeps all the rest into the waste paper basket: "Creating an NHS Fit for the Future".

Those reports were all subsequent to a document commissioned by the West Sussex health authority, which was faced in 2000 with growing fragmentation in health care provision, escalating and disproportionate management costs and rapidly accumulating debts, which are at the nub of our present unhappy state. Matters were so serious that the Government asked Michael Taylor, then chief executive of Oxfordshire health authority, to investigate and report on West Sussex as a failing and debt-ridden health authority. His report, which was damning, set out a series of recommendations, which were by and large completely ignored by Candy Morris, who was acting chief executive of West Sussex health authority until its demise. She was also responsible for the NHS consultation documents from 2000. By an astonishing quirk of fate, she is now one of the architects of proposals about to be announced for the apparent deconstruction of the NHS in West Sussex.

Those changes will throw the NHS in Sussex into even greater turmoil than is already the case. What Taylor exposed was a series of top-heavy management structures, in expensive premises—the sort of point made by my right hon. Friend the Member for East Hampshire—involving duplication, replication and wastefulness. No one paid any attention to his warnings and this continuing, wilful mismanagement of the NHS has now led to colossal debts of well over £100 million in West Sussex.

Another important contributory factor in this debacle has been the complete failure of the independent watchdog bodies—first, the community health councils and latterly the West Sussex health scrutiny committee and joint scrutiny committee—to refer any of the proposed configurations to the Secretary of State for intervention and for her to account to Parliament directly on that managerial vandalism.

What the Secretary of State must understand is that when the "Best Care, Best Place" consultation began in November 2004—incidentally, it was a total sham, in which, again, the scrutiny committee failed to act—it was represented to all my constituents and me by the management of the strategic health authority, and most especially by the primary care trust, as the way ahead for the foreseeable future. Many of them were deeply cynical of the Government's motive at the time, but they went along with it.

As recently as 25 May, at a meeting that I called in Burgess Hill in my constituency, the chief executive of the South East Coast strategic health authority—a newly created animal—never mentioned any of the changes that were likely to happen, even though they were being discussed at board level and elsewhere. My constituents and I feel that that amounts to a deceit, a betrayal and totally unacceptable behaviour by the management of the NHS, which has lost its way and has been party to the waste of hundreds of millions of pounds over recent years—money that could quite well have been spent on patient care.

I have referred that catalogue of incompetence and bad practice to the Comptroller and Auditor General, who, alas, cannot take it any further, but he has referred me to his excellent report on financial failings in the NHS. What I hope that the Secretary of State will understand is that we in Sussex think that her Department seems rather like the American Administration: apparently, at the same time, dysfunctional and fragile and unable to admit or unwilling ever to see—let alone to correct—the obvious mistakes that are being made in their name.

The constant reorganisations of the past few years may create for the Government an illusion of progress and reform, but in practice what has often happened in the recent past is that it has produced confusion, uncertainty, gross inefficiency, very serious staff demoralisation in excellent hospitals and, above all, a lack of a coherent sense of direction by managers.

Our area is expected to accommodate 41,000 new houses in the next 20 years; our local infrastructure is woeful. I have drawn to the House's attention on many occasions the infrastructure deficit in my constituency, yet with all the added pressure for existing and future growth it is clear that the PCT plans to downgrade the Princess Royal hospital by removing the accident and emergency department altogether, although I was assured by a Minister at the Department of Health on the Floor of the House a year ago that there was no question of that happening. Indeed, the "Best Care, Best Place" consultation document said that both the Royal Sussex County and the Princess Royal hospitals will keep their A and E departments. Those assurances turn out not to be worth the paper that they were written on.

Brighton, where the A and E department is to be removed in totality, is hopelessly inaccessible by road. Its hospitals simply cannot cope with the load that is being placed on them, with patients constantly being referred back to the Princess Royal hospital. Gatwick airport is only 15 miles away, and there is always the possibility of a major catastrophe. In times of conflict, the Princess Royal hospital would be needed as a casualty clearing station. There is a major and very busy motorway on the doorstep, combined with very high housing and population growth.

This weekend, I hope that thousands of people will march in Haywards Heath in an all-party campaign to support the Princess Royal, to draw the attention of Ministers to the fact that we cannot allow our services to be downgraded, because that is not safe, and to complain about the instability of the service provided to local people. Although I agree with my right hon. and learned Friend the Member for Rushcliffe that there have been many changes for the better and that excellent changes are afoot to move services into the local community, interfering with the fundamental infrastructure of the health service in the way that is being done is a fatal mistake.

Photo of Bob Blizzard Bob Blizzard PPS (Rt Hon Douglas Alexander, Secretary of State), Department for Transport, PPS (Rt Hon Douglas Alexander, Secretary of State), Scotland Office 4:05 pm, 11th October 2006

One of our greatest human failings is our lack of memory. I fear that today and in the weeks ahead the Conservatives will try to play on that by hoping that people will forget what the national health service was like in 1997. I would like to remind the House of what it was like in my area. Like everywhere else, we had long waits for elective treatment—18 months was the norm and, as we have heard, it could have been anything up to two years. The biggest change in the health service over the past 10 years is shown by the fact that nobody in my constituency now waits more than six months.

Going to accident and emergency in 1997 was really unpleasant. One could expect a long wait in crowded conditions in an environment that was miserable rather than comfortable. The second biggest change that we have seen is that today one can go to a completely modernised accident and emergency unit that is not crowded and one can be treated in under four hours. My hospital achieves that for 98 per cent. of patients.

They were chaotic times back then. The first national trust to go out of business was in my area. The Anglian Harbours NHS Trust, a community services trust, did not just have a deficit, but crashed and went out of business. Local NHS managers had to pick up the mess. Lowestoft community hospital was threatened with closure and, yes, we marched up and down the streets to save it, and we managed to under this Labour Government.

Mental health care was a complete failure in my area, with appalling Victorian and inconvenient in-patient facilities. Community mental health services were thin on the ground so that when I and my hon. Friend Mr. Wright were elected, we decided to march off to the Secretary of State to get something done. Thankfully, the regional health authority accepted our case and put matters right.

Photo of Graham Stuart Graham Stuart Conservative, Beverley and Holderness

Will the hon. Gentleman turn his mind to looking ahead? As my right hon. and learned Friend Mr. Clarke said, if we looked back, we would see significant improvements in any 10-year period such as the 81 new hospitals that were built under the last Conservative Government. Will the hon. Gentleman follow the example of Mr. Prentice who looked at the difficulties, which does not mean denying that improvements and benefits can be found? Looking at the problems and concerns today about the failure of productivity would help us to get a better deal for patients. After Mr. Austin, we have yet another party political rant based on the memories of what happened 10 years ago, and that is an entire waste of time. Mr. Blizzard should focus on tomorrow and the issues that we face today and try to make a difference not just to his party.

Photo of Bob Blizzard Bob Blizzard PPS (Rt Hon Douglas Alexander, Secretary of State), Department for Transport, PPS (Rt Hon Douglas Alexander, Secretary of State), Scotland Office

If we want to understand the future, we have to understand the past.

We thought of going to the then Secretary of State, my right hon. Friend Frank Dobson, because he had already intervened in the East Anglian Ambulance NHS Trust, which habitually failed to achieve its target response times. That trust delivered last year the fastest response times in the history of East Anglia.

All the trusts at that time found difficulty recruiting staff because pay was low and the NHS was just not attractive. That was the dismal picture of the Tory NHS that we endured for 18 years. We had reorganisations too and I will declare an interest: my wife works for the health service and she was reorganised and reorganised again. Sadly, she has been reorganised a few more times since this Government came to power, but one of the worst things the previous Government did was split the Great Yarmouth and Waveney district health authority and the natural health economy that shares the same hospital. I am delighted that the Secretary of State put that back together again in the recent PCT reconfiguration.

The transformation today is so great that if I had promised what we have today in 1997, I probably would not have been believed. The cornerstone of our local health service is our general hospital, the James Paget. So much investment has taken place in the hospital that I have no time to list it all. We have had our share of the extra doctors and nurses, a new accident and emergency unit, as I have said, new theatres, intensive care units, maternity units, pathology facilities, eye units, new renal stations, scanners, digital X-ray, and most recently a new emergency admissions and discharge unit, which is helping to make the hospital far more efficient and to treat more people.

Photo of Simon Burns Simon Burns Opposition Whip (Commons)

I am interested to hear the hon. Gentleman outlining all the investment in his hospital, but would he tell the House of his concerns at the east of England strategic health authority review, which has just begun, and comment on rumours that his hospital might face closure or cuts?

Photo of Bob Blizzard Bob Blizzard PPS (Rt Hon Douglas Alexander, Secretary of State), Department for Transport, PPS (Rt Hon Douglas Alexander, Secretary of State), Scotland Office

No; I have given way twice. I am absolutely confident that our hospital will remain a first-class district general, and I will not accept scare stories spread in this House.

The hospital is high quality because it has met every target set for it ahead of time: 100 per cent. of people do not wait six months or more; 100 per cent. of cancer patients are seen in two weeks; 100 per cent. of those diagnosed with cancer are treated in one month; and 98 per cent. of people who turn up at A and E are seen in under four hours. My local hospital has got to grips with MRSA: last year it saw 300,000 patients and had 41 cases. It has had only 14 cases in the past seven months, but it wants to do better. Even its food was given a 98 per cent. satisfaction rate among patients in a recent national survey. That is why the hospital has been a three-star trust for successive years, why it has had no deficit for 2005-06—in fact it had a surplus—and why in August this year it became a foundation trust hospital, joining the other 47 in the country.

I have been calling it the James Paget hospital, but its new name is the James Paget University hospital, because it is now part of the new medical school that was established at the university of East Anglia, which has done so much for the health service in our area, bringing new, young medics whom we can recruit when they qualify.

This year will be a challenge for the hospital, but it is having to make no redundancies and I am increasingly hopeful that all the trainee nurses will get jobs. In another recent national survey, on staff satisfaction, the hospital came 10th among 200 surveyed.

That is a great performance and it has been aided by innovation. I told the House last year about the work of orthopaedic surgeon Mr. John Petri, who carries out dual operating and so has no waiting list. He moves between two theatres and two teams. If hon. Members want to do something for their local health service today, they should ask their hospitals why their orthopaedic surgeons are not carrying out dual operating and getting waiting lists down.

The future is bright for my local district hospital. As a foundation trust and a self-governing hospital, it has £40 million to invest over the next five years on ward upgrades, to enable it to exercise even better infection control, and on upgrades of patient facilities too. Its aim is to be a full district general hospital of high quality. That is what local people want and I am confident that that is what it will remain.

Photo of Bob Blizzard Bob Blizzard PPS (Rt Hon Douglas Alexander, Secretary of State), Department for Transport, PPS (Rt Hon Douglas Alexander, Secretary of State), Scotland Office

No. I have taken two interventions and I get no more extra time.

The purpose of my telling the House about the hospital is that the James Paget hospital shows that a well run NHS hospital can operate within the finances available to it, meet all its targets and deliver quality services without any deficits.

I do not have time to go into so much detail on primary care and community services, but suffice it to say that Waveney primary care trust set out its own "care closer to home" approach before the Government paper, so we see an important role for our community hospitals. The Lowestoft hospital, which faced closure, has had a major overhaul with massive investment, and I welcome the Government's announcement of £700 million more across the country and hope that some of it will come our way.

Many of my constituents in the western part of the area are served by All Hallows hospital. It belongs to a charitable trust and has provided services for many years for elderly NHS patients in my constituency and in south Norfolk. A problem arises, however, when two neighbouring trusts do not move in the same direction, and we have such a problem at the moment with South Norfolk PCT, which is talking about reducing the number of contracts. If it does that, there will be a knock-on effect in my constituency, where the local trust wants to go in another direction, so I hope that we will see greater co-ordination. With practice-based commissioning, I know that local people will want to choose that hospital and that GPs will want to send them there, so with that type of commissioning and the new payments system, we hope we have a future.

As I said, the best thing to happen to primary care in my constituency was the formation again in the recent reconfiguration of a Great Yarmouth and Waveney PCT. That organisation can focus on commissioning the health services that are right for our local area based on local need, working closely with local GPs to serve local people, maintaining that relationship with the local hospital, and getting the funding appropriate to our needs. In mental health, we have brand-new facilities for in-patients. The ambulance service has turned itself around completely, as I said, and I expect it to get a good rating from the Healthcare Commission tomorrow.

What has made the difference since 1997? Obviously, the increased funding, which the Conservatives opposed, has made a great deal of difference, but the other element that has made a difference is targets. The Opposition criticise targets, but if life was so good without targets, why was the NHS such a mess in 1997? I admire medical professionals; I work closely with them and I know that they are dedicated, but they need co-ordination and direction. I do not think that we can simply leave them alone to get on with it.

That raises the question: what is the role of politicians in the NHS? I attended a meeting in Manchester where a gentleman from the British Medical Association kept referring to politicians "meddling" in the NHS. Well, my constituents expect me to meddle in the NHS—they elected me to meddle in the NHS. Every month some of them write to me asking me to meddle in the NHS, and the people who ask me to meddle the most are BMA members—local doctors. They ask me to lobby Ministers to get things done, and sometimes—quite regularly, in fact—it works. If politicians do not involve themselves in that way, people will ask what is the point of voting for them and turnout will fall even lower.

I do not want to hand over the NHS to an independent board. I do not believe that it would be independent or be seen to be independent. Politicians would still get the blame for things that go wrong, but they would have no power to deal with them. I wonder what an independent board would become under the Conservatives. I worry that it would float away in the direction of charges, self-pay, patients' passports, vouchers and all the other principles that we have often heard stated by Conservative Members.

I think that the NHS is safest in politicians' hands because the British people, who cherish the NHS, will punish those politicians who do not look after it, as they did the Conservatives in 1997. Politicians know that. That is why we are committed to the NHS and why the Conservatives just pretend to be. The Conservatives and their newspapers are trying to present a picture of an NHS that is falling apart, but the NHS Confederation has just published a report, "Lost in translation", which points out that when people who have been in hospital are asked about the experience, they say that they had good treatment. Some of them think they were lucky, but they were not lucky; they just voted Labour three times and they now have a Labour NHS.

Photo of John Pugh John Pugh Shadow Minister (Health) 4:18 pm, 11th October 2006

I shall be brief, because much of my thunder has been stolen by Mr. Prentice. I could not better his critique of what is going wrong in the health service.

The main focus of the debate is on NHS planning, or the lack of it. NHS planning is in danger of becoming an oxymoron, like "journalistic balance". Although it is not my habit, I can best illustrate that point using events in my constituency, where we have the usual litany of modern NHS ills, especially in the acute sector. Only this week, we had another ward closure; this summer, we had ward closures, cutbacks and redundancies, not only among support staff, but on the clinical side. All year there has been anxiety about deficits and disputes about their cause and the solution to them. We have seen plenty of management consultants, plenty of hassle and plenty of controversy. Despite all that controversy and hassle, the staff have got on and delivered an exemplary service, but the word "planning" has no place in their world that they can understand. One can plan only when one properly understands the environment in which one is working, and there is no evidence over the past 10 years in my constituency that anybody has been able to do that.

Ten years ago my local trust, which controls two hospitals, tried to deliver a plan—not a very good plan, but it was based on allegedly clinical criteria. It was based on the demands of the medical profession for safety, clinical standards, training capacity and so on. It was deeply flawed. It had children who had suffered any kind of trauma or accident by-passing a fully fledged casualty department, and it was not acceptable to the people of my constituency. It was supposedly and unconvincingly based on the latest recommendations from the royal colleges, but it was at least coupled with a substantial new build investment programme.

However, even before the quoted medical advice had changed and before the plans were allowed to settle down, they were all thrown into the melting pot by the unexpected implications of junior doctors' hours and changed conditions and the European working time directive, none of which hospital managers could do a great deal about. Just as that was heading for a settled outcome, payment by results appeared on the radar, ushering in uncertainty and further turmoil. Management consultants then proposed clinically absurd proposals at variance with all the previous proposals, and the new capital investment under payment by results became a financial millstone. The accountants—McKinsey's, Ernst and Young and the rest—rather than the doctors appeared to be calling the shots.

That was not planning. It was reactive. It was crisis management. It is crisis management, but each crisis is internally generated. The public are left baffled and angry and the politics is messy and at times unpleasant. At the height of all this, there was a blessed moment of sanity in my constituency. The primary care trust, backed by the strategic health authority, took matters in hand, called all the parties together, sat them down and asked simply, "What do people here need? What can people fairly expect to receive?" Genuine consultation took place and for a time real solutions seemed to be in the offing. It was a model of crisis resolution.

Clinical networks were planned, sensible co-operation between all parts of the local NHS was envisaged, including specialist hospitals such as Alder Hey, and a genuinely workable road map was worked out, but then it all got parked. The PCT was abolished, the strategic health authority was abolished, the plans were sidelined, clinical networks were dropped and people were moved on. New financial goals were set overnight, management consultants from outside came in again, politics intruded again and the local NHS was turned upside down again. Financial considerations seemed to dominate over clinical delivery.

Like most trusts in the NHS Confederation, my trust is reciting the current mantra that so many beds and so many nursing staff may not be necessary. People cite figures showing the considerable fall in hospital occupancy over the past decade. However, they omit to tell us that the number of acute beds, as opposed to beds for maternity and the elderly infirm, has not fallen appreciably. We get flimsy clinical excuses for financially based decisions. Looking on anxiously in almost every constituency are the poor public—the citizen, whether ill or well—unable to detect the shape of future services, unsure of what awaits them, and unconvinced of the existence of even a Baldrick-like cunning plan.

As I look back over the past decade, I can detect periods when the concerns of doctors were dominant, periods when the interests of hospital administrators were dominant, and times such as the present when the voice of the accountant and the management consultant is dominant, but I have yet to experience a period in which the voice of the community and the patient is dominant, and I have yet to see an argument against it.

Photo of Patrick Hall Patrick Hall Labour, Bedford 4:24 pm, 11th October 2006

When I was first elected to represent Bedford and Kempston in 1997, a regular feature of my postbag then and for some years thereafter was people asking for help because of the consequences of excessive hospital waiting—the pain, the living in distress and the time off work. Many people were driven to the private sector. If that goes too far, it undermines the principles of the NHS. That is the way it was nine years ago. Today, I hardly ever have such a case brought to me by a constituent. People acknowledge that there has been a real improvement in waiting times. The Conservative party must hope for a national collective outbreak of amnesia on this point if it is to make progress with its claim to be the true party of the NHS.

The Government have even more ambitions than their achievement so far. The plan is that, by the end of 2008, the overall maximum wait in the NHS will be 18 weeks. That is from GP to operation, including diagnostics, and that has never been attempted before. In practice, for many interventions, that will mean an in-patient treatment wait of seven or eight weeks, which will truly revolutionise the NHS.

Photo of Kitty Ussher Kitty Ussher Labour, Burnley

Does my hon. Friend agree that, under this Government, not only will the waiting time become a maximum of a mere 18 weeks, but that in the Conservative years it was 18 months?

Photo of Patrick Hall Patrick Hall Labour, Bedford

It was 18 months and sometimes more, with no prospect of improvement; quite the contrary.

The other aspect of modernisation and improvement of the health service is the switch to primary and community care—accessing health care more at local GP surgeries, local clinics and enhanced pharmacies, and treating people in the home if possible.

Photo of Tim Farron Tim Farron Leader's Parliamentary Private Secretary, Cross-Portfolio and Non-Portfolio Responsibilities

I acknowledge the investment in the NHS and the move towards community services, but the problem is that acute services cannot be operated directly in the community; they need decent sized hospitals that are relatively close to where people live. One consequence of concentrating on specialist hospitals alone is that, in rural areas such as mine, one ends up with the situation such as that at Westmorland general hospital where the medical emergency admissions may soon be shut down because of the drive for the best. The best is becoming the enemy of the good enough. Does the hon. Gentleman accept that we need to ensure that we have safe services that are close enough to people for them to get there in time to survive and be stabilised when they have conditions such as heart attacks?

Photo of Patrick Hall Patrick Hall Labour, Bedford

I did not follow that entirely, but yes, of course, we want a better NHS, if that is what the hon. Gentleman said. If we have more services in the community, that will free up the acute sector to enable it to treat more people more quickly. If people have to go to hospital, they want the prospect of safe treatment without having to wait too long and as locally as possible, although that depends on the nature of the operation that they face.

Not enough has been said about the plans to modernise the NHS. It has not been sufficiently reported. It involves change and change can be difficult, but it is a good news story which, when I discuss it with NHS staff and constituents, is one that they can broadly sign up to, even if it goes under the peculiar term of reconfiguration.

But the context has dramatically changed in recent months, and that context arises from the consequences in Bedford of the Bedford Hospital NHS Trust's £11.8 million deficit. I do not have time to go into why there is that deficit, but it is combined with the Government's decision this year to address the NHS's overall deficit of the last financial year by top-slicing the budgets to PCTs, and the two together have created real pressures. They are short-term financial pressures, but they could lead to up to 200 redundancies at Bedford hospital, although the figure is likely to be significantly less. Nevertheless, it is worrying, and damaging to staff morale, and it will slow up the development of the consequential primary care services that will be needed if there is to be a shift to some extent from acute to primary. Such uncertainty is bad for staff morale and the public do not understand what is happening. They know that there have been improvements and that there is a lot more money year in, year out, but they face difficulties such as they have not experienced for years. That situation provides fertile ground for others to increase people's fears by telling scare stories. In the case of Bedford hospital, the scare stories were started by the Liberal Democrats in The Daily Telegraph on 14 September. The scare tactic involved saying that Bedford hospital is scheduled for closure—a Bedford hospital consultant went on the record to make that point and Bedford and Kempston Conservative party is circulating a leaflet reinforcing the fear of the threat of closure. Let me make my position clear. I totally support Bedford district general hospital as a viable district general hospital. The hospital is not at risk from closure, and it is wholly wrong to whip up fears that it is.

The important issues are more difficult. The serious issues facing Bedford district general hospital are managing the four-year financial recovery plan to eliminate the hospital's debt, changing the shape of local NHS services to improve them for the long term and ensuring that those two tasks are carried out while maintaining a full range of services, particularly the 24-hour accident and emergency service. Those are the challenges in Bedford, and they clearly worry my constituents. We are not helped by fears being whipped up unnecessarily, which goes on day in, day out in my constituency.

There are real problems that we must face up to, so what should we do? First, when changes are prepared and published, there should be a three-month statutory consultation process with which people are urged by all parties to engage on the basis of facts and a measured and informed debate rather than on the basis of scare tactics.

Secondly, the Government must examine RAB, the resource accounting and budgeting financial management system that now applies across central Government. The principles of RAB have supposedly been applied to NHS trusts across the country, which means that, if a trust reports a deficit in one year, its income is reduced by that amount in the following year. That is a double whammy, which is unfair and guaranteed to make a difficult situation worse. Furthermore, the in-year deficit is reported to the balance sheet reserve and carried forward cumulatively. Bedford hospital trust reported an income and expenditure deficit of £8.48 million in 2004-05, and Bedford PCT passed on a reduction in its service level agreement income of that amount in the following year as a result of RAB. However, because that reduction would have devastated the hospital, which would not have been able to pay many of its staff, the trust was permitted to borrow that sum from the strategic health authority. That cash borrowing, which did not appear in the accounts in the normal way, was interest-free, and the sum was to be paid back in the following year. In 2005-06, the in-year deficit was reduced by the trust to £3.41 million, which under RAB should have led to a cut in its income of that same amount in this financial year, but that did not happen, because a deal was done with the SHA.

I hope that Ministers look carefully at the Audit Commission's review of the NHS financial management and accounting regime, which contains a clear and powerful critique of RAB and the labyrinthine system of complex financial devices which dominates, and has always dominated, the NHS. It calls for an end to RAB being applied to the NHS and for a system of much greater clarity and transparency. What is happening to Bedford hospital reinforces the message from the Audit Commission. In one year, RAB was applied, but cash borrowing was allowed to cover the cut, and then it was not applied in the next year.

Some might say that we muddled through and that the situation is okay, but I disagree, because the system is bizarre and confusing, and it perpetuates a culture within the NHS that is not businesslike. If RAB were not applied to the NHS, as proposed by the Audit Commission, which has also made suggestions for improvements, Bedford hospital and other trusts with deficits would still have to address their deficits. We are not talking about just wiping deficits clean and pretending that they do not exist, but at least we could then build on a system that enables clear planning, openness and transparency which more people than just the finance director could understand. The NHS needs that important development, so that it is not just left to the finance director to understand the finances, and so that all elements of a hospital, for example, contribute to financial efficiency.

It is also important to get rid of RAB so that we abolish its cumulative balance sheet feature. That element might not appear to matter, but it will from April next year when the capital funding regime is due to change and an NHS trust's ability to borrow will partly be judged by the state of the balance sheet. Under RAB, while Bedford Hospital NHS Trust should eliminate its deficit within four years, the balance sheet will show the deficit for eight years. That is a wholly ridiculous situation.

Thirdly, we should continue to close the gap between what the health economy in Bedfordshire gets and what it should get in terms of its capitation—the system known as fair funding. Year on year, in Bedfordshire, despite Conservative claims that somehow money is being robbed from Bedfordshire in order to over-fund the north of England, this Labour Government are closing the gap with regard to fair funding. We need, however, to continue that process.

Fourthly, we need a period of stability within the NHS—

Photo of Patrick Hall Patrick Hall Labour, Bedford

I am not going to not say something just because some Conservatives may agree with me. Sometimes, it is important to unite on issues in the national interest. I am speaking up for my health economy and my hospital, and I do not mind at all if Conservatives wish to support me in that. We need stability, because there has been too much structural change. Some welcome reforms, such as practice-based commissioning, the choose-and-book system and payment by results, are about to be introduced, but it is all happening at once. Whatever we do in reform and in government, there are still only 24 hours in the day, and sometimes things get a little too much.

The Government have a good strategic policy for the national health service, which is one of the reasons that Labour got elected in 1997 and has been re-elected twice. We have an exciting vision for the national health service that does not just end now but continues for the decades ahead. At the moment, however, it is to be delivered by a wholly inadequate financial management system, which is undermining delivery and urgently needs reform. I urge my right hon. and hon. Friends on the Front Bench to take on that point with seriousness.

Photo of Simon Burns Simon Burns Opposition Whip (Commons) 4:38 pm, 11th October 2006

I listened carefully to the speech by the Secretary of State for Health. The sheer horror of the situation suddenly came to me when I realised that either she is living in cloud cuckoo land or she is in a total state of denial about what is going on in the real world beyond this Chamber. Like all Members, the Secretary of State has constituents and, I presume, receives correspondence every day from them and the wider public because of her public role. I am amazed that she seems to think that everything is going well in the NHS and that there are no problems.

Equally, it is fatuous for hon. Members, Ministers and others simply to refuse to accept that the previous Government did good things in the health service. Since 1997, this Government have also done good things for the health service. As my right hon. and learned Friend Mr. Clarke rightly said, there is a growing consensus in this Chamber and the country over the national health service—a consensus to which I have adhered from the first day I entered this House—that we should have a first-class health service, based on free access for those eligible to use it and paid for by taxes, except for those areas on the fringes that, historically, have not been free at the point of use, such as prescription charges.

If we work from that basis, we have a golden opportunity—especially given the revenue that the Treasury has been able to glean in the past 10 years because of the economic situation that resulted from the difficult task on which my right hon. and learned Friend embarked on in the mid-1990s and the record amounts of money that the Government have put in, which it would be foolish not to acknowledge—to introduce fundamental reforms to ensure that we get value for money from our investment and that patient care improves. There have been improvements in the health service in the past 10 years, but there are also some significant problems. Because of the lack of structural reforms to improve productivity, we have returned to short-term thinking to try to address the emerging problems.

My constituency has a fantastic local hospital in Broomfield hospital, which has an excellent management team and a first-class, hard-working and dedicated staff. I pay tribute to them, but there are problems because the money that has been made available in record amounts by the Government is not reaching front-line services at the level and in the scope that we would expect. Chelmsford PCT has a deficit of £13 million. To try to overcome that problem, as it has been told to do, two intermediate care wards have been closed completely, so there is now a gap in intermediate care that will have a knock-on effect on the local hospital and, potentially, delayed discharges will begin to escalate again.

We also have a problem with the hospital trust. Some 200 jobs will be lost or not replaced to meet its financial deficit. We also have a nurse training school at the Anglia Ruskin university. Four or five years ago, the Department of Health was trawling the third world for nurses to work in our health service because it was short of nurses. More and more people were encouraged to train as nurses and investment was made in their training, but now that they have those nursing skills there are very few jobs for them. That is a terrible waste of investment, their talents and their potential contribution to improving and enhancing the national health service.

I wish to raise another issue that illustrates the problems of the NHS. Before the last general election, the Mid Essex Hospital Services NHS Trust came up with a brilliant PFI scheme worth £180 million. Chelmsford has two hospitals—Broomfield hospital, which is an old tuberculosis hospital that has been modernised and is now state of the art, and St. John's hospital, which was built in Victorian times and is way past its sell-by date. Contrary to what the Secretary of State said—it did not fit her agenda—there are Conservative Members who support hospital closures when they see the logic behind them. From the outset, I have supported the closure of St. John's hospital, as have the medical staff and my constituents, because the services were to be moved four miles to the Broomfield hospital site. That is the right thing to do when the building is outdated.

The PFI scheme was put together and I fully supported it. It was the centrepiece of the West Chelmsford Labour party's election campaign in 2005—the Government's investment in the health service. I have to hand it to them, because it is a centrepiece that would deliver an improvement in health care. The scheme was ready, it had been validated and approved by the Essex strategic health authority, and it went to the Department of Health in October for final approval. Unfortunately, the Department could not get its act together and, having said that we would have a decision by the end of November and then by the end of the year, it had still failed to make a decision by late January. At that point, the Chancellor stepped in and said that all PFI schemes had to be revalidated, so we were back to square one.

I raised the issue with the Prime Minister in May. I gave him advance warning and, to be fair, he gave an excellent answer, including the hope that

"it will have an optimistic conclusion."

He said that he would look into it and that he could give me

"an assurance that it will go ahead as quickly as possible, once the remaining issues have been sorted out."—[ Hansard, 10 May 2006; Vol. 446, c. 310.]

I was grateful to the Prime Minister for that response, but it is now 11 October, and the plan has not received the go-ahead. It has also been scaled down, to a probable value of £80 million. If it finally receives approval, the hospital will have 200 fewer beds than it has now, and the outcome will not be the tremendous, state-of-the-art improvement originally envisaged.

I wrote to the Minister a month ago, and he kindly replied to me today. The trouble is, his letter says nothing in response to my real questions. If the plan fails and does not get approved, the Prime Minister will look foolish. If that happens, I will feel a bit sorry for the people who briefed him when he gave me the assurances and commitments in May. However, there will also be the knock-on effect that a significant amount of money will have to be repaid if the project falls apart and is abandoned. That money could have been invested in health care and front-line services and used to wipe out the deficits of the Chelmsford PCT and the Mid-Essex hospital trust. I think that the East of England SHA is the cause of the problem. Going to see the people there would be a waste of time, as they would tell me nothing new. The Minister must look into the matter and try and get everyone working together, as quickly as possible.

In conclusion, it would be stupid to suggest that everything is wrong with the NHS at present. It would be equally stupid, however, to suggest that everything before 1997 was appalling. One should give credit where it is due, but Ministers and the Secretary of State must stop patronising the House. The right hon. Lady speaks to hon. Members like a know-all head teacher speaking to naughty schoolchildren. She must accept that there are significant problems with health care delivery in parts of the country, and in certain areas of medicine.

Those problems have to be addressed. I applaud the record amounts of money that the Government have made available, but that money must be channelled towards front-line service and the provision of even better health care. It must not be wasted on bureaucracy and ceaseless reform. We need stability, so that the NHS can get on with providing the finest possible care for all our constituents.

Photo of Andrew Gwynne Andrew Gwynne PPS (Rt Hon Baroness Scotland of Asthal QC, Minister of State), Home Office 4:48 pm, 11th October 2006

I welcome this debate, and am very pleased to be able to contribute to it. I should like to speak about the demands that the NHS faces, and to which it must respond. Demand for a mass health system is not always visible. I have many constituents in parts of Denton and Reddish who need NHS support but who do not actively seek it.

I think that that is the challenge. Of course, the NHS must respond to the demands made on it, but it must also find new ways for those demands to be made, and especially by the most dislocated and vulnerable people in Britain. The debate has moved on from being simply about quantities of investment. Stephen Watkins, the director of public health in Stockport, has written:

"For several years now the Government has been investing very large sums of new money into the NHS. This money far exceeds anything that would have been dreamed of throughout the late 1970s, 1980s, or early 1990s. Those who called for UK health spending to be increased to the European average were dismissed as unrealistic dreamers. In 1996, the BMA said that £6 billion of real new investment was required for the NHS and was attacked by other health organisations for going over the top. In 1999, the Government injected £12 billion of real new recurrent money to start a process of increasing NHS spending to the European average."

He continued:

"With this additional money the NHS has dramatically improved."

That is not a political statement. That comes directly from the director of public health in Stockport and his 2006 public health annual report. Clearly, the level of Government spending was the argument in the 1990s. To solve the problems that the NHS may face in the future requires reform for our changing society.

The Labour Government who took office in 1945 were a response to the demands of post-war Britain. War and sacrifice, both at home and abroad, led to the most demanding British electorate since the emergence of mass suffrage. That electorate demanded that the Government provide a free and first class health service for all throughout the country, and the Labour Government responded. The British people have, of course, changed a great deal since the 1940s. They have become ever-more demanding—my constituents included. Their expectations are much higher and rightly so.

As we look to the future, this will become an increasingly ageing society. The number of people aged 85 and over has grown to a record 1.2 million. That is resulting in ever-increasing demands on the NHS, but also in many more hidden and vulnerable people—sometimes without family support—with whom the NHS must make meaningful contact. As in the past, the national health service must be reformed and expanded to cope with the changes. By 2025, the number of people aged over 85 will have increased by two thirds. Each of those people will need, on average, five times as much care as the average 16 to 44-year-old. An NHS that can cope with those pressures requires both investment and reform. In fact, the NHS's ability to be reformed and to meet the challenges of the day is why it remains one of the most popular institutions in Britain.

During the 1980s and the early 1990s, NHS staff were let down by the Government. During the 1980s, the Conservatives managed to build just one new NHS hospital in Britain. Since Labour came to power in 1997, we have turned that decline around. By 2008, more than £90 billion will be invested in the NHS, in a huge range of services. As a result, the NHS is treating more people and treating them faster than ever before, with treatment free at the point of need and available to all.

Photo of Andrew Gwynne Andrew Gwynne PPS (Rt Hon Baroness Scotland of Asthal QC, Minister of State), Home Office

No, I will not.

Stepping Hill hospital is being rebuilt and Tameside general hospital has been approved for a massive £80 million private finance initiative investment programme. That will include the building of a new state-of-the-art health facility, including an expanded and improved accident and emergency department. The improvements being made to the NHS are, however, not simply a result of investment, but of careful reform. The Conservative party did not want careful reform. Just over a year ago, the Tories believed that the best way to help the people of Britain would be allow the wealthy to pocket NHS money, provided by hard-working families all over Britain, and take it away to subsidise private treatment. That would have left areas in which people have relatively poor health and low incomes, such as parts of my constituency, starved of much-needed funds. The Tories are still at it. Having voted against the extra investment in the NHS, they now want that money to be spent only in their areas, where deficits have accrued. They cannot campaign for more money in public while voting against it in the House of Commons.

Our challenge is to find the most efficient way of providing health care to all, not the fastest way to drain the NHS of funds. If NHS money is better spent caring for people in their own homes than in hospital beds in large general hospitals, that is what should be done. If the money is better spent on specialist units, that is what should be done, and if the money is better spent on an expanded and improved accident and emergency department at Tameside general hospital, that is what should be done—and that is what is being done.

A modern NHS requires a range of different services to provide the best care. If money is taken away from one service, it is not being cut or disappearing. It is being channelled towards a service that is better for more patients. The NHS survives through reform and investment. British society has changed immeasurably. We are living longer, becoming more demanding and expect state-of-the-art treatments when it is convenient for us, and rightly so. The people have not, however, changed their minds about the NHS. My constituents want the NHS. They want the first class state-of-the-art treatments that will soon be provided by the new £80 million investment at Tameside and by the new facilities at Stepping Hill, but they also want the freedom to choose when they want that treatment and whether they would rather stay in hospital or recover, supported by medical practitioners, in their own home. Many of my constituents are not the wealthiest people in Britain—far from it—but they deserve the best possible treatment.

The history of my Greater Manchester constituency is one of change. Denton was famous for making hats. Huge swathes of the population of Denton and Stockport were involved in hat manufacturing, as well as other textile and heavy industries. Today, the people of Denton and Reddish lead different lives, so the NHS must continue to find new ways to make itself accessible to people with varied lifestyles. It has been argued by many that the importance of choice in health care is exaggerated. No; choice in health care is not like choice in shopping—it is much more important than that.

Many people in my constituency—often those in the most deprived areas—are not sufficiently connected with doctors and nurses. Those connections must be strengthened for the sake of both my constituents' health and the efficiency of health provision. If my constituents, some of whom are trying to hold down two or three part-time jobs, cannot choose when and where they and their families access health care, their quality of health and NHS money will be wasted. If a range of times and locations are not available to those in need of treatment and advice, appointments will be missed. When that happens, treatments and advice are not given, medical practitioners are not able to understand further their patients' needs and public money is wasted. Without more freedom, many of my most vulnerable constituents will not access health care and health advice.

The health profile of England maps, which were published yesterday, show the problems that we still face, and I am well aware that my constituents face them every day. Like many northern areas of England, Denton and Reddish has higher obesity rates, more smoking-related deaths and, consequently, lower life expectancies than the English average. Men can expect to live for 74 years and women 79 years, but both figures are lower than the national and regional averages. The goal for the NHS should be to make it as easy as possible for those in need to receive the advice and treatment that they need to the end the health divide.

Under the Tories, the funding for hospitals was skewed towards richer areas, which embedded inequalities. The Labour Government are reforming the system because we believe that the divide is unacceptable. Since my election, I have worked hard in my constituency to ensure that our local PCT and acute services are reforming their provision of care. The Labour record on expanding NHS capacity should not be in doubt. Labour health reforms have been, and will continue to be, changes for the better.

Photo of Tony Baldry Tony Baldry Conservative, Banbury 4:57 pm, 11th October 2006

Various things have happened in the NHS in the past year. The crisis involving deficits affected many NHS trusts and demonstrated itself through the closure of many community hospitals, or, in my constituency, the non-opening of a new community hospital, which Mr. Milburn had promised from the Dispatch Box when he was a Health Minister. He said that we would have a new and enlarged community hospital in Bicester, but that has not happened and clearly will not now happen. The Secretary of State's speech gave us no explanation of why the Government have suddenly turned their back on community hospitals.

We are now moving towards another trend of downgrading so many services in smaller general hospitals that they effectively cease to be general hospitals. Such a thing is proposed and threatened for the Horton general hospital in Banbury. The hospital serves a large catchment area—much of south Northamptonshire, much of south Warwickshire and west Oxfordshire—which is why today my right hon. Friend Mr. Cameron, my hon. Friends the Members for Stratford-on-Avon (Mr. Maples) and for Daventry (Mr. Boswell) and I have submitted a joint observation to the Oxford Radcliffe Hospitals NHS Trust. If hon. Members want to read it in full, it can be found at www.save-our-services.com. The important point is that we say:

"We believe that the Oxford Radcliffe NHS Trust, the Strategic Health Authority and the Government should be seeking to ensure that we can keep the Horton as a General Hospital delivering all the clinical and medical services that one would reasonably expect a local General Hospital to deliver", which seems not unreasonable.

The tragedy about the proposals is that they are not a consequence of the trust saving particularly large sums of money. In fact, over a full year, the trust would save only some £1 million to £1.3 million, which is between 0.25 to 0.5 per cent. of the total Oxford Radcliffe Hospitals NHS Trust budget. If the trust, the strategic health authority and the Government had the will, they could find those savings elsewhere in the trust budget without leading to a significant downgrading of services at Horton general hospital—a downgrading that will have a major impact on local people.

The downgrading starts with the downgrading of paediatric services. The sadness of the matter is that long ago in 1974 a young boy from Bloxham, a village just outside Banbury, died. The then Secretary of State, Barbara Castle, ordered an independent inquiry that found that there should be 24/7 paediatric services at Horton general hospital to serve the wider catchment area. Under the proposals, we will effectively go back 30 years to the period before Barbara Castle's decision. The knock-on effect of not providing 24/7 paediatric services is that one can no longer provide obstetric services, because there is no special care baby unit, yet we are proposing to set up the largest midwife-led maternity unit in the country.

The consequence of the proposals is that 58 GPs—I hope that the House takes note of that number—have collectively made a submission to the Oxford Radcliffe Hospitals NHS Trust, in which they say in excoriating terms that the proposals are unsafe and inhumane. The GPs make excoriating criticism, too, of the fact that the consultation has been carried out with total disregard for any medical or professional consideration:

"Local services for children are the key issue around which many other services hinge. They have a significant impact on the viability of other hospital departments especially maternity and accident and emergency.

It is evident that paediatric emergencies such as meningitis, septicaemia, respiratory distress, and serious poisoning may all incur dangerous delay in receiving appropriate care if the nearest paediatric department is an hour away.

Serious, life-threatening illnesses do not confine themselves on the working day."

On maternity services, the GPs say that

"under the proposals, mothers who required unexpected medical care during birth would need rapid transfer to Oxford...This would carry significant risk and would be inhumane."

Even on the trust's own figures, a very large number of mothers who elected to have their babies at the Horton hospital would have to move to the John Radcliffe hospital in Oxford during labour. That is wholly unacceptable in the 21st century.

The issue is of concern to all political parties locally. Indeed, the "Keep the Horton general" campaign, under the excellent leadership of local Labour councillor George Parish, is supported by people from every single political party. Thousands of people marched through Banbury and rallied in the local parks in support of the issue, which is a completely cross-party concern. It is not surprising that, without dissent, Cherwell district council, said:

"The proposals in the consultation document potentially put patients at risk, fail to deliver the aims of the ORHT"— that is, the Oxford Radcliffe Hospitals NHS Trust—

"are contrary to current Government Policy, place an unnecessary cost burden on the local population and in no way meet the needs of the local community now or in the future, as such they are wholly unacceptable to this Council."

They are also wholly unacceptable to the people whom the Horton general hospital has served for the past 150 years. Local people are determined to do everything they can to ensure that the Horton hospital remains a general hospital.

I also hope that Ministers will recognise that the Oxford Radcliffe Hospitals NHS Trust has failed to carry with it any medical opinion. GPs can speak publicly, and they have done so collectively. But another concern that I wish to draw to the attention of the House is that many of those who work for the trust have felt unable to speak openly because of potential disciplinary and other pressures. During the summer I had a number of meetings with consultant specialists at the Horton and the trust, but they wanted to have them away from the hospital, and in private. I asked them, "Why on earth are you unwilling to speak on the record?" They replied that they feel that they would be discriminated against as a consequence. That is wholly unacceptable. The last time I had meetings of that kind was when I talked with dissidents in eastern Europe before the fall of the Berlin wall. That should not be happening when people are talking about reorganisation of general hospitals in the 21st century.

The proposals will lead to the downgrading of an excellent general hospital to such an extent that it will no longer be a general hospital in the way that people understand what a general hospital is; it will be merely a collection of medical services. The proposals are completely friendless and completely unsupported by medical opinion locally.

I very much hope that in due course the overview and scrutiny committee of Oxfordshire county council refers the proposals to the Secretary of State, and I hope that the very least that the Secretary of State will do is refer them to the Independent Reconfiguration Panel. But I would also hope that before then Ministers will have the nous to wake up to the fact that 58 GPs are opposed to the proposals; there is not a single dissenting GP in the entire area served by the Horton general hospital—there is not a single voice supporting the proposals. In the face of such widespread medical opposition, it might be sensible for the Department to intervene, and to suggest to the Oxford Radcliffe Hospitals NHS Trust that it should think again about this matter and seek to ensure that we keep the Horton general a general hospital.

Photo of Kitty Ussher Kitty Ussher Labour, Burnley 5:07 pm, 11th October 2006

I welcome the opportunity to speak in this debate. I also welcome the fact that the debate has been secured on an Opposition motion because there are a number of questions that the Opposition need to answer about their policies and their record, and the public should hear those answers. Therefore, I have a number of questions for them.

However, let me first talk about our record. As we have heard, NHS spending under this Government has trebled after inflation, from £30 billion to £90 billion.

Photo of Kitty Ussher Kitty Ussher Labour, Burnley

No, it has trebled in real terms. I thank the hon. Gentleman for his sedentary intervention, but it will very shortly have trebled in real terms. The number of doctors has risen by 32,000 and the number of nurses by 85,000. We are also meeting our targets on waiting times—we no longer have the shame of front-page headline news of horrific waiting times stretching on for years.

All of those are points of process. The desperately important issue, which we are not hearing about from the Opposition Benches, is that the survival rates and outcome rates are improving. That is what really matters. Under this Government, if someone has a heart attack, they are one third more likely to survive than they would have been under the Conservative Administration. People are also seven times more likely to survive cancer. People are living longer because of the changes that we have made, and will continue to make, in the NHS.

Photo of James Gray James Gray Conservative, North Wiltshire

The hon. Lady is making an interesting point, but would she accept the following two points? First, at least part of that greater survivability comes about as a result not of the Labour Government, but of developments in medical science that would anyhow have extended our lives, and secondly, even so, our survival rates are significantly lower than those of the whole of the continent of Europe.

Photo of Kitty Ussher Kitty Ussher Labour, Burnley

It will not surprise the hon. Gentleman to learn that I do not accept his argument. I agree that medical science advances, but that is because we fund medical science; it produces drugs that cost money, and we are spending the money. It is not inevitable that survival rates improve. Mortality rates are rising in some countries and I am extremely proud that we are not one them, because of the work that Labour Members are doing.

Photo of Greg Clark Greg Clark Conservative, Tunbridge Wells

Can the hon. Lady name a continental European country where mortality rates are actually rising?

Photo of Kitty Ussher Kitty Ussher Labour, Burnley

I do not know the figures for every country, but I am happy to talk to my colleagues on the Public Accounts Committee about this issue later.

How have we achieved these improvements in outcomes in the NHS? There are three factors, the first of which, of course, is the money. It is not by chance that these improvements have happened. On listening to some of the contributions from Conservative Members during this debate, one would think that we have somehow magically profited from benign economic circumstances and that, had they been in the same situation, they, too, could have done it. It is our economic policies that have led to this situation, but most importantly, we raised taxes, which Conservative Members opposed, to do it. This is not chance—it is deliberate action.

The second way that we have achieved our outcomes is by setting targets. We have not just thrown money into the system—the Government have sent an extremely clear signal about what we want devolved management to spend that money on. I hope that the Conservative Front-Bench spokesperson will say later which of those targets they would cut, given that they are on record as saying that they would do so. Would they cut our target of a mere 18 weeks from GP referral to actual operation—down from 18 months under the previous Government? Would they cut our target of seeing accident and emergency patients within four hours, which is practically being met, I am proud to say, in my constituency? Would they cut our target to have urgent cancer cases seen by a specialist consultant within two months, which I believe is also largely being met in my constituency? We need the answers to those questions because these are the issues that matter to the public; yet the Conservatives say that targets do not matter to them.

The third reason why we have achieved improved outcomes is, yes, reform and change: doing things in a better way than we have done them before. We can all debate the individual issues in particular constituencies, and it is right that we keep the pressure on to make sure that we get it right in our own areas. I support the efforts of my hon. Friend Mr. Prentice in that regard, and I will join him tomorrow to ensure that we get our local overview and scrutiny committee to refer to national Government the decision to downgrade Burnley general hospital A and E.

My question to the Opposition is this. You say that you oppose reconfigurations. Let me put this to you. What would you do if that reconfiguration was leading to better value for money for the taxpayer?

Photo of Sylvia Heal Sylvia Heal Deputy Speaker

Order. I should remind the hon. Lady that I just sit in the Chair; this has nothing to do with me. The parliamentary term that she wants is "Opposition Members".

Photo of Kitty Ussher Kitty Ussher Labour, Burnley

I stand corrected, Madam Deputy Speaker; thank you very much.

What would Opposition Members do if the reconfiguration that they oppose on principle led to better care and better value for money?

Photo of Kitty Ussher Kitty Ussher Labour, Burnley

I have given way several times and I am afraid that I do not plan to do so again.

What would Opposition Members do if changes in technology and in the way that services are delivered and hospitals run meant that more people were likely to survive? If new technology meant that it was possible to visit people in their own homes and give them the care that they need there, hypothetically speaking there would therefore be fewer beds locally. Would they oppose that, as they have said they would?

We have achieved better outcomes for our constituents throughout the country, and longer life expectancy and better mortality rates, particularly in respect of cancer and heart disease. We will continue to achieve that by investment, by putting up taxes—the Conservatives opposed that—by setting the clear targets that they also oppose and say they would scrap, and by reform, which we clearly need to get right.

I look forward to the Conservative Front-Bench spokesperson's contribution, because the public have some questions that need to be answered. I am grateful for this opportunity to put those questions, and I think that the public will see through, as I do, the attempt of Conservative Members—

Photo of Steve Webb Steve Webb Liberal Democrat, Northavon

Will the hon. Lady clarify her position on the important decision being taken in her constituency about local accident and emergency services? Who should make it? Local people or somebody in Westminster?

Photo of Kitty Ussher Kitty Ussher Labour, Burnley

On the whole, it is right for local trust managers to make decisions in their local area, but it is extremely important that the democratic system be made to work, so that where there are serious concerns about whether something is right the decision is referred to national Government and the Secretary of State. That is very much what I hope will happen. I would support other overview and scrutiny committees that took that view.

We are seeing a callous attempt from the Opposition to try to hoodwink the public that they care about an institution that the public rightly hold dear. We have heard nothing today to make us believe that the Opposition have policies that could make the serious and sustained difference that Labour members and our Government have been making for more than a decade. I look forward to hearing the Opposition's response to the debate because I do not think they have answers to the questions we are posing.

Photo of Richard Taylor Richard Taylor Independent, Wyre Forest 5:15 pm, 11th October 2006

I have been looking forward to this moment for a long time. I shall start by offering advice—freely given and well meant—to the Government and in the second part of my speech I shall offer advice to the Government and to the Tory Opposition.

First, what does service development mean? To me, it means improving and updating the service for the good of the patient: not for managers, not for staff, not for politicians, but for the patient. In the past 25 years, 28 reforms of the health service have been carried out by Governments of both colours. They were well described as debilitating changes by Mr. Prentice, and they were decried by Patrick Hall and by Mr. Clarke, so I shall not spend much time on them.

The crucial thing is hospital reconfiguration, which obviously strikes fear in the heart of many MPs because of what happened in Kidderminster so long ago. If anyone knows how not to set about reconfiguring hospitals it is me, so I offered the benefit of my advice to the chief executive of the NHS, whom I know vaguely. I thought that I would receive no reply, but this morning I had a letter from him saying that he would like to arrange a meeting. So it seems that he wants to take my advice, which is superb. Perhaps the Government realise that as an Independent I am not automatically against them all the time and that sometimes I can help.

There are signs that the Government are beginning to remember the lessons they have learned since Kidderminster. We have heard much about overview and scrutiny committees today and a little about the independent reconfiguration panel, the crucial body set up by the Government to ensure independence in the reconfiguration process and to take it out of the political arena. It is essential that they use the panel.

The Government's record so far is pretty abysmal. Until March, there had been eight referrals from OSCs to the Secretary of State, but only one to the panel. Yesterday, other members of the all-party local hospitals group and I met the chair of the IRP—a tough, no-nonsense GP from Nottingham—whom I would back as thoroughly independent. We heard several things. Perhaps the Government's record is improving slightly—there have been 18 referrals to the Secretary of State and four have got through to the IRP. Furthermore, we heard that the panel has the promise of money so that it can expand to cope with the work as it comes in. The Government have realised the importance of that and in this day, when there appears to be no money for anything, there appears to be money for this absolutely vital panel. I hope against hope that we now have the proof that the Government are beginning to listen and to realise that using the independent reconfiguration panel will take the politics out of it all. It is no good having the Government tsar for emergency services come up with an independent review. With all respect to the Government tsar, he is paid by the Government and cannot really provide an independent view, yet having such a view is crucial.

In the document, "Keeping the NHS Local", the Government showed that they were learning lessons about consultation. For example, it states that consultation

"with patients and the public, and with staff, needs to begin right at the outset—before minds have been made up about how services could or should change."

One of the document's core principles is

"developing options for change with people, not for them."

Even the Secretary of State—I am sorry to put it like that—was reported in The Guardian on 20 September as saying:

"The exact configuration must be determined locally by clinicians, ambulance staff and patients".

That is brilliant—no mention of managers, executives, the Government or politicians, but only of

"clinicians, ambulance staff and patients", which is exactly how it should be. I only hope that the Government will stick to that.