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Mr. Purchase: I am loth to interrupt my hon. Friend's interesting saga, and no one will feel anything but sympathy with the proposition that all possible measure must be taken to prevent fatal tragedies, but she predicated her remarks on the fact that the Treasury has a surplus of £23 billion. I may be mistaken--it would not be unusual--but that revenue has been accrued by different means. Some of the means were planned, and some were

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accidental or fortuitous windfalls. When the £23 billion has been spent on recurring expenditure, will my hon. Friend say what we should do for an encore?

Ms Abbott: I shall put my hon. Friend out of his misery. I am not saying that we should spend the £23 billion on renovating transport in London. I am arguing that the Government's PPP, which so resembles that used in the privatisation of British Rail, will mean that more Government money will have to be given in subsidy to private contractors. The Government do not draw attention to the fact that the Treasury is prepared to put in more public subsidy simply to bolster its stubborn insistence that only its preferred PPP option will do. My hon. Friend may rest assured that I am not attempting to lay a finger on the £23 billion, but my remarks about the future of London Underground had to be put in the context of public spending policy as a whole.

Mr. Purchase: I understand.

Ms Abbott: As I said, successful and positive negotiations had been held between the Department of the Environment, Transport and the Regions and the mayoral representatives when the Treasury stepped in at the last minute and said, "Our way, or the highway." Some token concessions had been made: Mr. Kiley will sit on a few more boards and will have the theoretical power to remove the chiefs of some of the privately contracted infrastructure companies. Those contractors have squealed about the concessions, but the fundamental issue--of unified management control of repair and safety issues--remains.

The excitement of today's Budget speech will die away, and a general election is expected in the spring. Londoners will focus as never before on what one of the most successful Chancellors in Labour party history has chosen to do with regard to transport in London. My right hon. Friend the Chancellor appears to have obstructed a constructive conclusion to negotiations on the future of public transport in the capital.

No one is asking the Government to spend a penny more on transport in London, and no one excludes the use of private investment. However, Londoners, the Mayor and the transport commissioner are all saying that there is a better, cheaper and safer way to structure transport in London. Londoners have made their preference clear over and over again. What is the point of devolving power to Londoners if the Treasury insists on retaining power at the centre when it comes to the most important element of London's economic regeneration? The Treasury is blocking the expressed will of Londoners, and of their Mayor and transport commissioner. When the glitter of today's Budget, with its masterfully presented cascade of tax credits, has faded from Londoners' memories, people will focus on the question of transport and the Treasury's insistence on its PPP model.

I have sat through Budget speeches in this Chamber over the past 14 years, and I know better than to jump to conclusions about how a Budget will turn out until I have studied its fine print. However, I can tell hon. Friends on the Treasury Bench that Ministers must be seen to act in good faith on the future of the London underground. They must not act in a partisan and arbitrary way.

The new Ken Livingstone scoured the world to find the best public transport manager, and he found Bob Kiley. Mr. Kiley is not some terrible left winger: I understand

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that he used to be a member of the CIA. That must surely endear him to Conservative Members, although some of us are worried that he may have seen our files. None the less, my hon. Friend the Member for Brent, East, the Mayor of London, went out of his way to find the most technically proficient, experienced and successful manager of public transport in the world.

Londoners have chosen their Mayor; he has chosen a transport commissioner. Londoners are not asking the Government for more money; they are asking them to put aside past animosities, grudges and stubbornness. They are asking the Government to put the interests of Londoners first and allow these negotiations to come to a successful conclusion--so that there is a way of financing the long-desired renovation and upgrading of the London underground that sits with the desires of Londoners and of London's transport commissioner.

6 pm

Sir Raymond Whitney (Wycombe): The hon. Member for Hackney, North and Stoke Newington (Ms Abbott) says that she speaks for herself and her constituents, and I am sure that the House would agree wholeheartedly with that. She certainly does not automatically seek the approbation of the Chancellor of the Exchequer or any other Member of her Front Bench. She talks about her details being held on file, but I suspect that the Labour party's headquarters at Millbank is more likely than the CIA to have a large file on her.

My right hon. Friend the Leader of the Opposition, in a brilliant reply to the Chancellor of the Exchequer, quoted, among other things, what the chairman of the general practitioners committee said about general practice being in crisis. We all know about the state of the health service in general from our local hospitals and consulting practices. Over the last quarter for which the figures are available, the waiting time between seeing the GP and hospital treatment has increased to 203.8 days--about seven months. Such a long waiting time would be incomprehensible and inconceivable in any equivalent industrialised country. It is on the state of the national health service, and the Government's attitude to it, that I wish to dwell.

The Chancellor of the Exchequer exultantly announced that over the next five years, health spending would increase by something like 50 per cent. However, that betrays either ignorance or a wilful determination not to understand the size of the problem. If we increased spending by 50 per cent. over the next five years, where would we be? Our health spending would still be £200 to £300 per head less than Germany's. We might just be at the level of the spending in France this year.

Over the next five years, health spending in France, Germany and all the other industrialised countries will not stand still. The gap will widen--indeed, it has been widening steadily over many years. Those countries spend so much more, and the Chancellor's proposals will not close the gap. Even those proposals, as the IMF has warned, represent a danger to our national finances. The right hon. Gentleman is sailing very close to the wind.

That issue underlines the need for new thinking in the structure of the national health service. I have been speaking about this ever since I was a junior Health

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Minister in the mid-1980s. We must go right back to the creation of the national health service to understand the extraordinary blight on thinking that this extraordinary institution has imposed on politicians of all parties.

The creation of a national health service, with its wonderful concept of health care free at the point of delivery, was an ambition shared by all the three major parties from before the first world war. The basic structure that was adopted in 1946 and put in place in April 1948 was based on the White Paper of 1944 introduced by Henry Willink, a Conservative Health Minister in the wartime coalition Government. Sadly, the idea of having everything free at the point of delivery was a flawed one.

Aneurin Bevan has been glorified as the architect of the health service--a highly contentious proposition. Yet only months after the creation of the national health service, even he complained about the


In 1950, he wrote to the Cabinet:


That is precisely what happened.

In 1949, the principle of totally free health care was abandoned, with the introduction of prescription charges. Bevan, with reluctance, went along with that. Two years later, when this fundamental problem was being revealed so that no one could deny it, and the Labour Government of the day introduced charges for spectacles and dentures, Mr. Bevan resigned. That was when he described the Chancellor of the Exchequer, Mr. Gaitskell, as a desiccated calculating machine.

Mr. Eric Forth (Bromley and Chislehurst): I am following my hon. Friend's analysis with fascination. I am sure that he is aware that quite recently the French health service was rated as the best in the world by a comprehensive and impartial survey. I know that he will be aware that French people pay when they go to their GP and are then refunded if appropriate, according to their level of income. In connection with his analysis of the development of charges post-Bevan, does my hon. Friend not think that that is an idea that any thinking person should consider?

Sir Raymond Whitney: My right hon. Friend will not be surprised to learn that that is precisely the path down which I hope to proceed, if you will allow me to, Mr. Deputy Speaker. I am sure that we shall arrive at a joint conclusion.

After that, matters were very clear. Eventually, even the British Medical Association, normally the most conservative body involved in the development of medical care, decided that something had to be done. In 1970, it set up a committee under Dr. Ivor Jones, which concluded that the wonderful ideal of 1946 was unattainable and unrealisable, given all the pressures that were growing in health care.


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