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6.36 pm

Mr. Stephen Dorrell (Charnwood): The comments that I shall make follow on neatly from the first of the two points made by the right hon. Member for Birkenhead (Mr. Field). The question that I put to the House is simple: why is the Bill creating so little interest among those who share the broad vision with which the Secretary of State concluded his speech and which the right hon. Member for Birkenhead endorsed?

No Member can doubt that health policy is an issue of concern to the great majority of voters. The Secretary of State's claim for his Bill was certainly not understated. He said that it represented the most fundamental reform of the health service since its foundation more than 50 years ago. If we are dealing with a subject of intense political interest, and the Secretary of State claims that his Bill is the most fundamental reform of the service for more than 50 years, why is there a deafening silence outside the House in the public reaction to the proposals he claims are so radical?

Any dispassionate observer looking at the comments on health politics would recognise that there is the occasional dutiful editorial, usually the second or third editorial in the broadsheets on a quiet news day. Even the

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Health Service Journal has found it impossible to limber itself up to care about the Bill. That is true whether the views expressed are in favour of the Bill or against it. The speeches we have heard so far have not roused passion for or against the Bill. Why is it that a Bill which focuses on an issue of major political import, and which the Secretary of State believes is a major radical reforming Bill, arouses almost no interest in the health service or outside it?

The answer is simple—the voters understand something which they fear the politicians do not, namely, that the problems of health care delivery in a modern society will not be solved by further administrative reform of the NHS. God knows, we tried it over 30 years. Sir Keith Joseph invented district health authorities, area health authorities and regional health authorities; Patrick Jenkin abolished area health authorities; Norman Fowler introduced general managers; my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) introduced trusts and fundholders; my right hon. Friend the Member for South-West Surrey (Virginia Bottomley) reorganised social care; and I played a modest part in the process by abolishing family health services authorities. The Secretary of State is reinventing district and regional health authorities. That is an abridged version of the process of administrative reform to which we have subjected the NHS over the past 30 years.

None of those reforms, whether sponsored by my right hon. Friends or by Labour Members, was as bad as people feared, but none delivered the results claimed for them when they were advocated. The voters do not care about the Bill because they know that reforms, as they are introduced and sponsored by the politicians, will not deliver what is claimed for them. People already understand that simple bureaucratic change will not deliver the social policy objectives that we all have for health care.

The Secretary of State identified in his opening remarks the right staring point for genuine reform of the health service, which is not yet another administrative change. He correctly said that, if we are to deliver our social policy objectives on health, we must understand how to deliver a health system that responds to the needs of consumers who have grown used in the rest of society to a different model for the delivery of services that are important to them. They have grown used to a world in which institutions must be customer, client and consumer responsive, and which faces in a way that the NHS has never yet learned.

The Secretary of State was right to emphasise in his NHS plan the importance of considering service delivery from the patient's perspective, but we cannot really be thinking about health care and social care delivery from the service user's perspective when the anomalous distinction between them still remains at the heart of our delivery system. That was pointed out by the hon. Member for Wakefield (Mr. Hinchliffe), with whom I do not always agree on health service issues.

I understand the bureaucratic distinctions that people draw, but in over four years as a Health Minister I never met a single 80-year-old who understood the difference between health care and social care, except to the extent that people understood jolly well whether those had to be paid for. That is the only difference for the service

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recipient, and it is the bigger problem of health care delivery caught in microcosm. How to deliver a health care and social care system that responds to patient wishes and grows in response to them, and how to pay for that, lie at the heart of genuine NHS reform. The voters are well aware of that and they think that the political class is in denial.

The Bill is a good example of the political class being in denial and its central message is that the health service will continue as before, although the bureaucracy will change. That has been the NHS message for 30 years. There is a disconnection because the voters know that, sooner rather than later, the model we have sought to deliver must be addressed more fundamentally. They agree with the Secretary of State, as I do, that the social policy objective must be to deliver health care on the basis of clinical need without regard to the patient's ability to pay, but they know, although the right hon. Gentleman is not willing to acknowledge it, that the service is not responsive enough and that it will not become so through such bureaucratic change.

The Secretary of State, like me before him and like all previous Secretaries of State, denies that people go private because they think that their capacity to pay will deliver better health care. All Secretaries of State know, as the World Health Organisation pointed out earlier this year, that other countries have found ways to harness the patient's willingness to pay with the social policy objective of equity of access. They also know that the NHS is underfunded and that the Chancellor or the Prime Minister saying that they can solve that problem through the tax system is the equivalent of the tooth fairy.

We in the House are in danger of being disconnected from our voters because we are in denial about truths that they recognise while we are unwilling to do so. Until we address those issues head on, we shall not earn their trust or respect.

6.46 pm

Siobhain McDonagh (Mitcham and Morden): I shall make a general contribution to the debate. I welcome the Government's continuing commitment to reforming the national health service to make it more efficient and more responsive to the needs of its users. The NHS remains a proud achievement of the 1945 Labour Government—perhaps the Administration with whom this ambitious Labour Government identify most closely.

The very existence of the NHS is one reason for my joining the Labour party 25 years ago. I am proud to be here to witness its reform and renewal as an organisation that is equipped for the challenges of modern health care and modern management and striving for equality of health care across our country. I hope that, in 50 years, our successors in the House will be describing the NHS, with equal enthusiasm and an equally protective instinct, as one of the best public services that this country has to offer.

However, that is not to say that any of us, least of all the Secretary of State, is blind to the problems that the NHS has faced for much of its existence. My constituents in Mitcham and Morden have recently had to bear the worry and stigma of their local hospital trust, Epsom and St. Helier, being criticised by the Commission for Health Improvement over the quality of services it provides.

Those failings are being addressed, but for a long time they were not news to people in St. Helier, Ravensbury or lower Morden, who tried endlessly to explain the

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problems but who were endlessly ignored. I know that my constituents will welcome the Government's reforms, provided that they have a tangible and visible effect on their hospital and give them a stake in the way it is run.

Members on both sides of the House know NHS hospitals at first hand or through the experience of elderly parents, children or friends. We all know that hospitals need to be improved and that a variety of causes hold that back. I remember when the unions were blamed for the ills of the NHS, but these days the public-private partnership has begun to be used as a catch-all scapegoat for whatever problems it faces.

Both those points of view have more to do with dogma than reality. Dogma never delivered a baby, found a cure for cancer, provided a modern hearing aid or helped people to rebuild their lives after the devastation of a stroke. We must stop considering the NHS through the prism of the past and, as modernisers and pragmatists, must work to a better NHS for everyone—all the people who have a right to decent public health care and who are not concerned about who builds the hospital, as long as someone gets on and builds it.

The people of this country expect us to crack on with building hospitals, operate existing ones to the highest standards possible and, where appropriate, reopen defunct cottage hospitals across the country as intermediate care facilities to provide step-down beds and ease the colossal pressure on larger acute hospitals.

For example, I would like the Wilson, which was once a very fine cottage hospital serving the community in Mitcham, to reopen. For some years, it has been used as offices by Merton, Sutton and Wandsworth health authority, so where there were once beds there are now desks and filing cabinets. Equidistant between St. Helier and St. George's hospitals, the Wilson could ease the pressure on the acute beds in both. People would strongly support opening a large number of such dormant facilities to ease the pressure on acute hospitals and care for the elderly.

In recent decades, the NHS has been hamstrung by a lack of resources and a lack of vision for its future, particularly in the bleak, bleak Tory years when it seemed to many that people were being forced to accept a poor, chaotic health service although, as patients and as taxpayers, they had every right to expect much better. We faced a mountainous task in May 1997, and four and a half years later we are still on the lower slopes.

A right hon. Friend of mine once said that we had 24 hours in which to save the NHS. Sometimes, when I receive letters from constituents who have had an appalling time in hospital, who have waited upwards of 12 months to see a consultant, or who must put up with ill-fitting temporary analogue hearing aids when their lives could be transformed by digital aids, I feel that 25 years might be nearer the mark.

The long struggle that we all face, in government or not, is the struggle to restore the diminished confidence in the health service, modernise its delivery to our people, and reform its structure so that it can offer a much more patient-focused service. We must invest heavily in hospitals throughout the country, so that everyone has access to health care they can trust at the time when they need it.

I was pleased to read the ambitious proposals in the document "Shifting the Balance of Power within the NHS—Securing Delivery". I am glad to note that they

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have been translated into effective legislation in the Bill. I welcome the creation of a national patients organisation and an overarching professional regulatory body, both of which will ensure greater protection of the rights and dignity of patients. It is entirely right for the people, whether they are patients or not, to have a voice—I hope it will be a loud voice—in decision making in the NHS.

Provided that they are adequately resourced and listened to, I also welcome the proposals for patients forums. I am glad to learn of the role they will play in gathering and reporting on the views of patients and carers about the services of trusts, giving patients and carers advice and information about those services and monitoring their operation. I am also pleased that there has been a far greater acknowledgement than ever before of the selfless role played by carers in delivering health care. That role has been ignored for too long.

In the context of regulation, I welcome the creation of more independence for the Commission for Health Improvement. Strong and effective links with other key bodies, including the Commission for Patient and Public Involvement in Health and the national patient safety agency, will be essential to ensuring a thorough and co-ordinated approach to monitoring and regulation. The case for inspection and regulation is strong. In the 20 months of its existence the CHI has published reviews of more than 50 trusts, and a further 50 reports will come before April. That will mean that more than 70 per cent. of acute hospitals have been reviewed.

The CHI has shown that it will be brutally honest when it identifies unacceptable patient care, as it has at St Helier hospital which serves people in my constituency. It has, however, been full of praise for hospitals that are succeeding—for instance, the North Tees and the Royal Devon and Exeter hospitals.

Patients know that such extremes exist in the health service. Sadly, they are to be found in every public service. It is important that the CHI reflects the reality experienced by patients; it is also important that it can say when an ailing hospital has turned the corner. I very much hope that that will be possible in my constituency. We are talking about a fundamental first stage in the rebuilding of public confidence in the services on offer there.

In the NHS, there are signs of improvement as a result of the CHI's work. The better trusts are putting their houses in order before its visits, and patient care is better as a consequence. But what of trusts that are dragging their heels, or simply have not the capacity to improve? At present, a CHI report is followed by an action plan written by the trust and overseen by the NHS regional office. That is all very well, but the CHI has no role in revisiting the trust for four years. When it finds quality to be unacceptable or there is a failure in management, it must be able to visit again much sooner, and must be able to require the trust concerned to take remedial action before its next visit. Those are the special measures of which the Bill speaks, and I think they are entirely justified if we want a more accountable, patient-focused NHS.

The CHI has shown itself to be equal to the task it has been given. The wider remit conferred by the Bill constitutes a recognition of that, but the Bill also gives the CHI the teeth it needs to deal with the difficult minority of hospitals that are failing patients to such an extent that they need further action and support in order to improve their care.

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Moves towards a patient-focused NHS and the tackling of health inequalities are entirely laudable, and many of my constituents would say it was about time such things happened. It is clear to me, however, that further reform will be needed in terms of patients' dealings with their GPs. I believe we have a duty to provide measures ensuring that patients cannot be removed from their GPs' lists without reasonable cause, and that they have the right to a fair and open explanation of a GP's reasons for taking any such action. I also feel that the current system of health charges should be revised to ensure that no patients are prevented from obtaining essential health care. That must be a fundamental plank in the eradication of health inequality.

I support the Bill's aims, and hope it will enable the Government to make significant progress in their mission of NHS investment and reform. I know that significant progress is what the people of Mitcham and Morden want, whether they are visiting their GPs or their local hospitals.

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