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9.16 pm

Mr. Andrew Mitchell (Sutton Coldfield): It is always an enormous pleasure to follow the right hon. Member for Birkenhead (Mr. Field), and never more so than tonight; he makes a thoughtful contribution to welfare and social affairs issues. He spoke about the two towering performances that the Chancellor has already given this week; I hope that that did not include the one that he gave tonight. I hope that the whole House agrees that the speeches of the right hon. Member for Birkenhead and my right hon. Friend the Member for North-West Hampshire (Sir G. Young) elevated a debate which sank following the scintillating performance of my right hon. and learned Friend the shadow Chancellor.

The right hon. Member for Birkenhead made two points on which I should like to comment. First, he is right that the lack of doctors and nurses is at the root of our problems; we need to recruit far more of them to the health service, and I shall return to that later. Secondly, to paraphrase the right hon. Gentleman, he said that politicians tamper with the NHS, a much-loved British institution, at their peril. I profoundly disagree that the time is not right for a proper elevated debate on the future of the NHS; the system simply is not working at the moment, another point to which I shall return to later.

Mr. Frank Field: I was not saying that we should not have that debate or that big changes were not necessary. All that I was saying was that there might be huge political costs if we get it wrong.

Mr. Mitchell: I am grateful to the right hon. Gentleman for that clarification. It is vital that we take a serious look at the state of the NHS because it is not delivering for our constituents. I very much hope that that debate will not be characterised by comments such as those by the Chancellor, in which he referred to the Tories wanting £50 billion- worth of cuts, or those from the Liberal Democrat spokesman, who said that the Conservatives do not support the NHS and, indeed, that there are no charges on the health service, when significant taxation goes into it.

We must elevate the debate above such comments, which were epitomised by the hon. Member for Halton (Derek Twigg), who stated as an article of faith that the Tories want to privatise the health service; quite simply, we do not. The interesting analogy that my right hon. Friend the Member for North-West Hampshire drew with the pensions regime is worthy of greater comment than the right hon. Member for Birkenhead suggested. I hope that that too will inform public debate on those matters.

Tonight's debate is timely, as the subject is of immense concern to our constituents. I declare an indirect interest, in that my wife is a doctor in general practice, so I take a particular interest in these matters at home, as well as in the House. I have been away in the real world for the past four years, and on returning to the House of Commons to represent my constituents in Sutton Coldfield, I am astonished at the massive increase in complaints about the quality of the health service that make up my postbag. Complaints about and problems with the NHS are by far the most important element of the post that I receive every day, and I am sure that my experience is not unique in the House.

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In a wealthy society, which ours undoubtedly is, it is a basic requirement that our constituents should be able to receive health care of the quality that their counterparts in continental Europe receive. That is not the case at present. I was astonished to see in a French newspaper the headline, "Les anglais exportent les malades". It may be acceptable at the margins for sick people from Britain to go overseas for treatment, but it is not acceptable as a policy that our sick should have to go overseas to Europe to be cured. Were we to behave in that way in any other aspect of life, it would be entirely unacceptable.

The Government's response to tonight's debate and over the past week or so has been cynical. At times it has been irrelevant, and at other times, downright misleading. We were told last week that it was important to decentralise the NHS, so that decision making takes place more at local level, yet only a few days before the House debated a Bill that does exactly the opposite. Under the Bill, which was ill thought out, 58 powers for the Secretary of State were added or reinforced. He will determine the funding of every primary care trust in the country. A chief executive quoted in the Government's own report said that he thought that the changes were the most ill-conceived set of changes in a decade, and wondered whether the intention was to torpedo the NHS plan.

If we have learned anything over the past 30 years, it is that administrative reform—tinkering reform—is not the answer to the problems of our health service. Since Sir Keith Joseph started, we have seen all sorts of reforms. I have sat on Committees that considered Bills introducing such reform. It simply does not work, as everyone seems to realise, apart from the Government.

Mr. Oliver Heald (North-East Hertfordshire): Does my hon. Friend agree that one of the saddest aspects is the Government's paucity of ambition? In Berlin recently, I was speaking to the Herr Professor Doktor who runs one of the hospitals there. I asked what the waiting list was. He said, "We do have a few troubles. Sometimes we can't get the patients in the same day. They have to wait till tomorrow." I explained to him that our NHS plan has an ambition that in eight years, nobody should have to wait for more than three months. He was horrified. Does not that anecdote reflect the paucity of ambition of the Government?

Mr. Mitchell: My hon. Friend makes an extremely good point. He emphasises that in this country we have too few doctors and nurses, as I observed earlier. The problem is getting worse. In Birmingham last year, we had seven vacancies for general practice. This year we have 65—a massive increase.

I said earlier that the Government's approach was cynical. We have heard in the debate about the way in which the Wanless report has been misrepresented, and how its terms of reference made its conclusions inevitable. I should like the Government to publish the terms of reference of the Adair Turner report. We are told that it will not be published. However, the House should hear what Mr. Adair Turner is being asked to do and how that fits into the NHS 10-year plan.

On Tuesday, we heard the Chancellor promising £1 billion more for the NHS, which we welcomed. The following day, after some contrary comment in The Sun,

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he made a handbrake turn to Wapping to explain that that was not his plan at all, and that there would be no new money until there was structural reform. Only a couple of weeks ago, the Prime Minister said in answer to a question at Prime Minister's questions that when the Tories left office, there were no new hospitals being built. That was completely untrue, as a parliamentary question answered the following week made clear. We also saw the cynicism of saying that there were 24 hours to save the national health service in 1997. No wonder the public are deeply cynical about politicians—a view that will not have been enhanced by Labour's contribution to this debate.

Last week, a clear commitment was made to improve spending on health by bringing it up to the European average, but yesterday, the article in The Independent on Sunday that has been mentioned by other hon. Members said that that was only a target in broad terms.

Roger Casale: Does the hon. Gentleman welcome the announcement of a debate about the future of public expenditure, and does he expect that the Conservatives will come out of it in the same way that they are entering it—by pledging cuts to public expenditure and threatening privatisation of the health service?

Mr. Mitchell: Of course I welcome a debate on public expenditure. That is why I am speaking now. However, the reality is that, under this Government, waiting lists have not decreased, but increased. Waiting lists for in-patients have increased by 63 per cent. since 1997. It is no good blaming the last Conservative Government for that. The current Government have had four and a half years to make an impact after having promised to do so, but have failed to achieve that.

I recently tabled a parliamentary question on in-patient and out-patient waiting lists in the local hospital in my constituency, the Good Hope hospital. I discovered that, in March 1997, five of my constituents were waiting more than 12 months for in-patient treatment, while there are now 152 waiting. When the Conservatives left government in 1997, 18 out-patients of the hospital were waiting more than 26 weeks, but there are now 135 such patients. When we left government, there were 287 out-patients waiting more than 13 weeks—a very high figure—but today there are 750. Throughout Birmingham, we have seen the proportion of patients waiting more than 12 months increase since the last election from 0.1 to 2 per cent. That is an enormous increase and we would have expected more contrition from the Government and more about how they would do better than were contained in the crass allegations made over the Dispatch Box by the Chancellor of the Exchequer.

To add insult to injury for the hard-working doctors and nurses and other dedicated staff in the Good Hope hospital in my constituency, they were recently marked down in terms of the number of stars that were awarded for service to my constituents. When we investigated the reason for that marking down, we discovered on careful analysis that it was done because of lack of beds and trolley waits. However, the reason for those waits had nothing to do with the excellent and dedicated staff in my constituency, but related to bed blocking in Birmingham and the failure of social services. As I said, the result

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was to add insult to injury, especially as the hospital had managed through its own endeavours to free up some funds to help with an innovative scheme to address the problem.

My right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard) started an important debate when he said that the Conservative Government had delivered on low tax and that it was now up to the Conservative party to deliver on policies for our public services. I strongly agree with what he had to say. It is very encouraging that my party is considering systems in other countries. My right hon. Friend the Leader of the Opposition is in Stockholm today and we are considering a range of different systems throughout the world.

The issue that we are addressing is how to deliver to our fellow citizens the quality of health care that they have a right to expect. I do not believe that the Labour party can achieve that, as it is wedded to a model of delivery that does not work. It is right that we should be committed to a service that is provided on the basis of clinical need and regardless of ability to pay. On the current system, it is absolutely clear that although Labour has pumped in money just as we did, outcomes have continued to deteriorate. It will discover that public disillusionment will grow as more taxes are spent and as health care of a standard that our constituents are entitled to expect continues to elude them.

The Government should encourage the private sector. My right hon. Friend the Member for North-West Hampshire made a most interesting point about workplace insurance schemes being provided for families. I believe that that is part of the solution in terms of getting more capacity and funding into the health service in the medium term.

I should like to end on a different matter: the benefit to the public services of private finance initiatives or public-private partnership projects—a most important policy that has been seamless between the previous Conservative Government and the current Government.

It is a great thing that the PPP provides for developments in infrastructure that otherwise would not happen for many years. I have written to the Secretary of State for Education and Skills to support an excellent PPP scheme that will benefit the Arthur Terry school in my constituency by replacing old school buildings.

The Secretary of State for Transport, Local Government and the Regions has, however, fundamentally undermined the PPP system. I am not especially interested in whether he has to resign because of his stewardship of Railtrack, but I care about the damage that he has inflicted on PPP. He simply does not understand it. I hope that the Chief Secretary to the Treasury understands that the actions of the Secretary of State for Transport, Local Government and the Regions will increase the costs of PPP schemes. Capital providers will not put up the money when such uncertainty exists. No amount of equity risk premium will compensate for that. For a few cheap cheers from Labour Back Benchers, he has inflicted massive, definitive damage on a good policy that enhances public service delivery.

Morale is falling throughout the NHS. Too many changes have taken place. In the west midlands, 37 per cent. of junior doctors break the working hours limit,

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primary care lists are closing and the Government have introduced a Bill that will do nothing to help because it is bureaucratic, centralised, rushed and wasteful.

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