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Andy Burnham (Leigh): Given that it takes more than four years to train both nurses and doctors, surely those problems were created by the previous Conservative Administration and can be nothing to do with the current Administration.
Mr. Lilley: The Government have been in power for more than four years. More importantly, there is in this country a substantial number of nurses who are qualified but not working in the NHS. There is therefore a vast pool of nurses from which recruitment could be made. However, rather than doing that, the Government have often recruited from the Philippines, as has been done for units elsewhere in Hertfordshire.
We then have the issue of waiting times. In 1997, the national figure for the proportion of patients waiting for more than a year was just over 2 per cent. Now in Hertfordshire, it is three times that proportion. Although improvements have been made in some areas during the 50 years in which the health service has been in existence, on a number of key issues things have got worse. The broad move forward that we were promised has not happened in the NHS and people are worried about what is happening.
When my right hon. Friend the leader of the Conservative party illustrated that point, the Prime Minister had no response to it. My right hon. Friend said that Scotland, Wales and Northern Ireland already spend a higher proportion of GDP on health than the continent spends, which is the target that the Government want to attain. Does anyone pretend that the quality of care, of health outcomes, in Scotland, Wales and Northern Ireland is one that we should seek to emulate and universalise across England? Does any Labour Member say that his or her ambition is to make the English health service as good as the Scottish health service and no better? None of them does, but that is the Prime Minister's ambition. That is why we believe that the answer does not lie just in spending targets.
The problem with the NHS, now and in the past, is that it is too centralised; Labour has made it even more centralised. Again, in my area, one sees that. The Government have taken away the right of the patient and GP to choose which hospital to go to. My area is surrounded by five general hospitals. We used to be able to choose which hospital to attend, despite some obstacles, but we can no longer do so.
Instead, the Government gave that responsibility to primary care groups. They then merged primary care groups into bigger primary care trusts. They merged the four health authorities in Hertfordshire in twos, so that there were just two. Those were merged into a single one for Hertfordshire. Now that is to merge with Bedfordshire. There is constant merger and increase in size. Across the country, about 95 health authorities are to be merged into 28 big ones.
Dr. Stoate: May I inform the right hon. Gentleman that it was his Government who got rid of the freedom of GPs to refer someone to whichever hospital they liked? Following the 1990 health reforms introduced by the right hon. and learned Member for Rushcliffe (Mr. Clarke), I phoned up Guy's hospital because I had a patient with a very rare type of leukaemia. The specialist said, "Have you got a contract with this hospital? If not, we cannot help you." It was the only hospital in the area that could help. In the end, I won my case but it was the Conservative Government who ended the right of GPs to refer patients to where those patients wanted to go.
Mr. Lilley: That is not the case. [Interruption.] I am sorry. What ended that practice was the circular that I have in my hand: circular 177 from 1999, which abolished extra-contractual referrals. The hon. Gentleman said that he achieved his aim in 1991an extra-contractual referral.
Mr. Lilley: The hon. Gentleman cannot say that we abolished that right and he none the less achieved it. It may not have been as easy as he would like or as I will propose, but the practice was certainly abolished as a right by the circular issued in 1999. Since then, my constituents have not been able to choose which of the five surrounding general hospitals to go to.
I have had deputations of surgeons and specialists saying that the problem of specialist care has been intensified and exacerbated by that policy change. That was repeated by the president of the Royal College of Surgeons, who said that it had seriously undermined the provision of specialist care of the kind that the hon. Member for Dartford (Dr. Stoate) mentioned.
Centralisation has been going on in the health service under this Government, at least up to now. It has culminated in central Government specifying in micro-detail what hospitals and parts of the local health service will do. My local hospitals are set about 248 targets. That is an archetypal sign of Stalinist centralisation: the belief of the people at the top that they can micromanage by laying down directives from on high, which all hospitals have to meet.
Nowhere in the modern world attempts to manage large organisations such as that. The lesson from most large organisations is that, increasingly, one should take the opportunity to delegate responsibility locally, to give much greater autonomy, to make much more use of flatter, leaner management structures and of the opportunities that modern management methods and information technology make possible. However, that has not happened under this Government.
That is partly because the mindset of the left is to centralise; it believes in central planning and control. That perhaps explains to some degree what has been going on, but it does not explain why new Labour Ministers who thought that they had shed the centralising tendency, or at least who were open enough to recognise that it had been at fault in the past and who declared themselves to be free of it in the present, have been involved in centralisation: the attempt to control everything from the centre. It is partly because of that other aspect of new Labour Ministers: they are initiators. They demand an initiative a day or a week to get the headlines. The simple way to get a headline is to launch an initiative from the centre, which inevitably involves some central decision imposed on the people at the sharp end of the service. That is why all those ring-fenced funds have been established, all those targets have been set, all those central directives have been laid downso that new Labour news managers can get cheap and initially favourable headlines at the expense of a much more centralised, rigid and inefficient health service. That is what has happened in the health service.
I have been advocating a move in the opposite direction. I published a document, which is already going through its nth print run, called "Patient Power". I recommend it particularly to the hon. Member for Dartford, who did not remember accurately the history of how these things have come about.
I have advocated that we return power, decision making and choice to patients and to the GP who advises them. That is the most important direction in which power should move. We should restore the right of the patient to choose which hospital to use, certainly for all normal operations; for more specialist procedures the choice will inevitably be limited.
As I say, from 1999, that choice was removed by circular 177. It has meant that, instead of the individual patient making a choice, the local health bureaucracy, the primary care trust in most cases, enters into contracts with hospitals, and patients follow the money rather than the money following the patient.
It is important to enter into the history and to acknowledge that the problems have not always been recognised, even by my own party. Choice existed before the establishment of the NHS and was perpetuated when it was established. It was recognised that patients could choose whichever hospital they wanted, although normally they went to the local one, which was right and proper.
However, patients should have the right, if they want, to go to a hospital with a shorter waiting list and to which the journey is shorter. They should have the freedom to go to a hospital that is nearer relatives should they want that. If they want to go to a hospital that specialises in the operation that they want, or has a particularly good record in it, they should have the right to choose that hospital, even if it means a longer wait than if they went to the local hospital. If they want to go to a hospital that they know has wonderful standards of cleanliness and care, they should have the right to opt for that. They may want one that does not have mixed-sex wards. For all those reasons patients may want to exercise choice, as they were historically allowed to do.
Then problems began to arise with tighter budgeting in the 1970s and 1980s. All too often, patients chose, naturally, the most popular hospital. Therefore, the most popular hospitals ran through their budget before the end of the year, and it was the most popular wards and most popular hospitals that tended to close.
That caused great perturbation among Members of Parliament in the early 1980s, and it was recognised that something needed to be done. Hence reforms were introduced by the then Secretary of State for Health in 1991. He gave GPs the right to be fundholding, which gave them greater flexibility, but where GPs were not fundholders and local authorities entered into contracts, the over-reliance on the contracting processI accept the pointrestricted choice and made it more difficult to exercise.