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Rob Marris: I am grateful to the hon. Gentleman for his generosity in giving way again. I salute his search for common ground between the two main partiesindeed, between the three main parties and the smaller parties represented in the Housebut Labour Members,
I am not talking about the kind of arrangements, such as contracting-out operations, into which the Government have recently entered. The right hon. Gentleman seemed to suggest that it would be a jolly good thing if more people were treated privatelyin contradistinction to the Leader of the Opposition, who seemed to decry the fact that there were 250,000 private operations last year. Those mixed messages from the Conservative party confuse Labour Members and make it more difficult to find what common ground there might be.
Mr. Swayne: I welcome choice for patients as I welcome choice in any market: 250,000 people deciding that they want to pay for their health care would be very different from the situation that we face. My constituents are writing to me complainingprecisely as my right hon. Friend the Leader of the Opposition saidthat they have had to use their life savings for life-saving or life- changing operations. They do not want to do that, but in the current environment they are having to do so. I share the hon. Gentleman's desire for a national health service that provides a comprehensive service that is available to those who need it, not on the basis of whether they can afford it, but if we simply continue the present funding structure exclusively for the NHS, we shall put it and that ideal in much greater danger than if we explore other possibilities.
The Chancellor largely pre-empted such a debate by having the Wanless report published this morning and then launching into his Budget speech clearly having made his mind up about the way in which we will proceed. Indeed, when he addressed the Social Market Foundation a month ago, he made it clear that there would be no debate or discussion about how we fund the NHS. Mr. Wanless may well be rightI do not know the answer to the questionin his assessment that a publicly funded system from taxation is the best and most efficient. I doubt it very much, but it might be the case. I want to have that debate and to test all the arguments. I want to examine and be open to other possibilities. The Government are trying to close down that debate, but the nation and, potentially, the NHS would benefit greatly from it.
Effectively, we are saying that, by and large, with a measure of modernisation here and there, the only problem that the NHS faces is underfunding and that it has been underfunded for too long. However, hon. Members will know from the five Budgets at which they have waved their Order Papers in delight that we have been spending a great deal more on the NHS for some time. Indeed, the Chancellor said that spending has increased by a third. The estimate of ordinary people is that that has not done the trickindeed, that things are marginally worse in some respects. It is a great leap of faith simply to say, "Let's double spending, and that'll do the trick." My belief is that it will not. It will be interesting to see whether at the end of this Parliament it has delivered the improvements in services that we want.
Mr. Swayne: The hon. Gentleman is right that the Government accepted for their first two years the plans that had been laid down by the preceding Conservative Government. As a consequence, expenditure on the NHS significantly increased, as was the plan. Of course that has been added to since, and spending has increased by a third. Of course it takes time to change things, but we are still running into enormous problems of loss of capacity as people become exhausted by the pace of modernisation. The last thing hospital staff are looking forward to is yet more change as a consequence of what the Government call modernisation. Staff are already exhausted by it.
The experience of my constituents as a consequence of increasing the health service budget by a third is a bleak one. We still wait three years in New Forest, West for a hearing test. If someone in New Forest, West, has a stroke, suffers dysphasia and as a consequence is in intensive need of speech therapy, they cannot have it unless they are over 65. That example is from the letters of complaint about the level of service in the NHS that I have received in just the past seven days.
As I said at business questions when the Leader of the House was trumpeting the heroic achievements of the NHS with respect to waiting lists, a lady wrote to me only last week to complain that she has been waiting for an operation in excess of the very sensitive figure of 18 months. She was telephoned by a Southampton trust and told that because she had been waiting in excess of 18 months, the operation could be carried out by the Royal Bournemouth and Christchurch hospitals trust. She agreed, but some four months later when she rang to ask why she still had not had the operation, she was told by the Royal Bournemouth and Christchurch hospitals trust that, as she had been waiting only four months, she did not have a prayer. The trick is to start the clock the moment that she moves trusts. Then, lo and behold, the target has been met because no one has waited for more than 18 months. That is not an isolated case. We saw what happened at Derriford hospital. When the executives who were responsible for the extraordinary system of hidden lists lost their jobs as a consequence, they tipped up elsewhere in the NHS executive in better-paid jobs. That sends a powerful signal to executives throughout the NHS.
We have also heard of examples of people being offered appointments when they have gone on holiday so that the trust can say that as they did not turn up for the appointment, they do not count on the waiting lists. The holiday dates were solicited and the appointment offered after the person had set off. It is shocking that such things should happen at this time.
Those examples characterise a malaise in the NHS structure that we have delivered. I should like to explore alternative ways of fixing the problem to simply throwing more taxpayers' money at it. I am prepared to accept a
Mr. Deputy Speaker: Order. Before I call the next hon. Member, I would point out that time is running out and several hon. Members wish to catch my eye. Unless contributions are a little shorter, some will be disappointed.
Gareth Thomas (Clwyd, West): This is not just a good Budget, it is a very good Budget. It is a courageous Budget and it is an important Budget because it will set the course for the Government for the remainder of this Parliament and, I hope, well beyond. It has a greater significance because it throws into stark relief the dividing lines between the Labour and Conservative parties. The Conservatives are committed to a decline in the size of the state, a low tax economy, tax cuts and the destruction of the NHS as we know it. On the other hand, the Labour party accepts the need not so much for tax and spend as for tax and investment in our public services, combined with a process of reform.
We know that in the general election of 1997 and last year, when the Conservatives ran on a policy of tax cuts and were comprehensively beaten, the great British public did not give us a blank cheque to spend their money. We must ensure that the outputs justify the increases in taxation. Labour Members accept that taxation is the price that we pay for living in a civilised society and I do not apologise for being fulsome in my praise of the Chancellor.
As well as being courageous, the Budget is also redistributive. The social measures, including the working tax credit and the child tax credit, will be of tremendous value to millions of poorer households and it is clear that the Chancellor has balanced the need to raise further taxes with the need to ensure an end to child poverty and the aim of lifting more people out of poverty.
The increases in public expenditure are substantial. The increase in the NHS budget between 2003 and 2008 will be 48 per cent. in real terms. That will make a difference, although we cannot be complacent about the need to ensure that the uses to which the money will be put will be considered carefully. That is why the Government are right to redouble their efforts to ensure that the process of reform continues. The Wanless report makes it clear that that is exactly what is required. We need a sound, long-term and sustainable programme of spending in the NHS if it is to remain a service that commands the respect and affection of the British public.
This is a Budget for the NHS, although additional spending will go into the other great public services, including education, policing and transport. As a Welsh Member, I am of course aware that we have created a democratic institution in the National Assembly for Wales and I hope and expect that it will wish to use the extra money for a drive to improve standards and cut waiting lists. I also hope that it will make those tough decisions
I turn to the measures that are, in my view, designed rightly to help fulfil the Government's commitment to creating an enterprising and fair society. Those terms are not mutually exclusive. We know that they have been a theme of the Chancellor's Budgets over the past five years, and it is a theme that I applaud.
I welcome the measures to promote enterprise, especially for small businesses. I welcome also the changes to corporation tax, which will be of great significance, as will be the changes to VAT and the research and development tax incentives. These measures will, as I have said, be a great help to small businesses, which are a considerable feature of the Welsh economy.