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The Government are shifting the blame, which they always do. The blame for bed blocking now lies with local government, rather than with those who created the problemcentral Government. The financial burden and the penalties will be transferred to local government: in other words, council tax payers will be fined for the Government's incompetence in terms of their care homes policy. That is a terrible indictment of this Government.
We seek detailed answers to those questions, because several things have become clear over the past 24 hours: that the Government now believe that one of the ways of helping recruitment and retention is to tax NHS staff more; that the Government have now returned to tax and spend; and that the third way and new Labour are gone.
When the Government came to power, they said no internal market, no money following the patient and no GP fundholding. Having broken their promises on taxes, they have now gone back to many of the reforms that they said in opposition they would never tolerate. They are admitting that they wasted five years for all those who use and work in the health service. They were wrong and we were right. The one word missing from today's statement was "Sorry".
Mr. Milburn: The hon. Gentleman either misunderstood or has not read our proposal on the new independent audit regime. In fact, it will mean less rather than more bureaucracy. We will put together the current arrangements, with the Commission for Health
The hon. Gentleman did not say one word about matching extra investment either in the national health service or in social services. It is a bit rich for him to bleat about bed blocking and problems in care homeswhich existand not to commit his party to matching the extra resources that we are allocating to social services.
On the hon. Gentleman's question about borrowing, we will put in place a new prudential borrowing regime, along the lines of the one that we are considering for local authorities. The details are in the document.
On importing staff, we envisage bringing in spare capacity from abroadfrom Europe. The hon. Gentleman is very keen on his travels in Europe. Normally, the purpose of travel is to arrive at a destination. This must be the only instance of travel narrowing the mind. His mind is made up. The challenge for him is threefold: will he match our extra investment, match the extra sources of that investment and match the reforms that we have outlined? The answer for all three is no.
The public will see that, rather than wanting to reform the national health service, the Tories want to abandon it. The hon. Gentleman gave the game away when, in his secret speech in Harrogate, he said that the Tories' strategy was first to talk down the national health service, and then to run it down, as a prelude to their real agenda of selling it off. That is not the right choice for the British people.
Mr. Kevin Hughes (Doncaster, North): I warmly welcome my right hon. Friend's statement and the reforms that he outlined, but those who will be paying the extra taxes will want a copper-bottomed guarantee that their money will be spent wisely. They will want improvements to be made, and quickly. Will he assure me and the people outside who will pay the extra taxes that this massive investment will find its way to front-line services and not be lost in more red tape and bureaucracy?
Mr. Milburn: My hon. Friend makes an important and telling point. It is important that people who work in the national health service and the managers who are responsible for delivering care understand that the extra resources do not come for nothingthis is not an unconditional offer. The days have gone when public spending worked on the something-for-nothing rule. We are offering something for something and we expect big changes and improvements, but we do not expect them overnight. No magic wand can be waved and no silver bullet can be fired, but people have a right to expect a steady improvement year by year, as capacity grows and the NHS plan is implemented over 10 years, providing more staff, more beds, more buildings, new hospitals and new ways of working backed by the reforms that I have announced today.
When people put more money into the national health service they have a right to expect more out of it. That is why the new arrangements for audit and inspection, which are not supported by the Opposition, and the new obligations on primary care trusts are being brought into
Dr. Evan Harris (Oxford, West and Abingdon): On the rise in tax, including a not so brave 1 per cent. on top earners such as the Secretary of Stateand the Prime Minister and Chancellor, who are leaving the Chamber to count their moneyto give the NHS the funding boost for which we have been calling for years, we would like to resist the temptation to say, "I told you so", but we cannot. Nor can the people who have died while waiting, the patients who suffered poor care during years of underfunding and the elderly who are stuck in hospital and who will still have to sell their homes to pay for the personal care that they thought they would get on the NHS.
The funding is welcome, but it would be more welcome if the Secretary of State apologised for his five years of the 23 years of underfunding and the two income tax cuts, for which the Conservatives also voted, because without them we could be halfway through a 10-year programme of NHS investment rather than at the start.
If the Secretary of State is serious about reform, why does he not consider truly decentralising decision making to publicly and democratically accountable local decision-making bodies instead of simply decentralising the blame and centralising the praise?
On the new financial incentives for hospital performance and the distortions, if the Secretary of State really thinks that doctors and nurses will treat patients better if he stuffs their mouths with gold, he simply does not understand the motivation of public sector health care workers. Does he really think so little of doctors and nurses? If he believes that these new people's foundation, grant-maintained hospitals that give financial incentives for admitting, discharging, operating and not operating, and the creation of an accountant's paradise, will produce no clinical distortions and improve clinical care, he misunderstands doctors and nurses in the health service. He is moving from stethoscope to spreadsheet, and that will damage patient care.
On social services, it appears that the Secretary of State, like Conservative Front Benchers, has just discovered social services underfunding and bed blocking. He has announced that he will suddenly get a grip. Does he not understand that the 1.2 per cent. real growth between 1999 and 2001, as set out in the Wanless report, was grossly inadequate, as was the real-terms cut in social services funding in the previous two years? Is he about to insist that local councils not only punish council tax payers, but cut services to the mentally ill, the vulnerable young and the disabled to avoid his fine? The real-terms increase in funding is only 3.5 per cent. now, rising to 6 per cent. this year. That is around £200 million, which is grossly inadequate for the amount of underfunding in health services.
Finally, can he assure people in Oxfordshire facing £9 million in social services cuts in the fifth year of a Labour Government that they will not have to face more cuts this year? Unless he can make that commitment and unless he apologises, people will not believe that he is serious and the Government will appear even more arrogant than they have to date.
Mr. Milburn: The hon. Gentleman said that my right hon. Friends the Prime Minister and the Chancellor of the Exchequer have left the House, and I now know why they did so. If I were the hon. Gentleman, I would be very cautious about raising national social services funding issues, given that the Liberal Democrats are cutting such funding at a local level. Indeed, as I have told him beforehe has failed to answer this chargethe biggest complaint that I heard on my recent visits to Liverpool and Sheffield was the cutting by Liberal Democrats of social services expenditure for the elderly, the disabled, people with mental health problems and vulnerable children; yet the hon. Gentleman has the temerity to complain about a 6 per cent. increase in social services investment.
The problem with the hon. Gentleman and the Liberal Democrats is that they always want more money but never want change. He must recognise what everybody else recognises: if we are to get the best from the resources and improve services for patients, investment and change must go together. It is about time that he learned that lesson.