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Matthew Taylor: I agree that self-pay is unfair. That is why I oppose a system that would force people down the private insurance, pay-as-you-go route that the hon. Gentleman's Front-Bench colleagues seem to prefer. The hon. Member for Epsom and Ewell (Chris Grayling) is in a difficult position. We know that the Conservative party is prepared to look at any option apart from the system that we actually have—the national health service—and they are prepared to delay any investment until they have made a decision, even though such delay would cost today's patients the treatment that they need. Under Conservative policy, people will have to carry on paying

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for treatment—if they can afford it; if they cannot afford it, they will have to carry on waiting. That is a wholly disreputable policy.

The reason that the Conservatives do not explain their policy publicly is simple: the public do not agree with it. In fact, the public hate it. They think that it is the worst possible idea and they are right. All the Conservative options would cost the public more and treat them less and, worst of all, later, because there would be delay in making the investment that is so obviously needed.

All the alternatives have one thing in common: they are more expensive and less fair. The Conservatives say that they have an open mind but they have closed their mind to saving the national health service.

Mr. Paul Tyler (North Cornwall): In the interest of proportionality, it is time for a Liberal Democrat intervention.

Has my hon. Friend noticed that, in the opinion poll published in The Guardian today, such is the popularity of the Conservative party's opposition to the NHS that it has dropped five points?

Matthew Taylor: We shall have to see whether that continues. I noticed that most Conservative supporters favour the increase in spending so it seems unlikely that the party can make much progress on that issue.

Conservatives raise one issue in particular as a weapon in their argument that the money should not be spent: they say that there is no way of spending it effectively. I want to suggest some ways in which it could be spent not only effectively but earlier than the Government's plans would allow.

First, it is well known that thousands of NHS beds are blocked by elderly patients who are kept in hospital not because they need hospital treatment but because there is no funding either for the residential or nursing care that they need, or for support in their own homes. That is a real issue now and the money could be spent now. Throughout the country, social services departments, including my own in Cornwall, could make the investment to find places for those people if they had the money to do so. That needs to be done now, not in a year or two, because the doctors and nurses who support the people in those beds could be treating patients who need hospital care.

One of the biggest worries about Labour's plans—I do not know whether the Government did not think of this, or whether they simply had no answer—is that the very local government organisations that are expected to spend the extra money to find places for those people will be hit by a national insurance increase for their staff, so much of the extra funding for social services next year will be taken out by the back door no sooner than it has come in through the front door.

The Government need urgently to consider how they can release to local authorities the scale of funds necessary to allow such placements to be made. The funds need to cover not only the extra beds, but the increase in fees necessary to stop many residential and nursing homes closing because the current fees simply are not enough for them to keep their doors open. That is urgent: my constituency has lost four nursing homes in the past year or so because the fees that they can be paid are too low, even though Cornwall county council has substantially

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increased them recently, at the expense of placing fewer patients. More needs to be done urgently. Conservative Members have argued for that, but they will not now agree to the means to pay for it.

Secondly, recruiting and retaining nurses is an issue. In many parts of the country, nurses have the training and skills to do the job, but they cannot afford to work in the NHS on the low pay that many—not all—nurses receive. There is now a reasonable pay scale, which starts to give nurses real rewards as they go up it, but pay is an immediate issue at the low end, especially for other professional staff in the NHS. That is why we budgeted for immediate pay rises for low-paid professional staff in the NHS, especially in areas of high housing cost. If hon. Members visit any hospital in the south-east, they will be told that there are trained nurses, but that they cannot be recruited on the salaries being paid.

The third immediate priority—again, Conservative Members need to pay attention to this—is massively to increase the number of people being trained. It takes five years to train a doctor, so things cannot wait one, two or three years, or however long it is until the next general election before the Conservatives decide what to do. We must start training doctors and nurses now, or no matter what system the Conservatives come up with, they will not be able to find the staff needed to look after those in the beds.

The Budget has at last delivered the increase for health on the scale that we called for and, very nearly, using the means that we called for, but we do not agree that the Government have chosen the best way to raise the money. We argued for the use of income tax. Instead of using employers' national insurance, the Government could have raised about the same amount of money with a new top rate of tax on earnings of more than £100,000 a year. That would have been fairer in its distribution and, unlike the Government's proposal, would not have hit jobs and manufacturing industry. That said, we want the increase in the NHS to take place, we will not stand in its way, and we charge the Government with spending that money well—none of which can be said of the Conservative party.

5.29 pm

Mr. Neil Turner (Wigan): First, may I apologise to the House and to you, Mr. Deputy Speaker, because I should be attending a Standing Committee sitting that is scheduled to continue until 10 minutes to 10, so I may not be able to return to the Chamber to hear the winding-up speeches or the rest of the debate; I apologise to those on the Front Benches and to yourself.

Tackling poverty—whether child, family or pensioner poverty—has been a major Government target, and to the Government's eternal credit, we have also set out to tackle overseas poverty. Of course, much progress has been made. On child poverty, however we want to measure it, either 1 million or 0.5 million children have been lifted out of poverty following years and years of inexorable growth in the number of children living in deprivation.

We recognised that the best way to lift people out of poverty is to ensure that they get a job—the Yosser Hughes way; "Gizza job." One million extra people in work represents 1 million extra people out of poverty. It is not a matter only of putting them in work, but of protecting them once they are there. The minimum wage, trade union rights and protected working conditions

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through the social chapter will ensure that their social needs are looked after as well as their economic needs. The Budget will build on that. This year, deprived areas such as Pemberton in my constituency will get additional help to ensure that the enterprise that lies within such communities can be released. However, even with the extra jobs, many deprived areas—not only Pemberton, but other parts of my constituency—will continue to suffer deprivation. Despite the protection of the minimum wage, far too many people are still on low wages, and skill levels remain low, leading to low attainment and low ambition, perpetuating the cycle of deprivation.

That cycle is further reinforced by the lack of collective wealth in such communities. People are not able to go and spend in local shops, thereby creating more wealth and jobs and improving the whole area. We need to pump more money into such areas to break the cycle. That is why the Chancellor's help through his support for enterprise, children and families is not only welcome, but essential.

However, that alone is not enough. The wages of poorer people comprise not only the wages that they get in their pockets through work or benefits, but what we used to call, and may still be called, the social wage. They cannot afford to send their children to private schools, to take out private medical insurance or to hire home helps to look after their parents or children when they are ill, as can people with much greater incomes. They depend on high quality public services even more than the average, because they have no alternative. They need good schools to lift their children out of declining educational standards, which were so evident in the Conservative years, and which we have addressed through the learning and skills promoted by the literacy and numeracy hours. They need better hospitals to give them better treatment, because they are poor not only in financial, but in health terms. They need the primary care facilities provided by GPs to ensure that the chronic diseases that are rife among people in deprived areas are treated. They need the protection provided by local authority social services. They need their environment to be protected so that they have access to clean air, clean water and the generally higher standard of life that exists in a better countryside. The vast majority of those services are provided locally.


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