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6.23 pm

Liz Blackman (Erewash): In a recent survey on health, the target group was asked two main questions. The first was, "What do you think of the NHS?", to which the majority replied, "It's in crisis." The second was, "What is your experience of the NHS?", to which the overwhelming answer was, "Extremely positive". There is a reality gap between most people's experience of the NHS and the headlines played for all they are worth by the Opposition. When the hon. Member for Woodspring (Dr. Fox) was speaking, Labour Members tried to count the number of times that he lapsed into the first phase of his plan to rubbish the NHS; we gave up because we got into double figures on the Tory lie.

Clearly, a great deal needs to be done in the NHS; it needs much more investment and a great deal needs to change. However, people's response to the second question in the survey showing that they are broadly satisfied is based on an already improving picture. I am in constant touch with health professionals in my constituency, the chief executive of Erewash primary care trust and local acute hospitals, and they tell me that good and quantifiable things are happening. I do not want to read out a great long list, but I shall give the House a flavour of what has happened during the past five years, especially the past two or three years.

Erewash PCT says that access to GPs in its area is better than the NHS target; the role of practice nurses managing patients with chronic diseases, such as diabetes, has been extended; clinical governance has vastly improved; there have been major improvements in managing patients with chronic heart disease—for example, the prescribing of statins—and personal medical services pilots have modernised contractual arrangements, leading to flexibility in GPs' employment and the use of nurses and allied health professionals to deliver care

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alongside them. In addition, we have had a valuable new minor injuries clinic at Ilkeston community hospital, which during the election did a sterling job treating three Labour campaigners for dog bites. All were seen and treated within the hour.

Mr. Salmond: I am not sure that the hon. Lady has caught up with events. I thought that we had abandoned the model in which everything is all right with the NHS and adopted one in which huge investment is required to put it right, so will she catch up?

Liz Blackman: The hon. Gentleman should wait, as I shall try to offer suggestions on the way forward later.

The Queen's medical centre, one of the largest teaching hospitals in the country and, indeed, in Europe, serves part of my constituency. The number of out-patients waiting for treatment there for more than 13 weeks has gone down from 12,000 in 1999 to 2,000; there are now no in-patients waiting more than 12 months; trolley waits are down; and a new accident and emergency centre is on the way. Interestingly, last February 83 per cent. of cancer patients were seen within two weeks, but last month 99 per cent. were seen; orthopaedic and out-patient clinics are expanding; there is a new day-case theatre, and another one—the third—is being built; the main X-ray department is being refurbished; there are new staff, including 14 consultants and 60 allied health care professionals; and 150 more nurses are on the way.

I will not go on about improvements, but I wanted to give the House a flavour of what has happened and explain the results of that survey. Change is happening, but I accept that there is a great deal more to do. I get some letters from constituents who tell me that they have had a good experience of the NHS, but a few tell me that they have not, which is a tragedy. I therefore fully accept that we need to do more and that there are no quick fixes.

I want to raise a few matters which, I hope, will be considered as ways of making progress. There is increasing pressure on statutory training as well as training to develop best practice. It must be recognised that training takes time and must be incorporated into work force planning in both primary and secondary care; it takes two years to train a nurse consultant, for example. Resources are needed to pay not just for training but for the backfill. Clinicians who provide much of the training are expected to deal with the same clinical case load. We must provide quality training, but not at the expense of clinical work.

We also need continued emphasis on recruitment of excellent managers. Every time that I make a speech about education or any other public service, I say that we can do nothing well without high quality management. I applauded my right hon. Friend the Secretary of State for Health a few weeks ago when he announced that he was recruiting 100 excellent managers, not just from within the public services, but from the voluntary sector and the private sector. They are vital to make the changes by leading, motivating, problem solving and communicating. I hope that that drive continues.

Turning to audit, I welcome the streamlining of the Commission for Health Improvement, the work of the Audit Commission on value for money, and the Care Standards Commission. However, my conversation last Friday with the chief executive of the Queen's medical

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centre convinced me that there is one aspect which we must consider carefully as we move to a more streamlined audit system. He told me that he was visited by the Commission for Health Improvement in January and by the Audit Commission a few weeks later. He was rather rude to the regional tier of the health authority when it visited him a few weeks after that. We must sort that out. We cannot have people asking for the same information time and again. I welcome the recognition that that is a problem, and we must move quickly to resolve it.

A further issue relating to audit is the fact that some outcomes are relatively easy to measure—for example, operations performed and infection rates. Others, such as community health promotion initiatives, delivered by good health partnership working, can produce enormously good results, but they are much more difficult to measure. We need to find ways of doing that effectively, and we should value those services. Many services have undergone multiple reconfiguration, making it difficult to produce an accurate picture of a moving target. Auditors need an in-depth understanding of the change that is taking place.

Where high quality initiatives are making significant improvements and are being rolled out—for example, the Bradford initiative for dementia care mapping—should we not consider mainstream funding? As someone who has a very good community hospital, I make a plea for greater emphasis on the development of community hospitals as new diagnostic and treatment centres. That is traditionally provided by acute providers, not by those smaller, and sometimes excellent, units.

Can we consider having chronic obstruction respiratory disease and heart failure specialists in primary care? That is not a service identified in the national priorities, but it is another partial solution to bed blocking. Can some evaluation be done on the effectiveness of making it a priority? Perhaps some thought has been given to that already.

I conclude on a more political note. At the weekend, I listened—as did many hon. Members, I imagine—to the radio programme "Any Questions?" hosted by Jonathan Dimbleby. The hon. Member for Ashford (Mr. Green) was asked how the Tories would fund the health service. His answer has been echoed so many times this afternoon in the Chamber—the Tories say that they need to explore other ways. The right hon. Member for Kensington and Chelsea (Mr. Portillo) also said that. The Welsh nationalist who was on the radio panel immediately cut in and said, "We don't need a debate. Stop navel gazing. We need to get on with it." The audience agreed.

If there is something valuable to say, the time to say it is now. Reform is happening, change is taking place and investment is going in. We are moving forward and changing the whole landscape. The Opposition cannot engage with that. All that they are doing is navel gazing and making noise, which people do not wish to hear.

6.34 pm

Mr. Francis Maude (Horsham): Until the hon. Lady's final remarks, I was about to say that there was a danger that the debate was approaching the level of seriousness that the public expect on matters of such importance. I am sorry that she lapsed back into narrow partisanship, which is a massive turn-off to the public and has led to the disengagement of so many people and the distrust and

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scepticism discernible not only in our conversations with members of the public, but in the opinion polls, about whether politicians can do even what they say they will do, let alone what the public want. It is important that we approach the debate with a high level of honesty and straightforwardness. We should treat the public with respect and tell them the truth. We should treat other people's views in the debate with respect. We should accept that none of us has a monopoly of the truth.

There is no health system in the world that is perfect. Our health system is manifestly imperfect, and we should be grown up enough to accept that change is needed and that not only is there room for a serious debate about what form that change should take, but that there is an absolute necessity for such a discussion. The attempt to close down the debate before it has even started is lamentable.

On the Budget more broadly, it is widely accepted that the Chancellor deserves some credit for the performance of the economy. My right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) made that clear and set out the case fairly. Equally, the Government should accept that the Chancellor had a fantastic legacy. Again, there is no point in being narrowly partisan about it. That is demonstrably the case.

The Chancellor deserves credit for the new monetary arrangements that he has put in place. They are not perfect, but they are a move in the right direction. He deserved some credit until this year—for reasons to which I shall return—for his approach to fiscal discipline, although there has sometimes been criticism of the way in which he achieved it. He deserves credit for a stated, broad commitment to enterprise, which I think he means. He goes on about it a great deal, and I do not think that that is just for the sake of form. He understands that a successful economy depends on successful enterprise.

The criticism of the Chancellor is that he never can resist meddling. There is hugely complex regulation and growing complexity of tax arrangements. For example, capital gains tax needed reform. The previous regime, if my right hon. and learned Friend the Member for Rushcliffe will allow me to say so, was too high, but it was at least very simple. It needed reform, but not the creation of a level of complexity that is to the advantage of no one except the accountancy profession.

Others have spoken about the Chancellor's approach to tax credits. There are huge complaints to be made about the complexity, the instability and the meddling. For families alone, the Chancellor has created five new credits, scrapped four of them and introduced two new ones.

The main complaint about the Government's approach to welfare reform is that it goes in the wrong direction. The aim should be, as Labour argued fiercely and rightly in opposition, to reduce the extent of means-testing. What the Government have done has gone in the other direction. It is a pity that we cannot have a more straightforward debate about that.

The Government were elected with a huge majority, a fund of good will and much political capital, and they have, to give them credit, done quite a lot to contribute to an intellectual consensus about the kind of welfare reform that is needed. It is such a pity that when they were elected and had the ability to do it, they decided to go off in a different direction because the Chancellor could not resist the complexity and the engineering. That has made the

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welfare system less satisfactory. As my right hon. and learned Friend the Member for Rushcliffe pointed out, 90 per cent. of families in receipt of what are effectively means-tested benefits does not make sense.

A great deal of complexity has been added—but returning to the theme of enterprise, higher taxes have also been introduced. In this case, they are overt taxes. I have spoken many times in the House about the stealth taxes that the Government introduced in the previous Parliament, when they were still trying to pretend that they were not a tax-increasing Government. They have now come out of the closet, however, and imposed direct extra taxes. Clearly, as everyone in the business world has told them, they are taxes on jobs, and there is no question but that they will affect the performance of the economy.

That is why there is genuine reason to question the Chancellor's commitment to fiscal discipline at this stage. My right hon. and learned Friend the Member for Rushcliffe devastated the sleight of hand with which the Chancellor increased his estimate on trend growth—he did so "just like that", as Tommy Cooper would have said—which is suddenly going to be 25 basis points higher than previously. There is such a thing as regression to the mean. It may be reasonable to assume that the mean will be higher in future when there is a genuinely low-tax economy with light regulation that will stimulate and encourage enterprise; it may be reasonable to assume that trend growth might increase in such circumstances—but everything that the Government are currently doing goes in the other direction. If anything, the Chancellor should be reducing his estimate of trend growth, not increasing it, especially in the aftermath of a year in which tax revenues grossly under-delivered because the economy under- performed in comparison with what was expected. It smacks much more of a short-term career plan than a long-term financial strategy.

Health care is obviously the nub of the Budget and I have a few observations to make about it. No one denies that more money is needed for health care. There is no arguing about that, and equally, there is no argument about the desperate need for NHS reform. I find much to agree with in the White Paper published by the Secretary of State for Health, about which he made a statement in the House last week. I would be more enthusiastic, however, if I thought that he had a high chance of achieving his aims. Indeed, if he were to achieve all that he set out in the White Paper, he would just about recreate the process of health service reform set in train by my right hon. and learned Friend the Member for Rushcliffe about 14 years ago—a process of devolution and of moving away from this country's obsession with centralised control of public services.

I applaud the White Paper's emphasis on choice, plurality and devolution, but although that is all good stuff, one must ask oneself whether the Secretary of State really means it. He said only last summer that

Suddenly, all that has changed. Instead of monopoly, he is in favour of plurality and wants the private sector, the not-for-profit sector and international providers to come in. I think that that is very sensible and I approve of it,

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but can we believe that he means it when he was saying only 10 months ago something that was different by 180 degrees?

Such a rapid conversion does not have high credibility and again contributes to the public scepticism that we have seen. Some months ago, an announcement was made about the creation of a new diagnostic and treatment centre to be managed by BUPA at the Redhill hospital. The project, which was mentioned by my hon. Friend the Member for Woodspring (Dr. Fox), is good stuff and very sensible. Local people and the local trust want it, but it has not happened because it is not being pushed. There is always resistance on the part of a monopoly producer within a public service to the introduction of diversity. The issue will need to be pushed if these important reforms are to be carried out.

I also applaud devolution in the health service, which is absolutely what is needed, but it is hard to believe that it will really happen. It is very difficult to drive change in any big organisation, as there will be a huge amount of inertia. Real will and the investment of significant political capital will be required to make it happen. My right hon. Friend the Member for Kensington and Chelsea (Mr. Portillo) pointed out that, by committing so much extra funding in advance, the Secretary of State for Health and the Chancellor have abandoned much of the leverage and purchase that they could have had on the health service in ensuring that the changes occurred in time. Apart from that, however, they need absolute commitment and they need to mean what they say.

Even when we consider what the Government are saying about devolution, we see that their approach and mindset are very top down. They are saying that if hospitals do well and are given so many marks out of 10, they will give them a little bit more independence through the gracious dispensation of a beneficent Secretary of State. He needs to understand that when people who are close to the front line and to the delivery of service are given more power and the ability to make choices, implement them and make a difference by dint of what they do, they will generally get it right. Of course, they will not all get it right. Devolution and decentralisation involve risks, and some people will get things wrong and some experiments will go wrong.

It is absurd for us to aim for a completely uniform health service throughout the country. A health service that seeks uniformity will be committed to mediocrity. We should look for local health providers to find different, better and transforming ways of doing things. That is how general improvement will happen, but that is not the approach that the Government are taking, because in their heart they do not believe that such devolution is the answer. Their approach depends on dispensation and is very top down, which is why it is very hard to believe that the process genuinely will happen.

I hope that the programme of reform that the Secretary of State announced will work, but it is hard to believe that it will do so and easy to understand why the public are so sceptical about it. The Government's mindset does not seem to have progressed very much. They claim that they are moving away from the 1948 model—I seem to remember that Aneurin Bevan said in 1948 that he wanted to hear the clatter of the bed pan in his office in Whitehall. But why should we maintain the absurd pretence that the Secretary of State is to blame for every single thing that

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goes wrong in the health service, any more than the pretence that he can take credit for every single thing that goes right?

The health service is very big and has been a monolithic organisation. We should seek to decentralise and devolve it, which will require a genuine, grown-up debate, and not the sort of juvenile approach in which we seek to suggest that anything that deviates from current orthodoxy is to be stigmatised as a desire to privatise or disband the national health service. That is the wrong approach. We need an open, serious, grown-up and honest debate; otherwise, I fear that the public's scepticism about the way in which we approach the matter and about whether the health service genuinely can be reformed and improved, as we all hope it can, will remain and may get worse.

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