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Mr. John Bercow (Buckingham): Smoke and mirrors.

Mr. Bailey: Sorry, smoke and mirrors. That is evident in the contributions made by Conservative Members. They talk seductively about certain aspects of health services in other countries, and consistently and progressively rubbish those in this country, but provide no overall consistent picture of what their alternative would be, so that the electorate can make a judgment. People in my constituency want more doctors and nurses and better facilities, and they know that those must be paid for. In all the comments made by Conservative Members, I did not hear them once mention how their policies would be paid for. Ultimately, my constituents believe that the increase is the fairest way of funding the national health service.

I want to make a plea relating to my constituency. Like many industrial constituencies, it suffers a legacy of ill health owing to its industrial background, as well as poor life expectancy, lower birth weights and so on. Those statistics are improving, but there is still a long way to go. That is why the area was designated as a health action zone. Those involved in it are pioneering a range of joined-up activities for developing more healthy lifestyles, including campaigns on exercise, healthy eating, teenage pregnancies, sure start and smoking cessation programmes, to name but a few. The problem is that funding for those programmes is announced year by year, and those working on them do not feel confident that they will be able to do so over the long term. Now that we have a five-year commitment on health spending, I hope that the funding for health action zones will be made more specific for longer periods to reduce the risk that those who work in them, and do such a good job, may move elsewhere.

The Budget will be of enormous benefit to a company that we are privileged to have in my constituency—Huntleigh Nesbit Evans, the major manufacturer of NHS beds and trolleys. Those of my constituents who are employed there will be reassured by the long-term commitment to a 7.5 per cent. growth in health spending.

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I want to comment briefly on social care. My local authority, Sandwell, welcomes the commitment on 6 per cent. growth. It believes that that should correct the difficulty that it, in common with most other major metropolitan authorities, has faced over the past few years in balancing its social services budget. It has a tradition of working in partnership with other agencies—it has received Government commendations for doing so—and welcomes the extra flexibilities and allowances that will be given to those who demonstrate good practice in that.

However, I have reservations about the penalty system for local authorities that are unable, for various reasons, to meet their targets on bed blocking. Although I can understand the Government's reasoning as regards the need to take action where partnership working is not taking place, in some areas local economic conditions and the scale of local private provision are such that local authorities have little control over the matter. Any penalty programme should be applied sensitively.

My constituency is crying out for the measures in the Budget. It is a Budget that will help the local economy; a Budget for the middle and lower income families who predominate; a Budget for better health care, which is greatly needed; a Budget to provide the basic requirements for a good standard of living for those on lower incomes; and a Budget for small businesses to develop in the area, which has suffered so much in the past. Above all, it is a fair Budget for constituencies like mine.

7.57 pm

Mrs. Angela Browning (Tiverton and Honiton): I want primarily to deal with the aspects of the health service that are covered by the Budget. We have heard a lot today about the amount of taxation that will be raised specifically for the health service over a five-year period and the reason why the Government felt it necessary to focus the Budget on one particular Department.

Labour and Liberal Democrat Members have sought to paint the Conservative position as being that we are not in favour of spending more money on the health service and that even if we were, it would not be publicly funded money. That is not true. Our position is not that we are not willing to spend more money—or even more public money—on it, but that we believe that, over the past five years, the Government have spent more money on health without delivering improvements. We therefore question the proposal that the tax increase in the Budget will do so.

I want to be constructive in my comments by addressing how the NHS is organised, especially in relation to its management and what needs to be done to make it more effective and to help it to deliver the benefits that we all, as constituency Members, want for our constituents.


In putting that on record, I have cited the comments of the leader of the Conservative party in a consultation pamphlet that was published only this month as part of a

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genuine attempt to find solutions to problems and to put before the British electorate policies in our name that have been well researched, tested and costed.

Mr. David Miliband (South Shields): Will the hon. Lady give way?

Mrs. Browning: I hope that the hon. Gentleman will forgive me, but those of us who are speaking at the end of the debate agreed to limit our speeches, and I shall try to finish speaking before my 15 minutes are up.

I wanted to begin by putting the Conservative position on the record. I shall now concentrate on the current position of the health service. It is not the same as it was in 1997, when the Government took over. Ministers have made a plethora of pledges and announcements, sometimes accompanied by money. Despite that, the health service has not delivered. The Labour party's 1997 general election pledge card stated that it would reduce NHS waiting lists by treating an extra 100,000 patients as a first step by releasing £100 million saved by cutting NHS red tape. We know that waiting lists did not decrease, but grew by almost 100,000 before they started to fall. There is more, not less red tape now. I shall give some examples of red tape that could be hacked not only to make savings but to affect people who work in the health service.

I worked in the health service under the previous Labour Government, when we were all crossing picket lines to get into operating theatres. [Interruption.] It is a matter of record. Nowadays, more and more health professionals at all levels find increasing bureaucracy. More decisions are made centrally and more systems and initiatives are set up while Ministers and other bureaucrats try to influence the way in which health professionals carry out their jobs. That not only detracts from resources at the sharp end, but has a terrible impact on the morale of people who work in hospitals and in the health service. I shall give a couple of examples.

I raised one example with the Secretary of State at Health questions. It was brushed aside, which is a typical occurrence at Health questions, and the Secretary of State implied that I was expressing only my view. I was not; I was conveying the view of doctors in my constituency. The problem that I raised must be sorted out if improvements are to be made.

In the past, when GPs believed that the condition of a patient on a waiting list had deteriorated, they had the opportunity to refer the patient back to a consultant because they believed that he should be seen again and perhaps be treated more quickly because, in their clinical judgment, the consultant should be made aware of the new circumstances.

A GP in my constituency wrote to a hospital consultant, and received a reply, which stated:

When that is unscrambled, it means that the consultant is telling the GP, "If you think your patient is deteriorating, don't refer him to me because I'm not going to do

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anything. Although I'm a consultant in a hospital, with all those years of training and experience, I am acting not on my clinical judgment but on a directive from central Government through the hospital management. If I fail to do that, there will be financial penalties."

In practice, financial penalties mean that hospitals that fulfil their waiting list targets will receive an additional sum of money that they can spend on patients. However, although some patients get treated more quickly, others who clinically deteriorate are not seen. Such micro-management and micro-interference with the judgment of GPs and consultants about what is right for an individual patient at any time in a specific hospital or on a waiting list does not deliver for patients. It makes GPs and consultants feel that they are not doing the job for which they trained because the executive decisions are not left to them. Instead, those decisions are second-guessed and orchestrated by others who do not have their experience.

We have discussed morale among medical professionals. I include nurses in that discussion because there is a big problem with nursing, not least our reliance on bank nurses. Of course, they have a use, but it is not the best way to proceed either economically or from a patient's point of view. Continuity of nursing on the ward helps to provide better patient care. Anyone who has worked on a hospital ward will appreciate the obvious advantages of continuity of care by a team of nurses who regularly deal with the same patients as they go on and off duty.

If we start to lose the professionals in our medical services and in our NHS, while we may successfully recruit new people, we will reach a point when we have lost a vast number of people with many years' experience. They will have left the system by early retirement or taking up other jobs. That will leave the health service, like all other public services, with a bank of professionals who tend to be younger but less experienced. We will not have the vital mix of experience that we need for continuity and training.

The way in which the money that the Budget allocates is spent and some key changes are important. A great orchestrated audit that will not kick in for another four years, and certainly not until after the next general election, is surely not the priority for the additional money. The Government should make practical suggestions for resolving the problems on the wards, low morale among medical staff and what patients perceive as simple matters. For example, people should be able to go into hospital in this country for general surgery and feel confident that they are not at risk from hospital-acquired infections.

I appreciate that there is an argument about prescribing antibiotics, but claiming that all MRSA is down to that problem is a smokescreen. I know from my constituency lists and debates in the House that people fear MRSA and that they acquire it in hospital. One constituent is confined to a wheelchair, but was not when he was admitted for a routine hip operation. He got MRSA; that was his experience of a hospital in this country. We must use the extra money to deal with such matters. It is worrying that despite such experiences in the NHS, so many resources are spent on unnecessary administration or double checking.

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I support accountability but much double checking in the NHS appears bureaucratic and unnecessary. I received a report about GP appraisals, which will be introduced in my constituency. In principle, I agree with GP appraisals, but do they require so many resources, so much administration and bureaucracy?

A newsletter, which provides an update on GP appraisals, states:

That is really out of this world. Surely to goodness our local medical committees should not have to get involved in something so complex and bureaucratic—which must, by definition, take up valuable resources, not least doctors' time—to set up a system that is so bureaucratic.

My worry about endorsing this Budget is not about the principle of spending more money or about the fact that the money is coming from the public sector; it is that there is no confidence in the Government to deliver. Throughout the public sector, there has been an inability to deliver. [Interruption.] It is not rubbish. If the House will bear with me, I shall find the piece of paper that I am looking for. Ah, here it is, to my right. I do not often move to the left.

Let me conclude with this comment about the Royal Bolton hospital, which was written by a 73-year-old gentleman. He says:

This was written by a former Labour Member for Bolton, Mr. David Young. He goes on to say:

That indictment, in a letter to the Daily Mail published only last month, shows only too clearly that the Government have got to start taking delivery seriously. The health service has deteriorated under their stewardship. That is a reflection not on the people who work in it, but on the Government's ability to manage and to deliver. I am very sceptical about their ability to deliver this money in a way that will make a difference to the staff and to the patients who rely on our NHS.

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