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Rob Marris (Wolverhampton, South-West): Will the hon. Gentleman give way?

Mr. Barker: I am afraid that I will not.

Scaremongering and sabre rattling serve only to stifle genuine debate. Sadly, the hon. Member for Leigh (Andy Burnham) was not listening to the speech of my hon. Friend the Member for Woodspring (Dr. Fox); the American model is not on the table and forms no part of the examination that the Conservative party is undertaking. The hon. Member for Leigh lowered the tone of the debate by pretending that it does. Whatever differences emerge between the Government and the Opposition, we must always remember the day-in, day-out commitment of the thousands of people toiling in the NHS, trying to make it work.

I have many concerns about the Chancellor's ability to make his massive cash injection work and achieve the results that we all desire, but nothing is of greater concern to me than the state of cancer care services, particularly the crisis in radiotherapy treatment. The United Kingdom has an appalling survival rate for a range of cancers compared with many of our continental partners. In Scotland, where funding as a percentage of gross domestic product has already reached levels previously targeted by the Prime Minister, survival rates for cancer and coronary heart disease are among the worst in the UK. However, it is the plight of cancer patients in my constituency that most concerns me.

Shortly after Christmas, I was alerted to the case of a lady in my constituency who, after surgery for breast cancer, faced a wait of 16 weeks for radiotherapy treatment, whereas her surgeon had recommended that she begin radiotherapy within four to six weeks. Sadly, that has proved not to be an isolated case. Not only are there other women in Bexhill and Battle who have to wait 16 weeks, but others soon emerged who have to wait 18 weeks and 20 weeks, and last week, I spoke to a lady in Battle who must wait 24 weeks. She had surgery two days after Christmas for what her surgeon described as a particularly virulent strain of cancer, but she has been told that she cannot commence radiotherapy treatment at the oncology centre at Maidstone until late June.

No wonder the president of the Royal College of Radiologists, Dr. Dan Ash, writing to the general manager of the Kent oncology centre on 8 March, stated:

He continued:

Those are strong words.

I spoke earlier to the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper), and I am grateful that she agreed to meet me and colleagues from my area next month to discuss this grave matter.

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Despite the desperate pressure on the radiotherapy equipment—the linear accelerators—all too often those expensive machines lie idle outside office hours because there are not the staff to man them. The recruitment and retention crisis in radiotherapy is putting lives at risk. It is no good the Government blithely saying that historically we have not trained enough qualified staff and it will take years for more to come through, when a third of those who qualify as radiographers do not go on to practise radiotherapy.

The NHS must become more flexible and able to meet the different local demands of both patients and staff. In an age when we can do our supermarket shopping on a Sunday and our banking round the clock, it seems extraordinary that cancer care and so many other disciplines and services in the NHS are available only on a nine-to-five regime. I hope that the Chancellor will ensure that the money announced in the Budget, unlike the investment that has gone before it, will find its way to the front line and ensure that we smash the nine-to-five culture in the NHS and move towards a real 24/7 health care service that reflects the way patients choose to live their lives in the 21st century. I fear, however, that that may not happen.

I should like to say more, but I know that other hon. Members want to get in, so I shall draw my remarks to a close. With the Budget, the Chancellor has set a clear course that will ultimately present the British electorate with a clear choice: to retain in aspic the model of health care that for the past three decades has singularly failed to keep pace with our aspirations and ambitions for British health care, despite the dedication of those who work in the system, or to open our minds to the possibilities of standards of care and service that prevail in the rest of modern Europe.

I believe that the Budget asks the country to pay up with more tax, but singularly lacks the guts and vision to make the reforms necessary to give this country the world-class health care that Britain deserves.

8.54 pm

Mr. David Miliband (South Shields): We have had an interesting debate over the past five or six hours. It is not often that we get to hear two former Conservative Prime Ministers-in-waiting showing off their debating skills—or three former Conservative Prime Ministers-in-waiting, if we include the shadow Chancellor. They may be Tories, but at least they are classy Tories, as they showed this afternoon. The contrast with the pitiful Budget response of the Leader of the Opposition last week should set Opposition Members thinking and should also give Labour Members pause for thought.

I am very pleased to be able to contribute to this debate, because I think that the combined effects of last year's general election and last week's Budget have shifted in a distinctive and important way the course of British politics. I want to focus my remarks on two points: first, the change in the political terms of trade engineered by a Government who have altered not only the size of public spending, but its composition, moving away from economic failure and towards public investment; and, secondly, the challenge of delivery in the health service.

To understand the change that has occurred, we need a bit of political history. In 1979, only a month after the general election of that year, Sir Geoffrey Howe came to

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the House and set out in his first Budget speech the new philosophy that would govern public policy in Britain. He spoke of the need to reward work and reform collective bargaining, but he also set out two key principles of the approach that came to be known as Thatcherism that are particularly relevant today. First, he said:

Secondly, he argued:

I believe that last week's Budget, building on five years' experience in government, challenges those two arguments at their very heart.

First, Labour Members do not accept that greater choice requires a smaller state. It depends; if a smaller state means poorer education or a worse health service, it means less choice. If it means cutting training schemes, reducing employment advice or cutting child care, it means that choice is narrowed, not extended. Secondly, we do not accept that commerce and industry can prosper only if public financing is reduced or that it will necessarily prosper if that happens. Again, it depends; if support for research and development is reduced, so is industrial innovation. If education is reduced, so is the quality of production and design. If health cover is reduced, commerce and industry pick up the bill for what the CBI accepts to be the £11 billion annual cost of sickness and ill health.

It is wrongheaded to believe that more spending in itself promotes choice or helps industry. I think that Labour Members cured ourselves of the folly of that position some time ago. However, it is frankly absurd not to recognise that the Government have the responsibility and capacity to contribute to the good society. In that sense, the composition of public spending is as important as the amount in terms both of its effectiveness and the public's willingness to tolerate the taxes that are necessary to pay for it. Keynes's famous remark about tax being the membership fee of a civilised society is undermined if the money is not well spent.

I have asked the Library to compare the composition of public spending in the first term of the Conservative Government after Sir Geoffrey Howe's 1979 Budget with that in the first term of this Government. The comparison is rough and ready, but it is illuminating none the less. Under both Administrations, spending in real terms increased by 6 per cent., but there the comparison ends. Under Conservative stewardship, debt interest payments increased by 6 per cent., but under Labour, they fell by 18 per cent. Social security spending rose by 20 per cent. in four years under the Conservatives to pay for unemployment; under Labour, it has risen by 1 per cent., above all to cover pension and child benefit increases.

The figures on what I would call productive investment in education and health are a mirror image of the figures that I have just given. Education spending rose by 3 per cent. in real terms under the Conservatives; under Labour, it rose by 15 per cent. Under the Conservatives, health spending rose by 13 per cent. in real terms; under Labour, it increased by 19 per cent.

So it was the Conservative party that cut choices and constrained industry. Tax rises and penal interest rates, combined with spending cuts on productive investment,

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left businesses in bankruptcy and ordinary people without weapons in the fight against unemployment. All that was happening with public spending heading for 45 per cent. of national income and, according to table C24 in the Red Book, total managed expenditure that was higher every year than in any year under Labour.

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