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Mr. Bercow: The hon. Gentleman has had one opportunity. He made a frightful, blithering mess of it. He can hardly expect me to have another go at indulging him—that I will not do.

Without change, we will not see the difference. In Scotland—

Mr. Kevan Jones: What reforms would the hon. Gentleman propose, in line with the tax plans that he does not intend to lay out tonight? [Interruption.] I accept his point about the election, but can he give a commitment that the Conservative party is committed to health care free at the point of need?

Mr. Bercow: I do not know how many times one has to underline one's commitment to a comprehensive national health service which is available to people on the basis of clinical need and not on the strength of ability to pay. I have said it many times before; I am saying it again. I am reiterating the commitment of the Conservative party to a fundamental, wholesale and searching review of the basis of delivery and funding of health care in this country. It could not be more explicit. It is not my fault that the intervention of the hon. Member for North Durham (Mr. Jones) was spoiled by the sedentary interjection of his hon. Friend the Member for Ealing, North (Mr. Pound).

Mr. Kevan Jones rose

Mr. Bercow: No, I will not give way again. I want to develop the arguments.

The Chief Secretary claims that the Bill will secure improvements. As I said, every year we see no reform, no change, no improvement; we see only the higher taxes which are both the instinctive response and the favourite sport of Labour Governments, new as well as old. Without change, as I said, we will not see the difference.

In Scotland, Wales and Northern Ireland spending on health is much higher than it is in England, but in key respects the service is getting worse. In Scotland over the

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past five years, spending has risen by 28 per cent. in real terms, but over exactly the same period the average waiting time for an out-patient appointment has risen by 25 per cent.

There could hardly be a more graphic testament to the sheer inadequacy of the status quo. The chairman of the British Medical Association said recently:

That change is essential if we are to translate care from a word to a deed. Even the Health Secretary has blurted out the worst kept secret in Britain—that the national health service is the last great nationalised industry.

Waiting lists and waiting times are rising. The number of care home beds is falling. Bed blocking and cancelled operations have soared. Mixed sex wards abound. Doctor and nurse shortages put us to shame in the league tables of the Organisation for Economic Co-operation and Development and of the European Union. Patients travel as far as South Africa for treatments that should be available here.

Mr. Bryant: Will the hon. Gentleman give way?

Mr. Bercow: No.

In 2000–01, the Department of Health failed even to spend £693 million that was allocated to it by the Chancellor. There are now more bureaucrats in the NHS than beds, and the morale of NHS staff is at an all-time low. Waste and fraud cost the service £10 billion a year.

Mr. Tam Dalyell (Linlithgow): Will the hon. Gentleman give way?

Mr. Bercow: Of course I shall give way to the Father of the House.

Mr. Dalyell: Will the hon. Gentleman help us with his credentials for being quite so certain about what is happening in Scotland, as I know personally that many improvements have been made there?

Mr. Bercow: I always listen carefully and with respect to the hon. Gentleman. My assessment is that the service in Scotland has not improved as one would expect consequent upon the increase in resources that it has enjoyed under his Government. I say to him that I have not depended on advocacy, but grounded my case in evidence. I have referred to what struck me—and I hope would strike him—as the significant fact that in precisely the same period as spending on health has increased by 28 per cent. in real terms, there has been a 25 per cent. increase in the average waiting time for an out-patient appointment. That is the reality; it may not seem natural and might not have been expected, but it is the consequence of the mismanagement of our national health service and the defects of the status quo that reigns within it.

There are now more bureaucrats than beds in the NHS—[Interruption.] These points are important, so I shall repeat them. The morale of NHS staff is at an all-time low and waste and fraud cost the service £10 billion a year. All too many wards are breeding grounds for MRSA—methicillin resistant staphylococcus aureus—and the Public Accounts Committee found but

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18 months ago that infections caught while in hospital killed about 5,000 people a year. Perhaps most tellingly all, one's chances of surviving cancer are markedly worse in the United Kingdom than in many other industrialised countries.

What was the response of the Secretary of State for Health to the miserable catalogue of underperformance that is failing the British people? The night before his statement to the House on the NHS plan, according to the 21 April edition of The Sunday Times, the right hon. Gentleman sat in his office with colleagues with a collection of papers strewn all over the place, munching on Marks and Spencer ready-made pasta and sweating over what he could possibly say to the House fewer than 24 hours later. Professor Alan Maynard, the eminent economist from York university, dismissed the Government's proposals for reform as "horse manure".

I shall not go as far as that because I am a charitable soul, as you can testify, Madam Deputy Speaker. However, what we do know is that the extra nurses, doctors, hospitals and primary care centres about which the Secretary of State for Health talked are only expected, not promised, and are not even expected until 2008. We know that he merely hopes that the legislation to establish the Commission for Health Care Audit and Inspection will be introduced in the next Session and that the first inspection report is unlikely to materialise before 2005.

We know that the Secretary of State has not even begun to consult local councils on the plans to make them responsible for bed blocking. He wants to pass the buck from a Government whose fault it is to local government, whose fault it is not, and he has not even had the decency to let the fall guys know of his plans to stitch them up. What a shower these Ministers are.

Mr. Ian Liddell-Grainger (Bridgwater): My hon. Friend is no doubt aware of the reduction in beds—256 of them have gone in Somerset—and that bed blocking is now a major problem in rural areas and is getting worse. Does he agree that unless the Government take action, care homes in rural areas will disappear and people will have to go into hospitals, as there will be nowhere else to go?

Mr. Bercow: My hon. Friend is entirely right; he speaks from personal experience. It is only to be hoped that even now, at the 59th minute after the 11th hour, the Chief Secretary might be prepared to reconsider the matter. I am sorry to say, however, that he has specialised in putting his own case even if that has meant distorting the statements of others. For example, he referred to Anthony Goldstone and his supposed verdict, but did not quote all his remarks. Of course, Mr. Goldstone, whom he prayed in aid, said:

Mr. Goldstone indicated that he did not think that the Government were going about things in the right way. What a pity that the right hon. Gentleman chose not to—or inadvertently omitted to—give the full context and flavour of Mr. Goldstone's remarks.

While the Secretary of State for Health ducks, dithers and delays, damage is done every day. The Bill offers no

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answer. It shows that the Government have a closed mind and refuse to learn from abroad. To adapt the celebrated and justified verdict on the Wilson Government,

6.16 pm

Vernon Coaker (Gedling): I am very pleased to follow the hon. Member for Buckingham (Mr. Bercow) and to have the chance to respond to one or two of the points that he made. I think that we are taking part in an historic debate in which we see clearly the divide between his side of the House and ours—it was made plain in his speech. It is historic as for the first time in a number of years, we have seen a clear argument put for the introduction of increased taxation to pay for improved public services.

With respect, I thought that the hon. Member for Buckingham made a strategic and tactical error when he referred to a range of occupations and professions and specified what the taxes would cost people in each of them. His mistake and that of the Conservative party is that they have not realised what Labour Members realise, which is that, far from seeing that cost in the old way in which they saw tax—money that they paid without getting anything—people are now saying that they want to invest in their public services. They have accepted the argument that was advanced at the last election for investment and reform in our public services. They now want to see that investment and they understand and realise that they will have to pay for it. The point is not what tax people pay, but what they get for it. The Government will be judged not on the amount of tax that we are asking people to pay through the increased national insurance contributions, but on whether they see the results of that increased investment that we are putting into the national health service.

The shift in the debate has been huge. I remember standing for election and arguing the case for increased taxes to pay for improved public services a number of times only to lose significantly. It is a great credit to our Government, the Treasury team and others that we have now shifted the debate away from tax cuts and on to investment and reform as the winning combination. That is a significant shift in our political culture.

We will pay for massive increases in health spending of 7.4 per cent. in real terms in the next five years. As my right hon. Friend the Chief Secretary said, the amount spent will shift from £65.4 billion this year to £105.6 billion in 2007 and 2008. Those are staggering figures—huge figures—but people accept the need to pay more because they want new hospitals, shorter waits, new drugs and a modern NHS with more doctors and nurses.

It is a mistake on the part of Conservative Members to rubbish the NHS as it currently stands. To say that there has been no improvement in the NHS over the past few years completely belies people's experience. It is not true to say that it is a complete shambles and that nobody receives decent service, decent treatment or a decent operation—every single day, tens of thousands of people go to hospital or to their doctor and receive treatment that they are proud to be able to receive and about which they write letters of thanks to ward staff and doctors.

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We need more investment, and significant problems remain to be addressed, but to say that every single hospital, every single surgery and every single operation goes wrong and is a disaster is not true, and it is not the experience of ordinary people.

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