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Mr. Mark Hendrick (Preston): What are the right hon. and learned Gentleman's targets for the national health service charges to which my right hon. Friend the Chief Secretary referred?

Mr. Howard: I am astonished at the extent to which Labour Members constantly refer to charges in the health

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service. In the Chancellor's speech last month, he said that it is entirely unacceptable for the sick to pay for being sick. Are he and other Government Members completely unaware that, last year alone, about 250,000 people who had no sort of insurance cover had to pay for their own operations because they could not face the delays that they would have experienced with the national health service, which is in crisis under the Government's stewardship?

Mr. Boateng rose

Mr. Howard: No, not at the moment. The Chief Secretary will have to wait.

Gone is the work and pensions target for promoting security and independence in retirement for tomorrow's pensioners. After the Chancellor's pensions tax, the crisis in pensions and the lowest ever savings ratio, it is not hard to see why.

What became of the Chancellor's promises over the past five years—there have been enough of them—to provide "skills for work" to invest

What happened to the right hon. Gentleman's promise to provide "new support for skills"? Does he agree with the Government's better regulation taskforce, which said last week that Government delivery of local economic development and skills training is a bureaucratic nightmare involving a maze of more than 50 Government agencies, Departments and other organisations, and 52 funding streams? Why does a training co-ordinator have to fill in up to 26 pieces of paper before starting a trainee on a work-based programme? Is that the way to encourage skills?

What of the targets that remain? The Government describe them as SMART—specific, measurable, achievable, relevant and timed—so let us see how smart they are. The Department of Trade and Industry has the target of bringing United Kingdom levels of competition and consumer empowerment and protection up to those of the best by 2006, but the level of the best is not defined, so how will the DTI or anyone else know whether consumer empowerment has reached the required level by 2006?

Roger Casale: On the subject of "how smart you are", may I ask the right hon. and learned Gentleman a question? Does he believe that it is possible for public service reforms to be successful if those reforms are not supported by appropriate financial resources? How does he imagine that those financial resources can be released if the share of Government spending were reduced to 35 per cent. of gross national product, as he wishes to do?

Mr. Howard: If the hon. Gentleman attends these debates, he will know perfectly well that I do not wish to do that. [Interruption.] Does the Financial Secretary to the Treasury wish to intervene? I do not wish to do as the hon. Gentleman suggested, and I have answered that question many times before.

James Purnell: I have attended many of these debates, and I find it impossible to find out what the right hon. and learned Gentleman's position is on tax and spending because he will not tell us, so I have had to read articles

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in which he has discussed his position. When asked whether he would match our NHS spending in the last Budget, he told The Scotsman:

That was six months ago; now he will not even say whether he will match our NHS spending increases. What has happened? Have our reforms been so successful that the NHS is not now in crisis, or is his agenda really about tax cuts and reducing public spending to 35 per cent. of gross domestic product? He will not admit that because all he is interested in is spin.

Mr. Howard: If the hon. Gentleman really thinks that the Government's attempts to reform the NHS have been successful, he must be living on a different planet. What I said in the article that he quoted is entirely consistent with what I am saying now. Our spending plans for the NHS will be derived not from the Government's failed policies on the NHS but from our policies on health care, which will deliver the ideals of the NHS and succeed.

Several hon. Members rose

Mr. Howard: I want to return to the Government's targets. I quite understand why Government Members do not want to talk about the targets, but I do.

The hon. Member for Kingston and Surbiton (Mr. Davey) referred to the targets set by the Foreign Office. The Foreign Office is meant to contribute to a 70 per cent. reduction in opium production in Afghanistan within five years. Is achieving that really within the power of the Foreign Office? If not, how on earth can it be judged to have succeeded or failed?

What of the framework the Chancellor established for his targets? He solemnly told the House in 1998 that public service agreements were a contract for the renewal of public services and that results would be demanded. He said:

So how many Departments have not had money released because they did not keep to their plans? After all, the then Chief Secretary, now the Secretary of State for Transport, said:

Last week, the Chancellor made no reference to the possibility of funds not being released. Treasury officials at a sitting of the Select Committee could not think of a single example of a departmental budget that would be different if that Department had performed better or worse against its PSA targets.

When the Chief Secretary to the Treasury was asked by the BBC whether any Department had yet had money withheld as a penalty for not meeting its targets, he replied:

Not only has that policy been dropped, but the current Chief Secretary does not even know about it. He has been at the Treasury for more than a year and no one troubled

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to inform him of that policy, which was meant to be at the heart of the Chancellor's strategy to improve the public services.

It is little wonder that the Chief Secretary, in his Financial Times interview this morning, said:

Andy Burnham (Leigh): A moment ago, the right hon. and learned Gentleman referred to Conservative health policies. To my knowledge, the only one that has been explained to us so far was the four-phase policy that the hon. Member for Woodspring (Dr. Fox) outlined a few months ago. Phase 1 is to persuade the public that the NHS is not working. Phase 2 is to convince people that the NHS will not work. Phase 3 is to introduce themes on learning from other countries. Phase 4 is to produce policy detail—ultimately the most difficult phase. Will the right hon. and learned Gentleman tell us which phase the Conservative party has reached?

Mr. Howard: May I give the hon. Gentleman a little advice? Next time, he should ask his Whips for better material. He and they need to do rather better than that.

I know that Labour Members do not want us to talk about their targets, but I do. What other sanctions are in place when the targets are not achieved? How are Ministers held to account for results? We have looked at the fate of some of the Cabinet Ministers from 1998 whose Departments now have the fewest targets described as "met", "met and ongoing", or "on course". What has happened to the Cabinet Ministers with the worst records in meeting their targets?

It is true that one of them—the then Secretary of State for Health—was indeed punished for his failure. He became Labour candidate for Mayor of London. Another Minister who achieved fewer than seven in 10 of his own targets was the Chancellor himself. As far as we know, he is still in post. The third, the Minister who achieved one of the worst results of all, was promoted to his current post of Home Secretary.

Meanwhile, one Cabinet Minister achieved in full more than nine out of 10 of the targets set. He had the best record of the lot, so surely he must have been promoted. Well, actually he was not—he was sacked. The right hon. Member for Islington, South and Finsbury (Mr. Smith) now sits on the Back Benches—a permanent reminder to his colleagues of the danger of over-achieving on the Chancellor's targets. So there we have it. So much for the Prime Minister taking the Chancellor's PSAs seriously. So much for their claim to reform.

Is it any wonder that Professor Colin Talbot, in evidence to the Treasury Committee, described the PSA mechanism as deeply flawed and as "a topdown, opaque process"; or that Tony Travers of the London School of Economics says that the targets represent "rigid centralisation"? Is it any wonder that even the BBC, on the night of his spending review statement, compared the Chancellor's approach with the 10-year plans of the Soviet Union?

Is the Chancellor aware that the Chairman of the Select Committee on the Treasury has said that there are so many targets that it reminds some people of Stalin's Gosplan?

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Is the Chancellor proud of the fact that he is becoming known as Gosplan Gordon? Why does he not understand that the result of that ever-tightening leash is that innovation and improvement are being strangled?

In today's NHS, doctors cannot treat patients in pain because they are not in the right Government category to fill empty hospital beds. Instead of recruiting an extra 2,000 GPs by 2004, as the Government promised, in each of the last two years, they have managed just 18.

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