Budget Statement

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Ian Lucas: Will the hon. Gentleman give way?

Adam Price: No, I shall conclude, if I may.

Most damningly, there is, as the Secretary of State for Transport, Local Government and the Regions put it so well, a lottery of location under this Government. Where one lives, works and goes to hospital, and what kind of family one is born into matters more for one's chances in life than when new Labour came to power. Britain has divided further under this Government, and the responsibility lies with the Labour party.

12.9 pm

Mr. Jon Owen Jones: Thank you for calling me early on, Mr. Griffiths. I shall endeavour to speak briefly and certainly for less time than the hon. Member for East Carmarthen and Dinefwr (Adam Price), although I hope to say more.

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One of the Committee's sittings last year took place following the Chancellor's Budget and the publication of the first Wanless report. I discussed the great expectation set out in that report, the difficulties involved in raising sufficient resources, and the issue of how to deal with the problems of choice and possible charging in the health service. Now that we have seen the second Wanless report, we can conclude that some of those big decisions have been made correctly. As a country and as a Government, we have decided to make a large-scale investment in the health service, and to fund it directly through taxation in the only cost-effective way, which is also less disruptive than the mechanisms that have been used in other western European countries. However, it is important to admit that there are difficulties with the system that we have chosen. The advantages outweigh the difficulties, but we do need to address the difficulties.

Because the systems in other western European countries are diverse and funded by various mechanisms, it is much easier to introduce or maintain competition and choice in those systems than in our health service. That should not be the crucial argument, but it should make us consider what mechanisms we can employ that will provide sufficient responsiveness in our health system. I am sure that that is why the Wanless report argues for a rigorous and regular audit to ensure value for money. People are being asked to give a vast amount to the health service through taxation—the opinion polls show that they are glad to give—but they want to see that the money is being used wisely and delivering the goods.

I shall give an example of the relative lack of responsiveness in the health service as it is currently managed. It is anecdotal, but something that I am sure many people in England and Wales will have experienced. About five months ago, I received a phone call in the early hours of the morning from a very close relative who was in an accident and emergency unit in the Royal Gwent hospital, and I went to be with my relative. He had been waiting quite a long time to see a doctor, but that is not the issue that I wanted to raise—that is a question of resources, which we are dealing with by investing extra money. He was distressed, not only because he had been waiting, but because of the conditions at the hospital and the lack of cleanliness in the waiting facilities, especially the toilets. When he was eventually seen by a doctor, the medical care that he received was superb, but by the time we left, I was distressed. When I visited the toilets next to the lifts in the hospital, I noticed that they had obviously not been cleaned for many months, if not years.

That evening, I went to a party meeting, held in Gladstone school. I was staring down at the floor thinking about what I was going to say, when I noticed that the floor was spotless. Later, I spoke to the caretaker—a very good caretaker—who showed me that the toilets were also spotless. There is no difference in the resourcing of the two places. Direct taxation funds both the school and the hospital, and we are not spending more money on cleaning the school than on cleaning the hospital, but there is a distinct difference in the responsiveness of the two

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institutions. What would happen if the school facilities were as dirty as the hospital? First, the governors of the school, especially the parent governors, would be incensed that their children were working in such conditions and would do something about it. That responsiveness is not in the hospital. One does not have that direct accountability to people who have a long-term interest in the hospital.

If, for some reason, the parent governors did not do something about the cleanliness of that school, there is another mechanism of responsiveness. Gladstone school is near to several other schools, and parents would make a choice and not go to it. They would choose to go to other schools, which would be a limited choice, but far less limited than the one available to my elderly relative, who had no choice about which hospital he was going to go to.

Kevin Brennan: My hon. Friend knows that I, too, have a relative in that hospital, and another relative in another hospital in south Wales. Does he accept that the argument that he is making gives strength to some of the proposals from the National Assembly to bring control over the health service closer to both patients and units of the health service? That is an argument for closer local control.

Mr. Jones: It can be argued that way, but my experience of a wide range of locally controlled, committee-run organisations does not fill me with confidence that one always gets that level of responsiveness because one has a local committee. Committees should want to improve the responsiveness of the organisation that they run, but often they feel that they have ownership of it. Sometimes they see the easiest thing to do as pretending that the problem is not as great as it is. Much more often, they say that there is a problem, but it is because they are not getting funded properly. They claim that, for some special reason, they should have more money than the place down the road, and they claim that that is why they are not performing quite as well. That happens often but not always.

Julie Morgan: Does my hon. Friend accept that there may be an issue about the cleaning staff not feeling part of a team? That has happened in hospitals in some cases in which cleaning staff have been privatised and are not seen as part of the main team. Does he accept that the proposals coming from the National Assembly that hospital teams should be seen to include cleaners and porters may address that problem?

Mr. Jones: I hear what my hon. Friend says. I am sure that it is desirable that everyone who works in an organisation feels part of a team. Having said that, there is no excuse for a toilet in a hospital being filthy and not being cleaned. It is the responsibility of the people who run that organisation to make sure that that does not happen. All I am saying is that it is our responsibility as politicians to try to ensure that mechanisms, which are as responsive as they can be, are there so that those problems either do not arise or arise as little as possible.

I am sure that Wanless accepts that difficulty. That is why there has to be an emphasis on ensuring that

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there is an independent audit of how efficient organisations in the health service are, how they are delivering and what standard they are delivering. It needs to be independent from both politicians and managers of those organisations. Yes, we need resources, which are the first thing. I am delighted to endorse what my Government have done in putting in resources that I am sure that no other Government of any other party would have done.

Both the Chancellor and Wanless say that we have to have reform and rigorous audit, and I endorse that. We must ensure delivery and we must not hide behind excuses.

12.19 pm

Mr. Evans: It is a pleasure to take part in the debate on the Budget and its impact on Wales. I have listened carefully to all the contributions so far. I think that I listened to a different Budget from the one to which Government Members were listening. I am now a bit of an expert on bingo and micro-breweries around Wales, and all the other things that the Chancellor spelt out in detail in the Budget. He waited until the very end to freeze the tax thresholds. National insurance rose by 1 per cent. on employers and the self-employed. The sting was in the tail—right at the very end—when he explained how all the extra money was going to be raised.

We know about the money that will be made available to the national health service during the next five years. I look forward to the reannouncement of those figures time and again during the coming months and years when Ministers speak in Committees such as this. The big question mark was how the increase in funding would be paid for. A few months ago, in the general election campaign, the Government said that there would be no increase in income tax. They were a bit more coy when national insurance was mentioned. Now, we know why. [Interruption.] The hon. Member for Monmouth (Mr. Edwards) says from a sedentary position that they are different. For the vast majority of people there is no difference. I admit that there are differences at the edges, but for the majority the tax on their incomes will go up by 1 per cent. The thresholds for tax will be frozen, and people will pay substantially more.

Julie Morgan: The Secretary of State has already mentioned the Peter Riddell article in The Times this morning. Did the hon. Gentleman notice that in its poll, 54 per cent. of Conservative voters specifically supported the use of the national insurance system to fund the NHS?

Mr. Evans: I think that the hon. Lady will find that the vast majority of people in this country would want to see that taxation, whether through income tax or national insurance, effectively spent. That is what it is all about.

Huw Irranca-Davies rose—

 
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