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Linda Gilroy: As the hon. Gentleman is highlighting the shortage of doctors, will he apologise to his constituents, my constituents and those of all hon. Members, given that it takes seven years to train one?
Dr. Fox: The logic of the hon. Lady's question is rather dubious, as the Government constantly trumpet the increased number of GP trainees. By her definition, all of them must have started their medical education under the last Conservative Government. If there is an increase in the number of trainees, that is nothing to do with the Government. The problem with the Government is that those trainees do not want a career in general practice because morale is constantly undermined by interference from politicians in clinical freedom. GPs have less ability to do what they think is right, and they are now being taxed more into the bargain, notwithstanding the fact that they are more likely to be sued. All those elements contribute to general practice being much less attractive as a career, and responsibility for most of them lies at the door of the Secretary of State. I suggest that the hon. Lady saves her questions for the wind-up this evening.
The Secretary of State told us this afternoon about the Government's closed mind. We have had many indications of what he described as their closed mind. That is perhaps the most disappointing aspect of the Government's policy. To make matters worse, the Chancellor's closed mind was forced on the Department
That closed mind, which the Secretary of State mentioned, prevents the Government from dealing with four of the biggest problems in the national health service. For all the talk, it remains hugely centralised. Devolution, which was written and directed in Whitehall, is a sham. The primary care trusts will have their budgets decided by the Secretary of State. He will set the budgets, decide the performance targets and withhold funding as he sees fit. Labour's concept of earned autonomy is an oxymoron; it means that people can do what they like, but only if it is what Labour likes. The system also remains hugely politicised. Far too many appointments are made according to political allegiance rather than health expertise. Since the introduction of the so-called independent Appointments Commission, the number of appointments given to those who expressed an allegiance to the Labour party has gone up. The system is becoming even more politicised than it was when it was being criticised by Dame Rennie Fritchie only a couple of years ago.
Perhaps most worrying is the Government's failure to deal with lack of choice in the NHS. All too often in the NHS, patients are seen to service the system, rather than the system being seen to exist to service the patients. What the Government mean by choice is extremely unclear. The Secretary of State told the House:
Since the Budget, desperate Ministers have described the NHS as the world's best insurance policy, so let us examine the case for that assertion. The first reason why the NHS is not the world's best insurance policy is that consumers cannot tell whether they are getting value for money. In Germany, whose system the Secretary of State
Let us imagine telephoning the world's best insurance company for car insurance. We might be told, "We can't say how much it will cost youwe'll take an unspecified sum directly from your pay packet each month. Although we will promise you fully comprehensive, high-quality, universal coverage, we won't detail what rights you have to expect that, and if you make a claim, we might not get around to the repair for 15 months, especially if your car's an older model, and even then you'll have no choice of repairer." How long would such a company stay in business?
Clive Efford (Eltham): The hon. Gentleman is fixated on people on low incomes, but when we talk about a universal insurance policy, we have chronic illnesses in mind as well. Can he tell me about one insurance policy that covers chronic illnesses?
Dr. Fox: The German social insurance policy ensures that people get access to chronic disease management far better than they get in the United Kingdom. The Chancellor says that we cannot even consider other systems because of the effect that they would have on the poor and vulnerable. I say to him, go to France, Holland or Germany and see what happens to the poor and vulnerable of those countriesthey get far better quality care than people in many parts of the United Kingdom.
There are real doubts about the NHS's ability properly to absorb spending increases of such magnitude within such a time scale. The Conservatives will continue to examine the ways in which other countries organise and fund their health care, to see what lessons we can learn for the sake of the people of the United Kingdom. As the King's Fund puts it:
Dr. Fox: It is entirely characteristic of the party with no arguments but lots of volume to adopt such an approach in the House. It knows, as do the voters of this country, that the Government will ultimately live or die as a result of the success or failure of producing not good, not better, but world-class health services by the next election. We will monitor their performance; we will support them when we think that they are right, and produce alternatives when we think that they are wrong. The push for deeper reform must continue. The life and death of the Government is one thing, but failure to reform is a matter of life and death for our fellow citizens and is of a completely different order of magnitude.