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NHS Workforce and Service Development

Volume 450: debated on Wednesday 11 October 2006

We now come to the main business: the 18th allotted Opposition day, which is a debate on NHS work force and service development. I inform the House that I have selected the amendment in the name of the Prime Minister.

I beg to move,

That this House, while welcoming past increases in the number of doctors, nurses and other health professionals working in the NHS, is alarmed at the recent reports of up to 20,000 posts to be lost in NHS hospitals and cuts in training budgets; is deeply concerned about the lack of training posts for junior doctors; condemns the severe shortage of posts for nurses and physiotherapists leaving training; regrets the complete failure of the Government to remedy flaws in the implementation of the European Working Time Directive in its application to doctors’ hours; further regrets the unemployment of specialist medical staff; believes NHS services are being cut back as a result of both financial deficits and staffing shortages rather than in the interests of patient safety; and calls on the Government to ensure that the NHS fully utilises the potential of healthcare professionals available to the service.

The purpose of this debate is straightforward. The NHS is, in a real sense, its staff. The number and quality of health care professionals in the NHS is key to the quality of health care provided, and I am sure that Members on both sides of the House share a deep gratitude to doctors, nurses, therapists, scientists and health care professionals of all types across the NHS for their tremendous work. Improving the number of NHS staff is central to improving services.

Under the Conservative Government, the number of doctors increased by 23,000 and the number of nurses by 55,000. Under the present Government, according to the work force census, there are 33,368 more doctors, contrary to what the Government amendment says. There are 85,305 more qualified nurses and midwives than in 1997. The number of administrators has, of course, increased by 107,000. Under Labour, not only have the resources been badly used—according to the Office for National Statistics, productivity has fallen by 1 per cent. a year during the life of this Government—but now deficits are hitting those very staff. We know, and have debated, the scale of the deficits—today’s debate is not primarily about that subject—and the Secretary of State has had to admit not only that the deficit last year was £1.3 billion gross, but that it was higher than she had previously estimated. It is now £547 million net.

Those deficits across the country are directly impacting on services. Decisions being made for short-term financial expediency have a direct impact on those staff. It is on that issue that we want to focus today—the impact on the staff of the NHS and, by extension, on the services that they provide, of the mismanagement of finances across the NHS.

There is one Opposition policy of which we are aware—their wish, as they say, to share the proceeds of growth between investment in public services and tax cuts. Can the hon. Gentleman tell us how much money will be removed from the NHS budget as a result?

The answer is straightforward: no money would be removed from the NHS. On the contrary, what my right hon. and hon. Friends have said means that the NHS will be able to participate in the enhanced economic growth that will be the product of our economic policies, and so can deliver more resources for the NHS in the future. I know that it depresses Labour Members that the Leader of the Opposition has frequently said that he will give priority to the NHS and has expressed his determination not only to increase its resources but to give it freedom from day-to-day political interference. We have said all of those things, and the public agree with them. The hon. Gentleman has to understand that we are putting that forward not on the basis of political advantage, but because it is in the interests of the national health service.

Can the hon. Gentleman confirm that, despite all the cuts that he claims will be made, staff will be safe and no jobs will be lost under a Conservative Government?

I am interested in what the hon. Gentleman says. He will forgive me if I am wrong, but I think that his local hospital is part of the Mid Yorkshire Hospitals NHS Trust. Is that right? [Hon. Members: “Tooting.”] I beg his pardon. I will give way to him again if he cares to tell us how he thinks that the deficits at St. George’s hospital, Tooting, will be resolved other than by giving the NHS, including hospitals such as St. George’s, much greater freedom to enable them to use resources more effectively. Frankly, under this Government, that is not happening. Hospitals such as St. George’s are living under a regime of regulation and control, and the financial imposition of costs by the Secretary of State is causing them enormous damage. Perhaps he can comment on the fact that the Government admit that a 25 per cent. increase in the cost of hospital services in the past three years has eaten up all the money that has been provided to hospitals such as his.

The hon. Gentleman mentioned money at St. George’s. He will be aware of our new walk-in centre and our new Atkinson Morley wing, which is preventing deaths by cancer, and he will also be aware that we have doubled the number of nurses in the past nine years and have 500 more doctors. Can he now answer my question? Will all the staff that might be cut throughout the country because of the devolved powers of their trusts be saved by a Conservative Government?

I cannot, of course, make that promise. How could I make it? If the Secretary of State and the Government would care to call an election tomorrow and disappear—[Interruption.]

If the Labour party would vacate the Government Benches and give us the opportunity to take up the responsibilities of government, we would ensure that NHS resources are used more effectively to deliver services for patients, that the staff the NHS recruit are front-line staff who deliver those services for patients, that accessible services—which are demanded by patients and GPs—can be commissioned by GPs on their patients’ behalf, and that the threat that is the consequence of the Government’s policies is lifted. Unfortunately, I cannot promise that, because the Government are not going to disappear tomorrow and the hon. Member for Tooting (Mr. Khan) is asking me about jobs that are under threat now. I cannot promise that I can restore those jobs—of course I cannot. But I can promise that we will have policies that never lead, through gross mismanagement, to the problems that we face today and for which the current Government are responsible.

Let me tell the House how many jobs we are talking about: 20,000. I heard what the Prime Minister said; he had the effrontery to stand up at the Dispatch Box at Prime Minister’s questions and say that there is no such threat of 20,000 job losses. He might like to look at some information I have, namely, that 64 NHS trusts have announced up to 20,000 posts that will be cut in the hospital sector alone. If the Prime Minister tries to deny that, let me refer him to the NHS Confederation, which is in no mood simply to support my party on this matter. It wants to minimise the effect of what might happen and it has issued a briefing. Labour Members seem to be reading only from the Labour Whip crib sheet, when what they should be doing is reading the briefings they have been receiving from organisations that know something about this matter. [Interruption.]

Order. Ms. McIsaac, I have already asked for some calmness in the Chamber and you are not helping me. You are not being as helpful as you usually are in such situations.

There is a lot of laughter on the Labour Benches, but there is not much laughter in my constituency, where 750 doctors, nurses and key medical workers are being sacked by this Government.

I understand exactly what my hon. Friend says. When the casualties of the Buncefield oil depot incident—happily, there were very few—were taken to an accident and emergency department, it was the one at my hon. Friend’s Hemel Hempstead hospital, and that accident and emergency department could have shut under this Government. Labour Members might like to explain why such things are happening. Indeed, they might like to explain—

I will in a moment, but to my hon. Friend the Member for Christchurch (Mr. Chope).

Labour Members might like to explain why the Prime Minister gets up and issues a denial in this, when the NHS Confederation says:

“The figures being widely quoted of up to 20,000 may turn out to not be too far off the total reduction in workforce numbers this year”.

In fact, what the NHS Confederation is saying is worse than I thought because it is talking about an overall reduction of 20,000, whereas I am talking only about an announced 20,000 posts to be cut in the hospital sector. One might have imagined that there would be at least some compensating increase in posts in the community sector, but that is not, apparently, the experience of the NHS Confederation.

When I attend the Conservative NHS action day stalls in Christchurch on Saturday, I know that I am likely to be asked what our policy is in response to the National Institute for Health and Clinical Excellence decision to deprive those in the early stages of Alzheimer’s of much needed medication. Can my hon. Friend assure me that we will overrule that decision by NICE when we get into government?

I am happy to be able to agree with my hon. Friend’s first sentiment, but on Alzheimer’s drugs I cannot give him the assurance for which he asks. [Interruption.]

Order, this behaviour certainly will not help the debate. Those who are listening to our proceedings will wonder why we are behaving in this way in a debate on such an important issue. I know that there is some excitement around, but things are getting to a stage where we are having a bawling or shouting match. Labour Members should understand that the Secretary of State’s turn to speak will come, and I will seek the same courtesies for her as I seek for the spokesman for the Opposition. I know that the Speaker should not intervene for so long, but the Chamber is getting far too noisy—and perhaps one Member will be disciplined if we continue in this way.

Thank you very much, Mr. Speaker.

I was endeavouring to explain something to my hon. Friend the Member for Christchurch, with which he may or may not agree. NICE has to do an exhaustive job of trying to assess whether it is in the interests of the NHS that a treatment be provided because it is both clinically effective and cost-effective. That process has been extremely useful because it has increasingly exposed what is cost-effective and clinically effective about Alzheimer’s drugs. They are effective for patients, especially for those with moderate and severe Alzheimer’s—dementia. However, in respect of mild dementia, they are not regarded as sufficiently effective to be a treatment that should be recommended on the NHS. Frankly, it is my opinion that in an independent national health service such decisions must be made independently and we must ensure that there is a correct statutory framework. On this matter, one important issue remains in my mind. Because of the nature of the regulations prescribed by the Government, the benefits that NICE can take into account apply only to the national health service and to publicly funded social care. The benefits to carers and their families beyond that point cannot be taken into account. We must look into that—and that might, of course, have a bearing on the outcome of any appraisal undertaken by NICE.

As my hon. Friend knows, hundreds of jobs have gone at Hinchingbrooke hospital, with hundreds more likely to go, and the hospital is now subject to a closure threat. It seems to me that the strategic health authority’s review is in fact cover for a slash-and-burn policy conducted by this Government. What does my hon. Friend have to say about that?

To some extent, my hon. Friend and I share that hospital. Patients from my constituency go to Hinchingbrooke hospital. That anticipates something that I was going to say. It is disgraceful that “reviews”—in inverted commas—should be taking place that are in fact driven by finance. The implication—[Interruption.] Members might like to listen to this point. The implication of that for staff working at Hinchingbrooke is that the maternity unit has to be closed because it is not safe, but that is not true as it has one of the finest patient safety records in the country. That is financially driven.

Frankly, I do not think that the strategic health authority should be the body doing that. We are supposed to be moving—this is what the Government say—towards a structure in the health service that is increasingly geared towards the decisions of local commissioners such as primary care trusts, practices through practice-based commissioning, and patient choice. However, on the contrary, we have a strategic health authority that has just been established and that has inherited a financial problem—many of my colleagues right across the east of England are in the same position. Because of a £233 million deficit, it will decide which hospitals stay open and which are shut. That is a disgrace. In a year or two services will be shut down by the strategic health authority, but in subsequent years we will have to re-establish them because they are required to meet the needs of patients.

May I ask the hon. Gentleman about a news story that I read on the Conservative party website? Does he agree with the Leader of the Opposition when he says that

“the NHS matters too much to be treated like a political football”?

Absolutely, and that is exactly why my right hon. Friend and I explained on Monday how we could take politicians out of the day-to-day management of the NHS. However, as we heard from the Prime Minister at lunchtime, he is so keen on having the NHS as a political football that he is not prepared to allow it greater independence. I am sure that when the time comes, the Chairman of the Health Committee will want to ask the Secretary of State what the NHS political football game looked like on 3 July, when she sat down with the chairman of the Labour party, Ministers and political advisers, including Labour party staff, in order to debate their “heat maps” and to decide where in the country hospitals were to be shut. Frankly, that is not acceptable. It is the Government who are indulging in that political football game, not us.

I will carry on for a minute. I have taken an intervention and I have yet to get on to the issues that we really need to reach.

We need to understand that all the deficits are having major consequences for staff. As I said, we might have imagined that, at the same time as jobs in hospitals were being cut, they were being created in the community. Members will recall that back in January, a White Paper was published the purpose of which was to state that precisely that shift of patients would happen. Well, what do we find? The work force census showed that in the last year for which figures were available, there were 485 fewer health visitors, 760 fewer district nurses, and even 36 fewer midwives. Yet the Government seem to think that those people are somehow magically going to increase in number and be available to provide services.

The Prime Minister made a speech on this issue last month. The action plan for social exclusion says that all additional health visitors and community midwives will be upskilled in order to undertake early interventions with families. Health visitors in my constituency used to visit every family, but that service disappeared about seven years ago. There simply is not the number of health visitors to enable that to happen.

I am grateful to my hon. Friend for giving way. Is he aware that in the first six months of this year—in other words, almost from the moment that the Secretary of State sat down after presenting the White Paper in this House—10 community hospitals across England were closed under this Administration, with devastating effect? That is the exact reversal of the Government policy set out in that White Paper—a vision that many Conservative Members shared, but which has not been delivered on the ground. It is that sense of betrayal—the difference between the words and the reality—that is so undermining confidence in this Government.

I entirely agree with my hon. Friend. Let me give an example. If the Government were serious about supporting community hospitals, they would have taken the technical step that would have helped: unbundling the tariff to enable patients to be discharged from acute hospitals and transferred to community hospitals, with the money going with them. The Government keep talking about it and saying that it will happen, but they have not done it.

I am most grateful to the hon. Gentleman for giving way. I cannot help thinking that we might be losing the focus of this debate. Surely what matters in the health service is patient outcomes and patient care. As I still work as a GP, I can point to the fact that it now takes only two weeks to see a cancer consultant and to the fact that waiting lists are falling and GPs are providing much more care in their own practices, thereby significantly reducing the need to refer people to secondary care. Those are significant improvements in patient care, which surely is the purpose of the health service.

I am grateful to the hon. Gentleman. Patient care does indeed matter tremendously, and in pursuit of that, patients in his practice will no doubt find things improving when he returns to full-time work in the NHS after the next election.

May I just answer the hon. Member for Dartford (Dr. Stoate), because there is an important point here? In their amendment to this motion, the Government say that

“death rates from cancer and heart disease are falling faster than ever before”,

and the Prime Minister said at Prime Minister’s questions that deaths from coronary heart disease had fallen since 1997. Indeed they have, but as it happens they have not fallen faster than ever before. In the seven years before 1997, the death rate for circulatory diseases and the cancer death rate fell slightly faster than in the seven years since that date. The right hon. Member for Rother Valley (Mr. Barron), the Chairman of the Health Committee, made a point earlier about the use of the health service as a political football. Well, a good starting point would be to tell the whole truth about what is going on.

Yesterday, the Government—[Interruption.] Let me finish this point. Yesterday, the Government published health profiles across England and said that cardio-vascular disease death rates have been falling since the mid-1990s. They have not—in fact, they had been falling for at least a decade before that. Let us be honest about what is going on. There is a long-term secular reduction in both coronary heart disease and cancer death rates, which is very much to be welcomed. That has not happened simply as the consequence of the 1997 election, or of additional money. It has happened in virtually every developed country across the world, so let us be honest about these things.

I am very grateful to my hon. Friend. In my view, Labour Members simply do not understand the reality of what is going on. Two weeks ago, there were thousands of people on the streets of Epsom protesting against the loss of services at our local hospital. We now face the loss of services not only there but in Guildford—ironically, given the Secretary of State’s clumsy party political intervention at St. Helier before last year’s local elections—and we are losing community services and district nurses. The podiatry service is now being provided by Age Concern, and it looks as though we are going to lose sexual health advice for teenagers. What is going wrong? Labour Members seem not to understand the reality of our health service today.

Frankly, the quality of management at the top of the health service is what is going wrong, and that stems from Ministers. I hope that the Secretary of State will have the grace to apologise for trying, for political reasons, to steer a capital project to St. Helier, rather than to where the evidence pointed to. She had to backtrack on that in August.

I am going to carry on because, as the hon. Member for Dartford rightly said, we have got to get to the points that really matter. There are a lot of NHS staff out there who want to know what the Government are actually going to do now about these problems. There are junior doctors worrying about whether they will find training places. I am glad that the Government said that they are going to find between 22,000 and 23,000 places in August 2007; indeed, I raised precisely that issue with the Secretary of State back in January. Of course, and as I recall from last year’s flu statistics, she has always had problems understanding what is England and what is the United Kingdom. In this instance, she has gone for 22,000 to 23,000 training posts in the UK, in order to meet a demand for 22,000 such posts in England, so the figures do not quite add up.

No; I am carrying on for a bit.

I do hope that the Secretary of State will also make it clear that, wherever possible, such posts will be run-through training posts that give the junior doctors concerned greater assurance that they can qualify and get their certificate of completion of specialist training in due course.

It is not only doctors who have problems. As the Royal College of Nursing made clear in its surveys, many nurses are leaving college unsure that they will find jobs; indeed, many do not find jobs. In some cases, half or more of the graduate output do not find jobs. Some 100,000 nurses are due to retire in the next five years, and over the next three years there will be a 20 per cent. reduction in the number of nursing training places. What are the prospects for nurses? I met a nurse in my surgery just last Friday, who said:

“I have just qualified as a nurse, and finished my degree in children’s nursing at the beginning of July. I have been applying for jobs since May and am still unemployed…for one interview I attended, 45 candidates were being interviewed from over 120 applications. I am at a loss to know what to do.”

I also received a copy of the following letter from a lady, who writes:

“My daughter will qualify as a psychiatric nurse in August after three years of training…She and her fellow students have been informed that there will be no training posts for them in Cornwall on qualification…The situation now is that she will not have a job in the Health Service within her chosen profession. And she will not be able to find employment abroad without one year of post qualification training.”

Let us consider physiotherapists. How many Members present met members of the Chartered Society of Physiotherapy when they came here in July? Well, I met the students from the Royal London: 99 students completed the course, but only one has a job.

A lady writes to me:

“My daughter is one of hundreds of newly qualified physiotherapists unable to get a job because of the crisis in the NHS…My local hospital has a waiting list of 10 months to see a physiotherapist.”

Somebody writes from Norwich that of 96 students leaving physiotherapy training only five found jobs. A letter from Lincolnshire states:

“Not one student from Nottingham (which is a centre of excellence for physiotherapy) has been able to find employment as a physiotherapist in the NHS. This abysmal situation appears to be directly due to the budget deficits across the NHS.”

I have a question for the Secretary of State, because a practical issue is involved. In Scotland, as she knows, the Scottish NHS guarantees nurses and physiotherapists a year of employment following their graduation. Will she say that the same thing will happen in England?

I agree that we should be honest about the debate. Part of the reason why death rates for cancer and heart disease are falling is that our Government have set targets—[Hon. Members: “Ah.”]—Yes, targets. There is faster treatment: 99 per cent. of people diagnosed with cancer receive treatment within four weeks of diagnosis. Will the hon. Gentleman tell us whether his policies will reflect that or whether their NHS plan stands for no honest solution from the Opposition?

I am sorry that the hon. Lady was clearly not even listening to what I was saying. As yet, there is no discernible change in the trend reduction in deaths from cancer, even as a consequence of the additional investment in the NHS cancer plan. We might wish it otherwise, but that is the case. The fact that death rates continue to go down is much to be welcomed, but it has much more to do with things such as the reduction of smoking, as well as with the quality of service. When we compare our cancer death rates to those in other countries, we see that early identification of tumours will be absolutely instrumental in their further reduction. The cancer plan said that there needed to be awareness of symptoms and up-front investment for prevention, but that has not happened.

Ultimately the question is one of money and value for money. If we are to have more local control and accountability, can my hon. Friend give the House an assurance that, through Parliament’s Committees—especially the Health Committee and the Public Accounts Committee—we will still be able to follow the money? Ultimately, the House must remain responsible for all public money spent.

I am grateful to my hon. Friend, who properly defends that important interest. Nothing we have said would deflect from it. The service would be publicly funded, where propriety and value-for-money considerations would remain the responsibility of the inspection bodies throughout the process, all the way down to the point where GPs exercise commissioning responsibilities. It needs to be so, because the service uses public money.

I do not want to take more than about half an hour, as many Members want to speak.

Deficits do not affect only trainees; they have a direct impact on existing specialists. A report suggests that, by December, 61 cardio-thoracic surgeons will be without a consultant appointment in the NHS. I am advised that 37 ear, nose and throat specialists do not have posts at present. The Royal College of Anaesthetists tells me that whereas in previous years there have almost always been about 30 advertisements a month for new anaesthetist posts—last year there were 31 in July and 29 in August—only 17 were advertised in July this year and only four in August. The president of the royal college rightly says that a great number of people in other countries are looking for anaesthetists. My concern is that if we make life difficult for too long, they will go; we will lose the specialists we need.

The Government should note that the British Orthopaedic Association has already told them that the average retirement age of orthopaedic surgeons has gone down by three years over the past seven years. Such is the extent to which we are losing services.

To go back to my hon. Friend’s comments about physiotherapists, does he agree that with the Government’s drive for more people to be looked after at home and closer to their homes, physiotherapy services, and physiotherapists, are absolutely crucial to ensure well-being and treatment, especially of an older population?

My hon. Friend is absolutely right. The situation for stroke patients, for example, is utterly depressing. Even if they are able to secure early and intensive rehabilitation, sometimes treatment cannot be followed up to maximise their chances of recovery, owing to the lack of physiotherapists in post. We must have more physiotherapists. The Government said that we needed more physiotherapists and that there would be 60 per cent. more. People went into the profession as a result. A physiotherapist told me: “I knew what was intended so I went into the course. Now there are no jobs.” That is a deeply depressing fact; it is a cruel irony played on people who took up such courses.

No, I am sorry.

Not only have we lost specialist posts but training budgets are being cut. The Secretary of State might like to tell us whether it is the case that, as reported, training budgets across the country will be cut by 10 per cent. this year. She might like to consider the example of Leicester, where the strategic health authority says that it will cut £52 million from the training budget. The University Hospitals of Leicester NHS Trust told Leicester university that it will cut clinical academic funding by 20 per cent. That will mean the loss of 15 per cent. of the medical school staff, who spend more than half their time treating patients. Some of the senior staff, who are integral to the trust’s delivery of service, will be lost.

To be fair to the Government, in 2002, they introduced the GP returner scheme and 550 GPs used it, but the money has disappeared. In 2006-07, there will be no money for the scheme; it is disappearing across the country.

No.

I want to mention one more important issue. The problem is not just deficits. In April 2004, Members may recall that we warned the Government about the impact of the European working time directive. I shall not rehearse all the arguments, but it was clear that if the Government did not secure an amendment to the directive there would be serious consequences for services. The Government claimed that would not be the case. The right hon. Member for Barrow and Furness (Mr. Hutton), now the Secretary of State for Work and Pensions, said that they would maintain access to services despite the working time directive. But what has happened?

I shall quote from a document about changing maternity and paediatric services produced by the Manchester SHA. Manchester itself—not the whole north-west—is a good example, as it is not generally driven by deficits and ended last year with a health economy in surplus. The document states:

“Staffing pressures on the 13 units providing in-patient care are getting worse. Already children’s wards and maternity units have to close on occasions because there are not enough staff to cover them safely. We will not be able to staff all these units by 2009 when the European Working Time Directive becomes law and doctors are not allowed to work the hours they currently work. This is already resulting in units being closed frequently. In 2002 there were over 200 closures to the admission of children and young people across 13 hospitals, due to either a shortage of doctors or a shortage of specialist nurses.”

If the Government had done what they said would do, they would have secured an amendment to the directive. Their replies to me make it clear that they tried to do so when they held the presidency. They took the matter to the Employment Council in December 2005 but they failed, and they have not attempted to do anything since. They must do something.

Will the Government do what Lord Hunt—then a Health Minister—said he would do on 4 March 2003? He said that if there were difficulties, the further extension of the working time directive, due in 2009, could be deferred until 2012 and that instead of a 48-hour week, it would be possible to go up to 52 hours. Will the Secretary of State do that?

No, I am not giving way, as I am moving towards my conclusion, but before I do so, I want to be fair to the Government. We are talking about work force planning and because I wanted to understand the Government’s approach towards it, I looked at their evidence submitted to the Health Committee, which is currently investigating the matter. Here it is. The Government say that there is now “a streamlined framework” for work force planning. There are workforce directorates within strategic health authorities and they work with the social partnership forum, with the workforce programme board, with the national workforce group, with the workforce review team, with NHS national workforce projects, with Skills for Health and with NHS employers. There is even a diagram to explain it all—and all that is supposed to be the “streamlined” framework! Whatever it is, it is certainly not yet streamlined enough. We need a much better system because out there in the NHS, staff have no idea what the work force plans look like, as even now, posts are being cut.

The staff of the NHS are, as we have said, its greatest asset. They work miracles daily and we need them to be motivated and inspired, but at the moment they are demoralised. The Secretary of State has gone from her “best year ever” in May to a “very difficult year” by September. NHS staff are seeing a feast turn into a famine. They see promises of expansion turn into cutbacks and they see the advertising campaigns of three or four years ago to recruit new nurses and therapists turning into the cruel irony of people leaving training unable to pursue their vocations and find jobs. They see sham consultations over service reconfigurations driven by short-term financial expedients.

The staff also note how the effects of the European working time directive are dressed up to suggest that services have to be shut down because they are deemed unsafe. Frankly, that is a slur on NHS staff. People are working across the country to save their local NHS services. Labour Members should not decry that as a Tory conspiracy; it is happening because people are angry about the loss of their local NHS services. They do not want to block changes, but they want them to be guided by evidence and to take account of needs for accessible services.

The new chief executive of the NHS says that more than one in four of district general hospitals have to be downgraded. He then tells us, in an interview in The Guardian, that he “understands the politics” of it. Well, we do not need an NHS chief executive who understands politics, but one who is focused on patients. We need a chief executive who is not spending all his time trying to work out what Ministers want him to do, but assessing what is in the best interests of patients and the NHS. We need an NHS free of the Secretary of State and the chairman of the Labour party sitting down with their advisers, trying to decide which hospitals to close.

I am an optimist. I believe in the NHS and I believe in what NHS staff can achieve, but they can do so only if we give them the framework, the resources and the freedom to deliver. That is our objective, so I commend the motion to the House.

I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:

“welcomes the Government’s historic investment in the NHS since 1997, trebling funding by 2008; pays tribute to the commitment of NHS staff; recognises the ongoing investment in their training and development; notes that there are now 32,000 more doctors and 85,000 more nurses, and that overall there are over 300,000 more staff working in the NHS; acknowledges that as a result of the Government’s investment and reforms and the hard work and dedication of NHS staff, virtually no-one now waits more than six months for their operation whereas in 1997, 284,000 people waited longer than six months with some patients waiting up to two years; further notes that over 99 per cent. of people with suspected cancer are now seen by a specialist within two weeks of being referred by their general practitioner, up from 63 per cent. in 1997, and that death rates from cancer and heart disease are falling faster than ever before; and further recognises the need to ensure NHS services continue to change to benefit from new medical technologies and treatments which mean more care can be delivered in local communities and people’s homes.”

Mr. Speaker, the hon. Member for South Cambridgeshire (Mr. Lansley) has spent nearly 40 minutes telling us, as he always does, what is wrong with the NHS. I want to start by congratulating the staff of the NHS—more than 1.3 million committed and dedicated men and women, many working in very difficult circumstances. There are more than 300,000 extra staff—my right hon. Friend the Prime Minister slightly understated the increase in Prime Minister’s questions—than there were in 1997. I particularly want to thank them for the improvements that they have made in looking after patients in recent years. We have seen dramatic improvements in waiting times, for example.

With additional new money, the NHS has improved dramatically. We have perhaps forgotten that in the 1990s we used to worry about the number of years that patients had to wait for treatment, whereas today we worry about the number of weeks. That is not from the Whip’s brief, as the point comes from the director of public health at Stockport primary care trust. Does my right hon. Friend recognise that that professional view represents the reality of what is happening out there?

I shall give way again in a few moments.

In 1997, 284,000 people were waiting more than six months—some for more than two years—whereas today almost nobody waits more than six months and the vast majority are treated far more quickly than that.

I am sure that my right hon. Friend would want to congratulate workers at Lancashire teaching hospitals on their dedicated work in ensuring that the quality of lives in Lancashire continues to improve. Does she support the continuation of the work at those hospitals and will she ensure that it does not go to the private sector, which would put them at risk?

I join my hon. Friend in congratulating the staff at those hospitals. As he well knows, the Government and I have supported both investment and reform from the outset, including, where it will help cut waiting times and secure even better care for NHS patients, the use of the independent sector.

While she rightly congratulates existing staff, what does the Secretary of State say to those newly qualified midwives and physiotherapists who were promised a job in the NHS only to find that they cannot get one? Why has she made such a mess of work force planning?

We have never made promises to NHS staff that either we or the Opposition could not keep. What we are saying to newly qualified staff, some of whom are indeed struggling to find a job, is that we will do everything possible to ensure that they get one. In some parts of the country, NHS hospitals are working with other organisations to ensure that, if a permanent job is not available for newly qualified nurses and midwives, they are at least taken on temporarily so that they can continue to build their skills and contribute to the NHS.

I want to make some progress before giving way again.

I also want to thank NHS staff for dramatic improvements—belittled, I have to say, by the hon. Member for South Cambridgeshire—in cancer care. I do not think that any of the 50,000 cancer patients who are alive today because of improvements in cancer care would want to belittle them and neither would the hon. Gentleman’s view be shared by cancer patients who have seen dramatic improvements over the last 12 months. Just 12 months ago, fewer than seven out of 10 patients with most suspected cancers could count on being seen, diagnosed and then beginning their treatment within two months. Today, nearly 95 per cent. of patients are doing so. That is the result of the incredibly hard work of staff, more money, which the Conservatives voted against, and the targets set for cancer care that the Conservatives would abolish.

On that very point, I would greatly appreciate it if my right hon. Friend would keep certain facts to the forefront of the debate. In North Tees hospital, for example, 100 per cent. of all breast cancer patients are seen and treated within 62 days. That is a superb achievement, which no one in the House should ever do anything other than congratulate.

My hon. Friend is absolutely right. It is a superb achievement when 100 per cent.—well beyond the target that we set—are being seen, diagnosed and beginning their treatment. That is one of the ways in which survival rates from cancer will be improved.

Ministers have frequently asserted—they are right to do so—that early intervention is vital to help children with speech and language difficulties. As the Secretary of State knows, I have a strong and continuing personal interest in that subject. Given that the Vale of Aylesbury primary care trust is now turning away new referrals and inviting hard-pressed parents to seek help privately, what does the Secretary of State say to those parents who, in a million years, cannot afford to do so and who, without immediate and practical help, will find that their children’s future prospects are permanently damaged?

First, as the hon. Gentleman knows because I have written to him on this point, I have already ensured that the Nuffield speech and language unit—an issue that he has specifically raised on many occasions—will continue to treat patients. [Hon. Members: “What about the Vale of Aylesbury?] Funding for the Vale of Aylesbury primary care trust has increased by more than 30 per cent. over the past three years, by £40 million. In Buckinghamshire PCT, over the next two years, there will be an additional £91.5 million. However, what we must do—Opposition Members refuse to accept this—is support the NHS in making decisions that are often difficult, to get better value for that money, to release the savings that it needs to pay for more speech and language therapists, for new drugs and for all the other services that need improving. The hon. Gentleman is not willing to accept that, any more than are other members of the Conservative party.

Although I do not doubt the Secretary of State’s sincerity, I hope that she will visit Cornwall to see for herself the impact of the reforms that she and others have been implementing in areas such as my constituency. Despite the protestations that her Department is not enforcing the diversion by local trusts of NHS resources into the private sector, is she aware that, in fact, patients who are facing unnecessary, enforced minimum waits, including waits of more than nine weeks for breast care at the moment, receive unsolicited calls from NHS managers inviting them to be seen sooner in the private sector? Will she come to Cornwall to see the results of those reforms and their impact on the financially hard-pressed service there at present? In fact, it is a financial mess. People are waiting unnecessarily and the money is going into the private sector instead.

My hon. Friend the Under-Secretary of State for Health will indeed shortly visit Cornwall; I hope to do so in the near future. There are indeed some real challenges not only in the hon. Gentleman’s constituency, but across Cornwall, in ensuring that the enormous amounts of extra money that we have put into the NHS in his part of the country are used to the best possible effect to ensure that patients get the best and fastest care everywhere. However, the NHS in the south-west has made superb use of the independent sector—for instance, at the Shepton Mallet treatment centre—to speed up the treatment of patients who need orthopaedic operations and to do so in co-operation with the rest of the NHS in an integrated fashion.

No, I am going to make some progress before I give way again.

Every debate about the NHS is important to all of us, but I was looking forward to this one with particular anticipation. This week, we have had the first sighting of a rare bird—Conservative policy on the NHS—but what a disappointment. What we heard from the hon. Member for South Cambridgeshire today and from the right hon. Member for Witney (Mr. Cameron) earlier this week was the mishmash of confusion and contradiction that we have come to expect from the modern Conservative party.

The leader of the Conservative party says that he will guarantee the NHS the money that it needs—a guarantee from the party that starved the NHS of funds for 18 years and a guarantee from the party and the leader who voted against the increased, record funding that we have put in? Conservative Members pretend, and they do so to NHS staff, that they can promise a blank cheque, but they also promised a new economic policy—a new fiscal rule, no less—that would mean £17 billion less for public services, including the NHS, this year. On top of that, their policy commission on taxation wants £90 billion of tax cuts. It does not begin to add up to a policy.

Hon. Members on both sides of the House are unanimous in praising NHS staff for their achievements, but are they unanimous in their views on funding “Agenda for Change”, particularly NHS staff pensions?

My hon. Friend makes a very important point. Of course, what the hon. Member for South Cambridgeshire did not bother to mention, as he talked about NHS staff, was that he is against the agreement that we have just entered into on public service pensions. He is against it, just as he was against proper funding for “Agenda for Change”.

Does my right hon. Friend agree that the British people might remember what the state of the NHS was before 1997, when people lay dying on trolleys in hospitals, when people sometimes had to wait five years for cataract surgery and many years for operations and when the Conservatives would not put the necessary resources into the health service? They are a disgrace and an embarrassment when they talk about the national health service.

My hon. Friend is absolutely right, and the position is in fact even worse than she and I have described. The Conservatives now say that they want fair funding in the NHS—fairness from the Conservative party?

Not yet; in a moment.

I, too, have a copy of the Conservative party’s campaign pack. The Conservatives claim that

“some areas with a low disease burden, but deemed to be socially deprived, receive much more funding than areas deemed to be affluent but with a high burden of disease.”

They go on to complain that

“some areas of Manchester receive 66 per cent. more NHS funding per head than some areas of Bedfordshire and Hertfordshire”.

Let me tell the House about some areas of Manchester—north Manchester, for instance, where a baby is twice as likely to be stillborn and 10 times more likely to die before the age of one as a baby in south-east Hertfordshire or South Cambridgeshire. [Interruption.] The hon. Member for Beverley and Holderness (Mr. Stuart), from a sedentary position, and the hon. Member for South Cambridgeshire complain that inequality in infant mortality is widening, but they want to take the money away from areas where infant mortality is worst—[Interruption]—north Manchester, where an adult is 50 per cent. more likely to die prematurely of cancer than one in St. Albans, South Cambridgeshire or south Oxfordshire.

In north Manchester, every GP has to look after about 2,500 patients; a GP in South Cambridgeshire has, on average, about half that number. That is why NHS funding this year is £1,600 per person in north Manchester and £1,000 per person in St. Albans, south-east Hertfordshire, South Cambridge and south Oxfordshire.

I shall give way to the hon. Member for Reigate (Mr. Blunt) on St. Helier; he has been very persistent.

Since we were last here, the Secretary of State has had to reverse the quite disgraceful decision that she took on 19 December 2005, to overrule a consultation that had the full support of the local medical community to build a new hospital at Sutton, not at St. Helier, and to site the thing at St. Helier, at the request of the hon. Member for Mitcham and Morden (Siobhain McDonagh). The Secretary of State was then taken to judicial review by Reigate and Banstead council and Surrey county council. The case would have gone to court in about a month’s time; but, in August, she gave in. Will she repay the costs of the legal action that had to be taken, because her action was so unreasonable, to Reigate and Banstead council and Surrey county council?

My decision was made precisely on the grounds of health inequalities and fairness, in which the hon. Gentleman and the Conservative party simply are not interested. The reason why things have moved on is that, unfortunately, the financial situation in south London, in that part of the NHS, is worse than those involved believed it to be when they came up with the plan for a new hospital. It is, I am afraid, no longer clear that the proposal for a new critical care hospital and nine new community hospitals is affordable in the way that the local NHS originally planned it. It therefore makes sense to look afresh at that model of care—which, in principle, is the right one—to ensure that it is affordable before any further decisions or arguments take place about where the hospital is sited.

May I suggest that my right hon. Friend has omitted another strand of Tory party policy that is very clear? The Leader of the Opposition made it clear on “Any Questions?” in 2001 that he did not want to fund the NHS in the same way that it is funded now. He said that we should have more social insurance schemes, and he has never resiled from that comment. What effect does my right hon. Friend believe that that policy would have on our most deprived areas?

My hon. Friend is absolutely right about the views of the right hon. Member for Witney. Indeed, let us remember that only last year he wrote the Conservative party manifesto that proposed to take millions of pounds out of the NHS for everybody and put it into subsidising private care for a few. That is what the Conservative party means by fairness.

No, I want to make some progress.

Conservative Members and the Conservative party refuse to accept that overspending has to be put right where it has taken place. They refuse to accept that it is wrong that a minority of hospitals and other organisations have overspent—some of them, I am afraid, for many years—at the expense of the majority who have been in balance or in surplus. Conservative Members have a simple solution to the overspending that has taken place in Bedfordshire and Hertfordshire even though the hon. Member for South Cambridgeshire did not come clean about it today. They want to take the money away from north Manchester and all the other parts of the country with the worst health needs and the worst health inequalities.

What does the Secretary of State say to the excellent staff at the QEII hospital? Two weeks ago, she met the senior management in Bedfordshire and Hertfordshire and two senior clinicians have now told me that she made it perfectly clear that the QEII will go, Hemel will go and our new hospital at Hatfield will go. Will she now put it on record that that is not her view and that that will not be the end result? The irony is that the end result would be one hospital in Stevenage, which is Labour, and one hospital in Watford, which is Labour.

Order. The hon. Gentleman has asked a question and the least that he can do is let the Secretary of State answer.

I am most grateful to you, Mr. Deputy Speaker. The hon. Gentleman should know—everybody in the NHS in Hertfordshire who has looked at the issue knows—that there needs to be a reorganisation of hospital services in that county. There needs to be a reorganisation of hospital services in order to keep up with modern medicine, to give patients better and safer care and to ensure that Hertfordshire does not go on overspending at the expense of other parts of the country that are far worse off. Those decisions will be made only after full and proper consultation with his constituents and everybody else in Hertfordshire and they will be made on the basis of what is clinically right for patients and not on the basis of party politics of any kind.

Conservative Members might have understood the issue of health inequalities a little better if they had bothered to turn up to the excellent event put on by the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint). It gave profiles for areas so that I and my hon. Friend the Member for Wigan (Mr. Turner)—we were the only two Members there—understood that Salford and Wigan, which are the areas closest to us, had very severe health inequalities and health needs. Does my right hon. Friend agree that given the resources that were needed to put on that event, it was a pity that Conservative Members, who do not understand the issue, did not bother to turn up?

I absolutely agree. The Conservative party’s policy of taking from the poor and giving to the rich, which is precisely what they are campaigning for, just shows that it has not changed an inch.

Conservative Members are missing the point of what patients want. Patients want three things: they want greater preventive services, they want services nearer to the community in which they live and, when they need expensive, high-tech services, they want them quickly and efficiently. What they want as the result of the new GP contract is to have more pharmacists and GPs working together to provide far more screening, far more care closer to home and far more preventive medicine with greater use of statins and ACE inhibitors. All that reduces the need for people to go to hospital at all and that is what patients are calling for—greater prevention, more care in the community and, when they need high-tech care, that care being available swiftly and in a centre that has all the expertise that it needs.

My hon. Friend is a GP and serves on the Health Committee and he is absolutely right. The contradictions that we have been pointing out in Conservative health policy do not end there.

The Secretary of State is not addressing the questions in the debate, but the issue is simple and we take exactly the same view as the NHS Confederation. Resources that are being allocated across the country to deal with health inequalities and that should be directed towards public health measures should be in separate budgets from resources allocated in relation to the burden of disease in an area in order to ensure that there is equitable access to care.

The principles that we set out on Monday are very clear and involve equitable access to service delivery so that we do not arrive at the position—it happens now—whereby I can stand in the stroke ward in Luton and Dunstable hospital and be told that there are two kinds of discharge arrangements. The first is for patients going to Luton, where the PCT has enough money to provide follow-up and rehab, and the other is for Bedfordshire Heartlands, which is in deficit and cannot provide those services. That is not fair to patients.

It is not fair to patients, but the answer is not to take money from the poorest areas with the worst problems and to give it to Bedfordshire, which has been overspending. The answer is to reorganise services in Bedfordshire. I spent a day a couple of weeks ago with community matrons in Bedford and they support patients with long-term conditions in their own homes and that slashes the need for those patients to go into emergency care. That is the kind of change that we want to lead.

I will not give way, as I want to make progress.

The Conservative party has told us this week that it wants an independent commissioning board completely free to decide where patients should be treated, but it opposes any change in NHS provision, including, it appears from one Conservative Member, the involvement of Age Concern in providing some services. It says that it wants to put decisions in the hands of NHS professionals but, every time the local NHS proposes to make a change in the organisation of services, members of the Conservative party are out marching in the streets to oppose it. They protest—they have been doing it again this afternoon—against every closure of a community hospital.

Conservative Members should go to Norwich and talk to Tony Hadley, the brilliant nurse manager whom I met recently who worked with his nursing and community team to reorganise community hospital services. They cut the number of community hospital beds, they closed some wards and closed two community hospitals and centralised them in a third. Conservative Members are out on the picket lines when anything like that is proposed in their constituencies, but what Tony Hadley and his team did in Norwich was to listen to patients who want to be cared for at home rather than in hospital and they put half the staff out of the community hospital and into the community itself. They doubled the number of patients that they could care for, they slashed the number of emergency admissions and they saved £1 million a year that can go into better care for other patients. The Conservative party has to decide whether it is for or against that.

I hope that the Secretary of State will recognise that no one on the Conservative Benches wishes to set community hospitals or other health services in aspic. We are perfectly happy to welcome change, but we do object to the cuts in local services that are precisely against the vision that she set out in January this year. That is what we are protesting against, and it is the cuts right across the country that upset not just Conservative Members but, if she cares to look behind her, those on the Labour Benches as well.

I am afraid that the hon. Gentleman is simply incoherent on this point. It is not possible to take advantage of all the changes in modern medicine that make it possible to take tests and treatments out of acute and community hospitals and into GP surgeries, health centres and patients’ own homes, which is where patients would rather be, without making difficult decisions about the numbers of beds, wards and cottage hospitals that we have. The hon. Gentleman and the Conservative party need to be willing, for once, to support the NHS in making difficult decisions that will improve care for patients.

Does my right hon. Friend share my dismay at the fact that the hon. Member for South Cambridgeshire (Mr. Lansley) wants to stop the NHS being a political football, yet the Conservatives seem to be obsessed with the number of posts in the NHS rather than the quality and quantity of output? Does she agree that it is somewhat hypocritical of the Conservatives to bang on every year in Finance Bill debates about productivity in the NHS, but to criticise her all the time for trying to address some of those issues and the configuration and suitability of services?

My hon. Friend is right. The Conservative party says one thing to one group and a completely different thing to a different group. Conservatives say that they are in favour of more health care close to people’s homes—we have just heard it again—but when emergency admissions are cut, as community staff are doing all around the country, when there is more day-case surgery, and some hospitals are not doing enough, and when the average length of stay is reduced, as all the best hospitals are doing, we do not need as many acute beds in some hospitals and we do not need as many staff in those hospitals. When a hospital makes such difficult decisions, and when it makes difficult decisions to bring the NHS back into financial balance instead of allowing the problems to build up over and again and to get worse and worse, the Conservative party completely refuses to support them.

We keep hearing the mantra that services are being reconfigured and moved into the community, which many would regard as quite a good thing, but will the Secretary of State explain why the Council of Deans and Heads of UK University Faculties for Nursing and Health Professions has stated that the cuts in training budgets have had a

“particularly severe effect in community nursing”?

If the Government are keen on realising what they state regularly, surely we should be increasing such budgets.

As the hon. Lady will know from the NHS work force figures, despite the fact that there has been a decrease, as the hon. Member for South Cambridgeshire was saying, in the number of health visitors, there has overall been a significant increase—of about 27,000, I think—in the number of nurses working in the community. We should expect to see that trend continue. One thing that we need to do, which I have asked our chief nursing officer to take charge of, is to modernise nursing careers so that we can support more nurses in the community.

The Secretary of State has talked about change and difficult decisions. She knows the position in Nottingham well. She recently visited the new Nottingham University Hospitals NHS Trust and she knows that services are being reconfigured there, and it is difficult and painful. Does she accept that it takes time to make those changes and will she give the new trust time to put those changes into place?

My hon. Friend makes an important point. As he says, I spent quite a lot of time recently with staff at Nottingham University Hospitals NHS Trust. It is indeed in a very difficult position, as is the partnership trust, as I know he will accept. The latter has massively improved services for mentally ill patients but has had over many years to give up some of its urgently needed funding to bail out the acute hospital. I have already asked the NHS in the east midlands to look at the length of time needed for the Nottingham acute trust to make the necessary changes.

Given that both my hon. Friend and the hon. Member for South Cambridgeshire have raised the issue of risk to significant numbers of jobs in some places, I draw the attention of the House to the fact that Mid Yorkshire Hospitals NHS Trust, for instance, which notified the Government of up to 400 jobs at risk—a matter of considerable concern and great anxiety for the staff—has in reality had to make only six staff compulsorily redundant. We would all wish that there had been none at all, but that is very different from the headlines.

Worcestershire Acute Hospitals NHS Trust identified that it needed to lose the equivalent of 670 jobs, including of course agency workers and so on. It notified the Department of Trade and Industry of 250 jobs at risk. It has made only 19 redundancies. We will support any staff member who loses their job or needs to move to a new one; none the less, those hospitals like every other have continued to reduce waiting times. It is essential—the hon. Member for South Cambridgeshire continues to refuse to accept this point—that hospitals continue to become more effective in their use of resources in order to give even better value for money, so that we can free up the money to pay for extra treatments and extra drugs for other staff to use.

Two months ago, it was announced that Ravenscourt Park hospital in my constituency will close in November. It was opened only three years ago. The then Health Minister, the right hon. Member for Barrow and Furness (Mr. Hutton), said at the time:

“We have spent £10 million on improving Ravenscourt Park Hospital. When the NHS took over this hospital, it had 16 beds; now it has 106, and is treating upwards of 3,000 patients a year. That means improved quality of service for NHS patients, who are being treated in state of the art facilities. That is what investment and reform of the NHS is helping to bring about.”

Only three years later to the very month, the hospital is to close. Will the Secretary of State explain that, and will she be sending one of her Ministers to the closing ceremony next month and apologising?

Ravenscourt Park hospital was an investment from the private sector. It went bankrupt—or pretty nearly so. We bought it for a very small amount of money and we did put some investment in it. It has treated a relatively small number of patients. I do not have the figures to hand, but it has never had anything like an acceptable level of bed use, because there are in fact enough beds and still some efficiency gains to be made in other hospitals that serve the hon. Gentleman’s constituents and other parts of west London. The Conservative party has clearly given up completely on economic stability and sound finances. I take an old-fashioned view of these matters: I believe in prudent use of public money. I believe that we hold taxpayers’ money in trust. I do not believe in keeping a hospital open if there are not enough patients to use it when they can be very well treated in other hospitals in that part of London.

From recently visiting Bedford hospital and talking to staff, my right hon. Friend will know that they and others in the community have concerns about what is called “reconfiguration”. Does she agree that the best thing to do in that circumstance is to wait for the proposals to be made by a strategic health authority and hospital trusts and others, so that people can then have a measured, informed, balanced debate about the future shape of health services? Did she notice that the hon. Member for South Cambridgeshire (Mr. Lansley) anticipated the outcome of the acute services review, the results of which have not yet been published, and is stirring up fears and unhappiness? That is not the way to improve the future of our health service. We should wait for the proposals and then have a proper debate about them.

My hon. Friend is right. Having met him twice recently in Bedford, I compliment him on the fact that he is indeed trying to ensure that there is a measured debate involving clinicians as well as patients and the public on the best way of organising services for patients in his constituency and other parts of Bedfordshire. It is absurd and unfair to patients for people to be campaigning to save a hospital when there is no proposal to close it and there is to be no proposal to close it.

I concur with the point made by my hon. Friend the Member for Sherwood (Paddy Tipping). It is important in a difficult merger situation in Nottingham that we have time to ensure that the process is efficient and effective for patients. Does my right hon. Friend agree that Opposition parties’ campaigning on the structure of the NHS is unnecessarily alarming patients? Although it is entirely understandable that staff are worried over mergers, patient care is better than it has been for many years.

My hon. Friend is correct. The truth is that the Conservatives simply will not face up to any difficult decisions. They want theirs to be the party of economic stability, but they pretend that the NHS can have a blank cheque and they promise their business friends a tax cut. They say that they support the staff, but they promise to scrap the agreement on public sector pensions and the hon. Member for South Cambridgeshire has the nerve to attack the new chief executive of the NHS, a distinguished public servant whose appointment has been welcomed across the NHS. They say that they want to devolve decision making to the front line, but they oppose the local NHS every time it makes a proposal to get better value for money and improve patient care. They say that they have been converted to the cause of fairness, but they want to rob the poorest communities in our country.

No, I will not.

The Conservatives want to be all things to all people—old Tory, new Tory, left, right and centre Tory—but they are being found out, because the more the British people hear from the Conservative party, the more they see the contradictions, confusion and intellectual dishonesty, the more they realise that, try as the Tories might, they cannot take the con out of Conservative. That is why the British people will never trust the Conservative party with the NHS. I commend our amendment to the House.

Let me join in the one note of consensus between the Government and Conservative Front Benchers by recognising and valuing the work that is done by almost 1.4 million people in the NHS. They are, rightly, the focus of today’s debate.

When we heard that the Conservatives proposed to spend a whole day talking about the NHS, we looked forward to seeing the motion for debate. We imagined—rather naively, I accept—that it might contain some answers. Given that, on Monday, the Conservative leader, the right hon. Member for Witney (Mr. Cameron), made a big speech about the NHS to tell us about his plans, I hoped that we would have the opportunity to see some more detail of those plans in the motion and to debate them. I was therefore startled to read the motion. I looked for something that was actually being called for, but first I found that the House “is alarmed” in line 2, “is deeply concerned” in line 3, “condemns” in line 4, “regrets” in line 5, and “further regrets” in line 7. We have to go to the penultimate line to find something that the Conservatives are calling for, which is “the potential” of health care staff to be used. I cannot disagree with that. We considered tabling an amendment that would simply add “and regrets the inability of Her Majesty’s official Opposition to have anything to say on the subject”, but, as a responsible and effective Opposition, we decided to table a substantive amendment.

Several hon. Members have waved around the “Stop Brown’s NHS Cuts” campaign document, which is being circulated widely. At the bottom of the page, we have a picture of the Chancellor with his scissors out, but we have heard the Conservative leader say that he cannot guarantee that any of the cuts planned would not happen if he were in charge. The “Stop Brown’s NHS Cuts” campaign should therefore be called the “Stop some of the cuts, but we can’t tell you which ones” campaign. Something tells me that, in every locality where the Conservatives are campaigning against a cut, they will say that that cut is one that they would stop and it is one of the others that they might not.

As the hon. Gentleman is aware, the Conservative party, unlike his own, has a prospect of entering government, so it tends not to make promises on expenditure without being wholly sure of what it can do. However, every Conservative Member knows full well—I hope that he accepts this—that the financially driven changes and cuts in staff and services would not happen in an independent NHS, freed from the political interference and control of both the chairman of the Labour party and the Chancellor of the Exchequer.

That is very interesting. If an independent NHS is central to fighting the cuts against which the Conservatives have started to campaign, why is it not mentioned in the motion? I just wondered.

The hon. Gentleman suggests that, if the Conservatives were in charge, we would not see “financially driven cuts”. I have to exempt him from blame, because he was not a Member of Parliament when the right hon. Member for Witney, now the leader of his party, opposed £8 billion for the NHS in the National Insurance Contributions Act 2002. I read the Conservative Q and A document on that subject, and this is what I found. The question asked is:

“Didn’t the Conservatives vote against every penny of the extra investment the Labour Government has put into the NHS?”

The answer is:

“This is just classic spin”.

Classic spin it may be, but I have here the Division lists from the Second Reading of the National Insurance Contributions Bill. The hon. Member for Buckingham (John Bercow) led for the Opposition in that debate, and he took an intervention from a little known Back Bencher representing Witney. That Back Bencher attacked the national insurance rise for the NHS, asking

“Has my hon. Friend calculated the effect of increased national insurance contributions on trying to hire badly needed staff in our hospitals?”

Whatever happened to him? The reply from the hon. Member for Buckingham was:

“the bull-headed and short-sighted policy on which the Government seem intent will make a difficult task much more difficult.”—[Official Report, 13 May 2002; Vol. 385, c. 543.]

In other words, when it came to the crunch—when it came to putting their money where their mouth was—where were the Tories? In the opposing Lobby.

Were that an isolated incident, a one-off, I might forgive the Tories—I am a very forgiving chap. Unfortunately, however, they have form. I asked the House of Commons Library for figures on real spending on the NHS. I was only interested in what had happened under Labour, but the Library staff inadvertently included on the chart the final year of Tory Government, which showed a real-terms cut. The last time the Tories controlled the purse strings, they cut NHS spending.

I am glad that, true to form, the Liberal Democrats have not risen above the student union politics that we expect from them. As long as “discouraging intellectual argument” can fit on the back of a “Focus” leaflet, that is fine. The hon. Gentleman should know that, in fact, in the period between 1979 and 1997, under Conservative Governments, real capital expenditure on the NHS increased by 60 per cent. above the rate of inflation. I am happy to correct him.

I am delighted to hear that. I wonder whether the hon. Gentleman can explain the following: if £8 billion of the approximately £80 billion currently being spent on the NHS is paid for by the 1p on national insurance contributions, which £8 billion does he think should not be being spent? A campaign against cuts is being run by a party that said that we should be spending 10 per cent. less than we are now. It is hard to reconcile those statements.

I would be prepared to forgive the Conservatives twice, in fact. I would forgive them real-terms cuts in the run-up to an election and I would forgive their later voting against the money. We therefore have to look at the manifesto on which every single Tory Member of Parliament was elected.

I shall in a moment—perhaps the right hon. Gentleman will be able to explain what his manifesto called for. For those who could afford from their own resources to buy their way out of the NHS, the manifesto called for a subsidy from the taxpayer to enable them to do so. That is at the core of the Tory vision of public services: not “excellence for the many”, but “enable the few to buy their way out.”

May I suggest to the hon. Gentleman, with respect, that he leave the Government’s propaganda to the Government? He is looking at the Division list on a national insurance tax increase and linking the £8 billion that was the result of that tax increase to increased NHS expenditure. That is the Government’s line, but it does not need to be the Lib Dems’. If he looks at the Budget for that year, he will find that the biggest single increase in public expenditure in the year in which that Bill raising the money to pay for it went through, was not for the national health service at all. The biggest single increase in public expenditure that year went into the social security budget, so why does the hon. Gentleman feel it necessary to accept the branding that the Chancellor of the Exchequer attached to a tax increase in order to make a spending increase on social security sound more acceptable by saying that it went into the national health service, when it did not?

I must be fair to the right hon. Gentleman. I checked the Division list while he was speaking and he is not guilty. He was obviously otherwise engaged at the time. I have some sympathy with the point that he makes. Simply because the Chancellor labels something does not automatically mean that it is so. I am very much of that view, but if we did not have the 1p on national insurance, which we supported and which we warned before the 2001general election would be required but which Labour never quite got round to mentioning, we would have £8 billion less of total Government revenue. We can argue about where that would come from, but clearly it is ring-fenced and earmarked for the NHS by statute, and that is the right place for it.

As my right hon. Friend the Member for Charnwood (Mr. Dorrell) rightly points out, it is a fiction that the change in national insurance directly determined the level of NHS expenditure. If the hon. Gentleman looks at the accounts for last year, as I am sure he has done, since he is a professor, he will find that national insurance provided £1.5 billion less to the national health service than it was expected to provide. Did that change the amount spent by the NHS? That is separately determined in public expenditure through the vote. The point that we were making in 2002 related to the economic consequences of the way in which the Chancellor would raise the money. That is why, at the subsequent election, we committed ourselves to maintain that level of expenditure, but of course my right hon. Friend might have chosen to raise the money in a different way.

I am interested in the hon. Gentleman’s claim that the Conservatives would maintain the expenditure. If the patients’ passport that his leader wrote into the manifesto had been implemented, money would have had to be found to subsidise people to buy their way out of the NHS. Where would that money have come from?

I thank the hon. Gentleman for raising the crucial issue of financing the NHS. The hon. Member for Peterborough (Mr. Jackson) referred to the period between 1979 to 1997, when expenditure under the Tories went up by 60 per cent. May I remind the House that from 1997 to 2008, under Labour, the budget will be going up by 300 per cent.?

Nobody could dispute that the rate of increase in spending under the present Administration since 1997 has been substantially in excess of what the Conservatives did or would have done, had they been in office. I am glad the hon. Gentleman mentions 1997. Part of the reason why I am addressing the House now is the record of the Tories on the NHS. In 1997, I had people coming to see me at my surgery with letters from their hospital stating that it would be two years before they could see an orthopaedic consultant to be put on the waiting list.

The reason Conservative Members object to my raising that and think we should be attacking solely the Government is that the Conservatives are portraying themselves now as the friends of the NHS. I find that laughable. They have form. They have form in cuts in their final year in office, they have form in voting against money for the NHS, they have form in the patients’ passport, and only last month the Conservative leader took out from the first draft of his speech a line that pledged to match Labour’s spending on the NHS. What was that about? If the hon. Member for South Cambridgeshire (Mr. Lansley) wants to reinsert that pledge on the record, I will give way to him.

It is clear that we were all elected on the basis that we would match Labour’s planned spending to 2008-09. We have no idea what Labour’s planned spending is after 2008-09.

So the hon. Gentleman does not rule out spending less than Labour on the NHS.

The hon. Gentleman said at the start that the debate was not principally about finance. One of the reasons why there are 90 per cent. unemployment rates among physiotherapists when they graduate, and one of the reasons that we are seeing redundancies, including of front-line medical staff, is the Government’s mismanagement of the finances of the NHS.

A recurrent problem throughout the debate is the issue of reconfiguration and who should decide when health services need changing for greater efficiency. At Prime Minister’s questions earlier today, the hon. Member for Hastings and Rye (Michael Jabez Foster) said that, if we do not like what is to happen to our accident and emergency department, whom do we ask? What do we do about it? There is only one person who has been anywhere near a ballot box whom people can ask, and she is sitting on the Government Front Bench. [Interruption.] The Secretary of State says overview and scrutiny. The local authority can scrutinise. What does it have the power to do? It has the power to go and ask her, and if she wishes and deigns to do so, she can refer the matter to an independent body.

My overview and scrutiny committee asked the Secretary of State to review the closure of Frenshay hospital in my constituency. Guess what? She refused. All three parties on the council, not just the Liberal Democrats, wanted a referral. I want a referral. Anyone who had ever been elected in the area wants a referral, but the Secretary of State blocks it, so she is the one who controls these matters centrally. How is that a democratic and accountable national health service?

Does my hon. Friend accept—the Secretary of State may anticipate this—that that must be right because, two nights ago, I went with four Labour colleagues to see her and the Minister of State Lord Warner to ask her to reinstate some of the cuts in south London for the most vulnerable this year and to look again at some of the prospective cuts for those with mental illness? The Secretary of State very reasonably said that she would reconsider because she believed that the formula that had been arrived at in London was unfair and she would seek to have it recast to reinstate some of the funding. We hope that that will be successful. We would not have gone to see her if it were not the case that the Secretary of State for Health is able to decide what happens. In the end, she calls the shots.

Indeed, except when there is bad news. When there is bad news, it is a local decision. The right hon. Lady is the Secretary of State for good news in the health service. Whenever a community hospital opens, it is because of a Government promise. Whenever a community hospital closes, it is because of local decision making.

Does the hon. Gentleman accept that I have been assiduous in going round the country to talk to staff in hospitals and local areas that are facing extremely difficult decisions, including Nottingham, about which we heard recently, and that I meet those staff privately to discuss the difficulties that they are facing? I do not go only to areas where everything is excellent. In the real world, most areas have to make difficult decisions to achieve the best use of their resources. Rather than continuing to sit on the fence, the hon. Gentleman must decide whether he is in favour of difficult decisions being made to get the best value, to take advantage of modern medicine and to get the best care for patients, even when that means, in his constituency or elsewhere, difficult changes.

At the risk of being parochial, there is the strange coincidence that the hospital in my Liberal Democrat-held constituency closed so that a new one could be built in the neighbouring Labour-controlled constituency. We need to know that the difficult decisions that have to be made are being made on clinical grounds. All too often, it seems blindingly obvious that other factors, shall we say, come into play.

The Government and the health service must treat the public as adults and give them the necessary information and the opportunity not to be consulted and ignored, but consulted and listened to and for their views to be acted upon. I have discovered a new word in the English language—it is sham-consultation. We cannot have the word “consultation” any more without the adjective “sham” in front of it. Throughout the country when I, like the Secretary of State, visit local people, they say, “Yes, we went to endless consultation meetings, we had engagement, then consultation, then review, and then all the rest, but in the end they did what they were always going to do.”

If people are making decisions against the will of the local people, they should be people whom local people can get rid of. How can it be right that decisions affecting hon. Members’ health services are made by people whom they never elected, whom they can never get rid of, and whose only right of appeal is to the Secretary of State—who has total discretion to ignore the appeal and, if she hears the appeal, can refer it to a quango, which we also did not elect? Where is the democratic accountability in that?

I have some sympathy with the idea of getting rid of centralised meddling, so to that extent I am with the Conservatives on the idea of independence, but it falls down because there is no democratic accountability, particularly at the local level. Local communities are frustrated because they feel that the decisions are being made for them, rather than with them. Lots of meetings take place, but how often do they change anything? That is one of the things in the health service that must be changed.

The Secretary of State met the press this morning. She is anticipating whatever the Healthcare Commission might find tomorrow about the health service’s performance. She said that we need action plans. In other words, where PCTs are found to be weak we urgently need action plans to start within a month. That typifies the Government’s mismanagement of the NHS. She does not say that we need long-term strategic thinking for efficiency over a period of years or that we need deep-seated financial problems sorted out in the medium term, but that we anticipate a bad headline tomorrow, so we need an action plan and we have a month—a month—to do things that presumably have not been done for the last nine years. Is that a month to put long-term plans in place; a month to consult and listen and refine? No, just a month to get them out of the mess they are in this month.

What is happening with NHS finances is that problems that have built up over years, decades in some cases, have to be sorted out by Wednesday week. How can that be a rational way to run the health service? We have huge financial instability. The Secretary of State complained that the Tories wanted to spend taxpayers’ money subsidising the private sector. The words “pot”, “kettle” and “black” spring to mind. Independent sector treatment centres are being given better prices than the NHS, guaranteed volumes of delivery, the chance to cherry-pick the easy hips, cataracts and scans, but at the expense of what? She mentioned the ISCT at Shepton Mallet, but that has resulted in job cuts at the Royal United hospital in Bath just up the road. Frenshay hospital will virtually close and the chances are that an ISTC will be built on the site, so the same people will be having the same procedures on the same site but done by the private sector instead of the public sector, probably at greater cost—and that is not privatising the NHS? I wonder what would be.

My hon. Friend has probably also seen the predictions that many of the ISTCs will not fulfil their full contracts, so they make more money. Does he share my concern that, for example, in Southampton we are faced with a treatment centre that will take cataract operations out of the system and threaten the viability of the extremely good and useful eye unit that we have?

My hon. Friend’s experience is absolutely typical. It is hard to see what was wrong with the eye unit at her local hospital, yet because the Government are obsessed with marketisation, with trying to create a fake market and with trying to shake up the NHS by subsidised private competition, good quality NHS facilities are being undermined throughout the country.

Will the hon. Gentleman therefore confirm that it is Liberal Democrat policy to close the existing ISTCs and not to open any more, or is it their policy to fund them in a different way?

I can give a straight answer to that—it is Liberal Democrat policy not to subsidise ISTCs, which is what has been happening. One question that I would ask the hon. Gentleman is where is the value-added coming from? As my hon. Friend the Member for Romsey (Sandra Gidley) said, some of the ISTCs have block contracts, so they are paid for work that they do not do. The hon. Gentleman’s party complains about low productivity in the NHS, whereas here the private sector is creaming it at the expense of the NHS.

Most patients go to their GP, in the vast majority of cases a private partnership, are given a prescription that they take to their local high street pharmacy, a private business, and are then given a drug from a private drug company. That is accessed free at the point of delivery, funded by the public purse, but provided by a range of providers—so I am not quite sure what his argument is.

The origin of the cheers says it all. The GPs are not providing services to make a profit, although the drug companies might be trying to do that. The critical point is why should the private sector have to be subsidised and bribed in order to bring it in. Does the hon. Lady support that? Does she really believe that the private sector should get more than the NHS for providing the same treatment? That is Government policy.

Is my hon. Friend aware that in Cornwall at the moment, despite the fact that GPs refer patients to NHS consultants, who have to operate with one arm tied behind their back, constrained by minimum waiting times, NHS managers intervene with unsolicited phone calls to offer the possibility of those patients being seen earlier in the private sector?

My hon. Friend raises some very strange matters that are occurring in the NHS. I assume that the Secretary of State knows what is happening. We are supposed to have patient choice. The patient is supposed to see the GP, go through a list on the screen, pick one, and then a booking is made—except that someone is tapping the phone line. Someone intercepts the call, second-guessing the GP’s referral, and in some cases saying, “Are you sure you want to do that? Let’s try to refer them somewhere else.” How that squares with patient choice I am not sure. If the GP and patient jointly decide one course of action and that is second-guessed, I do not see how that is patient choice.

My hon. Friend referred to minimum—not maximum—waiting times. We have examples all over the country—my hon. Friend the Member for Twickenham (Dr. Cable) has raised the matter with me—of people being told that they have to wait longer because there is no target at the bottom end. The people right up against the target will have priority, even if the others could be treated sooner because there is no target. Those are the sort of distortions that the Government’s obsession with targets are creating in the NHS.

I have great sympathy with what the hon. Gentleman says, but he is in danger of confusing one or two issues. I work part-time as a GP and I refer people on the choose-and-book system. I bring up the list of possibilities on the screen for the patient, given his condition, and the patient then chooses the hospital and makes the appointment to suit themselves. Waiting times on choose and book are very good indeed. On occasion, a patient may choose a private sector deliverer if there is one on the list within the NHS tariff, but in my area nine times out of 10 the patient will choose a local general hospital that they have had contact with before. I do not quite understand where he sees the confusion.

Perhaps the hon. Gentleman does not have referral managers in his PCT. Those are people who come between him and his referral to the consultant and suggest sending the patient somewhere cheaper. That is what happens.

Just to confirm the cases that have been brought up by my hon. Friend the Member for Twickenham (Dr. Cable), about a week ago my local GP complained to me that, having called up various consultants for treatment of his patients and been told that they and the operating theatre were available, when he tried to book in the patients he was told that there must be a 10-week delay until they are right up against the target barrier. That, presumably, is a mechanism for pushing costs, certainly within the London area, into the next financial year by delaying treatment as long as possible. My GP is very concerned about the deteriorating condition of his patients. I am now asking patients if they are willing to give me their names so that we can bring those cases forward.

My hon. Friend has illustrated the consequences of the financial squeeze in the NHS. Ministers seem to think that they are running a different health service in which such things do not take place, and, as my hon. Friend has said, sometimes they do not seem in touch with what is happening on the ground.

The focus of today’s debate is the work force, and the Council of Heads of Medical Schools has rightly criticised what is going on:

“Coherence is required—and this is sadly lacking at present—to the detriment of the entire nation.”

It is talking about the Government’s failure to ensure proper work force planning. Whenever I have asked written questions about that matter, I have been told, “That is the responsibility of trusts or health authorities.” I sometimes think that this Government are the “Not me, guv” Government, because they always say that it is someone else’s problem.

Where things need to be done strategically and nationally, the Government should be planning—I know that “planning” is a dirty word in new Labour—so that people who commit their lives to the NHS by undertaking three, five or seven years of training have a good prospect of obtaining a job when they complete their training. The Secretary of State has no answer to why 90 per cent. of recently graduated physiotherapists are unemployed. Is that acceptable? Has the right hon. Lady got anything to say on the subject? All she has said is, “We are trying to help. We will do what we can.” The situation is totally unacceptable; it is the result of mismanagement; and the buck must stop on the Government Front Bench.

Some things in the NHS must be done nationally, strategically and with accountability to Parliament. However, as much as possible should be done locally by local people, who should be engaged early in the decision-making process to allow them to face the difficult choices, to express their priorities and to have those priorities respected, which is not happening in the NHS at the moment.

One important issue that has arisen in the debate is that of switching money from people with longer life expectancy to people with shorter life expectancy. There is the question whether enough money is going into the system in the south and whether too much money is going into the system in the north. How can the Conservative party run a “no cuts” campaign without promising to spend any extra money? It is difficult to work that one out, until one realises that, with one or two exceptions, it does not intend to win any seats north of the Watford gap. Conservative candidates in seats south of the Watford gap will say, “We will spend more money in this area.” If, however, we were to have a parliamentary by-election north of the Watford gap, the Conservative candidate would not mention spending less in that area.

Does the hon. Gentleman accept that the economics of the issue and health outputs both involve using the money wisely and both concern productivity, which lies at the root of the Government’s failure? By reducing centralising bureaucracy and, as he has wisely pointed out, distortions caused by target setting, it would be possible to use the existing money to deliver more care. As the Labour party used to say before it got into power, which it has wasted, it is not only about money.

The hon. Gentleman represents a seat north of the Watford gap, and he is right that we need to spend every penny wisely. Every incoming Government say, “Vote for us and we will spend the money more wisely”, but the issue goes deeper than that. The Conservative party is saying that it would spend more money in the south of England without ever saying that it would spend less in the north. The shadow Secretary of State has said that the Conservative party should regard public health money as one pot and money for illness as another pot. Those two areas are clearly separate, but the total will not change—if one area gets more, another area must get less.

Will the hon. Gentleman clarify that the Liberal Democrats would not change the national distribution formula for the NHS one iota, which would help to rebut local Liberal Democrats who say, “We will get back the 10 per cent. that Labour has sent to the north”?

The hon. Gentleman will find that his Government have reviewed the formula in the past few years. It is wrong systematically to say across the south of the England that more money will be spent there without accepting the corollary of that choice. The Conservative party is saying, “Health cuts for the north”, which is official Conservative party policy. [Interruption.] The shadow Secretary of State has said that the board would be independent, which means that he cannot guarantee delivery. His argument is: “Vote for me, and we will give more money to the south, but only if the independent board agrees to do so.” Will he clarify the situation? [Interruption.] Would more be spent in the south because of the formula or would the independent board decide the matter?

It would be up to an independent board to arrive at a fair allocation of resources in relation to the burden of disease.

Tory candidates who are campaigning for a change to the formula to give more money to the south cannot be sure that it would happen. [Interruption.] If the independent board did not give more money to certain areas, no one could do anything about it because it would be unaccountable.

The shadow Secretary of State has said from a sedentary position that the independent board would allocate independently of Ministers the funding for each PCT.

That was my exact understanding of the shadow Secretary of State’s remark. At the next election, people will be asked to vote Conservative on the basis of a set of promises on the health service that will be entirely undeliverable because the health service would be run by an unelected board.

Today’s debate has provided a valuable opportunity to consider the NHS work force, but we have heard nothing from the Government about the lack of opportunities, which is due to the lack of planning for the work force. There is a place for central planning in the NHS—I know that that is a lefty thing to say—but it is not happening in the marketised NHS. Physiotherapists cannot find jobs because of the lack of planning.

More than anything else, we need an end to centralised meddling, which involves the centre dabbling, fiddling and changing when it should not do so. Every few months, managers must respond to the latest initiative and meet the next target. Unlike some, we have welcomed the money that has gone into the NHS, but we oppose the constant fiddling and meddling, without which the NHS would not face many of the pressures mentioned in the motion.

Order. Before I call the next speaker, I remind hon. Members that a 10-minute limit has been placed on speeches by Back Benchers, and it applies from now on.

I want to pick up a point raised by the hon. Member for Northavon (Steve Webb) about independent sector treatment centres. The Health Committee submitted a report to the House and the Government in July this year—we expect a reply to that report, which we may debate at some stage, in the next few weeks. The hon. Gentleman has stated that ISTCs are cherry-picking, but the Health Committee found no evidence on that point other than anecdotal, although I hope that hon. Members will provide evidence in this debate.

The orthopaedic treatment centre in Banbury is refusing to treat anyone under 18, anyone who lives on their own, anyone who does not have a telephone, and anyone who is overweight—in other words, anyone who presents any difficulties at all. I invite the Chairman of the Select Committee to come to that centre to see exactly how it is cherry-picking.

I will have a chat with the hon. Gentleman a bit later, but if what he says is the case, it is a great pity that those findings were not at least submitted as written evidence during the Committee’s inquiry, because that would have enabled us to comment on it.

On the motion—

No, I will start my speech, if the hon. Gentleman does not mind.

The events of this week involving the main Opposition party leave me a little confused. On Monday, as I drove down from Yorkshire, I heard about the Leader of the Opposition’s conversion in relation to the national health service, so I looked at the Conservative party’s website. Two comments somewhat confused me. First, the right hon. Gentleman says that he is

“committed to the NHS idea, ruling out any move towards an insurance-based system.”

I thought that he would have flagged that up at his party conference, assuming that it agreed with that, as just a few years ago, in 2001, he said in the Oxford Journal:

“We also need to look at a massive expansion of social insurance schemes, so that our health spending and outcomes can match that of other European countries. We want to keep and expand the NHS, but on its own it is simply not enough.”

Perhaps the Conservatives should have put that idea down for debate today.

Not just yet.

We could then have had a discussion about the apparent conversion that has taken place in the past six years in terms of the money spent in the national health service, and how services have kept expanding while being paid for out of the public purse and not through private insurance.

I intervened on the hon. Member for South Cambridgeshire (Mr. Lansley) to draw attention to the extraordinary statement by the Leader of the Opposition on Monday, quoted again in the Conservative website news story:

“So my message to the Government is clear: the NHS matters too much to be treated like a political football.”

Wonderful stuff, is it not? I also have the Conservative party’s NHS campaign pack, which, I understand, is about to appear on its website—[Interruption.] It is not entitled “save the NHS”, although I may sign up to one or two things in it, and I am prepared to share a few views about it with hon. Gentlemen. It is to be launched on Saturday by the Conservative party—I presume that it will be the non-political health service football that will be launched. That pack is very good and includes materials that can be purchased for action day, graphics to download and a template press release. All people have to do is take out the italics and put in how awful the NHS is in their part of the country. [Interruption.] Conservative Members who are making noises will find it very difficult to come to my part of the United Kingdom and fill in any type of press release saying that about the NHS there. I challenge them to come and do that on Saturday, although I will be holding a surgery.

If the Conservatives intend to launch that campaign in Halifax, may I remind them that we waited 20 years for a new hospital, and we got it in 2000 under a Labour Government?

Again, people would have difficulty taking out the italics and filling in the press release with details from my hon. Friend’s area.

Further to that press release—[Interruption.] I will let its author speak in a few minutes. It is different from the motion in subtle ways. It includes a template for a council motion to be tabled at local government level, again to try to get everybody to agree how awful the NHS is. Once again, it will be a struggle to fill that in in south Yorkshire. None the less, although that press release says that almost 20,000 jobs have been lost from the national health service, the motion does not do so—it refers to posts. All of us who want to share the truth about such matters know that nowhere near 20,000 jobs are being lost in the national health service—not in the last 12 months, two years, three years or anything else. There are more than 80,000 additional nursing jobs in comparison with 10 years ago, and many other grades have more people working in them.

We received an e-mail from NHS Employers alluding to this matter, some of which was quoted by the hon. Member for South Cambridgeshire. That e-mail stated:

“Last week, NHS Employers contacted 18 trusts which had identified potential redundancies. Across all the organisations, the original estimate of the number of posts to be lost was 7,900, with the DTI subsequently notified of 3,999 jobs at risk. The number of actual redundancies (voluntary and compulsory) is 766. Of these 540 are in two organisations”—[Interruption.]

I will go on, because the hon. Member for South Cambridgeshire missed all that out—clearly, he just picked up the second page when it came out of his printer. The document continued:

“The figures being widely quoted of up to 20,000 may turn out to be not too far off the total reduction in workforce numbers this year. This applies, however, not to people being made redundant but to the number of posts being taken out of the system in a total workforce of some 1.3 million which experienced an increase of 268,000 during the previous six years.”

That has not stopped the Conservatives saying in their petition to councils that there have been 20,000 job losses in the national health service. I shall ask my party if it will produce a motion for our councillors to take to their council chambers, which says that those are not job losses in the real sense.

I note what the hon. Gentleman says from a sedentary position. The Conservative motion alludes to nurses in training who will not be able to get jobs, as was reported on the front page of my local newspaper earlier this year about those who do their practical work in Rotherham and then go to the medical school in Sheffield for nurse training. But what happened to them? They all got jobs. The only redundancies made at Rotherham district general hospital this year were three compulsory redundancies among administrative staff. To read the local press, one would have believed that hundreds of staff at our local district general hospital would be out of work.

If the University Hospitals of Leicester NHS Trust employs fewer people next year than this year, I call that job losses. What does the right hon. Gentleman call it?

In my view, posts unfilled are not job losses. When the right hon. Gentleman was Secretary of State, I accept that there were job losses throughout the national health service. Unfilled posts, however, are not people being made redundant or people being added to unemployment statistics in this country; they are merely jobs not filled.

If Conservative Members want to listen, the Health Committee currently has two ongoing inquiries, one of which is on deficits, which we are trying to bottom. My voice is going hoarse from talking to organisations such as the Royal College of Nurses, which keeps saying to the media that there are hundreds if not thousands of job losses. I keep asking it to send me the evidence of people being made redundant from the national health service. I said that months ago, and again two weeks ago, and the evidence has still not arrived The inquiries on both deficits and work force planning are still ongoing, and as Chairman, I and other Committee members would be more than happy to receive that evidence if it exists. Putting out press releases about the work force that do not represent the reality on the ground does no one any good in this debate.

One of the problems for the Royal College of Nursing and the Royal College of Midwives is that they cannot extract the numbers from local NHS trusts and hospitals, or from the Department of Health. Surely the right hon. Gentleman should expect the Department to provide the numbers, not the RCN.

We are doing that, and we are asking witnesses. I did not have any difficulty finding out what is happening in my local health community, in the primary and acute sectors. Together with other Members who represent constituencies in the Rotherham borough, I have annual meetings on the issue. The reality is that this year there are three redundancies of administrative staff.

As a Yorkshire MP, my right hon. Friend may wish to comment on annex E of the Conservative campaign pack, which has a list of “job losses”, as they are called. It claims that 1,100 jobs will be lost in the Mid Yorkshire NHS trust. The information that the Department has is that although up to 400 jobs could be at risk, only six people will be made compulsorily redundant—though even six is too many. Does my right hon. Friend agree that the campaign pack includes such misleading information that it should be withdrawn immediately and not used as the basis for a national campaign this weekend?

Yes, I do, because it is wrong, false and misleading. This is no conversion to the national health service. They say on a Monday that they will not use the NHS as a political football and, before the ink is dry on that speech, they table a motion that does exactly that, with a campaign to be launched on Saturday morning. The people who work in the health service remember what happened between 1979 and 1997. Their memories are not as short as some people would believe. They know that the NHS has been a political football for far too long and they also know the improvements, for patients and the work force, that have taken place in the past few years.

When my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) began his excellent and thoughtful speech at the start of this debate, he was accompanied by the usual cacophony of noise that we hear in every debate we have on the health service, with people briefed by the Government Whips Office denouncing us for treating the health service as a political football. I find that recurrent atmosphere ever more remarkable, because we are steadily moving towards a consensus in principle on the health service, of a kind that I never thought I would live to see.

We are all in agreement about the principles of the national health service. I have consistently believed that it should be provided free at the point of treatment, according to clinical need and largely funded out of taxation. The final loophole is only for prescription charges and so on, which we have always had in the system. I actually agree in principle with the reforms that the Government are introducing, because they are remarkably like the reforms that have been embarked on for the past 20 years.

I was delighted to hear the hon. Member for Hackney, South and Shoreditch (Meg Hillier) give an explanation of how the health service has always been a partnership between the private sector and the public sector. Her views would have seen her drummed out of the Brownies 10 years ago if she had said anything of the kind from the Labour Benches. Her predecessor, who was a very left-wing Labour MP, has now joined the Liberal Democrats, who are the last defenders of the view of the old left opinion that provision by the state of the buildings, staff and everything else is a key part of the system.

We are all embarked on what I never really thought was a market system, but has been called the internal market. It is a market-influenced approach, in which there will be a wider variety of suppliers, including the independent sector with the state-owned and provided hospitals, and in which patient choice is brought into play because it gives rise to competition and cost control and directs taxpayers’ money to those places with greatest public demand because of the quality of service provided. In that way, the system reflects public need. That is our destination, but we are now in the middle of a familiar debate in which each side hurls at the other allegations about the acute crisis that we are in.

My principal complaint about the Government is that having had their miraculous Pauline conversion about four years ago, they have so far embarked on the process of reform in such an incompetent fashion that they are in danger of giving it a very bad name. They are in the middle of a classic crisis of the sort that my right hon. Friend the Member for Charnwood (Mr. Dorrell) and I are only too familiar with. The Government do not even understand how they got there and they are in denial about the financial problems underlying the present situation.

In a moment.

I heard the Secretary of State using phrases that I remember using frequently when I was closing hospitals that we did not need. In my day, they were often Victorian workhouses. I would explain how we had to strive for more day surgery, shorter stays in hospital and more use of community services. That is all common sense when running any health care system. The snag is, as has been illustrated over and over, that that is not at the root of the present bad crisis. At the moment, many parts of the country—including mine—are being driven to short-term expedients to address financial deficits. They are saving money wherever they can. The failure to offer jobs to physiotherapists has nothing to do with a movement towards a more rational service. Student nurses are having more difficulty finding jobs and clinical staff are being shed because the NHS is in a total shambles. If the Secretary of State will not acknowledge that, we do not have much chance of curing it. I preferred my hon. Friend’s approach.

The crisis is caused, as crises in health care systems throughout the world are caused, by a complete inability to control costs; the complete lack of a financial management system for most of the NHS; and an inability to localise the services sufficiently and give enough discretion to the people with the competence to sort them out, if that is what they wish to do.

I accept that there is no shortage of resources. The tragedy is that the crisis has occurred after the Government have poured money into the NHS for the past 10 years. That is not a matter of pride. How can they have trebled the expenditure in cash terms and doubled it in real terms, but still need to sack staff or close hospitals all over the place because costs have not been controlled? The Government cannot answer that question.

I am grateful to the right hon. and learned Gentleman for reminding the House that we have trebled spending on the health service. Does he agree that in percentage terms this year’s deficit is less than it was for several years under the Tories?

Well, I could retaliate with a list of the years in which we increased growth by 5 per cent. in real terms, but this is corny stuff. Expenditure on the health service has always gone up. We increased spending on health by 1 per cent. of GDP. Every developed country increases its spending on health care and, given today’s demography, will continue to do so. It is corny nonsense to say, “Aha, the Conservatives spent less than we did”.

I would point out that the rate of increase of recent years cannot be maintained. A fundamental spending review is on its way and it will be impossible to maintain 7 per cent. real-terms growth in health spending, without doing fantastic things to the budget of every other part of the public sector. The public spending review towards which the Government are just beginning painfully to creep cannot maintain that rate of growth. It will shrink, and the failure to tackle the present problems will produce more crises, unless the Government face up to the fact that they are going nowhere fast. They must face the fact that just spending money has not delivered what they wanted and expected.

Where has all the money gone? It has gone in costs, including—as it is bound to do in a health care system—payroll costs. Of course, there have been improvements. It would have been impossible to spend all that money without seeing some improvements, but the health service has always improved, year on year, ever since it was created. People cite the problems in 1997, but I say that they should have seen what it was like in 1979. Those are hopeless historic comparisons.

The health service has got better, but most of the money has gone on enormous payroll increases and pay rises for the staff, on a scale that has not been matched by increased activity. The productivity performance of the health service has, as everybody has pointed out, steadily deteriorated. If one thinks that the health service is important, that is no way to run it. Ministers take pride in the 300,000 extra staff employed in the NHS, but what do they cost?

No, as I am afraid that I have a time limit.

The NHS is the largest employer in western Europe, but Ministers must resist the temptation to make political claims about how many new jobs are being created. They must have regard to what the extra staff are being employed to do, whether they can be afforded, and how the system is being allowed to proceed.

In my day, pay negotiations were very difficult. Ministers of State used to have to get stuck in, because no one on either side of the House could be persuaded that the affordability of pay increases was something that had to be borne in mind. What has happened since then? The working time directive has been allowed to go through, and there has been a huge increase in the number of doctors. The 24-hour commitment of GPs has been abolished, and all nursing grades have been raised as a result of people writing their own descriptions of their responsibilities. Lots of other staff are now employed, and we have the best paid clinical professions in western Europe. I congratulate the BMA and the RCN: as usual, they have taken the Department of Health to the cleaners, but what were Ministers doing when all that was happening?

The NHS has no system of proper financial control. We all believe in a giant NHS run on principles that everyone accepts, but there must be a system of financial control. All other giant organisations—such as Marks and Spencer and BP, although they are smaller than the NHS—have that. I can think of no other business-like activity whose first thought is to cut back its service, or product. The health service goes running around closing wards because it cannot afford the staff to keep them open. It closes community hospitals and stops recruiting the necessary trainee staff, but none of those problems has been addressed.

Of course, those are not comfortable things for me to say. I might have to mute some of it at the next election, as the news that not all problems will be solved merely by getting rid of the present Government is not always welcome to a general audience. However, my hon. Friend the Member for South Cambridgeshire is trying to depoliticise and localise the argument, and that approach is absolutely essential.

The only way to manage the NHS is through more, and genuine, local budgeting and financial control. People will have to stick to their local budgets, but they will have discretion about how they spend the money. We are getting GP fundholders back, but I have yet to discover whether they will have real budgets and total discretion over where they spend their patients’ money in the service. All that has to be tackled, but what we do not need is more mad structural change all the time.

The Government have failed to manage the changes that their reforms require—of course the pattern of service has to change, but they are not even controlling the pace of change. It is crazy to go backwards and forwards on PCTs, commissioning, budgeting and so on, because that just demoralises the people who should control things. That is a failure on the Government’s part. They are in a crisis, and they need to start again and decide how they are going to reform the NHS.

I begin by declaring an interest, in that my wife is a member of the Wigan and Leigh hospital trust board. I am amazed at the brass neck displayed by Opposition Members in holding a debate on the NHS. They seem to forget some of the problems that existed in 1997. They do not like to hear what they were, but it is important to put what is happening in context.

I remember workers throughout the country holding a one-day strike to support nurses, who did not want to go on strike and therefore disrupt the services that they were providing. Other workers were prepared to give up a day’s work to support the nurses, to whom the then Conservative Government did not want to pay a proper wage.

I also recall the winter beds crises that arose year after year. Patients were forced to use trolleys in hospital corridors or were bused all over the country in ambulances. People were even treated in ambulances in those days, but such things do not happen now.

Two years was the norm for waiting lists throughout the country in 1997, but nowadays the maximum wait in Wigan in six months, and the vast majority of cases are dealt with in three months or less. I remember having to wait in an accident and emergency department in Wigan for more than eight hours before I was seen, but every patient is now dealt with inside a maximum of four hours.

All that represents a dramatic change from what was happening in 1997, and it would have been nice to hear an apology from Opposition Members for that. Given where the Leader of the Opposition was on Black Wednesday, I suppose we should expect him to say, “Je ne regrette rien.” However, instead of saying, “We regret nothing,” what we get is the Opposition saying, “We forget everything.” Well, neither I nor the people of Wigan have forgotten, and we will make sure that the people of Britain do not forget when the next election comes around.

What are the Opposition’s policies now? In 2005, as we have heard, we had the patient passport, which would have put wads of money into the private sector. In 2006, we have the Leader of the Opposition on his webcam telling us how good it is to wash up dishes, although I not sure what that says about him. The Conservative spokesperson on health says that his party does not want any more reorganisation, but that there will be a new organisation to reorganise things. He also says that there will be no more targets, but that his party will introduce protocols instead. The Opposition are all over the place: we have gone from flog it to blog it to blag it, but not one Conservative Member has shown any sign of embarrassment.

I want to tell the House what is happening in Wigan. The Wigan PCT and acute hospital trust covers Wigan and the constituencies of Makerfield and of Leigh, and parts of Worsley and West Lancashire. I am sure that my right hon. and hon. Friends who represent those areas—and they are friends as well as parliamentary colleagues—will not mind too much if I stray into their territories.

Since 1979, we have some 400 extra nurses and 100 extra doctors in Wigan. In the past two years, we have recruited 20 extra GPs, and 14 extra matrons are working in the community. Just as importantly, huge capital investment has been made. There are new maternity, neonatal and intensive care units at the Royal Albert and Edward infirmary, as well as a new X-ray department with a magnetic resonance imaging facility. The hospital has a new endoscopy unit, and extra beds. In case some of what I have listed does not work, the hospital also has a new mortuary.

At the Wrightington hospital in the Wigan area—where hip replacements were originally pioneered—there are two new clean-air orthopaedic clinics, while other wards have been refurbished and upgraded. Moreover, the Thomas Linacre centre is a brand-new outpatient facility in the centre of the town.

Over the recess, I visited the new cardiac catheter laboratory that has opened in the Royal Albert and Edward infirmary, and the new patients information centre at Wrightington. I also went to the renal unit opened under Wigan’s LIFT–local improvement finance trust––programme. Never has one so well gone to so many health units in so short a time.

We are all delighted for the hon. Gentleman’s constituents in Wigan, but how does he think that my constituents in Hertfordshire will feel? They were promised a hospital worth £500 million before the election, when a health Minister represented the seat that I now occupy, but the hospital has been withdrawn now that the election has passed. I understand the party political points that he makes, but how does he explain the fact that 18 years of so-called Tory cuts in the NHS meant that my constituency had the QE2 hospital, with accident and emergency, maternity, paediatric and other services? They have all been stripped away. The news is good for people who happen to live in Labour constituencies, but blooming bad for those who did not vote Labour. The Government’s policies are a punishment, are they not?

That is exactly my point: what happened in those 18 years is that we were not getting the service improvements that we needed, because you were gerrymandering so much of the money into your own areas. We have a new system now, in which money follows the needs of patients. What you have to ask your people—

Order. I think that the hon. Gentleman knows what I was about to say.

I apologise, Mr. Deputy Speaker. The hon. Gentleman should ask why his PCT is getting more money than the formula prescribes. Why does it get extra money through the market forces factor, yet remain incapable of running its service properly? In contrast, my PCT is underfunded under the formula and gets less money through the market forces factor, yet is able to budget properly. Our PCT is three star, and we also have a three-star hospital. They keep to their budgets. If the hon. Gentleman cannot make sure that his PCT keeps to its budget, that is a matter for him.

The cardiac catheter laboratory makes sure that there is early diagnosis of heart trouble so that people can be treated and kept out of hospital. The patient information centre makes sure that patients who go for difficult operations understand what is going on. In that extremely anxious period, they will be given the kind of reassurances that they want. The renal unit means that, instead of patients trawling all over Greater Manchester looking for somewhere to have kidney dialysis, they can now have that treatment in the centre of Wigan. That takes an incredible amount of stress off not just the patient, but the families and friends who have to drive them there.

Those last points illustrate the huge changes that are being made and that need to be made if we are going to deliver health care properly in this country. I am talking about a massive shift from secondary to primary care. The Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham) will know of the doctors surgeries in two-ups and two-downs in Leigh, and up and down the Wigan area. They provided a poor service, not because the doctors were bad, but because the facilities were. In Wigan, we now have a refurbished clinic at Tyldesley and new clinics at Atherton, Ince, Worsley Mesnes, and Golborne. Platt Bridge is being built. Pemberton is being extended. More clinics are planned at Standish, Shevington, Whelley, Wigan, Ashton and Leigh—all with a huge range of facilities and with brand new treatments. What is the result of that? As I said, there is local delivery of renal care.

The hon. Gentleman is positively triumphalist about the position in Wigan, but how does he explain the contradiction between the fact of greatly increasing expenditure nation wide on the one hand and no comparable increase in national health service productivity on the other?

I am not a statistician, but I suspect that one of the problems is that if a lot of money is put into making sure that people do not get ill, the productivity end—that is to say, the measurement of how many people are treated and how they are treated—will be difficult, because the reality is that one makes sure that people do not get ill and that means that one is less productive. That is nonsense. There needs to be a way to look at the statistics to make sure that they properly reflect what is going in.

Thank you. I thought that it was fairly successful, as well.

Not only do we have renal units, but diabetes is being treated in the community. People who have heart disease are being treated in their own homes, although obviously not while they are having their operation—I would not suggest that for one minute. The post and pre-operative aspects are being dealt with in people’s own homes. Cancer therapy is being delivered at home. There are smoking cessation clinics in the clinics that I mentioned. In the case of dental treatment, there is an emergency line that operates 24/7 for the whole of the borough. That shows a shift from secondary care to primary care when dealing with health. It is not just a matter of some kind of organisational shift; it is what patients need and want, and what we are delivering.

I will finish—I am well aware that many people want to speak in the debate—by giving my constituents a strong warning. What we heard from a number of Members, and particularly the hon. Member for Northavon (Steve Webb) and others who talked about the campaign pack from the Conservatives, was that that pack provides a stark warning. The Conservatives will move resources from Wigan to Windsor, from South Kirklees to south Cambridgeshire, and from Leicester to Leominster—from places that need those resources, because health there is poorer, to places that do not need them, because health there is better. Resources will no longer be based on health needs. They will be gerrymandered yet again to Tory areas. If anybody in Wigan votes for the Conservative party at the next election, they should know what they are voting for.

I want to respond briefly to the point with which the hon. Gentleman closed. It has been apparent several times in the course of the debate, listening to Members on the Front Bench, as well as the Back Benches, that the charge now being levelled against the announcements that were made by my right hon. Friend the Leader of the Opposition on Monday is that they represent at attempt to gerrymander resources. The truth is precisely the opposite. The announcements are a response to the Government’s gerrymandering of resources. We seek to set up an established authoritative body that can provide an independent assessment of where health resources ought to go. We want to do that in order to ensure that the national health service is in a position to deliver the objective that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) made clear is shared explicitly right across the House: we want to have a largely tax-funded health care system that is available to people on the basis on need—on the principle of equitable access to those who need it, without regard to ability to pay. Attempts by Labour Members to undermine, or eliminate, that political consensus across the House are doomed to fail. I want to return to some of those themes in a moment.

I congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on the fact that he has focused the debate on the key resource of the national health service. The message coming back right across the health service is that, although Ministers repeatedly say that the delivery of health care depends on the professionalism and commitment of health service staff, which we all know to be true, the message that is received by national health service staff themselves is that their professionalism and their commitment to the service is being systematically undervalued by the Government who are supposed to be their employer. Staff feel that their commitment is undervalued because—despite the huge increase in resources committed to the health service, which commands support right across the House—they find themselves in the too familiar situation of being caught up in the management of short-term crises that are repeating themselves right through the national health service. In any organisation, when people find themselves responding to firefighting initiatives and short-term crisis management measures, that undermines morale and that is precisely what is happening right through the national health service today.

Like my right hon. and learned Friend the Member for Rushcliffe, I think that it is fundamental that we understand why that situation has arisen despite the huge increase in resources committed to the national health service. I was struck by the fact that the Secretary of State was lecturing the House from the Dispatch Box on the importance of Ministers and managers in the national health service facing hard truths about the requirement to use resources efficiently if the health service is to deliver its objective of equitable access to high quality health care. As my right hon. and learned Friend said, he has made that speech, as have I—every Secretary of State for Health has made it. The problem is that this generation of Ministers had a once-in-a-lifetime opportunity to use resources to address some of those fundamental problems of efficiency in health care delivery in the health service and they fluffed it. They had an opportunity that was not available to my right hon. and learned Friend when he was Secretary of State for Health and that he made certain, when he was Chancellor, was not available to me when I was Secretary of State for Health—an opportunity to use that huge increase in resources to oil the wheels of change. The present Government had the opportunity to use those resources to provide a step change in the efficiency and quality of service that is being delivered by the health service. The present generation of Ministers has missed that opportunity and the result is that we are back with short-term responses and crisis management.

Let me give the House three specific examples of what that means in practice for people who deliver care to patients on a day-by-day basis, rather than make speeches about the health service. First, we have what are often called in health service-speak the priority services. There is an unintended irony in that phrase. I am talking about community services, therapies and the low-tech services that are delivered at community level that often bring a quite disproportionate benefit to the quality of life of patients. However, they are the easy targets every time a health service manager faces the need to make short-term cuts so that the books can be balanced. That is why we have unemployed physiotherapists throughout the country—the health service cannot afford to employ them—why occupational therapists are looking for jobs and why social services are complaining about their inability to get local partnership arrangements out of the health service.

The effect of such short-term cuts in community-based services throughout the health service is twofold. First, they undermine morale because those who are delivering the service know that it is not as good as it could be. Secondly, and absurdly, they mean that we are building up long-term costs in the health service because people are being trapped in hospital, rather than released to properly funded and resourced community services.

Will my right hon. Friend add to his concerns the example from my constituency of the effective cuts that have led to unfilled health visitor posts and caused the closure of baby clinics and the suspension of routine developmental checks? That, together with the danger that our children and maternity services will be transferred, has led to profound concern that services are being hit where it hurts most. We have the agenda for “Every Child Matters”, but that certainly does not matter in Enfield, Southgate.

My hon. Friend is entirely right. He cites a perfect example of the trend about which I am talking, which exists throughout the health service. Resources are being taken out of the community services because they are an easy hit.

The second example of short-term crisis management is the difference between the rate of inflation of health care costs in the system and the change that the Government have made to the tariff charged by secondary care to PCTs and commissioners. We all know that health care costs are rising very quickly—my right hon. and learned Friend the Member for Rushcliffe referred to that—and the latest estimate from the Office for National Statistics, which was published in August, is that they are rising by 6 per cent. a year. Given that the costs are rising at such a rate and the tariff that the Government published on 26 January increased by 1.5 per cent. a year, one does not need to be a statistician to work out that that represents a 4.5 per cent. cut in the real resources available for the delivery of individual procedures by NHS providers.

The situation shows that Ministers are not facing up to the consequences of their actions. If costs are rising by 6 per cent., yet Ministers fund them to the tune of 1.5 per cent., Ministers are effectively hoping that all the people in the national health service will somehow cover up the 4.5 per cent. gap so that they can avoid political embarrassment. It is not surprising that those people find their morale undermined if Ministers apparently believe that they are employed to do such a job. Those people think that they are employed to deliver high-quality health care to patients, as they should be. However, their experience is one of being asked to cover up the consequences of ministerial unwillingness to face precisely the kind of tough decisions about which the Secretary of State talked.

The development of training policy in the NHS, which is my third example of the short-term responses, has already been referred to during the debate. I have previously welcomed in the House the fact that we now spend more on training doctors and nurses in medical and nursing schools than we did when I was Secretary of State. I have reminded Ministers on previous occasions that that has happened partly because of carrying through plans that started to be generated when I was Secretary of State, but the big increase is welcome. However, it is not welcome that people who leave medical schools, and especially nursing schools, find that they cannot be employed in the national health service because Ministers have not faced up to the need to improve the efficiency with which health care is delivered. Furthermore, not only do we have unemployed nurses and doctors coming out of the growing medical and nursing schools, but the operators of the schools anticipate a 10 per cent. cut in the budgets available for training future doctors and nurses for the national health service. The Government have created a growing training sector, but they are not employing the people whom it produces, and they are also preparing a substantial cut to the increased training budget for which they are claiming credit.

Of course, that is true not only of doctors and nurses. Is it not particularly absurd that whereas there is a substantial increase in the number of trained and qualified speech and language therapists, there is also a substantial increase in the unmet need among children who require the service, but for whom the employed personnel to provide it do not exist?

My hon. Friend is right. Why does that undermine morale? It is partly because it results in unemployed people with training that they want to use and partly because the people in the service know better than the politicians the impact of the failures on the service delivered to patients from day to day. They can compare that service with what they want to deliver and what they know could be delivered if only the health service was led in a way that faced up to the real choices about which the Secretary of State likes to talk.

I agree with the Secretary of State when she talks about the importance of facing hard choices to deliver real improvements in health care. However, I look for a Minister who not only talks the talk, but walks the walk. I want to link the situation to the seven or eight rounds of bureaucratic change that we have had in the health service since 1997. The Government have brought us back round to virtually the same point at which they started nine years ago. Not only has that process led to a huge waste of resources—I have seen estimates suggesting that the whole rigmarole has cost roughly £1 billion—but more fundamentally and importantly, it has meant that the kaleidoscope of changing management structures simply has not addressed the real choices about which the Secretary of State has talked. That is the link between the bureaucratic changes for which the Government are responsible and their fundamental failure to deliver improvements in health care, which is what hon. Members on both sides of the House want.

The Member for Rushcliffe (Mr. Clarke) gently mocked Labour Members for hyperventilating when it comes to the Conservative record of all those years ago. I agree with him that policy convergence is taking place. In fact, the Prime Minister is on record as saying that a lot of policy cross-dressing is going on, yet we have these debates that are full of sound and fury about what the Conservatives did in their 18 years, and I think that it is just a big yawn.

The Prime Minister can be very tribal. At Monday’s meeting of the parliamentary Labour party, he told us—jacket off; gleaming white shirt—“The Conservatives have a marketisation agenda, you know. Get in there on Wednesday.” Goodness me, I thought. I will come on to the business of new Labour and the market in a minute.

I also wanted to pick up on the point made about structural change, which has been hugely debilitating. In the time that I have been a Member of Parliament, strategic health authorities have changed massively. We have a huge strategic health authority in the north-west. In east Lancashire, which is where my constituency is, East Lancashire health authority morphed into Burnley, Pendle and Rossendale primary care trust, which has morphed into an even bigger PCT. We had two hospital trusts—Burnley hospital trust and Blackburn hospital trust—but they have been merged. The Lancashire ambulance service has been abolished and we now have a regional ambulance service. Community health councils have been abolished and we now have public and patient involvement forums, which are about to be abolished and replaced by patient links.

Is it not especially tragic that while we started off with community health councils that people understood, no one now understands how patients or the general public have a voice in NHS change?

I agree entirely. Last year, there was a lunatic proposal from Lord Warner to transfer 250,000 people directly employed by primary care trusts from the NHS into the private, voluntary and not-for-profit sectors. That was stopped only because of the huge outcry from Labour Members. The announcement was made on 28 July, and it was finally overturned by my friend the Secretary of State last November.

Debilitating change has taken place. The Prime Minister tells us that we are the change makers, but every time that we change the organisation, it is set back a year, or perhaps 18 months. It takes time to recover, and as soon as it has recovered, we slap it in the face again and reorganise. The way in which we endlessly reorganise the health service is Maoist, which is why people in the health service are so antagonistic towards us, why the platform lost an important conference motion moved by Unison in Manchester, and why a statement by the national executive committee, saying that more work had to be done to engage people working in the health service, was rejected by the conference. We regard people working in the health service as pawns that can be moved about, but they are finally saying, “No, we are not having it.”

The private sector is moving into the health service in a big way, but that is being done surreptitiously. Ministers do not say that it is taking place, although they should do so. All the arguments are wrapped up in issues such as contestability; instead, we should just play it with a straight bat and say, “There are too many people sleeping at their desks in the national health service; we will put 20,000 volts through the NHS and bring in the private sector.”

That is what is happening in my constituency, where Netcare, a South African firm, has become involved. I have a letter from my primary care trust that reminds me that Netcare runs a local mobile ophthalmology unit at Rossendale hospital, but I am told that Netcare is coming to Lancashire in a big way. The contract will be signed by the end of the year. I am told that Netcare services

“will be established in the following specialities”—

I thought that it would just deal with the odd cataract, so that we process ophthalmology patients quickly, but it will be involved in work on ear, nose and throat, general surgery, trauma, orthopaedics and rheumatology. Urology and gynaecology, too, may be included, which does not leave much. Let us not kid people outside. The Prime Minister and the Government have a pro-market agenda, and they are pursuing it.

Does my hon. Friend agree that although the vast majority of NHS services in this country are provided in NHS facilities by NHS-employed staff, there are examples of cases in which it is not the best provider? I can give a personal example of a family member who was waiting for a wheelchair. She received it free at the point of delivery, but it was made by a private company, and private companies undertook the fitting. She was glad to receive the wheelchair. Is my hon. Friend suggesting that the NHS should open a wheelchair factory and make all the component parts, and provide the wheelchairs as well as the free service at the point of delivery?

That is the argument about NHS Logistics. We can deconstruct organisations such as the police service. One might say that police officers should be fighting crime, not patrolling motorways, so we should take that responsibility away from them. The same could apply to the national health service. There are many people who want to be in the national health service family, and I agree that they should be part of it.

I very much doubt it, because there are no consultation procedures when services are moved from the NHS into the private sector. There was no consultation—it just happened. I got my information from the PCT; I did not have an opportunity to say that I do not want Netcare to be responsibly for urology, gynaecology, and ear, nose and throat procedures. I do not want that South African company to be responsible, but I was not asked, and nor was anyone else.

I shall be brief. May I give my hon. Friend an opportunity to return to his characteristic loyalty to the Government by at least agreeing that the difference between the Conservative and Labour parties is that we do not pretend that we can grow the NHS while cutting tax?