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Secretary of State for Health

Volume 460: debated on Wednesday 23 May 2007

We now come to the second debate on the Opposition motions. I must inform the House that Mr. Speaker has selected the amendment in the name of the Prime Minister.

I beg to move,

That the salary of the Secretary of State for Health should be reduced by £1,000.

The purpose of the motion is to force the resignation of the Secretary of State. I am sorry that it has come to that. Members on both sides of the House will know that we have frequently used the time available to the official Opposition to raise a series of NHS and health-related issues. We have done so on health care-acquired infections, mental health, the NHS work force and planning, and the management of the health service, always on the basis of motions that are constructive and designed to support the national health service. However, NHS staff have reached the end of the line with the Secretary of State. Serial incompetence and a chronic failure to listen to those staff mean that she has no credibility left to resolve the imminent problems facing the national health service. It is not simply that she and the rest of the Government are paralysed by the non-election campaign of the right hon. Member for Kirkcaldy and Cowdenbeath (Mr. Brown). The fact is that even were she to remain as Secretary of State after a change in prime ministership, she cannot command the necessary confidence and support across the national health service.

Many Members will recall the matters that we have raised before. Let me reiterate the many serial failures for which the Secretary of State has been responsible over the past two years. In 2005, there was the botched reorganisation of primary care trusts, which led within months to the resignation of Nigel Crisp, now Lord Crisp, as chief executive of the NHS. Under this Secretary of State, we saw the NHS plunge into its largest ever deficit. Since May 2005, the number of staff—[Interruption.] Labour Members are always telling us—the Prime Minister did it again at Prime Minister’s questions today—how many additional staff have been recruited by the Labour Government. Of course, those include 107,000 administrators. When the Prime Minister says, “There have been 250,000 extra staff”, funnily enough he never goes on to say, “of whom 107,000 are administrators.”

We are focusing on the record of the Secretary of State. Since May 2005, the number of staff working in the national health service has fallen. Payment by results and the tariff—a critical element of NHS reform—collapsed in February 2006, weeks before the start of the financial year in which the NHS plunged into its largest ever deficit. In payment by results and the tariff, we have a system that is necessary but is not being delivered successfully. [Interruption.] The Minister for the Cabinet Office says, “Ah!” as though it is some kind of mystery. “Money follows the patient” was a policy advocated by the last Conservative Government; it took years for the Labour Government to get round to recognising it, exactly as happened with GP fundholding and market mechanisms inside the NHS.

The Labour Government do not understand that it took years to get back to a range of policies that were pioneered by the last Conservative Government. Of course we need “money follows the patient” and the tariff, but it is still true, all across the NHS—as the Secretary of State will have discovered today at the Royal College of Midwives conference—that the tariff does not support choice, does not support the range of services being provided across the NHS, and discriminates, for example, between normal births conducted in a midwife-led unit and those conducted in a consultant-led unit.

We need payment by results and the tariff to be delivered quickly, but what have we had under the Secretary of State? A chronic failure, a collapse in early 2006—[Interruption.]

I am sorry, Madam Deputy Speaker. I had not even noticed the hon. Member for High Peak (Tom Levitt), but as I have stopped I will give way to him.

I am grateful to the hon. Gentleman. Of course, the Tory Government were no stranger to deficits. Is it not the case that the deficit that he is talking about was smaller, as a proportion of the NHS budget, than many of those that the Tories had—and now it has gone?

The hon. Gentleman does not seem to understand that last year a deficit of more than £1 billion within the NHS masked a deficit in excess of £2 billion within the Department of Health as a whole. That scale of increase has never happened before. The hon. Gentleman and other Labour Members probably often sit there wondering why, in the year just gone, their primary care trusts have had so much of their money top-sliced in order to deal with that deficit. Why did that happen if the deficit is so modest? Why £1.5 billion out of PCT budgets? Why £350 million out of education and training budgets? Why hundreds of millions extra out of the central budgets of the Department of Health? It is all because in the previous year there was not only a gross deficit of £1.3 billion within NHS trusts but an unprecedented scale of overspending within the Department.

Is my hon. Friend aware that the new Norfolk and Norwich PCT started its operations with a massive £50 million deficit? Surely if the Government set up a new organisation going back to where we were 10 years ago, they should at least allow it to start without a deficit.

I understand my hon. Friend’s point. Indeed, the same can be said of Cambridgeshire primary care trust, which is, like his, in the east of England. We have the largest deficit proportionately anywhere in the NHS. Of course, there must be a transitional process of trying to deal with those deficits, otherwise the consequences to patients will be unacceptable. Ministers are only now beginning to realise the scale of the deficits.

Although Ministers are always telling the public about the unprecedented amounts of additional money that are provided to the NHS, the consequence of last year’s deficits recurring this year is no growth in resources on the front line of the NHS. That means that, far from growth in services and resources in the past two years, people in the NHS have experienced cuts and reductions.

Does my hon. Friend realise that the Great Yarmouth and Waveney primary care trust—which was created on the basis that there was previously no deficit—has entered into its existence with a special deficit, which the NHS central organisation invented, insisting that the PCT take on board a large sum of money because others have a deficit? Instead of starting deficit free, after working for five years to achieve that, it has to pay back money that it never owed.

My right hon. Friend makes an important point. When Ministers consider the consequences of dealing with deficits, they claim that they have done away with the old system, which they describe as opaque. They say that everything is more transparent now. Conservative Members, who actually speak to members of primary care trusts and others about their financial position, know that the system is anything but transparent. Ministers are still in the business of shifting the money around the NHS to cover up the deficits and, indeed, the consequences.

Ministers try to cover up the consequences of deficits in places where accident and emergency departments—for example, in Surrey, Sussex, Worthing and Enfield—are threatened with closure, not because of genuine clinical cases for change, which the Secretary of State promulgates, but because of financially driven cuts and the consequences of the European working time directive. The Secretary of State has told us more than once that she wished that that directive had been amended. The Secretary of State for Work and Pensions, who is present, promised in 2004 that it would be amended to tackle its worst aspects. He told us that services to patients in the NHS would not suffer as a consequence of the implementation of the directive. Yet maternity units in Manchester and A and E departments in the south of England are being shut precisely because of the failure in December 2006 to amend the working time directive, as the Government had promised.

What about the NHS IT programme? It began before the current Secretary of State was in charge but the implementation remains disastrous.

Unfortunately, no Conservative Member who is present today attended a meeting that I had the honour to chair last night to discuss the NHS IT programme. Let me pass on two figures from that. This week, the picture archiving and communications system stored 6,200,000 images, making a total of 237 million images stored on the system. The hon. Gentleman calls that a failure—he should get his facts right and learn a little bit about IT.

Oh dear. The hon. Gentleman knows perfectly well that digital imaging and the transfer of digital images happened before the NHS IT programme got going.

I shall not give way to the hon. Gentleman again. [Interruption.] Five years ago, Addenbrooke’s hospital told me that it was doing that already, but its problem was that it had to go at the same pace—[Interruption.]

I shall give way to the hon. Gentleman shortly, but let me tell him something else if he is interested in the IT programme. He will remember that, 10 days ago, the Chancellor of the Exchequer said that we had to deliver the electronic transfer of prescriptions. By the end of 2005, 50 per cent. of prescriptions were supposed to be delivered electronically. By now, the figure should have approached 100 per cent. Yet the last quarter for which figures are available shows that 4 per cent. of prescriptions were transferred electronically. Actually, it is worse than that: about 4,500,000 prescriptions were issued electronically, but only just over 1 per cent. of those issued could be dispensed electronically because bar codes had not been fitted to them and pharmacists did not have access to the necessary equipment.

I will give way again to the hon. Gentleman if he will explain why the Secretary of State has not delivered what the Chancellor is calling for.

Had the hon. Gentleman attended the meeting last night, he would have seen that more than 8,000 practices are now involved in the choose and book system. [Interruption.] The hon. Gentleman might like to put himself in my position as a patient. I have seen the system working. The IT system is working, and contractors are delivering up and down the country. He is doing a disservice not only to the best IT programme in the world, but to the 350,000 people working in the NHS.

It is always a help if interventions are accurate. The hon. Gentleman mentions choose and book, which is a classic example: it is two years late; GPs have not been listened to with regard to its implementation; and the target was for 90 per cent. of appointments to be made through choose and book by now, but the latest figure is 38 per cent., and half of those were done on the telephone, not online. His intervention is therefore rubbish.

Let us deal quickly with the implementation of contracts. The consultants contract did not deliver productivity and went over budget. The GP contract did not deliver the access that the Chancellor of the Exchequer now apparently wants. As for cutting GPs out of out-of-hours care, the cost was a quarter of a billion pounds more than estimated, and it has turned into a shambles. The dental contract, which was described by the British Dental Association as a shambles, has reduced and limited access to NHS dentistry.

On public health, the Secretary of State has been attacked by the chief medical officer over public health budgets being raided to deal with deficits. After the publication of the White Paper, prior to the Secretary of State taking up her position, it took two years to agree a definition of childhood obesity, and the Government have now resorted simply to measuring children. No actions or interventions are to follow.

It is instructive about the pace of change in the health service that, in 1997, people were waiting two years even to get an operation. They might be waiting now, but only for improvements in what is already a damned sight better service than we had 10 years ago.

If we look at the hospital episode statistics, I acknowledge that the proportion of patients waiting less than six months for operations increased from 84 per cent. in 1997 to 90 per cent. in 2006. Given that NHS budgets have tripled, however, that is not exactly a triumph.

The flu vaccine implementation has been delayed twice in each of the past two years, and the Government have now missed the World Health Organisation’s target for delivering flu vaccine to over-65-year-olds. When the Secretary of State took up her position, she said that hospital-acquired infections would be her priority. What has she done about it? We have seen a dramatic increase in the number of deaths associated with MRSA and clostridium difficile, and horrendous outbreaks of C. difficile in a number of hospitals across the country, including in her constituency.

We have also seen the Secretary of State in the humiliating position of having to admit, in early December, that whereas Ministers said that 99 per cent. of patients were admitted to single-sex accommodation, some people might still be getting admitted to mixed-sex wards. She asked for a report from health authorities across the country. It took her six months to admit, because the Healthcare Commission survey was going to present it anyway, that 22 per cent. of patients admitted to hospital were first admitted to mixed-sex wards. That was a complete failure on something that, as her Prime Minister said in 1996, cannot be beyond the wit of Government to achieve.

If things really are as bad as the hon. Gentleman makes out, how is it that we have enjoyed significant reductions in the levels of heart disease in cities like Sheffield and elsewhere?

The Prime Minister said at Prime Minister’s questions today, and it is stated in the amendment, that 200,000 lives have been saved by a continuing reduction in premature mortality from heart disease and cancer. That is true, and it is a testament to the work of staff right across the NHS. But if Members go back to Hansard of 27 November 2006, they will find that a member of the Front-Bench team asked what would have been the number of lives saved under the last Conservative Government, applying the same measure of the reduction in premature mortality. The answer was that, in respect of cardiovascular disease, between 1978 and 1996 535,000 lives were saved. In respect of cancer over the same period, 65,000 lives were saved. That adds up to 610,000 lives saved under the last Conservative Government on exactly the same measure as the Government say that 200,000 lives have been saved.

What does that prove? It proves, as we have always said, that the staff of the NHS are delivering an improving service every year. The point of the debate is that they know that that improvement in the service that they provide is not the result of decisions of the Secretary of State. It is not the result of what the Government have done. It is not even entirely the result of resources provided to the national health service, as staff achieved an improvement in thick years and thin.

Peter Carter, general secretary of the Royal College of Nursing, said:

“In the 1980s and 90s finance was extremely tight but you did not get the crisis we have seen in the last two years.”

Every year the NHS is improving and its staff are delivering better services, but they have no confidence in the way that they have been subjected to the serial failures and mismanagement by the Government.

Although it is undoubtedly welcome that we have seen improvements in premature mortality from cancer both under the last Government and under the present Government, will my hon. Friend reflect on the fact that, despite spending on health care in this country being in line with European averages, premature mortality from cancer in this country is running about 40 per cent. higher than in France, Germany or Italy? Should we not be comparing the performance of our health care system with other comparable systems elsewhere in Europe?

Yes. I am grateful to my right hon. Friend. That is indeed what should happen. I say “we” advisedly. On both sides, we should look at outcomes, whereas the Government are obsessed with targets that deliver processes, not outcomes.

At Prime Minister’s questions at lunchtime, the Prime Minister said that there was a survey which showed that the health service in the UK was better than anywhere else. Try telling that to people who have lung cancer, who find that there are half a dozen PET scanners in this country and 500 in Germany. Try telling that to a stroke patient who finds that there a few dozen places in this country where one can have immediate thrombolysis for stroke, but in Australia that is routine. We deliver 0.3 per cent. of appropriate patients thrombolysis for stroke. In Australia the figure is 10 per cent.

Is the hon. Gentleman seriously telling the House that the 35,000 extra doctors and 80,000 extra nurses are not delivering an improvement in health care? That is how it sounds.

The hon. Lady need not take it from me. The general secretary of the Royal College of Nursing—[Interruption.]

Order. The hon. Lady asked a question of the Opposition spokesman. Perhaps she ought to listen to the answer.

I am grateful, Mr. Deputy Speaker. Peter Carter, general secretary of the Royal College of Nursing, said:

“In the 1980s and 90s finance was extremely tight but you did not get the crisis we have seen in the last two years.”

He also said, as my right hon. Friend the Leader of the Opposition said at lunchtime, that money comes into the national health service but too much gets wasted. Staff right across the NHS are saying that they are trying to make progress but cannot because of the Government’s failures.

I am going to make some progress.

The latest and one of the most serious failures of the Secretary of State has been the disaster of the medical training application scheme. The Royal College of Physicians called it

“the worst episode in the history of medical training in the UK in living memory”.

James Johnson, who has resigned as chairman of the British Medical Association, described the policy failures—failure to estimate the number of applicants correctly, failure to put in place a fair selection process by adopting selection criteria and a scoring system that undermined the principles of Modernising Medical Careers and failure to implement the technology in terms of its security or its functionality. Furthermore, Mr. Justice Goldring said in the High Court this afternoon:

“The fact that the claimant”—

Remedy UK—

“has failed in what was accepted to be an unprecedented application so far as the law is concerned does not mean that many junior doctors do not have an entirely justifiable sense of grievance. The premature introduction of MTAS has had disastrous consequences. It was a flawed system.”

That is a flawed system introduced by this Government with consequences so disastrous as to lead the chairman of the BMA, the national director of Modernising Medical Careers and the national clinical director of MMC all to resign, yet the Secretary of State sits there ignorant and oblivious to the consequences of what she has done.

I would like to take the hon. Gentleman back a little to when he was talking about a crisis. Can he tell the House when there was last a winter bed crisis in the NHS?

From my recollection—I am sure that I will be corrected if I am wrong—it was 1999. That was the last time that there was a substantial bout of flu. We have been lucky—[Interruption.] Given that the Government failed to deliver flu vaccine at the right time, if we had had a substantial outbreak of seasonal flu at any point in the late autumn in either of the last two years, it would have had serious consequences.

Following the last piercing question from the hon. Member for Wolverhampton, South-West (Rob Marris) and my hon. Friend’s answer that the last time that we had a winter bed crisis was under this Labour Government, will my hon. Friend now answer another question? When was the last time that we saw a sustained improvement in productivity in the NHS?

The answer is in the mid-1990s. There has been a sustained reduction in productivity in the NHS since 1997, estimated by the Office for National Statistics as up to 1.3 per cent. a year.

The purpose of the motion is to give the NHS the management and leadership it needs. Frankly, that can be delivered only through a general election, but some things could be done now that are not getting done because the Government are not only divided, but paralysed and inactive. We need an end to the closure of accident and emergency departments and maternity services. They are not a result of a clinical demand for change, but are being driven by short-term financial considerations and the impact of the working time directive. For two months I have been asking the Secretary of State for more training posts for junior doctors, but she has consistently failed to get on with delivering them.

Does the hon. Gentleman accept that the problems of training posts for junior doctors extend beyond the software of MTAS? There is a fundamental mismatch between the number of junior doctors looking for training posts and the number of posts available because consultant expansion has failed and there are not enough training programmes coming through. Does he accept that it does not make sense to plan medical students, plan house officers, plan senior house officers and plan registrars without planning for the end product, which is consultant posts?

The hon. Gentleman participated fully in the Opposition debate on 24 April, which explored those issues. The short answer is that it makes no sense to have work force planning—the Government’s approach was described by the Health Select Committee as “boom and bust”—to set up the structures of medical training and to deliver large numbers of trainee doctors at a time when consultant posts are being abandoned because of financial deficits. Equally, it makes no sense to have junior doctors, costing £250,000 to train, who are then going to be without posts and who will abandon medicine and leave this country as a consequence of the Government’s failures.

We also need an independent review of the NHS information technology scheme.

Order. I do not think that the hon. Gentleman intends to give way for the time being. Until he indicates otherwise, the hon. Lady may resume her seat.

Thank you, Mr. Deputy Speaker.

We need a re-engagement of GPs with, for example, out-of-hours services. That is perfectly possible, but it will never happen while the Secretary of State is in place or if the Chancellor of the Exchequer carries on trying to engage in confrontation with the medical profession, rather than co-operation.

We need to abolish the central targets that undermine clinical priorities. NHS staff, particularly those in the medical profession, deeply resent the fact that the Government constantly dictate to them in that way, despite the fact that they are senior professionals. We need a fairer funding mechanism, because funding allocations have directly contributed to the impact of deficits across the country. We also need a Government who are prepared to accept the underlying good sense of many of the amendments made to the Mental Health Bill by the House of Lords, rather than persisting with their present approach to the Bill.

This Secretary of State has lost the confidence not only of the NHS but of many others with whom she has worked. Professor Halligan, the former deputy chief medical officer, has said that the NHS has

“a leadership void, which has caused it to lose its way”.

Andrew Foster, the former director of human resources for the Department, has spoken of

“a growing lack of confidence in the leadership”

of the Department—[Interruption.]

Order. We must not have interventions from a sedentary position. Hon. Members would expect the Secretary of State to be given a fair hearing when she comes to address the House. They should extend the same courtesy to the hon. Gentleman.

Thank you, Mr. Deputy Speaker. I remember that Sir Thomas More was a Chancellor of the Duchy of Lancaster, so, when it comes to it, perhaps decapitation is one approach to the problem.

Senior civil servants in the Department of Health were surveyed, and 84 per cent. did not believe that the Department was well managed. Professor Crockard, who is retiring as national director of MMC, said of MTAS:

“From my point of view, this project has lacked clear leadership from the top for a very long time”.

The Secretary of State has been jeered by nurses, and heckled by midwives only today. A unanimous vote among junior doctors at a BMA conference called on her to resign. James Johnson chose to resign as chairman of the BMA. All that he did, so far as I can see, was to stand between an angry medical profession and the Secretary of State. He said:

“It is the worst I have known it for over 30 years”.

NHS staff are continuing to deliver for patients. They are professionals, but they are not being treated professionally by the Government. They are angry because of the way in which they have been treated. The Government tell them that money is flowing, but they do not see it, and they are not given the chance to shape the care that they give to patients. They are angry because the Government are constantly telling them how to do their job, even though the Government are incompetent at doing their own.

The Secretary of State has been responsible for so-called NHS reform, but there is no coherent reform. Staff in the NHS do not know what is happening, why it is happening or where it is going. There is no inspirational leadership—there is not even competent management—but there are urgent tasks to be done. Even the Secretary of State’s own colleagues in the Government do not believe that she is capable of achieving those things, or that she will be responsible for doing so. The next Prime Minister will not keep her. The present Prime Minister would not defend her today. But the NHS needs change now. We should take charge, but we cannot. If there will not be a new Government, there must at least be a new Secretary of State, and that should happen now. 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:

“believes that there is no need to reduce the salary of the Secretary of State for Health at a time when patient satisfaction is increasing, with nine out of ten in-patients saying their care has been good, very good or excellent, waiting times are at their lowest since records began, an extra 200,000 lives have been saved from heart disease and cancer since 1996 and investment in the NHS is being trebled by 2008.”

In view of the motion, perhaps I should declare my interest—although it is almost worth £1,000 to have been able to listen to that defence of what passes for Tory policy on the NHS.

It is one of the greatest privileges in our country to be Secretary of State for Health, a privilege that carries with it enormous responsibilities. I believe that every one of my predecessors, in both parties, has felt the same. But I also believe that the real privilege is to be a Labour Health Secretary in a reforming Labour Government. In the past two years, I have sought to discharge those responsibilities not only on behalf of the Government as a whole but, above all, on behalf of the patients and the public who elected us into government in three successive general elections. I welcome this debate, as I welcome every opportunity to set out the Government’s record on health.

Not yet.

The hon. Member for South Cambridgeshire (Mr. Lansley) specifically mentioned junior doctors. I welcome today’s High Court decision to reject the findings of the judicial review initiated by Remedy UK. We are looking carefully at the comments of Mr. Justice Goldring, and I will make a statement to the House tomorrow on how we will fulfil our responsibilities to trainee doctors as we complete this year’s recruitment to more training places than there have ever been before.

Not on that point, no. I will deal with it in my oral statement tomorrow.

The most important judges and the single most important test of the state of the NHS are the patients who use the service every day of the week. I find it extraordinary that the hon. Member for South Cambridgeshire scarcely mentioned them. Only last week, the Healthcare Commission published its latest national survey of patients. Nine out of 10 recent hospital patients said that their care had been good, very good or excellent—an even better result than just a year ago. What a tribute it is to the dedication and hard work of NHS staff that, in a year when very difficult decisions had to be made to return the NHS to financial balance, the level of patients’ satisfaction with their hospital care went up, not down.

The debate is not about national health service nurses, who do a magnificent job; it is about the right hon. Lady and the great misfortunes that she has brought to the health service. Will she consider the real worries of the constituents of Members in all parts of the House in south-east England, where reconfigurations are proving impossible? They are taking so long that they cannot even be brought forward. The right hon. Lady should understand that the motion is directed not against the nurses, but against her stewardship of the NHS.

I will take no lectures from a party that starved the NHS of funds and left patients waiting 18 months or more for desperately needed operations.

No. I want to make some progress before I give way again.

It is no accident that patients are more satisfied with their hospitals. Of course, that is down to the staff. There are well over a quarter of a million more doctors, nurses and other NHS staff—an increase made possible by our reforms and investment, which the Conservative party opposed every inch of the way.

Does my right hon. Friend share my astonishment that the hon. Member for South Cambridgeshire (Mr. Lansley) suggested today, in response to an intervention from me, that the absence of winter bed crises during this century was due to luck? Surely it is due to the resurrection of the NHS by this Government, with preventive programmes such as bowel cancer screening, osteoporosis screening and flu jabs for pensioners. That is not due to luck. It is due to sound policies, backed by staff, resources and vision—policies opposed by the Conservatives, whose own policies would decimate the NHS in deprived cities such as Wolverhampton.

My hon. Friend is absolutely right. Just a couple of weeks ago, I was shown around the brilliant accident and emergency department at St Helens and Knowsley Trust by Graeme Inkster, one of the emergency consultants, who explained to me exactly why we do not have winter bed crises now. He showed me what he called the corridor of shame, which 10 years ago was full of patients lying on trolleys waiting for hours on end. He said that he used to come into work first thing on a Monday morning and find patients queuing in the corridor; they had been left over from the weekend because there had not been anybody to treat them. Some of them had been there for six, 12 or 18 hours. The hospitals did not have the money or the staff, and they had not reorganised the care around the patients. The investment we put in and the reforms we made—and the four-hour accident and emergency target, which the Opposition opposed—drove the changes that led to us ensuring that we do not have winter beds crises.

I am grateful to the Secretary of State for giving way. As she will not take any lessons from the Conservative party, will she take lessons from the Royal College of Nursing, the junior doctors and the consultants, who all think that her stewardship has been a disaster?

Of course I listen to staff. I listened this morning to the midwives at the Royal College of Midwives, who gave me several examples of why we need to do more in terms of maternity services. That is why we worked with the RCM to produce the action plan, “Maternity Matters: choice, access and continuity of care in a safe service”, which was published recently. However, what I do that the hon. Gentleman does not do is also listen to the staff and the patients throughout the country, who show me the superb care that is taking place—and which never gets into the headlines and which we never hear about from the Opposition.

This point is not only to do with patient satisfaction—nine out of 10 of them are satisfied with the NHS. Does my right hon. Friend agree that the picture painted by the Opposition does not fit with the findings of the Commonwealth Fund’s international survey, which shows that our NHS is one of the best health services in the world?

My hon. Friend is right. That latest survey by the independent Commonwealth Fund confirms what patients are saying. It looked at the health service in Australia, Canada, Germany, New Zealand, the United States of America and the UK. Four years ago, it rated the NHS as number three, and two years ago it was still number three, but according to the latest survey the NHS is now number one—it is the fairest, the most efficient and the best overall.

Is it not also the case that although specialists tell us one thing, sometimes the community wants something different? Sometimes specialists say to us that they want all services in one place. In my community, they wanted one specialist care maternity service and a midwife-led unit. We now have £30 million investment in community service hospitals. As a result, Holme valley hospital—which had been threatened with closure in 1997 and has been built up under this Government—will now provide even more hospital services to our community, so we now have both services.

My hon. Friend is right. I pay tribute to her for the leadership role that she played in ensuring that the voice of her constituents was heard. I also pay tribute to the clinicians. They said, “If we reorganise the services it will be safer and better for patients.” They were also listened to.

Hospital-acquired infection is a serious issue. We take it very seriously and we were the first Government to require every hospital to record cases of methicillin-resistant Staphylococcus aureus and C. difficile and to report that publicly. Therefore, we know the exact nature of the problem and we can hold hospitals and their boards to account for getting those rates down. I am glad to be able to say that MRSA rates are falling, but there is a new strain of C. difficile. It is not only a problem in Britain; it is causing problems in many health services and we must do more to protect patients from it.

It is unsurprising that hospital patients are more satisfied as the waiting lists are lower than they have ever been—almost nobody is waiting more than six months for the sort of operation for which people used to wait two years. That happened because we put in more money—opposed by the Conservatives. But we did not put more money into the old ways of doing things, we put more money into new and better ways of caring for patients. At Walsall Hospitals NHS Trust, which I visited a few weeks ago, I met the staff who had reorganised the service, and found that with no further funding increase they could care for six orthopaedic patients in the time that previously they had been able to care for only one. They slashed the waiting time for MRI scans from two years to just a few weeks. That is investment and reform in action.

Can the Secretary of State explain why children in my constituency with major jaw problems are waiting more than 60 weeks from first going to see their GP until receiving treatment? That figure is not collected centrally, but from local information they have to wait more than a year.

For the first time ever in the history of the NHS we are now collecting information on how long it takes for a patient to go from GP referral to actual treatment. We have got the waiting times for the first out-patient appointment down, and we have got the waiting times down at the other end for the in-patient treatment. Now what we are going to do—and I hope that the hon. Gentleman will support it—is ensure that for almost all patients and almost all conditions there will be no more than 18 weeks maximum from referral to treatment. For many people, the wait will be even shorter.

Let us take the example of Shepton Mallet treatment centre. I went there and talked to patients, including the chair of one of the local primary care trusts—a Labour chair, as it happens. At that treatment centre, patients see the consultant, have the scans and tests, get the diagnosis, decide on the operation and book the date for the operation—all in one visit. That never used to happen. Yeovil District Hospital NHS Foundation Trust has also changed its way of working and will now be one of the first hospitals in the country to deliver a maximum of 18 weeks for almost all of its patients. That is investment and reform in practice.

The Conservatives seem to be confused about the role of the Secretary of State. The Government should make the hard decisions about future funding and stability for the NHS and set tough targets, but they should leave the practitioners to run things. The Conservatives keep raising individual examples of particular treatments. Is it really the Secretary of State’s role to determine what happens in every hospital ward?

My hon. Friend is absolutely right. It is one of the many contradictions in the Conservatives’ so-called health policy that they want independence for the NHS, but they oppose every proposal from local NHS staff for a reorganisation of services. Whenever something goes wrong or they want more money for their own local hospital—as so many Tory Members do—they come straight to me and demand that I intervene. It is completely bizarre.

Over and over again, we see that the best care for patients, organised around them, is also the best value for patients’ money. That is why I was so determined that we dealt with the overspending in a minority of hospitals, restored the NHS as a whole to financial balance and ended the unfair system of well managed hospitals in some of the most disadvantaged parts of the country having to bail out the minority of overspenders. It went on for years, it was not fair or efficient, and we stopped it. Of course, that was difficult—especially for NHS staff—but we now have the fairest, strongest and most transparent financial system that the NHS has ever had. That is not my verdict, but that of the Health Service Journal, which said that

“the changes to the financial system brought about during her time will prove a lasting legacy.”

Does the Secretary of State provide the same advice to the right hon. Member for Salford (Hazel Blears), chair of the Labour party, when she complains about closures in her constituency?

That was not worth giving way for, I am afraid.

As I said a moment ago, we needed that four-hour A and E target to change what was happening in A and E. Now, the 18-week target is mobilising NHS staff in hospitals all around the country to end the waiting that has been part of the NHS for nearly 60 years. What an achievement that will be—what a birthday present for the NHS, as it ends waiting, as NHS patients have always known it, on its 60th anniversary.

The hon. Member for South Cambridgeshire is against the 18-week target. That is hardly surprising; he thought that 18 months and more was acceptable.

After visiting a GP, one member of my family had to wait only three weeks for cancer surgery; another member of my family went into hospital with terminal cancer and spent 10 hours on a hospital trolley in a corridor. Can the Secretary of State guess which experience took place under the John Major Tory Government and which took place under this Labour Government?

My hon. Friend makes his point very graphically. That is another real tribute not only to NHS staff and the new cancer networks, but to the target—the promise that we made—that patients diagnosed with cancer would wait a maximum of 62 days between an urgent GP referral and the start of cancer treatment. Just two years ago, fewer than two thirds of patients were getting from diagnosis to treatment so quickly; now more than 95 per cent. are. There have been real improvements in the past two years.

Most important of all, the NHS is saving more people’s lives. The lives of nearly 150,000 people with coronary heart disease have been saved. The hon. Member for South Cambridgeshire had something to say on that subject. It is perfectly true that under the Conservative Government, death rates from coronary heart disease were falling, but they were falling a great deal more slowly than in most other parts of Europe, and have been falling faster since. I looked at the numbers. During the 1980s, those death rates fell by about 20 per cent.; during the 1990s, they fell by 26 per cent. During the years of this Labour Government, they fell by 36 per cent., and we will meet early our target for a 40 per cent. reduction in those death rates. Furthermore, 50,000 more lives have been saved as a result of our changes to cancer care, and suicide rates are at their lowest level ever because of our changes to mental health services.

The hon. Gentleman mentioned the Mental Health Bill, which is going through Parliament. Since 1959, we have had a law under which a seriously suicidal mentally ill patient can, if the clinician judges it necessary to protect them from self-harm or suicide, be detained in hospital for treatment. We have discussed that recently. I find it extraordinary that the Conservative party should now want to end that provision and deny seriously suicidal patients the possibility of treatment from which they have benefited for decades.

Will my right hon. Friend accept the credit for giving greater responsibility to more NHS staff, such as nurse consultants and nurse prescribers? Will she reaffirm our party’s commitment to extend the same approach to mental health services? We want more members of mental health teams to have responsibility. We do not want to look back and defend vested interests, as the other place did with the support of the Conservative party.

My hon. Friend makes an extremely important point and I hope that it is one on which the Opposition will think again.

Would the right hon. Lady care to comment on the extent to which changes in coronary heart disease death rates are affected by changes in smoking habits made 10 or 15 years earlier? The improvements in the Tory years could have been due to changes in smoking habits 10 or 15 years previously, and some of the changes we are experiencing now could also be due to earlier lifestyle changes. Does the right hon. Lady accept that the long time lag means that the situation on death rates is not as simple as some people make out?

The hon. Gentleman makes an important point, although Sir Liam Donaldson, the chief medical officer, stresses the point that the impact of smoking, including second-hand smoke, can show up extremely quickly—within a year or two—in coronary heart disease. Part of the improvements we have been making in the NHS is the much bigger investment in “stop smoking” services, which have helped more than 1.5 million people to give up smoking. The smoke-free legislation, supported on both sides of the House, will be the biggest step forward for public health for decades.

Of course change is difficult—we are changing from the old public sector monopoly to a patient-led NHS. It is not easy, but we have to do it to meet the huge challenges of an ageing population, people’s rising expectations, new drugs, changes in medical technology and an epidemic of lifestyle diseases. We have to change the way the NHS works to safeguard what is most precious and enduring about it: the values of a health service that is paid for by all of us, available to each of us on the basis of clinical need and free at the point of use—the values we believe in on the Labour Benches.

I think that the Secretary of State betrayed herself earlier in her speech when she talked about a Labour chair of a PCT. I thought such people were meant to leave their politics behind when they discharged their duties to the NHS. However, our experience is reflected in a gerrymandered decision about the sites of hospitals in the south of my constituency, which drove the Surrey and Sussex Healthcare Trust into the largest deficit in the country under her predecessor. That was followed by her gerrymandered decision for a hospital at the St. Helier site in the face of recommendations. She was driven off only because the decision was so unreasonable that it would not stand up to judicial review. It is because the Secretary of State has put the political interests of the Labour party first that she should resign.

The hon. Gentleman is talking absolute nonsense. Appointments to primary care trusts are made by a completely independent statutory appointments commission. I cannot remember whether the Conservatives supported its establishment, but it is completely independent. Far from people being ashamed of their politics, if people in his party, my party or any other party are active, they declare it, but it makes no difference whatever to the appointments system.

I am extremely grateful to the right hon. Lady for giving way.

In September 2006, in response to protests, the Secretary of State rightly instructed that the consultation process on the future of the Nuffield speech and language unit should be undertaken again. Given that eight months later—on 16 May, to be precise—the representatives on the new steering group from the Royal College of Speech and Language Therapists and the Association for All Speech Impaired Children resigned their membership of that group on the ground that they did not wish to be associated “with substandard work”, will the right hon. Lady agree to meet me and a number of concerned parents and professionals, recognising, as she will, that the interests of highly vulnerable children are at stake?

Of course I will.

We have believed in the values of the NHS ever since we created it. The Conservative party now claims to believe in those same values, but we are entitled to look at the Conservatives’ actions, as well as their words. For 18 years, they starved the NHS of funds and took money out of the NHS to subsidise private health care for a few.

No, I will not give way again.

That is exactly the policy that the right hon. Member for Witney (Mr. Cameron) put into his party’s manifesto just two years ago. The Conservatives voted against the extra money that we are putting into the national health service—more than £8 billion more in this year alone—and they opposed the changes in local services that will benefit patients.

The Conservative party has prayed in aid the Royal College of Nursing, the Royal College of Midwives and the British Medical Association in its criticism of the Secretary of State. In the conversations that she has had with those bodies, have they asked to return to the staffing and funding levels of 1997?

My hon. Friend makes an extremely important point. Frankly, the message to NHS staff that we are hearing from Conservative Members is, “You don’t need more money because you would have made the improvements anyway, so you don’t need the extra staff or the higher pay and we won’t give you a decent public service pension either.”

Two days ago, the right hon. Member for Witney set out his seven-point policy for the NHS. His first point was

“an immediate stop to the closure of A&E and maternity services.”

Well, of course that is what he is saying. He wants the headlines. He loves the demonstrations and the marches. But let us look—[Interruption.] Conservative Members should take note of the small print of what their party leader said. He said that the changes should be suspended

“Until there is clear clinical…evidence”.

Those are weasel words from a Tory leader who says different things to different people and who will say anything at all if he thinks that it will please. He simply will not face up to the difficult policy challenges that confront our country. I have the clinical evidence in my hand and the right hon. Gentleman knows that it exists.

I am grateful to the Secretary of State for giving way. On the subject of weasel words, does she understand why Opposition Members sometimes find it difficult to put full credence in all the figures that she uses? That was illustrated yesterday, when she told my hon. Friend the Member for Bromsgrove (Miss Kirkbride), who asked about the recruitment of nurses from Africa, that, because of the Government’s uniquely ethical policy,

“we do not take nurses from…Africa.”—[Official Report, 22 May 2007; Vol. 460, c. 1089.]

When I pointed out that the Government have issued 50,000 work permits for nurses from Africa since 2000, her defence was that it did not really count because they came in via agencies rather than directly to the NHS and that that was difficult to stop. Can she tell us what is uniquely ethical about circumventing one’s promises in that way and telling the House that we do not take nurses from Africa when we have given out 50,000 work permits? Why is that so difficult to stop when it is the Government who give out the work permits?

The right hon. Gentleman should talk to Health Ministers in the Governments in Africa, with whom we have reached agreements on that very point. Let me also remind him that only last year we took nursing jobs off the skills shortage list in order to ensure that the jobs went to nurses here.

The point that I want to make about the clinical evidence for changes in services is that, as the hon. Member for South Cambridgeshire knows full well, in the case of the most serious emergencies—for instance, strokes and heart attacks—it is much better to bypass the local hospital and be taken straight to a specialist centre, where the specialist staff and equipment are ready 24 hours a day, seven days a week. Close to home wherever safely possible and in a specialist centre where necessary—that is what clinicians are telling us. If the NHS can do that, each year we can save 500 more lives, prevent another 1,000 heart attacks and support more than 1,000 stroke victims to regain their independence, rather than being condemned to lasting disability. That is the clinical evidence. Rather than giving us weasel words, the Conservative party should be supporting clinicians in making the case for change.

If we know that changing services will allow us to improve and save more lives, we would be betraying patients and the NHS if we refused to make those changes just because they were difficult. Leadership is about listening to clinicians, supporting them in making the case for change, involving local councillors and people in consultation, and then having the courage to back the NHS in making the right decision.

The Secretary of State waved around Sir George Alberti’s document on emergency access. He has told colleagues in West Sussex that for an accident and emergency department to be maintained, it must have a catchment population—he used the curious term “drainage population”—of between 400,000 and 500,000 people. Does the Secretary of State think that that clinical view should be applied throughout the country—yes or no?

Professor Alberti has said consistently that the most specialist services need a larger catchment area.

Of course I agree with him that for the most serious—[Interruption.] The hon. Gentleman was complaining earlier that he wanted better stroke services. He knows perfectly well that that means changes to local A and E departments and hospitals and some services moving from local A and E departments and hospitals to specialist centres. Of course I support Professor Sir George Alberti and Roger Boyle in arguing for precisely that, and that is what the hon. Gentleman should be doing, instead of organising a human chain to save a hospital that was never under the threat of closure and then telling the local newspaper that the right way forward for Hinchingbrooke hospital might be for its A and E department to deal with self-referrals and for the more serious cases to go somewhere else, such as Addenbrooke’s. His comments about Hinchingbrooke to his local paper are what he describes nationally as the closure of a local A and E department.

Look, just for the sake of accuracy, let me say that a consultation is under way on Hinchingbrooke hospital—it is in my neighbouring constituency of Huntingdon, but it serves part of my constituency—and one of the options is the closure of the hospital.

The local primary care trust and the hospital have made it perfectly clear that the right way forward, in their judgment, is a reorganisation of services that the hon. Gentleman claims to support one minute, yet describes the next minute as an outrage and a closure.

For the past 10 years, we have had a Prime Minister who has had the courage to make difficult decisions and has never shied away from difficult arguments. We have had a Chancellor who has had the courage to take the difficult decision to increase national insurance contributions and give the NHS the money that it needed. It was this party that created the NHS, although the Conservatives voted against it, and it was this Government who saved the NHS from ruin 10 years ago and put in the funding, although the Tories voted against it. It is this Government who will go on listening to staff and, above all, patients. We will make changes when they need to be made and improve services that still need improvement. We will back the NHS and improve it so that it is the fairest and best service in the world.

The Liberal Democrats will support the motion this evening because of the palpable loss of confidence in the Secretary of State, especially with regard to her handling of the junior doctors shambles—a subject to which I shall return. However, to some extent the right hon. Lady is a sacrificial lamb—[Interruption.] I thought the House would like that. She is a sacrificial lamb for the failings of the Government’s stewardship of the national health service; others should take their share of the responsibility.

The extent to which confidence in this Government’s stewardship of the NHS has collapsed is remarkable. There has been record investment, which we supported, and some genuine progress has been made, yet both the public and health professionals have lost faith. Just this month, a “Newsnight” poll found that, in relation to the NHS, Labour was the least trusted party. The Liberal Democrats came top. [Hon. Members: “What a surprise.”] I acknowledge that straight away. It is remarkable that, despite the Labour party’s record of supporting the NHS over the years, it is now bottom in terms of public trust in handling the NHS. What has gone so badly wrong?

Plenty of people other than the Secretary of State ought to appear on the charge sheet—for a start, the Tories. When they were in government, there were years of chronic under-investment in the NHS. In 1997, when the Conservative party left government, investment in the NHS was 6.8 per cent. of gross domestic product— 33 per cent. less than the EU average. Given that we were spending a third less than the rest of Europe, it was no wonder that people had to wait interminably for operations. I remember people coming to see me who were waiting for hip and knee-joint operations, sometimes for three years from the first referral to the point at which they had their operation. That is not a world to which we want to return. It was no wonder that the infrastructure of the NHS—the buildings—was worn out and so much investment was needed. In addition, not enough doctors or nurses were being trained or employed in the NHS.

The cumulative impact of that under-investment in the service that could be provided was massive. Let us compare our experience in the UK with that in the rest of Europe. In many countries elsewhere in Europe, waiting is simply not an issue. Never mind getting down to a maximum wait of 18 weeks next year; the fact is that people in many countries do not experience waits for operations. One has to take into account the massive head start that other countries have had because of their historically far higher funding for their health service than we have had in this country.

In 2002, this Parliament came to the point at which we decided whether to vote for increased investment in our NHS. Even after being turned out of government, the Conservatives voted against that increased investment. Had they had their way, cumulatively over the ensuing period we would have had £35 billion less to invest in the NHS. Just imagine the closure of hospitals that we would be experiencing without that money! At the last election, their plan was to drain money out of the NHS to subsidise private health care—that was stated in a manifesto drafted by the Conservative leader before he changed his mind. We need to remember that record of what the Conservatives did, both when they were in government and when we reached the point of voting on increased investment in the NHS.

In the spirit of setting the record straight, which is what the hon. Gentleman is trying to do, he might like to remember that although the 2002 tax increase was branded by the Chancellor as money required for the NHS, well over half of it was spent on the social security budget. The assertion made was simply untrue. The hon. Gentleman should not line up behind that party political slogan—it serves the Labour party’s interest, but I cannot see how it serves his party’s interest.

I thank the right hon. Gentleman for that intervention, but the simple fact is that there has been substantial increased investment in the NHS, which the Conservative party voted against. Whether or not part of that additional revenue was used for other means, it is still true that a substantial amount has gone into the NHS. We supported that and the Conservatives did not.

With great respect, the constant reassertion of something that is untrue does not make it true. It is absolutely right that we voted against the national insurance increase, but it is not true to say that we voted against increases in NHS expenditure. At the time, we made it crystal clear that we supported the increase in national health service expenditure.

No, I will not give way on that point.

I now turn my attention to the Labour party, and the question of whether everything is the Secretary of State’s fault. She has been left to take the flak for a decade of missed opportunity, inconsistent policy and botched reform. The chickens have come home to roost, and it is on her watch that we are experiencing the effects of so much mismanagement over the past decade. Let us consider the record and the roles of previous Secretaries of State.

In 1997, the Labour manifesto specifically said that the Government would scrap the internal market; that was the commitment made, but there is now an internal market. There is a purchaser-provider split, and hospitals compete for patients. That flip-flop in policy direction is the responsibility of the Labour Government as a whole, not just the Secretary of State. As for the other institutional reforms that have taken place, there was the introduction of primary care groups, then the creation of primary care trusts, the scrapping of health authorities, the creation of strategic health authorities, and the merger of primary care trusts. There has been endless organisational change, and it has not all been in a consistent direction; there has been a flip-flopping from one approach to another at great cost, and with an enormous impact on the morale of the people working in the health service, including the doctors and nurses.

Is my hon. Friend aware that health workers in my area were employed by three different trusts in three consecutive years? Despite all the contract rewriting costs and management change costs that went with that, their job did not change one little bit; it was all wasted investment.

I am very much aware of that. Every time there is a change of organisation, another group of people get early retirement packages and redundancy packages. The impact on morale is intense. Changes have just taken place in Norfolk, and I know lots of people who are still in temporary posts and are waiting to have new posts allocated to them. Change always affects morale, and because the changes have been so frequent the impact on the morale of patients, doctors, nurses and many other health professionals has been dramatic.

Botched reform has also hit the voice of the patient and the public in the NHS. The right hon. Member for Darlington (Mr. Milburn) was responsible for abolishing community health councils when he was Secretary of State. I have since heard it said that he had a particularly bad relationship with his local community health council. CHCs were abolished in 2002, and patient and public involvement forums were established after that, in 2003. Three years later, they were abolished, and the local involvement in health networks were created. That was another mess, and a botched reform that left all those involved with a sense of total frustration, including people who, as volunteers, were trying to make a contribution to improving our health service.

That same Secretary of State left another legacy: the current state of NHS IT. The hon. Member for Ellesmere Port and Neston (Andrew Miller) got very hot under the collar on that point, but it is as though he is living in a parallel universe, and is not aware of what doctors in the NHS are saying about “connecting for health”. Their view is very different from the rosy picture that he described. When a political commitment was made to “connecting for health”, no proper analysis was undertaken of the need for the system, or of whether financial benefits would outweigh the costs. That is the view of the Public Accounts Committee, and the majority of its members are from the Labour party. It took the view that there was no proper analysis.

The original budget was £2.3 billion, which will be exceeded. The PAC reckons that the costs range anywhere between £6.2 billion and £20 billion, compared with the original estimate of £2.3 billion. The project is therefore massively over budget and it is behind schedule, too. The PAC says that the highly controversial patient clinical records scheme is running two years behind schedule, with no indication of when that part of the project will be complete. If one talks to any group of doctors, whether they are GPs or hospital doctors, one is met by a chorus of groans—they are completely frustrated by “connecting for health” and the way in which it has been imposed from the centre. Again, that has impacted on morale.

May I commend to the hon. Gentleman a recent article in the British Medical Journal, which reported progress

Yes, that is what it says in my notes. The article reports progress so far on the national programme, and it includes interviews with 25 senior managers and clinicians in four hospitals. May I point out to the hon. Gentleman that, contrary to what the hon. Member for South Cambridgeshire (Mr. Lansley) said, there are 4,594 live sites providing the electronic prescription service, which is a huge improvement? I accept that it is a complex programme and that there are frustrations, but it is an immensely successfully development. There is now 100 per cent. coverage by PACS—picture archiving and communications systems—in London.

I am grateful that the hon. Gentleman at least acknowledged that there have been frustrations. I repeat that if one talks to any group of doctors, they are enormously frustrated with the system and the way in which it has been imposed centrally. When I hear that there has never been a thorough system review to ensure that the people who are building it, the people who will use it, and the people who will purchase it share a common view, I am completely amazed. People involved in the project on the private sector side have complained that there has never been a thorough system review.

The hon. Gentleman has just highlighted an unwelcome imposition from the centre, and it would be fair to say that he—and there are such people in all parties in the House—subscribes to the doctrine of localism. May I, however, in all honesty, put it to him and to the Secretary of State that when we talk about services that will be provided to, and are needed by, only a small minority of people with very severe and sometimes complex needs, there is frequently a compelling case for a central pot of money, and even some central direction; otherwise, the vulnerable people to whom I referred earlier may simply fall through the net? That has happened under successive Governments, so does the hon. Gentleman agree that the review of specialised commissioning, although welcome, could perhaps have gone further and that the Secretary of State might usefully be persuaded to take another look at it?

That is a very opportune intervention and I entirely accept the point made by the hon. Gentleman. In any system that tries to decentralise control and accountability there should be a role for the centre, too. It is a national health service, after all, and those specialist areas are particularly important to ensure that there is coverage across the country. I therefore accept his point entirely.

May I follow up that point? The hon. Gentleman, who lives in Norfolk, will accept that if he were run over by the proverbial 73 bus tonight, in an ideal system the first responder would have access to his medical records, thus enabling instant blood matching. There are good clinical reasons for centralism. Of course, there is a dichotomy, but he will accept that in a well developed system that is the kind of progress that we would like to see.

I am told by doctors in accident and emergency departments that they follow protocols in those circumstances. If necessary, my notes could be e-mailed from another part of the country.

In 2000, we had the NHS plan, part of which was to create 100 new hospitals by 2010. That was a very ambitious programme, but it was to be funded using PFI—a massive, uncosted commitment that will drain the NHS of resources long into the future. It is mortgaging our future and putting the NHS in a straitjacket of serviced accommodation. At the very time when Ministers are telling us that we must be flexible, that we must adapt to changing methods of delivering health care, and that we must shift care away from acute hospitals to care for people closer to home, we are stuck with the centralised provision of highly expensive serviced accommodation.

Thanks to the help of the Prime Minister, the Minister of State, the hon. Member for Leigh (Andy Burnham), and others, my constituency is benefiting from a £143 million investment in new facilities and new build at Broomfield hospital. If the hon. Gentleman had been Secretary of State, would he have allowed that scheme to go ahead—yes or no?

My point is simply that we have relied entirely on PFI. The National Audit Office and the hon. Gentleman’s own party—

I am not in a position to answer a question about one local hospital. Does the hon. Gentleman disagree with his own Front Benchers, who have also drawn attention to the cost of PFI? He seems to be in something of a muddle.

I will not give way again on that point.

Spending on PFI schemes is projected to be £17.8 billion by 2014-15. It has not been costed, yet it is imposing an enormous burden on local health economies.

The hon. Gentleman is wrong to say that all the new hospitals have been funded through PFI, but I am pleased to say that Russells Hall, the brand new £200 million hospital in Dudley, has been. Is his message to the people of Dudley, who will read whatever he says with great interest when we put it in our leaflet, that the Liberal party is against that investment and would not have supported the development of a brand new hospital, funded through PFI, for my constituents?

We have consistently supported the Government on increased investment in the health service, but the over-reliance on PFI has been a mistake. The hon. Gentleman might want to listen to the comments of Bob Ricketts, the head of capacity development at the Department of Health. In June 2005, he said:

“I have seen some awfully grand PFI schemes that are starting to give us a real problem in our capacity management. We need a fundamental rethink about how we invest in capital rather than human resources.”

The Government’s own Department of Health is questioning the over-reliance on PFI. That over-reliance is the responsibility of the Chancellor of the Exchequer, the next Prime Minister, who has at every stage driven PFI in the health service.

The hon. Gentleman may be aware that there has been a lot of controversy about Leeds children’s hospital, which is a proposed PFI development, and that one of his colleagues, the hon. Member for Leeds, North-West (Greg Mulholland), has been pushing hard for it to be built. Under a Liberal Democrat Government, would the hon. Gentleman have to disappoint his colleague by abandoning that scheme?

That is a ludicrous suggestion. We oppose over-reliance on PFI, as do the Conservatives. We entirely support the building of that new hospital, but investment in health facilities does not always have to be done using PFI—that is a remarkable argument. Other finance mechanisms can be used.

Does the hon. Gentleman recall that, at the last general election, the Conservative party issued a document about what we would do in Government? It included making resources available from the Department of Health capital budget to support several new children’s hospitals, one of which would have been the Leeds hospital.

The hon. Gentleman makes the point that there are other ways of financing new build. Health bonds are another method. To suggest that it is PFI or nothing is ludicrous. The hon. Member for Norwich, North (Dr. Gibson) often criticises PFI— plenty of Labour Members criticise the over-reliance on PFI. Not only Liberal Democrats take that view.

As someone whose constituency is served by two brand new PFI hospitals, let me emphasise that they not only provide good quality health care, but they were built on time and on budget. How would the hon. Gentleman fund the hospital building programme that the Government have achieved?

It is remarkable that Labour contributors appear to have swallowed the idea that the only way in which one can invest in capital projects is through PFI. Bonds are a perfectly good way of raising funds for capital investment. It does not have to be done through PFI.

We are in an extraordinary position whereby we have record investment in the NHS, yet there is also a record deficit. How did we get there? Too much investment has been wasted. The Health Committee drew attention to poor financial management, loss of financial control and the PFI obsession.

The failings are the fault not only of the Secretary of State but of successive Ministers. Indeed, the pain of forcing trusts to address their deficits was delayed until after the last general election.

Let us consider the legacy of another Secretary of State—the current Home Secretary. His legacy includes the GP contract, which ran massively over budget and continues to have an impact on local health economies; the handover of responsibility for out-of-hours care from doctors to PCTs, which the Public Accounts Committee described as “shambolic”; and the consultants’ contract, which also ran massively over budget and, according to the National Audit Office, fails to deliver the intended improvements in patient care. There is also his target for cutting MRSA infections, which will be missed by next year as C. difficile cases continue to increase. All those failures continue to afflict the NHS and the Government’s reputation.

Let us consider the current Secretary of State. She made a political commitment to sort out NHS finances, and the Government will undoubtedly hail the achievement of a small overall surplus as a victory at the end of the financial year, but at what price? Again, the Health Committee highlighted the impact on soft targets. Funding for voluntary organisations has been cut.

No, I want to make some progress.

Cuts have been made to mental health services in many parts of the country, including in my county of Norfolk. Public health initiatives have been cut.

No, I shall not.

Training budgets have been cut, with thousands of posts lost and newly qualified nurses unable to find work. Those are genuine cuts that affect patients and hit doctors’ morale.

Order. The hon. Member for North Norfolk (Norman Lamb) has indicated that he will not give way. I also remind the House that time is ticking away and many hon. Members are seeking to catch my eye. That should be borne in mind.

There is the threat to so many community hospitals around the country, including in my county of Norfolk. I fully accept that some reconfiguration of acute services is necessary, but in some cases it is driven by financial crisis—again, a point that the Health Committee made.

The dentists’ contract is also a shambles, with people finding it literally impossible in some parts of the country to find an NHS dentist. Primary care trusts throughout the country face deficits in their dental budgets because of the Government’s miscalculation of patient fee income.

We then come to junior doctors and the disgraceful shambles of the medical training application service—MTAS. The judicial review has failed, and the Secretary of State has applied for costs in the case this afternoon against the junior doctors. I understand that the judge awarded costs but asked the Secretary of State to reflect on that. He made the point that she had acknowledged that mistakes had been made and that she will have to work with junior doctors. Would not it be outrageous if she chose to pursue her recovery of costs against the junior doctors who have been the victims of the Government’s mismanagement of the system? I urge her—she is trying not to listen—to announce in her statement tomorrow that she will not pursue the recovery of costs against junior doctors. She could clear up the matter this afternoon, if she chose to do so.

Despite all the warnings that the system had severe problems, the Government ploughed on regardless, displaying a mixture of arrogance and complacency. Clearly, MTAS was not adequately piloted or tested. The statement of Nicholas Greenfield from the Department of Health to the High Court last week revealed that it became clear in April that the software was not working. A paper on 25 April noted that the

“allocation algorithm was giving a different allocation from what was expected”.

Another paper to the project board on 26 April highlighted difficulties with the allocation principles. I quote:

“It stated that until the issues were resolved, and the principles agreed, it would not be possible to confirm the feasibility of the allocation rules, to design and develop the allocation software, or to confirm the timetable for making offers to applicants.”

By 28 April, the situation was even worse. A report by Beverley Bryant, in the aftermath of the security breaches, concluded that further changes to system functionality were necessary. It stated, however, that making further changes

“could further compromise the quality and security of the system which…could be fatal to the programme”.

In other words, the Government had no option. They had to decide not to proceed with MTAS. Why were we not told that on 1 May or in last week’s statement? It was never mentioned.

The Secretary of State has still not confirmed the number of extra training posts that will be available this summer to avert significant numbers of junior doctors being unemployed.

One of my constituents, who is a consultant, drew to my attention last weekend the huge amount of consultant time being spent on trying to get the system back in order. He estimated that 140 hours of consultant time would be spent on the system and on trying to appoint junior doctors. That is a total waste of his effort, and reduces his capacity to give treatment to patients.

My hon. Friend makes a good point. The impact has been not just on junior doctors, but on all those who have had to conduct 15,000 extra interviews. There has therefore been an impact on patients, too. What a mess.

A litany of misjudgments, costly mistakes, changes of direction and botched reform has been the responsibility not just of the Secretary of State but of the whole Government. That is an extraordinary record of failure from a Government who warned us back in 1997 that there were 24 hours to save the NHS. Everyone knows that the Secretary of State will go when the new Prime Minister takes over. Is it not ludicrous that the NHS must wait six weeks for that to happen? When so much needs to be done, we have a lame duck Secretary of State. She should go now.

On a point of order, Mr. Deputy Speaker. I am not seeking to catch your eye in this debate, but it occurs to me that little time will be left once the Liberal Democrat Front-Bench spokesman has finished—[Hon. Members: “He has finished.”] He has just finished. What can you do to ensure that Back Benchers who wish to contribute to such debates have time to do so?

It is true that all three Front-Bench speeches have taken more than half an hour. That is a matter for those on the Front Benches. All I can do is urge hon. Members to make their contributions brief and, before they intervene, to think what they are intervening about and to make their interventions brief. But then—hope springs eternal.

I shall try and restrict myself to 10 minutes and take out all the digs at the Tory Front-Bench team, except to say that once again we are having a health debate on an Opposition day, in which I greatly enjoy taking part. I have taken part in almost all of them and I have yet to hear a Tory policy. Perhaps we will hear one later.

The Department of Health is massive and wide ranging. I shall focus on cancer treatment and survival rates. Cancer affects almost every family and every person directly or indirectly. It is terrifying. Most doctors speak of the C-word rather than refer to cancer itself, because it used to be a death sentence. That is no longer necessarily the case. Although cancer is wide ranging and survival rates differ greatly, depending on the type of cancer, people are still twice as likely to survive if they are diagnosed today than they were 10 years ago.

The reason that we have been so successful in cancer treatment and have such high survival rates is because of early screening, early diagnosis and far better treatment. Almost everyone with suspected cancer who is seen by their GP will be sent to a cancer specialist within two weeks, and 99 per cent. of patients who have been diagnosed with cancer will have had treatment within one month of their diagnosis. These are fantastic statistics.

Part of the reason for such success is that the NHS has introduced far greater flexibility in the system for cancer treatment and takes account of the needs of individual patients far more. Treatment is carried out in communities wherever possible. Simple chemotherapy treatments can now be given in district hospitals such as the Chesterfield and North Derbyshire Royal hospital, which has developed a chemotherapy suite so that patients do not have to travel all the way to Sheffield if they do not want to. The Chesterfield Royal has been so successful in its chemotherapy treatment that it is massively expanding its operation. It is a tiny district hospital, but the same is happening throughout the country so that patients diagnosed with cancer can receive treatment in a much calmer community-based environment, with their families close by. That is a huge achievement.

Eighty per cent. of women diagnosed with breast cancer will survive for at least five years, compared with 50 per cent. only 30 years ago—again, a massive achievement. Two thirds of women who are newly diagnosed with breast cancer are likely to survive for another 20 years. These sound like random statistics, but about 1,400 people who are alive today would not have been alive 10 years ago.

One of those people is my mother, which is the reason I wanted to take part in the debate. She is over 60, and three years ago had a routine mammogram at the Addenbrooke’s hospital. She lives in the neighbouring constituency of Huntingdon. The nurses were not entirely happy with the results, sent off for a biopsy on that day, and she was given a positive diagnosis there and then. She was seen and treated within three weeks of that routine appointment, which is staggering. On the day that she had her mammogram, she was given the name and telephone number for a nurse whom she could call day or night if she was worried. That was spectacular. Her experience has been fantastic. There are many other women like her throughout the country. Those cancer rates are fantastic.

Another example concerns a friend of mine who lives in my constituency and who has taken a terrifying but very brave decision. Her family has been blighted by breast cancer. She has lost grandmothers, cousins and aunts to breast cancer. When her mother was 38, she decided that she would have preventive breast surgery—a double mastectomy—to avoid having to go through with the cancer. She was the first woman in the country to have such a preventive double mastectomy.

Becky, a presenter of a breakfast radio programme on Peak 107 FM, decided at the age of 24 to become the youngest woman in the country to have a double mastectomy—an incredibly brave decision for someone so young. She is beautiful and vivacious and has a very high profile in north-east Derbyshire. It is absolutely amazing. She had an 85 per cent. chance of developing breast cancer in her life. Taking the decision to have both breasts removed at such a young age was brave, but it was, for her, only a liberating experience. She has had breast surgery so she now has even better breasts than she had before. She is still enjoying life.

The point is that modern technology and cosmetic surgery have meant that people like Becky can take blood tests and find out whether they are carrying a faulty gene, which was not possible before. A death sentence has been lifted from this girl and it is so easy to see it when we talk to her about her experiences.

Those are two small examples—albeit very close-to-home examples—of where breast cancer treatment and survival rates have made a huge difference, not just to my life but to the lives of other people. I hope that we can continue to make a difference. The best chance of continuing to be able to help people with cancer, especially breast cancer, is to maintain a Labour Government, as recent history shows.

Order. I want to underline the point I made a few moments ago. Everyone can see the number of hon. Members seeking to catch my eye. We shall start the winding-up speeches at about 6.30 or 6.40 pm, so I would be grateful if hon. Members made their contributions as brief as possible in order to allow as many as possible to speak.

I shall try to adhere to your guidance, Mr. Deputy Speaker.

If we are discussing the health service, it is important to acknowledge that extra money has been invested and some improvements made, particularly on waiting times. We then have to ask whether the money has been spent sensibly and whether we could get more from it by spending it more productively. One of the dangers of a debate like this is that we quickly descend into our own individual examples of exactly what is happening in our own local health economies and local hospitals. That sometimes misses the broader point, because it is always possible to find one example that proves or disproves a general rule, so I shall leave any comments about local matters until the end.

Accountability within the health service is one of its great problems, despite the amount of money going into it. I suspect that we have all experienced the problem of taking an issue on behalf of a constituent to an acute health trust. It tells us that the matter is not its responsibility, but that of the commissioning agency, the primary care trust, which then says that it is a matter for the strategic health authority, now a regional body. The SHA proceeds to tell us that it is not a matter that it can deal with because the Secretary of State needs to intervene. At that point, we contact the Secretary of State for Health, who tells us that it is a matter for the local health economy—[Hon. Members: “Absolutely”]—so we have gone round in a huge circle. It is extremely difficult, in a system that almost deliberately seems to go out of its way to cause such confusion, ever to pin down exactly who is responsible or accountable for what is happening locally.

I will be brief. Perhaps the hon. Gentleman should visit constituencies like mine, where the Homerton hospital is a foundation trust made up of members of the public who have joined and created a mutual to help to run and hold the hospital to account. Does he not accept that that is a real achievement—one that we should perhaps see more of?

I absolutely agree. We like the idea of foundation trusts and we want to go further and faster with them. We were going in that direction, until it was all reversed for the first half of the decade during which the Government were in power—before we realised the error of their ways.

As I say, it is a problem of accountability. A great example is closing a chemotherapy unit on a temporary basis, when the entire community realises that it is actually being closed permanently. Chemotherapy is a treatment that people want to have close to home, if at all possible, for the simple reason that it is an uncomfortable experience. It is highly undesirable for people who are feeling sick to have to travel miles after their treatment.

I have heard of cases of chemotherapy units being closed on a temporary basis in order to remove the need for the local NHS trust to consult the public on the closure. A temporary closure, unlike a permanent one, requires no consultation. Having temporarily closed the unit, the trust then consults on a permanent closure. The effect has been to close the chemotherapy unit permanently, while calling the closure temporary. The rules have been circumvented by pretending to have a consultation, even though the unit is already closed. That is just another example of the lack of accountability that has found its way, almost systematically, into the health service. The Secretary of State should address that issue.

There are many other issues to address. Week in and week out in the House, we hear about a new top priority in the health service. Just the other week, I was highlighting the problems surrounding in vitro fertilisation in the NHS. In 2002, the then Secretary of State came to the House and said that everyone should be able to get at least one cycle of IVF on the national health service. I was very relieved to hear that. All three of my children were conceived through IVF, and the idea that others would be able to get the treatment through the NHS was to be welcomed.

The trouble was that, after that had been happening for a while, it stopped. The reason for it stopping seemed to be that other priorities had come along and been piled on top of the original priorities set by the Secretary of State, resulting in the first priority being almost entirely lost. That applies to all manner of services. An investigation into audiology services revealed that, despite the 18-week target, the average wait is 42 weeks. In Liverpool, the wait for having a hearing aid refitted is five years—

I will provide the data to the Minister. In fact, I have already provided them to the Secretary of State after I issued my report. If the Minister goes to, he will be able to download that report for himself.

The truth is that there is a five-year wait for people trying to transfer from an old-fashioned analogue hearing aid to a digital one. The Government have recently said that their aim is to include audiology services in the 18-week target. That is fine—it is to be welcomed—but there will be a problem if all that that does is pile that target on top of all the previous NHS targets. It is the latest priority in the latest week, and it simply will not work. The Government do not understand that the answer to all the problems in the NHS is not simply to stand up in the House and announce the latest priority, because all that happens is that the previous priority—and the one before, and the one before that—gets trampled on. That is how we end up with so little accountability.

I want to be brief, so I shall simply do what I am sure all hon. Members want to do, which is to refer to a local case. Despite all the promises and pledges, and despite what we heard at Prime Minister’s questions today and in the Secretary of State’s opening comments about how wonderfully rosy everything should be in the NHS, we all have our own examples of how the exact opposite is the case. In my constituency, the Queen Elizabeth II hospital is the place that illustrates that problem.

A consultation is about to get under way into the closure of the accident and emergency unit, of maternity services, of elderly care and of paediatrics, and into ending all elective operations there. This is the proposed wholesale closure of all the acute services at the hospital. The Secretary of State and her Ministers must recognise that when we hear pledges and promises, or talk of the number of extra doctors and nurses, they mean nothing to those who live in a county such as mine, which has more than 1 million people but only two hospitals that are set to remain after this flawed consultation: one in Labour Stevenage, the other in Labour Watford.

I was first elected a member of a health authority in 1974. In 1977, I was appointed chair of Cumbria health authority by a Labour Secretary of State, and in 1979 I was not reappointed by a Conservative Secretary of State. There was something honest about that. There were people chairing health authorities who supported the Government’s views. Now, I am afraid that we have given that away. Now, the Healthcare Commission appoints retired civil servants. In my area it has just appointed a new primary care trust, not one of whose non-executive directors lives in a city or a town. They all live in a rural area, and I suspect that they all come from the middle class.

I do not think we have done very well in that regard, but I will say this. Since 1974, I have worked in one way or another—in the health authority or in Parliament—with every Secretary of State we have had, and I believe that the record of the Secretary of State we have today compares with that of the best of them.

Certainly my right hon. Friend’s record compares very well with that of the right hon. Member for Charnwood (Mr. Dorrell). I was a Member of Parliament during his time as Secretary of State.

I think that the Secretary of State would agree that she has been greatly assisted by dedicated staff, and also by record funding from a Labour Government. As we have heard today, the NHS has been transformed. We have heard about the experience of patients, as opposed to that of politicians or the general public: we have heard that 90 per cent. are pleased with the treatment that they have received, which is excellent.

We have slashed waiting times. Members who have been here for a while will remember when their postbags were full of letters and their surgeries were full of walking sticks, because people were waiting for hip replacements or elective surgery. They were not waiting for 18 weeks or for 18 months; some were waiting for two or three years. As Members know, that does not happen any more. The hon. Member for Scarborough and Whitby (Mr. Goodwill) is waving a piece of paper. I would like to think it was his resignation, but I suspect that it is not.

Deaths from cancer and coronary disease have declined, but it would be wrong of me to waste this short opportunity by saying that everything in the garden is rosy. Sorry, Rosie! I mean, I apologise to the Minister of State, Department of Health, my right hon. Friend the Member for Doncaster, Central (Ms Winterton).

Mistakes have been made. I happen to believe that the reorganisation of Cumbria PCT was wrong. It needed to be reorganised because it was ridiculous to have three PCTs for 40,000 people, but the creation of a unitary PCT for the whole of Cumbria was entirely wrong, because it has made the PCT too remote. I only hope that we do not make the same mistake in the local government reorganisation and end up with a unitary Cumbria.

At first there was great concern about clinics run by community action teams, but when we met the Minister of State he gave us assurances that the CATs would be tailor-made for rural areas like Cumbria, and would not take resources away. I hope that in the near future it will be announced not only that CATs will be complementary to services in Cumbria, but that one will be based at Cumberland Infirmary.

The out-of-hours service in my constituency is not satisfactory. We have an out-of-hours organisation called CueDoc, with a surgery at the top of the highest hill in Carlisle. As there is no public transport, I cannot imagine how the elderly and the sick manage to get there, especially in the middle of the night, but that could be altered.

However, let us compare that with how things used to be. My area had the first private finance initiative hospital in the country. I advise Members never to want to be the first at anything, because being at the cutting edge has its problems. My hospital had its problems, but they are being sorted out. However, the fact is that we had waited 40 years for that new hospital. The Conservatives cancelled it on four occasions. The previous hospital had been built a long time ago—during the time of Lloyd George—and the maternity service was dangerous because the district general hospital was three miles away from the maternity hospital and the consultants could not get to the maternity hospital and children were dying. That has now all been sorted out.

Finally, I shall talk about the dentistry service in Cumbria. In 2005, because of how NHS dentists felt about contracts, the vast majority of those in Carlisle opted out of the service. There were long queues in the streets of Carlisle—which was embarrassing and made the national news—as one dentist said that if people did not sign up immediately they would not get a dentist at all. Last week, it was revealed in The Cumberland News that we have provided 23,000 places for patients in Carlisle, and that there was no waiting list for dentistry there. When the Minister—my right hon. Friend the Member for Doncaster, Central—visited and we went to a surgery, we came across people who had not been to a dentist for 10 or 15 years. Under the current Secretary of State, we have cured the problems of dentistry in north Cumbria, and they can be cured throughout the country.

That is not all that should be said on this matter. A headline in today’s News and Star reads, “Smile! New dentists will treat extra 7,000”. That is not about my constituency; it is a story about the market town of Penrith, where there will also be no waiting list.

It is wrong to say that the Secretary of State has failed. She has had a difficult task, but we are getting things right. One thing that we must do is ensure that the Conservatives never get another chance to decimate the NHS. They have never believed in it—they voted against it—and they still do not believe in it. Many of them do not even use it, so why should we trust them with it?

First, I shall respond to the closing comments of the hon. Member for Carlisle (Mr. Martlew) by referring to what the Secretary of State said in her speech. She began by saying that being Secretary of State for Health is a great privilege—and she was generous enough to say that it was felt to be so not only by Labour Secretaries of State but by Conservative Secretaries of State as well. I did not agree with very much else of what she said, but I do agree that it is a great privilege to hold her office.

However, when someone is granted a privilege it behoves them to ask what is expected of them in return. Given that this Secretary of State and her three Labour predecessors have been the beneficiaries of an unprecedented increase in national health service funding—increases that the Conservatives support—we can legitimately expect from her in return a commitment from the top of the national health service to deliver the best possible outcome for those increased resources. The charge that sticks against the Secretary of State is not that she is not committed to the national health service and its ideals—of course she is committed to them—but that she has not delivered the level of competence that the taxpayers and patients of this country are entitled to expect in return for the investment provided by her colleagues in the Treasury.

The Secretary of State responds to that charge by setting out all the improvements that have been delivered in the NHS over the past 10 years, and I do not dispute that there have been big improvements in some aspects of the service it delivers. Conservative politicians who say that the NHS has got worse since 1997 are simply wrong. That defies the evidence and the experience of those who use the health service. As my hon. Friend the shadow Secretary of State made clear, the charge against the Secretary of State is not that things have not got better. They have got better under this Secretary of State as they have under all her predecessors going back to 1948. There are endless statistics that my predecessors and I could quote on the improvements that were delivered by the NHS. Such improvements have been delivered throughout its history and my hon. Friend was good enough to cite some of the statistics on cancer mortality this afternoon.

The charge against the Secretary of State is that, in the old words of the school report, she has been too easily satisfied with her own work. We criticise her for losing the opportunity to deliver even bigger benefits for the resources that have been provided to the NHS.

Given that the advances in medical science mean that whenever one devises a new cure, one effectively creates a new queue, does my right hon. Friend agree that uppermost in ministerial minds at all times should be the priority of increasing productivity in the NHS?

Yes, I do, as long as it is understood that we are looking for the maximum possible health gain for the resources that are provided to the NHS and, in particular, the delivery of the stated objectives that Ministers, under both Labour and Tory Governments, have set out for the NHS. I wish to focus on one of those objectives, because if we conduct the health debate—as is often the temptation—purely in terms of the structure of health care delivered to particular communities, we miss the point of what the NHS exists for and what patients expect us to deliver through its structures.

It has been said by every Health Secretary that one of the purposes of the NHS is to reduce health inequalities around the country. So one of the challenges for the Secretary of State is why, despite the huge increase in resources over the past 10 years, health inequalities in Britain have got worse. In my intervention in the speech by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), I said that we should look not only at the record on cancer mortality or infant mortality for this country now as compared with 10 years ago, but at the health outcome measures in comparison with other, comparable countries. We should challenge ourselves with the fact that although cancer mortality rates are better here now than they were 10 years, they are significantly—not merely statistically—worse in Britain than in France, Germany, Italy and Spain. The latter is possibly the most telling, because that country’s national income is significantly lower than ours.

We should not simply trade often meaningless party political anecdotes about health improvement, as we heard from the Secretary of State this afternoon: we should address the real consequences of the failure to use the resources supplied to her—she is now back in her place—that were not available to her predecessors.

I shall not detain the House with the catalogue of mismanagement that has already been discussed, including the record on MTAS or the huge increases in resources for primary care that have somehow delivered a diminution in the quality of out-of-hours care. As for the Secretary of State’s record on mixed-sex wards, I am tempted to say that that is a subject on which she may regard imitation as the sincerest form of flattery, because she has made the speeches about how dreadful they are, as I did, and her record is exactly the same as mine. Mixed-sex wards still exist in the health service, and there is no effective plan to remove them.

The Secretary of State cannot conceivably be proud of the record on IT. In April, the Select Committee on Public Accounts published a report that stated:

“The…patient clinical record, which is central to obtaining the benefits of the programme, is already two years behind schedule”.

Most extraordinary of all—just listen to this, Mr. Deputy Speaker—it added:

“The Department's investment appraisal of the Programme did not seek to demonstrate that its financial benefits outweighed its cost.”

What is an investment appraisal about, if not demonstrating that benefits exceed costs? It beggars belief that we can be launching a £12 billion programme on the basis of an investment appraisal that did not set out to compare costs with benefits and show that benefits exceeded costs.

I promised to be brief. The charge against the Secretary of State is not that she does not care or that she is not committed, but that she has not delivered. That is the basis on which we Conservatives have used the device of this debate to demonstrate our belief that she should resign.

I am delighted to speak in this debate, which gives us the opportunity to set out some of the dividing lines between the parties on the health service, to examine some of the choices that the British people will face at the next election and to consider the Government’s record on some of the issues.

The hon. Member for Welwyn Hatfield (Grant Shapps) said that he did not want to talk about his constituency, but I want to talk a little about mine because some of the things that we have seen in Dudley demonstrate well some of the wider improvements of the health service across the country. It is fair to say at the outset that none of the improvements in Dudley would have been possible without the leadership of the Secretary of State and her colleagues. That is why I am speaking against the Opposition motion today.

Dudley primary care trust has undertaken wide-ranging reforms to services in the community in the past few years. As a result, my constituents now receive in their own homes personalised, individual care that would previously have been found only in hospitals. New ways of working introduced by this Government mean that care is tailored more than ever to meet the specific needs of the individual patient.

There are new rapid-care teams, care staff working in the community with mental health patients and new nurse consultants working with those most likely to return to hospital most frequently. We are intervening earlier and working on ways of providing preventive care closer to home. When the impact of the work of those staff on just the first few patients was analysed, it showed that the length of their stays in hospital away from their families had been reduced by an average of one week. The most recent figures show that the strategy has slashed the average length of stay in hospital by almost a quarter.

There are new case managers, who ensure that patients who can be treated at home are not unnecessarily admitted to hospital and that those who are admitted return home more quickly. Such managers cut emergency admissions. Again, it is worth referring to the figures: the work of one manager alone meant that 88 people could be treated at home, away from hospital, in one eight-month period.

We are linking up health and social services in ways that could never have been dreamt of before. We are cutting out inefficiencies, speeding up treatment and reducing waiting times. Under the superb leadership of Rachel Harris at Dudley primary care trust, we have pioneered a new community heart failure team, which provides new services in health centres and clinics. As a result, emergency admissions caused by heart failure were reduced by 16 per cent. in the first year; a nearby PCT that did not then have a similar service saw its heart failure admissions increase by 10 per cent.

As I said earlier, services at our district general hospital, Russells Hall, have also been transformed. We have a brand-new £200 million hospital, developed under the private finance initiative, with more doctors and nurses treating more patients more quickly than at any time in history.

That is not to say that things are perfect—they never can be. We have problems with car parking, and infection rates always cause concern. Other issues of chiropody and audiology have been raised by constituents.

The truth is that none of the improvements I spoke about earlier would have been possible without the extra investment that the Government have put into the NHS, which the Opposition voted against, despite what the right hon. Member for Charnwood (Mr. Dorrell) said earlier. Whatever they say about their new-found commitment to the NHS, we must not let anyone forget that they constantly opposed that extra investment and would cut spending on the health service if they had the chance to do so.

Under the Labour Government, investment in the NHS has doubled and it will have trebled by 2008 to more than £90 billion. The NHS is receiving an extra £8 billion this year—the biggest cash increase ever. All that investment means that there are about 280,000 more staff, as we heard earlier. There are more staff than at any period, with 35,000 more doctors, 80,000 more nurses—

As my hon. Friend says, we have the best paid nurses in Europe.

Furthermore, 116 hospitals have already been opened, or will be opened in the largest hospital building programme in our history, and 2,800 GP premises have been improved or refurbished.

Whatever the words of the Conservative motion, the Leader of the Opposition said that the extra investment needed to deliver those changes was “fiscal irresponsibility” and he committed his party to a new fiscal rule that, whatever they claim, means that they would spend less on the NHS than we will.

The hon. Gentleman may say it is not true, but his leader and the shadow Chancellor have promised to cut taxes every year under a Conservative Government through a so-called proceeds of growth rule. Their new third fiscal rule applied over the economic cycle would require spending cuts—if enforced this year—of £21 billion. [Interruption.] Opposition Members are chuntering away, saying that they disagree, but they do not need to take my word for it; the Leader of the Opposition admitted that implementing the rule would lead to dramatic cuts in public investment compared with Labour’s plans. These are the right hon. Gentleman’s words—not mine. He said that

“as that money comes in, let’s share that between additional public spending and reductions in taxes. That is a dramatic difference. It would be dramatically different after five years of a Conservative Government”.

In the Budget, the Chancellor announced that spending on public services will be £61 billion higher by 2007-08 compared to 2004-05 and that total additional expenditure on the NHS in the coming year will be £10 billion higher than this year—a 10 per cent. increase. The Opposition refuse to match our spending plans.

As we supported the spending plans of the current Labour Government at the last general election, and those plans take us through to the end of this financial year, what spending plans is the hon. Gentleman talking about?

I am just a comprehensive schoolboy from Dudley, so the hon. Gentleman must forgive me if I cannot work things out, but as far as I can recall the Opposition voted against the national insurance increase that delivered extra expenditure for the health service. They voted against the increased expenditure for the health service that has been delivered and at the last election they did not promise to match us on the health service; they promised to take funds out of the health service to subsidise private care. They are not promising to match us—[Interruption.] If the hon. Gentleman wants to intervene again to tell me that the shadow Chancellor has committed the Conservative party to matching us on health spending, I shall be delighted to hear it, because he has not done that.

I am grateful to the hon. Gentleman for giving way. The Labour Government’s spending plans run only to the end of this financial year—that is, March 2008. We are indeed committed to matching those spending plans. If the hon. Gentleman has privy knowledge of the Chancellor of the Exchequer’s plans beyond April 2009, we shall be happy to consider them.

What I have knowledge of is the proceeds of growth rule, which commits the hon. Gentleman’s party to spending less on public services than we would. He has not denied that the proceeds of growth rule would result in a Conservative Government spending less on public services than a Labour Government. As I said earlier, if that rule was introduced this year, it would mean that spending would be £21 billion lower than under the Government’s plans. It would be lower still in every year after that. Let me put it another way: spending on the NHS accounts for almost a fifth of the Government’s total managed expenditure, so cutting £21 billion from public spending would mean slashing £3.6 billion from the NHS. To achieve that, one would have to sack 100,000 nurses, 35,000 doctors and cut by a fifth the number of new hospitals, clinics and health centres.

All the talk about a new compassionate Conservative party that is committed to the NHS is exposed as the old empty rhetoric masking the same old Tory party. The Conservatives might not give us the details about where the cuts would fall, but every speech makes it absolutely clear. What do they mean when they talk about cutting back the big state or cutting the fat from public expenditure? They might not give us the details about which services they would slash to pay for the tax cuts or which bits of the big state they want to trim back, but the fancy photo calls, the so-called rebranding, the hospital visits, the fact that the Leader of the Opposition spent time in a school in Hull, and lived with what the Opposition patronisingly referred to as an ordinary family in Birmingham for a week, cannot mask the truth that this is the same old Tory party, running down the NHS because it is committed to the same old spending cuts.

The British people face a choice at the next election: record investment and reformed ways of working, transformed treatment, improved care and the aim of keeping patients at home and alive for longer under this party, or the same old Tory party with the same old package of cuts, charges, and privatisation.

That was another good debate—at least until the last contribution—and another health debate in Conservative time. There was an unprecedented show of strength by Cabinet colleagues in feigned support for the Secretary of State’s valedictory performance, but we have to acknowledge the unprecedented scenes for which she is responsible. Thousands of doctors have taken to the streets to march against the Secretary of State and her policies. Thousands of Worthing residents, who are not known for taking to the streets, marched against the Government and the Secretary of State’s policy on health. Not so long ago, the Public Gallery erupted in applause at the suggestion that the Secretary of State might like to apply for her own job under the circumstances that she was forcing on doctors under the medical training application service—or at least she was until MTAS went pear-shaped.

The Secretary of State wants us to mention patients and staff. Those marching patients and staff are testimony to what she has achieved. They speak volumes. She talks about a 90 per cent. satisfaction rate among NHS patients. Back in 1994, there was a similar survey, with similar criteria, and what was the satisfaction rate? Surprise, surprise—it was 90 per cent. She wants to talk about the attitude of staff. Let me just remind her of some of the comments made this morning by midwives at the Royal College of Midwives conference at which she spoke. Rosemary Exton from Nottingham has been a midwife for 24 years and in the last year has seen “some real deterioration”, including

“reduced opportunities for training and development, increased risk, markedly so, desperate resources, and increased stress”.

Midwife Liz Stephens from London said this morning to the Secretary of State:

“I have never felt as demoralised about maternity services in the whole of my 30 years as I do now.”

There is a rather long charge sheet behind the motion. I will give the Secretary of State the abridged version. When she was first appointed back in May 2005, she said:

“Over the next three months my priority is to spend time listening and learning from the real experts—patients and staff.”

So, what did she do? From July 2005 to June 2006 she did not visit a single hospital outside London. She did not visit any of the Sussex hospitals—all of which are now threatened with closure or downgrading. In July 2005, she proposed merging primary care trusts and strategic health authorities, and the divestment of PCT provider functions. By November, that had been abandoned and she was forced to apologise. There have been three attempts at reconfiguration: the regionalisation of SHAs, the merger of primary care trusts and the regionalisation of NHS ambulance trusts.

The latest onslaught on the NHS locally is the reconfiguration that involves cuts masquerading as modernisation, as the Secretary of State knows. There are also the heat maps, and the 43 maternity units and the accident and emergency departments across all of Sussex and the rest of the country that are under threat on her watch. There is perpetual reorganisation, confusion and turmoil.

In the right hon. Lady’s first speech to the House as Secretary of State, she spoke of her aim

“to create a society based on fairness and social justice”.—[Official Report, 24 May 2005; Vol. 434, c. 578.]

Since then, according to the Health Service Journal, health inequalities—the difference between the life expectancies of the richest and poorest—have become greater than at any time since the Victorian era. Let us consider the deficits under this Secretary of State’s watch. In 2005, she promised to reduce the overall deficit, yet the turnout was £1.31 billion of gross deficit, which was the worst in NHS history at that time. Hospital trusts have had their financial planning plunged into chaos due to the withdrawal of the tariff. A Healthcare Commission report showed that nearly a third of hospitals had failed to balance their books. Seven out of 10 chief executives said that the care of their patients would suffer as a result of short-term financial decisions, while, according to the Health Service Journal, two thirds of them were closing wards.

Virtually no area of the NHS has been immune from the Secretary of State’s incompetent meddling. The new dental contract has been described as a “shambles” by the head of the British Dental Association’s general dental practice committee. Just last month, 85 per cent. of dentists said that they believed that the new contract had not improved access to NHS dentistry.

I will not.

We saw the shambles of the collapse of the home oxygen service in February 2006 under this Secretary of State’s watch. There has been the mess of the GP out-of-hours service—at least the hon. Member for Carlisle (Mr. Martlew) acknowledged that it had been a mess—which has cost £242 million more than the Government intended and led to a reduction in productivity. The targets to halve the number of MRSA infections have failed dismally, and now C. difficile, which kills twice as many people as MRSA, is endemic throughout the health service and growing at a faster rate than ever.

Conservative Members’ warnings of 20,000 job losses were derided by the Secretary of State, yet according to her work force planning department there will now be 37,000 job losses, which is 2.7 per cent. of the work force. There have been failures in public health on obesity, mental health, binge drinking and sexually transmitted diseases.

I will not.

The independent advisory group on sexual health and HIV found that substantial parts of the £300 million that had been set aside to improve sexual health had been raided by PCTs to cover deficits and that the money reached the front line in only 30 out of 191 PCTs. The ticking time bombs that are being built up under this Secretary of State could create catastrophic conditions in the future. Most recently, we have seen figures showing that a fifth of hospitals have failed to eliminate mixed-sex wards. Disgracefully, in the mental health service, 55 per cent. of acute hospitals now have mixed-sex wards. We do not need to repeat the debacle over the medical training application service. We should not be surprised about all that because the Secretary of State has form—she showed it when she was Secretary of State for Trade and Industry.

The Secretary of State has received a vote of no confidence from her own staff. An external survey for Whitehall showed that fewer than two out of 10 senior civil servants at the Department of Health believed that it was well managed, while only 4 per cent. thought that the Department was able to manage change well. If the right hon. Lady cannot successfully lead the 3,500 people in her Department, she cannot be trusted to lead the 1.4 million people working in the NHS.

A recent survey in Hospital Doctor showed that under this Secretary of State, 69 per cent. of doctors would not recommend a career in medicine. Some 56 per cent. of doctors believe that there have been no improvements in the NHS since 2002. According to an official survey by health service regulators, fewer than half of NHS staff would be happy to be a patient at their own hospital. What an indictment of the Secretary of State’s policies over the past two years. A survey by Health Service Journal found that among NHS chief executives, the right hon. Lady was the least popular Secretary of State for Health in the past decade—and she had some competition.

The Secretary of State has no support in her Department, no support in the NHS and, apparently, no support from her Front-Bench colleagues. The chairman of the Labour party has protested against the closure of maternity services and the Secretary of State for Culture, Media and Sport has protested against the closure of 24-hour emergency clinics. The Minister of State, Ministry of Justice, the right hon. and learned Member for Camberwell and Peckham (Ms Harman), and the Chief Whip have protested against the closure of maternity services, as have the Minister for Local Government and the Health Secretary’s departmental colleague, the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis). The Solicitor-General, Home Office and Work and Pensions Ministers, and Parliamentary Private Secretaries to Ministers at the Departments of Trade and Industry and of Health have all protested against the right hon. Lady’s health policy, on her watch as Secretary of State for Health in this Government.

The right hon. Lady has lost the confidence of her Department. She has lost the confidence of junior doctors and the next generation trying to train for a career in the NHS. She has lost the confidence of the RCN and nurses. She has lost the confidence of midwives. And she has lost the confidence of the patients she is here to serve.

The right hon. Lady has taken the culture of “Not me, guv” to new heights. It is never her fault. In November 2006, she told the Health Committee that it was the fault of the NHS for employing too many staff. In March 2006, she blamed “clinical resistance” to change in the NHS for all the problems. Just last week, for MTAS she blamed the BMA, the royal colleges and the postgraduate deaneries—never herself—and today we have seen her blame African Governments for her Government issuing 50,000 work permits for African nurses working in the NHS. It is never the fault of the Secretary of State for Health, never the fault of her Ministers and apparently never the fault of her Department.

There has been a catalogue of departures by people around the Secretary of State. In March 2006, Sir Nigel Crisp departed, as did a Health Minister in the Commons and another in the Lords. Since June 2006, no fewer than six of the 14 board members at her Department have departed. Most recently, James Johnson, chairman of the BMA, fell on his sword after MTAS. Why? It is never the Secretary of State who takes responsibility.

The NHS budget is larger than the GDP of 155 member nations of the UN and it needs skill and expertise to run it, yet under the right hon. Lady’s leadership the central management of the NHS has rapidly come to resemble one of the less distinguished banana republics. The Home Secretary has just announced a £3.5 million bonus scheme for his Department, which he described as “not fit for purpose”—a perverse system that rewards failure. The Secretary of State should take the leaf out of her own policy of seeking to implement payment by results and to link elements of GP pay to patients’ satisfaction—but I fear that if she took that route, she would end up a net contributor to the Exchequer, rather than taking the modest £1,000 reduction that our motion proposes.

This Secretary of State has taken complacency, incompetence, fantasy and the art of the patronising to new heights. She has exploited the good will and hard work of staff in the NHS, whose dedication has been in spite of her, not because of her. Their loyalty and patience have been and are being severely tested. Reducing her salary by £1,000 is poor compensation for two years of mismanagement. She is past her sell-by date. It is time that she gave the NHS a break. It is time for her to go.

The first responsibility of any Secretary of State for Health is to NHS patients. As much as we have obviously been hanging on every word uttered by Opposition Members this afternoon, I hope that they will not be too offended if I say that we set a little more store by the views of real patients treated in real NHS hospitals in the past 12 months. That is the ultimate verdict—the one that counts and the one on which every Health Secretary should be judged. So what is their verdict?

Let us start with the Leader of the Opposition’s constituents: 94 per cent. said that the care that they got from their local trust last year was good, very good or excellent. The shadow Health Secretary’s constituents were even more pleased: 95 per cent. of them said the same, with a full 43 per cent. saying that it was excellent. Just 1 per cent. said that the care they received was poor. The hon. Member for South Cambridgeshire (Mr. Lansley) is developing such a talent for whinging about the NHS that it would not surprise me if that 1 per cent. was him. The Healthcare Commission’s figures record an improvement in patient satisfaction on last year. Those are the facts. They tell me that under my right hon. Friend’s leadership, patient care is getting better in the NHS.

However, we are not so arrogant as to say that there are not real issues to be addressed in the health service. Many have been raised today. The hon. Member for North Norfolk and others talked about MTAS. We have acknowledged that there have been serious problems with the system and we have promised to learn the lessons from those problems. Interviews are taking place now, and I believe that today’s ruling in the courts will allow us to map out a way forward. My right hon. Friend the Secretary of State will say more tomorrow, including on the issue of costs, which the hon. Member for North Norfolk mentioned. I hope that that will enable us to move the issue on.

The hon. Gentleman made a big attack on private finance initiatives in his speech. He may correct me if I am wrong, but are not his constituents benefiting from a new PFI hospital, and is it not the case that PFI allows more areas to get their new hospital at once? Is it not a case of the hon. Gentleman saying, “We’ve got ours; we’re all right, and we’ll cancel those other hospitals” including the Leeds children’s hospital, which he was asked about, although he could not answer the question?

My hon. Friend the Member for North-East Derbyshire (Natascha Engel) made a powerful speech about the spectacular improvements in cancer care since the Government came to power. She was right to say that cancer affects every family in the country, including mine, which was affected by it only this year. One of the earliest targets that the Government set was on access to cancer services for people who have a suspected cancer. That is precisely the kind of target that the Opposition have been deriding and would remove. My hon. Friend was absolutely right to point to improvements in that regard.

We next heard from the Tories’ self-appointed campaigner-in-chief, the hon. Member for Welwyn Hatfield (Grant Shapps). He began his speech by saying that money had been invested, improvements had been made and waiting times were down. I have only one thing to say to him: I thank him very much for his support this afternoon.

My hon. Friend the Member for Carlisle (Mr. Martlew) made important points about the NHS appointments process. He said that experience of politics and public life should not bar people from appointments, and I do not think that he will find any disagreement from Labour Members. He also said that services should be provided locally, and of course we agree with him on that, too. I can understand his frustration about the primary care trust changes, but they resulted in partnerships being more coterminous with local government, and that allows us to strengthen those partnerships across the country. On the issue of community action teams, he will know that a Cumbria-wide review is in preparation. The question of CAT services will be addressed as part of that review, which will be published in a few weeks’ time.

My hon. Friend the Member for Dudley, North (Mr. Austin) tied the shadow Health Secretary up in knots on the issue of health funding. It was a pleasure to watch, and the shadow Health Secretary completely failed to address my hon. Friend’s points. The shadow Health Secretary said that the Tories had committed to the spending plan and would have invested the same amount as the Government did, but he conveniently forgot about the patient passport idea proposed by the right hon. Member for Witney (Mr. Cameron). Had he forgotten about that?

The hon. Gentleman shakes his head; I think that he had forgotten. I am afraid that that idea would have taken money out of our national health service.

Next, we heard from the right hon. Member for Charnwood (Mr. Dorrell), who delivered a pious lecture, but a touch more humility might have been in order from that former Secretary of State for Health, because I have been reading his reviews from the time when he was Health Secretary. Let me read the headlines from his dying days in office: in January 1997, the Daily Mirror had the headlines “400 kids turned away from intensive care”, and “two and a half days on a casualty department trolley”. A third headline said, “You’re off your trolley, Minister—NHS is in a critical condition”. Those were the comments made when the right hon. Gentleman was Health Secretary. Those were the reviews, and these are the facts: when he left office, 286,000 people had been waiting more than six months for NHS treatment and there was a large NHS deficit that was 1.5 per cent. of the total NHS budget. That is significantly larger than any deficit today. As I say, a touch more humility may have been in order.

The hon. Member for South Cambridgeshire came here to throw stones, but let us take a little look at his performance. He will remember that I told the House a few weeks ago that an NHS trust had accused him of scaremongering when he said that its local accident and emergency department was to close. In fact, no such thing was true. Last week, he went further and put his name to a pitiful press release that claimed that official Department of Health guidance could lead to half of all accident and emergency departments being axed. Let me be absolutely clear: there is no such official Department of Health guidance. That announcement was about as well worked-out as the one that came out the same day—that great Tory triumph—on grammar schools. It was good of the hon. Member for South Cambridgeshire to rush that rubbish out last Thursday to help the leader of his party out of a hole, but does he now accept that that embarrassing piece of tripe does not have any basis in fact whatsoever, so will he withdraw it? If you remember, Mr. Deputy Speaker, that is all part of the positive Tory NHS “yes” campaign which, in fact, is a nasty, negative campaign designed to scare the public and demoralise NHS staff.

The Secretary of State confirmed earlier that she agrees with Sir George Alberti, as her aim is that accident and emergency departments across the country should have a catchment population of 450,000, with the implication that 92 A and E departments will close.

If the hon. Gentleman had been listening, he would know that my right hon. Friend had said that it was for specialist care. I repeat that there is no official Department of Health guidance on the matter.

How does the Labour Secretary of State’s record compare with the record of Opposition Members? On my right hon. Friend’s watch, waiting lists have fallen to their lowest ever level—not just a low level, but the lowest ever level. Just 352 people have been waiting for more than six months, and the figures are falling further still in every English constituency represented in the House. She has had the political courage to take hard decisions to put the NHS back in financial balance, and it is on that platform that she laid out plans to invest an extra £8 billion in the NHS this year. She is the first Secretary of State since the early 1990s to see MRSA rates fall after the inexorable rise that began under the previous Government, and that is something on which we want more progress. She has presided over continuing falls in death rates from cancer and coronary heart disease, thus saving lives up and down the country. Moreover, there has been no winter crisis on her watch.

I must tell the hon. Member for South Cambridgeshire that the House fell about when, in response to my hon. Friend the Member for Wolverhampton, South-West (Rob Marris), who asked why there had not been a winter crisis since 1999, he said, “Luck”. I thought for one horrible moment that he was going to say “global warming”, but he did not. Let us look at my right hon. Friend’s achievements. We have the lowest ever waiting lists. Is that luck? No, it is not. We have the best cancer care that the country has ever seen. Is that luck? I do not think so. We have the best health care system in the English-speaking world, as judged by the Commonwealth Fund in a report this week. Is that luck? I do not think so. It is a record of which she can be proud. Waiting lists, infection rates, death rates from cancer and coronary heart disease—those are things that matter to the people who put us into office. They are the things on which every Secretary of State should be judged. It is a record of which she can be proud, and it is a record of which the Labour Government are proud. I urge the whole House to send those cocky Tories packing tonight.

Question put, That the original words stand part of the Question:—

The House proceeded to a Division.

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments):—

mr. deputy speaker forthwith declared the main Question, as amended, to be agreed to.


That this House believes that there is no need to reduce the salary of the Secretary of State for Health at a time when patient satisfaction is increasing, with nine out of ten in-patients saying their care has been good, very good or excellent, waiting times are at their lowest since records began, an extra 200,000 lives have been saved from heart disease and cancer since 1996 and investment in the NHS is being trebled by 2008.