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Access to NHS Services

Volume 462: debated on Tuesday 3 July 2007

I beg to move,

That this House reaffirms its commitment to equitable access to high-quality NHS care, based on need not ability to pay; regards local access to NHS services as an important aspect of quality of care; urges the development of practice-based commissioning to incentivise primary care access and the integration of GP services, out-of-hours care, urgent care and NHS Direct services; calls on the Government to publish its review of walk-in centres and patient access survey results; notes the continuing threat to community hospitals, local accident and emergency and maternity services; calls for the preparation of evidence-based service models which seek to maintain local access to accident and emergency services, and to maintain community-based treatment and diagnosis and maternal choice; and further calls on the Government to ensure the fair allocation of resources, relative to burden of disease, to secure equitable access to NHS services.

It is a great pleasure to welcome the Secretary of State and his fellow Ministers to their new responsibilities. I look forward to our exchanges across the House, and I look forward even more to having the opportunity to work together to improve the legislative, regulatory and political framework in which the NHS seeks to deliver services to patients. Despite her travails in her post, it was always the Secretary of State’s predecessor’s great privilege, and often pleasure, to meet NHS staff, as it is my great privilege and pleasure to do so. If ever one becomes tired or distressed by what happens here at Westminster, one need only visit doctors, nurses and other health care professionals around the country to be astonished at, as well as immensely respectful of, what they achieve and the way in which they go about their tasks.

For the sake of the NHS, however, I hope that the Secretary of State does not emulate his predecessor. At the then Department for Education and Skills, the right hon. Gentleman’s policies were rescued by the support of the Conservatives for his Education and Inspections Bill. The time has come for him to be rescued at the Department of Health, although not by our supporting his legislation, but by his supporting Conservative-inspired legislation. We have supported the right hon. Gentleman in the past—now it is his turn to support us.

The purpose of the motion is not to debate those proposals, as the Secretary of State plans to deliver a statement tomorrow. Following proposals from my right hon. Friend the Leader of the Opposition and myself for greater autonomy and accountability for the NHS, he will be aware that we recently suggested a White Paper containing legislative proposals. We are happy to work together to give the NHS core principles and values entrenched in legislation; a structure of greater autonomy, not only for medical professionals but for those responsible for commissioning services for patients; greater freedoms for those who provide services as well as the ability to invest and improve services; and a strengthened accountability structure that does not all track back to the Secretary of State, as it does now. All those proposals are included in our document, which I will leave on the Table for the Secretary of State to enjoy. I hope that in the weeks and months to come we can work together in a spirit of consensus which, according to the Government’s rhetoric, is one of their intentions.

May I trespass away from the subject of the motion, and say a word about the arrest of a number of doctors in relation to the terrorist attacks last weekend? The House and the public will be shocked that members of a profession dedicated to saving lives should, it is at least suspected, conspire to take lives in an indiscriminate act of terror. I hope that the House shares my view that we should not let the action of a tiny, extremist minority ever prejudice our positive view of the way in which thousands of Muslim and overseas doctors form an integral part of health care in this country. NHS employers are responsible for ensuring that doctors meet the requirements for clinical practice and, for example, in language proficiency. Checks on those entering the United Kingdom include visa and criminal record checks, for which the Foreign and Commonwealth Office and the Home Office are responsible. It is important to note—I am sure that the Secretary of State has already done so—that the code of practice for the recruitment of health care professionals from developing countries includes Iran, Iraq and Jordan, which are countries from which the UK has agreed not actively to recruit. I am sure that the House will understand if, when he responds to our debate, the Secretary of State will explain how that code of practice and the highly skilled migrants programme have been applied, and what checks are undertaken on medics who come here.

The Secretary of State has to address urgent priorities in his Department, but if he has any doubts about the scale of the problems he must tackle, he need only read the capability review published about his Department last weekend, when, as they say in business, the Department was “kitchen sinking” on the issues that it had to deal with. The review said that

“the Department has not yet set out a clearly articulated vision for the future of health and social care and how to get there”.

It had “serious concerns” about the setting of direction which, given the understated language of the civil service, is about as serious as it gets. There is no direction for the national health service, and there has been a failure of leadership and direction. Where my party leader has led, the new Prime Minister and the Secretary of State have followed in saying that the NHS is their priority. Constitutional affairs have turned out to be the new Prime Minister’s priority but, none the less, we have led by making the NHS our immediate and first priority.

What the new Prime Minister means by all this amounts to the belief that

“we need to do better”.

When he launched his leadership tour, he said that we must have

“more access to health services at weekends and outside normal hours, millions using NHS Direct, millions using walk-in centres, more access to GPs”.

I was not sure whether that was a statement of what exists at present or of what the Prime Minister hopes will be the case. He is right that access to NHS care must be regarded as a vital aspect of the way in which quality health care is delivered. We have argued that that is the case, which is why we tabled the motion.

As my hon. Friend knows, reconfigurations are taking place throughout the country, especially in south-east England. Will he consider asking the Secretary of State if it is possible to call a halt to them for the moment as they are an attempt to impose one-size-fits-all structures on local health services? The Princess Royal hospital in Haywards Heath is 15 miles south of one the biggest airports in the world, five miles from a major motorway and located in a changing area where thousands of new houses will be built. It is to have its accident and emergency and maternity services taken away from it and transferred to an impossible place to get to in Brighton. Does my hon. Friend agree that it would be proper to reconsider that in light of what he has said?

I am grateful to my hon. Friend for that intervention, and I entirely agree with his point. The new Prime Minister has stated that he must listen to what the public and NHS professionals are saying throughout the country, but he cannot do that when—as is happening in many places—top-down reconfiguration of services is being forced upon local health care economies. I was recently in Hastings in my hon. Friend’s part of the country. The way in which the reconfigurations are to be applied raises serious questions about both the evidential basis for them and to access the services that will result. I will say more about that.

The hon. Gentleman believes that reconfiguration should be halted and the medical profession should be listened to. However, what he recommends is the opposite of what is being said by Professor Roger Boyle, national director of Heart Disease and Stroke. He said that reorganising services could lead to 500 fewer deaths, 1,000 fewer heart attacks and 250,000 fewer serious complications such as stroke. Does the hon. Gentleman not agree that that is a firm medical basis on which to reconfigure services?

We have always argued that it is necessary to develop services; I am unsure whether the hon. Lady attended our debate on acute services reconfiguration. She is confusing the necessity for service development with the question of whether local access to services should consequently be abandoned. I have had discussions with Roger Boyle. I entirely agree with, and have argued for, propositions such as that patients suffering from a stroke should be admitted directly to a specialist stroke unit where they can access early scanning for possible thrombolysis and early stroke care. That would address a large proportion of the figures that Roger Boyle’s cites. There is also the issue of access to primary angioplasty; a smaller number of specialist units will be required in order to provide access to such services. However, for such achievements in service development to be followed through in respect of less than 2 per cent. of accident and emergency attendances it is not necessary for access to accident and emergency services to be denied to the other 98 per cent.

The hon. Member for Grantham and Stamford (Mr. Davies) is sitting next to the hon. Lady. She can ask him about this matter. He and I have argued that it is not necessary for local accident and emergency services in Grantham to be shut down simply because specialist services are available in Nottingham. I invite him to agree with me on that.

I am grateful to the hon. Gentleman for allowing me to do so. I am extremely grateful to the Government as we have now saved the accident and emergency unit at Grantham hospital. That happened several weeks ago. I received a great deal of sympathy on that matter from the then Health Ministers, my right hon. Friends the Members for Leicester, West (Ms Hewitt) and for Leigh (Andy Burnham), and no sympathy at all from the hon. Member for South Cambridgeshire (Mr. Lansley). We spoke about it, and he seemed entirely uninterested in the future health of the people of Grantham. He seemed about as interested in what I was telling him as he would have been if I had been talking about mediaeval numismatics or the number of potholes in New Zealand. I was getting nowhere at all with him, but I did rather well with the Government.

I do not know what world the hon. Gentleman is living in, but he is not living in Lincolnshire, because I remember the conversation that he and I had with the chairman of the United Lincolnshire Hospitals NHS Trust; however, I will not go further down that path.

It is not only Opposition Members who believe that it is necessary for there to be a moratorium on the service reconfigurations that are proceeding in the absence of support or evidence. The new Secretary of State for Work and Pensions, in the deputy leadership election, at least had the honesty to say that

“we need a moratorium on structural change and reorganisation in the NHS.”

So we have support from within the Cabinet ranks.

I will come back to accident and emergency departments, but I wish to start with primary care, because we seek a primary care-led service. I wondered where the new Prime Minister had been in recent years when, during his leadership election, he talked about access to GP services, because the GP contract has reduced GP access. We do not know to what extent, because the Department of Health has failed to publish the patient access survey that it commissioned at great expense. But we do know that the introduction of the out-of-hours contract was a shambles, according to the Public Accounts Committee. We know that NHS Direct has shut 12 of its 50 call centres, including the one in Cambridge, which I visited, because the planned expansion of NHS Direct has been abandoned.

Walk-in centres have been cut back. The figures for early 2006, compared with 2005, recorded fewer people attending walk-in centres. Indeed, fewer people visit walk-in centres in a year than visit GP practices in just three days. We have also seen community hospitals closed, local A and E services downgraded and birth centres and local maternity units threatened with closure. Care closer to home, which was a mantra of the previous Secretary of State, is turning, in many cases, into care further away from home. Care closer to home is not happening.

I welcome to the Front Bench the new Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), who was president of the Community and District Nursing Association. We have fewer district nurses and health visitors now, but they are the very people we most need to deliver care closer to home and reduce demand for these services. It is only really when demand for hospital services is reduced that it would be safe or appropriate to reduce the supply of services. What we have at the moment is a structure that is trying to ration demand for care by restricting supply of care, and that is no good.

Well, the hon. Gentleman mentioned community hospitals and if he will allow me, I will quote the hon. Member for Beaconsfield (Mr. Grieve), who said:

“there are occasions when community hospitals have to be closed. Politicians, we may not like saying it, but we’ve all fought for our community hospitals. Some community hospitals are very old and can’t really be done up. So difficult decisions do have to be taken.”

Does the hon. Gentleman agree with his hon. Friend or not?

We have made it clear throughout that we agree that services must be developed, but that must be done in response to the changing needs of patients and the development of technology. Where community hospitals are concerned, it is not only the Conservatives who argue that they are an integral part of the delivery of care closer to the patient: the Government said so in the White Paper published in January 2006. That White Paper presented the rhetoric of support for community hospitals and that is why the Government ostensibly provided for a new capital fund to allow community hospitals to be developed. But too much of that money has been siphoned off to primary care centres and too little is being delivered. At the same time as the fund was being established, too many community hospitals did not have the revenue to enable them to continue to work. So community hospitals are being shut down in Cornwall, Devon, Wiltshire, near Bristol, Norfolk and Kent, and the list goes on. There are probably a hundred more that are still under threat because the Government have not delivered on the promises made in the White Paper at the beginning of last year that services would continue to be commissioned—including diagnostic services close to patients, out-patient clinics and, most importantly in some respects, access to in-patient services that allow step-up and step-down services to be provided.

My hon. Friend rightly focuses on the services provided by PCTs. The Government are right to emphasise the importance of early intervention, but in Aylesbury Vale there are no fewer than 400 young children who are not statemented—some of whom are pre-school children, while others are on school action or school action-plus—and have not received the speech and language therapy that they desperately need. Can my hon. Friend offer a way forward in terms of collaborative exercises and joined-up government, so that the children who desperately need help get it before it is too late?

I entirely share my hon. Friend’s concern, and he has been a redoubtable fighter for the interests of children who need speech and language therapy. There are two aspects to the problem. First, we must make sure that those who are in college training to be therapists find posts and are employed in the community. Secondly, I do not think that we are going to join up the services terribly effectively, given the present arrangements at the centre. It is not the job of those at the centre to join up services: instead, we should take budgets closer to the patient, allow GPs and PCTs to have access to those budgets, and make clear their responsibilities for commissioning services for young people with speech and language needs. That will mean that parents in particular will have someone to talk to, through whom they can access services. It should be as simple as that.

Does my hon. Friend agree that the test of service reconfiguration is safety? Sir Ian Kennedy is the chairman of the Healthcare Commission, and he said the other day that people should keep an eye on safety considerations. Against that background, can my hon. Friend understand why my constituents in Banbury feel so desperate? They have had a consultant-led obstetrics and maternity unit for a long time, but it is to be taken away from them. The nearest consultant-led unit will be an hour away in Oxford, a distance of 26 miles. My constituents understandably feel that that will downgrade rather than enhance safety and access to NHS services.

I am grateful to my hon. Friend for that very important point. We have argued in this House many times that both safety and access need to be considered when one is talking about maternity services. Safety is an essential element of quality of care, and choice and access are highly desirable elements, but the evidence base of safety is absent from service reconfigurations such as the one affecting his constituency. We are happy to see that the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis), still has his Front-Bench place. He is the Minister responsible for maternity services, and we have asked him many questions about how great should be the distance that people must travel between, say, a birth centre or a midwife-led unit and a unit providing consultant-led obstetric care. He does not know the answer and has provided no guidance, but at the same time the Department of Health is driving ahead with service reconfigurations across the country. Ostensibly, those reconfigurations are about safety, but no evidence is produced to support that. I do not see how one can have safety without evidence.

Most of the reconfigurations of obstetrics and gynaecology services are going ahead not because the NHS wants fewer women to give birth in fewer hospitals, but because the royal colleges have said that consultants need a certain amount of labour-ward cover and experience of births to continue their professional development. If the hon. Gentleman were a woman in labour who had had to wait 12 hours for an epidural anaesthetic, he would know that being in a local hospital is no comfort if that means that she has to compete with people brought in from the trauma department. It is much better for a woman to give birth in a hospital with a dedicated obstetric anaesthetist, but not all hospitals across the country have one.

The hon. Lady should have attended our debate on maternity services, when we made it very clear that of course we must have proper risk assessment, and that mothers giving birth in places of relatively greater risk must have access to proper obstetric care. I am aware that, around the country, managers are representing the case for service reconfiguration by saying that, as a minimum, there should be 40 hours of consultant cover on labour wards. They make direct reference to what the Healthcare Commission said happened with the 10 tragic maternal deaths at Northwick Park and, in general, they say that there must be 2,500 live births at each hospital. One then asks how many live births there were at Northwick Park at the time, and the answer is 5,000. Another maternity unit had recently closed and a substantial amount of responsibility and additional births had been transferred to Northwick Park, and the transfer was not well organised. In fact, it was tragically badly organised. So there are issues to consider that are different and separate from the mechanistic approach of insisting on 40 hours of consultant cover on labour wards. We have to deal with the evidence, not just with simple management assertions that are driven as much by the European working time directive and financial pressures as by genuine evidence of clinical safety.

Two years ago, during the general election campaign, my hon. Friend came to Hornsea and visited people there to join the campaign to save the hospital. He will remember that the local Labour party said that it was scaremongering to suggest that there was a threat to Hornsea cottage hospital. In fact, my hon. Friend was barracked by a Labour councillor at the event that we held. Since that time, the primary care trust has formally made the decision to shut every single bed at Hornsea cottage hospital and to betray local people. That Labour councillor feels that the Government have broken their word and let them down.

I share my hon. Friend’s distress about the matter. It is clear that, on the criterion of access to services, his constituency will be extremely badly served by decisions that have emanated from the Government and are contrary to all that was said in the Government White Paper in January 2006.

Let me come to the points that I hope that the Secretary of State will have in mind. I understand that he has been in his post for only six days, but we need to get the immediate priorities up front. The following are among the things that he needs to do. He needs to start by working with primary care and especially family doctors. GP-bashing, which seems to have been the preoccupation of Ministers, has to stop—it is no good going down that path. Hamish Meldrum, the new chairman of the British Medical Association, has said:

“We are experiencing an unprecedented volume of misinformation, half-truths and politically-inspired doctor-bashing”.

That does not mean that one should just let GPs do as they like, but we know that GPs will respond if they have the right framework and incentives. The clearly required principal incentive, which has not been present in the new contract, is empowerment, professional autonomy and the ability to take decisions as senior public service and clinical professionals about real budgets, real commissioning and real opportunities to shape services.

Today, the NHS is not a primary care-led service but a centrally controlled service. The top-down initiatives are not working. Measures such as the 48-hour access target have been counter-productive, driving patients and practices into an absurd 8.30 am telephone scramble. Choose and book has been hopelessly mishandled and has compromised the freedom to refer that GPs always had.

Out-of-hours services under the new contract have de-emphasised the role of general practitioners. The hon. Member for Grantham and Stamford will recall that we had to fight that one too, because GPs simply did not form part of the out-of-hours service in south Lincolnshire, and we had to persuade Ministers to involve them. [Interruption.] I know that I have mentioned the hon. Gentleman, but I will not give way: we are just agreed about that issue, and we will settle at that.

Things can be changed. Let us take practice-based commissioning. Ministers, after a decade, have finally realised that the fundamentals of fundholding need to be brought back. GPs can take control of the commissioning of services, and that should include the commissioning of out-of-hours services. They can integrate those services more effectively with their own services.

The Department has also failed to publish an urgent care strategy, despite the fact that, at the beginning of last year, the White Paper stated that one of the jobs for 2006 was to produce such a strategy. I do not know whether the Department has admitted it to the Secretary of State, but it should have been done last year and it has not been done yet, and we are in July. We need an urgent care strategy which says to patients, “It is very straightforward how you access urgent care. If it is an emergency, you ring 999.” Some of our concerns about accident and emergency services would be met by such a strategy. We understand, however, that if someone is in an ambulance with a paramedic, they may not necessarily go to the local A and E, but instead go to a specialist centre for trauma, stroke and heart attack. Apart from that, however, we need a much more integrated urgent care structure. If it is not a 999 call and an emergency, the call should be made to 0845 4647, which would offer access not just to NHS Direct but to the necessary core handling and triage that determines whether an emergency response by an ambulance, a doctor response through the out-of-hours service, or a nurse or emergency care practitioner response is appropriate, or whether the person should be advised to attend a walk-in centre or an A and E department, visit their general practice the following day or receive advice on the telephone.

Does my hon. Friend agree that many people are completely muddled about what the Government are trying to achieve and the NHS that Labour Members describe? In my constituency, there have been cuts at Cranleigh hospital and Milford hospital. The whole of the Royal Surrey county hospital is under threat—accident and emergency, maternity and paediatric services are all under threat. That is not about increasing access for people and looking after them closer to their homes; it is about pushing all the care that my constituents in Guildford have been receiving further away from where they live.

I am really grateful to my hon. Friend for making that point, because she sums up exactly the experience of so many constituents throughout the country, rather than the rhetoric we keep hearing. After the failed combination of arrogance and incompetence that has characterised the Labour party’s approach to health policy for the past decade, the starting point should be the experience of constituents—what they are feeling and what they see happening in their health service locally. That is what our approach will be.

No, because I have already given way to the hon. Lady.

I was talking about what we need to do to co-ordinate urgent care. It is necessary for NHS Direct to be franchised out properly. As I have told the House before, NHS Direct call handlers, ambulance trust call handlers and out-of-hours call handlers can all be in the same room—for example, as they are in Cornwall or Norwich—yet they cannot have an integrated system of triage and referral to deal with patients. When patients ring in, they have to speak to each service separately. After all these years, that system is absurd.

Walk-in centres are another issue that has been left in the Secretary of State’s in-tray. Two articles have been published, one of which said that walk-in centres have had no impact on access to emergency care locally and the other said that they have had no impact in reducing demand for GP services. Questions about the costs and benefits of walk-in centres need to be dealt with.

Somewhere there is a review of funding for walk-in centres. It has not been published, yet cover at the walk-in centre in Luton has dropped from about 107 hours a week, including weekends, to 20 hours during weekdays only.

Does my hon. Friend agree that people are not only upset about having to travel much longer distances to hospital, but worried that when they are in those large monopoly hospitals they will be more prone to hospital-acquired infections, which puts them at considerable risk when they are already vulnerable?

I share my right hon. Friend’s concerns. Furthermore, he represents a part of the country that secures the lowest per capita distribution of resources. The Select Committee on Health made it clear that, as we had argued, there should be a review of the resource allocation formula to make it fairer in distributing resources relative to the burden of disease. It is interesting that the Secretary of State’s predecessor handed him one admission of our arguments. Only the week before last, the right hon. Lady said that the Advisory Committee on Resource Allocation should be given Bank of England-style independence. She acknowledged that we were right and that it had been the subject of political interference. In a letter to me on her last day in office, she also accepted our argument that the principal cause of variation in health-related need in the burden of disease is age, so as an urgent measure I look forward to an independent review of resource allocation to deliver a fairer distribution across the country.

The purpose of the debate is partly to set out the things that need to be done. Local services, such as accident and emergency and maternity services, should not be shut down in the absence of evidence of what constitutes safe, accessible and good-quality care. I hope that tomorrow the Secretary of State will say that he will have such a moratorium.

The Prime Minister and the Secretary of State should not be wandering around the country saying that they are going to listen and then overriding things before they happen. We need care closer to home to mean exactly that, and not have services taken away that people have relied upon for a great deal of time. We need to know whether the Prime Minister has any substance to add to what he said in passing at the outset of his leadership campaign, or does he, as it turns out, have hidden shallows to him? Where in the Government amendment is the recognition that they must do better? If that is what the new Prime Minister said in his leadership campaign, why is it not reflected in the Government’s self-congratulatory amendment?

Morale in the NHS is at an all-time low. The Health Service Journal asked NHS staff about morale and published the results the week before last. It asked whether morale in the NHS was excellent and 0 per cent. said that it was. Some 4 per cent. said that morale was good and 30 per cent. said that it was moderate. However, 41 per cent. said that it was poor and 25 per cent. that it was very poor. That is nearly two thirds.

The Secretary of State is a former general secretary of a trade union and he must know that relations between the leadership of the NHS and the staff of the NHS are at all-time low. Even in his own Department, morale is low. Direction and leadership are badly needed, and we must have greater autonomy for health care professionals to re-empower and motivate them. We must have accountability to patients exercising choice and a public voice on these issues. We need evidence for the policies that are being pursued rather than simply a slash-and-burn pursuit of the Government’s fiscal targets, which are delivering inequitable access to care in too many parts of the country. Not least, we need strong commissioning decisions taken closer to the patients and stronger primary care-led commissioning in urgent care.

We have a clear vision for an NHS that is patient- centred and professionally led. It is a vision of an NHS accountable for its outcomes and not hamstrung by targets, and in which we recognise that access to NHS care, as well the safety of care, is integral to quality services. It is a vision of what is, indeed, a national health service that respects the diversity and needs of patients at every level, and incorporates the essential principles that have stood the NHS in good stead for nearly 60 years, and puts them right at the centre of NHS care.

I hope that this is a starting point from which we and the Secretary of State and his ministerial team can work together positively and constructively to deliver a service that lives up not only to those principles, but to the ambitions of the people who work in the NHS and, not least, of those who depend upon it. I commend the motion to the House.

I beg to move, To leave out from “House” to end and add:

“supports the Government’s trebling of investment in the NHS by 2008 and welcomes the recent confirmation of an extra £8 billion for 2007-08; congratulates the staff and the medical professions for their hard work and commitment in helping progress towards this Government’s historic maximum 18 week wait from GP referral to treatment; welcomes the extra choice available to patients with new services more convenient for their lives including around 90 NHS walk-in centres and the £750 million programme for developing community facilities providing care closer to home; recognises the achievement of the NHS in delivering a wide range of quality personal services convenient for patients including NHS Direct, 23 new independent sector treatment centres increasing choice; further welcomes the 280,000 extra staff working for the NHS since 1997 including 80,000 more nurses and 35,000 more doctors; further welcomes the fact that over 85 per cent. of all GP practices have used Choose and Book to refer their patients to hospital and that over three million Choose and Book appointments have been made so far, allowing patients to choose appointments that are at convenient times to fit in with their lives; and recognises the need to ensure that the views of NHS staff and patients are paramount and that Government must engage fully in a dialogue with them about the future of the NHS.”.

I thank the hon. Member for South Cambridgeshire (Mr. Lansley) for welcoming me to the Dispatch Box and for the copy of the Conservative party document. I have had my attention drawn to many documents that could profoundly influence the NHS, but this was not among them. I will have a look at it in good time.

I pay tribute to my predecessor. My right hon. Friend the Member for Leicester, West (Ms Hewitt) is a woman of great courage, great intelligence and great ability—more courage, intelligence and ability than the hon. Member for Beverley and Holderness (Mr. Stuart) possesses in his little finger, incidentally. I pay tribute to her for the tremendous work that she has done in my Department.

I have been in post for the equivalent of only 10 minutes, I suppose, but my party has been in government for 10 years, so perhaps the best way to open my speech is to look back briefly at the health service that we inherited in 1997. The service was starved of essential funding; indeed, we were investing, as a proportion of our GDP, at about the level of the Czech Republic and Poland and well below the level of France, Germany and Sweden. Every winter heralded a new crisis, waiting lists topped 1 million and the chronic bed shortage meant that elderly patients were turfed out in the middle of night while critically ill children were denied essential intensive care. All that has changed.

In 1997, patients were left on trolleys in accident and emergency departments for hours, or even days, waiting for admission. Now nearly 98 per cent. of patients are either admitted, transferred or discharged within four hours of arrival. In March 1997, 284,000 patients had been on a waiting list for an operation for more than six months. Today, that figure is less than 500. In 1997, half of all NHS hospital buildings had been built before the NHS was created. Now, thanks to the biggest hospital building programme ever seen in this country, it is less than a fifth.

Ten years on, the position has been transformed thanks to greater investment, difficult but necessary system reform and, above all, the tremendous work of those who work for the NHS. We have trebled the health budget and there are now almost 80,000 more nurses and more than 36,000 more doctors. Cancer death rates are down by 15.7 per cent., saving more than 50,000 lives. Death rates from heart disease are down by 35.9 per cent., saving nearly 150,000 lives. Since 2000, 231 new CT scanners and 158 new MRI scanners have been installed in hospitals.

I will give way to the hon. Gentleman, who obviously wants to tell us about the tremendous new community hospital being built in Beverley.

Uncharacteristically, the Secretary of State has not started with the humility that is needed, given the Government’s record. The Conservatives recognise the increase in expenditure, but, like the public and those who work in the NHS, we have not seen value for money from that expenditure. Will the Secretary of State, on his first outing, accept that that is fundamentally true—as the Prime Minister appeared to in his leadership campaign—and tell the House that he feels we must do better in getting value for money for the vastly increased resources that—to give the Government credit—have been introduced to the NHS?

It was not worth giving way. I thought that the hon. Gentleman was going to tell us about the exciting developments in his constituency, but instead we heard the same mantra that the investment that has been put into the health service has not been matched by results. It is my genuine belief that, without a change of Government in 1997, the NHS would have weakened and withered with each subsequent year of neglect. That would have strengthened the position of those who oppose the whole concept of a national health service that is free to all and based on clinical need rather than the ability to pay. The mantra of such people is that no matter how much investment is put into the NHS, it will never work because of the principal basis on which it was founded.

The Secretary of State has rightly drawn attention to the fact that there have been significant improvements in many specialties in the past 10 years, but does he accept that there is a considerable distance still to go, particularly when the survival rates for conditions such as cancer and for strokes are compared with those in many other European countries?

May I say how pleased I am that the hon. Gentleman is the Liberal Democrat spokesman? We have history, the hon. Member for Norfolk South—[Interruption.] We have history, the hon. Member for North Norfolk (Norman Lamb) and I—although it does not extend to my remembering his constituency accurately. He is absolutely right: of course we will never be in a state of absolute perfection in the NHS. What I am setting out—and what I am using to counter the points made by the Opposition—is the fact that we are making huge strides forwards. I will come later to some of the issues that we still need to address, but it is right to put the debate in the context of where we were in 1997 and where we are now.

I welcome the Secretary of State to his new position. I knew him for a number of years before I came to this place and he is a man of great integrity and decency. As Secretary of State, he is in a profoundly important position when it comes to having an impact on the future of the NHS. In my constituency, we face the closure of hospital services in north London and services in the north of my constituency, in Welwyn. May I prevail upon him to grant me a 10 or 15-minute meeting so that I can discuss my concerns? We are between a rock and a hard place.

I would very much welcome a meeting with the hon. Gentleman to talk about the problems in his constituency.

I hope that in his speech my right hon. Friend will draw attention to the fact that before 1997 we did not have enough doctors and nurses. In Coventry, we now have a brand new hospital.

My hon. Friend is absolutely right, and that is the story of the past 10 years. We have used investment to turn things around. The reality now is that no mainstream political party, whatever its natural instincts, would dare to fight an election openly saying that it would use public money to enable people to leave the NHS, as the hon. Member for South Cambridgeshire did when he visited the constituency of the hon. Member for Beverley and Holderness. That, of course, was the position of the Conservative party at the last general election.

The Secretary of State will find that in our document, which he clearly has not read, we commit ourselves to accepting the 10 core principles signed up to by NHS organisations and the NHS plan 2000. Last December, his Department put forward a set of core principles from which one was omitted—the principle that public funds for health care should be used solely for NHS patients. We now subscribe to that principle, but apparently he does not.

I am pleased that the hon. Gentleman now supports the core values and principles in the NHS document. We have always believed that public money should go to NHS patients, and that we should not put that money into the private sector, as was the Conservatives’ previous policy. [Interruption.] If the hon. Gentleman is talking about the £2 billion, that is not the case; the £2 billion that the Chief Secretary to the Treasury mentioned recently is still in the national health service, and still used for patient care. Having created the NHS and having rescued it from Tory ruin, the Government must now continue our transformation of the health service so that it can thrive in the face of the considerable challenges that affect our country in the 21st century.

I congratulate my right hon. Friend on his appointment, and I wish him luck for the future; I am sure that he will do a marvellous job for the NHS. Surely the real issue is the need to improve access to primary care, and therefore to improve capacity in primary care. Has he had a chance to read the report on the future of pharmacy that was produced by the all-party group on pharmacy? What plans does he have to ensure that pharmacists and general practitioners work together more closely to increase capacity in both primary care and community services, so that we can improve patient outcomes across the board and reduce some of the pressure on hospital services?

My hon. Friend is absolutely right: we can go much further as regards the 10,000 pharmacies in this country offering services. We can go much further on access to primary care services, too; I will come to that subject in a moment. Thanks to medical developments, we are all living longer, and the number of people over 85 is set to increase by two thirds by 2026. Technological advances mean that operations that were once considered miraculous are increasingly commonplace. I cite the case of the heart transplant given last week to 18-month-old baby Zoe Chambers in my constituency in Hull. We now live in a far more consumer-oriented culture, where customers rightly expect goods and services to be provided at times convenient to them.

That leads me directly to the issue of access, which is the topic of today’s debate. We need to ensure that our provision is flexible and responsive enough to meet the demands of hard-working families, who face competing demands on their time. In 1997, surgeries were frequently shut at the times when patients needed them most, such as lunch time, after work and at weekends. It was hard to make an appointment, and the surgeries were often in a squalid state of disrepair. Since then, more than 3,000 GP premises have been rebuilt or refurbished. Nine out of 10 patients can now see a GP within two working days, and more than three quarters of patients say that they are seen as soon as they think it necessary. In 1997, just half of patients said the same thing.

Nurses, and particularly community nurses, are an important part of access to NHS services. When he was Secretary of State for Education and Skills, the right hon. Gentleman sanctioned an unstaged pay rise for teachers of 2.5 per cent. However, nurses have been granted a pay increase of only 1.9 per cent., owing to the Government’s decision to stage their pay award. Will he reconsider that decision in light of the fact that nurses are critical to improving access to care?

Nurses are indeed critical, and their pay has risen over the past 10 years. With reference to this year’s staged pay increase, it was a Cabinet decision—[Interruption.] We will not be looking at that again. We have made it clear—[Interruption.] We have made it clear that when one looks at how that works through the system, the pay increase for the majority of nurses is much—

Order. I am sorry to interrupt the right hon. Gentleman. The hon. Lady asked a question. She should remain silent to allow the Secretary of State to reply.

Perhaps I might add that the teachers’ pay increase comes later in the year. The NHS pay increase was due to come in on 1 April and the fear was—the Conservative Front-Bench team seems to be economically illiterate on these matters—that there would be built into pay increases this year an inflation figure that would fall by the end of the year.

On access to premises, when I return to my constituency office every week, I see a new local improvement finance trust centre which is nearing completion. That new LIFT centre in Walkden will replace one of the oldest, smallest and most unsuitable GP surgeries—a small terraced house—which is used by some of the most deprived and disadvantaged constituents in Salford. The GP who built that up from scratch years ago in an area of very few GPs put up his plate and built up his list from zero patients. The patients in that disadvantaged area will have access to that wonderful new centre. Does my right hon. Friend agree that for a disadvantaged area to have a fantastic new LIFT centre is a key part of access?

Order. Before the Secretary of State answers, may I say to the House that interventions are getting longer and longer? There is quite a long list of hon. Members seeking to catch my eye, and I remind the House of the Modernisation Committee report, which alluded to the problem of too many interventions, which Front Benchers generously allow but which nibble away at the time for Back Benchers to contribute to the debate.

Thank you, Mr. Deputy Speaker. I shall simply agree with my hon. Friend the Member for Worsley (Barbara Keeley) that that is a huge development in her constituency, as in mine. There have been tremendous achievements. We have put in place incentives for doctors to do more to improve access—the point of my hon. Friend’s intervention—with the new GP patient survey directly rewarding those doctors who meet their patients’ needs. [Interruption.] We will publish the document this month. The problem with publication is that the response was so high—2 million patients responded—that we needed a little longer to get the document into a fit state for publication.

Last weekend, the Prime Minister and I visited the Churchill health centre in Kingston, which is now open every weekday night until 8 pm and from 9 am till 12 midday on Saturday mornings. The centre does not provide such access because it is a national pilot or because it is in receipt of special funding; it is simply responding to the needs of its patients. The business case is clear, and the local personal medical services contract with the PCT provides for the practice to develop its service in this way.

We have invested more money in GPs through the GP contract, but this has been more money for better services. The quality and outcomes framework part of the contract pays GPs according to how effectively they care for their patients. This includes preventive work like gauging blood pressure more regularly.

The contract also incentivises better access. There are now around 90 NHS walk-in centres and 46 NHS treatment centres, including six commuter walk-in centres, offering free advice and treatment to all comers, without registration or an appointment. The centres are easy to access and they are open 365 days a year. They make a particular difference in improving services for the most vulnerable. We are closing the gap between GP referral and treatment times, so that waiting times are at an all-time low and more people are benefiting from earlier relief of symptoms, less anxiety and more convenient care.

We have also made it easier for patients to choose where they have their treatment. Patients needing a referral for elective care can now select from four different hospitals. Greater choice leads to better local services, and by making sure that funding follows the patient we have stimulated the development of more responsive, patient-centred services. One million people are seen by the NHS every 36 hours, and 1 million additional operations are now carried out each year. The maximum out-patient waiting time is now 11 weeks for over 99 per cent. of patients.

In-patient waiting lists are down by 476,000 since 1997, to the lowest figure since comparable data were first collected. The average wait for in-patient treatment is now six weeks. Virtually nobody is waiting more than six months for an operation. Cataract operation waiting times have fallen from two years to just three months, and waiting times for heart operations are also down to less than three months.

Almost all cancer patients are now treated within a month of diagnosis, while over 99 per cent. of suspected cancer patients are seen by a specialist within a fortnight of being urgently referred. In 1997, over a third of all suspected cancer patients had to wait longer than two weeks.

The service has been transformed since 1997, and this achievement has been a Herculean feat. I do, however, recognise that the financial turnaround and the reform programme have been delivered at some cost to staff engagement and public confidence. While those who use the NHS testify in ever greater numbers to its excellent treatment and improved resources, the public as a whole is not yet persuaded. The latest survey by the Healthcare Commission independently questioned 80,000 people with recent experience of in-patient treatment, and 92 per cent. found that treatment either excellent, very good or good, and only 2 per cent. found that it was poor.

I am glad that the Secretary of State has moved off his partisan opening remarks. What relevance does the White Paper “The Governance of Britain”, which the Prime Minister has just announced, have for my constituents, 140,000 of whom signed a petition complaining about the threat to St. Richard’s hospital in Chichester, which has existed for nearly two years? They just do not recognise the picture that the Secretary of State is painting. Will he say specifically whether my local community, which has

“tended to be seen as passive recipients of services”,

will be given the power to take decisions, and whether, for example, it will be allowed to use the mechanism of citizens juries to influence the decision on whether that hospital should be closed or reconfigured? Does this document have any meaning at all for my constituents and those who want to keep St. Richard’s?

We are still in consultation on the issue that the hon. Gentleman raises, but these issues are driven locally, and they are driven predominantly on the basis of clinical decision. [Interruption.] I am sorry, but Opposition Members have spent a long time putting forward scare stories about NHS closures, job losses and bad services. It is no wonder they do not wish to hear the Government’s record over the last 10 years. [Interruption.] Opposition Members are asking for a moratorium on reconfiguration. These reconfigurations are being driven by local decisions in local NHS trusts, and they are driven by clinical need, not by any financial constraints. That is the simple fact of the situation.

The Secretary of State will appreciate that he comes to his post at the very time that the plans to downgrade accident and emergency and maternity services at Chase Farm hospital have been published. Has he had an opportunity to look at the report, and will he join Sir George Alberti in recognising that there needs to be investment in primary care services and an expansion of the capacity of Barnet and North Middlesex University hospitals for the plans to be in any way viable? Does he recognise the cross-party opposition and fundamental local opposition to the plans?

In a moment, I will discuss some of the things that we need to do to take the argument forward. My point is that it is wrong to claim that proposals made in SHAs and PCTs across the country are driven by financial or political constraints; they are driven by the need to ensure a better service for the public. Overwhelmingly, that is the reason for those proposals.

It is impossible to explain to my constituents that taking away consultant-led maternity services, special care baby units and 24/7 paediatric cover in a general hospital that has had those services for years—Barbara Castle set up the inquiry that led to 24/7 paediatrics at Horton general hospital—is an improvement in NHS services. Conservative Members are not making partisan points, and the campaign in Banbury involves Labour councillors and others. We just want to maintain the existing level of NHS services.

I understand the hon. Gentleman’s point. As constituency MPs, we all face those pressures. The difference is that Conservative Members say the process is driven by financial constraints or by people in Whitehall; we say that the changes are necessary, as I have set out, for reasons such as medical advances, technological change and demographic change. There has always been reconfiguration in the NHS, and we must ensure that the NHS is capable of meeting today’s challenges and not the challenges of 1948. The decisions should be clinically driven, and they should not be driven by politicians.

There is the question of how the public feel about the issue. Those who have not experienced the changes at first hand are not convinced that they are getting value for the extra money that they have contributed, and—this answers the point raised by the hon. Member for North Norfolk—there is more to do before the NHS achieves everywhere the levels of efficiency and effectiveness that are essential if we are to cope with the huge challenges that I have set out.

Will the Secretary of State help me? My local hospital has experienced a degree of financial pain after reaching the targets laid down by the Government on treatment times. Now, an independent treatment centre is going to be placed within eight miles of its location. The hospital trust, the consultants and the staff are fearful that in some of the specialties in which they meet all their targets, patients will be diverted away from the local hospital to the ITC, which over a three-year period will cause significant financial problems for the trust and the loss of staff, who may move to the ITC because that is where the work is going. Why will that necessarily be good for efficiency and for my constituents?

I am willing to consider the hon. Gentleman’s particular case. Such developments should occur only where there is a capacity problem. If the hon. Gentleman contacts me, I will look at the case.

There is no question but that developments in recent years have damaged staff morale, with deficits in some health trusts placing unwanted additional strain on hard-working NHS employees. As we move to the next phase of the NHS transformation, there should be a much greater focus not on top-down reforms but on stimulating change among patients and practitioners. I want to maximise local autonomy for the doctors, consultants, nurses and managers who actually do the job, day in and day out. The policy framework that we set will be right only if the views of staff and patients are properly incorporated.

A modern NHS must move from a public sector monopoly to a truly patient-led public service. That means doing more than changing the relationship between Ministers and senior managers; it means transforming the entire relationship between the NHS and the public and creating a system that is publicly accountable locally, as well as through the elected Government. My predecessors have already taken significant steps towards creating an independent, self-improving NHS, steadily removing power from the hands of politicians and transferring it to clinicians. In 1999, we created the National Institute for Health and Clinical Excellence to give clinical guidance on what the NHS should and should not do. We also established the Commission for Health Improvement, which is now the Healthcare Commission and is soon to merge with the other independent regulatory bodies that we have created. There are now 67 foundation trusts independent of Whitehall, accountable to their members and making their own decisions on how best to serve their patients.

That increased transparency and independence has brought undoubted improvements, but it has also had a short-term effect on confidence, revealing what was previously hidden. That has made our lives in Government more difficult because transparency always does, and that is no bad thing, but we were right to introduce these changes. In the internet age, transparent information is not only a powerful spur to improvement but a part of what the public expect. Patients need staff to take the time to explain the condition and the treatment options. Citizens need to know what is going on and to be properly involved in collective decisions.

However, it would be foolish to pretend that we have not also introduced more centralisation—more top-down direction and more command and control. We introduced national targets to eradicate the unacceptably long waiting lists. Without those targets, the NHS would not have seen the transformation of services that I described earlier. However, the treatment needed for the NHS then, when the whole system was in intensive care, is not the same as the treatment that it needs now, when it is well on the road to recovery. Of course targets have their limits. With targets, there is always a risk that Governments end up improving only the health care standards that they can measure. Targets can also have adverse effects if they are not properly researched and informed; and the top-down performance management that goes with them leads the NHS to look up to Whitehall rather than outwards to its patients and local communities. That is why we are determined to move away from targets as we transform the NHS from a top-down bureaucracy to a bottom-up, self-improving organisation with power in the hands of patients, their advocates, crucially GPs and other primary care staff, and of course staff themselves.

The heart of the NHS will always depend on effective collaboration by professionals around the needs of patients. That is why we placed a duty of collaboration on all providers in the NHS family. In future, a key measure of the quality of care given by every provider will be not only performance but the partnership established with the rest of the health service. With more than 600 organisations in the NHS, we need to ensure that each patient has a clear path to follow so that they can obtain the right treatment at the right place and time. Primary care trusts have already been given the authority and finance to develop and commission services around local needs, meeting national quality standards without being locked into historical practice.

The Secretary of State mentioned patients having a clear path to follow. Many patients find it difficult these days to find an NHS dentist—a subject that he seems to have avoided. How will access be increased rather than decreased, as has happened so far?

Sadly, I do not have time to go into that subject at the moment, but I assure the hon. Lady that she will have opportunities to raise it in future.

PCTs need to work with their GPs to devolve decision making and ensure that practice-based commissioning transforms services for patients. The NHS now looks very different from the way that it looked 10 years ago. [Hon. Members: “Or 10 months ago.”] Very different from 10 months ago—very different indeed. Like many in the country, I do not believe that the Conservatives’ conversion to the principles of the NHS are credible. I think that my hon. Friend the Member for Grantham and Stamford (Mr. Davies) put it very well recently in his letter to the Leader of the Opposition. Only last month, the Cornerstone group of Tory Members of Parliament published a paper that called for the abolition of a tax-funded national health service. Of course, the party voted against extra investment in health. Its policy of sharing the proceeds of growth means that £21 billion less would be spent on public services this year.

The NHS is safe in the Government’s hands.

On a point of order, Mr. Deputy Speaker. Is it correct that someone can, without foundation, characterise an article in a particular way?

That is not a point of order for the Chair but a matter of continuing debate, which will doubtless be conducted in good spirit.

I was saying that the NHS is safe in the Government’s hands. The Labour party has no equivalent to Cornerstone and, to be fair, neither do the Liberal Democrats. It exists only among Her Majesty’s official Opposition.

As we move into the next phase of transformation, we will have created a modern NHS, in which its traditional values of care, compassion and universality remain enshrined, building the confidence of staff and public alike, so that that precious national asset is preserved for future generations.

I join in welcoming the Secretary of State and the rest of the ministerial team to their new roles. I believe that we all agree that the national health service is so vital that it is important that they do well in their respective roles. The Secretary of State is right to say that there is some history between us. I remember the Employment Bill in the previous Parliament and my role then as Department of Trade and Industry spokesman. He has always been good and courteous to deal with and I wish him well.

The Secretary of State was also right to allude to the state of the NHS in 1997. The proportion of GDP spent on health in 1997 was 6.8 per cent., compared with 9.1 per cent. in the rest of the European Union. That was an enormous gap, which amounted to almost criminal neglect of the health service. The results were clear for all to see. I remember people coming to see me who had to wait three or four years for hip or knee joint operations; the cancer survival rates were appalling compared with other European countries— and so on. The Conservative party has nothing of which to be proud in its record in government. However, the picture that the Secretary of State painted of what has happened since is too rosy, and I want to raise some specific issues. I hope that he will take them seriously and reflect on them, especially the important matter of equitable access to services, which the motion rightly covers.

The motion is broadly uncontroversial—it is pretty much motherhood and apple pie. I am sure that the Government will vote against motherhood and apple pie, but we will support the motion because we agree with its content. Of course, it is easy to make the commitment, but much more difficult to achieve the motion’s objectives. It is crucial to consider the way in which policies and proposals affect and influence the prospects of achieving equitable access. Like the Conservative spokesman, I want to acknowledge the extraordinary role that staff play in the NHS. We are remarkably lucky as a country to have such a dedicated work force, and we all rely on their work. They are a dedicated group of professionals.

Before considering equitable access, I want to highlight a part of the motion about which I am concerned. It is the Conservative proposal in their policy document, which I have read, and in the motion for a shift towards practice-based commissioning. There are limits to the extent to which it is sensible to proceed in that direction. Several organisations have expressed concerns about the impact of too much reliance on that. A couple of years ago, the Sainsbury Centre produced a report on the potential impact of practice-based commissioning on mental health. It stated:

“Plans to allow GPs to commission a wider range of mental health treatments will result in substandard care”.

The report referred especially to the previous fundholding scheme, which operated under the Conservative Government, and the risk of neglect of patients with severe and enduring illnesses. If we are holding a serious debate, it is important that the Conservatives understand and recognise the potential risks of practice-based commissioning.

In June last year, the Audit Commission criticised the Government’s plans for practice-based commissioning. It said that the scheme risked “exacerbating financial pressures”, “widening inequalities” and “wasting money”. Those conclusions were based on where practice-based commissioning had been initiated and appeared to be working well. There are, therefore, concerns about the scheme, and conflicts of interest could arise when GPs can commission services from organisations that they set up.

I appreciate that the hon. Gentleman’s report deals with that, but it is a legitimate concern.

Let me deal with equitable access to services and the related issue of health inequalities. The Secretary of State referred in his deputy leadership campaign to his specific concerns about health inequalities. I therefore know that he genuinely takes that seriously and I hope that the need to reduce inequalities will be a top priority for him. In 2002, the Government made a commitment—with which, I am sure, he is familiar—that by 2010 they would reduce inequalities in health outcomes by 10 per cent., as measured by infant mortality and life expectancy at birth. That is a legitimate direction in which to try to move.

However, this year’s departmental report highlights a shift in the other direction: health inequalities in our country are increasing. On infant mortality, it stated that the gap had widened and that the rate for routine and manual workers was 18 per cent. higher than that for the total population, compared with 13 per cent. in 1997-99. The Department’s statistics for 2001-03 show that among the most affluent, there were 2.9 infant deaths per 1,000 live births compared with 8.9 per 1,000 live births among the poorest members of our community. That is a stark contrast between the life chances of people born in good circumstances and those born in our most disadvantaged communities. I am sure that all Members are concerned about that and we need to find ways to reduce that gap.

The gap in life expectancy has increased, and it has done so most among women. The relative gap among women has increased by 8 per cent.; among men, it has increased by 2 per cent. Again, the Department’s statistics for 2001-03 found that in the best area in the country—east Dorset, for some reason; it is a reasonably affluent area—men could expect to live to the age of 80, whereas in Manchester they could expect to live to the age of 71.8. That is a stark difference, which we should all find unacceptable.

Do those differences have anything to do with the health service or are they all to do with much broader factors? Clearly, many factors such as poverty, deprivation, lifestyle and so on, play a part, but health care is relevant. Let me draw the Secretary of State’s attention to programme budgeting—a new development that the Department has pursued—which enables us to compare areas and consider not only how much is spent on each specialty, but the outcomes in each specialty. We can therefore ascertain the effectiveness of the money in each area of the country. A recent report concluded that there was a clear link between spending and health outcomes. If we commit resources where they are most needed, we can achieve improvements in health and longer life expectancy.

On the same issue of equitable access, I want to deal with access to GPs. In the least deprived PCT areas there are 62.5 GPs per 100,000 of the population, while in the most deprived there are just 54.2 per 100,000. Thus the areas with the greatest health problems have the fewest GPs as a proportion of the population. It is the wrong way around. All that points to a failure of policy—given that the Government highlighted the importance of the matter and set a target for reducing health inequalities in 2002, moving in the opposite direction is unacceptable.

What are the prospects for reversing those trends? I would like briefly to look at the issue of choice. There is a risk, which many people highlight, that increasing choice actually has the effect of accentuating inequalities, the argument being that the middle classes can exploit those opportunities while others cannot. There is a very good report by the Institute for Public Policy Research, called “Equitable Choices for Health”, which highlighted the potential risks. It referred to a pilot in London—the London patient choice project—in which disadvantaged people were given help with transport and given advice by patient care advisers about how best to exercise choice of hospital, treatment and so forth. The conclusion was that the pilot had had a positive impact on reducing inequalities. It had empowered people, particularly those at the bottom end of the income scale.

However, the report also pointed out that when the Government rolled out patient choice nationally, none of those support mechanisms was in place. There was no help with transport and no guidance on how people should exercise choice. The IPPR’s conclusion was that under the Government’s scheme, choice was likely to increase inequality. I hope that the Secretary of State will further examine those conclusions from the research and consider how best to ensure that choice actually empowers the least powerful in society, rather than accentuating differences in health outcomes.

I need to deal with the impact of deficits. The Secretary of State has perhaps arrived at a good moment because his predecessor had a pretty tough year. She made a political commitment to ensure that the NHS as a whole was in balance by the end of the financial year. She achieved that, but there are questions about the price that was paid to do so. The Health Committee drew attention to the fact that in the efforts to clear deficits some serious soft targets were hit. Particular attention was drawn to mental health services, which have been cut back in many parts of the country, including my own county of Norfolk. It is the same with public health programmes. Cutting back on alcohol prevention work, smoking cessation work and other programmes often hits the most disadvantaged people and again has the effect of accentuating inequalities in health outcomes. If the Secretary of State is serious about his commitment to reducing inequalities, those are the sorts of issues with which he needs to deal.

I also want to draw attention to the extent of geographical variation in access to health care—the so-called health care lottery. It is often said that one of the risks of moving towards a more decentralised system—one that I favour—is that we end up with a postcode lottery. Well, the fact is that we already have a postcode lottery with a vengeance under the existing highly centralised system. Another problem is that there is no local accountability to achieve any change. One example of variation in access to services is care of the elderly. There is massive variation in how the criteria are interpreted from one area to another, so that people in one area can get access to free long-term care for the elderly under the NHS, but people in another area cannot. The Secretary of State should also look further into audiology—another example of where the variations are enormous. Hundreds of thousands of people are on a waiting list for digital hearing aids. In some parts of the country, there is no wait at all—the Health Committee looked into that—while in other areas people are waiting two or more years for access to and the fitting of a digital hearing aid. Reassessments for people who have had an analogue hearing aid and who want a digital one can involve a wait of up to 260 weeks—five years.

Macular degeneration—a condition under which people lose their sight—provides yet another example of where people in some parts of the country can get access to the drugs that prevent sufferers from going blind and others cannot. People living in the no-access areas who have money are okay because ultimately, they can pay for the treatment, but people who have no money go blind. It is as simple as that. I would hope that we all find that completely unacceptable, yet it is happening now and it needs to be dealt with. The excuse provided by many PCTs is that they are waiting for a ruling from NICE. In fact, NICE has provided a rather unfavourable ruling, which leads me to question the criteria that it follows.

Variations across the country are enormous. The subject of dentistry and orthodontic waiting times may have been mentioned in an earlier sedentary intervention. The waiting time is enormous in some parts of the country. More general access to NHS dentists is another problem. In some areas, it is almost a thing of the past. Many people moving to a new area can often simply not get access to an NHS dentist.

I understand that the wait for orthodontics for children in Hull—the Secretary of State’s constituency—is now more than 60 weeks.

I am grateful for that intervention and I suspect that the Secretary of State will be aware of that. Waits of that length are unacceptable. There is a genuine and serious debate to be had about how best to use public funds to ensure access to top-quality dental care for those who need it most.

Two or three years ago, the Audit Commission was very critical of the ineffective use of public money to ensure access to NHS care for those who cannot afford the option of going private. The King’s Fund pointed out massive variations in spending on mental health across the country last year, while Sir Liam Donaldson also highlighted concerns about treatment following a heart attack, which varies enormously from one part of the country to another.

I would like briefly to consider the Conservative party proposals set out in their paper. The Conservatives have campaigned vigorously over recent years against reconfigurations, hospital closures and so forth, but I believe that the inevitable consequence of their proposals will be to make reconfigurations and closures more rather than less likely. The critical issue then becomes: who decides, under Conservative policy, if and when a hospital should close? As I have already said, the Conservatives propose a substantial shift of budgets towards practice-based commissioning, very much giving power to GPs rather than to PCTs. They also propose a significant shift towards using the private sector, while their document also endorses, of course, the principle of payment by results. The inevitable consequence will be that some hospitals will become unviable. The Conservative spokesman referred to the importance of care closer to home, which is again likely to make some hospitals unviable.

I would like to see a degree of honesty from Conservative Members on this issue—[Interruption.] The critical issue, as I have said, is who decides to close the hospital. Ultimately, it will be the national NHS board. If and when the system came into force, local people would end up asking why an unaccountable, national, remote quango was closing their local hospital. That is the inevitable consequence of what is being proposed. The board will take decisions, independently of Parliament, to close local hospitals.

I consulted the Library to check that my understanding of the document was correct and it appeared to agree with me. Specific reference was made to paragraph 2.17, which talks about HealthWatch, the new body to safeguard patients’ interests.

It states:

“HealthWatch will have statutory rights to be consulted over decisions which affect how NHS care is provided in an area. It will also be able to make representations to the NHS Board in relation to the planning of NHS services, such as where an Accident and Emergency Department closure is proposed.”

That is remarkable. In a decentralised world—which I thought the Conservatives believed in—we would have the NHS board deciding whether to close an A and E department. That is utterly ridiculous. I can imagine what local people would feel when such a decision was taken by a remote national quango. I do not think that it would be as attractive a proposition in reality as it might seem in theory.

I accept that tough decisions have to be made and that services sometimes have to be reconfigured. We have to ensure that health care is delivered in the safest possible way.

Does the hon. Gentleman share my view that it is far better to have planned reconfiguration of services resulting from a proper discussion on where is the best place to provide them, rather than adopting a practice-based commissioning approach—under which some hospitals might end up doing things that were not necessary and others would inevitably wither on the vine—in a completely unstructured fashion, with almost no control for local people? Surely that would be the greater evil by far.

As I have already outlined in some detail, there is a real risk that, in achieving the result that the Conservatives say they are concerned about, we might lose local hospitals even though they are socially important for delivering care to a particular area, because of the drift of the market following decisions made by GPs. There would be no powerful local body with a role to play in such arrangements. The public would have no say in what happened and, ultimately, it would be the national board that made the decision to close the local A and E unit, for example. I do not think that that would be the right way to proceed.

As I was saying, I accept that tough decisions have to be made, but they should be made locally. This is where I disagree with the Government’s approach. Interestingly, one of the Labour deputy leadership candidates floated the idea of locally elected boards. Even the former Secretary of State floated the idea of elected boards. It was interesting to hear the new Secretary of State, towards the end of his speech, using words that were identical to those in a speech given by the former Secretary of State at the London School of Economics about three weeks ago. Perhaps there will not be too much change of approach. It is interesting that, after all the tough experiences that the former Secretary of State has had, she recognises that there is a democratic deficit that has to be addressed.

The motion also refers to the importance of community hospitals. The hon. Member for Beverley and Holderness (Mr. Stuart) has been prominent in his campaigning for community hospitals and I applaud his work. I have been campaigning in my constituency to protect a number of community hospitals that are under threat. I urge the Government to recognise the value that local communities place on those institutions. There is, perhaps, something rather nebulous about it, but they are seen as very important local institutions.

It is remarkable how much money is raised by local communities for their community hospitals. On Sunday, I took part in the Great London Run to raise money for Wells hospital, which is now run as a charitable trust. That is an interesting development, and one that the former Secretary of State highlighted in Parliament last year when launching the White Paper. The idea of social enterprises of that sort running the local cottage hospital is an attractive proposition that ought to be explored further. If we close those local units, we lose the community involvement, the fundraising effort and the voluntary money that is going into our health service. We also lose a valuable local institution.

The motion rightly draws attention to the importance of choice in maternity services. There is a sense at the moment that the funding of maternity services is unbalanced. We now have a remarkable situation in which 23 per cent. of births involve a caesarean section—

It is now 24 per cent. The World Health Organisation says that when we get beyond about 15 per cent., we achieve no health benefits, yet we are committing enormous resources to caesarean sections for the 24 per cent. of women who give birth in that way. Only 3 per cent. of women give birth at home, compared with about 30 per cent. in Holland. There is something wrong there. That suggests to me that women are not effectively being given a proper, informed choice—

The hon. Gentleman might say that, but the remarkable difference between this country and Holland, where women are given a full opportunity to make a choice, suggests something rather different.

Of course women want choice, but the point that I was trying to make was that they might want to have their babies in midwife-led units, such as the one that is about to be shut down in my constituency.

I do not think that we are in any disagreement. I absolutely agree about the importance of choice—[Interruption.] This argument is not going anywhere. The hon. Gentleman and I agree on the importance of choice in maternity services.

On access to GPs, there are clearly problems with out-of-hours services and with the straitjacket that the Government have placed on GPs’ hours through the contract. There is an urgent need for that to be reviewed. I would be grateful if the Minister would also respond to a concern about independent sector treatment centres. There was a report in the press last week that two proposed new independent sector treatment centres had been cancelled. I would be interested to find out whether that suggests a change of approach, or whether the Government have at last recognised that it is not sensible to impose these private sector treatment centres from the centre. Such decisions should be made locally.

The NHS chief executive’s annual report described

“the biggest reform programme for the largest publicly funded health care system in the world”.

He went on to ask:

“How can you drive this degree and nature of change from the centre? The simple answer is you can’t.”

The former Secretary of State, learning from bitter experience, drew attention to the fact that if the NHS were a country, it would be the 33rd biggest economy in the world. It would be larger, for example, than Romania or Bulgaria, and four times larger than Cuba—and, as she pointed out, “more centralised” than Cuba. It is the fourth largest employer in the world after the Chinese army, Indian Railways and Wal-mart. It is a remarkable organisation, but it cannot continue to exist as such a centrally driven institution.

The former Secretary of State admitted that there was a democratic deficit in health services and, as I mentioned earlier, she floated the idea of locally elected boards. Local accountability and local responsibility are absolutely crucial and provide the best way to secure services that are relevant to the local area, combined with national entitlements for citizens so that they know what to expect from their health service. In his statement today, the Prime Minister talked about devolving power in the delivery of public services. Will that be a reality in the health service? It is badly needed.

Order. There are 51 minutes left before the wind-ups are due to take place. Eight hon. Members are seeking to catch my eye, and Mr. Speaker has placed a 10-minute limit on Back-Bench speeches. I hope that favourable deductions will be concluded.

May I add my congratulations to my right hon. Friend the new Health Secretary on his flying start today? I also offer my best wishes to his new health team in their new roles. May I also add my tribute to the previous Health Secretary, my right hon. Friend the Member for Leicester, West (Ms Hewitt)? I was her Parliamentary Private Secretary for the past 10 months. It was a privilege to serve her. I wish to say so in public, because I have said it to her in private. Her intellect, tenacity and dignity under fire were amazing. She will be remembered for having the courage to tackle the difficult issue of NHS deficits and pulling that off, which many Members on both sides of the House thought that she would not achieve. I hope that she enjoys her time on the Back Benches, but I hope that it will be a limited time.

Access to health care has improved around the country, and in my Swindon constituency. Local plans are under way to improve it still further. The hon. Member for South Cambridgeshire (Mr. Lansley) has once again shown a fondness for picking isolated cases and testimonies, then manipulating and exaggerating them. For example, he mentioned the reorganisation of NHS Direct, and criticised the Government in a sweeping statement for reducing the number of call centres. In fact, that was a patient-led change. People’s habits change, medicine changes and organisations change over time. NHS Direct was reorganised because more people were using the web service, and fewer people were using the telephone service. It was rightly reorganised because people’s habits and demands had changed, and the hon. Gentleman should pay attention to that. His criticisms, both today and in previous Opposition day debates, are empty, and they do not add up to an holistic health policy.

Fay Howard, a councillor and a nurse in my constituency, works at the Great Western hospital, which was built by Labour and opened in 2003. She is part of an NHS team treating more patients more quickly with better outcomes and higher patient satisfaction every year in Swindon. Apart from better access to GPs, accident and emergency services, and emergency care, Fay thinks that Labour’s programme of delivering care at home is crucial, and she gave me powerful anecdotal evidence:

“Some patients arrive with notes of visits and treatments they’ve been having at home which we didn’t used to see. But the big units are still there when people need them, as well as NHS Direct, the walk in centre, the kids day treatment unit”.

Things have changed, because health care has changed and people’s expectations have changed. My constituents expect the best: they also expect choice and appropriate treatment in the most appropriate place, whether that is in a hospital, a GP’s surgery or at home.

On a local level, front-line staff in Swindon are innovating to improve access, and I pay tribute to their hard work and dedication. The Government need to acknowledge that more: we must tell our NHS staff that they are doing a fantastic job, and listen to their views of the improvements and changes that we need to make. Swindon and Marlborough NHS trust is considering setting up a birthing centre to allow women with uncomplicated pregnancies to give birth in a homely environment, cared for by the midwifery team. That obviously improves access, but it also improves patient choice. Our sexual health clinic has developed a patient numbering system to protect anonymity, which encourages people to seek help. It also uses mobile text messaging for patients, which keeps the service anonymous so people return, which is crucial.

The cardiology department launched a new service in May for heart patients who need angioplasties. It carries out procedures under local anaesthetic on 100 patients a year who would otherwise have to travel 50 miles to Bristol. Our radiography waiting times are among the lowest in the country. There is a filmless radiography department—it is all digital. If people transfer to Bristol, their X-ray can be e-mailed to the doctor, which means that there is no waiting. I am pleased that my local health service is listening to patient feedback. People wanted the audiology clinic to extend its opening times; it has done so, and likewise the booking centre. We have been helped by the Department of Health. Last month, it published progress on the 18-week target and everyone in my community was concerned that Swindon was low on the list. I am pleased that an action plan is in place, and that there will be regular consultations with MPs. I hope that the new health team will continue that excellent initiative, because we need to know how well our health service is doing.

As well as acute care, primary care services have provided better access to patients in Swindon. Our walk-in clinic is a local success story, and constituents tell me that it is a great improvement on waiting to see a GP or going to accident and emergency. They have also praised increased pre-emptive care initiatives such as the falls clinic, which helps the elderly both to deal with falls and to prevent them at home, and the Alzheimer’s clinic, which has become well known in Swindon under the leadership of Dr. Bullock. There is therefore increased access, choice and patient satisfaction. From next week, a new Government initiative—the telehealth initiative—goes live in Swindon. It will provide specialist monitoring equipment at home for people with respiratory disease, and is another measure that brings health care closer to home. It is a Labour initiative, and we are proud of it. It helps to explain why, throughout the country, we have 98 per cent. satisfaction rates among patients using the national health service—[Interruption.] The Opposition are heckling me, because they do not want to hear that 98 per cent. of people who use the health service, whether in a Tory, Liberal Democrat or Labour constituency, are satisfied with it. Patients love our local NHS, but they often tell me that the reports they read in the paper suggest that their experience is not the norm. Even though I am biased when it comes to Swindon; I can confirm from my time on the Government’s health team that the NHS is good and improving all over the country, as I am sure we will hear from colleagues.

We in Swindon remember the national headlines about lack of access: 60,000 general and acute beds were lost, waiting lists rose by 400,000, and the total number of hospitals went down under the Tories. They closed our local hospital—the Princess Alexandra—and let our other hospital go to rack and ruin. Then, as now, the Conservative party had no proper strategy for increasing access. It has been my dubious pleasure to listen to every health Opposition day debate for the past 18 months. I have been proud to be on the front line since 2005. The Government will continue—[Interruption.]

I am about to finish, but I am grateful, Mr. Deputy Speaker. The Opposition are chuntering, because they do not like it. The new Parliamentary Private Secretaries, along with other Labour Members, will defend the improvements against the mud slinging from the Opposition.

It is a great pleasure to follow the hon. Member for South Swindon (Anne Snelgrove), who made her points very powerfully. I will help her, I hope, with the points that I want to make.

I should like to concentrate on the final part of the motion on access to NHS services, which urges the House to call

“on the Government to ensure the fair allocation of resources, relative to burden”.

First, however, I pay tribute to the consultants, doctors, nurses and other professionals who work in our health service. They are a tremendous asset to the country, and their dedication, professionalism and care know no bounds. Many nurses and doctors work longer than required to put patient care first, but they are often unrewarded financially for doing so. They are an asset to the country, and were it not for them, the NHS would be in crisis.

Unfortunately, in past years and months, and even in the past few weeks, I have had to attend a number of NHS hospitals across the country. The one thing that all the staff wanted me to say in the House of Commons when they found out that I was a Member of Parliament was that morale is at rock bottom. I did not know before today’s debate that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) had the figures from a survey to prove that, but that was just what they told me. Wherever I was, they said that morale was at rock bottom. When I asked why, they said that the main reason was that the Government set them priorities and targets. They head in that direction for six months, but then the Government change the priorities and targets, and they head off in the opposite direction. They thought that clinical judgment was not appreciated, and was not being used. A very senior consultant—one of the top cancer care specialists in the country—said that the book and choose system has had an adverse effect. He said that part of every surgery must be reserved for people using that system. He said that as a result he sees people who could be seen by a junior doctor rather than people who are seriously ill whom he should see. That is because of direct Government intervention on his clinical judgment.

The hon. Member for South Swindon made a powerful speech about how well things are going in her area and how much extra investment there is. That highlights an aspect of my argument: the situation is not the same across the country. The national capitation formula is supposed to produce fair play across the whole of the NHS, but north Northamptonshire does not get a fair deal. By the Government’s own figures, over the past five years north Northamptonshire has been underfunded by £111 million. If we in north Northamptonshire had £111 million extra, we would not be denying patients access to certain treatments. I want to highlight such patients to give a few examples of what underfunding actually means. I am not trying to claim that the Government do not want to invest; I do not believe that the Government want what is happening to happen, but because of how they have run the NHS—top-down, in a Stalinist manner—it is happening.

A 92-year-old constituent of mine has gone deaf. He currently manages to live on his own, but he cannot make do without a hearing aid. The waiting time to receive a hearing aid for that 92-year-old is 15 months, and yet they can, of course, be bought off the shelf. He has been let down; access to that has been denied him. There is also the case of a lady who needed a hysterectomy. My primary care trust has introduced a minimum five-and-a-half-month wait. When she eventually got into hospital, she was gowned up and had done all the tests when she was told at 5 o’clock in the evening, “Sorry, we can’t do it because the doctor’s run out of hours,” so she had to go back into the queue again.

There is also the issue of cancelled operations. I sat in a mixed ward and witnessed a consultant telling a patient on the other side of the room, “I’m sorry that we had to cancel your operation that was scheduled for six months ago. Unfortunately, your cancer has now got worse and the operation will be much more complicated.” That patient did not survive; he died on the operating table.

Let me give another example of a lady in my constituency who is almost 80 years of age. She went to hospital; it was not the local hospital as there is no hospital in my constituency, so she had to go to one in a neighbouring constituency. She was told that she was going blind and had macular degeneration and that the only way to fix it was to have injections of a drug called Avastin. The consultant told her that it was not available on the NHS but that if she went to the place down the road, she could have it done for £3,300. It is incredible that although we are supposed to have a national health service with access for everyone—and with great facilities in South Swindon—I have a constituent who will go blind unless her family finds £3,300. That cannot be the basis on which to run the NHS. It cannot be right that patients in my constituency can go blind because people in Whitehall will not fund the treatment they need.

I wish to speak briefly about the health care system in Wakefield, which presents a challenge, not least because we have to provide health care for two prisons. We have to provide mental health care, drugs and alcohol support and primary care in a women’s prison, a young offenders institution and in Wakefield prison, which is high security. A remote electrocardiogram system is now in place in Wakefield prison so that prisoners who might be having a heart attack can be remotely assessed by hospital clinicians, thereby avoiding the security risks involved in transporting prisoners to and from hospital, such as opportunities for escape.

According to the latest statistics, Wakefield has a positive first set of figures for the number of people waiting no more than 18 weeks to receive their treatment. At my local hospital, Pinderfields general hospital, 54 per cent. of patients received their treatment within 18 weeks. In a specialty such as gastroenterology, the proportion was more than 90 per cent. and in cardiology it was more than 70 per cent. Therefore, it is clear that targets are driving down waiting times, and it is vital that we keep them in order to improve patient care. Nationally, targets have resulted in 50,000 extra lives being saved from cancer and 150,000 lives saved from heart disease. That is also linked to our target to treat people in accident and emergency units within four hours. Anybody who had to wait in an accident and emergency unit 10 or 15 years ago with a sick child, a relative or a friend in pain, wondering when they were going to be seen—as many Members must have done—will welcome that maximum four-hour waiting target. It simply did not exist 10 years ago.

I also wish to address accessibility to GP surgeries for people in wheelchairs and those with sight and mobility problems. Last year, I visited Kirkburton health centre in my constituency. It has a fantastic new centre, which was built under the LIFT—local improvement finance trust—scheme. It is fully compliant with disability and discrimination legislation, unlike some of the terraced housing that was all too prevalent under the Conservative years of NHS underfunding.

In Wakefield we have had a problem with access to dental surgeries. I am delighted that that has been greatly relieved by the opening of a new dental practice in Queen street, which last year took on 8,000 new patients and is this year due to take on another 8,000 patients—a total of 16,000 people, most of them my constituents, who have never had access to dental care, or who have not had that for many years. I visited the surgery on Friday; goodie bags were being given to children, containing little toothbrushes that could stand up, little balloons that carried the message,

“Twice a day for two minutes”,

and a special egg-timer—because we all know that it is not just about encouraging children to brush their teeth, but encouraging them to do so for a considerable period of time and many young children do not have the patience to do that. Wakefield is seeing its share of the £400 million national investment in dentistry.

Like other areas, our local primary care trust has been underfunded. However, I am delighted that no PCT will be more than 3.7 per cent. below its target by the end of this financial year. There have been huge real-terms cash increases for our PCT, and in terms of our secondary and acute sector it was announced today—the celebrations are taking place—that Mid Yorkshire Hospitals NHS Trust’s £340 million private finance initiative to build new hospitals on the Pinderfield and Pontefract sites has been signed, sealed and delivered. I pay tribute to John Parkes, the former chief executive, Julia Squire, the current chief executive and Sir Hugh Sykes, the chair of the trust board, for reducing the in-year deficit of one of our hospitals from £30 million two years ago to £13 million this year. The projection is that balance will be achieved by October this year.

I am also delighted that we have finally got £1 million transferred from the PCT to the acute hospitals to improve the hearing aid services for my constituents. My constituency is in an old industrial area where many people were involved in mining and there is a clear link between such heavy industry and drilling activities and hearing loss. As for the rhetoric about digital hearing aids, may I say, as a former hearing aid user, that people suffering hearing loss are not necessarily always best served by a digital hearing aid? Analogue hearing aids can provide required levels of volume and clarity without the long waits that are associated with the fitting of new digital hearing aids.

To pick up on the points made by the hon. Member for North Norfolk (Norman Lamb), there are health inequality issues in Wakefield. People in my constituency live on average one year less than the national average life expectancy and seven years less than those with the highest life expectancy in Britain. Some 25 per cent. of the adult population are obese and we need to look at placing a statutory duty on primary care trusts to reduce those types of health inequalities.

In terms of access to health care, the new NHS choices website that was launched a couple of weeks ago provides patients with a great deal of information about what their local hospitals provide. For example, pregnant women in my constituency can look up Pontefract general infirmary and see vital information such as the number of women who knew their midwife in labour—in Pontefract it was 45 per cent. compared to an average of 22 per cent. They can also see if their local hospital has a neonatal intensive care unit or a special care baby unit, or a dedicated obstetric anaesthetist, which is related to my earlier intervention about waiting for an epidural. Crucially, women can discover whether, post-birth, they will have access to breastfeeding support—something that every mother would like to know. As we roll out choice and achieve greater transparency, we will see waiting lists and times coming down further.

The Conservatives will the ends but not the means when it comes to health care access. They voted against the national insurance increase that saw a huge cash injection for the NHS. They talk about abolishing targets that have been crucial in driving down waiting lists and tackling the scourge of hospital-acquired infections. I am delighted that the hon. Member for Wellingborough (Mr. Bone) is in his place. He did not mention his Cornerstone document, although some of the case studies that he mentioned came from it. He wants people to take out health insurance to cover all their family’s medical expenses. That would be

“set at a level to cover all your family’s medical expenses greater than 5 per cent. of your family’s income.”

That challenging new system would

“cover all serious medical conditions which could require significant costs.”

But the real driver of the document is in this sentence:

“An added bonus of this shift in policy would be a massive cut in taxation without penalising public services.”

The second part of that sentence is highly debatable. As in so many instances, the Conservatives offer warm words, but lying beneath them is cold comfort for families and patients in my constituency. We need to put our money where our mouth is, invest in the modern facilities that people deserve, and ensure that our NHS is safe as it approaches its 60th birthday and safe for the next 60 years.

Geography is not convenient: the Horton general hospital in my constituency serves a large part of north and west Oxfordshire, south Warwickshire and south Northamptonshire. It has been a general hospital for more than 100 years, but it is now facing the prospect of a serious downgrading of hospital services, including the removal of 24/7 paediatric care.

That level of paediatric care at Horton came about because of the death of a child. In 1974, Barbara Castle, then Secretary of State for Health, ordered an independent public inquiry, which ruled that there should be 24/7 paediatric care at the Horton. As a consequence of losing that care, we have the prospect of losing the special care baby unit and consultant-led obstetric and midwife maternity services.

When the Oxford Radcliffe NHS trust made those proposals, 86 GPs made a joint statement saying that they were unsafe and inhumane. As a consequence, the trust took its proposals off the table and set up two clinical working groups, which—slightly bizarrely—met and worked in secret. Many of us thought that their purpose was to wear down GP opposition to the proposals. Indeed, several GPs now say that although they are very unhappy about what is proposed, they consider it to be—and we should take note of this sentence’s construction—the least worst option. I do not want an NHS in my constituency that is the least worst option. Nor do I believe that Ministers want that.

The trust also set up a stakeholders’ group, with many members, including Labour councillors Surinder Dhesi, George Parish and Dr. Peter Fisher, who for many years was a consultant physician at the Horton and a Labour county councillor. The group has published a unanimous report, a bit like a Select Committee report, in which it expresses concerns. It says that

“health services must be designed in the best interests of patients and education and training should support that objective. Instead in Oxfordshire and other parts of England educational concerns are leading decisions about the pattern of healthcare with patient needs coming second. The position in maternity services is particularly acute as we understand that many more units across the country may be threatened by these changes to medical education and working hours.”

The group request that the trust

“raise this matter at a national level”.

I am glad that I have the opportunity to do so in the House today.

The group’s document also states that

“instead of being asked to consider a positive vision for the future we have found ourselves being asked to choose between the lesser of two evils—on the one hand there are the clinical risks inherent in the current service arrangements; on the other there are the proposals that by addressing the clinical risk will worsen access to services for local people. Both ‘evils’ are being driven by national policy changes which should be challenged…None of us believe that they”—

the changes—

“are desirable.”

I have two questions for Ministers. First, how are any of us to explain to people that a substantial downgrading of NHS services is an improvement? I would welcome any Minister who wished to come to Banbury for a rational debate—this is not a partisan issue. As I say, the chair of the “Keep the Horton General” campaign is a Labour district councillor and the campaign has broad support across the community. How can we explain that we are going back to pre-Barbara Castle days and that that is in some way an improvement?

My second question is what will Ministers do to protect smaller general hospitals, or are they content to see them downgraded? The stakeholder group concluded:

“The proposals that the clinical working groups have put forward may be a ‘least worst’ scenario but they represent a significant downgrading of access to services and a worsening of choice for women and children in the Banbury area.”

I cannot imagine that Ministers, or anyone, want to see a downgrading of access to the NHS for women and children.

Ministers should be concerned, because the Oxford Radcliffe trust seemed to suggest that the Royal College of Obstetricians and Gynaecologists had said that a maternity unit is not viable unless it has 2,500 births a year. The group points out that the college’s document, “Safer Childbirth: Minimum Standards for Service Provision and Care in Labour”, published in November 2006, actually says that units such as the Horton with fewer than 2,500 births should

“continually review staffing to ensure it is adequate based on local needs”.

The group comments:

“This does not seem to be saying that 2,500 is the minimum figure for births in an obstetric-led unit. Rather it seems to suggest that fewer hours consultant support would be required for this number of babies and that staffing levels should be determined locally.”

I would hope that Ministers would feel able to try to work out how health care provision in smaller general hospitals can be protected.

Sir Ian Kennedy, the chairman of the Healthcare Commission, in a recent speech, observed that

“it is terribly important that services and particularly maternity services, in the light of recent proposals from government and professional groups, keep their eye on the ball of safety as they go through the forthcoming period of change and development.”

I do not believe that making expectant mothers travel 26 miles, or more than an hour, to Oxford will necessarily enhance safety.

I hope that Ministers will hear what I have said and accept that it was not intended to be a partisan speech. Instead, I was making a genuine plea that they get a grip on what is happening in the NHS. They need to find ways to protect the services provided by smaller general hospitals, because people do not accept that the substantial downgrading of services in NHS hospitals is a way to improve the health service.

I wholeheartedly agree with a number of the ideas that have been thrown around this afternoon. First, it would be excellent to have elections to the boards of NHS hospital trusts, and the introduction of such elections would be thoroughly consistent with the spirit of the Prime Minister’s announcement this afternoon.

Secondly, I very much agree with what has been said about macular degeneration. It is a real problem, and the fact that some PCTs ration treatments for it is a disgrace. We are talking not about a condition that causes minor discomfort but about an illness that affects a person’s sight—a faculty that is desperately important to everyone. Under no circumstances should PCTs try to save money in that way; indeed, almost any other health programme would provide a better vehicle for saving money.

We have very little time, so I shall make only two, connected points. First, there has obviously been the most astonishing turnaround in the NHS over recent years. It would be churlish and an example of bad faith to deny that—

No, there is no time. I am sorry, but the hon. Gentleman must understand that.

The figures are amazing. There is no doubt that a lot of credit for that attaches to my right hon. Friend the Member for Leicester, West (Ms Hewitt), and I am very glad that my hon. Friend the Member for South Swindon (Anne Snelgrove) said what she did in that respect. It does not make much sense to talk about waiting lists: having 1.2 million people, say, wait a month for some form of elective treatment would be reasonable, in fact desirable, but it would be totally unacceptable to have 100,000 waiting for a year.

Instead, we must talk about average and maximum waiting times, They have been falling dramatically, and I hope that we will achieve the 18-week target this year. In addition, it is remarkable and very gratifying that we have achieved the target of ensuring that urgent cancer cases go from identification of symptoms and diagnosis to treatment in a maximum of two weeks. That is an absolutely vital achievement.

My second, related point, is that we would not have secured those improvements without targets. There is an enormous amount of confusion among my former hon. Friends in the Opposition about that. Indeed, it may be worse than confusion—perhaps there is an element of opportunism in their approach. At present, the Government are having a row with the health service unions, so Opposition Members ask themselves why they should not curry some short-term favour with the unions by promising them something. It does not matter how irresponsible the promise might be, so why not promise to get rid of targets in the NHS?

I am sorry to voice such suspicions, but that is the pattern of the Opposition’s behaviour over the past few months. It is deeply depressing, and needs to be exposed. Perhaps my exposure of their approach will make my former colleagues on the other side of the House think twice before they go in for a kind of politics that I deplore.

Of course I cannot, as we do not have time. The hon. Gentleman must understand that.

It follows that we must be very cautious about getting rid of targets. There may be too many of them, and some of them may be the wrong ones, but the new Administration gives us a good opportunity to look through them again. All targets risk having perverse consequences: when they do, they should be looked at again and either revised or strengthened. However, very stern measures should be taken when targets are abused.

One hears stories—I have no idea whether they are true—about accident and emergency departments keeping people in ambulances on the hospital forecourt so that they do not miss their four-hour target. People who do that are in breach of the fundamental Hippocratic principles according to which they are supposed to work. The whole point is that the spirit of those principles is important, because it means that people in the medical profession should always put the patient’s interest first, maintain the highest standards of professional behaviour and be attached to medicine’s scientific principles. Those principles are non-negotiable. They are deeply ingrained in every self-respecting doctor or nurse, and anyone who abuses them in the way that I described should be sacked. It is as simple as that.

Nevertheless, I share the view that many hon. Members have set out—that it would be splendid if we could provide a reasonable set of outcomes and outputs from the health service using only market disciplines—but that is never possible. Of course I want liberalisation of the supply side in health, especially in the secondary sector, and there is more that we can do to bring in the private sector in certain circumstances. The competition in central London between large general hospitals is a good thing and should be encouraged.

Of course we want patient choice too, but it is utterly delusory to think that the health service could be run according to market principles and mechanisms alone and still do the job for the country that it was designed to do in 1948—and which I hope it will continue to do for at least another 60 years, or even longer.

I am sorry, I have no time. The hon. Gentleman will have his chance in a moment. I always give way with pleasure in this House—[Interruption.]

Order. The hon. Gentleman has indicated that he will not give way at this stage.

The Opposition are merely attempting to disrupt my speech, Mr. Deputy Speaker. Their actions are childish, given that there is an agreement between the Whips that we should all try to limit our remarks so as to get as many people in as possible. I certainly intend to observe that request.

Where possible, I want the amount of competition and patient choice to be increased substantially, but there can never be redundancy, duplication or competition in disciplines such as neurosurgery, intensive care or ophthalmic surgery, for example. We have a choice with them, and one option would be to leave the producers to deliver what they want when and how they want, but that is never acceptable. If health producers are subject to no discipline or no counterbalance to their own inclinations, it is tantamount to our saying that we cannot influence the monopoly, which must be left to deliver whatever it wants to deliver. To say that would be an abdication of the responsibility that Parliament assumed when the National Health Service Act 1946 came into force in 1948. It is a hopeless way forward, and I am very sorry that my former hon. Friends in the Opposition have gone down that road, possibly for totally the wrong reasons.

I want to give the House another example. The Medical Training Application Service was a debacle because there was too much producer orientation. Ministers set up a quango and then declined to second-guess its results. I understand that it is difficult for a Minister to second-guess senior consultants and the people running the royal colleges, but it is clear in retrospect that that is what should have happened. Unfortunately, however, the senior doctors were influenced by their own interests: they thought that spending so much time interviewing junior doctors was boring, and that it would be a thoroughly good thing to allow a computer to do all that. That is an example of how producer orientation and monopoly power can go wrong—in medicine, as in other areas of human activity.

We set up the health service, and we in this House are proud if it. We have the responsibility to make sure that it produces the outcomes and outputs that the public demand and require, which means that rules and targets must continue to be imposed from the centre.

It is interesting to find myself following the hon. Member for Grantham and Stamford (Mr. Davies), especially given that, in his election address of just two years ago, he said:

“The Health Service is in many ways worse. Average hospital waiting times (the key measure) have increased from 90 to 95 days and deaths from diseases caught in hospital have more than doubled. The GP service has been run down. NHS dentistry has all but disappeared.”

The hon. Gentleman’s new friends may be interested to hear all that, but my hon. Friends and I know that personal slights and slighted vanity count for more with him than does fighting for the NHS. That is the central priority of the Conservative party, under its current excellent leadership.

Does my hon. Friend agree that the election address to which he referred has more to say? It goes on:

“The country deserves better. Can a Conservative Government provide it? I believe we can”.

I think that we have dealt with the hon. Gentleman fully.

Like many other hon. Members I should like to welcome the new health ministerial team. Before today, I thought that the new Health Secretary and his Ministers would offer new hope to the Department—at least compared with their predecessors, who left NHS staff and patients both demoralised and discontented. I hope that Ministers will learn from that history and perhaps show greater humility, given the recent record, than the Secretary of State showed today. He said that the former Secretary of State carried more political nous or ability than I had in the end of my finger. That is about my assessment: I think that she has got more ability than I have in the end of my small finger.

The hon. Member for Wakefield (Mary Creagh) said that we needed targets. She is absolutely wedded to targets. I am glad to say that the Secretary of State has taken a lesson from the consistent, hard-working and excellent Conservative Front-Bench team on the need to get rid of targets and has said that he will move away from targets. The hon. Member for Wakefield may resist that, but I am glad that there was one bright spark in the speech of the new Secretary of State.

In the few minutes that I have, I want to talk about community hospitals. When I came to this place, I found that hon. Members across the House had problems with community hospitals. I see some of them here this evening on the Labour Benches. Vital services were threatened with cuts or closure, so in November 2005 I formed community hospitals acting nationally together—CHANT—a cross-party group supported by Liberal Democrat, Labour, Conservative and Independent Members and patrons from both Houses of Parliament. I am not sure whether the hon. Member for Grantham and Stamford is a supporter or not. CHANT has fought to raise the issue of community hospitals in this House. We were delighted by the Government’s White Paper, which suggested that at last community hospitals were going to be saved.

When CHANT was established in November 2005, about 80 community hospitals were threatened with cuts or closure. That number, according to the Community Hospitals Association, is now more than 166. Across the country, especially in rural communities, we have seen services cut. In my local area, we have seen the 24-hour minor injuries unit service at Withernsea hospital cut to day times only. We have seen constant battles by the whole community, on a cross-party basis, as my hon. Friends, who have not been seeking to make partisan points, have pointed out. Proposals were put forward at one stage to close every bed in Hornsea cottage hospital on some spurious urgency grounds. That had to be resisted by the threat of going to court, which led to the trust backing down.

Then the primary care trust came forward with proposals that would have seen every NHS bed closed in my constituency—beds in Withernsea, which is a highly deprived, isolated community, Hornsea and Beverley as well as Driffield. The plan was that the only NHS beds to replace those closed beds would be in Goole and Bridlington—a four-hour round trip. Who knows how long it would take by public transport for the typical elderly patient and their spouse if they had to get to those hospitals? The community came together as one. The one benefit of the consultation was the way in which it brought the community together. They were united in opposition to the plan, as people have been in so many other parts of the country.

In fact, 3,500 submissions were made to the PCT. It was overwhelmed and had to delay its response. Tens of thousands of people signed petitions. I am pleased to say that every Member of Parliament in the East Riding of Yorkshire and the leaders of the Labour party, the Liberal Democrats, the Independents and the Conservatives on East Riding of Yorkshire council jointly signed a letter to the PCT board saying that it must stop the attack on vital services. I am pleased to relate that that did have an impact, such was the opposition. The trust has recognised the need to maintain beds in Beverley, which is a major step forward, and Withernsea. It has not saved any beds in Hornsea, although I hope still that there will be an opportunity for us to keep some beds in what I believe is the largest town in England that does not have an A road to it. It has B roads, which are all too often blocked by traffic in the summer. Local people need local services in that sparsely populated rural community. They should not be judged on the same basis as a unit in the centre of a city.

I congratulate the whole community, the newspapers, and the television stations. The Hull Daily Mail, the Holderness Gazette and the Beverley Guardian worked on the campaign. Political parties, voluntary groups and others came together and fought the decision, and the PCT was made to listen. However, we are losing beds in Hornsea and there is a pattern of such closures across the country. I hope that the new ministerial team will look again at the White Paper and send out messages from the centre that community hospitals will be supported.

There has been chaos in the way in which the Department has responded. Fortunately, there was a major effort in the House to put pressure on Ministers in the previous Administration. There was a response last summer from the previous Secretary of State; she announced £750 million of capital funding for community hospitals. That was supposed to be a five-year programme. Perhaps I may ask the new Minister of State to investigate the programme. My PCT was told by the strategic health authority with only a few weeks’ notice that it had to pull forward and get its bids in by the end of June—now postponed to the end of July. Yet it was supposed to be a five-year programme with full consultation. I ask the Minister to look again at community hospitals and ensure that the vision laid out in the White Paper, which had support across the House, can be delivered on the ground. Too often, Government rhetoric has not been matched by the reality that local constituents have had to put up with.

I have four minutes to bring to the attention of the new Ministers, whom I welcome, some practical suggestions. I have the amazing opportunity to bring together what the Secretary of State and the hon. Member for South Cambridgeshire (Mr. Lansley) said. The Secretary of State said that each patient must have a clear path to follow. The hon. Member for South Cambridgeshire pointed out the confusion about the path to follow for access to emergency care. That is what I want to talk about.

Ordinary patients have at least eight options for access to emergency care. They can dial 999; they can walk into an A and E department, a minor injuries unit or a walk-in centre; they can contact their GP if it is during the one third of the week when he or she is on duty; they can telephone the GP out-of-hours service; they can phone NHS Direct; or they can drop into a primary care out-of-hours centre. People are confused. Emergency access has to be clarified, and it is easy to clarify it. There must be just two options—go to the A and E if there happens to be one, or use a single telephone number.

If only the telephone triage service could be rationalised so that there was one number for everyone to phone across the country and a standardised triage system at the end of the phone, we would sort out the problems of access to emergency care in a moment. The huge point is that the Department of Health has the means to do that. I urge the Minister to look at NHS pathways, which has defined exactly the standard questionnaire that can sort out anybody. I tested it on a small boy who, sadly, died in my constituency as a result of inadequate triage. After about the fourth question, NHS pathways would have picked up the fact that the little boy needed to be admitted to hospital. I plead with Ministers to look at NHS pathways. It is being piloted in the north-east by the ambulance service there, which is to report in September 2007. It is being piloted in Croydon by the out-of-hours service, which is also to report in September 2007. The results are expected to show tremendous success and benefit.

I believe that NHS Direct should be limited to giving advice to patients about illnesses, and should not give advice on access to emergency care. Ministers should look at NHS pathways seriously to see why it cannot be rolled out to cover the whole country. It would have huge benefits, solve the problems with NHS Direct and release nurses to nurse, because the triage is so organised that it can be done by trained lay people. I urge the Minister to make it a high priority to create only two options for emergency care—A and E or a single phone number connected to NHS pathways.

I welcome the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), to his new responsibilities and I look forward to our exchanges at the Dispatch Box. I am sure that he will soon realise that nothing is more important to our constituents than their security and their health, so, in view of the values of the doctors’ pledge—the Hippocratic oath—it is poignant that we are meeting as we learn of the doctor arrested in Brisbane, Australia, who had worked in a hospital in my home and constituency county, treating my constituents and those in neighbouring constituencies.

We have had a good, wide-ranging debate, throughout which Conservative Members have defended the NHS from the ravages and ramifications of the Government’s poor planning and the even worse implementation of their top-down targets. The Secretary of State, who has just returned to the Chamber, had a prize opportunity to steal our clothes, but instead he dug in and defended everything done by his predecessor, who of course paid the ultimate political price for just that.

As we have said before, we remain concerned that the Government’s basis for their NHS policy decisions is a desperate scrabble for cash rather than a focus on the health outcomes for the people of our country. The hard-working staff of the NHS, to whom we all pay tribute, deserve far greater support than they are receiving from the Government, so we have presented the new Prime Minister’s team with a copy of our “NHS Autonomy and Accountability” white paper. Although the Prime Minister seemed to distance himself from the idea of taking politics out of the NHS in the closing days of his non-campaign, at the weekend he told the News of the World that he would be pursuing our policy. Clearly, he has found “all the talents” for NHS policy in the Conservative white paper.

Ultimately, whatever specific issues we have debated today, the future of fair access to our NHS services lies in the autonomy of the NHS to make decisions based on clinical, not political, criteria, and its accountability to the House and to the public and patients who use it every day. The case was made fairly and forcefully by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), supported by an excellent and powerful speech from my hon. Friend the Member for Wellingborough (Mr. Bone). In addition, I pray in aid the following quotation:

“The NHS was the creation of all three parties. Its fundamental principles have never been under greater threat.”

Those words appeared recently on the website of none other than the hon. Member for Grantham and Stamford (Mr. Davies).

My right hon. Friend the Leader of the Opposition has constantly confirmed our commitment that the NHS is our No. 1 priority, and that under an incoming Conservative Government it will continue to be a public service free at the point of need, with access based on need, not on ability to pay. I hope that even at this late hour the Government will support that part of our motion—interestingly, their amendment would delete that crucial overriding principle and value without repeating it or replacing it with words of their own. What do they mean by that?

Last December, when he was a Health Minister, the new Chief Secretary to the Treasury undertook the Government’s consultation on the core principles of the NHS, which we have committed to enshrining in legislation. In that consultation, the Government omitted the principle that

“public funds for healthcare will be devoted solely to NHS patients”.

What do they mean by that? Perhaps the new Minister will tell us whether he still wants to get rid of that central pillar of the NHS.

Amidst the various disasters that befell the NHS on the watch of the right hon. Member for Leicester, West (Ms Hewitt), the negotiation of the new GP contract will be remembered as one of her biggest political tombstones. The cost was over £250 million more than the Government had originally intended, for a service that had been slated by the National Audit Office—[Interruption.] I am happy to take all bids for admission of failure.

What does the Minister intend to do about those costs? As the motion makes clear, our recommendation is that practice-based commissioning be developed to provide greater incentives for the integration of GP services with out-of-hours care. I hope that the Minister will not be tempted to repeat the point that 96 per cent. of practices have taken up practice-based commissioning. As I have discovered through parliamentary questions, his Department only counts GP practices that take up component 1 of the PBC incentive payment, which is, in effect, free money: 95p per registered patient if the practice submits a plan on how it intends to deliver direct enhanced services. The practice receives that money whether or not it delivers on the plan. Component 2 of the payment is made available when it actually delivers, so I was not surprised to discover that information about the take-up of PBC is collected only at primary care trust level. Will the Minister tell us what percentage of GP practices have taken up component 2?

We also recommend the use of PBC to integrate urgent care. Will the Minister give us the timetable for publication of the urgent care strategy? The White Paper, “Our health, our care, our say” promised:

“During 2006 we will develop an urgent care strategy for the NHS.”

However, we are halfway through 2007 and all we have from Ministers is a commitment to publish “in due course”. We also await the review of walk-in centres and the patient access survey results. As regards the former, a year ago last month, according to the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis)—who has not returned to the Chamber:

“The matters are still under consideration.”—[Official Report, 13 June 2006; Vol. 447, c. 1161W.]

What is the hold-up? Perhaps the answer is in the new Minister’s in-tray, or walk-in tray, or his kick-it-into-the-long-grass tray. Who knows?

My hon. Friend the Member for Beverley and Holderness (Mr. Stuart), who has been a tireless campaigner on behalf of community hospitals, made a justifiably impassioned late contribution on the subject. Since 1999, more than 3,000 community hospital beds have been lost, 27 hospitals have experienced closures and 139 are under threat. Only £50 million of the £750 million community fund budget announced last summer has actually been allocated to community hospitals, with a further £50 million to polyclinics. Moreover, the Government have dropped their 2005 election manifesto pledge to build or refurbish 50 community hospitals. When will the Minister start defending community hospitals, which are the key to delivering care closer to home?

We have heard from Members on both sides of the House who face the threat of closure of their local accident and emergency departments. In April, when questioned by my hon. Friend the Member for South Cambridgeshire, the former Secretary of State refused to say whether she endorsed or rejected the Department of Health guidance on the subject. Will the new Minister tell us what he thinks? I caution him that if he accepts the Department’s guidance

“that to be viable, a full A&E Department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people”—

a claim for which we have seen no evidence, but which is being prayed in aid by strategic health authorities hoping to close A and E departments—he will be condemning 92 of England’s 204 A and E departments to closure, as was highlighted in an intervention about Haywards Heath by my hon. Friend the Member for Mid-Sussex (Mr. Soames).

Mothers-to-be in England might take heart from the elevation under the new regime of Government campaigners for maternity services. The new Secretary of State for Communities and Local Government is protesting against the closure of maternity services at Hope hospital in Salford. The new Home Secretary is protesting against closures at the Alexandra hospital in Redditch. Mothers-to-be will be pleased to hear that the Under-Secretary, who is still not in the Chamber, and who protested against the closure of maternity services at Fairfield hospital in Bury, is the only Health Minister from the previous line-up to keep his job.

Unfortunately, what the hon. Gentleman does in his constituency seems to bear no relation to the policies he signs off at Westminster. We have repeatedly asked for clinical evidence for reconfigurations of maternity services. The report failed to provide it and the hon. Gentleman confirmed that the necessary research will not be concluded until 31 August 2009, yet the mad march of threatened closures continues—such as the closure at Horton, as has been repeatedly and ably pointed out by my hon. Friend the Member for Banbury (Tony Baldry). Sixty per cent. of those services are operated by providers that finished the 2005-06 financial year in deficit, and 65 per cent. of them are situated in parliamentary constituencies held by Opposition MPs.

It is depressing that yet again the choose and book statistics have been run out. As long as a person has made just one phone call, even if it is completely useless, it is counted in the 85 per cent. “successful use” figure.

In the spirit of consensus building so beloved of the new Prime Minister, we have today taken a constructive approach and offered a positive way forward, but neither in their motion or in the debate have the Government attempted to answer any of our points. Perhaps the Minister, who is fresh from ducking the issues on badgers and controlling the spread of bovine TB, can set a new example of Government transparency when he speaks. Spending is not the same as delivering.

Surely now that the clunking fist of the ex-Chancellor has grasped power, the Government should recognise that there is a large elephant in the room, which is, as they say in the motion, their suggestion that the staff and the medical profession have worked hard to deliver the Government’s targets. No—they have worked hard to deliver better patient care and they have done so by working not necessarily with and for the Government, but often despite the Government who have set the top-down targets. That is why we need a new freedom of access and free access that is equitable across the country. I ask my hon. Friends on the Opposition Benches, and perhaps some good-thinking friends on the Government side, to support the motion.

This has been a mainly good debate and many important points have been raised. I acknowledge the warm welcome that Members on both sides have given to the new team on the Government Front Bench.

The health service we inherited in 1997 was starved of essential funding. Every winter heralded a new crisis, cancer death rates were going up, waiting lists topped 1 million, there was a shortage of beds, patients were left on trolleys in A and E for hours, and half of all hospital buildings had been built before 1948. Ten years on, the position is transformed thanks to greater investment, difficult but necessary system reform and, above all, the tremendous work of those who work in the NHS.

As recent successive independent surveys have shown, patient appreciation of the health service is at record levels. The Healthcare Commission survey, in line with previous years, showed that more than nine in 10 people rate their care as excellent, very good or good. The recent Commonwealth Fund survey of international rankings looked at the health services of the UK, Australia, Canada, Germany, New Zealand and the United States against health system indicators of quality, equity, healthy lives, access and efficiency and it placed the UK first, an increase of two places since 2006.

Certainly not. I very much regret that not all Back Benchers were able to contribute to the debate because the Opposition went on for too long. I will not give way in the 10 minutes that I have left to respond to the very important points that Back Benchers have made.

The Government accept that the transition that we have put through since 1997 has been delivered at some cost to staff engagement and some measure of public confidence. Those who use the NHS testify in ever greater numbers to its excellent treatment and improved resources, but the public as a whole are not yet persuaded. Deficits in some health trusts place unwanted additional strain on hard-working NHS staff.

I now come to some of the points that have been made in the debate. The hon. Member for North Norfolk (Norman Lamb) was absolutely right when he said that health inequalities remain a major challenge. Access to GPs, for example, differs widely even within regions of the country. In the north-east, there are 133 per 100,000 of population in Northumberland compared with 25 per 100,000 in neighbouring Redcar and Cleveland. He is right to say that we have more to do on that, and we are doing so through the fairness in primary care procurement. We have been working with the 30 primary care trusts with the fewest GPs for their populations, and contracts with new providers should improve access to services for thousands of people living in those areas. Advertisements for the initial four—Hartlepool, Nottinghamshire County Teaching, County Durham, and Yarmouth and Waveney—were placed in April. Advertisements for a further six PCTs were published for Ashton, Leigh and Wigan, Bolton, East Lancashire, Luton Teaching, Manchester and Trafford.

The hon. Gentleman is also right to point to the problems that we still face in audiology. We acknowledge that waits for hearing aids are still too long and we published a framework for tackling the problem in May. The Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), will publish the Government’s response to the Health Committee’s recent report shortly.

I can reassure the hon. Gentleman that there will be no change in the Government’s approach to independent sector treatment centres, and he is also right to say that challenges remain in orthodontics. As he will know, the old system led to huge variations in the provision of orthodontic services, because orthodontists could decide for themselves where to set up practice and how much work to do for the NHS. Last year’s reforms will address that issue, but I have to point out that the NHS spends more on orthodontic services per head of population than any other state-funded system in the world.

The hon. Member for Romsey (Sandra Gidley) said that she thought that the provision of dentistry was getting worse. That is not the case. NHS dentistry is expanding nationally. PCTs are now commissioning more dental services than the year before the reforms, and in March 2007 there were more than 21,000 dentists on NHS lists, an increase of 4,000 since 1997.

Most of the points made by Conservative Members seemed to focus on the configuration of hospital services, and community hospitals and community services in particular. The configuration of hospital services must be a matter for the local national health service. We do not believe that it is central Government’s role to micro-manage every local health economy. As my hon. Friends the Members for Wakefield (Mary Creagh) and for South Swindon (Anne Snelgrove) and my new hon. Friend the Member for Grantham and Stamford (Mr. Davies), in an excellent contribution, made absolutely clear, reconfiguration in their constituencies has led to considerable benefits in terms of health service provision.

As the hon. Member for North Norfolk pointed out, the implications of the Conservative party’s policy are more closures of community hospitals being decided not at local level but by a national quango. That is not the route that we intend to go down. Far from closing hospitals, this Government have delivered the biggest hospital-building programme ever, with 109 new hospitals open or under construction since 1997. The reconfigurations are taking place because doctors are telling us that specialist care needs to be concentrated in centres of excellence so that clinicians with the right expertise, experience and equipment can treat the sickest patients safely and conveniently.

Conservative Members also asked what the Government’s approach to targets would be and how many targets we have got rid of. My information is that targets have reduced in number over the past three strategic reviews from 108 to 20. The 18-week wait is the only remaining target when it comes to access.

We were presented with a paper by the official Opposition and, as my right hon. Friend the Secretary of State said, we will take a look at it. On the face of it, either the things that they are proposing are already under way, or we do not believe that they are necessary to achieve the improvements that we all want. As the hon. Member for Wellingborough (Mr. Bone) acknowledged in the Cornerstone paper, a large bulk of the Conservative party want private health insurance to pay for tax cuts.

As we move to the next phase of the NHS transformation, we agree that there should be much greater focus not on top-down reforms, but on stimulating change among patients and practitioners. The policy framework that we set out will be right only if the views of staff and patients are properly incorporated. A modern NHS must move from a public sector monopoly to a truly patient-led public service. The previous ministerial team, to whom I also pay tribute, took significant steps towards creating an independent, self-improving NHS, steadily removing powers from the hands of politicians and transferring it to clinicians. Increased transparency and independence have brought undoubted improvements, but have also had a short-term effect on confidence. However, we were right to introduce those changes.

Patients need staff to take the time to explain the condition and treatment options, and citizens need to know what is going on and to be properly involved in collective decisions. We introduced national targets to eradicate the unacceptably long waiting lists, and without those targets, the NHS would not have seen the transformation of services that I described earlier. But the treatment needed for the NHS then, when the whole system was in intensive care, is not the same as the treatment it needs now. We are determined to move away from targets as we transform the NHS from a top-down bureaucracy to a bottom-up, self-improving organisation with power in the hands of patients, their advocates and, crucially, GPs and others in primary care and the staff.

Waiting lists and waiting times are at record low levels. The Government are on course to hit next year their 18-week target for the waiting time from GP referral to treatment. We have seen huge falls in deaths from heart disease and cancer. There are 80,000 more nurses and 35,000 more doctors, and there is better pay for our brilliant NHS staff. There are more than 100 new hospitals. That is what the Labour Government meant when we promised to save the NHS after 18 years of Tory neglect. Of course we must learn from mistakes and listen to our critics and, in particular, to those who work on the front line, but our overriding principle must be what is in the best interests of patients. It is absurd to deny that our health service is in immeasurably better shape than it was 10 years ago. Under this Labour Government, it will continue to get better.

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

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

Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.


That this House supports the Government’s trebling of investment in the NHS by 2008 and welcomes the recent confirmation of an extra £8 billion for 2007-08; congratulates the staff and the medical professions for their hard work and commitment in helping progress towards this Government’s historic maximum 18 week wait from GP referral to treatment; welcomes the extra choice available to patients with new services more convenient for their lives including around 90 NHS walk-in centres and the £750 million programme for developing community facilities providing care closer to home; recognises the achievement of the NHS in delivering a wide range of quality personal services convenient for patients including NHS Direct, 23 new independent sector treatment centres increasing choice; further welcomes the 280,000 extra staff working for the NHS since 1997 including 80,000 more nurses and 35,000 more doctors; further welcomes the fact that over 85 per cent. of all GP practices have used Choose and Book to refer their patients to hospital and that over three million Choose and Book appointments have been made so far, allowing patients to choose appointments that are at convenient times to fit in with their lives; and recognises the need to ensure that the views of NHS staff and patients are paramount and that Government must engage fully in a dialogue with them about the future of the NHS.