I beg to move,

That leave be given to bring in a Bill to give protection to the human genetic sequence; to prevent the patenting of human genes; and for connected purposes.

There is a great deal of debate about science, including genetics, in the media at present, which makes the Bill somewhat topical. That topicality has been reinforced by the submissions that I have received since proposing to introduce it. I thank all those who have supplied me with background information to prepare for the debate, including the BioIndustry Association, which made its arguments on behalf of the industry. Although it may disagree with some of the points that I want to make, I appreciate it putting its case to me.

In 1996, the Parliamentary Office of Science and Technology produced a useful report entitled "Patents, Research and Technology", which kept ahead of the debate at that time—I recommend it to hon. Members—and the hon. Member for Lewisham, Deptford (Joan Ruddock) has tabled the very good early-day motion 298 on the subject. I agree with its sentiments entirely. However, some of the media debate can be disturbing in respect of the assumptions being made, especially about the public understanding of public policy issues in science and genetics in particular.

It is clear that the public contribution to the debate often lags behind the discussions in scientific and sometimes even political circles. That leaves many members of the public with the real worry that deals have already been done, which in turn leads to wider opposition and the polarisation of views. That was very clear in the debate about genetically modified organisms. My concern is that the gene patenting debate may represent a real risk of significant future public anger if we do not have a more comprehensive discussion now. That is part of my motivation for introducing the Bill to the House today.

Some of those who talk about science policy seem to think that only those with the relevant qualifications can understand and that ordinary people should be left out of the debate. Such a position is offensive in a democracy, as we shall all have to live with the results of decisions taken in science public policy. It also seriously underestimates most people's interest in, and understanding of, those issues. That attitude is more likely to generate an anti-science mood as people respond negatively to what they perceive to be scientific and technological arrogance.

The citizens of this country—men, women and children—are perfectly able to participate in the debate and will do so. We need to look for ways to improve public participation and to involve them better, rather than seek to restrict decisions to committees of experts. Some coverage does not help by referring to absurd examples that owe more to science fiction than science fact. For example, the debate about genetic patenting has been expressed in terms of private companies owning the biological material that is inside all of us so that, somehow, we would have to pay royalties to produce new cells containing those genes. That is no more the real issue than that the human cloning debate should be about brainless automata being created to donate their organs to the rest of us, although, when one listens to the questions in Prime Minister's Question Time, one wonders whether the Government already have the job of creating automata in hand.

The heart of the debate is about how to create the greatest benefit for the greatest number of people from the incredible potential that is now being realised by our ability to decode the human genetic sequence. Patent law is difficult to grasp, and the uncertainties will keep lawyers happy and well fed for many years to come. It is based on certain key principles that we established through legislation and through our international agreements, especially at European Union level, but increasingly at international level.

The most relevant legislation is the 1998 EU directive on the legal protection of biotechnological inventions, article 5 of which states:

The human body, at the various stages of its formation and development, and the simple discovery of one of its elements, including the sequence or partial sequence of a gene, cannot constitute patentable inventions.

It goes on to say:

An element isolated from the human body or otherwise produced by means of a technical process, including the sequence or partial sequence of a gene, may constitute a patentable invention, even if the structure of that element is identical to that of a natural element.

Hence the work created for lawyers in this area. The directive leaves major room for debate about what should constitute a patentable invention. There is some uncertainty about whether sequences can be patented, or only their specific applications.

The view of Myriad Genetics is that it can patent the genes, which is why it has attempted to secure patents on the breast cancer susceptibility genes BRCA and BRCA2. That has caused much of the current debate. Other companies are similarly seeking exclusive rights on particular genes through the EU patenting process. Their argument is that the only way to keep research going is by generating income from the results. I would argue that the rewards can instead come from the proper patenting of specific applications of the technology without granting patents on the genes themselves.

The analogy of a mousetrap patent has been used. It is better for a company to secure a patent on a mousetrap design than on the process of killing a mouse. However, I would argue that the patenting of human genes is equivalent to securing a patent on dead mice, rather than on a mousetrap. If that patent were secured, the dead mouse patent holder could seek royalties from anyone else who invents other methods for killing mice. It is that exclusivity over the material rather than the applications that is the major source of concern.

There will be some serious implications if we allow such an environment to develop. What will the costs be to the health service if the costs for genetic testing have to include royalties to the holder of the patent for that gene? What will be the effects on public research if the incentive to develop novel applications is tempered by the knowledge that those applications cannot go to market or be used for the public good in the public domain without negotiating with, and making payment to, the gene patent holder?

There are real ethical considerations. Although I do not subscribe to the notion that this will lead to the ownership of bits of our cells, there are nevertheless genuine concerns about where the commercial exploitability of such material should begin and end.

In September last year, the Government sent out signals that they were looking to defend the public interest on this issue. It was reported that the Prime Minister was holding discussions with United States President Bill Clinton. When I recently asked the Prime Minister a question in the House, I was a little surprised to hear him say that no negotiations were taking place. I find it difficult to square that response with the report in The Guardian of 20th September 1999 entitled "Blair and Clinton push to stop gene patents". The report states:

Tony Blair and Bill Clinton are negotiating an Anglo-American agreement to protect the 100,000 genes that control the human body. … The extraordinary deal—initiated by Mr. Blair—aims to prevent entrepreneurs profiting from gene patents and to ensure that the benefits of research are freely available.

Reports of discussions have been released under US freedom of information legislation, but the Government have gone strangely quiet since then.

There is an urgent need for a debate about our approach to the use of human genetic information. This urgency is reinforced by Tuesday's report in The Guardian, headed "Protocol on gene research is at risk as firm demands exclusive rights". Dr. John Sulston, the well-respected director of the Sanger Centre—one of the leading research institutes in the world and a proud British institution—has said of the US company Celera:

The emerging truth is absolutely extraordinary. They really intend to establish a complete monopoly … on the human genome for … at least five years."

Dr. Sulston says:

People ought to know about it.

I think that people are becoming aware of it, and that that awareness is growing daily. I believe that the Government can no longer refrain from making their view clear, and that they should, on an urgent basis, make progress with the negotiations begun so admirably in, I believe, September 1999—although that is now denied by the Prime Minister. I urge the House to demonstrate that it, too, takes the issue seriously by supporting the Bill.

Question put and agreed to.

Bill ordered to be brought in by Mr. Richard Allan, Dr. Ian Gibson, Mr. David Heath, Dr. Brian Iddon, Jackie Ballard, Mr. Norman Baker and Dr. Jenny Tonge.

I have selected the amendment in the name of the Prime Minister.

I beg to move,

That this House deplores HM Government's clinical and financial mismanagement of the NHS; condemns the distortion of clinical priorities resulting from the Prime Minister's refusal to abandon the Government's flawed waiting list initiative, which is described by the medical profession as anathema to them and which has resulted in some of the sickest patients waiting longer than necessary for treatment; notes the financial chaos in Trusts and Health Authorities as a result of ministerial incompetence; and deprecates the misleading of the public about funding as a result of the Treasury's culture of repeatedly re-announcing financial decisions, and the practice of using the NHS as a means of providing publicity and photo opportunities for Ministers, putting political priorities before the morale of dedicated and hard-working NHS staff and to the detriment of patient care.

When the Government came to office nearly three years ago, their message was that there was nothing essentially wrong with the model of the national health service, but that the Conservatives in government had not wanted it to work properly, and that therefore it had not worked properly. The message was "Vote Labour and save the NHS", and a great deal of the Prime Minister's personal prestige was invested in that pledge. Huge expectations were raised about what the Government would be able to do, and on what time scale they would be able to do it. Today, we shall ask where those expectations are now and what has become of the NHS under Labour management.

Most countries are grappling with the health care debate, and our debates here resonate throughout Europe and the rest of the western world. Most western countries generally accept some form of mixed health provision, and engage in relatively mature debate. Our Prime Minister says that he has no ideological problem with the private sector, but the Secretary of State has. We have financial mismanagement, with repeated announcements of funding to secure headlines for Ministers. We have, at the centre of the Government's plans, a waiting list initiative that is almost universally condemned by the medical profession, which considers that it distorts clinical priorities. We have a system of management and a culture that are corroding the system from within, eating away at morale in the NHS and destroying the considerable good will, which, it must be admitted, the Government enjoyed when they came to office.

We intend today to examine the questions of finance and the waiting list initiative in detail, but first I want to deal briefly with the Government's style of management and the organisational structures. The last Government abolished a tier of NHS management to give more autonomy to trusts. We now have, roughly, an 80:1 management ratio, with 80 trust chairmen reporting to one regional authority. This Government, however, have insisted on a highly centralised style of management, involving a flood of policies, targets and directives that are entirely beyond the capacity of trusts. The result is poor communication, with a devolved structure of management but centralised control of management from Whitehall.

We are seeing a non-stop series of knee-jerk reactions. It seems that, in the case of the present Government, the best way in which to get anything done—the best way in which to secure any new initiative—is to embarrass the Prime Minister, either in public or, especially, on television. The Prime Minister's embarrassment fund seems to be a bottomless pit: it is necessary only to ask him a difficult question on "Newsnight" and throw him a few embarrassing statistics, and he will have the Secretary of State running off to the next Department on Monday morning with a new initiative, pledging money—probably the same money that has been pledged before, but money none the less. We therefore have a fragmented finance process with arcane bidding mechanisms, in which no one really knows what is going on. The losers are the patients. Morale among staff is reduced. I hope that the Secretary of State will deal with the problem of morale among general practitioners.

My hon. Friend mentions problems of morale in the NHS. Is he aware that the head of staff recruitment at Victoria hospital in Lichfield has told me that it is virtually impossible to recruit nurses to the hospital as, for the first time, its future and its services are under threat? Does he agree that that is appalling? For 18 years, the future of the Victoria and Hammerwich hospitals was assured. Now, both hospitals and their services are under threat.

I am more than happy to take my hon. Friend's word about the problem of recruiting nurses. The more general problem is retaining them once they have been recruited. We have been over the factors involved in the House: pay; conditions; lack of professional esteem from other colleagues, and sometimes from the public; and shift patterns in the NHS, which do not entice many who would like to stay in nursing. I am sure that my hon. Friend is more than capable of making sufficient political capital out of the difficulties in his area.

GPs throughout the country have complained about their loss of status, the steady erosion of their position in the medical profession and, in particular, the loss of their role of gate-keeper, which many were developing very well, especially towards the end of the previous Government's term of office.

GPs feel, for example, that there is a complete lack of co-ordination between NHS Direct and the rest of the primary care system. The many problems with NHS Direct are increasingly showing up. It is expensive, and consultants have complained that it is stripping nursing staff, especially from accident and emergency departments. We are at the ridiculous stage where nurses who are part of NHS Direct are pretending to be answerphones and being caught out only because they happen to cough. That is indicative of the ridiculous system that the Secretary of State is forcing through at pace. However, the morale problem among GPs will inevitably result in reduced patient care if the Government do not address it. Will the Minister mention that in particular when he replies?

Let us look at finance. We have two questions to ask: what is really happening to finance in the NHS and how is it affecting health care? The NHS Confederation says that 2000–01 is likely to be one of the toughest years on record. There are several reasons for that. The first is the front-loading of the comprehensive spending review. The rise in NHS spending is 4.7 per cent. in real terms in 1999–2000, falling to 4.5 per cent. this year and to 3.9 per cent. next year. However, we then have the unfunded pay awards. Although those are entirely laudable and I am sure that no one would object to any NHS staff receiving higher remuneration, as the average trust pay bill is rising by about 4.2 per cent. this year—not the 3.5 per cent. that the Government predicted—and as funding is likely to go down, as predicted, over the next three years in real terms, the recurring cost of the awards can be met only by a reduction in patient care. That is not a political judgment, but simple arithmetic. The Government will have to tell health authorities and trusts how to deal with that; otherwise, there will be a reduction in patient services.

Health authorities and trusts are being asked to deal with additional financial burdens. The European Union working-time directive is one. Holiday pay, for example, will cost more. Nurses will have to be paid the average rather than basic pay for nursing leave. Again, no one would begrudge nursing staff that, but it will be an extra financial burden on health authorities. Prescribing budgets in primary care will rise, with the drugs budget perhaps up by 11 per cent. this year.

Structural deficits are carried over from year to year. They are increasing and make the first claim on funds that are available in April. For example, I shall randomly pick hon. Members and look at the deficits that their health authorities face. It is predicted that the deficit of the health authority that serves the constituency of the Under-Secretary of State for Health, the hon. Member for Birmingham, Edgbaston (Ms Stuart), will be £8.5 million. The health authority in the constituency of the Minister of State, Department of Health, the hon. Member for Barrow and Furness (Mr. Hutton), has a deficit of more than £1 million. The deficit for the health authority in the constituency of the Under-Secretary of State for Health, the hon. Member for Pontefract and Castleford (Yvette Cooper) is predicted to be more than £5.5 million.

Those Ministers will be pleased to know that—by complete coincidence—the one member of their team whose health authority is not facing a deficit is that of the Secretary of State. Although I am sure that hon. Members will agree that the location of health authorities among constituencies is entirely coincidental, not all hon. Members—not even all health Ministers—have been able to obtain such privileged funding for our own health authorities.

What does the funding problem entail for a typical trust? Ministers say that they have been extremely generous in providing a 6.7 per cent. funding increase, which includes the extra allocation made at the end of last year, but basic inflation has been running at 2.6 per cent. If we add to the inflation figure the effects of superannuation, the working-time directive, reduced hours for junior doctors and capital charges excess, the 2.6 per cent. figure increases to about 5.78 per cent. If we add to that the costs of clinical governance and increases in drug costs, the figure increases by another 0.5 per cent. If we add to it the costs of dealing with the maintenance backlog, winter and ensuring a nursing skill mix, the figure increases by about another 1.8 per cent. Finally, if we add the 3 per cent. deficit, it becomes clear that, before we treat another patient or increase any type of patient care, there is 10.5 per cent. in extra costs. However, only 6.7 per cent. extra has been provided. That is not generous.

People will be wondering why the extra £21 billion that the Chancellor announced for NHS spending is not being spent on patient care. They will be wondering where all that money has gone. I am grateful to Peter Kellner for his very simple analysis of the matter. After inflation, the £21 billion—of which England is receiving £17.6 billion—yields a real increase, over three years, of £10.9 billion. We must then subtract from that figure the costs of unfunded wages, more elderly patients and the drug budget—in short, the costs of medical inflation—which yields an increase of only £5 billion over three years.

If we also take into account the deficits, we can appreciate why Lord Winston came to the view that the national health service was being starved of funds. Health authorities are beginning the year with negative funding.

Ministers try to pretend that they have provided much more money to the NHS than they have, but I caution them about that. In future, the public will not believe them when they promise—like the boy who cried wolf—more money for the NHS.

I have written to the chairman of Worcestershire health authority to raise precisely the point that my hon. Friend is making. Although she could not give me a substantive reply, when I asked her about all the costs that my hon. Friend has mentioned so far in his speech, she could not assure me that there would be one extra penny for improved patient care for anyone in Worcestershire. The situation is shameful. I am awaiting a further reply from the chairman.

The shame is not that the money is not available—although all hon. Members are worried about the lack of expansion in patient care—but that Ministers pretend that more money is being made available than they are providing. People find unacceptable the essential dishonesty of the process. My hon. Friend has described a part of the pattern of constant re-announcements and the distortion of information that is at the heart of the culture of the Government.

rose—

A moment ago, the hon. Gentleman said that he thought that 6.7 per cent. was not generous. What sum would he consider to be generous, and what would Conservative Members do, if they were in power, to provide the increased funding for which he seems to be calling?

I did not say that the settlement was not generous, but that it was insufficient. I said that, given the added pressures that the Government have introduced—including the working time directive and all the other costs that I mentioned—extra pressure is being placed on the NHS budget. The Government are being dishonest with us. Although they say that they are providing a real increase, we all know that it is not a real increase. Across the country, people are asking why they are not seeing that extra money.

As I said, the Government came to power by raising expectations to a level that they themselves knew they could never fulfil. That promise of improving the situation far beyond what they knew they could accomplish has diminished the standing of politics in society and resulted in, for example, lower turnouts at elections.

Will the hon. Gentleman give way?

I may give way in a moment.

There has been a pattern of distortion and reannouncements. For example, this week, the Secretary of State has talked about an increase in the number of cardiologists. On "On the Record", John Humphrys said:

The point is they are there, they're waiting, they're registrars, senior registrars or whatever. Professor Alberti—

the Government's adviser—

himself the source on these matters says they are there, but there is not the money to create the consultancy posts.

The Secretary of State replied

But that isn't true … That simply isn't true.

He has been taking lessons from the Prime Minister at Prime Minister's Question Time. When confronted with a fact that they do not like, they simply deny that it exists.

Yesterday, I received a letter from a cardiologist who wrote as a result of comments that the Secretary of State made on the BBC. The cardiologist wrote:

He claimed that an expansion of consultant cardiologists could not take place immediately because it would take time to train such specialists. He stuck to this view despite the comments of Professor George Alberti to the contrary.

As a trained cardiologist looking for a consultant position, I take great issue with these comments because they are incorrect. There is in fact a surfeit of trained cardiologists in this country compared to consultant posts arising and projected to arise. It is estimated that there are about 50 trained cardiologists currently seeking consultant posts. I am one of three fully trained cardiologists … who face unemployment in the next few months following termination of our training posts under the new Calman scheme hellip; On the 21st January, I met with my local MP—

A Labour MP—

… to discuss the situation. I provided her with the above information, which she immediately relayed to Alan Milburn's department for comments. One would assume therefore that he was aware of the situation when he made his comments on the Today programme.

I do not know whether he was aware of that information or whether it was passed to him, but, as Secretary of State, I would expect him to know about it.

The hon. Gentleman mentioned Professor George Alberti. I wonder whether he has seen the statement issued, I think, today by the Royal College of Physicians. It says that

the College does not expect there to be any fully-trained unemployed cardiologists by the end of 2000 and indeed there are several unfilled posts at present.

Time will tell what will come to pass. I take the Secretary of State's comment to be a pledge that all those who are trained in cardiology will be found consultant posts by the end of the year. If any trained cardiologists have not been given new consultant posts created by the end of the year, we will know that what he has just said are simply words to get him through the debate and not a serious matter of policy.

The Secretary of State told us to judge him on his record. In October 1999, he said that a £50 million boost to cardiac surgery was there to increase the number of operations by 10 per cent. over the next two years. However, of course, that was not new money as he was forced to admit later. He said that it was part of the extra £21 billion that the Government were putting into the NHS. It seems that the words "new" and "extra" in the Department of Health mean the same as the Home Office's use of the word "extra" in relation to policemen.

When the Secretary of State spoke about consultants, he said that there would be an increase in the number of heart specialists by more than 400 in the next six years. However, Dr. Peter Hawker of the British Medical Association's consultants committee said:

The 400 additional heart specialists announced today are already in the NHS as specialist registrars on the training ladder.

The Secretary of State is trying to create numbers that do not exist. That can lead only to the dashing of the expectations of those who work in the medical profession and the patients who would be treated by them.

The Government's greatest trick is to reannounce. When one makes one announcement, one might as well make it many times. Let me give the House an example. On 29 September 1998, the Government announced—it was a welcome announcement—£30 million to modernise 50 accident and emergency units. On 28 October, they announced that there would be £30 million extra for A and E and, on 17 November, that there would be £30 million extra to fund A and E. On 16 February in the following year, on 15 March, 15 April, 7 May and 28 May, they announced each time that an extra £30 million was being made available for accident and emergency units.

Anyone outside the House might believe that if one announces seven times that £30 million extra will be spent on A and E in the NHS, that means that one is spending more than £200 million. However, in fact, only £30 million will be provided. That is the elastic arithmetic of the Government and a total inversion of the truth.

Is my hon. Friend aware that, on 21 July, the Prime Minister said:

We are renovating every accident and emergency department in the country?—[Official Report, 21 July 1999; Vol. 335, c. 1188.]

In reality, my constituents have found that the accident and emergency department serving them in south Shropshire is being scaled down.

If I may, just for once, be fair to the Prime Minister, I think that he said that every accident and emergency department that needs it will be upgraded. What beats me is where we can find the criteria by which "needs it" will be judged. Throughout Britain, many departments that I would regard as needing improvement do not seem to be eligible for the magical £30 million that the Government are bringing forward. It would be entirely justifiable if my hon. Friend were to table parliamentary questions to discover those criteria. I wish him good luck, because we have not been able to discover them.

Will the hon. Gentleman give way?

I shall give way to the hon. Lady in a moment because she has already tried to intervene twice.

What we see in terms of waiting lists is probably the greatest deception of all. Again, in "On the Record" this week, the Secretary of State said that, as everyone knows, waiting lists had peaked but were coming down, yet last month his Department announced a 36,000 rise, and the waiting list for the waiting list has more than doubled since Labour took office. Only the Government, with their Alice in Wonderland interpretation of data, could regard such figures as going down.

The hon. Gentleman talks about spending plans and the information given to the public, but who should the public believe—the hon. Gentleman when he says that Government spending plans are insufficient, or the former shadow Chancellor who said that they were reckless?

The lap dogs are all out today. I should have expected that, by now, the Labour Whips would have done a little work and got some new interventions.

The amount of money that has been made available, although described as "generous", is nothing of the sort. In fact, the money announced by the Government is not the amount that has been given to health authorities. It is becoming increasingly clear that the Government have perpetrated a con trick on the health authorities and the trusts, and on patients in Britain.

I share the accident and emergency department referred to by my hon. Friend the Member for Ludlow (Mr. Gill). The Government talk about changes and improvements to such departments, but at Kidderminster general hospital and the Alexandra hospital in Redditch, those departments are being downgraded to minor injuries units, which is why money is being spent on them.

That is an example of something else that the Government do continually: regrade things and give them a different title so that we are supposed not to notice that we are being given an inferior level of service. They must think that the public are as gullible as their own Back Benchers if they think they will get away with that for any length of time.

Will the hon. Gentleman give way?

No, I have just given way three times.

I come to clinical priorities. This is probably the most serious part of today's debate. The Government were warned at the outset by the Conservative party and, to be fair, the Liberal Democrat—the hon. Member for North Devon (Mr. Harvey)—and the medical profession, that its waiting list initiative was dangerous. Last week, Dr. Peter Skolar described it as complete anathema to the medical profession. Increasingly, that is how it is. It is dangerous because, with its obsession with numbers, it treats all patients as having equal clinical weighting, which is unfair. It is a manipulation of clinical priorities because, by penalising health authorities for not bringing numbers down quickly enough, health authorities are being encouraged, within any one given budget, to treat more minor conditions to satisfy the political masters, rather than treat them according to clinical priority. That is an unethical, unfair and immoral way in which to run a health care system.

Dr. Peter Wilde confronted the Prime Minister last week on "Newsnight" and said that, as a cardiologist in Bristol, he believed that patients had died unnecessarily waiting for cardiac surgery. The scandal lies in the fact not simply that patients were waiting too long, but that the health authorities were still treating minor conditions while those patients were waiting for more serious surgery. That distortion of a simple clinical priority is the ethical flaw in the Government's policy.

There is still time for the Government to abandon that policy. I have no intention of raising individual cases of patients who have suffered, but surely we can all see that it cannot be right, in any medical system with finite funding, to ration on the basis of getting the numbers down quickly rather than treating the appropriate patients and ensuring that the sickest are treated first.

Surgeons throughout the country tell us that they are under pressure from their managers to get the numbers down quickly to avoid being penalised financially by the Government. We most object to the culture that is driving the process. There is a corrosive—and, I believe, disreputable and dishonest—code driving not only the policy but its presentation. That is partly because the Government have no coherent philosophy. The Secretary of State told managers when he was a junior Minister that he would come down like a ton of bricks on anyone who dealt with the private sector, but the Prime Minister said on "Newsnight" that he had no ideological problem with the private sector.

There was no adequate consultation to avert the winter crisis. From April, employers who dare to give private sector cover to their employees as a benefit will be subject to a new tax. Hon. Members may want to know that yesterday the Fees Office said:

I am writing to confirm that there will be a National Insurance liability on Health Care payments …

All such payments should go through the payroll and will incur Employer's NI at a rate of 12.2 per cent.

Any Members of Parliament who dare to give their secretaries or researchers health perks will be taxed by a Government who do not have a problem with the private sector.

It goes to the root of the Government's culture that they say one thing and do another. They would say black was white if they thought they had to. They are so duplicitous that they would not ask for water if they were thirsty. What is more, they can never be wrong. The Secretary of State said last week that Professor Alberti—his own adviser—Stephen Thornton of the NHS Confederation, the Institute for Fiscal Studies and Rabbi Julia Neuberger of the King's Fund were all wrong. On "Newsnight", the Prime Minister said that the managers, the doctors and the public were wrong, and moreover that the media were to blame.

The Government have no core values and exist only to be in office. We have the sad spectacle of Back Benchers, rather than holding the Executive to account, worshipping at the altar of the Prime Minister's ego. If one statement said it all, it was when the Prime Minister was asked whether the distortion of clinical priorities by the waiting list initiative should be changed. He said:

If we abandoned waiting lists, you guys—

the press—

would come down on us first and then patients would come down on us.

That means that Ministers' reputations come first and patient care comes second.

We have a health care system run by politicians for politicians, not by doctors for their patients. On health care, the public expected much from the Government, but have been bitterly disappointed. The Government have replaced ethics with spin, hope with cynicism and dedication with dismay. The great Labour lie has turned into the great Labour betrayal.

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

"welcomes the Government's modernisation programme for the NHS and the reduction in waiting lists and times that are being achieved through the dedication and hard work of NHS staff; notes the progress being made on recruiting more doctors and more nurses, building more hospitals, treating more patients and modernising more services; applauds the Government's decision to make tackling cancer, coronary heart disease and mental illness a priority; believes that financial provision for the NHS would be reduced as a consequence of the Conservatives' Tax Guarantee and that clinical need would be abandoned in favour of ability to pay under the Conservatives' health plans."

I apologise at the outset for the fact that I will not be here for the winding-up speeches, as I have a prior speaking engagement.

The Opposition have called for a debate on financial provision and clinical distortion in the NHS. I am pleased to tell the House that financial provision for the NHS has never been greater. The NHS is now benefiting from the largest cash injection it has ever seen. I am also pleased to tell the House that the assault on clinical distortion caused by the postcode lottery of care has never been greater either: the failed, disastrous, divisive internal market in the NHS has been consigned to the dustbin of history, where it belongs.

Will the right hon. Gentleman give way?

Yes. I believe that the hon. Gentleman was a supporter of the internal market.

If everything is so wonderful for funding in the national health service, why is it that, this financial year, the Mid Essex hospital trust will have the largest deficit it has had in its history, and three wards, containing 84 beds, will be closed?

I do not know about that particular case, but the hon. Gentleman was a Minister at the Department of Health in 1996–97 when the NHS ran up a combined deficit of £459 million. He shares at least some of the responsibility for that, as I am sure he accepts. By the beginning of this financial year, that deficit had come down to £18 million, so we will not take any lectures from the hon. Gentleman or the Conservative party on deficits in the NHS.

If the Secretary of State could not answer the previous question, perhaps he can answer mine. In November last year, his predecessor, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), opened a brand new breast cancer unit at the Glenfield hospital in Leicester. That unit was opened thanks to private subscriptions and was not funded by NHS money. It will now be closed. Why?

The hon. and learned Gentleman is talking about the Leicestershire area and he will be aware that consultation is still taking place about some of the proposals. There are always difficult decisions to make about health care funding and services, and that is as true for this Government as it was for the previous Government. The consultation continues and I urge the hon. and learned Gentleman to take part in it.

The Conservatives' motion condemns financial mismanagement when the Conservatives are past masters of it. I remind the hon. Member for Woodspring (Mr. Fox), who was rattling on about financial mismanagement, that it was his Government who managed to spend a small fortune on financial mismanagement in the NHS, including more red tape and bureaucracy than it has had in its history. This Government are taking £1 billion out of red tape to put directly into front-line patient services. We are doing that because it is the patients' priority, the staff's priority and our priority. Needless to say, the hon. Gentleman and his party oppose it.

The Secretary of State referred a couple of moments ago to the ending of what he called the postcode lottery. Can he explain to me, so that I can explain to those of my constituents suffering from multiple sclerosis—some of whom are now in Westminster Hall—why one of my constituents from Hampshire is unable to obtain beta interferon and will have to wait 18 months, while another person from Surrey is able to obtain it immediately and tells me that it is down to the postcode lottery? Rather than going back to the past, will the Secretary of State recognise that people want to know what the Government whom they elected are going to do to improve their health care instead of making it worse?

I shall tell the hon. Gentleman precisely what we will do about it. Every hon. Member is aware of the situation in relation to beta interferon, and the first thing to say is that nobody should hold out beta interferon or any such product as a cure for MS. It is not a cure, because there is no such cure. However, this Government recognise that there is a lottery of care—unlike the previous Government who denied it—and, what is more, we are taking action to tackle it. That is why the National Institute for Clinical Excellence is considering beta interferon. I want to see a fair system of care that does not depend on where someone lives, or who their GP happens to be. Care should be determined according to clinical need. As the hon. Gentleman will be aware, the current guidance on beta interferon, which will be superseded once NICE has reported, is guidance that the Tory Government issued in 1995.

My constituent Stephanie Millward will be keen to hear when NICE is to report. If the Secretary of State is happy about the treatment of MS, will he explain why the Government spend a laughable £640,000 a year on research into the causes of MS? That is a ridiculous sum, so will the Secretary of State commit himself to increasing it?

There are always many demands on the NHS research and development budget—including for research into prostate cancer. We try to ensure that the R and D programme is best geared to meet patients' interests. We will, of course, look at the resources devoted to MS research. With regard to beta interferon, I can tell the House that we expect NICE to report in late summer or early autumn. We will try to make that report available to the national health service as quickly as possible, as we all have a shared interest in getting the matter right. I am afraid that, in the past, the problem has been swept under the carpet.

The Conservative motion also complains about

using the NHS as a means of providing publicity and photo opportunities …

The hon. Member for Woodspring has been caught short once already, so he ought to check his facts more carefully, especially with regard to photo opportunities. For some time, the BBC's "Panorama" programme has been contacting NHS hospitals up and down the land asking if filming could be conducted on their premises. At least 23 hospitals have been contacted, including Basildon hospital, Kettering general hospital, the Princess Royal hospital in Telford, the Royal Shrewsbury hospital, and Kidderminster general hospital. One might think that there is nothing unusual in that, but the filming is not for a factual programme. It is for a fictional programme—the story of one man's experience as a television extra.

I have a copy of the fax from the BBC about the programme, dated 20 January this year. Given the concern expressed in the motion about photo opportunities and the misuse of the national health service, I am sure that the House will be interested to know the proposed star of the extravaganza. The fax states:

William Hague has agreed to be filmed in a variety of situations.

There is more to the story than that. According to the fax, the Leader of the Opposition is to

take on a role in the hospital for half a day; a porter's job or something similar.

I suppose that we should at least be grateful that he is not going to masquerade as a brain surgeon. So much for the Opposition's complaint about photo opportunities: the hon. Member for Woodspring should check his facts before he comes before the House.

Will the Secretary of State give way?

In a moment, as I have given way six times already.

Will the Secretary of State give way on this point?

The hon. Gentleman, who is a Whip, should sit down. I might give way to him later—if he learns to behave himself.

I shall deal with each of the claims in the Opposition motion, and I shall start with the question of financial provision for the national health service—a subject that we are more than happy to debate.

Over the period of the comprehensive spending review—that is, this year, next year and the year after—the NHS is experiencing average real-terms growth of about 5 per cent. In the present financial year, real-terms growth is actually around 6 per cent. Health authorities are getting cash increases that average 6.8 per cent.

Let me put that in context. The average real-terms growth for the NHS over the full 18 years of the Conservative Government was around just 3 per cent—half the growth in this financial year. During the previous Conservative Government's final five years in office, they did not even manage 3 per cent. growth. They averaged growth of only 2.6 per cent. per year in that time.

It is little wonder, then, that the NHS that this Government inherited had too few doctors and too few nurses; that three quarters of accident and emergency units needed modernising; that the NHS was crying out for the biggest hospital building programme in its history; that waiting lists were too long and were rising; and that our country's record on coronary heart disease and cancer lagged so far behind that of other European nations.

It is also little wonder, after those 18 years of neglect and mismanagement, that we inherited an NHS that was on its knees. We intend to get it back on its feet, but of course that will take time. We will not be happy until it is up and running again as the pride of Britain and the envy of the world. Conservative Members want always to run down and talk down the national health service, but the Government are making progress towards "making political capital" out of the NHS, to borrow the graphic phrase used by the hon. Member for Woodspring.

There are 2,000 more doctors in the national health service than there were when we came to office. We are beginning to turn the corner, too, on nurse shortages. There are 4,500 more nurses in the NHS than there were a year ago, thanks in part to the largest real-terms increase in pay that nurses have had in a decade and a half. It was paid in full—without staging, as happened under the previous Government. The biggest hospital building programme that the NHS has ever seen is under way. Every casualty department that needs it is being modernised.

The hon. Gentleman was talking about difficult decisions. For the first time, we have a means of setting national standards, through the National Institute for Clinical Excellence, to tackle precisely the lottery of care that the Conservative created and connived at. We have also, for the first time, a means of monitoring and inspecting those standards through the Commission for Health Improvement.

The Secretary of State has mentioned NICE a number of times, and its views on beta interferon. He will be aware that many people in Westminster Hall right now are very concerned about that. In Worcestershire, only two people out of hundreds with multiple sclerosis are receiving beta interferon. If NICE agrees that beta interferon is a cost-effective treatment, as the right hon. Gentleman's Government would put it, does he promise that everybody in Worcestershire who is able to benefit from receiving beta interferon will have it, and will he make up the shortfall in Worcestershire health authority's budget as a result?

We have NICE for a very simple and straightforward reason. As both the hon. Lady and I know, different health authorities take different decisions about prescribing important drugs and making available different forms of treatment and intervention. We want to put that right, because we believe in a fair system of health care in which care is made available according to clinical need and not any other factor. When NICE produces its guidance, we expect health authorities, primary care groups, doctors, nurses and others to take full account of what it says.

Does that mean that, should NICE decide that beta interferon is not cost-effective and clinically effective, patients who currently receive it can anticipate ceasing to have it in the future?

That is not the position. We have discussed this issue with NICE, which is under an explicit instruction to look at the ramifications of any decision that it takes—for example, if it decides that in future a drug that patients currently receive is not cost-effective or clinically effective. The important thing about NICE is that it does not substitute for doctors or for other clinicians' decisions. It is there to help and support them and make their job easier. Ultimately, the individual clinician dealing with the individual patient will have to decide. Frankly, I cannot decide that; neither can the hon. Gentleman—and neither, with the best will in the world, can the NHS Executive or the National Institute for Clinical Excellence. It is a clinical decision, but it must be an informed clinical decision, based on what works and what does not, on what is effective and what is not.

It is a very important point that there is a distinction between cost-effectiveness and affordability. Although it might be a legitimate role of NICE or any similar body to examine the cost-effectiveness of any treatment—an aim which I am sure is widely shared—the decision on affordability should not be left at arm's length, but should rest with Ministers. Will the right hon. Gentleman confirm that if NICE agreed that beta interferon was a cost-effective treatment—especially, as seems increasingly likely, in the early stages of multiple sclerosis—Ministers would not stand in the way by saying that it was not affordable to the NHS?

There are clearly two separate sets of decisions to be made. One is about effectiveness. It is right and proper that NICE should look at clinical and cost-effectiveness side by side. That is the right thing for it to do; and it is best equipped to do it. The national health service has never had an independent means of considering those matters and it seems sensible to have one if, as Conservative Members claim—I am sure they are genuine in this—they want to deal with these problems.

There is a separate set of decisions which, in the end, I take. I take decisions about affordability. Those are my decisions. That is right and appropriate, and I will be held to account for them. When NICE comes up with its recommendations, we will of course consider what it says. That is the right thing to do.

I can tell the House that there has been no greater clinical distortion than allowing the NHS, as the previous Government did, to provide the lowest level of cardiac services in precisely the areas where coronary heart disease is highest. That is what we inherited, and that is what we are trying to change. We shall improve the health of the population as a whole, but we shall improve the health of the poorest fastest.

Yes, there are many things wrong in the health service, but there are many things that are going right. Slowly but surely the expansion of the NHS is under way. It is underpinned by the extra resources that we have committed to the service. Of course, it takes time to deliver results and they are always dependent on what we can afford, but we have achieved 5 per cent. funding increases on average during the current spending review. If we continue to manage the economy successfully, we can be confident that we will be able to make the sustained increases in funding that our health service needs, and get up to the European Union average.

The hon. Member for Meriden (Mrs. Spelman) has said that none of that is certain. One thing is certain—the Conservatives would not and could not match our commitment to the NHS. The first reason for that is that Conservative Front-Bench Members have already condemned Labour's investment levels as reckless and irresponsible and as madness. Secondly, the Conservatives' tax guarantee, far from delivering the growth in NHS capacity that the service needs, would result in

swingeing cuts in the health service.

Opposition Members shake their heads, but those are not my words; they are the words of the former Prime Minister, the right hon. Member for Huntingdon (Mr. Major).

Opposition Front-Bench Members cannot have it both ways. They cannot bemoan the improving financial position of the health service while proposing swingeing cuts. They cannot complain about NHS deficits while threatening to make them worse. What the Conservatives propose is not so much a tax guarantee as guaranteed attacks on the future of the NHS.

That is not what the NHS needs. It needs more investment and more reform. The only guarantee is that it will get neither from the Conservative party. The hon. Member for Woodspring says that, philosophically, the Conservatives have moved on from the NHS. The Government believe that the principles of the NHS are right, but we believe with equal passion that its practices have to change fundamentally.

Does my right hon. Friend agree that to say that waiting lists are unethical is to say that minor ailments should always be trumped by major ailments, and that under Tory rule someone with a cataract would never have treatment? Does he agree also that to say that a 6.8 per cent. funding increase is not sufficient and yet not to pledge any more is to open up the hidden agenda of privatisation behind the tax guarantee?

My hon. Friend is absolutely right, and I am coming to precisely those points.

The Conservatives cannot have their cake and eat it. They cannot have the tax guarantee and then complain about lack of investment in the NHS. That will open them up to the charge of hypocrisy, and that charge will stick as we go into future general elections. The hon. Member for Bromsgrove (Miss Kirkbride) and her colleagues on the Back Benches, who complain that there is not enough money going into the NHS, ought to take up their complaint with the new shadow Chancellor and the Leader of the Opposition because their policy, the tax guarantee, places an artificial straitjacket around NHS spending.

Our view is straightforward: we want to invest more in the NHS. We know that more investment is needed in the NHS, and that is precisely what we intend to provide.

Will the right hon. Gentleman give way?

One more time, and then I want to get on to clinical distortion.

It surprises me that the Secretary of State wants to get on to that subject. On taxation, he makes the ridiculously simplistic argument that it is impossible to reduce the burden of taxation and increase expenditure on the health service. In the 1980s, the NHS saw its biggest funding expansion in history, at the same time as the tax burden diminished. If the right hon. Gentleman asserts that that is impossible, how does he reconcile his two statements today about increasing and improving NHS funding and the Government's reduction in the standard rate of tax by 1p next month?

I presume, therefore, that the hon. Gentleman disagrees with the right hon. Member for Huntingdon. Is that right? Does he agree or disagree with what the former Prime Minister had to say about the tax guarantee?

As the Prime Minister has said many times, cutting income tax rates is the right thing to do—not least to compensate for other changes in the tax system. We can do that precisely because we are giving the NHS the biggest cash injection in its entire history. Let us not forget that the hon. Gentleman and his party opposed that at the time, and do so now, but do not have the guts to say so.

On the question raised by my hon. Friend the Member for Croydon, Central (Mr. Davies), clinical need drives our determination to speed up care. Faster care means better health. Let us be clear: the NHS is expected to treat all patients according to their clinical priority. Emergencies should be treated immediately, and urgent cases should rightly be given top priority. Our determination to get waiting lists down has not changed that one bit, and the figures prove it.

Compared with 1997–98—these are complex procedures; precisely the sort that the hon. Member for Woodspring says are not happening in the NHS because of all the toes and nails that are being done—last year, there were more than 6,400 additional hip replacement operations, more than 4,700 additional knee replacements and more than 1,400 additional coronary heart bypass grafts. Let us have no more of the argument that clinical priorities are distorted by waiting lists. Waiting lists are down, and we will go on to meet our manifesto commitment. What is more, we have turned the corner on out-patient waiting, too.

The hon. Member for Woodspring says that the lists are not coming down. Over Christmas and new year, hospitals rightly prepare to deal with the inevitable rise in attendance that extra winter pressures cause. This winter was no exception. We saw a rise in the number of people waiting for in-patient treatment in December. We will probably see a further rise in the January figures.

Imagine what a performance there would have been from the hon. Gentleman if those waiting lists had not risen this winter. He would have endlessly repeated the charge that waiting lists had distorted clinical priorities. Indeed, December must have been the only month of the year when he wanted waiting lists to go down. I am sorry to have disappointed him. The NHS did the right thing this winter. It put emergencies before elective cases. In the process, it has given the lie to those who claim that cutting waiting lists distorts clinical priorities. It has not, it does not and it will not in the future either.

In responding to my hon. Friends the Members for North Wiltshire (Mr. Gray) and for Bromsgrove (Miss Kirkbride), the Secretary of State wriggled like a belly dancer. For the benefit of the 1,000 multiple sclerosis sufferers and their supporters congregating this afternoon in Westminster Hall, will he tell the House in the form of a simple yes or no answer whether he stands by his statement that

No one will be denied the drugs they need. That is guaranteed … ?—[Official Report, 30 June 1998; Vol. 315, c. 143.]

Yes, in all circumstances, or no?

That is precisely what we want to do and that is precisely why we have established the National Institute for Clinical Excellence, which the hon. Gentleman opposed. I can therefore only presume that he and his hon. Friends are quite content, apart from specific instances of drugs and treatment, to let the lottery of care continue. I say one thing to him: we are not. Yes, we want to ensure that people receive the treatment that benefits them most. That is precisely what NICE will do.

What the NHS did not do was turn people away because they had the wrong sort of illness, or expect them to take out private medical insurance for a range of conditions deemed by politicians to be no longer necessary on the NHS. To do so would genuinely be to distort clinical priorities and put political priorities ahead of patient need. That is precisely what the hon. Member for Woodspring and the Conservative party propose to do.

My right hon. Friend has told the House how many more hip and knee replacements were carried out on the NHS last year. Will he tell me what would have been the increased burden on an average family, especially a pensioner family, had those treatments been carried out in the private sector with private insurance?

I was coming to precisely that point. I think that the average cost of a hip replacement on the NHS is about £5,000, and that of a cataract operation is about £2,000. Those are NHS costs, and the NHS is cheaper than the private sector.

My hon. Friend makes an extremely good point. To an overwhelming extent, cataract operations and hip and knee replacements are the operations of old age. Why, on 16 January, did the hon. Member for Woodspring tell The Sunday Times that private medical insurance companies should cover conditions such as

hip and knee replacements, hernia and cataract operations

leaving the NHS to do other things? It was not a slip of the tongue: later that month, on "Sky News", the hon. Member for Runnymede and Weybridge (Mr. Hammond) made it absolutely clear that, under Conservative plans, people would look to the NHS

when they had serious life-threatening conditions and would look to their private insurance to help them

with the rest.

There is no ambiguity and no weasel words—the message could not be clearer. Conservative policy is to reduce the NHS to a core service for life-threatening conditions, thereby leaving other conditions—such as hip and knee replacements and hernia and cataract operations—to the private sector. Surely, there can be no greater distortion of clinical priorities than the Conservatives writing off the 300,000 people—many of them pensioners—who rely on those operations every year. Pensioners are the people who most need health care and can least afford private health insurance. The Conservatives' policies amount to no more and no less than a new Tory tax on old age.

The right hon. Gentleman should read more than a few misquoted columns in The Sunday Times. Had he read this week's newspapers, he would know that I stated explicitly last week that, for many reasons, a core model NHS could not work in the United Kingdom. However, does he accept that if we do not have a core model, any rationing in the NHS has to be done by means of waiting times and proper prioritisation of cases? Does he also accept that if people were encouraged to take out greater private coverage, either individually or through their employer, it would reduce pressure on the NHS and produce an expansion of total health care, which would help to achieve the outcomes that everyone wants?

The last time the hon. Gentleman and I had exchanges about The Sunday Times article, he said that he was going to write to the newspaper to demand a retraction.

Yes he did—it is in the Official Report. Has he written that letter or not? If he has not, I can only assume that the article was an accurate reflection of what he told The Sunday Times about Conservative party policy.

Ridiculous.

If it is ridiculous, the hon. Gentleman should send The Sunday Times a letter demanding a retraction two months after the publication of the article in question. In fact, he knows that I am telling the truth—that is the Conservatives' policy.

If individuals want to take out private health insurance, that is a matter for them, but the idea that that could be a panacea for our health care system is fatuous. There is no army of unemployed oncologists—or, according to Sir George Alberti, unemployed cardiologists or cardiac surgeons—waiting for the private call to arms.

An expansion of the private sector must inevitably mean a contraction of the public sector. We have been down that route. We tried that model of care during the 1990s. The then Conservative Government spent £150 million a year subsidising old people to take out private medical insurance. It did not make a jot of difference to the numbers taking out private health insurance. The idea that that somehow acts as a safety valve for the national health service is simply wrong and fatuous.

Will the Secretary of State give way?

No, I am not giving way.

The contrast could not be clearer. Yes, the NHS needs modernising, which is what the Government are doing, but no, the NHS does not need privatising, which is what the Conservatives propose to do. Conservative health policy would indeed distort clinical priorities and mean financial under-provision for the NHS.

No one pretends that everything in the garden is rosy. It is not, but step by step we are making the NHS better. It takes time, but we are making real progress. The country and the service will recognise that. There are more doctors, treating more patients in the NHS; more nurses, training and working in the NHS; new hospitals beginning to be completed for the NHS; modern casualty units coming on-stream throughout the NHS; and fewer in-patients waiting and more out-patients being treated.

That is our record so far, but it is only the start. There is a lot more to do, but I say to the hon. Member for Woodspring and the Conservative party that we have only just begun and we intend to finish the job, because it is what patients and staff want. They want a national health service modernised and reformed, and that is what they will get with this Government.

I congratulate the hon. Member for Woodspring (Dr. Fox) on securing an opportunity for another debate in the House about health care provision. I agreed with a number of the points that he made. As he explained, the arbitrary waiting list initiative and the targets that were set have in many instances distorted clinical priorities, despite the protestations to the contrary from the Government Front Bench.

Anyone who visits hospitals and speaks to representatives of the professional organisations in the NHS knows that every time hospital managers are called upon to make decisions and set priorities, they are not making the decisions or setting the targets that they would otherwise have done, because they have to meet the waiting list targets.

The hon. Gentleman makes much of priorities, but is he aware that the National Audit Office found that last year the NHS performed an extra half a million operations? Will he give a big clap to the NHS, irrespective of priorities, for the fact that the overall amount of treatment is escalating rapidly, and we are committed to keep it going up?

I congratulate NHS staff on achieving the objective of performing more operations. It is entirely right that they should do so, and they deserve congratulation. However, there are still more people waiting longer for operations.

In its 1997 general election manifesto promise, the Labour party stated:

The Conservatives have cut Government spending … by the equivalent of more than £3 billion as spending on the bills of economic and social failure has risen. We are committed to reversing this trend of spending. Over the course of a five-year Parliament, as we cut the costs of economic and social failure we will raise the proportion of national income"

that is spent on health.

That was a sensible and laudable aim, but, despite the fact that extra money has gone into the health service—a matter to which I shall return—it was clear that demand would continue to rise over time. It always does. If the Government did not anticipate that the number of people needing those extra operations would rise, it was extremely shortsighted of them to frame the policy commitment in that way. The hon. Member for Woodspring was right to say that, from the outset, warnings were given about that. In the Liberal Democrat manifesto our policy commitment was measured on the length of time that people had to wait, not on the number of people on the waiting list.

The number of other people on the list is of relatively little interest to people who are in the unfortunate position of waiting for an operation. They want to know for how long they will have to wait. It would have been more sensible of the Government to set themselves targets on the length of time that people have to wait. People are having to wait longer.

I am slightly puzzled by the Opposition's political objectives in choosing the subject of this afternoon's debate. They have made some important, serious points, but none are new. The ground has been fairly well covered. If the hon. Member for Woodspring hoped to secure news coverage, he would have aroused more news interest if he had told us more about the Conservative policies that he was distilling, and especially the role that he envisages for the private sector. I suspect that more journalists would have been in the Gallery, waiting to hear that. We await more information with interest.

In the rush to get people off in-patient waiting lists, the number of people on out-patient lists has increased. It has more or less doubled since the election from 250,000 to more than 500,000. Although a small downturn occurred recently, the number of people on those lists has increased massively. That more than compensates for the Government's limited progress on the objectives that they set themselves of trying to reduce in-patient waiting lists.

The Secretary of State made a fair point in his speech when he said that we should not be too carried away by figures that appear over a couple of months, especially if they cover the mid-winter period, because authorities and trusts will set different short-term priorities to cope with winter pressures. He is right. However, the overall trend has been upwards for the number of people who wait for unacceptable lengths of time.

It is interesting to consider regional variations. In the south-west—my region—there has been an overall increase in NHS in-patient lists, never mind out-patient waiting lists, since the general election. In the last quarter of last year, 159,000 patients waited more than 26 weeks for an appointment with a consultant after a written referral by their general practitioner, compared with 149,000 in the previous quarter. Even before the Christmas problems and the winter worries, matters were deteriorating.

It should be no surprise that the winter pressures caused such havoc in the health services. Despite promises, and the analysis made in the Labour party manifesto commitment that I quoted, the vast, generous allocation of funding that the Secretary of State describes is not being made to the health service. In a Liberal Democrat Opposition Supply day debate, I said that the Government's methods of accounting are, to put it mildly, unusual.

Those methods have never been used previously, in other walks of life or in other countries. However, as a doctor put it to me, "If my child grows 3 inches in the first year, 3 inches in the second year and 3 inches in the third year, surely the child has grown 9 inches, but under the Government's accounting methods, the child has grown 18 inches." That is the truth about the £18 billion that has gone into the NHS.

I listened with interest to the hon. Member for Woodspring, who, assisted by interventions from his colleagues, went through some of the difficulties that the health service faces. He referred to those that the NHS Confederation had mentioned, and explained how they wiped out some of the money that appears to have been put into the health service. The hon. Gentleman was right to say that several important points needed to be made, not least on pay awards and the costs of coping with improved working rights and conditions, among others, that managers have to tackle. However, as he went through the list and as Conservative Members referred to the difficulties that those issues cause, I could not help but think back to the number of delegations of which I was a member during the previous Parliament that pressed Ministers for more funds on behalf of local education authorities, local councils and health authorities.

In those presentations, we invariably said to the Conservative Ministers facing us, "Look at the terrible pressures that the authority will face, not least funding pay rises." Unfortunately, I do not recall the provision of more cash ever being part of the response. I recall their saying, "These are simply the facts of life and local education authorities and the like are no different from businesses. Everybody has to face those additional costs." Although I very much agree with what the Conservatives have said today, on that particular aspect there seems to be a marked distinction between what they are saying in opposition and what I recall even the kindliest Conservative Minister saying in government when one petitioned for more cash.

The Secretary of State made the point that part of Government policy has been to set about a modernisation programme. In general terms that must be right and, indeed, in some specific terms it has headed in the right direction. We have detailed points of dispute with them over a number of changes, but their reforms of primary care, the introduction of the National Institute for Clinical Excellence and the Commission for Health Improvement, and the development of national service frameworks are all sensible policies that move in the right direction. However, the danger is that they will convince themselves that modernisation is in some sense an alternative to putting additional funding into the national health service. The reality is probably the reverse.

If the modernisation policy works as well as I hope it will, it will result in an improving NHS that will probably cost even more to run. I remember the Conservative Government setting about the process of introducing care in the community. The only thing that was wrong with what otherwise seemed to be an entirely laudable policy objective was the belief that it would somehow cost less. Anybody could see that closing down those appalling old mental asylums and putting people into care in the community was entirely right, but it was a banking certainty to cost a lot more money. We have found precisely that in practice.

For the first two years of this Parliament, the Government decided to saddle themselves with the spending objectives left in place by the previous Conservative Administration. Only in the last three, under the comprehensive spending review, have they started to load significant sums into public services. The result will be that, by the end of this Parliament, they will struggle to convince the electorate that they have expanded health service funding by any more than their Conservative predecessors. Were the election to be called next spring, which seems to be a fashionable bet in some quarters, they would have had only a four-year Parliament of two lean and two slightly better funded years. They would not even have achieved a real-terms increase year on year as great as that managed by the previous Conservative Government.

Unless the Government take radical action pretty quickly, they will face the electorate in May next year having to explain why their increases in health service spending have not even kept up with those of the Conservatives. With the Budget only three weeks away and the comprehensive spending review to be published in July, I can only hope that they find extra money that goes some way to meeting the objective—which the Prime Minister seemed to come up with on the hoof a few weeks ago—of trying to achieve average European Union health spending within five years.

That commitment does not stand close scrutiny because the EU' s membership might change considerably over the next five years, the economic cycle could make average EU health spending a completely different proportion of gross domestic product in any or all EU countries and exchange rate fluctuations could completely distort the figures in any event. The United Kingdom, as one of the largest EU countries, will push the European average up as the situation here improves, so we would be chasing a target that got further and further away.

It would be helpful if the Government nailed down what the Prime Minister meant, what they are seeking to achieve and over what period. If they were seriously to achieve the objective of getting up to EU average spending within five years, it would begin to address the serious funding and resourcing problems in the health service. The measure of success will be whether they achieve the objective that has been set.

Bearing in mind the fact that this Opposition day debate was mounted by the Conservative party, does the hon. Gentleman share my surprise and concern that only two Back-Bench Tory MPs are present to discuss these issues?

It seems surprising that, having chosen this subject for debate, there are not more Conservative Members wanting to participate in it. I am not sure how they will keep it going until 7 o'clock, but I suspect that some of them are frantically running round the Tea Room. I suspect that they are relying on me to keep it going. Other than that, we are looking forward to a long contribution from the hon. Member for Meriden (Mrs. Spelman). I shall see what I can do to help her.

Will the hon. Gentleman give way?

I shall give way to help out in these circumstances.

In the interests of fairness, the hon. Gentleman may like to know that many of my hon. Friends who were present during the speeches of the Front-Bench spokesmen are now downstairs in Westminster Hall seeing off the multiple sclerosis sufferers who came to lobby Parliament. Labour Members were absent from that lobby.

It is correct that a lobby on behalf of MS sufferers is taking place today, and I am sure that hon. Members from both sides of the House will want to hear what they have to say and to play a part in that.

Funding for the coming year will be hard for many authorities and trusts, which carry the deficits that have accumulated in previous years. The Government, the public and the media are expecting more and more of the national health service. If authorities and trusts are to achieve what everyone wants them to achieve, they will have to have more money than they are getting at the moment. We shall have to wait and see what the comprehensive spending review comes up with, but we hope that the method by which calculations are made in that review and the sums that the Government are able to announce will be clearer and more transparent than they have been to date.

The Secretary of State referred to spending announcements. I looked into 63 spending announcements during 1999, which emerged in the form of Department of Health press releases. Umpteen were already covered by earlier announcements—fair enough, we have got used to that—but several were straightforward repeats. The distance and time that the Government allowed to elapse before reheating the old spending announcements varied from two months at the cheekiest to about eight months, when they hoped that enough people had forgotten about it.

We need to see real money, calculated in a universal fashion that everyone understands and that bears historical and international comparison. When the comprehensive spending review comes out, it is essential that the laudable goal of getting up to the EU average within five years that the Prime Minister has mapped out can be achieved.

The hon. Gentleman has made a number of comments about funding, and I share his concern that we must ensure that the health service is properly funded. He claimed that the £18 billion that we promised for England does not add up, but were we to put in £6 billion in each of three years, he would have to agree with me that that would mean no growth in the second and third years.

Time and again, the Liberal Democrats have asked for money for the health service—there is nothing wrong with that—but they have not explained how they would fund the NHS, and have not said how much money they would put in. I have heard nothing from the Liberal Democrats that makes me feel happy that they have a viable alternative to the vast sums of money that Labour is putting in and will to continue to make available in the future.

I have a sneaking suspicion that the hon. Gentleman will never be entirely happy that the Liberal Democrats have a solution to the problems of the health service. Nevertheless, we shall continue to do our best to persuade him that that is so. We had a costed manifesto at the last election, which promised real-terms increases far in excess of what the Government have achieved, and we explained how those would be paid for.

Each time there has been a Budget we have produced an alternative Budget, and we shall do so again in a couple of weeks' time. After the July comprehensive spending review, both opposition parties will be able to take stock of the state of the nation's finances, and will begin the process of explaining to the nation before next spring's election what our spending priorities are and how we would pay for them. We will take those policies into an election next spring to try to convince the public that there is a better way of doing it. If the hon. Gentleman will hold his breath for a couple of weeks, he will be able to see our alternative Budget.

I remind the hon. Gentleman that last week we debated why the Government had decided on a tax cut this April, although all the polling evidence suggested that people did not want it. According to the polls, at least 80 per cent. said that they would prefer the money to be spent on public services. The Bank of England is raising interest rates almost every month because it is worried about a consumer boom, yet the Chancellor is considering putting the extra money into the pockets of consumers who do not even want it. It is a bit rich for the hon. Gentleman to claim that Liberal Democrats do not say how things should be paid for, just when we are saying that £2.6 billion could easily be found for the purpose.

The long and the short of it is that health service professionals, health authorities and trusts continue to struggle with adverse circumstances. Patients can see the state of hospitals: they can see that there is a lack of staff and that the staff who are there are so overworked that they are having to rush around like scalded cats, and they find it unacceptable that more people are still waiting for longer than they were at the time of the last election.

The Government have introduced some policy initiatives, which we applaud, but those initiatives are no substitute for adequate funding of the health service. The Prime Minister has now set an ambitious goal; we await the Budget and the July comprehensive spending review to see whether the Government are sincere and serious in their attempt to achieve it.

I realise that not many Conservatives wish to speak—although their numbers have doubled in the past few moments: four Tory Back Benchers are now in the Chamber, which is encouraging—but several of my hon. Friends want to say a word, so I shall be brief.

This morning I read a piece in the paper—I cannot remember which one—by some learned professor who argued that the ablest Conservatives were now leading a move back to the centre ground. I have observed no move in that direction on the part of Conservative Front Benchers today. There has been no departure from the clear commitment to a move towards a privatised system that we have heard consistently from successive Tory health spokesmen since the election. Significantly, however, the motion makes no mention of the Tories' privatisation solutions.

That is because we are not going to privatise.

I have a degree of respect for the hon. Gentleman, who, like me, is a member of the Select Committee on Health. He works hard on the Committee, and understands some of the issues—not all, but some. However, I have read statements made by the hon. Member for Woodspring (Dr. Fox) in The Sunday Times, which we discussed during our last debate. Those statements make clear the direction in which the Conservatives intend to go, and, although this is not in the motion, it has been made clear again from the Front Bench that they see the NHS as a core service to deal with serious conditions, and expect people to seek private treatment for conditions that are less serious.

At 2.40 pm, the hon. Gentleman and I engaged in a debate on "Westminster Live", in which I plainly stated that both my right hon. Friend the Member for Richmond, Yorks (Mr. Hague) and my hon. Friend the Member for Woodspring (Dr. Fox) had said explicitly that the Conservative party would not privatise the NHS. My statement could hardly have been made more recently; I hope that it was clear.

Playing with words.

Indeed it is. The Conservatives say that they will not privatise the NHS, but the hon. Lady's colleagues say that a number of patients will be encouraged to seek a private alternative to the NHS. That is on the record, and has been on the record consistently throughout all our debates in the current Parliament. It is the Conservatives' clear commitment. The point that I am making is that their motion makes no mention of any of their policies. In a sense, it treats the House with contempt to table a motion that simply comments on Government policy and sets out no alternative whatever. It has happened before. More than halfway, possibly, through the Parliament, the public deserve some explanation of what the Opposition stand for. The picture that we get is that they stand for moving away from the state health care system.

Will the hon. Gentleman give way?

No. I want to make some progress.

As I have said, the debate on 18 January focused around the interview in the latest edition of The Sunday Times with the hon. Member for Woodspring and his detailed thinking on the future direction of health care under the Conservatives. I made a point of mentioning one specific part of the article. I did not quote his words out of context; I quoted them exactly within the context of the article. It quoted his views on the direction of Conservative policy:

The Conservatives are no longer concerned with the maintenance of the NHS as the primary provider.

There was a clear message there.

There was some mumbling from the Front-Bench team at that time. The Secretary of State said that the Conservative Front-Bench spokesman intended to write to The Sunday Times. I have read it every week since. I have seen no corrections. I have seen no suggestions from the Conservatives in the letters column or elsewhere that it was a misrepresentation, because it is exactly what the hon. Member for Woodspring said. The key point that the Secretary of State made is that the tax guarantee will reduce public funding. Clearly, the expansion of private health care is allied to that.

The problem that the Tories face—they have never answered the question, although I have raised it in every health debate since the last general election—is that, if they expand private health care, where will the staff come from? They will come directly from the NHS, so it is their policy to expand the private sector—whether we call it privatisation or peripheral—with people being encouraged, as they have been today, to take out private insurance and use the private sector for hip replacements, cataract operations or whatever. The purpose is to expand and increase use of the private sector.

The Tories do not seem to understand that the private sector does not train its own staff. It recruits them directly from the NHS, so their policy is all about robbing the NHS of its staff and skills.

Will the hon. Gentleman give way?

No. I want to carry on because many Members want to take part in the debate. I have taken one intervention. I hope that I responded to the point that was made.

The simple political fact is that the Tory party has given up on the NHS. I made the point during the speech of the hon. Member for North Devon (Mr. Harvey): two Tory Back Benchers were in the Chamber for a Tory debate. That shows their commitment to discussing concerns about the NHS. If they are getting hammered by their constituents about problems in the NHS, look at the Tory Benches: there is no one there. That shows that they are doing nothing but going through the motions. They see the private sector as the way forward. It is no surprise because, as we all know, the Conservative party has never believed in the NHS.

May I try to put the hon. Gentleman out of his misery? I know that he is keeping to a script that he obviously wrote some hours ago, but just to reassure him: Conservative Members do believe in the NHS, free at the point of delivery. That is why we are so concerned on behalf of our constituents about what is happening with waiting lists, out-patient lists, ward closures and the lack of funding.

I am still mystified. If there is such concern, why do we constantly hear about the mixed economy? The first statement—I will check the record— of the hon. Member for Woodspring was about that. That gives a clear message: the Tories want not the state health care system, but the mixed economy.

Will the hon. Gentleman give way?

No. With the greatest respect, I have to make progress.

That has been the consistent message for nearly three years. It has not changed, so people understand the direction of Tory policy and will make up their own minds, as they did at the last general election.

I should like to deal specifically with the subject of this debate, as described on the Annunciator: the Government's waiting list pledge at the previous general election, and the alleged distortion of clinical priorities. I have long examined the issue, and I know that there are 101 ways of measuring activity and progress—or the lack of it—in the national health service. As I have said many times, I should not have chosen waiting lists as the best way of measuring progress made in the health service, but should have thought that progress in public health is the best overall guide in judging Government policy. Nevertheless, I accept that I was elected on that pledge, and I believe that I have a duty to ensure that the Government deliver it.

I recommend to hon. Members an exercise that I performed the other day—read the manifesto on which we stood at the general election. I re-read the manifesto that I issued at the election, and it included the pledge on waiting lists. It seems—looking at my picture on the manifesto cover—that I look younger now, under Labour, than I did then, but that is a separate issue. The point is that, with the exception of that one pledge, on waiting lists, we have delivered all of our promises, and I am damned proud of that. I also have a vested interest in ensuring that I can tick the last promise, on waiting lists. Although I had reservations about including the pledge, I believe that we have to deliver it, and that we will deliver it.

Is the pledge distorting priorities in the NHS? A couple of weeks ago, the Health Committee conducted a brief inquiry into the winter pressures initiative. The hon. Member for West Chelmsford (Mr. Burns) attended the inquiry, so I hope that he will concur on this.

At the inquiry, I asked a question of the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), which I couched in these terms: "If I were the chief executive of an NHS trust and I faced the dilemma of choosing between meeting the Government's waiting list target or treating people on the basis of clinical need, what should I do?" She was absolutely clear and categoric in her reply: "You treat people on the basis of need. The health service should treat urgent clinical needs first." The Secretary of State made precisely the same point today.

If hon. Members say that that is not happening in various parts of the country, I shall need to see the evidence of it. Although I have heard anecdotal evidence that urgent clinical priorities are not being treated first, I have not seen concrete evidence of it. I listen to people and, every day, I receive many letters from people who work across the NHS, but I have not yet received a concrete example of the practice. If I receive such an example, I shall examine it. I shall also say that the people in the health service who are involved in the practice have not been listening to the Government's statements, which have made it quite clear that urgent clinical needs should be treated first.

At that Health Committee inquiry, we also compared the performance of two acute NHS trusts, one of which was in the constituency of the hon. Member for West Chelmsford, in Essex, with the other in the north-west of England, in Cheshire. Allegedly, one of the trusts was failing, and the other was succeeding. What I learned in the inquiry—perhaps the hon. Member for West Chelmsford took from it a different message—is that, when we examined in depth the two trusts' figures, we were not comparing like with like. I also learned that one of the trusts was intervening earlier than the other trust in certain medical conditions, and that that practice was increasing its out-patient waiting list.

One trust gave the Committee the specific example of cataract operations. That trust tackled cataract cases earlier than it had before, on an out-patient basis, and did not leave them for the condition to worsen. However, the change in procedure increased the number of people on the out-patient waiting list. The size of waiting lists is, therefore, not the most reliable way of measuring local performance.

I hope that, at the next general election, we might consider including in our manifesto pledges on measurements other than waiting lists. Although I have no problem with including waiting lists, we should do so within the wider context of measuring progress, or lack of it, on other health issues, not only in the health service, but in public health.

As other hon. Members wish to speak in the debate, I shall make only one or two brief points on issues that the Government still have to address. I believe that the biggest distortion in clinical priorities has been caused by private medicine. Part-time NHS consultant status leads to a scandalous distortion, often placing treatment of those who are able to pay before treatment of those on NHS waiting lists who are in greater need. The same consultants are treating people in both sectors.

I ask my hon. Friend the Minister whether the Government will consider conducting a sample audit of NHS and private operating lists of part-time NHS consultants and comparing the clinical needs of patients in each sector. I know for a fact that the outcome of such an audit will show that the clinical needs of those who are on NHS waiting lists are far greater than those of people being treated in the private sector.

The message that I want to give the Government is that the waiting lists problems that we are facing will be dealt with seriously only when moonlighting in the private sector is ended once and for all. We have faced that problem ever since the inception of the national health service, and it is about time the Government dealt with it seriously, on behalf of those—the vast majority of people—who use the national health service.

We could fund that solution by using within the NHS the money that is currently being spent by the NHS on buying care in the private sector. A lot of money is being spent on buying private sector care that could be devoted to the NHS. I hope that Ministers will consider doing that, because such a change would fundamentally alter the treatment received by NHS patients waiting on NHS waiting lists.

I also hope that we shall make much better use of the scarce resources that we do have. When one has been an hon. Member as long as I have, one will—as the hon. Member for West Chelmsford is well aware—have heard it all before. We simply move to the Benches on the other side of the House and carry on dealing with the same matters as we dealt with before. The current Government are bolstering the health service with ever more money, just as the previous Government did. I am always mystified as to where all the money the Tories provided went. In my backyard, all I could see was things getting worse by the week. The money seemed to disappear into a black hole somewhere. There still seems, to some extent, to be a black hole.

We have talked about ending the internal market, which I fully accept. I have also commended the Government on ending competition, which is now officially gone, as the Health Act 1999 made absolutely clear. As an analogy, however, when I go to a market, I see various stalls selling similar products. In health provision, we still have a whole load of stalls that are selling very similar products. I should like some of those stalls to be combined.

I should also like us again to address the purchaser-provider split. I remain to be convinced, when I see what has happened in my own backyard, that such a split makes sense. I talk to people who know far more than I do about local operation of the NHS, and they think that there is huge duplication and a lot of money—which should be spent on patient care—being wasted. I hope that we will revisit that issue. I also urge Ministers to re-examine the framework, to make it more sensible and to cut more of the bureaucracy and waste still in the system.

It would not be a speech by me if I did not also argue that there has to be a much closer relationship between the NHS and local authority social services. I commend the Government on the way in which they have moved the two spheres much closer together. However, like many hon. Members, I fundamentally believe that there should be formal integration of the services. It does not make sense to keep the two systems separated.

I was struck by figures provided, a couple of weeks ago, in the conclusion to the national bed inquiry, showing that two thirds of NHS beds are occupied by over-65s. Since the mid-1990s, one half of the increase in emergency admissions has been of people over 75. Since the early 1990s, one half of the extra emergency admissions of over-75s have been for frailty, not medical need. The inquiry report, which was very comprehensive, provides concrete evidence showing that a substantial proportion of NHS admissions arise as a direct result of the failure to offer people alternative care in the community. In a previous health debate, my hon. Friend the Member for Dartford (Dr. Stoate) gave an example of how he was able to provide such alternative care. We have to provide it, and combining the NHS with local authority social services would make it much easier to do so.

I am very proud of my Government's achievements on the NHS. I am proud that they are addressing the issue of quality, and that they are re-establishing public health as a key public policy issue. I am proud that, so far, they have managed to increase NHS funding, although I look forward to more funding. However, as I said, improving the NHS is not only about money, but about organisation. I am proud also that the Government have ended competition and restored to the NHS the philosophy of collectivism.

The hon. Member for Woodspring said that the Government have no core values. For goodness' sake, we represent the values of the vast majority of people in the United Kingdom. We believe in the values of the NHS that have stood this country in good stead since the 1940s. The NHS has an excellent future in the hands of the Labour Government.

It is a pleasure to follow the Chairman of the Select Committee on Health, the hon. Member for Wakefield (Mr. Hinchliffe). Like the Minister, I listened with great care—the Minister was probably a little aghast—to the hon. Gentleman's comments on what should happen to consultants. I hope that the Minister will fully answer the important points that the Chairman of the Select Committee made. Conservative Members will be fascinated to hear how much the Minister agrees with the hon. Gentleman.

It was also a pleasure in some ways to listen to the characteristically robust, but somewhat worn speech of the Secretary of State. In places, his speech was extremely interesting and non-partisan, and there were even points in it with which no fair-minded person could disagree. The trouble was that he, like many other Ministers in this Government, got hooked on the Millbank syndrome and had to repeat the same catch-phrases, buzz words and on-line messages that the Government try to get across to the country, regardless of whether they are based on fact. Sadly, the hon. Member for Wakefield could not resist clutching at the Secretary of State's coat tails. I refer in particular to the bogus argument about privatisation.

As the hon. Gentleman well knows, we were in government for 18 years. We did not, in any shape or form, in those 18 years seek to privatise the health service. In every year that we were in office, we increased the real-terms funding to the health service. Just to try to convince the hon. Gentleman, may I point out that I certainly believe passionately in the national health service? Under no circumstances would I tolerate its privatisation, in any shape or form.

I accept that the hon. Gentleman personally believes in the NHS. However, he supported and was a member of a Government who had a key fiscal policy of encouraging people to use the private health sector. His Government gave people tax breaks to do that. That does not suggest to me that they believed in the NHS. They wanted to get people out of the NHS and into the private sector, with a consequential drain on staff in the NHS.

The hon. Gentleman says that we encouraged people to use private health care. That may well be true in certain areas, such as tax relief on insurance premiums for the elderly, but it is not privatisation.

If one makes it attractive, through tax breaks for individuals, totally voluntarily to spend the money that they earn as they wish on private health care, that relieves the pressures on the national health service and must be beneficial to the people on waiting lists. I see no conflict between the principle of a free national health service and some members of the public wishing to spend their own money to make their own provision. There is nothing wrong with that and it is not privatisation.

I do not want to speak at great length on this subject, but shall make one final point about it. The Government are not averse to using the private health care sector to treat patients, albeit, rightly, free at the point of delivery to those patients. One of the Government's cherished promises—which was that no one would wait more than 18 months for hospital treatment—was broken in my constituency at the end of November and the beginning of December last year. Fourteen people had waited more than 18 months for treatment and the trust picked up on that problem. It was so terrified that it had embarrassed the Secretary of State and that the Government's cherished promise had been broken that it wrote to all those people to say that they could have their operations as quickly as possible whenever they liked, and the private sector carried out the operations. I am delighted for my constituents, because they quickly received their treatment, having waited longer than the Government said they would have to wait. That shows that the Government are not averse to using the private sector when there are problems.

I do not want to pursue this point, but I want to try to get one thing on the record. The hon. Gentleman is probably a good deal brighter than the average Conservative Front Bencher, so perhaps he can answer a fundamental question that none of his Front-Bench colleagues appear able to answer. When one pushes people into the private sector and expands it, where do the staff come from to service the private sector? They come directly from the NHS; that is the central point.

The hon. Gentleman's question suggested that people are forced into the private sector. No one forces people to take out private health insurance or to use private health care. As he has alluded to, there were in the past encouragements through the tax system for the elderly, but no one forced them to use the private sector.

There are two ways in which staff can be trained for health care in this country. The first—it trains the largest proportion—is through the health service and the second is through the private system, which trains a much smaller proportion.

Will the hon. Gentleman give way?

No, I will not give way, because I want to finish my point.

The hon. Member for Wakefield raised the issue of consultants and seems to be obsessed by it. I think that I can anticipate the Minister's answer to his suggestion. He will say no, but the hon. Gentleman probably thought it was worth a try to raise the issue. It will reassure the profession and bring relief to the Government when the Minister says that he does not agree with him. Significantly, he did not mention general practitioners, who are all self-employed. It was interesting that he mentioned consultants, but did not, for some reason, refer to GPs. I assume that that was an omission and that he would like to include them in his system.

No.

The hon. Gentleman says no. That suggests that he has a contradictory view. However, I want to move on, or we shall get bogged down in what is a minor part of my speech.

I read the Government's motion with interest and I listened to the glowing picture that the Secretary of State painted of NHS funding. He suggested that everything was absolutely magnificent in the health service. I agree that some things are magnificent. The staff—the doctors, nurses, consultants and ancillary staff who deliver health care to all our constituents—are excellent. I also concede that the additional money that the Government, like the previous Government, have given to the NHS is welcome. As the country's financial position dictates, and when the economy is healthy and more money pours into the Treasury from tax receipts and other sources, I would like more investment in the health service. I hope that the Chancellor of the Exchequer's war chest for the general election is not squandered buying up different target groups of the electorate for polling day some time, presumably, next year. I hope that more money is given to the health service.

My hon. Friend the Member for Woodspring (Dr. Fox) said that the £21 billion over three years for the whole of the United Kingdom is not as spectacular as the headline figure suggests. He said that, once it is broken down and analysed, and if one takes into account the partial funding of pay awards and medical insurance, in effect, it works out at £5 billion. When the country can afford it—we are perhaps at a unique point in my lifetime because the country can afford it—I hope that substantially more money will be put into the health service. I say that because of what has happened in my constituency, which is causing grave concern to my constituents. Sadly, they have not enjoyed health care that is as good and glowing as the Secretary of State suggested was the case throughout the land.

I shall be fair and say from the outset that, under the Labour Government of the 1970s and my Government from 1979 until the early 1990s, health service spending was allocated under the resource allocation working party system down to the health authority, and what is now the health trust. RAWP was a crude and painful exercise for my constituents because we were part of the North-East Thames regional health authority, which lumped together places such as mid-Essex with Hackney, Tower Hamlets and other east London boroughs, which, to be frank, have worse social problems than mid-Essex. As a result, a disproportionate amount of health care funding, which, on a pound per head of the population basis would have gone to mid-Essex where the population was expanding, went to the east end of London. At the end of RAWP in 1990–91, it was calculated that mid-Essex alone had lost out to the tune of £15 million a year.

My right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) abolished RAWP and, in crude terms, introduced a pound per head system. From 1990–91 until 1997–98, mid-Essex did much better on a pro rata basis and started to recoup some of the £15 million lost as a result of RAWP. Unfortunately, one of the first things that the Secretary of State did as Minister of State when the Labour Government took office in 1997 was to tweak the funding formula. To be fair, it was only a small tweak, but it meant that more money went back into the east end of London and mid-Essex is losing about £1 million a year that it would have had under the system that existed in 1997–98. I regret that.

As I said in an intervention on the Secretary of State, at the end of this month the Mid Essex Hospital Services NHS trust will have the worst deficit that it has ever had—£4.2 million. Last summer, when the trust believed that the deficit would be £1.8 million by the end of this year, it closed three wards. Owing to the community health council's representations that autumn, it agreed to keep one ward open and, subsequently, due to the winter pressures, it was forced to use part of a second ward, but that was guaranteed only until March. Since then, the deficit has exploded from £1.8 million to £4.2 million. Even the closure of all three wards will not meet the trust's deficit, because that was expected to save only £900,000. One wonders how on earth that deficit would be removed in a recovery plan without even more adverse effects on health care, unless the Government were to provide more money.

The Government's amendment says that my constituents and those of my hon. Friends should welcome the Government's

reduction in waiting lists and times that are being achieved through the dedication and hard work of NHS staff.

I wholeheartedly concur with the second half of that sentence, but the first half causes me problems. Once again, it is Government spin, which bears little relation to reality.

As my hon. Friend the Member for Woodspring said, the waiting list to get on to the waiting list has increased during the past two and a half years from 250,000 to just over 500,000. The Government have pledged to reduce in-patient waiting lists by 100,000 in the lifetime of this Parliament. We may have only 12 or 14 months to go, so they have an uphill battle. In the Government's first year, waiting lists escalated almost out of control. They then started to come down—to be fair, they came down to 50,000—then they rose again. The Government will say, with some credibility and accuracy, that that was due to winter pressures, but it remains to be seen in the coming months how much of that rise was due to winter pressures and how much to financial pressures and demand on patient care.

Sadly, we in mid-Essex have not shared in that so-called improvement. If only we had, my constituents would not write to me so often about their problems. In mid-Essex in March 1997, 8,361 people were waiting for hospital treatment. In December 1999, the latest available figure, it was 9,851. In March 1997, 104 people, and falling, were waiting 12 months or more for treatment. In December 1999, the figure was 1,060, and rising. We have the added indignity that, at the end of November, early December, the Government's most cherished promise that no one would wait more than 18 months for treatment was also breached, yet we had no apology.

On out-patient lists, the Government thought that they had come up with a wonderful little wheeze. Some bright spark, realising the problems faced by the previous Secretary of State, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), because the figures were not falling and he had rashly said on the "Today" programme one morning that if they did not come down he would resign, decided to save the right hon. Gentleman's bacon—that was before the Prime Minister decided to save it for him by making him the Labour candidate for the mayor of London—by stringing out the length of time before anyone ever sees a consultant after having seen the GP, so creating a significant waiting list to get on to the waiting list for treatment. Nationally, that has been a disaster. The figure has risen from 250,000 to more than 500,000.

In my constituency, matters are even worse. In March 1997, a total of 555 people were waiting 13 weeks or more to see a consultant. Now, the figure is 3,699, which is unacceptable. That is why we need more money.

I come now to the distortion of clinical needs. The Secretary of State said that that does not exist and the hon. Member for Wakefield confirmed that. But, as Mandy Rice-Davies once said, they would say that wouldn't they? It is in their interests to try to spin that line. Unfortunately, to use a stockbroker term, what we are seeing is churning. If an operation is relatively minor, cheap and quick to do, it will be done more quickly than a non-emergency operation that is more complicated, expensive and time consuming, because of the pressures being placed on hospitals and trusts to deliver the Government's deadlines and targets.

As a general election approaches, the pressures will build even more, because the Government will have to show, by hook or by crook, that they have honoured their pledge on waiting lists. They may do it with mirrors or spin, but, whatever the real situation, they will claim to have achieved it because it would be too politically embarrassing for them to admit otherwise. People in the real world, waiting for treatment, will know what the Government are up to.

There is the further problem of trolley waits. Unison did a survey of my local hospital, Broomfield hospital, from 31 October to 5 December 1999. That end date is slightly before the problems of the winter pressures kicked in, so that cannot be used as an excuse. In that period, the number of people having to wait on a trolley from four to 12 hours for a hospital bed was 120. Even worse, the number waiting from 12 to 24 hours was 47. It is unacceptable to have people waiting around in A and E departments or elsewhere to get onto a ward.

Chelmsford has a problem that is shared throughout the country: the cancellation for non-clinical reasons of non-emergency treatment. A survey conducted at Broomfield between October and 22 December 1999—again, just before the winter pressures began to have a significant impact—showed that the number of people whose operations had been cancelled a month before admission was 118, but the number whose operations had been cancelled on the day of admission was 201.

Imagine being psychologically prepared for an operation, with the mental anguish and worry, and turning up at the hospital only to be told that, for non-clinical reasons, the operation has been cancelled. That is unacceptable. Everyone accepts that, if there is a major road accident or a disaster, operations will have to be cancelled to give precedence to emergency treatment, but for those 201 people, that was not the case. That is terrible.

The half-baked solution, which will not work, was to announce the closure of three wards in my constituency, with the loss of 84 beds. To be fair, part of the solution was to eliminate the problem of delayed discharge, and I welcome that, but the wards should not have been closed: they should have been used to bring down the waiting lists. I see the hon. Member for Harwich (Mr. Henderson) nodding in agreement. I wonder whether he knows that, six months after the introduction of the policy of working with social services to eliminate the problem of delayed discharge patients in hospitals, the number of people in Broomfield as delayed discharges is 89.

On a point of order, Mr. Deputy Speaker. Is it in order for the hon. Gentleman to filibuster the debate when many Back Benchers want to take part in this very important discussion?

That is not a point of order for the Chair, as the hon. Gentleman knows.

Thank you, Mr. Deputy Speaker. It is a sign of the hon. Gentleman's embarrassment that he has to call my speech a filibuster. He does not like to have to listen to what is going on in the real world, as it does not dovetail with the spin from Millbank. He should learn, because I cannot believe that his constituents do not write to him complaining about delays in their local hospital.

Everything is not as rosy in the NHS as the Secretary of State would have us believe. I am the first to wish him well, because we all want the most effective and efficient provision of health care for our constituents within the health service, for those who choose to use it. I only wish that, instead of trying to convey a situation that does not exist, the Government would be a little more honest and consider some of the tough decisions that will have to be taken to ensure that the health service continues to develop and improve, providing the health care that we all want for our constituents.

rose—

Order. So far, there has been no speech shorter than 18 minutes in this debate. I appeal to hon. Members to realise that shorter speeches make more friends.

Thank you for calling me, Mr. Deputy Speaker. I have told my Whip that if I take more than 10 minutes he must pull me down.

The hon. Member for West Chelmsford (Mr. Burns) said that his party was in power for 18 years and did not privatise the national health service. The reality is that it did. Anyone who knows how difficult it is for a constituent to get on an NHS dentist's list will realise that the Tories deliberately and cynically pushed dentistry out of the national health service. The vast majority of people who need dental treatment now have to pay for it. I needed dental treatment and refused to go private, but I had to wait three months for an appointment. That is what the Tories did: they privatised the NHS and they would do even worse next time.