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Ms Harman: That is fantasy.

Mr. Dorrell: It is not fantasy. The hon. Lady should look at the speech. In it she made a number of specific commitments to extra spending: it was an extremely expensive speech. The reality is that matters have become somewhat tighter since she left that post. They are probably not tight enough, but certainly tighter, and particularly in the health service. The Leader of the Opposition not only dictated the key sentences in the document from which I have quoted but made some statements on television which the hon. Lady would find quite uncomfortable. In "The Money Programme" on 24 September the right hon. Gentleman was specifically asked about extra spending on the health service. Peter Jay asked:

"It is your strategy, I think, that people are interested in. You will yourself have to increase taxes, will you not, in order to finance the increased spending programmes which Labour is talking about?"

The Leader of the Opposition replied:

"Well, you don't need necessarily to increase spending at all."

He did not speak about taxes, and he went on:

"In many of the areas we are talking about, for example, in the health service, there is money being wasted."

In response to a question about extra spending, the right hon. Gentleman was specifically making it clear that he regards extra money for the health service as an extremely low priority and was not prepared even to commit himself

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to any increased spending. That is a less generous commitment to the health service than that of the Government, because we are committed to a year-by-year increase in the real resources that are made available to the national health service. That increase has averaged 3 per cent. per annum in real terms since 1979.

I acknowledge that there is no difference between the parties on the commitment to the delivery of a high-quality, universal health care system. The real division is between Conservatives, who are prepared to take the necessary steps to deliver it, and Labour, which is prepared simply to wish for it without facing any of the real decisions. The question that the House and the country must face if we want to deliver a high-quality health service is how to sustain and deliver it, given the background of rising expectations, the advances of modern medicine and all the other pressures.

If the hon. Lady is to be taken seriously in her new portfolio, she will have to address some key issues. She has to recognise, as her predecessor ultimately and rather begrudgingly did, that the traditional health service was undermanaged and that investment in managing the service was needed. Secondly, we have to ensure that managers in the health service are allowed to improve its efficiency. Labour's commitment to abandon market testing must be ditched. That commitment would cost Labour £130 million and it would deliver exactly the same patient services but more expensively.

The hon. Lady will have to consider her predecessor's affection for regional health authorities. It is extraordinary that, although the hon. Lady likes to make speeches about there being too many administrators, Labour opposed the abolition of regional health authorities. That means that Labour opposed a saving of £60 million during the passage of that legislation in the previous Session. The Opposition will have to look again at how they develop their policy on partnerships with the private sector. They will have to allow institutions to change because if the health service is to deliver an efficient, high-quality health care system next year or five or 10 years hence, Labour will have to face some hard decisions.

Labour must recognise the need to invest in research and development, and that is the easy bit--extra money to understand what is effective. When that knowledge has been developed, it has to be used to ensure that clinical practice changes and that clinically less effective treatments are not preferred. The hon. Lady will have to learn about those pressures and disciplines if she is to be taken seriously as a party spokesman who is interested in and committed to the future of the NHS.

The Government have led the way at every stage in the process of health politics. I do not challenge Labour's general, genial good will towards the NHS. The Opposition certainly offer ineffectual support and make speeches about what a wonderful institution it is, but when the chips are down, they offer no real commitment to the NHS because commitment does not mean soundbites: it means thinking through the issues, understanding them and producing solutions. It means fighting against the vested interests that often oppose solutions and taking difficult decisions.

Ms Harman: Who are they?

Mr. Dorrell: One of them consists of the people who opposed market testing. Nurses are a great vested interest.

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I look forward to seeing the hon. Lady taking to the barricades and fighting the vested interests of nurses--if that is what she thinks they are. She will have to learn to resist the soundbite and prefer substance if she wants to be taken seriously as someone who is committed to the future of the NHS. Labour offers only a feeble echo of what the Government have decided to do. It is a late echo, a late endorsement of what has been shown to work. That is the true divide between the parties. Labour Members are not participants in the argument, but dilettante bystanders until the solutions have been shown to work. Until we hear something of substance from the Labour party about how the health service can face the next decade's challenges, it will be viewed by all true friends of the national health service with contempt.

10.29 am

Ms Harriet Harman (Peckham): The Secretary of State for Health is clearly practising for Opposition. He sounded not like the Secretary of State, but the shadow Secretary of State. In his wholly defensive speech, which lasted for nearly 55 minutes, he spent most of his time attacking Labour's plans for the national health service and hardly any time defending his Government's NHS record, let alone putting forward how they will solve the problems that they have created in the NHS. All he can do, like the other Secretaries of State, is attack Labour instead of getting on with the business of good government. That is exactly what we have seen this morning.

The Secretary of State for Social Security (Mr. Peter Lilley): The hon. Lady is reading from a prepared speech.

Ms Harman: I wrote those words on hearing the speech of the Secretary of State for Health. I could not possibly have anticipated how defensive he would be.

Labour has made health the subject of this debate on the Gracious Speech because it has a duty to expose the Conservatives' hidden agenda. The two-tier health service is with us today and the privatised NHS will be with us tomorrow: that is the sole aim of Tory health policy. The British people are proud of the NHS. They believe in a health service that is free at the point of need. With good reason, they do not trust the Tories to sustain and support that health service.

I shall set out what lies behind the Tories's health policy, how, under a Tory party that has lurched to the right, we are clearly on the road to a privatised NHS and what we will do to stop that process.

Of course I would not have expected the Secretary of State to deal with the Tory health agenda today because it is a hidden agenda. The Tories do not want this debate now or in future. The former Tory party deputy chairman, John Maples, spelt it out clearly and gave the game away. In his notorious Maples memorandum, he said that, for the Tories

"the best coverage for the next 12 months would be zero media coverage on the national health service."

He clearly recognised that any news on the NHS was bad news for the Tories.

Mr. Donald Anderson (Swansea, East): Far from zero publicity on the health service, is it not a fact that people up and down the country are recognising the real crisis in the health service? I look forward to handing to my hon.

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Friend an unprecedented edition of the local newspaper in south-west Wales, the Evening Post, entitled: "Your Health Service In Crisis: Sick and Tired", in which even that independent newspaper felt impelled to show to its already knowledgeable population what is happening locally and throughout the country.

Ms Harman: I shall carefully consider the information that I hope my hon. Friend will give me. Of course he is right. The British people will not allow the truth about the national health service to be swept under the carpet by this Government and nor will we.

Labour created the NHS and it is our duty to ensure that Tory Ministers do not succeed in destroying it.

Mr. Hartley Booth (Finchley): The hon. Lady refers to truth. As she is in favour of truth and open government, will she say what Labour Front-Bench Members receive from Unison?

Ms Harman: I am not dealing with that point in this speech. All the Registers of Members' Interests are properly complied with and, if the hon. Gentleman wants, he can look the information up in the Library.

Labour created the NHS and we will not allow distractions from the Tory Back Benches or hidden agendas from the Tory Front Benches to distract from that. The Tories' single-minded agenda, relentless but never admitted, is to push as many services out into the private sector and, at the same time, make the NHS work like the private sector. All that is done in the face of opposition from people who use the NHS and work in it, whose morale is at an all-time low.

Take the case of long-term nursing care. Close the long-stay wards and people must go into the private sector. They used to receive treatment free and now they have to pay. Take the case of dentistry. First, charges were pushed up so high that people could hardly tell the difference between NHS and private dentistry; then fewer and fewer dentists did NHS work, so more and more people ended up going private.

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