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Mr. Arnold: Will the hon. Lady give way?
Ms Harman: I should be grateful if the hon. Gentleman would desist.
Without clear national guidelines, people with assets above the new threshold will still pay for care which may be free in other parts of the country. Under the Conservatives, where one lives determines the care that one gets and the price that one pays.
The Chancellor of the Exchequer (Mr. Kenneth Clarke):
The hon. Lady has just said that the doubling of the disregard for contributions to residential care is inadequate. To what level would the Opposition raise the disregard and how much would that cost?
Ms Harman:
I am grateful that the Chancellor is asking me for advice; he has at least learnt something. The question on his Budget that he has to answer is how many of the elderly people who fear that the lifetime savings that they have accumulated and invested in their homes will disappear because they have to go into residential care will no longer have to worry about that. The answer is that his Budget at least recognised that there was a problem, but it failed to address it and that is what we charge the Chancellor with today. If he is asking us to produce a Budget, let him call a general election, after which we shall sit on the other side of the House and my hon. Friend the Member for Dunfermline, East (Mr. Brown) will deliver our Budget.
Mr. Clarke:
I have made it clear what we would do; it is what we have done. We have doubled the disregard at considerable public expense. I stand condemned by the hon. Lady, who says that the disregard is not good enough and does not satisfy her or elderly people. It follows perfectly logically that if we had a credible Opposition the hon. Lady would say what the disregard should be. She would have calculated how much it would cost and she would have got the permission of the shadow Chancellor, who is sitting alongside her, to say how much it would cost. It is clear that the hon. Lady has no more idea than the shadow Chancellor as to what the Opposition's policy is on this or on anything else.
Ms Harman:
The Chancellor is trying to make--
Mrs. Jane Kennedy (Liverpool, Broadgreen):
On a point of order, Mr. Deputy Speaker. With reference to the
Mr. Deputy Speaker:
Fortunately, this Deputy Speaker does not have eyes in the back of his head.
Ms Harman:
The Chancellor has recognised that there is anger and concern throughout the country about elderly people who would previously have got long-term residential care without having to sell their homes to pay for it. The Prime Minister promised that there would be a cascade of wealth down the generations, but that promise has been broken. The Chancellor said that he would address that problem in his Budget. I am here at the Dispatch Box today to say that he has not done so and that the Government have failed to keep their promise to address the problems that they helped to create.
Mr. Simon Hughes:
I understand the hon. Lady's point about seeking more resources for community care and for hospital building, but in that case why will she and her colleagues not vote tomorrow against the Government's proposal to cut the rate of basic tax by a penny in the pound?
Ms Harman:
We shall vote against the Budget because it has no vision, no direction and no strategy. We have tabled an amendment, and the hon. Gentleman is welcome to vote for it. Our proposals would deliver investment, jobs and fairness. On the cut of one penny in the pound, we are saying that people have suffered enough. One of the things that they have suffered is broken promises.
The next great engine of privatisation is rationing in the national health service. When people cannot obtain what they need on the NHS, they have to go without that treatment or they are forced to pay for it and go private. It is no good protesting, as many Conservatives do, about the word "rationing", because some local health authorities are calling it that. Rationing varies from authority to authority. That is why Sandy Macara, chairman of the British Medical Association, has said that access to treatment is becoming a national lottery.
What one can get on the NHS increasingly depends on where one lives. Rationing--that is, excluding treatment under the NHS--is taking hold at local level so that one now has to be careful where one gets ill. Do not get the menopause in west Kent, as there are to be no specialist menopause services there. Do not get brittle bones in west Dorset, as there is to be no osteoporosis screening there. Do not get infected wisdom teeth in Hertfordshire or Kingston and Richmond. Do not get glue ear in the Isle of Wight, because it has declared itself a grommet-free zone.
The NHS is becoming a lottery, but there is a pattern. Rationing starts with those operations which are the most controversial, such as gender transformation, sterilisation reversal and abortion, but that is just the thin end of the wedge. The Government seek to establish the rationing process with the less popular procedures. Having gained acceptability for the inevitability of the rationing process, they can then swiftly move on to other treatments. Yesterday it was grommets and fertility treatment; today it is varicose veins and osteoporosis screening; tomorrow it will be hernias and hip replacements.
Mr. Rowe:
I have often heard the hon. Lady say that what treatment one receives depends on where one lives, but most of the other members of her party's Front Bench
Ms Harman:
The hon. Gentleman is muddling two distinct things. We are saying that it is wrong for managers, area by area, to issue edicts which simply chop different national health service treatments off the list of what they provide locally. When the Secretary of State defends rationing, he often tries to imply, as he did again in the House today, that the removal of treatments from the NHS is part of the drive for clinical effectiveness. It is nothing of the sort.
Of course medical practice changes and the pace of change is accelerating. That means that we must have evaluation of treatments and dissemination of information, agreeing best practice, ensuring that clinicians are properly trained and kept up to date using new technology, and monitoring practice, doctor by doctor and hospital by hospital. But the prime reason for ensuring best practice is because it is in the interests of the patients.
That is the key issue. We are arguing for best practice in the interests of patients; the Government are using the argument of clinical effectiveness as a smokescreen behind which they allow managers at local level to chop services altogether.
Sir David Mitchell (North-West Hampshire):
Is the hon. Lady not aware that fundholding doctors can choose where to send their patients, so if certain services are restricted in one region and available in another, fundholding doctors can make use of that to send their patients to such regions for their benefit?
Ms Harman:
Before the Government introduced the internal market, all general practitioners were able to refer their patients to whichever hospital they thought was most convenient or would provide the treatment best suited to the patient's condition. Since the Government introduced the internal market and contract system, only GP fundholders have that freedom for referral.
On bureaucracy, it is ironic that rationing and assertions about what the national health service can no longer afford to do should come at a time when there seems to be a bottomless pit, an infinite demand for spending on bureaucracy. Earlier, the Secretary of State took some time talking about extra resources, but look where the money is going: it is going into the bottomless pit of NHS bureaucracy that the Government have created.
Three more things are driving the engine of bureaucracy into the national health service. First, if more GPs become fundholders, that is an extra £80,000 per practice on administration and every hospital will have to do more administration to deal with dozens of different purchases. Secondly, if local pay bargaining becomes a reality, as the Government wish, there will have to be new and enlarged personnel departments in every NHS trust to deal with that. Thirdly, having been told that there is no longer any money left in the NHS capital budget, NHS
managers will have to spend thousands of hours trooping around different private consortia trying to obtain private money for capital projects.
The cost of the internal market is already an extra £1.5 billion per year on administration. When people see the Government pouring billions of pounds into national health service bureaucracy, why should anyone accept that the NHS cannot afford to give them the treatment that their doctor says they need?
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