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Mr. McLeish: Would the hon. Gentleman like to extol the virtues of the 59 per cent. of fundholders throughout England that are commissioning groups?
Mr. Hayes: The hon. Gentleman refers to commissioning groups, but I understand that one of Labour's policies is that the internal market, or the split between purchaser and provider that has been denounced over the years at the Dispatch Box from which the hon. Gentleman will shortly address the House, will continue. Does the hon. Gentleman deny that? Of course not, because he knows that it works.
GP fundholders have been a great success, offering more services than ever before. There are now some 10,000 of them, covering 41 per cent. of the population, and it is expected that there will be an additional 660 by next year. If there is--heaven forbid--a Labour Government, the majority of people in the country will be covered by GP fundholders that work. According to GP fundholders in my constituency and elsewhere, it would be a grave mistake if they were not to continue.
That is why the fudges are beginning. I mentioned in an earlier intervention on my right hon. Friend the Secretary of State that the right hon. Member for Derby, South (Mrs. Beckett)--Labour's previous health spokesman--extolled some of the virtues of GP fundholding in October 1995, but had added that she hoped that they would be abolished in the first year of a Labour Government. I assumed that that would again be a Labour manifesto commitment as it was in 1992, but oh no. We now hear something totally different from the hon. Member for Peckham. The policy is now shrouded in secrecy, and I hope that the hon. Member for Fife, Central--as this is an Opposition Supply day--will tell us what that policy is.
What is a "comprehensive health care agreement", and how would it differ from the contract that we have at the moment? The hon. Gentleman knows that the contract system works because it gives incentives. Clive Wilkinson, chairman of the Wolverhampton NHS trust, said on BBC television:
I cannot see how the hon. Gentleman can possibly disagree with that.
There is total confusion among Opposition Members about the private finance initiative. On the day when the virtues of the PFI were extolled by the Opposition Treasury team--I can give the hon. Gentleman the quotations, although I am sure my hon. Friend the Minister of State will do so when he winds up--the hon. Member for Peckham
was calling it "creeping privatisation". Yet the PFI was extolled by the hon. Member for Rother Valley (Mr. Barron), who said it was a Labour party invention. Again, there is confusion and division in the Labour ranks.
Hon. Members should cast their minds back to before the reforms, to the time when no one knew the price of anything at all. If one does not know the price of a treatment, a medicine or a bandage, how on earth can one plan for the future? We must spend the money wisely. My right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) reminded the House that the Government were castigated when we introduced sensible management programmes.
I shall deal now with the Labour accusation of bureaucracy. The hon. Member for Fife, Central nods his head, and I suspect that he will later speak against bureaucracy with the eloquence of Satan denouncing sin. What does Labour want to do? It wants another tier of regional health authorities, which some of us have been trying to get rid of for years. That would cost £100 million, money that would be removed from patient care. The hon. Gentleman would have to get that £100 million from the Treasury if Labour were in government. The hon. Gentleman also wants a minimum wage--[Interruption.] Perhaps he does not want a minimum wage.
Mr. Hayes:
According to the hon. Member for Livingston (Mr. Cook), the minimum wage would cost the health service £500 million, and that money will all be taken away from patient care. The Opposition's policies are all about centralisation, whereas the Government's policies on health are very simple--we have decentralised, and brought better patient care to ordinary people. Since the introduction of the "wicked" reforms, 1 million more people have been treated, and the House will have heard my hon. Friend the Member for Wycombe (Mr. Whitney) give the figures. Some £41 billion is being spent--66 per cent. above the rate of inflation. We have the lowest waiting lists ever, and we have the citizens charter. Did one hear anything about a citizens charter under the previous Labour Government? It was derided by the Opposition as a rather sick joke--[Interruption.]--as a citizens anthem, I am grateful for the correction.
Mr. Edward O'Hara (Knowsley, South):
Is the hon. Gentleman aware that the citizens charter concept was invented by Labour local authorities long before the Prime Minister ever dreamt it up?
Mr. Hayes:
I am grateful to the hon. Gentleman. I wish that he had told that to his hon. Friends on the Front Bench at the time, who were so vehemently opposed to the concept. That is yet another division in policy in the Labour party.
Under the patients charter, we set down clear times for operations and for when ambulances should arrive at the scene, and we introduced checks and further checks.
Mr. O'Hara:
The Labour party criticised not the concept of the citizens charter, which it applauds and preceded the Government in thinking about, but the lack of resources to implement the set targets, which were utterly unrealistic.
Mr. Hayes:
The hon. Gentleman has highlighted the exact problem I was about to consider. In the past, all the
How much money will the hon. Member for Fife, Central pledge for the NHS? How much extra money will it take to get people off the trolleys? The Opposition have not pledged to the British people one single extra penny for the NHS. How do they intend to improve the health service, apart from the added bureaucracy of which we have heard, if they do not intend to spend any more money? Will they claim to be better managers of the NHS than the Conservative Government and NHS experts?
Let us destroy another little myth. We hear that the health service is overmanaged, but for every 26 front-line staff, there is one manager. Opposition Members should compare that with the relevant figures in France, Germany, the United States and the rest of Europe. They should check those figures and note that those managers account for just 4 per cent. of the NHS wages bill. We are very lucky to have such a management in the health service. Of course the Secretary of State is absolutely right to ensure that there is no waste and inefficiency.
Ms Janet Anderson:
Is the hon. Gentleman aware that in North East Thames region, which covers his constituency, in the past five years, the number of managers has increased by no less than 260 per cent.? Does he think that that represents an efficient use of resources?
Mr. Hayes:
If the hon. Lady looked at the figures, she would understand why that has happened. There has been an increase in managers all over the country because we happen to believe in a good role for women in management.
Mr. Hayes:
I thought that Labour was a politically correct party. Because we recognise the value of women and the value of nurses, we have re-registered many of them as business managers.
Ms Anderson:
Is the hon. Gentleman talking about nurses or about managers? Is he saying that all the extra managers are women?
Mr. Hayes:
There are nurses of both sexes. The hon. Lady can check the accepted facts in the Library, which show that many nurses have transferred to management posts. That is all that has happened. I note that the Minister of State, Scottish Office is nodding in agreement. The figures can be sorted out another time, but I promise the hon. Lady that what I say happens to be the truth.
If anyone wants to see decent health care, he should come to my constituency. I spent a long time fighting with respective Ministers because Harlow was genuinely underfunded under the RAWP--resource allocation working party--system. It was desperately unfair to my
constituency because so much of our money was sucked into London and elsewhere. We had some of the longest waiting times in the country and the three accident and emergency departments did not operate terribly efficiently. The service was a catastrophe because we were constantly in debt.
"You do have to have in the final analysis, don't you, the ability to take the contract away. Otherwise, if you don't have that, then all the incentive to the provider to deliver what they are asked to deliver disappears. We know from past experience that just cajoling public servants to do better is not effective".
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