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Mr. Robert Maclennan (Caithness and Sutherland): Is it not unlikely that, by absenting himself from the debate, the Secretary of State will promote consensus?

Mr. Hughes: I find the Secretary of State's absence surprising. I am glad that the Minister of State and the Under-Secretary of State are present, but, if the Secretary of State thinks the NHS as important as he claims, he should be here. This may well be the last debate on the NHS before the general election, which is another reason why the person in charge--in a system that I must say is very undemocratic: no other elected person can be in charge even locally--ought to be present.

Politicians will need to be bold. It is widely recognised that the Tory and Labour parties are not yet rising to the challenge. I am not the only one who says that: it was said the other day on a Radio 4 programme in the "Analysis" series, presented by Andrew Dilnot, entitled

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"Free for All". Let me briefly quote from what he and Chris Ham, professor of health policy at Birmingham, said in the programme. Andrew Dilnot said:

    "Clearly and unambiguously committed"--

the Secretary of State, apparently, is so committed--

    "to high quality, universal, tax-funded healthcare . . . With both major parties so firm in their backing of the NHS, surely we can just relax in the security of knowing that it will be all right.

    No, we cannot. In fact there is now a real risk that over the next five years the NHS will cease to be a universal, comprehensive, free service, without any real debate, because neither party"--

neither of the main parties, that is--

    "is prepared to promise anything like the rate of growth in spending seen throughout the life of the NHS."

Professor Chris Ham said:

    "This year is the toughest year for the Health Service in the last decade. There's always been a funding problem in healthcare because demand exceeds supply of resources, but in the current year that's a particularly acute problem. We're finding that hospitals all around the country, health authorities and GPs, are finding it very hard to make ends meet. In that sense the wheel has come full circle because a decade ago Mrs. Thatcher, when she was the Prime Minister, was forced to set up a review of the Health Service because of the funding problems. That review has led to increased efficiency and greater responsiveness but it's not really tackled the long-term underfunding of the NHS and it's that problem that the NHS continues to grapple with."

Mr. Phil Gallie (Ayr): Will the hon. Gentleman give way?

Mr. Hughes: Not for the moment: I want to proceed.

Therefore, there is no dispute that there is a long-term problem or that we owe an enormous, probably unspeakable, amount to the work of the people who are in the NHS locally in our constituencies, regionally and nationally. There is no doubt that many of them work under perpetual pressure and often regular crisis in the frontline, saving and extending lives and alleviating pain every day.

The predicted winter difficulties have, in large measure, come to pass. Hon. Members do not have to take my word for it. They just have to read reports in the past couple of days from the Greater London Assn of Community Health Councils and the British Medical Association, or a briefing from the Royal College of Nursing for today's debate. I did not know that it was going to be on, but last night I watched a report on "Newsnight" by Alexis Rowell on the health service in Whipps Cross hospital in north London. The report confirmed the crisis and acute difficulties of coping with people, some of whom testified to spending two days waiting in the casualty department before admission to a ward, and to not being able to get a moment's sleep--understandably, because it is a busy place and that is not where they should have been cared for.

Above all, hon. Members do not have to take the word of politicians or journalists if they talk to people in the health service. This morning, my right hon. Friend the Member for Yeovil (Mr. Ashdown) and I met a nursing student and three nurses: Jerry, an accident and emergency nurse from Homerton hospital in Hackney; Tracey, an HIV and AIDS staff nurse from just across the river in St. Thomas's hospital; and Richard, a senior staff nurse working with older people who are acutely ill. They all confirmed that there is a need for more staff, for better

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training and for urgent provision of methods to ensure that we keep staff--who, at the moment, often choose to leave. They also confirmed that we have the facilities for patients, who are just not receiving them.

Mr. Matthew Banks (Southport): Will the hon. Gentleman give way?

Mr. Hughes: Yes, but this is the last intervention.

Mr. Banks: I just wonder whether I could ask the hon. Gentleman, in view of that visit, where the right hon. Member for Yeovil (Mr. Ashdown) is at present?

Mr. Hughes: I do not know the answer to that question, but I assume that my right hon. Friend will be here shortly and certainly he has spent a lot of time in recent days on health service matters.

On the motion and the Government amendment, the big questions are these. Is the NHS doing enough, which in Government-speak is a question about volumes? Is the NHS doing it well, which in Government-speak is a question about quality of care; and has the NHS been given adequate resources, which in Government-speak is a question of NHS spend? My party's view is that, sadly, we are not doing enough, and we are not always doing it well enough; and those two conclusions are not surprising because we are not spending enough.

We have real concerns about the volumes. Where we used to count patients, we now count episodes of treatment. People whom we used not to count as admissions--for example, newborn babies--are now additional parts of the statistics. There is now widespread, probably universal, public and professional scepticism about the Government figures on increased volumes. In terms of separate individuals being treated by the NHS, those figures no longer accurately add up. We believe that the NHS statistics must be collected, verified and reported by a body independent of Government and of party politics. We propose a practical way of doing that. We are worried about the fact that no one independent of the authorities vouches, when people are discharged from treatment, for the fact that that treatment has been properly administered. We believe that the quality of work done in the NHS by the NHS should be checked, verified and reported by a body independent of the Government of the day and of the authorities, and independent of party politics in general. We propose a practical way of doing that.

We also have real concerns about costs. Again, no one independent of the authorities vouches for whether the NHS is given enough resources to do even the minimum amount of work that we expect it to carry out. An assessment of what the NHS needs should be done by a body independent of Government and party politics. Here too we propose a practical way of achieving that. The NHS needs an independent assessment of supply and demand, of the quality of its care and of what we should spend on it.

How we pay for the NHS is a separate question. I suspect that the debate over the next few years will develop our idea of hypothecating taxes instead of simply assuming that the NHS can always win its share from general tax and revenue held by the Treasury.

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For us, therefore, three issues must be dealt with: investment, planning and accountability. For us, investment means--above all--investment in staff: doctors, midwives, nurses and allied professions. We are committed to spending an amount equivalent to the cost of 10,000 nurses or 5,000 doctors to get the NHS back to a state in which it can do the job.

Waiting lists must be reduced; they are currently rising. The public should not have to wait, as they often do, for 18 months for routine operations. That requires investment; we have identified the money that can go into reducing those waiting lists. We believe that, over a three-year programme, waiting times could be reduced to six months.

Mr. Gallie rose--

Mr. Hughes: I have already said no. This is a half-day debate, and I want to give colleagues a chance to speak.

We must also make sure--careful language is called for here--that NHS expenditure keeps pace with inflation. The Government say that they are committed to year-on-year real-terms growth--referring to general inflation--but everyone knows that the NHS costs a bit more, and that, unless expenditure on the NHS keeps pace with NHS inflation, a real reduction in funding will occur.

There has been some debate this week about public sector pay. Last year, the nurses were awarded a flat rate--sometimes topped up locally--increase of 2 per cent., which was below the rate of inflation. This year, according to Red Book projected expenditure on health and community services, and if the award recommended by the review committee, when it is announced tomorrow after the Cabinet meets, is about 3.3 per cent., that amount can, we believe, be afforded.

An analysis of the real-terms growth in the budget for health and community services shows that the 3.3 per cent. increase anticipated by the Government for next year leaves money to spare to allow the Government to agree the recommended increase. We believe that the Government should tomorrow, without demur and without phasing, agree to implement the recommended award; and we would expect the Labour party to agree with us that the money should be paid straight away.

If morale is to be restored to the health service, it is essential to honour an independent recommendation on pay for the 1.3 million people at the bottom end of the public sector. We should stop being distracted by the pay of a very few at the top end--although they seemed to be the preoccupation of the shadow Chancellor this morning. Moreover, we must bring back national pay negotiations. Most of the health service has not even settled yet for last year, which is clearly nonsense. It wastes a great deal of professional time; it wastes millions of pounds. We think that the NHS should have a single pay review body, so that the chief executive and the porter, as well as the doctor, the dentist, the midwife and the nurse, all have their pay assessed at the same time.

Our motion also contains the simple proposal that we reinstate free dental and eye checks--an idea which has the support of Members on both sides of the House, as confirmed by their support for early-day motion 471, which was tabled by the hon. Member for Exeter(Sir J. Hannam).

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According to the Minister's answer of 27 January 1997, it would cost £120 million a year to reinstate eye tests, and £60 million a year to reinstate free dental checks--a total of £180 million a year. The Royal National Institute for the Blind confirms that people are becoming ill and are suffering incurable eye disease because of the loss of those free checks. We believe that the House and the public would be united in backing as a high priority the restoration of those preventative health measures by finding the relatively small amount of money required.

Thirdly--although the Secretary of State has hinted that he and the Government are moving towards this view--we believe that it is not possible to conduct planning in the health service if contracts between health authorities, health boards and health trusts are renegotiated annually. It is nonsense to do so. It is like painting the Forth bridge--no sooner has one finished than one must begin again. Some people in the service do nothing other than negotiate contracts. A generally held view is that the health service should be funded and that contracts should be entered into for a minimum of three years, and possibly longer, and that contracts should be altered according to the year-on-year outturn. We must stop the stop-start, on-off, nobody-knows planning of the health service. It is a mystery how one can plan on that basis, nationally or locally, the nation's largest service--a mystery not only to us but to those in the service.

The final matter most concerns the public. They just do not believe that the health service can stand any further service reductions, whether in beds or in other services, that are not replaced by equivalent services. The public simply do not believe that there are sufficient resources. I do not want to get into a debate with the Secretary of State about how many beds or hospitals there are, because Ministers say that they never know, as figures are not collected centrally--but I want us to have those figures, so that we can have a debate.

If the Government are not believed, and if politicians' dialogue does not advance the argument, we believe that there should be an immediate halt to any finance-driven closures--or such a halt could occur on 1 April, for six months. Yes, it would cost something, but during that time there should be an independent audit of health service resources, capacity and demand.

Yesterday, I spoke to the chief executive of the King's Fund, and learned that he and his organisation would be willing to conduct such an audit. Tomorrow the fund will celebrate its centenary, and it is an extremely reputable organisation, but so be it if there is a better organisation in Wales, Scotland or Northern Ireland to conduct an audit. The point is that such an audit should be conducted independently. We should stop the ridiculous nonsense in which we spend half our time disagreeing about the facts. Let us agree on the facts, and we can then consider our disagreements on funding.

There will always be differences in policy and priorities between political parties, but we must get away from the dialogue of the deaf, because patients and patients' interests are not being served. My colleagues and I can initiate a debate on the long-term future of the NHS and go through a litany of problems, but, today, we have limited ourselves to making four practical suggestions, which hon. Members on both sides of the House support and which the public and the professions overwhelming support. In an accountable NHS, realising those proposals would start us on the road to securing in the years ahead

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the place of the national health service in all four countries. I hope that we can make some progress, and I hope that the House will approve our motion.

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