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Mr. Simon Hughes: I am grateful to the hon. Lady for identifying the issues on which we agree. However, will she tell the House whether she and her colleagues can support our second proposal, which is

As I said, the public desperately want a national halt to service reductions while an independent assessment is made. Can she and her colleagues endorse and support that proposal?

Ms Jowell: The hon. Gentleman will be aware that we have made clear our commitment to a moratorium on any further acute bed closures in London, because of the particular circumstances and pressures that arose after the Tomlinson report. So we are committed to a moratorium in London. We have not made, and at this stage we would not make, a similar commitment nationally, as he would like. If elected to government after the next general election, however, we will carefully examine the position, particularly in deprived inner-city areas, where--for very obvious reasons--pressure on acute beds tends to be greatest.

Sir Donald Thompson (Calder Valley): The hon. Lady is making a very careful and interesting speech; and I heard what she said about the difference between London and the provinces, which seem to manage these matters rather better. Nonetheless, will she now take the opportunity to appeal to local government across the country to stop blocking hospital beds? In my constituency, 50 beds are being blocked by the local social services people, who will not allow old people who have been assessed into care homes, because those care homes are private. It is a scandal which the hon. Lady's words would help to alleviate.

Ms Jowell: It is absolutely clear that the way in which the Government have tilted the balance in distributing money for community care towards the independent sector has created the bed-blocking problem in so many parts of the country. There was virtually no independent provision in my own borough--which I shall use as a specific example--and it was therefore very difficult to move elderly people out of hospital and into care funded through community care money, which was made available by the reforms. All types of perverse incentives have been created because of the Government's doctrinaire obsession with care commercialisation, rather than with patients' best interests.

Several hon. Members rose--

Mr. Malone: The hon. Lady has confirmed that those councils--for political reasons and because they do not like the policies--are taking out their revenge on patients, and that she supports them.

Ms Jowell: The Minister is perfectly well aware that that is absolutely not so. One of the obstacles to many

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councils being able to provide effective community care has been the perversity of the Government's distribution formula for care in the community money.

Mr. Matthew Banks: Will the hon. Lady give way on that point?

Ms Jowell: No, I will not give way again--[Interruption.] In a short speech, I have already given way many times. I shall move on to the costings--[Interruption.]

Madam Deputy Speaker (Dame Janet Fookes): Order. I think that the House knows my views on seated interventions, especially when they are repeated.

Ms Jowell: I make no apology for not giving way to the hon. Member for Southport (Mr. Banks), who made a speech lasting almost half an hour.

As for costing the proposals made by the hon. Member for Southwark and Bermondsey and his colleagues, as I said, the Library has already performed some calculations. The cost of restoring eye tests and dental checks, based on 1994-95 prices, would be about £170 million. The pledge to increase NHS expenditure in line with NHS inflation would cost an extra £594 million in 1998-99, and £1.3 billion in 1999 to 2000. The pledge to recruit 10,000 more nurses and 5,000 more doctors, which appeared in 11 October 1996 edition of the Liberal Democrat News, would cost at least £100 million. The pledge to cut waiting lists to a six-month maximum, crudely estimated, would cost £240 million. In short, the Liberals' proposals would cost an extra £2.5 billion.

The way in which the Liberal Democrats have tried to explain where the money to meet those pledges would come from has not been completely convincing. I reiterate that they told us at last year's conference that an extra £350 million for nursing staff would be made available by closing a tax loophole, although that loophole had apparently already been closed. I therefore ask the hon. Member for Southwark and Bermondsey to think twice before he throws stones, and reconsider the credibility of the cost of his own policies.

Opposition Members should not be distracted by the hypothetical and irrelevant question--diverting as it might be--of how a Liberal Democrat Government would fulfil their commitments. Our main concern is the real crisis that is gripping the health service.

In recent weeks, it has become blatantly clear that the Government have only one immediate priority for the NHS--crisis management, so that they can get through to the general election and the end of the financial year. Health authorities and hospitals are being told to keep problems under wraps, so far as possible. We have heard how the chief executive of the NHS has dispatched a memo to hospitals on "managing the winter crisis". We have been told that hospitals are being advised not to pay bills so that they can make ends meet, although that means that small businesses which depend on that cash may go to the wall. We have also heard of a hospital in Liverpool being urged to find ways of "judiciously eliminating" patients from the waiting list.

Those are not the actions of a responsible Government who put patients' interests first; they are the actions of a Government and Ministers engaged in a desperate bid for

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survival. The needs of the NHS take second place to the electoral prospects of the Conservative party. While all that is going on, patients across the country wait on trollies in casualty; elective surgery is being cancelled, often at the last minute; and staff are working under intolerable and unacceptable levels of pressure. The Government should be dealing with those problems as a priority, rather than being concerned with news management and drawing a veil over the circumstances facing hospitals daily.

Every day, we read further evidence of the crisis. This week, the Greater London Association of Community Health Councils published a new report on how accident and emergency departments in London have coped this winter. It paints a bleak picture of the quality of patient care in London's hospitals. It states:

New terminology has had to be invented to explain how hospitals are dealing with the crisis. The report states:

    "Overnighters, people waiting overnight in casualty, are becoming a regular feature of London's health services."

In the past five years, a new nursing protocol has been created to deal with the pressure sores and dehydration that inevitably follow when very elderly people spend any time waiting on trolleys. The GLACH report adds that this year's crisis is affecting all patients, not just those admitted to A and E. It talks of

    "hospitals running at near to 100 per cent. occupancy and elective surgery frequently cancelled--including cancer operations".

Cancer operations are being cancelled elsewhere, too.

A letter from a consultant neurosurgeon at the Salford Royal Hospitals NHS trust to a patient awaiting surgery shows the intolerable pressure on his patients. The letter reads:

The Secretary of State's view that there are no waiting lists for cancer operations does not tally with the experience of patients across the country. Labour has already pledged to treat an extra 100,000 patients and take them off hospital waiting lists by releasing £100 million from the red tape which is the result of the Government's bureaucratisation of the NHS. As part of this pledge, we will ensure that cancer patients do not have to wait for surgery.

There are other immediate priorities to which a Labour Government will give urgent attention. We will end the two-tierism which has been the hallmark of this Government's treatment of patients needing primary care--the division is between people who are patients of fundholders and those who are not. We will extricate the NHS from the perverse incentives of the internal market and halt the moves towards the privatisation of the service.

This debate is an opportunity to pay tribute to the staff of the national health service, not only the doctors and nurses but all who work in it--very often in the most

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difficult circumstances--and who provide the very best care that they can. We will end the commercial internal market and restore the NHS as a public service which puts patients first because that is what the staff and the people of this country want--the immediate priority for the NHS is a Labour Government who will rebuild it.

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