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Mr. Dorrell: The Secretary of State has described the development of a wide range of different forms of purchasing in the health service, much of it led by primary care producers. That is fine. But my simple question is whether he will continue to allow those who wish to run budgets at a practice level the option of doing so. Will that option remain available?
Mr. Dobson: All will become clear as my speech proceeds. [Hon. Members: "Answer the question."] I will answer the question if Opposition Members wait a moment. [Interruption.] The right hon. Member for Charnwood (Mr. Dorrell) made his speech, and I will make mine--that is the arrangement in this House.
While we are reducing the excessive costs of the current system, we shall encourage more pilot schemes for local commissioning, building on what is already happening. We shall allow pilot schemes to show what they can and cannot do and we shall then assess which schemes work best. Then, and only then, will we move to change the structure of the NHS to start introducing new arrangements across the country. That will guarantee that our proposals for change will have been literally tried and tested before they are applied generally. They will embody the principles of fairness and equality and will not, as the Tories did, take chances with the lives and health of patients. Nor will they ignore the views, experience and professional knowledge of the dedicated staff of the NHS.
Mr. Dorrell:
I am simply seeking a yes or no answer to this question: will the option of managing a budget at practice level remain? The Secretary of State has said that other options will be developed, and no one could object to that. I simply want to know whether the option of practice-based budgets will remain--yes or no?
Mr. Dobson:
It seems likely--but not certain--that in the light of our experience in assessing the pilot schemes the fundholding basis will disappear because I hope that most doctors--[Interruption.] The right hon. Member for Charnwood was in charge of the NHS for two or three years. We have inherited a poisoned chalice in which 37 out of 100 health authorities were in deficit at the end of last year and 111 out of 425 trusts were in debt at the end of the year. Waiting lists are going up; waiting times are going up.
Mr. Dobson:
No, I will not give way. Waiting times are going up. Doctors tell me that there is a shortage of
Mr. Dorrell:
The right hon. Gentleman said that he thought that fundholding would disappear. I then asked him who would decide, and he said that he would decide. Does that mean that, if a doctor believes that it is in the interests of his national health service patients for his practice to continue to run its budget, the right hon. Gentleman will decide that that option is to be removed?
Mr. Dobson:
As the right hon. Gentleman knows, I am not one of those who try to get out of responsibility, and I do not expect to. I am saying that, ultimately, responsibility for all this will lie with the Secretary of State. The final decisions will have to be made, and I am saying that I expect that in the end that option will disappear. I repeat, however, that we are genuine when we say that we want pilot schemes, and we want to see how those schemes work. We want them to be allowed to run long enough for us to make an evidence-based assessment of how they work; then, in consultation with all concerned, we shall have to make the final decisions. That, as I understand it, is what being in government involves.
I know that many decisions that should have been made by the former Secretary of State over the past year have been left to us to try to sort out. The right hon. Gentleman mentioned some of them earlier. In the meantime, we shall get on with building more hospitals. The last Government, led in this area by the former Secretary of State, talked a lot about putting private finance into hospital building: they talked a lot, but they did not do a lot. Tonight, the right hon. Gentleman claimed credit for the idea of public-private partnerships.
My memory goes back sufficiently far for me to remember when those speaking from this Dispatch Box treated with total contempt the proposals for public-private partnerships that my right hon. Friend the present Deputy Prime Minister advanced in relation to transport. After four or five years in which the transport industries were deprived of capital, the Government finally got around to seeing some merit in, at least, the theory of public-private partnerships, but their record in promoting such partnerships is pathetic. They have obstructed more than they have achieved. Compared with the excellent record of many Labour local authorities in promoting public-private partnerships, the Government's record is a disgrace--[Interruption.] I mean the previous Government's record.
We shall introduce a short Bill to clear up any doubts about the powers of NHS trusts to enter into private finance initiative arrangements to help provide much-needed hospitals. That keeps a promise that we
made in the general election campaign. We also promised not to extend private finance to include clinical services, and we shall keep that promise.
The Queen's Speech fulfils another promise: we shall change the law to prohibit tobacco advertising. Smoking is the largest single preventible killer of people in this country: at least one in every five deaths is caused by smoking. The Tories did nothing about it because they are in the pockets of the tobacco barons, but we are not. We shall publish a White Paper spelling out a concerted programme to reduce tobacco consumption using every possible lever available to the Government: changes in the law, taxation, education and publicity.
At the same time, we shall publish a draft Bill to ban tobacco advertising. It will cover all forms of tobacco advertising, including sponsorship. We recognise that some sports are heavily dependent on tobacco sponsorship and, as we do not want to harm those sports, we shall give them time and help to reduce their dependency on tobacco and to replace it with sponsorship from more benign sources. We do not want to harm those sports, but they must recognise that by helping to promote tobacco sales they are harming the health of many of their spectators and viewers.
I hope that during the discussions on the White Paper and on the draft Bill we shall be spared the fatuous claims by the tobacco industry that its advertising is not designed to promote sales. The fact is that the tobacco industry, uniquely among industries, kills about 120,000 of its own customers every year, so it has to recruit another 120,000 new smokers every year to its ranks to make up for that year's casualties. Of course tobacco advertising is intended to promote sales.
The programme to reduce smoking, and therefore to reduce smoking-related disease and death, is part of our fundamental commitment to improving the nation's health. We have already carried out our manifesto commitment to appoint a Minister with responsibility for public health, but our commitment does not end there. As we all know, some illness is unavoidable: it can strike suddenly out of a blue sky. Some illness is caused by people's life styles--smoking or drinking too much or, as in my case, eating too much--while some is caused by the harmful conditions in which many people are forced to live and work.
As a society, we must try to help the victims of unavoidable illness. That is what the health service does. We should offer advice, help and inducements to people to choose a healthy life style. We must also act together to combat the innumerable causes of ill health and injury that spring from the conditions in which people are forced to live and work.
Under Labour, every Government Department will be charged with the task of contributing its share to improving the nation's health. We are committed to a root-and-branch attack on the factors that systematically make our people ill. That includes factors which harm us all, such as air pollution or problems with food--we shall reduce air pollution and introduce a food standards agency--as well as factors which bear down most heavily on the worst-off: homelessness, unemployment, low wages, poverty, crime and disorder.
All those things are awful in themselves, but that is not all: they are the main sources of gross inequalities in health. Poor people, homeless people, jobless people and badly paid people are ill more often and die sooner. That is the greatest inequality of them all: there is no greater inequality than the difference between being alive and being dead. We intend to tackle those inequalities.
Other measures announced in the Queen's Speech will contribute to tackling those inequalities. Homelessness and bad housing produce intolerable conditions. Labour's housing policy is based on the belief that every family should have somewhere decent and affordable to live. A decent, secure home is vital to family life: without it, a family's health suffers, grown-ups find it hard to hold down a job and children find it hard to do well at school. How can they do homework if they have no home to do it in?
Without a proper home, family relationships are soured and family breakdown becomes more likely. Without a proper home, life is vile. Many of our fellow citizens do not have decent homes. Several thousand families spent last night living in bed-and-breakfast accommodation, which does not provide a proper home. Bed-and-breakfast accommodation is vile.
A medical report on the problems of living in such accommodation states:
A further report emphasises the problem, stating:
"Even if hotel accommodation is in good order it is rarely appropriate to the needs of young children."
This is an official report, and therefore has a mastery of understatement. It continues:
"It is difficult to maintain hygiene while washing, eating and sleeping in one overcrowded room. High levels of gastro-enteritis, skin disorders and chest infections have been reported. Kitchen facilities are often absent or inadequate. So people are forced to rely on food from cafes and take-aways which is expensive and may be nutritionally unsatisfactory. The stress of hotel life undermines parents' relationships with each other and their children. Normal child development is impaired through lack of space for safe play and exploration. High rates of accidents to children have been reported, probably due to a combination of lack of space and hazards such as kettles at floor level"
in the room where the family are trying to live.
"Risk to health in bed and breakfast is well above that of the domiciled population. These risks stem from shared, or lack of, amenities, overcrowding and unsafe properties. Infection, accidents, malnutrition, sleep disturbances, low birth weight babies, eating problems, behavioural problems, depression and even death can result".
Those circumstances apply tonight to several thousand of our fellow citizens in towns and cities up and down the country. That is a disgrace and we intend to bring it to an end. That is why our manifesto contained the common sense promise to allow councils to invest the takings from the sale of council houses to provide new and improved homes for people with nowhere decent to live.
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