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Mr. Dobson: The Tories do not know what it means.

Mr. Jack: The Secretary of State is a statistical ignoramus because he is unable to understand what it means to define, in money terms, the sort of meaningless rhetoric that he puts forward.

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Perhaps I should refresh the Secretary of State's memory of what he said earlier today. He went to the seaside for an away-day and made a speech on health, in which he went even further. Not content now just with London, he is promising us top-quality primary scare--[Interruption.] [Hon. Members: "A scare."] My hon. Friends have flushed out Ministers, who talk about top-quality continuing care and top-quality mental health.

In his speech in Brighton, the Secretary of State ruled out any closures of any local hospitals--[Interruption.] Well, that is what he said in Brighton today. Do not shake your head like that.

Mr. Deputy Speaker: Order. The occupant of the Chair does not have responsibility for these matters.

Mr. Jack: Mr. Deputy Speaker, I am grateful to you for your kind words of advice.

In his speech, the Secretary of State made it extremely clear that he was welding himself effectively to an unchanged health service. That, in its own way, will have costs.

The Secretary of State tells us that he wants to have an excellent information service. The Government must come clean and tell us what all this means in terms of something that is quantifiable. We know that such promises will cost a lot of money and we have every justification in asking the Government for solid answers on how much this wish list will cost. Will the Minister of State give me an assurance tonight, first, that he will publish, in pursuit of his obligations to open government, the questions that will be the subject of this fundamental expenditure review? So that we may show the validity of our charge that the Government wish to introduce charges to raise revenue to fulfil their wish list, will the Secretary of State publish the questions that he is going to pose as part of the review that he mentioned in his press release?

We are entitled to believe that the Government of the day will require more money for this impressive list of ideas. In Scotland on Sunday, Mr. John Lloyd put forward this view:


The Government's amendment talks about access to the NHS based on need. "Access" is an interesting word. Access refers to the way in. No Labour Member has talked about what happens on the way out. On the way out is where one pays the bills--the new bills from the Labour Government.

The Minister of State puts his head in his hands, but that is just a simple way of trying to hide the fact that we have flushed out the truth of this matter. [Interruption.] The Minister is now barracking--another standard technique to avoid telling the truth.

I remind the Minister that the NHS chief executive, Mr. Alan Langlands, told us that


"Hard-headedness" is a code word for charges. That is clear.

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The Government's amendment criticises the previous Government. I expect that the Minister of State, in an effort to rebut the accusation with regard to charges, will once again go through the same litany as the Secretary of State on the subject of NHS bureaucracy.

I want the Minister to assure me that he will look at the staff salary costs for the NHS in 1992-93 at the time of the previous election. He will see that that came to 6.8 per cent. of the spending on the NHS. I want him to compare those figures, as I did this afternoon in the Library, with the figures for 1997-98, taking into account the £350 million reduction in staff costs occasioned by the terms of the 1992 legislation. The effect of that legislation was to reduce the bureaucracy costs of the NHS from 6.8 per cent. in 1992-93 to 6.5 per cent. in 1997-98.

That shows that Conservative policies contributed more money to front-line patient care, creating a health service of which we can be proud and which delivers more patient care than ever before, with a greater percentage of GDP than ever before. They delivered a health service that is not rotten with bureaucracy, because we cut out the problem and made more money available.

If we have done all that, we are entitled to return to the central issue of charges. If the Government are to deliver their incredibly long wish list, they will need more money. They have to tell us the funding deficit in the health service so that we can judge their actions in the future and know exactly where they will get the money. We believe, because they have not said otherwise, that it will come from charges.

9.47 pm

The Minister of State, Department of Health (Mr. Alan Milburn): I welcome the right hon. Member for Fylde (Mr. Jack) to his new responsibility as shadow Health Minister. I enjoyed working opposite him when he was in the Treasury and I look forward to working with him now. I urge him to be slightly cautious about bandying statistics around on bureaucracy in the NHS. I remind him that the Conservative party is not the enemy of red tape in the NHS but the friend of bureaucracy in the NHS. The Conservatives managed to spend an extra £900 million in extra administrative salaries alone in the first six years of this decade. Far from cutting red tape in the NHS, they increased it.

We have had a fairly a wide-ranging debate. The right hon. Member for Wealden (Sir G. Johnson Smith) talked about the cost of care for the elderly and the problems caused to the NHS by a growing elderly population. There are some dangers in being a prophet of doom, because the NHS has coped admirably with growing numbers of elderly people in every year since it was created in 1948. Even the previous Administration, in the evidence that they gave to the Select Committee on Health in the last Session, managed to recognise that, while the number of elderly people will continue to grow, we are past the worst.

Like many Tory Members, the hon. Member for Maidenhead (Mrs. May) quoted the Labour party's manifesto from the last general election. I am pleased that she did so. She asked me for an undertaking that we would honour our pledges in that manifesto, and I give her that undertaking unequivocally. The hon. Member for East Worthing and Shoreham (Mr. Loughton) talked,

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unwisely in my view, about prescription charges for pensioners. I caution him about lecturing us about increasing charges for pensioners when it was the Conservative Government who introduced value added tax on fuel, which so penalised pensioners.

As always, the Liberal spokesman, the hon. Member for Southwark, North and Bermondsey (Mr. Hughes), was the font of much advice, even urging me to beg the Chancellor of the Exchequer for more cash. I am grateful to him for one thing at least--his support for a review of the anomalies in prescription charges and of NHS spending. However, I remind him that we shall keep not only our manifesto pledges on the health service but our pledges and promises on other issues, not least taxation.

I deal now with the maiden speeches made by my hon. Friends. My hon. Friends the Members for Hemel Hempstead (Mr. McWalter) and for Wyre Forest (Mr. Lock) talked about the difficult problems they face in their areas because of the legacy that the NHS inherited. They talked in particular about the burden of debt facing health authorities and trusts. It is a difficult legacy, one that we shall have to tackle in the coming months, but they will be aware, as much I am, that there are no easy solutions or quick fixes to the problem.

From his own experience as a GP, my hon. Friend the Member for Dartford (Dr. Stoate) rightly talked about the anomalies in the current exemption regime for prescription charges. I am grateful for his support for the review that we shall be undertaking.

Finally, in an impressive maiden speech, my hon. Friend the Member for Leeds, North-West (Mr. Best), used a very important phrase about the sort of national health service we want. He said that we want a one-class NHS--a first-class NHS.

I deal briefly with the two other maiden speeches we have heard this evening, which were made by Opposition Front Benchers. I am sorry for the Opposition health team's having to make their debut on the NHS because they have been forced to defend the indefensible--the Tories' record on health and their running down of the NHS. The Tories leave a quite appalling legacy--[Interruption.] I know that Opposition Members do not want to listen because they do not want to face the truth about record waiting lists, record cuts in capital expenditure and record debt in the NHS.

The hon. Member for Southwark, North and Bermondsey asked us what we were going to do about the private finance initiative. We shall do one very simple thing--we will make it work and get hospitals built. It will take more than eight weeks for the new Government to put right the Tory record of 18 years, so we will not take any lectures from Opposition Members about our handling of the NHS.

Mr. Simon Hughes: Of course the Government have to deal with some matters quickly, but if the Minister thinks that the PFI is the solution that will get more money from the private sector to the NHS, he is badly mistaken. A far more fundamental review is needed; the PFI is not the way forward.


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