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5.12 pm

Mrs. Virginia Bottomley (South-West Surrey): The Conservative party does not need to spend too long debating the question of funding because, under

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successive Tory Governments, resources for the health service rose from £7.5 billion to £34.5 billion. That is a substantial increase.

It is disappointing that, so far in the debate, there has been a lack of serious consideration of how to manage public services, make them more accountable, achieve value for money, and get the traditional staff in schools and hospitals to work more flexibly to provide better education and better health care.

As it happens, the Conservative Government spent rather more than other countries on our education service, although we do not yet have the standards that we want. The Conservative Government increased by one percentage point the amount of gross domestic product spent on health, at a time when virtually every other Organisation for Economic Co-operation and Development country was reducing its percentage of GDP.

Dr. Brand: Does the right hon. Lady accept that the Conservative Government's GDP expenditure on health still made Britain second from the bottom in the western world?

Mrs. Bottomley: The hon. Gentleman--whom I know extremely well--is aware that the figures are not clear because we do not know whether the table takes into account Government spending on health, private sector spending on health or the link with social services and the care of the elderly. His party's debate is about the volume of resources--Liberal Democrats are not interested in anything else. They have effectively demolished the Government's position. I do not need to do that because I do not want to deal only with the volume of resources. I entirely endorse the points made by my hon. Friend the Member for Tiverton and Honiton (Mrs. Browning). Unfortunately, I live in an area where there is a Liberal Democrat council which has raised council tax by 30 per cent. more than the average under the Conservatives. It is spending money on empire building, locality offices and, in particular, consultants' reports when all else fails.

I want to talk about the more serious issues surrounding public services. If the Government cannot take a more serious long-term attitude to public services in their first year of government, it bodes ill for the future. As we approach the 50th anniversary of the national health service, and as we want to increase participation and achievement in education, we must address the serious issues. I take great pride in the role of the citizens charter in making public services more accountable, in providing more information and in making services more sensitive to their users. I worked in the public sector before I entered Parliament, so I know only too well how remote, monolithic and municipal were housing, health and education services in the past. My memory of the Lib-Lab pact is that it was the only time ever that real spending on the health service was cut, so the present regime offers little hope or encouragement.

I enjoy seeing the Secretary of State in his role, especially when he cites Department of Health statistics. I used to be a past master at citing statistics, until I was told that, the more statistics I cited, the less people

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believed me. That was disappointing for me, as a social scientist, who had always been told that we had to supply the hard evidence and that comment was not good enough. I congratulate those who have drawn up examples of new hospitals and developments in health care. However, the right hon. Gentleman did not answer the questions that are important to millions of people across the country, especially those 1 million people in the NHS--

Mr. Andrew Stunell (Hazel Grove): Does the right hon. Lady accept that one of the statistics that she might enjoy, but that others in the House would not, is that, when she left office, 97 out of 100 health authorities were running a deficit? Is there not a gap between what she says and what she practises?

Mrs. Bottomley: I cannot confirm the hon. Gentleman's statistics as I was Secretary of State for National Heritage when I left office. However, I can tell him that, when I went to the Department of Health, 213,000 people had been on the waiting list for a year. When I left, there were only 30,000. When I went to the Department, the hours worked by junior doctors were very much longer than when I left. The number of deficits fell substantially during my six years at the Department. I can send the hon. Gentleman the figures if he would like them.

I always felt that it was important to deliver a health service managed by objectives. I am concerned that the Secretary of State is already ducking and weaving and changing the objectives, which makes matters difficult for those in the NHS. He said that he would reduce hospital waiting lists, but already the words are being massaged. Like everybody else, I appreciate the additional money that is going to my health authority, but the right hon. Gentleman has created an appalling precedent. In every year until the next general election, the NHS will require its mid-year crisis intervention. I regret to say that the Secretary of State will recreate the old system--in which the more people howled, the more likely there was to be a mid-year bail out. That is not good for long-term health care planning.

I should like to feel that the Secretary of State will take a serious view on priorities. I should like to feel that the objectives that he has set were not simply those fed back by focus groups but those that were necessary for health gains and the long-term well-being of patients and of the British people.

I commend some announcements made by the Secretary of State. Today, I have decided--because, on every occasion on which I have asked him a question, he has subjected me to personal abuse and political invective--to try a different tactic. I will commend some of his actions, to see whether he might be lured into providing answers to some of the questions that I keep asking him.

Mr. Andy King: She likes beards.

Mrs. Bottomley: No, she does not like beards.

I commend the way in which the Secretary of State has continued with prevention. He will probably be aware that, when I introduced "The Health of the Nation" strategy, not every Conservative Member was particularly supportive of the preventive approach, which was thought to be a little nannying. Nevertheless, I think that it is right for the NHS to continue to take prevention seriously.

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I hope that the right hon. Gentleman will continue also to give priority to mental health--an NHS sphere that is all too easily overlooked. He talks about the popular issues, such as breast cancer and paediatric care, but could he, please, also remember unfashionable health care issues--among which mental illness is perhaps the most important?

I commend the right hon. Gentleman also for floating the idea of a national institute of clinical effectiveness. If we are to have an NHS of the 21st century, examining effectiveness will be enormously important. Effectiveness is at least as important as the volume of resources that are invested in the health service, and necessary health gains will be delivered only if money is spent wisely and well on effective treatments.

I commend the right hon. Gentleman for having talked about being a good employer. He will know that the previous Government joined Opportunity 2000, issued new guidance for ethnic minorities in the NHS, and, in many ways, treated NHS staff well, so that they could better do their job. Such action is a fundamental part of his role, and I have been pleased to hear him making comments on the matter.

I have not been so happy, however, about the right hon. Gentleman's persistent attack on what he calls NHS bureaucrats. Although the Secretary of State has softened his line, the Prime Minister, at last week's Prime Minister's Question Time--as on every occasion when the Prime Minister mentions the NHS--gratuitously attacked NHS managers.

The NHS is a tribal organisation. Doctors have their agenda, nurses have their agenda and professions allied to medicine have their agenda. NHS managers, however, have the difficult task of bringing together the different tribes and of delivering objectives. It would be absolutely deplorable if the Secretary of State and, particularly, the Prime Minister were gratuitously to attack NHS managers on every occasion.

In my new approach of being more emollient--in trying to get answers from the Secretary of State--I commend the Labour party and the Prime Minister for giving a life peerage to Philip Hunt. Philip Hunt, of the national health service confederation, is an outstanding example of an NHS manager. I hope that, in future, he will have great influence.

Although--as I said--I should like to elicit a favourable response from the Secretary of State, it is difficult for me to address my comments in a positive frame of mind when dealing with the matter of the huge number of non-executives who have entered the NHS, adding their skills and leadership to health authorities or trusts. There is despair over the total shambles in the NHS appointments system. A vast number were due to--[Interruption.] Would the hon. Member for Rugby and Kenilworth (Mr. King) like to say something?

Mr. Andy King: I hope that we shall soon put right the matter of Tory placepeople, who are still in the health service, doing a great disservice to the health service.


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