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Miss Widdecombe: It is always somebody else's fault. This time, it is the fault not of the trust chairmen, but of the statisticians--the right hon. Gentleman's own civil servants. He still has not answered the question, but I take it that 30 June 1999 is the date to which we are all now working. If it is, that can go on the record and we can hold him to account. That is no way to run the health service.

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The convenient confusion over the Secretary of State's waiting list pledge and the treatment of health service staff is just part of the picture that we are beginning to see of a health service in turmoil. In one breath to tell people that they have done us proud, as the Secretary of State puts it, and in the next to threaten them with the sack when it is the same Secretary of State's decisions that have caused the record waiting lists merely demonstrates that Labour has never been fit to manage anything. That rather sad display of macho management will serve only to demoralise health service workers even further.

Mr. Paul Truswell (Pudsey): Will the right hon. Lady give way?

Miss Widdecombe: In a moment.

The Secretary of State appears intent on alienating the most important workers in the health service. First, he alienated the nurses by giving them a staged pay rise. He said that he was embarrassed. So he should be--in July 1996, when the then Government proposed to stage the pay rises of Members of the House, the right hon. Gentleman voted against it. He voted to take his pay rise in one go. He was not embarrassed then, so no wonder he is embarrassed now, as should be the Under-Secretary of State for Health and the Minister for Public Health who also voted against staging then. Let the Secretary of State explain that to the nurses.

The Secretary of State should be embarrassed also that when he is closing hospitals across the country, there is to be a £1 billion hospital in his own back yard.

Mr. Roger Casale (Wimbledon): I appreciate that the right hon. Lady is speaking on behalf of the Opposition, but is she aware that the Government have made over £5 million available to West Kent health authority in the area that she represents which will be used to create 132 new beds, which were cut under the previous Government? Will she take the opportunity at least to thank my right hon. Friend the Secretary of State for the extra resources that he has made available for her constituency?

Miss Widdecombe: I shall discuss the position in Kent presently, and the hon. Gentleman will not then be smiling so confidently as he is now. The situation in Kent is grievous, and it is entirely the result of decisions taken since May 1997. We shall hear about that in a moment.

Mr. Dale Campbell-Savours (Workington): Will the right hon. Lady discuss what is going on in my health authority? It is getting an extra £1.8 million for these matters. Why is the right hon. Lady complaining, when every Member of the House of Commons represents a seat where millions of pounds has been allocated to shorten waiting lists? What is wrong with that? Labour is delivering.

Miss Widdecombe: First, that money must be allocated because the Government's policies are not working and waiting lists are lengthening. Secondly, when we discuss those millions, I shall show the hon. Gentleman that the money is not worth as much as he supposes.

I return to the demoralisation in the health service. The sources of increased pressure on waiting lists are not only the Secretary of State's bungled attempt at

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"tough management", as he calls it, but the pathetic financial settlement that the Government have seen fit to offer the health service. "Pathetic" is not my word; it is the word used by Dr. Sandy Macara, chairman of the British Medical Association--a group that has rarely criticised the Labour party in the past 19 years, and now says that its financial settlement is pathetic.

The BMA says that because, despite all the talk of extra money for the health service, we had an increase of 3.1 per cent. in real terms per annum, whereas the average increase under the present Government has been only 2 per cent. Of course they have made some extra sums available, but let us see what we have to remove from those extra sums. Perhaps the hon. Member for Workington (Mr. Campbell-Savours) will get out his calculator.

Mr. Campbell-Savours: I have it here.

Miss Widdecombe: We can remove higher- than-expected inflation. That is another broken pledge; Labour said that it would keep inflation low. We can remove health service inflation. We can remove the abolition of private medical insurance tax relief, deficit reduction, the phased pay award and other black holes in Labour's spending campaign, which render the additional money that they keep talking about only a fraction of its current worth. For example, if one removes the factors that I have suggested, the £417 million announced in the Budget becomes a paltry £32 million.

The effect that underfunding has had on the health service is now visible; what will be the cost to waiting lists of another year of short change? If underfunding and winter pressures were the only factors, the waiting lists situation might not look so desperate, but that is only half the story. The entire structure of Labour's health service reforms and its hospital closures programme will have an equally devastating effect on the future of the health service.

Labour's White Paper is a blueprint for increasing the people's waiting lists. The bureaucracy proposed in the White Paper will add substantially to health service running costs. The Government claim that they can save £1 billion from bureaucracy but, without saving anything, they have already added another £150 million a year from the cost of administering the primary care groups alone. Bureaucracy to co-ordinate health authorities and local authorities will be necessary within the structure of their reforms, but they have not accounted for any cost whatever. NICE, the national institute for clinical effectiveness, and CHIMP, the commission for health improvement--to name just two of their inventions--will also cost extra money, with no resultant administrative savings. The whole White Paper appears to be a return to the command-and-control structure for the health service, with all the associated running costs. There will be a raft of new quangos, none of which will keep the waiting list pledge afloat.

The Government have not, as they frequently claim, abolished the internal market. The purchaser-provider split remains. They have only clogged up its workings with unnecessary controls and bureaucratic mechanisms, requiring constant consultation before any decision is taken. That will reduce efficiency and lead to money being diverted from reducing waiting lists to unnecessary administration.

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There is reduced freedom for general practitioners because primary care groups, rather than fundholders, will choose between trusts, and that will reduce the flexibility of individual GPs to choose shorter waiting lists for their patients. The reduced efficiency caused--

Mr. Truswell rose--

Mr. Ian Bruce (South Dorset): Go on, read from your briefing.

Mr. Truswell: No, it is entirely of my own making; I have no briefing from anyone else.

I speak as a former member of a family health services authority, and that authority had some Tory nominees on it, none of whom subscribed to the concept of GP fundholders. Does the right hon. Lady think it was right that so much money accumulated in GP fundholder budgets while health authorities were running deficits? That money could have been used to treat patients and reduce waiting lists. Does she accept that while I was a member of a family health services authority, our auditors brought to our attention a number of cases where they thought that fundholders were not using the money efficiently, such as for the purchase of lavish oak furniture? Does she not think that those cases should have been dealt with, and that the money should have been spent on reducing waiting lists?

Miss Widdecombe: Fundholding increased flexibility and allowed doctors to choose what was best for their patients. Fundholding resulted in a vastly improved service, to such an extent that, although the early demand was cautious, there was later a huge demand for fundholding. I would have expanded fundholding, not got rid of it.

Even more disturbing than what I have described so far is the programme of hospital cuts and closures by stealth. Beds, wards and even whole hospitals are being shut down as Labour's lack of investment in our health service bites.

Mr. Nigel Beard (Bexleyheath and Crayford): My constituency was marked by years of hospital closure on the promise of a new hospital coming, which was intended to be built under the private finance initiative. However, dither and delay prevented it from coming, and confidence in the health service lapsed. My right hon. Friend has redeemed the promise and we are to have a new Queen Elizabeth hospital in the area.

Miss Widdecombe: I am delighted to hear about the Secretary of State's U-turn in accepting the PFI, but in the month that the election was declared--in March last year--Labour said, "We have no plans to close hospitals." Labour deceived the electorate. [Hon. Members: "Where?"] I shall give some examples.

In Oxfordshire, the outlook is especially bleak. Three community hospitals face the axe. One of those, Burford community hospital, contains a specialist Alzheimer's rehabilitation project. The unit is not replicable in the medium term, so if it goes, no substitute service will be provided. It will close when Burford shuts, despite being

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a centre of academic excellence for research into Alzheimer's. Patients using Burford will face a 40-mile round trip to out-patient facilities in Oxford.

The closure of the hospital will mean that elderly patients using Burford as a halfway stop when returning home from hospital stays will be forced to block beds for other patients waiting for treatment. I have heard that story from many community hospitals. One of their most important functions is to relieve acute beds by taking people who are no longer in need of acute beds, but who are not yet ready to return home, and rehabilitating and caring for them in the interim. If those hospitals close, that function will go with them. That can only result in longer waiting lists, as beds are blocked.

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