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Dr. Jenny Tonge (Richmond Park): Will the hon. Gentleman give way?

Mr. Horam: We have a relatively short time for the debate and I have already referred to the hon. Lady's colleague, the hon. Member for Southwark, North and Bermondsey, so I shall not give way.

The public have noticed that even Labour's meagre promise has not been fulfilled and that nothing has changed except that the problem is worse than when the Labour party was in opposition. In my area, for example, waiting lists have gone up to 8,500 over the past 12 months; they have gone up by 140,000 over the country as a whole. I accept that if one throws enough money at the problem the figure will begin to decrease. I expect that there will be cheers from the Labour Benches at some stage in this Parliament; I did not imagine that it would happen within one year, but perhaps within in two or three years the Government will say that they have reduced the number of patients not being treated compared with a figure when the Conservatives were in power.

How did the Government get into this situation? There is one simple reason--

Helen Jones (Warrington, North): Will the hon. Gentleman give way?

Mr. Horam: Perhaps the hon. Lady will let me complete my sentence. It is because they have not

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continued the funding that we put into the NHS. They have reduced the steady increase of extra funding that the Conservative Government put into the NHS year after year. The present Government are now increasing it--as they did previously--by 2 per cent. a year; we increased it by more than 3 per cent. a year when we were in power. That is the difference between us.

All the recycled pledges, recycled beds and recycled figures do not add up to anything by comparison with the simple fact that the present Government are spending less than we achieved throughout our 18 years in power. They have cut the increase--

Mr. Dobson: The hon. Gentleman was voting against the Conservative Government for much of the time--he was a Liberal.

Mr. Horam: The present Government have cut the year-by-year increase in NHS funding achieved by the Conservative party. That is the simple fact. Even the Secretary of State's brusque interventions cannot conceal the fundamental facts about the NHS. The Government have cut spending. That is not what the public expected and none of the Government's recycled pledges can detract from that reality.

What are the Government trying to do to get out of the mess that, as the Secretary of State admitted, he created by his injudicious pledges? He is trying to bully managers throughout the country into giving priority to reducing waiting lists. That is not a sensible way to carry on.

Mrs. Ellman: Will the hon. Gentleman give way?

Mr. Horam: No.

As the Secretary of State should know, even he, as Secretary of State, cannot turn round this supertanker with his own hands. He counts on the 1 million people--he keeps quoting that figure--employed in the national health service to do the job for him. They are the people at the chalkface.

If he knows anything, the Secretary of State should know that one cannot declare that, in one six-month period, priority will be given to accident and emergency services and, in the next, to waiting lists; the people will have gone. If, in one period, priority is given to accident and emergency consultants and nurses, they cannot be switched to orthopaedics, gastroenterology or urology in the next six months. The people cannot be made to reappear out of the hedgerows of the national health service once they have gone. One cannot run a service that way.

I repeat the argument made by the hon. Member for Southwark, North and Bermondsey: the reduction of waiting lists is the wrong target. What matters to the ordinary person in the street is not waiting lists--whatever they may be--but waiting times. Under the previous Conservative Government, in the period after 1988, when the reforms were introduced, the average waiting time decreased from nine months to four months. That was one of the previous Government's major achievements. The average waiting time for treatment was reduced by more than half during those seven or eight years.

Labour failed to address that issue in its famous pledge. The Government are now failing to address it in their attempts to bring their pledges under control, and they

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will continue to fail to address it if they continue with the absurd reduction of waiting lists aim as a result of their pledge--a cross that they took up themselves.

What should the Government be doing? The hon. Member for Harrow, West asked what the Conservatives would do if we were once again in power. First, we would reintroduce Conservative levels of spending--as the Government should. We increased spending by 3 per cent. in real terms over 18 years.

Mr. Gareth R. Thomas: Under the spending plans that the hon. Gentleman must have agreed, my health authority would have received two and a half times less than the current Government are giving it.

Mr. Horam: The hon. Gentleman may talk about his authority until he is blue in the face. In the country as a whole, spending increased by 3 per cent. in real terms, on average, during the last 18 years of Conservative government. It has increased by only 2 per cent. in the first two years of the Labour Government. That is fact, and it is one reason why waiting lists have lengthened.

I hope, as a Conservative Back Bencher, that if we were returned to power we would increase spending to the levels that we achieved in the last period of Conservative power. If the Government were to do so over the next three years--they are approaching the end of their comprehensive spending review, so in a few weeks we shall know what health will receive--it would cost them approximately £10 billion over three years. If, at the end of July, the Department does not receive at least £10 billion for health spending, the Government will have failed, over the next three years--never mind over the Parliament--to match what the Conservatives achieved over 18 years in power. The Government cannot get away from the fact that they are cutting spending by comparison with what we achieved.

Above all, the NHS wants a regular increase in spending. No party in the history of the NHS has achieved that. The NHS wants to feel that it will not receive an increase of 5 per cent. one year, 2 per cent. the following year, 8 per cent. the year after and perhaps no increase the next. It does not want that because it leads to bad planning, as switching priority from accident and emergency one month to waiting lists the next does. The NHS needs a regular, sustained increase over three to five years--the period of one Parliament. It is time that we, as politicians, addressed ourselves to that point. The NHS is underfunded; at least we can achieve continuity and stability in its funding increases.

Finally, the Secretary of State should consider his macho management style. People are working as hard as they can to fulfil these ridiculous pledges; it will not do to say that people will be sacked just like that. As a result of the Conservative reforms, we have built up a considerable core of clinical directors who are both managers and clinicians and know what life is like at the chalkface in the NHS. It simply is not good enough to produce diktats from Whitehall, or the Kremlin in Leeds, and expect them to follow them. We should trust them to manage the NHS as it should be managed. The Secretary of State would receive a much better response by doing so than by coming out with these absurd proposals. I hope

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that we would do so if we were returned to power. That would produce a better NHS than the Government are likely to, on their present plans.

5.56 pm

Mrs. Alice Mahon (Halifax): I support the Secretary of State's amendment to the Opposition motion.

I am pleased that the shadow Secretary of State is in her place. She made an inadequate but not surprising speech, given that she is on record as saying recently that

I understand that both she and her deputy--her sidekick--have very little experience of the NHS, as they both go private.

I should like to place on the record the fact that the shadow Secretary of State cannot escape her past. Not only is she inexperienced in the NHS; her most famous encounter with the NHS was when, as a Home Office Minister, she advocated shackling pregnant prisoners. She now pretends that she did not support the policy, but that is untrue--and I know, because I obtained an Adjournment debate on the subject during that period.

We need to explain how our policies will shorten waiting lists--they will shorten, because our approach is radically different from that of the Conservatives. As the Secretary of State outlined, we want to mould health services to meet patients' needs. That means modernising waiting lists. We want to increase public confidence in the NHS; shortening waiting lists is part of that process.

However, as the Secretary of State said, the national health service is a huge organisation. I accept that more than 1 million people work for it and that it will take some turning around. The national health service was neglected for 18 years; that is why we were returned with a landslide majority. The Conservatives seem to have learnt nothing from the state that they are in as a party, having been judged by the public on what they did to the national health service.

In the past 14 months, we have made a real start. As my hon. Friend the Member for Rother Valley (Mr. Barron) said, more than 850 schemes are now in place to shorten waiting lists. We have given an extra £2 billion for the national health service throughout the country and started the biggest hospital building programme in its history. One of the most important things we have done is publish a White Paper that sets out our far-reaching programme; it has some vision in it.

We have started to dismantle the internal market. Anyone who is still pleading in its favour has been silent today--I believe because Conservative Members have realised that it only produced a huge paper chase and increased administration and billing.

We are focusing on quality. I am pleased about the development of the national services framework to improve access and quality across the country. I am excited by the proposals for a commission for health improvement and the national institute for clinical excellence. Two recent scandals highlight the need for those initiatives. The Opposition were in charge when those scandals were occurring and being covered up. The Bristol case and the failure of cancer screening in Exeter and at Kent and Canterbury damaged public confidence in the NHS and demonstrate clearly the need for an added safeguard.

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Doctors from the commission will visit NHS trusts at least every three to four years. Where was such monitoring of quality and access when the Conservatives were in power? It was non-existent, and if hon. Members raised the matter in the House they were told to shut up because the Conservatives were doing everything right--but we know that they were not. That initiative is welcome if it will help to reduce waiting lists and wastefulness in the health service.

The figures that will be collected will cover various aspects of clinical care, including hospital deaths, complication rates after operations, death rates after heart attacks and death rates after fractured neck of femur. Such information can help a national health service that knows where it is going. Thanks to my right hon. Friend the Secretary of State, the health service does know where it is going.

The Green Paper on public health, with its proposals for tackling health inequalities and reducing avoidable death and illness, is one of the most radical initiatives since the inception of the national health service. By reducing health inequalities, waiting lists will be reduced. If people are not ill, they do not need hospital beds. The Green Paper is out for consultation now and will be a major step forward in breaking down barriers between health and social services.

I compliment my right hon. Friend on his honesty about care in the community. [Laughter.] The hon. Member for Rutland and Melton (Mr. Duncan) may laugh, but for the past 18 years his party used a concept on which we all agreed to close down wholesale care for the mentally ill. I hope that he is not laughing about what we read in the papers about the tragedies of mentally ill patients such as Christopher Edwards and Richard Linford. I hope that the hon. Gentleman feels a little guilty about that, because his party was in charge when the scandal took place.

The right hon. Member for Maidstone and The Weald (Miss Widdecombe) spoke about a little boy. I wonder whether she would like to speak to the parents of Christopher Edwards, who was not on a waiting list. There were no beds for him or Richard Linford and they ended up in a prison cell together. My right hon. Friend is to be commended on recognising that community care needs a good shake-up and that we did not get it right over the past 18 years.

The Green Paper is relevant to keeping down waiting lists. We must provide more access to treatment more quickly. We must recognise that health inequalities are tied into low income and that the income gap has widened massively under the Tories. We must recognise, as my right hon. Friend has done, that we need to do something about sex education, and about tackling drugs, smoking and bad housing. If we reduce bad health, people will not need to go into hospital.

The Green Paper proposes partnerships between local authorities and voluntary organisations and talks about going into schools to preach about preventable health problems. All that was anathema to the Conservatives when they were in power. They had their chance and they blew it. The right hon. Member for Maidstone and The Weald may laugh, but I thought that her speech was superficial.

The Opposition say that the Government have nothing to offer hon. Members by way of extra resources. Let me put on record what we have in Calderdale. We are on the

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verge of being signed up for a new hospital. I pleaded with the Conservative Government for 18 years for a new hospital and now we are about to get one. We have received extra money from the waiting list initiative, over and above inflation.

Our health authority received an extra £118,000 for breast cancer, which was extremely welcome. The previous Government neglected that area, even though many of us in the House pushed it for years. Twenty-seven beds that were due for closure under the previous Government are now to be kept open. The right hon. Member for Maidstone and The Weald tells us that we are getting less, but we have the facts at our fingertips so we know that we are getting more. It is there for all to see and it will be good for my constituents.

We are getting rid of the hated internal market and replacing it with integrated care. The idea of GP commissioning is far superior to GP fundholding. We do not want to continue with a system that wasted money--and we all know the scandals that arose from it.

The Leader of the Opposition has seen fit to appoint a rather intolerant and narrow-minded shadow Secretary of State. The British people will have noted that move. They have never trusted the Tories with the national health service and they never will again.

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