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Mr. John Bercow (Buckingham): On a point of order, Madam Speaker. I seek your guidance. Is it not out of order for an hon. Member to be reading a newspaper in the Chamber, which, it seems clear, the hon. Member for Rugby and Kenilworth (Mr. King) was doing until a few moments ago?
Madam Speaker: If a newspaper article relates to the debate, or if information is being obtained from it, it is in order to read it, whether in Committee or in the Chamber.
Mr. Andy King (Rugby and Kenilworth): Thank you, Madam Speaker.
Miss Widdecombe: I return to the matter in hand, which is the subject of the debate between the Secretary of State and myself.
I quite understand what the right hon. Gentleman has said, which is that he is seeking to change the system by which money is collected. But he also said that that was to collect it more efficiently and to get the money in. If that is true, I think that he will accept that the additional sum, which has not hitherto been collected as efficiently as it should have been, will have to be covered.
The question is simply this. If, in the process of covering that--I make no value judgment on whether this should be so; I am simply asking--drivers have to pay more, is that not a charge? The Secretary of State does not want to answer.
All these problems and bungles are happening at a time when the health service is supposed to be awash with new funding. The Secretary of State never tires of bragging about all the money that he claims to be spending, so how can anyone now believe--
Mr. Dobson:
Is the right hon. Lady's definition of a bungle 18 years of not getting in money to which the NHS was entitled, or a Government who, after 18 months, are going to get that money in?
Miss Widdecombe:
My definition of a bungle is when a Secretary of State does not know what is a charge and what is not. That is a bungle. He is afraid of the word "charge", but when the matter is discussed in the House, the exact extent of the way in which the Government are wriggling out of calling this a charge will become extremely clear.
How can anyone now believe the Government's warm words about modernisation? The truth is that too much of the money that the hon. Gentleman claims he is spending will go on a new bureaucracy--the bureaucracy that will not be cut in the upheaval that the Prime Minister assured us he was not about to impose on our health service.
Primary care groups will cost £150 million to set up. Is that a bureaucratic expense or not? Dragooning family doctors into general practitioner collectives--
The Minister for Public Health (Ms Tessa Jowell):
Dragooning!
Miss Widdecombe:
The hon. Lady obviously takes exception to the word "dragooning", so let us examine it.
When the Conservative Government set up fundholding, it was voluntary. Primary care groups are not voluntary. When we set up fundholding, doctors could choose whether to become fundholders. They have no choice about joining primary care groups.
Ms Julia Drown (South Swindon):
Does the right hon. Lady accept that, in making the system that she mentions voluntary, her Government necessarily set one doctor against another and one patient against another, whereas primary care groups will ensure that patients are treated like with like, and that clinical priority becomes the priority?
Miss Widdecombe:
No, because what the hon. Lady proposes is a levelling down, not a levelling up. By the time that we left office, between 50 and 60 per cent. of general practitioners were either fundholders or had applied to become fundholders because they saw the system working. We introduced the system gradually and
There is no choice. They are being dragooned. They are not even being dragooned gradually--it is all happening in one big bang, so that if anything is going to go wrong, it will go wrong universally on the first day. That is the policy of the Government.
Miss Widdecombe:
The hon. Member for South Swindon (Ms Drown) must control her jack-in-the-box tendency. I will not give way at the moment. I have already explained it to her--she wants to level down; the Secretary of State wants to level down; and the Minister of State is wholly committed to levelling down. The Conservative party wants to level up.
Mr. Simon Hughes:
I take it from that that the right hon. Lady is opposed to the Government's proposals. Will she elaborate on one linked point? Does she also hold to the view, expressed at her party conference, that the NHS will work properly only if fewer people use it by going private?
Miss Widdecombe:
What I expressed at the party conference was that it was total spending that counted. If one simply looked at public spending, and ignored completely the contribution that people made in their own right, one was necessarily limiting the degree to which we could increase total spending. If the Secretary of State would like to look at the spending patterns of our major European partners, he will find that, whereas public spending differs by a few points of 1 per cent., private spending differs by multiples. Those countries do not have many of the problems that we have because they have learnt that it is total spending that counts.
Actually, I should not be addressing the Secretary of State--I really ought to be addressing the hon. Member for Southwark, North and Bermondsey (Mr. Hughes). However, it is easy to confuse the Labour party and the Liberal Democrats today, and we are never quite sure when the Liberal Democrats are in opposition and when they are part of the Government.
Mr. Hughes:
Will the right hon. Lady give way?
Miss Widdecombe:
For the Opposition or the Government?
Miss Widdecombe:
I shall give way.
Mr. Hughes:
I wish to press the right hon. Lady a little further. That was a long answer about health funding
Miss Widdecombe:
I believe that the health service can treat more people and can give a comprehensive range of treatments if some of the burden of expenditure is shared. At the moment--as the hon. Member for Southwark, North and Bermondsey knows, because he has said so in this House--a number of people have no treatment at all and cannot exercise any alternative.
I have letters from elderly people, telling me that they can no longer receive clinical treatment for varicose veins on the NHS. Several have cashed in their life savings to go private. I make this deduction. Some people cash in their life savings and go private, however difficult that may be. Therefore, there must be people who cannot get the operations that are no longer available and cannot exercise a private alternative. At conference, I said that we would help to get a greater range of treatment available to NHS patients if there were more sharing between the private and the public sectors.
Perhaps I can return to the Queen's Speech, which we are supposed to be addressing. I am sorry that I was led into a discussion of my party conference. I am flattered that the hon. Member for Southwark, North and Bermondsey took such a close interest in it and I would be delighted to give him a verbatim copy if he wants to study it.
Dr. Desmond Turner (Brighton, Kemptown)
rose--
Miss Widdecombe:
I will give way again later, but I want to make some progress now.
Let us consider the national institute for the control of expenditure--sorry, I mean the national institute for clinical excellence--which will be the Government's rationing mechanism. As the Government claim that there is no rationing, where is the final directive that the Secretary of State promised on Viagra? I am extremely grateful to Viagra. It solved a very big problem: getting the Government to admit the truth--that the NHS has always rationed, is rationing and is likely to ration increasingly as it is unable to satisfy every last demand for every new treatment.
That is the truth that I stated at our party conference and that the hon. Member for Southwark, North and Bermondsey has also stated, but from which Labour Members consistently hide. The NHS cannot meet every last expectation. Undeniably, the national institute for clinical excellence will lay down what it calls priorities and what the man in the street would call rationing, forcing it on PCGs and removing once again the clinical discretion of individual doctors.
Can the Minister of State confirm his threat to change the Medical Act 1983 by ministerial edict rather than by secondary legislation if he wants to dismantle the 150-year-old tradition of clinical self-regulation, as exemplified by the General Medical Council? He sits tight.
The Government told us that NICE and CHIMP--the commission for health improvement--would not require any extra funding, but the British Medical Association and
the Royal College of Physicians disagree, telling us that without 10 per cent. more consultants, effective pilot schemes and proper evaluation the proposals will be catastrophic. Can the Secretary of State produce 10 per cent. more consultants? Will there be effective pilot schemes? Will he evaluate the proposals before rushing into them? I suspect that the answers will be no, no and no.
NICE and CHIMP will not be the end of the exciting career opportunities that the Government are creating for Tony's clinical cronies. We are also to have an advisory committee on resource allocation, a capital prioritisation advisory group and local education consortiums. It is unclear how health and local authorities are to be duty bound to administer joint investment plans without new co-ordinating bureaucracy.
Can this really be what the Government meant when they said that they would divert money from health service managers into front-line patient care? Even without this massive increase in pen pushing, the huge upheaval in the health service under Labour's new structures of political control will devastate patient care.
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