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Mr. Dobson: Will the right hon. Lady please give me the documentary evidence and I will deal with it.
Miss Widdecombe: The right hon. Gentleman is good at this. "Give me the documentary evidence," he says, "and I will deal with it." Unfortunately, he does not. Instead, he puts a good spin on what has been going on. He does not deal with the problem. For example, when we raised the problem of a child who had certainly waited in excess of the longest limits that the right hon. Gentleman claims, giving the name and all the details of the trust concerned, we were told from the Dispatch Box by the Minister of State--it is in Hansard--that the operation would take place on such and such a date as the trust had always planned. That was a good piece of spin, which was heavily undermined by the fact that a motorcycle courier was dispatched that very evening with the date of the operation.
Dr. Harris: The right hon. Lady is making an important point about the distortion of clinical priorities produced by the political need to bring down waiting lists rather than waiting times, and the underfunding of operations on an average cost basis. I join her in condemning that practice, but she must be careful not to fall into a similar trap with regard to basal cell carcinomas of the skin, for which a waiting time of four months might be appropriate to enable more urgent operations to be carried out. It is wrong to politicise any individual condition, particularly for people who may be waiting for treatment for such a cancer, which does not need urgent excision.
Miss Widdecombe: Then the Government should not make rash promises about a maximum waiting time of a fortnight. If that case is to be made, the hon. Gentleman should make it to the Government and convince them. Then we would not have such rash promises.
The Government have made a pledge, which they are distorting clinical priorities to deliver and they have made another pledge that they are coming nowhere near meeting. If the Government said, with humility, that that is because the problems of the NHS are not susceptible
merely to political solutions but are deep because demand and supply are so badly out of kilter, we might then have a rational and grown-up debate on the NHS instead of always having to deal with the Government's political priorities.
The right hon. Gentleman has challenged me to let him know of any fiddles that are going on so that he can sort them out. He has just said so. There is one, so I shall ask him to do something about it right away. It beggars belief that the Government try to claim credit for spurious waiting list falls and refuse to acknowledge the slightest shred of responsibility for the most blatant fiddles, even when those fiddles are the direct result of the climate of fear that the right hon. Gentleman has created in his panic to meet his so-called early pledge. We have found two further fiddles.
The Withington hospital in Manchester has a two-year waiting list for appointments with an orthopaedic consultant. I cannot believe that the right hon. Gentleman knew nothing of this, because he has been inaccurately boasting that he had eliminated two-year waiting lists. To get round this inconvenient fact, some patients have been palmed off on to physiotherapy practitioners, thus eliminating them altogether from the waiting list statistics. Again, we have documentary evidence.
Will the right hon. Gentleman assure the House that no patients are being kept off waiting lists by hospitals refusing for months to give a firm date for an operation, and then placed on the official statistics at the last moment by offering the patient a date and carrying out the operation super quickly? I should be surprised if he can give that assurance, because, apparently, that is happening in Macclesfield and in Altrincham. Again, I have some documentary evidence. It is not good enough for the Secretary of State to come to the House and, whenever we rumble one of his little fiddles, to say that he will make sure that it does not happen again. [Interruption.]
Miss Widdecombe:
The right hon. Gentleman has just said honestly that he cannot claim to make sure that that does not happen again. We note that.
Mr. Andy King:
The right hon. Lady is a control freak.
Miss Widdecombe:
Not a control freak. Oh dear, oh dear. If the hon. Gentleman asks the BMA, the nurses, those who will be rationed by NICE and those who may no longer exercise clinical judgment, the words "control freak" would be the first that they would apply to the Government.
For some time we and the BMA have been calling for a new system of waiting times for particular disease groups, instead of the crude, politicised system of waiting lists. I agree that it is not politically appealing, but it is at least practical and it is the system that measures what matters most to patients--whether they have been waiting for more than the appropriate time. If the right hon. Gentleman decides to go for that system, I will not tease him about how he has abandoned his pledge or his central political boast. I will welcome what he has done and support it. The Opposition will say, "Well done", but I do not somehow think that we will be able to do that.
May we at least have an assurance that the right hon. Gentleman will investigate ways of moving towards that common-sense approach and away from the discredited,
crude and fiddled waiting lists that are now posing some danger to patient care? I do not think that he will give that assurance, because his priority is not patient care but political control. It is evident in their scandal of broken pledges and patients on trolleys; in their hidden rationing agenda of NICE and CHIMP; in their refusal to take responsibility, despite taking unprecedented control over clinical judgment and health service planning; in clinical priorities that are being distorted by their waiting list obsession; and in taking choice away from patients and family doctors. As services suffer, patients suffer, waiting lists are fiddled and GPs are dragooned into collectives, this Queen's Speech sets out a blueprint for a centralised, bureaucratic health service set to undergo an unprecedented, deeply unwanted upheaval, where Ministers have all the power and none of the responsibility and where it is all about political control, not patient care.
Mr. Terry Rooney (Bradford, North):
I am inclined to say, "Now for something completely different." I rise principally to speak on social security but I must say a few words about health, especially after that performance.
Having never had to suffer a night in hospital, and having been a rare visitor to my general practitioner, my knowledge of the health service is limited to the experiences of my family and constituents. My constituents are delighted with the changes that they have seen in the past 18 months. Doctors in the Bradford health authority area willingly and rapidly agreed four primary care groups. The only time that there was a point at issue was when some were asked to cross the boundary into Leeds and there was danger of a revolution, as I am sure my right hon. Friend the Secretary of State understands.
Since the general election, Bradford health authority has received an additional £43 million, of which £34 million is over and above what was in the plans of the previous Administration. I pay tribute to the Minister of State, my right hon. Friend the Member for Darlington (Mr. Milburn), for his wisdom in selecting Bradford as one of the first health action zones. He knows that much of the bid was based on collaboration between the health authority and the social services department, which is about the best in the country. That is undoubtedly the way
forward and it is bringing new thinking into the provision of not only health care but health prevention, which must be the focus for the future.
I must toss in a cautionary note. Under Bradford health authority, there are still two hospital trusts and two community health trusts, with four chief executives, four boards, four finance directors, four personnel directors and all the rest. The sooner they come together, the better.
Finally on health, my right hon. Friend the Secretary of State knows about the advice, which I regard as nonsense, of the Medical Defence Union to its members never to say sorry. It is time that that advice was challenged for the rubbish that it is. Far too many cases finish in litigation because someone early on, when something has gone wrong--as things always will--refuses to say sorry because their insurance company has told them not to do so. I have had three cases that finished up in unnecessary litigation. Money disappears out of the health service as a result.
I am pleased by the commitment to the continuation of welfare reform announced in the Queen's Speech. The reform is based on clearly defined and public principles: that all those who can work, should; that there is security for those who cannot; that the state has a responsibility to help people into work, which we are doing through the new deal, education and the national child care strategy; and that work should pay. The minimum wage and the working families tax credit are helping those on the lowest incomes.
Under this Government, reform is based on those principles, which are maintained throughout, and not on requests from the Treasury. The previous Government doubled the social security budget but poverty increased dramatically. When they left office, 2.3 million children were in families dependent on income support for their sole income, and 1 million pensioners were entitled to income support but did not claim it. Take-up rates where nowhere near what they should have been. For income support, the take-up rate was only 79 per cent. and for family credit only 70 per cent. I am pleased that the Government have started pilot schemes to ensure that those 1 million pensioners claim the benefit to which they are entitled, and to discover the reasons why they have not done so and deal with them. Pensioners are a group who, perhaps more than any other, deserve an adequate income.
The working families tax credit is welcome because, unlike family credit, take-up will be automatic. The recent announcement by my right hon. Friend the Secretary of State for Social Security about the single gateway represents a magnificent and massive step forward, for two reasons: first, only those who are entitled to benefits will get them; and secondly, those who are entitled will get what they are entitled to get. Sadly, all too often that is not the case at present.
The Government are already putting their reforms into practice. Pensioners are being given £2.5 billion through the minimum pension guarantee and winter fuel payments. There has been a record increase in child benefit; the disability income guarantee has come on stream; and mobility payments for three and four-year-olds have been introduced for the first time--what a tragedy that it took 20 years to do that.
Reform of the ridiculous and discredited all-work test has been proposed. What a testament to the previous Government that is: one is either fit for work, in which case one is kicked down to the job centre to sign on and start looking for a job, or one is unfit for work; there is nothing in between. That is nonsense. On that basis, no one should ever claim incapacity benefit, because there is always one day in the week when one feels able to do something. A system that judges people to be either fit or unfit for work, with nothing in between, is a joke.
I welcome the extension to one year of the period in which people who are in receipt of incapacity benefit can try work and see whether they are fit for it, without fear of losing their entitlement. The most recent statement on widows and widowers is welcome, because for the first time all people--male and female--in that sad position will be treated in the same way. In addition, we shall be supporting people, especially those with children, in their time of need.
Two areas of welfare epitomise the differencebetween the Labour Government and the previous Administration--disability living allowance and the Child Support Agency. We had the nonsense of 40 per cent. of all lifetime awards of the care allowance element of DLA being on the lowest rate. If one is in such a condition that one needs an award for life, it is nonsensical to be given only the minimum rate. Logically, a lifetime award should be at the higher rate. In addition, far too many DLA claims--about 50 per cent. of the total--were awarded without any medical evidence being produced to support them.
We need to ensure that those who are entitled to DLA receive it, but, because of the lax manner in which the system was set up and the lack of training given to staff, far too many awards are incorrect. However, the benefit integrity project has been a disaster and I am delighted that my right hon. Friend the Secretary of State is to abolish it and introduce a reasonable, fair and sensible means of assessment. We need to move forward.
The Child Support Agency has been heavily criticised and much debated in the House. Seven years after its inception, and despite three major pieces of legislation, only one in eight parents with care get the full maintenance to which they are entitled. What a testament to the previous Government. The principal problem with the CSA is that, right from the start, it was not child focused. It was not about the family, it was about the need of the Treasury. That was the driving force from day one, which is why it has become such a mess.
The proposals in the Green Paper published earlier this year have been the subject of wide consultation and I believe that the principles have been widely accepted. The consultation was genuine and many of the comments received have been taken on board. When the legislation is published, we shall see the benefits of that consultation and of the Government having taken advice from a wide range of sources, instead of presuming that they know best. The system we propose will give genuine support to families and it will be fair, transparent and simple. People will understand, accept and respect the new child support system. We are developing an active modern service for claimants to replace the dead hand of bureaucracy. The linkage with the Employment Service in assistance schemes to get people into work is of real benefit.
Tremendous economic benefits are associated with being in work. The roots of prosperity will always be through work and never through the benefits system. However, it is important that proper conditions of work are maintained. I welcome particularly the Government's fairness at work proposals that we expect to see translated into legislation--especially those such as parental leave, which will affect families. The Government's extension of the maternity leave qualification, which has changed from two years to one year, will affect some 1.5 million women. The change in statutory maternity leave from 14 to 18 weeks will benefit 2.3 million women.
Those in work will have a better standard of living in the future through the introduction of the minimum wage. The working time directive--which has been much derided by the Opposition--will benefit families. It is a fact that, in the 1990s, it is still acceptable for people to work 60, 70 and 80 hours a week. How is that consistent with a family friendly employment policy? It is not.
The welfare reform programme, although good in itself, cannot be viewed in isolation. It must be linked to other social programmes if it is to bring combined benefits. We must address poverty and injustice and make work pay. We must remove barriers to work and ensure decent terms and conditions at work. We need a modern, active social security system that provides help to those in need when they need it and dispenses with the bureaucracy of the past. We must recognise that people can better themselves through work and provide employment opportunities to those who need them.
We have addressed the poverty of income, but we must address also the poverty of expectation. I am sure that all hon. Members will identify with the situation in my constituency where there are boys and girls of six, seven or eight whose older brothers and sisters, mothers and fathers, grandparents and aunts and uncles are out of work. Those children go on to become truants and disruptive pupils because they see no point in education when they will not be able to get a job when they leave school. We must eliminate the poverty of expectation and give that generation the hope and the opportunities that, sadly, too many of their parents and grandparents were denied. They were abandoned by the previous Government. The knock-on effects in terms of health and education are enormous and there are great bounties to be reaped.
My right hon. Friend spoke eloquently about the effect of poverty on health, and a similar argument applies to education. We must take a wide-ranging look at those issues. I look forward to the forthcoming pensions Green Paper. Nobody wants to see the present situation repeated in the future. Too many people are approaching old age with insufficient incomes. We need a permanent, and I believe compulsory, second-tier pension system. We have had compulsory second-tier pensions in the form of the state earnings-related pension scheme since 1975, and we must translate that into stakeholder pensions so that future generations do not suffer income poverty.
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