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Mr. Michael Heseltine (Henley): When reading through the Gracious Speech and the speeches of the Prime Minister and the Leader of the Opposition, the single overwhelming conclusion one draws is the stark contrast between the reality of the Government's actions and the rhetoric in which they clothe those actions. The Gracious Speech contains much high-flown talk about enhanced competitiveness and an effective economy, but it also contains many measures to move the economy in precisely the opposite direction.
A naivety seems to flow from the Prime Minister's rather breathless approach. He thinks that, if he says something, it will happen. Anyone who is a connoisseur of such matters should read Hansard, in which he talks about
Perhaps even more naive is the hostility with which the Government approach the previous Government's record. Britain has a position of strength in electronic publishing relative to parts of Europe, but that is because, in the 1980s, we made all the difficult decisions to privatise and deregulate, all of which were ruthlessly opposed by the Labour party. We know exactly where the heart of the Government lies--in yesterday's ideas and yesterday's solutions. Although they understand that most of those are out of date, unfashionable and unpopular, they are edging back, in their legislative proposals, to the practices, assumptions and policies that failed the country so dismally in the past.
Today's debate centres on the health service. I listened with great care to the opening speeches. Two fundamental weaknesses emerged in the case advanced by the Government. The first was brilliantly exposed by my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe), when she made the point that, to reduce waiting lists, the Government are dealing with the easy cases. Of course that is desirable, and I have no complaint about it, but if, in the broad spectrum of health care, a mercifully small number of cases are relatively serious and a huge number can be coped with quickly, the easy, cheap way to get the plaudits of the crowd is to deal first with the easier cases.
When my right hon. Friend made that point, there was no flicker of recognition by the Secretary of State that she had stumbled on the essence of what he is doing, which is to preside over a rise in the number of more serious cases. The heart of my right hon. Friend's case is that the Government are in the business of levelling down. They are pandering to numeracy and the case that is being argued about statistics, but they ought to be preoccupied with the quality of the service.
My right hon. Friend made an important point that contradicted the Secretary of State's case, which was that the Government have talked to doctors, and, of course, many are hostile to what they are doing, but--he used a
quotation--they have decided to co-operate. Doctors will always co-operate. They are passionate in the pursuit of health and the interests of their patients. They will not let anyone down, whoever are the Government of the day.
Under the system of fundholding introduced by the previous Government, we tried to put doctors into a position of power as close to decision-making as possible, so that they could judge their patients' best interests. That was not popular with the great baronies of power--the vested interests of the unions and bureaucracies. We all know that they never want front-line people to be given the power to exercise individual discretion.
The Secretary of State's case was that doctors did not need to worry, because the Government will set up primary care committees, and doctors can elect the majority of their members and even be the chairman. If I were a doctor, I would shudder at that prospect. What does it mean? Doctors will have to become involved in the politics of the health service. Instead of dealing with their patients in their practice, they will have to go to committee meetings, stand for election and sit on the committee with people from different pressure groups, which all have a political agenda. That is enormously time-consuming. If one has the stomach for it, one may prevail, but the vast majority of doctors did not go into the medical profession to become politicians.
Having regard to some of the politicians who have done so well on the left of politics as experts in the manipulation of committees, I do not blame doctors for not wanting to spend their valuable time trying to advance the interests of their profession by the bureaucratic process of negotiating their way through a labyrinth of committees.
In any human activity, including medicine, one has to make difficult decisions. It is essential that we trust people to experiment, make decisions, explore alternatives and exercise initiative. That was happening under the fundholding arrangements, which is why doctors were voluntarily adopting them. That flexibility will now be replaced by a centralist system that will gradually impose the will of the Department of Health on the medical profession. That will not succeed. It will lead to trouble. Ministers will get into an appalling mess when things go wrong, and they will be hauled to the Dispatch Box to account for a myriad of errors that are not their immediate, personal responsibility, but, the politics of the system being what it is, they will be in the firing line.
The vast majority of people think that the health service is a fantastic achievement. They thought so under the previous Government; they think so under this Government; and they will go on doing so, but the Secretary of State's proposals will politicise the service.
As the Secretary of State knows, I have to explain to my constituents why a hospital will be closed. No hospitals in my constituency were closed when the Conservatives were in power. [Interruption.] No, they were not. The Secretary of State has generously agreed to receive a delegation of my constituents so that they can listen to a Labour Minister explaining why this munificent Government, with all their extra money, are threatening to close a hospital.
Mr. Heseltine:
One of many, as my right hon. Friend says. She was generous enough not to make that point at great length in her opening speech, but I suspect that my colleagues will want to make it.
Mr. Dobson:
The right hon. Gentleman brought a delegation to see me. I have agreed to receive other Conservative Members who represent parts of Oxfordshire. They will tell me that they want to keep their hospitals open, and that the right hon. Gentleman's hospital should close.
Mr. Heseltine:
As the right hon. Gentleman has spent his life trying to explain the conflict about priorities in the health service, he should not be surprised about that. That is the legitimate responsibility of a Member of Parliament. He should be concerned by the fact that I am not the only hon. Member from Oxfordshire who has made a representation about a proposed hospital closure--my colleagues also face hospital closures. Why did the Secretary of State read out a long list of new hospitals that will be constructed, but make no reference to the fact that hospitals in Oxfordshire are threatened with closure? I find that extraordinary, when so much extra money is apparently available.
Miss Widdecombe:
Is my right hon. Friend not also surprised that that should be happening when, before the general election, the then shadow Secretary of State for Health said that the Labour party had no plans for a programme of hospital closures?
Mr. Heseltine:
No, I am not a bit surprised. That is exactly what I would have expected of the then Labour Opposition. They said anything to con the people into believing that they had miracle solutions. Having got into government, they have had to face up to reality, which for my constituents means facing hospital closure.
Dr. Harris:
Will the right hon. Gentleman give way?
Mr. Heseltine:
No, I shall not.
The wider issue is not merely one of trying to stifle individual initiative in the health service and remove competitiveness--those themes run through the Gracious Speech. There will be trade union reform. The Government use charming words about a new partnership between managers and employees. If one genuinely wants higher-quality industrial relations, one must create such partnerships. That is the aim of Investors in People, an excellent programme that the Government support. The one way to bring it juddering to a stop is to bring the unions back into the process. Once the unions are in charge, there is another career pattern and another range of motives--and all of us know exactly what happened when they were involved in the process before.
The union leader wants to enhance his own reputation. Where he can, he wants to create the impression that he is fighting for the lads and lasses in the factories, but, before long, there are tensions between managers and union representatives. Discussions take place behind closed doors; the union representatives leak what was said, to the disadvantage of management; the process festers, and the situation deteriorates. The union leader then becomes part of a national chain. People want to climb the union ladder. To do so, they have to be seen to
be fighting local battles. The more battles they can fight and the more rows they can create, the more they attract the activists in the union chain who can promote them to national leadership.
There is thus an agenda quite different from that of the company whose interests the representatives were first elected to serve. That process has gone from this country. We have excellent industrial relations and increasing productivity, and we are more competitive than ever before, but what is to happen now? The unions are to get their privileges back. It is a retrograde step, which will prejudice our recovery and our progress towards increased competitiveness.
The story is the same in local government. We are told that we are to have more modern local government. There is a great case for that, and I am the first to say it. We cannot get councillors of the calibre we need. No party finds it easy to recruit men or women of the calibre required to command the scale of resources involved in local government. Councillors do not have the experience necessary to challenge the bureaucracies on which they have been elected to serve.
One would have hoped that the Government would tackle the problem. I have no doubt that we must move towards the introduction of directly elected chief executives who are paid an income corresponding to the level of their responsibilities. That should be done as a matter of urgency. It would create a far greater sense of local accountability. The Government are committed to the experiment, but does it appear in the Gracious Speech? No, and why not? It does not appear because it is a complicated idea. Instead, we understand that compulsory competitive tendering is to be ended. The challenge of balancing services and their value and cost is to be removed from the marketplace, and CCT is to be replaced by what is known as best value.
Best value is another classic example of this Government's public relations skills. Who can possibly be against best value, but how does one decide what it is? Who decides? One has only to ask that question in the Government's presence to know exactly who is going to decide. The people who are administering the systems will decide, and will do so in cahoots with the unions and the direct labour organisations.
That is transparent, but what will the consequence be? The consequence will be a monopolistic regime from which the chill of private sector competition is eliminated, under which costs go up, restrictive practices are tolerated, and the abuse of the democratic process, characteristic of Labour's long-held monopoly over local government, is perpetuated.
"making this country No. 1 in . . . electronic commerce".--[Official Report, 24 November 1998; Vol. 321, c. 36.]
Anyone who has any idea about what is happening in the world will understand that, in electronic commerce, the Americans are light years ahead of anything that is happening yet in this country. The world has shrunk in recent decades. It is ludicrous to pretend to the House that introducing legislation on electronic commerce will enable us to close the gap between this country and north America.
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