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Mr. Denham: The right hon. Lady made no mention of that when in government, despite the considerable opportunities to do so. Indeed--there is some sense in this--the previous Government said:


I agree. There has been a need to set priorities in the health service from the beginning. There is such a need in every health service in the world. The challenge is to set those priorities properly, sensitively and effectively; to ensure that every penny that the NHS has is used to treat patients to the best effect.

Mr. Lansley: Will the hon. Gentleman give way?

Mrs. Angela Browning (Tiverton and Honiton): Will the hon. Gentleman give way?

Mr. Denham: No, I have made it perfectly clear that I am not intending to do so. [Interruption.]

Mr. Deputy Speaker: Order. The hon. Member for Tiverton and Honiton (Mrs. Browning) should calm down. The Minister is not giving way.

Mr. Denham: I am not intending to allow interventions because I want to make my points on priorities in the NHS.

This Government, as my hon. Friend the Member for Bury, South (Mr. Lewis) has reminded us, are investing record amounts. We put in an extra £2.25 billion in our first two years in office. There will be £20 billion more over the next three years. I found it strange that the hon. Member for Broxbourne (Mrs. Roe) complained that we were throwing money at the system. We are investing far more in the health service than any other party promised or contemplated in this Parliament.

Clinical judgment is at the heart of decision making in the NHS. But, to make the best use of that money, people working in the NHS and those taking decisions in it need to know what works and what does not. They need to be aware of the costs of what they do and the most cost-effective and clinically effective way of doing it. The NHS needs to be organised, so that decision making is effective and reflects national and local interest. The most

18 Jan 1999 : Column 623

damning indictment of the past 18 years of Conservative government is that the Tories failed in that key task. That is why, all too often, there are differences and variations in the health service that the Tories left behind.

It is true that patients with the same need will not always receive the same treatment. Some patients do not do so because the internal market was designed to set doctor against doctor, patient against patient, hospital against hospital. That was the entire logic of the internal market--each fundholding practice focusing only on the needs of its own patients; each trust focusing only on the patients sent to it.

Of course, in such a system, everyone has been working to do their best--GPs for their patients, hospitals for the people who are sent to them. However, doctors and nurses in every hospital know that they could see fewer patients with less severe conditions if the links between primary and secondary care were better. Doctors in every GP practice know that their work load reflects the failure to tackle the roots of ill-health and health inequalities in the wider community--in work, in provision for young children and through social exclusion. Yet those professionals are without the power to influence the way in which problems are tackled. We will abolish the internal market, replacing division and competition with co-operation and partnership. We shall improve primary care, ensuring that the whole service works together to tackle health inequalities.

The internal market is not the only problem. When hard-pressed doctors do not always have the latest information and analysis to hand, some patients will receive treatment that is not the most clinically effective and cost-effective.

Mr. Kenneth Clarke: Will the hon. Gentleman give way?

Mr. Denham: I have already given way to the right hon. and learned Gentleman. [Interruption.] Conservative Members do not want to be told why, in the health service that they have created, there are variations in treatment and access to treatment in different parts of the country.

One of the reasons for such variation is that there is no organisation that brings together in one place the best, evidence-based assessment of the latest treatment, drugs, surgical procedures and new technologies. As a result, despite the best efforts of professionals in the NHS, some patients do not receive the most cost-effective and clinically effective treatment. Some receive treatment that costs money but does not work well, or of which the risks may outweigh the benefits. When that happens, money is wasted--money that could have funded treatment for someone else. The organisation that could provide that information does not exist. Nor have we effective ways of getting information to those who need it. The national institute for clinical excellence will do that job, getting that information to doctors.

With total predictability, the Conservative party opposes such a proposal. It would rather that doctors worked without the latest information and patients received second best. It would prefer taxpayers' money to be wasted on ineffective treatment. It would rather that patients waited longer to benefit from proven advances in medical science.

Some patients do not receive comparable treatment because the NHS bequeathed by the Tories has lacked the tools to analyse how to manage services effectively. It

18 Jan 1999 : Column 624

has lacked the encouragement to work together to tackle inequalities in health provision. The Tories' health service could not measure the difference between a really well-run hospital and a poorly run one. We know the cost of seeing a consultant in every hospital, but not whether people get better having done so. Nor do we know whether there is fair access to services, or what patients and carers think of the services that they receive.

We shall introduce better performance measures--counting the things that count for patients. The commission for health improvement will oversee the quality of care in hospitals. We are setting out national service frameworks to define the standards that everyone should be able to enjoy. We will ensure that patients have better information, so that they can make the best use of the NHS. By April, 40 per cent. of England will be covered by NHS Direct--telephone advice from nurses 24 hours a day.

The message from the Opposition is clear: the Conservative party has given up on the NHS. We reject its pessimism; so do the British public. There has always been a need to set priorities in the health service, and our priorities are clear. We are funding extra nurses. We are training more doctors. One in four accident and emergency departments will be modernised in the coming year. Our priorities are making available money forwinter pressures; investment in modernisation; better information; less waste, and co-operation instead of competition. And the principles remain the same: that if people


Question put, That the original words stand part of the Question:--

The House divided: Ayes 169, Noes 336.

Division No. 34
[7 pm


AYES


Ainsworth, Peter (E Surrey)
Allan, Richard
Amess, David
Ancram, Rt Hon Michael
Arbuthnot, Rt Hon James
Ashdown, Rt Hon Paddy
Atkinson, Peter (Hexham)
Baldry, Tony
Beith, Rt Hon A J
Bercow, John
Beresford, Sir Paul
Body, Sir Richard
Boswell, Tim
Bottomley, Peter (Worthing W)
Bottomley, Rt Hon Mrs Virginia
Brake, Tom
Brand, Dr Peter
Brazier, Julian
Brooke, Rt Hon Peter
Browning, Mrs Angela
Bruce, Ian (S Dorset)
Burns, Simon
Burstow, Paul
Campbell, Menzies (NE Fife)
Cash, William
Chapman, Sir Sydney
(Chipping Barnet)
Chidgey, David
Chope, Christopher
Clappison, James
Clark, Rt Hon Alan (Kensington)
Clark, Dr Michael (Rayleigh)
Clarke, Rt Hon Kenneth
(Rushcliffe)
Clifton-Brown, Geoffrey
Cormack, Sir Patrick
Cotter, Brian
Cran, James
Davey, Edward (Kingston)
Davis, Rt Hon David (Haltemprice)
Day, Stephen
Dorrell, Rt Hon Stephen
Duncan, Alan
Duncan Smith, Iain
Emery, Rt Hon Sir Peter
Evans, Nigel
Faber, David
Fallon, Michael
Flight, Howard
Forth, Rt Hon Eric
Foster, Don (Bath)
Fowler, Rt Hon Sir Norman
Fox, Dr Liam
Gale, Roger
George, Andrew (St Ives)
Gibb, Nick
Gill, Christopher
Gillan, Mrs Cheryl
Goodlad, Rt Hon Sir Alastair
Gorman, Mrs Teresa
Gray, James
Green, Damian
Greenway, John
Grieve, Dominic
Hague, Rt Hon William
Hamilton, Rt Hon Sir Archie
Hammond, Philip
Harris, Dr Evan
Harvey, Nick
Hawkins, Nick
Hayes, John
Heald, Oliver
Heath, David (Somerton & Frome)
Heathcoat-Amory, Rt Hon David
Hogg, Rt Hon Douglas
Horam, John
Howard, Rt Hon Michael
Howarth, Gerald (Aldershot)
Hughes, Simon (Southwark N)
Hunter, Andrew
Jack, Rt Hon Michael
Jenkin, Bernard
Johnson Smith,
Rt Hon Sir Geoffrey
Jones, Nigel (Cheltenham)
Kennedy, Charles (Ross Skye)
Key, Robert
King, Rt Hon Tom (Bridgwater)
Kirkbride, Miss Julie
Laing, Mrs Eleanor
Lait, Mrs Jacqui
Lansley, Andrew
Leigh, Edward
Letwin, Oliver
Lewis, Dr Julian (New Forest E)
Lidington, David
Lilley, Rt Hon Peter
Lloyd, Rt Hon Sir Peter (Fareham)
Llwyd, Elfyn
Loughton, Tim
Luff, Peter
Lyell, Rt Hon Sir Nicholas
McIntosh, Miss Anne
MacKay, Rt Hon Andrew
Maclean, Rt Hon David
Maclennan, Rt Hon Robert
McLoughlin, Patrick
Madel, Sir David
Major, Rt Hon John
Malins, Humfrey
Maples, John
Mates, Michael
Mawhinney, Rt Hon Sir Brian
May, Mrs Theresa
Michie, Mrs Ray (Argyll & Bute)
Moss, Malcolm
Nicholls, Patrick
Oaten, Mark
Ottaway, Richard
Page, Richard
Paterson, Owen
Pickles, Eric
Prior, David
Randall, John
Redwood, Rt Hon John
Rendel, David
Robathan, Andrew
Robertson, Laurence (Tewk'b'ry)
Roe, Mrs Marion (Broxbourne)
Rowe, Andrew (Faversham)
Russell, Bob (Colchester)
Sanders, Adrian
Sayeed, Jonathan
Shephard, Rt Hon Mrs Gillian
Simpson, Keith (Mid-Norfolk)
Smith, Sir Robert (W Ab'd'ns)
Smyth, Rev Martin (Belfast S)
Soames, Nicholas
Spelman, Mrs Caroline
Spicer, Sir Michael
Spring, Richard
Stanley, Rt Hon Sir John
Streeter, Gary
Stunell, Andrew
Swayne, Desmond
Syms, Robert
Tapsell, Sir Peter
Taylor, Ian (Esher & Walton)
Taylor, Matthew (Truro)
Taylor, Sir Teddy
Townend, John
Tredinnick, David
Trend, Michael
Tyler, Paul
Tyrie, Andrew
Viggers, Peter
Walter, Robert
Wardle, Charles
Webb, Steve
Wells, Bowen
Welsh, Andrew
Whitney, Sir Raymond
Whittingdale, John
Widdecombe, Rt Hon Miss Ann
Wilkinson, John
Willetts, David
Willis, Phil
Wilshire, David
Winterton, Mrs Ann (Congleton)
Winterton, Nicholas (Macclesfield)
Yeo, Tim
Young, Rt Hon Sir George

Tellers for the Ayes:


Mr. John M. Taylor and
Mr. Tim Collins.


NOES


Abbott, Ms Diane
Ainger, Nick
Ainsworth, Robert (Cov'try NE)
Allen, Graham
Anderson, Donald (Swansea E)
Anderson, Janet (Rossendale)
Armstrong, Ms Hilary
Ashton, Joe
Atherton, Ms Candy
Atkins, Charlotte
Austin, John
Barnes, Harry
Barron, Kevin
Battle, John
Bayley, Hugh
Beard, Nigel
Beckett, Rt Hon Mrs Margaret
Begg, Miss Anne
Bell, Martin (Tatton)
Bell, Stuart (Middlesbrough)
Benn, Rt Hon Tony
Bennett, Andrew F
Benton, Joe
Bermingham, Gerald
Berry, Roger
Best, Harold
Blair, Rt Hon Tony
Blears, Ms Hazel
Blizzard, Bob
Boateng, Paul
Borrow, David
Bradley, Keith (Withington)
Bradley, Peter (The Wrekin)
Bradshaw, Ben
Brinton, Mrs Helen
Brown, Rt Hon Gordon
(Dunfermline E)
Browne, Desmond
Buck, Ms Karen
Burden, Richard
Burgon, Colin
Butler, Mrs Christine
Caborn, Richard
Campbell, Alan (Tynemouth)
Campbell, Mrs Anne (C'bridge)
Campbell, Ronnie (Blyth V)
Campbell-Savours, Dale
Canavan, Dennis
Caplin, Ivor
Casale, Roger
Cawsey, Ian
Chapman, Ben (Wirral S)
Chisholm, Malcolm
Clapham, Michael
Clark, Paul (Gillingham)
Clarke, Charles (Norwich S)
Clarke, Eric (Midlothian)
Clarke, Rt Hon Tom (Coatbridge)
Clarke, Tony (Northampton S)
Clelland, David
Clwyd, Ann
Coaker, Vernon
Coffey, Ms Ann
Coleman, Iain
Colman, Tony
Connarty, Michael
Cook, Frank (Stockton N)
Cook, Rt Hon Robin (Livingston)
Cooper, Yvette
Corbett, Robin
Corbyn, Jeremy
Corston, Ms Jean
Cousins, Jim
Cranston, Ross
Crausby, David
Cryer, Mrs Ann (Keighley)
Cryer, John (Hornchurch)
Cummings, John
Cunliffe, Lawrence
Cunningham, Rt Hon Dr Jack
(Copeland)
Cunningham, Jim (Cov'try S)
Dalyell, Tam
Darvill, Keith
Davey, Valerie (Bristol W)
Davies, Rt Hon Denzil (Llanelli)
Davies, Geraint (Croydon C)
Davies, Rt Hon Ron (Caerphilly)
Dawson, Hilton
Dean, Mrs Janet
Denham, John
Dismore, Andrew
Dobbin, Jim
Dobson, Rt Hon Frank
Donohoe, Brian H
Doran, Frank
Dowd, Jim
Drew, David
Dunwoody, Mrs Gwyneth
Eagle, Angela (Wallasey)
Eagle, Maria (L'pool Garston)
Efford, Clive
Ellman, Mrs Louise
Fatchett, Derek
Field, Rt Hon Frank
Fisher, Mark
Fitzpatrick, Jim
Fitzsimons, Lorna
Flint, Caroline
Flynn, Paul
Follett, Barbara
Foster, Rt Hon Derek
Foster, Michael Jabez (Hastings)
Foster, Michael J (Worcester)
Foulkes, George
Fyfe, Maria
Gapes, Mike
Gardiner, Barry
Gerrard, Neil
Gibson, Dr Ian
Gilroy, Mrs Linda
Godman, Dr Norman A
Godsiff, Roger
Goggins, Paul
Gordon, Mrs Eileen
Griffiths, Jane (Reading E)
Griffiths, Nigel (Edinburgh S)
Griffiths, Win (Bridgend)
Grocott, Bruce
Grogan, John
Gunnell, John
Hall, Mike (Weaver Vale)
Hall, Patrick (Bedford)
Hamilton, Fabian (Leeds NE)
Hanson, David
Heal, Mrs Sylvia
Healey, John
Henderson, Doug (Newcastle N)
Henderson, Ivan (Harwich)
Hepburn, Stephen
Heppell, John
Hesford, Stephen
Hewitt, Ms Patricia
Hill, Keith
Hinchliffe, David
Hoey, Kate
Home Robertson, John
Hoon, Geoffrey
Hope, Phil
Hopkins, Kelvin
Howarth, Alan (Newport E)
Howarth, George (Knowsley N)
Howells, Dr Kim
Hoyle, Lindsay
Hughes, Ms Beverley (Stretford)
Humble, Mrs Joan
Hurst, Alan
Hutton, John
Iddon, Dr Brian
Illsley, Eric
Jackson, Ms Glenda (Hampstead)
Jackson, Helen (Hillsborough)
Jamieson, David
Jenkins, Brian
Johnson, Alan (Hull W & Hessle)
Johnson, Miss Melanie
(Welwyn Hatfield)
Jones, Barry (Alyn & Deeside)
Jones, Mrs Fiona (Newark)
Jones, Helen (Warrington N)
Jones, Ms Jenny
(Wolverh'ton SW)
Jones, Dr Lynne (Selly Oak)
Jowell, Ms Tessa
Keeble, Ms Sally
Keen, Ann (Brentford & Isleworth)
Kelly, Ms Ruth
Kemp, Fraser
Kennedy, Jane (Wavertree)
Khabra, Piara S
Kidney, David
Kilfoyle, Peter
King, Ms Oona (Bethnal Green)
Kingham, Ms Tess
Kumar, Dr Ashok
Ladyman, Dr Stephen
Lawrence, Ms Jackie
Laxton, Bob
Lepper, David
Leslie, Christopher
Levitt, Tom
Lewis, Ivan (Bury S)
Lewis, Terry (Worsley)
Linton, Martin
Lloyd, Tony (Manchester C)
Lock, David
McAvoy, Thomas
McCabe, Steve
McCafferty, Ms Chris
McCartney, Ian (Makerfield)
McDonagh, Siobhain
McDonnell, John
McGuire, Mrs Anne
McIsaac, Shona
Mackinlay, Andrew
McNulty, Tony
MacShane, Denis
Mactaggart, Fiona
McWalter, Tony
McWilliam, John
Mahon, Mrs Alice
Mallaber, Judy
Mandelson, Rt Hon Peter
Marek, Dr John
Marsden, Gordon (Blackpool S)
Marsden, Paul (Shrewsbury)
Marshall, David (Shettleston)
Marshall-Andrews, Robert
Martlew, Eric
Meacher, Rt Hon Michael
Meale, Alan
Merron, Gillian
Michie, Bill (Shef'ld Heeley)
Miller, Andrew
Mitchell, Austin
Moonie, Dr Lewis
Moran, Ms Margaret
Morgan, Rhodri (Cardiff W)
Morley, Elliot
Morris, Ms Estelle (B'ham Yardley)
Mountford, Kali
Mullin, Chris
Murphy, Denis (Wansbeck)
Naysmith, Dr Doug
O'Brien, Bill (Normanton)
O'Brien, Mike (N Warks)
O'Hara, Eddie
Olner, Bill
O'Neill, Martin
Organ, Mrs Diana
Osborne, Ms Sandra
Palmer, Dr Nick
Pearson, Ian
Pendry, Tom
Perham, Ms Linda
Pickthall, Colin
Pike, Peter L
Plaskitt, James
Pollard, Kerry
Pond, Chris
Pope, Greg
Pound, Stephen
Powell, Sir Raymond
Prentice, Ms Bridget (Lewisham E)
Prentice, Gordon (Pendle)
Prescott, Rt Hon John
Primarolo, Dawn
Prosser, Gwyn
Purchase, Ken
Quin, Ms Joyce
Quinn, Lawrie
Rammell, Bill
Rapson, Syd
Raynsford, Nick
Reed, Andrew (Loughborough)
Reid, Rt Hon Dr John (Hamilton N)
Robertson, Rt Hon George
(Hamilton S)
Robinson, Geoffrey (Cov'try NW)
Roche, Mrs Barbara
Rooney, Terry
Ross, Ernie (Dundee W)
Rowlands, Ted
Ruane, Chris
Russell, Ms Christine (Chester)
Ryan, Ms Joan
Salter, Martin
Savidge, Malcolm
Sawford, Phil
Sedgemore, Brian
Shaw, Jonathan
Sheerman, Barry
Sheldon, Rt Hon Robert
Short, Rt Hon Clare
Simpson, Alan (Nottingham S)
Singh, Marsha
Skinner, Dennis
Smith, Rt Hon Andrew (Oxford E)
Smith, Angela (Basildon)
Smith, Rt Hon Chris (Islington S)
Smith, Miss Geraldine
(Morecambe & Lunesdale)
Smith, Jacqui (Redditch)
Smith, John (Glamorgan)
Smith, Llew (Blaenau Gwent)
Snape, Peter
Soley, Clive
Southworth, Ms Helen
Spellar, John
Squire, Ms Rachel
Starkey, Dr Phyllis
Steinberg, Gerry
Stevenson, George
Stewart, David (Inverness E)
Stewart, Ian (Eccles)
Stinchcombe, Paul
Stoate, Dr Howard
Strang, Rt Hon Dr Gavin
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Gerry
Taylor, Rt Hon Mrs Ann
(Dewsbury)
Taylor, David (NW Leics)
Temple-Morris, Peter
Thomas, Gareth R (Harrow W)
Timms, Stephen
Tipping, Paddy
Touhig, Don
Trickett, Jon
Turner, Dennis (Wolverh'ton SE)
Turner, Dr Desmond (Kemptown)
Turner, Dr George (NW Norfolk)
Twigg, Derek (Halton)
Twigg, Stephen (Enfield)
Vaz, Keith
Vis, Dr Rudi
Walley, Ms Joan
Wareing, Robert N
Watts, David
White, Brian
Whitehead, Dr Alan
Wicks, Malcolm
Williams, Rt Hon Alan
(Swansea W)
Williams, Alan W (E Carmarthen)
Wills, Michael
Winnick, David
Winterton, Ms Rosie (Doncaster C)
Wise, Audrey
Wood, Mike
Woolas, Phil
Wray, James
Wright, Dr Tony (Cannock)

Tellers for the Noes:


Mr. Kevin Hughes and
Mr. Clive Betts.

Question accordingly negatived.

18 Jan 1999 : Column 628

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.

Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.

Resolved,



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