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Mr. Bercow: In reflecting upon the Secretary of State's attitude to the Bill, is my right hon. Friend not reminded of a former leader of the Labour party and distinguished parliamentarian, Michael Foot, who, in a conversation some years ago, said, "Don't give me facts, they only serve to confuse my arguments."?
Miss Widdecombe: I am reminded of many things when I look at the Secretary of State, but mostly I am reminded of desperation--sheer desperation. So desperate is he, that he could not even address the Bill when he came to the House to present it. So desperate is he, that he has to manipulate the waiting lists to say that he is moving towards achieving a pledge that was supposed to be achieved early, but, after half a Parliament, is nowhere near being met.
Dr. Tony Wright (Cannock Chase) rose--
Miss Widdecombe: I have an embarrassment of riches. I shall go for the doctor.
Dr. Wright: I have been listening carefully to the right hon. Lady's remarks and trying to follow them. She gives a terrifying performance. There is certainly something of the fright about her. The right hon. Lady argues that there are dispossessed people whose treatments will be so expensive that the NHS will not be able to afford them. Exactly how will those desperate, dispossessed people be able to obtain treatment somewhere else?
Miss Widdecombe: That is the whole point. The whole point of what we are saying is that, if the private sector shares some of the strain with the NHS, the NHS will be freed up to look after the dispossessed. Instead, the Secretary of State wants to keep them dispossessed, and to increase their number and the range of treatments and drugs from which they are dispossessed. That is the
Government's policy. I cannot imagine that it is one of which the hon. Gentleman is proud, but at least now he may understand what I have been saying.
Miss Widdecombe: It might be for your convenience, Mr. Deputy Speaker, and for the convenience of the House, if I say that I shall make further progress before giving way. Compared with the Secretary of State, who refused to give way almost consistently throughout his speech, there has been a proper debate from the Conservative Benches today.
The Bill sets up primary care trusts, but it does not even contain a definition of one. The noble Baroness Hayman was rather embarrassed in the other place when she had to say that the Government would work out a definition. The Secretary of State has introduced a Bill setting up primary care trusts with no adequate definition of such trusts. I am not surprised that he does not address a Bill that does not even tell us what it is about.
This is a defective Bill, of which we have had a defective presentation by the Secretary of State. The Government have a defective health policy which has resulted in increasing numbers of dispossessed, manipulated waiting lists, longer waiting lists of people waiting to see a consultant and a winter crisis, yet still the Secretary of State tries to pretend that there is something new, modern and vibrant about the declining NHS over which he presides.
I will not say that the Secretary of State's language has been deceptive throughout, because you, Mr. Deputy Speaker, might call me to order, but it has certainly not portrayed an accurate picture. We all remember the right hon. Gentleman standing up in the House in great triumph saying, "I am providing 7,000 extra doctors". Everyone became very excited until he had to admit that they were just the doctors coming through medical school in the usual way, not "extra" at all.
There is nothing extra for any NHS patient in the whole of the Bill. There is nothing extra for any NHS patient in the whole of the Government's health policy. However, there is much less. There is much less choice for a patient's general practitioner to refer outside the area or to particular consultants.
Miss Widdecombe:
It is true, because whereas a fundholding GP could have decided that course of action for himself, a member of a primary care group will be able to do so only if the committee of that group has established that pattern. The right hon. Gentleman has just given an inaccurate portrayal of what PCGs will do.
We have frequently asked the right hon. Gentleman to guarantee that the choices and services that are now available to patients of fundholders will be available when PCGs are up and running. They are now up and running, and he has still not been able to guarantee that such choices, services and flexibility will be available. Why not? Because quite patently in some parts of the country--the evidence is flowing in--they are no longer available. There is less for NHS patients.
There will be fewer treatments and drugs available to NHS patients when NICE does its nasty, ugly work. There will be less available to patients when pricing policy
drives some drugs from the market and when GPs find for the first time that their budgets are cash limited. That is what the Bill provides.
The right hon. Gentleman talks about removing bureaucracy. It will cost £150 million to set up the PCG bureaucracy. He talks about cost-effectiveness. I hope that NHS Direct works, but studies currently show that the average NHS Direct call costs £20 whereas a call from a GP surgery costs £3, so there is not even a saving that can be passed on for the benefit of the NHS patient.
This ineffective, defective Bill does not deal with the real problems of the NHS. It does nothing to address the single biggest problem that has eaten away at the NHS from its inception--it was recognised by Nye Bevan himself, but is denied by the Government. The NHS cannot and never has been able to do it all. On top of increased resources from Government--which will always be provided under successive Governments--I want to find fresh ways of putting extra resources, facilities and expertise at the disposal of the NHS for the benefit of patients.
The Secretary of State has sat there and laughed at those patients. He has denied that the dispossessed are dispossessed. He pretends to be spending money that he is not spending, and to be creating extra doctors who are not being created. In the end, he will have to face a reckoning, because the true test of people's satisfaction with the NHS is not Government rhetoric, but patients' own experience. A quarter of a million more patients who are waiting to see a consultant have their own experience. Patients of former fundholders who are now unable to get the same services have their own experience. Patients coming off the lists because they are so desperate that they go private even if they do not want to have their own experience.
Those people know that the Government are not delivering on the NHS. The Secretary of State should come to the Dispatch Box and apologise for what must have been the most insulting performance that the House has witnessed in some years.
Mr. Deputy Speaker:
Order. Before I call the next speaker, I remind hon. Members that all Back-Bench speeches will be limited to 10 minutes.
Mr. Kevin Barron (Rother Valley):
I hope to stick to that time limit, Mr. Deputy Speaker. First, however, let me correct what the right hon. Member for Maidstone and The Weald (Miss Widdecombe) said about the PFI and our attitude when we were in opposition. The Conservative Government made a complete hash of the PFI--
Mr. Michael Fabricant (Lichfield):
We did not.
Mr. Barron:
Will the hon. Gentleman keep quiet for a few minutes? The Conservative Government did nothing at all. They did not set up a single hospital under the PFI. They introduced a Bill--
Mr. Fabricant:
You voted against it.
Mr. Barron:
Will the hon. Gentleman keep quiet? You introduced a Bill--
Mr. Deputy Speaker:
Order. Hon. Members must use the correct parliamentary language. I suggest that the House should settle down.
Mr. Barron:
The last Government introduced a Bill called, if memory serves me correctly, the National Health Service (Residual Liabilities) Bill. The Secretary of State and the Minister who were in charge of that Bill are present now. It was in Committee for two or three weeks at the most. We co-operated fully with the Government, and the Bill completed its stages in the House, but when those in the private sector had another look at it, they said, "It is not good enough: you will have to come back with something else."
About three weeks before the general election campaign, the right hon. Member for Charnwood (Mr. Dorrell) offered another Bill to the then shadow health team in the hope that they would endorse it promptly and allow its speedy passage, because the Conservatives could not get anything started with the PFI. In the end, he did not give us that Bill, although we would have gladly taken the matter off his hands, because he did not dare to go public about the mess that the Conservatives had made in regard to the PFI. The present Government have embarked on the biggest programme of building major NHS hospitals for years, because the last Government did not know how to handle the private sector in terms of the PFI.
The Bill makes major changes. I do not know how many Bills providing for structural change in the NHS we have debated when I have been in the Chamber, but there must have been many since my arrival in the House in 1983. It is a great pity that the right hon. Member for Maidstone and The Weald does not understand some of the changes in this Bill; I hope to tell her at some stage what I think is likely to happen.
In fact, I think that the NHS will experience a cultural change. That will not happen overnight--it will take many years--but I believe that aspects of it will challenge parts of the service, although if the service does not change it will not be capable of doing in the next century what it has done in the second half of this one. If it is to retain the admiration and support of its patients and the taxpayer, it must recognise the need for it to change to meet both the expectations of patients and advances in medical science.
Through the media, patients are becoming increasingly aware of new advances on both a national and an international scale. As they become more knowledgeable, they will expect the best treatments that are available. They will want to know more about the latest drug on the market, and how it could affect them. Professionals in the NHS will have to meet those new demands, and the Bill rightly aims to create a more patient-led service.
For the first time, a Government are introducing a statutory duty to implement a "quality of care". It beggars belief that any Member should make it clear from the Dispatch Box that he or she does not recognise the fundamental change that such a duty will make to health care. No one who does not recognise that can have read the Bill properly.
Making quality a driving force for decision making at all levels of the service should guarantee clinical excellence for all patients. I oppose rationing in the NHS, and I hope that every other hon. Member does as well. The Bill will enable us to get rid of it, by ensuring clinical
excellence for all patients. The establishment of the Commission for Health Improvement is another step forward, although it was dismissed by the right hon. Member for Maidstone and The Weald, who seems to oppose the idea of clinical improvement in the NHS. That is ridiculous.
Independent assessment of local work to improve quality should have been introduced years ago, and the use of a wide range of expertise and experience to investigate problems is also overdue. It should be welcomed by all who work in the NHS. It is clear--my right hon. Friend the Secretary of State gave a couple of examples--that past performance has been variable. People have been slow to detect and act on lapses in quality, and that is not acceptable.
The introduction of evidence-based national service frameworks should ensure consistent access to services and quality care throughout the country by setting national standards, and defining patterns and levels of care in relation to specific diseases or parts of the service. My right hon. Friend said that coronary heart disease and mental illness would be among the first conditions to be dealt with by the frameworks, which will be based on the Calman Hine model for the provision of cancer care. The recommendations of what was then the Calman committee were published in 1995. The final recommendation states:
The Bill will provide a new system of clinical governance to ensure that there is continued improvement in NHS trusts and primary care bodies. That is what I look for, as a patient, and what other NHS patients want. We are not interested in arguments about structures.
The National Institute for Clinical Excellence will be clinician-led. It will give a strong lead, in terms of both clinical services and cost-effectiveness. It will issue new guidelines for the NHS, putting an end to all the mixed messages that people receive about new drugs. How many hon. Members have sat in a doctor's waiting room behind a salesman who wants to sell another message about how his drug is better than those that the doctor already has?
The hon. Member for Oxford, West and Abingdon (Dr. Harris) looks confused. Let me tell him that I have sat in my doctor's surgery, and have seen salesmen waiting to sell their drugs. It is about time that there was a better way of conveying information to doctors.
We should be concerned about new drugs and treatments. Those in the NHS should understand the clinical effectiveness of drugs better, so that the decisions that are made are the best for patients. A recognition of cost-effectiveness will not necessarily mean the cheapest
treatment: in certain circumstances, it could mean that NICE will recommend the most expensive treatment if that is best for the patient. We should welcome that, however, as should the pharmaceutical industry.
5.49 pm
"The data suggest that the impact of specialised care for common cancers, and probably for many cancers, can increase long term survival by 5-10 per cent., a very important clinical outcome."
People reading that report might have thought that the NHS could continue to offer all services in all district general hospitals, as it has for years, but the report made it clear that that should end. I am pleased to say that it has in regard to cancer, but it should end in other contexts as well. We should ensure that our clinicians do the best that they can for every patient, regardless of where the service is being delivered. If Opposition Front Benchers are really concerned about what is happening, or should be happening, in our health service, they will comment on that.
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