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Mr. Alan Clark (Kensington and Chelsea): I was going to suggest that all the white middle-class males in the catchment area be employed as cleaners.

Mr. Dobson: On the basis of that comment, I shall not make the right hon. Gentleman the principal recruiting officer for the NHS in London.

My actions should help to make sure that proper attention is paid to rooting out institutional racism faced by patients and staff, but I emphasise that this is a task for everybody, not a lone member from an ethnic group who serves on a board.

That brings me to the wider question of tackling inequalities in health, not only through targeted effort by the NHS, but by using every instrument at the Government's disposal. Poor people are ill more often and die sooner. I have been stating that ever since I became an MP, and we have had further confirmation of the truth

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of that in the past few days in reports revealing that strokes and cancer are more common and more harmful for people who are badly off. We all know the factors that systematically make poor people ill: unemployment, low pay, poor housing, crime and disorder and a polluted environment. This Government are taking concerted action to tackle those problems.

There are now 143,000 more people in work in Greater London than there were two years ago, when we were elected; 36,000 young people have started the new deal, and 6,800 have already got jobs. There is still a long way to go, but our proposals are working despite the opposition of Tories and Liberals who preferred to defend the windfall profits of the utilities rather than invest in our young people and the long-term unemployed. Getting a job will improve the health of those people. The figures reveal that, if a middle-aged man loses his job, that doubles his chances of dying in the next five years, and the group that has suffered the highest increase in mortality is made up of young men who are out of work.

The introduction of the national minimum wage--I am inordinately proud to be a member of the Government who introduced that measure--has benefited 116,000 people in work in London by putting more money in their pockets and handbags. The working families tax credit, which guarantees a minimum full-time pay of £200 a week for a family with children will benefit 125,000 families in London.

As far as I know, all those measures were opposed by the Tories and some were opposed by the Liberal Democrats. They will all put money into the pockets of the worst-off and thereby improve their health and that of their families, and that is one of our main reasons for introducing them.

Mr. Duncan: Setting aside any arguments about whether the minimum wage is good or bad, will the Secretary of State, for the information of the House, advise us how much the implementation of the minimum wage has cost the national health service in London?

Mr. Dobson: For an organisation that will be spending £40 billion this year, the answer is next to nothing, and certainly not the stupid, harum-scarum sums of £500 million that were quoted by Tory Members who have held the job that I now have. They gave those "estimates", as they called them, because they wanted to put people off supporting the minimum wage and because they were too idle and feckless to have collected any information on the levels of pay in the health service. They apparently gloried in the thought that they had been presiding over a health service in which tens of thousands of hard-working staff were so badly paid that their pay would be improved by the introduction of a national minimum wage. The impact of the measure is minimal.

Mr. Eric Forth (Bromley and Chislehurst): As the Secretary of State has been so typically robust about comments that my colleagues have made in the past, will he now demonstrate his grasp of the subject by giving us the actual cost of implementing the minimum wage for the health service as a whole and the health service in London?

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Mr. Dobson: The costs are minimal. [Hon. Members: "What is the figure?"] Below £10 million--not £500 million, which the fools on the Opposition Benches were quoting. The last estimate that I received of the costs of implementing the £3.60 minimum wage was below £10 million.

Mr. Duncan: Is that for London?

Mr. Dobson: No, that is for everywhere in the country. We have not broken down the figure. Because levels of pay in London are that bit higher, I doubt whether anyone in the NHS in London is earning less than £3.60 an hour. I emphasise that such information was not available to me when I first became Secretary of State because the Tories had deliberately stopped the collection of that data three years earlier. Indeed, it cost us £46,000 to carry out a survey to find out what the impact would be.

Mr. Duncan: If the cost to the NHS was less than £10 million overall, how can the right hon. Gentleman maintain that there was a problem of low pay beforehand?

Mr. Dobson: I was not saying that.

Mr. John Horam (Orpington): What is the point of the minimum wage?

Mr. Dobson: If the hon. Gentleman asks the more than 2 million earners who are now getting a national minimum wage of £3.60 instead of £1.80, £2 or £2.30 an hour, which his well-paid little friends were paying them, he will find that plenty of people think that there are advantages to a national minimum wage. Practically every decent person in this country thinks so. Despite all the Tory propaganda, there was scarcely ever a time when less than three quarters of the people in this country believed that the national minimum wage was a bad idea. We have never thought that it would have much impact on the NHS. The Tories were estimating that it would cost £500 million, which shows how stupid and ill-informed they were about that aspect of the NHS for which they were responsible.

In London, 2.6 million employees will benefit from the cut in national insurance contributions, and the new 10p starting rate of income tax will halve the tax bill for 170,000 Londoners. Putting more money into their handbags and pockets will improve their health.

Record increases in child benefit will raise the living standards of the worst-off families with children. The sure start programme, over which my right hon. Friend the Minister for Public Health is presiding, will bring together early education, health services and family support for families when they need it--with more than £450 million over the next three years. Some of the pilot schemes will be in London. There will be one in Camden and, I believe, the other will be in Southwark. There seems to be some strange coincidence between the location of those pilots and the places represented by today's Front-Bench spokesmen.

New improvements in pensions and the £100 million winter payment fund will benefit 1.2 million London pensioners. Their finances and health will also benefit from the abolition of the charge for eye tests for over

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60-year-olds, which the mean-minded Tories were happy to introduce because they wanted to start charging for everything in the NHS.

As part of our efforts to provide people with somewhere decent to live, the Government are investing £145 million to reduce the number of people sleeping rough. The bulk of that money will be spent in London, which will certainly improve the health of the people concerned. We are also investing more than £5 billion a year on building new homes and renovating old ones; £390 million from the capital receipts initiative will be invested this year in new and better homes for Londoners, which will therefore improve their health.

It would be silly to try to pretend that everything is fine with London's health services, and that improvements can be made immediately, but it is certainly true that things are improving and will continue to improve. New hospitals are being built, old hospitals are being modernised, staff pay and conditions are being improved, new and better ways of working are being introduced, the quality of treatment and care is being raised and more and more patients are being treated.

In March, we published a modernisation plan for the NHS in London, which describes the targets that the Government are setting--no longer keeping them a closely guarded secret, but spelling them out, so that Londoners know what they are and can judge whether they have been met. I am confident that they will be met and that it will be largely because of the commitment, skill and professionalism of the NHS staff working in London, which, as I said at the beginning, were so amply demonstrated by their brilliant response to the three outrages in Brixton, Brick lane and Soho over the past three weeks. We owe them a great deal and we are determined to provide them with modern buildings, modern equipment and modern ways of working so that they can deliver a service to a standard to which they have always aspired.

1.45 pm

Mr. Alan Duncan (Rutland and Melton): May I associate myself and my right hon. and hon. Friends with what the Secretary of State said in some detail--it needed that detail--in praise of those who work in the national health service and their response to the three outrageous nail bomb attacks in London over the past few weeks? No praise can be too high. Lives have been saved and people have been treated quickly and well. Their response to what happened in Brixton, Brick lane and Soho was admirable. I am sure that the Secretary of State joins me in condemning the contemptible nature of those attacks, which were all the more contemptible for being targeted at minorities.

The praise given to health service personnel today is the sort of praise that hon. Members want to give pretty well all the time because, by and large, the health service is successful because of the people who work in it. It is the people who make it. It is their dedicated nature that makes it the success that it is. It is what they do that makes the health service something of which to be proud.

In London and every other part of the country, things are not perfect. As politicians, we have a grave duty to make sure that debate on this subject is of the highest standard possible. If we get the debate wrong and we are irresponsible in our discussions, quite literally, it can cost lives.

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The health service is a massive enterprise, probably one of the largest single employers in the world. It has a massive budget and a massive task. It has a duty of care which perhaps no other organisation has to meet on such a large scale. Therefore, it behoves us to treat it not with the political licence with which so many other topics are treated, but with a grave responsibility and deeper thought than many are prepared to give.

Conservative Members are trying to do that. We are trying to recognise that this is a modern world where wants are taking over from needs and people expect things to be delivered. It is a consumer world where people expect their wants to be met as well as their needs and, clearly, the NHS will not be able to do it all. It has never been able to. If our starting point for debate is a denial of that basic fundamental point, which every cabbie in the street will say is common sense, we will not be treating this matter with the responsibility it deserves.

I want to make it clear where we are coming from. We admit that rationing exists and that it always has. We admit that there is a shortfall between what the NHS can deliver and what its resources can allow it to deliver. Our basic position is simple--we recognise that the NHS cannot do it all.

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