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Mr. Hinchliffe: My hon. Friend makes a valid point. People who are frightened of the health service will go to the private sector, which is what the Tories want.
Mr. Bercow: Will the hon. Gentleman give way?
Mr. Hinchliffe: No, I have already spoken for longer than I intended.
Perhaps Conservative Members might care to look at the report about private medical care by the Select Committee on Health, which will be published tomorrow. They want to push people into the private sector, but I hope that they will draw some conclusions from the report's investigations.
Mr. Bercow:
Will the hon. Gentleman give way on that point?
Mr. Hinchliffe:
No, I said that I intended to conclude.
The Tories have given up on health. I never thought that I would miss their previous spokesman, the right hon. Member for Maidstone and The Weald, but I do. What she lacked in knowledge of the health service she made up for in bluster when she banged around at the Dispatch Box. I miss her already, and this is only the first debate since her departure. She was good entertainment, and livened up debates such as this, even if there was not a lot of content in what she said.
Mr. Kenneth Clarke (Rushcliffe):
The hon. Member for Wakefield (Mr. Hinchliffe) has followed the pattern of many Labour Members by devoting most of his contribution to a speech that he could have made at the last general election. In the two years since then, I have debated most of the matters that he raised, so I shall not go over them all again.
The hon. Gentleman went back as far as the early 1980s, when he referred to the difference of opinion about the Black committee report. The Labour party turned to the left at that time, and it has accused Conservative Members of wishing to privatise the national health service ever since. That accusation often dominated the debate, and it is still being used today, by the hon. Gentleman and by the Secretary of State. However, the record over more than a decade of the previous Conservative Government shows that we had no such intention.
We have no such intention now, and my own commitment to the national health service is beyond doubt. The debate should be about making the health service better, rather than about exchanging empty slogans.
Mr. Hinchliffe:
If what the right hon. and learned Gentleman says is true, what was the purpose of giving financial incentives to elderly people to insure themselves for private medical care? Was it not the Tory party's intention to move towards private medical care?
Mr. Clarke:
Many people in private insurance found that, when they reached an age at which they were likely to make a demand on that insurance, there was a risk that the premiums would rise. The aim of the incentive was to ensure that those who chose private insurance when they were of working age would not have to give it up when they were most likely to make a claim. That perfectly defensible policy reduced the demands on the national health service. We otherwise concentrated on improving the national health service--paid for out of general taxation and free at the point of treatment--and I remain committed to improving that service.
The Secretary of State also devoted much of his time to his old election speech. I shall not go over all that he said, but I will attack his lack of policies. I wish the Secretary of State no personal ill will as he and I get on well and he has always been amiable and straightforward in our countless debates on policy on many subjects. I understand his much-publicised desire not to drink from the poisoned chalice by becoming Labour's candidate for mayor of London. But if he is moved, I shall not mind; as an Opposition Back Bencher, I am indifferent to who the Secretary of State is. What matters is that he or she has a coherent policy for a vital service. I have criticised the Secretary of State for having no such overall strategy, and he has merely reinforced that criticism today.
The Secretary of State has made a welcome statement on meningitis vaccines, but I have previously criticised the Government, and will do so again, for putting presentation where strategy should be. A stream of press
releases and initiatives flows towards us. Often, the initiatives have already been reannounced, but they have to be reannounced yet again. Many are entirely beside the point when placed against the day-to-day problems confronting those responsible for delivering health care on the ground.
In the most striking recent example, the Secretary of State, as usual when he is under pressure for failing to deliver what he promised at the general election, grabbed for the headlines. He published targets for health standards well into the next century. I do not want to be accused of being against his worthy objectives, which included careful calculations to show that many lives would be saved if the targets were ever delivered. However, he produced not a scintilla of evidence of anything new being done to deliver them. He offered us, instead of policy today, desirable ambitions that he said would be delivered in a decade or more, long after the Government have gone. All that was intended to divert attention from pressing problems now all over the country.
Today's statement was welcome, but the Government's advisers ought to raise the Secretary of State's standards. On a bad news day, his diversion of attention was blatant. He began with a worthwhile statement on meningitis protection, but was unable to answer our complaints and allegations about the state of the NHS. In addition to his usual election address on the deficiencies of the Conservative party's performance on the health service, he reminded me of the Wilsonian speech-making process of using a stream of statistics to hold together the best bits of the press releases, while coming to no particular conclusion on the future.
I congratulate the Conservative Front Bench team on raising this debate, because the Government are failing to deliver on the expectations that they raised by setting specific targets--some of them unwise--at the last election. Service to our constituents is deteriorating, and the volume of complaints about the inability of the NHS to meet its obligations is growing.
Dr. Stoate:
I entirely agree with the right hon. and learned Gentleman on one point. We need debates of substance on matters of policy. Why, then, when this should be an adult, grown-up debate about the running of the health service, is there no shred of policy in the Conservative motion? I should welcome a debate on policy, but there is none before us. The Conservatives offer only a stream of criticisms and no suggestions on how to improve the health service.
Mr. Clarke:
I promise the hon. Gentleman that, by the conclusion of my speech, I shall be giving welcome advice to the Secretary of State and making suggestions on how he can move from here to make worthwhile progress towards the ambitions that he holds out for us as targets for the next century. He will not attain them if he continues to cause the damage to the service that he has in two years so far.
I have spoken in health debates before because I am so concerned about the health service. It is one of the weakest areas of performance by the Government. I could choose many others, but with the health service, they are at the greatest risk of getting into more and more political trouble as reality confronts their presentation of what they are doing.
I shall begin by briefly putting points that I have made before about why the Government are getting it so wrong and why we are worried about a crisis in the health service that appears to be looming even in the summer, when demands are not the greatest. I most fear a winter crisis after our experience of last winter. There are some clear reasons why the Government have got themselves into this position.
First, the Government have got the money for the NHS wrong. I am the first to admit that the problem of the health service is not only money. I often said that to Opposition spokesmen when I was in government myself. However, the Labour Government made a serious mistake in the first two years by imposing on the NHS two of the stiffest years that it has ever had. They used to justify that with the misleading claim that they were imposing Conservative spending plans. They know perfectly well that that is not sustainable. We never stuck to the second and third-year figures in our Red Books for the health service. We always had annual spending rounds, and we revised the spending targets in the light of the experience of the previous year. Everyone who works in the health service knows that it is a long time since it has had two such tough years.
As the hon. Member for Southwark, North and Bermondsey (Mr. Hughes) rightly said, the amount of debt being incurred throughout the service is enormous. All the great claims for how well the service is going sit ill alongside the serious financial crisis that rising demand and rising expectations have forced on health authorities, which have had two very severe years. As, to be fair, the Liberals warned us that they would, the Government hope that, in the run-up to the next election, they will be able to put more money into the health service to raise the feelgood factor in the next three years.
The Government have found a misleading and original way of presenting wholly unexceptional figures for those next three years. They are going back to the normal increases in spending roughly attained for most of the past 10 or 15 years. Those increases will not be good enough. The Government have locked themselves in for three years. They have said that they will not reopen the figures or review them in the light of each year's experience. I shall be surprised if they manage to stick to that.
The only good claim that the Government can make on resources is that they have a massive hospital-building programme. I cannot forbear to point out that that is entirely the result of the flow-through from the private finance initiative, which we initiated. The Labour Government inherited a great flow of schemes. The Labour party slowed up progress when we were in office, because its then spokesman kept opposing the PFI and saying that a Labour Government would scrap it, which made it more difficult to conclude the deals. I wish the hospital-building programme well. It is the one piece of good news on resources that the health service has.
To move on to policy, the Government are not distributing money properly throughout the service across the country. Staff, patients and the public read about the figures, but they know perfectly well that they have not got the money in local budgets. A great deal is being held back centrally for presentational purposes. The modernisation fund will be used to fund today's announcement. It is just one little pot of money kept safely under the Secretary of State's lock and key in London to feed the flow of popular announcements over
the next three years. The one that we had today was, I suspect, fairly modest in cost and was a perfectly sensible choice of priorities. However, in some initiatives, the Government are obviously pursuing the presentational impact of going for some spectacular area for which the Prime Minister or the Secretary of State can announce that money is now available.
Meanwhile, at local level, people do not have at their disposal to tackle priorities at their discretion the money that they are constantly described as having. Their priorities are being distorted, for example, by the meaningless waiting list targets, which are not being achieved and should never have been set in the first place. Cutting waiting lists is not the best objective to set the health service. In addition, ever-increasing bureaucracy and strangling of local initiative will inhibit the ability of people to deliver the service. That is my indictment of where we are headed and of why things are going wrong. We have been short of money; now we are not distributing it properly and we are not allowing people to use it properly on local priorities. That is evident everywhere and the problem will get worse.
Both sides of the House are committed to the NHS, but when we come to defend it, we discover that it is a hard taskmaster; it requires especially high competence, a rigorous choice of priorities and absolute clarity about what is at the disposal of the people who have to make decisions at the sharp end. Demand always rises inexorably, and has itself to be addressed by those responsible for the health service. The choice of priorities should be clinical and never political; it should certainly never be purely presentational.
The Secretary of State is taking some curious steps. Comments have already been made about his appointments and the right hon. Gentleman gave a curious and slightly tangential explanation. I realise that he is no longer in the Chamber, but I must make it clear that I have no personal complaint to make against him on appointments. I recommended one appointment, which the Secretary of State made--despite the fact that I made it clear that the person was a supporter not of the Labour party, but of the Conservative party.
Apart from the political complexion of the appointments, the Secretary of State does not satisfy me that he appoints on merit, or for the special qualities required for the huge, demanding and stressful task of managing a health authority or an NHS trust. He misunderstands the nature of the appointments that he makes. When I was Secretary of State for Health, I did not make political appointments. I had rows with some of my Back-Bench Members because I refused to make the political appointments that they wanted. I appointed, or re-appointed, at least two ex-Labour Members of Parliament. I might even have appointed people who were Members of Parliament at the time, if they had had the time to combine the job--it is a pretty full-time one--with being a Member of Parliament.
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