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26 Oct 1999 : Column 869

National Health Service

Mr. Deputy Speaker (Mr. Michael J. Martin): We now come to the next motion. I inform the House that Madam Speaker has chosen the amendment in the name of the Prime Minister and has ruled that there will be a 10-minute limit on Back-Bench speeches.

7.15 pm

Dr. Liam Fox (Woodspring): I beg to move--[Interruption.]

Mr. Deputy Speaker: Order. I ask hon. Members to leave the Chamber quietly as the hon. Gentleman is addressing the House.

Dr. Fox: That was a short soundbite, even for me.

I beg to move,


I hope that tonight's debate will be the first in a series of mature and incisive health care debates. However, given the amendment that has been tabled by Her Majesty's Government, I imagine that it will be a rather rhetorical conversation initiated by those on this side of the House, with Government Members advancing the usual simple, puerile arguments about how the Conservatives seek to privatise the national health service and so on. The Opposition will present reasonable, well thought out ideas about the future shape of health care, which I expect will be met with hissing and booing from the second-rate pantomime audience opposite.

We have three aims for health care in this country. We want a shift from throughput to outcome and from waiting lists to waiting times, and we want clinical priorities to replace political priorities. I say at the outset that I have some sympathy for the Secretary of State because he knows that we are absolutely right in those aims--he probably shares most of them. He must tonight defend not his waiting list initiative but that of his predecessor, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), and of the Prime Minister. The initiative has been condemned by almost every health caregroup, including the British Medical Association--that reactionary force which the Secretary of State loathes so much--the Royal College of Nursing, another reactionary group; the Royal College of Physicians; and the Royal College of Surgeons, each of which belongs to the forces of darkness that the Prime Minister sees around every corner. The Secretary of State is desperate to claim our territory, but he knows that he cannot dismiss the Prime Minister's pledge.

The Secretary of State is another of the Government's political prisoners: he is impotent in his Department because he cannot do what he knows to be right. He is

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desperate for a dose of political Viagra which, in this Government, is in as short supply as the real thing. The real problem that we face is not simply the Government's policy but the culture of the Government. As was revealed by the Home Office team in the previous debate, this Government engage not just in creative accountancy but in crooked accountancy. The Home Secretary's school of accountancy is applied in the Department of Health and in every other Government Department, so when the Secretary of State says that there will be an extra 410 cardiologists by 2005, he does not bother to add that those people are already in training and would be available to the NHS anyway.

The Government have a wonderful definition of "extra". Mr. Deputy Speaker, if you asked me to get you a sandwich from the Tea Room and I returned with an extra sandwich, you would expect to receive two sandwiches. However, if you sent the Secretary of State, you would get not only just one sandwich but an explanation that it was one more sandwich than you would have received if he had not gone in the first place. That is how the Government manage their accounting and their rhetoric.

More important is the Government's fundamental dishonesty. The Government promise things that they know they cannot deliver--it is part of the great Labour lie. While that is bad in other policy areas, to promise in health care things that one cannot deliver is to take advantage of the weakest and most vulnerable in our society when they are at their weakest and most vulnerable. The Government say that there will be extra consultants, but there are none. They say that there is no rationing when rationing is occurring. With Viagra and Relenza we have the most specific examples yet of health care rationing. The Secretary of State says that every drug that patients need will be made available--he should tell that to those whose consultants say that they would benefit from beta interferon. The Government, whose rhetoric does not match their actions, take cynicism to heights previously unknown in our politics.

Mr. Ronnie Campbell (Blyth Valley): How does the hon. Gentleman square all that he is going to do for the health service with the fact that a Tory Government would cut taxes at the same time?

Dr. Fox: During the 18 years of Conservative government we made dramatic moves, not only in increasing the funding for health care available in this country but in reducing the burden of taxation, which was higher when we came into office in 1979 than when we left. It is entirely possible with economic growth, as we demonstrated, to increase health expenditure while reducing taxation. The two, of course, are not mutually exclusive.

The Government's cynicism is most apparent in their manipulation not only of money but of waiting list figures. There have been several examples recently of quite scandalous manipulation of statistics.

Mr. Hilton Dawson (Lancaster and Wyre): Will the hon. Gentleman give way?

Dr. Fox: In a moment; I look forward to hearing the hon. Gentleman's defence.

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In Bradford, for example, it was decided that patients who had previously had surgery to insert metal plates or screws in their bodies through various types of orthopaedic surgery and were waiting for them to be removed were not really waiting for treatment because they had received part of it. They could not get through an X-ray machine at Heathrow, but, according to the Government, they were not waiting for any treatment. They were put on a new list called O5 and are part of the Government's great disappeared of the health service.

In Derriford in Plymouth, those who reached the 18-month maximum waiting time for heart surgery were, strangely enough, subject to further investigation, after which the clock was stopped. They may have had chest pain or angina, and they may have been waiting in fear for the surgery, but, according to the official statistics, no one waited more than 18 months for surgery at those hospitals. That is a crude and repulsive manipulation of the data. At the Alexandra hospital in Redditch, 759 patients simply disappeared off the waiting list. That was called an administrative clean-up, which is a rather nice term for removing from the list patients who are still waiting for treatment.

Mr. Dawson: As we are talking about manipulation, can the hon. Gentleman explain why the previous Conservative Government totally failed to give any credence whatever to the Black report, to health inequalities or to the prime role of poverty as a precursor to ill health?

Dr. Fox: We are talking about patients who are waiting for surgery that could be life saving and who may die prematurely if it is denied to them. That argument demands more than a cheap, sixth-form debating point.

How many patients are living in pain and fear while awaiting surgery but are simply being removed from the statistics because it is awkward for the Government if they appear in them? Getting on the waiting list is in itself quite an achievement. People have first to get on the waiting list for the waiting list and then, if they are very good, they might get on the waiting list itself. The total number of such people--those who have seen their general practitioner but have not yet had treatment--has increased massively under this Government: 237,000 extra patients are waiting for treatment. They are the real waiters in the NHS, not those who are defined narrowly by the Government.

The problem of waiting lists lies at the heart of all the Government's troubles. The trouble with the waiting list initiative is that it treats all patients on the list in exactly the same way. Someone who is waiting for a coronary bypass graft is treated the same as someone with an ingrowing toenail. They matter, and are weighted, the same on that particular list, so within a finite budget there is inevitably pressure on clinicians from hospital managers and others to try to get the numbers down by using theatre time in a way that gets the maximum number off the list. That means that three inguinal hernias can be dealt with instead of a coronary bypass and in the same amount of theatre time. That is what has been happening.

People say, "Surely getting waiting lists down is a good thing?" It would be if the initiative were applied according to correct clinical priority, but clinical priority is being completely distorted to fit the Government's political priorities. That, if not unethical, is certainly an immoral way of running our health care system.

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Since he took office, the Secretary of State has been willing to talk about a change of tack. I urge him to ditch the waiting list initiative, which is continuing to cause clinical distortion across the country. Surgeons and doctors are all complaining that their clinical freedom is being interfered with. He knows that the initiative is causing problems in the service--why does he not just ditch it? That might offend the Prime Minister's ego, but there would be plenty left if we lost a bit of it.

One matter that I want to concentrate on is the Government's attitude to cancer treatment. I did my junior doctor training in haematology and oncology, and I would be the first to agree that we need to improve our outcomes dramatically in respect of almost all cancers. I am right behind any Government of any political colour who seek to achieve that, but it has to be done in the proper way. The Government's cancer policy, as with everything else that they have tried to achieve, is not properly thought out and is run by gimmicks, headlines, crooked accountancy and incompetence.

Let us begin with some of the gimmicks. We have a drug tsar, so we have to have a cancer tsar. No doubt they will be joined by the gastroenterology tsar, the respiratory tsar, the cardiology tsar, the over-spending patient care group tsar and, when winter arrives, the winter crisis tsar. We may be short of consultants and have the smallest number per head of population of any comparable western country, but--my God--we will have the highest number of tsars per head of any western European country. What good will that do patients? None whatever. It is one of the many gimmicks employed by the Government, but what matters is the policies that follow.

The question of crooked accountancy comes up time and again. We hear great announcements of extra money and, before he deserted the sinking ship, the Secretary of State's predecessor sent all Members of the House a letter entitled "Cancer funding boost". It says:


However, sources in the profession tell us that exactly the same money had been earmarked for quite some time. Without extra funding, that money is enough to keep operating about only half the linear accelerators, which are an essential part of cancer treatment. It is a fraud and a sham. The whole thing is a complete charade.

On top of that, we have another example of Government incompetence. A serious point was put to the junior Minister at Question Time last week. We said that there was a grave danger--the point has today been echoed by the president of the Royal College of Surgeons--of swamping the system if every woman with a breast lump was to be referred within two weeks. I gave the Minister an example: neither the general surgeons nor the gynaecologists could cope if every woman with post-menopausal bleeding was referred within two weeks.

I asked:


before the Government's time pledge comes into account. Is every patient with suspected cancer or only those with urgent referral for suspected cancer included? My understanding is that only urgent patients fall within the two-week time scale. I look to Ministers for clarification of the position, but I assume from the Secretary of State's silence is that my understanding is correct--only patients who are referred urgently will be seen. It is important to

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clarify that because the belief out there, and that which has been spun by Ministers to the press, is that every patient with suspected cancer would be seen within two weeks. Which is it? We look for clarification because it makes a huge difference to the real running of the system with real doctors, not spin doctors, and real patients.

When the Minister was asked that question, answer came there none. She said:


That was very interesting because the letter that we received from the British Medical Association said:


    "I have checked with the GP Committee and discovered that they have not been involved in discussions with the Department of Health on any guidelines."

Will the Minister clarify exactly whom she was talking to?

My hon. Friend the Member for New Forest, West (Mr. Swayne) has tabled a parliamentary question about what recent discussions have taken place between the Department and representatives of general practitioners regarding guidelines, the level of clinical suspicion in cancer diagnosis and when those discussions took place. Having had a week to consider her diary, the Minister said that she would let my hon. Friend have a reply as soon as possible. Despite all the extra special advisers and civil servants, Ministers cannot even look back in their diaries and decide when they met GP representatives. We suspect, therefore, that no such discussions have taken place, and that that is another part of the fantasy politics in which Ministers are engaged.

Ministers scoff at the potential overworking of the system, but the president of the Royal College of Surgeons said:


We need to know tonight with far greater clarity exactly what the Government's policies are and what the Government will do in response to those important criticisms from people at the cutting edge of the service.

We have made our priorities clear. We believe in instituting a patients guarantee, ensuring that the sickest patients will be treated first; and those with less urgent conditions will have to take their appropriate place in the queue.


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