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Mr. David Wilshire (Spelthorne): The Secretary of State says that the NHS must be more convenient. In that case, why will my constituents be forced to travel further because our local accident and emergency department and 70 acute beds are to close? Services are being transferred out of the constituency. Does he consider that to be more convenient?

Mr. Milburn: The hon. Gentleman will recognise that changes in NHS structures and services are not a peculiar development of the past two years: they have been going on for the past 50 years or more, and will continue. We should welcome what is happening in the national health service. With the advent of new technology, such as telemedicine, and new treatments and drugs, more and more treatments are being brought closer to where people live. That is a welcome development.

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I can give the hon. Gentleman a good example of that. Twenty or 30 years ago, patients with a stomach ulcer would have gone into hospital for invasive surgery, which would have been risky, and would sometimes have resulted in time off work or serious injury. Nowadays, such patients are treated with drugs. That is better, faster, more convenient and a good development. Those who say that we have an enormous problem with the NHS drugs budget and that it is growing exponentially forget that those new drug treatments are welcomed by patients and by staff. Such developments are not peculiar to the past couple of years. They have been part and parcel of the national health service for the past 50 years or more.

Mr. David Tredinnick (Bosworth): Will the right hon. Gentleman give way?

Mr. Milburn: I shall make a little progress, and I shall allow the hon. Gentleman to intervene in a moment.

The hon. Member for Woodspring made allegations about fiddled figures. It is slightly galling to hear Conservative Members talk about fiddled figures, but I shall let that go for a moment. He made an allegation about Bradford, which was first raised in the House on9 November 1998, and was repeated on 25 March this year. The hon. Gentleman knows that that allegation has no foundation in truth. He referred to metal plates. Patients go into hospital to have a plate inserted and subsequently have to have it removed. Of course they are not on a waiting list to have it taken out. On that logic, pregnant women would be on a nine-month waiting list. As the hon. Gentleman knows fine well, that is a planned admission.

The hon. Gentleman and his party seem to gain some perverse satisfaction from trying to convince people that the national health service is failing. What is worse, they try to convey the impression that it is bound to fail and can never succeed.

Mr. Gerald Howarth (Aldershot): Will the right hon. Gentleman give way?

Mr. Milburn: In a moment.

The Conservatives present a catalogue of doom and a counsel of despair. There they are: Dr. Gloom on the Front Bench, and the doom merchants on the Back Benches. They are like some failed 1960s pop group. For each of the past 51 years, the NHS has proved the doom merchants wrong. It has coped with new ailments, new treatments, new drugs and an ageing population. It will go on coping for at least the next 51 years, but it will do that only by modernising and introducing new drugs and treatments.

There has been a lottery of care. The Conservatives were responsible for that when they created the divisive internal market. The uptake of treatments that work has been too slow, and the uptake of treatments that do not work has been too fast. We want fairer and more effective decision making in all parts of the national health service. That is why we established the National Institute for Clinical Excellence, new national health service frameworks and the Commission for Health Improvement.

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Our answer to those problems is not crude rationing decisions, but clear rational decisions. That is the difference between us and the Conservative party.

Mr. Howarth rose--

Dr. Fox rose--

Mr. Milburn: I shall first give way to the hon. Member for Aldershot (Mr. Howarth).

Mr. Howarth: The Secretary of State should not display such complacency. The Labour party is losing a lot of ground on this issue. How would he respond to my constituent who was diagnosed in February this year as requiring heart surgery? He was told that he would not be able to have that surgery until June or August next year. The reason given was that the Government have said that consultants should set themselves the objective of getting waiting lists down, not addressing clinical priorities. The Secretary of State had better beware, because the complacency that he has shown tonight will not go down well. He should respond to my hon. Friend the Member for Woodspring (Dr. Fox)

Mr. Deputy Speaker: Order. The hon. Member for Aldershot (Mr. Howarth) should not make a speech.

Mr. Milburn: There is no complacency on these issues. If the hon. Gentleman had bothered to listen, he would know fine well that one of the first things that I did when I became Secretary of State was to find new, extra money--

Mr. Philip Hammond (Runnymede and Weybridge): It is not new money.

Mr. Milburn: It is new money. I made the first allocation from NHS budgets for next year. No money had been allocated for next year. I allocated extra money to speed up heart surgery--£50 million to pay for 3,000 extra heart operations. Surely the hon. Gentleman should have welcomed that, rather than run it down.

Dr. Fox: I counsel the Secretary of State against using the word "extra", because it has the same currency as "read my lips". He said that there was no rationing in the health care system. People would say that there is rationing if a new drug is not made available, and if some drugs are available in some parts of the country but not in others on the ground of cost. What is the right hon. Gentleman's view? Does he believe that there is rationing in the health care system?

Mr. Milburn: The national health service has always faced hard choices. That is the reality of life in the NHS. It is the reality for clinicians on the ground, and it is the reality for those of us who are charged with running the service. There has always been priority setting inthe national health service, and there always will be. The issue is how priorities are set. We believe that priorities should be set on the grounds of effectiveness and what works. The difference between us and the Conservatives is that they want a system based not on what works, but

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on who can afford to pay for their care. That is the dividing line between Tories and Labour on health care. It is not about rationing: it is about rational decisions.

Dr. Fox rose--

Dr. Brand rose--

Mr. Milburn: I shall give way to a Liberal Democrat for a change.

Dr. Brand: The Liberal Democrats supported the National Institute for Clinical Excellence, and I support the Government's approach to rational decision making. However, hamstringing NICE by making affordability one of the criteria for NHS treatment is too restrictive. That decision should be made by politicians--the Secretary of State himself--rather than clinicians.

Mr. Milburn: Clinicians and managers throughout the national health service, whether in fundholding or other systems of care, have always had to decide how to align clinical and financial responsibility. What we are doing is helpful to clinicians. Doctors and managers on the ground want to know that when they take difficult decisions they have support from the centre. We are not abdicating responsibility--that is what happened under the previous lot. We take responsibility and make difficult decisions. I applaud my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), the previous Secretary of State, for the difficult decisions that he had to take on Viagra and Relenza. By and large, those decisions have been welcomed in the national health service.

Dr. Fox rose--

Mr. Milburn: I shall make some progress, if the hon. Gentleman does not mind.

The truth is that, in the debate about rationing, the Conservatives' aim is to stimulate not a debate, but doubts. They do not believe that the national health service can cope, and they do not want the public to believe that it can cope. They want more people to be treated privately. The hon. Member for Woodspring was explicit about this, both today and in his speech yesterday, with which I shall deal in a moment. As the Prime Minister said in Bournemouth just a few weeks ago, we want a health care system that delivers care when people want it, where they want it--and we want it on the national health service.

The Opposition motion is the product of a strange Conservative form of selective amnesia. Since the Conservative party's visit to Blackpool, there seems to have been an outbreak of it. First, on that occasion, the Conservatives forgot even to mention their former Prime Minister, the right hon. Member for Huntingdon (Mr. Major). [Interruption.] It is true: they forgot to mention him. As you know, Mr. Deputy Speaker, slips are made in politics. These things can happen.

Secondly, the Conservatives managed to expunge from the record their former conference darling, the right hon. Member for Hitchin and Harpenden (Mr. Lilley)--he of the famous "little list". They now want to take that amnesiac approach to politics a stage further by conveniently ignoring their own record on the national

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health service. This must be the first occasion on which a political party has tried to airbrush itself out of politics. Well, the Conservatives may have forgotten what they did, but we have not--and neither have the staff of the national health service, or the public who rely on it.

Let me remind the Opposition of the Conservative record on health, and the difference that a Labour Government are making to the state of the NHS. When we came to office, the Tories had cut the number of nurses in training by more than 4,000. It is no use the hon. Member for Woodspring going on about the shortage of nurses; the Conservatives created that shortage in the first place. This year, following the biggest real-terms pay increase that nurses have had in a decade, the number of student nurses is at a six-year high.

When we came to office, investment in new buildings, plant and equipment was at a 10-year low. This year, the NHS capital budget is at an all-time high. The biggest new hospital building programme in the history of the NHS is now under way, and about 200 casualty departments and 1,000 GP surgeries are being modernised. When we came to office, the Tories had undermined the NHS and demoralised its staff by introducing the hated internal market. The motion deplores mismanagement; I deplore it too. That is why we have abolished the internal market in the national health service. That is why we have ended the two-tier system introduced by GP fundholding, and that is why we are putting doctors and nurses in the driving seat to share the task of providing health care in the future. In the process, we are freeing £1 billion from bureaucracy so that we can reinvest it in front-line patient services. Those are the public's priorities for the national health service, and they are our priorities too.

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