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Mr. Deputy Speaker: Order. The right hon. Lady should not use the term "you" at such great length.

Mrs. Bottomley: I profoundly apologise, Mr. Deputy Speaker. The degree of emotion being generated in west Surrey is such that I want the Secretary of State to be aware of how desperate people feel.

The Royal Surrey county hospital has moved psycho-geriatric patients into surgical beds. Waiting lists are all rising. On the day that the Secretary of State's initiative on cancer was announced, a cancer specialist approached me saying, "Yes, we have to see people within a fortnight, but the surgery cases and chemotherapy waiting lists are both lengthening." On the day of the heart disease announcement, a doctor rang and said, "That is all very well, but the angiography waiting list has almost trebled in the past year."

The Secretary of State asks why I did not do anything. During my term as a Minister, I do not believe that I ever suggested that change would lead to a deterioration of services. No one in West Surrey health authority believes anything other than that services will deteriorate.

The ethical issue is: in those cases that I have identified, when a constituent says, "Should I go private if I can?", what is the appropriate response of the Member of Parliament? I have never believed that that situation would develop, but I have read the headlines of the local paper over the past month:

The funding raid on the home counties, which the Government describe as tackling inequalities, means that social services have lost £10 million. At the same time, the health service has a funding package that does not fund staff costs in an area with a high cost of living. It does not cover the cost of rents and all the other expenses in the area, which the Labour party dismisses as prosperous and treats in the same way as it treated the eight children from an independent school at its party conference. Other headlines state:

    "A and E patients forced to wait up to 20 hours";


    "Hospital could be £1m in the red by March."

I appreciate that Labour Members have little interest in areas such as the one that I represent. However, I wonder whether the right hon. Gentleman might have been concerned about recent newspaper reports that tour operators have been advising people visiting the United

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Kingdom to take out private health care insurance. When I held the right hon. Gentleman's office, a frequently heard quip--which no one ever challenged--ran, "If you're abroad and ill, what do you do? You come back to the use the NHS. If you're ill and a foreigner in Britain, what do you do? You use the NHS." Why, therefore, should tour operators, such as the German equivalent of the Automobile Association, now be advising people to take out private health insurance?

Nouvelles Frontieres states:

Portuguese tour operators have said that special health insurance was mandatory for the United Kingdom, but not for anywhere else in Europe. Elder Alves, of Top Tours, said:

    "We always arrange health protection for people visiting London. We do not use NHS hospitals."

The French Guide states:

    "You have to have an appointment to see a doctor. Insist that it is urgent--otherwise you could end up being healed next week for this week's flu."

Henri Menna said:

    "I tell French parents to take out private medical insurance so they can have peace of mind. If the person contracts something serious or needs surgery while in England, it is better to get the person straight back to France, where the treatment and care are much better."

Those comments should disturb Ministers and other Labour Members as much as they disturb Conservative Members.

If the reality is that the right hon. Gentleman cannot deliver services or provide adequate resources, it would be better to be courageous and say that there must be more co-payment and more explicit rationing, so that patients might know what is or is not available. Currently, however, people are being told to wait ever longer, and they are getting ever more worried about their inability to receive treatment. The situation is unacceptable.

Difficulties are being experienced not only by patients. The right hon. Gentleman will be aware that the problem of disillusioned doctors is bigger than ever before, partly because of the public sector salary structure compared with opportunities available for comparable graduates outside the public sector. However, the difficulties facing doctors, and Ministers' lack of realism, is causing doctors' frustration to become ever greater outrage.

Time and again, the Government's policy has been driven by the need to please No. 10 Downing street, with media initiatives such as supernurses, walk-in centres and NHS Direct. However, a telephone line will not help to cure the health service's problems. NHS Direct is perfectly all right, but it is essentially a trivial and marginal initiative. It is well known in the service that No. 10 Downing street drove that initiative, and imposed it on the previous Secretary of State for Health.

The right hon. Gentleman is about to encounter an extremely serious winter situation and all the problems caused by the new millennium. I do not know the accuracy of The Independent's report that the previous Secretary of State decided that seeking the office of London mayor would be preferable to facing the difficulties that he has left the right hon. Gentleman, but my--

Mr. Deputy Speaker: Order. Time is up.

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8.14 pm

Mr. David Hinchliffe (Wakefield): The Opposition motion demonstrates the remarkable narrowness of Conservative Members' views on health issues. In it, they make two key claims--first, that the waiting list initiative has damaged the national health service; and secondly, that there has been a

As the Secretary of State said, in their motion Conservative Members are sending a clear and quite profound message--that the Government's electoral promises do not matter. I accept that, for all political parties represented in the House, a sad fact of modern politics is that, frequently, hugely complex issues are slimmed down to one-line soundbites or pledges. Nevertheless, rightly or wrongly, an election pledge is an election pledge, and, like other Labour Members, I was elected on a waiting list pledge. Like my colleagues, I owe it to my constituents to ensure that the Government deliver that pledge.

Mr. Graham Brady (Altrincham and Sale, West): Will the hon. Gentleman give way?

Mr. Hinchliffe: No, I shall not; I have only 10 minutes.

It is wrong for the Opposition to criticise the Government for trying to meet the commitments and promises that we made at the general election. None the less, politics seems to have reached that strange state.

What evidence has been presented to support the claims made in the Opposition motion? Supporting evidence from Opposition Members has been very thin. However, I am able to state that, in Health Committee sittings, I have seen evidence of distortions in the formulation of waiting list targets. I saw it in 1991, after the introduction of internal markets. The hon. Member for Macclesfield (Mr. Winterton)--who usually attends health debates, but is not here today--will recall evidence that we received from some trusts, which said that the internal market's emphasis on competition with neighbouring trusts had forced them into skewing their priorities. I am also able to state that I have seen distortion of clinical priorities in favour of political targets. It happened in my own constituency, when, under the previous Government, the two-tier fundholding system was operating and some of my constituents who were not patients of fundholders were denied operations.

It is remarkable that the Opposition motion makes absolutely no reference to wider health issues. Earlier, my hon. Friend the Member for Lancaster and Wyre (Mr. Dawson) raised the issue of public health--a fundamentally important issue, which, at long last, a Government are taking very seriously. In response, however, the shadow Secretary of State dismissed the public health issue as a sixth-form debating point. Nevertheless, the Government's amendment to the motion rightly mentions cancer and heart disease, which were dealt with at length by the Secretary of State.

Today's British Medical Journal report on the number of young women who die from heart attacks caused by smoking is also entirely relevant to the public health issue. Let us consider those figures, which the Tories have not bothered to quote today.

The fact is that, since 1950--during the lifetime of many hon. Members, including me--6 million people in the United Kingdom have died prematurely from

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smoking. The fact is that, every year, 120,000 people die from smoking-related illnesses. Smoking is the single most preventable cause of premature death.

In 18 years in government, what did the Tories do about those facts? They blocked successive attempts in the House to pass United Kingdom legislation preventing tobacco advertising. They also blocked European Union efforts to reach agreement on tobacco advertising. Why? They did so because they were paid to do so by the tobacco companies. They were in hock to the tobacco companies, and therefore have a direct responsibility for the vast numbers of people who have died prematurely in the United Kingdom. The Tories could have acted on tobacco in their years in government, but they regarded public health--the point that was raised by my hon. Friend the Member for Lancaster and Wyre--as a public school debating point.

I ask Conservative Members: who is calling the tune on their health policy? Who is paying for their policy? I have my own suspicions on that. Since the general election, implicit in every statement made by a Tory Front Bencher has been the desire to shift health care into the private sector. Their desire is now explicit, having been written into their document, "The Common Sense Revolution". In their proposal to shunt patients into the private sector, we have an explicit recipe for destruction of the national health service.

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