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Mr. Brady: Will the hon. Gentleman give way?

Mr. Hinchliffe: I shall not give way.

I should like Opposition Members to answer one question that I have asked in probably every health debate since the general election. If people on a waiting list cannot be treated within the time set by whichever Government, possibly because there is a staff shortage in a particular hospital, what sense would it make to push them into the local private sector? That local private sector recruits entirely from the local NHS to treat those same patients. They will take the staff out of the NHS and shunt them into the private sector. It is a downward spiral that will lead to the destruction of a national health service in which the Tories do not believe and in which they have never believed.

The vast majority of the public, whatever their politics, believe in the basic principles of the NHS, as set out in the motion tonight. I wish the Government well in the process of rebuilding the NHS in accordance with those basic principles.

8.20 pm

Mr. Nick Harvey (North Devon): I welcome the opportunity to participate in the debate this evening on the state of the NHS. When I looked at the motion, I could not help admiring the brass neck of the Conservatives in tabling it. As I listened to the entertaining and rhetorical speech of the hon. Member for Woodspring (Dr. Fox), I felt that one could have been forgiven for imagining that all the catalogue of problems--

Mr. Hammond: Will the hon. Gentleman give way?

Mr. Harvey: I have barely begun. The hon. Gentleman will have to give me a chance to get started.

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I felt that one could have been forgiven for believing that the catalogue of problems that the Conservative spokesman ran through had magically commenced on 1 May 1997, and had come about in the last couple of years. Nothing could be further from the truth. The fact is that the Conservatives caused many of the problems that have been described this evening. Having passed them over--albeit reluctantly--to Labour two and a half years ago, their motion does not seem to have come up with any new solutions.

Apart from the idiosyncratic ideas of the hon. Member for Woodspring about private health care insurance policies, we heard nothing new tonight. I could have been forgiven for closing my eyes and thinking that this debate was indistinguishable from an Opposition day debate before the last election.

It all boils down to a question of resources. The NHS Confederation has been warning that the significant problems that authorities and trusts face in the coming winter will come about because there has been a history of ruthless year-on-year slicing and efficiency savings which has gradually stripped the system of flexibility and has eaten into service quality.

We hear from the Government that £21 billion is going into the NHS. That is a large sum of money which, on initial inspection, seems generous. However, when one looks more closely at the figures, one realises that it is not as much as it sounds. One must consider that, for the first two years of this Parliament, there was a freeze on public expenditure. The Government stuck to Tory spending plans--which it was highly improbable the Tories would have stuck to themselves.

As the £21 billion is measured out throughout the remainder of a four-year Parliament, we see that the Government will not even have increased spending onthe NHS up to the same standard, year-on-year, as the Conservatives did during their 18 years in office. When we take out a few spoonfuls from the £21 billion pot to pay for the latest Government initiatives, we see that the pot shrinks even further.

The Government come up with eye-catching initiatives which keep the spin doctors happy, but do not result in improvements in the NHS. Some of the initiatives are good ideas. NHS Direct--although it would have been better to have done it on a local footing--undoubtedly contains the kernel of a good idea. However, the extra funding needs to go to the basic bread-and-butter service before we start having Government wheezes and initiatives which, frankly, amount to honey on top.

As we look forward to winter, reports are coming in that trusts are being forced to overspend, and many are running up deficits that are much bigger than expected. This news comes five months before the end of the financial year, and before we know the scale of the problems that the coming winter may bring with it. More resources are needed.

I agree with the call by the hon. Member for Woodspring for a rational debate on the issue of rationing, and I was depressed to hear the Secretary of State, yet again, dodge the questions about rationing. Of course there is rationing in the health service--there always has been and there always will be.

The Government should define clearly the constraints that are presently applied in the rationing of resources within the NHS, and they should take full responsibility

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for the decisions that have to be made within national guidelines. It may be a question of semantics or vocabulary but, in my opinion, that amounts to rationing. We need to have national policies that patients and members of the public understand--for example, on infertility, cosmetic and obesity treatments, and a variety of other issues.

I was depressed to hear the Secretary of State dodging this matter by hiding behind decisions that will be taken by the National Institute for Clinical Excellence. NICE should stick to the remit that it was given when it was set up--of looking at clinical effectiveness and cost- effectiveness. It may be semantics again but, in myview, there is a fundamental difference between cost- effectiveness and affordability. Some things can be cost-effective and yet very expensive. When the White Paper set up NICE, affordability was not included as one of the criteria for the body to consider. When the chairman of the body took up his task, he emphasised that point in response to questions put to him at the time.

This evening, the Secretary of State surprised us by saying clearly that it is already the role of NICE to consider issues of affordability. That is the Government dodging decisions that they ought to take. I disagree with the general thrust of some of the other remarks this evening--the Government should be making such decisions on a political basis, having received from NICE expert advice on clinical efficiency and cost-effectiveness. The issue is becoming confused.

I would welcome a broader look at what constitutes cost-effectiveness. It should not be a question simply of what the NHS's current budget can afford, but rather what UK plc will have to pay out as a result of decisions. For example, there may be a variety of treatments that would enable people to get back to work--and which would save money on benefit bills and housing provision by local authorities--which should be incorporated into any true consideration of what constitutes cost-effectiveness.

I welcome the fact that the Minister with responsibility for public health has a role in considering public health issues that will rove across Departments, but I cannot understand why the same cannot be true when we look at cost-effectiveness issues.

I wish to refer also to the tension that arises following the central diktats launched by the Department of Health, and the difficulties that these cause to the local providers who must carry them through. The Government are forcing health care suppliers to fund some of their well-spun schemes without providing adequate resources.

I listened with interest to the comments of the hon. Member for Woodspring. I agree with those who have suggested that the basic Conservative prescription for increasing health care provision seems to be an expansion of private health insurance. However, I was puzzled by the logic of the hon. Gentleman's case. Some of his comments about the shortcomings of private health insurance policies were right. I understand why they are unattractive for many people. However, I do not understand how a modification of those policies would suddenly make them vastly more attractive to great swathes of the population, unless the NHS was so unappealing and unattractive that people felt driven to go to such lengths. If we follow his logic, he was almost

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arguing--I am not suggesting that he said this--in favour of maintaining long waiting lists to encourage people to make provision for themselves in the private sector. As an hon. Friend said to me yesterday, that is replacing rationing by postcode with rationing by tax code, which is no more desirable than the current situation.

Mr. Brady: The hon. Gentleman is right to draw attention to the problem. However, that is what is happening under the current Government. I have a constituent who has paid from his life savings to have a life-saving operation because he could not put up with the ludicrous waiting lists that the Labour Government were inflicting on him.

Mr. Harvey: It is certainly true that with the current long waiting lists, some people are paying to go into the private sector. I do not query what the hon. Gentleman says about that. However, the thrust of his hon. Friend's case seemed to be that there needed to be a great increase in the extent to which people were making such provision for themselves. A better objective would be to run the NHS so well that such provision became less attractive.

I also congratulate the Conservatives on taking up the issue of waiting times. It is not an entirely original idea that they seem to have come up with over the past few weeks. The Scottish Administration formed in May after an election campaign that addressed those issues decided that their performance should be judged by waiting times, not by the number of people on waiting lists. It is common sense that the key issue for a patient awaiting care is how long they have to wait: first how long it takes to see a consultant; then perhaps how long it is before they can have a scan or some diagnostic measure; and then how long they spend on the waiting list that the Government measure. Although there have been some extreme comments this evening about the manipulation of figures, it is not a fair assessment of the performance of the NHS simply to look at waiting lists for in-patients and not to consider the growing waiting lists for out-patients.

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