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9.24 pm

Mr. David Tredinnick (Bosworth): I congratulate the Secretary of State and his colleagues on the Front Bench on their appointments. I wish them well, but I think that they are up against it. That became all too evident when I heard my hon. Friend the Member for Spelthorne (Mr. Wilshire) talk about the cuts in his constituency.

If hon. Members are in doubt about statistics, they tend to go to the House of Commons Library. I did just that before the debate. I discovered--there may be some comfort for the Minister--that, as at 31 March 1997,

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the waiting list for patient admissions to the NHS trusts in Leicestershire stood at 16,546 and, by the end of June 1999, the list was 16,539. The Government have achieved a reduction in the waiting list of seven patients. However, there had been an increase of 514, or 3.2 per cent., over the previous quarter, which covers the period since the ending of fundholding on 1 April this year.

The trend is upwards, and perhaps that is not surprising given what has happened at Hinckley Sunnyside hospital in my constituency. Owing to a lack of funding, 10 rehabilitation beds have been closed at Hinckley Sunnyside hospital, where staff have an excellent record of getting patients back into the community. Six of those beds have been moved to Hinckley and District hospital through the redesignation of six surgical beds for geriatric rehabilitation. That is a reduction in provision for the ever-increasing need for rehabilitation beds, and a reduction in the number of in-patient beds for local people to have operations locally without having to go to Leicester.

The Secretary of State said that the issue raised by my hon. Friend the Member for Spelthorne had to do with the need to move patients around. That is not the problem. The problem is to do with funding in Hinckley, where there is not enough money to go round. I have received a letter about a 45-year-old stroke victim who cannot get a rehabilitation bed at Sunnyside, and must go to Leicester general hospital, which involves a difficult journey on public transport. Is that what the Secretary of State meant, because it is not what we need? People will face considerable problems if they have to take a half-hour journey to Leicester.

I want to raise two key issues: the Government's central funding policy and the position of primary care groups post fundholding. The Government have pledged to provide equity in funding across the nation. The situation in Leicestershire is catastrophic. The hon. Member for Wakefield (Mr. Hinchliffe) will recognise that. We are right at the bottom of the heap, and suffer from an historic problem of underfunding.

For the financial year 1999-2000, Leicestershire health authority has a funding allocation of £517 million compared with a target funding allocation of £530 million, so there is a gap of £13 million. The Government will not be able to make their policy work in Leicestershire unless the Secretary of State can find more money. I have spoken to the chairman and chief executive of the health authority, and they are cobbling things together by shifting money around from the old fundholding budget, but that will not work in the long term. Leicestershire spends £4 million less on community services than the average health authority.

The second big issue is the transition to primary care groups. In Hinckley, doctors rightly refused to join the primary care group board, and instead are opting to advise through the medical advisory panel. The problem for doctors is that they are not being given any real authority, and are not being allowed to exercise control over financial decisions. They said from the outset that they knew that the funding of primary care groups entailed the handing over of their fundholding money, and that they would be asked to administer and, as members, give tacit approval to what would increasingly become inadequate funding.

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I have been told privately that the Hinckley model is likely to become a model for the health service in the future. Doctors have refused to take on the burden that the Government wanted to impose on them, but are making a contribution through an advisory panel.

One of the problems that we have had in Hinckley since the demise of fundholding has been its impact on minor operations carried out by GPs at Hinckley and District hospital. General practitioners in my constituency have complained that the number of minor operations at Hinckley hospital has dried up. The Minister should take that on board. In April 1999, the waiting list stood at nil; since the cessation of fundholding, it has become fairly substantial, and there has been a tremendous knock-on effect, in that operations must now be performed at Leicester general hospital and the Leicester royal infirmary. The waiting list problem--the problem that the Minister and the Secretary of State want to solve--is being exacerbated by the reduction to zero in the number of minor operations at Hinckley hospital. We now have a six-month waiting list, which is growing.

Under the new arrangements for primary care groups, scheduled operations under fundholding have been stopped. The hon. Member for Bethnal Green and Bow (Ms King) referred to the policy of privatisation; I wonder how she will feel about this. A constituent of mine, Isabel Edgar, was due to have a second hip operation under the new primary care group arrangements. The operation had been scheduled under fundholding. She was told, "This is not possible: we will not do it." She has therefore had to have the operation done privately. Is that the kind of privatisation to which the hon. Member for Bethnal Green and Bow was referring?

One of the offices that I hold as a Back Bencher is treasurer of the parliamentary group for alternative and complementary medicine. In that capacity, I recently visited Bath to look at the new Bath spa project, which I commend to the Minister. Doctors whom I met there told me that, when they were fundholding, they were able to save 25 per cent. of their drug budgets through efficient management. That allowed them to offer a three-month wait for all operations, as well as to develop a full complementary medical team on their premises. They had homeopaths, hypnotherapists, herbalists, an osteopath and an acupuncturist.

Since the introduction of primary care groups--I beg the Minister to listen to this--complementary and alternative medical therapies are not being offered. There is a fundamental problem. People come to our surgeries saying that they can no longer benefit from homeopathy, herbal medicine, healing and other therapies. That represents a serious crisis for the Government. It will not be possible to meet the exponential increase in demand for complementary and alternative medicine, and the Minister must deal with that, because it is a vital issue.

At health questions last week, I raised the issue of how the prison service is dealing with complementary and alternative medicine. The Government have cut the list of services available from about 20 to about six. I visited Coldingley prison, and saw prisoners being treated there. One, a very violent man, had been treated by a cranial osteopath who had massaged and adjusted his skull plates. Another had received hands-on healing to channel energy.

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Both had responded well, but, although osteopathy remains on the list, cranial osteopathy is a different matter.

Let me draw the Government's attention to a newspaper cutting from The Times of 12 October in which someone is quoted as saying:

The lady says:

    "Sam spent his last 18 months at home, going to school, being a normal boy."

The boy, a cancer patient, went into remission after someone channelled energy to him through the use of hands. Such services should be available not just to prisoners, but in the health service. If the Minister wants to cut his budgets and to secure a wider service, he should draw on the services of complementary practitioners, many of whom offer their services free.

What about the future? The level of confidence in the NHS can be measured by a leaflet that has been dropped in my constituency today advertising Nuneaton private hospital and asking "Why Wait?" The truth is out: the waiting time for first out-patient appointments is up, and the waiting time for operations is up. I ask the Minister to note that. We look forward to better funding in Leicestershire.

9.34 pm

Mr. Philip Hammond (Runnymede and Weybridge): It has turned out to be a rather predictable debate. The Secretary of State for Health set the tone. He told us that waiting lists were down. That is clearly incorrect, given the total number of people who are waiting for treatment, or specialist consultation. He told us that the money that he has announced over the past couple of weeks is "new money." That is clearly incorrect as well. It is part of the £21 billion that was announced with so much fanfare last year. Again, he misrepresented Conservative policy. I find it odd that all the professions and patient organisations, and the great majority of informed commentators, agree with us that the waiting list initiative is a disaster.

My right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) and my hon. Friends the Members for Spelthorne (Mr. Wilshire) and for Bosworth (Mr. Tredinnick) gave a cameo of the position in many parts of the country: a funding crisis, services being cut and dissatisfaction among professionals and patients alike.

That was in stark contrast with the view of the world that was given by the hon. Member for Bethnal Green and Bow (Ms King), who seems to have a narrow, at best boroughwide, view of what is happening in the health service. All I can say to her--my right hon. and hon. Friends would echo it--is good luck to her constituents if they have been so lucky in the lottery of the Government's NHS funding formula.

The hon. Member for Wakefield (Mr. Hinchliffe) treated us to his usual review of history, with scarcely a glance to the future. On the only specific question that he asked, he based his position on the fallacy that there would be no complementarity between the private and public sectors.

The hon. Member for North Devon (Mr. Harvey) criticised the motion, but did not bother to table an amendment on behalf of the Liberal Democrats. He argued for greater health spending as a proportion of gross

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domestic product. We would agree with that, but he failed to tell us what split he would like between tax-funded and privately funded spending and, therefore, what income tax increase his party would propose at the next general election.

The hon. Member for Wirral, West (Mr. Hesford) accused us of not talking about the Government's additional spending plans for the NHS and challenged us to say what our approach would be. I am happy to confirm what it would be. My hon. Friend the Member for Woodspring (Dr. Fox) has already stated it, as did my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) when she was the shadow spokeswoman.

The next Conservative Government will increase tax-funded spending on the NHS in real terms year on year, but we do not believe that that is enough to deliver the health service that people need and deserve as we go into the 21st century. That is why we alone are looking for innovative solutions that will add to--supplement, not supplant--the NHS's work.

As usual, my hon. Friend the Member for Southend, West (Mr. Amess) made a fine and rousing speech. The hon. Member for Dartford (Dr. Stoate) made at least one important point, which I am happy to endorse: community pharmacists are an under-used resource. I wish that he had put that point to the Government before they jumped in with both feet in support of NHS Direct, an untried and untested idea.

The overall picture that has been painted in the debate is depressing. We have shown the position after two and a half years of government by a party that, in opposition, posed as the NHS's saviour. It is a picture, too, of shocking complacency among Labour Members. Who would have believed just a couple of years ago that, in opinion polls, 41 per cent. of people would tell pollsters that the NHS had got worse under Labour; that staff morale would be at record lows; that waiting lists overall would be completely out of control; and that half the NHS trusts would face massive deficits? Almost all PCGs have overspent, with the likelihood of cuts in drug prescribing later this year, despite the Secretary of State's pledge when he was Minister of State, Department of Health that patients would not be denied the drugs that they needed.

Clinical priorities are being distorted throughout the system. Patients are being deceived and hospitals are struggling to meet targets, with the sickest people often being put at the back of the queue in consequence. Does it please the Minister to think that, this very week, one of the largest and greatest teaching hospitals in London is having a blitz on grommets, possibly the cheapest and certainly the least clinically proven surgical intervention available, simply to meet the numbers that they need to meet to access a bonus?

In the face of all that, we have a Government who have not a clue of what their policy or strategy should be. They have their head firmly in the sand. They are perpetuating the myth, in the face of evidence to the contrary, that the NHS can deliver both excellence and comprehensiveness across the range of all demands, and further still the myth that, if the NHS cannot afford something, that something is valueless and should not be available from any other source.

The Government cannot decide whether they are trying stimulate demand, with 24-hour access and walk-in centres, or manage demand by controlling referrals and

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banning drugs. Indeed, the collective mind of the Government has become so confused on the matter that the previous Secretary of State, in his speech to the Labour party conference, seemed to suggest that the main purpose of the NHS was to compete with the private sector.

The appointment of a new Secretary of State might have been an opportunity for genuine change--a chance to put behind us the failed policies of the past two and a half years, and embark on a new and coherent approach to mapping out the future of our national health service. However, the Secretary of State has arrived already shackled by the Prime Minister's political pledge, and hemmed in by an ideological refusal to learn from the examples of the health care delivery systems of our European neighbours.

We have learned from this debate that there will be no change in the old Labour approach to health care. The waiting list pledge subordinates clinical to political priorities, and makes the sickest wait the longest. It turns the ethic of the national health service on its head. However, far from delivering on the waiting list pledge, as the Prime Minister's amendment might suggest, and based on their own fiddled figures, the Government have presided over a 170,000 increase in the total number of people waiting both for treatment and for first specialist consultation in the national health service.

In opposition, Labour Members said that they would spend £100 million to achieve a 100,000 reduction in the waiting list. In government, they have already spent £780 million to achieve a 170,000 increase. It is no wonder perhaps that the previous Secretary of State was sacked. I only hope that he never gets the chance to inflict on the bus queues of London what he has inflicted on the waiting lists of the national health service.

The truth is that, as long as the waiting list pledge remains the Government's key target--the one on which they base the rewards and penalties that they levy on hospital trusts--all other announcements are a zero-sum game; the rhetorical equivalent of rearranging the deck chairs on the Titanic. The facts are simple, and the Secretary of State knows them, but he cannot respond to them because he is a hostage to the Prime Minister's political pledge.

The NHS has limited resources and cannot manage now on those resources. If the waiting list initiative continues, any other focus or initiative must be at the expense of something else. Therefore, when the Secretary of State tells us that he is focusing on coronary heart disease, cancer and mental health, he must tell us also, if the waiting list initiative is to remain, what will bear the burden--which services will be discontinued or cut to finance those initiatives?

In focusing on the killer diseases, the Secretary of State is cherry-picking from the Conservatives's patients guarantee. My hon. Friend the Member for Woodspring has proposed precisely that the most serious complaint should be treated first, and that clinical priority should be the sole basis of running the national health service. He has also said that he would scrap the damaging waiting list initiative. He has had the courage and honesty to acknowledge that shorter waiting times for those who are most seriously ill will mean that those with more trivial conditions will have to take their place in the queue for treatment in the national health service. Surely,

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the rational way to run a health service is to deal with the sickest people first, but that is not the way that it works under the waiting list initiative.

The Secretary of State ignores the evidence all around him of chaos and demoralisation, and piles on more targets without scrapping the old ones. He displayed a frightening complacency when he told us last year that we have the best health service in the world. That is a health service which produces twice as many coronary heart disease deaths per 100,000 population as France; delivers half the lung cancer survival rate of Germany; and is pipped only by Romania for bottom place in a Europewide league table on the availability of renal dialysis. It is a system that delivers us the lowest number of doctors per thousand of population of any country in the European Union, and the lowest health spending as a percentage of gross domestic product.

If that is the health care system that the Secretary of State thinks that Britain deserves in the 21st century, that is a measure of the contempt in which this Government holds the British people.

The Government's insistence that the NHS can meet every last demand of every last person is a cruel deception which induces a dangerous complacency and becomes apparent only when it is too late. People are discovering that the NHS is not there for them, and the increasing numbers of elderly people using their life savings to pay privately for drugs and operations will testify to that.

We have set out our policy--transparent and explicit about the resource constraints on the system, putting the sickest at the front of the queue and letting doctors, not politicians, decide the priorities. That is a commonsense approach.

The Secretary of State is trying to ride two bicycles at the same time. He is trying to pursue the contradictory agendas of the Prime Minister's failed waiting list initiative and his own well-meaning, but ultimately doomed, killer disease initiative. The Secretary of State is not stupid, and he knows that he can effectively refocus the NHS towards the killer diseases only if the Prime Minister's misguided and damaging pledge is dropped.

It is time for the Government to grasp that nettle and start the real debate on how to resource the NHS for the 21st century--something about which we heard nothing from the Government this evening. They should stop letting the British people and the staff of the NHS pay the price for the Prime Minister's refusal to acknowledge what every responsible body has told the Government--that the waiting list pledge was a grave error, the pursuit of which is causing serious and lasting damage to our national health service.

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