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Kali Mountford (Colne Valley): Given the hon. Gentleman's comments on nurses and the length and cost of nurse training, will he congratulate the Government and nurses on the number of nurses who have chosen to return to the profession? They are ready to be on the job on the very day of their return.

Mr. Harvey: I am delighted that some nurses have been attracted back to the job, and of course I congratulate the Government on any nurses whom they have managed to lure back or recruit to the profession. Last year, the Government increased pay for those who are on the starting levels in the nursing profession, and that was a useful start. This year, Ministers are beginning to deal with various anomalies. However, there is much further to go before the nursing profession will look sufficiently attractive to persuade people to spend an entire career in it.

How will the pay rises be funded? The increases in authority budgets that were announced before Christmas mean that there is enough cash to fund the pay rises, but if they are to be fully funded from those budgets, something else has to give. Will it be progress on waiting lists or the Government's modernisation agenda? Whatever the authorities and trusts sacrifice to fund the pay increases, the result will be slower progress on improving the health service in the way that we all want and more cases of the kind that my hon. Friend the Member for Torridge and West Devon (Mr. Burnett) mentioned.

Dr. Brand: Will not the health authorities that received the lowest uplift in their funding for next year find it particularly difficult to pay the salary increases? They will have to make cuts in services rather than just failing to advance them.

Mr. Harvey: My hon. Friend is right to point out that there are great inequalities between different health

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authorities around the country. I am glad that there is a review of the formulae and I hope that the difficulties faced by rural health authorities in particular will be better recognised. Scotland, Wales and Northern Ireland use formulae that recognise those difficulties better than the English system.

On top of the difficulties with nursing that we have already dealt with, the Government are spending an increasing amount on agency nurses to make up for the shortfall in NHS nurses. Between 1991 and 1998, spending on agency nurses doubled to £216 million. In the past year, that figure has increased by more than 25 per cent. It now costs the taxpayer more than £273 million to bring in private sector agency nurses, most of whom have been trained in the NHS, to cover NHS vacancies that would not exist if we were paying our nurses properly and recruiting adequate numbers into the profession. That is not good value for the taxpayer.

The Conservatives have been talking up the benefits and advantages of the private health sector and private insurance. I have made it clear that we think that there should be a mixed economy and that both sectors can play a useful role, but they seem to imagine that it is possible to engineer a massive increase in the number of people taking up private health insurance. There is a competitive market for private health insurance. I am sure that other hon. Members, like me, receive direct mail fliers from health insurance companies almost every week touting their wares and policies.

There is no reason why there should be a big increase in take-up unless there is a policy to engineer one. There are three possibilities: it might be made compulsory to take out private insurance, there might be a tax incentive, or the NHS might be run down to such a pitiful state that people would be bound to take out private insurance because they would regard it as the only way to get any health cover. If the Conservatives want a financial inducement, we shall oppose them head-on. There is no justification for taxpayer funds that could otherwise be spent on the NHS to bring about the improvements that people want being diverted to induce people who can afford, or are on the verge of being able to afford, private health insurance.

We know from last year's Budget that there is to be another 1p reduction in income tax from April. We have conducted opinion polling on that, as have some newspapers. The results show that the public do not want a 1p tax cut to be put ahead of getting extra investment into the health service. Nearly 80 per cent. would rather have the money spent on the health service now than on a 1p tax cut in April.

Our call to the Government--who made promises at the general election and have done so over the past three years, with the Prime Minister making more promises the other day--is that they should get on with carrying out those promises and achieve the target of reaching European average spending. Only then, having achieved that for all to see, should they imagine that taxpayers want to enjoy the dividend of a tax cut. They are putting the wrong value on those matters, and they do not understand what people want. If they do not wake up to that soon, there will be a huge price to pay.

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5.10 pm

Mr. David Hinchliffe (Wakefield): I welcome the opportunity of today's debate. We are all aware of the difficulties facing the NHS. It is important that we discuss them, and that we contrast the Government's attitudes in terms of policy with those of the Opposition.

At the outset, I should make clear that I am the constituency Member of Parliament of Mrs. Mavis Skeet, whose case received a great deal of coverage in the national press last week. I should make it clear that I do not have the family's permission to go into the details of the case. However, I spoke to the Secretary of State last week about my concerns over the handling of the case. I hope that, with the family's consent, at some point he will make public the outcome of his investigations into her treatment.

I came into politics to fight to ensure that people such as Mrs. Skeet receive proper treatment. I am sure that most Labour Members, and some Opposition Members, would want to ensure that such problems do not arise. I am driven, in part, by my personal experiences, which I have shared with the House before--my father faced a two-year wait for a heart bypass and died before he got the operation--so I understand how families in such circumstances feel. It will not only be Mrs. Skeet; others will be going through difficulties of this nature.

Dr. Tonge: Will the hon. Gentleman give way?

Mr. Hinchliffe: With respect, I shall not take interventions. I know that many hon. Members wish to contribute, and the hon. Lady may well have the opportunity to make her own point.

Let us not deny the fact that the NHS faces serious problems. As the Chairman of the Select Committee on Health, I would not deny that, as we see those problems. Most hon. Members looking at their local health services would accept that there are difficulties. However, those problems have not developed overnight and will not be cured overnight. The problems have occurred over a long period. It is easy to blame previous Governments. When we talk about how the health service is run, however, we should understand that today's policy changes will not impact in many areas for five or 10 years, or more.

The current difficulties underline elements of Labour's inheritance on health policy and what we faced when we came to power. I want to make clear one or two areas for which I think the previous Government are responsible in terms of the current difficulties and those that we shall no doubt face again in the months and years to come.

First, the previous Government broke down the national service that we had had since 1948 into numerous competing fragments. We inherited the hugely expensive bureaucracy of the internal market--a wasteful exercise introduced by the Tories, where money that should have been spent on patient care was spent on chasing pieces of paper. Secondly, under the Conservatives, the national health service was heading rapidly in the direction of American-style private medical care. There is no doubt about that. The policies that they introduced included tax breaks for private medicine--mentioned again today--the wholesale privatisation of community care provision and two-tier access, which was clearly the case in my constituency. I have named constituents in the past who were denied certain services that their next-door

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neighbours could get because they happened to have a non-fundholding rather than a fundholding GP. That was the reality of Conservative policies.

Having spent time talking to health service staff, I know that we had a demoralised staff who were leaving the service in droves--often to go to the private sector, which was expanding under the Tories--because they believed that the NHS had no future.

I welcome many of the positive steps that the Government have taken to return health to the vision of Bevan and the socialist pioneers to whom I look in terms of where I want the health service to go. If we stick to those principles, the majority of people will support the steps that we take. I welcome the increased funding that the Government have been able to devote to health recently. Indeed, although I suspect that people will feel differently about tax in two months' time, I would be happy for the Chancellor to cash in on the current concerns of people who would be prepared to forgo the reduction in income tax if the money were devoted to the NHS.

I welcome the proposals in the Health Act 1999, which largely abolish the internal market. The duty to co-operate is common sense and will return the health service to what it was in the beginning. However, will my right hon. Friend the Secretary of State consider further the splits in responsibility at local level between the different elements that we inherited? My constituency has seven different elements dealing with health and community care, not including primary care. Many of those bodies could be combined.

I also welcome the Government's moves to emphasise quality of provision, because I have come across some worrying problems in my work on the Health Committee in recent years. It is early days yet, but I commend the results so far. I also welcome the emphasis on primary care, which was part of Bevan's vision but has never been realised, and the proposals for public health and prevention. That was a non-issue for the Conservative Government, but it is crucial in addressing the problems that people face.

I welcome the staffing strategy, the recruitment work that the Government have undertaken, and their work on winter pressures. I know that we have recently had some problems, but they would have been far worse without the Government's steps to prepare local agencies to work together. My right hon. Friend the Secretary of State and his team know that I welcome the work they have done on bringing the NHS and social services closer. As someone who worked before 1974 in a local authority with a health department, I think that my right hon. Friend should go further and consider full integration of the NHS with local authority social services. He will know that the Health Committee also recently recommended that approach.

The debate this week has been about more than simple practical proposals. It has been about the fundamental issue of whether we as a society can afford a national health service. The great and good have been wheeled out on both sides. For example, Mr. Roy Lilley suggested at the weekend that we penalise smokers and obese people. He did not mention that obesity and smoking are most common among the poorest and most disadvantaged in our society, as I know from my constituency.

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Private health insurance has also been mentioned, but no thought has been given to the fact that many people with pre-existing conditions, or of a certain age, would never get private cover. What would they do? They are why we have a national health service in the first place, and we should be proud of that. Regardless of people's background, class, income, social status or health problems, they receive equal treatment in the NHS. That is the objective that we set back in the 1940s.

We have heard consistently during this Parliament the Tories' belief that expanding the private health sector is the only way forward for health provision. Last week, the shadow Secretary of State was quoted in The Sunday Times as saying:


That is on the record in the paper--[Interruption.] The Tories may be sending letters to The Sunday Times, but that quotation is there in print and available in the Library. We know about the Tories and the NHS. They never believed in maintaining the NHS right from the start, but their obsession with the private sector ignores reality.

My views on the private sector are not based solely on ideology. I am concerned with the practical effects of expanding the private sector. The Select Committee was unanimous in its concern over the private sector's abysmal record in quality of provision. In one instance, I was accused of using strong language, but where I come from we call a spade a spade, as my hon. Friend the Member for Rother Valley (Mr. Barron) will confirm. We say what we mean, and people respect us for it. I was criticised for comments that I made after listening to a man whose wife had been treated in a private hospital. He told me that, when she died, he had to lay out her body because there was no one else to do it. I admit that I was angry about what I consider to be an unforgivable situation. If I had time, I could give other examples of the lack of quality in the private sector. The Opposition take no account of the genuine unease--even within the private sector--about the standards of the care that that sector provides.

The Select Committee report examined staffing levels, and our finding was clear: staff haemorrhaged from the NHS are going to the private sector, where they get more money and sometimes enjoy better conditions of service. We concluded that expanding the private sector merely removes staff from the national health service. It is nonsense, therefore, to suggest that it is somehow helpful to expand the private sector. It is helpful only if, for political reasons, the NHS is to be run down. That is the Tory party's approach.

I urge the Government to go in the opposite direction and bring about, at the very least, the complete separation of the NHS from the private sector. I should be interested to find out what impact there would be on waiting lists if part-time NHS consultants worked full time and cared for people on the basis of need and not ability to pay.

Finally, I want to let the House into a secret: before last Friday morning, I had never heard of Lord Winston, even though I know most of the great and good in the national health service. Moreover, the man from BBC national radio who telephoned me on Friday morning for a comment had never heard of him either, so it was not just a matter of me being a thick Yorkshireman.

No one is sure of what Lord Winston meant or said, but he appeared to suggest that a middle road--some sort of third way, perhaps--existed between the state system

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and the private sector. I believe that, in this instance, there is no such third way. Either one believes in the national health service concept and subscribes to its principles, or one does not. The Tories have shown today that the Government believe in that concept, and that they do not.


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