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Dr. Fox: The lap dogs are all out today. I should have expected that, by now, the Labour Whips would have done a little work and got some new interventions.

The amount of money that has been made available, although described as "generous", is nothing of the sort. In fact, the money announced by the Government is not the amount that has been given to health authorities. It is becoming increasingly clear that the Government have perpetrated a con trick on the health authorities and the trusts, and on patients in Britain.

Miss Kirkbride: I share the accident and emergency department referred to by my hon. Friend the Member for Ludlow (Mr. Gill). The Government talk about changes and improvements to such departments, but at Kidderminster general hospital and the Alexandra hospital in Redditch, those departments are being downgraded to minor injuries units, which is why money is being spent on them.

Dr. Fox: That is an example of something else that the Government do continually: regrade things and give them a different title so that we are supposed not to notice that we are being given an inferior level of service. They must think that the public are as gullible as their own Back Benchers if they think they will get away with that for any length of time.

Mr. Geraint Davies (Croydon, Central): Will the hon. Gentleman give way?

Dr. Fox: No, I have just given way three times.

I come to clinical priorities. This is probably the most serious part of today's debate. The Government were warned at the outset by the Conservative party and, to be fair, the Liberal Democrat--the hon. Member for North Devon (Mr. Harvey)--and the medical profession, that its waiting list initiative was dangerous. Last week, Dr. Peter Skolar described it as complete anathema to the medical profession. Increasingly, that is how it is. It is dangerous because, with its obsession with numbers, it treats all patients as having equal clinical weighting, which is unfair. It is a manipulation of clinical priorities because, by penalising health authorities for not bringing numbers down quickly enough, health authorities are being encouraged, within any one given budget, to treat more minor conditions to satisfy the political masters, rather than treat them according to clinical priority. That is an unethical, unfair and immoral way in which to run a health care system.

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Dr. Peter Wilde confronted the Prime Minister last week on "Newsnight" and said that, as a cardiologist in Bristol, he believed that patients had died unnecessarily waiting for cardiac surgery. The scandal lies in the fact not simply that patients were waiting too long, but that the health authorities were still treating minor conditions while those patients were waiting for more serious surgery. That distortion of a simple clinical priority is the ethical flaw in the Government's policy.

There is still time for the Government to abandon that policy. I have no intention of raising individual cases of patients who have suffered, but surely we can all see that it cannot be right, in any medical system with finite funding, to ration on the basis of getting the numbers down quickly rather than treating the appropriate patients and ensuring that the sickest are treated first.

Surgeons throughout the country tell us that they are under pressure from their managers to get the numbers down quickly to avoid being penalised financially by the Government. We most object to the culture that is driving the process. There is a corrosive--and, I believe, disreputable and dishonest--code driving not only the policy but its presentation. That is partly because the Government have no coherent philosophy. The Secretary of State told managers when he was a junior Minister that he would come down like a ton of bricks on anyone who dealt with the private sector, but the Prime Minister said on "Newsnight" that he had no ideological problem with the private sector.

There was no adequate consultation to avert the winter crisis. From April, employers who dare to give private sector cover to their employees as a benefit will be subject to a new tax. Hon. Members may want to know that yesterday the Fees Office said:

I am writing to confirm that there will be a National Insurance liability on Health Care payments . . .


All such payments should go through the payroll and will incur Employer's NI at a rate of 12.2 per cent.

Any Members of Parliament who dare to give their secretaries or researchers health perks will be taxed by a Government who do not have a problem with the private sector.

It goes to the root of the Government's culture that they say one thing and do another. They would say black was white if they thought they had to. They are so duplicitous that they would not ask for water if they were thirsty. What is more, they can never be wrong. The Secretary of State said last week that Professor Alberti--his own adviser--Stephen Thornton of the NHS Confederation, the Institute for Fiscal Studies and Rabbi Julia Neuberger of the King's Fund were all wrong. On "Newsnight", the Prime Minister said that the managers, the doctors and the public were wrong, and moreover that the media were to blame.

The Government have no core values and exist only to be in office. We have the sad spectacle of Back Benchers, rather than holding the Executive to account, worshipping at the altar of the Prime Minister's ego. If one statement said it all, it was when the Prime Minister was asked whether the distortion of clinical priorities by the waiting list initiative should be changed. He said:

If we abandoned waiting lists, you guys--

the press--

would come down on us first and then patients would come down on us.

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That means that Ministers' reputations come first and patient care comes second.

We have a health care system run by politicians for politicians, not by doctors for their patients. On health care, the public expected much from the Government, but have been bitterly disappointed. The Government have replaced ethics with spin, hope with cynicism and dedication with dismay. The great Labour lie has turned into the great Labour betrayal.

4.9 pm

The Secretary of State for Health (Mr. Alan Milburn): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:

"welcomes the Government's modernisation programme for the NHS and the reduction in waiting lists and times that are being achieved through the dedication and hard work of NHS staff; notes the progress being made on recruiting more doctors and more nurses, building more hospitals, treating more patients and modernising more services; applauds the Government's decision to make tackling cancer, coronary heart disease and mental illness a priority; believes that financial provision for the NHS would be reduced as a consequence of the Conservatives' Tax Guarantee and that clinical need would be abandoned in favour of ability to pay under the Conservatives' health plans."

I apologise at the outset for the fact that I will not be here for the winding-up speeches, as I have a prior speaking engagement.

The Opposition have called for a debate on financial provision and clinical distortion in the NHS. I am pleased to tell the House that financial provision for the NHS has never been greater. The NHS is now benefiting from the largest cash injection it has ever seen. I am also pleased to tell the House that the assault on clinical distortion caused by the postcode lottery of care has never been greater either: the failed, disastrous, divisive internal market in the NHS has been consigned to the dustbin of history, where it belongs.

Mr. Simon Burns (West Chelmsford): Will the right hon. Gentleman give way?

Mr. Milburn: Yes. I believe that the hon. Gentleman was a supporter of the internal market.

Mr. Burns: If everything is so wonderful for funding in the national health service, why is it that, this financial year, the Mid Essex hospital trust will have the largest deficit it has had in its history, and three wards, containing 84 beds, will be closed?

Mr. Milburn: I do not know about that particular case, but the hon. Gentleman was a Minister at the Department of Health in 1996-97 when the NHS ran up a combined deficit of £459 million. He shares at least some of the responsibility for that, as I am sure he accepts. By the beginning of this financial year, that deficit had come down to £18 million, so we will not take any lectures from the hon. Gentleman or the Conservative party on deficits in the NHS.

Mr. Edward Garnier (Harborough): If the Secretary of State could not answer the previous question, perhaps he can answer mine. In November last year, his predecessor, the right hon. Member for Holborn and St. Pancras (Mr. Dobson), opened a brand new breast

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cancer unit at the Glenfield hospital in Leicester. That unit was opened thanks to private subscriptions and was not funded by NHS money. It will now be closed. Why?

Mr. Milburn: The hon. and learned Gentleman is talking about the Leicestershire area and he will be aware that consultation is still taking place about some of the proposals. There are always difficult decisions to make about health care funding and services, and that is as true for this Government as it was for the previous Government. The consultation continues and I urge the hon. and learned Gentleman to take part in it.

The Conservatives' motion condemns financial mismanagement when the Conservatives are past masters of it. I remind the hon. Member for Woodspring (Mr. Fox), who was rattling on about financial mismanagement, that it was his Government who managed to spend a small fortune on financial mismanagement in the NHS, including more red tape and bureaucracy than it has had in its history. This Government are taking £1 billion out of red tape to put directly into front-line patient services. We are doing that because it is the patients' priority, the staff's priority and our priority. Needless to say, the hon. Gentleman and his party oppose it.

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