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Miss Kirkbride: Will the hon. Gentleman give way?
Mr. Hinchliffe: No. I want to make some progress.
As I have said, the debate on 18 January focused around the interview in the latest edition of The Sunday Times with the hon. Member for Woodspring and his detailed thinking on the future direction of health care under the Conservatives. I made a point of mentioning one specific part of the article. I did not quote his words
out of context; I quoted them exactly within the context of the article. It quoted his views on the direction of Conservative policy:
There was some mumbling from the Front-Bench team at that time. The Secretary of State said that the Conservative Front-Bench spokesman intended to write to The Sunday Times. I have read it every week since. I have seen no corrections. I have seen no suggestions from the Conservatives in the letters column or elsewhere that it was a misrepresentation, because it is exactly what the hon. Member for Woodspring said. The key point that the Secretary of State made is that the tax guarantee will reduce public funding. Clearly, the expansion of private health care is allied to that.
The problem that the Tories face--they have never answered the question, although I have raised it in every health debate since the last general election--is that, if they expand private health care, where will the staff come from? They will come directly from the NHS, so it is their policy to expand the private sector--whether we call it privatisation or peripheral--with people being encouraged, as they have been today, to take out private insurance and use the private sector for hip replacements, cataract operations or whatever. The purpose is to expand and increase use of the private sector.
The Tories do not seem to understand that the private sector does not train its own staff. It recruits them directly from the NHS, so their policy is all about robbing the NHS of its staff and skills.
Mr. Swayne:
Will the hon. Gentleman give way?
Mr. Hinchliffe:
No. I want to carry on because many Members want to take part in the debate. I have taken one intervention. I hope that I responded to the point that was made.
The simple political fact is that the Tory party has given up on the NHS. I made the point during the speech of the hon. Member for North Devon (Mr. Harvey): two Tory Back Benchers were in the Chamber for a Tory debate. That shows their commitment to discussing concerns about the NHS. If they are getting hammered by their constituents about problems in the NHS, look at the Tory Benches: there is no one there. That shows that they are doing nothing but going through the motions. They see the private sector as the way forward. It is no surprise because, as we all know, the Conservative party has never believed in the NHS.
Mr. Burns:
May I try to put the hon. Gentleman out of his misery? I know that he is keeping to a script that he obviously wrote some hours ago, but just to reassure him: Conservative Members do believe in the NHS, free at the point of delivery. That is why we are so concerned on behalf of our constituents about what is happening with waiting lists, out-patient lists, ward closures and the lack of funding.
Mr. Hinchliffe:
I am still mystified. If there is such concern, why do we constantly hear about the mixed economy? The first statement--I will check the record--
Mr. Burns:
Will the hon. Gentleman give way?
Mr. Hinchliffe:
No. With the greatest respect, I have to make progress.
That has been the consistent message for nearly three years. It has not changed, so people understand the direction of Tory policy and will make up their own minds, as they did at the last general election.
I should like to deal specifically with the subject of this debate, as described on the Annunciator: the Government's waiting list pledge at the previous general election, and the alleged distortion of clinical priorities. I have long examined the issue, and I know that there are 101 ways of measuring activity and progress--or the lack of it--in the national health service. As I have said many times, I should not have chosen waiting lists as the best way of measuring progress made in the health service, but should have thought that progress in public health is the best overall guide in judging Government policy. Nevertheless, I accept that I was elected on that pledge, and I believe that I have a duty to ensure that the Government deliver it.
I recommend to hon. Members an exercise that I performed the other day--read the manifesto on which we stood at the general election. I re-read the manifesto that I issued at the election, and it included the pledge on waiting lists. It seems--looking at my picture on the manifesto cover--that I look younger now, under Labour, than I did then, but that is a separate issue. The point is that, with the exception of that one pledge, on waiting lists, we have delivered all of our promises, and I am damned proud of that. I also have a vested interest in ensuring that I can tick the last promise, on waiting lists. Although I had reservations about including the pledge, I believe that we have to deliver it, and that we will deliver it.
Is the pledge distorting priorities in the NHS? A couple of weeks ago, the Health Committee conducted a brief inquiry into the winter pressures initiative. The hon. Member for West Chelmsford (Mr. Burns) attended the inquiry, so I hope that he will concur on this.
At the inquiry, I asked a question of the Under-Secretary of State for Health, my hon. Friend the Member for Birmingham, Edgbaston (Ms Stuart), which I couched in these terms: "If I were the chief executive of an NHS trust and I faced the dilemma of choosing between meeting the Government's waiting list target or treating people on the basis of clinical need, what should I do?" She was absolutely clear and categoric in her reply: "You treat people on the basis of need. The health service should treat urgent clinical needs first." The Secretary of State made precisely the same point today.
If hon. Members say that that is not happening in various parts of the country, I shall need to see the evidence of it. Although I have heard anecdotal evidence that urgent clinical priorities are not being treated first, I have not seen concrete evidence of it. I listen to people and, every day, I receive many letters from people who work across the NHS, but I have not yet received a
concrete example of the practice. If I receive such an example, I shall examine it. I shall also say that the people in the health service who are involved in the practice have not been listening to the Government's statements, which have made it quite clear that urgent clinical needs should be treated first.
At that Health Committee inquiry, we also compared the performance of two acute NHS trusts, one of which was in the constituency of the hon. Member for West Chelmsford, in Essex, with the other in the north-west of England, in Cheshire. Allegedly, one of the trusts was failing, and the other was succeeding. What I learned in the inquiry--perhaps the hon. Member for West Chelmsford took from it a different message--is that, when we examined in depth the two trusts' figures, we were not comparing like with like. I also learned that one of the trusts was intervening earlier than the other trust in certain medical conditions, and that that practice was increasing its out-patient waiting list.
One trust gave the Committee the specific example of cataract operations. That trust tackled cataract cases earlier than it had before, on an out-patient basis, and did not leave them for the condition to worsen. However, the change in procedure increased the number of people on the out-patient waiting list. The size of waiting lists is, therefore, not the most reliable way of measuring local performance.
I hope that, at the next general election, we might consider including in our manifesto pledges on measurements other than waiting lists. Although I have no problem with including waiting lists, we should do so within the wider context of measuring progress, or lack of it, on other health issues, not only in the health service, but in public health.
As other hon. Members wish to speak in the debate, I shall make only one or two brief points on issues that the Government still have to address. I believe that the biggest distortion in clinical priorities has been caused by private medicine. Part-time NHS consultant status leads to a scandalous distortion, often placing treatment of those who are able to pay before treatment of those on NHS waiting lists who are in greater need. The same consultants are treating people in both sectors.
I ask my hon. Friend the Minister whether the Government will consider conducting a sample audit of NHS and private operating lists of part-time NHS consultants and comparing the clinical needs of patients in each sector. I know for a fact that the outcome of such an audit will show that the clinical needs of those who are on NHS waiting lists are far greater than those of people being treated in the private sector.
The message that I want to give the Government is that the waiting lists problems that we are facing will be dealt with seriously only when moonlighting in the private sector is ended once and for all. We have faced that problem ever since the inception of the national health service, and it is about time the Government dealt with it seriously, on behalf of those--the vast majority of people--who use the national health service.
We could fund that solution by using within the NHS the money that is currently being spent by the NHS on buying care in the private sector. A lot of money is being spent on buying private sector care that could be devoted to the NHS. I hope that Ministers will consider doing that,
because such a change would fundamentally alter the treatment received by NHS patients waiting on NHS waiting lists.
I also hope that we shall make much better use of the scarce resources that we do have. When one has been an hon. Member as long as I have, one will--as the hon. Member for West Chelmsford is well aware--have heard it all before. We simply move to the Benches on the other side of the House and carry on dealing with the same matters as we dealt with before. The current Government are bolstering the health service with ever more money, just as the previous Government did. I am always mystified as to where all the money the Tories provided went. In my backyard, all I could see was things getting worse by the week. The money seemed to disappear into a black hole somewhere. There still seems, to some extent, to be a black hole.
We have talked about ending the internal market, which I fully accept. I have also commended the Government on ending competition, which is now officially gone, as the Health Act 1999 made absolutely clear. As an analogy, however, when I go to a market, I see various stalls selling similar products. In health provision, we still have a whole load of stalls that are selling very similar products. I should like some of those stalls to be combined.
I should also like us again to address the purchaser- provider split. I remain to be convinced, when I see what has happened in my own backyard, that such a split makes sense. I talk to people who know far more than I do about local operation of the NHS, and they think that there is huge duplication and a lot of money--which should be spent on patient care--being wasted. I hope that we will revisit that issue. I also urge Ministers to re-examine the framework, to make it more sensible and to cut more of the bureaucracy and waste still in the system.
It would not be a speech by me if I did not also argue that there has to be a much closer relationship between the NHS and local authority social services. I commend the Government on the way in which they have moved the two spheres much closer together. However, like many hon. Members, I fundamentally believe that there should be formal integration of the services. It does not make sense to keep the two systems separated.
I was struck by figures provided, a couple of weeks ago, in the conclusion to the national bed inquiry, showing that two thirds of NHS beds are occupied by over-65s. Since the mid-1990s, one half of the increase in emergency admissions has been of people over 75. Since the early 1990s, one half of the extra emergency admissions of over-75s have been for frailty, not medical need. The inquiry report, which was very comprehensive, provides concrete evidence showing that a substantial proportion of NHS admissions arise as a direct result of the failure to offer people alternative care in the community. In a previous health debate, my hon. Friend the Member for Dartford (Dr. Stoate) gave an example of how he was able to provide such alternative care. We have to provide it, and combining the NHS with local authority social services would make it much easier to do so.
The Conservatives are no longer concerned with the maintenance of the NHS as the primary provider.
There was a clear message there.
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