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6.40 pm
Mrs. Caroline Spelman (Meriden): As a relatively new Member of Parliament, I am disappointed by the debate. We have again missed an opportunity to lay aside cheap political points and to debate health care in this country with honesty.
Criticisms of the Opposition motion overlook the fundamental point. The Opposition can, of course, choose what to put in their motion. Our last health debate, on 18 January, was held in close proximity to what the Government then described as a flu epidemic. I note that today the Secretary of State described the winter just passed as "no exception". That is what general practitioners told us at the time. The purpose of our motion on that occasion was to allow debate on the impact of the flu crisis. Today's debate is held very near the end of the financial year for health trusts and authorities, so it strikes me as perfectly sensible to make that the main focus of our debate. However, although the debate has ranged far and wide, it has not focused on the roots of the financial crisis facing the national health service, or on the impact on patients of the distortion of clinical practice.
Patients who have to wait and who have operations cancelled no longer feel that they come first. The Government's waiting list initiative has undermined
clinical priorities; and to those who have to wait, it appears that the Government's priorities come first. That is anathema to health professionals who are trained to treat patients according to clinical need: they are trained to be able to rush into casualty in time of crisis and to decide within minutes who should be treated first. That is what prompted GP Sharon Bennett to tackle the Prime Minister on "Newsnight". She pointed out that
My hon. Friend the Member for South Holland and The Deepings (Mr. Hayes) hit the nail on the head when he said that one of the main purposes of the debate was to tackle the issue of unrealistic expectations. The Government have raised expectations so high that they now fail even approximately to match people's experience. The extra billions that we have heard about mean nothing to the patients waiting anxiously for the treatment they need. It is as well if we as politicians remind ourselves of that. My hon. Friend the Member for West Chelmsford (Mr. Burns) told us of 14 people who have had to wait more than 18 months. The extra billions do not appear to have reached them. To his information about cancelled operations, I should like to add that, in the last financial year, 57,000 operations were cancelled, and 9,000 of those who suffered cancellation were not recalled within a month. To them, some of today's debate will have been meaningless; they just want to get their treatment.
We as politicians and as the Opposition have the job of asking questions about the money that has been spent. I pay tribute to the hon. Member for North Devon (Mr. Harvey) for having summed up as neatly as anyone could the problem with the Government's elastic arithmetic. He did so in inches; as I see my children grow, I can relate to his methods. He said that if three inches, three inches and three inches are added together, the result is nine inches. That is pretty easy. In simple mathematical terms, three times three is nine. My hon. Friend the Member for Woodspring (Dr. Fox) referred to Peter Kellner's article, which pointed out that the claimed £18 billion is more akin to £5 billion once general inflation has been stripped out. Lord Winston was right about that; he was also right to speak his mind.
From that £5 billion, we have to take the £500 million deficit accrued by trusts and health authorities. My constituency is sandwiched between Birmingham health authority, which, as we have already heard, has a deficit of £8.6 million, and Warwickshire health authority, which has a deficit of £8.2 million. Managers in both trusts have told me that the problem is not only money that is promised but never received or that fails to match spiralling costs, but the parcelling of money in a way that makes operating based on clinical priority far more difficult: attaching money to particular uses creates great inflexibility.
The hon. Member for Dartford (Dr. Stoate) is keen on surveys, so here is one for him. Last year, the NHS Confederation carried out a survey of trusts and health authorities. It showed that 64 per cent. of trusts were less confident about their financial position than they were 12 months ago, and the figures we have discussed today
tell us why that is; 55 per cent. of trusts believed that income would exceed expenditure by up to £5 million--my hon. Friend the Member for Woodspring showed how costs increase; 37 per cent. of trusts believed that they would have to make cuts in direct service provision during the coming financial year to balance their budget; 24 per cent. of trusts said that their financial position meant that they would have to postpone or cancel developments in the Government's priority area, mental health; and 20 per cent. of trusts said that their financial position meant that they would have to postpone or cancel developments in the area of reducing health inequalities. That all makes unattractive reading, but we are debating the financing of the NHS and whether or not it is in crisis, and that is the right debate to be having at this point in the financial year.
It does not help public confidence one iota to re-announce money. We heard about an especially bad example, in which £30 million spent on accident and emergency facilities was announced seven times--that is right over the top. The Government appear to have reached the stage of believing their own rhetoric. In one breath, the Secretary of State said of the £50 million boost to cardiac surgery that it was new, extra money; with the next breath, he said that it was part of the extra £21 billion that the Government are putting into the NHS. I guess that, if it is said enough times, even a Minister believes it. That sort of thing has undermined confidence in the Government's pledges. On the question of matching European funding for health care, even the Prime Minister is caught between a firm pledge and an aspiration. Everything depends on a great "if"--if the economy performs well, and if the Government can afford it. That is the biggest "if" we have ever heard.
In a recent speech delivered in South Ribble, my hon. Friend the Member for Woodspring said:
The Minister of State, Department of Health (Mr. John Denham):
This has been an Opposition-day debate on a topic chosen by the Opposition. It is therefore a shame for the Opposition that, from the opening speech of the hon. Member for Woodspring (Dr. Fox), the debate from the Opposition side has lacked focus, facts, policy alternatives, analysis and, for a good deal of the time, an audience. It speaks volumes that, for a considerable part of the afternoon, only two Members from the Opposition party bothered to turn up for an Opposition-day debate.
On the subjects covered in the motion under discussion--financial management and deficits--the worst that we could deduce from the facts that emerged in the debate was that the situation was at least twice as bad in the last two years of the Tory Government as the worst that has been projected for the current year, and that does not take into account the extra funds that we have put into the health service over the past couple of years.
Cancelled operations were raised by the hon. Members for Meriden (Mrs. Spelman) and for New Forest, West (Mr. Swayne), yet there was less chance of an operation being cancelled during the first two years of the present Government than during the last two years of the previous Government. That does not mean that the situation is good, or that we are happy that anyone's operation is cancelled, but the situation is better than it was before.
My hon. Friend the Member for Wakefield (Mr. Hinchliffe) raised a number of issues, principally private medicine. I understand his continuing concern, but the Government's view is that our priority should be to concentrate on the time for which consultants are contracted to work for the national health service, and to ensure that we get the best contribution during that time. That is where we are focusing our effort in our discussions with the British Medical Association about a new contract.
The hon. Member for West Chelmsford (Mr. Burns) had the same difficulty as other Opposition Members who spoke--he did not understand the policy of his own party, when he said that he did not want the privatisation of many services provided by the NHS.
My hon. Friend the Member for Carlisle (Mr. Martlew) is right to be proud of the new hospital that the NHS and the Government are delivering for his constituents. He raised the question of the funding formula, as did the hon. Member for South Holland and The Deepings (Mr. Hayes). A review of the funding formula is under way. There will be no changes, other than the statistical changes, until we have the findings of the review. A wide range of factors will be taken into account in the review, and I cannot prejudge the outcome.
My hon. Friend the Member for Wirral, West (Mr. Hesford) correctly pointed out the huge unanswered questions at the heart of what we know about current Opposition policy.
The hon. Member for New Forest, West made me wonder, as he always does, what the other candidates in his selection conference were like.
My hon. Friend the Member for Dartford (Dr. Stoate) rightly underlined the good work of the NHS. It is important to strike a balance between the proper discussion of issues that have yet to be resolved in the health service, and the presentation of a negative view that might persuade some patients not to take up the services on offer.
Most managers are under extreme pressure to reach the targets. Waiting lists are being manipulated and as a doctor I find that completely unethical.
Ask doctors to do the unethical and they soon become demoralised. Ask patients to submit to the unethical and they soon lose faith in the service.
The British people want a system which guarantees that nobody ever has to endure the harrowing experience of someone whose treatment was postponed so often it became inoperable. They want a system that doesn't put half a million patients on the waiting list to get on the waiting list . . . a system in which doctors decide who should be treated, when and . . . no wait exceeds a clinical maximum. The Government has meddled with the system, making the sickest wait longest, which is . . . simply wrong. Staff are demoralised because they can't do what they were trained to do. The Government has raised expectations but they don't match people's experience. For the first time in a generation, we have a chance to hold an honest debate on how to buttress the NHS but the Government has closed its mind. The Prime Minister says there is "no alternative" to the Government's present strategy. What a missed opportunity! There is debate everywhere--in the press, in the professions and amongst the public. But the Government won't debate the options.
Like my hon. Friend, I believe that the NHS deserves better.
6.49 pm
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