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The Prime Minister: Well, in that case, I am afraid that I am at a loss to know exactly what the right hon. Gentleman's question is dealing with. At least he gave us some welcome for a process that will involve people in the health service. There are no holds barred in that--we shall sit down and talk about all the issues. If the right hon. Gentleman cares to explain at some other time exactly what he means by patient choice, I shall have a look at what he says.
Mr. Win Griffiths (Bridgend): May I also welcome the fact that the Government are not jumping straight into decisions on how the £2 billion should be spent in the health service? I am also pleased that the Prime Minister said that there will be a joint committee to examine those decisions. The NHS Information Authority produced figures on the 50 most common inpatient treatments and the 50 most common day-case treatments. In Wales, for 22 of the 50 inpatient treatments, costs could vary by more than 200 per cent; for some treatments, costs could vary by a factor of five; and, for 12 of the day-case treatments, costs could vary by a factor of between five
and 10. The issue, therefore, is finding the place where treatment can be provided best and most cheaply, and not simply throwing money at the health service and saying, "Get on with it."
The Prime Minister: That is absolutely right. The debate about variations in performance, and how we tackle them, is the debate that I had hoped we would have in the House today. Of course it is right that we need more resources and money in the health service. However, I think that there is a very honest appreciation by the vast majority of people in the health service that some performance variations cannot be explained by social factors, investment or money alone. There are failures in the system that need to be addressed. There is also, of course, really good practice in the health service which could be made universal if we had the right means to do it.
Mr. Kenneth Clarke (Rushcliffe): Will the Prime Minister concede that the Conservative party has been arguing the case for more money and reform in the national health service for more than 10 years--usually while facing resistance from Labour Members and the bogus claim that we secretly want to privatise the NHS, which he has repeated today. Will he also concede that today's statement shows that the Chancellor did not want to pre-empt his comprehensive spending review for the next four years on the scale that he did yesterday? Did not the Prime Minister, in return, agree that he would take personal responsibility for trying to ensure that the money would be spent better--and did not the cliche-ridden jargon that he produced a few moments ago show that so far he has no idea how to deliver on that?
While we will all keep an open mind until July, when the Prime Minister comes forward with a plan, will the Chancellor ensure that all the money that he announced yesterday--not only the £2 billion, but the current allocation--will be given to the health authorities and trusts that need it, as there is £500 million of financial deficit out there, rather than being kept back in little packages at the centre, in the Department, to be announced and reannounced as gimmicky new initiatives in the next few months?
The Prime Minister:
The right hon. and learned Gentleman probably does not agree with the Conservative policy on tax, and at least he is consistent in his view of his own Front Benchers, but the fact is that one cannot possibly have a policy which maintains that, regardless of economic circumstances, one will cut the tax burden the entire time without making swingeing cuts in public services.
The right hon. and learned Gentleman may not be properly familiar with the latest thinking on the Tory Front Bench, but let me point out to him what the Conservative chief health service spokesman--the latest Conservative health spokesman--said. He said:
In answer to the right hon. and learned Gentleman's question about the £2 billion, it is important that we get that money down to the front line. As I said, the Health Secretary will be giving details of that in his speech in the debate. However, I think that the right hon. and learned Gentleman, like me, will have to accept that there is no point in my coming to the House to say, "Here are all the details of everything that we are going to do. Now, I am going to go out and have this discussion." It is important to have that debate and discussion within the health service, and then come to the House with the plan. Then people can have a chance to question us on it. Of course we have ideas about how some of the problems should be dealt with, but it is important to have a dialogue and partnership with people. It is unfortunate that the type of one-nation Conservatism that the right hon. and learned Gentleman represents is no longer represented on the Conservative Front Bench.
Mrs. Alice Mahon (Halifax):
I thank my right hon. Friend for his welcome statement on the huge increase for the NHS and his commitment to getting better value for money out of it. I ask him to remind the Opposition that the proposals come on top of the biggest hospital building programme ever embarked on by any Government. Will he join me in paying tribute to the former Secretary of State for Health, my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson), and to the current Secretary of State, without whose commitment and dedication, we would not be getting a brand-new hospital in Halifax next year, for which we have waited 30 years?
The Prime Minister:
I am pleased to do that. It is not merely the hospital building programme, because we have an extra 4,500 nurses now in the health service; more doctors and cardiac and cancer specialists are in training; and every accident and emergency department that needs it is being modernised. We have made many changes already, including getting rid of the old Tory internal market and ensuring that the primary care groups and trusts are put in place. However, as my hon. Friend acknowledged, we must now go further, and we shall be able to go further quicker because of the additional funding that has been introduced. Nobody should be in any doubt about the Tory party's position, which is a desire to demoralise people about the health service so that there is no alternative left to them but the Tories' private health insurance way.
Mr. Nicholas Winterton (Macclesfield):
Yesterday the Chancellor of the Exchequer announced apparently huge additional sums for the health service, which are welcome. Today, the Prime Minister has announced reform and modernisation, and we all hope that that will be successful. However, does the right hon. Gentleman not agree that the NHS is sadly all too often used as a political pawn by all political parties? The people whom we are honoured to represent in this place will not accept that Governments of whatever party are really committed to the health service until they see an improvement in the service they receive. A Liberal Democrat councillor in the Macclesfield borough had a cancer operation cancelled four times because of the shortage of intensive care beds--and people who are waiting in pain for a hip operation should not have to wait so long. Only when such cases are dealt with promptly in accordance with
The Prime Minister:
That is obviously right and I thank the hon. Gentleman for his more constructive attitude. We should be able to reach a stage at which, as a result of the extra money, we can provide the intensive care beds that we need. We have increased the number of intensive care beds, but not by nearly enough, and we accept that. It cannot be done unless the money is put in, but that will only be a start. It is also the case that some acute beds in hospitals are not properly used, so change and modernisation have to happen as well. I hope that, by putting in the money and--for the time being at least--resolving the funding issue, we can get on with talking about the modernisation issue. I hope that the hon. Gentleman and other more constructive members of his party will join in that debate.
Mr. Chris Pond (Gravesham):
Does my right hon. Friend recognise that in my constituency people will prefer the five Ps of his modernisation programme--partnership, performance, professionalism, patient care and prevention--to the two Ps of pessimism and privatisation of the Conservatives, and the 1p that seems to solve all the Liberal Democrats' problems. Is he also aware that, despite the fact that we have a brand-new acute hospital of which we are very proud and which will open soon, some anxiety is still felt in my constituency about the provision of community beds. When he and my right hon. Friend the Secretary of State for Health talk to West Kent health authority and to the primary care group, will they underline the importance of a community hospital, because we have been waiting for one for a long time?
Philosophically we have moved on . . . Insurance companies could cover conditions that are not high tech or expensive, like hip and knee replacements, hernia and cataract operations, which currently involve long waiting times. We could then leave expensive treatments like cancer therapy to the NHS.
I appreciate that that is not the right hon. and learned Gentleman's policy, but that is Conservative Members' policy.
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