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Mr. Milburn: I shall deal with ring-fenced funding for coronary heart disease and cancer in a moment. I make no apology for setting tough national standards for the national health service. Anyone who takes even the most cursory look at the NHS will realise that, all too often, the care that people get and the services that they receive depend on where they live. That is unfair. It is unacceptable, and it has to change.

That is why we have created the first-ever independent inspectorate for the NHS, the Commission for Health Improvement, to drive up standards of care for all patients. It is also why we set up the National Institute for Clinical Excellence, and it is why we have been working with doctors, nurses and managers to draw up clear national standards to treat and prevent the biggest killers that our country faces--coronary heart disease and cancer. National standards for treatment have also been drawn up for mental health problems.

It is worth reminding the House that, when we came to office, there were no such standards for tackling heart disease, even though Britain has one of the worst records of heart disease in the developed world. Today, those standards are in place. A national service framework has been established which commands the confidence of the service and which sets out a clear, 10-year programme of reform and improvement. It is a blueprint for change which is backed by £100 million of ring-fenced cash. That money will be used to pay for 3,000 more heart operations, cut ambulance waiting times and set up fast-track chest pain clinics. In addition, smokers will be helped to give up smoking, rather than just being exhorted to do so.

Fiona Mactaggart (Slough): May I take this opportunity to thank the Secretary of State for making a difference in my constituency, which has one of the highest rates of death from heart attacks and strokes in the country? In nearly 20 years under the Conservative Government, my district general was almost unique in having no dedicated coronary care unit. The hospital now has £800,000 to invest in a coronary care unit. It is moving its intensive care beds out of the portakabin that has housed them for years. It also has £3.5 million for a new accident and emergency department. Will not that deliver better help for the appalling health record of the people of Slough?

Mr. Milburn: My hon. Friend is absolutely right. Frankly, it is a bit rich of the Opposition to cry crocodile tears over heart patients. There is no argument but that waiting times for heart operations are too long, but we are going to get them down. The waiting lists are too long for

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a self-evident reason--under that lot, there was no national plan for coronary heart disease, and inadequate training meant that we had too few cardiologists and cardio-thoracic surgeons. As a result, in today's national health service, there are only 171 surgeons capable of doing heart operations.

That is the legacy of the previous Conservative Government, not of this Government. I can tell my hon. Friend the Member for Slough (Fiona Mactaggart) that, over the next five or six years, we will increase the number of doctors capable of carrying out heart operations by between 50 and 60 per cent. That will be an investment in the future. Like everyone else, I wish that the increase could be accomplished faster, but we must make no bones about who were responsible for today's long waiting times for heart operations. They are the people who failed to invest in heart surgery yesterday--the previous Conservative Government.

Mr. St. Aubyn: Will the Secretary of State give way?

Mr. Milburn: No, I have given way once to the hon. Gentleman, who should not point his finger at me like that. It is most rude.

I do not say that we have solved all the problems the NHS faces, but we have made a start. The policies of the Conservative party would take the NHS back instead of moving it forward. There could not be a clearer contrast between the priorities of this Government and those of the Opposition.

The hon. Member for Woodspring gave an infamous speech to his party conference which has become known as his "NHS plc" speech. He said:

The biggest problem that we have in the NHS is that it is not a proper market.

Given that the Opposition see that as the biggest problem, I can only assume that it is their biggest priority too. We know now that they intend to tackle it by using public money to subsidise and expand the private medical insurance market.

The hon. Member for Woodspring confirmed this week that the Conservatives would spend £468 million subsidising employer-based private medical insurance. That is their policy and it is on the record--but it is just the start. On at least four occasions this year--twice in January, once in March and once in April--the Leader of the Opposition has repeated his commitment to introducing tax relief for individuals in private medical insurance schemes, as well as for those in employer-based private schemes.

The total cost of that policy could come to £1 billion. That would more than dwarf this year's pay rise for nurses, and all the investment that the Government are making in casualty departments. The resources that we have prioritised for the NHS would be frittered away in tax perks for people who already have private medical insurance--and all in the name of creating what the hon. Member for Woodspring calls a "proper market".

It is no good for Conservative Members to claim that that spending would be additional to matching our commitment to big increases in the NHS budget. They are spending money that they have not got. The Opposition's tax guarantee, their refusal to support tobacco taxation being ring-fenced for the NHS and their extension of tax

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perks for private medical insurance mean that they could not even hope to match the Government's spending on the NHS.

The Opposition cannot match our commitment to modernisation, so they are forced to prioritise their real policy. That is not to modernise the national health service, but to privatise it. [Hon. Members: "Rubbish."] Conservative Members say that that is rubbish, but the hon. Member for Woodspring has said that he wants more patients to be pushed into paying for treatment and for what he calls non-urgent operations.

Dr. Fox indicated dissent.

Mr. Milburn: The hon. Gentleman shakes his head, but that is what he told The Sunday Times in January--

Mr. St. Aubyn: Will the Secretary of State give way?

Mrs. Laing: Will the right hon. Gentleman give way?

Mr. Deputy Speaker: Order. It is obvious that the Secretary of State is not giving way at the moment.

Mr. Milburn: If they stopped shouting at me, I might give way. In an interview with The Sunday Times in January, the hon. Member for Woodspring said that

hip and knee replacements, and cataract and hernia operations

were at the top of his hit list. Whenever I have challenged the hon. Gentleman about that interview, in the House and elsewhere, he has always denied it and said that he was misquoted. I give him the opportunity to put the record straight today.

Dr. Fox: I have made it perfectly clear that if people choose to go privately, it is up to them. Yesterday, I said explicitly:

It is not important to us where treatment is carried out--simply that it is carried out in the appropriate time and of the appropriate quality. We must also ensure that the system works effectively to deal with debilitating if not life-threatening conditions such as patients requiring hip replacements or cataract surgery. One of the solutions is to have stand-alone surgical units dedicated to these procedures without the pressures of having to deal with emergencies. It is an attractive idea which I hope the Government might include in the national plan.

It could not be much clearer.

Mr. Milburn: The House will note that despite the fact that the hon. Gentleman claims that he has been misquoted by The Sunday Times, he did not use that opportunity to say that he was misquoted. He does not withdraw what he told The Sunday Times, published on 18 January. The House will be interested in that--as will, I suspect, The Sunday Times.

If the hon. Member for Woodspring does not agree with himself, I wonder whether he agrees with his hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond). In January, the hon. Gentleman said on Sky News--live on air--that the system that the Conservatives were advocating meant

people would look to the NHS to provide them with service when they had serious, life-threatening conditions--

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and we have no argument about that. He went on to say that people


would look to their private insurance to help them with those things where the NHS has to ask them to wait a little bit longer.

Is this another case of the hon. Gentleman being misquoted? Did he misquote himself? Does he stand by those remarks--yes or no?

Mr. Philip Hammond (Runnymede and Weybridge): I stand by those remarks entirely. Even the Secretary of State acknowledges that people in this country have a right to buy private health insurance. That is their choice and their right. Does the Secretary of State prefer a model in which people try to opt out of the NHS, buying private medical insurance that will cover all their needs? Or does he think it is a better model to have private health insurance products that are complementary to the NHS, so that people will look to the NHS for their serious and life-threatening conditions and turn to private insurance, if they have it, for those conditions

where the NHS has to ask them to wait a little bit longer?

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