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Mr. Milburn: I can feel a general election campaign coming on--I can feel it in my bones. I can see the leaflets and the party political broadcasts. There we have it, from the lips of the hon. Gentleman; the authentic voice of today's Conservative party. The Conservatives are no longer committed to getting waiting times down for everybody in the NHS; they are committed to extending waiting times in the NHS. They are committed to taking non-urgent operations out of the NHS altogether. [Interruption.] That is what the hon. Member for Runnymede and Weybridge said.

Let me tell the House exactly what those non-urgent operations are. Some 1.2 million took place in the NHS in England in 1998-99. More than 300,000 of them were carried out on pensioners. A quarter of a million were general surgery operations and a further quarter of a million were orthopaedics. Just under 200,000 were eye operations and more than 100,000 were gynaecological operations. The priority of the Conservative party could not be clearer: a two-tier health care system with fast-track treatment for those who can afford to pay and second-rate treatment for those who cannot. Those might be the Conservative party's priorities, but I tell the House that they are not the Government's priorities.

Dr. Fox: Will the Secretary of State tell us how many patients forced out of the NHS to buy their entire treatments in the private sector did not have private insurance last year?

Mr. Milburn: The hon. Gentleman knows that there are two trends in the private health care market. There is one trend for private health insurance that is basically flat, although I know that the hon. Gentleman wants to bump it up and spend taxpayers' money doing so. He would rather spend £400 million on subsidising people for their private medical insurance than invest it in precisely the areas that Labour Members would recognise as priorities.

There is a rise in the number of so-called "self-payers"; people who decide to pay for their own care. That is true. I was asked whether I thought people should have a choice. Fine--they should have a choice, but it should be a genuine choice with a first-class national health service,

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not just in some parts of the country, but in every part. That does not mean shorter waiting times for some treatments, but shorter waiting times for every treatment.

Mr. Burns indicated assent.

Mr. Milburn: I am glad that the hon. Gentleman is nodding so enthusiastically, and I can let him into a little secret; that is not the position of his Front-Bench colleagues.

Dr. Fox: Does the Secretary of State think that those 160,000 patients who, last year, paid entirely for their own care--many from out of their life savings--for operations such as cardiac surgery or major orthopaedic procedures, did so because they wanted to have that choice or because they were forced to do so by the unacceptable waiting times in the NHS, for which the right hon. Gentleman is responsible?

Mr. Milburn: The hon. Gentleman assiduously quotes his own medical experience. He will know at least as well as I do how many years it takes to train a cardio-thoracic surgeon. Could he remind me? How many years is it? Is it three years? Or is it seven or 10 years? Who was in power seven or 10 years ago? I will let him into another little secret--it was not a Labour Government, but a Conservative Government. The failures that we see now in our heart surgery services have everything to do with the failure by the previous Conservative Government to invest, plan and modernise. That is the case and however much the hon. Gentleman may wish to dismiss it, he knows that as well as I do.

I have described the Opposition's priorities, but they are not our priorities. Within four weeks, the Government will publish our national plan for the NHS. It will set out our national priorities for reforming the national health service. The national plan will be both radical and reforming. It will make clear that the nation's priorities are more doctors and more nurses, not more markets. Our priority is to expand the national health service; the Conservative party's priority is to extend the private medical insurance market.

Mrs. Teresa Gorman (Billericay): Will the Secretary of State give way?

Mr. Milburn: No, I will not give way. I have given way on countless occasions and, frankly, every one was a waste of time.

Our priority is to reduce waiting times for all conditions. The Conservatives' priority is to increase waiting times for many conditions. Our priority is the opportunity for all to have a decent health service. Their priority is to waste NHS resources on subsidising the private medical insurance industry.

The national plan will deliver on our priorities for a bigger, better NHS, treating more patients more quickly. Those are the priorities for the NHS. They are the priorities for Britain. I believe that they are the priorities of the British people. From what we have heard today, we now know that they are certainly not the priorities of the Conservative party.

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2.38 pm

Mr. Nick Harvey (North Devon): I congratulate the hon. Member for Woodspring (Dr. Fox) on securing this debate on priorities in the NHS. It is an important issue and a timely moment for the House to debate the matter, as we are a few weeks away from a national plan that will point the way for the NHS in years to come. Everybody in the Chamber will recognise that there is a still great deal to be done to improve our national health service and certainly that perception is shared by the general public.

The 1980s and 1990s saw a decline in the NHS, as it was starved of investment. The decline is demonstrated by the waiting culture which continues to bedevil the service. The public are increasingly aware and concerned about waiting lists and times, increases in the number of operations cancelled and poor access to appropriate drugs in certain areas. However, those are merely symptoms. The causes have been the dwindling number of health care professionals, too few staffed beds and the deteriorating state of equipment and buildings. At the start of the 21st century, the service is slow and often unresponsive to patients' needs.

The principal problem with the national health service is lack of capacity. There are too few doctors, too few nurses and other health professionals, too few hospitals, too few beds and not enough modern equipment. These are the problems that bedevil us, and which come to light all too clearly in circumstances such as the flu crisis last winter. Not having the capacity to cope with the sudden upsurge in the numbers needing to use the health service brought all sorts of problems.

In the midst of that crisis, the Prime Minister outlined his goal of seeing spending on health in the United Kingdom increase to the European average. In March, the Chancellor committed new sums of money to the health service. We welcome that money; in some cases, we feel that it comes with too many strings attached, but it is clear that, in committing these resources, the Government recognise the scale of the problems that need to be addressed.

Our criticism is that if the Government had started making such an investment, and had called together the stakeholders in the health service to formulate their national plan--which they are now doing--when they first came to office three years ago, the dividends from that investment would now be starting to show. At the most rudimentary level, if more nurses had started training in 1997, they would be qualifying this summer and could help tackle the problems. However, better late than never--I think that the Government have been absolutely right to sit the stakeholders in the NHS round a table to discuss what they believe to be the way forward.

When I listened to the hon. Member for Woodspring talk about political interference, I could not help but look at the contrast between the process in which the Government are currently engaged and the manner in which the previous Government's health reforms were steamrollered through in the early 1990s as they ignored all the warnings that were given and refused to carry out any pilot studies. The Government's stance is in marked contrast, and is a welcome change in approach and emphasis. It gives us an opportunity to consider what the basic principles of the NHS should be for the next 50 years.

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The NHS has been well served by the original founding principles outlined by the great Liberal, Beveridge, and implemented by the post-war Labour Government. The first of these principles, in my view, is that the NHS should remain free at the point of need and paid for out of general taxation. The principles have ensured that the NHS has survived 50 years in which it has often been deprived of the resources that it needed and has suffered all sorts of experimentation and tinkering. That the NHS still exists is testament to the fact that people in Britain still regard it as their most valued institution.

Let me nail the Liberal Democrat colours to the mast on this first key principle. We believe that a tax-based NHS is sustainable; we believe that a tax-based NHS should be the route to expanded health care, not increases in private health insurance. A tax-based system is fairer and more efficient than a system based on continental social insurance or on private health insurance. At its most basic, the British people will get more health bangs for their buck through the NHS than through privately funded health care.

Britain cannot afford to encourage cheap provision without the promise of quality. We cannot afford to promote health care predicated on profit, and we will not accept quality of life dictated by quantity of wealth. That is what private insurance would mean to the poor, the elderly and the disfranchised of this country.

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