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3.10 pm

Mr. Peter Lilley (Hitchin and Harpenden): I congratulate my Front-Bench colleagues on calling the debate--especially my hon. Friend the Member for Woodspring (Dr. Fox), who opened it by forcing the Government on to the defensive on health. The reason that he provoked such a weak, defensive and slightly irritable response from the Secretary of State was that my hon. Friend focused on positive proposals to improve the NHS, on which the vast majority of our constituents depend. He emphasised the importance of choice for patients in the NHS--a word not even mentioned by the Secretary of State in his contribution.

My hon. Friend brings to the debate the fact that he dedicated his professional life to working as a doctor in the NHS, treating patients. That gives us credibility as

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members of a party which cares for and wants to improve the NHS. We field real doctors; the Government field spin doctors on their Front Bench.

Over the years, it is strange that our debates on the NHS have tended to revolve exclusively around how much money is put into the service rather than how much health care comes out. That process was carried to its ultimate absurdity by the Chancellor in his Budget, when he set the target of matching the amount spent by our European partners. It would make sense to set as a target matching and surpassing the health standards achieved in other European countries, but it is bizarre to use their spending as a target, when there is little correlation between the amount a country spends and its performance in improving the health of its people.

Despite the Government's wish to focus on inputs, the debate increasingly turns--as it should--on the quality of care delivered by the NHS.

Dr. Stoate: Does the right hon. Gentleman belong to that section of the Tory party that believes that we are reckless to put extra money into the NHS, or does he believe that my right hon. Friend the Chancellor was right to allocate those extra billions of pounds? That money is undoubtedly improving patient outcomes throughout the country.

Mr. Lilley: The important thing is to target improvements in standards. That may well require extra money, but that is what the target should be--not spending money as an end in itself. Surely no one would want to spend money if it did not produce a good result. If we can improve quality without necessarily spending money, then surely we would all want that. That is certainly what our voters and constituents want; their concern about quality is growing.

Last year, there was a record number of complaints in the NHS. Patients have an increasingly consumerist attitude to health care--although that is good in the long run. There is a focus on the specific shortcomings of a minority of clinicians--sadly, misused and abused by the Government, who try to put on the medical profession blame that should rightly fall on the Government.

Our focus should be on improving quality. There are two broad approaches to that end. The first is that adopted by the Government: to focus exclusively on the command and control approach to managing the NHS. It is to focus on centralising the service; on sending out detailed circulars, like a shower of confetti; on micro-managing from Whitehall; on aiming for uniformity; on turning doctors into functionaries rather than professionals; and on treating patients as pawns rather than as people with a say in where and how they are treated.

The second approach is to try to modulate by more decentralisation those aspects of the NHS that must inevitably be centralised to some degree; to delegate responsibility to local hospitals and trusts; to encourage a greater diversity of provision within the service; and, above all, to harness the desire of patients and doctors to obtain the best treatment from the NHS. I want to focus on that aspect.

In every other service with which we deal--including those that are most important to us--when users have choice, it drives up quality of service. When users have

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choice, service providers know that, if they do not match the quality of the best provider, they will lose users and resources. As a result, they will not be able to expand or to provide more of the service to which they are dedicated--whether for charitable or commercial reasons.

Where choice exists, comparatively marginal movements of users between suppliers produce major improvements in quality, as providers respond.

Mr. Hinchliffe: I am interested in the points that the right hon. Gentleman makes about choice. I am concerned that when choice is afforded to certain people, it is denied to others. It is something of a myth to suggest that we all have free choice in health care. One person's choice to queue-jump to see a consultant denies someone else access to that consultant. Does the right hon. Gentleman accept that point?

Mr. Lilley: The hon. Gentleman will realise that I want to extend choice to everyone. I hope he believes that is right; it formed part of the original conception of the NHS.

Unfortunately, patient choice has progressively been largely eliminated in the NHS. I acknowledge that there were some restrictions as the unintended consequences of the otherwise desirable reforms that we introduced. However, at least we allowed choice through extra- contractual referrals in exceptional cases. Since April last year, the Government have, in effect, abolished the last vestiges of patient choice in the NHS.

A patient cannot, with a GP referral, choose to go to a hospital with a shorter waiting list than the hospital selected by the local health care bureaucracy--the primary care group. A patient cannot choose to be treated at a hospital with a better record of success, at a cleaner hospital, or at one with fewer avoidable referrals--information about which is available.

The Prime Minister has quite an instinct for what people want--I acknowledge that. No doubt many people heard and applauded his speech to the party conference. He said:

That is what he said and he was right to offer it as a promise. The Conservatives should try to deliver that promise.

However--as is characteristic of the Prime Minister--he says one thing and does another, because his Government have abolished choice. It is not only I who realise that. The director of the College of Health said that, under the arrangements introduced last April:

We should be moving in the opposite direction, for which there are three requirements. First, we must give patients and their GPs the right of referral to any hospital in the United Kingdom--in practice, not merely in theory. Secondly, we should publish information--on waiting times, success rates, specialisation and the availability of single-sex wards--in GP's surgeries and on the internet, so that patients can make informed choices.

Thirdly, we should ensure that money follows patient choice. That may seem the most remote requirement, but it is the most important. If money follows patient choice

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speedily and clearly, hospitals will be able to treat patients properly and we shall not simply lengthen waiting lists at the more popular hospitals.

Of course, that means that money will not go to the less popular hospitals. That will not tip them into a spiral of decline as some people imagine, but it will cause them to respond and ask why fewer patients want to go to them. If that is because they have a poor track record for a particular treatment, they will undoubtedly take action to change personnel. Hospitals will reassign doctors to operations that they are good at and not to those that they are less good at, or they will replace them so that the hospitals regain the confidence of the people living in the area.

If we do that, it will have three beneficial effects. First, it will drive up quality throughout the NHS. In my pamphlet "Patient Power", published by the Prime Minister's favourite think-tank, Demos, I quote details of a study undertaken in New York state which analysed the performance of every surgeon carrying out heart bypass surgery, and assessed their success rates. Under the American Freedom of Information Act, the study was forced to publish detailed information and the consequence was a dramatic improvement in performance. People had the knowledge and could choose which hospital to go to. As hospitals responded to that knowledge and choice, a dramatic improvement in the success rate of surgeons took place. In particular, that happened in the hospitals that previously had the worse success rates.

That example demonstrates that when one has choice, information and a variety of suppliers of health care, one obtains an improvement in quality. I want such an improvement for the people who depend on the NHS.

Mr. Jeremy Corbyn (Islington, North): Before the right hon. Gentleman gets completely carried away with the argument about the American model and freedom of information, will he address the fact that in the United States, which has a largely private health service, many people are denied access to any health care whatever for the type of surgery that he has highlighted? Does that study refer to the problem of social exclusion that is caused by the type of private health services that he appears to favour?

Mr. Lilley: I am not advocating those aspects of the American system. I simply propose that, within the NHS, patients should have choice. The hon. Gentleman may care to tell his constituents that he does not believe that they should have choice. He can try to argue that if he wishes, but it has nothing to do with whether there is a large private sector.

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