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Mr. Ivan Lewis: Will the right hon. Gentleman give way?

Mr. Lilley: Not now, because I wish to make progress.

If we move in the direction that I have described, it will have three beneficial effects. First, it will drive up quality. Secondly, it will facilitate the optimal degree of specialisation within the health service. The abolition of extra-contractual referrals last April is causing a crisis in specialist care in the NHS. As my hon. Friend the Member for Woodspring said, 24 surgeons issued a press release

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to coincide with the publication of my pamphlet last week. [Hon. Members: "Ah."] I had nothing to do with it; I did not know that they were going to issue it. However, I am flattered that drafts of my pamphlet have circulated so far round the medical profession that they chose to do so. They point out that

In the New Statesman, which may be read by Labour Members, the president of the Royal College of Surgeons criticised the consequences for the quality of care that resulted from the abolition of choice by this Government under their recent reforms.

The third beneficial effect of encouraging more choice and more information in the NHS is an improvement in its ethos. At present, the NHS is monolithic, centralised, secretive and producer-oriented. If there is more choice and information, the NHS will become more focused on satisfying patient needs and on providing the maximum quality of care. That must be in the interests of all of us who care for the NHS and the quality of service that it provides for our constituents.

Some people argue that we cannot have choice in the public sector, and they make the same argument about education. When money following pupil choice was introduced in the education system, that produced changes in schools, as I saw in my constituency. If we restore choice in the NHS and make money follow choice, not only will we bring about the degree of specialisation that people want and need, but we will see improvements develop in the future that have not occurred in the past.

We have had little specialisation in common treatments, such as for hernias and hip replacements. Specialisation has been limited to the most complex and difficult operations. If people had choice, some specialist centres would develop alongside general hospitals. People would have the option to go to those specialist centres or to go the general hospital.

A few days before my pamphlet was published, there was a leak that suggested that the Government were thinking of creating such centres--they wanted to get in first. However, what do they propose for the specialist centres? Will the Minister confirm that the leaks are authentic and that they are thinking of setting up such centres? If they do, who will decide which patients go to the specialist centre and which go to a local general hospital? Will it be the NHS bureaucracy? That would be wrong and improper. People should be given choice, and the proposal will work only if they are given choice. That will ensure that the specialist units stand and thrive alongside thriving general hospitals.

Mr. Lewis: The right hon. Gentleman has confined his remarks today and in the pamphlet that he published to the point that improvements to the NHS will improve the health care of the people of this country. Does he believe, as those on the Opposition Front Bench believe, that the expansion of the private health care sector has any place whatever in improving health care in this country?

Mr. Lilley: Yes, it has. However, my primary concern--like that of probably everyone in the House--is to improve the NHS. I do not suggest that choice within

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the NHS is the only solution, but if we introduce such choice it will reinforce all the other changes that Conservative Members have suggested and some of the changes that the Government have introduced.

People want choice; people have a right to choice; the NHS will benefit from choice, but only the Conservative party will give them more choice.

3.27 pm

Mr. David Hinchliffe (Wakefield): I am grateful for the opportunity to speak in the debate. In every debate on this subject since the election, I have been on the record praising much of what the Government have achieved in a short period to restore a collectivised state national health service. I am proud of what we have been able to deliver so far.

Bearing in mind that this is probably the last debate on the issue before we have the announcement on the national plan, I want to concentrate on the key matters that the plan should examine and those that need to be resolved and addressed before the next election and during the term of the next Labour Government. The relationship between the NHS and the private sector is at the core of the debate. It is crucial. Most colleagues are aware of my strongly held views. I am a believer in the NHS, and I am a member of the Labour party because I believe in the NHS. The NHS is only safe in the hands of a Labour Government.

I am aware of the comments made by the Conservative party yesterday and its commitment to "dramatically extending" the private health sector. I am interested in the comments made by the Government in recent weeks about making use of what they term as under-used capacity in the private sector. I may refer to that shortly.

The relationship between the NHS and the private sector is one of the great unresolved issues of the NHS. It has not been sorted out in the 52 years for which we have had a state health care system. The fact that the issue has not been resolved is at the heart of the failure to achieve the principle of equity that was one of the central principles that the nation aimed to achieve when the NHS was set up in 1948. I was interested by the fact that the hon. Member for Woodspring (Dr. Fox) used the term "equity" in his arguments for the Conservative party's new proposals. I would like to hear--I have not heard it yet--how his suggestion for extending the use of the private sector squares with the principle of equity. I do not see how the two match.

I wish to take up the point made by the right hon. Member for Hitchin and Harpenden (Mr. Lilley) on the issue of choice. I intervened on him to make a point about choice on health. We all know that it is common practice for some people who are waiting to see an NHS consultant who also has a private practice to pay to see that consultant privately and queue-jump. They are exercising their right to free choice but, by doing so, they deny access to an NHS patient on that same waiting list. The concept of choice therefore needs to be considered in far more detail than was done in the right hon. Gentleman's superficial examination.

The right hon. Gentleman made a comparison with education and said that we all have a free choice of schools. Of course some people have a choice, but to get

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access to schools that are not immediately on their doorstep, people need a car or access to public transport, and perhaps assistance with picking up their children. It is not quite as simple as saying that free choice means that someone can go from one end of the country to the other. By suggesting that that is free choice, we are automatically denying opportunity to vast numbers of people who cannot have choice in the way the right hon. Gentleman envisages.

The principle of allowing queue jumping is fundamentally wrong and undermines the equity principle. I hope that the Government will look at that in the national plan. Access to treatment should be on the basis of need: that is an ethical and moral issue. I recall taking part in a radio debate chaired by Boris Johnson with the hon. Member for Rutland and Melton (Mr. Duncan), who was previously on Conservative Front Bench. Mr. Johnson and the hon. Member for Rutland and Melton did not understand why I thought that access to treatment was an ethical and moral issue. A situation in which some people in need are denied access to treatment on the basis that they are unable to pay for it is fundamentally wrong in principle. I cannot understand how anyone can defend that kind of injustice.

The hon. Member for Runnymede and Weybridge (Mr. Hammond) spoke about opting out of the NHS. The idea that people who opt out of the NHS somehow help others is utter nonsense, as they are all seeing the same doctors. Those doctors should be working in the NHS and dealing with waiting lists, which should be organised on the basis of clinical need, not ability to pay.

Mr. Hammond: The hon. Gentleman may be interested to know that, right now, under this Government, West Surrey health authority is circulating a consultation document which states:

The authority, which faces an £18 million deficit, obviously believes that that will leave more resources available to deal with other patients.

Mr. Hinchliffe: I am sure that Wakefield health authority is not saying that. If it did, I would want to know. As the hon. Gentleman obviously understands, the thing does not add up, as the same people are involved. I hope that the Government will address that.

Another private sector issue that I have picked up time and time again is a grievance that I hear, especially from elderly people who come to me as their local Member of Parliament. They are on a waiting list, usually for a hip replacement or an orthopaedic problem, and have to wait a certain length of time. They are told that, if they pay a certain sum, they can be in that much sooner. A couple of years ago, a gentleman came to see me about his elderly wife, who could not walk and needed a hip replacement. He faced the choice of her suffering with the problem for about a year or paying the consultant money. He was selling his car to pay to get his 81-year-old wife in. At that time of life, people do not have a lot of time left. That is a disgraceful situation, and it is about time that we addressed it.

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