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

Mr. Hinchliffe: No, I am sorry, I must carry on.

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The only way of addressing the problem is to believe in equity on principle. We talk blandly about that belief, but do not address it practically or deal with providing people with access to care in a fair, reasonable and decent way.

I am conscious that the Select Committee on Health is bringing out a report next week, and I do not want to stray into that. However, we in the Committee heard evidence that raised strong questions about whether it is appropriate for consultants with private practices to manage their own waiting lists. The evidence was along the lines that there are perverse incentives, as the Secretary of State said. One witness said that the arrangement was an "invitation to mischief." We should look at those areas.

Mr. Burns: I do not want to break the thread of the hon. Gentleman's speech. However, is it right for him to be telling the House about some of the evidence that we in the Health Committee received before the publication of the report next week?

Mr. Hinchliffe: The evidence is on the record. Written evidence was available when the Health Committee took evidence. Everyone has seen it, and it has been in the press and on television. I have not referred to anything in the Health Committee's conclusions. The hon. Gentleman knows what those conclusions are, and we can have a debate next week.

Our debate is about NHS priorities. Some weeks ago, when we last debated the NHS, I said that the biggest distortion of priorities in the NHS arose from private medicine. I stick by that and I strongly believe it. People may try to contradict me, but I believe that that is true and that, 50 years on, we should do something about it.

I have practical concerns about the relationship between the state and private sector which relate not only to what the Opposition have said today but to what the Government have said in recent weeks. The Opposition fail to understand the way in which the private sector recruits its staff entirely from the NHS. As we have said time and time again, expanding the private sector means that there is a contraction of NHS staff numbers, reducing the ability of the NHS to cope with the need that they are attempting to address.

The Government have talked about the possibility of entire NHS staff teams moving to use capacity in private hospitals. I appreciate that distinction, and my only problem with the suggestion is that the track record on the short-term use of the private sector is that short-term fixes lead to a long-term arrangement. We need only look at the pattern of mental health provision in different parts of the country to see that, where the private sector has been used as a temporary fix, the arrangements have stayed in place for many years. We must look at that area very carefully.

I am not giving away any secrets from the Health Committee's recent inquiry by saying that we received evidence of under-used capacity in the NHS. Witnesses told the Health Committee that there are empty operating theatres in the NHS, so I hope that, before we start going into the private sector, we will make appropriate use of that capacity.

In the time I have left, I want to touch briefly on other key areas with which I hope the national plan will deal. I have argued for many years that the fundamental

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problem in the NHS is the lack of a proper relationship between it and local government, especially local authority social services. I was around before 1974, when there were local government health departments, and I believe that that system worked much better than the system that succeeded it. The health and social care divide can be addressed by looking at organisational issues, as well as some of the issues that the royal commission has discussed.

Commendably, the Government have introduced the potential for common budgets under the Health Act 1999, and I welcome that. I honestly believe, though, that we must examine organisational integration in a way that the Government have not done so far. I hear whispers, and there is speculation in the press that there is a move to put local authority social services in the health service. That would not be going in the right direction, as public health is the other area that suffers from the lack of a connection.

I worked in local government as a young councillor at the time when public health was a local government responsibility. It makes much more sense to have public health in a local authority setting than to have it separated, as it currently is, in a health setting, remote from such policy drivers as health, environmental health and a range of other local government functions. I hope that the Government will examine that area carefully. The position of public health needs to be addressed alongside its relationship with social services.

I welcome the Government's emphasis on primary care. I certainly urge a much closer relationship to enhance the public health role within a primary care setting. At the moment, there is a distance between primary care and public health, which we must examine.

I shall conclude with a point made, I believe by the hon. Member for North Devon (Mr. Harvey), the Liberal Democrat spokesman. We need to make the system of NHS governance far more open. We have never had a democratic national health service. I am happy to argue that micro-management should take place on a local level, but it should be democratic. In areas such as mine, it would be possible to develop regional government by combining health and local government functions in a way that we have not yet properly thought through.

I hope that the Minister has listened carefully, and I wish him well in his work on the national plan. I am sure that it will be an exciting development, and I hope that some of my points will be taken on board.

3.40 pm

Mrs. Marion Roe (Broxbourne): The most important priorities in the national health service are not those of the Government, health service managers or doctors and staff, but those of the patients themselves. The Government gained power at the last general election on the crest of many promises, one of which was to restore the confidence that they said had been lost in the NHS. Yet we cannot open a newspaper or hear a news broadcast without learning, almost every day, of the latest NHS catastrophe. All areas of the NHS seem to be affected: general practice, paediatrics, obstetrics and pathology, to name just a few of the specialties involved in recent high-profile cases.

We have to ask ourselves why. I believe that it is because the Government have set the wrong priorities. They have, for example, produced meaningless waiting

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list targets to tackle the wrong problems. As a result of inappropriate targets, priorities have been distorted. Hospital and primary care clinicians and managers have been told to focus on valueless directives and, as a result, they are failing to improve the services and care that really matter to NHS patients. The Government now stand indicted as the Government who destroyed NHS morale and snatched from patients the confidence that is so necessary to ensure that the patient-doctor relationship is effective and successful.

Primary care groups in general practice have disrupted the delivery of medical services to patients. Over a year ago, I warned the Government that the requirement that doctors should be involved in the management of primary care groups would have a devastating effect on patients' access to their own practitioner. There are estimates that 500,000 consultations by patients' own doctors are being lost every year, so the number of patients affected is equal to a population the size of Sheffield. That is a crucial reduction in the quality and availability of the service that patients demand and expect, and from which they benefit.

There are now greater administrative demands, with the Government focusing priorities on calling GPs away to lead ever more non-clinical activities. There are clinical governance leads, risk management leads, training leads, education leads, audit leads and more. It was reported recently that in one large general practice, the doctors have suggested that there should be a lead partner with the responsibility to see patients.

There are increasing examples of how the Government are full of hot air and waffle. The House should consider the report of the chief medical officer for England and Wales, Professor Liam Donaldson, which reveals spectacular failures in the NHS. It reports the deaths of 400 patients a year as a result of errors and failures in the health service. What uproar would there be if a jumbo jet crashed in the United Kingdom every year killing all the passengers and crew? The report goes on to say that there are 10,000 serious incidents in the health service every year. Can hon. Members imagine the Secretary of State or the Minister pontificating on all the actions that would have to be taken if, every year, every single passenger on a dozen rush-hour trains fell ill with a serious disease through no fault of their own?

Yet what has Professor Donaldson done? He has produced a complacent report that fails to set the necessary priorities. That goes hand in hand with a posturing Government who seek only froth without substance and who fail to solve, with encouragement and resources, the real problems that beset the NHS.

Dr. Stoate: I share the hon. Lady's concerns that there are far too many adverse and critical incidents in the NHS, many of which are due to poor training and to doctors failing to keep up to date. That is precisely why it is so important that GPs and hospital doctors take part in audit, training and continuous professional development. They must also take part in revalidation to ensure that the clinical skills that they learned when they were at medical school are maintained throughout their lives. Surely the hon. Lady is not arguing that GPs and others should spend less time in education, training and audit.

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