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4.13 pm

Ms Julia Drown (South Swindon): When introducing the debate, the Tories drew a wholly inaccurate picture of the NHS--one that gave no credit to the hard-working staff of the NHS throughout this country. I mean all NHS staff, not only the doctors and nurses on whom we often focus, but the huge teams of people working together in the interests of patients. A more accurate picture is the one that I see in my constituency--a positive picture of people working together in the interests of the population. A new hospital is being built. Local dentists now accept NHS patients and thousands of people have been added to their lists; by contrast, when Labour was elected, not a single dentist in Swindon took adult NHS patients. That shows how far we have come in three years.

I remember, very soon after Labour was elected--it was not because of any legislative change, but because of the way in which Ministers spoke and the direction in which we said we wanted the NHS to go--NHS staff came to me and said, "We are so thankful that we can now work together, the community trust with the acute trust, to sort out what we need to do in Swindon." Before that, a new hospital was being built but the trust managers at that hospital did not even speak to the community trust, even though they relied on the community trust to deliver some of the services that would be needed in future. The atmosphere of competition that had prevailed before did the patients and staff who wanted to work together no service.

Significant additional resources are now coming into the health service in Swindon. Staff now tell me, "We've got the money now." In part because of the pressure resulting from years of cuts under the Conservatives, it took time for the new money to come through and have an effect. A bit of slack is needed before people feel that there is new money and that they can start to do the new things that they wanted to do for years. Managers now tell me, "You have given us the money. Now it is up to us to deliver for your constituents." That is welcome news after what we heard in the past. Doctors--GPs and consultants alike--have welcomed the Government's actions, saying, "At last, we are looking at the real problems." For instance, we are examining the wider problems of public health, such as cancer, and focusing on cancer services, which were previously ignored.

In the motion, the Tories have, rightly, raised concerns about political pressure in the NHS. I share some of those concerns, but the pressures started under the Conservative Government. In that time, I worked in the NHS for 11 years. At meetings, I was told that specific political targets had to be delivered; when I looked purchasers in the eye and asked, "Even if it means that a patient will not get his operation soon enough and might suffer--for ever--because of that?", the reply was, "You have to deliver the outcome." That pressure must be removed.

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One measure that might have given rise to such problems is the abolition of regional health authorities and their replacement by civil servants. I worry that, sometimes, civil servants focus on a particular political objective and do not listen to the broad spectrum of Ministers' remarks. It is clear to me that Ministers always say that clinical priorities must take precedence--I hear that time and again--yet people working on the ground in the NHS say that, sometimes, it does not feel like that to them. To them, I have two things to say: first, listen to Ministers--the Secretary of State has said on several occasions that clinical priority is the important thing; and secondly, look at the things that Labour Members of Parliament are doing in this country. We visit our local hospitals and community units and talk to staff working there--[Hon. Members: "So do we."] Good--I am glad to hear that.

Mrs. Laing: We have families too.

Mr. Deputy Speaker (Mr. Michael J. Martin): Order. The hon. Lady must keep calm.

Ms Drown: Thank you, Mr. Deputy Speaker. Those remarks enable me to tell Conservative Members that if, during those visits, staff raise the concerns that I describe, they should tell them to listen to Ministers, because Ministers always say that clinical priority is important. In that way, we can get rid of the worry felt in the middle of the chain of command. I would hope that everyone in the House agrees that clinical priority must take precedence. In addition, the Government have said that they will protect whistleblowers in the NHS and elsewhere. Staff should raise their genuine concerns so that they can be properly addressed.

The Opposition have also criticised our national consultation exercise. I took the opportunity to meet people in my local hospital who were responding to that consultation. They welcomed the opportunity to say what they thought was important in the NHS. The hon. Member for Broxbourne (Mrs. Roe) referred to the importance of patients' views. If their views are important, surely we should support a consultation exercise that gives them the opportunity to make their views heard. It would be wrong and arrogant to say that doctors, nurses and other NHS staff have all the answers. Patients' views are important too.

Another accusation concerns the manipulation of appointment systems and of waiting lists. There was definitely pressure and manipulation of systems under the Conservatives. They have such a cheek to say that there were no out-patients waiting when they were in office.

Mr. Hammond: Will the hon. Lady tell me whether I have this right? I thought that she was elected on a manifesto pledge to save the NHS within 24 hours. Is she now saying that if she can point to certain things having happened before 1997, it is all right?

Ms Drown: No. I am saying that it shows a remarkable cheek for the Opposition to try to claim that no out-patients waited under the Conservative Government. It is clear that waiting lists grew under the Conservatives by hundreds of thousands.

Mr. Burns: I shall be cheeky, in the hon. Lady's terms. Will she tell me and my constituents what she thinks of

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the situation in mid-Essex? On 1 March 1997, 104 people in the area were waiting 12 months or more for hospital treatment. Today, 986 people are waiting. To be fair, I shall take the out-patient list. There were 555 people waiting more than 13 weeks in March 1997. There are now 2,946.

Ms Drown: I would say to the hon. Gentleman and his constituents that they should be glad that they have a Labour Government who are committed to reducing in-patient waiting lists, which was a manifesto pledge. However, we wish to go beyond that and to address out-patient waiting times, too. We will do more than the Labour party manifesto outlined because we believe that the NHS is important and that it is about in-patient treatment as well as out-patient treatment.

Nevertheless, it must be remembered that under the Conservative Government waiting lists grew by hundreds of thousands. That should not be forgotten.

Mr. Burns: My constituents who are waiting on out-patient and in-patient lists will be amazed and staggered by that reply. I have a weekly column in my local newspaper, so next Friday I shall be able to print her words. Will she answer the letters that will come to me as a result of her comments about what my constituents should think of having to wait for hospital treatment?

Ms Drown: I am sure that the hon. Gentleman is aware of the strict parliamentary convention that would limit me in replying to his constituents. However, I am happy to tell them that the Government are committed to having an NHS on which everyone can rely. The Conservative party wants to have an NHS to which people turn for urgent treatment. However, if the treatment is not urgent and if the individual can afford it, he or she will go to the private health sector. Many of the hon. Gentleman's constituents will not be able to afford that. They will thus be faced with a two-tier system, and they will be the sufferers.

It was remarkable cheek on the part of the Opposition to raise postcode rationing in their motion. Undoubtedly such rationing came into being under the Conservative Government. There has been much support throughout the House for the National Institute for Clinical Excellence to deal with this problem. The Conservatives have agreed that NICE should examine costs and clinical effectiveness. There is no doubt that that is needed.

I have a couple of quotes from general practitioners who have said that far too much is done in the NHS by habit rather than design. The co-ordinator of primary care in London, Dr. David Colin-Thome, a practising GP, has said that too many treatments are initiated more by habit than design. He claims that only 15 per cent. of treatments have been tested in randomised control trials. Dr. Tudor Hart has said:

In so far as that happens throughout the NHS in different specialties from time to time, there is a need to establish a national framework for all conditions so that all patients know what care and treatment has been properly tested and is the best for them and their families. NICE has been designed to do just that.

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We have had the leak over beta interferon. Possibly, it will be the first negative decision to be made by NICE. It will be a test of how a mature democracy can deal with that. It will be easy for Opposition parties to say, "We agree with NICE and we agree with the general proposals. We agree when it comes out with favourable results, but when there is something negative we will jump up and down and say, 'Let's not go along with this.'" That is worrying because it will raise many fears and will not produce the NHS that we need, which is one where all patients know that they are receiving the best care, and care that has been properly tested.

We return to the idiosyncratic behaviour of some doctors. If patients have been told by their GP or another doctor that beta interferon, for example, might help them, or another drug or treatment might, they will want to go ahead with that treatment once they have been started on that path. That has led to expectations, and psychological effects can often have an impact on people's physical health. Against that background, it is important for the patient to start on his course of treatment and to ascertain whether it works for him as an individual.

I hope that NICE will in future lay out proper clinical pathways. If these care pathways can be agreed for everybody across the NHS, everybody will have the confidence to say, "Yes, this drug is right for me and I will have it;" or, "This drug is not, and I will not be given it." It is important to get the outlines of NICE known across the health service so that patients do not think different things when they see different doctors. We must ensure that there is confidence in the NHS. If we are to have a mature debate about NICE and about priorities in the NHS, we should move more towards trying to establish all-party agreement on NICE being the right way forward, and on supporting its decisions.

We must try to work as constructively as possible. Of course the Opposition will continue to try to make political points out of the health service. I regret that in so doing they often scare patients. We should take no lessons from the Opposition. When in government, they were destroying the NHS. There were 24 hours in which to save it simply because the Conservatives were doing nothing for it.

The internal market did not work. I spoke to finance director after finance director. One after the other told me, "This is not working. The Conservatives' internal market does not work. It does not help patients and it does not help staff." Labour is rebuilding the NHS with staff and with patients. I commend the Government on their work.

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