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Mr. Denham: Does the right hon. Lady at least accept that this year her health authority has had an increase in funding of more than £30 million--a real increase of 5.7 per cent.--plus additional special funding? Will she tell me how long ago it was, under her Government, that her health authority received a real increase of 5.7 per cent?

Mrs. Bottomley: The Government have penalised Surrey when allocating resources. Durham has done much better. The position is deteriorating. It would help if the Government said that they were providing an increasingly unacceptable health service, and asked people--as my hon. Friend the Member for Runnymede and Weybridge (Mr. Hammond)--suggested, to use private health care if they could. If the Government were frank, open and responsible, they would do that.

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It is distressing for my constituents, my doctors, my nurses and my managers that the problem is worse than it has ever been. There has been a threefold increase in one-year waiters. That category affords one of the greatest tests for the health service. I have often been challenged by Labour Members about that. When I became a Health Minister, there were 200,000 one-year waiters; when I left the Department of Health, there were 4,000. I wish that none had been left. Waiting more than a year for treatment is the ultimate sign of an unacceptable service. I ask the Minister to step in and tell the people of West Surrey that the problem is out of hand. One in nine people wait more than a year for treatment in my area, whereas one in 50 wait more than a year for treatment in the Prime Minister's constituency. That is not equity.

I have made the local points, and I wish briefly to make a few general points about the motion and the Government's stewardship of the health service. An important development, which has been commended by almost every independent commentator, was the attempt by Ministers in the previous Government to distance the political process from the management of the service. The establishment of NHS headquarters in Leeds was a means of saying that, while the NHS could not be a separate agency, the chief executive should have the stature, dignity and independence to exercise authority in his own right, and not be at Ministers' beck and call.

It is widely understood that not only is NHS management too much under the political control of Ministers but, worse than that, No. 10 has undertaken a role that is out of all proportion to the role it has played in living memory. To anyone who saw the Prime Minister's performance on "Newsnight", the idea that the Prime Minister should chair a health committee is nonsense. I do not blame him for not being an expert on health care, but doctors, nurses and managers know that it is not a subject with which the Prime Minister is remotely comfortable.

Politicising the process, producing extra money and saying that it must be used in a programme about "partnership", "professions", "performance", "prevention", "patient access" and "patient empowerment" is trivial and insulting to serious people in the health service.

We now face a serious problem. It is proposed that the roles of the permanent secretary at the Department and the chief executive of the health service should be combined. I hope that the Select Committee on Public Administration will examine the matter and that Sir Richard Wilson will reconsider it. The role of the permanent secretary is to maintain the independence of the civil service, ensure propriety, and handle all Whitehall activities and overseas elements such as European Union and Council of Ministers affairs. A permanent secretary at the Department of Health therefore has a huge agenda.

I hope that my Front-Bench colleagues will be taking over as Ministers in future and I speak from that point of view. The permanent secretary maintains the independence and integrity of the civil service. That role is unlike that of the chief executive, who needs to be a hands-on person and a team builder. The chief executive must fulfil targets, set objectives, travel around the country, be seen in the hospitals and talk to the health authorities.

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I am pleased that the Secretary of State is here. I want to give a small example that means a lot to somebody who has held his office.

My hon. Friend the Member for Worthing, West (Mr. Bottomley) telephoned the Secretary of State's office to ask whether Members of Parliament would be part of the consultation on "whither the NHS?"--with a costly £500,000, according to the King's Fund, going into an exercise in which the envelopes arrive too late to be returned by the due date. The person in the right hon. Gentleman's office knew nothing about the consultation exercise. My hon. Friend replied, "It has been in all the papers. Perhaps you could investigate it." He was then told that the special adviser was responsible for that.

Anyone who has been in government appreciates why Conservative Members are so sensitive about the degree to which the Government are not sufficiently respectful of the distinction between the political process and the independent process which has been safeguarded by having a permanent secretary.

As the Secretary of State is now in his place, let me stress that an equitable service does not have one in nine people waiting for more than a year in Surrey and only one in 50 people waiting for more than a year in Durham. Will he please reduce the rhetoric, improve the reality and engage in debate which achieves solutions that can be delivered? Will he please consider NHS managers, whom the Prime Minister would cross the road to insult for two years before the election and for one year afterwards? We now understand that the Prime Minister has read an article by the British Association of Medical Managers and now thinks that managers might be a good idea.

Combining the roles of the chief executive and the permanent secretary will make it very hard for anyone in the health service to believe that the independence, stature and dignity that Sir Alan Langlands has had will be reflected in his successor. This is my last opportunity to pay tribute to Sir Alan Langlands, who has been a remarkably distinguished, able, talented and honourable chief executive of the most important and complex, and the largest, organisation in this country.

6.26 pm

Liz Blackman (Erewash): I shall be as brief as possible. I am not philosophically opposed to private health care. We live in a free and democratic society and people have a right to make that choice. However, I am opposed to the Opposition making private health care central to their desire to expand health provision through what the hon. Member for Woodspring (Dr. Fox) described as less expensive, non-serious, low-tech operations which he defined as hip replacements, knee replacements, cataract operations and hernia operations. I am also against his proposal to use taxpayers' money to provide tax breaks to encourage that. Their policy is economically illiterate and grossly unfair.

Between 1990, when the Conservative Government introduced a relief for the over-60s, and 1997, when the Labour Government abolished it, the number of people with private health care insurance fell. It was a deadweight relief aimed at altering behaviour and it did not work. As my hon. Friend the Member for Dartford (Dr. Stoate) pointed out, even Lady Thatcher and Lord Lawson have now reached that conclusion. In her

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post-Government reflective period, Lady Thatcher has realised that that logic is flawed. To introduce a relief funded by taxpayers for people who have already chosen private health care insurance is wasteful and will not alter behaviour, as has proved to be the case. It would cost £350 million to provide relief on existing employer health insurance before one extra person gained relief, and the total cost could be as much as £1 billion.

The Opposition have promised to maintain the investment that the Government have put into NHS services, but they have not said where the extra money would come from. They need to come clean on that. Pensioners are clearly the target audience for the Opposition's proposal as they represent a significant proportion of the population who are least able to afford health insurance premiums, as many of them are on fixed disposable incomes. They have paid taxes all their lives and they have paid for a national health service, and it is they who will need hip replacements, knee replacements, cataract operations and hernia operations. Such operations are essential and they deal with conditions that cause sufferers misery and distress.

The thrust of Tory policy would force them to do one of three things: to pay up, to take out insurance or to wait longer. It is worth reminding the House that a hip operation costs between £5,000 and £7,000, a knee operation costs a similar amount, a hernia operation costs between £1,000 and £1,500 and a cataract operation costs between £1,800 and £2,400. We should also remember that premiums for a pensioner couple are between £3,500 and £4,500. In the past 10 years, those premiums have risen on average by 10 per cent., and they are rising on average by 3.5 per cent. a year. Some insurance companies' premiums are rising by between 30 per cent. and 50 per cent.

It is also important to read the small print on insurance policies, because they have many exemptions. People are caught out because they believe that they are entitled to a level of health care that they are disappointed not to receive.

Finally, I wish to draw the House's attention to an evolving scam called dual pricing, which operates in health care insurance. A hospital will quote one price for someone who does not have medical insurance and another--up to 50 per cent. more--for someone who does. Some insurance companies suggest that their customers get round the disparity by initially paying for their own operations. Julian Stainton, the chief executive of the Western Provident Association, has said:

That quotation comes from Good Housekeeping. If private hospitals can afford to do the same operation at half the price, they are ripping off the health care insurers and, more importantly, the patients themselves through the premiums they pay. If tax relief were to be given, it would simply bump up the premiums. I urge the Government to look carefully at that practice, because further regulation would appear to be required.

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