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6.32 pm

Mr. Philip Hammond (Runnymede and Weybridge): We have had many contributions from Back Benchers and I shall pick up some of the key points. I hope that hon.

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Members will forgive me if I do not mention every contribution, but I need some time to respond to the Secretary of State's misinformation campaign in his speech.

The hon. Member for North Devon (Mr. Harvey) seemed to be parroting the Government line, and claimed that the Conservatives see the NHS as a residual service only. He ignored totally the explicit commitment we made on funding--to match the comprehensive spending review figures that the Government have produced. I can state categorically to the hon. Gentleman that the NHS will be at the heart of the system that we intend to put in place.

My right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) usefully drew the House's attention to the Government's attack on doctors. When the right hon. Member for Holborn and St. Pancras (Mr. Dobson) was Secretary of State, managers were responsible for all the problems in the health service. Now it is the doctors who are responsible. Perhaps the next Secretary of State will tell us that it is the patients who are responsible for all the problems in the health service. My right hon. Friend is passionately committed to the NHS and to the need for choice as well as access in the health service. He drew attention to the fact that my hon. Friend the Member for Woodspring (Dr. Fox) devoted the lion's share of his speech in Glasgow, which has been mentioned in the debate, to how we would improve the NHS. It is the Secretary of State who focused this debate on private health insurance.

The hon. Member for Wakefield (Mr. Hinchliffe) has the great benefit of consistency in his views and I know that his beliefs are genuinely held. He would like to ban independent health insurance and all forms of independent health care. However, I would be grateful if the Minister would reaffirm, when he winds up, that it is not the Government's plan to ban private health insurance or private treatment in the NHS. After all, as Lord Winston helpfully pointed out yesterday, it makes a significant contribution to the NHS. I agree with the hon. Member for Wakefield on one point: if there is any expansion of health care, whether public or private, it must be accompanied by an expansion of the real resources--the people who deliver the care, as well as the money. The two must go hand in hand if we are to achieve the effect that we desire.

My hon. Friend the hon. Member for Wycombe (Sir R. Whitney) gave us some telling and chilling statistics on where Britain stands in the world league of health outcomes. He said that no Government of either party would be ready to impose the tax burden necessary if, using taxation alone, we were to catch up with the amount spent on health in Germany. That example raises a pertinent question: should we therefore accept second best for the British people, or should we look for ways to supplement our national health service spending, while continuing to raise that tax-financed spending as economic conditions allow?

My hon. Friend the Member for West Chelmsford (Mr. Burns) spoke passionately about his commitment to the NHS, and in doing so he spoke for the Conservative party. He nailed the lie that the Conservative party wants to privatise or abolish the NHS. He referred to the Labour allegation that we would charge for visits to general practitioners--a possibility that we have explicitly ruled out.

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My hon. Friend the Member for West Chelmsford also made the important point that the lie that we would privatise the NHS is not new. The Labour party has said that for years. They said it before the general election in 1987, but the Conservative Government then elected went on to spend more than ever before on the NHS. They said it again before the 1992 election, and the Conservative Government that followed that spent even more than their predecessor.

The Labour party's cheap slur cuts no ice with anyone. If the Secretary of State thinks otherwise, he should look at the comments in the press.

The hon. Member for South Swindon (Ms Drown) said that whistleblowers in the national health service were guaranteed a fair hearing and protection. I think that she lives on a different planet from the one that we inhabit. There is a climate of fear and a palpable atmosphere of oppression in the NHS. Earlier this week, an official of the NHS Confederation told me:

The hon. Member for South Swindon also mentioned the National Institute for Clinical Excellence. Its decision about beta interferon has exposed it for what we always said that it would be--a mechanism for levelling down, not levelling up.

In addition, the hon. Lady missed the point about Conservative policy. We are quite prepared to support an institute that looks at clinical effectiveness and cost effectiveness, but affordability must be an issue for politicians, based on the overall resourcing of the service.

The hon. Member for Dartford (Dr. Stoate) gave the lie to the Secretary of State's position. He knows my colleagues and me better than the Secretary of State does. He knows that the privatisation lie is just that--a lie. My right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) reinforced the point that the NHS depends on a consensus, which itself depends on the fact that the great majority of people in all parts of the country have confidence in the service.

However, the tone of the debate was set by the speech of my hon. Friend the Member for Woodspring (Dr. Fox), and the response from the Secretary of State. My hon. Friend set out a catalogue of the distortions that the Government have imposed on the NHS. He talked about the waiting list initiative, and spoke of spin and information management. He mentioned the threat to tertiary referral centres of excellence through the abolition of extra-contractual referrals. He described the systematic denial of choice, the bullying and the culture of fear that pervades the service, in which clinical needs are subordinated to political ones. He also recorded this country's dismal relative position in international league tables.

My hon. Friend the Member for Woodspring continued on a more positive note, however. He told the House about the speech that he made yesterday, in which he set out a vision for health care delivery in the 21st century. He mapped out his objective of a patient-focused system appropriate to a modern consumer society. That system would draw inspiration not only from the traditional NHS values of comprehensive service and universality of access, but from the examples of our European neighbours.

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The system outlined by my hon. Friend the Member for Woodspring would be a mixed economy of health care, with the national health service at its heart, offering choice as well as access. We will have a national health service that is stripped of ideological baggage, puts the patient first and is determined to get the best health-care value for every pound that the taxpayer entrusts to it. Purchasing in the independent sector for the benefit of NHS patients, where that is the best-value decision, is a rubicon that the Secretary of State himself--at least in word, if not yet in deed--has crossed. We are delighted to endorse that step in the right direction.

We will have an NHS that acknowledges the finite nature of the resources available to it and the limits on its ability to deliver every want, instead of sticking its head in the sand. We will have an NHS that recognises that, in international comparisons, we do poorly; a service that prioritises according to clinical needs, not political ones. We will put the sickest first. Those with the most serious life-threatening conditions will be put at the top of the list and we will recognise that their needs must have the first call on the NHS's resources. That is common sense.

We are offering a guarantee--the patients guarantee--that, for the most important conditions--those which, in Bevan's words

the NHS will respond with the necessary treatment, using the best techniques and drugs available in a time frame that is clinically appropriate for the patient. That will allow the people of this country to be confident that, in cases of real need, they can be sure that the NHS will be there for them and their families.

The Secretary of State would have the world believe that priority for the most serious conditions means non-availability for others. That is just plain wrong. My hon. Friend the Member for Woodspring and my right hon. Friend the Leader of the Opposition have both made it clear that we have a commitment to a comprehensive national health service, free at the point of use. We have a commitment also to matching the Government's announced spending plans. There will be the same pot of money, the same total purchasing power for the national health service.

The question we are addressing is how we prioritise that spending. The Secretary of State's answer has been: according to his political agenda. He has played the numbers game, treating the hernias before the heart diseases because they are cheaper, easier and boost the throughput. Our answer is to allow doctors and NHS managers to prioritise according to clinical need and without political interference; without the dead hand of Richmond house on every decision and without the Secretary of State looking over their shoulders. That means treating the sickest first--those whose lives, livelihoods or life styles are threatened by disease--and asking those with minor conditions to wait, just as we do now. Indeed, we do that for some not-so-minor conditions.

Perhaps my hon. Friend the Member for Woodspring's most important point is the strategic one; the role of the Secretary of State. What happens now is truly incredible. From Richmond house, the Secretary of State seeks to run centrally the largest organisation in Europe, with a command-and-control structure that would not have looked out of place in the old Soviet Union. His NHS is

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subject to no independent or external inspection or checks to ensure quality and compliance with minimum standards. Instead, we have to rely on the organisation to police itself, and we all know what the result of that has been. We would redefine the role of the Secretary of State.

What was the Secretary of State's response? It was rather churlish, given our acknowledgment of the strides that the right hon. Gentleman has taken in our direction, in recognising at last the need for a partnership with private sector providers to deliver NHS objectives. He has come a long way since 1998 when, as Minister of State, he reportedly threatened NHS trust chairmen that he would

The Secretary of State does not want to draw attention to that recent development in his policy because not all of his hon. Friends are entirely on side with it. Instead, he decided to make the cheap points, working on the principle of "the bigger the lie". He repeated the tedious and offensive lie that the Tory party wants to privatise the NHS. Who in the Tory party? Not me; not my hon. Friend the Member for Woodspring; not my right hon. Friend the Leader of the Opposition; not any of the Conservative Members who have spoken in the Chamber tonight.

The Secretary of State used his old familiar quotes, out of context as usual. However, if he looks at the press, he will see that, by and large, his campaign is not succeeding. The press and the people of this country want to talk about the real issues and about the future of the NHS. They recognise the reality of the mixed economy in which we live and operate, and they want to see a positive view of the future of the national health service.

The greatest threat facing the national health service today is the threat to the consensus that supports it. Many hard-working, relatively affluent taxpayers up and down the country are no longer confident that the national health service can provide for them and their families. The Labour party is forcing them into taking up private insurance or being self-payers--they are afraid that the NHS will not be able to help them quickly and effectively because of the distortions of priorities within it.

I will give an example from my constituency. A patient goes to the local hospital; he is told that he may have cancer and that he needs a diagnostic procedure. They cannot tell him when that will be--it could be at least two months, because the bit of kit that they need to do it is broken. So he spends his savings--£700--to find out that he does not have cancer.

Such situations are being repeated up and down the country, day after day. They damage the consensus that underlies the national health service. Our vision is of a national health service in which everyone can feel confident of prompt, first-class treatment for the most serious conditions. That is a cohesive principle, not a divisive one.

What we have heard from the Secretary of State today is a smokescreen of misrepresentations, designed to distract attention from the changes that he is making--some of which do not enjoy support from his hon. Friends--and the embarrassing fact that the majority of the British people believe that the national health service has got worse, not better, since 1 May 1997. The Secretary of State will know that, because his private polling will tell him.

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The Government are obviously not prepared to fight this battle on the basis of a defence of their own record. Instead, the Secretary of State wants to fabricate a policy that he attributes to us and then shoots down. So let me spell it out unambiguously: we are committed to a comprehensive national health service, free at the point of need. We are committed to matching the comprehensive spending review funding plans for the NHS which the Government have announced. We are committed to a system that has the national health service at its heart, but that commitment alone is not enough. We need to prioritise the way in which the NHS works on the basis of clinical priorities. We will guarantee access times, through our patients' guarantee, on the basis of clinical need. In that way, we will restore the confidence of the great majority of the British people in the way our health service works, after the cynical manipulations of this Government.

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