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Mr. William Hague (Richmond, Yorks): I thank the Prime Minister for his statement, but warn Labour Members that in announcements from this Government, there is always a huge difference between the announcement and the facts--[Interruption.] I shall say what some of them are in a minute. There is also a vast gulf between the announcement and what really happens.

We agree with the Prime Minister that the staff of the NHS are indeed its greatest asset. We welcome what he said about changes to the role of nurses and his apparent acceptance of the need to use the private sector when it is of benefit to patients--which comes after years of hypocritical attacks on us for advocating the same idea. However, the importance of looking at the fine print is shown on even a cursory reading of the Prime Minister's statement. Will he confirm that when he refers to 7,000 extra beds, he is including beds in the private nursing sector? He talks about funding nursing care. Will he confirm that the Press Association has been briefed that it will not include dressings and catheters, which will be counted as personal care and not as nursing care? When he says that he will not have a two-tier system of GPs, will he confirm that what he has just advocated involves some of them being salaried and some not, and some providing personal medical services and some not; so how can he lecture others about a two-tier provision? Will he confirm that an extraordinary number of the targets in his four-year plan will not be met for eight or 10 years, if at all?

Will he confirm that, in the fourth summer of his premiership, he has now made a long statement on health to the House without a single mention of the waiting list initiative that has been the centrepiece of his policy for the past three years? Is that not a stark admission of his total failure on health for the past three years?

We all remember that before the general election the Prime Minister said that we had 24 hours to save the NHS--now it is 10 years and a four-year plan. Three years on, the waiting lists to see a consultant are up by 154,000; 80 per cent. of health authorities have more

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patients waiting more than a year for operations; the number of cardiac bypass operations has fallen for the first time in a quarter of a century; one fifth of people diagnosed with curable lung cancer are inoperable by the time the treatment begins; the nursing profession is facing its most severe shortages for a generation, and 140,000 NHS patients were forced to pay for private care in the last calendar year.

As the Prime Minister's own adviser summed it up so well:

People will judge today's plan against that background of mismanagement and failure.

Of course, selective extracts of the plan were leaked to the newspapers in advance. How extraordinary it is that the Government complain about leaks, when most of the leaking is authorised by the Prime Minister himself. It was therefore already known that the plan would contain more targets even though the current targets have not been met, and more pledges even though the current pledges have not been met. The only difference between the contents of this statement and the pledges in the Labour manifesto of four years ago is that the Prime Minister has set the targets so far in the future that he will not be held to account for whether or not they are met.

Yesterday, the Prime Minister conceded that the next Conservative Government would spend the same as this Government on health. The real debate is about how that money is spent. That is the debate about this plan. We will judge the national plan on whether it really extends patient choice, on whether it really puts clinical priorities ahead of political priorities, on whether it really breaks down barriers with the private sector and on whether--[Interruption.]

Mr. Deputy Speaker (Mr. Michael J. Martin): Order. There is far too much shouting in the Chamber. Hon. Members should calm down.

Mr. Hague: We will judge the national plan on whether it really devolves power away from Whitehall to doctors, nurses and other health professionals. The Prime Minister has a tendency to use words such as "choice" and phrases such as "putting the patient at the centre", but not to deliver in reality. People will naturally be sceptical.

Will the Prime Minister say whether the Government have at last abandoned their disastrous waiting list initiative, of which he made no mention in his statement? Will he assure the House that the plan means that the sickest patients, such as those with cancer or cardiac problems, will be treated first, as we have long proposed?

Secondly, for all his talk--[Interruption.]

Mr. Deputy Speaker: Order. It is not good for the Deputy Speaker to interfere, but I appeal to the House. We must be quiet. The Leader of the Opposition is entitled to a hearing. Hon. Members do not have to agree with what he says, but he is entitled to a hearing.

Mr. Hague: Secondly, for all the Prime Minister's brave talk, the plan appears to create a medical apartheid between the private and public health sectors, by prohibiting NHS consultants from working in the private sector. Is the right hon. Gentleman aware that it is not

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general practice for people to do that in the first five years that they work as consultants? Will he say whether the period of a "few years" to which he referred amounts to fewer than five years? If the period is less than five years, the provision will make no difference. If it is more than five years, it will surely risk reducing the number of consultants working in the national health service. Will not that risk adding to the waiting list?

How does that square with the Prime Minister's stated aim of working with the private sector on problems such as cancelled operations? Should not maximum waiting times include a commitment to use the private sector if the NHS cannot deliver?

The Prime Minister talks about patient power, and says that he will set up a lot of new patient advocacy quangos. However, what is he actually going to do to give patients a real choice about which hospital they are treated in? The director of the College of Health has said:

Would not the best way to drive up standards be to restore the right of GPs to refer patients to the hospital of their choice--a right abolished by this Government last year?

The Prime Minister said that the Government would pay for nursing care but not for personal care. Will the right hon. Gentleman define those terms, and say how they differ from one another? How much of the care needed by an Alzheimer's patient is the former, and how much the latter?

As well as the rhetoric, the reality of reforming the NHS has to be about patient choice, trusting the NHS professionals, partnership with the private sector, and getting rid of political interference. Instead, is not today's statement the final admission by the Prime Minister that he has broken every promise that he made on health in the past three years? Three years into his Government he has had to start from scratch. Given that absolute failure in the past three years, should he not be assured that the British people will judge him not on what he promises that his plan will achieve, but on what it is likely to deliver?

The Prime Minister: I think we saw that the moment he got on to policy, the right hon. Gentleman did not have a great deal to say. When he is making his jokes and his witty remarks, he can just about do it, but when it comes to serious policy, he really does not have a clue.

First, let me remind the right hon. Gentleman that his party was in power for 18 years when many of these things were being done. Let me also deal with a few of the facts. He was rather coy about mentioning some of them at the Dispatch Box, such as his extraordinary remark the other day that there are 14,000 fewer nurses in the health service under this Government. He did not mention that today, perhaps because he knows that there are 10,000 more today.

Another thing that the right hon. Gentleman did not mention--as I have the answer, I will give it to him anyway--was the nonsense about spending £200 million on the euro. Madam--Mr. Deputy Speaker--[Interruption.] We are back to that. Mr. Deputy Speaker, the costs on the euro are negligible in the national health service. No money is being spent on the euro in the national health service--the money is being spent on the patients in the national health service.

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The right hon. Gentleman says that waiting lists have gone up under this Government. Let me again give him the figures. It is true that waiting lists--in-patient and out-patient--had been rising for years when we came to office. We have brought down the in-patient list by more than we promised at the election. It is correct that out-patient lists have gone up; it is correct that they are coming down now. But they were rising year after year after year when the previous Government were in office.

We do not have to argue about the theory--let us argue about the facts. The right hon. Gentleman was in charge of the health service in Wales under the previous Government. What did he do then? The number of general practitioners was cut, he cut 1,200 hospital beds, the in-patient waiting lists went up by 6,000, and he cut by 300 the number of nurses, midwives and health visitors.

Since we came to office, let me tell the House what we have done in the right hon. Gentleman's constituency. There is the £3.3 million scheme for the conversion of the Friary in Richmond to a community hospital and primary care centre, operational since 23 March 1999. Northallerton health services accident and emergency department has received £600,000. Some £500,000 has been spent on intensive care beds and £180,000 on out-patient modernisation. Shall I tell the right hon. Gentleman what those improvements have in common? They were delivered by us and they would never have been delivered by him. [Interruption.]

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