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Mr. Rowe rose--

Mr. Milburn: The hon. Gentleman has already had one go. I want to make a little progress.

Thirdly, the Bill will deliver the NHS plan proposal to provide faster, more seamless care to patients by breaking down outdated barriers between services and staff.

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Appropriately trained nurses and other health professionals will be able to prescribe drugs to speed up care for patients and relieve the burden on doctors. Local health and social services will come together in a single care trust, overcoming the institutional boundaries that serve to confuse patients, limit services and block beds.

Fourthly, the Government are committed to improving health and social care services for older people. Standards of care must rise, access to care must improve and nursing care in nursing homes must be free on the NHS. The health and social care Bill will mean that people who are assessed as needing nursing care will no longer have to pay for the care and supervision provided by registered nurses in nursing homes or for specialist nursing equipment, thereby lifting the burden of care costs for about 35,000 people.

Fifthly, to complement the biggest hospital-building programme in the history of the NHS, the Bill will take forward the biggest ever capital programme of investment in primary care. Family doctor premises are the first port of call for most patients. Many of the premises are in urgent need of repair. Through a new joint venture company with the private sector, the NHS local improvement finance trust--NHS LIFT--the Bill will unlock £1 billion of new investment to refurbish 3,000 family doctor surgeries and primary care premises by 2004. NHS LIFT will have the greatest impact in those areas where it has traditionally been hardest to attract investment or GPs. It will deliver new health service facilities that are fit for this new century to the most deprived communities and rural areas.

Mr. Rowe rose--

Dr. Liam Fox (Woodspring) rose--

Mr. Milburn: I give way to the hon. Member for Woodspring (Dr. Fox).

Dr. Fox: The Secretary of State makes an important point about the improvement of GPs' premises, especially in inner cities. He will be well aware that one of the difficulties most often encountered is with planning problems for those surgeries. What talks has he had with the Deputy Prime Minister about easing the path of such plans?

Mr. Milburn: The hon. Gentleman is right--there are sometimes planning difficulties with new surgeries and, indeed, new primary care centres. In that context, we are not simply concerned with the traditional GP surgery. We should try to house in a single centre services that are provided by GPs, nurses, midwives and social workers for a simple reason--to make care easier and faster for the people who take advantage of those services. So, yes, discussions are taking place between my Department and the Department of the Environment, Transport and the Regions.

Moreover, the measures that we are taking to encourage, for example, personal medical services in general practices mean that those very real gaps in provision that occur particularly in the hardest hit inner-city areas are finally beginning to be plugged. I know from the discussions I had when I was in Sunderland recently that that city has real problems,

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especially on some council estates. For many years, the area has been unable to attract GPs, but now it can do so through the PMS route that we are seeking to roll out into general practice more generally. Many GPs are voting with their feet for the measure, which will make a real difference.

More investment is going into the NHS and more reforms are being made. The Conservatives cannot match that investment, although they claim that they can. The Leader of the Opposition and the shadow Chancellor claimed just this week that they would match Labour's expenditure on the NHS and on health more generally. That is not what the hon. Member for West Dorset (Mr. Letwin), the shadow Chief Secretary to the Treasury, told Jeremy Paxman on "Newsnight" on Tuesday. In response to a question, the hon. Gentleman said of spending cuts:

Jeremy Paxman asked: "Except for health?" The hon. Gentleman replied:

First, on a point of important information, the national health service consists not only of hospitals but of GP services, mental health services and other services provided in the community. Secondly, let us be clear about what administration in the Department of Health is. It is the Food Standards Agency, the National Blood Authority, the UK transplant service and the childhood vaccination programme, including that for meningitis C. It is the Public Health Laboratory Service, particularly the control of infectious diseases, and the budgets to train doctors and nurses.

There is a further issue that the hon. Member for Woodspring will perhaps clarify when he replies. Are he and his party now saying that they will match our spending on social services? His is the party that complains about care home numbers, bed blocking and delayed discharges. Let us hear from the hon. Gentleman. Let there be urgent discussions on the Opposition Treasury Bench. Are the Conservatives backing our 3.4 per cent. real-terms increase in social services funding--yes or no? That is what the country and the House want to know.

The truth is that the Conservatives cannot match our spending because their tax and spending policies are riddled with black holes from top to toe. The Conservatives cannot explain where the money is coming from to fill the £400 million black hole created by their failure to support us on putting extra tobacco revenue directly into the NHS. They had an opportunity to vote for that; they did not. They cannot explain where the money is coming from to fill the £750 million black hole created by their policies of tax subsidies for people who already have private medical insurance.

The only answer is that the £1 billion black hole will be filled at the expense of the NHS, its patients and its staff. There will be fewer beds, fewer nurses and fewer doctors. As sure as night follows day, that is the Conservatives' cuts guarantee for the NHS, and NHS

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patients will pay the price. The one health policy that the Tories do not want to talk about is the one health policy that they have: forcing people to pay for their care.

Mr. Simon Burns (West Chelmsford): Rubbish.

Mr. Milburn: Well, on 16 January the hon. Member for Woodspring told The Sunday Times:

That is what the hon. Member for Runnymede and Weybridge (Mr. Hammond) told "Sky News" on 31 January, and he confirmed it in the House on 29 June.

Just in case the hon. Member for West Chelmsford (Mr. Burns), who is shaking his head, thinks that that was just a passing fancy, he should consider what the shadow Chancellor told the "Today" programme on 30 October. He confirmed that a future Conservative Government would expect

Yes, there will be problems in parts of the NHS this winter; there will be pressures, but there will also be real progress, made by the Government, social services and health services together. NHS Direct will be taking calls nationwide to relieve pressures on GPs and hospitals. There will be millions of extra free flu jabs for pensioners and thousands of extra support packages for the elderly in care homes, as well as those in their own homes. There will be thousands of extra operations on NHS patients in private sector hospitals, 455 extra critical care beds, 6,000 extra nurses, 159 modernised casualty departments and 1,350 extra beds in NHS hospitals. Not every problem will have been solved--not by a long way; but, thanks to the Government's investment and reforms, the NHS is moving in the right direction. The NHS will be immeasurably strengthened by the legislation proposed in the Queen's Speech.

There are choices before the country: the stop-go of the past or the stability and growth of today; cuts in public services or investment in public services; the old social divisions of the past or a society providing opportunity for all and so able to demand responsibility from all. Nowhere are the choices starker than in the NHS. In the end, it all comes down to this: with the current Government, an NHS modernised and reformed providing care according to need, not according to ability to pay; or, with the Conservatives, a health care system in which how much one pays, how much one earns, how much one is worth determines the health care one receives. That might be the Conservative future for Britain, but it is a future that neither the Labour party nor the British people will support.

12.47 pm

Dr. Liam Fox (Woodspring): I must have made something of an error in thinking--until now--that the Government were in their fourth winter, not their fourth week, of managing the NHS. The Secretary of State has just easily shrugged off all of Labour's mismanagement of the national health service since the party entered office and all of the promises that Labour made before entering

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office, as though all the years of responsibility had never happened, but this is Labour's fourth winter in charge of the national health service.

Last night, the British Medical Association council met. Its report states:

The "general feeling" is that there is

Examples of the problems facing doctors include year-long waits for patients to receive physiotherapy, and orthopaedic appointments only just being received for 23 September 2002; GPs keeping patients who, clinically, should be sent to hospital in their own homes, because it is preferable to a long wait on a trolley; and trolleys being replaced by trolley beds, so that waits on them do not contribute to trolley-wait statistics. Hospitals are now on red alert, even though there is no flu epidemic; and, yesterday, there were no critical care beds available for children in London.

I suppose that all that has nothing to do with the Secretary of State or with the Government--it has everything to do with everyone else whom they normally blame, but nothing to do with them. In all my political life, I have never known a group of people take so little responsibility for their own actions. They are happy to take the salaries, but not any of the responsibility.

The Labour Government's failure to deliver on the exaggerated expectations with which they entered office has given rise to a great amount of cynicism among the electorate. The string of broken promises has resulted in unparalleled disillusionment. We all remember the slogans: "24 hours to save the NHS", "Health to be an early priority" and "Things can only get better". According to Lord Hunt this summer, things had got better. He said that

Then, last week, the Prime Minister admitted that things had not really got better, but the Government had a 10-year plan. He held a press conference in Downing street to apologise for the failure that has not yet happened, but to which the Government know their policies will inevitably lead. We get an endless diet of soundbites--witness the Secretary of State's speech--photo opportunities, spin, spin and more spin. The Secretary of State should tell the Prime Minister that telling the people, "Trust me, I am a spin doctor" does not have much credibility with the public.

Increasingly, there is a gap between the rhetoric of Ministers, who keep telling us that things have become better, and the reality experienced by doctors and nurses who are working in the NHS and patients who use the NHS. Ministers tell us that waiting lists are down, but the waiting list to go on the waiting list has rocketed, so more patients are waiting. They tell us that more operations are being carried out, but last week an orthopaedic surgeon from one of the London hospitals told me that he was told to stop doing so many hip replacement operations and to do more minor operations because that would reduce the list faster.

Ministers tell us that clinical priorities are not being distorted. Yet as clinical outcomes in many of the areas that the Secretary of State says are a priority--

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for example, cancer--continue to deteriorate in relation to those in other countries in northern Europe, we are continuing to speed up the treatment of bunions, ingrowing toenails and impacted wisdom teeth so that the so-called waiting list is reduced. The fact that we are having a debate about whether we should treat the sickest patients first shows how far down the spiral of ethical decline we have gone in health policy.

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