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Mr. David Tredinnick (Bosworth): In support of what my hon. Friend is saying, is he aware that I have received reports from surgeons stating that the extension of the requirement for them to have longer waiting lists has made it difficult to treat urgent cases? That is definitely reality. It should be taken into consideration when the Minister replies.

Dr. Fox: It is clear to anyone who talks to any surgeon throughout the country that that is the pattern. Hospital managers are under immense pressure to put pressures on surgeons to deliver reductions in the waiting list, however they achieve that, because of the financial penalties that they face if they fail to meet the targets set by the Secretary of State. It is symptomatic of a hugely politicised system in a hugely centralised system. It is a system where the Labour party has appointed, as Dame Rennie Fritchie said so damningly in a report, increasing numbers of Labour party hacks to health authorities and trusts, not because of their expertise in running the health service or because of what they may offer, but because of the loyalty that they will give to their party political masters.

I look forward to the plans that the Secretary of State mentioned. I look forward to confirmation that they will be in the Bill to create an independent appointments body for the NHS, that they will be enshrined in that legislation and that the Secretary of State will not be given even reserve powers to intervene in appointments. If the right hon. Gentleman would like to confirm that now, I am sure that the House would be extremely grateful--so we get more promises. It seems that spin has found its way into the House as well as anywhere else.

We have a politicised service and a micro-managed service, where the decision is taken behind a ministerial desk in Whitehall on the basis that there lies immense wisdom and that Ministers know how to run a system on the micro level that employs almost 1 million people. We had a good example yesterday in the Department's notes on the coming Bill on the formation of care trusts. The document states:

At the bottom of the page, we are told:

That is the voluntary principle of the press gang--"We would love you to do it, but if you don't do it we will make you do it." That is indicative of the Government's obsession with the Whitehall centralist culture that is doing so much damage inside the health service.

Mr. Rowe: As part of the Government's attempt to give the impression that they are decentralising, the Secretary of State explained that he is putting local authority members back on trusts. Does my hon. Friend share my concern that local authority members--the ones

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who take an interest in these matters--are those who are not doing their council work fully and effectively? The ones who are doing their council work fully and effectively are too busy to sit on trusts. We shall find, as we did before, that those who are interested in drawing their expenses and have no serious interest in the national health service will be responsible.

Dr. Fox: For the interests of clarity, I think that the Secretary of State was referring to community health councils and having local authority scrutiny in place of the CHCs. In fairness to the right hon. Gentleman, I do not think that he suggested that local councillors would be appointed to health authority boards. I am sure that I am right in that interpretation.

There is one area in which the Secretary of State must accept fully the responsibility for the Government's actions--that is, in respect of the care home sector. We know that between March 1997 and April 1999, some 25,000 care home beds were lost, first in local authority homes, but towards the end of that period increasingly in the private sector. We know that the Government's plans for intermediate care and some of their other plans were drawn up against a background of an expanding care home sector at the time.

The trouble with the diminishing capacity in the care home sector is that it puts extra pressure on the acute sector. In other words, there is no way that elderly patients can be discharged into the community if there is a dramatic reduction in capacity out there in the community. That leads to more blocked beds, and the trend is accelerating.

The present figures show that there may be a reduction of as much as 10 or 11 per cent. over the current year in the care home sector. That would mean a loss of some 50,000 to 55,000 beds in the care home sector. [Interruption.] The Secretary of State says that that is nonsense. After the debate, I will be happy to supply him with figures for the beds already lost in the community in places such as Cornwall, where 10 per cent. of the capacity has been lost, and Surrey. If we extrapolate a 5 per cent. loss in some areas in the six months up to now, the overall loss is even greater.

Mr. Milburn rose--

Dr. Fox: I will take an intervention from the Secretary of State in a moment. If he tells us that those beds are not being lost, that will be contrary to what is being told, I happen to know, to hon. Members on both sides. They find that throughout the country nursing homes are being closed with increasing frequency.

Mr. Milburn: I am grateful to the hon. Gentleman for giving way. It is true that there has been a reduction in the number of nursing home and residential care beds between March 1999 and March 2000. That is right, but not on the scale that he suggests. Laing and Buisson who, as he knows, are the foremost market analysts, say that about 7,300 beds were lost during that period. That is absolutely true. It has hit hardest in some parts of the country, especially the south coast.

We know that, but we also know that the number of intensive home care packages of support has dramatically increased, and that the number of local authority-supported

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residents in residential or nursing homes has increased too, more than offsetting the loss of--remember--empty beds. The crucial question for the hon. Gentleman is this: if he is so concerned about the loss of capacity, particularly in the social care sector, will he now confirm that he will match our spending on social services for the next three years?

Dr. Fox: It is entirely typical that the Secretary of State throws in statistics--[Interruption.] Hon. Members should control their passion. First, the Secretary of State employs his usual technique of throwing into the debate figures that are utterly irrelevant, in the hope of throwing us off track. Secondly, it is typical that the Government would think that all the problems in the sector are related to money.

It is a problem of far more than money. For example, the Care Standards Act 2000, many of whose basic proposals were in principle correct, has put a blight on the industry, because we do not know what the regulations attached to the Act are. Who can invest, and who will lend or borrow, on the basis of such uncertainty? It is the Government's policy that has caused the uncertainty. Increasingly, those who have not had a return on their investment are seeking a quick way out, especially in the areas of the country mentioned by the Secretary of State, which happen to have rising house prices. They find that the quick way to get their money back is to sell out to residential development.

That problem needs to be tackled, because the lack of confidence in the sector is undermining the Government's plans and making them more difficult to implement. The Government are planning to use the beds for intermediate care. As a result of a reduction in capacity, it is more likely that beds will be blocked in the acute sector. More beds blocked in the acute sector, combined with seasonal pressure, leads to a rise in the cancellation of elective surgery. We know that over the past six months there has been a rise in the number of cancelled operations across the NHS.

The Government's failure to understand the implications of their own policy will result in more blocked beds and more cancelled operations. [Interruption.] The Secretary of State is trying to trivialise the point, but within a few months he will have to explain why more operations are being cancelled and why more beds are blocked. No doubt we will hear the same excuses as the Government always give: it is due to decades of under-investment, they always say, and bad planning in the past. In fact, it is a result of the Government's mismanagement over three years. Three years ago, there were a lot more beds in the community than there will be at the end of this year.

Mr. Milburn: Will the hon. Gentleman give way?

Dr. Fox: I shall come back to the Secretary of State in a moment.

There is another area where we have a problem with incompetent micro-management by the Government. The Secretary of State talked about manpower numbers in the NHS, and the problems that may exist. However, the Government have done the very thing guaranteed to maximise opposition from the medical profession, especially from those who will soon be consultants and

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will be under the heaviest requirement to deliver the programmes in the Government's national health service frameworks and their cancer and cardiac pledges. In the Prime Minister's statement, the Government pledged that consultants will not be allowed to work in the private sector for seven years after they qualify as consultants. Understandably, the medical profession has reacted by saying that as its members have worked long hours for relatively low wages and undertaken a very difficult training period, they will not work for a service in which their training period is to be extended by the Government for another seven years, as a result of which they will get none of the financial rewards that they might have expected for all the efforts that they have put in.

If the Secretary of State takes such action, he is in danger of precipitating a manpower crisis in the NHS. There is still time for the Government to back off from their flawed ideological proposal. Will the right hon. Gentleman take this opportunity to say that the Government will abandon their plan? If they go ahead, they will further damage morale in the system, which will lead to a loss of manpower. As the Secretary of State does not wish to respond, I assume that, regrettably, the Government will press ahead. They are putting ideology above the running of the service, which will create only division and dismay in the medical profession. We need a more regulated system, as opposed to a managed one. We need less political interference and less micro- management, but we are getting more and more.

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