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Mr. Gareth R. Thomas: The right hon. Gentleman referred to spending increases. May I take him back to the election campaign and ask him whether the brief contribution of the hon. Member for West Dorset (Mr. Letwin), before he went into hiding, was helpful or unhelpful to his party's campaign?
David Davis: I shall pick up on that point in a few moments because I want to explain to the House what I think about the relationship between expenditure and taxation. Before that intervention, I was making the point that the Government may be concerned about these tax changes only if they have an electoral cost. The real cost to Britain is more important than that.
A rising burden of taxation will ultimately undermine our ability to invest in public services. Low taxes and high-quality public services are not mutually exclusive; they are essential partners. The logic is straightforward enough, and has been proven in this country before. Low tax rates lead to higher economic growth rates. High growth rates lead to higher tax takes--any Treasury Minister knows that. Higher tax takes give the opportunity of public service increases and subsequent tax cuts. That was the story and the lesson of the 1980s, and it is a lesson that we should understand today.
I predict trouble ahead for the Government. Judging by the new-found tone of humility, I think that they also fear trouble. Simply pouring resources into public services will not, in itself, deliver real improvement, any more than it did in the last Parliament. The hon. Member for Liverpool, Walton also touched on that point effectively, although not so explicitly.
The problem with our public services is not just under-investment, although that is a major issue in many areas. Their structures and organisations are incapable of delivering the quality of service that an increasingly demanding society requires--the very point about GPs not being able to meet the demands put on them.
When the Secretary of State for Education and Skills opened the debate, she talked about the transformation of public services. The so-called transformation proposed in the Queen's Speech has little chance of doing the job. In no area is that so true as it is in health. We should consider just a few of the country's problems. Every year, 5,000 patients die from infections that they did not have when they went into hospital. That costs the health service £1 billion a year. It is not a question of increases in expenditure: that swallows expenditure.
Comparisons with our European neighbours show that tens of thousands of people in this country die unnecessarily of cancer, strokes or cardiac disease. Tens of thousands more die of medical mistakes, which is an
issue that the Secretary of State and I have discussed. More than 2 million bed days are lost each year because of delays in the discharging of older people to carers. More than 1,000 operations a week are cancelled on the day of admission. Despite massive interventions--through targets that distort clinical priorities and reduce the quality of service--nearly 1.5 million people remain on waiting lists, and the new suspended lists have grown.My right hon. Friend the Member for North-West Hampshire cited the case of a cancer patient who had been in touch with him and who was on a waiting list for radiotherapy. Only four or five weeks ago I encountered a similar case, although this person was suffering from throat cancer rather than breast cancer. It had taken a year for him to be diagnosed, owing to a combination of mistakes and delays in being able to see a specialist--a story that we have heard time and again. As a result, after the operation it was found that the cancer had spread, and the patient needed radiotherapy. Like my right hon. Friend's constituent, he had to wait three months for that. I do not know how other Members feel, but I would find that a terrifying experience.
There cannot be a Member who has been here for the past four years who has not encountered such a case. That person was by no means the first of my constituents to describe circumstances in which terrifying waits or problems had been experienced or, alternatively, life savings had been spent on escaping a life of pain by opting for private treatment--sometimes in other countries.
The truth is that Britain, the world's fourth largest economy, is delivering health care whose quality is lower than that provided by most of our European partners. It is far lower than that in the United States, and it is lower than that in many countries that are much less wealthy than ours. The Government's solution is to increase public spending at a rate that will require higher taxes in future. Their increases in health spending cannot match those of our partners, or keep pace with rising demand; nor can an NHS structure designed more than half a century ago make the best use of the additional resources that both political parties have promised the health service for two decades.
This is the reality of the national health service. It is failing patients, and its centralised bureaucracy is delivering worse care than most of its equivalents abroad. The national health service reform Bill appears to recognise the problem of centralisation and bureaucracy--I will give the Secretary of State that--but its solutions are inadequate. They will create yet more futile reorganisation, which NHS workers must view with little enthusiasm.
We must think again. The NHS needs radical surgery. Advances in technology will undoubtedly make much more individually tailored health care available, but the worst possible organisation to deliver individually tailored health care is a centralised state bureaucracy. We should be making the state the guarantor of the free availability and quality of health care, rather than its primary provider. That is the key issue in this debate. We should be looking at the possibility of giving each patient an explicit choice of health care, as well as harnessing the effectiveness of the private sector in a more transparent way. Radical solutions do not necessarily mean privatising the NHS; what they mean is that we should personalise the service,
making it responsive to patients and their GPs rather than to the central bureaucracy and the central plan of the Secretary of State. There is a similar story in our schools.
Geraint Davies: Many of the statistics that the right hon. Gentleman has rightly quoted come from the Public Accounts Committee. Does he accept that many of the Committee's recommendations have already been embraced by the Government in their national health plan? Does he also accept that his final suggestion that we should lift responsibility from the state in some way was never one of the PAC's recommendations, and that he was making a political point?
David Davis: Of course, that is correct. That is the first time that I have ever been criticised for making a political point in the House of Commons, but let me answer the hon. Gentleman's question in the spirit in which it was asked. He is right. Indeed, as The Guardian rather tediously reminded people yesterday, the Government have carried out some 950 of the Committee's recommendations, but let me give one example of the sort of problem that arises from the centralised approach.
We criticised the cancellation of operations on the day of admission; the hon. Gentleman will remember the case. I commend the Secretary of State for Health for including in his NHS plan a requirement--a target--for the health authorities: there were to be no more than a certain number of cancellations on the day of admission. What did we see barely a month or two ago? The first health authority moved cancellations to the day before admission. That is not the way to run the health service. Regional organisations are distorting the intent in order to meet the new rules. That is the problem. As I have said throughout, the mechanism used was well intentioned--I have no argument whatever with the intention of the ministerial team--but the problem of running the service centrally is that we always run into difficulties, with regional organisations trying to meet the rules to the disadvantage sometimes of patients. We had a clear-cut example of that.
If we believe the Department for Education and Skills, everything is getting better in our schools. The truth is a little different. The currency of the qualifications is being debased. A-level standards have fallen by a full grade since the Government came to power. That point was raised by Durham university when the A-level results were published last August.
Let us look outside the Department for a more empirical and reliable external measure. International surveys show that standards in mathematics and science have not moved in the past five years when measured against those of our international competitors, so standards are stagnating rather than rising, and in any case are far too low. The worst standards--I come back to a point made by the hon. Member for Liverpool, Walton--are in the areas of highest deprivation.
It is a tragedy that this country--it is an issue not just for this Government, but for Governments in the next half a century at least--has let down the weakest pupils in education for as long as I can remember. I have forgotten which hon. Member on the Government Benches mentioned the failure of the secondary modern system, part of the system whereby we had grammar schools and secondary moderns. They failed because they did not
carry through the social experiment drawn up during the second world war. We have never done a good job for the weakest pupils in Britain, and it is about time that we set about that properly.The starting point for a fundamental reassessment of schools policy--in this area, I have some overlap with the Government--must be more robust use of testing, something that we fought for in government against opposition from Labour, although Labour has now adopted it. That is fine; I am always happy to welcome a prodigal son. If more parental choice in education is to be meaningful, it must be accompanied by clear information about the performance of schools. We need a proper standardisation of exams and new measurement of children's abilities on entering and leaving school. Crude league tables are no longer enough--they were a start; they raised the public's attention; and they raised interest in and focused political attention on school performance, but now they are no longer good enough. Our method of assessing relative school performance needs to be far more sophisticated.
The Secretary of State promised value-added measures by 2002. I welcome that. I hope that that means a complete set of measures being published by 2002, rather than the start of a five or seven-year programme to get them five or seven years thereafter. Nevertheless, the devil is in the detail. Standardised measures must be formulated properly and not biased by social or economic adjustments or by the judgments of local education authority officials. They must be formulated on the basis of an absolute standard.
The Secretary of State made a very good point about the problem of education in weaker schools. Expectations in weak schools are too low. One way of galvanising expectations would be to test and compare schools in a manner that is fair to all schools. I would be demoralised if I worked in a school in a poor area where new pupils had not been given a very good education and we were being compared with schools in middle-class or better areas. However, if I worked in such a school and knew that I would be compared fairly, I would be motivated to deliver the best possible outcome for those youngsters. Therefore, value-added testing is important not only as a means of measuring schools but as a means of motivating teachers.
We need more choice and a more diverse system, and we are being promised such a system, but it is ironic that it was this Government who declared war on grant-maintained schools, assisted places and grammar schools. As I said, however, we welcome the prodigal's return. Nevertheless, such changes alone will not be sufficient, and good schools should be allowed to expand freely. Still, we must worry about what happens at the other end of the scale.
We have to worry about how to rescue children from the worst schools when those schools are declining. Schools are not like shops, and children cannot simply move from one school to another, but tend to sign up to a school for five to seven years. We have to find a way of dealing robustly with failure. It is not a matter simply of sending in a few high-profile hit squads, accompanied by television cameras, or of martyring a few harassed superheads, let alone of posturing at a few National Union of Teachers conferences. The Government will have to
confront one of the toughest issues of all--whether to allow the very worst schools to continue at all in their current form, or to take much more direct action than they are currently planning.Policing is another social service. However, the Government have not been tough either on crime or on the causes of crime. They have simply been tough on individual freedoms and on our police forces. Between 1997 and the end of last year, police numbers had decreased by almost 3,000. Between March 1999 and 2000, crime increased for the first time in seven years. Our police are now too overworked to fight today's crime.
Compared with the situation of 30 years ago, a typical police officer now has annually to deal with double the number of crimes. Simply to return to the police officer to crime ratio that prevailed in the 1980s, we would need more than 30,000 more police officers and probably twice the number of special constables. Such an increase would be affordable over time, and the practical effects of such an increase would be rapid. Regrettably, however--as the previous Home Secretary knows only too well--funding for more police has not been one of the Chancellor's priorities.
The police reform Bill will bring some improvements in police complaints procedures and some helpful changes in how forces are run. However, the measure will do very little to make inroads into rising crime levels. It will not deal with the problems that prevent police from meeting the wishes of their local populations.
There is a resource issue to be addressed. The most important measure to deliver real crime reduction would be a dramatic increase in police numbers. That has been the experience of New York, which is now a safer city than London and has about one and a half times as many police. The Government, however, have taken a different course. They have cheap-skated our police forces and tried to make up for that with increasingly draconian changes to the law. An auction of our liberties has been accompanied by decreasing police numbers.
In the previous Parliament, the Government took the right to remove passports on suspicion and attempted to end some people's right to trial by jury. That attempt was defeated in the Lords last time and we hope that the new attempt will suffer a similar fate.
We all want to catch and punish the guilty, but we will not do that by eroding the rights of the innocent. This police state without the police undermines the fundamental British principles of liberty and justice and is wholly ineffective as a means of stopping crime. It is simply the wrong approach.
It is time to break the back of the idea that things will always get better if only we spend a little more. That is worse than just an illusion: it is a dogma that has beset Britain for too long and is directly responsible for the growing disillusionment with our entire political process referred to by the hon. Member for Liverpool, Walton.
People know that things are not getting better. Every day, patients endure unnecessary suffering, indignity and death because of the failure of our health service. Every day, children have their prospects and ambitions destroyed because the Government have not been resolute in tackling failure in schools. Every day, everyone pays the cost of record levels of crime, because we have not faced up to the need to police our streets.
Those whom we are letting down now are not the strong or the able: they are the weakest and the poorest, those without choice and without opportunity. They are part of the lost generation of voters for all parties. They are the people whom our political system, and the House, no longer offers any credible hope. We have all been imprisoned by a system that drives serious debate out of politics. It is time we were brave enough to be radical.
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