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Mr. Peter Duncan (Galloway and Upper Nithsdale): Have waiting lists in the hon. Gentleman's constituency increased or decreased since 1997?

Derek Twigg: They have gone down in the North Cheshire health authority, which covers my constituency. The authority has met its target. The funding increase to the health authority since 1997 was about 70 per cent. Furthermore, to deal with the health inequalities in my constituency, my right hon. Friend the Secretary of State for Health gave the health authority £1.2 million towards health improvement. As part of that, an important health study is taking place in my constituency in order to determine the factors that have led to the poor health that has existed for many generations. That shows the Labour Government making a difference to people's lives. That is happening in my constituency.

The Tories cannot make their figures stand up. Despite the sweet words we have heard this evening and the evasive answers to questions about whether they will privatise the health service—we all know that is what they want to do—they cannot make the figures add up. I repeat that if people vote Tory at the next election, we shall see

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a privatised health service—as the Liberal Democrats and my hon. Friends have pointed out. That is the dividing line between us.

The debate is about having a publicly funded NHS with a planned stream of funding over the next few years or the alternative of going down the Tories privatised NHS where we will not know what the funding will be from one year to the next.

Mr. Bercow: The hon. Gentleman talks helpfully about the importance of planning in health service expenditure, so he will of course recognise the need for specificity. What assessment has he made of the prognosis of the King's Fund for the average European Union level of public expenditure on health by the end of this Parliament? Does he intend that it be equalled by the United Kingdom?

Derek Twigg: Let me put it simply: on the ground, in my constituency, when I talk to GPs, NHS staff and others, they recognise the Government's commitment to ensuring the success of the health service and to extra funding. There may be disagreements as to how the money is spent, but the increased expenditure under the Labour Government will far outweigh what we saw under the Conservatives. The choice is between a privatised health service or a properly publicly funded NHS.

8.49 pm

Sir George Young (North-West Hampshire): It is a pleasure to follow the hon. Member for Halton (Derek Twigg). I hope to reply to some of the thoughtful questions that he posed about how we can improve the service for some of his constituents. However, he made a mistake towards the end of his speech by polarising the issue between a wholly privatised system and carrying on with the current system, and I hope to say a few words about that in a moment.

The debate was opened with a quality speech from my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), who posed four questions in his normal consensual way. It was sad that, after speaking for 30 minutes, the Chancellor did not give us any answers. Indeed, he seemed to be growing increasingly agitated as time wore on. I hope that the Chief Secretary will answer those four question when he replies to the debate.

Last Tuesday, the Chancellor announced the beginning of a debate on health, and at Prime Minister's questions the next day the Prime Minister also referred to a debate on health. I welcome that and think it important that the Government do not foreclose all the options before the debate has got under way. I hope that they will not impugn the motives of those who believe that the time has come for some lateral thinking about how we fund the health service. I am not sure that the Chancellor understands how difficult the position is for the NHS in many constituencies.

I want to make two brief points—one about funding and the other about social services, a close partner of the NHS. On the first, the key question that needs to be addressed is how do we adhere to the principles behind the NHS—free at the point of use and available on the basis of need—while enabling the country and the NHS to perform much better than it does at the moment? I want

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to develop briefly the analogy with pensions and find out whether the approach that has successfully been adopted can be applied to health.

When the welfare state was founded just after the second world war, broadly the same approach was adopted to pensions and health. On pensions, there was to be a compulsory contributory scheme, leading to a state retirement pension, which was designed to address poverty in old age and reduce dependence on means-tested benefits. It was not to be a funded scheme, but a pay-as-you-go scheme, with today's contributions paying today's pensions. The NHS was born with the same overall philosophy—a state scheme aimed at embracing everyone, designed to address ill health and paid for out of compulsory taxation.

With pensions, the Beveridge vision was never achieved. There was increasing reliance on supplementary benefit, income support and pensioner credits to tackle poverty and no Government were ever able to get the state retirement pension up to the level that would take people out of poverty. Over time, the emphasis began to switch to private provision, based on the workplace. Although the Opposition can claim much of the credit for what I call that mixed economy in pensions, a key player was actually Barbara Castle—as good a socialist as one could come across—whose pension Bill in the mid-1970s contained the architecture for the scheme that we now have.

Over the years, more emphasis has been placed, by Governments of both parties, on good employers having in place a quality pension scheme that complements, reinforces and works alongside the state retirement scheme—an ideal third way. No one has ever asserted that that is socially divisive. The trade unions support good private pension schemes, and this country's pensions are now on a sound financial footing. We lead Europe in funded pensions, given that most other European Union countries have schemes that will need an increase in taxation or contributions.

The question I pose this evening is whether a comparable model might not be looked at for health, against the background of the pressures on funding and delivery that confront the NHS as a monopoly provider. Should not one encourage employment-based insurance schemes to complement the NHS? They could be called, "NHS at work" if it helps Labour Members. It is indeed the case that many firms have private health insurance schemes, but, typically, they cover only senior employees. I believe we should move towards a system whereby not just all the employees within firms are covered, but their families as well. Such an approach would be welcomed by those who represent the work force. It would be in the interests of employers in improving the quality of care that employees and their families receive. I believe that the NHS should welcome it, as the growth of an independent sector of medicine would relieve it of much of the pressure that confronts it at the moment. I think that the Government should welcome it, as it would increase the percentage spend up to European levels. I do not think that anyone could argue that such an approach was socially divisive; rather, it would be an extension of good employment practice, as has already happened with decent pensions.

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There are, of course, cost issues for employers, although the bulk purchase of health cover can bring premiums right down to three rather than four figures a year. It could be phased in and the cost could be reduced by cutting employers national insurance contributions. I hope that the debate launched by the Government will permit us to explore that option.

My second point is about joined-up government. The debate launched by the Government is about the NHS, but we should not forget its partner, social services. Right hon. and hon. Members may have seen the letter in The Times today by Councillor Sir Jeremy Beecham, chairman of the Local Government Association, in which he says:

Certainly, many of the problems confronting the NHS in my constituency in Hampshire are due in no small part to the underfunding of social services. There is no point in providing more money for the NHS if it cannot be spent, because the revenue support grant is squeezing local authorities and social services. Let me say in passing, as my right hon. Friend the Member for Fylde (Mr. Jack) pointed out, that social services are extensively charged for.

Nine per cent. of all acute beds in the south-east—1,370 beds, or three district general hospitals—are blocked by delayed transfers of care. Some 23 per cent. of those patients are awaiting public funding. In my constituency, 83 beds are blocked in the Winchester and Eastleigh Healthcare NHS Trust.

The Government will say, with some justification, that they have twice in the past 12 months allocated extra sums—cash for change and winter pressure money. Hampshire received £1.9 million last year and £2.4 million in September this year. Of course, that money is welcome, but this simply is not joined-up government. It shows how inadequate the social services standard spending assessments are for local government. This is a one-off sum—local authorities do not how much they will get or when they will get it, but the revenue consequences for social services continue year after year. There is a strategic problem of loss of beds in residential and nursing homes, aggravated by measures introduced by the Government.

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