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Mr. Milburn: As I have said, I agree with my hon. Friends that the NHS has some very good managers; I know that it is unfashionable to say so, but that is what I believe. We have some outstanding managers who do a difficult job in extremely difficult circumstances; they manage large, complex organisations and, as we can see from some of the best performing hospitals and primary care trusts, they do so admirably. However, I am afraid that, as in any public service, there are always some that are good, some that are indifferent and sadly, some that are just not up to scratch; I do not think that we should hesitate to say so.
As my hon. Friend the Member for South Swindon (Ms Drown) will know from her own constituency, it is all too often the case that the poorest services end up being in the poorest communities. We should not sanction that situation; we should have the courage of our conviction and say that where management is not up to scratch, we are prepared to change it. The management, in this case, is the leadership of the organisation; we have chief executives and directors of finance to provide leadership in those organisations. If it is not being provided and services are poor, there have usually been persistent problems with organisation, culture, attitude and so on over a period of many years. We should say that that is not good enough and that we are prepared to change it.
Mr. Peter Luff (Mid-Worcestershire): On the earlier subject of Trotskyism, may I politely remind the Secretary of State that he is the real Trotskyist because he is keeping the national health service in a state of permanent
Mr. Milburn: Just as a small historical correction, if my memory serves me right, permanent revolution was more a feature of Maoism than Trotskyism. I am willing to admit that I could be wrong; the hon. Gentleman may be much more of an expert than I am, or was, on that sort of issue. If he cares to look at public services, whether in FE colleges, schools or whatever, he will see that we have a national framework of standards and diversity of provision. That is delivering the goods in improved standards in education, better outcomes for children and so on. We need to apply precisely the same disciplines to the national health service. We have a clear framework of national standards, which my right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) was partially responsible for putting in place. We have independent inspection. We have the right ethos, the right values and the right principles. In order to deliver improved services for patients, we must empower the NHS front-line.
Mr. Dennis Skinner (Bolsover): What are the special qualities that the private sector seems to have, as opposed to those who have dedicated 50 years to the national health service as a public service?
Mr. Milburn: As I said to my hon. Friend the Member for South Swindon a moment ago, we have some outstanding people working in the NHS as managers, and some outstanding hospitals and primary care trusts. However, my hon. Friend the Member for Bolsover (Mr. Skinner) will know from his constituency experience, as I know from mine, that sadly, in local government services and sometimes in the health service, the fact that service providers are located within the public sector does not necessarily mean that they deliver the best of services. I am interested in what the patient gets. NHS patients should get high-quality care. What we should expect to see in all our constituencies in all parts of Britain is the highest quality of care for patients, regardless where the care is provided.
Hywel Williams (Caernarfon): What are the implications, if any, of the Secretary of State's proposals for the NHS in Wales and Scotland? In a written question on 26 June, I asked the right hon. Gentleman
Mr. Mike O'Brien (North Warwickshire): I welcome my right hon. Friend's proposals to give greater freedom and power to succeeding managers, but like my hon. Friend the Member for South Swindon (Ms Drown), I am concerned that those ought to be balanced by proposals to make it easier to remove failing managers in the NHS.
Mr. Andrew MacKay (Bracknell): What is the real reason for the Secretary of State not making a statement to the House about a policy initiative that is clearly very significant? Could it be that he realised that there would be considerable support from the Opposition and no ringing endorsement from Labour Members, who look extremely upset?
Mr. Gareth R. Thomas (Harrow, West): As someone who represents one of Labour's new heartland seats, may I encourage my right hon. Friend to come again and visit Northwick Park hospital, where I could introduce him again to first-class management? Those managers are keen to persuade him of the case for more investment in maternity services to revolutionise the quality of care currently available at Northwick Park's maternity unit. I encourage my right hon. Friend to take no lectures from the Opposition, who axed two thirds of the accident and emergency provision available to my constituents, and whose proposals for new charges for access to GPs seem to strike at the heart of the NHS principles.
Mr. Milburn: My hon. Friend is right. This morning I listened with interest to the Opposition spokesman, the hon. Member for North-East Hertfordshire (Mr. Heald), refusing to rule out charges to visit the GP's surgery. [Interruption.] The hon. Member for Woodspring ought to keep an eye on his colleague because that hon. Gentleman was touring the studiosit was on BBC News 24, I think, or it may have been Sky Newsand repeating the interview. There is a fundamental difference between the Opposition and the Government. They want to charge; we say that services should be provided free. My hon. Friend is rightthe Labour party is building up the national health service, whereas the Conservatives would run it down.
Mr. Crispin Blunt (Reigate): I am intrigued by what the Secretary of State said about the undesirability of micromanaging the health service from Whitehall, given that it was only last month that he pre-empted negotiations between BUPA and the Surrey and Sussex Healthcare trust about the provision of elective surgery at the East Surrey hospital site, which will now be undertaken by BUPA in the old Redwood hospital. Can I now hold on to the hope that, as those elective operations will now be administered and managed by BUPA, there is a possibility that the whole East Surrey hospital could be managed by BUPA, which is a not-for-profit organisation?
Mr. Gordon Prentice (Pendle): It is not true that my right hon. Friend is a Trotskyist, although he is perhaps a Leninist in terms of policy being decided by the few and not the many. My specific question is this: who decides which assets will be sold? For NHS trusts located in the south-east, where property and land values are very high, there is an invitation to asset-strip.
Mr. Milburn: My hon. Friend is completely wrong. If he bothers to look at the star ratings that we produced late last yearI urge him to do sohe will see that there is a clear balance between the north and south in terms of NHS trusts with a three-star rating. We must get away from the idea that, because a trust serves a poor area, it is rather like a school serving a poor area and it can be assumed that it must inevitably have poor standards or organisation. That is simply not the case. It is an important incentive to improve performance for people running the services, whether they are in the north or south or in an NHS trust or primary care trust, that, if they want to make changes to local health services that are to the benefit of NHS patientswe must remember that they will continue to be inspected and annually assessed on their performancethey have the freedom to do so.
Mr. David Tredinnick (Bosworth): The right hon. Gentleman said that he would like more diversity in the national health service. Is that comment linked to the briefing that he gave to journalists before Christmas, which suggested that Ministers were calling for herbal cures on the national health service? The story was published in three or four national newspapers. Does it represent a change of policy at the Department? Is the Department now looking for an integrated health care service and is this development a part of that strategy to roll out more availability of different treatments through a new-style national health service with more diversity and more power given to managers?