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Mr. Bill Rammell (Harlow): Dream on. The hon. Gentleman referred to the role of policy advisers. One of the most senior under the last Conservative Government was Alfred Sherman, who wrote in The Guardian last

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week that any improvements to the rail service should be paid for solely by the rail commuter. Does the hon. Gentleman agree?

Dr. Fox: Well, that is an intellectual step up. As someone once said, "Advisers advise; Ministers decide." I am sure that there is another one somewhere.

Mr. James Plaskitt (Warwick and Leamington) rose

Dr. Fox: Yes, I shall take that one.

Mr. Plaskitt: The hon. Gentleman started his peroration by talking of no delivery across a range of services. May I tell him that 32 per cent. of Warwickshire primary school children were in classes of more than 30 in 1997 while today there are none in such classes? Does he call that no delivery?

Dr. Fox: No Government can get everything wrong. Even this Government, by the law of averages, are bound to score the odd success, but up and down the country and right through the public services, which are far from being a great success with either service users or service providers, the Government are presiding over greater demoralisation than ever before among service providers and a greater lack of satisfaction than ever before among service users.

Several hon. Members rose

Dr. Fox: I must get on, especially as those who are intervening cannot understand the difference between perorations and little perforations.

Nowhere is the failure seen more clearly than in health. The recent scandal, which is all it can be called, of the fiddled waiting list figures, which was exposed by the National Audit Office, is one of the most appalling stains on the Government's record. We, and in fairness other parties in the House, warned that their obsession with waiting list figures would result in clinical distortions. When asked whether clinical distortions occur, Nigel Crisp, the NHS chief executive, said:

What an appalling admission. The Prime Minister tried to understate the issue by telling the House that

Only 6,000. They are not mere statistics; they are real people, sick people.

Only last week, a GP friend told me that he had just returned from holiday only to find that his daughter had been taken off a waiting list because, while they were away, the health authority sent a letter saying, "If you don't write back within seven days, your name will be taken off the list." Now she has to go back to the end of the queue. What sort of system is that?

In another hospital, the maxillofacial surgeons were forced to add patients to the waiting list and give a date of 23 December for treatment, knowing that no patient would volunteer to go in for facial surgery so close to

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Christmas. Those patients were therefore temporarily taken off the waiting list. That is the extent of the scandal in the NHS.

Mrs. Angela Browning (Tiverton and Honiton): I am sure that my hon. Friend will share the anxiety that I experienced after receiving a letter from a GP in my constituency. A consultant surgeon at the Royal Devon and Exeter hospital wrote to him to say that the hospital no longer took any notice of GP referrals when patients had deteriorated while on the waiting list. The consultant stated:

The GP writes that he cannot interpret that in any other way than patients being treated by political diktat rather than GP referral.

Dr. Fox: When I trained as a doctor, patients were treated on the basis of clinical need. That appears to have been abandoned under the current Government. My hon. Friend might be interested to know that the list of what the Government euphemistically describe as the "inappropriately suspended" consists of 75,000 patients. That means that 75,000 people in our country who need care are being denied it to make the Government's figures look better. That is a cause for national shame.

The National Audit Office recommended that the Department of Health examined other trusts. It stated:

Have the Government commenced such an investigation? No. They do not want to know the embarrassing result. If the Secretary of State is genuinely anxious about the needs of patients who have been taken off the list for statistical reasons, I challenge him to announce immediately that such an investigation will be undertaken.

More than 1 million people are on the in-patient waiting list. There are 2,000 more people waiting more than 12 months for their operations than in March 1997. There are 400,000 more people on the list for the waiting list. The Audit Commission stated that, in 1996, 73 per cent. of hospital patients were seen by a doctor in an hour. That figure has fallen to 53 per cent. The proportion of patients admitted to hospital in four hours was 90 per cent.; the figure has subsequently fallen to 76 per cent.

Phil Hope: Will the hon. Gentleman give way?

Dr. Fox: No, once was enough.

The Audit Commission was damning about the effects of Government policy on accident and emergency provision. Since 1998, a year after Labour came to office, it concluded that matters were not only getting worse but were doing so at an accelerating rate. The Secretary of State described that as "pretty disappointing". He was not half as disappointed as the 88-year-old man in Bristol who waited 22 hours on a trolley this week, or the patients who had the wheels taken off their trolleys so that they counted as beds, or those who circled hospitals in ambulances so that they did not start the accident and emergency clock ticking. That is more than disappointing; it is a disgrace.

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What will happen to the community health councils, which provided the data on what was happening in accident and emergency? The Secretary of State dealt with them in his best Queen of Hearts manner—"Off with their heads." They are to be replaced by a more complicated, less understandable, more expensive and unwelcome system. The judgment has been that although some CHCs work well, all should be abolished because some are not working. I should love that to apply to the Cabinet.

Geraint Davies (Croydon, Central): The hon. Gentleman knows that the National Audit Office report stated that up to 6,000 so-called fiddles may have occurred out of a total of 5 million patients. That is 0.1 per cent., and it applied to only nine out of 300 trusts. All the chief executives and chairs of those trusts have gone. Does the hon. Gentleman not realise that the Government are committed to stamping out all such fiddles? He completely misrepresented the statistics.

Dr. Fox: Ah, well then, it is only 6,000 fiddles and nine trusts, is it? If the Government were as committed to stamping out this pernicious practice as the hon. Gentleman suggests, they would hold a full public inquiry into what these figures mean, rather than failing to ask the questions to which they do not want to know the answers.

On top of this scandal, we still have mixed-sex wards; thousands of patients are still contracting hospital- acquired infections and dying unnecessarily; and we still have the scandal of dirty wards in the NHS.

Ms Drown rose

Dr. Fox: The hon. Lady is very persistent. I shall give way.

Ms Drown: I want to point out that the same pressures to fiddle waiting lists existed under the Conservative Government. I was working in the health service at that time, and people came to me with the same suggestions. I hope that Ministers in that Government would have frowned on the practice and taken action. The hon. Gentleman needs to remember the background to these circumstances. The Labour Government have reduced waiting lists by more than 100,000. That is a fact, and it contrasts strongly with what happened under the Conservative Government, when waiting lists rose by 400,000.

Dr. Fox: No, the hon. Lady fails to get the point. This Government have not reduced waiting lists; they have reduced the numbers on the lists. Those are two very different things. Sick patients are still waiting for treatment. What lies behind the Government's approach to this question is not just their obsession with numbers. For this Government, there is no such thing as truth and untruth; there is only convenience and inconvenience.

Despite all these horrible statistics, one phrase echoes more than any other round Richmond House and the Treasury: "Where has our money gone?" Why are we all still getting letters saying that our constituents are waiting longer to see their GPs, waiting longer in casualty, and waiting longer for surgery? More people are coming to our constituency surgeries with these problems. If all this extra money is being spent, why are patients in the NHS not seeing any benefit?

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I shall give the House a simple example, involving last year's settlement for the NHS. The Government spent an extra £3.8 billion on the NHS last year; no one disputes that figure. However, when we take away the money that was inevitably spent on pay review bodies, pay costs, pensions, the debt overhangs and the Government's ring-fenced projects, the total amount available to expand core services was a maximum of about £560 million. That calculation assumes that the Government's national service frameworks came in at the bottom level of expectations.

That explains the picture presented by the experts at the King's Fund—these are not our numbers, but those produced by the King's Fund—who highlight how the Government's extra funding has had little impact on activity levels. The King's Fund has stated:

In other words, more money is going in, but less is coming out. Why? This is primarily due to the combined genius of the Health Secretary and his Minister of State, the right hon. Member for Barrow and Furness (Mr. Hutton), who have managed to lose—from the peak in 1996—49,000 care home beds, resulting in huge bed blocking right across the NHS. More than 6,000 NHS patients are stuck inappropriately in hospital at any one time—38 per cent. of them for more than a month, according to the Department's figures. There is a waiting list to get into hospital, and a waiting list to get back out. When they came to office, the Government claimed that the system had too little capacity; they have effectively managed to cut that capacity further. What a triumph!

That triumph is matched only by the ability of the Secretary of State for Transport, Local Government and the Regions to survive in office.

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