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Tony Cunningham (Workington) rose

Mr. Hilton Dawson (Lancaster and Wyre) rose

Mr. Clarke: The obvious object of government, by any party, must be to improve the NHS, the education system and the transport network. I want to try out a few of the propositions on which any approach to the great public services of this country must be based.

Experience shows everyone bar Liberal Members—or Liberal Democrat Members, as they are now, although the fact that the new party's proposals are as silly as the old party's used to be means that I am not greatly concerned about nomenclature—that the answer to improving public services does not consist solely in increasing funding. That lesson has been learned by every Government who have had to tackle the problem. Of course increased investment is needed, according to the capacity of the real economy to finance it, but everyone from the Prime Minister downwards in the present Government now accepts that a combination of finance and structural reform is needed in each and every case.

Mr. Dawson rose

Mr. Clarke: That was what underlay the evolution of the reforms of the third Thatcher Government, and it is the agenda to which we all must return.

He was not allowed to utter a word of it as he stood before his Back Benchers in the Chamber, but I thought that I had detected in some recent utterances from the Secretary of State the proposition that more diversity of provision was required, and that monolithic uniformity imposed centrally on a national level does not work. Why are the Government talking about specialist schools, for which the previous Conservative Government used to argue? Government briefings on education echo the words used in the argument on health.

Dr. Stoate rose

Mr. Clarke: I also believe that it is clear that the Government acknowledge the benefits of some competition in provision, especially in health. That competition is one of the benefits that arise when people have that most valuable thing—the ability to choose. The words were slipped into the Secretary of State's diatribe, but it is clear that the Government aim to give patients some choice about when and where they are treated in the NHS.

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That is only one example of a sinner come to repentance. The Government spent their entire first term trying to minimise such choice.

Dr. Stoate rose

Tony Cunningham rose

Mr. Clarke: I was hoping to establish a consensus, at least with the more loyal members of the Labour party. I shall finish my list of propositions, and then give way.

The Government are also accepting, at last, that extra finance in public services over and above what comes from public funds must come from the private capital markets and from private finance.

That sticks in the craw of most Labour followers and is not readily acknowledged by many Ministers but has plainly become central to the proposition. It has taken some time to convert them. All those are propositions to which the Prime Minister, Chancellor of the Exchequer, Secretary of State for Health and probably the Secretary of State for Education and Skills are being grudgingly converted. Far be it for me to help those right. hon. Members with their followers.

One has to tackle management in public services. The Government seem to have bought that concept completely in the case of London Underground. At least I prefer their proposals to giving public funds and credit to the likes of Ken Livingstone and Bob Kiley. I do not like the Government's proposals either but a history of mismanagement—which London Underground certainly has—is often at the root of many problems.

Private sector management often has skills that the public sector has never produced. It is astonishing that the Secretary of State for Health completely avoided mentioning one of the biggest revelations that has come to him in the past six weeks. He did not mention it even en passant because he knows that the dead wood behind him finds the proposition impossible to bear.

Phil Hope: Will the right hon. and learned Gentleman give way?

Mr. Clarke: I am not finished yet. These are, I hope, consensus points. Localisation of responsibility for choosing priorities and making decisions is essential to great public services. It has taken the Government five years to realise that they cannot sit behind a desk in Whitehall listening to a lot of swivel-eyed young men from the party's research department and deliver priorities and targets nationally and monolithically. It has even been suggested that the role of Ministers has to change to one of monitoring and facilitating, but not to owning and micromanaging everything in east Kent, Oxfordshire and Nottinghamshire—as they have been trying to do.

Several hon. Members rose

Mr. Clarke: Having made those unkind references to the dead wood behind the Minister, the least I can do is give way to one or two of them.

Dr. Stoate: In the interests of consensus, I agree with the right hon. Gentleman about diversity. Surely he agrees

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that when his Government introduced a measure such as GP fundholding, they failed to ensure that practices that chose not to be fundholders got a fair crack of the whip. Some fundholders forged ahead in innovative ways but only at the expense of others. That bred deep dissent and resentment in the health service, which did a huge amount of damage. If the right hon. Gentleman had been more interested in consensus, we might have got somewhere.

Mr. Clarke: I am delighted with the hon. Gentleman's acknowledgement that he agrees with some of my propositions. I am sure that the promotion he so richly deserves is at hand. I am glad to have done the hon. Gentleman a service by helping to further his career.

We offered the possibility to all general practices to become fundholders, and we were going to lower the patient number threshold. We adopted the same principle used for NHS trusts in trying to get clinicians on board. All the hospitals that chose NHS trust status did so voluntarily. When local management was tried out, it became so popular that by the time we left office, all had changed to NHS trusts.

GP fundholding was fought by the Labour party and the British Medical Association, so we looked for volunteers because we needed doctors committing themselves to making the system a success. Having taken the step of volunteering, they felt under a compunction to make sure that fundholding worked. It was spreading and becoming popular with most general practitioners. It would have become the norm and a universal provision but an ill-prepared new Labour Secretary of State—who came in on a few slogans and nothing else—committed the great mistake of repealing that innovation.

Tony Cunningham: I understand that for Conservative Members, 1997 was year zero—nothing happened before then and they cannot be blamed for anything. I will not concentrate on the past but will consider 2001—or year four, as far as the Opposition are concerned. In The Independent, the right hon. and learned Gentleman was quoted as saying:

Does the right hon. and learned Gentleman still believe in that statement?

Mr. Clarke: I congratulate the hon. Gentleman on making the first Labour intervention that has not referred to the past—indeed, almost no speech has referred to anything but the past—and on being the first to have the nerve to glimpse into the future. I do not think that the quote is wholly accurate. [Hon. Members: "Oh."] For the avoidance of doubt, I have repeatedly made it clear that I am completely committed to the national health service, which I do find an extremely attractive way of delivering health care. We must tackle the problems that are making it fail so badly at the moment.

These debates, and Prime Minister's questions, get coloured by repeated assertions that the Conservative party is now committed to a policy of cutting public spending and introducing charges for health. As a member

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of the Conservative party I have never heard any of my colleagues put that forward as the party's policy. It is not the policy.

Mr. Salter rose

Mr. Clarke: I return to my consensus points, which no Labour Back Bencher has had the nerve to gainsay because they probably all wish to be promoted at some dim and distant time in the future. Given where we are now, the only reference that I will make to the past is to say that when we were introducing those propositions into public service, they were always described as privatisation. In election after election, not just the Vale of Glamorgan by-election, we fought a parody of the policies that we were putting forward. That continues to the present day to be the position of the Labour party because the speech by my hon. Friend the Member for Woodspring was greeted by an attack which, whenever it referred to what we were proposing, bore not the slightest relationship to anything that I had heard my hon. Friend say from beginning to end of his speech.

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