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Mr. Kevan Jones (North Durham): The right hon. Lady has given us a snapshot of her constituency. In my constituency, for 18 years under her Government the GP in the ex-mining village of Craghead held his surgery in a terraced house with a leaking roof. Last week, he moved into a £250,000 purpose-built facility provided by a Labour Government. That snapshot of Durham is certainly not the same as the picture that she is trying to paint.
Mrs. Shephard: I am delighted to hear of the good fortune of the hon. Gentleman's constituents. He speaks as he finds. So do I, and so do my constituents. It is a matter of great mystery to them that they hear Ministers vaunting the improvements in the NHS and other public services made under this Government while their daily experience is a surgery closure. Frankly, while one would not want a leaky roof on a doctor's surgery, that is better than no surgery at all, which is the experience of my constituents under this Government.
Ministers have been approached by dentists from my constituency and they will have received a letter dated 31 December 2001 from Mr. Carmichael of Downham Market. His practice has served that area of west Norfolk since the mid-1940s and he recently lost one of his associates. As a result, and despite six months of expensive advertising, he has had to
- "deregister over 3000 patients and reduce staffing and it is unlikely that these Patients will find another Dentist."
It is a pity that no Health Minister is here, but, in passing, I draw it to the Minister's attention that I made an innocent inquiry of Norfolk health authority to discover how many bodies are responsible for administering health in my constituency and in Norfolk. In 1987, there were four or five. There are now 16. Each has a chief executive, a glossy annual general meeting report, a chairman, travel expenses, premises—everything. Of course, that represents but a flea-bite in the overall NHS budget, but these things too are noticed by the public.
Turning to education, in no other field have expectations been so raised and exaggerated or so dashed. Consider the daily experience of parents and teachers in Norfolk. In my constituency a year ago, it was revealed that a head was regularly teaching classes of 94. That was disavowed by Ministers and the Labour-controlled local education authority. Alas, it was the case, although it is no longer. That scandal was drawn to my attention by the parents, who said, "Why are they going on and on about class sizes of 30? We have 94 in ours."
I also draw Ministers' attention to a letter to me dated 10 December 2001 from Dr. Brian Slater, Norfolk's director of education. He states that 30 of Norfolk's 52 secondary schools are over-subscribed, which means
that if people happen to move to a town in which one of those schools is located, their children cannot be educated in that town. What does that extraordinary situation mean for rural investment, jobs, economic regeneration, children and parents and the schools themselves? It means more expense for council tax payers, bussing out of the county for many pupils and the end of choice. Talking of strategic planning, how can that have happened after five years under a Labour Government and, up to last June, eight years under a Labour-controlled county council? These people's priority is "education, education, education", but do not try to get a child into one of those 30 secondary schools because he or she will not get in. Apparently, these paragons—these enthusiasts for education—did not notice planning permissions, house building and new developments.
Mr. Kevan Jones: Will the right hon. Lady give way?
Mrs. Shephard: Not at the moment.
It could be argued that, by definition, authorities have 11 years' notice of the need for a secondary school place, but that was not enough. The situation is without precedent in my 30 years' experience of the education system and it represents the most extraordinary lack of strategic planning. It is a marvellous example of the mismatch between ministerial claims about public services and people's daily experience, and the blame must be laid at the door of the Labour Government and the Labour county council.
On police funding, my constituency was deeply affected by the Tony Martin case. In its aftermath, anxieties about the level of rural policing, the pointlessness of reporting crime when the police are so stretched and the fear of crime all surfaced only to be allayed by ministerial pronouncements on what would be done, but what we were told bears little relation to the chief constable's current perceptions. He has written to all Norfolk Members of Parliament to point out that there is a £162 million gap nationally between Government support next year and police need and that the Government propose a 3.6 per cent. budget increase in Norfolk even though the police authority calculates that it needs 4 per cent. just to stand still.
The debate has been informative and it is illuminating to hear the experience of Members from both sides of the House. It is to be expected that Labour Members will find constituency examples, which are perfectly accurate, of course, to support their Ministers' claims. Alas, public perception has moved on and they are sick to death of ministerial hype, which often bears no resemblance to their experience.
Ministers have only themselves to blame for the disbelief—or worse, cynicism—in the public mind over the state of the public services. Ministers make overstatements and exaggerated claims of improvement, but they have failed to grasp that there is a mismatch between what they say and what people experience. They will pay for it.
6.57 pm
Dr. Howard Stoate (Dartford): I am grateful to be called in this important debate, but I am disappointed with the contributions made so far, particularly those of Conservative Members, who have failed to grasp the
opportunity to draw out important public sector issues. I for one was looking forward to hearing what the Conservatives have to offer for the public sector. It is no good shadow Minister after shadow Minister ranting on about how terrible things are. We want to hear what they have to offer instead.The right hon. and learned Member for Rushcliffe (Mr. Clarke) appeared to want a spirit of consensus and appeared to lead the debate forward into constructive areas, but, unfortunately, all he really wanted to do was defend his record and knock the Government yet again—on and on and on he went.
I speak as the only practising doctor left in this honourable House and as one who has some expertise in the health service. There, as in so many areas, size does indeed matter. I shall not rehearse all the arguments made this evening, but it is impossible to defend the claim that the Government have not been funding the health service properly. Look at the figures: £49 billion for 1999–2000 and a projected £68 billion for 2003–04. That represents a real-terms increase of about 35 per cent., which must be the largest ever sustained increase in health service expenditure.
Chris Grayling: Has the hon. Gentleman considered the possibility that the Government may have increased spending, but delivered no results? On running the health service, has he considered the possibility that the Government might not be doing the right job?
Dr. Stoate: Oddly enough, the hon. Gentleman is beginning to engage in constructive comment. Perhaps we should be considering that matter. I want to focus on the way in which we should deliver services. Sterile debates about putting a penny on income tax, which party would put the most money in—
Mr. Barker: Will the hon. Gentleman give way?
Dr. Stoate: I want to make progress before giving way again.
I cannot understand the point of such debates. We go round in circles, trying to score points off each other. For example, the Liberal Democrats say that they want to put 1p here and 50p there. It simply does not make sense to people.
It is not only size that matters, however, but what we do with it. I want to consider reforms that the Government could introduce to improve the NHS and provide services with which not only hon. Members but the public are happy. We need to reform. Opposition Members have gone on and on about the Government's failure to deliver; they should suggest methods of putting that right. I want to try to tackle that.
My right hon. Friend the Secretary of State made an interesting statement about the three Ps, and said that we believed in patients, pupils and passengers. At least that is a constructive way of looking forward, and it is different from Conservative Members' three Rs—rant, rave and rhetoric, which get us nowhere. Opposition Members spend too long talking through their "Rs" and too little time on methods of improving things.
The NHS is a complex and convoluted organisation. It has taken 50 years of custom and practice to get where it is today. My right hon. Friend's leadership and vision is beginning to cut through that. The monolithic structure of the NHS is one of its problems because its size and complexity make it difficult to steer. The analogy with a supertanker is therefore apt. The Government have shown vision, determination and bravery in setting some of the units in the health service apart from others to ascertain whether they are able to provide services in a way that has not previously been done. That affords us an opportunity to find what can be provided. I welcome some of the pilot schemes that the Government are currently undertaking. They may show how far the NHS can go and the number of new initiatives that can be introduced.
I want to focus on some comparators. This week's British Medical Journal contained an interesting article, which compared the Kaiser Permanente group in California with the NHS. The group is a non- profit-making health maintenance organisation, which serves a similar population to the NHS and is largely based in California, where it has 6 million members. The paper in the British Medical Journal considers whether anything can be learned from comparing the organisations. It states:
- "The per capita costs of the two systems, adjusted for differences in benefits, special activities, population characteristics, and the cost environment, were similar to within 10 per cent . . . Kaiser members experience more comprehensive and convenient primary care services and much more rapid access to specialist services and hospital admissions."
- "Age adjusted rates of use of acute hospital services . . . were one third of those in the NHS."
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