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David Taylor: Ten per cent. of the almost £60 billion cost of the NHS is devoted to its drug budget. About 25 per cent of that £6 billion—£1.5 billion—is the cost of generic drugs. A review is under way to determine ways of driving down the cost of generic drugs, because too much of our investment in the health service is leaking out to inflate the already large profits of the pharmaceutical companies.

Dr. Stoate: I thank my hon. Friend for his expertise. He has an interest in this matter and has been examining

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it closely over the last few weeks, during which time I have discussed it with him. These are exactly the issues on which we should be concentrating.

We also need to find a way of freeing up far more resources into primary care. Working as a GP, I find that increasing the number of community nurses can reduce the number of hospital admissions quite dramatically. In my own practice, when we are fully staffed with district nurses, our admission rate to hospital is extremely low, and our ability to take patients back into the community after they have finished their treatment is extremely good. When there is a shortage of nurses in the community, however, our hospital admission rate goes up, and our ability to take ill patients back when they have finished their treatment is hampered. Such shortages make life much more difficult. I would like to see much more real work done to increase the number of community nurses and other support staff, so that we can keep patients at home, and in some way emulate the Kaiser Permanente system, under which the average bed-stay is about three days, as opposed to our average of about five.

Mr. Redwood: Has the hon. Gentleman noticed how people are turning more and more to alternative therapies and herbal remedies? What does he think GPs and the NHS should do in response to that movement?

Dr. Stoate: That is a very big question, and slightly off the subject of the debate on public services. The right hon. Gentleman is right to say that people are turning more to complementary medicines, which certainly fulfil a need for some. I have a lot of respect for people who carry out research in this field, and who are trying to find out which alternative therapies have something to offer. I have no problem with such therapies, and it would be helpful if GPs were better informed on some of these issues, because they could then explain to their patients which remedies might be of use. However, this is far too big a subject to discuss in detail in a debate such as this.

We can improve the efficiency of the public services, particularly the NHS, if we can determine where the cost-pinching and blockages are occurring—for example, in accident and emergency, or in relation to discharges or waiting times to see consultants. If we examine those pinch points, try to develop alternative strategies to smooth them out, take advice, and examine information and studies of alternative health care systems throughout the world, we should be able to introduce a far more seamless care system in this country.

I want to reassert that this is not just about money. Size matters, but it is not the only factor. It is what we do with it that really matters. The Government have made a brave decision to consider alternative ways of freeing up hospitals, PCTs and individual practices to provide different models of care, and to learn from and disseminate best practice. That is the way forward, and I am sure that, as a result, we shall see the genuine improvement that people in this country have a right to expect.

7.16 pm

Mr. Peter Lilley (Hitchin and Harpenden): Thank you, Mr. Deputy Speaker, for the opportunity to address the question to which this debate enables us all to respond. It is the question that the public are putting to all parties,

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and to every Member of the House. The public want to know how this country can have world-class public services. They are puzzled as to why, despite the claimed—and in some cases, real—injections of additional money by the Government, those services appear to be getting worse in many sectors.

The public are puzzled, and they want a thoughtful, reasoned answer from people in the House. They will be profoundly disappointed by the response from the Secretary of State today. They will not be pleased that his reply consisted only of negative, bad-tempered, partisan attempts to blame everything that is happening now on the past and on his predecessors. They have a right to expect something more reasoned, thoughtful and forward-looking from the Secretary of State, particularly as he has vouchsafed to the media outside the House his thoughts and inklings of his plans, which he failed to mention here today.

I want to try to address some of those issues. I hope that I can claim some respect across the House for being not exactly partisan on this matter. My departure from the Front Bench and from the deputy leadership of my party was precipitated by a speech that I made on the importance of focusing on and improving public services, and the limited role that private enterprise would have to play in that process. That evoked anger and horror in The Times and other organs of extremism that now relish reflections of what I said when they are uttered by the Secretary of State for Health.

Like my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke), I seek consensus, but I shall begin by spelling out a few facts as they appear to my constituents, based on their experience of public services in Hertfordshire. I shall focus on health in due course, but I shall start with education, and with the size of classes and the pupil-teacher ratio in maintained secondary schools in my constituency.

I was worried about what appeared to be happening, which seemed to contrast with what I was hearing from the Government, so I tabled a question asking what had happened to the pupil-teacher ratio since I was first elected in 1983. The answer showed that the pupil-teacher ratio improved during the period in which the Conservatives were in office, but in the secondary schools of Hertfordshire it has deteriorated every year since the Government were elected.

Class sizes have got bigger. A Government who told us that their top three priorities would be education have given us bigger classes, bigger classes, bigger classes. That may be partly because of the difficulty of recruiting teachers. Hertfordshire is a high-cost area and, despite the fact that our schools are attractive places in which teachers would generally like to teach, we have recruitment difficulties.

I therefore tabled another question asking how many teacher vacancies there were in Hertfordshire. The Minister for School Standards came back with the figures, on the central definition that he used, and said that there were just 50 unfilled vacancies in Hertfordshire. I issued a press release to that effect and, to my embarrassment, the local newspapers came back asking, "What do you mean by this? There are far more than that." Indeed, the county council figures show that the actual number of vacancies is more than four times as high as that revealed by central Government. [Interruption.] The figure

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recorded and collected by officials at Hertfordshire county hall is 209, not 50, and they believe that that understates the position because it does not include temporary cover in certain circumstances.

On transport—

Mrs. Shephard: Before my right hon. Friend leaves the subject, can he throw any light on the reasons for such a discrepancy? He was enjoined by Labour Members to give facts, and he seems to be in possession of two kinds.

Mr. Lilley: It could be that the Government's rhetoric is not accurate.

Several hon. Members rose

Mr. Lilley: This causes such horror among the loyalists anxious for promotion that I must give them their chance.

Mr. Rammell: Totally fortuitously, I happen to have information on teacher vacancies in Hertfordshire in my possession, because some months ago I was making a comparison between Hertfordshire and Essex, where my constituency is based. The definition of a vacancy has not changed. The figure for Hertfordshire in 2000 was 17, whereas in 1990 it was 216. Can we have some credibility and frankness on this issue?

Mr. Lilley: I am sorry, but the hon. Gentleman's figures are as unreliable as, and rather similar to, those deployed by the Government.

Mr. Rammell: They are from the House of Commons Library.

Mr. Lilley: I am comparing figures given by Ministers with those given by county hall officials. I have got hold of the questionnaire used by the Government, and it applies a more restrictive definition than that used by county hall officials, which explains how it is possible to get the figures that the hon. Gentleman is deploying. The head of teacher recruitment came to Hertfordshire for a one-day think-tank seminar on how to recruit extra teachers, and he acknowledged that the figures used by Government generally across the country are only a third of the number reported to local education authorities. I am grateful to the hon. Gentleman for enabling me to elaborate a little on that point.

David Taylor: Will the right hon. Gentleman give way?

Mr. Lilley: No. I now wish to move on to transport.

We were told that Thameslink 2000 would produce more train services and thus ease some of the problems on the already overcrowded line from Hitchin to King's Cross and from Harpenden down the existing Thameslink line. The cost of the project has risen from £250 million when it was first proposed to an estimated £2 billion now, yet the Strategic Rail Authority, a Government-created body, which made this proposal, now admits that the £2 billion will not, as formerly believed, result in any extra services. There will not be a single extra train at peak hours down either line. It will allow those trains to go further through London, and that is welcome. It will

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also make the service more attractive, but there is no point in attracting more passengers if there is not room for them on the trains because there are no extra trains to carry them.

Although those facts have emerged during the public inquiry, the effective renationalisation of Railtrack has so bemused and paralysed management that they have been unable to respond to it or to produce alternatives, which would have given us a little extra capacity for the £2 billion worth of public finance that it is proposed to put into this project.

As I said, I want to focus above all on health, so let me give a few facts about the situation affecting the NHS in my constituency. In 1997, we were told that it would take just 24 hours to save the NHS. Since then, I am afraid that in some material respects, things have got worse in Hertfordshire. There are now 60 vacancies for GPs in the county, and that figure has risen 20-fold in a year. The shortage of nurses has become so worrying that it has been necessary to close not just the special care baby unit but the maternity unit and the children's unit at Hemel Hempstead and transfer them all to Watford. We are awaiting the outcome of an inquiry, which may have reported to the Minister today, on whether that move will go ahead and, if so, whether it is likely to become permanent. If so, we fear that it may precipitate the undermining of Hemel Hempstead as a viable general hospital with its own acute and accident and emergency units.

That problem springs from the current shortage of nurses and the difficulty of recruiting staff.

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