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Mr. Henry Bellingham (North-West Norfolk): It has been paid for, but it has got worse.

Mr. McFall: The reason why the health service and other public services are not as good as they should be is that we have had decades and decades of underfunding. The present Chancellor is brave enough to recognise that and say that if we are to have high-quality public services, we must pay for them.

The right hon. Member for Wokingham, like his colleagues, said that he did not agree with the way that the Chancellor was going, but together with most people in this country, I do not know where the Conservative party is going. I have been on platform after platform with Conservatives, from shadow Secretaries of State down, and what do they tell me? They are studying the matter. We are not studying it. We are implementing a new proposal. The extra £4 billion to be provided this year will be very welcome.

My guiding principle is that if we want a health service, we must have one that is for all of the people all of the time. From what I can gather, the Conservatives are looking at other forms, which will be for some of the people some of the time, or for some of the people all of the time, but never for all of the people all of the time. I stick by the maxim that the NHS should be for all of the people all of the time. The Government will be able to challenge all the other proposals that have been put forward and win the ensuing debate, and that is important.

Let me reflect on the figures announced by the Chancellor today. There is to be a 7.4 per cent. average annual real-terms growth in UK NHS spending for five years, putting the NHS on a sustainable long-term financial footing, and a rise in NHS cash spending per household from £2,370 in 2001–02 to £4,060 in 2007–08, a 48 per cent. real-terms increase and a doubling for every household. Who in this Chamber would not welcome that?

Mr. Archy Kirkwood (Roxburgh and Berwickshire): The hon. Gentleman makes a serious and sensible speech, with much of which I agree, but we must be careful not to increase people's expectations of the spend. The increases are welcome, but the King's Fund has been at pains to say that if politicians are going around rightly saying that the money is coming, the expectations will increase faster than the rate at which the money comes, and there is a problem about that.

Mr. McFall: I always agree with my friend and that really worries me. I shall not fall out with him now, because I agree once again. My next point was that the resources that we are putting in must ensure delivery on the ground. At the last election, many people voted for a Labour Government on condition that we would get things right. We said that we had had four years, it had been tough, but we had the proposals in place, and we asked for another term to get it right.

Mr. Tom Harris: My hon. Friend said that the Conservatives would not tell him their plans for the health

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service. Perhaps I can enlighten him, because the shadow Secretary of State for Health has talked about a four-phase plan, the first phase of which is to break the link between the NHS and health care, and the second phase of which is to convince the people that the NHS will not work and cannot work, and will eventually result in self-pay by NHS patients.

Mr. McFall: I was coming on to that.

The hon. Member for Roxburgh and Berwickshire referred to the King's Fund. It stated that the NHS has been overwhelmed with well-meaning policy directives, investment targets and structural changes. In many ways that has been the problem. I agree with the hon. Gentleman. First, because of departmental underspends we must find the knack of teaching the civil service how to spend money, and, secondly, we must aim for decentralisation, so that there is no central command. The hon. Gentleman is right and I welcome the Chancellor's announcement today, but it will be a big job to get things right during the next four or five years.

Mr. Redwood: Does the hon. Gentleman not see that for people to have to pay £4,000 instead of £2,300 is not an inviting prospect? They want to know what they will have for the money, not how much extra they will have to pay. For example, can he tell us when people in my constituency will not have to wait for a hip replacement operation when they need one? That would be interesting to know.

Mr. McFall: I have never been to the right hon. Gentleman's constituency, but I am happy to acknowledge that there has been a problem with waiting lists. However, the Chancellor acknowledges the problems and is putting in place a structure whereby huge changes can be effected. That is the reality of the situation. I well remember the manifold problems under the right hon. Gentleman's Government. The internal market was a disaster and it took the Labour Government their first four years to correct that. The debate in the NHS will go on and will reverberate over the next few years.

As my hon. Friend the Member for Glasgow, Cathcart (Mr. Harris) said, the shadow Secretary of State for Health has four themes and the big issue behind them is to convince people that the NHS cannot and will not work. What a cynical ploy. That adds up to playing about with people's lives. That will not work and we must counter that argument head on. I am delighted that the right hon. Member for Ross, Skye and Inverness, West (Mr. Kennedy) and his colleagues will join us in doing that.

I come now to the international stage and the important work of the Chancellor and the Secretary of State for International Development. I applaud the Chancellor's Marshall plan speech in Ottawa and his proposal that the international community should provide an extra £50 billion a year. I also applaud the 2015 targets that were agreed. Already, in Uganda, the Government have doubled primary school enrolment and cut class sizes.

However, in other areas we have not been so successful and we must engage in the great debate in the IMF and the World Bank about the future of aid and development.

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The Treasury Committee was in Washington in January when we met representatives of the IMF and the World Bank. The United States proposes that we give countries grants not loans. Development agency representatives spoke to us on that subject, but we should not get hung up on the issue of loans as opposed to grants. In many ways I agree with the United States that we must have effective change on the ground, but the plan on which we should concentrate is developing a long-term approach to investment in developing countries. That is the big issue to which the Chancellor and the Secretary of State for International Development should turn their minds.

I see one of my colleagues on the Treasury Committee in the Chamber and we have expressed concerns about the effectiveness of the IMF and the World Bank. In the next few months, we will have the opportunity of questioning Horst Kohler, the managing director of the IMF, on that issue. However, we must remember that those institutions combined have annual expenditure of more than $30 billion. We have a seat at that table and it is important that we should put our point of view across.

One of the big surprises for me in the past four or five years has been how much interest ordinary people have in the subject of writing off international debt. In my constituency I communicate reasonably regularly with about 2,000 people who have written to me on the subject and want to be kept informed. That is a cross-party issue. The work of the Select Committee on International Development and others on that has been good and I look forward to continuing that work with them.

However, the big issue facing the Chancellor and the Secretary of State for International Development is trade. We should be considering using trade as a force for poverty reduction. The rich countries spend $1 billion every day on agriculture subsidies and the resulting surpluses are dumped on world markets, undermining the livelihoods of millions of small farmers in poor countries. When developing countries export to rich countries they face tariff barriers four times higher than those encountered by rich countries.

Those barriers cost the poorer countries $100 billion a year—twice as much as they receive in aid. We are giving with one hand and viciously taking away with the other. The rules of the World Trade Organisation on intellectual property, investment and services which protect the interests of rich countries must be looked at again and I ask the Chancellor to take that matter up when he meets his colleagues in the international forum. Most of us who have travelled abroad in the poorer countries realise that many of them have one commodity that keeps them going, but that the international community has failed to address the problem of low and unstable commodity prices that have consigned millions of people to poverty. For example, coffee prices have fallen by 70 per cent. since 1997, costing exporters in developing countries $8 billion in lost foreign exchange earnings. We must tackle trade if we are to bring everyone into the global economy.

I shall finish on that issue. It is always said that we have a global economy, but I contend that we do not, as half the people in the world are excluded. Half of them live on less than $2 a day, and a quarter cannot have a glass of clean water. Every minute, a woman dies during childbirth in developing countries. That is the reality that

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we face. If we are to tackle the issue of globalisation and bring people into the global economy, we must start with the other half of the world population.

We must also recognise that globalisation and terrorism are linked. As ex-president Bill Clinton said in his Dimbleby lecture last year, we can look forward to our children growing up and growing old—say, to 90 years of age—but we do not want them to grow up behind barbed wire. Globalisation has taken the walls down, which means that there will be less security if we do not collectively pursue proper policies. That is our big responsibility, which is why I welcome the Chancellor's statement and urge him to maintain a stable economy, give us high-quality public services, provide fairness to families and increase employment in this country. I urge him to ensure that our voice on the international stage is recognised and that we as a country do a lot for the other half who are not included in the globalisation process.

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