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Dr. Fox: I understand that the term "think tank" is entirely alien to new Labour. The whole point, when at an early point in opposition, is to bring together groups such as the NHS Confederation and the King's Fund—which I am sure the hon. Gentleman would not regard as having closed minds or being outrageously right wing—so that we can have a proper debate about these matters, in a way that the Chancellor is clearly trying to preclude in his own party. They came because we wanted to take soundings from a wide range of those involved in health care provision.
Mr. George Howarth (Knowsley, North and Sefton, East) rose—
Dr. Fox: I will give way again in a moment.
The Government would like us to believe that this is not the beginning of their sixth year in office but year zero for their health policy, and that if we only give them just a little more time, all will be well. They have already been in office for five years, however, and their record is hardly one to shout about.
Let me remind the Secretary of State what the real NHS looks like. We have seen the loss of 50,000 care home beds, a bed-blocking crisis, and record numbers of cancelled operations, hospital infection rates, and readmission rates among the elderly, many of whom are sent out of hospital early to make the statistics look better. We have also seen the clinical distortions arising from the Government's flawed waiting list policy.
Of course, there have been good things, too. The establishment of the Commission for Health Improvement, in particular, is a positive development. We shall wait to see whether the new primary care trusts achieve the benefits promised. When the Labour Government came to office, and when they were re-elected, they were promising more than just some improvement. Let us remember that they had 24 hours to save the NHS. That has now turned into the Prime Minister's aim to have it basically fixed by 2010. They promised us world-class public services by the next election, so it is only reasonable for us to expect them to have met some of the targets that they have missed so far.
Mr. Howarth: I want to take the hon. Gentleman back a few minutes in his speech. Most people would
accept that, at this stage in the political cycle, it is not unreasonable that the Opposition should look around and consider what policies are appropriate for them to adopt. I would certainly accept that. In the unlikely event of the Conservatives winning the next election, it would take them 12 to 18 months—perhaps even longer—to implement any new proposals. People find it perplexing at this stage in the political cycle that, in the absence of any meaningful proposals of their own, the Conservatives are not prepared to accept the Budget proposals of my right hon. Friend the Chancellor, and the proposals of my right hon. Friend the Secretary of State for reform and increased funding. The hon. Gentleman is incoherent rather than enlightening—
Dr. Fox: The choice for the Opposition on these occasions is simple. We are weighing up whether we think that the costs and benefits of the Government's proposals are sensible. The costs are certainly high in terms of both reducing personal income and increasing costs to employers, which will result in a loss of competitiveness in our economy. We have to balance that against whether we think that the Government's plans for reform will deliver. It is our judgment that they will not deliver what the Government promise and so our position is entirely justified.
We are looking not only at what the Government promise, but at what stage they should have reached according to their timetable of reform. They promised that they would achieve a set of benchmarks on the way to the 10-year NHS plan and it is reasonable for us to see whether those have been met. They promised us that more NHS patients would be treated in the private sector. They boasted in December last year of a done-and-dusted deal with the BUPA hospital at Redhill in Surrey. We now find out that nothing has been signed. So much for a done-and-dusted deal.
Before they were elected, the Government promised us an end to the indignity of mixed-sex wards, but patients still have to endure that humiliation five years into their Administration. They promised free nursing care, but it turned out not to be free because it was capped at £110 a week. They promised that by April 2002, 35 per cent. of trusts would have electronic patient record systems, but that is the case for only 3 per cent. They promised more capacity and less bureaucracy, but there are 12,000 fewer beds than when Labour came to office in 1997 and they have managed to increase the number of administrators to 1.15 for every bed in the NHS.
The Government told us that they had met the promise for patients waiting more than 15 months, with only two patients across the country now waiting for that long. When the Secretary of State announced that achievement, we were inundated with telephone calls, e-mails and faxes from people up and down the country wanting to know who the other person was.
Mr. Salmond: All that being so, can we return to thinking the unthinkable? What was the truth behind the leak in The Mirror? The hon. Gentleman is a fair-minded man and he must accept that his comments on the NHS read pretty badly. Was he lured into saying something he did not want to say? Was he tricked in some fashion? What was the truth behind that story?
Dr. Fox: The same newspaper said:
- "Today is a very good day to bury Alan Milburn"
Before, during and just after the Budget statement, it became increasingly clear that Ministers have a new lexicon. They have learned the language of reform, but what lies beneath that language? Are the soundbites made to please the private sector and the right-of-centre press, or do they have substance? There is a huge suspicion that the Chancellor has agreed to part with the cash before the plans to spend it have been finalised. Of course, that story has probably been planted by the Treasury so any failure will be blamed on the Secretary of State and will not interfere with the Chancellor's main agenda.
On Sunday, I wrote to the Secretary of State setting out a number of questions that illustrate the problems that arise because of the lack of detail in the Government's proposals. It will ultimately be the detail that matters in terms of whether the Government deliver on their programme. I asked: if money is to follow the patient, what new information technology systems will be required? Will money automatically follow any patient who wants to be treated outside their geographical area and, if so, what say will the PCTs have as they are now nominally independent? If hospitals are to be paid by results, what will happen to those that achieve no stars under the Government's rating if patients refuse to go there? What effect will that have on their funding and will they, or parts of them, be forced to close? That is an extraordinarily important question.
If patients choose to be treated in a private hospital or overseas instead of by the NHS, which has been mooted by the Government, will the entire NHS benchmark funding go with them, or will strings be attached? Will private companies competing to treat patients at nationally fixed rates be required to meet the same terms and conditions of employment for their staff as the NHS? Will the new auditors have powers to audit or inspect hospitals abroad that are treating NHS patients and receiving British taxpayers' money?
The subject of the auditor gives rise to other important questions. It will take time to introduce that office through primary legislation, time to get it up and running and time for it to report. By our reckoning, the very earliest that such a body will be able to report to Parliament is 2005. The body set up by the Chancellor to guarantee to monitor how our taxes are to be spent will not be able to report to Parliament until after the money has been spent. Once again, we are being entirely hoodwinked by spin and a false calendar—[Interruption.] As my hon. Friend the Member for North-East Hertfordshire (Mr. Heald) says, only after the next election will the body be introduced that will tell the voters how their extra taxes have been spent. What makes the difference to the provision of care is not how one audits and monitors but how one spends the money, and it is on that point that we intend to hold the Government to account.
Much has been said in this debate about opinion polls. It has been suggested that there will be much in which the Government can take comfort in the short term. This is the most popular Budget since 1977, according to the hon. Member for Croydon, Central (Geraint Davies). Oh, he has already left the Chamber—hard lines for him, but no sadness to the House. I shall just remind the Government what happened in the aftermath of that Budget. We saw Chancellors arriving at Heathrow airport, having been humiliated by the International Monetary Fund; we had the winter of discontent, and the Government were thrown out of office. If that is the precedent that the hon. Gentleman wants to follow, I am sure that we can live with that.
The clear message from pre-Budget and post-Budget polls is that there is public scepticism about the direct link between spending and outcome. There is no doubt that it is possible to spend more, much more, without success. Scotland, Wales and Northern Ireland all have spending levels per head which are much higher than those in England and, indeed, above the European average, but waiting lists in Wales and Northern Ireland are much longer than those in England, with rates of 23.7 and 33.2 per 1,000 respectively, compared with only 21.2 per 1,000 in England. Waiting times in Scotland are going up.
No one believes that with the increased cost of medical science, improvement can come without any increase in spending. Historically, health care has been underfunded in the UK compared with many of our European neighbours. The Secretary of State is entirely right about that, but it is worth pointing out that UK spending fell below the European average not in 1979 but in 1963. For all but 18 months of my life we have been falling behind our European neighbours, and when the Labour party tries to say that that is entirely as a result of Conservative Government, I have to point out that Labour was in office for 16 of those years. We clearly need a higher level of debate about attracting funding as well as about how we organise it.
We need to ask ourselves two questions. First, how do we best spend any available money to produce the best quality health care? Secondly, how much can we afford to spend? Unfortunately, the Government have those questions the wrong way round, and they have decided how much to spend before they have decided how to spend it. It was that mistaken order of priority that saw spending double in the 1990s, under both parties, and increase by £18 billion after 1998. Yet we still see increasing numbers of elderly patients trapped in hospital beds, A and E patients treated on trolleys or even on the floor and a recruitment and retention crisis among health professionals.
Nowhere in the NHS is that manpower crisis seen more clearly and nowhere is the challenge greater than in my previous area of general practice. One of the Government's central promises was that they would recruit 2,000 more GPs by 2004. They are already falling well behind that target, but I wonder how many hon. Members, even on the Government side of the House, understand quite how far. In 1996–97, the increase in whole-time equivalent GPs in England was 111. By 1998–99, that figure had fallen to 71 throughout the whole country, and in both 1999–2000 and 2000–01, the increase in England was 18.
The Government will no doubt argue that the number of trainee GPs has increased, which is correct. The number of fully trained GPs going into general practice, however, has gone down. The problem is even worse than it looks at first glance—16.5 per cent. of all GPs on 1 November 1992 qualified in overseas medical schools and roughly two thirds who were practising then will have retired by 2007. Not only will that have a disproportionate effect geographically, because of their distribution, but many of those doctors will work close to the retirement age of 65. When they are taken out of the statistics, the alarming revelation is that most UK-qualified doctors are retiring at the age of 58. Not only will the increase in the number of GPs come nowhere close to the Government's fantasy target of 2,000, but it is entirely possible that it will remain entirely static over the period in which the Government said that there would be a huge increase. There is nothing in this Budget to help the morale of the country's hard-pressed GPs.
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