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7.32 pm

Dr. Richard Taylor (Wyre Forest): I remind the House that I am a retired NHS doctor and that I have registered interests in some investments in health-related businesses.

With some provisos, I welcome the Budget, especially the Chancellor's commitment to the original ideals of the NHS. I am a passionate supporter of the NHS, having worked in it for a long time, and I am delighted that the Government are giving it what may be its final chance to improve and succeed when funded from taxation. The Government realise that they are putting their head on the block by staking all on improving the NHS.

As an Independent Member, I want to examine briefly some of the proposals and then discuss what is missing. I am delighted with the devolution of power to primary care trusts. That goes back a decade or more to the 1980s when local, small health authorities were responsible for running their small part of the health service. At that time, there was much more input from the hospital consultant; and, with the loss of the strict purchaser-provider split, I would like to see some input from hospital staff to PCTs. GPs should also have some accountability for hospital services.

I am delighted that power is moving away from the centre, but will devolution be real? Will central diktat still sway some decisions? I am thinking especially of NICE guidelines, which I fear might sway local priorities and override local decisions. Today, I received a letter signed by 30 senior clinical oncologists, expressing their disagreement with a recent NICE decision. The letter states:

I am worried that NICE may sway priorities.

I am delighted that the Commission for Health Improvement has been given more power. It is a logical step to amalgamate it with the Audit Commission and the National Care Standards Commission. That will avoid so many visits to trusts and health authorities and demands on their time. The CHI showed its capabilities by promptly removing stars from hospitals that it had inspected, illustrating the lack of reliability in the current star rating system. I am waiting to see whether league tables become more reliable under the new organisation.

I am rather worried that local authorities may be penalised for delayed discharges, even when a strong reason for such delays could be that a health authority had reduced capacity without considering the need for intermediate care.

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I approve of the plan for electronic booking of all appointments by 2005, although it is terribly challenging—an extremely tall order. It implies that IT systems throughout the health service will be able to talk to each other. We are also to have electronic patient records by 2008. The Government will be judged on such measures.

The loss of community health councils is disappointing. I cannot put it better than the Opposition health spokesman in the other place who, in a recent letter to The Independent, stated:

I have one or two comments on what is missing from the proposals. We need open, honest discussion of health care rationing. Political parties tend to veer away from that and are frightened of it, but it is essential.

Other hon. Members have mentioned the reform of health care management. Sir Terence Conran, writing in The Sunday Times recently, pointed out how marvellous we are in this country at organising events such as the Queen Mother's funeral. We have some superb businesses in my constituency: we make the best carpets; and amazingly, in the middle of England, we make superb ocean-going cruisers. We can do things well. In parts of the NHS we are doing that, so why are we not doing it in every part of the NHS? Excellent management is important.

As other hon. Members have mentioned, there is nothing in the proposals about abolishing waste. Hon. Members have referred to the report by Stuart Emslie, although it has been somewhat brushed aside. In December 2001, it noted that the removal of waste and fraud could save the NHS £7 billion a year. Sick pay and agency nurses account for £2 billion of that amount. Hon. Members who read The Sunday Times—one of the more reliable papers—will have seen that it recommended that people buy shares in a firm specialising in nursing agencies. Seven years ago, its share value was 44p; at present it is 560p.

The answer to the problem is a massive pay rise for nurses. That would go against devolution, but it is the one measure on which the Government should override devolution. It would stop us losing nurses who go abroad. Nurses would not leave the profession. They are our most precious resource and we are wasting money on agencies when we should be paying it direct to them. That is the only directive that I want the Department of Health to give the devolved bodies.

I will not go into all the details of the waste, but I shall list a few of them. We have heard about adverse events, such as delayed discharges, hospital-acquired infections, the over-prescription of drugs and clinical negligence claims. However, we have not heard about two of them: the cost of pay and locum fees when doctors are suspended—those suspensions can go on for two years and more—and the cost of patients not turning up for appointments. I met representatives of a firm today who think that they have an answer to that issue, and they will be persuading some trusts and the health authority to try to get to grips with it.

Dr. Evan Harris: I always worry when I hear doctors attacking patients for not turning up. Patients are often too

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ill to do so because they have deteriorated while waiting—some may even have died. No clinic that I ever worked in—perhaps the hon. Gentleman will remember this, too—did not over-book to allow for missed appointments, so it is hard to argue that the predicted non-attendance rate costs money when clinics and operating lists are over-booked. That seems like blaming the patients.

Dr. Taylor: I take the hon. Gentleman's point. I am certainly not blaming the patients, but published studies have shown that tremendous savings can be made in that way.

I shall move on to deal with local waste. I was very envious of the hon. Member for Erewash (Liz Blackman) because the majority of letters that she gets are complimentary. I wish I could say that since being elected I had had one letter that was complimentary about the NHS. I am sure that all hon. Members have examples of local waste in their own constituencies. I have the shining example of the closure of all acute in-patient services at a charter-marked efficient hospital, which many sources now readily admit was purely for financial reasons. One can imagine my constituents' derision when they are told that 40 new hospitals will be built, and one that stands largely empty could reduce that number to only 39.

Local affairs are made worse by the inadequacy of the replacement service provided; I receive letters about that almost daily. This weekend, a local Sunday newspaper damned, with local people, the replacement services that are available. Even worse, there is now a plan to spend £14 million on gutting a six-year-old block to recreate what, in the words of a disillusioned manager, we have got already.

Thus I shall support the Government's giving the NHS funded by taxation a final chance, but I draw to hon. Members' attention a quotation from a playwright. In 1624, in a play entitled "The Parliament of Love"—this is certainly not the Parliament of love, but it is a Parliament and the words are very relevant—Philip Massinger wrote:

The Government will be judged on their performance from now on. We have the words; we are waiting for the performance.

7.43 pm

Mr. Adrian Bailey (West Bromwich, West): The Budget will be welcomed in my constituency. Hon. Members will be aware that West Bromwich, West is in the heart of the industrial black country—the country's manufacturing heartland. Before I talk about the Budget's relevance to my constituency, I should like to say that today I am wearing the latest manifestation of the entrepreneurial spirit that still lives in the black country. I am of course talking about my St. George's rose, which is promoted and manufactured by the Tipton branch of the Royal British Legion. May I tell those hon. Members who have asked me where I got my rose that, for future St. George's days, I will be happy to contact the local officers to ensure that they are not denied that latest privilege and manifestation of the industriousness of the area that I represent?

I shall move to the specific Budget issues. My constituency was devastated by the monetarism and the boom and bust of the Tory Government. During this

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four-day debate, I have listened to dire warnings from Opposition Members about the state of British economy and the damage that the Budget would do to British industry. Those warnings sound hollow to my constituents. That so-called business-friendly Tory Government, who, by their long-established contacts and innate ability, are so good at managing the British economy, caused two recessions when almost every major manufacturer in my constituency—some of them household names—disappeared. They left behind devastation, and people's livelihoods and prospects were wiped out. To compound that, round after round of public sector cuts took further money out of the local economy and deprived people of their local services in the name of trying to create the very sort of enterprise and initiative that they had wiped out in the area.

Since then, under Labour, we have had two recessions, but employment has risen and economic growth has improved. My constituents will judge by their personal experience, and I am confident that they will know how to judge the improving prospects and public services under Labour, compared with their experience under the Tories, and that they will back the Government.

The reasons for those improvements are the low interest rates and low inflation which have underpinned our economic performance. To be fair, I have heard Opposition Members pay credit to the Government for that. However, Opposition Members have two explanations: one is that we inherited some sort of largesse from the previous Government; the other is that the true, debilitated state of our economy is being masked.

I have also heard Opposition Members say that the 1 per cent. extra national insurance cost will devastate local industry and be a tax on jobs. I am confident that that prediction will be as accurate as their prediction about the independence of the Bank of England and the possible cost in jobs of the minimum wage.

I do not deny that my constituency still has a long way to go before reaching the affluence of some areas, but unemployment in the most deprived ward has dropped from 25 per cent. in 1994, to 8 per cent. now—still too high, but an enormous improvement. Behind every percentage statistic, there is a tale of new hope, new commitment to work and a new contribution to the local economy.

The package of measures to help small businesses will be welcome. We no longer have the huge manufacturing employers in the area, but new businesses are starting up and creating jobs. The corporation tax reduction, VAT reliefs and research and development credits will all play a part. I also welcome the StepUp pilot scheme. Its aim is to provide a further 360 people in the most deprived ward in my constituency with the opportunity of a year's employment for the first time in many years, so that they can gain self-respect and self-discipline and enjoy the knowledge that they are contributing to the local economy.

I am sure that the 1 per cent. increase in national insurance contributions, which has been long debated in the Chamber, will be opposed by some. However, if one looks at what companies are getting for it, it is obvious that it is an investment that will benefit everybody. Yesterday, I heard my hon. Friend the Member for

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Telford (David Wright) talk about the cost to industry of sickness at work—£10.7 billion a year. If only a proportion of that is saved, that will be an enormous benefit to industry.

I read in yesterday's Guardian that late trains cost every company £21,000 a year, so our investment in the transport system has an obvious dividend for business. Other transport investments are much sought after in my local area, and they are being provided. Similarly, local companies want more police—and we are investing in more police—because they know that that reduces the chance of burglaries and the costs that accrue from them.

I could go on, but in essence the 1 per cent. on national insurance will provide the investment for a healthy, well educated, more mobile work force. That is an enormous long-term investment for local industry. Investment in human capital is every bit as important as investment in other capital.

I turn to health and social services. When I hear Conservative Members talk about the health service, I am not surprised that they are slipping behind in the opinion polls in that respect. Smoke and windows is a phrase that is often used in this House.

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