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8.33 pm

Andy Burnham (Leigh): Since last week's historic Budget statement, there have been questions, not least from Opposition Members, about whether the NHS is the right model on which to spend the substantial resources that are about to flow from the Government. I would encourage anybody with such doubts to visit north America, as I did with the Health Committee, including, I might add, the hon. Member for Southend, West (Mr. Amess), to see health care in Canada and the US for themselves.

There, side by side, are two health care systems, one offering high-quality care to the whole population, and doing so cost-effectively, and the other proving excellent for a minority but inadequate for many and intensely bureaucratic and costly. I was struck by the number of US health professionals who bemoaned to us the inherent unfairness of the system in which they work. We were joined on our travels by the hon. Member for West Chelmsford (Mr. Burns), a Conservative spokesman, and I am surprised that he has not taken those messages back to his Front-Bench colleagues who talk about learning from abroad.

Mr. Barker: Will the hon. Gentleman give way?

Andy Burnham: I am sorry. I do not have a great deal of time.

Perhaps the hon. Member for Woodspring (Dr. Fox), like Mr. Eriksson, is keeping his options open. He is attracted to the Swedish and Italian models but does not fancy the British much. I am picking up a feeling that there is unease on the Conservative Benches about that policy, as the hon. Member for Woodspring scours Europe for a new policy of his own. I remind the Conservative party of something that the hon. Gentleman said during the general election:

Until now, that is, as The Mirror tells us that the hon. Gentleman is rubbishing the NHS as part of a deliberate strategy to run it down.

Clearly, Conservative politicians were quick to appear in media studios at the weekend to distance themselves from the views expressed by the hon. Member for Woodspring in The Mirror. The hon. Member for Buckingham (Mr. Bercow), who has left the Chamber, was one of those who was quick to say that it would be nonsense to move away from and break up the NHS. Leading Tories were quoted in The Times yesterday expressing their doubts and saying that Labour will have a field day with the remarks of the hon. Member for Woodspring. They say that because they know that markets in health care create bureaucracy and two-tier access, which is what we saw when they introduced the NHS internal market.

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If the Tories have a point, and occasionally—very occasionally—they do, it is that the NHS has hitherto had a flaw in that it has not been sufficiently patient-focused. I agree that, for too long, NHS managers have been too insulated from public opinion and patient opinion. They worry more about Whitehall hearing the echoes of dropped bed pans than their next door neighbours. With systems to check that new money is spent wisely, we need more patient-focused responsiveness and accountability.

A good illustration of the problem is provided by the NHS complaints system. I have long had concerns that people in the health service treat it as a paper exercise with limited value. I have recently had family experience of trying to make a complaint in the NHS, and the onus is on encouraging people to drop their complaint as soon as possible. When complaints are not big enough for the General Medical Council, they are referred back to local level. People quickly find, however, that there is often no appetite to pick up those complaints and address the issues head-on. I therefore believe that the reforms being considered by the House with regard to patient involvement and empowerment must be accompanied by a recognition that the public, who, after all, are paying the bill, have a right to be taken seriously when making a complaint.

As always, those rights must come with responsibilities. Across the national health service, we are hearing how the prescribing budget is soaring. Currently, in my constituency, overspend is 12.1 per cent., and it is 7.2 per cent. nationally. That is partly driven by national service frameworks, which have brought welcome improvements in my constituency. It is also the case, however, that the public are becoming more demanding.

I recently met a group of Leigh GPs and heard them talk of visiting patients with medicine cupboards full of unused prescription treatments. They also talked of a demand for lifestyle drugs such as Losec—an anti-indigestion treatment that also, I believe, happens to be the best hangover cure known to man. Perhaps it should be made available in the Tea Room. When prescriptions are given to the public, perhaps it would help if the price of that treatment was printed on the medicine bottle to encourage more responsibility when people have those treatments and go back for more. I also encourage Ministers to consider the example of Canada, where a very progressive system of prescribing according to ability to pay has been introduced.

It may also be time to review the exemptions for prescriptions and to come up with a fairer system. The prescribing of Statins, however, as required by the national service framework, will be one of the most effective health interventions and will tackle the very high rates of coronary heart disease in my constituency. The high rates of ill health in my constituency mean that that policy will cost more.

That brings me to the formula whereby the new resources are to be distributed. Just as welcome as the new money is the Department's commitment to review the formula. This year, the system will provide £858 per person in Leigh, which is £37 less per person than neighbouring East Lancashire health authority will receive, £53 less per person than North West Lancashire health authority, £61 less per person than Wirral health authority, and £67 less per person than Sefton health authority. Given that in his annual report the chief medical officer highlighted the fact that in parts of my

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constituency death rates are the same as they were in the 1950s, there must be something wrong with the current formula if those are the outcomes it produces.

The formula gives equal weight to four factors: age profile, additional need, market forces and emergency services. It will never give us the resources that we need to tackle health inequalities. Older people draw heavily on the NHS, but the older population is one that is, by and large, healthier and living longer as a result. Any new system must give greater weight to deprivation and rates of ill health, so that the money follows sickness.

I have a word of warning about the market forces factor in devising a new formula. We have heard today about the difficulties facing key workers in London, but inner London health authorities already get significant resources to reflect those difficulties: for example, Lambeth, Southwark and Lewisham health authority gets £1,076 per head, and Camden and Islington health authority £1,204 per head—substantially more than Leigh's £858 per head. There is a good reason for that, but we should be wary of creating a formula that gives even more, fuels the property market and widens the north-south divide further. In addition, it can cost more to attract good-quality staff to the most deprived areas, which offer fewer incentives to prospective workers.

As well as good staff, deprived areas need extra facilities, principally because the private sector tends to be less well developed in such areas. Perhaps the Government should consider siting the new diagnostic and treatment centres in constituencies such as mine, where the private sector is unlikely ever to develop substantial capacity of its own. With the new resources, efforts should be made to renew the primary care facilities base. Most people's direct contact with the system is through primary care, and I think that renewal could be achieved fairly quickly.

New ways have to be found to ensure that the extra money coming into the NHS in the next few years is not devoured by hungry acute trusts. Now is the time to alter the balance of funding and innovate to create new models of care delivery. As well as boosting primary care, which will relieve pressure on the acute sector, we should expand non-acute NHS nursing capacity in the community. As the problem of bed blocking shows, the NHS is not the master of its own destiny: it cannot order local authorities to move people out of hospital, nor does it control residential care places in private homes. More flexibility is needed to move people through the system.

The United States system offers us some interesting examples of financial incentives to move people quickly through the system, and of forward planning to adapt people's homes so that they can live as full and as normal a life as possible after leaving hospital. That is what the NHS should be all about—not only treating sickness, but taking the broadest possible view of helping people to live full and healthy lives. Now, it has the resources to do that.

8.43 pm

Mr. Gregory Barker (Bexhill and Battle): After five years of Labour Government, the Chancellor in his Budget has correctly identified the most pressing concern of the broad mass of the British electorate: the declining state of our great public services. No public service

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arouses more anxiety than the national health service. Despite extra cash, the number of cancelled operations in the East Sussex, Brighton and Hove health authority has leapt by a staggering 138 per cent. in the five years since 1997. That is a clear illustration of the fact that behind the hundreds of thousands of committed individuals who staff our surgeries, hospitals and clinics, stands a 50-year-old system that is creaking at the seams. It is sad, but little wonder, that this year a record 250,000 patients who were without private insurance felt compelled to dig into their life savings to purchase private health care.

Despite publication of the final report of the Wanless inquiry just five hours before the Chancellor gave his categorical response in the Budget, we know that the Budget will not be the last word on health care in Britain—far from it—but has merely raised the political stakes. The Prime Minister said that he himself will carry the can if the Chancellor's massive tax and spend solution is found wanting, but the true arbiter of the success or failure of Labour health policy will not be the Prime Minister or even the Government's new army of super-auditors and cost accountants but the British people at the ballot box.

I wonder whether the Chancellor and the Prime Minister on their publicity tour of Chelsea and Westminster hospital found any nurse, doctor, staff member or patient enthusiastic about the prospect of yet more auditors and accountants. At the heart of this tax-raising Budget lies the Chancellor's plans to increase health spending above the rate of inflation for the next five years. To be fair, however we look at it, the significant increases amount to a huge boost for NHS funding, but we all know in our heart of hearts that the NHS has a proven ability to swallow large amounts of taxpayers' money without any discernible improvement in the organisation.

With the Budget, the Chancellor has embarked on a clear course to increase the burden of direct taxation to fund the growth of the NHS and welfare spending. He has brought forth an array of measures that will hit both individuals and families. Indeed, despite the Budget being presented as family-friendly, 50 per cent. of families with children will be worse off. Nor has business escaped, as there is yet another Government-imposed increase in employment costs. However, unlike previous Budgets, which relied on stealth taxes, the current full-frontal attack makes a welcome partial break with dishonest back-door taxation.

While we may disagree about particular fiscal measures, I believe—and our debate has confirmed it—that there is still broad consensus on a range of health care issues, particularly goals. We all want a world-class health care system available to all and based on need, not the ability to pay; that is sacrosanct. But a clear difference is opening like a chasm between the Opposition and the Government about the extent to which the NHS should embrace reform and to which we as a nation should embrace the best practice in health care that prevails in other parts of Europe, where waiting times are shorter and survival rates higher.

Looking positively at that political divergence, I hope that for the first time since the war, we can embark on a grown-up and sensible national debate about the best way

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forward for the NHS without the usual partisan scaremongering and name calling that is such a big turn-off for the electorate.

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