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Mrs. Lorna Fitzsimons (Rochdale): Does the right hon. and learned Gentleman agree with the comments made by the president of the British Chambers of Commerce yesterday in which he said that business

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understands that it costs money to get a world-class health service and that business would pay if we did not have such a service?

Mr. Howard: I did not hear the remarks to which the hon. Lady refers, but she ought to set those remarks—if they were made as she reports them—against the other remarks to which I have referred, and she may find that the president of the British Chambers of Commerce, whom I know and who is a notable supporter of the Labour party, may turn out to be rather an isolated voice in the business community on that issue.

Mr. Andrew Smith: Does the shadow Chancellor not accept that business, too, benefits from a health service that is comprehensive and free at the point of need? Does he recollect a leaflet that he issued during the last election campaign, which said that

"Conservatives will retain a free and comprehensive NHS"?

Is that still his position?

Mr. Howard: I have explained very clearly our position on health, and I shall have some more to say about health in a moment. [Interruption.]

Madam Deputy Speaker (Sylvia Heal): Order. The right hon. and learned Gentleman is replying to a question.

Mr. Howard: So much for the Government's promises on enterprise. Now we come to their promises on tax. Ministers claim that they did not mislead people at the last election. Last week, the Prime Minister said in that characteristic way of his:

"I think we have been very straightforward with people."

Well, let me remind the House of three examples of straightforwardness from the Prime Minister and his colleagues. He was asked by the BBC during the election campaign whether any reasonable person would not suppose that Labour proposed to increase national insurance contributions. He replied: "They shouldn't."

The Prime Minister then spoke straightforwardly to the Daily Express. It ran the story under the headline, "Blair in Vow not to Punish High Earners". I do not recollect the Prime Minister making any attempt to correct that headline. He told the Daily Express:

"We are certainly not going back to 1992 and the Shadow Budget . . . We have not the slightest intention of hammering people on £30,000 and £35,000 and the higher income brackets."

The Secretary of State for Trade and Industry—who, alas, is not with us this evening—engaged in some straightforwardness of her own. She said:

"We've got no plans at all to raise that ceiling on National Insurance contributions . . . It is not going to happen."

Before the election they make these promises; afterwards, they break them.

Ms Claire Ward (Watford): I am sure that the right hon. and learned Gentleman is a regular reader of The Daily Telegraph and The Sunday Telegraph, so he will perhaps have noted the recent poll in which 56 per cent.

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of Conservative voters thought that it was right to raise national insurance. Does he not agree with those who would normally support his party?

Mr. Howard: The hon. Lady will be aware that initial reactions to Budgets often do not last very long, and I suspect that that will turn out to be so in the case of this Budget.

Last November, the Chancellor called for a debate on the national health service. There is certainly a need for that debate. The Government's policies on the NHS are simply not working. Only yesterday, I received a letter from a nursing sister, who says that the NHS has

"got worse over the past five years"

and that she now feels

"undervalued, spending over 50 hours a week dealing with bureaucracy and troubleshooting."

She continues:

"I cannot remember the last time that my hands touched a patient or I even had time to teach and train my staff".

She says that she speaks on behalf of many of her colleagues.

In Britain in 2002, people are being forced to use their life savings to save their lives. Last year, 250,000 people without any insurance paid for their own operations. In Britain in 2002, people are dying of conditions from which they would not die elsewhere. Twenty-five thousand lives could be saved every year in this country if cancer provision were as good as it is in the best of the rest of Europe. In Britain in 2002, more than 1 million people languish on waiting lists, with another 360,000 on the waiting list for a waiting list—up by more than 100,000 since March 1997.

So there is certainly plenty to debate, but the Chancellor closed off the debate in advance. He rigged the terms of reference of the Wanless report so that it would only consider a "publicly funded . . . health service". As Mr. Wanless himself pointed out, the review was asked to look only at the level of resources required. He said:

"It is not set up to examine the way in which those resources are financed".

Several hon. Members rose—

Mr. Howard: I know that Labour Members do not like listening to this—they do not like being reminded of the failures of the health service over which their Government are presiding—but they are going to have to listen to a little bit more.

Not content with laying down the terms of reference for the Wanless report in that way, the Chancellor did not even bother to wait for its conclusions. Before he had received the final report, he told the Social Market Foundation that there were no lessons to be learned from the ways in which health care is provided elsewhere.

During this debate and previously, the Health Secretary has talked about reform, but he and his colleagues have been talking about reform for years. That is all that they

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have been doing—talking. In March 1998, the Chancellor assured the House that

"investment and reform"—

would—

"go hand in hand."—[Official Report, 17 March 1998; Vol. 308, c. 1097.]

Four months later, the Prime Minister said:

"By tying the money to reform and modernisation, we shall ensure that it is spent well and wisely".—[Official Report, 15 July 1998; Vol. 316, c. 402.]

That was in 1998.

In March 2000, the Prime Minister said that

"everybody knows . . . that the NHS needs fundamental reform".—[Official Report, 22 March 2000; Vol. 346, c. 981.]

He was certainly right about that. Last year he said:

"But investment is not enough. Public services need reform . . . It is reform or bust".

On 30 November 2001, the Chancellor told The Sun:

"There will not be one penny more until we get changes to let us make reforms and carry out the modernisation the health service needs".

So where is the reform? The British people were promised that a transformation of the national health service would flow from the 1997 election and the 2001 election, and they were promised it every year in between. But where are the reforms that we were assured would accompany the last spending review? Where are the improvements that were to flow from the 10-year plan and the public service agreements? Those targets were meant to focus attention on outputs, not inputs. There has been no genuine change, and without it, we will not experience the difference.

Every year, the Government promise better public services for higher taxes, but we simply get the higher taxes. They threaten the economic prosperity on which our public services depend. We all support the ideals of the national health service: high-quality health care, available to all when they need it, regardless of ability to pay. However, the tragedy is that Britain is further away from those ideals now than at any time since the NHS was founded.

The NHS is, unfortunately, not the only service in decline. In our schools, teachers are swamped with bureaucracy. On our streets, internal Home Office figures show a 26 per cent. rise in crime in recent months. On the trains, delays caused by track and signal failure increased by 45 per cent. in the weeks after Labour renationalised the railways.

The Government have given up on reform and decided that it is all about money. Before the Budget, they were already taking £1,600 more in tax every year for every man, woman and child in the country. Spending on the national health service has already increased by a third, but the service has got worse. We do not have to look far for more evidence. In Scotland—

Several hon. Members rose—

Madam Deputy Speaker: Order. The right hon. and learned Gentleman is clearly not giving way.

Mr. Howard: Hon. Members should listen to what has been happening in Scotland, where spending on health has increased by 28 per cent. in real terms over the past

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five years. Yet the average waiting time for an out-patient appointment has gone up by more than 25 per cent. since September 1997.

In Wales, spending has increased by 30 per cent. in real terms since 1997. However, since March 1997, the number of people waiting more than six months for an out-patient appointment has increased from only 6,000 to 70,000. Of course, we acknowledge that more resources are required for the NHS, but the problem is not only down to money. It is caused by patients and professionals alike being let down by the system.

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