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Mr. Rammell: I welcome the hon. Gentleman's statement that he remains committed to the national health service free at the point of use. If that is the case, can he explain what the shadow Secretary of State for Health meant by "self-pay"? What does that concept mean to the Conservatives?

Mr. Bercow: The hon. Gentleman has not grasped the reality of the situation in which we find ourselves. We have a two-tier system. Last year, 250,000 people without insurance paid for their operations. It should not be necessary in the year 2002 for people to use their life savings to save their own lives. My hon. Friend the shadow Secretary of State for Health has said that people are having to pay, and he does not want that situation to become worse. He recognises the need for reform and he is considering the various options. He knows that the Government have made a mess of things. I say to the hon. Member for Harlow (Mr. Rammell) that my hon. Friend has probably forgotten more about the national health service than the Secretary of State knew in the first place.

Mr. Chas Roy-Chowdhury spoke about the savage imposition on married women, as reported in the Financial Times on 3 May. He is the head of taxation at the Association of Chartered Certified Accountants. He said:

this is hardly a laughing matter, even for the hon. Member for South Shields (Mr. Miliband)—

There is speaking with forked tongue, the breaking of promises and picking on the most vulnerable. It is clear that there are no depths now to which new Labour will not sink.

John Whiting is a tax partner at PricewaterhouseCoopers and president of the Chartered Institute of Taxation. He often quizzes people as to what is the second biggest tax

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after income tax. It is not value added tax, it is not corporation tax and it is not petrol duty. It is the national insurance contribution. As he said:

What has been the reaction of business to what has been unveiled by the Chief Secretary and his ministerial colleagues? The CBI says:

The head of the Engineering Employers Federation, Martin Temple, observes:

Nick Golding of the Forum of Private Business labels the rises

Ian Fletcher of the British Chambers of Commerce attacked the rise as "indiscriminate".

Vernon Coaker (Gedling): The hon. Gentleman has quoted many organisations. Will he quote ordinary people? Will he quote what individuals in our constituencies are saying about the extra investment that will go into the national health service, and how important they think that extra investment is? Does he think that to quote them would be worth more in this debate than quotations from representatives of the organisations to which he has referred?

Mr. Bercow: I am slightly perturbed by the hon. Gentleman's intervention. The individuals to whom I have referred would find it peculiar to be described as in some way extraordinary. They have the advantage of the hon. Gentleman because they boast experience and expertise that lend authority to their pronouncements. However, the hon. Gentleman is always good at egging me on and encouraging me in debate. If he will exercise some patience, which is a virtue, he will recognise that I intend to refer to the impact of the measures set out in the Bill on the very ordinary people for whom he purports to care.

Mr. Andrew Smith: Is the hon. Gentleman prepared to quote the shadow Chancellor of the Exchequer, who may be an ordinary person? At the last general election, he said:

Will the hon. Gentleman repeat that pledge? If he cannot, why not?

Mr. Bercow: I am disappointed in the Chief Secretary. He should know by now that my right hon. and learned Friend the shadow Chancellor of the Exchequer is an ordinary person blessed with extraordinary abilities. That should be patently apparent to all Members of this place and others well beyond. [Interruption.] The hon. Member for Dumbarton (Mr. McFall) must contain himself; he must exercise what restraint he can muster. I know that he is a distinguished Member of this place and I believe that he is the Chairman of the relevant Select Committee. I say to him in all kindness that if he behaves himself, I will give way. If he does not, I will not. He has a simple choice, but he must allow me to deal first with the Chief Secretary, which I shall relish. My right hon. and learned

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Friend the shadow Chancellor, and all my right hon. and hon. Friends and I are committed to an improved NHS which serves the people of this country instead of letting them down. I reiterate the fundamental principle that the availability of health care should be determined on the basis of need, not ability to pay.

Mr. Kevan Jones (North Durham) rose

Mr. Bercow: The hon. Gentleman must wait.

That consideration is so strikingly clear that, as the late Enoch Powell used to say, only an extraordinarily clever person could fail to grasp so simple a point.

Mr. David Cameron (Witney): On the impact of the increase on ordinary people, is my hon. Friend aware that the John Radcliffe hospital, which serves the Oxford, East constituency of the Chief Secretary, as well as the constituencies of the hon. Member for Oxford, West and Abingdon (Dr. Harris) and myself, is short of 300 nurses and its vacancy rate is running at 14 per cent? Has my hon. Friend calculated the effect of increased national insurance contributions on trying to hire badly needed staff in our hospitals?

Mr. Bercow: It is very simple; the bull-headed and short-sighted policy on which the Government seem intent will make a difficult task much more difficult.

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

Mr. Bercow: In due course; I do not want to squander the hon. Gentleman's contribution. His professorial interventions are of great value and it would be a pity to waste one just yet. If he will allow me, I shall store him up and deal with him a bit later.

Most strikingly of all, Stephen Alambritas of the Federation of Small Businesses stressed that taxes will rise for 3 million self-employed workers. Pointing out that the average income from self-employment is just £13,890 a year, compared with an average income from employment of £21,842 a year, he rightly castigated the Government for undermining any attempt to help the low-paid. My right hon. and hon. Friends will have noticed that whenever I have spoken today about increased burdens, higher taxes and objections from business and other organisations, Government Members have been determined to throw me off the scent. They do not want to talk about damaging consequences, to focus on the realities or to acknowledge the protests that are springing up from reputable organisations and individuals the length and breadth of the United Kingdom, because they prefer to live in an ivory tower. They can try to do so, but it will not work; we shall point out the damage inflicted by their policies.

John Mann (Bassetlaw) rose

Mr. Bercow: The hon. Gentleman is a regular contributor to our debates; I anticipate eagerly what he has to say, but he will not say it just yet.

The timing of savage tax rises could scarcely be more insensitive. In the past year, manufacturing output has fallen at its sharpest rate for a decade. Manufacturers are

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struggling in a sea of tax, regulation and administrative complexity which is deeper and more hazardous than ever before. Ministers' response has been to deliver a financial body blow by jacking up the cost of employment. It is no wonder in those circumstances that representatives of no fewer than nine manufacturing industry trade associations from the plastics, rubber, coatings and associated machinery and tool-making sectors, speaking for 315,000 employees, fired off a letter of protest to the Chancellor and the Secretary of State for Trade and Industry only last Wednesday, complaining that a staggering 78 per cent. of all the new money to be raised in 2003–04 will be grabbed from business. If the Chancellor knows that for 20 plastics companies the extra bill will be £3.4 million a year, or that 60 per cent. of them plan to meet that cost by cutting jobs, he should be ashamed. If he is ignorant of that important fact, it is frankly time he did his homework.

Mr. Chris Bryant (Rhondda): Earlier, the hon. Gentleman said that the shadow Chancellor was an ordinary man of extraordinary talents; he seems to be proving this afternoon that he himself is an extraordinary man of ordinary talents. He said that the increases in national insurance contributions on both sides may be a tax on jobs. What is unemployment in his constituency, and what was it in 1997? How does he explain the fact that it has fallen by 55 per cent.?

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