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John Mann: I merely seek slightly more clarification: definition of the word "substantial". The amendment is an attempt to frame legislation, so it is important for the hon. Gentleman to assist our deliberations by giving us a

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definition of "substantial". Will he be precise about the basis on which an employer would pay the lower rates under his proposal?

Mr. Bercow: The hon. Gentleman is a new Member but he is astute and well informed so I think that he will be aware that when one tables amendments one discusses them with the Clerks, who provide guidance on such matters. The drafting requirements of the Bill, as we have been informed, are such as not to enable us to go into the full details that we would want in due course to pursue. If the hon. Gentleman is putting it to me that, to guarantee efficacy and avoid abuse, we would need some precise definition in practice and some scheme that might require the approval of the Secretary of State, he has a fair point.

There was a very poorly drafted amendment in the last group, on which it would be cruel to focus for too long, but in respect of which the hon. Member for Oxford, West and Abingdon (Dr. Harris) and his sidekick, the hon. Member for Truro and St. Austell (Matthew Taylor), observed in cavalier fashion that the fact that they had not provided for its application to Northern Ireland was a piddling point that it was pedantic of me to insist on raising. In this case, I think that the hon. Member for Bassetlaw will accept—

John Mann rose

Mr. Bercow: The hon. Gentleman might get a third go in due course but he must exercise what patience he can muster. The fact that I have not gone as anorakishly into the detail as his natural earnestness and curiosity demand does not of itself invalidate the purpose of the amendment.

6.15 pm

The hon. Gentleman would, I fear, like to take us away from the thrust of the argument, which is this: some employers are helping their employees by providing health insurance packages; under the Government's Bill, those employers—despite their forward-looking and employee-friendly policies—will be obliged to pay the tax hike in respect of care for which they are already privately making provision for most of, or even all, their employees. We are suggesting—

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

Mr. Bercow: I am always happy to give way, but the hon. Gentleman must be patient. He is doing considerable damage to the leather of his Bench by the frequency of his springing up and down from it—not something that I have ever done, as he will readily testify.

My right hon. and hon. Friends and I think that it is unfair that employers should be obliged to pay twice. We can dilate on that matter. Indeed, I have a suspicion that, subject to your patience and restriction Sir Alan, we might be in for something of a dilation on the subject in the period ahead. However, I do not want in any way—

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

Mr. Bercow: In a moment. I promise the hon. Gentleman that I shall give way to him. I am always intoxicated by his interventions—there is no reason why tonight should be different.

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We must not leave the central argument. Is it fair that employers pay twice, or is it unfair? If hon. Members believe that it is fair that employers should have to pay twice, they will support the party of iniquity and vote with the Government. If they believe that it is unfair—if they have a social conscience and favour a progressive approach—they will support the Conservatives. That is the thrust of the choice that lies before us.

John Mann rose

Mr. Hendrick rose

Mr. Bercow: I shall in due course give way again to the hon. Member for Bassetlaw if he is patient, but meanwhile I must give way to the hon. Member for Preston (Mr. Hendrick).

Mr. Hendrick: I thank the hon. Gentleman for giving way and I hope that I can intoxicate him to a level at which he feels satisfied.

Given his concern for responsible employers who want to provide private health packages for their employees and his concern that some employers might, as a result of this debate and the subsequent vote, end up having to pay twice, is he in favour of making all employers provide private packages so that no individual in any company in the land is without private health insurance, thereby removing the need for the extra 1 per cent. that the Government are adding?

Mr. Bercow: No. I applaud the hon. Gentleman's ingenuity. I do not want to get too personal, because I like him very much and enjoy jousting with him, but it is unfair—purely, of course, in the context of the amendments on which we are narrowly focusing—that his efforts have not been rewarded so far. I shall have a private chat with him, but in view of how hard he is trying he is suffering cruel and inhumane treatment by having to sit on the Back Benches and not on the Treasury Bench.

The hon. Gentleman is ingenious, but the answer is no, we are not advancing the proposition that all employers should have to provide health insurance. We are not arguing for the privatisation of the system. On previous occasions, he has discussed with us precisely what our health proposals will be. It is to his credit that he tries to establish the answer through both the back door and the front door, through punching above our heads and punching below our feet. He goes hither and thither, this way and that but as yet he has been disappointed, because we are not prepared to provide him with the answer that he would find convenient for his purposes.

However, so that we can be clear and so that it will not be necessary for the hon. Member for Bassetlaw to intervene in a similar way—although he may use different devices in due course—I make the argument explicitly. We are looking at our health care policy. We are doing so with an open mind, in contrast to the closed minds of Labour Members.

The Government's position is clear—it is not in any sense stealthy—and it is honest. Their position is to say that they have learned nothing over the past five years from the countries of continental Europe which translate

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care more effectively from a word to a deed than they do, and they do not think that they have anything to learn from them in the next five years either.

Mr. Tom Harris (Glasgow, Cathcart): Will the hon. Gentleman give way?

Mr. Bercow: The hon. Gentleman does not enjoy the truth being blurted out, but I am afraid that he will have to suffer the results, at least for a short time.

The position of Conservative Members is that we can learn a lot from other countries, whose records on cancer care, cardiac surgery, choice among GPs, guaranteed treatment after 28 days, and no national waiting lists, as in Germany, show that they do things better than we do. We want to look open-mindedly and in detail at those countries. We will consider all the different systems, establish what is best practice, discover what is in patients' interests and, as I have said before, make a judgment.

I do not suppose that the hon. Member for Preston heard me at lunchtime yesterday—it would probably have spoiled his digestion if he had. I do not blame him, but I made the point yesterday—I have to repeat it now—that the Conservatives will consider what needs to be done in the health service, what reforms are required for the purpose, how much those reforms will cost and in what way they should be financed. When we have gone through that considered and logical process of study, we will produce a conclusion. It will be a detailed, credible, costed and attractive alternative to this Government's persistent and disappointing failures in health policy. In due course, that policy will be unveiled by my hon. Friend the Member for Woodspring (Dr. Fox), the shadow Secretary of State for Health, and I hope that the hon. Member for Glasgow, Cathcart (Mr. Harris) will not be disappointed with the results.

John Mann rose

Mr. Bercow: The hon. Gentleman has had several goes. He favours equity of treatment, so he will expect me to give way first to the hon. Member for Glasgow, Cathcart.

Mr. Tom Harris: The hon. Gentleman claims that the Government have not learned from the experience of others. May I suggest that they have learned a great deal from the experience of 18 years of Conservative Government, and so have the electorate? That is why a huge investment in the NHS has been planned, in complete contrast to what the Conservative Government did in those 18 years.

Mr. Bercow: That is a disappointing intervention. I have listened many times during the past 12 months since the hon. Gentleman was elected, and I have been impressed by what I have heard. He is capable of so much better than what he has just delivered, so I am sorry that he delivered it. I say that in relation to the arguments that we shall enunciate for assistance for employers who provide health care insurance for their staff, and I do so conscious of some of the facts in Scotland.

I should have thought that the hon. Gentleman, of all people, would be well informed about the position in Scotland. If he is as well informed as I thought that he

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was and as I know that he should be, he will be aware of the extraordinary combination of facts on health care provision in Scotland. On the one hand, since his party took office in 1997, there has been a 28 per cent. real-terms increase in expenditure on health but on the other, concurrent with that increase in expenditure, there has been an average increase of 25 per cent. in the waiting time for treatment.

That emphasises the patently true fact that, in health care, it is not simply a matter of increasing spending. Sadly, the hon. Member for Rhondda (Mr. Bryant) is not in his place today, as he had some difficulty grasping that point when I explained it to him. Manifestly, if expenditure is increased without an accompanying reform, we will not achieve the improvement in performance that we all want. We know in relation to many aspects of health delivery in Scotland that there is more money, but there is not a better performance.

I have already been in danger of straying from the narrow course of the amendment, which I want to commend to the Committee. That is ultimately my responsibility, but because of my natural generosity of spirit, I wanted to give way to Labour Members to allow them to release their frustrations.

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