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8 Jan 2003 : Column 188—continued

Mr. Milburn: That is simply not true—[Interruption.] If the hon. Gentleman and his hon. Friends give me a moment or two, I shall explain why. He is citing hospital episode statistics or HES figures, which count certain forms of activity, but not all. They include elective activity, but they do not count, for example, the procedures carried out nowadays with out-patients or primary care that used to be carried out with in-patients.

I know that the continual refrain from the hon. Gentleman and Opposition Members, for self-evident reasons, is that money never works or never gets to the right place in the national health service, so investment simply is not worthwhile. We know why they say that—they must justify their 20 per cent. programme of public spending cuts. However, I ask them to tell that to the 250 million patients being seen in primary care each year, more than 80 per cent. of whom now get appointments within two days, although many used to have to wait for weeks. They should tell it to the extra 750,000 people who get hospital operations each year, the 500,000 cancer patients who are now being seen within two weeks, although many used to have to wait months to see a hospital specialist, or the 30,000 cancer patients who are now eligible for the best and latest cancer drugs while there used to be a lottery in care in cancer drug treatment. Perhaps most importantly, they should tell it to the patients who are waiting for a heart operation and will, by April this year, have seen maximum waiting times halve from 18 months—the position that we inherited from his Government—to nine months, which is the position that will be reached in a few months.

How on earth does the hon. Gentleman think that those improvements have happened? Does he think that they have happened through the invisible hand of the free market, to which he and his hon. Friends are so deeply attached? They have happened not through the free market, but precisely because of the extra resources that the Government voted for and the Opposition voted against.

Dr. Stoate: It is puzzling to hear claims from the Opposition that hospital treatment is not improving when I can tell my right hon. Friend that in the Dartford and Gravesham NHS trust, the Darent Valley hospital has just been awarded a diagnostic and treatment centre worth #9 million and there is expansion in the A and E department. The chief executive wrote to me this week to say that the trust had hit every single target that the

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Government had set and that it was very proud of the achievements that it had managed to produce. How can that square with the Opposition's claim that hospital treatment is failing?

Mr. Milburn: Because the Opposition have a story to tell. The story that they want to tell is that investment never works, that the public services can never deliver, and that it is not worth putting extra investment and resources into, or reforming, the national health service. The hon. Member for Woodspring was candid enough to admit in his speech that he does not believe that the NHS has ever worked or can ever work. The Conservatives therefore have to justify their attacks on the NHS and their policy, as set out by the Leader of the Opposition, of a 20 per cent. cut in public spending, not just in the other public services but in the national health service, too.

Dr. Fox: I would like to clarify for the House what I said before, because the Secretary of State will otherwise be misleading us in his interpretation of it. I said that the way that the NHS is currently constructed and run is not working and could not work. That is absolutely true and it is why the Prime Minister is demanding reform. In its current form, the system will result in money being sucked in and nothing coming out the other side.

Mr. Milburn: That is not what the hon. Gentleman said to the Conservative party conference, unless the Daily Mirror is wrong. I have not yet seen a letter of objection from the hon. Gentleman in the letters column of that newspaper. [Interruption.] The hon. Gentleman asks whether it has a letters column; he should do a bit more reading. It would be good for his soul and get a bit of breadth into his life. He told the Conservative party conference—this was faithfully reproduced by the Daily Mirror—that his strategy was to persuade the public that the NHS is not working and has never worked before. That is the policy of today's Conservative party.

Several hon. Members rose—

Mr. Milburn: I give way to the hon. Member for Chichester (Mr. Tyrie).

Mr. Andrew Tyrie (Chichester): The Minister has said that the NHS is working, but does he not realise that there are some extraordinary absurdities in the way in which funds are currently allocated? The King Edward VII hospital in my constituency is facing closure because primary care trusts are unable to fund the operations and the work that has been carried out there. Is the Secretary of State aware that many people in my constituency are being sent abroad for orthopaedic treatment when they could perfectly well be treated up the road at King Edward VII? They cannot be treated there because of the absurd budgetary arrangements operating in the NHS today.

Mr. Milburn: As I have said to the hon. Gentleman when he has raised this issue with me privately, I shall be very happy to look into it. He has written to me about it today, and I have his letter with me. I shall respond as soon as I can. I would, however, sound a note of caution. If he believes, as he does, that his local private

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hospital needs extra resources from the local primary care trust to secure its future and better to secure services for NHS patients—I accept that there will be a relationship between those two equations—he has to be able to answer one difficult but important question. Does he believe that the extra investment that the Labour party voted for and that his party voted against is necessary—yes or no? I know that when he had the opportunity to answer that question, he voted against the extra resources.

Sir Nicholas Winterton (Macclesfield): Will the Secretary of State answer one specific question? I am sure that he will agree that the hospice movement is a vital and excellent part of health care in this country. Will he tell me whether it is sensible for four beds in a 15-bed hospice in my constituency—the East Cheshire hospice—to be closed because it cannot fund the staff to man them, when there is a growing need for remedial and other care in hospices? Are the foundation hospitals going to be able to enter into contracts with hospices to enable them to run efficiently, and to provide the beds that are desperately needed?

Mr. Milburn: On the second part of the hon. Gentleman's question, that will be a matter for the NHS foundation hospital to determine. It will be determined locally, not nationally. The hon. Member for Woodspring has been urging me to see that as the right way forward. On the hospice movement and palliative care services more generally, I want to associate myself absolutely with the remarks of the hon. Member for Macclesfield (Sir Nicholas Winterton). Hospices do a sterling job, which is why the Under-Secretary of State for Health, my hon. Friend the Member for Salford (Ms Blears), who has responsibility for public health, has announced extra resources over the last few weeks specifically for palliative care services, including for hospices not only in the hon. Gentleman's constituency but in constituencies up and down the country.

Ms Julia Drown (South Swindon): I have no doubt that the extra investment in the NHS is needed or that it is having a significant impact in my constituency. We have NHS dentistry back in Swindon, and we have a walk-in centre, a new hospital, and much more besides. The Opposition are wrong to suggest that 20 per cent. extra money should produce 20 per cent. more activity. If we are going to make up for the supposed efficiency improvements that were in fact cuts after cuts in the Tory years, and if we want to relieve the huge pressure on staff, we need money without a corresponding increase in patient care. This debate is about foundation hospitals, however—

Mr. Speaker: Order. The hon. Lady has not asked a question. She must now stop.

Mr. Milburn: I agree with that part of what my hon. Friend was saying. I am not sure that I would have agreed with the second part, but there we are.

I want to set out, as the Government amendment does, how our proposals for NHS foundation trusts fit into the wider programme of NHS improvement and reform. Today the national health service is the fastest-growing health service of any major country in Europe.

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Six years ago, under the Conservatives, NHS budgets were falling in real terms. By 2008, they will have doubled in real terms. That is the difference between a Labour party committed to a policy of investment in the health service and a Conservative party committed to a policy of cuts in the health service—a policy that would lead not to reform in the NHS but only to its abandonment.

In a world in which health care can do more, but costs more, than ever before, it is an enormous source of strength for our country that we have an NHS based on the right values, namely of health care that is free at the point of use, because none of us knows when we will get ill, how long it will last or what it will cost. There has never been a time when these NHS values have been more relevant. Today's world of medical advances and technological changes occurring almost by the week positively calls for health care based on the scale of a patient's need, not the size of their wallet. And yet, for all its great strengths—most notably its staff and their ethos of public service—the NHS has major weaknesses too.

For more than 50 years, uniformity in health provision has not guaranteed equality of outcome. Indeed, it is sad to say that, over those 50 years, health inequalities have widened rather than narrowed. Most hon. Members know from their own constituency experience that, too often, the poorest services are in the poorest communities. Top-down Whitehall control has tended to stifle local innovation. It has too often ignored the differing needs of different local communities. It is not surprising, therefore, that staff sometimes feel disempowered, local communities are disengaged, and patients have traditionally had little say and precious little choice. Our reform programme—indeed, any reform programme—for the health service should be about addressing these weaknesses so that we can build on the NHS's great strengths.

The idea that the Conservatives support our reform programme is laughable. They are against national standards, even though equity in health care demands precisely those national standards of care. I am proud to have served in a Government who have, for the first time, established national standards of care to tackle the country's big killers—cancer and heart disease. As a consequence, in the last few years, death rates from cancer have fallen by 6 per cent. and from heart disease by 14 per cent.

So, national standards make a difference. That is also why we have targets to reduce waiting times, and why there is more open publication of information about NHS performance, as I mentioned to the hon. Member for Oxford, West and Abingdon (Dr. Harris). That is also why we have introduced independent inspection to guarantee those standards. We reject the internal market idea that NHS hospitals should simply be left to sink or swim as part of a free-market competitive environment. Every hospital—every part of the national health service—needs help, support and, where necessary, intervention to raise standards, whether it is the best performing hospital or the worst.

However, all the national standards and national systems of inspection in the world cannot by themselves deliver improvements. Sustained improvements in local

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services can happen only when staff feel involved, when local communities are better engaged, and when improvement is something done by local people, not just done to them. That is why devolution is at the heart of the Government's reform programme, and why the new primary care trusts are so important. PCTs are about shifting the balance of power in the health service so that, while standards are national, control is increasingly local. That is why we are now seeking to reconnect local hospitals to the local communities that they serve.

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