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8 Jan 2003 : Column 198—continued

Mr. Milburn: On that basis, does the hon. Gentleman's party support foundation trusts?

Dr. Harris: I am talking about the commissioning side, which is where the power lies. We need democratically accountable decision making and commissioning, delivered through democratically elected local and regional bodies. We believe that NHS funding should be guaranteed through an earmarked NHS contribution that would replace national insurance contributions. The Secretary of State may disagree with those reform proposals, but he should not say that they do not exist.

Dr. Fox: Will the hon. Gentleman give way?

Dr. Harris: In a moment, as I am coming to a matter on which the hon. Gentleman may want to respond.

My party has also proposed that there should be a diversity of providers. I can assure the hon. Member for Woodspring (Dr. Fox) that we do not describe as privatisation his calls for a diversity of providers of NHS services. It is not who provides the service that matters,

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but who pays for it. Equity is delivered best when a service is free at the point of delivery, but the Conservatives are going wrong in two respects. They have called for more self pay, and even for subsidy for more self pay, but that would mean that people with few resources who rely wholly on the NHS having to subsidise people who are well off or people who have at least some resources that they could put towards private health care.

If the better off are to be subsidised by resources that could be used for the least well-off, as the Conservatives propose, that would not be equitable. That is why we are worried about the creeping privatisation of the NHS that the Conservatives have proposed.

The hon. Member for Woodspring also demonstrated his failure to understand equity and health inequality in the way that he described health funding in Scotland. He has said consistently that he supports an increased focus on public health, but that assertion is preposterous unless he accepts that some areas of the country suffer from greater health need and inequality than others. That requires differential funding. The claim that Scotland and Wales receive more funding as a proportion of national wealth than France yet achieve worse outcomes is not reasonable.

Scotland and Wales should properly be compared with the least well-off areas of Frances that have the greatest health need. Every country has pockets of deprivation that have greater health needs and require more resources. In addition, there is always a time lag between making resources available and achieving results. That is why the improvements in cancer survival are due less to the efforts and best intentions of the Government than to changes in lifestyle instigated many years ago. Some of those changes even began under a Conservative Government.

Dr. Fox: I accept that there is always a time gap between investment or change and the outcomes that might be achieved. We have a problem with the standardised methodology for determining outcomes, but my point was that it says something about the process when there is a huge increase in expenditure and also an increase in waiting lists and times. The hon. Gentleman said that his party's policy was to introduce a hypothecated health tax. Which tax would he like to have hypothecated, or would he like a new tax to be levied? If the latter, which tax would that replace? Would it be set at a level that would provide higher or lower funding than the Government are providing at present, according to their own estimates?

Dr. Harris: That is a fair question, and I am grateful for the chance to respond briefly in what is a Conservative Opposition day debate. We propose that existing national insurance contributions should be earmarked for the health service, and that the funding from general taxation currently used for the health service would cover what is currently paid for by national insurance contributions. The proposed levels are in line with current Government spending proposals. If the NHS needs more resources for specific matters, our next election manifesto will describe how they will be made available. In addition, we propose that

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the national health contribution could vary according to region. People in each region could vote democratically to raise or lower that contribution. Moreover, our proposed system of local income taxation would be fairer than the council tax system and be more directly related to people's ability to pay. It would mean that the health and social care budgets, which we would merge at local level, could be increased—or, conceivably, decreased—through local demand at the ballot box.

Dr. Fox: I am grateful to the hon. Gentleman for giving way a second time. The problem with national insurance is that one of the largest NHS user groups is made up of pensioners, who do not pay national insurance. Would he extend the new tax to pensioners?

Dr. Harris: The proposal is to modify existing taxation. Pensioners do not pay national insurance contributions, and they would not pay the proposed national health contribution. We do not believe that the people who use the health service should necessarily be the ones who have to pay for it. The Conservative party's psychology is that only those who use the NHS must pay for it sooner or later, directly or indirectly. It is a sign of civilisation that people who are better off should pay more, proportionately, even if they use the NHS less.

Mr. Jon Owen Jones (Cardiff, Central): Will the hon. Gentleman give way?

Dr. Harris: No, I want to make progress.

The problem with the Government's funding measures is one of delay, not with their global level overall. The Government must accept that they could have reached the targets set for five years into their 10-year plan if they had put the significantly increased resources that they are now putting in five years ago. They made the political decision not to tax better-off people more and to let patients wait longer. The elderly have been left to suffer and to linger in hospital beds when that was not necessary. Those patients have paid the price, as has today's health service. A huge amount of resources has been wasted on false economies. For example, agency nurses are paid three times over the odds to bring then back into a health service that they have left. Also, elderly people are kept unnecessarily in hospital beds. That is bad for their health and prevents other people from using the beds. Resources are wasted in many other ways, because the NHS has not been resourced properly.

Earlier, the hon. Member for Woodspring teased me about Denplan. It is a fair point, although he may have taken an opportunity to give that organisation a free advert, as I understand that it is partially based in his constituency. Clearly, that was only a malicious rumour, but he must understand that the Liberal Democrat party is not against private companies. We favour the free market and private enterprise, but we oppose private companies and private provision being supported at the expense of people who are not able to use them. We agree that people who can afford it should have the right to use private health care—and private education—but that right should not come at the expense of people who are less well off. That is the problem with the way the previous Conservative

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Government eroded NHS dental care. It led to the growth of private dental plans and dental insurance that the poorest people in our society could never afford.

I have a series of questions about foundation hospitals for the Government. Many of these were rehearsed in an excellent debate secured by the hon. Member for South Swindon (Ms Drown) yesterday in Westminster Hall. I hope that we have an opportunity to hear more from her today.

One of our concerns is that the Government seem to believe that a financial incentive will motivate the NHS to do more. They seem to think that nurses and doctors enter their training and careers, with the long hours involved, in the belief that if their hospital were offered more cash prizes, they would work harder. That simply is not the case, and the right hon. Gentleman and the Government fundamentally misunderstand, in a counter-productive way, the motivation of people who work in the NHS and in public services generally. There is a series of paragraphs in his prospectus about cash payments by results. Bidding for cash prizes is another of his gimmicky policies. Not only does that simply smear the money around in a different way, it undermines morale in the health service. Its workers do not want to chase cash; they want to treat people on the basis of clinical priority.

The right hon. Gentleman talked about the supposed freedom of foundation hospitals, but that freedom is only for the few, not the many. Why should not such freedom—if it exists, and it certainly should not exist on the model of the foundation hospitals—be available to all?

The right hon. Gentleman chooses the lucky few to have what he considers to be this worthy status on the basis of the star rating system. It is hard to think of a worse basis upon which to choose—he would do better drawing lots. Those in the health service recognise that star ratings merely measure the ability of the NHS trust to jump through Government hoops, not their ability to treat patients well.

Siobhain McDonagh (Mitcham and Morden): Is the hon. Gentleman aware that St. Helier hospital, in the constituency of the hon. Member for Carshalton and Wallington (Mr. Brake) obtained no stars in the first star rating? That was of great benefit to my constituents as, for the first time in years, it was acknowledged that their local hospital was not up to standard and needed to be improved. It was not a question of jumping through hoops but of nobody being able to get that point through to the people who ran the trust at the time.

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