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8 Jan 2003 : Column 213—continued

Mr. Deputy Speaker: Order.

2.45 pm

Mr. David Hinchliffe (Wakefield): It is a pleasure to follow the right hon. Member for Charnwood (Mr. Dorrell), who always makes an interesting speech. I did not agree with much of what he said, but he is one of the declining number of Tory Members who believe in the basic principles of the NHS. His time in the Department showed his concern for the health service, and I appreciate that. I recall many happy hours arguing with him about the internal market.

This is an Opposition day debate, but it is worth remarking on the fact that six Conservative Back Benchers are present and three of them are possibly here because they wish to make leadership bids. I wonder what Tory Members do with their time. It is their debate, so I would have expected far more interest in it from them.

Dr. Stoate: They are still at lunch.

Mr. Hinchliffe: They may have had a good lunch. It is not quite 3 o'clock, so they are probably still at lunch. [Interruption.] I will get on with it. Conservatives might be embarrassed by the fact that they have to defend their party when it is committed to a 20 per cent. cut in resources.

Mr. Simon Burns (West Chelmsford) indicated dissent.

Mr. Hinchliffe: The hon. Gentleman might try to contradict me, but, as my right hon. Friend the Secretary of State pointed out, it is pretty clear from the comments that were made over Christmas that the Conservative party is looking at significant savings in the public sector. I listened with interest to the comments of the hon. Member for Woodspring (Dr. Fox). He referred to seeing the NHS dismantled. [Interruption.] He used the term Xdismantled" in his

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speech, so it is interesting that this debate gives us an opportunity to consider where the Tories would go on the NHS.

I start with the basic belief that the NHS was the finest social policy achievement in this country in the 20th century. It established basic principles that are at the core of a decent society. They relate to how we treat the sick, and the NHS was the Labour party's greatest achievement. It is one reason why many of us on these Benches are members of the Labour party. I am proud to be a member of the party that created the NHS.

However, 54 years on from the NHS's introduction, it is worth reflecting on some of its positive and negative aspects. I accept that we have faced problems in those 54 years, and we must consider where we are now. First—this is relevant to the current debate—there has always been a democratic deficit in the NHS and the ownership issue is worthy of debate, even in the context of foundation proposals with which I am not entirely happy. There have been unforeseen medical advances and, consequently, costs and expectations have risen. Another problem that I have mentioned constantly and with which I have bored some of my colleagues to death is the failure to integrate health and social care. That is a factor in continuing difficulties with our health care system.

There has also been a failure to exploit the immense potential of primary care. It is worth remembering that, in the 1940s when the NHS was introduced, health centres were viewed as a key element of bringing the service together locally. We have never managed to deliver on that all these years later. I am delighted that, in my area and elsewhere, that concept is gradually, at long last, coming together.

Throughout the 54 years, one of the problems has been the dominance of the hospital sector. It saddens me that today's entire debate is geared to the hospital sector. We must understand that one of the fundamental failings of our health care system has been the way in which we have allowed ourselves to be drummed into believing that health is about hospitals. The picture goes much wider than that, and it saddens me that the Opposition's motion focuses solely on the hospital sector. That is evidence of a very narrow view of what health is all about.

It is incredible that the motion accuses the Government of creating a two-tier NHS. Talk about brass neck, as they say in my part of the world. The Conservatives are, of course, experts on two-tierism. It was a key concern in some of the debates that I had with the right hon. Member for Charnwood when the internal market was introduced. I compared the treatment available to my constituents in Wakefield with the treatment available in Leeds when we had postcode prescribing. The Government are trying to move away from that and they have achieved a number of successes.

I remember being phoned by a non-fundholding GP. She was concerned because when her patients rang the hospital to find out when they would be admitted, they were asked, XAre you a patient of a fundholding GP or a non-fundholding GP?" The simple fact was that patients of fundholding GPs, with more resources than

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the health authority, were admitted in advance of their next-door neighbours with similar conditions. So the Tories know all about two-tierism.

Dr. Stoate: On fundholding GPs, before I came to the House I had a patient who was seriously ill with an acute form of leukaemia. When I phoned the hospital to get that person admitted as an emergency, I was asked whether I was a fundholding GP. As I was not, I was told that there would at the very least be severe complications in getting that person treated that day.

Mr. Hinchliffe: My hon. Friend must therefore understand why some of us are concerned never to replicate the experience of two-tierism that we had under the Conservative party. We do not want to return to a situation in which there is competition between NHS providers.

Mr. Jon Owen Jones: Will my hon. Friend give way?

Mr. Hinchliffe: No. My hon. Friend is from Wales and has nothing whatsoever to do with the issue because there will be no foundation hospitals—

Mr. Jones: On a point of order, Mr. Deputy Speaker. Can you confirm that the Bill is an England-Wales Bill—[Interruption.] It is an England-Wales debate, and as such every hon. Member has an equal right to speak.

Mr. Deputy Speaker: As the hon. Gentleman acknowledged, we are not dealing with a Bill. This is an Opposition motion with a Government amendment. If he waits his turn, he may catch the eye of the occupant of the Chair.

Mr. Hinchliffe: I mean no disrespect to my hon. Friend, but it has been made clear that foundation hospitals will not be introduced in Wales. If a foundation hospital in Bristol takes staff from his hospital in Cardiff, he might understand our concerns. However, if we were debating rugby in Wales, I would be happy to assist him with some of its current problems.

I welcome the serious steps taken by the Government to address the two-tierism that they inherited from the Conservatives. I welcome the advent of the National Institute for Clinical Excellence and its ability to consider the merits of treatment. It also ensures that there is consistency in prescription and the offering of treatments to individual patients. I welcome what is happening with primary care trusts, the collaboration between GPs at local level and the emphasis on primary care, which arises directly from the introduction of the trusts. I welcome the statutory duty of co-operation. My right hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) mentioned that. It is exactly what the health service should be about. I also welcome the emphasis on quality, which interestingly has not been mentioned. The Government have taken serious steps to deal with quality problems in the NHS. The Health Committee picks up on quality issues and I appreciate the Government's attempts to deal with some of the difficulties.

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There are a number of concerns about foundation hospitals. I am attracted to the discussion on placing NHS governance in the hands of local communities. I have argued for that for many years. If it is okay for foundation hospitals, why not for PCTs? The principle surely applies elsewhere in the health service. We should consider that. NHS governance and the foundation model are two separate issues. I am attracted to one but, frankly, not to the other. The foundation model is inconsistent with the positive broad direction of Government policy, which is travelling towards primary and community care. It is moving away from the dominance and power of the hospital sector towards the grassroots health workers in the community who know what patients want because they are nearer to them. The other direction of travel has been towards co-operation and collaboration and away from the internal market. It strikes me that a Conservative idea has emerged in the Red Box of my right hon. Friend the Secretary of State in Richmond house.

The Health Committee went to Sweden a couple of weeks ago. We saw its foundation model, which was introduced after a Conservative county council election victory. I should tell the House that the county councils in Sweden run the hospital sector. The foundation hospital was working in isolation and the links that I would expect from the acute sector in this country were not present. The hon. Member for Woodspring welcomed the foundation concept before Christmas. He said that it was


It strikes me as something of a Trojan horse if it is a future Tory market model of health care. I am worried because the NHS began after the second world war, during a time of great reform and concerns about what the country had gone through. At the time, Britain recognised that a market system could never deliver basic decent principles of health care on the basis of need.

The Health Committee has agreed to undertake an inquiry into foundation hospitals. There will certainly be marked differences of opinion among Committee members who approach the problem from different perspectives. There are several key issues. The first is the apparent inconsistency with wider Government policy, most of which I strongly support and commend. The second is the impact on the wider NHS. My right hon. Friend the Member for Holborn and St. Pancras illustrated that for London, and I can say the same for west Yorkshire. It is highly likely that the three-star Bradford hospital will become a foundation hospital. That will have an impact on Leeds, Huddersfield, Wakefield and all surrounding areas. We should be concerned about that, especially in relation to staffing. I also fear the impact of the freedoms proposed. They will result in relative deprivation for some areas. I do not expect that from a Labour Government.

The Government do listen to concerns. I can think of many examples of the health team commendably listening to Back Benchers. I hope that they listen to the serious concerns within the parliamentary Labour party and to the outcome of the Health Committee's inquiry.

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2.57 pm


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