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8 Jan 2003 : Column 221—continued

3.12 pm

Mr. Jon Owen Jones (Cardiff, Central): Thank you for calling me, Mr. Deputy Speaker. I have often sat on these Benches frustrated by my inability to take part in a debate when I wanted to do so, but I have never before found that that had anything to do with my nationality. I am pleased to be able to take part in the debate on foundation hospitals. Although it is true that for the time being the First Minister of Wales has said that he does not wish to introduce foundation hospitals in Wales, their introduction, and their success or otherwise in the rest of the United Kingdom, is bound to have an influence on my constituents.

As a former Health Minister for Wales, I can claim to have some experience of the problems of health service management, and as a Member whose constituents suffer the longest waiting lists not only in the United Kingdom but in Europe, I understand something of the frustration that they feel about the present provision of services. As I represent those people, I may say that the impression that has sometimes been given in the debate, that the present system does not involve more than one tier of provision, is completely erroneous. We have a wide disparity of provision within the United Kingdom, and the present system does not appear to be eroding that disparity—or at least, not at any great pace.

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Momentous decisions were taken when the Prime Minister was convinced by a Member of the other place that money needed to be invested in the health service at a great rate, as happens in the rest of Europe, and the Wanless report was commissioned. That report said that the most efficient mechanism for paying for services would be through general taxation, rather than introducing some of the more disparate funding mechanisms used in the rest of Europe. It would also be much less destructive to fund the health service out of general taxation. However, the Wanless report also recognised that there was a downside to that, in that there would be less accountability and choice, and less competition, in the model that we were choosing. To make up for that, the extended audit system, which has yet to be put in place, was recommended, so that the taxpayers could be assured that they were receiving value for money in exchange for the considerable increase in spending on the health service.

If we compare the activity rates of the present health service with the rate of increase in spending, we see that there is a fairly wide gap. That point has been made by the Opposition—for political reasons, and also maybe for better ones. The defence against that argument—I think it is a substantial one—is that there is bound to be a lag between the time when we start putting in the investment and the time when we begin to achieve the full benefit of that investment. The underinvestment that went on for several decades under Conservative Governments will take a considerable time to undo. I agree that that is a substantial defence, and that we should not expect to see in the short term rapid increases in activity rates commensurate with the extra spending.

Nevertheless, hon. Members will acknowledge—it is difficult to prove this, but it will be backed up by the many anecdotes that will be told them in their surgeries—that there are problems inherent in our system that are not simply a matter of investment. I shall tell the House one anecdote that made me think about structures. It is not to do with my constituents; it is about my family.

About a year ago, I had a call at 5 o'clock in the morning from a close elderly relative who was in an accident and emergency unit in a major hospital in south Wales. He had a life-threatening condition and had not seen a doctor. I drove straight to the hospital, and was most distressed. He had not seen a doctor because of a lack of resources, which are now being put in. However, another reason for his distress was the condition of the waiting room he was in and the filthy toilets alongside. Knowing that he was possibly about to have a life-saving operation, he did not have overwhelming confidence in the institution he was in. When he went on to the ward, he received excellent service, and he began to feel far better. On my way out, I went into the toilet next to the lift which had probably not been cleaned for a year.

I was most distressed by my elderly relative's condition. That evening, I had to attend a party meeting in a junior school, and was thinking about what I would tell the party members. I looked at the hall floor, and noticed that it was spotless. I spoke to the caretaker, and told him of my experience. He took me to the toilets, which were also spotless. I thought, XThere is no way we are investing money and resources to ensure that the schools are kept cleaner than hospitals. It is not a matter

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of resources." If the school floors and toilets were as dirty as that hospital, the governors would not put up with it. The parent governors in particular have such an investment in the school that they would not tolerate it. However, even if they did, parents have a choice, albeit limited, about which school their children attend, and they would choose not to send them to that school.

That accountability did not exist for my elderly relative in hospital—there is no equivalent of the parent governor there. He had no choice about where he would go. Somehow, we must introduce systems that provide greater accountability, transparency and choice. If we do not, the service will not be as responsive as we wish, never mind the resources that we put in. The right hon. Member for Charnwood (Mr. Dorrell) mentioned grant-maintained schools, of which there are none, I am glad to say, in my constituency. However, local management of schools was a good idea introduced by his party. Something like the local management of hospitals would improve the service that is provided.

Mr. Redwood: I do not know whether the hon. Gentleman remembers that when I was Secretary of State for Wales I diverted money from elsewhere in the budget to put extra into the health service. I found that with all the command and control that a Secretary of State is meant to have, it was extremely difficult to get the health service to spend that money on the extra nurses and doctors whom I thought it needed.

Mr. Jones: I well remember the right hon. Gentleman's time as Secretary of State for Wales, about which I have mixed views. However, our debates were open, he was always prepared to debate his point of view and was supportive of local hospitals.

I am prepared to welcome the idea of foundation hospitals. I do not think that they will necessarily provide all the solutions, but they are an experiment that we need to look at. However, I am wary of suddenly expanding that experiment without any testing, as the Opposition seem to be suggesting. I urge my hon. Friends, who are reluctant to look at foundation hospitals for understandable reasons, to see the ideological position that needs to be defended—public services, including the provision of health care, must be successful and must be seen to be successful. As a Government, we must successfully deliver good-quality health care. If we fail, that will provide a true opportunity for the Opposition. If we are not prepared to look at the reform of our health service, we will fail.

3.24 pm

Mr. Richard Page (South-West Hertfordshire): Although I usually speak on the trade and industry and manufacturing sector, which has severe problems of its own, I am delighted to be able to contribute to the debate, because of the serious situation that faces the hospitals in my constituency. If those hospitals are facing difficult situations, it means that my constituents are suffering. The complaint ratios coming in over the past three years or so are more severe than for the previous 20 or 30 years. I am not surprised. We are led by a Government whose experience is limited to what I

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have described as sucking on the hind teat of political experience, rather than knowledge and experience in the real world.

I have a terrible mixture of anger and sadness—anger because I remember vividly the criticisms made by the party now in government when we were in government. We heard how they would make things so much better, and how dreadful we were—24 hours to save the NHS. What have we got now? We have a list of complaints as long as one's arm. I am saddened by the stories that I hear from my constituents. What do I say to a widow who comes to see me and tells me, XMy husband was a year on the waiting list for heart surgery, and he died as they were preparing him for surgery, having waited a year"?

What do I say to my constituent who came to my surgery a month or so ago, saying, XI can't get the diabetic treatment in Hertfordshire, although I can get it in Buckinghamshire"? What do I say to the old boy who told me, XI went in for some tests, and I saw how dirty it was under the bed, so I put a #1 coin under the bed. I had my tests and they took a week, and when I left, I bent down and picked up my #1 coin and took it away again"? What do I say to the man who had a stroke and did not receive any physiotherapy for four months? We all know how necessary it is to have physiotherapy immediately. I had a case in this morning of a poor lady who had suffered a stroke, and had already had three bouts of infection from hospital. The list can go on and on.

Dr. Stoate rose—

Mr. Page: Of course I give way, as that gives me another minute or so.

Dr. Stoate: I am sure that the hon. Gentleman does not tell constituents who have those problems that the way to solve them is to cut public expenditure and reduce the amount of money going into the health service. He must tell his constituents that the only way to solve the problems is more investment and the reform needed to make that investment work, so that his constituents can look forward to increased rather than reduced health care.


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