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12 Feb 2003 : Column 919—continued

Andy Burnham: On that figure concerning NHS productivity, does the hon. Gentleman accept that the biggest problem that the NHS faced in 1997 was a lack of capacity in buildings and in human resources, and that making those investments does not necessarily lead to an increase in patient outcomes? Will he address that specific point? Conservative Members have mentioned it at least four or five times, but it is facile rubbish.

Mr. Cameron: I shall come to that. A particular problem in the health service, especially in the south of England, concerns the number of nurses. That is the key factor, and it has to be got right.

Here are my three reasons why I believe that money is being wasted. First, we have heard the Chancellor say many times that resources must be backed by reform. Conservative Members would all say that we agree with that, but the question is, what reform? There have been loads of changes in the health service—the primary care trusts, which are now being repackaged and reformulated, the Commission for Health Improvement, and a billion quangos—but have they been the right ones? Take the NHS in Oxfordshire, where the problem centres on nurse shortages. In the John Radcliffe hospital, which serves my constituency, there is a shortage of 400 nurses and a 14 per cent. vacancy rate. The effect of that is cancelled operations. Many constituents come to my surgery having had their operations cancelled six or seven times. There are queues in the accident and emergency department, and our trust is one of the places where patients are being kept in ambulances outside the hospital. We also have bed blocking. Older people who should go into homes in the community cannot because their care packages cannot be put together. What is the problem? A shortage of nurses. Why is there a shortage of nurses? Because in the south-east the cost of living is much higher and we cannot retain them.

Phil Hope: If the hon. Gentleman's criticism is that there are insufficient nurses in Oxfordshire, can he explain how a 20 per cent. cut in spending on the health service will resolve that problem?

Mr. Cameron: As I sat down I thought that it might be a mistake to give way to the hon. Gentleman—now I am certain. If he has been listening to the debate and it has stayed in the gap between his ears for long enough, he should know that we are not committed to a 20 per cent. cut across the board—we are looking for savings.

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If the extra money cannot go into extra pay for nurses in areas that need to retain nurses, the money simply will not work. I speak from experience, because my son has been ill and I have spent two of the past 10 months in various hospitals in Oxfordshire and London. The John Radcliffe hospital in Oxford has a superb staff who do a fantastic job. Money is being invested in it. The accident and emergency department has been closed, the temporary department is much better and the new one will be even better. However, delays persist because the hospital does not have enough nurses. The number of entry points to accident and emergency does not matter; if the nurses are not there to process the patients, the problem cannot be solved.

I shall give the hon. Member for Corby (Phil Hope) another example, from a conversation with a male nurse in Great Ormond Street hospital. I was on my way to Health questions and I asked him what he would like me to ask the Secretary of State if I was called. He wanted me to ask about the appalling waste of money on agency nurses. He said, "They cost this hospital hundreds of thousands of pounds. They're far more expensive than normal nurses. It's an absolute scandal and not nearly enough has been said about it." I asked how he knew so much about the subject. He replied, "I am an agency nurse. I'm doing quite well out of it, but the amount of money being spent is scandalous."

I shall relate one more story from my experience. I had to go to the accident and emergency department at St. Mary's, Paddington—a hospital in the centre of London—with my son at about 11 pm. I waited seven hours. We were not in the children's accident and emergency department because a shortage of nurses means that it does not open at night. After sitting there for seven hours, we were offered a bed. None was free in the whole of central London; the nearest was in Guildford.

Shortage of nurses is the problem in south-east London. The extra money will not work unless we have different rates of pay in different parts of the country. [Hon. Members: "More money."] It means more money in some parts of the country. However, the key element is more freedom. We must give all hospitals, not simply 12 foundation hospitals, the freedom to respond to their needs.

In the remaining four minutes, I want to draw hon. Members' attention to another example of wasted money and no improvements. It is a microcosm of the debate. In some places, more spending does not lead to a better or even a level outcome. It can lead to a worse outcome. The NHS has experienced problems with care homes, and the new regulations have led to the closure of several. To give the Government their due, they have listened and intend to make some changes, which may have an impact.

No one, however, has paid attention to the effect of regulation on adult placements in the community. In Oxfordshire, 100 adult placement carers take vulnerable adults into their homes. They are like foster parents. They are heroes and heroines, who do a fantastic job. They are paid a modest amount of money and they keep vulnerable adults, who often have mental health problems, physical handicaps or have been in care, out of the care system. They do a great job.

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Until now, county council social services departments regulated the carers. The departments interviewed them for 40 hours and inspected them every year. That system worked well. In Oxford, 100 adult placement carers look after approximately 250 people. The Government, armed with all the new money, set up the National Care Standards Commission and introduced the Care Standards Act 2000. As well as care homes, the commission has to regulate adult placement carers.

First, the carers must read a document that is approximately an inch thick and pay for the privilege of registering. They subsequently have to read a 75-page document entitled, "Care homes for younger adults in adult placements". I remind hon. Members that we are considering people who look after vulnerable adults in a loving family atmosphere in their homes, not care homes. The carers must also read the regulations, which comprise 27 pages. They have to plough though 142 pages simply to be regulated.

It is unsurprising that several of the 100 carers who take in vulnerable adults are giving up the ghost. A letter from Oxfordshire county council states:

Paul Farrelly rose—

Mr. John MacDougall (Central Fife) rose—

Mr. Cameron: I shall give way to the hon. Gentleman who used to work for The Observer.

Paul Farrelly: Before we explore every nook and cranny of Witney, let me take the hon. Gentleman back to his initial question. He asked where all the money had gone. Given the public debt that we inherited in 1997 and the state of the public infrastructure, will he explain what happened to the windfall from privatisation and North sea oil under previous Conservative Administrations?

Mr. Cameron: The hon. Gentleman would probably have done better to stay at The Observer.

An easy answer is available to the Government. They need only tell those running adult placement schemes, "You do not have to be regulated by the National Care Standards Commission; the arrangement works perfectly well when managed by social services departments". If the Government do not do that, they will find that in this and other areas all their extra spending will be devoted to extra bureaucracy, extra publications, extra documents, extra inspections—and no extra services. Indeed, in some instances, such as the one I have given, services will actually get worse.

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3.40 pm

Dr. Liam Fox (Woodspring): It is clear from the debate that some things are beyond dispute. That the Government have taxed more and that the Government have spent more cannot be disputed by anyone with any objective sense. The question is this: why have the Government failed to deliver? Today the Opposition have first tried to reveal areas in which the Government have failed to deliver, and then suggested reasons for that failure.

The debate began with a forensic dissection by my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), the shadow Chancellor, of the Government's failures to handle the economy. He mentioned the unpredicted deterioration in the public finances, the disastrous state of our manufacturing sector, the fear that grips the business community in regard to our economic prospects, and the long-term suffering that older people will endure as a result of the Chancellor's pension theft. Robert Maxwell's pension theft was a national scandal; the Chancellor has made it a part of central Government policy.

My right hon. Friend the Member for Wokingham (Mr. Redwood) told us that more regulation, higher taxes, more bureaucrats and greater waste led to a weaker economy and poorer public services. He depicted the Chancellor as the destroyer of pensions. He spoke of the Chancellor's failure to build on the success of the Conservatives' telecommunications revolution, and dismissed the disastrous sale of gold that has cost the British taxpayer more than £750 million. It did my heart good to listen to my right hon. Friend. Far too many Conservatives readily accept criticism of failures in office; too few are willing to accept responsibility for our many achievements.

My hon. Friend the Member for Sutton Coldfield (Mr. Mitchell) rightly spoke of the golden inheritance received by new Labour. Never had a Government come to office, he said, at a time of more favourable economic trends. As he also said, despite that—and despite two overwhelmingly good parliamentary majorities—the Government have achieved very little during their time in office.

As my hon. Friend the Member for Witney (Mr. Cameron) pointed out, the shortage of nurses, the huge vacancy rates, the cancelled operations and the level of bed blocking are indicative of a mismatch between supply and demand in relation to NHS staff, especially nursing staff. That in itself points to the need for substantial reform. As my hon. Friend said, flexible pay arrangements are needed, but there are other ways of attracting nursing staff. We need to think about shift flexibility, the physical security of staff—all staff, that is, not just nurses—training and supervision, and professional freedom and self-respect. In the case of the nursing profession, that means not using surgically trained or gynaecology nurses in general medical wards, but affording them the respect that they are entitled to expect given their expertise.

One of the most enlightening speeches was made by the hon. Member for Truro and St. Austell (Matthew Taylor). As usual, he had his finger on the pulse of public sector failure. He said, "We found out today that thousands of old people are waiting for discharge in our

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hospitals." He must be one of the last people in Britain to discover that; only Liberal Democrats could be surprised by it.

What really galled me about the hon. Gentleman's performance, however, was this. It is clear that the Liberal Democrats will tell one group that taxes are too high, and will tell others that they should be raised. They will tell one group that spending needs to increase, and as the Chancellor said, they will write to another group saying that it does not need to increase at all. They tell one group that they are the party of the inner city; they tell another that they are the party of the country. They are pro-war; they are anti-war. They are for free nursing care, but they will raise the cost of nursing care when they are in charge of local government. The fact that the once great Liberal party has descended into the second-rate charlatan collective that the Liberal Democrats are today is indeed a national tragedy.

My hon. Friends have drawn attention to Labour's failures on a number of fronts—education, for instance. The hon. Member for Colne Valley (Kali Mountford) talked a great deal about literacy and numeracy, but according to the 2002 survey one child in four now leaves school unable to read, write or count properly. These pupils are leaving primary school after six years of her Government's being in office, so talk of incremental change is complete nonsense. In GCSEs, the gap between children in inner cities and elsewhere is actually growing, according to a departmental survey of December 2002. Only 39 per cent. of children are getting grade C or above in maths, English and science.

On law and order, the Prime Minister said that

In the year to September 2002, overall crime was up by 2 per cent. Robberies were up by 13 per cent., domestic burglaries by 5 per cent., retail crime by 6 per cent., and drug offences by 12 per cent. In the past year, crimes involving the use of firearms were up by 35 per cent., and those involving the use of handguns by 46 per cent. The number of robberies involving the use of firearms increased by one third in the past year, and such robberies are at their highest level for more than a decade. Crimes involving the use of firearms are up by 80 per cent. since Labour came to power in 1997. How can there be any doubt about their failure to deliver on public services?

Transport is a complete shambles. So far, the Government's answer to making the trains run on time is to cut the number of trains running. Well, that is an act of genius. The London underground is a complete debacle. The Government do not know whether to build more roads or to have fewer of them, and they cannot seem to make up their mind whether to build more airports, or to have fewer of them. Today, they have tried very hard to distance themselves from the soon-to-be-hated congestion charge, which is a direct result of their Transport Act 2000.

We need to look not only at the failure to reform, but at the reason behind it, which is to be found in the contradictions within the Government themselves. As I have pointed out, the Prime Minister said:

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How far can that possibly be from the Chancellor's view, as expressed in his speech to the Social Market Foundation? In it, he said:

These views are not compatible, but at least the clear difference that has emerged in the war of No. 10 succession—in the axis of acrimony—is far better than the confused position of the Secretary of State for Health. He began by saying that he would

Now, not only does he use the private finance initiative at every opportunity; he also wants to establish foundation hospitals, with the freedom to borrow and to set pay and conditions. As a concordat with the private sector, he is using private hospitals for NHS patients, and he wants to put private management into failing NHS hospitals. That is rather striking when one compares it with what he said in this House on 26 June 2001:

Little wonder that we cannot get proper reform, and that there is no impetus for real change in the public sector, when there is such a division of ideology and philosophy on the Government Front Bench. The Cabinet fight like ferrets in a sack. They cannot sit on the same platform, and now it is more a question of who is likely to succeed the Prime Minister, rather than what is best for the country. We are all victims of the proxy war in the battle for No. 10.

We have heard several times today about the statistics that are most damning in respect of the national health service. Despite a 21.5 per cent. increase in real-terms funding in the past two years, the level of finished consultant episodes has increased by only 1.5 per cent., and the number of patients admitted to our hospitals actually went down last year by 0.5 per cent. It takes quite a lot of doing to spend that amount of money and get fewer patients into hospitals.

No one doubts the need for greater capacity or the Government's genuine commitment to achieving it. However, before any Government spend the tax that they are taking away from hard-working people, they have a duty to ensure that it is wisely spent. The NHS remains too centralised, too politicised, and too bureaucratised, and there is too much waste. The NHS is a victim of the target culture, and there is too little choice. There is an incipient crisis in general practice, for which vacancies have risen by 70 per cent. in the past year. Indeed, the number of applicants for each place has fallen by 50 per cent. in that time.

The Chancellor has had a good political run, but his own share price is falling. No. 10 and No. 11 may be very close to each other geographically, but the distance politically can be very great indeed. The Government need to remember that they have no money but taxpayers' money. Anyone can spend more money—spending it well is much more difficult. The Labour Government believe that the state can make better choices than individual citizens. We believe that citizens

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make better choices than the state. Labour believes that the state is the best manager for public services. We believe that the state is an inappropriate and poor manager for public services.

The Labour Government believe that Whitehall knows best; they believe in standardisation, centralisation, taxation, taxation, taxation and taxation. We believe in personal choice. We believe in diversity. We believe in innovation. We believe in excellence. We believe in trusting individual citizens. Enough is enough.

3.50 pm

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