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8.6 pm

The Secretary of State for Health (Dr. John Reid): As several speakers have said, there is never sufficient time to examine and debate a subject as important as this, but today's has been a long debate that is the culmination of previous long discussions.

Mr. Patrick McLoughlin (West Derbyshire): Will the Secretary of State give way?

Dr. Reid: It looks as though the debate is going to be even longer.

Mr. McLoughlin: The Secretary of State said that there can never be sufficient time to deal with this subject, but the other place will not have a time restraint put on it. Does the right hon. Gentleman not find it rather odd that the elected House is timetabled, yet the unelected House can speak on the Bill for as long as it likes?

Dr. Reid: Of course the other House is constrained by its own conventions. I do not know whether the hon. Gentleman was making a threat; I suspect that he was. If so, I remind him that this House—specifically the majority of this House who form the Government—has a mandate from the people of this country, especially when it comes to decentralising power and modernising the national health service.

Mr. Burns: Not on foundation hospitals.

Dr. Reid: Let me tell the hon. Gentleman that if the Labour Government have one mandate it is to defend and modernise the national health service. Since we have done that successfully for six decades, I do not see any reason why we should change now.

Dr. Fox: Purely on a technicality, can the Secretary of State tell us which part of the Labour party manifesto mentioned foundation hospitals?

Dr. Reid: The manifesto contains several references to the defence of the national health service, to putting patients first and to decentralising decision making. Once again, the hon. Gentleman is wrong. It has not been a particularly good week for foxes, and that has not changed tonight.

Dr. Stoate : Does my right hon. Friend agree that the real issue surrounding the Bill is that people deserve a modern health service that is accountable to the people and gives them more flexibility, more control over local services and more choice? That is what this Government are trying to do. The Opposition are trying to get rid of the health service and privatise it, while we want to modernise it and bring it into the 21st century to provide the level of care that people deserve.

Dr. Reid: Even though I am well used to the articulacy of my hon. Friends, I am sometimes astounded by just how articulate and on the mark their comments can be. I could not have put it better myself.

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I begin by paying a courteous tribute to my predecessor, my right hon. Friend the Member for Darlington (Mr. Milburn) for all his work, and to my Ministers, especially the Minister of State, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton), who has performed so admirably today. I say with total modesty that he has carried the weight of the Bill. He is a great asset to me, my team and the Government.

The Government have a proud record of investing in and developing the national health service. That is not only because politically it is a child of the movement, but because morally it has long been at the centre of our values that no one in this country should be deprived, through lack of finance or station in life. of health care when needed, free at the point of need. Such a national health service, through collective provision, is increasingly not only a moral but a circumstantial imperative. As our health becomes more predictable through advances in genetics—they may not become definitive for some considerable time but they must be taken into account—the NHS becomes more, not less relevant. That is especially true when the health service is compared with private health insurance. Any health insurance actuary who is doing his job will give the minimum coverage to those who need it most. Actuaries are paid to do that. [Interruption.]

Mr. Deputy Speaker: Order. The Chair frowns on electronic devices in the Chamber. I wish hon. Members would ensure that they were turned off before they came into the Chamber.

Dr. Reid: I was explaining why the NHS is so important to us and why we are intent on ensuring that it will be as effective and well supported in future as it has been in the past.

We introduced the Bill because the same strong belief in the values that drove the architects of the NHS endure to persuade me, the Government and, I hope, all other Labour Members to support the measure.

Mr. Burns: Not all of them.

Dr. Reid: The hon. Gentleman may point to differences in the Labour party, and I would be the last to deny them, but they are as nothing compared with the yawning chasm between all Labour Members and the hon. Gentleman over the real dividing line: our insistence that everyone in this country has health care when it is needed, free at the point of need. I shall refer to that later.

The Bill and the changes in it are intended to ensure that the NHS survives and thrives for future generations as it has done for the past six decades—three or four generations. We intend it to serve our children and grandchildren as it served our parents and grandparents: as a national health service free at the point of need, without regard to background or station in life.

Our challenge, the response to which is enshrined in the Bill, is to ensure that the same values that underpinned the NHS remain in a service that fulfils the rising expectations and ambitions of current and succeeding generations. The Labour party, which forms

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the Government, can claim to have been a central dynamo over the past century in ensuring that the influence as well as the affluence of working people in this country increased with each generation. We rejoice that one of the effects is that their expectations and ambitions increase with every generation. Our job is not only to provide a socially just system of Government and public service but to develop that system and service for each generation.

It is the job of those of us who believe in the NHS to ensure that people's desired choice and increased expectations can be fulfilled in the NHS. Otherwise, we will do the NHS a great disservice. As people in this country become better off, they will make choices, fulfil their ambitions and have their expectations met. They will do that because, as their expectations rise, increasing financial affluence allows them to make choices. It is our job to ensure that we develop a national health service in which expectations can be met rather than forcing those who wish to fulfil their ambitions to go outside the NHS.

Mr. Graham Allen (Nottingham, North): Will my right hon. Friend consider that a key factor in providing such a health service and such choices might be a period of stability, not least for him and his new, welcome Front-Bench team, thus allowing people a year or possibly two in which the many changes that have been introduced in recent years can bed in, and letting staff and patients use the NHS in the way he outlined?

Dr. Reid: I have discussed the matter with my hon. Friend. We do not agree about everything but I take the sense of his point. However, I cannot say to any organisation—my party, Parliament or the services that serve the people of this country—that it can exist in a world that does not change. As one old philosopher said, the only constant is change. I cannot promise that the NHS will be isolated from the necessity to change. I take my hon. Friend's point that sudden lurches and changes in direction, pulling back and stopping and starting are most debilitating for a service that wants to use the increased capacity that we are providing to the best effect. I was therefore pleased to tell the NHS Confederation last week that, although in a sense the big challenge is that change occurs, the good news is that the direction of change will not shift. In partnership, we want to work out how we can increase the momentum of that change, but I take my hon. Friend's point that we do not want yet another road map, road sign and direction for everyone.

It is important to recognise that, whatever our differences over introducing change, they are minuscule compared with the big debate about the essential nature of the health care system that future generations will inherit. Not everyone wants us to succeed in the task of modernisation because not everyone shares the values on which the NHS is based. Those values are under attack from the Opposition who want to introduce finance into the relationship between doctor and patient. The Conservative party is capable of reducing the highest moral values to the cash nexus. It has a genius for that, despite the fact that we know from experience how that affects the human condition. For example, the United States has a health system that the

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Opposition greatly admire, and no less than 40 per cent. of all personal bankruptcies are attributable to people's inability to find the money to pay for their health care.

Dr. Fox: I hope I can save the Secretary of State time by stopping him peddling the myth that Conservative Members are attracted by the American system. We have gone out of our way to say that we are not attracted by it. But we are very attracted by the social insurance systems of other European countries. Why do the Chancellor and the Secretary of State insist, Don Quixote-like, on chasing monsters that they have imagined?

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