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Mr. Bercow: Will the right hon. Gentleman allow me?
Dr. Reid: Of course, and I will listen with a view to learning from the hon. Gentleman how great men should speak.
Mr. Bercow: I am grateful to the right hon. Gentleman for giving way. May I clarify his position, for the avoidance of doubt? In response to my hon. Friend the Member for Woodspring (Dr. Fox), the Secretary of State's attitude is that if the Prime Minister makes a promise in 1999 to be delivered in 2001, and in 2003 it still has not been delivered, that is the fault of a Government who left office in 1997. Is that his position?
Dr. Reid: No, I did not say that. If we make a promise and fail to deliver on it, we should say from the Dispatch Box, "We have not delivered on that promise. We continue to try to do so." But it is not irrelevant to explain to people that although we have free will, we do not, as an old philosopher said, operate in circumstances of our own choosing: those circumstances were largely created by the Conservatives. In this party, we suffer from the great disadvantage of knowing that when our leaders make a promise, they are liable to have to answer, a few years hence, on whether it was delivered. The Conservative party has the good fortune to change its leaders every so often, so none of them can ever be held accountable for anything, let alone promises that they made 24 hours ago. [Interruption.]
Dr. Reid: Thank you, Madam Deputy Speaker. As you know, there is a great deal of nervous energy among Conservative Members at the moment.
Is the Conservatives' problem that we have set targets or—for them, it is a bigger problem—that we are meeting those targets?
Mr. Hendrick: Does my right hon. Friend agree that the state of NHS dentistry is due not to the resources that are being ploughed in or the commitment of the Prime Minister, but to the fact that it takes six years to train a dentist?
Dr. Reid: Any fair and balanced person would accept that the Conservatives' introduction of a contract that alienated the whole dentistry profession has had long-term consequences. That is why, despite the comments of the learned doctor, the hon. Member for Woodspring, I take some small and modest satisfaction from the fact that doctors and consultants gave us an overwhelming vote in acceptance of the contracts that we proffered. That is because they achieve a balance between giving central direction and setting strategic objectives and recognising the flexibility, independence,
integrity and professionalism of doctors and consultants, so that they can contribute towards a general corporate effort that recognises their individual contribution and autonomy in so doing. We are achieving a great deal in that respect, despite the nay-sayers.I wonder why Conservative Members decided to decry not only the targets, but all the achievements and improvements of the past six years, which, for all their partisan comments, they must know are going on. The answer lies in what the hon. Member for Woodspring is alleged to have said at his party conference—that if the Government were to succeed in improving the national health service, in line with the plans that I set out, the Conservatives would be politically "flummoxed". I am not sure that that was the word that he used, but I remember that it started with an F. He is probably right. His party is in a state of complete flummox—indeed, I would go so far as to say that they are well and truly flummoxed.
The truth is that the investment that we have put in, the systems reform that we are carrying out and the strategic objectives and targets that we have outlined have had a dramatic effect on the health service. Unlike the hon. Member for Woodspring, I shall try to give a balanced picture. I have already accepted that in some areas we have not made the advances that we should, but it is reasonable to point out that in 1997, when we took office, there was no standard waiting time to see a GP—no objective had been set—because so many people were waiting too long. Now, nine out of 10 people can be seen within 48 hours. In 1997, when the hon. Gentleman's party had been in power for some considerable time, more than 30,000 people were waiting for operations: last month, there were 31. That is the result not of lying, cheating and fiddling managers, but of a huge, determined effort by NHS staff, increased capacity and changes and reforms in the system. Making that reduction from 30,000 to 30 is surely an achievement by the NHS that even the most grudging Conservative spokesman should be prepared to flag up and offer an accolade.
I remember the days, not that long ago, when Conservative Members wondered aloud whether they would be able to give a guarantee that no one would wait more than two years for an operation. Now, almost no one waits for more than a year. By March next year, I hope that no one will wait more than nine months; by the following year, I hope that no one will wait for more than six months. Those are the targets that I set. Let me say, because it is relevant to one of the cases that was mentioned, that even if we achieve a six-month maximum wait, it will be six months too long for me. We should be aspiring to give people what anyone with large amounts of money would demand—that is, an operation within weeks, sometimes days. I take some satisfaction from the fact that seven out of 10 patients are admitted for treatment within three months of joining the in-patient waiting list. More than 90 per cent. of people—almost double the rate under the Conservatives—are seen, diagnosed and treated within four hours in accident and emergency departments. It is
simply not true, as the hon. Member for Woodspring implies, that the achievement of that target was a one-week wonder.
Dr. Reid: The hon. Gentleman repeats the calumny. In fact, it has been maintained for five months consecutively. It is not one week's effort by a bunch of fiddling and lying staff, but a sustained effort from March until now. Indeed, I can tell the House that in August, the last month for which we have figures, the average was 90.3 per cent. We should celebrate that achievement by NHS staff, not decry them at every opportunity.
Although such successes do not completely transform the health service—we will be years in that job—they remind us of the horrific mess that the Conservative party made of it when it was in power. I am not in the least complacent. We have further work to do to improve access to accident and emergency, GPs and practice nurses. Yes, on occasion people have used methods that none of us would condone to achieve targets or to pretend that they have done so. I recently condemned those methods in front of an audience of 500 or 600 GPs, saying that they are not only unwanted, but deleterious to the whole service, as well as patients. However, they are not the norm. The hon. Member for Woodspring implied that the Audit Commission's report says nothing but that all the targets had been met only by wholesale cheating and lying. That is a complete misrepresentation. I recommend that he and his hon. Friends read it again to get a more balanced picture.
Of course, we have to shorten the waits for admission to hospitals even more than we have done already. As I said, we want to achieve nine months next year and six months in the year after that. But nobody is helped by an Opposition who have clearly broken away from the post-war consensus and, in pursuit of their political objectives, claim that the NHS is incapable of improvement. Another aspect of that argument is to say that the volume of targets and their rigid centralised structure stifle local innovation.
Again, the truth, when it is pushed too far falls into error, as Nye Bevan said. I agree that there has to be a balance between central objectives and local decentralisation, and operational autonomy at the front line. Surely we would all agree with that. However, claiming that any centrally set objectives and targets are nothing more than a stifling of all local autonomy is different. That is similar to saying that the only way in which to run a business or a concern is along the lines of an anarchist convention, whereby everybody has to decide what they want without any central objective being laid out strategically.
It is simply not true that the volume of targets in the national health service is so immense that it stifles all local initiative. The Department of Health has a budget of more than £60,000 million and 62 targets. That is roughly one target for every £1,000 million that we spend. No reasonable person would consider that to be excessive. Of course, if doctors genuinely believed that there was a contradiction of their oath or an undermining of their clinical position, we would discuss that with them and, if that was inadvertently happening,
be prepared to reconsider. We did that with the accident and emergency services when doctors said that reaching a 100 per cent. target would remove the necessary clinical decision making and autonomy. Of course, we were prepared to change.Our success has been maintained only because we have combined central targets with power and resources that are devolved to the front line to give health professionals and managers the freedom to innovate in pursuing the objectives and targets.
Mr. Stephen McCabe (Birmingham, Hall Green): Clearly, it is true that no reasonable person would take the view of tracking the money that my right hon. Friend outlined. However, someone who is on tape at a closed Conservative party meeting, telling people that his strategy is to talk down and run down the NHS as a pretext for dismantling it would have to ridicule targets. He would need the ensuing chaos to achieve his ambitions.
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