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Dr. Reid: Exactly. In such straitened times, we are all obliged to help the Conservative party. First, I advise Conservative Members that if they want to call emergency debates, they should not choose the subject of the health service. Secondly, if they choose it, they would do better to change their policy. The hon. Member for Woodspring may believe that he is ploughing a furrow towards the leadership of the Conservative party, but he is digging a grave for the party in the country because his animosity towards the national health service and all the improvements is so difficult to hide that it is obvious to everyone.
David Taylor: Will the Secretary of State acknowledge that perhaps he has been a little unfair to the Conservative party? Our NHS framework for mental ill health might benefit from some of the targets that the Opposition have set themselves in trying to reduce the number of people who suffer from chronic panic attacks to below 25. Is not that an admirable target?
Dr. Reid: If I have been unfair to the Opposition in any way, I am sorry. Although our team of Ministers maintain above all that NHS priorities are those of the public and the Government, and that fulfilled targets make a genuine difference to people's lives, we would be the first to accept that we sometimes fall short. One example has been mentioned tonight and we have much work to do on that. We also fall short in other cases. However, even when we fall short of 100 per cent. success, the significant improvements mean that people are hugely better off than they were under a Conservative Government.
The Opposition celebrate every time we fall short. That happened earlier this year, when we had hoped that, by March, nine out of 10 patients who wanted to see a doctor would be offered an appointment in 48 hours. We fell short of that, as one or two newspapers noted, and the Opposition celebrated our failure to reach the 90 per cent. target. We fell short; we achieved only 88 per cent. success. We therefore missed by a fraction. However, the achievement remained a huge stride forward from the position that we inherited from the Conservative Government whereby only half the
patients were seen by a doctor in 48 hours. Even when we miss the target marginally, there is a vast improvement for the people who matter—the patients.What exactly motivates the Opposition to keep raising such subjects? They cannot be doing so to add to the coherence and motivation of their troops, who have little love or respect for the NHS. Is it right for the Opposition to complain that we have more than 55,000 extra nurses? Is that a rightful complaint for a responsible Opposition to make? Should we really consider nearly 14,000 more doctors towards our target as a great failure? Is it truly a cause for regret that in 2000–01, there were nearly 300,000 more in-patient operations than in 1996–97, when the Conservatives left office? As I said earlier, 98 per cent. of those unfortunate enough to be suspected of having cancer can now see a specialist in a fortnight—half as many again as when the Conservatives were in power. Are all those achievements truly a source of disappointment to the Conservative spokesman?
Dr. Fox: Since the Secretary of State wants to give the balanced picture this evening, I ask him the following question. If there are 14,000 extra doctors and it takes five years to train a doctor and the Government have been in office for six years, how many began their training under the previous Government?
Dr. Reid: Some did and some have come from abroad. Yet as the hon. Gentleman pointed out, we have more vacancies than ever. Let me explain that conundrum. [Laughter.] I am trying to be helpful to the laughing cavalier, the hon. Member for East Worthing and Shoreham (Tim Loughton), who obviously finds it difficult to hold two concepts in his head at the same time. He finds it difficult to understand how we can have more doctors than ever and more vacancies. The answer is easy. We have more doctors but we have created more posts than ever. That should not be a cause for complaint.
The application of targets for quicker access to cancer treatment has helped to cut death rates from cancer in this country by nearly 9 per cent. Does the hon. Member for Woodspring believe that the figures are being fiddled by people not dying when they should? No one can question the figures. We have cut deaths from cancer by nearly 9 per cent.
Let us consider coronary heart disease. No patient now waits longer than nine months for heart surgery, compared with 2,700 in March 1997. Does the hon. Gentleman believe that those 2,700 people view targets as a mistake? Does that apply to those who have been helped because targets for quicker access to treatment for coronary heart disease has cut mortality rates by almost 19 per cent. in the past three years?
The details that I have outlined should be cause for celebration. We should raise the roof because the efforts of NHS staff have reduced cancer deaths by 9 per cent. and coronary heart deaths by 19 per cent. To my knowledge, that significant figure has not been replicated anywhere else in the world.
Why do the Conservatives need to misrepresent the position? Why do they have to run down the successes of the NHS instead of presenting a balanced picture? They have to do that to justify their plans to run down the
NHS. They need to create the illusion of irredeemable failure inside the NHS to justify their craving to subsidise private health care outside the NHS. What they plan is simple: it is not a patient passport for the many, but an exit visa from the NHS for the few who are well off.More to the point, that exit visa will be paid for by the rest of us with longer waits, more distress, fewer operations, fewer doctors, fewer nurses and no targets, as the Conservatives have confirmed tonight. There will be no standards by which we will drive our health service. As always, the Conservatives have contrived, after great thought, to abandon their so-called compassionate conservatism—a contradiction in terms if ever I heard one—and return to the old policy for the few to be paid for at the expense of the many. [Interruption.]
The hon. Member for Woodspring shouts, "Rubbish." The suggestion that our old folk should find almost £2,000 if they want a quicker cataract operation or over £5,000 if they want a quicker hip operation could have come only from the Conservative party in this country. The idea that anyone who needs an early bypass should get it early by virtue of their ability to pay over £9,500 is completely in tune with the Conservatives' philosophy and completely out of tune with the sentiments of people in this country.
The Tories' policy is not a matter of increasing choice for the many; it is cheque-book choice for the few, which they have come back to as ever. Our answer is to reduce waiting times for everyone by investing, reforming and driving the NHS in partnership with its patients and staff. It is to deliver better care, more quality and more operations for more people more quickly than ever before.
The Conservative answer is diverting investment from the NHS into the hands of those privileged enough to be able to afford the purchase of priority treatment while extending the waiting times for the others. [Interruption.] The hon. Member for Woodspring asks about the diagnostic and treatment centres, where I am purchasing in the private sector in bulk and delivering free for every single person in this country. I am not asking people to buy earlier operations by spending their own money if they have it or to wait longer if they do not. That is the difference between him and me. I will not be constrained by dogma.
I will be prepared to deliver health care wherever it can be provided, always provided that it is built on the foundation of the NHS of equal access to health care free at the point of need, but the hon. Gentleman and his party, driven by dogma, can come only to the one solution, which is to divert money from the NHS to the few people who can afford to pay the other half of the costs of the operation in the private sector. That is less choice for the many and the cheque-book choice of earlier operations for the few, subsidised by the taxpayer.
I thank the hon. Gentleman for tonight; I thank him for what he did. He has provided us with the real dividing line in British politics, which will run from now to the general election. That dividing line is between those of us on the Labour Benches who believe in a
national health service free at the point of need and those on the Tory side who believe in subsidising those who can afford to pay for health care and the privileged few in this country. I tell the hon. Gentleman this: when it comes to that choice and that great dividing line, the vast majority of the people of this country will be on our side.8.24 pm
Mr. Paul Burstow (Sutton and Cheam): As I listened to the debate unfold and to the arguments about target setting in the NHS, it increasingly came into my mind that perhaps the biggest target we are debating is the Conservative party. That is our difficulty tonight: there are many distractions that have resulted in many choosing to be elsewhere and not to listen to the valid criticisms of targets that have been made by Conservative Front Benchers.
I will try to deal with those points, but first I want to place on record my party's appreciation of the NHS and its staff for delivering better health care for the vast majority of our citizens. The hard work of front-line staff deserves to be applauded, but all too often—perhaps inevitably—that does not happen in these debates. As constituency Members, we receive correspondence from constituents who had bad experiences of the NHS. That distorts our impression of what is happening in the NHS, but the truth is that the public are strongly committed to the principle of health care free on the basis of need, as are the Liberal Democrats.
Many who have experienced acute hospital care, in particular, in the NHS are seeing a difference as a consequence of the extra investment that is going in. That is extra investment that the Liberal Democrats had the courage and conviction to vote for, and to argue for at the general election. We are delighted that, at long last, that extra investment is arriving and beginning to bear fruit. We hope that it will continue to bear fruit in developing patient care.
Tonight's debate is about targets. Reference has already been made to the Audit Commission report, which, earlier this year, rightly shed a strong light on some darker and more disturbing aspects of the target-setting culture that the Government have introduced, not just in the NHS, but right across the board in public services. The debate is a welcome opportunity to discuss the targets and the damage that they can cause to the way in which priorities are set and the way in which health care needs are being met.
It is perhaps worth stressing that there is nothing new about target setting in the NHS. Indeed, the Conservatives, when in government, started it a long time ago—one has only to think of the patients charter—and their ideas continued through to their 1997 manifesto and to their 2001 manifesto with their patient guarantee proposals. However, under Labour, target setting has been developed into a pervasive and corrosive tool of ministerial control of every aspect of the way in which the NHS delivers care.
Performance in the NHS needs to be measured—of course it does—and the Secretary of State is absolutely right to say that he should be setting strategic goals for the delivery of health care, but the reality is that we are not setting strategic goals for our health care system or
for the health improvement outcomes that we wish to see for our population. We are micro-managing detailed aspects of health care delivery. That is not strategic management but detailed micro-management.The targets should be evidence-based and they should be outcomes-focused, but to my knowledge the Government have never published any systematic research evidence of the efficacy of the targets that they have set to date. Indeed, I wonder whether the Secretary of State, even at this stage, would be prepared to subject all the 62 targets that he has in place to evaluations and appraisals by the National Institute for Clinical Excellence. Perhaps then we would see whether they really deliver a clinical benefit and better outcomes for the patient. Will he make that offer tonight? Perhaps NICE could look at those targets.
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