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Tim Loughton (East Worthing and Shoreham): I regret that the hon. Gentleman is playing the bogus figures game with the ones that the Government came up with. If he had visited hospitals in the independent, not-for-profit sector, he would know that that the price paid to those hospitals is much lower than the tariff that he suggests; indeed, in some cases it is equivalent to the NHS headline figures. Would a Liberal Democrat Administration—God forbid—commission no operations outside the NHS, not even the 250,000 that this Government are commissioning but misleading us about, in terms of the figures that they are paying?
Mr. Burstow: What we would not do is to try to palm off the passport idea as a golden opportunity to liberate people, giving them the chance to receive health care quickly. In reality, they would still have to pay huge bills, at the expense of our national health service itself.
Mr. Hendrick: Why is the hon. Gentleman against targets if he is genuinely in favour of measuring performance? Without targets, there is no benchmark. He talks about outputs, but we also need inputs. We obviously need quality care, but we also need some form of target to deal with patient numbers; without it, we cannot determine whether the outcomes are effective. The Liberal Democrats say that they are against targets and against the Conservatives' patient passport, but what would they do to improve the health service?
Mr. Burstow: As I said—I am more than happy to amplify the point a little—we propose genuine, democratic local control of health care commissioning. We believe that health care commissioning is best done in the context of local government, in which there is the opportunity not just to integrate health and social care commissioning, but to look across the piece and address environmental health, housing and a range of other factors that are the real underlying causes of health problems. That is the agenda that we want to move on to, because we believe that it is the way to secure better health outcomes in the long run.
The Minister of State, Department of Health (Mr. John Hutton) rose—
Mr. Burstow: I see that the Minister is becoming very alert. That is not a good reason to give way, but I will nevertheless give way to him.
Mr. Hutton: I am very grateful. I am following the hon. Gentleman's argument closely and giving it the respect that it is due. I understood what he said about local government, so can I take it that, if there were to be a Liberal Democrat Secretary of State for Health, no national targets would be set for the NHS?
Mr. Burstow: Absolutely, because national targets of the sort produced by the Government are input and process-driven, not outcome-led, so they do not make a difference. What we want in respect of national priority setting and strategic goals is to move the focus of our
health care system to public health. As to the current process targets, I am happy to go on the record and repeat what my colleagues have consistently said for a long time in critique of the Government's approach. If that gives the Government any form of succour, they are suckers to take it that way.
Mr. Burstow: I give way one more time to the Front-Bench spokesman.
Tim Loughton: I am terribly grateful. We are starting to get at the beginnings, but only the beginnings, of a Liberal health policy. Is the hon. Gentleman saying that if Liberal Democrat councillors are put in charge of health policy locally, everything will be rosy? Why does he not trust professionals in the health service to determine the medical objectives that need to be followed? Many professionals will be on a national body, but at arm's length from political control, as we have suggested. Apparently, the hon. Gentleman wants more, not less, political control.
Mr. Burstow: The reality is that I am prepared to trust the patients and the people, and to achieve that through local democracy rather than through the central autocracy proposed by the Conservatives. It is interesting to see that the Conservatives dare to criticise an exposition of Liberal Democrat policy when they did not have the courage to outline any of their health care policies in the debate tonight—[Interruption.] It is a great pity that the shadow Secretary of State did not take that opportunity. It is also a great pity that he is not in his place to take up the challenge later.
In setting out the Conservative health care policy in early October—it seems a long time ago when so much water and so many leaders have gone under the bridge since—the hon. Member for Woodspring (Dr. Fox) identified the fact, as reported in the Daily Mail on 7 October, that 300,000 people currently had operations in the private sector. That is entirely right, but the number is important: 300,000 people opting to go private. In the same article, he took the example of a hip operation as the basis for working through the proposals. If 300,000 are already opting to go private and, under a Conservative Government, they could claim a contribution to a third or less of their private bill, what would that do for the NHS budget? We should remember that this is before a single extra NHS patient opts to use their patient passport at all. Without a single extra operation being performed, the Conservative policy would cost the NHS at least £900 million a year—possibly more, depending on the types of operation done in the private sector under the policy. That is taxpayers' money leaving the NHS with not a single extra operation being performed as a consequence.
Where will the extra £900 million come from? Typically for the Conservatives, we have heard no detail, no costings and no proposals for how the policy would be rolled out in practice—[Interruption.] If the detail exists, I wish that Conservative Front Benchers had taken the opportunity to outline it. It has certainly not been put into the public domain—[Interruption.] It is no good the hon. Member for East Worthing and Shoreham (Tim Loughton) protesting from a sedentary
position that there is detail, and then not publishing it. That hardly amounts to a Conservative policy. Can he now provide some detail?
Tim Loughton: The hon. Gentleman should know that, for the last few weeks, our party has talked an awful lot about the patient passport. Considerable detail has come out. We are about to produce some rather interesting costings on how it will work. If he would be more patient, he might be pleasantly surprised. Perhaps he will now tell us how much extra in local council tax—the latest invention of the Liberal Democrats—it will cost us all, again before a single extra operation is done, to install all the extra managers and political bureaucrats that he wants to introduce into the NHS.
Mr. Burstow: I am afraid that the hon. Gentleman protests too much. We should wait to hear the details of the Conservatives' policy, then have a good belly laugh when they come out, because they will not add up. The Conservatives have not yet outlined how they are going to carve this £900 million out of the NHS budget to pay for their policy. That money will not add a single operation, private or public. That is the charge that the Conservatives must answer when developing their policies and selling them to the public.
The Conservatives would have us believe that they want to reform the national health service. I cannot criticise their motion in terms of its analysis of many of the flaws in the Government's approach, but the Government's amendment is much too self-serving and self-congratulatory to deserve the support of the Liberal Democrats tonight. From what I have heard of the Conservatives' policies, and of the details that they have outlined bit by bit during the exchanges that we have just had, we certainly would not wish to demonstrate our support for them in the Lobby. The Conservatives say that they favour reform, but what did they do when they were in office? They ran the national health service down and, in opposition, they are now all about abandoning it. That is not the solution that this country wants.
8.51 pm
David Wright (Telford): Before I was elected to the House, I spent some 13 years working in the public sector. Much of that time was spent working under a Conservative Government who brought in a whole raft of indicators and targets for local government. We struggled with them a bit at the time, but that Government were right to build up those targets and to increase the amount of information that was collected relating to delivery. Therefore, it is interesting that, in this debate, the Conservatives seem to have performed a complete volte face. Originally, they tried to approach the issue from the perspective of placing a business emphasis on the management of public services and, as I have said, they were probably right; yet they now seem to have changed their position and to be considering abandoning responsibility for key targets in the health service.
How can we manage a service of the scale of the NHS without targets? If we cannot measure it, how can we manage it? I assume that the Conservatives will not be
using targets in future debates, yet their Front-Bench spokesman's opening speech used a whole raft of targets to try to illustrate how badly the health service was doing. Indeed, without such information, he could not have delivered his speech. Throughout my time in local government, I particularly enjoyed the contribution to management theory of Tom Peters, who said:
- "Get hard data. Get it quickly. That's the key."
The Conservatives' attack on targets completely misses the point. Labour Members have said all along that targets are not an end in themselves, but a vital mechanism by which we can improve our health service and increase accountability. Of course we must decentralise control of the health service, so that bureaucracy and form filling are reduced, but that must be balanced by the need for national standards. Patients should get the same guarantees of basic quality from the NHS wherever they live in the country, and national targets help us to drive up performance and standards where necessary. The Government are, of course, bringing in proposals for foundation trusts for those hospitals that reach the very highest standards. We are trying to improve national targets across the board, and when they are achieved the trusts will give greater freedom and flexibility to local managers to set targets and priorities. I very much welcome that initiative.
The public want to know how their money is being spent and what the results are. The main focus is, of course, on acute services, although target setting through primary care trusts is also delivering significant improvements in community-based health care.
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