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3.16 pm
Richard Burden (Birmingham, Northfield) (Lab): I am one of the Labour Members who have significant and severe reservations about the principle of variable fees, and it is to that that I shall devote the majority of my remarks. First, however, I pay tribute to my right hon. Friend the Secretary of State for Education and Skills for the thoughtful and detailed way in which he has approached the debate and in which he has engaged in dialogue with people who take a view different from his. That is in marked contrast to the rant that we heard from the Opposition. I am still trying to work out how their figures add up; as the hon. Member for Harrogate and Knaresborough (Mr. Willis) observed, we shall perhaps find the answer on the island where the Conservatives plan to put asylum seekers. We certainly did not hear it today. What we do know is that if their policies hold together at all, which is extremely doubtful, they will mean a huge and severe restriction of opportunities for many, many thousands of our young people.
I also pay tribute to my right hon. Friend the Secretary of State for taking an important step in higher education policy through the proposal to abolish up-front fees. That is long overdue, and it is welcome. Whatever else comes out of the debate, I hope that that proposal will remain and will influence future policy. In giving that welcome, however, I ask my right hon. Friend to consider the following point, although it may be covered as debates on the Bill proceed: if we abolish up-front fees, the issue of fee waivers must be reassessed. Whether the fees are to be variable or flat-rate, we do not need fee waivers if we abolish up-front fees because students will not be paying them. Graduates may pay them but students will not, so that aspect needs to be rethought.
I also urge my right hon. Friend to consider carefully the paper produced by my hon. Friends the Members for The Wrekin (Peter Bradley) and for Southampton, Test (Dr. Whitehead), which discusses whether the network of bursaries and the other things that we are
proposing is the most effective way of achieving the important objective of ensuring access for students from lower-income backgrounds. Could that be better achieved by moulding a grant system targeted at those from less well-off backgrounds?My first problem with the principle of variable fees is two-tierism. Hon. Members are right to point out that we already have a multi-tiered university system. It is true that universities are multi-tiered in terms of the type of course and the type of teaching that they offer. Sadly, they are sometimes multi-tiered in teaching quality and, even more sadly, in terms of institutional status. If we do nothing else, we need to confront the latter point.
We need to do something about all the things that I have listed, but we must not do so by putting in place a price tag for students or graduates, which would follow them into their working lives. It is self-evidently true that courses in biochemistry, medicine, sociology, modern languages and so on cost different amounts to teach, but do we want students to calculate which course to select according to whether the job that they get at the end will allow them to repay the cost of their teaching? That seems to me to be the wrong approach.
I do not think that the poorest students will be the worst affected, if we get right the questions of access, grants and so on. The students worst affected will be those who are not well off, who are nearly poor, or who are at or just below average income. That is where the problem will be felt. We are talking about repaying a fee of about £3,000 a year, but once the principle of variable fees is established, that will probably turn out to be the thin end of the wedge. I do not know how broad the wedge will be, but it will exist. I am loth to embark on a journey whose end we cannot foresee.
My right hon. Friend the Secretary of State said that a university in the Russell group was talking about getting rid of fees for undersubscribed courses, such as physics. I have heard similar reports, and I consider that the possibility is highly dangerous and would have two consequences. First, such a course would be subsidised by other courses for which fees are paid, with variable fees rising as a result. Secondly, if no fee is payable, there will be no relationship with the graduate's ability to pay when the course is finished. Graduates from such courses will have no fees to repay, because no fees were charged. Therefore, if we allow universities not to charge fees for certain courses, the link between the proposed system and graduates' ability to pay will be destroyed.
My second problem has to do with people's trust, both in what we have said and in what we will say. We have to admit that we went into the last election saying that we would not introduce top-up fees. Technically, it is true that the legislation need not be enacted until the next Parliament—that is, until after the next election. However, will constituents make that equation, or will they think that we said one thing and did another?
I do not dispute the fact that difficult choices have to be made. We must confront those choices—as must the other parties, sooner or later, if their policies in opposition are to have credibility. We are embarking on the big conversation project, which I think is exciting. We want to engage with people outside and look at the big issues. As part of that discussion, we should look at whether our traditional position in respect of variable fees should be retained or whether it should change. We should also look at flat-rate fees.
Another past manifesto commitment was never to raise the top rate of income tax. We need to consider whether that needs to be reviewed. Those are difficult matters, and they need to be discussed.
We need to consider the appropriate balance between the contributions made by individuals and by society as a whole. We have to make a judgment about the training that a teacher gets. How much of the benefit goes to that teacher, and how much to society as whole? The same applies to doctors and to people in other professions. We should discuss such matters among ourselves, with others in different parts of the political world and with the people whom we represent.
Given what I have heard so far, I do not believe that the proposal to introduce variable fees is right. However, even if it is right, it is certainly wrong to introduce it now. It should be discussed and introduced later.
It may be claimed that we cannot wait and that universities' financial needs are so severe at the moment that the cash injection is needed now. If so, such a claim has consequences. If fees have to go up, how can we remain true to what we have said in the past? We should abolish up-front fees, but that can only mean an increase across the board. I do not think that that is the only option, but it may be the speediest. Again, that is why I commend the proposals put forward in their pamphlet by my hon. Friends the Members for The Wrekin and for Southampton, Test.
Finally, I turn to student debt. Regardless of whether fees are variable or flat-rate, we have not yet grasped the full significance of the impact of debt on students. We need to do so. Students must repay loans as well as fees, and they face other expenses as well. We need to link up our policies. At the same time as we are telling students in their early 20s that they will need to incur very substantial debts as a result of their education, we are also telling them that they must think about providing for their security in retirement by contributing to pension schemes.
It was difficult enough to interest young people in pensions 10 years ago, let alone now. However, we are trying to get them interested in what their circumstances will be at 60, 65 or 70 at the same time as we are asking them to incur debts that will restrict their income in the period immediately after graduation. We should do that only very reluctantly, and only after much thought—
Madam Deputy Speaker (Sylvia Heal): Order. The hon. Gentleman's time is up.
3.26 pm
Sir George Young (North-West Hampshire) (Con): It is a pleasure to follow the thoughtful and courageous, if not career-building, speech by the hon. Member for Birmingham, Northfield (Richard Burden). I am sure that he was right to say that the Government will suffer a loss of public confidence if they pursue their policy on top-up fees, as that policy sits very uneasily with the commitment in their manifesto. However, I hope that the hon. Gentleman and the House will forgive me if, in the short time available, I focus my remarks on the Opposition amendment to the Loyal Address, which relates to the health service.
I welcome to the Front Bench my hon. Friends the Members for South Suffolk (Mr. Yeo) and for South Cambridgeshire (Mr. Lansley), who now have responsibility for health service matters. I can think of no two people better able to dismiss the absurd allegations made by Labour Members from time to time about Opposition policy on the NHS.
When the Conservative Government were elected in 1979, we were able to stick to the spending levels that we inherited from the previous Labour Govt. At a stroke, that demolished some of the absurd claims made before that election. I hope that we will be able to do the same again. I hope that our policy will be to stick to the core values of the NHS and to build on its strengths but address its weaknesses.
I confess to having, from time to time, a moment of sympathy for the Secretary of State for Health. He has extracted record sums for the NHS from the Treasury, yet he finds himself besieged by colleagues highlighting areas in which the NHS could do better. However, the moment of sympathy passes quite quickly. Ministers must largely bear responsibility for the frustration, because they have let the rhetoric run ahead of reality, stifled the initiative and skills of those who work in the NHS, and overwhelmed it with endless and misguided legislative reforms. People are less interested in new laws than in what is actually happening. I want to spend a moment looking at what is happening.
I recognise that the problem of declining NHS dentistry precedes the advent of this Government in 1997. This Government said, however, that they were going to address it. Six years on, people who have had NHS dentistry all their lives are now losing it. I received an e-mail on 19 November from Mr. Cull of Tadley:
- "I have recently been told by my local Dental Practice . . . that they no longer accept NHS patients . . . If it were possible, I would now choose to opt out of paying tax and national insurance, and pay for any services as and when my wife and I need them. I want the Government of the day to recognise that those who pay are entitled to something back!"
- "I discovered yesterday that my family has been taken off the NHS register at our local dental surgery and my children cannot get treated unless we the parents register as private patients."
A third constituent was told that he had to join Denplan at £14 a month. He wrote:
- "Both myself and my wife are in our 70s and we find that we cannot afford this level of charge from our pensions. We both only have nine teeth remaining and therefore find this situation is very poor. Can anything be done so that pensioners are not faced with these excessive charges in the future?"
The situation with general practitioners in Andover, the main town in my constituency, is not much better. A member of my staff recently moved to Andover. All the GP lists near where she lives are closed. Another constituent e-mailed me on this subject on Monday to
say they had attempted to get onto books throughout Andover, but had been informed that the only surgery available is somewhere else. My constituent wrote:
- "I would invite your comments on the current state of medical provisions in your constituency when, despite Andover being chosen as an area for expansion, 99 per cent. of all surgeries have closed their books."
Moving upwards to hospitals, we have a popular hospital in Andover with dedicated staff struggling to provide modern services. The building in which the out-patients department is located, however, is straight from "Carry on Nurse" in the 1950s, with people standing in long queues waiting for blood tests on a Monday morning. I ask the Secretary of State, who is chuntering away on the Front Bench, why that is happening and why it is tolerated. In a nutshell, it is because Hampshire gets about £85 per person for every £100 that the rest of the country gets. That is simply inadequate to provide the quality of service that my constituents expect.
We just have to look at the accounts for one of the two three-star hospitals that serve my constituency for the year ended in March to see the pressures. It brought forward an underlying deficit of £3.5 million, and had unfunded commitments of £3.9 million, a cut in primary care trust income of £1.4 million and unfunded cost pressures of £600,000, leading to a deficit of £8.6 million. Of that, £6.1 million was found by savings and income plans—code for increasing car park charges and looking hard at service provision. The balance of £2.5 million was found from the strategic health authority.
Like most of the NHS in south-east England, the local primary care trust has similar structural problems. It had a deficit of £1.5 million last year, made good by capital-to-revenue transfers. In the current year, it can balance the books only by either land sales or capital-to-revenue transfers of £2 million. If we go on transferring from capital to revenue, the position that I have just described at Andover hospital will remain.
I know what the Secretary of State will say—that he has given a record cash increase this year. Yes, the trust that runs the largest hospital in my constituency has had a 9 per cent. cash increase this year over last year. I asked it how much of that was swallowed up by increases over which it has no control. The answer was 6.5 per cent.—national insurance, nurses' pay, doctors' hours and pharmaceutical prices. Therefore, 6.5 per cent. out of 9 per cent. disappeared. Of the 2.5 per cent. remaining, 1.5 per cent. was applied to the deficit that was brought forward, and the 1 per cent. of growth was ring-fenced for a number of specific services. Therefore, virtually no money was left over to develop all the other services that were not ring-fenced.
That pressure feeds through to individual constituents. Mr. S of Andover saw his GP in January and was referred to a neurologist. The appointment was on 10 June. He was told that he needed a brain scan. He wrote:
- "After two months, I had not heard so I phoned Southampton Hospital; imagine my anxiety when I was told my scan was classed as routine. My appointment would be in June 2004".
- "At present our wait is now 8 to 9 months, but unfortunately this waiting time is currently rising as we are suffering staff shortages due to a scarcity of trained radiographers nationwide."
- "Unfortunately due to the NHS allocation of funds for this year having already been exhausted, the operation is currently delayed until April next year at the earliest."
To address the problem, Conservative-controlled Hampshire county council plans to develop an extra 4,500 nursing home beds in the county to help to overcome the shortage—a much more constructive response, dare I say it, than the Community Care (Delayed Discharges etc.) Act 2003. However, Hampshire county council is threatened with capping if it attempts to deliver the quality of service that the Government want.
My advice to the Secretary of State is this: first, stop constantly interfering; secondly, moderate the rhetoric; thirdly, allocate resources fairly. If he does all that, he will begin to bridge the gap between expectation and reality in Hampshire.
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