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Only one sentence in the Gracious Speech refers to the national health service, but it includes four crucial words"reform", "choice", "freedom" for staff and "control" for communities over hospitals. As I have just a few minutes, I shall speak only about choice and reform. When considering choice, we must ask what patients want. When considering the needs of hospital in-patients we must look carefully at two issueselective services and emergency servicesas the choices in each case are quite different. If someone has an extremely painful hip, the time that they have to wait is crucial. If it is less painful, the timing and place of the treatment, as well as the consultant who will carry it out,
If it is impossible to keep full emergency services for every community, there must be a local assessment facility, which will prevent patients from being moved unnecessarily far from their area. That will become even more essential with the constraints put on the service by the European working time directive. I am delighted that pilot trials are under way, but I am distressed that 135,000 people in my area are not being considered for a local emergency centre. I am looking forward very much to the results of a wide-ranging national consultation on choice, responsiveness and equity. It asked for the opinions of patients, users, carers and everyone running and providing health and social care, as well as the voluntary and independent sectors, patient organisations and, not to miss anybody out, the public. I hope that the Government will not only listen to the comments, but act on them.
On reform, almost 20 major changes have been made to the national health service in the past 20 years. Both major parties have obviously taken a hand in the reforms. The service is almost punch drunk from reforms and needs to be left in peace for some time to get on with them. I remind hon. Members of John Stuart Mill, a philosopher and economist who wrote almost 150 years ago:
The time is particularly ripe because of the recent publication of the Nuffield Trust report entitled "The Quest for Quality in the NHS". In the report, there is at least the beginning of an attempt to defuse the argument in which all Labour Members say that everything in the NHS is wonderful, while other Members tend to say that things are not so good. A British Medical Journal leader referring to the report asks this question about current Government action:
My own primary care trust, which deservedly won three stars, is now, unfortunately, red-lighted for eight key targets, six of them relating to problems with the acute trust. The Government have made the welcome announcement of 170 extra trainee doctors with national training numbers in obstetrics and gynaecologybut without the necessary funding, will the PCTs be able to afford them? There are worries about funding a consultant contract and emergency GP care under the new contract.
Peter Bradley (The Wrekin): I am sorry that the right hon. Member for Horsham (Mr. Maude) has left his place, because, as he disclosed to the House, our deep and dark secret is that we attended the same independent school. There are some significant differences between us, however. He became the chair of governors and I have never been invited back; those two facts may be connected.A more profound difference is that when he left school he joined a party whose central tenet is that the privileges that we enjoyed should be the province of the few, but paid for by the many to whom they are denied; and I joined a party that believes in equality of opportunity.
I welcome the delay in the publication of the Bill. On the one hand, that gives the Government an opportunity to persuade people with reservations about certain aspects that the Government are right; on the other, it offers those people an opportunity to persuade the Government, through constructive criticism, that they may be wrong.
I commend the Government for grasping the nettle of higher education funding, although it might have been better had they worn thick gardening gloves in doing so. They are to be commended for the twin principles that underpin the White Paperthe principle of raising standards and quality in all our universities and the key principle of expanding access to prospective students from lower-income groups to whom it has previously been denied. However, although the ends are well intentioned and to be welcomed, the means are flawed.
I agree with many of the Government's proposals. It is right that graduates should be asked to contribute to the cost of their education and the advantages that they derive from it. On leaving university, graduates enjoy an immediate differential of £3,000 to £4,000 between their salaries and those of people without degrees, and that widens as their careers progress. I welcome the Government's enlightened view that graduates, not students, should repay their tuition costs.
I do not subscribe to the widely held view about debt-aversion that was cited by the hon. Member for Harrogate and Knaresborough (Mr. Willis). I would liken the debt that students will accrue to an investment that bears a dividend, such as a mortgage. Indeed, the repayment terms are rather better for tuition fees than for mortgages, because someone who loses their job still has to pay the mortgage, whereas if a graduate loses their job, their loan repayments cease. The system will remove significant obstacles that deter students from lower-income households from attending university.
Too little attention, however, has been paid to the severe problem of living costs, which can deflect talented young people from low-income groups from university, where they would be better off, into work for the short-term advantage of earning wages. If they overcome that obstacle and enter higher education, they tend to try to save on living costs by attending universities that are close to home, but do not necessarily offer the courses that are best suited to their abilities, aspirations and interests.
In my view, the problem is not tuition fees but variable fees. I do not believe that they will work or create the market for which the Government hope, not least because I have not heard of a university that does not propose to charge the full £3,000 for its courses. Other hon. Members have also made that point. Why would universities forgo the income that they desperately need? Why would they want to signpost to students the fact that their courses are low value and low premium? That is not the smartest move in marketing.
Even if the access regulator obliges the Oxbridges of the world to double their intake from lower-income groups from 10 per cent. to 20 per cent., they will derive the enormous credit of fee income over the bursaries that they have to give to those students. However, other universities, including Wolverhampton, which is closest to my constituency and already has a 75 per cent. intake from lower-income groups, will derive tuition fee income from only 25 per cent. of students while disbursing bursaries to 75 per cent. That is only a modest credit.
It is strange for the Government to suggest that we give incentives to universities that default on access for lower-income students and penalise those that deliver the Government's commitment to expand access to people from those groups.