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Mr. Deputy Speaker: Order. Treasury Front-Bench spokesmen must not keep intervening from a sedentary position. Although a certain amount of latitude is allowed, today we are debating not Opposition policies, but the Budget.
Mr. Yeo: I am afraid the fact is that Government Front-Bench spokesmen do not like to hear the facts about how they run the health service and the damage that they cause to the health of the British people.
The report from the Cabinet Office highlighted that
- "many organisations do face excessive externally set targets, measures and compliance requirements".
- "the Department of Health has only 12"
- "targets across the NHS and Social Care. Front line trusts and PCTs however face more than 4 times as many PSA-related controls . . . with a further 125 non-PSA related controls".
The Secretary of State promises that bureaucracy will be reduced and that staff numbers at his Department will be cut. He promises that patients will be given more choice. Those promises, however, are at odds with the Government's instinct for control freakery. Ministers may talk a good game, but the row over foundation hospitals showed just how reluctant the Labour party actually is to allow any genuine freedom to the providers of health care. We are now asked to believe that the very Ministers who presided over a rampant growth in bureaucracy are the best people to tackle the problems that they created. We are asked to believe that the same Ministers who have been obsessed with setting targets, through which they have tried to control every detail of the delivery of health care, will now allow clinicians and managers freedom to do their jobs.
As for patient choice, the improvements that the Government have promised will be available only to patients on a limited scale and after they have endured long waiting times. The danger is that if the Government's preoccupation with acute and emergency care continues, the needs of the 17 million people with long-term medical conditions will again be neglected. Earlier this month, the Secretary of State suddenly woke up to the fact that most of his targets have overlooked the suffering of those people and their families, but it will take more than a speech about "integrating the care landscape" to tackle the problem. That is why my colleagues and I have opened a dialogue with the Long Term Medical Conditions Alliance.
Mental health is another neglected area. More than 18 months after the end of the Government's consultation on the draft mental health Bill, we still await publication of the responses. Meanwhile, services continue to suffer. The NHS plan promised to introduce 335 crisis resolution teams by 2004, but fewer than half are in place. Some 50 early intervention teams were promised to reduce the period of untreated psychosis in young people and to help to improve long-term outcomes. Only 27 have been established.
Public health is another subject of deep and growing concern. I mentioned the rise in TB. Obesity is another problem that is growing worse under this Government. Last month's report from the Royal College of Physicians, the Royal College of Paediatrics and Child Health and the Faculty of Public Health contained a clear warning about where present trends are leading. The British Diabetic Association issued a similar warning.
The Government's response to these worsening trends is chaotic. Faced with growing concern over obesity, Downing street floated the idea of subsidised
gym club membership and a tax on fatty foods. Those wheezes succeeded in getting a headline but little else, and perhaps that is all that was intended. The ideas were soon rubbished by the Treasury's public health guru, Derek Wanless, but, having called for a report on public health, the Chancellor made no mention of that in his Budget. Meanwhile, the Department for Culture, Media and Sport has at last discovered that sport in schools is a good idea after all. As for the Secretary of State for Health, he is so confused that the only thing he can think of is to ask the public for their view—another big conversation when what the public need are answers. Who is supposed to be in charge? These issues are far too important to be dealt with in this muddled way. A co-ordinated approach right across Government is needed, and the Secretary of State should take responsibility, but taking responsibility is something that Ministers in this Government are extremely reluctant to do.Last week, the Chancellor was so busy patting himself on the back, he did not mention that each time he makes a statement to the House the amount of money that he has to borrow to pay for his spendthrift ways increases. He has presided over the biggest trade deficit since records started over 300 years ago, a halving of the rate of productivity growth compared with the last Conservative Government, the destruction of hundreds of thousands of jobs in manufacturing and a collapse in the savings ratio, and he has ruined the expectations of thousands of members of occupational pension schemes. One would search his Budget speech in vain for any reference to those important facts, just as one would search in vain for any admission of the inevitability of tax rises in the next Parliament if Labour wins another term.
I have given credit where it is due, especially to the dedicated and hard-working staff in the NHS. I have acknowledged that progress is being made in some respects, but to make real improvements to the nation's health a different approach is needed. With the founding principle of the NHS as our starting point we will make far-reaching and radical changes to the way that health care is delivered: by giving patients more control and freedom within the system; by giving genuine independence to health care providers; by having a much clearer focus on public health, the one aspect of health policy which should be delivered from the centre; and by launching a vigorous attack on waste at every level. It will not be enough merely to give patients more say in how and where they are treated. We must give more freedom to the providers, too. We want to give professionals, doctors, nurses and others working in health, including managers, freedom to do the jobs that they have been trained to do.
We will abolish the star ratings and most of the Whitehall-set targets through which Ministers have constantly meddled with the NHS, often to the detriment of patients' interests. At the next general election the country will have a clear choice when it comes to health: either continue with Labour's wasteful ways, in which standards in Britain lag behind other countries, an over-centralised system demoralises staff, and patients are denied control because Ministers think that Whitehall knows best, in a system where the state is too large and patients are too small. Or follow the new Conservative path, which will transform the way that health care is delivered, ensure that taxpayers' money
reaches the front line, put patients in control and let doctors and nurses do their job. That is the choice that we will offer the people of Britain.After seven years of tax, waste and spin, the public cannot see where all their money has gone. They know that the Government have not delivered on health, the Labour party knows that the Government have not delivered on health and the Secretary of State knows that the Government have not delivered on health. We relish the opportunity to offer the people of Britain the first-class health care that they have paid for and deserve.
Mr. Deputy Speaker: Order. Before I call the next speaker, I remind the House that there is a 15-minute limit on Back-Bench speeches, and that applies from now.
5.39 pm
Mr. Alan Milburn (Darlington) (Lab): It is a privilege to speak after my right hon. Friend the Secretary of State for Health, and I welcome his extremely important announcements. Would that I could say the same about the hon. Member for South Suffolk (Mr. Yeo), whose speech almost made me long for the return to the Dispatch Box of the hon. Member for Woodspring (Dr. Fox). I suspect that the reason for concern on the part of Opposition Members, which was perhaps reflected in the hon. Gentleman's speech, is that last week's Budget was one of not only considerable economic acumen but considerable political acumen. Few right hon. and hon. Members who listened to my right hon. Friend the Chancellor of the Exchequer could have doubted that they were hearing the starting pistol being fired for what promises to be an extremely long and interesting general election campaign.
Mr. Peter Luff (Mid-Worcestershire) (Con): On a point of order, Mr. Deputy Speaker. I think that the right hon. Gentleman will be grateful to me for raising this matter. There is a considerable problem with the sound system in the Chamber today, and I think that I have guessed correctly that the Hansard writers are having some difficulty hearing him. Can you do anything about that?
Mr. Deputy Speaker: I think that we shall simply have to carry on and use our voices as they did in days of old.
Mr. Milburn: I shall shout at the Opposition—I have done a bit of that in my time.
The Opposition's locker, which looked reasonably full only a few weeks ago when the shadow Chancellor published the Conservatives' spending plans, looked decidedly empty once the Chancellor had delivered his Budget. I have to say that it never struck me as credible that the Conservative party, purportedly committed to strong defence and law and order, could go into a general election campaign promising cuts at the Ministry of Defence and the Home Office. The truth is that the Budget has made its position even more painful, because the choice that it faces is whether to enter that campaign promising to take extra resources out of education to pay for tax cuts. The Budget has made the
choice for the electorate even more stark: cuts in taxes, or investment in services. It was James I of England who was famously described by Henry IV of France as
- "the wisest fool in Christendom."
Sixteen years ago almost to the day—in fact, I think the anniversary was yesterday—Lord Lawson, then Chancellor, hailed in this House what he called an "economic miracle". As we now know, his words were to turn to ashes in his mouth within a few short years, as economic mismanagement led inexorably to economic recession. When Lord Lawson spoke, the economy was doing reasonably well, but almost 2.5 million people were none the less unemployed and the inflation rate was just shy of 5 per cent. Today, by comparison, unemployment and inflation are roughly half that. I am not especially religiously inclined, so I do not say that what has been achieved in recent years is miraculous, but it is pretty remarkable. In the midst of a worldwide economic downturn, the British economy has continued to grow year after year, quarter after quarter. Even the most jaundiced economic commentators have been forced to concede that the fundamentals—inflation, interest rates, debt and jobs—are sound. I say that because there is sometimes a temptation to take all the progress for granted, as though it were purely natural. As even a cursory glance at the plight of some of our competitor nations, or at our recent economic history, shows, that is not so: Britain is in a good position because of good economic management.
We cannot hope to compete on pay or prices with the likes of China or Taiwan. Our future is not at the low-tech, low-skills end of the world market; it lies in high-skill, high-tech services and industries. That is why I applaud the Government's decision to invest further resources in education, just as they have in health. The investment being made in public services is not simply about creating more opportunity for better health and better education, important though they are. Nor is a social dividend all we will reap from that investment, as better-educated citizens lead healthier lives. There will be an economic dividend as well. In the short term, it will come from the stimulus that spending provides to the economy. Oxford Economic Forecasting Ltd. estimates that current spending will boost GDP growth by at least 0.8 per cent. this year and, indeed, next year. It is sound long-term economics for low-debt countries such as our own to be able to borrow so as to invest for the longer term. Providing that our expenditure plans are affordable, which I believe them to be, then public spending—far from being always a burden as too many assume, including, tragically, the Conservative party—can be a benefit. The long-term benefits are even more significant.
The primary rationale for investing more in health is to relieve pain and extend life. There are also important economic spin-offs. Many historians have noted that perhaps one third of per capita growth over the past two centuries in this country resulted from improvements in nutrition and health status. In a modern, knowledge-based economy, there is an even bigger premium on good health. When the Institute of Directors, not normally known for its political radicalism, still less for
its adherence to Keynesianism, says that sickness is a hidden tax on business, undermining competitiveness and reducing productivity, it really is time to take note. The number of long-term sick and disabled people wanting a job but not presently looking for one has more than doubled in the past decade. In an economy that is moving towards full employment and already reporting labour shortages, such morbidity levels pose a real threat to future growth.That is why my right hon. Friend the Secretary of State for Health is right to insist on improvements in NHS responsiveness to reduce waiting times for treatment. That will deliver not only a health benefit, but an economic benefit. It is one of the reasons why I also welcome my right hon. Friend's renewed focus on public health and prevention. In time, too, it will make a positive contribution to the UK's longer-term performance.
If health investment performs an economic function, the same argument can be advanced in spades for education investment. In the United States, it is widely accepted that every dollar invested in early years provision brings a sevenfold payback in lower crime, higher educational attainment and, most importantly, better jobs. Our Government have much to be proud of in that regard, providing extra nursery places and Sure Start projects in constituencies such as mine.
The Budget promised yet more child care centres. That, too, is welcome. However, in a country in which rising economic prosperity means that there are more two-income earners and more families struggling to balance their working lives and family lives—I speak with some experience about that—child care cannot just be centred on institutions. It must be centred on parents' needs. Above all else, working parents say that they need child care that is affordable and flexible. That is why I hope that the Government will go further than the Budget by ensuring that parents have a choice in how they receive help with child care.
For some, that care might be in a nursery or a child care centre. For others, it might be in the home. The point is that a one-size-fits-all approach will not work. Nowadays, people need flexible, personalised services. It is vital that choice is widely extended, not only in respect of child care, but for the wider public services. In that way, we shall get services that are not just more responsive but more fair. When we extend choice in the NHS, as my right hon. Friend is rightly doing, so that it becomes accessible to those without the ability to pay for treatment, as well as to those with that ability, and when we ensure, as I hope we will, greater parental choice over schools for those without wealth as well as for those who have it, we will be redistributing opportunity in our society. Today, people who can afford it buy choice in health and education. Those without do without. That is unfair, and it must be a Government priority to change that.
I suggest one further area where this modern form of redistribution should be taken forward, and that is housing. The promise of more resources in the Budget, alongside the Barker review of housing supply, is welcome and long overdue. Quite simply, our country is short of houses. The result, as Kate Barker rightly points out, is a negative impact on labour mobility. In a modern global economy, such inflexibilities exact a high price, but my principal concern is more social than
economic. Over the past four decades, social mobility in our country has slowed markedly. The generation of children born, like me, in 1958, were far less dependent on the economic status of their parents for their eventual economic progress than those born just 12 years later in 1970. Birth, not worth, has become more and more a key determinant of life chances, and sadly, changes in the housing market are opening an ever larger gulf between those with assets and those without.Rising house prices are making home ownership more unaffordable for more people. Not surprisingly, the number of first-time buyers entering the market has declined. In the longer term, rising house prices threaten to impede social mobility across generations. While the value of housing assets has increased markedly, the number of people with no assets at all has more than doubled in the past 20 years. The principal inequality in our society today is no longer about income but about ownership of assets, whether a pension or a home. In London today, the child of a home owner stands to inherit an average of £230,000 when the parents die, but a classmate whose family rents will inherit nothing. In other words, the housing market is widening inequality.
It must therefore be the Government's explicit objective and priority to increase home ownership. I agree that more social housing is needed, but I do not agree with the orthodoxy that the only future for those without a home lies in social housing. When interest rates are low, it is often cheaper to buy than to rent. Moreover, given a choice, most people prefer to buy rather than rent. Welcome as the Barker report is, we need to do more than simply build more homes; we need to open up more opportunities for people to own their own homes. Helping people on to the housing ladder will not only address issues of labour mobility and economic flexibility, but be a route to greater social justice and fairness in our country. It is a modern means of redistributing wealth in our society. The job of a progressive Government is not just to beat poverty but to help people realise their aspirations so that we are capable of levelling up in society, not levelling down.
New Labour won in 1997 and 2001 as a party of aspiration. Future victories depend on our pursuing policies that promote aspiration and enhance choice. That requires investment, of course, but also reform, whether in health, education or housing. Good foundations have been laid, and the Budget builds on those foundations. Its proposals for extra resources are welcome, as investment, not tax cuts, can best secure the long-term prosperity of our country. A flexible economy and a fluid society, however, cannot be bought simply by increasing resources. With investment rising, it is time to put our foot firmly on the accelerator, not on the brake, for reform as well, and I hope that my right hon. and hon. Friends will do so.
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