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6.56 pm
Alistair Burt (North-East Bedfordshire) (Con): It is a pleasure to follow the hon. Member for Plymouth, Sutton (Linda Gilroy), who made a skilful defence of the Budget in relation to the health needs of her constituents. I hope to match her eloquence, but I will not necessarily agree with all her arguments.
It was quiet in Biggleswade last week. The still waters of the River Ivel were disturbed more by the gathering winds and gales that swept across the country at the weekend than by anything that the Chancellor said. That was not a great surprise—my constituents do not expect all that much from this Chancellor, and they were not disappointed. They recognised, as we all do, in all parts of the House, that it was a highly political Budget, of which my constituents were not the targets. It was a speech all about the Chancellor, and his targets were sitting all around him, rather than across the Chamber or among my constituents.
The Budget included serious political gestures; let me pick out two—one good, and one less good. I am sure that mine is not the only constituency to have a significant number of historic, old churches and, given that, we welcome very much the removal of VAT on church repairs. It will make a difference, and will recognise the position of churches in local communities. Whether or not that is related to their churchgoing and Christian communities, those churches are symbols of what is good and great in our communities. Full marks to the Chancellor for that.
As a political gesture, the council tax bribe was crass and will be ineffective. The whole point of a bribe is that one is not supposed to see it coming or to know that it is there. The more obvious it is, the less effect it has. My constituents are not fools. My pensioner constituents well understand that their council tax bills have been rising in recent years at the Chancellor's behest. They have seen money taken away from their county council as it has been shifted from rural areas to other areas. They have seen extra responsibilities put on the county council, which have not been paid for. To compound that by effectively taking money from their neighbours and children to pay for what the Chancellor has asked leaves a very sour taste. They will not be fooled—it is like a magician explaining to everyone what the trick is, doing the trick, and then expecting applause for the suspension of disbelief that he has just dispelled. The Chancellor gets no marks for such a crass political gesture.
Before I say something about health, let me touch on two themes that are increasingly becoming a hallmark of the present Chancellor, and are perpetuated by the Budget. Notwithstanding all the things that are working well and are encouraging in today's UK economy—and how grateful the Chancellor must continually be to my right hon. and learned Friend the Member for
Rushcliffe (Mr. Clarke) and my right hon. Friend John Major for the economic legacy that they left him—the Chancellor is steadily taking risks and undermining the very basis of the things of which he can boast so grandly at the Dispatch Box.I am indebted for an excellent speech last Wednesday by my right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley), who patiently explained the cumulative and long-term beneficial effects of Conservative reforms on trade unions, taxation, the competitiveness of the economy, the regulatory framework and the nationalised industries. He explained that it would take time for those effects to show in the economy. The flip side, as he also explained, is the damage being done by failure to understand the impact of those changes. A move away from their beneficial effects is inevitable, but it too would take time to feed through.
We are already seeing some signs. There is an obvious decline in the UK's competitiveness, which is recognised throughout the world. There is also the growing voice of business and industry, which observe the damage being done. Nothing in the Budget speech suggested to me that the Chancellor understood the danger of throwing away what he was throwing away. Truly, in the words of Miss Joni Mitchell, you don't know what you've got till it's gone.
The second theme that the Chancellor is increasingly in danger of failing to understand is his inability to restrain his two impulses, towards spending and towards being in complete control. Spending we know all about: it is easy to spend. Whether it does any good, and whether it does the good that it is designed to do, we have already discussed today in relation to health, and we will continue to do so. As for the control issue, the determination to control was illustrated in the Budget by two gestures, one very significant and one throwaway.
The significant gesture was the casually offered snub to the Prime Minister when the Chancellor made it clear that it was he who would decide whether the Government opted to join the euro—a point picked up earlier by the hon. Member for Luton, North (Mr. Hopkins) when he welcomed "the Chancellor's decision" not to join. I did not think it was the Chancellor's decision to make—someone will correct me if I am wrong—but the Chancellor, of course, makes clear that it is.
The throwaway gesture was the Chancellor's statement that he accepted a recommendation in Kate Barker's report on housing, published that morning, without much consideration and with no consultation. The report recommended that in the regions there should be one body responsible for housing and planning—no doubt under significant Whitehall control. So there it is: goodbye local democracy. Goodbye to those who understand the importance of greater development in their area, not at regional level but at local level, to the local communities and authorities that must deal with the consequences.
It is consequences that I want to discuss now. One of the consequences of increasing large-scale development will involve local health services. Bedfordshire will have
to accept 54,000 new houses in the next 17 years. Let me give the House an idea of the scale. The two biggest towns in my constituency are Sandy and Biggleswade, which between them have a little under 30,000 inhabitants. It has taken them hundreds of years to reach that size. In less than 17 years, new developments twice that size will come into being.In such cases, there is always an immediate pressure on health. Services lag behind development. My county is now irrevocably committed to years of catch-up. Bedford primary care trust already has a shortfall of some £19 million, and it was clear from the latest Government figures, released before Christmas, that there were no plans to close the gap in the next 20 years. Now there will be that further development. The proposal to take planning decisions further away from local communities and towards regional bodies, which the Chancellor so casually recommended, is scarcely good news for my constituents or those who plan health matters.
It is not just about money. The Government, and the Secretary of State this afternoon, have made it clear that as far as they are concerned the major indicator in all issues related to health and public services is how much is spent—not how good a system is, how efficient it is, how welcome it is in a particular area or how understanding it is of that area's needs. Not all problems are solved in terms of how much is spent. Let me give two examples.
First, there is the question of how the money is spent. Where in the Budget debate did we sense any confidence in the new GPs' contract and its effects, to which the Secretary of State did not refer? On 1 April, the new contract will come into force. What assurances have been given to primary care trusts, which are taking over its administration, that they will be able to provide a better out-of-hours service for their patients than GPs have been providing?
We already know that the PCTs have been given a certain amount of money with which to handle the contract. We know how much the GPs were charged by those running out-of-hours services, and how much they intend to charge the PCTs; and we know that the two do not balance. What will happen? Here was an opportunity, just two weeks before the introduction of the new contract, to give PCTs some reassurance about what would happen should the money run out. There was no such reassurance. It is not a question of how much is there; it is a question of how it is used, and how it can be ensured that those responsible for services know what is to be done.
The second problem is how to deal with the fact that more and more doctors and nurses are leaving the system. The system can have all the money it requires, but if it is not recruiting or retaining doctors and is losing nurses, it will not be able to deliver the services that it wants to deliver. Six months ago, the magazine Hospital Doctor published the results of a survey that indicated that up to three quarters of all hospital doctors intended to retire early. They cited stress, increased work load, declining clinical autonomy and a lack of support from management as key factors.
Many of the issues are structural. They can be related to an overbearing, over-prescriptive regime in which targets and quotas have played their part. Do the
Chancellor and the Government not see that putting money into an inadequately reformed system does nothing to alter those problems? All that happens is that raised expectations are followed by frustration and disappointment as doctors still feel unable to carry out their duties. They leave a poorer service, and patients lose faith as a result. I detected no understanding of that in the Budget debate and the Chancellor's remarks.Two weeks ago, the New Statesman reporter Glenda Cooper dealt with the issue of nurses in the NHS. She wrote
- "the NHS still needs to find 35,000 more nurses during the next five years—while at the same time a quarter of the workforce is due to retire, and up to one in five nurses drops out before the end of training."
- "Nursing, they say, has become divorced from caring, sisters have been reduced to ward managers, and degrees and diplomas have become more important than bedpans and bedside manners."
Let me end with a short plea. As I said earlier, I welcomed the concession on VAT related to church repairs. Will those at the Treasury have a word with the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton) about the charging of VAT on capital projects for the NHS? Where public appeals have been launched to support them, might there be any relief of VAT required for building works resulting from such appeals?
Recently, the Primrose appeal in Bedfordshire raised more than £2 million to support a new cancer unit at Bedford hospital. Donors throughout Bedfordshire were surprised and disappointed to learn that a concession given to the Macmillan charity, enabling the VAT that it would have to pay to be recovered through an internal mechanism in the health service, would not be available for the bulk of the money raised for the building itself.
My hon. Friend the Member for Mid-Bedfordshire (Mr. Sayeed) and the hon. Member for Bedford (Mr. Hall) have visited the right hon. Member for Barrow and Furness, and I think that we have a ready ear there. We may be able to find a local solution to our particular problem, but I ask the right hon. Gentleman to investigate whether, where public appeals have been made on behalf of capital projects that will benefit the NHS, there is a way of ensuring that VAT that would otherwise be chargeable is spent on patient care, so that people raise money for treatment, not tax.
The NHS is a great service, to which I am personally very strongly committed. My father worked all his life as a GP in the health service. My brother is a consultant anaesthetist and neither my wife nor I or any of our children have any private medical insurance. We are
members of and wholly dependent on the NHS. Where the Budget has been singularly lacking in terms of response from the Government has been in understanding that money is not the answer, and in the determination of the Secretary of State to continue with partisan and rather tedious arguments and discussion of what we might do. It is not what the debate on the current NHS is all about, and I have offered some examples for consideration. I am perfectly confident that when my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) replies from the Opposition Front Bench today and when he and our colleagues have the opportunity to run the service themselves, the public will finally get not only the Budget debates that they deserve but the NHS care that they have paid for, deserve and are entitled to expect.
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