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Dr. John Reid: There is no confusion. I ask a question to which I did not get an answer—perhaps the hon. Gentleman can enlighten us. The hon. Member for South Suffolk (Mr. Yeo) insisted that the Conservative party is committed to equity of access. How can two people have equal access to an operation if that is dependent on them both having half the cost of the operation?
Mr. Lansley: The Secretary of State misses the point again. We have made it clear that the patients passport will be a mechanism for the delivery of patient empowerment. It will give patients control over their health care. It is astonishing that he does not understand when he is playing grandmother's footsteps with the Conservative party.
At the Conservative party conference in Harrogate two or so weeks ago, my hon. Friend the Member for South Suffolk made it clear, just as we made it clear at our last party conference that we wish to extend the patients passport to chronic disease management, that we are starting work on how we will achieve that, as he reiterated today. It involves placing particular emphasis on diabetes and asthma, as early diseases that would qualify for that approach, and empowering patients to control their health care. That happened on the Saturday. Lo and behold, the following Thursday, the Secretary of State went to a conference organised by The Guardian—the type of event to which he tends to go—and announced that he intends to focus on chronic disease management and self-management of such diseases, with an emphasis on diabetes and asthma. We are forging the way in the health debate.
The Secretary of State needs to persuade his hon. Friends of his policies. The hon. Member for Newcastle-under-Lyme (Paul Farrelly) spent most of his speech attacking the concept of patient empowerment. He is not interested in the idea that someone might choose the type of health care that they receive and where they receive it. He wants the money spent in his local hospital and does not want anyone to choose anything else.
Mr. Lansley: I shall give way to the hon. Member for Newcastle-under-Lyme, because I just referred to him.
Paul Farrelly: I welcome the hon. Gentleman's return to the Front Bench. He was a talent wasted on the Back Benches. I also know him to be a reasonable man. Does he truly believe in the voucher, the visa or the passport policy, or is it something that he inherited?
Mr. Lansley: Before the hon. Gentleman chides me on policy, he should find out about his party's policy,
because the Government have been chasing us. For heaven's sake, it is his party's policy increasingly to use the private sector. The Government have been buying services at 143 per cent. of the NHS cost. According to the The Times today, they are negotiating for bulk purchasing in the private sector. We want independent health care providers to stand alongside NHS providers. Our interest is in ensuring that patients get the health care they need and not to be hide-bound by an idea of who provides it, whether it is NHS owned or independent.The detail of the Government's plans often reveals that choice is limited. Rather than providing choice at the point of referral, it is choice after six months. As my hon. Friend the Member for South Suffolk said, it is not a choice of any hospital across the country—a genuinely national health service—but a choice of the specific hospitals that the Government say people can go to. My hon. Friend the Member for North Dorset (Mr. Walter) told us about his constituents who were not allowed to be referred to the Royal Surrey County, even though that was their choice. Just as this Government did away with extra-contractual referrals and out-of-area treatments, and have introduced limited choice within the NHS, only a Conservative Government will restore choice to my hon. Friend's constituents.
Mrs. Patsy Calton (Cheadle) (LD): Will the hon. Gentleman give way?
Mr. Lansley: No, I have only a few minutes left and the Liberal Democrats did not participate in the debate to any extent.
The right hon. Member for Darlington made some important points. I want to mention just one—his conversion to increasing home ownership, as one of my hon. Friends put it. Given the right hon. Gentleman's record at the Department of Health, surely he could help to shift the definition of affordable housing away from a definition of social housing, which is geared to the rented sector and, in particular, the housing association-owned rented sector, to one that offers opportunities of equity stakes for those in key-worker housing. That would be enormously helpful. That is what people around Addenbrooke's hospital in my area want. They do not want to rent. They want the opportunity to buy, and if they cannot buy the whole of a property, they want to have some equity in it.
I must not be too unfair: the hon. Member for Sutton and Cheam (Mr. Burstow) did make a speech. He talked about our policies, but he neglected, so far as I could tell, to say anything about Liberal Democrat policies. In particular, he neglected to tell anybody that the Liberal Democrats appear to be opposed to patient choice, but he did talk about public health.
The Secretary of State did not talk about public health very much. In particular, he did not give us the opportunity to ask him why he supposes that, in a recent survey of doctors published in "BMA News", 78 per cent. of those who responded said that they were not confident that the Government could or would achieve significant improvements in public health. That is exactly why my hon. Friend the Member for South Suffolk and other colleagues put improvements and a
new strategy for public health at the forefront of our policies—there is no confidence in the Government on that matter.
Mrs. Calton : One thing that the hon. Gentleman failed to note is that my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) asked where the £1 billion of dead money for the patients passport is. I should be grateful for an answer.
Mr. Lansley: I should be glad to answer the hon. Lady, who at least had the patience to listen to the whole debate, but I confess that I do not remember the hon. Gentleman saying that. I must have been in the midst of a rather dull debate. Since the hon. Gentleman had nothing to say about his own policy, however, I shall not bother to say too much. If the hon. Lady wants to chide us about policies, she might like to remind the House that in the debate on foundation hospitals she was against the principle of those hospitals, but when challenged on the fact that in her constituency she supported Stockport district general hospital, which I have visited, in becoming a foundation trust, she said, "Well, of course, in the Liberal Democrats, one changes one's principles according to the circumstances."
Mrs. Calton: Will the hon. Gentleman give way?
Mr. Lansley: No, I have given way to the hon. Lady once, and that is enough.
The hon. Member for Luton, North (Mr. Hopkins) told us a little about his views on the Budget, which should worry the Chancellor because, basically, that consisted of agreeing with the Chancellor that his borrowing an enormous amount of money was a good thing and, if there was one criticism, it was that he was not going to put the price of alcohol up by 10 per cent. I am not sure how that will go down in Scotland, and with the Scotch Whisky Association.
My right hon. Friend the Member for South-West Norfolk (Mrs. Shephard) departed from the subject of health to tell us some very important things about biofuels. If I may, I will simply say that, from my perspective in East Anglia, I share her view of the importance of giving credibility to the Government's acceptance of the EU biofuels directive and their commitment to 2 per cent. biodiesel by 2005, and the necessity of showing how those targets will be achieved.
The hon. Member for Plymouth, Sutton (Linda Gilroy) told us about Derriford hospital and went into the subject of payment by result, which I hope Ministers will take note of. I must confess, however, that I would be surprised if she got much of a reception among her colleagues for her criticism of the market forces factor, since that is one of the components of a distribution factor that so benefits the constituencies of Labour Members as compared with the way in which NHS resources are distributed among Conservative Members' constituencies.
Linda Gilroy: Will the hon. Gentleman give way?
Mr. Lansley: No, I do not have time. I must respond to the points made in the debate.
My hon. Friend the Member for North-East Bedfordshire (Alistair Burt) made some very important points, and I want to echo two of them. The first was about the GP contract. I know from correspondence with Bedfordshire Heartlands PCT that it is concerned about where the money will come from. That concern has recently been reflected in "Health Press". The cost to the trust of running an out-of-hours service is to rise from £1 million to £1.9 million, and the Government's proposals, including the recent announcement by the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), will only take it to about £1.5 million, so it is looking at finding £400,000 from somewhere to maintain the service.
On a positive point, I shall not chide the Minister of State because I hope that he will be able to deliver for my hon. Friend on the subject of the Primrose appeal and the associated costs. I leave that with him. We will thank him if he is able to deliver satisfaction for the appeal by turning charitable donations not into tax but into the cancer centre for which they were subscribed.
My right hon. Friend the Member for North-West Hampshire (Sir George Young)—[Interruption.] It is all very well the Secretary of State not listening to me speak—I am used to that—but neither he nor any of his colleagues at the Department of Health came to hear my right hon. Friend speak. They would have learned a great deal had they done so, and I recommend that they read his speech tomorrow, because it illustrated the problems that are being experienced in the areas represented by Conservative Members. Deficits of more than £20 million are reported in Hampshire and Isle of Wight strategic health authority and in the Surrey and Sussex strategic health authority, and similar deficits are anticipated at the end of December in the Norfolk, Suffolk and Cambridgeshire strategic health authority. Then—lo and behold—came the hon. Member for Newcastle-under-Lyme (Paul Farrelly) to say that no deficits were reported in his area. Well, that is a surprise. I wonder how that happened.
My right hon. Friend the Member for North-West Hampshire also made it clear that the Secretary of State had managed to come to the Chamber and give a speech about health but not talk about all the things that people working in the health services are talking about. They are talking about NHS IT, GP contracts, consultants' contracts, the European working time directive, payment by results, the tariff, and foundation trusts, but the right hon. Gentleman mentioned none of those subjects. People in the NHS might wonder why he omitted them from his speech, but we do not. He missed out all those things because they are problems, and the Secretary of State did not come here to dwell on the problems. He came here to talk about our policies, not about his.
My hon. Friend the Member for North Dorset spoke about the problems that his constituents are experiencing, and my hon. Friend the Member for Reigate (Mr. Blunt) referred to the European working time directive. The hon. Member for Newcastle-under-Lyme—I am sorry to mention him again—spoke about Keele university and all the additional medical students training there. Well, good—they will be needed, because the BMA estimates that if Labour Members of the European Parliament, who voted to get rid of the opt-
out from the working time directive, have their way, by 2009 we will need 9,900 more junior hospital doctors to cope with the demands of that directive. Those demands will hit us this August, and they are causing many in the NHS real concern.My hon. Friend the Member for Fareham (Mr. Hoban) referred to relocation issues—I suppose that last Wednesday's announcement of 1,000 jobs to be lost to his area hit like a Titchfield thunderbolt. He also spoke about lack of accountability in planning and housing in the south-east and the east of England. I entirely share his view: that is a disgrace.
I have referred to the hon. Member for Newcastle-under-Lyme sufficiently. My hon. Friend the Member for Bury St. Edmunds (Mr. Ruffley) reminded the House that only the Conservatives can offer the real structural reforms that are required. My hon. Friend the Member for Mid-Worcestershire (Mr. Luff) drew our attention to the tax increases that already appear in the Red Book, quite apart from the further tax increases that will be required if the evidence of revenue shortfalls and overruns in borrowing is accurate. My hon. Friend the Member for Spelthorne (Mr. Wilshire) quoted personal experience of the effects on the NHS in his constituency, which comes within the North West London strategic health authority—
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