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Jonathan Shaw: My right hon. Friend will recall that the hon. Member for South Cambridgeshire (Mr. Lansley) mentioned several issues that arose from
 
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the conference of the Royal College of Nursing. Does my right hon. Friend recall that more than 90 per cent. of nurses at that conference voted against the passport to pain proposed by the Opposition?

Mr. Hutton: Yes, I intended to mention that shortly. I suspect that the hon. Member for South Suffolk remembers that even more clearly than I do.

The Leader of the Opposition has now confirmed that they intend to keep the policy of top-up patient vouchers, under which people have 50 per cent. of costs met by the NHS and make up the difference from their own resources.

Mr. Lansley: When something wrong is put on the record, it stays there, so to put the Minister right, under our proposals, which we shall announce shortly, no NHS patient will have to pay anything to receive NHS treatment.

Mr. Hutton: I know that, but that policy will provide patients with an exit visa from the national health service. I shall come on to that point in a second. We need to be clear about those vouchers, because they affect the issues that we are discussing. The policy will put ability to pay ahead of clinical need, and it will cost the national health service more than £1 billion to finance.

It should come as a surprise to no one that the only aspiration that lot have—the only objective the Tory top-up voucher is designed to serve—is to persuade people that the only way to get faster treatment is to leave the national health service, to leave the public sector altogether and to go private. It will not provide the same level of choice and opportunity to all NHS patients but will offer more choice to those who can afford it. It concedes that the fastest treatment will be available only to those who can afford it, and only in the private sector.

Under the Tories, it will be money that talks; it will be money that guarantees access to the fastest treatment, not the degree of pain and suffering that a patient might be enduring. What a contemptible policy: fundamentally flawed, fundamentally unfair—a typical Tory policy.

Mr. Bellingham: Will the right hon. Gentleman consider two points? First, if one of my constituents who is waiting for a hip operation decides to use the voucher scheme—to go to the BUPA hospital in Norwich, for example—she will free up an NHS place. It is as simple as that. Secondly, will he comment on the fact that a record number of people are having to go private to get their operations done in time?

Mr. Hutton: No, I very much doubt whether that would be the case. On costs, typically, the hon. Gentleman's constituent would have to find several thousand pounds from their own resources to fund that treatment, taking money directly from the NHS. Furthermore, it is very likely that the surgeon who treated the patient would also be an NHS surgeon.

David Taylor: Under Conservative policies, if people switched from the NHS to a private hospital, would it
 
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not be almost certain that NHS doctors and nurses would have to be sacked? Has my right hon. Friend made any estimate of the numbers that might be involved?

Mr. Hutton: We have estimated the cost of the patients passport as £1 billion. The hon. Member for South Cambridgeshire, who is keen to match our spending on the NHS, would clearly have to find that money from somewhere else. The truth about the patients passport is that the policy has not been thought through; it is fundamentally unfair and it will discriminate against ordinary NHS patients.

Helen Jones (Warrington, North) (Lab): Does my right hon. Friend find it as odd as I do that in a debate in which the official Opposition have said how much they value NHS staff they are still promoting a policy that states that those NHS staff cannot deliver the kind of service they want? In fact, NHS staff have delivered, and are delivering, improvements because we have put in the resources. What would my right hon. Friend say to the students I met recently at the school of nursing and midwifery in Warrington, all of whom are enthusiastically waiting to go into jobs in the NHS, about the value that the Opposition put on them now?

Mr. Hutton: I think those student midwives have already made up their minds about the policy of the hon. Member for South Cambridgeshire and about what a Conservative Government would do to the national health service; they simply have to remember what the Conservatives did to the NHS when they were in office.

Mr. Andrew Turner (Isle of Wight) (Con): The right hon. Gentleman did not answer—or rather he answered wrongly—my hon. Friend the Member for North-West Norfolk (Mr. Bellingham)—[Interruption.] The Minister answered my hon. Friend wrongly because he said that he did not believe that someone who goes private, and thereby ceases to be on the waiting list, was freeing up a space in the national health service. Can he explain how someone who has already had their hip operation privately could use the space?

Mr. Hutton: I want to return to the patients passport in a moment, and I am sure that the hon. Gentleman will be able to follow the logic of the case that I make.

The main thrust of the attack on the Government made by the hon. Member for South Cambridgeshire relates to recruitment and retention of NHS staff. I should like to tell him and his hon. Friends some of the facts that he failed to cover. When we came to office six years ago, investment in the NHS was being cut in real terms—it was falling. The NHS did not have enough front-line staff. As a result, waiting times were rising. The number of nurses in training, about which the hon. Gentleman has spoken eloquently, had been falling and was less than it had been in 1992. As a direct result, the NHS was short on both investment and capacity. It had failed to invest properly not only in the buildings, equipment and drugs that it needed, but in its staff as well. In the NHS, our staff are our most precious asset.

In 1997, the starting salary for a newly qualified nurse was £12,000, and NHS porters earned £7,000 a year—pitiful salaries, given the responsibilities of those staff.
 
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Training budgets were falling. There was no coherent or visible strategy for recruiting and retaining front-line NHS staff. Terms and conditions of employment, which the hon. Gentleman has also spoken about today, were antiquated and fragmented. There was only a handful of NHS staff nurseries. Pay awards from the pay review bodies—again, he referred to them—were implemented in stages, further diminishing the value of those pay rises to NHS staff. That was the legacy of the Conservative Administration.

Mr. Pike: My right hon. Friend may not know that, when I asked a question before the Conservatives lost office in 1997, they did not know how many GPs were due to retire in each area of the country, so they could not recruit and train enough GPs because they did not have the records in the system.

Mr. Hutton: I am not surprised; and we need to remember the Conservatives' legacy. The hon. Member for South Cambridgeshire has not presented any coherent case today. People are entitled to judge an Opposition not just on what they claim that their policies will do, but on their record in office as well. Undermined by his record in office, as he was today, he made his case with no conviction and no credibility. He has no serious alternative to the policies that we are pursuing.

Mrs. Gillian Shephard (South-West Norfolk) (Con): The Minister has now begun to talk about recruitment and retention. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has said that he welcomes the increased number of nurses in the NHS, as indeed we all do. The Minister will accept, of course, that early intervention and public health are among the Government's priorities. Will he explain therefore what policy priority he and the Government put on the recruitment and retention of school nurses? Will also explain why one team in my constituency is working at 42 per cent. of its capacity? The reason cannot be the number of nurses, or recruitment or retention, because both are fine, according to the Minister, so what is it?

Mr. Hutton: I do not dispute for a second that it would be a good idea if more school nurses were working in the NHS and our schools. That is an excellent idea. My only difficulty with the right hon. Lady's suggestion—I have a lot of respect for her views—is that she has not fully understood the policies that the hon. Member for South Cambridgeshire has been outlining today.

Mrs. Shephard: Will the Minister give way?

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