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Mr. David Hinchliffe (Wakefield) (Lab): The hon. Member for South Cambridgeshire (Mr. Lansley) has had to leave the Chamber for a moment, for which he has apologised. I want to wish him well, in his absence, in his new role. He has a good command of health policy, and I am sure that our debates will be assisted by
 
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his contributions. Having said that, I think that his contribution today was somewhat thin, to put it mildly—about as thin as the Tory Benches have been during a Tory debate. There are just two Tory Back Benchers in their places at the moment, which raises serious questions about the Conservatives' commitment to health policy. They cannot drum up more support than that, yet it is their own Opposition debate.

I have always believed that effective opposition, whether at the national or local level, will bring about better government. However, this Parliament has lacked an effective Opposition. What worries me particularly about the Opposition's focus is that their attention on policy issues has tended to skew us away from what I believe are the real issues on health policy. A good example was the first Opposition debate this year, which was on care of the elderly. The Conservatives skewed the entire debate by concentrating on the number of people in care homes, failing to debate prevention, how to assist people or measures to help people to retain their independence in the community. It was basically the Tory party being led a dance by nursing home and care home owners—and the Conservatives danced well to their tune.

Today's debate, following the Tory motion, portrays health as an essentially curative process. We are talking about the response to illness and about cures. We are bogged down with the institution of the hospital, just as we were bogged down in the earlier debate with the institution of the care home. I really think that we need to question the focus of the Opposition's concerns about health care.

We are not talking today about the fundamentally important health issues, although they were touched on by the hon. Member for Sutton and Cheam (Mr. Burstow)—by that I mean the preventive agenda, which is about helping people to avoid being in hospital in the first place. The NHS Confederation said this week that one in 10 people who are in hospital do not need to be in hospital—and I believe that that is a gross underestimate. A consultant I spoke to recently told me that one in three people did not need to be in hospital, so let us examine why that is the case. It is sad that our debate has not touched on that crucial issue. The Opposition's frame of debate distracts us from addressing the crucial issues of health policy at the present time.

Turning specifically to the motion, the Opposition are, frankly, daft in trying to censure the Government over staff shortages. For anyone seriously looking into health policy, that really does not wear. The present Government have probably done more than any other in the history of the NHS to try to deal with staff shortages and they should be commended rather than criticised for their efforts during their seven years in power. The Government deserve praise for their initiatives on recruitment, which have been set out by the Minister of State, Department of Health, my right hon. Friend the Member for Barrow and Furness (Mr. Hutton). The efforts of the Government have also brought about investment in training and they are attempting to establish a family-friendly NHS environment. My right hon. Friend spoke about 6,000
 
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nursery places. That is important for getting people, particularly nursing staff, back into the health service when they have left to have children.

David Taylor: My hon. Friend is focusing on family-friendly policies and the attitudes of hospitals as employers towards human resource issues. Does he agree that, as these policies start to bed in and become more widely known, many returning nurses will return direct to the NHS work force rather than, as some do now, choosing to work for agencies on account of their more flexible employment policies? That will be good for continuity and good for economics.

Mr. Hinchliffe: Yes, I believe that that is the case. It will be a long, slow process, but we are heading in the right direction.

We should do more to care for our NHS staff and seek to improve the environment in which they work. About six months ago, I spent one night—a Saturday night and Sunday morning—with my daughter in a casualty unit in my constituency, and I saw the pressures placed on nursing and medical staff. It really opened my eyes to the pressures that they are under and I think that we need to address those pressures. I saw how members of the public who ought to know better could abuse our health service staff.

The motion talks about the role of staff in high-quality health care. The Government are guilty of failing to emphasise the progress that has been made on quality of care. The hon. Member for South Cambridgeshire talked about numbers of finished consultant episodes, the normal measurement that is used, and he said that the number of FCEs did not reflect the amount of investment that had been made.

However, the Opposition very rarely mention one factor—the improvements that have been made in the quality of care offered by the NHS. The Government deserve great credit for the measures that they have taken to address in detail some of the problems that used to exist. For instance, the introduction of clinical governance has made a big difference to the operation of the NHS. The Commission for Healthcare Audit and Inspection, which replaced the Commission for Health Improvement, has done a lot of work on quality at local level, and that has made a big difference nationwide. Again, professional validation seems like common sense, but the Government deserve credit for ensuring that people's skills are checked and updated.

The Opposition's motion talks about bureaucracy and red tape. One assumes that that very easy criticism is aimed at organisations such as the Commission for Healthcare Audit and Inspection, or at the measures and mechanisms introduced to cover the important question of quality.

I disagree fundamentally with the Tory motion, but I have a few personal anxieties that I want to express about the direction of certain Government health policies. I begin with the question of central directives to the NHS. I said earlier that the debate had a curative approach and, all too often, central directives reflect a curative, hospital-based approach to health. That needs to be examined when the direction and targets set for the NHS by the Government are reviewed.

Occasionally, the central directives can also be seen to constitute a market-style approach to health. I am genuinely concerned about the consensus in respect of
 
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choice that has developed among the three main parties in this Chamber. Where will that concept take us? We are all for choice—of course we are—but we need to discuss in detail what the word really means.

Who is pushing for choice in the NHS? I get hundreds of letters about the service from all over the country, but I do not recall one that asked about choice. People write to ask about all sorts of things, and to tell me that they want their local service to give them what they need, near where they live. However, they do not go on about choice. Where does the concept of choice come from? I should be interested to get to the bottom of that.

Also, are we prepared for the consequences of choice? We know about the impact of choice on education, and about what is commonly called middle-class flight from schools. People with inner-city schools in their constituency will know that choice has meant that middle-class people move out and shift their children to schools in the leafy suburbs. Are we prepared for the same thing happening in the NHS? There is no doubt that it will happen, and the consequence that it will have for the NHS needs to be thought through.

What is the consequence for the wider health care agenda of concentrating on choice? I must tell my hon. Friends on the Front Bench that, if we are not careful, we are in danger of making again the mistake that the Tories made—that is, we will create a public perception of health that is all hospitals, treatments and cures but which has nothing to say about prevention.

Mrs. Patsy Calton (Cheadle) (LD): Is not real choice a matter of getting timely diagnosis and treatment for people near where they live, and not about chasing all over the country after the best surgeon? Not everyone can go to the best surgeon, although some would like to be able to buy their way into doing so. We need good, local treatment that is available when needed.

Mr. Hinchliffe: I agree with the hon. Lady. I think that the Government probably agree with the point that she has made. On the choice issue, when we discuss Tory policy we often get down to the idea that somehow a person choosing to go private assists the NHS. The Tories do not seem to understand that the doctors treating people in the private sector are the same ones treating people in the NHS. They are not some magic, additional number of consultants. People say, "We are helping the health service by going private." What a load of tripe. What a load of nonsense. Of course they are not. They are damaging the health service by giving consultants the continuing incentive to treat people privately. We have to get those consultants back working in the health service. It is the big issue that has not been addressed by successive Governments since 1948. This Government have tried, and I wish them success in it. It is the key to solving so many of the problems.

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