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Madam Deputy Speaker (Sylvia Heal): Order.
Dr. Reid: From a sedentary position, I am being asked what is different from the policy put forward yesterday. I will oblige the House. Let me make it clear that it would be nothing short of hypocrisy to come to the House and promise that greater choice will be open to everyone, while reducing or diverting resources away from the national health service to a privileged few, allowing unlimited waiting times by removing targets and proffering an advantage in access to those with money. That combination would, in reality, reduce choice for the many in this country and in practice extend it only to those able to pay the charges outside the NHS in the private sector. That hypocrisy would be precisely the effect of yesterday's proposals from the Conservative party. We will not do that.
Our choice is in reality for everyone, paid for by the NHS and backed by further resources in the NHS, by continuing reform and by new patient rights. But there is another group of patients for whom local services in the community are important—at least to Labour Members—so we will extend the greater personalisation of patient care to people with chronic and long-term medical conditions. [Laughter.] Those people are not a matter for laughter; they are people who are suffering from some incurable and extremely difficult illnesses—arthritis, diabetes and asthma. [Interruption.] They are to be taken seriously, not frivolously.
Some 17.5 million people in this country have long-term conditions that cannot yet be cured and that have a real impact on their life. Providing those people with the personalised support and care that they deserve and need to live fulfilling lives should be a priority for all of us. We will do that by providing thousands of new and additional community matrons, rolling out the expert patients programme across the country and ensuring that the new contract for GPs delivers the best care for patients—thousands of new people in the community to help the 17.5 million people whose suffering was such a cause of frivolity among those on the Opposition Benches.
As the Select Committee on Health has pointed out, we need to ensure that the NHS becomes more than just a sickness service. We have a duty as a Government to ensure that everyone has the chance to live a healthy life, and to foster prevention as well as providing cures. The White Paper that I will publish in the autumn will set out in more detail our plans to tackle the major causes of ill-health, including smoking, obesity and sexually transmitted infections. We will do that by ensuring that
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the NHS takes a leading role, but that it involves other relevant organisations. [Laughter.] I note that the reference to sexually transmitted infections causes schoolboy humour among those on the Opposition Benches.
The plan that I have outlined today will therefore deliver a national health service characterised by access based on need, not ability to pay; free delivery to everyone, not charges that can only be paid by some; investment in the mainstream national health service, not cuts or diversion; guaranteed waiting times, not unlimited waits; queue cutting, not queue jumping; and a national health service fair for everyone and personal to each of us, not just to those who can afford it. It is above all an improvement plan to ensure that the greatest gift ever from the people of this country to the people of this country—our national health service—will not only retain its basic fairness and equity, but be able to meet the expectations of all our people in this new century irrespective of their wealth, race, geographical dispersion or social standing and background. That is how the national health service started and that is how we will continue in this century. [Interruption.]
Madam Deputy Speaker: Order. The House must come to order.
Mr. Andrew Lansley (South Cambridgeshire) (Con): I am grateful to the Secretary of State for sending me a copy of his statement, but we knew yesterday morning what he intended. He told the "Today" programme that what the NHS needs is "more targets". No one in the NHS tells me that they need more targets. They tell me that they need less bureaucracy, fewer targets, more autonomy and more resources which reach the front line. Today, we have heard the Secretary of State reiterate Labour's pigheaded belief that setting a target is the same as getting things done. It is not. It is the staff in the NHS who get things done. It is the doctors, the nurses—[Interruption.] Is the Minister arguing with me? It is the doctors, the nurses, the professionals in the NHS, the support staff and the managers—[Interruption.]
Madam Deputy Speaker: Order. This is an important statement; we will have some order.
Mr. Lansley: It is the doctors, nurses and professionals, it is the support staff and, indeed, the managers in the NHS who deliver health care. They tell me that targets distort clinical priorities and that red tape and bureaucracy stop them devoting the time that they wish to devote to caring for patients.
Let us take the Secretary of State's statement on his own terms. The Government have failed through their obsession with plans and targets. Let us look at the NHS plan 2000. It referred to
"an end to the postcode lottery in the prescribing of cancer drugs",
but the availability of some cancer drugs varies from 18 per cent. to 100 per cent. in different parts of the country. The NHS plan 2000 said there would be
"7,500 more consultants by 2004",
but the latest whole-time equivalent figure is just over 5,000. The director of human resources in the NHS has said:
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"we now know the way the target was originally constructed was not as helpful as it could have been".
On mental health, the NHS plan 2000 said that the Government would establish 335 crisis resolution teams, but the chief executive's report says there are 137.
On mixed-sex wards, the NHS plan said:
"old Nightingale wards will be phased out",
but the Commission for Health Improvement found mixed-sex wards and unassigned toilets in one in six of the acute trusts that it reviewed. On cancelled operations, the plan said:
"From 2000, when a patient's operation is cancelled"
"another binding date within 28 days",
but last year 5,500 patients were not readmitted within 28 days.
On dentistry, the plan said that the Government were
"firmly committed"—
in this instance Members will note that the NHS plan said "firmly committed"—
"to making high quality NHS dentistry available to all who want it by September 2001",
but 40 per cent. of children and nearly 60 per cent. of adults are not registered with an NHS dentist, and only just over 40 per cent. of dental practices are making NHS dentistry available.
On patient and public involvement, what happened to the letters on an individual's care being copied to the patient? That idea was in the NHS plan, but it disappeared. The NHS plan said that patient and public involvement would somehow be improved. It is my experience in my constituency that a community health council that did an effective job in scrutinising and representing patients is replaced by patients forums, and we do not even know who the members of that forum are. Labour's record is not one of targets set and targets met, but one of targets set and targets not met.
Let us consider what the Secretary of State is saying will happen. There was a lot of advance briefing about public health. We now know that there will be a White Paper in the autumn—as distinct from the summer, when he originally said it would be published. There is an epidemic of sexually transmitted infections. Cases of chlamydia and, I think, gonorrhoea have doubled. HIV infection has increased, whereas after the 1980s a successful Conservative-led campaign was fought against HIV infection and for safe sex.
The Government are now going to have a target on obesity, at a time when it is at a crisis level, as everyone has recognised far too late. As a result of binge drinking, young people are at serious risk of increases in liver disease. TB rates are up significantly and the Government have not delivered an action plan. Some 180,000 people have undiagnosed hepatitis C and there is no active screening programme. The Secretary of State talks about smoking. In his report, Sir Derek Wanless said that the Government's target on smoking was "unambitious". How likely is it to be achieved if the Secretary of State's attitude is that it is one of life's few pleasures? So the Government have failed on public health.
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Now the Secretary of State says that the Government are going to think about chronic disease—seven years after they came into office. My hon. Friend the Member for South Suffolk (Mr. Yeo) said in March that it was necessary for us to give patients greater control over the management of their care. Of course the Government are playing a game of grandmother's footsteps: we say one thing, and they follow along. But there is a big difference between the way in which we are going to deliver care for those with long-term diseases and the Government's approach.
We are going to design the service around the needs of patients, and there will be an entitlement to a standard of care. The Secretary of State, however, says that he will have community matrons. Community nursing would be a jolly good thing. [Interruption.] The Government Chief Whip might like to know that there are 800 fewer district nurses than there were in 1997. She might also like to know that the number of episodes of care from health visitors has gone from 3.6 million in 1997–98 to 2.9 million and that the number of episodes of care from district nurses has gone from 2.2 million to 1.9 million. It has gone from 370,000 to 320,000 for community mental health nursing; from 930,000 to 830,000 for chiropody; and from 1 million to 500,000 for community dental services. We are not going to take any lessons from the Secretary of State about what is needed in the community—[Interruption.]
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