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Dr. Reid:
I shall respond as briefly as I can. The question of choice goes much wider than hospitals. It is about giving people power. We all know that in the real
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world there are some people in this country who get choice. There are people outside the NHS who have money. They can get choices that are not available, or have not been until now, to others. Within the NHS there are people who might have connections, influence, a degree of affluence, relations, knowledge and social capital that others do not have, which informally gives them choice.
I exhort the Liberal Democrats not to get into a position where they are against what we are trying to do. They are against much of their own philosophy, in a sense, if they are denying people the empowerment to make choices about their health and health care. We want to extend that to people irrespective of social background. That means collectively putting the finance in to compensate for people's lack of money in their own pocket.
When it comes to decentralisation and targets, I want local decision making. Personalisation is about much more than either the secondary sector or just about the idea of choice. It is about accepting that there are groups in our society—individual, personal-type groups, ethnic minorities, working-class people, and people from the north of England as opposed to the south—who have suffered a widening gap in health outcomes over the past 60 years despite all of the advance. We are committed to tackling those inequalities. That is part of personalisation, as it is about providing care for those who are chronically ill, who know much more about their own illness and disease than they are sometimes given credit for, and information and support in the community to enable them to deal with the situation.
I shall not make any comments about the White Paper on public health because it has yet to come out. I note the hon. Gentleman's comments. At least we are discussing in the most radical fashion the biggest ever programme of potential public health moves. The hon. Gentleman asked me whether I would change the criteria now by which we judge waiting lists. If I changed the criteria mid-term, I would inevitably be accused, even if it were to my own detriment, of fiddling figures. I have said already that we should be completely honest. For the past 60 years, under every Government, there has been a hidden wait, which we should now take into account. Let us do that in the next Parliament. We shall certainly look at diagnosis.
I agree with the hon. Gentleman's criticism of the so-called patients passport. It has been repackaged—the Opposition have shot the messenger and have given the new guy—they are going through new guys at a fair rate now—a little box with a new bow which, however, contains the same product. The patients passport reduces the NHS capacity and opportunities for fast access, forcing people to go to the private sector. The Tories are telling people who can afford half the cost of an operation that they will provide the extra money, but we can read them like a book and oppose their policy completely. Medical need, not the money in someone's pocket, should dictate health care priorities.
Finally, if the hon. Gentleman will allow me, I will avoid the subject of snuffing. I have already been accused of being almost personally responsible for binge
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drinking and the spread of sexually transmitted infections, so the last thing that I need is to get involved in snuffing with the hon. Gentleman.
Mr. David Hinchliffe (Wakefield) (Lab): I warmly commend the Secretary of State on his statement and the Government's positive progress in health policy. I have been concerned over the past few years about the increasing consensus between the two major parties on a range of policy issues, including health. I am delighted that at the end of this week there is clear distance between them, on which I commend the Government. I should also like to commend the Opposition, because their policies are extremely helpful to the Labour party.
I should like to ask my right hon. Friend about two things. First, if people are sent to private hospitals to be treated by consultants, whether as private patients, semi-private patients or NHS patients, they will be seen by people who work in the NHS, as consultants work in both sectors. Is it therefore not nonsense to suggest that by putting people in the private sector we are increasing capacity, as we are simply taking that capacity out of the health service? Secondly, I welcome the fact that in the autumn a public health White Paper will be published. However, will my right hon. Friend reflect on how we can shift the focus of debate on health policy away from an obsession with hospitals and treatment and towards prevention and public health?
Dr. Reid: It is no longer the case that when someone goes into the independent sector they will automatically be seen by someone who also works for the NHS. Some of our actions—incidentally, they brought a new efficiency to private sector services, for which there was previously an unlimited demand because of rising waiting lists—have resulted in the introduction of additional assets in the form of treatment centres staffed by the best clinicians from the United States, South Africa, and Germany. In their own countries, those people provide the best health care only to the rich but they are now here to assist and add capacity to the NHS by providing services that are free at the point of need. That supplements the NHS and is not a substitute for it, and I hope that all Labour Members accept that.
I agree that the old way of doing things, in which we bought individual treatments at any price and were prepared to pay public money to the private sector, no matter what the price, was crazy, inefficient and unfair. That is exactly what the Opposition want to bring back. Just as we are achieving efficiency in the NHS, driven by targets, they are abandoning them, and just as we are introducing efficiency in the private health care sector, because many private providers are performing operations for us at a reduced tariff, they want to hand the sector a big book of blank cheques so that anyone who wants to pay half the cost of a private operation will have the rest funded by public money, which is crazy and inefficient. I agree with my hon. Friend about the emphasis on primary care and prevention, and I hope that, despite the headlines that appear on choice, we all recognise that what people in this country want most of
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all is a decent, easily accessible, high-quality health service in their locality to which they can go in times of need. That is our first priority.
Madam Deputy Speaker: Order. Many Members are hoping to catch my eye, so I ask for brief comments, questions and responses, so that more of them are successful.
Mr. John Gummer (Suffolk, Coastal) (Con): Does the Secretary of State not accept that all waiting times are personal, as they affect individuals? I failed to discover from his statement whether he could meet the considerable concern about the amount of bureaucracy, control from the centre and the fact that people are not free enough, which would allow my constituents to know that they would not have to wait six months to get a hearing aid, would not have to raise private money to provide accommodation for children with diabetes in Ipswich hospital, and would no longer have to wait on trolleys all day in hospital, which is a current issue. Can he explain how he will stop centralisation and enable people to make those decisions locally?
Dr. Reid: If I may say so without ruining the right hon. Gentleman's career, those are sensible points, and I agree with all of them. If people are waiting on trolleys all day that is not acceptable, so I urge him to contact me about that.
We are trying to do two things. First, we are trying to drive the third biggest organisation in the world from the centre with a series of targets that we established some years ago which, as they are met, are not being replaced. Secondly, we are simultaneously changing the system so that patients have more power, choice and information. Gradually, 80 per cent. of the money and 80 per cent. of the driving of the system will be controlled by patients themselves. We are half way through that journey, and it would be crazy to assume that we can drive everything from the centre indefinitely. It would be equally crazy, however, to drop all the targets in our efficiency drive and just put in £90 billion without any objectives whatsoever. No business in the world, whether public or private, would behave in such an irresponsible fashion, and Opposition spokesmen would not have done so if they had not been so keen to cobble a policy together in a fortnight so that they could issue a statement before mine.
Mr. Kevin Hughes (Doncaster, North) (Lab): I welcome my right hon. Friend's statement, unlike the Opposition spokesmen, who behaved disgracefully while he was making it. As my right hon. Friend knows, most people's contact with the national health service is with their GP, so what does he propose to offer GPs so that they can improve and expand local services at their surgeries?
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