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Dr. Reid: The first, best and most important contact is in primary care, as my hon. Friend the Member for Wakefield (Mr. Hinchliffe), the Chairman of the Select Committee on Health, said. We have already extended choice in that sector, as I can demonstrate. A few years ago, a mother whose child was coughing late at night
 
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could not visit a walk-in centre where an appointment is not needed. She could not pick up the phone and ask for advice from NHS Direct, as 6.3 million people did last year. She could not go to accident and emergency and be seen within four hours. All those options are now available, quite apart from someone being able to see their doctor or a nurse practitioner within two days. We are therefore opening up the sector but, in addition, we have a new contract for doctors that encourages them to expand in an entrepreneurial fashion by bringing in chiropodists, nurse practitioners, and physiotherapists at primary care rather than hospital level. We have increased primary care funding for doctors by 33.3 per cent., which represents a genuine advance, and shows that we are taking radical action for everyone's benefit.

Mr. Nick Gibb (Bognor Regis and Littlehampton) (Con): A constituent of mine told me yesterday about his appalling experiences after he was diagnosed with cancer two years ago at a London hospital. His CAT scans went missing several times, his notes were mixed up with those of another patient, and his consultant's demand that he be treated immediately was ignored by administrative staff. Is that not the result of poor-quality management and administrative incompetence, which are also the principal cause of the spread of MRSA and high levels of waste in the NHS? How will the Secretary of State's announcement today tackle the deep-rooted management problem in the NHS? Will not policies such as foundation hospitals, which increase the diffuse nature of accountability in the NHS, do nothing to bring about high quality modern management methods?

Dr. Reid: The hon. Gentleman will forgive me if, after yesterday, I do not attempt to respond to the accuracy or otherwise of what he claims he was told by someone else who is a constituent. Yesterday should be a lesson to all of us, as the hon. Member for Sutton and Cheam (Mr. Burstow) said, not to use constituency cases, especially when we have not checked the facts against what we are told for propaganda purposes.

If the hon. Gentleman is making a general statement that we want to decentralise more power to patients to drive the system, the answer is yes. If he is suggesting that we need more and better management in the NHS—he is nodding—the answer is yes. That is completely at odds with what those on his Front Bench continually say—that we need less management in the NHS—but at least he is not making the mistake that they make when they continually portray all the new staff in the NHS as useless and unproductive bureaucrats. I can tell the hon. Gentleman that nothing angers the staff more than the constant implication that they are all bureaucrats, and that they are getting lots of money but producing no increased output. It is not true. The NHS staff, including management, but more importantly the 85 per cent. who are involved in direct patient care, do a wonderful job and we ought to be proud of them.

Mr. Jon Owen Jones (Cardiff, Central) (Lab/Co-op): I congratulate my right hon. Friend on bringing forward the fruits of investment, which the Conservative Opposition have traditionally opposed, and reform, which the Liberal party has traditionally opposed. My
 
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right hon. Friend has brought those fruits to us in England, but will he do all he can to encourage a situation that allows his constituents, my constituents and perhaps the family of Madam Deputy Speaker also to benefit?

Dr. Reid: I am always willing to help when asked. Wherever people are—England, Scotland or Wales—there will be a choice at the next general election between two philosophies as regards the national health service. One of them believes in continuing investment for the 95 per cent. of the population who are dependent upon it, continuing reform and efficiency, greater output driven not only by the staff, but by objectives such as any business would have, decreased waiting times, and greater choice in real terms. The philosophy of the other party would offer the old theoretical choice that we all have—of dining at the Ritz, were it not for the fact that we were too skint to do so. The Opposition would divert money away from the NHS to the minority to help the relatively rich jump the queue, they would reduce capacity and, above all, they would introduce the right to charge. That seems to me a pretty clear choice.

Sandra Gidley (Romsey) (LD): I welcome the Minister's commitment to fairness and equity and the NHS being free at the point of delivery, but that is all very well unless one happens to be old. He said little about choice in long-term care, and little about the fact that people have to supplement that care from their own pockets. What do the old look forward to? Would it be better to provide free personal care for the elderly?

Dr. Reid: It is a little unfair to say that I said nothing about the elderly or chronic care. I did speak about chronic care. On personal care, let us be quite straight. We have made a decision in this country that there will be free medical care for everyone, and that in the vast majority of cases there will also be free personal care. About 30 per cent. of people who are the better-off have to contribute towards their own personal care, not medical care. If we were to say that everyone including the best-off in Britain—including millionaires—would also get free personal care, it would cost us £1.7 billion, which we would have to take from elsewhere. We have made a decision, consistent with our priorities, that it is better to allocate that to those who cannot afford the medical and the personal care. That is a judgment that we have made.

Finally, I did not comment when the hon. Member for Sutton and Cheam mentioned it because it seems a bit churlish, but it would be a little more consistent if what was suggested by the hon. Lady was not entirely contradicted by Liberal councils, including, say, Cumbria, which is introducing charges for social care for the elderly in the area that it controls.

Mr. Dennis Skinner (Bolsover) (Lab): Is the Secretary of State aware that the most important decision taken by the Government in the past two or three years was the brave decision to increase national insurance by 1 per cent. in order to ensure that we had the wherewithal to make the massive improvements that we have made in health and to make even greater improvements in the future? May I also inform him that I am pleased that there is a manager in the national health service—the Opposition call it red tape—who sends me a letter to go
 
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for a cancer check-up every six months? I am pleased that he is a manager looking after me. As for being a target, yes, I am pleased to be a target when I go for another treadmill test in order to look after my heart. In an era when technology is so important in the health service, we do not see all the people who are helping us dressed in white uniforms. In all the policies that we present, we have to please people and persuade them, but with the national health service, we must please, persuade and inspire. That is what we are doing today.

Dr. Reid: That is certainly what my hon. Friend did, as he always does, to me. If we were looking for the living embodiment of the huge benefits that the NHS brings to the country, we could not find a national treasure comparable with my hon. Friend. He is right about inspiration. Let us remember when this country decided that everyone, irrespective of their background or their money, would be an equal partner in the fight against that great disease. It was after everyone in this country, irrespective of their background, had fought against the great evil of fascism on the continent, when the country was on the verge of bankruptcy and after it had come through six long years of war. If we could afford a system that gave everyone in the country health care irrespective of the money in their pocket at a time of such difficult circumstances, surely to God everyone in the country apart from those on the Opposition Front Bench believes that we can provide it in this century as well.

Mrs. Cheryl Gillan (Chesham and Amersham) (Con): My constituents in Chesham and Amersham will not be impressed by the self-congratulatory statistics trumpeted by the Secretary of State, not least because they get 18 per cent. less per head than the average funding in the national health service. I hope the right hon. Gentleman will be grateful to me, as I shall give him an opportunity today to put his money where his mouth is. He will be familiar with the National Society for Epilepsy in my constituency, which looks after people in the NHS from across the country who have a chronic and long-term medical condition—epilepsy. The NSE does not have the money to modernise its care homes. If the Secretary of State really means that he will provide those people with the personalised support and care that they need and deserve in order for them to live fulfilling lives, and that he will make that a priority, as he said in his statement, will he now agree to fully fund the Government-required upgrades at the entire site of the National Society for Epilepsy? When can I tell the chief executive that he can expect the cheque for £17 million?

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