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Michael Fabricant (Lichfield) (Con): Is my hon. Friend aware that a nursing sister in my constituency was telling me that in a major hospital in Birmingham there is no clear guidance to ancillary staff? She gave the example of water jugs and other crockery being taken from an isolation unit and mixed with crockery—[Interruption.] The Secretary of State laughs, probably because he does not care about MRSA infection. Does my hon. Friend agree with me that, if crockery and jugs from an isolation unit that is known to have MRSA, are mixed with crockery that was previously sterile, it too will become infected, and so in turn will infect other patients?

Mr. Lansley: Yes. My hon. Friend makes a good point. If there is to be infection control in hospitals, there must be clear guidance about the standards that need to be maintained, whether in terms of cleaning—such as a model cleaning contract—or of the role of the infection control teams and staff. But the fact is that the manual has not been published. The Government have not given it the priority that is necessary.

Kali Mountford (Colne Valley) (Lab): Will the hon. Gentleman give way?

Mr. Lansley: No, I will move on.

My hon. Friend the Member for North-West Norfolk (Mr. Bellingham) asked me about deficits. The Labour party is always parading the fact that it is providing additional money for the NHS, but we know what is happening because the strategic health authorities tell us exactly that in their latest document. South-west London is reporting a projected total deficit for the year end of £79 million. Norfolk, Suffolk and Cambridgeshire strategic health authority, in my area, is projecting a year-end deficit of £51 million. Avon, Gloucestershire and Wiltshire SHA, in the area of my hon. Friend the Member for Westbury (Dr. Murrison), is projecting a deficit of £27 million. The projection of Surrey and Sussex is £22 million. Throughout the
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country, 75 primary care trusts and 73 NHS trusts are forecasting deficit. The total across—[Interruption.] From a sedentary position, the Minister of State, Department of Health, tells us that we should go back to the last century and try to examine what the comparison would be. That is terrific.

I thought that the Government pretended that in the past seven years things had changed. It seems that their argument is that things are the same now as they were in 1996. If the public believe that nothing has changed since 1996, they will look to us for the change that is necessary and not to the Government, who have achieved nothing. If the Minister of State is happy that half way through a financial year 75 PCTs and 73 NHS hospital trusts are forecasting deficits because he and his colleagues have imposed costs on the NHS that are far in excess of the financial resources that are made available, along with unfunded GP contracts, unfunded consultant contracts and risks associated with "Agenda for Change"—[Interruption.]

Mr. Deputy Speaker (Sir Alan Haselhurst): Order. I think that the Minister of State, Department of Health should contain himself.

Mr. Lansley: Thank you, Mr. Deputy Speaker. Perhaps I should contain myself as well, or I shall raise my blood pressure, which would not be good for me, and the Secretary of State would tell me off.

Laura Moffatt (Crawley) (Lab): The hon. Gentleman mentioned the trust that covers the area in my constituency, and he is making a point about deficits. I am very much aware that the extra funding in the Surrey and Sussex trust has expanded services enormously. If he is trying to make an important point about deficits, can he tell us how much the deficit would be had the Conservatives still been in power without the spending commitment that we now have?

Mr. Lansley: For goodness' sake. I do not think that the hon. Lady can reasonably expect me to reconstruct history from 1996. Let us deal with the world as it is, not the world as it might have been. In the world as it is, Surrey and Sussex SHA is forecasting a £22.6 million deficit resulting from delayed transfers of care and the discovery of a significant number of patients on its orthopaedic register whom it has had to pay to have treated by other providers. There is also the increasing costs of drugs consequent upon the guidance of the National Institute for Clinical Excellence. In addition, there has been a 5 per cent. increase in in-patient activity. There are deficits, and the hon. Lady will have to accept that many NHS trusts throughout the country are finding that they are not resourced to meet the objectives that the Government are proposing for them.

We and the Government might at least enjoy ourselves together for a moment. I accept that the Government are committed to increasing resources for the national health service in the next two years, but in talking about finances we should have regard to the position of the Liberal Democrats. I do not know what the hon. Member for Sutton and Cheam (Mr. Burstow) will tell us about their policy, but it will not wash. When I discussed Liberal Democrat policy with the hon. Gentleman, he said that everything would be all right
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because over the economic cycle—he sounded a bit like the Chancellor of the Exchequer—national insurance contributions would provide sufficient money for the NHS. Having looked at the detail of the Liberal Democrat proposals, however, I discovered that this financial year there would be a shortfall of £4.5 billion between national insurance contributions and NHS expenditure across the country. Next year it would be £8.2 billion, and the year after, £12.2 billion. In 2007–08, it would be £17.1 billion. If the Liberal Democrats believe in hypothecation of national insurance to the NHS they must aim for a 5 per cent. increase in NICs to pay for the shortfall. Perhaps the hon. Gentleman will tell us later whether he will cut funding for the NHS by £17 billion in the next three financial years or increase national insurance by 5 per cent.

The Queen's Speech is lacking in health provisions. We had exchanges on public health a couple of weeks ago, but in the past week the Secretary of State has treated the issue as if it were year zero and nothing had happened in the past seven years. He published a sexual health strategy which, in some respects, simply followed our suggestions about the need for a national awareness campaign on the consequences of poor sexual health. However, I must challenge him, because his strategy simply produced more evidence that the Government cannot co-ordinate their efforts in this arena. He proposes to initiate a public awareness campaign in the coming months about the risks of unprotected sex and poor sexual health. Waiting times for genito-urinary clinics are 12 days on average for men and 10 for women, but his 48-hour target—this is all about targets—will not apply until 2008. If, in the next few months, he seeks to encourage young people in particular to attend clinics—there are no more clinics today than in 1997—that will not be consistent with the delivery of services.

In our amendment, we once again express disappointment that the Government have failed to introduce mental health legislation. One in four people are affected by some form of mental illness. In the debate on last year's Queen's Speech, we called for the introduction of legislation on mental health services.

Mr. Hinchliffe: We have got that legislation.

Mr. Lansley: The hon. Gentleman knows perfectly well that it is undergoing pre-legislative scrutiny. The Government have simply promised to undertake that process, even though they said that they would introduce legislation. We could have introduced mental health legislation that would deliver the framework that people who work in mental health services want.

Mr. Hinchliffe: The hon. Gentleman is being rather unfair, as he knows that this is a hugely complex area. The Government are right to be careful, so that the legislation will be introduced in a workable form. There are many conflicting views about the way forward on mental health legislation, so it is proper that both Houses spend time on scrutiny. That will ensure that the Bill is right and enjoys a consensus of support from people across the community.

Mr. Lansley: Of course we need a Bill that is right, which is why we called for one in our amendment to last
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year's Loyal Address. We did not want a Bill that locked people up to satisfy the Home Secretary but one that gave them the health care that they needed and the access that they were entitled to expect. We do not need a Bill that introduces fear and coercion into what ought to be a therapeutic relationship. The legislation should provide quality care for patients, and compulsion should be a tool of last, not first, resort.

Before concluding, I shall put some questions to the Secretary of State. The Queen's Speech presages the introduction of legislation on identity cards. Indeed, the Identity Cards Bill has just been published. I do not understand the relationship between the ID card and the NHS, so perhaps he will enlighten us. We are told that the card will be used to facilitate access to NHS services. According to the Bill, however, it could not be used for that purpose until holding such a card is compulsory—according to the Home Secretary, that will be in 2013. In terms of action, therefore, the card is irrelevant, because it will not become obligatory for another decade. However, the NHS improvement plan that the Secretary of State for Health published in June says on page 30:

Are there going to be two cards—the NHS card and, later, the ID card—and what will be the relationship between them? Quite separately, the European Union requires us to replace the E111 system. A number of EU member states have already introduced a card for access to their health services that serves as an E111 entitlement when one visits those countries. Surely we will have one of those cards, so where does the ID card fit in?

Children would not have an ID card but, presumably, to access NHS services they will need an identifier for personal patient records and so on. Whether or not they have an ID card, they will have an identifier already, so what is the point of the identifier on the ID card? Entitlement to NHS services is based on ordinary residence, but the ID card will be based on citizenship. All those problems illustrate the fact that many of the Government's proposals are ill thought-out. There are questions about the NHS and ID cards to which no one seems to know the answer. Perhaps the Secretary of State will tell us later whether he has any answers.

Our amendment expresses the hope that we will soon have a chance to deliver an NHS that is geared towards patients, not the Department of Health. It will be exclusively concerned with clinical standards, priorities and the needs and wishes of patients, not central targets and the demands of bureaucracy and administrators. It will be geared to give information to patients, with all the positive impacts on quality that that can deliver. It will give choice to patients, because in an era of added consumer pressure that will deliver quality and incentivise people across the NHS to deliver services and ensure that when staff treat patients, they receive the resources that they are clearly not receiving at the moment. It will give people suffering from chronic diseases control of their care, and will increasingly
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empower them to manage their care to meet their needs. It will give GPs control of their budgets through fundholding. The total purchasing pilots introduced in the latter stages of the last Conservative Government were a great success, but they were abandoned by the present Government who, however, proposed to reintroduce them in a distorted, cut-down form following the failure of their measures.

Once again, in our amendment we are demonstrating that there is a forward agenda for the health service that will provide freedom and independence for the NHS, choice for patients, and opportunities for the NHS to deliver the care that its staff work hard to deliver. That is our objective, and we will seek to achieve it as soon as the election gives us an opportunity to do so. On that basis, I urge colleagues to support our amendment.

1.59 pm

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