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Mr. Stephen Dorrell (Charnwood) (Con): Like everyone else, I enjoyed the Secretary of State's speech—perhaps even as much as he enjoyed making it. However, I have one or two comments to make that arise from it.

The right hon. Gentleman delivered a Jekyll and Hyde speech. The Dr. Jekyll personality gave a presentation of the Government's health record that, broadly speaking, I sign up to. He offered the view that the NHS is not perfect, but invited us to appreciate the fact that it has made solid progress since 1997. I freely concede that it has done so. Indeed, I made the same speech on the NHS, inviting people to recognise that it was not perfect before 1997, but that it made substantial progress between 1979 and 1997, as it has done since its foundation in 1948.

It is possible to have a debate that recognises that every party in the House is committed to developing the NHS. We have all played a part in that development. We are all responsible for some of its failings and we can all claim some credit for some of its successes, but we should always recognise that the real successes are the result of the contribution by the professional staff, not of the politicians who are briefly responsible for it.

That was one personality that the Secretary of State presented. Although I disagree with aspects of his record and the Government's record—I shall say a bit about that later—I gladly sign up to some of the things that he said. However, it was not just Dr. Jekyll who was on display. In Mr. Hyde mode, the right hon. Gentleman offered us straightforward party political knockabout. We know that an election is coming when a Labour health spokesman says that the Conservative party is secretly planning to extend charging in the NHS, like all Conservative Oppositions and Governments have secretly done since 1948. It is worth reminding ourselves that there are three charging regimes in the NHS—for prescriptions, eyes and teeth. The historical fact of the matter is that two of the three charging regimes were introduced by Labour Governments.

The first stage of the argument is that we will introduce charges; the second is that the Conservative party is planning to cut NHS spending.

Mr. Charles Clarke: Would the right hon. Gentleman be good enough to set out his view of the patient's passport and how it relates to the charging discussion?

Mr. Dorrell: I shall come to that in due course. Before I do so, I want to respond to the charges made from the Dispatch Box. The first was that we would extend charging—an accusation that is always made in the run-up to an election. The second was that we would cut NHS spending, blind to the fact that no Conservative
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Government have cut NHS spending during their period office and that the shadow Chancellor made it crystal clear that we intend to carry through the spending plans published by the Government.

The third and most absurd proposition that Labour spokesmen advance is that the Conservative party is not committed to the principles of the NHS. As always when I hear that charge, I get out my calculator to remind myself of how many years there have been since the foundation of the NHS in 1948 and of how many years there have been of Conservative government and of Labour government during that period. When I do so, I find that the Conservatives have been in government for 35 of those 56 years.

I invite the House and, more importantly, the voters and anyone who might be interested in the arguments to reflect on the fact that if it were true, as Labour spokesmen have said consistently throughout those 56 years, that the Conservative party was not committed to developing the principle of the NHS, would it not have been likely that at some point during its 35 years in government it might have done something about it?

When the Secretary of State presents what I have called his Dr. Jekyll personality, he is realistic; I do not agree with everything he says, but we can have a sensible debate. When he presents the other side of his personality, it is a sign that an election is coming. When Labour spokesmen advance an analysis of Tory threats to the health service, it is one of the most sure bell-wethers of British politics that an election is not far around the corner. I guess that that confirms what most of us know.

The reality, and by far the most important point that emerged from the Secretary of State's speech, for which I give him some credit, is that to be committed to the principle of the NHS is to be committed to making difficult decisions about its evolution. Those who are genuinely committed to the development of the service and those who are genuinely committed to the development of maintained schools and the broader education sector are not and cannot at the same time be committed to no change in those sectors. The difficult argument—the interesting argument—involves the nature of the changes that need to be made to ensure that the commitment that we all have to the principles that lie behind them is delivered in reality in the years ahead, and that we continue to see regular improvements for children and patients.

I should like to address the nature of the changes that are taking place in our key public services, the rate at which the Government are introducing changes and the faltering nature, as I see it, of the process of change in health and education services.

It is one of the oddities of Queen's Speeches under this Government that they provide us, in the sense of a Kremlinologist, with a barometer that tells us about the current state of the relationship between the Prime Minister and the Chancellor of the Exchequer. It is—[Interruption.] The Secretary of State for Education and Skills should listen. I shall develop the argument, and the right hon. Gentleman will be hard put to deny its different elements. When we read the Queen's Speech, we find that the areas in which the Government will act are those where the Prime Minister and the Chancellor agree. The areas where the Government are
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introducing some generally fine-sounding words but nothing very radical are those where the Prime Minister would like to do more but the Chancellor will not let him. That is the argument around the evolution of public services that lies at the heart of the Government.

We all know what the Prime Minister's instincts are on this subject, and he loses no opportunity to tell us. We remember him telling us that he bears the scars on his back from those who oppose reform in the public services. We saw some of those responsible for inflicting those scars sitting behind the Secretary of State for Health.

The Prime Minister railed famously against the forces of conservatism, which in the press release was conveniently spelt with a capital C. The reality is that many of the most difficult opponents that the Prime Minister faces in the political arena are in his own party. They are relentless opponents of change within the public services.

The Prime Minister and I would number the Secretaries of State for Education and Skills and for Health among his friends on this subject. They understand the need for radical reform, but they are repeatedly blocked by internal opposition within the Labour party, led by the Chancellor. The most prominent example, foundation hospitals, arose in the previous Session, when the then Secretary of State for Health wanted to return to an agenda that we set out in the 1990s to create more independent and flexible management for major hospitals to allow them to respond more effectively to local needs—the needs of their patients and the priorities of the local communities that they are there to serve. It is well documented that the then Health Secretary repeatedly lost arguments with the Treasury and the Chancellor of the Exchequer. The Bill on foundation hospitals that was finally introduced did not deliver the measure of reform required to make the health service the flexible, responsive and efficient service that we all want in the coming years. It did not provide local hospital management with the capacity to evolve their own local employment terms for staff and gave them an absurdly politicised management structure. It did not give them freedom to borrow and thus access the resources that they need to develop their hospitals. The Chancellor obstructed reform by the Prime Minister and the then Health Secretary—now Cabinet supremo for policy development and winning elections and, I am sorry to tell the Secretary of State for Education and Skills, heir apparent.

Alistair Burt : The Health Secretary, too, will be sorry.

Mr. Dorrell: Indeed. The Treasury obstructed the drive to reform. I believe that the agenda for reform of the public services lies at the heart of political debate and will be the key domestic priority in the years ahead, so I approach the Queen's Speech with a sinking sense of disappointment. It is clear that the Prime Minister has largely left the field, and there are no major proposals that will continue the reform of health care and education that is needed if we are to deliver our objectives for those services.

That does not mean, however, that there is nothing of value in the Queen's Speech. I shall begin my examination of the proposals for the year ahead by
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looking at a measure that is not in the Queen's Speech because, I suspect, it does not need to be. In the middle of our party conference this year, the Government published a paper that I was pleased to welcome in a later question to the Prime Minister. He would not accept this description—indeed, he did not do so—but the paper outlines the Government's plan to reintroduce GP fundholding. I am delighted, however, that they aim to do so. They have, of course, changed the name—they call it practice-based commissioning, but they give the game away in the opening line of the paper which states:

You can say that again! From April 2005, GP practices can, if they so wish, be given indicative commissioning budgets, which is exactly what GP fundholding was about. I take a particular interest in the subject, because it was the first major issue for which I took ministerial responsibility when I was appointed junior Minister in the Department of Health in 1990. I read the document and almost wrote to the Secretary of State in the belief that I could offer my services as someone who has been here before. There are a number of things that I would have worded differently. The Government have fallen into a number of traps, which could have been avoided if they had been prepared to learn some of the lessons of experience. We could have made quicker progress towards a shared objective.

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