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Mrs. Louise Ellman (Liverpool, Riverside) (Lab/Co-op): In view of the hon. Gentleman's remarks, will he give a firm commitment that the Opposition will support a ban on smoking in all public places and in all pubs?

Mr. Lansley: No, we will not—[Hon. Members: "Ah!"] There are two perfectly viable ways of proceeding: either having a legislative ban everywhere, or move forward on a voluntary basis. [Interruption.] Labour Members jeer, but yesterday the British Beer and Pub Association announced that its pubs would get rid of their happy hours, so action on public health is already being taken. We have set out clearly that we should proceed on a voluntary basis—it is perfectly possible—to deliver an environment in public houses and other public places that is smoke-free for all those who want it and smoke-free for children. Frankly, if the Government are really interested in the public health aspects, rather than talking about a partial ban they should devote more attention to delivering effectiveness in smoking cessation services.

The evidence is very clear that the real dangers lie in smoking, in being the partner of someone who smokes or in being the child of parents who smoke. Those are the critical issues. If we can continue the downward trend in the number of people who smoke in this country, we will deliver substantial improvements in public health. That has not happened in the past few years, but it did happen—

David Taylor (North-West Leicestershire) (Lab/Co-op) rose—

Mr. Lansley: No, I am finishing in a few moments.

There are many other issues to which the Secretary of State should devote herself in this Parliament, but I am not going to cover them all. My apologies to the House and to my hon. Friends if I have left out specific issues.

During the 2001 general election, the Government announced that they would have 10,000 more doctors and 20,000 more nurses, but we did not hear a peep from them about those objectives during the recent campaign. It was the Conservatives who set out clearly how they could deliver 20,000 more doctors, 30,000 more nurses and 30,000 more allied health professionals. If the Secretary of State and the Government are keen to increase capacity in the NHS—and I hope that they are—they must learn from what we have been saying. The private sector must be used more efficiently and fully, but the total health care capacity in this country must also be increased, and that means more doctors and nurses. More resources must be put in and we have set out how that could happen, not just through to 2007–08, but to 2009–10 as well.

Resources in the NHS must be used more efficiently. The Office for National Statistics has shown that there has been an 8 per cent. reduction in productivity in the NHS since 1997, but what does that mean in practice? The number of finished consultant episodes—that is, in
 
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effect, the number of operations carried out in hospitals—rose by 26 per cent. between 1990–91 and 1996–97, but by only 14 per cent. in the six years since 1997. My right hon. Friend the Member for Charnwood (Mr. Dorrell) was responsible for part of the rise between 1990–91 and 1996–9—and if that trend had been maintained, the NHS would be performing 1.4 million more operations a year.

The Secretary of State announced with some fanfare that she was going to buy 1.7 million more operations from the private sector in the next five years. If the earlier productivity rate in the NHS had been maintained, we would have had 1.4 million more NHS operations every year. That is the difference, and the key to the problem.

Dr. Starkey : Will the hon. Gentleman give way?

Mr. Lansley: No, as I am about to finish.

When the next general election is held, perhaps in four years' time, we will ask whether the resources have gone in and whether they have delivered increased capacity, efficiency and productivity through the application of competition and choice. The most important question will be whether the resources have delivered results. In four years, our health spending will broadly equal the European average, but matching the European average in respect of respiratory disease would save 35,000 more lives a year; achieving the European best in respect of cancer mortality would save 23,000 more lives a year; and doing the same in respect of mortality from heart disease would save 41,000 more lives a year.

As things stand, we lag far behind the European best. The appropriate amounts of money may be going in over the next few years, but results are what count. In the general election, the electorate told the Government the simple truth—that they have not delivered on the results. In four years, they will be held accountable for that, and they will no longer be the Government of this country.

4.8 pm

The Secretary of State for Health (Ms Patricia Hewitt): It gives me enormous pleasure to take part in this debate, which is my first as Secretary of State for Health. I begin by thanking the hon. Member for South Cambridgeshire (Mr. Lansley) for his kind words to me and my ministerial colleagues at the start of his speech, although he omitted to mention my hon. Friend the Member for Doncaster, Central (Ms Winterton), who is one of my Ministers of State. However, I join him in extending a warm welcome to the hon. Member for Northavon (Steve Webb) as he takes up his new post on the Front Bench.

The health and education measures outlined in the Gracious Speech—and I shall say more about them in a moment—are firmly rooted in the values represented by Labour Members. They are the values of equality of opportunity and of mutual responsibility. All Labour Members came into politics to help create a society in which all individuals, irrespective of background, have the opportunity to fulfil their potential. We want every family to be able to give their children the best possible
 
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start in life, and every child to be inspired and valued at school. We also want every patient to feel that their health is being safeguarded and improved by our NHS.

Mr. Andrew Turner (Isle of Wight) (Con): The Secretary of State mentioned her commitment to equality of opportunity. Can she explain how a headline came to be printed in The Times which reveals that 11,800 of the best performing pupils do well in grammar schools and the better comprehensive schools, but 16,500 are failing—after eight years of Labour Government—in inner-city and poorly performing comprehensive schools?

Ms Hewitt: I am responsible for many things, but they do not include the headlines printed in The Times. My understanding is that that headline does not reflect the evidence, to which the piece refers, of the way in which standards are rising in our schools—and rising even faster, I am glad to say, in schools serving our most disadvantaged areas than in other parts of the education system.

The values that I referred to are timeless, but they have to be applied in changing times, in a society in which people are better educated and informed and have higher expectations than in any previous generation. Everybody wants to be treated with full respect as an individual, with their particular needs and abilities properly recognised. So our challenge and our goal, as we embark on our third term in government, is nothing less than to create world-class public services that are fair to everybody and personal to each. That is our vision of public services for all of our people and not, as the Opposition tried to propose in the election campaign, just the privileged few.

It was interesting listening to the hon. Member for South Cambridgeshire and reflecting on the election campaign in which we have just participated. In that campaign, the Conservatives did their best to avoid saying anything about their vision of public services and had nothing whatever to say about the economic policy that might enable the creation of world-class public services. They certainly did not want to talk about their policy to take billions of pounds out of public health and education to subsidise private provision for the few. I notice that the hon. Gentleman said nothing about those policies today. Indeed, his speech was, in most respects, a policy-free zone. He will certainly have to do better than that in the next election campaign that he intends to fight—I believe that it is a little less than four years away.

Mr. Stephen Dorrell (Charnwood) (Con): Will the Secretary of State confirm that when public money is used to treat patients of the NHS through private sector provision, they remain NHS patients? In what sense are people taken out of the NHS or the maintained education sector if the taxpayer buys better care and better education for patients and pupils from providers best placed to meet their needs? [Interruption.]

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