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Mr. Shailesh Vara (North-West Cambridgeshire) (Con): My right hon. Friend says that the consultation process is a sham. Huntingdonshire PCT has already been informed that some £12 million to £13 million will be taken away from its budget in the 2006–07 financial year. Does he agree that that clearly reflects the fact that this is a sham?

Mr. Gummer: I cannot speak about Huntingdonshire, but it is clearly a sham when we always have the same answers. Let us take the regionalisation of the ambulance service. Is it not amazing? We ask those in the charge of the police, and curiously enough, they suggest the regions as the natural way of policing. We ask people about the fire service, and curiously enough, a whole lot of other people make exactly the same proposal—that for the fire service, the region is the ideal unit. We then ask the ambulance people—well, we do not ask too many of them, but we ask those who might come to an answer—and what do they say? Surprisingly enough, they think that the regions are the answer. We then to the SHA, and it says that regions are the answer. Regions are the answer because the Government want them to be the answer, not because anyone inside those organisations thinks so.

Mr. Wills: I want to clarify something about ambulance trusts. Earlier, the hon. Member for Eddisbury (Mr. O'Brien) said that only ambulance trusts should decide whether they undertook managerial reform. Does the right hon. Gentleman agree with him?

Mr. Gummer: I agree with what my hon. Friend said during the rest of his speech as well, which was that we should at least listen to the ambulance trusts and to others around them. It all seems very peculiar, when none of the ambulance trusts have campaigned for regional operation.

I then asked the Minister about dentists. I said that I could not find any dentists for my constituents in the southern part of my constituency and asked him to tell me where they could be found. He sent a letter back and said, "I rang up NHS Direct and here is a series of dentists." I looked at them. Half of them no longer took NHS patients or had closed their books, and the other half of them were in Frinton. He had not noticed that there is a river between us and Frinton, so instead of the dentists being 10 miles away, they were 45 miles away, unless people can swim. That shows the Government's understanding of my locality. It was a rude letter, too, because it suggests that I could have found out the information for myself—and I probably should have done that, given the sense and intelligence of the answers that I received from the Government.

The Government are now going back to the same pattern as the one that they abolished three years ago in many of the areas that they are talking about. As was suggested by the hon. Member for Falmouth and Camborne (Julia Goldsworthy), who spoke for the
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Liberal party, the Government are demanding "anything, so long as it's bigger"—I am not sure that she is quite right—unless they can make it a region, when the region is the answer.

The Government are also demanding that we should take seriously their definition of PCTs. PCTs are nothing other than the creatures of the Secretary of State, but she is busy pretending that if the PCT loses money, it is nothing do with her, nothing to do with the control from the centre and nothing to do with the SHA. She says that that is to do with the PCTs. So the Government reappoint the people who made the mistake and fine the locality for the mistake that has been made, because those sums must be found in so short a time that no sane organisation would possibly consider doing so.

I thought that I would find out whether any Minister at the Department of Health had ever run a large organisation, and I find that none of them has done so. There is not a chief executive of any major company, nor even a chief executive of a Government organisation among them. All they have run are things that other people have decided on, and they are now asking us to believe that we should blame the PCTs for the mistakes that have been made by central Government, when those mistakes have been made necessary because central Government have fiddled the funding formula, so that in many areas, particularly in the south and south-east, we are underfunded.

We are therefore asked to be serious about consultation. My local PCT has now consulted on three separate ways to deal with the problems of my constituency in less than 18 months, each of which is dramatically different, and we are told that each has been proposed entirely for clinical reasons. I do not believe that; no one in Suffolk believes it; not even the local Labour party believes it. The only person who does believe it is the hon. Member for Ipswich (Chris Mole), who is looking for a job. No one else believes it.

I therefore went to see the Minister of State, the hon. Member for Doncaster, Central—a person whom I respect—and she turned half way through the meeting to the SHA representative and said, "Well, none of these new changes will come in until they're ready, and when they're ready and they take over, then we'll close the hospitals." She was told, "Oh no, you're wrong, Minister: we close the hospitals first, because we haven't got the money to make the changes."

What are the changes? They are to ask for care in the community. We still do not have sufficient people to carry out care in the community now, without the changes. There are no more people to do that work in Felixstowe and Aldeburgh and along the coast that I represent—and if I may say so, Mr. Deputy Speaker, as you are unable to speak, in your constituency next door exactly the same is true. Those who can pay cannot find people to do that work, and we must try to pretend that the poor in my constituency should be faced with an inferior service because money must be saved to pay for debts that now stretch back for years.

I find it impossible to take seriously the Government on the health service. Those of us who represent constituencies such as mine know that the Government
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have presided over the worst changes to the health service that we can remember. I have represented my constituency for nearly 30 years, and now know that the health service that the Government leave will be significantly worse than the one that I was able to welcome when I was first elected to the House.

8.19 pm

Mr. Eric Martlew (Carlisle) (Lab): I did not really take seriously what the right hon. Member for Suffolk, Coastal (Mr. Gummer) said. I remember when he was Minister of Agriculture, Fisheries and Food and his Department was a shambles. I was surprised that he said that there had been no improvement. Anyone who has been a Member of the House for any period of time—new Members can be forgiven—will remember the letters that we got about waits for hip replacements of two, three or four years. That does not happen anymore. Although we have a problem with dentists, there have been massive improvements. When people ask where the money has gone and why productivity has not increased, the answer is simple: a lot of money had to be used to pay the staff a decent salary because they were underpaid under the Conservative Government—I sometimes wish that the staff would remember that, too. The reality is that we now have a lot more nurses and consultants.

I welcome the opportunity for the debate that the Conservatives have given us, although they cannot be taken seriously because when we debated extra money for the NHS—the penny on national insurance—they voted against it. Conservative Members may say that their PCTs are in trouble, but they really would have been in trouble if the Conservatives had won that vote.

Mr. Paul Truswell (Pudsey) (Lab): Does my hon. Friend agree that Conservative Members have a brass neck when it comes to talking about changing the NHS? He has been a Member for longer than me. Does he remember the hugely expensive chaos that was caused by so-called general management, when our area got the manager of a biscuit company to run the NHS? The family practitioner committee became the family health services authority, and that authority amalgamated with the district health authority. The district health authority was then split between three provider trusts and a commissioning health authority, but the commissioning function was then divided between a health authority and a family health services authority. Are we not hearing absolute doublespeak from Conservative Members?

Mr. Martlew: I remember that well. My only caveat is that the biggest employer in my constituency is a biscuit factory and its manager is very good.

I would like to talk about the situation in the north-west and Cumbria. I must say from the outset that we have had too many reorganisations, so I hope that we get this one right. I was a young member of a city council back in 1972 when the ambulance service was part of the local authority, but I do not know whether Conservative Members advocate going back to that situation. Of course, the service was then taken into the health authority, but we must have had eight or nine serious reorganisations since then. I agree that reform is needed because last time it happened in our area, it was not done very well.
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