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Mr. Tobias Ellwood (Bournemouth, East) (Con): Dorset primary care trusts are being made to hand back £11.5 million to the central pot in the Department of Health. That is having an adverse effect on PCTs in Bournemouth and Dorset, which are some of the best run and some of the worst funded in the country, and it is simply because this Government want to address the bigger problem of the national deficit in the NHS.

Mr. Letwin: My hon. Friend is right. We know the problems of the NHS in Dorset, because we represent
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Dorset constituencies. [Interruption.] My point is that Brown's cuts, which arise from Brown's largesse, can be explained by this pattern—

Madam Deputy Speaker: Order. Front Benchers on both sides seem to be making comments from a sedentary position. If hon. Members want to comment, perhaps they will do so in the usual way.

Mr. Letwin: You are right, Madam Deputy Speaker, as always. However, I have at least managed to provoke the Chancellor into discussing the NHS, which is more than we managed to do yesterday.

The Secretary of State for Transport (Mr. Alistair Darling) rose—

Mr. Letwin: I shall give way in a moment. [Interruption.] If the Secretary of State for Transport wants to join in and discuss the NHS, it is good news, but it would be better if the Secretary of State for Health were to come to the House and talk about the NHS.

Madam Deputy Speaker: Order. May we continue the debate in an orderly fashion?

Mr. Letwin: At business questions, we repeatedly asked for the Secretary of State for Health to come to the House, and I hope that the Chancellor and the Secretary of State for Transport will now make representations to her that she should take over a slot in the Budget debate or find another opportunity in order to allow us to debate Brown's cuts with her.

Mr. Darling: If I understand the right hon. Gentleman correctly, for the past five minutes he has been busy making an eloquent case for the Government to spend less, but a moment ago, he told the hon. Member for Bournemouth, East (Mr. Ellwood) that we should spend more on his PCT. When the shadow Chief Secretary, the hon. Member for Chipping Barnet (Mrs. Villiers), was asked yesterday afternoon whether the Conservatives would spend less, she said that it "would certainly mean that". Was she right?

Mr. Letwin: The shadow Chief Secretary was very clear. She said that we believe that over a period we should share the proceeds of growth, which is part of the Chancellor's programme, and that we should find a means of trying to deal with the Chancellor's ballooning borrowing, which is a prerequisite for economic stability.

In his intervention, the Secretary of State for Transport showed what happens when he amuses himself by talking to the Chancellor instead of listening to what is being said. My point may or may not be right—I cannot claim omnipotence or omniscience; I am a mere fallible human being—but at least it has a logic, and it would be helpful if the Secretary of State were to grasp it. It is not the case that spending a large amount of money achieves the desired result if the methods by which it is done are wrong. This Government have proved that it is possible to spend an enormous amount of money while achieving few of the
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desired results, if one manages to spend the money badly enough to create reactions from society that destroy one's own efforts, and my hon. Friend the Member for Bournemouth, East (Mr. Ellwood) raised exactly such a case in his admirable intervention.

How can it be that the wall of money has gone through to the NHS, yet we have Brown's cuts all over the place? The answer is that what is going on in the NHS is a vast effort to deal with Government targets. The people who are getting into the most appalling mess on that issue include the now-to-be-ennobled former chief executive of the NHS, the Secretary of State for Health and, much more importantly, people up and down the country who are wrestling with the problem of trying to run hospitals. Despite the vast wall of money, people who are trying to run hospitals are encountering difficulties, because they must constantly chase targets under a system by which they get directive after directive after directive. They know not whether they are coming or going, so they are demoralised, which results in a health service that is not performing up to the levels which, like us, the Government genuinely and passionately want to see.

I have taxed the patience of the House enough. [Interruption.]

Madam Deputy Speaker: Order. Will all hon. Members please come to order to let us have a reasonably conducted debate?

Mr. Letwin: I had imagined that this would be a quiet event.

Edward Miliband (Doncaster, North) (Lab): Will the right hon. Gentleman give way?

Mr. Letwin: No. I said that hon. Members would welcome the fact that I was about to sum up, and so I shall do so.

There is only one way out of this conundrum, and that is to have a Government who understand that one has to trust people more and share responsibility with them. We must have a Government who recognise that the people who are working their socks off in our health service, our schools and our police services will not be able to do their job properly if they are constantly controlled by an overwhelming state with its targets, agencies and bureaucracy. The Chancellor can throw money at them left, right and centre, over and again, in Budgets where he does mention the NHS and Budgets where he does not. He can go on trying to pretend that he is going to solve the pensions crisis in Budgets where he mentions Lord Turner and Budgets where he avoids mentioning him—this Budget was one of those—but he will never succeed in achieving the admirable goals that we share across this House if he continues to try to run the country from a desk in Whitehall. It cannot be done and it will not be done. It will produce adverse reactions, as it is today, and the money will be wasted.

1.30 pm

The Secretary of State for Transport (Mr. Alistair Darling): I am sorry that the shadow Chancellor is not among us, and surprised that the shadow Chief Secretary is not—although I see that she has just
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entered. There is something of a history in the Conservative party of people going missing when things get awkward. I well remember those happy days in Millbank in 2001, when the right hon. Member for West Dorset (Mr. Letwin), having announced his plan to cut £20 billion of expenditure, then went missing, only to reappear a few days later in a field dressed in a sheet—I think that he was meant to be a Roman emperor. Of course we also remember him in 2005, when he masterminded the plan to cut £35 billion from public expenditure, with similarly disastrous results for the Conservatives. I suspect that one or two of his colleagues wished that he had gone missing in that election as well.

Having heard the second speech on the Budget from Conservative Front Benchers, I am struck by just how light they have been on Conservative party policy. As the Chancellor said yesterday, if we consider the big issues that face this country and the choices that we have to make to see what is best in our long-term interests, whether on education, transport, fairness, taking children out of poverty or dealing with world poverty, the Conservatives have had absolutely nothing to say.

The interesting thing about the brief remarks of the right hon. Member for West Dorset—who is after all in charge of making Conservative party policy, which gives Labour Members some comfort—is that he made the case against any Government intervention at all. It was straight out of the book of the Republican party in the United States in the early part of this decade—arguing that Governments cannot make any difference. We believe that whether in education or transport, of course the efforts of individuals make a difference, but it is absolute nonsense to argue that Government cannot make any difference or that it does not matter how much or how little one spends.

The right hon. Gentleman eloquently demonstrated just how far to the right the Conservative party remains, despite everything that its leader has tried to pretend. It is clear that the dominant view in the Conservative party is now that the state—the Government—can play no part at all, and individuals should be left on their own, instead of the belief, which we hold, that Government can make a difference to the opportunities for people in this country, as we have shown by taking children out of poverty and improving their chances at school—and yes, by putting money into the health service, which has dramatically cut waiting lists. People had to wait 18 months when the Conservatives were in power; by 2008 that will come down to just 18 weeks.

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