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Mr. Heath: Indeed the Conservatives cannot, and I would be the last person who would allow them to do so. The hon. Gentleman has always been a beacon of common sense from the Labour Benches, which, I suspect, is why he has not had the advantage of any preferment during the long period of this Government.

Let me move on to the second topic that clearly requires a debate because of its importance to many hon. Members: the state of the health service. I will start with a clear statement: the Government have invested more money in the health service than I can remember any previous Government doing. That is extremely welcome and we should not run away from that fact, or be anything other than pleased that they were prepared to make that investment. However, the outcomes do not match the input, and that is why members of the public and Members of the House are worried.

I was part of the primary care system in my previous professional existence, although that was an awfully long time ago. I am extremely worried about what is
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happening in primary care. I worry that out-of-hours services have been decimated throughout the country. The situation is especially worrying for those of us who live in rural areas because there is now every likelihood that people will not get a general practitioner to attend for a considerable time if they have the misfortune to fall ill. A similar point can be made about the ambulance service, which is underperforming in many of our rural areas.

There is no such thing as NHS dentistry in many parts of the country. No matter how many times the Government insist that everything is all right in dentistry, our constituents know that everything is not all right because their local dentist practices are opting out of the health service and no longer providing NHS treatment. The idea that people having to travel 40 or 50 miles to visit their dentist is convenient health provision under the NHS is nonsense.

There is huge variation among our acute services and hospitals. The substantial programme of hospital building has been extremely welcome. I have been waiting for a new hospital in Frome for nine or 10 years, so it is wonderful news that it looks as if we will soon have one. However, equally, cottage hospitals in many parts of the country are closing because of a lack of funds. Major general hospitals are being hamstrung by their lack of funds, which might be because of existing operating practices, or debts that they inherited from management failures years ago. For example, the Royal United hospital in Bath is still shackled by the mistakes of a previous generation of managers, and that is affecting care in our communities now. I do not for the life of me understand how it can be right for a present generation of patients to pay the price for funding mistakes made a generation ago, and the situation is a real worry.

Siobhain McDonagh: Will the hon. Gentleman join me in celebrating the fantastic reduction in waiting times for hip replacements in the NHS since 1997? The average waiting time was well over 18 months then, and it is six months today. Will he also welcome the introduction of statins, which have reduced the need for cardiac surgery, yet do not appear in any statistics on outcomes in the NHS?

Mr. Heath: Of course I welcome those things. I welcome the significant advances that the Government have made on reducing waiting times, although that certainly should have been the case, given the investment that has gone into the service. I am sorry, but I cannot give the Government the credit for discovering statins and disseminating their use. However, it is welcome that they are available. I was one of the first Members to call for their provision as a first response, and that is now a matter of course. It is extremely welcome that the need for cardiac surgery has been massively reduced.

However, I do not welcome wards that are mothballed. There are medical and surgical staff, as well as lay staff, who are being laid off. I do not welcome the fact that I have a constituent who came to see me the other day who is in the third stage of breast cancer—a late stage. She has been refused Herceptin by her hospital trust. All the arguments about Herceptin involve whether it is appropriate for first-stage cancers,
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and the need to await an assessment by the National Institute for Clinical Excellence as to whether it is an effective remedy for first and second-stage cancers. I am talking about a third-stage cancer. The only reason why the lady cannot receive the drug treatment that not only she wants, but her consultant physician insists is the right course for her, is that the hospital will not pay for it, because it does not have the money. That is scandalous.

The Deputy Leader of the House of Commons (Nigel Griffiths): That is wrong.

Mr. Heath: The Minister says that that is wrong. But that is what has happened to one of my constituents. I have written to the Secretary of State for Health. Other constituents who write to me cannot understand why their long-term prescriptive needs are not met by the health service, when those of some other categories are. We should be profoundly worried about that, and about the state of the health service.

I worry that we spend our time changing the structures of the health service rather than getting to grips with the outcomes, which are so important for patients. Mental health is always a Cinderella service. It is always the last area to be considered when it comes to funding, and the appropriate emphasis is not placed on it. I thought that we would see that happening when the right hon. Member for Darlington (Mr. Milburn) was the Secretary of State. He showed a genuine interest in the mental health service. Since then interest has evaporated, and we can see it no longer.

Long-term care is a scandal in this country. When I say "in this country", I mean in England, because it is not a scandal in Scotland. In England, patients receiving long-term care are still required to sell their homes so as to maintain their dignity in old age and look after their personal social care, as Sir Derek Wanless has pointed out in his report published today, and as the royal commission pointed out years ago. The Prime Minister said in 1997 that he could not live in a country where people had to sell their homes to secure long-term care. Yet he is still living here, and elderly people still have to sell their homes to secure long-term care. We must deal with that.

Norman Lamb (North Norfolk) (LD): Is it not incredible that the Government set up a royal commission to examine the matter that my hon. Friend has raised, nothing was done to implement the recommendations, and now a taskforce is being set up to re-examine it?

Mr. Heath: It is incredible, because we know what the answer is. We know what needs to be done.

There is an artificial division between personal care and nursing care when dealing with elderly patients, particularly with people who have Alzheimer's disease or another dementia. This is nonsensical, but the practical implications for patients and their families are immense. If we are a civilised society, it is something that we need to address. There are many things that pensioners would have on their list of priorities.

I cannot let this opportunity pass without mentioning yet again the £200 rebate. I cannot think of anything more cynical, or more guaranteed to bring the body
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politic into disrepute, than offering a bribe of £200 before a general election. The Chancellor of the Exchequer said from the Dispatch Box that the Government could now afford, because of their management of the economy, to mitigate the cost of the council tax for pensioners. One year later, council tax increased by 5 per cent. and the Chancellor could no longer afford the £200. Pensioners ended up paying an extra £200 or £250 on council tax. That is disgraceful. Labour Members should be ashamed of that.

I despair of a system that is so unfair for so many of our fellow citizens. I will not prolong the argument over council tax, but the system does not work for those who are on low or fixed incomes. It is unfair to them. We should recognise that and do something about it.

Mr. Andrew Turner (Isle of Wight) (Con): Whatever the demerits of council tax, does the hon. Gentleman accept that with local taxation the key issue is the decisions made by local councillors about how much to increase the tax? Whatever the system, if councillors spend too much they will have to put up the tax by too much. That is self-evident from my local authority. Having been under Liberal Democrat control for almost 20 years, in the past four years it has increased council tax by 13 per cent., 14 per cent. and then by about 3 or 4 per cent. consecutively. This year, when the Tories took control, they were able to increase council tax by less than the rate of inflation. That is a decision for local people, whatever the tax system.

Mr. Heath: The hon. Gentleman can make his local political points if he wishes. I invite him to reflect on the experience of Conservative councils throughout the country, which had to increase council tax year after year because of the withdrawal of Government grant. Let us not get into a big debate—[Interruption.] I am happy to have a debate if that is what hon. Members wish. I make it absolutely plain that there is no relationship between local spending decisions and the main part of council tax increases, because of the gearing effect and the infamous effect of central Government decisions. That is why councils throughout the country, whether they are Conservative, Labour or Liberal Democrat, find themselves increasing council tax every year, knowing that the people whom they serve cannot afford the increases. Councils have to meet the statutory requirements that the Government foist upon them.

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