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Mrs. May: I am grateful to the hon. Gentleman for his generosity in giving way to me for a second time. In response to my hon. Friend the Member for Isle of Wight (Mr. Turner), he referred to Conservative councils. Does the hon. Gentleman not accept that the figures clearly show that the average band D council tax throughout the country for people living under Conservative-controlled councils is still £81 less than those in the same band under Labour-controlled councils, and £88 less than council tax under Liberal Democrat-controlled councils?

Mr. Heath: The right hon. Lady knows better than that. She knows the structure of local government finance. If she wants an illustration, I will take her to my constituency. I can take her to Milbourn Port, on one
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side of the county border, where the average band D payment for a council tax payer will be £50 less in Liberal Democrat-controlled South Somerset district council and Liberal Democrat-controlled Somerset county council than if one were to cross the county border into Conservative-controlled Dorset county council.

We can all give such illustrations, but they do not mean anything. There is something deeply wrong about the structure of local government finance. There are some authorities that historically have never had a fair share of education funding, for example. They have never had the resources provided per pupil to match in any way those provided for other areas. The hon. Member for North-West Leicestershire (David Taylor) knows this very well, because Leicestershire has been dealt with badly over many years. Somerset is another example, and I believe that Norfolk is another. There must be transparency in the system.

What the hon. Member for Isle of Wight (Mr. Turner) says is right. People make local decisions and they should set the tax, which would be related directly to the amount that they were spending. The local population could then decide whether to back the councillors or sack them. That is the right way in which to operate local government.

Mr. Wills: Will the hon. Gentleman give way?

Mr. Heath: I will not take any more interventions on this point, because I want to move on to my last point.

Norman Lamb: Will my hon. Friend give way on another point?

Mr. Heath: All right. This is the last intervention that I shall take.

Norman Lamb: My hon. Friend mentioned the £200 payment, which was used as a means to get the Government through the general election. We have found that in health, for example, difficult decisions appeared to be postponed until after the election. In Norfolk we have a £20 million black hole with the Norfolk and Norwich University hospital—a flagship private finance initiative hospital that is facing some 700 possible job cuts. Does that not demonstrate that the system was manipulated to get the Government through the general election? Now all the problems are coming to light.

Mr. Heath: My hon. Friend is right. I make a prediction: we will have a particularly liberal Budget in about three or four years, which will see the Government through the next election. It was ever thus. Whichever Government are in power, they manipulate the figures for their electoral advantage. It is a great shame.

My last point takes us right away from parochial and even national matters to the international scene. We need a debate on what is happening in the areas of the world in which we as a nation have taken a particular interest. I find it extraordinary that since the onset of the
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conflict we have not had a debate on the foreign affairs issues associated with Iraq. We have an Army in the field in a country racked with violence, where enormous difficulties face our very brave men and women who go out there and serve their country—and the House does not debate it.

The House hears occasional statements from the Ministry of Defence, but we do not have an opportunity to say what we think about the conduct of affairs in Iraq, or in Afghanistan, another dangerous theatre in which we are engaged. That seems wrong. I look back at the speeches that I made on 18 March 2003 in the debate on the Iraq war, and I do not resile from any of the points that I made then. I believe that I was right. Others will take a different view. I accept that there respectable differences of opinion about whether we should have engaged in the conflict in Iraq, but events have happened exactly as I said they would at the time, to the detriment of many people in Iraq, and sadly, many British lives have been lost. We owe it to the people whom we send to Iraq to have a clear view about what is likely to happen.

A much more mature debate is taking place in America. American military doctrine is being questioned—not just the decision to go into Iraq, but how the American military conduct themselves. The idea of overwhelming strength, which has been a basic American military doctrine since Colin Powell, is being questioned as an appropriate response to insurgency. Americans are looking at the conduct of British troops back in the Malay insurgency and in east Africa, to learn lessons about how to deal effectively with insurgency.

That may be a lost cause for the Americans. I was disturbed to read in a poll recently that 90 per cent. of all American soldiers believe that they are fighting Iraq as a direct consequence of 9/11—a matter in which Iraq was not involved. But they believe that that is a direct response. Iraq lurches towards civil war, despite the good things that we perceive happening. I am not one of those who say that the election was not a good thing. Of course it was a good thing to have an election, but I also recognise the escalating violence, the determination of large parts of the population to engender further conflict, and the difficulties that our troops face daily.

We should have a debate on that in the House, as we should on the very difficult task that we have set our troops in Afghanistan, another lawless area in the world, without a clear mission that they are expected to achieve. The sooner we have that, and the sooner we establish the grounds that we set for the withdrawal of our troops and an appropriate exit strategy, the better it will be not only for British interests, but for world interests and increasing stability.

That was a brief canter—with many interventions, which prolonged the time for which I spoke—through essential topics of debate for the House, which we have failed to debate over the past Session or before the recess, and which we should debate at the first opportunity when we return.

1.4 pm

Mr. Michael Wills (North Swindon) (Lab): I shall be fairly brief. I am grateful for the opportunity to make a plea to Ministers to implement as rapidly as possible some of the recommendations in the recent health
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White Paper, particularly in relation to integrating care services. In my constituency I have a special interest in seeing the integration of Swindon social services, run by the borough council, with Swindon primary care trust.

Since its inception in 1997 Swindon social services department has had a long and troubled history. It inherited from Wiltshire county council a deficit of £1 million, and it has never been able to get out from under that burden. That has nothing to do with the quality of the social workers involved, who are all, in my experience, public-spirited public servants who work extremely hard to try to deliver services to their clients. The Government have recognised the considerable problems with Swindon social services over the years, and there has been Government intervention.

Thanks to £1 million from the Office of the Deputy Prime Minister, the borough council was able to bring in consultancy services from Kent county council, one of the better social services departments in the country. Under its tutelage and with a great deal of engagement by the borough council, there have been real improvements in Swindon social services. I pay tribute to everybody who has been involved, particularly to the social workers on the front line, who have a difficult and often thankless job. I know from my own experience how hard they work and how deeply they care about the people they serve, and I pay tribute to them.

There are, however, still huge problems with social services. We cannot run away from them. Every week I see examples in my caseload. Recently, I had a case of a young woman with pronounced suicidal tendencies who had been made known to Swindon social services over many months. She had not had a proper assessment and she was getting no support. One afternoon recently she threatened to commit suicide. Her mother was desperate. She rang social services, but she could get no one to come out.

In the end, the situation was so desperate that the police had to go to the house and spend six to eight hours with the young woman to ensure that she did not harm herself. All the time the police were there doing that job—I pay tribute to them in this case—I was on the phone, trying to get social services to engage with the case. Having spent most of the day on it, it was only at about 6.30 pm that we got a duty officer to come out and take charge. That was an extreme case, but there are other cases that I see every week, showing how far social services have to go.

On the other hand, Swindon primary care trust is widely recognised to be one of the best in the country. It is an exceptional team led by Jan Stubbings, with high quality management throughout the primary care trust. It is discussing its future, a matter to which I shall return at the end of my remarks. We have the opportunity to combine an operation that desperately needs better managerial support and continuing reform with an organisation that has already proved its worth.

In a bold and inspired move, Swindon borough council has appointed the chief executive of the PCT to spend four days a week running Swindon social services. It is early days, but it seems to be working extremely well. She still spends one day a week running the primary care trust, but because of the quality of the team that she has built up there is no dilution, as far as anyone can see, in the quality of the management of the primary
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care trust. The gains from integrating those caring services are potentially enormous. The Government have begun to recognise that—the recent White Paper on health suggests that they do, but we must move fast.

I conclude my remarks by drawing attention to dementia care. We know that the numbers of people suffering from dementia are growing all the time. As people live longer, that is increasingly likely to affect many people in the United Kingdom. It is extremely difficult for the statutory agencies to deal with the problem. Symptoms are often not recognised early on. Typically, long-standing partners shoulder a huge burden of care, particularly in the early stages of dementia. Statutory agencies often come in quite late. There is often a great deal of confusion, which is difficult to resolve, about who should take responsibility for the care. For example, in the local hospital there are still a large number of delayed discharges, which are due to people suffering from dementia not being able to go anywhere. When elderly people are unable to look after their partners, it creates huge problems for hospital staff. As everybody knows, people with dementia need a lot of care and attention, because they go wandering, which takes up an awful lot of hospital staff's time. When I visited the hospital last month, staff told me that managing the day-to-day routine of people with dementia is still a considerable problem. People in the early stages of dementia should not really be in hospital, but there is nowhere else for them to go.

Integrating caring services could do a great deal to provide more effective care for people with dementia, and it would also have wider benefits at the boundaries between the various caring agencies, which are often quite diffuse. I hope that the Government will move quickly to implement the recommendations, because there are huge gains to be had, and I also hope that they will examine the opportunity to make Swindon a pilot for such integrated services.

In conclusion, I hope that my hon. Friend the Deputy Leader of the House will pass on to Health Ministers the point that the huge gain offered by such integration can be achieved only if Swindon PCT remains as a stand-alone PCT and is not integrated with some of the other potential partner PCTs, which the strategic health authority is currently advocating. I hope that my hon. Friend will carry forward the message that Swindon should have a stand-alone PCT and the rapid integration of social services.

1.11 pm

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