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I repeat the promise that I made to the House—by next April, the NHS as a whole will be back in financial balance. That is why we have asked the strategic health authorities in each region to work with primary care trusts to create a financial reserve so that the organisations in deficit, particularly those with the biggest deficits—that small minority—can be supported while they make the necessary changes.
I want to thank the leaders and staff of the primary care trusts and strategic health authorities who are making very difficult decisions. I particularly thank all those organisations that have already done so much to improve services, have done it within their budgets and are now having to postpone some of the further improvements that they want to make for their patients in order to help solve problems elsewhere.
I stress to the House—as I have said to the strategic health authorities—that, unlike under the old system, every area that is contributing to the new reserves will get its money back, normally within the three-year funding period, and that, wherever possible, the areas of greatest need to which my hon. Friend the Member for High Peak (Tom Levitt) referred will get their money back first.
Mark Pritchard (The Wrekin) (Con): While many of us would agree with some of the health reforms that the Government are proposing, particularly as regards delivering health care in the local community, how is it that they are bringing back cuts in the district general hospital in my constituency, the Princess Royal, while at the same time cutting back on the very community hospitals through which they are suggesting that they want to deliver their reforms?
Ms Hewitt: On community hospitals, I made it very clear in the White Paper in January that any local NHS that was proposing to cut or close a cottage hospital or community hospital should look again at that decision in the light of strategy to get more services not only into community hospitals but into people’s own homes. I am glad to say that those changes have already been made in some parts of the country.
Mr. James Gray (North Wiltshire) (Con): The right hon. Lady says that she called on local primary care trusts to turn around any decisions that they may have taken locally to close community hospitals for purely financial reasons. Will she have a particular word with the Kennet and North Wiltshire PCT, which is consulting on closing seven community hospitals? Its chief executive has said that she is determined to close them, despite what the Secretary of State says, because she is the Margaret Thatcher of the national health service, and the lady is not for turning.
Ms Hewitt: As the hon. Gentleman knows full well, every part of the NHS that is proposing such changes has to consult its local patients and users and to seek the approval of the strategic health authority. We have already promised a new generation of at least 50 community hospitals, because some existing cottage hospitals are not providing the right services, are not in the right buildings, and will need to change.
Ms Hewitt: The hon. Member for South Cambridgeshire took a very long time, and I would like to allow some time for Back-Bench contributions.
Mr. Burns: Will the Secretary of State give way?
Fiona Mactaggart (Slough) (Lab): Will the Secretary of State give way to me?
Ms Hewitt: I give way to my hon. Friend.
Fiona Mactaggart: The Secretary of State may have noticed—
Mr. Charles Walker (Broxbourne) (Con): You’ve been sacked.
Fiona Mactaggart: The hon. Gentleman is misinformed—I chose my role.
The Secretary of State may have noticed that the loudest voices in the debate—I recall the intervention of the hon. Member for Banbury (Tony Baldry)—are from places where overspending has occurred in the NHS. The consequences for communities such as my constituency are that important services for my constituents, such as their mental health services, are being seriously affected to deal with the imbalance in the funding in the strategic health authority. Yet the voices that are noisiest in the Chamber, and often noisiest in the community, are those of privilege. What will my right hon. Friend do in future to protect those whose health is poorest? [Interruption.]
Ms Hewitt: My hon. Friend makes an enormously important point. We are prepared to ask only the organisations that are in balance or even surplus to— [Interruption.]
Mr. Deputy Speaker: Order. There may be controversy in the debate but we must nevertheless conduct it in an orderly manner.
Ms Hewitt: My hon. Friend made the point that her primary care trust has had to postpone improvements in services that her constituents desperately need to help sort out overspending in other parts of the country. It is precisely because those postponements can only be temporary that I am insisting that the organisations in areas that have been overspending must make the decisions necessary to sort themselves out. I will not take complaints about that from Conservative Members who troop in to see me and stand up, week after week, in Prime Minister’s questions and Health questions to demand more money for their services, patients and hospitals when they voted against the record investment that we are already making.
We have written a very big cheque for the NHS. Conservative Members voted against it. However, it is
not a blank cheque—it never has been and never will be. Conservative Members delude themselves and try to delude the public when they pretend that there is a limitless amount of money, that overspenders can be bailed out without any difficult decisions and that no part of the NHS should be expected to become more efficient.
Conservative Members say that they want more efficiency and more services in the community but they refuse to back the local NHS and local hospital trusts that are making difficult decisions to release resources for other improvements. They voted against increases in taxation to invest in the NHS, and they demand cuts in funding today. It simply does not add up, like the rest of their policies.
The changes that we are making in the NHS are true to its founding values. It is funded by taxation and free at the point of use. Care is based on what people need, not on what they can afford to pay. There must be fair funding to tackle health inequalities in the poorest parts of the country. Only by continuing to change and improve the NHS will we keep those values relevant in times that are changing faster than ever.
Mr. Paterson: Will the Secretary of State give way?
Every health care system in every developed country faces the same challenges of rising public expectations, an ageing population and extraordinary advances in medical science. I believe that the NHS—the fairest health service of them all—will meet those challenges better than any other health service in the world as long as we have a Labour Government. Only a Labour Government who believe in the values of the NHS and do not blow hot and cold about them can combine the courage to make the huge investment needed—
Mr. Paterson: On a point of order, Mr. Deputy Speaker. I am stumped. I have written three letters to the Secretary of State about my constituents. I have raised the matter three times in business questions. I have written to the Prime Minister and asked the Secretary of State directly whether she can advise me—
Mr. Deputy Speaker: Order. The solution is not to raise a point of order. There are other parliamentary means of pursuing those matters, which are matters of debate, however strong the feelings on both sides.
Ms Hewitt: I entirely recognise that the hon. Member for North Shropshire (Mr. Paterson) feels strongly about that matter, but I am not prepared to take lectures on the NHS from the Conservatives, or from the hon. Gentleman, who keeps demanding more money for new treatments—more money is, indeed, needed for new treatments—but will not support the investment that we are making or the difficult decisions needed to get all the NHS to the levels of effectiveness necessary to deliver the best care for patients with the best value for money. Only a Labour Government who believe in the values of the NHS will combine the courage to make the huge investment that the NHS needs with the courage to make the tough decisions to see the job through.
5.10 pm
Steve Webb (Northavon) (LD): I should also like to begin by welcoming the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham) and the Under-Secretary of State for Health, the hon. Member for Bury, South (Mr. Lewis) to their new ministerial roles. I congratulate them on their appointments. On the theme of turnarounds, it has been interesting to watch the Secretary of State turning around from being a Blairite to a Brownite in the course of her speech. She used the code word “renewal” twice, so we now know that, after the Government have been in office for nine years, the key need for the health service is renewal. We heard it here first.
It is my pleasure to kick off our contribution to this debate as the health spokesman for the party that is most trusted by the British public on the health service. What a discerning group the British public are! We understand why the Conservatives, who tabled this motion, are still not the most trusted party on the NHS. I recall being elected to Parliament in 1997, and having constituents coming to see me with letters saying that they would have to wait 104 weeks to see a consultant and to get on to the waiting list.
We owe it to the House to avoid the rewriting of history that can occur on occasions such as these. When I was elected as an MP, partly because of the Conservatives’ record on the health service, people were waiting two years to get on to waiting lists, and we must not forget that. We must not allow the British public to be deceived into thinking that the Conservatives are committed to the health service and that, if only they were in power, the health service would be sorted. So much progress has been made. Indeed, if it were only a matter of the Conservatives’ record on what was happening nine or 10 years ago, we might be tempted to think that the leopard had changed its spots. However, they have form not only in government but in opposition.
Mr. Graham Stuart (Beverley and Holderness) (Con): The hon. Gentleman has referred to the fact that it has been almost 10 years since the Conservatives were in office. Flat-lining in the polls as they are, if the Liberal Democrats want to be a real Opposition, they need to focus on joining us in holding the Government to account. It is the patients, the most vulnerable, and the poorest and weakest in our society who are being let down by the Government today.
Steve Webb: I can reassure the hon. Gentleman that there will be plenty of holding the Government to account—
Steve Webb: It is interesting that the Conservatives want immediately to get the focus off where they stand on these issues. I have here a copy of the letter sent by the leader of the Conservative party to his colleagues. In summary, it says, “They don’t trust us on the NHS; we’d better do something about it. Let’s join leagues of friends. Let’s have some Opposition day debates. Let’s do some visits. Let’s try to deal with the terrible reputation we have on the NHS.” Well, that will not
wash— [ Interruption.] I am asked whether the Conservatives are just faking it. Why did the shadow Secretary of State for Health vote against an £8 billion rise in national insurance for the national health service— [ Interruption.] I am told that that would have been the wrong way to raise the money, but I was not aware of an alternative £8 billion tax increase being proposed. Perhaps the Conservatives had secret stealth tax plans. Who knows?
Mr. Walker: When that announcement was made by the Chancellor, the then Secretary of State for Health, the right hon. Member for Darlington (Mr. Milburn), said breathlessly that he and his officials had worked tirelessly overnight, over pizza and takeaway curry, to decide how to spend it. Does the hon. Gentleman agree that the money was given a little prematurely, because most of it has been wasted?
Steve Webb: To get this straight, the hon. Gentleman thinks that the money should have been raised, even though his party voted against it—
Mr. Walker: There was no business plan—
Mr. Deputy Speaker: Order. The hon. Gentleman must not pursue the debate from a sedentary position. He has asked a question and must give the hon. Member for Northavon (Steve Webb) a chance to answer it.
Steve Webb: The Conservative party has form in opposition, not just on voting against the £8 billion. In the past 12 months, every Conservative Member has been elected on a pledge to take taxpayer’s money to buy people’s way out of the NHS. That is the Tory instinct. Rather than being the salvation of the NHS, as we heard in the speech of the hon. Member for South Cambridgeshire (Mr. Lansley), the reality is that the Tories believe that if a public service does not work, the few should be helped to buy their way out of it. That was in the manifesto on which every Conservative Member stood at the general election.
Mr. Jim Devine (Livingston) (Lab): Will my hon. Friend give way?
Steve Webb: I do not think that I am the hon. Gentleman’s hon. Friend, but I will give way.
Mr. Devine: I am still a new boy and learning the technique. Does the hon. Gentleman agree that it would be the height of hypocrisy for Conservative Members to shed crocodile tears for the local NHS if they do not use it themselves and are covered by private medical insurance schemes?
Steve Webb: My view, although I have no private medical insurance, is that we have always had a mixed health economy, with the NHS predominant, which I profoundly support. There has always been a role for the private sector, to which I do not object. My concern is the way in which the Government have provided for that.
The Liberal Democrats supported the additional £8 billion investment in the NHS. There has been a growth in the number of front-line doctors and nurses, but on the Government’s figures, without counting all sorts of obscure people as administrators, the growth in the number of managers over the past 10 years has been twice as fast. That is a statement of fact, and that is where things have gone wrong. It is not that those managers are doing nothing all day; they are running around chasing Government targets, monitoring and form-filling, which they should not have to do, and that is the problem.
When challenged about bureaucracy, the Government say, “We’re going to sweep away managers and merge primary care trusts, which will result in less bureaucracy.” I have been contacted from West Sussex, where one new primary trust will replace five. A non-executive director of one of those PCTs has written a letter saying that the new plans have
“produced an organisational structure that creates an additional layer of management.”
That is the new streamlined NHS. Instead of having a health authority, a primary care trust and the doctors, it will now have a health authority, a primary care trust and eight local practice-based commissioning areas. Each of those eight—there were only five before—will have a business director and support staff for finance and commissioning, public health partnerships, primary care development, patient and public involvement and so on. Incredibly, an extra tier is being introduced, which is typical of this Government. A whole raft of new bureaucracy is being introduced in the name of efficiency. It is classic new Labour reform.
Kali Mountford: The hon. Gentleman makes an interesting point about the commissioning process. But does he prefer practice-based commissioning, which would surely cost even more?
Steve Webb: I am slightly baffled by that intervention. I was under the impression that practice-based commissioning was Government policy, but perhaps I have misunderstood.
Many of the reforms are not inherently bad; the idea that the NHS should know what its costs are seems entirely good. However, the reforms have not been co-ordinated, planned, phased and staged; they have come helter-skelter, all at once, and have not been effectively implemented. One example of that is the failed implementation of the new tariff for children’s specialist services, about which, it is reported, the former Minister of State, the right hon. Member for Liverpool, Wavertree (Jane Kennedy), resigned, although I do not know whether that is the case, and I am happy to be corrected. We have raised the issue of specialist children’s hospitals, such as Alder Hey, Great Ormond Street and others, which are saying that the amount of money that they get for doing the clever things that they do for sick children is not sufficient to meet their costs.
Ms Hewitt: My right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy) did not decide to leave the Government because of Alder Hey. It was a completely separate issue, to do with the independent
appointments to NHS posts. On the subject of Alder Hey and specialist children’s hospitals, however, let me make something absolutely clear. More work is needed on the specialist tariffs, and we are doing that work in conjunction with the children’s hospitals; but the top-up to the tariff that we give those hospitals has been increased. Last year it was 53 per cent. over and above the normal tariff, and this year the figure will be 69 per cent. We shall go on working with Alder Hey and the other outstanding children’s hospitals to ensure that their essential work continues.
Steve Webb: I shall be delighted if that proves to be the case, but the letter issued by Alder Hey and others only weeks ago suggested that there were multi-million-pound deficits because of the inadequacy of the tariff. The situation is extraordinary; the new tariff is being introduced very rapidly, people are not having time to adjust to it, and there is a threat to valuable front-line services. What is worrying, and what angers people about the Secretary of State, is that she appears to be out of touch with what is going on.
John Pugh: As my hon. Friend will know, Alder Hey is not only cutting the funds that it can provide for care but cutting its building programme, in an unexpected and unpredictable way.
Steve Webb: My hon. Friend, who is relatively local to Alder Hey, has raised an important point. What we need are long-term efficiency strategies, long-term reform and structured change. What we are getting are emergency cuts packages, and that is not a rational way in which to run the health service.
The Secretary of State talked about job cuts, implying that they involved just a few agency staff; and who would not want to cut agency staff? I recently received a letter from a young woman in Stoke-on-Trent; well, a relatively young woman. She writes
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