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That is just one example, but it is disingenuous to say that this is all about agency staff. It is not solely about them. Clearly things can change, but we are talking about permanent and front-line staff. We are talking about doctors and nurses. This is having an impact not just on services but on morale. As the Secretary of State herself knows from experience, we need good will and good morale above all in the NHS. So much runs on that basis, and the Government are systematically undermining it.

John Bercow: The hon. Gentleman has referred to specialist children’s hospitals. May I give an example that falls into a slightly different category? Does the hon. Gentleman not agree that it is truly a national scandal that the Royal Free Hampstead NHS Trust is proposing to close a centre of excellence in the form of the Nuffield speech and language unit, whose total expenditure accounts for only 0.1 per cent. of the trust’s expenditure last year? The closure could take place in 10 weeks. I do hope that the Secretary of State is aware of that, and will do something about it.

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Steve Webb: I am aware of the centre to which the hon. Gentleman has referred. An early-day motion has been tabled in its support, to which I added my name recently because I share the hon. Gentleman’s concern.

Is it just a bit of waste and inefficiency that is being eliminated, or is it front-line services? I received a letter from a psychoanalytical psychotherapist—also from Stoke-on-Trent—who says that the local PCT is saying this:

Of course we want to protect “life or death care”, but this does not mean just stripping out a few agency nurses; it means cutting a raft of services that constitute the bread and butter of the NHS.

Mark Pritchard: Does the hon. Gentleman agree that mental health services may suffer worst as a consequence of the Government’s so-called reconfiguration of health services? That means that more people will be wandering around our communities who should be receiving day-to-day care and should perhaps be looked after in the community, but who should certainly not be abandoned with no support and no treatment as a result of the Government’s reforms.

Steve Webb: The hon. Gentleman is right to highlight the fact that in several parts of the country, mental health services have borne the brunt of the problem, even though, in many cases, those services were actually in financial balance and were feeling the knock-on effect of other areas. It is often very vulnerable people and their carers who are suffering.

Mr. Dan Rogerson (North Cornwall) (LD): I am glad that my hon. Friend shares my concern about the effect of such a policy on mental health services. Does he agree that in some areas, the emphasis on targets is badly affecting the funding of preventive work on smoking and obesity?

Steve Webb: I am grateful to my hon. Friend for making that pertinent point, which is at the heart of my argument. None of us is saying that the health service is perfect, that nothing should change and that no job, once created, should ever go, but we are saying that change should be measured, rational, planned and undertaken according to a long-term strategy. The preventive work to which my hon. Friend referred—smoking cessation and work on childhood obesity—tends to have a long-term payback. It is the first thing to be cut, therefore, because it provides no immediate, tangible benefit.

Mark Pritchard: Will the hon. Gentleman give way?

Steve Webb: If the hon. Gentleman will forgive me, I will not give way to him again.

My concern is that so many of the cuts that we hear about are part of emergency cuts packages. When the Secretary of State says that in many cases, these problems have existed for decades and are only now coming to light, she is right, but the answer to solving decades-old problems is not to try to solve them in weeks. The point is not that nothing should ever be changed, but that the Government are trying to make
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changes at breakneck speed because someone somewhere is in a hurry for a legacy.

The Government consistently blame local health services for overspending and inefficiency, yet general practitioner costs, consultants’ costs, the tariff and practically all the targets are centrally determined. However, if the numbers do not add up at the end, the fault, apparently, lies at a local level. How can we square that argument? The Government cannot work this one out; what is their responsibility and what is not? If a community hospital closes, it is a local decision; if one opens, it is Government policy. Which is it? They need to decide.

Tim Farron (Westmorland and Lonsdale) (LD): The Government initially allocated £2.3 billion for the “connecting for health” project, but by their own admission, they are likely to spend £6.2 billion on it. Indeed, experts project that the figure could be as high as £30 billion. Given NHS deficits of some £600 to £800 million and the impact on my constituents of the potential closure of the coronary care unit at Westmoreland general hospital, does my hon. Friend agree that there is a juxtaposition to be made between what are relatively small deficits and vast Government overspending on administrative projects?

Steve Webb: My hon. Friend makes an important point. When a centrally imposed cost falls locally and upsets the financial balance, the cause of the problem is somehow deemed to be local mismanagement. There is a story to be told about the Government’s information technology projects in general and the NHS project in particular, to which we will doubtless return.

Another key issue that has arisen in this debate is waiting. With the best will in the world, I caution the Secretary of State against talking about the Government’s abolishing waiting, because if she does so she will cause real distress and anger. On 13 December, she said:

With the greatest of respect, she should think carefully before she repeats that phrase. In many areas of the health service, that assertion is at total variance with people’s experience, and if she goes on making it, she will make herself look a fool.

Mr. Peter Bone (Wellingborough) (Con): I sometimes think that the Government are more interested in spin doctors than real doctors. Last November, the Prime Minister promised that nobody would wait more than six months for an in-patient operation. However, the number waiting for such an operation has been growing month by month.

Steve Webb: The Government mean something very specific when they use that phrase; however, some people are having to wait much longer than the Government are saying. For example, a lady who came to see me on Friday was told that she will have to wait three and a half years for fertility treatment. Now the Government will say that that does not count, because
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they are not talking about that sort of waiting list. But if they keep saying that they are getting rid of waiting in the NHS and thousands of people are waiting long times for treatment of different sorts, they will not be believed, and it will really undermine what credibility they have left. So I urge them to pull back from that.

Tom Levitt: I acknowledge that pressure on audiology services is causing problems with waiting times for hearing aids, but we should put the hon. Gentleman’s remarks into context. Will he acknowledge that the investment in digital hearing aids has been good, the investment in hearing testing for newborn babies has been an excellent innovation and the extra demand that has been caused by the popularity of digital hearing aids is partly responsible for the stress on audiology services?

Steve Webb: The hon. Gentleman cannot have it both ways. I do welcome the extra investment in digital hearing aids, but if people have to wait longer because of induced demand, the Secretary of State cannot claim that the Government are abolishing waiting in the NHS.

A case of what waiting is doing to people was drawn to my attention only this week. A consultant at Guy’s and St Thomas’ hospital wrote to a lady—who sent a copy of the letter to me—about a genetic blood test for breast cancer. The consultant wrote:

The Government’s motion states that they welcome

However, they will not get that far if they have to wait six to nine months for the blood test. The consultant concludes, ominously, that that

That is the NHS in which the Government have nearly abolished waiting.

Anne Milton (Guildford) (Con): The hon. Gentleman raises an important point about the confusion over waiting lists. There is a huge gap between the Secretary of State and the general public. The Government say that waiting lists are falling, but they are not talking about the sort of issues that constituents come to see me about. Does the hon. Gentleman agree that there is a huge problem not only with waiting lists, but with people being refused tests or treatment? Constituents have been told by the hospital that they need procedures such as PET scans or other tests for Parkinson’s, but that the PCT is not funding them at present. Those people are not waiting, but they are being denied treatment that they need.

Steve Webb: The hon. Lady raises the important issue of what the NHS does and does not do, which is separate from the issue of waiting. If some people cannot get treatment at all, it is another facet of that problem.

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We should also talk about what needs to be done. I listened in vain for nearly 45 minutes to the hon. Member for South Cambridgeshire for any suggestions, and there is nothing in his motion about what needs to be done. A constructive and effective Opposition say what needs to be done, so I shall point out several measures that need to be taken.

The first is that if one accepts the Government’s logic, the NHS should be given greater time to adjust. If one believes in a market directed by incentives—including incentives to be more efficient—it needs time to adjust. Incentives do not work over night. If the NHS is to be restructured, new units built and old ones closed, the effect will take time to be felt. The logic of the Government’s position is that we should not have wholesale reform all at once to be implemented quickly. Instead, change should be phased, staged and managed, but that is not what is happening. One cannot sort out the problems of decades in weeks.

The second key aspect is the need, at the very least, for the infamous level playing field between the NHS and the private sector. All too often, the independent treatment centres, which are supposed to be the dynamic, free-market, capitalist competition that will ensure efficiency, are being subsidised and given guaranteed business. That is the exact opposite of what should happen. For example, a doctor wrote to me recently saying:

to the problems of the NHS—

He makes an interesting point when he states that the number of staff working there is very similar to the number of redundancies at the Royal United hospital, Bath. He says that that is no surprise, as those staff members are doing the work that the RUH has lost, although at a higher price. That cannot be a rational way to manage efficiency in the health service.

The shadow Secretary of State, the hon. Member for South Cambridgeshire, asked about what should happen when a district general hospital “loses business”, as the jargon has it. He did not answer his own question, but the logic of the Government’s policy is clear, and it is that district general hospitals may close when their work can be taken up by regional specialisms, treatment centres and GP surgeries. However, have the Government talked to the British public about that? Has there been a debate about whether we think that district general hospitals have a future?

The answer to both questions is no. We have had no such debate. What is missing most of all from the NHS is real local democratic accountability. The NHS employs 1.3 million people, or one voter in 35. The only person democratically accountable to all those people is the Secretary of State, who has just left the Chamber.

I shall give the House an example from my own part of the world. In the former area of Avon, none of the local MPs and councillors, regardless of party, wanted the PCT configuration, but the health authority just said, “Tough.” Where is the democracy and accountability in that?

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That is not merely a constitutional point. We want the NHS to be genuinely accountable and answerable to us not just because we pay for it, but because that would be more efficient. Local people and those whom they elect would be able to scrutinise what went on and ask pertinent questions. At present, they are completely shut out; only one person is accountable for the NHS, and she takes no responsibility for it.

Over the past nine years, the amount of money going into the NHS has risen from historically low levels to something more credible, but the problem has been the endless interference and issuing of diktats from the centre. Local discretion has been limited, but the blame when things go wrong is always shifted to local NHS management.

That has to stop. We want real local democratic accountability, and that will mean that the NHS is different in different parts of the country. That is what local people want; they should be allowed to have it, and not be told from the centre how things are going to be.

We should not go back to the pre-1997 regime that failed the NHS. There have been real improvements since then, but we need a measured pace of reform, serious accountability and decentralisation. Running an organisation of 1.3 million from one office in Whitehall is not the way to proceed.

Several hon. Members rose—

Mr. Deputy Speaker: Order. Given the obviously large number of hon. Members who want to take part in the debate, it may be helpful to the House if I repeat that there is no time limit on speeches today. When that decision was made, there was an insufficiency of speakers, which shows what can happen with the best laid plans of mice and men.

5.38 pm

Mr. Kevin Barron (Rother Valley) (Lab): I begin by saying how intrigued I am by the Opposition’s motion today, which seeks a turnaround in the Department of Health. When I was in opposition, I sat on those Benches and demanded that the Conservative Government of the day save jobs in the NHS. Now, some Conservative Members are doing the same thing. That is the biggest turnaround in my experience of this House, although the difference is that there are now 300,000 more jobs in the health service than when they left office. [ Interruption. ] The hon. Member for Beverley and Holderness (Mr. Stuart) asks a question from a sedentary position, but I invite him to intervene. I am quite happy to take him on, but I see that he does not want to get up. That is okay, and I shall move on.

The Opposition motion mentions the word “turnaround”, but the greatest turnaround in our NHS began in May 1997. It may have taken a couple of years to take effect, but that was when the NHS started to get the expenditure that it had needed for a long time. I have to disagree with my right hon. Friend the Secretary of State when she says that 18 years of Conservative Government took money away from the NHS; the process began in 1976 under Denis Healey when he started to attack the NHS capital expenditure programme—an easy public sector target whenever a Government come under pressure. The cuts have decades of history and the process did not end for a long time, but it has ended over recent years.

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The Conservative motion suggests that the Secretary of State does not understand the realities of the NHS. I fundamentally disagree. My right hon. Friend knows fine well what the realities are. The hon. Member for Northavon (Steve Webb) referred to some of them when he talked of the need for staged change in the NHS. He said that the changes needed to be better timed, because things had been done in a bit of a rush. I have been hearing that in this place for 23 years. Before that I was active in local politics and I heard it there, too. Every time we ask for change in the NHS, we are told, “Yes, but don’t do it now.” I do not say that things could not be done better, but I suspect that the hon. Gentleman is listening to the voices of vested interests—people who work in the NHS and do not want to change. In certain circumstances, it is a great pity that they do not want to. We have all heard those vested interests in media reports over the past few weeks, and I have heavily criticised some of them.

I want to set out what has been happening in the NHS since the Government took office in 1997. We have dealt with waiting times of more than six months, although earlier we heard an example that showed they were increasing again. In March 2000, three years after we took office, more than a quarter of a million people had to wait more than six months for an operation; by December 2005 the number was almost nil. The bar on the Department of Health graph is so small that I cannot see what the number is.

In 1998-99 the mean waiting time for a cataract operation was 225 days; in 2004-05 it was 91 days—a reduction of 60 per cent. The mean waiting time for a heart operation in 1998-99 was 136 days; it is now 91 days—a reduction of 33 per cent. There has been a reduction of 19 per cent. in the waiting time for hip replacements and of 25 per cent. for the diagnosis of heart conditions. When I look at all those changes, I cannot recognise the NHS that was described earlier.

Mr. Stewart Jackson (Peterborough) (Con): I am listening to the right hon. Gentleman with interest. Will he explain why after increased expenditure of more than 23 per cent. during the period to which he refers, the number of clinical episodes has increased by 1.6 per cent? Will he reflect on that?

Mr. Barron: National health service funding has doubled since Labour came into office in 1997, and in two years’ time it will have trebled; that relates to deficits. I do not want to talk about deficits in this debate, because the Health Committee, which I chair, will be looking into how trusts can run up massive overspends after the Government have given them increased budgets year on year for at least the last six years.

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