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John Bercow: Ministers have frequently asserted—they are right to do so—that early intervention is vital to help children with speech and language difficulties. As the Secretary of State knows, I have a strong and continuing personal interest in that subject. Given that the Vale of Aylesbury primary care trust is now turning away new referrals and inviting hard-pressed parents to seek help privately, what does the Secretary of State say to those parents who, in a million years, cannot afford to do so and who, without immediate and practical help, will find that their children’s future prospects are permanently damaged?

Ms Hewitt: First, as the hon. Gentleman knows because I have written to him on this point, I have already ensured that the Nuffield speech and language unit—an issue that he has specifically raised on many occasions—will continue to treat patients. [Hon. Members: “What about the Vale of Aylesbury?] Funding for the Vale of Aylesbury primary care trust has increased by more than 30 per cent. over the past three years, by £40 million. In Buckinghamshire PCT, over the next two years, there will be an additional £91.5 million. However, what we must do—Opposition Members refuse to accept this—is support the NHS in making decisions that are often difficult, to get better value for that money, to release the savings that it needs to pay for more speech and language therapists, for new drugs and for all the other services that need improving. The hon. Gentleman is not willing to accept that, any more than are other members of the Conservative party.

Andrew George (St. Ives) (LD): Although I do not doubt the Secretary of State’s sincerity, I hope that she will visit Cornwall to see for herself the impact of the reforms that she and others have been implementing in areas such as my constituency. Despite the protestations that her Department is not enforcing the diversion by local trusts of NHS resources into the private sector, is she aware that, in fact, patients who are facing unnecessary, enforced minimum waits, including waits of more than nine weeks for breast care at the moment, receive unsolicited calls from NHS managers inviting them to be seen sooner in the private sector? Will she come to Cornwall to see the results of those reforms and their impact on the financially hard-pressed service there at present? In fact, it is a financial mess. People are waiting unnecessarily and the money is going into the private sector instead.

Ms Hewitt: My hon. Friend the Under-Secretary of State for Health will indeed shortly visit Cornwall; I hope to do so in the near future. There are indeed some real challenges not only in the hon. Gentleman’s constituency, but across Cornwall, in ensuring that the enormous amounts of extra money that we have put into the NHS in his part of the country are used to the best possible effect to ensure that patients get the best and fastest care everywhere. However, the NHS in the south-west has made superb use of the independent sector—for instance, at the Shepton Mallet treatment centre—to speed up the treatment of patients who need orthopaedic operations and to do so in co-operation with the rest of the NHS in an integrated fashion.

Several hon. Members rose—

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Ms Hewitt: No, I am going to make some progress before I give way again.

Every debate about the NHS is important to all of us, but I was looking forward to this one with particular anticipation. This week, we have had the first sighting of a rare bird—Conservative policy on the NHS—but what a disappointment. What we heard from the hon. Member for South Cambridgeshire today and from the right hon. Member for Witney (Mr. Cameron) earlier this week was the mishmash of confusion and contradiction that we have come to expect from the modern Conservative party.

The leader of the Conservative party says that he will guarantee the NHS the money that it needs—a guarantee from the party that starved the NHS of funds for 18 years and a guarantee from the party and the leader who voted against the increased, record funding that we have put in? Conservative Members pretend, and they do so to NHS staff, that they can promise a blank cheque, but they also promised a new economic policy—a new fiscal rule, no less—that would mean £17 billion less for public services, including the NHS, this year. On top of that, their policy commission on taxation wants £90 billion of tax cuts. It does not begin to add up to a policy.

Charlotte Atkins (Staffordshire, Moorlands) (Lab): Hon. Members on both sides of the House are unanimous in praising NHS staff for their achievements, but are they unanimous in their views on funding “Agenda for Change”, particularly NHS staff pensions?

Ms Hewitt: My hon. Friend makes a very important point. Of course, what the hon. Member for South Cambridgeshire did not bother to mention, as he talked about NHS staff, was that he is against the agreement that we have just entered into on public service pensions. He is against it, just as he was against proper funding for “Agenda for Change”.

Geraldine Smith: Does my right hon. Friend agree that the British people might remember what the state of the NHS was before 1997, when people lay dying on trolleys in hospitals, when people sometimes had to wait five years for cataract surgery and many years for operations and when the Conservatives would not put the necessary resources into the health service? They are a disgrace and an embarrassment when they talk about the national health service.

Ms Hewitt: My hon. Friend is absolutely right, and the position is in fact even worse than she and I have described. The Conservatives now say that they want fair funding in the NHS—fairness from the Conservative party?

Mr. Crispin Blunt (Reigate) (Con): Will the Secretary of State give way on St. Helier?

Ms Hewitt: Not yet; in a moment.

I, too, have a copy of the Conservative party’s campaign pack. The Conservatives claim that

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They go on to complain that

Let me tell the House about some areas of Manchester—north Manchester, for instance, where a baby is twice as likely to be stillborn and 10 times more likely to die before the age of one as a baby in south-east Hertfordshire or South Cambridgeshire. [ Interruption. ] The hon. Member for Beverley and Holderness (Mr. Stuart), from a sedentary position, and the hon. Member for South Cambridgeshire complain that inequality in infant mortality is widening, but they want to take the money away from areas where infant mortality is worst —[ Interruption ]—north Manchester, where an adult is 50 per cent. more likely to die prematurely of cancer than one in St. Albans, South Cambridgeshire or south Oxfordshire.

In north Manchester, every GP has to look after about 2,500 patients; a GP in South Cambridgeshire has, on average, about half that number. That is why NHS funding this year is £1,600 per person in north Manchester and £1,000 per person in St. Albans, south-east Hertfordshire, South Cambridge and south Oxfordshire.

Several hon. Members rose—

Ms Hewitt: I shall give way to the hon. Member for Reigate (Mr. Blunt) on St. Helier; he has been very persistent.

Mr. Blunt: Since we were last here, the Secretary of State has had to reverse the quite disgraceful decision that she took on 19 December 2005, to overrule a consultation that had the full support of the local medical community to build a new hospital at Sutton, not at St. Helier, and to site the thing at St. Helier, at the request of the hon. Member for Mitcham and Morden (Siobhain McDonagh). The Secretary of State was then taken to judicial review by Reigate and Banstead council and Surrey county council. The case would have gone to court in about a month’s time; but, in August, she gave in. Will she repay the costs of the legal action that had to be taken, because her action was so unreasonable, to Reigate and Banstead council and Surrey county council?

Ms Hewitt: My decision was made precisely on the grounds of health inequalities and fairness, in which the hon. Gentleman and the Conservative party simply are not interested. The reason why things have moved on is that, unfortunately, the financial situation in south London, in that part of the NHS, is worse than those involved believed it to be when they came up with the plan for a new hospital. It is, I am afraid, no longer clear that the proposal for a new critical care hospital and nine new community hospitals is affordable in the way that the local NHS originally planned it. It therefore makes sense to look afresh at that model of care—which, in principle, is the right one—to ensure that it is affordable before any further decisions or arguments take place about where the hospital is sited.

Several hon. Members rose—

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Ms Hewitt: I will give way to my hon. Friend the Member for Warrington, North (Helen Jones).

Helen Jones (Warrington, North) (Lab): May I suggest that my right hon. Friend has omitted another strand of Tory party policy that is very clear? The Leader of the Opposition made it clear on “Any Questions?” in 2001 that he did not want to fund the NHS in the same way that it is funded now. He said that we should have more social insurance schemes, and he has never resiled from that comment. What effect does my right hon. Friend believe that that policy would have on our most deprived areas?

Ms Hewitt: My hon. Friend is absolutely right about the views of the right hon. Member for Witney. Indeed, let us remember that only last year he wrote the Conservative party manifesto that proposed to take millions of pounds out of the NHS for everybody and put it into subsidising private care for a few. That is what the Conservative party means by fairness.

Several hon. Members rose—

Ms Hewitt: No, I want to make some progress.

Conservative Members and the Conservative party refuse to accept that overspending has to be put right where it has taken place. They refuse to accept that it is wrong that a minority of hospitals and other organisations have overspent—some of them, I am afraid, for many years—at the expense of the majority who have been in balance or in surplus. Conservative Members have a simple solution to the overspending that has taken place in Bedfordshire and Hertfordshire even though the hon. Member for South Cambridgeshire did not come clean about it today. They want to take the money away from north Manchester and all the other parts of the country with the worst health needs and the worst health inequalities.

Mr. Mark Prisk (Hertford and Stortford) (Con): What does the Secretary of State say to the excellent staff at the QEII hospital? Two weeks ago, she met the senior management in Bedfordshire and Hertfordshire and two senior clinicians have now told me that she made it perfectly clear that the QEII will go, Hemel will go and our new hospital at Hatfield will go. Will she now put it on record that that is not her view and that that will not be the end result? The irony is that the end result would be one hospital in Stevenage, which is Labour, and one hospital in Watford, which is Labour.

Ms Hewitt: The hon. Gentleman should know because everybody who has looked at this—

Mr. Prisk: Are they safe?

Ms Hewitt: Just let me answer— [Interruption.]

Mr. Deputy Speaker (Sir Michael Lord): Order. The hon. Gentleman has asked a question and the least that he can do is let the Secretary of State answer.

Ms Hewitt: I am most grateful to you, Mr. Deputy Speaker. The hon. Gentleman should know—everybody in the NHS in Hertfordshire who has looked
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at the issue knows—that there needs to be a reorganisation of hospital services in that county. There needs to be a reorganisation of hospital services in order to keep up with modern medicine, to give patients better and safer care and to ensure that Hertfordshire does not go on overspending at the expense of other parts of the country that are far worse off. Those decisions will be made only after full and proper consultation with his constituents and everybody else in Hertfordshire and they will be made on the basis of what is clinically right for patients and not on the basis of party politics of any kind.

Barbara Keeley (Worsley) (Lab): Conservative Members might have understood the issue of health inequalities a little better if they had bothered to turn up to the excellent event put on by the Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint). It gave profiles for areas so that I and my hon. Friend the Member for Wigan (Mr. Turner)—we were the only two Members there—understood that Salford and Wigan, which are the areas closest to us, had very severe health inequalities and health needs. Does my right hon. Friend agree that given the resources that were needed to put on that event, it was a pity that Conservative Members, who do not understand the issue, did not bother to turn up?

Ms Hewitt: I absolutely agree. The Conservative party’s policy of taking from the poor and giving to the rich, which is precisely what they are campaigning for, just shows that it has not changed an inch.

Dr. Stoate: Conservative Members are missing the point of what patients want. Patients want three things: they want greater preventive services, they want services nearer to the community in which they live and, when they need expensive, high-tech services, they want them quickly and efficiently. What they want as the result of the new GP contract is to have more pharmacists and GPs working together to provide far more screening, far more care closer to home and far more preventive medicine with greater use of statins and ACE inhibitors. All that reduces the need for people to go to hospital at all and that is what patients are calling for—greater prevention, more care in the community and, when they need high-tech care, that care being available swiftly and in a centre that has all the expertise that it needs.

Ms Hewitt: My hon. Friend is a GP and serves on the Health Committee and he is absolutely right. The contradictions that we have been pointing out in Conservative health policy do not end there.

Mr. Lansley: The Secretary of State is not addressing the questions in the debate, but the issue is simple and we take exactly the same view as the NHS Confederation. Resources that are being allocated across the country to deal with health inequalities and that should be directed towards public health measures should be in separate budgets from resources allocated in relation to the burden of disease in an area in order to ensure that there is equitable access to care.

The principles that we set out on Monday are very clear and involve equitable access to service delivery so
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that we do not arrive at the position—it happens now—whereby I can stand in the stroke ward in Luton and Dunstable hospital and be told that there are two kinds of discharge arrangements. The first is for patients going to Luton, where the PCT has enough money to provide follow-up and rehab, and the other is for Bedfordshire Heartlands, which is in deficit and cannot provide those services. That is not fair to patients.

Ms Hewitt: It is not fair to patients, but the answer is not to take money from the poorest areas with the worst problems and to give it to Bedfordshire, which has been overspending. The answer is to reorganise services in Bedfordshire. I spent a day a couple of weeks ago with community matrons in Bedford and they support patients with long-term conditions in their own homes and that slashes the need for those patients to go into emergency care. That is the kind of change that we want to lead.

Several hon. Members rose—

Ms Hewitt: I will not give way, as I want to make progress.

The Conservative party has told us this week that it wants an independent commissioning board completely free to decide where patients should be treated, but it opposes any change in NHS provision, including, it appears from one Conservative Member, the involvement of Age Concern in providing some services. It says that it wants to put decisions in the hands of NHS professionals but, every time the local NHS proposes to make a change in the organisation of services, members of the Conservative party are out marching in the streets to oppose it. They protest—they have been doing it again this afternoon—against every closure of a community hospital.

Conservative Members should go to Norwich and talk to Tony Hadley, the brilliant nurse manager whom I met recently who worked with his nursing and community team to reorganise community hospital services. They cut the number of community hospital beds, they closed some wards and closed two community hospitals and centralised them in a third. Conservative Members are out on the picket lines when anything like that is proposed in their constituencies, but what Tony Hadley and his team did in Norwich was to listen to patients who want to be cared for at home rather than in hospital and they put half the staff out of the community hospital and into the community itself. They doubled the number of patients that they could care for, they slashed the number of emergency admissions and they saved £1 million a year that can go into better care for other patients. The Conservative party has to decide whether it is for or against that.

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