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Mr. Graham Stuart:
I hope that the Secretary of State will recognise that no one on the Conservative Benches wishes to set community hospitals or other health services in aspic. We are perfectly happy to welcome change, but we do object to the cuts in local services that are precisely against the vision that she set out in January this year. That is what we are protesting
against, and it is the cuts right across the country that upset not just Conservative Members but, if she cares to look behind her, those on the Labour Benches as well.
Ms Hewitt: I am afraid that the hon. Gentleman is simply incoherent on this point. It is not possible to take advantage of all the changes in modern medicine that make it possible to take tests and treatments out of acute and community hospitals and into GP surgeries, health centres and patients’ own homes, which is where patients would rather be, without making difficult decisions about the numbers of beds, wards and cottage hospitals that we have. The hon. Gentleman and the Conservative party need to be willing, for once, to support the NHS in making difficult decisions that will improve care for patients.
Rob Marris: Does my right hon. Friend share my dismay at the fact that the hon. Member for South Cambridgeshire (Mr. Lansley) wants to stop the NHS being a political football, yet the Conservatives seem to be obsessed with the number of posts in the NHS rather than the quality and quantity of output? Does she agree that it is somewhat hypocritical of the Conservatives to bang on every year in Finance Bill debates about productivity in the NHS, but to criticise her all the time for trying to address some of those issues and the configuration and suitability of services?
Ms Hewitt: My hon. Friend is right. The Conservative party says one thing to one group and a completely different thing to a different group. Conservatives say that they are in favour of more health care close to people’s homes—we have just heard it again—but when emergency admissions are cut, as community staff are doing all around the country, when there is more day-case surgery, and some hospitals are not doing enough, and when the average length of stay is reduced, as all the best hospitals are doing, we do not need as many acute beds in some hospitals and we do not need as many staff in those hospitals. When a hospital makes such difficult decisions, and when it makes difficult decisions to bring the NHS back into financial balance instead of allowing the problems to build up over and again and to get worse and worse, the Conservative party completely refuses to support them.
Sandra Gidley (Romsey) (LD): We keep hearing the mantra that services are being reconfigured and moved into the community, which many would regard as quite a good thing, but will the Secretary of State explain why the Council of Deans and Heads of UK University Faculties for Nursing and Health Professions has stated that the cuts in training budgets have had a
“particularly severe effect in community nursing”?
If the Government are keen on realising what they state regularly, surely we should be increasing such budgets.
Ms Hewitt:
As the hon. Lady will know from the NHS work force figures, despite the fact that there has been a decrease, as the hon. Member for South Cambridgeshire was saying, in the number of health visitors, there has overall been a significant
increase—of about 27,000, I think—in the number of nurses working in the community. We should expect to see that trend continue. One thing that we need to do, which I have asked our chief nursing officer to take charge of, is to modernise nursing careers so that we can support more nurses in the community.
Paddy Tipping (Sherwood) (Lab): The Secretary of State has talked about change and difficult decisions. She knows the position in Nottingham well. She recently visited the new Nottingham University Hospitals NHS Trust and she knows that services are being reconfigured there, and it is difficult and painful. Does she accept that it takes time to make those changes and will she give the new trust time to put those changes into place?
Ms Hewitt: My hon. Friend makes an important point. As he says, I spent quite a lot of time recently with staff at Nottingham University Hospitals NHS Trust. It is indeed in a very difficult position, as is the partnership trust, as I know he will accept. The latter has massively improved services for mentally ill patients but has had over many years to give up some of its urgently needed funding to bail out the acute hospital. I have already asked the NHS in the east midlands to look at the length of time needed for the Nottingham acute trust to make the necessary changes.
Given that both my hon. Friend and the hon. Member for South Cambridgeshire have raised the issue of risk to significant numbers of jobs in some places, I draw the attention of the House to the fact that Mid Yorkshire Hospitals NHS Trust, for instance, which notified the Government of up to 400 jobs at risk—a matter of considerable concern and great anxiety for the staff—has in reality had to make only six staff compulsorily redundant. We would all wish that there had been none at all, but that is very different from the headlines.
Worcestershire Acute Hospitals NHS Trust identified that it needed to lose the equivalent of 670 jobs, including of course agency workers and so on. It notified the Department of Trade and Industry of 250 jobs at risk. It has made only 19 redundancies. We will support any staff member who loses their job or needs to move to a new one; none the less, those hospitals like every other have continued to reduce waiting times. It is essential—the hon. Member for South Cambridgeshire continues to refuse to accept this point—that hospitals continue to become more effective in their use of resources in order to give even better value for money, so that we can free up the money to pay for extra treatments and extra drugs for other staff to use.
Mr. Greg Hands (Hammersmith and Fulham) (Con): Two months ago, it was announced that Ravenscourt Park hospital in my constituency will close in November. It was opened only three years ago. The then Health Minister, the right hon. Member for Barrow and Furness (Mr. Hutton), said at the time:
“We have spent £10 million on improving Ravenscourt Park Hospital. When the NHS took over this hospital, it had 16 beds; now it has 106, and is treating upwards of 3,000 patients a year. That means improved quality of service for NHS patients, who are being treated in state of the art facilities. That is what investment and reform of the NHS is helping to bring about.”
Only three years later to the very month, the hospital is to close. Will the Secretary of State explain that, and will she be sending one of her Ministers to the closing ceremony next month and apologising?
Ms Hewitt: Ravenscourt Park hospital was an investment from the private sector. It went bankrupt—or pretty nearly so. We bought it for a very small amount of money and we did put some investment in it. It has treated a relatively small number of patients. I do not have the figures to hand, but it has never had anything like an acceptable level of bed use, because there are in fact enough beds and still some efficiency gains to be made in other hospitals that serve the hon. Gentleman’s constituents and other parts of west London. The Conservative party has clearly given up completely on economic stability and sound finances. I take an old-fashioned view of these matters: I believe in prudent use of public money. I believe that we hold taxpayers’ money in trust. I do not believe in keeping a hospital open if there are not enough patients to use it when they can be very well treated in other hospitals in that part of London.
Patrick Hall (Bedford) (Lab): From recently visiting Bedford hospital and talking to staff, my right hon. Friend will know that they and others in the community have concerns about what is called “reconfiguration”. Does she agree that the best thing to do in that circumstance is to wait for the proposals to be made by a strategic health authority and hospital trusts and others, so that people can then have a measured, informed, balanced debate about the future shape of health services? Did she notice that the hon. Member for South Cambridgeshire (Mr. Lansley) anticipated the outcome of the acute services review, the results of which have not yet been published, and is stirring up fears and unhappiness? That is not the way to improve the future of our health service. We should wait for the proposals and then have a proper debate about them.
Ms Hewitt: My hon. Friend is right. Having met him twice recently in Bedford, I compliment him on the fact that he is indeed trying to ensure that there is a measured debate involving clinicians as well as patients and the public on the best way of organising services for patients in his constituency and other parts of Bedfordshire. It is absurd and unfair to patients for people to be campaigning to save a hospital when there is no proposal to close it and there is to be no proposal to close it.
Dr. Nick Palmer (Broxtowe) (Lab): I concur with the point made by my hon. Friend the Member for Sherwood (Paddy Tipping). It is important in a difficult merger situation in Nottingham that we have time to ensure that the process is efficient and effective for patients. Does my right hon. Friend agree that Opposition parties’ campaigning on the structure of the NHS is unnecessarily alarming patients? Although it is entirely understandable that staff are worried over mergers, patient care is better than it has been for many years.
Ms Hewitt:
My hon. Friend is correct. The truth is that the Conservatives simply will not face up to any
difficult decisions. They want theirs to be the party of economic stability, but they pretend that the NHS can have a blank cheque and they promise their business friends a tax cut. They say that they support the staff, but they promise to scrap the agreement on public sector pensions and the hon. Member for South Cambridgeshire has the nerve to attack the new chief executive of the NHS, a distinguished public servant whose appointment has been welcomed across the NHS. They say that they want to devolve decision making to the front line, but they oppose the local NHS every time it makes a proposal to get better value for money and improve patient care. They say that they have been converted to the cause of fairness, but they want to rob the poorest communities in our country.
Grant Shapps (Welwyn Hatfield) (Con): Will the Secretary of State give way?
The Conservatives want to be all things to all people—old Tory, new Tory, left, right and centre Tory—but they are being found out, because the more the British people hear from the Conservative party, the more they see the contradictions, confusion and intellectual dishonesty, the more they realise that, try as the Tories might, they cannot take the con out of Conservative. That is why the British people will never trust the Conservative party with the NHS. I commend our amendment to the House.
2.1 pm
Steve Webb (Northavon) (LD): Let me join in the one note of consensus between the Government and Conservative Front Benchers by recognising and valuing the work that is done by almost 1.4 million people in the NHS. They are, rightly, the focus of today’s debate.
When we heard that the Conservatives proposed to spend a whole day talking about the NHS, we looked forward to seeing the motion for debate. We imagined—rather naively, I accept—that it might contain some answers. Given that, on Monday, the Conservative leader, the right hon. Member for Witney (Mr. Cameron), made a big speech about the NHS to tell us about his plans, I hoped that we would have the opportunity to see some more detail of those plans in the motion and to debate them. I was therefore startled to read the motion. I looked for something that was actually being called for, but first I found that the House “is alarmed” in line 2, “is deeply concerned” in line 3, “condemns” in line 4, “regrets” in line 5, and “further regrets” in line 7. We have to go to the penultimate line to find something that the Conservatives are calling for, which is “the potential” of health care staff to be used. I cannot disagree with that. We considered tabling an amendment that would simply add “and regrets the inability of Her Majesty’s official Opposition to have anything to say on the subject”, but, as a responsible and effective Opposition, we decided to table a substantive amendment.
Several hon. Members have waved around the “Stop Brown’s NHS Cuts” campaign document, which is being circulated widely. At the bottom of the page, we
have a picture of the Chancellor with his scissors out, but we have heard the Conservative leader say that he cannot guarantee that any of the cuts planned would not happen if he were in charge. The “Stop Brown’s NHS Cuts” campaign should therefore be called the “Stop some of the cuts, but we can’t tell you which ones” campaign. Something tells me that, in every locality where the Conservatives are campaigning against a cut, they will say that that cut is one that they would stop and it is one of the others that they might not.
Mr. Graham Stuart: As the hon. Gentleman is aware, the Conservative party, unlike his own, has a prospect of entering government, so it tends not to make promises on expenditure without being wholly sure of what it can do. However, every Conservative Member knows full well—I hope that he accepts this—that the financially driven changes and cuts in staff and services would not happen in an independent NHS, freed from the political interference and control of both the chairman of the Labour party and the Chancellor of the Exchequer.
Steve Webb: That is very interesting. If an independent NHS is central to fighting the cuts against which the Conservatives have started to campaign, why is it not mentioned in the motion? I just wondered.
The hon. Gentleman suggests that, if the Conservatives were in charge, we would not see “financially driven cuts”. I have to exempt him from blame, because he was not a Member of Parliament when the right hon. Member for Witney, now the leader of his party, opposed £8 billion for the NHS in the National Insurance Contributions Act 2002. I read the Conservative Q and A document on that subject, and this is what I found. The question asked is:
“Didn’t the Conservatives vote against every penny of the extra investment the Labour Government has put into the NHS?”
“This is just classic spin”.
Classic spin it may be, but I have here the Division lists from the Second Reading of the National Insurance Contributions Bill. The hon. Member for Buckingham (John Bercow) led for the Opposition in that debate, and he took an intervention from a little known Back Bencher representing Witney. That Back Bencher attacked the national insurance rise for the NHS, asking
“Has my hon. Friend calculated the effect of increased national insurance contributions on trying to hire badly needed staff in our hospitals?”
Whatever happened to him? The reply from the hon. Member for Buckingham was:
“the bull-headed and short-sighted policy on which the Government seem intent will make a difficult task much more difficult.”—[ Official Report, 13 May 2002; Vol. 385, c. 543.]
In other words, when it came to the crunch—when it came to putting their money where their mouth was—where were the Tories? In the opposing Lobby.
Were that an isolated incident, a one-off, I might forgive the Tories—I am a very forgiving chap. Unfortunately, however, they have form. I asked the House of Commons Library for figures on real spending on the NHS. I was only interested in what
had happened under Labour, but the Library staff inadvertently included on the chart the final year of Tory Government, which showed a real-terms cut. The last time the Tories controlled the purse strings, they cut NHS spending.
Mr. Stewart Jackson (Peterborough) (Con): I am glad that, true to form, the Liberal Democrats have not risen above the student union politics that we expect from them. As long as “discouraging intellectual argument” can fit on the back of a “Focus” leaflet, that is fine. The hon. Gentleman should know that, in fact, in the period between 1979 and 1997, under Conservative Governments, real capital expenditure on the NHS increased by 60 per cent. above the rate of inflation. I am happy to correct him.
Steve Webb: I am delighted to hear that. I wonder whether the hon. Gentleman can explain the following: if £8 billion of the approximately £80 billion currently being spent on the NHS is paid for by the 1p on national insurance contributions, which £8 billion does he think should not be being spent? A campaign against cuts is being run by a party that said that we should be spending 10 per cent. less than we are now. It is hard to reconcile those statements.
I would be prepared to forgive the Conservatives twice, in fact. I would forgive them real-terms cuts in the run-up to an election and I would forgive their later voting against the money. We therefore have to look at the manifesto on which every single Tory Member of Parliament was elected.
Mr. Stephen Dorrell (Charnwood) (Con): Will the hon. Gentleman give way?
Steve Webb: I shall in a moment—perhaps the right hon. Gentleman will be able to explain what his manifesto called for. For those who could afford from their own resources to buy their way out of the NHS, the manifesto called for a subsidy from the taxpayer to enable them to do so. That is at the core of the Tory vision of public services: not “excellence for the many”, but “enable the few to buy their way out.”
Mr. Dorrell: May I suggest to the hon. Gentleman, with respect, that he leave the Government’s propaganda to the Government? He is looking at the Division list on a national insurance tax increase and linking the £8 billion that was the result of that tax increase to increased NHS expenditure. That is the Government’s line, but it does not need to be the Lib Dems’. If he looks at the Budget for that year, he will find that the biggest single increase in public expenditure in the year in which that Bill raising the money to pay for it went through, was not for the national health service at all. The biggest single increase in public expenditure that year went into the social security budget, so why does the hon. Gentleman feel it necessary to accept the branding that the Chancellor of the Exchequer attached to a tax increase in order to make a spending increase on social security sound more acceptable by saying that it went into the national health service, when it did not?
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