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I accept that there is no shortage of resources. The tragedy is that the crisis has occurred after the Government have poured money into the NHS for the past 10 years. That is not a matter of pride. How can they have trebled the expenditure in cash terms and
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doubled it in real terms, but still need to sack staff or close hospitals all over the place because costs have not been controlled? The Government cannot answer that question.

Tom Levitt (High Peak) (Lab): I am grateful to the right hon. and learned Gentleman for reminding the House that we have trebled spending on the health service. Does he agree that in percentage terms this year’s deficit is less than it was for several years under the Tories?

Mr. Clarke: Well, I could retaliate with a list of the years in which we increased growth by 5 per cent. in real terms, but this is corny stuff. Expenditure on the health service has always gone up. We increased spending on health by 1 per cent. of GDP. Every developed country increases its spending on health care and, given today’s demography, will continue to do so. It is corny nonsense to say, “Aha, the Conservatives spent less than we did”.

I would point out that the rate of increase of recent years cannot be maintained. A fundamental spending review is on its way and it will be impossible to maintain 7 per cent. real-terms growth in health spending, without doing fantastic things to the budget of every other part of the public sector. The public spending review towards which the Government are just beginning painfully to creep cannot maintain that rate of growth. It will shrink, and the failure to tackle the present problems will produce more crises, unless the Government face up to the fact that they are going nowhere fast. They must face the fact that just spending money has not delivered what they wanted and expected.

Where has all the money gone? It has gone in costs, including—as it is bound to do in a health care system—payroll costs. Of course, there have been improvements. It would have been impossible to spend all that money without seeing some improvements, but the health service has always improved, year on year, ever since it was created. People cite the problems in 1997, but I say that they should have seen what it was like in 1979. Those are hopeless historic comparisons.

The health service has got better, but most of the money has gone on enormous payroll increases and pay rises for the staff, on a scale that has not been matched by increased activity. The productivity performance of the health service has, as everybody has pointed out, steadily deteriorated. If one thinks that the health service is important, that is no way to run it. Ministers take pride in the 300,000 extra staff employed in the NHS, but what do they cost?

Andy Burnham: Will the right hon. and learned Gentleman give way?

Mr. Clarke: No, as I am afraid that I have a time limit.

The NHS is the largest employer in western Europe, but Ministers must resist the temptation to make political claims about how many new jobs are being created. They must have regard to what the extra staff
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are being employed to do, whether they can be afforded, and how the system is being allowed to proceed.

In my day, pay negotiations were very difficult. Ministers of State used to have to get stuck in, because no one on either side of the House could be persuaded that the affordability of pay increases was something that had to be borne in mind. What has happened since then? The working time directive has been allowed to go through, and there has been a huge increase in the number of doctors. The 24-hour commitment of GPs has been abolished, and all nursing grades have been raised as a result of people writing their own descriptions of their responsibilities. Lots of other staff are now employed, and we have the best paid clinical professions in western Europe. I congratulate the BMA and the RCN: as usual, they have taken the Department of Health to the cleaners, but what were Ministers doing when all that was happening?

The NHS has no system of proper financial control. We all believe in a giant NHS run on principles that everyone accepts, but there must be a system of financial control. All other giant organisations—such as Marks and Spencer and BP, although they are smaller than the NHS—have that. I can think of no other business-like activity whose first thought is to cut back its service, or product. The health service goes running around closing wards because it cannot afford the staff to keep them open. It closes community hospitals and stops recruiting the necessary trainee staff, but none of those problems has been addressed.

Of course, those are not comfortable things for me to say. I might have to mute some of it at the next election, as the news that not all problems will be solved merely by getting rid of the present Government is not always welcome to a general audience. However, my hon. Friend the Member for South Cambridgeshire is trying to depoliticise and localise the argument, and that approach is absolutely essential.

The only way to manage the NHS is through more, and genuine, local budgeting and financial control. People will have to stick to their local budgets, but they will have discretion about how they spend the money. We are getting GP fundholders back, but I have yet to discover whether they will have real budgets and total discretion over where they spend their patients’ money in the service. All that has to be tackled, but what we do not need is more mad structural change all the time.

The Government have failed to manage the changes that their reforms require—of course the pattern of service has to change, but they are not even controlling the pace of change. It is crazy to go backwards and forwards on PCTs, commissioning, budgeting and so on, because that just demoralises the people who should control things. That is a failure on the Government’s part. They are in a crisis, and they need to start again and decide how they are going to reform the NHS.

3.3 pm

Mr. Neil Turner (Wigan) (Lab): I begin by declaring an interest, in that my wife is a member of the Wigan and Leigh hospital trust board. I am amazed at the brass neck displayed by Opposition Members in holding a debate on the NHS. They seem to forget
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some of the problems that existed in 1997. They do not like to hear what they were, but it is important to put what is happening in context.

I remember workers throughout the country holding a one-day strike to support nurses, who did not want to go on strike and therefore disrupt the services that they were providing. Other workers were prepared to give up a day’s work to support the nurses, to whom the then Conservative Government did not want to pay a proper wage.

I also recall the winter beds crises that arose year after year. Patients were forced to use trolleys in hospital corridors or were bused all over the country in ambulances. People were even treated in ambulances in those days, but such things do not happen now.

Two years was the norm for waiting lists throughout the country in 1997, but nowadays the maximum wait in Wigan in six months, and the vast majority of cases are dealt with in three months or less. I remember having to wait in an accident and emergency department in Wigan for more than eight hours before I was seen, but every patient is now dealt with inside a maximum of four hours.

All that represents a dramatic change from what was happening in 1997, and it would have been nice to hear an apology from Opposition Members for that. Given where the Leader of the Opposition was on Black Wednesday, I suppose we should expect him to say, “Je ne regrette rien.” However, instead of saying, “We regret nothing,” what we get is the Opposition saying, “We forget everything.” Well, neither I nor the people of Wigan have forgotten, and we will make sure that the people of Britain do not forget when the next election comes around.

What are the Opposition’s policies now? In 2005, as we have heard, we had the patient passport, which would have put wads of money into the private sector. In 2006, we have the Leader of the Opposition on his webcam telling us how good it is to wash up dishes, although I not sure what that says about him. The Conservative spokesperson on health says that his party does not want any more reorganisation, but that there will be a new organisation to reorganise things. He also says that there will be no more targets, but that his party will introduce protocols instead. The Opposition are all over the place: we have gone from flog it to blog it to blag it, but not one Conservative Member has shown any sign of embarrassment.

I want to tell the House what is happening in Wigan. The Wigan PCT and acute hospital trust covers Wigan and the constituencies of Makerfield and of Leigh, and parts of Worsley and West Lancashire. I am sure that my right hon. and hon. Friends who represent those areas—and they are friends as well as parliamentary colleagues—will not mind too much if I stray into their territories.

Since 1979, we have some 400 extra nurses and 100 extra doctors in Wigan. In the past two years, we have recruited 20 extra GPs, and 14 extra matrons are working in the community. Just as importantly, huge capital investment has been made. There are new maternity, neonatal and intensive care units at the Royal Albert and Edward infirmary, as well as a new X-ray department with a magnetic resonance imaging
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facility. The hospital has a new endoscopy unit, and extra beds. In case some of what I have listed does not work, the hospital also has a new mortuary.

At the Wrightington hospital in the Wigan area—where hip replacements were originally pioneered—there are two new clean-air orthopaedic clinics, while other wards have been refurbished and upgraded. Moreover, the Thomas Linacre centre is a brand-new outpatient facility in the centre of the town.

Over the recess, I visited the new cardiac catheter laboratory that has opened in the Royal Albert and Edward infirmary, and the new patients information centre at Wrightington. I also went to the renal unit opened under Wigan’s LIFT—local improvement finance trust——programme. Never has one so well gone to so many health units in so short a time.

Grant Shapps: We are all delighted for the hon. Gentleman’s constituents in Wigan, but how does he think that my constituents in Hertfordshire will feel? They were promised a hospital worth £500 million before the election, when a health Minister represented the seat that I now occupy, but the hospital has been withdrawn now that the election has passed. I understand the party political points that he makes, but how does he explain the fact that 18 years of so-called Tory cuts in the NHS meant that my constituency had the QE2 hospital, with accident and emergency, maternity, paediatric and other services? They have all been stripped away. The news is good for people who happen to live in Labour constituencies, but blooming bad for those who did not vote Labour. The Government’s policies are a punishment, are they not?

Tom Levitt: QED.

Mr. Turner: That is exactly my point: what happened in those 18 years is that we were not getting the service improvements that we needed, because you were gerrymandering so much of the money into your own areas. We have a new system now, in which money follows the needs of patients. What you have to ask your people—

Mr. Deputy Speaker: Order. I think that the hon. Gentleman knows what I was about to say.

Mr. Turner: I apologise, Mr. Deputy Speaker. The hon. Gentleman should ask why his PCT is getting more money than the formula prescribes. Why does it get extra money through the market forces factor, yet remain incapable of running its service properly? In contrast, my PCT is underfunded under the formula and gets less money through the market forces factor, yet is able to budget properly. Our PCT is three star, and we also have a three-star hospital. They keep to their budgets. If the hon. Gentleman cannot make sure that his PCT keeps to its budget, that is a matter for him.

The cardiac catheter laboratory makes sure that there is early diagnosis of heart trouble so that people can be treated and kept out of hospital. The patient information centre makes sure that patients who go for difficult operations understand what is going on. In that extremely anxious period, they will be given the kind of reassurances that they want. The renal unit
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means that, instead of patients trawling all over Greater Manchester looking for somewhere to have kidney dialysis, they can now have that treatment in the centre of Wigan. That takes an incredible amount of stress off not just the patient, but the families and friends who have to drive them there.

Those last points illustrate the huge changes that are being made and that need to be made if we are going to deliver health care properly in this country. I am talking about a massive shift from secondary to primary care. The Minister of State, Department of Health, my hon. Friend the Member for Leigh (Andy Burnham) will know of the doctors surgeries in two-ups and two-downs in Leigh, and up and down the Wigan area. They provided a poor service, not because the doctors were bad, but because the facilities were. In Wigan, we now have a refurbished clinic at Tyldesley and new clinics at Atherton, Ince, Worsley Mesnes, and Golborne. Platt Bridge is being built. Pemberton is being extended. More clinics are planned at Standish, Shevington, Whelley, Wigan, Ashton and Leigh—all with a huge range of facilities and with brand new treatments. What is the result of that? As I said, there is local delivery of renal care.

John Bercow: The hon. Gentleman is positively triumphalist about the position in Wigan, but how does he explain the contradiction between the fact of greatly increasing expenditure nation wide on the one hand and no comparable increase in national health service productivity on the other?

Mr. Turner: I am not a statistician, but I suspect that one of the problems is that if a lot of money is put into making sure that people do not get ill, the productivity end—that is to say, the measurement of how many people are treated and how they are treated—will be difficult, because the reality is that one makes sure that people do not get ill and that means that one is less productive. That is nonsense. There needs to be a way to look at the statistics to make sure that they properly reflect what is going in.

Mr. Nicholas Soames (Mid-Sussex) (Con): Jolly good try.

Mr. Turner: Thank you. I thought that it was fairly successful, as well.

Not only do we have renal units, but diabetes is being treated in the community. People who have heart disease are being treated in their own homes, although obviously not while they are having their operation—I would not suggest that for one minute. The post and pre-operative aspects are being dealt with in people’s own homes. Cancer therapy is being delivered at home. There are smoking cessation clinics in the clinics that I mentioned. In the case of dental treatment, there is an emergency line that operates 24/7 for the whole of the borough. That shows a shift from secondary care to primary care when dealing with health. It is not just a matter of some kind of organisational shift; it is what patients need and want, and what we are delivering.

I will finish—I am well aware that many people want to speak in the debate—by giving my constituents a
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strong warning. What we heard from a number of Members, and particularly the hon. Member for Northavon (Steve Webb) and others who talked about the campaign pack from the Conservatives, was that that pack provides a stark warning. The Conservatives will move resources from Wigan to Windsor, from South Kirklees to south Cambridgeshire, and from Leicester to Leominster—from places that need those resources, because health there is poorer, to places that do not need them, because health there is better. Resources will no longer be based on health needs. They will be gerrymandered yet again to Tory areas. If anybody in Wigan votes for the Conservative party at the next election, they should know what they are voting for.

3.14 pm

Mr. Stephen Dorrell (Charnwood) (Con): I want to respond briefly to the point with which the hon. Gentleman closed. It has been apparent several times in the course of the debate, listening to Members on the Front Bench, as well as the Back Benches, that the charge now being levelled against the announcements that were made by my right hon. Friend the Leader of the Opposition on Monday is that they represent at attempt to gerrymander resources. The truth is precisely the opposite. The announcements are a response to the Government’s gerrymandering of resources. We seek to set up an established authoritative body that can provide an independent assessment of where health resources ought to go. We want to do that in order to ensure that the national health service is in a position to deliver the objective that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) made clear is shared explicitly right across the House: we want to have a largely tax-funded health care system that is available to people on the basis on need—on the principle of equitable access to those who need it, without regard to ability to pay. Attempts by Labour Members to undermine, or eliminate, that political consensus across the House are doomed to fail. I want to return to some of those themes in a moment.

I congratulate my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on the fact that he has focused the debate on the key resource of the national health service. The message coming back right across the health service is that, although Ministers repeatedly say that the delivery of health care depends on the professionalism and commitment of health service staff, which we all know to be true, the message that is received by national health service staff themselves is that their professionalism and their commitment to the service is being systematically undervalued by the Government who are supposed to be their employer. Staff feel that their commitment is undervalued because—despite the huge increase in resources committed to the health service, which commands support right across the House—they find themselves in the too familiar situation of being caught up in the management of short-term crises that are repeating themselves right through the national health service. In any organisation, when people find themselves responding to firefighting initiatives and short-term crisis management measures, that undermines morale and that is precisely what is happening right through the national health service today.

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