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Those are weasel words from a Tory leader who says different things to different people and who will say anything at all if he thinks that it will please. He simply will not face up to the difficult policy challenges that confront our country. I have the clinical evidence in my hand and the right hon. Gentleman knows that it exists.

Mr. Lilley rose—

Ms Hewitt: Professor Sir George Alberti and Professor Roger Boyle—

Hon. Members: Give way.

Ms Hewitt: I will give way to the right hon. Gentleman.

Mr. Lilley: I am grateful to the Secretary of State for giving way. On the subject of weasel words, does she understand why Opposition Members sometimes find it difficult to put full credence in all the figures that she uses? That was illustrated yesterday, when she told my hon. Friend the Member for Bromsgrove (Miss Kirkbride), who asked about the recruitment of nurses from Africa, that, because of the Government’s uniquely ethical policy,

When I pointed out that the Government have issued 50,000 work permits for nurses from Africa since 2000, her defence was that it did not really count because they came in via agencies rather than directly to the NHS and that that was difficult to stop. Can she tell us what is uniquely ethical about circumventing one’s promises in that way and telling the House that we do not take nurses from Africa when we have given out 50,000 work permits? Why is that so difficult to stop when it is the Government who give out the work permits?

Ms Hewitt: The right hon. Gentleman should talk to Health Ministers in the Governments in Africa, with whom we have reached agreements on that very point. Let me also remind him that only last year we took nursing jobs off the skills shortage list in order to ensure that the jobs went to nurses here.

The point that I want to make about the clinical evidence for changes in services is that, as the hon. Member for South Cambridgeshire knows full well, in the case of the most serious emergencies—for instance,
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strokes and heart attacks—it is much better to bypass the local hospital and be taken straight to a specialist centre, where the specialist staff and equipment are ready 24 hours a day, seven days a week. Close to home wherever safely possible and in a specialist centre where necessary—that is what clinicians are telling us. If the NHS can do that, each year we can save 500 more lives, prevent another 1,000 heart attacks and support more than 1,000 stroke victims to regain their independence, rather than being condemned to lasting disability. That is the clinical evidence. Rather than giving us weasel words, the Conservative party should be supporting clinicians in making the case for change.

If we know that changing services will allow us to improve and save more lives, we would be betraying patients and the NHS if we refused to make those changes just because they were difficult. Leadership is about listening to clinicians, supporting them in making the case for change, involving local councillors and people in consultation, and then having the courage to back the NHS in making the right decision.

Mr. Lansley: The Secretary of State waved around Sir George Alberti’s document on emergency access. He has told colleagues in West Sussex that for an accident and emergency department to be maintained, it must have a catchment population—he used the curious term “drainage population”—of between 400,000 and 500,000 people. Does the Secretary of State think that that clinical view should be applied throughout the country—yes or no?

Ms Hewitt: Professor Alberti has said consistently that the most specialist services need a larger catchment area.

Mr. Lansley: Does the right hon. Lady agree with him?

Ms Hewitt: Of course I agree with him that for the most serious —[ Interruption. ] The hon. Gentleman was complaining earlier that he wanted better stroke services. He knows perfectly well that that means changes to local A and E departments and hospitals and some services moving from local A and E departments and hospitals to specialist centres. Of course I support Professor Sir George Alberti and Roger Boyle in arguing for precisely that, and that is what the hon. Gentleman should be doing, instead of organising a human chain to save a hospital that was never under the threat of closure and then telling the local newspaper that the right way forward for Hinchingbrooke hospital might be for its A and E department to deal with self-referrals and for the more serious cases to go somewhere else, such as Addenbrooke’s. His comments about Hinchingbrooke to his local paper are what he describes nationally as the closure of a local A and E department.

Mr. Lansley: Look, just for the sake of accuracy, let me say that a consultation is under way on Hinchingbrooke hospital—it is in my neighbouring constituency of Huntingdon, but it serves part of my constituency—and one of the options is the closure of the hospital.

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Ms Hewitt: The local primary care trust and the hospital have made it perfectly clear that the right way forward, in their judgment, is a reorganisation of services that the hon. Gentleman claims to support one minute, yet describes the next minute as an outrage and a closure.

For the past 10 years, we have had a Prime Minister who has had the courage to make difficult decisions and has never shied away from difficult arguments. We have had a Chancellor who has had the courage to take the difficult decision to increase national insurance contributions and give the NHS the money that it needed. It was this party that created the NHS, although the Conservatives voted against it, and it was this Government who saved the NHS from ruin 10 years ago and put in the funding, although the Tories voted against it. It is this Government who will go on listening to staff and, above all, patients. We will make changes when they need to be made and improve services that still need improvement. We will back the NHS and improve it so that it is the fairest and best service in the world.

5.24 pm

Norman Lamb (North Norfolk) (LD): The Liberal Democrats will support the motion this evening because of the palpable loss of confidence in the Secretary of State, especially with regard to her handling of the junior doctors shambles—a subject to which I shall return. However, to some extent the right hon. Lady is a sacrificial lamb —[ Interruption. ] I thought the House would like that. She is a sacrificial lamb for the failings of the Government’s stewardship of the national health service; others should take their share of the responsibility.

The extent to which confidence in this Government’s stewardship of the NHS has collapsed is remarkable. There has been record investment, which we supported, and some genuine progress has been made, yet both the public and health professionals have lost faith. Just this month, a “Newsnight” poll found that, in relation to the NHS, Labour was the least trusted party. The Liberal Democrats came top. [Hon. Members: “What a surprise.”] I acknowledge that straight away. It is remarkable that, despite the Labour party’s record of supporting the NHS over the years, it is now bottom in terms of public trust in handling the NHS. What has gone so badly wrong?

Plenty of people other than the Secretary of State ought to appear on the charge sheet—for a start, the Tories. When they were in government, there were years of chronic under-investment in the NHS. In 1997, when the Conservative party left government, investment in the NHS was 6.8 per cent. of gross domestic product— 33 per cent. less than the EU average. Given that we were spending a third less than the rest of Europe, it was no wonder that people had to wait interminably for operations. I remember people coming to see me who were waiting for hip and knee-joint operations, sometimes for three years from the first referral to the point at which they had their operation. That is not a world to which we want to return. It was no wonder that the infrastructure of the NHS—the buildings—was worn out and so much investment was needed. In addition, not enough doctors or nurses were being trained or employed in the NHS.

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The cumulative impact of that under-investment in the service that could be provided was massive. Let us compare our experience in the UK with that in the rest of Europe. In many countries elsewhere in Europe, waiting is simply not an issue. Never mind getting down to a maximum wait of 18 weeks next year; the fact is that people in many countries do not experience waits for operations. One has to take into account the massive head start that other countries have had because of their historically far higher funding for their health service than we have had in this country.

In 2002, this Parliament came to the point at which we decided whether to vote for increased investment in our NHS. Even after being turned out of government, the Conservatives voted against that increased investment. Had they had their way, cumulatively over the ensuing period we would have had £35 billion less to invest in the NHS. Just imagine the closure of hospitals that we would be experiencing without that money! At the last election, their plan was to drain money out of the NHS to subsidise private health care—that was stated in a manifesto drafted by the Conservative leader before he changed his mind. We need to remember that record of what the Conservatives did, both when they were in government and when we reached the point of voting on increased investment in the NHS.

Mr. Stephen Dorrell (Charnwood) (Con): In the spirit of setting the record straight, which is what the hon. Gentleman is trying to do, he might like to remember that although the 2002 tax increase was branded by the Chancellor as money required for the NHS, well over half of it was spent on the social security budget. The assertion made was simply untrue. The hon. Gentleman should not line up behind that party political slogan—it serves the Labour party’s interest, but I cannot see how it serves his party’s interest.

Norman Lamb: I thank the right hon. Gentleman for that intervention, but the simple fact is that there has been substantial increased investment in the NHS, which the Conservative party voted against. Whether or not part of that additional revenue was used for other means, it is still true that a substantial amount has gone into the NHS. We supported that and the Conservatives did not.

Mr. Dorrell: With great respect, the constant reassertion of something that is untrue does not make it true. It is absolutely right that we voted against the national insurance increase, but it is not true to say that we voted against increases in NHS expenditure. At the time, we made it crystal clear that we supported the increase in national health service expenditure.

Norman Lamb: The right hon. Gentleman has made his point, but the record speaks for itself.

Daniel Kawczynski (Shrewsbury and Atcham) (Con): Will the hon. Gentleman give way?

Norman Lamb: No, I will not give way on that point.

I now turn my attention to the Labour party, and the question of whether everything is the Secretary of State’s fault. She has been left to take the flak for a
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decade of missed opportunity, inconsistent policy and botched reform. The chickens have come home to roost, and it is on her watch that we are experiencing the effects of so much mismanagement over the past decade. Let us consider the record and the roles of previous Secretaries of State.

In 1997, the Labour manifesto specifically said that the Government would scrap the internal market; that was the commitment made, but there is now an internal market. There is a purchaser-provider split, and hospitals compete for patients. That flip-flop in policy direction is the responsibility of the Labour Government as a whole, not just the Secretary of State. As for the other institutional reforms that have taken place, there was the introduction of primary care groups, then the creation of primary care trusts, the scrapping of health authorities, the creation of strategic health authorities, and the merger of primary care trusts. There has been endless organisational change, and it has not all been in a consistent direction; there has been a flip-flopping from one approach to another at great cost, and with an enormous impact on the morale of the people working in the health service, including the doctors and nurses.

Andrew Stunell (Hazel Grove) (LD): Is my hon. Friend aware that health workers in my area were employed by three different trusts in three consecutive years? Despite all the contract rewriting costs and management change costs that went with that, their job did not change one little bit; it was all wasted investment.

Norman Lamb: I am very much aware of that. Every time there is a change of organisation, another group of people get early retirement packages and redundancy packages. The impact on morale is intense. Changes have just taken place in Norfolk, and I know lots of people who are still in temporary posts and are waiting to have new posts allocated to them. Change always affects morale, and because the changes have been so frequent the impact on the morale of patients, doctors, nurses and many other health professionals has been dramatic.

Botched reform has also hit the voice of the patient and the public in the NHS. The right hon. Member for Darlington (Mr. Milburn) was responsible for abolishing community health councils when he was Secretary of State. I have since heard it said that he had a particularly bad relationship with his local community health council. CHCs were abolished in 2002, and patient and public involvement forums were established after that, in 2003. Three years later, they were abolished, and the local involvement in health networks were created. That was another mess, and a botched reform that left all those involved with a sense of total frustration, including people who, as volunteers, were trying to make a contribution to improving our health service.

That same Secretary of State left another legacy: the current state of NHS IT. The hon. Member for Ellesmere Port and Neston (Andrew Miller) got very hot under the collar on that point, but it is as though he is living in a parallel universe, and is not aware of what doctors in the NHS are saying about “connecting for health”. Their view is very different from the rosy
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picture that he described. When a political commitment was made to “connecting for health”, no proper analysis was undertaken of the need for the system, or of whether financial benefits would outweigh the costs. That is the view of the Public Accounts Committee, and the majority of its members are from the Labour party. It took the view that there was no proper analysis.

The original budget was £2.3 billion, which will be exceeded. The PAC reckons that the costs range anywhere between £6.2 billion and £20 billion, compared with the original estimate of £2.3 billion. The project is therefore massively over budget and it is behind schedule, too. The PAC says that the highly controversial patient clinical records scheme is running two years behind schedule, with no indication of when that part of the project will be complete. If one talks to any group of doctors, whether they are GPs or hospital doctors, one is met by a chorus of groans—they are completely frustrated by “connecting for health” and the way in which it has been imposed from the centre. Again, that has impacted on morale.

Andrew Miller: May I commend to the hon. Gentleman a recent article in the British Medical Journal, which reported progress

Dr. Andrew Murrison (Westbury) (Con): “It says here.”

Andrew Miller: Yes, that is what it says in my notes. The article reports progress so far on the national programme, and it includes interviews with 25 senior managers and clinicians in four hospitals. May I point out to the hon. Gentleman that, contrary to what the hon. Member for South Cambridgeshire (Mr. Lansley) said, there are 4,594 live sites providing the electronic prescription service, which is a huge improvement? I accept that it is a complex programme and that there are frustrations, but it is an immensely successfully development. There is now 100 per cent. coverage by PACS—picture archiving and communications systems—in London.

Norman Lamb: I am grateful that the hon. Gentleman at least acknowledged that there have been frustrations. I repeat that if one talks to any group of doctors, they are enormously frustrated with the system and the way in which it has been imposed centrally. When I hear that there has never been a thorough system review to ensure that the people who are building it, the people who will use it, and the people who will purchase it share a common view, I am completely amazed. People involved in the project on the private sector side have complained that there has never been a thorough system review.

John Bercow: The hon. Gentleman has just highlighted an unwelcome imposition from the centre, and it would be fair to say that he—and there are such people in all parties in the House—subscribes to the doctrine of localism. May I, however, in all honesty, put it to him and to the Secretary of State that when we talk about services that will be provided to, and are needed by, only a small minority of people with very
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severe and sometimes complex needs, there is frequently a compelling case for a central pot of money, and even some central direction; otherwise, the vulnerable people to whom I referred earlier may simply fall through the net? That has happened under successive Governments, so does the hon. Gentleman agree that the review of specialised commissioning, although welcome, could perhaps have gone further and that the Secretary of State might usefully be persuaded to take another look at it?

Norman Lamb: That is a very opportune intervention and I entirely accept the point made by the hon. Gentleman. In any system that tries to decentralise control and accountability there should be a role for the centre, too. It is a national health service, after all, and those specialist areas are particularly important to ensure that there is coverage across the country. I therefore accept his point entirely.

Andrew Miller: May I follow up that point? The hon. Gentleman, who lives in Norfolk, will accept that if he were run over by the proverbial 73 bus tonight, in an ideal system the first responder would have access to his medical records, thus enabling instant blood matching. There are good clinical reasons for centralism. Of course, there is a dichotomy, but he will accept that in a well developed system that is the kind of progress that we would like to see.

Norman Lamb: I am told by doctors in accident and emergency departments that they follow protocols in those circumstances. If necessary, my notes could be e-mailed from another part of the country.

In 2000, we had the NHS plan, part of which was to create 100 new hospitals by 2010. That was a very ambitious programme, but it was to be funded using PFI—a massive, uncosted commitment that will drain the NHS of resources long into the future. It is mortgaging our future and putting the NHS in a straitjacket of serviced accommodation. At the very time when Ministers are telling us that we must be flexible, that we must adapt to changing methods of delivering health care, and that we must shift care away from acute hospitals to care for people closer to home, we are stuck with the centralised provision of highly expensive serviced accommodation.

Mr. Burns: Thanks to the help of the Prime Minister, the Minister of State, the hon. Member for Leigh (Andy Burnham), and others, my constituency is benefiting from a £143 million investment in new facilities and new build at Broomfield hospital. If the hon. Gentleman had been Secretary of State, would he have allowed that scheme to go ahead—yes or no?

Norman Lamb: My point is simply that we have relied entirely on PFI. The National Audit Office and the hon. Gentleman’s own party—

Mr. Burns: Answer the question.

Norman Lamb: I am not in a position to answer a question about one local hospital. Does the hon. Gentleman disagree with his own Front Benchers, who have also drawn attention to the cost of PFI? He seems to be in something of a muddle.

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