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Secondly, I very much agree with what has been said about macular degeneration. It is a real problem, and the fact that some PCTs ration treatments for it is a disgrace. We are talking not about a condition that
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causes minor discomfort but about an illness that affects a person’s sight—a faculty that is desperately important to everyone. Under no circumstances should PCTs try to save money in that way; indeed, almost any other health programme would provide a better vehicle for saving money.

We have very little time, so I shall make only two, connected points. First, there has obviously been the most astonishing turnaround in the NHS over recent years. It would be churlish and an example of bad faith to deny that—

Mr. Brian Binley (Northampton, South) (Con) indicated dissent.

Mr. Burns: Will the hon. Gentleman give way?

Mr. Davies: No, there is no time. I am sorry, but the hon. Gentleman must understand that.

The figures are amazing. There is no doubt that a lot of credit for that attaches to my right hon. Friend the Member for Leicester, West (Ms Hewitt), and I am very glad that my hon. Friend the Member for South Swindon (Anne Snelgrove) said what she did in that respect. It does not make much sense to talk about waiting lists: having 1.2 million people, say, wait a month for some form of elective treatment would be reasonable, in fact desirable, but it would be totally unacceptable to have 100,000 waiting for a year.

Instead, we must talk about average and maximum waiting times, They have been falling dramatically, and I hope that we will achieve the 18-week target this year. In addition, it is remarkable and very gratifying that we have achieved the target of ensuring that urgent cancer cases go from identification of symptoms and diagnosis to treatment in a maximum of two weeks. That is an absolutely vital achievement.

My second, related point, is that we would not have secured those improvements without targets. There is an enormous amount of confusion among my former hon. Friends in the Opposition about that. Indeed, it may be worse than confusion—perhaps there is an element of opportunism in their approach. At present, the Government are having a row with the health service unions, so Opposition Members ask themselves why they should not curry some short-term favour with the unions by promising them something. It does not matter how irresponsible the promise might be, so why not promise to get rid of targets in the NHS?

I am sorry to voice such suspicions, but that is the pattern of the Opposition’s behaviour over the past few months. It is deeply depressing, and needs to be exposed. Perhaps my exposure of their approach will make my former colleagues on the other side of the House think twice before they go in for a kind of politics that I deplore.

Mr. Burns: Will the hon. Gentleman give way?

Mr. Davies: Of course I cannot, as we do not have time. The hon. Gentleman must understand that.

It follows that we must be very cautious about getting rid of targets. There may be too many of them, and some of them may be the wrong ones, but the new Administration gives us a good opportunity to look
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through them again. All targets risk having perverse consequences: when they do, they should be looked at again and either revised or strengthened. However, very stern measures should be taken when targets are abused.

One hears stories—I have no idea whether they are true—about accident and emergency departments keeping people in ambulances on the hospital forecourt so that they do not miss their four-hour target. People who do that are in breach of the fundamental Hippocratic principles according to which they are supposed to work. The whole point is that the spirit of those principles is important, because it means that people in the medical profession should always put the patient’s interest first, maintain the highest standards of professional behaviour and be attached to medicine’s scientific principles. Those principles are non-negotiable. They are deeply ingrained in every self-respecting doctor or nurse, and anyone who abuses them in the way that I described should be sacked. It is as simple as that.

Nevertheless, I share the view that many hon. Members have set out—that it would be splendid if we could provide a reasonable set of outcomes and outputs from the health service using only market disciplines—but that is never possible. Of course I want liberalisation of the supply side in health, especially in the secondary sector, and there is more that we can do to bring in the private sector in certain circumstances. The competition in central London between large general hospitals is a good thing and should be encouraged.

Of course we want patient choice too, but it is utterly delusory to think that the health service could be run according to market principles and mechanisms alone and still do the job for the country that it was designed to do in 1948—and which I hope it will continue to do for at least another 60 years, or even longer.

Mr. Stephen O'Brien (Eddisbury) (Con): Will the hon. Gentleman give way?

Mr. Davies: I am sorry, I have no time. The hon. Gentleman will have his chance in a moment. I always give way with pleasure in this House— [ Interruption. ]

Mr. Deputy Speaker: Order. The hon. Gentleman has indicated that he will not give way at this stage.

Mr. Davies: The Opposition are merely attempting to disrupt my speech, Mr. Deputy Speaker. Their actions are childish, given that there is an agreement between the Whips that we should all try to limit our remarks so as to get as many people in as possible. I certainly intend to observe that request.

Where possible, I want the amount of competition and patient choice to be increased substantially, but there can never be redundancy, duplication or competition in disciplines such as neurosurgery, intensive care or ophthalmic surgery, for example. We have a choice with them, and one option would be to leave the producers to deliver what they want when and how they want, but that is never acceptable. If health producers are subject to no discipline or no counterbalance to their own
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inclinations, it is tantamount to our saying that we cannot influence the monopoly, which must be left to deliver whatever it wants to deliver. To say that would be an abdication of the responsibility that Parliament assumed when the National Health Service Act 1946 came into force in 1948. It is a hopeless way forward, and I am very sorry that my former hon. Friends in the Opposition have gone down that road, possibly for totally the wrong reasons.

I want to give the House another example. The Medical Training Application Service was a debacle because there was too much producer orientation. Ministers set up a quango and then declined to second-guess its results. I understand that it is difficult for a Minister to second-guess senior consultants and the people running the royal colleges, but it is clear in retrospect that that is what should have happened. Unfortunately, however, the senior doctors were influenced by their own interests: they thought that spending so much time interviewing junior doctors was boring, and that it would be a thoroughly good thing to allow a computer to do all that. That is an example of how producer orientation and monopoly power can go wrong—in medicine, as in other areas of human activity.

We set up the health service, and we in this House are proud if it. We have the responsibility to make sure that it produces the outcomes and outputs that the public demand and require, which means that rules and targets must continue to be imposed from the centre.

6.58 pm

Mr. Graham Stuart (Beverley and Holderness) (Con): It is interesting to find myself following the hon. Member for Grantham and Stamford (Mr. Davies), especially given that, in his election address of just two years ago, he said:

The hon. Gentleman’s new friends may be interested to hear all that, but my hon. Friends and I know that personal slights and slighted vanity count for more with him than does fighting for the NHS. That is the central priority of the Conservative party, under its current excellent leadership.

Mr. Burns: Does my hon. Friend agree that the election address to which he referred has more to say? It goes on:

Mr. Stuart: I think that we have dealt with the hon. Gentleman fully.

Like many other hon. Members I should like to welcome the new health ministerial team. Before today, I thought that the new Health Secretary and his Ministers would offer new hope to the Department—at least compared with their predecessors, who left NHS staff and patients both demoralised and discontented. I hope that Ministers will learn from that history and perhaps show greater humility, given the recent record, than the Secretary of State showed today. He said that
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the former Secretary of State carried more political nous or ability than I had in the end of my finger. That is about my assessment: I think that she has got more ability than I have in the end of my small finger.

The hon. Member for Wakefield (Mary Creagh) said that we needed targets. She is absolutely wedded to targets. I am glad to say that the Secretary of State has taken a lesson from the consistent, hard-working and excellent Conservative Front-Bench team on the need to get rid of targets and has said that he will move away from targets. The hon. Member for Wakefield may resist that, but I am glad that there was one bright spark in the speech of the new Secretary of State.

In the few minutes that I have, I want to talk about community hospitals. When I came to this place, I found that hon. Members across the House had problems with community hospitals. I see some of them here this evening on the Labour Benches. Vital services were threatened with cuts or closure, so in November 2005 I formed community hospitals acting nationally together—CHANT—a cross-party group supported by Liberal Democrat, Labour, Conservative and Independent Members and patrons from both Houses of Parliament. I am not sure whether the hon. Member for Grantham and Stamford is a supporter or not. CHANT has fought to raise the issue of community hospitals in this House. We were delighted by the Government’s White Paper, which suggested that at last community hospitals were going to be saved.

When CHANT was established in November 2005, about 80 community hospitals were threatened with cuts or closure. That number, according to the Community Hospitals Association, is now more than 166. Across the country, especially in rural communities, we have seen services cut. In my local area, we have seen the 24-hour minor injuries unit service at Withernsea hospital cut to day times only. We have seen constant battles by the whole community, on a cross-party basis, as my hon. Friends, who have not been seeking to make partisan points, have pointed out. Proposals were put forward at one stage to close every bed in Hornsea cottage hospital on some spurious urgency grounds. That had to be resisted by the threat of going to court, which led to the trust backing down.

Then the primary care trust came forward with proposals that would have seen every NHS bed closed in my constituency—beds in Withernsea, which is a highly deprived, isolated community, Hornsea and Beverley as well as Driffield. The plan was that the only NHS beds to replace those closed beds would be in Goole and Bridlington—a four-hour round trip. Who knows how long it would take by public transport for the typical elderly patient and their spouse if they had to get to those hospitals? The community came together as one. The one benefit of the consultation was the way in which it brought the community together. They were united in opposition to the plan, as people have been in so many other parts of the country.

In fact, 3,500 submissions were made to the PCT. It was overwhelmed and had to delay its response. Tens of thousands of people signed petitions. I am pleased to say that every Member of Parliament in the East Riding of Yorkshire and the leaders of the Labour party, the Liberal Democrats, the Independents and the
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Conservatives on East Riding of Yorkshire council jointly signed a letter to the PCT board saying that it must stop the attack on vital services. I am pleased to relate that that did have an impact, such was the opposition. The trust has recognised the need to maintain beds in Beverley, which is a major step forward, and Withernsea. It has not saved any beds in Hornsea, although I hope still that there will be an opportunity for us to keep some beds in what I believe is the largest town in England that does not have an A road to it. It has B roads, which are all too often blocked by traffic in the summer. Local people need local services in that sparsely populated rural community. They should not be judged on the same basis as a unit in the centre of a city.

I congratulate the whole community, the newspapers, and the television stations. The Hull Daily Mail, the Holderness Gazette and the Beverley Guardian worked on the campaign. Political parties, voluntary groups and others came together and fought the decision, and the PCT was made to listen. However, we are losing beds in Hornsea and there is a pattern of such closures across the country. I hope that the new ministerial team will look again at the White Paper and send out messages from the centre that community hospitals will be supported.

There has been chaos in the way in which the Department has responded. Fortunately, there was a major effort in the House to put pressure on Ministers in the previous Administration. There was a response last summer from the previous Secretary of State; she announced £750 million of capital funding for community hospitals. That was supposed to be a five-year programme. Perhaps I may ask the new Minister of State to investigate the programme. My PCT was told by the strategic health authority with only a few weeks’ notice that it had to pull forward and get its bids in by the end of June—now postponed to the end of July. Yet it was supposed to be a five-year programme with full consultation. I ask the Minister to look again at community hospitals and ensure that the vision laid out in the White Paper, which had support across the House, can be delivered on the ground. Too often, Government rhetoric has not been matched by the reality that local constituents have had to put up with.

7.6 pm

Dr. Richard Taylor (Wyre Forest) (Ind): I have four minutes to bring to the attention of the new Ministers, whom I welcome, some practical suggestions. I have the amazing opportunity to bring together what the Secretary of State and the hon. Member for South Cambridgeshire (Mr. Lansley) said. The Secretary of State said that each patient must have a clear path to follow. The hon. Member for South Cambridgeshire pointed out the confusion about the path to follow for access to emergency care. That is what I want to talk about.

Ordinary patients have at least eight options for access to emergency care. They can dial 999; they can walk into an A and E department, a minor injuries unit or a walk-in centre; they can contact their GP if it is during the one third of the week when he or she is on duty; they can telephone the GP out-of-hours service; they can phone NHS Direct; or they can drop into a
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primary care out-of-hours centre. People are confused. Emergency access has to be clarified, and it is easy to clarify it. There must be just two options—go to the A and E if there happens to be one, or use a single telephone number.

If only the telephone triage service could be rationalised so that there was one number for everyone to phone across the country and a standardised triage system at the end of the phone, we would sort out the problems of access to emergency care in a moment. The huge point is that the Department of Health has the means to do that. I urge the Minister to look at NHS pathways, which has defined exactly the standard questionnaire that can sort out anybody. I tested it on a small boy who, sadly, died in my constituency as a result of inadequate triage. After about the fourth question, NHS pathways would have picked up the fact that the little boy needed to be admitted to hospital. I plead with Ministers to look at NHS pathways. It is being piloted in the north-east by the ambulance service there, which is to report in September 2007. It is being piloted in Croydon by the out-of-hours service, which is also to report in September 2007. The results are expected to show tremendous success and benefit.

I believe that NHS Direct should be limited to giving advice to patients about illnesses, and should not give advice on access to emergency care. Ministers should look at NHS pathways seriously to see why it cannot be rolled out to cover the whole country. It would have huge benefits, solve the problems with NHS Direct and release nurses to nurse, because the triage is so organised that it can be done by trained lay people. I urge the Minister to make it a high priority to create only two options for emergency care—A and E or a single phone number connected to NHS pathways.

7.10 pm

Mr. Stephen O'Brien (Eddisbury) (Con): I welcome the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw), to his new responsibilities and I look forward to our exchanges at the Dispatch Box. I am sure that he will soon realise that nothing is more important to our constituents than their security and their health, so, in view of the values of the doctors’ pledge—the Hippocratic oath—it is poignant that we are meeting as we learn of the doctor arrested in Brisbane, Australia, who had worked in a hospital in my home and constituency county, treating my constituents and those in neighbouring constituencies.

We have had a good, wide-ranging debate, throughout which Conservative Members have defended the NHS from the ravages and ramifications of the Government’s poor planning and the even worse implementation of their top-down targets. The Secretary of State, who has just returned to the Chamber, had a prize opportunity to steal our clothes, but instead he dug in and defended everything done by his predecessor, who of course paid the ultimate political price for just that.

As we have said before, we remain concerned that the Government’s basis for their NHS policy decisions is a desperate scrabble for cash rather than a focus on the health outcomes for the people of our country. The
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hard-working staff of the NHS, to whom we all pay tribute, deserve far greater support than they are receiving from the Government, so we have presented the new Prime Minister’s team with a copy of our “NHS Autonomy and Accountability” white paper. Although the Prime Minister seemed to distance himself from the idea of taking politics out of the NHS in the closing days of his non-campaign, at the weekend he told the News of the World that he would be pursuing our policy. Clearly, he has found “all the talents” for NHS policy in the Conservative white paper.

Ultimately, whatever specific issues we have debated today, the future of fair access to our NHS services lies in the autonomy of the NHS to make decisions based on clinical, not political, criteria, and its accountability to the House and to the public and patients who use it every day. The case was made fairly and forcefully by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), supported by an excellent and powerful speech from my hon. Friend the Member for Wellingborough (Mr. Bone). In addition, I pray in aid the following quotation:

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