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the problems of the NHS are not just about political interference. And it would be odd for politicians not to take an interest in an organisation spending almost £100 billion of tax payers money.
Autonomy and independence are more to do with the nature of relationships in the system than the structures. If the relationships are not clearly defined, then no amount of structural change will protect frontline organisations.
Mr. Kenneth Clarke: I thank the Secretary of State for trying to establish consensus, although the consensus was not thought to be so left wing when we were in office. If he is committing himself to competition, choice and the locally and clinically led development of the service, does he agree that much more autonomy and control need to be given to those GP practices that are keen to develop practice-based budgeting and commissioning, and that it is a mistake to leave all the power in the hands of the PCTs, especially at a time when most of them are struggling to set themselves up but wish to keep the power to commission to themselves?
Alan Johnson: I agree with the right hon. and learned Gentleman. The point is, as he said in his speech, that he believed the single tariff was a good idea. That is the big difference from the policy of GP fundholding, which led to constant haggling about prices and tariffs and took all the focus away from patient care. He ought to speak to the hon. Member for South Cambridgeshire because the same proposals are re-emerging in Conservative Front Benchers new policy proposals.
Conservative Front Benchers say that we should introduce price competition in the expectation that that would lower the cost of care. Professor Michael Porter, who is probably the world expert on these issues, disagrees with that with regard to care. I can see no way
in which the hon. Gentlemans proposals would not reintroduce something that the right hon. and learned Member for Rushcliffe and I agree should be consigned to the past.
Mr. Lansley: To avoid people being misled, let me say that our policy is clear: we accept the current payment by results tariff. However, as I have made clear, what we want to do is to allow that tariff progressively to become not just a uniform price, but a maximum price against which discounts are available. A GP budget holder exercising the sort of powers that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) mentioned would be free to purchase at the tariff, which is simple, or to negotiate discounts, or to negotiate improvements in quality.
Alan Johnson: I was just about right on that, then. The biggest effectthe single biggest advantageof the single tariff is that providers, including those in the private sector, compete on quality, not on cost.
I was interested when the Conservative party changed its logo to an oak tree, which is a deciduous tree, because the party sheds its policies regularly. I am talking not about the Conservatives in government, but about the Conservatives in opposition. The call for a grammar school in every town has been and gone, as has the patient passport. They were against tuition fees, but now favour them
Alan Johnson: The hon. Gentleman was not a Member of Parliament at the time. The explicit policy of the Conservative party in 2003 was to contract participation in higher education to 36 per cent. as a way to deal with the funding issue. The independent appeal panel in health was introduced by the previous Government, but the Conservatives now say that they would get rid of it.
The subject of diplomas and the education Bills brings me to the hon. Member for Surrey Heath. My right hon. Friend the Secretary of State for Children, Schools and Families was absolutely right when he talked about the progressives and the modernisers on the Opposition Benches. I see the hon. Member for Havant (Mr. Willetts) in his place; he is certainly one of them, and we had high hopes that the hon. Member for Surrey Heath would be as well. However, one cannot be a progressive on education and oppose the introduction of diplomas and the increase in the education-leaving age. We had high hopes that the hon. Member for Tatton (Mr. Osborne) would prove to be a progressive when only a couple of years ago he stated, unambiguously, that the Conservative partyhe was not speaking only for himselfsupported not only our proposal on diplomas, but Tomlinson, lock, stock and barrel. An amazing change of policy has occurred in only a couple of years.
The education-leaving age is the issue that will define education in the coming 20 or 30 years. Labour and the Conservatives have a shared ambition to raise participation to the highest possible level. Our ambition is to reach 90 per cent. participation by 2015. The Leitch report is saying that there are 3.2 million jobs that require no qualifications now, but there will be only 600,000 by 2020the number of vacancies in
our economy. We are expanding higher education. The hon. Member for Esher and Walton (Mr. Taylor) was wrong when he said that our policy is to get 50 per cent. of youngsters into university; in fact, it is to get 50 per cent. of 18 to 30-year-olds into higher education, a big chunk of which will be accounted for by vocational foundation degrees delivered in the workplace. My right hon. Friend the Secretary of State for Innovation, Universities and Skills is doing great work on following Leitch and increasing the number of people with level 4 qualifications.
On the one hand, a youngster in this world gets the message that it is really important to get qualifications and make the best of their education; on the other, they are able to disappear off the radar screen at 16. First, that tends to make GCSEs a school-leaving certificate and the whole education system becomes geared towards a certain proportion of children leaving school at 16. Secondly, it gives mixed messages to youngsters who should be given the clear message that previous Governments gaveand not just the 1918 Government. God, the Liberal party were in power then; that shows how long ago it was. That Government looked to raise the school leaving age, eventually to 18. The great coalition Government of the second world war, with Rab Butler as Secretary of State, said that we should move from a leaving age of 14 to one of 15 immediately, and then to one of 16that took too longand said that we should then move to 18, either full or part time. The proposal is that when youngsters get to the age of 16, they either have offers of an apprenticeship, or undertake in-work accredited training, or take diplomas, which are crucial to the diversity of routes that they can take, and have the opportunity to stay on at school, too. All that is crucial to the future of education.
Mr. Ian Taylor: I accept everything that the Secretary of State said about ambition, but as part of that ambition it is important to try to stress lifting the calibre and the ambitions of the children involved. In each area, it is important not to bring down the barriers to meet the average. There is a wonderful Matt cartoon in The Daily Telegraph that shows Captain Fantastic, about to perform in a circus ring, saying, I shall now attempt to fail a GCSE. We have to try to lift the barriers. What worries me about the Governments programme is that the challenge for excellence, which occurs at all levels and not just at grade A of A-level standard, is not understood.
Alan Johnson: I congratulate the hon. Member for Esher and Walton on a deeply interesting contribution. He made that point about the level of excellence, saying, Dont bring the level of excellence down in the pursuit of excellence. There is no one on the Front Bench or in the Government who would disagree with him. Howeverthis refers back to the argument on diplomaswhat we are saying is that despite previous attempts, we in this county never achieved a system which allowed the correct mixture of the theoretical and the practical. That was achieved in Germany just after the war, and we had high hopes of doing it in this country, but we never managed to do it. People who want to take a vocational route now are very much considered to be taking the second-class route; that is where the parity of esteem argument comes in.
On Tomlinsons radical proposals on diplomas, my hon. Friend the Member for Bury, North (Mr. Chaytor) was right about incorporating O-levelsI mean GCSEs; that shows how old I amand A-levels in diplomas, or having GCSEs and A-levels separately. They do not disappear. Tomlinson said that if we are really to crack the problem, we have to allow people to achieve their own level of excellenceit could be excellence in hairdressing or anything elseand to lift their self-esteem. Ensuring that good, high-quality English and maths skills for life are incorporated in that is what the diploma programme is all about.
Let me turn to the hon. Member for North Norfolk, who I thought managed to sound sanctimonious. I know that he will be deeply wounded by that. He made all the right points; indeed, I thought that he was quoting from my speech on health inequalities. He raised the issue of patients being empowered to speak for themselves, not least on subjects such as MRSA, and being able to tell the consultant, I didnt notice you wash your hands. He also mentioned the self-care issue that Wanless raisedall the right issues to pursue. However, he said it in a way that suggested that nothing at all had happened. He gave us a bit of cursory credit for the introduction of psychiatric therapies, which was revolutionary, but went on to say that we had done nothing on mental health.
I remind the hon. Gentleman, who I know would want the record corrected, that we launched a 10-year programme of reform on mental health in 1999the national service framework. Everyone in mental health to whom I speak says that it has been revolutionary. We put an extra £1.9 billion into mental health. There are now 700 new community mental health teams offering home treatment, early intervention or intensive support.
Since 1997, there have been increases in main staff groups, including 1,300 extra consultant psychiatristsup by 55 per cent.2,700 extra clinical psychologists, which is an increase of 69 per cent., and a 24 per cent. increase in mental health nurses. The national patient survey tells us that 77 per cent. of community patients rate care as very good. The World Health Organisation says that England has the best mental health services in the world, yet the hon. Member for North Norfolk says that we have done nothing on mental health. I have to say that I do not agree with him, as you probably noticed, Mr. Speaker.
My right hon. Friend the Member for Oxford, East (Mr. Smith) was right to say that the education and skills Bill is epoch-making. I agree with him, too, about the importance of the role of employers, including small employerswe must not forget that they sometimes introduce the most revolutionary practices, because they do not start with a set of inherited practicesand of further education colleges. I have already mentioned the right hon. and learned Member for Rushcliffe, but may I just tell him that the Government are committed to reform? He hinted at the involvement of the independent sector, and we have consistently said that we will use it when it helps us with capacity, when it is cost-effective and when it contributes to patient care. This is not some ideological experiment: the independent sector canand doesplay an enormous role in improving health care. We shall continue that reform. The only thing that we have saidand I very much doubt that this would be any different if it had been said two months ago, four
months ago or four weeks agois that we will not have a third wave of top-down independent sector treatment centres. We have had two centrally driven waves, but we are now taking a bottom-up approach. That is the only difference between us. Finally, we have introducedand we have to give these things grandiose namesworld-class commissioning, so that people know what to do with practice-based commissioning, which the right hon. and learned Gentleman rightly supported. It is one thing to say that we will give a practice a role in commissioning, but it is another thing to give it help and support, including from the private sector if it wants to use it, to deliver.
I congratulate my hon. Friend the Member for Huddersfield (Mr. Sheerman) on his first speech since becoming Chairman of the new Select Committee. He is not in his place, but earlier this year he introduced a private Members Bill to raise the education-leaving age, of which he is a long-time advocate. I am pleased that he is now chairing the Children, Schools and Families Committee. My hon. Friend the Member for Barnsley, Central (Mr. Illsley) spoke about the importance of the building schools for the future programme. I congratulate his local authority, first, on what it has done for education. It was one of the first local authorities to become involved in foundation trusts, and it has used BSF not just to build new schools but as a way of transforming education throughout Barnsley. Secondly, I congratulate it on its work on adult social care, as it is ahead of the game, given the revolutionary things that are going on in Barnsley. My hon. Friend pointed out, too, the importance of the education maintenance allowance. The hon. Member for Braintree (Mr. Newmark) intervened on him to say that it was not a factor, but the allowance has made the single biggest contribution to lifting the participation rate. It was right to introduce it, and its role should not be underestimated.
The hon. Member for Mid-Bedfordshire (Mrs. Dorries) has strong views on abortion. The Government have made it clear that they do not see a case for changing the law on abortion. I accept that an amendment may be tabled to the Human Fertilisation and Embryology Bill, but it will not be tabled by Government Ministers.
Ms Dari Taylor: On the human fertilisation and embryology Bill, will my right hon. Friend ensure that the House supports the commitment given by a previous Secretary of State for Health that couples who find it difficult to conceiveone in six couples in the community find it difficult to conceivewill benefit from the full NICE guidelines, which means that they will get three transfers of embryos, and not one? Some PCTs have no facilities at all. Will my right hon. Friend confirm that the situation will be clarified and that people desperately in need of NHS help will receive it?
I heard my right hon. Friend the Secretary of State for Children, Schools and Families, who opened the debate, speak about guaranteeing apprenticeships for all who want them. That is a great
idea. What mechanisms can the Government introduce to make sure that apprenticeships are available? I have come across cases where young people want apprenticeships but cannot find an employer with whom to do that apprenticeship.
Alan Johnson: The Bill will ensure that every youngster who is properly qualified and wants to do an apprenticeship has the right to an apprenticeship place. It shifts the whole basis on which apprenticeships are offered.
I congratulate the hon. Member for Beverley and Holderness (Mr. Stuart), who is not in his place, on getting almost everything wrong in his contribution. Incidentally, in an intervention he said the most delightful thing. He asked whether the Secretary of State would agree that there is an epidemic in sexual health. I wish there were an epidemic in sexual health. That would be wonderful. However, I hasten to add that there is not an epidemic in sexual disease. The hon. Gentleman said that productivity in the health service has fallen. It has not. He said that social mobility was getting worse. It is not. There is a long time lag on that, but the latest statistics show that the social class gap has stopped widening, which is an important precursor to narrowing it.
My hon. Friend the Member for Newcastle upon Tyne, North (Mr. Henderson) made a powerful speech and highlighted the importance of one-to-one tuition for youngsters from poorer backgrounds, as well as those from more prosperous backgrounds. It was an important contribution because raising the education-leaving age will not solve all the problems by itself. Introducing diplomas will not solve all the problems. The measures must be seen in the round, and must start with Sure Start for the youngest children and continue right the way through.
The hon. Member for Mid-Dorset and North Poole (Annette Brooke) made an interesting contribution, particularly on the need for therapeutic assistance for children. My right hon. Friend the Secretary of State for Children, Schools and Families and I will work together on childrens health on a Joint Committee to try and join services up in the way that the hon. Lady seeks. My hon. Friend the Member for Bury, North is a fellow member of the David Willetts appreciation society. The hon. Member for Havant was not in his place when my hon. Friend was eulogising his speech. I shall repeat it because I know that the hon. Member for Havant always likes to hear it. The hon. Gentleman said that selection does not spread advantage; it entrenches it. That is right, and my hon. Friend the Member for Bury, North was right to point that out.
I wish I could mention all the interesting contributions from my hon. Friend the Member for Gateshead, East and Washington, West (Mrs. Hodgson), the hon. Member for Wyre Forest (Dr. Taylor), who is, as always, knowledgeable on these issues, my hon. Friend the Member for City of Durham (Dr. Blackman-Woods), the hon. Members for Enfield, Southgate (Mr. Burrowes) and for Braintree, and my hon. Friend the Member for Stourbridge (Lynda Waltho).
Our vision is of health and education properly resourced, offering world-class services, with parents and patients fully empowered through voice and choice
to have a real impact on quality. Ten years on, it is a vision that retains hope and aspiration. I commend the Gracious Speech to the House.
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