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Mr. Lansley: Is the Secretary of State interested in history, as he seems to have glossed over the fact that since the 1950s, the year in which the largest reduction in NHS spending took place—a reduction of 2.9 per
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cent. in real terms—was 1977-78, under a Labour Government? Perhaps he will confirm that that is correct. Will he acknowledge that Governments both Labour and Conservative have sought to support the NHS, but that the year in which there was the least financial support for the NHS occurred under a Labour Government?

Alan Johnson: The Conservative party has tabled a motion saying that “all political parties” have supported the NHS. I am not dealing with the vagaries of finance; I am saying that the Conservatives opposed the NHS when it was founded, and came up with a plan to move to a national insurance system, which thankfully was scuppered, and that as recently as the last general election, every single Conservative Member stood on a manifesto that said that people could take money out of the NHS to go private. I point that out merely because of the terms of the motion.

The hon. Member for South Cambridgeshire has tried to put all that in the past, primarily to try to encourage the public to forget what the Tories did to the NHS when they were last in government. That was an era of 18-month and sometimes two-year waits for life-saving operations. It could take weeks to get a GP appointment. As the chief medical officer tells us, when he was working in the north-east an 81-year-old man wrote to him to ask whether he could bequeath his place on the waiting list for a cataract operation to his nephew, who was 60 and developing eye problems. That man had been on that waiting list for 11 years. Waits in accident and emergency were sometimes 24 hours, and infection rates in hospitals soared.

Such was the public anger that the debate was not always about how we could save the NHS, but about whether we should abandon it altogether. Now, thankfully, the debate is about how we take the NHS from good to great, and from world class in some aspects to world class in all. Here I come to my quibble with the Conservative motion. While it rightly mentions the need to focus on outcomes, as we are doing, it implies—this point was referred to by my right hon. Friend the Member for Enfield, North (Joan Ryan)—that targets have had no role to play in rescuing the NHS from years of neglect and underfunding.

Clive Efford: This is an area where the Tories have created more than a bit of confusion for me. Heaven forbid that we should ever have a Conservative in charge of the NHS again, but exactly what would a future Conservative Government be responsible for? Three issues have been raised—Chase Farm hospital, which was mentioned by my right hon. Friend the Member for Enfield, North (Joan Ryan), and two others, which were raised by Labour Back Benchers—on which local decisions were made to change the NHS to try to improve it and make it ready for the 21st century, but the hon. Member for South Cambridgeshire has prayed them in aid to attack the Government. There is localism and decisions are being made, but the hon. Gentleman brings them here to attack the Government. Exactly what would a Conservative Government do for the NHS, and who would be responsible for what?

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Alan Johnson: That is a very good question. [Interruption.] It is a very good question. Last week we had a debate on polyclinics. The argument about GP-led health centres— [Interruption.] I will say it in words of one syllable: we had a debate last week about health centres. We heard that the argument against putting GP-led health centres in every part of the country—open from 8 am to 8 pm, 365 days a year, with access for people whether they are registered or not; they can walk in—was that we were determining things from the centre.

When it was pointed out that in London the proposals for polyclinics had come from a consultation involving clinicians and the population, that was opposed. When it was pointed out that there were proposals for a further three centres in Hull, in my own constituency, that was opposed. My hon. Friend the Member for Eltham (Clive Efford) is right to be confused: the Conservatives oppose what is driven from the centre, and oppose what comes from the local level as well.

Mary Creagh (Wakefield) (Lab): Does my right hon. Friend agree that quality and dignity go hand in hand in the NHS, and that our target to ensure that all A and E patients are seen within four hours of entry to hospital is a massive improvement on patients spending the night on trolleys, as they used to in my local hospital, Pinderfields, 10 years ago? Does he also agree that the debate about targets and outcomes represents a semantic difference, and that we should all be working together to improve health care?

Alan Johnson: The public will be bemused by all this discussion about outcomes. They want to get through A and E in a reasonable time. They want not to wait years for an operation. Samia al Qadhi, chief executive of Breast Cancer Care, said this morning that targets had their uses. She certainly thinks that it is important that there are targets for the timing of cancer care in particular, not only because of the emotional distress of waiting for a diagnosis or for information, which should certainly not be underestimated as it is considerable, but because there is plenty of evidence that early diagnosis saves lives with breast cancer and other cancers. So there was no support there for this weird argument that we concentrate just on outcomes and there is no place for targets at all.

Barbara Keeley (Worsley) (Lab): I have referred to this before, but it is a key point about cervical cancer screening. We know we have a problem, which has developed more recently, with young women in their 20s and 30s falling away and not attending screening. There have been some wonderful initiatives, including one at Salford PCT, which has studied the process, worked with GPs and improved our uptake of screening in Salford by 7 per cent. It is true that we have to focus on process and on targets to achieve those different outcomes.

Alan Johnson: I saw what is happening in Salford when I was there a couple of weeks ago. When I went to King’s, I also saw how the areas of south-east London where the most deprived communities live are being targeted to ensure that they get the breast cancer screening programme to reach the parts of the community that are most difficult to reach. Those are very important local initiatives. We reject totally the Opposition proposal that we should abandon targets. In achieving reduced waiting times and in tackling health care acquired infections, they remain important.

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The transformation of the NHS is due to the hard work and dedication of its staff, but national targets, together with sustained growth in resources, delivered significant progress: better access, improved treatment in A and E, better treatment for cancer patients and significant reductions in mortality rates from the major killer diseases. From December, no patient will be waiting more than 18 weeks for an operation following referral to treatment.

I shall quote Professor John Appleby, chief economist— [Interruption.] I mean that no patient would wait that long apart from those who book an appointment but decide that they do not want to have their operation yet, and those who decide that they are going on holiday.

Mr. Lansley: It is quite important that we are clear about that. For example, the Government will say that nobody waits beyond four hours in A and E, but last year 129,000 people waited more than four hours. There is a tolerance. I understood that Ministers were proposing an 85 per cent. target for the 18-week referral to treatment, so hundreds of thousands of people will wait beyond 18 weeks.

Alan Johnson: Why did the hon. Gentleman have to intervene? I was just mentioning the tolerance: the figure is 10 per cent., so there is a 90 per cent. target because of the fact that there is a tolerance and— [Interruption.] The hon. Member for Guildford (Anne Milton) says from a sedentary position that I said “nobody”. Before the hon. Member for South Cambridgeshire intervened, I made it clear that there is a tolerance level, as there is for all targets.

Let me quote Professor John Appleby, chief economist at the King’s Fund:

His words:

That is from the independent King’s Fund. He continues by saying that

Patients do not want to see a return to perilous waiting times, and we will continue to be their advocates.

We are now coming through the necessary era of top-down targets, and are refining and improving how we measure performance. As my noble Friend Lord Darzi of Denham has made clear, quality must be the organising principle of the service. We have already proved by our actions our commitment to letting go from the centre. In 1999 we relinquished power to determine which new drugs and technologies the NHS should adopt, and put it in the hands of a new independent body, the National Institute for Health and Clinical Excellence. In the same year, we established the Healthcare Commission and the other commissions, making them responsible for setting standards, and inspecting and reporting on every hospital, mental health and social care provider in England—completely beyond the influence of politicians. Four years ago, we established NHS foundation trusts—independent of Whitehall, accountable to their members and making their own decisions on how best to serve their patients.

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The NHS is in rude health: we no longer debate its survival, but its continuing success. On Monday, we will publish our next stage review. From the NHS plan in 2000 right up to now, there has been consistency: first the resources; then the mechanisms for reform; and now a fundamental concentration on improving quality. A national, enabling framework will be driven by the local priorities set out by thousands of clinicians, patients and members of the public; they drove the process that set the direction of the health service in every region of the country. It was developed locally because local clinicians, patients and managers are best acquainted with the specifics of improving patient care, and are best equipped with the knowledge and ideas necessary to shape the future of the service.

Unlike the situation in 1948, we are no longer in the age of infectious and acute disease, but in the age of chronic and lifestyle disease. The burden of modern and future health care systems will be to support an ageing population, to help those with long-term conditions to manage their care better, to promote health and well-being so that we can ward off disease, and to keep up with the astonishing advances in medicine and technology. Only through universal health care, free at the point of need, can we make sure that all citizens benefit from those advances. Whereas our national health service makes screening and vaccination programmes available to all, an insurance-based system could use what we discover about disease to increase premiums. Under such a system, the scientific knowledge that could liberate a patient from the threat of disease and early death would instead remove their right to treatment.

At the beginning of the 21st century, therefore, the value of the NHS is even more important than at any time in the past 60 years. Only because of the attention and care that the Labour party has shown the NHS—running beyond a mere expression of support, welcome though that is—can we address the challenge of today’s health requirements. Massive increases in investment put us in touching distance of European spending levels. There have been huge gains in staff numbers—80,000 more nurses and 38,000 more doctors. Every week another new building to host primary and social care services opens, and 125 new hospitals will be open by 2010.

For today’s NHS, the way ahead is through a greater emphasis on prevention, personalisation, individual choice and easier access to even safer services. It is right that we pay tribute to the NHS as we approach its 60th anniversary. Nobody would claim that it is perfect, but it is deeply cherished by the British public because of its enduring values, and because it epitomises the social solidarity that is as important today as it was 60 years ago. I commend the amendment to the House.

8.13 pm

Norman Lamb (North Norfolk) (LD): I am pleased to join in celebrating the 60th anniversary of the NHS. It is right to acknowledge and express appreciation for the massive contribution of the staff in the NHS, from those at the bottom of the organisation to the most specialist clinicians. The motion also rightly identifies the role of volunteers and charitable organisations, which often work in partnership with the NHS. They play a vital role, and are often staffed by people who
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have had a particular experience, or whose loved ones have, and who demonstrate a real commitment to the care provided.

It is also right to acknowledge and celebrate the extraordinary founding principle of the NHS—that everyone, irrespective of income, should have the same access to care, based on need, not on ability to pay. As the other two Members who have spoken have acknowledged, it was a Liberal, William Beveridge, who laid the foundation stones of the NHS. It is a pity that the Liberal Democrats have not yet had the opportunity to administer the national health service, but one day our turn will come.

We should never be complacent about the future of the NHS, its safety and security. It could be undermined by two factors: first, funding levels; and secondly, the way in which the money is spent.

Back in 1997, at the end of the Conservative Government, this country was spending a third less than the average European spend on health. The consequences were there for all to see. Hospitals were decaying, and not enough doctors, nurses or other health professionals were being trained or recruited. There were real weaknesses. At the end of the Conservative years in government, whether we look at cancer, heart disease or stroke care, the outcomes—the issue on which the Conservative spokesman focused—for people in this country were poor compared with those in other European Union countries.

Today, a difference has been made to funding. This country now spends about £100 billion a year, which is a dramatic increase in investment in the health service. We supported that all the way through. We called for it in 1997, and when it came we supported it in votes in this Parliament. Given that funding has increased, however, we must ask, first, whether we are getting enough out of the investment, and secondly, how the NHS will cope with the challenges of the future.

As has been said, the current spend is at about the European average. Yet, as the Conservative spokesman has said, our outcomes still lag behind Europe’s on heart disease, cancer, stroke care—

Mr. Lansley: And lung disease.

Norman Lamb: Indeed.

This country has gross inequalities in health outcomes. That issue has not been focused on particularly in this debate, but we ought to focus on it. Health inequalities in this country continue to be completely unacceptable, and indicators suggest that they are getting worse, not better. I fully recognise that the causes of those inequalities are often well beyond the remit of the national health service, but the NHS has a role to play. Part of that role is to ensure equal access to health care, which we simply do not have at the moment, and that should be addressed. In some areas of health care, particularly those which are not subject to targets, access is still poor. I want to focus on mental health.

Under the Freedom of Information Act, we did a survey asking mental health trusts across the country how long people have to wait for access to cognitive behavioural therapy. In some parts of the country,
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people have to wait more than two years; in many areas, the wait is more than one year. Given the view of clinicians that outcomes improve significantly as a result of early access to such treatment, it remains a scandal that people are having to wait so long for something that could make a real difference to them. One of the themes on which I want my party to continue to focus is the inequality between the treatment of patients suffering from mental health problems and the treatment of those suffering from physical health problems. That disparity cannot be justified, and must be remedied.

In recent years, when trusts throughout the country got into financial difficulties and trusts were forced to deal with their balances, it was public health budgets that suffered, although they can do so much to prevent health problems from developing in the first place. The experiment that has taken place over the past decade, involving top-down command and control and big government, has clearly been found wanting. It has failed in so many respects.

We see gross waste and inefficiency, and a dependency culture in which no innovation takes place at local level because the Government dictate everything to primary care trusts and hospitals. We see funding that always has strings attached, because the Government know best how the money should be spent. We see micro-management from Whitehall: the Government tell every hospital in the country to undertake a deep clean, at vast expense. The clinicians tell us that that is not the best way to tackle hospital-acquired infections; but the Government know best. Then there is the debacle of the Medical Training Application Service— [Interruption.] Does the hon. Member for Cleethorpes (Shona McIsaac) wish to intervene? It appears that she does not.

I was talking about the MTAS debacle. The Government sought to impose an entirely new system for the recruitment and selection of junior doctors throughout the country without piloting it first to establish whether it would work, leaving chaos in its wake. Similarly, we have an IT system that has been imposed from the centre.

Sandra Gidley (Romsey) (LD): We do not have an IT system!

Norman Lamb: The crux of the problem is that, as my hon. Friend says, we do not have an IT system. It was a system designed in Whitehall, a political imperative. No cost-benefit analysis was undertaken. There was no proper review to ensure that people who were building the system, the people who were paying for it and the people who were using it understood the same thing. Nothing like that happened; all that was undertaken was a massive commitment to spend over very many years. What do we see now? We see the whole scheme running years behind schedule, according to the National Audit Office, and we see the total cost massively above budget.

We see polyclinics—sorry, GP-led health centres—being imposed on every primary care trust in the country. The Secretary of State sought to defend that, but it is indefensible. It is not sensible to tell every primary care trust that it must have a GP-led health centre and that contracts must be concluded before the end of this year. Again, that is dictating to the health service because of political priorities and political imperatives rather than sound clinical judgment.

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