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24 Jun 2008 : Column 241

I have mentioned salesmanship and smoke and mirrors, as well as the roadblock to reform. The right hon. Member for Witney (Mr. Cameron) has made empty promises on hospital closures, but the Liberal Democrat spokesperson, the hon. Member for North Norfolk (Norman Lamb), has already identified the problem: closures will be made without any political accountability, unlike at the moment. The Conservatives say that in effect there will be no local closures, but how on earth will the system be regulated when the service must modernise and new facilities, operation procedures and the like must be implemented— [ Interruption. ] The hon. Member for South Cambridgeshire is chuntering from a sedentary position, but he does not want to intervene.

The Conservatives would also put NHS finances at risk and, as I have said, finance has been a contention between the parties down the years. The right hon. Member for Witney is on record as saying that his party would allow hospitals to borrow against building and equipment, but that would put the financial stability of local hospitals at risk. Who would bail them out if they went wrong? Would they be allowed to close under the independent board? The Conservative party must explain to my constituents why such financial instability would exist.

I suspect that the reason why the Leader of the Opposition is considering the idea of local hospitals’ borrowing against their capital is that an element of central funding would be cut, so local hospitals would be required to consider raising their budgets. That policy would reduce central responsibility and create local responsibility, but run the risk of creating a postcode lottery and financial insecurity for local hospitals.

The final element of the roadblock to reform is that the Conservatives are against GP-led health centres. Again, if there was a 21st century, forward-looking Conservative programme, I cannot see why they would be against them. In my constituency, for example, there will be a GP-led health centre. It will not destabilise local GPs. That entirely new facility will be open from 8 am to 8 pm and will bring new doctors into the Wirral. My working constituents’ busy lives will be enhanced, as they will be able to choose between dropping in at the new centre when that is appropriate or convenient or going to see their own GP. That is a significant reform and improvement of the service in my constituency.

At the request of my colleague MPs on the Wirral, since 1997 I have had the lead responsibility for dealing with local NHS matters. For the past 11 years, I have been in constant touch with the PCT and all other health local providers in the area, and I should like to take this opportunity to review the improvements that have taken place.

The hon. Member for South Cambridgeshire said that the target-driven system left no room for innovation at a local level. That is utterly wrong, and completely outside my experience over the past 11 years. A few months ago, I visited the Wirral University Teaching Hospital NHS Foundation Trust. That is my local hospital, and I was shown an example of innovation—a new machine in the urology department that enables the consultant to look at prostate trouble using a laser, thus eradicating the need for invasive surgery or investigation. The procedure takes only about two hours, as opposed to the overnight stay that used to be required.

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The machine is one of only two in the area, and I am pleased that my constituents have access to such an innovation. The urology consultant had read about it on the internet and then had a word with the hospital’s chief executive and board of governors, who decided to buy it. That is a perfect example of how local innovation can make a new service available, and I simply do not understand how a system of targets designed to raise national standards and provide equity across the country can be said to be inimical to local innovation. Targets and local innovation can—and do—work side by side across the country.

I am delighted that the hon. Member for South Cambridgeshire mentioned Clatterbridge, a specialist cancer trust and a world-class oncology centre that provides excellent and timely treatment for people in the north-west and the Isle of Man. A recent Healthcare Commission described it as “excellent”, and Clatterbridge is a trust going forward into the 21st century.

Again, the hon. Gentleman says, almost as a scaremongering tactic, that somehow the NHS is sclerotic in terms of its innovation. That trust has taken the courageous decision to spend £15 million to £30 million over the next five years on a linear accelerator across the water in Liverpool; that is a huge investment for a relatively small trust. It is doing that to save patients the trouble of having to come across the Mersey for treatment. That decision was taken at a local level—not through some strategic health authority or diktat from Whitehall. It will immeasurably improve patients’ experiences. The families who come from Liverpool and points north of it will not have to travel so far.

Mr. Stephen O'Brien: I was interested to note that the hon. Gentleman holds an important leadership position across the Wirral in respect of all the hospitals. No doubt he has had the same conversations as I have had with the people at Clatterbridge, who also serve my constituents. One of their biggest problems relates to tertiary referral. Owing to the Government’s target regime, oncology centres are penalised because so many of the targets for which they are forced to try to qualify are so far outside their control, at the tertiary end of the process, that they find themselves struggling with financial penalties that they could do without.

Stephen Hesford: The hon. Gentleman has a point in that that was a problem historically. It is a perfectly serious point. When some of the targets were first introduced, they were clearly not designed for oncology trusts of that kind. They were designed more to relate to a district general hospital. There was some tension around that. I have investigated the matter on the centres’ behalf to some extent, and my understanding is that that tension is now more historic and that accommodation has been made for such trusts in respect of those targets.

The Minister of State, Department of Health (Mr. Ben Bradshaw) indicated assent.

Stephen Hesford: I see that the Minister is nodding; I think that I have described the up-to-date position. However, I acknowledge that there was a serious point to be made a few years ago.

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In a recent Healthcare Commission report, Cheshire and Wirral Partnership NHS Trust, the local mental health trust, was described as “excellent”; that trust is also innovating hugely in its outreach provision. Certainly the number of consultant psychiatrists that it has brought on board in the past five or six years has transformed its provision to my constituents and others in Cheshire and Merseyside.

The hon. Member for North Norfolk rightly pointed out that the NHS has not always got mental health services right. However, I can honestly say that Cheshire and Wirral Partnership is innovating and making good progress—

Mr. Lansley indicated dissent.

Stephen Hesford: The hon. Gentleman is shaking his head; perhaps he wants to intervene.

Mr. Lansley indicated dissent.

Stephen Hesford: He does not.

I have mentioned my local district general hospital in passing. Two things happened to it. Under the old system, it was a three-star hospital. It became a foundation hospital and is going from strength to strength, I am delighted to say. I do not recognise the stifling of innovation at a local level that has been mentioned. The institution that I have mentioned used to be the second largest non-teaching hospital in the country. It is now a teaching hospital because it was able to innovate with local universities to provide a £7 million education centre on the hospital campus. That decision was made locally by the hospital with the aim of upskilling its staff, and I welcome that.

The final local organisation that I want to mention is the Wirral primary care trust. I am proud to be able to say, as I have said in the House on a previous occasion, that my local PCT has been recognised for its innovations in the Wirral, not least on public health. Towards the end of last year, it was voted the best primary care organisation in the country for 2007-08.

It may be that those excellent, innovative organisations on the Wirral peninsula are unique. Of course I am proud of my constituency and proud of the Wirral, but I do not believe that that is the case—they are exemplars of what is going on around the country. It would be a huge coincidence if I just happened to be the lead MP for health in the Wirral and we had uniquely good health services. I would like to think that, but it is not so.

I pay tribute to the staff in my local health service, which is the second largest employer in the Wirral. Some of the local practices have been innovative in working with part-time workers, ensuring that public transport is available, and advancing green issues by making imaginative use of the local Sainsbury’s car park. Such arrangements have enabled staff and patients to use the hospital in different, innovative ways.

I am proud that the local NHS in my constituency is in such good shape for the future. I commend the work of this Government and look forward to working with my hon. Friends as we take matters forward for another 60 years.

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9.8 pm

Mr. Stephen Dorrell (Charnwood) (Con): I begin by congratulating my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on tabling the motion and on the tone in which he introduced it. The key point that he wanted to draw out—I wholeheartedly agree with him—is that the political fact in 2008, as opposed to 1946, is that the national health service is built on a political consensus that includes every single Member of this House from every party.

A key element of the background to my hon. Friend’s initiative in introducing the debate is that it is a relatively unusual experience over the 60 years of the NHS for a Conservative spokesman to be able to point to opinion polls saying that the Conservative party is the most trusted party on health policy issues. I congratulate him on achieving that as our health spokesman; I certainly never achieved it when I held that post some years ago. The important point is not to luxuriate in the fact that we are more trusted than the Government on health care, but to draw a political conclusion about the fact that Labour spokesmen go round the country saying that because the Conservative party voted against the national health service in 1946, it is somehow not committed to the principles of the health service—despite the fact that we have been responsible for it over 35 of its 60 years of history and have never taken action that undermined the principles of the health service.

I say to my hon. Friend the Member for South Cambridgeshire that the more often he can create opportunities for that argument to be developed, the more it suits our purpose, because it demonstrates that the arguments used by our political opponents cut no ice with the voters. The voters regard us as the more trusted party because they accept that there is no point of difference on the matter in the House of Commons. There is an all-party consensus on the principles of the national health service, and the true debate in politics is not who is committed to it and who is not, but who can deliver. On the 60th anniversary of the NHS, we should focus on that argument.

The charge against the Government is the one I mentioned during a brief intervention on my hon. Friend. The Government have hugely increased the budget of the national health service over the past 11 years. I applaud them for that—it is the right thing to have done—but they have not brought about the improvements in the delivery of health outcomes and health care that we should have expected for that scale of resource increase. One or two of our more partisan supporters say that all that money has been spent, but that there has been no improvement. That is not true. Of course there has been an improvement in the delivery of health care in Britain over the past 11 years, just as there was during the previous 49 years. A year-by-year improvement in the delivery of health care is the consistent story of the NHS since 1948.

If we are to be reflective on the 60th anniversary of the health service, what should disappoint us is that over the past 11 years there has been a huge increase in resources, but no improvement of performance commensurate with that increase. The question is, why is that true? Ironically, some analysis of the reasons for that failure is implicitly shared by those on the Opposition Front Bench and those on the Government Front Bench. If we look at what happened to health policy during the
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past 11 years, we see that the truth is that, in some important respects, it has gone round in a huge circle.

The neatest way of encapsulating that is to refer to a speech I heard made in the summer of 2006 by Paul Corrigan, the health adviser to the former Prime Minister, Tony Blair. He explained that as a result of the insights of Mr. Blair, a new idea had been introduced into the health service—commissioning. By empowering commissioners, we would introduce conditionality about the use of resources, and we would ensure better value in terms of efficiencies and health outcomes for the money provided by the taxpayer. I am afraid that when I heard that speech, I could not resist observing that its sentiments were precisely the same as those in the comments made by Professor Sir Donald Acheson, who was the chief medical officer when I first became a Health Minister in 1990 and my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) was Secretary of State for Health.

The truth is that we introduced what we called purchasing and it has now been relabelled commissioning. We introduced trusts; the hon. Member for Wirral, West (Stephen Hesford) referred to the importance of local decision making and trusts and I entirely agree. We introduced what we called GP fundholding, and the Government introduced practice-based commissioning. A gigantic circle has been drawn and the health service’s institutional framework today bears a sharp resemblance to the one that we left in 1997. The regret is that it has taken so much money and such a long time—wasted time and money—to get back to the point that we had reached in 1997, not in resources, for which I give the Government credit, but in their use and the management of health service institutions.

Several hon. Members rose

Mr. Dorrell: I am spoilt for choice, but I shall give way first to the Under-Secretary.

The Parliamentary Under-Secretary of State for Health (Ann Keen): Will the right hon. Gentleman comment on waiting lists? What was happening to waiting lists—for cancer, hip and heart operations—in 1997? People died on those waiting lists, as he knows.

Mr. Dorrell: I shall now inveigh against a slight conspiracy between Conservative and Labour Front Benchers. It suits both sides to say that the Government invented national targets for waiting times in 1997. That is untrue—they were invented by Virginia Bottomley before I became Secretary of State. Waiting times were reducing well before I became Secretary of State. They continued to decrease during my time in post and reduced further after 1997 as a result of national waiting time targets.

The point that my hon. Friend the Member for South Cambridgeshire makes about national targets, with which I wholeheartedly agree, is that they were introduced in the early 1990s to tackle precisely the problem to which the Under-Secretary referred. They were effective before 1997 and became more effective afterwards, but the commitment to national targets has now become obsessive, distorting the use of resources.

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Clive Efford: I accept that there is some cross-fertilisation of ideas about the future of the NHS. However, on commissioning, the right hon. Gentleman needs to explain how the choice in the manifesto on which he stood to allow patients to opt out of the NHS fits into the framework that he describes.

Mr. Dorrell: May we debate election manifestos for previous elections on another day?

I believe that targets are symptomatic of a deeper malaise, which has been the focus of some work that the Local Government Association initiated on a commission on which the hon. Member for Wyre Forest (Dr. Taylor) and I had the honour of serving. It examined the national-local balance in the NHS. I believe that the Government have got that wrong, and it is vital to tackle that as we look forward, beyond the 60th anniversary of the NHS.

The former Health Secretary described our current health system as being more centralised than Cuba. I used to say laughingly to my colleagues in the Division Lobby that I was the last manifestation on earth of Marxist-Leninist ideas. We were both saying the same thing in different ways: the culture of the NHS attributes too much authority and power to the centre and inadequate authority and influence to the local view. The result of that is the current debate on polyclinics. In some circumstances, they are a good idea. What is wrong is that Department insists that, because it is a good idea, everybody do it.

Ann Keen indicated dissent.

Mr. Dorrell: The Under-Secretary shakes her head but it is deeply imbued in the culture that, when a good idea is proposed, the immediate question follows, “Why can’t everybody have one?”

We need a stronger local influence in shaping the NHS around targets and polyclinics and dealing with one of the consequences of over-centralised health care provision: too much concentration on the issues that grab the headlines, acute medicine, and too little on community medicine, mental health—all the Cinderella services that always lose out when a high profile debate goes on in the national newspapers.

Of course there needs to be a national view in the national health service. When people observe differences in different parts of the country, they will ask why they exist and whether they should exist. However, I invite the House to recognise that one perverse consequence of an over-centralised culture is precisely those health inequalities in different parts of the country that the hon. Member for North Norfolk (Norman Lamb), the Liberal Democrats’ spokesman, referred to earlier.

We have an over-centralised culture that delivers, at the local level, an unacceptably wide variety of health outcomes. What my hon. Friend the Member for South Cambridgeshire is rightly seeking, and what we were arguing for through the Local Government Association commission, is to empower local people. If we do that, we will find, ironically, a greater similarity of outcomes, because by decentralising management we empower people to address the inadequacies of the health care delivery that they experience locally.

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As we look forward to the next 60 years of the health service, I hope that we can move on from silly arguments about who is committed to it. Over 60 years, we have all been committed to it, and we all remain committed to it. However, if we are going to deliver the objectives that our constituents have for it, we have to move away from a model of over-centralised management that has failed in all its other manifestations on earth, empower local people, local management and professionals, and learn to let go. By letting go of over-centralised controls, we will deliver better health outcomes and, ironically, a more common experience of health outcomes in different parts of the country.

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