---

Health and Education

When I was returned to Parliament a couple of weeks ago, I was, naturally, itching to scrutinise the Department for Work and Pensions for the seventh consecutive year, but the call came from my right hon. Friend the Member for Ross, Skye and Lochaber (Mr. Kennedy), who tempted me into the health sphere, and—kicking and screaming—I agreed to take on a new challenge. It is therefore my pleasure to take part for the first time as an MP in a major debate on health. I welcome the Secretary of State and her ministerial team to their roles or their new roles, as applicable. The House might not be aware that the right hon. Lady and I have some history—[Hon. Members: ““Oh?””]—and later I might tell hon. Members all about it. In fact, 10 to 15 years ago, she and I were fellow members of the commission on social justice. The humble secretary of that body is now the right hon. Member for South Shields (Mr. Miliband) and the Minister of Communities and Local Government, and its vice-chair is now the Secretary of State for Health, so I think I made some good connections. The right hon. Lady encouraged me to stand for Parliament in 1997, and because I owe her that, for the first week in my new role I have not gone in too hard. I was concerned about how quickly I was supposed to come up with expert opinions, but it occurred to me that, despite having had only one week more in a new job, she was having to make expert decisions; I suddenly realised that we have both been thrown in at the deep end. Like her, I intend to a do a good deal of listening, not only for the next few months, but beyond, and this afternoon I thought it would be helpful to set out some of the key issues that I want to address in my new role and some of the philosophical approach that I bring to the critical area of health. First, I thank the hon. Member for South Cambridgeshire (Mr. Lansley) for his gracious comments about my predecessor, my hon. Friend the Member for Sutton and Cheam (Mr. Burstow). As the hon. Gentleman rightly says, my hon. Friend was extraordinarily thorough and meticulous in his research, he raised many important issues in a fair way and contributed greatly to our debates on health. I am grateful to the hon. Gentleman for his generous comments and for his welcome to me. I believe passionately in the founding principles of the national health service and whenever my hon. Friends and I see them being threatened, we will speak out loud and clear. We believe in universal access to the health service, free at the point of use, and we believe that one’s access to quality health care should not depend on one’s needs. We will uphold those principles in whatever reform we argue for, because I have in common with the Secretary of State the belief that we need a reformed NHS. I support the additional resources that the Government have committed. That is why I was pleased in the previous Parliament to back additional national insurance for the health service. We had campaigned for additional resources. We had argued that they were needed and we were willing to take the difficult decision to support them. Yes, resources need to be put in; yes, reform is needed. However, I have huge respect for the many of our constituents who work in different roles in the NHS. They are often unsung heroes and heroines in the work that they do. They deserve to be supported. If over the coming weeks, months and years we criticise what is happening in the health service, that criticism will not be directed at the front-line staff, who are doing extraordinary work. Very often, the criticism will be directed at the Whitehall management of the service, which is often letting us down in providing the quality health care that we want to see. I reject the philosophical approach that where a public service is struggling, we should help people to buy their way out of it. That is not the answer in health or in education. We must ensure that the health service is one that the vast majority of people want to remain within because it is excellent, and not one that the state helps them to buy their way out of. That cannot be the right approach. Where the private sector is involved, it must be on level terms. One of my concerns—this is something that I will want to investigate—is how far the Government’s involvement in the private sector is on the infamous level playing field. I am concerned, for example, that some of these operation factories, some of these treatment centres, allow the private sector possibly to get a better price than the NHS for the operations that they undertake. I understand that the providers at independent treatment centres will get a price that is not necessarily the same as payment by results or treatment delivered by the NHS. It cannot be right that private providers will get a better deal than the NHS, especially if private providers are doing easy operations and leaving the NHS with the difficult ones. If the private sector is to be involved, it must, as I have said, be on equal terms, and I am not convinced that it is. I am concerned that NHS money is leaching out of the system to pay for private sector profits, and as a result is not providing as much health care as it should. Investigation is needed. I am sceptical about over-reliance on the dogma of the market within the health service. The logic of the market, if the product is called baked beans, is that if it is no good, the company goes out of business. We cannot allow NHS hospitals to start going out of business, not least because the geographical coverage is critical. If the logic is that NHS hospitals cannot go out of business, how do we have a market mechanism that says that with payment by results, people choose where they have their treatment, with some hospitals getting less business? They then suffer financially. The logic is that they cannot be allowed to go under, so that cannot be the mechanism for improving their performance. If that is not the logical conclusion of the policy, what is the market doing in its place? In the gracious Speech we heard about choice and diversity. As Liberals, we have no problem with that concept. Who could be opposed to giving people new choices and new options? However, when our constituents come to talk to us about the health service—this is my experience—I have yet to meet someone who says, ““If only I had more choice and diversity.”” Ninety-nine times out of a hundred they say, ““If only I had prompt access to quality health care.”” In my part of the country, near Bristol, my constituents have a choice of three NHS trusts or hospitals. All of them, until recently, were zero star trusts in terms of the league table mentality. If my constituents were told that they could have three zero star trusts or one very good one, we would know the answer 100 times out of 100. Unless the Secretary of State can explain how the choice mechanism will drive up standards, and if so-called failure institutions cannot go to the wall, I do not follow the logic. The priority must be prompt access to local quality care. If we can offer a choice of quality care, that is great. However, that does not come first unless the Secretary of State can explain what the causal mechanism is. I have not yet heard a convincing account from the Government of what that is. In coming new to a subject area, one is rather like the person who sees that the emperor has no clothes and asks the blindingly obvious questions. With NHS dentistry, the rhetoric is great. However, the reality startled me when I read the answer to a question that my hon. Friend the Member for Sutton and Cheam tabled just a few months ago. I discovered that adult and child registration with NHS dentists is falling. I had heard ministerial rhetoric and had assumed from that that things were getting better remorselessly. As my hon. Friend said, it was as if every day was the first day of spring. In fact, the reality is very different. I was startled to learn that between 2003 and 2004 NHS dentistry registrations for children fell to barely half our children registered with an NHS dentist, and for adults fell to little more than a third. I know that there are plans for investment, but it looks as though things have been getting worse. We as a party will pursue the goal of not merely reversing that decline, but getting back towards an NHS dentistry service worth the name. We clearly do not have that at present. If I think of the issues about which my constituents come to see me, there have been changes in the NHS over the past 12 months that do not seem to be working. I am sure many of my hon. Friends would agree. The system of out-of-hours GP cover is not yet working. I have heard horror stories in my constituency about people who call a GP in the middle of the night, and four hours later someone is being chauffeur-driven from Birmingham to Bristol. That cannot be a sensible use of taxpayers’ money. I hope the Secretary of State’s smile is a recognition of that, but that is happening now. The number of out-of-hours GPs is insufficient, yet the cost of providing the service has risen astronomically, compared with when it was provided in house. Those are the sort of nitty-gritty issues on which we intend to press the Government.