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Health and Education

It has been a privilege to listen to a string of such extraordinarily good maiden speeches this evening. Whatever people say about the decline of public speaking as an art, the new intake of Members on both sides suggests that it has not deteriorated as much as people say. I want to pick up on one point made by my hon. Friend the Member for West Lancashire (Rosie Cooper), who spoke of the expertise that she hopes to bring to health service debates in this House. In some ways, she echoed a comment about the Government’s health policy made to me in an e-mail by a local general practitioner, who said:"““My concern is to maintain sufficient contact between the centre and those of us working on the ground. If messages only travel one way—top down—the richness of local knowledge and experience is not capitalised.””" I look forward to the implementation of our Government’s manifesto and the health service measures in the Queen’s Speech, but I want to raise a few concerns about how they might be implemented in relation to the health service in Southampton. I am in favour of choice; public services should offer choice. We want our local services to be good, but that is no reason why we should not have a choice of service to fit our lifestyle, working arrangements, family patterns and personal preferences. However, there is sometimes a sense from the Government’s agenda that there is a more profound set of beliefs on choice and a set of tenets of faith. The suggestion seems to be that choice will be the major driver of improvement in public services, that a quasi-market in which the public, as consumers, exercise their choice and switch money from hospital to hospital or school to school is the best way to make choice a reality, that the same quasi-market has enough power to make providers provide a better standard of service, that providers have sufficient ability to respond to those markets to provide a better service, and that those ideas are all better than alternative ways to improve public services. Those ideas are not stated in our manifesto, but they come across in some current thinking, and I want to raise concerns about that. First, it must be acknowledged that there is no published body of evidence to justify that series of claims. I hope that the Government will be more transparent on this area of policy making in the future. We know, for example, that the NHS pays over the odds for private sector operations to build up the capacity of the private sector so that there will be greater future efficiencies from more contestability. The Government should publish the evidence on which their current investment is judged so that we know what we will get for the money that goes in. My second concern is that in the pursuit of that series of quasi-market changes, the immediate danger is that we end up with a mish-mash and hotch-potch of market and non-market approaches to public sector management—a bit of socialist planning, a bit of state capitalism and a bit of liberal markets. That makes it hard to work out how it all fits together.