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Access to NHS Services

I am grateful for that intervention and I suspect that the Secretary of State will be aware of that. Waits of that length are unacceptable. There is a genuine and serious debate to be had about how best to use public funds to ensure access to top-quality dental care for those who need it most. Two or three years ago, the Audit Commission was very critical of the ineffective use of public money to ensure access to NHS care for those who cannot afford the option of going private. The King’s Fund pointed out massive variations in spending on mental health across the country last year, while Sir Liam Donaldson also highlighted concerns about treatment following a heart attack, which varies enormously from one part of the country to another. I would like briefly to consider the Conservative party proposals set out in their paper. The Conservatives have campaigned vigorously over recent years against reconfigurations, hospital closures and so forth, but I believe that the inevitable consequence of their proposals will be to make reconfigurations and closures more rather than less likely. The critical issue then becomes: who decides under Conservative policy if and when a hospital should close? As I have already said, the Conservatives propose a substantial shift of budgets towards practice-based commissioning, very much giving power to GPs rather than to PCTs. They also propose a significant shift towards using the private sector while their document also endorses, of course, the principle of payment by results. The inevitable consequence will be that some hospitals will become unviable. The Conservative spokesman referred to the importance of care closer to home, which is again likely to make some hospitals unviable. I would like to see a degree of honesty from Conservative Members on this issue—[Interruption.] The critical issue, as I have said, is who decides to close the hospital. Ultimately, it will be the national NHS board. If and when the system came into force, local people would end up asking why an unaccountable, national, remote quango was closing their local hospital. That is the inevitable consequence of what is being proposed. The board will take decisions, independently of Parliament, to close local hospitals. I consulted the Library to check that my understanding of the document was correct and it appeared to agree with me. Specific reference was made to paragraph 2.17, which talks about HealthWatch, the new body to safeguard patients’ interests. It states:"““HealthWatch will have statutory rights to be consulted over decisions which affect how NHS care is provided in an area. It will also be able to make representations to the NHS Board in relation to the planning of NHS services, such as where an Accident and Emergency Department closure is proposed.””" That is remarkable. In a decentralised world—which I thought the Conservatives believed in—we would have the NHS board deciding whether to close an A and E department. That is utterly ridiculous. I can imagine what local people would feel when such a decision was taken by a remote national quango. I do not think that it would be as attractive a proposition in reality as it might seem in theory. I accept that tough decisions have to be made and that services sometimes have to be reconfigured. We have to ensure that health care is delivered in the safest possible way.