Mr. Peter Lilley (Hitchin and Harpenden): We have had some interesting, constructive and distinguished speeches in this debate, not least from my right hon. Friend the Member for South-West Surrey (Virginia Bottomley) and her counterpart, the right hon. Member for Holborn and St. Pancras (Mr. Dobson). I have to say, however, that of the 20 or so Queen?s Speeches that I have heard in my time in Parliament, the speech made by the Prime Minister in introducing and defending the programme in the Gracious Speech was probably the worst?the thinnest, the least substantial and the one which contained the least attempt to justify any of the measures in the programme. At first, I wondered why that was so. I think that it is because the Prime Minister sees those measures essentially as pegs on which a headline can be hung by the complacent elements of our media, rather than as substantive measures to make real changes to the governance of this country.
I want to begin by speaking about health?rather rashly, perhaps, given that two former Secretaries of State for Health have already spoken. I spelled out in a recent ten-minute Bill speech and previously in a Demos pamphlet my views on the need to restore patient choice in the health service. Choice is the dynamic force which drives up improvements in quality and efficiency when it is allowed to operate and people are given a choice between different suppliers. Unfortunately, choice within the NHS was abolished by the Government in 1999 by circular 117. We no longer have the right to choose a hospital other than that to which our local health authority, or health bureaucracy, is contracted to send us. We cannot choose to go to one with a shorter waiting time, with better outcomes, for a particular operation, or to one which is known to be cleaner or is more convenient for any reason.
When I put forward my proposals for restoring choice, they were, sadly, derided, by the present Front-Bench health team. They said that to restore choice in the health service would mean individuals running all over the country looking for better care or shorter waiting times. That comes a bit rich from a Government who subsequently have sent people running all over the Mediterranean on the same search. But today the Secretary of State invoked the language of choice and diversity of provision. Have the Government changed? Have they been converted? If so, no one would be more joyful than me. There is more joy in heaven and Hitchin and Harpenden over the conversion of one sinner who repenteth than 99 of my colleagues who need no repentance.
Dr. Tonge: I am a little puzzled, because I seem to remember that when the right hon. Gentleman?s party ran the health service, although there was an internal market, the patient followed the money in the form of a contract from the health authority and had very little choice, except in the occasional extra contractual referrals.
Mr. Lilley: Unlike the hon. Lady, I do not think that everything my party did was right and that we cannot learn from experience. I spelled out in my speech and pamphlet both the ways in which I thought that some of the changes that we introduced had unforeseen consequences which we did not approve of and
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improvements which should be made in future. I hope she will give credit for that rather than make silly, knocking points about the past.
I am not sure that the Government have substantively changed their policy on this issue, certainly not as much as I would hope. To harness the dynamo of choice within the NHS would need four things. First, there is the need to restore the right of patients to choose which hospital they are treated at. Sadly, there is no proposal to repeal circular 117. Secondly, we need to give patients information about waiting times, hospital outcomes, cleanliness and so on. There was no mention of that in the Secretary of State?s speech. Thirdly, we have to make money follow the choice. Again, there is no reference to that in the financing mechanisms for new foundation hospitals or otherwise. Fourthly, we have to make hospitals genuinely independent. There was reference to greater independence for hospitals in the Queen?s Speech and the Secretary of State?s speech, but it seemed to be an element of typical, new Labour tokenism rather than the mark of substantive change.
The Secretary of State spoke only about new control mechanisms and new accountability at democratic local level in addition to centralised control. There was nothing about greater freedom or replacing centralised control by local control. He said nothing about removing the application of the several hundred targets. My local hospitals have 248 targets applying to them. Are they to apply to foundation hospitals? The Prime Minister strongly defended the use of targets, so I must suppose they are. There was no indication of whether the ring-fencing of funds by Ministers for certain applications is to apply to local trusts. There is no indication whether the star-rating system is to apply to foundation hospitals.
It looks as though the Government are talking essentially about a change in local democratic representation on hospital boards, to which I have no objection?indeed, I am rather sympathetic to it, although I appreciate that there are enormous difficulties in working out where the electorate lies?but not any serious independence for NHS hospitals.
In practice, we observe that the Government are in the business not of widening choice and diversity for patients but of narrowing it. Throughout the country, they are busy closing and merging hospitals. They always claim that such decisions are medically driven. Theoretical arguments exist that bigger hospitals may in certain circumstances provide better standards of care, but where is the practical evidence that those mergers and closures work and produce improved outcomes for patients?
I have repeatedly asked Ministers to carry out such studies. Indeed, there is a Minister on the Front Bench now whom I have previously asked and who has previously refused to give us that evidence or to commission research that would provide evidence of whether or not mergers which have taken place have worked. In Hertfordshire, we saw the merger some years ago?the hon. Member for St. Albans (Mr. Pollard) will remember it?of the accident and emergency and acute services of St. Albans with those of Hemel Hempstead. Although I have asked for evidence repeatedly year after year, no evidence has ever been provided that a merger has resulted in the improvements in medical care that every consultant who advocated that merger said it
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would bring about. Now we are seeing more proposals for mergers and centralisation, including the closure of what remains of St. Albans hospital. We should have the evidence first, before we see any further mergers and closures.
I want to see a new teaching hospital in Hertfordshire, but not as an excuse or a way of dressing up the centralisation of existing capacity in one place. We are told that the proposal for a new hospital will simply siphon off capacity from existing hospitals and result in no extra beds.
In practical terms the Government are talking about choice, but reducing choice. They are talking about decentralisation but they are taking decisions centrally. In substance, there is still the bureaucratic centralism which the right hon. Member for Holborn and St. Pancras clearly still believes in and at least has the integrity and honesty to defend.
I welcome the constructive and interesting speech on pensions from the hon. Member for Stalybridge and Hyde (James Purnell). Pensions are in crisis, yet there is nothing in the Government?s programme to deal with that. The Government ignore this issue at their peril. In my time in Parliament, the largest single post bag I have ever had was when it was rumoured that the Government were going to change the taxation treatment of pensions. It was larger than that received on any other subject in my 20 years here. People now are concerned because they are seeing the damage done already by the ?5 billion tax change imposed on pension funds.
Kevin Brennan (Cardiff, West): Did the right hon. Gentleman have a large post bag at the time of the Tories? mis-selling of pensions scandal?
Mr. Lilley: No I did not. That was partly because the regulator ensured and guaranteed that no one would lose from that scandal. I had a large post bag at the time of the Maxwell scandal when the hon. Gentleman?s former colleague stole ?500 million from the pension funds?a feat only ever exceeded by the Chancellor of the Exchequer who steals 10 times that amount every year from current pension funds in his Robert Maxwell memorial tax.
We are told that the reason why the Government are not proceeding with any relevant measures is that they are looking for a consensus. That is usually a symptom of indecision or an attempt to silence criticism. Although many people think that our adversarial mode of parliamentary government leads an incoming Government to uproot everything that has gone before, that rarely happens. It has never happened with pensions. Governments have always built on the measures introduced by their predecessors rather than reverse them. Therefore, the Government do not have a need for a prolonged royal commission to achieve consensus. They should go ahead and act now to improve the current situation. They can be sure that an incoming Conservative Government will build on that rather than simply uproot any new measures that the Labour Government introduce. It will be our duty, however, to criticise the proposals that they put forward and that, I am sure, we will do in a constructive spirit.