NHS (60th Anniversary)

Despite that suggestion, I will not leave it out, because it is a central issue that needs to be addressed. We see endless botched reorganisations, and with every reorganisation come more payoffs to senior executives. They drive clinicians crazy, and they certainly drive the public crazy. A recent example is the enormous payoff—£700,000—to a chief executive of a hospital trust in Leicester, aged 52, who now receives a pension of some £60,000 a year while also working as a consultant for the Healthcare Commission. That sort of waste of money drives people mad. We are not the only people who say that the health service is ludicrously over-centralised. As she reached the end of her troubled tenure last year, the former Secretary of State, the right hon. Member for Leicester, West (Ms Hewitt), made a speech to the London School of Economics in which she described the NHS as"““four times the size of the Cuban economy and more centralised.””" That seems to me to describe it rather well, and I suspect that the right hon. Lady was in the best position to make the judgment, having tried to control the beast for so long. This, then, is Labour's NHS: loads of cash, the right instincts certainly, but dreadful waste and inefficiency and an absolute failure to let go. Interestingly, the Labour manifesto at the last general election made a bold claim—promise, indeed—to cut the number of staff in the Department of Health by a third, and to halve the number of quangos. Neither, of course, has happened. When we asked a question about the number of people working in the Department, the answer suggested that it was pretty much the same as the number three years ago. How can we meet the challenges of the future better than the top-down, command-and-control approach that has proved so wasteful over the past 10 years? We face enormous cost pressures in a modern health service. New technologies are emerging, and new drugs are constantly being developed. There is a continuing debate about top-ups and about how on earth we are to fund new drugs which, in many cases, can provide good clinical benefits but may not meet the NICE criteria for public funding. We face all the challenges posed by lifestyle conditions such as obesity, alcohol consumption and smoking; and, critically, we have a massively ageing population. I recently met a specialist in mental illness in the elderly in Liverpool. He showed me a graph showing the number of centenarians in our society over the next 50 years. It was frightening to observe the growth in the number of people who will reach the age of 100. At the same time, the ratio of people of working age to older people will change dramatically, so we are losing the work force that will provide the care for older people. Therefore, we face massive challenges. As well as all the extra cost pressures, we have to recognise that patients now expect something different. Nowadays, in all aspects of life, people behave as consumers—they want to make their own decisions and to have control over their lives. That is the case in health care as well, and the NHS must adapt to that. On top of all these matters, tackling the gross health inequalities that continue to afflict our country must be a priority in the years ahead. What is the Conservatives' solution? First, let me say that they are right to focus on outcomes. There can only be any point in all of this vast amount of public spending if we manage to make people stay healthier and live healthy, longer lives; that is the aim. However, that focus is only a partial solution, as willing the end does not always achieve delivery. We must always ask how we are going to achieve the improved outcomes that today's Conservative paper rightly points to the value of trying to achieve. Its approach is to scrap all national targets—to have no access incentives at all, as far as I can see. Under its plans, there will be no entitlements for individual patients across the country, wherever they live, to ensure that they get access to the health care they need. It is worth remembering the origins of targets. They emerged when the new Government came to power in 1997 because of the dreadful and unacceptable waste under the previous Conservative Government. The political debate in 1997 focused particularly on the fact that people were waiting so long for treatment. I remember when I was first elected to Parliament in 2001 taking up cases on behalf of constituents who were waiting three or four years for orthopaedic operations—for hip and knee-joint operations. It is worth remembering what it was like; it was dreadful. Therefore, I believe that access is an important issue in its own right. While waiting for treatment, people often suffer from anxiety and trauma. If they are waiting for a hip or knee-joint operation, when it finally takes place the outcome might demonstrate that the operation has been performed well, but if they have waited two years to have the operation, they will probably have waited in severe pain and will also probably have had a carer who had to cope with them in that condition during that period.