NHS (60th Anniversary)

The Under-Secretary shakes her head but it is deeply imbued in the culture that, when a good idea is proposed, the immediate question follows, ““Why can't everybody have one?”” We need a stronger local influence in shaping the NHS around targets and polyclinics and dealing with one of the consequences of over-centralised health care provision: too much concentration on the issues that grab the headlines, acute medicine, and too little on community medicine, mental health—all the Cinderella services that always lose out when a high profile debate goes on in the national newspapers. Of course there needs to be a national view in the national health service. When people observe differences in different parts of the country, they will ask why they exist and whether they should exist. However, I invite the House to recognise that one perverse consequence of an over-centralised culture is precisely those health inequalities in different parts of the country that the hon. Member for North Norfolk (Norman Lamb), the Liberal Democrats' spokesman, referred to earlier. We have an over-centralised culture that delivers, at the local level, an unacceptably wide variety of health outcomes. What my hon. Friend the Member for South Cambridgeshire is rightly seeking, and what we were arguing for through the Local Government Association commission, is to empower local people. If we do that, we will find, ironically, a greater similarity of outcomes, because by decentralising management we empower people to address the inadequacies of the health care delivery that they experience locally. As we look forward to the next 60 years of the health service, I hope that we can move on from silly arguments about who is committed to it. Over 60 years, we have all been committed to it, and we all remain committed to it. However, if we are going to deliver the objectives that our constituents have for it, we have to move away from a model of over-centralised management that has failed in all its other manifestations on earth, empower local people, local management and professionals, and learn to let go. By letting go of over-centralised controls, we will deliver better health outcomes and, ironically, a more common experience of health outcomes in different parts of the country.