Mr Mark Fisher (Stoke-on-Trent Central)

Thank you, Mr. Deputy Speaker, for giving me an opportunity to make my maiden speech in this debate. Last week, in apportioning subjects for discussion on particular days. Mr. Speaker, somewhat to my surprise, described today as the day for discussing the "attack on the welfare state". I agree with this description, and the Gracious Speech, taken together with what the Secretary of State has seen fit to say today, makes it clear that there is an attack. The effects of this attack can be seen in Stoke-on-Trent, the Central division of which I have the privilege to represent.

My predecessor, Bob Cant, worked tirelessly in this House for 17 years for the people of the Potteries and for that he was greatly and properly respected. In recent years, much of the work that he did was to try to protect the people of the Potteries from the curse of unemployment and to preserve their essential welfare services. In spite of his efforts, these services, and particularly the Health Service, are today in a critical condition in Stoke-on-Trent.

For that reason, although I have worked in education for the past 10 years, I seek today to concentrate on the Health Service in the welfare state, and to challenge some of what the Secretary of State has said. North Staffordshire is now the most deprived district health authority in England. On the Government's figure, set out by the resource allocation working party, its revenue funding is 14·1 per cent. below target. In cash terms, that is £10 million a year less than we should be receiving.

However, it is the human terms that are important, not the statistics, because in any attack it is people who are hurt and who are the casualties. In human terms, that £10 million a year deficiency means old buildings, out-dated operating theatres, waiting lists for general and orthopaedic surgery, of more than 12 months, critical under-staffing in geriatric and psychiatric hospitals and — if one can believe this — only three ophthalmic surgeons for a catchment area of nearly 500,000 people. Such deficiencies are not fair on dedicated staff or on patients needing treatment.

I turned to the Gracious Speech in the hope of finding something that would address these problems. I found just one sentence: Further action will be taken to ensure that patients receive the best value for the money apent on the National Health Service. That is a sentence that could, at best, be described as open to interpretation. I was particularly interested to hear the Secretary of State's interpretation today. I was extremely disappointed by what he said because he seemed more intent on rehashing the tired arguments that the Conservative party put forward in the general election campaign than on offering anything positive for the future of the NHS.

The Secretary of State spoke of the private sector, although he talked little about the draft circular or about the practical application of privatising catering, cleaning and laundry staff. In north Staffordshire we are crying out for operating theatres and more surgeons. Are the Government seriously offering us privately washed sheets and privately cooked food as their solution for those deficiences? How will such fiddling around on the margins of Tory dogma help patients in desperate need of surgery?

I welcome what the Secretary of State had to say about private health insurance schemes and his undertaking that they would not be made compulsory. However, I was frightened by his emphasis of the word "compulsory". There are many ways of making the schemes more attractive than by compulsion. Those private schemes do not offer any value for money for the chronically sick or the mentally handicapped. I should be grateful if the Secretary of State would explain how the 27,000 people unemployed in Stoke-on-Trent at the moment are to find an insurance company that will give them cover when everything except basic services has been taken away by the Government, and how they could pay for such premiums even if they could find such a company.

The Secretary of State talked throughout about efficiency savings, but I refer him to the 1982 report of the Social Services Select Committee which says: 'efficiency savings' are becoming a regular euphemism for 'expenditure cuts'. There is nothing in the Gracious, Speech or the Government's plans as outlined by the Secretary of State that offers any hope for a nationally fair service or for a service that is concerned with the health of the country. Value for money is all that the Government prize.

Of course value for money is important, but the NHS is already very cost-efficient. In north Staffordshire, the administration and management costs of our district health authority are just 3·9 per cent. of its budget. Nationally, the figure is between 5 and 6 per cent. European countries have administrative costs averaging over 10 per cent., so the public is already getting value for money from the money spent. The trouble is that the money spent is inadequate to provide equality of service. The Secretary of State knows this, and that the money is unfairly and unevenly distributed.

The Prime Minister is fond of telling us that public services such as the NHS are paid for by taxes and that we can only get out of them what we put in. That is patently not so. Why should we, in Stoke-on-Trent, pay the same national insurance contribution and the same taxes as everyone else, but receive £10 million a year less than our fair share of health care and resources? That is not value for our money. Such inequality is indefensible, and I should be interested to hear what the Secretary of State says when he makes a stab at explaining these inequalities. The Government could do something about this. That is what the resource allocation working party is for, but the Government do not appear to have the will to make it work properly or fairly.

I extend through you, Mr. Deputy Speaker, a genuine invitation to the Secretary of State, or the Prime Minister should she wish, to come to Stoke-on-Trent to see for themselves this value-for-money Health Service. The Prime Minister is said to be fond of 19th-century Victorian values. If she came to Stoke-on-Trent we could show her some of the best 19th-century Victorian hospitals in late 20th-century Britain. I should be glad to introduce the Secretary of State and/or the Prime Minister to some of the people receiving those services—patients suffering from pneumoconiosis and sillicosis from working all their lives in our two local industries, the Potteries and the mines.

One such patient is an old man of 78 who lives alone. His neighbours telephoned me in despair last week because he had been immobilised after a fall. He had to remain in a bed made up in his front room for a month, unable even to go to the lavatory. That happened because our geriatric hospitals in north Staffordshire are full and there is a waiting list of 480 for part three accommodation. That man received home help for just one hour a day because our county council cannot increase the provision for home helps, much as it wishes to, for fear of slipping still further into the Government's financial penalties for overspending. I invite the Secretary of State to come and tell those patients that they are getting value for money. The truth is that they are not getting value for money in resources, in fair distribution or in comparison with other countries in Europe.

The Secretary of State played around with national statistics. He did not mention that we spend 5·5 per cent. of our gross national product on health care—the lowest per capita of the 10 most developed countries in the world. In return, we have the fourth highest mortality and morbidity rate. That is a terrible record. How on earth does the Secretary of State explain that imbalance? Does he recognise that there is a relationship between low spending and high mortality and morbidity? The best, indeed the only, value for money is good health care and that means real investment, not the phoney figures that the Secretary of State gave the House today, nor the Government's phoney growth which offers development money only if it is in part financed by efficiency savings. Only by real investment can our doctors respond to the real challenges of the future. The Secretary of State was right to mention demographic changes. Our population is getting older and frailer. He did not mention the challenge of new medical techniques or the changing priorities in primary and community health care—prevention rather than cure.

I ask the Secretary of State to reconsider that one sentence of the Gracious Speech, particularly the policies that appear to lie behind it. He said that he was giving us a commitment to the NHS. I shudder to think what his policies would be if he had any lack of commitment to it. If he will not change that sentence in the Gracious Speech, we shall oppose the Government until the British people see those policies for what they are — uncaring, inadequate, and, as my hon. Friend the Member for Islwyn (Mr. Kinnock) said, parasitic.

Britain has some of the finest doctors, nurses and health workers in the world. We have patients who desperately need medical treatment, not financial dogma. Labour Members will not sit silent while staff and patients are sacrificed to some kitchen accountant's idea of cutting costs. The Labour party created the NHS and we shall fight to preserve it.

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