I congratulate my hon. Friend the Member for Leominster (Mr. Temple-Morris) on his good fortune in being allowed to introduce the debate, even if it has taken place at an unusual hour. He introduced a valuable and important debate and gave many of my hon. Friends the opportunity to make a contribution. He opened by explaining that he proposed to cover all the activities of the Department of Health and Social Security. He proceeded to do so, and I shall do my best to answer all the points that have been raised. However, we all appreciate that the Department is so vast that even in two hours we cannot do much more than touch the surface.

This is an unusual hour of the night at which to make a maiden speech, and it says a great deal for those who made maiden speeches that they showed enthusiasm for this subject. My hon. Friends the Members for Stockport (Mr. Fayell) and for Mid-Kent (Mr. Rowe) made notable contributions. I am sure that we lock forward to them contributing often and, I hope, at more sensible hours.

I encountered my hon. Friend the Member for Stockport shortly after he arrived in the House, when he immediately began to lobby me, on behalf of his constituents, about deficiencies in the deputising services used by some general practitioners, and I hope to give him a response to that tomorrow. His maiden speech went much wider than that and showed a broad range of interests and originality.

I have known my hon. Friend the Member for Mid-Kent for many years and I always expected that, when he was elected to the House, he would make a notable contribution. I have the pleasure of congratulating him and I look forward to his valuable contributions to all that the Conservative party has to offer in this context.

As the Minister who has been brought at this hour of the night to reply to the debate, I am proud to belong to a party which contains a group of Back Benchers who are capable of getting together to sustain a debate on social services policy for two hours. The Conservative party has not always been able to mount such an effort. This shows that at the moment our party is one of care and concern and is making the most original contributions to thought on the problems of social service policy.

The hon. Member for Bishop Auckland (Mr. Foster), as the solitary representative of the Labour party Front Bench, made an eloquent contribution which did not contain new ideas or policies in this field. His party has destroyed any ideas on social policy. I suppose that this is one occasion when one should not comment too heavily on the fact that the Liberals and Social Democratic parties did not make a contribution to the debate. Since they emerged as a new alliance in politics I have heard nothing of any new policy on social matters from either of those parties, except an attempt to rehash some of the ideas about benefits and taxation on which many in the Conservative party were working in the 1970s. Some of them were mentioned by my hon. Friends during the debate.

My hon. Friend the Member for Leominster dealt in particular with the National Health Service, and I should mention that first. I confirm entirely the commitment which my hon. Friend the Member for Suffolk, South (Mr. Yeo) mentioned to the National Health Service. I agree with him entirely that we expect the financing of the National Health Service to continue to come largely from taxation. When we spoke during the election campaign about the National Health Service being safe with us, we were reaffirming that commitment and making it clear that it was untrue to suggest that we had any intention of changing the basis upon which the National Health Service was financed, and that remains the case.

My hon. Friend the Member for Leominster gave the details of our record during the past four years of increased spending on the National Health Service. I have no need to repeat it. It is pointless for people to try to undermine our commitment and record of spending by drawing exaggerated lessons from the £100 million that we took out of the cash limits in July this year.

As a result of those changes, total spending on the National Health Service this year remains as we planned at the time of the Budget. There is some increase in our forecast of spending on the family practitioner service and there is therefore a small decrease in the planned cash limits of £100 million out of a total of £8 billion for the hospital and community health services. It takes the hospital and community health services in real terms back to about the level of spend that they had for last year and does not represent any reduction on last year's spending. It is pointless to take those small adjustments, as the hon. Member for Bishop Auckland did, and suggest that they somehow undermine our general record or our commitment to the future.

My hon. Friends were also right to mention that, apart from all our efforts to continue to raise as much as the economy can stand by way of taxation to finance the Health Service, it is nevertheless the case that almost limitless demands are made on the Health Service. Everyone can see that, with demographic change, the pace of medical advance and the rising expectations of our population, the National Health Service has to try to cope with new needs.

For that reason, I agree with my hon. Friends who said that we must look not just at the level of spending to satisfy our desire for a reasonable level of Health Service but increasingly at the value that we receive from the money that we provide for the National Health Service. It is an essential part of a caring policy towards the Health Service that we continue to stress the need for efficiency, improved performance, constant change and development and the need to address ourselves to priorities all the time to ensure that we do our best to keep up with the needs.

My hon. Friend the Member for Leominster mentioned our policy of comparing the cost of support services in the Health Service by inviting competitive tenders from outside. It is an obvious way to ensure that we keep down to a minimum the costs of such services as laundry, cleaning, building maintenance and so on. Any money saved on those services can be released for the development of patient care.

We are consulting about a draft circular which is intended to guide health authorities on how to set about competitive tendering. There is no need for health authorities to wait for the final circular, and several health authorities are already showing an interest in tendering and are making progress. We shall shortly be producing the circular in its final form with the best advice that we can give to health authorities as to how best to procede with competitive tendering in various areas, and we hope to see progress in the year or two ahead.

My hon. Friends the Members for Leominster and for Suffolk, South also referred to our policy of partnership with the private sector in the provision of care. This is a part of our policy on which the Labour party made the greatest play during the election. It claimed that the policy was contained in a secret document that it had discovered, but it was a document that had been circulated two or three months before to regional chairmen. It contained much commonsense advice.

My hon. Friend referred to the need to ensure that one looks to the needs of the patients and ways in which one can avoid wasteful duplication of effort between the NHS and the private sector in the same geographical areas or the same specialties. We looked for ways in which they could co-operate sensibly with each other, for the benefit of the patients of both sectors.

My hon. Friend the Member for Leominster was right to refer to the wide range of private sector provisions that we have to consider, and it is not merely a question of up-market hospitals in the big cities, but of many smaller private hospitals. Probably the biggest contribution in terms of quantity that the private sector makes to care is the many nursing homes for the elderly. It is to the private sector that we look for the great bulk of provision for nursing home accommodation for the growing numbers of elderly people.

It makes sense for the hospital service, with a growing number of elderly persons occupying beds in hospitals on a long-stay basis, to look for ways in which it might be able to provide more suitable care for the patients nearer their homes by taking places for those patients in private homes for the elderly thus freeing the bed for another patient. That is one of the things about which we consulted.

My hon. Friend the Member for Leominster was also right to remind us that, in addition to collaboration, we are anxious to make sure that the standards ofthe private sector are maintained. An Act in the last Parliament, carried through by this Government, with the long title the Health and Social Services and Social Securities Adjudication Act, contained an important provision for the licensing of private nursing homes, increasing the powers of the inspectorate, and making sure that all nursing homes maintained the high standard already achieved by the best.

All my hon. Friends who spoke about the Health Service referred to the need to provide care for the rising number of the elderly, and we give that a high priority in every way. We have stressed to all health authorities that care for the elderly, together with care for the mentally ill and the mentally handicapped, must be the first national priority in the development of those services.

One final matter bears on value for money and improving the performance of the Health Service, and that came in a point made by my hon. Friend the Member for Suffolk, South about the need for a drive to sell surplus land and make sure that no resources were locked up needlessly in buildings or land that should be disposed of for the best available price as quickly as possible, to get the resources to pay for the care.

My hon. Friend made a particular and topical reference to Tadworth court hospital. When, in another guise, he was working for the Spastics Society, he played a notable part in stepping in with proposals for the future of that hospital, which relied heavily on the fact that the hospital was surrounded by surplus land not being used for health purposes and for which there was no use. The key to unlocking the finances of the Spastics Society experiment with Tadworth court hospital lay in opening the way to dispose of that spare land and making use of those resources for health care.

I was talking about the elderly. With Tadworth court I am talking about respite care for families of mentally handicapped children, and I spoke of our priority of improving services for the mentally ill. As several of my hon. Friends have said, when we talk about those priority groups, we are not just talking about hospital services. In some cases, we are not even talking about hospital services.

One of our problems is that too many patients in each of those categories occupy hospital beds on a long-stay basis when they would be happier and more suitably cared for in small units at or near their own homes. That would enable redundant beds to be closed and resources released or other patients to be admitted to take advantage of the hospital services.

Recent discussions have been stirred up by the report of the development team on conditions in some hospitals for the mentally handicapped from 1976 to 1982. In considering what has been done to develop policy we are looking just as much at community services as we are to increased expenditure on the hospital service. To some extent, development of community services will steadily replace some of the unnecessary hospital care.

Reference has been made to the restraints which the present economic circumstances necessarily impose on local authority expenditure. They have been imposed on expenditure on community care just as they have been imposed on the Health Service and the rest of social policy.

My hon. Friend the Member for Suffolk, South said that some local authorities had experienced difficulties in developing community care to take patients away from the hospitals and to move in the direction that we all wish. Of course there are some restraints. At present the Government are looking to local government to reduce its expenditure and get within the limits that the economy can afford.

Before anybody examining this matter gets too carried away by arguments about the inability of local authorities to finance community services let me suggest that we keep this in proportion. It must be realised that the Government are now financing personal social services on a vast scale. Under the Conservative Government, expenditure on those services has increased. The Government's policy need not necessarily constrain desirable forms of spending on personal social services.

I shall deal with each of those points and explain what I mean. First, expenditure on the personal social services as provided by the local authorities costs a little under £2 billion and about 200,000 people are employed. During the Conservatives' first four years of office, the growth in expenditure on the social services in real terms has been about 9 per cent. I make allowance for all the usual conventions which apply to personal social service spending which tend to reduce the figures if we use a straight comparison with the retail price index. In each and every year bar one since we came to office there has been a real growth in expenditure by local authorities on the personal social services. That process seems to be continuing.

Some of the authorities which complain most bitterly about Government controls and restraints and claim that their social services are being cut to the bone are actually achieving incredible increases in expenditure in real terms. I shall refer to a few London boroughs which are fond of saying that their social service provision has been cut to the bone. During the last four years of Conservative Government, Brent has increased its spending on personal social services in real terms by 31·7 per cent., Hillingdon by 33·9 per cent. and Waltham Forest by 30·7 per cent. Those increases in real terms are unmatched elsewhere in the public sector and show that the restraints on local government have not bitten so hard on the personal social services as critics claim.