This morning I presided at a meeting of the Cabinet and had meetings with ministerial colleagues and others. In addition to my duties in the House, I shall be having further meetings later today.
Does my right hon. Friend agree that parents have a great responsibility for their children, and is she aware that parents who find themselves at risk of transmitting severe genetic disorders, such as epidermolysis bullosa, which cannot be detected until the 18th week, wish to choose, on medical advice, whether or not they should continue with such a pregnancy?
My hon. Friend makes his point very effectively. It is a matter that will be considered in the debate tomorrow, when doubtless hon. Members will make up their own minds about how to vote on that Bill. It is for each of us to do that. Speaking for myself, as the Bill is drafted at present, I could not support it.
I am glad that, in at least one area, the Prime Minister and I are in complete agreement. When it is clear that the Prime Minister has enough money to meet the demands of the presidents of the royal colleges and of the nurses, without further dispute and without further crisis, why does she not use that money now?
The Prime Minister knows that those figures are calculated on exactly the same basis as the figures for this year, which required her to find some supplementary sums and which still leave the hospitals in deficit. Does she not realise that she is guaranteeing a further underfunding crisis for next year unless there is an additional amount? Why does she not make Budget day a National Health day?
The right hon. Gentleman is aware that the public expenditure estimates have just been published. Before those were published, in December an additional £100 million was made available to the National Health Service to get over this difficult time of year for some. The amount of public expenditure has been decided. The Budget is about how to raise the taxation and borrowing, not how to add extra expenditure.
Does my right hon. Friend agree that it is a great pity that the Opposition and some parts of the media do not pay more attention to all the good news in the National Health Service? Was she as heartened as I was to learn of the formal opening earlier this week of the new maternity unit at St. Helier's hospital in my constituency, where the dedicated staff are able to deliver 10 babies a day? Does she agree that this is a sign of the excellent performance in the National Health Service and also of the vitality of the nation?
Yes, I noted the opening of that hospital, and I congratulate it on the way in which it has got up to its fullest possible capacity and on the excellent work it is doing. It would be pertinent to remind the House that, although we hear of difficult cases from time to time, since we discussed the National Health Service last week there have been about 45,000 operations in the NHS. That is not a Health Service in crisis. We are doing very well.
Surely the wise decision of the Royal College of Nursing not to sanction any strike action now deserves more than mere verbal support. Will the Prime Minister give it the assurance that it wants to hear, which is that the pay rise due to nurses will be funded in full by the Government, and that the price for that will not be exacted in any way from the National Health Service?
The Royal College of Nursing, for which we have the highest regard, is very much aware that the nurses were given an independent pay review body because the royal college had never gone on strike, as it cared too much for its duty to patients. I note what the right hon. Gentleman said. May I remind him that the Government of which he was a member cut the pay of nurses by 20 per cent. in real terms?
Does my right hon. Friend recall the words of the late Aneurin Bevan, who said that he would stuff the mouths of the doctors with gold? As doctors have been well rewarded over the years, is it not right to expect them to make their contribution to improving efficiency and value for money in the National Health Service?
Everyone has a duty to obtain the maximum from the enormous amount of resources that the taxpayer pays to the Health Service, to operate with maximum efficiency and treat the maximum number of patients. Certainly, performance varies greatly between districts and hospitals, and it is with a view to examining that that we are obtaining some interesting figures and hoping to raise the standards of those who are not so good at using their resources to the standards of the best. Doctors will play a welcome part in that process.
May I draw the Prime Minister's attention to the continuing difficulties of Chester district health authority, which treats thousands of my constituents? Does she know that on Christmas Eve two elderly patients were transferred between hospitals in a 4-tonne Bedford van because of a result of cuts? Does she know that that van was cold, dirty and smelly? Would the right hon. Lady like any member of her family to be transferred in such a shameful way, and does she realise that we do not think the Health Service is safe in her hands?
As the hon. Gentleman is aware, those matters must be addressed to the local management, because it is responsible for the conditions. From 1979 up to March 1988—[Interruption.] The Opposition do not want to know the extra amount of money that the taxpayer has found for the Welsh Health Service —[Interruption.] Yes, it is the taxpayer who finds the money. Almost £500 million at current prices has been invested in the capital of the hospital and community health service in Wales, and expenditure on the National Health Service in Wales has risen by a third, after allowing for general inflation between 1979 and 1987. It is for the management to make the best of the opportunities that that money affords them.
Does my right hon. Friend nevertheless agree that it is not a simple matter of more money— billions more have been spent on the NHS, and billions more are planned to be spent—but that it is also a case of efficiency, good management and evaluation between hospitals and practices?
We notice great differences between departments, hospitals and districts in how the money is spent and we are trying, as I said, to bring more of the best practices to those areas that have hitherto not been able to manage as well, although they may have had as many consultants and nurses. In general, the Health Service is expanding, it is treating many more patients, it is doing many more operations and it is treating more day and out-patients. The polls show that 80 per cent. of the enormous number of people who use the Health Service every year are highly satisfied with the treatment that they receive.
Why is the Prime Minister demanding extra-special NATO meetings? Is it to bounce the Germans to accept battlefield nuclear weapons, which they do not want, or is it to tie President Reagan's hands in the coming peace talks? Is the Prime Minister using NATO to nuke the negotiations? Would not the money which she is determined to spend on new bombs be better spent on the Health Service?
No. If we did not have an effective defence there would be nothing like such a good Health Service, education service or standard of living. That has been mostly accepted by past Labour Governments. I understand that it does not seem to be accepted by the present Labour party.
Is my right hon. Friend aware of the deplorable action of the Birmingham council in trying to prevent the free extra tuition for gifted children in the area, which teachers are prepared to provide? Is it not a duty of a local education authority to ensure that there is good education to maximise the abilities of the children in the area?
I saw those reports this morning. I have not been able to find out whether they are accurate, but if they are I hope that everyone will condemn the action. The teachers are willing to give those especially gifted pupils extra tuition on Saturday morning. I think it is our duty to give every child a chance to develop its best talents and abilities and not to let the Socialist dogma of levelling down interfere with that process.
Will the Prime Minister take time out today to talk to the chairperson of the Tameside and Glossop health authority to discuss the proposed cuts in health care: 24 per cent. in orthopaedic beds, when there has been a 51 per cent. increase in the waiting list this year; 18 per cent. in surgical beds; 19 per cent. in medical beds; and the closure of a hospital? All this in an area that the Black report described as one of the worst in the country for health provision. Will she come with me to Tameside to meet the doctors, nurses and patients to gauge their opinion of these Government-imposed cuts?
I am grateful to the hon. Gentleman. I have made inquiries from the Tameside and Glossop health authority. The number of patients that it has been treating since the reorganisation of 1982 is substantially up. In-patients are up by 34 per cent., and out-patients by 10 per cent. On capital building, there has been completed in the Tameside and Glossop health area a £2·6 million geriatric unit and there is under construction a £16·6 million phase 2 redevelopment of Tanieside general. It has received £110,800 extra from the waiting list fund for additional orthopaedic, gynaecological and ear, nose and throat patients, et cetera, et cetera.
May I congratulate my right hon. Friend and the Government on the firm and proper stand that they are making on the question of extra finance for the National Health Service? Does she agree that there is no shortage of funds, but that those funds are being improperly used and that what we need is greater efficiency? Does she further agree that in the whole 40 years of the lifetime of the National Health Service it has never been properly managed? [Interruption.] Why is it that we have 12 chairmen employing a total of 870,000 people in the other nationalised industries —[Interruption.]—but have never had a chairman with full and effective power to look after the National Health Service.
My hon. Friend is absolutely right. Well over a million—nearly l¼ million—people work the National Health Service. It can be properly run only by effective management. It was in the lifetime of this Government that managers were appointed. It is not the Government who provide finance; it is the taxpayer. This year the average family of four provided to the Health Service £1,500 in taxes and charges. Next year the average family will provide in taxes and charges £1,600 to sustain the National Health Service. It has a right to expect that money to be effectively used.
Despite the Prime Minister's pathological hatred of the Health Service, which she sees as a manifestation of Socialism to be destroyed, is she aware that on Wednesday 10 February Health Service workers and trade unionists in Liverpool will be engaging in a day of action to defend the Health Service? Will she now, at the eleventh hour, instruct the Chancellor, instead of giving tax handouts to the rich, to divert that money to the Health Service, or is she prepared to accept full responsibility in the event of a nationwide National Health Service dispute?
I had hoped that the hon. Gentleman would condemn those who take strike action at the expense of the patients—[Interruption.]
They are hitting out deliberately at the patients. It sounds as if the Labour party supports that strike and that industrial action.