I thank you for calling me to speak in the debate, Mr. Deputy Speaker, because this issue is of immense importance to my constituents. Indeed, no more important area of concern has been expressed in correspondence from consultants, doctors, and the general public than the reform of the National Health Service.
We cannot discuss the Bill without considering resource allocations—on which the Bill is silent. Whether we are talking about hospital services, community services or general practitioner services, the Government's proposals are silent on the need for extra resources. Ministers trot out figures time and again about the extra money that is spent on the Health Service, but they never put that in the context of the extra demands for health care, the growing numbers of elderly people who need health care and the new technologies that increase the cost of health care.
We should consider the Bill in the light of what is found in individual health authorities, such as my own in south Manchester. It has been suffering from a financial crisis for many years and, despite all the cost improvement programmes that it has implemented, it is now £1·5 million short in its budget for this financial year. The health authority has therefore had to freeze vacancies, and 120 posts in the provision of health care have been lost this year.
Despite repeated representations to the Secretary of State for Health for more resources for south Manchester, he has refused to entertain our request. The latest letter that we have received from him shows his thinking on how that financial crisis has arisen. He says:
I do not know whether the clinical regrading costs arise from previous errors in the original gradings or over-generous findings on appeal.
The Secretary of State says that one reason for the problem is that south Manchester health authority, when it was assessing the grade of staff in the nursing service, was overgenerous, and gave them more money than it should have. That is the sort of Secretary of State we have; that is how he considers the needs of our staff.
What is the health authority now doing to save money because of the financial crisis? It has published a consultation document on rationalisation of the service. That means further cuts in service. The document does not identify how much money it intends to save or give the figures. We can be sure that two things will be lost in south Manchester: the accident and emergency department at Wythenshawe hospital will be closed for major accidents and transferred to Withington—Wythenshawe is next to Manchester airport, but it will not have a major accident service—and Withington hospital maternity unit will be closed, with all mothers transferred to Wythenshawe. What patient choice does that mean?
Let us consider the Second Reading debate to date. When asked about obstetric services, the Secretary of State said:
The other day, it was hinted that expectant mothers may lose local obstetric services because of our proposals. That is
nonsense. No right hon. or hon. Member would suggest any of that rubbish."—[Official Report, 7 November 1989; Vol. 163, c. 503.]
South Manchester is having to close maternity services to save money. Can we believe the Secretary of State's statements about the Bill?
I have the unhappy task of trying to defend one of the hospitals that is on the Government's long shortlist for opting out—Christie hospital in south Manchester.
The Secretary of State justified opting out, saying that it will free nurses and doctors who have been frustrated by the constraints of bureaucracy for years, and will allow them to use their abilities and to work as they wish. When I asked doctors, consultants and nurses why they had expressed an interest in opting out, they identified one reason—lack of cash. They are heartily sick of a Health Service in which they cannot provide care to the number of patients they want because they are short of resources. That is the only reason why they have expressed an interest in opting out. They do not want to go down that road, but they want to get more money out of the Government. They are appalled that the regional health authority is bringing in extra staff to develop plans for opting out when there is a freeze on nurses' jobs in the hospital. There is a freeze on nursing staff, but more accountants can come into the Health Service. That shows the strength of the Government's commitment.
A meeting of 185 local doctors in Manchester and of the local medical committee passed a resolution that was in absolute opposition to the Government's plans for GP services. GPs are fearful, regardless of the assurances given by the Secretary of State, about what cash-limited budgets will mean for the service delivered. As my hon. Friend the Member for Burnley (Mr. Pike) said, what is happening to the social fund is a good example.
Last weekend a constituent came to me because she had been refused a community care grant. She was told that there was no money left in the budget. After further investigation, I found out that the Department of Social Security is having to reassess priorities within the budget, because the cash is running out rapidly. If my constituent had gone to the DSS earlier in the year, she would have got a grant, but at this stage, because of the change in priorities, she will not. GPs fear that the same thing will happen with their practice budgets. They may be able to prescribe a particular treatment for one patient at the beginning of the year, but when money is getting short they may have to prescribe another treatment for a similar patient later in the year.
General practitioners are worried that they will not have the capital that they need to develop their clinics and practices to meet the demands of the extra treatment that they will have to undertake.
In my area of Chorlton, the local health centre is already bursting at the seams. There is no room for a typewriter let alone a computer to undertake the administration that will be imposed by the Bill.
General practitioners are anxious because they already face restrictions on where they can send patients. Last week they received a letter from the regional health authority which said that, because of financial and manpower resources constraints, neurosurgery would be limited to which hospital a particular doctor in a particular area could send his patients. We already have restrictions on patient choice, and the Bill will make that worse.
Finally, GPs are concerned that waiting lists will be transferred from the hospital to the GP's practice. GPs will have to determine where to send patients, but the amount allowed for under the contract with a particular hospital for a range of services may have run out. The waiting list will be at the GP's door, not at the hospital's door.
Our opposition to the Bill is summed up best by a letter that I received from a constituent. He clearly reflects the Labour party's view when he says:
I am an ordinary citizen, with a wife, three young children, and elderly parents. We all have cause to be thankful that our GPs have given us the best treatment they could provide to meet our needs, rather than the best treatment they could offer within the limits of their local budgets. And they have referred us to hospitals near our homes which provided services the population needed, rather than those which managers decided they could market efficiently. I would like it to stay that way, and if that means I must pay more in tax, I will pay more in tax. I have never before written to make my feelings known to a Member of Parliament. That I do so now is a measure of my profound opposition to the Government's proposals.
That letter is one of thousands that I have received. The people of Manchester and the other people of Britain will totally oppose the Bill.