I congratulate the hon. Gentleman on securing this opportunity to discuss the position in his health authority and, particularly, to clarify several important points causing great anxiety in the North East Thames regional health authority. The hon. Gentleman has raised questions about the health service on several occasions in the House. We respect and understand his interest and anxiety. That anxiety is shared by the Government. The hon. Gentleman will be aware that we are determined to ensure that we use the record resources going into the health service and the record number of people working in it to provide a high standard of care of the people of Britain.

The hon. Gentleman began by asking me about the principles of the national health service and whether we held to the essential founding principles. I can give him an unequivocal assurance that the national health service is, and will remain, available to all, free at the point of delivery, financed largely out of taxation and funded to a record level that many would have thought inconceivable only 10 years ago. That is so, with regard to not only the numbers of people working in the service and the way in which they are paid, but the knowledge, the pharamaceuticals and the technology available to the hon. Gentleman's constituents and to mine. However, it is precisely because of the growing and developing nature of medical care that we cannot avoid change. We need to rationalise and to develop the ways in which we provide care.

The hon. Gentleman referred several times to bed closures and to hospital closures. It is a simplistic view of the health service to regard it as primarily concerned with beds. It is primarily concerned with patient care. We must always get the balance right between the provision of acute care and operations, which are enormously important to those who need them, and the broader care—the community care—and the services for the priority groups, such as the mentally ill and the mentally handicapped.

A distinguishing feature of our national health service, as the hon. Gentleman is aware, is the family doctor service. I hope that he will set the way in which that services has developed in recent years in his constituency alongside his concerns about acute care, with which I shall deal in a moment. In the hon. Gentleman's family practitioner committee area—now the family health services authority area—there are now three times as many practice nurses as there were three years ago. Over the past 10 years, there has been a fall of more than 100 in the number of patients on the average GP list in his constituency. There has also been an increase of 13 per cent. in the number of GPs in his family health services authority area and there have been great developments in the care provided by the hospitals in his area.

I will give an example about which the hon. Gentleman will wish to tell his constituents. Between 1988 and 1990, the number of day cases undertaken by the major hospital in his area increased by nearly 50 per cent. That is an achievement of which to be proud. Only recently, the Audit Commission took a number of health authorities to task for the lack of speed with which they had moved towards day cases. There has been an increase of about 60 per cent. in London as a whole, which is excellent, but the hon. Gentleman's area has done particularly well.

It is not our intention to put people into beds and leave them there indefinitely, but to use the resources to the full to provide better care. That certainly applies to operating theatres. The recent Bevan report dealt with the essential need to use operating theatres to the full. The hon. Gentleman said that operations had been cancelled, but "cancelled" is not the right word. Some have been postponed for a variety of reasons, the lack of validation of a list and the lack of proper planning to ensure that staff would be available. Sometimes emergencies have occurred and the non-urgent cases have been put back. Alongside that, about 10 per cent. of patients do not show up for their appointments.

We must ensure that the national health service manages its services effectively and that the public and the patients realise that it is not a cost-free service. It may be free at the point of use for our constituents, but next year costs will approach £30 billion. The onus is on all of us to ensure that we understand the range of resources brought together through the work of the district health authority and the family health services authority and integrated under the umbrella of the region. We must ensure that we evaluate and monitor our work to continue to push forward the frontiers.

The hon. Gentleman has centred the debate around a letter sent out by the regional general manager of the North East Thames regional health authority. I welcome the opportunity to clarify the matter. The idea that the letter was leaked is fanciful. It was a routine letter, which I have with me, and there is no question of its being confidential or private. I am sure that the hon. Gentleman can confirm that there is no mention of its being secret, confidential or private. I appreciate the opportunity to clarify the issue. Duncan Nichol, the chief executive of the national health service management executive, has written to all regions to put the position more clearly. In order that there should be no misunderstanding, I intend to place a copy of the letter in the Library of the House. Misunderstanding and mischief often lead to unjustified anxieties among patients.

Waiting lists and waiting times are important in terms of the length of time an individual waits, rather than the exact number on the waiting list. We have made it clear that we want action to be taken on the long waits. Our health service treats patients according to clinical priority so that 50 per cent. of patients are admitted immediately because they are urgent or emergency cases. Of the 50 per cent. of patients who are not admitted immediately, half are admitted within five weeks, so three quarters of all patients are admitted immediately or within five weeks. We share the hon. Gentleman's concern about those who are not admitted within that time scale and for whom there are sometimes unacceptable delays. Inevitably, there are the ones who do not require urgent, acute operations. The hon. Gentleman will know that it causes anxiety and uncertainty to the patients and their families if it is not certain when they will be admitted.

The number of patients waiting more than a year reduced by nearly 7 per cent. in the year to 31 March 1990, and provisional figures show that that downward trend is continuing. The North East Thames authority has bettered those figures—there has been a reduction of long-wait patients of 28 per cent. In the year to 31 March, provisional figures show that the region's figures are continuing the downward trend. I am pleased to see the great strides being made in the region in terms of dealing with long-wait patients especially since, as the hon. Gentleman is well aware, the North East Thames authority has had a particular problem with the number of such patients.

In the district health authority covering the hon. Gentleman's constituency of Haringey, the period from March 1989 to 31 December 1990 saw a 35 per cent. decrease in the total number of in-patients waiting, so the authority has done particularly well in recognising and meeting that challenge. In the year ending March 1990, Haringey reduced the number of in-patients waiting more than a year from 842 to 385—a 54 per cent. reduction. I am sure that the hon. Gentleman will want to join me in congratulating Haringey health authority on so clearly and strongly identifying that problem as one needing action. However, there is room for more action. That is why the management executive and the Secretary of State have identified long waits as a special priority in the health service.

We have been working with the special waiting list fund. During the past five years we have spent £154 million to enable hundreds of thousands of extra patients to be from the waiting lists. Next year, £35 million will be allocated to health authorities from that fund, and the regions will supplement that with a further £25 million from their own resources. The North East Thames authority, which covers the hon. Gentleman's area, will be allocated £2·63 million from the fund, which the authority will match, making a total of £5·26 million.

It is not just a case of increasing resources, but of increasing efficiency. I have spoken about the importance of validating the lists, of some of the administrative tasks which need to be undertaken and also of clinical validation.

The aspect that the hon. Member for Tottenham (Mr. Grant) mentions applies to clinical validation. It is important for clinicians to examine the list, to check and to satisfy themselves that the people on it are in need of surgical treatment. I think that the hon. Gentleman will agree that there is the world of difference between a varicose vein which may be unsightly, but is not troubling a gentleman who wears long trousers all day and causes him no pain or difficulty, and a varicose vein which is extremely unsightly, possibly ulcerated, or causing great difficulty. Similarly there is a difference between a tattoo which can be seen by no one and, although disliked by the patient, cannot be said to be causing distress or pain and a tattoo which causes great psychological distress and is a source of great concern. Wisdom teeth can be in need of clinical attention and can cause pain and difficulties to the patient, but patients may also simply wish that they did not have wisdom teeth although there is no clinical need for their removal.

North East Thames regional health authority was seeking to identify a range of operations where districts and, especially, clinicians would wish to satisfy themselves about the clinical aspects. It would be quite wrong to think that that list constituted a prohibition on those operations—on the contrary—but a need has been identified to check on the clinical need for such operations.