Does the Prime Minister know of the grave shortage of resources that is affecting children's wards and units in hospitals throughout Britain? Is he aware that the unique baby life-saving unit in Groby Road hospital in my constituency is likely to have to close because there is no money locally and the Department of Health has refused central NHS funding? If that unit closes, as is almost certain unless the Government change their mind, what will the Prime Minister say to the parents of babies who will certainly die, totally unnecessarily?
As the hon. and learned Gentleman will know, I cannot carry in my head the details of each and every aspect of the national health service, but he knows that the average annual increase in the national health service budget has been more than 3 per cent. during the period of this Government—substantially higher than it was under any previous Government.
If public spending is to be paid for in the future by increases in our economy, in the opinion of my right hon. Friend do policies of increased taxation, increases in quangos and Ministries and a minimum wage level make a sensible policy to increase such a demand?
I suspect that I know what my hon. Friend is driving at. The reality is that the Labour party would never deliver any growth whatsoever to fund increased public expenditure. It never has and never would and any suggestion that it would is sheer wish fantasy.
Has the Prime Minister seen the letter from the health authority district general manager to his clinical directors stating that
the reality of GPs holding their own … budgets
equity has gone out the window"?
In view of that, will the Prime Minister withdraw the claim that he made in the House on Tuesday that operations are done on the basis of clinical need, as that claim is obviously fiction?
It is not fiction. Operations are done on the basis of clinical need. I have been advised within the last hour or so that the doctor to whom the right hon. Gentleman referred has also said that the big advantage of the trusts is that you are opting out of bureaucracy, not out of the national health service. At Bart's, the hospital at which he works, they are treating more patients at less cost. Over 1,000 jobs may have gone in the last five years, but more patients are being treated.
Since the Prime Minister also wants to quote Dr. Grant, I remind him that he is the man who said that they are opting out of equity. Can I put it to the Prime Minister again? Is not it clear that the Prime Minister's health market policies have now made queue-jumping the order of the day and that the clinical needs of patients are coming second to commercial considerations? I put it to him again. In view of that reality, on the testimony of Dr. Grant, will he now withdraw the false claim that he made two days ago that operations are done on the basis of clinical need? It is fiction.
No, I will not, and I will call in evidence to support my position Mr. Rowden, the chief executive of West Lambeth health authority, who writes to the press as a nurse, a general manager in the national health service and a member of the Labour party. I quote:
For Labour to suggest that the old-style district health authorities provided a sound basis for the management of the NHS is spurious to say the least. Decisions prior to the reforms were arrived at by a process of those who screamed the loudest, and we have all witnessed various displays of shroud-waving … This was not a rational way of making difficult decisions, and perhaps the key benefit from the NHS reforms will be the evolution of a system that will lead to rational and informed debate about how and why we use precious resources in our NHS.
Like his predecessor, the more the Prime Minister goes on in his answers, the less convincing he becomes. May I put it to him again? Does not he agree with the testimony of one of his supporters, a district general manager, who says that because of his system equity has gone out of the window? Will not he affirm now that, as a consequence, operations are not being done on the basis of clinical need but on the basis of commercial considerations?
I neglected inadvertently to complete the quote from Mr. Rowden, the Labour party supporter. He deals with the point that the right hon. Gentleman now raises:
Will my right hon. Friend give an assurance that, unlike the Labour party, he will keep public expenditure in line with what the country can afford? Furthermore, as the First Lord of the Treasury, will he make available to Her Majesty's Opposition the full facilities of the Treasury to check out their taxation and spending plans, as clearly their sums do not add up?
I can certainly give my hon. Friend the assurance that he seeks. Our economic policies in the last 12 years have achieved a remarkable treble—tax cuts, spending increases on public services and a reduction in the national debt. The extra £20 billion that Labour promises is spending that it could never deliver out of growth which it has never previously provided when in government. The only things that would grow under the Labour party would be taxes, inflation and national health service waiting lists, just as they always have done.
Does the Prime Minister realise that while the scale of international relief in Bangladesh is still pitiful in relation to need, there is nevertheless real pride about Britain's lead in providing it? I again ask the Prime Minister why it is that he, his Government and, it appears, the written press continue to ignore the incalculably greater scale of the disaster now unfolding in Africa? I want the right hon. Gentleman to assure the House that he knows and understands that 27 million lives are imminently at risk and that in some areas food will run out at the end of this week. If he knows about these matters, will he tell the House what he intends to do to help?
I am grateful to the right hon. Gentleman for what he said in the first part of his question. The assistance that we have given to Bangladesh has made us the largest single national donor. We are prepared to do more and are urging others to do more. Particularly in the months ahead we will need to seek a better international way of co-ordinating assistance when great tragedies such as this are faced. I shall do what I can to bring that sort of system about. On the subject of Africa, I remind the right hon. Gentleman that we are providing substantial aid and providing it fast. After the United States, we are the second largest bilateral food aid contributor to the Horn. We have done a great deal and, where necessary, we will be able to do more. However, we cannot do everything that is necessary on our own. We have a better record than almost anyone in the world and we can justly be proud of that record.
Is my right hon. Friend aware that 12 years ago to this day he and I first entered the House? I congratulate my right hon. Friend on his personal dedication and commitment to an improvement in public services throughout that period. If the history of the 1980s shows anything it is that it is possible to reduce taxation while simultaneously and dramatically improving public services.
My hon. Friend is quite right about that. Perhaps I may take this opportunity to welcome my hon. Friend back to the House after his illness. We are all very pleased to see him here and looking so fit and I look forward to seeing him sit here with me for at least another 12 years and possibly a good deal longer. My hon. Friend is absolutely right. Such improvements depend on the levels of growth that we have achieved over the last decade, which levels Conservative Governments traditionally achieve and Labour Governments fail to achieve.
As the Secretary of State for Scotland and the Secretary of State for Energy both oppose test drilling by Nirex in their constituencies, does the Prime Minister understand why the people of Scotland do not wish to see up to 6,000 planned test boreholes being drilled in Caithness? If Nirex proposes to spend such time, effort and money in drilling up to 6,000 boreholes, how can the Prime Minister expect anyone to believe that Nirex has not targeted the north of Scotland as a nuclear dump? Scotland has been badly let down by this decision.
As the hon. Gentleman will know, there will need to be quite specific planning consents before there can be any dumping of waste there. That matter lies in the future, but before any dumping at all could take place after the test borings, quite specific planning consents would need to be granted. We will look carefully at those when they come forward.
Will my right hon. Friend accept that when we came to office 12 years ago the top rate of taxation was 82 per cent., that it is now 40 per cent. and that the miracle has happened because everyone has been encouraged to work harder which has meant that £17 billion more has been spent on the health service this year than when we came to office? Does he agree that a nightmare will strike people such as a police sergeant, a deputy head teacher or a doctor when they hear that if they earn £20,300 a year they are among the rich and are to be taxed and taxed and taxed again.
That would certainly do nothing but damage to enterprise; and it is certainly true that, over the past few years, lower rates of tax have produced a higher yield.
My hon. Friend is right about people earning £20,000 a year. In no sense can they be described as rich. Last year in London and the south-east £20,000 was less than the average white collar wage and it will certainly be much less this year. It is less than many Metropolitan police constables and sergeants, senior house officers, registrars or junior doctors earn. It is less than many teachers earn. Those are the people whom the Opposition regard as rich and whom they would tax not only unreasonably but as they did in the 1970s: right out of this country.
As the poll tax has been a big mistake, why should people be hounded and imprisoned in England? Why should they suffer because the Government got it wrong? People outside think that something has to give—that there should be an amnesty. The Government should understand the position of the 16 individuals in England—[Laughter.] It is not funny.
This is important, because people cannot be imprisoned in Scotland but they can be in England. Let us free these political prisoners. That would be an important decision.