With permission, Mr. Speaker, I should like to make a statement on the national health service in Wales.
I am pleased to be able to announce to the House next year's Government expenditure on health and personal social services in Wales. Funding will increase by a massive £186 million, taking national health service spending in Wales to further record levels in real terms. My proposals mean that national health service expenditure in Wales will be boosted to £651 a year for every man, woman and child in Wales, or, put another way, more than £2,600 for a family of four.
The Government are determined to ensure that health in Wales is accorded the highest possible priority. The figures reflect our personal commitment—and my commitment in particular—to secure the investment for health care in Wales that will enable the national health service to go forward from strength to strength.
Our commitment to the national health service cannot be clearer. We are giving it the support that it needs to move forward quickly on the imaginative and exciting course on which it is embarked. But that support is not limited just to words: I am backing my judgment with cash and at record levels.
Planned provision for the national health service in Wales will increase to £1,877 million next year. That compares with the figure in 1979–80 of £481 million. That is £1,877 million against £481 million—the record speaks for itself. Of the £1,877 million, £1,420 million is earmarked for hospital, community health and related services. This includes the costs arising from Welsh patients who travel to England for treatment following the new charging arrangements.
The new money that the Government are making available will provide the national health service in Wales with an increase of 11·1 per cent. on comparable expenditure plans for this year. In addition, health authorities will keep as a minimum an extra £13 million generated by cash-releasing efficiency savings.
I expect to announce allocations to health authorities next month, but I can say today that my proposals will enable them to continue to plan with confidence for the health care needs of the people of Wales. They will be in a position to increase activity significantly next year and this will maintain downward pressure on waiting times. In addition, capital allocations will provide for the building of new hospitals and the uprating and expansion of existing units.
I also wish to refer to the development of national health service trusts in Wales. Pembrokeshire health authority formally applied to become a national health service trust on 16 July and the statutory consultation period ended on 31 October. Taking account of the views received, alongside the individual merits of the application, I have decided to establish the Pembrokeshire national health service trust with an operational date of 1 April 1992. The order giving effect to this decision has been made today and the trust will commence "shadow" running on 16 December.
Pembrokeshire will be the first trust in Wales and, I believe, clearly shows the way forward for the future delivery of health care. I am on record with my pledge that applications for trust status in Wales will not be approved unless I personally am convinced that patients will benefit.
Local people can be justifiably proud of the NHS in Pembrokeshire and I am confident that the trust will generate even stronger links within the community in responding to present and future health care needs. The local identity of the national health service trust will be reinforced by a board drawn from local people and led by Mr. A. J. G. Bowen.
Elsewhere in Wales, NHS trusts are progressively being seen as the natural organisational model for patient care. They bring the management of health services closer to the local communities and respond directly to local needs. When I met health authority chairmen last week, they reported that they expected a significant number of expressions of interest to be lodged to become national health service trusts in 1993. They expect that they will account for nearly half our major patient care providers in Wales. I expect shortly to announce the details of hospitals and other health service units invited to proceed to draw up applications.
As part of the consultative arrangements on the trust application, I had proposed separately the creation of a new West Wales health authority. In the form suggested, this proposal had only limited support locally and, in recognition of this, I have decided not to proceed with the new authority. As a consequence, Pembrokeshire and East Dyfed health authorities will be retained, with Captain Phillips remaining as chairman of Pembrokeshire. However, I shall be looking to both health authorities and the Dyfed family health services authority to work closely together in developing clear strategies to identify and then meet local needs. The residents of Pembrokeshire will expect no less.
A further growing development in the NHS in Wales is the creation of GP fund holders. I have already given details of the seven practices established as fund holders in April this year. I can now tell the House that a further 19 practices have successfully applied for fund-holding status from 1 April 1992. Final decisions rest with the GPs involved, but I will provide in due course details of the practices which will formally become GP fund holders in 1992.
Those developments and the extra resources that I announced earlier will enable the NHS in Wales to respond positively to the challenges of the future. The Principality can look forward with confidence, secure in the knowledge that our vision of the future is founded on a greater range of services, more opportunities for individual choice, and even higher standards of care for everyone.
We know what the right hon. Gentleman is attempting. He is putting his sugared financial announcement on a bitter trust pill. On the finances, we have seen it all before. During the run-in to the general election there is a little more money, but do not Conservative cuts come after a general election victory, if they have one?
The key part of the statement was about trusts. I remind the right hon. Gentleman that more than 2,500 people are waiting longer than one month for urgent surgery—more than 12,000 are waiting more than a year —and that more than 86,000 are waiting for a first out-patient appointment. That is after the Conservative Government have been in power for 12 years.
The right hon. Gentleman has just said:
Pembrokeshire will be the first trust in Wales and, I believe, clearly shows the way forward for the future delivery of health care.
With that sentence he threatens Wales. It is symbolic. Clearly, hospital trusts are to be the norm if the Government are re-elected.
The statement that we have just heard is one of the most disgraceful and extraordinary ever to be made by a Secretary of State for Wales. I remind the right hon. Gentleman that time and again the Conservative vision of a commercialised internal market in patients with opt-out trust hospitals competing for patient contracts has always been rejected by the people of Wales. Why, even with the spectre of general election annihilation before them, are Welsh Office Ministers persisting with that discredited plan?
The statement shows again that the national health service is not safe in Conservative hands. Does the Secretary of State accept that the opt-out proposals for a Pembrokeshire trust are nothing more than an elaborate con job paid for by a £50,000 Welsh Office sweetener? Will he admit that the trust, and any other trusts, will be unaccountable to the local community and will take, in secrecy, behind closed doors, crucial decisions on health care for Pembrokeshire? Does the right hon. Gentleman understand that the process of creating trusts in Wales will be stopped by an incoming Labour Secretary of State for Wales and that any hospital that has already opted out before the general election will be brought back under the management of the local health authority?
What the right hon. Gentleman has said today will never be accepted by the people of Wales. When the general election takes place, the right hon. Gentleman and his contemptible proposals will be swept away.
On the first point about funding, the hon. Gentleman said that he had seen it all before. He has seen it all before under this Government, but he did not see it when Labour was last in office. I remind him of the figures. In 1979–80, we spent in the national health service——
I will come to those.
In 1979–80, we spent in the national health service £170 for every man, woman and child in Wales. If spending this year was at the same level, uprated to take account of inflation, we would now be spending at the rate of £392 for every man, woman and child. The actual figure this year is £614 and, under my proposals, it will go up to £651[Interruption.] Opposition Members do not like the figures, but they cannot dispute that the figure for spending in 1979–80 was £481 million in cash terms. My announcement increases it in real terms by 60 per cent.
Under the previous Labour Government, the number of new out-patients treated fell by 3 per cent. Under this Government, the increase between 1979 and 1990–91 has been 29 per cent. Between 1974 and 1979 under Labour, the number of in-patient cases went up by 6 per cent. Under this Government, the figure has gone up by 39 per cent. and the number of patients being treated is now at a record level.
The hon. Gentleman said that the first trust threatened Wales and he used the phrase "opt out". We had all that in the Monmouth by-election. That phrase has scared many people in Wales. Opposition Members were more interested in scaring than in caring. I visited Nevill Hall hospital last week, where I found that the people are very satisfied with the national health service in Wales. I reminded people that in 1979, 1983 and 1987, the Labour party said that the health service was not safe in the hands of a Conservative Government. The latest poll shows that 93 per cent. of people are satisfied with the health service.
Of course we must not see hospitals opting out of the national health service; that has never been the intention. I want national health service trusts which mean that management gets closer to the people. The hon. Gentleman said that the trust was unpopular. Since my visit to Nevill Hall, there has been a by-election in a Labour seat in Abergavenny and the seat has been won by the Conservatives. That carries a message to the Labour party.
The extra money for the health service in Wales is an inflation-busting announcement which will be welcomed in the Principality. It will mean that our very good health service will be able to expand in quality and in quantity.
I welcome the trust status for Pembrokeshire. We have heard the most disgraceful claims, made for electoral reasons, that hospitals will close or basic health facilities will be denied, but the people who have really studied the matter in the interests of the patients—the community health council, the staff and the doctors—have come out in favour of trust status. That proves that the opportunity for trust status means that decisions will be taken locally in the interests of local people.
I greatly welcome what my hon. Friend said about funding and I have cited the revenue figures. Let us look at what happened to capital in the health service under Labour. Whereas capital has increased substantially under this Government, in real terms between 1974–75 and 1979–80 it went down by £11·7 million. No wonder Opposition Members are so silent.
As for trusts, I totally agree with my hon. Friend, but I am not prepared to approve an application for a unit, hospital or an authority to become a national health service trust unless I am satisfied that that will lead to better and more local management and a better range and quality of service to patients, with clinicians involved in key management posts and better patient care.
Does the Secretary of State's announcement on NHS trusts for Pembrokeshire and possible proposals that may come from elsewhere in Wales show that we are to have a two-tier health service—those who get the service and those who get a second-class service? At Nevill Hall hospital, which also serves my constituency, the consultants and staff are opposed to trust status. Will the right hon. Gentleman tell us whether he has received any proposals from that hospital for NHS trust status and whether he will grant it?
I am concerned that the Liberal party has not welcomed the funding announcement. The hon. Member for Brecon and Radnor (Mr. Livsey) has not said anything at all about it. Members of Parliament always call for more money, but, when I come to the House and bring record sums with me, I get no welcome. On the trust point, of course we will not have a two-tier health service in Wales. I want every national health service trust to remain within the family of the national health service. I want every national health service trust to provide patient care which will remain free at the point of delivery. I want every national health service trust to remain funded out of general taxation as it is at present. That is the position. That is not a two-tier service; it is a better service.
Is it not well nigh incredible that, after the manifest collapse of command economies in eastern Europe—a collapse that was precipitated by the absence of any market mechanism to demonstrate where resources are needed—the Labour party should continue to oppose the use of market mechanisms within a truly free national health service in order to show precisely where resources can best be used? Did my right hon. Friend, during his triumphantly successful visit to Ysbyty Glan Clwyd in my constituency, note the general satisfaction of patients, staff and doctors with the changes that have been brought about, and did he note the utter baselessness of the charges that have been brought by the National Union of Public Employees about changes in that hospital?
I greatly welcome what my hon. Friend said. I enjoyed my visit to Ysbyty Glan Clwyd yesterday. I found a very positive attitude by all the people whom I met and I met many patients. I opened the new foyer, which was built in response to a questionnaire that the hospital had carried out among patients to see what they wanted to be improved.
No, I am now talking about the truth that my hon. Friend has put forward. That foyer was very much what the public wanted. I provided special additional money for it. The league of friends, the local volunteers with whom I was extremely impressed——
The hon. Gentleman should listen and pay tribute to the league of friends. The league of friends raised £50,000 specifically to improve the foyer. I hope that the hon. Gentleman visits that hospital, too, because he will find general satisfaction. The surgical ward is now scheduled for redecoration. At that hospital, several hundred more operations have been performed than at this time last year.
The Secretary of State mentioned that his aim was to bring management closer to the people. He also announced that East Dyfed health authority would remain and that there would be no West Wales health authority. Is he aware that, as a result of the Government's vindictive and often partisan appointments to health authority boards, there is no representative, and has not been for some time, from the Lanelli area on East Dyfed health authority, yet Llanelli is the only major industrial area in all west Wales? Will the right hon. Gentleman now make good his statement about management being closer to the people and appoint someone from the Llanelli area to the board of East Dyfed health authority?
We have to have the most able people serving on the health authorities. If the hon. Gentleman can provide any names, I am perfectly prepared to consider them—[Interruption.] Well, I shall simply tell the hon. Gentleman that under the last Labour Government—[HON. MEMBERS: "Disgraceful."] Yes, it is pretty disgraceful for the hon. Gentleman not to pay tribute to the fact that, thanks to the Conservatives, there is a new hospital in Llanelli, the Prince Philip hospital.
The right hon. Gentleman chided the Liberal party for not welcoming his increased expenditure, but will he tell the House the comparable figure for actual expenditure last year, because he compared the figure that he announced today with last year's expenditure plans? Will he use the actual figure for the comparison to see whether that shows an 11 per cent. increase? Does he accept that, whatever he says today, he and his party have lost the political debate over the future of the health service in Wales and that, whether he likes it or not, his announcement today will be seen as extremely divisive? Does he accept that the public see the setting up of national health service trusts as one step away from privatisation? Is not that the case?
No, not at all. I suppose, however, that I have gained something because one Opposition Member actually said the other day that the proposals are halfway to privatisation, so I have managed to move the Opposition halfway. I hope, however, that hon. Members will soon realise that this has nothing to do with privatisation. As far as I am concerned—as far as the Government are concerned—the health service will not be privatised. The hon. Gentleman said that I chided the Liberal party, but I now chide Plaid Cymru for not welcoming my announcement——
No; if the hon. Gentleman looks at Hansard he will see that he did not actually say that he welcomed it. He questioned some of the figures. The 11·1 per cent. is an increase on the provision for this year and an 8·2 per cent. increase on the outturn. When the hon. Gentleman bears in mind the fact that inflation is 3·7 per cent. and notes the increase since 1979–80, he will recognise that these are substantial increases which represent 60 per cent. more in real terms.
The Secretary of State may not realise that I regularly read the Pembrokeshire newspapers which, during the past few months, have contained many letters about the trust application, most of which—in fact, the large majority—have been hostile to it. May I draw the right hon. Gentleman's attention to an opinion poll that was conducted by the Western Telegraph last August, which showed that 85 per cent. of that newspaper's readers opposed the Pembrokeshire trust application? Why does not the Secretary of State listen to the people of Pembrokeshire? Does he realise that his foolish decision today will cost the Under-Secretary of State, the hon. Member for Pembroke (Mr. Bennett), his seat at the next election?
I, too, read the Pembrokeshire newspapers and constantly see praise of my hon. Friend the Under-Secretary of State—[HON. MEMBERS: "In his own column."]—not only in his own column, but elsewhere in the newspapers. I am keeping a careful watch on the situation to which the hon. Gentleman has referred and I hope that he will recognise that there are polls and polls. When the legislation was going through the House, there was a long debate about whether local polls should be held and the House decided against that. Of course, we must take the right decision for the sake of all the patients in the health service. I sincerely believe that what I have announced today is a move in that direction.
The Secretary of State will know that the opt-out process for schools involved at least a partial, if flawed, consultation process. Is not he ashamed that there is no provision at all in this process for accountability or consultation? Is he aware—he must be—that we are already approaching a general election campaign and that the hospitals that have decided to bow to Welsh Office pressure on this matter are effectively intervening in a partisan way in what will be one of the major issues of that general election campaign? Will he therefore give an undertaking that Nevill Hall, which, despite the right hon. Gentleman's visit, has decided not to seek opt-out trust status, and Morriston hospital and others, which have not set out recklessly on that path, will not face any reprisals from the Conservative party until the election?
There were about 10 wrong assertions in what the hon. Gentleman just said. I cannot possibly deal with them all if I am to allow other people to ask questions. I wish that the hon. Gentleman would stop using the phrase "opt-out". A leaflet is going round, issued by Support the Wales TUC, called "Defend the NHS". It says:
Opting out. Throw out opt-out.
On the second page it says:
Street ballots are to be held across West Glamorgan as a means of offering the public the opportunity to show their opposition to opting out.
That sort of ballot is bogus.
There is no opting out, I am prepared to approve a national health service trust only as long as I am satisfied that it will lead to better patient care and that it will remain within the national health service. There is no pressure from the Welsh Office. It is up to the local hospital to reach the decision.
I am sure that the Secretary of State is aware that I have opposed his trust proposals for a long time and I believe that the majority of my constituents in North Pembrokeshire are against such a trust. Now that the Secretary of State has made the decision, I wish the trust the best of luck in the years to come in the interests of the people of Pembrokeshire. I compliment the staff, the nurses and everyone involved with Withybush hospital.
Can the Secretary of State give an assurance to the rest of the people in Dyfed that he will not form another trust until the Pembrokeshire trust has completed a three-year trial run to determine whether the trust status now on offer to the people of Pembrokeshire is a success?
I accept the first part of what the hon. Gentleman said. It was a recognition of the reality. As I understand it, the local community health council in Pembrokeshire decided to support the application for NHS trust status. So did the staff and the consultants. The hon. Member for Swansea, East (Mr. Anderson) talked about a lack of consultation, but there was a clear expression of view.
The hon. Member for Ceredigion and Pembroke, North (Mr. Howells) talked about the future. I sincerely believe that NHS trusts are the way forward. They bring management closer to the people and the hospital. They allow hospitals to be independent of any outside bureaucracy, to make their own decisions and to have their own budget. That is why I certainly would not block any further applications.
Obviously, any extra money for the health service or any other public service, in Wales or anywhere, is to be welcomed. What we find most difficult to accept is the sanctimonious self-congratulation and the hyping up of the extent of the increase in the money provided. Of course, we know that the figures are bogus. For example, how much of the increase in spending is simply due to the extra number of old people and people getting older who need treatment in this decade compared with the 1970s? That is a significant part of the increase.
I have already answered that point. Of course, some of the increase is to take account of increased need. I am arguing against the Labour party's constant accusations that the Conservative Government are making cuts. I analyse the figures on a per capita basis because that is one of the fairest ways. That we spent £170 per capita in 1979 is without challenge. It is the actual cash figure. Taking inflation into account, the figure would be £392 today. It is actually £614. It will be even higher as a result of my announcement today.
As a result of the increase in funding that the Secretary of State announced today, can he guarantee that this year it will be possible to carry out 1,200 open heart operations in Wales? A commitment was made as long ago as 1984 by his predecessor, yet fewer than 800 operations are being carried out. If GP fund holders are able to buy that or any other service, will the Secretary of State guarantee that in no unit in Wales will it be possible for a consultant surgeon to discriminate against a non-fund holding GP in favour of a GP fund holder who has referred his or her patient to the hospital?
On heart operations, I cannot give the guarantee for which the hon. Gentleman asked, but all district health authorities in Wales are signed up to reduce waiting lists and waiting times in this financial year and to continue that process in succeeding years. The latest evidence shows that activity levels in Wales will be 4 to 5 per cent. up on 1990–91 and that health authorities will meet the "agenda for action" targets for patients waiting more than one year for in-patient care, which is only 19 per cent. but is still too high. We want some improvement. We want to come close to the target for out-patients waiting more than three months for an appointment, which is 28 per cent.
I am a shy and retiring violet.
Will the provision that has been made for extra funding be able to help the Taff Ely and Rhondda districts of Mid Glamorgan health authority, which is £900,000 overspent, and which faces the closure of wards in the coming winter, including ward 11, a children's ward, which has just been refurbished? The Secretary of State knows very well that that ward will soon be full of children with asthma and bronchial problems. How are they to manage if that money is not made available to them?
On the serious remarks that he made, obviously it is up to the health authority to manage the budget that it receives. He should take up those areas of concern with the chairman of his health authority. However, will he again recognise that we are talking about record levels of funding? Today's announcement means an even higher record than before.
The Secretary of State for Wales is busily carving up the health service in Wales like a Christmas turkey. Is he aware that thousands of my constituents are flooding me with signatures on petitions which oppose the opting out of Neath hospital and its registration of an interest to start the application process? Will he arrange for a ballot to be conducted by Neath borough council and let the people of Neath have a voice in whether their hospital should opt out?
May I remind the hon. Gentleman that not long ago he was congratulating me on having announced the new hospital in Neath. He cannot suddenly move from one extreme, which I welcome, to another, which I do not. Or, I suppose he can.
On ballots, I, too, would vote against opting out of the NHS, but that is not what is on the agenda and never has been.
Will this new money—if it is new and is not vired from some other budget—help waiting lists, bearing in mind the fact that the right hon. Gentleman mentioned that the surgical ward in Ysbyty Glan Clwyd is to be closed for redecoration for six months? That is probably an inefficient way to decorate a ward. The surgical team who face that ward closure have been successful in reducing waiting lists until now, when the money has run out. Will the money help? Which waiting lists will it tackle? One gentleman in my constituency is having to wait 18 months to get on a waiting list. According to my reckoning, there are two waiting lists. Which one will it stop—the waiting to get on a waiting list or the 18 months' wait that that man has to face when he gets there?
I do not know what point the hon. Gentleman is making. Today I announced overall funding for the NHS in Wales. I must admit to the House that I have put much more money into the NHS than was perhaps originally expected because I believe that that, and better patient care, are among my highest priorities as Secretary of State. I was determined to fulfil that obligation with the announcement. Having secured those additional funds, I must sit down and work out how to allocate them between health authorities. The hon. Gentleman will know about the extra millions of pounds that we have put into the waiting lists initiative. However, the purpose of the funding package that I announced is to reduce waiting times throughout Wales.
Will the right hon. Gentleman confirm that the surest way to acquire a new hospital is to cause a by-election? Will he also agree that he still has a good deal of arguing to do to convince the people of Wales that the creation of a large number of hospital trusts is motivated by patients' interests rather than by his political beliefs?
I wonder whether there is something I should know as to why the hon. and learned Gentleman is so favourably disposed towards by-elections. We would rise to the occasion with Jeanie France Heyhurst if he decided to step down. There would be an extremely good by-election campaign.
On national health trusts, I will approve an application only provided that the hospital, the unit and the authority will remain within the family of the NHS. There is no dogma here. I am proud of my commitment to the health service, which is evidenced by the record level of resources that we have announced today.
I can well believe that the national health service needs more money in Wales because there are many more administrators, computer operators and accountants in the service. No doubt the opted-out trusts will ensure that their board members pay themselves inflated salaries. Nevertheless, I welcome the extra money, if it is genuinely new money and is not taken from some other budget. What is the difference between the coming year, 1992, and 1987, 1983 and 1979, when more money was promised by the Conservative party and promises were made, only to be cruelly withdrawn after the elections in those years?
There was just one little thing that the hon. Gentleman left out—to welcome the fact that, thanks to the Conservative Government, Wrexham Maelor hospital was built. That is something of which we are very proud.
On funding, of course this is extra cash for the NHS. The money will be allocated to the health authorities as soon as I am able to make further announcements. It will be greatly to the benefit of the health service and to patients. We have published a patients charter, we believe in better patient care, and what I have announced will greatly assist in bringing about that objective.
Does not the Secretary of State recognise that the 11·1 per cent. increase not only becomes the 8·2 per cent. that he admitted to when it is measured against expenditure, but becomes about 2 per cent. when measured against the real rate of inflation within the NHS and disappears altogether when care in the community is taken into account?
On an important constitutional point—I hope that he will take this seriously—whatever happens after the election we are in the dying months of this Parliament. There is a bitter doctrinal argument between the parties on trust status. Will he give an assurance that, whatever happens in present consultations on further trusts—I shall avoid the emotive term "opt-out"—and whatever their conclusion, he will leave it so that the Government appointed after the election can make a decision about whether there will be more trusts?
No, it is a real-terms increase of 60 per cent. When the right hon. Member for Swansea, West (Mr. Williams) was in government, funding increased by nowhere near that figure and capital spending decreased.
On trusts, we do not hear as much opposition in England to NHS trusts now. It has gone rather quiet because trusts have been rather successful. In Wirral the local Labour party first opposed every NHS application—that was at the behest of the unions, which were equally opposing them. Now throughout Wirral one will find general approval of trusts and they are nowhere near the party political football that the Labour party in Wales is still trying to suggest.
Does the Secretary of State realise that this is not so much a statement as a press release? Does he not know that the increase about which he told us is inadequate to meet the needs, especially with the increasing numbers of the elderly in our population, and year after year falls back compared with all comparable countries? Why does so much money go on gimmicks, such as the £203,000 on his so-called charter for health in Wales, with cash going to a firm in Northampton and an appalling and unproductive paper chase in this so-called market in care?
Cannot the Secretary of State understand the message from the 93 per cent. of people in Wales who are satisfied with the NHS and do not want the muddle and meddle of his trusts and opt-out policy? What is unpopular is the proposal to take the health service in Pembrokeshire into a trust. It is as unpopular in Pembrokeshire as is the hon. Member for Pembroke (Mr. Bennett), the obsessed architect of all that we despise about Conservative policies on health in Wales.
Does the Secretary of State accept that the Conservatives broke the consensus on health in Wales and that the trust idea will and must be scrapped—if not by him, by the people of Wales at the general election?
There was some sweet music among the discordant notes. In previous health service debates the hon. Gentleman has come to the Dispatch Box and said that there have been cuts in the health service and there was great dissatisfaction in Wales with the Conservatives. Now is a wonderful moment. He has come to the Dispatch Box and said that 93 per cent. of the people in Wales are satisfied with the Conservative administration of the health service.
The hon. Gentleman did not include the words, "Conservative administration or. He said that 93 per cent. were satisfied with the national health service in Wales. I welcome that.
On the hon. Gentleman's discordant notes, I want to ensure that the record levels of funding now announced are targeted in the best possible way for the patients. I want to see a health service that is better managed and where the staff are paid properly.
I have one last fact and statistic for the House. When Labour was last in power, the pay of nurses, midwives and health visitors fell in real terms by 21·1 per cent. and of hospital doctors and dentists by 9·9 per cent. Under this Government, from 1979 to 1991 pay has increased for nurses, midwives and health visitors by 48·7 per cent. and for hospital doctors and dentists by 28·7 per cent. No wonder the hon. Gentleman says that the Conservative Government are running the health service well. We are determined to do even better and my announcement today will enable us to do so.