National Health Service

Opposition Day – in the House of Commons at 4:03 pm on 20th November 1996.

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Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State 4:23 pm, 20th November 1996

I beg to move, That this House reasserts its belief in the fundamental principles of the National Health Service, established fifty years ago, that health care should be available to all, based on need and not on ability to pay; expresses its dismay at the changes effected by Her Majesty's Government, which are undermining these principles; is alarmed at the way in which the competitive internal market in the NHS is distorting decisions on patient care, creating a two-tier inequitable service, and has led to an explosion of unnecessary and expensive bureaucracy; expresses grave concern about the impending winter crisis in the NHS in many parts of the country, about which Her Majesty's Government appears wholly unconcerned; resolves to take wasteful expenditure out of the bureaucratic procedures of the internal market and devote it instead to improving patient care; and seeks to restore the ethos of the NHS to that of a public service, not of a commercial competitive business.

The starting point for this debate must be a reassertion of our fundamental belief in the founding principles of the national health service, which was founded 50 years ago with the clear statement that health care should be available according to need, not according to ability to pay. The crucial question is whether those principles are being carried out in practice in the here and now. It is the Opposition's contention that the Government's actions, especially in the past five or six years, have fundamentally undermined those founding principles.

Of course the Government say that they believe in the national health service and its principles; they issued a White Paper a few days ago to make that point at great length. However, we must turn our attention to what is happening in the health service throughout the country now, not in a fictitious future conjured up in a White Paper full of warm words and lacking a single legislative proposal. There is a large gap between the Government's rhetoric and what is happening on the ground.

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

On the subject of rhetoric, has the hon. Gentleman seen the splendid article in The Independent, entitled "Is the NHS safe under Dr. Blair's team?" Does the hon. Gentleman prefer the point that says: Labour's complacent attitude, which has focused on scoring points in opposition rather than constructing a viable alternative", or the point from the left-leaning Institute for Public Policy Research, which says: From where we stand now, there will be no significant new public money for health care in the UK."? Which of those is right?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

I had expected rather better from the hon. Gentleman, who is normally more intelligent. If he had read the article that I wrote in response to that piece three days after it was published, he would know that neither of those accusations contained any truth whatever.

The reality is that the national health service is facing a crisis this winter, and everyone in the NHS knows it. The chairman of the consultants committee of the British Medical Association has said that the service is "close to collapse" and the National Association of Health Authorities and Trusts has said that there are serious problems and that the health service faces the worst situation for years; only the Government seem to be unperturbed about what is happening on the ground.

Photo of David Winnick David Winnick , Walsall North

Did my hon. Friend see the article in last night's Evening Standard by its art critic? I strongly doubt whether he is a long-standing Labour supporter, but he wrote about his heart attacks and about the fact that he had to choose private surgery because of the crisis in the national health service. Does not that illustrate yet again how many people in our country feel betrayed by the Government because the national health service is not in a position to help when help is absolutely essential?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

My hon. Friend makes a valid point. I never want the day to come when people feel that they have to go private because the national health service cannot deliver the care that they expect and to which they are entitled.

Photo of Hugh Bayley Hugh Bayley , City of York

Does not that answer illustrate the fact that under Conservative management the number of private beds in the national health service has increased year on year to the point where people are encouraged to go private?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

My hon. Friend is right. The private content of health provision has more than doubled under the Conservatives; the figure for private treatment is 11 per cent. and rising. I believe from what he has told the press that the Secretary of State for Health has private medical insurance.

In figures presented to the House in an answer to my hon. Friend the Member for Newham, South (Mr. Spearing) a few weeks ago the Government had to admit that health authorities throughout the country will face an overall net deficit of about £120 million by the end of this financial year. What the Government cannot tell us, or at least they say that they cannot tell us, is how much deficit trusts are facing. However, the Health Select Committee has helpfully assisted us by showing that serious deficits are looming for a range of hospital trusts.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I would not like the hon. Gentleman to develop his argument on the basis of a misunderstanding of the position. Some questions have been tabled about the financial position of trusts. We are preparing answers and intend to publish them. The net figure anticipated for the end of this financial year for the whole trust sector is a surplus of £60 million.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

That is indeed interesting and new information. If this debate does nothing else, it has been useful in flushing that out. If that is the case, can the Secretary of State explain why the Royal Sussex county hospital has cancelled all dialysis for new patients for the rest of the financial year; why the King's Healthcare NHS trust has increased its waiting times for orthopaedic patients to 18 months, even for patients with infected hips; why Merton, Sutton and Wandsworth health authority has decided not to contract for any elective surgery from St. Helier NHS trust and St. George's NHS trust next year; or why no new ear, nose and throat patients are being taken on by the Royal Hospitals NHS trust in London for the remainder of the financial year? If there is such a healthy surplus in our hospitals, why are they withdrawing care and treatment from patients with every week and month that passes?

Photo of Brian Jenkins Brian Jenkins , Staffordshire South East

My local trust took two and a half years to find that it was £1.5 million in debt. The financial regulations and the state of accountability are such that I do not know any trust that can say that it will be in surplus or debt next year because of the way in which they are run. Many of them simply do not know.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

My hon. Friend is right. Does the £60 million that the Secretary of State told us about take account of the £100 million that the recent decision of Customs and Excise on the repayment of VAT to hospital trusts will cost hospital trusts in the course of the year?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The hon. Gentleman may have missed the fact that Customs and Excise announced at the end of October that it was giving every trust, health authority and NHS body until the end of November to submit applications for VAT repayments. The story that has been running in the newspapers on that subject is wrong, too.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

The Secretary of State ignores the fact that that does not apply to money that was paid out in VAT two or three years ago and which has not yet been reclaimed. The fact is that health trusts say that the recent decision by Customs and Excise eases the burden but does not remove it entirely. Whereas previously the burden might have been some £160 million, health trusts estimate that it will be about £100 million after the Government's recent announcement. Clearly, the Secretary of State does not know what is happening.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I am not sure about that. Will the hon. Gentleman explain how an organisation can assess outstanding VAT so that it can provide the estimate that the hon. Gentleman gave but cannot send it to Customs and Excise to reclaim the tax?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

That is what the hospital trusts are saying and I place greater credence on what they say than on what the Secretary of State says.

Photo of Mr Nigel Spearing Mr Nigel Spearing , Newham South

A few moments ago my hon. Friend asked why the Royal Hospitals NHS trust had to make cuts. Is he aware that yesterday the East London and The City health authority announced cuts in the forthcoming year of £14 million of general treatment—an additional £4 million is to be announced in January, which could mean the closure of St Andrew's hospital, Bow—despite the fact that its capitation from the Secretary of State is about 600,000, yet the doctors' lists are 700,000? If that anomaly were corrected, would not some of those difficulties be removed?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

My hon. Friend has identified two factors. The first is that the Government often get their figures wrong—they have clearly done so in my hon. Friend's case as they do in many others. Secondly, there is an enormous gulf between the reality of what happens—in hospitals, health authorities and health services received by people up and down the country—and what the Government say is happening. There is a serious difference between what the Government say and what is being experienced.

What is the Secretary of State doing about the winter crisis that is affecting east London and hospitals elsewhere in the country? Everyone in the health service knows that there is a serious problem looming. What is the Secretary of State doing about it? Precisely nothing. When he was pressed specifically on that point on television on Sunday he said clearly and firmly that there was no new money available this year to help hospitals through the crisis. He then said, "But it is the expectation of what will happen next year that really matters and makes the difference in the decisions that hospitals and health authorities have to make." What is he saying? Is he saying to health trusts that cannot legally overspend, "Don't worry; overspend if you have to. Get through the winter. Don't alarm the electorate in advance of a general election—help will be coming along in next year's funds"?

I offer the Secretary of State the opportunity of today's debate to spell out precisely what he is saying to health trusts and health authorities around the country. Is there to be money this year or is there only going to be extra money next year—placating this year's crisis with next year's funds? If so, what happens next year? If he uses up next year's money to try to resolve this year's crisis, we shall end up with exactly the same problem next year. Instead of year on year on year of additional funding for the health service—the mantra that the Secretary of State likes to chant—it will be year on year of winter crises in the health service under a Tory Government.

Photo of Lady Olga Maitland Lady Olga Maitland , Sutton and Cheam

Perhaps the hon. Gentleman will enlighten the House. Instead of criticising the Government on their handling of health policies, which is satisfactory, perhaps the hon. Gentleman will tell the House what his party would do. Would it spend more money on health? If so, would that money be in addition to the pledges already given which would increase taxation by 9p in the pound? We should be told.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

I am surprised that the hon. Lady does not seem to be worried about what is happening at St. Helier hospital, which I should have thought would have been of concern to her constituents. I am astonished at the hon. Lady who, along with the Secretary of State, says that the Labour party will not spend more money on the health service. Meanwhile, the Chief Secretary to the Treasury and the chairman of the Conservative party publish documents purporting that Labour will spend an extra £1.3 billion on the health service. Can they make up their minds? Do they believe that we will spend more money on the health service, or that we will not? There are two voices coming from the Tory party—sometimes two voices coming from the same person. I am sure that we are about to hear them from the Secretary of State.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I have been too kind to the hon. Gentleman, because I have always assumed that the proposals that were set out this morning by my right hon. Friend the Chief Secretary and which would have the effect of increasing costs in the health service without treating a single extra patient would be paid for out of a Labour extra spend. Is the hon. Gentleman saying that those extra costs would be paid for by the fewer patients who would be treated in Labour's health service?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

The Secretary of State is talking as much rubbish as the Chief Secretary did. He must concern himself with what is happening now in the health service.

The right hon. Gentleman must also show particular concern for the position in Northern Ireland. The Under-Secretary of State for Northern Ireland has publicly acknowledged that the 3 per cent. efficiency savings that the Government have required of the health service in Northern Ireland cannot be made through efficiency alone. The Labour party did not say that and nor did anyone in the health service—it was the Government's own Minister who said that the effect of the 3 per cent. cut in funding for Northern Ireland, supposedly for efficiency purposes, actually involves 1.5 per cent. of cuts in the service. I am surprised that the Secretary of State shows such a cavalier attitude to a Minister in his own Government admitting that the requirements of funding in the current financial year in Northern Ireland mean a cut in service of 1.5 per cent.

Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Health)

The hon. Gentleman will know that I endorse his criticism of both the deficit in funding for this winter and the risk of deficit in the years to come and that I share his commitment to the NHS. However, he owes the House an obligation to confirm whether it is currently Labour policy that the only additional funding committed to the NHS by the Labour party is £100 million to be derived from bureaucracy savings; and that, as the shadow Chancellor confirmed this morning, there will be no more money from the Labour party for the NHS in the foreseeable future.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

I am surprised that the hon. Gentleman has fallen into precisely the trap that the Tories want him to fall into. Before we can go with any real confidence to the Chancellor, the shadow Chancellor or the taxpayers of this country to argue for additional funds for the national health service, we have to be able to demonstrate that every single penny that is currently raised and spent is being spent wisely. I have to tell the hon. Gentleman that that is not the case at the moment—it is self-evidently not the case from the bureaucratic procedures that have been introduced with the internal market.

Indeed, it is precisely that competitive internal market that is worsening the current winter crisis. It is setting hospital against hospital and doctor against doctor; it is leading to the fragmentation of the service and a lack of strategic planning; and it is distorting decisions on patient care.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

I have given way a lot, but I shall give way for the final time to the hon. Gentleman.

Photo of Mr Cynog Dafis Mr Cynog Dafis , Ceredigion and Pembroke North

The hon. Gentleman speaks of hospitals being set against hospitals. May I draw his attention to the situation in mid-Wales, where it is clear that the only way in which Ceredigion and Mid-Wales NHS trust will be able to cope financially next year is by either reducing the range of services at the district general hospital, or closing community hospitals? Is not that an intolerable dilemma?

Does the hon. Gentleman agree that community hospitals have an essential place and that trusts should not be put in that sort of position? Will he make it clear that his party, when in government—I ask this question in all sincerity—will ensure that hospitals and trusts of that sort will be protected against the unreasonable rigours of the internal market?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

The hon. Gentleman is right to draw attention to the problems confronting community hospitals and cottage hospitals throughout the country. The Conservative Government told us at the Tory party conference that they believed that reinventing the cottage hospital was the way forward. They are right to regard that as an essential ingredient of a good-quality health service of the future, but perhaps they can tell us why they have closed 250 cottage hospitals in the past five years. As always, the Government's rhetoric on the Tory party conference platform is not reflected in what is happening in the health service.

The introduction of the internal competitive market has introduced a two-tier service into the NHS. Anyone who doubts that need only consider what is happening in Lincoln County hospital. It has written to all non-fundholding GPs in its area, saying that it is cancelling all out-patient appointments for the rest of the financial year; but out-patient appointments are continuing for the patients of fundholders.

Norfolk and Norwich hospital has cancelled all routine surgery for patients of non-fundholding GPs. Edinburgh Western General hospital has told patients of fundholders that they can be given diagnostic scans in one or two weeks, but patients of non-fundholders must wait a year.

Yesterday, The Times published a letter by the consultant orthopaedic surgeon at St. Thomas' hospital, just the other side of the river from the House. He said: At St. Thomas' Hospital surgeons have been advised by the local purchasing authority that it will pay only for patients who are medically urgent or who have been on the waiting list 18 months. A fundholding patient can be seen and treated much more quickly.

That is the reality in hospital after hospital throughout the country. The patients of fundholders are able to obtain access to treatment in a very different way from patients of non-fundholders. That situation is a fundamental breach of the principles of equity, fairness and equal access to treatment that are supposed to be at the heart of the national health service.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The hon. Gentleman has just made an oft-repeated charge against the fundholding scheme. It is a golden opportunity for him to tell the House his policy for the future of fundholding.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

Before I do so, perhaps the Secretary of State will tell us what he will do about restoring equity to the national health service, because the Government in which he serves and his policies have created the unfairnesses and the injustice. It cannot be right that patients living in the same street, with the same condition and the same needs, are treated differently because they have a different type of general practitioner.

The Secretary of State says that everyone now accepts the market changes that the Government have introduced. He said frequently on radio and television last week, backing his White Paper, that he was seeking to draw a line under the changes to the health service because everyone agreed with them now, so he wanted to move on to other things.

I must tell the Secretary of State that everyone does not agree with the changes. One of the reasons why we do not agree is that the two-tier nature of the service that has been created fundamentally undermines what the NHS is supposed to be about. As the hon. Member for Southwark and Bermondsey (Mr. Hughes) pointed out, we want among other things to take money out of unnecessary bureaucratic procedures—the invoices for every patient, the paperwork chasing itself from one end of the system to the other, and the fact that a hospital such as Great Ormond Street each year has to establish 60 contracts with health authorities around the country and 1,500 contracts with fundholding practices. There are now 20,000 more managers in the NHS than there were five years ago and 50,000 fewer nurses. That speaks volumes about the Government's priorities for the health service.

The British Medical Association estimates that the internal market bureaucracy which the Government have imposed on the health service costs £1.5 billion a year. Certainly, we want to take money out of red tape and put it into patient care, because that is what is desperately needed.

Ministers will say that everything is fine because of the Prime Minister's commitment to increase funding for the health service year on year. The people of Britain will recall that he is the same Prime Minister who promised tax cuts year on year at the election, yet the Government have ended up putting up taxes 22 times since then.

What does this supposed commitment from the Government actually mean?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

How much more money? How much do the Government actually mean to spend on the health service? What are the figures? The Chancellor of the Exchequer gave a revealing interview just a few minutes after the Prime Minister had made his speech to the Conservative party conference. On Sky News, a reporter pressed the Chancellor on how important the commitment was. "What is the minimum?" he asked. The Chancellor replied: Oh well, there's … What we actually did was not say"— whereupon the reporter interrupted as follows: You can't say. It could be £1 above inflation! The Chancellor replied: We've not planned for five years ahead, it could be a lot of, um … everything depends on getting the economy right. So much for the pledge that the Government have given us—it all depends on getting the economy right. Under pressure from the reporter, the Chancellor had to admit that he could not say what the expenditure would amount to.

It is always useful to read the book instead of gazing into the crystal ball. During the 20 years to 1992, under Governments of both political persuasions, average real-terms growth in expenditure on the health service—even under Lady Thatcher—was 3.1 per cent. And what have the Government managed during the past five years? They have managed an average of 2.9 per cent. The Red Book which accompanied last year's Budget tells us that there will be a 0.6 per cent. increase in real-terms NHS-expenditure next year, and a 0.1 per cent. increase the year after that. If the Government match that, they will have fulfilled the Prime Minister's promise—but by an amount way below the solid average rate of increase achieved by previous Governments.

We are told that the Secretary of State for Health has fought the good fight with the Chancellor and secured extra resources over and above 0.6 per cent. for next year. I expect that the sum will be rather more than the £500 million that has been leaked to the press, probably by his own Department, because he likes to massage public opinion in advance and create the expectation of a particular figure. Lo and behold, when a larger amount is allocated, a great triumph is proclaimed.

Whatever the figure is, I bet you, Madam Deputy Speaker, that it will be below the 3.1 per cent. average that previous Governments achieved. For the record, the last five years of the Labour Government achieved a 16 per cent. increase in real-terms in national health service expenditure. During the past five years this Government have achieved a real-terms increase of 14 per cent., so they have performed worse than the previous Labour Government and we will take no lessons from them about our commitment to the funding of the NHS.

The Prime Minister made no mention of capital spending in the national health service. There is no mention of it in the White Paper. There is no mention of the Government's 17 per cent. cut in capital spending in the health service. They will tell us, of course, that the private finance initiative will close the gap. That is what they told us in the Red Book last year. At the time of the Budget last year, the Red Book stated: Several large hospital private finance schemes are due to complete the procurement process and receive approval in 1995–96"— that was a year ago, not the current financial year— with a total capital value of around £250 million. The Red Book goes on to state that by the end of next year it is expected that projects worth £1 billion will have come forward for approval. During 1996–97 it is expected that the private sector will invest around £165 million in NHS facilities and these figures are expected to be exceeded in subsequent years. Perhaps the Secretary of State can tell us why not a single brick has been laid in a single hospital scheme under the PFI to date.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

Perhaps the Government can also tell us why hospital after hospital around the country and contractor after contractor complain about the bureaucratic process, the expense, the complexity and the inadequacy of the PFI system for funding hospital building work. I will give way for the final time.

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

Will the hon. Gentleman concede that the biggest cuts in the capital programme for hospital building were made by the last Labour Government in the 1970s? That is indisputable.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

Perhaps the right hon. Gentleman can tell us why, back in 1990, the Government promised that Norwich would have its new hospital under the private finance initiative, yet it is still not signed, sealed and delivered. The Government relaunch the plan every year and tell us that it is about to happen, but Norwich is still waiting for its new hospital.

There are two more specific points that I want to raise. The first relates to mixed sex wards in hospitals. The Patients Association is right to describe having to be in a mixed sex ward against one's will as an affront to the dignity of the patient. It causes distress and concern to many patients, especially women, to be placed in a mixed ward when they do not want to be in such a ward. This, of course, happens at a time of great trauma: when patients face surgery or treatment.

When my right hon. Friend the Leader of the Opposition pressed the Prime Minister on this point yesterday, he pointed out that that promise was made by the Government two years ago in the patients charter. Yet it remains unfulfilled. In January 1995, the patients charter said that patients could expect single-sex washing and toilet facilities and that their wish to be treated in single-sex wards will be respected wherever possible". Those two promises sound very good on paper, but the report from the Patients Association yesterday revealed that segregated washing and toilet facilities are far from being the norm, and that patients throughout the country commonly report that if they express a preference to be treated in a single-sex ward—as the charter encourages them to do—they are suddenly told that their wait for treatment will be far longer as a result. The pledge in the patients charter effectively offers patients only a Hobson's choice, and it is not worth the paper that it is written on.

In addition, I am very concerned that the Department of Health does not even collect information on hospitals that force patients on to mixed sexed wards against their will. The Prime Minister did not appear to understand the question when asked by my right hon. Friend yesterday, let alone answer it.

In almost every case, both men and women prefer to be treated in single-sex wards in hospital. Labour believes that it should be a matter of good practice, and the improved management of beds to achieve this end should be one of the priorities in the Government's management of the health service.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

The Secretary of State says that it is, but the Prime Minister appeared to disagree with that yesterday. He was saying, "There are other things that are more important. We have been concentrating on other things. Then in due course we'll turn to this matter." He does not recognise the urgency of the matter and the need to deal with it in the immediate future.

The second issue that I wish to raise is the gagging of national health service staff, who are told in their contracts that they cannot speak out about the service in general or in particular. It is all right, of course, for the bigwigs who support the Government. The national health service "good news network" has been established by the Conservative party. Four of the group's regional organisers hold positions on trusts and health authority boards. They include Mrs. Audrey Collins, chair of South Tees Acute Hospitals NHS trust, Charles Bunker, director of East Hertfordshire NHS trust, Mrs. Mary Firth, chair of the Royal Oldham Hospital and Community Services NHS trust, and Mrs. Susan Wrigley, chair of the North Yorkshire health authority.

The good news network in the national health service is supposed to supply information to help the Government. It engages in overtly political activities, such as feeding back good news stories so that Ministers and Conservative Central Office can use them. There is one rule for them, but for ordinary staff in the national health service it is completely different. [Interruption.] The Secretary of State says that that is total rubbish.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

Perhaps he would like to say that to the ambulance man from Surrey ambulance service whom I met this morning. He told me that he had written a letter to his local newspaper to complain about the downgrading of the local fire station and the implications that it would have for other emergency services in being able to reach and treat patients. He is now threatened with disciplinary action by the Surrey ambulance service. If the Secretary of State means what he says—that it is perfectly all right for people who work in the health service to speak out about what they see and are worried about and to raise complaints of a general nature about what is happening in the service and in their area—perhaps he will tell not just the Surrey ambulance service but hospital after hospital throughout the country, as they are disciplining members of staff who speak out. Perhaps he will tell them that the Government's policy has changed, because it certainly has not changed on the ground.

We have a health service that is in crisis, that tries to silence its members of staff, that cannot even deliver same sex wards to the people who wish to have them. Year on year, the Government creates a winter crisis. Year on year we see an explosion of bureaucracy. Year on year we see more managers and fewer nurses. Year on year, we see patients on trolleys in accident and emergency departments. Year on year we see cancelled operations. Year on year we see lengthening waiting lists. Year on year we see staff in the health service struggling to cope with the changes that the Government have imposed on them.

The Labour party believes that the national health service should be run as a public service, not a commercial business. Health care is not something that can be bought and sold in the marketplace. It is too important for that. The NHS should not be for contracts, invoices or market forces; it should be for patients, first, second and third. It will take a Labour Government to rescue and restore a real health service in this country.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health 5:06 pm, 20th November 1996

I beg to move, To leave out from "House" to the end of the Question and to add instead thereof: believes the National Health Service is one of the success stories of modern Britain and is wholeheartedly committed to developing the NHS on the basis of its founding principles of universality, high quality and availability on the basis of clinical need, without regard for the patient's ability to pay; expresses its support for the Government's initiatives to release £300 million from unnecessary NHS administration; welcomes both the Government's further plans to develop NHS primary care and the recent White Paper A Service With Ambitions, which sets out a medium-term framework for a high-quality patient-focused NHS; and welcomes the Government's pledge to spend more money on the NHS, over and above inflation, for each year of the five years of the next Parliament. The House has just heard a speech of breathtaking complacency from the hon. Member for Islington, South and Finsbury (Mr. Smith). Not only that, his speech further demonstrates, if it were necessary, the bankruptcy of the Labour party—the dilettante approach that it has taken for 17 years to the development of health policy.

We are having this debate because the Opposition Front Bench chose health as the subject for today's debate—

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

Yes, and we will keep on doing so.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I look forward to it—every week if we can have this kind of debate and speech from the hon. Gentleman.

We might have expected, as the Opposition chose this subject for debate, that they would have had something to say. Instead, we have heard a tissue of innuendo and half truth, undermining public confidence in a great public service. Frankly, there is something rather indecent about the spectacle of the hon. Gentleman luxuriating in anecdotes of service weakness while offering absolutely nothing of any substance as to what he thinks should be done to strengthen, build and plan for the future of the national health service.

We heard not even the merest hint of a policy from the hon. Gentleman this afternoon, simply the complacent suggestion that the national calamity of a Labour Government somehow offers a short cut into a garden of Eden for the national health service. Let us take his arguments one by one and analyse what he told the House.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

No, I shall develop my argument and give way later.

Let us begin by examining the so-called arguments—that is a grand word to describe what the hon. Gentleman used. He referred to the statistics that were much beloved of his predecessor, the hon. Member for Peckham (Ms Harman), but mere repetition does not make them true. They like talking about 50,000 fewer nurses. The only problem with that argument is that the nursing work force of the national health service has grown by 55,000 under the Conservative Government, and the nursing work force today is at exactly the same level as it was in 1990. It is simply not true to say that the nursing work force in the health service has decreased.

The hon. Gentleman and his hon. Friends like to talk about the increasing number of managers in the NHS, but they speak with forked tongue on that subject. In June this year, the Leader of the Opposition told the Daily Mirror:The Health Service needs to be managed and the management probably needed to be improved. When they are under pressure, Labour Front Benchers acknowledge that the traditional system of management in the health service was inadequate. The Leader of the Opposition and the hon. Gentleman's predecessor, the hon. Member for Peckham, have said so repeatedly. A few years ago, the Socialist Health Association said that the NHS was "traditionally under-managed" and that Labour "should avoid bureaucrat-bashing". That is rather good advice, and the hon. Gentleman would do well to take it.

The hon. Gentleman should also examine the Labour party's record when it comes to squeezing unnecessary administrative costs from the health service. We would take his comments about squeezing out £100 million in unnecessary administrative costs more seriously if it were not for the fact that every Opposition Member voted against abolishing regional health authorities, which removed £100 million in unnecessary administrative costs from the health service at a stroke. We introduced a programme to make administrate savings of £300 million in the two years ending next March. It would be nice if Opposition Front Benchers recognised our achievements occasionally rather than glibly asserting that they would knock off £100 million—without providing any evidence of how they would do it.

In his closing passage, the hon. Gentleman mentioned waiting lists. I think that he used the phrase, "year-on-year increases." That is an impossible charge that does not reflect what has happened to waiting lists in the past five years since we began to take effective action to reduce waiting times in the national health service. In 1979, one in four patients waited for more than a year for elective surgery. That figure is now one in 250—a huge cut.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

Will the Secretary of State tell us the total waiting list figure for the last quarter, which was published only a month and a half ago? Did that figure show an increase or a decrease?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The hon. Gentleman should consider what is important—I believe that it is the time that individuals spend on the waiting list. In 1979, one in four patients waited more than a year for treatment. That figure is now one in 250. Does the hon. Gentleman deny that that is an improvement in the waiting time performance of the health service? Will he go to the Dispatch Box and say that things have not improved when the number of people waiting more than a year for treatment has fallen from one in four to one in 250?

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

In other words, the Secretary of State's answer to my question is that the waiting list figure has increased.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I simply ask the hon. Gentleman whether he believes that we should focus on improving the performance of and the service provided by the NHS, or play silly statistical games.

Photo of Mr John Garrett Mr John Garrett , Norwich South

What does the Secretary of State mean by "waiting list"? The greatest increase has been in the number of people awaiting a first out-patient appointment. In my constituency and in London, people often wait six or eight months for their first out-patient consultation before they go on the waiting list for an operation in a year or 18 months.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I mean exactly what the last Labour Government meant by the term "waiting list": the number of people who have been told by their consultants that they need a particular course of treatment and are waiting to receive it—the published figure. There has been a huge improvement in the quality of service delivered by the NHS, and it is simply dishonest to talk about a deterioration in the NHS waiting list performance.

So much for the hon. Gentleman's arguments. Let us look at what a Labour Government would do. Although the hon. Gentleman offered no hints this afternoon, I would like to discuss some evidence with the House.

Photo of Mr Donald Thompson Mr Donald Thompson , Calder Valley

I know that my right hon. Friend has many important points to make and I thank him for giving way. I fear that, as usual, he is being too generous. He has not put his finger on the reason why the hon. Member for Islington, South and Finsbury (Mr. Smith) is sitting on the Opposition Benches and why we have been sitting on the Government Benches for nearly 20 years. When Labour controlled the health service, it was not Health Ministers but convenors of the local union who determined who would have operations in area after area, month after month. It is not a myth; it is the truth. Furthermore, patients who died while on waiting lists in Liverpool could not be buried until the same convenor said it was their turn. That is why the Conservatives are on the Government Benches and why we shall stay here.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

As ever, my hon. Friend advances exactly the right argument. There has been a huge improvement in the quality and range of NHS services and in the conditions outside it—to which my hon. Friend referred—which disrupted patient services in a quite indefensible manner in the declining years of the last Labour Government.

Let us consider what Labour would do. That consideration did not detain the hon. Gentleman while he was at the Dispatch Box this afternoon, but I suppose that that is not surprising: he does not believe that he must answer the academic question what he might do if he were responsible for the health service. Let us begin with money. The Prime Minister has made crystal clear the Conservative Government's commitment to real-terms growth, year by year, in spending on the national health service during the next Parliament. I agree with the comments of the hon. Member for York (Mr. Bayley) to the Fabian Society earlier this year. He said:*** Labour's health policy will not look credible at the general election if we do not commit ourselves to matching the rate of growth delivered by the Conservatives in recent years. He is spot on, and he should persuade the hon. Member for Islington, South and Finsbury and the shadow Chancellor, the right hon. Member for Dunfermline, East (Mr. Brown), of the force of his argument, or he will take the rap in York.

Photo of Hugh Bayley Hugh Bayley , City of York

It is hardly a great promise by the Government to increase health spending in real terms—after all, every Government have done that in every year since the national health service was established to meet increasing demand arising from an aging population and new treatments. The Secretary of State presented to the Health Committee this year figures that show that, during the past five years, real-terms growth in spending on the NHS has decreased from 6.5 per cent. to 5.4 per cent., 3.3 per cent., 1.9 per cent. and 0.7 per cent. Growth has decreased year after year, to a point where it can no longer pay for the increased costs of aging and new technologies and treatments.

Photo of Miss Janet Fookes Miss Janet Fookes , Plymouth Drake

Order. The hon. Member for York is beginning to make a short speech. He must wait his turn.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The hon. Gentleman's speech is extremely helpful to the Government, because he reveals why the hon. Member for Islington, South and Finsbury and his shadow Cabinet colleagues dare not give the same pledge as the Prime Minister. To do so, they would have to reveal the skeleton in Labour's cupboard about its record in office.

The hon. Member for York said that the NHS budget has always increased in real terms year after year. That is not true. Under the last Labour Government, the NHS budget was cut by 2.8 per cent.—it did not grow by 3 per cent.—in real terms in 1977–78. Labour's record is worse still. In 1979, under the last Labour Government, health expenditure was lower in real terms than it was in 1976. Three years on, as a result of the cut imposed in 1977–78, health expenditure was down in real terms from what it was in 1976. The skeleton in Labour's cupboard—I understand why Labour Members do not want it to be revealed—is that, during the last three years it was in office, it failed to deliver what my right hon. Friend the Prime Minister has pledged we will deliver during the next five years of Conservative government, as we have done for the past 17 years.

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

The Secretary of State ignores the fact that, in the five years of that Labour Government, the overall real-terms increase in national health service expenditure was 16 per cent., which is better than this Government have achieved in the past five years.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

The hon. Gentleman glosses over the fact that expenditure was lower in real terms. In the three years from 1976 to 1979, the NHS did not grow, and that was not the only cut made between 1974 and 1979.

The Leader of the Opposition said that we should look at Labour's record. I have been looking at the Labour party's record in office, and it is quite instructive. It uses fine words about the health service, but it cut nurses' pay by 3 per cent. in real terms. What party builds a future for the national health service on a real-terms pay cut for nurses—and, furthermore, a real-terms pay cut for doctors of 31 per cent? When Labour was in office, there was 31 per cent. less than inflation for doctors. No wonder Labour is not keen to pledge itself to real-terms growth.

It is a matter not just of money, but of how the health service should be managed. If the Labour party is at sea on the issue of money, it is in the middle of the ocean on the question of how the health service should be managed.

Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Health)

I entirely agree with the Secretary of State's last sentence. When the Prime Minister made a commitment at the Bournemouth conference that money for the NHS would rise to keep pace with costs year on year, was that commitment to keep pace with national inflation, or to keep pace with inflation as it affects the health service, which for the whole period of Conservative government has been greater than average inflation across the economy? To which of those two figures did the commitment relate?

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

As every taxpayer knows, we pay tax in pounds, not in NHS pounds. We are talking about real-terms growth in pounds corrected for inflation. That concept applies to the economy as a whole, and not to a specific part of the economy.

Several hon. Members:


Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

I shall make progress, and give way again later.

I want to get on to the issue that is of great interest to people working in the health service. If the hon. Member for Islington, South and Finsbury were ever to be responsible for the health service, how would he want it to be managed? He is fond of the soundbite: he used that device again this afternoon when he said that Labour would abolish the internal market. The problem is that he also uses another soundbite, which is that he is in favour of the purchaser-provider split. He sometimes uses both soundbites in the same paragraph.

The problem for anyone trying to understand the Labour party's policy is that those two phrases have precisely the same meaning. The hon. Gentleman is in favour of one description of the present state of affairs, but is not in favour of the other description of it. What kind of a policy is that?

The hon. Gentleman is clear about the purchaser-provider split. In an interview with John Humphrys on the "Today" programme, he was asked: But you would still keep this split between the purchaser, the health authority, and the provider, that's to say the hospitals"? The hon. Gentleman replied: It is sensible to have a distinction between the people who plan and order treatment and the people who actually provide treatment. He could not have been clearer than that.

The hon. Gentleman was merely confirming Labour party policy, which was set out in the policy document "Renewing the NHS." The document states: There will be a clear distinction between the commissioning process … and the delivering process—using budgets within those services to meet needs. Again, it could not be clearer.

The policy document goes on to make another important point. It states: Health authorities will have agreements with different local health services and will have choice as to where to place them to suit patient needs. The document is crystal clear. The Labour party is in favour of the purchaser-provider split and of purchasers having a choice between different providers to reflect patient needs. That could not be clearer.

The document states that between the purchaser and provider there would be a long-term comprehensive health care agreement". The Labour party does not like the word contract, but prefers the phrase, a long-term comprehensive health care agreement". Why use one word when five will do? However, the concept is the same. Despite repeated assertions to the contrary by Opposition Front Bench spokesmen, the Government are not committed to annual contracts for everything. I have repeatedly said that I am in favour of long-term contracts if there is a case for them in a particular context.

The Labour party's policy documents are clear: it is in favour of a purchaser-provider split with the purchaser having the freedom to make a choice that will reflect patient need. The problem for the hon. Gentleman is the role of general practitioners in that process. The Government's position is crystal clear: GP fundholders have the power to place contracts; if the GP is not a fundholder, the health authority has an obligation to listen to the GP, but when a contract is placed referrals must be within that contract.

Opposition Front Bench spokesmen are in total confusion. They say that they are in favour of GPs having a say in where long-term health care agreements should be placed. The hon. Member for Peckham was clear about that when she spoke to health service managers. She said that such agreements will not be concluded without the involvement and consent of local GPs", but that when the local plans have been agreed GPs will have to work to local strategies. The Labour party wants long-term care agreements to have teeth—very blunt teeth, it seems. In speeches made at the same time, Labour Members repeatedly asserted that a GP must be free to refer his or her patients anywhere in the country.

What Labour's health policy amounts to is that purchasers should have the freedom to place agreements to reflect patients' interests, but GPs should be free to take no notice of agreements that health authorities have been paid to negotiate. The hon. Gentleman should decide which of his two soundbites he wants to run with: is he in favour of the purchaser-provider split and of the internal market, or is he in favour of abolishing the internal market, putting the health service through another round of management upheaval and having a different model of health service management? He cannot fudge this issue: he must come clean.

In his speech, the hon. Gentleman did not even address the central question of the management of the health service, and he repeatedly refuses to do so. When I gave him the opportunity, he refused to deal with the other key issue relating to the management structure: the future of fundholding. Fundholding is the means by which we allow GPs to refer their patients directly where they choose. The Labour party has still to make its policy clear, although every policy document commits Labour to replacing fundholding. It tries to draw a distinction between replacing fundholding and abolishing it. No doubt my hon. Friends will tease out the difference between those two concepts, but I do not propose to detain the House any longer on it.

The Labour party is irrelevant, because it has nothing to say about the future of the NHS. It is widely recognised by those who have analysed them that Labour's policy statements are contradictory: they say one thing, then they say the opposite. They offer no vision of the future of the national health service. That is provided by the Government. Last week we published our White Paper, which sets out clearly the principles on which the NHS is based. It addresses the issues that politicians are said to be frightened to address. Can we afford the NHS? How does the NHS decide priority setting? When have we heard a speech from the Opposition Front Bench about any of those issues?

The White Paper also sets out the agenda with which the NHS must now deal. I am told that we do not publish legislation; the only flaw in that argument is the fact that I published a piece of legislation this morning, which sets out a future for a different contracting model in the primary care sector. I look forward to hearing the reaction of the hon. Member for Islington, South and Finsbury. The proposition that the Government do not have a clear view about the future of the health service as a whole and, in particular, the future of the primary care sector, is the result of Labour's applying to the Government a criticism that properly applies to itself.

Photo of Stephen Dorrell Stephen Dorrell The Secretary of State for Health

No, I will not.

In their White Paper, the Government have set out a clear route to the future of the national health service, converting into substance and reality the one thing said by the hon. Member for Islington, South and Finsbury with which I absolutely agree. I refer to the founding principle of the national health service. In this country, we believe that health care should be available on the basis of the patient's clinical need, without regard to ability to pay. That is the key principle on which the national health service was built, and I believe that those who are committed to it have a clear obligation—a clear duty—to show how that high aspiration will be converted into reality. That is the duty that Opposition Front Benchers have failed to discharge.

The NHS deserves better of the Opposition's health spokesman than we have had this afternoon. It is increasingly clear that we shall not get better from this bankrupt Opposition, and that we have not the slightest chance of seeing from them a clear path to the future of the national health service.

Photo of Mr Llew Smith Mr Llew Smith , Blaenau Gwent 5:31 pm, 20th November 1996

I represent an area that is generally regarded as being the birthplace of the national health service. Indeed, my predecessors include not only Michael Foot but Nye Bevan.

My area also has some of the worst health problems in the United Kingdom. The number of deaths from cancer, respiratory diseases and heart disease are well above the national average. The 1991 census for Blaenau Gwent showed that 41 per cent. of households included someone who suffered from either a long-term illness or a disability, and in 1993 the social services department had 4,000 people registered as disabled. On top of all that, we have the worst mental illness problems in Gwent. Ours is also one of the poorest areas in Wales—a fact that even the Welsh Office recognises.

A Gwent health survey carried out between 1985 and 1989 confirmed that the most deprived parts of the county experienced the worst health. That conclusion is not peculiar to Gwent: it has been reached time and again elsewhere. If we are to tackle bad health, we need not only a first-class health service but to be successful in combating poverty.

I want to concentrate on Gwent health authority, Gwent Community Health NHS trust and the South and East Wales Ambulance NHS trust, which do not seem to care about, or act in response to, the problems that I have described. I will deal first with Gwent health authority. Let me say at once what the authority is good at: it is good at producing one glossy magazine after another, filled with promises that it has no intention of keeping. For example, Jeremy Hallett, who until recently was chief executive of the authority—before, to put it politely, securing a job for one of his colleagues and then doing a runner to a nice little earner in another authority—stated in one of those glossy magazines: Sharing responsibility is more than a quick fix consultation exercise. It must be about developing a long term relationship". He went on to say: To no small extent community involvement has become conventional wisdom because we have been seen to make them work in Gwent to the great benefit of local people. Lindy Price, chairperson of Gwent health authority, stated, again in one of those many glossy magazines: I would like to develop a culture of working together in the trust and county boroughs, with all general practitioners and community health councils and the general public when they are patients and when they are well". All those statements are rubbish and no more than a public relations stunt: the authority has continually treated my constituents with total disdain.

Although everyone accepts that we have major health problems in Blaenau Gwent, Gwent health authority's response has been to cut the number of doctors. Most people would assume that the response to such problems should be an increase in the number. For example, in Cwm, near Ebbw Vale, the authority advertised for a replacement for a doctor who had resigned; instead of appointing another doctor, however, it merely handed over the patient list to another doctor already practising in the village. After a public outcry, the authority retreated, announcing that another doctor was to be appointed, but many local people thought that it would not happen—that it was just a publicity stunt to placate them. I did not believe that at the time, but I do now. I accept that the health authority was deliberately deceiving our people. But those people have no intention of sitting back and accepting the deception: they will continue to fight until they get the justice that they deserve. I hope that the Minister will investigate the health authority's deception, and the way in which it deliberately misled those with the greatest health problems.

I am not surprised at the incompetence of Gwent health authority and its failure to respond to health needs. One has only to look at some of the appointments to its board. An executive from the Midland bank was appointed recently. I look forward to the time when nurses, ancillary workers and doctors are appointed to the board of that bank, although I suspect that it will not happen in the foreseeable future.

Then we have the South and East Wales Ambulance NHS trust which under the previous chief executive and board decided to organise shopping trips to France in an attempt to generate income. I do not expect the trust's members to know everything, but in the circumstances I would have expected them to find out first whether there was a bank holiday in France and whether the shops would be closed. However, that was obviously too much for the chief executive and senior staff, because when the trippers arrived the shops were closed. The trust was then forced to repay the cost to the trippers, together with compensation.

Never short of ideas, the trust then decided to invest £125,000 in another computer control system, which has still not been made to work. I suspect—I may be wrong—that it may have used that system to organise the trip to France. That seems logical.

Not satisfied with those disasters, the trust decided to invest £3.6 million in new headquarters, which it now accepts was an overspend of 50 per cent. It told the Welsh Office that the cost would be £2.4 million, although the directors knew at the time that it would be £3.1 million, and the actual cost was even higher.

After all that—and much more—the non-executive directors are still in place. Will the Minister investigate and find out why that is? In the mean time, ambulance cover is being cut and morale is at a low ebb. I could give one example after another of the trust's inefficiency, but I will give just one more. The trust spent £350,000 employing consultants to cut transport costs. The cuts still have not reached more than one third of that figure, so that was not good value for money for taxpayers.

Bob Hudson, chief executive of Gwent Community Health NHS trust, decided to reorganise mental health provision for people in a part of my community without consulting patients, their families, friends, nurses, doctors or anyone on the local authorities. When we protested about that in meeting after meeting, Mr. Hudson's response to the most vulnerable people in our community was: Well folks, you've lost out". He then told us that he could not make the next meeting as he had decided to go on holiday in Ireland, and that in any event there was no chance of altering the plans. Consultants attended the next meeting, where the plans were totally changed and it was obvious that the reason was based on medical advice as opposed to advice from managers and senior administrators.

I mention those examples—I could mention many more—to highlight the incompetence of Gwent health authority, Gwent Community Health NHS trust and the South and East Wales Ambulance NHS trust, and the uncaring attitude of their senior people. They do not understand, care or have a commitment to the NHS. To them, it is just another way of making a quick buck. Their promises in those glossy magazines were just words—a publicity stunt.

I hope that a future Labour Government will examine those people, who are in senior positions in the health authority and on the board, and start replacing them with people who understand the service, who care for it and who know what is required to make it better. We must reject the philosophy of the NHS as a business and develop it into what Nye intended: a service, and a great service at that.

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield 5:42 pm, 20th November 1996

At the beginning of the debate, the hon. Member for Islington, South and Finsbury (Mr. Smith) referred with approbation to many quotations about the so-called "crisis in the health service." He gave a further quote, that it was "close to collapse", and said that it was in the "worst position for many years".

Other press cuttings assert: Crisis has become an uncomfortable way of life for the health service". They even assert that the "NHS faces collapse". The Times asserts: Patients are suffering and the wait for an appointment is lengthening into months, and even years". Those are serious charges. Those phrases are almost identical to the phrases used by the hon. Member for Islington, South and Finsbury. The difference is that those press comments were made in 1975, not in 1995 and 1996. The same sort of comments as the hon. Gentleman made and the same sort of quotations as he used were made in 1975, 1976, 1977 and 1978 under the last Labour Government. In 1975, the Labour Government had to bring in an outsider, Lord Goodman, to sort out the mess in the NHS.

My first point—I make it with some humility—is that a certain amount of care is necessary when talking about the state of the health service. Anyone who seriously believes that the election of a Labour Government would transform the health service's internal morale is not only deceiving himself, but arguing against all historical evidence. In the past 50 years, disputes in the NHS have been entirely politically neutral. If—God forbid—there were to be a Labour Government, that would not mean an end to disputes in the health service. No hon. Member seriously believes that. If they do, they should not be Members. The British Medical Association and the health unions would continue their attacks and continue to press for more resources.

Let us try, therefore, to get away from dangerous nonsense that the NHS in some way faces collapse. It is not true of the NHS today any more, frankly, than it was in 1975. In the past 17 years, there has been a successful development of the NHS. No one would claim for a moment that there have not been problems, but the development has continued.

Photo of Mr John Gunnell Mr John Gunnell , Leeds South and Morley

Does the right hon. Gentleman agree that it was not until the present Government's so-called reforms that trusts operated their budgets individually? Inevitably, those trusts have found themselves running at a considerable deficit. One of the trusts in my constituency is talking about an £11 million deficit this year. Therefore, we are talking not about the service as a whole, but about particular parts of it. The people in that service feel that it is on the point of collapse because they consider the budgets and the need to be met, and they know that they cannot meet it.

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

I am grateful for the hon. Gentleman's statement that we are not talking about the whole of the NHS. I will make a specific point about NHS trusts that is the exact opposite of his point, but I am glad that at any rate some sanity is beginning to reassert itself in the general debate on the health service.

However we measure it, in the past 17 years more resources have been devoted to the NHS, more patients have been treated than ever before, and more new hospitals have been built. I do not remember receiving a reply to my question to the hon. Member for Islington, South and Finsbury, who leads for the Opposition, about capital cuts in the 1970s. Waiting times have come down and nurses' pay has improved. The Government gave them a Nurses and Midwives Pay Review Body, which the profession had wanted and which has had a profound effect on the pay of nurses throughout the service.

In addition, the Government have made a commitment on the health service's future funding, which compares starkly, as anyone who has listened to the debate would agree, with what is coming from the Opposition Front-Bench team. I hope that, before the Opposition call another supply day on this subject, we might at least receive some replies to the questions of my right hon. Friend the Secretary of State for Health.

The hon. Member for Morley and Leeds, South (Mr. Gunnell) raised a point about the trusts. One of the trusts' impressive features has been the way in which they are now able to respond quickly to some of the problems in the health service. We deceive ourselves if we think that there will never be problems in the health service. Twelve months ago, my local hospital of Good Hope in Sutton Coldfield was at the centre of a storm. There was a great dispute about waiting times and patients waiting on trolleys. What has been impressive is the way in which the dispute has been handled, thanks particularly to my hon. Friend the Under-Secretary of State for Health. We now have a new reception area, a new ward for receiving accident and emergency patients and two new operating theatres. That is the impressive way in which the trust has responded.

I do not say to the hon. Gentleman that, in some miraculous way, this is going to guarantee for all time that there will not be problems and crises. No one can guarantee that. Let us be adult about that and accept it, but the new facilities have had a profound effect on morale in the hospital. Anyone who visits it will understand and recognise how much they are welcomed.

I should like to deal with the central point of this debate, and to concentrate on the section of the Opposition's motion that the hon. Member for Islington, South and Finsbury rightly concentrated on, as did my right hon. Friend the Secretary of State for Health. It states: That this House reasserts its belief in the fundamental principles of the National Health Service … that health care should be available to all, based on need and not on ability to pay … and seeks to restore the ethos of the NHS to that of a public service, not of a commercial competitive business. That brings us to the crucial and persistent charge made by the Opposition against the Government for the past 17 years: that we are somehow concerned with moving away from the principle that health care should be available to all, based on need and not on ability to pay, and that we are concerned with—although I welcome the fact that, for once, the hon. Member for Islington, South and Finsbury did not use the word—privatising the health service. That is arrant nonsense, but it has not prevented the scare from being run, year after year and in every election in which I have taken part since 1979.

Photo of Hugh Bayley Hugh Bayley , City of York

During the time the right hon. Gentleman was Secretary of State for Health, the NHS provided long-term nursing care free. If one needs long-term nursing care now, it is necessary to go to the private sector and to private nursing homes. It is no longer a free service: it is a means-tested service.

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

I am grateful for that endorsement of my period in office, although that fact did not prevent my being attacked—just as every Secretary of State responsible for the health service has been attacked—for wishing to privatise the NHS. I remember that on one Saturday morning in 1983 the Opposition had published a "leaked" copy of a "secret" Health Department report planning the privatisation of the health service. Those reports are always secret, and they are always leaked. Michael Foot called it the most serious attack on the NHS since it was originally started. That does not exactly understate his opposition to my policy. The only trouble was that neither I nor the Minister for Health could remember precisely which leaked report Mr. Foot had in mind.

It subsequently became clear that Mr. Foot had in mind a consultation document published under the very threatening title, "Co-operation between the NHS and the private sector at district level" and containing such threatening ideas as allowing NHS patients access to underused high-technology equipment in the private sector. In short, the radical idea that was so attacked by the Opposition was that of co-operation between the sectors. The idea was that resources were out there which, whether they were labelled "public resources" or "private resources", they could be used for the good of patients—an entirely sensible policy which I hope and believe that Ministers are developing.

The only sensible meaning of the charge of privatising the health service can be that we intend to change the entire basis of financing the health service and that we are intent on moving it from an essentially tax-funded service to one based on private health insurance. However, surely the only significant point of that debate is that that option has been rejected by every Conservative Secretary of State responsible for health since 1979. It has been rejected by successive Conservative Cabinets. It has been rejected explicitly, in his latest White Paper, by my right hon. Friend the present Secretary of State for Health. It was rejected by Lady Thatcher, and it is most certainly rejected by my right hon. Friend the Prime Minister. We are committed to a tax-funded service. Moreover, we are committed to providing real increases in its resources to an extent that, up to now, the Labour party has not even dared to hint at.

Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Health)

I accept those two commitments, but does the right hon. Gentleman agree that if the percentage of those using private health insurance continues to increase—it is currently 11 per cent. and projected to be 14 per cent. by the end of the decade—we shall have privatisation of the UK health care system not by intention but by fact?

Photo of Mr Norman Fowler Mr Norman Fowler , Sutton Coldfield

That is not privatisation in the remotest sense, whether by intention or by fact. Let us turn the situation around. If the Liberal party wishes to say that it will abolish the private sector in the NHS, let it do so, but I do not think that 14 per cent. is an extraordinary percentage. We believe in freedom of choice. If the Labour party or the Liberals wish to say that that is not their policy, let them do so. Up to now, however, they have not done so. I will let the hon. Member for Southwark and Bermondsey (Mr. Hughes) make his own speech—he has a wonderful habit of making speeches during the speeches of other hon. Members—but I would like to have their position explained.

We are also committed to achieving the very best value for the taxpayers' money that we use, which also distinguishes us from the Opposition. The real difference between us and the Opposition is in this sphere. We are committed to the NHS as a public service, which does not mean that everyone in that public service has to be employed directly by the NHS. Opposition Members seem to think of the performance of the health service, and perhaps of public services generally, in terms of whether it directly employs all its work force. That is why the Opposition have consistently opposed, for example, the initiatives taken in contracting out services.

The reason for contracting out ancillary services is clear enough, and the policy—which is not in the least controversial—is followed by other service providers and by virtually every other major industrial company in the United Kingdom. The case for it is simple. They have found that specialist companies outside can often provide a better and more cost-effective service than an in-house provider. The fact that we want to use contracted-out services certainly does not mean that we want to privatise the health service.

I am sceptical about the Opposition's new-found enthusiasm for attacking bureaucracy. If more can be done in delayering the health service, I should be very much in favour of it—although I realise that my right hon. Friend the Secretary of State for Health is already promising £300 million in savings from administrative reforms. The real scandal of bureaucracy, however, occurs when responsibility is shuffled from one administrator to another, when no one takes responsibility, when no one knows where the buck stops, when difficult decisions are avoided and when decisions are for ever delayed in cumbersome committees. That is why, in the 1980s, we acted to introduce general managers into the NHS—so that the buck would stop somewhere. The reform was, of course, fought all the way by the Labour party, but we introduced it in the teeth of Labour opposition. That reform is one of the reasons why decision making in the health service is better today and I hope that Opposition Front Benchers will accept it as a permanent piece of policy for the future.

We should recognise that all parties are basically agreed that the future of the health service is as a tax-based service. There is no dispute about that. The real debate should be about which party can provide the strong economy that is necessary to provide a strong health service. That is the addition to the argument—it must be. Although the hon. Member for Islington, South and Finsbury criticised the Chancellor for making that obvious point, it is clear and obvious that without a strong economy and strong financial policy, the health service would suffer. It may be reassuring for some to say that all that is needed is the stating of priorities, but history shows that that is not so. The matter is not simply one of making statements. When the Labour Government cut the hospital-building programme—and it was, I repeat, a devastating cut—it was not because they wanted to do so, but because they were forced to do so due to the collapse of their economic policy.

The judgment that the public need to make relates to health service performance and health service commitment. On those two matters, the Government have nothing to fear. The public also need to judge economic policy because without a successful economic policy, pledges and promises are frankly just words.

For six years, I was the Secretary of State for Health and Social Services. In that time, I acquired an immense respect for those working in the health service—whether nurses, doctors, managers or staff. The health service in this country provides the most cost-effective service of any health system in the world. Of course, at any stage in the past 50 years a case could be made for spending more money. That has been so for any Government at any time, but it should not disguise just how well and effectively the NHS has performed, especially over the past 17 years.

I would never remotely support privatisation of the health service, but that is not a real issue. The Government have made their commitment to the NHS crystal clear. It is because of the Government's commitment and record that I shall support the amendment tabled by my right hon. Friend the Prime Minister.

Photo of Bernard Jenkin Bernard Jenkin , Colchester North

On a point of order, Madam Deputy Speaker. You will be aware that earlier today a number of hon. Members raised the issue of an apparent slur on the Cabinet Secretary and on the impartiality of the civil service. Since then, the Cabinet Office has issued a statement claiming that the Evening Standard story is "a travesty". Is there any way of bringing those hon. Members back to the House to apologise to the civil servants who have been drawn into a political controversy in a completely unwarranted manner?

Photo of Miss Janet Fookes Miss Janet Fookes , Plymouth Drake

It is my understanding that Madam Speaker indicated that the matter was not one with which she could deal. The matter must be dealt with in some other way.

Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Health) 6:02 pm, 20th November 1996

I am very happy to follow the speech of the right hon. Member for Sutton Coldfield (Sir N. Fowler). His speech should be read widely, because it reinforced the view that the national health service is not the property of any one political party and has not been supported or, indeed, encouraged only by any one political party. It has become part of the fabric of British life. Providing a health service is one of the things that we do best. It is certainly a hugely cost-efficient and effective way of delivering health care. The right hon. Gentleman's stewardship of it was extremely responsible and committed. I have some minor quibbles with him, but, in general, his job was handled very securely.

It is welcome that it became clear in the White Paper—which, to be honest, was not really a White Paper, but came out under such a title—that was published last week, that the Secretary of State reinforced without qualification the view that not only should we have a tax-funded NHS, but we can afford it. I hope that the one message that comes out of the debate is that there is no threat to the existence of the NHS from some specious belief that large numbers of older people will make it unaffordable. In fact, I would argue that paying for a good health service is not undermined by an argument that older people are more disadvantageous to society. The NHS is as likely to be as affordable in the lifetime of every hon. Member as it has been in the past.

Like the Secretary of State, I welcome a debate on the NHS. I welcome an opportunity to pay tribute to the service, to praise those who work in it and to say how good I believe it is. It serves hon. Members and our constituents extraordinarily well. Of course, things go wrong and sometimes there are sad mistakes and tragedies.

I also share the Secretary of State's view that the Labour party has made an extraordinary choice of subject for the debate. Nye Bevan would turn in his grave at the lack of the Labour party's financial commitment to the health service. As somebody who was brought up in south Wales and who shares and understands Nye Bevan's commitment to the health service, I understand now the problems that he said he had in the 1940s.

In 1942–43, when Beveridge wrote his famous report and said that the precondition for a welfare state was a health service funded by the taxpayer, Nye Bevan supported that view, but had the greatest difficulty in persuading the Labour party to agree until well into the beginning of the 1945 Government. After the implementation of the Beveridge report, in the period at the end of the war, from 1943 to 1945—at the time Beveridge was not a Member of Parliament, but became a Liberal Member of Parliament in 1945 and a Liberal Peer thereafter—Nye Bevan said: It is a form of torture unknown to the ancients … to convert the leaders of the Labour Party … to recapture territory occupied by Beveridge … I can sympathise with that fellow Sisyphus and his bloody boulder". For all sorts of reasons, the Labour party found it difficult at first—there were many objections—to accept the whole idea of the welfare state being predicated on a national health service. It came round to the view, thank goodness, voted for it and put it in its post-war programme. We supported Labour, the Tories opposed it, but now there is unanimity.

The Secretary of State, the hon. Member for Islington, South and Finsbury (Mr. Smith) and I were pre-recording a Granada Television programme last week—which, coincidentally, is going out tonight in the Granada region—during which someone from the audience asked whether we could please reach all-party agreement on the health service and have less party politicking on it. I endorse that view. Out there, the public are fed up with our trying to score silly points on the health service and want us to take it back into common ownership and to make as many common commitments as possible.

The right hon. Member for Sutton Coldfield is absolutely right. The precondition for a successful health service is having the necessary money to spend on it. It will need more money, because demand is growing. Paradoxically, the better the health service and the more successful primary care, the more demand will grow. At the moment, demand is growing quite strongly.

Whatever the success of the economy, however, the public will always need to know the respective parties' specific commitments for the coming Parliament. Today, the Government have said that, year on year, funding will keep pace with inflation, although not NHS inflation, and all we have heard from the Labour party is a commitment to make £100 million-worth of bureaucracy savings. My colleagues and I are now in the position that we have made a simple budgetary decision to commit a significantly greater amount than either of the other two parties. I shall address the fact later that this may mean that taxes would not be cut.

Unarguably, there will be difficulties in the national health service this winter. The sequence of events went something like this: in the run-up to the autumn, no public figures were available on what the difficulties would be. As the NHS did not produce the figures, my office calculated that the shortfall this year in the health authorities in England would be at least £133.4 million, of which about £55 million came from the two Thames regions.

In October, the British Medical Association estimated that £200 million was needed. The National Association of Health Authorities and Trusts said something similar. The Government then produced their figures, in response to the hon. Member for Newham, South (Mr. Spearing), which stated that the shortfall would be about £122 million. I do not pretend that that figure is cast in stone. I accept that it will change as the year goes on. However, I know that health authority after health authority and trust after trust are really worried about what will happen this winter. The problem exists because last year we overspent what was allocated and the extra money was taken out of this year's budget.

The first issue on which I should like a response from the Government—the Secretary of State knows that I am concerned about this—is that, whatever the final arrangements for the Chancellor's Budget announcement next week, which, we understand will include a welcome increase in funds for the health service, some money needs to be made available for this winter. If that money is not made available, some people will be turned away from hospital doors and told that they cannot be treated, waiting lists will increase and there may well be tragedies that certainly should not happen.

I should like to add a postscript to that. It must be a long-term objective of the health service, if not a short-term objective—long-term should mean a few years rather than just a few months—to arrive at a situation in which we do not have mixed wards. Beyond that, we should aim to have no wards. Hon. Members may not be aware that in America—a country that we often castigate for having a lousy health service—wards have not been known for 40 years. Everybody has their own room, whether they are on Medicare or Medicaid or go through the insurance-funded system. We must move towards this more civilised system for acute treatment.

I have a second specific issue on which I should be grateful for an answer. A reply from the Under-Secretary of State for Health, the hon. Member for Orpington (Mr. Horam), to a written question from me published in today's Hansard, contains the most extraordinary figure, revealing that the national health service needs £2.4 billion for its repair backlog. That is the Government's figure. It has increased by 40 per cent. in the past five years. The backlog in one region—Trent—has doubled in that period from £102 million to £200 million. While pursuing the private finance initiative, the Government have left a lot of hospital stock to rot where it stands. We need a significant amount of money to begin to catch up with the NHS repair backlog. That is an unacceptable situation, meaning that many places have poor buildings that are not likely to be replaced in the near future.

I should now like to make one regional point and one south London point. It is clear that London health authorities will have acute deficit problems this year and next. East London and The City health authority—hon. Members from that area are present today—and Merton, Sutton and Wandsworth health authority have significant projected deficits of up to £17 million. My local health authority, Lambeth, Southwark and Lewisham—it is also the local health authority of the hon. Member for Dulwich (Ms Jowell), who speaks for the Labour party on health—has a projected deficit of £19 million for next year. I think that the hon. Lady agrees that it would be unacceptable for our health authority, serving the second most deprived area in the country, to have a settlement that forced it to cut £18.8 million out of next year's budget. That cannot be done without significant adverse effects. I have it in writing that the maximum waiting times for routine in-patient and day care treatment for our residents have already increased, as the hon. Lady knows, from 12 months to 18 months. They are likely to increase further. Those waiting times will not go up to the same extent for the patients of fundholding GPs, who have the advantage that that part of the two-tier system delivers.

I have a plea. This is not a partisan point; it is a view informed by professionals who work for the health authorities. We cannot sustain the present level of service on the present level of funding. The Government must come up with more money. That is the most important issue that we should be concerned about.

I am also concerned that the health service is becoming increasingly fractured as a result of breaking everything down to trusts and health authorities. The best example of that is locally negotiated pay. People no longer feel that they are part of the NHS if they have to negotiate locally. It is also inefficient, costing probably as much as £40 million or £50 million extra a year because professionals have to stop their radiography or physiotherapy to attend local pay negotiations.

There is clearly a lack of regional strategy. The health service would be on a much more secure footing if we had proper, democratically elected regional health authorities that could plan strategy, rather than competition between one provider and another.

I believe that the Secretary of State and Ministers accept that there is, in effect, a two-tier health service. There is a difference between those who go through the GP fundholding route and those who do not. Providers need to advantage GP fundholders' patients in many cases because otherwise that business might go elsewhere. They are less concerned about favouring the large bulk contracts from the local health authority. Patients of fundholders therefore jump the queue. That is not a fair system. If the principles enunciated by the former Secretary of State, the right hon. Member for Sutton Coldfield, and by the current Secretary of State — principles that are also contained in the wording of the Government amendment —are to be upheld, equality of access must mean equality of access and must not depend on a patient's GP.

The final aspect of the health service that is clearly not working is the time spent on the bureaucracy of the annual contracting round. I was interested and grateful to hear the Secretary of State say that he was willing to consider moving to longer-term contracts. I hope that we can persuade the Government that it would be better for three-year contracts between purchaser and provider to be the norm. Obviously, there must be adjustments year on year, but the substantive contract should be for three years, not one year. It may even be possible to have longer contracts. That change, together with national rather than local pay negotiations, could save significant amounts of money.

I have one other short point to make before my concluding remarks. One priority identified in "The Health of the Nation"—there is no dispute on this and it is not a party political matter—is that we should put more emphasis on mental health services. In some areas, it is very difficult to receive treatment for mental health needs in the community or in hospital. In the same way that justice delayed is justice denied, care delayed can often be care denied or care altogether too late. We must put mental health in the same league as physical health. We are all as likely to be as vulnerable to a failure of one as we are to that of the other. That should not be a matter for dispute.

What would the public like to hear from politicians as a result of today's debate, next week's Budget and the forthcoming general election? I think that they would like a year-on-year commitment to keep up with real terms spending. The Secretary of State was honest when he said that the increase was to keep pace with inflation. It is not true that there is not differential inflation in the NHS. There is. It is also true that it has been greater in the recent past. It may not always be greater—it has been coming down—but we cannot claim to make a commitment to real terms growth if that commitment is not to real terms growth in the health service, should that be greater than inflation. On the Chancellor's Red Book projections, unless there is significantly more money next year, we shall go below a real terms increase for the first time since 1979.

We also need, if humanly possible, to halt the closures resulting from the short-term cuts this year and next year. Those finance-driven closures—they are not strategically planned—of beds, wards, hospitals and clinics must be prevented. The only way to do so is to find the funds so that health authorities do not need to save the money by closing facilities.

We need more staff in the NHS. As a party, we are happy to pledge £200 million a year. which would buy the equivalent of 10,000 nurses or 5,000 doctors. We desperately need them. In parts of the country, the service is crying out for general practitioners and in some places it cannot get nurses or midwives. We should aim to reduce waiting lists to six months within three years. It is achievable, but more resources are necessary—probably about £150 million a year. We have made that commitment.

Finally, as well as preventive measures such as restoring free eye and dental checks, which we should never have taken away and which can be funded by putting extra tax on tobacco and cigarettes, which we support, we have to make a commitment to ensuring enough general funding for the health service. It is no good relying on bureaucracy savings. Of course, there can always be savings on bureaucracy, but those are not enough.

On behalf of my colleagues and the majority of the people, I must make what might be my last plea to the Government before the Budget. They should renounce the tempting, pre-election bribe of, "Let's cut taxes." I am sure that the public want a fair tax system, with higher earners paying more to fund the public services.

As for the Labour party, I am sad that Labour Members make it a tale of some sound and a little fury, signifying almost no coherent policy and almost no funding. They have offered no answers to any of the funding questions. If they want to be credible before the election, they have to persuade the shadow Chancellor to put his money where their foot is—in their mouths. The Labour party needs to make some proper financial commitment to the health service, or it will be justifying the fears of Nye Bevan. He may have anticipated that the Labour party would not necessarily be able to guarantee the funding that the health service needs.

The public want us to make commitments across the Floor of the House. I welcome the Government's commitments, as far as they have gone—they must go further. The Labour party has to start to show what it is made of.

Photo of Mrs Marion Roe Mrs Marion Roe , Broxbourne 6:22 pm, 20th November 1996

First, I must congratulate my right hon. Friend the Secretary of State on his White Paper, "A Service with Ambitions". Like the chairman of the British Medical Association council, Dr. Sandy Macara, I welcome the document as a commitment by the Government to the continuation and development of a comprehensive and truly national health service. It is appropriate that, following the implementation of the reforms of the early 1990s, a focus is given to delivering a better quality of NHS care year after year, and I am sure that we would all endorse the Government's far-reaching ambitions for the national health service and the steps that they believe must be taken if they are to be achieved.

I also want to place on record a welcome for the Prime Minister's health guarantee, which he gave at this year's Conservative party conference, when he pledged that the next Conservative Government would increase the real resources available to the NHS every year for the five years of the next Parliament. I therefore believe that, under a Conservative Government, the NHS can look forward to an excellent future.

Unfortunately, when I intervened on the Leader of the Opposition during the debate on the Queen's Speech a few weeks ago, inviting him to match the Prime Minister's pledge, he refused to do so. Not only that, but it would appear that the Labour party is unable to give any policy commitments, either.

I have listened carefully to the contributions to the debate and I fear that the Opposition parties seem to prefer always to give the impression that the national health service is terrible, that patients are being neglected and ignored, and that there is always a crisis around the corner. That is a slur on all those who are working within the health service.

A few months ago, I conducted a survey in my constituency and found that, of those who responded to the 38,000 questionnaires circulated, just under 80 per cent. treated by the NHS within the past two years were either satisfied or very satisfied with their treatment. Of those who were dissatisfied, the complaints were mostly minor, and have since been addressed. Over and over again, the high quality of care was remarked upon.

One reason is that there is no doubt that East Hertfordshire NHS trust, which serves my constituents, has progressed enormously since achieving trust status in April 1992. Its substantial achievements in patient services during that time exemplify the sort of developments throughout the country in recent years.

I have drawn attention in the House to the notable advances in acute hospital care that have benefited patients in east Hertfordshire as a result of the NHS reforms, which enabled local doctors, nurses and managers to meet health care needs swiftly, flexibly and with outstanding value for money. That increased ability to respond puts the NHS in a strong position to face the pressures of current demands.

It is undeniable that hospital services are under pressure, but nor can it be denied that the NHS has always worked under pressure, from its earliest days. As the demands on our health service have increased, so too have the ability and determination of our health workers to meet those demands. They are supported in this by the substantial improvements that the Government have made in the structure of our national health service—for example, the enormous advances in community health services in the past few years. Whether run by family doctors or by community trusts, community health services are vital to everyone. They are the services to which we all need access more frequently than any other.

In east Hertfordshire, we are fortunate to have a network of general practitioners who have used the freedoms and opportunities given them by recent legislation to provide vastly improved patient services. New and enlarged premises now give space and facilities for hospital consultants to come away from the large district general hospitals to see patients in their neighbourhoods.

Patients can see their hospital specialists in the familiar surroundings of their family doctors' surgery, close to home, at a time that fits in with their work and family commitments. They receive quick assessment, with the confidence that more comprehensive treatment will be made available to them back at the general hospital if it is needed.

GP fundholders have used the flexibility of holding their own budgets to pay for those services direct, as their patients require them. Many family doctors are also using their new potential to offer minor surgery and diagnostic facilities in their premises.

Since the inception of fundholding in 1991—for example, at the Stockwell Lodge medical centre in Cheshunt in my constituency—the level of secondary care delivered in a primary care setting has gradually increased such that, at present, each month 20 new clinics are provided on the site in the specialties of general medicine, general surgery with two consultants, gynaecology, orthopaedics with two consultants, ear, nose and throat, psychiatry, psychology, dermatology, counselling, and ophthalmology. There are also six minor surgery lists, with four audiometry sessions, one coloscopy session and four ultrasound sessions.

That has all been achieved with a minimum saving of £250,000 in the year 1995–96, which is subject to review, with further considerable savings forecast in the next 24 months. The secondary benefits include shorter waiting times for all patients, fundholding and non-fundholding; the provision of services in an acceptable location; better communication between primary and secondary care doctors; and greater patient and doctor satisfaction.

In east Hertfordshire, the trust hospital and community services work closely with local family doctors to deliver those improvements. The continuing advances in the trust's community services are a further indication of the benefits that patients now enjoy on a daily basis.

For example, I was recently delighted to open the newly refurbished Waltham Cross community clinic, which represents a significant development in community services for people in my constituency and in east Hertfordshire. A clinic has been on the site, providing a range of services for local people, since 1938, but the major new development will enable patients to obtain a wider, more diverse range of services than before.

Services available include a multi-disciplinary child assessment team with a speech and language therapist; a consultant community paediatrician; and a physiotherapist and occupational therapist who will visit the clinic weekly. Audiology, family planning, chiropody, continence, dental, orthoptic, ante-natal and post-natal services are also available.

The clinic is one of the many community units being developed throughout Britain as our health services meet the challenge of the primary-care-led NHS. Local access is essential, especially for the elderly, the disabled, families with young children and those with mental health problems, for all of whom a long journey to a distant district general hospital is daunting and difficult, if not impossible. The clinic and others like it ensure that health care is much more easily accessible to all.

The Waltham Cross clinic scheme was approved in 1994, with money from the North Thames region that forms but a small part of the £40 billion spent on health services in the past year. Improvements in community services result not only from better premises but from a host of advances that the Government's initiatives are helping to create.

Further examples of benefits are listed in East Hertfordshire NHS trust's recent application for charter mark status—itself a reaffirmation of the Government's policy to provide objective analysis of achievements in public service.

Those benefits include the introduction of a maximum 15-minute wait for out-patient appointments in community clinics; Saturday clinics for working parents who are unable to attend during the week; the introduction of a night nursing service; and an improved wheelchair service that will provide at the assessment clinic routine chairs that patients will be able to take away, thus providing an immediate benefit from visiting the clinic, before the customised wheelchair is delivered by the approved supplier within five to 10 days.

Among the further benefits listed are improved car parking, with facilities for wheelchair users and the provision of outside covered pram shelters and safety gates for small children; an improvement in the range of information available on a wide range of health issues; the introduction of a user committee to ensure that patients and their carers can contribute to the scrutiny and development of community services; a standard policy that, whenever possible, the needs of patients are given top priority and staff are encouraged to arrange appointments and visits that minimise disruption; and, finally, the development of a community child protection team, based in a community clinic to facilitate access for all staff and clients using the service.

There are examples throughout the country of the genuine benefits experienced by patients as a result of the Government's initiatives to improve the national health service. All those benefits have been achieved cost-effectively, with key improvements directed to patients' needs. In east Hertfordshire, benchmarking reviews show that all the improvements have taken place in an area where staff numbers are lower than average, but total patient contacts higher.

East Hertfordshire NHS trust is an outstanding example of how the Government's reforms, put properly into practice, can daily provide genuine improvements for patients.

Photo of John Heppell John Heppell , Nottingham East 6:35 pm, 20th November 1996

My hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) spoke about the good news club that has been formed by some Conservatives. It seems that every Conservative Member who has spoken today has been a member of that club, because the national health service they talk about is not the NHS that I recognise. The only time they talk about anything bad is when it is something that happened in 1975.

I remind those hon. Members that 1975 was 21 years ago; many of the people who will be voting at the next general election had not even been born then. Even if I accepted their criticisms about what happened in 1975—which I do not—I would have to tell them that it was a different health service then, at a different time, with different needs and different economic circumstances.

In the 21 years since 1975, we have had 17 years of the Conservatives in office. If the news is all good, why do we still have 1 million people on the waiting list, year after year? Why have 250,000 people been on the waiting list for more than six months? Why, last year alone, did almost 55,000 people effectively have their operations cancelled at the last moment? Nobody can tell me that that is good news.

I do not want to bandy national statistics with the Minister, because, whatever statistic anyone mentions, he will find a different one. The Minister is obviously a proponent of the idea that there are three types of mathematician: those that can count, and those that cannot. The penny will drop in a minute.

I want to talk about the reality of what is happening locally in my patch. The right hon. Member for Sutton Coldfield (Sir N. Fowler) talked about how trusts could respond quickly to events. He is right, and I know a good example of how they respond quickly—an article in my local paper, saying: Cash crisis axes more ops … City Hospital and QMC' — Queen's medical centre— are forced to postpone routine operations". That is how they act quickly, because they are running out of money.

For November and December alone, the Queen's medical centre has postponed 350 operations that people were expecting. The city council has stopped all routine, non-emergency operations, because more emergency operations are needed than it thought, and it has effectively no contingency in its budget to meet the demand.

Unless there is extra money for Nottingham health authority, it is predicted that next year no medical equipment will be replaced. Plans to introduce the latest treatments and develop breast cancer services will be dropped. The waiting list for routine operations will grow even more. All high-cost treatments will have to be restricted. National standards for the ambulance service will not be met. There will be no contingency plans, because there will be no contingency fund; there will be no money.

The Minister may think I exaggerate, but these are not my predictions but those of the chairman of the Nottingham health authority, Sir David White, who is not a noted socialist. He was knighted by the Government. He is one of the kings of the quangos. The Government not only think that he is good enough to chair the health authority; he is on almost every conceivable quango for the Nottingham area. He is not noted for his criticism of the Government. However, he is publicly saying that all those things will happen next year. He says that part of the reason is that Nottingham has been underfunded for many years. It is funded at 97 per cent. of the average, when, because it is a teaching district, it should be funded at more than 100 per cent. The gap between 97 and 100 per cent. funding is £11 million.

The confusion in the Government about how to deal with the problem is interesting. In February, the Secretary of State agreed that there was underfunding, although of £9 million rather than £11 million. The hon. Member for Gedling (Mr. Mitchell), who has since become the Minister responsible for the Nottingham area, said that the underfunding dated back to the 1960s, and could not be solved overnight. I did not expect anyone to solve it overnight, but if it dates back to the 1960s, I should have thought that the Government might have tried to tackle it in the years since 1979.

That was not the end of the story. Only weeks later, the Prime Minister contradicted the hon. Member for Gedling, and said that there was no underfunding. He said that the health authority had made it up so that it could bid for more money. Within a week of the Prime Minister contradicting the hon. Member for Gedling, a junior Health Minister, the hon. Member for Orpington (Mr. Horam), said that there was underfunding, and that there was a battle to address a £7 million deficit this year. Finally, the Secretary of State agreed on 12 November that there was underfunding, and gave a hint that some more money might be made available to the people of Nottinghamshire.

That is all well and good, but how am I to tackle the letters I get from people who have been told they cannot have operations? I want to be able to tell them who is responsible for the failure to give the public the service that they deserve. Who is responsible for ensuring that patients get treated and for looking after the sick? Should I tell them that it is the Government and the way that their policies have changed the health service that has put those people in that position?

Should I say that the health authority or the trusts have handled it badly? I have some difficulty with that, because many of the people on the health authority and the trusts are Tory placemen. They are guilty only of doing what the Government want—and doing it with enthusiasm. It is difficult to blame them entirely for the problem. The blame rests fairly and squarely with the Government.

If underfunding, which we have had since 1960, is the only problem that has caused the crisis in Nottingham, why have we not faced such a crisis before? Underfunding may be part of the problem but the real problem has more to do with the changes that the Government have made: the internal market and the growth of bureaucracy. The Government talk about increasing spending year year on year, but £1.5 billion is being spent, year on year on year, on extra bureaucracy. That money must come from somewhere, and it comes from services.

There are fewer doctors and nurses and more accountants and managers. Last year alone, there were pay rises of 18.5 per cent. for senior managers, while for nurses the figure was only 3 per cent. Many people in the health authorities and trusts have watched things going wrong for some time and have not spoken out.

That is what I accuse them of. They are guilty of complicity, of not making criticisms. They have not been willing to speak out until now. The hon. Member for Gedling said that the present position had not been reached overnight. It has been known about for years, and the authority managed to survive because of the reserves it built up before the Government made their changes.

One group that I do not want to criticise is health service staff. The nurses, doctors, auxiliary staff and ambulance drivers deserve praise, not criticism, because they have been putting off the crisis, and they are still putting it off in many hospitals. They have kept the NHS as good as it is—despite, not because of, the Government. The staff will have to bear the consequences of the failure of the Government, the health authority and the trusts. The financial pressures on Queen's medical centre, which is running a £1.6 million deficit, mean that staff have been told that, because the centre's budget is 70 per cent. of costs, many of them may be made redundant. Many people who should be rewarded are suffering.

I have one more point on the local situation. I have tried to keep off the national situation, which other hon. Members understand better. Part of the reason for the present crisis is the Government's private finance initiative. It has been developed in such a way that short-term financial gains can be made, but only with long-term financial consequences. It is selling off the family silver.

For example, on 7 December last year, Nottingham health authority opened its refurbished headquarters, at a cost of £4 million. I think that it was opened by the Chancellor of the Exchequer. I objected that I was not sure that that was a good way to spend money when other services were under threat. It is on Standard hill, an historic site in the centre of Nottingham. I did not know that the authority already had plans to sell it. I was amazed after the grand opening to find that out, not from the health authority but from a leak.

I asked the chairman of the health authority why the public did not know anything about it. He said, "You should know about it, because it is in the public domain." I then asked to see the discussions in the minutes of the multi-million pound deal to sell the headquarters building, the staff, fixtures and fittings, and then rent them back. But those matters had not been discussed. The massive deal did not appear anywhere on the health authority's public agenda, although it had been in process for more than a year.

The deal was only placed in the public domain through an advertisement in the Estates Gazette. My constituents do not spend their time browsing through that gazette to see whether the health authority is planning to sell buildings for £4 million or £5 million—the story is that it is to be sold for £4 million. If £4 million is spent on refurbishing something that is then sold for £4 million, it is being given away. The public in Nottingham have a right to object to that, but they cannot object, because they do not know about it.

I am amazed that, when the Government drafted new guidelines to ensure greater openness in the NHS, they said—in the annual report for 1994–95: In its turn, accountability demands openness. Adding to existing codes of conduct and accountability, a new code of practice on openness for the NHS was published in April 1995. Its key principle is that information should be publicly available unless there is a good reason for confidentiality. It continues to outline what people are expected to do under the code of practice.

When I was questioning the chairman of the health authority, he told me that lawyers had been brought in to see how little he could tell me. He said that he could tell me everything that was happening, as long as I made a vow of confidence and did not let the public know.

What is the Minister going to do to enforce his code of practice on openness and accountability? The chairman of the health authority has effectively told me that he is accountable to no one but the Secretary of State. I do not believe that; I believe that he is also accountable to the people of Nottingham—and to me.

Unless the people of Nottingham are told what is happening in relation to the private finance initiative, that accountability does not exist. The Government have turned the PFI on its head: and it has become the public finance initiative. The public sector chips in £4 million, which can then be passed over to a private company with no risk. When the Minister winds up, I hope that he will say what he plans to do about that.

It has become apparent in Nottingham that the trusts and the health authority try to operate no longer as services to the community, but as businesses. The board members are business people. I have no objection to trying to run things efficiently, effectively or cost-effectively, but the health authority and the trust need members who understand people's needs and not simply how to balance books.

Photo of William McCrea William McCrea , Mid Ulster 6:53 pm, 20th November 1996

The debate has been interesting—each hon. Member has naturally referred to his or her part of the United Kingdom. I have been left with the impression that Conservative Members are saying that everything is grand and good, while Opposition Members are saying that everything is bad and wrong. To be honest, I do not think that what either side is saying is strictly true: everything in the health service is not good, but nor is it bad.

I wholeheartedly agree with the comments of the hon. Member for Southwark and Bermondsey (Mr. Hughes), who said that we should speak about a common health service and its common ownership. As has been said, the NHS—and its record over the years—of which we in the House are rightly proud, is not the property of any one political party, but of the nation. We must therefore be careful not to overstate the case on either side of the argument. Right hon. and hon. Members should express their constituents' feelings and concerns about something that is near and dear to their heart.

The public rightly wants value for money. No one can excuse inefficiency in any public service—inefficiency is unacceptable. Cost-effectiveness is appropriate and proper, whether it be in the health service or any other community service. The people of Northern Ireland—a part of the United Kingdom—believe that the NHS is in crisis. Owing to lack of finances for capital and revenue costs, we face difficult times, especially as we approach the winter months.

I am not trying to make a party-political point. Amendment (b) states that the following words should be added to the motion: and regrets that the official Opposition is proposing almost no extra funding for the NHS. While I agree with much of the motion, which expresses many of the concerns that I hear from my constituents—it is right that those worries should be expressed on the Floor of the House—I do not believe that any credible political party can say that it condemns what another party is doing unless it says that it will make more funds available to the NHS. There have been White Papers, major documents, consultation documents and charter marks—all intended to improve the service—but there have to be follow-up finances.

There was a direct shift of policy in Northern Ireland designed to put care back into the community. I do not argue with that concept as I believe that people should be kept in the community for as long as possible. But although that policy has been introduced, arrangements and finances for the changeover have not been made available. The change from the use of institutions to placing people in the community—there was a dramatic change in the number of mental health beds in the Province and people were encouraged to go back into the community—cannot be made without appropriate preparation for such a move. Neither appropriate preparation nor sufficient finances were made available for that move.

We are proud of our NHS. I join other right hon. and hon. Members in congratulating those who work in it on their commitment—their service and high-quality care to the community is beyond reproach. But it would be wrong to suggest that there are no problems. My constituents tell me daily about their genuine problems and concerns at what is happening: they see a change in the health service. Many of our elderly people feel concerned and forsaken. They believed that the health service would be there for them, whenever it was needed. When they were helping to build the service, as many of them did, they believed that they would be looked after in their old age.

I am greatly concerned that many doctors are anxious about the fact that, no sooner has a patient been in hospital for a few days, they are handed brochures for nursing homes to help them to choose to which one they should go. Homes are touting for business. I have no objection to nursing homes—they provide a service that the people need—but many of our elderly people are concerned about that. Many people who have worked all their lives and tried to save a few pounds for their old age are now finding that, when they are put into nursing homes, most of their savings are used up. Those concerns are widely felt in my constituency.

Many of the farms in my constituency are small, family farms that have been handed down for generations. The farmers do not consider that they own those farms, but that the farms have been lent to them for the period of time that they are on this earth, to be passed on to the next generation. Now, however, when many elderly people enter nursing homes, their farms have to be sold, which has caused a change in the make-up of the community. The elderly are right to express their concerns to us, as their elected representatives, and, as such, it is right that we express those concerns in the Chamber tonight to the Minister concerned.

The Minister with responsibility for health services in Northern Ireland, the hon. Member for North-East Cambridgeshire (Mr. Moss), sent out a document stating that there had to be a 3 per cent. cut for three consecutive years, starting this year. Half of that—1.5 per cent.—is demanded from cuts and savings in administration; but the other 1.5 per cent. will come directly from the service to the people.

To be fair to the Under-Secretary, I have to say that he is the first Minister who has come out and stated that to be a fact. Every other Minister would cover it up and say, "No, no, no. There are no real cuts—we are looking for those 3 per cent. cuts, but it will not affect the service." At least this Minister had the honesty to state openly that savings were being sought in the service. Although I am prepared to give him full credit for his honesty, it does not alleviate my concern about the effect of the cuts on the community.

Photo of Ian Paisley Ian Paisley Leader of the Democratic Unionist Party

My hon. Friend will be aware that there was an Adjournment debate today, in which was highlighted the case of a hospital that five successive Ministers for health promised would be built in the Causeway to serve the region of north Antrim and east Londonderry. That project is now in doubt and, although £10 million has already been spent on the scheme, it is now questionable whether it will ever be completed. Surely that should set the alarm bells ringing.

Photo of William McCrea William McCrea , Mid Ulster

I thank my hon. Friend for his intervention—that case causes me great concern. I have been a member of several delegations and deputations to the Minister in respect of that hospital. The Minister promised us, with hand on heart, that the hospital would be built and that, therefore, the moneys that had already been spent would not be lost. I should be greatly concerned to learn that it is now being suggested that all those Ministers' promises down the years have been nothing more than hot air and are meaningless.

There is an urgent need for a Causeway hospital in Coleraine to serve that wide area. A hospital was taken away from Ballymena, in the constituency of my hon. Friend the Member for North Antrim (Rev. Ian Paisley), and the people were promised that the area around Coleraine and Portrush would be served by a modern, up-to-date hospital. The Minister cannot get away with reneging on a promise that he has made and that successive Ministers have consistently made to the community.

Those year-on-year 3 per cent. cuts will eat into the very heart of health service provision to the community and we must not permit them to happen. Although the Government, perhaps with the forthcoming election in mind, have suggested that more money will be made available on the mainland—perhaps as much as £300 million will be released for the health service here—the truth is that no extra finance is coming to the Province. Therefore, the 1.5 per cent. direct cut in the service will certainly be felt by the community. We face the closure of homes for the elderly and cuts in the home-help service. That is a crying shame and the community is deeply concerned at the lack of resources.

Photo of Simon Hughes Simon Hughes Opposition Deputy Chief Whip (Commons), Shadow Spokesperson (Health)

I support the hon. Gentleman in the two points that he has made. First, as an English Member of Parliament, I say that it would be completely unfair if the additional money for the health service that has been announced by the Chancellor and by the Secretary of State for Health was not shared throughout the United Kingdom on an equal basis. Secondly, we cannot continue to have an arbitrary percentage cut in the budget year on year imposed simply in the name of efficiency, without any explanation or justification. The Government cannot set a target without explaining it. If the health service needs more money, it needs more money even if it also has to strive continually to be efficient.

Photo of William McCrea William McCrea , Mid Ulster

I thank the hon. Gentleman for his intervention. First, it is sadly true that none of the tranche of money that has been announced will go to Northern Ireland. Secondly, as the Minister has openly stated, half of that 3 per cent. cut—1.5 per cent.—will directly hurt the service that is provided. I wholeheartedly accept the points that the hon. Gentleman made, both in that intervention and in his earlier speech.

The current system of trusts in the Province has created a level of administration that is unprecedented in any other part of the United Kingdom. In order to enable competition within the service, we have created many businesses—more than 20, serving 1.6 million people and all with their own chief executives, accountants and other administrative staff. We seem to be filling up the health service with an increasing number of senior administrators, who exert a great draw on the available resources, while at the same time the number of staff who actually deliver service to the patients is decreasing, to the detriment of patients in the Province. We need extra nursing staff and doctors in the health service.

I give the ambulance service in my constituency as an example. Two weeks ago, a newspaper reported that the ambulances going out on emergencies to people suffering cardiac arrest are breaking down because they are years out of date. We can no longer be sure that ambulances will get to those who require urgent hospitalisation. The community is, rightly, concerned. I ask the Minister to encourage the Under-Secretary of State for Northern Ireland, who is now on the Front Bench, to provide the appropriate ambulances for my constituents so that they will get to hospital and receive the treatment they need.

Many other hon. Members want to speak, so I shall conclude. Although in the Province we appreciate the good things—and there are good things—in the health service, we believe that we are confronted with a crisis. We believe that the waiting times of patients requiring urgent hospital treatment and so on need to be attended to, and they cannot be attended to without adequate resources.

Whatever the governing party, no matter what is said about the national health service, unless the finances are made available we shall never be able to ensure that the national health service maintains the standing that we and our constituents have come to expect.

I shall listen with care to what other hon. Members, especially from Her Majesty's Opposition, say about their commitment to ensure adequate resources for the health service. For without adequate resources, all the rest will be hot air.

Photo of Mr John Gunnell Mr John Gunnell , Leeds South and Morley 7:10 pm, 20th November 1996

I shall start by contrasting the image presented in the so-called White Paper, "The National Health Service: A Service with Ambitions", with the reality, especially as seen by a Member representing a Leeds constituency.

As its title suggests, the White Paper portrays the national health service as the Government would like it to be, not as it is. If the comprehensive health service in Leeds—the trusts, the health authority in its purchasing role and the Leeds Community and Mental Health Services Teaching NHS trust—were to receive £1 million for every time that the words "should", "could" or "needs to be" appear in that document, the health service in Leeds would be doing very well indeed. Sadly, the truth is rather different.

In their paper, the Government have postulated a health service in which their reforms are achieving what it is or was claimed that they would achieve. Perhaps if that were the case, the "ambitions" of the White Paper could be realised; but when examined in the real world, which is very different from the glossy aspirations, which reflect more hope than expectation, it becomes plain that the NHS reforms are not working, and that the proliferation of bureaucracy, which other hon. Members have spoken about, and the basic underfunding, which I want to speak about, have combined to the worst possible effect. That is evident in Leeds.

The Government themselves obviously believe that the NHS is underfunded. The uncosted promise made by the Prime Minister at this year's Tory party conference shows that they are at least conscious of the need for an increase in funding. But what are the public to make of an ambition to increase spending in real terms "year on year" which is conditional on what is described as a "growing economy" when the same Government are now telling the British people that a series of Labour aspirations—no more than wishes—add up to £30 billion of spending commitments?

I am dismayed by the attitude of the Minister and the approach of the Government, and of the hon. Member for Southwark and Bermondsey (Mr. Hughes), who spoke for the Liberal Democrats, who expects commitments to be treated in the way in which the Express today talked about things that were desirable as resources allowed. Understandably, it is very difficult for members of the Labour party to offer spending commitments when their wishes are so misused by the Government in their propaganda and by other parties. We are embarked on a process in which electioneering of the lowest possible kind is becoming an everyday fact of life.

Given that process, and given this morning's publicity, I believe that the Prime Minister's vague NHS spending pledge should be regarded as having all the veracity of the White Paper's "ambitions".

I want to talk about the health services in Leeds. I believe that, by doing so, I shall shed light on the fictitious examples of best practice that the White Paper says should occur everywhere, revealing them as hollow. In the Leeds area, there are many skilled hospital and medical staff who share the Government's ambitions but strongly disagree with the chosen means of achieving them. I believe in being fair, so I shall mention some good aspects of the service in Leeds.

I have visited and spent time in the paediatric intensive care unit in the Leeds general infirmary, headed by Dr. Mark Darowski. It is an extremely good service, providing the best paediatric intensive care in the region. It is true that its skilled staff should, in the language of the White Paper, be able to meet the needs of the area, but that is a matter for the Government. They certainly did not do so last winter, and the changes that have come about or are coming about as we approach this winter will not enable them to meet those needs, despite the Secretary of State's promise in a statement to the House.

The community mental health day facility in Leeds has some longer-term beds, but it is run by the Leeds Community and Mental Health Services Teaching NHS trust. It was a great pleasure to open a facility in Middleton in my constituency. It must be able to meet fully the needs of the community that it is intended to serve, but the Leeds Community and Mental Health Services Teaching NHS trust, like the other parts of the Leeds service, is in deficit.

To surprise the Minister, let me pick out a welcome development. A GP fundholding practice in my constituency is building a day facility for people in Morley. It will not carry out large day surgery operations but it will do some things that will save people going to Leeds. In view of transport costs, I welcome that facility.

However, I very much hope that—as I am sure is the intention of those who are carrying out the development—the facility is available to all patients. If it were available only to people who happen to be patients of fundholding practices, it would emphasise the inequity in the system. I hope that, with the co-operation of the health authority and Her Majesty's Government, that facility can be made available for use by every general practitioner in Morley, as it would be under a local commissioning system that the Labour party would introduce.

I am not saying that good things are not happening; they are, but in each case there are flaws in the current system. The fundamental flaw is that, as the Secretary of State well knows, Leeds is grossly underfunded. Leeds general infirmary, the United Leeds Teaching Hospitals NHS trust, has a large deficit. I have been told that the trust's deficit is between £5 million and £11 million; I believe that it is nearer to £11 million.

The chief executive of the trust is one of the few chief executives with a salary of more than £100,000 a year. Running a facility like that, which the Government regard as a business, is obviously a highly responsible job, but the salary may be excessive, given the trust's deficit. I would expect the Minister to agree with me about that.

St. James's hospital, too, is suffering from a massive shortfall in funding and is in debt to the tune of between £2 million and £6 million. The Secretary of State knows the problems of Leeds very well because my fellow Labour Leeds Members of Parliament and I visited him some time ago to stress the difficulties being faced. We were encouraged to do so by the Leeds health authority, which also faces a considerable deficit and cannot purchase as it would want to.

In Leeds, all the bodies set up by the Government's reforms are in deficit, so the Leeds hospital service faces something of a crisis. When we spoke to him, the Secretary of State agreed to facilitate a meeting between the community health council—it also feels strongly about the shortage of funding—and the Minister. Representatives spoke to the Under-Secretary of State for Health, the hon. Member for Orpington (Mr. Horam). As a result of those discussions, however, no new money has been promised to Leeds. I am not talking about new money for the distant future; I am talking about money that is needed now, for this winter.

Leeds general infirmary was exercised—so were Ministers—about the two patients who were relatives and who both died on trolleys waiting for treatment at the infirmary. One of them had waited for eight hours before dying, the other had waited five hours. It is pure coincidence that they happened to be brother and sister. Leeds general infirmary soon realised that it needed more space for intensive care beds, but it can achieve that only at the expense of cutting 40 beds in the gynaecological unit. That work, too, is important.

My hon. Friend the Member for Nottingham, East (Mr. Heppell) drew attention to the fact that the number of bureaucrats has been increasing in the service every year while the number of beds in hospitals has declined. It is certainly a priority to increase the number of intensive care beds, but surely not at the expense of 40 other beds. The trust should not have to make that choice.

I wrote to the Secretary of State about the paediatric intensive care unit, which lacked the space for more than the five beds which it had been granted. It was then granted a sixth bed—which seems to represent an increase of one, but the space remains the same. Last winter, when there was a crisis, six beds were put into the same space. Now that the unit officially possesses six beds, perhaps a little more money will be forthcoming to staff it. It is a first-rate facility offering skilled treatment. That, after all, is why Nicholas Geldart was sent in the direction of Leeds. But a skilled facility needs enough space in which to operate. I therefore look forward to hearing that the intensive care unit will receive the funding for the extra beds that have been promised to the region: that is essential.

It is instructive to look at real cases, as opposed to the fictional cases offered us in the White Paper. When asked whether those cases were fictional, the Department of Health described them as composites of what they hoped future cases treated by the service would look like. I should like to describe some waiting list cases from the real world.

A woman of 93 suffered from a cataract, and her neighbour brought her to see me. She had to wait two years before even being seen, so between age 93 and 95 her vision would remain badly impaired. I am glad to say that because I wrote to the chief executive she was rapidly treated. It should not however be necessary for a woman of 93 to be put in touch with her Member of Parliament for action to be taken. A person who obviously needs treatment right away should be dealt with right away.

Another case that has come to my knowledge concerns a patient whose need to be seen was less urgent. When he came to see me, he had been told that he was on a waiting list of 108 weeks. I wrote to the chief executive of St. James's and Seacroft hospitals, who answered me as follows: On a more general note, at present the orthopaedic service receives more referrals than we are currently able to deal with. This is not a new problem and we are working closely with our major purchaser, Leeds Health Authority, to reduce the waiting times for first appointment. We have 250 patients waiting to be seen for the first time in the orthopaedic out-patient department … The length of time these patients wait varies very considerably, often depending on their clinical need. Once these patients have been seen, if the decision is taken to place them on the in-patient waiting list, again the length of waiting time varies. We achieve the Patient's Charter standard of no waiting longer than 12 months". So having waited two years and two months for his first appointment, my constituent faces another 12 months of waiting for treatment.

Before closing I want to mention the Leeds radiology service. I have written to the Secretary of State about the service run by the United Leeds Teaching Hospitals trust. I was referred to the chairman of the trust, to whom I suggested that people were not being treated on time. Referring to a recommendation from the Royal College of Radiologists, he said: We acknowledge this recommendation … but due to inadequate capital resourcing our ability to start radiotherapy when clinician/clinically required is about four weeks longer than we would wish for some categories of breast patient. It is not good enough to have to wait an extra four weeks—and all for lack of at least one new linear accelerator. We cannot wait for it to come; people are waiting longer than they should for the crucial first treatment that will enhance their survival chances.

It is, I contend, immoral to spend taxpayers' money on producing thousands of copies of a glossy, 60-page White Paper that presents an idealised account of what the health service could be with no concrete explanation of how to get there, in Leeds or anywhere else. The answer of course is more money. I also believe it wrong to involve civil servants in the preparation of a document that is totally bereft of practical policy. It is no more than a treading-water exercise, six months short of an election, conducted at great public expense to enhance the electoral prospects of the Government—and the career prospects of some of its members. What the White Paper will not do, however, is benefit any member of the public who takes it, as intended, at face value.

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow 7:27 pm, 20th November 1996

I apologise for not having been present for much of the debate, but I have been serving on a Standing Committee in which no pairing is allowed. Secondly, I declare an interest as an adviser to the Ivax Corporation and to the Western Provident Association, a non-profit-making body.

A few weeks ago my mother was seriously ill. She was immediately taken to the Royal Aberdeen infirmary where she was given the finest treatment imaginable. She is not exceptional: millions of other people are treated well by the national health service. We can all shroud-wave if we want to: we all know of constituency examples involving absurdities, bad management or the stupidity that one expects from any bureaucracy—but those are the exceptions, not the rule. The majority of people in Britain get a darned good service from the national health service.

I am fed up with being defensive about the health service. We should be proud of the achievements over the past few years: the fact that the health service is growing by 3 per cent. per year; the fact that productivity has increased by 40 per cent.; the fact that we are spending more money above inflation than ever before; the fact that, despite all the upheavals of the reforms that were necessary, we are treating 1 million more people than ever before and the waiting lists are at their lowest level since records began.

People would have laughed in our faces if, 10 years ago, we had given guarantees—in so far as guarantees are possible in any bureaucracy—that there would be treatment or an operation within a set period, as the patients charter requires. Yet it works—and, by and large, it works pretty well.

Earlier in the debate I challenged the hon. Member for Islington, South and Finsbury (Mr. Smith) about an article that appeared in The Independent entitled, "Is the NHS safe under Dr Blair's team?" The sub-heading states: The Opposition's once distinctive stance on health has dissolved for lack of fresh thinking. Jack O'Sullivan examines a failure that the Tories will exploit in the next general election". The article begins: The NHS may be in poor shape, but its condition is nothing like as moribund as Labour's performance on health. After 17 years in opposition, the party no longer has a stance on the NHS that is either distinctive or convincingly deals with the problems that the service faces.The Independent is not exactly a Conservative newspaper. The journalist refers to Labour's complacent attitude, which has focused on scoring points in opposition rather than constructing a viable alternative. That is precisely what we have heard today. I know that we are in that awful pork-barrel cycle in the run-up to a general election, but Labour's attitude seriously worries the elderly, the frail and the vulnerable. I hope that the Opposition realise how irresponsible their shroud-waving and scare stories are.

The article goes on to ask: But what did Labour's opposition amount to? That the NHS needed more cash and that the Tories' changes would lead to privatisation". We have heard all that. The message rang true for voters. But it was a cynical tactic because, in reality, Labour offered little alternative to Tory policy, an inadequacy overlooked in the hysteria about funding shortfalls and the supposedly sinister hidden agenda of the Tories. The article states that the best that Chris Smith, Labour's new health spokesman, could offer at the party conference was an extra £40 million, gleaned from administrative savings, to cut cancer surgery waiting times. The writer reports that a policy document, "New Agenda for Health", was published a few weeks ago by the left-leaning Institute for Public Policy Research, which states: From where we stand now there will be no significant new public money for health care in the UK". That is where Labour stands. I admire the courage of Opposition Members who use the forbidden word—the U word—underfunding. Why do they not tell us how they will match the money that the Government have given to the health service? Why do they not tell us their spending plans? It is not surprising that so many people—

Photo of Mr Chris Smith Mr Chris Smith Shadow Secretary of State

Will the hon. Gentleman tell us precisely what the Government's spending plans are for the next three years?

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

It has been made clear what spending on the health service will be. My hon. Friend the Minister will go into great detail later.

Photo of Mr Llew Smith Mr Llew Smith , Blaenau Gwent

Will the hon. Gentleman tell us some figures? The Government have not done so. No specific figure has been given for any of the next three years.

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

In line with inflation—3 per cent. growth per year, year on year. That is the Government's promise: in line with inflation. They will deliver more money than the health service has ever had before—£42.5 billion.

Photo of Denis MacShane Denis MacShane , Rotherham

I am fascinated by the vision of the health service getting richer and richer under the Conservatives. I do not ask the hon. Gentleman for further details relating to south Yorkshire, but Rotherham health authority has to cut last year's budget by £500,000 to £1 million. If all that new money is coming in, why are my constituents getting a worse service? Why is North-East Derbyshire health authority tell GPs that there can be no more elective surgery until the end of the financial year?

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

I do not believe for one moment that any constituent is getting a worse service than before the reforms. I cannot give the exact figures to answer the hon. Gentleman's question because I am not an expert on Rotherham, but more cash has gone into his health authority and his national health service trust than ever before. It is up to the people who run those trusts to spend it in the right way.

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

The hon. Gentleman knows the amount of money that is being poured into the health service. He cannot deny it. He is an honourable, reasonable man. He knows the reality. He is trying to score a few political points, for which I cannot blame him in the run-up to a general election.

The hon. Member for Islington, South and Finsbury wrote an article in response to the terrible accusations against his policy—I use the word loosely—by The Independent. He stated: But we do want to make changes, because the introduction of the competitive internal market has caused immense damage. It has set hospital against hospital, doctor against doctor. One might have thought that there would be a massive policy change, but there will still be the split between the provider and the purchaser. If that split still exists, can the hon. Gentleman tell the House that there will not be an internal market? Of course there will be an internal market. That is what has been producing the results and leading to greater efficiency and more patients being treated than ever before.

The article goes on: Secondly, we envisage the development of a recuperation service, to help people recover from major treatment in a supported environment near to their home, rather than being forced out of hospital too early. Have we had any figures for that? Is it an aspiration? Is it an aim? Is it costed? If so, will the hon. Gentleman tell us how much it will cost? I will give way to him, if he is listening. That is an important spending commitment. Is it a policy or just an election bribe with no price tag on it?

The article continues: Fourthly, there is our proposal to use savings from excessive bureaucracy to fund, among other things, a reduction in waiting times for surgery for cancer. The hon. Gentleman voted against the Government's plans to reduce bureaucracy. He and his party voted against the abolition of the regional health authorities. He wants to free £100 million from savings on bureaucracy. This year alone the Government have released £300 million, as my hon. Friend the Minister explained.

The article states: Inequality of income and condition has a major impact on the quality of people's health, and inequality has widened dramatically over these past 17 years. We want to begin to put that right in government. We all want to put that right in government, but it is a typical Labour aspiration of motherhood and apple soufflée. It is meaningless. The hon. Gentleman does not tell us how it will be done, or what money will be put into it, because he does not know. The iron shadow Chancellor will not tell him, because he does not know either.

What are these great policies—this great new Jerusalem—towards which the Opposition are leading us? The issue is not more money for the health service, although that is the issue on which they have fought election after election. It is the battle of the suits. They claim that Labour are better managers than the Tories.

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

The hon. Gentleman says yes. He should go around some of the local authorities that are run by Labour. He should come to Harlow, where £1.8 million was lost out of a budget of £12 million and a load of people had to be sacked. That is the sort of management that there would be under Labour. Just look at local government.

The Labour party's proposals are delightfully vague. They tell us absolutely nothing.

Photo of Denis MacShane Denis MacShane , Rotherham

indicated dissent.

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

The hon. Member for Rotherham sagely shakes his head, because he knows that the moment any spending plan is brought before the electorate and the House my right hon. and hon. Friends on the Treasury Bench will explain to the people where it is to come from.

Photo of Denis MacShane Denis MacShane , Rotherham

Will the hon. Gentleman endorse Labour's policy for a windfall tax to put a quarter of a million people back into work?

Photo of Mr Jerry Hayes Mr Jerry Hayes , Harlow

Like so many other things, that does not work. The hon. Gentleman is talking about raiding pension funds, about raiding the consumer and about raising energy prices, which will affect the elderly, the frail and the vulnerable. That is what the hon. Gentleman wants to do, but it does not add up—like everything else that we have had from the embattled party on the Opposition Benches, which genuinely believes that it will win the next general election.

If ever an Opposition motion should have been strangled at birth, it is this one. I beg the House to oppose it.

Photo of Dr Joseph Hendron Dr Joseph Hendron , Belfast West 7:40 pm, 20th November 1996

Health has been defined by the World Health Organisation as a state of complete physical and mental well-being, not merely the absence of disease. The national health service was established in Northern Ireland in 1948, two years after it was established in Britain. Its purpose was to provide cradle-to-grave care for the entire community. That was nearly 50 years ago. Today there is a crisis in that great service, and there is a crisis in Northern Ireland.

I have listened carefully to the debate. Of course there are many good things with the national health service. Why would there not be? But that does not mean that there is not a crisis. I speak as a non-fundholding general practitioner who does very little GP work at this time. The main threat to health care provision is the across-the-board efficiency saving of 3 per cent. per annum which has been imposed by Government. It is, of course, Government policy to encourage people to take out private insurance.

In a recent article in the British Medical Journal, a group of senior medical consultants said that patients' lives were being placed at risk because of the pressure on trusts to make year-on-year efficiency savings of 3 per cent. The consultants said that cash cuts meant that patients were being sent home by hospitals much too soon after surgery. Indeed, in Northern Ireland there are many examples of patients being discharged with undue haste and with limited provision for follow-up care at home.

Although Northern Ireland receives 11 per cent. more per capita on health expenditure than the average for the United Kingdom, other statistics must be taken into consideration. Northern Ireland suffers 20 per cent. more heart deaths among men than the average in the United Kingdom. That indicates that for that component of the health service we would need an increase in resources of about 20 per cent. Northern Ireland's unemployment rate is 40 per cent. higher than the rest of the United Kingdom. With unemployment comes increased visits to GPs, increased drug prescribing, increased referrals to out-patient departments and increased admissions to hospitals. Those were the words of the Chief Medical Officer for Northern Ireland in her recent report on the health of the people of Northern Ireland.

In addition to the increased number of heart deaths and the increased numbers in unemployment and poverty, it must be remembered that a quarter of a century of terrorist violence has brought with it increased health needs among our peoples, and that applies very much to both communities.

In recent weeks, the Prime Minister endowed the Secretary of State for Health—I hesitate to say this, as I have heard other hon. Members mention the figure of £300 million—with additional money for the health service. The Northern Ireland media gave the figure as £500 million. Perhaps that is inaccurate, but it is somewhere around that figure. I understand that not a penny piece of that will be directed to Northern Ireland. Indeed, it appears that it will go to England and Wales. If the first figure is correct, in terms of population it would mean £17.5 million for the health service in Northern Ireland.

In his statement of 12 February, the Health Minister for Northern Ireland, who was here earlier, said that cuts would not be implemented without reductions in service. I believe that that point was made by the hon. Member for Mid-Ulster (Rev. William McCrea). I congratulated the Minister at the time on his forthrightness in making that statement. I hope that he will guarantee that additional funding, in real terms, will be made available to deal with the implications of the Children Order. Will additional resources be made available to ensure that health boards can fulfil the commitment in terms of community care, which is required by the Government's legislation?

Has the Department of Health in Northern Ireland an accurate device to calculate the health needs and resources for health for the people of Northern Ireland in comparison to a base population, for example, that of England and Wales? How can the Minister be sure that resources that have been provided are adequate to meet the health needs of the population in Northern Ireland, bearing in mind the increased disease, poverty and unemployment? In its report published on 14 November, the Northern Ireland Audit Office recommended that any review of the capitation formula for funding should aim to ensure that the distribution of funds to purchase treatment matches the identified and prioritised needs of the purchasing authorities.

Why do we need more resources in Northern Ireland? It is the poorest region in the United Kingdom. I do not think that anyone would argue with that. In Northern Ireland, unemployment stands at 11.1 per cent.—39.8 per cent. higher than the United Kingdom average—and 38 per cent. of households live in poverty. Basic essentials cost more in Northern Ireland. For example, electricity prices are 3 per cent. higher. Although we spend 11 per cent. per capita more on the health service than the rest of the UK, our coronary heart disease level is 20 per cent. higher and unemployment is 40 per cent. higher. Long-term unemployment is linked with an increase in the use of prescribed drugs, in consultations with GPs, in the use of hospital services and in the level of physical illness. Those figures come from the 1995 annual report of the Chief Medical Officer for Northern Ireland. All of that inevitably leads to increased demands on the health service in Northern Ireland.

What do the health cuts mean to the people of Northern Ireland? They mean that home help services are being cut, a reduction in meals on wheels, a reduction in key staff in the community such as social workers, community psychiatric nurses and day centre staff. I pay tribute to the people involved in primary health care, having been involved in it myself for 35 years in west Belfast. The cuts mean waiting lists for funding for domiciliary care packages and residential care. The hon. Member for Mid-Ulster referred to that earlier.

The Royal Victoria hospital Belfast has announced that it will not carry out non-emergency surgery on patients from non-fundholding GPs. The Ulster hospital carries out cancer procedures on patients of non-fundholding GPs free of charge, and I give it full marks for that. The Western health board in Northern Ireland has cut coronary artery bypass operations by 10 per cent. and there has been a 20 per cent. reduction in joint replacements and in ear nose and throat operations. If that is not a crisis, I do not understand the meaning of the word. There have been massive cuts at the Mater Infirmorum Hospital Health and Social Services trust. And so it goes on. I am aware that other hon. Members wish to speak, so I shall move on quickly.

On 30 October 1996, the Royal Victoria hospital, which is known world wide for its excellence—it was the first hospital in the world to have a cardiac ambulance—announced that because of funding difficulties faced by the Eastern health board it would have to stop non-urgent work across a wide range of specialties. The patients of GP fundholders would be all right—it was the patients of non-fundholding GPs who would suffer. I find it difficult to understand when Conservative Members seem to scoff at the fact that the patients of non-fundholding doctors have to wait. I could go on for hours about that subject alone. It is a crisis, but Conservative Members do not understand that. We are talking about thousands of patients and about primary health care.

Some people may try to blame non-fundholders and say that they should become fundholders, but I do not accept that argument. However, at present non-fundholding doctors have no choice but to apply to become fundholders. They must then wait nine months to a year to prove their accountancy abilities— although they were trained as doctors—before they are accepted.

The Government appear to have ring-fenced resources for the patients of fundholding GPs but have not done so for patients of non-fundholding doctors through the Eastern board. The Royal group of hospitals is the largest trust in Northern Ireland and has proportionately the lowest management costs in the Province. I opposed the introduction of trusts from the beginning, but I admit that in management terms the Royal group of hospitals seems to have performed its work fairly well in comparison with other establishments.

I appreciate that the Minister is currently considering an option appraisal for the Royal Maternity hospital, but I remind him that the hospital's neonatal unit serves the whole of Northern Ireland. It is a place excellence where all major paediatric services are located, including paediatric cardiology, nephrology and urology. The main orthopaedic hospital in the north of Ireland is Musgrave Park hospital, which is part of the Green Park Healthcare trust. The Minister has asked the boards to channel cuts towards "non-life-threatening procedures"—I think that that is the correct term—which means reductions in elective surgery.

Hip joint replacement surgery will be cut dramatically from the record-breaking total of more than 2,000 joint replacements last year. Activity will probably be reduced by 50 per cent., which will mean an increase in waiting lists—waiting time is currently less than nine months—month after month. By the end of the financial year, patients may be waiting more than two years for joint replacement surgery. Further cuts will mean the dismantling of what has become the world's leading centre for joint replacement surgery.

The Minister is conducting a cost appraisal of the cancer services at Belvoir Park hospital, and it is important that the Green Park trust is represented on the team that carries out that appraisal. Industrial action has been taken at the Downe hospital in Downpatrick and at other hospitals throughout the north of Ireland. I should point out that the private organisation Compass is able to change the contracts of support workers involved in strike action: non-negotiated contract changes are totally unacceptable.

The Ulster, North Down and Ards hospital trust has also been severely affected by the cuts. Daisy Hill hospital in Newry—in the territory of my hon. Friend the Member for Newry and Armagh (Mr. Mallon)—serves all of South Down and Armagh, which is a remote rural area. The local population is implacably opposed to plans to centralise services at Craigavon area hospital. No direct public transport serves the hospital, so access is a major problem.

On what basis are decisions made to reduce the number of hospitals or to cut trust and hospital services? Are the reasons clinical, financial or professional? I should like to understand the basis of the decision making. Community trusts are also badly affected. The Eastern board has informed the North and West Belfast trust in my territory that "a phased programme of realignment"—what a lovely expression—is to be implemented. What does that mean? The board has simply used fancy words to say that services for the elderly will be greatly curtailed. The Down Lisburn trust has similar problems.

Community district nurses, community psychiatric nurses, social workers, health visitors and midwives are overworked and underpaid. They provide a magnificent service, but they are not appreciated by Government. Some such people are my patients and I have worked with others for years. They have told me their problems and I take no pleasure in recounting them today.

On 1 April this year, the British Medical Association produced a discussion paper entitled, "Financing the National Health Service". I accept Conservative Members' assertions that there must be some limits on the amount of money spent on the health service and that expenditure is based on taxation. I understand those points. The British Medical Association document: raises many issues, but the two central points are: first, the national health service is grossly under-funded and needs an immediate injection of funding; secondly, work must be done on methods of forecasting future demands and health care needs.

I believe in the fundamental principles of the national health service established 50 years ago. I believe that health care should be available to all, on the basis of need and not on the basis of ability to pay or whether one is the patient of a fundholding or a non-fundholding GP.

Photo of Mr David Evans Mr David Evans , Welwyn Hatfield 7:54 pm, 20th November 1996

We all know that the Labour party is quite capable of believing its own fairytales; its decision to debate the national health service shows its inability to tell the difference between fantasy and reality. To set the scene, we should take a trip down memory lane—after all, it is the only way in which we can measure Labour's achievements in government. The 1974 Labour party manifesto promised: A Labour Government will expand the national health service". Three years later, in 1977, Mr. David Ennals, Labour's Secretary of State for Health, was forced to concede: In the present economic climate the Government could do little more than provide for the increasing number of old people, leaving a small margin for improvements in methods of treatment". In 1977–78, the health budget was cut by 3 per cent. in real terms and capital spending was cut by a third in real terms—the biggest, most devastating cut ever inflicted on the national health service capital programme. Those who began the NHS, who gave birth to it, have battered it more than any Tory Government—eat your heart out, Aneurin Bevan. Between 1974 and 1979, nurses' pay fell by 3 per cent. in real terms, doctors' pay fell by 16 per cent., surgeons' pay fell by 25 per cent. and waiting lists increased by 48 per cent.

The economy as a whole reflects the state of the health service. Who will forget the 83 per cent. higher rate of tax, the 26.9 per cent. inflation rate or the Chancellor of the day turning around on his way to Heathrow and being told that the International Monetary Fund was running our economy? In 1978, Dr. James Cameron, the chairman of the British Medical Association, described how The national health service is sick in Britain. It is inadequate and impersonal. It is losing the confidence of the medical profession and the public". The 1978 Royal College of Nursing congress at Harrogate talked about a crisis of manpower, finance and morale in the service". The national health service went on strike in 1978–79, led by the Confederation of Health Service Employees and the National Union of Public Employees. Telephonists were on strike and clinical staff manned public telephone boxes to get calls into the hospitals. Clean linen was not allowed through picket lines and foul linen was destroyed because the unions would not allow it to be taken from the hospitals to be cleaned. Meals were provided by volunteers and cleaning was non-existent.

Let us cast our minds back to the news stories of the time, which do not reveal a health service nurtured by a caring, sharing Labour Government—quite the opposite. A 1978 article in The Times entitled, "Hospital is to turn away patients with cancer", stated: Patients with breast, lung and other cancers, and abortion cases are to be turned away from the Kingston hospital, Surrey, because of industrial action by health service workers and supervisors. The hospital said yesterday, 'From midnight next Tuesday, even known cancer cases will be denied admission and lives immediately threatened. Investigative surgery, even where there is a strong suspicion of a life-threatening condition, will not take place'". Even when we wanted to bury our loved ones—who might have died outside Kingston hospital—we could not do so, because the Transport and General Workers Union would not let the gravediggers dig the graves. We had to keep our loved ones in our living rooms until the gravediggers went back off strike.

In her confessions, the former Secretary of State for Health, Baroness Castle, described her attack on pay beds during the winter of discontent as an "essential political sweetener" for the trade unions. The Labour party is still committed to tossing political sweeteners to trade unions. In return, the unions toss financial sweeteners to the Labour party. We know that 176 Labour Members are sponsored by unions. As the TGWU boss said, "No say, no pay."

New Labour says that it intends to turn the clock back to the bad old days of the savage 1970s. As if that were not bad enough, it intends to strip health care professionals—administrators, doctors and GPs—of their power and put it in the hands of its new regional assemblies. What a recipe for disaster. Once again, the comrades will cut care. Their motto is, "Strikes first, patients last." Yet again the Labour party refuses to listen to the views of the professionals. Instead, it plays politics with the health service.

If Labour had its way, the national health service as we know it would be destroyed. Decision making would be stripped from health care professionals and given to pompous, political shop stewards, who would tear the service apart as a result of regional, industrial and political battles.

The lot opposite should turn the clock right back and try to understand Nye Bevan's intentions for the NHS. In 1946, he said: I believe that democracy exists in the active participation in administration and policy. Therefore, I believe that it is a wise thing to give the doctors full participation in the administration of their own professions. Given that statement, if Nye Bevan were still a Member of Parliament today, and he reflected on the Conservative reforms and Labour's plans, I am pretty certain that he would vote for the Government amendment at the end of the debate.

We have referred to the total disaster that was created last time Labour had power, and control of the health service and the lives of others. Let us consider what has happened since those dark days. It is an incredible story. Take GP fundholding. If all applications to join the scheme from April 1997 proceed, a further 3 million patients, and a total of 58 per cent. of the population, will be covered by GP fundholding. Since 1991, 15,000 general practitioners have joined the scheme, which is more than half of all GPs. In east Hertfordshire, which includes Welwyn Hatfield, fundholding covers 78 per cent. of the population, which is 20 per cent. more than the national average.

We are now spending on the national health service £80,000 every minute of the day. We are spending £724 a year for every man, woman and child. Total spending this year will be £42.6 billion. Spending on the national health service has increased in real terms in every year of Conservative government since 1979. The service treats 80 per cent. more acute patients than it did 17 years ago. Nurses' average earnings have increased by 70 per cent. in real terms over that period. Capital spending has increased by 66 per cent. since 1979, which is in stark contrast to the 28 per cent. reduction under the previous Labour Government. Almost £2 billion was invested in NHS buildings in 1995–96 alone.

Now we come to the heart of the matter. The number of doctors in England increased from 56,000 in 1978–79 to 81,000 in 1995. The number of nurses and midwives has increased by 55,000 since 1979. Nurses' pay has increased from £68 a week in 1979 to £311 a week in 1995, which is an increase of 70 per cent. in real terms. The number of dentists has gone up from 11,919 in 1978 to 18,668 in 1996. Infant mortality per 1,000 live births has gone down from 13.2 to 6.1. Under Labour, it went down from 16.3 to 13.2. Even more impressive is the fact that over 3 million more treatments were carried out in 1995–96 than in 1979, and over 1 million more than in 1991. In all, 10.5 million treatments are carried out each year.

That lot over there have scored many own goals, and they have scored another one tonight. The NHS is safe in our hands. The elderly are safe in our hands. The sick are safe in our hands. The surgeons are safe in our hands. The nurses are safe in our hands. The doctors are safe in our hands. The dentists are safe in our hands. Our national health service has never been fitter, faster or more effective. The only people who would benefit from that lot over there being in power are the shop stewards and their trade union bosses. Labour would do what it always does: make a total mess of it. We owe it to the nation to ensure that Labour never gets the chance.

Photo of Mr Brian Sedgemore Mr Brian Sedgemore , Hackney South and Shoreditch 8:06 pm, 20th November 1996

In the spirit of the age—which has clearly bypassed the hon. Member for Welwyn Hatfield (Mr. Evans)—I shall eschew ideology and party political point scoring and, instead, talk about health care in east London.

A few weeks ago, the Royal Hospitals NHS trust launched a £300 million private finance initiative scheme for a new hospital at Whitechapel, which is to be built and run by the preferred bidder, the Health Management Group. The press launch took place in a blaze of self-congratulatory publicity, but what was not revealed was the apprehension of clinicians, consultants and junior hospital doctors. Their apprehension was set out in a letter dated 9 October 1996 to Dr. Duncan Empey, the medical director of the Royal Hospitals trust. It was signed by David MacLean, the chairman of the Royal London hospital medical council, Larry Baker, the chairman of St. Bartholomew's medical council and Mr. P. Magee, the chairman of the London chest hospital medical council.

The letter refers to the £300 million scheme. It states: We have heard from a large number of consultants, all of whom have been concerned that the space allocation in the new hospital for their relevant departments is smaller than they enjoy at present, and would certainly be inadequate for the planned patient flows. We were all originally promised that in the move to a single site the facilities would be equal to or better than those currently enjoyed, but this does not appear to obtain in plans from either consortium. This has caused a considerable degree of concern, and we feel that the future of the hospital as both an Accident and Emergency centre for the local population, and as a national and international centre of excellence, would be severely compromised under the available plans. The letter continues: We are deeply concerned that if the issues of quality and quantity are not met, while in the short-term the Medical School and Hospital may appear to prosper, in the long-term recruitment will inevitably suffer and the quality of medical care, research and education will decline. In my view, it takes a peculiarly incompetent Government and hospital trust to spend £300 million on a project and make things worse rather than better.

There is also considerable concern about the financial implications of the private finance initiative schemes that were referred to earlier, and particular concern about the financial end-loading of such schemes. It would seem that, in years to come, that could cause havoc to the revenue flows of the area health authority, and to the making of all its decisions. It might have to decide whether to support the PFI scheme down the years, or to stop spending money on hospital care in a variety of other local hospitals.

I am a member of the Treasury Committee. We have done some research into PFI end-loading, but I believe that more is needed. Let me make two suggestions. First, I hope that the National Audit Office will look into the matter. I know that John Bourne, who is in charge of the NAO, would like to issue guidelines on the potential dangers of the end-loading that will occur in future years. Although the NAO does not currently look into schemes that have not been completed, in order to issue guidelines it would have to do so, because there are not enough PFI schemes around. I hope that the Royal Hospitals NHS trust scheme, which is easily the biggest PFI scheme in the NHS, is be one of those that John Bourne will examine.

Secondly, the Health Committee should look at the revenue implications of PFI schemes and the dangers imposed on end-loading by the revenue flows. That must be examined in the context of the health management group in the scheme that I have mentioned asking for a rate of return no lower than 17 per cent.

As I have said, the Royal Hospitals NHS trust scheme is very big, and I feel that it is proceeding with undue haste. I believe that it is being driven by political imperatives rather than by serious medical considerations. The health management group might pause to consider that there could be a change of government early next year, and that the new Government might take a very different view of a PFI scheme that proposes, for example, to close St. Bartholomew's hospital. I see that one of its great alumni, the hon. Member for Wimbledon (Dr. Goodson-Wickes) is present; I hope that he will catch your eye, Mr. Deputy Speaker.

The health management group might like to consider that the children of my right hon. Friend the Member for Sedgefield (Mr. Blair), the leader of the Labour party, were born at St. Bartholomew's. It might also like to consider that the constituents of the next Secretary of State for Health, my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith)—who is also present—actually use the hospital. Not only are there powerful logical, financial and medical reasons for the health management group to go a bit easy, unless it wants to wreck its own scheme and its own financial future; there are powerful emotional forces backing the retention of St. Bartholomew's as part of any PFI that eventually sees the light of day.

Another point, which relates partly to the PFI scheme, concerns the future of paediatric care in east London. We have been told that there is no crisis, but there is certainly a crisis in east London's paediatric care. Part of that crisis is set out in a document marked "Strictly Private and Confidential" which comes from Vanessa Wright, clinical director of children's services at the Royal Hospitals NHS trust. It is dated 4 September 1996. It begins: The financial position of the Children's Services Directorate at 31 July 1996 … shows a worsening overspend of …660,418, with a predicted year end out-turn of £1.366 million overspent … Senior management in The Royal Hospitals NHS Trust have made it abundantly clear that radical action has to be taken now to address this situation.

The overspend has knock-on effects on paediatric care at both St. Bartholomew's hospital and Queen Elizabeth hospital for children. Everyone knows that St. Bartholomew's has a world-renowned paediatric cancer service. Following the scare document produced by the Royal Hospitals NHS trust, two proposals have been made so far. The document itself suggests shutting that world-famous paediatric cancer service—which would cause a public outcry—and transferring it to Queen Elizabeth hospital for children by 31 March next year. I do not believe that that will happen; I think that there will be second thoughts.

Professor Lilleyman, however, has made an even more bizarre proposal. The professor, who has a privately financed chair at St. Bartholomew's, has proposed taking the whole unit—its facilities and patients—to Guy's hospital, south of the river. He made that proposal without the consent of the hospital for which he works. May I ask the Minister whether it is lawful for a professor with a privately financed chair to take an entire unit and its patients to another hospital without the permission of the Royal Hospitals NHS trust? I understand that Guy's is quite prepared to pinch that world-famous unit for reasons of prestige.

Even the Royal Hospitals NHS trust does not like the idea. I have spoken to its chief executive, Gerry Green, who has made it clear that if Professor Lilleyman does try to scoot off down the river with the unit, he will go without facilities, without money and, in fact, without his clothes. I understand that he has said that the professor will go in his underpants and nothing else.

It is the legality aspect that I find bizarre, as, I am sure, will every Member of Parliament. I want to ask the Minister about the future of paediatric care, without scoring any political points and without attacking the trust. I hope that he will give us a guarantee that if the Queen Elizabeth hospital, whose closure was announced three years ago, does close within the next year or so—it was originally intended to continue into the year 2000— alternative facilities will be made available before it shuts. If it does, three things will be needed.

First, the new Homerton hospital has no paediatric beds at present, although it has just appointed an ambulatory paediatric consultant. If QEH shut, 25 or 30 children's beds would be needed at Homerton, probably by next autumn. Secondly, two wards would probably have to be moved from QEH to St. Bartholomew's to complement the existing two wards. Thirdly, the shortfall in beds that would still exist would have to be made up by the provision of more children's beds at the Royal London hospital.

I have spoken to the Royal London hospital, to the chairman and chief executive of Homerton hospital and to consultants at St. Bartholomew's. I hope that the Minister can give us an assurance that, should QEH have to close rather than stay open until 2000, the new beds will be provided at Homerton, the two new wards will be opened at St. Bartholomew's and the extra beds will be made up by more children's beds at the Royal London. Queen Elizabeth hospital is much loved, but it does not have state-of-the-art facilities. Its theatres and its diagnostic back-up are not state of the art. Unless rebuilt on its present site, it will probably be impossible to keep it open. If the Minister can give me that assurance, some use will have come out of the debate.

Photo of Dr Charles Goodson-Wickes Dr Charles Goodson-Wickes , Wimbledon 8:19 pm, 20th November 1996

Until the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) enlightened me, I did not think that I had much in common with the Leader of the Opposition. I now find that both he and I had children born at St. Bartholomew's hospital, which proves two things. We both know a good hospital when we see one and we both believe in the national health service because, for those Members who are not aware of the fact, St. Bartholomew's has never had any private beds. I was trained and I worked in the hospital as a clinician, and I am proud of its record and all that it stands for.

The Government's reforms, particularly those since 1991, have been a great success and are a cause for rightful celebration after 50 years of the NHS. I never believed that, in my professional life, the health service could claim to be world class and decentralised, with emphasis on primary care teams. For proof of the success, one need look no further than the Opposition's typical hypocrisy on all the reforms over which they have fought so vigorously. Will they abolish NHS trusts? Of course not. Will they abolish general practitioner fundholding? Of course not.

I read the words of the hon. Member for Islington, South and Finsbury (Mr. Smith), soothing members of the British Medical Association—again I declare an interest—and telling us all that he is not a revolutionary. If he is ever lucky enough to hold office, he may tinker around the edges, but I suspect that the whole thing is an absolute farce and that he and his party will, in effect, continue the reforms that the Government have ably put in place.

The ultimate test is always whether patients have benefited. The answer, of course, is that they have. The figures are absolutely irrefutable. Since the reforms, patient treatments—I think that they are called episodes in modern parlance—have increased vastly, by around 1 million. Waiting lists have been reduced to their lowest level ever. All that has been achieved in the context of the oft-derided patients charter.

During the summer recess, I found myself on the receiving end in Odstock hospital, in the constituency of my hon. Friend the Member for Salisbury (Mr. Key). I cannot speak highly enough of the treatment that I received. There was none of the hanging around that I remember so well as a medical student, clinician and patient. My condition was hardly life threatening, but I was whisked from accident and emergency into theatre within an hour. On the ward, I saw nurse teamwork, which I had not always seen in the past, and excellent liaison between nurse teams as they came on and off duty.

When I was discharged from hospital—I am sure every hon. Member knows that I and my family have always been NHS patients—I was admirably looked after by my local GP fundholding practice, by its district nurse and by the community pharmacist. That was an index of what the reforms have achieved: efficiency in a caring atmosphere.

In my constituency, no less than 79 per cent. of patients are covered by GP fundholding practices. The borough of Merton, in which my constituency lies, is arguably the best served in London by NHS trust hospitals. Perhaps the service is equivalent to anything in any conurbation in the world, even though none of the four hospitals is actually situated in the borough. My hon. Friend the Minister and his colleagues, however, will be aware of recent consternation in south-west London. Merton, Sutton and Wandsworth health authority, recognised by the Under—Secretary of State for Health, my hon. Friend the Member for Orpington (Mr. Horam), as not a profligate one, reported a financial crisis in the offing. Its proposals to counteract the potential crisis were alarming.

For instance, there was talk of non-urgent elective surgery being savagely reduced—not stopped, as the Labour Front-Bench spokesman said earlier. Inevitably, that would mean the return of longer waiting lists, which not only goes profoundly against everything that the Government have achieved, but is clearly unacceptable to patients and their families, and puts an extra financial burden on the social security budget. That litany of events has therefore caused much concern in my constituency and in the constituencies of many of my hon. Friends and of Opposition Members.

My right hon. Friend the Secretary of State for Health was generous with his time in listening to our concerns. I trust that that generosity will be matched by my right hon. Friend the Chief Secretary when he responds—as I speak, he probably has responded. I hope that my constituents' understandable alarm will not be prolonged beyond next week's Budget statement, after which, clearly, rapid executive decisions will have to be made as to how funds are applied.

I recognise that, in winding up the debate, my hon. Friend the Minister cannot give assurances, but I emphasise the number of meetings that we have had on an all-party basis. We have had meetings with representatives from St. George's hospital, St. Helier hospital, Kingston hospital, Queen Mary's hospital, Roehampton, and Merton, Sutton and Wandsworth health authority, its chairman and its chief executive. They have already—I congratulate them on this—found efficiency gains of some £5 million, but further savings that have been asked for of £9 million are, I believe, impractical. They have a genuine case. I hope that my right hon. Friend the Secretary of State for Health has been able to pass on our concerns to his Treasury colleagues.

After that acute problem has been solved—I am confident that it will be—it would be prudent for my hon. Friends to revisit the issue of the calculation of the capitation formula for resource allocation. We all know that such formulae are beset with difficulties. In Merton, we have had awful problems with the standard spending assessment. That has affected, for instance, teachers' pay because Merton is neither a truly inner nor a truly outer London borough. All hon. Members know how complex those calculations are, but we should revisit the matter in relation to our local health authority.

From the point of view of my constituents, I can never contemplate surrendering the potentially bright future of Nelson hospital, which is bang in the middle both of my constituency and of the borough, and for which many of us have fought so hard and so long to ensure that it has a vigorous future in Merton. It absolutely epitomises the return of the cottage hospital. We have heard talk of cottage hospitals being closed. I am delighted to tell the House that I have received assurances from the St. Helier NHS trust that, despite its financial difficulties, it believes that plans for Nelson hospital can go ahead. That will be cause for much celebration in my constituency.

Even Nelson hospital, with its proud record as a hospital in Merton, will give due deference to St. Bartholomew's hospital, for which the hon. Member for Hackney, South and Shoreditch has been such a doughty fighter. For too long, I have had to live with a sense of terrible guilt about what was done to the hospital. I believe that an academic and medical act of vandalism has been carried out on that hospital, after its nearly nine centuries of being in the forefront of delivering medical care, often to the most needy people in a part of London that was never particularly privileged.

During the consultation period, in February 1995, I expressed in writing to East London and The City health authority my gut feeling that the new buildings at the Royal London hospital might never appear, or not appear to the extent that was predicted. I very much hope that I am wrong, but I suspect that my worst fears will prove to be true because of financial demands or for other very practical reasons.

I profoundly regret that I was persuaded to vote in favour of the reconstruction and the effective movement on to one site of Bart's and the Royal London hospitals. In the context of party unity, I suppose that we must all trim occasionally. I am certainly ashamed, however, that I rationalised my vote on the basis that there was never an undertaking from the Opposition that they would reverse the decision.

I am even more aggrieved that one of the arguments made about closing Bart's, to reassure me and those of my hon. Friends who had doubts about it, centred on the issue of accident and emergency facilities for the City of London. I remember being reassured by former occupants of my right hon. Friend the Secretary of State's office that I need have no worries, because there would be adequate cover from the accident and emergency unit at Guy's hospital. We all know what has happened since then. It seems inevitable that the accident and emergency department at Guy's will be closed and shifted to St. Thomas's hospital. Therefore, the entire argument proved to be entirely bogus. One day, I suspect that the House and those who made the decision will come to regret it.

Now there is at least some light on the horizon. I do not expect that I shall be able to make entirely common cause with the hon. Member for Hackney, South and Shoreditch, but, in the past, I have criticised the City of London for being less than vigorous in its defence of St. Bartholomew's hospital. It is quite extraordinary that a body of that strength and antiquity should appear to be so inhibited in protecting such a unique—I use the word in its proper sense—hospital. Now we may be able to retrieve something positive from a disastrous situation: the Royal Hospital of St. Bartholomew Charitable Foundation. The fact that that charitable foundation has been allowed to use the word royal is significant. Its members are working with the special trustees of St. Bartholomew's hospital and the Corporation of London, forming a tripartite body of absolutely impeccable credentials.

While a decision is awaited on the private finance initiative application, which the hon. Member for Hackney, South and Shoreditch mentioned, the waters continue to be muddy. I do not pretend to the House that I can predict the outcome. Perhaps we shall end up with a dual-site option, with some specialist units continuing at Bart's, or perhaps there will be a completely new and exciting opportunity for an innovative model on the Bart's site, where the public-private interface will work. It has even been suggested that there might be a private provider that will provide a community centre or even contract back into the NHS. That type of synergy sounds like a very exciting possibility. An accident and emergency department could even be reintroduced with private funding.

Those proposals could be a blueprint for the future. I do not say that any of them are in a final stage of formulation, but I beg my hon. Friend the Minister to assure the House that, whatever happens to the Bart's site in the future, he will properly involve the Royal Hospital of St. Bartholomew Charitable Foundation, the aims of which are To establish on the Bans site an Independent Charitable Hospital and a Medical School of International standing", so that the fine traditions of that hospital can continue in a manner that is best suited to the century ahead.

None of us can predict with any certainty how the NHS will develop and what administrative, financial and political factors may guide it. In the future, I believe that there may even be fewer tiers. The Government have done admirable work in reducing tiers in the NHS, and there may be further radical moves that they could make. An NHS executive, for example, could deal directly with NHS trust hospitals, which might provide greater flexibility and responsiveness, always with the patients' needs at the forefront.

One matter about which I am absolutely certain is that the Labour party will always prove to be the old guard, dragging its feet until it sees that the reforms make sense. Labour Members cannot bring themselves to admit that the changes make sense and congratulate the Government on what they have achieved. That is the pattern of what has happened over the past 17 or 18 years.

Today we heard about new Labour's expenditure plans, which will certainly entail more costs, although no more patients being treated. Whether one is talking about abolishing the internal market, withdrawing the PFI, reintroducing regional health structures or ending compulsory competitive tendering, the battles have been fought and won by the Government, and the Opposition's proposals will simply ensure that money and effort will be diverted from patients. In stark contrast, no one can challenge the effectiveness, innovation and courage of the Government's initiatives.

I hope that between now and the general election, whenever it comes, the opportunity will present itself not only to continue those excellent policies, but to publicise their benefits rather more vigorously to patients and to the country.

Photo of Martin Smyth Martin Smyth , Belfast South 8:36 pm, 20th November 1996

The hon. Member for Wimbledon (Dr. Goodson-Wickes) gave a balanced speech and, while pointing out the positive aspects, expressed his concerns about what has happened with some of the reforms. I should like to share the positive note that he struck, because too often we minimise the excellent work that has been done in the national health service over the years. I am familiar with the NHS through my personal experience and as a pastor and because my family has used it, and I understand not only the good work that it has done but the changes that it has undergone. Having said that, however, I think that the Government occasionally overstress the positive side of the NHS and fail to realise that there may be problems with it.

Some years back, when he was a Health Minister, the right hon. Member for Peterborough (Dr. Mawhinney) was answering in a very positive manner for the Government during Question Time, and I was called by Madam Speaker to ask my supplementary question. I asked, "Will the Minister accept that we are not in heaven yet?" There was a sedentary intervention from a Conservative Member, who cried out, "That's what we're trying to prevent." I understood what he meant, but the fact is that there are problems in the health service, and we should at least be dealing with them.

Earlier in the debate, it was said that, in the past, hospitals and health authorities were always able to balance their books. I wonder whether the problem today is that we have a different type of accountant, or that medical politics are being played. We are consistently told that we cannot provide services because we are already in the red. If it was possible to balance the books in the past when there were shortages in the health service, why can that not be done now? At no time have any Government been able to provide the finance to cover all the health service's demands.

Another difficulty through the years has been with changing medical practices. Some practices were held on to for too long because people were accustomed to the work, happy in their environment and not prepared to move on. At times, developments were retarded.

Rather interesting comments have been made about cutting administration costs, for which there is a place in some areas. Dr. Sandy Macara of the British Medical Association said not so very long ago that the question was not whether there should be less management; the service was happy with it. What it needed, he said, was more money. When we constantly criticise the amount spent on administration, we should bear in mind such a salutary warning, which was repeated by a recent witness to the Select Committee on Health, who claimed that more and better management was necessary to improve and co-ordinate children's health services.

On the other hand, we must fire a shot across the bows of some managers, for I am not convinced that some of them are managing well. When one bears it in mind that some of them are getting more money for a year's work than the Prime Minister of the nation, it seems that we should demand a better service from them. In previous debates both in the Province and in the House, I have asked whether it is right to give bonuses to managers for cutting down on lower-paid workers, which seems to have been happening for some time. I have very little sympathy with trusts anywhere, especially in Northern Ireland, when they make ancillary workers redundant to save money, yet increase managers' salaries. I shall illustrate that point with regard to one of the finest hospitals in the United Kingdom.

I have a letter from a person in North Down, a copy of which he sent to the hospital's chief executive. It said: I visited a friend who is a patient in ward 17 … and found that she and others on the ward were on beds that did not have sheets, pillowcases or indeed any proper bed covers. When I enquired why this was so my friend advised that the laundry had not been received, this was at 4.00 pm!!I find this totally appalling and unacceptable. I realise that it has been necessary to implement cuts in the health service but surely the people who are ill deserve to receive humane treatment. and that includes clean bedding. I had had experience of such a problem earlier when I raised a similar issue with the management.

I share the concerns of the hon. Member for Belfast, West (Dr. Hendron), who referred to the letter that the medical director of the trust wrote to general practitioners in October, which said: elective activity for patients of non fund holding medical practices "— within the board area— will be ceasing". I am not convinced that the question is simply one of giving preferential treatment to GP fundholders, for I am reminded constantly that emergency work and other types of serious surgery are still paid for—even that of GP fundholders—by the boards and regional authorities.

There is an experiment in total fundholding at the moment. Given last year's experiences, it seems that there is a tendency to go ahead with spending the money that is available from GP fundholding, in the knowledge that at the year end the boards will be able to provide extra money because they have saved it. Have the Government rightly been blamed for gross underfunding, when no one—from my party, other Opposition parties, the BMA or anybody else—has said what amount is needed adequately to provide what is demanded of the NHS? Those who constantly criticise the health service will have to address that issue realistically.

At the same time, I am not prepared to accept the explanations of the Department and of others in Northern Ireland who blame the shortage in health care and other areas on what they call the "disturbances" of the summer. As I understand it, all the budgets were set before the summer. Unless the Minister and the Department employed the services of Mystic Meg, I do not know how they foresaw that perceived disturbances in the summer would have an impact on the budget. I refute such an allegation, especially bearing in mind the fact that the Consolidated Fund does not include security matters. Indeed, we are regularly told in appropriation debates that we should not be referring to the security budget. The 3 per cent. cut was changed to 1.5 per cent. when the Minister realised that such a cut could not be made.

Concerns are being raised—I have heard the Minister and others speak of them—that capital investment might be cut to feed current expenditure. That would be deplorable and short-sighted, bearing in mind the fact that it has been pointed out in the debate that, under a former Administration, there was no funding of capital building for years. It takes a long time to catch up on such capital expenditure. It therefore seems that such cuts would ultimately add to unnecessary expense in the long run. I am convinced, however, that there is still a case to be made for efficiency savings, while at the same time providing the extra funding that is needed to meet the shortfall because medical, surgical and other establishments are developing new forms of treatment. They are expensive, but in the long run they will add to the quality of life for patients and for the rest of the people.

Having spoken of the large improvement in the health of our nation and praised ourselves for it, we should ask: why is there suddenly a spate of emergency admissions? Is it as a result of self-interest, as people try to add to demands on their budgets, in order to demand more money from the Treasury for their particular speciality or trust? We are all competing in the same field.

Photo of Mr Matthew Banks Mr Matthew Banks , Southport 8:47 pm, 20th November 1996

It is a great pleasure to catch your eye, Mr. Deputy Speaker, in this important health service debate. Hon. Members on both sides of the House know only too well that sometimes, as a result of commitments in this place to Standing Committees, and so on, it is not always possible to be present for all the debate. I sincerely apologise to the Opposition Front-Bench spokesman, and to my right hon. Friend the Secretary of State for Health for—unusually for me—not being able to be here as a result of service in a Committee earlier this afternoon.

The debate has been interesting. As I look across the Chamber and along the Conservative Benches—although to a place perhaps a little detached—it is pleasing to see that we not have not only Members who represent English constituencies but our friends from Northern Ireland. Northern Ireland is very much an integral part of the United Kingdom, and it is entirely right that Northern Ireland Members should contribute to the debate. I regret that, in the unlikely event of there ever being a Labour Government, devolution plans will carve up the country, and who knows what will transpire.

In an interesting and forthright speech, which we have come to expect from him, my hon. Friend the Member for Welwyn Hatfield (Mr. Evans) read out what to me was an appalling record, and an indictment, of the last Labour Government.

My constituency should have had its brand new hospital in the 1970s. The references made by my hon. Friend the Member for Welwyn Hatfield to the Chancellor rushing to the airport and then having to come back to London and the crisis surrounding this country having to go cap in hand to the International Monetary Fund struck a chord with me, because the new hospital in which I have been a patient and which many of my constituents use, should have been built in the 1970s but was not, because the capital building programme was cut by one third by the Labour Government. My constituents had to wait for the election of a Conservative Government before progress could be made.

In the same vein as other hon. Members, I should like to refer to some of my personal experiences of the national health service and make a couple of points on national issues, as well as referring to one particularly important local issue for Southport. I know that one or two other hon. Members wish to speak, so I shall be brief.

I do not propose to repeat most of the points raised by my hon. Friend the Member for Welwyn Hatfield in his early remarks. However, when I receive a critical letter from a constituent about the health service, I shall send them a copy of his speech, which sets out only too well the record of the 1970s. As my hon. Friend said, there is no better way to see what may happen in future than looking at how people have acted in office in the past.

I have been fortunate in having been in hospital on only a couple of occasions. Touch wood, I have had good health, apart from when my career in the Gordon Highlanders was cut short and I had to be invalided out; and, more recently, during the Maastricht debates. I do not know whether it was because we seemed to be going through the night rather a lot, but I remember turning up for what I thought would be a routine meeting of about 30 minutes with the chairman of my local NHS trust in 1993, and coming out of intensive care seven days later.

I pay tribute to the professionalism and care of all the staff and administrators at the Southport and Formby Community Services trust. I am sure that the quality of health care provided to my constituents by one of the country's flagship trusts is reflected in other parts of the country. What my hon. Friends have already said proves that.

The difficulties in and around my constituency are, in some ways, the difficulties of success. As a result of the Government's policies and the year-on-year real-terms increases in health service spending, we have a couple of pretty new hospitals five miles apart. Over the past few months, two local health authorities—South Lancashire and Sefton—have conducted a public consultation exercise on their plans to put particular specialist services in one hospital or the other. The advice of the clinicians—not the bureaucrats—has been that, to maintain important services such as cancer services, there must be centres of excellence throughout the region, never mind throughout the country.

With two new hospitals not far apart, tough decisions sometimes have to be made. One difficulty of having two health authorities is that sometimes, for the wrong reasons, bureaucracy can take over. The provision for my constituents and those of the hon. Member for West Lancashir (Mr. Pickthall), who, unfortunately, cannot be here for this debate because of important engagements elsewhere, has been the subject of a review, because the two authorities have not been able to agree on what to do. Because they could not decide which services should be concentrated on one site, they decided to commission Sir Duncan Nichol, the former chief executive of the national health service, to undertake a report. He decided that there should be a hot site and a cold site. He then decided that the hot site should be in Southport, and the cold site in Ormskirk.

Unfortunately, in spite of having commissioned the report, the two health authorities were still not able to agree on implementing its recommendations. I understand perhaps more than most the sensitivities of the issue, but, as others have pointed out, it was as a sop to those in the Ormskirk area that the two authorities decided that, although all the services would go to Southport, a new maternity unit would be based in Ormskirk.

That process has got no further, because a petition was put together with more than 20,000 signatories. It was concocted by several local people with a passionate and genuine interest in the continued provision of local maternity services in Southport. They did not want those services to go five miles down the road to Ormskirk.

Unfortunately, as so often happens, one or two local politicians jumped on the bandwagon of what had, until then, been a non-political public debate. One in particular, a local councillor by the name of Ronnie Fearn, who is known to hon. Members, decided to take hold of the petition, saying that it would be safe in his hands, and he would present it to the health authority. So safe was it in his hands and so competent was he that he presented it to the wrong people. They had to put it in a brown envelope, put some stamps on it and send it to the health authority that was conducting the review.

The point of that story is that neither of the community health councils, made up of local people, has been prepared to object to the health authority's proposals. We have a problem if local people on the community health council are not prepared to oppose plans that concern so many people in my constituency.

As I have made clear once before, I believe that the way to make progress on this constituency difficulty is to try to bring all the health services in Southport on to one site. The way forward is certainly through the private finance initiative. I am pleased that the Southport and Formby Community Services trust is undertaking pioneering work in that respect on new buildings.

There is one further piece in the jigsaw that I should like to see in future. I hope that my hon. Friend the Minister will listen to my plea for him to consider closely the arguments that I am putting now, and shall put again in writing, for a special capital allocation, perhaps through the regional health authority, to ensure that the services at Southport general infirmary, which is now very old, can be moved to the new hospital site at Kew. I hope that my hon. Friend will be able to give me a positive response to that request at the end of the debate.

As other hon. Members wish to catch your eye, Mr. Deputy Speaker, I will conclude simply by saying this: the record of the last Labour Government was such that we cannot trust the health service in Labour hands in the next Parliament. My constituents should have had their new hospital in the 1970s. We did not have it, because the Government of the day had to go cap in hand to the International Monetary Fund after they had bankrupted us. We had to wait for the election of a Conservative Government, and I have no doubt that, as far as local health services are concerned, the best interests of my constituents are served by the re-election of this Conservative Government.

Photo of Ms Audrey Wise Ms Audrey Wise , Preston 8:58 pm, 20th November 1996

We have heard a pretty remarkable display of complacency from Conservative Members, who have suggested that any criticism of the national health service is a slur on the service, or even shroud waving. Conservative Members seem to think that Labour Members are the only people who are worried about the current situation in the NHS. If that were so, it would not really matter, but it is not. Conservative Members should listen more to their constituents and to the staff who work in the service.

Much praise has been directed towards the staff from both sides of the House and I certainly want to add my voice to that. I admire the devotion of most people who work in the NHS, who are expressing their worries in no uncertain terms. Their devotion is often taken advantage of. I worry about their work load, and they are often underpaid. At the moment, they have to waste time, effort and money in local negotiations, causing a completely wasteful duplication of effort, whose only purpose is to play one area and one worker off against another. That is nothing to be proud of, and it is certainly not efficient.

People who work in the NHS do not complain only, or even mainly, about their pay. I think that all hon. Members will have received the briefing from the Royal College of Nursing, which states: The RCN has conducted two surveys of accident and emergency units in 1994 and 1996. Last winter our survey results showed that nearly half the A and E units monitored still had patients waiting overnight on trolleys. The RCN is not casting a slur on the NHS. Its members work in the NHS, and I believe that they are proud of it. They are not proud when patients have to spend many hours on trolleys.

The management of the Preston Acute Hospitals NHS trust were not casting a slur on the national health service when they recently expressed to me their great worry and unease that the private finance initiative, at least as it is presently constituted, would remove from them the control that they should have over future hospital development. Theirs was a thoughtful appraisal of something that will have a long-term effect; it was not casting slurs or shroud waving. We ignore such expressions of concern at our peril.

Of course, Conservative Members are too busy filling the airwaves with claims that more and more people are being treated. All sorts of somewhat spurious statistics are put before us. In the figures used by the Government Front-Bench team, it is not patients who are measured, but finished consultant episodes. Those are not necessarily the same as people. The Government should spend more time and effort trying to collect meaningful statistics— for example, for the league tables that rate hospitals one against another, which are important, as they can greatly affect which hospitals attract contracts. Often it is not the most vital things that are measured.

Why not do as the RCN suggests, and collect information about the incidence of hospital-acquired infections? That would be a measure of hospital efficiency, and it would be a great deal more meaningful.

Day care is another item that has to be considered. We are all in favour of day surgery units for appropriate use. I recently had the pleasure of opening a day surgery unit at the Royal Preston hospital. As a member of the Select Committee on Health, I have questioned Ministers about how they define day surgery units, and have discovered that they count only those that send people home in the evening; so, if a hospital prefers to have a unit that provides overnight recovery beds, it is not counted as a day surgery unit, yet that unit can use its facilities far more efficiently, because the whole day is available equally for operations and procedures.

In other units, less recovery time is available as the day wears on, so only more minimal procedures can be carried out in the afternoon; yet a hospital that considers that and decides to have overnight beds will not be counted as providing day surgery, and will suffer in the league tables and when purchasers consider awarding contracts.

In the national health service, we have to consider equity according to age and equity according to geography, among other issues. The national health service is not truly national and equitable across geographical areas. I shall give an example that works in favour of my area in the north-west. Far more multiple sclerosis patients in the north-west than in any other area are treated with a new drug, which can be extremely useful in certain circumstances but which is undeniably expensive. I do not believe for a moment that that is because the profile of multiple sclerosis sufferers in the north-west is fundamentally different from that of those in the rest of the country; it is an example of geographical inequity.

It may be that other health authorities do things that are not done in the north-west, but the differences stem not from local accountability to people but from a lack of strategic planning and overall consideration of people's needs. If clinical need were the guide, geography would not normally be, as it often is, the deciding factor in whether or for whom treatment was available.

I reinforce what my hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) said about mixed sex wards. I, too, believe that they are an affront to the dignity of patients, and cause a great deal of distress. I also believe that to cause distress to patients is to be inefficient. Those who consider beds and people as though the people were merely pawns to be moved around are not doing their care any favours. My hon. Friend dealt extremely well with the subject of mixed sex wards, but he did not make particular mention of psychiatric wards. I believe that mixed sex psychiatric wards are especially obnoxious and worrying.

There is much talk about value for money, and I agree entirely that we should obtain it, but that cannot be done if people are treated and cared for by staff who are not appropriately trained; yet that is the case for many of our children.

There is a shortage of paediatricians and other child-trained clinicians in our hospitals. I am shocked that paediatrics is regarded as a Cinderella specialty. Children form a quarter of our population, and what happens to them when they are sick can affect them all their lives. To achieve efficiency, we must ensure good and appropriate treatment for children. Half the children in hospital are in adult wards. That is a disgrace. I do not think that one Conservative Member has mentioned children. That is typical of our neglect of that quarter of the population in health matters.

Many of our sick children, including children with complex disabilities, are now cared for at home. It is especially important to examine the care available for them. They need a community children's nursing service, but in half the country there is no such service. As adults, we expect trained nurses—district and community nurses—to be available. They give us wonderful service. Children have equal need, and should have an equal right to a nursing service trained for their special care, yet half the country has no such service.

Only 10 per cent. of the country has a 24-hour nursing service. Conservative Members who are pointing at their watches should desist. I have sat here for many hours; none of them has been here for as long as I have. It speaks volumes that it is while I am talking about our children and telling the House some uncomfortable facts about how we do not look after them properly, that 1 am interrupted.

Only 10 per cent. of the country has a 24-hour children's community nursing service. That means that 90 per cent. of parents with kids who may have complex difficulties or be terminally ill have no district nurse to call on who is trained to look after children. In the whole country, there are only about 400 such nurses. More urgently need to be trained, and then employed to provide that service. Without appropriately trained staff, we do not get value for money.

I also suggest that we would get value for money if we gave better support to voluntary organisations such as Home-Start, which exists to support families with needs, often health needs. It is wrong that, when people are willing to give time and effort to voluntary work, they should be given the overwhelming burden of perpetual fund-raising. If we are trying to get the best value from every pound expended by the state, we should direct more money at organisations such as Home-Start.

A Conservative Member said that a strong economy was the fundamental need. Of course I agree with that, but it is rich coming from a Government who have presided over constant high unemployment and the destruction of our manufacturing industry. It is not only to provide the wherewithal that we need a strong economy. Economic and social problems make people's health worse, so it is important that we have a strong economy with people in work, because, if people are unemployed, they suffer more sickness.

It is important that we devote our resources to a fairer society. For example, old people still suffer cold in the winter. That is something which I am trying to remedy by the modest Bill I presented today. Let us have a strong economy with the right priorities, so that we have a fairer society. A fairer society is a healthier society.

Photo of Michael Fabricant Michael Fabricant , Staffordshire Mid 9:14 pm, 20th November 1996

The hon. Member for Preston (Mrs. Wise) has allowed me only five minutes, because I know that those on the Front Benches wish to start summing up at about 9.20 pm.

The hon. Lady says that statistics are meaningless, yet, like so many other Opposition Members, she presented a tirade of criticisms of the national health service. The NHS, which is the largest employer in the United Kingdom, is certainly not perfect. Of course it is not. There will always be room for improvement. However, my local chairman always said to me, "If you want to know how the health service is doing, ask someone who has been a patient." That is extremely good advice.

I shall talk briefly about the NHS generally, but more particularly in Lichfield, which I have the honour to represent as part of my constituency. The overriding statistic that Opposition Members choose to ignore is that, in 1979, in the last few months of the Labour Administration, 25 per cent. of all patients waiting for treatment had to wait for hospital treatment for over a year. Now, in 1996, there has been a reduction to only 0.4 per cent. Instead of one in four patients, it is now one in 250 waiting for hospital treatment for longer than one year. Surely that is something of which we must be proud.

The right hon. Member for Livingston (Mr. Cook) said that the acid test of how well the health service is doing is the number of patients who are being treated. In that respect, too, even by the right hon. Gentleman's criterion, the Government have passed the test. More patients are being treated in primary care and in hospitals than ever before.

Premier Health trust, which is based in Lichfield, runs the Victoria hospital in Lichfield. Waiting times at that hospital have been reduced to the shortest time ever. The majority of patients with non-urgent problems are seen within four weeks for their first appointment. That enables more patients than ever before to be treated.

A rehabilitation unit has been operating for the past 18 months. It provides more appropriate services in responding to need in Lichfield, where previously patients had to go to Birmingham, Sutton Coldfield, Burton or Stafford.

The Victoria hospital has introduced an abdominal ultrascan unit. Since July 1994, when it was introduced, the number of patients scanned has doubled. Obstetric scanning was introduced at the beginning of 1995, enabling mothers to be scanned locally rather than travelling to the district general hospital. The minor injuries unit is meeting patient charter standards for the first time this year.

I am impressed by the number of consultants who now go to the Victoria hospital to treat patients. In the old days, under the old NHS scheme which Labour would like to preserve in aspic, it was always the patients who had to follow the consultants. We now see the consultants following the patients. In the out-patients department of the Lichfield Victoria hospital, 51 consultants are attending each week. For day cases, there are 20 visiting consultants in five different specialties, whereas previously patients would have to travel to Burton, Stafford, Sutton Coldfield or Birmingham.

We have heard cant, hypocrisy and soundbite from Opposition Front Benchers; but when they are asked how much more money Labour will give to support the NHS, they are silent. When Labour is asked how it will restructure the NHS, its Front Benchers are silent. When Labour is asked precisely how it will replace GP fundholding, its Front Benchers are silent. Most telling of all, when Labour is asked how it can defend its stewardship of the NHS under the last Labour Government, when NHS expenditure was cut by more than 30 per cent., Labour Front Benchers fidget and remain silent.

Labour's soundbites cannot guarantee the wealth of the nation, nor the safety of the NHS. As the right hon. Member for Livingston said, the acid test is how many patients are being treated. This Government—this Conservative Government—have passed that test.

Photo of Tessa Jowell Tessa Jowell Shadow Spokesperson (Health) 9:20 pm, 20th November 1996

I begin by declaring an interest: I have for four years been a member of the parliamentary panel of the Royal College of Nursing.

In winding up the debate, I want to address three issues. The first is the damaging gap between what is actually happening in hospitals up and down the country and the fantasy world in which the Secretary of State and other Ministers believe. Secondly, I shall address the way in which the internal market and fundholding have destroyed a founding principle of our national health service: that patients are treated according to their need, not their ability to pay or any other consideration. Finally, I shall address the transformation of the culture of the national health service as a result of Government reforms from a public service culture to one that apes that of a commercial organisation.

The debate has demonstrated beyond doubt the scale of the crisis facing our health service this winter. We have heard eloquent evidence from my hon. Friends the Members for Blaenau Gwent (Mr. Smith) and for Morley and Leeds, South (Mr. Gunnell) about the real difficulties facing their constituents in securing treatment this winter. We have heard my hon Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) describe the great fears of his constituents about the pre-emption of revenue by the large private finance initiative scheme in east London.

We also heard a surprising confession from the hon. Member for Wimbledon (Dr. Goodson— Wickes), regretting his failure to join us in opposing the devastation of London hospitals four years ago. He eloquently described the medical and academic vandalism that was inflicted at that time—a loss to the capital's medical resources that will be hard to recover.

I want to pick up the reference made by my hon. Friend the Member for Preston (Mrs. Wise) to the iniquity of mixed sex wards and underline the enormous concern about the persistence of such wards in psychiatric hospitals. About 50 per cent. of women who are admitted to psychiatric hospitals have, at some time, been victims of sexual abuse. Research has shown that and shown how damaging to their well-being is the fear of vulnerability to and the possibility of sexual attack while in hospital. There is an urgent need to phase out mixed sex wards and the experiences of women in psychiatric hospitals and of men and women in general wards bear testament to that.

More than anything else, the way in which this winter's crisis has been debated today has marked a clear dividing line between Government and Opposition. Ours is no longer a health service that treats people according to their clinical need—examples from throughout the country have emphasised that. The Government have created that set of circumstances and now shrug off responsibility, saying that the circumstances result from local decision.

The NHS is fast becoming an emergency-only service—a safety net service for those who are acutely ill, while waiting lists lengthen. The crisis—the uncertainty that has been created for patients this winter—is being managed by nods and winks.

We hear reports that regions are telling trusts not to pay creditors after February, as a way to tide things over. I am happy to give way to the Minister if he can confirm that the Government do not intend to break the agreement that creditors are paid within 30 days. I see that the Minister does not wish to answer that point.

Regions are telling trusts that waiting lists should be allowed to lengthen, and that decisions as to how to manage the crisis are down to local managers, so that those who are responsible for the shambles—Ministers—stay as far from blame as possible. It amounts to something when the chief executive of the national health service executive sends a letter to trusts about handling the winter crisis, stating emphatically that it is not a new set of instructions or requirements.

Making the noise, as it is termed, is left to the Secretary of State, as he briefs the media and persuades Tory-supporting chairs of trusts to join his new NHS Network, using their position as public appointees for naked electioneering.

Someone who obviously is not a member of the Tory good news brigade is the chair of the Queens Medical Centre, Nottingham, University Hospital NHS trust. As my hon. Friend the Member for Nottingham, East (Mr. Heppell) said, he has been vocal in expressing his anxieties about his trust's capacity to treat patients this winter.

What is happening at the Queens medical centre in Nottingham helps us to understand the distortions in the health service. On 1 November, the centre stopped taking any routine elective admissions from non-fundholding GPs. As only 23 per cent. of Nottingham's population is covered by fundholders, 77 per cent. of the population now cannot have surgery unless they can be admitted as an emergency. That means that the centre has empty beds, so nearby Derbyshire, where 90 per cent. of GPs are fundholders, is referring its patients for treatment in the empty beds.

In 1990, the reforms were introduced with much-vaunted claims that the money would follow the patient. Patients now follow the money—where their GPs are fundholders. The chances of getting elective surgery done before next April are increasingly remote anywhere in the country unless a person is the patient of a fundholder, regardless of what is wrong with him.

King's College hospital provides a local example of the two-tier national health service, described as "an everyday reality" by Derek Smith, the chief executive. At the public meeting earlier this year, he said: Having succeeded in driving down waiting lists for all patients to twelve months it is with regret that we now see waiting times rising again for patients from Lambeth, Southwark and Lewisham. We are a national and regional centre of excellence but we live and work at the centre of our local community from which patients have longer waits than those from outside the area.This is in effect a two-tier NHS…the last few years King's has seen major expansion and development as part of an ongoing modernisation programme. We have new, high-tech facilities such as our day surgery centre which is under-used while there arc patients on waiting lists that it can care for. A surgeon at King's College hospital, which treats my constituents, recently sent me a letter that had been circulated to all senior registrars, registrars and consultants in the surgery and critical care groups. They are working closely with the marketing department to attract additional ECRs and fundholding GP activity. They are concerned to draw attention to the clinical urgency of some of the cases that will face extended waits as a result of insufficient contract volumes. That is especially pronounced in neurology, where many cases involve following up, treating or diagnosing cancer.

The vascular clinic will now, on Wednesday mornings and Friday afternoons, book in only the patients of GP fundholders and extra-contractual referrals. I should like Ministers to tell me how I can justify all that to my constituents.

Of course people suffer as a result. The need for routine surgery becomes a necessity for emergency treatment when, for instance, a man with angina has a heart attack, or a man with prostate problems becomes unable to pass urine. A cardiologist in Bedfordshire recently observed that his patients waiting for heart surgery are more likely to die on the waiting list than they are to die of the operation.

There is another inequity in the system. Fundholding GPs do not have to meet the costs of emergency treatment for their patients. As emergencies increase, therefore, the costs are a further drain on the resources of health authorities, not fundholders. So health authorities are faced with an increasing number of emergencies and with meeting, where possible, the costs of elective surgery for the patients of non-fundholding GPs.

All this represents more broken promises. Moorfields Eye hospital has just extended its out-patient waiting time to 26 weeks, in clear breach of the patients charter standard of 13 weeks.

This may be bad news for patients; it is certainly good news for private providers and the insurance companies, for which insecurity and lengthening waiting lists are the best possible recruiting sergeants. Increasing numbers of people are paying twice for their health care. What is so damaging is that no one in the Conservative party takes the problem seriously. The Government live in a world of make-believe. Most recently, the Secretary of State published a White Paper setting out, as he called it, his credo for the national health service. In it we read fairy tales about the triumphs of the NHS. There have certainly been some triumphs, but they are achieved by the dedication of staff—despite, not because of, this Government.

The White Paper failed to mention elderly patients waiting on trolleys or patients re-admitted after premature discharge—or lengthening waiting lists, cancelled operations or the winter crisis. All these are the daily facts of life for staff and patients alike. Furthermore, there was no mention of those great Government icons: competition and the market. The Government believe that they have been a howling success. They should perhaps take seriously the findings of the recent "British Social Attitudes" survey. When asked whether they thought that the health service had improved, 81 per cent. of those interviewed said that they saw no improvement and 49 per cent. believed that things had got worse or much worse.

Photo of Michael Fabricant Michael Fabricant , Staffordshire Mid

Is the hon. Lady aware of the poll of patients who had recently been treated by the health service, over 80 per cent. of whom said that they thought the health service had improved in the past few years? Is she not merely reflecting Labour party propaganda? How effective that has been in convincing people who have not been treated that the health service is not successful.

Photo of Tessa Jowell Tessa Jowell Shadow Spokesperson (Health)

The hon. Gentleman makes my point. There is a view of reality that is shared by Conservative Members, and there is the real world outside, across the bridge at St. Thomas's hospital, at King's College hospital, Guy's hospital and Chase Farm hospital.

At the root of all that is the fact that the Tories do not really believe in the national health service. They voted against it 50 years ago. They have come to see it as inevitable, but they do not see it as desirable. The Secretary of State continues to protest that his intentions are good. Perhaps they are; let us give him the benefit of the doubt. But the truth is that his heart is not in it. For the Conservatives, state medicine is like state education: the odd hon. Member may use it, but most do not.

At Richmond house, where the Secretary of State sits, in a world where the raw pain and hard choices are sanitised, and where management-speak has taken over from patient care, a particular language is spoken. Nasty words such as "patients", "pain" and "waiting lists" have been eliminated from the vocabulary.

I was recently sent a copy of the minutes of the management board, the most senior board responsible for the NHS. One need read no further than those minutes to understand that patients have simply been written out of the script. Nowhere in the long deliberations of that meeting are patients mentioned. My hon. Friend the Member for Preston made the point that the Government no longer speak about patients, but speak instead about finished consultant episodes.

To give the House a flavour of the way in which the board speaks, I quote from the document. It states: The Board considered the areas of the country which faced the most difficulties. It agreed that support must be given to the NHS to manage through these problems without impacting on the many improvements already achieved … A more open position on prioritising was inevitable. What on earth does that mean?

There is no mention of patients in the letters sent to trusts and health authorities about the winter crisis. The NHS is aping the culture of a commercial organisation and failing both patients and staff in the process.

I received a letter today from the Royal College of Midwives expressing great concern at the fact that "Changing Childbirth" was becoming less viable. That is supported by both sides of the House as the way forward in maternity care. "Changing Childbirth" is threatened by the recruitment and retention crisis hitting midwifery.

The people of this country will have to get through this winter. There will be heartache and anger as clinical priorities are determined by the crude mechanisms of a false market. In the spring there will be a general election. That will be the last chance for our national health service.

Labour will rid the health service of the dogma-driven reforms foisted on it by the Government. It will mend the fractures that have shattered the NHS into hundreds of small businesses. We will rebuild a health service in which our constituents can have confidence and of which the country can again be proud.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester 9:38 pm, 20th November 1996

The hon. Member for Dulwich (Ms Jowell) had an opportunity to set out some of her party's policies, as the country approaches an election, about the future of the national health service, but we heard absolutely nothing about what the Labour party would do. The same was also true of the hon. Member for Islington, South and Finsbury (Mr. Smith), who opened the debate.

The emptiness of the Labour party and its policies on the national health service characterised the debate. All that the hon. Lady did in winding up the debate was to reiterate threats about the privatisation of the NHS and the hidden agenda for the NHS that the Government were supposed to have in 1979, 1983, 1987, 1992 and 1997. The hon. Lady will doubtless make the same speech about our hidden agenda when we come up for re-election again in 2002, still supporters of our national health service.

Our future for the NHS is contained in "secret documents" called White Papers, which appear in public and are debated. It also appears in things called Bills, which come before the House—currently before the House of Lords—in terms of bringing forward primary care. It is astonishing that not one Opposition Member even bothered during the debate to mention what is at the centre of the debate on our health service today—the future of a primary care-led NHS—and that a Bill has been presented to Parliament. Not a word did we hear from Labour Members about that, what their thoughts about it were and how they would take it forward. We will talk about that later in my speech, I promise.

We also failed to hear the Labour party's pledge on spending. Again, the hon. Member for Islington, South and Finsbury totally refused to match the promise that made by my right hon. Friend the Prime Minister and repeated by my right hon. Friend the Secretary of State.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

It is a real-terms increase year on year on year on year for the next Parliament, just as we have done in this Parliament and in the Parliaments before that. If the hon. Gentleman thinks that getting down to specifics on health spending will do him any good, he should look at the record of the last Labour Government. Not only was that pledge not honoured in its final years, but—for the first time in the history of the health service, I believe—the percentage of gross domestic product spent on health care in this country slipped from 4.8 per cent. to 4.7 per cent. The figure has now been increased to 5.9 per cent.

Photo of Mr Llew Smith Mr Llew Smith , Blaenau Gwent

Can the Minister confirm two things? First, will he confirm that the percentage of GDP currently spent on the national health service is less than it was at the general election in 1992? Secondly, will he confirm that the last Labour Government raised national health service spending by more in real terms in its five years than has happened in the past five years?

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

The hon. Gentleman made much of his party's custody of the health service while Labour was in Government. In Government, we have gone from 4.7 per cent. of GDP to 5.9 per cent. The hon. Gentleman cannot fudge that.

It beggars belief that, even in the winding up of the debate, when the hon. Gentleman intervenes he does not take the opportunity to repeat or match the pledge that the Prime Minister has given. The hon. Gentleman made much of Red Book figures—outline figures —and the House knows that they are not normally the figures lit upon at the end of the day. He said that a 0.1 per cent. increase in health spending in real terms was tiny. If that is so, will he now pledge to match even that minimalist amount in real terms spending on the health service if he were in Government? I invite him to do so now, but he will not, as I am sure that the House will have recognised.

The truth is that the Tories are now running the agenda on the NHS. That is what I believe that the hon. Member for Hartlepool (Mr. Mandelson), Labour's spin doctor, may well have said. I can hear it characterising the debate. "Come on, Chris. The Tories are running the agenda on the NHS. Even if we can't promise anything—and you can't promise anything—let's simply declare a crisis." After all, that is what the Labour party has done for 17 years, but I can tell the hon. Gentleman that it has not done the Labour party any good.

Many right hon. and hon. Members have participated in the debate. I shall refer to a number of the contributions and try to answer the points that were made.

My right hon. Friend the Member for Sutton Coldfield (Sir N. Fowler) was Secretary of State for Social Services for six years and he drew on that extensive experience in his speech. He pointed out that trust hospitals are able to respond to problems, and he used a constituency example to illustrate very clearly how trusts can make rapid changes in order to improve service provision.

The hon. Member for Southwark and Bermondsey (Mr. Hughes) raised two points. First, he referred to mental health and asked whether the Government consider it a priority. I assure him that we do. In the current year, £95 million in additional revenue has been devoted to improving mental health services—£53 million from health authorities, £10 million from the mental health challenge fund, £10 million in matching health authority funding, and £20 million from the mental illness specific grant, plus a £2 million contribution from local authorities. I hope that he will accept that as proof of our earnest intentions and our acceptance of mental health as a priority.

The hon. Gentleman also mentioned backlog maintenance. That figure must be put in perspective, as it represents only 3 per cent. of the replacement cost of NHS estates. He should bear in mind also the fact that the NHS is responsible for more than 700 listed buildings, which is more than the National Trust.

The hon. Member for Blaenau Gwent (Mr. Smith) highlighted problems with the South and East Wales Ambulance NHS trust. I assure him that my right hon. Friend the Secretary of State for Wales is taking a close interest in the matter.

My hon. Friend the Member for Broxbourne (Mrs. Rowe) mentioned a primary care-led NHS and set out the improvements that that will bring—including quicker access and new clinics located closer to patients. The legislation that is currently before Parliament: will encourage further developments in that area. It embraces the principle that patient care should take place closer to the patient where that is clinically appropriate. Although Labour Members said nothing about it, the move is welcomed by the medical profession and by those who are involved in primary care delivery.

The hon. Member for Nottingham, East (Mr. Heppell) raised two points. First, he asked what was happening at the Queens Medical Centre NHS trust. That trust is increasing the treatment that it provides, and the number of cases rose by 2.2 per cent. last year. Trusts up and down the country are facing pressures and difficulties, but I hope that the hon. Gentleman will view current events in the context of an overall increase in treatment. Secondly, the allocation for his local health authority increased by £15 million last year— which is the largest percentage increase in the Trent region.

The hon. Member for Mid-Ulster (Rev. William McCrea) made the very good point that we must follow policies with real finance. In so doing, he put the Labour party on the spot as he clearly understands that there can be no pledges regarding the health service unless they are followed with real cash commitments. He raised several other matters that are the responsibility of my right hon. Friend the Secretary of State for Northern Ireland and I shall ensure that they are drawn to his attention.

I do not usually enjoy the contributions of the hon. Member for Morley and Leeds, South (Mr. Gunnell), but I think that he has been taking tablets to relieve his gloom because there was some optimism in his speech when he referred to positive primary care developments and hospital improvements in his constituency. I thought that we might be persuading him to our point of view, but, sadly, the clouds soon gathered again. Despite his praise for the health service, he raised several specific points. He referred to increased intensive care and high dependency bed provision. West Yorkshire is allocating £4 million to achieve that increase and my right hon. Friend the Secretary of State announced measures earlier this year to increase the number of paediatric intensive care beds by 20 per cent.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

I shall not give way. The hon. Gentleman may raise a specific point with me later, but I must make progress now.

My hon. Friend the Member for Harlow (Mr. Hayes) vigorously attacked the Labour party's lack of policies. I agree with him, as today Opposition Members again indulged in shroud-waving. My hon. Friend referred to The Independent article attacking Labour, and pointed out correctly that we have taken over the health care agenda, which the Labour party always claimed for itself.

My hon. Friend the Member for Wimbledon (Dr. Goodson-Wickes) asked for specific reassurances about the future of the Bart's site. As he knows, the matter is being considered by a committee that is due to report in the not too distant future. He will be kept up to date with developments in that important area.

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

I am afraid that I do not have time.

The hon. Member for Belfast, South (Rev. Martin Smyth) asked about managers who receive salaries that are disproportionate to the task involved. The salary of an individual NHS trust chief executive is a matter for the committee of that trust. He also asked about emergency admissions. Concern about that has been expressed, and the problem is not explained by looking at the situation across the service. However, the matter is being investigated. Good management can often cope with an unexpected rise in emergency admissions.

My hon. Friend the Member for Southport (Mr. Banks) raised a constituency point about a private finance initiative. He asked for my assurance that I would keep the matter under review. I will watch developments in his constituency. I understand how important this is to him: he is a great campaigner on behalf of his constituents, and draws such matters to the attention of Ministers. I promise him that I will keep it well within my view.

The hon. Member for Preston (Mrs. Wise) raised a point that deserves the House's attention. She talked about the number of finished consultant episodes as if it was a magic figure that was irrelevant. I remind her—and perhaps the House—of their history. She may have forgotten that the move towards finished consultant episodes as a true measure of performance in the NHS was recommended by the working group chaired by Edith Körner. The hon. Lady may also have forgotten that the then Department of Health and Social Security, in its consultation document, proposed a joint steering group to examine this matter, which was established in February 1979. It was welcomed by Labour's Royal Commission on the national health service, which said: Improvements in information will initially require additional expenditure on administration but we expect the quality of decision making would thereby be much improved. A journalist called Ann Clwyd happened to be a member of that commission.

The use of proper statistics was put in place by a Labour Government and was carried on by the Körner committee. They are the truest measure of NHS activity. It does the hon. Lady and her hon. Friends no good at all to denigrate the increased activity of the NHS by saying that the statistics are false. They are not. The hon. Member for Islington, South and Finsbury said that this was a Labour idea in the first place. Similarly, the right hon. Member for Kingston upon Hull, East (Mr. Prescott) keeps telling us that the private finance initiative was his idea in the first place. On investigation, it seems that finished consultant episodes started off their life in the dying days of a Labour Government.

Labour Members did not touch on their plans for the future of the health service. They were silent on that. They tried their usual trick of denigrating the achievements of people in the health service. They set those achievements at naught.

Let me set out what I think people take as the true benchmarks of the success of a national health service, and the benchmarks of a Government's commitment to it. First, I shall deal with the work force. How many more nurses are there in the health service since the Government entered office in 1979? There are 55,000 more nurses, which is not the figure that Labour Members consistently peddle, even though they have been told time and again that their figures and the basis on which they are calculated are false. If the hon. Member for Islington, South and Finsbury wants to test me further, I can tell him that since the reforms there has been a smaller increase of 1,000 or 2,000, so he is wrong on that as well.

The number of hospital staff has increased from 48,590 to 55,350, which is a huge increase. That investment in the medical profession has been financed as a result of the Government's determined efforts. Let us pick another benchmark that Labour Members are always keen to talk about when it suits them—waiting times. It is absurd to use the overall number of people who are waiting for operations as the benchmark of the health service's success. As a service grows, and as more and more people are treated by it, so the number waiting for treatment at any given time will increase in absolute terms. What the hon. Member for Islington, South and Finsbury fails to recognise is that whereas 195,185 people were waiting for more than a year in 1979, in 1996 the figure is 4,576. I must point out to the hon. Gentleman again that it is the length of time for which someone waits for an operation and treatment that counts.

Earlier, an Opposition Member who is not present now said, from a sedentary position, that we were cheating with our figures, because we were not including out-patient waiting times. But the Government pass that benchmark test as well, with flying colours: 85 per cent. of patients are now seen within 13 weeks at out-patient clinics, which is a great achievement.

Another thing that we did not hear about from the Opposition is their policy on GP fundholding, which changes regularly with every change in Opposition Front-Bench spokesmen. The language has changed—and I hope that the nation understands what that language means as well as GP fundholders do. First the Opposition were going to abolish fundholding; then they were going to replace it. Now, I understand that—following a speech made in Harrogate by the hon. Member for Islington, South and Finsbury to the Association of Fundholding Practices—we have heard something else: it is going to evolve.

It is no good for the hon. Gentleman to go to conferences of GP fundholders and praise them for their achievements, saying that he will listen to what is said about fundholding in the future, and then to come to the House and make a speech that denigrates those achievements in the clearest and most absolute way. Whatever words he and his hon. Friends use about GP fundholding, my goodness, we know what replacing it, evolving it or abolishing it actually means. If anyone who was a member of Stalin's Politburo was told that he would be evolved or replaced, he knew exactly what would happen—and that is precisely what GP fundholders understand.

Let me end not just by confirming the Government's commitment to the White Paper that my right hon. Friend the Secretary of State has rightly presented—indicating confirmation of our adherence to the principles of the NHS—but by talking about the primary care-led NHS. It is a tremendous achievement for GPs across the country, both fundholders and non-fundholders, that we are now in a position to proceed with a primary care-led Bill that will make a primary care-led NHS a reality.

I object to Opposition Members' denigration of what has been happening, both in innovation in primary care through fundholders and in other ways. A policy of denigration is a disgrace, because it betrays the work of all who perform services in the NHS.

I recently wrote to the right hon. Member for Sedgefield (Mr. Blair), the Leader of the Opposition, raising with him an issue that he had raised at Prime Minister's Question Time. On that occasion, the right hon. Gentleman made yet another unfounded assertion about our NHS, saying that maternity services had declined under the present Government in recent years. [HON. MEMBERS: "Hear, hear."] I note that that is given some support by the Labour party. I hope that the midwives who deliver maternity services, and all who have worked hard to develop changing childbirth techniques—

Photo of Mr Gerald Malone Mr Gerald Malone , Winchester

Not now.

I hope that all those who have improved the quality of maternity services will understand how little the Leader of the Opposition values them.

I have issued a challenge to the Leader of the Opposition, and I issue it to the hon. Member for Islington, South and Finsbury as well. Those who criticise the NHS should put up or shut up. They should give us the facts and figures, so that we may respond. What is intolerable to all who work in the service is the denigration of their achievements through unfounded accusations, which has been the tactic of the Labour party in recent years. It has had an opportunity today to explain to the House and to the electorate whether it has a vision for the future of the NHS. It has none. It is this party and this Government who have that vision and who will carry it forward in the next Parliament.

Question put, That the original words stand part of the Question:—

The House divided: Ayes 268, Noes 274.

Division No. 16][9.59 pm
Abbott, Ms DianeDavies, Chris (Littleborough)
Ainger, NickDavies, Denzil (Llanelli)
Ainsworth, Robert (Cov'try NE)Davies, Ron (Caerphilly)
Allen, GrahamDavis, Terry (B'ham Hodge H)
Alton, DavidDenham, John
Anderson, Ms Janet (Ros'dale)Dewar, Donald
Armstrong, Ms HilaryDixon, Don
Ashdown, PaddyDobson, Frank
Austin-Walker, JohnDonohoe, Brian H
Banks, Tony (Newham NW)Dowd, Jim
Barnes, HarryDunwoody, Mrs Gwyneth
Barron, KevinEastham, Ken
Battle, JohnEtherington, Bill
Bayley, HughEvans, John (St Helens N)
Beckett, Mrs MargaretEwing, Mrs Margaret
Beggs, RoyFatchett, Derek
Beith, A JField, Frank (Birkenhead)
Bell, StuartFlynn, Paul
Benn, TonyFoster, Derek
Bennett, Andrew FFoster, Don (Bath)
Benton, JoeFoulkes, George
Bermingham, GeraldFraser, John
Berry, RogerFyfe, Mrs Maria
Betts, CliveGalbraith, Sam
Boateng, PaulGalloway, George
Bradley, KeithGapes, Mike
Bray, Dr JeremyGarrett, John
Brown, Nicholas (Newcastle E)Gerrard, Neil
Burden, RichardGilbert, Dr John
Byers, StephenGodman, Dr Norman A
Caborn, RichardGodsiff, Roger
Callaghan, JimGolding, Mrs Llin
Campbell, Mrs Anne (C'bridge)Graham, Thomas
Campbell, Ronnie (Blyth V)Grant, Bernie (Tottenham)
Campbell-Savours, D NGriffiths, Nigel (Edinburgh S)
Canavan, DennisGriffiths, Win (Bridgend S)
Cann, JamieGrocott, Bruce
Chisholm, MalcolmGunnell, John
Clapham, MichaelHain, Peter
Clarke, Eric (Midlothian)Hall, Mike
Clarke, Tom (Monklands W)Hanson, David
Clelland, DavidHarman, Ms Harriet
Clwyd, Mrs AnnHarvey, Nick
Coffey, Ms AnnHenderson, Doug
Connarty, MichaelHendron, Dr Joe
Cook, Robin (Livingston)Heppell, John
Corbett, RobinHill, Keith (Streatham)
Corbyn, JeremyHinchliffe, David
Corston, Ms JeanHoey, Miss Kate
Cousins, JimHogg, Norman (Cumbernauld)
Cox, TomHome Robertson, John
Cummings, JohnHood, Jimmy
Cunliffe, LawrenceHowarth, Alan (Statf'd-on-A)
Cunningham, Jim (Cov'try SE)Howarth, George (Knowsley N)
Cunningham, Ms R (Perth Kinross)Howells, Dr Kim
Dafis, CynogHoyle, Doug
Dalyell, TamHughes, Kevin (Doncaster N)
Darling, AlistairHughes, Robert (Ab'd'n N)
Davidson, IanHughes, Roy (Newport E)
Davies, Bryan (Oldham C)Hughes, Simon (Southwark)
Ingram, AdamPickthall, Colin
Jackson, Ms Glenda (Hampst'd)Pike, Peter L
Jackson, Mrs Helen (Hillsborough)Pope, Greg
Jamieson, DavidPowell, Sir Raymond (Ogmore)
Janner, GrevillePrentice, Mrs B (Lewisham E)
Jenkins, Brian D (SE Staffs)Prentice, Gordon (Pendle)
Jones, Barry (Alyn & D'side)Primarolo, Ms Dawn
Jones, Ieuan Wyn (Ynys Môn)Purchase, Ken
Jones, Jon Owen (Cardiff C)Quin, Ms Joyce
Jones, Dr L (B'ham Selly Oak)Radice, Giles
Jones, Martyn (Clwyd SW)Randall, Stuart
Jones, Nigel (Cheltenham)Raynsford, Nick
Jowell, Ms TessaReid, Dr John
Kaufman, GeraldRendel, David
Keen, AlanRobertson, George (Hamilton)
Khabra, Piara SRobinson, Geoffrey (Cov'try NW)
Kilfoyle, PeterRoche, Mrs Barbara
Lestor, Miss Joan (Eccles)Rogers, Allan
Liddell, Mrs HelenRooker, Jeff
Litherland, RobertRooney, Terry
Livingstone, KenRoss, Ernie (Dundee W)
Lloyd, Tony (Stretf'd)Rowlands, Ted
Llwyd, ElfynRuddock, Ms Joan
Loyden, EddieSalmond, Alex
Lynne, Ms LizSedgemore, Brian
McAllion, JohnSheerman, Barry
McAvoy, ThomasSheldon, Robert
McCartney, Ian (Makerf'ld)Shore, Peter
Macdonald, CalumSimpson, Alan
McFall, JohnSkinner, Dennis
McKelvey, WilliamSmith, Andrew (Oxford E)
Mackinlay, AndrewSmith, Chris (Islington S)
McLeish, HenrySmith, Llew (Blaenau Gwent)
McMaster, GordonSmyth, Rev Martin (Belfast S)
McNamara, KevinSoley, Clive
MacShane, DenisSpearing, Nigel
McWilliam, JohnSpeller, John
Madden, MaxSquire, Ms R (Dunfermline W)
Maddock, Mrs DianaSteinberg, Gerry
Maginnis, KenStevenson, George
Mendelson, PeterStrang, Dr Gavin
Marek, Dr JohnStraw, Jack
Marshall, David (Shettleston)Sutcliffe, Gerry
Marshall, Jim (Leicester S)Taylor, Mrs Ann (Dewsbury)
Martin, Michael J (Springburn)Taylor, Matthew (Truro)
Martlew, EricThompson, Jack (Wansbeck)
Maxton, JohnThurnham, Peter
Meacher, MichaelTimms, Stephen
Meale, AlanTipping, Paddy
Michael, AlunTouhig, Don
Michie, Bill (Shef'ld Heeley)Trickett, Jon
Michie, Mrs Ray (Argyll Bute)Turner, Dennis
Milburn, AlanTyler, Paul
Miller, AndrewVaz, Keith
Mitchell, Austin (Gt Grimsby)Walker, Sir Harold
Molyneaux, Sir JamesWallace, James
Moonie, Dr LewisWalley, Ms Joan
Morgan, RhodriWardell, Gareth (Gower)
Morley, ElliotWareing, Robert N
Morris, Alfred (Wy'nshawe)Watson, Mike
Morris, Ms Estelle (B'ham Yardley)Wicks, Malcolm
Morris, John (Aberavon)Wigley, Dafydd
Mowlam, Ms MarjorieWilliams, Alan (Swansea W)
Mudie, GeorgeWilliams, Alan W (Carmarthen)
Mullin, ChrisWilson, Brian
Murphy, PaulWinnick, David
Oakes, GordonWise, Mrs Audrey
O'Brien, Mike (N Warks)Worthington, Tony
O'Brien, William (Normanton)Wray, Jimmy
Olner, BillWright, Dr Tony
O'Neill, MartinYoung, David (Bolton SE)
Orme, StanleyTellers for the Ayes:
Paisley, Rev IanMrs. Jane Kennedy and
Parry, RobertMs Angela Eagle.
Pearson, Ian
Pendry, Tom
Ainsworth, Peter (E Surrey)Evans, Jonathan (Brecon)
Alexander, RichardEvans, Nigel (Ribble V)
Alison, Michael (Selby)Evans, Roger (Monmouth)
Allason, Rupert (Torbay)Evennett, David
Arbuthnot, JamesFaber, David
Arnold, Jacques (Gravesham)Fabricant, Michael
Ashby, DavidFenner, Dame Peggy
Atkins, RobertField, Barry (Isle of Wight)
Atkinson, Peter (Hexham)Fishburn, Dudley
Baker, Kenneth (Mole V)Forman, Nigel
Baker, Nicholas (N Dorset)Forth, Eric
Baldry, TonyFowler, Sir Norman
Banks, Matthew (Southport)Fox, Dr Liam (Woodspring)
Banks, Robert (Harrogate)Fox, Sir Marcus (Shipley)
Bates, MichaelFreeman, Roger
Batiste, SpencerFrench, Douglas
Bellingham, HenryFry, Sir Peter
Beresford, Sir PaulGale, Roger
Biffen, JohnGallie, Phil
Body, Sir RichardGardiner, Sir George
Booth, HartleyGarel-Jones, Tristan
Boswell, TimGarnier, Edward
Bottomley, Peter (Eltham)Gill, Christopher
Bottomley, Mrs VirginiaGillan, Mrs Cheryl
Bowden, Sir AndrewGoodlad, Alastair
Boyson, Sir RhodesGoodson-Wickes, Dr Charles
Brandreth, GylesGorst, Sir John
Brazier, JulianGrant, Sir Anthony (SW Cambs)
Bright, Sir GrahamGreenway, Harry (Ealing N)
Brooke, PeterGriffiths, Peter (Portsmouth N)
Brown, Michael (Brigg Cl'thorpes)Grylls, Sir Michael
Browning, Mrs AngelaGummer, John
Bruce, Ian (S Dorset)Hague, William
Burns, SimonHamilton, Sir Archibald
Burt, AlistairHampson, Dr Keith
Butcher, JohnHanley, Jeremy
Butler, PeterHannam, Sir John
Butterfill, JohnHargreaves, Andrew
Carlisle, John (Luton N)Harris, David
Carlisle, Sir Kenneth (Linc'n)Haselhurst, Sir Alan
Carrington, MatthewHawkins, Nick
Carttiss, MichaelHawksley, Warren
Cash, WilliamHayes, Jerry
Channon, PaulHeald, Oliver
Chapman, Sir SydneyHeath, Sir Edward
Clappison, JamesHeathcoat-Amory, David
Clark, Dr Michael (Rochf'd)Hendry, Charles
Clarke, Kenneth (Rushcliffe)Hicks, Sir Robert
Clifton-Brown, GeoffreyHiggins, Sir Terence
Coe, SebastianHogg, Douglas (Grantham)
Colvin, MichaelHoram, John
Congdon, DavidHordern, Sir Peter
Conway, DerekHoward, Michael
Coombs, Anthony (Wyre F)Howell, David (Guildf'd)
Coombs, Simon (Swindon)Howell, Sir Ralph (N Norfolk)
Cope, Sir JohnHughes, Robert G (Harrow W)
Cormack, Sir PatrickHunt, David (Wirral W)
Couchman, JamesHunt, Sir John (Ravensb'ne)
Cran, JamesHunter, Andrew
Currie, Mrs EdwinaHurd, Douglas
Curry, DavidJack, Michael
Davies, Quentin (Stamf'd)Jackson, Robert (Wantage)
Davis, David (Boothferry)Jenkin, Bernard (Colchester N)
Day, StephenJessel, Toby
Deva, Nirj JosephJones, Gwilym (Cardiff N)
Devlin, TimJones, Robert B (W Herts)
Dorrell, StephenKellett-Bowman, Dame Elaine
Douglas-Hamilton, Lord JamesKey, Robert
Dover, DenKing, Tom
Duncan Smith, IainKirkhope, Timothy
Dunn, BobKnight, Mrs Angela (Erewash)
Dykes, HughKnight, Greg (Derby N)
Elletson, HaroldKnight, Dame Jill (Edgbaston)
Evans, David (Welwyn Hatf'ld)Knox, Sir David
Kynoch, GeorgeSainsbury, Sir Timothy
Lait, Mrs JacquiShaw, David (Dover)
Lang, IanShaw, Sir Giles (Pudsey)
Legg, BarryShephard, Mrs Gillian
Leigh, EdwardShepherd, Sir Colin (Heref'd)
Lennox-Boyd, Sir MarkShersby, Sir Michael
Lester, Sir Jim (Broxtowe)Sims, Sir Roger
Lidington, DavidSkeet, Sir Trevor
Lilley, PeterSmith, Tim (Beaconsf'ld)
Lloyd, Sir Peter (Fareham)Soames, Nicholas
Lord, MichaelSpeed, Sir Keith
Luff, PeterSpencer, Sir Derek
MacGregor, JohnSpicer, Sir Jim (W Dorset)
MacKay, AndrewSpicer, Sir Michael (S Worcs)
Maclean, DavidSpring, Richard
McLoughlin, PatrickSproat, Iain
McNair-Wilson, Sir PatrickSquire, Robin (Hornchurch)
Madel, Sir DavidStanley, Sir John
Maitland, Lady OlgaSteen, Anthony
Malone, GeraldStephen, Michael
Mans, KeithStern, Michael
Marland, PaulStewart, Allan
Marlow, TonyStreeter, Gary
Marshall, John (Hendon S)Stott, Roger
Marshall, Sir Michael (Arundel)Sumberg, David
Martin, David (Portsmouth S)Sweeney, Walter
Mawhinney, Dr BrianSykes, John
Mellor, DavidTapsell, Sir Peter
Merchant, PiersTaylor, Ian (Esher)
Mitchell, Andrew (Gedling)Taylor, John M (Solihull)
Moate, Sir RogerTaylor, Sir Teddy
Monro, Sir HectorTemple-Morris, Peter
Montgomery, Sir FergusThomason, Roy
Moss, MalcolmThompson, Sir Donald (Calder V)
Needham, RichardThompson, Patrick (Norwich N)
Nelson, AnthonyThornton, Sir Malcolm
Neubert, Sir MichaelTownend, John (Bridlington)
Newton, TonyTownsend, Cyril D (Bexl'yh'th)
Nicholson, David (Taunton)Tracey, Richard
Norris, SteveTredinnick, David
Onslow, Sir CranleyTrend, Michael
Oppenheim, PhillipTwinn, Dr Ian
Ottaway, RichardVaughan, Sir Gerard
Page, RichardWaldegrave, William
Paice, JamesWalden, George
Patnick, Sir IrvineWalker, Bill (N Tayside)
Patten, JohnWaller, Gary
Pattie, Sir GeoffreyWardle, Charles (Bexhill)
Pawsey, JamesWaterson, Nigel
Peacock, Mrs ElizabethWatts, John
Pickles, EricWhitney, Ray
Porter, DavidWhittingdale, John
Powell, William (Corby)Widdecombe, Miss Ann
Rathbone, TimWiggin, Sir Jerry
Redwood, JohnWilkinson, John
Renton, TimWilshire, David
Richards, RodWinterton, Mrs Ann (Congleton)
Riddick, GrahamWinterton, Nicholas (Macclesf'ld)
Robathan, AndrewWolfson, Mark
Roberts, Sir WynWood, Timothy
Robinson, Mark (Somerton)Yeo, Tim
Roe, Mrs MarionYoung, Sir George
Rowe, AndrewTellers for the Noes:
Rumbold, Dame AngelaMr. Bowen Wells and
Sackville, TomMr. Roger Knapman.

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

MR. DEPUTY SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved,That this House believes the National Health Service is one of the success stories of modern Britain and is wholeheartedly committed to developing the NHS on the basis of its founding principles of universality, high quality and availability on the basis of clinical need, without regard for the patient's ability to pay: expresses its support for the Government's initiatives to release £300 million from unnecessary NHS administration; welcomes both the Government's further plans to develop NHS primary care and the recent White Paper A Service With Ambitions, which sets out a medium-term framework for a high-quality patient-focused NHS; and welcomes the Government's pledge to spend more money on the NHS, over and above inflation, for each year of the five years of the next Parliament.