§ Mrs. Margaret Beckett (Derby, South)
I beg to move, as an amendment to the Address, at the end of the Question to add:But humbly regret that the Gracious Speech omits measures which either address the fears or advance the hopes of the British people; calls instead for a commitment to provide a National Health Service which offers equal access to care for all, is run for the public good and has clear accountability to those it serves, and for a commitment to build a Social Security system designed to take people out of poverty, offer opportunity and enhance skills; and further calls for a legislative framework for occupational pensions fully implementing the Pension Law Review Committee's report, for regulations to control the mis-selling of private pensions, for the abandonment of Incapacity Benefit and the Jobseekers Allowance, which both target vulnerable people in society, for the early and urgent reform of the Child Support Agency, and for the introduction of comprehensive civil rights legislation outlawing discrimination against disabled people.The Queen's Speech has left a dominant impression with everyone, from Members of the House, through the news media to the nation as a whole: it is of a Government not only dithering, divided and demoralised, but hopelessly out of touch with the reality as well as the challenges facing the people of Britain. It is a Queen's Speech which could have been computer-generated. Like three-dimensional computer graphics, it allows the Prime Minister and his colleagues at least to imagine that they are interacting with reality. However, like computer users with their mouses or space balls, the image and view of the world reflected back through the speech is a virtual world. It is an encounter with virtual reality, not with the real world.
The Prime Minister and all his colleagues, including the Secretary of State for Health, have retreated into a two-dimensional world of their own. It is a world in which the Maples memo so clearly and chillingly reveals the priorities set by the Government. We are told that it contains a long analysis of what the Tory party should do about health—not, please note, what it should do to redress the damage done to the national health service, but what the Government should do to conceal that damage from the public.
473 Mr. Maples recommends slowing down the process of change, to conceal its full effects, if possible, until safely after the election. Meanwhile, he says that the Secretary of State should silence the staff and keep flannelling away with so-called killer facts. However, the Secretary of State for Health has been doing that for years. That is how the Tories ended up 55 points behind in the polls.
What are those killer facts? They seem to me to be what Norman Mailer famously called factoids. According to the dictionary, they are statements that take on the reality of a fact simply by virtue of being uttered and repeated and repeated. They are factoids like, "The national health service is safe with us." They are factoids like the Prime Minister's, "The national health service will not be privatised while I live and breathe." They are factoids like, "The old NHS was a centralised bureaucracy," when, in 1986, there were only 500 general and senior managers in England in the NHS and by 1992, there were 16,700. They are factoids like, "The national health service now treats 3,000 extra patients a day," when the truth is that those figures refer not to patients, but to finished consultant episodes. Patients can be double counted if they see more than one consultant or if they are discharged too soon and have to be readmitted.
Those are factoids. The killer facts are those which the Government seek to suppress. They are killer facts like that pointed out by the chairman of the British Medical Association recently:there is no longer one National Health Service. There are 100 purchasing consortia and 400 provider units each with its own self-serving view of its best interests.Another killer fact is that there are fewer nurses in the health service today than 10 years ago and more accountants. There are killer facts like the one in the press today that 18 county councils are close to running out of money for community care. There is the killer fact that thousands of families in every part of Britain are finding out that there are no longer any NHS dentistry facilities in their area.
In the real world, there is deep disquiet about the state of our national health service. In an Opposition day debate a few days ago, we referred to the Secretary of State for Health as the Madame Mao of the health service, embarked on a process of continual revolution. The structural proposals contained in legislation to abolish regional health authorities are the latest development in that process.
Those proposals, together with the others referred to in the Gracious Speech, demand and will receive careful scrutiny in the House. Both on Second Reading and in Committee, we shall want to explore in depth the worth of the Government's justification for their proposals; what else might be the effect—intended or otherwise—of them as they stand and thus what amendment might be required; and last, but by no means least, the background against which the legislative changes will operate.
The questions that we want to ask about the structural changes, which will be explored in depth when the Bill is introduced, have been thrown into sharp relief by other statements made during the past few days—statements far more revealing than the Secretary of State's factoids about what the Government's so-called reforms are doing to the 474 national health service. They are revealing, too, of what her public relations drive seeks to conceal and what the reforms are intended to achieve.
§ Mr. Duncan
Before my hon. Friend the Member for Woodspring (Dr. Fox) gives the right hon. Lady some cream to cure her factoids, will she refer to the amendment, which demands clear accountability to those whom the NHS serves, and explain in detail what she means by structural reforms? Is she suggesting that, once again, local councillors should have a hand in deciding how the NHS is run? [Interruption.]
§ Mrs. Beckett
I hear from my hon. Friends behind me that that is precisely the idea being floated in Wandsworth, but I would not care to take responsibility for anything that the Conservative council there might propose.
I say to the hon. Gentleman what has been said repeatedly in the House, in the hope that neither he nor anyone else will feel the need to raise the matter again for a while—that we have produced a consultation document that is being considered across the country. I know that Conservative Members are unfamiliar with such a process. We have identified the key questions and problems raised by the Government's reforms and we have invited suggestions on what should be put in their place. We have given people months to complete that process. Conferences have been held by a variety of interested bodies, such as the British Medical Association, to discuss what should replace the Government's reforms. That process is under way and we expect responses within, we hope, another couple of months. We shall then consider what policy to put forward.
I fully understand that that process is completely foreign to Conservative Members. They think that consultation means that first they make up their mind, then they give everybody else three weeks to digest at least some sign of what they have in mind and then they rush through the legislation and we all pick up the pieces afterwards. That is not consultation as the Opposition understand it. It is because we want to preserve the NHS as the British people cherish it that we are undergoing a proper consultation process. I hope that I have made the matter quite clear to the hon. Gentleman.
The first of the observations to which I referred emanated from one of those people hand-picked by the Secretary of State to carry out Government policy—Mr. Roy Lilley, the chair of the Homewood trust. We have questioned the degree to which those appointed to trust boards have overwhelmingly, although not exclusively, been drawn from the ranks of members and supporters of or contributors to the Tory party. We recognise that within even those exclusive and fast-diminishing ranks there appears to have been a bias in selection towards those so in tune with the Government's health policy that they can be instinctively relied upon to understand what the Government are really about and so quietly help them to pursue their objectives, stated or unstated.
Mr. Lilley has always been seen as, in the Secretary of State's terms, the creme de la creme; one of her red guards. When he says that the first duty of a doctor is to 475 the organisation in which he works and that his duty to patients comes in only third place, we know that the British people are absolutely right to be deeply distrustful of the intentions of both the Government and the Secretary of State. Now, the truth is out. Roy Lilley has done for trusts what Gerald Ratner did for his jewellery business—he has told us what the consumers are really getting from the Secretary of State.
Again, Mr. Lilley said:The proposition that a doctor's first duty is to his patient, is without question, definitely, positively, wrong … The more I think about it the more I am convinced it is not only wrong. It is stupid and dangerous to entertain the thought that it might be, even partly, right. No it is out of the question. The doctor's fast duty is not to the patient.Those words, coming as they do from one of the Secretary of State's hand-picked appointees and one of those closest to the pace and direction of her reforms, carry more significance than do 55 copies of the patients charter.
Astonishingly, despite what the Secretary of State said in our previous debate, the view that patients should not come first does not seem too unhinged to command her support. To be fair, at first she dithered a little. One member of the Department's army of press officers was instructed to issue a press release that seemed to distance her from Mr. Lilley's remarks. But when she was questioned at another press conference, she blurted out a ringing endorsement of Mr. Lilley and his bona fides. The Secretary of State endorses Roy Lilley's vision that a hospital should be run like a giant store, with the major imperatives being maximum throughput and commercial gain. That may be Mr. Lilley's vision of the national health service. It is not what the British people expect, or what they were told to expect, from the Government.
I have no doubt that the Secretary of State will argue that her vision is a little more upmarket. She prefers, after all, to shop not in such a giant store but in Marks and Spencers when there is no one else about. She took a lot of stick, I know, after her special treatment was made public. I could not set foot in Marks and Spencers for weeks afterwards without complete strangers stopping me to chortle, "I see they have not made any special arrangements for you, then." It is much more worrying that, when it comes to health, the Secretary of State can tolerate a two-tier system which allows people like herself to sail through undisturbed while most of the community are expected to jostle and muscle their way through the crowds for a little service from their consultant and a little decent health care.
I have no doubt that the Secretary of State will tell us that the social attitudes survey published recently shows a smaller degree of dissatisfaction with the health service than has been the case on some occasions in the past 10 years. I certainly accept that, but lest the Secretary of State intends to dwell at length on what the social attitudes survey reveals, let me make sure that the House is clear that from 1983 to 1989 there was a continuous increase in dissatisfaction with the health service which reached major, unprecedented proportions. All that we have seen is that in the past 12 months or so there has been a slight decline in the degree of dissatisfaction.
Moreover, we are indebted even more recently than we are indebted to Mr. Lilley to Eric Caines, professor of health service management at Nottingham university, for 476 a further revealing insight into today's national health service. Professor Caines said in an article in The Times on 17 November this year:public service never had a very solid foundation, and is now commonly regarded as something either to be avoided or exploited.Professor Caines is not any old professor of health service management, but a former senior civil servant in the Department of Health, a deputy secretary no less, and the former director of personnel for the NHS.—[Interruption.] I will say that again, especially as the Minister of State seems to find it amusing. The man who tells us that public service has never had a solid foundation was, until last year, the director of personnel for the NHS. What, for heaven's sake, was he doing in that job? He was the man responsible for the employment of doctors, nurses and ancillary staff.
What does he say in praise of the new system over which the Secretary of State presides? He says:Competition is the new form of motivation—based on the recognition that when all else fails, anxiety is the most effective motivator.That is his vision of the health service in the hands of the right hon. Lady and her colleagues. He describes a climate of fear—fear in the absence of a public service ethos. That climate of fear ties in all too well with existing and expected developments in the NHS.
§ Mr. Peter Thurnham (Bolton, North-East)
Everything that I have heard the right hon. Lady say so far supports the case for the reforms and shows how well they are working. While she is quoting professors, should she not also quote Professor Julian Le Grand, founder of the Socialist Health Group, who has said:Few in the NHS would want to go back to the old pre-reform system"?
§ Mrs. Beckett
The hon. Gentleman cannot conceivably have been listening if he thinks that that is what I have just said. I have been quoting supporters of the Government and of the reforms, to show that they believe that they are there to build a health service in which competition is king; a health service that is run as a business; a health service in which members of staff are to be set at each other's throats and put in fear of their jobs. That is not the health service that the hon. Gentleman promised the British people at the last—or any other—general election.
Professor Caines is describing a climate of fear, as I said, and it ties in all too well with what is happening in the NHS. There are, for instance, what I understand to be the Secretary of State's long-standing instructions that, nationally and locally, it is the job of press officers to keep bad news about the health service out of the media. Their task is to keep the Secretary of State in the limelight but out of the firing line. Suppression of information and/or promoting misinformation along the lines advocated by John Maples is already much too widespread a feature of the health service under the right hon. Lady.
Quite apart from the misuse of civil service press officers to serve political interests instead of the public interest, there are also the notorious gagging clauses which are now widely imposed in the new health service contracts that staff at all levels are being required to sign.
Just in case anyone is in any doubt as to where performance-related pay might lead us, Mr. Lilley gives us a helpful steer. Staff are expected to promote the trusts' 477 interests, not patient care, and it is presumably on that basis that the quality of their contribution, and presumably their pay, will chiefly be judged.
I am well aware that in recent days the Government have been claiming that there has never been any suggestion that pay should be related to the performance in service of individuals; rather it should be related to the overall performance of a trust. That still raises questions about the dangers of giving trusts a greater incentive to concentrate on more straightforward or more lucrative areas of treatment at the expense of those that are difficult or costly. Of more significance in this context, however, is the fact that it appears to be untrue that individual performance-related pay is not what the Government first proposed or intended.
As I recall, in November last year the Government referred to performance-related elements for doctors. On 19 October the Minister of State spoke of local pay being based on organisation-wide performance, but the fact is that trusts will still have complete freedom to organise whatever pay structures they want, and individual PRP is still on many of their agendas.
In any case, as I have said, organisation-wide PRP does not appear to be what the Government initially proposed. In 1993 they said:each scheme should have clear objectives linked directly to the organisation's business needs"—yet another sign of how the Government see the health service. The Government maintained thatsystematic assessment should be the backbone of performance pay schemes",and went on to refer to thepositioning of staff on PRP scales".That has to mean individual performance-related pay: the statement can be read in no other way. I recognise, of course, that it suits the Government now to pretend that they had something less direct in mind, but their own statements do not bear that out.
§ Lady Olga Maitland (Sutton and Cheam)
I thank the right hon. Lady for giving way, but I have to say that her script, which clearly is produced for her by her spin doctors, is serving only to alarm and to frighten patients. Is she aware that my constituents, who are patients of the St. Helier trust hospital, are delighted with the service that they are getting? They are grateful for the result of the health service reforms, which are giving them faster and speedier treatment.
Perhaps the right hon. Lady might care to comment on one factor. Does she regret the fact that, when she was a member of the Labour Government, she supported a programme that cut doctors' pay, cut nurses' pay and cut health spending?
§ Mrs. Beckett
I think that the hon. Lady does not need lessons from anybody on how to perform to a script. I am delighted, of course, if the patients in her part of Britain are receiving exactly the treatment that they want and deserve from their local trust. It is just a pity that that is not the case everywhere else. I will say quite bluntly to the hon. Lady that it is not Opposition Members who are raising fears that are unjustified. It is not we who are ignoring the reality of the health service. Why, I ask the hon. Lady, does the Secretary of State come lowest—even 478 among the Cabinet—in the public ratings for sincerity? Why, I ask the hon. Lady, does she think that the Conservatives are 50 percentage points behind in the opinion polls if it is not we who are describing the reality of the national health service? She is living in an unreal world.
The Minister tried to pretend that the Government did not originally intend to create a system of individual performance-related pay. I am afraid that that is not the only recent example of a Minister being parsimonious with the actualité. In the previous debate on the health service, the Minister for Health was good enough to quote a headline in a recent edition of the Derby Evening Telegraph, my local paper, which talked about the people whom we can trust. Because it referred to the people who manned the boards of the health trusts in our locality, he said that that showed that what we were saying—about how difficult it was to get information on why the matters were not in the public domain—was ill founded and untrue.
I have, especially for the Minister, a fresh copy of the Derby Evening Telegraph from the following day. As he will see, its headline is, "No Minister!" In a most interesting observation, the editor said:Mr. Malone has shot himself in the foot. It took us … weeks to prise those names out of the authorities.No-one would tell us who was going to be in charge of running our hospital, how much they would be paid or how they came to be given the posts.And when we did manage to find out who the chairman would be, and that he was to be paid £20,000 a year for a few hours work a week, the powers-that-be went into an immediate sulk and refused"—
§ Dame Jill Knight (Birmingham, Edgbaston)
On a point of order, Madam Speaker. After some years as a Member of the House, I thought that it was not usually the done thing to read verbatim at length from a newspaper report during the course of a debate, but merely to quote.
§ Madam Speaker
I thought that the right hon. Lady for Derby, South (Mrs. Beckett) was quoting from a newspaper. It did not seem to me to be unduly long. Perhaps I was distracted from what was happening. Has the right hon. Lady finished her quote?
§ Mrs. Beckett
Only a very few more words, Madam Speaker.
As the hon. Member for Birmingham, Edgbaston (Dame J. Knight) will realise, I am most anxious to be accurate, because I do not wish to be unfair to the Minister.
The editor went on to say that the spokespeoplerefused to tell us anything about the rest of the unelected board members.He continued:When you consider that the old district health authority was required by law to hold public meetings every two months, while the new trusts are obliged to have one public meeting a year, it makes a mockery of the minister's assertion that there is no secrecy.I am grateful to the Minister for allowing me to make clear the view of public commentators in our locality. I do him the justice of assuming that—at least on that occasion—he simply did not know any better. Somebody gave him a handy headline and he did not bother to make inquiries about the facts behind it. It is part of our charge 479 against the Government, as it is our charge against the Gracious Speech, that, on so many occasions, they are simply and completely out of touch with real life in Britain today.
In fact, the Secretary of State is not only out of touch with the people; she is out of touch with her party—whose activists attacked her at its conference on just that basis—and with the experts, the City of London, the chattering classes and even some of her ministerial colleagues. The City of London clashed with her over Bart's. Hardly a journalist in the land will write copy in defence of her new health service.
Indeed, things have become so bad that the Secretary of State is not even in touch with the Daily Mail any longer. Let me quote—briefly, of course—what Lynda Lee-Potter wrote in that paper:Maybe Margaret Thatcher will finally concede that she made the greatest error of judgment of her political life when she instigated the so-called health reforms without any consultation with the medical profession.The Secretary of State is out of touch even with her own colleagues. Only two weeks ago, the Secretary of State for Wales—who does not seem to be with us now—complained to a conference on health managers that there was too much jargon, and that it was about time that they got out from behind their desks. He said:When I visit a hospital I would like to be greeted with news of medical triumphs … not with more views on hospital reorganisation.I never thought to see the day when I would agree with the Secretary of State for Wales, but it has clearly dawned.
It already seems clear that, whatever the merits of the legislative proposals for reorganisation contained in the Queen's Speech, they will need careful examination so that their potential drawbacks can be explored. We are prepared in principle, for example, to give a fair wind to proposals to allow the General Medical Council to address the question of the service and care provided by general practitioners; and we have no great quarrel with the strategy to bring together the work of family and district health authorities.
We view with a degree of mild cynicism the trumpeting of claims that abolishing regional health authorities will be a triumph for the reduction of bureaucracy, coming as they do from a Government who have presided over an unprecedented explosion of bureaucracy and costs in recent years, most of which will be left completely untouched by their proposals. We shall, however, want to explore the practical effects of those proposals.
As the Secretary of State must know, there is concern about the consequences for medical education and training. We shall be seeking assurances that some of the specialised patient services that are provided at regional level will not be disbanded if they cannot be provided at district level: there is real anxiety about services such as cancer registries, NHS screening programmes, surveillance and control of communicable diseases, health promotion and environmental health.
There is also anxiety about the implications for the wider community of the alternative means of consultation and representation that will be created. Medical, nursing and other staff wonder if and when their voice and experience will find an outlet.
All who noticed the Secretary of State's first stab at a replacement for existing sources of advice about such matters as appointments—the idea that a respected local 480 figure should be the main and perhaps even the sole source—will have been strongly reminded of the Home Secretary's attempt to draft Lord Lieutenants into service to nominate the chairs of police authorities, one of the more ludicrous examples of the Government's striving to escape from the consequences of the richly deserved electoral hammering that they took at local level when the lies that they had told to win the general election had been exposed.
In the light of that great deceit, and of the lesser, almost daily examples of the Government's economy with the truth, we shall look in the legislation not only for clear, categorical assurances but for practical measures to ensure that there is no loss of hard information enabling the public to test their own experience and the wealth of anecdotal information available against published evidence.
Let us take waiting lists, for example. In common with most health service staff and the general public, we regard them today as fiddled figures; but at least some figures used to be centrally collected and readily available. In Wales, I understand, that has not been the case to anything like the same degree, the reason being the different structure of the service there. NHS administrators in Wales are civil servants, responsible to, and with a duty of official secrecy to, the Welsh Office. Consequently, what information is supplied is supplied when it suits the Secretary of State rather than when it is first available and might be most useful to those judging the worth of Ministers' statements.
Under the legislation proposed, English regional staff, too, will be civil servants, owing a duty of official secrecy to that fine exemplar of open government, the Secretary of State, whose press office was charged with keeping news away from the public even before she had the benefit of Mr. Maples' wise advice.
We shall want to look very carefully at the legislation, as will my Welsh and Scottish colleagues. In view of the existing organisational differences, they have asked me to seek guidance from the Secretary of State about whether there will be, as we assume, separate legislation for them.
We shall also want to give much thought and scrutiny to the Government's proposals for supervision orders for the small number of patients whose violent behaviour makes them a danger to the public. That is a proposal about which, as the Secretary of State will know, those in the field are expressing considerable anxiety.
Our concern will be not just for the specific proposals in the legislation, but for the background against which they will be implemented. For example, the Opposition are very conscious that the Ritchie report, which was issued following the tragic death of Jonathan Zito, contained 21 pages of recommendations, of which supervision orders was only one. His widow, Jayne, is on record as describing such orders as "a cosmetic response to a critical situation"—inadequate without more far-reaching change.
Recently, both the Audit Commission and the Mental Health Foundation published serious and weighty studies which suggest greater difficulties with implementing care in the community than the Government seem ready to acknowledge.
I give the Secretary of State fair warning: while we will look constructively at whatever proposals the Government make, we shall expect and demand evidence that, outside 481 the legislation itself, the Government are taking action to address the issues. We will not be party to any process which seems destined primarily to create scapegoats to take the rap for the Secretary of State.
The fear that that may be the outcome of the legislation is fuelled by the record and approach of the Tory party in the past 15 years. One of the Government's first acts on obtaining office was to bury the Black report, which highlighted the consequences of poverty and deprivation. Ever since, they have sought to ignore and deny not only the steady increase in poverty and deprivation to which their economic failure has led, but its inexorable consequences for mental and physical health: the knock-on effects and the costs, especially to the health service itself.
A few days ago the Government signalled that nothing has changed when, having commissioned from York university research to assist in finding a better measure of health need to guide the distribution of health money, they decided to avoid taking too much notice of it until after the next election because, inconveniently, it suggested that less money may be needed in the kinds of leafy suburbs represented by the Secretary of State.
We want to see the greatest measure of public money going to where there is the greatest need. We want to see it used sensibly for investment and not wasted as it was on Health Care International, the Wessex health authority and in the west midlands. We want the available resources to be used in the front line for patient care. I again quote Lynda Lee-Potter:When we're sick, frightened and in pain … We want to believe that the most important thing in any hospital is not its bank account, but its commitment.The Government and the Secretary of State believe that patients, like the unemployed and pensioners, have to learn to stand on their own. For 15 years, the Government have been telling people to stand alone when, increasingly, it means that people live in insecurity and fear. For example, the Government have encouraged people to take out costly health insurance which is needed only because the Government have put in jeopardy the quality and security of the national health service.
We in the Labour party believe that everyone's self-interest is inextricably intertwined with the common interest, and that the national health service is the greatest expression of that common interest and of the spirit of community that this country has ever known—community not just as an aspiration, but as a living and breathing daily experience.
That is why the NHS is not just valued by the British people; it is loved. That is why, contrary to the notions of Professor Caines, Labour will rebuild a public health service and run it in the common interest.
§ The Secretary of State for Health (Mrs. Virginia Bottomley)
The Gracious Speech has shown that important social reform will be at the heart of the agenda for the new parliamentary Session. I welcome the measures that it contains to improve the working of the economy, because it is wealth that makes welfare possible. I shall address in a moment some of the prejudiced, short-sighted and blinkered comments that we 482 heard from the right hon. Member for Derby, South (Mrs. Beckett). I want to start with some of the most important issues.
The Labour party is disqualified from ever again being trusted with our national health service. Perhaps the most serious reason for that is that its current policies and its history in office show that they would destroy our economy. Listening to the radio yesterday, we heard the serialisation of the diaries of the right hon. Member for Chesterfield (Mr. Benn). We were all reminded again of the time when volunteers had to man the hospital kitchens, when the economy suffered under the right hon. Gentleman and his colleagues, and when the NHS suffered bitterly. Unlike the right hon. Member for Derby, South, I was at that time working with the national health service, and I remember that only too clearly.
§ Mrs. Bottomley
At that time, the right hon. Lady was one of the culprits. She sat on the Government Benches during that time. She was a Member of the grim reaper Government who cut doctors' pay, cut nurses' pay and cut real terms spending for the only time in NHS history. I am grateful to my hon. Friend the Member for Sutton and Cheam (Lady Olga Maitland) for pointing that out once again to the House. Before the right hon. Lady lectures us, let us look at the disgraceful record of the Government of which she was a Member.
The background to the Gracious Speech this year is very different. We have an economic climate that is as favourable for long-term growth as it has been for decades.
§ Mrs. Bottomley
Inflation is firmly under control, unemployment is falling and exports are surging. We have been able to make Britain, in the words of the President of the European Commission, a paradise for inward investment. We have been able to do that not least because we have rejected the social chapter, which the Labour party would foist upon us. The Government's programme for this Session will help us to build on those prospects. That is good news for the country and good news for the national health service. The longer the faces on the Opposition Benches grow, the louder patients should cheer.
Thanks to our health reforms, we are better placed than ever to maintain a comprehensive service, available to all, at a cost that our economy can afford. I notice that the right hon. Member for Derby, South is happy to recite a vision of what might be achieved in the health service, but that she is totally devoid of any mechanisms by which the Labour party would deliver that objective. As a result of the reforms, we now have the potential to achieve more and more.
Last week, I was invited to address the conference of the Organisation for Economic Co-operation and Development on health care reform. The OECD experts have looked at the United Kingdom health reforms, and they like what they see. Their report highlighted a series of positive results stemming from the reforms.
§ Mrs. Roche
Does the Secretary of State agree with the vice-chairman of the Tory party, who advised his party 483 that the only way in which it could deal with the Government's record on the health service was to have a total news blackout?
§ Mrs. Bottomley
I would certainly like a blackout of the endless denigrating comments from the Labour party.
It is bizarre. I am keeping a check on how long it is before the right hon. Member for Derby, South gives a single word of credit to the people who work in the health service in Derby. We had no mention last time of the £48 million programme in Derby and we had no mention this time. I am just waiting until all those thousands of people who work in and serve the national health service in her constituency get any recognition. What matters is that we continue to deliver the results.
§ Mrs. Beckett
I am sorry that the Secretary ofState is so at fault. She has clearly forgotten that, during our previous debate only a few days ago, I opened my speech by praising the staff of the national health service.
§ Mrs. Bottomley
The right hon. Lady made no recognition of the achievement of that team and of how the service has seized the opportunity of the reforms to reduce waiting times and to improve the quality and the quantity of patient care.
It is an example of the way in which the Labour party behaves that it does not hesitate to denigrate, for example, the work of Roy Lilley, but I wonder how many Labour Members have visited the Homewood Trust, which is a Rolls-Royce service for patients. That is the Rolls-Royce that I mind about.
The trust cares for some of the most severely—[Interruption.] It is interesting that the Labour party derides and jeers a trust providing care for some of the most severely mentally ill patients. When the right hon. Member for Derby, South was busy as a trade union official, my life's work involved trying to improve services for those patients. If I thought then that there would be the quality of service—[Interruption.]
The hon. Member for Wakefield (Mr. Hinchliffe) is right. He has long been a champion of the cause. I invite him to visit the Homeward Trust and to see for himself the quality of care and the commitment of staff to that group of patients. He, as much as I, has long wanted to ensure that they are given the recognition and respect that they deserve. Before jumping to vituperation and personal attack, the Labour Members should visit and see with their own eyes some of the quality care that is being provided.
Rather than dwelling further on the gossip and on the pasting together of press cuttings of the Labour party, I should like to return to the comments of international experts, such as those at the Organisation for Economic Co-operation and Development, which I was invited to address last week. Its report highlighted a series of positive results stemming from the reforms. They include the improved performance of hospitals, especially trusts, the success of GP fundholders and the doubling in the number of day cases, greatly contributing to increased efficiency.
Health care systems around the world face similar challenges. Changes are driven by medical advance, rising expectation and demographic pressures. Our response is widely regarded as well judged. Other countries that have long respected the national health service are looking to 484 us as pioneers of health service reform. The World Health Organisation, for example, described our "Health of the Nation" strategy as a model for other countries to follow.
It is still this Government who are coming up with the ideas. It is still the Labour party that has none of the answers. It does not even know the questions that it should be asking. The right hon. Member for Derby, South tells us that, for the third time of asking, the Labour party is consulting on what its policy should be. It is difficult for Conservative Members to hear that with a straight face. I have faced three Opposition health spokesman. All of them were looking for a policy and searching for the questions and the answers, without delivering anything which could have given any assurance to the people of this country.
Five years ago, the Gracious Speech unveiled the historic Bill to reform the NHS. Responding for the Opposition, the hon. Member for Livingston (Mr. Cook) offered his usual rash of predictions—or should I say, his rash predictions? He said that the Bill would spell the end of the Conservative Government, and that not a Tory Member of Parliament would be left between here and Aberdeen if we dared implement the Bill. My hon. Friend the Member for Aberdeen, South (Mr. Robertson), who so ably seconded the Gracious Speech and who won his seat from Labour in 1992, might beg to differ.
The Conservative Government are still here, returned for the fourth time, with more votes than any other party in history. Our reforms are still here, and they are here to stay. Even the local hospital in the constituency of the hon. Member for Livingston went off to become a trust, and the hon. Member went off to another job.
§ Mrs. Jane Kennedy (Liverpool, Broadgreen)
I am grateful to the Secretary of State for giving way, as I know that many other hon. Members wish to intervene.
She is talking about reform of the national health service, but will she consider for a moment the change for change's sake that has been forced on the National Blood Authority, whose staff are highly skilled and provide an excellent service to the people who rely on it? Will she recognise that the donors who contribute to the service are deeply worried about the proposal to close five centres? When will we be told about the outcome of the consultation process?
§ Mrs. Bottomley
If ever we needed proof of the jeopardy in which people would be placed if the Labour party were to form the Government again, that intervention is it. The hon. Lady speaks, understandably, on behalf of the unions involved in the delivery of that service. Our health service, like that of every country, needs to change. Change is necessary, and we are rationalising the 14 processing centres to release resources for mobile units. I look to the courage of the people who are prepared to say that change is necessary because patients will benefit.
I pay the warmest possible tribute to the millions of people who regularly give blood to the national health service. The gift relationship established in our blood transfusion service, which is one of the best in the world, is remarkable, valuable and precious, but that does not mean that we should not rationalise the centres where the 485 processing is undertaken if we can streamline the service, thus releasing more resources for mobile units and for parts of the health service where there is pressing demand.
§ Dame Elaine Kellett-Bowman (Lancaster)
Is my right hon. Friend aware that the chairman of the National Blood Authority came to Lancaster last Monday and spent the whole day there from 8 am? He spoke to all the staff and the anti-D donors and made it clear that there was no way on earth that he would imperil the donation of blood from the anti-D donors or others. His object was to make it easier to give blood, not more difficult. He also said that blood was a valuable commodity, and that, as it was given freely, it was up to us to look after it as best we can. I am sure that he will do that.
§ Mrs. Bottomley
I thank my hon. Friend for putting the case fully and fairly.
I was talking about history and the hon. Member for Livingston. His great hot tip was that the general election would be a referendum on the NHS. A number of hon. Members have raised the question of public opinion and perceptions. The hon. Gentleman later kept pretty quiet about the fact that he had said that the general election would be a referendum on the NHS. It was a good thing for the health service that he lost.
Dismantling the reforms, as the hon. Gentleman promised then and as the right hon. Member for Derby, South is promising again today, would mean chaos, upheaval and disillusion in the service. Incredibly, the right hon. Lady seems to have learnt nothing, as she is still pledging to reverse the reforms. She said that she would abolish trusts, that fundholders would go and that she would bring back the old command and control bureaucracy that encased the health service in cement.
She would be foolish to try it, and she must know it. In fact, I do not think that she believes for a moment that it would happen. It is a posture, an empty gesture that impresses no one—except, of course, her old friends the unions which sponsor the Labour party's health Front-Bench spokesmen.
I was wondering whether the right hon. Lady would have learnt from her predecessor's awkward predicament. He spent two years dithering about how to respond to the reforms and their growing success in dealing with patients. Like the right hon. Member for Sedgefield (Mr. Blair), he would not say yes and he would not say no. Finally, however, he got off the fence and decided that he was against them. Two weeks later, he was sacked. He is not making the same mistake twice. As the House will know, he made a spectacular and humiliating U-turn in Labour education policy. My advice to the right hon. Lady is to follow his example, to hoist the white flag now on health and decide to support the reforms, before she too gets shunted off.
§ Mr. Dafydd Wigley (Caernarfon)
I am sorry to intervene in this private Punch and Judy show, but the Secretary of State mentioned the comprehensive health service available to all. Is she aware that, not only in my constituency but in many other areas, it is no longer possible for someone to get dental service on the NHS if he or she is seeking it for the first time? More and more dental practitioners are telling even the patients on their lists that, unless they pay a monthly subscription, the 486 service will no longer be available. When will the right hon. Lady make the NHS dental service available again to everyone in need?
§ Mrs. Bottomley
I beg to differ. Our weekly figures make it clear that dental services are available. But if the hon. Gentleman wants me to investigate the situation in his constituency, I shall be more than happy to do so. Although the number of dentists and the amount of dental care have increased, more children are registered and there is an unprecedented level of dental cover, we accept, as the House will know, that it is time to re-examine the system under which dentists are employed and remunerated, and the structure of the service. That is why we commissioned the Bloomfield report, to which we are now considering the responses. We want a service that is fairer to patients, to dentists and to the taxpayer.
My task is certainly to set out the achievements of the health service, but where issues need reconsidering with the profession, with patients and with the public, we should openly say so, and take forward that process of debate.
I notice that the right hon. Member for Derby, South has been singularly quiet on the subject of health care since her appointment. That is no surprise, because she was silent on the subject before that, too. The debates ahead on the Health Authorities Bill will afford her an opportunity to make her position and that of her party clear, and to admit before it is too late that the Labour party is wrong about the health reforms, as it has admitted that it was wrong about almost everything else.
We welcome the opportunity that the Queen's Speech provides to take three Bills through Parliament this Session, because we wish to speak at great length about the achievements and the further developments in the health service. My hon. Friends look forward to being in Committee, where they will miss no opportunity further to explain and to set out the achievements of the health service, and the way in which our reforms have made it possible to do even better for patients.
The Bill will complete the unfinished business of the reforms. It will abolish regional health authorities, and build on the decentralised system of decision making now largely in place. In place of the existing arrangements, it will create single health authorities, better able to champion patients' needs. It will ensure that we have a streamlined system of management, able to balance local flexibility with greater strategic direction on core issues. Regional health authorities have served us well, but now that, rightly, decisions are taken closer to patients, they are no longer needed. A redundant layer of management can be removed, and the Bill will secure that.
The right hon. Lady identified several areas, and I agree that it will be important to make it clear how medical education, training, research, communicable diseases and the other factors that she mentioned will be dealt with. Only yesterday, I saw the Committee of Vice-Chancellors and Principals to discuss some of the issues involved concerning education and research.
In sweeping away the regions, we shall be able to save substantial sums on administration, and we shall invest that money in even more and better patient care. I challenge the Opposition to support the Bill, and I hope they will. If they resisted it, that would confirm what we have long suspected, so I welcome the right hon. Lady's comments. However, we believe that the Opposition are 487 still the disciples of old-style central planning, the friends of the command and control bureaucracy that we have consigned to history, and the true champions of bureaucracy and bureaucrats.
§ Mr. D. N. Campbell-Savours (Workington)
I understand from the health authority in West Cumbria that it is £1.5 million short. An argument has broken out among the general public about how that shortfall should be funded. Many of the people who come to me say that they are prepared to pay higher taxes to ensure that they have a proper health service in West Cumbria. What does the right hon. Lady say to them?
§ Mrs. Bottomley
I say to the hon. Member for Workington (Mr. Campbell-Savours) that his constituents should appreciate the fact that they have a Government who are able to invest progressive extra resources in the national health service—£1.6 billion this year—and a Government who can afford to make a commitment of real-terms increases in resources. As I set out at the beginning of my speech, the Labour party, which the hon. Gentleman supports, was lamentably unable to deliver. Whatever its promises, it cannot deliver and it ultimately betrays the public, the patients and NHS staff.
§ Mr. Thurnham
A moment ago, my right hon. Friend talked about blood donors. I do not know whether, like me, she has been over to the Treasury to one of its blood-letting sessions. Is not that as good a place as any to reflect on how much greater value for money she is achieving in the national health service? Is not the latest national health service report as good an example as any of all the points where we are getting much better value for money and much greater efficiency in the national health service, under my right hon. Friend's direction?
§ Mrs. Bottomley
The point made by my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) is certainly right. I find the association between blood-letting and the Treasury too close for comfort. When I give blood, I go elsewhere because I do not feel totally relaxed in that environment.
I noticed that in responding to the Gracious Speech, the Leader of the Opposition, as the right hon. Member for Derby, South (Mrs. Beckett) did today, made a number of mean-spirited and frankly disgraceful attacks on NHS managers. Labour claims to be in favour of efficient management, yet it always attacks the very people in the system who have brought it about. The right hon. Member for Sedgefield (Mr. Blair) then quoted the usual inflated figures about increases in the number of managers. He failed to mention the 18,000 extra qualified nurses, the 8,000 extra hospital doctors and dentists and the 3,000 extra general practitioners. The right hon. Member for Derby, South may look at the figures for nurses. I commend her to look at the project 2000 nurses and at the dramatic increase in practice nurses. She will then want to look again at her figures.
What the Leader of the Opposition did not, of course, mention was that NHS management accounts for less than 3 per cent. of staff while front-line doctors and nurses account for almost two thirds. I know of no health service in the world that can better those figures and all the members of the team deserve congratulations for their work for the health service. The Labour party seeks to set doctor against manager, nurse against executive and 488 clinician against clerk. A well-run health service needs them all and if the Labour party knew anything about running a modern health service, it would admit that.
Frankly, I resent the Labour party's insinuating comments that the information provided by the Department of Health and by the NHS is made up of factoids, and is dubious and somehow not to be trusted. Last week, the national health service, the biggest organisation in the country and one of the most significant health services anywhere in the world, published the NHS annual report. It documents the achievements of our staff and it is a tribute to them and their work.
I remind the House of some of the highlights. The number of patients treated rose to more than 8 million for the first time ever. That is thanks to the work of NHS staff. It is a rate of increase in one year twice the annual average increase in the 1980s and, as my hon. Friends will want to know, five times the miserable figure achieved under Labour. The annual report showed that there were significant reductions in junior hospital doctors' hours and that there was improved training for nurses. There were more and better immunisation servaces for children, breast and cervical cancer screening programmes, community nursing, services for mentally ill people and much, much more. Those are the achievements of health service staff and they do not wish their achievements constantly to be belittled by the Labour party.
§ Lady Olga Maitland
I am grateful for my right hon. Friend's catalogue. Does not she also agree that the Labour party would choke rather than admit that this Conservative Government have launched one £l million national health service project every eight days?
§ Mrs. Bottomley
Once again, my hon. Friend is right. Is it not interesting that all the Labour party can do is jeer and sneer? Most people think that a million-pound project every eight days is something from which the patients would benefit and about which patients would be glad to hear.
On waiting times, which have traditionally been the great problem of our national health service, I am pleased to inform the House of further excellent figures published today. There has been a small, welcome reduction in the overall list size, but, more significantly for patients, because this is what really matters to them, we have made even further dramatic progress on cutting waiting times.
In the past year alone, there has been a fall of nearly 10,000 in the number of patients waiting more than a year for treatment. That is a dramatic achievement—10,000 fewer patients waiting more than a year now compared with a year ago. The figure now stands at 62,000—still too many, but less than one third of what it was before the reforms. Half of all patients do not wait at all, but for those who do, our policies have virtually halved the average waiting time. By extending and improving the patients charter guarantees, we will drive that figure down further still and provide an even greater dividend for patients.
§ Mrs. Bottomley
We are building a national health service fit for the 21st century. Increasingly, we want to focus on the quality of care. We need to home in on, and wherever possible improve, clinical outcomes. As 489 technology advances and medicine evolves, we must ensure that patients reap the full benefits of a state of the art health service.
I am pleased to be able to announce today that the Government will set aside an extra £40 million next year especially to support research and teaching in the NHS, which will bring to £530 million the earmarked funds dedicated for this purpose. The decision underlines the Government's commitment to research and teaching in the national health service. It will support the health service in training tomorrow's doctors, and allow work to be accelerated in the NHS research and development programme on innovative and evidence-based health care.
The NHS R and D strategy has made impressive and often unsung progress. Its continued evolution is essential for the NHS to take full advantage of the advances in science and technology. Research is crucial for identifying those methods in health care which will lead to better ways in which to promote health, prevent illness and treat patients more quickly and effectively. I look forward to the opportunity of working with the profession to enhance further the NHS's national and international reputation for teaching and research—again, an area about which we hear very little from the Labour party.
§ Mr. Kevin Barron (Rother Valley)
If we are to have the confidence that the right hon. Lady wants us to have in her and the health service, will the right hon. Lady tell the House what she thinks about a report on the front page of The Guardian, which states that a letter leaked from the Ian Greer Associates office names the principal Member of Parliament involved in lobbying Ministers and individuals of the House against the tightening of the voluntary code for tobacco advertising as her own Parliamentary Private Secretary?
Mrs. Bottomley: Certainly my Parliamentary Private Secretary has no recollection of such a matter at all. Much more to the point is the fact that any holder of my office who is not used to energetic lobbying by people from all persuasions and interests would be unable to do the job. If anybody wanted to take lessons in lobbying, for all the respect, indeed, affection that I have for them, there would few better advisors on the arts of lobbying than the British Medical Association and the Royal College of Nursing themselves.
Talking of the BMA and its colleagues, the recent meeting of the medical profession on core values in medicine was, I believe, a landmark. It showed that the Government and the profession share a commitment to the same objective—to a modern, dynamic health service based on knowledge, informed by research and focused on outcomes for patients, to a health service of the future and for the future.
In the same way, I am pleased to be working with the medical profession in taking forward our proposed Medical Act (Amendment) Bill. The public rightly have confidence in the vast majority of our doctors, but there is regrettably also a very small number of doctors whose performance is deficient. The General Medical Council, the doctors' regulatory body, wants to improve the procedures which they have for dealing with that minority. There may be some, for example, who need further training before they can be allowed to continue to 490 practice. This Bill will provide those necessary powers, and the Government are glad to be able to support the GMC in that matter.
My hon. Friend the Under-Secretary of State and Opposition Members have long made that point, and I am pleased that we are able to take it forward at this stage. I also welcome the support of the right hon. Member for Derby, South and of the hon. and learned Member for Montgomery (Mr. Carlile) on behalf of his party. I hope that that support will translate into practical action which will facilitate the passage of the Bill through the House.
I want to speak now about the important Mental Health Bill also announced in the Gracious Speech. The principle of caring for mentally ill people, where proper and possible in the community, is long-standing and supported on both sides of the House. The national health service now spends more than £2 billion on services for mentally ill people. More and more of that money is being spent in the community. There are now better services for the vast majority of mentally ill people than ever before—four times as many psychiatric nurses, four times as much residential provision, twice the number of day centre places. However, the right hon. Lady and many of my hon. Friends know of areas in which we have not yet delivered the comprehensive standard of care that we want for all patients, and we are determined to take that work forward.
We have, for example, a £45 million capital programme to increase the number of medium-secure psychiatric beds. It has long been a concern of mine, as members of the Select Committee and others will be aware, that, while care in the community generally works well for the majority, a small group of the most vulnerable patients do not always get the support they need. There have been a number of well-publicised cases which have brought the issue into sharp perspective. The national health service needs to do more to make services for that group a greater priority. It is beginning to happen.
For years, in the cities in particular, the large acute hospitals commanded most of the money available. Our Bill introduces stronger powers for looking after the most severely mentally ill people in the community. The new power of supervised discharge will build on our programme of action to strengthen care in the community. We have already introduced tougher and clearer guidance on the discharge of patients from hospitals. Four out of five health authorities now have in place supervision registers.
Supervised discharge will apply to those patients who have been detained in hospital and who, on discharge, need special support in the community. A patient subject to supervised discharge will be required to abide by the terms of the care plan drawn up by the clinical team when he or she leaves hospital. Failure to comply would lead to an immediate review and the possibility of compulsory readmission to hospital under the Mental Health Act.
That, too, is a measure which I hope should command support on both sides of the House. It will significantly tighten care in the community. It will provide added 491 protection for the public and for patients themselves, and it will reinforce confidence in the policy of care in the community itself.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I am sure that the House will welcome what the Secretary of State has said about mental health. I know that she has a personal commitment—[Interruption.]
§ Mr. Deputy Speaker (Mr. Michael Morris)
Order. I appreciate that the hon. Gentleman is asking a question, but I would be most grateful if other hon. Ladies and hon. Gentlemen would keep their peace so that we may hear that question.
§ Mr. Kirkwood
We all welcome what the Secretary of State has told the House. We all accept the need for filling some of the gaps to which she has referred. Does she not accept, too, that, in community care more generally, some of the transitional arrangements are producing some difficulties, which I do not believe are caused by lack of good management in local authorities? If those local authorities which are suffering some shortfalls in transitional arrangements demonstrate to her that it is not bad management which is causing that shortfall, would she consider addressing some of the financial gaps which are emerging?
§ Mrs. Bottomley
When I became Secretary of State, a number of hospitals and health authorities came to see me in the ninth month of the year and said that they were greatly surprised to discover that the year had 12 months, not nine, that it came as a great shock and that they were running out of money. I said then, and I say now, to local authorities that, when people take on a position of responsibility, it is their job to act as good stewards for the extra resources that they have available. It is essential that they realise that they must plan that resource through the year.
Some of my hon. Friends may want to know the sums of money going to some of the local authorities which have been making the most noise. The Isle of Wight, for example, has received a 2 per cent. increase this year in its personal social services—almost £2 million more.
§ Mrs. Bottomley
Liberals, as the hon. Gentlemen says.
Gloucestershire, for example, has a 10 per cent. Increase—an extra £5 million. Devon has a 13 per cent. increase in personal social services moneys—an extra £14.6 million. Local authorities have an extra £1.2 billion for community care. It is a policy which local authorities fought hard to secure, as it were, from the Government. They were determined that they would act as good stewards. They worked closely with us in the implementation of the policy.
They must now demonstrate that the trust that was placed in them was well founded. It is irresponsible to indulge in scaremongering tactics in respect of some of the most frail and vulnerable in the land when this year there are resource increases to which no other Department in local government is looking, even remotely.
§ Mr. Alan Howarth (Stratford-on-Avon)
On the issue of good stewardship, and on another aspect of care in the community, did my right hon. Friend note the report 492 yesterday, published jointly by the Policy Studies Institute and the British Council of Organisations of Disabled People, which showed that, in terms of cost-effectiveness—indeed, by a factor of about one third—and of quality of life and dignity in independent living, there is a clear advantage in allowing disabled people to manage their own budgets for domestic and personal care rather than having services provided for them?
My right hon. Friend has expressed her relish for reform, and she made some encouraging remarks recently to the conference of the Association of Directors of Social Services. Will she confirm that it is the Government's intention to amend the National Assistance Act 1948 during the Session to allow individuals to make their own arrangements?
§ Mrs. Bottomley
My hon. Friend has been a long-standing champion of that cause, as the House knows well. I began being somewhat sceptical and cautious, feeling that local authorities might not be able to be trusted to take on the responsibility. I have been assured that, on the contrary, they are able stewards. I must confess my concern about the signs that we have been seeing this year that the authorities might be playing at the sort of games that we have seen in other areas. They will need to demonstrate that they can be trusted to manage a budget through the year without holding to ransom the most frail and vulnerable.
I am not able to say more on the issue that my lion. Friend the Member for Stratford-on-Avon (Mr. Howarth) has raised, but I shall continue to reflect on his persuasive comments before I am able to make final announcements.
Before completing my speech, I wish to comment on the police investigations at Bassetlaw hospital and at other hospitals. It is clear that they involve serious matters. The police have our full support in the inquiries that they are pursuing. The House will understand that I am constrained in what I can say in advance of the investigations coming to a conclusion. I have made it clear, however, that I expect the NHS to co-operate fully, and I am sure that it is.
All seven hospitals involved have given a helpline number for any past patients, or their relatives, who are worried. Inevitably our minds all go back to the appalling crimes committed by Beverley Allitt. As I recently stated in a written answer, all recommendations contained in. Sir Cecil Clothier's important report have been or are being acted upon. If there are further lessons to be learnt from the Bassetlaw case, I give the House an assurance that action will be taken as soon as they become apparent.
§ Mr. Joseph Ashton (Bassetlaw)
If I can catch your eye later, Mr. Deputy Speaker, I shall say a few words about the investigations that are taking place. There is, however, something that I would rather say in private to the Secretary of State. Would it be in order for me to have a private meeting with the right hon. Lady later this week, when we could discuss the matter?
§ Mrs. Bottomley
I am more than happy to arrange such a meeting. I well understand the hon. Gentleman's profound concern about the issue.
The Gracious Speech carries forward the Government's programme of enlightened social reform. In the NHS, our programme has led to a service that is more responsive to the needs of patients. It is more flexible and it is 493 responding better to the challenges that it faces. By being more efficient, it is a far better servant of both patients and the taxpayer.
Through four successive Parliaments, the Government have supported the NHS, as we have supported the welfare state. There has been extra funding, extra staff and better results. Over 3,000 more patients are treated every day, there are shorter waits and there are great improvements in the quality and range of care.
In the 1980s, despite significant extra spending, public satisfaction with the health service fell. That trend has now been reversed. Even the right hon. Member for Derby, South acknowledged that the British social attitudes survey, published last week, shows that, since 1990, satisfaction with how the health service is being run has risen. Dissatisfaction has fallen. Those patients who use the NHS, as hon. Members know only too well, as opposed to those who wish to write it down, are overwhelmingly satisfied with the service that they receive. As the benefits of the health reforms become ever more clear, that trend will be sustained and increased.
The speech of the right hon. Member for Derby, South was a sign of a bankrupt Opposition. Wherever the Opposition look—the economy, health, education and social security—they know that the Government have acted courageously and responsibly to safeguard the best interests of the country and its people. They know also that only by appearing to adopt our policies or adapt our principles would they ever have even the faintest hope of success with the voters.
There is one unanswerable question that faces the Opposition: if they were wrong for so long, as they now admit, why on earth should anybody trust them now? They have nothing to offer the health service, and they have nothing to offer the country. After the next general election, once again, they will have nothing to show for ditching their principles. It is not enough to swear allegiance to the NHS and then to bury one's head in the sand.
A great public service such as the NHS must evolve. It must adapt to meeting changing needs, changing expectations and changing capabilities. Governments must face and not fudge the difficult decisions that have to be made. Our policies address the challenges that lie ahead. The new health service is better able than ever before to maintain and enhance the comprehensive, high-quality service that the public deserve and patients expect. The measures in the Gracious Speech will help us to make a great service even greater.
§ Mr. Ashton (Bassetlaw)
I hope that the House will forgive me if I concentrate on an aspect of the national health service that has become of great importance—security in our hospitals, especially the Bassetlaw hospital and the seven other hospitals that have been mentioned. At the end of January, it was reported that there had been 16 incidents in the new Bassetlaw hospital—it was built only a few years ago. It appeared that someone had tampered with the high-tech equipment in the intensive care unit. After a check was made of the work rotas, a nurse who had been on duty on all the relevant occasions was suspended.
494 In the ensuing nine months, the police interviewed 500 members of staff and patients. They have now widened the inquiry, and 1,870 interviews have taken place, spreading over eight other hospitals, involving a further 57 incidents. No one has yet been charged and no one has been interviewed as a suspect. That is despite 20 detectives spending well over nine months on investigations. The investigations have spread to Nottingham city hospital; Sheffield Northern general; the Gloucestershire royal; Bristol Southmead; St. George's, Tooting; the Radcliffe infirmary, Oxford; and the Middlesex Central hospital.
Bassetlaw hospital is run by a trust. I suppose that it is no different from, or any worse or better than, any other modern hospital. In the intensive care unit there has been a 12 per cent. death rate, which is the national average in such units; there is no sign that deaths at the intensive care unit at Bassetlaw have been any different from anywhere else. Two patients died during the period when the hospital authorities say that tampering took place. Following investigations, the 16 incidents that were reported have grown to 30.
It is alleged that tampering has taken place mainly with the settings on life-saving ventilators and intravenous pumps—in other words, the settings have been altered. Sometimes relatives were left alone with patients. It is obviously extremely worrying if they think that they might be accused of tampering with equipment. Admission to the unit was by digital code security, the details of which were not generally known. I understand that that is the practice in all the other hospitals.
On Monday, I met the hospital trust chairman, Mrs. Valerie Dickenson, and the chief executive, Mr. Munro Donald, following allegations and revelations in The Independent on Sunday by Mr. Jonathan Foster, who has a long history of specialising in health service issues and, in particular, Beverley Allitt issues. He revealed that further widespread investigations were taking place.
When I met the hospital trust chairman, I was told that the nurse who had been suspended had been recruited in the normal way from the Northern general hospital in Sheffield, which is 12 or 13 miles away. She had answered an advertisement. Her boy friend had come to work in Bassetlaw and she wanted to move to Worksop. She was obviously cross-examined. Her qualifications were bound to be in order and there was no reason to think that there was anything untoward about the appointment.
The nurse in question applied for promotion and passed her examinations. There had been no problems before and I understand that there is nothing to show that anything was untoward at the seven other hospitals or places at which she worked. I am not accusing her or anyone else at the hospital of being involved in the incidents. However, 30 incidents took place at the Bassetlaw hospital and 57 incidents took place at another eight hospitals. That is very worrying for my constituents, for patients and for the town in general.
I have not revealed the names of any of the constituents who have complained. However, Mr. Steven Shaw of Workshop, whose mother Muriel died after many months in intensive care, spoke to The Daily Mirror. If the House will forgive me, I want to quote what he said in that paper:Detectives have interviewed everyone connected with my mum. They wanted to know if any of us had seen anything suspicious going on around her—if we had seen anyone tampering with 495 equipment. The inquiry has been going on so long now that we all want to know when the agony will end. It has been very upsetting waiting all these months without knowing what was going on. In many ways, it would be easier to bear if we were given the worst news. But the police say it could be next year before they can tell us anything definite. With all these other incidents, there are obviously going to be a lot more devastated families like us.The situation is extraordinary. After all these months, and after 1,800 interviews and hundreds of statements, no one has been charged. The police have told me that no one has been questioned along the lines that that person was a suspect.
A cloud has been hanging over the hospital for nine months and the inquiry does not seem to be getting any further. There have also been a series of worrying incidents in the Trent region. Again, I do not allocate blame or say that those incidents are connected. However, we must remember the Beverley Allitt affair. She is now in Rampton in my constituency. Indeed, she was treated at the Bassetlaw hospital after mutilating herself during the trial.
Beverley Allitt was accused of killing four children and of attacking nine others over a period of 58 days. She was given 13 life sentences and is now in Rampton. The usual checks were carried out on her stability before she was employed at Grantham hospital.
Earlier this year, the new-born baby Abbie Humphries was kidnapped from a Nottingham hospital. That baby was missing for 15 days before she was found. Those are worrying aspects of security in our hospitals. The Secretary of State referred to the report of Sir Cecil Clothier, who led the inquiry into the Beverley Allitt affair. Sir Cecil Clothier, a former ombudsman, said:It takes only two minutes alone with a helpless patient to kill or injure.He made 11 recommendations. The Secretary of State says that she has sent them to the health authorities and to the trusts and asked—I do not know whether she ordered—that they be implemented. I am not trying to be political, but the trusts virtually run themselves as they choose. They may be satisfied that such things could not happen in those trusts, but they might happen.
This is all rather like the problem with our football stadiums. People thought that the Hillsborough disaster could not happen and people could not be killed in that way, but ultimately it did. Action then had to be taken to improve football stadiums. A similar thing happened to the ferry when its doors were open and in respect of the King's Cross fire.
The security aspect of our hospitals is unbelievable. What has been done about Sir Cecil Clothier's recommendations on the screening of staff, camera surveillance inside hospitals, controlled admission for visitors and curfews on visiting times? Some of our hospitals are like King's Cross station: anyone can walk in or out of them whenever he or she likes. That is very worrying.
Staff in any inner-city accident and emergency department will be aware of the drunks who roll in at 10 pm on a Saturday night. Some of them just come in to get warm and have a cup of tea. However, nurses and doctors sometimes have to endure horrendous situations. Those drunks do not walk into nightclubs, because there are bouncers on the doors to keep them out. There are no bouncers at a hospital on a Saturday night.
496 This sort of thing is happening regularly. We have security in our town halls and in the Houses of Parliament. People cannot simply walk into the BBC or into a police station. I was in a London hospital in August. It seemed to me that half the neighbourhood took a short cut through that hospital. I do not want to mention the hospital by name, because the medical treatment was absolutely superb. The doctors and nurses worked wonders under impossible conditions. However, there were four lines of beds, 18 of which were occupied out of 24. There was a mixture of men and women in the ward. There was one bathroom, three toilets and horrendous traffic noise. Any weirdo could take a short cut through the hospital from one street to the next instead of walking around. There were no controls. People had to be wheeled into the street on trolleys to get to the operating theatres.
All hospitals are different. Some were built when Strangeways prison was built and, in many ways, their architecture is no better than that of the prison. However, others are very good. Many have no locks on internal doors and there is no one on the main door to stop people coming in. Visitors at the hospital to which I have referred rolled in at 11 pm looking as though they had come straight from the pub. The trusts are doing exactly what they like.
The problem with Bassetlaw is not the first case of trouble in health service hospitals. In 1990, two surgeons were knifed to death in Pindarfields general hospital in Wakefield. The man who did it is also in Rampton in my constituency. In 1991, a man was stabbed at Rake Lane general hospital in North Shields while he was in intensive care. In 1992, a patient was shot dead while talking on the phone at the Royal Free hospital. In 1994, three babies were abducted from hospitals in Bath, London and Nottingham.
Some trusts have said that they will electronically tag babies. Why only some and not all? When that question is asked, the first answer is, "But we will want more money." The Secretary of State said that more money is being made available and it is up to the trusts to manage their own resources. However, with regard to this problem, we no longer have a national health service. We have local health services which are spending their money and operating their hospitals as they think fit.
When a Beverley Allitt comes along or a baby is abducted, there is tremendous uproar in the media and there is tremendous news interest. Twenty detectives have been working on the case at Bassetlaw hospital for nine months. I do not know what that is doing to the crime figures in the rest of the county, but it cannot be doing them any good.
Morale in Bassetlaw hospital is very low, patients and patients' relatives are afraid, and the situation is getting worse after nine months. There seems to be no end to the inquiry. The police say that medical inquiries take a very long time. People have to be cross-examined and their memories become confused as time passes. The police must also consult experts. The problem is very difficult.
There must be a public inquiry into what has happened in Bassetlaw and what is happening to security in general. We have specific rules about dangerous drugs in hospitals. However, there do not seem to be any rules about dangerous people. They can come and go as they like. To stop allegations being made, we have rules whereby a male GP is not supposed to examine a female patient without another woman being present. However, in the 497 case of the problem at Bassetlaw, allegations ran throughout a hospital. False allegations were made about people at the beginning of the inquiry which have not helped the police and have not improved the situation. I hope that, sooner or later, there will be an arrest or that eventually there will be a public inquiry. Such incidents are happening far too often in far too many hospitals to far too many people.
Patients have the right to believe that, when they go into hospital, they will be not only treated but protected. Highly technical equipment can be fiddled with as soon as a nurse turns her back. Nurses cannot watch everything all the time. Anyone can wander in and say, "We'll have a bit of fun and alter this machine." Suspicion then falls on other patients, on relatives and on nurses. None of this is doing the health of the nation any good.
I shall have more to say to the Secretary of State when we meet later. I hope that she will now set up not just the sort of inquiry held under Sir Cecil Clothier into the Beverley Allitt case, but a general inquiry into hospital security and whether we need national rules and regulations on visiting and the conduct of patients.
§ Mr. James Hill (Southampton, Test)
It is a pleasure to speak in this debate, because health is of such importance to all of us. My wife had a major accident on the motorway on Thursday. The car was completely wrecked and she had to be freed from it. An ambulance came from the Royal South Hants hospital within 10 minutes. After being kept in hospital for three hours, she was released, so it was a happy ending. I hope that that shows the Opposition that the national health service has tremendous back-up facilities, for which we will all be grateful at some time in our lives.
The hospitals in Southampton all have trust status and they are doing very nicely. There are no major grumbles. Figures that I obtained today show that in Hampshire the total money for social services and community care has risen from —148 million in 1993–94 to £173 million in 1994–95—an increase of 16.9 per cent. That is a very good increase, but the Opposition never mention such things. I am disappointed with Labour Members. Sometimes, they can be outspoken in the Chamber and give credit where credit is due, but not as often as in Committee where they back many of the initiatives taken by my right hon. Friend the Secretary of State.
What is the point politically of deriding the national health service? That does nothing other than depress those working in the service, and the patients waiting to go into hospital get a bad impression. I have been in the House a long time, but I have had few letters from patients in Southampton hospitals criticising them.
The security of babies has been mentioned. There was a problem with the maternity unit of the Princess of Wales hospital when babies were given to the wrong parents. It was a rather nasty little episode, but I think that the problem has been solved completely by using armlets for identification.
Surely the emphasis of today's debate should be one of congratulation to my right hon. Friend. I have read nothing that proves that it is not sensible for us to increase the number of patients treated—to 8 million for the first 498 time ever, according to the NHS annual report. That is 8 million in a population of 55 million— [Interruption.] Already, the barrackers are jumping in and denigrating the system. The hon. Member for Glasgow, Garscadden (Mr. Dewar) is a shadow Minister dealing with the NHS nationally, yet he sits there denigrating it. That must stop. We have the best health service in the world and no one should forget that, whether he lives in Scotland, Wales, Northern Ireland or England.
The facts must be stated once in a while. We must look on the good side and not carp, especially on the late-night television shows where politicians get around the table and tear things to pieces. The numbers on the waiting list have fallen quickly—by more than 3,000 in one year. That is admirable. Had the Opposition been able to achieve that, they would be wearing funny hats and carrying balloons; because we have achieved it, they treat it with disdain. General practitioners, consultants and those at the sharp end of the NHS do not like being constantly denigrated. They do not like the fact that they work an incredible number of hours, sometimes in cramped accommodation, while some politicians do nothing but sit here criticising them.
Any grumble that I might have is not about the health service, but about the social and welfare service. I am especially anxious that the Child Support Agency should be investigated intensely. I have some cases from my constituency advice service of unfortunate individuals who have become tied up in the system. One case involves a police officer who has served for 23 years—[Interruption.] Do Labour Members want to denigrate that chap's suffering as well? [Interruption.] Mr. Deputy Speaker, will you protect me from these denigrators? That is all they are; they are not here for the debate.
As I said, the case involves someone with 23 years' police service. He was married for 17 years and has three children. He left home with the clothes he stood up in and the family's second car. He gave his ex-wife the house, the contents and the main car, and she had custody of the children. He continued to pay the mortgage for a further year. He paid for the divorce and ran up an overdraft. He paid for clothes and holidays for the children, in addition to paying maintenance. He remarried and has a second family. He was just starting to get back on his feet financially when in December 1993 the CSA stepped in and then in June 1994 assessed that he should pay three times the amount of maintenance that he was paying.
As a police officer, if that man goes into debt, he will be in danger of losing his job and pension. The chief constable has told him that he is not eligible for financial help, as it is a domestic matter. His second wife—this may be greeted with a certain amount of glib humour by Labour Members—has now walked out on him. That is the result of a less than flexible approach by the CSA.
The second case involves a lady with two teenage children who was divorced in 1987. She was awarded £16 a week for the son and £12 for the daughter. In January 1993, the court awarded an increase to £20 a week for each child. Now we get to the nitty-gritty. In May 1993, she received forms from the CSA. She explained that she had just had a maintenance increase, but was told that if she did not fill out the forms family credit would be stopped.
499 In July 1994, the CSA awarded my constituent £17.62 a week, to be split between both children. The lady said:One final point, if the CSA had not reduced my weekly maintenance so drastically I would not have needed family credit next year, now I shall need the support for the next three years until my daughter completes her 'A' level exams.As a compassionate, deep-thinking Parliament, we must admit that the matter requires further investigation.
We know that we cannot have a perfect society. We cannot give everything to everyone who wants it. Nevertheless, once in a while one has to come to an abrupt halt and say that the matter has to be dealt with. It must be investigated in the light of one of the political aspects that we invariably fail to consider: the public relations side of a severe policy. We must make sure that the public know exactly what Parliament is trying to do.
The difficulty in the House is that we have opposing political views. I sympathise with my right hon. Friend the Secretary of State because the Opposition are not always co-operative. They do not always work with her. They look ahead to two or three years hence when they think that they will get the wheel and drive us right over the cliff. We need more co-operation, certainly on social services and welfare matters, and on hospital trusts. So many trusts are doing well and they will do even better if they see that we are one team here in the House. I wish my right hon. Friend the Secretary of State every success in the future.
§ Mr. Alex Carlile (Montgomery)
I am sure that everyone in the House will join me in giving our best wishes to the wife of the hon. Member for Southampton, Test (Mr. Hill) in her recovery from her unfortunate accident. The hon. Gentleman gave a good illustration of the quality of the people who work for the national health service, particularly those who have to deal with accidents and emergencies.
I start on a positive note by welcoming the commitment in the Gracious Speech to a Bill to introduce new procedures to enable the General Medical Council to deal with those doctors whose professional performance is found to be deficient. I must declare my interest. It has been referred to already. I have been a lay member of the GMC for five years. With me on that council has been the hon. Member for Chislehurst (Mr. Sims), and we have been joined recently by the hon. Member for Gower (Mr. Wardell) from the Labour party.
The hon. Member for Chislehurst and I have come to admire the GMC, although neither of us joined with admiration particularly in mind. The GMC is sometimes criticised, although usually, I fear, from a position of ignorance. The GMC can do only what statute permits it to do. That is something which the newspapers and, as a result, the public rarely understand. It is fortunate, therefore, that the GMC appears to be a beneficiary of the Post Office debacle. It has earned a small but important slot in this year's legislative programme.
The council has pressed for change for two to three years. At present it can deal only with what is called serious professional misconduct—a term the meaning of which has been restricted over time by judicial interpretations in the Judicial Committee of the Privy Council. It can also deal with doctors who are so sick that the health committee of the GMC is enabled to interfere with their registration.
500 Under the presidency of Sir Robert Kilpatrick, the GMC has sought to modernise the way in which it is run, not only by increasing the lay membership of the council and examining its procedures but by introducing what has been called, as a working definition, "performance review". This is not, as was suggested in one Health Department press release, a lesser offence than serious professional misconduct. It is much broader than that.
The GMC wishes, and is now to be allowed, to deal with doctors whose performance falls below acceptable standards. The aim of the council is universal good doctoring. With that extra shot in our locker, the council of which I am proud to be a member will be able to deal with bad doctoring. There is more to it than merely widening the remit of the GMC. The causes of bad doctoring are complex. It can be based on overwork, cultural misunderstandings, poor mutual support systems in the profession or sometimes poor support systems from family health services authorities. I suggest to the Secretary of State that some more research is needed into the reasons why doctors run into difficulties.
Another interest that I should declare is the unpaid position of parliamentary adviser to the Overseas Doctors Association of Great Britain. One of the matters that troubles me greatly is the disproportionately high number of overseas qualified doctors who find themselves facing the professional conduct committee of the GMC. It is perhaps time for the Secretary of State to consider funding some research into why that occurs. I know that it worries the Overseas Doctors Association of Great Britain as much as anyone else.
The Secretary of State mentioned medical schools in her speech. They, too, are a direct responsibility of the GMC. It has responsibility for the accreditation and quality control of medical education. There is some anxiety about the future of the medical schools and medical education under the new management structures. I hope that the management structures that replace the regional health authorities and those at other levels of the health service will properly reflect the important role of the universities. It is vital that they are involved in appropriate ways at various levels of the restructured NHS management to achieve joint planning in the disposition of staff and the provision of patient services. We have excellent medical schools in Britain. They must not be disadvantaged by management changes.
The Secretary of State made a passing reference to whether patients were cheering. In that context, I should like to make some remarks about fundholding general practices. I do not think that patients care very much—I do not think that they 'cheer or otherwise—about whether their general practitioners are fundholders, save when they find that they are disadvantaged by fund holding. I ask the Government to respect the views of GPs who conscientiously do not wish to become fundholders.
It is recognised that in certain circumstances fundholding practices may gain advantages, but there is a perception, which is justified occasionally by evidence, that those advantages may be unfair. There is also some evidence that in a few fundholding practices—I do not wish to blacken them all with a sweeping statement— 501 those whom one might describe as expensive patients are not welcome. It is logical that to try to drive all GPs into fundholding is a kamikaze policy for the Government.
§ Mr. Carlile
If I may just finish the sentence. If all GPs become fundholders, the advantages which are available to the few fundholders will no longer be available to any of them. They will all face the chaos which, in some areas, they all faced before.
§ Mr. Malone
It is not the benefits being available to fundholders that matter: it is the fact that benefits should be available for patients. There is no question either of departing from the voluntary principle of fundholding. Of course the Government would like as many GPs as possible to take advantage of the system, but I assure the hon. and learned Gentleman that there will be no compulsion.
§ Mr. Carlile
That assurance is welcome as far as it goes, but I urge the Minister to look at the success of some non-fundholding commissioning groups. He should look at what is happening in Nottingham, where 200 doctors have become involved in a non-fundholding commissioning group which has had at least as much success as fundholders—and probably more—in securing better services for their patients. I accept that the discipline may have arisen from the introduction of fundholding—I do not deny it for a moment—but I would ask the Minister to take an objective look at the idea, and possibly to accept that in some places it is not wise to urge fundholding when a better alternative may be available.
Another aspect of general practice that patients are not cheering is on-call services performed by locums. Much better quality control is needed to ensure that locum doctors working at night, especially for GPs, are fit to do the job they do—and have the equipment to do it. There is evidence—I heard it repeatedly in my five years on the professional conduct committee of the GMC—to suggest that some locum services are extremely slipshod in their management and in the way doctors are engaged to carry out the work.
I urge the Secretary of State and the Minister to the view that we are approaching the time when we must recognise that extra skills are required for a doctor doing locum work. He does not have the advantage of knowing the patient, or of knowing the aetiology of the patient's illness; he does not have the advantage of the patient's records. He needs a better history and quicker and more perceptive skills. He needs special training, in short, to be a locum doctor.
I suggest that the best night-call services are carried out not by the commercially-run services, but by GP co-operatives. I ask the Government to look closely at ways in which co-operatives can be encouraged to take more of these services—
§ Mr. Malone
I am always glad to point out to the hon. and learned Gentleman the fact that he is supporting a 502 Government policy. He will be well aware that measures are in hand to try to encourage co-operative practices for night cover. I hope that he will join us in persuading the medical profession of their acceptability. We need to make progress quickly, and his support would be extremely valuable.
§ Mr. Carlile
I seem to be on a lucky streak, so I will give that support wholeheartedly.
I should like next to discuss hospital locums. I was a member of the GMC's professional conduct committee when Dr. Gaud, the doctor who operated on patients knowing that he had hepatitis B, was erased from the medical register. It would not be right to comment on that hearing, but I would like to comment on the issue. In that case, a surgeon was able to obtain employment in hospital after hospital because his references were not pursued. It is common practice, when locum consultants and assistant consultants are taken on, for their references to be taken as read. It should not be so. I invite the Government to take urgent steps to ensure that there is a foolproof and fraud-proof system to guarantee that references are always pursued.
Furthermore, there is evidence that some senior consultants are sometimes all too ready to give a favourable reference without possessing the material to justify one—perhaps even occasionally to get rid of a colleague whom they no longer want around. Those are hard words to say, but I believe them to be true. I ask the Health Department to treat this as an issue requiring serious attention. We cannot afford another Dr. Gaud.
I turn next briefly to pay for medical and paramedical staff at all levels. The right hon. Member for Derby, South (Mrs. Beckett) commented on performance-related pay, its definition and its nature, and on whether it is to be individually performance-related or local pay. At the moment that is causing a real worry for all staff. They have no confidence—and I feel none—that a fair system of performance-related or local pay can be devised.
In my constituency, the Powys NHS health care trust has declared its intention to switch to local pay. That has engendered the worst possible morale among staff. It is not right to impose on the NHS a system of pay led by business needs instead of deciding priorities according to patients' needs. There is a danger that rural areas will start to lose medical and nursing staff because of the threat of local pay. It undermines the whole principle of the doctors and dentists review body, which considers pay objectively and nationally.
While on the subject of dentists, I should add that the Secretary of State was plain wrong. She should go and find out what is happening around the country. NHS dentistry for adults is not available in vast areas of rural Wales. In the county of Gwynedd, the situation has become so bad in the past week that no NHS dentist is now available for new adult patients. In my constituency, for distances of 30 miles or more, it can be impossible to find an NHS dentist. The situation has become critical; even if someone finds an NHS dentist—save for a genuine emergency—he has to wait months for treatment.
In other areas of the country, things are different. I understand that in parts of London it is easy to obtain a consultation with a good NHS dentist, but it is not sufficient to use London or urban statistics to distort what is happening in other parts of the country.
503 I shall end with a few comments on community care. It will never be the jewel in the crown of this or any other Government unless it is properly resourced. Local authorities' standard spending assessments bring huge variations in the money available to the authorities, and in many areas that is leading to increased rationing of care. The elderly, the disabled and their carers can be the losers. Local authorities have worked hard to make a reality of community care, and the idea that some local authorities are trying to wreck the system is a calumny which cannot be demonstrated to be true anywhere.
The increased help given to local authorities was warmly welcomed by members of the public, but it has led to increased demand. The Government unfortunately failed to estimate correctly the element of unmet need. They consistently state how much money has been directed to social services departments, omitting to say where it has come from. By making that omission they perpetuate the myth that it is new money. It is not. It is a reallocation of social security payments to people who previously could have opted for residential care with no assessment of their needs. The Government had no accurate figure for the extra costs required before introducing the policy. The suspicion is that they know no better now. By transferring a fixed sum to local government, however, the Government are successfully capping the spending that is going into community care.
The Government further added to the problems of local authorities by restricting the use of the money transferred from the DSS, so that 85 per cent. of it must be spent on the private sector. The argument for that, apparently, was that it was private sector finance. It was not. It was public money paid in from public taxes. Indeed, that whole area has been so mismanaged by the Government for so many years that £2.5 billion of public money was poured into the private sector without any regard to proper assessment of the individuals, or any attempt at strategic planning.
The Government must recognise two things about community care. First, they must recognise that there are acute funding problems, which have been mentioned already and which largely arose because the Government changed the rules; and secondly, that community care, certainly in rural areas, often means anything but care in one's own community. For many people, it means being shunted off into a community far away from one's life and times, from one's friends and relatives. That is not acceptable.
There are a multitude of other issues that one could raise in this part of the debate on the Gracious Speech, and we shall certainly have a lively debate during the Session on issues relating to health and social services. I hope that the Clydesdale hospital will not remain as the memorial of the Session—an incident led by dogma rather than by considerations of quality and value. Knowing the price of everything and the value of nothing is no basis for improving the nation's health. I hope that, by the end of the Session, we will, by some co-operation—I hope that there will be a large measure of that—have succeeded in improving the nation's health and the way in which the nation is cared for. But I believe that a change of attitude by the Government is needed if that is to be achieved.
§ Mr. David Atkinson (Bournemouth, East)
I begin by expressing my appreciation and that of my constituents to my right hon. Friend the Secretary of State for Health for 504 taking time out during her very busy Conservative party conference week in Bournemouth last month to visit the Royal Bournemouth general hospital in my constituency. I know that she was suitably impressed by its undoubted success and performance in treating my patients and those of my hon. Friend the Member for Bournemouth, West (Mr. Butterfill), but I wonder whether she was informed that it was originally scheduled to be built in 1977, but, like so many hospitals, was a casualty of the Labour Government cuts at that time. There was also a reduction in nurses' pay, to which my right hon. Friend referred. It took the restoration of Conservative Government prosperity for that hospital to be built, for the benefit of our constituents.
I shall make four points, two of which relate to the theme of today's debate. I want to reflect the concerns expressed to me at a public meeting on law and order which I held in my constituency last Saturday afternoon. Apart from when party conferences are in town, there are simply not enough police patrolling our streets during the day—some 20 or 30, I am told—and their resources are fully stretched during the night. Those are the police's words, not mine. They do not want to see more clubs opening in Bournemouth, because they could not cope. That situation threatens to hold Bournemouth back as a successful resort.
Of course, I welcome the new freedom that is now given to chief constables to increase manpower without Home Office approval, but there can be no more police without more money. So I hope that my right hon. and learned Friend the Chancellor of the Exchequer will announce a substantial increase in resources for police manpower in his Budget statement next week and that some of that will come Dorset's way.
I particularly welcome the proposed legislation in the Gracious Speech to make it easier to return those who are mentally ill to hospital, for which I have called for some time in my capacity as the honorary parliamentary consultant to the National Schizophrenia Fellowship, with the hon. Member for Birmingham, Selly Oak (Dr. Jones). I commend my right hon. Friend the Secretary of State for Health on the initiatives that she has already taken in mental health during the past three years—more than the previous 300 years put together. I hope that she will consult widely on what she is proposing.
I strongly urge that the new legislation be subject to the same Special Standing Committee procedure that the Mental Health (Amendment) Act 1983 underwent. It is a process that is sadly underused, inviting as it does interested parties to come before a Standing Committee, just as they are invited to come before a Select Committee. I may be one of the few Members left to have served on the Special Standing Committee that considered that Bill. I hope very much to be able to do so again.
I welcome the reforms that I expect will be announced by my right hon. Friend the Secretary of State for Social Security, to soften the impact of the Child Support Agency on absent fathers who have handed their houses over to their ex-wives in clean break settlements. I also hope that the travel-to-work costs of absent fathers and those incurred by children visiting the father, or by the father visiting the children, will be taken into account when assessing his payments. That is only fair and just. I look forward to learning from my right hon. Friend just how he will reconcile those changes while maintaining the whole point of the CSA, which is to ensure that parents accept the 505 financial responsibility for their children, and not the taxpayer, many of whom might be much worse off than the parents.
I shall conclude on a foreign affairs issue, which I could not refer to in the debate last Thursday, because I was in Azerbaijan.
The House will be aware of the six-year conflict over Nagorno-Karabakh. The Armenian people have been seeking independence from Azerbaijan, which has resulted in some 40,000 dead, more than 100,000 wounded and maimed and well over 1 million people displaced. I have now seen—
§ Mr. Deputy Speaker
Order. I am not sure whether the hon. Gentleman will refer to the health service or the pension policy in Azerbaijan and relate it to the Gracious Speech, but I hope that if he is minded to do so he will link it in.
§ Mr. Atkinson
I will, of course, be referring to the humanitarian support, including the health services that the refugees desperately need at the present time. I understood, however, that in the debate on the Gracious Speech, one is allowed to stray a little from the theme of the day—
§ Mr. Deputy Speaker
Order. The hon. Gentleman must know that we have an amendment before us. Had he spoken yesterday, he would have been entirely in order, but today he would not be in order to stray wide.
§ Mr. Atkinson
Thank you, Mr. Deputy Speaker. I will, of course, refer to health issues in what I propose to say.
I have seen the refugee camps in Armenia and Azerbaijan, and it is clear that, without further substantial and immediate help, many of those refugees will die during the coming winter, particularly those living in very insubstantial tents. They need the benefit of medical aid and other supporting health services through the United Nations, to whom I pay tribute for the considerable amount—
§ Mr. Robert Hughes (Aberdeen, North)
On a point of order, Mr. Deputy Speaker. I have always understood that, following the Gracious Speech, we would debate what was in it. The fact that an amendment has been tabled surely cannot restrict Members in what they wish to debate.
§ Mr. Deputy Speaker
The hon. Gentleman is a senior Member. He will recognise that the question is on the amendment before us, which the Labour party, of which he is a member, tabled. That is the question before the House. Therefore, today's debate, until 10 o'clock, is about the national health service and pensions policy, as related to the amendment tabled.
§ Mr. Deputy Speaker
The hon. Gentleman may shake his head, but those have been the rules of the House for the 20 years that I have been here.
§ Mr. Deputy Speaker
Order. I appeal to the hon. Gentleman to return to the specific issue that the House is debating.
§ Mr. Atkinson
It is clear that I have strayed beyond the parameters that you have allowed, Mr. Deputy 506 Speaker. Let me end my speech, however, by referring to the Queen's Speech as it relates to the situation that I mentioned. I welcome the statement that the Government will seek to enhance the role of the Conference on Security and Co-operation in Europe in conflict prevention and the resolution at the Budapest summit in December, and look forward to its contribution to a successful outcome of the dispute over Karabakh.
§ Mr. Gerry Sutcliffe (Bradford, South)
I shall confine my speech to health issues.
The very purpose of Government is to have duties and responsibilities, and the election of a Government carries the burden of trust from the electorate. I believe that the present Government have lost that trust as a result of their actions on the national health service. One would expect the ideological vision of any party that has been in power for 15 years to be near completion, but the Tory philosophy that everything should be left to the market or the business ethic has proved to be fundamentally flawed. It is not what the people want and at the next general election—in two years' time, or even next Monday—we shall see what they do want; the Government will then pay the price.
Meanwhile, for the past 15 years, the price has been paid by those who are not equipped to defend themselves. No area of government demonstrates that more clearly than the NHS. On behalf of my constituents, I take this opportunity to thank all its workers for their skill and dedication, and for always putting patients first: that has always been, always will be and always should be the culture of health care, and to suggest otherwise is to insult the integrity of all who work in that field. I hope that Mr. Lilley of the Homewood health trust will resign; if he does not do so voluntarily, the Secretary of State should ask him to. After what he has said, he has no place in the national health service.
With a population of more than 475,000, due to rise to half a million by the year 2000, Bradford is the only metropolitan district in England whose population is growing. It is growing mainly among the very young and the elderly, especially those above the age of 85. Both groups depend heavily on the NHS. A recent report by Bradford Health Strategy drew attention to the relationship between health and wealth, stating:The health of Bradford's citizens vanes in direct proportion to their wealth.Given that one third of Bradford's population survive on some form of benefit, it is vital for health provision to meet the community's needs.
In 1991, Bradford's hospital trust was launched as a flagship; but it has been a complete disaster. It is already on its second chief executive, and in June was heading for a —6 million deficit. Morale is at its lowest as staff see more resources being poured into bureaucracy: there are more accountants than ever before, spending money on letterheads and administration. Remedies considered to reduce the deficit included the closure of a day ward at St Luke's hospital.
My constituents are still on long waiting lists, but under the Bradford system patients must decide whether they still require operations. Having waited 12 months, they receive a card asking whether they want to go on waiting; 507 if they do not return the card, they are removed from the list. That is quite convenient when it comes to waiting list figures.
A consultant in my area recently wrote to me complaining that he could not respond to one of my constituents because he was overworked and there was a shortage of neurosurgeons in the United Kingdom. In fact, he said that there were more neurosurgeons in downtown Tokyo than in the whole of the United Kingdom. The spin doctors of the Tory party tell us that there are no problems in the NHS and accuse Opposition Members of talking it down; but that is not true. Conservative Members do no good by saying how wonderful the service is while destroying it and gagging NHS workers who complain about what is going on.
The Tory record speaks for itself: we have seen increased prescription charges—
§ Mr. Stephen Day (Cheadle)
Does the hon. Gentleman admit that expenditure on the NHS in real terms is now 60 per cent. higher than it was in 1979? Does he also admit that a record number of patients are now being treated and that nowhere is the number being treated greater than in areas where trust hospitals and fundholding practices work together? Is that not an argument for extending reform, rather than sticking to a system that was designed to meet the needs of the 1940s and cannot possibly meet those of the 1990s?
§ Mr. Sutcliffe
Surely, if the system is to be changed, those changing it should listen to what the health care professionals have to say. That has not been the Government's record. I can only go on the record of the trust in Bradford, which was formed in 1991 as part of the Government's "flagship": the resources being provided there do not meet the needs of Bradford people.
§ Mr. Malone
Is the hon. Gentleman prepared to concede that the great advantages secured by that trust include the removal of dialysis services from Leeds to Bradford, and far better physiotherapy in the hospital, where it can be provided in a community context? I know, because I have visited the trust and seen those improvements. Why does the hon. Gentleman persistently describe the picture as black when it clearly is not?
§ Mr. Sutcliffe
That is not true. If the Minister has indeed visited the hospital, I hope that he commented on the £6 million deficit. I do not know at which time of the year he visited, but if he wishes to return to find out what methods of reducing the deficit are being used, I will gladly accompany him and try to find the answers myself. When asked what it is doing, the trust plays its cards close to its chest; that is due to lack of accountability.
Moreover, not all the developments referred to by the Minister match local needs for certain types of health provision—for instance, provision for the elderly. As the Minister knows, I used to lead Bradford council; I was happy to discuss and negotiate Bradford's health care strategy with many local agencies, but when we tried to talk to the trust we found that it adopted a very distant attitude to the people of Bradford.
Let me return to the Tory record of increased prescription charges and charges for eye tests. Today we have heard about the privatisation of dental care; we have also heard about the two-tier family practitioner service and the discrimination against patients according to 508 whether their GPs are fundholders. In the place of the old service, we see more costly, more bureaucratic and less accountable health trusts.
The following question could be asked: if people do not use the service, does all that matter? I wonder how many Conservative Members use the NHS. What is so tragic is that the position could have been very different. I have been told that the recently privatised utilities and other privatised companies, have secured millions, if not billions, of pounds in shareholder dividends and profits; if only a proportion of that had been used for the:NHS and similar services, people could have received service at the point of need.
The Queen's Speech gives the health service nothing new; in fact, it provides less of the same. It does not provide the accountability that we require, or give doctors, nurses and health care workers what they want. It is necessary only to talk to those employees to see how low health service morale now is. They want the resources to use their dedication to provide services for people in need; what we need is a speedy change of Government. I hope that that will happen on Monday, but I doubt it: not many Tory Members have the backbone to do what they say they are going to do.
§ 6 pm
§ Mr. Hartley Booth (Finchley)
I support the Government in their opposition to the amendment that has been moved this afternoon. Like many hon. Members, I have sat patiently listening with great interest to the debate. We heard a great deal about "factoids" and "killer facts" from the hon. Member for Derby, South (Mrs. Beckett), who led for the Opposition. I hope that the good Lord will save us from the hon. Lady if she ever comes back to the House with killer policies for the NHS. She singularly lacked any policy proposals today.
At the start of my speech, I have to declare a vested interest: many years ago I was employed by the NHS as a porter—my first paid employment. I do not know whether that has to go on the Register of Members' Interests, but I thought that I should bare my chest at the outset.
I support what my right hon. Friend the Secretary of State for Health said earlier. When one goes to any group of people to ask them about the NHS, 95 per cent. say, "When I used it, it was marvellous. The doctors and nurses were splendid." The users of the NHS think that it is good news. As for my local experience, I have to thank the Government for promising to rebuild Barnet hospital.
But I make no apology for moving the debate sideways within the terms of the amendment moved by the hon. Member for Derby, South. I believe that if the former Member of the House who, at various times, represented Devon, Cornwall, Dorset and a pocket borough called Mitchel, and who is otherwise known as Sir Walter Raleigh, brought back his noxious weed from America today, he would not be welcomed. I wish to talk about that subject in the health context.
On 8 October this year, the British Medical Journal published a 40-year study on health and death. It was the longest and most in-depth study of its sort ever undertaken. It contained the prediction that about half of all regular cigarette users will eventually die as a result of their habit. It forecasts that by 2025 no fewer than 10 million people will die from smoking each year. By that 509 time, more than 200 million will have died from the habit. Currently, 3 million people die from smoking each year and in Britain the figure is 110,000. Even with the so-called 17 per cent. yearly reduction in smoking in developed countries such as ours, that figure is far too high, and this House must address it.
It is well known that smoking causes 90 per cent. of all lung cancer deaths. It is less well known that 25 per cent. of cases of ischaemic heart disease are caused by smoking, as are 75 per cent. of deaths from bronchitis and emphysema. We must weed out this killer from our nation. We owe it to the world to spell it out now that the British Medical Jou rnal has published these new facts. We must take action to prevent the spread of tobacco use and to prevent the vulnerable and the ignorant from choosing to smoke.
The horror catalogue of tobacco use contains one fiend of dreadful aspect with gory hands and bloodstained jaws, if I may put it that way. I speak of our complicity, both in this country and in Europe, in the tobacco business. Belatedly, the most recent research findings have convinced me that tobacco advertising is indefensible—even with its health warning. No hair splitting or sophistry can disguise the fact that we are responsible for allowing what is wrong merely because duty from tobacco use is so large.
In the House we have a history of eventually doing the right thing—of course, this Government do it more regularly than most. Slavery was wrong, but, thanks to Wilberforce, in 1832 we rose above the vested interests. The denial of votes and political representation to women was wrong, but we got over that earlier this century. We now have to abolish tobacco advertising.
I welcome the Government's good sense in raising the tobacco issue in Europe. I thank the Government for raising the level of tobacco duty—one can point to no other single more important factor in explaining why more people are choosing not to smoke. I look forward to more good sense in the Budget next week, when I hope that the Government will announce that they will increase tobacco duty again. That alone will save lives.
My right hon. Friend is right to act on this subject in Europe. It is fair to say that, so far, only Britain has resisted the ban on tobacco advertising and I hope that it will shift its position now that it has new facts to grapple with.
For some time, British Health Ministers have taken the right decision to put pressure on spending Ministers to stop tobacco subsidies. As early as 19 July 1991, Baroness Trumpington said in another place:The Government have consistently criticised the tobacco regime on health grounds and will continue to do so."—[Official Report, 19 July 1991; Vol. 531, c. 364.]That decision is right and it is to be welcomed, but there is new evidence not only of the evil effects of the product, but of the crazy nature of the European tobacco subsidy regime.
The European tobacco subsidy scandal is not understood fully. Each year the European Union gives £1 billion to tobacco growers in southern Europe. The money goes mostly to Italy, but also to Greece and, surprisingly, countries such as Belgium, France and Germany. So not surprisingly, votes for its abolition are in short supply. Britain receives not a puff of subsidy in this area.
510 Of all the current frauds in Europe—it seems that frauds are a big growth industry there—this is the worst, and the House should address it. Conservative Members sometimes find it difficult to explain the details of the excellent efficiency savings that we are making in the NHS, yet at the same time we are spending money on a scandal in Europe.
Our money is spent on the poisonous weed in this way. In another place, the Government have admitted that British taxpayers spent at least £50 million on the European tobacco crop in 1990. Bearing in mind the fact that this country is responsible for 16 per cent. of the total European spending of £1 billion on tobacco, our tobacco subsidy is £160 million. As we are net contributors, our proportion is probably closer to £250 million. But taking the lesser figure of £160 million, each year we are spending the equivalent of one to three hospitals on supporting the growth of this poisonous crop in southern Europe.
That is not all. Another issue is how the tobacco is produced and where it goes. Half the black tobacco cannot be smoked by the people in Europe because it is so awful. It is dumped on the third world, where there is no health warning on the advertising. It is not surprising that the demand for that noxious product is rising all the time.
That is not all. The quality of European tobacco for which we pay is dreadful. With its high tar content it is likely to cause cancer and the other problems that I have mentioned. This must stop. We must gain for ourselves line item veto in our budget proposals. This Parliament has never flinched from curbing squandering and spendthrift rulers. Kings, lords and Ministers have fallen to the demands of the House. The House must give notice that it will block any spending that is onerous, oppressive and damages human health.
I support the Government's fine record on preventive medicine and on far-reaching and far-sighted funding of community medicine. However, they should polish their crown. They should abolish tobacco advertising in Britain and move to stop tobacco dumping in the third world. They should put pressure on the finance and fanning Ministers to veto any budget that contains another pound, ecu or lira to be spent on black tobacco growing in Europe.
§ Mr. Ronnie Campbell (Blyth Valley)
I do not suppose that the people in my constituency or any other really mind who runs the health service, so long as it is run well and is free when people need treatment. I do not want to knock the trusts. They are there and they will stay until we have the power to put them right in the way that we see fit. Unfortunately, we have had some trouble with the trust in south-east Northumberland, where my constituency is located.
The Ashington hospital is about to close, although part of it is still open. There is the new Cheviot and Wansbeck hospital run by the Cheviot and Wansbeck trust, which became a trust in April last year. Three months after that it announced that it was £1 million in debt and the cuts began. Little did we know that some cuts had already taken place because there were already debts. My argument is this: why did it apply for trust status? If it had stayed with the health authority when it knew that there was a £1 million debt, help might have been available. Now that it is a trust, there is no help. We 511 understand that that £1 million debt may grow to at least £2.5 million by the end of the year, so there are more cuts on the way.
One of the day care wards will be closed and the pathology laboratory is to be shared with another hospital. We all know what might happen there. The worst event was the sacking of midwives and nurses at the hospital to save money. The maternity wing of the hospital took a fairly big cut. Over a few months, 12 well qualified midwives were made redundant. Of course, the trust brought other people in—new health care workers at £2.80 or £3 an hour when fully qualified midwives could easily command £6 or £7 an hour. It was getting rid of experienced midwives and nurses and replacing them with inexperienced health care workers—that is the new term.
One of the gynaecologists at the maternity hospital had seen what was happening. He wrote a letter to the chief executive of the trust and sent a copy to the chairman of the regional health authority. He said that he was amazed to see the work of the midwives and health care workers in the maternity wing. He was amazed at their exhaustion and their worry. He saw their frame of mind and knew that they were overworked. He said that lives would be lost if something was not done, but nothing was done. As we know, those involved in the trust ignored any warning that they were given from the people who matter—the doctors.
There was a disaster. A mother in my constituency lost her first baby after experiencing a perfectly normal pregnancy. I saw the local doctor and he said that there should have been nothing to fear and that there should have been a normal delivery. She went into the maternity wing at Ashington hospital and was in labour for 12 hours. For three of those hours the baby was in the birth canal, but no one was attending to the mother. The nurses and midwives were overworked and were dealing with somebody else at the same time. It was not the nurses' fault: they simply could not cope—that is why the gynaecologist had written the letter.
When the baby was born, it was exhausted and the hospital had to send for an emergency baby unit from the Royal Victoria infirmary, 20 miles away in Newcastle. The unit was rushed to the Ashington hospital in an attempt to save the baby's life. The experts had to insert a needle into the baby, but it missed the child's heart, hit an artery and the baby died.
When I heard about the case I took it immediately to the ombudsman. Unfortunately, the mother is, quite rightly, suing the hospital. That event was a warning.
Lo and behold, about a month and a half later there was another incident. This time the mother came from the constituency of my hon. Friend the Member for Wansbeck (Mr. Thompson) and I had no dealings with it. The family were very upset and were not saying much. All we knew was that the child had died in strange circumstances in the same maternity unit. Very little was said. I could not get in touch with the parents because they did not come from my constituency, but we understand that they are now taking legal action against the hospital.
All that arose because the trust was in debt by £1 million and decided to save some money by cutting a few hospital workers, particularly midwives. The deaths of those two children should never have occurred, especially when there had already been a letter of warning from a gynaecologist, which the regional health authority and the 512 chief executive of the trust had chosen to ignore. I think that the Minister has received that letter. If he has not, I shall give him a copy. It is a disgrace when something like that happens and two mothers lose their children.
The trust asked some of the midwives whom it had made redundant to come back. It knew that it had made a mistake. The union man's advice to the midwives was to stay out for another month because they could lose redundancy money if they came back too quickly.
Other things have been happening in relation to the trust. The problems are all down to the lack of money and to a hospital becoming a trust when it was in debt. I should like to ask the Minister how a hospital can become a trust when it is in debt. On two occasions, I asked the chief executive of the trust and the panel of men who sit either side of him why the hospital became a trust when it was in debt. I received a little bit of an answer from one of them. He said, "Captain Harry did not tell me." How in heaven can one believe that? A person could pull the bells on my foot if he wanted me to believe that one.
The position in Wansbeck is not good. If cuts of £2 million or £3 million go ahead at the end of this year, I foresee that that brand new hospital serving south-east Northumberland will close, or that another hospital may take it over, as has been rumoured will happen. I asked some of the people working there whether they had heard any Americans talking because some Americans might be after a nice private hospital in south-east Northumberland. That is a danger.
I asked the Minister for an inquiry, but I did not get one. Naturally, there should be an inquiry and the matter should be examined. The health of people in south-east Northumberland is at stake. I received a letter from the Minister saying that I had made some good, valid points but that, unfortunately, he could not call for an inquiry.
Never mind: things have developed since then. Only a few weeks ago, a sub-committee of the community health council£another sub-committee£passed a resolution of no confidence in the Cheviot and Wansbeck trust. Lo and behold, two Tory councillors put forward that motion of no confidence, which still has to go before the full council for ratification. Two Tory councillors oppose the trust, but the Conservative party says that trusts are wonderful and great and must remain.
I do not know why the Minister's colleagues in Northumberland put forward the motion of no confidence. Perhaps the Minister will be able to find out. All that I ask the board to do is to resign and to let someone in who can do the job. The hospital is in a downward spiral and, unless money is found, it will either close or be taken over by another hospital. Of course, the money will never be found because the Government will never bail the trust out and it knows that.
It is interesting to consider what is happening with GP fundholders. Fundholders and non-fundholders in my constituency have a large number of patients. I visit the practice of a non-fundholder who wishes to remain so. The GP at a nearby practice is a fundholder.The non-fundholder knows that fundholders receive preferential treatment. Patients of fundholders are being admitted to hospital before those of non-fundholders. That is being done deliberately to force non-fundholders to become fundholders. That view was expressed by my doctor; I did not find it out myself.
513 I am aware that at least one practice is getting rid of some of its patients, pushing them on to non-fundholders as well as fundholders. One practice in my constituency is removing old people from its books. Another will not treat drug addicts. Whatever one's views on the subject, drug addicts are patients and they need treatment. Nevertheless, that practice refuses to treat them and sends them to another practice.
That practice has lost about 1,000 patients in about 18 months and has made an application to become a fundholder. It is getting rid of patients who will cost a lot of money to treat. It wants to have an elite of patients who will not cost it too much money. That is a dangerous position. Many burdens are being placed on non-fundholders who, on principle, will not become fundholders. They face the burden of looking after old people, drug addicts and anyone else who costs a lot of money to treat.
I hope that the Minister will consider what some of those practices are doing. I am sure that it is happening not only in Blyth Valley but in other regions. The Minister should take time to consider the number of patients that fundholders have lost in a year and how they have pushed them off somewhere else. I hope that he will seriously consider the problem.
§ Mr. John Butterfill (Bournemouth, West)
I should like to deal with the pensions issue and to welcome the Government's proposal to introduce a Pensions Bill. The need for pension legislation is manifest—recent scandals have made that clear to everyone—and it is right that the Government should legislate to protect people who receive pensions.
My hon. Friend the Member for Bournemouth, East (Mr. Atkinson) and I probably represent more occupational pensioners than anyone else. No one is more assiduous in defending their rights than my hon. Friend. There are concerns about some of the Government's proposals in the White Paper. I should like to bring them to the attention of the House and of my right hon. Friend the Secretary of State for Social Security. I hope that, before the Bill is introduced, problems will be corrected in the ways that I should like.
I pay tribute to the assistance that hon. Members have received from the Association of Consulting Actuaries and the National Association of Pension Funds, both of which have guided us through some-of the more difficult and tortuous parts of this rather esoteric subject.
It is right that a minimum solvency requirement should be built into all pension funds. There is nothing worse than someone working all his life to receive an occupational pension, having paid into it all his life, only to find that the fund contains insufficient money to pay him the pension to which he rightly believes that he is entitled. It is essential, therefore, that we frame our legislation to give adequate protection.
I am concerned that bureaucratic rules may be drawn up which defeat the object that we intend. If the mechanism for defining minimum solvency requirements is too rigid, it could undermine specifically defined benefit schemes and deter employers from providing them. That would be a great shame for employees and 514 would also hurt the Government, who would have to pay out more in means-tested benefits. There would be no winners in those circumstances.
Similarly, we must remember that pensions and pension investment are long-term businesses. They provide for liabilities for pensions and pension trustees many years ahead, whereas markets are essentially short term. Yields, values, equities, values of properties and values of gilts go up and down. The danger is that too strict a mechanism may drive fund managers out of equity investment and, at least predominantly, into gilts. That would not only disrupt the market but deprive British industry of a valuable source of investment funds.
One of the greatest dangers at the moment is that not enough of our institutional money is channelled into investment in productive industry. Too strict a mechanism may defeat that desirable objective. The House will know that the Select Committee on Trade and Industry commented on that fact and suggested ways in which we could guide pension fund moneys into investment in industry. It would be a great shame if the proposed Bill were to defeat that objective.
Secondly, I wish to deal briefly with the contentious issue of trustees and their investment policy. Who should be trustees? It is suggested—rightly—that trustees should not be comprised entirely of employers because, as happened with Mr. Maxwell, they may choose to raid the funds to prop up their businesses, with thoroughly undesirable results. Equally, however, we must be aware that if employees are too heavily involved in the management of a scheme they may have a similar interest in keeping the company going, an interest which may not coincide with that of existing or deferred pensioners. There is therefore a danger both in having too many employers and in having too many employees as trustees. We need independent trustees of proven probity who will be able to protect all those involved in the complex business of investment policy and in where and how pension funds are held.
Thirdly, I am a little worried that the White Paper does not deal with the custody of funds. Who holds the cash or the assets? By whom are they controlled? The example of Mr. Maxwell proves that, unless such issues are clearly defined, there is a danger that cash and assets may fall into the wrong hands. It is therefore extremely important that we provide for proper independent custody of valuable assets.
Finally, I wish to deal with regulation. Most of us agree that it is important that we continue to encourage occupational pension schemes. Valuable as private pensions may be, they satisfy the needs of only a limited number of the population. Those who are young or who may change their jobs often will probably be better off with a private pension. For many other employees in industry and commerce, however, an occupational pension to which a benevolent employer makes a valuable contribution will probably produce a better result. It is therefore vital that nothing in the legislation should prevent the continuing provision of occupational pensions.
I am concerned about regulatory costs and burdens. We are in danger of imposing on pension funds the same costs and burdens that we imposed on the investment industry through the Financial Services Act 1986. Were we to do so, the effect would be simple: employers would vote with their feet, stop providing occupational pension schemes 515 and say that employees should have private pensions. Everyone would then suffer. I therefore urge that the costs of regulation be kept to a minimum.
Specifically, I believe that the cost of funding the regulator, which the Government propose in the White Paper should be met by employers and pension funds themselves, should fall on the Government. We aim to protect the public, but if we place too heavy a cost on employers they will not provide occupational pension schemes. If that were to happen, we should all lose. I urge my right hon. Friend the Secretary of State for Social Security to ensure that the Government pick up the bill in this instance.
§ Mr. Frank Field (Birkenhead)
I greatly welcome the contribution of the hon. Member for Bournemouth, West (Mr. Butterfill) because it seemed almost a generation ago that the flickering light was taken to the social security brief which is occupying half of our debate. I shall continue in the same vein as the hon. Gentleman, but I hope that he will forgive me if I do not follow him into his sphere of concern and expertise, namely pensions.
It might be helpful if we move to a recent speech that did not gain the coverage that it perhaps deserved. I refer to a speech made by the Secretary of State for Social Security in Northern Ireland. It is perhaps a sign of the lack of confidence we have in ourselves that it is not what happens in the Chamber that matters so much as the coverage that we get might outside. As I am anxious to promote the Secretary of State's career, I shall spend a short time bolstering it now.
I believe that the Secretary of State's speech is the most important given by a senior politician this year. He outlined the theme of his lecture, which was what he believes to bethe single most significant social change affecting the UK and most other western countries.He went on to explain:That phenomenon is not the ageing of the population. Nor the breakdown of the family. Nor the increasing proportion of women at work. Rather, it is a phenomenon which is still largely unrecognized—the growing dispersion of earnings power.I shall consider to what extent the Gracious Speech covers what the Secretary of State regards as the big issue of our time.
There are some wonderful give-away points even in the brief quotation that I read out. Indeed, one can build from it the modern Tory laws of politics. The beginning refers to a worldwide trend. Whenever the Government discuss a trend that is unfavourable to them, they describe it as "worldwide". Thus, the dispersion of earnings, which is very bad, is a "worldwide" trend. However, when trends begin to be favourable—for example, when unemployment goes down—it is all thanks to the Government, although, of course, when it goes up, it is part of a terrible worldwide trend.
In his speech, the Secretary of State did not concern himself—unusually, given the rigour of his analysis—with the fact that we know quite a bit about the dispersion of earnings in this country, and the trend is not as worldwide as he alleged in his lecture.
The record growth in inequality of earnings in this country can be accounted by three forces: half of that growing inequality is due to the Government's tax changes since 1979; a quarter is due to the rise in 516 unemployment, and a quarter to the changes in the job market to which the Secretary of State devoted so much of his interesting discourse. I provide that information because it is something that we need to consider.
We shall be examining our tax policy between now and the election, and considering how we are going to fashion our fair tax policy. If half the inequality that we deplore has been brought about by the Government's tax changes, we clearly have to think carefully about the changes that we shall reverse in order to lessen that inequality. Instead of doing that, the Secretary of State, understandably, considers the unemployment rate. Again, I thought that that was rather unfair, because figures can be used to favour one side or the other.
When examining any modern economy, it is no longer appropriate to concern oneself merely with the unemployment rate. We must combine it with the number of people who would usually be in work but are not—or, to use the technical jargon, the inactivity rate. If one adds the inactivity rate to the unemployment rate, it is clear that our performance—sadly—is no better than that of other countries. Nor is our performance in job creation.
Again, the Secretary of State chose two key dates for his analysis. He took the period after the first Thatcher recession and just before we went into the recession caused by Lord Lawson's Budget. And, looking at that very limited time span, he said, "Haven't we done rather well with job creation?" All of us would wish that the Government's claim about job creation were right, but the sad fact is that, if we take the total period of stewardship, from when the Government came into office until now, our economy over the past 16 years has been good at producing jobs, but by their management of the economy the Government have destroyed most of those new jobs. We have created many jobs, but we have not sustained them.
When considering the Gracious Speech, we should take the framework that the Secretary of State has given us and examine some of the more serious trends on which we need to spend more of our time. I shall give one illustration. Sir Brandon Rhys Williams was for long the Member of Parliament for Kensington, and one of his many activities was to safeguard the National Birthday Trust, which was responsible for three cohort studies.
The 1970 cohort study has now examined its subjects at the age of 21, and it found that many of them, having been through 11 years of our state education system, are largely illiterate. Of course there are points to be scored across the Floor of the House about the various stewardships of the different Administrations, but we should all be appalled by the fact that, after 11 years of taxpayers' money being spent on their education, people come to our surgeries hardly able to read or write.
We must consider that trend against what the Secretary of State described as the globalisation of the world economy, which will make it harder rather than easier for people without skills to get work in future. We must address that central problem. What is in the Queen's Speech to tackle it? There are two measures.
First, there is talk about allowing technical courses in schools for pupils aged 14. As someone who has lobbied the Government for eight years to carry out that small reform, it would be ungracious of me to say, "About time too"—although I now believe it to be totally inadequate. What is wrong with our city technology colleges is the 517 fact that there are not a thousand of them, so that we could produce an education relevant to many of our young constituents.
The other measure in the Gracious Speech is the job seeker's allowance. Opposition Members would have no complaints about that if it were being introduced at a time when most people who wanted to work had work. But our great fear is that, under the guise of their supply-side measures, the Government will try to rough up many of our least able constituents so as to get them out of the dole queues, and that that, rather than getting them back into work, will be the primary objective.
Those two measures are totally inadequate to deal with what we all see in our constituencies now. As we have disfranchised younger people from work, two trends have appeared. One is that some of our younger female constituents, rather than being bound to their own homes, are deciding to start their own new homes and to have children and thereby gaining a certain freedom. That is a trend about which I am deeply unhappy, but it is happening.
For our very young male constituents, the opposite is happening. Ironically, they are even more firmly bound than ever before to their original families. In our constituencies are being created groups of unskilled young males condemned to a state of permanent adolescence. They are not in school; they are not in training schemes; they cannot get work.
While we are considering the extent to which the Gracious Speech meets the challenge that we see in our constituencies all the time, and which the Secretary of State boldly and clearly outlined in his recent speech, I ask the House how we are to judge the worth of the two measures. Sadly, I come to the conclusion that we now have a Government who—collectively, as opposed to some of the individuals within it—seem to have no will power to match measures to the situation that many of our constituents face.
The hopeful note in the Secretary of State's speech was about the Reich theory of the labour market and about taking our constituents up market for their skills. But even if that were possible in the short run, I do not believe that there would be the levels of employment that we require.
Similarly, I do not think that we shall see another American election won by a free trade candidate. Nor will we be able to maintain the line on free trade when we see how devastating is the impact of that policy on our poorer constituents. I believe that we shall need to move towards much clearer trading blocs, with competition being maintained within them rather than between them. Before some hon. Members look too shocked at that idea, I remind them that, although we all refer to GATT and free trade, if we really had free trade we should not need GATT, which is in itself a way of managing trade.
I suggest that, if we are serious about securing a breathing space in which to take the people now confined to a state of permanent adolescence back into the labour market, we shall have to dream things that we in this Chamber have yet to begin to dream about.
§ Mr. Peter Thurnham (Bolton, North-East)
The hon. Member for Birkenhead (Mr. Field) made what was an 518 interesting speech to start with, although I am sorry that he ended on what seemed a pessimistic note. I do not share his pessimism. The hon. Gentleman must have been selective in his reading at the weekend. Although I commend him on following the Secretary of State's speech in Northern Ireland, he seems to have missed the weekend's bigger headlines, which were all about lottery fever, and the concerted effort by many people to increase inequality.
The thrust of the hon. Gentleman's speech was that inequality was a bad thing, but presumably everybody going in for the lottery did so on the basis that inequality was a good thing. We must accept that people believe that we live in a world not only in which there is inequality but in which there should be inequality. Otherwise, such an enormous number of people would not have supported the lottery and put in money that, although some of it went to good causes, also went into the pockets of the people fortunate enough to win large sums, and who now sit there having achieved great inequality through the wishes of the large number of people who bought tickets.
The hon. Gentleman may rather have lost sight of the human motives that underlie our feelings about inequality. That made me think more about the subsequent news about large salaries for the directors of utilities. The hon. Gentleman may feel that something should be done about those; perhaps we should empower the shareholders of privatised utilities to decide what directors' salaries should be in advance, rather than having to read about them in the newspapers some time later, after a small group of non-executive directors have made the decisions. To the extent that many people are happy that there should be inequalities, perhaps we can all be winners on the privatisation front in one way or another.
I was a little perplexed by some of the remarks made by the hon. Member for Birkenhead (Mr. Field) about the Government not being good at sustaining jobs. I look at the record for Bolton as a whole. When the Labour party was in power, unemployment trebled from 2,100 to 6,500. Admittedly, the unemployment figure is higher today at 9,300, which is a 50 per cent. increase on the figure under Labour, but there was a threefold increase while Labour was in power. The hon. Gentleman's memory must be a little short if he criticises this Government for not sustaining jobs. He should remember what happened before.
I very much commend my right hon. Friend the Secretary of State for Social Security for the measures in the Gracious Speech on the social security front. There are three major measures covering pensions, the job seeker's allowance and disability, to which I shall come later. Those measures prove that the Government are a strong reforming Government; there is plenty in the Gracious Speech on that front.
What we might see in the Gracious Speech if we ever had the misfortune of being given a Labour programme crossed my mind. If that happened, there would be a Clinton-like con trick on the British public, as they would soon realise. The Labour party has performed U-turns on school league tables, on its position on the Campaign for Nuclear Disarmament and on its position on Europe, which suddenly changed after the former Prime Minister obtained a £600 million rebate. There are U-turns on clause IV, and there have been great disappointments with the social justice commission. Labour is now wriggling on the minimum wage.
519 The minimum wage is a classic example of how a Labour party programme would lead to unemployment. Almost 20 years ago, the former Secretary of State for Social Services, Barbara Castle, produced a paper showing how minimum wage legislation would lead to increased unemployment, especially in the regions. She showed that there would be an especially severe effect in Northern Ireland, as well as in other regions, if there was any attempt to introduce a minimum wage.
I noticed at the weekend that Bill Morris of the Transport and General Workers Union, one of the paymasters of the Labour party, was wriggling when asked what would happen to differentials if there was a minimum wage. He was more or less forced to concede that wages would leapfrog as differentials came in, which would lead us back to inflation, back to high interest rates and back to higher unemployment—perhaps the International Monetary Fund would come in again.
Looking at the picture in the United States, it is interesting to note that, according to The Economist this week, 16 per cent. of workers in the United States have wages that are below the minimum wage in France. If the minimum wage in the United States was at the level that it is in France, the jobs of 16 per cent. of workers in the United States would presumably be at risk. That shows why unemployment in France is double the level it is in the United States, where the latest figures show that it is at 5.8 per cent. and falling. In France, unemployment is at 12.7 per cent. and rising. There seems to be a clear correlation.
The minimum wage is a classic example of how Labour policies would lead to unemployment and to weakening the economy. By contrast, this Government's policies are leading to a strong economy. I am confident that the Budget which will be before us in a few days' time will be good for business in the country as a whole and for business in Bolton, where there is a strong emphasis on manufacturing. I am confident that the Budget will help to reduce unemployment even further. Unemployment in Bolton has fallen by 2,000 in the past 12 months, and I am confident that it will continue to fall.
We have the strength of an economic recovery based on an export-led boom. Exports are up by 11 per cent. overall and by 17 per cent. to the European Community, much of which is still in recession. That has given us 4 per cent. growth in gross domestic product, the fastest in Europe. Inflation is at the lowest level for almost 30 years. Productivity is up by 6 per cent., and unemployment nationally is down by the best part of half a million. That is the way in which we can fund the sort of welfare state that we need.
I do not know what else we shall see in the Budget, but I am sure that we shall see further evidence of the control of public spending as the basis for it. I hope that items such as housing benefit will be brought under control. I am sure that it should be possible to cap housing benefit if it is done on a local basis and at the same to give a boost to the private rented sector. We may see housing investment trusts coming forward, and I hope that there will be a boost to the sale of council houses. We may need more legislation on that front to make it easier for 520 councils to dispose of their council houses, even if the tenants are unable to buy the whole freehold under the right to buy.
§ Mr. Alan Howarth
My hon. Friend has just advocated a regional, or even a local, cap on housing benefit. Would not that flatten out differentials and effectively set a going rate, which would encourage landlords to move their rents up to that level if they happened to be below it? That would do nothing otherwise to encourage the development of the private rented sector which, my hon. Friend said in the same sentence, he advocated. Will he explain a little more why he supports such a possible change?
§ Mr. Thurnham
As my hon. Friend knows, the rents that landlords set are limited by the rent officers. I am sure that he appreciates that there are no incentives for tenants to move to cheaper accommodation. There are no incentives for either tenants or landlords to seek any savings in the cost of the accommodation they have at the moment. We have seen housing benefit increase substantially.
I am sure that it should be possible to arrange matters so that there were incentives for people to make use of the least expensive accommodation that they can sensibly afford. At the moment, as my hon. Friend will be aware, there are massive abuses of housing benefit throughout the country, especially in areas such as London, where some high rents have been charged. I am confident that it should be possible to control that, although I take my hon. Friend's point that we need measures to boost the private rented sector at the same time.
We have the "rent a room to a lodger" arrangement, which gives £3,000 free of tax. That should be extended to a lodger who is not under the same roof. In other words, people should be able to rent out a property they own at up to £3,000 a year without having to pay tax on it. That would be an incentive for them to provide accommodation up to that cost.
I very much welcome the fact that the Government are introducing their own Bill on disability. I am sure that that is to the credit of my hon. Friend the Member for Richmond, Yorks (Mr. Hague), the new Minister for Social Security and Disabled People. I also give praise to his predecessor. I am sure that there have been some strong discussions behind the scenes. We look forward to hearing the full details, and I hope that we shall have a full statement of the details this evening or before too long, so that we know exactly what the Government have in mind. When the Bill is published, we shall see the full details.
My message to the Government is that they should be as bold as possible. They have an excellent record on disability overall, and spending on disability has trebled to £17 billion a year. The Government's general approach has been a step-by-step, balanced approach, in contrast to that in the private Member's Bill promoted by the hon. Member for Kingswood (Mr. Berry), the Civil Rights (Disabled Persons) Bill.
I see that the hon. Gentleman is here at the moment. He knows that I had reservations about how one could proceed with a big-bang approach. I shared his aims, but I believed that, when it came to implementation, it would be more sensible to proceed in stages rather than to try to achieve everything at once. I hope that my hon. Friend the Minister will be as bold as possible, and that he may 521 be able to go beyond what was in the consultation paper, by introducing measures that will provide as much additional opportunity as possible for disabled people.
The Government's own example is important. The public sector is a huge employer in its own right, yet organisations such as the BBC employ only one tenth of the so-called "quota". There are health authorities and local authorities that do not employ any registered disabled people. That goes to show that the quota itself is nonsense. There is no doubt that we can dispense with the quota and go towards legislation that will outlaw unfair discrimination in the whole area of employment. We have excellent examples of some organisations, such as the Shaw Trust, which work to provide opportunities for disabled people at a cost substantially lower than that of the Government's own arrangements through Remploy.
I hope that the Government will go as far as possible to provide access to buildings. This is the expensive area, and we have already had long debates about what the costs would be. The Government need to assess what sort of time scale is appropriate.
We must outlaw some of the blatant discrimination one comes across. Recently, I saw a case of a lady suffering from cerebral palsy, who had worked all her life. When she came to retire, she put her name down for a retirement home and was given an indication that she would be able to proceed with her application. However, when the owners of the retirement home found that she suffered from cerebral palsy, they suddenly said that they did not think that they could proceed with the deal.
It is that sort of nonsense which needs to be totally banned, because it is blatant discrimination of the worst sort. We look forward to seeing the details of the Bill, and I hope that it will be strong in all the areas that I have outlined.
I hope that the Bill is especially strong in the area of transport. A recent opinion survey of the members of the Conservative disability group showed that their number one priority was transport. I hope that we can bring in measures such as ensuring that all new buses are of the low-floor type, and that taxis and so on are made to enable disabled people to make as much use as possible of all forms of transport.
In deciding where the right balance should be struck and how far the Government should go with their Bill, we need to keep as wide a perspective as possible, and not only consider exactly what we may want to do in this country. We must bear in mind the fact that, in a global sense, there are enormous difficulties for disabled people. Although we should do everything that is sensible, practical and pragmatic in this country, we should bear in mind the considerable difficulties and chaos abroad.
It is a few years ago that I visited Romania, but I remember going to an adult psychiatric hospital—so-called—at Podriga, where the conditions were simply frightful. There was no doctor in the hospital, patients were dead in their beds, there was no running water or proper heating, and the lavatories were blocked and overflowing from one floor to the floor below. The conditions in that place were absolutely horrific.
My daughter happened to be working in Romania in that hospital at that time. If anyone would like a Christmas present, I certainly recommend the book published this 522 week, entitled "Sophie's Journey", in which she describes the dreadful conditions under which the people in that hospital were placed, as well as the conditions in the Ionashen orphanage where she also worked.
I give great credit to the Government for the measures which are in the Gracious Speech. I wish them well with those measures, especially the measures which will be announced shortly in the disability Bill.
§ 7.1 pm
§ Mr. Roger Berry (Kingswood)
Twelve months ago, we would have been surprised to hear that the Government were to introduce a Bill to tackle, in their words, discrimination against disabled people. I welcome the fact that we now have that Bill, although perhaps it is useful to reflect on what has happened over the past 12 months to change the situation. As a matter of fact, a Government report published in 1982 by the Committee on Restrictions Against Disabled People—the CORAD report—recommended that the Government should make discrimination unlawful. Of course, every year since then, no action has been taken.
Comments have even been made about how inappropriate it is that private Members' Bills deal with the matter. I could not agree more. The fact that the issue had been left for so many years and private Members had to seek to legislate on an important matter of civil rights was wrong. If we are now generally agreed that we should use the law to outlaw discrimination against disabled people, I very much welcome that change of heart.
It is, in fairness, generally recognised that disabled people face discrimination in every aspect of their lives—in employment, in education, in access to leisure facilities, transport, and so on. No doubt some right hon. and hon. Members will have attended the Scope reception at lunchtime, where one of the reports published, the result of an extensive survey of disabled people undertaken by an independent research agency, concluded:The problems faced by disabled people in coping with hostile attitudes and inadequate support are much greater than many think.I hope that it is now recognised that this is a serious area of discrimination and also that there needs to be legal redress. After all, we have laws in this country that seek to banish discrimination on the grounds of gender and race and, indeed, in Northern Ireland, on the grounds of religion. Why, therefore, should we not make it illegal to discriminate on grounds of disability? We should.
If the House has achieved that consensus over the past 12 months, I am very grateful. It has to be said—I say this in as constructive a manner as possible—that, in the past Session, not many issues were as controversial as the Civil Rights (Disabled Persons) Bill. It resulted, of course, in a couple of apologies for misleading the House, and led to the departure of a Minister. It resulted more positively, perhaps, in raising the political profile of the issue. I have no doubt that the events of last year also resulted in the Government's publishing a consultation document in the summer and I have no doubt that the events of the past 12 months resulted in the commitment in the Queen's Speech to introduce a Bill to tackle discrimination against disabled people.
I believe very strongly that disabled people's organisations deserve every credit for the fact that this issue has been put at the top of the political agenda. We must recognise that every organisation of and for disabled 523 people was saying last year, as such organisations have said every year recently, that comprehensive, anti-discrimination legislation was required and, therefore, that they wanted the Civil Rights (Disabled Persons) Bill. The Rights Now campaign deserves credit for the way in which that lobbying was conducted over the past 12 months.
Support for the Bill has been voiced not only outside but inside the House. A clear majority of hon. Members support the Civil Rights (Disabled Persons) Bill. They did so last year and, if we examine support for early-day motion 1, we see that they also support it this year.
Briefly, I shall refer again to Scope. I am not advertising it, but its reception happens to be the only one to which I have been today, so far. The Scope reception also published another report. Again, it was an independent survey of how Members of Parliament feel about civil rights for disabled people. I am sure that the Secretary of State is aware of the outcome—70 per cent. of Members of Parliament responded by saying that they supported civil rights legislation. A clear majority responded by saying that they supported the specific measures in the Civil Rights (Disabled Persons) Bill. I believe that it is the extent of support outside the House and inside the House that has brought about the change in the Government's attitude, and I welcome it.
The Government ought to be aware that some of us may be slightly less charitable than the hon. Member for Bristol—sorry, the hon. Member for Bolton, North-East (Mr. Thurnham). Goodness me, what a strange slip, given that I am from Bristol myself. The hon. Gentleman has a vision that the Government have been struggling to liberate themselves from various constraints and have finally done so. I suspect that, rather than the Government struggling to get out, people were pushing the Government.
The Government have now realised the extent of support for the Civil Rights (Disabled Persons) Bill. Indeed, that is probably why none of them voted against the Bill on Second Reading in the last Session. Not one vote was cast against it. It is probably also why not a single vote was cast against a single clause in the Bill in the past Session. Indeed, not a vote was cast against the Civil Rights (Disabled Persons) Bill in the entirety of the debate in this Chamber in the past Session. That was not how the Bill was killed.
This House has repeatedly supported the Civil Rights (Disabled Persons) Bill. It has been through all its stages in another place. Indeed, in the past Session, it had yet another unopposed Second Reading in another place. In summary, the Bill was not defeated in the past Session because it lacked support. It is a fact that support was so clearly demonstrated that the Government were forced to respond to it.
The Bill envisaged in the Queen's Speech has yet to be published, although I have read some very interesting accounts in the press. There has obviously been some degree of either briefing or lack of security—I do not quite know which. If the Bill is along the lines of the consultation document, clearly, there are problems for many of us. The consultation paper that the Government issued in the summer did two things: first, it made untrue statements about the civil rights Bill; secondly, it set out a number of measures that in my view—this was the view also of disabled people—were far from comprehensive.
524 I shall refer briefly once again to the Government's arguments on the costs of the civil rights Bill. I hope genuinely that we shall never again have to listen to the contention that we cannot have the civil rights Bill because it would cost £17 billion. It was not argued that it was badly drafted or that the Government could produce a better Bill. The cost argument should not be repeated, because £17 billion is a bogus figure. As I have said before in the House, it is true that the compliance cost assessment arrived at that figure.
The all-party disablement group has said—the hon. Member for Bolton, North-East (Mr. Thurnham) and are members of it, and we share the view of the group—.that £17 billion is the result of several serious errors, conscious or otherwise. There is double counting in the assessment. For example, the chapter submitted by the Department of the Environment includes certain costs of access to buildings. Those costs crop up again in the chapter produced by the Department for Education and in that produced by the Department of Employment. The double counting accounts for about £6 billion.
It is not good enough for people to reiterate numbers that they know are wrong, and I hope that it will not happen again. The documents which demonstrate clearly that such assertions are wrong have been in the hands of Ministers for several months.
§ Mr. Thurnham
I wish to intervene because the hon. Gentleman referred to me. Perhaps he will admit that he had not been able to provide a costing of the provisions of his Bill. Is it not naive to imagine that a Bill that, on any reckoning, would have cost many billions of pounds could be slipped through the House on a Friday, when attendance in the Chamber is often very low, and at the same time to claim that there was no opposition to it because most hon. Members were not present?
§ Mr. Berry
I am grateful for the hon. Gentleman's intervention. The Second Reading debate was hardly about slipping the Bill through the House. On the Friday that debate took place, 231 Members were present to vote for the Bill's Second Reading; taking account of the four Tellers, there were 235. With great respect, we surely cannot say to those right hon. and hon. Members who took the trouble to be in their places in such numbers on that Friday that they were doing something casual in trying to slip the Bill through the House.
The Government were invited to oppose the Bill on that day if they wished to do so, and they did not. It is for the Government to explain why, having not opposed the measure on Second Reading or in Committee, they were then to invent the story that somehow the Bill was fatally flawed or that it would be so expensive that it would wreck the economy.
I have always contended that it would be difficult to put a precise figure on the civil rights Bill. I moved an amendment in Committee to ensure that there could be no reference to a binding time scale. I recognised that it would be for the Secretary of State of the day to determine the level of expenditure implied for his or her Department. If it is said that I cannot produce a figure, it should be remembered that the Committee and all those who supported the Bill were anxious not to tie any Government to a specific timetable. That argument cannot be used as an excuse for blocking the Bill.
525 The compliance cost assessment, as I have said, engaged in double counting. That was wrong. The assessment assumed also that all the Bill's provisions would be implemented within five years. There was no reference in the Bill to five years or any other period. The report to which I referred demonstrates that, if we allowed for the phasing in of accessible public transport vehicles—producing such vehicles, not retrofitting—we would be able to save £5 billion to £6 billion. That leaves only £5 billion.
When I mentioned that saving earlier in a packed Chamber—I think that the House was waiting for a debate on sleaze—hon. Members groaned and said, "We are left with only £5 billion." I say with the greatest of caution that £5 billion phased in over a few years is not a great deal of money. The outlay would be about a third of what it cost the Government to introduce the poll tax, to try to prop it up and then to axe it. If the Government are able to find about £14 billion for an exercise of that sort, I shall not apologise for seeking to find £5 billion to ensure that there are equal rights for disabled people.
§ Mr. Alan Howarth
The hon. Gentleman is right to say that the cost of compliance with the civil rights Bill would be about £5 billion spread over many years. Does he agree that netted off against that cost should be the economic benefits of introducing the Bill, which consist of having a significant proportion of 6.5 million disabled people contributing to the economy through their employment opportunities, the development of new consumer services and tax and national insurance contributions? When those economic benefits are netted off—they must be real, but they are difficult to assess with precision—it is at least possible that the net cost of the Bill's implementation will be zero.
§ Mr. Berry
The hon. Gentleman is right. I pay tribute to the fact that over recent months he has stressed the need for a proper cost-benefit analysis of the civil rights Bill. It is absurd that we have a compliance cost assessment of proposed legislation but no proper cost-benefit analysis. It is absurd to examine the costs of operating a Bill without assessing the costs of not doing so. That is an odd approach. To give credit to the private sector, I am sure that it would not make decisions on such a basis, and nor should we.
Several studies have estimated the benefits to the Treasury of removing discrimination- in employment. The estimates range from £2 billion to £4 billion. If we cease denying disabled people their right to work, they will pay tax and receive less benefit. Studies have been made of access to public transport, something that would benefit disabled people and enable us all to move more quickly. The experience in Holland shows what can happen. Estimates vary, but it seems that about £1 billion could be saved.
I do not seek to argue that the civil rights Bill is something for nothing. There would, of course, be costs, especially in the short term. In the medium term, however, there would be direct financial benefits. As the hon. Member for Stratford-on-Avon (Mr. Howarth) suggested, they would be of the same order as the costs. Surely the most unacceptable costs are those of discrimination.
526 Last week, the Prime Minister said that the anticipated Billwill include a right not to be discriminated against in employment, a right of access to goods and services and the establishment of a national disability council to ensure that the voice of disabled people is heard more clearly within Government."—[Official Report, 16 November 1994; Vol. 250, c. 31–32.]I welcome the Government's conversion to the idea of rights for disabled people. Not long ago there were those in the House and elsewhere who thought that the idea of talking about rights for the disabled was extraordinary. I remember being savaged by Bill Deedes in the columns of The Daily Telegraph for being obsessed with political correctness and for using the term "rights", a demand so unreasonable as to put one beyond the pale. Against that background, I welcome the Prime Minister's talk about rights instead of talking only about what good government can do for disabled people.
Let me explain why, on present signs—based on the provisions set out in the consultation document—the Government's Bill is likely to be inadequate. If the Government follow the line set out in the consultation document that was published in the summer, we will have a set of piecemeal proposals. We will not have the comprehensive anti-discrimination legislation that disabled people want and require. Two very important areas—education and transport—were completely excluded from that document.
In the consultation document, access to goods and services was limited to direct discrimination. For example, if a publican refused to serve a Down's syndrome sufferer, that would be outlawed. I welcome that, but that would not deal with physical access. The consultation document states:It is very important that those providing goods and services should not be required to carry out modifications to existing premises.That may be important to the Government, but it is not important to disabled people who require access to premises. Anything that deals with the broad area of access to goods and services must address physical access.
Last Wednesday, the Prime Minister referred to setting up a new advisory body called the national disability council. I am deeply alarmed that that might simply be a talking shop. Unlike the disability rights commission which would have been set up under the Civil Rights (Disabled Persons) Bill, the Government's advisory body would have no investigative or enforcement powers. It would not have the same status as the Equal Opportunities Commission or the Commission for Racial Equality. If that is true—the document shows that it is—disabled people would again be offered second-class treatment, and that is simply unacceptable.
My response to the Prime Minister's comment last week about ensuring that the voice of disabled people is heard more clearly within Government is that I believe that that voice has been clear. Disabled people have stated very clearly what they want and require. The obstacle to the voice of disabled people being heard more clearly in Government have hitherto been the Government themselves.
The Government should recognise that every organisation of or for disabled people, whose views have been known over the past 12 months before, during and after the consultation exercise, has said that a 527 comprehensive civil rights Bill is necessary. Anything less than that will be unacceptable. Anything less than that will not defuse the campaign for civil rights.
As I have said before, in a few years we will look back and wonder why on earth we had to have this debate in 1994 about whether we needed to ensure equal treatment for disabled people in exactly the same way as we seek to ensure equal treatment for women and black people. Let us hope that we have a comprehensive civil rights Bill as soon as possible. I very much hope that that is what the Government have in mind.
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)
Order. In the two hours before the winding-up speeches, no fewer than 10 hon. Members hope to catch my eye. With a little co-operation, I hope that they will all be successful.
§ Lady Olga Maitland (Sutton and Cheam)
I warmly welcome the speech made by my right hon. Friend the Secretary of State for Health. I particularly admire her for her vigorous support for the achievements in 0the national health service that we have made over a considerable period. I was sorry that the right hon. Member for Derby, South (Mrs. Beckett) made a rather mean-spirited speech. It is almost as if the Labour party is seeking to make the health service its own health service rather than our health service in respect of which we, the Government, are the custodians of the future of the health service.
The remarks made by the right hon. Member for Derby, South bore no relation to the health service that I know. I am proud to use the health service. I visit a national health service GP and I queue up like everyone else in her surgery. I have never been let down.
It may be worth while to travel overseas and ask people in other countries about their fears and their terror of falling ill and being unable to afford the treatment that they desperately need. By contrast, we should then be able to understand and appreciate how precious and valuable our health service is. It is terrible to learn that one third of the American people have no automatic health cover. We should compare that with what we have in this country. We have a fine record, of which we should be enormously proud. The fear in America does not exist here.
What concerns me is that, where there is fear in this country, it is the result of scaremongering. I often knock on people's doors wanting to know how they are getting on. When I ask about their concerns, people say that they are worried about the health service. When I ask whether they have had any treatment which has gone wrong, I am told, "Oh no. In fact, the treatment has been the best possible. It has been fast and speedy. The doctors were wonderful, the nurses were dedicated and I'm feeling fine."
When I ask, "Well, why do you feel like this?" The answer is, "Oh, it's what they say on television and in the media. It's what the Labour party is saying. Clearly, they 528 are trying to make me feel that there's something wrong." However, their personal experiences have always led them to be appreciative and supportive of their treatment.
§ Lady Olga Maitland
The hon. and learned Member for Montgomery (Mr. Carlile) asks about the nurses. I frequently visit my local hospitals. Morale at the St. Helier national health service trust hospital is excellent. I have yet to come across a nurse, doctor or consultant who has criticised the management. To a large extent, critic ism is politically inspired by the Labour party. Perhaps Labour Members should visit hospitals to see for themselves what is happening.
§ Lady Olga Maitland
No, I must move on.
Having made clear my appreciation of the health service, I have a message for my right hon. Friend the Secretary of State for Health. I support comments made by hon. Members on both sides of the House about mixed-sex wards. It is clear to me that many people, particularly women, do not wish to share a mixed-sex ward. A close elderly relative of mine was in that situation and, frankly, it was very embarrassing for her.
§ Ms Tessa Jowell (Dulwich)
I support the hon. Lady's call for single-sex wards. Will she join me in pressing the Secretary of State to instruct and direct purchasers to ensure that women—particularly those being admitted to psychiatric hospitals, 50 per cent. of whom have suffered sexual abuse at some time in their lives—have a choice when they are admitted to hospital and can choose to be cared for on a single-sex ward?
§ Lady Olga Maitland
I sympathise with the hon. Lady and I support her call. It is something that we should be seriously considering, not something about which we should be doctrinaire. There is a way around the problem while also ensuring that we get the most efficient health care available.
I give a warm welcome to the Government's plans, outlined in the Gracious Speech, to introduce a Bill to tackle discrimination against disabled people. It seems somewhat ironic that the first person even to touch on that topic today happened to be my hon. Friend the Member for Bolton, North-East (Mr. Thurnham) rather than a Labour Member, despite the fact that the Opposition's amendment mentions it. I was surprised that the matter was not raised until rather late in the debate, and then by a Conservative rather than a Labour Member. It makes me wonder whether it really is such a high priority for the Opposition after all.
Disabled people are entitled to new rights which give them greater dignity and respect and more facilities to enable them to lead the life of their choice. I have seen their frustrations—the "does he take sugar" syndrome is grossly insulting. More than that we, the able-bodied, are the losers because we deny ourselves the benefit of the massive contribution that disabled people can make to our society.
529 In short, as one disabled man, a former high-flying executive in my constituency—Mr. Ted Gates—said:Think of us in terms of what we can do. The white stick, the wheelchair, the hearing aid can mask able and quick-minded people whose talents we should be taking advantage of. In any case, why should we be denied access to services that everybody else takes for granted?I totally agree with him.
The truth is that education and persuasion can go only so far. As my right hon. Friend the Prime Minister rightly said, the point is to focus on what can be done now and to present a Bill that will progress quickly. Sweeping statements calling for "comprehensive civil rights", which in any case is an American term tailored to their constitution, not ours, are not in themselves tangible, practical answers to daily problems. The borrowing of moral and legal fashions from America, ignoring the fundamental differences between our two systems and cultures, is rapidly becoming a curse in British politics. It is far better to concentrate on practical, day-to-day matters on which everybody is fully consulted—both the disabled and the providers of services on whom financial burdens can fall.
It is appropriate to concentrate, as our consultation document does, on employment rights, building regulations, access to goods and services and the establishment of a national disability council. Judging by the response from disabled people whom I know, those moves are very much appreciated. In my constituency, the Sutton Alliance of Disabled People welcomed the opportunity to meet my hon. Friend the Minister for Social Security and Disabled People last week. Among the points that were put to him was the need for a fully accessible transport system, and especially for accessible buses. They should be more widely available. I have to agree that, interlinked with the section in the consultation document on goods and services, attention must be paid to transport.
Interestingly enough—my hon. Friend the Member for Bolton, North—East touched on this-when a survey by the Conservative disability campaign asked responders to list in order of priority the three disability issues that they felt were most important, they put improved access to public transport first. The second was access to public buildings and only third came anti-discrimination legislation. Over and over again, people have said to me that access to buildings is meaningless unless they can physically travel there. Not everyone has an adapted car. Indeed, barely half a million disabled people hold a driving licence—hence the importance of considering bus provision.
Sixty-eight low-level platform buses are already being piloted in north London on five routes, with great success. They are sought after not just by wheelchair users, but by mothers with children in buggies, by people laden with shopping and by the elderly and frail who do not have the strength to haul themselves on board a normal bus. The custom is there, but sadly only a small number of bus companies are bringing such buses on stream. I accept that they cost about 15 per cent. more than a conventional bus, bringing the final cost to more than £120,000, but bearing in mind the fact that demand for them goes much wider than just registered disabled people, why not insist 530 that all new buses coming on stream must be fitted with a low-level platform? That is something that cannot be left to persuasion; it requires legislation.
I also welcome the decision to consider employment rights. Again, it is an area on which persuasion needs to be hardened up, but by the same token we must listen carefully to what the employers tell us about the problems that they have in employing disabled people. I wholly agree that it is iniquitous to have about 2 million fit and able-bodied people with disabilities who are not working. To get them off benefits and into earnings would make them net contributors, which must be to our advantage. In any case, employers would find that disabled people were excellent workers and more reliable because the job would mean so much to them.
I am delighted that my hon. Friend the Minister for Social Security and Disabled People appreciates the need for an advisory body—the national disability council—and that he accepts that it must have teeth. A toothless tiger would be a waste of time and money. There is no point monitoring discrimination without the power to do something about it.
A case that such a body would take up might be that of a young woman in Sutton who came to me for advice. She is in her early twenties, has two university degrees and is a skilled computer operator. Unfortunately, she cannot get a job. Admittedly, she is not very mobile and she does not speak very clearly However, so desperate was she to prove herself that with one potential employer she even offered to work for one week free of charge just to show what she really could do. As it happened, the job was well below her academic qualifications and she was rejected out of hand. I should like to think that the proposed national disability council would fight such monstrous discrimination tooth and nail. That woman should not be fobbed off without any means of seeking conciliation or redress. The council must not be just a talking shop.
Having said that, the major steps that the Government have taken over the past 15 years to make life easier for disabled people are well documented. In all, 35 pieces of major legislation have been introduced. Last year, we spent £17 billion supporting current disability programmes—that is equivalent to £300 for every person in the country, which is almost as much as we spend on our national defence whose budget is £23 billion. There will always be more to be done, but we do not have a track record of which we should in any way be ashamed.
I have one plea to make, and it is to the ardent campaigners who work with such great zeal on behalf of disabled people. The uproar in the summer may have had the positive effect of concentrating our minds on the cause, but it also had the dangerous effect of raising disabled people's expectations to unrealistic levels. I visited disabled groups in Sutton and saw for myself just how unsettling that was. Sadly, the whole issue became political and partisan. As a result, disabled people became confused, worried and anxious. I trust that now we shall have a period of calm and thoughtful work to take advantage of the 1,000 responses that have come in from all over the country from national and grass roots level organisations in shaping a Bill that will respond to very real needs.
Of course, some will say that the Bill does not go far enough. One can never satisfy everyone, but the truth is that most people will find that it plays a significant and 531 helpful role in their life. I am glad to say that, after a hiatus in the summer in which many passionate words were spoken, I now have a good working relationship with the disabled community in Sutton. We understand each other much better and I look forward to continuing my links with it. I should not like to see that relationship destabilised by those who seek political advantage from elsewhere.
In conclusion, I congratulate my hon. Friend the Minister for Social Security and Disabled People on his determination to chase across the landscape from north to south, listening to groups and grass roots individuals, let alone to go to the United States and examine the strengths and weaknesses of the American disability legislation. No one could argue that the Government are not a listening Government. The consultation document made that clear as it repeatedly said, "Let us have your considered views."
The Bill is the disabled people's Bill. I want it to reflect their practical input. I welcome the report that my right hon. Friend the Secretary of State for Social Security argued strenuously for an extra £100 million to support the Bill. All that is on top of the £17 billion that the Government spend every year on helping the disabled. There is commitment on our side. For the sake of all the disabled people whom I have met over several years, I hope that the Bill will have a smooth passage through Parliament.
§ Rev. Martin Smyth (Belfast, South)
I appreciate being called in the debate on the Loyal Address. Those hon. Members who know me will appreciate that I always welcome conversions. However, I recognise that genuine conversions are preceded by true repentance.
I wholeheartedly support the movement for action to remove the discrimination against disabled people that has existed for far too long. I do not retract my support for them. I have had a good relationship with the people in my community for many a long year. There has been no hiatus.
In the United Kingdom, the reforms of the national health service have been proceeding for some four years. In Northern Ireland, they are just getting under way. They started later, but they are now getting up a head of steam. Elements of the Eastern board have moved to trust status. The Northern and Southern boards are well on the way, but the Western board shows little sign of movement. Has it spotted something that the other boards have not? Could it be that it looks with dismay at the pain and confusion which has resulted from some parts of the transition?
From my knowledge of the slimming down that has taken place in the Eastern board and the Southern board, I wonder whether the supposed reduction in administration that will result from the abolition of the regional authorities is not merely a move to other areas of management. We have discovered that most of the people in the Eastern and Southern boards have moved to the various trusts and continued in management.
There is no denying that some aspects of the NHS reforms have brought improvements. However, too many decisions have been ill thought out. I wish to comment on several of them in Northern Ireland. Many of the factors also have relevance to other parts of the United Kingdom.
532 For example, I understand that boards and trusts in Northern Ireland have been told that they must implement a cost improvement programme and make efficiency savings of 3 per cent. in the coming year. Although 2 per cent. savings are likely to be made from improved productivity, where will the remaining 1 per cent. come from? In a public service which has been required to find regular savings, there comes a time when such cuts can be made only by imposing redundancies. I am concerned that the time is nigh.
Redundancies are also likely to result from some of the competitive practices that are being employed. I have nothing against competition; it often leads to a better deal for the consumer. However, the practice of multiple service tendering is causing a great deal of angst in the Province. In the past, NHS organisations had in-house services. Many such services were by nature small scale and not, on the new basis of competitive tendering, cost-effective ventures in their own right. For that reason, few private suppliers entering the NHS market wish to bid for individual services. Instead, the companies bid to supply all the services to a trust.
Under the competitive tendering system,the former providers can set up a company and tender an in-house bid. I take a particular case in Belfast, in which the contract winners bid £1 million less than the organisation in second place and £1.5 million less than the in-house bid, which came in third place. How can a company offer a bid £1.5 million lower than the in-house team, which has a detailed knowledge of what is involved?
§ Mr. Campbell-Savours
I am sponsored by Unison, which pays me no money directly, as the hon. Gentleman will know. As members of Unison, we are repeatedly approached by health service workers in Northern Ireland who express the deepest anxiety about the issue he raises. They say that competitive tendering is simply a charter to cut pay.
§ Rev. Martin Smyth
I appreciate the intervention. Under the Transfer of Undertakings (Protection of Employment) Regulations 1981, contractors are obliged to take on the staff under the existing terms of employment. However, human nature being what it is, even the acceptance of a small financial inducement changes those terms and leaves the staff vulnerable. I suspect that the contracting companies, as in the Belfast case, will be able to come in under budget only by making staff redundant.
It is fascinating to discover how competition has been eroded. In my constituency, the saga of the City and Royal Victoria hospitals continues. A decision has been made to rationalise laboratory services, and one laboratory or part thereof is likely to close. The element of competition, which was one of the prized benefits of the new approach, has gone. The closure rather appears to be an attempt to avoid competition. The inevitable result will be redundancies among some of the finest medical scientific staff one can find anywhere.
I do not wish to spend time on the issue of the Jubilee maternity hospital again, but will the Minister clarify, either in the reply to the debate or in a few days, his response on complementary medicine? The issue is causing great concern throughout the community.
I welcome the letter that he sent to all of us, but the very fact that confusion remains has been emphasised by early-day motion 14 and the subsequent amendment to it. 533 It shows that there is still some concern, which is heightened by the fact that we in the United Kingdom are apt immediately to implement European legislation, and that officials go further than they ought to. Other countries either ignore it or take years to implement it. It is time we started to protect our industry and services.
May we have an explanation of the outburst against "The Cook Report", which investigated sudden cot deaths? I raised this subject years ago, but I was never satisfied with the answers we were given. Neither am I satisfied with the attempt to rubbish the work of a scientist who has been pursuing the matter for years. I welcome the fact that the trend towards making children sleep on their backs has minimised the number of deaths—but have the pathologists and scientists at the Department examined the issue? My information is that they have not. Instead, they have accepted other explanations, without doing the necessary pathology work.
I have no intention of playing down the good work of the national health service, but I disagree with those who keep telling us that we are better off than other countries. That is not saying much. We want to maintain the high standards of our health service.
I offer the House a simple illustration of how the tendency towards privatisation can be detrimental. A constituent of mine with a small business to run was prevailed upon, because he needed heart surgery, to go private for the operation. The operation was successful, but then septicaemia set in. Specialists at the hospital advised his wife to take him home, on the grounds that he was going to die in a short time, anyway. She refused. She said that he had contracted the problem in the hospital, so he should be treated in the hospital. He was given antibiotics and, once he had recovered, he was transferred to another hospital for treatment of his arthritis.
Owing to his long stay in hospital, my constituent's firm went bankrupt. He was charged not only for the cardiac surgery but for the time he spent in hospital recovering—a further nine days at £200 a day, simply because he had contracted septicaemia. That is scandalous. As we seek to keep our health service moving forward, we must begin to eliminate some of these anomalies.
§ Mr. Sebastian Coe (Falmouth and Camborne)
I am pleased to be able to contribute to what has been a wide-ranging debate. Although I intend to speak about health, I should like first to compliment the hon. Member for Birkenhead (Mr. Field)—not in his seat now—on a speech of substance. It is a great pleasure to watch the faces of the hon. Gentleman's colleagues as he trespasses with such furtive guile into subjects that have remained no-go areas for his party for so many years.
I begin with a remark that runs the risk of sounding trite, but it is a truism all the same to say that the economic and cultural strength of a country, particularly this country, lies in its people: they are its greatest asset. Their health and well-being are at the centre of any discussion on health.
534 We know this from the stark reality of third world poverty. We know it from the pockets of deprivation in the United Kingdom, which are matched by equally challenging medical difficulties, in densely populated inner cities or in peripheral rural areas. We know it, too, from World Health Organisation statistics, and from the figures of similar agencies.
On no issue more than health does the House have a great responsibility to enter into responsible and dignified debate, and we have had such a debate this evening. It is a prerequisite of such debate that we avoid the anecdotal trail at all costs—the tabloid slogan that panders to scare stories of dubious origin, and even more dubious academic or scientific rigour.
The media have a major responsibility to fulfil. I would have liked to ask the editor of "Panorama", after the programme a few weeks ago that examined health care for the elderly, whether he would have slept as easily after the programme if he had known of the concern expressed to me only some hours later by a constituent about to receive treatment at the Treliske hospital in Truro. The hospital serves many of my constituents very well. He had got in touch with my office in a blind panic. After watching the programme, he feared that he would turn up at the hospital the following day only to be turned away. He thought that everyone over the age of 65 was suddenly going to be refused hospital treatment. His fears were, of course, unfounded.
The hon. Member for Belfast, South (Rev. Martin Smyth)—I am sorry to see that he is not in his place—spoke with erudition and with his long-standing concern about cot deaths. I am very pleased to have been given a son seven weeks ago. During my maiden speech, it was my great pleasure and privilege to thank the staff at Epsom general hospital for the safe birth of my daughter. Tonight, it is a great pleasure to thank them for the safe delivery of my son.
A few days ago in Cornwall, my wife and I switched on with great interest to watch "The Cook Report" on cot deaths and the problems surrounding some of the fire-retarding agents that have supposedly contributed to them. While we should never turn our backs on new information—scientific rigour is all about scrutiny and monitoring—we should also be careful about engendering unnecessary panic. Forty thousand people rang up ITV straight after the programme, and I for one wonder whether the programme makers took great pleasure in the glee with which they were able to announce that fact. Those people were extremely frightened.
I must also question the editorial judgment of any programme that decided to leave in the crass, ludicrous advice to parents of young children that, if they believed their mattresses comprised any of these substances, they should wrap them up in polythene. I am pleased that the Department of Health and the Chief Medical Officer managed to put the lid on that one quite quickly.
Hard evaluation, nationally, locally and at the point of delivery, often tells a story very different from that portrayed by selective editing. The constituent I mentioned, who was so unnecessarily frightened, went on to receive the right treatment. It was successful, and he is recovering. But he is not alone. He is one of the 7.4 per cent. more people who have been treated at Treliske in the past year, and had he needed out-patient treatment, he 535 would have been one of 8.3 per cent. more people going through the system. He is using a hospital that serves the medical needs of my constituents extremely well.
The hospital has just invested £1.4 million in a new dermatology unit, creating 14 more bed spaces and freeing resources in Falmouth community hospital. The hospital has a new public health laboratory—£3.6 million worth of facilities, opened in April and incorporating some of the most modern clinical microbiology provision to be found anywhere in the country. It has a county-wide coronary angiography service. That means that many of my constituents will not now have to travel to London for treatment—a total saving to London hospitals of some 400 patients a year.
Patients now enjoy the reassurance of being treated locally in familiar surroundings, with staff whom they know and with families close at hand. That enhanced service for my constituents, and the other services that will be created locally, are all part of the reordering of priorities from the centre, which have given new life to many of our regions.
If the London reforms mean that none of my constituents has to make a 520-mile round journey to London for treatment, I welcome them with open arms. For my constituents, the importance of health care delivered through community provision is, of course, all-important. They see new and expanding health centres, more practice nurses and well-funded care in the community, which, in Cornwall, is bedding down remarkably well. They see general practitioners who provide a standard of care and commitment that is unrivalled and who strive for continual improvement and, more often than not, achieve it.
My constituents are now part of practices that have more control over local hospitals. Gone are the days of the conversations that I once had with a local GP who, when confronted by one of his patients who had been booked in for a 2.30 appointment at a local hospital, but who was not seen until 6 o'clock, went to see the hospital administrator, who looked askance at him and said, "Well, of course, we book everybody in at 2.30."
There are new initiatives in health centres. Only last Friday in my constituency, I opened Link Line, a computer service that now operates from the Poole health centre, allowing information to be collated and disseminated among my constituents—all in support of care in the community. Health education and, more importantly, health promotion must be central to any national health strategy. There is more evidence in GPs' surgeries than ever before of real developments.
We still have much to do. As we go about our duties in this place over the next week, some 450 people will die from coronary heart disease. As we go about our duties in this place next year, some 40 million days will be lost to that disease. The sadness behind those statistics, behind the tragedies, is that so many of the deaths are preventable—not all of them, but so many. Recent figures highlighted our concerns about the number of women who smoke and who remain resistant to health campaigns. It is certainly no coincidence that coronary heart disease now claims more women than ever before.
We have much to do to remove the embarrassment factor from health promotion—the kind of embarrassment that seems to be behind the inordinately high incidence of prostate cancer, which goes undiagnosed and treated for so long, and which claims so many men.
536 Some of the major developments in health promotion have been in female diseases: advances in breast screening, cervical cancer screening, not to mention the major step forward in our immunisation programmes.
The right hon. Member for Derby, South (Mrs. Beckett) in part grudgingly accepted, then dismissed, the statistical significance of the recent British social attitudes survey. I must say that I find it more than statistically significant.
Let me return to the anecdotal evidence. I can count on the fingers of both hands the number of letters that I have received from constituents complaining about health services, GPs or hospitals over the course of this year. That is not to say that problems do not exist, but when constituents write, it is often not about a direct experience, but in response to a newspaper article or television programme that may have been badly researched. Very rarely are they from people who have suffered bad patient care.
The British social attitudes survey supports that. Nearly three quarters of those with recent experience of in-patient care are satisfied with that service, as compared with 56 per cent. of those without recent experience.
When the Government tackled the reforms, it was to an institution, a management dynamic that had remained inviolate from any reform for nearly 40 years. There are few institutions in this country about which one could say the same. The national health service still remains the biggest single employer in Europe, at one time employing more people than the Red Army. There was a management sclerosis. It is uncomfortable in some quarters to say that, but it was the case. Few things, if any, were costed—from bandages to serious operations.
The answer, of course, is that organisational change and the pattern of the new relationships that emerge within that change cannot be transformed over night or by the single flourish of the legislative pen. It has taken time, and it will take time, but it is gratifying that the British social attitudes survey is now identifying that transition and the very real advances made on behalf of the British people.
§ 8.6 pm
§ Ms Tessa Jowell (Dulwich)
I am pleased to be able to contribute to the debate and I would particularly like to address the proposals contained in the Queen's Speech that will give effect to changes in the law in relation to the community care that is provided to people suffering from serious mental disorder.
I shall draw on my own experience as for 13 years I was assistant director of MIND and, for five years, I was a member of the Mental Health Act Commission, which was a statutory body charged specifically with supervising the needs of people who are seriously mentally ill. It is important to place on record that the legislative proposal arrived in the Queen's Speech belatedly and only as a result of its successful battle for space after the proposal to privatise the Post Office was dropped. It is not a mark of great Government commitment to solving the problems of community care for people suffering from serious mental illness.
The first issue that we must deal with is the number of people who will be, or potentially be, affected by the proposals. The estimates based on research vary enormously from 300,000 to the more tightly defined estimate: that people who are seriously mentally ill are 537 about 1 per cent. of the 1 per cent. of the population who suffer from schizophrenia—between about 2,500 and 4,000. When the Minister replies, I hope that he will be able to shed some light on the size of the group that the proposals are expected to cover.
I am sure that I do not need to remind the House of the background to the new proposals and the public concern about recent tragic cases that has given rise to a crisis in public confidence about the effectiveness of community care. Why do things go wrong? None of the people who committed dreadful acts of violence, which, in some cases, resulted in murder, was unknown to the services. They had all at some time been in touch with the services. Characteristically, that group of people rarely commits an offence without talking to somebody beforehand about their intention.
Those dreadful tragedies occur because the system fails the victim and the patient. Too often, they occur after a culmination of events—after several cards have been posted through the door, saying, "Sorry you weren't in, and I missed you." When the community psychiatric nurse, the social worker or whoever is charged with responsibility fails to make contact, dreadful consequences follow.
In the past two years, there has been more debate about the crisis of confidence in community care for mentally ill people in the leader columns of newspapers, in pubs and on buses taking people to work than on the Floor of the House. We should not forget that, for every murder and every failure in community care, there are a hundred successes which are quickly obliterated. We now need to rebuild public confidence in a tattered policy.
What is causing the crisis in community care? The picture is complex. That there are many causes rather than just one has been the consistent theme of reports during the past 12 months. It has been expertly documented by the Mental Health Foundation and, more recently, by the Audit Commission, whose authoritative report was dismissed by the Government in an appalling and disgraceful way. They accused the report's authors of being unbalanced; I think that when any of us reads an Audit Commission report that is truly unbalanced, we look out of the window to see pigs flying past.
The crisis in care in the community relates not to the intention or the policy, but to the realisation of intention and policy. There is now ample evidence and experience to show what needs to be done to build effective, valued and co-ordinated services and guarantee high levels of professional performance. Living in the community, with a range of support services and practical assistance, is a viable alternative for all but a handful of patients who, for periods of time, need secure hospital treatment: indeed, it is the consistently preferred option for those needing such services.
For the policy to work, however, the needs of those whose lives will be shaped by it must be acknowledged and respected. Both the Mental Health Foundation and the Audit Commission argued that the approach to the development of community care services should be led by the needs of patients. They described the essential framework as including an appropriate place to live, an adequate income, a useful daytime occupation, access to help and support on a 24-hour basis and the opportunity to be consulted about the range of support available.
538 It should be remembered that—as many survivors of mental illness will say—mental illness is a career. Too often, planning and support are provided in relation to a single episode as though it were a discrete event rather than, as is sadly the case, likely to be one of a series in the individual's adult life.
Although we know so much about what makes community care work—have, indeed, known so much for 30 years, since the long-stay mental hospitals were first run down—we now have a geographical lottery. In only a handful of regions is there anything approaching a comprehensive mental health service capable of providing the support that patients need. What a scandal it would be if a cure for breast cancer were known, but available only to those living in, say, the Wirral or Edinburgh. Precisely that position exists in relation to the long-term care and support of mentally ill people. We know what is needed, but the Government have failed to provide it on a consistent and national basis.
Sixty-six per cent. of resources spent on mental health services are still tied up in the mental hospitals which treat 10 per cent. of those who suffer from mental illness. That means that, in the community, 90 per cent. of mentally ill people benefit from only a third of the mental health budget—an imbalance that desperately needs to be corrected.
The Secretary of State has said that reforms to mental health law have caused thependulum to swing too far".Interpreting such generalities is always difficult, but the Secretary of State appears to have claimed that patients' freedoms and civil liberties are now respected more than the need for those freedoms and liberties to be restricted or removed in the interests of the patients, or of society.
The changes in the law are primarily designed to adjust the swinging pendulum, and to reassert power and control over the way in which patients choose to live and behave; they are not intended to create any new legal regime whereby patients can be assured of the service that they need and to which they should be entitled. In words that the Secretary of State has been heard to use, "patients must take their medicine".
That is how the Secretary of State's legislative proposals will be regarded by those who fear being subject to the new powers, and by professionals who strive to win more—and more versatile—resources for their clients, only to find themselves being made legally responsible for supervising patients within services that are unable to meet even minimal levels of need.
Last year, I served on the health committee inquiry that examined in detail the case for additional legal powers, and broadly rejected the proposals that the Secretary of State is now presenting. We did so because we felt that a more fundamental review of the Mental Health Act 1983 was needed, and that piecemeal reform was misconceived; in our view, extensive legal powers were already available but insufficiently used, or insufficiently effective.
I still believe that to be the case, but I firmly believe that the time has come for the House to debate proposals of a different nature which would legally oblige health and social services authorities to provide those in need with a minimum level of service. Unless Parliament requires such action, I do not envisage the Government, 539 or those with local responsibility, ever taking seriously their duties to those who suffer from serious mental illness.
In the report of its 1993 review of mental health law, which recommended the creation of a new supervised discharge power, Department of Health officials stated:it must be recognised that the use of the power implies a reciprocal obligation on the statutory services to provide the support the patient needs".Any approach that does not make obligations explicit, easily enforceable and adequately funded will be both unjust and ineffective. I fear that the Government's measure promises to be both.
§ Mr. Mark Robinson (Somerton and Frome)
I warmly welcome various aspects of the Gracious Speech, but I intend to concentrate on social security and health.
The Gracious Speech heralds a constructive legislative programme, containing measures that will be important to many people. It is a pity that the absence of ideas in the Labour party should present such a stark contrast. I could not help noticing that on seven occasions the right hon. Member for Sedgefield (Mr. Blair) failed to provide answers to what were, after all, very direct questions.
The success of the programme that has been announced will depend on the Government continuing their policies for a sound economy. Only through those policies can the programme be financed. They have resulted in the lowering of inflation, a steady fall in unemployment levels and—in succeeding months—the fastest-growing economy in Europe. Efforts to promote enterprise and improve economic performance must therefore remain at the heart of Government policy.
The Government must build on the work that they have done already to reduce the budget deficit, even at the expense of short-term popularity. I hope that the forthcoming Budget to be delivered by my right hon. and learned Friend the Chancellor of Exchequer will reflect that.
As the honorary president of Frome Mencap, I welcome the Government's decision to introduce a Bill to tackle discrimination against disabled people. I have always believed that this task should be undertaken by Government, especially in view of the costs involved, and not left to a private Member's Bill. I wish legislation had been introduced earlier, but I am delighted to see it now.
We must not overlook the fact that the Government approach this subject with a considerable record of support for disabled people. Spending on benefits for the long-term sick and disabled has increased by more than 200 per cent. since 1978–79, rising to the present level of £17 billion. The new legislation must help disabled people in their struggle to achieve independence and secure even greater recognition of the successful contribution that disabled people make to life in the community.
I visit many community activities for disabled people in my constituency, and I never fail to be impressed by the dedication and achievements of the participants and by the carers who help disabled people so much. If I have a plea this evening it is that we do not forget the carers; that we do not forget to care for the carers. After all, respite makes a better carer. By encouraging and helping carers to look after disabled people, we ensure that they are able to do a better job.
540 Attitudes to disabled people have changed beyond all recognition over the past 30 years. That is reflected by the speeches that are made again and again on both sides of the House. I pay tribute to those members of the all-party group on disablement—the hon. Member for Kingswood (Mr. Berry), my hon. Friend the Member for Exeter (Sir J. Hannam) and all the others, including Lord Ashley from the other place—who have done so much to raise the level of recognition of, and interest and concern for, disabled people.
That is why I believe that, when it is enacted, the importance of the legislation will be recognised. I am sure that it will work effectively. However, we must remember that we cannot achieve everything at once. It is by working hard, effectively and consistently for disabled people that we have secured vast achievements over past years. Fifteen years ago, people would not have believed that we could have come as far as we have today. That is not to say that we have gone as far as we can; we have not. We have much work to do and there is great enthusiasm in the community to undertake that work.
I visited the Bath and West show in my constituency this summer, where I attended a disabled persons games. This was not a special activity, heralded with special fanfare; it was a normal and natural activity which has gone on for a number of years. That is the way in which I believe that disabled persons want to carry out their activities: they do not want them to be seen as something special, or something to be gawked at, but as natural a part of community life as a hospital open day or whatever.
I now turn to the issue of unemployment or, more importantly, the need to get people back into employment. Many people come to my advice centres to complain about the inflexibility of the benefits system. People often say that they have sons or daughters who want to get back into employment but who are finding it extremely difficult. That is why I welcome the job seeker's allowance initiative.
It is very difficult to enact change in the benefits system, because whenever an attempt is made some pressure group will scream that it will disadvantage X or Y. It does not matter which party enacts the legislation, that is the automatic reaction—particularly as the negative points tend to be highlighted in the media whilst the positive ones are left, rather conveniently, to one side. It is only at a later date when one sees that the legislation is working and that people are benefiting from it that the press realise the success of the measures which the Government have already undertaken. I see the job seeker's allowance as building on such success by introducing the concept of incentive, which is what the back-to-work bonus will be all about.
I endorse wholeheartedly the remarks by my hon. Friend the Member for Falmouth and Camborne (Mr. Coe) in recounting experiences from his constituency. Not only is the national health service working well currently, but it is improving all the time. The Labour party does not like to acknowledge that fact for obvious political reasons, but it is borne out by monthly published statistics.
The long hospital waiting lists are reducing, and we need to see that. When I was first elected as the Member for Somerton and Frome in 1992, there was a long-running campaign for 24 hour ambulance cover. I was astonished that there was no such cover in Frome when it should have been provided. So I went straight to the Wessex regional health authority and I would not take 541 no for an answer. Within nine months, that necessary service was implemented and since that time I have received no further complaints about ambulance cover. That is a good local example of an improvement in the national health service.
Similarly, there were almost outraged demands for a comprehensive breast-screening service in the Frome area. Those involved in the campaign seemed to assume almost automatically that the Government would not make this service available. Equally speedily, the problem was resolved—another local example of improvement in the national health service.
I have seen great improvements in the quality of health care provided. I pay tribute to the local hospital trusts, which operate from Yeovil, Taunton and Bath, for the work that they have done to secure that improvement. Waiting lists in my constituency have come down substantially and the number of complaints in my mail bag is also coming down.
I meet people all the time who have returned from some sort of hospital treatment. They often express surprise at the quality of treatment that they have received. When I ask why they are surprised, they say that it is because of all the negative reporting about the national health service that they have seen in the newspapers. They say also that it is because of the negative comments that they hear from the House of Commons. Those comments come not from Conservative Members but from Labour Members. The Liberal Democrats are not free of blame on that score.
The most vociferous complaints about the NHS often come from people who have not been near a hospital for 10 years, and base their views simply on what they have read in the newspapers. I will not talk for London or Birmingham, but we often hear about the problems facing people in rural communities.
My constituency is wide-ranging and covers many rural communities. The people living in those communities are being extremely well-served and well looked after by the NHS. If they do complain, those complaints are taken up and dealt with extremely swiftly and the problems are sorted out. It is a sad fact that nine tenths of those problems are due to bureaucratic mismanagement, which, once it is looked at by senior managers, can be sorted out quickly and easily.
The improvements that have been brought about by my right hon. Friend the Secretary of State's insistence on supporting and developing the hospital trust concept and the success of many of the fundholding practices has brought about a need to refine and reduce administrative structures. That is why I am glad that a Bill will be introduced to abolish the eight regional health authorities. I would not say that it is overdue, but the time has now come. The regional offices that will replace them will employ just over 1,000 people, compared with nearly 4,000 managers and their support staff employed in the 14 regions two years ago. Time and again, constituents come to me to complain about excess management in the NHS. We are tackling that problem.
We can never do away with management, particularly in a service that is complex and which has strongly entrenched professional organisations. However, we can improve that management. We can streamline it and ensure that it works effectively. By breaking management 542 down to individual hospitals through the hospital trust system, we have managed to bring about a far better performance and, with it, thank goodness, substantial reductions in waiting times.
John Yeats has done a great deal of research into this subject, and he has said time and again that it is the time that people have to wait that matters, not necessarily the numbers waiting. People are prepared to wait a reasonable time for non-urgent surgery. People should not have to wait at all for urgent surgery. I am sometimes disappointed when I find constituents who are being treated as non-urgent even though their condition has worsened but their general practitioner has not reported that change to the local hospital. Once it is reported, treatment is effected quickly.
There is a great deal to encourage me in the Queen's Speech. I should like to mention briefly the reform of agricultural tenancy law.
§ Madam Deputy Speaker (Dame Janet Fookes)
Order. The hon. Gentleman must not mention that even briefly. It does not fall within the terms of the amendment.
§ Mr. Robinson
I understand that, but it is enormously welcome to farming interests in my constituency.
§ Mr. Alan Milburn (Darlington)
John Maples's advice to Ministers to batten down the hatches on NHS matters clearly came too late for the Gracious Speech. The Government will live to regret that. The NHS management changes outlined in the Queen's Speech will bring yet further health trouble to a Government who are drowning in a mess of their own making.
In October last year, the Secretary of State for Health first told the House of her plans to reform the management of the NHS in England. Her intentions were radical. She said:These changes will slim down NHS management. They will make it simpler and sharper … They will save money on administration to spend on patients, and they will uphold and strengthen accountability. They will continue the process of decentralisation".—[Official Report, 21 October 1993; Vol.230, c.400.]How could anyone disagree with those aims? The claims will be judged when detailed proposals are laid before the House, but they also have to be judged against what has gone before. There, the Government's record betrays their rhetoric.
To date, the Government's assault on NHS red tape has turned out to be a damp squib. Even that inveterate self-declared campaigner against bureaucracy in the Welsh NHS, the Secretary of State for Wales, has failed to come up with the goods. Since he declared war on bureaucracy in the Welsh NHS in autumn last year the number of health service managers there has not fallen but has increased. The same is true in England, where the latest Department of Health figures show that in the year to September 1993 managerial numbers increased once again, this time by 13 per cent. That is despite a blatant attempt by Ministers to massage the figures. So much for the Secretary of State's claim about slimming down NHS management. It is not slimmer or leaner and it certainly is not fitter, but it is fatter.
What about the other side of the equation? What about saving money to spend on patients? The evidence is equally graphic. An extra £1.5 billion has been spent on 543 managerial salaries since the advent of the market in the NHS. There are bumper salaries for a few but a pay squeeze for the many. This year there are 17,500 fewer nurses on England's hospital wards than there were last year. Increasing the number of managers and cutting back on nurses is hardly the priority for a national health service where 1 million patients are currently waiting for hospital treatment.
The Secretary of State for Health now says that she has learnt all the lessons. She says that the abolition of the regional health authorities will put matters right by launching a new assault on bureaucracy. Her Department's figures give the game away. They show that she has the wrong target in her sights if she wants to make an effective job of tackling NHS red tape. The abolition of the regions will do nothing to tackle the 7,500 extra managers outside the regional health authorities who have been recruited to implement the Government's market changes. The boom in health bureaucracy has taken place not at regional health authority level but at hospital level as a new contract culture has taken over inside the national health service.
The abolition of regional health authorities will achieve at least some of the Government's objectives. It will undermine health service planning and further undermine local accountability in the national health service. The light touch that the Secretary of State commends as a virtue of NHS management executive outposts is irrelevant in a region such as mine, where the incidence of ill health and health inequalities call not for a light touch but for strong Government intervention. Those health inequalities and the health problems that characterise the north also call for in-depth knowledge of the region so that resources can be targeted where they can be most effective.
The merger of Northern regional health authority with Yorkshire regional health authority will make for a more centralised, out-of-touch service and a less accountable NHS. The future of health care will be the preserve of people without any stake in the regions. Policy, however, will mirror the sort of confusion that exists at more local level.
There is no disputing the merits of the proposal to merge family health services authorities with district health authorities, which makes sense, but greater coterminosity is being compromised by other Government policies, most notably by the free market approach to health authority mergers, by the advent of health commissions, which are even further distanced from local communities, and by allowing the local government review to happen without reference to institutional change in the NHS.
In my own area, for example, the Local Government Commission is likely to recommend in a few weeks' time the welcome restoration of self-government to Darlington. Henceforth, the town will run its own social and housing services, but the devolution of local government powers from County Durham to Darlington is being accompanied by the centralisation of health powers from Darlington to County Durham. The forced merger of Darlington health authority has resulted in the purchase of health care being undertaken by a county-wide commission. Inevitably, the already yawning gap between social services and health services, so apparent in community care, will become a chasm as decision-making structures become ever more distant from one another.
544 It is a classic case of one set of Ministers not knowing what the other set is up to. The dog's breakfast that results can only compromise patient care. Nor is that a problem peculiar to my area. Across the country, a laissez-faire approach to health authority mergers has given rise to a patchwork quilt of purchasers. There is no direction from the centre, no overview and no planning. Instead, the market and the whims of local health managers are deciding the future shape of the NHS.
There is one bonus, of course, for the Conservatives in this hands-off approach: a further distancing of NHS decision making from the local communities that the health service is supposed to serve. That makes it easier for centrally determined free market thinking to be imposed on the NHS in all parts of the country.
That policy is aided and abetted by a secretive and closed health appointments system. Not surprisingly, that system puts the friends, supporters and even the relatives of members of the Conservative party into key positions, both in NHS trusts and in health authorities. To date, the public have footed a —40 million salary bill for turning NHS trusts into a lucrative job centre for redundant Conservatives.
Ministers could have used the Queen's Speech to make the minimum changes necessary to restore credibility to that discredited system. They could have used the speech to ensure that the lists of people nominated to serve on a health authority or an NHS trust are published. They could have insisted that the selection procedure and the criteria be made transparent. Finally, they could have insisted that, as is the case for people wishing to serve on magistrates benches, the party political affiliations of individuals be declared.
Ministers' refusal to accept those changes clearly shows that they believe that jobs for the boys and for the girls are more important than public accountability in the NHS. They are unscrupulously using the current appointments system to further Conservative interests in the NHS.
I remind Ministers that the health service is not their plaything. It is certainly not the plaything of those people appointed by Ministers. It belongs to the people as a whole. It is a public service and it should be properly and publicly accountable. In place of the chaos and inefficiency of the Government's health care market, we need an NHS that is free, fair, open, accountable, well planned and properly managed. I am afraid that that sort of vision for the NHS will have to await a future Queen's Speech from a future Government.
§ Mr. Robert Hughes (Aberdeen, North)
There is much that I should have liked to debate with the Secretary of State for Health. Unfortunately, time does not permit that. I shall say, however, that she constantly says at the Dispatch Box that the previous Labour Government cut nurses' pay. I am afraid that she is misinformed. She should look back at the records. It was the Labour Government who set up the Hallsbury committee on nurses' and midwives' pay, and it was of great benefit to the nursing profession, in terms of both their pay and their status. I hope, therefore, that the Secretary of State will consider the facts.
The Aberdeen Royal Infirmary NHS trust in Aberdeen was the flagship of the Government's trust proposals and campaign in Scotland. It was trumpeted as one of the best 545 trusts that would be available. All sorts of tributes were paid to it. What has happened? Waiting times have lengthened and the number of patients on waiting lists has increased to the extent that something has had to be done about it.
For some reason or other, the new trust, a flagship of the NHS trust system, has run into rough water. It is in choppy seas. Grampian health board, the purchaser, has had to do something about it. Today, it announced a new £500,000 plan to cut waiting lists. The result is that some services that are to be additionally provided will go to NHS trust hospitals. Some people, however, will have to travel from Aberdeen to Elgin, some 50 miles away, to have their operations.
Even worse, some 50 urological operations and 100 plastic surgery operations will be bought from local private hospitals. I fear that that is what the future holds. As the health service runs into difficulty, services will be bought from private hospitals, which is creeping privatisation. Of course, Ministers will say, "Do you want patients to wait longer and to suffer? Is it not better that services are bought from private hospitals?" It is all very well saying that, but a deliberate attempt is being made to run down the health service.
Grampian health board even went to the extent of trying to purchase about 100 operations from Health Care International hospital in Clydebank. Only seven people from Aberdeen wanted to be treated there. They did not want anything to do with that hospital. That sort of thing brings the health service into disrepute.
§ Mr. Hughes
I am sorry, but I have sat in the Chamber all day and I shall not give way to hon. Members who have just entered the Chamber—at this point.
§ Mr. Hughes
I am generous to a fault, but I do not want to be diverted.
Community care has been at the core of the Government's national health service reforms. I think that all hon. Members agree that the right principle is behind the community care policy. No one would wish any long-stay patient to remain in hospital any longer than necessary. We would much prefer that such patients received community care. The problem is that for many people what is supposed to be community care is not community care at all.
In Grampian, there are some very good examples of small units for former patients of mental hospitals. They are well supported and are a tribute to the community care system, but they are not a cheap option as they can be even more expensive than in-patient care. However, what so many elderly people are offered under community care is simply a transfer from institutionalised public care to institutionalised private care. What lies behind that is one of the most damaging things that the Government have done, which is to abandon the duty to care. That is fatal for the health service and for the patients it serves.
We are witnessing a cynical exercise by the Government to transfer people from hospitals into the private sector to save the public purse. They wish people 546 to pay and to enable private nursing homes to make a killing. Some months ago, I had a very interesting conversation—that is a polite term for the exchange—with the owner of a private nursing home. At any rate, he was more open than the Government. He said that the first method of dealing with the elderly who were in need of nursing care was private hospitals, and that the NHS should be the last resort. He complained that too many social workers were interfering with his ability to choose who he wanted to accept in his private nursing home. When I asked him how he chose, he admitted that his test for admission was not whether his nursing home could provide adequate care or whether particular patients were the most needy, but whether they could pay.
I asked the owner what would happen if he accepted someone, but it turned out that his home could not provide the proper care. He replied that that would be someone else's problem and that the patient would simply go back to the NHS. The notion that the NHS is to be a sort of slum where people go only when there is nothing else available is what I find most offensive about the Conservatives' treatment of it. The NHS should be about excellence, and its first priority should be to ensure that people get the care that they need.
I deal now with an issue of particular importance to Aberdeen, which is the future of Woodlands hospital. It is not, in fact, in my constituency but in that of the hon. Member for Kincardine and Deeside (Mr. Kynoch), to whom I might give way if he seeks to intervene again. However, many of the patients are, in a sense, my constituents, and certainly their parents are.
The patients at Woodlands are very vulnerable and require specialist medical care and attention. In its business plan, Grampian Healthcare NHS trust proposed that the hospital should be closed and its patients transferred to a unit on the site of the Royal Cornhill hospital. From the beginning, this issue has been handled extremely insensitively, to put it mildly. The manner in which it has been handled exposes a major flaw in the purchaser-provider split. Patients have been almost bandied about between purchaser and provider as though they did not count. I am sure that that was not the intention, but that is what has happened.
The unit that was to be opened at the Royal Cornhill site was to be a refurbished and extended former acute psychiatric unit for severely mentally ill patients. It was feared—indeed, this was mentioned in the trust's own documents—that the distinction between mental handicap and mental illness would be at best blurred or at worst extinguished.
There has been the three-month statutory consultation period about the closure, but Grampian health board—the purchaser—has confirmed the closure of Woodlands hospital and the transfer of patients to the new Royal Cornhill site. However, it is proposing a new-build hospital costing £3.5 million, which is £1.6 million more than the earlier cost.
Many of my colleagues might ask, where is the problem? They might jump at the chance to have in their constituency a new-build hospital costing £3.5 million. I do not reject the proposal out of hand—it must be examined seriously—but the recommendation raises as many questions as it seeks to answer.
547 Grampian Healthcare trust—the provider—has made it abundantly clear that it does not have the necessary money, so where is the capital to come from? There has been great controversy about the problems of selling the current Woodlands site, but why is it not possible to refurbish and upgrade the current hospital buildings, which were opened only in 1974? Admittedly they were built for children, but they could well be improved and adapted, because far fewer patients now use the service.
I am anxious to put patients first—they are the only ones who matter—but the parents must also be satisfied because they have a close and continuing interest in the future of those whom they still regard as their children although they are, in fact, adults. I hope that the Secretary of State will not rush to make a decision until all the facts have been thoroughly explored.
Would Lord Fraser of Carmyllie be prepared to meet a deputation of parents or friends of Woodlands? I discussed the matter last Friday with some of the parents as I do not believe that Members of Parliament can adequately articulate their fears and concerns. We are dealing with a very vulnerable group of people whose parents are naturally anxious about the future. Would the Secretary of State or Lord Fraser of Carmyllie be willing to meet such a deputation?
I am happy to report that three other hon. Members who share this "common resource"—the hon. Members for Aberdeen, South (Mr. Robertson), for Gordon (Mr. Bruce) and for Kincardine and Deeside—agree that the proposition is worth pursuing.
§ Mr. Kynoch
I thank the hon. Gentleman for his courtesy but point out that Woodlands hospital is in my constituency. He has accepted that there are some successful examples of community care in Grampian. Does he also accept that the people whom we are unfortunately having to put into a purpose-built, highly modern building, which may be at the Ross clinic on the Royal Cornhill site, or where the Grampian health board has proposed, require hospital treatment? Does he further accept that, however sad it may seem, the relatives of those poor unfortunate people will more than likely find it very difficult to stand back from the situation and take a purely rational view?
§ Mr. Hughes
There is no doubt that there is no real alternative to in-patient care for those patients. Certainly the parents are emotionally involved, but I believe that they are capable of standing back and taking a rational view. If they could see the Secretary of State, they would put the case strongly, because, as I have said to them and as they all understand, we cannot allow the situation to last for months. We must arrive at a decision.
The problem about the new £3.5 million proposal that the hon. Gentleman mentioned is that it has been made almost as an afterthought. After three months of discussion in the statutory consultation period and some months of discussion beforehand, we were suddenly presented with that proposal. That is not the way to plan the health service. I agree with the secretary of the Grampian health board at least to the extent that having consultation after a de facto decision, rather than discussing the future planning of the health service, is not 548 the right way to go about things. I shall be pleased if a real rational discussion about the future of the health service comes out of the debate, even if nothing else does.
I should have liked to mention, even if only in passing, a great injustice in my constituency concerning the exgratia payment by the Department of Employment to redundant trawlermen. However, I can see the light in your eye, Madam Deputy Speaker, and I shall not transgress against your good nature. I simply hope that if I apply for an Adjournment debate on the subject, you will use your good offices with Madam Speaker to ensure that I get it.
I believe strongly in the health service. We must have the first and the best class of treatment. I do not believe that the Queen's Speech provides that; it is deficient in many respects for my constituents, who are short of employment and who badly need housing and decent education. Regrettably, the Queen's Speech fails the nation, as the Conservative Government have failed it over the past 15 years. I look forward to a Queen's Speech that will redress the wrongs that have been done over the preceding decade and a half, or however long it might turn out to be.
§ Mrs. Alice Mahon (Halifax)
In the short time available, I shall concentrate on a health care issue which needs widespread public debate, and on which we need answers from the Government. In recent years, there has been a dramatic reduction in national health service continuing care beds. Parallel with that development there has been massive growth in the number of long-term beds in private residential care homes.
For years, since the early 1980s, that trend has taken place with little if any public debate. Tory-appointed health service managers, acting by stealth and helped by the Government's cash restrictions, are closing down wholesale the beds for people with long-term illnesses. That means not only the elderly but anybody who needs a long-stay bed.
However, the situation was given a good public hearing when the health service ombudsman concluded earlier this year that the Leeds general infirmary had failedto provide long term NHS care for a brain-damaged patient".That patient had been in hospital for 20 months and needed full-time nursing care. That fact was never in dispute; what was in dispute was where the care should be given and who should pay for it.
Similar arguments and discussions have been taking place in every part of the country, and are the subject of intense debate in my constituency of Halifax, where the Tory-appointed managers have decided to close a purpose-built hospital—Northowram hospital, where I worked for nine years. It now has only 261 beds, because the rationalisation programme is already taking place, and it cares for the elderly and mentally ill, offering excellent treatment. We are not talking about an old Victorian geriatric hospital. Northowram hospital offers excellent rehabilitation and reorientation programmes, and respite care for elderly, sick and mentally ill people, which gives carers a much-needed rest. It also has a number of continuing care beds for people who need them.
The Independent recently published a good compassionate article supporting someone whose husband was at that time in Northowram, although sadly he has 549 now died. Clifford Smith desperately needed full-time nursing care, 24 hours a day. His 80-year-old wife, now his widow, agreed to the publicity because she did not want the hospital that had cared so well for her husband to close, and she was frightened of what might happen if it did.
In his judgment on the Leeds case, the ombudsman quoted the Department of Health's guidance on discharge, specifically that part of it which says:No NHS patient should be placed in a private nursing or residential care home against his/her wishes if that means that he/she or a relative will be personally responsible for the home's charges.I followed up that decision by asking the Prime Minister directly in the House if that guidance still applied. Would he give a guarantee that people would retain the right to a free national health service bed? The Prime Minister's reply was quite specific. He said:I can certainly give the hon. Lady that guarantee: the right to national health service care free at the point of delivery is an integral part of the Government's policy, and will remain so"—[Official Report, 14 July 1994; Vol. 246, c. 1167.]We also remember the Prime Minister's speech to his party's national conference when he talked about his own frail, elderly father and said that he would never do anything to harm such a patient. He should be reminded of what is now happening to many people.
We know that in practice, because of the massive bed closure programme over the past few years, many elderly sick and chronically sick people have been bullied out of their free national health service beds. A recent statistic from the National Association of Health Authorities and Trusts shows us that the number of beds for the elderly and mentally ill in the national health service fell from 73,000 in 1990 to 59,600 in March 1993. Over the same period, the number of beds in private nursing homes rose from 89,600 to 144,000. That is a massive shift of elderly people and chronically sick people out of the national health service into the private health care sector, where they or their relatives are means-tested. In most cases, they have to find the money.
This privatisation had been happening quickly enough, but seemingly not quickly enough for the Government. When the ombudsman blew the whistle on this inhumane treatment of the elderly and the chronically sick, the Secretary of State for Health decided to do something. On August 12, she issued new draft guidance to health authorities which was aimed, ostensibly, at clarifying the responsibility for long-term care. It was an underhand way to introduce new guidelines as Parliament was in recess and the consultation period ended before Parliament came back. We can only conclude that the Secretary of State wanted to avoid the debate—but she will not be able to avoid it.
The new draft guidance, if implemented, will take away the right of a vulnerable group to have treatment on the national health service. It says that only patients withcomplex or multiple health-care needsrequiringcontinuing and specialist medical or nursing supervisionwill have the right to long-term nursing care free of charge. The significant majority of people who need continuing care in a nursing home are expected to have their needs met through the social services.
550 We all know how patchy the social services provision is. We also know that, if the shift takes place, this group of people will no longer be entitled to a free national health service, but will be subject to a means test. Such patients may be discharged to a private nursing home against their will and they or their relatives will have to pick up the bill. That is the truth, because we do not have massive, comprehensive packages of health care in the community and those that we do have are not free. That is a complete betrayal of elderly people.
Many thousands of elderly people will lose their life savings and their homes because the draft guidelines introduce strict demarcation lines between what is medical and what is social. All that we get from the Secretary of State are the usual lengthy diatribes, which we had today, about how many more people are being treated on the NHS. She blathers on like a clockwork parrot and some of us are getting pretty sick of it. She has reneged on the principle of the national health service providing for medical and nursing needs from birth to death, and she has done so quite openly.
When the Select Committee on Health recently questioned the Secretary of State on the subject, she said that it was necessary to reissue the guidance because of the ombudsman's comments about the Leeds case. Later in the same evidence session, she refused to say, in response to a question from my hon. Friend the Member for Preston (Mrs. Wise), whether under the new guidance the patient in the Leeds case would have been entitled to national health service care. She said:I do not feel sufficiently intimately aware of the individual case.We have had a major change in policy based on a case of which the Secretary of State admitted in a public meeting she was ignorant. The elderly and the long-term ill have no friends in this Government. The Secretary of State can only regurgitate as many statistics as she can think of at the moment. The elderly and the long-term sick are absolutely right to be frightened of her.
Anyone who saw the "Panorama" programme the other week and who saw people speaking out about their fears knows that it is not a question of the Labour party making them frightened. It is everything to do with what the Secretary of State is doing. She talks about community care which for many people does not exist. She should listen to elderly people, she should listen to the pensioners. I give her a warning: if she does not start listening, their voices will be raised to such a crescendo that even the present Secretary of State, who is blind to any opinion but her own, will be forced to listen.
§ 9.9 pm
§ Mr. Geoffrey Clifton-Brown (Cirencester and Tewkesbury)
I am pleased to be able to follow the hon. Members for Halifax (Mrs. Mahon) and for Aberdeen, North (Mr. Hughes). I wholeheartedly welcome two measures in the Gracious Speech, which state that the Governmentwill bring forward legislation to make further improvements to the management of the National Health Service; and to provide for people with a serious mental disorder discharged from hospital to be cared for under supervision."—[Official Report, 16 November 1994; Vol. 250, c.6.]I am sorry that I have been unable to attend the whole of the debate, but in the little time that I have been present I have heard some monstrously political statements about the national health service which, since the reforms that 551 we introduced in 1991—the introduction of national health service trusts and fundholding GPs—has gone from strength to strength. I noticed that both main Opposition parties—certainly the Labour party—wanted to abolish NHS trusts and fundholding GPs, which have so much benefited the care of health service patients in this country.
§ Mr. Clifton-Brown
I was not even speaking from a brief, actually. The hon. Gentleman, who interrupted from a sedentary position, should look before he speaks. I was not even speaking from a brief. I have some notes prepared, but I do not even need them because the Government's record on the national health service is so good and I happen to have one or two facts in my head about their achievements in that respect.
§ Mr. Wilson
If the hon. Gentleman does not need the Conservative central office brief, perhaps he would lay it down.
§ Mr. Clifton-Brown
I am more than happy to lay it down to keep the hon. Gentleman happy and I am perfectly happy to speak without the brief because, as I have already said, I have the facts in my head.
The main party of Her Majesty's Opposition want to abolish NHS trusts and fundholding GPs, which is absolutely disgraceful, considering the benefits that they have brought to the health service patients of this country.
There are now some 419 NHS trusts. My own NHS trust, the East Gloucestershire national health service trust, was introduced in April 1991 and has brought continuous benefits to the patients in my constituency in Gloucestershire ever since it was introduced. It has been able to bring about more refurbishment to the local hospitals and it has been able to treat patients in a more sympathetic way than ever the NHS was able to do before its introduction.
The result is that 92 per cent. of patients in Gloucestershire are now treated within six months. That is a significant performance. Also, as a result of the trust, nobody has to wait more than nine months for treatments for hip replacement, unlike the position in some neighbouring authorities where people have to wait considerably longer.
On the national scene, the performance is even more impressive. Some 98 per cent. of all NHS patients are now treated within one year. Waiting lists beyond two years have all but been abolished—[Interruption.] I hear sedentary interventions from Opposition Members. I remember the bad old days when Labour was in control in the 1970s. One was admitted to hospital merely as a number. One was lucky if one's appointment to see the specialist was not cancelled and, even if it was not cancelled, one probably had to wait some considerable length of time to see the specialist. Having seen the specialist, one then had to wait many months, if not years, for treatment.
552 With the introduction of the patients charter, patients are no longer mere numbers within the NHS; they are customers—[Interruption.] Opposition Members may laugh, but my constituents, whom I meet in their hundreds throughout the year, welcome the care and dedicated treatment that they receive from NHS nurses and doctors. How much better the service is now, compared with its performance in the 1970s when you were in charge of it—
§ Mr. Clifton-Brown
I would never credit you with being in charge of the NHS, Madam Deputy Speaker. I pay due deference to the Chair. Labour Members were in charge of the service, however, and what a chaotic shambles it was in those days.
To enter into a more serious political debate, it is fair to say that the NHS has never been better than It is nowadays. It has never had more money spent on it. We shall be spending £32 billion on it this year. That spending will be second only to expenditure within the social services budget. It is much to the Government's credit that expenditure on the service has increased from £8.5 billion in 1979, when the Conservatives regained power, to its present level.The money now being directed to the NHS will be better and more wisely spent than ever before.
There have been many critical speeches from Opposition Members about bureaucracy in the service. Yet one of the Bills described in the Gracious Speech is designed to abolish regional health authorities. That will surely reduce bureaucracy in the service, yet Opposition Members criticise what we are trying to do. We are reducing bureaucracy in the health service and providing better and better patient care by increasing the resources available for front-line treatment by doctors and nurses.
There is reference in the Gracious Speech to a Bill which will enable the long-term mentally sick to be cared for properly. I feel that I must mention the sad case of one of my constituents who was working in the East Devon NHS trust in the Edith Morgan mental health unit. A patient who had recently been discharged from the unit came back and killed her by stabbing her with a knife. On behalf of my constituents generally, I express my deep sympathy in regard to that case.
I welcome the Bill that the Government intend to introduce. I believe that it will come forward as a result of some of the representations that I made to my right hon. Friend the Secretary of State for Health. The Bill will enable the long-term mentally sick to be safely discharged into the community under long-term care—[Interruption.] Instead of making sedentary remarks, Opposition Members should warmly welcome the proposed Bill. I hope that they will support it as it makes its passage through the House—[Interruption.] I understand that time is pressing and that the Front-Bench speeches are due to be made—
§ Mr. Clifton-Brown
I understand that, Madam Deputy Speaker. I also understand that it is a fundamental principle that when a Member has the floor he is entitled to conclude his speech. If you will be very kind, Madam Deputy Speaker, I shall rapidly conclude my remarks.
553 Contrary to all the scaremongering of Opposition Members, the health service is providing better care. Patients are spending less time in hospital, scientific advances are being made every day within the service, there are better practices and better treatments, and better drugs are being applied. Those advances have all been brought about because the Government have provided the resources and stewardship that the NHS needs.
§ Mr. Donald Dewar (Glasgow, Garscadden)
My only comment on the contribution of the hon. Member for Cirencester and Tewkesbury (Mr. Clifton-Brown) is that he would pass any loyalty test likely to be put to him by the Government Whips. He does not need to worry about his rating in that respect.
When considering the Queen's Speech, it will not surprise Ministers if I begin by referring to a sin of omission. There is nothing in the Queen's Speech about the Child Support Agency or its reform. May I say very briefly and sparely—there should be. We are seeing a disaster on a scale that none of us anticipated back in 1991. It is a disaster in respect of which our worst fears are being constantly outdistanced by reality as it emerges.
We received the report of the chief child officer the other week and I want to refer to only one bare set of statistics. Of a sample of 1,188 maintenance assessments examined by the chief child officer, he could certify as correct only 157. Some 545 were incorrect and in 486 the file was so incomplete that it was impossible to decide whether the cases were correct or incorrect.
I do not want to be vindictive, but I wonder how the civil servants' concept of performance-related pay would deal with such a situation. That is perhaps now academic as there have been changes at the top of the CSA. However, that point underlines the immense scale of the crisis.
I can think of no social policy initiative under this or any other Government that has produced so much anger and bitterness. Enormous damage has been done to individuals who have been caught in the system's inflexible cage. However, they are not the only casualties. Other casualties have been confidence in the law and, to some extent, the reputation of Parliament itself.
The figures are consistently obscure. It is difficult to discover exactly what is happening. My best guess from what I can discover is that we are now seeing a withdrawal of consent on a scale that is making a mockery of the aspirations and objectives of the system and bringing it into disrepute.
I agree entirely with the hon. Member for Southampton, Test (Mr. Hill). He said that, once in a while, there is a policy that must come to an abrupt halt. As Ministers know, I want to preserve the principle, but I agree with the hon. Member for Test that we must get away from the present position. That is why the silence in the Queen's Speech in respect of the CSA is so worrying and such a concern to all hon. Members.
§ Mr. Dewar
I do not know why the hon. Gentleman is shouting, "Rubbish." For a long time, Ministers have sheltered behind the coming Select Committee report. It 554 is no longer coming; it has arrived. I must say that it has sadly disappointed expectations in the country and, I suspect, in the House. It has done that for a good reason—the determined and disciplined voting by the Conservative members of the Select Committee, who ruthlessly stripped out a series of key proposals in the Chairman's original draft report.
I cannot go through the Select Committee report in detail. However, let me remind the House that there was in the draft report a recommendation for an independent review procedure to allow departures from the normal financial formula if circumstanced justified that. A disregard was suggested that would make the system rather more child centred and do something to make it measure up to the advertisements for it in its early days. Both those suggestions were filleted.
The proposals that 100 per cent. of pension contributions should be taken into account—which would increase the protected income—were binned by Conservative Members voting in a block. The Tories criticise the block vote, but I must say with some sorrow that they use it cynically when the situation demands. I believe that that exercise did no service to the standing and reputation of the Select Committee system, leaving aside the narrow matter of the merits of the issue.
§ Mr. Thurnham
As a member of that Select Committee, I ask the hon. Gentleman to make it clear whether he is speaking for official Labour party policy. Maintenance disregards would have cost about £300 million, according to the central estimate. The hon. Gentleman is talking about being cynical. Is he being cynical or is it official Labour party policy to support the £300 million cost of maintenance disregards?
§ Mr. Dewar
We have made it clear that we are in favour of the principle of a disregard. I have put that on the record during many debates in the House, so I do not understand why the hon. Gentleman sounded quite so peeved.
I was saying that we had witnessed an unpleasant exercise and that common justice demands urgent action. It is no good the Under-Secretary—the hon. Member for Bury, North (Mr. Burt)—honourably going around like a man with a burden of sorrow, because that is little consolation to those who are caught in the turmoil and distress of the system. It is important that the Secretary of State makes it clear that there will be action on this matter and that reforming legislation will be introduced this Session. We are entitled to have that point clarified today and I hope that the right hon. Gentleman will do so.
Indeed, the right hon. Gentleman should go further, when the time comes, than the watered-down Select Committee report recommends. It may mean one or two hon. Members—for example, the hon. Member for Dover (Mr. Shaw)—being left hanging out to dry, but Labour Members would regard that as a public service. I shall not bang on about that point, but the right hon. Gentleman should deal with it and give the assurances that I have requested.
Another matter that is directly within the right hon. Gentleman's remit and competence is the compensation package for VAT on domestic fuel. Its impact has been considerable and there is no doubt that the increase from 8 per cent. to 17.5 per cent., from which, apparently, there is to be no escape, will inflict serious fiscal damage.
555 I was looking at a recent report—hon. Members will be familiar with it—commissioned by the Disablement Income Group, which considered a series of cases where the principal person involved had severe problems, usually physical. It discovered that the added tax burden per week, after taking into account the compensation package, increased the bill from just under £1 to £3.22 in that range of cases.
The Chancellor said last year—I should like the Secretary of State's comments on this—that his intention was to award the same weekly cash increases again in April 1995, taking help overall to £1 per week for all single pensioners and £1.40 per week for all pensioner couples. The trouble is that the majority of people listening to those words will not recognise the small print in the footnotes. They will be looking for 50p and 70p, depending on whether they are single pensioners or pensioner couples, over and above the uprating that is due in April. They will be astonished to find that the additional payment will be 25p and 30p respectively.
§ Mr. Michael Connarty (Falkirk, East)
I am grateful to my hon. Friend for giving way. I had already informed him that I wished to intervene when he spoke about pensioners. Perhaps I could put before the House the case of a pensioner today—unfortunately, my mother—who is 76 years of age. She went to hospital at 10 o'clock this morning for some pre-tests for a kidney operation that she is having on Thursday. She was not seen by a doctor until 6 o'clock this evening. When my sister saw her at 3.30 pm, she was still sitting in the same waiting room at Monklands general hospital in which she had been left at 10 o'clock this morning. She had received only a bowl of soup as sustenance all day long. Is that not exactly the sort of treatment pensioners are getting, both with VAT and from the health service?
§ Mr. Dewar
I am grateful to my hon. Friend. I know from my earlier brief conversation with him how distressed he is about this matter. Any family faced with that position would be upset. Obviously, I cannot comment on what went wrong, although something clearly did. It is perhaps a salutary reminder to everyone in the House that we can talk theoretically and statistically, but often human situations lead to great distress and tragedy. I hope that they will be put right in the period ahead, but I do not think that they will be if the present policies continue. I can only say to my hon. Friend that I hope that he will follow up the matter, as I am sure he will, on behalf of his mother and with the help of her Member of Parliament.
I want to return to the point I made about the single pensioner's £1 and ask for the Secretary of State's confirmation that it is made up of last year's 50p and 25p—this is a lovely euphemism—feeding through in the uprating figure. In other words, the 25p is hidden in the 2.2 per cent. by which we understand that pensions will be uprated this year. The only additional cash in hand above the uprating will be 25p for a single pensioner and 30p for a pensioner couple. Does not the Secretary of State recognise that that will be widely seen as sleight of hand bordering on a confidence trick, and that it will leave many pensioners fearful and angry as they face mounting fuel bills?
We know that some Conservative Members are prepared to vote against the April increase in VAT. Two Scottish Conservative Members have already signaled 556 their intention to vote against it if they are given the opportunity to do so. However, it would be useful if the Secretary of State could deal with the fact that there will be astonishment and some anger among pensioners in every part of the country when the arithmetic which I have just described becomes more widely known, and certainly when they receive the end product in their hands.
I remind the Secretary of State—I must do so in shorthand-of the problems in the private pensions sector that have arisen from the high-pressure techniques used to sell pensions. They have done great harm to confidence in the system and have produced many blameless, innocent and badly hurt casualties. All of us will remember the KPMG survey: the 9 per cent. of 735 files in which there was decisive and substantial evidence of compliance. None of us can quantify the scale of the problem. We recognise that the Securities and Investments Board is attempting to pick up the pieces.
I remind the Secretary of State—it is important to do so—that many of the problems can be fairly traced back to the irresponsibility of the Government. I am thinking of the uninhibited—that is a nice euphemism-advertising campaign that cost —1.2 million in 1986 and the 2 per cent. premium put on to the contracting-out payment. There was a general lack of any critical atmosphere or of any suggestion that some people might benefit from taking out a personal pension but that many would not. That is what created this difficulty for so many people.
I should make it clear that I do not want to undermine the private pensions sector. I recognise that there is a constituency for its product. However, it does not include people at the bottom end of the income scale, many of whom put the contracting-out payment and nothing more into a private pension. The tragedy is that many of them will find themselves, as anyone in the industry will confirm, with no significant cover. I am afraid that they are living under an illusion. They are left in limbo and they will be bitter and disillusioned at the end.
Although there was nothing in the Queen's Speech on private pensions, the Secretary of State owes it to the House to look toughly at what is happening and to try to build confidence, a sense of direction and perhaps social purpose back into the private pension sector. That sense of direction has been lacking because of Government policy in recent years, which led to an inflationary boom in buying when the circumstances did not justify it.
We have had a night of quoting the Secretary of State's speeches. I want to remind him that he spoke in Spain recently. In a snappy piece of copywriting from the Department, the headline of a press release was:Private pensions are the way forward, Peter Lilley tells the Spanish.They must have been fascinated by, and grateful for, the right hon. Gentleman's message. It does not suggest to me that he has learnt all the lessons. I commend that to him for his attention.
I ask the Secretary of State to consider housing benefit for a moment. The matter was raised by the hon. Member for Bolton, North-East (Mr. Thurnham). He suggested regional rent capping as one way of cutting the housing benefit bill. The bill has undoubtedly risen a great deal, but to be fair to the Secretary of State, one of his departmental documents, "The Growth of Social Security", specifically recognised that the increase was linked to the Government's rent policy.
557 To clear the air and to help us in the debate, will the Secretary of State end for all time the rather unpleasant implication of the words of the Chief Secretary to the Treasury, which seemed to suggest that the Government were contemplating hitting people held to be under-occupying properties simply because they have one or two bedrooms too many? In particular, the Chief Secretary instanced council house tenants. The Secretary of State will know that council house tenants who are "under-occupying", according to Government space standards, represent only 28 per cent.—not 50 per cent., as the Chief Secretary suggested—of public sector tenants on housing benefit. Of that 28 per cent., 79 per cent. are over retirement age.
If we go down this route, therefore, we shall target, typically, a widow left on her own, her family grown up, living on in the family home. The clear threat that has been implied in what the Chief Secretary said, both in radio interviews and subsequently in correspondence with me, is that these people will be left with a choice of moving out of the family home or paying a financial penalty in the form of reduced housing benefit help. That would be wholly unacceptable to the House and I hope that the Minister can end the argument today by making it clear that the Chief Secretary to the Treasury is on a trip of his own and does not speak for the Government on this matter.
I welcome the pensions Bill. Of course it is right to move on to the Goode agenda. The House, however, will be familiar with the fact that it contains matters of contention. There is, for instance, the vision of the regulator as a long stop—to use the phrase that the Secretary of State once unfortunately chose. I agree strongly with the hon. Member for Bournemouth, West (Mr. Butterfill), who said that the regulator's fees ought to be met by the Government, not the industry. Unfortunately, he argued the case in terms of saving the industry money. I would argue it in terms of the need for the regulator to command public confidence in his independence. It is important that he is seen to be operating at arm's length from the industry, scrutinising, monitoring and using his powers. He will not be able to establish that position if he is seen as having the industry as his paymaster.
There are other matters of contention, too—the appointment of trustees, surpluses and contribution holidays, to name but three. I am upset by the fact that the Government have rejected important safeguards recommended by Goode. Then there is the future—or lack of it, if the Secretary of State has his way–of the guaranteed minimum pension.
Can the right hon. Gentleman deny or confirm that the pensions Bill will start its journey through Parliament in another place? If that is in the Government's mind, I should be very sorry. I speak for the whole Opposition when I say that.
I also welcome the disability Bill. It is not so much a tribute to Ministers—that has been suggested—as a tribute to the crass insensitivity with which the Civil Rights (Disabled Persons) Bill was blocked, and to the Government's desperate need to head off another private Member's Bill tackling the same problem. Of course I will welcome such a Bill—if it is strong and comprehensive, and if it deals with education and 558 transport, two subjects that were neglected in the discussion document. I will also welcome it if it sets up not just an advisory body at the heart of the process—that could be swept aside—but a body worth its space. It must be a body that can innovate, which can use the courts in test cases to establish its position and to push out the frontiers. We shall be looking for that kind of strength and that sense of purpose before we turn a qualified welcome for the fact that there is a Bill at all into a warm welcome for its provisions.
I gather that the Minister of State is to be in charge. I read in one of the disability newspapers an interesting interview with him. It was run under the heading "A Just William". That was rather better copywriting than the Department managed in the previous quotation I used. In any case, a lady from the British Council of Organisations of Disabled People was quoted as saying that the Minister of Statetook his jacket off and I felt it was like talking to my younger brother".I can only assume that the Minister has been on a charm offensive℄I enter the caveat that I do not know the worth of the tribute as I have never met the younger brother. All I would say is that the test will be what is in the Bill.
We give no welcome at all to the job seeker's allowance. It is an attack on the contributory principle. At a stroke, the rights and entitlements to benefit of people with a full contributions record will be reduced from 12 to six months. Some 90,000 people will be left after six months with no entitlement to benefit at all. Perhaps even worse, 190,000 people will be driven on to means-tested benefits. There can be no welcome for a Bill with those consequences, in the House or the country as a whole.
I do, however, recognise that there is bumping along behind it a raft of small measures designed to encourage people to re-enter the labour market, of which the back-to-work bonus is the most substantial. I am glad that the Government are now giving some attention to that aspect. We have been urging it on them for a very long time. I have always believed, and made it clear, that the social security system should not just be a grudging safety net but should be a way of building in opportunity and providing hope for those out of work.
We will judge those measures, and what the Budget adds to them, on their merits. I have no ambition to make a grandstand finish to my speech. I am very conscious of the fact that there should be quality, not quantity. That is fashionable at the moment. I hope that it is not sinister that the Secretary of State for Social Security is the leader of a pack, if not the pack. He has a Minister of State, three Under-Secretaries, a clutch of Parliamentary Private Secretaries—almost beyond count. I hope that, at the end of the day, what they do adds up to something rather better than what they have managed in the past.
I am, of course, a well-known optimist in these matters, but on the Government's record it is difficult to be optimistic. I hope, however, that my optimism will be justified tonight and that we will get an assurance on CSA reform, some comments on the way in which the compensation for VAT will be dealt with this year, some assurances on the control and regulation of the private pension sector, a slap on the wrist for the Chief Secretary to the Treasury and the removal of all worries on the private pension score. I await with interest what the Secretary of State has to say.
§ The Secretary of State for Social Security (Mr. Peter Lilley)
This has been a good debate. We heard a splendid opening speech from my right hon. Friend the Secretary of State for Health, which entirely demolished the rather negative and unconstructive contribution from the right hon. Member for Derby, South (Mrs. Beckett).
There have been some excellent contributions from my hon. Friends, especially from my hon. Friend the Member for Bournemouth, West (Mr. Butterfill), who raised some important points about the pensions Bill, and I will respond to him in detail.
I agree that we must balance the security of funds, which is very important, with the need to keep costs for employers to a minimum, as we do not want to discourage employers from continuing to organise pension schemes for their employees. But I would disagree with him, as I would with the hon. Member for Glasgow, Garscadden (Mr. Dewar), about the funding of the regulator. It is appropriate that the schemes themselves should fund it, because not all taxpayers have the benefit of occupational pension schemes, and therefore I do not see why they should meet that cost. [Interruption.] Everybody goes to school at some stage, but not everybody has an occupational pension scheme.
I welcome the contributions from my hon. Friends the Members for Bournemouth, East (Mr. Atkinson) and for Southampton, Test (Mr. Hill). They raised concerns about the position of absent parents and of parents with care under the CSA and emphasised the need to balance those two positions.
The hon. Member for Garscadden, like the right hon. Member for Sedgefield (Mr. Blair), seems to want me to make some immediate changes to the CSA, without waiting to consider fully and sensibly the important report from the Select Committee, which I will do. I would simply remind him of the warning that was given to me in the report from the Commission on Social Justice, which warned against the Governmentrushing into …ill-considered changes in response to immediate public pressureon the CSA.
We will, of course, respond as soon as we reasonably can to the Select Committee. I think that it is appropriate to indicate then the sort of changes that we would wish to make.
My hon. Friend the Member for Bolton, North-East (Mr. Thurnham) made some characteristically constructive comments about both housing benefit and disability issues, on which he speaks with great authority. Interesting contributions were also made by Opposition Members—especially the Chairman of the Select Committee on Social Security, the hon. Member for Birkenhead (Mr. Field), who was characteristically generous in his remarks about my recent speech in Ulster, and made a constructive response to it.
I believe that the job seeker's allowance is an important aspect of our response to the problems that I identified in that speech, as are the changes that we have made in family credit. The point of my speech, however, was to highlight a supremely important issue—I thought it extraordinary that, in 400 pages, the Commission for Social Justice did not address it specifically—to which we should all devote attention if we are to deal with the major issue now faced by the western world.
560 The hon. Member for Kingswood (Dr. Berry) made an important contribution on disability issues. I am grateful to him, and to the hon. Member for Garscadden, for welcoming the Government's proposal for a disability Bill; I shall say more about that in the main part of my speech. The hon. Member for Belfast, South (Rev. Martin Smyth) made a number of important points, which I shall ask my right hon. Friend the Secretary of State for Health to consider.
The hon. Member for Garscadden raised the question of VAT on fuel, complaining that the £1 for single people and £1.40 for couples that will be included in this year's pensions to help people cope with VAT was inadequate. He thought that people would be surprised about that; I think that people will be rather surprised that the hon. Gentleman raised the point. Exactly a year ago, according to The People,Shadow Social Security Secretary Donald Dewar said: 'The Government has to add something on to take account of that and they could do it with an extra 50p on pensions."Now the hon. Gentleman is complaining when we give two or three times that amount.
§ Mr. Lilley
I simply quoted what the hon. Gentleman said word for word, in its entirety.
I welcome the choice of social security for today's debate. Reform of social security is now rightly top of the national political agenda. That is not just because it is the largest component of public spending, constituting a third of total public expenditure; it is also because social security is one of the most sensitive issues facing us all. It concerns vulnerable people who are sick, disabled, elderly, unemployed or caring for children and families. It is also crucial to our economic success, determining our tax burden, our incentives and the flow of savings to industry.
The total cost of social security is now some £85 billion, which means that just to finance it, on average, every working person must pay £15 every working day. It is therefore vital that any Government, or any party seeking to represent itself as a credible alternative Government, should have a strategy for the reform of social security to ensure that the system is modern, that it is focused where it can do most good and that it does not outstrip the nation's ability to pay.
Conservative Members have a clear strategy for social security reform. I spelled it out in my Mais lecture, and the Gracious Speech takes it further forward. Each of the three Bills will deal with at least one of our key objectives.
Our first objective is to reinforce incentives to work. The job seeker's allowance Bill contains important new incentives which have been widely welcomed, and which I thought would be a litmus test of the Labour party's conversion to modernism. However, it has chosen not to endorse the Bill, which I think makes it backward-looking.
These incentives include increasing the ceiling of partners' hours from 16 to 24, which will help some 20,000 people. National insurance credits will be extended to those 561 working part-time, which will also help a substantial number of people. Most important of all, the back-to-work bonus will enable people who are working part-time on benefit to accumulate a credit of up to £1,000, which is cashable upon taking up full-time work. That measure will assist 165,000 people per year. Finally, the employment on trial rules will be relaxed to enable people to try out a new job and leave if it does not work out, without loss of benefit. This will assist 200,000 extra people.
Our second major objective, contained in the pensions Bill, is to encourage increased self-provision, especially for retirement. Three years ago this month, confidence in occupational schemes was dented by revelations following the death of that socialist millionaire, former Labour Member of Parliament and principal Labour spokesman in the press, Robert Maxwell.
I would not normally have mentioned his allegiance but, in the climate of modern-day McCarthyism— or perhaps it should be called "Prestonism" nowadays— which has been fostered recently in the press, we have been led to believe that corruption and fraud are associated exclusively with one party.
Prestonism assumes that it is more important to rake up a perfectly innocent seven-year-old hotel bill than devote any attention to a £500 million fraud perpetrated by a socialist. The Guardian would not devote any space to fraud by a socialist millionaire who extracted hundreds of millions of pounds from pension funds, because it prefers to devote its entire front page to stories about Tory Ministers extracting teeth on a Saturday. But it was an important issue.
§ Mr. Lilley
I have given way once to the hon. Gentleman; that is enough. He conspicuously ignored the problems of his former colleague.
§ Mr. Lilley
I will not give way.
In this Bill, we will implement the essence of the recommendations put forward by the Goode committee. We will create a strong regulator, which will be widely welcomed.
Pensions are a success story, despite what the hon. Member for Garscadden said. A total of £500 billion is invested in pension funds in this country. We want to build on our success and increase the £52 billion flow of new investment which those funds make available to British industry each year.
Thirdly, we wish to focus help on those who are in greatest need. That is the aim of the disability Bill. We already focus increased financial help on disabled people, and we spend five times as much on disabled people in real terms as was spent under Labour. We help six times as many people with the cost of care and eight times as many with mobility needs. But disabled people want opportunities even more than cash, and we support them in that endeavour.
§ Mr. Tom Clarke (Monklands, West)
Obviously, many hon. Members took part in the debates last Session and considered the Government's consultation document. 562 Given that the document did not refer to transport and education, have they changed their mind, and will those matters be included in the Bill?
§ Mr. Lilley
My hon. Friend the Minister for Social Security and Disabled People will make a statement to the House shortly about the measures included in the disability Bill and legislative package. He has had a very constructive dialogue with disabled people and business men and women involved in this sphere. He will come forward with proposals that will be widely welcomed in the House. They will go further than our original proposals put out for discussion, and I therefore hope that they will meet the genuine needs and desires of disabled people. I recognise that the hon. Member for Monklands, West (Mr. Clarke) and many other hon. Members want to see those needs satisfied, as do we all.
§ Mr. Lilley
I should be grateful if the hon. Gentleman would allow me to continue.
We believe that it is possible to make progress, which will be widely supported and accepted, without imposing excessive burdens on industry. I hope that those measures will have the support that many hon. Members on both sides have said they may be willing to give.
The debate has revealed that the Labour party has no strategy for social security. Its motion calls for the abandonment of the job seeker's allowance and abandonment of the incapacity benefit, going straight back to invalidity benefit. That benefit has no objective medical test, which has allowed the number of people claiming it to double over a decade, during which health has improved.
It would impose an extra £1 billion or more of costs on the budget, and it would mean that the benefit was not well targeted. It would put general practitioners back into the invidious position of being split between loyalty to the taxpayer and loyalty to their patients. I cannot believe that a sensible, modern party would want to go back in that direction. I note that even the Commission on Social Justice does not recommend that the Labour party should do so.
The amendment is remarkable as much for what it omits as for what it includes. Financially, the most momentous decision in the Bills mentioned in the Gracious Speech, albeit the most long-term, is the equalisation of the state pension age. If we had chosen to equalise at the age of 60 instead of 65, it would have cost an extra £12 billion a year. Yet that was not even mentioned by the hon. Member for Garscadden.
That is all the more remarkable, because he gave it pride of place in his speech at the Labour Party conference, when he warned his party against joining the Government in the "Gadarene rush" to equalise retirement at 65. Who are the mad swine who are joining in the Gadarene rush? My right hon. and hon. Friends will recall that those who performed the Gadarene rush were swine possessed of a devil that had been cast out by our Lord.
We are being joined in the Gadarene rush by none other than the Commission on Social Justice. It does not think that it is a mad idea. It says:it is quite reasonable to start phasing in a common pension age of sixty-five in the next century".Sir Gordon Borrie, who might think it a touch uncomradely to be likened to a mad pig possessed of a devil rushing headlong into a lake, wrote: 563as people live longer and as health improves … reducing the working lifetime and increasing the retirement period does not make sense".What makes it all the more remarkable is that the hon. Member for Garscadden had in his hand a copy of the report when he made his speech to the Labour party conference. On the cover it says:Essential reading for everyone who wants a new way forward for our country".It is a shame that the hon. Gentleman did not read as far as page 284. I got there, but only by dint of starting at page 283.
Does the Commission on Social Justice fill the huge vacuum that up to now has constituted Labour's social security policy? Alas, no. There is a welcome change in rhetoric, but no change in substance. Recently The Independent published a costing of what it considered to be the key proposals in the report of the Commission on Social Justice, and those which could be readily costed. It found that it came to £7 billion. However, it had a reassuring headline which said:'Social Justice' plans almost pay for themselves".Alas, it turned out that the so-called £7 billion of savings all involved increases in the income tax burden on ordinary people.
After today's debate, the House will reject the Opposition's amendment. It will realise that only the Conservative party has a coherent programme for social security reform, that that is essential for any modern Government and that the Labour party has fallen at the first hurdle in its attempts to prove itself a modern Government. I urge the House to reject the amendment tabled by the Opposition.
§ Mr. Derek Conway (Shrewsbury and Atcham)
rose in his place and claimed to move, That the Question be now put.
§ Question, That the Question be now put, put and agreed to.
§ Question put accordingly, That the amendment be made:—
§ The House divided: Ayes 272, Noes 309.567
|Division No. 1]||[22.00 pm|
|Abbott, Ms Diane||Betts, Clive|
|Adams, Mrs Irene||Blair, Rt Hon Tony|
|Ainger, Nick||Blunkett, David|
|Ainsworth, Robert (Cov'try NE)||Boateng, Paul|
|Allen, Graham||Bradley, Keith|
|Alton, David||Bray, Dr Jeremy|
|Anderson, Donald (Swansea E)||Brown, Gordon (Dunfermline E)|
|Anderson, Ms Janet (Ros'dale)||Brown, Nicholas (N'c'tle u Tyne E)|
|Armstrong, Hilary||Bruce, Malcolm (Gordon)|
|Ashdown, Rt Hon Paddy||Burden, Richard|
|Ashton, Joe||Byers, Stephen|
|Austin-Walker, John||Caborn, Richard|
|Banks, Tony (Newham NW)||Callaghan, Jim|
|Barron, Kevin||Campbell, Menzies (Fife NE)|
|Battle, John||Campbell, Mrs Anne (C'bridge)|
|Bayley, Hugh||Campbell, Ronnie (Blyth V)|
|Beckett, Rt Hon Margaret||Campbell-Savours, D. N.|
|Beith, Rt Hon A. J.||Canavan, Dennis|
|Bell, Stuart||Cann, Jamie|
|Benn, Rt Hon Tony||Carlile, Alexander (Montgomery)|
|Bennett, Andrew F.||Chidgey, David|
|Benton, Joe||Chisholm, Malcolm|
|Bermingham, Gerald||Church, Judith|
|Berry, Roger||Clapham, Michael|
|Clark, Dr David (South Shields)||Hutton, John|
|Clarke, Tom (Monlands W)||Illsley Eric|
|Clelland, David||Ingrain, Adam|
|Clwyd, Mrs Ann||Jackson, Glenda (H'stead)|
|Cohen, Harry||Jackson, Helen (Shef'ld, H)|
|Connarty, Michael||Jamieson, David|
|Cook, Frank (Stockton N)||Janner, Greville|
|Cook. Robin (Livingston)||Johnston, Sir Russell|
|Corbett, Robin||Jones, Barry (Alyn and D'side)|
|Corbyn, Jeremy||Jones, Ieuan Wyn (Ynys Mon)|
|Corston, Jean||Jones, Jon Owen (Cardiff C)|
|Cousins, Jim||Jones, Lynne (B'ham S O)|
|Cox, Tom||Jones, Martyn (Clwyd, SW)|
|Cummings, John||Jones, Nigel (Cheltenham)|
|Cunliffe, Lawrence||Jowell, Tessa|
|Cunningham, Jim (Covy SE)||Kaufman, Rt Hon Gerald|
|Cunningham, Rt Hon Dr John||Keen, Alan|
|Dafis, Cynog||Kennedy, Charles (Ross,C&S)|
|Dalyell, Tam||Kennedy, Jane (Lpool Brdgn)|
|Darling, Alistair||Khabra, Piara S.|
|Davidson, Ian||Kilfoyle, Peter|
|Davies, Bryan (Oldham C'tral)||Kinnock, Rt Hon Neil (Islwyn)|
|Davies, Rt Hon Denzil (Llanelli)||Kirkwood, Archy|
|Davis, Torry (B'ham, H'dge H'I)||Lestor, Joan (Eccles)|
|Denham, John||Lewis, Terry|
|Dewar, Donald||Liddell, Mrs Helen|
|Dixon, Don||Litherland, Robert|
|Dunnachie, Jimmy||Livingstone, Ken|
|Eagle, Ms Angela||Lloyd, Tony (Stretford)|
|Eastham, Ken||Llwyd, Elfyn|
|Etherington, Bill||Loyden, Eddie|
|Evans, John (St Helens N)||Lynne, Ms Liz|
|Fatchett, Derek||Macdonaid, Calum|
|Field, Frank (Birkenhead)||Mackinlay, Andrew|
|Fisher, Mark||MacShane, Denis|
|Foster, Don (Bath)||Madden, Max|
|Foulkes, George||Maddock, Diana|
|Fraser, John||Mahon, Alice|
|Fyfe, Maria||Mandelson, Peter|
|Galbraith, Sam||Marek, Dr John|
|Gapes, Mike||Marshall, David (Shettleston)|
|Garrett, John||Marshall, Jim (Leicester, S)|
|George, Bruce||Martin, Michael J. (Springburn)|
|Gerrard, Neil||Martlew, Eric|
|Gilbert, Rt Hon Dr John||Maxton, John|
|Godman, Dr Norman A.||McAllion, John|
|Godsiff, Roger||McAvoy, Thomas|
|Golding, Mrs Llin||McFall, John|
|Gordon, Mildred||McKelvey, William|
|Graham, Thomas||McLeish, Henry|
|Grant, Bernie (Tottenham)||McMaster, Gordon|
|Griffiths, Nigel (Edinburgh S)||McNamara, Kevin|
|Griffiths, Win (Bridgend)||McWilliam, John|
|Grocott, Bruce||Meacher, Michael|
|Gunnell, John||Meale, Alan|
|Hain, Peter||Meale, Alun|
|Hall, Mike||Michie, Bill (Sheffield Heeley)|
|Hanson, David||Michie, Mrs Ray (Argyll and Bute)|
|Hardy, Peter||Milburn, Alan|
|Harman, Ms Harriet||Miller, Andrew|
|Harvey, Nick||Mitchell, Austin (Gt Grimsby)|
|Hattersley, Rt Hon Roy||Moonie, Dr Lewis|
|Henderson, Doug||Morgan, Rhodri|
|Heppell, John||Morley, Elliot|
|Hinchliffe, David||Morris, Estelle (B'ham Yardley)|
|Hodge, Margaret||Morris, Rt Hon Alfred (Wy'nshawe)|
|Hoey, Kate||Morris, Rt Hon John (Aberavon)|
|Hogg, Norman (Cumbernauld)||Mowlam, Marjorie|
|Home Robertson, John||Mudie, George|
|Hoon, Geoffrey||Mullin, Chris|
|Howarth, George (Knowsley N)||O'Brien, Bill (Normanton)|
|Howells, Dr. Kim (Pontypridd)||O'Brien, Mike (N W'kshire)|
|Hoyle, Doug||O'Neill, Martin|
|Hughes, Robert (A'deen N)||Oakes, Rt Hon Gordon|
|Hughes, Roy (Newport E)||Olner, Bill|
|Hughes, Simon (Southwark)||Orme, Rt Hon Stanley|
|Patchett Terry||Soley, Clive|
|Pendry, Tom||Speller, John|
|Pickthall, Colin||Squire. Rachel (Dunfermline W)|
|Pope, Greg||Steel, Rt Hon Sir David|
|Powell, Ray (Ogmore)||Steinberg, Gerry|
|Prentice, Bridget (Lew'm E)||Stevenson, George|
|Prentice, Gordon (Pendle)||Stott, Roger|
|Prescott Rt Hon John||Strang, Dr. Gavin|
|Primarolo, Dawn||Straw, Jack|
|Purchase, Ken||Sutcliffe, Gerry|
|Quin, Ms Joyce||Taylor, Matthew (Truro)|
|Radice, Giles||Taylor, Mrs Ann (Dewsbury)|
|Randall, Stuart||Timms, Stephen|
|Raynsford, Nick||Tipping, Paddy|
|Redmond, Martin||Turner, Dennis|
|Reid, Dr John||Tyler, Paul|
|Rendel, David||Vaz, Keith|
|Robertson, George (Hamilton)||Water, Rt Hon Sir Harold|
|Robinson, Geoffrey (Co'try NW)||Wallace, James|
|Robinson, Peter (Belfast E)||Walley, Joan|
|Roche, Mrs Barbara||Wardell, Gareth (Gower)|
|Rogers, Allan||Wareing, Robert N|
|Rooney, Terry||Watson, Mike|
|Ross, Ernie (Dundee W)||Welsh, Andrew|
|Rowlands, Ted||Wicks, Malcolm|
|Ruddock, Joan||Wigley, Dafydd|
|Salmond, Alex||Williams, Alan W (Carmarthen)|
|Sedgemore, Brian||Williams, Rt Hon Alan (Sw'n W)|
|Sheerman, Barry||Wilson, Brian|
|Sheldon, Rt Hon Robert||Winnick, David|
|Shore, Rt Hon Peter||Wise, Audrey|
|Short, Clare||Worthington, Tony|
|Simpson, Alan||Wray, Jimmy|
|Skinner. Dennis||Wright, Dr Tony|
|Smith, Andrew (Oxford E)|
|Smith, Chris (Isl'ton S & F'sbury)||Tellers for the Ayes:|
|Smith, Llew (Blaenau Gwent)||Mr. Jim Dowd and|
|Snape, Peter||Mr. Eric Clarke|
|Ainsworth, Peter (East Surrey)||Burns, Simon|
|Aitken, Rt Hon Jonathan||Burt, Alistair|
|Alexander, Richard||Butcher, John|
|Amess, David||Butler, Peter|
|Ancram, Michael||Carlisle, John (Luton North)|
|Arbuthnot, James||Carlisle, Sir Kenneth (Lincoln)|
|Arnold, Jacques (Gravesham)||Carrington, Matthew|
|Arnold, Sir Thomas (Hazel Grv)||Carttiss, Michael|
|Aspinwall, Jack||Cash, William|
|Atkins, Robert||Chapman, Sydney|
|Atkinson, David (Bour'mouth E)||Churchill, Mr|
|Baker, Nicholas (North Dorset)||Clappison, James|
|Baker, Rt Hon K. (Mole Valley)||Clark, Dr Michael (Rochford)|
|Baldry, Tony||Clarke, Rt Hon Kenneth (Ru'clif)|
|Banks, Robert (Harrogate)||Clifton-Brown, Geoffrey|
|Batiste, Spencer||Coe, Sebastian|
|Beggs, Roy||Colvin, Michael|
|Bellingham, Henry||Congdon, David|
|Bendall, Vivian||Conway, Derek|
|Biffen, Rt Hon John||Coombs, Anthony (Wyre For'st)|
|Body, Sir Richard||Coombs, Simon (Swindon)|
|Bonsor, Sir Nicholas||Cope, Rt Hon Sir John|
|Booth, Hartley||Cormack, Patrick|
|Boswell, Tim||Couchman, James|
|Bottomley, Peter (Eltham)||Currie, Mrs Edwina (S D'by'ire)|
|Bottomley, Rt Hon Virginia||Curry, David (Skipton and Ripon)|
|Bowden, Sir Andrew||Davies, Quentin (Stamford)|
|Bowis, Jonn||Davis, David (Boothferry)|
|Boyson, Rt Hon Sir Rhodes||Day, Stephen|
|Brandreth, Gyles||Deva, Nirj Joseph|
|Brazier, Julian||Devlin, Tim|
|Bright, Sir Graham||Dicks, Terry|
|Brooke, Rt Hon Peter||Dorrell, Rt Hon Stephen|
|Brown, M (Brigg & Cl'thorpes)||Douglas-Hamilton, Lord James|
|Browning, Mrs. Angela||Dover, Den|
|Budgen, Nicholas||Duncan Smith, Iain|
|Duncan, Alan||Jopling, Rt Hon Michael|
|Dunn, Bob||Kellett-Bowman, Dame Elaine|
|Durant, Sir Anthony||Key, Robert|
|Eggar, Tim||Kilfedder, Sir James|
|Elletson, Harold||King, Rt Hon Tom|
|Emery, Rt Hon Sir Peter||Knapman, Roger|
|Evans, David (Welwyn Hatfield)||Knight, Dame Jill (Bir'm E'st'n)|
|Evans, Jonathan (Brecon)||Knight, Greg (Derby N)|
|Evans, Nigel (Ribble Valley)||Knight, Mrs Angela (Erewash)|
|Evans, Roger (Monmouth)||Knox, Sir David|
|Evennett, David||Kynoch, George (Kincardine)|
|Faber, David||Lait, Mrs Jacqui|
|Fabricant, Michael||Lamont, Rt Hon Norman|
|Fenner, Dame Peggy||Lang, Rt Hon Ian|
|Field, Barry (Isle of Wight)||Lawrence, Sir Ivan|
|Fishburn, Dudley||Legg, Barry|
|Forsyth, Michael (Stirling)||Leigh, Edward|
|Forth, Eric||Lennox-Boyd, Sir Mark|
|Fowler, Rt Hon Sir Norman||Lester, Jim (Broxtowe)|
|Fox, Dr Liam (Woodspring)||Lidlington, David|
|Fox, Sir Marcus (Shipley)||Lightbown, David|
|Freeman, Rt Hon Roger||Lilley, Rt Hon Peter|
|French, Douglas||Lloyd, Rt Hon Peter (Fareham)|
|Fry, Sir Peter||Lord, Michael|
|Gale, Roger||Lyell, R Hen Sr Nicholas|
|Gallie, Phil||MacGregor, Rt Hon John|
|Gardner, Sir George||MacKay, Andrew|
|Garel-Jones, Rt Hon Tristan||Maginnis, Ken|
|Garnier, Edward||Maitland, Lady Olga|
|Gill, Christopher||Major, Rt Hon John|
|Gillan, Cheryl||Malone, Gerald|
|Goodlad, Rt Hon Alastair||Mans, Keith|
|Goodson-Wickes, Dr Charles||Marland, Paul|
|Gorman, Mrs Teresa||Marlow, Tony|
|Gorst, Sir John||Marshall, John (Hendon S)|
|Grant, Sir A. (SW Cambs)||Marshall, Sir Michael (Arundel)|
|Greenway, Harry (Ealing N)||Martin, David (Portsmouth S)|
|Greenway, John (Ryedale)||Mates, Michael|
|Griffiths, Peter (Portsmouth, N)||Mawhinney, Rt Hon Dr Brian|
|Grylls, Sir Michael||McLoughlin, Patrick|
|Gummer, Rt Hon John Selwyn||McNair-Wilson, Sir Patrick|
|Hague, William||Mellor, Rt Hon David|
|Hamilton, Neil (Tatton)||Merchant, Piers|
|Hamilton, Rt Hon Sir Archi||Mills, Iain|
|Hampson, Dr Keith||Mitchell, Andrew (Gedling)|
|Hanley, Rt Hon Jeremy||Mitchell, Sir David (Hants NW)|
|Hannam, Sir John||Moate, Sir Roger|
|Hargreaves, Andrew||Molyneaux, Rt Hon James|
|Hawkins, Nick||Montgomery, Sir Fergus|
|Hawksley, Warren||Needham, Rt Hon Richard|
|Hayes, Jerry||Nelson, Anthony|
|Heald, Oliver||Newton, Rt Hon Tony|
|Heath, Rt Hon Sir Edward||Nicholson, David (Taunton)|
|Heathcoat-Amory, David||Nicholson, Emma (Devon West)|
|Hendry, Charles||Norris, Steve|
|Heseltine, Rt Hon Michael||Onslow, Rt Hon Sir Cranley|
|Higgins, Rt Hon Sir Terence||Oppenheim, Phillip|
|Hill, James (Southampton Test)||Ottaway, Richard|
|Hogg, Rt Hon Douglas (G'tham)||Page, Richard|
|Horam, John||Paice, James|
|Hordem, Rt Hon Sir Peter||Patnick, Sir Irvine|
|Howard, Rt Hon Michael||Patten, Rt Hon John|
|Howarth, Alan (Strat'rd-on-A)||Pattie, Rt Hon Sr Geoffrey|
|Howell, Rt Hon David (G'dford)||Pawsey, James|
|Howell, Sir Ralph (N Norfolk)||Peacock, Mrs Elizabeth|
|Hughes, Robert G (Harrow, W)||Pickles, Eric|
|Hunt, Rt Hon David (Wirral W)||Porter, Barry (Wirral S)|
|Hunt, Sir John (Ravensbourne)||Porter, David (Waveney)|
|Hunter, Andrew||Portillo, Rt Hon Michael|
|Hurd, Rt Hon Douglas||Powel, William (Corby)|
|Jackson, Robert (Wantage)||Rathbone, Tim|
|Jenkin, Bernard||Redwood, Rt Hon John|
|Jessel, Toby||Renton, Rt Hon Tim|
|Johnson Smith, Sir Geoffrey||Richards, Rod|
|Jones, Gwilym (Cardiff N)||Riddick, Graham|
|Jones, Robert B. (W Hertfdshr)||Rifkind, Rt Hon Malcolm|
|Robathan, Andrew||Taylor, Sir Teddy (Southend, E)|
|Roberts, Rt Hon Sir Wyn||Temple-Morris, Peter|
|Robertson, Raymond (Ab'd'n S)||Thomason, Roy|
|Robinson, Mark (Somerton)||Thompeon, Patrick (Norwich N)|
|Roe, Mrs Marion (Broxbourne)||Thompson, Sir Donald (C'er V)|
|Ross, William (E Londonderry)||Thornton, Sir Malcolm|
|Rowe, Andrew (Mid Kant)||Thurnham, Peter|
|Rumbold, Rt Hon Dame Angela||Townend, John (Bridlington)|
|Ryder, Rt Hon Richard||Townsend, Cyril D. (Bexl'yh'th)|
|Sackville, Tom||Tracey, Richard|
|Sainsbury, Rt Hon Tim||Tredinnick, David|
|Scott, Rt Hon Nicholas||Trend, Michael|
|Shaw, David (Dover)||Trotter, Michael|
|Shaw, Sir David (Pudsey)||Twinn, Dr Ian|
|Shepherd, Rt Hon Gillian||Vaughan, Sir Gerard|
|Shepherd, Colin (Hereford)||Viggers, Peter|
|Shepherd Richard (Aldridge)||Walden, George|
|Shersby, Michael||Walker, A. Cecil (Belfast N)|
|Sims, Roger||Walker, Bill (N Tayside)|
|Skeet, Sir Trevor||Waller, Gary|
|Smith, Tim (Beaconsfield)||Ward, John|
|Soames, Nicholas||Wardle, Charles (Bexhill)|
|Speed, Sir Keith||Waterson, Nigel|
|Spencer, Sir Derek||Watts, John|
|Spicer, Michael (S Worcs)||Wells, Bowen|
|Spicer, Sir James (W Dorset)||Wheeler, Rt Hon Sir John|
|Spink, Dr Robert||Whitney, Ray|
|Spring, Richard||Whittingdale, John|
|Sproat, Iain||Widdecombe, Ann|
|Squire, Robin (Hornchurch)||Wiggin, Sir Jerry|
|Stanley, Rt Hon Sir John||Wilkinson, John|
|Steen, Anthony||Willetts, David|
|Stephen, Michael||Wilshire, David|
|Stem, Michael||Winterton, Mrs Ann (Congleton)|
|Stewart, Allan||Winterton, Nicholas (Macc'fld)|
|Streeter, Gary||Wolfson, Mark|
|Sumberg, David||Wood, Timothy|
|Sweeney, Walter||Yeo, Tim|
|Sykes, John||Young, Rt Hon Sir George (Acton)|
|Tapsell, Sir Peter|
|Taylor, Ian (Esher)||Tellers for the Noes:|
|Taylor, John M. (Solihull)||Mr. Timothy Kirkhope and|
|Taylor, Rt Hon John D. (Strgfd)||Mr. Michael Bates|
§ Question accordingly negatived.
§ It being after Ten o'clock, the debate stood adjourned.
§ Debate to be resumed tomorrow.