§ Mrs. Margaret Beckett (Derby, South)
I beg to move,That this House views with alarm the growing evidence of dangerously inadequate patient care and of overstretched staff and facilities in the National Health Service; takes heed of the testimonies of those senior staff who are still free to speak, who say that the very existence of a nationwide service in health care is at risk; rejects the drive to replace it by local health businesses; and calls for a moratorium on bed closures in London, and on the Government to reassess their dogma-driven policy changes and to foster co-operation, not competition, between staff and institutions.We move the motion today at a time when the Conservative party's "huge national experiment", as the chief executive of the NHS has described it, is turning health care into health chaos. Many of those who work in the health service would view with considerable irony the wording of the Government's amendment, since they think that the Government have already created chaos out of the health service as it is.
We move the motion at a time when those charged with responsibility for the public health of our nation are held in ever-rising contempt by lifelong Conservatives who are also distinguished consultants. The British Medical Association's "News" reported in October 1994 that half of consultants surveyed believed that the standard of care had declined in the last five years and 63 per cent. believed that the NHS as we know it will disintegrate. The Government are held in contempt by staff at every level of the health service, by journalists on newspapers that span the political spectrum, but, above all, by the wider British public.
There is today a threat to the sheer existence of the NHS that the Government and the Prime Minister claimed was safe in their hands. The threat shows in the evidence: in a growing catalogue of difficulties and problems—in the events. Problems can and do arise under any Government, but not on the scale, for the duration or with the consistency with which they are arising under this Government.
The threat shows too in the testimony of staff of the health service—privately, for those in fear of the sack, publicly, for those who feel that they are still free to speak. The threat shows in the stark evidence that, whatever the Prime Minister said last October at his conference, the NHS is being privatised, by stealth, before our eyes and with intent, and the only people who are not supposed to be in on the secret are the people of Britain.
Let us begin with the evidence of decay. This debate is taking place after a week in which the corpse of a patient was found under piping in St. Thomas's hospital, parents in Truro found a hypodermic needle under their baby's skin, a woman in Sheffield's Royal Hallamshire hospital left her bed for five minutes, I believe to go to the loo, and returned to find that it had been taken away for use in another part of the hospital.
858 Nor are those isolated incidents. There is other evidence too of decay and decline in the health service. The latest final figure of 1,071,000 is the highest published total of people on waiting lists since records of in-patients and day cases waiting have been available. When the provisional waiting list was published, Ministers boasted, and have gone on boasting, that their reforms have delivered shorter waiting lists, but when the corrected final figures showed a record high, Ministers were uncharacteristically silent. They did not even issue a press release.
§ The Secretary of State for Health (Mrs. Virginia Bottomley)
I recognise that the right hon. Lady is relatively new to her job, but the Government have consistently talked about waiting times. Does the right hon. Lady recognise that the average length of time that an individual has been on a waiting list has just about halved since the reforms came in? What is more, does she recognise that the new patients charter, for the first time ever with a standard for out-patients, means that not only has a dramatic improvement in long waiters been achieved, but a limit has been set on out-patient waits?
§ Mrs. Beckett
The Secretary of State need not disturb herself. I propose to come later to the Government's waiting list figures, and to put them in context.
It is noticeable that on this as on so many other occasions, the right hon. Lady chose not to refer to the point that I made but to raise some other point entirely. That is a characteristic habit of hers, and one which does not contribute to the public's trust in her. As for the length of time that I have been in my post, indeed it has been very short. If I had been in the Secretary of State's post as long as she has, I would be ashamed of myself.
§ Mr. Terry Lewis (Worsley)
Is my right hon. Friend aware that there is now a waiting list to get on to a waiting list? As I have pointed out twice before in the House, I waited 14 months to see a specialist before I was placed on a waiting list for treatment—and I needed that treatment. That is the position in the north-west, writ large.
§ Mrs. Beckett
My hon. Friend is entirely right. As I hope to show later, that is widely true in the country as a whole—which is why what the Secretary of State says so often seems irrelevant.
§ Mr. Kevin Hughes (Doncaster, North)
In fact, there are now three waiting lists. There is a waiting list to get an appointment, followed by a waiting list to get a consultation; then, and only then, are patients put on a waiting list to obtain treatment.
§ Mrs. Beckett
That is quite true, and highlights what could be described as a question mark. I believe that it was in yesterday's Daily Telegraph that a journalist observed that the Secretary of State gives plenty of statistics, some of which are correct and some of which bear more than one interpretation.
§ Dr. John Marek (Wrexham)
I hate to correct my hon. Friend the Member for Doncaster, North (Mr. Hughes), but there are not three but four waiting lists. Having eventually gone through three waiting lists at my local hospital, the daughter of one of my constituents was given an appointment for an operation and was then kept waiting for six hours. She was told to telephone at 7.30 the following day; there was no bed. She was told to 859 telephone again at 8.30, then at 9.30, then at 10.30. At 11.30, she was told again that there was no bed for her. She is going back next March.
§ Mrs. Beckett
This has been an interesting exchange. The same thing is happening throughout Britain. Ministers, and the Secretary of State in particular, trot out statistics which, although not necessarily inaccurate—they are inaccurate sometimes, however—are relatively meaningless. One hon. Member after another can rise to contradict them from his or her own experience.
I have never regarded The Daily Telegraph as a socialist rag, but, according to yesterday's edition, this is why the Secretary of State is so distrusted and disliked.
§ Mrs. Beckett
I advise the hon. Gentlemen, both of whom represent very marginal seats, to be wary of associating themselves with such perceived deceit of the country.
§ Mr. Brandreth
The right hon. Lady spoke of decay. How does she square that with the increase of some 8,000 in the number of doctors and dentists over the past decade, and the fact that there are 3,000 more general practitioners? Most patients in my constituency are now looked after by fundholding GPs, and they seem to like the service they are getting.
Can the right hon. Lady tell us the cost and the implications of her proposals to abandon GP fundholding, which is working well in my constituency? My constituents believe that those proposals would increase bureaucracy and the number of local committees, and would reduce the amount of patient care, which has been improved by the introduction of fundholding. More doctors and better service: that is what we seem to be getting in Chester.
§ Mrs. Beckett
I am familiar with some of the claims that are made for the advantages of fundholding—[Interruption.] There is no need for the hon. Member for Lancaster (Dame E. Kellett-Bowman) to scream at me; I can hear her quite clearly.
Patients are almost always happy with the service they receive from their GPs—and a very good thing, too—whether or not the practice involved is fundholding. Let me, however, say two things to the hon. Member for City of Chester (Mr. Brandreth). First, it is far from proven that the advantages to patients of fundholders are linked with the fundholding system itself. Secondly, let me recommend to the hon. Gentleman—who has talked of costs and bureaucracy—an article published, I believe, last week in the fundholders' own magazine. It suggested that the administrative and knock-on cost of each fundholding practice was some £80,000.
860 I have been in the House, and studied the present Government, rather longer than the hon. Gentleman.
§ Mrs. Beckett
May I remind the hon. Lady that it is I who am making the speech? She says that I am speaking for too long, but I am making a speech and not an intervention.
§ Mrs. Beckett
The hon. Lady has succeeded: I have finally forgotten what I was going to say. I am sure I shall remember shortly.
The main point that I am making to the hon. Member for City of Chester is that the advantages that he claims to exist are not necessarily related to the system of fundholding. Many doctors who have taken it up do not actually support the system as it now exists, but believe that they are wise to take advantage of the money while it is there.
I have now remembered what I was going to say to the hon. Gentleman. Long scrutiny of the Government's policies tells me as clear as day that, once the costs of fundholding become apparent, GPs who hold funds will be squeezed and squeezed and squeezed. They have been bribed into the system, as they are aware, by the use of public money. I assure the hon. Gentleman that it will not last. The more of them there are, the less generous the Government will be to them.
I have been diverted from my speech, and I had better return to it.
§ Mrs. Beckett
The hon. Gentleman will forgive me if I do not give way. I am sure that he will have an opportunity later. I know that he is one of the Government's avant-garde when it comes to interventions. [Interruption.] I hope that I am not complimenting the hon. Gentleman too much.
A survey of English regional health authorities showed today that more than 10,000 operations were cancelled on the day of or after admission to hospital, and that about 10 per cent. of the people involved were not readmitted within a month. The number of hospital complaints has risen 300 per cent. in the past 10 years. That is a good example of how different interpretations can be put on the evidence.
In The Daily Telegraph yesterday, the Secretary of State said that the 300 per cent. increase in hospital complaints was evidence of how well the system was working, because it was easier for people to make complaints. The Daily Telegraph reporter asked her, if she judged such an increase in complaints as evidence of success, by what measure she would judge failure—a pertinent point, and one that I have yet to hear the Secretary of State deal with. I am sure that she will come to that matter in her speech.
Hospital and ward closures are continuing. The NHS lost more than 10,000 beds in 1993.
§ Mrs. Beckett
The hon. Lady is right. The number of hospital beds has decreased partly as a result of day case 861 treatment, and partly because of the advantages of medical technology. Will she explain, however, why, side by side with reductions in the number of beds in the public sector, the number of beds in the private sector has increased? It is clear to us that what is happening is a matter not simply of medical advance, but of changing direction in the provision of health care in Britain. That is especially striking when it comes to psychiatric beds, where the position is even more crystal clear.
A study, which I think was carried out by the Royal College of Psychiatrists, suggests that many units, especially those in London, have a so-called bed occupancy rate of more than 100 per cent. The study states that some units in inner London have a bed occupancy rate of 120 per cent. because of the disappearance of long-stay beds. The number of people needing care far exceeds the number of beds in which to treat them.
§ Mr. Jacques Arnold
The right hon. Lady referred to anecdotes from her colleagues. She might like to hear the anecdote of a constituent of mine who rang up to say how pleased he was with the treatment that he had received in our local NHS—a treatment that was not available on the NHS only a few years ago, and especially not under the Labour Government. The only reason that he is receiving the treatment is the more than 50 per cent. real terms increase in the Government's spending on the health service.
§ Mrs. Beckett
As I said in our previous debate—I do not think that the hon. Gentleman was here on that occasion—in all honesty, people in the NHS and the British public find few things more offensive than Conservative Members taking the credit for medical advances, for the work of health service staff, or for anything else that has gone right in the health service, especially when they so patently refuse to take the blame for anything that has gone wrong. I am delighted to hear that his constituent—
§ Mrs. Beckett
Public reaction suggests that that is exactly what the British people believe, and they are right to believe it.
§ Mr. Peter L. Pike (Burnley)
All too often, because of financial restraints and financial considerations, patients are discharged from hospital far too quickly, purely on financial, rather than medical, grounds. Is not that one of the ways in which the Government reduce the number of beds, and one of the factors that lead to complaints? Even worse, on some occasions those patients do not even have the back-up so that they can be looked after when they get home.
§ Mrs. Beckett
My hon. Friend is right. Real concern exists about whether we respond adequately to the changes with discharge procedures, and about whether we arc considering readmissions and other matters. We continually press the Government on that matter.
§ Mr. Alex Carlile (Montgomery)
The right hon. Lady focused on psychiatric care, a subject in which the Secretary of State has some professional expertise. Does the right hon. Lady agree that it is not only the shortage of psychiatric beds in London that is a scandal but the 862 fact that some patients are being shunted 100 or 200 miles from their homes although their families are an essential element in their psychiatric treatment?
§ Mrs. Beckett
The hon. and learned Gentleman is entirely right. It is especially worrying that this most vulnerable group of people are being treated in that way. No one who knows the position is at all happy or satisfied with the level of care that it implies.
A survey carried out by the Royal College—
§ Mrs. Beckett
No, I am sorry, but I had better get on. I have given way a great deal already; I may give way later if I have time.
A survey carried out by the Royal College of Radiologists was cited in a Which? survey of the Government's health care changes—I know that the Government always approve of consumer surveys. The Which? report states:A survey carried out by the Royal College of Radiologists in 1993 found that 14 out of 29 cancer units reported waiting times for radiotherapy of four weeks or longer. In some cases the delay is seven or eight weeks"—which no one can think desirable in terms of health care.
The Evening Standard has done a great deal of work on health care, and it is noticeable—this pattern occurs not only in London but across Britain—that it has more health stories that worry reporters, editors and readers than it can readily print. On 25 January, the Evening Standard stated:This winter, there have been several occasions when not a single intensive-care bed has been available anywhere in the capital for either an adult or a child.Despite that fact, seven of London's 48 intensive care units are said to face closure.
I refer now to the Secretary of State's use of statistics. Which? states:It simply isn't true"—as the Secretary of State said yesterday—to say that no one is waiting more than two years. The figures published by the Government under the Patient's Charter"—which I regard as a cone hot line for the health service—reflect"—they should do so, but they do not—the experience of people".The article draws attention to the fact that the top priority in the NHS since the Government's so-called reforms has been to reduce waiting times and how much money the Government have put into it, but it also states that the targets and proposals represent only half the story. It finishes by saying:The only national figuresfor waiting timesthat are currently published are compiled by the independently-funded College of Health. These show that some patients wait well over a year or more to see a specialist, who then decides whether or not to put them on a waiting list.It goes on to state that some of the longest waits are of three years for general surgery and more than two years for orthopaedic care.
I am struck by the fact that the Secretary of State used to imply—I do not want to misrepresent her, but it may even be that she used to say—that the issue to which my 863 hon. Friend the Member for Doncaster, North (Mr. Hughes) drew attention—that of people waiting to go on waiting lists—was not a problem. Suddenly, however, a standard has been set in the patients charter, which suggests that the Secretary of State was perhaps being less than forthright with us in the past.
The Prime Minister's local hospital is this month turning patients away because of a bed crisis. People are having to be sent 70 miles away, and the hospital has twice closed its doors to all admissions, once for a full 24 hours. A three-year-old girl in urgent need of treatment for asthma was turned away from St. Thomas's before Christmas and eventually had to be taken to Addenbrooke's in Cambridge.
In another incident, a war veteran had to wait at King's. After he had waited several hours in casualty, his family asked whether a private bed was available, and one was found within 50 minutes. There has since been a dispute, as it seems that the family had apparently misunderstood that they might be asked to pay, but of course the hospital did not intend them to pay, at least once the press got on the case.
The Hull Royal infirmary has recently had difficulties with staffing, and asked that patients with minor injuries should, if possible, care for their own injuries rather than go to the accident and emergency department.
A leaked report from the King's Fund draws attention to a range of problems, such as lack of privacy, inadequate early pain relief and the lack of information given to patients waiting for beds. It says that Government policy should have been based on well-researched facts rather than "anecdotal evidence" before accepting the Tomlinson committee's hypothesis about London. It continues:It might have been possible to predict the current increase in patients waiting long periods on trolleys in London's A and E departments as the level of hospital resources in the capital continues its ever-downward spiral.Earlier this week, a report was published by the—
§ Mrs. Beckett
No, I really must get on.
A report to the Secretary of State was published by the Clinical Standards Advisory Group about the problems caused by people having to wait for treatment in accident and emergency departments. We discovered that, although that report was published this January, it was sent to the Secretary of State last January. The Secretary of State has been sitting on it for a year, until—presumably—she could come up with some proposal for a trolley standard for her new patients charter.
The report says—[Interruption.] I do not know if Conservative Members think that that is funny. I certainly do not think that it is funny at all. The report says that NHS market changes—the changes that the Government have made to the structure of the health service—are causing hospitals to concentrate on non-urgent work, on which their income depends, at the expense of work to treat accidents and emergencies. The report also says that, in hospitals where people have to wait the longest limes to be treated in accident and emergency units, the highest rates of death in those accident and emergency units occur.
864 My final quote from the press in this section of my speech is of the right hon. Member for Brent, North (Sir R. Boyson), who said to the Evening Standard:Every week I fight to get people into hospital within the year.Perhaps some of his hon. Friends should have a word with the right hon. Gentleman.
In considering the evidence of problems in the health service and how widespread those problems are, I shall refer to the Casualty Watch results of 30 January. Under that procedure, people go into different casualty departments and ask people what is happening, why they are there and how long they have been waiting.
In Queen Mary's, someone with heart failure was being seen and was to be admitted, but had already been waiting for almost two and a half hours. In Bromley, someone of 81 years of age with pneumonia was awaiting treatment for three and a half hours. In King's hospital, someone who had collapsed with hypothermia was waiting for more than three and a half hours. Also in Bromley, someone of 77 who had had a heart attack was awaiting a bed for almost four hours. In King's again, someone who had diarrhoea and vomiting had to wait for almost four hours for a bed. Also, someone of 95 years old who had infectious diarrhoea was waiting almost four hours for a bed.
There is a whole string of such cases. They are all a snapshot of what is happening in our national health service accident and emergency units in one day. The worst cases included those in Chase Farm, where someone of 78 with diarrhoea and bed sores had been waiting for almost seven hours, and someone with gastritis, who had previously arrived at 4 o'clock in the morning and who reappeared at 10 o'clock in the morning, had been waiting for seven hours.
Someone in Newham of 75 years old had heart failure and had been waiting for eight hours to be admitted. That is the health service in which the Conservative party says its reforms have solved all the problems, and that there is no need for the Secretary of State to continue to address them.
I turn now to the testimony of the staff.
§ Mrs. Beckett
Yes, it is a sad catalogue, but it is the state to which the Government have reduced our national health service. The very least that the Government can do, when patients in that service are waiting seven hours to be admitted—elderly patients, people who fought in the war and who were in this country during the war—and the very least that the Minister can do is listen for 40 minutes to what his Government have done.
The chairman of the BMA—
§ Mrs. Beckett
I am more interested in the testimony of the staff of the health service at the moment than that of Conservative Members. The chairman of the BMA, Dr. Macara, said:There is despair in the air today…despair about the mood of alienation and demoralisation in the NHS.He talked about the Government's changes beingto serve a perverse philosophy of winners and losers.865 There also is the testimony of Dr. Lee-Potter, a self-described lifelong Tory voter, but perhaps not for much longer. He says that the Government's changes in the health service are dogma driven, and that the Government may claim that what they are doing is not privatisation, but itis the next best thing.He hopes that people will recognise that, if someone such as he is saying how disastrous the changes are, matters really must be bad.
Five professors, world-renowned experts in molecular genetics, resigned from the health service in the summer. Four more are considering their positions. They talk about Government policy forcing themto engage in a competitive destructive conflictand how the Government's changes havepoisoned the environment between research groups who should be collaborating with one another and instead are being forced into competition.In a letter to The Guardian on 28 January, the professor of diabetic medicine at the Royal Hallamshire hospital in Sheffield said that peopleshould realise that they are sitting on a medico-legal time bomb…The image created is of an improved modern NHS…The reality is stress and dangerous practices relating to the pressures and it has become worse in the past year".He went on to say:Five years ago our wonderful NHS was reasonable but had some problems. Now reason has gone out of the window and problems dominate.Earlier this week, Charles Clarke, a distinguished neurologist, said:As a neurologist I can no longer offer effective emergency care at either hospital in the trust to the district general hospital I serve … in the last six days I have been unable to admit six out of seven patients I regarded as emergencies".He talks about there being fewer beds available in future.
There is also the testimony of London's leading cancer experts, who are finding it increasingly difficult in the market-based NHS to obtain permission to undertake trials and to become involved in research, because that is not the priority of those who control the purse strings.
I shall finish by quoting an anonymous contribution from a junior hospital doctor who wrote—again—to The Guardian. It is sad, is it not, but people will write to and read that newspaper, much though Ministers dislike it and much though they object? He or she said:I work as a junior hospital doctor in a typical district general hospital. Over the last 18 months I have seen the hospital spiral into crisis.That person talks about patients waiting in casualty for up to 10 hours before being transferred to an outlying ward, and calls the patients charter a sick joke. He or she finishes by saying:Patients are already suffering unnecessarily, and some have died…The situation continues to deteriorate and soon the NHS will have sunk altogether.[Interruption.] One hears just about barely sotto voce comments from Conservative Members about how awful and terrible it is to quote all those newspapers.
In our previous debate, the Minister of State accused me of simply talking from the point of view of what the Labour party thought about the health service. He 866 demanded evidence. He asked for testimony as to whether there were any problems in the health service. I am giving him testimony in spades. I assure the Minister of State and the Secretary of State that there are shovelfuls more where that came from. All of it is the real experience of patients and doctors of the problems in today's health service, under the Government and resulting from the changes that they have made.
§ Mrs. Beckett
I will give way shortly. [Interruption.] How dare the Under-Secretary of State for Wales? It is not a lazy speech to quote extensively from the experience of patients and doctors. It requires great work, study and collaboration. The hon. Gentleman hates and resents it because I have given him the authentic voice and experience of patients, the authentic voice and experience of the medical profession, of the nursing profession and of everybody else. The Government's stupidity and insensitivity will ultimately bring them down.
§ Mr. Tracey
The right hon. Lady has read us rather a lot of press cuttings, and I accept that she thinks that those are making her case. Will she comment on the latest edition of "Social Trends", which reports that our population is healthier now than it is has ever been? Presumably that also includes the time of Labour Governments.
§ Mrs. Beckett
Factually, what the hon. Gentleman says is extremely questionable. There is a sharp disparity in health standards across the population. Those at the bottom of the heap in terms of income, housing and all the other policy factors which impinge upon health care are certainly doing very much worse under the Government; again, there is a great deal of testimony to that.
The Minister will be delighted to hear that I shall now quote from the Government's own document. I presume that he will not object to that. I have given evidence and testimony as to the state of the health service and the opinions of staff, and I want now to turn to the Government's purpose, which I believe is clear.
The Government are intent on ensuring that the NHS will no longer be national. They are intent on fragmenting the service and—through a failure to plan, destructive competition and profound demoralisation within the service—they are intent that the NHS shall no longer play a major role in maintaining the nation's health. Finally, by starving the NHS of resources, the Government are intent on transforming the public service into a private market.
Ministers openly advocate the privatisation and commercialisation of the NHS. The Government's own document—the NHS executive's document called "Managing The New NHS"—states that their capital investment manualmakes it clear that private finance alternatives should be viewed as a standard option…Approval will not be given to business cases unless there is a clear demonstration that private finance alternatives have been adequately tested.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
We have waited 32 minutes to hear a single word of policy from the right hon. Lady on behalf of her party. This is the big moment for which 867 we have all been waiting. She mentioned that resources had been starved. Is she confirming the pledge made by her predecessor, the hon. Member for Sheffield, Brightside (Mr. Blunkett), that Labour would increase spending on the NHS by £6 billion?
§ Mrs. Beckett
Nobody has ever said that. The Minister is perfectly well aware of that, although the Secretary of State continues to pretend that it has been said. We have always said that, on coming into office, we would examine the state of the NHS, see what money was available, where it was being used and whether it was being used as it should be—
§ Mrs. Beckett
The Minister need not get up, as I will not give way to him again. We would see whether the money was being used properly for patient care. We would also, of course, have to assess the state of the economy and what could be afforded.
I must say that, in my day—in terms of the years of experience in the House which the Minister has had—it was usually left to Back Benchers to put the kind of point which the Minister has just raised. The Minister is obviously under-worked at the Department. I do not intend to be diverted further, but I might say to the Minister that the length of time which I have taken for my speech has been primarily due to my giving way to interventions from Conservative Members.
§ Mrs. Beckett
No, as the hon. Gentleman will only make the same point.
Ministers are now openly advocating the privatisation and commercialisation of the NHS. The Government have already fragmented the service into almost 500 individual businesses competing for the profits to be made from sickness and disease.
I am asked frequently—I am sure that the Secretary of State will ask again today—why the NHS, or parts of it, should not be privatised. There is a tendency for those of us who believe in a public health service to think that that question need not even be addressed, as it is too self-evident. However, after the week that we have just had in the NHS, we should spell it out again. I shall do so briefly.
The national health service should not have been privatised, for the same reasons that British Gas should not have privatised—because a privatised service skimps on public service. Privatised services enrich executives with barrowloads of cash, and it is only about a week since we heard the figures for the huge salary increases that some of them are being paid. While such services enrich executives with cash, they threaten to cut services to the elderly and the blind.
Privatised services do less, and their public relations people make it sound like more. In a privatised service, money talks; where money is absent, and in consequence there is silence, the sick, the poor, the frail and the dying wait on trolleys in corridors, in long queues in waiting rooms, or in the frightening isolation of their homes.
At the Conservative party conference, the Prime Minister said that, while he lived and breathed, the national health service would not be privatised. He is, I 868 suppose, living and breathing, but yet again he is being, at best, economical with the truth, because the evidence shows that the health service is being privatised.
The National Association of Health Authorities arid Trusts issued an "Update" leaflet headed "Private Finance and the NHS", in which it talks about a "mixed economy" in the health service, and says that that wouldalso allow for the increased participation of the private sector through the development of joint ventures.It concludes thatcontrol of the joint venture must be in the hands of the private sector partner".The Secretary of State has said:Private finance should be the rule and not the exception.In a recent survey carried out by the Health and Social Service Journal, health service managers express their concern and say that they are unhappy about the process of market testing being driven by the Government because they fear that it isso time consuming that any benefit gained would be offset by the costs … In addition, scarce resources might well be diverted into unprofitable procedures for the sake of quasi-political dogma.Yet the Government have spent almost £1 million market-testing NHS services. They have tended to talk as if market testing were unimportant—merely for catering, or whatever, although people may have a different view about whether that is important or not.
A recent parliamentary answer to me by the Under-Secretary of State for Health clearly revealed that we have moved way beyond ancillary or support services, and that the Government have market-tested no fewer than 30 clinical and clinical support services in England during that time—services that range from anaesthetics to nuclear medicine, ophthalmology, pharmacy, and radiology, and take in a range of other core NHS clinical services on the way.
The private insurance industry is identifying those opportunities and trying to move into those fields. A conference organised by a string of private insurance companies was held in early December. They say—
§ Mrs. Beckett
Certainly. They are Norwich Union Healthcare, Friends Provident, Employers Reassurance, Guardian Health, Private Patients Plan and a whole string of other involved and interested parties. In the brochure to encourage people to attend the conference, they highlight a statement that they clearly believe will draw people there:As the UK population becomes increasingly receptive to the concept of private healthcare insurance … every player must ensure that their business strategy will increase both profit and market share.In the lectures listed, someone was to speak onwhich methods are most effective when convincing traditional NHS clients to take private insurance cover".My hon. Friend the Member for Sheffield, Brightside (Mr. Blunkett), as the shadow Health Minister, was to address the conference, and was supposed to speak onhow far are the Labour party willing to reverse the privatisation of the healthcare industry"—a privatisation that the Government say is not taking place.
869 For helpful illumination, let us turn yet again to Mr. Roy Lilley, the chairman of the Homewood trust, in whose opinion the Secretary of State places such value and whom she is so keen to defend. Mr. Lilley wrote a long article about privatisation. He said:Could we—or should we—`privatise' the NHS?…The question is more likely to be whether you could get away with it.Technically, privatising the NHS would be easy. Trusts are tailormade for the job.He goes on to say:So let us not pretend the NHS cannot be privatised, because it can—with a minimum of upheaval.That is because of the structures which the Government have put in place, and which they keep telling us we may not disturb.
But what does it matter, because, as Mr. Lilley says in his closing paragraph:after all, the NHS is only a concept".The NHS is a concept of such huge value to the British people that the Government have consistently denied the real effect and direction of their policy. But it does not stop there.
BUPA proposes to offer people lifelong disability cover policies in the near future. The reason BUPA is thinking of making that offer and moving into new areas is because it believes that the Government will reduce the disability living allowance next year, making private insurance against disability more attractive.
Whether BUPA's insight into what the Government have in mind is to do with the fact that a past chief executive of the NHS executive is now on its board, I am sure the Secretary of State can tell us. But it is interesting that what it sees as a further cut in the welfare state may be designed to create a market for private insurers.
§ Mrs. Audrey Wise (Preston)
Along with that creeping, or perhaps galloping, privatisation and greater reliance on companies such as BUPA, has my right hon. Friend noticed the increased reliance on charitable fund-raising? She may have seen in the Nursing Times and Nursing Mirror recently a spirited debate among nurses about whether they should spend their time fund-raising or caring for patients. Surely everyone in the House should want them to care for patients, not rattle tins on the street.
§ Mrs. Beckett
My hon. Friend is entirely right. It is particularly alarming that they must spend time doing so when staffing levels and service in the NHS are already under so much pressure.
At the Chelsea and Westminster hospital, there is an example of a national health service ward being converted into a luxury private ward. In another case in Epsom, a ward previously closed to NHS patients because the hospital could not afford to run it then reopened to the private sector. All that is an on-going process. We are already seeing it in mainstream health care; we now see it in disability.
I was recently contacted by someone working in medical market research, who told me that insurance companies have undertaken, on the street and no doubt in the home, research to test the market for privatised general practice. People are being invited to comment on various packages of general practice which they might find 870 attractive: a relatively straightforward core general practice service for a monthly fixed fee of £20; a more widesprtad service including physiotherapy and dentistry for a higher fee; paying a further fee for a full range of treatment, including hospital care; and so on. All that would be for a fully privately run and operated general practice service, rather than a public sector service.
The National Association of Health Authorities and Trusts pointed out that the only way to get privately financed primary health care centres built in inner London would be to allow private health providers to both build and operate them. So we are seeing a steady encroachment of the private sector into the national health service, which is why we say that the existence of that service is being put at risk.
I draw a parallel to the attention of the House. In the early 1980s, the Government began to squeeze funds for all the services that local authorities provided, just at a time when demography and changes in national health service care were producing increased demand for residential and nursing care for growing numbers of elderly people. They began to squeeze local authority funding and places. They began to allow—indeed, to encourage—public funds to be used to subsidise the purchase of places in the private sector to fill the gap because the public sector could no longer provide enough places for the perceived and evident need. As the bills began to grow, the Government began to rein in that level of public support, but continued a steady process of attrition—squeezing, cutting and discouraging extra alternative local authority facilities from being provided, even though the need continued to grow.
Now, we have reached the point where those in private sector residential and nursing care receive allowances that are withheld from those in local authority homes—who face a financial penalty. Local authorities are forced to spend by far the greatest bulk of the money that they have available for community care in the private sector. Increasingly, there is little or no availability of community care in the local authority sector. There is simply private sector care—the local authority is restricted to providing inspection of that care. In effect, community care is being and has been privatised.
§ Ms Ann Coffey (Stockport)
Would my right hon. Friend he interested to know that my local authority of Stockport plans to charge elderly people for community care provided through the public or private sector that comes to more than £350 a week—incidentally, the price of a place in a private home? I am sure that my right hon. Friend knows that £350 a week does not provide much community care.
That policy will drive people into private sector residential care, when the object of the Government's policy is to keep them in community care. Does my right hon. Friend agree that it is simply a way of local authorities trying to recoup money that they are having to spend on private nursing homes because they cannot provide community care?
§ Mrs. Beckett
My hon. Friend makes an interesting point. It is an example of how the process is developing still further.
The end result of the steady process of attrition that has taken place over 12 years is that people are being moved out of the shelter of the welfare state. They no longer have access to public places; they have access to limited public 871 funds—they have no choice but to be in a private sector place. Individuals and their families have to provide the funds to meet the costs of private sector places. It is a process of privatisation by stealth.
The existence of the national health service is being threatened. We are seeing not only a decline in standards and damage being done by Government structural changes, but a steady and deliberate process—a parallel process—of attrition of publicly funded health care.
Ministers are already talking about being neutral in their approach to public and private sector provision, which is exactly what they said about community care. Already, as I told the hon. Member for Lancaster, the number of national health service beds is falling, at the same time as the number of beds in the private sector is increasing. As a result, the number of people treated in the private sector is rising because there is no choice—there is nowhere else for them to be treated.
A conference—"Strategic Market Testing—Clinical and Clinical Support Services"—was held by a range of private sector interests. In the blurb telling people why they should attend the conference, the organisers state:New government guidelines on Market Testing of clinical and clinical support services are due to be published next year and there is increasing speculation that it may become a compulsory procedure for pathology services.We are seeing exactly the same process—a neutral approach to the public or private sector, increased use of the private sector because the public sector is squeezed, then use of the private sector starts to become compulsory. All that is happening despite the fact that, on the waiting list initiatives—
§ Mrs. Beckett
No, I am sorry, but I have almost finished. I would have given way earlier, but not now.
We are seeing the steady attrition of the public sector and the steady growth of the private sector irrespective of the cost involved. Take the Government's waiting list initiative as an example. There is no question but that, on average, it costs more to treat patients in the private sector than in the public sector, yet the Government continue to insist on private sector treatment.
There is no doubt that private health insurance can cause continuing problems. Lord Lawson, a former Chancellor of the Exchequer, refers to private health insurance in his book:There are in practice only two ways in which health care can be financed. One is by the taxpayer, and the other through the individual taking out an insurance policy—that is the course to which the Government are seeking to drive the British public—The latter method, which is the basis of the US system, inevitably results in a massive further escalation in the cost of health care".It is not a question of value for money; it is dogma-driven policy, which was identified by Dr. Lee Potter and which has so disillusioned people like him. Speaking earlier this year, Dr. Macara said—[HON. MEMBERS: "What is Labour's policy?"] I will tell Government Members what the Labour party's policy is. Our policy is to recreate a public health service which is national in its scope and equal in its access. 872 [Interruption.] Does the hon. Gentleman wish to intervene, or is he simply bellowing from a sitting position in a rather ill-mannered way?
§ Mr. Peter Butler (Milton Keynes, North-East)
I am grateful to the right hon. Lady. I did not intend to intervene, but as she insists, I will do so. She has spoken very eloquently for 50 minutes, but she has not even hinted at a Labour policy. All she is giving us now is a description of the Opposition's aims. Do they not have a single policy? It is not too much to ask: just one policy to go on with.
§ Mrs. Beckett
I can only commend previous debates on the subject to the hon. Gentleman. We have made it very plain that we remain committed, not just in theory but in practice, to the provision of a public health service which is national in scope and which gives access to people across the country on the basis of clinical need and not on the basis of ability to pay. We are concerned that that objective is being put at risk by the Government.
We have also identified three elements in the Government's health reforms which we believe are directed specifically towards privatising the health service. Those elements are: market testing, the use of the internal market and the introduction of competition; the introduction of individual trusts, tailor-made, as Mr. Lilley said, to be moved to the private sector as individual health businesses; and the introduction of general practitioner fundholding, which has created a two-tier system. We have made it clear that those structures must be replaced, and that we are consulting on how that can be best achieved.
I know that Government Members do not like consultation—frankly, I do not think they know what ii means. In a previous debate on the Health Authorities, Bill, the hon. Member for Hereford (Mr. Shepherd) drew attention to what the Government consider to be consultation. In referring to the consultation process on the changes that the Government are at present pushing through, he said:I am not entirely sure who has been consulted … myself and my hon. Friend … had a meeting with the health authority chairman … It was certainly not a consultation … I understand that the chairmen of the health authorities were not consulted. The general managers … were summoned … and told what was to be the case".He went on:What will be the value of so-called consultation if, as I perceive, decisions have already been made and written on tablets of stone"?—[Official Report, 12 December 1994; Vol. 251, c. 659.]I assure the hon. Member for Milton Keynes, North-East (Mr. Butler) that we shall publish some proposals in the early summer. When it comes to a question of detail, I commend to those hon. Members who are not fortunate enough to serve on it the proceedings of the Committee considering the Health Authorities Bill. They will discover that the Government are pushing through legislation to finalise quite sweeping changes in the structure of the national health service without the faintest idea of their impact.
What will happen to the contracts of junior hospital doctors? The Government say that they might be held at regional level, but nobody really knows. The Government have not decided what will happen to nurse education. What will happen to community health councils? The Government say that that is under consideration. The 873 Government are pushing through legislation without settling those details. Why on earth do Government Members expect me to give them details of our proposals which will take effect in two years?
If the hon. Gentleman can tell me today how many hospitals will be in the national health service in two years, he knows more than the Department of Health does today. If he can tell me how many accident and emergency units there will be, he knows more than Ministers do today. They do not know the answers to those questions.
§ Mrs. Beckett
I will not give way, because I am almost at the end of my speech, and have given way frequently.
Recently, Dr. Macara said that he was concerned about the existence of almost a plot—although those were not his words—against the national health service. He stated:I am categorical about this. I did not want to believe it for a long time, but I now have every reason to believe it is deliberate policy on the part of a number of senior people".He believes that there isa political agenda to break up the NHS.I drew parallels with the process of attrition and privatisation by stealth in community care. I quote finally from the document "Managing the NHS", published by the Office of Health Economics and written by William Laing, who is a well-known commentator on the role of the private sector in the NHS:The relatively streamlined administrative model for community care may prove to be the model towards which the NHS internal market evolves in the future, if the NHS follows the path of community care, in the sense of contracting out the bulk of services to independent providers, the principal function of the NHS Management Executive, or any successor organisation, may change to one of monitoring quality through inspection and registration.That is exactly what happened in community care.
Our task today and in the months ahead is to ensure that the British people realise the real threat to the national health service's existence; lead the resistance to privatisation and, as we did with the Post Office, prevent privatisation if we can; and work to restore to the British people that which the Government's folly and incompetence has put at risk—the health service, whose worth the people of Britain know and, knowing it, value. The Government's continued existence places in jeopardy the continued existence of the national health service. They must go if the health service is to survive.
§ The Secretary of State for Health (Mrs. Virginia Bottomley)
I beg to move, to leave out from "House" to the end of the Question and to add instead thereof:congratulates National Health Service staff in hospitals and in the community for providing ever more and better care for patients with 122 patients being treated for every 100 four years ago; welcomes the health reforms which have provided a coherent structure to enable them to do so; recognises the challenges faced by the National Health Service resulting from medical advance, the ageing of the population and rising public expectations and believes that the new National Health Service is better placed than ever to meet these challenges; welcomes the 68 per cent. real terms increase in National Health Service spending since 1978–79 and the Government's manifesto commitment to further real terms increases; and condemns Her Majesty's Opposition for its ill-thought-out 874 commitment to abolish the reforms, an act which would inflict chaos and confusion on the health service, deprive patients of the benefits of National Health Service Trusts and general practitioner fundholding and prevent the health service from responding to the changing needs of the public.I am almost at a loss to know where to start. It is clear that the right hon. Member for Derby, South (Mrs. Beckett) and her colleagues have got rid of their policy groups and instead have taken on a selective cuttings service. The right hon. Lady covered a great number of newspapers, and started to read conference agendas as the substance of her speech. My hon. Friends were waiting to hear anything that resembled policy or approached a practical way forward.
If one is to deliver a comprehensive service available to all, young and old, regardless of ability to pay, in the face of medical advances and rising expectations, great pressure will be placed on the service. That is why it is important to devise a framework of coherent policies that address those issues. I urge the right hon. Lady to consult independent commentators, the Organisation for Economic Co-operation and Development, and the London School of Economics—which I visited last week—about the significance of the changes that we have been putting in hand.
Changes in scrutiny and balance, and in the outcomes that the health service is now delivering, are being followed by health care experts throughout the world. As ever, we heard endless smears and innuendos about privatisation. It is hard to understand whether the right hon. Lady dislikes someone ever paying for something or private sector involvement in any provision. In our party, if the private sector can deliver a service of higher quality and good value, we have no vendetta against it. Of course, we are not sponsored by health unions. We do not have one hand tied behind our back, knowing that whatever we say about patients, it is jobs for the boys and girls that must come first. That is not our problem.
It is well understood that the greatest recruiting sergeant ever for private health care was the industrial dispute in the final days of the last Labour Government. If one wants to drive people into the private sector, the most powerful argument is to have shop stewards on the hospital gate deciding whether someone is an urgent case and volunteers manning the kitchens.
The right hon. Member for Derby, South may be interested to know that there has been a decline in the number of people taking out private health care insurance in recent years. That is an interesting reflection on public confidence that the NHS is delivering a quality of care in which they could never have confidence in the past. That reflects the effectiveness of our reforms.
§ Mrs. Beckett
Does not it strike the Secretary of State that the recession is having an impact on the ability of people to afford private health insurance premiums—let alone loss of employment?
§ Mrs. Bottomley
The right hon. Lady totally fails to address the point that there is growing public confidence in the care that they receive from their health service locally. Nothing that we heard from the right hon. Lady takes the debate forward.
§ Mr. James Couchman (Gillingham)
The right hon. Member for Derby, South (Mrs. Beckett) was reluctant to quote from cuttings reflecting the state of the health 875 service in the winter of 1978–79. Does my right hon. Friend remember the years 1974 to 1976, when the then Secretary of State, Mrs. Barbara Castle, was confronted by simultaneous industrial disputes with every staff group in the NHS—a feat never equalled before or since?
§ Mrs. Bottomley
My hon. Friend may, like me, have watched last weekend's television programme about Barbara Castle. It provided a reminder that, ironically, the people who always have the greatest problems with health unions are Labour Secretaries of State for Health, because expectations are so high. It is a case of post-dated cheques—"Why are we paying for sponsorship?" As COHSE told the Nolan committee today, why is it giving £5,000 a year to Opposition health team researchers if, at the end of the day, it does not want something for that money?
§ The Parliamentary Under-Secretary of State for Wales (Mr. Rod Richards)
It pays £15,000.
§ Mrs. Bottomley
My hon. Friend reminds me that the sum involved is £15,000 a year, not £5,000—and, as far as I know, that is only COHSE's contribution.
§ Mr. McLoughlin
The right hon. Member for Derby, South (Mrs. Beckett) referred to several press cuttings, many of which related to London. Will my right hon. Friend confirm that there has been a redirection of resources in London, so that facilities in other parts of the country may at long last enjoy a fairer distribution of resources? They include two hospitals in Derby, which have been almost totally rebuilt—the Derby royal infirmary and Derby city hospital, where the right hon. Member for Derby, South opened new facilities just a few weeks ago.
§ Mrs. Bottomley
I am grateful to my hon. Friend for making that point. Our health service, like every health service in the world, is undergoing change. That change includes investing in the community and trying to put more into mental health services. That change requires leadership, courage and commitment to health care principles. If on every occasion, on every decision, Labour goes for the short-term headline and populist gesture, it will never again be worthy of the stewardship of the health service. Labour is the party of protest, not of progress or responsibility. It backs every campaign against closure and supports every pay dispute, because it can never face the difficult decisions involved in taking responsibility.
§ Mr. D. N. Campbell-Savours (Workington)
I ask the Secretary of State for an honest and straight answer to this question, because I need her reply for my evidence to the Nolan committee, to which the right hon. Lady referred.
Does the right hon. Lady ever meet lobbying companies on matters relating to health? Does she ever meet manufacturers of health products to discuss procurement issues? If she does—these activities may be perfectly legitimate—is she prepared to reveal when those meetings took place and what issues were discussed at them, if I table parliamentary questions? Is she prepared to be open with the House about these matters?
§ Mrs. Bottomley
As Health Secretary I am overrun by lobbying groups every day of the week. Last week I spent three hours at a dinner at the Royal College of Nursing.
§ Mrs. Bottomley
The hon. Gentleman seeks to draw a distinction between people who produce a product that 876 they wish to sell to the health service and the interests of the people who work in the service. I have also met representatives of the Manufacturing, Science and Finance union, of COHSE and of the health unions. Certainly, one aspect of my job is to be involved in promoting some of our most successful industries. I have had lengthy meetings with representatives of the pharmaceutical industry, because I was determined that London should win the Medicines Evaluation Agency. The pharmaceutical industry is one of Europe's, and Britain's, most successful industries. The new agency in London will act as a magnet for further inward investment.
As a member of the Government involved in spending an enormous amount of taxpayers' money, I certainly have an interest in being part of a wealth-creating economy which creates jobs for people and wealth for the taxpayer—and delivers ever-higher standards of health care. I am sad that the hon. Gentleman has so little interest: in wealth creation. The Labour party's inability to generate wealth meant that the Labour Government, as my hon. Friend the Member for Gillingham (Mr. Couchman) reminded us, had to cut nurses' and doctors' pay and instigate the first ever real terms cut in the health service.
§ Mr. Campbell-Savours
On a point of order, Mr. Deputy Speaker. I have just had a very long answer to a simple question. Will the right hon. Lady answer my parliamentary questions about meetings?
§ Mr. Deputy Speaker (Mr. Michael Morris)
First, the hon. Gentleman did not ask a simple question: he asked a long one. Secondly, I am not in the least responsible either for the question or for the answer.
§ Mrs. Bottomley
I would not dream of giving the hon. Gentleman details of every meeting I have had. I can only say that the holder of my office is continually bombarded by campaigns and initiatives on all fronts. My job is to discriminate between issues and to make sure that patients benefit as a result.
§ Mr. Alex Carlile
May I throw the right hon. Lady a lifeline? She had reached the point in her speech dealing with mental health, and had just said something about more resources for it. Why, if more resources are being poured into mental health, do psychiatrists in London virtually to a person—complain that they do not have enough resources or beds, and that they are having to send dozens of patients out of London, away from their families and communities, for treatment?
§ Mrs. Bottomley
The hon. and learned Gentleman will know that I am extremely sympathetic to his point. London has had a great duplication and concentration of specialty services. We have 14 cardiac centres and 13 cancer services. Because of the fixed overhead cost of all those centres, I do not think that we have given mental health services the priority that we should have given them.
As the hon. and learned Gentleman will be aware, it is not just a matter of health service contributions. It is also a matter of making sure that local authorities play their full part and collaborate. We have made it clear that we want a greater focus on mental health services in London. The changes involve that greater focus. It is not just a question of resources: it is a question of better organisation and targeting. That is why the Bill that we hope to introduce on supervised discharge is so important, 877 to make sure that we target the most severely mentally ill and that supervision registers are set up to maintain contact.
§ Mrs. Bottomley
The hon. and learned Gentleman is letting down a good case. If he reads the report on the Clunis inquiry, he will see that hundreds of professional hours were devoted to Christopher Clunis without proper co-ordination or management. We must adopt a more assertive, pro-active approach—an approach that Louis Blom-Cooper has come round to advancing. I have been taking it for some time.
§ Sir Michael Grylls (Surrey, North-West)
On the general standing of the national health service, for which my right hon. Friend is responsible to the country, is she aware that in a survey of 30,000 homes undertaken in my constituency, asking people who had used the NHS what they thought of it, 87 per cent. said that they were satisfied or very satisfied? Surely that is hard evidence, not just tittle-tattle from bits of newspapers.
§ Mrs. Bottomley
My hon. Friend has rightly identified the real issue. Time and again, when patients are asked what they think of the service they have received, that is precisely the degree of support that they give the NHS. Nobody hearing the disgraceful speech by the right hon. Member for Derby, South would think it a fair reflection of how the health service is experienced by our constituents around the country.
If I may, I should like to tell the House a story. Like many right hon. and hon. Friends, I recently spent a week by the seaside at the excellent Conservative party conference in Bournemouth. During my time there it was a pleasure to visit a smart new hospital with a new A and E department, and with a cancer service that has a recently installed linear accelerator. I also toured its new hospice; and learnt that the hospital had introduced the new arrangements for junior doctors' hours and brought down the maximum waiting time for any care to five months.
At my request, I met privately six of the hospital's junior staff—two doctors, two nurses and two managers. I found them in very good spirits: realistic about the tough job that they have to do, and enthusiastic about the tasks ahead. Indeed, the hospital was a model of what the NHS should be—a model followed by hospitals in many of my hon. Friends' constituencies. It was well run and well equipped. There was a good sense of teamwork. The hospital provides high-quality clinical care in comfortable surroundings.
Just before leaving, I remembered that the hospital also employed a well-known consultant who had in the past been critical of the Government's policies. I tracked him down to his lair and put to him the point that there seemed to be a startling difference between how he portrayed the NHS and what I had found and heard in his hospital. "Oh no," he replied,when I speak out I'm talking generally. This is an excellent hospital.I am sure that the House will want to know that the consultant's name was Jeremy Lee-Potter.
My story illustrates an important point about the health debate. Today we heard a great deal from the right hon. Member for Derby, South about how the service is 878 supposed to be on its last legs. That is simply not borne out by the experience of hospitals such as the one in Poole which I have just described. I am sure that my hon. Friends will readily confirm that it is not borne out in their constituencies either.
What the right hon. Lady said is not borne out by the massive expansion of modern family doctor services, new cottage hospitals, as it were, where patients receive locally more and better services than ever before. It is not reflected in the health of the nation either. Life expectancy is increasing for old and young alike. Infant mortality is falling in every region and every social group. Our capacity to prevent disease through immunisation and screening is also better than ever. Only today, I am pleased to say, we have announced our commitment to bone scans for women at high risk of osteoporosis.
Of course, it is against the Labour party's trade union rules—literally, I suppose—to mention any of that. It denigrates the NHS and denies the achievements of staff. Its big idea is to exploit every mishap, every unfortunate incident, for its own short-term political advantage. Constantly, it plays politics with the lives of the vulnerable and the weak. But the public do not like it and will not wear it. It was not such a laughing matter at the previous general election when the Labour party found itself out on its "Jennifer's ear", and it still has not learnt its lesson. The people want progress in the NHS, not protest from the Labour party.
§ Dame Elaine Kellett-Bowman
My right hon. Friend referred to the family doctor service. The right hon. Member for Derby, South (Mrs. Beckett) denigrated trusts and fundholders. She wonders why people want them. In my city, by the end of next year, every doctor will be a fundholder. That would not be the case if the patients did not want it and did not flock to the doctors who are fundholders.
§ Mrs. Bottomley
Once again, my hon. Friend has the point exactly. I believe that in the right hon. Lady's constituency 75 per cent. of patients are covered by GP fundholders. What is the merit in destroying a system that has so much empowered GPs—a system that has enabled them to get more choice, to pay more attention to detail and give greater care to their patients than any previous system? My hon. Friend goes to the heart of the issue.
We welcome the debate. We welcome the opportunity that it provides for our hon. Friends to reveal the contradictions between the real health service and the twisted picture presented by the Labour party. I welcome the chance to spell out the strong future for the NHS under our stewardship. There is more to do.
I welcome the opportunity to describe some of the challenges ahead and our policies for meeting them. We relish the chance to expose the disastrous and destructive policies threatened by the Opposition and the NHS nightmare that they would bring about. Unlike their motion, our amendment congratulates NHS staff. We recognise their achievements: more patients treated than ever before; falling waiting times; and dramatic cuts in the hours worked by junior doctors. There is massive investment in new technology and research.
Advances are taking place in our NHS, at the leading edge of medicine: in cystic fibrosis; the genetics of breast cancer; the ability now to create an artificial heart; and in many other areas. All that is taking place in the NHS today to serve patients for today and tomorrow. Teams of 879 dedicated doctors, nurses—and managers—are working together to provide the very best that they can. Those achievements command the confidence and the support of those who use the service. The closer people are to the NHS, the more they like it.
§ Mr. Ronnie Campbell (Blyth Valley)
I thank the Secretary of State for giving way.
I do not know whether the Secretary of State has ever been to Northumberland and to Wansbeck general hospital, which is part of Cheviot and Wansbeck NHS trust, but last year, only one month after becoming a trust, it was nearly £2 million in debt. Later, when cuts were made in the hospital, two mothers lost their babies at birth and are now suing the hospital. That is the state of affairs in Northumberland and I would ask the Minister to come up and visit the hospital.
§ Mrs. Bottomley
It is disgraceful to suggest that those tragic episodes had anything to do with these issues. [Interruption.] I listened quietly while the hon. Gentleman asked his question. The least that he can do, having worked so hard to get me to address his question, is to listen to the answer.
The hospital to which the hon. Gentleman referred received five stars in 11 categories in the league tables, such is the quality of care that it now delivers to patients. Its financial control, however, has not been of the standard that we would wish.
Today, the holder of my office can speak with confidence about the NHS, because the financial control is better than ever it was. When the Labour party was in power, this was the time of year of sudden closures, of running out of money, and of shambles in the health service as people were unable to meet their financial commitments through the year. [Interruption.] I have already explained that the financial control was riot all that we would have wished it to be, but the point is that it is a hospital that is delivering a quality of care for patients that matters.
I noticed that the Labour party sneered when I described that. It is interesting that it sneers at the league tables, because most people think that the length of time that one waits in out-patients and in accident and emergency departments, and the length of time that one waits for an appointment, matters. Time and again, that is the issue about which patients will complain in our NHS if one asks them. That is why the patients charter has been such a dramatic success.
My hon. Friends will remember when we launched the first patients charter three and a half years ago. They will remember that the best that we could do then was to offer a two-year maximum wait, and that 50,000 people were waiting longer than two years for treatment. Within only three and a half years, the wait has decreased, not to two years, but to 18 months.
§ Mrs. Bottomley
It is my intention now to make headway with my speech. I do not intend to give way further, having given way an excessive amount. If I do, I shall be rebuked by my hon. Friends, who feel very strongly about the changes in the health service. [Interruption.] I think that I have made myself clear.
880 The patients charter, which we launched only two and a half weeks ago, shows that not only have we got rid of the two-year waiters, and not only are 18-month guarantees being successfully delivered for hips, knees and cataract operations, but we can now deliver an 18-month guarantee for all care. More than that, we can move into the important area of out-patients. Nine out of 10 are being seen within three months. Nobody is waiting more than six months. [Interruption.]
§ Mr. Deputy Speaker
Order. The hon. Gentleman heard the Secretary of State say that she was not giving way.
§ Mrs. Bottomley
What is even more disgraceful is the way in which the Labour party, when the health service really has delivered improvements, as it has on the patients charter, says that it does not like the figures and that it is suspicious of the statistics. It must understand that, if one is running one of the largest national services, having authoritative figures is absolutely vital. It will be pleased to know that the Audit Commission helped us to validate the figures on the league tables. We want to measure improvements, to compare and contrast. That is precisely what an internal market is all about. It is interesting that the Labour party sneers and jeers about league tables on the achievements of staff. If Opposition Members visited the hospitals concerned, they would see the sense of achievement among nurses, doctors, managers and others who have delivered a quality of care that matters to their patients.
I am pleased to tell the House that patients are not as cynical as the Labour party. They welcome the charter. They want us to go even further. We listen to them and respond. They want us to do better on the waiting times. I have set that out. They want action on mixed-sex wards. They want more information and more choice. The new charter meets their aspirations and will meet their needs. It will continue our drive to lever up standards in every part of the service.
Once again, the right hon. Member for Derby, South made some rather sneering comments about complaints; certainly the expression that complaints should be "jewels to be treasured" is a phrase used by Brian Edwards, the regional general manager in the west midlands, who has led many of the changes in the patients charter and delivered quite remarkably.
The contrast between the sneering and the public's perception of reality is interesting. Last week, a television programme, "Pulse", made some pretty sharp comments about the health service. It offered a user's guide to the NHS which people could send for. I simply read from the Channel 4 user's guide to the health service—what was said in the book as opposed to the film:There has been a lot of effort to encourage hospitals and GPs to raise their standards. Patients are being offered information—once very hard to obtain—about the standards of service they can expect. More than that, they are actually being encouraged to comment and complain if the service does not meet their needs.That is the new culture that we have been establishing in the NHS. That is the new culture that our constituents and patients appreciate.
The charter makes the NHS more accountable to those whom it serves. The league tables, interestingly much sneered at by the Opposition, provide information so that people can make comparisons and look for further improvements. The Opposition, as we have seen today, 881 attack the charter and the league tables. For them, accountability is something that one talks about at Islington dinner parties, and power is what one gives to the trade unions. We well understand that.
I want to say a little more about primary care, which is, sadly, too often neglected in our debates. Every year, about eight out of 10 people visit their family doctors. General practitioners carry out, on average, nearly three consultations a year' for each patient on their list. Even with list sizes nearly 10 per cent. smaller than a decade ago, that means a lot of patients and a lot of GP time.
Our family doctors deserve recognition and support. The Government are giving them that, not only in the form of improved premises, additional staff and an attack on paperwork, but in what is perhaps the most important area of advance, GP fundholding, so rightly mentioned by my hon. Friend the Member for Lancaster (Dame E. Kellett-Bowman).
My hon. Friends and, I suspect, in their hearts, many Opposition Members as well, will know of hundreds of examples of how patients have benefited from GP fundholding. News has even reached the BMA which, in a recent document, stated:It could be argued that fundholding, because of the size of the population served, is a good model for achieving consumer accountability in the NHS.GP fundholding has brought about the most decisive shift in power in favour of family doctors and their patients in the history of the health service. It is at the heart of making the NHS more responsive to patients, more respectful of their choices and better at meeting their needs. That is why we are working to extend the benefits of fundholding to all patients.
Nowhere is the true nature of the so-called new Labour party better revealed than in its spiteful pledge to abolish fundholding. That is socialism in action—the envious grudge against success, the distrust of innovation, the ideological urge to reduce everyone and everything to the level of the slowest and the worst.
§ Mrs. Beckett
Is the Secretary of State aware of a survey conducted by "Pulse" among general practitioners which showed that more than 75 per cent. of general practitioners would like to see fundholding abolished?
§ Mrs. Bottomley
Fundholding has been commended not only by the Organisation for Economic Co-operation and Development and the London School of Economics, but even by the National Audit Office as a way of delivering more flexible and better care to patients. GP fundholders throughout the country are proud of their success. I do not believe for one moment that they would welcome the right hon. Lady's commitment to vandalise one of the most exciting and important innovations in primary care. Throughout the country, fundholders are outraged by her stance and, as my hon. Friend the Member for Lancaster said, their patients will be outraged when they discover that she plans to rob them of all those advances.
§ Mr. John Gunnell (Morley and Leeds, South)
If the Secretary of State envisages 100 per cent. fundholding, what will be the purchasing role of her new health authorities?
§ Mrs. Bottomley
The health authority, much discussed on Second Reading of the Health Authorities Bill and in 882 Committee, will continue to have a strategic role in monitoring, supporting and encouraging. Fundholding is a voluntary initiative. I do not anticipate that we will have 100 per cent. GP fundholders in the foreseeable future. But those GPs who wish to take that step do so in the interests of their patients.
The hon. Gentleman may also not be fully aware of the fact that few fundholders will be purchasing all the services that their patients need. I announced last week a doubling of the number of full fundholder projects and an evaluation scheme to consider carefully how they work. However, doubling the number takes us to only 50, so health authorities will continue to have an important role in the foreseeable future.
One of our great successes in recent years, but rarely debated because there is such agreement about it, is "The Health of the Nation" strategy, the delivery of which is through the local health authority, partly so that it can collaborate with other agencies in order to ensure that they play a direct role in improving the health of the local community.
Throughout the country, change is under way. Change is difficult for the people involved, but it is necessary in order to build a better and more responsive service, to have top-quality centres of excellence and to have accident and emergency departments with 24-hour consultant cover, as at the Royal London hospital, which was the first to have such cover.
The Labour party, by resisting every closure and undermining change, something for which it was attacked only the other day in the much-quoted article in The Guardian, would store up trouble for itself. It would be failing to recognise the success of the changes and the importance of what is being achieved.
Above all, we now hear with growing alarm about all the socialist hangers-on, all the different organisations, beating a path to the right hon. Lady's door to protect the interests of the purchaser-provider divide. The Socialist Health Association and Unison, when the right hon. Lady embarked on her vindictive attack on managers and the right hon. Member for Sedgefield (Mr. Blair) pledged to sack 8,000 health service managers—never have I known such a vindictive attack on a group of health workers—
§ Mrs. Beckett
I do not know where the right hon. Lady got that from, but there is not a word of truth in it, as I am sure she must know. I know that it was in the Daily Mail, but that is no recommendation.
§ Mrs. Bottomley
The fact that the Socialist Health Association and Unison have already made urgent representations to the right hon. Lady and the right hon. Member for Sedgefield that such an unprecedented attack on managers is not in their interest shows the extent of their power over the words that are uttered by Opposition Members.
We have heard a huge amount about what a villainous lot NHS managers are. I am pleased that there was an improvement in that regard today and I imagine that that is simply because of the representations made by the Socialist Health Association and others.
The Opposition are totally cynical. The right hon. Member for Sedgefield has pledged to turn hack the clock on the NHS reforms. That brings hack memories to Conservative Members. He has made a cynical deal with the unions. They give him a new clause IV, he gives them 883 the NHS. It is not as if the trade unions do not already have enough power over the Labour party's health policy. The right hon. Lady is their greatest friend in the shadow Cabinet. All her team are sponsored by the unions. We have already talked about the cosy sweeteners to help them on their way.
The chairman of the home policy committee is a union apparatchik, deciding on Labour party health policy and other policies that it would pursue, such as the minimum wage and the abolition of competitive tendering, which we heard about again today. The unions will be pleased. The end of pay beds is proposed—another tick in the box of what has been asked for. That is all for the unions. It will cost patients £1 billion every year simply to pay the paymasters and to keep them quiet. Given Barbara Castle's experience, I am not sure that even that will keep them quiet.
Even The Guardian, much quoted, has told the Labour party that it is talking nonsense and that it would bedisastrous for the NHS if Labour only looked back".That is right. The Labour party undermines trusts, described by the right hon. Lady in our previous debate as an abomination, and would rob GPs and their patients of fundholding status. Instead, she promises more power for the unions and less for the patients. The Health Authorities Bill will abolish the regions and sweep away an entire tier of bureaucracy. She proposes an amendment that would place a duty on the Secretary of Stateto establish Strategic Health Planning Authorities".Oh dear. Strategic health planning authorities? I think we all know what that means. It is clear from his famous memorandum that Leo McKinstry knows what it means. Mr. McKinstry, a former adviser to a Labour health spokesman, wrote:That's what Labour is good at: creating bureaucracy. Establishing a new body is one of the few solutions a Labour policy-maker can ever propose when confronted with a problem.I think that my hon. Friend the Minister for Health remembers that from the Committee stage of the Health Authorities Bill. It is the only thing to emerge from the interminable consultations organised by the right hon. Member for Derby, South.
The right hon. Lady wants to create a new tier of unnecessary interference and a new group of bureaucrats to second-guess the bureaucrats down the line; she wants to give more power to the planners, and take power away from doctors and nurses. Oh dear. But she does not just want to put the bureaucrats back in charge: she and her party want to break up the national health service and hand it over in little pieces to the so-called regional assemblies, described by Mr. McKinstry asirrelevant and unwanted talking shops".I agree with him.
The right hon. Lady wants to take the ability to make decisions away from staff of trusts, who know what patients want, and give it to her friends in local government. Again, the McKinstry memorandum spells out what that means.
§ Mr. Eddie Loyden (Liverpool, Garston)
Is the right hon. Lady aware that, under the present structure, it is virtually impossible to gain access to information? Trusts are failing to respond to local needs and local advice, or to deal with any of the problems that, as Liverpool people know, are damaging their health service. When will the trusts and the Secretary of State listen to the voice of those 884 who use the health service—the consumers'? At present, the trusts are a closed shop from the point of view of the people of Liverpool.
§ Mrs. Bottomley
I imagine that the people of Liverpool rejoice every day of the week that Sir Donald Wilson rather than Derek Hatton has been leading the health service. If Labour had its way, however, the Derek Hattons of this world would be in the driving seat.
The hon. Member for Liverpool, Garston (Mr. Loyden) says that there is a problem with information. I wonder where he has been all these years. What did he ever know about the number of patients treated, about outcomes and about waiting times? The trusts must hold annual meetings and produce annual reports; they must publish their accounts. There is a whole process of scrutiny, evaluation and provision of information. When the Labour party was in power, all that the hon. Gentleman could collect were statistics on deaths and discharges. There was no competitive or comparative information—which was a wonderfully cosy arrangement for those who worked in the health service, because there was no way of keeping them on their toes and ensuring that they all aspired to the level of the best.
I think that we have dealt with Mr. McKinstry and the appalling picture that he paints of Labour's plans. He called Labour councilsa mean minded cocktail of political correctness, bureaucracy, intervention and abuse of public money…massive procedural delays and rumours of corruption.As I have said, Mr. McKinstry advised one of the most recent Labour health spokesmen; I am very pleased that he is so well informed.
§ Mr. Deputy Speaker
Order. Is the hon. Gentleman deaf? He should obey the Chair. The Secretary of State is not giving way, and I hope that he can see that she is not. There should be proper decorum in the Chamber, and we will have it.
§ Mrs. Bottomley
I am grateful to you, Mr. Deputy Speaker. I have given way to Labour Members an excessive number of times—many more times than the right hon. Member for Derby, South, as the hon. Member for Cardiff, West (Mr. Morgan) will doubtless find when he reads the record.
§ Mrs. Bottomley
I hope that I shall.
The Labour party paints a picture of a fragmented, bureaucratic health service, hobbling from crisis to crisis with neither vision nor direction: a pen-pusher's dream, and a shop steward's idea of Christmas. Labour's policies would result in chaos, upheaval, confusion and waste. They are rejected by the British Medical Association, which describes the "major organisational upheaval" that would result from local authority control of the health service; people do not want that. They are also rejected by the Royal College of Nursing, which believes that the very principle of equity would be lost. They are rejected 885 by the doctors and nurses in trusts and fundholding practices, who are not prepared to see their precious freedoms wrenched away and given to the Labour party's friends; and they are, and will be, rejected by the public and by patients.
The right hon. Member for Derby, South used a phrase that Opposition Members always seem to find irresistible. Referring to scientists leaving the country, she spoke of a "brain drain". She should think again, and recognise the enormous brain gain from which the country benefits. Only the other day, I met a team of scientists who had come from America, Australia, New Zealand and other countries all around the world to work in Britain, because of the advantages of working in this country and with our national health service. Moreover, under the director of research and development we have developed a new strategy, providing extra funds so that we can build on our excellent medical research and ensure that its results are properly considered throughout the service.
What the Labour party calls the market mechanism is actually a process whereby purchasing authorities and GP fundholders can measure outcomes and effectiveness. They want to know whether they are getting value for money; they want to scrutinise and to question. At last we have a knowledge-based, evidence-based national health service, fed by our research strategy and feeding into further and profound improvements in patient care throughout the country.
That is possible because of the changes in the health service. It is possible because, by being more effective and efficient, we have secured additional resources to put into the service. What Labour has offered does nothing to encourage researchers, doctors, nurses and managers, and certainly does nothing to encourage patients. Our policies, by contrast, are creating a coherent and stable framework for a strong and modern service.
The national health service has always embodied the finest values and the strongest ethos; there can be no doubt about that. But in its old rigid, centralised form it was decaying; it was falling behind the pace of change that is necessary for evolving medicine, and demanded by the growing needs of patients. Thanks to our reforms, the service has been invigorated with new, local freedoms. We have established the right balance between central direction and local flexibility. Many of the recommendations of today's Select Committee report can be implemented more effectively because of the new structure that we have put in place.
We have a national health strategy; we have national as well as local accountability; we have ensured that national policies can be, and are, delivered more effectively through local action. What Labour derides as "the market" is, in fact, the power of health authorities and fundholders to challenge the system, to question and scrutinise, and to insist on benefits for patients. That is their aim and aspiration: to demand the answers to questions that would not even have been asked when Labour was in power.
Of course there is more to do. There is more to do for mental health, for junior hospital doctors and for a whole range of services. But by acting as good stewards for the health service, and improving efficiency and the number of patients treated, we have put ourselves in a better position to go even further forward. Let me make it clear that we are proud of the changes that we have set in hand. 886 We are proud of the extra money that we have put into the national health service, and we are proud of the achievements of staff. It is simply not good enough to utter populist gibes from the sidelines: the NHS deserves better.
Conservative Members want to protect trusts and fundholders. We want further progress in primary care, and even more improvements in the health of the nation. We will not stand by while Labour seeks to destroy all that has been achieved to meet the outdated, grasping demands of the unions. We will not let the clock turn back to nods and winks, and post-dated blank cheques. If anyone can speak as the guardian of the national health service, it is the Conservative party, which has run it for twice as long as the Labour party.
The Government need no lessons from the Labour party on our commitment to a comprehensive and coherent health service. We have taken the action necessary to equip it for the future. We have acted while the Labour party has ducked, dithered, plotted and fudged. I suspect that it will be a long time yet before the Labour party has the nerve to come to this place, without a policy to its name, simply to threaten upheaval and turmoil. It is under a Conservative Government, and only under a Conservative Government, that the NHS can look forward to a strong, secure and exciting future.
§ Mr. Sam Galbraith (Strathkelvin and Bearsden)
Listening to the Secretary of State for Health and to her exposé on the health service, I had a certain feeling of déjà vu. Once again, she made what a number of hon. Members have come to regard as slightly distasteful comments in claiming responsibility for almost every medical development in the health service. She spoke again of the development of artificial hearts. Such hearts have been developed elsewhere for many years, and it is no thanks to the Government that such developments have taken place.
I recall that when a former Under-Secretary of State for Health wanted to attract lots of publicity she used to make various claims for key-hole surgery, organ transplantation and other treatments, as though she had pioneered them herself. The fact that more patients are treated is due not to the Government but to the nurses and doctors who work in the service. The sooner the Government stop making false claims, the better.
§ Mr. Couchman
The hon. Gentleman rightly praises the excellence of national health service staff. Does he agree, however, that when things go wrong in the NHS, it is often down to a member of staff?
§ Mr. Galbraith
That truism has no particular relevance to what we are discussing. I did not understand the point of that intervention.
There is no 10-minute limit on speeches, although I shall definitely try to—
§ Mr. Deputy Speaker
Order. There is no 10-minute limit, hut hon. Members should not feel that they have to fill the whole time.
§ Mr. Galbraith
You, Mr. Deputy Speaker, can be assured of that. I just wondered how many interventions I should take on this matter.
§ Mr. Galbraith
That is more than I usually take, so there should be no problem.
I want to concentrate on rationing in the national health service. Debate on .the subject is increasing in health service journals, including in the British Medical Journal. I consider it to be a serious and sinister matter, which we should knock on the head at this stage. The reasons for that debate are secondary to what has been done to the health service under the Government. Their policies have led to the starvation of resources and to a market mechanism in the health service. To camouflage that and to enhance the changes, we get discussions about rationing health care.
It is said that rationing is necessary. We should not accept that argument and that, somehow, we cannot fund the service properly, and that some needs cannot be met. We should object to and resist that argument. We should not agree that the health service must accept rationing.
A definition of the rationing of health care is important. Rationing of health care is the denial of treatment that would benefit the patient, that the patient wishes to have and that the service wishes to give him. That is the correct definition. Within that definition, I do not include unnecessary treatment of patients. Many antibiotics exist for upper respiratory and viral infections. Stopping such problems is good medical care and a proper use of resources, but it is not rationing. We must remember that rationing is the denial of treatment that would benefit patients.
An important criterion of rationing is that no exit from the system is possible. There is only one true form of rationing in this country: transplantation. There is no equilibrium between the need for and provision of transplantation services; need exceeds provision because of limits on the service. The important thing, which is true rationing, is that there is no exit from that system: one cannot have a transplant in the private sector. The problem is that we are talking about rationing not of other provision but of NHS provision.
People who have money immediately exit and are treated in the private sector. The private sector is growing under the creeping, growing, sinister, behind-the-scenes privatisation of the NHS, which has been going on for many years.
§ Mr. Bottomley
This is almost the same point that the hon. Gentleman is making, and I put it in a non-partisan way. If the number of cataract, hip and heart operations has significantly increased, is that because doctors are more able to carry out such operations, because people could not receive them before or because of some form of rationing? Is there another explanation? It is certainly 888 true that more major treatments, which are of great advantage to elderly people in particular, are being offered. Is that an end to rationing or an increase in it?
§ Mr. Galbraith
If the hon. Gentleman will let me continue, I shall develop my argument and raise a number of other related issues, and I hope that, in doing so, I shall answer the questions.
One of the other justifications for rationing that we must dispense with is that, somehow, health care is a bottomless pit and that, therefore, need will never be met. That is not so. It may be true of a demand-led service, with unnecessary treatments and demand generated by the private sector and popular consent, but not of a needs-based service, which the NHS should be.
We know how many people require hip replacements—not everyone does, so demand is not bottomless. We know how many people require hernia operations, and demand is not bottomless. All we have to do is establish the extent of such need, after which it is a question of having the political will to meet it. Let us hear no more justification for rationing on the basis that need is a bottomless pit. That argument is fallacious and we should dispense with it.
Another argument for rationing that is often advanced is that everyone is doing it so we are no different from them. Again, that is not quite true. Many health care systems are concerned about cutting resources, but that is not necessarily the same as rationing care. The United States of America is not rationing health care; it is trying to stop unnecessary investigation and treatment, which is a different matter. In this country, the culture of medicine and all its ramifications are based on clinical judgment rather than on clinical independence, which is different. We should try to enhance that culture, which is threatened under the market system.
It is said that we already have some rationing in the NHS and that it is achieved through waiting lists. That is not true. Waiting lists are a system not of rationing health care but of delaying it, which is different. It is an unfair, arbitrary system that, again, allows people to exit from it to receive their treatment. It does not ration treatment but delays it.
The other system involves the general practitioner as the gatekeeper: the GP sees bigger waiting lists and, therefore, does not add to them. Again, that is not true. If a GP thinks that a patient needs health care, he sends him for it. The system allows the GP to use his or her clinical judgment and it reinforces the need not to get involved in unnecessary investigation and treatment. That is the system here, unlike in the United States. Someone who goes to see his GP with a headache does not need a CT scan or elaborate investigations. Instead, the GP uses his clinical judgment, which is what happens under the gatekeeper system. It is not a rationing system if it is based on clinical judgment.
§ Mrs. Virginia Bottomley
I support much of what the hon. Gentleman is saying. His point shows why GP fundholding is so successful and effective.
§ Mr. Galbraith
The Secretary of State is completely wrong. That system works only if the patient has a trust relationship with his or her doctor. [AN HON. MEMBER: "What does that mean?"] That question reveals the ignorance of the hon. Member for Milton Keynes, North-East (Mr. Butler), who listened to my right hon. Friend the Member for Derby, South (Mrs. Beckett) while 889 laughing and giggling about the health service. The trust relationship between patient and doctor means that they trust one another, which is in the best interests of the patients. The way to destroy that system is to introduce a GP fundholding practice, which will introduce a financial element into the decision-making process, as happens in the United States, where the doctor and his patient wonder whether the financial element will come between them. The Secretary of State is completely wrong and will ruin the trust mechanism. The loss of that trust mechanism leads to secondary defensive mechanisms and increased costs.
The hon. Member for Eltham (Mr. Bottomley) mentioned rationing. There has been, and there still is, a form of rationing in the sense that some sections of the population have low expectations. The rates for operations such as cataract removal, prostatectomy and others vary across the country and across the social classes—there are higher rates in the higher social classes and lower rates in the lower social classes. It might mean that the higher social classes have a few unnecessary operations, but I doubt that. However, it does mean that the lower classes have lower expectations. I hope that that deals with the hon. Gentleman's point. That form of rationing has persisted for some time but we should be seeking to eliminate it.
§ Mr. Peter Bottomley
The hon. and caring Gentleman speaks from experience. Most of us would accept that people need to have higher expectations and the royal colleges can help by carrying out studies in their various fields of expertise into what would happen if there were equitable treatment for all. However, does the hon. Gentleman accept that a significant increase in the number of heart, cataract or hip operations must be a reflection of extra resources or better organisation, but certainly of meeting higher ambitions, which is something for which we should all be aiming?
§ Mr. Galbraith
The hon. Gentleman has identified rationing as it used to exist. Renal dialysis is a case in point. That treatment was introduced when I was but a lad in medical school. It was limited for quasi-medical reasons but there was a form of rationing. However, there is a difference between that form of rationing and that proposed today. Under the previous systems, rationing of new developments was recognised but the aim was to eliminate it and expand the service. We are now going the other way by reducing and denying treatment.
I conclude by cautioning against two systems that have been suggested for use in this country. The first is the Oregon system, which the Secretary of State said was flawed. For those who may not be aware of it, it is a system used in Oregon to try to ration health care. It involves condition treatment for pairs of patients in a ranking system based on utility and disability. It is not an effective system for rationing care and should not be introduced here. I trust that health managers will not attempt to use it. It is not a true rationing system because it is concerned only with rationing Medicaid, which is only one part of the care available for the indigenous population. There was public consultation but it was a sham because it involved only middle-class people and not those affected. The major flaw is that it does not deal with an individual patient's needs.
890 The second system that is occasionally advocated is "qualys", or the quality adjusted life years system. It is quasi-scientific involving given numbers but its reputation has no basis. I have tried to use qualys from time to time along with other systems of practically no value in dealing with individual patients. Such a system is nothing more than a useful research tool. The main reason why qualys and similar systems are useless is that they do not deal with the individual patient on whom we should be concentrating. The problem is that we often end up talking about categories, as the Government tend to do.
We must deal with the different factors affecting individual patients. Rationing systems have no part to play. Practices may have to be varied because someone wants extra time to see his grandchild, son or daughter graduate but, at the end of the day, someone has to sit on the bed, look the patient straight in the eye and say, "Yes, the treatment would be of benefit to you but because the Government have told me to ration it, I'm afraid you can't have it."
I am in favour of the elegant muddle through, whereby pressures are adjusted according to individuals and patients are consulted under the trust relationship that exists between them and their doctor. That relationship is being threatened by the Government's underfunding and the introduction of market mechanisms into the system.
§ Mr. Peter Brooke (City of London and Westminster, South)
It is a pleasure to follow the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). He is a classic example of how much the House gains by having among its number those who have had an expert career outside—an issue that I hope the Nolan committee is considering.
I express appreciation, too, for the right hon. Member for Derby, South (Mrs. Beckett), who, if imitation is flattery, paid me the great compliment of imitating an anecdotal technique that I developed in national health service debates as a novice Back Bencher between 1977 and 1979 when she was a Minister elsewhere. My one salient regret about her speech was that she left her mission statement so late that she did not allow herself adequate opportunity to develop the strategies that would have given that mission statement meaning.
It was a little more than three months ago that a debate on the national health service in London afforded me a maiden recent opportunity to speak about Bart's and its merger with the Royal London and the London chest hospitals. I am grateful to the Opposition for affording me a further opportunity today. I said at the time that Bart's had entered into the merger negotiations with good will and in good faith but that I was disturbed by the spirit in which progress was being made, given the fact that for the merger to bear fruit it was essential that the parts of Bart's that might transfer to the Royal London should feel that what was emerging was an institution greater than the sum of the parts. I choose my words carefully about the shape of the merger because of the current consultation about the trust's proposals.
I should like to be able to tell the House that my anxieties have been allayed by the developments since our previous debate. Since then, the consultation has been initiated, which is as it should he. I am confident that on such a serious issue responses to the consultation document will be comprehensive and well informed. Of course, the consultation period still has some time to go.
891 I am more uneasy, however, with the spirit underlying the merger, which is critical to the process. Since conspiracy theory was already rife at St. Bartholomew's, to which I shall return, it is unfortunate that conspiracy theory should have emerged at the Royal London hospital as well. I refer to the recent press conference on the shape of the future hospital, at which allegations about Bart's and its behaviour leached into the national press. It seems to a bystander careless, on so sensitive a subject, that it was not arranged for anyone to be present to represent Bart's at that press conference, when the participation of Bart's representatives is critical to the future and the future merger.
That is what I mean by saying that the spirit of the merger process seems to have gone unnecessarily sour, when the trust is asking Bart's to make the principal emotional sacrifices. The unfortunate consequence has been an overwhelming vote of no confidence in the trust's management and leadership by the medical council at Bart's, at precisely the moment when maximum confidence would be desirable for the future success of the enterprise.
I implied earlier that conspiracy theory had been present at Bart's. That followed the health authority's decision to recommend the closure of Bart's accident and emergency department, barely days after the consultation period had ended and when there had been a massive numerical majority of representations in favour of its retention. That was followed a year later by the trust adopting a one-site solution with what seemed unexpected speed against the grain of the earlier debate.
One of the consequences—it is a bad consequence—is an imbued conviction among some at Bart's that the current consultation is all over bar the shouting. I have total confidence that the authority and my right hon. Friend the Secretary of State will measure most judiciously the evidence laid before them. If they were in any doubt previously, I hope that recent events have brought home to them how essential it is that the decisions reached on the consultation's evidence are seen to have been evaluated with exceptional—indeed, preternatural—fairness. They have a delicate and highly frangible vessel in their hands.
I am not seeking to revive the controversy over Bart's A and E unit. I pay tribute to the way in which the national health service elements are working with the City of London corporation to examine plans for an expansion of the minor injuries unit at Bart's, to ensure that residents of the City, south Islington and south Hackney—a cohort of about 30,000 people in all—are not disadvantaged by developments at Smithfield, whatever in future they may precisely be.
My right hon. and hon. Friends have not, however, laid to rest the fears of the wider City about how well prepared they are for an emergency in the City on the scale of the five in recent years involving the railways and terrorism. It is understood that the paramedic provision is a response to individual heart attacks. That is accepted, but very serious evidence was given to the consultation on the Bares A and E unit by the City of London police about traffic patterns in the area—notably after the anti-terrorist traffic restraints were imposed on the perimeter of the City. That evidence has never been properly countered or those fears assuaged in the context of a major emergency.
892 I hope that in his winding-up speech my hon. Friend the Minister will comment on the scale of paramedic provision available against the known statistics of past emergencies. I mean no unkindness to my hon. Friend or others on the Front Bench when I say that it is not enough for them to believe that all will be right on the night. The public and the police have to believe that it will all be right on the night, too.
All that said, there is no reason why good cannot come of change—a proposition that, paradoxically, is more widely recognised by Conservative Members than by Opposition Members. The South Westminster health clinic, which was promised for the aftermath of Westminster hospital, has trodden cautiously, hut, in so doing, has secured and enjoys the increasing confidence of consultants and local residents alike. It is a friendly, welcoming and effective facility. With some tactical differences, the similar new clinic in Soho promises well, after years of my Soho constituents raising their voices to heaven to say, "How long, 0 Lord, how long?"
There is no reason why the national health service cannot meet rising expectations, even in inner-city communities, with élan and efficiency. What is so depressing about the stance of Her Majesty's Opposition is the sterility of their thinking and their motion today in the face of problems that the NHS will face in the next century, and which the Government's reforms were admirably and timeously designed to address. It is no good the Opposition thinking that the problems presented by demography on one hand and the advance of medical science on the other will go away, yet there is no evidence of what their solutions would be.
When the hon. Member for Livingston (Mr. Cook) was health spokesman for the Opposition in the previous Parliament, there were glimmerings of recognition that the national health service's future problems were stark and that neither the status quo nor a suspiciously flexible amount of extra public expenditure in billions of pounds would solve them.
The fatwa of the hon. Member for Dunfermline, East (Mr. Brown) against public expenditure commitments has inevitably exposed the bareness, not to say the barrenness, of the intellectual policy cupboard of the right hon. Member for Derby, South. Of course, we understand the defensive mantra that states in response to any problem that it would be inappropriate and imprudent of any Opposition spokesman to say anything at all about their future policies until they take office. There are still some highly specific decisions that I acknowledge could not be taken until one knew the price of eggs on the night, hut that does not apply to strategic thinking about the national health service. A repeal of the reforms of this Government would take one back to the status quo ante and, even among the most atavistic on the Opposition Benches, there cannot be many who think that that would do as an adequate posture.
So we are confronted by a wall of moth-balled, first world war E-boats, with their weaponry masked; a generation of naval architecture on a chronological par with clause IV. Whoever replies for the Opposition will have to do better than the right hon. Member for Derby, South if the Opposition want to claim that what they have initiated today can properly he called a debate.
§ Mr. Alex Carlile (Montgomery)
It is always a pleasure to follow such an exemplary parliamentarian as the right hon. Member for City of London and Westminster, South (Mr. Brooke). He treated us to a piece of English at least, which will be well worth re-reading tomorrow. I also agree with much of what he said about Bart's. I know that my hon. Friend the Member for Southwark and Bermondsey (Mr. Hughes) would have wished to be here this afternoon to comment on that issue.
During the first hour and three quarters of this debate—it seemed at times a good deal longer—reference was made to a number of surveys. Of course, most of them had been carried out after treatment had been completed and on questions asked of patients. The tribute which those surveys pay is not to the organisation of our national health service but to the doctors, nurses and other staff who serve in that service. The issue in this debate is the conditions in which those servants of the public give their service.
I suspect that many Conservative Members read The Daily Telegraph, so they will know -what I am talking about when I refer to the "Bottomley ward". The "Bottomley ward" was described in an article by Martyn Harris in The Daily Telegraph on Monday. It is that overflow ward, now common, made up of trolleys in the hospital corridor—the place where, literally, patients are allowed to fall off their trolley and are sometimes not noticed until it is too late. That is one of the adversities that staff face, and it makes calls on all their resources of humour and determination; but I suspect that those staff would take a very different view from the complacency offered by the Secretary of State.
Mine is a rather different approach from that of the right hon. Member for Derby, South (Mrs. Beckett). She believes that the Government want to wrap up and privatise the national health service. I do not think that that is right at all. In a sense, it is worse than that. The Government do not want to wrap up the national health service, but they are doing so without trying. It is not privatisation by stealth; it is failure by bungling.
The Government's reforms of the NHS have reached crisis point—at least that is what we are told day after day by the people working in it. It is a crisis in which the reality of trolleys in the corridor is but one small, overt sign. The concern of patients and staff has turned to dismay and despair as they feel the brunt of the Government's market-driven policy stick. Indeed, political obsession with the market is coming before health issues, and it is time that the Government realised that that is happening.
Now a new sophistication has been added—one might call it the Bottomley lobotomy. It is a very simple, non-invasive procedure. It involves taking the truth, debriding it, dressing it in healthy-sounding platitudes, and then plastering it with statistics. For example, I refer to waiting list statistics.-Some people are waiting to wait to go on the waiting list. Waiting list statistics that allege that nobody has to wait more than two years are simply not true. It is time that the Government recognised, accepted and confessed that what they say about waiting times, if not waiting lists, is simply untrue.
In an attempt to back the Department's campaign of what must be called deceit about what is happening in the NHS, the NHS trusts have tried to gag those who know 894 best—the staff. I have witnessed that in my constituency. Many right hon. and hon. Members have had NHS staff from senior to junior level sidle up to them and say, "I really shouldn't tell you this because we are told not to talk to our MPs about it, but things are going sadly wrong."
Whereas the Tory party vice-chairman, Mr. Maples, proposed that the best tactic might be merely zero media coverage, the Secretary of State and the health quangos have introduced a new element, the contractual silencing of staff. Surely there could be a need to gag staff only if there were something to hide.
The one reassurance that we can gain from that concealment is that the Government are failing in any event to stop the failed reforms in the NHS from becoming a focal and vocal issue. A 300 per cent. increase in complaints from patients to hospitals tells us all that we need to know.
The mother of my constituent, five-year-old Rhiannon Louise Evans, telephoned me yesterday and gave an example. Rhiannon needs to have her tonsils and adenoids removed—the sort of thing that used to be done routinely, followed by a diet of jelly and ice cream, but these days it is not so common. Three times the mother has prepared that five-year-old child on the basis that the child was to go into hospital shortly, and three times the arrangement has been changed. That cannot be acceptable.
Indeed, hostility to the Government's reforms has even reached Dr. Jeremy Lee-Potter. We have heard the Secretary of State turn from praising Dr. Lee-Potter, which used to be the order of the day, to attacking him today. What did the Prime Minister's office do when Dr. Lee-Potter turned native on the Government and decided to give his real opinion? It telephoned the chief executive of Dr. Lee-Potter's trust to find out what it was going to do about him. The Prime Minister's office was prepared to interfere in the contractual arrangements that Dr. Lee-Potter enjoyed. Of course, there was not much that it could do, as Dr. Lee-Potter was in an advantageous position to leave the trust in any event, and he has announced that he will do so.
I see the hon. Member for Eltham (Mr. Bottomley) frowning in surprise, but I challenge the Minister to deny that someone in the Prime Minister's office telephoned the chief executive of that trust to ask what it was going to do about Dr. Lee-Potter.
§ Mr. Peter Bottomley
The reason I looked quizzical is that the hon. and learned Gentleman said that someone telephoned, as though one could do something about someone who has announced his retirement. What is the allegation to which the hon. and learned Gentleman refers? What was the Prime Minister's office supposed to have asked the trust to do? Will the hon. and learned Gentleman confirm that three quarters of the newspapers that referred to Dr. Jeremy Lee-Potter put his age at 59, whereas he had passed normal retirement age some time before?
§ Mr. Carlile
I said clearly that the Prime Minister's office was seeking to interfere with Dr. Lee-Potter's contractual arrangements. The Prime Minister, through his staff, has no business to telephone the chief executive of an NHS trust and ask, as though of Thomas a'Becket, "What are you going to do with this unruly priest'?" That is what happened.
895 I was about to refer to the development of a two-tier system. That has become irrefutable, as fundholding GPs have access to speedier provision than non-fundholders. It is a fact. In my constituency, treatment to be obtained in neighbouring districts on reference from non-fundholding GPs is being postponed until the next financial year, whereas fundholders' patients obtain treatment this financial year. What clearer evidence could there be of a two-tier system than that?
The growing number of consultants who, out of utter frustration, are taking early retirement shows the extent of discontent in the service. Dr. Lee-Potter is not the only example by any means. Dr. Sandy Macara, chairman of the council of the British Medical Association, was mentioned. [Interruption.] I hear a few guffaws from Conservative Members at the mention of his name. If the hon. Member for Gillingham (Mr. Couchman) knew Dr. Macara well, he would know that Dr. Macara is no radical. He is a man of moderate opinions and great medical distinction. It is with a heavy heart that Dr. Sandy Macara criticises the Government, but he does so on the basis of fact.
The confusion of priorities in the NHS today arises inextricably from the operation of the internal market in a way in which patients are following money rather than resources following patients.
I have referred specifically to problems in psychiatric care. In summary, the situation in London and in some other big towns and cities, but particularly in London, is that patients with psychiatric illnesses are placed in overcrowded wards. In some cases, they are moved out of overcrowded wards as far as 200 miles from London. They are forced to be treated away from their relatives, friends and communities. The right hon. Member for City of London and Westminster, South is right; demographic changes must be taken into account. In that context, the provision of psychiatric care must be a major consideration.
The decline in psychiatric provision has happened since the Secretary of State took over at the Department of Health. The problem has become worse. The right hon. Member for Derby, South is not solving the problem; she is exacerbating it. Why are psychiatric patients in London suffering at the hands of the Government? If psychiatric care is to have its proper priority, it will not be dealt with simply by providing supervised release; that is but a footnote on the page. A proper, adequately funded service for psychiatric treatment is needed. It is astonishing that the present Secretary of State, whose professional background is as a psychiatric social worker—a respected one—has not been able to provide the level of funding, beds and community care which her very own profession needs.
I welcome the Labour party's choice of subject for the debate. It provides the House with a much-needed opportunity to challenge the Government's failing policy which threatens the very essence of the health service which provides health care free on the grounds of need, not on income. The debate is also an opportunity to discuss the new Labour party's view of the future of the NHS.
It is easy for Opposition parties to score political points on this issue and, with the record of the Government, it would he harder not to score. A bigger challenge in many ways is to address seriously the reform of our service which is required to ensure quality care for everyone.
896 There are specific problems to be solved, but there is a much bigger issue—the strategy needed for the future, once those problems are resolved.
One of my concerns which is shared by many interested Labour-watchers is that the Labour party might attempt to return the NHS to a centralised, totally provider-driven institution. That the internal market in its present form is failing is not in question; what is in question is how best to provide health care that is sensitive to the needs of patients and their communities, and can balance costs and benefits in terms of value and quality. Labour in opposition may wish to sustain the myth that the NHS can be a fund without end, but that could not be the reality under a Labour Government.
§ Mr. Carlile
I know that the hon. Gentleman is getting sensitive, but he must hear some more before I give way.
From the speeches we have heard from Labour Members, it seems hard to believe that there would be waiting lists under Labour, as there are with any Government. No amount of Beckett and Brown soundbites—we may be about to receive a dose of the latter—will avoid the reality that decisions must be made which involve choices, and that priorities must be chosen in modern health care.
The Government have failed by putting costs before provision. Inversely, Labour—while speaking in the language of fiscal prudence—has to tell us how it would deal with the problems which arise. I shall now give way.
§ Mr. Carlile
I shall say a bit more, and perhaps I shall tempt the hon. Gentleman to intervene.
Would Labour destabilise a significant part of our health provision by abolishing all trusts? If so, how much would it cost? Does the party recognise that, although the system is not one with which it would have chosen to start, it does not start with a clean sheet of paper? Would Labour abolish all fundholders, despite the fact that a large number of GPs like the fundholding principle? Would Labour abolish all competition in health care, despite evidence that competition can, in some circumstances, be healthy for the service? If so, what would Labour put in place of those things? What would the structural changes envisaged by the Labour party cost?
I share the Labour party's belief—I hope that it is also the Conservative party's belief—in the NHS. It is a straightforward principle. Those of us who believe in the NHS believe in a service in which health care is available to all, based on need and not on ability to pay. We need to have a rational and factual debate which is not based on soundbites, and which takes place across, as well as along, party lines. Ideological brick walls should not he built to block the development of a better health service.
§ Mr. Matthew Banks (Southport)
The hon. and learned Gentleman says that he wants facts. Does he still agree with the drift of a consultation paper which the Liberal Democrats issued in the summer of last year which proposed the retention of the division between the commissioner of services and the provider of services? Does he still believe in the retention of trusts and modified GP fundholders? Some of us are concerned at the accuracy—again, the hon. and learned Gentleman asks for 897 facts—of an editorial in the Health Service Journal in September last year which, commenting on the Liberal Democrats' health policy, said that, with luck, someone might be kind enough "to offer some direction". Could we have that from the hon. and learned Gentleman?
§ Mr. Carlile
The consultation paper was a part of the policy-making process, and I agree with what it says. I became the Liberal Democrat health spokesman in September, and I am seeking to provide the direction which the hon. Gentleman seeks. I hope that he will be more knowledgable about my drift by the time I sit down.
The Labour party should address these questions. If a private provider can provide scanners—as is happening in some parts of the country—on a 24-hour basis more economically to the NHS than could be provided by a district general hospital, does the Labour party exclude that provision from the private sector? If it does, it would seem to be asking for serious trouble, as it would be going back to an old-fashioned view of the service. Would Labour drive the private sector out of the market? Would it renationalise cooking and cleaning services, scanners and all elective surgery?
My party and I share many of the aspirations of the right hon. Member for Derby, South for the NHS, but, just as the Liberal Democrats are asking how and why a changing NHS can be sustained, so, too, must the right hon. Lady and the hon. Member for Newcastle upon Tyne, East (Mr. Brown). The right hon. Member for Sedgefield (Mr. Blair) has led the Labour party for only a few months, but it is now becoming time for those of us who watch the Labour party with considerable interest to see whether we will continue to have from it only the sound and fury born of 15 years of opposition, or whether that sound and fury will signify something for the health service, which certainly needs something new.
The service needs a fresh sense of direction and a commitment that will convince staff that it will survive and that it will enable them to continue what they do very well—serving the public whom they have to treat. The Government have failed the national health service, but the Labour party has still to give us a sign that it has something viable to offer. The NHS will remain positive only if the policies for it and the structure envisaged for it are also positive.
§ Mrs. Marion Roe (Broxbourne)
There is no doubt in my mind that the Government's record regarding their health reforms shows clearly that there has been an increase in the quantity and quality of patient care, and also better value for money. My right hon. Friend the Secretary of State has already given the details, and even independent surveys have demonstrated patients' growing satisfaction with the NHS. I am referring to the "British Social Attitude Survey" last November and a survey that the National Association of Health Authority Trusts carried out in June 1994.
The "British Social Attitude Survey" shows that the trend in falling public satisfaction with the national health service during the late 1980s has been reversed—1993 was the first year since 1986 when more people were satisfied than dissatisfied with the way in which the NHS is run. As we have had plenty of quotes from newspapers, 898 I shall quote The Guardian, which reported that the survey suggested that the NHS reforms have achieved "considerable success" in helping to restore confidence in the NHS.
The other survey by NAHAT showed that nine out of 10 patients who had attended hospital in the previous year found the service very good, good or average, and three out of four found it very good or good.
We have a more accountable NHS because the Government have considerably strengthened the mechanisms of the service's independent audit, especially by extending the remit of the Audit Commission, and have also set out standards and rights in the patients charter. More information and more patient involvement in the decision-making process, especially through GP fundholders, are required. All those factors add up to putting the patient first—a sound philosophy.
To that end, the all-party Select Committee on Health, of which I am the Chairman, has also been playing its part in monitoring and scrutinising the performance of the NHS, as our contribution to identifying the challenges and improving the service.
A common theme in several of the Committee's inquiries during the present Parliament has been priority setting in the national health service. Last July, we published a report that concentrated on the implications of a continued increase in the cost of drugs to the NHS for priority setting. The report presented a package of radical recommendations on the drugs budget.
I am delighted to have this opportunity to draw the attention of the House and of the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) to the fact that we published a report today on the wider issue of priority setting in relation to the purchase of health care within the NHS. I am pleased to be able to say that that report was agreed unanimously. In addition to thanking all my colleagues on the Committee for their help in producing that report—I see one, the hon. Member for Halifax (Mrs. Mahon) in her place—I thank our five specialist advisers and our secretariat.
The report deals with issues of major importance to the future of health care. In our opening paragraph we state:As medical developments open up new opportunities for treatment, it is widely believed that pressure upon resources will continue to increase. Coupled with an aging population and changing patient expectations, these issues are likely to become ever more important. The way in which priorities are set within the NHS affects everyone. This report reviews how NHS purchasers have decided priorities in the midst of competing demands upon resources.The principal conclusions and recommendations of the report are, as usual, set out in an annex. I will not attempt to recite all of them, but will concentrate on a brief summary of the report. It begins by considering how other countries are grappling with setting explicit priorities. We discussed the radical experiment in health rationing that is under way in the American state of Oregon, which the Committee visited as part of its inquiry. We also explain the systematic approach to priority setting that is being attempted in two other countries—New Zealand and the Netherlands.
Next, we studied some of the factors that might influence future demand for health services in the United Kingdom. For reasons that we explain, we do not make 899 judgments on future demand, nor do we enter the debate about current or future funding levels—they reached an all-time high of £37 billion in 1993–94.
As part of our inquiry, we commissioned a research paper from the Office of Science and Technology on "Factors Affecting Pressure on Health Care Resources". That forms the basis for our discussion and the paper is printed within the report as annex A, which we hope will help hon. Members and those outside.
We considered the potential impact on health costs of demographic changes, changing patterns of disease, advances in medical technology and changing patient expectations. Of those factors, demographic change is the most certain source of upward pressure on costs—in particular, the aging population, although the short-term impact of that change during the next 10 years is projected to be relatively limited. The Office of Science and Technology report makes clear the extent to which all such projects are subject to considerable uncertainty.
Of course, not all choices regarding the provision of services involve balancing competing demands in the light of increasing demand and restricted resources. Choices can often involve using resources more effectively. Against that background, we examined the process of making choices in the NHS—at national level, by individual purchasers and finally by individual doctors, nurses and other professionals.
At national level, we began by asking the basic question, "What is the NHS for?" We set out previous attempts to answer that question and formulated our own set of fundamental principles for the NHS, based on the principles of equity, public choice and the effective use of resources. We expressed our view that an honest and realistic set of explicit and well-understood ethical principles is needed at national level to guide the NHS into the next century.
We considered the way that Ministers and the Department of Health communicate their priorities to the service and we shared the concerns of witnesses who complained about "priority overload". The Committee urged greater clarity when deciding which items are of crucial importance—those that should be regarded as priorities, while others, however urgent or desirable, should be regarded simply as initiatives. We called for a reduction in the total number of national priorities and initiatives.
In a helpful spirit, we recommended how the Government could improve the communication of priorities. We called on the Government to issue an explicit statement every year of how they expected the service to develop during, for example, a three to five-year period.
At the local level, we contrasted the decentralised approach adopted in the United Kingdom with methods used in other countries. Here, districts have had to develop their role almost from scratch. While that approach has encouraged innovation among the most able purchasing teams, we were struck by the seemingly enormous variation throughout the country. Some purchasers know exactly where they are going—others have yet to find the map and are drifting. Our conclusions on local decision making are based on detailed research. We received submissions in response to a questionnaire from all regions and from nearly half of all districts.
900 We set out the criteria that the districts should adopt when decision taking and reviewed the development of local health strategies. We recommended that the NHS executive should take steps to ensure that, at minimum, epidemiological profiles, including variances from national averages, analyses of need and details of current provision, were open and accessible to public scrutiny and that the statutory requirements governing consultation over community care plans should be extended to cover consultation over health plans.
The Committee also stressed the importance of input from providers to good purchasing and called for GP fundholders to be required to sign up to an agreed set of local priorities each year prior to gaining access to their budgets. We examined the extent to which shifts in purchasing have occurred since the introduction of the internal market in 1992 and concluded that, to date, no major shifts have occurred. Districts have concentrated on setting priorities only at the margins. We believe that health authorities must develop the analytic tools to enable them to review existing services in depth and to redeploy resources from services of uneconomic or low health gain to services of real benefit.
We also reviewed how the NHS at district level has traditionally restricted access to non-emergency services through waiting lists and cost shifting and by giving particular services a low priority. We discussed the extent to which services have been excluded and concluded that, in terms of the impact on overall NHS resources, the absolute exclusion of services to date has been of marginal significance and is not appropriate.
We therefore recommend that the Department refines the operation of waiting time targets to increase flexibility and sets out clearly the framework within which purchasers will be expected to define the local package of services. We recommend that it sets out criteria by which decisions may be scrutinised, debated and, if necessary, challenged by individuals. We state that there should be no absolute exclusion of services from NHS provision. Whether a specific service should remain available must depend solely on whether there is a clinical need for that service and whether the service will demonstrably improve the health status of an individual.
Some of our witnesses argued that, instead of exclusions, greater emphasis should be placed on better value for money by making more efficient and appropriate use of existing resources. We draw attention to the large variations in the use of routine services across the country. There is a pressing need for greater information on those to be made available to purchasers and the public. The variations suggest that some routine treatments may be largely ineffective and a waste of resources, and even the most conservative estimates suggest that, by tackling that problem, there is greater potential to release resources for other services.
We warmly welcome the recent attempts to take effectiveness more seriously through research at Oxford and York, and by means of effectiveness bulletins. Feedback from our witnesses suggests a long untapped demand for greater information on effectiveness, and we make specific recommendations on how that information could be better disseminated. However much information is available, it is of no use if clinical behaviour does not change appropriately. We are convinced that persuasion rather than coercion must be used. We therefore make urgent recommendations on how that might he done.
901 Our evidence suggests that previously implicit criteria are now becoming more explicit. Clinical guidelines and protocols are bringing those criteria out into the open. We see a need for greater explicitness also in the scrutiny of those criteria. Patients must be involved more fully in the choices regarding their own treatment. It is clear from our evidence that health authorities are making greater efforts than hitherto to involve the public in priority setting, but performance remains patchy. While some consultation exercises have led to welcome changes in local services, others are perceived to have had little impact on services. That has led to disappointment and alienation. Variation between districts is worrying. There are difficulties in gaining genuinely representative public views on priorities but we recommend that the Department sets minimum standards for involving the public in the development of services.
I have now covered the report's main points but urge hon. Members to read the whole document. It is fair to say that, unlike last year's report on the drugs budget, this report does not contain a package of radical proposals because the issues involved are complex. They are taxing every Government in the developed world and, in many cases, as hon. Members will have gathered from my remarks, there are no easy nostrums or straightforward solutions; it would be dishonest for us to pretend that there were.
We hope that our report will be taken as a systematic attempt to review those difficult matters, take a snapshot of the current state of decision making in the health service, and contribute to a debate that will undoubtedly continue for years to come. We await with interest the Government's response to our report and recommendations in due course.
§ Mr. Brian Sedgemore (Hackney, South and Shoreditch)
When I went to St. Bartholomew's hospital this morning, an official sign in big red letters outside said:There is no accident and emergency unit at this hospital".The notice signalled, and was intended to signal, that everything about St. Bartholomew's hospital is to be destroyed. There were flowers and wreaths under the notice. A card on one of the bunches of flowers said:Sadly missed, from Whitecross street traders".A card on a large wreath said:For all those who may become the victims of Bottomley's stupidity".It was signed, "Local Residents".
Last week, a moving, beautiful, poetic candlelight procession moved off from St. Bartholomew's hospital to St. Paul's cathedral to pray that some good might come of the evil that was being done. The bells pealed out across the City. Heads were bowed, but people's faces shone with a sombre pride. Some cried openly and unashamedly in the street. We were witnessing a tragedy that should never have happened.
What a sad epitaph for the Secretary of State that she should go down in history as the person who hired a pathetic, second-rate, professional mafia—Sir Timothy Chessells; Admiral Staveley; Sir Derek Boorman; Gerry Green; and Francis Heidesohn—to destroy the world's 902 oldest and possibly greatest hospital. If ever a Secretary of State failed to understand the true principle of conservatism—that of conserving excellence—it is this Secretary of State.
Today, the Royal London hospitals trust, which was born of the merger between the Royal London hospital, St. Bartholomew's and the London chest hospital, is an institution at war with itself—torn and driven by strife, caused, ironically, by the chairman and chief executive of the trust. That war and strife exemplify what is wrong with the NHS today.
On 11 January this year, Mr. David Maclean, chairman of the Royal London hospital medical council, told the St. Bartholomew's hospital medical council that a recent press conference, at which a gang of five consultants from the Royal London hospital had slagged off consultants from St. Bartholomew's to the Daily Express newspaper, had been orchestrated and initiated by the trust's chief executive, Mr. Gerry Green.
If anyone doubts the truth of that, I have the minutes of the meeting with me. Can anyone imagine the chief executive of a trust organising a press conference to destroy his own institution and to encourage one group of consultants to destroy the reputation of another group of consultants?
At the press conference, the gang of five—Wilson, Cunningham, Wright, Swash and David Maclean himself—lied, lied and lied again about their colleagues at Bart's, and did so at the behest of the trust's chief executive. They defamed Mr. Steven Miles, who ran the Bart's accident and emergency unit. In an even more bizarre twist, they defamed Professor Mike Besser, one of the world's top doctors, the former acting chief executive of St. Bartholomew's hospital and currently the deputy president of the Royal College of Physicians. If that is not bizarre, what is?
On 25 January, 86 consultants from the medical council of St. Bartholomew's hospital passed the following motion:That the actions of Mr. G. N. V. Green"—the chief executive—and Sir Derek Boorman"—the chairman of the trust—in respect of recent press allegations impugning the integrity of senior members of this Institution and their subsequent responses to them are unsatisfactory, have led to unnecessary divisions between consultants on the three Trust sites and are not seen as providing an even-handed approach to management of the Trust. Medical Council sees this as part of a wider inability to pursue, as initially promised, such an even-handed approach. Medical Council therefore resolves that it has no confidence in the Chief Executive and Trust Board Chairman and that each should resign forthwith.That motion was carried nem. con., which means that 80 consultants voted for it and a few abstained.
The minutes of that meeting stated:It was further resolved that the Acting Chairman should write to each of the five consultants involved, expressing:903 It is extraordinary that the clinical director and ethical committee chairman should act without ethics and morality, and five consultants may be suspended pending a full inquiry into their actions. What is going on at the Royal London hospitals trust?
- (1) Dissatisfaction with their actions and failure either to justify their allegations or to withdraw and adequately to apologise for them.
- (2) To request those of them holding positions of authority such as Clinical Director and Ethical Committee Chairman, to consider whether they can continue to enjoy the confidence of their colleagues on this site in these positions."
The Daily Telegraph subsequently carried an article in which it was alleged that the consultants at Bart's had misused funds from the Imperial Cancer Research Fund. That allegation was equally untrue. The Imperial Cancer Research Fund is about to write to The Daily Telegraph to say that it was untrue. We are witnessing a dirty tricks campaign—political and military games carried out on behalf of the Secretary of State by the chairman of the trust, who happens to have been a former joint chief of the intelligence staff. It is extraordinary.
The turmoil at the trust has continued with the appointment of the warden to the merged medical colleges. Sir Colin Berry, a pathologist, was appointed, even though he is subject to investigations on two serious cases of medical negligence involving two women who have had their breasts cut off as a result of his misdiagnosis. The general view is that Sir Colin should not have allowed his name to go forward while those allegations are being investigated. We need a full statement from Sir Derek Boorman, the chairman of the trust, to explain.
§ Mr. Couchman
On a point of order, Madam Deputy Speaker. I have been listening carefully to the hon. Gentleman, and I seek your guidance. Are the hon. Gentleman's accusations against a distinguished doctor's clinical judgment in order, in view of the fact that the matters are currently being investigated?
§ Madam Deputy Speaker (Dame Janet Fookes)
The sub judice rule applies only to court action. I am assuming that there is no question of court action in this case. I have no doubt that the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) can elucidate on that.
§ Mr. Sedgemore
I am not aware of any court action, but I am aware of investigations currently taking place. I believe that it is appropriate, in the House, for me to say that it is my contention that Sir Colin Berry should not have put himself forward to he the warden of the joint medical colleges, given the nature of the allegations. One must be seen to be cleaner than clean and show qualities of leadership. I do not see how that can be done in such circumstances.
It is also unfortunate that Sir Colin was appointed when there was an infinitely superior candidate called Professor Lesley Rees, who is generally regarded in medical spheres as perhaps the best dean that this country has ever seen. I am convinced that she was not appointed partly because she is a woman—the male chauvinism of the Royal London college is legendary—and partly because, although she fought to make the merger of the Royal London and the St. Bartholomew's medical schools work, she also fought to preserve activity at Charterhouse square for the medical college and at the Smithfield site for the hospital.
Sir Derek Boorman has meanwhile shown himself to be paranoid and has set up an extremely expensive inquiry into the leaking of a document at the time the warden was being appointed. That seems bizarre. During the course of that inquiry, there was an extraordinary homophobic 904 outburst, in which Sir Derek made it clear that he regards being gay as a human weakness. That seems to be beyond the pale for someone who is chairman of a hospital trust.
Recently, there have been more general allegations about Sir Colin Berry, and an investigation is taking place. We should be told the nature of those allegations, the evidence that was given and the results of the investigation. The right course would be for Sir Colin to stand down and for the post to be readvertised.
I was talking about war and contrition at the hospitals trust. No fewer than four consultants independently told me—wrongly, I am sure—that they believed that their telephones were tapped. Many people have a paranoia about the tapping of telephones, but is it not odd and undesirable that four senior clinicians should separately report to their local Member of Parliament that they think that that has happened? It seems to suggest that there is something radically wrong at the Royal London hospitals trust.
The right hon. Member for City of London and Westminster, South (Mr. Brooke) mentioned the role of the East London and Hackney health authority. It is clear that the purchaser, in the form of Frances Heidesohn, has for the past year been working behind closed doors with the provider, Sir Derek Boorman, to close St. Bartholomew's hospital.
I went to see her for an hour and a half recently. The Evening Standard stated simply that such treachery would never be forgiven. I do not want to use such emotive language, but it seems that claims that there is competition—and that the purchaser-provider split has brought about that competition—cannot be upheld when the consultative document produced by the purchaser is identical to documents that were leaked to me earlier this year and were prepared by the provider. That is not competition, but collusion. Not only were the figures and the language the same, but so was every comma and colon.
The right hon. Member for City of London and Westminster, South said—I am sure that he meant it—that he hoped that the Secretary of State would give serious consideration to the consultation process, where the purchaser and the provider jointly propose that the site of St. Bartholomew's hospital at Smithfield should he completely closed down.
No such examination of the proposals will be prepared. Within the past 24 hours, the acting chairman of the medical council at St Bartholomew's hospital, Larry Baker, has been to see the trust chairman Sir Derek Boorman, the chief executive Gerry Green and Dr. Duncan Empey. When Larry Baker said that the Bart's people were insisting that serious medical activity should continue at the Smithfield site, Sir Derek told him that the Government had made enough U-turns on medical affairs, and they were not going to make another one.
The chairman of the medical trust has said that he knows what the Secretary of State will do. Clearly, he is acting on the orders of the Secretary of State. I am confident about that because, before he took up his post—before he had viewed any evidence or even entered his office—Sir Derek Boorman told me that he intended to close the St Bartholomew's site. They were his political instructions, and that was what he intended to do.
I trust implicitly the sincerity, honesty and integrity of the right hon. Member for City of London and Westminster, South, but he has to start asking a few hard 905 questions about some of the people around him. I believe that the plight of St Bartholomew's hospital could end in tragedy, and I will fight against that.
At the meeting between the acting chairman and the chairman of the trust, the question was raised as to what would happen if a Labour Government were elected in two years. The acting chairman was told that those who board the train now will prosper, and those who do not will not prosper. That has nothing to do with medicine; it is dreadful politics, and it is an insult to this country.
The motion moved by my right hon. Friend the Member for Derby, South (Mrs. Beckett) clearly states that there should be a moratorium on hospital closures in London while the decisions are viewed rationally. There is no reason for the actions of the Royal London hospitals trust; it is gut and nasty politics, from which the House should disassociate itself completely.
§ Mr. James Couchman (Gillingham)
I do not wish to follow the line taken by the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) or that of my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) with regard to St Bartholomew's hospital. I do not know the arguments between St Bartholomew's hospital and the Royal London hospital, and I do not understand the circumstances. However, I do know that hon. Members as far afield as myself in my mid-Kent constituency have been lobbied by both sides of the argument.
As long ago as 1908, it was realised that there were too many large hospitals in a three-mile ring based around the central point of Harley street. Ever since that time, the rationalisation of the facilities in London has been a troublesome and contentious issue.
A dozen years ago, I was the chairman of an outer London health district which was deprived of resources because so many resources were allocated to the inner-London ring. My constituency in mid-Kent and the Medway towns have been a most deprived district, vis-a-vis population size, for a long time. We are very pleased that we are to see a £45 million extension to our district general hospital in Gillingham. That will provide services to a population of 300,000 people which we expected a long time ago but which we were deprived of because of the over-resourcing of inner London.
I shall devote most of my speech to examining the pursuit of value for money in the health service, particularly with regard to primary health care. The debate has been very interesting so far. The spokesman for the Liberal party, the hon. and learned Member for Montgomery (Mr. Carlile), rubbished the Government's policy on the health service. He then asked the Opposition spokesman whether a Labour Government would abolish trusts and fundholding, as well as a number of other questions which I thought would be asked by those on my own Front Bench.
However, the hon. and learned Gentleman did not tell us what the Liberal party would do for the health service—although it is unlikely ever to have responsibility for the national health service. As I said by way of intervention during the Secretary of State's speech, running the health service is somewhat different from 906 sniping from the Opposition Benches. The Opposition do not have to seek best value for money from this year's £33 billion budget for England and Wales, and they do not understand the responsibility involved.
Ten years ago, the pursuit of value for money from any part of the national health service was somewhat less than fashionable. The suggestion to doctors at that time that it was a laudable aim to derive best value for every pound that was spent on health care was likely to bring forth the lofty response, "You worry about the cost while I get on with the healing."
The resources debate then was about the absolute level of the money voted to the national health service rather than the deployment of that budget, whether at a national or a local level. Much has changed since that time and, politics notwithstanding, the change has been in the interest of the patient. While my speech is mainly about value for money in primary care, many improvements in the deployment of resources have occurred throughout the hospital and community services sector as well.
Awareness of the need for the NHS to provide value for money is growing, and will continue to develop. In 1992–93, the national health service budget for England and Wales was more than £30 billion, of which approximately one quarter—£7.3 billion, which was the entire health service budget in 1978–79 when the Labour party was last responsible for the national health service—was spent on primary health services. The four main service areas were ophthalmic, pharmaceutical, dental and general medical services.
The cost of pharmaceutical services, at more than half £7.3 billion, dwarfs even the cost of 27,000 registered general practitioners' salaries and their practice allowances. About 10 per cent. of national health service expenditure is spent on drugs prescribed by GPs, who typically write 1.5 million prescriptions daily. It is little wonder that such emphasis has been put on rational prescribing in the search for value for money in primary care. I must declare an interest in the subject, which is on the Register of Members' Interests, as I advise a pharmaceutical company, Pfizer Ltd., in Kent.
Three major initiatives have motivated improvements in the services provided by GPs: the National Health Service and Community Care Act 1990, the general practice contract and the patients charter. The recent reforms have flowed from the NHS and Community Care Act, including GP fundholding, which is now in its fourth year and will undergo major extensions from April.
As my right hon. Friend reminded us, in November 1994, the National Audit Office published a report on the first two years of fundholding. The report concluded that fundholders reported that they had achieved a wide range of benefits for their patients, including reduced waiting times for non-urgent hospital admissions and first out-patient appointments, a more responsive service in diagnostic test results and discharges from hospitals, and the provision of additional services in their practice premises such as advanced equipment and consultant out-patient clinics.
Fundholders have become more aware of the need for rational prescribing, and they have curbed the growth of their drugs expenditure compared with non-fundholders. Although initial budget setting was hampered by lack of good historic data, from 1993–94 the NHS executive has required regions to develop benchmarks based on average 907 treatment and prescribing levels, to help set budgets. That should prevent the sizeable underspends and overspends of the first two years.
Early experience showed that GP fundholders were three times more likely to underspend than to overspend their budgets. Although some large windfall underspends were repaid to regions for distribution, in 1992–93, underspend of £28.3 million was retained to be spent by fundholders, to the benefit of their patients. Fundholders have drawn up objectives, and some consulted not only health authority purchasers but their patients on how their practices might be improved. I wonder whether anyone can remember that happening before the 1990 Act was implemented.
All general practitioners are independent contractors to the NHS. Fundholders are accountable to regional health authorities for how they use their funds. It follows that regions and family health service authorities must monitor fundholder performance, not just for financial competence and probity—I will say more about that later—but for the quality of service offered.
The National Audit Office report made a number of recommendations, which I will summarise. The NHS management executive should extend the benefits of GP purchasing involvement to all patients. It should use benchmarks rather than historic figures to set budgets and consider introducing fund management plans for all fundholders, to provide a basis for agreeing objectives and monitoring performance. Regional health authorities are urged to manage underspend by fundholders more effectively, and, where windfall underspends occur, to negotiate voluntary return.
District health authorities are urged to set indicative budgets for non-fundholders on a comparable basis to budgets set for fundholders, and fundholders must be able to demonstrate the likely cost and benefit for patients of their plans to utilise fund savings.
It is clear that the NAO report is broadly favourable to the fundholding concept, and applauds the value for money achieved during the scheme's first two years. That is just as well, for the Government propose dramatically to extend the scheme from April this year, when there will be a three-layer fundholding scheme.
Small practices will have community fundholding that will not involve the purchase of acute hospital treatment. Standard fundholding will be extended and available to practices with just 5,000 patients, compared with 7,000 now. A total purchasing pilot scheme will allow GPs in a locality to purchase all hospital and community health services for their patients, including accident. and emergency services.
The NAO report called for the extension of the benefits of GP purchasing involvement to all patients. The 1995 extension should enable progress to be made towards that goal. It will be even more important that fundholders keep and submit proper accounts of their activities and that the new health authorities will need to monitor those accounts carefully on a value-for-money basis as well as for strictly accounting purposes. Expertise in auditing that sizeable operation must be developed speedily, and any malpractices rooted out. I will return to that point.
The patients charter, in conjunction with the new GP contract, has given patients the right to expect a number of services not previously available. They include check-ups 908 when a patient is first registered, a regular check-up for the elderly every year at the surgery or at home, and check-ups every three years for other patients.
§ Mr. Thomas Graham (Renfrew, West and Inverclyde)
Is the hon. Gentleman aware that, in parts of Strathclyde, a printed sticky label is used to say, "Sorry—we can't meet the nine-week target in the patients charter"? Some folks wait 19, 20 or 25 weeks to meet consultants and surgeons. The patients charter is certainly not working in Scotland.
§ Mr. Couchman
With respect, I was talking about the expectations from the patients charter in respect of GP services rather than hospital services. I must allow my hon. Friend the Under-Secretary of State for Health to answer the hon. Gentleman's question when he winds up.
§ Mr. Graham
I was trying to make the point that GPs are having to apologise to their patients because they cannot arrange appointments with consultants and others for long periods.
§ Mr. Couchman
I am sorry that I gave way again, because I do not think that added to the hon. Gentleman's first intervention. My hon. Friend the Minister will answer for the patients charter in the round, in Scotland as well.
As a result of the GP contract and patients' expectations, many practices have extended their provision for immunisation, well person clinics, specialist clinics for chronic diseases such as diabetes and asthma, and minor surgery—as well as for alcohol and drug misuse. The best practices now offer substantially better value for money than before the new contract, and are being rewarded appropriately.
I mentioned that the pharmaceutical bill accounts for half the primary care bill of £7.3 billion, and it would be impossible to refer to value for money in primary care without expanding on that aspect. There has been a tendency to rely on driving down the cost of each prescription to contain the burgeoning NHS drugs bill. It is a cliché to say that cheap is not always best, but to emphasise that maxim, I will quote the words of my right hon. Friend the Secretary of State in Committee on the National Health Service and Community Care Bill, speaking then as Minister of State:Sometimes the best prescribing is restrained prescribing high-cost items. Low-cost prescribing is not necessarily the right way. There are some new drugs which, if applied at the right time, can achieve the best results. It is simplistic to think that prescribing is anything other than a subtle, complex and frequently changing subject."—[Official Report. Standing Committee E, 1 February 1990; c. 641.]
Those wise words prompt a number of questions, but I do not want to overstay my welcome. The Audit Commission report "Prescription for Improvement", published last year, offers a comprehensive analysis of factors that make the case for rational prescribing, and thereby counters the pressures that my hon. Friend the Member for Broxbourne (Mrs. Roe) mentioned, of demographic change, treatment in the community, continuing pharmaceutical development and the impact of GP contracts in spurring screening—which identifies more disease in more patients, who obviously then demand treatment.
The speech of the right hon. Member for Derby, South (Mrs. Beckett) was one of her least impressive offerings at the Dispatch Box. It was a litany of newspaper cuttings, and I was at pains to discern much of Labour's policy.
909 The right hon. Lady mentioned waiting lists, and I declare an interest. I and my family are national health service patients and always have been. We do not pay private health insurance. The only treatment for which we pay is dentistry, because NHS dentists are difficult to come by in my part of the world. [HoN. MEMBERS: "Oh."] I have written to my right hon. Friend the Secretary of State on many occasions about the provision of NHS dental treatment, because I am as unhappy as hon. Members in other parts of the House about that matter.
I would defend to the limit people who have private health insurance. Having paid their taxes and national insurance, they have a right to contribute to such insurance. They do so in the expectation that, if they need a non-urgent procedure performed, they will be able to have that done more quickly than if they were to rely on the NHS.
§ Mr. Couchman
The hon. Gentleman says that that is terrible, but I am quite prepared to defend the right to do that, even though I do not choose that option. People who do save the NHS a great deal of money. What I am less happy about is the apparent manipulation of waiting lists by some consultants, to their own advantage.
I went home from here last Thursday evening and watched the video of a Channel 4 programme in the "Dispatches" series, called "Serving Two Masters". It related the findings of Dr. John Yates, a senior manager in the health service until two or three years ago, when he became a full-time academic researcher. His project on health service waiting lists left me profoundly disturbed. He says that 96 per cent. of private patients see a consultant within a month, but only 9 per cent. of NHS patients do. That is worrying. He also asked a number of pertinent questions: was it just coincidence that consultants working in specialties with the longest waiting lists have the highest private sector earnings? He asked whether private sector operating concentrates on conditions which, in the NHS, have the longest waiting times for treatment.
Dr. Yates gave some disturbing facts about cardiac surgery in London, and about orthopaedic and ophthalmic consultants throughout the country, particularly in Birmingham, where he was doing most of his work.
I think that Ministers need to pay some attention to Dr. Yates's findings. The time has come to take the Duncan Nicol line of one private practice session a week being the right amount for any consultant who is full time, or the part-time equivalent of ten elevenths. I know that that will not be popular with some consultants, but it is right to keep them to their contracts with the NHS.
§ Mr. Couchman
I am not sure that that is as effective a mechanism as where the contract is placed. Most consultants' contracts are still with the regional health authorities. That has been a problem since I was chairman of a district health authority; for it is very difficult for a DHA, now a trust, to call to order consultants who appear 910 to be kicking over the traces. There have always been consultants with split responsibilities—three sessions here, four there, two in another district. They were always in the other place.
The time has come for my right hon. Friend the Secretary of State to grasp the nettle and to place contracts at the point where consultants are employed—with the trusts, if they serve trust hospitals.
My right hon. Friend must deal with the problem of waiting lists, because she must give confidence to national health service patients that they are not losing out to abuses by consultants whose probity and integrity, I fear, are falling short of the highest standards expected under their contracts with the NHS.
§ Mrs. Alice Mahon (Halifax)
I am pleased to have been called to speak. It is worth repeating what the debate is about: the threat to the existence of the national health service resulting from Government policies.
I thought that my right hon. Friend the Member for Derby, South (Mrs. Beckett) made a brilliant speech in which she analysed the Government's intentions with devastating accuracy. The sedentary insults that were hurled at her—there have been more since—only went to prove that her speech hit home.
I shall use my time to allow the patients who have written to me to speak to the House through me about their recent complaints. Under this Government and Secretary of State for Health there is always a yawning gap between the slick image of an improved modern health service and the real world.
The reality for patients can be very different from the Secretary of State's version. The description of a Bottomley ward in The Daily Telegraph—trolleys in the corridors with patients lying on them—says a lot more about the NHS than anything the Secretary of State said today.
In my constituency trust's area, as with every other trust in the country, we are inundated with glossy brochures full of propaganda, but I tend to read more closely the letters that I receive from patients and former patients. In October, for instance, I had a letter from a patient who was attending the oncology clinic at the Royal Halifax infirmary. Hers is a very different story from the one in the glossy brochures. I will not give the House her name, but it has gone to the Secretary of State. She writes:Words are inadequate to try and attempt to praise the care and commitment of Dr. Howard Close",the consultant in charge of the cancer unit.
My own experience has shown that on Thursdays in Halifax he attends to in-patients, new patients and out-patients from late morning until who knows what time in the early evening…He is a man of tremendous warmth and gives each patient the time and individual attention each one so badly needs. As a cancer patient one feels at one with Dr. Close in a trusting relationship … The nurses too are equally committed, working in archaic conditions, supporting Dr. Close in this busy, demanding clinic.Whenever we bring patients' complaints to the attention of the Secretary of State, she sounds off about how we criticise staff and doctors. But I share this patient's admiration for the team working in that clinic.
The patient goes on to describe her concerns about the clinic:The clinic and its surroundings are small, cramped and cheerless. It is far too small to cater for the number attending at any one time. At a rough count there may be seating for 25 to 30 people. The seats 911 are the plastic bucket type, very uncomfortable especially for sick people … The seats are placed close together so that it is impossible to read because of sheer space. We just sit. It is a silent clinic, broken only by the nurses calling out the names of people to be weighed; whilst we just sit and listen. At times very sick people are brought into the clinic in wheel chairs to wait. It is a very pathetic sight for ill people to wait at this clinic with little or no privacy for anyone. There is nowhere for a patient to have a drink and the waiting time can be anything from two and a half to four hours…I have been an in-patient at the Cookridge hospital when undergoing chemotherapy for 10 months last year and have never experienced the sadness and desolation in the atmosphere one feels in the Halifax out-patient clinic.
I took up this emotional complaint with the chief executive of the trust. I will not bore the House with the reply, except to say that she agreed that Dr. Close and his staff were excellent, caring employees, and agreed about the condition of the clinic, but went on to say:Unfortunately, I am not able at this point to guarantee that we will be able to make this funding available.She was of course referring to funding for improvements to the clinic. This same hospital has £500,000 in trust in the form of donations and bequests from grateful patients' relatives and fund raisers—yet nothing has been done about the clinic. It really is a desolate and desperate place. Calderdale health trust is behaving in exactly the same hard-hearted way as many other trusts all over the country. It especially behaves in that way on early discharge. Primary care and community care in Calderdale is the same as in many other places; it simply means passing the buck, and Calderdale health trust is doing that as well.
I attended recently a forum for Halifax and Calder Valley pensioners, to discuss with the trust one of the so-called "consultation exercises" that it carries out from time to time to put into yet another glossy brochure—some more propaganda. Elderly people gave their testaments and the trust gave a written report afterwards of the answers. I shall read out a couple of questions on early discharge, because it is symptomatic of what is happening in the country.
One relative of an 84-year-old widower spoke of the widower being discharged from hospital, only to be readmitted shortly afterwards owing to a lack of nutrition. When discharged again, he was provided—to make it easier for him—with a chemical toilet, hut no chemicals to enable him to use it. Although he was readmitted with nutrition problems—malnutrition, no doubt—he was told that he was not eligible for "meals on wheels". There was no answer to that complaint for the Halifax pensioners who raised the matter on his behalf.
When patients brought up the issue of what will happen when the purpose-built Northowram hospital, for elderly and psychiatric patients, closes, which it will—it is a new hospital, not an outdated Victorian unit—they were told, "If we have all the services on one site, it will save on running costs." I could go on about some of the thoughtless responses—heart-breaking in some cases—when the pensioners asked genuine questions about what would happen to them in the future.
In Halifax, hospital wards are closed almost monthly. Yet patients are crammed like battery hens in old, outdated wards, and men and women are nursed side by side in some of those wards. No matter what the objection to mixed wards, the trust—the people who are giving us all the choice—simply tells us that mixed wards will continue to be the norm in Calderdale. On a recent visit 912 to see a patient, I witnessed a severely brain-damaged lady expose herself to a very embarrassed male patient, and some loving and caring patients walked in and caught her doing that. That simply is not good enough today.
Other women, who had suffered strokes or heart attacks, were mixed in with all kinds of patients, cramped together like battery hens. Some of those people were waiting to go into the hospital for rehabilitation. The hospital is about to be closed. It is a disgrace. We are told that we can lose 300 beds without it harming patient care. It is already harming patient care, very badly.
§ Mrs. Wise
It occurs to me that my hon Friend's points have some relevance to the statement that was made by the Secretary of State—that more patients are being cared for. I am thinking particularly of a friend of mine in the north-east whose mother was discharged, in the circumstances that my hon. Friend described, although clearly extremely ill. She had to be readmitted within a day and died two days later. That, of course, would count in the statistics as two hospital episodes. It would show up as patients. No wonder more people appear to be treated. It is directly linked with premature discharge.
§ Mrs. Mahon
My hon. Friend makes a very clear and telling point, and what she says is the truth.
Mixed wards are not generally liked. I received a letter only yesterday from the Townswomen's Guilds, which has been complaining against mixed wards for more than 10 years. It told me:Our members are very concerned about many health issues and have recently expressed their dismay and dislike of mixed sex wards in British hospitals…Townswomen have personal experience of staying in mixed wards and have written to me with their stories detailing their discomfort and upset when they found themselves in this situation. Many of those writing to me expressed concern that the extra stress of mixed wards could hinder rather than help the healing process.It goes on to talk about the lack of dignity and the embarrassment experienced by many in such wards. That is the experience that I get as a Member of Parliament, but my trust does not listen to me. I simply get brushed off with, "Oh, well, we only seem to get complaints from you." That is simply not true.
I know that the Secretary of State said that, in future, she will ensure that people are told whether they are to go on to a mixed ward, before they are admitted to hospital. But will they have to wait longer if they object? It is serious, indeed.
§ Mr. Bowis
The hon. Lady makes an important point about mixed wards. It is something that we take seriously and I hope, therefore, that she will welcome what has been incorporated in the new and updated patients charter. It puts the pressure on—not just her pressure but that of the NHS as a whole—calling for people to be given that option where available and to be given information so that if no place is available on a single-sex ward, there may be an option to wait a week or two until one is available. We are with her on that.
§ Mrs. Mahon
Or six months, perhaps. The Calderdale trust is taking no notice of that advice. It is advice and the very nature of the advice means that trusts can ignore it if they want. I shall wait to see whether any more teeth is given to the suggestion that the Minister makes.
913 I deal now with the excellent document "Serving Two Masters" by Dr. John Yates, an eminent health service manager, as has been said. He exposes not only what is happening with some of the consultants but the Government's claims on waiting lists. He says:There is now a queue of over one million people waiting for an operation. For years, the length of this queue has been used as a measure of waiting time. Although the length of the waiting list does not necessarily predict the length of wait, most people see a relationship between the two. The NHS, politicians and the press watch the statistics of waiting lists quite carefully, but rarely admit that they have only examined half of the problem: there is another, sometimes longer, wait just to get on the waiting list. The waiting time for an out-patient appointment to see the surgeon is not information that the NHS gathers systematically, nor does it publish national statistics about it.As we heard from my hon. Friends the Members for Doncaster, North (Mr. Hughes) and for Wrexham (Dr. Marek), who is not in the Chamber at the moment, there are not three waiting lists but four. We should investigate that further. Also on waiting lists, my hon. Friend the Member for Preston (Mrs. Wise) made the point very well about counting twice, and the radical statistics group makes the same point. That is relevant, because at the moment, it is meaningless jargon at best and at its worst it is simply lies. It bears no relationship to the reality and to people's everyday experiences. There really is an image-reality gap.
The reality is that of Lewis Braun, an 18-year-old teenager from Wilmslow, about whom we all read a couple of weeks ago, who suffered horrific burns but was driven 60 miles, in agony, after being turned away from the Christie hospital—his nearest hospital—because there was no intensive care bed. Then there is the reality of Roberta Gierardo, who died of a brain haemorrhage on new year's eve after an eight-hour wait in casualty at the North Middlesex hospital while staff spent the night scouring London and the home counties for an intensive care bed. I wrote to the Secretary of State shortly after that incident was reported because someone in London had contacted me, but she has still not replied to my letter.
I want to talk about the reality of the NHS today where the elderly, sick and psychiatrically ill are denied a bed simply because they have grown too old or because it has been decided that they can be cared for in the community when, in reality, there is often no community to care. The new draft guidance on long-term care, which clearly departs from the founding principles of the NHS of care from the cradle to the grave, will not solve any of the problems put to me by my constituents or provide an answer when they ask me whether they will have a bed when they become sick and old.
As I shall continue to say in the House at every opportunity, the elderly and the long-term sick are being betrayed daily by the Government. Elderly people are not animals to be dumped by a system that they brought into being and for which they paid. The members of the Halifax Pensioners Association, which has complained to me of that betrayal, are the best in the world and most of them are the product of two world wars in the span of a single lifetime. They deserve better. Too often, their reality is that of an 84-year-old constituent of mine whose 914 case is detailed in a letter written to me by his son, which I received just this week, and which I intend to read again. It says:Last Wednesday my 84 year old father"—the letter gives his name, but I shall not repeat it—entered the 'Calderdale Health Care', I still prefer the Royal Halifax Infirmary, for an operation on Thursday. He was told that he would be in until Monday"—23 January—yesterday"—three days earlier than the date on which he had been told he would be discharged—when I rang to find out his condition I was told he was being discharged. I rang my parents to find out how he felt, my father is one of the countless millions who never complains and feels grateful for any help he receives, said he felt 'wobbly' and that while he had been waiting for my severely arthritic mother to find someone to give her a lift to the hospital to pick my father up, he had urinated into three pairs of pyjamas…Is this another example of Virginia Bottomley's brave new world? If so, I am thoroughly disgusted. All his working life my father has worked and paid his tax for treatment like this. I cannot let the British public know of this disgusting example of the new NHS but you can and I hope this will help you to do so.I have also forwarded that sad letter to the Secretary of State. We hear all the statistics being churned out, but we should look at the reality for elderly people. I wonder if the Secretary of State would describe that letter as a "jewel to be treasured". It is a sad indictment of the Government and how they have let down the NHS.
As I said earlier, people are not animals who must be corralled into the private sector where they are means-tested down to the last pound by smart accountants acting as zoo keepers. They are the people who gave us the NHS and they should not be left to the mercy of community care that scarcely exists because councils have been squeezed and squeezed since 1979. When the Government talk about community care, they mean secondary care where people are dumped out of the NHS.
§ Mrs. Mahon
Elderly people are increasingly dumped out of the NHS. It is the Government who are rubbish, not the elderly people who complain to me.
The Secretary of State refused to give way to me and my hon. Friend the Member for Dulwich (Ms Jowell) about psychiatric beds in London because she has been grilled by the Select Committee and knows well that she has no answers for every expert and professional who told her that there were not enough acute beds for psychiatric patients in London. Yet she refused to stop closing them.
The fight is on to save the NHS and to end the market fascism that seeks to destroy it. That is a well-chosen description of what is happening. I want the Government to go and go quickly, but for the sake of the NHS I should like the Secretary of State to go a lot faster.
§ Mr. David Evans (Welwyn Hatfield)
I am proud of our NHS. It has developed and flourished under successive Conservative Governments who have invested additional funds in real terms in the service each and every year since 1979. That commitment has resulted in an even greater proportion of gross national product being directed towards health—from 4.7 per cent. in 1979, the legacy left us by the Labour party, to 6.1 per cent. currently.
915 The Secretary of State has already announced a further large injection of funds for the forthcoming year. For the year 1993–94, a massive £37,000 million was invested to provide a comprehensive and efficient health service which is still the envy of the world and which is available to every man, woman and child in Britain irrespective of age, race, colour or creed.
Why is the NHS the envy of the world? Why do health professionals visit from Europe and America to find out how we provide such good value for money in health care? The answer is simple. It is because of the health service reforms introduced by the Government in 1991. As a result of those reforms, the country now benefits from more health facilities and ever-increasing quality. But that cannot be taken for granted, nor would it continue under a Labour Government.
I am sorry to say that I have heard a load of rubbish being spoken about the NHS this afternoon by the lot opposite—scare stories, slurs, misrepresentations and stretching the truth to the limit. That has been a deliberate ploy, instigated by that lot over there in a feeble attempt to obscure what most people see as a clear-cut issue.
The health service is a perfect reflection of the state of the two main political parties in Britain. On the Conservative Benches, we have a party which sees the need to alter and adapt policies and institutions to the needs of a changing environment. The Conservative party is the true party of change and has been rewarded for its progressive approach with four successive election victories.
The Labour party, however, is politically and financially handcuffed to the policies of the past arid, as a result, has stagnated. The Labour party fears change and thus, following the principle of Darwin's theory recorded in "On the Origin of Species", is doomed to extinction.
It might be useful if I put a couple of things into perspective. The NHS became operational on 5 July 1948. At that time, electricity generation was the task of the British electricity authority, the forerunner of the now defunct central electricity generating board. British Rail, established only a year earlier, was investigating technologies to replace the steam locomotive.
In the 1990s, 50 years later, the electricity industry hasbeen privatised and British Rail is in the process of restructuring and reorganising. In 1991, the Government introduced their NHS reforms. Demographic changes, new social aspirations and advances in medical science all contributed to the need for a new service culture.
Conservative reforms centred on a set of simple and sensible principles. First, we believe that the national health service should put patients first. Our reforms transformed the NHS, ending the boom-bust mentality of the old provider-led system. In those days, hospitals worked flat out; all their beds were available for the first two thirds of each year, but they then had to cope with bed closures because the money had run out. That resulted in the indiscriminate cancellation of urgent as well as routine operations.
We have now created a purchaser-led system, in which the purchaser identifies needs and responds to the requirements of the local population. Purchasers arrange contracts to ensure that hospitals and community units know what services, and how many services, will be required of them, so that they can plan the delivery of those services with optimum staff and bed numbers. The process 916 encompasses the principles of local decision making, partnership and efficiency. Efficient hospitals will receive more funds to cope with the increased number of patients whom they serve: the funds follow the patient.
The success of those reforms speaks for itself. First, the number of patients treated in hospital has increased from 7 million in 1991–92 to 8 million in 1993–94. Secondly, more than 800 hospital building schemes, each worth more than £1 million, have been completed since 1980, and nearly 300 are in the pipeline. Thirdly, waiting times have decreased dramatically: 50 per cent. of patients are seen immediately, 30 per cent. of the rest are seen within two weeks, 75 per cent. of patients are seen within three months and 98 per cent. are seen within a year.
Fourthly, spending on the NHS has increased by 66 per cent. in real terms since 1979. Over 1995–96, the Government will again increase their NHS spending—to £37,000 million, an increase of £1,300 million on the year before. Fifthly, between 1979 and 1992 the number of nurses and midwives increased by 25,000, and the number of medical and dental staff by nearly 10,000. Sixthly, since 1979 nurses' average earnings have increased by 65 per cent. in real terms, and doctors' pay by 35 per cent.
Seventhly, for the first time we have published hospital performance targets. Eighthly, we have established the patients charter, which has had an enormous impact in raising standards and improving efficiency. Ninthly, the proof of the pudding is in the eating: following the Government's 1991 reforms, 419 NHS trusts are now in operation. There are also 8,000 fundholding GPs, accounting for more than 50 per cent. of all eligible practices and more than 35 per cent. of the population.
The success of the Government's reforms is reflected in the excellent Queen Elizabeth II hospital in my constituency. Since the hospital was given trust status in 1991, the number of in-patient and day-case operations has increased by 28 per cent. The average waiting time has dropped to just three months, which is well below the national average, and the trust has introduced a number of new developments and schemes amounting to £13 million in total capital expenditure.
That lot over there are a cynical mob. I have watched them shake their heads while I have merely presented the facts. If they cannot accept the truth from me, perhaps they will listen to the people. In a survey conducted in June 1994, nine out of 10 patients who had attended hospital during the previous year found the service very good, good or average. That hardly tallies with the tales of gloom and disaster that we hear from Opposition Members.
Perhaps it would be a good idea to take a trip down memory lane and remind ourselves exactly what happened under the last Labour Government—as opposed to what has been said in more recent statements. Labour's political interference in the Government's health reforms can be traced back to 1990, when the poisoned dwarf, the hon. Member for Livingston (Mr. Cook), who was then Labour's health spokesman—
§ Mr. Nicholas Brown
On a point of order, Mr. Deputy Speaker. Is it in order to describe an hon. Member as a poisoned dwarf?
§ Mr. Deputy Speaker (Mr. Geoffrey Lofthouse)
I did not catch what the hon. Member for Welwyn Hatfield 917 (Mr. Evans) actually said, but if he used the phrase "poisoned dwarf" I invite him to think again, and withdraw it.
§ Mr. Evans
I withdraw it unreservedly.
The hon. Member for Livingston, who at that time was Labour's health spokesman, threatened NHS managers who were working on the implementation of the Government's health reforms. Issuing a blatant threat, the hon. Member for Livingston told them to "go slow", because all the reforms would be reversed by the next Labour Government. The Health Service Journal condemned the outrageous interference of the hon. Member for Livingston, saying:The threat was barely veiled: everyone judged to have appeared to be enthusiastic about the White Paper need not expect to have their contract renewed by a Labour Health Secretary.The journal went on to describe the hon. Gentleman's actions asoutrageous interference in NHS management and flagrant intimidation of NHS managers.So much for democracy.
The right hon. Member for Sedgefield (Mr. Blair)—balding Bambi—
Mr. Deputy speaker
Order Again, I appeal to the hon. Member for Welwyn Hatfield, who has been in the House for a long time and is an experienced campaigner. I invite him to withdraw his remark.
§ Mr. Evans
I withdraw it.
The right hon. Member for Sedgefield, with his £60 haircuts and his £500 suits—sponsored by the Transport and General Workers Union—has indicated that, under a Labour Government, he will be prepared to see the clock turned back on the NHS reforms. That means that the management of the health service will be taken away from the health professionals, and returned to the claws of the unions. It is hardly surprising, given that 156 Labour Members are sponsored by unions—including all Opposition Front Benchers.
The 1978–79 winter of discontent is indelibly printed on the minds of the public—so much so that that lot over there received four red cards in the last four elections. They lost in 1979; they lost in 1983; they lost in 1987; they lost in 1992; and they will lose again in 1997. How could the British public put the health service into the hands of the right hon. Member for Kingston upon Hull, East (Mr. Prescott)? He cannot even remember where he parked his car, let alone cast his memory back to the appalling way in which the Labour Government bungled the health service in the 1970s.
In 1974 the Labour party manifesto promised:A Labour Government will ‖ expand the National Health Service".Three years later Mr. David Ennals, Labour's Secretary of State for Health, was forced to concede:In the present economic climate, the Government could do little more than provide for the increasing number of old, leaving a small margin for improvements in methods of treatment".In 1978, the health budget was cut by 3 per cent. in real terms. Capital spending was cut by one third in real terms—the largest cut ever inflicted on the NHS capital 918 programme. Aneurin Bevan, eat your heart out. Between 1974 and 1979, in real terms, nurses' pay fell by 21 per cent., doctors' pay fell by 16 per cent. and surgeons' pay fell by 25 per cent. Waiting lists rose by 48 per cent.
Dr. James Cameron, chairman of the British Medical Association, described in 1978 howthe national health service is sick in Britain, it is inadequate and impersonal and is losing the confidence of the medical profession and the public".The Royal College of Nursing congress at Harrogate in 1978 talked ofa crisis of manpower, finance and morale in the service".In 1978–79, the national health service went on strike, led by the Confederation of Health Service Employees and by the National Union of Public Employees. Telephonists were on strike and clinical staff were manning public call boxes to get calls into hospitals. Clean linen was not allowed though picket lines. Foul linen was destroyed because the unions would not even let it out of the hospital. Meals were provided by volunteers and cleaning was non-existent.
Let us cast our minds back to the news stories of the time. They did not reveal a health service nurtured by a caring, sharing Labour Government—quite the opposite. An article in The Times in 1978 with the headlineHospital is to turn away patients with cancerstates thatpatients with breast, lung and other cancers, and abortion cases are to be turned away from the Kingston hospital, Surrey, because of industrial action by health service workers and supervisors, the hospital said yesterday. From midnight next Tuesday, even known cancer cases will be denied admission and lives immediately threatened. Investigative surgery, even where there is a strong suspicion of a life threatening condition, will not take place.That was the national health service under that lot. That is what it was like—a total nightmare. If loved ones died, one could not even bury them because the picket line would not let the grave-diggers through to dig the grave to put them in. That is what it was like.
§ Mr. Evans
No, I will not give way.
Finally, we come to the confessions of the former Secretary of State for Health, Barbara Castle. During the winter of discontent, she described her attack on pay beds as an "essential political sweetener" for the trade unions. The Labour party is still committed to tossing political sweeteners to unions. In return, the unions toss financial sweeteners to the Labour party. As the leader of the Transport and General Workers Union said last year, "No say, no pay."
So Bambi intends to turn the clock hack to those had old days of the "savage seventies". As if that were not bad enough, he intends to strip power from the health professionals—the doctors and general practitioners—and to put it in the hands of his new regional assemblies. What a recipe for disaster. Yet again, the Labour party refuses to listen to the views of the profession. Instead, it wants to play politics with the health service. Just who does the right hon. Member for Sedgefield think he is—the Milky Bar kid?
If Labour had its way, the NHS as we know it would he destroyed. Decision making would be stripped from health care professionals and given to shop stewards, who would ultimately tear it apart as a result of regional and industrial political battles.
919 Labour should listen to its friends at The Guardian. In an article on 4 January this year, The Guardian argued thatthe problem with trying to restore the NHS is twofold: first, the disruption which yet another organisational change would make and, second, the danger of re-introducing the old inequalities and inefficiencies.Perhaps the lot opposite should turn the clock right back to go back and truly to understand Nye Bevan's intentions' for the NHS. Back in 1946, he said:I believe that democracy exists in the active participation in administration and policy. Therefore, I believe that it is a wise thing to give the doctors full participation in the administration of their own professions.Going by that statement, if Nye Bevan were still an hon. Member today, and if he reflected on the Conservative reforms and Labour plans, I am pretty sure that he would vote for the Government's amendment at the end of today's debate.
§ Mr. Kevin Hughes (Doncaster, North)
There we have it from the historical and intellectual wing of the Tory party. The lack of understanding of the hon. Member for Welwyn Hatfield (Mr. Evans) on this issue is surpassed only by his lack of understanding on every other issue that he speaks about in the Chamber.
The national health service is the most important of our public services, but we know that the Government's reforms have created a two-tier system, with treatment decided by ability to pay, by whoever one's doctor happens to be, or by the performance of a contract. The service, as we know it, has been split into small, competing health businesses—the internal market. It implies competition between those businesses, purchasing on the basis of cost, and making local hospitals work against each other rather than together. One unit poaches patients from another in a war that is fought and won primarily on the basis of cost. Patients are the losers on that commercial battlefield.
The trend is towards not localisation but a health service where people are shipped around for the cheapest treatment. That is the logic of the Government's reforms. Some hospitals, of course, will always have to buy specialty services that they cannot provide and have never been able to provide, but it goes beyond that. The results are only just beginning to be shown, but I know from my discussions with health managers in my region that that is the way in which trust managers think.
Doncaster Royal infirmary is being forced to develop plans to treat patients from other areas. Although that might be good news for the hospital's staff, it is not such good news for facilities elsewhere. They will be run down as they lose patients, who will be forced to travel for treatment.
The Government's sleight of hand, to put it mildly, with statistics on the NHS is evidence of how far they are prepared to go to cover up their failures. Patients are no longer people. They have become episodes, to be counted not once, not twice, but sometimes even three times by administrators. It is convenient for the Government that they have decided on finished consultant episodes as the best means of measuring the amount of work undertaken in our hospitals. The Government can con their Back Benchers, but they cannot con the people, who know how long they have been waiting for treatment.
920 The Government claim that waiting times are improving, but the people who are waiting know that that is not true. More and more people—more than 1 million—are waiting for treatment in today's NHS. Patients are waiting for an appointment to be granted, waiting once an appointment has been given, and waiting for treatment after their initial consultation—three waiting lists for the price of one.
The market makes it expedient for trusts to cook the books and it is politically convenient for the Secretary of State for Health to sit idly by while they do so, and then to quote the distorted figures. That distorted picture makes it hard to determine what is happening in the NHS.
My constituents have been made to wait for months for an appointment, or they have had to pay to jump the queue for a consultation, because if they do not receive the treatment, they could lose their job. It is becoming a pay-as-you-go health service.
The Government have not given an adequate reply on the concerns expressed about the extent of the work done privately by consultants. An extension of private work can only mean a retraction in national health services and longer waits for patients who do not have the means to pay. The two-tier system is emphasised by GP fundholding, which gives some patients a fast track to hospital care while others lose out. Again, that can mean only that clinical need has gone out the window as a basis on which to decide who gets treatment.
Finally, there is a problem of contracts being completed while there are patients still needing treatment. These people have to wait for treatment because the year's money has run out. Health care is being turned into a lottery, and everywhere we look we see the same signs.
The Government have managed to upset dentists so much that many are refusing to treat NHS patients. A dentist in my constituency has stopped treating them and is instead asking patients to take out Denplan insurance. In response to a letter to me, he wrote:To remain wholly within the Health Service is like having a'I your eggs in one basket … with the person holding the basket intent on emptying it".The Government have turned dentists away from the NHS and have, in the process, fragmented and commercialised the services that they provide.
Less than two months ago, the Secretary of State claimed that the reforms hadeffected a fundamental and irreversible shift in favour of the patient."—[Official Report, 12 December 1994: Vol. 251, c. 632.]The evidence says not; the evidence says that it is the insurance companies and private sector that stand to gain the most and the patient who has gained the least.
The Government's claims for patients do not fit very well with the facts. The Government's aim is to privatise our health service by taking away its truly national meaning, introducing inappropriate competition and making patients pay for more of what they get. The inevitable conclusion is that the NHS is not, and never has been, safe in their hands.
The Government have systematically excluded the voice of professionals and that of local people and replaced them with the voice of business, with more than half the chairs of family and district health authorities appointed by the Secretary of State having a business background. We can see where the Government's priorities lie—with the commercialisation and 921 Privatisation of health care rather than democratic decision making about the allocation of resources within the NHS.
§ Mrs. Virginia Bottomley
Does the hon. Gentleman think that there was a better state of affairs when Greenwich local authority placed on its health authority three prospective Labour parliamentary candidates, or when Lambeth health authority had placed on it someone who was not fit to serve on the local authority and who was a disqualified councillor? We are in a very much better position now that we have people committed to the delivery of health care to which they bring a range of skills. They are not politically motivated and making ludicrous points and undermining the institutions that they should be protecting.
§ Mr. Hughes
Through the Secretary of State, the Government have systematically replaced local people with business people, usually those who have connections with the Tory party or those who, if they are not members of the party, undoubtedly make donations. Often, such people do not live in the areas on whose boards they serve. The Government are reducing democracy in the health service at the local level.
§ Dr. Norman A. Godman (Greenock and Port Glasgow)
I hesitate to interrupt this English exchange, but may I point out that we in Scotland have experienced the same thing? Literally hundreds of Tory placemen and women, including failed candidates, have been put on NHS trusts the length and breadth of Scotland and its islands.
§ Mr. Hughes
I am grateful for my hon. Friend's intervention. The people of Scotland are undoubtedly facing the same problems that we are facing in England.
The inescapable conclusion is that the Government are edging towards privatisation of the health service by a process of fragmentation and commercialisation. They are filtering more public funds into the private sector and their ultimate aim is a small public sector element dealing with residual purchasing and strategic planning. It is privatisation by the back door, but with denials issued every step along the way; but that is the logic and the effect of the Government's reforms, which is why we shall continue to oppose them.
§ 8.5 pm
§ Mr. Jerry Hayes (Harlow)
I must first declare an interest in that I am an adviser to the Western Provident Association which, as everyone who knows anything about health is aware, is a non-profit-making organisation.
I read the motion most carefully and I was amazed because I had thought that the right hon. Member for Sedgefield (Mr. Blair) was turning—or trying to turn—the Labour party into the acceptable face of Channel 4. He is clearly failing, because, to judge from the motion, this is the same old Labour party. The motion could have been drafted by Dave and Deirdre Spart; it is full of spite and envy and, of course, full of jobs for the boys.
The Labour party has drifted to the left. [Interruption.] I was going to congratulate the hon. Member for Doncaster, North (Mr. Hughes) on a swash-buckling speech, but it contained more buckle than swash. He 922 asked what evidence there was for the reforms' success, so I shall tell him. He should read what the Organisation for Economic Co-operation and Development said about the Government's reforms. Its July 1994 report criticised the command and control system—the Labour party should know about that as it almost invented it—inherent in the pre-reform national health service. It said that the pre-reform NHS lackedflexibility, incentives for efficiency, financial information (and hence accountability) and choice of providers of secondary care".It went on to highlight the "possibilities" opened by the reforms and the improvements introduced by national health service trusts and GP fundholders whoseem to have done a better job of purchasing than district health authorities".
§ Mr. Brown
The National Audit Office, to test the efficiency of the exercise, did its best to ascertain what resources had gone to GP fundholders and what was therefore left for non-fundholders. However, it was unable to draw any conclusions because, as I am sure the hon. Gentleman knows, not a single region could provide it with statistics for non-fundholders. How does the hon. Gentleman arrive at the conclusions to which he is treating the House?
§ Mr. Hayes
If the hon. Gentleman had read the report, he would know that it commended the purchaser and fundholder. He should remember that it was the Conservative Government who created the Audit Commission, thus leading to the financial profiles of every single health authority being given for the first time.
§ Mr. Hayes
I have done my best to answer the hon. Gentleman by saying that the reforms were commended by the OECD and the National Audit Office. I was drawing his attention to the fact that, for the first time, the Audit Commission has given a financial profile of every health authority. That is a very good thing and I hope that the Labour party will accept it as such.
The hon. Member for Doncaster, North asked what the people thought. We know from the survey of attitudes that the overwhelming majority of people are satisfied with the service that they receive from the NHS.
§ Mr. Hayes
I shall give way in just a moment if the hon Gentleman is patient. I am giving way a little too much.
Why are the majority of people satisfied? Because far more money is put into the health service than ever before—66 per cent. more than the rate of inflation since 1979. There is far more choice than ever before. Waiting lists have gone down way beyond anybody's dreams and are continuing to go down. As well, as my right hon. Friend the Secretary of State said, there are patients charters that deal with referrals from consultants to hospitals, which was a major bone of contention.
923 I am not suggesting for one moment that everything is perfect in the health service. It never will be. But a few years ago, before the reforms, no one knew the cost of anything in the health service. If people do not know their unit costs, they cannot plan for the future. That is the essence of the reforms.
§ Mr. Hughes
I agree that people are generally satisfied with the service that they receive from the national health service. The point is that they are satisfied only when they eventually get it.
§ Mr. Hayes
They are getting it far more quickly than they ever did under a Labour Government. It is all very well for Labour Members to sit there as if polyunsaturated butter would not melt in their mouths, but they were responsible, as my hon. Friend the Member for Welwyn Hatfield (Mr. Evans) said, for the largest cut in revenue in real terms in the history of the health service. They cut capital expenditure by 27 per cent. Do Labour Members live in the real world? Do they understand that, every eight days, there is a multi-million pound capital project in the health service? Oh, no. All they talk about is the closure of hospitals. They do not say that, for every closure, a new day surgery opens.
§ Mr. Hayes
I shall give way in a moment because I am building up for the hon. Gentleman's state tour of Harlow. He ought to see our new computer-aided tomography scanner. He ought to see our new magnetic resonance imaging scanner. He ought to know, before he suggests that we are stuffing the trusts full of Tory placemen, that I proposed two candidates. Guess what, they were not Conservatives, they have never voted Conservative in their life and they probably never will.
The fact is that those people believe in the policy and they are competent. That is what the appointment system is all about. That is why those who sit on trusts include people such as Helene Hayman, a former Labour Member of Parliament. She runs a trust. She is a socialist. She does not vote Conservative, but she believes in the policy because she believes in patients. Rabbi Julia Neuberger is not a Conservative. She probably never will be. Why was she appointed? Because she is competent and believes in the best possible care for patients.
§ Mr. Hayes
Harlow holds its breath.
Last night, we had a little time to spare because of the Liberal Democrats, as often happens, so I went into the Library. [HON. MEMBERS: "Where are they?"] Looking, I suspect, for policies. I found some policies last night. I had the misfortune of looking through every single policy and consultation document that Labour has published in the past two years. It was not an edifying experience, 924 because every other document had a glossy picture of the Front-Bench team smiling like snake-oil salesmen. There is a picture of the hon. Member for Newcastle upon Tyne, East (Mr. Brown). I shall show it to him later, as he probably does not want it to be shown on the television here.
Labour Members are pretending that they are consulting, because they do have the nerve to put their policies to the British public. They do not want to upset the beautiful luvvie view of the Labour party. We all know that it is a mirage.
"Health 2000" is well worth a look. What will Labour Members do about compulsory competitive tendering? They say:We are already committed to ending CCT for hospital services. This, plus the maintenance of a national framework for bargaining including a minimum wage, the retention of Pay Review Bodies and a full acceptance of T.U.P.E."—I suppose that should be NUPE—will do much to raise morale and develop increasing commitment to the service.That is absolute codswallop. The minimum wage will cost at least £500 million, according to the hon. Member for Livingston (Mr. Cook). He is on record as saying that. We know that ending CCT will probably cost patient care more than £100 million.
What about the internal market? I would love to give Labour Members an opportunity to explain their next proposal. "Health 2000" says:We propose"—I hope that the hon. Member for Newcastle upon Tyne, East is paying attention, because I shall test him on this in a second. It says:We propose an alternative to the 'internal market' which would allow funding for agreed minimum programmes of work within a given period of time (service-level agreements). These programmes could be continually updated so that long-term planning of hospital and community services would be possible. This would also avoid treatment being cancelled because the workload had been under-estimated and the budget contract"—oh, dear—had been exhausted.What on earth does that mean? The hon. Gentleman does not know, and it is his policy.
§ Mr. Hayes
I am grateful to my right hon. Friend.
What about general practitioners? The consultation document says:We will"—this is very important, this is a real debate—abolish fundholding and replace it with a system which brings GPs and their local health authority together to provide the best possible care for their patients and the community they serve. Easing the burden of running a business will allow GPs to spend more time with their patients and less time on paper-work.The very fact that we give them a grant for doing that and the fact that doctors' lists are going down—
§ Mr. Hayes
—10 per cent. down, as my right hon. Friend says—is of no consequence. By the next general election, more than 50 per cent. of GPs will be 925 fundholders. What are Labour Members going to do? Will there be a massive upheaval of a policy which is popular at the moment, as all the opinion polls show?
Let us move on to the trusts. "Health 2000" says:As a priority we would remove the unaccountable self-governing and self-perpetuating Trusts which run hospitals and community health services. The non-executive members of trusts are currently Tory Government appointees—this is unacceptable. Drawing together those with a commitment to the NHS would offer a forum for the involvement of local people in their hospitals and community facilities as set out in Health 2000."The fact that 96 per cent. of hospitals are national health service trusts and that at least 99 per cent. of them will shortly be trusts would mean another massive upheaval for the people who are working so hard on behalf of patients in the health service. The very fact that trusts are far more efficient than directly managed unions ever were is totally ignored by the Labour party.
Probably the most important proposal of all concerns accountability, about which "Health 2000" says:There are a number of ways of achieving this. Possible options include some form of nomination"—now there is a surprise—direct elections,"—there is a surprise—or integration with local government.There is no surprise there at all. It goes on:We will consult closely with patients and health service workers to establish real democracy and accountability.We all know what this means—jobs for the boys. It means trade unions and health authorities, which are more interested in politics than in patients, and it means regional authorities dealing with health.
§ Mr. Hayes
The hon. Gentleman must accept that. That is part of the policy. It is here in the document.
One or two people are not terribly happy with that. The British Medical Association is not very happy. Of course, the Labour party always ignores the BMA, except when it needs it. The Royal College of Nursing—again, not exactly a branch office of Conservative central office—does not think that it would go well.
There is probably someone more important than that. Some time ago, in the House of Commons, someone said:"It is quite impossible … to hand over the voluntary hospitals to the local authorities.He said:People appointed to the regional hospital boards will not be there merely as representatives of local authority interests, but will be selected for their knowledge of hospital needs and hospital problems and will, therefore, be interested in hospital development, and not retarded, all the time, by considerations of a local character, particularly the incidence of local taxation."—[Official Report, 30 April 1946; Vol. 422, c. 49.]That was Nye Bevan, the founder of the health service, an icon to the Labour party. Even he said, in those pioneering days, that it could not possibly work, so why do Opposition Members put forward policies that they know cannot possibly work?
I now refer to efficiency. [Interruption.] I am sorry if the hon. Member for Leeds, East (Mr. Mudie) is disappointed. I hoped that he was listening and learning. Obviously, I have failed. At the moment, £1.5 million is 926 being cumulatively saved to the health service—not to go to my right hon. and learned Friend the Chancellor but to go back into patient care. By abolishing regional health authorities, which is happening at the moment, we will save £150 million to go into patient care. In that great policy document we hear what Labour Members would do. They would set up an efficiency unit at the Department of Health. What a good idea. I wonder who would be on that committee. All the hon. Gentleman's chums, of course.
Let us explode once and for all the myth about an overmanaged health service. It has 2.6 per cent. of the work force and 3 per cent. of the wages bill. There is one manager for every 26 front-line staff. Opposition Members should know the disastrous realities of their policies.
The limited list of restricted drugs saves a lot of money to the health service. As my right hon. Friend the Secretary of State said, the health service spends about 10 per cent. of its £32 billion budget on its drugs. What would the Labour party do'? Labour Members say:The government has been engaged in an exercise aimed at decreasing the choice of prescribable drugs. Choice is important to patients and health professionals who prescribe and this will he respected by a Labour government.Is it the intention to scrap the limited list, or are those just weasel words from the Labour party?
The real Disneyland of Labour proposals, such as they are, is to be found in paragraph 9.27 of the document, which states:Labour will therefore examine the contribution which might be made by the establishment of a panel, including those working professionally in the field and representatives of patients, in order to develop national guidelines for the allocation of scarce resources. Advice might also be offered where difficult or ethical judgments have to be made.Surely the history of government is that Departments cannot run anything from the centre. Centralisation and bureaucracy—[Interruption] My right hon. Friend the Secretary of State has given power to the national health service and community trusts. She has given power to the local people. Opposition Members want to give power to their friends and bureaucrats. That would do a grave disservice to the patient.
§ Mr. Deputy Speaker
Order. There are 57 minutes available before the winding-up speeches, and five hon. Members, who have been in the Chamber for most of the day, hope to catch my eye. The Chair hopes that they will be able to do so.
§ Mr. Eddie Loyden (Liverpool, Garston)
I am grateful for the opportunity to speak in the debate. I wish to reflect on some comments of the hon. Member for Welwyn Hatfield (Mr. Evans) about the origins of the national health service. He failed to say that the creation of the national health service was opposed by the then Tory Opposition. The national health service is probably the greatest leap forward in social progress that the country has seen this century.
People are rightly emotive about the health service, especially those who, like me, lived in the days when there was no health service. We appreciate all the efforts of the post-war Labour Government in establishing a 927 national health service that was free at the point of need and available to all. Our health service was the envy of the world. Sadly, there has been a deterioration in it; the Government cannot sit hack and pretend that the Opposition want to do nothing other than be critical of the Conservative Government.
The facts are available for everyone to see. Why are a growing number of people organising action committees to save their hospitals? Why are hospitals such as St Paul's in Liverpool, an excellent, long-standing eye hospital, being closed under the Conservative Government? Why did the Royal hospital want to extend its activities and develop a hotel in the hospital grounds? Theoretically, it was to move patients rapidly from beds into the hotel. The hotel would have had no medical staff, only telephones, television and a meals service. I asked what would happen if a person who was being moved from an acute ward into the hotel had a haemorrhage during the early hours of the morning. I asked where the hospital staff would be to deal with it. No answer was given. I fear that that is the direction in which the national health service is going.
That same hospital applied to extend its incineration facilities, not to incinerate its own medical waste but to enter into a sub-contract commercial deal to take waste from as far away as the Republic of Ireland and even further. That hospital would have endangered the lives of people who live in the centre of the city of Liverpool. The plan was withdrawn only after a successful campaign was organised not by the Labour party or trade unions but by the community. That forced the trust to drop its proposals. The national health service is being run by people whose first interest is the long-term commercialisation of it and of some hospital services.
Broadgreen has been an issue almost since the York report was published. Whenever we question the Secretary of State about the future of Broadgreen, there is a stony silence. Broadgreen hospital catered for a large community, including my constituency. There is no hospital in my constituency. My constituents depend on Broadgreen hospital, which is at least eight miles away. Its accident and emergency unit is being closed. We asked why it is being closed, and we were told that it was a decision of the trusts. We now find that the two independent trusts are merging into a single trust.
There is no doubt in the minds of the people of the Broadgreen action committee that the hospital will wither on the vine. The hospital responsible for almost all the area will be the Royal University hospital in the centre of Liverpool, which now takes patients from the former eye hospital and is also responsible for accident and emergency patients from Broadgreen.
That is what is happening in the NHS. People quite rightly feel afraid that the NHS is not safe in the Government's hands. Conservatives opposed the creation of the NHS in 1948 and never had to depend on it. The majority of Tories at that time enjoyed private health insurance, and one of the things that concerns some of us now is the apparent link between private insurance companies and the chairmen and members of trusts.
I fully support the views expressed by my hon. Friend the Member for Liverpool, Broadgreen (Mrs. Kennedy) in relation to the chairman of the local trust, Sir Donald Wilson. He is a medal-hunter—no more than that—and he has as much interest in the NHS as the man on the 928 moon. People in Broadgreen are maintaining their support for the retention of important hospitals and accident and emergency units.
Is it any wonder that people are beginning to see that the Government have gone only part of the way in reforming the NHS? I have no crystal ball, but I read the hooks and that is better than gazing into a crystal hail. I see either a two-tier system, with a first and second grade of care within the NHS, or the eventual privatisation of the NHS. The latter will he hotly denied by the Government, but nevertheless all the signs at this stage are that that is their intention.
To the Tory Government, public expenditure is the work of the devil. Analysis of Government policy on the NHS shows that they believe the NHS to be a burden on the taxpayer. We know where the Government stand in relation to the NHS.
The service will retain its excellence only by having the necessary funding. We must recognise that changes have been made, and Labour's mistake was not to identify the changes that were taking place not only in the hospital service but in the health service generally. We should have found out what new methods were being proposed to treat various illnesses.
In the pre-war period, the hearse was a constant visitor to the street where I lived. Almost every house contained three or four families, which was why ill-health prevailed. Tory Governments did nothing to remedy the problems. Mothers lost children—sometimes three or four out of a family. My own mother lost a baby because we lived in poor conditions, along with the other people who lived in the slums of Liverpool. The slums were the cause of that. .[Interruption.] Conservative Members may smile about those people living in slums. They were prone to illnesses that Conservative Members would not even know about.
Death was imminent in every family who lived in such impoverished conditions. The action of the post-war Labour Government ended that. The NHS contributed so much to the health of nation. Post-war babies were six inches taller than babies born 30 years previously. Babies and their mothers were healthier, and mothers were able to give birth in decent hospitals rather than in slum homes.
There has been a massive change since those days, and the NHS means something to the working class of this country. Working-class people will defend the NHS. They will not be motivated by political activists, but they know that the NHS is a treasure that they must defend. Whatever the Government are saying at the moment, we know their intention. They say—as they always do—that money for the NHS must come from taxation. They should be taxing their rich friends to maintain a decent NHS for those who need it.
The Government should be condemned for the way in which they have dealt with the health service. One reads in the papers every day—the right-wing press, the left-wing press or the middle-of-the-road press—more and more complaints about the NHS. People are saying that the NHS is not being run in the interests of patients and patient care. That should be a lesson for the Government.
People are saying loud and clear: hands off our NHS. It is not the Government's health service. It was brought into being by the post-war electors who came back from the war, determined not to go hack to the slums and unemployment of the 1920s and 1930s. People used to stand on street corners, waiting for something to turn up.
929 We must not go back to that. The people of this country recognise what the Government are doing to the NHS. I will be out fighting for the retention of the NHS, and I hope that the next Labour Government will clear away all the legislation that this Government have introduced.
No longer can one get answers from people in authority in the NHS; they are unaccountable in every sense of the word. The Secretary of State has lost control, and she and her Ministers believe what the trusts tell them. Hon. Members in my area have to write to the trusts to ask what is going on at Broadgreen. The Secretary of State, her Ministers and the Department of Health are not simply out of touch, they are out of control. They no longer control the NHS, which is now free-running, with the trusts doing all the management.
The Government's propaganda was referred to earlier. Propaganda is one of things at which the Government excel, and I give them full credit for that. They send an unbelievable amount of stuff saying that everything is fine, along with other misinformation or irrelevant information. They send almost nothing about how long patients have to wait for treatment, about the closure of accident and emergency units at Broadgreen or about the fact that the NHS cannot recruit junior doctors because of their conditions.
All those things show that the NHS is not safe in the Government's hands. The Secretary of State had better get control of the situation, and start acting as a Secretary of State. She must find out what is going on in the trusts, which often are making decisions when they have not even considered the effects of those decisions on the hospitals concerned. In other words, the Government are completely out of touch with people's needs.
Recently, a man—I do not know the guy—told an interviewer on a radio phone-in programme in Liverpool that he had been waiting two and a half years for a hospital appointment, and he duly turned up at the hospital when he was summoned with nine other patients. The patients were told to stay in the corridors and to get a cup of tea if they wanted. They were there about eight hours. Staff were trying to find out how many people would he discharged that day—beds would still be warm when the new patients got in. In the end, he was sent home, along with other patients, because there were no discharges that day. Is that any way to run a national health service? What justification can there be for that?
This debate has made it clear that the people have an emotive regard for the national health service. They cherish it and recognise that it will he safe only when a Labour Government are back in power.
§ Mr. Matthew Banks (Southport)
I mean the hon. Member for Liverpool, Garston (Mr. Loyden) no discourtesy, as he is an honest man and he represents a constituency that I know well as it is not far from mine. I know that he will understand if I robustly, but genuinely, disagree with some of his arguments. In the few minutes that I have to make my speech, I shall touch on several of the issues that he mentioned and relate them to the area that I represent in the north-west, which in recent years has witnessed one of the greatest reductions in waiting times in the United Kingdom and the greatest increase in the number of patients treated.
930 The picture is entirely different from that painted by the hon. Member for Garston. He said that the national health service was one of the greatest leaps forward in social policy and I do not disagree, but, heavens, that was decades ago: things have moved on. Old hospitals have to close—they become clinically unviable. The Government have built new, bigger and better, clinically more viable hospitals and nowhere is that more evident than in north Merseyside, central Liverpool and the north-west of England.
I am concerned that we heard too much scaremongering from Opposition Members. My hon. Friends have done their best to put the record straight and, in the time available, it would not be right for me to trot out yet more statistics. My hon. Friends have more than adequately drawn our attention to the improvements that have been made in recent years as a result of the reforms that Ministers have pioneered.
In my constituency, which is in northern Merseyside, there is growing satisfaction with the way in which the NHS operates. I referred to the reductions in waiting times and the increase in the number of patients treated. It is pertinent that national health service trusts now treat 3,000 more patients per day than the same hospitals three years ago. Waiting times have reduced dramatically. Half the patients who need treatment are seen immediately and half of the remainder are seen within five weeks.
One striking aspect of this debate is that, if the Labour party had the opportunity to introduce its plans for devolution and breaking up the United Kingdom, it would also have the opportunity of handing many of the powers that have been devolved locally, nearer to the patient, away from clinicians to the politicians, with the setting up of regional assemblies. I am very mindful of what my right hon. Friend the Secretary of State said about moving to "irrelevant and unwanted" talking shops.
We have not seen new Labour this evening. We listened intently to the right hon. Member for Derby, South (Mrs. Beckett) trotting out many news cuttings from The Guardian, but we did not hear anything of policy. My hon. Friends said that it was little wonder that the patient did not always come first as the union interest came first because the Opposition receive so much money from unions and from the Confederation of Health Service Employees in particular.
I hope that the hon. Member for Newcastle upon Tyne, East (Mr. Brown) will have the opportunity to reply shortly—I see him shuffling in his place—and that he will at least have something positive to say about what the Government have done in recent years. It is not all doom and gloom, but I did not hear the right hon. Member for Derby, South make one positive point, despite the statistics to which my hon. Friends rightly referred.
In my constituency and the north-west of England tremendous improvements have been made. I very much regret the remarks of the hon. Member for Garston about Sir Donald Wilson, as he has done more than the hon. Gentleman in this place or at home in Liverpool to improve the service to NHS patients in Merseyside. The hon. Gentleman should he ashamed of his remarks.
We have heard the politics of envy about salaries. I regularly meet people who work in the health service in north Merseyside and in Southport and Formby district and the well-paid staff and administrators provide the public with a very good service.
931 My hon. Friend the Member for Harlow (Mr. Hayes) proposed some of his former political opponents to serve on trusts. Some of my political opponents sit easily on the board of the Southport and Formby Community Health Services trust. They work well and are committed to the Government's reforms.
Those reforms are paying dividends and I speak as someone who has been an in-patient at Broadgreen hospital and Southport and Formby district general hospital. One cannot compare the two, however. Much good work goes on at Broadgreen and I pay tribute to its staff, but we need to move forward, especially with the private finance initiatives that have been pioneered so well in north Merseyside—with imaginative proposals for new building—and in partnership with the private sector. We need to move forward and to improve hospital infrastructure. Sadly, if that means closing older hospitals, that is what we must do if it is in the patient's interest.
We heard that the average waiting time for operations has been cut by half, but we heard no mention of that fact from the right hon. Member for Derby, South. She did not pay any tributes. I recall only the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) paying tribute to those who work in the health service. Perhaps I did not hear the tributes, but I do not think that they were paid, and that is regrettable.
This Opposition Day debate started at 3.45 pm, but the Opposition Front-Bench spokeswoman—in a speech that lasted nearly an hour—said nothing about what a Labour Government would do, if there ever were one. She said nothing of their plans for the future, let alone giving us serious costings of how those plans might be paid for.
I hope that the hon. Member for Newcastle upon Tyne, East will set the record straight. It is time to stop consulting and to let the public know what the Opposition would do, if they ever had the opportunity to implement their plans.
I cannot let the remarks of the hon. and learned Member for Montgomery (Mr. Carlile) pass. I challenged him and gave him an opportunity to answer when I referred to his consultation document. In a mealy-mouthed response, he said that he was appointed to his present post after the consultation paper was published. Is it not about time that we heard where the Liberal Democrats stand? Instead, as the editorial cif the Health and Social Service Journal of September 1994 stated, we have to hope thatWith luck, someone might be kind enough to offer some directions.I gave the hon. and learned Gentleman the opportunity to tell the House and the people where his party stood. He promised to do so and to give us a sense of the direction in which he and his colleagues are going—I wrote it down—but, as the hon. Member for Greenock and Port Glasgow (Dr. Godman) said, by the time that the hon. and learned Gentleman had sat down he had given us no sense of direction.
§ Mr. Carlile
I shall be very brief. Which question that he claims I have not answered is the hon. Gentleman asking me to answer? I would be delighted to help him further.
§ Mr. Banks
Unfortunately, the hon. and learned Gentleman will not have time to answer my questions in this debate but we shall certainly look for a fuller explanation later. My question will be in the Official Report tomorrow for all to see and it will be clear that I received no answer. I asked whether the hon. and learned Gentleman believed in retaining the division between commissioner of services and provider of services, and the retention of NHS trusts and GP fundholding. His party changes its policy from one day to the next. It is up to the hon. and learned Gentleman in his own time to put the British public and the House straight on where he stands. Like other Liberal Democrats, he says one thing in this place and another back in his constituency. Moreover, he says one thing at one end of his constituency and another at the other end, depending on who he talks to. The whole House knows that I tell the truth on that.
I draw my remarks to a more premature conclusion than I would wish by returning to my concern about the scare stories put about in my constituency and the north-west. My constituency had to wait for the election of a Conservative Government before funds were found to build a brand new hospital. My hon. Friend the Member for Harlow referred to the cut in the hospital building programme because the Labour Government had got the British economy into such a mess. The hospital to which I referred, where I have been an in-patient, should have been built years ago but we had to wait for the election of a Conservative Government in 1979. I pay tribute Lo the clinical staff and administrators at the Southport arid Formby NHS trust.
I make no apology for expressing my concern tonight on a parochial point. My predecessor, who was a Liberal Democrat, had little knowledge of health matters despite the fact that he was national spokesman on health. When health became an important issue, he had to he moved sharpish because he was so hopeless. He has been saying publicly that the current local health service review will close the maternity services that cover the Southport and Formby area. So concerned is the trust—it is not concern on the part of the health authority conducting the review—at what that gentleman has been saying that it has had to call him in for a private briefing because he has been going off the rails.
There will be no loss of maternity services in my constituency. My right hon. Friend the Secretary of State and my hon. Friend the Minister will continue to listen carefully to representations that I have made privately, and now publicly, to ensure that there will he a proper capital allocation so that when the Christiana Hartley maternity hospital closes because of a lack of clinical viability, and when the private finance initiative, to which I referred, allows for new and further building at our new hospital in Southport, maternity services will he transferred within the town to the main hospital site at Kew.
I hope that we shall now hear something positive from the hon. Member for Newcastle upon Tyne, East, because we heard nothing positive from the right hon. Member for Derby, South earlier.
§ Mr. Thomas Graham (Renfrew, West and Inverclyde)
I have listened to the entire debate and am surprised that the Government have not recognised the fact that they have packed the trusts and boards to the gullet with Tory supporters. They have wiped out any democratic opinion from other sources—from people who are neutral, people from other political parties and people with opposing opinions but who nevertheless wish to see a successful health service. In my area, all the trusts and quangos are packed stupid with Tory placemen.
§ Mr. Roy Beggs (Antrim, East)
Does the hon. Gentleman accept that the same conditions apply in Northern Ireland, where every quango has been packed with individuals who have no Ulster Unionist credentials?
§ Mr. Graham
I am grateful for that information. If we travelled the length and breadth of Britain, we would find no balance of opinion on how the national health service should be run in either the trusts or the boards.
I place on record my absolute praise for health service staff: consultants, doctors, and our wonderful nurses who look after people magnificently. I also praise those who back them up—auxiliary nurses, porters and those who make our hospitals function. Ultimately, it is they, not the Government, who make our health service function. The Government do not deliver the service; they simply cripple it and they continue to cripple it. I express my great appreciation to all those who work in the industry and deliver the services.
Since the Tory party introduced its great reforms, we have seen a huge escalation in staff. Instead of patients receiving better treatment, the service is creating more and more paperwork. I and my whole family have been treated as patients at the Paisley Royal Alexandra hospital. Indeed, some members of my family are grateful for being alive today because of the treatment that they received from people trained in our educational establishments and the national health service, not in trusts.
Now that the hospital has become a trust, things have changed. A friend of mine had an operation in the hospital, was sent home too early and had to return to the hospital. On waking up in his bed, he found a man sitting at the end of it. When he asked, "Who are you?" the man replied that he was waiting for his bed because he would be leaving. My friend then had to consult the doctor about whether he would be leaving. What an incredible scene.
In another case, a father in my constituency phoned the emergency doctor, who said that he would need to get the man's daughter into hospital immediately. But the local hospital had no beds and, having phoned around other hospitals, the doctor eventually found a bed in a hospital well into the Glasgow area. When they reached the Glasgow area, they were told that that had been happening all the time. I hope that the Minister is listening because folk in my constituency rely on the Government listening to their pleas.
The Royal Alexandra hospital is a big, brand new hospital that epitomises the best on offer, yet the other week it had no bed for a constituent of mine who needed one in an emergency. In the same hospital, an elderly woman with a broken bone had to wait more than 48 hours before seeing a surgeon. Eventually, she saw a surgeon because her family phoned me and I asked what the blazes was going on and why my constituent had not 934 been treated. I was then sent a lovely letter explaining what had happened. What the letter did not tell me, however, was that a woman in the next bed should have been seen before my constituent and was therefore broken-hearted. Although that woman was ready to go in for treatment, my constituent went in front of her because I, as a politician, had argued my constituent's case. I did not know that at the time, but it is an indictment on a trust hospital.
We heard tonight about hospital closures. In my constituency and some other parts of the country, mentally ill and mentally handicapped people who are in desperate need of care and attention can be seen walking the streets at night. I saw them last night in London and the other week in Glasgow. Those people should be receiving the best of care. Are they receiving care? They are in cardboard cities, lying under the bridges and arches. They cannot receive treatment. If we check up, we find that those folk were put into institutions and released without the necessary back-up.
What do the Government propose in my area? They set up a quango and appointed Tory clones who are recommending that Ravenscraig, Bridge of Weir, Merchiston and Dykebar hospitals should close. The Tory clones say that they must quickly meet the Government targets. They are not interested in meeting the target of looking after patients.
§ Mr. Beggs
We in Northern Ireland share the problems that the hon. Gentleman has in his constituency. Does he agree that inadequate provision is made for young people aged between 14 and 18 with mental illnesses such as schizophrenia? There should be separate and special provision for those young people throughout the United Kingdom. They should not be lumped in with adults.
§ Mr. Deputy Speaker
Order. I said earlier that it does not help if hon. Members make long interventions.
§ Mr. Graham
I am grateful to the hon. Member for Antrim, East (Mr. Beggs), with whom I entirely agree.
§ Dr. Godman
My hon. Friend mentioned Ravenscraig hospital in my constituency. Scores of constituents have contacted me regarding the threatened closure of that hospital. I sincerely hope that we can conduct a campaign to keep it open.
§ Mr. Graham
I am grateful to my hon. Friend.
The Minister should he aware of our constituents' feelings. The Government arc running the health service badly. To rescue the health service we probably need a general election. We need to go in a different direction with a different political party—we need people who are committed to running the health service and want to see it grow, develop, be innovative and deliver the best services.
I shall speak for another two minutes, Mr. Deputy Speaker, and finish when I have spoken for exactly 10 minutes.
I remember raising in the House the problem of one of my constituents, Mr. Kennedy, who could not see a urologist or get an appointment. He was eventually given an appointment after I had continually harassed the Government to ensure that he was looked after. Mr. Kennedy was eventually looked after and had his operation. What is he like now? He is a brand new man, 935 enjoying the full fruits of life. He is an elderly, retired gentleman of over 70. I met him at Christmas, when he was dancing, singing and enjoying a drink—a new man. This country needs a health service that puts people back on their feet.
§ Mr. Brian H. Donohoe (Cunninghame, South)
My hon. Friend must understand that the Tories have a hidden agenda. They want to privatise the health service, and are beginning to do so with trusts. The health board in my district this week signed a contract with a private American company that will lead to profits going across the pond. What does my hon. Friend think of that?
§ Mr. Graham
I do not have time to answer my hon. Friend's question as I have just one minute left.
The people of Britain no longer have any trust in the Tory's trusts. No one has any faith in the Government's ability to ensure that our health service is the best in the world. The Government no longer treat our young doctors as humans. They make them work like slavesߞ80 hours a week with hardly any pay. They treat nurses as cannon fodder and do not recognise their skills with proper wages. I have questioned Ministers a million times, but they hang their heads and say that they will never do what is needed. The only thing that we can hope for is a speedy general election. I hope that the Prime Minister is daft enough to call an election next week.
I have been delighted to take part in tonight's debate to argue the case for my constituents. The Minister should give us some heart and give up now.
§ 9.3 pm
§ Mr. James Clappison (Hertsmere)
I welcome the opportunity to make a brief contribution. There have been distinguished contributions from my hon. Friends the Members for Broxbourne (Mrs. Roe) and for Welwyn Hatfield (Mr. Evans) and from my right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke).
There have not been many cross-currents during the debate, but one came across the House from the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith), who talked of the need for everyone, including those in low-income groups, to have high expectations for health. That struck a note on both sides of the House. I know that my right hon. Friend the Secretary of State is particularly interested in maintaining high expectations in health and her policies for improving the health of the nation have gone a long way towards achieving that aim.
My right hon. Friend the Member for City of London and Westminster, South hit the nail on the head when he said that the speech by the right hon. Member for Derby, South (Mrs. Beckett) became interesting only at the very end when she began to talk about her views, her vision and the Labour party's policies. She said precious little in the rest of her speech and simply trailed before the House every press cutting from Labour's press file.
The right hon. Lady answered most of her own questions when she said that in any large organisation things can go wrong. She began by relating some admittedly serious-sounding incidents, but she then moved on to some rather mundane ones, including the examples of a bed being moved and Hull Royal infirmary asking people with minor injuries not to go to the accident and emergency department.
936 The right hon. Lady's speech was not really worthy of an Opposition day debate about the national health service. It suffered from two principal defects: first, there was a lack of detail about Labour party policy; and, secondly, she went over very old ground. Any Opposition Member could have made the same speech at any stage in the past 15 years. That sort of sensationalism and trivialising of individual stories does the right hon. Lady no credit at all—indeed, her credibility is threadbare.
The Opposition's big revelation is that the Government are trying to privatise the health service. Opposition Members have been saying that for the past 15 years and it has not happened. Indeed, there is evidence to confound it utterly. During that time an increasing volume of resources—measured in real terms, set against health service inflation or viewed as a proportion of gross domestic product—have been allocated to the health service. Contrary to what the hon. Member for Liverpool, Garston (Mr. Loyden) said, the Government are committed to the national health service through public expenditure.
The health service suffered real cuts and was constrained and driven down by the last Labour Government. My hon. Friend the Member for Welwyn Hatfield spoke eloquently about that and I do not want to go over the same sad story. We heard also about Baroness Castle, who seems to be rather a ghost in our proceedings. She recorded in her diaries what took place under that Labour Government and she recalls a verse which was penned by one of her Labour colleagues about the activities of the then Chancellor of the Exchequer, now Lord Healey. It went like this:All things bright and beautiful, all projects great and small, all things wise and wonderful, the Chancellor cuts them all.He cuts the old age pension, although he cuts by stealth, and while he looks for savings, he cuts the national health.That is the record of the last Labour Government as revealed by one of their distinguished former Cabinet Ministers.
We have made a great deal of progress since then, not just through increased funding, but through improvements in efficiency and management—managers have been much maligned by Labour Members—and through the Government's health reforms. When the right hon. Lady talked about the reasons for improvements in the health service I could hear the goal posts being moved—in fact, I could hear them being sawn down and taken to a different stadium.
I will remind hon. Members of what one of the right hon. Lady's predecessors, the hon. Member for Livingston (Mr. Cook), said when he set out the acid test of the success of the Government's reforms. I advise Opposition Members never to set targets which might be a hostage to fortune: if the targets are surpassed they will be made to look foolish. In the House in April 1991, the hon. Gentleman said:Is the Secretary of State prepared to measure the success of those trusts that opted out by the simple test of whether they do more or less work on NHS patients?"—[Official Report, 17 April 1991; Vol. 206, c. 457.]According to the hon. Gentleman's own test, the Government's reforms have succeeded. More patients are being treated now under the reformed national health service than ever before—3,000 more per day for the whole country and a rise of 20 per cent. in the health authority which covers my constituency. By any measure, 937 that is a substantial increase. The Labour party, confronted with indisputable evidence of the success of the reforms, moves the goal posts. On Second Reading of the Health Authorities Bill, the right hon. Member for Derby, South told the House that her party's supporters resented the Governmentclaiming credit for those improvements, as though they all flow from the Government's reforms and changes. In fact, they have absolutely nothing to do with the Government's reforms and changes. Indeed, in many cases those changes have seriously impeded the development of better health care".—[Official Report, 12 December 1994; Vol. 251, c. 649.]
§ Mr. Clappison
The hon. Gentleman said yes. It is a fairly safe bet that if there had been a fall in the number of patients treated since the introduction of reforms, members of Labour's Front Bench would not be saying that that had little to do with Government reforms but would blame it on those reforms. We cannot win. However many more patients are treated, it is said that has nothing to do with Government reforms—even when the rate of increase in NHS activity has improved. We have seen a move from Cook's law to Beckett's law. One could almost say that the move is to Beckett's fork, because I am most reminded of Morton's fork of Henry VII fame. We cannot win, whichever way we go.
Health service reforms are working. For all the sensational stories from Labour, the proof is there in the greater number of patients being treated and shorter waiting lists. The maximum waiting time for my constituents has been reduced not only to the 18 months in the charter but to 12 months, because of the target that the health authority set itself. The average waiting time has reduced from seven months to three months.
I welcome the Government's introduction of a new measure of waiting time in respect of out-patients wishing to see consultants. That is another step forward and further evidence that the patients charter is working. New targets are set all the time and the health service is being driven forward for the benefit of patients.
The challenge for Opposition Members is not to search every hospital for every bed that has been moved or mistake made, but to declare how they would do things better and achieve more. We heard precious little about that in the debate, and nothing about the future of trusts. There was vague talk about accountability. Does that mean that trusts will be left the same but that they will be joined by a few Labour councillors as the magic, miracle ingredient for success? We have already heard the views of the people of Merseyside, and they might have something to say about that. Would they have one of the most successful health authorities in the country if they had the benefit and wisdom of certain Liverpool city councillors, or of the regional councils being imposed on England as a quid pro quo for Labour's mess over Scottish devolution?
Labour Members make it up as they go along. They said nothing about policy. At least the right hon. Member for Derby, South did not fall into the same trap as her predecessor, who had outbursts of frankness and candour—for example, when he said that the status quo was not an option in respect of London health reforms. For his pains, he was banished from Labour's Front Bench when that subject was debated.
938 I urge my right hon. Friend the Secretary of State to drive forward reforms and to aim at ever-higher standards, to show the commitment of the Conservative party to the national health service.
§ Dr. Tony Wright (Cannock and Burntwood)
Time is short, so I will be brief. The most interesting and alarming part of the Secretary of State's speech was her assertion that if one wanted to know what is happening in the national health service today, one should go to the London School of Economics—and if one is not satisfied, to the Organisation for Economic Co-operation and Development. That was meant to trump the evidence of people who work in and use the health service. It is a rather strange kind of evidence.
I cite three experiences from my area. The first concerns complaints. Like all Members of Parliament, I am visited from time to time by people who tell me that they want to complain, or they have complained, and they are usually dissatisfied with the outcome. They usually receive a letter from someone with a title such as assistant customer services manager—telling them nothing but reassuring them that everything is basically all right.
Complaints do matter, however. As the Minister said earlier, they should be the jewels in the crown. They are actually more like a kind of buried treasure. We have had an inquiry into the NHS complaints system. Since the Wilson inquiry, we have been given endless promises about the implications of the report and of the Government's proposals. We have it on the authority of the Secretary of State that the present complaints system isfragmented, confusing, cumbersome and slow".Back in May, a report in the British Medical Journal said thatthe Health Secretary, Virginia Bottomley, said that she accepts the broad thrust of the report Being Heard; she has begun a three month consultation period before introducing legislation".The least we expected today in this health debate was that the Government would announce that they had clear plans to reform the unsatisfactory NHS complaints system.
When asked when they intend to take action, the Government always tell us that it is imminent. I happened to discover a document issued just before Christmas by the health service in Scotland. Entitled "The Patients Charter: What Users Think", it says:The committee chaired by Professor Wilson to look at NHS complaints procedures has also recently reported its findings and the Government will be making a response to the recommendations in January.Fortunately for us, this is the last day of January; so I presume that when the Minister rises to reply, he will give us a dramatic announcement—no doubt the cause of muted cheers behind him—about a new start for the jewels in the crown, the complaints about which the Minister spoke earlier. Nothing less will be satisfactory; anything less will be a breach of promise.
A few weeks ago I had occasion to visit the mental health trust in my constituency in Staffordshire. I met the chairman of the trust, a decent gentleman, and asked him how he had become chairman. He said that he had been a timber merchant but had wanted to hand over to the next generation. I said that that was interesting, but asked what it had to do with running an NHS trust. He said, 939 "Well, I had a friend who was a consultant. I phoned him up and asked him whether it would be a good idea for me to take the job on. He said it would."
I happened to discover later that this same gentleman is chairman of the local Conservative association. And this is a trust whose consultants have just passed a vote of no confidence in the chief executive, and, by extension, in the board. The health service is being run as a kind of occupational therapy for retired timber merchants with Conservative connections. No wonder it has lost all legitimacy in the community.
Cannot the Government understand that they are eroding the foundations of respect inside the service? This is not our argument: listen to Simon Jenkins, no friend of my party, writing in The Times last week:As for the 15,000 health authority posts that had to be filled in 1991, it was the most undignified case of catch-as-catch-can in the history of public patronage. On seeing his list, one health administrator paraphrased Wellington and hoped they would 'terrify the consultants as much as they terrify me 'This is a scandalous story; little wonder that people have lost faith in the system.
Every so often a piece of paper will come under my constituency office door. One came recently from a nurse—whether a he or a she I do not know. The nurse felt unable to come and speak to me about what was going on in the health service, but nevertheless wanted to communicate with me. What a situation we have reached. Health service employees feel that they have to come covertly in the middle of the night and put pieces of paper under the doors of Members of Parliament to let people know what is going on. Revealingly, when the Government recently issued a document on how NHS staff can take up complaints with the media, they were told to approach their Members of Parliament—in the first instance through their line managers. No wonder the Government were told off by the Select Committee for saying such things. They have since had to back-track.
I do not want to return to how the world was before 1979. There was always an agenda of health service reform. It was about efficiency, quality and accountability. The tragedy is that we have gone down a false road, a cul-de-sac. The Government have managed to grow 10 accountants when there was one before. They have grown 20 managers when there was one before, and have recruited graduates from the Eric Cantona school of public sector management to do it. It is that which is eroding the health service. The agenda remains—of quality, efficiency and accountability. That is the agenda that will have to be taken up by the next Government.
§ Mr. Nicholas Brown (Newcastle upon Tyne, East)
I congratulate my hon. Friend the Member for Cannock and Burntwood (Dr. Wright) on his vigorous contribution to the debate. Indeed, hon. Members on both sides of the House concentrated their fire on right hon. and hon. Members on the Front Benches. As I understand it, the charge against us from Conservative Members is that we have no policies. I will have something to say about that in a moment.
Our charge against the Government is that they have the wrong policies, and I have something to say about that now. Before doing so, however, I pay tribute to Britain's health care workers, to the medical staff and to the non-medical staff, including the management. The 940 workers in the health service are not responsible for Government policy. Indeed, their recent protests have in part inspired today's debate.
The charges against the Government on secondary care are well known and have been well rehearsed in the debate. Since 1979, one in five hospitals have closed; one in three general hospital beds have gone; and one in four acute beds have gone. Since 1987, a third of all NHS psychiatric beds have gone. More than 1 million of our fellow citizens are on hospital waiting lists. Between July and September of last year, more than 10,000 operations were cancelled, either on the day or the day after admission to hospital, and 10 per cent. of those were not readmitted within one month.
In primary health care, GP fundholding has created a divisive two-tier service—patients are fast-tracked from fundholders' practices, disadvantaging the patients of non-fundholders. It has cost more than £100 million in management allowances to put that unfair system into place. Budgetary concerns have been put before the needs of patients. It has undermined, as my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Galbraith) said, the necessary trust that must exist between a GP and the patient. Worst of all, although the Secretary of State likes to boast about the National Audit Office report as an endorsement, no region has been able to supply it with hard information on the reliable costs of fundholding versus non-fundholding.
The reforms, of which the Government are so proud, have almost ended national health service dentistry. Prescription charges have risen tenfold in real terms since 1979. The provision of community care is disfigured by demarcation disputes between health authorities and social service departments. They are mostly about money as well as responsibilities. The Department of Social Security's rules are rigged against the public sector provision of community care facilities, such as council-owned care facilities. Indeed, the distinction that it draws between the purchaser and provider is wholly consistent with the Conservative party's general approach to the issues.
The Secretary of State and the Minister claim that fundholding is popular, at least with the profession. My hon. Friend the Member for Liverpool, Garston (Mr. Loyden) pointed out that GP fundholding is not popular. Indeed, "Pulse", a professional magazine, conducted a survey of GPs to find out how popular the idea was. The survey shows us that more than 75 per cent. of GPs want fundholding abolished. What is the Government's response to that? General practitioners are saying that they want the fundholding structure abolished. Indeed, just under half of fundholders want it abolished. That is not a ringing endorsement.
My hon. Friend the Member for Hackney, South and Shoreditch (Mr. Sedgemore) spoke about the special problems of London. He is right.
My right hon. Friend the Member for Derby, South (Mrs. Beckett) quoted examples not from the previous Labour Government—that was fashionable with Conservative Members—but from last night. I also have the list with me, but time is short, so I shall not read my examples from it, although there are enough of them. Instead, I make the following points.
In London, there is a high prevalence of social deprivation. People there have higher than average levels of ill-health; there is a large transient population and 941 higher ground rents and labour costs than in the country as a whole; and it is a centre of excellence for secondary medical care, something of which we should be proud rather than undermine. Yet the Government will not establish a London-wide health authority or a London health care planning strategy. The Government use London-wide arrangements for their internal planning, but they will not put the structure in the public domain.
There is no London-wide review of accident and emergency services, although we have heard of the enormous tensions that there are in the capital. There has been long-term underfunding of London health care and, although it is the nation's capital, London has some of the country's lowest rates of general practitioner registration, putting further strain on the hospital services. Therefore, there is a particular crisis in London which is not being met by the Government.
The Secretary of State claimed that under the previous Labour Government when the financial year came to an end there was fear and terror throughout the NHS as people tried to get the budgets to balance for the year. I can tell her that that has not changed but is still going on now. I have an example from my own region, or regions as we think of them—the north and Yorkshire.
My regional health authority has a financial monitoring report which sets out the position as at 30 November 1994 which David Florry, the director of finance, has sent me. I do not know whether he knows that he has sent it to me, but I have it now and I am sure that he would not mind me sharing it with the House of Commons. At least, in the interests of open government, I shall share it with all the Members of the House of Commons and the public when they read Hansard tomorrow. He says:the overall regional forecast is an underdraw against cash limit of some £34m.That is just for our region. He draws the following conclusion:Contracting and other pressures are now clearly showing across a number of Authorities with reserves of some £6.0m having been deployed to meet these costs and continuing pressures may lead to deficits being forecast which will need to be funded from non-recurrent sources or working balances. Particular attention will need to be given during the remainder of the year to managing the overall regional resource to that agreed within the NHSE.That is exactly what the Secretary of State complained had happened under the previous Labour Government. We have not moved on far there.
Another issue that has been raised in the debate quite forcefully is the question of the democratic deficit in the NHS—how appointments are made to non-executive posts. Mr. Roy Lilley, a mentor to Ministers on such issues, says:Non-executives are like bidets—stylish to have, but no one knows how to use them.Those words were spoken by a man who clearly from his other actions, misuses his bidet.
The Secretary of State says that politics play no part in appointments to office within the NHS and the Minister of State said the same thing in a written answer to me. However, I have a letter from a retired health care professional who applied to be a non-executive trust 942 member having seen the advertisement in the paper. Writing to my right hon. Friend the Member for Derby, South, she says:In 1993 I applied for a post advertised locally as a 'non-executive Trust Member' of the new Haywards Heath Hospital. On the application form was an actual request for me to supply one's political affiliation. Needless to say, I was not appointed".My hon. Friends, particularly my hon. Friend the Member for Doncaster, North (Mr. Hughes), are right to believe that the Government's protestations of not taking politics into account are not to be taken at face value. It would be remarkably coincidental, if they were able, at random selection, to appoint their own relatives, friends and former supporters to those boards without reference to the rest of the population. What do Conservatives, those who have a responsibility for party management, as opposed to the conduct of ministerial office, think about that? They say this. Mr. Maples—whom I remember from my time in Labour's Treasury team—says:We can never win on this issue".I can almost see him shaking his head sadly as he says:People perceive the reforms as clumsy and believe what doctors and nurses say about them, which is almost universally hostile".Wide-eyed and innocent!No doubt that was received with a certain amount of pain in the Secretary of State's office.
What is the Government's response? Since 1989, they have spent some £1.1 billion on their market-led reforms; over the same period, the managers' pay bill has increased by 206 per cent., the number of managers has risen dramatically and the number of nurses has fallen almost as dramatically. Sixty per cent. of hospital staff budgets are now spent on non-medical activities. Public-private partnerships for capital projects, which have predominated this year, have been entered into on an uneven basis: profit and certainty of outcome are transferred to the private sector, while the risk is transferred to the public sector.
My hon. Friend the Member for Doncaster, North pointed out that when the Government boast about the number of patients treated, it is important to remember that, when considered for statistical purposes, patients are episodes and not people. The same accounting device is used when the Government boast about waiting lists. In fact, more than 1 million of our fellow citizens are still awaiting hospital care as we speak, and not receiving the treatment that they ought to receive.
My hon. Friend the Member for Strathkelvin and Bearsden spoke of our values and the Government's values. I said that I wanted to set out the Labour party's approach to the national health service, and compare and contrast it as fairly as I could with that of the Government. We in the Labour party believe in a unified service; the Conservative party believes in a fragmented service, and, indeed, takes pride in that. We believe in a public service; the Conservatives praise privatisation. We believe in achieving efficiency within the public sector; the Conservatives believe in a market mechanism, which they argue will achieve economic efficiencies.
We believe in professionals taking responsibility for the service that they provide. The Conservative party believes in management checks, sometimes—in one instance, at least—pursued to the absurdity of hiring private detectives to follow consultants. We believe in a co-operative model of health care for different professionals to share; the Conservative party believes in, and indeed boasts of, a competitive model. We believe that public representatives 943 should represent the public interest, and that if the public interest is to be represented in the laity of health service structures it is best for the public to choose their representatives. The Conservative party believes—if it is to be judged by its actions—that those representatives should be chosen by the Secretary of State, or on her behalf, from the relatives and friends of her ministerial and other parliamentary colleagues.
We believe that hospital services should be in the public sector, and that other provider services should be public sector responsibilities. The Conservative view—I have heard the Secretary of State express it on the radio, and I have heard the Parliamentary Under-Secretary express it in Committee—is that it does not matter whether the provider of the service is in the public or the private sector. I draw a clear distinction there between provider and purchaser.
That is clearly a green light, at least ideologically, for the privatisation of the providers, including trust hospitals. As we have heard today, the trust hospital structure has been set up for privatisation purposes. We believe that general practitioners' first duty is to the patient; Mr. Roy Lilley has said, presumably from a Conservative perspective, that their first duty is to the paymaster and the service. We believe in setting national pay and conditions for a national service, on grounds of fairness and economic efficiency; the Government believe in local pay bargaining, presumably on grounds of unfairness and economic inefficiency.
Clear distinctions exist, therefore, between the point of view of the Labour party and that of the governing party. I hope that, in setting out those distinctions, I have given the Conservative Members who asked for it an idea of where the Labour party is going in the consultations and policy review that it is conducting, is drawing to a conclusion, and will have drawn to a conclusion by the time of its conference this year. There will, therefore, be plenty to debate in the run-up to the general election, which, as was helpfully announced from the Conservative Benches, will be in 1997.
Where are the Government going? Back in 1988, Dr. David Green, director of the grandly titled Institute of Economic Affairs health unit, proposed health vouchers as a way of getting around the difficulty with the status of general practitioners—are they purchasers or providers? His idea is to have an age-weighted cash payment to purchase private health care insurance and thus private medical care. In his model, everything except regulation would be run as a private sector function.
For people who think that the voucher idea is a long way off, let me point out that vouchers are already in place to pay for spectacles. Dr. Green was echoed by Mark Bassett from the European Policy Forum. His argument is that every individual should receive a weighted insurance entitlement. It is a similar argument to Dr. Green's. He calls it a "health cheque". For the avoidance of any doubt, he meant cheques, in case people thought that he meant regular medical checks. The purpose of that payment would be to insure for comprehensive ordinary health and social care. He argues that it would createan individual cost-awareness that is currently absent.The commissioners of health services would include private insurers and would be subject to public licensing and oversight. These roles"—and I think he means those roles alone—
944would be assigned to the health authorities.Madsen Pirie of the Adam Smith Institute argues for the creation of health maintenance organisations for the entire population. He argues for competition between different producers of health care, and for subscription-based health care from private or public sources. One final ideologue has a contribution to make—Dr. Ann Robinson, head of the influential Institute of Directors policy unit.
It is important to know that those people play an important part in the thinking of the Conservative party. What they say today, Conservative Ministers say from the Dispatch Box tomorrow, probably because they are paid to do so, which is the allegation that they always make about Labour Members and the unions, so why not throw it back at them?
The head of that influential policy unit says in criticising the Government's trusts:They cannot make profits, establish subsidiary companies to trade, nor go to the money markets to borrow money. And they cannot become bankrupt no matter how poorly managed they are.She is right. We argue that, because of those things, a real market does not exist, and that it would be better to have a unified, publicly owned health service.
Dr. Robinson goes on to argue, and no doubt this is the Conservative party's point of view:Running a hospital should be subject to the same disciplines as business. If it becomes insolvent, it should go into receivership or administration and a new management with tighter financial control installed".That is where the ideologues, who drive the Conservative party and who create its dogma, are trying to take that party.
There are two visions. Ours is of a national public service and the Conservative vision is of a fragmented private health care market. In urging my hon. Friends to vote for the motion standing in the name of my right hon. Friend the Member for Sedgefield (Mr. Blair), I should like to give the last word to Dr. Lee-Potter, an inspiration for the debate, and a man who is frequently chaired—[Interruption.] I mean cheered. If he had stayed on, he would have been chaired. He is frequently cheered from the Conservative Benches. He says:I am sorry to say it but I have given up on this Government.Surely they cannot believe what they are doing is good. If they believe it, then that is another reason not to talk to them …if the election were tomorrow I would not like the Conservatives to win.I agree with him on that. I think that he was speaking for doctors everywhere when he said—[Interruption.] I am sure that he is. Very well, I shall correct that—he is speaking for doctors everywhere but not for Members on the Tory Benches. He said:We are valued less than the managers, boards and authorities put over us, but lions led by donkeys have a habit of eating the donkeys in the end and John Major would do well to remember this.The problem for the Prime Minister is that if things carry on as they are he will he eaten not by the lions but by the donkeys.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Bowis)
Having listened to the hon. Member for Newcastle upon Tyne, East (Mr. Brown), think that we heard a rather better effort from the hon. Member for Renfrew, West and Inverclyde (Mr. Graham), aided by the hon. Member for Liverpool, Garston (Mr. 945 Loyden), in terms of summing up the Labour party's point of view. I suppose that Renfrewshire meeting Welwyn is as good a summing up of the debate as any.
By and large, it has been a good-humoured and sometimes thoughtful debate. We heard a song of pride from the Tory Benches, and occasionally from the Labour Benches—pride in the achievements of our new national health service and in. what the men and women who work in it have done. We heard calls for further progress, and rightly so. We have been pressed to remove the occasional example of poor and even bad practice, and that is right, too. However, the calls from the Tory Benches are made in the knowledge that more is achievable because so much has already been achieved.
I shall deal briefly with some of the points that have been raised. We heard a great deal about political appointments, but I must tell the hon. Member for Newcastle upon Tyne, East that I have here pages of appointees, starting with Audrey Callaghan and including Helene Hayman, Baroness Jay, Brian Stoten, Roy Widdowson and Brian Hanson—I wonder whether they would claim to be card-carrying members of the Conservative party.
In their contributions, the right hon. Member for Derby, South (Mrs. Beckett) and others showed that they did not understand the difference between waiting lists and waiting times. What is important is how long one has to wait for treatment, but we are very much aware of the need to do more, which is why we introduced the patients charter, extending a patient's rights to out-patient appointments. Of course, there was no patients charter of any sort when Labour and the Confederation of Health Service Employees were in power. Then, patients waited longer on every list.
Much has been said about beds which are, of course, important—not just the number but the type, the appropriateness of their use, the management of and advances in beds. I recently opened the first London hospital-at-home scheme and I realised how the bed argument should move forward. The Labour party should examine its record on beds.
Reference was made to mental health. Let us look back to Labour's record on medium secure beds. The Glancy report which called for medium secure beds was published in 1974, but how many were there by 1979? The answer is not one. We now have 1,300 secure and interim secure beds and we shall increase the number this year and next.
We also heard about the supposed privatisation of the health service. Patients want services commissioned by the NHS, but they do not especially mind the status of the provider as long as the provision is good. That is, after all, what they have been used to all their lives. They have been used to receiving such service from their general practitioners because every GP is an independent contractor to the NHS, and the voluntary sector and private nursing homes have long been doing contract work for the NHS, bringing a great quality of service to people in need. The Labour party's ideological slip is showing across the Chamber, perhaps even as a threat to the independence of GPs.
946 If Opposition Members do not want to listen to me, let them listen to Labour's health spokesman in another place, Baroness Jay, who endorsed the market approach to meeting patients' needs and wishes. She said:If patients can be persuaded to treat the health service like a service industry they will naturally expect and insist on high standards of personal care in all things, ranging from good food to single-sex accommodation."—[Official Report. House of Lords, 18 January 1995; Vol. 560, c. 739.]She went on to applaud the contract culture of the national health service, and I applaud her for doing so and hope that the right hon. Member for Derby, South will have a word with her, too.
We have heard a lot about community care. Again, the ideology of hostility to the independent sector, of not listening to the Audit Commission's message that much better use could be made of the independent sector for the benefit of patients, shines through. It is a partnership that we look for in providing community care. That is why we are proud of the partnership between our health service and our social services. That is why we have committed our support, through specific grants for acquired immune deficiency syndrome, drugs and alcohol and for mental illness, and why we have taken that partnership with the voluntary sector through with section 64 funds. I am pleased tonight to be able to announce that we are extending that support by taking section 64 money over £20 million for the first time.
A good and thoughtful speech was made by the hon. Member for Strathkelvin and Bearsden (Mr. Galbraith). It was thoughtfully answered by my hon. Friend the Member for Broxbourne (Mrs. Roe) on behalf of the Select Committee on Health. In many ways, her response answered the hon. Gentleman, and it would not he right for me to pre-empt our careful consideration of her Committee's report. We shall certainly consider it well. What she says is entirely in tune with what we believe.
My right hon. Friend the Member for City of London and Westminster, South (Mr. Brooke) and the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) referred to St. Bartholomew's. As my right hon. Friend said, the consultation is in process. He asked for special care to be taken over the results of that consultation and, of course, we agree to do that. He asked for the preparedness for emergencies in the City to be looked at carefully. That, too, we will do. He paid tribute to the co-operation since the decision on accident and emergency units. I am grateful for his acknowledgement that good can come from change.
The hon. and learned Member for Montgomery (Mr. Carlile) raised a number of issues, including trolleys. Of course, the patients charter goes some way down that line. He referred also to waiting times for out-patients. I have already referred to the patients charter in that role. He referred to whistle-blowing. I hope that he has read carefully the guidance which we have issued to ensure that staff have a route to use.
The hon. and learned Gentleman referred to psychiatric care. Of course he is right that it should not only he supervised discharge. We never suggested that it was. Sir Louis Blom-Cooper said in his report that that was the missing element in our provision and that is why we have come to the House with that measure. The hon. and learned Gentleman is right and I hope that he will acknowledge that we are right in saying that the care programme approach is central to the care of people in 947 the community. Our clinical discharge guidance is central to ensuring that those who need hospital care receive it for as long as they need it and until care in the community is provided.
The hon. and learned Gentleman asked the Labour party questions. I did not hear them being answered, but no doubt he will pursue that mini-duet of a debate at another time. He did not mention much about Liberal Democrat policy, as my hon. Friends have said. I understand that. The one Liberal Democrat policy of which I am aware is the proposal to merge health and local government. As the hon. Member who represents a borough right next to the London borough of Lambeth, the thought that my neighbouring friends in Lambeth may have their hospitals run by Lambeth council is a little startling to me. I suspect that that could be copied around the capital.
§ Mr. Bowis
It is not my local authority. Mine is Wandsworth—a good authority and a good health authority. Authorities are doing their own jobs in their own ways and working and co-operating together. That is not Liberal Democrat policy.
My hon. Friend the Member for Gillingham (Mr. Couchman) made good points about good management of budgets and the need to monitor the fundholding world and to monitor consultants fulfilling their contracts.
The hon. Member for Halifax (Mrs. Mahon) mentioned mixed wards and I replied to her during the debate. She did not like the draft continuing care guidelines. I hope that she likes what she sees in the full guidelines that we shall issue before long.
I shall return to the comments made from the Opposition Front Bench, especially those made by the right hon. Member for Derby, South. We can say tonight, as did Dorothy Parker, that the right hon. Lady ran the whole gamut of her emotions from A to B.
My right hon. and hon. Friends have paid tribute to the NHS and to its year-on-year, day-on-day progress, and their tribute rings true. Why cannot the Opposition bring themselves to salute that progress, too? I do not mean the lip service that they pay to the health service or the genuflection that they make to their Unison bosses; I mean full, whole-hearted, public recognition of the light years of progress that have made since their stewardship of the NHS ended in striking hospital workers, broken promises, broken morale among doctors and nurses, cuts in pay, cuts in health spending and cuts in health investment.
I do not expect Opposition Members to say sorry for their failures in the past. I do not expect them to pay tribute to the Government, who have steered that great service into the waters of success. I want them, just once, to praise the NHS, instead of trying to bury it. If they did that, we would accept their strictures on those rare occasions when someone, somewhere, in one of the biggest enterprises in the world gets something wrong.
When I hear a justified complaint or report, I take it seriously, but I also recall that, each year, there are more than 8 million in-patient treatments, 34 million people receiving out-patient treatments, and 256 million people visiting their GPs. In a year, there are nearly 300 million treatments and visits. That is the context in which the 948 small number of errors takes place. Each and every error is one that we try to put right. Each and every single error is portrayed by the Opposition as typical of the NHS. That attitude does more than anything else to undermine the morale of staff who, all over the country, are dedicated to their patients and to the NHS, and it undermines public confidence, too.
We have heard quotations from the Transport house press cuttings service from the right hon. Member for Derby, South. We had many press cuttings and readings from her, but we do not seem to have heard yet from the letter that she received from a man in Manchester. He wrote:Dear Mrs. Beckett,In any large organisation like the National Health Service there are bound to be one or two mistakes … When you blow those few mistakes out of all proportion, splash them all over the media you can actually change the perception of the Health Service in the minds of the public. That may be very good for your party and for you personally but what does it do for the morale of the people who actually work in the NHS and the people who have to receive the treatment?He went on to give the example of his own excellent treatment in hospital, with the care and attention of people in the service. He said:This kind of service does not happen in an organisation that is falling to pieces or where the staff are totally de-motivated, it can only happen where it is well managed, well funded and well run…I don't expect to hear this matter raised on the floor of the House because it happens thousands and thousands of times every day and you are not interested in what is working well, only in the very few mistakes people make.
§ Mrs. Beckett
That gentleman might have sent a copy of his letter to the Minister, but he has not sent one to me—and, by the way, I do read all my letters.
§ Mr. Bowis
Perhaps that explains why the right hon. Lady has not responded to that man—why he has not had the courtesy of a reply. I am sure that the letter is somewhere in the right hon. Lady's postbag. If she gets her office to work on it, she will have to decide whether to raise that man's testimony on the Floor of the House. I suspect that she will not.
Everything that we have heard from the Labour party today shows that it seeks only to knock the NHS. Knock, knock, who's there? It is the Labour party saying its prayers, longing for disasters and praying for delays.
Let me return to Labour's policies. That is a little difficult to do. We have waited courteously and patiently for the right hon. Lady to master her new brief. We have looked forward to debates and Question Times in which we might see a glimmer of policy emerging from her lips, or even a glint of policy from her eyes. I even combed the right hon. Lady's article today in the Evening Standard looking for policies.
Perhaps the Newcastle minder imposed on her by the Labour leader has not allowed her to come out. Can I persuade her tonight to be brave, and to loosen those apron strings? Will she just say a word about her policies'? Will she tell us a little—not a lot? Will she give us a soupcon, an appetiser, a tantalising and titillating taste of things to come under a Labour Government? Let me tempt her, if such a phrase is not unparliamentary, to give us the Labour policy tune.
We remember a penetrating response from the former Labour leader, who said that where you stand depends on where you sit. So let the right hon. Lady tell it to us from 949 where she sits. Let her perm any two from four. Is the Labour party in favour of NHS trusts? It used not to be, but then it nearly was and now it does not know. Will it keep GP fundholding? It said that it would not, then said it would and now thinks that it will not.
Will the Labour party stick by the pledge of the right hon. Lady's predecessor as health spokesman to raise NHS spending by £6 billion? Is it now £10 billion or £12 billion, or has the computer broken down? If it is any of those figures, how will the Opposition pay for it? The right hon. Lady suggested that no such pledge has been made. I refer her to the pledge of the hon. Member for Sheffield, Brightside (Mr. Blunkett) to spend 7 per cent. of gross domestic product on the NHS—an extra £6 billion.
What about bureaucracy? How many layers are the Opposition planning? There will be Government Departments, regional assemblies, regional health authorities, district health authorities and hospital authorities. If one puts on that many blankets, one will smother the patient. The Opposition policies certainly will not do the NHS much good.
I am not asking for much. If two answers out of four are too much, I shall go for one. Surely to goodness, Alastair Campbell will let the right hon. Lady come out with one policy. Is not the truth that health is the sop to the left? Has not health been given a spokesman of the left, and will not health have policies of the left? We must never forget an early Beckett line:I have my faults, but changing my tune is not one of them.The words are those of Samuel Beckett, but that is the theme song of his namesake who seeks to lead her health troops to the left, left and left again, back to days when the Confederation of Health Service Employees, and not patients, felt comfortable in the NHS.
The record of our health service is the envy of the world. During our stewardship, the facts speak for themselves. The facts are sometimes the statistics of improvements—for example, the fact that, under the new NHS since 1990, the average waiting time for hospital treatment has fallen from nine months to under five months; the fact that the number of those waiting for more than one year for hospital treatment has fallen from more than 200,000 to under 65,000; the fact that NHS hospitals see and treat over 3,000 more patients every day than they did three years ago.
Those are facts, but facts are not just statistics. They are the reality that I see as I go around the country—the children cured of diseases which would have cut short or wrecked their young lives only a few years ago, the young adults helped slowly and painfully back to normal life by drug and alcohol rehabilitation units and the independent living awards which are helping to advance the horizons of technology for people with disabilities. They are the elderly living in a nursing home environment of comfort, care and dignity, instead of a geriatric ward, or those who are able to live in their own homes with a package of care from the health and social services. They are the former residents of antediluvian institutions who are now able to live in sheltered homes in the community.
950 One must talk to families to hear how similar moves have transformed the life of their son or daughter, and how a light in the eyes of someone without articulate speech shows new awareness of the surroundings. The new light shows the happiness within.
That is the health service of which I am proud, the health service to which I feel proud to be able to contribute, as a Minister and the health service on whose behalf I feel angry that all I hear from the Labour party is sniping and carping and not a single word of support. The NHS deserves better than that and better than this negative and nasty Labour motion—it deserves the support of the House and the House's overwhelming support for the amendment.
§ Question put, That the original words stand part of the Question:—
The House divided: Ayes 263, Noes 300.954
|Division No. 59]||[9.59 pm|
|Abbott, Ms Diane||Clwyd, Mrs Ann|
|Adams, Mrs Irene||Coffey, Ann|
|Ainger, Nick||Cohen, Harry|
|Ainsworth, Robert (Cov'ty NE)||Connarty, Michael|
|Allen, Graham||Cook, Robin (Livingston)|
|Alton, David||Corbett, Robin|
|Anderson, Donald (Swansea E)||Corbyn, Jeremy|
|Anderson, Ms Janet (Ros'dale)||Corston, Jean|
|Armstrong, Hilary||Cousins, Jim|
|Ashdown, Rt Hon Paddy||Cunningham, Jim (Covy SE)|
|Ashton, Joe||Cunningham, Rt Hon Dr John|
|Austin-Walker, John||Dalyell, Tam|
|Banks, Tony (Newham NW)||Darling, Alistair|
|Barnes, Harry||Davidson, Ian|
|Barron, Kevin||Davies, Bryan (Oldham C'tral)|
|Battle, John||Davies, Rt Hon Denzil (Llanelli)|
|Bayley, Hugh||Denham, John|
|Beckett, Rt Hon Margaret||Dewar, Donald|
|Beggs, Roy||Dixon, Don|
|Beith, Rt Hon A J||Dobson, Frank|
|Bell, Stuart||Donohoe, Brian H|
|Benn, Rt Hon Tony||Dowd, Jim|
|Bennett, Andrew F||Dunwoody, Mrs Gwyneth|
|Bermingham, Gerald||Eagle, Ms Angela|
|Berry, Roger||Eastham, Ken|
|Betts, Clive||Enright, Derek|
|Blair, Rt Hon Tony||Etherington, Bill|
|Blunkett, David||Evans, John (St Helens N)|
|Boateng, Paul||Ewing, Mrs Margaret|
|Boyes, Roland||Fatchett, Derek|
|Bradley, Keith||Field, Frank (Birkenhead)|
|Brown, Gordon (Dunfermline E)||Fisher, Mark|
|Brown, N (N'c'tle upon Tyne E)||Flynn, Paul|
|Bruce, Malcolm (Gordon)||Forsythe, Clifford (S Antrim)|
|Burden, Richard||Foster, Rt Hon Derek|
|Byers, Stephen||Foster, Don (Bath)|
|Caborn, Richard||Foulkes, George|
|Callaghan, Jim||Fraser, John|
|Campbell, Mrs Anne (C'bridge)||Fyfe, Maria|
|Campbell, Ronnie (Blyth V)||Galbraith, Sam|
|Campbell-Savours, D N||Galloway, George|
|Canavan, Dennis||Gapes, Mike|
|Cann, Jamie||George, Bruce|
|Carlile, Alexander (Montgomery)||Gerrard, Neil|
|Chidgey, David||Gilbert, Rt Hon Dr John|
|Chisholm, Malcolm||Godman, Dr Norman A|
|Church, Judith||Godsiff, Roger|
|Clapham, Michael||Golding, Mrs Llin|
|Clark, Dr David (South Shields)||Gordon, Mildred|
|Clarke, Eric (Midlothian)||Graham, Thomas|
|Clarke, Tom (Monklands W)||Grant, Bernie (Tottenham)|
|Clelland, David||Griffiths, Nigel (Edinburgh S)|
|Griffiths, Win (Bridgend)||Morgan, Rhodri|
|Grocott, Bruce||Morley, Elliot|
|Gunnell, John||Morris, Rt Hon Alfred (Wy'nshawe)|
|Hall, Mike||Morris, Estelle (B'ham Yardley)|
|Hanson, David||Morris, Rt Hon John (Aberavon)|
|Harman, Ms Harriet||Mowlam, Marjorie|
|Harvey, Nick||Mudie, George|
|Hattersley, Rt Hon Roy||Mullin, Chris|
|Henderson, Doug||Oakes, Rt Hon Gordon|
|Heppell, John||O'Brien, Mike (N W'kshire)|
|Hill, Keith (Streatham)||O'Brien, William (Normanton)|
|Hinchliffe, David||O'Hara, Edward|
|Hodge, Margaret||Olner, Bill|
|Hoey, Kate||O'Neill, Martin|
|Hogg, Norman (Cumbernauld)||Orme, Rt Hon Stanley|
|Home Robertson, John|
|Hood, Jimmy||Parry, Robert|
|Hoon, Geoffrey||Patchett, Terry|
|Howarth, George (Knowsley North)||Pearson, Ian|
|Howells, Dr. Kim (Pontypridd)||Pendry, Tom|
|Hoyle, Doug||Pickthall, Colin|
|Hughes, Kevin (Doncaster N)||Pike, Peter L|
|Hughes, Robert G (Aberdeen)||Pope, Greg|
|Hughes, Simon (Southwark)||Powell, Ray (Ogmore)|
|Hutton, John||Prentice, Bridget (Lewisham East)|
|Illsley, Eric||Prentice, Gordon (Pendle)|
|Ingram, Adam||Prescott, Rt Hon John|
|Jackson, Glenda (H'stead)||Primarolo, Dawn|
|Jackson, Helen (Shef'ld, H)||Purchase, Ken|
|Jamieson, David||Raynsford, Nick|
|Janner, Greville||Reid, Dr John|
|Jones, Barry (Alyn and D'side)||Rendel, David|
|Jones, Lynne (B'ham S O)||Robertson, George (Hamilton)|
|Jones, Martyn (Clwyd, SW)||Robinson, Geoffrey (Co'try NW)|
|Jones, Nigel (Cheltenham)||Roche, Mrs Barbara|
|Jowell, Tessa||Rogers, Allan|
|Kaufman, Rt Hon Gerald||Rooker, Jeff|
|Keen, Alan||Rooney, Terry|
|Kennedy, Jane (Lpool Brdgn)||Ross, Ernie (Dundee W)|
|Khabra, Piara S||Ross, William (E Londonderry)|
|Kilfoyle, Peter||Rowlands, Ted|
|Kirkwood, Archy||Ruddock, Joan|
|Lestor, Joan (Eccles)||Sedgemore, Brian|
|Lewis, Terry||Sheerman, Barry|
|Liddell, Mrs Helen||Sheldon, Rt Hon Robert|
|Livingstone, Ken||Shore, Rt Hon Peter|
|Lloyd, Tony (Stretford)||Short, Clare|
|Llwyd, Elfyn||Skinner, Dennis|
|Loyden, Eddie||Smith, Andrew (Oxford E)|
|Lynne, Ms Liz||Smith, Chris (Isl'ton S & F'sbury)|
|McAllion, John||Smith, Llew (Blaenau Gwent)|
|McAvoy, Thomas||Smyth, The Reverend Martin|
|McCartney, Ian||Snape, Peter|
|Macdonald, Calum||Soley, Clive|
|McFall, John||Spearing, Nigel|
|McNamara, Kevin||Spellar, John|
|MacShane, Denis||Squire, Rachel (Dunfermline W)|
|Madden, Max||Steinberg, Gerry|
|Maddock, Diana||Stevenson, George|
|Mahon, Alice||Stott, Roger|
|Mandelson, Peter||Strang, Dr. Gavin|
|Marek, Dr John||Straw, Jack|
|Marshall, David (Shettleston)||Sutcliffe, Gerry|
|Martin, Michael J (Springburn)||Taylor, Mrs Ann (Dewsbury)|
|Marttew, Eric||Taylor, Rt Hon John D (Strgfd)|
|Maxton, John||Taylor, Matthew (Truro)|
|Meacher, Michael||Timms, Stephen|
|Meale, Alan||Tipping, Paddy|
|Michael, Alun||Turner, Dennis|
|Michie, Bill (Sheffield Heeley)||Tyler, Paul|
|Michie, Mrs Ray (Argyll & Bute)||Vaz, Keith|
|Milburn, Alan||Walker, Rt Hon Sir Harold|
|Miller, Andrew||Wardell, Gareth (Gower)|
|Mitchell, Austin (Gt Grimsby)||Wareing, Robert N|
|Moonie, Dr Lewis||Watson, Mike|
|Wicks, Malcolm||Worthington, Tony|
|Wigley, Dafydd||Wright, Dr Tony|
|Williams, Rt Hon Alan (Sw'n W)||Young, David (Bolton SE)|
|Williams, Alan W (Carmarthen)||Tellers for the Ayes:|
|Wilson, Brian||Mr. Jon Owen Jones and|
|Wise, Audrey||Mr. Joe Benton.|
|Ainsworth, Peter (East Surrey)||Delvin, Tim|
|Aitken, Rt Hon Jonathan||Dicks, Terry|
|Alison, Rt Hon Michael (Selby)||Dorrell, Rt Hon Stephen|
|Allason, Rupert (Torbay)||Douglas-Hamilton, Lord James|
|Amess, David||Dover, Den|
|Arbuthnot, James||Duncan, Alan|
|Arnold, Jacques (Gravesham)||Duncan Smith, Iain|
|Arnold, Sir Thomas (Hazel Grv)||Dunn, Bob|
|Ashby, David||Dykes, Hugh|
|Aspinwall, Jack||Eggar, Rt Hon Tim|
|Atkins, Robert||Elletson, Harold|
|Atkinson, Peter (Hexham)||Emery, Rt Hon Sir Peter|
|Baker, Rt Hon Kenneth (Mole V)||Evans, David (Welwyn Hatfield)|
|Baker, Nicholas (North Dorset)||Evans, Jonathan (Brecon)|
|Baldy, Tony||Evans, Nigel (Ribble Valley)|
|Banks, Matthew (Southport)||Evans, Roger (Monmouth)|
|Banks, Robert (Harrogate)||Evennett, David|
|Bates, Michael||Faber, David|
|Batiste, Spencer||Fabricant, Michael|
|Bellingham, Henry||Field, Barry (Isle of Wight)|
|Bendall, Vivian||Fishburn, Dudley|
|Beresford, Sir Paul||Forman, Nigel|
|Biffen, Rt Hon John||Forsyth, Rt Hon Michael (Stirling)|
|Booth, Hartley||Forth, Eric|
|Boswell, Tim||Fowler, Rt Hon Sir Norman|
|Bottomley, Peter (Eltham)||Fox, Dr Liam (Woodspring)|
|Bottomley, Rt Hon Virginia||Fox, Sir Marcus (Shipley)|
|Bowis, John||Freeman, Rt Hon Roger|
|Boyson, Rt Hon Sir Rhodes||French, Douglas|
|Brandreth, Gyles||Gale, Roger|
|Brazier, Julian||Gallie, Phil|
|Bright, Sir Graham||Gardiner, Sir George|
|Brooke, Rt Hon Peter||Gare-Jones, Rt Hon Tristan|
|Brown, M (Brigg & Cl'thorpes)||Garnier, Edward|
|Browning, Mrs Angela||Gill, Christopher|
|Bruce, Ian (Dorset)||Gillan, Cheryl|
|Budgen, Nicholas||Goodlad, Rt Hon Alastair|
|Burns, Simon||Goodson-Wickes, Dr Charles|
|Burt, Alistair||Gorman, Mrs Teresa|
|Butcher, John||Gorst, Sir John|
|Butler, Peter||Grant, Sir A (SW Cambs)|
|Butterfill, John||Greenway, Harry (Ealing N)|
|Carlisle, John (Luton North)||Greenway, John (Ryedale)|
|Carlisle, Sir Kenneth (Lincoln)||Griffiths, Peter (Portsmouth, N)|
|Carrington, Matthew||Grylls, Sir Michael|
|Carttiss, Michael||Gummer, Rt Hon John Selwyn|
|Cash, William||Hague, William|
|Channon, Rt Hon Paul||Hamilton, Rt Hon Sir Archibald|
|Churchill, Mr||Hamilton, Neil (Tatton)|
|Clappison, James||Hampson, Dr Keith|
|Clark, Dr Michael (Rochford)||Hanley, Rt Hon Jeremy|
|Clarke, Rt Hon Kenneth (Ru'clif)||Hannam, Sir John|
|Clifton-Brown, Geoffrey||Hargreaves, Andrew|
|Coe, Sebastian||Harris, David|
|Colvin, Michael||Haselhurst, Alan|
|Congdon, David||Hawkins, Nick|
|Conway, Derek||Hawksley, Warren|
|Coombs, Anthony (Wyre For'st)||Hayes, Jerry|
|Coombs, Simon (Swindon)||Heald, Oliver|
|Cope, Rt Hon Sir John||Heath, Rt Hon Sir Edward|
|Couchman, James||Heathcoat-Amory, David|
|Cran, James||Hendry, Charles|
|Currie, Mrs Edwina (S D'by'ire)||Hicks, Robert|
|Curry, David (Skipton & Ripon)||Higgins, Rt Hon Sir Terence|
|Davies, Quentin (Stamford)||Hill, James (Southampton Test)|
|Day, Stephen||Hogg, Rt Hon Douglas (G'tham)|
|Deva, Nirj Joseph||Horam, John|
|Hordern, Rt Hon Sir Peter||Patten, Rt Hon John|
|Howard, Rt Hon Michael||Pattie, Rt Hon Sir Geoffrey|
|Howarth, Alan (Strat'rd-on-A)||Pawsey, James|
|Howell, Rt Hon David (G'dford)||Peacock, Mrs Elizabeth|
|Hughes, Robert G (Harrow W)||Pickles, Eric|
|Hunt, Rt Hon David (Wirral W)||Porter, Barry (Wirral S)|
|Hunter, Andrew||Porter, David (Waveney)|
|Hurd, Rt Hon Douglas||Portillo, Rt Hon Michael|
|Jack, Michael||Powell, William (Corby)|
|Jackson, Robert (Wantage)||Redwood, Rt Hon John|
|Jenkin, Bernard||Renton, Rt Hon Tim|
|Jessel, Toby||Richards, Rod|
|Jones, Gwilym (Cardiff N)||Riddck, Graham|
|Jones, Robert B (W Hertfdshr)||Rifkind, Rt Hon Malcolm|
|Kellett-Bowman, Dame Elaine||Robathan, Andrew|
|Key, Robert||Roberts, Rt Hon Sir Wyn|
|King, Rt Hon Tom||Robertson, Raymond (Ab'd'n S)|
|Knapman, Roger||Robinson, Mark (Somerton)|
|Knight, Mrs Angela (Erewash)||Roe, Mrs Marion (Broxbourne)|
|Knight, Greg (Derby N)||Rowe, Andrew (Mid Kent)|
|Knox, Sir David||Rumbold, Rt Hon Dame Angela|
|Kynoch, George (Kincardine)||Ryder, Rt Hon Richard|
|Lait, Mrs Jacqui||Sackville, Tom|
|Lamont, Rt Hon Norman||Sainsbury, Rt Hon Sir Timothy|
|Lang, Rt Hon Ian||Scott, Rt Hon Sir Nicholas|
|Lawrence, Sir Ivan||Shaw, David (Dover)|
|Legg, Barry||Shaw, Sir Giles (Pudsey)|
|Leigh, Edward||Shephard, Rt Hon Gillian|
|Lennox-Boyd, Sir Mark||Shepherd, Colin (Hereford)|
|Lester, Jim (Broxtowe)||Shepard, Richard (Aldrige)|
|Lidington, David||Shersby, Michael|
|Lightbown, David||Sims, Roger|
|Lilley, Rt Hon Peter||Skeet, Sir Trevor|
|Lloyd, Rt Hon Sir Peter (Fareham)||Smith, Tim (Beaconsfield)|
|Lord, Michael||Soames, Nicholas|
|Luff, Peter||Spencer, Sir Derek|
|Lyell, Rt Hon Sir Nicholas||Spicer, Sir James (W Dorset)|
|MacGregor, Rt Hon John||Spicer, Michael (S Worcs)|
|MacKay, Andrew||Spink, Dr Robert|
|Maclean, David||Spring, Richard|
|McLoughlin, Patrick||Sproat, Iain|
|McNair-Wilson, Sir Patrick||Squire, Robin (Hornchurch)|
|Madel, Sir David||Stanley, Rt Hon Sir John|
|Maitland, Lady Olga||Steen, Anthony|
|Major, Rt Hon John||Stephen, Michael|
|Malone, Gerald||Stern, Michael|
|Mans, Keith||Stewart, Allan|
|Marland, Paul||Streeter, Gary|
|Marlow, Tony||Sumberg, David|
|Marshall, John (Hendon S)||Sweeney, Walter|
|Marshall, Sir Michael (Arundel)||Sykes, John|
|Martin, David (Portsmouth S)||Tapsell, Sir Peter|
|Mates, Michael||Taylor, Ian (Esher)|
|Mawhinney, Rt Hon Dr Brian||Taylor, John M (Solihull)|
|Mayhew, Rt Hon Sir Patrick||Taylor, Sir Teddy (Southend, E)|
|Mellor, Rt Hon David||Temple-Morris, Peter|
|Merchant, Piers||Thomason, Roy|
|Mills, Iain||Thompson, Patrick (Norwich N)|
|Mitchell, Andrew (Gedling)||Thornton, Sir Malcolm|
|Mitchell, Sir David (NW Hants)||Thurnham, Peter|
|Moate, Sir Roger||Townsend, Cyril D (Bexl'yh'th)|
|Monro, Sir Hector||Tracey, Richard|
|Montgomery, Sir Fergus||Tredinnick, David|
|Moss, Malcolm||Trend, Michael|
|Needham, Rt Hon Richard||Trotter, Neville|
|Nelson, Anthony||Twinn, Dr Ian|
|Neubert, Sir Michael||Vaughan, Sir Gerard|
|Newton, Rt Hon Tony||Viggers, Peter|
|Nicholls, Patrick||Waldegrave, Rt Hon William|
|Nicholson, David (Taunton)||Walden, George|
|Nicholson, Emma (Devon West)||Walker, Bill (N Tayside)|
|Norris, Steve||Waller, Gary|
|Onslow, Rt Hon Sir Cranley||Ward, John|
|Opoenheim, Phillip||Wardle, Charles (Bexhill)|
|Page, Richard||Waterson, Nigel|
|Paice, James||Watts, John|
|Wells, Bowen||Winterton, Mrs Ann (Congleton)|
|Wheeler, Rt Hon Sir John||Winterton, Nicholas (Macc'f'ld)|
|Whitney, Ray||Wolfson, Mark|
|Whttingdale, John||Wood, Timothy|
|Widdecombe, Ann||Yeo, Tim|
|Wiggin, Sir Jerry|
|Wilkinson, John||Tellers for the Noes:|
|Willetts, David||Mr. Sidney Chapman and|
|Wilshire, David||Mr. Timothy Kirkhope.|
§ Question accordingly negatived.
Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments) and agreed to.
Question accordingly agreed to.
MADAM SPEAKER forthwith declared the main Question, as amended, to be agreed to
That this House congratulates National Health Service staff in hospitals and in the community for providing ever more and better care for patients with 122 patients being treated for every 100 four years ago; welcomes the health reforms which have provided a coherent structure to enable them to do so; recognises the challenges faced by the National Health Service resulting from medical advance, the ageing of the population and rising public expectations and believes that the new National Health Service is better placed than ever to meet these challenges; welcomes the 68 per cent. real terms increase in National Health Service spending since 1978–79 and the Government's manifesto commitment to further real terms increases; and condemns Her Majesty's Opposition for its ill-thought-out commitment to abolish the reforms, an act which would inflict chaos and confusion on the health service, deprive patients of the benefits of National Health Service Trusts and general practitioner fundholding and prevent the health service from responding to the changing needs of the public.