Health Care

Mrs. Margaret Beckett (Derby, South)

I beg to move, That this House shares with the public, with patients and with health care professionals, growing alarm at the incremental erosion of the public service ethos upon which the National Health Service was founded; rejects the drive to replace the cherished principles of public ownership, co-operation and fairness with private markets, excessive bureaucracy and inequity; calls for a slowing down of the passion for reorganisation; and urges that change in the NHS be based on health arguments, not financial considerations.

Madam Speaker

Order. I have selected the amendment standing in the name of the Prime Minister.

Mrs. Beckett

The debate is taking place at a time when Ministers have been squabbling among themselves, while in the country at large there is concern that the policies that the Government pursue are neither what the country needs nor what its people want. In no area of policy is that shown more clearly than in the health service, where there is growing alarm at the way in which co-operation and fairness in the delivery of health services are being displaced by competition and bureaucracy, and at the way in which the Government openly use the private finance initiative to privatise core clinical services.

There is little doubt that we shall again hear from the Secretary of State not only that the fears that we express are unfounded but that in holding them, the Labour party stands entirely alone. Unfortunately for the Secretary of State, our debate coincides with the annual conference of the British Medical Association. In a sermon on the eve of that meeting, the Bishop of Ripon attacked the Government's so-called reforms for fragmenting the health service and encouraging confrontation within it, and suggested that their dependence on the market and competition struck at the root of the principle of caring.

This morning, Dr. Macara, the chairman of the BMA council, addressed the conference and spoke of the dismantling of the NHS—and the creation of a grim game of winners and losers. Over the weekend yet another senior clinician, the orthopaedic surgeon Professor Colton—who, like all too many doctors these days, is taking early retirement, in his case at the age of 55—said that many of the reforms had more to do with politics than with patient care. He pointed out that he had received a £20,000 bonus for treating fewer patients—in fact, for having had a children's clinic closed for four months because that closure meant that all his patients were treated in times that met the citizens charter targets. He was paid for seeing fewer people. That puts into context the barrage of statistics with which the Secretary of State will no doubt again bombard the House.

Those are not the only voices raised in concern.

Mr. Jacques Arnold (Gravesham)

Will the right hon. Lady give way?

Mrs. Beckett

I shall give way in a moment. I am about to come to something very pertinent to the hon. Gentleman.

24 Some of the criticisms that we make, such as excessive bureaucracy, sweeping and sometimes ill-founded structural and organisational change, have been echoed in the ranks of the Government. The final words of our motion echo the words of the right hon. Member for Wokingham (Mr. Redwood)—and from before he left the Cabinet.

Mr. Arnold

Does the right hon. Lady really mean that she, in order to prove a point, would have been happy for patients' treatment to have been spread out through the year so that they would have had to wait longer? Surely it was in the interest of those patients to be seen early and well within the time scale that has been required by my right hon. Friend the Secretary of State for Health?

Mrs. Beckett

The hon. Gentleman has entirely missed the point. The professor was saying that his clinic was closed; he was not allowed to treat people. As a result of not treating people, the few people whom he did see were dealt with within the Secretary of State's target time. In consequence, he got a £20,000 bonus, which he thought was money misplaced. He saw fewer people than he could have seen had he been allowed to go on treating patients. That is what happens under the Government's reforms. It is not what is supposed to happen.

Mr. D. N. Campbell-Savours (Workington)

As the hon. Member for Gravesham (Mr. Arnold) contests the point, and as my right hon. Friend has raised an extremely interesting case, perhaps during the next four hours the Government could inquire about what happened and give us an explanation in the winding-up speech. We would all, including the hon. Member for Gravesham, like to know what happened.

Mrs. Beckett

I am confident that the Secretary of State will be able to explain it to us. It was announced at the weekend, so she will have had the opportunity to make her own inquiries.

I have no doubt, however, that the fundamental direction that the health service would take under the right hon. Member for Wokingham is exactly the policy followed by the Secretary of State. His policy is also privatisation, as he first made clear back in the 1970s when he spelt it out explicitly in a joint publication with Oliver Letwin, and it is a direction confirmed by his record in Wales.

To be fair, the right hon. Gentleman was approaching the medium to long-term project of privatising the health service with rather more political subtlety than the Secretary of State. As he made clear to the Welsh Select Committee, he seems genuinely able to see something that the Secretary of State apparently cannot—that the Government's plans for the health service are going visibly wrong, and he has enough wit to say so.

In the BMA News last August, the right hon. Member for Wokingham said—

Dame Elaine Kellett-Bowman (Lancaster)

Will the right hon. Lady give way?

Mrs. Beckett

In a moment; I am in the middle of a sentence. The right hon. Gentleman said that he was not mad keen to cut hospital beds. It's not politically popular". 25 I now give way to the hon. Member for Lancaster (Dame E. Kellett-Bowman), who perhaps does not share that view.

Dame Elaine Kellett-Bowman

Is the right hon. Lady aware that the ex-Secretary of State for Wales reduced the number of bureaucrats in the health service in Wales by only 340, which is a smaller proportion than that by which my right hon. Friend the Secretary of State for Health has reduced the number of bureaucrats in the health service in England?

Mrs. Beckett

I am grateful to the hon. Lady. If she will allow me to continue, I am pointing out that there is some contradiction between what the right hon. Gentleman said and what he has done.

Dame Elaine Kellett-Bowman

Absolutely. Down with him.

Mrs. Beckett

I can without difficulty detect that the hon. Lady does not intend to offer her support to the right hon. Gentleman in the contest.

I was pointing out that the right hon. Gentleman has rather more sense than the Secretary of State for Health and knows when to keep quiet. Perhaps even more startling is his apparently unique perception among Cabinet Ministers that it would be important not to reduce the number of a beds to a point where there are not enough. That is an insight which has so far escaped the Secretary of State for Health.

The right hon. Gentleman can see that the Secretary of State's proposals for grand solutions and the closure of popular hospitals are deeply angering the public, something that she apparently cannot see. He is sharp enough to spot that the public are deeply disillusioned with Tory commitments that the NHS is safe in their hands.

The Welsh NHS has not adopted the Secretary of State's star rating system now in place in England because the right hon. Member for Wokingham said that quality is very important but it's harder to measure than factors such as numbers treated and cost. He also believes that tables are crude and simplistic.

As I said, the right hon. Gentleman knows when to keep quiet especially if, by not doing so, he would jeopardise his long-term project, which is also that of the Secretary of State—privatisation of the NHS. Therefore, when the private sector bid for a new cardiac centre at the Morriston hospital in Swansea proved uncompetitive and the bid went to the in-house team, the right hon. Gentleman said nothing, refraining even from reporting the outcome to the House.

In spring 1994, the then Secretary of State for Wales announced that the National Blood Transfusion Service would be market-tested and then, this year, he announced that, on the contrary, it would remain within the Welsh Health Common Services Authority. Sadly, the Secretary of State for Health does not know when she has gone too far. She knows neither when to keep quiet nor when to give way, gracefully or otherwise. Although the right hon. Gentleman can see when the Government are mishandling the NHS debate, there is no doubt that he shares the objective of privatisation, except that he would have undertaken it more quickly and more ruthlessly.

26 The right hon. Gentleman has railed against the growing number and cost of non-clinical staff in the health service but appointed an accountant to chair the WHCSA. He supports performance-related pay, which would demoralise staff and set one against another. In Wales, as in England, NHS services have already been market-tested, including clinical services such as blood culture management, dental services, pathology and pharmacy. In most parts of Wales, NHS dentistry has been allowed to wither away as it has elsewhere in England and, while the right hon. Member for Wokingham believes that the Secretary of State should keep popular hospitals open in England, he has refused to support the reprieve of what I am told is Wales' most popular hospital—Cardiff royal infirmary—whose services are being run down.

Since 1991, 6 per cent. of acute beds have been lost in Wales, the same percentage as have been lost in England. Since 1992 the number of managers in the Welsh health service has risen from 890 to 1,330. The right hon. Member for Wokingham claims that he would spend more on the NHS, but in 1993–94 the Welsh Office underspent on health to the tune of almost £30 million. In short the right hon. Member for Wokingham is a little less hamfisted in his public pronouncements than his colleagues at the Department of Health, but he is just as committed to the privatisation of the NHS—

Mr. Dennis Skinner (Bolsover)

The Secretary of State has said that she would work for him.

Mrs. Beckett

As my hon. Friend the Member for Bolsover (Mr. Skinner) says, no doubt that is why the Secretary of State has said that she would be happy to work with him.

The Minister for Health (Mr. Gerald Malone)

Will the right hon. Lady give way?

Mrs. Beckett

No, I will not give way to the Minister. He will have plenty of time to speak later.

The right hon. Member for Wokingham is just as committed to privatisation as he is to the long-term project of ensuring that the NHS no longer provides comprehensive health care for all our people but will instead becomes a small core means-tested service for those who cannot afford any private health care. The Secretary of State and the right hon. Member for Wokingham are clearly at one. It appears that the Tory party is faced with no choice at all.

Mr. Michael Fabricant (Mid-Staffordshire)

It is all very well for the right hon. Lady to carp about the health services that are being provided by the Government, but has she set any standards for the number of patients that she would treat if the reforms were carried out? To what extent would waiting lists be reduced? Can the right hon. Lady quantify the result of her intended reforms compared with those that we have already made?

Mrs. Beckett

I am not aware that the Government have ever tried to quantify in advance the results of their changes. I and most people in the health service believe that if the policies that we advocate were adopted as opposed to the ones that the hon. Gentleman and his party support, NHS staff morale would be far better, services would be far better delivered, and patients would benefit as a result. When a Labour Government assess the 27 delivery of health care, we shall certainly not count finished consultant episodes but we shall count what actually happens in the treatment of patients.

While the Tory party is apparently not faced with any choice, the British people have a stark choice—privatisation under the Conservatives or modernisation of the health service under Labour. Under the Conservatives there have been disasters such as the one described last week by at least one newspaper as a "bloody shambles". That of course refers to the shambles that was caused when operations were cancelled after 15 per cent. of the country's blood supplies were recalled by the National Blood Authority because of a fault in a number of blood bags. As the authority's minutes show, it made a policy decision to buy a proportion of its bags from a new supplier, first and specifically to get them at lower cost and, secondly, to introduce competition to the supply, a policy that the Government are always urging.

The debacle that has followed is alarming in itself but it contains a number of striking ironies. For example, the fault was detected by staff at the centre in Oxford, which is threatened with closure in the reorganisation. Those donors who were called in to provide emergency supplies were called to centres such as that at Brentwood which are also threatened with closure because the National Blood Authority says it does not need them any more. Another irony, which I think is unintended, was contained in remarks by the authority's spokesperson, who said that the incident showed that the authority was right to bring in the new company because it was evidently dangerous to rely on one supplier. But the danger arose as a direct result of bringing in a new company, solely to lower costs and introduce competition.

Last week's problems are not isolated examples. Blood stocks were already low: they had been below the safe recommended level for four days. Stocks of O-negative had been below the safe recommended level for 11 consecutive days. That was a result of the worry and the low morale in the service and among donors following the National Blood Authority's recent proposals. All those problems arose before the most recent problem caused the fresh destruction of stocks.

Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

There is clear evidence that, before any decision is made in the House, this quango will proceed with the appointment of a vast number of administrators. Instead of using its existing centres to continue and expand its service, it is causing chaos.

Mrs. Beckett

I share my hon. Friend's view. No doubt she, like me, hopes that the Secretary of State will come to the House before the summer recess to tell us what decisions have been made about the National Blood Authority's proposals, and what progress there has been—and also hopes that the suspicion that has arisen in the service that the Government intend to postpone any announcement until the House has risen for the recess will prove ill founded.

Operations have been cancelled as a result of the problems that we have identified, but that too is not an isolated occurrence. The most recent figures show that the number of cancelled operations rose by 22 per cent. in the last quarter of 1994–95, and that the number of patients not readmitted within a month rose by nearly 50 per cent.

28 Those specific examples of more dramatic problems are only part of a general catalogue of difficulties in the service.

Nor are the moves towards privatisation occurring in isolation. I wonder how many hon. Members have seen brochures such as the one from SMI, which advertises a conference to be held in September this year.

The conference, entitled "Private Finance in Clinical Services", has been called to "assess" the moves towards private finance in core and clinical services". The brochure suggests that the private finance initiative involves a complete culture change, creating entirely new markets", and states that Health authorities … are about to look increasingly to the private sector … to manage pathology and core health services". I also have a copy of The Link, the staff newspaper for the Royal Hospitals NHS trust. It contains an article by the head of financial planning, one Mr. Sanford, who writes about the private finance initiative. He says: In all private finance deals the private sector partner will plan to earn enough income from the NHS to make a profit and cover the cost of its investment.

Mr. Malone

What a surprise.

Mrs. Beckett

It is not a surprise to us that the private sector will want to make a profit out of health care; that is why it exists. What we object to is that it should be making that profit, rather than our public and free national health service.

What may, or should, be of rather more interest to hon. Members who care about public finances is that Mr. Sanford also says: So often it may be difficult to demonstrate better value for money through the private sector's involvement. He goes on to suggest a number of ways in which the extra cost of borrowing from the private sector could be offset. His basic pitch is that, whether in laser surgery or pathology, the private sector will hope to cover the initial investment with income from the health service, and to make large profits out of the potential for private patient income. In the case of pathology, however, Mr. Sanford suggests that the private sector would gain through its profit on the sale of tests from a private sector service to NHS hospitals.

So there we have it: a finance director and specialist explains that it may not be possible to demonstrate better value for money from the private finance initiatives being used for clinical services, although they will certainly be used to generate profits. That may be the Conservative party's project, but it is not what the health service needs or what the country wants.

The Government try to pretend that their policies are right and successful, and that there is no alternative. None of those propositions is true. There is an alternative—in public health policy, for example. There appears at first to be some common ground between the Labour party and the Government, in our recognition of the importance of promoting good health rather than merely curing ill health; but, as always with this Government, the policy is flawed. Their first concentration is solely on the individual. It is up to him to eat sensibly, to keep warm in winter, and not to smoke, but the Government refuse to acknowledge their responsibility, the role of public policy, or the harmful effects on health—let alone on the ability of the individual to carry out those exhortations— 29 of unemployment, bad housing, environmental pollution or poverty. Of course, when it comes to a choice between promoting good health by banning tobacco advertising, and the financial interests of the Conservative party, there is just no contest. A Labour Government would take action at national and local level to tackle such problems, insisting that Government Departments and local authorities alike assess and report on the impact of their policies on health.

We propose alternatives too for health care itself—nothing less than the renewal of health care, national in scope and run as a modern public service, not as a set of individual private businesses. With Labour, the national health service would be a single organisation, its assets owned and its staff employed by the nation. We would replace competition with co-operation, and we see all engaged in the service as partners. Doctors, nurses, professions allied to medicine, accountants, staff, managers, the patients, the public, their representatives—all are or should be health partners in a new health service.

The internal market depends on contracts and on competition. It is divisive, expensive and bureaucratic. We would replace it with a system in which funding came from the Department of Health to health authorities and, through them, to general practitioners and the organisations now known as trusts. That funding would flow to health authorities on the basis of weighted capitation.

The new health authorities will be required to assess the health needs of the population whom they serve, commission care and monitor overall service delivery through comprehensive and long-term health care agreements, covering the range of services required to specified quality and volume within a fixed budget.

Mr. Peter Bottomley (Eltham)

I may have misheard, but I think that I heard the right hon. Lady say that everyone in the national health service would be employed directly by the NHS. Does that mean that general practitioners would lose their self-employed status and become salaried family doctors?

Mrs. Beckett

No. What I am saying is that the staff who are employed in hospitals and other trusts would be employed within the NHS, not within individual businesses, as they are at present. I am sure that the hon. Gentleman understood that that was the proposal.

Mr. Keith Mans (Wyre)

That is not what the right hon. Lady said.

Mrs. Beckett

If I can correct the hon. Gentleman, who is interrupting from a sedentary position—I am sorry but I have forgotten his constituency—[Interruption.] No, I am not worried about it: the hon. Member for Wyre (Mr. Mans) may not be representing it for long. What I said was that all staff will work within the NHS, which they all do.

As these new authorities will have a greater range of responsibilities than the individual bodies that they replace, and as we believe that they should give greater attention to the area and to the policies of public health, we do not believe that it is right for those authorities, as was the case with those that they will replace, directly to manage the services that deliver health care. Although the trusts would cease to be separate businesses, and their assets would be owned by a national health service, with Labour, hospital and other trust services would have 30 day-to-day financial and managerial independence, and would be free to make day-to-day decisions about how they delivered the care commissioned.

The authorities and services would have governing bodies reconstituted to reflect the interests of stakeholders, and within the guidelines of the Nolan committee. They would be reconstituted to include representatives of the health partners—staff, managers, the local community, service users and so on.

The hon. Member for Eltham (Mr. Bottomley) raised the question of GPs. Again, the House will know that we opposed the creation of GP fundholding on the grounds that it fragmented the health service, added to costs and could lead to a two-tier system. All those concerns, I am sorry to say, proved to be well founded in practice.

Fundholding is one end of a spectrum that we find unacceptable, but so is the extreme alternative: a system of health authority commissioning without any consultation or without the involvement of general practitioners or others in primary care. We find both of those extremes completely unacceptable, but between them there is a range of possibilities and models for GP commissioning that could be acceptable.

In the policy document that we published last week, we identified a number of examples of such models being developed at the grass roots by GPs working in concert with their health authorities. We would find many of those varieties acceptable, but there is one absolutely clear bottom line that must be present in every scheme or model, but which is not present in the model proposed by the Government—that what is good about the provision of primary care must be available to every GP and, through him, to every patient.

With Labour, GP fundholding will be replaced by a system aimed to benefit all patients, not just a few. Every GP will have the opportunity to take part in the commissioning of care. Every GP will have the freedom, at present exercised only by fundholders, to refer hispatient to whatever service and for whatever treatment he believes can best provide the necessary care. Those matters are essential to the provision of a renewed health service that will establish and stand by the principles that the British people expect.

In our proposals for health care, we do not seek to turn back the clock—as the Secretary of State, on automatic pilot, automatically assumed and asserted. However, nor do we suggest that the health service can stay as it is, and certainly not that it should continue to head in its current direction towards privatisation.

In our new document, we identify the stark choice before the British people. They can choose a truly national health service, available to all and based on need rather than ability to pay, or they can choose a fragmented collection of health businesses, increasingly dominated and driven by the interests of commerce. They can choose the competition of the marketplace or the co-operation of a single national health service. They can choose between a privatised health service under the Conservatives or a modernised health service with Labour.

This week, the Conservative party is making a choice which is no choice, between two people bound to the same policies. We believe that it is time for Britain to choose and that that choice should be for a new Government and for a new health service in a new century.

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: notes that since the introduction of the Government's health reforms, over one million more patients are treated in hospital every year and waiting times have fallen to the lowest on record; welcomes the Government's commitment to a strong and stable publicly-funded NHS where trusts and general practitioner fundholders are free to build further on these achievements; and condemns the inadequate, inconsistent and incoherent policies of Her Majesty's Opposition, which would destroy the key features of the new NHS, would undermine patients' interests and would throw into reverse the progress of recent years.". We have just heard a speech of incoherence and emptiness, which was soporific most of the time and which did not adequately answer the questions that the public and the Conservative party wanted the right hon. Member for Derby, South (Mrs. Beckett) to answer.

Dame Elaine Kellett-Bowman

My right hon. Friend is too generous.

Mrs. Bottomley

I apologise for being far too generous.

There was a moment when I wondered whether the right hon. Lady's speech had been drafted in Cowley street, but we moved on from that point. The underlying theme of her speech, apart from her clear and profound discomfort about the health policy that has been foisted on her, was a real loathing of the private sector and the profit motive. The Conservative party knows that only by having a wealth-creating nation can we adequately fund a national health service. The difficulty for the Labour party is that it has never really understood wealth creation and job creation, which provide the fundamental key to a flourishing health service.

Mrs. Dunwoody

rose—

Mrs. Bottomley

I hope that you, Madam Speaker, will not mind if I make a little progress before giving way.

Last week, the Health Authorities Act gained Royal Assent. That landmark legislation completes the structural reforms for the national health service. It abolishes the regional health authorities and creates fewer, better, all-purpose health authorities at local level to plan the entire range of health services. The Act is the culmination of a long path of health reforms.

The National Health Service and Community Care Act 1990 established the basic geography of the new health service—NHS trusts, general practitioner fundholders and the internal market, all aimed to achieve improvements in performance and efficiency. Underpinning the reforms is the principle that the decision should be taken as close as possible to patients. Underpinning the words of the right hon. Member for Derby, South is the principle of a command and control economy, with everything being decided in Whitehall. The regional health authorities had to go. They represented the last bastion of that old structure so favoured by the Labour party.

National health service trusts have freedom to run their own affairs. They can control their assets, their organisation, and—increasingly—their greatest item of cost: pay. The Labour party claims with every passing 32 soundbite that it does not want to turn the clock back, yet it would strip trusts of those powers. Trust freedoms are not simply abstract concepts: they work for patients.

Since we liberated trusts from the straitjacket of central control, the number of patients treated every year has increased by well over 1 million. [Interruption.] It is very interesting that, whenever we talk about the numbers of patients treated, the Labour party loathes it. It dismisses fact and statistics. It simply likes to cobble together newspaper cuttings from the inevitable examples where, from time to time, things do not work as well as they should.

Mr. William O'Brien (Normanton)

I am grateful to the Secretary of State for allowing this intervention. Since she is referring to trusts and their work, will she address a situation on 7 June involving a constituent of mine? His doctor applied to admit him to Pinderfields general hospital in my constituency and was told that no beds were available. When a bed was arranged at Dewsbury district hospital, my constituent was told that no ambulances were available. How does the Secretary of State intend to deal with the situation under independent trusts? Will she hold an inquiry to find out why that incident was allowed to occur?

Mrs. Bottomley

If the hon. Gentleman had wanted a detailed answer, he would have given me notice of the question. I shall, of course, come back to him on the detail of that particular case.

There is no health service anywhere in the world where from time to time individual cases are not treated less well than one would have hoped. Nearly always, behind the headlines so sought by the Labour party—food and drink to its debates—there are far more complex and detailed aspects, very often involving confidential information about patients or clinical staff. [HON. MEMBERS: "That is rubbish."] If I may, I shall take, for example, the case of Professor Colton raised in the debate.

The House will have heard about Professor Colton and his decision to spend his time in the independent sector in Switzerland. It was the case that they decided at his clinic not to accept elective, non-urgent cases for a limited period. That was because, at that time, 242 out-patients were waiting a maximum of 56 weeks for treatment. At the end of that programme, 22 out-patients were waiting a maximum of four weeks, and they now offer an orthopaedic service for children, delivering a quality of care of which I, as Secretary of State, am happy to be an advocate. They were quite right to take that necessary short-term decision so that all patients could receive a standard of care.

Labour simply does not care—

Several hon. Members

rose—

Mrs. Bottomley

No, I will not give way.

Labour does not care about the detail. It simply wants mischievous interpretation. That is only too clear because it is quite unable in any way to undermine evidence that the people of this country now receive a better service than at any stage in the history of the health service.

Several hon. Members

rose—

Mrs. Bottomley

I am not giving way. I have a short amount of time. [Interruption.] The debate is limited, and I gave strict undertakings to my hon. Friends not to over-speak.

33 Apart from the 1 million more patients treated every year since the reforms, we have also put into the hands of doctors, nurses, managers and staff working in hospitals the ability to slash waiting times overall. The average waiting time is now—

Mr. Alex Carlile (Montgomery)

On a point of order, Madam Speaker. Is it the procedure of the House, and therefore in order, to refuse interventions on the ground of undertakings given only to Members of one's own party?

Madam Speaker

As the hon. and learned Gentleman knows, it is up to the hon. Member who has the Floor to decide whether to give way. It is certainly up to the Secretary of State to determine whether she will take interventions. She appears to want not to do so, but to make some progress for the moment.

Mrs. Bottomley

I have already taken interventions. I noticed that the right hon. Member for Derby, South refused to allow an intervention even from my hon. Friend the Minister for Health.

Mr. Carlile

Will the Secretary of State give way?

Madam Speaker

Order. The hon. and learned Gentleman must not insist; the Secretary of State has made her position quite clear. I shall do my best to call the hon. and learned Gentleman; he may like to make his point then.

Mr. Skinner

He is the only Liberal Democrat in the building.

Mrs. Bottomley

True. I want to proceed with my speech, but I shall try to find time to give way when I have made a little more headway.

Waiting times have been slashed to the lowest levels ever recorded. Clinics that were previously open on a strictly nine-to-five basis now open in the evenings or at weekends. Requests for help that previously met with the slamming of glass partitions are now handled with courtesy and speed. Where once 20 people were given a 9 o'clock appointment and then had to wait all morning, individual appointment times are now the rule.

I must make it clear to the House that survey after survey of the patients who use the NHS endorses their enthusiasm and appreciation of the service they have received, and shows that their confidence in the service is growing. I find it extraordinary that the Labour party, whenever the achievements of health service staff are pointed out, sneers at and denigrates that work.

Mr. Nigel Spearing (Newham, South)

Will the right hon. Lady give way?

Mrs. Bottomley

Even more achievements have been documented in the latest figures. In the year to March 1995, the number of patients waiting for more than a year for in-patient treatment fell by a half. That matters to patients. The new figures for out-patient waiting time show that 82 per cent. of patients were seen within 13 weeks, and that 95 per cent. were seen within 26 weeks. We are on course to meet the new patients charter target for out-patient waits that I announced earlier this year. That matters to patients and it is an achievement by the staff.

I can tell the right hon. Member for Derby, South that the league tables coming out later this month will again show that the NHS is becoming ever more efficient and 34 responsive to patients. The Labour party sneers at and denigrates the remarkable document setting out the achievements throughout the country.

Mr. Spearing

Does the Secretary of State agree that what she has just said does not apply to the ambulance service, as is shown by the report from the Select Committee on Health? If, after nine debates:in the House, the ambulance service was not provided with what the Government eventually thought was necessary—they had given £5 million extra in 1991, and they gave £14 million extra last year—how can the Secretary of State say that the Government have calculated the real needs of the health service as a whole? If they got it wrong with the London ambulance service after nine debates in the House, how do we know that they will get it right for the country as a whole?

Mrs. Bottomley

Our Government are committed to making information public and available. There has been a transformation in the amount of information that people have on the performance of ambulance trusts and health services throughout the country. It is precisely by making such information available that we can lever up standards.

The hon. Gentleman is, however, right about the London ambulance service; he and I have spoken at great length about that service, and about its long-standing management and trade union problems. My hon. Friends are only too well aware that the London ambulance service is not an NHS trust. It is a sign of old-style health services and not of the way in which we want to manage health services for the future.

The Labour party claims that trusts would remain, but that they would be called local health services.

Mr. Nicholas Brown (Newcastle upon Tyne, East)

Will the Secretary of State give way?

Mrs. Bottomley

Is the Labour party really saying that all it has to show for five years of consultation, deliberation, effort and thought is simply a new name? Oh, no: the plan of the right hon. Member for Derby, South is much more sinister than that. She has already told the House that she thinks that trusts are an abomination. The truth behind her document is that NHS trusts would go. The right hon. Lady wants to take away their assets and freedoms. She aches to get back to the old regional health authorities with their web of committees, bureaucracy and grind. [Interruption.] The hon. Member for Bolsover (Mr. Skinner) agrees.

The Opposition voted against the Health Authorities Act at every stage, and they voted against the abolition of the regions that will save £150 million on administration to spend on patients. The difference between our parties is that the Labour party would pay the pen-pushers and bureaucrats, while we fund the front-line staff and the managers whom the Opposition never avoid denigrating.

The right hon. Lady should be aware that we know the offence she has caused to many in her party who are public servants working in the NHS as managers, and the work of the right hon. Lady and the leaders of her party in constantly denigrating the achievements of those managers is a subject that every Government Front-Bench spokesman has heard time and time again.

35 The right hon. Lady would have national pay, although someone—doubtless from the Leader of the Opposition's office—went over her head and inserted the meaningless words "with local flexibility". No wonder Bob Abberley, whose union Unison helps to pay the right hon. Lady's costs, welcomes her proposals. If the Labour party were ever in government again, it is clear that negotiations with the management side would be extremely difficult, as the management side would have one arm held behind its back by the very people for whose benefit it was negotiating.

Until the Labour party renounces the sponsorships of its Front-Bench spokesmen by the health unions, it will never have any credibility. As for the Labour party's acceptance of research costs being paid for by the health unions, I think that that is an absolute outrage, and the public will increasingly think that also.

One of the advantages of local pay is that it will take pay bargaining out of the national political arena and place it within trusts, closer to patients and focused on patient needs. Staff can and will benefit. Pay and conditions determined according to local circumstances can reinforce teams within trusts. Trusts can design packages for their staff to replace the bewildering array of national terms and conditions that currently exist.

I was pleased that the Royal College of Nursing and the Royal College of Midwives last week accepted the principle of local pay, and they have agreed to start negotiating locally this year. I hope that other unions will see sense and follow their good example, so that we can put this unnecessary dispute behind us.

I am tempted to speculate as to why we are having this debate. Is it the right hon. Lady's chance to put her spin on Labour policies? It must have been galling for the right hon. Lady on Thursday to see her policies being given the soft soap treatment by the Leader of the Opposition. Even as best supporting roles go, I think that the right hon. Lady will be pipped for an Oscar by my hon. and multi-coloured Friend the Member for Northampton, North (Mr. Marlow). Against a delicate pastel background, the Leader of the Opposition put his pastel spin on her policies, but green was closer to the colour with which I would associate the right hon. Lady.

The Labour party has assured us that it will keep the good elements of the Conservative health reforms. Is it turning the clock back? Heavens, no. The Labour party believes in continuity, progress and—above all—nicking good Conservative policies. The Labour party would renationalise the NHS—a meaningless piece of rhetoric. The spectre of privatisation was, as ever, waved about as the last bullet in the Labour party's threadbare locker.

The right hon. Lady made a performance on "Newsnight", where she snapped at the gentle Mr. Paxman that the market would definitely go, and that fundholding would not only go, but would be gone within the year. All day long, the Leader of the Opposition had been cuddling the NHS with his policies of continuity, but after he was tucked up with his Islington cocoa, the right hon. Lady was out of her cage to tear the whole thing apart.

36 Let us be clear—the right hon. Lady does not think that there is anything good about our reforms. She has been forced into a wholly unconvincing and inconsistent compromise by the Leader of the Opposition. The result is: Another fudge. These policies have not been properly thought through. They are spatchcock reactions, plundering what is newly popular while genuflecting to old vested interests".

Mr. Dennis Turner (Wolverhampton, South-East)

Redwoodism.

Mrs. Bottomley

The hon. Gentleman says Redwoodism, but those were not my words, or those of my right hon. Friend the Member for Wokingham (Mr. Redwood), but those of Melanie Phillips writing in syesterday's The Observer—neither noted for their unswerving support of Conservative causes. Dr. Vernon Coleman, in that other well-known propaganda newssheet for the Government, The People, said that the Labour party's proposals made him want to weep.

The right hon. Member for Derby, South is hopelessly trying to have it both ways. She says that she would keep the purchaser-provider system, but would abolish the internal market. Only Labour would try to ride a bicycle that had the right cogs in place, but no chain. What is the relationship between a health authority and a hospital, if it is not a managed and a market relationship? It is hard to find any precise answers in the document, because it promises armies of think tanks, consultation groups and even royal commissions for all the policies and details that the Opposition have been unable to clarify.

The right hon. Member for Derby, South says that Labour wants to give power to general practitioners, but makes it clear that it would abolish within a year the single most effective means of giving them that power— fundholding. She says that Labour would cut bureaucracy, but in place of local, direct management, she wants commissioning committees, a new tier of regional administration, and enhanced powers for the centre to second-guess local decisions. That is not just turning the clock back, but taking it off the wall and jumping up and down on it. Patients would be the losers.

Mr. Campbell-Savours

May I raise with the right hon. Lady a question that is causing me much anguish? Last Friday, I attended a meeting in my constituency of parents whose children are unable to speak properly because of the absence of speech therapy. The meeting was deeply worrying, because teachers said that as many as 20 per cent. of children in schools in my constituency are unable to speak properly because of a row between the health authority and the county education provider.

Those children have a medical condition. Can someone bang heads together and get the local health authority to recognise that it has responsibilities? Those children will probably be disabled all their lives because of an argument that is going on now. The right hon. Lady has it within her power to get the health authority to do something about it.

Mrs. Bottomley

I hope that the House will bear with me if I do not give way to Labour Members again. The hon. Gentleman has a good case, and I will be more than happy to provide him with a detailed examination of it, but the issue is the health authority assessing the need and commissioning care on behalf of the local community, and working with education and often social service authorities.

37 The point of the reforms and the significance of the distinction between purchasing and provision is that it is being done so that there can be assessment of need and a collaborative approach with other agencies to meet it. I am more than happy to go into further detail, but I will not rehearse the great increase in the number of speech therapists and the improved training and arrangements—I will spare the House those statistics.

The progress of the past few years has been formidable. The Opposition would throw it all into reverse. Fewer patients would be treated, and there would be longer waiting times as staff struggled—in a way that they have no wish to do—to come to terms with the ghastly new world of the right hon. Member for Derby, South, who has ignored the advice that she has received from many of her supporters. There is an obvious temptation for Labour to cash in on public concern and promise to undo every change the Tories have made … Such a gut reaction should be resisted. Those are not my words, but those of two health experts, one an adviser to the last Labour Government, writing in the June Fabian Review.

Professors Brian Abel-Smith and Howard Glennester went on:. There is now overwhelming evidence that fund-holders are able to get a better deal for their patients. They can pick those hospitals or departments of hospitals which give their patients a better and more convenient service … They can bully specialists about waiting times. They can insist that test results come back quickly … Fund-holding represents a major transfer of power from specialists to GPs".

Hon. Members

Disgrace. Apologise.

Mr. Deputy Speaker (Sir Geoffrey Lofthouse)

Order. I did not hear what the hon. Gentleman said.

Mr. Rhodri Morgan (Cardiff, West)

I apologise to the House for any discourtesy. If you, Mr. Deputy Speaker, did not hear my remark, that is all for the best.

My objection was to the idea that GPs can send contracts for all their out-patients to one hospital, as happens in Bath, while the X-rays are in another hospital. Is that in patients' interests?

Mrs. Bottomley

The point was about the leverage that GP fundholders have within the system to deliver better care for their patients. It is for GPs to make those decisions.

Those are precisely the dynamics of the new NHS which the right hon. Member for Derby, South finds distasteful, because they work and deliver improvements for patients, and patients throughout the country know that. The 10,000 GPs or GP fundholders will make their message only too clear to the Opposition.

Naturally, we are working to spread the benefits of fundholding to all GPs. We believe in levelling up, not levelling down, and have been listening to GPs' concerns. We shall make life easier for family doctors by cutting paperwork. We shall spell out the details of our plans shortly, but I can announce to the House today that an estimated 15 million forms a year will go.

On out-of-hours payments, I remind the House that, as a result of our offer, a typical GP would receive an extra £800 a year for an average of six night visits a month. There can be no excuse for family doctors taking action 38 that damages patients. I am, however, sympathetic to their concerns. The criticism or concern that they have raised about the patients charter—not the cynical reaction of the Opposition—relates to the extent to which we need to remind the public of the importance of using the service responsibly rather than calling out GPs inappropriately, keeping appointments and supporting health staff in their work. That is an area in which we can work together and make good progress.

Our task is to realise the potential of the reforms. We must not turn the clock back and throw the whole system into upheaval. We believe in working with staff constructively and practically. We recently announced extra doctors and a 10 per cent. increase in new medical students. I set out many of those issues in a recent speech to the Royal Society of Medicine. I want to see the long-term perspective.

On contracting, we need to develop more sophisticated purchasing patterns. Contracts should be drawn up with imagination and an eye on the future, and not simply replicate the patterns of the past. They should take account of quality, outcomes and how services will improve, not simply cost.

The Opposition fail to understand that the information that we now have about health services, quality, cost and a number of other issues means that we can progressively fashion an innovative, pioneering and evidence-based service. Such a service will be developed on a research strategy, which is increasingly being acclaimed not only here but around the world, as is our "Health of the Nation" strategy.

In her grudging and mean-spirited way, the right hon. Member for Derby, South talked about the importance of improving health, but did not say that we are now marking the third anniversary of our "Health of the Nation" strategy, which the World Health Organisation is using as a model and which the French Government and many health advisers around the world commend. Today, we launched the next phase—a new phase—in the "Health of the Nation" strategy, to target young people. We have much more work to do in that area.

The Opposition simply wish to reorganise, turn the clock back and disrupt all that is taking place within the service.

Change is necessary in the national health service, but that is change that is driven by new medicine—by new science. Day surgery, laser surgery, bio-pharmaceuticals, genetics, information technology: all those and more are stamping their mark on the evolving pattern of health services. But what does the Labour party do? It resists every closure, every change of use, because Labour frequently supports the patterns of the past, not the patterns of the future.

The Opposition speak about the "public service ethos". Of course the national health service must remain publicly funded, but there is scope, as we see through the private finance initiative, to diversify and expand the range of provision without threatening that public service ethos.

Mr. Hugh Bayley (York)

The Secretary of State speaks about the Government's record on reducing waiting times, and says that it is important that services for young people should be improved. What would she say to the boy in my constituency whose mother wrote to me to complain that he had waited 20 months for a first out-patient appointment for orthodontic treatment, which 39 he has now had, but that, if he is to receive treatment, he will have to wait a further 24 months before he receives the orthodontic treatment he needs, for which his general practitioner has referred him to the hospital?

When will the Secretary of State provide the improvement in services for all people—not just young people—that the patients charter promises?

Mrs. Bottomley

That is another individual incident, which I am more than happy to investigate.

The Labour party appears unable to see the wood for the trees. We have a health service that provides everyone with everything, almost without the use of charges. We have some of the best medical research anywhere in the world. We pioneer new services which are comparable with services anywhere in the world.

Our achievement on waiting times is formidable. We used to have 200,000 one-year waiters; we are now down to 32,000 one-year waiters. In the area of the hon. Member for York (Mr. Bayley), we used to have 7,000 two-year waiters when I first came to the Department, six years ago. Now, no one waits more than nine months in the west midlands.

I believe that the hon. Gentleman should commend the fact that the west midlands has gone from 7,000 two-year waiters to a guarantee of nine months, albeit that, with the complexity of delivering the service that we are entrusted to deliver, there will always be aspects where there is more to do. [Interruption.]

I apologise to the hon. Member with whom I momentarily confused the hon. Member for York. Be that as it may, I could offer him the figures—[Interruption.] Be that as it may, I shall spare him a similar comment about what is happening in York, except to say that the work taking place at the university on the dissemination of reviews—the service it provides and the interest that that is developing throughout the world—provides another example of the way in which we have made the service more fit to meet the future and to tackle the issues, not only of today, but of tomorrow.

One will be able to achieve that only by embracing change—not, like the Labour party, by turning the clock back.

Mr. Brian Sedgemore (Hackney, South and Shoreditch)

There is no tomorrow for you.

Mrs. Bottomley

I profoundly reject the Opposition's misleading motion. The NHS is not a business; it is not for profit; it is not for sale. It will remain a service for all the people to use, regardless of their ability to pay. It must be a health service, not only an illness service; a service focused on the individual patient, responding to their needs and influenced by their choices. It must be an innovative service, evidence-based at every level, and an efficient service, providing value for the taxpayer's money. It must be a service with a long-term view, and a public service with strong ethical foundations.

That is precisely what we are achieving by means of the changes that we have set in hand. The Labour party is stuck in the past, and, although it furiously tries to deny it, the health policies that it proposes show that old Labour is far from dead and buried"./ 40 I say to the hon. Member for Hackney, South and Shoreditch (Mr. Sedgemore) that those are not my words, but those of the Financial Times. The Labour party would tear up the key elements of the reforms; it would inflict upheaval and uncertainty on staff; it would rob patients of the benefits they receive under the Government's policies.

The choice is not between private markets and public health; it is between the Conservative party, which wants to modernise the national health service, and the Labour party, which wants to take it back to 1948.

Mr. Richard Burden (Birmingham, Northfield)

I am sorry that the Secretary of State has already fired off one set of statistics about the west midlands in the wrong place. I can explain to her that the west midlands is in a different part of the country from York, although it is a city that I know well.

I should like, with your permission, Mr. Deputy Speaker, to give one illustration of the way in which the national health service internal market has worked. It is from my constituency in Birmingham. It shows graphically how a bureaucratic nightmare has developed in which the buck is passed from manager to manager, trust to trust and authority to authority. The end result is delay upon delay in the development of new NHS facilities. The much-vaunted private finance initiative, which the Secretary of State mentioned in her speech, has only made matters worse.

In my constituency there is a former psychiatric hospital campus called the Rubery-Hollymoor campus. It takes up about 200 acres of land. The hospitals have closed. The regional health authority, or NHS Executive West Midlands, as it will become, decided to sell off the land and develop it. There has been a great deal of controversy about to what extent local people would have a say in the development, and so on. I do not have time to go into that, but I recommend that hon. Members have a look at that story because it is fairly instructive in its own right.

From the beginning it was said that local people would be able to get out of the development a primary health care centre—something that they had demanded for years. They were told that when the land was sold off, money would come into the health service from the sale. Whatever else happened on that land, they would have a primary health care centre. There was a fair amount of discussion—this is going back to about 1990—between people in the area and the South Birmingham health authority about what the primary health care centre should deal with.

In 1994, the regional health authority published a new plan for health care in the west midlands. It had had some problems up to that point. It had become unpopular with its blueprint for health care in Birmingham. That even led to the resignation of the then chair of the regional health authority. In 1994 the authority published a new document called "Looking Forward". That document referred to a new preoccupation and emphasis in the west midlands on primary health care. It mentioned two flagship projects that would take place in Birmingham. One was a primary health care centre in a place called Quinton and another was a centre on the Rubery-Hollymoor site.

I have to tell the Secretary of State and the House that even though the project was talked about back in 1990, guaranteed at that time, and even though it was proposed 41 in the document in 1994, not one stone has been laid to construct that new primary health care centre. For the first year or so, even though we in the area became frustrated, we thought that the delay was due to the various delays in the development in general.

Towards the end of last year I approached the regional health authority and asked what was happening about the development of the centre and why it appeared to be taking so long. The story that I got back was essentially that the main reason why no stone had been laid was that no one in the health service could decide whose responsibility it was to build the centre.

The original initiative had come from South Birmingham health authority. It could not be responsible for building the health centre. Why? Because all that it did these days was purchase health care. It could not be involved in developing a facility. The land was owned by the regional health authority so I asked why it was not taking the project forward. The answer was that the RHA did not really do anything these days but merely monitored what other people did. It was not the RHA's responsibility to build the primary health care centre. I was told that it was the responsibility of the local trusts and that the local mental health trust would develop the primary health care centre. When I asked why it had not got on with the job, I was told that that trust had been in negotiation with the other trusts to try to work out how it would fund the centre. After all, that primary health care centre was designed to offer a range of different services, including community services, general practitioner services and chiropody.

That was a great idea, so why had the mental health trust not got on with it? I was told that its negotiations with the other trusts had ground into the dust. It had asked the other trusts for the type of financial commitment that it felt it needed to develop the centre in the years to come, but they said that they could not make those financial commitments because, under the new NHS market, their financial regime operated just one year in advance. Those negotiations therefore produced no result and the project came to a halt. It was only when local councillors and I started to ask questions that the trusts decided that they had to get on with the centre.

Earlier this year we were assured that the project would go ahead. I asked the trusts what they intended to do and they said that they now had to prepare a business case. I asked for whom and I was told that the project had to be considered under the private finance initiative. The project had, effectively, to be put out to tender. I argued that the project had first been approved way back before PFI was ever contemplated, but I was told that that did not matter and that the project now had to be governed by the rules of the PFI. When I asked what that meant, I was told that the trusts were getting on with the project but the plain fact was that it would be another two years before the health care centre saw the light of day.

I was subsequently told by South Birmingham health authority that a notice for tender would be placed in the relevant journal in May 1995 and that pre-qualification submissions would be returned in early June. On 14 June pre-qualification tenders would be selected and an invitation to prepare an outline tender would be issued to between six and 10 companies. On 21 July, two preferred tenders would be short-listed and invited to prepare fully costed tenders. They are due to be returned on 8 September 1995 and on 3 October a finance committee, 42 of the mental health trust I assume, will meet. The trust board will meet on 6 October and the full business case submission will be explored. That is what is due to happen in 1995—about five years after the health authorities agreed to the centre and almost one year after they had been chased up about why nothing had happened until then.

Once the private tenders have been returned and it is decided to work on the basis of the PFI, does that mean that the health care centre will then be built? No, it does not, because it is only at that stage that the trusts can start to submit their planning applications. It is only at that stage that the trusts will talk to local people about what they want at that health care centre.

Mr. Fabricant

The hon. Gentleman has offered us a long catalogue of tender procedures. Is he suggesting that such procedures should not be used and that the project should be given to one bidder only, who might just be the highest bidder? Would not that mean taking money away from patient care?

Mr. Burden

The project was given the go-ahead in early 1990s and had the support of local people. The health service then had a management structure that worked. The different parts of that service hung together and it would have been rather better if people had made the necessary decisions then. We would then never have reached the stage, as we did a year ago, where different trusts were unable to make a decision about who would fund the project, who would use it and who, indeed, would own it because it is always considered to be someone else's responsibility.

The hon. Member for Mid-Staffordshire (Mr. Fabricant) has implied that the PFI may offer better value for money to the health service. I am not too sure about that. I received a letter from South Birmingham health authority on 23 June, when I was updated on progress on the project. I was provided with the list of dates that I outlined a few moments ago. The health authority explained that taking the project through the PFI was a complicated exercise. It is so complicated that it appears that South Birmingham health authority, the trusts or even West Midlands regional health authority, cannot be expected to conduct it themselves. That is why I was told that, in order to pursue the PFI, the mental health trust had brought in outside help, Nexus Health Finance Ltd., to assist it to perform its task under the PFI regime. The trust, in order to obtain that finance, has had to commission and pay a private company to help it. That has happened on the back of the RHA's decision to call in Erdman Lewis company to help it market the land and another private firm to help it develop that land. Some questions must be asked about how much all that activity costs.

The primary health care centre in south Birmingham is just one example from a catalogue of disasters, and it says a great deal about the way in which the health service operates. Any individual manager or health practitioner will have the interests of the patient at heart. It is most unreasonable for Conservative Members to say that the Opposition have attacked people working in the health service. Goodness, we spend our days listening to them and taking up their grievances. We articulate for them because they are often not allowed to do that. That demonstrates what is wrong with the way in which the health service is operating.

43 It is clear that throughout the entire process in south Birmingham everyone has had the interests of the patient at heart, but when one puts the picture together and inserts the crucial mechanism of the market, the outcome is chaos. A decision was made that could never be carried through. The RHA wanted the health centre to be developed, but it never had the power to do that. In effect, the RHA took its eye off the ball. The trusts and provider units wanted the centre developed, but they could not reach the necessary agreement. That failure was not intentional, but they knew that the financial regime imposed upon them by the internal market forced them to expect of each other unrealistic financial demands. That led to delay and, finally, the much-vaunted PH. The only effect of that initiative on the proposed health centre in south Birmingham has been to create further delays and add to costs.

At the end of the day, who knows—public money may be used to build that health centre. We know, however, that it will not be built for another two years. Let us go back to the start. It all arose from the sale of hospital land. We were told that that would raise money that could be put back into the health service. The one obvious project arising from that development, however, cannot be financed out of health service money.

There is something radically wrong with the way in which the health service now operates. The market mechanism has not worked. It is because of that example in south Birmingham, and countless others throughout the country, that I welcome the new policy document issued by the Labour party. It is designed to bring to an end that disastrous market mechanism and, in a modern context, get back to the essential principles on which the health service is based. It will then serve the interests of people and patients, not bureaucrats and markets, and it will not be governed by an obsession with privatisation.

Mrs. Marion Roe (Broxbourne)

There is no doubt in my mind that the health service reforms were radical and bold. They are now nearly five years old and they have matured into an understanding of the need for strategic long-term relationships between purchasers and providers and, where appropriate, between providers themselves.

I remind the right hon. Member for Derby, South (Mrs. Beckett) that NHS trusts are NHS funded and NHS managed. But, of course, they will tender for services from public or private suppliers where it is advantageous in terms of improved quality and efficiency—for example, for cleaning and catering, and for patient transport. But the objective always remains the same: to secure improved services that are balanced and non-ideological.

Competition stimulates innovation and improves efficiency; it also encourages new and better ways of providing health care. The NHS market is a public market, which is publicly accountable and publicly controlled. All purchasers, responding to the needs of the people they serve, seek to maintain good access to a comprehensive range of general hospital services. Those services will include all emergency treatment, which accounts for 35 to 40 per cent. of all expenditure.

However, in some other services, planning needs to be undertaken jointly between purchasers and two or more providers. The implementation of the chief medical 44 officer's recent important report on cancer services could not effectively be undertaken without joint work between trusts to ensure the highest-quality surgery, chemotherapy and radiotherapy—that requires strong links between cancer centres and local cancer services.

In other services, the private sector may offer the best quality of care—but still funded by the NHS. Private psychiatric providers have specialist expertise for people with severe problems. Some purchasers are now obtaining much improved care at home for very dependent elderly people, such as quadriplegics, who need to receive customer-designed care, fitted to their needs, from specially and specifically trained carers. The private sector can often best provide such carers—funded and supervised by the NHS and social services together.

Mr. Alex Carlile

If it is right that the private sector provides facilities—as well it might—for some areas that are better and give better value than the NHS, can the hon. Lady explain why, in some areas of medicine, the NHS is obtaining services from neither the private nor the public sector? For example, why is it so difficult to obtain medical treatment for anorexic teenagers in the NHS in London, so that some of them suffer for years, while those whose parents can afford to pay can be in a psychiatrist's chair within minutes?

Mrs. Roe

I should draw the hon. and learned Gentleman's attention to the Select Committee's report on purchasing. If he reads the report in detail he will see that we considered those sorts of services that were not being provided in some areas, but found that such services were being provided in other areas and were certainly meeting the needs of the local population. I advise him to read that report in detail as he will see that his point is covered by it.

Mr. Fabricant

I am grateful to my hon. Friend for giving way because I wish to raise a point relating to the intervention by the hon. and learned Member for Montgomery (Mr. Carlile).

Is my hon. Friend aware that the family health services authority in Staffordshire produces a list of waiting times and availability of treatments for various types of disfunction? Is it not true that there is no reason why, if the fundholder is in London, the patient should necessarily have to be treated in London? If the treatment is not available, the patient could certainly easily be treated in areas surrounding London, where treatment is available.

Mrs. Roe

I take my hon. Friend's point but, again, the Committee's report shows that in some areas particular services are provided and are of a high quality.

The East Hertfordshire NHS trust, which covers my constituency, has established a deserved reputation as a prudent, well-operated organisation that has consistently met all its financial targets and contractual requirements, while placing key emphasis on developing new services for local people. In doing so, it has sought and benefited from private sector developments in just the sort of projects that provide benefits for patients first, for the trust second, and for the private sector third.

Most importantly, services for national health service patients have been extended and introduced when that would not otherwise have been possible. For example, new and improved equipment has been introduced where private finance has improved the cost-effectiveness of 45 services in a wide range of areas. The use of leased equipment has enabled vital advances while relieving the NHS of the burden of risk and cost.

The East Hertfordshire NHS trust has been able to acquire more than £700,000 worth of essential equipment, ranging from image intensifiers, blood gas analysers and other critical medical equipment, as well as equipment that brings benefits to staff and patients, such as a new switchboard, new information systems and refurbished refreshment facilities within the main hospital. The trust has also developed improved diagnostic services through the provision of an on-site, state of the art, privately operated MRI scanner in a purpose-built unit.

The Chase Farm Hospital NHS trust, which also covers my constituency, has a partnership with the private sector; the trust and its patients have benefited, both financially and by means of direct clinical care, through their partnership with BMI. There is a partnership arrangement with the Kings Oak private hospital, which is on the Chase Farm hospital site and which was built by the private sector on Chase Farm hospital trust land. That yields an immediate income of a minimum of £380,000 a year, with additional benefits.

The benefits include: the sharing of expensive clinical equipment; training offered by the trust to the Kings Oak resident medical officer, with the trust in return receiving the funding for an additional doctor in its accident and emergency department; the ability to sell pharmacy, pathology and CTC scanning services to Kings Oak and generate income for the department involved; the opportunity for the doctors to undertake private practice on the Chase Farm site, thereby being easily accessible to the NHS when they are required; the ability jointly to develop new services such as mammography screening; and sports injury clinics. The Chase Farm trust has also worked closely with Broxbourne borough council, which was able to facilitate a land swap with the private sector, enabling the trust to re-provide Cheshunt community hospital with purpose-built premises in a central location in my constituency.

In my constituency we are concerned about the grass roots delivery of an excellent health service, not about ideological rhetoric, where the word "private" has developed into an abusive term.

Britain does not have to make a choice for the national health service between the public service or private markets. The key to maximising our resources and to providing the high-quality health care we need lies in creative and energetic partnerships between our national health service and the private sector. That is the way forward.

Mr. Alex Carlile (Mongomery)

It is now 16 years since the Government's political experiment with the national health service started. One would have thought that, by the end of 16 years, even by the standards of the right hon. Member for Wokingham (Mr. Redwood), the experiment would have come to fruition and would have achieved the panacea of the national health service that we had been promised. Listening to the hon. Member for Broxbourne (Mrs. Roe), one has the impression that the panacea has been delivered, at least in leafy Hertfordshire. If it applies in Broxbourne, it certainly does not apply all over the country.

46 The hon. Member for Mid-Staffordshire (Mr. Fabricant), who has temporarily left the Chamber, suggested in response to my earlier intervention that an anorexic teenager from London could be treated in Staffordshire. Are we really to believe that that is the recipe or prescription offered by the Government to people who are facing severe illness early in life? Where is the evidence that the national health service is meeting the acute needs of the great majority of the people?

The reality behind what the hon. Member for Broxbourne described is that there has been a tenfold increase in the number of NHS administrators. Senior managers are earning over £63,000 a year on average, and the best employment offers in the jobs pages of the heavier newspapers are not for doctors, but for national health service administrators. Of course the national health service needs good, well-paid managers who can administer it well; what it does not need is a management structure which has overwhelmed the medical ethos of the service.

It is all very well to talk about day surgery, laser surgery and technological changes; it is right that they should be embraced by the national health service. However, can we really be as satisfied—indeed, as self-satisfied and smug—as the Secretary of State and the hon. Member for Broxbourne when we hear, for example, the intervention by the hon. Member for Workington (Mr. Campbell-Savours) about speech therapy in Cumbria? It is not only in Cumbria that speech therapy is not available. There is a chronic shortage of speech therapists in rural Wales.

Why have the Government failed to meet the need for speech therapists? Why is there a shortage of physiotherapists? Why does the training that paramedics who attend accidents receive vary greatly from one part of the country to another in a way that may critically affect outcomes?

The Government ought to tell us what answer they have to the triple whammy which they have been given in the past two or three days by senior figures who have made comments about the national health service. The Secretary of State tried to rubbish the comments of Professor Colton, but she failed to deal with the comments of his chairman, Martin Suthers. He is the chairman of Queen's medical centre, Nottingham University Hospital NHS trust, and, one is told, a prominent Conservative. He said: I am sorry to see him go, but I understand his frustration. What frustration was that? Perhaps the Government would care to explain it.

I do not believe that Mr. Suthers is about to go to Switzerland to practise health in the private sector. He remains to try to pick up the pieces after the departure of Professor Colton, a leading paediatric surgeon, from Nottingham, and has been left to find somebody else to take over the children's clinic.

What about the Bishop of Ripon, the Right Reverend David Young? The Minister may laugh at the notion that bishops have any right to say anything about what is going on in our society, but the fact is that bishops see a lot of what goes on through their diocesan work. Why is it that the Bishop of Ripon, despite the Minister's smug and dismissive smile, said: The increasingly competitive nature of health care is damaging. He finds it difficult to see how competition can benefit patients.

47 Then, of course, we have Dr. Macara, the chairman of the council of the BMA. That name brought from the Minister not a smile but a double raise of his eyebrows, probably because he cannot do them one at a time. I see that he can. He raised one eyebrow in response to that.

Let us consider Dr. Macara for a moment. He is not a firebrand trade unionist; he has a long record of support for Conservative health policies. However, as chairman of the council of the BMA, this morning he described the regime under which the NHS now labours as "alien." He described the internal market as "an infernal bazaar". He has complained that there is neither equity nor integrity, and called the system whereby whistleblowers working in the NHS are under threat of losing their jobs "dedicated secrecy".

Can the Government really, in the style that the Minister of State carries so well off-the-shoulder, shirk such criticisms? Can the Government really be satisfied with having lost the support of the medical profession?

It simply will not do for the Secretary of State to say that general practitioners who are fundholders will fight to retain their fundholding status. She omitted to tell us that 60 per cent. of GPs have refused fundholding status. It is only the minority who are fundholders. There is some evidence that many of them regret it.

The Nottingham fundholding commissioning group has received a lot of praise, both from the Labour party and from my party. In Nottingham, a very successful alternative has been found to GP fundholding. Part of the evidence is that fundholders have declared that they wish to join the Nottingham group.

Why are the Government not prepared to give a fair run to fundholding groups such as that? Why do they insist on pressing the case for individual practice fundholding as their priority? Why are the Government not even prepared, as my party suggests, to test fundholders before they are given fundholding status, not on the basis of the size of the practice but by a strict system of accreditation, to ensure that they are fit to run the funds for their practices?

When the Minister replies, I would ask him to explain why it is that, mysteriously, only a few days ago, the extremely able chief executive of the new joint Nottingham health commission, who has given great administrative support to the Nottingham fundholding commissioning group, resigned his job. Did that involve interference by the Government? Have there been subtle words to lever him out because he is doing rather too well and the Nottingham experiment is beginning to show great success? We deserve an answer.

Mr. Malone

Will the hon. and learned Gentleman give way?

Mr. Carlile

I will gave way later, even though the Secretary of State refused to give way to me. I ask the Minister to find out the true explanation for the departure of the chief executive from his post. He should give an informed answer at the proper stage of the debate.

Mr. Spearing

Is the hon. and learned Gentleman telling us that in Nottingham, for which the Minister is responsible but in respect of which he may or may not reply, there is a group of GPs who wish to avail 48 themselves of advantages through some large-scale co-operative organisation, thus benefiting local citizens, but who are being prevented from so doing? If so, the Government must say why.

Mr. Carlile

The Nottingham fundholders group is extremely well run, by some very good doctors. It is clear evidence that doctors can run important parts of the health service for themselves without large numbers of administrators. However, they have had a great deal of help from the chief executive of the Nottingham health commission, who sadly disappeared—I do not mean physically, but from his job, with very little notice, I understand, at the end of last week. If the Minister can give an informed explanation, I shall give way. I apprehended from his sedentary reaction that he was ready with one of his usual off-the-cuff ripostes rather than the true reasons.

Mr. Malone

The hon. and learned Gentleman asked two specific questions: had the Government engineered the chief executive's departure, and had the Government had any words? The answer to both is no, but I shall see whether there is any explanation that I can offer him. I cannot undertake to do so, but I shall certainly try. While I am on my feet, may I ask the hon. and learned Gentleman whether, as seems to be the case from what he said about fundholding, he shares the Labour party's view that it should be abolished?