NATIONAL HEALTH SERVICE

HC Deb 20 April 1978 vol 948 cc682-812

Mr. Speaker

Before I call the right hon. Member for Wanstead and Woodford (Mr. Jenkin), I remind the House that I have an impossibly long list of right hon. and hon. Members who hope to catch my eye in this debate. I shall be able to call more than otherwise would be the case if there are brief speeches, but it is up to the House.

4.0 p.m.

Mr. Patrick Jenkin (Wanstead and Woodford)

This is the first full day that we shall have had on the National Health Service for some time. The Conservatives have but two objectives. The first is to convince the Secretary of State that the NHS is facing very serious problems indeed, that the widespread anxieties which we read about in the Press every day are real and are not imagined, that morale in the Service is at a very low ebb and that none of this is helped when he and other Ministers go around the country trying to give the impression that all is well. Our other purpose is to spell out our view of what needs to be done about it all.

The Secretary of State for Social Services (Mr. David Ennals)

Good.

Mr. Jenkin

The Secretary of State says "good". I have had a slightly curious letter from him in the last day or two under the heading Six straight questions on the NHS in which he says This debate initiated by the Opposition gives the Conservative Party an opportunity to set out its policies on the NHS I do not know what the right hon. Gentleman thought we were going to do, but he will find that by the time I sit down I shall have answered his six questions. Perhaps I may invite the right hon. Gentleman, in those circumstances, not to put those questions all over again, in order to give more hon. Members on both sides of the House a chance to make their speeches.

I should like to start with a text taken from the Daily Mirror—which is not a paper which on the whole is inclined to support the Conservative Party On 13th March, under the heading "The Sick Service", it stated: There's only one word for the National Health Service today. Sick". When one bears in mind that 1978 is the thirtieth anniversary of the NHS—I understand that the right hon. Gentleman is proposing a little celebration later in the year—this is a verdict which can give no one any pleasure at all. The Daily Mirror puts its view with a characteristic pungency. The right hon. Gentleman will know that the same verdict is echoed up and down the country.

I do not intend to weary the House with a large number of quotations, which I could. From Cornwall to Cumbria the message is the same—sagging morale, lengthening waiting lists and falling standards, all exacerbated by industrial disruption, by anger over pay anomalies, by staff shortages in some areas, by building work years late, by forced closures and so on.

Waiting lists are often taken as an indicator of NHS progress. In 1974 there were fewer people waiting for inpatient treatment than in 1970. Since 1974 the number has risen dramatically and has been hovering around 600,000 over the last two years. That is a good deal higher than for a very long time past. More serious, the Secretary of State has had to disclose that nearly 40,000 of these cases are urgent, of which nearly two-thirds have to wait over a month. I find it very difficult to disagree with the view of Dr. James Cameron, the chairman of the British Medical Association Council, who said: The sum total of human misery represented by these record figures for waiting lists over the past year is a scandal without parallel in any technically developed country. But the best that the Secretary of State can say about it is that the number of urgent cases is falling. Yet even there he cannot resist the temptation to try to fudge the issue. This was clearly brought out in a recent leading article in the Health and Social Service Journal on 10th February which stated: While it would be harsh to describe Ennals as a man not given to honesty, there is certainly a case to be made against him in the selective use of figures when he claimed the number of urgent cases awaiting treatment had fallen. For what he failed to mention was that there was a rise in the percentage of urgent cases waiting for more than one month. It is this kind of attempt to put a favourable gloss on what everybody recognises is a serious situation that so exasperates people.

Or take the growth of industrial disruption. This is another cause for serious concern and is evidence of a malaise in the Service. We have had the telephonists pulling out the plugs and censoring doctors' calls. We have had the guerrilla walk-outs at Westminster Hospital, which brought all admissions to a halt, and which the Daily Mirror described as the unacceptable face of trade unionism … on parade". We have had the operating theatres at Dulwich closed because professional staff with clinical responsibility for patients found themselves quite unable to maintain discipline among ancillary staff. Again, I could cite examples from all over the country, but I shall spare the House the burden of listening.

Mr. Lewis Carter-Jones (Eccles)

Why?

Mr. Jenkin

Because many hon. Members want to speak.

Mr. Carter-Jones

Tell us.

Mr. Jenkin

I have brought a file, but I shall not weary the House with the details. Of course, the great majority of staff in the hospitals work cheerfully, conscientiously and without interruption. They give devoted care to the patients in their charge. I would not wish it to be thought otherwise. However, there can be no hon. Member who does not recognise that this rash of disputes has become too numerous and too disruptive to ignore and that it is evidence of a deeper malaise.

Mr. Carter-Jones

Name them.

Mr. Jenkin

I can, but I have already quoted some examples. Perhaps I can leave it there. My hon. Friends may wish to give other examples.

But of all the reasons that are given the most frequent and most insistent is the shortage of money. We had that from the BMA, the TUC, the National Association of Health Authorities—in the letter from Mr. Bettinson, the chairman—and many others. I should like to look at the question of money.

I put down a recent parliamentary Question to the Secretary of State which showed that betweeen 1948 and 1976 spending on the NHS increased in real terms, at constant prices, by nearly 130 per cent. According to my mathematics, that is an average annual growth of almost exactly 3 per cent. a year. That was a pretty steady increase with only minor fluctuations. By and large, during those years the NHS broadly kept pace with the demand.

But the latest public expenditure White Paper—Cmnd. 7049—shows a very marked slowing down of spending. From 1972–73 to 1976–77 the annual average growth was not 3 per cent. but 2.1 per cent. Perhaps more serious, the forecast for spending from 1976–77 to 1981–82 shows an average annual growth of 1.6 per cent. These figures relate to the situation prior to the Budget increase of £50 million in the current year 1978–79. If one adds that in, the figure of 1.6 per cent. rises marginally to 1.8 per cent.

What we have faced in recent years is a growth at about two-thirds of the rate in the first two decades of the NHS. Over the next four years the NHS is facing a growth in expenditure at about half the rate of the first two decades. That is for total spending—capital and revenue.

Mr. Carter-Jones

Are we now hearing from the right hon. Gentleman that he intends to increase that spending substantially? When will that take place?

Mr. Jenkin

If the hon. Gentleman will have patience and wait, I shall, of course, deal with that. But I hope that there will not be too many interruptions because many hon. Members want to speak.

Mr. Jack Ashley (Stoke-on-Trent, South)

We are all very interested in these proposals. I know that, in challenging the Secretary of State, the right hon. Gentleman is prepared to give exact details of how much public expenditure he is prepared to propose in this debate. It is exact details that we should like from him.

Mr. Jenkin

That was actually one of the Secretary of State's questions—but never mind, I think that the hon. Gentleman will get his answer.

I was going on to say that capital spending has been cut in absolute terms to two-thirds the level of three or four years ago. That is the level at which it will run over the next four years. That is the harsh reality, yet, as we all know, the demands on the Service are constantly increasing, for all sorts of reasons—the increasing age of the population, new medical technologies and new drugs—and the results of this equation are becoming apparent all over the country.

But, again, the difficulty is that on this subject the Secretary of State speaks with two voices. He wisely confessed to the British Medical Association—he will know that I wrote an entire article around this text: Resources do not meet all needs and I shall not stop saying so. That is absolutely right, and we applaud his saying it. That poses the eternal dilemma of infinite demand and finite resources. But what are we to make of the Secretary of State's statements elsewhere? In "The Way Forward", he included this remarkable sentence: the money available will be enough in principle to meet increased demand arising from demographic change". What does "in principle" mean? The right hon. Gentleman has never answered that question. How does one meet expenditure "in principle" unless the money is there in practice? That is one of the oddest statements ever made.

I therefore find it surprising that, in his letter to the BMA referring to the document "The Way Forward", the right hon. Gentleman said: 'The Way Forward' was brutally frank in recognising the difficulties and problems". I see nothing "brutally frank" in trying to fudge the issue and saying that there is enough money "in principle" to meet the demands on the Service.

It did not stop there. The right hon. Gentleman has gone on pretending. I quote now from the most recent official document, the planning guidelines published on 20th March: It has been argued that, unless a greater increase is achieved in the total resources available for health and personal social Services, the strategy underlying the priority guidance contained in previous documents is untenable. The Secretary of State does not accept this … he is satisfied that the broad strategy, as promulgated, is the right one and capable of achievement nationally. If the right hon. Gentleman believes that, he is just about alone. It has not been accepted by the great majority of those with whom he has to deal. Of course he has been trying to get more—we all Know that—

Mr. Ennals

I have succeeded.

Mr. Jenkin

How much he has succeeded we shall perhaps see.

The Health and Social Service Journal said: It is an open secret that David Ennals fought long and hard in Cabinet to get a substantial increase for the NHS and it is understood that the DHSS was hoping for about three times the amount which it eventually got. But the opposition, one presumes from Treasury mandarins, was formidable and obviously successful. I have been Chief Secretary to the Treasury. I know what is involved in facing spending Ministers who are asking for more money. I know that the Treasury carefully studies what those Ministers say when they speak to the public outside. Of course, if the right hon. Gentleman has been trying to pretend to everybody that he has enough money, why should the Chief Secretary or anyone else provide him with large sums more?

Therefore, instead of the £200 million or £150 million for which the right hon. Gentleman was hoping, he got £50 million Thus, the Chancellor announced last week these ludicrous priorities—free milk for all children whether they need it or not, subsidised meals for all children whether they need it or not—

Mr. Ennals

Hear, hear.

Mr. Jenkin

The right hon. Gentleman says, "Hear, hear", but this is while the NHS, which is facing acute problems of which we are all aware, has to live on a rate of increase of spending over the next four years which is about half the rate with which it has been blessed over the first decades of its existence.

The Secretary of State has tried to specify in detail exactly what the £50 million is to be spent on—commissioning completed hospitals, £8 million; capital cost to help waiting lists, £2 million; new equipment and urgent maintenance, £8 million to £9 million; more staff and urgent maintenance for mental and geriatric hospitals, £14 million. I would seriously ask, does it make sense to try to spell out in this detailed way exactly how every pound shall be spent?

Mrs. Gwyneth Dunwoody (Crewe)

Yes.

Mr. Jenkin

The hon. Lady says "Yes," but can one honestly say that those in the DHSS at the Elephant and Castle know exactly the priority needs of each health district all over the country? How can they know?

Is it not one of the chief causes of the malaise in the NHS that the gentlemen in Whitehall think they know best how to meet the needs of local communities? The right hon. Gentleman says that there will be 9,000 more jobs. How can he know that? Is this not just another part of the pattern of make-believe, with more of an eye on votes than on patient care?

Mr. Ennals

Does the right hon. Gentleman really think that I and my colleagues in the Department do not have the closest links with the health authorities and know what their priorities are? We have worked out their priorities with them on their own strategic plans. Of course we know where the urgent needs are and, therefore, of course we can say how that money will be spent. I think that the country respects us more if we come clean about how we will spend the the money. People do not want to think that it simply goes into a pool. They want to know how it will be spent, and I think that they will thank us for it.

Mr. Jenkin

This may be one of the differences between us—a difference, I think, of degree rather than of kind. I just do not believe that the central bureaucracy can know as well as local people what are their immediate priorities. I very much doubt the wisdom of this kind of earmarking.

The Health Service is facing great difficulties, and it does no service to the nurses, doctors and other professional people who are struggling to make it work to go on pretending that all is well, that things are better than ever, and so on.

I shall now spell out what I believe should be done. I have no hesitation in saying that the first requirement is realism. We must be absolutely realistic and face the facts, acknowledge the deficiencies and recognise the limitations. I would say to some Labour Members below the Gangway that realism means that, before more money can be spent, more money must be earned. The state of the NHS today is a reflection of the poor performance of our economy over many years.

My hon. Friends and I have visited health services in other countries, where we often found higher standards, shorter waiting lists—in some cases none at all—and better hospitals. The reason is that they are spending more because they have more successful economies. The quality of United Kingdom medicine still stands as one of the centres of excellence of the world. It is as high as anywhere in the world. But it will not survive if this nation cannot generate the resources to nurture and sustain it.

Improving the performance of the economy has therefore to be a top priority. On that there is no difference between the two sides. Therefore, I am not standing here to argue for a massive new injection of funds at this stage. That would be quite unrealistic. If I am the first Opposition spokesman on health to say just that, let history record it. I do argue that we can make better use of the money we have, and I shall go into detail on that in a moment.

I group my remarks on the NHS itself under five main heads: first, our commitment to a National Health Service and a proper partnership with the private sector; second, the funding of the NHS; third, the structure and management of the Service; fourth, financial discipline and incentives; fifth, the people who work in the Service and on whom all depends.

I would therefore state clearly in the House, as I have frequently said outside, that the Conservative Party unequivocally supports the concept of a National Health Service—national in the sense that it is substantially funded by the Exchequer and with no one denied access to care because he cannot afford it; national also—here I answer one of the right hon. Gentleman's questions—in the sense that standards of health care should not vary widely across the country but should be brought progressively to a national standard. But it must be a process of levelling up and not of levelling down. The Secretary of State has occasionally cast doubt on our commitment to the NHS, and I hope that he will now stop.

There are two other principles. First, we must seek to foster in each individual citizen a proper sense of responsibility and awareness of his own and his family's health needs. Education, and especially education in preventive health care, is essential, but I draw a clear distinction between education in the sense of imparting information and instruction in the sense of preaching. I think that the Secretary of State will recognise that some of his pronouncements, particularly those on smoking, have been profoundly irritating to many people and may well have been counter-productive. He certainly got a very bad Press.

I believe that giving health information is the role of the general practitioner, the health visitor and the community physician. That is vital. It is also needed in the schools.

The second principle is that we must build a proper partnership with the independent sector. My party firmly opposes the system of medical apartheid embodied in the foolish Health Services Act 1976. We are committed to reversing it. We believe that the Health Service can ill afford to lose the money coming in from pay beds. It was £26 million last year, and it will be more as the charges rise.

We believe too—and Nye Bevan himself realised this—that there is positive merit in keeping the best consultants in the National Health Service hospitals. We shall therefore see that pay beds are provided where there is a demand for them and that the pay bed revenue accrues to the hospital where it is earned.

We see no reason for quantitative controls on the private sector. They seem to us incompatible with a free society, and they are there solely because the pay beds have been hounded out of the National Health Service hospitals.

Mr. E. Fernyhough (Jarrow)

When the right hon. Gentleman's party may get the chance—I do not believe that it will ever happen—will he assure me that those consultants who take in private patients will also be responsible for the hospital debt that many of the private patients leave behind?

Mr. Jenkin

I recognise there is a problem. It is a minor problem, but I note the right hon. Gentleman's suggestion.

I come to my second point, which is the funding of the Health Service. I have already said that I do not think that a new injection of funds in the short term is possible, but we see no reason for holding down prescription charges when the National Health Service needs every penny it can get. They should keep pace with rising costs. Especially in the context of the Secretary of State's newly-launched attack on drug costs to the Health Service as a whole, it would be reasonable that prescription costs should rise—with all the usual exemptions, of course.

As for other changes in the basis of funding the Service, we shall wait to see the report of the Royal Commission. It would be very unwise for any party to commit itself in advance either way. We shall also wait for the report to see what the Royal Commission has to say about switching more of the cost to specific health insurance contributions. This is clearly within its remit, and it would be very unwise for a party to commit itself to anything in that line in advance.

Thirdly, I turn to the structure and management of the Service. Ministers have themselves testified to the positive side of the 1974 reforms. Four Labour Secretaries of State subscribed to a document which said that it was now possible to look at priorities more comprehensively and to plan the allocation of resources more effectively both at local and national levels. I think that that is right.

But no one can deny, and I do not deny, that reorganisation has not fulfilled the hopes of its progenitors. My right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) said last Saturday that the NHS reorganisation had been in part patchy, in part awful, in part not bad and in part curable". It has proved over-bureaucratic, but reorganisation is not responsible for much of the bureaucracy. [HON. MEMBERS: "Oh."] Let us look at this example. I have here a DHSS circular of December 1977, HN(77)190, which tells health authorities how to cook turkeys. There must be some limit to the bumf that comes out from the right hon. Gentleman's Department.

Mr. William Hamilton (Fife, Central)

The right hon. Gentleman's Government told us how to clean our teeth.

Mr. Jenkin

Let me return seriously to the structure of the Service. We do not want to see another major "big bang" upheaval. The watchword must be evolution, not revolution. The National Health Service needs, as my hon. Friend the Member for Reading, South (Dr. Vaughan) has said on a number of occasions, a period of intensive care if it is to come through the present crisis. How would we deal with it?

First, we do not want a uniform, dull mediocrity. No one pattern can possibly be right in all circumstances across the country. Secondly—this is absolutely crucial and ties in with what I said a short time ago about the £50 million—we must aim to make the Service as local as we can. It is wrong to talk of the National Health Service as if it were a vast, great, integrated machine, controlled and manipulated by the Secretary of State sitting at a great console like a power station console. It does not work like that. It involves an enormous bureaucratic tail if one tries to work it like that.

The National Health Service is a large number of local services delivering health care locally to local communities. Therefore, the primary control should be by local people. Probably, but not universally, the district is the right level at which to focus authority.

The mistake in 1974 was to separate out management, through the district management team, at the district level from direction or control by the area health authority at area level. I believe that the right answer is that the lay element in management should be at the district level, with the DMT answerable directly to a district health authority, with local lay representation at that level.

The result of this would be that over much of the country an area tier would be seen to be superfluous. It should be merged into the districts, which would become the primary authorities. It is at the district level that the buck should stop. There never has been any reason why decisions should go chuntering up the tiers of management. That was never the intention.

Mr. Doug Hoyle (Nelson and Colne)

The right hon. Gentleman's Government introduced the change.

Mr. Jenkin

I recognise that that is what has happened, but it was never the intention. When I come to funding I shall explain how one can make sure that it cannot happen.

The Department's role must be to lay down overall policy and establish broad priorities. That is the proper role for the Secretary of State. It will be his duty to allocate the cash to the various authorities, to lay down minimum standards, which I believe is enormously important, and to establish a proper inspectorate to maintain those standards.

Between the Department and the districts I would retain a regional tier, but essentially as a co-ordinating and planning tier, with most of its members drawn from the districts which it would administer. It would in no way be concerned with day-to-day management. It would be a strategic tier.

We would reinforce the structure with a more effective financial discipline. The instruments are to hand. We now have working across most of the Health Service an effective system of cash limits. This gives us the chance to introduce effective management incentives to cut out waste, to cut out extravagance, and to make the buck stop where it should, with the people who actually have to take the decisions.

Mr. Ashley

rose—

Mr. Jenkin

I must get on.

Incentive budgeting should allow for a good deal more flexibility. As one chairman put it to me, one should give each authority its crock of gold, as it were, capital as well as revenue, subject to a regional plan and to ministerial priorities, and then leave it to that district to get on with it. If one does that, there is no reason to have the nonsense of what one regional chairman called "the colour television sets in March syndrome", the last-minute scramble to spend money right at the end of the year. This is still going on. My hon. Friend the Member for Ealing, Acton (Sir G. Young) drew my attention to what an Ealing alderman, Alderman Tomlinson, a member of the North West Thames Health Authority, said the other day. He said that the regional health authority was £5 million underspent for the current financial year. That was last year. He added that the authority will have to work quickly to reduce the surplus, because only £3.46 millions of it can be carried forward into the financial year. … One also wonders whether the money is going to be spent wisely, since they only have a couple of months in which to dispose of it. This practice still goes on, because there is only a 1 per cent. allowance for spillover.

Mr. Ennals

rose—

Mr. Jenkin

I will gladly give way but the right hon. Gentleman is to speak immediately after me and I am anxious to finish my speech.

With the cash limit system there is no need to have any limit on carry forward. When we had the old system of Treasury control of expenditure, when I was at the Treasury, perhaps this rule was necessary, but I do not believe that it is necessary now. It is widely accepted within the Health Service that it is wasteful. I visited a hospital the other day where every secretary in the hospital had been furnished with a new electric typewriter because it was the only way the authority could spend the money before the end of the year. That is crazy financing. No business allows itself to be run in that way.

Mr. Ennals

Would the right hon. Gentleman agree that during his time at the Treasury there was no carry-over period at all and therefore there was a mad rush? The 1 per cent. carry-over that has been agreed has changed the basis of the financing of authorities.

Mr. Jenkin

So have many other things been changed. When the Conservatives were in power we were still working on the basis of Supplementary Estimates. The cash limit system, with its built-in rate of inflation, creates—I am glad to see the Under-Secretary nodding his recognition of this—a new opportunity to give authorities flexibility in managing their money efficiently. Why should not an authority decide to save a bit out of revenue for a couple of years and then spend the money on something which it badly needs? Why should it have to squander money in the last few weeks of the financial year?

Mr. Ashley

rose—

Mr. Jenkin

I have given way a number of times.

I turn finally to the people on whom the Service depends. It is on the professions that the main burden and the main responsibilities must lie. They are entitled to the resources necessary to do the job. They are entitled to the respect and willing support of those who work with them. They are entitled to the level of pay commensurate with their responsibilities and comparable with other professions. Above all, they are entitled to the unqualified backing of politicians who administer the legislation under which they work.

In recent years doctors, nurses and administrators have had none of these things in proper measure. Pay has fallen badly behind. I hope that the Secretary of State can give us some news about that today. The Prime Minister has had the report of the Review Body for two weeks now. The profession is waiting anxiously to know how the Government will deal with it.

Although pay is important, I believe that clinical authority is even more important. Nothing has done more to undermine confidence in the National Health Service than the repeated attempts of groups of unqualified people to usurp the function of doctors and nurses. I believe that Jennifer Burke, the courageous theatre sister at Dulwich, deserves the praise and thanks of all right-minded people for the stand she took in defence of discipline. As The Times said on Tuesday of last week, hospitals cannot be run safely and efficiently unless clear-cut responsibility in clinical matters lies with those who are qualified to take clinical decisions. We look to the Secretary of State today to give unqualified and unequivocal support for that proposition. The unions, of course, have an important role to play. My right hon. and hon. Friends and I are meeting union leaders at several levels within the Health Service so that we can better understand their problems. One important role must now be to go to the limits to see that patients never suffer as a result of industrial action.

We do not intend to divide the House today on this motion. The main thrust of National Health Service policy ought not to be a matter of party dispute. What we look for is some recognition by the Secretary of State that the state of the National Health Service today is a good deal more serious than he has so far allowed. Whether or not he acknowledges it today, I suspect that by the end of the debate the House will have left him in no doubt of it.

4.35 p.m.

The Secretary of State for Social Services (Mr. David Ennals)

I very much welcome this debate, which is an opportunity the House does not have often enough to consider the state of the National Health Service, its problems and its achievements. It gives us the chance to look at the way forward, especially in the thirtieth anniversary year of the National Health Service.

Most of all, I welcome the debate because it has given to the Opposition the opportunity to spell out their alternative policies. This is why I sent my letter with its six questions to the right hon. Member for Wanstead and Woodford (Mr. Jenkin), to enable the right hon. Member to explain to the country what would be the nature of the Health Service if the Leader of the Opposition were, by some misadventure, to become Prime Minister.

This issue is of no slight interest because, however much people may be concerned about the problems of the National Health Service, there is no service in this country which is more respected. There is no service—it has been established by a Labour Government—which has rendered a greater service to the quality of life of our people than the National Health Service. I believe that the people want to see it as a National Health Service and basically as a service which is free at the point of delivery. There is no doubt that people will be interested to know what changes the right hon. Member would make.

I gave the right hon. Member plenty of notice of my questions. He has given me some answers. Let us look at what he has said on financing. He has said that there is no case for holding down prescription and other charges. We know that prescription charges will go up under a Tory Government. I asked him a supplementary question on that point because I wanted to know by how much these charges would go up. At least we know that prescription charges will go up.

I also asked the right hon. Gentleman whether there would be charges for seeing the family doctor. He said "We shall leave that to the Royal Commission. It has not made up its mind." He did not say that the Royal Commission was talking about this subject, although we know that it is. The right hon. Gentleman did not deny the suggestion in my question.

My next question was whether the Tories would introduce "hotel charges" for hospital patients. Again I asked him by how much. Again he said that we would have to wait for the report of the Royal Commission. The right hon. Gentleman did not deny that that was one of the proposals studied by the Opposition. I also asked the right hon. Gentleman what he thought of the reorganisation of the National Health Service. I put it in this way. I asked: Is it now the official Conservative view that the reorganisation of the NHS imposed on the Service by the right hon. Member for Leeds, North-East was a costly mistake? The right hon. Member for Wanstead and Woodford did not actually say that it was a costly mistake but went on to say that he believed, in effect, that it was a costly mistake. He said that there was one tier too many. He said that the Service was excessively bureaucratic—as if somehow or other the Tories did not have total responsibility for the establishment of this system.

The right hon. Member and his hon. Friends can trip around the country saying that they have decided to abolish an area tier and will have members at district level. They have reached conclusions on that. What happens when I ask whether patients will pay when they are ill or whether patients will pay to see their general practitioner or will have to pay to go into hospital? The right hon. Member has said that we must wait for the report of the Royal Commission. What sort of an answer is that? Why cannot he be honest with the country? Is it that he wants a little more time? If so, let him get up and say so. I would have thought that this was the occasion to come clean with the House and the country. Since the Tories have not been prepared to deny these suggestions, we must assume that it is their intention to make these charges.

Mr. Patrick Jenkin

The right hon. Gentleman is making bricks without straw. I meant exactly what I said. These are matters which are being looked at by the Royal Commission. I think that it would be unwise for any political party to commit itself firmly either way on this issue until we have the benefit of the Royal Commission's advice.

Mr. Ennals

I am glad that the right hon. Gentleman said that. In terms of structure, or whether there should be an area tier, or a district tier, or a regional tier, he felt it possible to come forward with his views and spell them out in articles, going round the country and creating uncertainty among those who work in the area tiers. He is perfectly satisfied to do that. But on the matter of deep principle—whether the people who are sick should have to pay at the moment when they are sick rather than pay for the services from taxation—he hides behind the Royal Commission. There is no honesty in his answer.

On what is perhaps the most fundamental question of all I asked him: Is it Conservative policy to reorganise the National Health Service into a two-tier service, one for the elderly, the chronic sick and those on modest incomes financed from taxation, and a private acute sector financed from tax deduct-able insurance premiums? To that question, which is fundamental, he gave no answer at all. Yet the right hon. Member for Leeds, North-East (Sir K. Joseph) certainly hinted at that policy over the weekend—his speech could have meant nothing else.

The right hon. Member for Wanstead and Woodford himself said in March, speaking in York: I believe we should seek ways of transferring more of the cost of the health service from taxes to insurance. This could be achieved by extending the existing health contribution, or by offering a choice (as in Australia) of insuring with the State or insuring with the private sector. What on earth does that mean? The idea seems to be to cut income tax—we know that that is the objective of the Conservative Party—but to raise national insurance. The only gainers from that would be the rich, because national insurance contributions are paid on earnings only up to a certain level.

There is a whole series of questions for the Opposition. I shall not go into all of them but I shall mention only two or three. Will the Conservatives allow the better off to opt out of paying for the NHS altogether? That is what the right hon. Gentleman's proposal amounts to, with its option to insure privately instead. Will there be two services, one for the rich and one for the poor? Will there be different premiums to pay for these different standards of service? Will parents have to pay extra premiums for their children? I shall not go further, but certainly these are questions which the electorate would expect to be brought before the House and answered.

I shall give way to the right hon. Gentleman now if he wants to deny that this is the purpose of the Opposition when it comes to presenting their plans for the NHS. I know where the answer lies. From this debate, in this thirtieth anniversary year, when the deep principles of the NHS that we hold will be shared by the public, we shall see what alternatives would be before the public if the Leader of the Opposition were ever to become Prime Minister. We are quite clear.

Mr. Patrick Jenkin

The right hon. Gentleman, when he wrote to me about these thirtieth anniversary celebrations—I hope that I am not disclosing anything that I should not—said that he saw no reason why they should be on any party basis at all. I replied in similar vein. Is he now saying that he will use the occasion to attack the Opposition for what he imagines may be their plans?

Mr. Ennals

I shall treat this very coolly. One of those parts of the right hon. Gentleman's speech that I welcomed was his conversion to the NHS—a conversion and commitment. I welcome it. I hope that it will be possible for us, during this time of anniversary celebrations, to stand together on certain common platforms about the future of the NHS. But I am certainly not going to pledge myself that, during a whole year, I shall not seek to press relentlessly upon the right hon. Gentleman and the Leader of the Opposition to say where they stand on the future structure of the NHS.

Our position is clear. We believe in a National Health Service financed out of general taxation. That is the right and fair thing to do. Of course there are limits to the amount of money that can be made available and limits to what we can do within any given budget. We should all like more money for the NHS But there is only so much that the taxpayer is prepared to afford.

I was interested to hear the right hon. Gentleman say that he would not use this occasion as an opportunity for demanding additional expenditure. Perhaps he would like to have done so, but his right hon. and hon. Friends—particularly those who have been demanding cut-backs in public expenditure—would hardly allow a sort of errant boy to stand up and make demands which would put him absolutely out of turn. No doubt he hopes for promotion—or perhaps he just hopes to stay in his present job. When the right hon. Member for Leeds, North-East made his speech over the weekend, some people in the NHS thought that his spectre was returning, that perhaps he was taking over responsibility for speaking for the Opposition on the NHS.

Mr. Ashley

My right hon. Friend the Secretary of State is making a very good speech, with which I wholly agree. If I am fortunate in catching your eye, Mr. Deputy Speaker, I shall nevertheless be criticising the Government and asking for more expenditure. But my right hon. Friend should sit down now and allow the right hon. Member for Wanstead and Woodford (Mr. Jenkin) to spell out exactly how much the Opposition would give to public expenditure for the NHS if they took office. That figure has not been forthcoming. Why does not my right hon. Friend listen to the figure put forward for increased expenditure on the NHS by the right hon. Gentleman?

Mr. Ennals

I do not sit down because I suspect that, if I were to do so, there would be a blank silence from the right hon. Member which would be readily filled by some of my right hon. and hon. Friends waiting to get into the debate.

Of course we have only so much money available. But, even so, the Government have consistently, year by year, increased the total resources available to the NHS. In spite of economic difficulties and restraints on public expenditure, we have given priority to the NHS because we recognise its vital role in the lives of ordinary people.

Since we took office in 1974, the proportion of our gross national product that is spent on the NHS has risen from the 1973 figure of 4.7 per cent. to 5.8 per cent. in 1976. Certainly that is not enough, with all the needs, to solve all the problems. I have made that clear on many occasions. We are under heavy pressure on many fronts, and I was interested in and agreed with the point made by the right hon. Gentleman which was generally in line with a statement made two or three weeks ago by the right hon. Member for Down, South (Mr. Powell), as a former Minister of Health. The right hon. Member for Down, South said: The National Health Service is not about to break down. Of course it is not; to suggest that it is is a lot of nonsense. Such a statement is nonsensical, It is no nearer breaking down now than in 1958, and also no further away. The life of the Service is a continuing confrontation between finite resources and infinite demand. I have never denied the pressures on the NHS. I live with the NHS. I travel the country, and I know what people feel and the difficulties they face. I will touch on a few. We have a legacy of neglect in the Cinderella services for the mentally ill and the handicapped and the care of the elderly. Before I came back to this House in 1974, I spent years visiting precisely those hospitals and seeing the problems we have to face now. We have still an unfair allocation of funds across the country, which we are steadily putting right, thereby remedying an injustice which has been done over the years to such regions as the North, the North-West and Trent, which have been denied funds to which they were entitled.

We have a growing number of elderly people making bigger and bigger demands on the Service. I am not saying that this is a tragedy. Indeed, it is a tribute to the National Health Service that people are living so long, but they make demands on the Service.

We have made rapid advances in medical techniques. We have new and expensive equipment and treatments which had not been thought of a few years ago. We have long waiting lists for treatment, but these are often for treatment that was not available a few years ago.

New hospitals have been coming on stream, replacing older outdated facilities, with all the problems of closures, changes of use, loss of familiar local hospitals and so on.

The right hon. Gentleman accused me of being less than frank in "The Way Forward." Of course, he is very selective. But I direct his attention to paragraph 3.3 on page 18, where I said: In some districts, long sought improvements will be further delayed. Some hospitals will have to continue to manage with facilities which are outdated or inadequate. The expectations both of the professions and of users will not be fully satisfied. In other places where services are not under the same pressure, the provision of new facilities which are expensive will have to be postponed. This is the price which has to be paid if progress is to be made in those parts of the service which have been given priority for development. Could any Secretary of State be more frank than that in indicating the problems that the National Health Service has to face, and pointing out that, in the context of scarce resources, we have to use courage and show some leadership? Even when resources are tight, we must get our priorities right, and shift resources into those geographical areas which have been neglected, and into those parts of the Service which have been neglected. That means determining priorities, and that is the Secretary of State's task.

Mr. Cranley Onslow (Woking)

Can we have the Secretary of State's assurance that, before he ends the speech, he will touch on the very important point which many people feel to be one of the problems of the National Health Service—that a growing minority of employees in the National Health Service is more interested in rights than in duties?

Mr. Ennals

That is a very serious accusation. I shall be coming soon to industrial relations, but I shall not wait five minutes before dealing with that intervention.

Mr. Hoyle

Will my right hon. Friend say something about another part of the Service that is under severe pressure—the accident and emergency services? I am completely alarmed when I see a letter from the district administrator in Burnley which talks about closing down the Burnley accident and emergency service if more staff cannot be obtained. It also speaks of having talks with Blackburn, which is also under severe pressure. This sort of difficulty is not confined just to my area but is to be found countrywide. There is a need for more money. If the threatened closure were to take place, there would be a great outcry from my constituents. I hope that my right hon. Friend will say something about that aspect of the service.

Mr. Ennals

I shall not make any immediate comment on the accident and emergency service in Burnley, otherwise I shall have to deal with other similar situations. But the importance of the additional £50 million in the Budget package is clear, and it will help several different parts of the Service. I shall not spell out, as I have done previously, the different ways in which help is being given. Having given way a good deal, I feel that I should now be permitted to get on with my speech in my own way.

The right hon. Gentleman mentioned administration costs. He referred to the increase in the administrative staff employed by the National Health Service since 1974. He has done this on many occasions. All over the country he has been talking about a swollen bureaucracy, the increasing number of staff, and so on. It is true that there has been an increase from 82,700 administrative and clerical staff in 1974 to 98,500 in 1976, the last year for which we have reliable figures, but that was the direct result of the Conservative Party's reorganisation.

Mr. Patrick Jenkin

According to the Ninth Report of the Public Accounts Committee, in the seven years before the reorganisation of the NHS, the number of staff employed by former hospital authorities in England and Wales increased by 40 per cent. from 39,296 to 54,974. I am not quite sure what con- clusion the right hon. Gentleman is drawing.

Mr. Ennals

What I conclude is that, quite apart from the figures I gave, which showed the increase as a result of reorganisation, the right hon. Gentleman's Government, when in power, were unable to deal with the situation.

I share the right hon. Gentleman's desire to cut unnecessary administrative costs, but much of the present criticism, as he well knows, is ill-informed and unfounded. Many administrative and clerical staff, such as ward clerks and medical record officers, make a direct contribution to services to patients, and, by relieving them of clerical duties, enable doctors and nurses to spend more time on patient care. Nevertheless, I felt that the administration of the Service ought to be slimmed. Therefore I did something about it.

After discussion with the chairmen of regional health authorities, a standstill on management costs was introduced in 1976. As a second step, and with the agreement of regional health authority chairmen, all regions were required to reduce their management costs to a common proportion of their revenue allocations—5½ per cent.—by 1980. Overall, this will result in a reduction of about 5 per cent. in real terms in the level of management costs at 31st March 1976 and will free about £11 million a year to be spent on services more directly of benefit to patients. That figure of 5 per cent. is not bad by any standards for a national or local organisation.

Most regions have already achieved their 1980 objective. The number of managerial posts has already been reduced by over 2,000 since 1976. I was very glad that the right hon. Gentleman intervened with his figures, which showed that when his party was in power it not only imposed a structure which virtually forced additional administration but was unable to restrain it.

I say with some pride that we have been able to make this reduction as well as achieving a major saving on non-staff costs. If, as I expect, the present trend continues, in the current financial year some £10 million will be available to be spent on services to patients which, without our initiative, would have been spent on management.

I want no lecturing from the right hon. Gentleman on the administration of the National Health Service, after the mess that he and his party made of it when they were in power. I hear too much of people who get cheap applause by pointing fingers at the administrators. We have some very fine administrators in the National Health Service. There are not only men of long years of experience. There are also young men who have been trained in the Service and are doing a fine job. It is not they who should be the target of attack. We should attack the system itself.

The right hon. Gentleman referred to industrial relations. Of course there are industrial problems in the National Health Service. There have been more industrial problems since the reorganisation of the NHS than there were before. One reason was the extent to which NHS pay had fallen behind that in the private sector at the time when we took office. A second reason has been the management structure for the NHS which we inherited, under which it is by no means always clear where management responsibility lies. This is one of the questions that the Royal Commission on the NHS is examining.

Until we took office, industrial relations in the NHS had been sadly neglected. It was my predecessor who asked Lord McCarthy to study the working of the Whitley machinery at the national level. Since we received his report, intensive training courses for industrial relations specialists have been mounted under the auspices of the National Training Council. I am doing all I can to develop the personnel function as a specialist service in the NHS.

I am as anxious as anyone in this House to find ways of avoiding local industrial action which disrupts services to patients and causes irritation to the public and to those who work in the Service. Our Health Service is too precious to be marred by irresponsible industrial action.

I have already held a meeting which brought together leaders of the doctors and the NHS trade unions representing the largest groups of staff to discuss these questions. What was remarkable was that, as far as I am aware, a meeting of this kind had never been held before. I have also discussed this matter with representatives of the Royal College of Nurses and the Royal College of Midwives. I shall be meeting again to discuss the possibility of agreeing a code of practice to define the parameters of industrial action in the NHS.

We must improve the local disputes procedures. The NHS is not a factory but a service for patients. Everything must be done to ensure that the interests of patients come first. One must consider the fact that we have working in the National Health Service almost 1 million people of all sorts of skills, backgrounds and organisations. The amount of industrial upset in the NHS is minimal. However, every time something happens at local level it is big news. I am not surprised at that, but I think that Conservative Members should keep it in proportion and recognise that the vast majority of doctors, nurses, technicians, porters and ancillaries are dedicated to the cause of the NHS. If our system is not good enough to deal with industrial disputes, it is the system that we must get right.

On the question of waiting lists, the last figure I have shows that in September 1977 there were 594,000 on the waiting lists as against the peak of 607,000 in December 1976. Of the total waiting last September, 40,000 cases were designated as urgent. There is a serious problem, but the fact that the figures have gone down since December is a matter for some satisfaction, even though the fact that they are as high as they are must cause us concern.

This is not a new problem. There has been a waiting list figure of around 500,000 for most of the life of the NHS. Although it is sickeningly high, one should consider that if that figure is taken as a proportion of the total number of patients who are dealt with, it is considerably less than it was some years ago.

The increase in waiting lists during the life of this Government was caused not by under-financing but by industrial action. The number of main operations performed in hospitals fell by 250,000 between 1974 and 1975. The main reason for this was the dispute with the junior doctors. The origin of that dispute can be traced to the previous Government's pay policy and their unwillingness to concede a new contract for junior doctors. The new contract negotiated by my predecessor paved the way for the reduction in waiting lists which has since occurred.

We have considerable ground to make up. Most urgent cases are nearly always admitted quickly. Thus the main problem is the time spent waiting for treatment of conditions which, although not life threatening, nevertheless involve pain, discomfort or incapacity which could and should be avoided. That is why I have told the health authorities that a proportion of the extra £41 million allocated to the Health Service in England this year should be spent in ways to help cut down the waiting list problem.

On the question of priority for the Cinderella services, it is time for a complete rethink of our attitudes towards elderly people, the kind of help they need and the contribution that they can make to the rest of society. This is one of the biggest pressures on our health and personal social services. For this reason we are publishing a discussion document on the elderly in a few weeks' time with a view to stimulating public debate to help us with the preparation of the first ever White Paper on the elderly next year.

Nor have we forgotten our commitment to the mentally ill and handicapped. For example, the last six or seven years have been years of action by society in tackling the problems of mental handicap.

In 1969 there were 24,500 day places in adult training centres in England and Wales. Today there are 37,900 places, and we are well on the way to achieving the target set in the 1971 White Paper of 72,000 places by 1991. The number of children in mental handicap hospitals is now only 4,500—already below the White Paper target for 1991. No one can be complacent about the mentally sick and handicapped and the elderly. We must put more and more resources into the Cinderella services and do so with determination.

Mr. Carter-Jones

I do not intend to be helpful to my right hon. Friend; I never am on these matters. However, nor do I wish to be helpful to the right hon. Member for Wanstead and Woodford (Mr. Jenkin). If there is a perinatal death rate in an area that is well above national average, we should not talk about not intervening and allowing local autonomy. Surely we should do something when 4,000 babies die and 10,000 kids are born disabled. We cannot keep on saying that there should be local autonomy and allowing that to continue. Let us get our priorities right.

Mr. Ennals

At this moment I am not going to make any new statement about the powers of local authorities. Nor will I go into the problems of establishing minimum standards which, I think, eventually will be a necessity. I recognise so clearly the problems that my hon. Friend has raised that in my statement on the allocation of £50 million I said that additional money would be devoted to capital projects in inner cities—on-the-spot accommodation for health visitors and special care units for new-born babies, and health education. All these things are designed to deal with the serious problem of perinatal mortality rates.

Mr. Paul Hawkins (Norfolk, South-West)

Although I agree with my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) that the Secretary of State cannot realise what is happening in every region, I know that he understands Norfolk's problems pretty well. Therefore, I want to ask him about the waiting lists and the serious extent of the lack of geriatric services in Norfolk. Will he tell us whether the amount we are to receive from the £50 million is £2,400,000 as stated recently in the Eastern Daily Press, or £1,700,000 as the Eastern Regional Health Authority told me the other day.

Mr. Ennals

That second figure that the hon. Member gave was correct for the East Anglian Region. In the East Anglian Region Norfolk is an area of considerable deprivation, which has the largest growth rate. I am not saying that because I am a Member for a constituency in that area but because that is what the RAWP formula shows.

In looking at the problems of the National Health Service we must get into proportion the major problems and the major achievements of the NHS. I want to touch on two aspects. We have increased the number of doctors, nurses and midwives in our hospitals. In the three years between 1973 and 1976 the number of doctors went up by more than 3,000 and the number of qualified nurses by 21,000.

Our hospitals are treating more patients. During the same three years the numbers of in-patients and day patients rose to record levels. There are many achievements of which the country should be aware. The NHS is alive, active and battling with severe problems and coping.

If the Conservatives should come to power the NHS, as we know it, might come to an end.

Mrs. Lynda Chalker (Wallasey)

Non-sense.

Mr. Ennals

Unless the hon. Lady is denying what her right hon. Friend said about an insurance-based system, I am entitled to make my claim. The official spokesman on policy for the Conservatives, the right hon. Member for Leeds, North-East, said so as well, and if she is saying that that is a load of bunkum, I agree with her. Opposition spokesmen are going round the country making vague noises about further reorganising the structure of the NHS and the basis of its funding. This is disturbing for those who work in the Service and for patients.

The right hon. Member for Leeds, North-East has great experience in these matters. He was responsible for the 1974 reorganisation, which his party recognises was a failure, and now he is bringing forward a new proposal. I suppose the Conservatives have seen the error of their ways and what they wish to destroy was something of their own creation. It is a callous case of infanticide. They brought the creature into the world and propose to kill it without even waiting for a trial.

The Opposition have failed to give answers to four of my fundamental questions, and this will be noted. We shall ensure that it is noted. Some things are clear from what the right hon. Member for Wanstead and Woodford said. To put it at its lowest, the Conservative Party is considering major new charges in the Health Service, including charges for visiting one's GP and charges for being in hospital with, perhaps, other charges as well as increased prescription charges. They are preparing to cast aside the basis of the NHS which is a national service financed out of taxation.

Mr. Patrick Jenkin

Absolute rubbish.

Mr. Ennals

The Service at present is available to all on the basis of medical need.

Mr. Patrick Jenkin

The right hon. Gentleman was kind enough about 20 minutes ago to welcome the commitment to the National Health Service that I gave on behalf of my party. He should tear up his peroration and say something sensible.

Mr. Ennals

It is easy for the right hon. Gentleman to say in one sentence that he believes in the NHS and for him, his right hon. Friend the Member for Leeds, North-East and his other hon. Friends to spend the rest of their time putting forward proposals that would destroy the NHS and the basis on which it is constructed.

If the right hon. Gentleman had been prepared to deny my allegations, the country would know where it stood. If the hon. Gentleman who is to wind up for the Opposition claims that what I am saying is a load of nonsense, he will have his chance to say exactly what the Conservative Party policy is. His right hon. Friend blatantly failed to do that.

5.12 p.m.

Mr. W. R. Rees-Davies (Thanet, West)

I thought that it was appropriate that the Secretary of State dropped his trendy peroration on the floor just before he finished. It was better that it rested there.

The matters that I want to say a few brief words about arise from the fact that, strangely enough, one gets certain advantages when one becomes disabled. I derived certain advantages from the fact that I was knocked down on my way to the House when trying to attend for a three-line Whip. In the event, it would not have been very helpful to have reached the House, because we were soundly defeated on that occasion.

Nevertheless, it is not until one is disabled that one sometimes sees the small ways in which disabled people can be helped. I pay tribute to the Minister with responsibility for the disabled who is dealing with the Access for the Disabled Week that is to be held in June. Schools and local authorities are participating, at the Government's instigation, to see what part they can play.

I was involved in a small film on this matter recently and I found myself in the middle of Margate in an area that had been specially designed for the disabled. There was an excellent ramp to help disabled people to get into the local authority buildings and it was a perfectly designed centre. The problem was that, in trying to get to the centre, I was bamboozled because there was no place where I could get on to the pavement in a wheelchair and, once on the pavement, when I tried to get down, I was left like a stranded whale in front of my constituents.

A few changes to kerbstones, alterations to the entrances of hotels and boarding houses and a little more thought by those in charge of cinemas and places of entertainment would do a great deal to help access by disabled people. Pregnant women would also get on the bandwagon. There are many opportunities for improvements and much of the work can be done on an all-party basis.

While I was in the Westminster Hospital, I saw the excellent work being done not only by the staff but by the volunteer helpers, some of whom turned out to be my friends. It is amazing how valuable their work is. They not only look after the books and sweets but help with the evening meals. They also provide a rather welcome change of face from the general staff, and it is entertaining to see them.

I invite the Minister to make an appeal, through the hospitals and elsewhere, to encourage a considerable increase in this sort of voluntary help. It is in the best traditions of this country and could be very much improved. Many local authorities would find local people willing to help in that way.

In addition, it is not the job, if it can be avoided, of trained nurses and sisters to serve meals in hospitals. This could be done by voluntary helpers and paid auxiliaries. In the Westminster Hospital we found at various times, particularly in February, that, through illness and other causes, there was an acute shortage of nursing staff. The more we can encourage the use of auxiliary staff, whether paid or voluntary, the better it will be.

In East Kent and Thanet we have a grave problem with waiting lists. The waiting time for ophthalmic treatment is more than 12 months and for orthopaedic work, including hip treatment and other expensive work, the delay is more than a year and, in some cases, two or three years. We badly need another operating theatre and additional services in the Royal Sea Bathing Hospital. We must try to encourage the recruitment of the necessary additional staff and find the money for that. The question is, where we save the money that is required.

I take the point that my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) may be partly responsible, with his colleagues and, indeed, all of us in the House, for not getting the structure right. We must now get it right and we must begin by ensuring that the NHS is more of a local service wherever possible. We must set up and encourage the expansion of the district health service and abolish the county services at an early date.

The Kent County Health Authority is unnecessary. The region is necessary, but its task is communication and coordination. Let us keep the regions and districts and get rid of the county authorities. I am advised that this would save about £200 million.

It is a great change that I am proposing. I believe that the administrative services are grossly overmanned, although many of the staff are competent and able. I am not criticising the quality of the staff. I am merely saying that there is too much duplication. For example, when we write a letter on an NHS matter it is necessary to send six copies. We write to the Minister and copies go to Sir John Donne, the Kent regional chairman, the Kent regional authority, the district, the specialist or doctor and the person who has raised the matter. It is an impossible situation. We must make big cuts in the whole area of administration.

It seems that there is only one basically controversial difference between the two major parties. My right hon. and hon. Friends want to see the continuance and expansion of the private sector. We want to save money to spend on the public sector. That is our aim. If we can reduce dependence upon the NHS by payment and by setting up various different organisations, we shall be able to do a great deal in that direction. I should like to see many public companies pay for the NHS by supporting a nursing home and their own staff. There should be encouragement wherever possible to increase the sum that has been obtained from patients overseas and to expand our service to make money in that sector, which could then be spent on the doctors, the services and all the other things that we need.

There are many other matters that I could raise, but I end by saying that we should introduce financially careful local balance sheets in the local district councils and ensure thereby that we provide management incentive at that level and the best of value for money.

I am indebted to you, Mr. Deputy Speaker, and to the House for having the opportunity of making this brief contribution. I hope that something will be done by the Secretary of State, especially as regards voluntary service.

5.23 p.m.

Mr. E. Fernyhough (Jarrow)

I am sorry to see that the hon. and learned Member for Thanet, West (Mr. Rees-Davies) has a further disability. I am sure that we all wish him a speedy recovery from his latest handicap.

Having been complimentary in that way, I must say that if Nye Bevan had heard the hon. and learned Gentleman's speech he would have been killed by it before his tragic death. I was in at the birth of the National Health Service. The Service was introduced by Nye Bevan to offer that in which I had been brought up to believe—namely, equality. It introduced equality in the one area in which there should never be any inequality. When it comes to health, the least of us is as important as the greatest of us. There should never be any question of inequality.

I do not mind others buying larger houses, larger motor cars or having holidays abroad. I am not denying them those things. They can have all those things. But once we say that one man, one woman or one child has a right to jump the queue so as to receive medical treatment the more quickly—it might be that such a person is suffering from an identical illness or that the individual with the money is not suffering as much pain—we are departing from the morality on which I was bred, born, reared and suckled.

Over the many years that I have been in this place I have gone through some dreadful days and weeks. When some of my right hon. and hon. Friends in former Governments decided to stick an unnecessary needle into the Service, to impose some charge upon it, I felt that to be a personal attack. I felt that we were surrendering to the forces of greed. I have always felt deeply about these matters.

We have always had a national health service. Such a service existed even before the present Health Service. After all, we have a national health service in the Army, Navy and Air Force. No one would ever pretend that any of our Service men—I would attack anyone who tried to say this—should not receive free of charge whatever they want in the way of medical, optical, surgical or dental treatment. None of us would ever think for a moment of questioning the right of every man in the Services to have such treatment. It would never he questioned that only the best is good enough. There would be no question of any inferior service. That is a wonderful principle and I want it extended universally to every man, woman and child so that there is never any question but that if a person needs treatment, he will get it immediately, even if he does not have any money.

When the right hon. Member for Wan-stead and Woodford (Mr. Jenkin) said how he might be able to make more money available he talked about the provision of school milk for the children and said that we need not do that.. He spoke in the same way of school meals. How mean can we get? How low can we sink? These are the basic expressions of a civilised Christian society.

Mr. Patrick Jenkin

It is a matter of priorities.

Mr. Fernyhough

Of course it is, and we shall note the right hon. Gentleman's priorities within the next three weeks when, no doubt, he will be voting for further reductions in income tax. I can prove to him that repeatedly in my election addresses I have told the electorate that if it wants tax reductions, it should not vote for me. I cannot do what I want for Jarrow and its people on the basis of reduced taxation. I want a free Health Service. I want it to be as efficient and as capable as possible. I want waiting lists reduced. I want everyone to have the speediest treatment possible. I am prepared to pay for that and I want everybody else to pay for that.

It may be said that at my age that is a natural point of view. However, throughout my life I have been more afraid of being killed by cancer than by Communism. I have never lost any sleep as a result of worrying whether I might be killed by Communism, but I have had the occasional bad moment when the doctor has said to me "You are not up to the mark. You are smoking too much." When he has said that I have thought "It's the old cancer bug that is getting me". Some may say that in such circumstance it would be a self-inflicted wound and that I should not receive any treatment. All right, but I want those who need treatment for chest, heart or anything else to receive it.

I am prepared to defend in my constituency whatever income tax measure may be necessary to give us the Service that Nye Bevan started to build. Whatever any Government in post-war years have done, no piece of social legislation is comparable with the National Health Service. I tell Opposition Members for their own benefit and advantage that, although there are many things that they may be willing to attack and to undermine, they will undermine their own standing with the ordinary people of this country if they tamper with and try to crucify the one thing of which the British people are most proud—their National Health Service.

5.31 p.m.

Mr. Geoffrey Johnson Smith (East Grinstead)

First, I should like to thank the Minister of State for so kindly, courteously and helpfully receiving a deputation which I led from East Grinstead concerning the lack of provision of geriatric services and the problems which face people in that area. I do not want to weary the House—I know that many hon. Members wish to speak—with a detailed exposition of the problems facing East Grinstead and which we explained to the Minister. East Grinstead is not the only area which suffers from a lack of proper care for the old, but it is a growing and serious problem.

I believe that it has something to do with administration. I think that East Grinstead—I promise not to be too local in what I say—suffers, as probably other areas do, not only from the top-heaviness of administration but from the multiplicity and confusion of it. East Grinstead is not the only place which is at the crossroads of different health authorities, but such a situation leads to great confusion in the minds of the elderly and those who have responsibility for administration.

I welcome any steps which could lead to the simplification of the administration of the National Health Service. Reference has been made repeatedly to the fact that the Conservative Government had something to do with this problem. If it is as bad as it is supposed to have turned out to be, the responsibility is clear. We should do something about it. No doubt the Government are waiting, as is my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), for the Royal Commission to say something about administration. There is only one comment that I should like to make in passing. We should give some credit to the reorganisation which took place under my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph), because it brought together the three different parts of the Health Service under one roof. If that is the kindest thing to be said about it, it is worth it on those grounds.

Another aspect arising out of the East Grinstead situation is financial. It is intolerable—more and more people throughout the country are beginning to realise this—that as the years go by we seem, at what I should call the point of consumer medicine—there are other aspects of medicine to which I shall turn later—to suffer from a lack of resources and a decline in standards.

I respect what was said by the right hon. Member for Jarrow (Mr. Ferny-hough). He belongs to a generation which felt that this was the birth of a noble ideal. I share his idealism. What I have to say to him and to other Labour Members may make it appear that I have deserted the ideal—that I have come to preside over the obsequies of the death of the ideal. I know many people in the National Health Service who believe in that ideal but who are equally committed to changing the structure of the NHS. They believe that unless we do change it, we shall see the complete destruction of that ideal.

I do not want to bring my wife into this matter, but, if it is of any interest, she is a part-time doctor in the NHS. I understand the value of the work that she and her colleagues do. I give praise to all at every level in the National Health Service who practise a high standard of medicine in many quarters and give devoted and dedicated service which is second to none.

Having said that, there is no reason why we should be complacent. I do not accuse anyone of complacency. I believe that Labour Members' political ideology runs away with them and blinds them to sad defects in the NHS.

The quality of administration is bad, not because the people administering it are bad but because the administration is top heavy. There are too many administrators. We now have 100,000 more nurses than we had in 1965, but we have a shortage. That cannot be right. Too many are administrators.

The ratio of doctors to administrators—I shall not weary the House with figures they are there for anyone to see—is appalling. It is deteriorating. The bureaucracy groans. It has something to do with the structure, not as my right hon. Friend the Member for Wanstead and Woodford pointed out, with the reorganisation of a few years ago.

I should like to quote from a distinguished member of the medical profession whose comments I saw recently. He said: The dangerous delays and utter frustration of such a system can perhaps be imagined, but not really appreciated by anyone who has not personally suffered it. And this top-heavy, overmanned administration has to cope with such vitally urgent problems as dissatisfied medical staff, militant trade unionists, insufficient funds, ageing facilities (70 per cent. of Britain's hospitals are pre-war and 50 per cent. of these are last century!) and a demanding public. That is the first point which arises out of what I see as a confusing situation in one tiny corner of Britain.

I turn now to the financial aspects. It is an interesting fact that in 1978—many years after the end of the war and many years in which country after country settled down to look at its social services—Britain is the only country in the Western world which has sought to finance its Health Service almost exclusively from taxation. That was part of the ideal to which the right hon. Member for Jarrow referred. Therefore, we can say, as has been said today, that at the point of delivery the Service is regarded as "free".

I do not want to underestimate the contribution to the peace of mind of a patient, or any member of the public, that the knowledge that he does not have to pay can bring. It can bring a great deal of comfort, particularly to someone who suspects that he is about to enter into a catastrophic phase of his wellbeing which may result in long, protracted diagnostic procedures which could lead to a great deal of expense and some agony of mind. I recognise that that aspect of the NHS has removed much anxiety, but I should like to make some comments on it.

I do not think that this free Health Service about which we talk should remove from the whole of our population—this has been the trend recently—the right for all, be they rich or of limited means, to pay through insurance—if they wish to make some sacrifice, as the majority of people with private insurance schemes do—for the provision of more comfort for themselves and the medical care of their choice. There is a difficult balance between equality and freedom of choice, and it is not resolved by slogans. I believe that there is room here for some freedom for both the medical profession and, indeed, the individual citizen. A society does no good to the noble ideal to which the right hon. Member for Jarrow referred if it denies that right to people. There is a balance here. I believe that it is unwise to weaken the will of the citizens to devote part of their resources to medical care. Unfortunately, that is what we are doing now.

I said that no country had followed our example of setting up a basically "free" Health Service out of taxation. Perhaps that is because other countries suspect that no country in the world has been able or has the will to provide sufficient funds to ensure the maintenance of a comprehensive State medical service. But I can think of one such country—the Soviet Union.

Mr. William Molloy (Ealing, North)

It does not.

Mr. Johnson Smith

All right, it does not. I am told that it has a comprehensive State medical service. The Russians do not allow the private market to flourish in the drug industry on the pharmaceutical side or with regard to the individual patient. However, I suspect that no country is able to sustain a comprehensive State medical service.

I believe that the countries to which I refer in the Western world are as caring as we are. They have an equally dedicated concept of the nobility of the medical profession and of the regard that we should have, as members of legislature, that people, regardless of their means, should have the very best possible medical care and attention that the nation can afford.

I do not believe that we have any monopoly of moral care, yet it is interesting that so many of these countries spend more on health than we do. It used to be said that other countries spent more on health but that this did not necessarily indicate an increase in the quality of care. It was said that this was because it was more expensive in other countries and they were more commercially minded. That used to be argued about the United States. I doubt whether that argument can seriously be sustained now.

If ours is the cheapest Health Service in the West, that perhaps has now less to do with our being more cost-effective than other countries and more to do with the fact that our standards are falling behind, our hospitals are more out of date, the staff are more badly paid and our waiting lists are too long. So it makes common sense and is furthering the ideal to which the right hon. Member for Jarrow referred to find supplementary methods of ensuring additional funds for the provision of health in this country.

Mr. Molloy

Is the hon. Gentleman's philosophy that the only way in which ordinary people can obtain the finances for a Health Service is for the rich people to be ill? What happens then, as is happening now in Great Britain, is that many of those who have private medical treatment in our National Health Service hospitals cheat and do not pay.

Mr. Johnson Smith

I do not want to get drawn into that sort of ridiculous statement.

Mr. Molloy

Of course the hon. Gentleman does not.

Mr. Johnson Smith

All I know is that with the phasing out of pay beds we are getting more and more polarisation of private and State medical care in this country, which is a reprehensible step, in my view.

It is alleged now—we have to study this carefully—that other countries with less ambitious schemes than ours are beginning to produce better medical care. The Australians consider things carefully. They have a compulsory national insurance scheme, except that the very destitute are not expected to pay. They back their national insurance scheme by State subsidy as and where necessary.

In France and in Canada, I understand, the public enjoy the status of private patients. That is a status that we regard as something to be enjoyed. It can give an independence of attitude to those concerned. In France a charge has to be paid by a patient on a visit to his doctor. For ordinary people no one would want a charge to be pitched so high that it becomes a deterrent, but it might well be argued that a nominal charge can help to prevent abuse.

Mrs. Dunwoody

How much?

Mr. Johnson Smith

I am not going into details. I am talking now about the ideal. It is not too difficult to devise a system in which there is a nominal charge, which helps to prevent abuse and encourages the private independence and individuality of the patient.

I therefore welcome the fact that the Royal Commission is looking at all these problems. I think that it should. It would not be doing its job unless it did. This is—or I hope it will be—one of the best Royal Commissions that this country has appointed for many a long year. It is high time that we considered the problems which vex so many of us who want to see the opportunity for better medical care increased and improved.

I do not believe that the areas that I have mentioned or those mentioned by my right hon. Friend strike fundamentally at the basis of the National Health Service. I shall say why I think that is so. This is the problem that we have to face. We have moved away from a basically horse-and-buggy type of medicine in this country. The sort of medical care to which the Chancellor of the Exchequer referred involving kidney machines, the increased cost of modern diagnostic procedures, the capitalisation of medicine, the cost of expensive drug treatment and the transplants is that which people will increasingly demand. If it is assumed that the Health Service from taxation can meet people's needs in those areas as well as in the ordinary day-to-day areas, I believe that we shall see the death of a very noble ideal.

5.46 p.m.

Mr. Jack Ashley (Stoke-on-Trent, South)

It is always interesting to follow the hon. Member for East Grinstead (Mr. Johnson Smith) although he would not expect me to go along with many of his views. But those views were similar to those put forward by the Shadow Secretary of State. At least the hon. Member for East Grinstead was prepared to give way when he was interrupted. I am sorry that the Shadow Secretary of State cannot be present. He is very busy and I am not blaming him for that, but I was disturbed that he could not give way to interruptions from Labour Members. I am always willing to give way and I would hope that other Members are always willing to do so. My hon. Friend the Member for Ealing, North (Mr. Molloy) and I were very concerned that the right hon. Gentleman was not prepared to give way on a basic issue, which was that if we are to listen to Conservatives putting forward their views about the National Health Service they should spell out exactly how they are prepared to pay for the improvements that they propose. We welcome their suggestions. We are always glad to hear of improvements. But they must spell it out.

We do not mind having a debate, but we object when Conservative Members put forward a policy and say "We are not prepared to give way to challenges" when asked to say exactly how much they are prepared to pay and what kind of a Health Service they are prepared to pay for.

I am glad to see that the Minister of State is present. The last debate that we had about the National Health Service concerned kidney machines and on that occasion no one was present from the Department of Health and Social Security on the Government Front Bench for part of the debate. I think that that was absolutely disgraceful. I hope that never again shall we have a debate on any aspect of the National Health Service during which Back Benchers are treated with contempt by the Department of Health and Social Security.

I listened to the hon. and learned Member for Thanet, West (Mr. Rees-Davies) with great interest and great sympathy. It is very rare that I listen to him with sympathy because on every issue we are diametrically opposed, whether it is the law or whether it concerns the Home Secretary, the Prime Minister or whatever. However, I share his views that we should all try to pull together on the question of disablement. There is one point on which I would disagree with him. He said that there are advantages to being disabled. That is nonsense. There are no advantages to being disabled. They are all minuses. One loses in every way, whether one is blind, deaf, dumb or paralysed. Whatever disablement one might have, one has a profound handicap. There are no advantages. I therefore disagree with the hon. and learned Gentleman, even though I appreciate the spirit which motivated his remark.

When we speak of the National Health Service and the way with which it deals with disabled people we are often far too preoccupied with physically disabled people. I have been guilty of precisely that error. We neglect the problems of mentally ill people and mentally handicapped people; such people live in the shadows of the National Health Service and the nation at large. I wish to beg forgiveness for my sins of omission, because I am as guilty as anyone of failing to appreciate the appalling problems of these people. I pay tribute to the Secretary of State, who has a fine personal record of working for MIND, and to his compassionate concern for mentally ill people and mentally handicapped people.

I also wish to pay tribute to my hon. Friend the Member for Basildon (Mr. Moonman), who has been assiduous in fighting a lone battle in this House for these people. I know that he has been supported by some hon. Members, but he has fought practically by himself for the mentally ill and mentally disabled. The message I wish to convey to my hon. Friend publicly is that the very small band that supports him will be enlarged. That group now has interested many Members who are at last becoming aware of the fantastic problems of the mentally ill and mentally disabled.

It is true that the physically disabled have a degree of public sympathy and it is equally true that the mentally ill and mentally disabled have suffered a large degree of public indifference, or indeed derision. It is time that we ended that situation, but in order to end it we do not want only fine words from the Department. We have had some fine words and some action, but we want now to see a radical transformation in the place of the mentally ill and mentally handicapped in our society. We want to see the Department using its powers in this context and we want that to be backed by the full and enthusiastic efforts of the Treasury. Furthermore, we want the warm and wholehearted co-operation of the local authorities.

I do not presume for a moment that we shall achieve that situation overnight, but the extent of the problem appals me when I examine it. Let me tell the House that one in eight women and one in 12 men will receive in-patient treatment for mental illness. I am appalled, especially when one recognises that that is additional to the 5 million men and women who annually seek tranquilisers or other drugs from their general practitioners. I understand that the Secretary of State has said that each year about 600,000 people receive specialist psychiatric help.

I have examined the evidence given to the Royal Commission by MIND. It is a marvellous organisation and its work moves me deeply. To my astonishment the share for the mental health services out of the total capital and revenue programme for the National Health Service and the social services has dropped from 8.2 per cent. in 1970–71 to a figure of 7.8 in 1975. What moron is responsible for cutting expenditure when the problem is so large? Is it a Minister? Is it something that has been done by default? Is it a statistician who has gone out of his mind or is it just a matter that has slipped through because some of us have been preoccupied with physically disabled people? I hope that the Minister will say whether this under-financing is something we are prepared to tolerate in health problems or whether there is to be a radical, instant and immediate reappraisal.

I believe that a time in which 65 per cent. of our psychiatric hospitals were built before 1891 and in which 40 per cent. of all psychiatric hospitals are over 100 years old is not the right time to slash expenditure. We must bear in mind the fact that the most recent costings in respect of hospitals reveal gross discrepancies in expenditure between acute hospitals and psychiatric hospitals.

The amount of expenditure on food, laundry, lighting and heat and on medical and nursing care is worse for the mentally ill and mentally disabled people. What a scandalous situation that shows. If one has a son or daughter who is mentally disabled, does one expect that son or daughter to be treated with derision and to be given less food, fewer clothes, less light because of being mentally disabled? That is a scandalous and outrageous situation. It is the Government's responsibility that they have allowed that kind of situation to happen.

I have been campaigning for a long time for various groups of disabled people, but are these groups of mentally disabled people to be cast aside, especially after the so-called exposures of the Dick Crossman era? How long is it since Dick Crossman's exposé of this scandal? What has the House of Commons been doing since? I do not profess to know the answer, but I hope that when an answer is given to this debate, good reasons will be given to the House for allowing this situation to develop. A great number of words have been used when dealing with this subject. The question now is what sort of action we shall see from the Government.

The Department has suggested that we should examine ways in which the Department can assume a more strategic role in ensuring that the policies for the care and treatment of the mentally ill are implemented at area level. It is always a problem. How can the Government, with the best will in the world, compel area regional or local authorities to do what is necessary? I do not pretend to know, but I have one proposal to put to the Minister. I suggest that the Government should earmark funds categorically and say to the local authorities "Do not fiddle about. Do not start building bypasses with this money. Allocate it as a specific grant for mentally ill and disabled people". We have been pressing for a very long time for specific grants for physically disabled people. The time has now come when we have to insist that local, regional and area authorities are instructed on what should be done.

I appreciate that joint funding has made a major contribution towards solving this problem. I want to congratulate my right hon. Friend the Secretary of State for Social Services and his colleagues on initiating joint funding and on pressing as strongly as they can on that score. But this commitment to earmarking funds by local authorities is of crucial importance and I hope that pressure will be brought to bear by the Government on local authorities.

I have a good deal to say but I shall trim my remarks because I know that many other hon. Members wish to take part in the debate. I wish to say a few words not only about the mentally ill but about the mentally handicapped. I know that many hon. Members will have read a book entitled "Children Living in Long-stay Hospitals", by Maureen Oswin. It is a very moving book, indeed, and it makes one wonder how well we do our job in this House and how effective the Government are in dealing with these problems.

Some of the facts outlined in this book are as follows: mentally handicapped children and adults are in an appalling situation. They are pushed away in hospitals when they should not be in hospitals. About 5,000 children under the age of 16 are in these hospitals. The hospitals are incapable of offering them substitutes for the parental or foster care which we should be providing for them. The numbers have fallen as a direct result of the fine efforts of the Department of Health but we are still in a serious situation.

The problem can be resolved only if we get these children out of the hospitals into residential care where they can be given education and treatment within a developing pattern of community based services.

The Spastics Society is financing this wonderful study by Maureen Oswin. There can be no more articulate spokesman for the society than James Loring. Many hon. Members will have read his letter in The Times a few days ago. He said that we should ask the Government to make a mandatory provision for each local authority to provide that each mentally handicapped child within the normal range of provision should be able to live with his own family as soon as possible. He also said that by January 1982, at the latest, the local authority programme of alternative care should be completed. He said that no child should then be living in a hospital for the mentally handicapped, that children's wards would be closed and no child would be admitted to such hospitals.

I find that James Loring is being too tolerant about this problem although I am prepared to be as tolerant as he if the Government are prepared to go along with his line.

In order that hon. Members may understand the issues behind that letter, I shall give one quotation from Maureen Oswin's book. It comes from the cover of the book. If any hon. Member can listen to this without being appalled at the problem, very well. But it is something that should be pinned up in every hon. Member's room. It states: A group of Committee members was visiting the mental handicap hospital. In the spastics' ward, six-year-old Shirley played with her tears, whirling her fingers disconsolately around in them as they puddled on the bare table in front of her. Her action epitomised a bleak existence. One of the visitors said 'These children are cabbages' and the others agreed with him, but perhaps it had not occurred to them to look at Shirley and consider that cabbages don't cry. The theme of any discussion about the mentally ill or mentally handicapped should be that "cabbages do not cry." Far too many of these children and adults are written off as cabbages. We are far too easily deterred by the parrot cry that they do not really understand, that they are cabbages and beyond human reason. This is a rubbish which we should never accept.

I pay tribute to my hon. Friends who have been campaigning for the mentally ill and the mentally handicapped. Let me assure the Government that, much as we appreciate what is being done for them, unless a radical reappraisal takes place, unless radical action is taken and more money is provided, the Government are due for a very rough ride indeed.

6.5 p.m.

Mr. David Crouch (Canterbury)

If the mentally ill and the mentally handicapped now have a new champion in the hon. Member for Stoke-on-Trent, South (Mr. Ashley) they are in some small measure fortunate. I know that that is using the word "fortunate" in an exaggerated way and in a way in which the hon. Member would not wish it to be used, but there can be no greater champion of their distress and problems than he. We are grateful to him for the approach that he has adopted during his years in the House to those who are disabled. We admire enormously his courage in overcoming his own problem and facing the most difficult audience in the world, in this House. We admire him for fighting for what he believes in for so many people who are disabled. Now the mentally handicapped and mentally ill are to have his help, and they deserve our help also.

I was glad to see my hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies) in the Chamber. We saw that he had to struggle in here today. He has never been afraid to fight his disabilities. He might have been dismembered again but he has never been "disvoiced". He spoke only briefly, but we enjoyed what he had to say, because he had something to contribute from an inside knowledge of the working of the Health Service.

I have to declare two interests. I am a non-executive director of a pharmaceutical company. I am also involved in another organisation, which employs 74,000 people and which has an annual income of £352 million. I should have been there today attending a board meeting, but I chose to put the House of Commons first.

That organisation, for which I have some responsibility, does not make a profit. It is the South East Thames Regional Hospital Authority. I give more time each month to that authority than I do to the other interest that I declared this afternoon. I was appointed to that authority by the patronage of a friend—my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph). I was kept on by the friendship, patronage—call it what one will—of the right hon. Member for Blackburn (Mrs. Castle) and the present Secretary of State.

I regard it as an honour to do a small service in the Health Service. I am very proud if it. It is a fearsome responsibility. It is a responsibility which every hon. Member points to every time we consider the Health Service at Question Time or in debate. That £352 million for which I am in a small way statutorily responsible is a fearsome and worrying responsibility. In the South East Thames Region we have been short of cash for many years, but in the last two years the situation has become much worse. We have been subject to criticism in the House from colleagues, particularly those from my own county of Kent, for the failure of the region to be more generous towards Kent.

This year in the South East Thames Region, income will rise by only 0.3 per cent. We need between 1 per cent. and 1.5 per cent. to remain as we are. These figures include compensation for inflation, and I have deducted that. The Region, income will rise by only 0.3 per South East Thames Region covers a quarter of London and two counties—Kent and East Sussex. The population of Kent and East Sussex is rising, and the population of London is declining. We have been charged by the Secretary of State with the responsibility of redistributing funds accordingly.

Kent has asked for another £22 million, and we have just allocated it £3.3 million. The process of equalisation will have to continue for a number of years and Kent will need about another £40 million in the next 10 years. Where is the money to come from? It will not come from the Secretary of State or, as I believe, from his successor on the Conservative Front Bench.

Health is suffering because our economy is sick. In the same way, education is suffering. Teachers cannot get jobs, and teacher training colleges are being closed down. That is the sort of thing that is happening in the social services in the brave new world that we say we live in. Our social provision in Britain is being curtailed. Where is the money to come from in my South East Thames Region? It is to come from London. London is thought to be too well provided for. Many hon. Members will dispute that—[HON. MEMBERS: "Hear, hear."]—and rightly so. Yet there is a case for maintaining the degree of excellence of our capital city in medicine if for no other reason than that it is here and in our other great cities that we have established a worldwide reputation in medicine and health care.

Our great teaching hospitals have to be sustained. I am thinking of Guys, St. Thomas's, over the river, and King's College Hospital. We have a statutory responsibility to maintain the medical universities, and so it is right that a cry should go up from inner London, notwithstanding the population decline, or that it might get provision beyond that of other areas, bearing in mind that in London and the other big metropolitan areas there reside the great teaching hospitals of which we are so proud.

We are having to tell London that we have been over-generous in the past and that now it must take a cut. That is the economic truth. We must say that there are areas where the people are less well provided for and that there is nothing we can do about it—London will have to like it or lump it.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I do not seek to deny the general thesis that the hon. Gentleman is advocating, but it is the Government's firm intention that nothing will be done to reduce the teaching hospitals' output of doctors for the future. We must maintain that.

Mr. Crouch

I accept that from the Minister of State. He is quite right to have made that proper correction of the emphasis that I am giving. I am not seeking to over-emphasise the problem. I hear the cry from London Members representing those areas that are concerned about the cuts, just as the Minister of State hears it.

The result of these cuts will be a reduction in services to the sick, not in the production of graduates from the teaching hospitals. But wards will be closed and the number of beds will be reduced. That is what it is like these days in the Health Service.

I do not want to dwell just on the problems of my region and I shall therefore stop being parochial. The many troubles in the health business today are nation-wide. I could so easily make a call this evening for more money for Kent, particularly for my constituents, and I should no doubt be thanked for that. That would not help to solve the national problem, however.

In the present crisis it has become fashionable to turn on the Health Service and say that it is failing the nation. I do not join in that chorus. Perhaps I should be more radical, or perhaps more reactionary. Perhaps we should be considering a change in our delivery of health care and the prevention of sickness. There is no doubt that we need more money, but the Government cannot afford it. They are broke and in the hands of the receiver. Perhaps we should be looking for additional ways of attracting money into the Health Service. I would favour such an examination, because we must explore all avenues.

I believe in the principle of more self-reliance as an addition to the State provision, but I do not want another major upheaval in the Health Service. I was glad to hear my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) say that this afternoon. Such an upheaval could be catastrophic at this stage. The ice is pretty thin and we must move with care and responsibility in any changes. We must also, however, have courage, because something must be done to enable health provision to match the demands of the people.

What are those demands? As our standard of living has increased in recent years, so has our demand for social provision. Better incomes lead to demands for better schools, more universities, and so on. Similarly, there has been an increase in demand for more and better health services. I agree that the health provision stock that was inherited 30 years ago was not up to date, but we have not done enough in those 30 years to replace it.

Another question arises whether we are using our resources wisely, economically, and scientifically. I say that we are not. We are tending to use the hospitals, particularly the out-patient departments, too much. Perhaps once again in the history of health care in this country there is happening what happened in the latter part of the last century, when there was too much referral from the GPs to the hospitals and consultants. In many cases a second opinion could be gained from another GP working in the practice, in the health centre or in the group practice. Dr. Finlay could ask Dr. Cameron for his opinion, perhaps, rather than refer the patient to the hospital where health provision is much more expensive, and where the queues can form.

I agree with the Secretary of State, who said recently that we should encourage people to consult their local pharmacist in the case of minor ailments. That is a practice which the medical profession has always encouraged, up to a point. The history of the health profession is that the pharmacists were assisted by the medical profession from hospitals such as Barts and the Royal Free—I am going back 100 years. Pharmacists have always been ready to accept this responsibility and we could rely on them to advise a medical consultation if that seemed necessary. There is nothing wrong in that. If everyone went to hospital or to the doctor for every trivial disorder, the Health Service would be overwhelmed.

Consideration of the way in which we use our resources—not just money—would not be complete without a reflection on the nature and the definition of ill health itself. If that were narrowed down, the provision of medical care could be allocated more scientifically as I have suggested. The problem today is that in the NHS we are concerned primarily with ill health, while the problem of social medicine is insufficiently regarded.

If we were more concerned to keep people healthy and in a position to ensure that the body could perform its functions we should be going a long way to redefining what is meant by ill health. We should also be doing something that is fundamental to the Health Service—moving the centre of gravity and allocating to the GP a much bigger responsibility in health care. We should be reducing at a stroke the demand on the more expensive health services of the hospital and the consultant. We should be putting the GP into a closer relationship with his patient.

That would entail a greater responsibility from the GP and a better understanding and trust from the patient. Such a move could gather momentum and cause the development in our society of a greater awareness of the advantages of preventing ill health and avoiding disability. Such a reallocation of resources, quite distinct from shifting money from one area to another, might do more to revive the NHS than anything else.

This week's edition of the British Medical Journal contains some very interesting thoughts on this problem. It points out that even in the United States, where expenditure on health care is half as much again as it is in Britain, they are facing a medical care crisis. There is now a considerable public subsidy of the national health bill in the United States through Medicare and Medicaid and through generous tax exemptions, with the result that there is little restraint on the use of the most expensive health services. There is no incentive to doctors or hospitals to cut costs, which has produced a multiplication of expensive and under-utilised specialised facilities and services.

The British Medical Journal says that the problem in the United States is how to improve medical care without at the same time giving the health-care providers an open cheque on public funds. That is not bad, coming from the British Medical Journal. But is goes on further to say: The medical profession"— in Britain— has a special responsibility for helping to find a solution for this problem. … The price of professional freedom is clinical self-restraint. I close on this thought. I believe in the NHS and I want it to succeed. I want to do nothing that would weaken or reduce the service that it provides for everyone. I am immensely impressed by what I have seen of the delivery of service on the shop floor, as it were, where health care is delivered to the patient. I am immensely impressed by the GP in the health centres and by the approach to their work of everyone in the hospitals—ambulance men, ancillary workers, radiographers, and so on. When I say that they are dedicated, I mean it. But we should not trade on their dedication to their profession. It is remarkable how good their morale is, often in very difficult, frustrating and depressing conditions.

We need new hospitals with wards of six beds and not 32. This week I was in Liverpool, at the great new Royal Liverpool Hospital. I was immensely impressed by this hospital of 850 beds. It is a magnificent complex. It is a credit to those who have put their abilities into its design and construction—albeit that as a member of the Public Accounts Committee I was looking into its excessive cost. But that is over and done with. The fact is that that hospital is designed to meet conditions today, and the biggest ward that we saw had six beds in it. I thought that it was a well designed hospital, and I wish it well.

As I say, we need more of these hospitals, and hospitals with plenty of modern bathrooms and lavatories, because those are extremely important to patients' morale. We need hospitals with efficient central heating, and, where possible, air conditioning. But we shall not get them by shooting now at the NHS or at the administrators. Costs get out of hand, in Liverpool as anywhere else, when administration and costs management are not good, and one needs an element of extremely able administrators and controllers to ensure that one works within one's budget.

We are, of course, entitled to take a pot-shot at the Secretary of State and the Minister of State from time to time. However, as has been said already, we in Britain must recognise that we have got ourselves into a mess economically, and we are paying some price for it. That is the Government's fault. We have to accept certain restraints on Government expenditure, even in essential areas, but there are limits. We must not neglect the sick and the disabled. We must cut the waiting lists and remove the agony from so many people's lives.

It is the duty of the Government to produce the service and make it work. They should remember that it is the patient that matters. The problem is not so much what to do with the NHS, the RHAs, the AHAs and the DMTs; the problem is the health of the community that the NHS seeks to serve. I believe that the time has come to send for the doctor.

Mr. Moyle

The hon. Gentleman said that there was a very modest growth rate of ⅓ per cent. for the South East Thames Regional Health Authority. He might like to know that it has been slightly increased, and is now ¾ per cent.

6.26 p.m.

Mr. David Penhaligon (Truro)

One advantage of being a Liberal Member is that one lands up being the party's spokesman on several subjects—in my case, about four. Therefore, one finds oneself attending rather a lot of debates on subjects that have no connection whatsoever. I have got to know the hon. Members who deal with health, the hon. Members who deal with energy, the hon. Members who deal with employment, and the hon. Members who deal with transport. Therefore, I am able to reflect more, perhaps, than some hon. Members on who won the debate between the Government and the Opposition on a particular day. Today, there is no doubt that the Government won, and quite handsomely. They also won on not a very good record. However, they won the argument overwhelmingly.

One of the aspects that has been discussed in various ways today is just what we in Britain should do about private medicine. I believe that both sides of the House, from their various points of view, are exaggerating either the dangers or the advantages that might be created by it. For example, even if there were no control of it whatsoever, I do not believe that private medicine would ever make a really significant contribution to health care in Britain. I cannot imagine a private hospital in my part of the country—it is the same in other areas—seriously dealing with the problems of geriatrics. That is what really costs money—when someone is in hospital for three, four, six or nine months with some sort of ailment. I cannot see any real contribution ever being made to solving that problem of geriatrics.

The hon. Member for Stoke-on-Trent, South (Mr. Ashley) mentioned mental health. I have never heard of private treatment for mental health. That is yet another example of something that costs an enormous sum of money.

I believe that the Conservative Opposition are fooling themselves if they believe that an extension of a separate private system—which I would not discourage—will solve the problem.

Mr. Michael Morris (Northampton, South)

The hon. Gentleman said that he has never heard of private provision for mental health. I should like to invite him to my constituency, which has one of the very best hospitals, St. Andrew's Hospital. It is one of the largest in the country, and it is totally provided for out of private funds.

Mr. Penhaligon

I am delighted to hear of it. I do not know what percentage of the total number of people in mental hospitals is provided for under that system, but certainly I am encouraged to know that that exists, and I may well accept the hon. Member's invitation, although I am not quite sure how far his constituency is from London. I suspect that the percentage is very small indeed.

I can illustrate one problem that exists in the constituencies of all hon. Members. At Christmas and, perhaps, at other times of the year, we all make our visits to various old folks' homes. One of the standard pieces of conversation goes as follows: "Mr. Penhaligon, I have been to see the doctor. Mr. Penhaligon, the man says that I should have a new plastic hip. Mr. Penhaligon, can you get it done for me?" If we are honest, most of us know that the answer, most of the time, is "No." What real contribution will private medicine make to the solution of that problem?

One-third of our pensioners—this is art absolute scandal—are on supplementary benefit. We all know that probably another third are not more than a little better off than those at the supplementary benefit level. Just what contribution will private medicine make to people who are 70 years of age and have this sort of difficulty?

Mrs. Dunwoody

Has not the hon. Gentleman taken on board one simple fact? Insurance schemes that support private medicine always specifically exclude from the sort of medicine that they get from the National Health Service anyone old, chronically sick or really in need.

Mr. Penhaligon

I would not argue with that.

Mr. Michael Morris

It is not true.

Mr. Penhaligon

The schemes that I have been offered certainly exclude those categories.

It is obvious that the Conservatives are considering imposing a charge to visit one's local GP.

Dr. Gerard Vaughan (Reading, South)

Absolute rubbish.

Mr. Penhaligon

The Minister challenged the Opposition about eight times in his speech and no one denied that they were considering it. It is obvious that it is being considered. The rhetoric is that we must charge a fee which prevents abuse but does not discourage use. There is no such fee, and this House is fooling itself if it believes that there is.

There are many people in my constituency, some of whom I have known for many years, who are no doubt a pain in the neck to doctors with their frequent visits, but if they had to pay a small fee each time, they would still go. There are others whom I try to persuade to go to the doctor. I do not know what is wrong with them, but they do not look very well to me, as an ordinary individual. They will not go. They say, "I do not want to bother him." No fee can manage those two objectives.

Hon. Members may laugh, but if they have not met people with similar views they are not talking to those whom they represent.

There has also been discussion of pay beds. I voted against the Health Services Act to phase out pay beds because I thought that the whole issue should have been given to the Royal Commission. No doubt I shall be corrected if I am wrong—

Mr. Timothy Raison (Aylesbury)

You will be.

Mr. Penhaligon

—but I believe that the Government have closed hardly any pay beds which were actually used. In those parts of the country that I have studied, those which have been closed were not used, anyway. To pretend that to reverse that legislation will bring a great inflow of cash to the NHS is just not true, and it is not fair of the Opposition to pretend that it is.

If we held a referendum on what public expenditure should be increased, the NHS would win overwhelmingly. It is the one subject on which no one says that we should spend less.

Mr. A. J. Beith (Berwick-upon-Tweed)

I am not sure that no one says it.

Mr. Penhaligon

Even the Opposition say that they would not spend less. The right hon. Member for Wanstead and Woodford (Mr. Jenkin) said that of course they would not spend more. In effect he congratulated the Secretary of State—rare for an Opposition spokesman—on having got the spending just right. There is only one answer, and that is to spend more on the NHS. There are 600,000 people on waiting lists-1 per cent. of the population. We are kidding ourselves if we think that we can make those lists disappear totally, but 600,000 is too many.

I was disappointed that the Secretary of State did not mention some of the current disputes in the NHS. We need an explanation of the dispute involving the pharmacists and chemists, who have asked to go to arbitration. After reading their submissions, I find their request reasonable. I should like to know why the Government have rejected it.

I was amazed that nothing was said about dentists. Some hon. Members might think this funny, but a few weeks ago a lady on supplementary benefit who was talking to me in my surgery in a mumbling way reached into her pocket for a handkerchief and at the same time pulled out her dentures. She said "I have been trying for a month to get these repaired and have not been able to do so." Being on supplementary benefit, she could find no one in my constituency to repair her dentures. Dentists say that they lose money on that sort of work and they will not do it. That is an appalling scandal. I managed to ring a dentist whom I know who eventually did that job for my constituent. This dispute is severe in some areas, and the Government should have said something about it.

How valid is the dentists' complaint that, for some basic forms of treatment, like the removal of a tooth, they have received increases of as little as 3 per cent. or 4 per cent. over the last three years? Can the Minister tell us what increases they have had for one or two common forms of treatment? They might have a good case, but I am amazed that the matter was not mentioned by the Secretary of State.

Everyone has asked everyone else to condemn industrial action. No one has failed to condemn it. I believe that industrial action in the NHS will get steadily worse over the next decade. The tragedy is that in about 1973, because of the niggardly attitude towards nurses' pay, large sectors of the NHS became unionised overnight. The militancy bred then and the success that it brought has caused a fundamental change of mind among those in the National Health Service. They now know that if they want to make a point they have to cause trouble.

During my first 12 months as an MP, the junior doctors went through the same process. They knew that if they were militant, people would take notice. We must find a better solution to these problems. But even if we do, I suspect that this sort of industrial action in our hospitals will rise steadily. It is part of the disease of modern Western society, and that is that.

Mr. Molloy

Does the hon. Gentleman believe that we should spend more money on the NHS to meet the threats which we both recognise, or that we should make more cuts in income tax?

Mr. Penhaligon

I believe that we should impose a payroll tax, which could largely achieve both objects at the same time.

The Under-Secretary will not be terribly surprised if I turn now to some of the problems that I know so well in my county of Cornwall. I do not know how many times I have brought them up, but here we go again.

Cornwall has a winter population of 400,000 and, I am told, 3½ million visitors a year. If each of them stays a week, as I understand is the average, that is equivalent, in terms of Cornwall occupation weeks, to an extra population of 70,000. Obviously, if someone has an accident, a heart attack, or some other disaster on holiday—it is amazing how a change of environment on holiday can lead to sudden health problems—he should have treatment, and the only hospitals in which he can have treatment are those in Cornwall.

That is accepted, but it has long been a matter for anguish in my county that we do not get any allocation of funds to deal with that. For at least the fourth time I ask the Government to instigate a major inquiry into that allegation. It is not unique to Cornwall—it relates to other areas which have substantial numbers of visitors—so the inquiry should be broadly based.

Many people in my area would be greatly relieved to know that an investigation was to take place—preferably, it should not take long—and that this problem would be recognised and evaluated for what it is, or for what it is not. The facts should be examined. We should first have the facts, as opposed to the rumours, which is all that we can deal with now.

The other matter that is relevant to Cornwall—but Cornwall is not unique in this respect—is that of equal health care throughout the United Kingdom. Some time ago I asked, by way of a parliamentary Question, how much money was spent on nurses per 1,000 population in my county and in the rest of England. I was told that for Cornwall the figure is £18,200 and for the rest of England it is £24,100. That is a massive difference. Whether it is greater in my county than anywhere else in the country, I do not know. I shall ask a further Question to obtain the figures for elsewhere.

When will the great day arrive when we receive equal treatment, at the present rate of equalising expenditure throughout the country? According to those figures, another 33 per cent. should be spent on nurses in Cornwall merely to bring us up to the average for the United Kingdom, but those of us who have done a little mathematics know that if we bring Cornwall up it will push the average up, so that we shall still be behind. We shall need more than an additional one-third in Cornwall to bring every area to the same sort of level. That is the trouble with averages.

I do not know how the Conservative Party will ever deal with this problem in Cornwall, the North of England, or wherever it exists—

Mr. Hoyle

The North-West.

Mr. Penhaligon

—if, at the same time, it says that it will not increase expenditure on the Health Service.

I think that the right hon. Member for Wanstead and Woodford said that we must bring standards up to a common level, not bring some down. That will make a lovely quotation. But it is a nonsense. It does not square the circle. It is time the Conservative Party clearly recognised that.

The simple fact is that once again the people who are paying most for our failure to run our economy sensibly are a disadvantaged section of our community. The Health Service deals with one of those sections of the disadvantaged who vary at different times. One goes into ill health and comes out again. I had pneumonia last year. I suppose that for a period I was disadvantaged.

It is a direct penalty that the unemployed, the disabled and, in this case, the sick are being asked to pay. There is nothing more important in this country than to get our basic economy running in a reasonable manner. That is why I totally defend what my party has done in the past 12 months, because I believe that we are nearer to that basic object than we were. I am not saying that we have got the economy right, by any means, but progress has been made. Until we get the economy right, solving this deep and fundamental problem is a pipe dream.

With any improvement in the economy, and even within the present economy, there is a good and substantial argument for spending any extra money that we can find on the National Health Service, even to the extent of money that was put in the Budget to be spent on education. I honestly believe that the arguments are far more pressing within the Health Service than within education.

My son, who is 5 years old, lives in the village in which I have lived for many years, in my constituency. He attends a primary school that is 139 years old—a very old primary school, indeed. But I tell the people who live in my village that, given the choice of doing something about my local hospital or building a new primary school in Chacewater—and making such decisions is what politics is all about—I would spend it on doing something about our local hospital. In reality, that is what this debate is all about.

6.44 p.m.

Mr. Lewis Carter-Jones (Eccles)

In this country 4,000 babies die unnecessarily every year and 10,000 are born with a handicap that they should not have.

I have no doubt that the Hansard reporters have written this down time and time again, but I must say to my hon. Friend the Under-Secretary of State for Health and Social Security, who is on the Front Bench, "This is a matter you can do something about." I am not asking for anything substantial. I am merely saying "If you use the best medical practice known, we could, without a great deal of additional cost, save ourselves substantial sums of money."

I want to talk about two items in the National Health Service—prevention and rehabilitation—which have been neglected. From time to time hon. Members on both sides of the House have raised the matter with my right hon. Friend the Secretary of State. The latest statistic I have, which is the only additional one I shall give, is one which means that of 3,363 children born in Wolverhampton in 1976, 50 died unnecessarily and 125 were born with handicaps which could have been prevented.

The "in" term in government these days is "self-financing productivity deals". I tell my hon. Friend, "If you go for good perinatal care, it will finance itself and you will make money on it." I hope that my hon. Friend will not think that I want no money. I want a lot more money, but I am telling him one way in which he can save substantial sums.

The right hon. Member for Wanstead and Woodford (Mr. Jenkin), who opened the debate, said that he wanted local autonomy. I think that we all want it, but I shall not go along with him if one area has a perinatal death rate of 19.6 and a good area has a rate of less than 14. We are presiding over death and disability unless we tackle that matter.

The rules of the House prevented me from bringing into the Chamber the documents that I wanted to bring. I wanted a portmanteau to bring in all the documents produced by my hon. Friend's Department since 1945 on the prevention of perinatal death and disability. They all say the same thing. No matter which report is produced, no matter how thick it is, it will contain a summary. In all those reports the last two pages summarising their findings say the same thing, that too many babies die and too many children are born with a disability which is preventable.

I do not think that one should merely issue paper. There comes a time when one must act, because one has clearly identified that in certain areas death and disability are being caused by lack of interest and lack of activity by the area health authority.

If anyone wants me to give a figure for prevention, I shall. I think that £10 million would buy it. What is £10 million? It is peanuts in terms of what we are spending.

How do I arrive at my figure of 4,000 children dying unnecessarily and 10,000 being handicapped unnecessarily? It is simple. It is done by comparing the perinatal mortality rate of Sweden with ours. One ends up with 4,000 deaths and 10,000 disabilities every year. I say in a non-partisan way that those of us on both sides of the House who go to surgeries know precisely what is involved.

The loving, caring mother will say "I will look after this baby." She does so. She lavishes love upon the child. But we all know that 20 years later that same woman will be sitting in one of our surgeries, having worn herself out caring for that child, with not much longer to live, asking who will sustain the child. She will want to know what happens when she has gone. Such problems must rest with this House.

The Secretary of State would be upset if I did not attack him. If he uses the appropriate muscle he can make sure that such problems are solved. He has one disadvantage. The Treasury has not yet seen sense. Yesterday I saw a film, in which I participated, called "Priority of Priorities". It was given that title, not because of anything that we did but because in 1966 the French Treasury asked itself "How do we save money? How do we prevent disaster and suffering?" It decided to go for good perinatal care. As a result, much suffering and hardship have been avoided. Incredibly, substantial sums of money have been saved. The best is often the enemy of the good.

The second area in which I should like my hon. Friend to spend some money concerns rehabilitation. We in this House hide behind paper excuses. They are no substitute for action. We have had no end of reports, from the Court Report down, on perinatal care. The same thing is true of rehabilitation. I believe that as parliamentarians we hide behind these reports. We are cowards. When a report tells us what we ought to do, we should do it and not beat about the bush. Court has told us what to do with children. Tunbridge and Mair have told us exactly what we should do for the disabled who need rehabilitating. What have we done? We have buried these reports. They are gathering dust on the shelves.

There is a method of rehabilitating all kinds of people. In industry people survive medically, following accidents, to be tucked away and forgotten. That is immoral. As a result of motor accidents people are paralysed but, because we have the medical knowledge, they survive tucked away for 30 or more years. Why cannot they come back into our society? Nothing new is required: simply the will to implement what is known.

We have heard people talk about the elderly and the fact that a growing proportion of people are living until the ages of 70, 80, or 90. There is absolutely no reason why we cannot rehabilitate the elderly. It has been done in such places as Ladywell. I have seen it done for the severely handicapped by people such as Dr. Philip Nichols of Oxford, and across the water by people such as Geoffrey Spencer. This has involved the most severely handicapped people. Let us get our values right. We should spend more. We could spend it more effectively if we supported perinatal care and good rehabilitation.

6.54 p.m.

Mr. John Stanley (Tonbridge and Malling)

It is a pleasure to follow the hon. Member for Eccles (Mr. Carter-Jones). whose speech I am sure was appreciated on all sides of the House. I wish to address my remarks to the problem of the distribution of resources, a topic touched on by other hon. Members. I make no apologies for dealing with this subject. It is a fitting reflection on the parlous state of the National Health Service in the county of Kent that two of my hon. Friends representing parts of the county have taken part in the debate so far. I hope that that remark in no way prejudices the prospects of my hon. Friend the Member for Folkestone and Hythe (Mr. Costain), who is also in his place.

The Secretary of State referred to the Government's policy of continuing the process of producing a greater measure of equality of treatment between the various geographical parts of the country. I fully endorse that. There is a fundamental point involved here and, while I believe the right hon. Gentleman accepts it, we have yet to see action taken in my constituency. The disparities between regions are, to some extent, severe but they are at least equalled, if not exceeded, by the disparities within the regions. As my hon. Friend the Member for Canterbury (Mr. Crouch) has said, we have the most serious problem in the South-East Thames Region affecting the county of Kent.

There is a marked contrast between a falling population in London and a dramatically expanding population in the Home Counties on the periphery of London. I realise that London Members feel that this is no reason for there to be any reduction in the standard of service in London. Over the county of Kent we are caught in a serious "nutcracker" situation involving a rapidly rising population and resources which in no way match that increase. Over the county as a whole we are £27 million below our RAWP target and we have almost 20,000 people on our waiting lists.

I see that, of the 90 area health authorities, there are only two others with a greater number on the waiting lists. One is Birmingham and the other is Lancashire. In Kent we have a poor ratio of beds to population. To lend perspective to my point about contrasts within regions, I would point out that the ratio of beds to population in Kent is lower than the average for the whole of the North-West Region, the Mersey Region, the Northern Region and the Yorkshire Region. That must be taken into account in deciding on the distribution of resources.

I realise that this may smack of special pleading but I believe that we in Mid-Kent are in a special position. Within the county we have a critical position developing in the Maidstone health district. In that area there is an exploding population as a result of its designation as an area for growth within the South-East strategic plan. In a parliamentary answer yesterday the Secretary of State gave me the figures for population growth in the Maidstone Health District. In 1971 it was 175,000 and in 1976, 189,000. The forecast for 1981 is 196,000 and for 1986, 208,000. We are facing a population explosion involving 33,000 people within a 15-year period. When we set that against the fact that the Maidstone Health District is further behind its RAWP target than any other district in the county, we can see the size of the problem.

I can bring home the reality of the kind of pressure being created in this part of Kent by referring to some of the letters I have received from those working in the NHS in my constituency. We have often heard it said that, although there is a very serious increase in the length of time it takes to get treatment if one is not an emergency case, those who need treatment on emergency grounds can get it very quickly indeed. But I do not believe that even that is now necessarily the case in our area. A doctor wrote to me a week ago about a cancer patient. He said, One of my patients (man aged 35) had to wait from 11th January to 27th January to be admitted for treatment of this disease despite being on the most urgent waiting list". As we know, with that disease, literally days can matter.

The situation is also affecting the children. Another doctor wrote to me concerning a child needing a hernia operation. He said, A typical child (aged 4) on my list has a right inguinal hernia, which is a large one. He is still waiting for operation, having been referred on 29th January 1976. That is a four-year-old baby.

I have another letter from a doctor referring to orthopaedic treatment. He said, This girl aged 15 suffers her knee locking, and then falls in the street without warning. I have just referred her. She will be seen in 15–28 weeks, and have an operation in 4 years from then unless she is categorised as urgent when the operation will be 3 months. Thus, she has a minimum delay of 6½ months. Again, as other hon. Members have said, the elderly are also affected acutely by the pressure of the waiting lists. I refer to the case of a husband and wife. She is waiting for a hip operation, and another doctor has written to me as follows: She has now been waiting one year and the Surgeon can give no idea how much longer she will have to wait—possibly another two years. Her husband is also on a surgical waiting list to have his prostate removed, and it is likely he, too, will have to wait two years, during which time he will probably develop acute retention, and require urgent hospital admission. Both are retired, and I just wonder whether either of them will live long enough to have their operations. So it is evident that, in this area of designated and rapidly expanding population, we are facing acute pressures on our health services. I accept fully what the right hon. Gentleman said—that there is no need for alarmist talk about the NHS breaking down; but I believe that at particular points of pressure we have nearly got to that situation. I must remind the right hon. Gentleman of the pressures that those in the NHS, particularly those meeting the patients most regularly and closely, come under as a result of the enormous strain of trying to cope with a growing population with such demands on limited sources—pressure from relatives, pressure from patients in particular.

I refer to what another doctor said to me about the sort of pressure that he comes under from his patients and the relatives in these conditions of such enormous strain on our resources in the Maidstone health district. He said: I have had distressed patients, distressed relatives telephoning me and abusing me about the situation and the shortages. Not only are the patients suffering stoically, their relatives are distressed and my workload is increased some two or three times above that which is necessary, due to my having to constantly badger the hospitals on my patients' behalf. I offer three proposals to the right hon. Gentleman in this situation. First, will he do all he can to examine the way in which he is constructing his formula for the allocation of funds as between the regions, and in particular ensure that the highest possible priority is given to the population factor in determining how such funds should be allocated between regions?

Secondly, will the right hon. Gentleman ensure that clear instructions are given to the regional health authorities themselves that, when they in turn make their allocations to the areas, they give the highest priority to the population factor? It seems to me to be fundamnetal that, when trying to establish a fair distribution, the basic number of patients must be the first and foremost criterion to follow in establishing how money can be distributed fairly.

Thirdly, will the right hon. Gentleman ensure—this is not a criticism of him, because the situation has gone on for many years under successive Governments—that there is far better co-ordination between his Department and the Department of the Environment when major planning applications are under consideration? I shall illustrate this point, because it applies everywhere in the country and many other hon. Members will have found themselves in this position.

In the last few months, the Secretary of State for the Environment has made a decision to release another large area of land in my constituency on which 1,000 houses will be built. At the public inquiry, a large number of representations was made against the development on ground of the inadequacy of the existing hospital facilities. The inspector, Mr. Adshead, in his report to the Department of the Environment—and I assume that he was simply following existing policy in that Department—in commenting on the argument that the development should not go ahead because of inadequate hospital facilities said: Any difficulties caused by deficiencies in the medical or other similar services … appear to me to be a matter for the appropriate authorities and should not be regarded as a reason for not allocating any more land for housing. If we are talking about overall planning, it is absurd that we do not build into our planning and planning judgments the key question of the provision of hospital and health facilities for the people for whom the houses are proposed. It is fundamental that the Department of Health and Social Security should get into the planning process.

In the application I am referring to—at Leybourne—the Ministry of Agriculture gave evidence against the development but the Department of Health and Social Security, no doubt following existing practice—gave none. It is very important that the DHSS should express a view, which may be in conflict with the Department of the Environment in some of these cases. It is entirely valid that if the DHSS feels that the existing provision of hospital facilities is not sufficient to support a development, that is a major argument why the development should not take place.

I fully appreciate the pressures on the Secretary of State, that he has to work within his existing resources, and that it is not likely that they can be increased. But I urge on him that he should look very closely at the distribution of existing resources so that in the areas with acute population growth the allocation of health resources reflects the need to provide for that increasing population.

7.8 p.m.

Mr. Eric Moorman (Basildon)

I begin by referring to the problem faced by the Opposition in this debate, as we have heard it outlined already and as we shall probably hear it repeated later this evening. It stems from what is perhaps a paradox which is reflected in many of their policies. On the one hand, they chastise the Government for not doing enough in the social services and, on the other hand, they wish to see cuts in public expenditure. I make this point at once because later I wish to be somewhat more critical of the Government's decision-making in the NHS than of the Opposition as reflected in the speech by the right hon. Member for Wanstead and Woodford (Mr. Jenkin).

It seems to me that if the Opposition were rather more wily than appears to the case and, further, if they were genuine in their belief that there is need for improvement in the health services, there is no reason why they should not beat us in telling the nation that they want more spent on the NHS and not less.

We were not bored with listening to one Kent Conservative Member after another, but we were surprised that so many Members from Kent wished to speak and were successful in catching your eye, Mr. Deputy Speaker. We listened with interest to the statements that were made by them. No doubt if my colleagues from Essex had wished to deal specifically with the problems of our county, we should all have been able to give some tragic examples showing that there is a need not for contraction but for expansion of the Service.

The problem for the Opposition, as I see it, is to decide, when planning their alternative financial structure for this county, how to come to terms with the fact that there is such a widespread demand for a greater and improved National Health Service. If they are talking about the way in which the money is spent and decision-making in the NHS, that is another question.

I listened very carefully to what was said by Conservative Members—no doubt we shall hear others as well—and to the points made by the representative of the Liberal Party. There was emphasis on the need for a greater degree of improved services to people, and on the need to shorten the hospital queues—in other words, to give people more rather than less. I doubt whether the Opposition will be able to square the circle, but they will establish credibility with this nation only if they can show that in arguing for an improved Service it means, inevitably, a greater degree of public expenditure. But that is their problem, and I leave it with them.

Mr. Geoffrey Johnson Smith

I am sure that the hon. Gentleman would acquit me of any charge of demanding more money from the taxpayer, but does he not agree that we must look very carefully at additional or supplemental methods of health financing of the sort used in other countries? Our present structure actually suppresses the demand for health services. That is the awful consequence.

Mr. Moonman

It might well be that the very action of looking for alternative measures of supporting the Health Service in the way that the hon. Gentleman suggests would have the effect of depressing the existing National Health Service. The point has been made by a number of hon. Members—including the representative of the Liberal Party—that many of the people in the greatest need of health services are not people who would be able to afford the fees of the private companies associated with health care.

I am sorry that my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) is not here. He said some kind things about the work of the all-party parliamentary mental health committee, and myself. I am sure that the members of the committee welcome the interest in this matter which he expressed in the debate. We know that he is a great champion of the needs of the handicapped.

I turn now to the way in which the Government are handling the administration of the National Health Service. I was surprised not to hear anything from the Secretary of State about the report, published only a week or two ago, of the Parliamentary Commissioner, which indicated that the Department of Health and Social Security had more complaints against it than any other Government Department. This is probably only the tip of the iceberg, but it reflects the deep concern that is felt about the way in which decisions are made by those administering the Health Service.

Mr. Ennals

What the ombudsman said was that my Department, which covers both health and social security, had the largest number of complaints. But it must be remembered that in terms of social security we are supplying benefits to about 18 million people at any given time. That is quite apart from the very large number of people who are dependent on the Health Service. In view of these very wide responsibilities, touching so many members of the population, it would be extraordinary if the Department did not have the largest number of complaints. In fact, the complaints are from only a minute proportion of the people who receive the services.

Mr. Moorman

I agree that the size of the Department and the widespread nature of its services may be factors to be taken into account; nevertheless, the complaints should be a genuine matter of concern.

I monitor the work of the Department of Health and Social Security, and the comments that I make are offered in a spirit of the greatest support and admiration for my right hon. Friend. We have worked very closely together in mental health matters. But, in all innocence, I ask my right hon. Friend: who is running the National Health Service? On a number of occasions recently I have been told by Ministers from the Department of Health and Society Security, in regard to the different issues that I have raised with them, that when it comes to the crunch I cannot count on their support and that these matters must be resolved by the regional health authority.

I shall give two examples, both of which have aroused considerable public and parliamentary concern. The first relates to Friern Hospital in North London. Information came to the parliamentary mental health committee which suggested that conditions in that hospital for the mentally sick left much to be desired. There were allegations of the rough handling of patients and the forcible confinement of voluntary patients. The matter was investigated and a report was produced. Despite what I believe to be considerable public interest in this type of report, it was not published.

There was a leak in a national newspaper, but that is by the way. As members of the all-party committee, we were not able to receive a copy of the report. The committee, of which I am chairman, expressed concern about this secret report. Some of us went to the hospital and talked to the people concerned. We felt that the report ought to be published.

When I raised the matter with my right hon. Friend the Secretary of State—I am sure that he will confirm this—we had a very helpful discussion. He did all that he could, but he had to end by saying that it was up to me to persuade the chairman of the regional health authority to publish the document, that this would be the only way. I think that is a fair reflection of what was said.

I do not believe that a senior Minister should have to leave to the discretion of a regional health authority the decision whether a critical report is published. I could have understood it if it had been an in-house report or an internal management document. Had that been the case, I would not have challenged it. Obviously, there must be a degree of operational work which must remain within the confines and the concern of the people who are implementing the Service. But there was considerable public interest in the matter to which I have referred, and the fact that it leaked into the national Press gave another dimension to our concern.

This is not a matter of the day-to-day running of the Health Service; it is a matter of public policy. Regional health authorities usually consist of the same self-perpetuating oligarchies as were on the old hospital boards, on which Labour representation is very low, and consumer representation is often nil. This gave us little confidence in their willingness to reveal the weaknesses in the services which are theoretically under their control. The Secretary of State should have power to step in and take the necessary action to allay public suspicion about cover-ups and whitewashing. This should not need spelling out, least of all to a Labour Government pledged to reduce secrecy in official matters.

Mr. Patrick Jenkin

Did the hon. Gentleman take note—as I did, with great interest—of what was almost an aside in the Secretary of State's speech, when he said that he thought that he would have to establish certain minimum standards and have some kind of inspectorate? Does the hon. Gentleman support that view? It seems to me that that would be a most important and valuable development in achieving exactly the objective which he is seeking.

Mr. Moonman

I take the right hon. Gentleman's point entirely. I believe that on both sides of the House we accept the importance of the National Health Service. I do not think that at this late stage anyone needs to justify its importance. Let us take that as read. What we are trying to do at this stage is to go into rather more detail than is possible on other occasions—certainly it is not possible at Question Time—and to look at some of the fundamental questions that concern us. My concern is with the decision-making aspects within the NHS.

Mr. Ennals

I am grateful to my hon. Friend for giving way. If he raises detailed points, he must expect that I shall want to respond to them. He referred to a report on Friern Hospital—a report that was produced by a regional team. It was not a report for which I had any responsibility. I did not say—in what my hon. Friend rightly described as a helpful interview—that I would wish to see that report published. I told my hon. Friend that I thought that it was an irresponsible and tendentious report, which gave no evidence of any of the allegations contained within it, and that it would serve no purpose, in the interests of Friern Hospital or those concerned about psychiatric hospitals generally, that an appalling report such as this should be given credence by the Secretary of State's asking that it should be published. I put it on record that my interpretation of the conversation is quite different from that of my hon. Friend.

Mr. Moonman

I am glad that the Secretary of State has intervened. He is quite wrong and has misunderstood what I said. Hansard will show what I said, when it is published. I did not say that he felt the report should be published. I made no comment about that. I said that it was a helpful interview and that the Secretary of State said that I had to convince the regional health authority chairman. I said very little about the contents of that meeting, because I regard much of what took place as confidential. I repeat that what we were told was that if we could convince the regional health authority chairman that the report should be published, that was fine. He certainly condemned the way in which some of the items were discussed in the report.

I had no intention of detailing this problem; I wanted to raise it as one of the problems of decision-making. If the Secretary of State is now saying that this is a tendentious report, it reflects on the manner of inquiries and the conduct of a regional health authority. Therefore, he will not be too surprised if some of us feel that we have too many levels of organisation. It would be appropriate if the Secretary of State could give Back Benchers some encouragement occasionally on how we weighed some changes in the organisational structure. It is not without faults. At some point a review must be made—I am not in favour of another major reorganisation—but one of the problems of the Friern Hospital case was that the regional health authority was in some degree in conflict with the area health authority. We all know where that put the hospital.

The second example is that of the Royal Liverpool Teaching Hospital. The hon. Member for Canterbury (Mr. Crouch) said that the Public Accounts Committee had been there again this week and that he was impressed with the hospital and its concept. But, of course, we have a report on this hospital. The PAC last year expressed concern about the fact that the costings of the hospital had escalated. At the end of the day it was costing five times the original estimate. That original estimate was just about enough to bring the fire precautions, apparently overlooked in the original design, up to current standards.

Following the all-too-brief debate on this subject and some 60 other matters on which the PAC reported, I argued that the Department of Health was not tackling its management responsibilities adequately. The Minister of State wrote me a rather critical letter. I hope that we do not have a further disagreement about this. He took me to task for having said that the Department of Health had awarded a new contract to Bovis Limited, whereas in fact the Mersey Regional Health Authority awarded the contract (with our full approval) and the Department is neither named in it nor legally a party to it. The Minister went on to say: To be fair I should add that, as far as the Liverpool Teaching Hospital was concerned, the distinction between the Department's role and the Health Authority's role was less clear cut before 1974 than it is now. What I find alarming is that the Minister considers that the more clear cut distinction that now exists is an improvement. Surely the Department of Health has learned something from its mistakes over Liverpool, for example that the placing of responsibility for major teaching hospital projects on the shoulders of inexperienced boards of governors is obviously dangerous. While it is true that the new regional health authorities have specialist advisory staffs, they cannot build up the managerial experience in hospital building that the DHSS could. This is simply because each region is apparently not involved in a sufficient number of projects to enable it to build up such experience. Yet it is the regions that will design hospital projects, place the contracts, and supervise the building.

My examination of this type of decision-making in the Health Service throws up many problems. Perhaps the Government are unable to tackle them in the way that some of us would like. It shows which problems relate to matters that should be decided centrally and which should be delegated. It is a continuing complaint of the nationalised industries, which I do not always accept, that the Government are always intervening in their day-to-day running. In the Health Service matters that are delegated should be kept under central control. But the point has been reached at which morale inside the Health Service is so low amongst the medical staff, management and auxiliaries that the Service is failing to achieve its fundamental purpose—the care of the sick.

It is not enough simply to pay lip service to Aneurin Bevan's memory, and pass the buck. Nye's dream was a great one, but if the National Health Service must not rest on its laurels, reality will become even more nightmarish for those caught up in its toils. The attempt to cure its maladies by reorganisation has made matters worse, involving everyone in a bureaucratic tangle because there is no longer any clear chain of responsibility.

I suspect—it may only be a suspicion—that many of the individual problems, complaints and concerns that have been expressed on both sides of the House as reflections of constituents' complaints, are not necessarily due to the amount of specific budget allocations. They are caused by the way in which the Service is interpreted and the way in which advice is given at area and regional levels. They are caused by the way in which correspondence is handled and the way in which people fail to get a decision quickly enough.

Of course everyone will argue for more money. I am talking about making money work—through good management and organisation. In this area, industrial relations also play a part. Looking at the National Health Service as a management entity, knowing the problems that lie ahead, one sees that the chances of industrial relations being anything like reasonable over the next five or six years are illusory. The management structure of the NHS simply will not be able to cope with some of the acute problems. It has not been able to deal with them in the past year, and God knows it will not be able to deal with them over the next few years.

I believe that people working in the system find that they have to go through two tiers in order to get a decision. One consultant told me that this meant that it now took two years to get a piece of vital equipment instead of two or three months. Medical staff have found themselves involved in industrial relations negotiations with non-medical staff. Not only is this not their job, and not only has the time spent in such negotiating been lost from doctoring; medical staff are not particularly well qualified for it, and some of the resultant clashes have led to industrial action in which the only losers were the patients. That is what matters. I believe that management failure in the National Health Service leads to failure in relation to patients. We have to devise a formula and a system, and I think that this is an area that must be given serious consideration.

We need to consider seriously how far the moneys that have recently been allocated and distributed will go, and to what extent certain sectors of the country can be given greater support. I am bound to say that I would be more impressed if we could have, after the money, a reassurance from the Secretary of State that he was instituting a critical analysis of the way in which moneys were to be used and, more important, that he would be satisfied that the money would not be lost in terms of adding additional support for the autocratic structures that we have created in the National Health Service.

Mr. Ennals

When I announced the ways in which the £50 million extra was to be spent I made perfectly clear not only how it would be spent but that I would ask for reports from the authorities by the end of June about the way in which it had been spent, so that I could report back again. I made it clear that I would monitor this expenditure. My hon. Friend may not have been in the House at the time, but he should not make these allegations against me without having made inquiries in advance.

Mr. Moonman

My right hon. Friend must not be so hostile. I am not making allegations against him. We are all entitled to make much stronger points than have been made so far in this generally low-key debate. However, if my right hon. Friend wanted to put that important statement on the record, I appreciate that and I am glad that he did. By the same token he must realise that we must also monitor and assess his actions—his ability to deliver. This is not something between the parties. This is something that every Member wants.

NHS money must be used in an effective way. This will be difficult to monitor in fact, and we shall be subjected to pressure from constituents. Having said that he will monitor this, the Secretary of State should give some time and thought to the way in which the Service is run within the structures.

If the Secretary of State thinks that monitoring means, in such a critical service, that he will continue to instruct hon. Members to refer key decisions to the regional boards, he will find growing criticism from this House; sadly, it means no more than passing the buck from one level of authority, and that surely is not worthy of a Secretary of State's responsibility for the NHS.

Several hon. Members

rose—

Mr. Deputy Speaker (Sir Myer Galpern)

Order. Assuming that the winding-up speeches will begin at 9 o'clock we have one and a half hours left in which to try to accommodate the 16 hon. Members who are still anxious to take part in the debate. My appeal to the House is for some effort at brevity, so that we may do the best we can for those who have been sitting patiently throughout the whole debate.

7.30 p.m.

Mr. Neil Macfarlane (Sutton and Cheam)

I shall do my best to follow your instructions, Mr. Deputy Speaker. It is always a pleasure to follow the hon. Member for Basildon (Mr. Moonman) and I echo all he said in the latter part of his speech. It would be interesting to a number of my hon. Friends to be present at the next meeting between the hon. Member and the Secretary of State, because I should like to hear the rest of their argument being developed.

I shall ignore the generalities that I wanted to make about the National Health Service and confine myself to a number of constituency points that highlight much of what has already been said by hon. Members on both sides of the House. I wish to draw the attention of the Minister to two or three important matters affecting the London Borough of Sutton, which is part of Surrey and part of the Merton, Wandsworth and Sutton area health authority.

First, however, at the risk of striking a note of discord with my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), I must say that the reorganisation of hospitals and the NHS in the early 1970s needs drastic reconsideration. My constituents would need a lot of convincing that the reorganisation had benefited them.

The creation of the St. Helier super district general hospital in my constituency has created a number of difficulties in an area of London where there are many elderly people. The hospital is located on the edge of the borough boundary and access is not easy. The problem has become more acute because this hospital, having developed as a centre of excellence in a variety of ways, has tended to denude of funds the old community hospitals elsewhere in the constituency.

In the past four years, junior medical staff with, not unnaturally, an eye to their future, have looked at this type of large unit as an ideal means of furthering their training. The diagnosis equipment is sophisticated and of the latest design and the facilities are good, ranging from coronary care through physio-care and the entire medical care range. It is all at this big district general hospital. The same applies to the nursing staff who need to get training in this type of large unit. Technicians, radiographers and physiotherapists are in the same category. They all tend to gravitate to this type of hospital centre and the effect on the hospitals further down the line does not need development by me.

Following the creation of this large St. Helier Hospital, which has 547 beds, only five of which are private—there used to be 14 private beds—it is still touch and go whether it is able to meet its commitments to the community. There is enormous pressure on a worthy staff, not only medical, but nursing and administrative and the most worrying aspect was summed up recently in a newspaper report in the Sutton and Cheam Herald under the headline Beds crisis—plea for help. The story said: Local hospital officials have made an urgent plea to the Area Health Authority to ease what is now becoming a 'crisis' pressure on bed space at St. Helier Hospital. The plea comes after five years of gradual increase in the number of patients without an increase in the number of beds. Instead, the number of beds has been dwindling because of alteration work and staff shortages. Mr. Richard Springall, secretary of the 547 bed hospital, said 'Last week for half a day we had a crisis situation of having no beds available for any male patient who might have had to be admitted as an emergency. 'What we want are more beds. We have a 30-bed ward which is closed awaiting upgrading—we need it now.'. The article goes on in the same vein, but in deference to other hon. Members who are waiting to speak, I shall not quote more of it.

Sutton is an outer London area where there is an ageing population. There is no let-up even in the summer and I fear that some patients may be discharged prematurely—not so as to endanger life, but they will lose a comfortable post-medical recuperation period. This early discharge creates other pressures on locai GPs, home helps and visiting nurses.

On this question of the ageing population, the Government must begin planning now. I was encouraged to hear the Secretary of State refer to the plan that I understand is to come out later this year dealing with the problems of geriatric and psychiatric cases. The problems within the next decade in the cities will be massive. These twin problems will cause a great deal of difficulty and extending resources will create all sorts of problems whatever party is in power.

If hon. Members doubt what I say, I suggest that they spend a day or two in the next recess, as I did, a summer or so ago, with the local meals-on-wheels service. I was horrified with what I found when I was delivering meals in an area in my constituency. I had no idea of the number of potential elderly geriatric cases living alone and dependent upon the service. A detailed assessment of this problem is essential.

I turn to the Royal Marsden Hospital which, as I said in a debate earlier this year, is the leading cancer hospital and cancer research unit in the United Kingdom. I understand that on a recent visit the Secretary of State was as impressed as my wife and I have been on our visits there in the past three years.

The reputation of the hospital is of the highest order, but, as the Minister knows, there is a question mark over its future role within the framework of our health organisation. At present, it is funded directly by the Department of Health and the research institute is financed by the Medical Research Council and the Can- cer Research Campaign but, because of its specialised work, I make the plea for this hospital to be permitted to stay out of the local health service structure. I do not criticise the area health authority. Its resources are good. It is stretched, but it is doing what it can. However, the Royal Marsden is unique and it must be permitted to stay, in effect, as its own health authority. I hope that the Minister can say something about that because I understand that the five-year exemption expires in the spring of 1979 and the many people who work in this hospital and the community itself would like to be given some idea in the Minister's speech of future proposals.

A look at the other hospitals in my constituency reflects the problem faced by all hon. Members. At the Sutton General Hospital there is, in community terms, a most difficult situation. I believe that it would be far better deployed as the district general hospital. Its location is better than the St. Helier Hospital in every way, but while it has 200 or so beds and handles a range of general medical care—ear, nose and throat, a children's ward, general surgery, a geriatric ward and a psychiatric ward—it has had to close its casualty ward within the last 18 months. This happened at a time when a GLC overspill estate was developed just 500 yards away, bringing with it 3,000 or 4,000 people into the area. Recently we had the absurdity of an elderly patient at the hospital falling and breaking a limb and having to be taken to the St. Helier Hospital live miles away. It is a great pity and quite absurd that this has to happen.

Alas, the Sutton General has no pathology lab so everything has to be referred to the St. Helier Hospital and this results in delays and time being wasted. I suggest that the Minister should find time to visit the hospital because I and many people in the area would welcome a visit.

Sutton General, with the wide range of services to which I have referred, has to wait very much as a back-up hospital upon the St. Helier Hospital and this creates a classic example of the shortage of resources to which my right hon. Friend the Member for Wanstead and Woodford referred earlier. The Secretary of State is not in the Chamber at the moment, but I hope that other Ministers will pass on the invitation to visit the hospital.

Before I conclude, I ask the Minister of State what he intends to do to help area health authorities overcome the expenses that they incurred during the national firemen's strike. I can do no more than read a letter that I received two or three days ago from the chairman of the Sutton and West Merton Community Health Council. It sums up the problem. The letter states: members were informed that the potential cost to the Merton, Sutton & Wandsworth Area Health Authority … of payments to staff who undertook additional night duty to act as fire patrols during the national firemen's strike was approximately £16,500, and grave concern was expressed that this sum had to be financed from the National Health Service resources and from the area's budget. In the fullness of time I shall send copies of that correspondence to the Secretary of State. It highlights further potential deprivations to patients and a substantial burden on our already hard-pressed National Health Service resources. What can the Minister do to help in that respect?

Generally speaking, we in Sutton are well served by the full range of dedicated workers in all aspects of hospital life. However, the morale of staff is low everywhere. The reputation of the Department is not high. The hon. Gentleman should not dismiss the concern that I and others express. I urge him to fulfil his thrice cancelled visit to the St. Helier Hospital. If he undertakes it, he will be able to assess for himself the many problems that are facing a large unit in outer London.

If the Secretary of State fails to recognise the problems of low pay, a standstill in some hospitals of gradings and the shortage of staff—the charge of complacency has been levelled against him on previous occasions and I think it is an accurate one—he may well, alas, have the dubious distinction of being the Secretary of State who, unhappily, presided over the disintegration and collapse of the Health Service. I hope that that does not happen.

7.43 p.m.

Mr. William Molloy (Ealing, North)

It is fair to say that those of us who have a deep interest in the National Health Service would not mind if we had a debate of this nature for an entire week. However, we are now reaching a position of selecting what to leave out of our speeches, which is most distressing.

There were a number of matters that I wanted to raise in the debate—for example, the family practitioner service, health centres, equipment in the NHS, hospital services, dental services, the various forms of health council administration manpower resources, the supply and manufacture of pharmaceuticals and the role of the representative staff organisations. Those are only a few of the matters on which I wished to speak.

I am apprehensive whether those facets of the NHS will be improved, because in the current situation they do not bring any happiness either in their administration or in the contribution that they are making to the Service. It is even more agonising that no blame can be attached to any one of them. Therefore, it has to be faced that Parliament has a responsibility. I have to acknowledge that we are spending, despite what some Members have said to the contrary, more money on the Service than ever before. It has to be acknowledged that the health and personal services of Great Britain are costing us £7,000 million a year. That means that merely paying out more money does not guarantee that we shall get a better Service.

We all know that there are many people in our constituencies who are proud of the Service when they need it and when it serves them well. They are proud of it and, quite rightly, they reveal a Dr. Jekyll attitude. However, when they face the bill they display a Mr. Hyde attitude. Some of the speeches from the Opposition Benches seem to reveal a Mr. Hyde attitude Mark I and a Mr. Hyde attitude Mark II.

I have a constituency matter that I wish to draw to the attention of my hon. Friend the Minister of State. He is aware that it is my judgment and the judgment of many who have been involved in the issue that the building of Ealing Hospital is one of the most fantastic disgraces in the history of the Service. That is not a nice thing for any Member of Parliament to have to say about the private enterprise contractor, the trade unions and everybody involved in the building of the hospital, work which started about eight and a half years ago. It was scheduled to be finished in four years and with a bit of luck it might be opened this year.

That is serious enough. My hon. Friend knows full well that I have narrowly missed having an Adjournment debate on the matter. At the time that I tried to raise it a piece of prices and consumer legislation was passing through the House. As hon. Members on both sides of the Chamber will understand, I lost an Adjournment debate. However, to the credit of my hon. Friend, I must add that he allowed me to set out in a somewhat lengthy letter what I would have said in the Adjournment debate He is aware of the situation. I hope that he will undertake an examination.

I press the matter because of a disgraceful handout by the publicity men of the regional health authority in announcing some form of opening for the hospital. It is said quite blandly that it has taken twice as long as was expected and that it will probably cost millions more than was estimated but that it is nobody's fault. It is said that it is not the fault of the contractor as events have taken place beyond his control. If it is not the responsibility of the regional health authority, if it is not the responsibility of the contractor and if it is not the fault of the local people, what has happened?

I urge my hon. Friend to take on board an examination of the incredible story of Ealing Hospital. I accept that nothing can be done to shorten the incredible time that has been taken to build the hospital. I raise the matter on the Floor of the House in the sincere hope that something will be learnt from a full-scale examination and inquiry into the hospital so that nothing of the sort will happen again. The Service has probably lost millions of pounds that it need not have lost.

It is time, too, that we acknowledged that there is the possibility of grave industrial unrest in the Service at all levels. There have been extremely good industrial relations in all parts of the Service. That is because organisations such as the Confederation of Health Service Employees spend as much time advocating improvements for the Service and the patients who need it as they do for their own members' remuneration and other aspects of their employment. The Whitley system has served the Service well, thanks to the unions and the employers.

There have been difficult and dangerous moments, especially when the cuts started to take effect. There could have been not so much a wages explosion within the Service as a Service explosion, with no one wanting to go on any more. It is to the credit of my right hon. Friend the Secretary of State, who laboured so hard and diligently, that he was able to get many of those on the Whitley staff side to recognise his point of view and not to take some of the action that in many instances they would have been right to take. A great deal of credit is to be shared by the general secretaries of the unions and the ever-ready attitude of my right hon. Friend to meet them and hold discussions.

I have an interest that I declare. From time to time I advise the Confederation of Health Service Employees. It is a trade union of the Health Service. As I have said, CoHSE—I think that that is a beautiful name—is campaigning for improvements in the Service on behalf of the general public and not for personal gain. It wishes to ensure that its members can work in a better service. It is pursuing that policy not so that its members may have a better time but to ensure that they make their contribution in a better and more efficient Service. Therefore, when it speaks, it speaks with the voice of knowledge and of experience.

I hope that my right hon. Friend understands that much of what it is putting to him is not a wage or pension claim but a desire to work in a Service which gives a high standard of care to the people who have to take advantage of it—the patients.

I should like to make one recommendation to my right hon. Friend—that he be prepared to read the evidence that CoHSE has given to the Royal Commission.

Mr. Ennals

I have.

Mr. Molloy

Then I hope to see it reflected in future legislation.

There is one other matter which is vital to all London Members. The community health service in London is in grave difficulties for a number of reasons, but one in particular. Will my right hon. Friend look at the problems facing the community health service, because they are not coterminous with the London boroughs? It would help if that could be done.

The duties set out in the 1946 Act on the promotion of a comprehensive Health Service are as valid and objective today as they were then. I believe that the nurses, doctors, specialists, those who look after the mentally ill, the NHS trade unions and all the people of this country want it.

Let us not be hypocritical about this matter. If, when we have a great debate about our National Health Service in the House of Commons, we say "It is a wonderful principle; we must improve it; but unfortunately, now and then, we must cut public expenditure", the sick and the maimed will not give us any thanks. We shall be looked upon as hypocrites if we say that. Therefore, I hope that there will be real unity in the House towards the uplifting and sustaining of this great institution—the National Health Service. Those who work in it and those who receive its benefits want it. I believe that the people of this country want it. I hope, therefore, that Parliament will respond.

Several Hon. Members

rose—

Mr. Deputy Speaker

Order. I propose to remind each hon. Member, before he is called, of the desire and need for brevity. Mr. George Thompson.

7.53 p.m.

Mr. George Thompson (Galloway)

I shall do my best to heed your admonition, Mr. Deputy Speaker.

I should like to record my personal commitment and that of the Scottish National Party to the National Health Service.

The Secretary of State posed a question. I do not write shorthand, but I think that I got the gist of it. He asked: is there to be one service for the rich and another for the poor? The answer, in my opinion, clearly is that that is not the way forward at all. We must go forward with a Health Service which caters for the whole population and which is financed for the most part from taxation.

I congratulate the Secretary of State on unmasking the Tory Party's intentions with regard to financing the Service by increasing charges and perhaps by charg- ing for free services. We shall certainly await what the Tories have to tell us about that aspect after the Royal Commission has reported.

I welcome the £50 million allocated to the NHS in the Budget. I assume that about £5 million of it will come to Scotland, and I welcome that. But I regret that the Government have not set up a special fund for using revenue from North Sea oil in ways which could be identified. I think that people would have reacted well to the imaginative use of a fund for doing things such as replacing the very old hospital buildings which are still with us. I should add that my area has been remarkably lucky in obtaining new hospitals, but that does not apply throughout Scotland.

Will any of the extra 400 kidney machines which have been promised be coming to Scotland? There was a dispute some time ago whether there was a shortage of such machines in Scotland.

I should now like to refer to geriatric services. I welcome the discussion document and the White Paper which is to come. The Minister did not tell us whether these documents would cover Scotland or whether his right hon. Friend would be instituting a special discussion document and White Paper for Scotland.

One problem in my constituency is the relationship betwen old folks' homes which come under the social work departments of regional councils and geriatric units in hospitals which come under the health boards. It would seem reasonable to place both institutions together and let them share services, but there is difficulty in running them because people naturally like to have their own service to themselves.

I should like to touch on immediate care schemes. Galloway has an excellent scheme in the West Galloway accident service. We are well aware of the number of road accidents in the area. After all, like the hon. Member for Truro (Mr. Penhaligon), I am aware of the influx of holidaymakers to my constituency in the summer and of the difficulties that we have on our particularly bad A75. Some constituents in the remoter parts of my constituency have raised with me from time to time the possibility of helicopter service. We are well aware of the num-areas as well as in the Islands. I think that matter should be looked into.

I should like to raise again the matter of detoxification centres for alcoholics. If more of these centres were set up, I am sure that we could cut the rate of alcoholism in Scotland, to the great benefit of the general population and to the reduction in the numbers of inhabitants of our prisons.

A further point arises on rural areas. Will the Government bear in mind the effect of bus fare increases on the frequency of hospital visiting. It may not matter much for adults, although they are helped by hospital visits by relatives, but children seem to suffer.

I should like to make two points on the Scotland Bill which is now making its way in a sensible manner through another place. I am glad that the Minister of State is present, because he will be as aware as I am of the difficulties that were occasioned in Scotland by reports in the Press about the implementation of the Briggs Report. It seems that Briggs attended carefully to the EEC implications of the rearrangement of the nursing professions but he could not have foreseen devolution. It does not seem to make sense to devolve with one hand and then to centralise with the other. What pressures are being exercised by EEC bodies on the organisation of the health care professions within the United Kingdom?

I should like to see the Health Service's professional bodies in Scotland—the trade unions and so on—being actively and dynamically committed to devolution so that, when the time comes for the Scottish Assembly to take over the Health Service in Scotland, they will be committed to the concept of devolution and ready to take advantage of the new directions which will be possible under the new system.

Finally, as we were reminded earlier today that this is the thirtieth anniversary of the Health Service, I wish it a happy birthday and many happy returns of this day.

7.59 p.m.

Mr. William Hamilton (Fife, Central)

The hon. Member for Galloway (Mr. Thompson) does not seem to understand the extent of devolution or of the provision for health in Scotland as it is. At the moment, Scotland has a completely distinct and separate Health Service administratively and otherwise from the English Service. I remind the hon. Gentleman that Dunfermline has the only new mental hospital to be built in this century in the United Kingdom. We have nothing to apologise for about what has been done for the Health Service in Scotland.

I stress a point made by the hon Member for Galloway on the emphasis that must be put on preventive medicine within the next 25 or 30 years. Through preventive medicine we can prevent a lot of people from going into hospitals. We need to save money rather than thinking about spending more money on new hospitals.

The hon. Gentleman had a point when he referred to alcohol abuse and excessive cigarette smoking. Both involve considerable expense within the Health Service and could be avoided if there were more positive and aggressive action taken by the Health Education Council. I agree with the hon. Gentleman that alcohol abuse in Scotland is a cause of constant anxiety and increasing worry. It is three or four times as great in Scotland as in England proportionately to population.

It is a startling fact that 3 per cent. of the young male adult population of Scotland is consuming 30 per cent. of all alcohol consumed in Scotland. The Scottish health education unit tries to combat this on a budget of £100,000 whilst the brewers are spending at least £50 million a year on advertising drink in a glamorous and romantic way, and most of their profits go into the coffers of the Tory Party. This is part of a problem that needs to be considered.

Despite the enormous investment in the Health Service over the last 30 years and in the Welfare State, there are savage inequalities between regions and between social classes. Therefore, not only should we try to save resources by preventive medicine but we should consider carefully how those resources are allocated between one region and another and between one social class and another. I have no time to give the statistics, but this kind of question should be exercising every mind of those in the House who are concerned with the Health Service. Instead of that, Labour Members become frightened when they hear the Tories saying the kind of thing that I now quote from "The Right Approach". This was the last version of the Tory Party policy statement: We should encourage rather than deter private provision. That means quite simply that if we have enough wealth we can buy our way and receive superior health treatment compared with those who might need it more, the elderly, who have not the resources. The document continues: It will be our aim to encourage this trend"— that is, towards private medical provision. The Conservative Party document goes on to spell it out by giving tax concessions to those who contract out of the public service and into the private sector. "The Right Approach" continues: We see no reason for quantitative controls over the development of the private sector outside the NHS. Yet within the NHS there is said to be no case for holding down prescription and other charges. The message that that conveys is quite clear and unequivocal, that the Tory Party is committed to increasing prescription charges and every other charge in the National Health Service. Unless there is the rigmarole of a means test, the ordinary working people are bound to suffer.

On 28th March there was a television programme on how the United States deals with these matters. That programme made me physically sick. It was obscene. It was the antithesis of the principles on which our Health Service is based. The proposition that I have quoted from "The Right Approach" were underlined by the expert on that matter, the head of the research department, the former Secretary of State for Social Services, the right hon. Member for Leeds, North-East (Sir K. Joseph). He spelt it out. He is a one-man Tory think-tank in these matters. It was not a spontaneous speech, but carefully prepared.

The right hon. Member spelt out the policy in all its stark detail. He said that the Health Service should have a monopoly of care in all the specialties—in the areas of handicapped people, in geriatrics, in mental illness and in all such services. Those are not glamorous specialties. Very few specialists are normally attracted to those aspects of medical care. But all the rest would be in the private sector. That is a brutish division of the sick based on wealth. That is the basic philosophical difference between the policies of the Conservative Party and the Labour Party.

My hon. Friend the Member for Holborn and St. Pancras, North (Mrs. Jeger) has asked me to say a few words about the Elizabeth Garrett Anderson Hospital. My hon. Friend the Member for Ealing, North (Mr. Molloy) and I have been involved in this matter. We have visited the hospital. I understand that it will cost less to renovate existing buildings there than it would to put it in any other place. The EGA has always been one of the cheapest hospitals in London to have patients treated. The buildings have been examined by a well-known firm of consultants, Mott, Hay and Anderson of Croydon. It has assessed the situation and announced that it is soundly built and in relatively good condition—in much better condition than most of the buildings in the Whittington Hospital to which it is proposed to transfer the patients. To move it would therefore be expensive and unnecessary. The EGA would also lose its valuable identity.

Insufficient has been said about the enormous dedication of the staff that we grossly exploit in this country in the Health Service. It would have lapsed long ago if the nurses and everybody up to the consultants had not given dedicated service without complaint.

The closure of this hospital is opposed by all the trade unions concerned. It is opposed by all the staff and by thousands of petitioners. A petition has been signed by 50,000 people in favour of maintaining the hospital. They are mostly ordinary working people, who would suffer by the closure. There is enormous sentimentality attached to the hospital. Deliberately to destroy something in the National Health Service which is unique, infinitely precious and cheap to run would be a wanton act of ministerial and administrative vandalism. A decision is imminent. I hope that it will be the right one because if it is not, there will be repercussions in the House and, I fear, outside among the unions.

This has been a good debate. I hope that I have not exceeded my time. I hope that I have spoken for not more than five minutes. However, if I have, I apologise.

8.7 p.m.

Mr. Tim Smith (Ashfield)

Although I disagree with most of what the hon. Member for Fife, Central (Mr. Hamilton) has just said, I agree with him on one point and that is the importance of getting a fair allocation of resources between regions and, within regions, between areas and, within areas, between districts. I make no apologies for being parochial, but I hope from what I say to draw two general conclusions.

I want to say a word or two about the financial provision for the health services in the central Nottinghamshire health district within which most of my constituency falls. The Minister of State, who, I am pleased to say, is present, visited the district last October. Therefore, he is well aware of the local problems that we face. The district is historically a deprived district because the hospital management committee was under-funded from the inception of the National Health Service in 1948.

The amount that is spent per head is substantially below the national average and is even below that spent in the two neighbouring districts of South and North Nottingham. The geriatric services in the district are poor and, as in almost every other district in the United Kingdom, the percentage of old people is likely to increase rather than decrease. The psychiatric services are extremely limited and patients have to travel enormous distances to get to the Saxendale Hospital, which is near Radcliffe on Trent. The services for the mentally handicapped are also causing great anxiety. The situation at the main hospital for the mentally handicapped, which is the Balderton Hospital, is such that many parents of mentally handicapped children refuse to let their children go into the hospital when it is necessary.

The waiting lists are exceptionally long for surgical facilities. The latest figures show that in September last year at Mansfield General Hospital there were 57 urgent cases on the list for more than one month and 430 non-urgent cases on the list for more than one year. The situation is similar for orthopaedic surgery where waiting lists are equally long.

It was to overcome this historically inadequate funding in the Health Service, and in particular to eliminate the regional variations, that the Resource Allocation Working Party was set up. The working party was concerned not just with the allocation between regions but also with the allocation within regions. In its report RAWP made this point emphatically when it said: The criteria for establishing regional differentiation of need and the methods recommended for resolving the ensuing disparities would have no purpose unless applied to allocations below regional level. Indeed the only way in which our recommendations can have a real effect is to carry them through to the point where services are actually provided—the areas and districts. The situation in the Trent Region is that, since along with the North-West Region we are the most historically deprived, we have been allocated for 1978–79 the highest real percentage increase of 2.8 per cent., which means in cash terms £9.2 million.

Mr. Moyle

The hon. Gentleman's figures are now out of date as a result of the Budget. The growth rate is 4 per cent.

Mr. Smith

I am grateful to the Minister, because I was not aware of the way in which the £50 million had been allocated. I welcome that statement, and I hope that a proportion of the addition for the Trent Regional Authority will filter through to my district.

The point is that the Nottinghamshire area is doing reasonably well within the region. Almost all the new money that is being devoted to the Nottinghamshire area inevitably has been attracted to the City of Nottingham itself to provide the revenue funding for the new teaching hospital. I fully understand that it is necessary and that capital naturally attracts revenue expenditure, but it leaves the central Nottinghamshire health district, which is some distance from Nottingham, in a position in which it is receiving only 1 per cent. increase for the next three years. This is not only below the regional average—which I am now told by the Minister is 4 per cent.—but it is also below the national average of 1.4 per cent.

We have a situation in which a district which is already under-provided will now in real terms become worse off than it was before. This is precisely the opposite of what was intended and recommended by RAWP. Surely there must be a good case—and I am sure that the Royal Commission will examine this suggestion—for the abolition either of the area level or of the district level. I am not an expert on the National Health Service but it appears to me that the region should have more control over the way the money comes into the district.

I wish to conclude by quoting some words of the Secretary of State for Social Services in December 1976: I am determined that the resources of this national service should be more fairly shared. Redistribution must be not only between regions but within regions, as some of the biggest inequalities are between rich and poor areas or districts. He went on to say that it would not be possible to implement the recommendations on the timescale that was recommended, but it appears that we shall be into the 1990s—or on the basis of the 4 per cent. it might be sooner, and I hope that that is the case—before this happens. It will certainly be spread over a long time span. In respect of the central Nottinghamshire health district, we now seem to be going backwards.

8.15 p.m.

Mr. Ian Wrigglesworth (Thornaby)

So far the debate has concentrated largely on the resources in the Health Service and on their management. I am very much tempted to go down that road and to talk in general terms, but that will have to await another occasion.

I wish to concentrate this evening on the predicament in the South Tees health district, which is the larger part of the area that I represent. Before I do so, I wish to mention the interest that I have in medical equipment and the fact that my wife works in the National Health Service.

Complaints have been made over a considerable time about waiting lists and staff shortage in the South Tees area. They blew up recently in a dramatic way with the presentation of a petition by the nurses in February of this year. In that petition the nurses from the Middlesbrough General Hospital said that, as the situation at that hospital had reached a critical level, they felt that it was now necessary to bring the matter to our attention. Let me quote from the petition To maintain any degree of nursing efficiency it is absolutely vital that the number of trained staff be increased. At present the hospital employs 249 trained and untrained nurses to cover 449 beds, plus five theatres, a casualty department dealing with approximately 1,500 patients a week, an out-patients department and a number of regional and sub-regional specialities such as rheumatology, plastics, neurology and neurosurgery. A careful estimation made by the staff shows a shortfall in staff at the hospital of 150 people. That is a staggering state of affairs.

I presented the petition to the Minister to draw his attention to it and to the chairman of the area health authority so that action could be taken. The response by the district management team was to produce a proposal aimed at closing 217 beds—not in the Middlesbrough General Hospital but in other hospitals in the area, so that staff could be moved to the Middlesbrough General Hospital. It was a case of robbing Peter to pay Paul. The exercise involved moving beds from one area to another, which achieved precisely nothing. Among the 217 beds allocated for closure at that stage were 93 children's beds.

As a result of the representations made to the area health authority, action was suspended and the authority established a committee of inquiry to examine the situation, because it was so critical. I hope that the inquiry will report soon, but I am sure that it will call for more resources and emphasise better use of such resources in the area. I hope that the Government will back the recommendations of that body.

I welcome the redistribution of resources to regions, such as the Northern Region. Of the £50 million in the Budget we are being allocated £2.7 million. Therefore, we shall be receiving some more, but not a great deal more, for the Cleveland area. I hope that we can have some more resources and concentrate the money we receive on the provision of more staff. But in my view we must also concentrate on the better use of the resources that we have in our hands and the increased resources that we shall be given.

The worst area for waiting lists in Middlesbrough, in the South Tees district, is in the ear, nose and throat department, where almost 2,000 people are on the waiting lists for treatment. Sixty-two of those cases were classified as urgent the last time I tabled a Question on the matter. For one consultant in the out-patient department in the ear, nose and throat specialty the waiting list is over three years. In respect of another two consultants the waiting list is over two years. Can one imagine anything more dispiriting than for a person to find that he has to wait over three years for an out-patient appointment?

The community health council and others have made various suggestions on cutting back the tremendous waiting lists. The community health council in my area does a marvellous job and has advanced many constructive suggestions. It does not fail to be critical, but it is doing its job fully. The council put forward an eight-point plan, and I hope that the management and staff in the hospital, including the consultants, will co-operate in reducing these lists.

Our comparison in respect of cases per bed and beds per 1,000 of population shows that we have more beds per 1,000 than in the rest of the Northern Region and in comparison with the national average. It also shows that we have fewer cases per bed than in the Northern Region, or compared with the national average. Clearly, there is a case for reallocation of resources and for increased productivity in the South Tees district and the area as a whole.

We must use our resources more efficiently. One of the ways that we can do this is by reorganising the services in our area and making it a single-tier authority. I hope that the Minister will look at that. It is nonsense to have both a South Tees and a North Tees district management. Perhaps Hartlepool should be kept separate, but having two district management teams and two separate administrations for the area makes no sense at all.

On Teesside, local government has spawned as a result of the local government reorganisation by the last Government. The same applies to the Health Service. If my right hon. Friend could move on this before the Royal Commission reports I am sure that there would be great relief and that more resources would be available for patient care in the district. That would be a great relief not only to the patients and the population but to the staff, who are complaining constantly that more and more money is being spent on administration when it could be spent on patient care.

Mr. Deputy Speaker

I remind the House of my appeal for brief speeches.

8.21 p.m.

Mr. Robert Boscawen (Wells)

When one has to make a rushed speech at the end of a long debate, one is in danger of making an unbalanced speech. If I appear very critical of the National Health Service, it is because of that.

But I endorse what hon. Members have said about the dedicated skill and attention to duty of thousands of individuals who are working for the National Health Service in all parts of the country. I pay tribute to them for their skill, service and duty to the sick. Many people who reach hospital receive treatment and service that are without equal.

However, there is far too much wrong with the NHS for us to be asked to tolerate it and not to draw attention to it. The length of hospital waiting lists throughout the country in most of the specialties for non-acute cases—and regrettably even in some urgent cases—is a symptom of much that is wrong with the National Health Service.

I have spent some time examining this problem. I understand what a complex and difficult one it is. I know that there is no single answer, and that money will not solve it just like that. Other hon. Members have made that point. Money is no guarantee that we shall have a Health Service with a high standard.

Where must we start? We must start by looking at some of the things that the parties and the country must take the blame for. The Conservative Government misjudged the growth of bureaucracy that would result from reorganisation. The Conservatives tried to do what was necessary to bring the three pillars of the Health Service together. That had been needed since the beginning of the Service. It was the right thing to do. It was right to bring together the family doctor, hospital and local authority services. But that resulted in too much bureaucracy and over-management. We must try to put that right.

The Government must also look at what they have done in the last two years. They caused considerable harm to the Service by undermining the morale of doctors and nurses with their obsession with preventing doctors from using its facilities in their own time for come private practice. That dispute had consequences which bit deeply into the Service—consequences which continue and which will continue for some time. It would be wrong for the Government to continue their vendetta against the private sector of the National Health Service. I heard with alarm the comments of the right hon. Member for Blackburn (Mrs. Castle) on a television programme last night.

The administrative mandarins of the Health Service have elevated their position and their own importance to an extent that has caused the treatment of patients in hospitals to suffer. Consultation with those in the front line of the hospital service has in too many cases appeared to be a farce. That must be put right.

In certain places the trade unions have involved themselves too much in disputes over matters that are outside their province. Too often they have put their noses into decisions that should be left to the doctors and nurses. That must be put right.

The public do not always help the Health Service. When people do not turn up to keep an appointment that has been made some time before, that can dislocate the hospital programme. That does not help the waiting list. Sometimes members of the public use unreasonable, selfish and bullying tactics to jump the queue. Many hon. Members will know of such instances from what their doctors and hospital administrators have told them. That must be put right.

There has been too much of prejudice and politics within the Service within recent years. We should be better off if we got down to trying to make it work more smoothly and agreeably without trying to create a class battle between the various sides in the Health Service.

The career structure for ancillary hospital workers is not good enough. They do not feel that they are part of the Service. They feel that they could be doing their job anywhere. That must be put right if they are to have more job satisfaction.

It is no good the Government's thinking that doctors are really satisfied with their pay structure or terms of contract. It is not nearly good enough when they see what some of their friends overseas are able to earn for less service and less skill in hospitals in other parts of the world. We must put that right if we are to maintain high standards of skill here.

There is little doubt that this deplorable but complex problem of the waiting lists will not be cured overnight. It will have to be cured, because unless it is the people who are suffering much from being unable to obtain appointments with their consultants or treatment in hospital without having to wait for many months will lose confidence in the whole system. That would be a great tragedy to the system of health care in Britain.

There are many things other than money that must be looked at in order to improve the NHS. I hope that each of us will see his own faults in this matter, not least the Secretary of State, who I hope will seek to put right some of the faults for which he is responsible.

8.30 p.m.

Mr. Bryan Davies (Enfield, North)

This debate has been about fundamental issues in the Health Service, including how much we are prepared to spend on it. We have had a series of speeches from Opposition Back Benchers who have followed the line established by the right hon. Member for Wanstead and Woodford (Mr. Jenkin) suggesting that the Conservative proposals would not affect the restoration of health to the NHS. The contrary is the case. Every time Opposition Back Benchers have advanced a case, it has been one of special pleading for extra expenditure in their areas, or seeking regional redistribution which could in no way be helped by an increase in the private sector.

Where do the Conservatives think the private resources will go? The doctors will follow those resources and the resources will follow the wealth of the country. We shall be confronted with the historic picture that we know so well, in which the distribution of health resources reflects the distribution of wealth. The only thing that can change that will be consciously directed policies clearly defining areas of public expenditure.

My right hon, and hon. Friends should take careful note of the sort of attacks that the Conservatives launch upon the administration of the Health Service. The reorganisation of the Health Service through the misconceived 1973 reforms has created problems, but let us beware of the extent to which we sustain and support the attack upon the administration. I believe that behind such an attack is the Conservative defence of the existing interests in the Health Service, which oppose the kind of redirection of policies and priorities that we on the Labour Benches believe should be made.

Complaints about the administration of the Health Service come predominantly from those interests in the medical profession which seek to resist the redirection of policy. Although excessive bureaucracy is wrong, we should not forget that a fundamental problem of democratic society is the relationship between the needs of society and the professional who satisfies them. We are beyond the stage at which we can pretend that determination of Health Service priorities is the preserve of the medical profession. This has created a problem in the organisation of the Service that we have never succeeded in resolving satisfactorily. That problem requires sympathetic and imaginative administration, carried out by competent and well-rewarded administrators.

The hon. Member for Reading, South (Dr. Vaughan) came to my constituency and commented on one of the hospitals there—St. Michael's, which is an old hospital housing geriatric patients. That hospital faces the most acute difficulties in securing adequate resources. The hon. Member rightly praised the staff there. The staff are appallingly underpaid, however. Nearly every complaint levelled at that hospital—there are many, and they are well-founded, and cause me the greatest concern—revolves around the fact that the hospital has a nursing establishment which cannot be filled because the nurses will not do the work at present rates of pay.

The Opposition argue that their priorities are the firemen—when they are in dispute—the Armed Forces and the police, and that other items of public expenditure do not rate such a high priority. Given our public expenditure rec- ord over the last couple of years, this is an issue that my right hon. and hon. Friends should handle with some care, but in those circumstances it ill behoves the Conservatives to attack the level of public expenditure in the Health Service.

Bearing in mind the contraints of time, I make one final point. It is a point that reflects my own interest at present. I have the honour to be the parliamentary representative on the Medical Research Council. In that I succeed the hon. Member for Reading, South. There are very acute problems in medical research. When my hon. Friend the Minister of State winds up the debate, he ought to think very carefully about medical research. Ultimately, if we do not plan and allocate resources to this area in a very real sense, we shall not be able to provide the service that we need.

My worry is that a great deal of our present medical research relates closely to the question of higher education resources and the position of universities. We all know that they will be under severe constraints in the early part of the 1980s. If there is a student increase in that area, the research function will come under pressure. I am worried about the fact that the present career pattern that the Medical Research Council offers to its staff is excessively limited. At one time the universities offered a position as a cushion for staff when their services were no longer needed for a particular research project. That safety net is no longer available.

What is required is a major rethink about the strategy of the Council and a major consideration on the part of the Department as well of just how far we have got along the post-Rothschild consideration of research in relation to the Health Service. In my view, in this area it is still the case that many more questions are posed than there are answers. We cannot depend upon the strength of the Health Service for the future unless we look very critically at the question of medical research.

8.36 p.m.

Mr. Timothy Raison (Aylesbury)

This debate has largely hinged upon resources. I shall not try to elaborate on that matter, important though it is, except to say that one of the great problems of resources in medicine that we face—and I imagine that in a sense this is what a number of my hon. Friends have been saying—is that, whereas there is an understandable inclination on the part of the Government to pour additional resources into the deprived areas—the inner cities, and so on—it is, nevertheless, a fact that in the areas of growing population in this country there are inevitably very great problems.

The Minister of State knows a certain amount about the problems in my constituency of Aylesbury. We have exactly that problem. We have the new town of Milton Keynes in North Buckinghamshire, and we have Aylesbury, which is still growing pretty rapidly. Inescapably, we have a very difficult situation. Frankly, there is a sense of disbelief when Ministers claim that we are still raising standards overall in the Health Service when we see in our own hospitals the harsh necessity of cutting back on beds and, indeed, of scrapping hospitals.

I do not blame the Government for being concerned about the inner cities and the older areas, but I hope that they will never forget that they have a basic duty to provide a sufficiency of beds for everyone and that a poor person, a mentally handicapped person, a disabled person or a person with any kind of sickness is just as much entitled to service if he lives in Buckinghamshire as he is if he lives in the North-East or some other area of that kind.

Secondly, the Government must accept that under the present Administration morale in the Health Service has sunk to a level that has never previously existed. They cannot duck that. Under the present Secretary of State and under his disastrous predecessor we have had an appalling loss of morale. Of course, some of that is to do with factors beyond the Government's control. It is to do with the change in the economic situation which followed the oil crisis in 1973, so there would always have been problems.

But the Government have unquestionably aggravated those problems. They have aggravated them by the war against pay beds. I declare an interest as a director of Private Patients Plan. The Government are doing the very damaging thing of creating two quite separate health services in this country. It is they who are creating separate health services as a result of their policy, and that is damaging.

The feeble line that the Government took over the early signs of industrial action in the hospitals about three years ago has led to a lot of trouble since then. I acknowledge that industrial relations in the hospital service are difficult and that there has been very little experience of dealing with industrial relations in the hospitals over preceding decades. In a sense, I think that the hospitals have been taken unawares by this new phenomenon and have not known how to respond. However, I believe that, because of their irresolution three years ago, the Government must accept some of the blame for what has been going on.

I want to touch lastly on the difficult question of the administrative structure. The 1944 White Paper on the creation of a National Health Service said: There is a certain danger in making personal health the subject of a national service at all. It is the danger of over-organisation, of letting a machine designed to ensure a better service itself stifle the chances of getting on. Although it went on nevertheless to advocate a national service, that warning has had echoes in succeeding years.

The Royal Commission is looking at structure, and I hope that no one will form a final view. I hope, in particular, that my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), who opened this debate so ably, has not come to a final view.

It is still an open question whether it is realistic to switch to a much more insurance-based Service. I should want to see that much more fully argued before we took a strong line. There is a place for insurance in the Service—I have an interest in it, as I said—but I am not yet persuaded that a basically insurance-based Service would be the right approach.

I also think—I know that here I am in very much of a minority—that the right organisation is not a three-tier or even a two-tier system but a one-tier system. I should like to see the area retained and the region and the district in due course disappear. My fundamental reason is that at the end of the day—I know that it is a long way off—health and local government should merge. The only effective basis for that is the area-county basis or, in the case of metropolitan areas, the metropolitan districts. I therefore hope that, in any kind of new reorganisation, we do not lose the area and thereby lose the chance of what I believe to be ultimately the right solution to this whole problem.

In the interests of better administration and saving money, I suspect that we should abolish the community health councils, but I think that we should give them a little longer before taking such a drastic step.

To cast a final bombshell, I think that there is a very good case for splitting up the DHSS once again. The business of running health and the local authority personal social services, on the one hand, and the enormous social security element in Government today, on the other, is too much. There are two Cabinet Ministers in the Department, but that is not the right way to tackle the problem. I seriously question whether this leviathan can do as good a job as two separate Departments.

8.43 p.m.

Dr. Edmund Marshall (Goole)

I should like to concentrate attention on the critical situation building up in various parts of the country over the use by general practitioners of surgery facilities in health centres owned by area health authorities.

The terms under which family practitioners work in these centres are now drawn up in a licensing agreement. A new model licensing agreement was set out by the Department of Health and Social Security in April last year in Circular HC(77)8 which stated that the terms available to doctors were such terms as the Secretary of State sees fit. It is clear, however, from the evidence which has come to my attention that that is causing difficulties in various parts of the country.

I hear from a doctor who is actually practising in a health centre at Oakley near Dunfermline that his running costs have gone up fourfold as the result of moving from his previous surgery. I have a letter from the secretary of the community health council in Wandsworth and East Merton saying that the Balham health centre, in the constituency of my non. Friend the Member for Tooting (Mr. Cox), has five suites for doctors only two of which are currently in use.

Similarly, I have seen reports in local newspapers of doctors refusing to go into brand new health centres that have been recently constructed at Bransholme in the constituency of my hon. Friend the Member for Kingston upon Hull, East (Mr. Prescott) and in the Bentley area of the Doncaster district in the constituency of my hon. Friend the Member for Don Valley (Mr. Kelley). The Doncaster Area Health Authority has asked that it should be able to provide additional financial inducements to attract doctors to new health centres. I am disappointed to learn that that request has been turned down by the Department.

But the silliest situation I have ever come across in relation to health centres is in my constituency, where, on the Warwick Estate at Knottingley in the area of the Wakefield Area Health Authority, there is a health centre built more than 10 years ago containing four consulting suites for family doctors which have never been used for that purpose. The health centre stands in the middle of a large housing estate now accommodating more than 5,000 residents, who still have to travel to other ends of the town to attend doctors' surgeries.

I have described the situation in detail before in the House, in an Adjournment debate on 24th November 1972. There has been no official progress towards resolving this major local problem since then, despite representations to successive Ministers in different Governments. The medical practices committee refuses to reclassify Knottingley as a designated area, so there cannot be made available an initial practice allowance as a financial inducement to bring doctors to set up a new practice in this health centre.

The local people have signed a declaration—1,040 adults from homes with an additional 1,260 children—saying that if the new practice were established at the health centre they would in general wish to be included on the panel of patients there, so there is clearly an opportunity for a viable new practice.

However, in the absence of a new practice allowance it is very difficult to start such a practice from scratch. Attempts are now being made to raise such an initial practice allowance by private subscription from individuals, trade union branches and local firms, but it seems to me incongruous that we should have to appeal for private donations in this way to encourage the use within the National Health Service of public facilities which have been empty for over a decade.

In this situation we need some remodelling of the legal framework within which general practitioners operate, making it possible either to set up machinery which directs doctors in some way or other to use facilities provided for them in this way or to allow area health authorities to employ doctors to carry out general practice from health centres in much the same way as junior hospital doctors are employed within hospitals.

I appeal to my hon. Friend the Minister of State, who I realise knows this problem full well, to agree that such measures are necessary. I hope that he will be able to give an indication of how he proposes to tackle these difficulties in respect of health centres and my constituents at Knottingley in particular.

8.48 p.m.

Mr. Robin Hodgson (Walsall, North)

On 20th March, or perhaps in the ungodly hours of 21st March, we debated hospital services during the debate on the Consolidated Fund Bill, and I was lucky enough to catch the eye of the Chair. I wish now merely to make a few additional points.

I am sorry that the Secretary of State is not here, because he is a proud product of the town of Walsall, which I have the honour to represent. He is also a proud product of Queen Mary's Grammar School, an ancient educational foundation which this Government are trying to destroy.

It is worth considering the view of the stewardship of this citizen of Walsall as seen from the grass roots. I think that the general feeling at the grass roots in Walsall and other parts of the country is that the right hon. Gentleman in his stewardship is showing a reluctance to come to grips with the real issues involved. There is too much of a bland Press release here and a carefully posed photograph there, by which he endeavours to persuade people that all is well. In his speech, at least a third of which, and probably half, was devoted to knock- about point-scoring concerning our policies rather than discussing his own, the right hon. Gentleman confirmed that impression.

All is not well and those on the ground know that that is so. Ask anyone connected with the National Health Service and the story is very much the same—at best there is indifference and at worst open hostility to the present policies. Few Secretaries of State can have so universally offended opinion, medical and lay. If anyone doubts this, let him ask the nurses. The whole profession is in a state of flux awaiting the reaction of the Government to the Briggs Report. We have raised this matter at Business Question Time during the past six months, but it is obvious that we shall get no resolution of this problem in the current Session.

Let people who have doubts about the state of the National Health Service ask the chemists. There are more chemists' shops closing than ever before, affecting the fabric of many of our towns, villages and high streets, thereby affecting the lives of many people who are unable to shop as they used to do. Ask the ancillary workers. We have already heard that industrial unrest is at record levels. Telephonists in the West Midlands are actually censoring telephone calls. They censored one of mine. I was speaking to someone in one of the Walsall hospitals when I was told that the call was not urgent and I was left with a buzzing telephone line.

Let people concerned about the National Health Service ask the doctors who face an appalling situation, with lengthening waiting lists and a mismatching of resources which leaves completed hospitals unopened because of a lack of medical staff. Ask the consultants, who await the outcome of the negotiations on their present contract and who are faced with a Government who seem bent on taking away a most important personal freedom, the freedom to practise professional skills and the right to earn a living in the way they wish.

Above all, let people ask the patients, the patients in my constituency who are waiting one year and five months for gall-bladder operations and three years and 10 months for hernia operations. Let them ask the pensioner in my constituency who, desirous of obtaining a minor operation to cure a small foot deformity, has been offered a first consultation—not an operation—on 2nd September 1980.

What do we see ahead? If we are to base our hopes on the contents of the Secretary of State's speech earlier today, we have only a gloomy picture. On Monday night, the "Tonight" television programme looked at the burgeoning private health sector, much of it taking badly needed revenue which could and should be brought into the National Health Service but which is lost because of the Government's petty vendetta against pay beds. What did the right hon. Member for Blackburn (Mrs. Castle) say in that programme? She was the right hon. Lady who introduced this policy. She did not say that her policies were faulty. Rather she said the system needed more rules and regulations and, no doubt, more administrators to enforce them.

The idea, it seems, is to strangle the private sector with red tape, if at all possible, but it will not be strangled. It will, if necessary, go abroad and take with it facilities, doctors, nurses and, above all, money.

Earlier the Secretary of State said that his programme was designed to even up regional differences. We have to applaud that and support it absolutely. But the right hon. Gentleman did not say how vast those differences are or how slowly they are being ironed out. In the Walsall Area Health Authority the difference between the RAWP allocation figure and the actual position is between £7 million and £8 million. Our annual increment at the moment is £85,000 per annum and at that rate it will take well over half a century before the difference is finally made up.

What we need above all—and we support the Government on this absolutely—is a commitment to the National Health Service, but not a commitment to an unchanging Health Service in a changing world. What we need is a fresh approach. There must be a fresh approach towards revenue, which in turn means a fresh consideration of pay beds. We need to reconsider the possibility of encouraging the private sector rather than restricting it.

There must be a fresh approach towards man power and woman power. That means taking up some of the points made earlier by my hon. and learned Friend the Member for Thanet, West (Mr. Rees-Davies) about bringing in voluntary movements and getting them to play a fuller and more varied part in the running of hospitals. It means bringing in private sector firms to undertake catering, laundry and cleaning. In this way we make better use of our resources and free our skilled doctors and nurses to carry out the tasks for which they are properly trained. Above all, we need more real action and less public relations action. The Secretary of State has put a lot of effort into the latter and it is cynical that he should not be as assiduous in his practice of the former.

8.55 p.m.

Mr. Bruce Grocott (Lichfield and Tamworth)

I can only assume that there has been an outbreak of masochism on the Opposition Front Bench in selecting this subject for debate today. The speeches that I have heard—and I have been here all the time—have boiled down to two basic points; either that the NHS needs more money or that the money that is in it needs to be more effectively spent.

Considering that the Opposition are opposed to any more money being spent on the NHS, and that they were responsible for the structure of the Service which determines the way in which the money in it is spent, they should have had the sense to keep quiet about the whole subject. Nothing that I have heard from the Conservatives today has done anything to give anyone the conviction, in this any more than in any other subject, that they are capable of running the country.

The speech of the right hon. Member for Wanstead and Woodford (Mr. Jenkin) was of a pretty low standard, even by comparison with the standard that one has come to expect from the Opposition Front Bench. In effect, he said that Tory Party Health Service policy would be determined by the Royal Commission. We all know that the Opposition's industrial relations policy is to be determined by referendum. Now their policy on the NHS is to be determined by the Royal Commission. We know that they have not got an economic policy. One wonders what is left for a Tory Government to do. There does not seem to me to be any kind of choice between a Conservative Government and a Labour Government.

I want to direct the attention of the House to two aspects of the administration of the NHS which deserve attention. One is the question of democracy in the Service. We all know that there is no proper democratic structure in it; that in the reorganisation the only sop to democracy was in the form of community health councils. Whatever one thinks of them, they are not accountable; they are not democratically elected. I know that many of them do their utmost to do a good job, but they need to be strenghened.

At the very least, they should be strengthened by being given the right to have observers at meetings of family practitioner committees. It is idiotic that they have not got that right at the moment. As far as I know, my right hon. Friend does not intend to direct them, and it seems to me that in considering democracy in the NHS we are going through again the same old tired arguments that we used to have about democracy in local government and the openness of committees 10 or 15 years ago. Most of the arguments against such democracy and openness in local government have proved unfounded.

Then there is the question of the relationship between doctor and patient. Democracy is about attitudes as much as about structures. Essentially, in the NHS the real relationship between the doctor and his patient is a paternal one; it is not one in which there is an attempt to discuss problems as near equals, as happens with most other professional groups. Professional groups other than the medical profession are prepared to discuss the problems of their profession with others outside them.

In putting my other suggestion, I am referring to a crying need in the West Midlands, namely, that patients should be given details of the waiting lists of various consultants. It is ridiculous that the waiting times can vary dramatically between hospitals just 10 or 15 miles apart. It is clear that if patients were told by their general practitioner "You need surgery. If you go to hospital A, the waiting time for the consultant is so-and-so; if you go to another hospital further from your home, the waiting time for the consultant will be such-and-such," the waiting times would, to a large extent, equalise themselves. In effect, the patients, through patient choice, would balance out the waiting times.

The other aspect of the administration of the NHS—and it relates to matters outside it—is the question of private practice, about which both sides of the House are highly equivocal. For half the time the Tory Party says that private practice helps the NHS. The hon. Member for Walsall, North (Mr. Hodgson) at least had the honesty to say that as far as he could see, it did not help the NHS at all. He was the only Conservative Member who admitted it.

We should be absolutely plain about private medicine in this country. I am rather pleased when Socialism and political self-interest coincide. I certainly think that they do on this issue. We should make it plain to the people that a private sector is not compatible with the concept of the National Health Service and that to have a private sector at all means that the resources are taken from the NHS. It means that, inevitably, we shall end up with the system under which the people who run this country, whether civil servants, leaders of industry, leading politicians or whatever, will find themselves being treated in one type of Health Service and the rest of the population in another.

I very much welcome the attempt by the Leader of the Opposition, these days, to apply Christianity to modern British politics. I understand that she has been in the pulpit once or twice recently. I hope that she follows through the logic of her position, because she cannot stay in the Tory Party long if she continues to apply Christianity.

On the issue of private medicine and treatment on the basis of cash, I know of no evidence whatsoever that when Jesus was faced with the 10 lepers, he asked which of them wanted to be treated privately, so that he could deal with them first. As far as I know, Jesus dealt with them on the basis of need. I wish the Tories would occasionally think through some of the conclusions to which their views bring them.

We need to have a clear commitment to end private practice, for as long as it exists the NHS cannot develop as a truly national Service. I hope that this Labour Government—and certainly the next Labour Government after the General Election—will be firmly committed to that objective.

9.2 p.m.

Mr. Tony Newton (Braintree)

I am grateful to my hon. Friend the Member for Reading, South (Dr. Vaughan) for allowing me a few moments in which to say a few sentences, as I have been here throughout the debate.

I do not want to follow the hon. Member for Lichfield and Tamworth (Mr. Grocott), except that I think the unkindest thing I could say to him is that his speech had a lot in common with that of the Secretary of State. About 50 per cent. of each of those speeches consisted of the crudest type of party political points. I can only hope that they were not broadcast, because they would have confirmed in the mind of the British public that our party political system is quite incapable of discussing serious problems in a serious manner. Frankly, if I had to listen to too many speeches of that sort, I should also be put off the party political system.

I found the Secretary of State's speech depressing for another reason. It seemed to me that he displayed a closed mind about any kind of fresh approach to our problems. I should be grateful if the Minister of State, when he replies, could tell us whether there is any real point in the Royal Commission on the National Health Service proceeding with its work, because the implication of what the Secretary of State said was that he has no intention whatever of considering any proposals about finance, and nothing very much about administration either. I fail to see any point in setting up a Royal Commission on that basis.

Although we can see aspects of the Health Service where improvements could be made, I think that it is common ground on both sides of the House that more money is needed. But neither side feels able to offer an addition to public expenditure in this respect. Yet despite this, Labour Members—the speech of the hon. Member for Lichfield and Tamworth is an illustration of the point—appear to be totally unwilling to consider the very real question of priorities.

The hon. Gentleman was among those who laughed and jeered when the question of school meal subsidies was raised. My children take sandwiches to school because they prefer them. If they wanted to have school meals, I would immediately qualify for a subsidy which would be equivalent to a pre-tax pay increase of between £4 and £5 a week.

Hon. Members may complain about their pay, but we are not yet among the group of people who cannot afford to feed their children. It is ridiculous that that sort of subsidy should be offered to people such as myself when, if my children fell down in their school playground and hurt themselves, the State could not offer them a decent accident and emergency service. I leave that thought with the Ministers.

When I raised the subject of my constituency and the catastrophic difficulties over the Health Service a few weeks ago the Minister assured me that it was the Government's intention to redistribute resources towards Essex. He told me that the problem had been recognised. On the information that I have from the Essex Area Health Authority, which is calculated to have been £24 million underfunded in l976–77—£1 short in every £5—the redistribution within the North-East Thames Region is giving Essex only £250,000 a year of additional uncommitted revenue this year and for the next four years. This extra revenue will not be enough even to maintain standards of services already provided. One must also consider this against the background of the increasing population.

The Minister said that it is his intention to redistribute resources towards Essex. I take it that that means he intends some improvement in the services provided for a rapidly expanding population. The area health authority does not believe that is happening. I do not believe it is happening, and neither do my constituents. I shall require a great deal more assurance from the Minister than I have had today that it will happen.

Mr. Deputy Speaker (Mr. Bryant Godman Irvine)

I offer the commendation of the Chair and the House to the last 11 speakers, none of whom has exceeded nine minutes.

9.7 p.m.

Dr. Gerard Vaughan (Reading, South)

I should like to join in the congratulations, particularly to the brief and constructive comment of my hon. Friend the Member for Braintree (Mr. Newton).

I am sorry that at the end of this debate, which was positive and far-ranging, the hon. Member for Lichfield and Tam-worth (Mr. Grocott) should have spoken as he did. It was a pointless, irrelevant and rather nasty speech.

As hon. Members know, I have spent the greater part of my working life, other than in Parliament, working within the health field. In all sincerity, I must say that never has the National Health Service been more in need of a genuine, quiet and honest look at what is happening. I am appalled at the way in which standards have fallen recently. There cannot be any argument about that. Nowadays it is commonplace to have minor misunderstandings, accidents and areas of communication that a few years ago would have led to a serious internal inquiry being considered as so ordinary that they are just part of the daily wear and tear of the Service. It is common to have rudeness to patients and frustration caused to them of a kind that was never seen some years ago.

That is why I was so sad when I listened to the Secretary of State. I remind him that it is not his National Health Service. Neither is it the Government's or the Labour Party's. It is our National Health Service, and it is part of our national heritage. We all have a vested and real interest in seeing that we have an effectively functioning, high-standard NHS. That is why my party wholeheartedly and unequivocally supports the concept of a National Health Service with immediately available high standard health care for all who need it.

I was sad to hear the Secretary of State make such an extraordinary defensive, truculent and strident speech. Out of it came his total unawareness of what is going on and how morale has fallen within the Service. He said that he lived with the Service and knew what people felt. The hon. Member for Truro (Mr. Penhaligon) said that this was a debate about reality, but that part of the debate was not about reality.

The Secretary of State seems to have no understanding of how morale has gone to pieces. Of course, there are places where a great deal of devoted work of a very high standard is going on. The Secretary of State says that he knows what people feel, but so do I. With the help and support of my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), I have been to hundreds of meetings in the last year or so, right across the country. I defy any hon. Member to name any part of the country that I have not been in or near in the last year or 18 months.

During that period, time and again people have come to me saying how awful conditions are. Some Socialist administrators said that they would never vote Conservative because they do not agree with other aspects of our policies, but they wanted us to know how wide a gap there is between the administration and the patient, how awful it is to work in the Service and how much they were looking to the Opposition to make constructive suggestions about what should be done.

At another meeting a surgeon told a roomful of young consultants that he had worked all his life to get where he was and, now that he was there, he did not think that it was worth it. I recently asked another surgeon why he was looking so fed up and he said that he no longer enjoyed working within the National Health Service.

One nurse in a roomful of nurses said that she was no longer so proud, when asked what she did, to reply that she was a nurse. [HON. MEMBERS: "Nonsense."] Hon. Members may claim that it is nonsense, but this is what is being said.

I wonder where the Secretary of State gets his information. Who talks to him? When he goes to hospitals, do they show him the new things because they want to please him, the bad things because they want extra money, or do they show him the great multitude of small things that are going wrong? I do not believe that they do.

Has the Secretary of State failed to grasp what is going on, or is it that he does not like to admit it to us? Does he ignore the opinion of the Royal College of Nursing, and Miss Hall, who is a most careful person in choosing words, who said on 4th March that staffing levels of qualified nurses had fallen so drastically in the last two years that looking after patients has become impossible? Does the right hon. Gentleman ignore her warning that the health services are close to breaking point? Does he ignore the nurses from King's College Hospital, who said: It is time Social Services Secretary David Ennals woke up to the fact that the National Health Service is breaking down"? Nurses in the Guy's group wrote to Sister Burke recently to congratulate her and tell her how comforting they found it that someone was speaking out about the steady deterioration that they saw going on in the Service. These are cries from people working in the field.

A nurse from Bristol wrote—these are sad words: It used to be a matter of pride to work in an operating theatre. But now, due to the invasion of the militant … porters, that has been shattered. God only knows what people awaiting operations feel. One of my colleagues was recently taken ill in France and went into a French hospital. She had thought that the London teaching hospital where she works had high standards, and she was proud of it. When she returned to this country, she told me that she was shattered to discover what a difference there was between her own hospital and the working conditions there and those in a modern French hospital.

If the Secretary of State is not hearing these things, we shall tell him. We shall gladly pass them on to him. It is important that he should know the reality of what is happening. He clearly does not know at present. If he did know, he would not have made the sort of speech that he delivered this afternoon.

There are a whole series of scandals, one of them being the tragedy of the waiting lists to which the right hon. Gentleman referred. I regard waiting lists as rather like taking a person's temperature. That operation does not tell us what is wrong but it tells us that something is wrong. The total figures that the right hon. Gentleman quoted are not the really serious ones, although they are tragic in themselves. Many factors decide whether we shall have this number of thousands or that number of thousands. Many people decide not to join the waiting lists, as they do not think it is worth while. The really serious figures apply to the waiting lists for urgent cases. The Secretary of State took the extraordinary step, in my view, of blaming junior hospital doctors.

The numbers on the urgent waiting lists have increased, as he knows. We must all have been moved by the examples that my hon. Friend the Member for Ton-bridge and Mailing (Mr. Stanley) recited. My hon. Friend the Member for Maidstone (Mr. Wells), who cannot be present, has told me that he is extremely anxious about waiting lists in his constituency. It is the length of the urgent waiting lists that has doubled. The right hon. Gentleman does not do himself any good or improve his credibility when he appears on television, as he did in January, and says that he does not believe that patients have to wait as long as five months or six months for urgent investigation. He said in January that if there were any such instances, he would like to know about them. That is incomprehensible to those who are working in the NHS.

There are many urgent cases that have to wait over a month. Between 60 per cent. and 70 per cent. of urgent cases in some parts of the country have to wait over a month. Many of them have to wait five months and six months. Some of them are likely to die as a result of that wait. The right hon. Gentleman knows that. In fairness to him, I must say that since January he has admitted that such waits do happen.

We now have the longest waiting lists of any country in Western Europe. The only country with comparable waiting lists is Sweden. What does Sweden have? Sweden has what we are being moved to, namely, an almost complete State service. That is one of the factors that causes Sweden to have such long waiting lists.

Mr. Martin Flannery (Sheffield, Hillsborough)

You do not wait, you pay.

Dr. Vaughan

What do the figures tell us? For example, Bolton—

Mr. Flannery

To think that the hon. Gentleman is a doctor.

Dr. Vaughan

That is why I care so much about these matters.

Mr. Flannery

The hon. Gentleman should be ashamed of himself.

Dr. Vaughan

The Bolton waiting lists have increased enormously. I do not know whether the Secretary of State knows that. The number of urgent cases awaiting attention has increased enormously.

Mr. Flannery

They would wait longer if the Tories were in power.

Dr. Vaughan

The present situation is a tragedy for those living in the Bolton area.

I have before me a letter referring to the beds that have been closed down in the Bath area. It refers to the waiting period in Switzerland for hip operations, which is between six and eight weeks. In the United Kingdom it is a matter of months or years.

Mr. Flannery

What is the cost of such operations in Switzerland?

Dr. Vaughan

In the Bath area the situation will become worse. Some of the beds available for that sort of operation are no longer available. We have details from throughout the country.

Another scandal is that of unopened units. What are the effects of opening some of the units at long last? It seems that there will not be enough money to maintain them properly once they are open. Where they are opened they will operate at the expense of closing many smaller units, which have advantages in terms of contact, communication and local community interest.

My hon. Friend the Member for Hampstead (Mr. Finsberg) is deeply worried about the problems of the Elizabeth Garrett Anderson Hospital. He would have spoken here today, were it not for the fact that he is out of the country.

I turn now to a very serious matter—industrial unrest. Last week the Secretary of State was ungracious enough to say—I think that he should apologise for and withdraw his remark—that I, on 13th March, had referred to widespread industrial action within the National Health Service and that such exaggeration was trouble-making. That was a disgraceful remark to make, because there is widespread industrial action within the NHS.

Mr. William Hamilton

There is not.

Dr. Vaughan

Of course there is. We know about Dulwich, Westminster, Southampton, Charing Cross and Liverpool, because they are publicised. But does the Secretary of State know about all those which do not hit the headlines?

In practically every hospital to which I go—there are some exceptions—I am told about threats of intimidation and restrictions on services if certain procedures are not carried out in the way that some members of the ancillary staff, particularly the porters, think is necessary.

I have here a letter from the Royal Northern Hospital. I wonder whether the Secretary of State knows about that. In this letter he says—

Mr. Flannery

Who says?

Dr. Vaughan

—that there is widespread blockage to their work.

We have had numerous meetings at all levels". The thing which upsets him, the writer of the letter—

Mr. Hamilton

Who said that?

Dr. Vaughan

I will give it to the Secretary of State— is the apparent total lack of concern of the Area Health Authority. That is the point that I wish to make.

In my area only last week I was inquiring about a report that wards had been left without any staff at all in the Borough Court Hospital. I discovered, to my amazement, that there was longstanding and major industrial unrest going on in that hospital. The porters and the ancillary staff have now stopped all admissions, including emergency admissions, of mentally sub-normal and mentally handicapped patients. At one point they closed the day unit, so those patients had no help whatsoever. Does the Secretary of State know about that hospital?

Mr. Hamilton

Can the hon. Gentleman substantiate that?

Dr. Vaughan

Of course I can.

Mr. Hamilton

The hon. Gentleman had better do so.

Dr. Vaughan

I have done. There is a campaign of industrial blockage.

Mr. Flannery

At which hospital?

Dr. Vaughan

The Borough Court Hospital, Henley. All admissions have been stopped. I have a letter here. I shall not go into further details, but I shall be glad to give them to the Secretary of State.

We have letters of all kinds complaining on this front. There is a letter from a former radiographer at King's College. She says: I had one difficulty or another with the porters every week. When they refused to work, I was quietly sent 'on holiday'. I regret I was unable to cope with the unreasoning power of the porters' union and finally quit the NHS to come to Australia where hospital work is untarnished by unionism. I took the easy way out. I am happy to hear that at least one senior nursing sister"— she was writing to Sister Burke— has got the guts to stand firm. I was glad today to hear from the Secretary of State that he has taken up our suggestion, which is only common sense. He has had a letter from me on this matter. He does not seem to know that. Perhaps his Department did not tell him that either. I do not know. In his discussion with the BMA and the TUC he is trying to produce a code of practice. The interesting thing about this is that locally, in different parts of the country different people are endeavouring to do exactly that.

Mr. Ennals

Will the hon. Gentleman give way?

Dr. Vaughan

I shall not give way for the moment. The Minister of State wants to have a full speech.

I tell the Secretary of State that when local groups feel that they are so frustrated that they have to take action, they usually do so because there is a lack of leadership from the top. It would not be necessary for local groups to do this if the Secretary of State were giving the guidance and firm handling called for by so much of the NHS.

There is the scandal of the unemployed nurses. Who but the present Government could achieve a situation in which units are closed through a shortage of nurses and yet there are nurses unemployed because there are not jobs to take them? We are disappointed—we shall give our support if the Government can find the time—that the Briggs Report has not been produced in this Session.

There is the scandal of the specialised services. We have heard a good deal recently about the kidney services. One of the things that the Secretary of State has told us is that he will do this great thing—I welcome it—of increasing the number of kidney facilities. But he has not told us that we are bottom of the league in Europe for renal provision. Even Italy, with all its problems, provides services for twice as many patients as we do.

I have the figures for all the major countries in Western Europe. In Italy they treat 7,000 patients. We treat 3,078 patients. In Italy they treat 93 per cent. of the kidney patients who come before them. In this country we treat 42 per cent. This is a serious situation caused by a Government who claim to be caring for this type of patient. There is no reason to believe that the incidence of kidney disease is any different in this country from what it is in Italy, France and Germany, the figures for which countries I have in front of me.

There is the scandal of the dentists—the scandal of the centres of excellence to which my hon. Friend the Member for Canterbury (Mr. Crouch) referred. There is the scandal of the pay beds, which we were assured were needed for NHS patients but which are lying empty. There is the scandal of the committees which clog and frustrate the whole service.

My right hon. Friend outlined to the House the steps that we would want to see taken. This is important. We divide those steps clearly into two stages. We think that there is an immediate, urgent and desperate need for something to be done. Afterwards, we see as a second stage perhaps the examination of more general changes in funding, and matters of that sort. We envisage in the first and immediate stage a package of needs. We think that the Service should be made local, so that there is somebody local to take decisions, who can give answers and be responsible for what is happening.

We think that the Service should be made simpler. In most places that would mean doing away with the area health authority and turning the region into what it was intended to be—a co-ordinating body rather than an administering body. We think that it should be properly costed, which is not the case today. We think that there should be proper incentives, which would make economies and fresh ideas worth while. The voluntary services have been neglected and abused, and should be developed and encouraged. The private sector should be allowed to rise to whatever level it likes. Every penny that is spent in the private sector releases money in the National Health Service.

We near the end of the debate. It was very clear why we called for this debate and why the Government did not. The Secretary of State for Social Services was foolish enough to say that he was showing courage and leadership. I have news for him, because what most people say is that he is not showing leadership. I ask him to exercise his mind on this matter. It appears to us that he is surrounded by far too many Press officials. He thinks that paper is a substitute for action. I once called him the Nero of the National Health Service, but the difference between the right hon. Gentleman and Nero is that at least Nero knew that Rome was burning, whereas our present Secretary of State for Social Services has no idea at all what is happening in the Service that is under his care.

9.31 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

I am grateful for the courtesy which the hon. Member for Reading, South (Dr. Vaughan) exercised in allowing me to speak for a full half hour. We have had an interesting debate, and a large number of points have to be answered as a result of the short speeches which the Chair urged upon the House—a request which has been so well followed by hon. Members.

I only wish that the hon. Gentleman had taken the opportunity to make a constructive contribution to the debate. I thought that it was a disappointing concluding speech by the Opposition spokesman. The Conservative Party at least pretends to be one of the major national parties and to make a contribution to national policy. However, what we heard from the hon. Gentleman was nothing more than a long jeremiad based on anecdotal evidence. Everybody knows that one can construct any case one likes on the basis of such evidence.

There are 1 million employees in the National Health Service, and the hon. Gentleman in seeking to build up his case must have quoted at least 13 malcontents from different parts of the country. I repeat that it was a disappointing contribution to what has been—for all the inconsistencies of the right hon. Member for Wanstead and Woodford (Mr. Jenkin)—a debate about national policies and principles, however inadequately they might sometimes have been developed.

Let me turn to the points raised by the hon. Member for Reading, South and seek to test their accuracy. Miss Hall is a very sensible person. The Royal College of Nurses has a warm and strong interest in the National Health Service and the hon. Gentleman must have misquoted Miss Hall, or quoted her words out of context, because the fact is that nurse staffing standards in the Health Service are going up. Between 1974 and 1976 the number of fully trained nurses in the Health Service increased by 21,000. I believe that the number has subsequently increased by a further 10,000 since then, and there is no correspondence between what the hon. Gentleman said and the actual situation. I do not believe that Miss Hall would make a misinformation of that sort.

The hon. Gentleman then mentioned the nurses at King's College Hospital. The fact is that at King's there has been a considerable development of advanced medicine over the past years. Nurses have been drawn into highly intensive care nursing and have been under some strain. The nurses have made it clear that they have been under strain, and the area health authority has given authority to recruit an extra 50 nurses to ease that strain.

We then come to the question of renal care. I agree that the provision of kidney machines in this country is not as substantial as we should like it to be, but in the Budget we have provided money for an extra 400 machines up and down the country.

What the hon. Gentleman did not do—and what he should have done if he intended to give a full rounded picture—was lo say that in this country we have a proud record indeed of kidney transplants. In that regard we are ahead of most other countries in Europe, and if my right hon. Friend's publicity campaign succeeds for the donation of more kidneys, we shall consolidate and improve on that situation.

The hon. Gentleman went on to talk about industrial relations in the NHS. The way in which he spoke on that subject was revealing. Given that there are 1 million people employed in the NHS, it is not surprising that from time to time there are some industrial disputes. What is important is that there are so few disputes in relation to the numbers employed and most of them are unofficial. A high percentage of them involve personality clashes.

I was disappointed that the right hon. Member for Wanstead and Woodford, who was reinforced by the hon. Member for Reading, South, commented in detail on the Dulwich dispute. That was essentially and importantly a personality clash. The less that is said about it at this level the more likely is conciliation.

Mr. Moonman

Apart from the politics in the last speech, which I agree was regrettable, does my hon. Friend recognise that there are fundamental industrial relations problems? This means that management and administration must be alert to having a good consultation system, because it could become a serious issue in the next few years.

Mr. Moyle

This is a serious issue now. My hon. Friend the Member for Waltham Forest (Mr. Deakins) has been supervising the implementation of the McCarthy Report, for which we were responsible, with a view to improving consultation in the National Health Service. We were left with an organisation which was bereft of adequate machinery for consultation.

The whole tenor of the speech by the hon. Member for Reading, South on industrial relations and of other Opposition speeches involved the question of conflict. The Conservative Party has had a secret commission to investigate industrial relations. Not only are the conclusions reached interesting but another interesting point is that the Conservatives thought that such an investigation was necessary. The basis of the report was "Can we beat the unions if it comes to a clash?" The Conservatives came to the conclusion that they could not beat the unions and therefore they are to try to work with them. The basis of the hon. Member's contribution to the debate was not to consider how we can come round a table and sort out the problems as sensible and reasonable people with different interests. The burden of his speech was that industrial relations in the Health Service were in conflict. That is the trouble with the Opposition. It is a matter that they should consider.

Many points have been made and I shall try to answer them as best I can in the time that is available. The hon. and learned Member for Thanet, West (Mr. Rees-Davies) paid a warm tribute to my hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris) for the work that he has done. The hon. and learned Member is not here. We can understand that, because he is in considerable discomfort. The hon. and learned Member drew attention to the importance of access to buildings for disabled people. There is now a requirement that access to public buildings for disabled people should be built in when the buildings are constructed. We are conscious of the access problems involved in private buildings and the barriers that are put in the way of disabled people.

With that in mind, my hon. Friend the Minister who is responsible for the disabled established the Silver Jubilee committee last summer to improve access for disabled people. He set the committee the task of making the public in general, and those who manage public and social service buildings, more aware of access difficulties and the ways in which these can be minimised.

My hon. Friend the Member for Lichfield and Tamworth (Mr. Grocott) was unfairly attacked. He made some good points about democracy in the Health Service. One of the things that we have done since we came to power in 1974 is to ensure that locally elected councillors can become members of area and regional health authorities. In that way we have done our best to import an element of local democracy into the administration of the Health Service. It is too early to say whether it has been completely effective, but there was a general desire for more democracy.

Those representatives are elected by the people, and we have given them the chance to join in on the administration of the Health Service. My hon. Friend felt that community health councils should have observers on family practitioner committees. More than 40 family practitioner committees now allow observers from the councils into their proceedings.

There is one speech that I can dismiss fairly easily. It is that by the hon. Member for Walsall, North (Mr. Hodgson). It was a grotesque travesty of the Health Service and was designed only to stir up as much trouble as possible in his part of it. His speech does not require much of a comment or answer.

My hon. Friend the Member for Goole (Dr. Marshall) raised the problem of health centres. He suggested that their legal framework should be recast. We are examining that. We are anxious to provide the best possible terms to encourage general practitioners to move into health centres. But I warn my hon. Friend that there are many other problems which arise in large part from the independent contractor status of GPs, and these need to be solved if the health centres are to be properly used. For example, the centres take a long time to plan, build and bring into commission. During this time, groups of GPs who originally committed themselves to moving into health centres often change their composition. Some of them change their minds. Sometimes there are personality clashes. Sometimes some of the partners die. All these problems, in addition to the purely legal ones, have to be surmounted.

My hon. Friend asked about the centre at Knottingley in his constituency. Given the long history of difficulties there has been in that area I shall look personally into the matter to see what can be done to assist his constituents in getting a proper service going in that part of the world.

The hon. Member for Aylesbury (Mr. Raison) raised a number of interesting points. He spoke of scrapping hospitals in his area, but we are to open a new community hospital in Milton Keynes this year. I shall be visiting Milton Keynes among other places next week in order to see the situation there.

The hon. Gentleman made a sweeping criticism of the existing Health Service organisation. But I should remind him that not only did he vote for the new organisation, but he was actually a member of the Government which recommended it to the country—

Mr. Raison

No.

Mr. Moyle

The hon. Gentleman was an Under-Secretary.

Mr. Raison

I was not a member of that Government when the Health Service reorganisation was brought in.

Mr. Moyle

That is a feeble excuse. [HON. MEMBERS: "Withdraw."] I said that the hon. Member was a member of the Government which introduced the Health Service reorganisation, and he was. After the Health Service reorganisation went through, he joined that Government so he could not have found much that was objectionable in the reorganised Service. There have been more blinding lights on the Opposition Benches than Paul ever saw on the road to Tarsus on this question of the reorganisation of the Health Service—[Interruption.] The right hon. Member for Leeds, North-East (Sir K. Joseph)—

Mr. Speaker

Order. I think that the Minister has upset hon. Members with his theological reference.

Mr. Moyle

I knew you would appreciate it, Mr. Speaker.

Mr. Speaker

I would have appreciated "Damascus" even more.

Mr. Moyle

The reason why I am making this point is that I think that the right hon. Member for Leeds, North-East has a very bad Press. Anyone would think that he was a single-handed party on his own, but the fact is that he was just one member of a Government that included the right hon. Member for Wanstead and Woodford. He cannot get out of it on any ground on which the hon. Member for Aylesbury got out of it. The right hon. Member voted for every hook, line and sinker, dot and comma of the reorganisation—[An HON. MEMBER: "Get on."] I am getting on. I am pointing out the inconsistencies in the right hon. Member's position. He voted for all of it. He recommended to the House, along with his colleagues, that the reorganisation should take place and he was supported by his hon. Friend the Member for Reading, South. These points are worth bearing in mind. It was a concerted Government exercise. It was not something that the right hon. Member for Leeds, North-East thought up by himself.

Mr. Patrick Jenkin

Perhaps the Minister of State will say whether he agrees with four of his right hon. Friends—the right hon. Members for Blackburn (Mrs. Castle) and for Kilmarnock (Mr. Ross), the Secretary of State for Wales and the Home Secretary, all of whom put their name to a document in which they said: The reorganised NHS … provides an improved administrative framework within which it is now possible to look at priorities more comprehensively and to plan the allocation of resources more effectively both at local and at national levels. Does the Minister accept that?

Mr. Moyle

Quite honestly, what we have done is to set up the Royal Commission. My right hon. Friends have set up the Royal Commission, which will look at all these problems with a view to solving them. That is the difference between our position and the right hon. Gentleman's position.

The hon. Member for Truro (Mr. Penhaligon) raised a very important point in regard to the influx of tourists into his constituency in the summer. He raised this point in the debate on the Consolidated Fund Bill. I think that it is most important that as a Government we know the impact of movements of short-term populations into and out of various areas, in the interests of proper health planning. I shall certainly examine the situation in Truro to see what is the impact of this as an example that we can take for the rest of the country and for country-wide planning, and I shall ascertain what comes out of that to see what can be done and what is necessary to assist places such as Truro up and down the country. I hope that the hon. Member will be pleased about that.

Incidentally, it is worth making the point that on the question of funding the NHS, as far as I can see, Opposition Members are out on their own. All other parties that have made a contribution to the debate—the SNP, the Liberal Party and, of course, my right hon. and hon. Friends—are totally opposed to the concept of funding the NHS that has been put forward in the debate.

Mr. Geoffrey Johnson Smith

Will the Minister give way?

Mr. Moyle

I have only a very limited amount of time in which to reply to the debate. I shall be talking about the hon. Gentleman's speech if I have time before 10 o'clock.

My hon. Friend the Member for Fife, Central (Mr. Hamilton) raised a couple of interesting points with regard to alcohol abuse in Scotland. He talked about the £50 million advertising budget of the drink industry. Of course, we are entering into discussions with the brewers and with the wine and spirit trades with a view to agreeing a code of practice on the advertising of drinks. They are co-operating with us to ensure that there is no undue association between glamour occupations and situations and drink, and no encouragement to young people to develop the habit of heavy drinking.

My hon. Friend also raised the question of the Elizabeth Garrett Anderson Hospital, as did one or two other hon. Members. We have always been determined that the service for women should be maintained in the concept of an Elizabeth Garrett Anderson, whether or not it is in its existing buildings. The Camden and Islington Area Health Authority examined the question of the facility being placed at the Whittington Hospital, but was not happy with that proposal. The AHA is now discussing the matter with the regional health authority, which has accepted the AHA's report, and my right hon. Friend will await whatever the regional health authority has to say.

The hon. Member for Galloway (Mr. Thompson) raised a number of interesting points. He emphasised that the NHS should be for the whole population and financed by taxation. He asked whether kidney machines will go to Scotland. An increased proportion of resources will go to Scotland for increased numbers of kidney machines. He asked whether Scotland would have its own White Paper on policies for the elderly. The Scottish Office is not planning such a White Paper, but no doubt it will keep in close touch with our debate with a view to developing its policies.

The hon. Gentleman mentioned the Briggs Report. I regret as much as other hon. Members that we could not legislate on it this Session, but I am determined to do my best to get the reorganised nursing profession set up with its framework of legislation in the next Session. We are working hard on that.

The hon. Member for Galloway also mentioned derogation under Briggs. Few nurses in Scotland or England would welcome differences in professional training between the two countries being increased in a way which would limit free movement for purposes of employment. The united nursing profession will make its maximum contribution to the free movement of nurses. There will be a Scottish national board to look after particularly Scottish problems.

My hon. Friend the Member for Basildon (Mr. Moonman) mentioned the Friern Hospital. My right hon. Friend and he are now crystal clear about their varying standpoints. He also raised with me the question of the Royal Liverpool Teaching Hospital and the structure of the NHS management as an example. It is not possible for my right hon. Friend, even with the brilliant assistance of my hon. Friend the Member for Waltham Forest and myself, to run the entire NHS from the Elephant and Castle. It is the concept of the Health Service that we delegate functions to area and regional health authorities, who look after the NHS in their areas and know the details of local problems much better than we possibly could.

Dr. Vaughan

That is news.

Mr. Moyle

This is the way we run the NHS. I am sorry that the hon. Gentleman was not aware of that before.

My hon. Friend chose as an example of a breakdown the Royal Liverpool Teaching Hospital. It was a poor example. Most of its problems arose under the old board of governors. The contract between the Merseyside Regional Health Authority and the new contractors re-established the position in Liverpool and allowed us to make progress. For example, at one time we were afraid that the fire precautions would cost £11 million. The new fire precautions will cost much less than that—probably not more than £5 million. If my hon. Friend wants the exact figure, I can get it for him. So that was not a particularly good example.

My hon. Friend the Member for Ealing, North (Mr. Molloy) was anxious to ensure that never again did the sort of trouble suffered at Ealing Hospital arise in any part of the NHS. The hospital was handed over on 19th April. I am informed by the regional health authority that it expects no difficulties in bringing the hospital into commission. But money has been held back for liquidated and ascertained damages because the revised date of completion was to be November 1976 and that date was not met.

At the same time the consulting architect will be holding the most thorough inquiry into the contract and all these matters and will be reporting to us before we make final payment of the sum of money for the Ealing District General Hospital.

The hon. Member for Sutton and Cheam (Mr. Macfarlane) raised the question of the postgraduate hospitals. At least, he raised the question of the Royal Marsden Hospital, but I do not think that I can reply without dealing broadly with the whole matter of the postgraduate teaching hospitals. We are considering the future of those hospitals as a group, and we shall issue a discussion paper in the late spring or early summer for consideration by them and the National Health Service. What we do in the future will depend on the result of that debate.

Mr. Macfarlane

When the hon. Gentleman says "late spring or early summer" presumably he means "in the next few weeks".

Mr. Moyle

I do indeed. Preparations are reasonably well advanced for the publication of a paper.

Mr. Carter-Jones

What about maternity?

Mr. Moyle

One of the most thoughtful speeches made from the Opposition Benches was that of the hon. Member for East Grinstead (Mr. Johnson Smith). He had obviously thought out his position very clearly. It was interesting that he said that he did not think that any country could maintain a comprehensive national health service which was free at the point of user.

Mr. Johnson Smith

Financed out of taxation.

Mr. Moyle

Broadly speaking, that means free at the point of user. That is how we on the Government Benches look at these terms. It was very interesting, because it seems to me that the same health cost must be met whether it is met through private or public means. The only implication of the hon. Gentleman's remark must be that we could afford what he would regard as a health service only if private services were used. It therefore means either that standards of service to substantial numbers of people will be reduced or some people will be excluded from the Health Service altogether. That is the logical conclusion. The hon. Gentleman is nodding his head.

My hon. Friend the Member for Ealing, North put it in his irrepressible way by saying that the Opposition were thinking of running a health service on the basis that if a service was provided for the rich the poor would somehow be taken care of. That is not true.

In spite of the denial about charges—now the hon. Member for Reading, South is shaking his head—the hon. Member for East Grinstead was joined even by the hon. Member for Canterbury (Mr. Crouch) in talking about supplementing public funds for the National Health Service. He was also joined by his right hon. Friend the Member for Wanstead and Woodford, who has been arguing for it. Indeed, the first four Conservative speakers all urged that public funding of the National Health Service should be supplemented by a substantial raising of funds by private charges in the Service.

To Labour Members that can only mean that one develops two health services. Our limited experience of pay beds in the National Health Service was that they were used for queue-jumping, that people bought a higher place in the queue because they could pay for it.

If that principle is extended by the Opposition to cover more facets of the National Health Service, we shall have a two-tier National Health Service which will cease to be a National Health Service. For Conservative Members to say that they believe in a National Health Service when they support such measures and to say that the Health Service should be confined to geriatrics, the mentally ill, the mentally handicapped and the less glamorous specialities of that sort, is merely playing with words.

Mr. Johnson Smith

rose—

Mr. Moyle

I shall not give way, as I am nearly at the end of my speech. The hon. Gentleman agreed with my comment on his speech.

Mr. Johnson Smith

I was shaking my head. I did not agree with what the hon. Gentleman said.

Dr. Vaughan

Nor did I.

Mr. Moyle

In that case, there is a substantial division of opinion between the hon. Gentlemen and their right hon. Friend the Member for Leeds, North-East, who was urging that the Health Service be divided into two, that people pay privately for substantial parts of the acute medicine section, and that the rest of the Health Service be devoted to a second-rate workhouse-type service for the future. That is the obvious development of the lines along which Conservative Members are determined to proceed.

It being Ten o'clock, the motion for the Adjournment of the House lapsed, without Question put.

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