NATIONAL HEALTH SERVICE

HC Deb 02 November 1978 vol 957 cc200-342

3.36 p.m.

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

I welcome the opportunity of today's debate on the Gracious Speech to review the state of the National Health Service and to discuss its problems. No public service is held in higher regard than the National Health Service. It has within it men and women of high skill and dedication. None is held in higher esteem than the nurses—and I speak from experience, having had five weeks as a patient in an NHS hospital this summer.

I believe that much of this respect is due to the basic principles on which the National Health Service is based—namely, a service for everyone, paid for by everyone, free at the point of delivery.

Today's debate provides an opportunity for the Government to set out their policies and aims. There is today concern about the state of the NHS. I hope that the Opposition, having chosen this subject, will give the House and the country some straight answers to some straight questions.

There are three main areas of concern that worry patients, staff and the public generally. First, there is the problem of resources and the priorities for using them. Secondly, there is the bureaucracy in the NHS and the reorganisation carried out by the Conservatives. Thirdly, there are the difficulties over industrial relations and pay, and the alarming effects that industrial action can have in our Health Service.

I propose to deal with these three areas in turn, starting with resources and priorities. The needs for more cash and more staff in the NHS are plain for all to see. There are increasing demands on the service from growing numbers of elderly people.

There are new methods of treatment for conditions that would have gone untreated only a few years ago. We have long waiting lists—now sadly longer still. There is a backlog of old, inadequate hospitals and the inheritance of an unfair share-out of health funds and facilities across the country. There are not enough staff, cash or facilities for our geriatric wards or our mental illness hospitals or our hospitals for the mentally handicapped. There is the need to cut still further the number of babies who die at or shortly after birth, and to reduce to a minimum those born handicapped. There is also the need for a further improvement in community care, and better primary care, particularly in inner cities. The list could go on. I said at the Labour Party Conference that I had the longest shopping list in the business. I have recognised—I think that we all do—the pressures on the Service, the strain on staff of all kinds, and the suffering of patients who have to wait too long for treatment or face unsatisfactory conditions—let us face it—in some of our hospitals.

That is why we are planning to spend this year £120 million more in real terms on the NHS than we did last year. The £50 million Budget boost is only now beginning to show results. We have seen the opening of modern new hospitals in, for example, Newcastle, Northampton, Oxford and elsewhere. There has been the recruitment of more staff—especially nurses—and the provision of more resources for the Cinderella services. There is more home dialysis for kidney patients. This is beginning to happen.

In addition, we have made provision in the Gracious Speech for a scheme of payments for those seriously damaged by vaccination—a problem which has caused great concern in this House over many years. I am proud that it was this Government who responded to that concern. Legislation to cover the scheme of payments will shortly be introduced and will, I hope, have the support of the whole House.

We are now spending about £8 billion a year on our health and personal social services, an increase from 4.7 per cent. of GNP in 1973 to 5.7 per cent. on the latest available figures. What is more, we are spending this money in accordance with a clear set of priorities, worked out after careful discussion. We are pressing ahead with a steady programme to achieve a fairer share of health funds across the country. That means that while programmes are held back in some regions, particularly in the Thames regions, areas of greatest need in the North, North-West and the East Midlands are seeing very rapid growth. I am sure that that principle is right and should be supported by the House.

We are giving the Cinderella services for the elderly, the mentally handicapped and the mentally ill a higher priority. The House will know that during the recess there have been two important developments in these areas. First, the Government published a White Paper on our review of the Mental Health Act in which we propose new safeguards in the treatment and detention of mental patients and other reforms. Secondly, the National Development Group reported to me on "Helping Mentally Handicapped People in Hospital", and I have made a statement setting out the Government's proposals for further improving the quality of care for the mentally handicapped.

The Cinerella services and geographical redistribution of funds are two of our key priorities. A third is a shift towards prevention. My hon. Friend will have more to say on this subject, especially in relation to perinatal mortality. I hope soon to announce some further initiatives, building on the much improved figures for perinatal mortality of the past few years.

The Gracious Speech stated: Fresh support will be given to enable the National Health Service to fulfil and extend its services to the public. The Government have a firm commitment to strengthen and develop our National Health Service. We have made it plain that, as the economy improves, it will be possible to devote more resources to the services. We have given practical effect to that commitment twice in the past year, in the November and April measures.

The House will, of course, have to await announcements at the appropriate time on the Government's plans for public spending in the period ahead, but there will be an increase in resources available for 1979–80, compared with figures in the last White Paper. It will give us some more room for manoeuvre and will, I am sure, be warmly welcomed in the country, especially by those working in the Service.

We shall stick to our agreed priorities, and I hope to announce additional resources to help meet the needs of the elderly, to assist mentally-handicapped children, to assist disadvantaged groups, particularly in areas of high mortality, and to make some contribution to the assault on the long waiting lists.

I have set out the Government's priorities on resources and the way in which they will spend them. The House and the country will also wish to know where the Conservative Opposition stand. Let us start with the issue of spending on the Health Service. A few months ago, the right hon. Member for Wanstead and Woodford (Mr. Jenkin) was quite clear. He said that a Conservative Government would adopt the projections in last February's White Paper on public expenditure. His actual words were We have to live within that, and there is no possibility of extra money. What could be plainer than that? And that was after the Budget injection of £50 million. He was saying that under a Tory Government there would not have been that £50 million boost and there would not be any further increases beyond the figures in the White Paper.

I hope that the right hon. Gentleman will confirm that that is the dismal prospect facing the NHS if the Tories, by misadventure, were to be returned to power. [Interruption.] If the hon. Member for Reading, South (Dr. Vaughan) doubts that, his right hon. Friend will have an opportunity of dissociating himself from his own quoted statement.

The subject of resources raises, I believe, two further issues—charges and the Tory plan to shift to an insurance basis of finance. When we last debated the National Health Service in this House, I put a number of questions to the right hon. Member for Wanstead and Woodford. He refused absolutely to answer them. So, having got no way at all with the monkey, I went to the organ-grinder. In order not to confuse the public and the House about who really is the Leader of the Opposition, I should explain that when I use the term "organ-grinder", I do not mean the organist. I am referring to the right hon. Member for Finchley (Mrs. Thatcher) and not to the right hon. Member for Sidcup (Mr. Heath). In any event, I got no reply. So I shall put the questions again, and give the right hon. Member for Wanstead and Woodford the chance to answer them.

How much would a Tory Government put on the prescription charge? Will the Tories introduce a new charge for seeing a GP? If so, how much? Will they bring in so-called hotel charges for staying in hospital? If so, how much? Will they bring in a new insurance-based system of finance? If so, will there be different levels of service for different levels of premium, and will there be separate premiums for each member of the family, with extra to pay for the children? When will the Tories publish the Vaughan report on charges? We have had a lot of open government. It is about time we had a little open opposition.

These are fair questions. I warn the right hon. Member for Wanstead and Woodford that he cannot get away—as he did once before—with saying "We are waiting for the views of the Royal Commission." He is quite happy to tell us in detail what he wants to do about the organisational structure of the NHS without waiting for the Royal Commission—and that is purely technical matter. This is a matter of deep principle. He does not need the Royal Commission to tell him where his principles lie—or I hope he does not. Let us see what he has to say.

While he is about it, I hope the right hon. Gentleman will spell out where the Conservative Party stands on the issue of queue-jumping. Where does it stand on common waiting lists for private and NHS patients in NHS hospitals? The Government's position is plain. While pay beds are being phased out, we believe that those who pay should not be able to jump the queue for treatment. That is why I made proposals in the summer for the implementation of common waiting lists. The hon. Member for Reading, South leapt up and sharply criticised this policy. The issue is all the more important since, as we understand, the Tories want to bring back more pay beds. So I ask the question today: do the Tories support common waiting lists, or are they now openly in favour of queue-jumping? I hope we shall hear an answer to that question from the right hon. Member for Wanstead and Woodford.

I also hope that, instead of carping criticism, we shall get from the Opposition some recognition of what has been achieved by this Government and those who work in the Health Service. The fact is that, in spite of all the difficulties and the financial restraints, we have more and more staff treating more and more patients. The facts speak for themselves. I am comparing the position in 1977 with that in 1973, the last full year of the Tory Administration. The number of inpatients treated is up by 213,000 to 5,345,000—an all-time record. The number of day-patients is up by 123,000 to 532,000—again a record. The number of medical staff is up by 14 per cent. The number of nurses and midwives is up by 12 per cent.

In spite of these achievements, waiting lists remain very long, with all the pain and the suffering that means for patients. This is one of the many problems we face in the National Health Service. We have a great deal still to do. But let us take a balanced view and recognise not only the tasks ahead but the real achievements of the many dedicated people who work in the Service.

I have dealt with the first area of public concern: resources and priorities. I turn now more briefly to the second: the organisation and structure of the National Health Service.

There is no disguising the very widespread concern over the reorganisation that the Conservatives foisted on the Service four years ago. The public believe—no one doubts it—that there is too much bureaucracy, that the machine is insensitive to the needs of patients and staff and, perhaps especially, that decisions are sometimes taken too far away from the patients themselves.

I know that the right hon. Gentleman likes to wax eloquent on this last point—he makes speech after speech—but it is a little difficult to take seriously what he and the right hon. Member for Leeds, North-East (Sir K. Joseph) have to say on this matter. Somehow or other they talk as if they had no responsibility for it at all, as if somehow the situation that they are graphically describing is the responsibilty of the Labour Government. But they are responsible for it—they and they alone. It was their pet scheme and it was vigorously opposed by Labour when we were in opposition. We knew that they had it wrong. But now they are coming forward with yet another Tory blueprint. The right hon. Gentleman's party is coming forward with a new blueprint for the reorganisation of the NHS. I ask whether you, Mr. Speaker, would buy a second-hand reorganisation from the men who planted the first one upon us.

My right hon. Friend the Prime Minister, in his speech to the Labour Party conference, made clear that this Government intend to make decision-making more democratic in a number of spheres of life. In the light of the views of the Royal Commission on the NHS, we are determined to make the Health Service more responsive both to those who use it and to those who work in it. As the Prime Minister made clear, we shall not take major steps on this before we have had a chance to consider the views of the Royal Commission that will be reporting to us early next year.

This is in stark contrast to right hon. Members on the Opposition side. They are so embarrassed by what they have done that they are falling over themselves to suggest new remedies. I believe that in their haste they seem to be seeking to impose yet another rigid, ill-thought-out pattern upon the Service. Frankenstein may be dissatisfied with his first monster so he is helpfully making another. Let the public be warned.

Mr. Stanley Newens (Harlow)

Is it not a fact that one result of the dreadful structure which has been imposed by the present Opposition on the Health Service is not only bureaucracy and administrative waste but the diversion of too many resources from patient care to administration? Ought we not to be seeking some reorganisation which will put more of the money which goes into the Health Service into patient care?

Mr. Ennals

That is absolutely right. Until we can carry out the changes that we need—because the burden of bureaucracy must be reduced—we have to see what we can do right now. I advise right hon. Gentlemen that we are first cutting down on management costs which, as my hon. Friend said, result directly from the reorganisation for which they were responsible. In the past two and a half years we have cut out nearly 3,000 administrative posts and at the same time we have seen the number of doctors and nurses increasing. As a result, this year we have been able to release about £13 million for patient care. In a sense, this is a form of organic change. As for districts, we are also looking at the structure at local level to see how we can meet local needs. I have already given approval for four area reorganisations and there are several others in the pipeline. We are making savings on fuel, supplies, drug costs and the rest. My hon. Friend is absolutely right. These are the issues on which we are concentrating.

That brings me to the third and final area of concern for the Health Service—the problems of industrial relations, pay disputes and industrial action. That is perhaps the most immediate area of concern for the public generally. In fact, the last time this House debated the National Health Service—it was at a time when I was in hospital and could not be here—it was about industrial relations in the Service.

As patients see only too clearly, the real damage that can be caused by industrial action is the lengthening waiting lists, postponed operations, real problems for staff morale and all the rest. It is in times of internal conflict that the NHS sometimes gives the appearance of having too many warring factions rather than being a united team. The right hon. Member for Wanstead and Woodford will understand what I mean by that. The difficulties are enormous.

There are no easy answers to problems of pay. Many other disputes can blow up, and they blow up locally. We have all been greatly alarmed by the recent works supervisors' dispute and by troubles in particular hospitals. There may be more difficulties ahead as we enter the pay bargaining season.

What judgment can we pass on the use of industrial action in the National Health Service? In 1973 it was the ancillaries who used it, in 1975 it was the doctors, and in 1978 the works supervisors. Some people have attacked industrial action within the NHS as part of a general attack upon the trade unions. That is absolutely unfair.

I pay tribute to the commitment of the leaders of the Health Service unions to the Service and the interests of patients. Can we—as some people suggest—impose a requirement that because they work in the Health Service they should forswear the normal rights of trade unionists? I believe that that would be unrealistic. Most organisations—and I suspect that they include the British Medical Association—would not agree to have their hands tied. Of the three areas of concern being discussed today, I think that this is the one in which Tory hypocrisy is at its worst.

Mr. Eldon Griffiths (Bury St. Edmunds)

Before the right hon. Gentleman continues his attacks, may I say that the vast majority of people who work in the Health Service at all levels hate the idea of strikes against patients? They do not like it any more than we do.

Would the right hon. Gentleman consider at least what was done in the recent police pay settlement, when the police agreed to continue to give up the right to strike but were compensated by an inflation-indexed pay increase and machinery to maintain it? Large numbers of doctors and nurses and other members of the National Health Service have written to me saying that they would like such a deal to be tried out in the Service.

Mr. Ennals

I suppose that many people would say that they were prepared to make some sacrifices if they were given 25 per cent. extra pay. I can see that prospect winning a battle across the country.

I want to come on to the inflationary consequences, because we cannot totally exclude the National Health Service from this Government's battle against inflation, as the hon. Gentleman seems to think we can. I believe that those who choose to work in the NHS have a very special responsibility to those they serve and to sick people. A hospital is not like a factory complex. Human health and lives are at stake. It cannot be right to put human lives at risk and to cause suffering as an indication of industrial muscle. We must find a better way. We must get our procedures right. We owe it to the Health Service workers and to the patients. Let us look at what we can do in a serious way.

I believe that there are two distinct problems. First, there is the question of pay and conditions of service, matters dealt with in the Whitley Council machinery. Secondly, there are the disputes that blow up locally—rows about the duty roster, the level of staffing on a ward, where someone parks his bicycle, or a clash of personalities. If they are not tackled, these problems fester and eventually erupt into industrial action, with all that it involves for patients, and all the publicity and effect upon morale.

That is why earlier this year I brought together round my table the general secretaries of the main Health Service unions, the chairman and secretary of the British Medical Association council, the chairman of the Conference of Medical Royal Colleges and the secretaries of the Royal Colleges of Nursing and of Midwives, together with a representative of the Trades Union Congress and a representative of management. It was the first time that such a meeting had ever taken place in the lifetime of the National Health Service. As a result, I was able to put forward concrete proposals only last week for a new disputes procedure in the National Health Service. This up-to-date procedure is designed to settle disputes quickly at the local level where they arise. The general Whitley Council is now considering these proposals, and I hope that it will embody the essential features in an agreement that can be put into effect as soon as possible throughout the NHS.

This is a practical down-to-earth initiative that I hope will cut to a minimum the number of avoidable local disputes. I was impressed by the extent to which the leaders of the professions and the unions came together and hammered out something that they could all support.

The Opposition are always quick to criticise whenever they see the chance, but let us remember that when they had responsibility for these matters, they did absolutely nothing. Now they draw on their great reservoir of imagination and come up with fanciful ideas of a patients' charter. I hope that the right hon. Member for Wanstead and Woodford will tell us about it. It sounds good. What does it mean? How will it work? I hope that it is more sensible than the right hon. Gentleman's best known proposal that we should brush our teeth in the dark. At least I can understand that, and perhaps he will enable me to understand his ideas for improving industrial relations in the National Health Service.

We are talking about industrial disputes. The Opposition's attitude to disputes about pay is equally unconstructive. They did nothing to be proud of when they were in office, but they are quick to make capital out of any difficulties that we have.

Mr. David Crouch (Canterbury)

rose—

Mr. Ennals

I would have preferred to give way later to the hon. Gentleman. However, as I know he takes a great interest in this matter, I shall give way now.

Mr. Crouch

I wish to intervene only on the matter of pay policy. The Secretary of State told us that he had a meeting recently when he called together the representatives of the responsible trade unions operating in the Health Service. Do they appreciate that not only do they operate under the Cabinet's pay policy so strongly advocated by the Prime Minister, but they also operate under the cash limits that fall on his Department? If they take more than the pay policy limits allow, it will be a matter of robbing Peter to pay Paul. Did he make that clear to them?

Mr. Ennals

The conference that produced this initiative on local disputes was dealing specifically with non-Whitley-Council-type disputes. I believe that there may be merit in inviting the same group of people to meet to see whether we can improve methods of dealing with the types of disputes that affect Whitley Council issues. I shall cone to the main issue—the question of the supervisors—in a moment.

In the case that we have been discussing, the machinery is not the real issue. The real issue is what sort of pay rises various groups of NHS staff are seeeking and what they can be given. Here, not only the question of cash limits but the question of pay policy is crucial.

I must comment briefly on two recent matters of concern—the supervisors' dispute and the worries expressed about the pay and morale of nurses. I deal first with the dispute.

I have no doubt that the House will have shared my great anxiety about the effect of the recent dispute on waiting lists and the very real risk to patients. Happily, a settlement has been reached with the help of the good offices of the general secretary of the TUC—and the House will, I know, be grateful to Mr. Len Murray for his most helpful initiative.

I have no wish to rake over the coals. But there have been suggestions that this dispute could have been settled weeks earlier if Ministers had wished, suggestions that the issue had nothing to do with pay policy, and suggestions that the Government finally accepted a deal that I had said earlier was not on. All these suggestions are false.

Ministers intervened on a number of occasions in efforts to settle the dispute. It was at my request that ACAS made an attempt to conciliate after talks had broken down. What was really being suggested by some critics of the Government was that we should simply have given the staff concerned all that they were demanding—regardless of pay policy and regardless of cash limits and the consequences for other groups of staff. It was a sure recipe for further disputes and further industrial action in the NHS. Pay up and hang the consequences seemed at one stage to have been the attitude of the hon. Member for Reading, South in a statement that he made. No doubt he or his right hon. Friend the Member for Wanstead and Woodford will tell us the purpose of his intervention at that time, if that was not it. I suppose that is what he wanted.

Mr. Doug Hoyle (Nelson and Colne)

Does not my right hon. Friend agree that this dispute was not connected with pay policy but was a hangover from the reorganisation that should have been settled much earlier?

Mr. Ennals

No. Let me spell it out. It is most important that the House should understand. Of course it was not a straight issue of whether the pay claim was above 5 per cent. This dispute was not about annual pay settlements. It was about a genuine regrading of staff.

There were two very important issues of pay policy. First, the Government had to be satisfied that the new salaries offered for the new posts were commensurate with the job descriptions. On this basis, we approved the salary scales that had been offered by the management side several weeks before. The rejection of that management offer was the start of the supervisors' action. Happily, six weeks later, after the disruption in the Service, they accepted precisely the same salary scales that they had rejected.

Secondly, we had to be satisfied that any improvements to the supervisors' productivity allowances were genuinely self-financing. That condition is met in the agreement reached last wek. Bonus payments are clearly subject to the financial viability of the scheme.

During the negotiations, the staff side was demanding a minimum—I repeat minimum, because it was from 15 per cent. up to 30 per cent.—of 15 per cent. allowances for all supervisors regardless of whether they were involved in productivity schemes and regardless of whether the schemes were saving enough money to cover the costs. I said that that was not on. Productivity deals must be genuinely self-financing. I have stuck to that position. The agreement reached last week is entirely consistent with it. The 15 per cent. allowances provided for will not be an unconditional minimum available to all, regardless of membership of schemes and their viability. All supervisors will now have the opportunity to participate in schemes, but the allowances paid, which we hope may reach 15 per cent. six months after schemes are initiated locally, will depend upon the financial viability of the schemes. That is the crucial point. I am glad that the unions were able to accept it. Until they did, no settlement was possible.

The other subject that I have to mention is the morale and pay of nurses. I recognise the great pressure that nursing staffs are under, particularly during industrial action by other groups when, in a sense, nurses have to pick up the tabs and carry on seeing that patients are cared for. I think that the House will join me today in expressing the country's deep feeling of thanks to the nurses and to other staff who did so much to maintain the services during that very difficult and, I believe, tragic period.

Nurses are under stress for many other reasons. There has been a steady increase in the number of nurses working in the National Health Service. It has doubled in 30 years. There has been an increase in the proportion of trained nurses. But they are under very great pressure. I know that from my own experience in hospital. The number of patients increases, the period that an in-patient stays declines, and inevitably the amount of attention that each patient needs increases. As more patients are elderly, they make heavier demands upon the nurses. The nurses need to master new skills.

I am very glad that we have managed to include in the legislative programme a Bill to establish a new, unified structure for the regulation, discipline, education and training of nurses, midwives and health visitors. This structure will comprise a United Kingdom central council and four national boards, one for each country of the United Kingdom, with supporting specialist committees which will replace the existing statutory and non-statutory bodies. For heaven's sake, the nurses have been waiting for a long time for this.

Mr. Laurie Pavitt (Brent, South)

Since 1972.

Mr. Ennals

We can go back to 1974 at least, when my right hon. Friend the Member for Blackburn (Mrs. Castle) announced the Government's acceptance of the main recommendations of the Briggs report.

I am pleased to say that we can now start moving forward. I know that many nurses will welcome this, but that they will also say that their pay has fallen behind. They have asked me to look at their position in the light of the "special case" provisions in the White Paper. The question of nurses' pay is one that will have to be looked at by the Government in the light of our declared policy on pay as set out in the White Paper.

I hope that Conservative Members will not seek to make capital out of this matter. With their record on nurses' pay, they have nothing to be proud of. What did they ever do about it when they had the chance? It was a Labour Government who raised nurses' pay by 20 per cent. in 1970—I know because I was a Minister in the Department at that time—and it was a Labour Government who gave nurses a further boost of 30 per cent. in 1974 following the Halsbury report. And what happened between 1970 and 1974? Nothing—because we had a Tory Government.

In the months ahead we face many difficult problems over pay in the National Health Service. I hope that they can be resolved without industrial action. As I have said. I deplore any industrial action in the NHS that puts patients at risk. I hope to explore, with leaders of the profession and the unions, what scope there is for avoiding such action in relation to pay disputes. But to those who say that industrial action in the Health Service must be avoided simply by giving in to whatever demands are made, I give this reply. Of course we must see, within the scope of what is economically possible, that justice is done to the staff. But merely to give in to all demands is the road to anarchy, in the Health Service itself and in the wider pay context.

I repeat what my right hon. Friend the Prime Minister said yesterday. This Government are not prepared to take that road. Here we see one of the great divides that is opening up in British politics today. The Conservative Party is taking up a series of extreme positions, on the NHS and on the economy. After 30 years of bipartisan approach to the principles behind the NHS, the Tories seem to be showing their true colours. They seem ready to tax the sick with new and heavier charges.

Dr. Gerard Vaughan (Reading, South)

Rubbish.

Mr. Ennals

I am glad. In that case the hon. Gentleman will be able to assure us that it is rubbish and that that part of the Tory programme has been set aside. That will be a great relief for the whole country. I shall see whether we can get some more cries of "Rubbish." The Tories are committed to a two-tier Health Service. No "Rubbish"? We shall see. The right hon. Member for Leeds, North-East seems to know what it is, because he has been putting forward the idea himself, as have the right hon. Member for Wanstead and Woodford and the hon. Member for Reading, South. They do not know what it means. Perhaps they cannot spell it out; perhaps they do not understand their own proposals. But the moment will come in a minute for the right hon. Gentleman to explain.

The Tories are committed to massive cuts in public spending which cannot fail to hit the health and personal social services. No doubt the right hon. Gentleman will speak of that. They are also in favour of a free-for-all approach to wages, which would send inflation through the roof. If they restrain pay at all, it will be in the public sector only, so that nurses and other Health Service workers will again have to bear the brunt of rising prices. That is the Tory prescription, not only for the economy of the country but for the National Health Service. The contrast between the positive achievements and the positive programme, of this Government and what the right hon. Gentleman and his hon. Friends have to offer is patently obvious.

Mr. David Price (Eastleigh)

Before the right hon. Gentleman sits down—

Mr. Speaker

Order. Has the Minister sat down?

Mr. Ennals

I have sat down.

4.14 p.m.

Mr. Patrick Jenkin (Wanstead and Woodford)

May I begin with a word of welcome to the right hon. Gentleman? This. I think, is the first occasion on which he has addressed the House since he was struck down and whipped off to hospital in July. We very much welcome his return to health and hope that this time it will be lasting.

I can agree with the right hon. Gentleman on two of the matters to which he referred. First, he said at the outset of his speech that there is real concern in the country about the state of our Health Service. That is correct, and it is why we have chosen to devote the second day of the debate on the Queen's Speech to the subject of health.

Secondly, I agree with the right hon. Gentleman's expression of the thanks of the House, and indeed of the whole country, to those who work in the Health Service. He singled out the nurses. That was certainly justified, and one can add all the other professional, para-medical and non-professional people who work and strive to give of their best, often in extremely difficult circumstances.

The Prime Minister has intimated to me that he must depart very soon, so, if I may, I shall break the natural order of my speech and make one point now in his presence—and may I say how grateful I am to him that he has chosen to wait.

One of the things that we expected to hear about in the Queen's Speech was a Bill to reorganise the Health Service. The right hon. Gentleman made a powerful statement at Blackpool—in fact, I think that he startled his right hon. Friend. He certainly startled the Health Service when he said that it was to be further reorganised.

Naturally enough, the press, caught a little unawares by this, tried to find out what was happening. There was an interesting article in The Times. After referring to the Prime Minister's words, Mr. George Clark, whom we all know well and greatly respect, wrote: According to the ministers closely involved, the area health boards will disappear in the reorganisation and there will be greater democratic control of the hospital service. Mr. George Clark contacted me and asked me what were the implications of that statement—he was obviously making his inquiries. He is not a man who writes the words According to the ministers closely involved unless he has had some contact with Ministers closely involved. So there it was. Presumably, this was what the Prime Minister was referring to, and it is interesting because it is exactly what we have been advocating. We believe that there needs to be a slimming down of the structure, the merging of a tier, and, in most of the country—although there must be flexibility about this—it is the area tier which must be merged into the others.

But, alas, it was all wrong. That was not what the Prime Minister meant—or certainly not what the Secretary of State meant—because apparently a letter was written on behalf of the Secretary of State to administrators of regional and area health authorities of which, Mr. Speaker, for greater accuracy, I have obtained a copy. This was a little difficult because, despite the great importance of the Prime Minister's remarks as interpreted by Ministers, and the very wide interest they had aroused, no publicity at all was given to the letter. There was no press release, no press guidance, no private briefings, not even one of the Secretary of State's many speeches.

But the letter is clear beyond peradventure. It is short, blunt and to the point. It reads: Dear Administrator, In view of some of the misleading press comments on what the Prime Minister said at the Labour Party Conference on 3 October you may like to know that the Secretary of State has given an assurance that there is no commitment on the part of the Government to introduce legislation on the organisation of the National Health Service in advance of receiving and considering the Report of the Royal Commission.

The Prime Minister (Mr. James Callaghan)

Hear, hear.

Mr. Jenkin

The Prime Minister said "Hear, hear." What, then, are we to make of Mr. George Clark's statement beginning: "According to the Ministers closely involved"?

Mr. Ennals

The right hon. Gentleman should not allow himself to be fooled by everything that he reads in the press. I can assure him that no such statement was made by any Minister in the Department. Perhaps the right hon. Gentleman should have taken the trouble to read what the Prime Minister actually said, which was: Subject to the recommendations of the Royal Commission on the Health Service, we intend to undo much of the damage caused by the Tory reorganisation and make the management of the Health Service more responsive to the patients and to the dedicated people at all levels who work in the Service. I hope that the right hon. Gentleman will warmly congratulate my right hon. Friend on setting that lead.

Mr. Jenkin

Yes, if I knew what the Government's intentions were. What we have in this episide is that on Tuesday 3rd October the Prime Minister goes to Blackpool and cheers up the Labour troops by telling them that it is all going to be changed. On Friday 6th October, quietly and surreptitiously and without any publicity at all, the Secretary of State reassures the managers principally concerned that, of course, it is all nonsense and that nothing whatever will happen. All I can say is that it is one hell of a way to run a health service.

I am grateful to the Prime Minister for staying in the Chamber, but he must realise that he caused great dismay by his talk of a major reorganisation at this stage. This most emphatically is not our policy.

The Prime Minister

I am not sure that it was worth staying. I have the very highest opinion of Mr. George Clark, as of every other journalist, as we all have; we all know how splendid they all are. But I think that the misapprehension could have been avoided if the initial words of my statement had been quoted, but, alas, they were left out of a number of the press documents. They were subject to the recommendations of the Royal Commission", which, I understand, we shall not have until several months from now. Anybody who really studied these matters would therefore know very well indeed that we could not possibly legislate in the current Session, so there was no need for the apprehensions.

I would just say this in conclusion. Every morning I say to myself "Shall I really correct this error that is in the newspapers?", and then I decide "No. If I spend my day correcting all the things that are wrong which are written about me I shall never do anything else".

Mr. Jenkin

Perhaps we can leave it at that. I accept the Prime Minister's bona fides on this. Apparently, he did not mean what was attributed. But it seems to me that with a matter of this importance—and the Secretary of State had a very strong letter from John Bettinson, the chairman of the National Association of Health Authorities—a little more publicity might have been given to the denial, as a good deal of publicity had been given to the original misapprehensions.

I said that we selected the subject of health for debate today because of the real concern of the people over the state of the National Health Service—not just because of the appalling damage done by the recent dispute, or even on account of the evidence that we have recently had from the Royal College of Nursing about falling standards and collapsing morale, but because as I go round and talk to people in the hospitals and in the constituencies I detect a growing fear that the NHS is rapidly sliding out of control while the Secretary of State stands, as it were, feebly expostulating on the sidelines and quite powerless to halt the slide.

We read in the Queen's Speech about "fresh support". I come straight away to the points that the Secretary of State has made about the financial support. I thought that today he might be announcing additional spending for the Health Service. Certainly that is what I read into his remarks in his reply to the nurses' deputation. He has said that this will come. May I put this to him? We would welcome this. It would be a step to get back to the rates of growth which the Health Service enjoyed under the last Conservative Government. Let me repeat the figures to get it clear. On capital expenditure alone, in real terms, for every £2 that is being spent now on Health Service capital spending, £3 was being spent when we left office—I am talking about real terms, taking account of inflation. After a prolonged period of more than 3 per cent. growth per year, the growth rate has been cut back to 2 per cent. over the last four years, and the figures in the public expenditure White Paper, even taking account of the £50 million, made it 1.8 per cent. over the next four years. There was a suggestion in one of the medical magazines that the Government were aiming to get back to the long run rate of growth of spending. That would involve very substantial sums indeed. We shall wait and see what comes.

A more general point is that in the Health Service local health authorities are large and complex organisations. If they are asked to change speed and direction at short notice and suddenly, as, for instance, with the extra £50 million in the Budget coming only three months after the public expenditure White Paper, this makes rational planning of health services for the future almost impossible. It is bound to lead to a waste of resources. Of course people welcome the extra money. But one does not get the best value for money if one is constantly chopping and changing; sensible planning is made almost impossible.

Mr. William Molloy (Ealing, North)

The right hon. Gentleman should have told the right hon. Member for Leeds, North-East (Sir K. Joseph) that.

Mr. Jenkin

On the contrary. When we were publishing White Papers on public expenditure and health expenditures over a prolonged period, we tended to stick to the projections. If more money is to be spent on the Health Service, the sooner that people know when it will be available so that they can incorporate it into their plans the better value we shall get for the money.

Mr. Ennals

I gave an assurance without giving the figures. However, the right hon. Gentleman is clearly dedicated to George Clark and what he writes in the columns of The Times. I read on 16th May: Mr. Jenkin explained the scheme when he was asked whether the Conservatives, if returned to office, would provide extra resources for the National Health Service. He said the Conservatives would adopt the projections for spending contained in the present White Paper on public expenditure. 'We have to live within that, and there is no possibility of extra money'. Did George Clark get that wrong, too?

Mr. Jenkin

I was asked on that occasion whether we were proposing to cut the money for the Health Service. I gave an absolute commitment then, and have repeated it since on a number of occasions. We have no plans for cutting the Health Service below what we shall inherit. That is the phrase I am using. I made that statement soon after the publication of the White Paper on public expenditure. The phrase I have used, which I stand by and repeat today, is that we shall not cut spending on the Health Service below the figures that we shall inherit. How far and how fast we shall be able to increase spending will depend, as is common ground between the two parties, on how successful we are at managing the economy and restarting economic growth. It will be our aim, when we can, to get back to the rate of growth and spending on health that we had under the last Conservative Government.

Dr. M. S. Miller (East Kilbride)

It is not the same thing for the Conservative Party to say that, if elected, it will not cut expenditure. Other allegations have been made about increasing the money going into the Health Service by charges which are to be levied.

Mr. Jenkin

I have nothing to add to what I said in the earlier debate. The Secretary of State played the same old tune and perhaps I may be allowed to: we must wait for the advice of the Royal Commission. Listening to the Secretary of State fiddling his old tune, one might have thought that everything had stood still in the meantime. The fact is that we are expecting the report of the Royal Commission in a few months and it would be foolish now to make pledges in advance of that.

I turn briefly to the subject of the nurses, because they have made a long and detailed critique of the Health Service. They talk of the falling standards in the Health Service, of the collapse in morale, and use very serious language about "continuing deterioration" and the serious threat to the maintenance of standards of care. In describing clinical areas, they talk of the resulting positively dangerous standards of care. We need to take those criticisms very seriously indeed. I do not know whether the nurses' complaints are to be included in the right hon. Gentleman's description of "carping criticism" which he made in his speech, but I take the memorandum, which I have carefully studied, extremely seriously.

I take no part more seriously than the figures given of the rapidly declining number of learner nurses in the Health Service. Initial entrants from March 1977 to March 1978 are down 17 per cent. and learners down 13 per cent. That is very bad news for the country and for the Health Service. We did not hear anything from the Secretary of State on what is to be done about that.

In many parts of the country—and this is true in my own area—it is not possible to fill those posts for which funds exist and they are below the regional norms. What the future position will be like fills one with great despondency. We are in the grip of a vicious circle, with falling numbers that result in overwork, leading to lower standards and increasing job dissatisfaction for the nurses. Consequently, many leave early, many do not complete their period of training, and the situation deteriorates further.

Job satisfaction for nurses is the absolute key. They want to feel that their work is up to the highest standards that they were taught in their nursing schools. There is nothing more demoralising for people in that kind of work to know that they are giving only second or third-rate service.

Mr. Molloy

I agree with much of what the right hon. Gentleman is saying. Indeed, I think that the whole House agrees with it. However, we should like to know whether he will also agree that there must be a massive resurgence of resources to put right the matters about which the nurses have been complaining.

Mr. Jenkin

I made the point that we could afford a substantial increase in money spent on health only when the economy is once again producing the resources to enable that to be done. That is common ground between the parties. I do not think that there is any point in calling for a huge influx of funds at this stage, because we know that that cannot be done.

I turn to the Briggs report, which was referred to in the Gracious Speech. We shall debate that, I believe, on Monday week, so I need say little now about it. It has been a long time coming, and we welcome it. I know of the lengthy consultations that have taken place, because of the understandable desire on the part of professional groups who wish to preserve their separate identities within the profession, bearing in mind their long and honourable records of service to the community. At the same time, we must avoid—and this is a question of balance—creating an over-rigid, over-cumbersome structure. We support the general aims of the Bill, but we shall certainly wish to study the details very carefully.

The Gracious Speech referred to vaccine compensation. We also welcome that. May we ask the Under-Secretary to state whether that will be taken into account in the calculation of supplementary benefits for affected families? When the Government were last asked that question, they reserved their position, but we now need to know. I do not know whether the Under-Secretary intends to say something on the future of the Pearson report and where the Government stand on that. These subjects are clearly interrelated.

I turn next to the Bill to pay attendance allowance to kidney patients. The conduct of Ministers here has been a good deal less admirable. The sad thing is that those payments could now be being made if the Government had had the sense to adopt the Private Member's Bill presented by my hon. Friend the Member for Ealing, Acton (Sir G. Young) in the last Session. I have been singularly unimpressed by the excuses why that did not happen. The Government said that the Bill was not properly worded and did not cover the subject adequately. My hon. Friend—indeed, the whole House—would have been ready to accept any amendments that could have been made to the Bill, either here or in another place, to enable those payments to be made to kidney dialysis patients as rapidly as possible.

I have a horrid suspicion that the reason we have not had that Bill is that the right hon. Gentleman has an almost obsessive compulsion to take the credit for everything that happens. Why cannot he have a little grace and give credit where credit is due? Why could he not have allowed my hon. Friend's Bill to reach the statute book? The right hon. Gentleman has not enhanced his reputation in this affair.

Important though all this is, it is overshadowed by recent events in the Health Service—the maintenance supervisors' strike. I should like to examine in some detail the arguments which the right hon. Gentleman has put to the House and those which were advanced during the strike. By common consent, this has been the most damaging strike—although it should not be described as a strike but a dispute; the supervisors were being paid all the time—in the history of the NHS. That point has been raised by my hon. Friend the Member for Aylesbury (Mr. Raison) on a number of occasions. We cannot know whether deaths actually resulted from it, but we certainly may assume that deaths may have been hastened and that some who could have been cured will not now be cured. A total of 9,000 beds were closed, 300 hospitals were on emergencies only and waiting lists are now up by 60,000—a 10 per cent. increase—with untold misery and despair for patients. The dispute certainly dealt a further blow to morale in the NHS.

The Secretary of State's explanation has left a whole raft of questions unanswered. It needs to be made clear why the dispute was left outstanding for so long. That point was made by the hon. Member for Nelson and Colne (Mr. Hoyle). The dispute dates back to 1974. For all the criticisms of this party, the Government have been in office for four and a half years; they have been in charge of matters. They really cannot put the responsibility back on the last Conservative Government.

The pay structure was settled for senior work staff in grades 1, 2 and 3 but not for grades 4 and 5. Yet it was only two months ago that management got round to putting forward pay scales for grades 4 and 5. Why was the grievance allowed to fester for over four years?

By his inaction on this matter alone, the Secretary of State deserves severe censure. However, a much more serious question that he must answer—he has not yet done so to my satisfaction—is why this dispute was not settled within the first few days. His case, as he presented it to the public throughout and as he presented it again today, was that the Government were standing firm in defence of their pay policy. In his letter of 9th October to Allan Black, the chief staff side negotiator, he wrote The Government would not be prepared to authorise any offers which would involve further increase in cost … we must ensure that any agreement is consistent with pay policy. He has maintained that attitude throughout, including his phrase, repeated this afternoon, that what the staff side was demanding was "just not on".

The Daily Mirror quoted him as saying on 26th October, that …we mustn't create a situation which makes such a hole in the pay policy that there is nothing left. Yet there has now been substantial evidence, from authoritative sources, that pay policy had nothing whatever to do with it. The Sunday Times quoted one of the staff side negotiators, Mr. Ray Harris—[Interruption.] I am quoting what the paper reported him as saying, and I believe it to be true that he said it. He said: he … first realised that pay policy was an issue when they met Ennals two days after their action began. We were amazed at his attitude.… until then, and from our meeting with the Secretary's junior colleagues at the ministry,"— that will be the Under-Secretaries— we had been led to believe that pay policy had nothing whatsoever to do with our dispute. Mr. Len Murray, whom the Secretary of State praised—and to whom we pay tribute for his part in settling the dispute—said: 'Whatever the merits of the pay policy this dispute was concerned with the relationship between supervisors and related grades on the one hand, and electricians on the other. In no sense did the works staff concerned, or their unions, regard this as an attempt to break the pay policy.'". This is a powerful case, which the right hon. Gentleman must answer. Yet he later went on the radio simply repeating that it was a matter of pay policy. As I understand it—and I have made my own inquiries—the issue, at the end, was relatively simple. It was whether all supervisors should share in the productivity bonuses, or only where a productivity scheme was in operation. The unions were insisting "all". The management side was insisting "No. A productivity scheme must be financially viable". That is common form when anyone introduces a productivity scheme. It must pay its way. There were also arguments about the lead-in time.

But does not this mean that all we had here was not a dispute that put at stake the whole Government pay policy but a haggle over the small print of a productivity deal? That was the view of The Times, which said: … the immediate issues are small beer to both sides. The Guardian, in one of the strongest worded leaders that I have seen on the issue, said that it was a snivelling pay anomaly of the most petty nature … It was foolish to try to construe the present dispute as a challenge to pay policy. We may be in Stage Four, but the supervisors' grievance, hoary with age, predates even this Government's long-running incomes policy. The House needs to know which was right. Was it the view of management? The management told me that at no stage in the negotiations was pay policy even mentioned. Was that right? Were the unions right—Mr. Harris and Mr. Murray? Were the junior Ministers right, when they gave their indications earlier that pay policy was not involved? Or are we now to believe the Secretary of State that it was all a matter of pay policy?

I am bound to tell the right hon. Gentleman that he has not emerged from this episode with any credit at all. Throughout he has given the impression of thrashing about in frenzied futility, blaming everyone and everything except his own dilatoriness in settling the matter years ago, and one of the reasons for his ineffectiveness has been his total confusion about whether pay policy was or was not at the back of it.

Mr. Ennals

Of course I can well understand the right hon. Gentleman, who represents a party which does not believe in pay policy—well, part of it dots and part of it does not; the Front Bench does not. I can well understand that The Times or The Sunday Times, or all sorts of other spokesmen, would wish to say that it was not a pay policy issue. The people who have to decide whether it is a pay policy issue are those who have responsibility for pay policy. That is Her Majesty's Government. I say straight away that my hon. Friends did not give that impression. That was incorrect. When I spoke, I spoke not just for myself. I spoke for my Government—our Government—who have responsibility for pay policy. I have spelt out in detail the two clear roles in which this was a breach of pay policy. I can understand that people would say "No, we are not trying to break the pay policy". The Government have to decide whether the pay policy is being challenged.

Mr. Jenkin

I wish that I had not given way to the right hon. Gentleman because I am coming to these points. I think there was throughout a confusion as to whether it was pay policy or not. But I should like to take the argument a little wider and look at it in the context of the discussion that took place here yesterday between the Prime Minister and my right hon. Friend.

Let us suppose, in the first instance, that the negotiators were right and the Secretary of State was wrong—that the junior Ministers were right and that pay policy was not the issue. Where does the case stand then? Surely, it is that this episode demonstrated, as starkly as could be imagined, that if one has a rigid pay limit it can foul up negotiations even where it is not relevant at all.

Alternatively, let us take the other way. Let us assume that the Secretary State was right—and there may be some grounds for saying that at the later stage, when the 25 per cent. claim across the board for productivity bonus was made—and pay policy did by then become an issue. Does not this, too, demonstrate the folly of brandishing about a fixed limit at this stage in a pay cycle in that one sets up an Aunt Sally for the trade unions? We know that there are unions which are prepared to have it as their objective to smash the limit, irrespective of the merits of the particular case. None of the unions which are used to negotiating in this Whitley Council can have believed for one moment that a 25 per cent. across the board productivity payment irrespective of financial viability was a starter at all; but it was as good a way as any of trying to smash the Government's pay limit.

Mr. Ennals

That is right.

Mr. Jenkin

Yes, but let us see where it takes the right hon. Gentleman. This was the view of a person who perhaps should know, the chairman of the area works officers' association, West Midlands region, who has written an extremely interesting letter in this week's Health and Social Service Journal. I quote: It is only within the past week that both the media and our colleagues within the Service have considered that this is a direct confrontation with the Government pay policy. There appears to be evidence that this dispute is being used as an attack on the Government pay policy by unions and preventing a reasonable settlement. I have no doubt that the Under-Secretary was right when he saw the staff side some time ago and said that to settle this dispute need not involve pay policy at all.

Mr. Ennals

Absolute nonsense.

Mr. Jenkin

What has happened by having the Prime Minister's 5 per cent. pay policy is that it provoked the unions into putting forward a totally unreasonable claim which the Secretary of State then had to say was in breach of pay policy.

Mr. Ennals

rose—

Mr. Jenkin

Let me just finish my case. Whichever way one looks at it, whether pay policy was involved or whether it was not, the fact of the matter is that this dispute has taken us right to the heart of the argument which we had yesterday. At this stage of a pay policy, does it help to have a rigid 5 per cent. figure, which either gets fouled up with negotiations which are not relevant or else is used as a target by the unions to try to smash?

Mr. Ennals

I did not wish to intervene again, but the right hon. Gentleman has made an accusation against my hon. Friends which I have already denied. I made it absolutely clear that my hon. Friends in their discussions said no such thing. The right hon. Gentleman really cannot do this in the House. It is quite wrong. I have given him an assurance that no such statement was made by Ministers, and if he wishes to turn this into an economic debate, let him do so.

Mr. Jenkin

I accept what the right hon. Gentleman says. If he gives me an assurance, of course I accept it. The fact of the matter is that we are in the heart of an economic debate, and as a result of the way in which the situation has been handled we have had now the worst dispute in the history of the National Health Service. It is well known that the 5 per cent. figure was plucked from the air by the Prime Minister in the course of a television interview, much to the dismay of many of his colleagues. They knew what the consequences would be. In 1974, a rigid limit plunged the country into the three-day week and brought down the Government. Now, in 1978, another rigid figure has hit the National Health Service with the worst dispute in its history and may well have led to loss of life.

In his speech yesterday the Prime Minister asked: Are we to have a winter of strikes? It means, he continued: that life could seize up in a closely-knit industrial society such as our own."[Official Report, 1st November 1978; Vol. 957, c. 53.] In the National Health Service it is not just that life seizes up, it is that lives are snuffed out. That is the price that we are now paying for an over-rigid pay policy.

Of course, this would not be so if it were not for the activities of those in the National Health Service who use patients as weapons in their disputes, by taking industrial action. We debated this subject last July, but it has now become one of even more intense public concern.

People have been horrified by what they have seen and read in recent weeks. In a straightforward battle for more money, the unions involved have not hesitated to use the torment of patients as a weapon in their struggle—and "torment" is the right word. There was the lady sent home with a fractured knee joint, in agony and untreated; the 85-year-old man with a broken shoulder joint, sent home in agony and untreated; cancer patients, where surgeons reported that cases which were operable were now becoming inoperable. The list is very long.

My hon. Friend the Member for Aylesbury received a letter last week from an elderly lady of 77 with polio in one leg who needs an operation on an arthritic knee in the other. She has already been waiting over 10 months. She wrote: Mr. Taylor the consultant has told me that owing to the industrial dispute the waiting list will now be much longer and as I live alone and am not able to get out life is becoming very depressing. When working before retirement I worked 10 years in the hospital service including the Royal Bucks. What does she think of what has been going on during the past few weeks? All over the country there were similar stories, and 60,000 cases were added to the waiting list.

I have to ask this—have we all gone mad? How can one justify using the sick and injured in this callous and inhuman way? Have we reached such a level of moral bankruptcy that we accept with a resigned shrug that one man's pay claim may be another man's coffin? [Interruption.] I have said many times that I condemn all those who strike in the Health Service. We were very firm about that when we were faced with strikes in the medical profession.

Look at the defences we have heard. First, there was the flat denial that anything at all was going wrong. COHSE's spokesman, Nick Grant, said: It is extremely doubtful whether there's a cause-and-effect relationship between the patients being turned away and the supervisors' action. Further on he said: The difficulty we always have in disputes is that certain consultants tend to exaggerate and make some sort of capital out of them. We can treat that statement with the contempt it deserves.

Then there was the counter-attack. The right hon. Gentleman felt its blast when he finally, from Norwich, made his appeal to the men to go back and pointed out what the consultants there had told him. Of what was he accused? He was accused of "blackmailing the union" which, when one considers what was going on really makes one puke.

Perhaps almost more offensive than the other defences was the mealy-mouthed excuse "Yes, we know. We are very sorry, but it is not our fault." I have said that I thought the men had a case that should have been dealt with years ago, but it seems to me absolutely outrageous that the sums of money involved should have given rise to the hardship which we have been facing.

Geoffrey Drain, in his letter to The Times, which aroused a pretty fierce riposte from a number of people, said: NALGO joins … in feeling sympathy for patients caught up in the effects of the industrial action currently being undertaken by hospital engineers and building supervisors. Mr. Rodger "— who had written earlier— however, is misinformed. These NALGO members are not on strike. They are refusing to undertake tasks for which they are not being paid; additionally they are not carrying out certain maintenance work. In law a man is presumed to intend the natural and probable consequences of his act. If a union orders men not to service essential equipment and as a result patients have to be sent home in pain and untreated, it does not lie in the mouths of the union leaders to claim that that consequence is unintended. However we look at it, the object, the purpose, is to put the screws on management, but the result is to punish the patient.

None of the men concerned would, individually, set out to cause suffering to a sick or injured person to secure a private gain. I must again ask the question that I asked on 3rd July, to which I have never had an answer: why does it apparently become quite acceptable to do so collectively in order to secure a collective gain? What is it about trade union morality which seems to blunt individual consciences?

When I asked that question in July Albert Spanswick, the general secretary of COHSE, in reply to the debate, wrote a very intemperate article in the COHSE journal, accusing me of "an extraordinary display of Tory prejudice." On some matters I admit to prejudice. I am prejudiced against depriving patients of urgent medical care as a weapon in a dispute over more money. That is one of the matters on which I shall maintain my prejudice, because I believe that that is totally wrong.

Therefore, I ask—and I was half encouraged by what the Secretary of State said—that we now work towards what I have called a patients' charter. Of course, that must mean improved negotiating procedures. The Secretary of State said that the Whitley machinery existed to avoid such disruption when difficulties arose. It is clearly not working. Four and a half years have passed without this grievance being dealt with.

The action announced last week was a small step in the right direction, but, as the Secretary of State conceded, it does not deal with major issues. It may deal with the kind of case that occurred in the constituency of my hon. Friend the Member for Kingston upon Thames (Mr. Lamont), where, because of a keen and efficient security manager, thefts totalling £100,000 a year were traced and stopped, but the unions have walked out on strike because they think they are being victimised. I hope that the right hon. Gentleman's new procedure will stop that sort of scandal. It makes me very angry. That security manager has now been suspended because of union pressure pending the inquiry. It is absolutely outrageous.

Mr. David Price

Will my right hon. Friend answer the question that I wished to put to the Secretary of State? Surely, at the non-pay level we must have a more effective consultative industrial relations machine in the Health Service. I do not wish to be pompous, but I have had much experience in industry. Although one may have national agreements, a great deal of detail is filled in at work level. That is what participation is about. I do not wish to mention particular cases from my part of the country—I am speaking as one who was once a governor of a London teaching hospital—but surely we must have better machinery whereby more matters can be settled in the hospitals and not have to go higher.

Mr. Jenkin

I agree. We want more than just the short-term brush-fire operation which the Secretary of State announced last week. My hon. Friend is saying that there must be a greater capacity to deal with industrial relations problems at the working level. I am sure of that. The right hon. Gentleman has had the McCarthy report; practically nothing has happened—

Mr. Ennals

Oh.

Mr. Jenkin

No doubt, the Under-Secretary will tell us what has happened. Consideration of the McCarthy report, which dealt with the structure of the staff side, seems to be grinding exceedingly slowly. Meanwhile, the nation is having to suffer as we suffered over the past few weeks. It is already clear that we are to suffer again in the future. Other unions are threatening to follow the supervisors down the same road. The National Union of Public Employees has tabled a 40 per cent. pay claim for hospital ancillary workers, as reported in the Financial Times, warning that it has completed detailed contingency plans for industrial action against the Government's 5 per cent. pay policy. The Financial Times gave an account of what is envisaged: The plans are aimed at identifying areas of maximum disruption to the Health Service and the effects could be similar to—and possibly worse than—the crippling action taken by hospital works supervisors over the last five weeks. That is a grim outlook, which is already casting dark shadows over the next few months in the life of our hospitals. Yet against that background all that we have had is the bland and reassuring words of the Queen's Speech that more resources will be made available. Against that kind of background it is empty rhetoric.

The Government have presided over the Health Service for four and a half years and the result is now rock-bottom morale, falling standards and growing public disillusion with the whole concept of the NHS. It is time for a fresh start—the kind of start that only a General Election can bring.

4.54 p.m.

Mr. Laurie Pavitt (Brent, South)

You must have heard hundreds of speeches, Mr. Speaker, in which an hon. Member has apologised to his predecessor, saying "I shall not be following you". I want to reassure the right hon. Member for Wanstead and Woodford (Mr. Jenkin) that I shall be following him very closely because, somehow or other, without straying very far from my own notes, I seem to be moving step by step in the same framework.

I wish to pick up three points which arose earlier. First, may I dispose of the intervention about Mr. George Clark? Mr. George Clark came to see me on the Friday after the Labour Party conference, and we had a chat. I assure the right hon. Gentleman that, although my right hon. Friend the Secretary of State has affection and respect for me, I have never been close enough to be able to influence what he says or what the Department does. So I am afraid that, as the right hon. Gentleman knows, the idea that someone could have direct access to the DHSS by talking to a Back-Bench Member is not feasible.

The second point that I should like to take from the right hon. Gentleman's comments is the challenge put to him by the Government Front Bench. He made the categorical statement that a Conservative Government will not in any way allow less expenditure than that which they inherit on the NHS budget. Secondly, he believes that public expenditure must be contained. Thirdly, I accept that he sincerely believes that resources for the Health Service must be improved. If we take those three propositions together, we reach the inescapable conclusion that the only way in which he can get fresh resources without increasing public expenditure—while maintaining the expenditure which he inherits—is by some form of charging. I hope that whoever winds up the debate from the Opposition Front Bench will tell us whether there will be increased prescription charges, board and lodgings charges, increased charges for spectacles or teeth, a fee for an interview with a general practitioner, or any of the other kites that have been flown.

The right hon. Gentleman concluded by expressing anger and concern. For every case that he has put to the House—and I know of these cases, too, in the past few weeks—I know from personal experience of cases where, in spite of difficulties, devoted Health Service workers—including some in the grades that we have been discussing—have managed to clear the lines, do a job of work and save people from going on the waiting list. I speak from personal knowledge.

Why do we always hear this jeremiad about all that is wrong and how the trade unions do not do the job, yet never hear the compensating points? I hear both sides. It would be helpful if the House sometimes heard both sides as well.

The right hon. Gentleman said nothing about the attitude of the Tory Party when industrial action by doctors raised the waiting list from 500,000 to 600,000. That was the time when he should have spoken out about industrial action being harmful to patients.

Mr. Patrick Jenkin

I have not checked back through Hansard, but the conduct of my hon. Friend the Member for Sutton Coldfield (Mr. Fowler), who was then our spokesman, was in marked contrast to the attitude of Labour Ministers when we were facing strikes not only in the Health Service but elsewhere. My hon. Friend made it abundantly clear that in no way could we support industrial action aimed at disrupting the Health Service or indeed at breaking the Government's pay policy. That has been our consistent and responsible view throughout. I held my peace entirely during this last dispute because I did not think that an Opposition spokesman not privy to the negotiations could make a comment upon it.

Mr. Ennals

What about the hon. Member for Reading, South (Dr. Vaughan)?

Mr. Jenkin

The natural revulsion of my hon. Friend the Member for Reading, South (Dr. Vaughan) stems from the fact that he is a doctor and perhaps feels more passionately than most of us what doctors feel when they are unable to treat patients whom they are asked to see.

Mr. Pavitt

I have been in the House on many occasions when statements have been made from the Front Bench. Health is a subject in which I take an especial interest. I can assure the House that at no time have I sensed any of this anger, indignation or passion and fire about doctors, whatever the comments of the hon. Member for Sutton Coldfield (Mr. Fowler) at that time.

One word on the Resource Allocation Working Party. My right hon. Friend has dealt with it, and I do not want to spend long on it because it is not really part of our brief today. The principle is absolutely right. There must be a fair distribution of resources. But the administrators are using an axe when they ought to use a scalpel. The blanket regional figures—or even area figures—give no account to the morbidity rates or of the inner city problems which exist within those same regions. The sooner we get Mark II or Mark III of the Resource Allocation Working Party, the greater will be the possibility of dealing with the resources problem in a more just way than the present RAWP formula.

In the Queen's Speech, my right hon. Friend has put forward non-controversial legislation. There is a general welcome for it, but I am afraid that this year he is not the only Secretary of State putting forward non-controversial legislation. In fact, I am having a job to find any controversial legislation in the Queen's Speech. I do not envisage any all-night sittings dealing with the Briggs report, or any protracted Committee stage.

Mr. Deputy Speaker (Sir Myer Galpern)

I hope that the hon. Gentleman's forecast will prove to be correct.

Mr. Pavitt

I apologise to you, Mr. Deputy Speaker. As ever, you are always right and such sittings are onerous on the Chair.

Therefore, as usual, we can commend the things that we like in the Gracious Speech and comment on the omissions. I should like to make two quick comments.

Thank goodness that the anomalies in the attendance allowances—the right hon. Member for Wanstead and Woodford dealt with this point—for those on renal dialysis are at last being dealt with. For too long there have been unfairness and administrative muddle when subjective judgments have been made and have led to different awards in similar cases. The fact of home dialysis qualifying is now quite clear, and the fact that one has to have other justifications when being dialysed in hospital will clear up a good deal of the muddle. I am grateful for that.

Secondly, in welcoming the compensation for vaccine damage, which was announced in the Gracious Speech, one cannot say emphatically enough or often enough that immunisation and vaccination remain one of the greatest means of prevention rather than cure. The vast majority of parents should not be put off by the minority of cases in which damage has occurred. We still need the public to have confidence in these procedures.

I make this special plea now, and the House will know why. I make a special plea because deafness can be dramatically reduced if German measles can beaverted. I know the present difficulties. I have followed the case very carefully. I know what the BMA is saying. However, I plead with my right hon. Friend that the rubella vaccination programme shall proceed as comprehensively and speedily as possible and that he inaugurates immediately combined operations between the DHSS, the BMA and all concerned. This should take place and the House should be given some statement on the matter before Christmas.

I turn to the legislation on the education of nurses—the Briggs report. I have been pressing this matter, as have other hon. Members, for some time, because it was a bit of nonsense to implement the Salmon report on structure and then to wait for so long to decide what one did about the education of nurses within the structure.

I sometimes wonder whether the first initial of the DHSS means "delay" or "defer", because certainly those delays and deferrals aggravate not only some of the points that the right hon. Member for Wanstead and Woodford was making but many other problems that the NHS faces.

The Salmon report was published as long ago as 1966, we had Briggs in 1972, and we had a Government statement in 1974. Now we may see some benefit by 1980.

I do not ever regard the Royal College of Nursing as being the most revolutionary of bodies or as being composed of the most militant people in these matters. However, I confess that I had no surprise when, after the nurses met my right hon. Friend at Harrogate, they immediately sent him a telegram urging less complacency and categorically declaring that a crisis existed in manpower—and that means nurse power, of course—money and morale.

When the Briggs legislation is discussed in detail, the key question will be whether students should be employees of the NHS—another pair of hands and pair of feet, carriers of bed pans and bedmakers—or whether they should have full-time student status. This is a vexed question, because in the present circumstances these two differing things must be incorporated into their work situation. For myself, I accept the COHSE statement that nurses must retain employee status but that their placement and where they work must be determined by educational needs and not by the requirements of a shortage of staff in some hospital or other. The School of Nursing, in the ultimate, must be responsible for their supervision throughout the training period, even though they are employees in ordinary terms within the hospital service.

The Second Reading and the further discussions on this legislation will enable us to go into a number of these points and the whole question of the way in which the nursing profession at present is feeling within the NHS. It is a much loved profession. In this place no Member of Parliament ever makes a speech against nurses. We are always for them. But although kind hearts may be more than coronets, nurses can do with a bit more practical help in respect of their pay and conditions and a little less of the sentimentality of the Florence Nightingale image. We are only too pleased to pay tribute to them. It is about time we gave them the money.

The problem of nursing today can be illustrated best by the way in which we overload and exploit those nurses who are the most devoted and who have the heaviest responsibility—those who are in charge of nursing staff. They are devoted because that is what their training has led them to. Patient care is so much a part of their philosophy and the way in which they have worked for years that, come staff shortages, come sisters on courses and then come crises in the wards, these are the people who do overtime, work at weekends—the lot. It is the best nurses who are being clobbered the most.

When he replies to the debate, my hon. Friend the Under-Secretary might better inform us about the compensation for overtime and entitlements for compensating time off. I am not sure whether, when someone has worked over a weekend, she gets another three days or only two days off. If two, that is totally inadequate. We need to solve the problem, not to compensate for it. I commend to all hon. Members the document that the right hon. Member for Wanstead and Woodford and I have both read, which is called "An Assessment of the State of Nursing in the NHS 1978", which was published this week by the Royal College of Nursing, because there is enough meat in that to enable our debates to be informed and for us to be able to talk with knowledge about what the nurses themselves feel about the circumstances in which they work today.

I regret that the Gracious Speech contained nothing at all about the reform of the Whitley Councils. Some years ago, in The Lancet, a council member said: There is no subject, however complex, which if studied with patience and intelligence, will not become more complex. He went on to say that the author must have been a member of a Whitley Council. I welcome the new initiatives that the Secretary of State has announced today. I welcome the getting together of an upper echelon which might, perhaps, be able to cut through some of the problems which develop at lower levels and remain unsolved through the ordinary Whitley machinery. But can one wonder at the recent disputes when there are as many as 56 different scales in the Administrative and Clerical Whitley Council alone, apart from the other Whitleys, when there are 41 organisations each with the right to negotiate in the administrative and clerical grades, and when out of the 56 scales quite a number have been obsolete for years and have just never been deleted? Why not? Is it not about time that all this was put in order?

I welcome the Secretary of State's consultative document on the settlement of disputes at local level but, as I have said, consultative documents can be a way of buying time. In my view, in health matters time is not on the side of right decisions. One needs consultation, but one also needs to be able to reach the right decisions as speedily as possible.

The right hon. Member for Wanstead and Woodford started his speech by talking about the omission of the dog that did not bark. That was the reorganisation of the NHS. As I said in my opening remarks, the only person who seemed not to be surprised was me, but I was quite certain that there could be no possible legislation this Session on that subject. Indeed, I informed Mr. George Clark of the same. I am sorry that he did not print all of the rest of what I said rather than the bits that he did print.

Change is inevitable, whichever party wins the next General Election. My right hon. Friend was a little chiding of the fresh group on the Opposition Benches having another look at NHS organisation, but I remind him that that is all to the good. The last group that the Opposition had studying this subject cost £300,000 of taxpayers' money. Then, after they had done the job and made a mess of it, they said "We are sorry. We made a mistake." At least the working party will not cost the taxpayers anything; therefore, the more homework it does the greater will be the advantage to the House.

Mr. Nicholas Winterton (Macclesfield)

The hon Gentleman has expressed the view that a further reorganisation is necessary. Will he specify to the House not necessarily his party's official view but his own view as to how that reorganisation should take place, and what should be done?

Mr Pavitt

That lecture usually takes me an hour and a half, and I do not wish to delay the House for that length of time.

There is a good deal of misapprehension and delusion on costs, and in spite of the very good news today of a shift of £13 million from administration to patient services, the idea of shedding a tier by getting rid of the area health authority or the regional health authority, and thus releasing massive resources, is a complete fantasy. I have the figures of the total cost of management. The cost of the regional health authorities is £35 million, of the area health authorities £90 million, and of the districts £74 million. That is about £200 million altogether.

I estimate that the most that we could save—and I hope we shall save it—would be about £20 million. In terms of the £8,000 million that we are spending at the moment on the Health Service, that is neither here nor there. What is more important about the reorganisation is not the financial aspect but the waste of time by having decisions made in a much too cumbersome way, and having too many clinically trained and other qualified people sitting round tables rather than sitting round ward beds. I shall welcome reorganisation when it comes, because there is no doubt that one of the greatest losses of morale has arisen from the disappointment of hospital staff, general practitioners and community physicians in finding that reorganisation has not produced greater efficiency but has led to greater inefficiency.

In my view, when we talk about resources, nothing less than 7 per cent. of the gross national product will start to meet our problem, and that is a massive increase. I accept all the economic factors that were stated from the Front Bench yesterday and this afternoon, but I still think that my Government should accept the figure of 7 per cent. as the target to be phased in. I hope that they will plan towards achieving that target, because anything less will make it almost impossible to deliver the services to which people now feel they are entitled.

We shall be discussing public expenditure in relation to other parts of the Gracious Address. It is my right hon. Friend's responsibility to see that it is used to the best advantage. For example, massive savings could be made in the drugs bill. There could be savings made in the way in which supplies are brought in. There are other ways in which one would hope that savings could be made.

There is one small matter that I wish to bring to the attention of my right hon. Friend. I think that he should take steps to arrest any action on the part of the private enterprise sector which yields profits to entrepreneurs and leads to heavy losses to the taxpayer. I understand that there is a proposal to import, from the United States of America, coin-operated blood pressure measuring machines. This could mean that every time a person went to the chemist he or she could become a do-it-yourself heart specialist, taking his or her blood pressure by putting a coin in the slot.

I think that the introduction of a machine of that sort would be a disaster. I can think of no better way of producing a nation of hypochondriacs than to have people checking their blood pressure—especially after making speeches in the House of Commons, or anywhere else for that matter. I can think of no surer method of producing an astronomical rise in the cost of medical treatment by general practitioners, nurses and pharmacists. I can think of no quicker way of putting jet propulsion into the cost of medicines, which is at present £540 million—half as much again as we pay general practitioners—and sending that cost up into the stratosphere. I realise that this is a small matter but I ask my right hon. Friend to make sure that we are not involved with any machines of that sort.

The Gracious Address always finishes with a prayer. I also feel like praying for a healing process within our National Health Service. I believe that it will get back on course only when the morale improves and when the 1 million people who work within it can identify themselves with a purpose greater than the self-interest of the small group, and greater than their own personal self-interest. Only then, I believe, will they begin to feel proud of their own contribution and proud and respectful of the efforts of every other participant in the National Health Service, however important or lowly their task involved may be.

I have spent a good deal of my parliamentary life in addressing myself to that task, Mr. Deputy Speaker. Indeed, it is 20 Sessions ago that I was the first new Member to make a maiden speech on precisely this subject. Although, 20 years later, my head is a little bit bloody, it is still unbowed. I pray that we shall do our part in this House towards the fulfilment of this task.

5.15 p.m.

Mr. David Crouch (Canterbury)

if thought that it would affect the blood pressure of the hon. Member for Brent, South (Mr. Pavitt) I would not say what I am about to say, Mr. Deputy Speaker, but I think the hon. Gentleman knows that I am about to make a declaration. I am obliged, by the conventions of the House, to state that I have an interest in providing pharmaceuticals for the National Health Service. As the right hon. Gentleman the Secretary of State knows, I am also one of his employees. He holds my job in the palm of his hand and can consider sacking me at the beginning of a speech, and certainly at the end of it, because I work on one of the regional health authorities.

The other day I read one of those typically waspish and gossipy comments about my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) having put his head in his hands at the Elephant and Castle and said "What have I done?" If I worked in the Elephant building, I would put my head in my hands every morning, but that is a purely architectural thought. When thinking about that waspish comment I could not help remembering that it was my right hon. Friend who projected me into this interest in the Health Service eight years ago. Whatever may be wrong with it, I am still there, thanks to the good will of the right hon. Gentleman the Secretary of State and his predecessor.

The hon. Member for Brent, South always addresses the House on these health questions with great sincerity and always shows that he has given considerable study to the problems involved. He knows a great deal about health matters and makes a very genuine contribution. Like him, I too feel very much concerned when I express my views on the Health Service. I do not think that he or I can be accused of being guilty of rushing in to find ready scapegoats for what is wrong in the Health Service today.

When I use the term "scapegoats", I do not mean persons. One of the most obvious scapegoats—picked on by the press, by the public, by doctors, by consultants, by nurses, by many who work in the Health Service, and also by patients and by Members of Parliament—is the reorganisation of the National Health Service. It is said to be the cause of all our problems, but it is not. There are many causes of the problems in the Health Service today, and I suggest that it is wrong always to asusme that reorganisation four years ago was the cause of the problems that we face in the Health Service, and, indeed, the crisis that we face today.

The Secretary of State took the opportunity to tell us something about the state of the NHS today. I noted one of his comments in particular. He picked out as a good point that in the last few years, under his own leadership of that Service, the number of in-patients treated in our hospitals had increased by a very large amount.

We were supposed to be pleased at this increase in the provision of health care by the National Health Service. I would only say to him "I wonder whether this really is something to be proud of". I have felt for a long time, and I have said it in this House on many occasions, that we should be looking more to preventive medicine to prevent people having to go into hospitals as in-patients or outpatients—much more so than priding ourselves on the fact that our hospitals are able, and are having, to provide more service today for in-patients and out-patients.

This is one of the areas in the reorganisation which has been neglected. We used to have regional hospital boards; now we have regional and area health authorities. The change from the title "hospital boards" to "health authorities" meant that these bodies operating under the Minister were to be responsible for the whole panapoly of health provision—for the GP service, preventive medicine, the ambulance service, and so on. But we neglect to this day to recognise the massive and major change that has occurred. We are still paying much too much attention to the hospital problem, which, enormous as it is, should not dominate our thinking and our decisions to the neglect of those other areas so vital in the Health Service.

Mr. Ennals

Quite right.

Mr. Crouch

The Secretary of State says "Quite right ". I am delighted to have his support but I am sure that he will not make such a nice comment about what I next have to say.

As the right hon. Gentleman stood at the Dispatch Box, with the Prime Minister listening to him, I was surprised that he, as the responsible Minister on this second day of the Queen's Speech debate, devoted so much of his speech to criticising the Opposition and saying "Come on, tell me what are you going to do". That was an extraordinary turnaround for a Secretary of State. We heard the Queen's Speech delivered in the other place. We heard the debate started yesterday by the leader of the Opposition and responded to by the Prime Minister. Today we have the first Cabinet Minister coming to this House to tell us about the state of the Health Service, and he is doing so only because my Front Bench decided that we would force this issue on an unwilling Government. We asked for the debate. It could not have come from the Gracious Speech, because only the minutiae of health happens to be mentioned there—the Briggs report. That was a little piece of necessary action, but not a major action, to put right something that is going gravely wrong in our country. It is one of our major social provisions for which I bow to no one in saying that I praise the Labour Govenment of 1948 who brought in the Bill which produced the National Health Service. I am the first to praise that, but now we have a crisis in the Health Service and we find an almost passing concern on the part of the Government—

Mr. Eric Moonman (Basildon)

rose—

Mr. Crouch

I shall give way in a moment. I know that the Secretary of State takes his responsibilities very seriously. We have heard his expressions of concern, almost emotion, on television. We cannot blame him for that, because some people's lives are at stake. I do not think that he neglects his responsibilities at all. But the right hon. Gentleman did not write the Queen's Speech. I believe that when the Prime Minister and his inner Cabinet came to consider what would be done in this last Session of this Parliament they ought to have given much more serious care to giving and deciding on much bigger action to help the National Health Service out of its difficulties. That is what I am complaining about.

The Secretary of State chose as his principal topic my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) and tried to deflect everything across the Floor of the House by asking my Front Bench "What are you going to do when you become the Government?", as though he is almost expecting that to happen within the next few months.

Mr. Moonman

I am grateful to the hon. Gentleman for giving way. I believe that the point on which he is teasing at the moment is an unfair one. If my right hon. Friend wishes to obtain the views of the Opposition Front Bench, that is perfectly legitimate in a debate on such an occasion as this. After all, in previous debates both sides have indicated that many of the difficulties that we are facing, including the industrial relations one, go back four years. I am referring to the reorganisation of the Health Service. It is totally unfair for any hon. Member to select or reject those items which have come up in debate when much of the problem arises directly from actions taken by the previous Administration.

Mr. Crouch

That is no doubt a good debating point. The hon. Gentleman is a good debater, but he will not trip me up like that. I came here wanting to hear what the Secretary of State would say. He might even have said "We cannot do it now, but we shall do it when we next have a Labour Government". The right hon. Gentleman might have looked ahead to that, but he did not.

Mr. Ennals

I think that when the hon. Gentleman comes to read my speech he will see that about four-fifths of it dealt with the three major aspects of the Health Service and the position of the Government. It is perfectly true that I put a number of questions to the Opposition to which I hoped they would give answers. I was deeply disappointed to find that I did not get answers to any of them. But most of my speech was devoted quite positively to the Government's policy. I hope that the hon. Gentleman will read it.

Mr. Crouch

Of course I shall read it very carefully. I am glad that my right hon. Friend did not start intervening in the Secretary of State's speech, because that might have delayed this debate and we want to get on. I have no doubt that my hon. Friend the Member for Reading. South (Dr. Vaughan) will be making some comments on those points at the end. But enough of that.

The Secretary of State took three subjects as his text—resources and priorities, organisation and, finally, industrial relations. We are grateful to him for having singled out the three major areas where problems exist in the NHS. There are other areas, but those are the three major ones. In the main, I should like to comment on two of them. I shall leave out industrial relations, because what I would say would not really help the situation at this stage.

It is revealing to learn that we are today spending £8,000 million a year on resources and priorities—more than we spend on defence. Such is the priority of health care in this country. In my view it is not a penny too much. But spending is not unlimited, as I said to the Secretary of State in an intervention. I was glad that the Prime Minister could hear that intervention, because spending is not unlimited. In April 1976, cash limits came into operation. I not only sit on a regional health authority, but I am also a member of the Public Accounts Committee. It is very revealing to sit on that Committee and see behind the scenes and discover exactly what happens.

Outside this House, I am a business man. Only this week I said to some industrialists "I have never seen in private business of the biggest kind the operation of such stringent control of expenditure as now exists in the operation of the cash limits". It is so stringent that I do not think it is realised by those down the line who have a delegated responsibility for spending that money. The Secretary of State knows what I am thinking about. I am thinking of people in some areas in the country who are reluctant to accept the figures given to them for their budgets for the year and who even turn to him and say "We shall not accept the figures". The Secretary of State is thus put in a very difficult spot. But he has no freedom, because it is the Treasury which has set those cash limits. If those cash limits are exceeded the matter will be reported to the Public Accounts Committee. Such is the way that we work our democracy today, and it is right that we should.

Even with £8,000 million a year not being a penny too much—it is strictly controlled to that amount—in my view it is still not enough. We lack resources for the provision of care for 54 million people in this country. Why? Perhaps because we use the most expensive part of the Service too readily. We use the hospitals too readily. They are the most expensive part, and, let us face it, people are living a lot longer than used to be the case. Although there are not all that many people between the ages of 75 and 85, that is where there is a major expense in the Health Service today, because such people need the expensive health care which only a hospital can provide.

The crisis in the Health Service—at £8,000 million a year—means that the Service is dragging its feet in the development of new techniques in medicine. Some of these techniques have been invented in this country. Some of our major teaching hospitals do not even have a brain scanner, which was invented by EMI. One can go to hospitals in America and find five scanners in one hospital. These have been exported from Britain, earning us foreign currency, but we cannot afford the privilege of having them in this country. We have had to close down neurological and neurosurgical units in this country because we can only afford to have them in certain places. It is expensive to have the modern techniques that can save lives and save suffering.

That is why the Service is in such a crisis. But it is not just a matter of money. Of the £8,000 million, about 70 per cent. goes in wages and salaries. That means that pay demands and pay awards will have an enormous effect on the provision of resources for the whole of the National Health Service. In short, the operation of a pay policy, however it is determined and structured, is crucial in the effect that it has on the resources available for health care.

I turn to the question of priorities. It is not for me to say where we should get the extra money. I can only say, as a Back Bencher, that I do not think we can spend any less.

Mr. Ennals

Have a guess where it should come from.

Mr. Crouch

Yes, I shall have a guess. The Secretary of State will draw something rather Tory out of me. I believe that the money need not all come from taxation. I acknowledge that we must provide some money, and that there has to be a contribution towards the cost. That would have been anathema 30 years ago, but we live in different times now. I believe in a high-wage economy, and from high wages I believe that there should be greater responsibility for people to provide something more towards this enormous cost.

If we are to get new equipment—particularly new radiography equipment—to produce the sort of luxury service that can be found within the Health Service we must have more money, and some of that money must not have to come from general taxation. It must come from a voluntary provision as well. I am not saying that it should replace it. The last thing that I want to see growing up alongside the Health Service is a second health service. I am saying that within the National Health Service there must be an additional contribution, made by decision.

I am glad that the Secretary of State is here. Let us acknowledge that he is listening to our debate. He could leave because his Under-Secretary is on the Front Bench, but he has not done so. Wait till he hears what I have to say about reallocation! Who knows, perhaps he will agree with me. I want to talk about priorities. I have had a lot to do with the Resource Allocation Working Party—RAWP—and I am not happy about reallocation. It is having a traumatic effect in its operation.

I come from Kent, and the population of Kent and East Sussex is growing. There is considerable emigration to these areas from London. Therefore, there is under-provision for health services in these outer areas. They need more money. The amount spent per head there is very much less than is spent per head of the population in London. All this has been revealed in answers and publicised statements. Nevertheless, no matter how much reallocation is justified, it is very rough in its operation.

Of course there is over-provision in the London areas because of the declining population of the capital. The 12 London teaching hospitals are expensive hospitals that were built either a long time ago or since the war. They are expensive, their standards are high, and that is right. They are centres of excellence, and we must keep them that way. They are also universities. We must not forget that they are also engaged in research and development of new techniques and studies for higher standards of care which permeate to the rest of the Health Service and to the district hospitals later.

We all know that in teaching hospitals one can find different techniques, higher standards of care, and even a higher performance on some occasions. That is why people elect to go there. There is a great deal of moving across the boundaries into the London teaching areas. Anyone would think that I was a London Member when I talk in this manner. I am not, but I talk like this because I have an affection and great regard for the London teaching hospitals. But with our limited resources, reallocation is necessary. It has been ordered by the Government, and I support it. But in areas outside London we must allocate more, particularly to the north-west, Trent, and so on.

Mr. F. A. Burden (Gillingham)

And Medway.

Mr. Crouch

Yes, I agree. But I confess that I am not happy about the prospect for the London teaching hospitals. They are centres of excellence, and they provide a very special contribution to our Health Service. Whatever we do, we must not cripple them. I know that they must relate to the community as a whole, and that they must be related within the NHS as a national service. They cannot be seen as something distinctly different. But I believe that they have certain differences which make them distinct. We must recognise those differences.

Perhaps without waiting for a Royal Commission we should consider seriously whether the London teaching hospitals should be separately managed. I know that the Secretary of State has such a consideration, in a small degree, in the back of his mind. They are so important that we cannot allow them to suffer from blanket decisions which must be made because of national provisions, because if that were done we could lose something very valuable in the process.

I want to make a comment that criticises not so much the Secretary of State as the Prime Minister. Let us go right to the top.

Mr. Hoyle

He is not here.

Mr. Crouch

No doubt it will be reported to him. He reads my speeches, and I read his. It is amazing how the hon. Member for Nelson and Coln (Mr. Hoyle) cannot resist taking part in my speeches. That is always the way.

The Prime Minister, in his calm, bland, cool and almost unflappable manner said that no major steps would be taken in the Health Service until after the Royal Commission had reported, and with that he packed his bags and left. But why should we have to wait? It is wrong to have to wait. There is a crisis in the Health Service and something needs to be done. We expect something to be done. There are many people in the Health Service who will note very carefully what has been said this afternoon.

I believe that it is not so much a question of suffering from the sins of my hon. Friends who established the reorganisation. We are suffering today from lack of leadership in the Health Service. We are suffering not from over-management but from mismanagement. We are suffering from a failure to operate line management in the Health Service. I see it all the time. With £8,000 million a year, and 1 million employees, the NHS is an enormous responsibility. Delegation and devolution of responsibility are essential. Control must be exercised from and by the Government at the centre. The Secretary of State must give leadership because he is the boss. One thing that the Prime Minister could have done was to relieve the Secretary of State of his other responsibilities and require him to give all his time to the health of the nation. It would be worth it. At £8,000 million a year, it is one of the largest appointments on its own, without the right hon. Gentleman having to be responsible for other aspects of social provision.

There is a crisis in the Health Service, and there is restiveness. The situation is so serious that we should not have to wait for the Royal Commission to tell us what to do. At a time when we are facing this grave problem it is extraordinary to say that we can do nothing, that the Government cannot act, and that Parliament is not even allowed to think about the matter. We should not have to wait, but we continue to suffer. The Government have decided to soldier on and to turn their backs on this crisis in the Health Service. This is not good enough. The Government's failure, and indeed refusal, to act is a monstrous example of indifference to one of the major social problems of our time. They have missed their opportunity, and they do not deserve our confidence.

5.42 p.m.

Dr. M. S. Miller (East Kilbride)

I am sorry that the hon. Member for Canterbury (Mr. Crouch) has taken 25 minutes to tell the House that there is a crisis in the National Health Service, and has told us nothing else.

I wish to add my welcome to the Government's commitment to fresh support for the NHS. I was sorry that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) devoted the major part of his speech to a post mortem examination of the recent industrial action which upset the Health Service. I am not saying that we should not discuss the problems in the NHS, but I wish that the right hon. Gentleman had stuck to the theme of today's debate, namely, what is to be done in this Session of Parliament about the Health Service.

Having listened to the right hon. Gentleman, and having heard press and television reports, one would imagine that the problems in the NHS were new, and that there was once a golden era in medicine before the establishment of the NHS. Nothing could be further from the truth, as those of us who remember the days before 1948 can testify.

The fact of the matter—and I say this with a good deal of regret—is that at present another battle is being fought in the long war against the NHS, a war which unfortunately has been going on for 30 years. It is all very well for the Opposition to pledge their support now for the Health Service. Their predecessors did not take that view in 1947 and 1948. There has been stubborn opposition to the development and continuation of the Health Service which has followed on from the stubborn opposition which occurred when the idea of the Health Service was first mooted in 1946 and 1947 during the long debates that then took place. That opposition has not disappeared.

Yet if we face the situation honestly—and this was a matter on which the hon. Member for Canterbury was totally wrong—we must take the view that a Health Service is needed even more today than it was 30 years ago. It is all very well for the hon. Gentleman to say that people should make a contribution. Costs in the Health Service are growing in geometric progression. Not only do we have to pay much more for old-established, well-tried services, but in addition advances in science and in technology have yielded diagnostic and therapeutic procedures unheard of, indeed undreamed of, 25 or 30 years ago.

All branches of medicine and surgery have made enormous strides enabling those with kidney failure, heart conditions and blood disorders, to mention only a few examples, which used to have rapidly fatal consequences, to lead useful and even completely normal lives. Orthopaedic procedures for hips and knees have literally transformed a generation of sufferers, who a short time ago would have been confined to wheel-chairs, into fully ambulant members of the community.

Even in conditions which as yet are not amenable to cure, the Health Service is the great saviour. I have a constituent who suffers from a relatively rare disease of the nervous system known as Hunting-ton's chorea. Recently I had a long discussion with the secretary of an organisation which is striving valiantly to combat this genetic disease. Although the disease is incurable, the Health Service provides a great deal of support for the victims—support which has bankrupted families in the United States, for example, where there is no National Health Service. There the very rich can afford the enormous amount of money necessary to sustain the sufferer over many years, and the poor can obtain institutional care. But the vast majority of the population who are in the middle have to pay and pay and pay. This is also true of many other long-term illnesses.

The point I am making is that this enormous expense must be met on a national and not on an individual basis. The Health Service must be free at the time of use. But I do not think that shortage of money alone lies at the root of present unrest in the Health Service. Part of the problem is of our own creation. I am referring to the greater and greater expectations which the nation now has in respect of the part which the Health Service can play in our lives. This applies to all the workers in the Health Service. It applies to doctors, nurses, medical laboratory scientists and all the staff, as well as to the patients.

This is a good thing, but it imposes an enormous strain on our resources of skill. This is an important aspect of the matter. There is a limit to the total amount of skill upon which we can call. This is one of the great problems that face us in the Health Service. There is no panacea, no overall speedy cure for all the problems, no shibboleths to be mouthed as passwords to perfection.

There is no lack of suggestions. Indeed, the suggestions are so numerous that it is obvious that we need a rethink of how to dispose of NHS income. But—and this is important—there can be no question of going back or of nibbling away at the Health Service until it is completely eroded. Perhaps the Royal Commission will come up with some answers.

Is there, for example, a surfeit of organisation? If so, we know where the responsibility for that lies. It is interesting to note that Scotland has a different structure from that in England and Wales and, in addition, Scotland has a much higher proportion of consultants who are full time in the National Health Service. This is a mode of action which my right hon. Friend the Secretary of State for Social Services would do well to examine carefully, and perhaps copy.

Should we, for example, encourage even greater authority to the doctors in the Health Service? Would this help? One eminent medical journalist put the matter this way only a few days ago: Doctors are the sine qua non of this or any other health service. We know that we are indispensable, or at any rate most of us believe it, and so do most of our patients. He continues in the following vein: The solution to the problems of the NHS, I suggest, is to restore doctors openly to the position of authority which they once held. There is no point in pretending that medicine is a democratic profession, for it is not. It is a profession where vital decisions often have to be made quickly and clearly and democracy is not a very good way of doing that, whatever advantages it may have in other fields. He then concludes: Doctors are despots, but they are on the whole benevolent and enlightened despots. Furthermore, they are elected despots, for the patient has—or at any rate should have—the right to tell his doctor to go to hell, and to seek another one. I mention this at some length because there is no use denying that it is a widely held view in the medical profession, but I hasten to add that it is not my view. However, we must examine whether over-organisation has not given doctors the feeling that professional freedom has been seriously eroded. But doctors must realise that accountability must accompany the very real freedom which they enjoy.

I make only one suggestion which, in my opinion, would go a long way towards accomplishing what the Government describe as: Fresh support … to enable the National Health Service to fulfil and extend its services to the public. I advocate a considerable switch of funds to the family doctor sector. It is not good enough that this sector should command only 8 per cent. of the total budget. General practitioner services are the vital element and the GP is the first, and for most people the only, contact with the NHS. An increase in resources in this area would pay handsomely in fewer referrals to hospital and consequently more time being available to surgeons to carry out operations and reduce waiting lists. It would also reduce the enormous drug bill and have other benefits on which time does not permit me to elaborate. To accept the family doctor as the linchpin of the whole Service and to allocate funds accordingly would have a snowballing effect on the whole Service.

I am not being complacent, because I know that there are problems, but I should like to move on to a serious omission from the Gracious Speech, namely, that we should have had a complete revision of the conditions that have to be satisfied before a pension is paid for industrial deafness. Unfortunately, deafness is regarded as something to poke fun at or, at least, as something not to be taken as seriously as blindness, and this is not so. The Secretary of State can be assured that those of us involved in this area will continue to press for legislation.

Today's debate concentrates on the NHS and, according to my calculations, should occupy about 5 per cent. of the total time allotted for the debate on the Gracious Speech. However, I know that you, Mr. Deputy Speaker, do not have a rigid 5 per cent. fixation and I should therefore like to mention briefly one other matter that is related to health, if not directly. I refer to housing. Proposed legislation for a new charter of rights for public sector tenants is included in the Queen's Speech. Nothing could be more welcome, but I conclude with one question directed to my right hon. Friend the Secretary of State for Scotland and of which I have given him notice. Will the provisions envisaged in the Queen's Speech apply to the development corporations of new towns in Scotland?

5.52 p.m.

Mr. George Thompson (Galloway)

When one debates the National Health Service, one has an impression of déjà vu, but those of us who regularly attend such debates at least look like tributes to the NHS in the standard of our health and our voices. In any case, there cannot be much déjà entendu on these occasions, because the NHS has so many facets that we can regularly turn to it and always find new elements that one or other of us would wish to emphasise.

I wish to deal with the short section of the Gracious Speech that relates speci fically to the NHS. It falls neatly into three segments. First we are told that Fresh support will be given to enable the National Health Service to fulfil and extend its services to the public. The Secretary of State has spelt out a little of this fresh support, because he specifically promised more money for geriatrics. We in the SNP welcome this extra help, and this is the area on which I should like to concentrate, because it is the area on which the Scottish Home and Health Department concentrated in its report for 1977.

In the section dealing with mental hospitals, the Department said: Greater emphasis might be placed, however, on the development of day areas and on the recognition of the need for day and bed areas to be on one level in view of the increased numbers of elderly patients with restricted mobility. Will some of the extra funds which are envisaged be used to help this development?

The main sections of the report on which I wish to comment are those dealing with the geriatric services, and they are sections 9.12 to 9.14. In section 9.12 we are told that There is still, however, a shortage of paramedical support in many hospitals resulting in an inadequate input from occupational therapists, speech therapists and physiotherapists and that there are still considerable waiting periods for admission. This is in part due to a lack of resources in the community for the reception of discharged patients. It would be interesting to know what action the Government intend to take on that matter in this Session.

In section 9.13, we are told that there is a need for further expansion in in-service nurse training with possible increases in the availability of courses in geriatric nursing care". What does the Gracious Speech hold out in this area? In section 9.14 we are told that The development of day care has been slow". I emphasise that I am quoting from the Department's report, and if I am thought to be sniping at the Department I am doing so with the ammunition that it has provided. Can we now expect some speedier provision in the development of day care? The report says that there is interest and willingness, but problems of accommodation and transport have delayed the much needed expansion in this field". I accept that there are problems of transport, particularly in rural areas, but we must still recognise that for some, possibly many, patients, the only solution may be hospitalisation, and there is a problem in cities such as Glasgow, with declining populations and therefore, to some extent, ageing populations. It would be useful to know what the Government propose to do about such cities.

The Under-Secretary will remember that in paragraph 227 of the White Paper "Prevention and Health", published in December 1977, we were promised a White Paper on the elderly in 1979. Is that White Paper on schedule?

My party is not alone in believing that geriatric patients should, wherever possible, be maintained in the community. We would give priority to the building up of an effective community geriatric service, even if we had to accept a reduction in hospital-based facilities—provided that the resources thus saved were devoted to the community geriatric service. We would aim at a planned and co-ordinated medical service for the elderly, both in hospital and in the community.

I was much impressed by a sheltered housing development that I saw in Dunbar during a recent by-election campaign. I had not previously seen sheltered housing, although I had spoken about it in the House and outside. I was very impressed with the standard of this development and the care shown for the residents by the staff.

Although I was not terribly successful in winkling out votes for the SNP candidate during my canvassing, I was pleased that all the residents declared their belief that they were receiving an excellent service from the staff and that they were very satisfied with this provision. I am glad to see that in Stranraer, in my constituency, sheltered housing is being provided partly by the district council and partly by the Church of Scotland.

When we consider the elderly in the community, we ought to pay tribute to the many voluntary groups that work with them as friendship groups, and so on. I recently attended a concert organized by one such friendship group and I felt obliged to tell the people there that they looked considerably more cheerful than do hon. Members, yet they were being subjected to precisely the same treatment—a short speech from me.

I turn now briefly to the second point to which I wish to refer in the Queen's Speech—the proposal to implement the Briggs report. I am well aware that we shall have the opportunity to debate the Bill soon. It has been published today. My party will oppose that part of the measure which seeks to centralise and standardise, because we are not convinced that after devolution those two processes will necessarily be a good thing. The Government's consultation with the nursing profession in Scotland caused considerable anxiety and agitation among certain members of the profession last year. It will be interesting to see what approaches are made to us when the Bill has been studied by the various bodies involved.

The Queen's Speech refers to the proposal to compensate vaccine-damaged people. I welcome and support that on behalf of my party. We believe that it will encourage parents to seek vaccination and immunisation for their children, a course which I regard as highly commendable. I am old enough to remember the problems that diphtheria used to cause, problems which now rarely arise in society.

I agree with one point made by the hon. Member for Canterbury (Mr. Crouch). The Scottish National Party believes that there is a need in Scotland for greater concentration on health education. Too many of Scotland's health problems are self-inflicted by abuses of alcohol, tobacco and, occasionally, of wrong diet. Our people therefore need to be encouraged to pursue a higher degree of personal and family responsibility for self-help and support during illness.

6.3 p.m.

Mr. Doug Hoyle (Nelson and Colne)

I am always amazed that the Tories take exception at being asked to give their plans for the Health Service. That is a fair point, and one upon which they should come clean. I am certain of one thing. They would destroy the Health Service as we know it and would base it once more on wealth and privilege.

I am sorry that my right hon. Friend the Secretary of State has had to leave. I must take issue with one or two of his comments. The important point about the Health Service is that 75 per cent. of the budget goes towards providing pay and conditions for the staff. It is obvious that we shall not obtain the Health Service we deserve unless we can satisfy the demands of the staff. We hear a lot about the way in which the staff are alleged to strike, at the expense of the patients. There are no more dedicated bodies of workers in this country than the Health Service staff, and it is because of their dedication that there have been so few disputes. We should not, however, stretch that loyalty too far.

The dispute of works superintendents and engineers recently was a case in point. These people waited for four years for resolution of a simple grading question. Which other industry would have tolerated that state of affairs? We should be addressing our remarks not to the fact that a dispute occurred but to the fact that it took so long for the matter to be resolved. This body of people did not take a sudden decision. They were most reluctant to take action, but they were pressed into doing so.

The right hon. Member for Wanstead and Woodford (Mr. Jenkin) asked why a pay scale for grades 4 and 5 was put forward only two months ago. The dispute had nothing to do with the Government's 5 per cent. limit. The whole affair could have been settled without a dispute. I see my hon. Friend the Under-Secretary of State shaking his head. He had dealings with this matter and at that time things were going quite smoothly. Perhaps he should have continued to deal with the issue. We might then have avoided a crippling dispute. The dispute was not the fault of the trade unionists in the Health Service.

Let me make one or two points about the Whitley process. It is nonsense to go through the charade of trade unions meeting the so-called representatives of the employers, many of them coming from the councils and the RHAs. These people are well-meaning and well-versed, and they have the interests of the service at heart. They are short, however, of knowledge of industrial relations and of the bargaining procedure. I used to serve on an RHA and I was the first trade unionist that these people had met. Yet it is they who are supposed to represent the employers. The negotiations should involve the people who take the decisions—namely, the officials. It was the officials and the TUC who finally settled the dispute to which I have referred.

Certain grades negotiate directly with officials, but in other cases there is a game of musical chairs. We have seen the result of that. The patients are affected, and the staff of the Health Service do not want that to happen.

Let me declare an interest as the president of ASTMS, and let me raise the question of the appointment of health and safety representatives. One would have thought that the Health Service would be taking a lead in this area, but the necessary funds to enable it to do so have not been made available. I hope that my hon. Friend the Under-Secretary will tell us why. Safety should be a prime concern in the Health Service in the interests both of the staff and the patients. So often, however, the Service falls down in this area. Some of the happenings in laboratories are disgraceful.

Matters should be handled a great deal better than they are, especially where they affect the staff. It is a shame that the situation has reached its present pitch. We should cut out a lot of the waffle and appoint people who are more experienced in labour relations and man management. We should get rid of the top-heavy bodies in the Health Service.

I want the Health Service to be what it should have been in 1948—the jewel in the Socialist crown. We can make it that only by providing decent conditions, pay and salaries in order to keep staff in it. If we do that we shall be well on the way to getting the Health Service that we all want and deserve, and we shall at the same time be giving the workers the conditions that they deserve.

6.10 p.m.

Mr. David Penhaligon (Truro)

Something more serious has happened in the National Health Service over the past few years than has been referred to in the debate so far. I have in mind industrial action. We all know that there is tremendous loyalty among hospital staffs and that dedication is shown to those whom they treat. However, there has been a breakthrough in industrial action. At various times three or four sections of those working in the Health Service have had reasons that to them have been important enough to cause them to go through the barrier. When the barrier has been broken once, such action becomes an acceptable part of wage negotiation within the Service.

Since I have been a Member of Parliament the barrier has been broken on three or four occasions. That action has been taken by nurses, doctors and superintendents. The dentists had a sort of half strike. We are now near the stage when the breaking of the barrier is considered to be an acceptable part of wage negotiation within the Service. Once that stage has been reached, there is, tragically, no going back.

There is little about the way that attitudes are developing in our society that makes me believe that there will be any step taken back once it is considered that strikes are acceptable. It would be interesting if those who campaigned so long and hard and ultimately set up the National Health Service in 1948 could reflect on the present situation.

It may be that the overall percentage of strikes is not especially high, but we must recognise that striking is a growing trend. One has only to talk to those in the Health Service to realise that the breakthrough has been made. How many more groups are now prepared to talk about strike action, or at least go-slows or threats of industrial disruption, in pursuing their claims?

I do not know whether the negotiation system for NHS pay settlements is wrong. I do not know how justified the superintendents were in the action that they took. We cannot possibly make a judgment unless we have an intimate internal knowledge of exactly what individuals do at various levels throughout something as complex as the NHS. Looking in from the outside as a layman—I am by training an engineer—as opposed to someone who describes himself as even a quarter medically competent, I believe that the situation is not satisfactory. A great deal more attention should be given to putting it right than the attendance in the Chamber indicates.

It is not satisfactory to have a system that means that the Health Service is free and available when someone is not on strike. That is not the concept of the NHS, and we should be far firmer in saying precisely that.

I have no wish to talk all the time about the national health part of the Minister's portfolio. According to a recent newspaper article, the Minister's total budget is now £20,400 million. That is a remarkable budget. It must represent 30 per cent. or 40 per cent. of total public expenditure. It is truly an enormous sum. However, one of the most expensive areas of the Department's expenditure is pensions. I cannot be satisfied when there is a never-ending stream of constituents attending my surgery to discuss their social security problems. Many of them have recently retired after working throughout their active life.

We have developed a system that means that those who retire on supplementary benefit will die on supplementary benefit. The new pensions Act has increased that likelihood. We are not even talking about introducing a scheme that will remove from supplementary benefit those who have retired on it.

We are clearly committed, and rightly so, to increasing supplementary benefit levels in line with wages or costs. It seems that the present system will jog along and that those who retire on supplementary benefit will die on it.

The new pensions Act means that those who are now 45 may find that some of the present problems have been solved when they reach retirement age. However, it is not satisfactory to tell a retired man of 66, for example, that his weekly income will be examined by the State bureaucracy every week from now until he dies. That is not satisfactory, and every hon. Member will know of the complexities of the State bureaucratic system from their surgery experience. The present system is not a satisfactory way of dealing with those who retire after working for their country for so long.

We should consider a scheme that would pay a supplement to those who have retired. We could start with those who have retired and who are now over 75. I do not know exactly what we can afford. Expenditure in these areas is colossal because of the numbers involved. A supplement automatically given to pensioners who have never had the opportunity presented by earnings-related schemes, which have now existed for some years, would remove some of them from the terrible cycle of supplementary benefit examinations. The present system is unsatisfactory in a sophisticated society.

I recently attended a social occasion in my constituency. I was approached by a young man who looked incredibly fit. He ploughed straight into a conversation about kidneys. I was rather surprised. We both had exactly the same drink. I had chosen it because I am teetotal. Apparently, he was drinking it because he is on a dialysis machine.

As the conversation continued he asked me to put some questions to the Government. Will the Government tell me how many kidneys have become available for transplant in the past 12 months? What was the figure five years ago? What is the percentage of useful kidneys presented by premature deaths? What is the recovery rate of good and useful kidneys?

I admit that while talking to the young man I was horrified to realise that he had already been on a dialysis machine for four years. He had had one unsatisfactory transplant. He was not in despair—he was remarkably cheerful—but he asked "When do you think that I will get another try?" There will be no freedom for that man until he has another kidney transplant.

The machine is good and the attendance allowance, if he receives it, obviously helps with financial problems, but those are not the solutions. The young man I met needs an active kidney in his body so that he can lead the sort of life that is led by the rest of us. His children are much the same age as mine.

I turn to a parochial matter. After some encouragement from me, the Minister promised this summer to carry out an investigation within Cornwall to ascertain the effect of visitors on hospital demand. There has been some substantial correspondence with the Government. I have been asking about the allocation for what is called in parliamentary circles the migratory population. In Cornwall that is better known as tourists.

Has the survey been completed? When can we expect to have a report? I would be even more interested if the Minister could give some indication of the effects in the short term. I know that there is a pilot scheme running in Truro. That could well have application in a number of other areas besides Cornwall although the county, for better or worse, seems to have more visitors than almost any other area.

Mr. Molloy

What about London?

Mr. Penhaligon

Cornwall had 3½ million visitors last year. That means that there were nine visitors for every member of the local population. The hon. Gentleman may complain when London has 72 million visitors.

It is frustrating that the Royal Commission has become a sort of Aunt Sally. A Royal Commission is an excuse for doing nothing. I agree with the Government when they criticise the Conservative Party for its NHS reorganisation. There is no doubt that it was a mess. The more honest Conservative Members will now admit that they made a mistake. All parties have made mistakes. There is not much point in going on about the mistake of reorganisation in this place, although no doubt that point will be useful during a General Election campaign. There is not much point in the Government, after four and a half years in office, continuing to criticise the actions of the Tories. There is not much point in pointing out the various errors that were made. Why have they not done something to remedy those errors during the past four and a half years?

The only answer is the abolition of one of the tiers of the NHS. I suspect that different tiers should be abolished in different areas. In my area the tier that seems to serve no useful purpose is the regional health authority. I do not apply that judgment throughout the country, but it appears that in various areas one tier needs to be scrapped. Whether that will save the £20 million that has been prophesied, or the higher figures that have been put forward, is of no matter. Clearly, this will save money.

With all the problems in the National Health Service such as providing dialysis machines, treating people who need plastic hips or operations to improve their eyesight, wasting £20 million a year is indefensible. After four and a half years that sum amounts to about £100 million. The Government have wasted that amount of money by not putting right the mistakes made by the previous Government. When shall we get around to rectifying those mistakes? The Royal Commission is little more than an excuse for doing nothing. It is time for action.

6.20 p.m.

Miss Jo Richardson (Barking)

The hon. Member for Truro (Mr. Penhaligon) talked about the change in the attitude of workers in the National Health Service. He said that they now seem more inclined to take industrial action. Labour Members are proud of the National Health Service, but I am sure that those who designed the service 30 years ago did not visualise that workers would experience the present stresses and strains.

The pattern of industrial strife began with the junior doctors and consultants. The hon. Member for Truro gives a false impression—which I am sure he does not intend—by pinning the blame upon those involved in the more recent industrial disputes.

Mr. Penhaligon

The pattern was started because of the scandalous treatment by the last Government of the nurses' pay claim. I am saying that the situation is becoming worse and that that is terrifying.

Miss Richardson

I add my welcome to the promise by the Government to give fresh support which will enable the National Health Service to extend its services to the public.

I wish to make several brief points about the National Health Service. I am not alone in my opinion of these matters. A mention of them in the Queen's Speech or in the Secretary of State's speech would have gladdened the heart of many people. There is no mention of taking control of the drug industry, or of even attempting to do that.

I and the Department receive much correspondence about this matter. Many people believe that it is wrong that such high profits should be made by the drug industry at the expense of patients and the National Health Service. Private companies can virtually decide what drugs they produce, whether or not they are in the interests of the NHS or the patients. To the layman that appears to be the situation. The companies do not appear to produce drugs on the basis of what is required.

I am also perturbed that the industry should be run by salesmen. That is the situation in private industry generally. I do not knock general practitioners, but they can be conned into the use of drugs which are not necessarily in the best interests of the patients.

I can give an example. I have arthritis, a disease from which many people suffer. I do not complain of that. I cannot speak highly enough of the treatment that I receive from the National Health Service. But since it is a disease that afflicts so many it is not unnatural that I should have friends who also suffer from it. They often say "Why do you not try what I have tried? I have found it helpful?"

A few months ago a friend came to me in excitement. She had suffered from arthritis for some time. She told me that she had found a marvellous product which was produced by a foreign company, the name of which I shall not mention. She said that she was sure that the drug would suit me. It was a drug that had to be administered by a doctor.

I took the drug to my doctor at the hospital. I would not take anything without consulting him. He said "My dear girl, if you take this you will go blind." He said that the drug had been tested many years ago in its original form and that its use had been rejected because of the possible side effects. He said to me "Please go back to your friend and tell her to stop using the drug."

That might be an isolated example, but the drug industry must be responsible for it. I doubt whether in the few months left to this Government we could take the drug industry into public ownership. However, we gave £46 million to Hoffman 1a Roche in Scotland to provide jobs there. That company is rich and profitable. Since we are providing that money, why do we not say that we want to have some control over the way in which the British side of it is run?

I regret that the Queen's Speech does not mention the concern that is felt about the growth of private hospitals. This must affect the future strengthening of the National Health Service. We often hear of applications to local authorities for the building of small private hospitals containing under 100 beds. Sometimes they are in the neighbourhood of National Health Service hospitals. This means that doctors, nurses and ancillary workers are attracted from the National Health Service to private hospitals which are newer and have better conditions.

I regret that the pay beds Bill which was introduced two years ago did not go the whole hog, cut out private beds altogether and bring the whole system within the NHS.

Again I plead with the Minister not to go ahead with the closure of the smaller and in some cases specialist hospitals with which we have been threatened in the last couple of years. The names of such hospitals are numerous. We have experienced sit-ins and demonstrations at Hounslow Hospital and at the Elizabeth Garrett Anderson Hospital, which is dear to my heart.

A working party has been set up to consider the Elizabeth Garrett Anderson Hospital. But we want to know that the hospital is to remain and that the necessary funding will be made available to repair its poor old lift so that the dedicated band of people who have continued to work there during this difficult time can use the hospital in the way in which it was intended to be used.

I make no apology for mentioning a subject which is related in two ways. First, it concerns disabled people, whose health concerns us all. Second, it concerns benefits, for which the DHSS is also responsible. I see that the Gracious Speech makes a welcome reference to disabled people. A measure will be introduced to extend benefits for the disabled". I take that to mean that there will probably be an extension of the mobility allowance, but I have no means of knowing whether that is so. I wish that I could believe that whatever extension of benefit is intended for the disabled could undo the damage done in the past few weeks by the Government's action in restiffening the law relating to the housewife's non-contributory invalidity benefit.

Many thousands of disabled women felt that a long struggle had ended in November last year when the Government extended that benefit to cover disabled married women. Some of us at that time and since felt that the introduction of a household duties test was discriminatory. Married men, single men and single women had to show only that they were unable to take paid employment. It is discriminatory to provide that married women should go back to their old class image of the housewife and have to go through that sort of test. But that argument is for another time.

In spite of this provision, thousands of women have been able to claim HNCIP and have been grateful for it—

The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)

indicated assent.

Miss Richardson

I must remind my hon. Friend that many married women have been unable to qualify and have become bitterly disappointed over many months. Most of those who have not qualified have been disabled women who have to struggle the hardest to help themselves. If they have managed to invent something to help them to peel the potatoes or reach into corners, that very inventiveness has often precluded them from getting the benefit. Because of this, they have failed to qualify. It seems to be a case of saying "The more you struggle to help yourself, the more chance you have of disqualifying yourself from benefit." That is how many disabled married women have come to see this matter.

There have been wide variations over the months in decisions in individual cases. Married women in almost identical circumstances have received different treatment in different parts of the country.

A large proportion of claims have been won at local level and the DHSS, or the insurance officers, have appealed against them. That has caused endless problems for those married women. They are disabled to start with, and the trauma of an appeal is daunting enough for an able-bodied person.

Because of all the difficulties of the past few weeks, as the Minister must be aware, the National Insurance Commissioners decided recently on a test case to try to reach some decision about the interpretation of the law. They chose the case of a lady in Worthing who had had a favourable decision by a local tribunal. This was appealed against by the insurance officer, represented by a DHSS solicitor. It was a rare step for the commissioners to set up a special tribunal. They do not normally sit with three commissioners as they did on this occasion, on 8th September.

The commissioners made a far-reaching and welcome decision for disabled married women—that a woman would be entitled to the new benefit if she proved either that she was effectively prevented from running her household in a manner to be expected of a housewife in her circumstances and to maintain it to the standard appropriate in such circumstances, or that she was so disabled as to be incapacitated so far as household duties were concerned "to a substantial extent". "Substantial" was taken to mean "weighty, ample or considerable".

That does not seem an unfair or unduly generous set of criteria, but many people were horrified at the speed with which the Department—within four or five days, which is very speedy, however much it may have anticipated the decision—rushed through when the House was not sitting a regulation restiffening the law to what it had thought it was in the first place.

Since I have been a Member of Parliament, whenever I have written to the Minister on behalf of a constituent disadvantaged by tribunal decisions, I have received letters saying "We set up this independent machinery and the Government cannot interfere with it. We must stick by the decision of the tribunals." On balance, I cannot really complain about that, even though a constituent may have been disadvantaged.

I was therefore doubly horrified to find that this principle applied when a claimant did not get his or her money but that when the Government were going to have to pay out more money they moved to change the law and break the concept of independent machinery. I do not know whether this is the first time that it has happened, but it is the first that has come to my notice.

The Government have already issued a long list called "Guidance for Insurance Officers". I do not know quite how I came by this, but I do not think that we want to inquire into that. It is marked "For Official Use Only" and says that insurance officers should make sure that appeals put in before 12th September—the date that the regulation was made—should be considered separately from those made after 13th September.

I wonder why the Government chose this precipitate action, which has caused grave disquiet not only among several hon. Members but in outside organisations and among those disabled married women who are suffering in this way. Why did not the Government go to appeal, for example, on a point of law to the Queen's Bench Divisional Court? Why did they not refer their own suggestions to the National Insurance Advisory Committee? They had already told the committee that it was for the National Insurance Commissioners to define "incapacity". Then, when they changed the law when it did not suit them, this matter should have gone back to the committee once more.

I guess that the reason why the Government did not do it was a financial one, that they found that their "guesstimate" of the number of disabled married women who might qualify was wildly out, and so they felt that they had to draw a line. If that is so, and the money was not available in the Department to meet prospective new claims, I hope that the Department argued as forcefully as possible with the Treasury. If it is a fact that there was not enough money, the whole House should argue with the Treasury to ensure that funds are available so that the National Insurance Commissioners' decision can be implemented.

We were told in June in answer to a Written Question that the estimated un claimed supplementary allowance amounted to £170 million and the estimated unclaimed supplementary pensions amounted to £80 million. Those are considerable amounts. If there was not the money available to pay the benefits to the disabled married women who might have claimed after the National Insurance Commissioners' new decision, why could not some of the unclaimed money that has been building up be used? If suddenly a large number of those who had not claimed the allowances and pensions now put in a claim, will the Government say "We had not allowed for your claiming it. We had it there in the first place but now we shall change the law and see that you do not get it"?

We need to sort out in the best possible way the whole matter of unclaimed supplementary pensions and allowances, and have a proper judgment as to who should qualify for what.

I am sorry to have widened the debate beyond the matter of health, but I felt that this was perhaps the only opportunity we might have to air the matter. It has left a nasty taste in the mouths of thousands of people, not only those who are disqualified from benefit but others who are concerned about disabled people. I believe that it is not too late for the Government to change their minds and to allow people such as those I have described to have the benefits.

6.42 p.m.

Mr. Geoffrey Pattie (Chertsey and Walton)

The House will be grateful to the hon. Member for Barking (Miss Richardson) for "widening the debate", as she says. I think that she quite legitimately widened it in asking the Government to give us an explanation of the matter that she raised. Although the Minister will probably be speaking to a less than full House when he winds up the debate, those of us who are here then will be waiting with interest to hear the Government's explanation of the curious manoeuvre which was carried out in September.

Many hon. Members who have spoken in the debate have concentrated on the various defects in the National Health Service and on the several regrettable disputes. I wish only to mention the dispute at Prestwich, of which the hon. Member for Basildon (Mr. Moonman) and I, in our respective capacities as chairman and vice-chairman of the all-party committee on mental health, are particularly aware. We are grateful to the Department of Health and Social Security for allowing us to visit Prestwich on 30th November. I do not want to comment now, not having been there, but the dispute has been giving grave cause for concern to many people, including the Government. That is the reason for our visit.

However bad matters are in the NHS—and sadly, they are bad—it is generally agreed that they are even worse in that part of the NHS that is generally recognised to be the Cinderella. I refer to provision for the mentally ill and the mentally handicapped. Under successive Governments over a long time, provision for those people has come at the end of the line. If the NHS is not in good shape, they are in even less good shape.

For a few minutes I wish to concentrate on the publication on 12th September this year of the White Paper, "Review of the Mental Health Act 1959", because I still believe—I hope that I am not totally naive in this—that one test of a civilised society is the extent of its provision for those in its ranks who most need its support. The review was badly needed. It has taken far too long to produce. I shall not chronicle the dreary saga of proposed dates of publication. Season followed season—spring, summer and autumn—still with no White Paper. We feared that it would come during the recess, and our fears were confirmed.

The position was not helped by a strike at the Stationery Office at the time. Although the White Paper was "published", it was published almost in the legal and technical sense of the word only. It took me some time to obtain a copy, and in the end I did so only through the Secretary of State's private office.

Clearly, such a review must try to reconcile the various, sometimes conflicting, interests of the public, the staff and the patients, always bearing in mind that the public can at various times be both staff and patients.

It would be wrong of me not to mention briefly at this point a constituency matter. In my constituency there is the hospital known as Botley's Park, where for some time there has been a dispute. It takes the form of allowing no further admissions until the shortfall of staff, which is about 75 or 80, has been made good. I very much sympathise with the staff and understand their problem. The unions are anxious about the degree of care that their members can give in the hospital. They are worried that unless further recruitment can be allowed—I am aware that that requires more resources—they will have to return, retrogressively, to the days of almost custodial treatment. Their members cannot give the kind of treatment that they believe they have joined the service to provide.

I am aware that as a result of the staff's position there is considerable, not to say acute, domestic pressure, because patients should be admitted. My hon. Friend the Member for Woking (Mr. Onslow) has raised the matter with the Secretary of State. The Surrey Herald and other local newspapers have written of examples of serious domestic situations that are likely to occur, with talk of suicide and so on, unless admission takes place.

I have digressed slightly simply to highlight the fact that any review of the working of the Mental Health Act 1959 must reconcile all the interests, which at times are conflicting. We have in my constituency a dispute which adds further weight to the fact that conflicts are occurring between members of the public, would-be patients and staff. That must be a matter of regret.

I understand that four Government Departments were involved in the working parties behind the White Paper. The power struggle has clearly been as prolonged as it has been bitter. The sad thing from the patients' point of view is that the victor in the power struggle has been the Home Office, with its emphasis on the custodial aspect of mental care. After 20 years, the review should have seized the opportunity to plan for the new look that is needed if we are to move the services for the mentally ill and the mentally handicapped in the direction that is widely agreed to be necessary.

We need the establishment of a modern community-based mental health service, and I say at once that this can be achieved only by a substantial shift of resources from the National Health Service to the local authorities. The whole emphasis in the future must be on community involvement wherever possible. It must be outside the hospital and medical environment. The emphasis must be on crisis intervention to avoid hospitalisation in cases of mental illness, and it is particularly important to grasp the challenge of developing the potential which is possessed by the mentally handicapped and not just to assume that if people are mentally handicapped they have zero potential and cannot be in hostels in the community. They need to have whatever potential is there developed to the maximum extent possible.

I regret that the provision for the mentally handicapped has not been separated from the provision for the mentally ill. I know that this is an old chestnut of an argument. It must have been debated up hill and down dale in the various working parties. But, sadly, a great opportunity has been missed. When we are talking about the mentally ill, we are talking about a treatable condition, whereas when we are talking about congenital disabilities, such as those possessed by mentally handicapped people or psychopaths, we are talking about the recognised non-treatable conditions. It is unfortunate that, if we talk about something as basic as a White Paper which looks ahead 20, 30 or 40 years, the Government have not grasped the nettle and recognised that various problems will flow from it—resource problems, monitoring problems and so on—and that the challenge should be met head on by separating the resources.

In his excellent opening speech, my right hon. Friend the Member for Wan-stead and Woodford (Mr. Jenkin) referred to the resistance by the Secretary of State to the Private Member's Bill put forward by my hon. Friend the Member for Ealing, Acton (Sir G. Young) on the subject of kidney machines. The Minister will be aware that about a year ago he and I discussed a proposal of mine to introduce a rather humble measure which some months later eventually emerged as a Ten-Minute Bill entitled the Mental Health Tribunals Bill. In my naivety I had assumed that because the proposal that I was discussing with the Minister had been in the Government's consultative document and that I also had evidence that it was widely welcomed and supported by all sections of what I might describe as the industry, at least we could get something moving in the direction of mental health tribunal review procedures. Sadly, the Government fell back on the rather classic response that we were about to have a White Paper and that it would be unfortunate to advance one small area of it.

I am glad to see that something on substantially these lines is contained in the White Paper. The Government have said six months. I was hoping for a three-month period. However, the sad feature is that we are talking about a matter which is in the White Paper. Goodness knows when this House will be able to debate the White Paper. What is more, we do not know when the consultative process following the publication of the White Paper will be completed, let alone when there will be any legislation.

The problems are so enormous that if we are not to do something fundamentally at variance with future policy, it is quite in order to say "Here is a minor amendment which is widely agreed and which can be made, so why not make it?" Let us not wait to get the whole thing lined up so that in 1987 we move forward. I do not wish to give the impression that I have nursed some appalling grievance all these months. But it is sad that the Minister felt he could not move forward what was about 3mm. but that the Government now put the same proposal in their White Paper when it could have been on the statute book already if only the Minister had given me his agreement.

I hope very much that we shall debate this White Paper rather than attempt now, in what is inevitably an unbriefed House, to go through all these various details. However, perhaps I might put forward a few points in passing. In the White Paper, mentally abnormal offenders are referred to, but no attempt has been made to improve their lot. I am thinking here of bodies such as MIND which, as the Minister knows, services the all-party group of which I am vice-chairman. Obviously I see a great deal of MIND and have a great deal of regard for what it does. A lot of the Department's difficulties arise from individual cases which come up—for example those where MIND represented four patients at the European Commission. This is a state of affairs which I hope the Government will look at a little more closely. If we stand back for a second and look at our policy on custodial "care" of mentally abnormal offenders, we see that it does not differ enormously from those in a lot of foreign regimes that we care to criticise. We are certain in this country that we know what we are doing, that these people are a bit difficult, and so on. However, these people have rights. I appreciate that it is difficult if they have been engaging in unusual behaviour. But it behoves any civilised society to ensure that they are given full opportunity to exercise their rights, and I think that the White Paper has missed out on this one.

I referred earlier to crisis intervention services. Mention of them is made in the White Paper, and I hope that it is more than a passing genuflection.

The title of "mental welfare officer", which is now well established and familiar to people in the community, is to be changed to that of "approved social worker". That causes a slight chill down my spine. I wonder what the word "approved" means—approved by whom, and to what standards?

There is also a great deal of apprehension, to put it no stronger, about consent to treatment and what is to constitute "hazardous" treatment. The Minister will be aware that there are a number of courses of treatment which may not be hazardous on the first occasion but which are hazardous cumulatively. Therefore, it is important for the patient to have certain safeguards built into his or her position so that he or she is quite clear that "hazardous" is not open to too wide a definition.

I conclude my remarks by quoting from the leader in The Times of 13th September. On the subject of the White Paper, it said: The White Paper's proposals are generally humane and moderate, and in some cases (as with the proposed panel to review treatments where there is dispute over consent) imaginative. But inevitably when the need to have such things cut and dried is felt, the result tends to be more administration, consultation and delay. It is plain that there is not yet wide enough agreement on the proposals to make early legislation desirable. In the consultations to come, all parties should bear in mind the consequences, familiar in the NHS above all institutions, of elaborate discussions ending in elaborate arrangements which, in setting out to please everybody, are too cumbersome to please anybody. Anyone who has studied the National Health Service will know that that is a great problem and a great danger.

I hope that the House will take this White Paper seriously and will have an early opportunity to debate it. Mental patients, be they mentally ill or mentally handicapped, make up a sizeable group in our society. One person in nine will be mentally ill at some time in his or her adult life. These are a group of people in society to whom this House should pay greater regard than it has done in the past.

7.59 p.m.

Mr. Eric Moonman (Basildon)

I want to take up the references made by the hon. Member for Chertsey and Walton (Mr. Pattie) to the mental health service. However, before doing that, I take head on the point made by the right hon. Member for Wanstead and Woodford (Mr. Jenkin) about resources—a point also made by my right hon. Friend the Secretary of State when he opened the debate.

Many people believe that most of the problems of the National Health Service would be solved if we increased the amount of revenue allocated to it. I take the view that it would solve some but not all of them.

One of the great dilemmas of the political hassle which has to go on in debates such as this is that we overlook some of the real problems encountered by individual patients in psychiatric hospitals or in general hospitals or because of the treatment which they get from their GPs. We also overlook the fact that it is too easy for the political parties, including my own, to become involved in a sort of auction about which is the greatest sum of money that a party will be able to put forward either in the course of a political discussion or at the time of a General Election. If it comes to a General Election it is even more confusing and frustrating for the population. Any attempt to deal with the problem by an expansion of NHS resources must recognise that this aspect is only part of the current crisis. Unless we can identify the weaknesses in the Service, X resources will not alone resolve the difficulties.

If we continue to talk about an increased allocation we shall divert attention from some central issues. Ultimately, we shall increase the frustrations of the staff because we shall not be able to meet some of their claims. We shall certainly frustrate and divert patients because it will not be possible to provide all the facilities that they would like. We shall also confuse the public in that we shall confirm the impression that the political parties are not prepared to produce even a semblance of agreement on a deep and critical issue.

One of the major issues in this dilemma concerns industrial relations. My right hon. Friend and the right hon. Member for Wanstead and Woodford dealt with this point today. What disturbed me was that they omitted an important part of any analysis of industrial relations in the NHS. This is a fragile element in a service involving long hours and night working. The reorganisation of the Service has aggravated industrial relations and created new and bitter tensions. Not only is this demeaning to the staffs concerned but the public suffers as a result of the growing number of days lost through disputes. In the industrial disputes table this has become a high risk industry. Where does all of this start? The frustrations felt by the manager who has to keep the NHS running are real. He has to do his job, since reorganisation, without adequate authority on direct line relationship. We have heard about the responsibility, or, as some people say, the irresponsibility of the unions. We have heard of some of the committee problems of reorganisation. What I say is that management within the Service has a right to manage. This many of them are finding it impossible to do.

It has been argued that we may have a management system which is all wrong. This is an over-simplification. What has happened since reorganisation is that we have encouraged the belief that there is such a thing as consensus management, which is not the same as participative management. Nor is it the same as some of the items dealt with in the Gracious Speech. I have argued to justify the whole concept of worker participation. However, I am a little frightened to think where this is taking some of my colleagues. I am not sure that they have thought this through adequately.

We can have more participation in schools and hospitals. Apparently, one member of the Cabinet has said that we ought to have it in terms of our security services, too. But there comes a point when we have to say, if we have any management experience at all, that someone still has to manage. There may be the greatest degree of participation, which will satisfy some, but it will not satisfy all. It is hypocritical and unfair and it diverts attention from the main problems of the Service if we, choosing the mood of the Gracious Speech, say that participation is to be an element in today's debate. My guess is that we shall hear that participation will be an element in tomorrow's debate and throughout the debates next week. Fine. If a Socialist Government want to see this, they are entitled to say that participation is an element in what needs to be done.

What I object to is that we have upgraded the whole concept of worker participation and consensus management as if, in itself, such a thing—if achieved—would solve the problems. It would not. To believe that is to confuse the position and to divert attention from the central issues which are not, therefore, being tackled. This concept arises from the new structure, which attempted to bring in modern management theory which was not properly understood, let alone implemented. Many people in the Service talk about consensus management. They are deeply concerned about the problem. It is not simply a question of pay or conditions. The problem concerns the way people are unable to do their jobs.

While consensus management has rationalised grievance procedures—a new industrial relations machinery has been introduced—the enthusiasm for this process has produced a management structure in which no level has any direct authority for the layer beneath. The formula was that the region would be responsible for long-term planning and liaison with the Department of Health, while the area had responsibility for employing area and district staff.

However, the officer team does not include a personnel officer. If there is any meaning in having an industrial relations expert within the management team it is lost because he is not in this structure. We can look at the way that industry operates. We may not accept a strict parallel and we may feel that the Service has certain unique characteristics, but if there is a case for a personnel officer with industrial relations training and competence, surely he should be at the level where he is likely to have the greatest degree of influence.

There is for me no discernible management style in this structure of industrial relations. There is no management pattern. I do not believe that in the main this is due to the people who are the participants in this extraordinary battle. It is due to the way in which the reorganisa tion was carried out, the lack of direction from the top and the way in which the structure has led to there being so many levels and layers with the result that no level is able to influence the other.

There is sufficient information and reaction on this aspect from those engaged in personnel. Let me give an example. Often, to get decisions made, personnel officers have to go to two tiers of authority, even at their own level. The team of officers at district or area level consists of one or two doctors, a nurse, an administrator, a finance officer and a works officer. But the personnel officer, the man with the industrial relations competence, who should be able to help on matters of collective bargaining, the key man—the man who is not referred to by either Front Bench because he does not exist in terms of their strategy—is responsible to the administrator. To introduce change a personnel specialist has to convince his boss, the administrator, of his value.

I have had a great deal of experience in management, in many situations and many industries. If I were to create a structure in an industry in which the person who had a particular degree of competence, whether in cost accountancy, management control or industrial relations, had to work through another grade, another function, I would not be surprised if ultimately I was spending more and more of my concern and anxiety on industrial disputes, grievance procedures and a general drop of morale. These things do not just happen because people are greedy or because they want to go on strike. These issues require fundamental care.

In this case we do not have to be too shrewd or do any research to see what has gone wrong. I offer this quotation from Derek Warner, who was an area personnel officer for Kent area health authority. He says: This system of consultation and committees is very, very frustrating. It is remarkable that we have been able to make any progress at all. The success of personnel depends largely on the ability of an administrator and his relationship with his colleagues. Whether people get backing depends on personality. In no management system should it be the case that decisions, or the resolving of conflicts, should depend on personalities. One man may have an agreeable personality, but he may leave the organisation. It is the way in which we organize the structure which should produce some of the results.

As chairman of the all-party committee on mental health, I feel duty bound to make a reference to another matter. My concern about the mental health service at present is that there is little emerging from the Department of Health to suggest that we have been able to overcome the problem of neglect. The role of this service is ill-defined and it is underfinanced. There are some shocking stories to be told about the mental health service. It has been referred to already and I do not wish to prolong the references to statistics.

If we were to operate on the simple argument of increased resources we should have to compliment my right hon. and hon. Friends on the way in which they have managed to resolve some of the allocations. There are ambiguities here. At some point, whether in this debate or in subsequent correspondence, I would like to hear some rationale setting out why the mental health service within hospitals is the Cinderella service. It is astonishing to me that it functions at all.

I can give some brief examples. First, I think that it is horrifying that 45 per cent. of NHS beds are occupied by the mentally ill or mentally handicapped whereas only 11 per cent. of consultants work with them. Again, 100 mentally ill people in hospital are cared for by 45 nurses compared with 122 nurses per 100 in general hospitals. While it may be argued that the physically ill require a higher degree of nursing care, my inquiries at two or three hospitals recently reveal that in some psychiatric hospitals at least staffing levels are at danger point.

These are things which concern people. We have accepted, not in the last century but in this century, as we move towards the 1980s, service and treatment in psychiatric hospitals of a level that we would not tolerate in general hospitals. It is not just a question of actual care, of doctor-patient relations, and so on. It is a question of how we look after people in such hospitals. There are serious discrepancies in expenditure between the two types of hospital, and that cannot be accounted for purely in terms of staffing.

For example, there are psychiatric hospitals which still have long-stay wards with more than 50 beds, and many of them have wards which are unacceptably overcrowded. Again, 65 per cent. of our mental hospitals were built in the last century and many are more than 100 years old. More money is spent on food for general hospitals than for psychiatric hospitals. The cost of feeding a patient in a hospital for the mentally ill or mentally handicapped is £3.58 a week compared with £8.80 in a general hospital.

There is much more that one could say to show these extraordinary discrepancies. I do not know the rationale for them. No Minister could feel satisfied with the situation. My right hon. Friend should be very troubled by these figures and should demand from the civil servants in his Department not only how they can justify the situation but that a change be brought about. It is far too easy to talk about an increase in resources—that is one way. It is easy and dangerous to talk about industrial relations in terms of strikes and greedy people and difficult management. What we need, however, is a shift of resources so as to achieve a reasonable balance between the types of hospital. We must ensure a fairer expenditure on the hospitals for the mentally ill and mentally handicapped so that there shall not be such an alarming gap.

I know that the Minister takes these things seriously. It is important to look at the question of setting up a system of establishing minimum standards for psychiatric services within the NHS which could be regularly reviewed and updated and provide more than a basis for minimum acceptable levels of service. This would not solve some of the fundamental issues to which I have referred, but it would at least begin to provide a credibility on the part of those who work in the Service. If we could get that credibility perhaps we could achieve some of the other things which may be more deep-rooted.

7.15 p.m.

Mr. Nicholas Winterton (Macclesfield)

I congratulate the hon. Member for Basildon (Mr. Moonman) on his constructive contribution, and I extend my congratulations to my hon. Friend the Member for Chertsey and Walton (Mr. Pattie). Both Members have done a great deal for the mental health services. I am sure that their positive contributions to the debate will help the National Health Service. I am sure, too, that the Minister will heed what has been said and take whatever action he can within the Government's guidelines. But, having said that, and having welcomed also the positive contribution by my right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), I am sure that the Government will not expect me to welcome the contents of the Gracious Speech.

In short, I would describe the Gracious Speech as a non-event. It is a Speech to tide us over to the General Election, designed to appear superficially popular with the electorate, but, in the end, it contains very little.

However, it would be wrong of me not to welcome the compensation that is to be made available to those who have suffered from vaccine damage. I have made many representations to successive Governments on this matter on behalf of people in my constituency, and I know that the proposed measure will be warmly welcomed on both sides of the House.

I want to talk about the National Health Service but in doing so I do not want to cover ground already adequately dealt with in the debate. I take up a point, however, raised by the hon. Member for Basildon—that the shortage of resources is only part of the problem of the NHS. We have also been told, rightly, that the problems of the Service will not be solved by removing one of the tiers of authority. I know that many hon. Members on the Opposition Benches feel unhappy about what was done by the last Conservative Government in reorganising the NHS, but there is no point in stirring over that matter again. The reorganisation took place, and we have to make the best of the NHS, making further touches on the tiller to make this mammoth Service more effective and more sensitive to those who have to use it.

Primarily I want to talk about people. For example, I want to talk about a Mrs. Wilson, a constituent of mine who, before her sad death, lived in Prestbury. Then there is that splendid and indomitable lady, Pat Seed, in the north-west, who is leading a fantastic campaign to raise money voluntarily for a cancer screening machine. Mrs. Wilson died of cancer. She took up this campaign in my constituency. I met her and was unaware that she was suffering from a terminal illness. Indeed, she died but a few weeks after I last met her in my efforts to help her in an event to raise money for a cancer screening machine which enables doctors to diagnose cancer at a much earlier stage than they can do so now, so that people, instead of dying in great pain can live and overcome this terrible disease for which medicine has not yet found a cure.

I am pleased that the hon. Member for Ealing, North (Mr. Molloy) is here because, when my right hon. Friend was speaking, he interjected "What about the private sector? Do you want everyone to pay?" That indicated, of course, that the State could provide all the services that the people require. But here I have indicated, in the area of cancer, that it is the voluntary contribution of many wonderful people which perhaps will ultimately give the Health Service the machinery and facilities in order to help with the cure for cancer.

Mr. Molloy

I do not dispute that with the hon. Gentleman. Indeed, looking at the history of medicine, one realises that many of the great advances that have been made in overcoming serious diseases and illnesses have been made by people who have almost had to work somewhere else in order to follow up their ideas on helping mankind. What I was concerned about was whether people such as Semelweiss and Pasteur would have been happy to think that their great endeavours would be placed at the disposal only of those who were wealthy enough to buy them.

Mr. Winterton

It would be wrong for me to launch into a major debate on this issue of principle, and also a philosophical debate is asked for when the hon. Gentleman poses that question. No, I want all the expertise of the medical profession to be available to all people. It is significant that the private sector of health in Britain has made available to people who cannot afford to pay facilities which at present are not available to them in the NHS. I refer to the heart patients who have been treated by private medicine.

I pay tribute to the part that the private sector of the Health Service plays in treating both people who can pay and, on occasions, those who cannot pay. Perhaps there should be more cooperation between the two sectors. I know that the consultants and doctors want this. But sadly, too often medicine, like education, has become a political pawn, and the private sector is prevented from playing its part in the Health Service.

I have referred to Mrs. Wilson, a very brave lady in my constituency, who raised many hundreds of pounds before she died as a result of cancer. She helped that magnificent woman, Pat Seed, who is still with us, in raising hundreds of thousands of pounds to provide equipment for people who may well be suffering from cancer so that they could be screened early and perhaps cured.

I mention another person, a little girl called Lisa dos Reios. Again, she is no longer with us. She died, at an early age, of leukaemia. But the people of my town, Congleton in Cheshire, rallied round. The parents, too, although they had lost one of their children, wanted some good to come out of this tragedy. A fund was started in order to purchase a blood cell separator machine, which again might, if it had been available, have given this little girl some extra life and given the doctors who were treating her an extra opportunity of trying to cure her.

Sadly, that machinery was not available. But the public reacted. The public of this country are very generous and very constructive people. They rallied round and raised thousands of pounds, together with another family based in the Greater Manchester area, in order to purchase this machine for a local hospital. No doubt, at this very moment it is being used in order to help sufferers from leukaemia.

It is, perhaps, a matter of people being prepared to react and to dig into their pockets in order to ensure that there exists a Health Service which can cope with all emergencies, all crises and all eventualities.

Very briefly, I move on to a subject about which many hon. Members hold different views. Although this matter is not within the portfolio of the Minister responsible for the disabled, who alone sits on the Treasury Bench at this moment, I welcome his presence. I refer to the ques tion of mixed wards. I know that mixed wards in intensive care units have existed for many years, and rightly so, too, because the equipment required for these wards is very expensive. When people are in intensive care they do not know or care whether their neighbour is a man or woman. However, the extension of mixed wards to the recovery wards and the normal wards is causing a great deal of concern in my area. I speak now for my area.

I hope that the bureaucrats—I use that word purposely—who dictate to and apparently also control our Health Service will listen to what people are concerned about. The matter of mixed wards is of considerable public concern. If there are to be adjustments and modifications to a public service, people's sensitivities at a time of illness should be taken into account.

I am delighted that the Secretary of State is now on the Government Front Bench. I know that it is stated by the hospital authorities that people do not have to go into a mixed ward. However, if they do not go into a mixed ward, very often the treatment or the operation that they need is put off for very much longer. Therefore, people occasionally have to do something which they do not like doing and which makes them very unhappy and causes them deep concern—and go into a mixed ward.

Certain cases concerning the problems that can arise in a mixed ward have been drawn to the Secretary of State's attention. I hope that hospitals will always ensure that men can go into men's wards and that women can go into female only wards if that is their choice. This is a service for the people. Let us listen to what the people want.

I now turn to a matter that I have already raised with the Under-Secretary and the Minister of State. I refer to representations which have been made to the Secretary of State personally by the Macclesfield community health council. These representations were originally made way back in April of this year and concern two particular subjects. They concern, first, the new nucleus hospital, which is to be built, I hope, in the not-too-distant future, at Macclesfield, and secondly, the growing waiting lists for operations in the Macclesfield hospitals.

I regret to say that the representations that were made by the Macclesfield CHC have, sadly, gone unanswered. Perhaps I may say that they have been ignored by the Secretary of State. Just to show that I am not misleading the House, let me say that in connection with the new nucleus hospital, the CHC wrote its original letter on 3rd April this year, sending a copy to the Mersey regional health authority. The CHC had heard nothing by 18th May, six weeks later, so it wrote asking for a reply. On 25th May a telephone call was received from a Mr. Brittain, of the DHSS, saying that he had not received the original letter. A copy was sent by the CHC on that day. On 12th July the CHC wrote again for a reply. No reply was received. On 1st September the CHC wrote again asking for a reply. On 28th September the CHC telephoned Mr. Brittain, who, sadly and unfortunately, was not available, but the CHC left a message asking him to ring back. He did not ring back. On 29th September the CHC telephoned Mr. Brittain again. He apologised profusely for the fact that the CHC had not received a reply. He said that he would deal with the matter immediately and that the CHC should hear from the Department within 10 days. On 10th October no reply had been received.

I hope that the Secretary of State will take note of this small case and take it up with this Department. I bear in mind the heavy responsibilities on his shoulders. Although the letter was sent to him, I know that he would not necessarily have dealt with it, because of the mass of correspondence flowing into his Department. However, it seems quite outrageous that an important letter such as this should have been, appparently, ignored by his Department.

Mr. Ennals

Having heard the recital of the attempts to get a reply, I assure the hon. Gentleman that I shall look into the matter personally.

Mr. Winterton

I am most grateful to the right hon. Gentleman for that. Perhaps when he is looking into that case he will also look into another. I may be piling additional burdens upon his shoulders.

The community health council is also concerned about the growing waiting list for operations in the Macclesfield health district. It sent a letter on 3rd April, with a copy to the Mersey regional health authority. In this case the letter was acknowledged on 11th April, a week later, which was very satisfactory. On 18th May a reminder was sent. On 19th May a letter was received in reply, stating that a Mr. Probett was making inquiries of the Cheshire area health authority. On 12th July another reminder was sent from the Macclesfield community health council, and on 18th August a letter was received in reply, stating that Mr. Probett's inquiries were taking him longer to complete than had been expected, and that he hoped to be able to reply fully in the near future. That was in August, and on 10th October still no reply had been received. At a meeting of the community health council on 9th October, the feelings of all the members ran very high indeed at what they considered to be the lack of concern and urgency shown by the Secretary of State and his Department on these two very important issues.

In relation to the new nucleus hospital in Macclesfield, I point out to the Secretary of State that when the community health council wrote, it expressed grave concern about a number of matters. One was about patient comfort, which would appear to be almost totally overlooked in the nucleus hospital concept. The council is very concerned about the recovery beds in operating theatres. It believes that such beds should be available. but they are not provided in the nucleus hospital that is proposed for Macclesfield. The council also believes that the nucleus hospital concept—and I ask the Under-Secretary to tell me in reply whether this is a general view—is too inflexible to cater for all the changing local demands which are made upon a hospital to serve a particular area. It is the view of the council that in the plans for the nucleus hospital to cover Macclesfield, the arrangements for the wards do not include a high dependency nursing area for patients who have had major surgery, for their use prior to their return to the general ward. As a result, the recovery ward must fill this role and must be provided with a greater number of beds than the six beds at present proposed for the ward.

I now refer to the waiting lists as they pertain to the Macclesfield health district. I am well aware that there have been many problems within the Health Service, not least industrial problems, which have exacerbated the situation, but the main problem as it relates to Macclesfield arose before this latest industrial dispute within the Health Service. The total waiting lists—details have been sent to the Secretary of State—have increased in the Macclesfield area by 62 per cent. over the last three years.

This indicates that the Health Service is in a very sad and unfortunate condition. The number of patients waiting over two years for treatment and an operation has increased by 28 per cent. The number of patients waiting over two years for treatment and an operation has now risen by 203 per cent. It is noted that the total number of operations in the hospitals covered by the Macclesfield health district has decreased since 1974. As a result, it is quite clear that the situation is intolerable.

It was first apparent in 1975 that this was happening. That was approximately the period of the consultants' work-to-rule and the implementation of the Halsbury award for the nurses. This would convey that there are two particular factors which are causing the increased waiting lists. First, the consultants have been declining—quite rightly, I believe—to return to the pressures they experienced before their work-to-rule, as these were detrimental, in some cases, perhaps, to patient care. The other factor is that beds are not being used, due to the lack of funds to employ nurses at the rates set out in the Halsbury award. This matter has already been raised indirectly by hon. Members in the debate. There is no point in having an establishment figure if, as a result of the rates of pay which have been awarded, quite rightly, to the nursing profession, it is not possible to employ enough nurses to man the wards. This is a matter of very serious concern to the people in the area which I serve.

I have spent some time on raising local matters, but the sorts of matters that I have raised in detail could probably be taken up by many hon. Members on each side of the House. The point is that the situation in the Health Service is very serious indeed, and it is a pity that in the Gracious Speech we heard very little indeed about what the Government are to do to improve it. It appears to me that very often it will be up to the people themselves to provide equipment which will enable the consultants and the doctors to save lives and, in doing so, save the Health Service considerable sums of money.

I hope that I may be permitted, Mr. Deputy Speaker, to raise one other matter which is not strictly in accordance with the topic laid down for today's debate. I shall not, therefore, expect the Under-Secretary of State to deal with this matter. We discussed at great length yesterday, and at somewht shorter length today, the problems created by the Government's pay policy. I shall not talk about the problems of pay policy relating to the hospitals in my area, although there are grave problems. I want to refer to a small manufacturing company in my constituency which is suffering grave difficulties at the moment in trying to do what it can do very well. It cannot get labour because it is not permitted to pay the rates which would give it the opportunity of employing that labour.

The company to which I refer is Arclex, which produces glass bonded mica for the electrical insulation trade. The process was developed in Macclesfield about 18 years ago, in conjunction with the founder company of Arclex. called Mauritex Limited, which produces textiles for the electrical insulation trade. As both processes were continuous and Mauritex Limited was already working two 12-hour shifts, both companies adopted, quite rightly, the same working procedure. As the House knows, the rate of pay for textile workers in those days was lower than in most other industries in this country, and to an extent still is today.

There are not many strikes in the textile industry, however, as the people know the problems under which their industry is operating. On its inception, Arclex wages were in line with those paid by Mauritex Limited, as both companies occupied the same manufacturing building. Arclex NEI Reyrolle Limited developed over the ensuing years, and has now become a recognised supplier of the material which I have mentioned to the electrical industry both at home and. more important, overseas.

When it became possible for the company to reduce the basic working week for its employees—I am sure this would be welcomed by Labour Members—this was done, in the first year, from 60 hours to 56 hours. The company's policy was to try to reduce the basic working week each year, so that it could come into line with the average week for the country, but due to pay restraint, brought in by the Government, it has been unable to do this over the last few years. It has obeyed the law and kept in line with Government strictures and legislation.

The company has, however, during the last two or three years, suffered severely in production, and it is losing certain of its work force because of wage rates. It is finding it very difficult to attract new labour, and its existing labour is going to other industries in the area which pay higher hourly rates. This is now becoming so serious that the company has raised the matter with me. The company is not only increasing its sales within the United Kingdom; during the last year it has increased its export market from an average of just £9,000 worth of business to something in excess of £50,000 today. One of the main requirements of its foreign customers is that it gives quick and prompt delivery. This is now becoming impossible due to the shortage of labour.

Perhaps those people who are in favour of the 5 per cent. inflexible pay policy will appreciate that here is a profitable company which can increase its labour force, but because it wants to keep in accordance with the Government strictures, guidelines and advice in order to help curb inflation it is unable to get the staff and the workers in order to ensure that the business not only survives but actually grows.

If the Minister is going to transmit some of this information to the appropriate Government Department, I hope that he will appreciate that the inflexible policy which appears to be the present Government's main plank leading up to an election can cause and is causing grave damage to some companies which perhaps one day could play a major part in the economic recovery that this country so desperately needs. Such companies can also play a part in employing people. With nearly 1½ million people out of work, it is no good the Government pouring £469 million into persuading employers to put people on short time rather than making them redundant. What we require is real jobs so that this country can go from strength to strength and provide the standard of living which people rightly expect.

I am disappointed that there are so few positive proposals in the Queen's Speech. It can be summed up by saying that it is a survival package, a series of sops to woo the nationalists. It is, I feel, significant that no members of the minority parties are with us to talk about what is a very important subject or to participate in what is a very important debate. The Speech is also a sop to the politically naive. I think it is wrong that measures are being introduced by the Government to mask the real problems of unemployment caused by the present Government's incompetence.

This country, to which I am proud to belong, is desperately seeking a positive lead, a real hope for the future and a glimpse of a different and better tomorrow. It will look in vain if it seeks to find these ingredients in the Government's programme announced in the Gracious Speech. Above all, it is sad, especially when we are talking about health, to find so few positive proposals. My goodness, the Government could take a great deal from the comments made by the hon. Member for Basildon, who sadly is no longer in his place. If they took that attitude in relation to the Health Service I am convinced that many of the problems could well be overcome. We could then get that regeneration of the Service which would make it one of which those who serve it so loyally and well could be proud. The people of this country could know that they would be able to rely upon that Service when they fell on hard times, when they had a crisis, or when they were ill.

I wish the Health Service all the best. I hope that the present Government and the future Conservative Government will do all they can to aid this vital Service.

7.44 p.m.

Mr. William Molloy (Ealing, North)

There are very few occasions on which I would agree with some of the views of the hon. Member for Macclesfield (Mr. Winterton), but I am pleased that I can agree with him on such a great humanitarian issue as the National Health Service which so many Tories have praised tonight. Of course, they forget that they voted dead against it at every stage of its inception. It has taken a long time to convert them, but slowly we are winning.

I was impressed by the hon. Gentleman's speech, especially when he referred to some of his constituents who are suffering. What he said about cancer and other things confirms that there is still much more that the NHS can do. But that does not mean that it has not done anything.

As a child in the valleys of Wales, which used to produce four anthracite coals which supported British industry and the Royal Navy, I can remember when the average life of a Welsh coal miner was 38 years. If he worked in the pits for 20 years and had what we called "the dust", which is now poshly called pneumoconiosis, he rotted and died and there was no one to investigate why. This point was made by the hon. Member for Macclesfield about cancer and other things.

Many of the things from which people died in my young days, and which brought suffering and death before they were 40 or 50 years of age, have been eliminated from our society. They have been eliminated because of the National Health Service. Let us put that properly in perspective, especially when we hear of people—there are very few—in the medical profession who look at suffering, illness and disease as a means of making a lot of money. That has to be said loud and clear because they exist, tiny minority though they are, and they are a dangerous element in the building up of our National Health Service.

The hon. Gentleman spoke about pay beds. During the last debate on this subject I was appalled when a Conservative Member, who is not in the House today, said—and it was not contradicted by his Front Bench—that it would be a good idea if we had many more pay beds and imposed bigger and bigger charges when the rich were sick to enable us to make so much money from the rich being sick that we would be able to let the poor have all that could be provided by the Health Service for nothing. If that is the attitude of Great Britain in 1978, we do not deserve to get on.

Let us not assume that all those who occupy pay beds get cured and get out of hospital pay their bills. Many do not. I have previously asked my right hon. Friend to investigate this matter. There is a well-known hospital within five miles of this House which has an enormous debt because a number of fancy-named people went into pay beds and then reneged and did not pay. That is another thing which must be looked at.

Earlier in the debate the gladiators at the two Dispatch Boxes—my right hon. Friend the Secretary of State and the right hon. Member for Wanstead and Woodford (Mr. Jenkin)—had an altercation which revolved round the fact that my right hon. Friend wanted to know what the right hon. Gentleman would do about reorganisation of the Health Service. That was not an unreasonable request. It is a common practice in the House of Commons, and rightly so. When the Conservatives were in Government they wanted to know what the Labour Party would do if ever it became the Government. That was right. Indeed, part of our responsibility is to query, dig and try to find out. Therefore my right hon. Friend was right, because we all have a few worries, not only on this side of the House, about what the Tories would do.

I have been reading an article by the hon. Member for Aylesbury (Mr. Raison) which appeared in The Times on Friday 19th May. It is entitled Before the Tories begin to consider reorganising the Health Service". I do not have time to read it all, but the hon. Gentleman mentions the right hon. Gentleman who speaks for the Conservative Opposition. It would appear that there has been a lot of thinking about the sort of reorganisation that will come about. It is natural that we should want to know the form of that reorganisation. Last time, the Conservatives' reorganisation turned out to be a disaster. Even now the right hon. Member for Leeds, North-East (Sir K. Joseph) puts his head in his hands when he remembers what he did. Therefore it is not unreasonable for us to ask about it. We do not want to find that there are nice propositions for the Health Service but in the end it turns out that Tory promises are nothing more than flamboyant labels on empty luggage.

All the recent talk about the National Health Service disintegrating has been greatly exaggerated. I agree that there are real dangers and that if they are not dealt with the Service could disintegrate. But let us not say that it is already falling to pieces. Many people have been making loud noises about the disintegration and collapse of the Service, but there has been at least one sane, cool voice. That was the voice of Mrs. Betty Patterson, the chairman of the North Thames regional health authority. She made a valuable and sensible judgment outlining some of the dangers but at the same time outlining what must be done. There was much more balance from her—a woman with experience in this field—than in the frenetic outbursts of some politicians and the newspapers.

The hon. Member for Macclesfield complained that there is not much in the Queen's Speech about the Health Service. It might interest him to know that there are about the same number of words in this speech as there were in an earlier King's Speech which said simply that it was the Government's intention to establish a National Health Service".—[Official Report, 15th August 1945; Vol. 413, c. 56.] With those words Nye Bevan built the National Health Service.

In those days there was a great deal of consternation over whether the Health Service would ever see the light of day. Even doctors were labouring under misapprehensions which only they themselves could have created. They were terrified of becoming civil servants—I do not know what is wrong with that—and that the patient would have to accept the doctor ordered by the State. In the original Bill, the right was firmly established for a patient to change his doctor whenever he liked. Also, there was no intention whatever of making doctors civil servants. In the end, a combination of the good old British compromise—at which we are such geniuses—and a lot of good will on the part of all people in the profession when they really understood what was involved, enabled the Health Service to be born and to thrive.

I believe that we must recapture that sort of feeling. The Health Service started off almost as a catastrophe, but within a matter of 10 months the profession and the ministerial team working together towards an ideal ultimately established the Service. That is the kind of spirit that we must try to recapture. It does not matter what form of administration one has; unless the people who work in the Service are proud of it one can never make it a success. It is a question not just of administration, but of people being proud to work in the Service at all levels.

I was very pleased when I read at the bottom of page 5 of the Gracious Speech the simple statement: Fresh support will be given to enable the National Health Service to fulfil and extend in services to the public". I want to hear how my Front Bench will make a reality of that phrase. In my judgment the National Health Service is one of the things of which this nation can be proud.

I understand that it is the Government's intention to introduce a number of Bills, some of which will be based on the recommendations of the Briggs Committee. Far too often in the past we in the House of Commons have assumed that a little consultation here and there, and a few letters from interested bodies, are enough to build an Act of Parliament that will affect millions of people. That is wrong. I urge my right hon. Friend to make sure that the great organisations within the Health Service, such as the Confederation of Health Service Employees with which I am associated, are brought in right at the beginning, because of their vast experience throughout the Service. When I attend meetings of the executive of COHSE, I often find that wages and salaries are not discussed at all. The great issues that are debated are how to increase efficiency and reducing bureaucracy within the Service. We should acknowledge that from time to time.

Right hon. and hon. Members on both sides of the House have said that what happened recently in the Health Service was to no one's credit. It does not matter where the fault lay. We must all share the blame that such a distasteful and nasty thing should have happened at all. It is regrettable that those in charge do not understand the machinery that exists for joint consultation. The wrong people are in charge. At least they should be trained to understand what is meant in this complicated field when a large organisation such as COHSE, representing nurses, ambulance men and others, has to negotiate agreements.

No one can say today that any small or large employer will see every individual employee and ask him how much money he wants, how many holidays he wants or how many hours he wishes to work. That is ludicrous. But there are some who take that absurd view. I hope my right hon. Friend will understand that the responsibility of organisations such as COHSE is enormous, and that with that responsibility they have garnered a great deal of wisdom and understanding about the Health Service. I beg him to see that in any future Bills not only COHSE but representatives of the consultants and other elements of the Health Service and those who are still the very base of the Service—the GPs—are consulted about any proposed changes.

I understand that one of the Bills to be brought forward will be based on the Briggs Committee report and that a great deal of its purpose will be to give nurses a new deal. They deserve it. I find it repugnant that we still live in a society where a young lady who carries a couple of double gins and a few whiskies in some nice night club a quarter of an hour from this place earns more money in an hour than a nurse does for a whole week emptying bed pans. We must consider that and acknowledge that there is something wrong and sick with our society if a young woman can take her clothes off to be photographed and earn more in a couple of minutes than a nurse or a doctor earns in a whole year.

We should all join in and say that loud and clear, and let some of our newspaper owners and managers understand that, too. There is a growing feeling among people about this. The British are a funny people. They buy newspapers to make themselves angry. They buy The Sun, turn to page 3, and see the nude and say "What a lot this is." I still think that we have a responsibility to point out that we do not want the young people of our nation to end up doing that sort of thing. We should make it clear that a nurse is one of the finest ex amples of the way in which a young woman can give service to the nation and to humanity.

I wish to draw the Minister's attention to another serious problem. My hon. Friend the Member for Basildon (Mr. Moonman) and others have made interesting an informed speeches on the subject of mental health. I wish to add one more dimension to this matter. The Confederation of Health Service Employees is almost by itself responsible for the representation of nursing staff in our medium secure units and mental hospitals. Some of the problems which it faces are enormous. The hon. Member for Macclesfield gave figures of the large number of mental illness cases which are being dealt with in the Health Service, and he stressed how small was the amount allocated to deal with these problems.

There is another angle to the matter which is growing more difficult. It concerns the legal position of a male nurse in a mental hospital who finds it necessary to restrain a patient who is trying to butcher another patient or strangle or destroy somebody. If that male nurse overdoes it, he can be brought before the courts.

Let me give an example of what happened on one such occasion. At one mental institution, patients were enabled to go home for a while and later return to the hospital. Because of the shortage of ambulances, male nurses were entitled to use their own cars to take the patient home and later to return him to hospital. In the instance to which I refer, the patient who was being transported suddenly tried to strangle the male nurse who was driving the car back to the hospital. As a result there was an accident. Nothing happened to the patient, because he was not regarded as responsible, but the male nurse was summoned because of the damage that he had caused to another car. When he returned to the hospital he found himself in a difficult situation because he, as an experienced male nurse, had allowed that situation to arise. If after the attempt to restrain him the patient had said, "I did not intend to do anything", it would have been the patient's word against that of the male nurse. Often, male nurses land up in court or find themselves threatened with legal action.

I must point out in passing that I would not like to undertake this kind of work. I would not do it for £200 a week. Male nurses have to deal with people who are often highly dangerous and mentally unstable. Because of their mental state, they are sometimes incredibly powerful, vicious and cunning. This has to be said so that we may understand the situation. It is wrong that those who look after these patients should be put at great risk because of the inadequate protection which is given to them within the Health Service, and indeed by the law in general. I hope that this unsatisfactory and demoralising situation will be examined by the Minister.

I strongly believe that we should remove some of the petty irritations that beset the nursing service. For example, a nurse has to return to duty at 10 o'clock in the evening and work until midnight, similar to the dog watch in the mercantile marine. All these procedures are unnecessary.

Many old-fashioned Victorian attitudes still exist in the Health Service, and they should be abolished. If that happens, it will make for a better feeling in the Service.

I wish to mention the important subject of preventive medicine. This relates to the pursuit of health by collective action, and hence the prevention of suffering. I believe that there must be a closer partnership in the great amount of research that takes place between private enterprise and the Government so that the results of that research can be made freely available.

Most of those who work in the Health Service are dedicated people, and this applies to all the professions and callings, whether they be nurses, general practitioners, therapists, surgeons, consultants or ambulance crews. We have all seen the keenness and devotion of ambulance men and staff when there is an accident in the street, or when a person is carried from his house to an ambulance. Everybody knows that there will be somebody at the hospital in the emergency ward to deal with the patient immediately and later to enable him to receive the full treatment. We must all agree that in any civilised society this kind of attention should be given top priority.

The hon. Member for Macclesfield referred to the devoted work of those who seek to relieve suffering and to prevent pain. This is not a new story. We all know of the excellent work carried out by the ambulance men, the nurses and the doctors when the patient reaches hospital, and at a later stage by the surgeon and the specialist. This is part and parcel of the service provided by the fine people who work in medicine. Their work is in the tradition of Pasteur, Lister, Semelweiss and Fleming. All those who work in the Health Service are following in the footsteps of those great names. Mankind is proud of those great men, and we can also be proud of all those who work in the Health Service.

The Health Service can survive only if we are able to pay for it. It is no good taking the view that we are proud of that Service if we grumble and groan when we get the bills in the form of taxation. We must get rid of that kind of hypocrisy. I believe that the principle behind the Health Service is part of a fine social code, and it has as its aim the wellbeing of all our people. I believe that the Service is the best of our social achievements. We have pioneered many splendid movements in this country, and the Health Service is the finest.

It will not be long before the Government are able to make a reality of the words on this subject in the Queen's Speech. I believe that the overwhelming majority of people want to see a massive resurgence of effort so that we can build up the Health Service and enable it to benefit from a massive increase in resources. The Soviet Union has not such a fine service. The Russians can put Soyuz in the sky, but we know that many millions of Russians cannot afford an aspirin. We have provided such a service, and we should be proud of it. In a recent television programme it was said by Senator Edward Kennedy that the United States was hoping to set up a service on the lines of our Health Service. Of course we should be proud of our Health Service. It is British, and it can be one of our finest exports. However, let us seek to find ways of perfecting it. Let us see that it has the money and the resources which are necessary to make it the pride of this country. Let the House of Commons see to it that those resources and funds are made available as swiftly as possible.

8.8 p.m.

Mr. Tony Newton (Braintree)

Having taken part in most recent debates in the House on the Health Service, I believe that this debate has followed earlier patterns. In one respect this debate has been most encouraging. I refer to the thoughtful contributions made by many hon. Members about the problems in their constituencies or matters thrown up by their experience in all-party groups.

All this is to be taken against the background of a speech by the Secretary of State for Social Services—I wish he were present to hear me say this—which sought to play politics, because it asked questions about other people's policies rather than told us what the Government thought and planned to do, and conveyed a sense of inertia on his part in the face of problems. The right hon. Gentleman's speech also displayed an unwillingness to discuss many of the matters which we all know need to be discussed.

I do not want to press this point at great length, but, as we all know and as is gradually dawning on more and more of the public, there is no way of solving the problems of the health services, in terms of the demands that could be made upon them, within the resources that are likely to be made available. There is an infinite possibility of demand and we need to look seriously at how we get the resources and how we are to finance the best possible Service, instead of engaging in catcalls between the two sides of the House about particular aspects of policy.

One clear example of this fact is that the policy of the Labour Party is to abolish NHS charges, but we all know that that will not happen. Indeed, existing charges have been put up—against the long-term policy of the Labour Party. That is a reflection of reality and we should face up to the reality that we need to look for potential new sources of finance. Some of the ideas that have been floated are not very good, but others merit genuine examination. What we cannot do is to look at our Health Service and assume that if we get another ½ per cent. growth in the economy or whatever we shall be able to solve all the problems. The world is not like that. We need serious thought about how we are to pro vide for the maintenance of the Service in the years ahead.

That is not the main point of my speech, but it is a matter about which I feel very strongly because we are failing the public with the political "yah boo" atmosphere in which this part of the NHS debate has tended to take place on successive occasions in the House. No one could get away with that in front of an audience of constituents and we do ourselves and the public less than justice when we let our debates proceed on that basis.

In recent debates on the NHS and during the Consolidated Fund Bill proceedings shortly before the Summer Recess, I have spoken at length about the specific problems of my constituency. I do not propose to do so again now, but I wish to thank the Under-Secretary for the long and courteous letter that he sent to me after our last debate and for his assurance, which I accept and of which there is now evidence on the ground in my area, that the proposed new district general hospital at Broomfield really will go ahead. I have to say that my constituents, having been given such assurances so often before, still say that they will believe it when they see it, but I have reason to believe from local inquiries that I have made that work is proceeding in a way from which one can take real assurance that we shall at last get this new hospital which is so badly needed in my part of Essex.

The new hospital will not, of course, solve all the problems. It will not, for instance, solve the problem of minor casualty facilities in the two main towns in my constituency, Braintree and Witham. It will not solve what I sense to be the growing pressure on general practitioner services in areas, such as mine, with growing populations. I assure the Minister that I shall continue to press him on these matters when necessary—and I am pretty certain that it will continue to be necessary.

In his letter to me, the Minister referred to the responsibility of doctors to provide 24-hour emergency services in the context of the argument about minor casualty facilities. My impression is that there is very great confusion among the public about precisely what to do when an emergency arises. People do not seem to be clear about whether they should rush their child or relative to the nearest casualty department or whether they should ring their GP and, if so, whose responsibility it is to provide the necessary transport.

It seems that there is a need for the public to be informed again about the line of communication when a medical emergency arises. I have come across a number of cases in which people have been uncertain whether to approach their GP or go to the local hospital. A good deal of delay and confusion has arisen as a result.

The Secretary of State referred to the redistribution of resources and the problem within the Thames regions and also took credit for the improvement in facilities in some other regions. I recognise that the right hon. Gentleman was speaking in some haste and, no doubt, in a form of shorthand, but to at least one hon. Member from Essex and, I imagine, to all my colleagues in Essex, to have the discussion continuing in only regional terms when it is repeatedly acknowledged that Essex is an under-funded area within what is said to be an over-funded region is extremely irritating.

I am fed up with being told that the north-east Thames region, which covers the constituency of myself and the Under-Secretary, has more money than it should have by some calculations when everyone who looks at our problems knows that Essex is at least as underfunded as any of the regions in the northern part of the country to which the Secretary of State referred. If only for reasons of public relations, I hope that Ministers will recognise that fact when talking about the redistribution exercise. I know that it is recognised when the point is pressed, but it is aggravating to my constituents to have this constant implication that they are in an over-provided area and should not be worrying quite so much about their health services.

Mr. Nicholas Winterton

My hon. Friend is well versed in NHS matters and I am wondering whether he can indicate how it could arise that a district is instructed to appoint a new consultant but cannot afford to employ the consultant because it does not have sufficient nurses or facilities to give him an oppor tunity of undertaking his work. Does this not show complete chaos between the area and the region or between the region and the Government over the redistribution of resources?

Mr. Newton

I cannot answer my hon. Friend's specific question, but I agree with his conclusion that there is a good deal of confusion in this matter.

In my part of the country, there is also some doubt whether the policy that is supposed to benefit Essex by the redistribution of resources within the region is proceeding as effectively and fairly as it should. The chairman of the regional health authority has said in a letter: Our case is that the element of over-provision in London is still being over-stated and that equity still requires that this Region (and indeed all London Regions) should receive a somewhat larger annual allocation than we currently do. And further that the delay in effecting closures makes it impossible, even within our existing resources, to make the sort of internal transfers —that is, transfers to Essex— we believe should be made at the planned speed. That worried me because the only possible implication is that the Minister is delaying decisions on recommendations of the regional health authority which are designed to move resources from London to Essex. Let me be clear about this matter. I do not particularly want to see our problems solved at the expense of others, but this redistribution is the Government's policy for dealing with the problems of Essex and it would be wholly wrong if, for reasons of political pressure in London, decisions that are needed to improve the situation in Essex are delayed or held up when the policy of the Government is that those transfers should take place.

I shall conclude with two specific points, the first of which picks up a common strand in much of the debate, namely, the mentally handicapped. I wish to refer to problems which specifically affect the parents and relatives of young, severely handicapped people.

There is serious continuing anxiety about whether the Central Council for Education and Training in Social Work is right in its apparent determiniation to phase out the diploma for the training of mentally handicapped adults in favour of a more generalised course in social work. This has undoubtedly caused a great deal of anxiety. My impression is that it continues to cause anxiety and that there are those who are not satisfied that this is the right step to take in the interests of mentally handicapped adults and young people who are moving into adult training centres.

These problems affect only a relatively small number of people, but they cause immense anxiety and problems for the families of those who suffer from them. There is great anxiety among a group in my constituency who are affected by the provision for the most severely mentally handicapped young people when they leave the special schools. There is a special school in my constituency which I visited recently. I understand that it contains about nine young people who within the next few years will be leaving that school where they are being very well looked after and helped, on attaining the age of 16.

In the view of the parents, the headmaster, and probably the authorities, there is nowhere in the area where they could be properly catered for after leaving the school. This is an aspect of the current debate about mentally handicapped people and provision for them in which the Department needs to give a further lead. It is acknowledged in the Warnock report and elsewhere that at present there is a grave deficiency of provision for young mentally handicapped adults. There appears generally to be good will and a desire to help among all the authorities who might be capable of helping. There is not, however, simply a problem of resources but also of insufficiently clear guidance or decisions from the Department about precisely who is responsible for providing the after-school care.

This could be dealt with in a variety of ways. The parents and others in my constituency prefer a special care unit attached to the adult training centre. There are two such centres in Essex which are to some extent jointly financed and run with the help of the local mentally handicapped societies. There seem to be problems, however, in making further progress. In my part of the county, for example, there is uncertainty, and this stems in part from the Department, about precisely where responsibility lies.

The Warnock report makes the point that education authorities have a duty to provide for 16 to 19-year-olds, regardless of other circumstances, any further education they may need. Many people feel that a special school which would also be attended by many younger people would not be the right place for 16 to 19-year-olds, and that this would not necessarily provide an ideal solution.

I have a letter from the area health authority which makes the point that the responsibility for the placement of young persons beyond statutory school attendance age has been with the social services department. I also have a letter from one of the county councillors concerned with the problem at Essex county council who makes the point that although the DHSS has recommended that a service of this kind should be a social services responsibility, the DHSS has never officially transferred that responsibility from health to local authorities or, of course, provided any funding for it.

The result is that the county social services department has many demands for its money for purposes for which it has a statutory responsibility, and here is another responsibility the importance of which is acknowledged but for which it has never been given direct statutory responsibility.

On the face of it, therefore, there seems to be some confusion, and I hope that the Minister, even if he cannot comment on the matter tonight, will make some comment to me subsequently. If there is a gap here it is a serious one. It is causing chronic anxiety for parents with children of this kind, and it greatly adds to the strain they already suffer from looking after their severely mentally handcapped children.

I wish now to deal with the implications of this issue for the argument about reorganisation. I hope that both Front Benches will take note of my comments. I hope that very great emphasis will be put on the need for flexibility in further Health Service reorganisation. It may be that in some cases to change the area tier of responsibility within the Service will be right. But, given the degree to which social services and health authorities will already have to co-operate on matters such as the one I have been discussing and a whole range of others, there are real risks with further change in Health Service organisation, at least in some parts of the country—and I speak from experience of Essex—which would make it more difficult for direct and easy co-operation to take place on the same geographical basis. There is, for example, that which exists between the Essex area health authority as the authority responsible for health services and Essex county council which is responsible for social services.

This point has been made forcibly to me in Essex, and I hope that it will be borne in mind by Ministers and by my own Front Bench when they consider reorganisation.

I shall conclude my speech in order to enable my hon. Friends to speak. I am grateful for the opportunity of addressing the House.

8.26 p.m.

Mr. Peter Bottomley (Woolwich, West)

I look forward to the Under-Secretary's speech with perhaps more pleasure than I can associate with the memory of the speech by the Secretary of State, who seemed to be somewhat out of tune with the general theme of the debate, which has been one of concern for the Health Service.

I pay tribute to all parts of the Health Service and the Department, but I mention first an unsung and probably little known branch of the DHSS which is concerned with advice on residential institutions. I do not want to go into great detail, but I am aware of the way in which advice is given to local authorities about certain institutions and inspections are carried out. The discretion, the diplomacy and, yet, the rigour with which the DHSS officials do their job should occasionally be commented upon, and I pay tribute to them now.

My second point concerns the Halsbury report and the way in which experienced school health visitors and TB visitors were by oversight discriminated against. In the main these are ladies who lost up to £1,000 a year because they failed to have a certificate that in any event was not available when they took up their work. With calm dignity and great determination they carried on with their work.

As a result of the pressure brought about in part by myself and by my colleagues, the DHSS recognised the validity of their claim. However, because of the operation of the pay policy it was unable for a time to meet it. When the opportunity came the Department acted. Those concerned in the profession are grateful. It is worth again paying tribute to the Department. It did not act as fast as I should have liked, but the fact that it acted should be put on record.

There is a pension problem for those in that position who retired when their pay was at a lower level than it would have been had the pay policy not operated. It is a problem that I ask the Minister to consider. I do not ask him to reply tonight. If the Halsbury report should have kept those with great experience—which must be worth more than a new certificate—from suffering in their final years of service, that should not be reflected in a reduction of pension or a failure to increase the pension to what it should have been had the pay scales applied. Some consideration should be given to an increase in pensions or the making of an arrangement that would avoid a total penalty for those concerned.

I shall refer again to the Health Service, but before doing so I look back to some of yesterday's debate. The Queens' Speech as a whole has been important. One of my great desires as someone who has not normally been regarded as on the extreme Right wing of the Conservative Party is to ensure that when the next General Election comes the bulk of each of the main political parties will take roughly the same approach to pay policy. Others have addressed themselves to the question whether we concentrate too much on the pay aspect of earnings and not enough on productivity or output. I should welcome a General Election when neither political party offered the British people the prospect of an average increase in pay, in real terms, greater than the average increase in output or production.

That is an important feature that needs to be put across to the British people. However it is dressed up, and whether incomes policy or monetarism is the most important part of getting that message through, I should like to see a General Election in which all political leaders and trade union leaders of significance, as well as all major employers, were united in saying that we cannot have real increases in pay that are greater than underlying output, whether in goods, services or exports. Obviously, the fluctuation of the exchange rate has some effect, as does North Sea oil.

The underlying truth needs to be put across. There were glimmers of that in yesterday's debate. I pay tribute to my right hon. Friend the Leader of the Opposition, the Prime Minister and other leading politicians of both parties who have been willing to put the message across, or work towards it. Those who merely rehearse the theoretical arguments about monetary policy versus incomes policy miss the point that has been put forward by my right hon. Friend the Member for Sidcup (Mr. Heath), a neighbour of mine, and a few Labour Members who have had the courage to do so.

It is rather sad that about 30 years after the establishment of the National Health Service, 100 years after the establishment of the Eltham and Mottingham hospital, in my constituency, and at a time when we are trying to retain reasonable Health Service facilities, the Eltham and Mottingham hospital should be under threat of closure.

When the Secretary of State talks about greater democracy in the Health Service he should think about explaining to the House. and certainly to my constituents, why that is so when in the democratic exercise of asking local people in Eltham and surrounding areas whether they thought the Eltham and Mottingham hospital should continue the overwhelming verdict was "Yes". I asked the Secretary of State whether anyone in that area had agreed to the closure of the hospital and he replied that no one had put forward that view.

With the large new general hospitals at Greenwich and Sidcup, the establishment of the Queen Elizabeth Military Hospital, which is offering beds to the NHS, and with the apparent desire to retain the Brook and St. Nicholas hospitals, perhaps there is an over-supply of what I call acute beds. However, surely it is about time that the Government, and especially the NHS, recognised the mistakes that were made in building enormous council estates and secondary schools. These mistakes should not be repeated. We should not reach a stage when we have lost every small hospital in every community in London, let alone in the country as a whole.

I have asked repeatedly for a full justification for the closure of the Eltham and Mottingham hospital. All that I have heard is the answer that there is an oversupply of acute beds in the Greenwich and Bexley area. We do not hear any comparison between the £500,000 a week that the Department pays out in supplementary benefits to the families of Ford strikers—I shall not become involved in the argument whether there should be supplementary benefit paid to strikers' families, which should take place in a different debate—that can lead to jacking up the expectation of pay increases for the rest of us and in turn will probably make it necessary to close more small hospitals, and what £500,000 would do to assist the running of the Eltham and Mottingham hospital.

Consideration should be given to the trials and tribulations of those who use the services of the Eltham and Mottingham hospital, bearing in mind what they will go through when they take children or an aged relation to the Brook, the Greenwich district hospital or St. Mary's. When that comparison is made, we begin to realise that we have our priorities wrong.

Every possible argument has been made in favour of maintaining the services at the Eltham and Mottingham hospital. The argument involves the maintenance not of operations but of every other service, including outpatients and physiotherapy. It is a hospital which is at the centre of a real community. I wonder whether the Secretary of State has thought sufficiently about the possibility of democracy in the National Health Service.

I turn to the greatest failure which the country has experienced in the last four years. We have not experienced the economic growth that many of our industrial friends and competitors in Europe have experienced. If we had had anything like the growth that the Government spoke of when they launched their industrial strategy in 1976, or anything like the growth which the public expenditure increases in 1974 anticipated, it would not have been necessary—even with the Resource Allocation Working Party report—to close Eltham and Mottingham hospital.

One of the failures of this country, which I associate with the present Government, is that institutions raised by voluntary funds which even since the nationalisation of the hospital service 30 years ago have had great support from the community, have to be closed. That is a consequence of a failure to achieve economic growth. However, I hope that it is still possible to save that hospital.

I turn to the question of pay in the public sector, which covers the National Health Service. I shall speak of the hospital supervisors. If the National Health Service and, by extension, the Government, are negotiating by grade—which is what occurs because of our diverse union structure and our split negotiating procedure—and the Government after four years are not able to anticipate that people who supervise others expect to earn as much, if not more, than the people they supervise, the Government have no justification for saying that the Conservative Party does not understand industrial relations.

One of the problems that arose out of the electricians' settlement was that the supervisors were to be paid no more than the people whom they supervised. The Government failed to discharge their responsibility of anticipating future problems as a result of that situation.

One of the responsibilities of an employer is to recognise what the knock-on effects of a settlement will be on the other groups and, if necessary, to bring the different negotiating bodies together in order to understand how they interact.

It is worth remembering that the Government introduced the £6-a-week pay policy a week or two after my election success in 1975. I demonstrated then, perhaps to the present Prime Minister's surprise, that one could win an election by arguing in favour of wage restraint and by doing that openly and publicly even at the time of a crucial by-election.

During the last three years the Government have done nothing to bring home to the trade union movement—and one must remember that the Labour Government have as father, and perhaps as mother, the Labour movement—the danger of having paper increases in earn ings such as the 25 per cent. increases that were common in 1974 and 1975. The Government and unions have failed to recognise this. It was not understood at the TUC and Labour Party conferences.

The public sector has become more and more aware that the possible wage drift in the private sector makes it increasingly difficult for those in the public sector to accept the fairness of the way in which incomes policy appears to have worked in the last three or four years. Many unions with members in both public and private sectors are unwilling to accept the consequences, in terms of inflation, public expenditure and unemployment, of leap-frogging claims or at least successive claims which are not compatible. One must say, in that light, that the Labour movement and this Government have failed.

I do not want to make a partisan point, but in three years, from social contract through phases 1, 2 and 3, and now on the verge of phase 4, we have not seen sufficient concentrated work of the type that was done during the last two years of the previous Conservative Government. The cost to the country in lack of economic growth and increases in unemployment and inflation, as well as the reduced value of the pound, in the interregnum between 1973–74 and the present Prime Minister's dedication to keeping down pay increases to what we can really afford, has been horrendous for the country—and just as much for NHS patients as for anyone else.

It is pleasant to be able to end as I began, with a tribute. The hospital service has been threatened by disputes not only by NHS employees. Nearly a year ago, during the firemen's dispute, many hospitals were left without the fire cover that they were expected to have. They could not expect to get the red fire engines turning up at perhaps three minutes' notice.

I pay tribute to those—hospital and area administrators, for example—who, in my area of Eltham and in many others, helped to lay on voluntary fire watchers who slept overnight in hospitals. Many of us took part in that exercise. I am glad to have worked with people in management and the work force in providing that cover. When I stayed in the hospital overnight there were, fortunately, no fires, although there was one in my chimney at home on another occasion. The way people worked then to deal with the possible consequences of a dispute outside the NHS is the kind of attitude that we need in the Service as a whole. I hope that one consequence of this debate is that that will come sooner rather than later.

8.42 p.m.

Mr. Robert Boscawen (Wells)

I agree with my hon. Friend the Member for Woolwich, West (Mr. Bottomley) that the sooner we can get a proper procedure for settling these damaging disputes in the NHS the better. We have just passed through a period of which all of us who care deeply about health care should be ashamed. Once again, an industrial dispute has affected not just the organisation of the NHS but patients, and not just for the short period of the dispute but for a long time ahead. The damage done by a dispute of this kind shows up in the waiting lists for a long time ahead.

We are still suffering in some ways from the damage of the doctors' strike. That happened two or three years ago, and some of the waiting lists which built up have never been cleared. Some of us who took an interest then deplore the fact that doctors found industrial action necessary—just as we deplore the same action among those employed by the NHS today. It is a major defeat for those who run the NHS from the Secretary of State downwards. The Department must take considerable responsibility for the fact that this latest dispute was not overcome a long time ago. It should never have reached that point.

I hope that the Government are learning the lesson that dispute procedures should be reviewed and reformed as soon as possible, not only locally but at the Whitley Council level, which was perhaps as much responsible for the dispute as the local levels were. These two levels must be improved if we are not to go on having the type of damaging industrial action in the National Health Service that we have seen in the past few years.

Such action is not only damaging to the smooth running of the Service but is deeply damaging to the morale of all those hard working, dedicated people who run the Service, whether medical staff, nurses, or administrative or maintenance staff in our hospitals.

We have been through a very black period. I hope that the lessons are well learned. If they are not, those responsible in the Government, the Civil Service and the area health authorities will receive the condemnation of ordinary people, patients and workers in the NHS for a long time to come.

There are many deep problems that have nothing to do with industrial disputes facing the Service. The waiting list problem in the hospitals is perhaps the worst of all. In the area where my constituency lies we have a deplorable example of the failure of long-term planning within the NHS to provide sufficient human and financial resources to meet what is undoubtedly a growing demand for orthopaedic surgery.

Surely it should have been obvious to those who plan the NHS at local and national level that there would be an explosion of demand for orthopaedic surgery as a result of new techniques. Surely it has been obvious for some years that this would happen, so why is it that at a major unit such as the Royal United hospital in Bath, when there is already a waiting list of 1,300 or 1,400 patients for orthopaedic surgery. The orthopaedic wing of that hospital was closed this summer for nearly four months, from the end of June to nearly the end of October, because of a lack of nurses. I have been in touch with the Department, the area health authority and the hospitals involved about this lack. The reasons are complicated. The shortage of nurses has a good deal to do with the difficulty of attracting young people for basic training in orthopaedic nursing. It seems to me that the education service in the area may have something to answer for as well. The number of children with suitable O-levels who want to go into nursing does not seem to be sufficient.

Nevertheless, I wonder whether long-term planning inside the National Health Service at area level is good enough. Those of us who have been thinking about the National Health Service and party policy believe that more responsibility for planning the future should be pushed down to hospital level. But even if we give the districts more authority, I wonder whether the level of technical ability in planning for the needs of the hospitals in a given district is of a sufficiently high standard to get the answers right.

It occurs to me that we may need a general staff in the National Health Service which can advise or even guide area health authorities and district health authorities in planning for the provision of nurses and nursing skills for future demand in the different disciplines. At the moment, it all seems very hit-and-miss. The areas do not know what is going on in neighbouring areas. This does not apply only to district hospitals; we have this problem at present in planning for the future of long-stay mental hospital beds.

The area health authority in my own area does not seem to be able to obtain future wishes or needs of adjacent areas, and to some extent they are all seen to be planning in the dark. A good deal more thought in the National Health Service should be given to planning hospital care not so much regionally but across area borders where they involve different regions. I question whether we have the quality of people at present capable of coming up with the right answers.

I come now to the other big failing in the National Health Service. In former days, the consultants used to be kings in our hospitals. Their word went. They were listened to. They gave the lead. They were the local centres of leadership. All that has disappeared. To some extent, it can be said that the reorganisation threw up the local administrators as the persons to give the local lead about what was needed, what could be done and what the future of local hospitals was to be. But they have not replaced the doctors. At local level there is often a lack of leadership. The National Health Service needs people locally who can take responsibility, but at present there is no one locally able to take decisions.

The Secretary of State has just experienced an incarceration in hospital in his own area. He may well have become aware of the lack of leadership in hospitals. It comes out so often, and it needs looking into. The administrator cannot give that leadership, although he is very often the only person in a position to give it. In many cases senior consultants appear to have been brushed aside. Today their opinions are often hardly sought at all. Where will the leadership come from? I believe that it should come from multi-disciplinary groups within the hospitals at the lowest levels.

Mr. Ennals

I did not find this at all. Perhaps I was fortunate in that the area chairman concerned is an extremely able man and my consultant is a member of the district management team. It was an energetic and hard working team which gave a great deal of leadership. It had to face difficulties over shortages of funds but it dealt with matters in a realistic and skilful way.

Mr. Boscawen

I am glad to hear it. I hope that that good example will spread throughout the Service. Not all local leadership is organised well enough. Individuals cannot always go to someone and get a decision. They have to go to and fro, up to the area and down to the district, from doctor to administrator.

There are too many warring factions in the Service. Why cannot we get rid of the politics in the Health Service and get back to a greater sense of idealism? Those who work in the Service at any level are there to serve the sick. If we could do this we should be serving our constituents and those who are in need to much greater effect.

8.56 p.m.

Dr. Gerard Vaughan (Reading, South)

We have had a long and useful debate. I hope to leave ample time for the Minister to deal with the many points that have been raised. I begin by adding my welcome to the Secretary of State and expressing my pleasure at his return to good health. I hope that he has now fully recovered. It is good to have him with us this evening. My recent comments about him may have been unpopular but they were not meant personally.

Listening to the right hon. Gentleman today I found myself gripped more and more by a sense of unreality. This was obviously shared by my hon. Friends the Members for Braintree (Mr. Newton) and for Woolwich, West (Mr. Bottomley). After listening to the right hon. Gentleman giving us a list of the improvements which the Government have made, I have to ask how it is that capital spending, has been reduced in the way that it has over the past four years.

How is it that the Service now has the longest waiting list in Western Europe? I heard the right hon. Member's robust statements and then wondered how it was that the hon. Member for Basildon (Mr. Moonman), in an excellent speech, was able to say that there was a lack of any sense of direction in the Service. That is what we hear on every side as we go round the country. It is said that there is no direction at the top.

It was good to hear the Secretary of State say, I think for the first time, that he is concerned about the state of the Service. It seems to have taken the most drastic, appalling and terrible dispute from which the Service has ever suffered to produce this change of mind. I have spent the whole of my life, until recently, outside politics working within the Service, and for me this recent dispute has been the most ghastly tragedy. I have seen at first hand, apart from all the comments in the press, the effect that it has had on waiting lists and on individuals who find their condition changing from treatable to untreatable. I am sorry to come back to that unpalatable fact, but that is what has happened in recent weeks. Many of us believe that the tragedy was totally avoidable had action been taken at the beginning.

I agree also with my hon. Friend the Member for Canterbury (Mr. Crouch), who said that he was surprised by how much time the Secretary of State spent in asking the Opposition what their plans are and so little time, relatively, telling us what the Government's plans are. But that is typical of what goes on. It sounded from this side of the Chamber as if the Secretary of State was trying to defend himself by constantly coming back to the question of what our views and plans are. But at the moment it is his responsibility and the responsibility of the Government as a whole to deal with the situation. I saw no reason for the hon. Member for Basildon to chide my hon. Friend for saying what he did.

I can understand the Secretary of State's emphasis on resources. I agree that there is a shortage of resources. But he made no comment at all on a factor which most people working in the Service complain about—misuse of the resources that we have. One of the economies that we see is a proper redirection of the way resources are being used. Our information is that millions of pounds could be saved if money were properly spent instead of being spent in the complicated and extravagant way it is at present.

It is difficult to feel a sense of reality when the Secretary of State talks about the shortage of resources while, for example, the Government continue to close down private beds, thereby cutting down the resources that those beds have brought to the NHS. We were promised that they would be used by the NHS, but in the majority of cases they are simply being shut down altogether and the space used for storage or offices. That is a disgraceful situation.

Against the background of lack of resources, how is it that the Government continue to pursue their aim of having a common waiting list? It is desirable probably in the long run, but it would, as the professions have told the Secretary of State, create disruption during its introduction. Is it right to introduce another disrupting factor at a time when so much is going wrong and when the waiting lists have gone up by 60,000 cases–10 per cent.? The introduction of a common waiting list will increase for a time the general numbers of people on the waiting list. That is the view taken by many people. So it is difficult to accept as reality what the Secretary of State was saying.

My right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin) set out clearly our views on the Gracious Speech. Our concern about the Gracious Speech is not what is in it but what is not in it. Its contents will do nothing to deal with the real ills that face us in our health care—unless, that is, we accept, as I do not, at their face value, the words: "Fresh "—an interesting word— support will be given to enable the National Health Service to fulfil and extend its services to the public. I regard that as mere window dressing, and I fear that nothing will come of it. Nothing that the Secretary of State said today has changed my view. I hope that the hon. Member for Barking (Miss Richardson) will turn out to have been justified in congratulating the right hon. Gentleman on this, but I doubt it.

We welcome the undertaking to provide compensation for vaccine-damaged children and the proposal to legislate on Briggs. As the House knows, we have consistently supported the compensation proposal. I agree with the point about deafness and german measles made by the hon. Member for Brent, South (Mr. Pavitt). We shall want to question whether the amount of compensation is right, because there is no doubt that the sums suggested are well below what the children would expect to obtain through an ordinary court of law. We shall want to consider this aspect.

As many hon. Members know, I chair the medical panel advising on the thalidomide children. All I would say from that experience is that I hope that the Government will put this matter into the hands of a very small group of people so that compensation procedures can go through quickly and humanely and we do not experience the terrible delays and suffering for families that we have all seen with the thalidomide compensation process.

I turn for a moment to Briggs itself. I was rather surprised that the Secretary of State did not refer to it in more detail. He merely referred to it in passing, rather late in his speech. There is no doubt that from the nursing profession's point of view, this is something that they want very much indeed.

Mr. Ennals

There will be a whole day's debate in about 10 days' time.

Dr. Vaughan

Of course, and on that occasion we shall be discussing with the Government the concern that the professions within the profession—the midwives, health visitors, district nurses and psychiatric nurses—all feel about their future identity. It has already been put to us that the health visitors, for example, are considering whether they will have to move out of nursing altogether and into the social services field. This would be a disastrous outcome. We must persuade them not to go ahead with that.

When it comes to the Bill and the Committee stage, we shall want to have a very good look at the cost and at whether there is a danger of setting up yet another large central bureaucratic structure that will crush all initiative underneath it.

We welcome these proposals. We were very glad to see them. But where in the Gracious Speech is the awareness of and comment on the appalling situation in the NHS today, and where are the steps to deal with it? We were certainly not given them tonight. Are we to drift on, waiting for the Royal Commisison in June, which may be delayed? Then, once it has made its recommendations, presumably there will have to be time to discuss them and to work out what sort of action should be taken.

My hon. Friend-the Member for Canterbury and the hon. Member for Basildon think that there should be action now. So do we. That is because we do not accept that a caring Government, about whose caring we hear so much, should let the situation drift. We regard that as irresponsible and very damaging. Therefore, we ask the Government to rise to the matter of dealing with the needs.

This is not a personal matter. We are now discussing the condition of a great Department of State and the Government's credibility as regards their control over it. Many people think that the Government have no control at all over what is going on.

The Secretary of State seems to regard himself as some kind of Houdini. No situation is too difficult for him to know the way out of it, waving a press release of some kind and claiming credit when there is total disaster all around him. This theme of his that all is well is not the picture that one gets as one goes around the country. The right hon. Gentleman shakes his head, but in January, on television, in "Panorama", when he was told that urgent cases were having to wait for investigation, he said that he had never heard about it. He wanted people to let him know. He did not think that it existed. He said what he has said so often, and so damagingly to himself—that we have the finest Health Service in the world. He brushes these other things on one side.

Mr. Ennals

indicated dissent.

Dr. Vaughan

This is a very important point. I suggest to the Secretary of State that he has done himself and the Health Service great damage by pretending, on many occasions publicly, that these problems do not really exist. He has acquired a reputation for fumbling government in health matters.

It is true. We have it in the newspapers at present. There are constant accusations that had the right hon. Gentleman stepped in earlier on the recent dispute, it would not have developed to the extent that it did. He has a reputation for too little too late, and it is up to him to live it down.

Dr. M. S. Miller

Will the hon. Gentleman give me an example of one Labour Social Services Secretary about whom that accusation has not been made?

Dr. Vaughan

The Government and Ministers are accused of a lack of direction, of mismanagement and a lack of awareness of the situation which really exists. We have had it today in the debate from the Secretary of State's own side.

Let us examine for a moment, as the hon. Member for East Kilbride (Dr. Miller) has raised it, how this has come about. In January 1977—a long time ago—the Royal College of Nursing produced a report setting out very clearly some of the anxieties about the standard of care of patients. The report set out very clearly that the flow of nurses would drop by about 10,000. The report was ridiculed. The college was told that it did not know the position and that this was not a reliable assessment, yet everything set out in the report has proved to be true, and the assessments have been shown to be completely reliable.

Not long ago we had the abortion figures, and the Secretary of State said that the number of abortions was going down. Within a few weeks he had to tell us that the number of abortions was going up.

There were the problems of disability and the appalling mishandling of the issue of the trike, which led to thousands of people becoming housebound. It is no use the Secretary of State shaking his head. This is what happened.

There was the situation concerning the agency nurses. The Government made very strong attempts to close down the nursing agencies. What has happened? The Government are now making greater use of agency nurses than they ever have before.

There is the problem of the waiting lists. It was denied that the waiting lists were a major problem. We were told that the figures were going down. The Secretary of State told us this not very long ago, but in fact they have gone up.

Mr. Ennals

rose—

Dr. Vaughan

I should like to finish this point, if I may. Early this year Miss Catherine Hall, a most moderate and responsible woman, made a statement, on behalf of the Royal College of Nursing, that the nurses were so concerned about the standards of care for patients that they thought we had a very serious and disastrous situation on our hands. I raised the matter in the House in a Question to the Secretary of State. He ridiculed me and said that nurses were always asking for more of this and more of that. It is all on record in Hansard. Then the Secretary of State went to Harrogate and discovered the truth when he had to listen to the people who actually do the job.

How does that sort of behaviour and history raise credibility for the Government? It does not. That is why, as one goes round the country, one finds so many people saying that they have no faith in the direction from the top.

Mr. Hoyle

What would the hon. Gentleman do?

Dr. Vaughan

The British Medical Association has warned us that standards are falling. It has gone further than that. This is a very serious thing for a medical group to do. It has warned its members of the legal danger of using equipment which is not in good repair and is not serviceable. This is the kind of thing that is going on, and at the same time we have this increasing move to anarchy and disruption which is spreading right through the Service. Only the Royal College of Nursing has come out clearly and said that so far as it is concerned there will be no strike action within the health field.

Only today we were accused—my right hon. Friend quite rightly denied it—that we had in some way supported strike action, or did not speak out against it. I was here in this Chamber when the doctors were operating the work to rule, and we said that that kind of behaviour did not justify itself, in our opinion, in any circumstances in the health field.

I could go on through a great list of statements which have turned out to be untrue or situations which have been misjudged within a very short period. In the past few days The Daily Telegraph has commented that the recent dispute was one which need never have occurred.

Earlier this year—again I believe this was window dressing—the Secretary of State tried to produce a code of practice. Today he spoke with pride about the number of different people he had brought together to consult. Frankly, why does one have to have consultations for a code of practice to which every humane and feeling person would agree? Why does one have to have consultations to say that the care of patients must come first? It is absolute nonsense. Of course it must come first. Why does one have to have consultations to say that there is no place for strike action in the care of the sick? Why does one have to have consultations to say that intimidating and frightening people is totally barbarian and outside ordinary civilised behaviour? In time of war we have the Red Cross and the Geneva Convention to ensure that injured and sick people are, where-ever possible, not caught up in acts of warfare. Yet in peace, in our own Health Service, we think nothing at the moment of jeopardising the lives and treatment of patients. I feel very strongly about this indeed.

Mr. Hoyle

Why does the hon. Gentleman denigrate the staff of the NHS who, after all, have been so loyal to the patient? Does he not agree that the worst thing that could happen, if we do not get the pay and conditions right, and early settlement of grievances, is that there will be a drift away from the Health Service? Then patients will suffer. It is largely due to the bureaucracy which the Conservative Opposition set up when in Government.

Dr. Vaughan

I am glad the hon. Gentleman intervened in that manner, because he clearly has not understood what we are saying. I am not denigrating the staff. I pay great credit to the staff. We heard from my hon. Friend the Member for Woolwich, West what appalling mismanagement there is with regard to negotiation if staff have their pay increased above the level of people who supervise them. I am not denigrating the staff at all. What I am saying is that there is a lack of leadership and confusion at the top.

Mr. Hoyle

You lot set it up.

Dr. Vaughan

Now we have a special proposal that a team should be set up in each region—another Quango—in order to come in from outside and sort out industrial problems. Why? Why not give authority to act to those who are actually concerned? What is what my hon. Friend the Member for Wells (Mr. Boscawen) was asking for. Why not give support and authority to those who are already there? One does not need to bring in people from outside to see that once again there is someone actually in charge of running a hospital. It is this complete inability to take any positive action over the past four years which has done so much damage to the Health Service, because there has been drift and confusion.

We believe that it is not the place of the Government to keep stepping in and telling the staff how to behave in their day-to-day activities. It is their job to deal with the day-to-day activities, but it is the Government's job to show leadership from the top on general policy. I hope that the Secretary of State will take this seriously.

I went to the hospital at Alton the other day. The ancillary staff are not in communication with the nurses and the doctors. Until very recently the nurses and doctors were not in communication with the area staff. A decision was taken to close that hospital without any consultation with the local people. Is that the way to run a Health Service? Of course not. Now the hospital has been told that its future is likely to cease, that it will be closed as a specialist hospital, at a time when an almost identical hospital is being planned at Cambridge in another part of the country. It does not make sense to them or to me. I hope that the Secretary of State will stop this wild activity of closing down smaller hospitals without examining the damage being done to the local community.

I hope that the Secretary of State will take seriously the call from many hon. Members on his side of the House for action now. One of his hon. Friends described the Royal Commission as an "Aunt Sally for doing nothing".

I hope that when the Secretary of State comes to face the nurses he will not try to brush off their problems as he has brushed off so many other problems in the past. It is scandalous that nurses today should earn £26 a week on average less than a primary school teacher. That applies to a registered or enrolled nurse or midwife. It is also scandalous that a nurse should earn less than a secretary. How can one expect to encourage people to come into this great profession if they are to be constantly concerned about the lack of finance in their salaries?

Mr. Ennals

The hon. Gentleman must be aware that at the time of the change of Government the nurses were in a state of uproar because of the failure of the Opposition, who were then in Government, to deal with nurses' pay. It took my right hon. Friend and the Halsbury report to produce a 30 per cent. increase in nurses' salaries. How dare the hon. Member come to the House and lecture us on nurses' pay?

Dr. Vaughan

What the Secretary of State has omitted to say is that the main reason for the shortage of nurses is the cut back on training schools and courses for nurses. In many areas these have been cut back by one-third. If he looks at the nurses' assessment of the situation he will see that the Government are urged to recognise this and not to continue increasing the facilities without increasing the number of nurses. There are great problems and I hope that he will take them seriously.

A lot of play has been made by the Secretary of State about our policies. They are very simple. It was put to us that we should have policies to put right every single thing that is going wrong at present. That would be ridiculous. To have a major change of that kind would only create more damage than good. Therefore, we have looked at the main problems and we have found that these lie in lack of resources and in poor morale.

When one examines why morale is so bad—and it is terrible—one finds that it is caused by lack of resources, and by the fact that people cannot make decisions. Therefore, we have come down clearly on returning the Health Service to a local base—to locally based small units, where decisions can be made quickly and effectively. Local units will have their own budgets, will know what they are doing and will be able to plan properly again. This will improve morale. We also have plans for introducing incentives locally and increasing the voluntary contribution locally.

Mr. Pavitt

Will the hon. Member tell the House that this is precisely what happened before the reorganisation? This happened under group hospital management committees which had their own budgets. All this happened previously.

Dr. Vaughan

Let us at least recognise what the Health Service needs now. It needs to be able to make quick, effective local decisions. We see great contributions coming from collaboration with the private sector. We would give proper priority to reducing the waiting lists and we believe that the private sector would join in reducing them.

Mr. Pavitt

Will the lion. Gentleman give the figure for BUPA and Private Patients Plan? Even if one doubles that figure, it surely will not touch the problem.

Dr. Vaughan

I am telling the hon. Gentleman what our policies are. He asked, and I am happy to tell him. We have plans for local freedom of action in the Health Service. This will mean—not in every part of the country, but in many areas—the phasing out of area health authorities.

We heard earlier in the debate that this proposal would not save a great deal of money. It would save some money directly, but it would save much more money indirectly by making the Service efficient and streamlined again. The regional health authority could then revert to its proper role of being a planning and co-ordinating body, instead of trying to do the day-to-day running of the Service.

Those are our proposals. We would put right in the front of them priority for the care of patients and for doing away with or severely reducing waiting lists. We believe that that can be done with proper leadership and incentives locally. We have no plans—and let us hear no more of this—for cutting the existing resources in the Health Service. Such a suggestion is a malicious, smearing lie. We have no plans to impose new charges.

Mr. Hoyle

Not yet.

Dr. Vaughan

I repeat that we have no plans at all in that respect. Therefore, it is no good accusing us of having such plans.

In our view, the criticism of the Government's handling of the National Health Service is totally justified. That is why I wrote to the Prime Minister as I did last week. There is now a widespread lack of confidence. One has only to travel the country to discover this. That lack of confidence is to be found among patients and staff. The Royal College of Nursing says that there is a crisis of manpower, money and morale; and we in the Opposition say that there is also a crisis of mismanagement.

9.28 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)

I wish first to apologise for the absence of my right hon. Friend the Minister of State, who is on an official visit overseas.

Because of its size and importance in the national economy and because of its role in the lives of every citizen, the National Health Service is properly the subject of public concern and rightly it is also a matter of great political concern. Although all parties agree on the need for a National Health Service, there is a great deal of political disagreement between them on a number of contentious issues, some of which have figured in this debate.

Ministers can have no complaints where the Opposition challenge them on straightforward political grounds. We would be unrealistic to think that our political opponents—and even our friends—will always see eye to eye with us on everything that happens in this great organisation of which we in the Labour movement are so proud.

I hope that the right hon. Member for Wanstead and Woodford (Mr. Jenkin) will forgive me if I do not immediately reply to the points that he made in his speech, because my right hon. Friend wishes me to deal with a subject which has not figured in this debate but which I know is in the minds of all hon. Members with an interest in health matters. I refer to perinatal mortality rates. I wish to say a few words on that subject before I come to the substance of the debate.

In this country we have long been maintaining a steady reduction in the perinatal mortality rate. There are wide variations in that rate between different areas. For example, in 1977 it varied from between 10.2 per 1,000 live births in Kingston and Richmond to 26.6 per 1,000 in Rochdale. Although there may be room for improvement everywhere, the major problems are obviously linked with areas of multiple deprivation. Any action that we might take in regard to health services needs to be accompanied by broader measures of environmental and social improvement. We are working, and intend to continue working, to develop and sustain a broad attack on these problems through our partnership schemes for inner cities and the urban programme in seeking to help areas of special need.

I wish to pay tribute to my hon. Friend the Member for Eccles (Mr. Carter-Jones), who is unable to be here today but who has led almost a one-man campaign—although he has been assisted by other hon. Members—in the past year or so attacking the Government, and perhaps rightly, for what he feels has been the neglect of this problem. My hon. Friend has certainly had a great deal of influence publicly and behind the scenes. We are especially concerned about the problems of areas with infant and perinatal mortality rates consistently above the national average where they show no sign of significant reductions.

In our debate earlier this year on preventive medicine, my right hon. Friend the Minister of State undertook to approach the areas concerned. A short while ago, we wrote to the chairmen, sending them figures for infant and perinatal mortality for the four years up to 1977 and asking them to obtain special reports from the chairmen of areas where there was cause for continuing concern on the specific policies they would be adopting to improve the situation. That is an example of substantial action and direction from above. We have been criticised quite a lot in the debate for a lack of those qualities.

I should also make clear—I believe that the House will support me here—that individuals have a right to look after their own health and a responsibility to do so. For example, expectant mothers have a responsibility for their own health and for that of their unborn babies. One of the ways in which they can exercise this responsibility is by making full use of the services provided. Late booking for antenatal services is a major problem in many areas, and it is unfortunate that those at risk are often those who are most likely to book late. In an effort to find better ways of reaching them, we and the Child Poverty Action Group jointly organised a conference earlier this year on reaching the consumer in antenatal and child health services which had as one of its principal objectives the aim of identifying some of the problems involved. A number of useful ideas emerged and the report of the conference has been widely circulated.

In addition, the Government have expressed their commitment to the introduction of a prenatal screening service for spina bifida and other neural tube defects as soon as its safety and effectiveness can be assured. In the meantime, we have set up a working group under the chairmanship of Sir Douglas Black, chairman of the Royal College of Physicians, to review the problems and advise on how they may be met. We hope that this shows that, at least in this area, the Government are taking positive action to remedy something that is of great public concern.

Mr. Pavitt

Will the Government consider using the same incentive methods used so successfully by the French in order to get the services of our antenatal clinics up to the same standards as those in France?

Mr. Deakins

We look carefully at what is going on overseas, but we have to bear in mind that conditions differ from one country to another and I hope that the lines we are working on in making the services better known and ensuring that people are got to the clinics in time will have an effect. If the policies on which we are working do not have an effect, we shall obviously have to look elsewhere, but I am confident that, given good will and adequate resources, we shall see them succeed in bringing down still further the perinatal mortality rates.

The right hon. Member for Wanstead and Woodford spoke about finance and I shall have something to say about that later, although my right hon. Friend the Secretary of State also dealt with this subject. The right hon. Member said that nursing recruitment, particularly of nurse learners, was appalling and asked what we would do about it. The subject of nursing manpower has received a great deal of attention, not merely in the past few days. I think that it would help if I clarified some of the main questions that would pose themselves to any Minister in our position.

First, neither we nor DHSS officials have imposed any cuts in nursing manpower or recruitment to nurse training. Decisions on manpower levels in relation to services are taken by each health authority in the light of resources available and its perception of the requirements of its area. Similarly, admissions to nurse training are determined locally. There certainly are problems, but the difficulties vary widely from one area to another. We have heard from Conservative Members and the Secretary of State heard from the Royal College of Nursing on Monday about the increased work load putting a great deal of pressure on our nurses, and the reasons for that.

We are under no illusions about the difficulties, and we shall have to redress shortfalls in provisions in some of the priority services which are not always in the limelight when these matters are debated in the press. However, we have to recognise that the number of nurses working in the NHS has continued to grow, although in the past two years there have been only very small increases—not sufficient. It is the fall in the number of young people entering nurse training in the past two years that has caused serious concern.

Here again the pattern is somewhat mixed, and on has to look at all the figures. The figures for the first quarter of the current year show an increase over the same quarter in the previous year. If the present trend is continued the numbers entering for training for the SRN qualification should return to the levels of earlier years. There has been some improvement in the number of entrants who remain to complete their training, which is another important factor. But the numbers entering training as pupils for the SEN qualification have continued to fall. That is a matter of major concern. While there are some encouraging signs, we are in no doubt that the Service faces real problems on the question of nurse manpower. We fully appreciate the feelings of nurses who are working under increasing pressure in many areas.

It is essential, therefore, that positive nurse manpower planning should be developed in all areas of the Service to cope with our future needs. Here I agree with the hon. Member for Wells (Mr. Boscawen) that we need much more manpower planning, and not merely with nurses. To stimulate this process my right hon. Friend intends to issue to NHS authorities early next year a document dealing with a wide range of issues affecting nurse manpower planning.

The right hon. Member for Wanstead and Woodford also asked me about vaccine-damage payments in relation to supplementary benefits. I am not sure whether this was covered in a parliamentary answer in July, but I am informed—this is, of course, a matter for the Supplementary Benefits Commission—that the effects of payment under the scheme with regard to eligibility for supplementary benefit have been carefully considered by the Commission. It has decided that where the vaccine-damaged person is a child it would be right in assessing the parents' entitlement to supplementary benefit to disregard the payment to the extent that it is held in trust for the benefit of the child or is earmarked for particular major items of expenditure such as adaptations to the home.

Where the vaccine-damaged person is an adult the payment will normally remove the need for payment of supplementary benefit, but the Commission will give sympathetic consideration to such cases where there are any special circumstances.

I shall now deal with a point that was raised by the right hon. Gentleman but which was taken up by hon. Members on both sides of the House. I refer to the works staff dispute. My right hon. Friend the Secretary of State dealt with this aspect in some detail, but in view of the subsequent remarks that were made in spite of his speech I ought to spend a little time on the matter. The background to the dispute goes back to 1974. The dispute was primarily about a new grading structure and the salaries attached to it. A joint working party of the Whitley Council was set up late in 1974 to make proposals to the council. The proceedings of the working party were protracted because of the complexity of the task and the need to agree a structure which was acceptable to both staff and management interests.

Eventually—we must remember that stages 1 and 2 of pay policy intervened—the proposed structure was put to the Whitley Council early this year. The management side offered to discuss salaries for the new grades in this structure within the context of the 1978 pay round. That was unacceptable to the staff side and the 1978 settlement was confined to existing grades, who received an overall increase of just within 10 per cent. Subsequently, the staff side made representations to Ministers and approval was later given to the Whitley Council to negotiate salaries for the new scales. The staff side had given notice of industrial action if salaries were not negotiated. Of course, in approving the opening of negotiations Ministers explicitly reserved their position in terms of acceptance of the outcome.

I must reinforce what my right hon. Friend said about pay policy. He and I and my right hon. Friend the Minister of State have been closely involved in the past two months with this issue, often on a day-to-day basis. Obviously, both the level of the new rates and the timing of the introduction of the structure were important issues. We had to satisfy ourselves that these matters were in conformity with pay policy, particularly since we shall start to introduce them less than 12 months after the last pay increase.

The second point at issue is, I believe, a more significant one, and one on which most of the negotiations have been conducted in past months. It concerns bonus payments. Clearly, a bonus not linked with genuine productivity agreements would be outside pay policy, and that is why pay policy came into the matter. The unions have made it a sticking point that there should be payments of at least 15 per cent. rising to 30 per cent. to all supervisors whether or not they were involved with productivity agreements, and regardless of whether such schemes were self-financing. That, as the management side told them, was not on, and we said so publicly, too. Happily, the unions moved away from that unacceptable position and enabled an agreement to be reached with NHS management.

I hope that no one in future—because we may have other disputes to deal with—will feel that when Ministers say something about pay policy implications they are in any way being misleading. They are not. There were genuine pay policy implications. Pay policy was concerned not merely with the appropriate percentage in each year but with a whole range of other issues.

Mr. Hoyle

I thought that my hon. Friend would have been most indignant about the fact that a group of workers had to wait four years for the settlement of a grading dispute. That is the issue to which he should be addressing his attention. As I said to my right hon. Friend the Secretary of State, pay policy should not have entered into the dispute. We should be addressing our attention to considering means of solving these disputes far more quickly and efficiently. If there is a point of explosion, that must be understood if a group of workers has to wait four years for a simple grading issue to be settled.

Mr. Deakins

I have already explained—I am sure that my hon. Friend did not fully appreciate all my remarks—that an offer was made and could have been accepted early this year. Admittedly, there would still have been a long delay, but the dispute would not have built up into such grievance. The basis of the grievance was not the grading and salary structure but the bonus scheme.

I shall not take up the remarks of the right hon. Member for Wanstead and Woodford on pay policy generally. I should be unfair to those who had taken part in the debate if I were to take up his argument about not having a fixed limit for pay. If we do not have a fixed limit, I do not understand how negotiators in pay settlements throughout the country in the public and private sectors will have any idea of what is in the national interest. The Government must give a lead.

My hon. Friend the Member for East Kilbride (Dr. Miller) observed that many nostrums are being circulated. Fortunately, there have not been too many offered in the debate. I think that we are becoming more realistic when we debate the National Health Service and other areas of the public sector. However, magic solutions are often put forward in the press. As my hon. Friend said, and as most who have taken part in the debate will agree, there are no magic solutions.

My hon. Friend was concerned about the importance of the general practitioner and the primary health care team. That is an area with which we are much concerned. We should like to see more resources directed to that area. Although joint financing moneys will help, we have to take other steps as well. We have set up a joint working group—the Standing Nursing and Midwifery Committee and the Standing Medical Advisory Committee—with the following terms of reference: to examine the problems associated with the establishment and operation of primary health care teams and to recommend solutions.' The first meeting of that group is tomorrow.

We are also preparing a departmental circular entitled "Primary health care, health centres and other premises". The report will give guidance. It is hoped that it will help health authorities to press ahead with suitable accommodation for primary health care teams. In some areas the lack of suitable accommodation is holding up progress.

Dr. M. S. Miller

Should this matter be left in the hands of the British Medical Association? Should my hon. Friend not give general medical practitioners who are involved the opportunity to give him their opinions?

Mr. Deakins

We are always open to receive opinions from any organisation or individual. I hope that my hon. Friend, who is an ardent trade unionist as I am, will recognise that the BMA is a trade union. We have a right to receive its representations.

My hon. Friend the Member for Brent, South (Mr. Pavitt) said that the problem of RAWP and the inner cities has occupied him a great deal. Indeed, it occupies Ministers' attention. An advisory committee is considering the problem. I am grateful to my hon. Friend for welcoming the Bills that we shall be introducing.

My hon. Friend referred to rubella. I do not have time to develop his reference in any great detail. We are considering a national campaign during next year, the International Year of the Child. There are some medical difficulties. The difficulties are not technical or administrative. We are considering the financial manpower and administrative implications of the proposal. Obviously, any campaign has to be well planned with public health laboratories and other interested parties, including health authorities. Until a decision is made on proposals that are to be put forward by our Joint Children's Committee, I cannot say precisely what the action will be. However, I can assure the House of our deep concern and our determination to do something as quickly as possible to increase the uptake of rubella vaccinations.

Mr. Patrick Jenkin

That is an extremely important issue and I am glad that the hon. Member for Brent, South (Mr. Pavitt) referred to it. The key is the acceptance by the Government that we have to have eradication. That means immunising both boys and girls and not merely having the limited campaign of trying to immunise girls before they reach the age of childbearing. Does the examining committee have that proposal on its table, or has that been ruled out?

Mr. Deakins

I do not know the answer to that question. I shall ensure that the right hon. Member's question is conveyed to the committee. It is a technical and medical question. I am not a medical expert. I shall see that the matter is passed on.

My hon. Friend the Member for Brent, South also referred to nurses and their terms and conditions of service. These are matters for the Whitley Council. I shall write to him about them. He mentioned reform of the Whitley Council. We have made a response to the McCarthy report. Where we have not been able to reach definite conclusions it is because staff and management have not been able to reach agreement. In some cases the staff associations have not been able to reach agreement. We have made clear that there must be a consensus between staff and management before implementing the McCarthy proposals.

I turn to the speech made by my hon. Friend the Member for Nelson and Colne (Mr. Hoyle). He thought that the Whitley system was a charade. I do not agree. It is under great strain but it has worked well. I am confident that it will continue to work well, providing that its members are determined to make it work.

My hon. Friend the Member for Nelson and Colne spoke about direct negotiations with the DHSS, not necessarily with the management. It should be made clear that although he might be speaking for the union of which he has the honour to be president, he is definitely not speaking for all the Health Service unions in the TUC. My hon. Friend also mentioned funds for health and safety. There is disagreement between us. But we have promised to examine the extra costs involved in the running of the Act that might be incurred by health authorities in the next year and to review the situation in a year's time.

My hon. Friend the Member for Barking (Miss Richardson) made clear her disappointment about the absence of a number of measures from the Queen's Speech. I appreciate her concern, but it is a full programme for my Department. Half a dozen Bills affect my Department. We must consider not only Ministerial resources but those that are available to the Department.

I should like to reassure my hon. Friend about drugs. The Secretary of State has made clear on a number of occasions that the restrictions on drug promotion to GPs are working adequately and that they are reducing the total expenditure in that sphere.

My hon. Friend the Member for Barking mentioned the licensing of new medicines. There is strict control. My hon. Friend mentioned a drug that she had been offered. She said that she was told that it was likely to make her blind. I hope that she will give me details of that drug and of the people involved. I shall ensure that it is investigated.

My hon. Friend the Member for Barking also mentioned the housewives' non-contributory invalidity pension. While on the Front Bench I have had the advantage of consulting the Minister who is responsible for disabled people. There will be an opportunity to debate this matter. My hon. Friend the Member for Barking has indicated that she will pray against the regulations. All that she has said will be noted carefully. There will be a full reply in the House when the matter is debated.

My hon. Friend also mentioned the Elizabeth Garrett Anderson Hospital. My right hon. Friend has announced previously that the closure of this hospital has been postponed to allow time for discussions on alternative accommodation. Representatives of the hospital staff, the area health authority and other interested parties have come together under the chairmanship of a senior official in the Department and they are giving careful consideration to the practicalities involved in providing an EGA facility within the district general hospital. I hope that a satisfactory solution can be found so that the service provided by the EGA can be preserved in an identifiable form.

I turn to the speech made by the hon. Member for Canterbury (Mr. Crouch). Much of his speech was favourable to the National Health Service, of which he has great experience. The only part of his speech with which I disagreed was when he said that we should find a different system for financing direct contributions. That is a political difference between us. He accepted the necessity for RAWP. He made a good point when he said that hospitals were often used too readily. That ties in with what my hon. Friend the Member for Brent, South said about the need to extend primary health care facilities which will do much to relieve pressure on the health services.

The hon. Member also said that we need to devote more resources and attention to preventive medicine. The House will be aware from an earlier debate this year of our views on things like smoking and alcohol and of the measures being taken by the Health Education Council, with extra money from the Department, to bring these matters home to individuals. But each of us has a responsibility for ensuring that we lead healthy lives.

The hon. Member for Chertsey and Walton (Mr. Pattie) was mainly concerned about our White Paper on the mentally disordered. I noted with interest his expert comments and those of my hon. Friend the Member for Basildon (Mr. Moonman). We shall study them with interest. The hon. Gentleman had a strong point about separating the mentally ill from the mentally handicapped. Having gone around some rather antiquated institutions run partly by social services and partly by health authorities, I accept that that is desirable. The hon. Member made a number of detailed points on the White Paper. I can write to him about them, but this depends on whether we have an early debate, which is a matter not for me but for the Lord President.

My hon. Friend the Member for Basildon echoed a number of the hon. Gentleman's comments. He said a lot about statistics on the mentally ill. We need no convincing—nor does any party—that we need to devote more resources to this area, which is one of the priority areas set out in our priorities document in 1976 and in "The Way Ahead" in 1977. I am sure that that would be a priority of any Government, because it is a Cinderella service.

I also agreed with what my hon. Friend said about NHS management. We can make no fundamental alterations before the Royal Commission reports, but as someone who, like my hon. Friend, has spent a third of his working life in management in industry and commerce, I see the idea of consensus management as a nonsense. I agree that there is no substitute for line management. No doubt the Royal Commission will make some recommendations in this area, but we shall have to wait and see.

The hon. Member for Truro (Mr. Penhaligon) raised some detailed questions about kidney transplants. Because of lack of time, I will write to him about these matters. He also mentioned tourism in Cornwall. I have seen some correspondence on this. I do not know the latest situation, but I will find out. The Minister of State has been dealing with it. We are over the tourist season now, but if the numbers are going up each year, we may be able to get something extra done for next year.

My hon. Friend the Member for Ealing, North (Mr. Molloy) referred to the NHS ideal and the spirit which needs to be recovered. We will all agree with that. He mentioned the concern of COHSE with the future of the Service and its efficient operation. We shall continue to maintain close contact and co-operation with the Health Service unions on these issues of major concern.

My hon. Friend made an interesting point, which was echoed by the hon. Member for Reading, South (Dr. Vaughan), contrasting nurses' earnings, which are fairly low, with those of other groups—my hon. Friend with strippers and the hon. Member with secretaries. Perhaps, for the first and I hope the last time, I might quote myself in a book I wrote as a young man and which was published over a decade and a half ago. In that book, I asked why a nurse should earn less than a stockbroker. It is a political example, but a pretty good one.

If it is a question of training, a nurse has far more training than any stockbroker. If it is a question of dedication, no one would argue that nurses are less dedicated than anyone in the City. Finally, I said that one could imagine a society without stockbrokers but one could not imagine a civilised society without nurses. I therefore accept the point made by both hon. Gentlemen.

My hon. Friend also mentioned nurses' handling of mentally disordered people. I will look at this and write to my hon. Friend. We have had previous correspondence about the matter.

The hon. Member for Macclesfield (Mr. Winterton) made a very interesting speech. I am sorry that I was not here for the whole of it. I had to nip out to get a bite to eat during the debate. The hon. Gentleman spoke about the importance of the private sector. For us, it is the public side of the NHS that is most important. The hon. Gentleman referred to increasing concern about mixed wards. I shall study his remarks and write to him about the matter.

The hon. Member for Braintree (Mr. Newton) made a point that I think a number of hon. Members who took part in the debate accept, that resources are limited. He also asked one or two specific questions. He spoke about con fusion about what should be done in an emergency. I shall examine the matter, because if there is a need to clarify lines of communication it is clearly a task that Ministers should undertake.

The hon. Gentleman also mentioned under-funding in certain areas of the Thames region. There can be no doubt about this. We both come from the same region.

The hon. Gentleman raised two major points about mentally handicapped children and teaching. In view of the limited time, I think that I can best write to the hon. Gentleman about both questions.

School nurses were mentioned by the hon. Member for Woolwich, West (Mr. Bottomley), He spoke in particular about the pensions of those who retired before the grievance was remedied. I am not optimistic about a satisfactory solution—at least, a solution satisfactory to the hon. Gentleman and the nurses—but I shall look into the matter and write to him.

Finally, I come to the hon. Member for Reading, South, who spoke of misuse of resources and the need to redirect resources that are used at present. He was clear later on about what Conservative policy would be, and I am not pressing him on this. If he has any evidence of existing NHS resources being misused, I ask him "Please let us know." I assure him that we shall look into it very seriously.

Mr. Patrick Jenkin

The Minister knows that in his own constituency the area health authority closed down the Connaught hospital two and a half years ago. How can he explain and justify the fact that it has still not sold the site, and that I was told by the district management team that it cannot sell it this year because it could not use the money this year; it must wait until next year. If that is not a waste of resources, what is?

Mr. Deakins

I do not want to become involved in a constituency argument with the right hon. Gentleman, but I can assure the House that at a meeting in my presence he supported the closure of the hospital in my constituency. I leave it at that. I have to get on.

The hon. Member for Reading, South made comments about pay beds. We believe that it is wrong that scarce NHS facilities should be used for the treatment of private patients. As pay beds and other private facilities are phased out, the resources previously devoted to the care of fee-paying patients will become available to meet the needs of the vast majority of people who rely exclusively on the NHS to meet their needs.

The hon. Gentleman also spoke about common waiting lists. One of the Health Services Board's statutory tasks was to consider the question of common waiting lists for NHS and private patients and to submit a report to my right hon. Friend the Secretary of State for Social Services. This the board has done, and its report has been the subject of widespread consultations. We have considered the board's recommendations and comments and we reaffirm our commitment to common waiting lists to ensure equal access to NHS facilities. We have now written to the joint consultants committee setting out the Government's proposals for implementing these common waiting lists at an early date. We have agreed to hold a discussion with the JCC if it wishes before we publish our proposals. We are awaiting its response. We are anxious to make early progress.

This has been a fairly good, even-tempered debate, with very little of the ya-booing to which the hon. Member for Braintree referred. That is a good sign of growing realism on both sides of the House.

It is legitimate in drawing the debate to a close to emphasise some of the difficulties that face any set of Ministers in the NHS. First, there is the question of resources. Demand for health care is a function not merely of need but of medical technology. Experience shows that the public's expectations increase faster than do the resources available to satisfy those expectations.

Staff in the NHS feel themselves to be entitled to better pay and conditions of service. NHS management feels that it could do an even better job if resources could be increased faster, a point that the hon. Member for Reading, South made, though he did not say where the extra resources would come from. There is a need to stress that resources are limited, not merely during a time of economic constraint but always. There will never be enough money to do all that we wish in terms of improving health care for our citizens. Therefore, we must choose priorities.

We have made clear our own priorities, but they are regularly reviewed in the light of experience. What it is wrong for any of the Government's critics to do is to imply that more resources will answer the problems of the NHS. We have difficult choices to make from time to time.

Secondly, there is the question of the powers available to Ministers. They have final responsibility for the NHS, but its management is a task for health authorities. Parliament decided that in 1973, and until such time as Parliament decides otherwise we must all accept that the NHS is not and cannot be run from Whitehall. Hon. Members may find that frustrating. It is probable that Ministers do from time to time. Certainly I do. But we all have to accept the position.

A number of problems have emerged since the Tory reorganisation, some of them connected with the form of that reorganisation. We are well aware of these problems and, where appropriate, changes can be made after consultation with all concerned—

It being Ten o'clock, the debate stood adjourned.

Debate to be resumed tomorrow.