§ The Secretary of State for Social Services (Mr. Norman Fowler)
I welcome this debate on the welfare state for two main reasons: first, because it allows me to set out not only our record in social services over the past four years but our policies for the future, and, secondly, because it gives me a further opportunity to reply to the charges made, particularly in the election campaign, that in some undisclosed and secret way the Government were plotting to destroy the welfare state.
In particular, that charge was associated with the National Health Service. Yet the record of the Government in relation to the Health Service is quite clear. In spite of the world recession and the general need to control public spending, the Government have spent not less, but appreciably more, on the Health Service. We raised spending from £7.75 billion in 1978–79 to £15.5 billion in 1983–84. That was an increase against the retail price index of about 17 per cent. It enabled a real increase in services of about 7.5 per cent.; it enabled the employment of more nurses and more doctors.
Above all—and this is surely what the NHS is all about—it enabled more patients to be treated. If 1981—the last year for which we have figures—is compared with 1978, it can be seen that in 1981 500,000 more inpatients and day cases were being treated in England alone; that over 1.5 million more outpatient and emergency cases were treated; and that 375,000 more people were visited at home by district nurses and health visitors. At the same time we made it absolutely clear during the election campaign and the 12 months preceding it that we were committed not just to the concept of the NHS but to the present method of financing it. We were specific that we did not intend to change over to some form of compulsory private health insurance. We made that clear from the Dispatch Box time and again and we made it clear throughout the election campaign.
§ Mrs. Gwyneth Dunwoody (Crewe and Nantwich)
Will the Secretary of State confirm that he will not in any circumstance support compulsory private health insurance? After all, it is clear that that is what the Prime Minister wants for the Health Service.
§ Mr. Fowler
The hon. Lady is again leading with her chin. I have made it clear that the Government have rejected any proposal relating to compulsory private health insurance. That viewpoint has been expressed by me by my hon. and learned Friend the Minister for Health and by the Prime Minister. The hon. Lady must stop trailing round the country saying and pretending that the Government are intent on following a policy that we have specifically rejected.
The hon. Lady has again illustrated the sort of campaign that the Labour party ran throughout the election. The Labour party's campaign can be described only as one of sustained hysteria, which piled untruth upon untruth, invention upon invention and fear upon fear. At national level, it published a leaflet which asked:Are you going to vote for the death of the health service?At local level we had a candidate, Mr. Tony Williams, in Hendon, North who said:If you cannot afford private health insurance you could go bankrupt like they do in America.355 I am glad to say that Mr. Williams rightly came third in the election.
At the same time, burrowing ever deeper and lower was the hon. Lady who, for the time being at any rate, is the Labour party's health spokesman. This is what the hon. Lady told the north-west region of the Labour party in Warrington at the end of April:If we as a nation do not act now, the next four years will see the National Health Service blasted out of existence. Make no mistake, the Tories plan to close down the Health Service after the next election … Since 1979 the Tories have forced through a four-stage plan in preparation for their own final solution to the problems of the sick and the elderly.I suggest to the hon. Lady that even the language of political debate cannot justify the casual tastelessness of phrases such as the "final solution". Even the language of political debate cannot justify a politician who seeks to make such a comparison with the indescribable real horror of what took place 40 years ago.
An even more fundamental point has emerged from the campaign over the past two months. I refer to the arrogance and irrelevance of Labour's charges. The charges are overwhelmingly arrogant because they amount to a claim that the Labour party can be, and is, the only defender of the welfare state. It makes its claim as though rhetoric was enough and as though words will provide the resources necessary for health, social security or education. Yet the economic policies to which the Labour party is committed would inevitably lead to financial crisis and inflation which, equally inevitably, would undermine, not sustain, the welfare state.
hy was it that the previous Labour Government cut back the capital programme inside the Health Service by 35 per cent.? They did not want to do that. The cuts were the biggest capital cuts in the history of the National Health Service. They made them because inflation was going through the roof and the economy was in chaos. The cuts in the welfare state were forced upon them by their lack of economic policy, and all their words and protestations of good intent could not prevent them.
The Government are restoring the capital programme. There has been a 17 per cent. increase since 1978–79 in the capital programme of the NHS. Planned capital spending stands at over £1,100 million and over 140 major new hospital projects are being designed or are under construction in England alone.
§ Mr. Fowler
During the previous Conservative Government over 100 hospitals were shut, but under the previous Labour Government 250 were shut. In other words, the Labour Government closed two and a half times more hospitals than the Tory Government.
The Labour party's charge is irrelevant because the continuance of the welfare state — the provision of health care irrespective of ability to pay and our responsibility to the poor, the elderly and the unemployed — is not and has never been in doubt. Opposition Members do not have a monopoly of concern about the future of the welfare state. It would be strange if those of us brought up in the welfare state—the beneficiaries of the state school provision and of the National Health Service—were suddenly to turn our backs upon it.
That is not the issue. The real issue facing both parties is how we can develop those services, provide resources 356 for them, and make the services as efficient as possible. The real danger is to believe that the state can do everything, and that we should turn our back on the help given by the family, voluntary organisations and the independent sector. The state has never managed alone and never could manage alone. The real challenge is to ensure that the economy continues to recover because social progress is, and must always be, dependent upon economic strength.
I in no way wish to minimise the areas of need. It would be wrong and foolish not to recognise the new pressures that, for example, will come from the increase in the numbers of the very elderly. Between now and the end of the century the number of people aged over 75 is expected to increase by over 400,000 to over 3 million. It would be wrong not to recognise the further progress that is necessary in some of our traditional Cinderella areas, such as mental illness and mental handicap. But equally it would be wrong simply to paint the picture of need without setting out the full policies that are necessary to meet it. We must recognise the connection between the needs of the country and the means whereby they are met.
That is why the Government do not believe that it is possible to ring fence social policy from what is happening elsewhere in the economy. Indeed, any attempt to do that is doomed to failure. The previous Labour Government presided over a period of inflation of 110 per cent. That is socially devastating in at least two ways: it undermines industry, which provides the wealth for social provision, and it undermines the position of all those on fixed incomes, including the elderly, who find the real value of their savings reduced. It is for such reasons that we give priority to achieving low inflation and keeping it low. That is important not only industrially and economically but socially.
As my right hon. Friend the Secretary of State for Education and Science said in the House in a debate just before the election, the amount of public spending is an imperfect guide to the quality of public services. League tables of spending beg many of the most important questions in social policy. Nevertheless, the House should remember just how much public spending is going to the social policy areas.
We are devoting about 45 per cent. of public spending to social security, health and social services. If one adds education to that total, the proportion of public spending going on those main services in the welfare state is about 57 per cent. That hardly sounds like the action of a Government determined to dismantle the welfare state.
Taking the social security budget alone, we are now spending £35 billion a year, half of which is being devoted to spending on the retired and the elderly, and 17 per cent. of which is being devoted to spending on the unemployed. The bulk of it is going to the retired and the elderly. It has meant that we have been able to more than price protect pensions and other linked long-term benefits, but it has also meant that we have been able to give special help to a range of other important groups. That has been demonstrated by the measures announced in the Budget earlier this year and in the uprating statement last week. Let me give four examples of what we are doing.
First, we have sought to help families with children by raising child benefit to £6.50 a week—an increase of about 11 per cent. That will mean that child benefit in November will be at its highest ever level in real terms and will directly help 7 million families with children. At the 357 same time we are giving one-parent benefit the same percentage increase — which will bring help to over 500,000 families—and our efforts have also meant that take-up of this benefit has now increased from 60 per cent. to 70 per cent.
Secondly, we are increasing the rate of supplementary benefit, which goes to some of the poorest people in this country, by 4.3 per cent., we are raising the heating additions, which go to over 2 million households, by 8.6 per cent., which will mean that help with special heating costs will rise to a record level of well over £350 million; and to help those with small savings and so as not to penalise their saving, we are increasing the supplementary benefit capital disregard to £3,000.
Thirdly, pensions will increase by 3.7 per cent., which in itself reflects the success of the Government in bringing inflation down to levels not experienced in this country since the 1960s. Millions of pensioner; and retired people will welcome the fact that inflation is under control and that savings are safer than they have been for well over a decade. Other pensioners will welcome the fact that the Government have moved another step towards the abolition of the earnings rule by raising it by 14 per cent. to £65 a week.
§ Mr. Neil Kinnock (Islwyn)
Will the Secretary of State give a categorical assurance that there will be no introduction of means testing for child benefit, nor a reversion to the system of tax allowances? As the right hon. Gentleman is taking credit for an improvement, as he describes it, in arrangements for supplementary benefit, will he recommend to his right hon. Friend the Secretary of State for Employment that there should be the same procedure for the long-term unemployed? Why is the only Minister responsible for the disabled now a junior Under-Secretary of State in the right hon. Gentleman's Department instead of a senior Minister?
§ Mr. Fowler
On the first question, I give the hon. Gentleman a categorical guarantee about child benefit. We do not intend and never intended to change the basis of that benefit. That was just another scare during the election, which was denied at the time.
Secondly, what stands in the way of the supplementary benefit measure for the long-term unemployed is the cost, which will continue to be under review. My hon. Friend the Member for Braintree (Mr. Newton), who is on the Front Bench, has become the Minister with responsibilities for the disabled. I believe that his knowledge of this subject is recognised on both sides of the House, and I cannot think of a better person to have in that position.
The fourth area that I would mention is the help that has gone to the disabled. For example, we are now removing the invalidity trap. At present invalidity beneficiaries cannot qualify for the higher rate of supplemenary benefit. From November they will be able to qualify for the longterm rate of supplementary benefit and will of course, also be able to get additional help under the supplementary benefit scheme which can help on heating and in other areas. This will directly help some 30,000 sick and disabled people under the age of 60, while, as a separate measure, all men over the age of 60, whether sick, disabled or unemployed, will be able to qualify immediately for the long-term rate of supplementary benefit. The Labour Government were not able to end the 358 invalidity trap. The Conservative Government have done so. Such improvements hardly sound like the action of a Government determined to dismantle the welfare state.
Our approach to personal social services has been, and will continue to be, to mobilise all available resources to improve the quantity and quality of care available. We have increased the funds provided to health authorities for schemes financed jointly with local authorities. We have increased grants to voluntary bodies by about 33 per cent. in real terms since 1978–79.
For the elderly, the mentally ill and the mentally handicapped, the objective is to encourage and help people to live in the communities to which they belong. That means assisting families, friends and neighbours who do more now than any national or local organisation can. Voluntary organisations in their place can do much to support individual carers, and the Government in turn will give as much help as possible to the voluntary sector.
§ Mr. Dafydd Wigley (Caernarfon)
Does the Minister accept that in integrating mentally handicapped and ill people into the community the cost of support to the families may be greater than the cost of keeping them in hospitals? If that is the right policy to follow, are the Government willing to pay that additional cost?
§ Mr. Fowler
I agree with the hon. Gentleman that movement to the community has never been a cheap option. That policy is pursued because it is right for the individual, not because it is economically right. I believe that it is correct to continue that policy. The overriding reason should be the individual's need, not economics.
We also need to ensure that the statutory social services operate as efficiently and flexibly as possible. It is no good health authorities and local authorities planning their own services independently of each other and of the non-statutory agencies. We have increased the allocations of funds for joint finance; we have widened the range of activities for which joint finance money may be used; and we have strengthened the machinery for collaboration between statutory authorities by ensuring the involvement of the voluntary sector. There is more to do, but I hope that no one will doubt our determination to meet the challenges ahead.
The issues in the debate are not simply those of past records. The issues in the debate also concern the ways in which we meet future needs — our approach to the problems we face and will face over the next years.
One of the most revealing incidents during the election campaign was the point when the Labour party claimed to have found a secret document which it said set out a plan to dismantle the Health Service. That was its claim. In fact, the document proved to be so secret that it had been circulated for discussion to every regional health authority in the country. It was called "Co-operation between the NHS and the Private Sector at District Level"—perhaps one of the less sinister titles of the 20th century. The introduction stated:The independent sector can relieve pressure on hard-pressed health services either directly or by allowing health services to direct resources to other areas. The Health Service has always made some use of facilities in independent hospitals and nursing homes as a means of providing services to Health Service patients.The paper suggested a number of ways in which there could be constructive co-operation between the Health Service and the independent sector.
§ Mr. Fowler
Whether there was scope for developing the partnership between the Health Service and private nursing homes, and whether National Health Service patients could use beds in independent hospitals if there was spare capacity. In other words, the document recognising that there was an independent sector, was seeking further ways of developing co-operation and partnership between the public and private sectors.
§ Mr. Laurie Pavitt (Brent, South)
Will the Secretary of State confirm that when, for example, medical or paramedical services are being pushed from a National Health Service hospital to a private hospital, not only will the economic costs be recovered but there will be no effect upon the work load and the demand for services within the Health Service?
§ Mr. Fowler
What the hon. Gentleman said has a great deal of force. The main change will be achieved at the margin of the Health Service. As the independent sector and the National Health Service exist, we have to decide how they should operate. I should have thought that that made sense. Every opinion poll shows also that it is the public's wish that there should be as much co-operation as possible between the National Health Service and the independent sector. I believe that the Labour party dislikes ideas of co-operation and regards partnership in health care as being dirty words. Labour's reaction revealed its basic attitude—that in its ideal world only the state shall be allowed to provide.
The Labour party feels so strongly about voluntary organisations that I could find no mention of them in its election manifesto. It is more explicit about the independent sector. It does not like it. It does not want it. It wants to discourage and prevent it. It ignores the fact that in dealing with the health and closely intertwined social service problems there is a need for partnership because there is a clear and vital role for the family, for the voluntary organisations and for the independent sector which, for example, has developed nursing home provision.
I do not believe that this should be a provider debate centred on who should be allowed to provide care. The criterion that counts is how best care can be delivered in the circumstances of each case.
During the past months we were attacked for our supposed view of the NHS. Our attitude towards it is that we are committed to the NHS, and we see it as an indispensable part of the future of health care.
We see the NHS as a patient-oriented — not a provider-oriented—service. In other words, the essential criterion is the quality of service given to the patient.
We expect the process of change in treatment inside the NHS to continue—a process of change which has led to more patients being treated, and a process of change often started by the individual clinician and not from the centre.
We intend to take further steps to provide the maximum value for the money the taxpayer provides by measures such as regional reviews, management inquiry and competitive tendering.
At the same time as we support the NHS we shall explore ways of deepening the partnership in care, whether that be through joint finance, working with voluntary organisations, or co-operating with the independent sector. That, it seems to me, is the only sensible policy to pursue if we are to tackle the problems of the years ahead. Those problems are real and will be acute.
360 Before the election, the hon. Member for Islwyn (Mr. Kinnock) said:If Margaret Thatcher wins on Thursday—I warn you not to be ordinary. I warn you not to be young. I warn you not to fall ill. I warn you not to get old.That election has now been fought. Millions of ordinary people voted for the return of a Conservative Government. They did so not because they belonged to a great privileged class, but because they saw that a Conservative Government's policies would match their aspiration.
Young people want to see economic and industrial recovery. Sick people want to see a Government who care and can put their plans into effect. All people want to see an end to the long nightmare of high inflation. That is why millions of ordinary people voted for the return of a Conservative Government. They voted for a Government who would tackle the problems of the 1980s. They decisively rejected a party which is still rooted in the 1930s and fighting battles which were hardly relevant then. I suggest that that is the real warning to Labour Members.
§ Mr. Neil Kinnock (Islwyn)
I listened intently to the Secretary of State's remarks. He described a Health Service that would be unfamiliar to the 56-year-old woman in my constituency who needs a hip replacement operation. She has been told that she must wait 19 months before she can be relieved of the pain and inconvenience that her condition causes her. His Health Service is different from that which has been reported to me by many doctors, some of whom have my political views but most of whom do not. It is a different system from the one about which specialists in my area complain, because it does not permit them properly to reduce their waiting lists. They say that they are denied the facilities that they would like to enable them to reduce the numbers on the lists.
The right hon. Gentleman talked about the success of the Conservative party in securing its return to government. I congratulate it on having taken the art of Conservative politics in the 20th century to a higher level than ever before. That art is to persuade poverty to use its power in democracy to vote property into power. That it certainly managed to do with the assistance of Messrs. Saatchi and Saatchi and their mastery of falsehood.
My warning of what the prospect of a Conservative Government held, which I gave in the last week of the election campaign, still holds good. I hope intensely that I shall be proved wrong. However, given the past four years of Conservative government, there is no evidence to suggest that I was doing anything other than understating the prospect of horror that is held out to us for the next few years.
The best and the worst that I can say for the right hon. Gentleman is that he has stayed in the position that he occupied before the election. That means that he was neither important enough to be promoted nor soggy enough to be demoted. Apparently he was not wet enough to be chucked out. I suppose that that must be bringing him some comfort. Although I am not given to the discussion of personalities in the context of politics, having witnessed a purge on such a huge scale, a scale that would have made Joseph Stalin blush with envy, it might be relevant to consider the ups and downs and the ins and outs of individuals as a context for the Queen's Speech.
Gone from the Government Front Bench, for instance —I see him on the Government Back Benches—is the 361 right hon. Member for Cambridgeshire, South-East (Mr. Pym). He has been discounted. Gone, too, is he who was the right hon. Member for Penrith and the Borders, Mr. Whitelaw, who has been discounted and viscounted to boot. Although there is an extended patch of damp in Northern Ireland, for the remainder the reward has gone to the arid. I note with some pleasure that my old sparring partner, the hon. Member for Brent, North (Dr. Boyson) is in his place on the Government Front Bench. He has been elevated from being a lowly Under-Secretary of State in the Department of Education and Science to a full-blown Minister of State for Social Security. I can only come to the conclusion that Wackford Squeers has become Bumble the beadle overnight. I hope that the Prime Minister was moved by that sort of literary impetus in the course of making her choice.
The most spectacular change involved the right hon. Member for Blaby (Mr. Lawson), who was appointed Chancellor of the Exchequer. I suppose that that was only fitting, because the right hon. Gentleman is a true believer in the religion of inequality. He is, indeed, an ideologue. He is a constipated intellectual in that particular creed. We can look forward to the full implementation, with a new zeal, of the Government's policies, with all the dread that that must hold out, especially since, by comparison with the Chancellor of the Exchequer, the newly appointed Secretary of State for Foreign and Commonwealth Affairs was something of a moderate when he held that office.
There have been some disappointments. Mr. Paul Johnson was given absolutely nothing. I suppose that if there were any justice in this world, Sir Woodrow Wyatt would have been given a peerage. Their lack of reward must have been due to something that they did or said. It is difficult to imagine exactly what it might have been because there was scarcely an opportunity for obeisance that they left disregarded at any time over the past five years. Their full inventive skills will now be properly tested in defence of a Government who begin their new reign with this Queen's Speech.
This is more a declaration of war than a Queen's Speech, especially on those who have especial need for publicly provided health, welfare and education services. It is a mixture of selling out and wiping out. It is a further chapter in the Prime Minister's resolute determination to lead us back to pre-Churchill Toryism. If it is considered in a slightly different context, it is yet another phase in the movement away from the welfare state towards the warfare state.
§ Mr. Kinnock
That is borne out by an assessment of the current public expenditure proposals of the Government. Taking defence expenditure as 100, expenditure in 1978–79 on education was 107. It was 99 on health, 62 on transport, 40 on industry and 46 on housing. By 1984–85, according to the Government's proposals and again taking defence spending as 100, the Government will be spending 76 on education, 88 on health, 46 on transport, 20 on industry and, due to a horrific cut, only 18 on housing. It is against that background that we should consider the Queen's Speech.
Education should be of especial interest to us all. The Queen's Speech states that the Governmentwill pursue policies for improving standards of education and widening parental choice and influence in relation to schools. 362 Legislation will be introduced to enable grants to be paid to local education authorities in England and Wales for innovations and improvements in the curriculum.There is a great need for the improvement of standards and the widening of parental choice. There are still 132,000 primary schoolchildren in classes of more than 35 pupils. According to Her Majesty's inspectors—I quote from the report that they published last year—it is unlikely that existing standards of numeracy and literacy will be maintained (in primary schools) if the cuts continue.The HMI and everyone else report a severe deficiency in the quality and quantity of essential textbooks in schools. Laboratories and workshop facilities and teaching have been significantly reduced as a result of cuts. Modern languages and craft design technology are among the subjects that the inspectors report have been removed from the curriculum in several secondary schools. That and much else was the result of only two years of Toryism. We have not yet had this year's report from the HMI. An assortment of excuses and reasons have been offered for its non-appearance. I presume that when we do see it there will not be a fortunate improvement in the news. No one has reported an improvement in levels of necessary provision and the Government, who promised to improve standards, will have some difficulty in explaining how they can make cuts and create great improvements, how they can make better bricks with less straw.
§ The Secretary of State for Education and Science (Sir Keith Joseph)
I am grateful to the hon. Gentleman for giving way. There can be no excuses for any delay in publishing the HMI report about provision for this year. There has been no delay. The report has not reached me. When it has reached me, it will be published. The Opposition are in a poor position to criticise on this subject since they did not publish that report themselves, so the Conservative Government published it. Furthermore, it is outrageous for the hon. Gentleman to claim that. book provision was stunted only during the life of the previous Conservative Government. Books were notoriously inadequate when the Labour Government slashed education expenditure, capital, repairs, books and the provision of teachers after the International Monetary Fund took over.
§ Mr. Kinnock
I am interested in the right hon. Gentleman's irritation by what he calls the slashing and the monstrous acts of the Labour Government. I could share his irritation, but I would find him more convincing if, instead of trying to persuade us that matters were not satisfactory at a Labour Government level of expenditure, he explained how they are better at the Tory Government's reduced levels of expenditure. Has the right hon. Gentleman invented some new law of arithmetic?
§ Sir Keith Joseph
Since the Labour Government left office, there have been 10 per cent. fewer children in our schools, against which we have cut the number of teachers by substantially less. The hon. Gentleman seems to forget that.
§ Mr. Kinnock
I do not forget that. Neither do I forget that HMI has been compiling reports since 1977. In 1980 it told the Select Committee on Education and Science that it was so disturbed by the deterioration in the circumstances in our schools that it had taken upon itself the task of publishing its assessment of the impact of 363 public expenditure cuts on education. If the right hon. Gentleman does not believe me, I refer him to the evidence afforded to the Select Committee by Miss Sheila Brown.
§ Mr. Kinnock
I really must get on. I am sure that the right hon. Gentleman will have an adequate opportunity to reply and to try and rebut the truth on many other occasions. [Interruption.] I have nothing to withdraw. I was referring precisely and accurately to what Sheila Brown said.
§ Mr. Kinnock
My current difficulty means that I must be more courteous than usual. Nevertheless, I shall remain as insistent as ever.
We have seen a reduction under the Conservative Government of parental choice, not an increase. We have seen the closure of nearly 600 schools, many without adequate educational justification. We have seen the essential choices within schools being lost as the curriculum was narrowed as a consequence of cuts, and we have seen the much-vaunted parents' charter—section 6 of the Education Act 1980. But preferences can be denied if the preferred school is selective or if the granting of a choice would prejudice the efficient use of resources. There has not been an increase in effective choice so what can the promise made in the Gracious Speech be about? It was originally about the voucher system but that has been dropped. The Prime Minister told the Daily Express on 15 June that that scheme simply cannot operate. What we now have is what The Times Educational Supplement called "son of vouchers", which is the open enrolment system. That scheme is said to attract the Secretary of State intellectually, which must be a way of cancelling its validity to begin with. Open enrolment is the application of market forces to school places in a system that allows oversubscription for some schools while allowing others to decline. It is a supermarket system with a corner shop budget.
I am sorry that the Under-Secretary of State for Education and Science, the hon. Member for Dartford (Mr. Dunn) who will be in charge of this matter, is not present. The hon. Member is especially well-suited to manage the open enrolment system as he used to be a buyer in Sainsburys before he gave up work and became a Member of the House. The hon. Member is further well qualified to deal with the open enrolment system as he represents a Kent constituency. Kent has been using the open enrolment system since September last year. It is an unmitigated disaster. Hon. Members need not take my word for that but need only read the report that has been compiled by the chief education officer for Kent, Mr. Barnes, which was submitted to the education committee on 13 June. It says:In the selective Judd School the planned admission limit was 90 and 117"—that is, 55 per cent.—of the 214 pupils who expressed first choices were accommodated through increasing the admissions by form of entry last year with the provision of extra mobile accommodation. The head teacher has expressed the view 'this year there is insufficient room on site for further mobile accommodation and any increase in admissions would need to be accompanied by the provision of additional accommodation off site.'364In the non-selective Huntley School the governors have expressed considerable concern at the impact of open enrolment on admissions to the school….The governors of Chatham, South secondary school 'having considered the consequences of the expansion of the school under open enrolment … are of the opinion, … supported by the Head Teacher, that it would be to the disadvantage of pupils within the school'.Similar comments are made by other schools involved. The Tory chairman of the education committee Mr. Bill McNeill, said that it would be an act of supreme folly to continue in that way.
Open enrolment, as opposed to the voucher system, is a very low-cost exercise".I suppose that the argument could be made that sapphires, as opposed to diamonds, are a very low-cost exercise, but that does not necessarily commend the necessity of buying precious stones.
As to the innovations and improvements in the curriculum that are promised in the Gracious Speech, the Secretary of State will have control of the £35 million that will be withheld from local education authorities. This is not new or additional money. Presumably, some of that will be spent on the Cockroft recommendations, some on the new technical vocational initiative, with all of its mixed blessings, and some on the purchase of Portakabins. That, probably, is the only industry or service that will derive any advantage from open enrolment.
The Secretary of State for Social Services spoke of the way in which the Government were seeking to protect pensions. The Government will have difficulty substantiating that claim. We know that single pensioners will be losing 75p a week and married pensioner couples will be losing £1.20 per week as a result of an uprating on a historic rather than anticipated inflation basis. The single pensioner will lose £39 a year— more than a week's pension — and a married pensioner couple will lose £62.40 per year, which is £8 more than a week's pension. I am speaking of people who cannot afford to lose anything, let alone the equivalent of more than a week's income in the forthcoming year.
Those on supplementary benefit suffer almost as much. The unemployed with children — I did not get a satisfactory answer to my question—will still be nearly £2 a week worse off in real terms than they were in 1979. Since the abolition of earnings related supplement, newly unemployed people are worse off by as much as £17 a week—a huge amount for people who must live on such incomes. Instead of at least giving the long-term unemployed long-term supplementary benefit rate, at press conferences and on other occasions, the Prime Minister has spoken of cutting the dole in real terms to deal with what she calls "the unemployment trap".
The prospect grows more ominous for all beneficiaries and all who use the welfare services. The Government's current public expenditure plans assume a growth rate of 2½ per cent. According to the then Chancellor, that assumption was based onan expansion of the private sector encouraged by reductions in interest rates"—that is the earliest laugh of this Government—and in taxes".That is a fantasy. It will not happen. The Prime Minister already has her alibi prepared. Indeed, it was repeated today by the Secretary of State. Three times in six column inches of last Wednesday's Hansard, the right hon. Lady said: 365The welfare provision that we all want can be provided only through industrial and commercial success". — [Official Report, 22 June 1983; Vol. 44, c. 59.]
§ Mr. Kinnock
The hon. Gentleman says, "Hear, hear". Even to minds more intelligent than his, it sounds like a reasonable equation, but we know that it is a preemptive excuse from the Prime Minister. It is an alibi. In the past four years the Government have presided over 34,000 bankruptcies; a 20 per cent. reduction in manufacturing output; a 36 per cent. fall in manufacturing investment; a trade deficit in manufacturing goods for the first time in British history; and as a result, a loss of profits, high interest rates, an overvalued currency and an actual fall in the gross domestic product of 3 per cent. Therefore, we shall not get from this Government an increase in growth over the next three Dr four years of 2.5 per cent. The Prime Minister knows that there will be no such growth rate. She will be very lucky if she presides over a country that experiences a growth rate of 0.5 to 1 per cent.
If that is the case, we shall either have a huge increase in the PSBR, which the Government say they absolutely refuse to accept; a huge increase in taxes of anything up to £15,000 million; a huge cut in welfare state provision, including cuts in benefit provision; or bits of all three, which I suspect will be the case. The Government cannot finance their own public expenditure proposals on the basis of even the best anticipated growth rate, given their restrictive policies and graveyard economics.
The nightmare is turning into reality, and the knowledge that that would occur is what made the former Chancellor say in the Treasury documents leaked from the soon to be abolished Think Tank:We must find new ways of permitting some of the demands to be met"—that is, demands for benefits, welfare and health—both by encouraging people to make extra provisions for themselves, at least at the margin"—that is an interesting phrase, because the Secretary of State used it three times in his speech today—and by finding ways in which those extra services demanded can be supplied without burdening the Exchequer. We must consider the extent to which we are denying ourselves room for manoeuvre by past pledges and commitments.Against that background, the vapid phrase in the Queen's Speech:Further action will be taken to ensure that patients receive the best value for money spent on the National Health Service",takes on a new menace.
It is all elegantly decorated with the language of patronising compassion, of which the Secretary of State is now an accomplished master. It is all disguised by the cosmetic vocabulary of "choice". However, when we know that the Government grossly fiddled the Health Service figures last year and that they do not really believe in anything more than a rudimentary "safety net" service, we know that "value for money" for patients really means fewer resources and less care. We do not have to rely on Think Tank leaks, rumours or guesswork to know that, because the 1983 Conservative manifesto promisedcloser partnership between the State and the private sectors, in the exchange of facilities and ideas in the interests of all patients".The Secretary of State has already referred to the draft circular sent out earlier this year to regional health authorities entitled "Co-operation between the NHS and 366 the private sector at District level". It contained many suggestions, and the House should again be reminded of them. The first was that districts could put patients, especially elderly patients, in private hospitals and nursing homes, soenabling more effective use to be made of total resources".It offered the idea thatHealth authorities could make use of independent sector capital by arranging for private companies to provide facilities which the authorities could contact to use … Authorities could use private high-tech equipment and laboratories and seek private sector help in acquiring equipment for NHS hospitals".A further suggestion was that private hospitals could use NHS facilities and servicessuch as the provision of radiology and pathology".The circular added:Such arrangements offer a useful way of avoiding wasteful duplication of support services between the two sectors … Health authorities could sell land… Pay-bed wards could be improved by seeking donations from the private sector"—once again, a flag day Health Service. It also said that pay beds could be—managed for a fee by the independent sector"—that is very nice—or that wards could besold to the independent sector, which would run (them) outside the NHS but would be guaranteed access to the main hospital facilities".It is an utter disgrace that that should emanate from someone who should choke on the very words with which he concluded his speech about his commitment to the NHS. He is not a dull man and must know that if we so undermine the Health Service by the installation of such propositions, we reduce its strength and flexibility, withdraw resources and demolish the status of and confidence in the NHS by running alongside it a pay system that sponges off it and, indeed, could not survive without it.
That is exactly why the former Chancellor had to say that the Government wanted new ways of permitting some of the demands for health care to be met by encouraging people to make extra provision for themselves, at least "on the margin".
Can Conservative Members really imagine what that means? The geriatrics will become popular for the first time ever, especially with the private sector, because they carry money with them. They will be for sale. They can be farmed out to the private nursing homes and to private hospitals. They will be a guaranteed supply to the bed sellers. Radiology and pathology facilities will be for hire, in a hospital service that is under pressure from cuts. Hospital administrators will have to say to medical and paramedical staff, "You must give precedence to the application from the private sector for the use of your facilities because the money that you can earn by so doing is the difference between life and death for our hospital. You will have to sell your services".
Hon. Members should also imagine hospital facilities being diverted to service private wards to raise necessary money. The Secretary of State will make his bid for the hospital budget and the Chancellor of the Exchequer will respond according to what is necessary to provide a rudimentary service plus an estimate of what the NHS hospitals, laboratories and facilities can raise by selling to the private sector.
We know what the partnership that the Tory manifesto, so glibly promised, means. BUPA is giving St. Thomas's hospital 1.05 million over five years to buy and maintain 367 a machine that dissolves kidney stones. The agreement is that, in return, one quarter of the use of that facility will be for private patients.
However, according to the right hon. Gentleman's Department's estimate, the NHS must bear £5.5 million costs that are additional to the original £1.05 million. That is some partnership. BUPA pays 18 per cent. of the cost and gets 25 per cent. of the use whereas the NHS meets 82 per cent. of the cost and gets 75 per cent. of the use. There would be no possibility of BUPA making such a provision were it not for the general environment provided by a public health service and the NHS providing the great bulk of the money.
In spite of that, BUPA is not doing all that well. According to its annual report, registrations this year are down 14,000 because of a fee increase in 1981 following a trading deficit. That, at least, is what Lord Wigoder reports. He is the chairman of BUPA, a Liberal peer, of course, who earned £16,000 from his operations last year. He is bound to believe in private health care at that type of rate.
The so-called partnership works in other ways. The promotional brochure for a private hospital that is to be built next to University college hospital, London, says:The private sector would gain a high quality new private hospital, with the back-up availability of the full resources of a major teaching hospital. For a private hospital the availability of sophisticated supporting services and skilled staff within University College Hospital would provide a range and quality of services which are not generally available in private hospitals and which probably could not be provided by other means.The Tories call that partnership. I call it parasitic.
§ Mr. David Crouch (Canterbury)
The hon. Gentleman probably knows that I am closely associated with BUPA's expenditure propositions in St. Thomas's hospital. Will he bear in mind that there is no such equipment in Britain and that the only example in Europe is in Munich? To have that equipment installed for a little over £1 million will provide for National Health Service patients to the extent of 75 per cent. of the use. That is not ungenerous. The alternative would be for the revolutionary treatment, which is known as lithocryter, to be available only in Munich and for the NHS to have to consider sending patients there rather than to St. Thomas.
§ Mr. Kinnock
I know what £1 million is—it is one two hundred and fifteenth of what the Government propose to spend on the new runway in fortress Falklands. If the Munich machine is the only one in Europe, why cannot the Government provide the extra £ 1 million? I entirely agree with the hon. Gentleman that it is a marvellous advance, would be a tremendous asset and, ultimately, what a cost saver it would be. Why cannot the Government find the £1 million?
I remember reading the Prime Minister's view about relationships and partnerships in the NHS in an interview with Hugo Young which was published in The Sunday Times in February. It was peculiar, as she talked about Harold Macmillan and "Winston", as she calls him. She said that we were all brought up on their belief that there must be a safety net and a ladder. That is a misinterpretation of what the late Sir Winston Churchill had to say on the subject, but I was not brought up on that, anyway. I knew from a relatively early age that if the safety net was too near the ground it was useless. If access 368 to the ladder is dependent upon the ability to pay, it is a taunt not an escape from difficulty. Mr. Young asked whether the private system does not take scarce medical resources and doctors away from the NHS.
Oh, no."—said the Prime Minister—If you have extra demand coming up you'll have extra jobs … extra demand for doctors and for nurses".The Prime Minister obviously believes that the problems of health care arise because there is not enough demand — that there are not enough sick people. Millions disagree with her. There are millions of people who wait in prolonged pain because they cannot get a place. There are many more people who are members of their families who share their anxieties and endure the consequences of unemployment as a result of sickness. They grow increasingly irritated at the idea that they must wait. Moreover, they know that if they could pay they would not have to wait months, or, in some cases, years but that their wait would be reduced to weeks.
Those people are no more envious of the advantaged than the Labour party's attitude is generated by envy. Our attitude is generated not by envy but by pity for the disadvantaged many in such a system and by the knowledge that we shall not achieve proper provision for all—that must be the objective of a health service—as long as access to opportunity and care is narrowed by the ability to pay and liberty is measured by the size of the wallet, as it demonstrably is under the present type of Government.
I hope that I can persuade some Conservative Members to agree about that. I am ill-equipped to get them to agree. I might be among those who are least welcome to try to get them to agree. Nevertheless, I hope that they can open their minds to it. What I am trying to persuade them of is not futile or underwater hang gliding. However much they might try to avoid the contact, they know that, in their surgeries and elsewhere, in the next few years, they will meet more people who are being pushed into poverty by Government policies. Many Conservative Members are active in this regard. They will meet more of the sick who are being required to bear their pain and they will meet more of the homeless, the disadvantaged and the unemployed because their numbers are multiplying and will multiply.
Conservative Members should know that they will not be convincing if they tell those people that they should bear up, be self-reliant and make extra provision for themselves. That would rightly generate outrage. I do not put that point to Conservative Members out of sentimentality. I think that they agree that the fit have a primary duty to care for those who are not fit, that those of us who are strong have a primary duty to care for the weak and that those who are young have a heavy moral obligation, that we must discharge, to look after the old. We should undertake that obligation without hindrance, embarrassment, diversion or lack of will.
I think that both sides of the House agree about that in general. The real issue is not whether we aspire to such decency and charitable feelings as human beings but what we intend to do about them. Is there to be a gamble on philanthropy and chance, with all the risks, dangers, conditions and condescensions that go with philanthropy, or will we try to provide a dependable equity of organised compassion as a means of efficiently and justly organising our best feelings as human beings? That is the choice 369 between us. For me, it is a matter of philosophy, conviction and experience. That may not be true for Conservative Members but I appeal to their sense of utility, efficiency and justice to require them to refuse to endorse the actions of a Government that are deliberately cutting; to refuse to endorse the actions of a Government who are deliberately undermining the National Health Service; to refuse to endorse a Government who are deliberately withholding a week's pension from the poor elderly. They should refuse those endorsements, withdraw their support, rebel, stand on their own feet, and stand up for their constituents. They should do all that, regardless of their politics, as a demonstration of the integrity required from democratic representatives.
§ Mr. Speaker
Order. Before I call the first of the Back Bench speakers may I thank and congratulate right hon. and hon. Members who have taken inn in the debate on the Queen's Speech so far. No fewer than 55 Back Benchers have been able to speak, including 13 maiden speakers. Today I have a long list of right hon. and hon. Members who wish to catch my eye—no fewer than 23, of whom seven wish to make their maiden speeches. Hon. Members can do their own arithmetic. I appeal to them to speak briefly, please.
§ 5 pm
§ Mrs. Jill Knight (Birmingham, Edgbaston)
When I listened to the speech by the hon. Member for Islwyn (Mr. Kinnock) I was not in the least surprised that Labour lost the election. The hon. Gentleman made a speech with a great deal of froth, particularly from the mouth, but with few facts. I welcome the fact that he has started to care about people waiting for hospital treatment. This is the first time that he has displayed that care. He expressed not one word of pity for the people who waited patiently for weeks in great pain for hospital treatment when the cause of the delay was the strike by National Health Service workers. He expressed not one word of pity for the people who waited for hospital care under a Labour Government. Conservative Members do not measure the degree of their pity by what causes the trouble.
I welcome warmly in the Queen's Speech the words:Further action will be taken to ensure that patients receive the best value for the money spent on the National Health Service.The Opposition never seem to get their thinking up to date.
I confidently expect that an hon. Member entering the House afresh, to represent the Labour party, will introduce a Private Member's Bill regulating the trapping of dinosaurs or the preservation of dodo eggs under the Wildlife and Countryside Act. It is time that the Opposition came up to date.
Until recently the one sustained demand has been for more and more money to be spent on the National Health Service. That is all that the Opposition have had to say about the Health Service. Never, until the last year, did anyone seriously question or suggest an inquiry into how money was being spent.
I congratulate my right hon. Friend on setting up the Griffiths committee earlier this year. I have spent some time examining the way in which money is spent in the National Health Service. The more I look, the more examples I see of money that should be available for patient care being frittered away, legally and illegally, through the leaky sieve of lax and week monetary control.
370 Last November the British Medical Association, in a letter to all regional chairmen, stressed how essential it was that all resources available to the service should be effectively used. How splendid it would be if the Opposition joined in that call. The BMA said that consultants should exert pressure for the utmost economy in administration and in the provision of support services. By that it meant hotel services, building and maintenance. The BMA stressed the need to use drugs better There is not time for me to go into the argument about generic drugs, although it is important.
The BMA talked about the misuse of disposable equipment, and about beds and theatres. The hon. Member for Islwyn mentioned path labs and radiological labs. The BMA said that its investigation departments could and should be administered better and that if that happened a considerable amount of money would be saved for patient use.
The quality of care for patients must be the first priority. I know that that is what my right hon. Friend the Secretary of State believes, but there is a wide variation in the throughput of similar work in different hospitals which must be examined. Why can a patient requiring a varicose vein operation be dealt with so much more quickly—and just as successfully—in some areas than in others? The Southampton district authority is remarkable. It leads the way in day surgery. In that authority's area about 8,000 patients a year—perhaps more—have an operation and return home in one day. It is estimated that even that could be improved upon.
The argument that day surgery merely transfers the cost and care burden to the community medical services is, said the BMA, false. It said that it is rare for a day surgery patient to have to consult a GP about post-operative problems. Although community nursing services have to be used to change bandages, and so on, that would have to be done in hospital anyway. The current cost of a bed in. an NHS hospital is about £114 a day. If a patient is sent home within a day a tremendous saving is made for the National Health Service. It is also better for patients. I have never met a patient who would not rather go home than stay in hospital.
The savings for the Southampton district amount to about £1 million a year. That authority is only one of 72. It seems possible, therefore, for £72 million to be saved by a more effective use of the one-day system. Many other areas in the National Health Service are ripe for cost cutting without bad effects on the patient. Such savings will help patients because they will free more money for equipment and care facilities which patients badly need and for which they have to wait.
Over-prescribing applies not only to GPs. The worst examples of over-prescribing take place in the hospitals where there is a great deal of over-administration. We are always hearing how the ratio of chiefs to indians is wrong. There are endless examples of bad management in relation to building and maintenance. I heard of new terazzo theatre floors in two hospitals having to be relaid three times because of material and construction faults. The refurbishing of wards, the building of hospitals and the construction of kitchens invariably take far longer and cost more than planned. I wonder how the private sector can decide on the site of a new hospital and open its doors eight months later. There must be something that we can learn from it.
371 Pilfering is a serious problem in the Health Service. Only today some trenchant comments were made by NHS security officers about pilfering. Just before the election a conference of security officers within the NHS drew attention to the £7 million worth of food which has been stolen from kitchens. Sides of beef, sugar and all the other things that just walked out of the hospital add up to £7 million. There are endless examples of sheets, towels, clothing, kettles and anything movable being stolen, but nothing is done.
There are two other matters on which I hope that my right hon. Friend is in touch with the BMA. As one who laboured long in Committee on the daintily named Health and Social Services and Social Security Adjudications Bill [Lords], I join the BMA in pressing for an answer to whether the jettisoned provisons of the Bill are to be salvaged and refloated. There is nothing in the Gracious Speech about that. In particular, what is to happen to the family practitioner committee? Primary health care is probably the most cost-effective part of the NHS, and expansion will benefit patients and reduce overall costs. However, effective planning will not be possible until the change in the Bill is made. In Hansard of 11 May 1983, c. 878, a promise was made by my hon. and learned Friend the Minister of State on this matter. I hope that we can have some information today.
Secondly, while my right hon. Friend is having talks with the BMA, will he remonstrate on its recent disgraceful ruling that doctors who tell the parents of young children that their daughters are on the pill or have had an abortion will be struck off the medical register, unless the girl agrees to her parents knowing? This is monstrous. There must be many hon. Members who have daughters as young as 12 or 13. Do they think it right that, if their daughters are prescribed contraceptives or have had an abortion, they should have no rights, as parents, to be told what has happened to their child? It is not only contraception and abortion, but treatment for alcoholism, drug addiction, glue sniffing and so on, about which parents should know. Many hon. Members on both sides of the House will feel strongly about the new ruling by the BMA. I hope that my right hon. Friend will have a word with the doctors about this matter, which is worrying many people.
§ Mr. Mark Fisher (Stoke-on-Trent, Central)
Thank you, Mr. Deputy Speaker, for giving me an opportunity to make my maiden speech in this debate. Last week, in apportioning subjects for discussion on particular days. Mr. Speaker, somewhat to my surprise, described today as the day for discussing the "attack on the welfare state". I agree with this description, and the Gracious Speech, taken together with what the Secretary of State has seen fit to say today, makes it clear that there is an attack. The effects of this attack can be seen in Stoke-on-Trent, the Central division of which I have the privilege to represent.
My predecessor, Bob Cant, worked tirelessly in this House for 17 years for the people of the Potteries and for that he was greatly and properly respected. In recent years, much of the work that he did was to try to protect the people of the Potteries from the curse of unemployment and to preserve their essential welfare services. In spite of 372 his efforts, these services, and particularly the Health Service, are today in a critical condition in Stoke-on-Trent.
For that reason, although I have worked in education for the past 10 years, I seek today to concentrate on the Health Service in the welfare state, and to challenge some of what the Secretary of State has said. North Staffordshire is now the most deprived district health authority in England. On the Government's figure, set out by the resource allocation working party, its revenue funding is 14.1 per cent. below target. In cash terms, that is £10 million a year less than we should be receiving.
However, it is the human terms that are important, not the statistics, because in any attack it is people who are hurt and who are the casualties. In human terms, that £10 million a year deficiency means old buildings, out-dated operating theatres, waiting lists for general and orthopaedic surgery, of more than 12 months, critical under-staffing in geriatric and psychiatric hospitals and — if one can believe this — only three ophthalmic surgeons for a catchment area of nearly 500,000 people. Such deficiencies are not fair on dedicated staff or on patients needing treatment.
I turned to the Gracious Speech in the hope of finding something that would address these problems. I found just one sentence:Further action will be taken to ensure that patients receive the best value for the money apent on the National Health Service.That is a sentence that could, at best, be described as open to interpretation. I was particularly interested to hear the Secretary of State's interpretation today. I was extremely disappointed by what he said because he seemed more intent on rehashing the tired arguments that the Conservative party put forward in the general election campaign than on offering anything positive for the future of the NHS.
The Secretary of State spoke of the private sector, although he talked little about the draft circular or about the practical application of privatising catering, cleaning and laundry staff. In north Staffordshire we are crying out for operating theatres and more surgeons. Are the Government seriously offering us privately washed sheets and privately cooked food as their solution for those deficiences? How will such fiddling around on the margins of Tory dogma help patients in desperate need of surgery?
I welcome what the Secretary of State had to say about private health insurance schemes and his undertaking that they would not be made compulsory. However, I was frightened by his emphasis of the word "compulsory". There are many ways of making the schemes more attractive than by compulsion. Those private schemes do not offer any value for money for the chronically sick or the mentally handicapped. I should be grateful if the Secretary of State would explain how the 27,000 people unemployed in Stoke-on-Trent at the moment are to find an insurance company that will give them cover when everything except basic services has been taken away by the Government, and how they could pay for such premiums even if they could find such a company.
The Secretary of State talked throughout about efficiency savings, but I refer him to the 1982 report of the Social Services Select Committee which says:'efficiency savings' are becoming a regular euphemism for 'expenditure cuts'.373 There is nothing in the Gracious, Speech or the Government's plans as outlined by the Secretary of State that offers any hope for a nationally fair service or for a service that is concerned with the health of the country. Value for money is all that the Government prize.
Of course value for money is important, but the NHS is already very cost-efficient. In north Staffordshire, the administration and management costs of our district health authority are just 3.9 per cent. of its budget. Nationally, the figure is between 5 and 6 per cent. European countries have administrative costs averaging over 10 per cent., so the public is already getting value for money from the money spent. The trouble is that the money spent is inadequate to provide equality of service. The Secretary of State knows this, and that the money is unfairly and unevenly distributed.
The Prime Minister is fond of telling us that public services such as the NHS are paid for by taxes and that we can only get out of them what we put in. That is patently not so. Why should we, in Stoke-on-Trent, pay the same national insurance contribution and the same taxes as everyone else, but receive £10 million a year less than our fair share of health care and resources? That is not value for our money. Such inequality is indefensible, and I should be interested to hear what the Secretary of State says when he makes a stab at explaining these inequalities. The Government could do something about this. That is what the resource allocation working party is for, but the Government do not appear to have the will to make it work properly or fairly.
I extend through you, Mr. Deputy Speaker, a genuine invitation to the Secretary of State, or the Prime Minister should she wish, to come to Stoke-on-Trent to see for themselves this value-for-money Health Service. The Prime Minister is said to be fond of 19th-century Victorian values. If she came to Stoke-on-Trent we could show her some of the best 19th-century Victorian hospitals in late 20th-century Britain. I should be glad to introduce the Secretary of State and/or the Prime Minister to some of the people receiving those services—patients suffering from pneumoconiosis and sillicosis from working all their lives in our two local industries, the Potteries and the mines.
One such patient is an old man of 78 who lives alone. His neighbours telephoned me in despair last week because he had been immobilised after a fall. He had to remain in a bed made up in his front room for a month, unable even to go to the lavatory. That happened because our geriatric hospitals in north Staffordshire are full and there is a waiting list of 480 for part three accommodation. That man received home help for just one hour a day because our county council cannot increase the provision for home helps, much as it wishes to, for fear of slipping still further into the Government's financial penalties for overspending. I invite the Secretary of State to come and tell those patients that they are getting value for money. The truth is that they are not getting value for money in resources, in fair distribution or in comparison with other countries in Europe.
The Secretary of State played around with national statistics. He did not mention that we spend 5.5 per cent. of our gross national product on health care—the lowest per capita of the 10 most developed countries in the world. In return, we have the fourth highest mortality and morbidity rate. That is a terrible record. How on earth does the Secretary of State explain that imbalance? Does he recognise that there is a relationship between low spending 374 and high mortality and morbidity? The best, indeed the only, value for money is good health care and that means real investment, not the phoney figures that the Secretary of State gave the House today, nor the Government's phoney growth which offers development money only if it is in part financed by efficiency savings. Only by real investment can our doctors respond to the real challenges of the future. The Secretary of State was right to mention demographic changes. Our population is getting older and frailer. He did not mention the challenge of new medical techniques or the changing priorities in primary and community health care—prevention rather than cure.
I ask the Secretary of State to reconsider that one sentence of the Gracious Speech, particularly the policies that appear to lie behind it. He said that he was giving us a commitment to the NHS. I shudder to think what his policies would be if he had any lack of commitment to it. If he will not change that sentence in the Gracious Speech, we shall oppose the Government until the British people see those policies for what they are — uncaring, inadequate, and, as my hon. Friend the Member for Islwyn (Mr. Kinnock) said, parasitic.
Britain has some of the finest doctors, nurses and health workers in the world. We have patients who desperately need medical treatment, not financial dogma. Labour Members will not sit silent while staff and patients are sacrificed to some kitchen accountant's idea of cutting costs. The Labour party created the NHS and we shall fight to preserve it.
§ Mr. David Crouch (Canterbury)
The House has been treated to a maiden speech of considerable strength and we are undoubtedly impressed by the approach of the hon. Member for Stoke-on-Trent, Central (Mr. Fisher). It is a relative innovation in the traditions of the House that an hon. Member should not be controversial in his maiden speech. It is not a tradition that I would necessarily support because uncontroversial speeches are rather dull affairs.
The House was interested in the passion shown by the hon. Gentleman in the subject of health. It is a passion which all hon. Members who speak on health in the House — there are many hon. Members present who do so regularly—share with him. We respect, too, the fact that he is a worthy successor to Mr. Robert Cant, who was such an interesting and stimulating speaker in all our debates, speaking, as he so often did, from the far corner and holding our attention with his genuine and original contributions.
There was something about the hon. Gentleman today that made me reflect that his father used to sit on the Conservative Benches, almost exactly opposite to him. He was a great friend of mine and of all hon. Members here. There was something in the hon. Member's passion today, although he would not want to admit it, which reminded me of his father, and which he must have picked up from him. He was a distinguished Member. We hope to hear more from the hon. Gentleman and I am sure that we shall. I am sure that our health debates will be greatly improved as a result of his concern about the problem.
I too, as the House knows, have a concern about the Health Service. This afternoon the Secretary of State and the hon. Member for Islwyn (Mr. Kinnock) referred to the welfare state. I wish that we could drop that phrase. We have grown out of talking about the welfare state. It is something much more important. There is something 375 belittling about the word "welfare". It suggests being in receipt of welfare payments—something that is handed out. It is much more important than that; it is a social provision. The welfare state has become no less than the provision of a just society and it is on that basis that I want to make some contribution to the references in the Gracious Speech to a just society and to the NHS in particular.
There is, of course, no question, as the Opposition hinted so darkly during the election campaign, of the Government dismantling the Health Service. It is nonsense for anyone to entertain such an idea. However, it is not nonsense to entertain the removal of a bad Health Service. That is something that I would subscribe to and which we must consider. It is the important duty of all hon. Members to remove what is bad about the Health Service and constantly to improve and reform it.
The NHS is costly and we are worried about that. Previous Labour Administrations found it costly and they had to introduce cash limits in the Health Service as well as in other Departments. In the past four years the Conservative Administration saw expenditure on the NHS increase enormously. It has risen from £7.75 billion to over £15.5 billion today. That is an increase well above the rate of inflation. It is an increase about 17.5 per cent. ahead of the retail price index. That is a measure of the Conservative party's approach to the provision of a just society.
We know too that the share of the gross domestic product of NHS expenditure has increased in four years from 4.7 per cent. in 1978 to about 5.5 per cent. in 1982. Those are real figures. However, 5.5 per cent. of GDP is still not an over-provision for a just society. It is one thing to be worried about cost—I accept that we must be and that it is our duty as the custodian of the taxpayers' contribution to Government, even in the provision of a just society — but it is another thing altogether to be concerned about the service and the provision of health care.
Britain is proud of the National Health Service. Even so, it is still inadequate and poor. It is easy to say that people should look after themselves more, take greater care of their families, and so on, but the Government and Parliament have a duty to provide a Health Service for society. To do so is no different from maintaining law and order by providing the police and the courts. It is no different from providing the roads and railways for transportation and it is no different from providing street lighting to prevent mugging and other problems in our inner cities. It is no different from the provision of sanitation, which is perhaps one of the great contributions to health provision in this country.
Health cannot be left to chance. The Health Service is part of living and part of a modern society. It is our responsibility as such to ensure that it is a good service. It is one of the main purposes for which we are here in Parliament. It is one of the main purposes for which the Government are here. We are not here to run a business in health to make profits. We are here to run a society—a health society.
There are still aspects in our society, particularly with regard to housing and health, that are positively Dickensian. When we were on the doorstep canvassing and seeing inside people's homes many of us were amazed 376 that today, with high standards of living, one still finds conditions that can only be described as Dickensian. I could take you, Mr. Deputy Speaker, into hospitals that were built during the Dickensian period and to which the hon. Member for Stoke-on-Trent, Central referred. We all know of such places. These are the matters that must be put right. There are the problems, too, in our inner cities, of inefficiencies in primary health care, of overworked GPs working on their own in inadequte accommodation, unable to give sufficient time to their patients. These are the problems to which we should be directing our minds because unless we solve those problems we shall not come out of the last century into an age when we feel we are providing a much better society for all.
Saving money alone will not remove those problems. Neither will spending more money necessarily remove them but we cannot turn our backs on the deficiencies and inadequacies that still exist in the Health Service. Yes, we have a duty to consider the costs and, as the Gracious Speech says, to see that we get value for money and give value for money in the Health Service to the patients. But there is much that can be done therefore to reduce costs.
We can reduce costs by really working at the problem of overmanning in the Health Service, particularly in our hospitals. We can work on the problem of over-provision, referred to by my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight), whose constituency, like mine, is one of the few that has not changed names. There are the problems of over-provision and hospitalisation — hospitalisation that takes place too readily. It would be much better to have a better primary health care and GP service, which could return us to the days of the family doctor caring for patients whom he really knew, seeing families growing up and looking after them, knowing their weaknesses, strengths and their problems, rather than too ready a remit to hospital. There is also over-provision in prescribing, particularly in drugs.
We need to see a much greater emphasis on effective health education—an area in which we can do much to reduce the cost of health to our society. Yes, I agree that there is an important place for private provision, for private health care, but I must give the House a warning about the private health service versus the National Health Service. I have worked in the National Health Service, in a regional authority, for almost 14 years. I should perhaps also declare an interest, as I have forgotten to do so. I am involved in the drug industry, as I think the House knows, but I will not touch on that matter this afternoon. I wish to warn the House about the problem of private medicine versus national medicine. I am not against private medicine. We should not discourage in any way the provision of a private medical service but we need to be careful about its effect on the National Health Service. Privatisation is not the answer to improving the National Health Service but it is an additional option that can be helpful.
My concern from my personal observation is about National Health Service consultants being tempted to offer a better service for a private fee. We must be aware of what is happening, sometimes in the front line of health. Consultants, like GPs, work under great pressure and must cope with queues of patients. They are not always able to give enough time for consultation and patients sometimes get a short interview — perhaps a few minutes. We should be seeking ways to improve the position by the education of GPs, doctors and consultants, by direction if 377 necessary by Health Service circular, by better facilities, by the keeping of better records and by the computerisation of records. But we must avoid the consultants saying that they can offer a better consultation to patients if they see them privately. I am not saying that this is a common occurrence but I have known it to occur and it fills me with serious concern. It does not matter on which side of the House one sits—this matter must be watched.
I know that my right hon. Friend the Secretary of State and my hon. and learned Friend the Minister for Health and all those who sit on the Government Front Bench would share equally my concern that nothing should be done in the introduction of wider private services to jeopardise the delivery of the most efficient service under the national scheme. I wish to avoid, as I know has happened in my recent experience, a surgeon saying that he would perform an operation personally if the patient would care to see him privately for a large fee but that if the patient did not see him privately that surgeon could not be sure that the patient would not be operated on by a student doctor. Those are the facts of life. That is why I say that it is one thing to consider costs; it is one thing to be a staff officer considering from Alexander Fleming house the costs and the disposition of the troops; but it is another thing to be at the front line. I am not at the front line. The people who are on the front line are the patients who see GPs and consultants. We have a duty as Members of Parliament to be sure that we really know the problems that exist in the Health Service as well as to try to improve the service and, as we all try, to get more money into the service.
I conclude by saying that what I have hinted at this afternoon is just a warning that that is not the type of closer partnership that I would wish to see. I know that no one would want to see such a partnership, but the danger does exist and the House should be warned. As we proceed to seek this closer partnership—the private service into the public service—we must be warned to ensure that the mistakes, the errors and the misbehaviour at which I have hinted do not creep in.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
I was interested to hear the defence put forward by the hon. Member for Canterbury (Mr. Crouch). The House is always interested to hear what he has to say, but he was echoing the speech by the Secretary of State and defending the privatisation of parts of the Health Service. Essentially, the Government are condoning the running down of the National Health Service.
I should like to comment on the speech of my hon. Friend the Member for Stoke-on-Trent, Central (Mr. Fisher) who made a powerful and excellent speech and one which I warmly welcome. My hon. Friend touched on something which affects the whole of north Staffordshire—the failure of the Government to redistribute resources to the poorer regions. Stoke-on-Trent and north Staffordshire have been suffering for years and the Government are failing to do anything about it.
I am glad to see the Minister for Health present because he knows that he has been told time and again about the failure to redistribute resources to underprivileged areas such as Stoke-on-Trent. The failure is the failure to pursue the recommendations of the resource allocation working party — RAWP for short. There has been no real 378 progress under this Government. The south has taken the cream of medical services and such areas as Stoke-on-Trent and North Staffordshire are deprived. I hope that the Minister can assure the House that something will be done. The doctors, patients and nurses are suffering.
I shall make a brief speech as I know that many hon. Members wish to make their maiden speeches.
I was struck by the omission from the Queen's Speech of any reference to the disabled. I was concerned at the Secretary of State's failure to respond to the intervention of my hon. Friend the Member for Islwyn (Mr. Kinnock). He did not reply to my right hon. Friend's question about the demotion of the office of Minister with responsibility for the disabled to Under-Secretary with only a part-time responsibility for the disabled. That is a grim augury for the future. The Under-Secretary will be responsible for families, ethnic minorities and the disabled. That is outrageous. I am not making a personal attack on the Under-Secretary. The Secretary of State twisted my hon. Friend's remarks, but my hon. Friend made a legitimate point. The Secretary of State said that the Under-Secretary was a fine fellow, but that is not the point. We all agree that he is a fine fellow, but he cannot do a part-time job looking after ethnic minorities, families and Britain's 4 million disabled people. The job of dealing with the disabled should be undertaken by a full-time senior Minister. I hope that the Minister will comment on that point when he replies. It shows the Prime Minster's attitude — it is a curt and dismissive gesture to the disabled.
What could the Queen's Speech have proposed for the disabled? It could have said that the Government would introduce a comprehensive disability income— not all at once, but phased in based on the severity of the disability. It should include a cost allowance. There is no mention of such a scheme in the Queen's Speech. There should be an end to the discriminatory household duties test which is depriving married and cohabiting women of their pensions. It is outrageous that they should be so deprived.
The Queen's Speech could have said that there would be a specific allocation of funds for the disabled in the rate support grant. Without such an allocation money is spent on all sorts of other matters rather than on the disabled. It could have said that there would be full implementation of the Chronically Sick and Disabled Persons Act which is being evaded by many local authorities. It could have said that there would be adequate resources for the care and community schemes and also cash support for the carers—those who care for the disabled. There should be an extension of the invalid care allowance to married and cohabiting women. All those matters are important, but none of them was mentioned in the Queen's Speech. We should discuss those issues in this House.
I wish to raise specific issues connected with the disabled. The figures for unemployment among the disabled are horrific. Last year 17 per cent. of the registered disabled were unemployed, 76,134 people. The percentage of the total work force unemployed for more than one year was 28 per cent., but for the registered disabled the rate was almost twice as high at 54 per cent. Only 32 per cent. of employers complied with the quota scheme, which shows that there is a massive failure by employers to accept their mandatory obligations. It is disgraceful that the Government have not pursued a single prosecution of any employer, even though they are 379 breaking the law by not fulfilling their quota and by taking on fit and able people instead. If anyone breaks the law he should be prosecuted.
The disabled need legislation to outlaw discrimination. Anyone who is severely disabled knows that discrimination against the disabled is rampant in Britain today. Despite the progress of recent years, there is monumental thoughtless and wilful discrimination which extends to jobs, services and recreational facilities. It is deplorable that such incidents as the Teignmouth disaster should occur in the 1980s. The people of Teignmouth should be ashamed of themselves for treating the mentally handicapped as they did.
It is disgraceful that some people in the long stay mental handicap and mental illness hospitals are still living in 19th century conditions. They are denied choice, privacy, personal property, informed consent to medical treatment and freedom from degrading punishments. Such people would benefit from legislation outlawing discrimination. It is regrettable that the previous Minister with responsibility for the disabled spoke against the Bill that I introduced to outlaw discrimination. I introduced the Bill not because it was my idea, but because it was suggested by the committee on restrictions against the disabled under the chairmanship of Peter Large. The committee produced a marvellous report. The Bill was reintroduced by the right hon. Member for Western Isles (Mr. Stewart), but the Minister still spoke against it.
That measure, and the other measures that I have outlined, could transform the lives of the disabled. I hope that Back Benchers, and especially the new Back Benchers, will fight the Government's refusal to support such legislation. I am sure that Labour Back Benchers will support my right hon. and hon. Friends on the Front Bench and demand a fair deal for the disabled.
§ Mr. Roy Galley (Halifax)
My maiden speech will, I hope, be somewhat less controversial than that of the able and hon. Member for Stoke-on-Trent, Central (Mr. Fisher), but I hope that it will not be too dull. It is a great privilege to be the first Conservative representative for Halifax since 1964. My predecessor in that role was the right hon. Member for Surrey, South-West (Mr. Macmillan) whose long and distinguished service in this House as the right hon. Member for Halifax and for Farnham is well known to all. He and his wife are still regarded with great affection by many people in Halifax today.
Halifax prospered as a textile town during the industrial revolution and became known to many as the imperial capital of Yorkshire, not least because it was a major centre of the brewing industry. It was also the place from which the building society movement was founded. Employment today, while still including textiles, brewing and the building society, is more diverse and the town is gradually adapting to the needs of the modern age. Its fine Victorian centre, combined with its industrial past, provide a heritage of which we in Halifax are greatly proud. The surrounding countryside is some of the best in Britain and I commend it as an excellent centre for a holiday.
Recently the constituency has had the additions of the townships of Southowran, Shelf and Sowerby Bridge. The 380 area of Shelf was formerly in the Bradford, South constituency. The hon. Member for Bradford, South (Mr. Torney) who previously served the people of Shelf, is currently recovering from illness. I am sure that the House will join me in sending him every good wish for a full and speedy recovery. The town of Sowerby Bridge also has an ancient history and heritage. It is a place of enormous potential. It was formerly represented by my hon. Friend the Member for Calder Valley (Mr. Thompson) and I am delighted that he has been returned to this House with a large majority which is more appropriate both to his ability and his girth.
Finally, in these tributes I wish to mention the previous Member for Halifax, Dr. Shirley Summerskill. She served Halifax for 19 years and was a respected Member. We owe her a considerable debt of gratitude. She was greatly concerned with questions of health and social services and it is appropriate that my maiden speech should be on those subjects.
In contrast to some of the comments which have been made by other hon. Members today, it gives me pleasure to say that in Halifax and the surrounding area during the past four years there have been considerable improvements in health and social services, and we are soon to have a major new hospital costing £8 million. I am delighted about that.
Reference is made in the Gracious Speech to achieving the best value for money in the National Health Service, and that includes the possibility of examining the use of private enterprise for laundry, cleaning and catering services. In that respect, the Calderdale health authority, which serves my constituency, has been in the forefront. The use of commercial services, instead of major capital investment in a new NHS laundry, is under active consideration. It may be that, when all the relevant factors have been taken into account, commercial contracts will not be entered into. But the very least that the exercise will have ensured is that a full appraisal will have been made of all available options, rather than taking what was previously considered the obvious course of action, that of investing large sums of public money in a new laundry. Several novel ideas are being considered. The overall object is to achieve value for money, whether by using private contractors or by using public money more effectively. That can only be to the good and provide more money at the end of the day for patient care. Being a Yorkshireman, I am concerned about value for money, as are the people of Halifax, who, to use the vernacular, recognise that one cannot get owt for nowt.
If substantial savings in other areas—such as local authority refuse collection services—can be taken as a guide, savings in the NHS by using contractors for services or by the more effective use of public funds could save about 20 per cent., or £160 million, which would then be available for patient care. Economies of that scale have resulted both from local authorities using private contractors and by the tendering procedure in effect bringing to light in-house savings.
On the broad issue of care in the community, coming from an area where the aging population is a particularly high percentage of the total, I am acutely aware of the problems of the elderly. It is obviously right that we should care for as many of the elderly as possible in the community for as long as possible, and I welcome the expansion locally and nationally of the home help, warden, meals-on-wheels and other services. The very 381 sheltered housing concept, if handled wisely, can also make a major contribution, but there will always be a need for residential and hospital accommodation. Care in the community needs a balanced approach and we must take care that, though soundly based, the policy does not result in some old people staying in the community when they should be in a hospital or a home.
I am sure that my right hon. Friend the Secretary of State for Social Services fully recognises the vital role of the voluntary sector in providing services for the elderly and other groups. Hopefully the voluntary organisations will he fully involved in services for the elderly as with other groups, because often it is the voluntary services which are able to respond more flexibly and are more in tune with individual needs than are the statutory services.
In that respect, private nursing homes have a part to play. In my constituency we have several homes with a high standard of professional management and nursing care. Local authorities should not, as they often tend to these days, refuse to make use of such local homes when considering the available options for the care of the elderly.
As for funding arrangements for caring in the community, local authorities' social service departments will he taking a much greater burden and that will need sound and longer-term financing. It will mean the increasing and more flexible use of joint funds and the transfer of funds in some cases. Hopefully, schemes will have a long-term financial base which will not be in question so that health authorities, local authorities and voluntary organisations will be able to plan on a firm footing.
I wish to thank you, Mr. Speaker, for calling me to speak. I wish also to thank the staff of the House for the courtesy which is shown by them to all new Members. It is very much like one's first days at a new school or college. Their unfailing kindness and courtesy has made a firm foundation for me and many other new Members. I hope that I shall be able to build on that and represent fully the interests of my constituents.
§ Mrs. Renée Short (Wolverhampton, North-East)
In all the time I have been in this House, which is a year or two now, I have never had the opportunity to congratulate a maiden speaker, and it is with great pleasure that I do that today. The hon. Member for Halifax (Mr. Galley) has obviously dug himself into his new constituency. He understands some of the problems and, as he explained, he represents an interesting and nice part of Yorkshire. I am sure that all hon. Members will have been impressed by the caring speech that he made and look forward to hearing him when he is next fortunate enough to catch Mr. Speaker's eye, and I warn him that that may take quite a time to happen again. We all suffer from that.
I also thank my hon. Friend the new Member for Stoke-on-Trent, Central (Mr. Fisher), who is an old friend of mine. We have worked together on party committees, particularly the working party that produced our policy for the arts, of which he was a valued and well-informed member. It was a great pleasure to work with him.
While I am in a thanking mood, I should also like to thank my hon. Friend the Member for Islwyn (Mr. Kinnock) for his excellent speech. It was an absolutely splendid speech—one of the best speeches on Health Service matters that I have heard from ether side for a long 382 time. If I may prescribe for my hon. Friend, I think that, unless he rests his vocal cords for at least a month, he will not be able to make any more speeches.
My hon. Friend's speech was in marked contrast to what we have heard from the Government Front Bench and what we heard from the Prime Minister during the recent election campaign. I must say a word about the election campaign. On the part of the Prime Minister and the Conservative party, it was a disgraceful campaign. They got back to power by bamboozling the people about their real intentions. The truth about the real state of the economy was withheld, but, now that it is too late, people are beginning to see it. A few days after the election, the mortgage rate was increased. People were not told about that during the campaign. The Prime Minister persuaded the electorate that we were on the right path and that things were getting better. She persuaded them that our problems were due to the excessive wage demands of those who were lucky enough still to be in jobs and to excessive social security payments to the 4 million that she had already put out of work.
The Government are determined to reduce public expenditure still further. What will be cut next? Will there be cuts in unemployment pay, in the level of social security benefit, in public service wages, or in the National Health Service? In due course we shall see where the axe falls. In their unprincipled election campaign, the like of which we have not seen in this country before, the Conservatives and the tame Tory press, with their torrent of phoney opinion polls, brainwashed the electorate into believing that there was no alternative to the Conservative party and the policies that it was offering.
In the face of the report of the Treasury and Civil Service Committee, which concluded that at least 50 per cent. of the jobs lost since the Tory Government took office were lost as a direct result of Government policies and had nothing to do with the crisis of international capitalism on which the Prime Minister placed the blame throughout the campaign, the lie was successful The people believed her—or gave her the benefit of the doubt. The well-oiled Tory party publicity circus, and the Tory press with its banner headlines giving alleged public opinion polls almost by the hour, did the trick. We now have another even more reactionary Government with an increased majority in the House, but with a reduced number of votes. The discredited Social Democratic party, with its irrelevant intervention in British politics, has much to answer for in aiding and abetting the return of this reactionary Government.
The British people will have noted the type of candidates presented by the Tory party — former members of the National Front, reactionary hangers and floggers, and those who support the contemptible comedian whose Tory rally cry was "Bomb the Russians." I have not noticed that the Prime Minister has dissented from that.
§ Mrs. Short
A very funny sense of humour—but the Prime Minister has no sense of humour.
My constituents in Wolverhampton, where there is nearly 20 per cent. unemployment, are being reduced to an ever-decreasing standard of living in an ever-worsening environment as the local authority finds itself unable to 383 replace or repair the housing stock and provide the services that people need. Some of our estates, with row upon row of boarded-up houses, are a most depressing sight, and a powerful condemnation of what has happened in the past four years. My constituents and people throughout the west midlands are contemptuous of the Prime Minister's gimmick of appointing the hon. Member for Coventry, South-West (Mr. Butcher), the Under-Secretary of State for Trade and Industry, to solve the problems of the west midlands. It needs more than one little man dashing around like a grasshopper from one town to another to resolve the problems that the Prime Minister has created in the west midlands.
During the campaign the Prime Minister repeated her claim that there were now more doctors and nurses in the National Health Service. We heard that from the Government Front Bench on several occasions before the election. Why then do we hear of patients left in wards at night with no senior trained staff on duty, and of off-duty sisters having to be telephoned at home when post-operative patients need drugs at night? Why do we hear of bed and ward closures, of hospitals closed because of shortage of staff and money, of growing waiting lists because of the shortage of beds and of consultants? We even hear of new hospitals which cannot be commissioned because there is no money to pay the new staff needed to run them. The Minister knows a thing or two about that.
Every medical conference now being held is anxious about unemployment in the profession. To their credit, the responsible bodies have turned down some of the more extreme demands to curtail the training of overseas doctors, to slash the entry of medical students into training or to provide dead-end non-consultant grades into which women and overseas doctors would be shunted in order to keep them quiet. They have supported the Select Committee's proposals for the appointment of more consultants. I do not know when that proposal will be implemented. Perhaps the hon. and learned Gentleman will tell us, if he replies to the debate. They have supported our proposals for better working conditions, for more patient care to be delivered by fully-trained doctors, for a proper retirement age for doctors and for a reasonable list for general practitioners. All these measures will help to provide jobs for the number of doctors at present unemployed. They urge the implementation of Greenfield, and they are appalled at the Government's cavalier attitude towards the considerable savings that could be made by the introduction of generic prescribing. Perhaps the Minister will tell us what is to be done about Greenfield. Why has the Secretary of State not accepted it? It is time that he gave us an answer.
The Royal College of General Practitioners has taken many of these matters on board. It is anxious to improve doctor-patient relationships. Is the Minister on the side of the Royal College, or not? Paediatricians have expressed their deep concern at the lack of trained staff to deal with distressed neonates. Before the election I raised this matter with the Prime Minister at Question Time, but I doubt whether she cares very much about the damage done to specialised National Health Service intensive care units, whose highly skilled trained nurses—all trained within the National Health Service—are being enticed away into the private clinics. I wonder what the Secretary of State is doing to ensure that all neo-natal intensive care 384 units are properly staffed. A private paediatric hospital was opened in London recently. That was the case that I put to the Prime Minister. In the glossy brochure of the hospital, 10 consultants were listed as directors. All those consultants gained their reputations and experience by working in the National Health Service. They are no good to the private sector unless they are consultants of some reputation who will, it is hoped, persuade patients to use the hospital. That is what it is all about. Of course, the directors, working within the NHS, are allowed under certain conditions to do some private work, for which they are well paid. Presumably they also get their directors' fees for attracting patients into the private paediatric hospital.
However, the British Paediatric Association has told the Secretary of State that four out of every 10 children's wards in this country are understaffed. At any one time more than one third of the wards are without trained children's nurses, and nearly half the country's children's wards are still below the minimum staffing level recommended in 1976 by the Court report. So let us not hear any more from the Secretary of State or the Prime Minister about the Government's magnificant performance. Theirs is a divisive class attitude, which seeks to encourage private medicine to the detriment of the NHS, and the people of this country will not stand for that.
The Gracious Speech states:Legislation will be brought forward to provide a selective scheme to curb excessive rate increases by individual local authorities, and to provide a general power, to be used if necessary, for the limitation of rate increases for all authorities." I emphasise the words "for all authorities".To my mind that is a declaration of war on those local authorities that will wish to provide care and services for the elderly, the handicapped and the young to replace those destroyed by Government cuts. That is a warning to all Members of Parliament, because I believe that some new Members of Parliament and some of those who have been returned again care about the Health Service.
My colleague the hon. Member for Canterbury (Mr. Crouch) made an interesting contribution. He and I worked together on the Select Committee and I hope that we shall work together again during this Parliament. There are Conservative Members who care about the NHS and the social services and I hope that they will take their courage in their hands, stand up to the Prime Minister and to the Chancellor of the Exchequer and ensure that proper resources are made available to carry out the obligations laid upon us in those two spheres, which are important to all our people. I hope that they will join us in ensuring that we have the type of NHS that we and the public—despite the way that they voted during the election—want to maintain.
§ Mr. Robert Hicks (Cornwall, South-East)
Like the hon. Member for Wolverhampton, North-East (Mrs. Short), I too congratulate my hon. Friend the Member for Halifax (Mr. Galley) on his excellent maiden speech. It was an extremely good contribution, and I am sure that the sincerity and knowledge that he manifested will endear him to his constituents.
In the last Parliament the central feature of the Government's economic strategy was the need to reduce inflation. I believe that that was correct, and the Government have undoubtedly been successful in 385 achieving that objective. There is no reason to believe that inflation cannot be contained at 4 to 6 per cent. in the foreseeable future, provided that we as a nation are sensible and prudent. However, although the immediate outlook for containing inflation is encouraging, I would respectfully point out to Ministers that, whereas a year ago inflation was probably the electorate's principal worry, the evidence not only during the election campaign but also beforehand was that unemployment specifically, and in more general terms this Government's approach to the whole structure and range of welfare services, had become the major economic and political issue in the country.
In that context, people in work are not only worried about their own job security, but are perplexed about the economic cost to the nation as a whole of having more than 3 million people currently unemployed. In particular, constituents are most anxious about youth unemployment and the job prospects of their children who will leave school during the next few years.
I appreciate that I am widening slightly the parameters of this debate, but it is important, on a day that has been allocated to a discussion of health and welfare and to the whole ambit of the welfare state, that we should bear in mind the needs and requirements of the unemployed. After all, as with other people, they are in need.
I appreciate that my right hon. Friend the Secretary of State for Employment is shortly to introduce his youth training scheme on a comprehensive scale. I hope that it will be both successful and effective, but there can be no concealing the fact that, although the scheme may improve the quality of training for our young people, disillusionment and frustration will soon set in unless there are real job opportunities for them at the end of that year. The time is approaching for us to consider the full implications both for the country as a whole and for the individual families and local communities affected of having more than 3 million people out of work.
The Conservative party, and Ministers in particular, must not misinterpret the recent election result. The electorate gave the Government the benefit of the doubt this time about unemployment and related issues. It recognised that, because of the background of world recession and technological change, unemployemt was international and the Government should not be held responsible. As I do not believe that the public would react in the same way four or five years hence, it is important that in this Parliament the Government should give the same priority and emphasis to the problem of unemployment as they gave to inflation in the last Parliament.
It is estimated that the cost of unemployment to public funds is between £5,000 and £6,000 per year for each family. It is surely not beyond the capabilities of all concerned to devise the necessary arrangements whereby the scarce financial resources can, at least in part, be used for positive job creation.
§ Mr. Hicks
All hon. Members know my views on the subject, and this is not the first nor will it be the last time that I express similar sentiments about it.
Not only would the programme I have mentioned have the desirable effect of increasing output and the extent of the services provided, but it would help to alleviate the 386 adverse social implications of unemployment. I do not need to remind the House that unemployment in my constituency is invariably between 50 and 100 per cent. above the national rate, whatever the national rate is at any time. The number of long-term unemployed in the southwest has risen by 150 per cent. in the past 15 months
A tragedy of the past decade is that successive Governments have allowed our public works capital investment programme to be steadily eroded. It is now an appropriate moment to reverse that trend by providing long-term investment for the nation's benefit while at the same time providing much-needed employment opportunities. Hon. Members should remember that we would start by saving over £5,000 per annum per family. That should appeal to my right hon. Friend the Chancellor of the Exchequer in relation to the public sector borrowing requirement, and the creation of real jobs, rather than synthetic ones, in important sectors such as home improvement, energy conservation, water and sewerage replacement schemes and rail electrification programmes, to name but a few, should appeal to my right hon. Friend the Prime Minister. [Interruption.] I hear Opposition Members saying that I am cribbing suggestions from a certain party's election manifesto, but on 27 July 1982, as reported in c. 996 of Hansard, I expressed identical views.
§ Mr. Hicks
As my hon. Friend says, "Who has done the cribbing?"
The public recognise — as was shown earlier this month — that the Government have been prepared to take some harsh decisions that were necessary to place our economy on a sounder basis. Our prime requirement now is to ensure that those in our society who are the victims of those decisions are adequately compensated. I am not being unnecessarily critical when I say that tolerance and compassion are not words that the public automatically associate with the Government. My right hon. and hon. Friends on the Front Bench will rightly remind the House, and me in particular, that pensions and other personal entitlements have been increased in real terms by more than the rate of inflation over the past four years. However, I remind them that in politics not only are the merits of an individual economic or social strategy important, but also the psychology accompanying those political decisions.
That is why it is essential for the Government to demonstrate practically over the next few years that they understand the personal situation of those in our society who, through no fault of their own, find themselves in need or at a disadvantage. In my judgment, that means a less clinical, less abrasive approach in future, backed by tangible evidence that the Tory party cares and believes in the creation of a society in which tolerance and compassion are widely recognised.
§ Mr. Malcolm Bruce (Gordon)
Thank you, Mr. Speaker, for calling me on this, my first occasion of speaking in the House. I suspect that, like many other hon. Members who are here for the first time, I am doing so with a sense of unreality that I am actually here. After spending nine years trying to achieve this goal, it is an 387 experience to address the House for the first time. I am glad to be able to do so. I hope that I shall have many more opportunities to catch your eye, Mr. Speaker.
§ Mr. Bruce
I have the honour to represent the constituency of Gordon, which used to be called Aberdeenshire, West. It is a large, diverse constituency. It has the largest electorate in Scotland — 68,000. I believe that it is the fastest growing constituency in the United Kingdom. I suspect that its boundaries will need to be redrawn more quickly than others in the country over the next few years. It has a wide range of problems and many different industries. It covers the suburbs of Aberdeen, the airport and the fast growing commuter areas round the city. It includes rural areas and rolling farmland.
The constituency also encapsulates two types of problems. One is that the rural areas are fighting for survival and to maintain services. The other is that the fast growing urban areas are fighting to secure services against a background of public spending cuts, which are making life extremely difficult for both communities.
The nub of the debate is the Health Service and the welfare state. I am particularly proud, as a Liberal, that the idea of the welfare state was a Liberal idea. Many of the benefits that have been discussed in the House today were introduced by Lloyd George and Ministers in a Liberal Government. I pay tribute to the great Liberal, Lord Beveridge, whose idea the National Health Service was. I am also pleased to associate myself with Aneurin Bevan, who brought the National Health Service into being. I am more than glad to pay that tribute.
It is therefore not surprising that we in the Liberal party are keen to ensure that the National Health Service and the welfare state continue to thrive and develop.
The constituency of Aberdeenshire, West has been represented by a number of Members of Parliament over the past 20 years. My immediate predecessor was Sir Russell Fairgrieve, who was a junior Health Minister in the Scottish Office during part of the last Parliament. It is appropriate that I am choosing to speak for the first time in a debate on health and the welfare state. While Sir Russell Fairgrieve was a Minister, he and I exchanged correspondence. We had a mutual concern in the area that I now represent. I pay tribute to him for the courtesy that he showed me when he was a Minister and Member of Parliament for my constituency.
Sir Russell Fairgrieve's predecessor was Lieutenant-Colonel Colin Mitchell, better known to the House and outside as Mad Mitch of Aden. Before him, the hon. Member for Aberdeenshire, West was James Davidson, who was a Liberal and whose mantle I now inherit. I am proud and honoured to do so. Many constituents have said to me, "If you are half as good a Member as James Davidson, you will serve us all right." I hope that you will not think it arrogant, Mr. Speaker, if I say that I aim to be as good a Member as James Davidson. That is something that I wish to follow.
We shall resist any measures that we feel threaten or undermine the service. For example, last year's damaging Health Service dispute was bad for the morale of the Health Service and, worse still — this is what really 388 matters—for the patients, many of whom are suffering from having a much longer waiting list than would have been the case had that dispute been averted.
Whatever the Government's claim to the contrary, it is clear to my constituents that the Health Service has inadequate resources to maintain and develop itself. I shall quote from a letter that I received from the Grampian health board, dated 9 June, in reply to my letter of 15 April. The significance of the letter's date will not be lost on hon. Members. I asked, among other things, how the 6 per cent. increase in funds would translate into providing increased services. The letter states:Dealing first with your question about the 6 per cent. increase in allocation the position is that the total allocation to Scottish Health Boards for 1983/84 has been increased by £68 million (6 per cent.) over the 1982/83 level. Of this increase it is estimated that £55 million will be required to meet increases in the cost of pay, goods and services, leaving £13 million (1.06 per cent.) available for developments for all Scotland. This assumes that inflation will stay at its present, relatively low level and that pay settlements will average 4½ per cent. It does not allow for making good any short-fall from last year nor for the cost of demographic and other changes.My constituency has experienced those more than most. The letter continues:It can, therefore, be readily seen that the monies available for actual development of the service are extremely limited.The letter then explains local options. It concludes that the board may now commission two recently completed units in the city of Aberdeen.
The letter also confirms the need for more geriatric beds. It acknowledges the link between sheltered housing provision and the need for geriatric beds. I believe that the allocation of more money to sheltered housing would reduce pressure on the Health Service.
The letter continues:One way to achieve an increase in the number of geriatric beds and to release the funds to run them is to close some of the badly under utilised maternity beds in the area. Economic arguments (and there are others) for closing local maternity units are always unpopular, but they are arguments which must carry weight with an authority whose responsibility it is within the limited resources available to it to provide the best possible health care to the greatest number of people in its area.The letter, referring to figures for bed occupancy, states:They will be before the Board very soon when they carry out their scheduled review of the peripheral maternity services, the specific outcome of which, if as seems likely it includes proposals for closures, will be the subject of full consultation with all interested parties.The tenor of this letter is ominous for the future of health care in my constituency which contains problem areas. It is fighting on two fronts—against decline and for services to cope with growth.
I shall quote one or two examples of how health care cuts have bitten. The ambulance based in the highland community of Strathdon was withdrawn unilaterally last year without consultation. The community mounted a magnificent effort and raised enough money to buy and run its own ambulance. That is how the community's cover is now provided. However, I do not believe that that is the way the Health Service should develop. The irony of that incident is that the original Strathdon ambulance was provided in 1947 by the efforts of the local community and was handed over subsequently with a cash balance to the Scottish ambulance committee. That committee has proved unworthy of the local community's trust.
389 At the other end of my constituency is the community of Ellon which has grown rapidly in resent years. In spite of a priority rating it still has no ambulance service. The Scottish Office can only tell me:The need for an ambulance station at Ellon will be kept firmly in mind.This is hardly a firm assurance. Services provided by the small hospitals in my constituency at Inverurie, Huntly and Insch are under constant review, but always for reductions, never for increases.
The consultant surgeon who was at Huntly is now employed part-time. The maternity units are under constant threat. We do not have the promised health centres. The delay at the Bridge of Don has been so great that local doctors have withdrawn their support. There is a danger that the same may happen at Westhill.
I believe that overall Government spending cuts have hit the Health Service hard, and, in the absence of any other provisions for communities in my constituency, the burden has fallen harder and more disproportionately.
I suggest that the productivity of our rural areas—I mean not just my area and Scotland, but the whole of the United Kingdom—in terms of their contribution to the nation's wealth justifies greater commitment to their needs, not a constant cut in the services that they need to survive. I suggest that the rapid expansion of new communities required to accommodate the people who are helping to provide North sea oil and gas and massive revenues for the Government, justifies faster provision of essential services — not just health, but long overdue bypasses, nursery schools and community centres.
My constituents are hard-working and reasonable. They accept the need for careful monitoring—
§ Mr. Speaker
Order. I am sorry to interrupt the hon. Member. Will the hon. Member who is reading that interesting magazine kindly listen to the debate?
§ Mr. Bruce
Thank you, Mr. Speaker, for your courteous intervention.
My constituents accept that money is not unlimited and that we must watch carefully what we spend. However, they do not accept that they must wait for ever for those services. They will not fly with the Government to a "never-never land" where nothing actually comes.
There is a crisis within the National Health Service. The Gracious Speech regrettably does not acknowledge this. Whatever the role of private services within the National Health Service, the fundamental commitment to the service must continue. The Government have so far said nothing to suggest that they will continue with that commitment.
I quote one short phrase of Scotland's bard:An' forward though I canna see, I guess and fear.My colleagues and I are committed to improving health care for all people, regardless of their means, and I hope that the House will support us.
§ Mr. David Madel (Bedfordshire, South-West)
The House has just listened to an excellent and interesting speech. I am delighted to be the first to congratulate the hon. Member for Gordon (Mr. Bruce). He is the first Member for Gordon because, as he said, it is a newly created seat. I felt that he was talking about a Scottish edition of Bedfordshire because the balance between rural and urban areas and the problems of growth areas are matters that affect part of the county that I represent.
390 The House also appreciated greatly the hon. Gentleman's warm tributes to Sir Russell Fairgrieve, Colonel Mitchell and James Davidson. I am sure that the House looks forward to hearing him further on the National Health Service and the problem of growth areas in Scotland.
Secondly, I add my voice in congratulating my hon. Friend the Member for Halifax (Mr. Galley) on his maiden speech and the hon. Member for Stoke-on-Trent, Central (Mr. Fisher) who made a vigorous maiden speech. We look forward to hitting back when the rules of combat allow us. It was a most interesting start to the Session.
I want to deal with the pace of legislation. Having a June start after a general election gives the Government more time in their first parliamentary Session. The Telecommunications Bill has featured again in the Gracious Speech. I hope that before the Government proceed with it, they will collect not just their thoughts but the thoughts of others. When canvassing in a general election one is bound to meet many people who work for the telecommunications industry. Many of the people I spoke to were worried about this Bill. They are worried about the possible effect on employment.
I am not asking the Government to drop the Bill, but I ask them to accept that they could easily afford time for consultation before they proceed. I note that there is notice of presentation of a Telecommunications Bill on the Order Paper. However, the Government could easily spend six months talking to those in the industry before proceeding further. It was a slip in the previous Parliament to try to race the Bill through the House so quickly. There is no need to repeat the process in this Parliament.
In my view some Bills need automatically to be subject to a guillotine or timetable. For example, huge chunks of the previous Telecommunications Bill went through without proper debate in this place. Their Lordships would have had a field day if the Bill had ever reached them. We must alter our procedures so that we get balanced and thorough discussion in Committee.
I suggest, too, that every six to seven weeks the Government could generously provide a day for debating Select Committee reports. A mass of reports is stacked up awaiting consideration by the House during this Parliament. I hope that the Government will provide the necessary time.
I shall confine the rest of my remarks to the part of the Queen's Speech which refers to the education service. It states that the Government willpursue policies for improving standards of education".Reference is made to providing local authorities with grants for specific projects. We must be straight with the people. In spite of the Education Act 1980, we cannot guarantee absolute parental choice when it comes to deciding where children will go to school. That cannot be done. We have extended choice, which I welcome, and I hope that the Government will move on to consider the appeals system within the 1980 Act. They should consider the time that it takes for parents to get their appeals heard and the sort of the questions that are asked by those who sit on the appeals panels. There is a need for my right hon. Friend the Secretary of State for Education and Science to consider the appeals system and the need for guidelines or additional legislation.
The Education (Schools Information) Regulations 1981 need amending so that all schools are obliged to publish an explicit statement on curriculum aims. Full details of 391 the curriculum that is offered should be given to parents of prospective pupils. The curriculum must be seen as a contract or a consensus in which individual schools, governing bodies and parents play a major part. The Government have provided grants for research and consultancy into good practice in curriculum-led staffing. Once that work has been completed, the findings can be published by Her Majesty's Inspectorate so that parents have wider knowledge of the subject.
If these measures were adopted, they would avoid the startling rows that have taken place over parental choice and the allocation of school places since the 1980 Act was placed on the statute book. It is for the Government to consider them carefully, to heed what has been suggested about curricula and to consider whether they can make parental choice, or greater parental choice, more of a reality.
There is a reference in the Queen's Speech to grants that will be paid tolocal education authorities … for innovations and improvements in the curriculum.At a time when local education authorities are being asked to be careful about spending, the Government should direct themselves to the youth training scheme and expenditure thereon. Bedfordshire estimates that it will run into a £100,000 deficit as a result of the initiatives that it must take under the community programme and the youth training scheme. If Bedfordshire overspends by £100,000 it could face a reduction in grant of £200,000. Surely that is not satisfactory.
The Government have been pushing local education authorities hard and they will push them harder to ensure that they play their proper part in the youth training scheme. If we are not careful, the Manpower Services Commission will urge authorities to go ahead on the basis that it will partly fund what they do, the authorities will do so and then they will find that they have overspent and will be made to suffer a grant penalty. I believe that the Government want to make the youth training scheme successful. If they do, they must consider the financial implications with the utmost urgency.
In page 7 of the Government's report on their expenditure plans published in February 1983 they state:The Government accordingly recognise that local authority expenditure in 1983–84 will be higher than desirable.That statement will need a manuscript amendment pretty quickly. Local authority expenditure will be higher notwithstanding whether that is desirable. Increased expenditure will be unavoidable because of the extra responsibilities that are being placed on local education authorities, especially by the youth training scheme. This is a factor that we must consider urgently.
The craft, design and technology sector of education is opening up and there is a greater opportunity for young people to receive training. I think that we all welcome the work of the Fulmer research institute, which has led it to report that technology awareness should permeate the whole curriculum from the primary stage onwards. If extra resources are to be made available, we want to ensure that universities adjust their entrance qualification to take account of the extra emphasis on craft, design and technology in schools and that opportunities for girls to participate in these courses are given greater prominence. There is evidence that many girls in our schools get no 392 opportunity to take advantage of craft, design and technology courses. It is essential that they should have a greater part in the curriculum and we must ensure that this is achieved by suitable university entrance qualifications and the provision of opportunities for girls.
My right hon. Friend the Secretary of State for Education and Science sent a consultation paper to local education authorities on his new initiative on spending and on specific grants for specific projects. In that paper he stated:The existence of these new grants would not affect directly the Government's plans for total local authority expenditure.It appears that some of the extra £47 million will be used in the development of a more practical slant to the final years of compulsory education and in the supply of microelectronic equipment to very seriously handicapped children. It will be expensive to carry out those two vital projects properly and there will have to be a loosening of the purse strings controlling education expenditure, both locally and nationally, if the part of the Queen's Speech which refers to improvements in the curriculum and to specific grants is to be implemented successfully.
I beg the Government to stay their hand before getting tough with local education authorities that are not acting quickly enough on surplus school places and all that flows from them. The MSC is moving into education and we shall need an expansion of further education to give young people opportunities under the youth training scheme. Local authorities must be given more time before they are placed in the penalty zone for not having acted quickly enough on surplus places.
The maximum effort is being made by the MSC on youth training but we must turn our attention pretty quickly to a strategy for adult training. There is an increasing number of young adults who have had no initial training. We could use financial incentives to employers to persuade them to provide extra training in skills where there is an identifiable local shortage. The quickest and easiest way of encouraging employers to do more about providing training, to take on more young people and to spend more on training would be to cut the cost of the national insurance stamp that employers have to pay. It could be phased out for a period for a certain number of employees if an employer could prove to the Government that he or she was providing extra training.
We need rapidly to build up the adult literacy and basic skills unit so that the unemployed can become acquainted with basic computer techniques and information technology. Just one year after the Government's successful information technology year there is a vital need to follow that up with the practical examples of help to unemployed people that I have suggested.
The Conservative party won the 1979 general election even though the election began with a question mark about whether we chould have peaceful and reasonable relations with the trade unions. The electorate nevertheless gave us the benefit of the doubt. Four years later we have proved to the country that we can, in spite of anxieties in 1979, govern ourselves and have good relations with the trade union movement.
The question mark over our policies during the 1983 general election campaign was whether we could successfully knit together an education and training scheme so that adults and young people have a real opportunity to get a job when unemployment starts to fall, as fall it must. I was delighted to hear the Chancellor of 393 the Exchequer say during the election campaign that he expected unemployment to start to fall in 1984. The sooner it falls the better for the state of the nation. When it falls, I trust that the Government will follow through the spirit of the Gracious Speech and ensure that local education authorities and the Manpower Services Commission are ready with useful and practical schemes so that those who are, unfortunately, out of work have the maximum chance to acquire a skill and, thereafter, a job.
§ Mr. Stuart Bell (Middlesbrough)
I am most grateful to you, Mr. Speaker, for calling me so early in this Session in such an august debate as this one on the Gracious Speech.
I was told before I entered the House that it was customary for a new Member to be congratulated on his maiden speech. Senior colleagues informed me that I was unlikely to catch your eye, Mr. Speaker for the next year. While I am looking forward to the comradely and friendly words of my colleagues after I have made this speech, I hope that the second part of the prophecy proves false.
As is the custom of the House, I wish to refer to my immediate and distinguished predecessor, the right hon. Arthur Bottomley. My predecessor came from the east end of London. He was the national organiser of the National Union of Public Employees from 1935 to 1941. He first entered the House in 1945. There was a short lapse on his part when he lost his seat at Rochester and Chatham in 1959. But he returned to the House to represent Middlesbrough, East from 1962. He retired gracefully at the last election after serving for 21 years. Arthur Bottomley asked me, when I came to the House, to get myself sworn in early. When I asked him why that was, he said that in 30 years' time I would be well placed to become the Father of the House. Arthur Bottomley has great hopes and expectations of me. [HON. MEMBERS: "Hear, hear."]
I wish to say one word on behalf of his wife, Dame Bessie. In all the years that Arthur Bottomley served his country, and he rose to be the fifth-ranking Cabinet Minister in 1964 when he became Secretary of State for Commonwealth Affairs, she was always at his side. Dame Bessie gave him great aid and comfort through his long and distinguished career.
I might have been in the House of Commons 27 years ago when I was 18, not on the Floor of the House but in the parliamentary Gallery. My youthful ambition was to be a Hansard reporter—
§ Mr. Bell
I actually learnt shorthand at Pitmans College in Southampton Row, where I reached a speed of 150 words a minute. My ambitions then changed with my youthfulness and I took up a different career.
I often regret that I did not continue with that ambition because, had I done so, I would have seen and listened to the great debates on the Suez and on the Falkland Islands crisis. I could have listened to the debates on the vote of confidence in 1979 when the Labour Government fell. That is something which I regret. However, I have taken a more circuitous route in arriving here, thanks to the Labour party and the grace and good sense of the electorate of Middlesbrough, which was sufficiently sensible to send me here with an absolute majority over all other candidates and with a majority greater than the Prime Minister.
394 I wish to refer to my own personal background. I come from a village in north-west Durham and the first job that I held was at Chopwell colliery. Chopwell in the 1920s, as my hon. Friend the Member for Easington (Mr. Dormand) will know, was known as the reddest village in the country. That was how the Morning Post described it. It was said to be full of precocious Lenins. I hasten to add that I do not consider myself to be a precocious Lenin; I am a constitutionalist and I believe in our parliamentary democracy. Although I have views on the other place, this is neither the time nor the place to expound them. I am proud of that background and proud that three hon. Members have come from Chopwell colliery. The first was Will Lawther, who rose to become the president of the National Union of Mineworkers; the second was R. E. Woof — better known as Bob Woof — who was the Member of Parliament for Blaydon from 1955 to 1979 and the last one is myself. Since the colliery closed in 1966 the tradition will end.
Next month the banner of Chopwell colliery will be unfurled again for the 100th Durham miners' gala, and I shall be proud and pleased to take my place behind that banner when marching in the procession through Durham.
My constituency of Middlesbrough, has been built upon the work ethic. British Steel, at Redcar, is on the coast, where 3,000 of my constituents work; ICI Wilton and ICI Billingham are to the south and north respectively and there is the Tees dock and Smith's dock where roll-on/roll-off containers are made. There is also the manufacture of accommodation rigs for the North sea oilfields.
The work ethic is strong in Middlesbrough, and the north-east has seen the ravages that unemployment can bring. During the election campaign—like many other candidates—I heard the great confusion and disappointment felt by those who are unemployed. I met a man who has been unemployed for 10 years. I gained no satisfaction from knowing that during part of that 10 years there was a Labour Government. I met others who have been unemployed for four years, and families who do not have a single breadwinner. I even met a lady who had been given the opportunity to buy her council house but could not afford the mortgage as her husband was on the dole.
I hope that the job haemorrhage that we have seen on Teesside has come to an end. It is like the lines of Torres Vedras, from which we must now move forward and try to create employment in the area.
I wish to tell my constituents that the first line of defence for jobs on Teesside will be in the House of Commons. Teesside polytechnic has an excellent standard of education and it gives hope to many of our young people who are coming on to the employment rolls and who find tha they are better off continuing their education for that little while longer to get themselves better placed for a job in the future. As a previous vice-chairman of Newcastle education committee, I watched with great care the creation of the National Advisory Board on behalf of the Secretary of State for Education and Science. I shall he looking with interest to ensure that the National Advisory Board will examine the curriculum of Teeside polytechnic from an educational rather than a financial standpoint, and that the educational standards at that polytechnic are maintained.
Having listened to the debate on the welfare state, I remembered the words of Hannen Swaffer, who was a Socialist journalist in the 1950s. He was talking about the Conservative Government of 1951 to 1959. He said that 395 there was a danger that the welfare state would be turned into the farewell state. I was heartened when I heard the Secretary of State renew his commitment to the Health Service. In Middlesbrough, where there are several hospitals, there is still a residue of bitterness from the long ancillary workers' strike last year. We are most concerned at any possibility of privatisation of any sector of the Health Service, be it the laundry, cleaning or meals service. While it is proper to put the emphasis on patient care, it is worth pointing out that 900,000 people still work in the Health Service. I remind the Secretary of State of a phrase of Pierre Mendes France, a French Socialist, who said that people are not tools and cannot be disposed of at will. At all times we must take into account the feelings of those who seek security in the Health Service, where they invest their working lives.
I began by talking about my village in the north-west Durham hills, and from my youth I remember some of the quotations of William Morris. He once said:Socialism is no dream but a cause.Men and Women have died for it not in ancient time but in our time.They lie in prison for it,They are exiled for it,They work in the mines for it,They suffer all for it.Believe me, when such things are suffered for dreams theDreams come true at last.I associate that dream with all those who live in the housing estates or the terraced houses of Middlesbrough, and with those who work at ICI Billingham, ICI Wilton, Tees dock or Smith's dock. I associate that with the young generation of people looking for work, a sense of security and expectation in life. In short, it is a Socialist dream, and although our concept of Socialism must be redefined as we enter the last part of the 20th century, nevertheless that Socialist dream is very true to me. If the Socialist dream lives on, like a flame it will never die.
§ 7.1 pm
§ Mr. Alan Haselhurst (Saffron Walden)
Like the hon. Member for Wolverhampton, North-East (Mrs. Short), I too have never had the opportunity of following a maiden speech and offering congratulations, but I offer congratulations to the hon. Member for Middlesbrough (Mr. Bell) on his maiden speech. He commended himself to the House very much by the manner and style of his speech. If he continues to speak with such ease and fluency, he will be listened to with pleasure and not only by those on his own side.
The hon. Gentleman also commended himself to the House by his generous references to Arthur Bottomley, who was well respected and loved in the House and was a good friend to new Members, from whichever side they came. We miss him, but we very much appreciate the remarks made about him. We trust that in the fullness of time the hon. Gentleman will command the same respect that his distinguished predecessor enjoyed.
We have been fortunate in the quality of the maiden speeches that we have heard. I add my congratulations to the hon. Members for Stoke-on-Trent, Central (Mr. Fisher) and for Gordon (Mr. Bruce) and my hon. Friend the Member for Halifax (Mr. Galley). I particularly commend my hon. Friend; as a fellow Yorkshireman may I say that it is good to see a Conservative Member representing Halifax.
396 I should like to extend the meaning of welfare, just as my hon. Friend the Member for Cornwall. South-East (Mr. Hicks) did. The issues of the election for me were unemployment, unemployment and unemployment. There is no question but that that was the predominant subject discussed on the doorsteps and when meeting people. I represent a constituency which at the last official count ranked 591st out of the then 635 seats in terms of its level of unemployment, yet there is still great concern among the constituents of Saffron Walden, which goes beyond the unemployment that they see around them. They are also aware of the seriousness of the problem in the country as a whole. I am sure that the test of this Government will be what they can do to ease the unemployment problem in the next four to five years.
I lay great store by what is said in the Gracious Speech, that the Governmentwill promote growth in output and opportunities for employment".We must either get the jobs, which I believe is possible—my hon. Friend the Member for Cornwall, South-East outlined some of the possibilities for genuine work creation — or we must achieve the adjustments to a world of less work, if that is really where the new technology is taking us. Economic recovery is the main hope for the creation of more work, and in current terms the question that is asked is, "How can the recovery be moved into second gear?"
As my hon. Friend the Member for Staffordshire, Moorlands (Mr. Knox) said, there must be some Government assistance to ensure that the recovery moves from one gear to another. There must be some judicious assistance to ensure that suitable projects are backed and certain types of expenditure undertaken, with due regard to maintainingfirm control of public expenditure",to quote again from the Gracious Speech. It must also be judicious to persuade people that, if we are to maintain the drive for efficiency, by employing the minimum number of people to make products in line with the best that competition can do, they are not simply signing their own death warrants in respect of work. I believe that more work will be created by embracing the new technology and promoting higher standards of effeciency, but I am not sure whether that understanding is widespread. If people are to be encouraged to co-operate in measures aimed at higher productivity, they must be shown that alternative job opportunities have been created.
If the economic recovery is to be sustained, there is great importance in what the Gracious Speech says about "improvement in training" and the need for it to be "sustained". It is galling that some shortages of certain types of skill have already taken place. My part of the country may be more favoured than others— I accept that—but even there there are already visible shortages in certain types of skill. For example, people in the building industry are saying that they fully expect shortages in certain types of skill in the not-too-distant future if the pace of recovery is maintained.
It is extraordinary that after a period of deep recession we should so early have talk of skill shortages. Therefore, it is absolutely right to continue the emphasis on training. The Government have a perfectly good record in that respect. I also welcome the youth training scheme which will be initiated this year, and wish it all success. I dare say that there will be teething problems. There will be 397 occasions when employers feel that they are getting less than their full recognition and response from the Manpower Services Commission, but I am sure that the philosophy of the scheme is correct. I am sure that it has been constructed on the right lines, and I am equally sure that it will be of enormous benefit to generations of young people throughout their working lives.
Will the companies do enough to sustain the training effort? That is the question which the Government must face. The changes made in the training arrangements were perfectly reasonable — I was no great lover of the statutory training boards — but can we be sure that alternative arrangements will provide a number of training places that are necessary? Should we be providing incentives to ensure that companies carry out more training? If incentive does not work, will we be prepared to use the stick to ensure that all companies within an industry will co-operate in the voluntary arrangements that have been made and play their part in a proper training programme?
§ Mr. Roland Boyes (Houghton and Washington)
Would the hon. Gentleman like to comment on the fact that those youngsters will get only £25 a week? Does he have any idea of what it means when a youngster who belongs to a family on a low income earns only £25 a week? Will he express an opinion on the Government's decision not to pay them £28 a week?
§ Mr. Haselhurst
I do not want to pursue that point too far. Perhaps the hon. Member for Houghton and Washington (Mr. Boyes) is not aware that I was one of the hon. Members who, in the previous Parliament, spoke up strongly for the allowance being set at at least £25 a week rather than what was originally thought to be a low level. I believe that it was right to set a realistic allowance. However, we must recognise that resources are scarce and that, while we might wish to provide a larger amount for training, the essence of the scheme is to get as many young people as possible into training. The extent of the scheme must have priority over the size of the allowance that is paid at the beginning.
I should like to deal with the relationship between training and education. I cannot help feeling that we shall not achieve the correct long-term approach to training until we grasp the nettle of bringing training and education together in one Government Department. The people I meet, whether they be in education or in training, believe that that is what we should do— yet no decision has been made. It is extraordinary that the two streams still run separately. We shall not achieve the best use of resources or the best results until the two are brought together.
If we are to sustain economic recovery and have better training, another ingredient—the continuing improvement of industrial relations—must receive attention. I am pleased that the Gracious Speech refers to encouraging industry to be adaptable, efficient and able to compete successfully. Are we making enough progress in that regard for ordinary employees or is there still a risk that such improvement as has been detected recently has been achieved more by fear of unemployment?
Good industrial relations in terms of good management practice have not yet been universally attained. I recently had thrust before me an example in my constituency, where one week the work force was commended on its sales effort and co-operation — each employee was 398 presented with a token bottle of champagne for his efforts — but the following week the company was closed down. The story is not quite as simple as that, but it gives an extremely unfortunate impression.
We have not learnt all the lessons that we should have learnt from effective co-operation between management and employees. I hope that we shall witness more effort in that direction. I do not want anything prescriptive. Lord Bullock set good industrial relations practice back a good deal with his unfortunate report that suggested that there should be workers on the board statutorily. I have dabbled with the idea of legislation that embraces a code of practice suggesting the way forward for companies so that there could be some yardstick.
If that would be too restrictive, as there is a wide range of measures which could be taken, I wonder whether the Government should consider establishing a Queen's award for good management practice. There is a Queen's award for export achievement and another for technological achievement. Industrial performance would be improved considerably if we paid more attention to, and rewarded merit in, good relations in the workplace. It would not be difficult to draw up criteria on which such an award could be given. It might help industrial performance.
The key to success in improving job opportunities lies in industrial performance. If industry is more efficient, we can create wealth and therefore expect investment which will create more jobs. We must ensure that the right steps are taken in conjunction with economic measures that make success more likely and more sustained. If we are to improve our people's welfare, all our efforts must be directed towards getting them jobs. That, ultimately, is how the Government will be judged.
§ Mr. Terry Lewis (Worsley)
I thank you, Mr. Deputy Speaker, for calling me so early in this Parliament. I hope that this is the beginning of a long career in the House.
I am privileged to have been sent here by the electors of Worsley, which comprises parts of the old Leigh, Newton and Farnworth constituencies. I pay tribute to two of my predecessors. I am deeply conscious of the standards set by my hon. Friends the Members for Leigh (Mr. Cunliffe) and St. Helens, North (Mr. Evans). They have been most helpful in the past two weeks when I have been threading my way through the House. The hon. Member for Halifax (Mr. Galley) likened it to starting school. In the first few days, I thought that it was rather like being called up for national service. The only difference was that the Ministry of Defence gave me a sight more information about the new organisation than I have received from this one. It will be hard to follow my two hon. Friends. They have set a high standard which I hope to match in time.
The area that I represent has always been at the centre of our nation's work. The constituency has embraced the work ethic for many centuries. The people have been industrious, inventive and resourceful. They have also worked on good industrial relations. Industrial relations in my part of the world have been exemplary and cannot be criticised by anyone. There is a long hi story of steelmaking, coalmining, engineering, textile manufacture and other manufacturing in my constituency. Economic depressions have come and gone, but the resilience of the people has always enabled them to keep their heads above water.
399 My constituents have introduced new techniques and industries where others have been lost. We have recently lost a major steelworks, mines have closed and there have been major closures in the textile and garment industries. However, much of that appalling tragedy has been ameliorated by the quality of the work force in the constituency. Nevertheless, I am sorry to relate that the de-industrialisation of the past four years has given a new dimension and meaning to the word "unemployment". We are now witnessing the wholesale destruction of large and small enterprises, and it is difficult to see how even the most resilient people can overcome the disaster that is now apparent.
Since I arrived here two weeks ago, I have listened for encouragement. I have studied the Gracious Speech, and I find no cause for rejoicing. It is a catalogue of more despair for those whom I represent. At best, the Queen's Speech is irrelevant to the needs of the nation; at worst, it is a recipe for suffering yet to come.
I come to the House fresh from local government. I am sorry that I find it difficult to say what the Queen's Speech does for local government. In the past four years many trip wires have been placed in front of local councils. According to the Queen's Speech, the same is to apply in the next four years. I fear for those who rely on local government services for their well-being.
Rating controls introduced in recent years have proved to be unfair and unworkable and have caused great hardship. I regret that the Government are intent on further adventures in that direction. I shall do all that I can, inside Parliament and beyond, to frustrate their iniquitous policies.
It is ironic that those who created the metropolitan counties less than 10 years ago should seek on a whim to destroy them. Can it be that under Labour control they have done the job of providing for the less well off rather too well for the Government's liking? I suspect that that is so.
Much will become clear in the coming months. My party's claim during the election campaign that an alternative manifesto exists will be vindicated. It is there, coded in the Gracious Speech. I come to the House angry at the treatment meted out to my constituents. I assure the House that in the coming weeks and months I shall fight tooth and nail to defend those who are being callously disregarded by the Government.
§ Sir Brandon Rhys Williams (Kensington)
We have heard a series of exceptionally competent and sincere maiden speeches. I pay tribute to the hon. Member for Worsley (Mr. Lewis) and the other hon. Members who have made their first speeches today. The House welcomes speeches of such quality and sincerity. We look forward to hearing all the new Members again. Many of them made speeches of alarming conviction and capacity, but they will forgive me if I do not follow their lines of argument. I want to deal with a matter than has not been mentioned much today—the cash side of the welfare system, or what might be called the redistribution of income.
We need a clear statement about the Government's intentions. There is no reference in the Gracious Speech to the Government's intentions for administrative reform, or for the reform of the underlying principles on the cash 400 side of the welfare state. But we cannot go on as we are. I think that the Secretary of State accepts that as much as hon. Members on both sides of the House. My right hon. Friend made a number of trenchant statements this afternoon about what the Government will not do. We support him in each of his commitments; but we must press him to let the House know as soon as possible the Government's intentions for the reform of the redistribution of income.
Local government, the Inland Revenue and the Department of Health and Social Security employ hundreds of thousands of people in taking the public's money away or in handing it back. The redistribution of income industry appears to be seething with discontent. It is grossly overmanned, but at the same time it is gravely overworked. Its methods of raising and distributing money are obsolete and dangerously near to breaking down. I understand that Inland Revenue officials are required to make about 25 million manual entries every week to support the income tax and national insurance contribution system. That is intolerable in the computer age.
I also regret that 7 million people in Britain have to be dependent now on supplementary benfit. The number is rising. It will have risen as a result of my right hon. Friend's statement to the House last week about the increase in pensions and supplementary benefits to pensioners. The figure now is equivalent on average to 10,000 people in each constituency. We are not talking about a safety net. Supplementary benefit is becoming an enormous and divisive institution. The present position is intolerable for a Government who are comitted to a humanitarian approach, and at the same time to efficiency in public administration.
Let us examine the method of raising finance for the redistribution of income on current account. The PAYE system was brought in in haste as an emergency wartime measure in 1943. From the start, for the majority who pay income tax by that method, it has been incomprehensible. It is unnecessarily complicated and laborious, wasteful of manpower and inaccurate, places heavy burdens on employers and is widely evaded. Keeping national insurance records has become an unnecessary extra nuisance.
The computerisation programme is based on the wrong approach. The Civil Service should welcome the computer for the opportunities that it provides for innovation. Instead, civil servants are trying to find ways of adapting computers to complicated manual methods used to administer PAYE which they have inherited from the past. They are spending years introducing the computerisation of PAYE because they have adopted the wrong approach from the beginning. They should think out the system first and lay it out after. It will be years before the computerisation of PAYE is complete. After that, there will be a period of "bedding down". If we saw that in "Yes, Minister" we would think it hilarious; but it is not funny because it is true. It is intolerable that no reform of social security and income tax can be accomplished for many years for this reason.
The accumulation of pension records is a growth area of unnecessary complexity which should also be examined.
I should like to suggest criteria for a satisfactory system for the redistribution of income. It must be seen by everyone to be morally right. It should be simple, comprehensible, immediate in administration, effective in 401 terms of coverage and take-up, and not a disincentive to work or to increased effort. It must not be an inducement to spend or to run down personal savings. It should be fair between different beneficiaries with similar circumstances. It should involve no distortion of the economy and no stigma should be attached to the receipt of benefits. The present scheme fails all those tests.
We must admit that huge sums of money are being churned round every week in a money-transfer system which is obsolete, unprincipled and desperately in need of wholesale reform. What is the basis of the beneficiaries' entitlement? Many millions of people receive benefit through the redistribution of income every week. Why are they entitled to what they get? Is it because of citizenship—the underlying principle behind child benefit? Is it because of contribution records — the old national insurance concept which is still the basic reason for the receipt of unemployment and other benefits? Or is it need, as in the case of the 7 million on supplementary benefit? The Government have to choose which of these major roots of entitlement they wish to make the foundation of the new system for the redistribution of income.
At the beginning of the 20th century the national insurance system was a revolutionary idea; but although it had its satisfactory aspects, we have to admit that in practice the national insurance system has failed. The flat rate contribution system cannot produce the necessary resources to meet the demands on the welfare services that the public rightly place on them. Some years ago, in recognition of this fact, we abandoned flat rate national insurance contributions and put the system on an earnings-related basis. We decided to collect the contributions through the income tax mechanism. In other words, it became another aspect of the income tax system and ceased to have any relationship to a valid insurance principle. It should now be scrapped. We brought in the concept of earnings-related contributions for flat rate benefits. That may be a good principle, but it is not an insurance principle. I dare say that many hon. Members will agree that the time has come to get rid of the whole apparatus of the national insurance fund and contribution-based entitlements altogether.
As to entitlement through need, I resent the idea that people should be obliged to apply for help on grounds of necessity, but we must recognise that this is a safeguard that has to exist. There must be a safety net, but it ought not to include even one tenth of the number of people who are beneficiaries of the present system. We have not a safety net, but a vast catchment area. It was never envisaged by Beveridge or other social reformers. It relies on individual casework to deal with millions of routine problems that could be dealt with by machinery. In case after case the circumstances of the claimants are easily predictable and routine. They do not require the dedicated work of the people who man the offices of the DHSS, all of whom we admire, while we deplore the necessity for them to go through the motions of assessing need in the way that they have to do in order to make the present obsolete system work.
Entitlement from citizenship has to come as the main root of entitlement to benefit under our system for the redistribution of income. It has to come administratively, because we have to cut out the casework and move it forward into the computer age. It is also right to base entitlement on citizenship in a country that has entirely accepted the idea of universal suffrage. We cannot divide 402 the country into those in work and those in need or those who are second-class citizens because they have failed in some way to meet the desiderata as independent souls who are able to look after themselves. That is not the way that modern social life is organised. Every citizen should be entitled to the same treatment on the basis of citizenship and should not be forced to go through the humiliation of the test of need.
One good feature of the present system of which we can be proud—perhaps it is the only good feature—is that, in a ramshackle, unhappy and incompetent way, it does actually supply a basic income guarantee. Fortunately, few people are significantly below the poverty level because they have fallen through all the different methods that we apply to help those on the very lowest level of income and other resources. We have to build on the fact that in practice we have achieved the basic income guarantee for all British citizens. It is a foundation that we must use when the whole of the present superstructure has been swept away, as I hope that it soon will be, and rebuilt from first principles.
What I call the basic income guarantee, or "the big idea," is something that I sought to recommend in the evidence that I gave last year to the Treasury and Civil Service Sub-Committee dealing with the structure of personal income, taxation and income support. That extremely interesting Sub-Committee attracted a number of memoranda of great significance which have recently been published. I regret that the Sub-Committee did not complete its work and left us with only partly digested recommendations that do not take us much further.
The basic income guarantee is something that the Government should now be studying and deciding to implement. We have had recommendations for another Beveridge study or a long-term analysis of the problems of the welfare state; but such recommendations are merely a waste of time, because minute attention has already been given to the working of the present system. We know its deficiencies and the remedies for them. The Government should seize their opportunity and not hesitate to institute major reforms.
The basic income guarantee is not a new idea. It has been advocated for many years by social reformers, and, under the name of the tax credit scheme, it was official Conservative party policy in the 1974 general election, following the work of the Select Committee two years before. It remained a manifesto commitment in 1979, but there are two things, often repeated by spokesmen of this subject, that we need to examine — two particular objections to progress being made. One of them is that the whole idea, however desirable, is too dear, too expensive to bring in. I realise that when the Conservative Government decided that they would implement such a scheme 10 years ago, they knew that in the course of the reform it was likely that some people would gain and others would lose, so they decided to implement the reform in such a way that there would be no losers, only gainers. That was an admirable concept within the outlook of those times, but it meant that the scheme cost money because there were only plus signs where changes were made.
I do not wish to recommend a large number of minus signs, but it is possible to implement the scheme on a neutral basis. If the tax rate is placed at a level that raises the necessary funds to provide the benefits and if the benefits are put at a level that, broadly speaking, leaves 403 everybody where they are at the moment, it will cost nothing to implement. There might be some significant changes, if the Government wish to see them, in the treatment of different people in different circumstances at different times; or, if the Government chose to do so, with a great deal of ingenuity they could introduce the basic income guarantee in such a way that virtually the entire population, in the week following the introduction of the scheme, would have the same money to dispose of as they had in the last week of the previous scheme. There is nothing intrinsic in the concept that it is "too dear" or likely to place a strain on the economy, because it is open to the Government to choose the figures that they will put into the scheme. The scheme should not be postponed on the ground that it would cost too much. There are overwhelming advantages for the economy in introducing a reform along these lines. The difficulties are administrative, not cost.
The other objection is that the idea is premature because while the Inland Revenue is proceeding with its computerisation of the existing PAYE system—which will take until 1989, or possibly later, after which there will be a bedding down period of some years—it is impossible to contemplate any major reform. However, the basic income guarantee will make the computer programme to sustain the present PAYE system almost entirely superfluous, because it will introduce a major simplification of taxation and of benefit. The computer could handle the scheme, and it is ideal for doing so. It is not necessary to programme the computer to handle the existing obsolete and unnecessary system that has so many faults before we can introduce major innovations.
I want the Department of Health and Social Security to get to work with the Treasury at once. We do not need a long-term study which will lead to legislation possibly after another general election. That would simply be a time-wasting manoeuvre.
§ Sir Brandon Rhys Williams
I want to proceed because, although the hon. Gentleman may not be interested, there are millions of people outside the House who are affected by what I have to say.
I want the Government to make a commitment to wholesale reform in the present Parliament.
To summarise—I hope that the hon. Gentleman will listen to this— I recommend that we stop the pay-as-you-earn computerisation programme at once. We should instead direct our studies immediately to the introduction of a basic income guarantee scheme. We should end national insurance now, and run the national insurance contribution and income tax into one. We should end the fiddling business of counting contributions, the deprivation of people from entitlement on the ground of deficiency of contributions and all the rest.
Although my right hon. Friend the Secretary of State is a man of considerable courage and integrity, he may not welcome my suggestion that we should break up his Department entirely. But I recommend that we should take health administration out and set up an independent Minister of Health once again. All the personal casework handled by the hundreds of DHSS regional offices should be amalgamated with the local government offices which are doing almost precisely the same work. My right hon. 404 Friend has already hived off housing to local authorities and the natural consequence of that reform should be the full amalgamation of the regional offices of the DHSS with local government.
All aspects of the Department's work dealing with the redistribution of income should then be included in the Inland Revenue, and a new Department should be set up to handle all aspects of the money-transfer budget.
To summarise the advantages of a basic income guarantee, the majority of people would pay a single flat rate of income tax. Taxation of income would be placed on a single, unisex basis. Everyone would automatically enjoy a minimum income by virtue of citizenship. Housing subsidies would be unified in a single system of housing allowances. The disincentive effects of the poverty trap and the "Why work?" syndrome would be ended. There would be no barriers to taking work full-time, part-time or on a casual basis. Unemployment would cease to be a qualification for benefit and there would be no loss of benefit for those out of full-time work who take part-time work to supplement their income. The stigma of the means test would be removed. Child benefits would be the same for all families, whether the parents were in work or not.
I hope that the Government will take those recommendations seriously. The problems will not go away even if the hon. Member for Kensington fails to bring them constantly to mind. My right hon. Friend should regard what I am saying not as an unhappy necessity, but as a great opportunity for a Government with a handsome majority to implement a long overdue reform.
§ Mr. Chris Smith (Islington, South and Finsbury)
As a new Member in the House, I begin by saying that I am pleased and proud to represent the electors of Islington, South and Finsbury. I am particularly delighted to place it on record that that constituency and the borough of which it is part have returned to their political allegiance after a temporarily imposed period of political uncertainty.
As many hon. Members will know, my constituency lies only four miles from the House, yet it contains within it extremes of wealth and poverty in as stark a contrast as will be found anywhere in Britain. It ranges from the leafy roads which are now full of reporters from The Guardian and Channel 4 producers to the crumbling staircases of decaying council estates and the overcrowded basement rooms of private landlord controlled houses.
In my constituency one adult in four is unemployed. Two thirds of school leavers have no chance whatever of finding permanent employment and on our council estates the crime detection rate for burglaries and break-ins is 2 per cent. That is the background from which I come to the House.
It is customary for a new Member to pay tribute to his predecessor. However, I fear that I must depart from that tradition. George Cunningham and I fought each other in the election and it would be hypocritical of me to claim that I was anything other than delighted by the result. However, I shall say—and hon. Members will know this better than I — that George Cunningham was a skilled, supremely effective and, at times, deadly parliamentary operator. As his successor, I want to apply such skills in my constituent's interests and to the cause of Socialism for which they sent me here to fight.
405 The main subject of debate today is the welfare state — that network of provision upon which millions of British people depend for their livelihood which has been so painstakingly built up over the past 40 years. A key element of that provision which has not been discussed in great detail yet tonight and which was touched on in the debate last Thursday, but so briefly that I shall do so again, is the right for everyone to have a decent home at a price that they can afford.
I have spent most of the past two years chairing my borough's housing committee, and as a result I am acutely aware that some 60 per cent. of my constituents live in council housing and are dependent on the council for their welfare and their home. We have 7,000 people on the waiting list, 8,000 people on the transfer list, 1,500 people reporting as homeless each year and 75 families a week joining the waiting list. It is with their interests in mind that I have looked at the Gracious Speech and I have seen in it nothing with which to comfort them.
The Gracious Speech has, first, a tired reiteration of the desire to limit public expenditure. That means that local authorities will not be given sufficient housing investment funds to renovate old estates and to build new housing to rent to those in need. It means also that there will be no certainty for investment and housing in future years and that will mean that local authorities will continue as they have over the past few years to fail to meet the targets which the Government, supposedly, give them.
Secondly, there is no guidance in the Queen's Speech on rent levels. It says a lot about rates and excoriates Labour local authorities for high rate increases. However, it says nothing about the Government's record of increasing rents far beyond the rate of inflation over the past four years. The Government and Conservative Members might do well to consider some proposals for rent capping as well as for rate capping.
Thirdly, we are promised—we were promised by the Prime Minister at the beginning of the debate on the Gracious Speech—that the mortgage tax relief threshold will rise from £25,000 to £30,000. That is wonderful if one can afford a mortgage of £30,000. In my constituency, where one person in four is unemployed and where average earnings are far below the national average, precious few people can afford such mortgages. What the proposal also ignores is the gross unfairness and imbalance of a system that gives tax incentives for owner-occupation but no fiscal advantage at all for people who rent.
Fourthly, there are provisions for the extension of the right-to-buy legislation. For tenants living on decaying council estates the right to buy is frankly a joke. It is no joke for those on the estates waiting to move into better quality accommodation. It is precisely that better quality accommodation that is literally being sold down the drain by the Government's right-to-buy legislation.
In short, the Government, in a headlong rush to protect, promote and espouse home ownership and home ownership alone, have forgotten and ignored the cause of those who can only rent or want to rent their accommodation. I warn Conservative Members, on behalf of my constituents, that I shall not forget and ignore the interests of those people.
One of the most distinguished of my constituents, had he now been alive, would have been Eric Blair who wrote under the name of George Orwell. He had a profound belief in the decency of ordinary working people and a smouldering anger at the injustice and oppression which 406 they suffered. That smouldering anger is needed more now than it ever has been. I warn Conservative Members that it will come consistently in the coming years from my colleagues and me on the Labour Benches.
§ Mr. Peter Bottomley (Eltham)
The House has enjoyed listening to the speech of the hon. Member for Islington, South and Finsbury (Mr. Smith). Both his constituents and the House will welcome his commitment to serve his constituents in the best way that he can. I can add to that only by saying that, if he serves them as assiduously and as effectively as his predecessor, his constituents will get a good deal. The hon. Gentleman also threatened to pursue the rights of Socialism but perhaps we can leave that until open debate is encouraged.
I should like also to pay tribute to the hon. Member for Middlesbrough (Mr. Bell) whose speech, I thought, will live on for a long time in this House. The hon. Gentleman paid an elegant tribute to his predecessor. As part of the club, may I say that Bottomleys go far in this House and that soon I hope there will be another one to bring it back to two again.
The House was well served by the predecessors of the hon. Members for Islington, South and Finsbury and for Middlesbrough. Whatever political differences there may be between the present hon. Member for Islington, South and Finsbury and his predecessor, I think that both the former right hon. Member for Middlesbrough, Mr. Arthur Bottomley, and the former Member for Islington, South and Finsbury, Mr. George Cunningham, in their own different ways, were great servants of the country through their service to the House. If their successors do the same the House will, I am sure, be paying tributes to them in however many years it takes for them to deserve such tributes.
The hon. Member for Islington, South and Finsbury also spoke of the warmth with which he will pursue the interests of the ordinary working people of his constituency. I am sure that that is the right way to use time in this House. That is what I have been doing in the eight or nine years since I took over as Member of Parliament in an ordinary area of London, an area that used to have the strongest Labour party in the country. In that constituency, the Labour party was fortunate to stay above the alliance in votes at the last election. I am aware that the alliance attracted a good many votes from the wealthier parts of my constituency. It also attracted a fair number of votes from people whom I and my supporters have helped detach from the Labour party and who, I think, are using the alliance as a halfway house to the Tory party.
The Conservative party, at least in my constituency, represents the ordinary people and is gaining further strength from the estates that were built as council estates. They are not remaining council estates because people, given housing help at the time of family formation or shortly afterwards, have the same ambition as many hon. Members on both sides of the House to own their own homes. They wish to be able to ensure that when they die their children can remain in their home or have the mobility that many people wish, to move away from the area in which they presently live.
I welcome the reintroduction this Session of the Housing and Building Control Bill and especially clause 21, which in the last Parliament was termed the "elderly orphan's clause". It provides that where a council, as 407 landlord, wants to require a surviving child of a council tenant to move, the council would have to take into account the length of time that that "elderly orphan" has lived in the home, and the physical, financial or other support that that surviving child has given to parents.
Those are the type of issues that concern ordinary people. In the last Parliament many Labour Members supported the representations I was making. Sadly, Greenwich council did not see fit to make it possible for a 57-year-old woman, who had spent 20 years caring for her parents at home, to remain in the home in which she had lived for 50 years. I had another example of a 48-year-old man, who 14 years ago, after his father had died, had, with his mother, given up a fairly large council home to move into a smaller one. Yet, after paying the rent for his mother, he received no allowance or rebate. When she eventually died—his care and help had kept her out of hospital and expensive institutional care — he, again, was about to be required to move. However, he got help from his representative in Parliament and from others to fight a court case, which is a difficult thing for an ordinary man and, admittedly on a technicality, he was given permission to stay in that home.
Those are the type of issues with which I hope to make common cause with the new hon. Member for Islington, South and Finsbury. I go a stage further. I hope that the evidence given to the Treasury Sub-Committee on the taxation of benefit, which was previewed by my hon. Friend the Member for Kensington (Sir Brandon Rhys Williams) will be read by all Members of the House and by many people outside. That Select Committee's half-completed report is one of the most important things left over from the last Parliament. Looking forward over the area of tax and benefit may be boring to some hon. Members new to the House, but it is critical to many millions of people outside, in employment and out of employment, whether caring for dependants or not. Looking through the family life cycle and bringing the family perspective into social and economic policy requires attention to tax and benefits and an attempt to bring more sense into the system and to set more ambitious targets for a simpler and more effective system than we have managed to achieve in the years since Beveridge.
I believe that one of the reasons why I am a relatively successful Member of Parliament, albeit a fairly Left-wing one for the Conservative side of the House, is that I pick up the ideas of my hon. Friend the Member for Kensington 15 years after he has put them forward. I tend to put them forward five years before their time rather than 20 years before their time. I hope that anyone who finds that he cannot adopt the whole of my hon. Friend's big idea—the basic income guarantee—straight away will study my evidence to the Treasury Sub-Committee and at least get on with my bits first and then move to my hon. Friend's ideas later on.
I congratulate my right hon. Friends at the Treasury and at the DHSS on the significant increase in the real value of child benefit. An increase in child benefit of 11 per cent. during the past year is an amazing achievement that many with an ungenerous cast of mind might have thought unlikely from this Government. Even more praise is deserving if that is true. It helps a great many people in and out of work. It makes it possible to get rid of at least some of the child dependency additions and it ensures that 408 families, especially those on lower incomes at the time they have children, can have an increase in—or at least a protection of—their standard of living without having to join the fruitless and often counterproductive chase for higher and higher nominal pay claims. It does not need spelling out, even to this new House, that to try for higher percentage claims on behalf of the low paid is counterproductive. Our system of free, or relatively free, collective bargaining means that the same percentage increase goes to the low and higher paid with or without children, and the resulting inflation hits the low paid hardest at a time when they have family responsibilities.
The only way to combat that problem is through child benefit. In 1955 the combined value of child tax allowances and family allowances was at its peak and we were not faced with so much pressure for large pay increases. If we are to move towards eliminating inflation there must be increases in child benefit above the rate of inflation to make low settlements acceptable to the low paid with family responsibilities.
The hon. Member for Islington, South and Finsbury raised the subject of housing. Like him, I see little justification for increasing the mortgage interest relief from £25,000 to £30,000. Unlike him, I have been saying so in this House for years. Because I usually speak between 6 pm and 8 pm, I am not reported. The best way to keep a secret is to speak in the Chamber and the easiest way to gain publicity is to mutter behind the hand of a journalist outside the Chamber. If one puts forward sensible ideas in the Chamber, it takes five to 15 years to get them accepted.
Another important matter, which ties in with many of the remarks made by my hon. Friend the Member for Kensington is that many of the tax changes in the past have occurred because of such things as mortgage interest. Employers and the Inland Revenue had to adjust tax codings each time someone moved home or there was a change in interest rates charged by building societies. The Government have made changes to help cut down that work so that the lender deals with the tax. I hope that if we make certain changes in the higher rates of tax we can eliminate mortgage tax relief at the higher rates.
We should aim over 20 to 40 years to ensure that housing help is concentrated at the time of family formation. In time, but gradually, we must get away from the idea that a mortgage of £20,000 should be worth four times as much in tax relief as insurance premiums. There is no social, economic, or moral justification for that and we should start to make changes. Given that there is a mortgage pool of money, we need a system that encourages people to borrow what they need when they need it and to pay it back when they can. I am fed up with reading in the family financial pages on Sundays about how sensible it is to keep a mortgage at the highest possible level and to keep it going for as many years as possible because it is the cheapest way to borrow money. That is purely a consequence of the tax treatment and it should be changed so that the mortgage system makes sense.
It is sad that we give greatest help for house purchase and pension contributions, which is not as good as giving the greatest help when people are caring for children. For those hon. Members who wish to spend their time reading Hansard, I refer them to a speech I made in a family policy debate in December and to another in 1977. It is all there 409 to be read, and with the new computer-assisted reference system in the Library I recommend it to all those who wish to look for ways to help the community.
The Queen's Speech deals mainly with legislation. We all support sensible legislation and much of what the Government put forward is sensible legislation and should be supported. But beyond that there is the example that the House can set to the country. I hope that more and more, in such areas as crime, we will get away from debates about retribution versus the effectiveness of the death penalty and move on to deal with crime as a whole. Juvenile delinquency is a great waste and a cause of much worry to many families. We must provide a help service so that when parents are worried about their children someone will listen to them and give them advice and effective help. That should happen when the parents are worried and not be left until society or the professionals are worried.
There are marvellous voluntary organisations, professional services, social services, welfare services, child guidance clinics and the probation service, but that is catching people too late. If we talk to teachers or those in what I call the "fire brigade" services, many will say that they know which families or children will cause trouble. It is expensive to provide services when the damage has been done to families, children or the community. The help and resources are poured in then. Why cannot we make those resources and help available at an earlier stage? That would bring the family into perspective in our social policy.
The hon. Member for Islington, South, and Finsbury mentioned rates and rent. I represent Greenwich, which made the classic mistake of putting up its rates by 59 per cent. to finance an increased spending of 20 per cent. Three times as much must be paid by business and domestic ratepayers and the elderly to achieve for every £4 only £1.30 expenditure. There is no justification or economic sense in that. Yet there was no rebellion from the local Labour party members. Why? Because there are fewer and fewer of them. The borough could have raised expenditure by 15 per cent. and raised the rates by only 5 per cent. That is a bargain. For every £1 it took off ratepayers it could spend an extra £3 because of Government grant. What worries me about the Labour party is that too often, as its ordinary members stop renewing their subscriptions, what is left of the Labour party makes decisions that do not receive the support of the electorate.
Different boroughs have different experiences. I can speak only of mine and do so with authority, confidence and clarity.
§ Mr. Bottomley
I try to be modest, but when people come out in overwhelming numbers to support me on my patch, I can talk in this manner. If rents had risen by 85p a week in my constituency it would have been possible for the burden of rent and rates combined to be lower than it is with a rents freeze and rates rising by 59 per cent. We should introduce legislation to control what Greenwich council and a few others like it are doing with the rates.
On some of the newer estates the insides of the homes are fantastic, and I understand why people want to buy them. But outside, especially around the garages, it looks like Beirut on a bad day. People bring in stolen cars, set 410 fire to them, they explode and it becomes an area of concrete debris. We shall have failed if we do not provide a system to encourage local authorities to ensure that the environment where so many people live matches both the people and the insides of their homes. There have been great improvements during the past 20 or 30 years. We are right to encourage local authorities to maintain and improve the fabric of what exists rather than attempt: more comprehensive redevelopment.
I hope that the Government will reach a compromise with the housing associations on the sale of homes. Through the help of another place, the housing associations managed to block the clause in the Housing and Building Control Bill, which would have retrospectively allowed tenants of charitable housing associations to buy their homes. The difficulty with not including such homes is that there is little justification for the Government to provide up to £650 million a year to charitable housing associations to add to their stock by about 20 per cent. a year. It would be better to give the money to local authorities in whose areas the right to buy is established.
The National Federation of Housing Associations and the Department of the Environment would be sensible to reach an agreement that would provide help to would-be tenants in housing need who wish to own their own homes. Moving from being a tenant to an owner-occupier is best achieved if one wishes to occupy the house in which one has been living. It helps keep a settled community, and stops one group in tenure from dominating an area and makes it possible for people to get on who might otherwise come here as Members of Parliament. While they would be welcome to come here and join us, if they move into the dominant housing mode of Members of Parliament who own their own homes they are able to go on living in the homes in which they grew up, in the way that I came to represent the people living in my area.
There are many other issues which I hope to raise in the next five years—
§ Mr. Andrew F. Bennett (Denton and Reddish)
If the hon. Gentleman has five years, I hope that he will not raise them all tonight.
§ Mr. Bottomley
I do not intend to raise them all tonight. If the hon. Gentleman intends to make sedentary interruptions perhaps he will join his hon. Friend the Member for Bolsover (Mr. Skinner), who owns the reputation of being the wittiest intervener in our debates. Obviously practice may help in making some interventions funnier. Alternatively, the ad lib which has been rehearsed outside and brought in to be used at a suitable moment can also be funny.
One subject that I must raise tonight is that of animal welfare. I was disturbed to receive a piece of paper from an alliance of animal welfare societies and charities saying, "Vote Labour, except in a small number of constituencies, where you should vote Liberal." If people believe that it is charitable or sensible to try to hijack one area of concern for one political party, they are making a grave mistake which will alienate their supporters and suggest that otherwise well worthwhile bodies which should be supported have got into the clutches of one political party. That would be a grave political mistake as well as a mistake in terms of fostering the welfare of animals. I am glad that one of the last acts of the 411 Conservative Government before the election was to bring forward a new White Paper from the Home Office, a document for which I had been campaigning.
We must also keep a sense of balance in all this. There were 10 times as many prosecutions for cruelty to animals during the lifetime of the last Parliament as there were for cruelty to children. I remind the House of an infamous BBC radio news programme one lunchtime which started with a detailed account of the killing of a baby in Australia, with, towards the end of the programme, the announcer telling listeners, "The next item may be distasteful to many people, who might wish to switch the radio off for three or four minutes." That was followed by a description of how five rabbits had their necks broken in front of a biology class in a school. Without making comments about such a biology class, I suggest that if we can hear the details of the murder of a baby and regard that as acceptable, yet regard the killing of five rabbits as unacceptable, we have our priorities wrong.
I look forward to the time when we are able to care for and represent not only the interests of animals but the interests of all families, including families in need, babies, young children, people during their years of working life, and those not in work, and people when they come to take their pensions. When we can do that, we shall have given ourselves a better reputation and can join cause across the Chamber of this House on many issues. Then we shall be able to start providing the sort of politics which go beyond Rab Butler's description of politics—being the art of the possible — more nearly to politics being the art of making possible what is right.
§ Mr. Laurie Pavitt (Brent, South)
I am sure that the hon. Member for Eltham (Mr. Bottomley) will forgive me if I do not comment on the subjects that he raised. He appeared to fire off so many Woolwich arsenal guns in so many directions that I should find it difficult to know which to follow.
I have had the privilege of hearing every maiden speech made today, and I have regarded them as some of the best performances that I have heard, and I have been in this place for quite some time. I commend all the maiden speakers. It is clear that we shall have an interesting House in the period ahead.
It will not surprise hon. Members to learn that I propose to concentrate on the National Health Service. The Gracious Speech might remind one of Sherlock Holmes' dog that did not bark. Considering the 1 million people working in the NHS and the fact that £15½ billion is spent on the service, the whole lot is boiled down to one sentence in the Gracious Speech:Further action will be taken to ensure that patients receive the best value for the money spent on the National Health Service.That is a masterpiece of saying nothing, and perhaps hides far too many of the intentions of the Government which are not being brought into the open.
The speech of the Secretary of State was typical and revealed his usual occupation of being concerned only with treatment and not with prevention; and in terms of the NHS overall, he was concerned mainly with surgery, acute beds and the hospitals but not with what is the whole basis of the NHS, and that is the service in a much wider context.
412 In terms of prevention, it has been revealed this week that whereas the Government talk of preventive medicine, when it comes to the greatest killers of all—carcinoma, emphysema and chronic bronchitis caused by smoking cigarettes—as usual, the Government have had rings made round them by the tobacco industry. The voluntary agreements which the Government have made with the industry are not worth the paper on which they are written. At Wimbledon this week the agreement which was reached last year was flouted by the British-American Tobacco Company. The agreement said categorically in section 13:The display of house or brand names or symbols on participants and their equipment or on officials and their equipment actively involved, and likely to come within the range of television cameras, is not permitted during the course of a televised activity.Despite that, this week again we had Martina Navratilova, the women's champion, wearing the Kim cigarette symbol, which consists of yellow, orange, red and brown wavy lines on a white background. The only change was that a small label which we saw last year saying "Kim" now reads "Top Line". The voluntary agreement says that that should not be done.
When I took up the matter with the Minister for sport last year, he assured me categorically that it would never happen again. In a letter the Minister told me:The British-American Tobacco Company (UK) were left in no doubt that I considered this to be a most serious breach of the agreement and that there must be no repetition. They are taking further measures to ensure this does not recur. I have now received from the British-American Tobacco Company a letter containing a statement of deep regret for the incident and an assurance of the Company's total commitment to both the spirit and the letter of the Voluntary Agreement.As I say, anybody watching television last week would have seen the company being able to renege on that commitment.
As for a profit-making business being able to run rings round the Government, nobody can do it quite so well as the drug companies. They get away with profits that amount almost to a rip-off. I remind the Goverment of the recent examination which showed that about £35 million in excess profits was being made, whereas a voluntary price agreement is supposed to be in existence to prevent such profits. I hope that an investigation will be conducted into the whole affair.
It is very worrying that two of the greatest recipients of those profits — two British companies that make medicines, Beechams and Glaxo—are two of the largest contributors to the Conservative party central funds and political funds. No Government should be prepared to sweep such a matter under the carpet. We shall hope to hear more about that issue from the Government Front Bench in the weeks ahead.
The Government say that they want to get the maximum benefit from Health Service funds. Why, then, do the Government not implement the Greenfield report on generic prescribing? I can offer the Government some help on this matter. My Bill on that subject was published on 22 April. It is easily available, and might save the Department a lot of drafting. If my name comes out of the hat, I am prepared to use my time. If not, I hope that the Government will use their time. The Pharmaceutical Society states that we could save £29 million on 10 medicines alone. If the Government want to get the 413 maximum benefit from Health Service funds, let us take £29 million out of the excess profits of the drug companies.
I am worried stiff about what is happening in nursing. I was able to attend the international conference of the European Dialysis and Transplant Nurses Association in the Barbican a few days ago. I was shocked and horrified to learn of the danger of death to which those devoted nurses are now subjected because of the greed of a patent-holding multinational pharmaceutical firm and the cash limits policy imposed by the Department. The Minister will remember the deaths in a renal department in Edinburgh a few years ago. He will be aware that people working in renal departments face a constant hazard. There is now a vaccine against the most prevalent risk, hepatitis B. There is only one manufacturer and one source of supply, and the cost almost goes through the roof. In consequence, each region and each district health authority operates its own resource allocation.
In most cases, all doctors working in renal units are vaccinated, and the nurses and technical staff are vaccinated according to the policy of the regional health authority. That is indefensible. It is outrageous that protection by immunisation should be given to doctors but not to nurses, and that in some cases nurses in charge of renal departments are told that they can have enough vaccine for a percentage of those working there, and have to decide which nurses to protect. The nursing officer in charge of a renal unit should not have to make that decision.
The Minister for Health should immediately intervene with the regional health authorities and lay down rules and regulations about vaccination of nurses and technicians employed in renal departments, who should not be regarded as second-class citizens it comparison with doctors.
I should be grateful if the Minister would inform me of the legal position. I am fairly certain that the Department would be liable if a nurse or technician died because they had not been vaccinated, and that there would be a very strong case against the Department for heavy damages. I do not expect the Minister to answer that question off the cuff, but I ask him to look into the matter and let me have a reply at a later date.
§ The Minister for Health (Mr. Kenneth Clarke)
The Government have had a policy of providing the vaccine against hepatitis B for those members of staff who are most at risk. I shall look into the matters raised by the hon. Gentleman and send him a written reply in due course.
§ Mrs. Dunwoody
Would the Minister also consider what is happening in some homes in my area, where a number of mentally handicapped children have been subjected to a bad outbreak? I hope that the Minister will give the same undertaking in relation to the staff there.
§ Mr. Pavitt
Nurses get a raw deal from this Government. Last year, after seven months of negotiations, the settlement worked out at about 4.5 per cent. over two years. The nurses accepted an assurance from the Government that they would be better off than most sectors of the NHS. However, in recent weeks the Government have given the doctors 8.5 per cent. Why are the nurses 414 second-class citizens once again? I should be grateful if in his reply, or at some future date, the Minister would give us some further information.
The review body on nurses' pay should have been established soon after I April. What is happening? Is it just that the election has intervened and prevented it from being established? The hon. and learned Gentleman knows very well that there must be a settlement. The body must be established and must consult and negotiate. By 1 April 1984 a pay demand will have to be met. The important point is whether he intends to accept the proposition that not only state registered and state enrolled Nurses should be included in that review but also nursing auxiliaries, assistants and all those participating in the nursing profession. It would be most unfair if the Minister were to seek, once again, to divide nurses into different categories. The review body should cover the whole nursing profession.
I should like to draw the attention of the House to the phrase "value for money", which is a euphemism for asset-stripping. We are witnessing the unprecedented sale of hospital land. It will be interesting to see to whom it is sold and who benefits from it. In my part of the country a hospital, Leamington park, with 95 geriatric beds is to be sold off on the casting vote of the chairman of the district health authority, who was formerly a Conservative mayoress.
The regional health authority, North-West Thames, has accepted that, so I plead with the Minister to intervene at ministerial level to stop the sale of that asset. After all, he will look at the papers, because he will have finally to pass them.
Time and again, the Secretary of State gives the House global figures, but the constituency experiences of Members of Parliament do not correspond with this tremendous success story. This morning I received a copy of my local newspaper, the Wembley Observer, and the banner headline states: "Murder of your hospital". It states:Victim of officials' panic, declares clergyman.Wembley hospital is to be turned into a geriatric hospital. Local general practitioners have already had the pathology department taken away from them. It is to go to another hospital on the other side of the borough. We are witnessing that hospital's creeping death. Local residents and citizens know well that the death knell has been tolled. Unless there is some intervention, yet another community hospital will be lost.
The signs and portents in the Gracious Speech bode ill for the ordinary citizen and his family. I can assure the Government and their supporters that we shall fight every further inroad into one of the greatest social edifices to be created by the very far-sighted postwar Attlee Government.
§ Mr. Deputy Speaker (Mr. Paul Dean)
I repeat Mr. Speaker's plea for brief speeches. The winding-up speeches are expected to begin at about 9 pm. Several hon. Members wish to speak beforehand, including at least two who wish to make their maiden speeches.
§ Mr. Robert McCrindle (Brentwood and Ongar)
Not for the first time I find myself speaking after the hon. Member for Brent. South (Mr. Pavitt), and not for the first 415 time we find ourselves participants in a debate on an aspect of the welfare state. Like him, I plan to concentrate on the National Health Service. With an aging population it can hardly be surprising that the demands on the National Health Service appear to be moving away from the centres of gravity that existed some years ago. The number of old people in our community is expected to rise as the decade progresses, and that means that the NHS must place more emphasis on their needs.
If there is a movement in the need for health provision, it cannot be surprising if at the same time questions—some of which we have never dared to pose before—are asked about whether we have still got Health Service financing right. Although there was a great reaction—some would say an over-reaction — when the Think Tank report was issued, or, more accurately, leaked, last September, I, in retrospect, rather welcome the fact that such suggestions were made. It allowed us to consider, perhaps for the first time in a long period, whether the basis of financing the National Health Service should in the immediate future continue to be as it has been since it was introduced. There have been suggestions that we should consider a different method of financing it.
Some hon. Members are aware that I am associated with the insurance industry. It has been suggested that one of the ways in which the NHS could be financed, as an alternative to the present basis, is to adopt something close to what applies in one or two continental countries and to move to an insurance basis. That would require each of us who can afford it to effect our own insurance policy against the cost of hospital or other medical treatment, and there would be a subsidy for those who could not afford the premium.
I make it as clear as I can that although I understand the efficient operation of the insurance principle in other areas, I would be opposed to any suggestion that we should move from the basis that we have had since the Health Service was introduced to the insurance principle. It is neither practical nor fair. If I do nothing else this evening, I hope to urge upon my right hon. and hon. Friends on the Front Bench the fact that, in the opinion of some of us, the source of finance for the NHS, having always been principally from taxation, must continue to be so. That is the only fair way in which to proceed.
On the other hand, I make it clear that although those words may find a ready echo on the Opposition Benches, I am also very much in favour of encouraging the private sector health service. I do not take the view that is held by almost all Opposition Members—that it is somehow an unnecessary addition to our health provision, which does little more than siphon off what would otherwise go to the NHS. On the contrary, I believe that the two health services are parallel and complementary. If one tries to approach the matter in a non-doctrinaire fashion, one can see opportunities for the sharing of facilities between the NHS and the private health system. That is to be applauded rather than deplored. I want to see a developing partnership.
It is sometimes underestimated how effective the system has been in keeping our doctors within the United Kingdom and giving them the freedom to operate not only within the NHS but within the private sector. The advantage of the private health system in relieving the waiting lists of the NHS, at least for minor operations, 416 should not be overlooked. However, I repeat that the NHS must always be the principal source of health care and that it should be financed mainly from taxation.
All that underlines the great need for us to keep costs under control within the NHS. Surely no hon. Member on either side of the House fails to recognise the real need to achieve the control of costs. I do not wish to make more than a passing reference to the level of staff costs in the NHS. It is a labour-intensive industry, but it has occurred to me on many occasions that perhaps an inadequate balance has been struck between the amount of money that we have spent on equipment and buildings on the one hand, and, on the other hand, on staff salaries and so on. I hope that the Government will keep a close watch and try as much as possible to keep those different costs well balanced.
I am sometimes told that it is immoral to impose any sort of charge on NHS patients. I know that Opposition Members believe that prescription charges are evil in principle. I shall not return to the history of the Government who first laid the ability to charge for prescriptions before the House, but I believe that everyone would acknowledge that, if the patient can contribute without undue difficulty, we should not ignore that possibility. It is not possible for the ordinary man in the street to contribute towards the building of hospitals or towards the setting up of a doctor in general practice, but it is certainly possible for him to contribute by paying a prescription charge. When one recalls that about 60 per cent. of the population is not expected to pay, it is not outrageous to expect the remaining 40 per cent. to contribute towards the cost of medicine. The present level of prescription charges is £1.40 while the full cost per prescription under the National Health Service is about £6. I believe that it is correct for us to continue to apply these charges, which should be increased year by year in line with inflation.
I believe that it is appropriate to move towards the privatising of cleaning and catering services within the National Health Service. We should be taking an unduly extreme view if we were simply to say to the health authorities in some doctrinaire fashion, "You must put these services out to private industry." The health authorities should be obliged to put them out to tender. If the services can be done as well and cheaper by private contractors, the health authorities should be expected to use them, not least because the savings which can be achieved can be fed back into the Health Service, thereby increasing patient care.
I am sorry that the hon. Member for Brent, South has gone because he made great play—we have heard him say it many times before—excess profits made by drug companies. In so far as excess profits have been claimed by the drug companies, no one could fail to endorse the hon. Gentleman's call upon the Minister to investigate the position thoroughly. I have every reason to believe that that is being done.
The hon. Member for Brent, South seemed to imply that moving to generic substitutes would somehow create a vast new supply of cash for the Health Service. I wonder whether, in expressing that view, he takes into account the fact that the drug companies must continue to be the principal source of research into new drugs to attack disease. They have been successful in the past. I do not say that I should oppose a movement towards generic substitution, but I ask the House to be careful not to go in 417 that direction in such a headlong rush that it fails to recognise the benefits that can come from the profits made by drug companies which are invested in research and development for the benefit of new products.
I want to talk about occupational pensions, which are another responsibility of the Minister who is to reply. I suspect that during the election campaign all candidates were confronted by the view that something must be done about the vexed question of "early retirers" within the occupational pension schemes. We rightly encourage the greater mobility of labour at a time of high unemployment, but it seems to me that for far too long we have failed to tackle the problem of the loss of pension rights to a man who changes his job possibly two or three times during his working career. It is easy to suggest that, by some sleight of hand or legislation, that could be achieved painlessly. In my opinion, that is not so. However, I believe that there is a strong case for my right hon. Friend the Secretary of State to lean heavily upon occupational pension interests with a view to solving the problem within that sector. That could perhaps be achieved through a clearing house.
If the occupational pension world is unable to solve the problem itself, the Government, sooner or later, as the Conservative party manifesto makes clear, will have to introduce legislation. That legislation will have to be fair to the employer, fair to the employee who stays with a company throughout his working life and fair to the person who chooses to change his job once or twice during his career. A solution is unlikely to be found without some increase in the contributions from all three parties. However, failure to attend to the issue for that reason would be a failure to recognise that it is a matter of considerable concern to a growing number of people.
In the short time that I feel has been at my disposal I have touched on two important strands under the heading of the welfare state. I hope that we can continue to have a National Health Service financed primarily from taxation. At the same time, I hope that we can continue to encourage the development of a private health service. I trust that my colleagues on the Government Front Bench will take on board the need to recognise the problems that are created by job changes in relation to occupational pension schemes.
§ Mr. Sean Hughes (Knowsley, South)
I am grateful for the opportunity to make my maiden speech in this debate. Having talked about the history of the House for the past 13 years, I am well aware of the privilege and responsibility which the electors of Knowsley, South have given to me. The constituency consists of four communities, which are Huyton, Halewood, Whiston and Cronton. Halewood, Whiston and Cronton were represented during the previous Parliament with distinction by my right hon. Friend the Member for Halton (Mr. Oakes).
The major part of Knowsley, South is the town of Huyton, which for 33 years was represented by Sir Harold Wilson. Huyton and Harold Wilson have become synonymous. During the election campaign I read a newspaper article entitledExit the Man who gave Huyton to the World".The House will recall the illustrious career of my predecessor as a Cabinet Minister, Leader of the Opposition and four times Prime Minister. I confidently predict that the last achievement will not be emulated by the present Prime Minister.
418 In my constituency Harold Wilson is remembered simply as Harold. He was as much at home locally as he was in the great offices of state. If I can win the loyalty and affection of my constituents as he did over 30 years, I shall have achieved something very real. That is perhaps the greatest tribute that I can pay to him. In my tribute to my predecessor I wish to refer to Mary Wilson, who has come to be regarded by my constituents with equal affection.
If I am to maintain the loyalty of my constituents, I shall have to do something to alleviate the daunting problems that they face. It is a new constituency because of the artificial boundaries that have been redrawn and because the bulk of the constituency has been developed over the past 25 years. Knowsley, South faces a unique combination of problems. It is not an area of homeless thousands and it does not suffer from insufficient schools. There are no staple industries that are apparently outliving their usefulness. The disease which gnaws at the foundation of my constituency is not easily understood by contemporary observers of urban decay. The large council estates that characterise Knowsley, South are a graphic illustration of what Christopher Booker called the evaporation of the 20th-century dream.
The attempts to rebuild our cities and to outlaw the slums in the 1950s and 1960s have seen exciting hopes evaporate into the reality of estates that are monotonous labyrinths, bleak, grimly regimented and dehumanising. That is not to deny that we have made progress. To do so would be absurdly ungenerous as well as historically inaccurate. I wish to pay tribute to my local authority in attempting the Herculean task of putting right the wrongs with ever-diminishing resources. The stark fact is that local authorities lack the resources to tackle the work that must be done.
In 1979 Knowsley received £6.5 million in Housing Act subsidies. This year the figure is nil. Total rebates and subsidies this year are a third of what they were in 1979. Dry statistics may often be meaningless, but the clear and unmistakeable message that I bring to the Government is that large housing estates will inevitably remain centres of acute malaise as long as resources for their improvement are withheld. I am talking about ordinary people whose morale is being sapped by such depressing and disheartening matters as vandalism, graffiti, litter and the general neglect that overlies the basic inadequacy of the design of our estates.
One of the most urgent, obvious and, perhaps, major problems in housing in my constituency in terms of scale is repairs. The depressing fact is that physical neglect has been intensified by excessive wear and tear. We shall never improve the morale of our tenants if the Government starve local authorities of resources to maintain their properties and environment in reasonable repair. Unless we do that, the definition of a problem estate will be a self-fulfilling prophecy. It is no use calling for community responsibility as community spirit will be reduced to a hopeless sense of powerlessness. Isolated decay and increasingly delinquent neighbourhoods are being formed and tenants will become increasingly stereotyped and self-selective. Estates become real problems as that is how they are regarded since the Government have lacked the imagination to tackle the problem at source.
A major factor destroying morale in Knowsley, South is that inadequate housing compounds the felony of unemployment. The failure to provide job opportunities in 419 areas such as mine has meant that we have shifted to a new location the social problems we hoped to solve by building the estates in the first place. Several parts of my constituency have unemployment levels far above even the Merseyside average. With migration and a lack of training provision, the skill structure of some of our communities is even more unbalanced and certain areas are becoming unemployment ghettos.
The conditions and circumstances to be found in my constituency derive from a multiplicity of factors, each one exacerbating the other. If housing provision is inadequate, coupled with high unemployment, what chance have our schools to achieve excellence or to create the ethos in which excellence is sought, what chance is there of making any significant improvement in the physical and mental health of those who must live with the everyday pressures of such deprivation, and how can we expect the police and the public together to produce civilised standards of what is euphemistically called law and order?
In Knowsley, South we are seeing what has been called dynamic poverty, not poverty in the sense of lack of money—although that is manifest in its acutest form—but poverty of the environment, of facilities and of recreation. It is poverty of all those things that make life worth living, whether or not one has money.
I am under no illusion that my maiden speech will hit the national headlines, but unless the Government attend to problems such as those in Knowsley, South, those problems assuredly will hit the national headlines of their own accord. In 1972, a Shelter report stated:If urban society does not alleviate the despair of individuals in our urban junkyards, it will surely reap the retribution it deserves".At best the Gracious Speech demonstrates that the Government lack the imagination to comprehend the enormity of the problem we face. My constituents are not seeking some historic act of class revenge. They are not asking for the barricades to be erected. They are simply saying that society seems to have doled out to them a pretty rotten fate — and since 1979 "dole" has been the operative word.
The people of Knowsley, South are not asking for the moon. They simply want a fair share of the national wealth, and desperately want to contribute constructively to increasing that national wealth. In other words, they want jobs. In that very reasonable ambition, the interests of the more prosperous regions should be just as deep as ours, not simply out of a sense of natural justice, but out of a sense of the national cost that will have to be paid if areas such as mine are ignored much longer.
§ Mr. Harry Cohen (Leyton)
I begin by paying tribute to my predecessor as the Member for Leyton for the constituency casework that he undertook, and I apologise in advance that I cannot abide by the parliamentary convention that a maiden speech should be non controversial. I feel too strongly about the matters on which I wish to speak.
I shall, however, begin on a lighter note. A Jewish colleague on the local council on which we served, when commenting on the Prime Minister's recent Cabinet changes, asked whether a Jewish Home Secretary, a 420 Jewish Education Secretary and a Jewish Chancellor of the Exchequer meant that there was likely to be compulsory circumcision. The answer is, "Probably not", but it certainly means compulsory cuts, not those in the Jewish male tradition, but those of the welfare sort.
Some people, many of whom are in this House, for their own political purposes deny that there have been cutbacks, and others delude themselves into believing it. But those connected with our welfare services, and those at the sharp end—the clients— know differently. I was a leading member of a local authority that had an excellent programme for home building, repair and improvement. From 1979, after the election of the Conservative Government, its housing investment programme, over which the Government held the purse strings, was cut 40 per cent. in one year, another 40 per cent. on the reduced figure the next year, and 10 per cent. on top of that the year after.
Those cuts have meant that many more of the local residents than would have been the case are now living in had conditions. Homes are in disrepair and families are unable to get the moves they require from tower blocks or neglected estates.
Our education service was the envy of many. Year after year, Waltham Forest appeared in The Guardian among the top 20 education authorities for its quality of education and excellent pupil-teacher ratio. Now, a mixture of cuts that are being imposed by the Government and the local Tory-Liberal administration means that that service is retreating into mediocrity. Schools are being closed and teachers are being sacked. Perhaps the greatest source of anxiety locally is the cuts in the Health Service. I shall read from an article that appeared in the local paper. I make no apology for reading it in full. It is headlined, "More cuts at Whipps." It reads:At least 820 people will not he treated as expected at Whipps Cross Hospital this year. They are the 10 per cent. non-immediate cases — who include cancer, kidney and hernia sufferers—axed in a package of cutbacks that was agreed last Thursday by the district health authority.The other decisions affecting Whipps Cross include: Closure of a ward; One less waiting list patient being seen for every emergency dealt with; Outpatient attendances cut by 3 per cent. (1.000 new patients and 4,000 total attendances);Elsewhere in the district, the authority's decision involved: Staff reductions at many levels; Reduced spending on staff uniforms, gardens, catering — and 'stringent control' over disposable bedding; Reduced heating and lighting levels at Forest and Jubilee hospitals; Chopping the supplies of Guinness and cordials to Langthorne and Harts patients.In this case, Guinness is not a luxury, as many of the elderly who drink it are frail and it provides nourishment in the form of calories and iron.
Describing the cuts, the local health administrator said that many of the patients would have to go to other hospitals which already have long waiting lists. He said:Some people could have to wait another year or two to be seen and some, depending on how serious their complaint is, might give up altogether. Others could die while waiting.I also deal with cases involving discharge from hospital at 3.30 am. One such patient had had a mild heart attack the previous night. Presumably, discharge at that time is the result of a shortage of beds.
On 7 June in the "Election Call" radio programme, the Prime Minister said:Do you concentrate your medical services in the bigger hospitals where you can have absolutely every facility, or do you keep more of the cottage hospitals?; and one tries in fact to have 421 something of both. I mean I personally would like some of the cottage hospitals still to stay, because I think there are many things that they can do which don't need to go to a big hospital.The Prime Minister's answer shows that cuts and closures are occurring and that more are planned both for large and small hospitals. In view of her sentiments about small cottage hospitals, we should like to know why Government cuts will entail the closure of two such hospitals in our area. Harts and Lugano care principally for elderly patients. In fact, they are in the constituency of the Secretary of State for the Environment, but their closure will adversely affect health care for my constituents as well.
In addition to the declining hospital provision to which I have referred, we must bear in mind the sacking of more than 100 staff from a local hospital for the elderly — Langthorne — and the announcement of the proposed closure of Claybury by the end of the decade. It is the only hospital for the mentally ill in the area. The respectable "front" for those hospital closures is community care. It is the idea that the elderly and others who are at risk should be looked after by the community in their own homes. That approach is laudable and relevant for many elderly people, but there are many for whom it is not relevant. They need proper care in community homes, not their own homes. In Leyton and Leytonstone about 4,500 old age pensioners live alone and more than 6,000 live in couples or in groups. Yet the provision is 113 permanent places in homes for the elderly, five short-stay places, 12 day-care places and 187 warden-supervised units. That amounts to just over 300 places, which is inadequate.
It is no wonder that a couple in their seventies recently came to me because they could no longer care properly for a parent of over 90 who lived with them. The couple thought that she should be cared for in a home for the elderly. The old lady agreed and wanted to go. Three independent doctors said that that would be best, as did the local clergyman who took a keen interest. Only the local council held out against the move because of the shortage of places. Community care cannot be an excuse for having insufficient community homes.
Community care services are also suffering from the Government's cash cuts to local authorities. Under such circumstances community care means sending someone home to die or sending them back under the railway arches.
A local case brought to my attention involved a bedridden, doubly incontinent old lady who was released from hospital into the care of her blind, 80-year-old sister. She was found in a confused state in a wet bed with an unprotected electric light bulb switched on inside her bed. If she had touched it she would have been electrocuted. These are examples of community callousness, not community care. As the newly elected Member for Leyton I shall do my best to reverse the misery caused by the cuts and to expose those with overall responsibility for causing it—the Conservative Government. I won my mandate on care, not cuts. That is what I am here to fight.
§ 9.2 pm
§ Mrs. Gwyneth Dunwoody (Crewe and Nantwich)
Seldom can a Front Bench spokesman have had the privilege of welcoming eight such interesting and lively maiden speeches. We have heard speeches of vigour, passion and sincerity. Those of us who remember what it 422 is like to face the House for the first time must be impressed with the talents and abilities of the new Members.
My hon. Friend the Member for Stoke-on-Trent, Central (Mr. Fisher) is one of my near neighbours. He will be a tremendous asset to the area. I consider his commitment admirable, as I do his resemblance to his parent for whom I have a soft spot.
The hon. Member for Halifax (Mr. Galley) mentioned his predecessor, a woman of great warmth and wisdom whom I admire and who was for many years an ornament of the House. She will be much missed, but I am sure that we shall look forward to listening to the hon. Member's contributions.
The hon. Member for Gordon (Mr. Bruce) spoke of his connection with his constituency which contains the largest electorate in the United Kingdom. He paid tribute to Aneurin Bevan's commitment to the NHS. I should be delighted to assist him establishing an ambulance service in his area because that would provide good health care in a rural area.
I hope that I shall be forgiven for paying special Tribute to my hon. Friend the Member for Middlesbrough (Mr. Bell) for the facility, ease and warmth with which he addressed the House. He was impressive. I was glad too that he paid tribute to his predecessor, Arthur Bottomley, a man who had many friends on both sides of the House.
My hon. Friend the Member for Worsley (Mr. Lewis) said that it was like the first day of National Service coming to the House, although he was not impressed with the assistance that he received in the form of information. If he continues to make speeches of such brilliance, he will be the one who is informing his electorate and the House.
My hon. Friend the Member for Islington, South and Finsbury (Mr. Smith) told us of the problems of the inner city areas and said that he had more than one in four unemployed in his constituency. I understood why he did not feel entirely able to pay wholehearted tribute to his predecessor, but that gentleman was a man of some parliamentary skills, as my hon. Friend said, and his individuality will be remembered with considerable interest. I am sure that his successor will admirably serve the constituency.
My hon. Friend the Member for Knowsley, South (Mr. Hughes) has a new constituency which will be well served if he speaks with such feeling on the dynamic of poverty. If only we were able now to solve some of the problems of some of those estates, the morale of which he talked would be rapidly repaired and the houses would once again begin to be homes for those who deserve them.
My hon. Friend the Member for Leyton (Mr. Cohen) spoke with great vigour about the NHS, and we understand and share his vigour. It is outrageous that there should be 10 per cent. non-immediate cases waiting for treatment for yet another year at the Whipps Cross hospital. I am sure that my hon. Friend will be an active and lively advocate of the needs of those people.
Along with a great many highly dangerous policies, the Gracious Speech is depressing because it has so little to say about the true needs of the people. It is noticeable that whenever the Prime Minister speaks of welfare she does so in terms of money. Sometimes she talks about value for money and sometimes of cost. For the Prime Minister, welfare is something handed by the rich to the poor and written off in tax returns as charitable donations. Occasionally, when speaking of the NHS, she has been 423 known to translate numbers into people but only for doctors or nurses, never for patient care. For her, the NHS has been a necessary evil to be tolerated at least until the general election was over.
The Tory party that the right hon. Lady leads is different in kind from its post-war predecessors. Support for the less fortunate is an aberration, in its view, or a misunderstanding of what is necessary to make people work. In the capitalist society of Margaret Thatcher, penalties are better than benefits and privilege than compassion. She will not tolerate those who cannot keep up or those who urge restraint. Hers is the unstoppable juggernaut and the next object that she intends to run over is the NHS.
The Conservative party manifesto was more interesting for what it did not say than for what it said. It promised:We shall continue to make extra provision for those parts of the country in the North and the Midlands"—I am delighted to hear that the Conservative party has heard of the north and the midlands—which have always been comparatively short of resources.Scotland, Wales and southern England are to get nothing.
Even when the Conservatives promise more, there is no guarantee that that more will keep up with inflation, let alone cover the deprived areas of the midlands and the south. They reject the idea that the state can and should do everything, but how much will they allow the state to do? They will brighten up shabby walls but not build new ones. They will develop new ways to encourage private giving. The Secretary of State tells us that there is not a compulsory insurance scheme, and said that the document that the Labour party quoted has the least sinister title that he has ever encountered. It is entitled "Co-operation between the NHS and the private sector".
It is true that the right hon. Gentleman carefully quoted some parts of the document, but he was extremely selective. For example, he did not say that in the section on care of the elderly we are told:Health authorities could assess the scope for contracting with nursing homes where charges average between £135 to £200 a week for the care of elderly NHS patients, so 'freeing' NHS acute beds and enabling unsatisfactory geriatric accommodation to be closed.That is not a particularly revolutionary idea. Indeed, some authorities already do precisely that.
Nor did the Secretary of State quote the next paragraph which reads:Health authorities could make use of available independent sector capital by arranging for private companies to provide facilities which the authorities could contract to use. (We know of one company with extensive experience of running nursing homes in Canada, which is interested in a development of this sort).It is true that that should be read in conjunction with the changes that were made by the latest NHS legislation which allows the capital of old people who are put into part III accommodation to be taken into consideration when assessing the charges that they will have to pay. Most old people have only one basic asset—their home. I am not sure whether they are yet aware of the extent of the changes that will take place in the NHS in future in geriatric care.
Only last week the Secretary of State told the National Association of Health Authorities that the NHS will continue to be funded mainly from taxation. Does that mean that the present system of tax-based finance is to be 424 diluted by the introduction of charges for medical care? It is true that the Prime Minister told the Daily Express this week that we need a health service, although she was careful not to specify exactly what she meant by that. There was no commitment in the Conservative manifesto to the continuation of the NHS, to new funds or to any attempt to improve the facilities that are needed to provide a reasonable level of patient care.
By the end of the election campaign even the numbers game was going to the heads of Conservative Ministers who, in a desperate rush to refrain from talking about anything but doctors and nurses, were quoting wilder and wilder numbers. To go from 6,500 to 7,500 doctors in three weeks takes some doing, even for bright young public relations experts. However, the burden of the message was simple. The Tory party has supported the NHS in the past. Now it will be looking for a different formula.
There have been innumerable Think Tank reports, but during the election campaign the true quality of Tory forward planning was revealed by the document that has already been quoted. We should now see how the NHSmight make more effective use of non-NHS facilities to meet the needs of their localities".That included putting the elderly out to grass in private homes and part III accommodation for which they will be charged, selling off hospitals and wings of hospitals to private firms and allowing the use of NHS facilities by private companies.
Lest it be thought that my objections are purely political, let me quote the response of two regional health authority chairmen to that document. They said that it hadenormous implications for the NHS".The NHS should discharge its responsibility for medium and long-term care by paying for patients to be located in private sector facilities.
The future is clear. For the new Tory party, health care can be defined as, first, a top layer of fee-paying patients who will enjoy all the benefits of the NHS with rapid access to high-powered technology. After all, they will have provided themselves with some means of footing the bill. Then there will be the lesser mortals, those who are unable to get their bosses to fork out for the same amount of insurance. The hon. Member for Brentwood and Ongar (Mr. McCrindle), a previous chairman of the Conservative health group, made it clear that many insurance companies do not welcome the responsibilities that they see themselves having in future.
Finally, there are the uninsurable who will be at the bottom of the pile. They will be the mentally ill, the chronically sick and the geriatric. Every part of the service that can be forced into the private sector will be handed over. Thus the awkward issue of ancillary workers will cease to exist. Doctors will once again be allowed to dominate—up to a certain expenditure level dictated by the patient's income—and the private health companies will at long last be satisfied. They will have obtained exactly what they were after — access to staff, equipment and facilities, and the right to cream off any profit that they can get. The National Health Service that will be left under the Tory Government will be a shell for the harbouring of foreign bodies—a source of food for the parasites.
It must be made clear that the thought processes that make it possible for the Government to think in this way about the National Health Service are the same thought 425 processes as the ones which say, "If one cuts the allowances for the young, they are bound to enter any so-called training scheme; if one lowers unemployment pay, one will force the unemployed back to work." It is immaterial that there is no work, that the sick cannot get insurance or that the old cannot pay for private nursing homes. Where necessary, of course, the state can always fund some facilities—so long as they are kept at a level inferior to those provided for the more privileged.
No matter how often Ministers prate about their commitment to the National Health Service, what they have done in reality is to shut down wards, to cut the number of beds available, to cut services and to underfund basic facilities. Now they will attempt to sell off the hospitals and to asset-strip the district health authorities. Some district health authorities already have the message and are preparing to sell off every available piece of land to developers in order to placate their new masters.
The South-West Thames regional health authority is to sell 570 acres on five hospital sites, which is almost three times the amount sold in the whole of last year when 199 acres were sold. The motive is simple. More than 60 per cent of the patients are over 65—they will not get better but they cannot pay their way. So, in future, health authorities will be increasingly faced with an extra burden and they will farm out their geriatric patients into part III accommodation.
At the same time the health authorities are facing the threat of forced privatisation. Let us be clear: that is what the Tory party has in mind. Last week the conference of the National Association of Health Authorities passed the following resolution:this conference … believes that mandatory contracting out of hotel services will prove counter-productive; that each health authority needs to be committed to economic as well as operational effectiveness in these services, but that the decision as to whether or not to contract Out all or specific services should be a matter for individual DHA choice, having considered and identified the standards of quality and cost-effectiveness required within each service.The Secretary of State promised these conditions for support services but in an earlier speech, when reference was made to the Calderdale hospital, it was said that whatever happened a number of options would now be offered to the patients of that area. It was not pointed out, however, that Ministers went to argue with the authority about the position and said that it should accept privatisation despite the loss of £170,000 to the DHA. On four occasions the Ministers have tried to push through privatisation; on four occasions the authorities have rejected it. Now we shall be faced with an even more determined attempt to cream off the profits. The staff increasingly understand that the Government have no real wish to improve their conditions of work. The nurses who were frequently quoted with approval by the Secretary of State during the NHS strike have not benefited from that long-promised review of their pay structure. After six months, all that has happened is that there is a sad little two-sheet document which complicates a great deal more than it solves.
The new body will have to decide for itself how to operate. It will be staffed by people with no experience of the NHS. The link with the Whitley councils has not been properly worked out, as only pay is to be discussed by the new body and not conditions of work, which are an integral part of any pay,negotiations and will still come 426 under the Whitley council machinery. The review body can be easily overruled if there are "clear and compelling reasons" for doing so.
What about the other aspects of nursing life? The Nursing Standard said this week that some parts of the housing provided for nurses have become so bad that they are slum areas. Not one bath or sink has a plug. Yet after giving the nurses 12 per cent. over two years, the Government have raised their lodging charges by 60 per cent. at a stroke.
Perhaps one of the solutions that the Secretary of State has in mind for the nurses is also to be found in the consultative document, which says plainly that it will be convenient, where necessary, to hand over nurses' homes to the private industry and to charge an economic rate. The Government are really saying that new hospital development could involve new purpose-built housing units run on a commercial basis but with rents that staff can afford. If the Secretary of State seriously thinks that nursing staff can afford to pay a commercial rate for their accommodation, he had better consider how he will pay for the enormous rise that the pay review body will have to give nurses in the first year.
The consultative document also suggests that existing staff quarters might be sold to private companies and run on a commercial basis, or the staff accommodation might be leased to the health authority with or without private management. The Secretary of State said that the document is not sinister and should not be taker, as a plan for the future of the NHS. He said it would be effective only on the fringes of the NHS. Who is it in his Department who does not listen to what he says? Who is it at such a senior level who can frame a number of basic changes and put them out as a consultative document without his having seen it? That appears to be the burden of his remarks. He has spelt out a change so major that it does not matter if he says that he is prepared to remain in charge of the NHS. By the time the changes have been brought about, there will be no NHS. The cost to the patients will be very great indeed.
If the Secretary of State is really looking for a way to make money for the NHS, why does he not have a go at the drugs industry? It is strange that a Conservative Government commissioned the Greenfield report. The chief scientific officer of the DHSS was asked to look at the expenditure on drugs in the NHS. He produced a report that was so hot to handle that the Minister sat on it for more than 12 months before he could bring himself to discuss it. It was an effective document. That has been made clear by the publicity campaign now being mounted by the drugs industry which last week suggested that cures for cancer and multiple sclerosis can be found only if it is allowed to continue to pocket the 23 per cent. return on investment that it has cheerfully lifted from the NHS. Mr. George Teeling Smith based his wise predictions on the assumption that the doctors researching into those diseases were wrong in thinking that cures could take far longer than 20 years. Of course, his salary depends on the drug companies.
But the Minister is responsible for the NHS. Will he retrieve the £33.2 million that the drugs companies have taken in unfair profits? Will he give the House a guarantee that his Department will in future monitor the effect of transfer prices, and so keep drug company profits under control? Will he accept the PAS recommendation that profit levels should be 17 per cent. rather than the 20 per 427 cent. which, for the drug companies, has meant 23 per cent. or more? Will he ensure that if these problems arise in the future they will be dealt with as and when they arise, and that he will not wait for some arbitrary time limit to expire before he acts to save cash for the National Health Service? We know that the movement towards generic drug substitution would save the National Health Service enough to wipe out all prescription charges, or to improve patient care considerably.
The Government speak frequently of the need to spend more money on patients and less on other aspects of the National Health Service, but they are slow to tackle an abuse by a major drugs industry. Let them demonstrate the commitment that is essential if they are serious about the need to improve patient care. What has happened has been the very opposite.
When he opened the debate, the Secretary of State said that children would benefit from the policies in the Queen's Speech. There are 2 million children in this country whose parents are on supplementary benefit, and who will have only a 4.3 per cent. rise because their child benefit is swallowed up in the incomes section of their social security benefit. The pensioners will be in trouble too. In real terms, they have lost a considerable amount of money.
Worse still, it is clear that the continuing rise in unemployment will place on the NHS a burden which it will be increasingly unable to bear. The cost of unemployment to the people cannot be measured only in terms of loss of finance. It has to be measured in terms of the social pressure, the increasing resort to psychiatrists and the increased need for support in families driven to despair by inability to earn enough bread for their own welfare.
Under this Government there has been a consistent attack upon those least able to cope with the problems engendered by Conservative policy. If we continue to add more and more young people to the numbers on the dole and more and more middle-aged people to the unemployment figures, the Minister will not only have a responsibility to improve benefits and the provision for the National Health Service; he will have a very much simpler responsibility to look, for once, at the way in which the Government treat ordinary families with disdain and contempt, and to wonder whether he is happy with the vision of a Conservative future that he has presented to the House.
§ The Minister for Health (Mr. Kenneth Clarke)
First, I should like to apologise to those hon. Members who took the opportunity of the debate on the Queen's Speech to go slightly outside the field of welfare and to discuss matters for which my right hon. and hon. Friends are more directly responsible than I. For instance, my hon. Friend the Member for Bedfordshire, South-West (Mr. Madel) will receive a letter from my hon. Friend the Minister of State, Department of Employment, on his points about the new training scheme. Similarly, my hon. Friends the Members for Bodmin (Mr. Hicks) and Saffron Walden (Mr. Haselhurst) made general speeches. I and my colleagues have noted what they said, but I shall not reply to them this evening.
428 I also apologise to the maiden speakers. They have been so numerous that it is not possible to give them the full courtesy of responding to them individually and paying them the usual compliments. I shall, however, try to deal with all their arguments about the welfare state. The sole maiden speaker on the Government Benches was my hon. Friend the Member for Halifax (Mr. Galley). My right hon. Friends and I are particularly glad to welcome him to our ranks. It was obvious as he spoke—although I only discovered it to be the case afterwards—that he had knowledge of these matters, and I understand that he brings to the House the experience of being a member of a social services committee of a county council.
To mention among the eight opposition maiden speakers those who most caught my ear would be invidious. The hon. Member for Middlesbrough (Mr. Bell) and the hon. Member for Gordon (Mr. Bruce) both particularly attracted the House, but all the others spoke with considerable passion about their constituencies and political beliefs. It is obvious that we must treat them all with considerable respect now that they are fully-fledged Members.
I was glad that the tradition that maiden speakers should make non-controversial speeches was, on the whole, abandoned by at least three-quarters of those who spoke. When I came to the House in 1970 it was more or less honoured by those who entered at that time. I fell neatly between the two stools when I made my maiden speech. But as the hon. Member for Islwyn (Mr. Kinnock) said, who now aspires to be the Leader of the Labour Party, it was not followed by him when he made his maiden speech on entering the House in 1970. I seem to recall being present at the time. He made it on the subject of the National Health Service and the social services, having been a member of a regional health authority.
I did the hon. Gentleman the courtesy of re-reading his maiden speech. It was a good speech, given the political views of the hon. Gentleman. Indeed, it was almost the same speech as he made today, 13 years later, and I remind the House of the point of view that he took on that occasion. He said:Perhaps I have a suspicious mind, but the South Wales valleys breed suspicious minds, and I have reason to believe that the 'one nation' party is conducting a survey of the Welfare State system and the National Health Service with a view to undertaking extensive mining operations. Doctors and nurses who are so desperately needed in the public health system will be sucked out of the pool of medical manpower into private medicine, where they will be available to few people. New developments in medical technology will become available in the first instance and for some time to come only to people who can afford to pay either through heavy insurance premiums or directly. Public confidence in the National Health Service will be eroded by governmental neglect and by the garish shop window of private health schemes."—[Official Report, 13 July 1970; Vol. 803, c. 1183.]That, he declared within a month of being elected, was what would happen to the NHS under the Heath Government, the most right-wing, anti-NHS Government elected since the war, as the hon. Gentleman would have called that Government. No doubt he warned his constituents that that would happen if they voted Conservative.
Those were the sort of remarks that the hon. Member was using at that time, and he still uses them. They were not true then; history proved him wrong on that occasion and history will prove that his allegations now are tendentious political nonsense. The hon. Gentleman has 429 not moved on. Indeed, on that occasion he was speaking to a motion tabled by the then Opposition to the policies of the then Conservative Government. It was moved by Mrs. Barbara Castle—who, with respect to her, was a slightly trimmer, red-haired version of the hon. Member for Crewe and Nantwich (Mrs. Dunwoody). The motion was familiar old stuff to hon. Members who had heard previous debates on the NHS:That this House expresses its anxiety that the unrealisable election commitments entered into by Her Majesty's Government are likely to lead to damaging cuts in the social services, including the National Health Service; calls on Her Majesty's Government to maintain the expanding programme of hospital building projected in the Labour Government's Public Expenditure White Paper … and reaffirms its belief in a comprehensive National Health Service giving equal treatment to all, regardless of their ability to pay.Well, the Heath Government did not abolish the NHS and did not make cuts in it. In fact, the only Government to have made substantial cuts in the NHS were the Labour Government in which Mrs. Barbara Castle and the hon. Member for Crewe and Nantwich served and which the hon. Member for Islwyn supported, when, in 1976, they made the IMF cuts and cut the NHS capital building programme by one third.
I hasten to assure the hon. Member for Islwyn and the hon. Member for Crewe and Nantwich that I bear them no ill will. I realise that this is a significant evening for them, because they face another contest and are both aspiring to high office in their parties. They both have the full support of Conservative Members. This evening's debate gave us the dream ticket for the Conservative party. We look forward to the hon. Member for Islwyn and the hon. Member for Crewe and Nantwich being the Leader and deputy Leader of the Opposition.
§ Mr. Kinnock
I can give the hon. and learned Gentleman an undertaking, on his last point, that we shall show considerably more decorum and felicity than marked the occasion of the election of the leader of the Conservative party. I recall her, like another figure in history, housepainting, and her main rival at the time—now a Viscount, no less—consorting in washing the dishes for the sake of promoting themselves in the Conservative party — [Interruption.] I realise why Conservative Members groan. There are people in the Conservative party who have regretted the election of the housepainter ever since.
In the years of the last Labour Government the net growth in support for the Health Service was 10.8 per cent. May I have an undertaking from the Minister that when unemployment increases by, let us say, 1 million under this Government, they will resort to exactly the same scale of reflation as marked the Heath Government, and that the hon. and learned Gentleman will undertake with his colleague to be as generous — not to say, indeed, spendthrift — as the current Secretary of State for Education and Science, then Secretary of State for Social Services, was? If I receive those undertakings I shall be willing to withdraw a great deal of my criticism. However, until then I still say that the Conservative Government are out to destroy the Health Service.
§ Mr. Clarke
The hon. Gentleman has responded to my remarks on Health Service spending by pointing out that revenue spending under the Labour Government increased by about the same amount as it did under the previous 430 Conservative Government. However, substantial cuts were made in capital spending which the Conservative party has been restoring since it came to office.
We could teach the Labour party much about the conduct of leadership elections. Our leadership elections are conducted by Members of Parliament on a democratic basis. The problem facing the hon. Gentleman and the hon. Member for Crewe and Nantwich is that although they may have won the occasional utterance of support this evening, such as that made by the hon. Member for Wolverhampton, North-East (Mrs. Short), their fate remains to be decided, undemocratically, outside the House. It is decided by people acting on behalf of trade union block votes, most of which are made up of Conservative voters who are mere spectators, or by extreme Left-wing activists in the unions, who should not be casting votes at all in Labour leadership elections.
However, I returned to the speech made by the hon. Member for Islwyn to show that the attacks on the Conservative Government contain no new ideas. The theory that we are secretly plotting to abolish the NHS has been pursued at every election that I can remember and no doubt at every election since the war. I am happy, for example, to agree with all the sentiments expressed by my hon. Friend the Member for Brentwood and Ongar (Mr. McCrindle), who gave his commitment to the existing basis of financing the NHS. It is a commitment that is shared by my right hon. Friend the Secretary of State and me, and by the Government. We have no intention of changing the basis upon which the NHS is financed.
What is worse, and what one can really criticise the Labour party for after an election, is not that it has no new basis for attacks on us, but that it appears to have no new ideas of its own to put forward as a contribution to the politics of welfare. It mentions only the needs that we could all identify in every area of welfare spending. It hints that its contribution would be to spend much more, but it makes no contribution to the real debate. Its attacks tend to mislead the general public so that people do not face the serious issue of how we provide welfare services when we have gone through a recession and face more restricted growth than any of us expected a decade or more ago.
The Labour party obscures debate and runs away from the issues when Labour Members deny that we have spent more money on key national services. After an election we should be able to get away from allegations that a Conservative Government have cut the National Health Service. That is frankly not true, unless we regard the official statistics as completely fiddled. My right hon. Friend said that the resources increased under the previous Government by 17 per cent. ahead of the retail price index. The hon. Member for Wolverhampton, North-East touched on our reference to 6,500 more doctors and asked rhetorical questions about other things that were not strictly relevant and gave rise to wider debate. However, she cannot deny that there are now 6,500 more doctors in England and Wales.
The hon. Member for Gordon in his maiden speech talked of the cuts made in the Health Service in his constituency after he had read a letter describing the increased resources that the Scottish Office is putting into the Health Service there. That does not help.
I realise that there is a gap between the figures showing what we can claim by way of increased resources, more doctors and nurses and more patients being treated in the system, and the feeling of many professionals and 431 constituents that there are still glaring inadequacies in the system. One has to face that dilemma. It does not help to pretend that somehow there has not been growth in the resources in the first place. There has been a massive increase in resources. The proportion of the gross domestic product spent on the NHS under this Government has risen during the recession, and still we can identify the frustration of the professionals, the length of the waiting lists and the demands to improve medical services. That shows that there is a growth in demand caused by the aging population, medical advances and the rising expectations of the population. It also shows how easy it is to mount a lobby for any sort of Health Service spending.
However, there is no easy answer if one accepts the reality that, despite the recession, we are pouring in extra resources. Because there is no easy answer, the problem is one that the Opposition parties will not begin to confront. They prefer to talk about the myth of Tory cuts.
Anybody wishing to take the debate further must accept that it is simply not possible to pour resources into health care in response to all those demands regardless of the effect upon the taxpayer, industry and the productive economy. Our view of the welfare state is no different from that of those who oppose us in terms of our compassion, care, or even our awareness of patient needs. We accept that rising national standards and increased economic prosperity, when the country has earned them, should produce rising standards of health care, education, social services and housing, but we believe that a responsible Government — and only the Conservative party could comprise a responsible Government at present —should realise that the extent of those services, which we all want, at any given time and the methods by which they are provided and financed must not damage the productive economy. The Government have successfully faced that dilemma so far, and they will continue to do.
It is no good dismissing the problem. When one looks at the scale of resources that go into the health care, education provision and welfare standards that we enjoy, one sees that huge sums of money are being spent. During the four years of the previous Conservative Government NHS spending rose from £7.75 billion to £15.5 billion. Education spending rose from £7.5 billion to £12 billion.
We are talking about more than half of public spending if we take together health, the personal social services, the social security system and education. In addition to the massive resources which are going into those services, the Government have reduced inflation. In terms of the welfare state and social policy, reducing inflation to its present level is as significant an achievement as all the extra public resources that we have put into our services.
Inflation is the enemy of the poor, pensioners and those authorities struggling to provide health care, social services and welfare. Against that background it is utterly irresponsible of the Opposition to run away from all the problems and not to offer a solitary new idea beyond the Beveridge system and the National Health Service—
§ Mr. Clarke
—and to talk simply about offering more and more public money to any lobby that comes along. I lost count rapidly during the debate once I began to add all the money coming from the hon. Member for Islwyn 432 and the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) and those Opposition Members who wish to solve all the problems by merely piling on more public money.
§ Mrs. Dunwoody
Will the Minister admit that during the first two of the past three years the National Health Service was not given anything like the rate of inflation and, in effect, that constitutes a cut in the amount of money that was allowed? The Minister must accept that.
§ Mr. Clarke
I do not accept that off the cuff. I do not believe it to be the case. Spending, vis-a-vis inflation in terms of the retail index, has increased well ahead of inflation throughout our period of office. There is a convention by which it is turned into growth of services. That has varied year by year. We have gone ahead of the RPI by 17 per cent. during our period of office. The growth in services has been 7.5 per cent. That is using the same basis for figures as the previous Labour Government.
I have already said that it is no good talking about cuts when more money is going into the services. We must face the fact that we must find extra resources without destroying the productive economy, creating more unemployment and eventually destroying the ability to pay for the services, which is what happened under the previous Labour Government and led to the 1976 IMF cuts.
In addition to the efforts that the Government have made, we should welcome—and the Government do welcome—all the resources that people are prepared to devote to their own welfare and that of their families. We believe that in a free society people should be free to spend their money as they wish, including spending it on things such as their own housing, education and health care which are by no means anti-social.
That is not the position of the Labour party. The Labour party wants a large council tenantry in state-owned housing. My hon. Friend the Member for Eltham (Mr. Bottomley) illustrated the abuse of power to which that can lead, quite apart from the effects on society, which we deplore.
The Labour party is hostile to private funding of education and private health care within the National Health Service. Therefore, for doctrinaire reasons, it is prepared to reject resources which come from those members of the community who are prepared not just to pay tax for general education and welfare but to produce extra resources for their own health care.
The Labour party chooses to parody the document which we produced which tried to recognise that in a plural society we should have private provision alongside state provision and try to produce healthy co-operation for the good of both and to avoid the useless duplication and waste of resources. The circular referred to by the hon. Member for Crewe and Nantwich contained nothing objectionable, nothing for which we apologise. It was known by Ministers and circulated freely. The hon. Lady could have had a copy if she wished. It is not secret and it contains nothing remotely damaging to the National Health Service. The hon. Lady produced a crude parody of the document to try to sustain her case. The hon. Member for Islwyn attacked an example of collaboration between the Health Service and the private sector such as the provision of the new lithocrypter at St. Thomas's hospital across the river.
I have taken a close interest in the agreement from the moment that it was mooted. It has been entered into by 433 BUPA and the West Lambeth district health authority. Both parties recognised that the agreement would be in their mutual interests and in the interests of their patients. The figures that the hon. Gentleman produced were wrong. The capital cost of about £1 million has been produced by BUPA and the running costs will be met by St. Thomas's hospital. The figures that the hon. Gentleman produced came not from the Department but from the Health Service magazine. They were based on a fundamental error about the costs that will be incurred in servicing the machine. The Health Service will pay for about two thirds of the running costs and will obtain three quarters of the use of the machine. The Health Service will save capital expenditure and obtain a valuable piece of new equipment to which its patients will have access. Its resources will be left free for other purposes.
The remedy that the hon. Member for Islwyn proposed would involve the Government producing additional capital of £1 million. More revenue expenditure would be incurred by the over-resourced West Lambeth district health authority. All this would be done merely to give the hon. Gentleman the ideological satisfaction of saying that BUPA had nothing to do with the deal. It is all very well to say that we are talking about one two-hundredth of the cost of the Falklands runway, but that is not the sort of contribution to social policy that someone who aspires to be Leader of the Opposition should be producing.
§ Mr. Kinnock
My concern in this argument was not ideological. When the machine is installed the doctors who have control of its use will obviously ensure the formation of a queue of patients who will benefit from using it. It will be an extremely valuable service. Those who go to the head of the queue will be determined on the basis of who pays and who does not.
§ Mr. Clarke
The allocation of use will be as I have described. Three quarters of the patients who use the machine will be NHS patients and a quarter will be BUPA patients. It is no good the hon. Gentleman shaking his head. If he reads the agreement he will find that that is a firm condition. My right hon. Friend the Member for Wanstead and Woodford (Mr. Jenkin), who had responsibility for these matters, introduced arrangements to ensure that queue-jumping for emergency operations could not take place. The allocation of use will be as I have described for non-emergency operations. That is made clear in the agreement. It was entered into by the health authority and BUPA because they believed it to be in their interests and in the interests of their patients.
§ Mr. Clarke
There is clearly a gap between the resources that we can produce without damaging the productive economy and the demands and expectations of our constituents. In addition to continuing to put into the Health Service the maximum resources that the economy can stand and encouraging extra resources to be provided by the private sector, we must try to solve the problem by getting the best possible value for money from the ever-increasing public resources that go into the service. It is as important to ensure that we get the best value for money as it is to produce the resources in the first place. That must be so if we are to be responsible custodians of the service and to put the patients' needs first.
In administering the Health Service we must ensure that we satisfy demand as effectively as 'possible within the 434 resources that we can produce. We have to be responsive to the changing pattern of population in different areas, changes in medical practice and demand, falling rolls in education and the movement of the population out of the cities into the suburbs. We must recognise, for example, that for many hospital services the patients are in hospital for shorter periods.
We are introducing to the National Health Service concepts such as value for money and better efficiency. We are making the best use of modern management techniques and ensuring that the service is responsive to changes in demand.
§ Mr. Clarke
All these pressures are the allies of welfare, but as soon as they turn to the particular, especially when they conflict with the interests of the providers of the service as represented by the trade unions whose votes are being courted by those who speak on behalf of the Labour party, we suddenly hear that value for money is no longer the prime consideration.
§ Mr. Pavitt
The Minister is attacking the chronic sick —those who have angina and season ticket prescriptions, which have risen by 350 per cent. in five jumps since the Government took office. Is the Minister satisfied that that is the way to finance the National Health Service? Does he suggest that those who need permanent medication from the age of 45 onwards must pay?
§ Mr. Clarke
Prescription charges, in the opinion of the Government, represent a reasonable contribution to be made by those who can afford them. Seventy per cent. of prescriptions are exempt from any charge. The remaining charges produce 3 per cent. of the total income of the National Health Service. It is not a helpful or new contribution, and not one that the Labour party need make immediately after an election, to suggest that all the income for a service, the inadequacies of which Opposition Members deplore, should be forgone. It is not possible to go back to a policy to which they have been committed since 1951, but never implemented, of abolishing all prescription charges.
I want now to refer to the points made in the debate about the best management techniques and the use of resources.
The hon. Member for Stoke-on-Trent, Central (Mr. Fisher) and his hon. Friend the Member for Stoke-on-Trent, South spoke about the unfair distribution of resources and the need to follow the principles put forward by the Resource allocation working party to ensure that the growing resources of the Health Service are distributed fairly round the country. The Government are committed to that position. The House does not lack hon. Members from the midlands and the north. When the hon. Member for Crewe and Nantwich complained about that, the House was full of hon. Members representing constituencies in the north and the midlands.
When the Government pursue, as they will, the principles of RAWP, I advise the hon. Member for Stoke-on-Trent, Central to examine the speeches of the hon. Members for Brent, South and for Leyton (Mr. Cohen). The resistance to reallocation comes from central London Labour parties which are backing the policy of the trade unions by trying to keep resources for a surplus of acute beds. They are trying to resist the redistribution of 435 resources by protecting community care in their localities without regard to the unfairly deprived suburbs of Essex, the midlands, the north or wherever. The Government must look for efficiency, either by reducing overmanning, as my hon. Friend the Member for Canterbury (Mr. Crouch) stated, or by examining the drugs bill which was mentioned by the hon. Members for Wolverhampton, North-East (Mrs. Short) and for Brent, South. The Government are not ignoring the impact of the drugs bill upon the National Health Service. We are reviewing the PPRS system and our conclusions will soon be put forward. We are consulting, as we were before the election, on the Greenfield report. It is quite right that the Government should examine the cost of drugs to the National Health Service. I do not understand how it is said to be right for us to ensure that we are not paying excessively for the drugs that the Health Service receives, but for it to be somehow wrong for us to examine the cost of the support services, such as laundries, building repairs, maintenance and cleaning facilities.
I would like to have time to discuss the features of the National Health Service that we should be anxious about. Throughout the debate we have been obsessed with money and manpower. The Government's record in those spheres is extremely good. We are spending more money on the Health Service, we have more manpower and, more importantly, the NHS is treating more patients. If any of the Opposition parties had any new ideas between them, the House should be discussing those parts of the Health Service where standards should be improved. Everyone knows that the Government's chosen priorities are the elderly, the mentally ill and the mentally handicapped. The hon. Member for Wolverhampton, North-East spoke of improvements in perinatal care and the fall in perinatal mortality in recent years which has been dramatic.
I wanted to talk about the improvements in the ratio of nursing staff to the mentally ill and mentally handicapped in our hospitals, and about the initiatives launched by the Government in the less popular areas of drug abuse, the elderly, the senile and the demented, all of which have been given priority.
I do not apologise for returning to our capital programme, where the Government are building 140 new hospitals and diverting much of our revenue resources to brightening up wards. I realise, as the hon. Member for Stoke-on-Trent, Central said, that there are plenty of Victorian workhouse buildings in this country and second world war huts. The way to tackle those problems, which were caused by our predecessors, is to maintain the capital programme.
Those are the kind of policies and discussions that we should move towards, but we do not. Even the one contribution from the Liberal party brought in the names of Lloyd George, Beveridge and Aneurin Bevan. No Opposition Members took any view beyond the views of those three distinguished men in their time, or put forward their solutions to the problems of 1983.
Those problems are being tackled by this Government. Given the lack of new ideas, I commend the policies that we are pursuing of safeguarding the Health Service and giving it the resources that the productive economy can afford.
§ Debate adjourned.—[Mr. Sainsbury.]
§ Debate to be resumed tomorrow.