The National Health Service

HC Deb 05 July 1984 vol 63 cc477-558

Mr. Speaker

Before we proceed to the important Opposition debate on the National Health Service, I should announce to the House that I have selected the amendment that stands in the name of the Prime Minister.

I repeat what I said earlier, that 37 right hon. and hon. Members have indicated their wish to take part in the debate. I make a special appeal today for brief contributions.

4.24 pm

Mr. Michael Meacher (Oldham, West)

I beg to move, That this House condemns the damaging failure of the Government to provide sufficient resources for the National Health Service or stable conditions in which those working in the National Health Service can concentrate on patient care; deplores the suffering for individuals and families which have resulted from the Government's policies; calls for an end to the promotion of private medicine and contracting out of services to the detriment of the National Health Service; and recognises the desire of the British people for Labour's approach to the National Health Service which is to reverse the Tory emphasis on cuts and closures and the drift to centralised control and to provide adequate funding for the proper development of community and preventive care throughout the country and a new framework for genuine democratic accountability. The Opposition have tabled this motion today not only to mark the 36th anniversary of the founding of the National Health Service but, above all, to reiterate our commitment — and, I firmly believe, that of the overwhelming majority of the British people—to the principle of the highest quality medical care being available free at the point of need to everyone, irrespective of income, creed or class.

The NHS is perhaps the finest monument to Socialism in this country and, as such, has won, and continues to command, the enduring loyalty and support of the whole nation. It is a service and a principle with which almost everyone identifies, and the set of petitions which I have before me, headed "Save our National Health Service", containing about 35,000 signatures from just one town, Stockport, is eloquent testimony to that. I have been handed these petitions only today.

I say "almost everyone" because it is surely of the most profound significance that an institution that is almost universally treasured by the nation should have been pointedly and personally spurned by the Prime Minister. When the right hon. Lady had an eye complaint, she went private, for a second time, though I believe that the NHS down the road had to be brought in to do the operation — [Interruption.] If the NHS was safe in her hands, which is what she had the gall to say during the election, why did she not feel safe in its hands when there was something wrong with her? The Prime Minister could not have demonstrated more dramatically that it is not her but our National Health Service, a service that belongs to the British people but with which she does not identify.

If the NHS is safe in Tory hands—words that we shall never let the Prime Minister forget—how come that more than 160 hospitals and 11,000 beds have been closed since the Tories came to power? How come that more than 2,000 doctors and 10,000 nurses and midwives are now on the dole? How come that an unprecedented number of senior members of the medical profession—the vast majority of them by no means Socialists—have gone public in the outcry against the cuts? And how come that the chairman of the BMA, the auspiciously-named Mr. Tony Grabham, issued a public warning only two days ago saying: The gap between what we can do for patients and what we actually do is steadily widening"? That has been reinforced by the TUC policy statement, "The Growing Gap", issued today, which highlights the £0.5 billion gap between needs and resources in the NHS.

The Tories have never believed in the NHS. Indeed, from the start of their Administration they have gone out of their way to express outright hostility to it. The Prime Minister's antagonism to the NHS is proverbial, while the Chancellor of the Exchequer, in a "Weekend World" broadcast at the outset of his chancellorship, explicitly staked out cuts in the NHS, along with education and social security, as his target for cutting public expenditure and holding down sterling M3. So much for the NHS being safe in his hands. It is about as safe as entrusting an alcoholic with a bottle of whisky.

The Secretary of State is different. He is the front man, the acceptable face of authoritarianism, even dubbed "Honest Norm" by the Tory press. He is the fall guy in this Administration, a man detailed with the task of trying to convince the Tory ladies with flounced hats that the Government really care about the NHS. It is about time that the case that he has so assiduously peddled in the last year was exposed for the farrago of myths, half truths and innuendo that it is.

It is claimed that there has been a huge increase in NHS spending over the past five years. The right hon. Gentleman claims that it has been greater than any previous one. The Prime Minister confirmed in a parliamentary answer on 3 April that the real increase in NHS funding over the five years from 1979 to 1984 was 15.1 per cent. The Secretary of State always omits to say that the Prime Minister went on to admit in the same answer that the real increase in NHS funding for the previous five years under the previous Labour Government was 18.6 per cent. That means that over comparable periods Labour increased real expenditure by 23 per cent. more than this Government have done. Let us have no more of the spoof about the generous Tory funding of the NHS.

We are grateful for anything from this Government. We are told by the Secretary of State that the Government are spending an extra £800 million this year on the NHS. That sounds impressive until we realise that it will do no more than keep up with inflation. There will be almost nothing extra in real terms. That can be confirmed by means of a back-of-an-envelope calculation. The NHS budget is about £16 billion and inflation is running at about 5 per cent., and 5 per cent. of £16 billion is £800 million. Like everything else that the Government boast about concerning the NHS, their claim of extra spending collapses like snowflakes on a boiler as soon as it is nudged.

By adjusting definitions and statistics the Secretary of State contrives to come up with a claim of 1 per cent. growth this year. I am sure that he realises that that is bogus because it excludes rising demographic demands for health services of about 0.75 per cent. to 1 per cent. a year from the growing number of elderly people. It ignores the 0.5 per cent. a year faster-than-inflation rise in the cost of medical technology. Above all, it conceals the central fact that NHS workers are being asked to take a 2 per cent. pay cut this year. We all know that they will not do so. They have already rejected an offer of 3.8 per cent. and I think that they were right to do so. It is patently true that NHS standards will fall this year. There will not be 1 per cent. growth, to use the empty phrase that the right hon. Gentleman continues to parrot around the country. Instead, there will be cuts this year of about 2 per cent. or more.

If the Secretary of State says that there will be no growth this year because NHS workers are claiming more than their allotted 3 per cent., he will be blackmailing and exploiting some of the lowest paid and most vulnerable workers in society, and that is despicable.

The Secretary of State claims that there are now more nurses and doctors—he has said this on many occasions and perhaps he will repeat it this afternoon—in the NHS than in 1978. The reason for that has nothing whatever to do with the Government. The apparent increase in the number of nurses is largely the result of a definitional change. The definition of their working week was reduced by Professor Clegg in 1980 from 40 hours to 37½. The number of full-time equivalent nurses increased automatically following that mathematical change. There is nothing more to the increase than that. The increase in the number of doctors is merely the consequence of the trend which was set by the previous Labour Government.

What the right hon. Gentleman does not say is more significant than what he says. He does not say that he is doing his level best to reduce the number of nurses. That is what the manpower cuts are all about. That is why hundreds of nurses this year will finish their training and will not find jobs. He is trying to reduce the number of doctors too. That is why the DHSS is consulting on introducing work permits for overseas doctors and on reducing the medical student intake. Perhaps the Minister for Health will confirm that that is so.

It is even more breathtaking that the Secretary of State does not mention that unemployment among doctors is rising far faster than employment generally. In September 1980 there were 493 registered unemployed doctors. In September 1982 there were 1,418, an increase of 188 per cent. in two years. After that the Government were so embarrassed that they resorted to their usual tactic and ceased to collect the statistics. We do not have the recent figures but we know that the BMA warned a Year ago in The Times on 24 March that a further 1,500 doctors would be on the dole within a year unless the Government changed their policy, and they have not. Instead of all the processed cheese that the Government are churning out in their propaganda machine about an increase in the number of doctors, they should present us with the real truth and tell us exactly what has happened over the past three or four years. They should explain that unemployment among doctors has increased about sixfold under the Conservative Government.

Mr. Nicholas Winterton (Macclesfield)

Will the hon. Gentleman concede that the Select Committee on Social Services, of which I am a member, and of which the hon. Member for Wolverhampton, North-East (Mrs. Short) is also a member, urged upon the Government that there should be a reduction in those who are permitted to take up medical education? Further, the Select Committee produced a unanimous report that included a recommendation that the Government should reduce the number of overseas doctors coming to Britain. Perhaps the hon. Gentleman should have had a word with his right hon. and hon. Friends before he addressed the House.

Mr. Meacher

I am aware of what the hon. Gentleman has said about the Select Committee on Social Services. Perhaps he will tell his right hon. Friend the Secretary of State not to go around the country boasting about the number of doctors increasing under this Administration.

Mr. Nicholas Winterton

The number of doctors has increased.

Mr. Meacher

The Secretary of State cannot have it both ways. He cannot boast that the number of doctors has increased and then do his level best to reduce their numbers.

The Secretary of State has had the effrontery to tell us that activity rates have increased in the National Health Service. He seems to suggest that he is doing this with his own hands. I do not think that he has a clue about what is happening in our hospitals. I shall quote the words of someone who is rather nearer the coal face and whose judgment is perhaps a great deal more accurate than that of the right hon. Gentleman. A few days ago Mr. Tony Grabham said: Far too many patients wait far too long for out-patient consultations in hospital. Far too many wait far too long for necessary operations, and far too often the general practitioner is having to cover as best he can for the deficiencies in the hospital services. He added: the council had become increasingly concerned about 'very considerable deficiencies in the health services.' That is his phrase and not mine. He explained: These were a direct consequence of chronic underfunding. So much for the Government's defence.

We indict the Government for damaging the NHS on five main counts. First, financial and manpower cuts have damaged patient care. There is a mound of evidence, which is accumulating, to substantiate that charge. I am sure that my right hon. and hon. Friends will cite abundant evidence from their own constituency experience to support that charge. I shall confine myself to quoting from the recent report of the BMA junior doctors. The Hospital Junior Staff Committee has stated: A document containing details of cuts reported by 41 districts reveals the extent to which patient care is being damaged…Examples quoted in the document include an increase in out-patient waiting times in one district in Wessex from 6–17 weeks, a closure of beds or hospitals in many districts where waiting lists will increase as a result, closure of out-patient and casualty departments in several districts and a concerted attack on doctors' terms and conditions of service, including reduction of local cover and study leave.

It mentions one specific effect of the Government's cuts. The committee states: At Clatterbridge hospital on the Wirral, lack of money to replace obsolete equipment and a cut of 2½ whole time equivalent radiographers has meant a quite unacceptable waiting list for cancer treatment. Some patients are no longer being accepted for treatment because their life expectancy is less than the length of the waiting list. That is the state to which the Government cuts have brought the NHS.

The Minister for Health (Mr. Kenneth Clarke)

That report, like much of the hon. Gentleman's other material, was produced some time ago. We have had time to check the facts on the ground at Clatterbridge. There was a staffing problem involving two or three radiographers, but that was resolved. There is no evidence to support the irresponsible assertion in that report that cancer patients are being forced to wait longer than necessary for their treatment. The hon. Gentleman should not clutch at such material. A local difficulty has been exaggerated into an alarmist statement to boost his case.

Mr. Meacher

With great respect to the Minister, I prefer to give credence to those who know what they are talking about and who have experience on the ground of conditions in our hospitals. The junior doctors who work in the hospitals know a great deal more about what is going on than does the Minister. Putting aside Clatterbridge, I hope that the Minister will accept that all the other comments in the report are accurate.

The Opposition indict the Government with chronic underfunding of the NHS. Britain currently spends about 5.5 per cent. of its national product on health. France spends 8 per cent., Germany 8 per cent., and the United States 9.5 per cent. In real terms, that means that if we spend the same proportion of our national product on health as does the United States, we would have an additional £12.25 billion for the NHS budget this year.

It is no good the Government saying that increased funding cannot be afforded. While the Government still opt to spend £10 billion on a Trident nuclear weapon system that we do not need, while they continue with the grotesque maldistribution of the nation's resources in handing out enormous tax relief of thousands of millions of pounds to the rich—year after year, Budget after Budget—and while the drug companies are permitted to continue to rip off the NHS, with excessive profits this year probably in excess of £250 million, Government talk of "Can't afford any more for the NHS" is simply stinking hypocrisy.

It is not only hypocritical; it is lethal. The British Kidney Patient Association estimates that 3,000 kidney patients will die this year because dialysis units are not available. The Short report in 1980 on maternity provision — and I pay a warm tribute to my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) for chairing that Select Committee—said that 5,000 cases of perinatal death and handicap could be prevented by spending just an additional £25 million to extend existing medical knowledge.

The Royal Free hospital in London, where bone marrow transplants for young children are carried out, said two years ago that as little as an additional £114,000 a year would save another 15 lives. Wythenshawe hospital in Manchester says that with only an additional £147,000 it could perform another 50 life saving operations each year. Rather than save lives, the Government's priorities are for massive tax handouts to the rich who do not need them.

Mr. James Couchman (Gillingham)

Does the hon. Gentleman agree that, far from giving tax handouts to the rich, the Government are taking slightly less away from them?

Mr. Meacher

If the hon. Gentleman really believes that, he will accept anything.

Our third indictment of the Government is what I can only call the politics of pretence in the handling of the NHS. There has surely never been another Government who have elevated wishful thinking to the status of an instrument of policy. Time and again Ministers have come to the Dispatch Box and publicly declared their commitment to particular objectives, and then have turned around and refused to provide the money without which those objectives are pure fantasy.

How many times have we heard Ministers give a commitment to community care? Yet they have subjected local authorities to reduced rate support grant, grant penalties and, now, ratecapping. That is a cynical example of deceit. The Government profess to believe in preventive medicine, but they have provided virtually no additional funding to make that workable. A heroin outbreak of almost epidemic proportions is sweeping the country. What has been the Government's response? They have wrung their hands and provided a mere £6 million over three years, which scarcely scratches the surface.

Mr. John Maxton (Glasgow, Cathcart)

The Government have done slightly more than wring their hands — they have substantially cut the Customs and Excise staff, which has meant that large amounts of heroin have been allowed into the country.

Mr. Meacher

That is right. I apologise to my hon. Friend for my usual fault of understatement.

The Minister pontificates about the special health needs of black people, but by providing no funds for the screening of sickle cell anaemia he renders all such claims empty. The Minister reaffirms his concern to maintain the reputation of the NHS as a world-class centre of excellence in research, yet spending cuts have been imposed by the Secretary of State for Education and Science on the Medical Research Council, which is now closing Europe's leading brain research centre in Cambridge, the pneumoconiosis centre in south Wales that has an international reputation for research into lung diseases affecting miners, and the mineral metabolism research unit in Leeds. They are financial economies of a stupefying short-sightedness.

Fourthly, we indict the Government for their obsession—and I use the word advisedly—with commercialism rather than care and their dogmatic imposition of privatisation, even where health authorities have shown that they want nothing to do with it. We utterly reject that because it has nothing to do with greater efficiency; it has everything to do with opening lucrative markets and bigger profits for private capital at the expense of the NHS and the taxpayers.

The overwhelming evidence where privatisation has been tried is of a serious deterioration of standards, especially in laundering, with increased dangers of cross infection. All the evidence shows that cost reductions do not reflect improved performance; they simply reflect savage cuts in the wages of some of the lowest paid workers in our society. The women workers at Barking hospital have a wage of a mere £55 a week, but they are being subjected to a 41 per cent. cut. At the same time, the lists of shareholders and parliamentary consultants to the private companies read like a roll call of Tory Members and the Tory Front Bench.

Ms. Jo Richardson (Barking)

The women involved in the Barking hospital dispute have been on strike for 17 weeks and all support to them. The scab labour that the private contractors have been bussing into the hospital has not done the work to the standards produced by the women. The hospital is now at risk. So much for the myth that the NHS is safe in the Government's hands.

Mr. Meacher

It is absolutely shameful that workers who were performing a perfectly efficient and valuable service should be subject to a 41 per cent. cut in their wages—especially when the consequence is not a better service but, as my hon. Friend said, a deteriorating service that will probably spread infection in the hospital. At least—I do not say this in a political way, because it is relevant — 31 Tory Members of Parliament have a financial stake in companies profiteering from health care. At the same time, Tory Ministers—

Mr. Nicholas Winterton

Name them.

Mr. Meacher

I shall name them; I have a letter listing them. Tory Ministers are forcing through privatisation, even where the NHS in-house tender is lower than the lowest private tender, as happened in the case of the Cornish laundry service—the Minister of Health knows this only too well—in respect of Johnson group cleaners and its new subsidiary.

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

Will my hon. Friend make a point of reading into the record—the public do not see what is in the Register of Members' Interests—the names of those hon. Members who have a pecuniary interest in privatisation, so that their constituents can establish the duplicity in their position?

Mr. Meacher

I shall not mention 31 names—

Mr. Nicholas Winterton

There are 41 of them.

Mr. Meacher

—but it is right to mention a few, because of their particular interests. In 1981–82 the hon. Member for Shipley (Mr. Fox) was a parliamentary consultant to the Brengreen group, one of the big privatising companies. On 1 October 1983 he joined the board of the Shipley-based multi-million pound international Care Services group. He is non-executive director of Hospital Hygiene Services, which recently won the first three contracts in Britain for private hospital cleaning. The hon. Member for Southampton, lichen (Mr. Chope) was parliamentary consultant for an undisclosed fee to the Grandmet group. He was Tory leader of the Wandsworth council until June 1983, and during that time Wandsworth council gave the lucrative street cleaning contract to Grandmet. I refer also to the hon. Member for Stirling (Mr. Forsyth), because of his particular interest. In 1983 he was a consultant to the Pritchard Services group, author of "The Myths of Privatisation" and a member of the Adam Smith Institute. He has regularly used his position in the House to push hard for privatisation of the NHS.

Mr. Nicholas Winterton

That is only three.

Mr. Meacher

I intend in due course to give publicity to all the other names.

The Secretary of State for Social Services (Mr. Norman Fowler)

rose—

Mr. Meacher

I shall make my point before the right hon. Gentleman intervenes. I hope that he will reply. The right hon. Gentleman can see the degree of feeling of Opposition Members about this issue. This is a sleazy, murky, dirty business and it has nothing to do with health care.

Mr. Fowler

I was going to ask the hon. Gentleman, who is working himself up

Mr. Ron Brown (Edinburgh, Leith)

On a point of order, Mr. Deputy Speaker. The hon. Member for Rugby (Mr. Pawsey), who is the Parliamentary Private Secretary to the Secretary of State, snarled from a sedentary position, "What about sponsored members of trade unions?" I make it perfectly clear that, unlike one who is employed as a consultant and getting money in his hand, sponsored Members—certainly members sponsored by the General, Municipal, Boilermakers and Allied Trades Union like myself—do not benefit by one penny.

Mr. Deputy Speaker (Mr. Harold Walker)

Order. I am sure that every hon. Member has made any interest perfectly clear in the Register of Members' Interests. I call Mr. Norman Fowler.

Mr. Fowler

I was going to ask the hon. Member for Oldham, West (Mr. Meacher) about his sponsorship by the Health Service union COHSE. I understand that he is sponsored by that union. To what extent—I accept what the hon. Gentleman says — does the policy of that Health Service union dictate his attitudes in the House?

Mr. Meacher

My hon. Friend—[HON. MEMBERS: "Answer."] — I shall answer. My hon. Friend the Member for Edinburgh, Leith (Mr. Brown) has made the obvious and correct point that no members of COHSE or, I am sure, of any other trade union that sponsors Members, receives a penny of the money for himself. My views have not in the least way been influenced by my trade union sponsorship. I give the Secretary of State that assurance if he needs it.

We indict the Government for their anti-democratic centralisation of power within the NHS. All the chairmen of regional and district health authorities who did not comply with the Government's policies on cuts and closures have now been removed. Almost all of their 192 district health authorities are now pre-packed with a majority that is pro-Conservative, pro-privatisation, pro-cuts, and anti-union.

Where there is resistance, it is overruled by authorities being swamped by new appointments, as happened with Brent. Where there is even one lone voice of dissent—for example, one against 11 as at Roehampton and Twickenham this week—even that lone voice is being snuffed out. It is a case of "Fowler clones rule, OK?" I warn the Secretary of State that he is sowing the seeds of a whirlwind, the bitter fruits of which the Tories will ultimately reap.

As if that were not enough, the Government have undermined and cut the finances of the community health services, which are the only really democratic elements in the NHS, and are now rounding off the steady drift of authoritarianism in the NHS by the appointment of the all-powerful Griffiths general managers.

For those reasons, we believe that the NHS is being hobbled by the Tory Government's hostility. When we come to power, we shall reverse those policies. Reversing Tory cuts is not enough. We need a new vision for the Health Service in the 1980s. The Government's reliance purely on cost containment as the answer has failed because it is self-defeating. The Government have pursued their so-called efficiency savings—if ever there was a euphemism for cuts, that must surely be it—but have been forced to spend far more on health breakdown because of accelerating long-term unemployment. It is self-defeating also, partly because the NHS starts from a position of chronic under-funding. However hard one tries, one cannot get a quart out of a pint pot.

None of the fundamental problems of the NHS—deteriorating capital stock in all hospitals, lack of grass roots accountability in the administrative structure, chronic manpower crises, poor regional balance and continuing class inequality in the delivery of health care—can be solved unless there is funding of the NHS on a par with other countries.

The Government's policy is self-defeating for another important reason—it locks the NHS into a structure of care with over-emphasis on high-tech diagnosis and intensive and specialised medical care, rather than prevention and wider health education where cost escalation is remorseless. The Government's accounting mentality is leading the NHS more and more into a dead end where resource use by the NHS increases ever faster, but with rapidly diminishing returns in reduced illness and mortality rates.

To break out of that self-defeating spiral the Labour party says that an alternative vision—turning away from what we have, which is not a national health service but a national illness service, towards a genuine national health service—is needed. The Labour party will fund an expanded service. At the last election we committed ourselves to a 3 per cent. real increase in NHS expenditure each year. That is an extra £500 million a year above inflation. That is our bottom line. The Labour party will make a reality of community care. We shall draw up plans for comprehensive health and social services to carry through during the next decade, with GPs, community nurses, social workers and environmental health officers working together in neighbourhood health teams.

Yes, Labour will shift the emphasis away from over-concentration on medical engineering and more in favour of the preventive approach and wider health education. We recognise that this Government have not done that. More and more contemporary disease is rooted in problems associated with nutrition and diet, with environmental pollution, with crowding and urbanisation and with rapid social and economic change.

Yes, Labour will reverse privatisation, with its falling standards for the NHS and its get-rich-quick profiteering for sleazy contractors. We shall look to a service that is full-time for all its practitioners rather than a lucrative adjunct to the private market.

Yes, the Labour party will put money and weight behind a campaign to reduce the still tragic inequalities in health care, especially the yawning class differentials in child mortality, which are a disgrace. We recognise, too, the special health needs of women that are largely unmet, and we shall increase the number of women doctors at all levels.

Yes, Labour will reverse the top-heavy centralisation of power in the National Health Service, and we will reverse the crude political patronage and blatant partisan loading of health authorities. We will strengthen the CHCs and we will inject a real element of democratic accountability into the administrative structure so that local services are genuinely responsive to local demand and consumer complaints.

That is a new and profoundly better vision for Britain's health services than the miserable obsession with cuts that we have now. I believe that it will be backed by the overwhelming majority of the British people.

Does the Prime Minister intend, by contrast, to take us back to the kind of system that still exists in the United States, which she so much admires, where hundreds of thousands of people cannot get the medical services that they need because they cannot afford them; where ambulance men finding anyone lying in the street check his wallet before checking his body; where only a few weeks ago a man was left comatose in the back of an ambulance whilst an emergency telephone call was made to his London bank to see whether his account would stand the cost of the treatment that his condition needed; where one third of all personal bankruptcies result from people being unable to pay their medical bills; where the old, the psychiatrically ill, the mentally handicapped and the elderly always get the worst of the deal because they will always be bad risks in the books of the private health insurance companies? If the Prime Minister intends to take us back to that, she shall not pass.

5.2 pm

The Secretary of State for Health and Social Services (Mr. Norman Fowler)

rose—

Mr. Dennis Canavan (Falkirk, West)

On a point of order, Mr. Deputy Speaker. During his speech my hon. Friend the Member for Oldham, West (Mr. Meacher) rightly referred to a list of Tory Members with financial interests, directly or indirectly, in companies which in turn were after contracts resulting from the privatisation of the National Health Service. You said, Mr. Deputy Speaker, that you hoped that it would be clear from the Register of Members' Interests in the Library what the interests were of various right hon. and hon. Members.

I have had a cursory look through the Register of Members' Interests in the Library. Some of these financial interests are not clear. I understand that some of the right hon. and hon. Members concerned may seek to catch your eye during the debate. If I give you the list of Tory Members concerned and any of them seeks to take part in the debate, I ask you to make it clear that he should declare his interest before commencing his speech so that the House and people outside know who the right hon. and hon. Members are who are trying to bleed the National Health Service and make a fast buck out of it.

Mr. Deputy Speaker

The hon. Member knows the decision of the House on the matter. Any hon. Member who has a pecuniary interest in matters that may come before the House should have his interest in the Register. If there are right hon. and hon. Members who feel that they have been affronted by any remarks, I have no doubt that they are capable of defending themselves in the debate.

Mr. Dennis Skinner (Bolsover)

Further to that point of order, Mr. Deputy Speaker. Taking into account what my hon. Friend the Member for Falkirk, West (Mr. Canavan) said about the interests of certain right hon. and hon. Members not being included in the Register of Members' Interests, I shall, with your permission, read out the names which appear in a newspaper article today.

The Tory Members named are Michael Ancram, Peter Bottomley, Timothy Brinton, Michael Brown, John Browne, Michael Forsyth, Eric Forth, Marcus Fox, John Gorst, Sir Anthony Grant, Robert Hicks, Peter Hordern, Charles Irving, Robert Jones, Geoffrey Lawler, Anthony Marlow, Dr. Brian Mawhinney, Tim Renton, Sir Hugh Rossi, Fred Silvester, Anthony Steen, Neville Trotter, Sir William van Straubenzee and John Whitfield. They are wets, jets and dries from top to bottom, but they are all trying to line their pockets out of the National Health Service and the misery of thousands of ordinary people.

Mr. Deputy Speaker

rose—

Mrs. Elaine Kellett-Bowman (Lancaster)

rose—

Mr. Deputy Speaker

Order. The hon. Lady must resume her seat when I am on my feet.

If any hon. Member whose name has been referred to in that catalogue is called during the debate and he or she has an interest in the matters under discussion, I have no doubt that he or she will make that interest clear.

Mr. Jeremy Corbyn (Islington, North)

Further to that point of order, Mr. Deputy Speaker. Can you advise the House what action should be taken by the House where the hon. Member himself is not a substantial shareholder in a private contract cleaning company or contract catering company which could benefit from Government policies but where a substantial shareholding is held by the husband or wife of the hon. Member or by close members of his or her family? Do you not think that it is a gross interference in our democracy if substantial family benefits can accrue from a decision taken by Members of the House in support of the Government's policy on privatisation?

Mr. Deputy Speaker

The House has discussed these matters several times in the past. It is up to each hon. Member to make his or her position clear during the debate. I doubt whether it is necessary for me to add to the ruling that I have already given.

I draw the attention of the House to the fact that there are more than 40 right hon. and hon. Members seeking to take part in the debate. The more time we spend in this fashion, the less time there is for hon. Members to speak in the debate.

Mr. Nicholas Winterton

Further to that point of order, Mr. Deputy Speaker. In the list of hon. Members which the hon. Member for Bolsover read to the House, he mentioned the name of one Michael Ancram. If I am correct, my hon. Friend the Member for Edinburgh, South (Mr. Ancram) is a Minister and is not permitted to have any vested interest. I put it to you clearly that either the hon. Member for Bolsover withdraws what he said or an inquiry has to be held into whether my hon. Friend the Under-Secretary of State for Scotland has a vested interest.

Mr. Deputy Speaker

I am quite sure that the Under-Secretary of State for Scotland is as capable of taking care of himself as any other hon. Member.

I think that we ought now to get on with the debate.

Mr. Fowler

rose—

Mr. Robert C. Brown (Newcastle upon Tyne, North)

On a point of order, Mr. Deputy Speaker. My hon. Friend the Member for Bolsover (Mr. Skinner) read a list containing the names of two hon. Members with my own surname. Since my hon. Friend has a pronounced Derbyshire accent, I am anxious that people outside should know that I, the hon. Member for Newcastle upon Tyne, North, have no such financial interest.

Mr. Max Madden (Bradford, West)

On a point of order, Mr. Deputy Speaker. You will have heard the intervention by the hon. Member for Macclesfield (Mr. Winterton) drawing attention to the allegation by my hon. Friend the Member for Bolsover (Mr. Skinner) that Mr. Michael Ancram had interests in these matters.

My understanding is based on information supplied to a number of hon. Members. According to that, Mr. Michael Ancram owns 1,491 shares in Grand Met Catering Services, which is a subsidiary of Grand Metropolitan. If that is true, what action can you take to ensure that the procedures whereby Ministers are not allowed to have shareholdings in companies is observed by this hon. Member?

Mr. Deputy Speaker

First, I draw attention to the long-standing convention of the House that an hon. Member is referred to not but name by indirectly and usually by reference to his constituency.

Turning to the more substantial point raised by the hon. Member for Bradford, West (Mr. Madden), hon. Members should be very careful about using the privilege bestowed upon them by the House in making remarks which reflect on the characters of other hon. Members, whether they are Ministers or otherwise. Until the contrary has been determined, we must assume that all hon. Members are honourable in their conduct and that Ministers observe the rules relating to the conditions of their taking office.

Mr. Skinner

rose—

Mr. David Winnick (Walsall, North)

rose—

Mr. Deputy Speaker

Order. We really ought to get on with the debate. We are wasting a great deal of time on points of order.

Mr. Winnick

Further to that point of order, Mr. Deputy Speaker. The hon. Member for Macclesfield (Mr. Winterton) said that if the Minister holds shares, either there should be an inquiry or a statement should be made. My hon. Friend—

Mr. Deputy Speaker

Order. I hope that under the cloak of points of order hon. Members will not seek to hold a debate on hypothetical assumptions about Ministers' or any other hon. Member's conduct. We should get on with the Opposition day debate.

Mr. Winnick

Further to that point of order, Mr. Deputy Speaker. The Minister concerned is now in the Chamber. One would have thought that he would now be willing to make a statement whether the list that was read out was true. It would be simple for him to come to the Dispatch Box and make a statement.

Mr. Skinner

Further to that point of order, Mr. Deputy Speaker. You just remarked that Members of Parliament should be careful not to abuse their privilege to name people in the House. I remind you that I have not acted under the cloak of privilege. What I read from a newspaper I am prepared to repeat outside, as the newspaper did in today's edition, and no doubt many other newspapers will. It is not a question of privilege as far as I am concerned. Those names are public. If anyone in the House is upset by the publication of those names, he should deal with the newspaper that printed them.

Mr. Deputy Speaker

I refer to the point raised by the hon. Member for Walsall, North (Mr. Winnick). I remind the House that the rules governing ministerial conduct are matters not for the House but for the Government.

Mr. Fowler

I beg to move, to leave out from "House" to the end of the Question, and to add instead thereof: congratulates the Government on its record of increasing the resources and efficiency of the National Health Service; applauds the higher level of service provided by the National Health Service and its staff which this has made possible; and supports the Government in its determination to maintain and develop a modern health service, giving maximum value to the public as patients and taxpayers. This debate marks several anniversaries. Perhaps not as notable at the 36th anniversary of the National Health Service but interesting in its own way is the fact that it is almost 14 years to the day since the hon. Member for Oldham, West (Mr. Meacher) made his maiden speech in the House. It is fascinating to see how little things have changed in that time. On 10 July 1970 the hon. Gentleman said that no one should rely on his "personal artistry" in putting forward his constituents' case. Having listened to his speech, the House will agree that the hon. Gentleman got his self-assessment absolutely right. He put a bad case extremely badly. What is that case? It is, first, that the Government's policies are damaging the Health Service and, second, that the promises for the future — we listened with fascination to the hon. Gentleman's manifesto—made by the Labour party were established by its record when it was in government.

Let us go back to 1978, which was a rather more meaningful anniversary. It was the 30th anniversary of the Health Service and the last year in power of the Labour Government. What was being said then about Labour's policies for the Health Service? What praise was being heaped upon Labour's health Ministers? The Sunday Times commemorated the success of Labour policies with a three-part series entitled "Crisis in the NHS". The hon. Member for Oldham, West referred to the chairman of the British Medical Association, Dr. James Cameron. In 1978, he was calling for a £1 billion injection of money into the Health Service. Speaking of Labour's policies, he told the BMA's annual representative meeting: The National Health Service in Britain is sick. It is inadequate and impersonal and it is losing the confidence of the medical profession and the public. The idealism so apparent when the NHS was started 30 years ago has been dissipated by lack of adequate resources. A special conference was organised by the Trades Union Congress on 29 June 1978 to mark that 30th anniversary. The chairman of the TUC social insurance committee, Mr. Parry, said in opening the conference: It cannot be denied, by even the most committed supporter of the NHS, that we do face real problems…there have been cutbacks in capital spending leading to delays in using new facilities; there have been hospital closures purely for reasons of economy; there are lengthening waiting lists; and there have been all the problems arising from the shortage of the finance needed to ease the problems of change. There is the crime of nurse unemployment". All that was said about the Labour Government in 1978. The then Secretary of State for Social Services, now in another place, was struggling to defend his record at a Confederation of Health Service Employees conference when he said: Don't believe those who try to suggest that closures are evidence that the Government is starving the health service of funds. The reverse is in fact the case. That was the line of a Labour Government who closed 272 hospitals—around 100 more than in the same period since. Therefore, when I see in the motion before the House talk of condemning the Government for "cuts and closures", I say that the motion is amazing not only for its inadequacy but for its total hypocrisy.

At the same time in 1978, from around the country there came complaints particularly about hospital building, because in 1977–78 capital spending was cut back by 22 per cent. in real terms, just part of a total cut of 35 per cent. over the lifetime of the Labour Government—the biggest capital cuts in the history of the Health Service. The hon. Member for Oldham, West gave the explanation with absolute accuracy in his book "Socialism with a Human Face", in which he said: Public expenditure was in 1976–78 for the first time since the war cut back, not only below planned levels of increase, but absolutely in real terms. In other words, mismanagement of the economy had driven the Labour Government to the International Monetary Fund and the result was changes in policy that vitally affected the lives of the sick, the poor and the old. So I say to the hon. Gentleman first and foremost that we in the Government do not intend to take lectures from a member of that Labour Government, who led the NHS first into crisis and then into chaos. However, further than that, there is every reason to believe that they would do exactly the same again. It is quite clear that, even after five years' opposition, the Labour party has learnt precisely nothing. It has certainly not learnt that a successful social policy has to be based on economic policy.

That brings me to the second part of the hon. Gentleman's case—the attack on the Government. Let us first get the facts straight and take some of the measures to which the hon. Gentleman referred. On finance, the facts are that the Government have increased spending on the NHS from £7.75 billion in 1978–79 to over £16 billion in the current year. That is an increase of 18 per cent. more than inflation. We provided £800 million extra for the NHS in our public expenditure plans for this year, and, far from cutting back, we have now provided a further £200 million to meet the vast majority of the costs of the review body awards to doctors and nurses. We have provided the money to sustain real growth in services sufficient to meet the needs of the growing number of elderly people in the population. But what is more—surely this is crucial—the health authorities are now doing more than ever before to help patients in their own areas by improving efficiency and productivity. This year they have already put forward plans from which they estimate they will be able to save almost £100 million to develop services in England alone. That money is over and above the extra resources provided by the taxpayer. It is money that will not only meet the small contribution that authorities are making to pay costs but enable them to continue to make real improvements in services.

Mr. Campbell-Savours

Es the Secretary of State aware that what he calls a small contribution from health authorities amounts, in the case of my health authority, to £100,000 which it does not have. In order to find it, we shall have to close community facilities. Does he think that that is fair?

Mr. Fowler

My point about the position throughout all the regions is that the regions and health authorities put forward proposals which, by their own measure, save £100 million. In other words, with the resources that we are providing and the resources from the health authorities, almost £200 million is available. From that only 20 per cent. or £36 million is required for the pay award.

The truth about capital spending is that we are restoring the programme after the wasted years of the Labour Government. We have increased capital spending from £365 million in 1978–79 to £719 million in 1983–84. That is a real increase of a quarter and means that we have reversed nearly all the damage which the Labour Government inflicted.

Mr. Frank Dobson (Holborn and St. Pancras)

Will the Secretary of State confirm that if he compared the average amount of capital spending in real terms on hospital building under the Labour Government of 1974–79 with that of the present Government during their full period of office, they would show that the Labour Government spent more on average per year than the Conservative Government?

Mr. Fowler

The hon. Gentleman raised that question before. He is profoundly wrong. I have the figures for both the real and the cash increases. They show that between 1974 and 1979 capital spending under the Labour Government was reduced to £582 million. The hon. Gentleman cannot establish that that average capital spending is miraculously more than what is now being spent.

Mr. Dobson

I shall repeat my question so that the Secretary of State does not deliberately mislead the House and escape from answering the question by attempting to misunderstand my question. Will he confirm that if he took the figures in real terms, totalled them for the five year periods of the Labour and Tory Governments respectively, and divided each total by five, the Tory figure would be lower?

Mr. Fowler

I will not confirm that. I check my facts before I come to the House. However, I will confirm that the previous Labour Government presided over a 35 per cent. cut in capital spending. That is a fact and there is no use in the hon. Gentleman looking shifty about it. That is the truth about the Labour Government's capital spending programme. We have increased that capital spending. The hon. Gentleman cannot get away with that, even with his ingenuity in playing with figures.

Mrs. Kellett-Bowman

Is my right hon. Friend aware that the north-west regional hospital authority has enabled the Lancaster health district to bring phase three of its hospital building forward by 10 years?

Mr. Fowler

I shall come to precisely such points. For 1984–85 we are providing for an increase in capital spending by health authorities over their allocations to show the importance that we attach to building new hospitals and maintaining old hospitals better. Health authorities showed their commitment to this objective by using some of the revenue they saved last year by more efficient use of manpower to pay for an extra £40 million worth of capital investment.

We are now seeing the results of that. In the 12 months since the general election 15 major new hospital development schemes have been opened. Ten of those were started in the lifetime of the Government. That means that there will be better hospitals in Newham, Orpington, Huntingdon, Maidstone, Macclesfield, Croydon, Ipswich, Dudley, Salford and Rotherham.

Those developments are symbols of the commitment of the Government to the future of the NHS and the capital programme. But they are only a part of the story. In total 23 schemes worth over £2 million are expected to reach completion this year. They are just part of our programme of 140 schemes, each of which costs more than £2 million and which are being planned, designed or under construction today.

Another major scheme is being added to the programme today. I have today given final approval to the board of governors of the National Heart and Chest hospitals to proceed with the building of a new centre for the treatment of heart and lung disease near to the Brompton hospital in London. It will provide 200 beds, including 50 for children, an intensive care unit and six operating theatres. It will also enable the Cardiothoracic Institute to proceed with its plans to improve its research facilities on an adjacent site. The project will cost some £15 million and is an example of co-operation between the health service, which will meet the bulk of the costs, the University of London and voluntary and private interests. That new development will create Britain's most important single centre for medical and surgical treatment of heart and lung diseases and should enable the hospitals and the Cardiothoracic Institute to maintain their international standing in treatment, teaching and research in this vital field.

Mr. Laurie Pavitt (Brent, South)

rose—

Mr. Fowler

I will not give way. The new cardiothoracic centre, like the other developments now under way, will enable us to continue to provide better services in better conditions to more patients.

That surely brings us to the heart of the health debate. Ultimately what matters in the health service is not a measure of the resources that are devoted nor the manpower that is employed. No service should or can be judged on those criteria. In the health service what matters above all is the number of patients treated and the illness which is prevented. What matters is the service we can provide for patients. In those terms the Government's record is quite clear. More patients are being treated and more services are being provided than ever before in the history of the NHS. I shall compare 1978 with 1982. In England there were almost 500,000 more hospital inpatient and day cases in 1982 than in 1978; nearly 2 million more attendances at outpatient and accident departments in 1982 than in 1978; and nearly 500,000 more people visited at home by health visitors and district nurses in 1982 than in 1978—

Mr. Geoffrey Lofthouse (Pontefract and Castleford)

rose—

Mr. Fowler

The hon. Gentleman does not like the facts, but I shall not give way. The debate was delayed by ludicrous points of orders and I shall give the facts to the House whether hon. Members like them or not.

Mr. Lofthouse

rose—

Mr. Deputy Speaker

Order. It is clear that the Minister is not giving way.

Mr. Fowler

I shall repeat those facts so that the hon. Gentleman can grasp them. There were nearly 500,000 more people being visited at home by health visitors and district nurses in 1982 than 1978; there were 30 per cent. more total hip replacements, and nearly twice as many coronary artery by-pass grafts in 1982 as in 1978; and there were more than 50 per cent. more kidney transplants in 1982 than in 1978.

Let me be clear and frank, in the way that the hon. Member for Oldham, West was not today, and never is. I in no way want to suggest that the Health Service is without problems. That would be an absurd case. My case is that the Government are not just tackling those problems, but are making unprecedented progress in tackling them. During the five years in which the last Labour Government held office, the number of patients treated annually in hospitals in England increased by 1 million only. In the first four years of this Government, that total rose by over 2.25 million.

In fact, the only thing which has slowed progress in the last few years has been the industrial action in the Health Service in 1982 which the Labour party did absolutely nothing to condemn. That action did not stop the Health Service continuing to meet its obligations, thanks to the dedication of the staff who continued working. The total number of cases seen in hospital in fact increased slightly during 1982, but many non-urgent operations had to be postponed and waiting lists increased by over 100,000 as they had during the 1979 "winter of discontent".

However, I am glad to report to the House today that during 1983 all the signs are that the upward trend in patients treated has been re-established. Waiting lists have begun to fall again. During 1983, the provisional figures available so far suggest that the number of inpatients treated increased by up to 5 per cent. and the number of day patients by up to 10 per cent. That is a substantial and formidable improvement.

Authorities were also seeking to reduce staff during this period, and Opposition Members made a great deal of that. Health authorities were asked to achieve savings last year of 4,800 by the end of March 1984. In fact, they were able to save over 10,000 posts and at the same time improve patient services, measured by the figures that I have given. That gives the lie to those who think that the Health Service can develop only by being given more money to employ more staff. Those figures show how important the value-for-money measures are for patients. They show that value for money is not simply a slogan or a debating point for the statisticians. It is about caring for people and serving patients better.

Mr. Dobson

The right hon. Gentleman has blamed all the problems of the Health Service on industrial disputes. Will he acknowledge that, five months after the industrial dispute in 1979 ended, waiting lists had been reduced by 52,000, but that nine months after the last major industrial dispute—almost twice as long a period—because of the Government's economies and their so-called increases in efficiency, they had managed to reduce the waiting list by 22,000 only?

Mr. Fowler

The hon. Gentleman is clutching at straws. He has had the figures explained to him as clearly as I can. More patients are now being treated, and the rate of increase of patients being treated is infinitely higher under this Government than under our predecessors.

There is plainly a great deal more to managing the Health Service than simply spending money on an ever-expanding bureaucracy. It means looking carefully and critically at all the services we provide to see how we can provide them better. It means constant and continuing efforts to cut costs and cut out waste. It means translating a bigger share of available resources into direct patient care.

That is what we have been seeking to achieve since 1979, and it was on our success in doing that which caused the Health and Social Services Journal—not exactly the inhouse journal of the Conservative party—to comment in its editorial on 21 June that the Government has probably brought about a greater genuine improvement in the capacity of the NHS to deliver services efficiently than most of its predecessors. It has now left the NHS in a better position to carry out its major management function of making the most effective use of resources.

Mr. Lofthouse

rose—

Mr. Fowler

I am not giving way. Let me make that clear.

We have taken a number of measures to improve Health Service management. We have, for example, set up the Rayner scrutinies — scrutinies of aspects of Health Service performance carried out, not by the Government but by people who work in the service. They have shown substantial scope for savings—in a transport service, with 25 per cent. of its vehicles surplus to requirement; in an advertising system which uses £8 million a year on advertisements to its own staff; in owning residential accommodation worth over £1 billion, much of which is sub-standard and over 20 per cent. of which is simply standing empty.

We have the programme of performance indicators. They have already revealed major discrepancies of performance between similar health districts and similar authorities. Why is it, for example, that when we study the cost of catering for patients in large acute hospitals we see that the most expensive 30 hospitals spend at least 75 per cent. more per patient per day than the least expensive 30 hospitals? The job for management is to ask why those differences occur and where improvements can be made.

Mr. Campbell Savours

Perhaps they give them food.

Mr. Fowler

I expect a superficial remark like that from the hon. Gentleman, with his profound ignorance of this subject.

We have the policy of competitive tendering—about which the hon. Member for Oldham, West has been talking. The basic fact that he must remember is that the domestic services—cleaning, catering and laundry—cost the NHS about £1 billion a year. If the in-house organisation can do the job as cheaply and effectively as anyone else, they will keep the contract, but there is no monopoly of talent in cleaning in the public sector. At the Ministry of Defence, where hospital cleaning has already been contracted out, savings of up to 20 per cent. have been achieved. The most recent eight contracts let in the Health Service have saved over £1 million a year for spending on patient care. A single laundry contract—[Interruption.] I know Opposition Members do not like hearing this, but they will hear it — in north Warwickshire will be saving the health authority nearly £250,000 over the next three years. The sense of the policy should be clear. So I say to the hon. Gentleman, it is not for us to defend this policy. It is rather for him to explain to the taxpayer and to patients on waiting lists why Health Service money should be used unnecessarily on cleaning, laundry and catering when it can go to patient care.

Mr. Tom Clarke (Monklands, West)

rose

Mr. Fowler

All those policies were endorsed by Roy Griffiths and his team in their review of management in the Health Service.

Mr. John Maxton (Glasgow, Cathcart)

rose

Mr. Fowler

I apologise. I have been constrained to keep my remarks to the necessary minimum. Unnecessary points of order delayed the start of my speech.

Those are just some of the ways in which we will be helping Health Service general managers to achieve better quality and better directed care. We need clearer cut decision taking and more effective follow-up of decisions in the Health Service. We need cost improvement programmes.

At the same time, I want to carry forward the policy of care in the community. Our interest is not limited to what happens to patients in hospitals. Caring for patients does not begin or end there. What is equally important is to be able to provide good primary care. That is particularly true in our inner cities. Last year I announced that we would be spending £9 million on measures to improve primary care in the inner cities over the next three years. Last year, as part of that initiative, we provided funds to health authorities to help over 200 projects for improving primary care. Only last week, we announced the allocation of a further £2 million. That is just a small part of what we are doing to carry through our policy of providing care in the community. Most people who are sick, handicapped or in need of support would prefer to have that support at home, among families and friends.

An immense contribution to the total sum of care is made by families, neighbours, and voluntary organisations. For that reason, I am announcing today that I shall be making available some £10 million over the next three years for a new programme called "Helping the Community to Care". Its chief aim will be to improve support for elderly people and for those who are mentally ill and mentally handicapped by helping those who help them — the volunteers, the friends and the family members who are day by day in the front line in care. [Interruption.] It is extraordinary that even when the Government come forward with proposals that by any objective measure are taking care forward, the reaction from Labour Benches is always grudging and critical. The Labour party's complete hypocrisy is what most people find so disgraceful about this debate.

Often, those who are looking after the sick and handicapped need training or better back-up services to make their contribution more effective. We shall be working with the major national voluntary organisations to identify and support the projects that can help most.

Ms. Harriet Harman (Peckham)

Will the right hon. Gentleman accept that the Labour party is very much in favour of shifting the emphasis away from big institutions into care in the community? Will he give the House the commitment that the money made available to local authorities under joint funding will be 100 per cent. exempt from being taken into account on rate penalties and rate capping? If not, any money that comes from the Health Service to help local authorities to provide care in the community will lead to local authorities being penalised for picking up that money and trying to provide service in the community.

Mr. Fowler

As the hon. Lady knows, we have improved the position on a par with the urban programme, and we have made the rules more flexible. I was announcing to the House the new scheme which will be going basically to voluntary organisations—

Mr. Campbell-Savours

Answer the question—it is very important.

Mr. Fowler

I have answered the question. This policy—

Mr. Maxton

On a point of order, Mr. Deputy Speaker. The Secretary of State has just made a very important announcement on finance. However, his remit does not cover Scotland. Is it possible for the Under-Secretary of State for Scotland responsible for health services, who is sitting on the Front Bench, to make a similar announcement from the point of view of the Scottish Office?

Mr. Deputy Speaker

That has nothing to do with me.

Mr. Fowler

Our policy arises from our recognition that our duty is not simply to provide support, but to provide it in an understanding and caring way and to provide it in the way that individuals in need want. We believe in the National Health Service. I do not belittle the problems that still exist in the Health Service, such as the constant pressure of new demands. However, I put it to hon. Members that that constant pressure makes our cost improvement measures all the more important. It also emphasises the importance of a sense of balance and readiness to mobilise all the sources of care in the community. This is where the Opposition's motion is so wrong. Our job is not simply to develop public sector services. We need to welcome and encourage the kind of family, voluntary and private sector contribution to which I have referred. That is support that the public sector never could, and never should, replace.

A few weeks ago the hon. Member for Oldham, West, Labour's spokesman on the social services, told COHSE that he would take into public ownership private hospitals and private clinics. A few minutes later, he was telling reporters that that was not Labour policy. I hope that in the course of this debate he will make his position clear on that point, because in the manifesto that he set out at the end of his speech he made no mention of it. I shall gladly give way if the hon. Gentleman would like to tell me what the policy is.

The hon. Member for Oldham, West said at the COHSE conference: Why don't we in the National Health emergency which we will inherit take into public ownership their private hospitals, their private clinics, when there are long Health Service waiting lists.

Mr. Meacher

Yes.

Mr. Fowler

The hon. Gentleman is now applauding his words. Therefore, does this represent Labour party policy or is it COHSE policy? In what capacity was he speaking at the COHSE conference? Again, I shall gladly give way if he wishes to answer.

Mr. Deputy Speaker

Order. I hope that the Secretary of State will not keep inviting hon. Members to intervene when more than 40 hon. Members are seeking to catch my eye.

Mr. Fowler

I certainly do not—

Mr. Lofthouse

On a point of order, Mr. Deputy Speaker. Is it correct for the Secretary of State to keep offering to give way to my hon. Friend the Member for Oldham, West (Mr. Meacher) when he has repeatedly refused to give way to Back Benchers?

Mr. Deputy Speaker

I have no power of control over that, but I am bound to draw to the attention of the House the fact that the Front Benches are taking a disproportionate amount of time. Interventions are made only at the expense of other hon. Members' time, and so are points of order.

Mr. Fowler

I take your advice, Mr. Deputy Speaker. It will be in your recollection that my speech was slightly delayed by bogus points of order.

The ideas set forth by the hon. Member for Oldham, West show the hollowness at the centre of the Labour party's health policy. When the hon. Member talks about raising Health Service spending by 3 per cent. a year in real terms, he is saying—although not explicitly—that the vast majority of that amount, will be taken up by the abolition of health charges. The hon. Gentleman may think that that is an extremely good policy, but the point that the public should understand is that those measures would use up the so-called extra resources that the Labour party says it will be using for providing extra health services. The Labour party may want that to be its priority, but it cannot have it both ways. It cannot pretend that at the same time it will also be expanding health services. The impact of a Labour Government would be to end real growth in the resources available for the Health Service. At the same time, there will be an extra burden on the taxpayer.

All that leaves out of account the hundreds of millions of pounds that will have to be made good to fulfil any pledge that a bashful spokesman on the Opposition Front Bench might want to make about nationalising private hospitals and pharmaceutical companies, which the Labour party has already pledged itself to do. The Labour party's pretence to a policy does not bear a moment's analysis.

The Government are committing more resources to the Health Service than ever before. They are endeavouring to ensure that the Health Service uses those resources better than ever before to achieve better value for money in patient care. Together, those policies mean that the Health Service is treating more patients than at any stage in its 36 years of life, and that is the acid test of the Health Service. The Government are committed to the National Health Service, but we are also committed to helping it to work more efficiently, in the interests above all of the patients whom it serves. The hon. Member for Oldham, West talked about almost everything in his speech. What we are about is improving the service to patients. That is what the Government stand for, and that is why I ask the House to reject the Opposition motion.

Several Hon. Members

rose—

Mr. Deputy Speaker

Order. I remind the House that many hon. Members wish to speak in the debate. The shorter the speeches, the fewer hon. Members will be disappointed.

5.50 pm

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

The rosy picture which the Secretary of State has just presented to the House bears no relation to the reality in hospitals, surgeries and the homes of sick people. We have heard a speech of gimmickry, selective statistics and party political stunts. I thought that the Secretary of State would be capable of making a better speech, but I have never heard such a distorted — [Interruption.] Obviously, I thought wrongly. I did not realise that the Secretary of State could skate over some major issues in that generalised way. Some of the phrases that he used—for example, about value for money — showed his real attitude. When he talks about cutting waste, what he really means is "efficiency savings" whereby the Government deem that they have given money to health authorities.

The right hon. Gentleman's comments about community care and all that the Government are doing are only half the truth. There is grave anxiety throughout the country that people are being brought out of institutions but that there is no proper provision for community care. The Government are damaging the interests of the mentally ill by not making proper provision for them. The Secretary of State should not boast about what has been done. He is doing only half a job, and he must provide much more money, planning and care.

The Secretary of State failed to explain the Government's inability to cope with the demands of the National Health Service, including the demographic and technical factors. That failure cannot be disguised by rhetoric, because the effects on patients are obvious to everyone. The reason for the failure is straightforward. Despite his propaganda, the Secretary of State does not believe in the National Health Service. The difference between us is that the Labour Government were passionately committed to the Health Service, whereas the Secretary of State is running an institution with some reluctance. He should accept that.

One sign of the Government's lack of concern for the Health Service was their handling of community health councils, which represent the interests of patients regardless of professional or political considerations. They are the only bodies which look after the interests of patients regardless of politics or profession. The councils are now being attacked by the Government, who are trying to starve to death—I challenge them to deny it—the Association of Community Health Councils for England and Wales. Perhaps the Minister for Health will tell us whether this is correct. In 1981 the association received more than £74,000 from his Department, in 1982 it received a mere bridging grant of £25,000, and in 1983–84 it will receive a pathetic £15,000 to help with deficits. The Minister met representatives of the association yesterday, so he can tell me whether those facts are correct. He can also deny or confirm that the association's newsletter "CHC News" has had to be closed, thus effectively strangling its method of communicating with individual councils and with the general public.

Strangulation and starvation are mean-minded weapons to use against an organisation that is speaking for the, consumer. It is also wholly inappropriate, because the Griffiths report, which the Secretary of State quoted a moment ago, said that the consumer should have a stronger role. The Government should hang their head in shame and stop trying to gag legitimate comment by an association for the consumer. They should restore proper funding to the association.

My hon. Friend the Member for Oldham, West (Mr. Meacher) eloquently criticised the lack of proper funding of the Health Service, but another major concern is the maldistribution of funds in the Health Service 30 years after it was established by a Labour Government. Those distortions and maldistribution may have been understandable for historic reasons immediately after the service was introduced, but now there is no economic or moral justification for the vast discrepancies among the health regions, which result in gross deprivation of medical care in the underfunded regions.

The four Thames regions receive an average of 6 to 8 per cent. above the resource allocation working party target, whereas the west midlands region is 5.36 per cent. below the RAWP target. North Staffordshire is 12 per cent. below the target. If we compare north Staffordshire with the north Thames region, we see that there is a massive gap of about 20 per cent. If those figures are translated into human terms, they mean that the people of north Staffordshire have more pain, and undoubtedly more deaths, because of the fewer facilities allocated to them. They face exceptionally long waiting lists, and, of all the districts in the region, north Staffordshire has the second longest waiting list. It has especially long waiting lists for treatment in gynaecology, cardiology, orthopaedics, neurology, dermatology, renal disease and general surgery. The lists are excessively long because the regional health authority and the Government cannot fund the district properly. It is important for the Government to do something about it.

It is impossible for the Secretary of State to argue that money cannot be found for those underprivileged regions and districts, because everyone knows that prudent handling of the drugs bill would comfortably provide resources and eliminate most of the unfairness in the Health Service. The Government are renowned — I should say notorious—for their belief that the price of everything should be determined by market forces—that is, everything except the price of drugs. The saga of the drug industry's manipulation of the DHSS to make itself the third most profitable industry in Britain after oil and advertising is well known. The criteria of the United Kingdom Joint Formulary Committee identifies between 22 and 24 per cent. of the 2,000 branded drugs which it has evaluated as "less suitable for prescribing". That is a diplomatic but meaningful phrase.

In his book "The Wrong Kind of Medicine", Mr. Charles Medawar claims that in 1967 one-third of the most prescribed drug products were officially described as "undesirable preparations". The Department's attack on waste is conspicuously lacking when it comes to drugs, and it is failing to implement genetic prescribing. In my opinion, the drug industry is getting away with a great deal, and the DHSS has a clear duty to respond to the committee's claim, based on official information, that the NHS is wasting millions of pounds through the prescription of more than 800 drugs known to be ineffective or inappropriately or extravagantly prescribed.

There are two basic faults. First, the Committee on Safety of Medicines concerns itself only with safety, whereas it ought to be concerned with the efficacy of drugs. Secondly, the Department should relinquish its burden, which it should never have accepted, of ensuring that the pharmaceutical industry is a strong industry. It should ensure that that industry stands on its own two feet. This buttressing of the drugs industry by the DHSS is inexcusable. If the drugs industry wants a subsidy, it should go to the Department of Industry and ask for one outright. It should not be working hand in glove with the DHSS on a hidden subsidy. That is quite wrong.

Those are some of the important issues with which the Department ought to be dealing. It ought to be helping the community health councils and the under-privileged regions and districts. It ought to be ensuring that proper drug prices are charged. If the Department tackles those three issues, we shall get a more sensible and properly funded Health Service.

6.2 pm

Mr. Robert B. Jones (Hertfordshire, West)

I congratulate my right hon. Friend the Secretary of State on the vigorous way in which he advanced the catechism of Conservative belief in the NHS and our commitment to it, which I share. He gave a catalogue of new hospitals that have been started under this Government. That was a more impressive list than the small one wielded earlier by the Opposition.

My right hon. Friend omitted from that list a hospital that is of great interest to me—the Hemel Hempstead general hospital. Bearing in mind what the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) said about the Labour party's passionate commitment to the NHS, it is interesting to note that phase 1 of the Hemel Hempstead general hospital was cancelled by the last Labour Government and has now been brought into the programme by the present Conservative Administration. I am grateful to the Secretary of State, who I know enjoyed his visit to Hemel Hempstead to see for himself the difficult conditions which will now be much improved as a result of his decision.

I know that the hon. Member for Oldham, West (Mr. Meacher) is familiar with my constituency, as that is where he went to public school. He ought to visit the consituency again to see what Conservatives have brought to the people of that area.

The debate has rightly concentrated on the total resources devoted to the NHS, but it is also about the distribution of resources and the efficiency of that distribution within the NHS. I represent an under-resourced district within an over-resourced region, and while I have much sympathy with what the right hon. Member for Stoke-on-Trent, South said about the problems of his district—he referred to over-provision in regions such as the Thames regions — I draw his attention to the fact that not all districts within those regions are in the same position. Those with growing populations such as my own are placed under particular strain.

When money is diverted from areas such as north-west Thames to other areas of the country, the strain on the under-resourced districts increases, because when a region is losing money it is more difficult to redistribute funds to the districts which need them. I hope that the Secretary of State will take account of what I believe to be a strong case for closing at least one of the teaching hospitals in the centre of London to enable those resources to be more readily redistributed elsewhere.

I am also concerned about the growing proportion of the NHS budget which is devoted to drugs. That point was also made by the right hon. Member for Stoke-on-Trent, South. It is striking that 100 million more prescriptions are now written each year than in 1949 and that the NHS drugs bill is rising both as a proportion of GDP and as a proportion of money spent on the NHS. In fact, it went up 10 per cent. between 1975 and 1983.

Mr. Stuart Holland (Vauxhall)

The fact that the NHS drugs bill has risen as a proportion of GDP and as a proportion of total spending simply means that the drug companies are making enormous profits. Is the hon. Gentleman aware that, despite the price cuts in respect of Librium or Valium which are made by Hoffman La Roche, these profits are way above those normally earned in the manufacturing sector?

Mr. Jones

I do not entirely disagree with what the hon. Gentleman says, but there is no incentive for GPs or patients to be efficient in the use of these drugs, quite apart from the profit margins. Other countries which levy prescription charges based on a proportion of the cost rather than on a flat-rate basis are more economic in the use of drugs. That was a recommendation of the committee that was set up in the 1950s to look into this question. Belgium is perhaps the best example, and I commend it to the Secretary of State.

We should also bear in mind the fact that certain types of surgery which we all admire, such as heart transplant surgery, increasingly take up resources that might be better used on various other ailments. That is a worry in my area, and rightly so.

I very much welcome the Griffiths report, partly because it suggests a proper structure for the NHS, which the more old-fashioned of my constituents might call "Bringing back matron". This will also allow officials more time to look at long-term problems rather than getting totally absorbed in the administration of individual departments. That must be better for the NHS.

All health authorities struggle to make efficiency savings, but some are more successful than others. Last year, north-west Hertfordshire made efficiency savings of £100,000, over half of which were laundry savings as a result of competitive tendering, and at the end of the day that stayed in house. That will result in a saving of £200,000 in a full year. All that money is being used up in pay awards which are in excess of Government guidelines. That puts us back to square one, and we shall have to find more efficiency savings in the coming year.

It is extraordinary that in this day and age hospital patients should be supplied with toothbrushes and that some hospitals have their own cobbler. Surely we could dispense with such services and make savings so that more money can be devoted to patient care. I hope that the implementation of the Griffiths proposals will result in a substantial improvement.

It is interesting that the hon. Member for Oldham, West would not give way earlier when he was labouring the point about the percentage of GDP that we spend on health care compared with that spent by France, Germany and other countries. We spend only about 6 per cent. of GDP on health care, while France, West Germany and Holland spend about 8 per cent. In Britain, 91 per cent. of the money spent on health comes from the public sector, whereas in France, Germany and Holland the figure is 75 per cent. The extra money that comes from the private sector is one of the main reasons for the disparity. If Opposition Members were less dogmatic, they would realise that the private health sector has a lot to offer, not least because of the private sector's emphasis on screening, which saves resources for the NHS directly.

I draw lessons from the geographical variation in the number of people covered by private health insurance. About 22 per cent. are covered in the south-east of England and only 3 per cent. in Scotland. If the percentage in Scotland and the north was the same as in the south-east, considerable resources would be released for patient care.

We are not talking about the destruction of the National Health Service. Even if we reach the level of France, Germany or Holland where 75 per cent. of the money spent is public and 25 per cent. private, we should still have a substantial and well-endowed Health Service.

More resources should be devoted to health. That is what the general public want. We must recognise that that cannot be achieved entirely within a tax-based and tax-financed system, because that involves waiting for economic growth. The growth in health care should be ahead of growth in the economy. That means that we must tap resources from other things. That is best done through the harnessing of the dynamics and energy of the private sector as well as through efficiency in the NHS.

6.12 pm

Mr. Charles Kennedy (Ross, Cromarty and Skye)

I am one of the few in the House who is used to the National Health Service and no other system. I cannot speak with the authority of age and cannot contrast the NHS with what happened before, but on the anniversary with which this debate coincides I find it difficult to imagine going back to the former system. The hon. Member for Hertfordshire, West (Mr. Jones) seemed to leave the door open for that to happen, even if he did not encourage it. His speech led us to suspect that the general thrust of this Government's policy is to create in a variety of ways the conditions through which the NHS will be regarded as less than the norm, and more emphasis will be put on the individual taking out some type of private health care insurance. Far from easing the burden on the NHS, such a policy would have the opposite effect. It attacks the fabric and roots upon which the NHS is based. I hope that the debate will result in general support for the principle and pragmatics of the NHS.

I should like to comment on what the hon. Member for Oldham, West (Mr. Meacher) said, and on the general position of the Labour party in relation to the NHS. The hon. Member was open-minded enough to say that the NHS was not the prerogative of any one political party but that it was for all the people of the country. He is right. He said that the NHS was a victory for Socialism when it was established. The hon. Gentleman spoke of how Labour, if returned to office, will right just about every wrong that exists through a financial policy that he believes can be implemented.

I do not doubt the hon. Gentleman's motives or sincerity. I do not doubt his passion for wanting to make the improvements and reforms that he listed. However, he is in error if he thinks that he can persuade the House or the country that there is any common ground between the economic policy in which he believes—on which he campaigned for the deputy leadership of the Labour party last summer and on which he was defeated by the now shadow Chancellor—and that of the shadow Chancellor. He is in error if he thinks that that is a basis for the commitments that he spewed out in the last three or four minutes of his speech.

The Labour party makes all sorts of pledges from the Opposition Benches when it is known that the man who would be Chancellor of the Exchequer, if Labour is returned to the Treasury Bench, disagrees so fundamentally with the health spokesman about economic policy. The hon. Gentleman is raising expectations across a whole range of interests and areas of health care in an unfortunate fashion. There is little chance that he will be able to deliver what he promises. The hon. Gentleman speaks about the politics of wishful thinking. His speech encapsulated that defect in an extraordinary fashion.

Mr. Stuart Holland

It is clear that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) has been asked by his party to speak in the debate in order not to raise expectations. He is fulfilling that duty admirably. Will he explain what his party would do faced with an economic crisis and cuts in the Health Service? Would he increase spending?

Mr. Kennedy

I shall be delighted to explain. If the hon. Gentleman is patient, he will hear a detailed but brief resume of exactly where my party stands in terms of financial commitment to the NHS, and priorities.

We have common ground with the Opposition spokesman in our criticisms of the Government. The Labour party seems tied to a type of health care which is over-institutionalised and which keeps people dependent on the state. It is no wonder that it wants to do that. For the same reason, the Opposition are opposed to the sale of council houses. They want to lock people into a social structure that will deliver enough votes to produce a Labour Government. The Opposition may be wrong in that respect, but they are right about their criticisms of the Government.

The Conservative party seeks to lessen dependency by moving more towards a private, insurance-based system. Yet, as was pointed out in the Government's own Green Paper from the Treasury earlier this year, the problem is that there is a relentless in-built mechanism of demand for the welfare services generally, and for the Health Service in particular. There are demographic pressures, such as the increasing proportion of elderly people in the population. The pace of advance in medical technology is increasing, and aspirations increase as a result. As we approach the end of the century, there will be an ever greater log-jam. The Green Paper states: over a wide range of services the only means of controlling the cost is for the government to limit the supply. Elsewhere, with specific reference to the health and personal social services, the Green Paper states: Even where unit costs have been reduced widespread demand for such treatment may strain the resources available. That is slightly complacent. The Minister would be the first to agree that it is complacent to say that the available resources "may" be strained. Resources are already strained, and will be under even greater strain in the future.

The great philosophical contradiction facing the Government is that one cannot demand-manage people's aspirations for health care when medical technology is advancing at such a rapid rate. One has to try to match those aspirations. The hon. Member for Vauxhall (Mr. Holland) asked to what extent my party would try to match increasing demand, or what our priorities in the Health Service would be. We would not pledge ourselves to an unrealistic 3 per cent. per annum real increase. We would limit ourselves to 1.5 per cent. per annum. [Interruption.] At least we do not adopt the approach of the hon. Member for Oldham, West which is to think of a number or a problem and double it. [Laugher.] I am glad that the subtlety of the joke was not wasted on the Labour Front Bench. The Treasury's figures demonstrate that an increase of 1 per cent. per annum is needed simply for the NHS to stand still. Given the economic shambles that would face any party taking over government from the Conservative party, it would not be realistic to try to meet the range of pledges that the Labour party is giving. Although 1.5 per cent. must be regarded as a minimum base figure, and every possible effort would have to be made to exceed it, there is more political credibility in arguing for such a target than in promising Havana tomorrow as the Labour party does — [Laughter.] I choose my words with care.

The Secretary of State also referred to care in the community. We would certainly welcome the allocation of an extra £10 million to care for the elderly in the community. We would welcome further extension of that principle. I was disappointed to hear a Government spokesman say yesterday elsewhere that more benefits could not be extended to carers because the finance cannot be made available. More finance could surely be channelled into the care of the housebound elderly, but not by the excessive centralisation that the Government are pursuing in Whitehall and at the Elephant and Castle. We argue in our amendment that if the Health Service is to be made more responsive to local needs and aspirations, there must be a greater degree of local control. I am not convinced that civil servants, however well intentioned, are the best people to make decisions about the nature or level of health provision in the regions.

If health authorities are to become more democratically accountable, as we would wish them to be, they must also be given greater revenue-raising powers of their own. Within the decentralist programme for which the Liberal and Social Democratic parties argue, although there would be a need for a RAWP formula and an equalisation pool to help the disadvantaged regions of the country, and therefore a distributive element of central control, the root thrust should be towards greater regional authority and greater regional decision-making. That in itself would provide local authorities with a way out of the dilemma in which they are placed over joint funding arrangements. Having been encouraged by the Government to enter into joint funding arrangements, they now find that, because of other local government funding decisions, they have either to axe the voluntary organisation support to which they are committed or to face rate-capping penalties. That is a hopeless political dilemma.

Equally, greater emphasis must be placed on preventive medicine and primary care. The existing joint funding arrangements must be extended to the voluntary organisations and more democratic accountability must be injected into the system at local health authority level.

It is clear from the earlier exchanges between the Front Bench spokesmen that the crisis of morale created in the NHS by the policies of the present Government is not helped by the spurious and often unobtainable promises made by the official Opposition. Those promises do not improve morale in the Health Service because they do not provide a more positive framework within which one could argue against what is currently being done and in favour of improvements and of the raising of the horizons of health care.

The National Health Service is facing a philosophical attack from the Government. However, I hope that, in T.S. Eliot's words The end of all our exploring Will be to arrive where we started And know the place for the first time. I hope that the mistakes made by this Government in their attempt to dismantle the Health Service, and with it many areas of community care and the welfare state, will be reversed in due course. I hope that the reversal will be based not on the Labour party's ideas but on a more sincere and practical argument. That argument is represented by the health and social services policies of the Liberal and Social Democratic parties.

6.27 pm

Sir David Price (Eastleigh)

I found the speech of the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) somewhat more agreeable than that of the hon. Member for Oldham, West (Mr. Meacher). The latter did the National Health Service no service by indulging in his intemperate attacks upon the Government. He indulged in personal abuse in a manner not fitting to a Front Bench spokesman — I am rather more tolerant of the Back Benchers—and he developed once again his well-known conspiracy theory of politics, which does not help the NHS at all.

As an example of the hon. Gentleman's intemperance, it was not clear whether he was in favour of developments in the United States or agin them. At the beginning of his speech, he made much of the fact that the United States spends more on health care than we do. At the end of his speech, he attacked the failures of health care in America. One need not take the hon. Gentleman too seriously. We shall not help the NHS by decrying its many achievements. When we are celebrating the birthday of the NHS, we should rejoice at its achievement, and consider how to improve its performance. That is certainly my own approach. All Governments have done their best, in view of the economic circumstances, to improve the NHS. It is indulging in needless party political abuse to suggest otherwise. I know of no Secretary of State for the Social Services who did not take his duties extremely seriously.

In spite of the fact that the Wessex regional health authority is one of the less well funded and is well below its RAWP target, it has made substantial progress in the past 25 years since becoming an independent health unit. I could read out a long list of achievements, but I shall take them as read. Suffice it to say that Wessex treats more patients in fewer beds at lower cost per case than at any time in its history; yet much more needs to be done. In our previous debate on the NHS I said: The current challenge facing the National Health Service is one of expectations exceeding resources". — [Official Report, 27 October 1983; Vol. 47, c. 467.] I think that I have the support of the hon. Member for Ross, Cromarty and Skye in that, as he made exactly the same point. That is why there is nothing inconsistent in my praising the achievements of the Wessex health authority while insisting on it being given more resources. That is why my right hon. Friend the Secretary of State can point to the Government's record of increasing provision in cash and real terms and why, at the same time, his critics can claim that the service is under-funded. Both statements are correct. Potential demands on the NHS are virtually unlimited. Its very success breeds further demand.

If we consider the effects of demographic change and the improvement in life expectancy, we find that the increasing number of the very elderly makes increasing demands on the Health Service. Acknowledgement of the unlimited nature of demand on the service is fundamental to our understanding of its needs. I should like to remind the House what the Royal Commission on the NHS, which was set up by, and reported to, the previous Labour Government, said: Whatever the expenditure on health care, demand is likely to rise to meet and exceed it. To believe that one can satisfy the demand for health care is illusory, and that is something that all of us, patients and providers alike, must accept in our thinking about the NHS". In support of my proposition that expectations are likely to run ahead of resources, I remind the House of the original estimate of what a comprehensive National Health Service would cost. The hon. Member for Oldham, West was incorrect to claim for the Labour party all the credit for the creation of the NHS, as it was the wartime coalition Government which issued the original proposals in 1944 in a White Paper on a National Health Service. They calculated that a health service would cost £148 million at the start and that that cost would rise to £170 million when all the services came fully into operation. A subsequent White Paper estimated that that would happen in 1955. In 1944, £148 million was worth £1.79 billion and £170 million was worth more than £2 billion in today's prices. According to the current Blue Book, the Government's current and capital expenditure on the Health Service is well over £13 billion. A little simple arithmetic shows that we are spending six and a half times more in real terms than what was anticipated 40 years ago. Nobody can say that that is not advance, expansion and progress.

I have consistently argued that there is rising demand and rising expectation. They have gone ahead of the increase in available resources. Such trends suggest a major problem that we must all face if we care about the Health Service. I should like to quote from the transcript of a lecture given by Dr. Bryan Thwaites, the chairman of the Wessex regional health authority, who is a distinguished mathematician: By now, the proportion of the GNP which is being devoted to the NHS is so large that no government over the next two decades is likely to be able to increase it significantly. We are, in these early 1980s, at the turning point where the limit is being approached. The curve of resource simply must flatten out, at least in the foreseeable future… I have already put it in rough quantitative terms on the 20-year view—a possible difference of supply and demand of anything between one-sixth and one-third. Such a large discrepancy calls for the most radical thinking; and the longer such thinking is delayed, the more difficult will be the solution. I share his view that we must think radically about how we approach the ever-growing gap between increasing resources and even more rapidly increasing demand. That is the great issue before us. I do not believe that we shall secure a future for the Health Service unless we share a recognition that this is the real issue.

I hope that Opposition Members will agree with me, as I should like to quote from "The Way Forward". The then Labour Government said in that document: Public expectations of the health and social services will frequently outrun supply and sometimes hard decisions will be needed to hold back some services to allow others to be developed". In other words, it is all about priorities. I believe that we should do much better service to the NHS if we discussed what those priorities should be, tried to see whether we can achieve agreement and not play the crudest form of party politics, which is what the Labour Front Bench spokesman did today.

6.37 pm

Dr. M. S. Miller (East Kilbride)

The trouble with the analysis of the hon. Member for Eastleigh (Sir D. Price) is that it is based on what he calls realism—the realism of statistics. Statistics are important to Governments but people should not be considered as statistics, and I defy the hon. Gentleman to tell a mother that her child cannot be saved simply because the country will not spend money.

I have a high regard for the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) but I am sorry that such a young man sets his sights so low. One would have imagined that he would have a bit more idealistic fire and would want to achieve a little more than 0.5 per cent. The Health Service is apparently regarded as yet another area in which we must consider our priorities. I must declare a great interest as a doctor in wanting to do everything possible to enable people to live. I do not accept that we should be so pessimistic as to set a limit. We must keep working until we satisfy the demand. We as privileged members of society — for I believe that we are privileged—will demand the services that we need and make sure that we get them.

Dr. Brian Mawhinney (Peterborough)

rose—

Dr. Miller

I shall not give way, because many hon. Members still wish to speak in the debate.

The Secretary of State's speech was disappointing, but that is not surprising, because it was made in support of a pathetic amendment which congratulates the Government on their record and speaks in vague terms of their determination to maintain and develop a modern health service, giving maximum value to the public as though they were marketing cheese or a new brand of detergent. The amendment sounds like a market place slogan, whereas there is no room for medicine in the market place.

We had a better NHS until the Tories started chopping and changing. When, on 5 July 1948, the service came into being, an era came to an end — an era when parents, in addition to fearing illness in their children, suffered the agony of trying to find the money to pay the doctor. Although only relatively small amounts of money were involved, ordinary people could not afford them, and I remember that well because I practised in a working-class district of Glasgow before the NHS came into existence.

The NHS ushered in a new era. It was a comprehensive health service open to all, paid for by the state from the contributions of all earners, with no charges whatever. Although hon. Members have referred to contributions in a general way, they should accept that, at the end of the day, they come from everybody, whether they are paid so-called privately or to the state. The contributions still come from the people, and if the people can afford to pay a proportion of the Health Service privately, they should be able to afford that proportion to increase the amount of money available to the NHS.

I regret that we deviated from the original concept of everything being free. It is a pity that we imposed charges for prescriptions and so on. I should like to see all charges removed. As I say, if people can pay for health care privately, they can pay for it through the NHS, too.

The NHS is under attack. After all, it was never a popular proposition within the ranks of the parliamentary Tory party. It is all very well for Conservative Members, including the hon. Member for Eastleigh, to say that it was the brainchild of Sir William Beveridge and the coalition Government. While that may have been true, the enabling Bill was voted against at every stage, including the Third Reading, by the parliamentary Tory party. Today, the NHS is one of its targets. Its slogan is, "Set the people free", but I fear that it is setting them free to become ill and not to be able to pay.

I agree with the hon. Member for Eastleigh that the cost of the NHS today is high, but we shall not solve that problem by positively encouraging private medicine. The NHS needs more money, and we agree that we must keep pace with inflation, allow for higher costs of modern technology, take account of the increasing number of elderly people in society and so on.

The TUC has produced an interesting paper in which reference is made to five important areas of medicine which, when I graduated and for years afterwards while I was practising, I knew nothing about. Kidney machines — haemodialysis — were unknown, as were hip joint replacements. In my day nobody imagined having a heart operation. Today, there is incredibly better care of newborn babies. In my day many of them died. The treatment of haemophilia is now possible.

Those are just five areas of modern medicine. Are we supposed to say that one of those might not be a priority, and thereby condemn thousands of people to die? We cannot do that. Nor can we solve the problem by putting part of the payment for health costs on to the shoulders of the people. Those who suggest that that should be done are not aware of the enormous costs involved to the individual.

My hon. Friend the Member for Oldham, West (Mr. Meacher) referred to the situation in the United States where, I accept, much more is spent on health than is spent in this country. But medicine in America is more of a business than it is of a profession, and many doctors there concur with that view. Certainly the American public believe it.

I shall not delay the House, because many hon. Members still wish to speak. I am totally committed to the NHS and I urge people not to look at it simply in cold financial terms. We must have an emotional attachment, as it were, to the way in which diseases can be cured, regardless of cost. We must also weigh the cost of the NHS against other priorities, such as £10 billion spent on Trident. Not a great percentage of that need be spent on the NHS to put things right, and I would have thought that the Health Service should have a higher priority than Trident.

The public at large cannot appreciate the rosy picture that is painted of the NHS by the imagination of the Secretary of State and the Prime Minister, for they find that they cannot get elderly parents into hospital, that there are long waiting lists for serious conditions, that hospital wards are closed, that research is cut and that there is discontent everywhere. I wonder whether the right hon. Gentleman and his right hon. Friend the Prime Minister would answer a simple question which is puzzling millions of people: if things are so good, why are things so bad?

6.47 pm

Mr. Ken Hargreaves (Hyndburn)

In view of the remarks of the hon. Member for East Kilbride (Dr. Miller), I feel that I should declare an interest. I am a supporter and user of the National Health Service. The debate so far has concentrated on general and national issues affecting the NHS. I wish to draw the attention of the House to a local issue, one which may affect other constituencies.

Hon. Members have spoken with feeling about the resources of the NHS, and it is clear that the amount of money allocated to the service is important. I welcome the fact that the Government have increased spending in real terms on the service, as the Secretary of State explained.

There has been disquiet for some time in my constituency about the amount of capital resources allocated to the North-Western regional health authority compared with those allocated to other regions. I am glad to say that the Government have increased that proportion and that our capital allocation this year is the second highest in England, although we still have some way to go before our facilities are comparable with those in other regions.

However, there is little point in the Government allocating more money unless it is spent wisely. It is essential, before money is divided among the district health authorities in each region, that their various and varying needs are accurately established. I welcome the fact that the Government are considering ways of strengthening the general management function to secure the more effective management of resources.

I say that because at present, in my constituency, which is part of the Blackburn, Hyndburn and Ribble Valley district health authority, the health authority does not appear to agree with the regional health authority about our needs and the community health council does not agree with either of them. I am greatly concerned at there being so much confusion about what our needs really are, because we may end up wasting vast amounts of that valuable extra sum that has been allocated to us. That would be a scandal because, with the advancement of technology, there are many extra demands on scarce resources.

In 1979 the strategic plan published by the North-Western regional health authority proposed that children's services in the district should be centralised at Queen's park hospital, Blackburn, by the provision of 46 children's medical beds under phase one of the plan, work on which, thanks to the Government, has started. It proposed that 46 children's surgical beds should be provided under phase three in the 1990s, giving the district 92 children's beds, eight more beds than at present. The region appeared to be saying that the district did not have enough beds and that their proposals would rectify the shortage, albeit over the next 10 to 15 years.

On 17 January, the 15-bed children's hospital at Accrington was closed without consultation, despite regular assurances from the district health authority that that could not happen. The ward is padlocked and the formal consultation document for permanent closure has been issued. The closure is not the consequence of cuts. The number of children's beds in the district has been reduced from 84 to 69 by the action of the district health authority. However, the regional plan is for 92 beds in the 1990s, when the population will be smaller. How can we possibly manage with 69 beds now?

At a meeting of the district health authority on 1 February, the district administrator said that we could manage with 69 beds because the implications for orthopaedic and general surgery treatment of removing nine beds in these categories at Accrington Victoria will be virtually non-existent. Yet far from taking away nine beds, the regional authority is planning to give us 23 more, to double the present total.

The disagreement about the number of beds is not as straightforward as that. At the same meeting on 1 February the unit management group reported that, as a result of the closure of the children's ward at Accrington, it had put forward a scheme to be incorporated in the district's 1984–85 programme to extend children's ward 8 at the Blackburn royal infirmary. The group said that the scheme should be given high priority because if it were not implemented the ward could become a bottleneck and restrict the amount of paediatric surgery that could be undertaken.

There are three views of our needs. One view is that the ward at Accrington should be closed even though only last year it was upgraded by the installation of a new kitchen, new baths and new toilets and completely redecorated. We are told that we shall still have enough beds, even with that closure. The second view is that, if the ward is closed, despite the money that has been spent on it, it will be necessary to spend more money to extend the ward at Blackburn. The third view is that we are so short of children's beds that double the existing number should be provided.

What are our needs? Do we need 84 beds as at present, 92 as the region intends to provide, 69 as the district administrator says we can manage with, or 69 plus a few more as demanded by the unit management group? There appears to be confusion among the authorities. Unless one view can be agreed upon, there is a great danger of money being completely wasted. If that happens, it is likely that the Government will be accused of not providing enough money.

My constituents believe that money will be wasted if the children's ward at Accrington is not reopened. The situation has been made worse because the new wards have been centralised at Queen's park hospital, Blackburn. Centralisation seems to be a god that is worshipped by experts. It is said that it is essential for the improvement of health services, just as high-rise flats and putting policemen in panda cars were thought by experts to be essential. Ordinary folk said that those ideas were nonsense, and how right ordinary folk have been proved to be. It seems that we must have centralisation, never mind where units are centralised and irrespective of whether it is in the most inaccessible place in the Blackburn, Hyndburn and Ribble Valley district health authority. It seems that that makes no difference. Despite all that, it is claimed that centralisation will improve our services.

Centralisation makes some sense if money is spent wisely, but we cannot have centralisation at any price and in any circumstances. If that happens, sick children in need of the most minor operations will have to be treated in a hospital that will be three bus journeys away for many parents. That will happen if the region's plans come to fruition. If those plans are implemented we shall have beds which, according to the district, we do not need. They will be provided by the region in the wrong place. All we want is the existing children's ward reopened.

It seems that there are only two ways in which my constituents can be saved from the region's proposals, which they reject. First, the Minister could inquire closely into local needs, perhaps visiting the area and taking account of the strong feelings locally before making a decision, as he will eventually have to do. Secondly, the Government could do what the previous Labour Government did and make drastic cuts in Health Service capital expenditure. I would not recommend the second option to my right hon. Friend.

6.57 pm

Mrs. Renée Short (Wolverhampton, North-East)

I was rather disappointed with the Secretary of State's speech. He gave us many figures to show how the Health Service is flourishing under his control and said that there were more doctors employed in the NHS now than under the previous Labour Government. I do not know whether the right hon. Gentleman remembers, but in 1981 the Select Committee on Social Services published a report on medical education which recommended a consultant-based service. The Government endorsed that report, but we do not have a consultant-based service. The ratio of consultants to junior doctors in England and Wales in 1980 was 1:1.76. In spite of what the right hon. Gentleman said about an increase in the number of doctors employed in the NHS, the ratio in 1983 was 1:1.75. That can hardly be described as a dramatic rate of progress. We have a long way to go yet.

There is no doubt that without the NHS many poor families—the number of poor families is growing under this Government—would not receive health care in the sort of society which the Prime Minister wants to impose on the British people, in which those who have money can buy health care, while those who cannot afford it do not get it. There can be no choice of health care for those without resources, because they will not be able to exercise a choice.

Many people are denied health care even though it is clear that they will soon die without it. The shortage of dialysis machines and comparatively few kidney transplants are two examples. There is also the threatened closure of the bone marrow transplant clinic for children at the Westminster hospital. The Black report showed clearly that the upper and middle classes are large consumers of health care. It showed also that they are disproportionate consumers, for while the poor have the least spent on them, the wealthy enjoy the greatest provision.

Health care is often denied, not because the individual cannot pay for it, but because the Government will not pay to make it available. The Government have used various ploys to try to reduce the cost of the Health Service. There has been privatisation of the housekeeping services, accompanied by the sacking of men and women directly employed by hospitals. In the wretched economic climate that has been produced by the Government, those people have become a considerable charge on the state. They cannot get work and they remain unemployed. More money goes out of the public purse, while hospitals wrestle with inferior services. There are unsatisfactory meals and the private laundry refuses to wash dirty linen, some of which is washed in public when the hospital decides to sack the private contractor and bring back its former staff, which it had sacked.

The Government try to save pennies when the savings are set against overall expenditure on the NHS. They have taken some odd decisions and some rather damaging ones. Because the Government have reduced the budget of the Medical Research Council, the pneumoconiosis unit at Penarth is to be closed—for a saving of £1 million. If, as the Secretary of State says, so much more money is being pumped into the NHS, why can he not find £1 million for that unit? Without going into the detail of the report on the quality or otherwise of the research carried out at the unit, it must be clear that it is in the interests of the health of the mining communities that research into pneumoconiosis and other industrially-related chest diseases continues. The benefits to the nation must be worth more than £1 million.

The House of Lords Select Committee on Science and Technology recently reported that occupational health research in the United Kingdom is insufficiently co-ordinated. That is true. I hope that the Minister will tell us that the unit is to be properly funded and staffed so that it can continue with its work.

There is growing concern among women that screening and treatment facilities for cervical cancer are becoming more deficient. The Womens National Cancer Control Campaign, with which I am associated, has been urging women to have smear tests, with great success, but it is now clear that screening facilities are inadequate and that many women have to wait for the results of their tests, yet during that time cancer can invade.

Mr. Tony Lloyd (Stretford)

Is my hon. Friend aware of the famous Christie hospital in Manchester, where the consultant is having to turn away applications for cervical screening? That is not simply crass in the direct sense; it is counter-productive, because cervical screening not only nips potential tumours in the bud, but is more cost-effective than later treatment.

Mrs. Short

My hon. Friend is absolutely right. Speed is crucial if a test proves positive. Women are dying of cervical cancer when they need not do so. The test is the most cost-effective way of detecting cancer of the cervix in the early stages, when treatment is simple and does not involve a stay in hospital. It also saves lives. I hope that the Minister will respond to that point. The recall centre at Southport has been shut down and 155 jobs have been lost—yet women continue to die of cervical cancer.

The Select Committee report on medical manpower and the career structure showed the Government how to provide better health care for patients and how to fill posts in shortage specialties. Because of cuts in resources, doctors, whose training costs the country £100,000 each, are unemployed. Therefore, 10 newly qualified doctors cost the country about £1 million to train, but because of the shortage of pre-registration posts many have not become fully registered. That happened in 1983, and is happening again now. The junior doctors believe that there are now 2,000 doctors unemployed, which is a fine achievement for the Government.

On 24 February I asked why the Minister had stopped keeping accurate figures for the number of unemployed doctors. He said that his Department had never collected figures on unemployed doctors. I suggest that it is high time that the Department did that. It would then know how many doctors were available for vacant posts.

The Government are supposedly committed to a policy of consultant expansion. In 1982–83 that expansion took place at the rate of only 1.8 per cent., whereas a rate of 4 or 5 per cent. was needed. Therefore, many towns are without consultants in important posts, and the inequality between north and south becomes more acute.

Many regions are under-funded and have made only snail's pace progress towards their targets. The Wessex region was 4 percentage points below target in 1981, and is now 5 percentage points below target, so its position has deteriorated. The west midlands was 5 percentage points below target in 1981, and is still 4 percentage points below target. To crown it all, because of the recent doctors' pay award, the west midlands region must find £3.6 million to make good the shortfall. That £3.6 million must be distributed to the districts, which are already facing great difficulties. The cost should be borne by the Government, not placed on the already under-funded regions and districts that are already in considerable difficulty.

When I asked in February how many consultant posts were vacant and in which regions, the Secretary of State gave me the figures but passed the unnecessary comment that the figures seemed to lack any significance. Surely the figures for vacant consultant posts are highly relevant to patient care, especially if the vacancies occur in shortage specialties. Those are the areas where patient care needs to be improved and where waiting lists are longest. In the west midlands, 110 whole-time equivalent consultant posts are filled by locums, and 84 posts are unoccupied. It is one of the worst records in the country.

The conditions in dentistry are also serious, because higher charges are deterring patients from seeking treatment. The White Paper shows that family practitioner services charges revenue will rise by 12 per cent.—from £344 million to £386 million. Some 13 per cent. of that comes from optical charges, which will be lost when dispensing optical services are discontinued except for charge-exempt patients.

Dental and prescription charge increases are being imposed, and the public are complaining. They also complain that dentists are abusing the pay machinery. Those are serious allegations, which I understand were made during two recent television programmes. Why has the Minister not acted on the proposal of the British Dental Association that the reference dental officer service should be extended? The Government seem content to let the dentists take the blame for the Department's management failures. The Minister should be aware that there is considerable concern among dentists.

It is not as though there is not a great deal of money around — there is. One part of NHS expenditure has been rising steadily and irreversibly under the Government, who claim to be short of funds. In 1979–80 that area experienced real growth of 4.8 per cent., in a year when the remainder of the NHS was cut. In the following years it experienced growth rates of 5.2 per cent., 3.4 per cent., 4.9 per cent. and, in the last year, an astounding 10.2 per cent.—while the remainder of the NHS had difficulty in keeping pace with inflation.

I do not refer to the general practitioner services or to some developing high tech branch of medicine such as renal failure operations or coronary bypass treatment, which are expensive. The figures that I gave are for the so-called centrally financed services. Last year those services cost £539 million. If the Secretary of State does his sums, he will find that 20 per cent. of that amount is the cost of the Department of Health and Social Security at the Elephant and Castle. Much of that cost is attributable to various boards and quangos. Those bodies perform valuable work, but it is anomalous for them to enjoy the growth rate that we would like to see at the sharp end of the NHS—where patient care is delivered—at a time of restraint and when the Health Service has to bear additional burdens.

Mr. Fowler

I am sure that the hon. Lady does not want to mislead the House. I am sure that she recognises that since 1979 the headquarters staff of the DHSS dealing with health has been reduced by 20 per cent.

Mrs. Short

If the numbers have been reduced by that amount, the increase in cost is even more staggering. The Secretary of State should take that point on board. Perhaps the Select Committee will help him. The right hon. Gentleman should note what is happening under his nose before wringing his hands at the shortage of resources. That is fantastic.

No section of the NHS escapes the chill hand of Treasury Ministers. Demand for services is increasing. That demand is triggered by growing long-term intractable unemployment. With 4 million people unemployed and families dependent on them, it is clear that the demand for resources is increasing. In those circumstances, psychosomatic problems increase. Unless people are resilient, they fall ill. Worsening conditions mean that greater demands are made on the Health Service.

The feelings of hopelessness and depression which the Government have engendered throughout the population lie at the root of many of our health and social service problems. The Prime Minister and her docile followers, many of whom are making money out of the NHS, as we have heard today, have a great deal for which to answer. I hope that the Secretary of State will revise his attitude to resource allocation in the Health Service and ensure that the economies that can be made in the administration of his Department — perhaps the Griffiths management system will produce some results—are used for patient care.

7.13 pm

Mrs. Jill Knight (Birmingham, Edgbaston)

In view of certain comments made in points of order at the beginning of the debate, it is incumbent upon me to declare that I have no pecuniary interest in cleaning services in hospitals, the private medical sector or any other aspect. It is disgraceful that the hon. Member for Oldham, West (Mr. Meacher) read out a list of hon. Members. As far as I am aware, he did not warn those hon. Members, as is the normal practice in the House that he would mention their names. Another list of hon. Members was read out, and, as far as I know, not one was in the Chamber or had sought to speak in the debate. [Interruption.] The Opposition cannot have it both ways. They accuse my hon. Friends of having a private interest in the subject that we are discussing and say that that is the reason why they will be involved in the debate. Now the Opposition are complaining that those hon. Members are not involved in the debate. I wish that the Opposition would make up their minds.

We are well used to exaggeration from the hon. Member for Oldham, West, who works himself into a lather with less reason and more ferocity than anyone else I have ever seen. I must concede that the wording of the Opposition's motion is masterly. In one brief paragraph — 10 lines—the motion combines deceit, inaccuracy, unreality, hypocrisy, spite and confusion. It refers to the failure of the Government to provide sufficient resources As my right hon. Friend the Secretary of State said, the Government have more than doubled expenditure on the NHS. Expenditure has increased from just over £10 billion per annum to just over £15 billion per annum. What do the Opposition call "sufficient resources" if that increase is not enough? Are "sufficient resources" £40 billion, £50 billion or £60 billion per annum? After all, that is only taxpayers' money. Why stop there? Why not just make it £100 billion per annum? That is a nice round sum.

We must recognise that when the unreality of opposition becomes the reality of government—heaven forfend that that should ever happen to this Opposition—economic truths catch up. All Opposition Members are well aware that, despite what is said by Opposition Front Benchers and Back Benchers, past Labour Governments have had to cut costs, impose charges and limit spending in direct contravention of what they said when they were in opposition. That does not surprise me; but I am surprised that the Opposition flatly refuse to join us in our call for better value and an end to waste in the NHS, even though there is incontrovertible evidence of inefficiency, overmanning in administration, overprescribing of drugs, pilfering and misuse of resources. The Opposition do not want to know about that—worse, they do not even want it to stop. The Opposition encourage continuance of all those elements and resist all attempts to improve matters and obtain better value for money.

The Opposition's pretence that they understand the desires of the British people impels me to tell them that the British people do not want resources to be wasted in the NHS. They want, as do the Government, every penny spent in the NHS to give them value for money.

The motion calls for an end to private medicine. That point was emphasised by the hon. Member for Oldham, West. If private medical care provision ended tomorrow, the NHS could not cope. About 34,000 patients are being cared for in independent hospitals and nursing homes. On 31 December 1982—these are the latest figures that I could obtain — there were 2,929 pay beds in NHS hospitals. In all, about 37,000 people are cared for by the independent private sector. Direct savings to the NHS by the private sector—I hope that the Opposition recognise that this figure is important—cannot be less than £600 million per annum. [Interruption.] The Opposition say that many of the patients are not British subjects. I care that, when those people go in for treatment, their money is used for the alleviation of difficulties within the Health Service. [Interruption.] If hon. Members possessed their souls in patience, they might learn something.

Mrs. Renee Short

rose—

Mrs. Knight

I shall not give way, because I am trying to finish my speech. The hon. Lady made her speech. I am making mine, and no one will stop me.

Thousands of small private nursing homes for the elderly and the infirm are scattered all over the land, caring for well over 20,000 people.

It is not feasible for the Opposition to pretend that if private medical care ended the National Health Service could offer beds and care to these people. It could not do so. So let us take pleasure from the fact that this burden is lifted from the shoulders of the Health Service.

In addition to those private beds, recently there has been a big growth in hospices where terminally ill people go who are not necessarily old, and wonderful places they are. To the best of my knowledge, all these hospices are private or independent of the Health Service. Where would the patients in these places go if the Opposition had their way? Hon. Members should note also that in the past 23 years the number of people of retirement age, according to the latest census, has increased by more than 1 million. The problem of elderly people is great, and so much of Health Service resources is saved because so many of these people are cared for in private nursing homes.

There is an element of hypocrisy in the motion since the trade unions themselves maintain a private hospital. I refer to the Manor House hospital, in North End road, Golders Green. It irritates me when Opposition Members turn a blind eye to the extent to which their own trade unionists support private medical care. A recent National Opinion Poll of trade unionists showed that 67 per cent. of them thought that people should be allowed to pay for private medicine; 65 per cent. thought that private medicine shortened Health Service waiting lists; 69 per cent. felt that companies should be allowed to offer workers private medicine as a job benefit, and so do I; 80 per cent. of them felt that private medical insurance should not be abolished; 67 per cent. thought that private hospitals should not be taken over by the state; and 80 per cent. thought that the Health Service and the private sector should work more closely together, and so do I. In my view, the private medical sector should be recognised as a partner and not as an enemy of the Health Service.

I could give many examples where this is happening. I restrict myself to one. At the moment BUPA is placing a litho-tripter at the disposal of the National Health Service at St. Thomas' hospital, and shortly my right hon. Friend will be able to see advances of the plans for the placing of that litho-tripter. It is a marvellous machine which, working externally, shatters kidney stones and makes operations to remove them unnecessary. Not only does the patient not require an operation, but he will be in hospital for three to four days instead of three weeks. There is therefore an initial saving there to the National Health Service as well as tremendous benefit to the patient.

BUPA has made this machine available to St. Thomas' hospital. It cost £1 million. The deal is that for 75 per cent. of the time the machine will be treating Health Service hospital patients, and that for 25 per cent. of the time it will be treating private patients.

Mr. Stuart Holland

Will the hon. Lady give way, since St. Thomas' hospital is in my constituency?

Mrs. Knight

No, I will not give way. It is hoped that the machine will be in situ early in 1985. [Interruption.] Surely Opposition Members recognise that this is a tremendous example of the partnership between private medicine and the Health Service.

Mr. Holland

rose—

Mrs. Knight

The cost of the machine was paid entirely by BUPA. The hon. Member for Vauxhall (Mr. Holland) must try to get his facts right. It will be an excellent plan for NHS patients at this hospital, many of whom will come from the constituencies of other hon. Members and not just from that of the hon. Member for Vauxhall.

My support for the independent sector rests on two main planks. The first is the tremendous benefit that it confers on the Health Service. The second is that it is the inalienable right of people to spend their own money as they wish. Every citizen who has paid his rightful dues in rates and taxes and who then opts to spend his money on his own health care is freeing a bed for someone who needs treatment and who cannot afford or does not wish to seek that treatment privately.

The Labour party had better understand that private medical care exists all over the world, except in totalitarian countries. The Opposition should understand what they are asking for when they demand the end of private medical care. They should also recognise what they are asking for when they seek an end to the contracting out of services, many of which not only save money for the Health Service but improve standards.

We all want a good and flourishing Health Service. Cannot we agree that my right hon. Friend's announcement today of important advances is to be cheered? I saw not a suspicion of pleasure on the faces of Opposition Members. They seemed to deplore the advances that my right hon. Friend announced, but these are matters for pleasure. Cannot we all cheer when advances are made in the Health Service?

Cannot we use the opportunity of this debate to congratulate those whose wonderful work is daily improving the chances of life for cancer patients? I have in mind the people who have discovered that bone marrow cancer can be dealt with with magnets. I also have in mind the people at the Cromwell, a private hospital, who are perfecting a system to deal with liver cancer. Cannot we all cheer that this very day a case came to the notice of our national newspapers of a tiny boy of only 18 months who had had a pacemaker implanted?

All that we hear from the Opposition seems to decry and deny the advances that are being made. Cannot we say that these are important developments and that we all support them? Cannot we at least acknowledge that the money spent on the Health Service, although we all wish to spend more, is being spent to advantage?

7.29 pm

Mr. Terry Lewis (Worsley)

I come from a local government background where members have to declare specific interests of a pecuniary nature before contributing to a debate or voting at the end of it. In my view, it is appalling that in the Mother of Parliaments hon. Members who have such interests do not have to declare the exact sums of money they receive and from where it comes.

Government supporters can go blue in the lace and Opposition Members can go red in the face arguing the pros and cons of this motion. If I had not received a vast number of letters from constituents, and a great many answers from Ministers over the past week or two about individual cases in my constituency, I could be lulled into believing that all was not bad with the National Health Service.

I recently tabled a question to the Minister asking to be told why health authorities had exceeded the number of staff cuts that he had ordered a year ago. His reply was that in his opinion it was because they had improved their efficiency in the use of manpower to a greater extent than the minimum targets that Ministers required of them. That is all very well, but one should consider the fact that in the north-west region alone 1,521 jobs were cut after the Minister had asked for only 561 to be cut.

I accept that the service has to become more efficient, but people working in the north-west regional health authority say, not that the service is more efficient, but that there are more problems. I should like to refer to a recent article in the Daily Telegraph. Even Conservative Members would not suggest for a moment that it was an organ of the Labour party. The article stated that managers at district health authority level tended to over-react by freezing appointments on the Minister's instructions, and that the policy was to cut non-medical staff. Now the number of nurses is 79 below the minimum for the area. That is incredible and unacceptable. If that is what the Minister thinks efficiency is, Opposition Members cannot support it for two minutes.

Several cases have been brought to my attention where individuals have suffered because of the cuts. I asked the Minister about a constituent who had a heart attack within 1½ miles of an ambulance station that had just lost an ambulance and an ambulance crew during the self-same staff cuts. My constituent had to wait over half an hour for an ambulance to travel from more than 6 miles away. That is the efficiency about which the Minister is talking. In that ambulance, on the way to hospital, my constituent died twice and had to be resuscitated by the attendant.

That is incontrovertible. When such things happen, ordinary people cannot understand the efficiencies about which the Government are talking. They are not efficiencies, but deficiencies, in the service. Services are being cut to get the bottom line in the balance sheet. That bottom line is not consistent with health care. En this debate we should be talking about health care. It is appalling that Conservative Members worry about the total amount of money that we wish to spend on the Health Service, when in another debate they can blithely go through the Lobby and vote for £10,000 million to be spent on weapons of death and destruction.

Another specific case graphically illustrates what we in the Opposition are trying to argue. I hope that this story does not raise too much of a laugh. My constituent, who was a day care patient, awoke from the general anaesthetic to find himself sharing a bed with another patient in the recovery ward. It was another man. I confess that when my constituent came to see me I could not suppress a titter, but then I wondered how serious the miscare of patients must be before Ministers will understand. My constituent rushed to the local newspaper, which printed his story in an amusing article, which, thankfully, had sufficient bite to get people to understand that he was badly treated and had a case to make. He was treated in what we have always regarded and do regard as an excellent hospital in my area. After that item appeared in the newspaper, I received a letter from a senior consultant surgeon in that hospital. I have since spoken to him. I shall withhold his name because that was his wish, but I should like to quote from his letter, which appalled me. I promise that the Minister will be hearing much more about this in the weeks and months ahead. The letter stated: I am writing in connection with a recent article…which I gather has been brought to your attention…The article in question reports that a patient had to share a bed…with another man as both were recovering from day care surgery…I entirely agree with the patient's grievances, and the report in the…Journal is accurate. The only inaccuracy, unfortunately, comes from our own hospital Administrator who did not consult any member of the Medical Staff before making his statement". That statement was that my constituent had not had a general anaesthetic, but was a local anaesthetic case, and had gone into the day care recovery ward under his own steam.

The letter continued: As I think the article made clear the medical and nursing staff in this hospital are working extremely hard in conditions which are not of our choosing. The complaint is, I think, only the tip of the iceberg and many other patients have, I think, even more grounds for complaint". I should like Ministers on the Front Bench to listen to the next part with great care: but in the nature of things most of our patients are to a certain extent unrealistically understanding and are very kind to us. In fact they might do us more good by complaining about the service that we are able to offer at the moment. I emphasise that the hospital is not one of the side-street run-down hospitals, but a teaching hospital of excellence.

The letter continued: Although this hospital now has an excellent reputation for the treatment of most illnesses and now gets patients referred from well outside the…area, those of us who work in the hospital are very concerned about our steadily diminishing services. On the surgical side we have been for some time desperately short of nurses and things are now so bad that major surgery now regularly has to be cancelled as there are not enough resources for post-operative care. Recently I heard of someone who went into hospital to have a serious heart operation, but had to be sent home after pre-medical care because there was no post-operative care. That is what is happening to our Health Service.

The letter stated further: In addition we have noted a small number of post-operative deaths, usually inpatients having emergency surgery, which seem potentially avoidable if we simply had additional nursing staff to supervise the patients. The letter goes on and on. I stress that I am talking about the things that are happening on the ground in the Health Service. Ministers are talking about the desiccated calculating machine of the Tory party.

I end on a personal note. My hon. Friend the Member for East Kilbride (Dr. Miller), an eminent doctor in his previous incarnation, talked about the independence of the people in the poor area of Glasgow where he lived, who were worried because of the health care provided by the Health Service.

Today is the anniversary of the start of the Health Service and in some respects it is an anniversary for me. Personal experience is more useful in the debate than clever arguments that may have been researched in the Library. Nine years ago today my family consisted of two youngsters who would run about for 23 hours a day if they were allowed to do so. They never had a childhood illness, we rarely used the services of the local general practitioner and even after inoculations they would run about the place. Suddenly, over a period of days, the youngest of the two, who was nine and a half years old, was diagnosed as having a brain tumour. Within nine months he was dead.

My point is that during that nine months the child received the best possible health care for the illness from which he suffered. I worked in industry, earned a few quid more than the national average—I worked shifts to do that—and I had a mortgage which I could barely afford. If we had lived in a country without a national health service, I would have gone bankrupt. We would have had the worry of selling our home and keeping the family together. The Health Service emancipates ordinary people who do not have much money from the worries associated with illness. Illness strikes at the very rich and the very poor. The only difference is that the rich can pay for health care and maintain their homes and families. Those of us who are not rich cannot do that without the help of the National Health Service. I thank God for Nye Bevan and that emancipation.

7.43 pm

Dr. Brian Mawhinney (Peterborough)

I agree with the hon. Member for Worsley (Mr. Lewis) that the Health Service has brought emancipation to many people. I did not intend to tell the House of a personal experience, but I shall follow his example.

When my sister was 26 she had a brain haemorrhage and received the best possible care from the Health Service. If we had had to provide the money for it, she would have died then. When she had a second brain haemorrhage and died at 28, she again received the same exemplary service, for which we are proud, in the National Health Service. Therefore, I identify with the hon. Gentleman's comments.

I shall comment on two previous speeches. The hon. Member for Oldham, West (Mr. Meacher) made a great deal about the cuts in hospital provision that he alleged had taken place under the Government. That comment will be greeted with a horselaugh in Peterborough. It is a new town into which people were being moved because of Government policy, yet it was not provided with health care. Health care in the form of a second district hospital was to have been authorised by the Labour Government. It was stopped the day that the right hon. Member for Leeds, East (Mr. Healey) returned from the airport, brought back by the International Monetary Fund. It was not continued until my right hon. and hon. Friends took office. That hospital will be built about six years too late. The increased suffering and illness of my constituents during the next three or four years until the hospital is opened is the result not of this Government's policies but of those of the Labour Government. That suffering should lie on the conscience of that Government's Ministers. For that reason the hon. Member for Oldham, West will receive a horselaugh from people in Peterborough.

The hon. Member for East Kilbride (Dr. Miller) pointed out that because of the limitation on resources many people would die before they were treated. That is, unfortunately, true. But he said it in such a way as to suggest that it was a new phenomenon. It would have been more in keeping with our attempt at fairness if he had had the grace to say that that had always been so.

The statistics that my right hon. Friend the Secretary of State gave at the beginning of the debate clearly demonstrate the Government's commitment to the Health Service. Today is its 36th birthday and I thought for a moment that I was sitting in a Northern Ireland debate because hon. Members were keen to debate history. We are talking not about the Health Service's history but about its future. The NHS was a visionary concept and it continues to be one. I am wholly committed to it. However, I am worried that after 36 years we have seen little organic change within the Service to keep abreast of the developing world in which it must offer its service.

The motion condemns the Government's failure to provide stable conditions for those working in the service so that they can concentrate on patient care. I agree that stable conditions are important, but it could be argued that the Health Service over the past 36 years has been too stable. It reminds me of forests in the south-west of the United States. The trees seem beautiful until one gets close to them, when one sees that they are petrified.

I commend the Health Ministers for the fact that for the first time they are prepared to think strategically about the Health Service, and are not prepared and content to sit back and make decisions on a week-by-week or month-by-month basis. They understand that they have a responsibility to deliver into the 21st century a health service which is geared to the 21st century and which can provide a comprehensive and visionary service such as we have been enjoying. It is indisputable that in the years before we took office there had been no real examination of the Health Service. There was no information about the number of people who worked in the service, nor information which allowed people effectively to manage the service. My hon. Friend the Parliamentary Under-Secretary will remember that we lifted a veil from a small corner of that during an Adjournment debate.

My hon. Friend the Member for Eastleigh (Sir D. Price) pointed out that resources were finite and demand infinite. That has always been and will continue to be the case. Opposition spokesmen should not create the illusion that if they were in power resources would be unlimited. That would not be so.

There has always been dissatisfaction within the Health Service with Governments. In July last year my right hon. and learned Friend the Minister gave a speech to the Association of Community Health Councils. He said: Decent people have always lobbied for more resources for the NHS and criticised every Government for shortcomings in the service over the last thirty-five years. Decent people will continue to point to unmet needs in the service, even while we employ more doctors and nurses and steadily open modern new hospitals all over the country. People are quite entitled to lobby but lobbying alone never solved any problems. Dissatisfaction with Government's performance in respect of the Health Service is good because it keeps Government on their toes. There has been dissatisfaction with management.

I do not want to take time this evening talking about specific health care cases. I see the Government's role as providing a framework in which the professionals within the Health Service can provide services as effectively, cost efficiently, humanely and caringly as possible.

Mr. Corbyn

rose—

Dr. Mawhinney

If it is the Government's job to address themselves to providing the strategic framework, I believe that the Government have an excellent record.

Mr. Corbyn

On a point of order, Mr. Deputy Speaker. Is it in order for the hon. Gentleman to talk about the Health Service in this way without informing the House that he is a director of Service Master Hospital Services Limited? Perhaps he should explain what that company does?

Mr. Deputy Speaker (Mr. Ernest Armstrong)

Order. It is entirely a matter for the hon. Member.

Mr. Winnick

Further to that point of order, Mr. Deputy Speaker. If it is a matter for the hon. Gentleman, does he not have an obligation to declare an interest when the debate is on the Health Service and he has a strong financial, commercial interest?

Mr. Deputy Speaker

Order. It is a matter for the hon. Member. I would say only that these points of order make it more difficult to call those hon. Members who are desperately anxious to address the House.

Dr. Mawhinney

I shall make my own speech in my own time in my own way. I shall observe all the courtesies and customs of the House in that speech, as you will discover, Mr. Deputy Speaker.

The first thing the Government did was to remove the area health authority tier. The point of that was to make decision making more sensitive to local needs. In that regard, I find the Opposition's motion incomprehensible because it talks about "the drift to centralised control" and yet the Government's actions have been in the opposite direction.

The Government introduced the Griffiths report because it was clear that one of the grave disadvantages of the Health Service was its inability to manage and to bring together coherently the many disparate professions and groups that operate within the Health Service. I commend the concept of audit and departmental budgets, which are central to the good management of any organisation and certainly to any business. It should also be the case in the Health Service.

The Government have also addressed themselves to the strategically important issue of information so as to allow National Health Service managers to manage. They have already anticipated that need by setting up the Komer committee. The three reports that that committee has produced, coupled with the Government's commitment to see them implemented, and the rapid introduction of computerised records means that in the 21st century, long after this debate is forgotten, the Government's actions will have laid the foundation of a modern Health Service which will be able to cope with future needs.

Rayner was introduced and discovered something that people never knew—we had more ambulances than we had people to drive them. We had supplies worth £1.7 billion which could be substantially reduced if managed properly. We had performance indicators which revealed for the first time that identical services in different parts of the country cost considerably different amounts of money.

Mr. Ron Davies (Caerphilly)

Reflecting different needs.

Dr. Mawhinney

The hon. Gentleman is right. That might reflect different needs. It might reflect different levels of management ability or different priorities, but what is indisputable is that if we do not have the information we cannot make the correct decisions which are in the best interests of the Health Service.

Time and time again, Opposition Members must be reminded that the debate is not about how much money can be thrown at the Health Service, but about how that money is used within it for the benefit of patients. I was interested to note how seldom the word "patients" has been mentioned by Opposition Members.

I move on to the Government's decision on competitive tendering. At this point, Mr. Deputy Speaker, I remind the House that the hon. Member for Bolsover (Mr. Skinner) has already declared my interest. I have a pecuniary interest, but my overriding interest is that the services that are provided should be provided to a quality, and I stress quality to my right hon. Friends, and with regard to those who work in hospitals, provide the most cost-effective use of resources so that the money saved can go towards patient care. It was interesting to note that there was a kind of stunned silence when my right hon. Friend mentioned that the first eight of those contracts have produced a saving of £1 million to the benefit of patients.

The last issue upon which I wish to commend my right hon. and hon. Friends is the steps that they have taken with respect to family practitioner committees. We could not face the 21st century with a Health Service where the demand for primary care was as great as it is today, without a radical re-examination of the role of family practitioner committees and their functions with respect not just to the service that they give but to the interrelationship of that service with the hospital services.

The record is good because it is strategically related to the future. It builds on the past and protects the visionary element of the Health Service which all on both sides of the House applaud, but for the first time the Government have started to act strategically. They are making decisions which will not come to fruition next month or even next year but five and 10 years down the road. That is a substantial and overriding contribution that my right hon. Friend and hon. Friends are making to the next 15 years of the Health Service. That is a commitment that demonstrates better than all the statistics and all the words that the National Health Service is particularly safe in my right hon. and hon. Friends' hands.

7.56 pm

Miss Betty Boothroyd (West Bromwich, West)

The hon. Member for Peterborough (Dr. Mawhinney) will forgive me if I do not follow his comments, because I wish to pick up the final comment of my hon. Friend the Member for Worsley (Mr. Lewis). He spoke about the heart and guts of the National Health Service. From the strength of feeling with which he spoke, I am sure that he will share my sentiments when I say that 36 years ago millions and millions of people, young and old, transposed the legal jargon of the National Health Act into simple terms of reference and related it to themselves. I believe that many of those people thought that at last here was a service which did not differentiate between rich and poor, where riches did not bring gains, and where it was not a disadvantage to be poor. That was the feeling then, and we must embrace and enhance it now.

For all that, we must accept that it is not a perfect service. I do not expect it to be. I do not believe that it can be when there are such enormous human elements involved. In a service that is performed by human beings on behalf of other human beings, there are bound to be warts, and complaints coming from all sides—patients, staff and administrators. For all its imperfections, I believe that it is the responsibility of those of us who respect those terms of reference to defend them, to see that they stand the test of time and endure.

Ministers who apply double standards in their dealings with the service and pledge to safeguard it and develop it and then use their authority to weaken and dismember it are neither allies of those who work in the service nor friends of those who are sick and need its care. None of us needs to have too long a memory to recall the commitment given by the Secretary of State to the nation during the election campaign. He pledged that spending plans for the Health Service would be subject to further consideration, and "upward review" was the phrase that he used. He said that it was out of the question that any downward review would take place. Those words meant nothing. The first massive manpower cuts in the history of the service were imposed within a few weeks of his taking office. His action was roundly criticised at that time by many people outside the House. It was described in a leading editorial as a rapid and cynical ditching of the spirit and detail of an election pledge and an appalling treatment of the National Health Service, and so it was.

In areas such as mine, where resources were already overstretched, the position became even worse. Constraints were placed on the local health authority, both in financial and manpower terms, which dramatically changed what had previously been achieved. Previously, those who had trained in a variety of techniques in the authority were offered jobs in the service. That is no longer possible. Staff who are finishing their training at public expense are jobless or are going into the private sector. In my area, radiographers are finishing training, but no jobs are available. Yet, at the same time, a consultant radiologist in the hospital rightly complains that the equipment that he needs for patient care, equipment that cost thousands of pounds, is lying unused because the staff on the basic grade of pay cannot be employed to operate it. That is nonsense.

The Minister tells me that the long delayed start of the community hospital in Sandwell might begin in four years' time. It has been so long delayed that local doctors who pioneered the project and know of its necessity to the community are on the point of retiring. Mine is an area in which the proportion of elderly people is far higher than the national average, the queue for surgery is lengthening and more than 6,000 in the catchment area are waiting for necessary operations. A community hospital would ease the pressure on bed spaces in other hospitals, needed by patients who must have the use of high technology equipment.

Although the Minister has given a glimmer of hope, he nevertheless has that famous caveat always put there by his Department, that the hospital project is still "under review." I wonder whether this is the upward review about which the Secretary of State told us in the June election campaign, or whether it is the downward review that came about after the election. I wonder whether the project, which conforms to all the priorities which the Government set for health care, will be further postponed.

I am deliberately restricting my remarks to the west midlands, to some extent because the Secretary of State represents a part of it, as I do. It cannot have escaped his attention, as it has not escaped mine, that the region is becoming one with some of the longest hospital waiting lists for surgery. Nor can the flood of comment and concern have escaped his notice, coming as it does from senior people in the medical profession who are now compelled to speak out, as they never have done before, about the problems of long delays, the cancellation of treatment which has been mentioned by my hon. Friend the Member for Worsley (Mr. Lewis) and the demoralisation that this is causing both to staff and patients.

The Secretary of State seemed to give the impression that because of the increased efficiency and various other measures that he had taken more people were being helped in the National Health Service. He cannot be ignorant of the fact of what has happened in his region. Consultants are now publicly expressing concern about patients who are on waiting lists and who are now suffering such deterioration in their condition that they have gone downhill too far to be helped. The Secretary of State must know that the consultant surgeon at the Queen Elizabeth hospital in Birmingham branded the provision for cardiac sufferers as "the worst anywhere". He said: The chance of dying is much higher on the waiting list than after the operation. He went so far as to say that as many as 18 operations were cancelled on the day of surgery because of lack of intensive care facilities. I am sorry that the hon. Member for Birmingham, Edgbaston (Mrs. Knight) has left the Chamber, but I understand that she has another commitment. People in her position who boast about patients getting better value for money from this Government should realise that people on waiting lists who are made ready for surgery one day and are turned away because there are no facilities do not believe that they are getting value for money. Recently it was made clear that we had reached a point at which, because of the chronic under-funding, the gap between what could be provided for patients because of advances in medical science and what is being provided is rapidly widening. The chairman of the British Medical Association made that point only this week.

I am not suggesting to the Secretary of State that the problems of health care in inner cities, about which many of us know, and the unequal distribution of resources has happened overnight. It has not. The problem has been with us for some time. What is a fact is that the problem is rapidly worsening, and we crucially need a major shift of national resources into the service. The imbalance has to be redressed in areas of unequal distribution, so that those who are further disadvantaged by decay and poor environment, and those who are dispossessed by industrial change, as we know they are, will at least receive the necessary social investment to compensate for the inadequacies of the environment in which they have to live.

For a time, the Government went some way towards recognising these problems. In the 1983 Tory election manifesto, on page 27, they singled out the midlands for special attention. They said that it was short of resources and pledged to make extra provision for it. That commitment is not worth the paper on which it was written. Some £8 million was taken from the midlands' budget. The increased facilities and much needed development have been halted. Staffing levels have been reduced by more than 3,000. The chairman of the regional board came to see Labour Members because we could not get the precise figures from the Department. We ask him to give us the figures, and I have a breakdown of them. The unredeemed pledges of the Government rekindle Disraeli's description of his party as "an organised hypocrisy".

The Secretary of State cannot hope to squeeze the service harder in the interests of efficiency. He knows what the figures are, and he must know that, far from being a burden on public expenditure, it takes a smaller proportion of our national resources than do similar services in comparable countries.

The Health Service cannot be shackled to the purse strings of the Prime Minister and dismembered and dismantled. It is not the Government's property. It belongs to all of us, and although a Labour Government had a major hand in creating it, and I am enormously proud of that, it does not belong to any Government. It did not belong to that Government, it certainly does not belong to this Government and it will not belong to future Governments. It belongs to the people of Britain, and we have put down the motion to demonstrate that fact clearly.

8.10 pm

Mr. David Atkinson (Bournemouth, East)

The hon. Member for Oldham, West (Mr. Meacher) mentioned the Prime Minister's eye operation last year. Any Prime Minister, or Minister, Conservative or Labour, deserves the best possible health treatment, because of the job that he or she does. They are entitled to choose where they obtain that treatment, just as Labour Ministers have done in the past. No decent, fair-minded or honest person would disagree with that. The comments of the hon. Gentleman and the comments made last autumn by the hon. Member for Crewe and Nantwich (Mrs. Dunwoody), who suggested that an account should be rendered for the cost of some NHS surgical instruments that were used during my right hon. Friend's operation, were petty, pathetic and prejudiced. I regret that they were said.

I thank my right hon. Friend the Secretary of State for all that he and his Department did behind the scenes to ensure the commencement last week of the building of the long-awaited Bournemouth general hospital in Castle lane in my constituency. It has been awaited for more than 20 years. It was delayed by the cuts in the hospital building programme imposed by the Labour Government, and further delayed because of recent changes in design and hospital building policy. My constituents will heave a sigh of relief now that the first stage is under way for completion in 1987. By the time the entire 670-bed hospital is ready, no doubt one or more of our older hospitals will be closed. I hope that there will be no criticism from the Opposition when they are closed, because those hospitals will have outlived their usefulness and will have been replaced by modern ones.

The debate is about resources for the NHS. The word "crisis" has been overworked, since, within a year of its birth, Aneurin Bevan put a lid on NHS expenditure. The debate is also about demand, and we ignore at our peril the facts contained in the Green Paper on public expenditure, to which the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) referred, the trends to which my hon. Friend the Member for Eastleigh (Sir D. Price) referred —he also quoted the anxieties of the chairman of Wessex regional health authority, which were reported in a local newspaper under the heading, Action Now on NHS or Collapse within 20 Years"— and the warnings given at this week's conference of the British Medical Association.

In response to present demand, my right hon. Friend the Secretary of State and his predecessors have done all the right things. He has more than maintained public expenditure on the NHS since 1979, which is no mean achievement during a world recession. He is achieving greater efficiency per pound spent on health care and is pursuing more. He is right to reorganise management and to introduce manpower monitoring. To be the largest employer in western Europe invites scrutiny of labour, especially when the number of employees in the NHS grew by about 487,000 between 1970 and 1980, which matched exactly the growth of the British population during that decade. We had one extra employee for each extra citizen born.

My right hon. Friend is right to ask health authorities to submit plans for contracting out non-medical services where real savings can be made, especially as hospitals in other countries make far greater use of private contractors. In France, Belgium and Germany the figure is 50 per cent.; in Denmark it is 60 per cent.; and in New Zealand and Socialist Sweden it is 70 per cent. In Britain we contract out only 2 per cent. of services. That is the measure of what can be achieved in this area.

However, the signs are that what my right hon. Friend is doing will not be enough to provide resources to satisfy the expected and predicted demand on the NHS. When that problem was put to the Think Tank two years ago, its recommendation to change to a service based on insurance funding was never published and was immediately shelved. But no responsible party should assume that a nationalised Health Service such as ours is or will ever be superior to any alternative system. We should not assume that it will match people's expectations or demands in the future. Indeed, more and more people—more than 4 million to date—are showing their dissatisfaction with their feet, by paying not once but twice for medical cover.

The Government should now look positively in the direction of a greatly enlarged private health service if their successors are to satisfy the future demand to which we have all been alerted. We should not be afraid to put that case to the British people, who are prepared to accept greater responsibility for their health needs and those of their families. That does not mean that we should go down the American road, where it seems that one is left untreated if one does not have a membership card or if they have run out of Medicaid funds for that year. We should encourage evolution towards a more balanced partnership based on a closer working relationship between both services, to avoid wasteful duplication of resources.

Several initiatives that should soon be taken by the Government and the private sector will help to determine the potential without committing either party to it. The private sector — the insurers and hospital groups —remains its own worst enemy. It seems completely incapable of getting its act together and presenting the Government with sensible recommendations for private sector development. A national council representing the five main components is long overdue. Of course, the sector is far too small with 7,000 private hospital beds and 3,000 pay beds, and is insufficiently competitive in its choice of cover. The public must have a wide range of choice in price, so we should encourage more British, American and indeed European enterprises to become established here, just as we are capable of exporting our health services and hospital capability.

Many advantages could be gained by breaking down our personal income taxation so that taxpayers are more aware of how much they are paying towards their social security and the NHS. It is not generally understood that 85 per cent. of the cost of the NHS comes from general taxation and 11 per cent. from national insurance contributions. Surely it is not beyond the capability of our computers to separate income tax from a health tax and social security tax— [HON. MEMBERS: "What will that do for sick people?"] It will make all of us as taxpayers and consumers more aware of the lack of value for money for the taxes which we pay.

While I have reservations against all forms of tax relief and allowances, instead preferring lower general income tax, I believe that there is a strong and sensible case for providing tax relief for health insurance premiums for those aged 65 and over. That is the age of which most people find that their incomes fall; usually quite significantly, while at the same time they are faced with a rise in subscriptions. Understandably, many of them let their subscriptions lapse for economic reasons at the start of the very time of their lives when they are likely to need more medical cover. Consequently, the NHS picks up the bill. Surely it is better to encourage the maintenance of private cover for the rest of their lives at minimum loss to the Revenue by giving tax relief on their private medical insurance subscriptions than for the NHS and the state to take on the full cost of their care.

The NHS has done, and is doing, an extremely good job, but the demands made upon it now, and the demands that are expected, are and will be beyond the capacity of the NHS, and the gap between demand and resources will widen. We must now approach the private sector positively to make up the balance and to respond to the growing demand of our people to accept greater responsibility for themselves rather than to rely on the state.

8.21 pm

Mr. Ernie Roberts (Hackney, North and Stoke Newington)

I shall be brief as many of my hon. Friends wish to take part in the debate. I can remember the 1920s and 1930s. I also remember that a national health service was opposed by previous Tory and Liberal Governments. It was introduced by a Labour Government who always fought for a health service paid for out of taxation.

The Government are butchering the health services, and by doing so are killing people. In spite of all their bleating about spending more, they continue to cut back on health services and are closing hospitals. That is what is happening in places such as Hackney where hospital closures have taken place. At present, patients and citizens are occupying St. Leonards hospital which the Government are attempting to close.

Yesterday I received a message from the doctor responsible for the drug unit at Hackney hospital telling me that no further drug cases could be taken on because of insufficient finance. Similarly, I have received letters from staff and patients from the neurological rehabilitation unit asking me to protest against the threatened closure of this essential and important unit. All this is in spite of the bleating of the Minister for Health about what the Government are doing for the Health Service. We should judge them by their actions. The people of Hackney do so, and are dissatisfied because the area does not enjoy many of the health services.

I have concrete evidence of how the Government's actions are placing the nation's eyesight in danger. Like me, Mr. Deputy Speaker, you wear glasses, as does the Secretary of State for Social Services. The glasses that I am now wearing were bought today as a result of a handbill which has been distributed to many thousands of people.

It states: Guaranteed superb quality reading glasses — £6.50 to £13.50. Why pay more? Victoria Market, 5 Wilton Road". I went along and discovered that the stall was next door to a clairvoyant. I did not know whether to go to the clairvoyant first to get a prescription, but I went to the stall and was told, "Try these on for size." I did and read the card displaying various sizes of print. They did not do, so I tried another pair and they did not do. I then tried on another pair and asked, "What is happening?", and was told, "They are getting stronger each time." Eventually I purchased the ones that I am now wearing, and I can read with them.

The handbill, under the heading of "Your Eyesight", contains some dangerous information, which must be the responsibility of the Government. It states: Reading difficulties which come with age, our consultant reports, are not a defect but a natural ageing process—very like greying hair…The eye's lens hardens with time and is no longer supple enough to focus on near objects. This generally affects both eyes equally and one needs only a pair of identical simple magnifying lenses"— which these glasses are, but even though I can read with them I can see better when I take them off— to allow for this and restore ease of reading. The slight difference between the two lenses"— that applies to my glasses— of many spectacles supplied by opticians are added only because there is no further inconvenience. The customer is often unable to tell the difference between a pair that includes them and a pair that does not. These glasses do not fit properly and fall off when one bends down.

I went to Dollond and Aitchison, the opticians in Victoria street, and had my prescribed glasses and the new pair checked. The results show a clear difference between the glasses that I bought, with which I can read, and the spectacles that I had prescribed. Therefore, glasses that are sold in this way are far from satisfactory and could be dangerous to those who buy them.

Furthermore, poor people, such as those I represent, will be driven to these places to buy glasses. As in the 1930s, people will begin purchasing spectacles from second hand shops and off stalls, where they are even cheaper. The old and the poor, who cannot afford to go to the optician to get a proper pair of glasses, will be forced to purchase them elsewhere. It is time that the Government looked at the real problems of the Health Service instead of bleating about how much they are spending on it.

8.28 pm

Mr. Mike Woodcock (Ellesmere Port and Neston)

In response to your request, Mr. Deputy Speaker, I shall be brief. Like many hon. Members, I am concerned about the state of the NHS. However, I am less concerned about the amount of cash that the Government give the NHS than I am about the management of the Health Service, the concern shown by the NHS for local opinion, waste in the Health Service, lack of health education in our schools, lack of stability caused by constant reorganisation and the level of management training in the NHS. If we showed more concern about these things, we would go a long way towards bridging the gap between what the NHS can do and what we would like it to do.

I am one of those fortunate people who has never had to spend a day of my life in hospital, but I have had cause to be grateful for the availability of casualty and minor injuries units. I know how important they are in an emergency, and appreciate the importance of people knowing when and where they are available.

There is such a unit in Ellesmere Port in ray constituency. It is small by casualty unit standards, but it treats 10,000 cases each year. For many years it has provided a reassuring, effective and acceptable service. It has provided exactly the service that should be provided and has been much appreciated locally.

The service is, and was, additionally important for three reasons. First, it is important because Ellesmere Port is an industrial town and provides 15 per cent. of all the jobs in Cheshire. Many cases treated at the unit are the result of industrial injuries. Secondly, the unit is important because there are 25 schools within a mile or so of it. They regularly use the facility. Thirdly, it is important because the town is in a depressed area with a high unemployment rate, a particularly high youth unemployment rate and a high proportion of elderly people, many of whom do not have the facilities to go to alternative units by private transport.

In spite of that, in October last year the district health authority proposed the closure of the unit on cost-saving grounds. Much concern was expressed locally and many representations were made to the district and regional health authorities. Many constituents wrote to me, including teachers, nurses, industrialists and family men and women. A petition containing 12,000 signatures was organised. The borough council strongly opposed the proposal and went as far as to consider the possibility of financing the unit itself. The community health council also opposed the proposal.

Nevertheless, the district health authority pressed ahead and after the consultation process the Minister confirmed that he will allow the closure. The case for closure was based on cost savings, but I think that the closure is likely to increase the cost of treatment. The authority says that the savings, based on staff costs, non-staff costs, medical supplies and overheads, will amount to £51,000 a year. That is £5 per patient treated.

One might think that that is a modest amount for the treatment of one person, but that calculation ignores the fact that patients will still have to be treated elsewhere and that costs will be incurred. It ignores the fact that no staff redundancies will take place, when staff costs total 75 per cent. of the £51,000. Even more important, the calculation ignores the extra costs that will have to be borne by the community. It ignores the costs of extra transport to the alternative facilities at the West Cheshire hospital. It is estimated that over £15,000 will have to be spent on bus fares alone for the additional journeys.

The calculation also ignores the extra time taken by patients and those who accompany them when travelling to the alternative facilities. It ignores the extra loss of working time and disruption to production in factories. It also ignores the fact that some people, because of extra time or cost, may not even bother to present themselves for treatment.

I do not say that savings should not and cannot be made. The National Health Service is the nation's largest employer. It employs almost 1 million people. Since 1979 National Health Service expenditure has risen from £7.75 billion to £16 billion—that is 18 per cent. over the sum required to compensate for inflation. Between 1971 and 1981 about 200,000 extra staff were employed in the service.

In any organisation as vast as the NHS in which spending has risen to that extent, efficiency should be increased and savings made wherever possible. In the long term the best way to preserve and expand the National Health Service is to ensure that it provides an efficient service at reasonable cost. That necessitates constant review of practices and resources.

Mr. Kenneth Clarke

Basically, I agreed with the arguments about cost expressed by my hon. Friend the Member for Ellesmere Port and Neston (Mr. Woodcock). I was not impressed by the cost case put forward by the authority. It seemed to me that cost savings were being used as an excuse for a decision that should be based on service grounds. I have never approved of closure on cost-cutting grounds alone. In this case, on balance, I thought that a better service could be provided by the transfer. I think that using cost-cutting as the reason for the closure was a lazy way to present the case that my hon. Friend has effectively destroyed.

Mr. Woodcock

I am grateful to my right hon. and learned Friend the Minister. My point is that, although savings and increased efficiency are necessary, savings within the NHS should not be the result of imposing greater financial burdens on services outside the NHS. It is a false saving to eliminate cost-effective local services by increasing the cost to industry and to the public. Such closures are unnecessary. I suggest 10 areas that the NHS and the Government could consider to improve efficiency and so prevent such closures as that which is about to take place in my constituency.

First, the NHS should look at its own administrative tail and to the 100,000 or more administrators and 100,000 ancillary staff which it employs. Secondly, the NHS and the Government should make greater use of the opportunites to privatise ancillary services because of the cost reductions that could be so obtained.

Thirdly, the NHS should examine and learn from the management techniques and manpower planning and management training practices of some large employers in the private sector. Fourthly, it should recognise that voluntary help is important in the Health Service and do more to welcome it.

Fifthly, the NHS and the Government should now stabilise the organisational structure of the service because continual changes undermine morale and efficiency. One NHS administrator told me, "It seems that in the NHS constant change is here to stay." Recently I led a discussion with a group of senior Health Service staff which included the chairman of a health authority, the senior nursing officer, the health authority secretary, treasurer, medical administrator and a senior surgeon. They were united in the view that the major need now is for a period of stability in long-term plans.

Sixthly, the National Health Service and the Government should together examine ways of utilising unemployed people to assist with care in the community. Seventhly, the Government should encourage private health care, if necessary by tax incentives, not to undermine the NHS but to reduce the burden on hard-pressed resources.

Eighthly, there should be a tighter audit on those who practise both inside and outside the Health Service. Ninthly, we should all recognise that the nation's health needs are social, mental and physical—probably in that order, and not in the reverse order, as much spending now assumes. Finally, we should pay more attention to health education, particularly in our schools. It is nonsense that many schools insist upon religious education but not compulsory health education. If we paid more attention to health education we should come closer to the health service that we require and move away from the present national disease service.

If the NHS and the Government concentrated on those 10 areas there would be less need to argue, as we have argued all afternoon, about the financial resources devoted to the NHS, and we should have a much more efficient and effective Health Service.

8.38 pm

Mr. Robert C. Brown (Newcastle upon Tyne, North)

I take hon. Members' minds back to October 1982, when the Prime Minister, at the Tory party conference, said: The NHS is safe with us. Last October she said: The NHS is safe only with us. I do not apologise for repeating those oft-repeated words. A previous Prime Minister, the right hon. Member for Old Bexley and Sidcup (Mr. Heath), had the words "at a stroke" hung firmly round his neck. We should never let the present Prime Minister forget the words: The NHS is safe only with us if for no other reason than her great belief in her divine right. Who knows, she might try to walk on water!

The Government's policies are driving us towards a two-tier Health Service—a private sector looking after the healthy and the wealthy, and a poorly financed and demoralised Health Service designed to look after the rest of us. In one short year since the Government took office, what have they done? They have cut the cash for health services in real terms, slashed staffing levels for the first time in the history of the NHS and forced local health authorities to privatise ancillary services. They have done all that they can to encourage the development of the private sector in health care.

In last year's election campaign the Secretary of State claimed that the Tories had increased spending on the NHS by 7.5 per cent. in real terms during the previous four years. He did not point out that, because of increasing demand, that figure was needed just to enable the service to stand still. Arthur Taylor, the chairman of the Newcastle area health authority, who was confirmed in office by the present Government, has said on television that an increase of 1.5 per cent. per year means simply that the service stands still.

The Prime Minister constantly bleats about being the daughter of a grocer. She talks about the need to run services with the efficiency of a corner shop. The House of Commons Social Services Select Committee said in 1972 that the Government's use of the phrase "efficiency savings" had become a euphemism for expenditure cuts. That cannot be denied. Within a month of the general election, which saw the Tory arty promising to look after the Health Service, the Chancellor of the Exchequer cut £140 million from the hospital and community health services budget. As a result, our Health Service is approaching chaos, because health authorities are faced with a 1 per cent. cut in budgets only four months into the financial year.

The Government's own calculations for growth by 1.2 per cent. were reduced by the Chancellor of the Exchequer to just over 0.2 per cent. In 1983–84, despite the growing demands, services have been cut by between 2 and 2.5 per cent. Because of this, hospitals in cities, towns and villages are under threat. Since May 1979, 160 hospitals have been fully or partly closed, with the loss of 8,000 beds, and the threat of closure is hanging over 35 community hospitals and 50 other hospitals in London. Family planning clinics have been axed and some 6,000 newborn babies are at risk each year because of the lack of special care units.

In the face of that situation, the Government claim that more nurses and doctors are working in the NHS than ever before. Good-oh. However, the Government do not brag about the record level of unemployment among nurses and doctors. Between 1979 and 1982, unemployment among qualified midwives and nurses more than doubled, from more than 4,000 to more than 9,000. In September 1982, when the Government conveniently stopped collecting evidence on unemployment within the NHS, nearly 1,500 doctors were unemployed. Yet there has never been greater demand for comprehensive health care. Even the British Kidney Patient Association states that 3,000 patients are dying each year because of lack of treatment. Perhaps one should allow for the fact that pressure groups tend to make extravagant claims, but even if we assumed that the association had overestimated the figure by 100 per cent., 1,500 patients could still be dying each year. That is a damnable state of affairs.

The Tory manifesto of June 1983 stated: Conservatives reject Labour's contention that the State can and should do everything. We welcome the growth in private health insurance in recent years…We shall continue to encourage this valuable supplement to state care. What is being reflected in present developments is the fact that private practice can survive only as a parasite on the NHS. Private health insurance does not cover childbirth or provide the care offered in our NHS for the very elderly. Private insurance does not cover provision for the mentally ill or mentally handicapped, which costs the NHS so much. The only services in which the private organisations such as BUPA are interested are the lucrative patient services. They do not care about the needs of the community. They care only about the needs of their bank managers.

Why should men and women who may have lived through two world wars, brought up families and contributed a great deal to the wealth of the country now be treated as unwanted commodities to be shunted off into some place that is financially convenient for Governments rather than socially and morally acceptable to the old people concerned and their families? When someone has spent his life in a certain town, what justification is there for pushing him into a large hospital somewhere else when the facilities exist in his own community to enable him to live out his life contented and happy, with his own folks around him? Yet hospitals which offer geriatric care are to be closed because the Prime Minister is too tight-fisted to finance them. I hope that the Minister for Health will explain to the elderly who have given so much to this country why the Conservative Government have neither the time nor the money to look after them.

As more and more of our Health Service is privatised, more and more of our health provision will be centralised in the major cities. It is not profitable to run hospitals in rural areas, and unless the Government can make a profit out of everything—including the care of the sick and disabled — provisions which may have existed for decades will simply disappear. We must fight to save our Health Service. Although the Prime Minister's performances in recent times could make one doubt it, we still live in a democracy in which the Government do not have power to destroy without recourse to the electorate. That is why public campaigns are so important in educating families on the dangers of allowing our Health Service to bleed to death.

At some time, every one of us—or some member of our family—will need the facilities of a hospital or the services of a doctor. We must fight to regain and retain the principles of the NHS. It was supposed to be a service which would be free at the point of use and funded out of general taxation. We all need that facility, and we need to retain the NHS at a high level, as a comprehensive and universal service.

8.47 pm

Mr. John Heddle (Mid-Staffordshire)

I hope that the fact that my speech will last only for three or four minutes will enable one more hon. Member—or even two more hon. Members—to take part in this interesting debate. I regret the fact that I missed the speech of the right hon. Member for Stoke-on-Trent, South (Mr. Ashley) because I was detained in Committee elsewhere. However, I heard the speech of the hon. Member for West Bromwich, West (Miss Boothroyd), who made roughly the same points. The right hon. Gentleman said that waiting lists in north Staffordshire were excessively long. The hon. Lady said that waiting lists in the west midlands region were excessively long. We can all refer to individual constituency cases, and identify distortions in the waiting list pattern. However, I should like to suggest a practical solution to the hospital waiting list problem.

Mr. Stuart Holland

Euthanasia?

Mr. Heddle

That remark is not worthy of a gentleman who has spent some of his time in an intellectual environment.

Of the 700,000 people on hospital waiting lists, about 120,000 want orthopaedic surgery. One such person, a 78-year-old great-grandmother, came to my advice bureau in 1981 having been told by her orthopaedic surgeon in the west midlands region that she would have to wait more than 40 years to have her hip replaced. Her hip was causing her pain and might have caused her early death. The problem was the result of a road accident 12 years before. Because pain is not a criterion used by health authorities for a non-urgent case such as hers and because the demand on the surgeons in that part of the west Midlands was such, she could not have her operation. For a 78-year-old, the prospect of a 40-year wait is unbelievable.

I wrote 360 letters to orthopaedic surgeons throughout the United Kingdom. I am happy to say that one, at Stracathro general hospital in Scotland, replied saying that he had only a six-month waiting list and that if she was prepared to travel to Scotland at her own expense to be examined and if he deemed that her case was urgent and if her doctor was prepared to allow her to travel back to Scotland for the operation, he was prepared to put her on his waiting list.

Mrs. Caroline Pulcella had her operation within six months and now, at the age of 80, she can look forward to at least another 20 years of active life. If an ordinary overworked hon. Member writing 360 letters can identify a vacancy on a surgeon's list somewhere in the country, I believe that a computer and a computer bed bank could do it in a matter of seconds. My right hon. and learned Friend will of course tell me that I am citing an exceptional rather than a general case. I entirely accept that, but the previous Labour Government set up, under Professor Duthie, an inquiry into the problem of hospital waiting lists. He reported to the Department early in the previous Conservative Government's term of office. In response to that report, the Minister said: I particularly welcome the emphasis the report places on the need for collaboration between doctors, other professional and management teams, in evaluating the efficiency of their existing services, and in studying how they may be improved within the resources available to them. In my view, the approach proposed by the working party should be studied also by those in other surgical specialities. The time has now come for the Department to announce the pilot scheme to see whether a computer bed bank which links hospital waiting lists with surgeons' operating lists is possible and to see whether patients in genuine need can travel from one part of the country to another to have their pain relieved.

Today's debate is not about the district health service or the regional health service but about the National Health Service. Everyone, whether living in England, Wales, Scotland or even the EEC, has an equal right to the facilities and access to the facilities which the NHS offers. A computer bed bank, if only initially on a regional basis, might provide a solution to the problem of hospital waiting lists.

8.53 pm

Mr. Michael Meadowcroft (Leeds, West)

I was interested in what the hon. Member for Ellesmere Port and Neston (Mr. Woodcock) said, as he gave us something other than the catalogue of approbation that we have heard from most Conservative Members. Today's debate, which is supposed to demonstrate our solidarity on the 36th anniversary of the foundation of the NHS, has not taken the debate about where the NHS should go much further forward. The knockabout across the House has demonstrated the accuracy of the alliance amendment.

There can be no doubt that the NHS needs more resources. There always has been and always will be such a need. It is obvious wherever we go. I am regularly assailed by constituents who tell distressing stories of long and painful delays for treatment. Whenever new treatments or techniques become available, they are immediately assumed to be available to everyone, whatever the cost. In that respect I agree with the hon. Member for Eastleigh (Sir D. Price), who honestly drew attention to the problem that expectation will always outrun resources.

A debate on the NHS and which Government put more resources into it which failed to recognise the fundamental problems of accountability and the legitimacy of decisions on health provision and financial control does not do much to help the marvellous service to which many hon. Members have paid tribute. As the Secretary of State showed, we judge how well a Government are looking after the NHS by the amount of money that is spent on treatment and how many patients are treated.

In one way, that is entirely the wrong end of the telescope, as success might better be measured by reductions in the amount spent on the curative service. It is odd that we tend not to consider whether the nation is healthier. It has constantly been said that the prime aim of the NHS is preventive. Beveridge said that, as did the Merrison Royal Commission, and yet today we still spend only 7p on health education for every £1 that is spent on curative medicine.

It is significant that it is the women's movement which is leading the field in changing our perception of health care. It is significant that the Well Woman clinic, for example, is drawing attention to a different way of looking at the type of service which we need and which might be possible in future. In 1983, more than 2,000 young women died of cervical cancer. The death rate from that complaint has risen from 11 per cent. in 1969 to 30 per cent. in 1980. That is not evidence of our becoming a healthier nation. However, the recommendations sent out by the Department suggest that tests be made only every five years and general practitioners are paid only for tests on women over 35. The health authority in Cornwall, which ignores those guidelines, has found that deaths from cervical cancer in its area have fallen by 60 per cent. since 1969. Such health care is not getting the attention that it deserves.

Because the subject is highly emotive, and because the needs of the Health Service are infinite, it is an easy subject for any party to launch an attack from the Opposition Front Bench. Following his period as Minister of Health, the right hon. Member for Down, South (Mr. Powell) wrote honestly and shrewdly: The separation of the power to tax from the power to spend ensures that health authorities have no incentive whatever to make economies, or even to extol the successes and virtues of their facilities. Just the opposite. He made an interesting comment when he added: The contrast between the nationalised and local health services is not explained solely by the fact that the local elected representatives share the responsibility. It extends far beyond the politicians and goes right through all who provide and use the services. One does not find the professions in the local health services embattled against local government as the professions in the National Health Service are embattled against the central Government. The problem of raising the finance for the proper type of health services that we need lies in the fact that the RHA and DHA members have no electors to whom to answer. They have no decision to make on what their areas can afford and they have no public forum to which to report. Rudolf Klein, in his book "Politics of the NHS", described the uncomfortable shifts in management style and structure in a vain attempt to control service. He repeatedly comments that the local option has never been tried. My hon. Friends and I believe that it is about time that it was tried.

The only other point on which time permits me to comment is the question of clinical freedom. Nye Bevan in 1947 gave the assurance that it was "a basic principle" that there should be no interference with the clinical freedom of any doctor. I am concerned that there is an understandable deference on the part of lay people and politicians towards clinicians which is increasingly detrimental to broader health care.

There is a constraint on clinical freedom, and that constraint is the waiting list. Rather than have what is an unspoken and negative constraint, we need to look at legitimate ways of balancing the positive benefits of such freedom with the damaging effects elsewhere. A start could be made by developing the medical audit. What evidence there is for this concept goes back to the turn of the century in America and back to the 1930s in Britain. People examined the quality of service and the results of certain kinds of treatment and drew conclusions from that. That work has not been acted on and we have not developed the medical audit. As a result, we have the way in which clinical freedom motors at expenditure without necessarily producing results.

The NHS deserves better treatment than it has received from the Front Benches today. There is a crisis and a huge problem, and it does no good to pretend that it can be solved by centralised management or by pumping more and more cash into the existing service. We face a very difficult prospect and it is about time that we tackled it.

9.1 pm

Mr. John Maples (Lewisham, West)

I hope that the hon. Member for Leeds, West (Mr. Meadowcroft) will forgive me if I do not follow him down the road which he has been exploring, because I wish to confine my remarks to the Griffiths report.

We can probably all agree that our objective is to see that the NHS delivers the best possible health care for the money available. That involves the most effective use of the resources that are available to the service.

There is some confusion between input and output. People boast about the amount of staff or money that they would devote to the NHS, but those are inputs. The outputs are represented by the quality of health care. The relationship between them depends on how the money and staff are used, and the processes by which those decisions are arrived at are what management is all about.

The need for better management in that respect in the NHS is clear. A telling passage about it appeared in the Griffiths report, on page 10: The NHS does not have the profit motive, but it is, of course, enormously concerned with control of expenditure. Surprisingly, however, it still lacks any real continuous evaluation of its performance against criteria such as those set out…Rarely are precise management objectives set; there is little measurement of health output; clinical evaluation of particular practices is by no means common and economic evaluation of those practices extremely rare. I should have thought that that was a telling and fundamental criticism of the way in which necessarily scarce resources are managed and that it was an almost overwhelming argument for the type of management system which the Griffiths report proposed.

I suspect that the fear which people seem to have of the implementation of a general management system has to do with fearing — I believe wrongly — that the style of management would be dictatorial and that professional work would be controlled by non-professionals with an eye only to cost. No large service organisation, particularly one which is delivering a public service such as health care, could function in that way.

Management plans must be agreed by most of the people involved in working with them, or they will not work. While everybody must be involved in the decision-making process, management is about making sure that there is clear individual responsibility for implementing the decisions which are taken.

It was also clearly the intention of the Griffiths report that clinicians should be involved in those procedures, for the report said that it was essential to involve the clinicians more closely in the management process, consistent with clinical freedom for clinical practice. Clinicians must participate fully in decisions about priorities in the use of resources. Thus, it is not the intention to involve them less in the process, but to involve them more than is the case at present, and if it is on that ground that the fear of the change proposed by the Griffiths report is founded, I hope that that fear will not be borne out. I am sure that it will not, and perhaps, when he winds up the debate, the hon. Member for Holborn and St. Pancras (Mr. Dobson) will say how the Labour party views the proposals in the Griffiths report. If he does not agree with them, perhaps he will tell us how he would propose to deal with management problems in the Health Service.

We are all aware that staff costs account for much of the budget of the NHS. The South East Thames regional health authority is responsible for the area in which my constituency lies. During 1978–83, when enormous cuts are supposed to have taken place, it increased its work force by nearly 2,000, from 64,500 to 66,500. I do not resent that, for I do not suggest that manpower policy should be directed only to getting rid of employees. It should be directed to ensuring that employees are used in the most effective way to deliver health care to patients. If someone is employed by the Health Service, let us ensure that that is what he does. Let us ensure that Health Service employees are utilised properly.

Several hon. Members have referred to unit costs, especially to the performance indicators that are published by the Department. The indicators tell an interesting story. I shall quote some telling comparative figures for the South East Thames regional health authority and the Oxford regional health authority. For example, the South East Thames authority employs 441 ancillary workers per 100,000 patients treated, against 278 in Oxfordshire. On the same basis, the South East Thames authority employs 250 clerks and administrators, against 203 in Oxfordshire. The Thames authority employs 61 management staff, as against 44 in Oxfordshire. There may be good reasons for the massive disparities, but they cry out for management attention.

Some comparisons are even more telling. The cost of preparing 100 items of laundry can vary from £4.50 to £18. That is a huge disparity. Ambulance trips can cost between £7 and £17 depending on the local authority involved. The cost of a maternity admission can vary between £215 and £690. These are pieces of evidence to which any management should want to address itself to ascertain whether more efficient systems are available to allow it to free resources on overheads to deliver more patient care.

Another area to which new management might address itself is the Health Service Supply Council. At the end of last year, the Comptroller and Auditor General drew attention in one of his reports to the council, which had been instituted to try to get health authorities to co-ordinate their purchasing to save money. He reported: My staff were unable to establish from their selective inquiries that HSSC activities since 1981 had resulted in any increase in the use of co-ordinated contracts by health authorities in England. That is a telling criticism of what was an extremely good idea. Such co-ordination would save money and allow it to be deployed on patient care.

A third area to which a new management system might address itself is the choice of implementation of objectives, which so often goes by default or goes because a part of the Health Service has a momentum of its own or because consultants choose to do one thing rather than another. Should we perform less exotic and expensive operations and direct ourselves to humbler and cheaper ones? The queues for hip replacements and the treating of varicose veins and hernias could be reduced. It may not be possible to remove queues in the Health Service altogether, but it would be possible to remove some of them. Consultants often choose to do an exotic or interesting operation because it interests them rather than six or seven hip replacements. These are choices that lie with the Health Service, but they are often made by default rather than decision. Is some Health Service surgery too expensive? One heart transplant probably costs as much as 15 hip replacements.

There has been some well-documented criticism recently of hospitals purchasing high technology equipment sometimes because another hospital down the road has the same piece of equipment. It seems that this happens because a hospital will say, "They have it, so why should we not have it too?" Very often there is no cost-benefit analysis. These are the sort of decisions taken by the management of the Health Service, with everyone involved discussing them, but they should be real management decisions. Decisions should not be allowed to go by default merely because that is how the system has developed or because an especially powerful consultant says that he wants to do something in a certain way.

This leads to clinical practice, an area in which the chairman of the district health authority in my constituency says enormous savings lie. According to him and many others, consultants often do not know the costs of the different treatments which they can prescribe. If they knew the costs, they would make their decisions in that light. It is not that they would necessarily choose the cheaper treatment; they must be free to choose whichever they feel is most appropriate. But if one treatment costs 10 times as much as another — as it does, for example, in the difference in cost between human and pig insulin for the treatment of diabetes — that is a factor that the consultant should bear in mind when deciding which to prescribe.

Doctors are often not aware of the costs. They are not involved in the decision-making processes that lead to the allocation of resources and the statement of objectives. If they made decisions in the light of the costs, resources would be used more effectively. The process in which consultants are involved in evaluation will show great benefits. Doctors will then realise the cost of the different choices available to them and the trade-off between them. There can be trade-offs while the total resources of the NHS are limited.

There is a clear need for better management in the NHS. The proposals in the Griffiths report will lead to that, and I look forward to their implementation. It will improve decision making and ensure proper evaluation of choices and proper allocation of resources to agreed objectives, so that plans can not only be made but can be implemented and monitored. Above all, it will lead to better health care for the community.

9.11 pm

Mr. Frank Dobson (Holborn and St. Pancras)

I shall not follow the hon. Member for Lewisham, West (Mr. Maples) in talking about the Griffiths report. If he had deigned to grace the Chamber with his presence a few Fridays ago, he could have taken part with other hon. Members in the six or seven-hour debate on the report.

I hope that I shall be forgiven if I begin on a personal note. Members of other parties may not understand, but I am sure that my right hon. and hon. Friends will when I say that I count it a great privilege to reply to the debate on the anniversary of the founding of the NHS—on behalf of the Labour party that founded it and against the Conservative party that sought to strangle it at birth.

In July 1948, although I was only a child, I can remember how my parents—both Labour party members—were buoyed up with hope and pleasure when the NHS came into being. They, and thousands like them, had, in those familiar words on Labour movement banners, worked to educate, agitate and organise to achieve the establishment of a Health Service. It was the outcome of years of struggle by millions of ordinary people against the pain, suffering, inequality and impoverishment that had gone before. The benefits of that for working-class people were movingly explained by my hon. Friend the Member for Worsley (Mr. Lewis) in his contribution to the debate.

The Labour party manifesto of 1945 made a simple promise on health. It said: The best health services should be available to all. Money must no longer be a passport to the best treatment. On those unimpeachable principles, the NHS was founded. It was, and it remains — despite all the Government's efforts to undermine it—the cheapest and most efficient system of health care in the developed world. But it is now under threat, not only in practice but in principle. The Right-wing obsessives who run the Conservative party challenge its continued existence. They claim that market place medicine can do the job better. They are arguing not only about practicalities—they are saying that individualism and greed are a sound basis on which to organise society. We know that they are wrong.

Our view of the world conflicts with theirs, and nowhere is the distinction clearer than over the future of our nation's health. That is why there is such a fundamental division between the Labour party and the Government on the issue. We believe that people should obtain treatment when they are ill because they are ill—the Government do not believe that; we believe that the worse off should have priority—the Government do not; we believe that the NHS needs more money — the Government do not.

Apparently, faced with that fundamental division of belief between the Labour and Tory parties, all that the SDP-Liberal alliance can say is that there is a sterile current debate about the future of the NHS. It simply does not understand—perhaps the Tories do not understand either—that, when there are fundamental decisions to be made, one must come down on one side or the other. My impression is that if their intellectual forebears had been around in the United States at the time Abraham Lincoln said 'A house divided against itself cannot stand'"; we cannot be half slave and half free the SDP-Liberal alliance would have said, "Oh yes, we can."

We live in a society that is steeped in inequalities—not minor matters of how many colour televisions or videos there are but fundamental inequalities. It is still the case that manual workers are usually worse off, live in worse housing, work in worse conditions and get less pay. They are more likely to be unemployed, to be ill more often and to die sooner. There can be no greater inequality in life than an early death. Chronic sickness is twice as likely for an unskilled man and three times as likely for an unskilled woman as for a professional. We in the Labour party are saying that we want all our people to live as long as the well off and for their lives to be as healthy. Until that has been achieved, our society will be unjust and unequal. It will be a hard, long struggle to achieve that aim, but we believe that the National Health Service, true to its original principles, has a vital role to play in achieving that aim.

What do the Government propose instead?

Mrs. Kellett-Bowman

Will the hon. Gentleman give way?

Mr. Dobson

I am sorry, I shall not give way.

Do the Government propose running down the NHS, starving it of money, decrying its efficiency, abusing its dedicated staff, constantly subjecting them to reorganisation and privatisation, and promoting private medicine instead? Many parts of our country are now badly served — not just deprived inner-city areas, but many rural areas where the collapse of public transport and other services makes getting proper health care difficult for many. As my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) pointed out, preventive work such as screening for cervical and breast cancer is being reduced and medical research is being cut back. It is not just those measures that are damaging the nation's health—3 million people cannot afford to heat the living areas of their homes, 6 million people lack some essential clothing, 5.5 million people cannot afford all the food that they need and the proportion of children getting school meals has decreased from two thirds to under one half during this Government's term of office. All those things damage our nation's health.

We need to spend more on the NHS. We need to improve our hospitals, to staff them properly and to restore the confidence of people working in the Health Service; but we need to go much further. We need to make our health system more responsive to individuals' needs, including the special needs of women and the ethnic minorities, because early and sympathetic treatment is good for patients and costs less than later drastic remedies. We need more and better-directed efforts put into health education. Even that will not be enough. Much ill health springs from poor housing, bad working conditions, inadequate diet and, above all, too much stress and strain. Yet the Government's general policies worsen working conditions. The Government care little about the environment, and less about the housing needs of poorer people. Above all, their policy of competition at all costs and of throwing 4 million people on the dole and filling those in work with fear of the dole is causing stress and strain such as we hoped had been banished from the end of the second world war.

The Government's priorities for spending are wrong—more money for the army and police than for nurses and health workers, more money on the dole queue while hospital beds lie empty and waiting lists stretch years ahead, more money on status symbol weapons such as Trident, and less on research into cot deaths.

The Prime Minister claims a mandate for all this. She wants us to go back to having flag days to raise money for our hospitals. If she is so confident that her priorities command the people's support, I offer her this challenge: try a few flag days to pay for Trident and give the Health Service the funds that it needs.

Because the Government know that the Health Service is so successful and popular, they pretend to look after it, but they are like that guyed version of the Hippocratic oath: Thou shalt not kill but need not strive officiously to keep alive. No one could accuse the Government of striving officiously in that respect.

The Secretary of State spends most of his time in public fiddling the figures and making speeches claiming that all is well with the NHS. He did it again today. When I challenged him, I had not the figures readily to hand. But I can tell the House now that even the last Labour Government — many of whose actions on health I criticised before I came to the House and whose capital spending on hospitals the right hon. Gentleman abuses and despises—spent £654 million a year on average during their five years in office and that the present Government have not yet reached an average for their five years of £600 million a year.

Mr. Fowler

rose

Mr. Dobson

No, I shall not give way.

Mr. Fowler

rose—

Mr. Speaker

Order. Is the hon. Gentleman giving way?

Mr. Dobson

No, Mr. Speaker.

Mr. Fowler

rose—

Mr. Speaker

Order. The hon. Gentleman is not giving way.

Mr. Dobson

I am merely using figures that the Minister gave me in answer to a parliamentary question on 4 November. In private the Secretary of State connives at the destruction of the Health Service. He claims in public that the Health Service is getting more resources than it is. However, Government spending on the Health Service has not kept up with the combined effects of inflation, the higher costs of medical technology and the needs of an aging population.

Mr. Maples

rose—

Mr. Dobson

No. I shall not give way.

Mr. Maples

rose—

Mr. Speaker

Order. If the hon. Member will not give way to the Secretary of State, clearly he will not give way to a Back Bencher.

Mr. Dobson

Without the increased income from prescription charges, the financing of the Health Service would be quite disastrous. Everyone but the Government knows the truth and by "everyone" I mean not just the Labour party and the trade unions but the British Medical Association, the Royal College of Nursing and the junior hospital doctors. All say that there are cuts and that the cuts are doing damage to patient care. Can it be that we are all out of step except little Norman?

When people ask what is the truth about the Government's claim to be spending more, I advise them to look around, to read their local papers, to watch local television and to listen to local radio. They should trust the evidence of their own eyes and ears. All over the country hospitals are closing, wards are closing and improved services are being postponed, and the Government's response is just a blather of statistics.

The most distinguished politician to come from my constituency was Benjamin Disraeli, and we all know that he said there are lies, damned lies and statistics. He said that before the Secretary of State was born. He also described the Tory party as "an organised hypocrisy", and so it is.

The Government's alternative to a well funded Health Service is to promote private medicine. They know that every time that they damage the Health Service they help their friends in the private sector and that, every time they promote the private sector, they damage the Health Service. No one is more guilty of this than the Prime Minister. Honeyed words about the Health Service put together by her public relations advisers for slick delivery at Tory party conferences are one thing. Deeds are another. She claims to lead by example. Perhaps she does. But she should ponder the words of her favourite poet, Rudyard Kipling:

• "Ah! What avails the classic bent
• And what the cultured word,
• Against the undoctored incident
• That actually occurred?"

Let me remind the House what actually occurred. The right hon. Lady has had two operations since becoming Prime Minister. In 1982 she had her varicose veins seen to at the Fitzroy Nuffield hospital. That was just plain, old-fashioned queue jumping; paying to get better treatment. However, the Prime Minister's next operation the following year was something different. She had a detached retina and it needed to be put right. There is no queue for detached retina treatment. The NHS can provide it. But what did the Prime Minister do? She appeared on television and said, "We chose a quiet little hospital near Windsor." She gave the impression that the NHS and all its staff were not good enough for her. Only the private Princess Christian hospital was good enough. What she did not say on television was that the equipment for the operation had to be borrowed from the King Edward VII NHS hospital down the road. Contrary to the impression that she deliberately created, only the NHS had the tools for the job. The private hospital could not cope.

What prospects for our country's health does private medicine, this Tory alternative, offer? Does it concentrate resources on patients and areas most in need? It does not; quite the reverse. Despite all the misleading advertisements by BUPA, its claim to classlessness has been rumbled. The general household survey shows that 23 per cent. of professionals and 19 per cent. of employers and managers have private medical insurance, compared with just 2 per cent. of semi-skilled and unskilled workers.

The Government's policy is to shift health resources from what they call the prosperous south-east to other areas, but most existing private hospitals and the new ones have been and are being built in that very area. There is precious little private hospital building in the areas that the Government say need more hospital beds. Why? Because there is no money to be made. Private hospitals seek out not sick people, but quick profits.

There is also the myth that private medicine supplements the NHS. To be fair to the Tories, not just they are involved. The Social Democratic party and the Liberals are at it too, in the form of Lord Wigoder, the Liberal peer who chairs BUPA. He said that NHS patients benefit because users of private medicine contribute tax and national insurance to the NHS while for the most part seeking nothing in return. Poor man—being a Liberal, he does not know the facts. For a start, BUPA does not usually cover general practitioner visits, and 90 per cent. of everyone's contact with doctoring is through general practitioners. However, even more revealing is the fact that the general household survey shows that, for those with private medical insurance, more than half of their inpatient stays in hospital and four fifths of their outpatient attendances are made under the NHS. Those are official Government figures.

As one of my hon. Friends said, private hospitals are parasites living off the NHS. In their unguarded moments, they admit it themselves. The Private Patients Plan, BUPA's greatest rival, drew up a feasibility study for a private hospital to be built on NHS land next to University College hospital in my constituency. The glossy brochure for potential investors stated: 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. In other words, if the patients got really sick, they would be able to rely on the NHS.

Following that example, United Medical Enterprises had a plan for a dozen private hospitals, each to be developed in close proximity to a major teaching hospital. We all know why. Private hospitals also rely heavily on the NHS to provide pathology and other services. They must do so because they are so ill equipped. In 43 per cent. of them there is no radiology department, and in 70 per cent. no pathology laboratory. To promote private medicine the Government have given tax handouts to hospital companies, including American ones, and have changed consultants' NHS contracts to encourage them to moonlight in private hospitals. Most consultants do their NHS jobs, but no less a person than Oliver Rowell of Nuffield hospital publicly admitted that the present arrangements cause some detriment to the NHS". Jim Barker from American Medical International said: a lot—or a significant number—of consultants abuse their NHS contracts. Almost all the skilled staff in private hospitals were trained in the NHS at public expense. It costs taxpayers £100,000 to train a doctor and £9,000 to train a nurse. That is yet another massive subsidy to the so-called independent sector. All over the country from St. Albans to Blackpool NHS hospital services are being damaged by the loss of trained nurses to private hospitals nearby.

I have another objection to the Tory alternative to the NHS. On top of its incapacity and parasitism, it would introduce American values and practices to the detriment of patients and staff. Recently I received a letter from the United States which, as Tory Members will agree, describes the position more eloquently than I could. It states: I was born, brought up, and trained as a State Registered Nurse in Southampton. I now live and work in the United States, although I am still a British citizen. I have worked as a Registered Nurse in Maryland and am now working in Tucson, Arizona; I hold licences in both states. Nursing in America is hard, high-stress, and very frightening. There is so much paperwork, so much 'litigation phobia' and so much emphasis on the abstract that it is hard to find time for the patients…I would do anything to prevent such a situation happening in England. So would anyone with sense.

We face a stark choice about the future for the Health Service. The Government offer a two-tier system an accelerating rundown of the NHS to provide poor-law medicine for many and the development of highly subsidised, highly suspect private medicine for the healthier and better-off. The alternative is to return to the basic principles of the NHS, and to find sufficient resources to give health workers the tools with which to do their jobs. That must be accompanied by a new attitude to health care—a commitment to give full priority to the health implications of all that we do as a country, and to raising everybody's prospects to the level of the best.

The trouble with the Tories is that they know that they are on the run. They know that the Opposition's analysis of the present and vision for the future has the support of the majority of British people. Labour Members are proud of the NHS, and British people cherish it to the same extent that hardline Tory Members fear and hate it. They hate it because it is based on Socialist principles, is popular and has blown a great hole in the idea that market forces are the answer to the world's problems. They fear it because its success and popularity demonstrates the effectiveness of Socialism in action. They are scared that people will think that if Socialist principles work in the Health Service they should be applied across the board.

The Opposition are proud of what our party established on 5 July 1948. In adversity — we have had our bad times, and Tory Members will meet adversity ere long — we take heart from the commitment of those who struggled for years to give the great Nye Bevan the opportunity to set up the NHS. We take heart from the growing recognition of the British people that the Tories must not be allowed to destroy their Health Service. We are confident that it will survive even the most vicious attacks. We promise that the next Labour Government will restore a reinvigorated National Health Service to its right place in this country's priorities and, again, set an example to the world. We shall not rest until that job is done.

9.34 pm

The Minister for Health (Mr. Kenneth Clarke)

It is my recollection that when the hon. Member for Holborn and St. Pancras (Mr. Dobson) goes around the country delivering his speeches he usually rolls into town accompanied by the Labour party's campaigning ambulance. After hearing his performance over the past 25 minutes, I believe that the old van is beginning to run out of steam. I believe that that is true of the campaign being mounted on the National Health Service. The Labour party has, I will concede, had a pretty good run with its campaign about NHS cuts with the general public over the past 12 months, but the campaign is losing credibility, and the attempt to revive it this evening also lacks credibility.

The Opposition made a fundamental mistake at the election, which can be made in politics, as it can be made in other walks of life. They cried wolf. They accused us of wishing to dismantle the National Health Service; they said that it was near to destruction; they said that they were saving the NHS from people who wanted to turn us into Americanised recipients of private practice. That has proved to be nonsense, and the attempt to sustain it is becoming sillier by the moment, and it has never been sillier than in the Front Bench speeches that we have heard today.

I shall even agree with the alliance on half a point—the public are becoming more and more irritated with the sterile debate where one side howls "Cuts" about every problem in the Health Service, while we describe the growth in services and the attempt that we are making to develop services in the face of the demand. That is repeated each time a member of the Opposition Front Bench, and most of their Back Benchers, attempt to turn the figures on their heads and produce statistics which the public merely find a nuisance in the way of their understanding.

Mr. Lofthouse

rose—

Mr. Clarke

If the Opposition Front Bench will not give way to the Secretary of State, I do not see why I should give way to the Opposition in the first 30 seconds of my speech.

I was going to try to reply to the figures which the hon. Member for Oldham, West (Mr. Meacher) gave. We are familiar with them. He made his usual attempt to try to demonstrate that an 18 per cent. real increase in expenditure is a cut if one makes all kinds of notional calculations. He criticises us for boasting that we have employed more doctors since we came into power—there are 6,519 more doctors. He was worried by our claiming that there are more nurses—there are 46,100 more nurses since we came into power. That is a 13 per cent. increase. I was going to deal with his attempt to try to turn all those matters into a rundown, a cut and a despairing cry on behalf of the Health Service, but the hon. Member for Holborn and St. Pancras got up—

Mr. Tony Favell (Stockport)

No doubt my right hon. and learned Friend heard the hon. Member for Oldham. West (Mr. Meacher) refer to a petition which was raised in and around my constituency. There is no finer place for a petition to be raised, because it is the best-attended shopping centre in the north-west. Since then I have had a word with the chairman of the district health authority, and my right hon. and learned Friend will be pleased to hear that over the past three or four years there has been no reduction in services in Stockport, nor did the chairman foresee any reduction in services.

Mr. Maxton

rose—

Mr. Speaker

Order. That sounded rather more like a speech than an intervention.

Mr. Clarke

The hon. Member for Oldham, West is no more reliable on the problems of Stockport than he is on the problems of the United Kingdom.

The hon. Member for Holborn and St. Pancras produced yet another variant of the figure of which he is proud, after an accusation that we were fiddling the figures. He was challenged, but he stood there refusing to retreat. He has the figures of the average capital spending in the period of the Labour Government compared with the figures for the period of our Government. He knows what is wrong with that comparison, which is why he would not give way. The Labour party took over a high capital programme and reduced it by 35 per cent. We took over a low capital programme and we have increased it.

Mr. Dobson

No.

Mr. Clarke

Oh yes, we have. The hon. Gentleman takes an average—

Mr. Dobson

rose—

Mr. Clarke

I shall worry the hon. Gentleman by giving way in a moment. He is reckless to seek to intervene. He is taking an average from a pattern of a peak, a trough and a rise again, and he reckons that the average spend during the Labour period of government was higher than the average during ours.

However, the hon. Gentleman is taking credit for the higher spending which the Labour Government inherited from the Conservative Government to get this higher average, and he is lumbering us with the problems of the low spend that we inherited, which brought our average down. I have the figures. At constant 1982 prices, the period of 1974–75 to 1979–80 shows an average of £652.5 million. In the period 1979–80 to 1984–85, the average is £652 million. On that totally fraudulent average, the hon. Gentleman can show, in a £652 million average, a £500,000 advantage to his Government, based on the fact that they inherited a big capital programme from us and we have not managed to get the programme up high enough now to get the £500,000 difference.

Mr. Dobson

Unlike the right hon. and learned Gentleman, I do not have a gang getting the figures for me. All that I can do is rely on the parliamentary answer given on 4 November by the Secretary of State for Social Services. The Minister said that when the Labour Government took office they immediately reduced the Tory level of spending. That is not true. The figures are these. The level of spending started at £711 million, which rose to £733 million, and went down to £714 million. There were then the cuts and the figure went down to £552 million, then it went back up again to £562 million and then, under this Government, it went down to £514 million. It then crept back up to £558 million and then to £650 million, then to £655 million and now, according to the answer that I received from the Library this evening, it has gone back down to £625 million.

Mr. Clarke

I have never accused the Labour Government of immediately cutting capital spending, because they inherited a building and construction programme. They did not come in and immediately stop the benefits of what was under construction, so the spending for the first year or two was what they had inherited from the projects in the pipeline, which had been started by the previous Government. Our first year or two spending was what we had inherited from the previous Labour Government. When the crash came, they made a 35 per cent. cut, which set back the building of the new hospitals to which reference has been made. We are putting the capital spending up and bringing on the new hospitals again.

There is an important figure about closures and openings. We have closed the old and opened the new. People correctly say that we have closed more old hospitals than we have opened new ones. That is because we have opened big new ones and closed small old ones. There is another figure. Between May 1979 and March 1984 we authorised closures representing 11,900 beds. Since we have been in office, in the same period, 34 new major schemes have opened, with 11,000 new beds. A whole lot of smaller schemes are providing yet more beds. My hon. Friends the Members for Bournemouth, East (Mr. Atkinson), and for Peterborough (Dr. Mawhinney), and my hon. and learned Friend the Member for Mid-Bedfordshire (Mr. Lyell) are able to point their constituents in the direction of hospitals which were delayed by Labour Governments and inherited by us and opened. Only this afternoon the Elizabeth Garrett Anderson hospital was formally opened for inpatients. The new hospitals are coming through the pipeline steadily and will improve patient care.

We should not be arguing about the phoney figures that pour out of Transport house and the research departments of trade unions. We should measure the Health Service in the terms that matter to the public. They include how many patients are being treated, what is happening to waiting lists, what should be done about those awaiting treatment and where we are going. My right hon. Friend the Secretary of State gave objective, dispassionate figures which were unchallenged. I shall not repeat those figures, which can be studied on the record. They show that more patients are being treated, there are more inpatients and outpatients, that waiting lists became shorter when we took office and are decreasing further after the hiccup of the strike, and that we are not just providing extra money—we have, of course, spent more money on the service—but are providing a substantially better service.

As my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) so eloquently said, and as my hon. Friend the Member for Lewisham, West (Mr. Maples) said in an extremely clear speech which explained the point about value for money—it was immediately followed by a cheap remark from the hon. Member for Holborn and St. Pancras, who went on to give knockabout, spartist rubbish with his fiddled figures in the middle—our efforts to get better value for money come on top of extra spending. We should try to get more value for money to deliver more patient care and to deal sensibly and constructively with the needs which we know exist.

The most criticised area of higher efficiency, because the day has been organised outside the House by the trade unions, is the tendering process which we are introducing to try to reduce the support costs of the NHS to a more reasonable level so that we can release more money for patient care. The most amazing attack upon that operation was conducted earlier today, including an attack on several of my hon. Friends who are supposed to have private interests. No hon. Member on either side of the House has approached me or my colleagues on this subject without declaring an interest. No improper approach has been made. I have no evidence that any right hon. or hon. Member has behaved improperly, although that was the innuendo running through much of what was said.

A source of such innuendo was The Guardian, which tried to attack my hon. Friend the Parliamentary Under-Secretary of State because he had had lunch with representatives of a catering association. My hon. Friend also had tea with the trade unions, and he will have dinner with the NHS catering and laundry managers. I have met the NHS catering managers. Ministers constantly meet anyone with a legitimate interest in their subject, and it is farcical to try to trivialise the attack on our policy in that way. Are the Opposition claiming, or is it their answer to the savings that have been made, that we are embarking on the exercise because of some shareholdings that may or may not be held by my hon. Friends the Members for Southampton, Itchen (Mr. Chope) or for Hornsey and Wood Green (Sir H. Rossi)? We shall make substantial savings that will boost patient care and we shall continue to expand services in the way that we have done.

Mr. Lofthouse

The Secretary of State and Conservative Members said much about savings and efficiency, but I wish to be clear what they mean by that. A few weeks ago, I visited Stanley Ryhood hospital, in the constituency of my right hon. Friend the Member for Wakefield (Mr. Harrison). I visited an all-male ward of aged people. These men had fought in two world wars, had worked hard all their lives, and had had psychiatric breakdowns, and their one pleasure in life was one day a year out with the staff. For the other 364 days they sat inside four walls. They were all looking forward to the following week, but when I went back that following week it had been decided that because of cuts and savings only half of those men could go on that one day outing—[HON. MEMBERS: "Shame."] Is that the type of saving to which the Minister is referring?

Mr. Clarke

I have visited the hospitals in Wakefield. I have met the right hon. Member for Wakefield (Mr. Harrison) and the chairman of the Wakefield health authority. Wakefield is suffering, not from cuts of any kind, but from a combination of demands. In particular, we are discussing ways of improving geriatric provision in Wakefield and are trying to sort out an effective policy.

One way of improving services in Wakefield and elsewhere is to cut out unnecessary costs and to make sure that we provide basic support services at a competitive rate. At present, £1 billion is spent on catering, cleaning and laundry support services. As my hon. Friend the Member for Lewisham, West and others have said, the gap between the costs in the Health Service and outside makes it obvious that there are savings to be made which can be devoted to looking after more patients. If the Ministry of Defence were to make savings of up to 20 per cent., we would be talking about substantial sums.

The hon. Member for Oldham, West said that the Labour party would reverse privatisation. Presumably, in the interests of those who lobby the Labour party and support it, he would eliminate those savings and go back to the spending levels which previously existed. If that is the vision that the hon. Member is offering to the electorate, I do not understand where that will lead to. He solemnly promised £500 million more on behalf of a future Labour Government. I do not think that he had the slightest authority from his shadow Chancellor to say so, but I may be contradicted. Nevertheless, the hon. Gentleman promised £500 million more in real terms.

The hon. Member for Oldham, West is committed to abolishing health charges, which in itself would absorb more than £400 million of that £500 million of new money. If he were to reverse the savings on tendering, he would overshoot his £500 million total before he even started. That financial commitment, even if he could make it, would, when combined with his other policy commitments, wipe out any advances that he might otherwise make in patient care. The monument to Socialism described by the hon. Member for Oldham, West is a return to what happened twice under a Labour Government. They would return to real cuts in NHS financing. That is something which we have never done and never propose to do.

What are health authorities to do in the face of the Labour party resisting savings which it could make by reducing the costs of support services? Opposition Members made a great issue of Barking and claimed that privatisation had damaged Barking's interests. However, cleaning in Barking has always been carried out by a private contractor, and the same private contractor was given the tender at a reduced price after a fresh tendering process. Barking health authority now makes a saving. ft cut manning levels, but not wage rates. Barking has saved £143,000 in a year. — [Interruption.] Opposition Members do not want to listen. That £143,000, I am assured by the chairman of the Barking health authority, is being spent on improved nurse staffing levels and a night community nursing service. The Labour party is putting pressure on me and on the health authority to reverse those savings, to reinstate the previous arrangements and to go back to high staffing and high cost cleaning at the expense of improvements in nursing services.

I ask the more responsible members of the Labour party, who have been outnumbered in the Chamber for most of the day, to ask themselves why they are putting pressure on the health authority to go back to high cleaning costs at the expense of nursing improvements, at the request of the people on the picket line inside and outside Barking hospital. Greenham common women and Kent miners are turning up. They take no notice of the so-called TUC guidelines about emergency supplies. In response to that pressure, the Labour party is eager to put up cleaning costs again in Barking to the level required by NUPE, and they have the nerve to say that we are pressing on because of our interests. The Opposition include 43 hon. Members sponsored by trade unions who are on the TUC health services committee.

At the end of the last Labour Government, Mr. Roland Moyle, the then Minister for Health, was a NUPE-sponsored Member. He went through an entire strike with divided loyalties because the union was trying to close the service down and he, supposedly, was trying to keep it going.

We know why we had that performance at the beginning of today's debate. We know why the hon. Member for Oldham, West (Mr. Meacher) went into a diatribe, dragging out all his old and favourite phrases. We know why we had a procession of Members of Parliament, who do not often attend our health debates, getting in their points of order about outside interests. The reason was that two general secretaries of trade unions were sitting in the box under the Gallery. The general secretary of NUPE and the general secretary of COHSE were sitting there watching their creatures perform.

Mr. Terry Lewis

rose—

Mr. Speaker

Order. The hon. Member for Worsley (Mr. Lewis) should not do things like that.

Mr. Clarke

It seems that I am being provocative. I am sure that not only my hon. Friends regret that members of a once great party should put on a lot of silly badges, sit here and perform in front of two general secretaries of two powerful unions. We are as concerned as anyone on the Opposition Benches about staff interests.

Throughout today's debate there has not been a mention of the pay and conditions of nurses. There are a few nurses in COHSE, and fewer in NUPE, but they do not count inside the trade union movement, because they do not take industrial action. Labour Members, so passionate about nurses' pay two years ago, know that the recent settlement of nurses' pay was a triumph of common sense over militancy. The Government chose a special case with public support and gave those dedicated people an independent review body. We took the advice of that review body and gave a special case award in this year's pay round. That is our approach to the NHS—that and delivering patient care. I am sorry that our critics are driven by unpleasant pressures to make such a performance of themselves and such an unconstructive contribution.

Mr. Michael Cocks (Bristol, South)

rose in his place and claimed to move, That the Question be now put.

Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—

The House divided: Ayes 174, Noes 297.

Division No. 393]	[10 pm
AYES
Abse, Leo	Callaghan, Rt Hon J.
Adams, Allen (Paisley N)	Callaghan, Jim (Heyw'd & M)
Anderson, Donald	Campbell, Ian
Archer, Rt Hon Peter	Campbell-Savours, Dale
Ashley, Rt Hon Jack	Canavan, Dennis
Ashton, Joe	Carter-Jones, Lewis
Atkinson, N. (Tottenham)	Clark, Dr David (S Shields)
Bagier, Gordon A, T.	Clarke, Thomas
Banks, Tony (Newharn NW)	Clwyd, Mrs Ann
Barnett, Guy	Cocks, Rt Hon M. (Bristol S.)
Barron, Kevin	Cohen, Harry
Bell, Stuart	Coleman, Donald
Benn, Tony	Concannon, Rt Hon J. D.
Bennett, A. (Dent'n & Red'sh)	Corbett, Robin
Bidwell, Sydney	Corbyn, Jeremy
Boothroyd, Miss Betty	Cowans, Harry
Boyes, Roland	Cox, Thomas (Tooting)
Bray, Dr Jeremy	Craigen, J. M.
Brown, Gordon (D'f'mline E)	Crowther, Stan
Brown, N. (N'c'tle-u-Tyne E)	Cunningham, Dr John
Brown, R. (N'c'tle-u-Tyne N)	Dalyell, Tam
Brown, Ron (E'burgh, Leith)	Davies, Rt Hon Denzil (L'lli)
Buchan, Norman	Davies, Ronald (Caerphilly)
Caborn, Richard	Davis, Terry (B'ham, H'ge H'l)

Deakins, Eric	Maxton, John
Dewar, Donald	Maynard, Miss Joan
Dixon, Donald	Meacher, Michael
Dobson, Frank	Michie, William
Dormand, Jack	Mikardo, Ian
Douglas, Dick	Millan, Rt Hon Bruce
Dubs, Alfred	Miller, Dr M. S. (E Kilbride)
Duffy, A. E. P.	Mitchell, Austin (G't Grimsby)
Dunwoody, Hon Mrs G.	Morris, Rt Hon J. (Aberavon)
Eadie, Alex	Nellist, David
Eastham, Ken	Oakes, Rt Hon Gordon
Edwards, Bob (W'h'mpt'n SE)	O'Brien, William
Evans, John (St. Helens N)	O'Neill, Martin
Ewing, Harry	Orme, Rt Hon Stanley
Fatchett, Derek	Park, George
Faulds, Andrew	Parry, Robert
Field, Frank (Birkenhead)	Patchett, Terry
Fisher, Mark	Pavitt, Laurie
Flannery, Martin	Pendry, Tom
Foot, Rt Hon Michael	Pike, Peter
Foster, Derek	Powell, Raymond (Ogmore)
Foulkes, George	Radice, Giles
Fraser, J. (Norwood)	Redmond, M.
Freeson, Rt Hon Reginald	Rees, Rt Hon M. (Leeds S)
Garrett, W. E.	Richardson, Ms Jo
Godman, Dr Norman	Roberts, Ernest (Hackney N)
Golding, John	Robinson, G. (Coventry NW)
Gould, Bryan	Rooker, J. W.
Hamilton, W. W. (Central Fife)	Ross, Ernest (Dundee W)
Hardy, Peter	Rowlands, Ted
Harman, Ms Harriet	Ryman, John
Harrison, Rt Hon Walter	Sedgemore, Brian
Hart, Rt Hon Dame Judith	Sheerman, Barry
Hattersley, Rt Hon Roy	Sheldon, Rt Hon R.
Haynes, Frank	Shore, Rt Hon Peter
Heffer, Eric S.	Short, Ms Clare (Ladywood)
Hogg, N. (C'nauld & Kilsyth)	Short, Mrs H.(W'hampt'n NE)
Holland, Stuart (Vauxhall)	Silkin, Rt Hon J.
Howell, Rt Hon D. (S'heath)	Skinner, Dennis
Hughes, Dr. Mark (Durham)	Smith, C.(Isl'ton S & F'bury)
Hughes, Robert (Aberdeen N)	Smith, Rt Hon J. (M'kl'ds E)
Janner, Hon Greville	Snape, Peter
John, Brynmor	Soley, Clive
Kilroy-Silk, Robert	Spearing, Nigel
Kinnock, Rt Hon Neil	Strang, Gavin
Lambie, David	Straw, Jack
Lamond, James	Thomas, Dafydd (Merioneth)
Leighton, Ronald	Thomas, Dr R. (Carmarthen)
Lewis, Ron (Carlisle)	Thompson, J. (Wansbeck)
Lewis, Terence (Worsley)	Thorne, Stan (Preston)
Litherland, Robert	Tinn, James
Lloyd, Tony (Stretford)	Torney, Tom
Lofthouse, Geoffrey	Wardell, Gareth (Gower)
Loyden, Edward	Wareing, Robert
McCartney, Hugh	Weetch, Ken
McDonald, Dr Oonagh	Welsh, Michael
McGuire, Michael	White, James
McKay, Allen (Penistone)	Williams, Rt Hon A.
McKelvey, William	Winnick, David
McNamara, Kevin	Woodall, Alec
McTaggart, Robert	Young, David (Bolton SE)
McWiiliam, John
Madden, Max	Tellers for the Ayes:
Martin, Michael	Mr. Willie W. Hamilton and
Mason, Rt Hon Roy	Mr. John Home Robertson.
NOES
Aitken, Jonathan	Beith, A J.
Alison, Rt Hon Michael	Bellingham, Henry
Amess, David	Bendall, Vivian
Ancram, Michael	Benyon, William
Ashby, David	Berry, Sir Anthony
Ashdown, Paddy	Best, Keith
Aspinwall, Jack	Bevan, David Gilroy
Atkins, Rt Hon Sir H.	Biffen, Rt Hon John
Atkins, Robert (South Ribble)	Biggs-Davison, Sir John
Atkinson, David (B'm'th E)	Blackburn, John
Baker, Nicholas (N Dorset)	Boscawen, Hon Robert
Baldry, Anthony	Bottomley, Peter
Banks, Robert (Harrogate)	Bottomley, Mrs Virginia

Bowden, A. (Brighton K'to'n)	Gregory, Conal
Bowden, Gerald (Dulwich)	Griffiths, E. (B'y St Edm'ds)
Boyson, Dr Rhodes	Griffiths, Peter (Portsm'th N)
Brandon-Bravo, Martin	Grist, Ian
Bright, Graham	Ground, Patrick
Brinton, Tim	Grylls, Michael
Brittan, Rt Hon Leon	Gummer, John Selwyn
Brooke, Hon Peter	Hamilton, Hon A. (Epsom)
Brown, M. (Brigg & Cl'thpes)	Hampson, Dr Keith
Browne, John	Hancock, Mr. Michael
Bruinvels, Peter	Hanley, Jeremy
Bryan, Sir Paul	Hannam, John
Budgen, Nick	Hargreaves, Kenneth
Bulmer, Esmond	Harris, David
Burt, Alistair	Harvey, Robert
Butler, Hon Adam	Haselhurst, Alan
Butterfill, John	Havers, Rt Hon Sir Michael
Carlile, Alexander (Montg'y)	Hawkins, C. (High Peak)
Carlisle, John (N Luton)	Hawkins, Sir Paul (SW N'folk)
Carlisle, Kenneth (Lincoln)	Hawksley, Warren
Carlisle, Rt Hon M. (W'ton S)	Hayes, J.
Carttiss, Michael	Hayhoe, Barney
Cartwrlght, John	Hayward, Robert
Cash, William	Heathcoat-Amory, David
Chalker, Mrs Lynda	Heddle, John
Channon, Rt Hon Paul	Henderson, Barry
Chapman, Sydney	Hickmet, Richard
Chope, Christopher	Higgins, Rt Hon Terence L.
Clark, Hon A. (Plym'th S'n)	Hill, James
Clark, Dr Michael (Rochford)	Hind, Kenneth
Clark, Sir W. (Croydon S)	Hirst, Michael
Clarke, Rt Hon K. (Rushcliffe)	Hogg, Hon Douglas (Gr'th'm)
Clegg, Sir Walter	Holland, Sir Philip (Gedling)
Colvin, Michael	Holt, Richard
Conway, Derek	Hooson, Tom
Coombs, Simon	Hordern, Peter
Cope, John	Howard, Michael
Cormack, Patrick	Howarth, Alan (Stratf'd-on-A)
Corrie, John	Howarth, Gerald (Cannock)
Couchman, James	Howells, Geraint
Cranborne, Viscount	Hubbard-Miles, Peter
Critchley, Julian	Hughes, Simon (Southwark)
Crouch, David	Hunt, David (Wirral)
Currie, Mrs Edwina	Hunt, John (Ravensbourne)
Dorrell, Stephen	Hunter, Andrew
Douglas-Hamilton, Lord J.	Hurd, Rt Hon Douglas
Dover, Den	Jenkins, Rt Hon Roy (Hillh'd)
du Cann, Rt Hon Edward	Johnson-Smith, Sir Geoffrey
Dunn, Robert	Johnston, Russell
Durant, Tony	Jones, Gwilym (Cardiff N)
Dykes, Hugh	Jones, Robert (W Herts)
Edwards, Rt Hon N. (P'broke)	Jopling, Rt Hon Michael
Eggar, Tim	Kellett-Bowman, Mrs Elaine
Emery, Sir Peter	Kennedy, Charles
Evennett, David	Kershaw, Sir Anthony
Eyre, Sir Reginald	Key, Robert
Fallon, Michael	King, Roger (B'ham N'field)
Farr, Sir John	King, Rt Hon Tom
Favell, Anthony	Knight, Gregory (Derby N)
Finsberg, Sir Geoffrey	Knight, Mrs Jill (Edgbaston)
Fletcher, Alexander	Knowles, Michael
Fookes, Miss Janet	Knox, David
Forman, Nigel	Latham, Michael
Forsyth, Michael (Stirling)	Lawler, Geoffrey
Forth, Eric	Lawrence, Ivan
Fowler, Rt Hon Norman	Lawson, Rt Hon Nigel
Fox, Marcus	Leigh, Edward (Gainsbor'gh)
Franks, Cecil	Lennox-Boyd, Hon Mark
Fraser, Peter (Angus East)	Lester, Jim
Freeman, Roger	Lilley, Peter
Freud, Clement	Lloyd, Peter, (Fareham)
Gale, Roger	McCurley, Mrs Anna
Galley, Roy	MacKay, Andrew (Berkshire)
Gardiner, George (Reigate)	MacKay, John (Argyll & Bute)
Gilmour, Rt Hon Sir Ian	Maclean, David John
Glyn, Dr Alan	Major, John
Goodlad, Alastair	Maples, John
Gower, Sir Raymond	Mather, Carol
Grant, Sir Anthony	Maude, Hon Francis
Greenway, Harry	Mawhinney, Dr Brian

Meadowcroft, Michael	Steen, Anthony
Miller, Hal (B'grove)	Stern, Michael
Mitchell, David (NW Hants)	Stevens, Lewis (Nuneaton)
Monro, Sir Hector	Stevens, Martin (Fulham)
Moore, John	Stewart, Allan (Eastwood)
Morris, M. (N'hampton, S)	Stewart, Andrew (Sherwood)
Morrison, Hon C. (Devizes)	Stokes, John
Moynihan, Hon C.	Stradling Thomas, J.
Murphy, Christopher	Sumberg, David
Needham, Richard	Tapsell, Peter
Neubert, Michael	Taylor, John (Solihull)
Newton, Tony	Taylor, Teddy (S'end E)
Nicholls, Patrick	Tebbit, Rt Hon Norman
Norris, Steven	Temple-Morris, Peter
Onslow, Cranley	Terlezki, Stefan
Osborn, Sir John	Thatcher, Rt Hon Mrs M.
Owen, Rt Hon Dr David	Thomas, Rt Hon Peter
Parris, Matthew	Thompson, Donald (Calder V)
Patten, Christopher (Bath)	Thompson, Patrick (N'ich N)
Patten, John (Oxford)	Thorne, Neil (Ilford S)
Pawsey, James	Thornton, Malcolm
Peacock, Mrs Elizabeth	Thurnham, Peter
Penhaligon, David	Townsend, Cyril D. (B'heath)
Porter, Barry	Tracey, Richard
Powell, William (Corby)	Trotter, Neville
Powley, John	Twinn, Dr Ian
Price, Sir David	van Straubenzee, Sir W.
Prior, Rt Hon James	Vaughan, Sir Gerard
Rhodes James, Robert	Viggers, Peter
Roberts, Wyn (Conwy)	Wakeham, Rt Hon John
Robinson, Mark (N'port W)	Walden, George
Ross, Stephen (Isle of Wight)	Walker, Bill (T'side N)
Rossi, Sir Hugh	Walker, Rt Hon P. (W'cester)
Rost, Peter	Wallace, James
Rowe, Andrew	Walters, Dennis
Ryder, Richard	Ward, John
Sackville, Hon Thomas	Wardle, C. (Bexhill)
Sainsbury, Hon Timothy	Warren, Kenneth
Sayeed, Jonathan	Watson, John
Scott, Nicholas	Watts, John
Shaw, Giles (Pudsey)	Wells, Bowen (Hertford)
Shaw, Sir Michael (Scarb')	Wells, Sir John (Maidstone)
Shelton, William (Streatham)	Wheeler, John
Shepherd, Colin (Hereford)	Whitfield, John
Shepherd, Richard (Aldridge)	Whitney, Raymond
Shersby, Michael	Wilkinson, John
Silvester, Fred	Winterton, Mrs Ann
Sims, Roger	Winterton, Nicholas
Skeet, T. H. H.	Wolfson, Mark
Smith, Sir Dudley (Warwick)	Wood, Timothy
Smith, Tim (Beaconsfield)	Woodcock, Michael
Soames, Hon Nicholas	Wrigglesworth, Ian
Speller, Tony	Yeo, Tim
Spencer, Derek
Spicer, Michael (S Worcs)	Tellers for the Noes:
Squire, Robin	Mr. Ian Lang and
Stanbrook, Ivor	Mr. Tristan Garel-Jones.
Steel, Rt Hon David

Question accordingly negatived.

Question,That the proposed words be there added,put forthwith pursuant to Standing Order No. 33 (Questions on amendments):—

The House divided: Ayes 279, Noes 195.

Division No. 394]	[10.15 pm
AYES
Aitken, Jonathan	Banks, Robert (Harrogate)
Alison, Rt Hon Michael	Bellingham, Henry
Amess, David	Bendall, Vivian
Ancram, Michael	Benyon, William
Ashby, David	Berry, Sir Anthony
Aspinwall, Jack	Best, Keith
Atkins, Rt Hon Sir H.	Bevan, David Gilroy
Atkins, Robert (South Ribble)	Biffen, Rt Hon John
Atkinson, David (B'm'th E)	Biggs-Davison, Sir John
Baker, Nicholas (N Dorset)	Blackburn, John
Baldry, Anthony	Boscawen, Hon Robert

Bottomley, Peter	Gregory, Conal
Bottomley, Mrs Virginia	Griffiths, E. (B'y St Edm'ds)
Bowden, A. (Brighton K'to'n)	Griffiths, Peter (Portsm'th N)
Bowden, Gerald (Dulwich)	Grist, Ian
Boyson, Dr Rhodes	Ground, Patrick
Brandon-Bravo, Martin	Grylls, Michael
Bright, Graham	Gummer, John Selwyn
Brinton, Tim	Hampson, Dr Keith
Brittan, Rt Hon Leon	Hanley, Jeremy
Brooke, Hon Peter	Hannam, John
Brown, M. (Brigg & Cl'thpes)	Hargreaves, Kenneth
Browne, John	Harris, David
Bruinvels, Peter	Harvey, Robert
Bryan, Sir Paul	Haselhurst, Alan
Budgen, Nick	Havers, Rt Hon Sir Michael
Bulmer, Esmond	Hawkins, C. (High Peak)
Burt, Alistair	Hawkins, Sir Paul (SW N'folk)
Butler, Hon Adam	Hawksley, Warren
Butterfill, John	Hayes, J.
Carlisle, John (N Luton)	Hayhoe, Barney
Carlisle, Kenneth (Lincoln)	Hayward, Robert
Carlisle, Rt Hon M. (W'ton S)	Heathcoat-Amory, David
Carttiss, Michael	Heddle, John
Cash, William	Henderson, Barry
Chalker, Mrs Lynda	Hickmet, Richard
Channon, Rt Hon Paul	Higgins, Rt Hon Terence L.
Chapman, Sydney	Hill, James
Chope, Christopher	Hind, Kenneth
Clark, Hon A. (Plym'th S'n)	Hirst, Michael
Clark, Dr Michael (Rochford)	Hogg, Hon Douglas (Gr'th'm)
Clark, Sir W. (Croydon S)	Holland, Sir Philip (Gedling)
Clarke, Rt Hon K. (Rushcliffe)	Holt, Richard
Clegg, Sir Walter	Hooson, Tom
Colvin, Michael	Hordern, Peter
Conway, Derek	Howard, Michael
Coombs, Simon	Howarth, Alan (Stratf'd-on-A)
Cope, John	Howarth, Gerald (Cannock)
Cormack, Patrick	Hubbard-Miles, Peter
Corrie, John	Hunt, John (Ravensbourne)
Couchman, James	Hunter, Andrew
Cranborne, Viscount	Hurd, Rt Hon Douglas
Critchley, Julian	Johnson-Smith, Sir Geoffrey
Crouch, David	Jones, Gwilym (Cardiff N)
Currie, Mrs Edwina	Jones, Robert (W Herts)
Dorrell, Stephen	Jopling, Rt Hon Michael
Douglas-Hamilton, Lord J.	Kellett-Bowman, Mrs Elaine
Dover, Den	Kershaw, Sir Anthony
du Cann, Rt Hon Edward	Key, Robert
Dunn, Robert	King, Roger (B'ham N'field)
Durant, Tony	King, Rt Hon Tom
Dykes, Hugh	Knight, Gregory (Derby N)
Edwards, Rt Hon N. (P'broke)	Knight, Mrs Jill (Edgbaston)
Eggar, Tim	Knowles, Michael
Emery, Sir Peter	Knox, David
Evennett, David	Lang, Ian
Eyre, Sir Reginald	Latham, Michael
Fallon, Michael	Lawler, Geoffrey
Farr, Sir John	Lawrence, Ivan
Favell, Anthony	Lawson, Rt Hon Nigel
Finsberg, Sir Geoffrey	Leigh, Edward (Gainsbor'gh)
Fletcher, Alexander	Lennox-Boyd, Hon Mark
Fookes, Miss Janet	Lester, Jim
Forman, Nigel	Lilley, Peter
Forsyth, Michael (Stirling)	Lloyd, Peter, (Fareham)
Forth, Eric	McCurley, Mrs Anna
Fowler, Rt Hon Norman	MacKay, Andrew (Berkshire)
Fox, Marcus	MacKay, John (Argyll & Bute)
Franks, Cecil	Maclean, David John
Fraser, Peter (Angus East)	Major, John
Freeman, Roger	Maples, John
Gale, Roger	Mather, Carol
Galley, Roy	Maude, Hon Francis
Gardiner, George (Reigate)	Mawhinney, Dr Brian
Garel-Jones, Tristan	Miller, Hal (B'grove)
Gilmour, Rt Hon Sir Ian	Mitchell, David (NW Hants)
Glyn, Dr Alan	Monro, Sir Hector
Goodlad, Alastair	Moore, John
Gower, Sir Raymond	Morris, M. (N'hampton, S)
Grant, Sir Anthony	Morrison, Hon C. (Devizes)
Greenway, Harry	Moynihan, Hon C.

Murphy, Christopher	Stewart, Andrew (Sherwood)
Needham, Richard	Stokes, John
Neubert, Michael	Stradling Thomas, J.
Newton, Tony	Sumberg, David
Nicholls, Patrick	Tapsell, Peter
Norris, Steven	Taylor, John (Solihull)
Onslow, Cranley	Taylor, Teddy (S'end E)
Osborn, Sir John	Tebbit, Rt Hon Norman
Parris, Matthew	Temple-Morris, Peter
Patten, Christopher (Bath)	Terlezki, Stefan
Patten, John (Oxford)	Thatcher, Rt Hon Mrs M.
Pawsey, James	Thomas, Rt Hon Peter
Peacock, Mrs Elizabeth	Thompson, Donald (Calder V)
Porter, Barry	Thompson, Patrick (N'ich N)
Powell, William (Corby)	Thorne, Neil (Ilford S)
Powley, John	Thornton, Malcolm
Price, Sir David	Thurnham, Peter
Prior, Rt Hon James	Townsend, Cyril D. (B'heath)
Rhodes James, Robert	Tracey, Richard
Roberts, Wyn (Conwy)	Trotter, Neville
Robinson, Mark (N'port W)	Twinn, Dr Ian
Rossi, Sir Hugh	van Straubenzee, Sir W.
Rost, Peter	Vaughan, Sir Gerard
Rowe, Andrew	Viggers, Peter
Ryder, Richard	Wakeham, Rt Hon John
Sackville, Hon Thomas	Walden, George
Sainsbury, Hon Timothy	Walker, Bill (T'side N)
Sayeed, Jonathan	Walker, Rt Hon P. (W'cester)
Scott, Nicholas	Walters, Dennis
Shaw, Giles (Pudsey)	Ward, John
Shaw, Sir Michael (Scarb')	Wardle, C. (Bexhill)
Shelton, William (Streatham)	Warren, Kenneth
Shepherd, Colin (Hereford)	Watson, John
Shepherd, Richard (Aldridge)	Watts, John
Shersby, Michael	Wells, Bowen (Hertford)
Silvester, Fred	Wells, Sir John (Maidstone)
Sims, Roger	Wheeler, John
Skeet, T. H. H.	Whitfield, John
Smith, Sir Dudley (Warwick)	Whitney, Raymond
Smith, Tim (Beaconsfield)	Wilkinson, John
Soames, Hon Nicholas	Winterton, Mrs Ann
Speller, Tony	Winterton, Nicholas
Spencer, Derek	Wolfson, Mark
Spicer, Michael (S Worcs)	Wood, Timothy
Squire, Robin	Woodcock, Michael
Stanbrook, Ivor	Yeo, Tim
Steen, Anthony
Stern, Michael	Tellers for the Ayes:
Stevens, Lewis (Nuneaton)	Mr. John Hunt and
Stevens, Martin (Fulham)	Mr. Archie Hamilton.
Stewart, Allan (Eastwood)
NOES
Abse, Leo	Callaghan, Jim (Heyw'd & M)
Adams, Allen (Paisley N)	Campbell, Ian
Anderson, Donald	Campbell-Savours, Dale
Archer, Rt Hon Peter	Canavan, Dennis
Ashdown, Paddy	Carlile, Alexander (Montg'y)
Ashley, Rt Hon Jack	Carter-Jones, Lewis
Ashton, Joe	Cartwright, John
Atkinson, N. (Tottenham)	Clark, Dr David (S Shields)
Bagier, Gordon A. T.	Clarke, Thomas
Banks, Tony (Newham NW)	Clwyd, Mrs Ann
Barnett, Guy	Cocks, Rt Hon M. (Bristol S.)
Barron, Kevin	Cohen, Harry
Beith, A. J.	Coleman, Donald
Bell, Stuart	Concannon, Rt Hon J. D.
Benn, Tony	Corbett, Robin
Bennett, A. (Dent'n & Red'sh)	Corbyn, Jeremy
Bidwell, Sydney	Cowans, Harry
Boothroyd, Miss Betty	Cox, Thomas (Tooting)
Boyes, Roland	Craigen, J. M.
Bray, Dr Jeremy	Crowther, Stan
Brown, Gordon (D'f'mline E)	Cunningham, Dr John
Brown, N. (N'c'tle-u-Tyne E)	Dalyell, Tam
Brown, R. (N'c'tle-u-Tyne N)	Davies, Rt Hon Denzil (L'lli)
Brown, Ron (E'burgh, Leith)	Davies, Ronald (Caerphilly)
Buchan, Norman	Davis, Terry (B'ham, H'ge H'l)
Caborn, Richard	Deakins, Eric
Callaghan, Rt Hon J.	Dewar, Donald

Dixon, Donald	Hughes, Simon (Southwark)
Dobson, Frank	Janner, Hon Greville
Dormand, Jack	Jenkins, Rt Hon Roy (Hillh'd)
Douglas, Dick	John, Brynmor
Dubs. Alfred	Johnston, Russell
Duffy, A. E. P.	Kennedy, Charles
Dunwoody, Hon Mrs G.	Kilroy-Silk, Robert
Eadie, Alex	Kinnock, Rt Hon Neil
Eastham, Ken	Lambie, David
Edwards, Bob (W'h'mpt'n SE)	Lamont, Norman
Evans, John (St. Helens N)	Leighton, Ronald
Ewing, Harry	Lewis, Ron (Carlisle)
Fatchett, Derek	Lewis, Terence (Worsley)
Faulds, Andrew	Litherland, Robert
Field, Frank (Birkenhead)	Lloyd, Tony (Stretford)
Fisher, Mark	Lofthouse, Geoffrey
Flannery, Martin	Loyden, Edward
Foot, Rt Hon Michael	McCartney, Hugh
Foster, Derek	McCrea, Rev William
Foulkes, George	McDonald, Dr Oonagh
Fraser, J. (Norwood)	McGuire, Michael
Freeson, Rt Hon Reginald	McKay, Allen (Penistone)
Freud, Clement	McKelvey, William
Garrett, W. E.	McNamara, Kevin
Godman, Dr Norman	McTaggart, Robert
Golding, John	Madden, Max
Gould, Bryan	Martin, Michael
Hamilton, James (M'well N)	Mason, Rt Hon Roy
Hamilton, W. W. (Central Fife)	Maxton, John
Hancock, Mr. Michael	Maynard, Miss Joan
Hardy, Peter	Meacher, Michael
Harman, Ms Harriet	Meadowcroft, Michael
Harrison, Rt Hon Walter	Michie, William
Hart, Rt Hon Dame Judith	Mikardo, lan
Hattersley, Rt Hon Roy	Millan, Rt Hon Bruce
Haynes, Frank	Miller, Dr M. S. (E Kilbride)
Heffer, Eric S.	Morris, Rt Hon J. (Aberavon)
Hogg, N. (C'nauld & Kilsyth)	Nellist, David
Holland, Stuart (Vauxhall)	Oakes, Rt Hon Gordon
Home Robertson, John	Brien, William
Howell, Rt Hon D. (S'heath)	Neill, Martin
Howells, Geraint	Orme, Rt Hon Stanley
Hughes, Dr. Mark (Durham)	Owen, Rt Hon Dr David
Hughes, Robert (Aberdeen N)	Park, George

Parry, Robert	Soley, Clive
Patchett, Terry	Spearing, Nigel
Pavitt, Laurie	Steel, Rt Hon David
Pendry, Tom	Stewart, Rt Hon D. (W Isles)
Penhaligon, David	Strang, Gavin
Pike, Peter	Straw, Jack
Powell, Raymond (Ogmore)	Thomas, Dafydd (Merioneth)
Radice, Giles	Thomas, Dr R. (Carmarthen)
Redmond, M.	Thompson, J. (Wansbeck)
Rees, Rt Hon M. (Leeds S)	Thorne, Stan (Preston)
Richardson, Ms Jo	Tinn, James
Roberts, Ernest (Hackney N)	Torney, Tom
Robinson, G. (Coventry NW)	Wallace, James
Rooker, J. W.	Wardell, Gareth (Gower)
Ross, Ernest (Dundee W)	Wareing, Robert
Ross, Stephen (Isle of Wight)	Weetch, Ken
Rowlands, Ted	Welsh, Michael
Ryman, John	White, James
Sedgemore, Brian	Williams, Rt Hon A.
Sheerman, Barry	Wilson, Gordon
Sheldon, Rt Hon R.	Winnick, David
Shore, Rt Hon Peter	Woodall, Alec
Short, Ms Clare (Ladywood)	Wrigglesworth, Ian
Short, Mrs R.(W'hampt'n NE)	Young, David (Bolton SE)
Silkin, Rt Hon J.
Skinner, Dennis	Tellers for the Noes:
Smith, C.(Isl'ton S & F'bury)	Mr. John McWilliam and
Smith, Rt Hon J. (M'kl'ds E)	Mr. Austin Mitchell.
Snape, Peter

Question accordingly agreed to.

Mr. SPEAKER forthwith declared the main Question, as amended, to be agreed to.

Resolved, That this House congratulates the Government on its record of increasing the resources and efficiency of the National Health Service; applauds the higher level of service provided by the National Health Service and its staff which this has made possible; and supports the Government in its determination to maintain and develop a 'modern health service, giving maximum value to the public as patients and taxpayers.