§ The Secretary of State for Social Services (Mr. Norman Fowler)
I very much welcome the opportunity of this debate. It gives me an opportunity to deal with the issues of health and social security and the reform of pensions that are central to this Government's concerns. My right hon. Friend the Secretary of State for Education and Science will deal with issues in his area of concern.
I am bound to say that I am reminded of the debate on the Health Service we had 12 months ago. That debate took place in the context of the manpower policy introduced a short time previously—the first time any Government had asked for a manpower policy from health authorities , over 70 percent. of whose spending is taken up by staff costs.
During that debate the right hon. Member for Islwyn (Mr. Kinnock) talked ofthe intensification of the attack on the NHS by the Governmentand ofan unmitigated crime against the British people"—[Official Report, 27 October 1983; Vol. 47, c. 441–49]
The hon. Member for Crewe and Nantwich (Mrs. Dunwoody) spoke of decisions beingKafka-like in their nightmare quality."—[Official Report, 27 October 1983; Vol. 47, c. 504.]
The hon. Member for Oldham, West (Mr. Meacher) in a speech in London a few days later, said:The gloves are off, the pace of attack is accelerating for the kill".
Yet what have been the results over the past 12 months? Over the past 12 months there have been 300,000 more inpatients treated in English hospitals. There have been 100,000 more day cases treated in English hospitals and there have been 850,000 more outpatient attendances at English hospitals. What is the significance of these figures? Far from showing that there has been a deterioration in health care, they show that the Health Service is providing more care, more services and more help for patients than at any stage since the inception of the NHS. They show also that, compared with 1978, the last year in office of the Labour Government, our hospitals provided treatment for 3½ million more cases. There were 650,000 more inpatient cases, 2½ million more outpatient attendances and ¼ million more day cases.
The reason for quoting these figures is simple. We can argue over the number of staff employed—in fact, we 223 are employing 12 per cent. more doctors and 13 per cent. more nurses than when we came to office. We can argue over the amount of money spent—in fact, expenditure has increased by 17 per cent. against inflation since 1978–79. However, those are not the crucial tests.
One of the crucial tests is not how much is spent but the results that are obtained from the resources. That is the test in any service, any industry and any business. The message of the figures is unmistakable. If we compare the rate of improvement in patient services over the five years of the Labour Government, from 1974 to 1978, with the five years of Conservative Government that followed, we find that between 1973 and 1978 the number of inpatient cases treated per year rose by 4½ per cent. whereas over the past five years it has risen by over 12 per cent.—almost three times as fast. The increase in inpatient cases treated last year was considerably more than was achieved under the five years of the Labour Government.
§ Mr. Laurie Pavitt (Brent, South)
How does the 17 per cent. that the right hon. Gentleman claims compare with the 7 per cent. that is declared in the report published only last week by his Department? I can refer the right hon. Gentleman to the relevant page if he wishes.
§ Mr. Fowler
I am well aware of that, because I wrote the report myself. The increase in economic cost terms was 17 per cent. We made it clear that expenditure has increased by 17 per cent. against the retail price index. The hon. Gentleman is referring to the volume estimate of 7 per cent. The two percentages are not incompatible with each other, but I ask him to take note of the figures that I have drawn to the attention of the House. What matters in the end—I suggest that it matters to him as much as to me, given his long connection with the NHS—is what we are doing with the resources and how we are putting them to use.
Over the past four or five years the Health Service has been putting resources to extremely good use. The hon. Gentleman may agree with me that the figures are, first and foremost, a tribute to the staff of the NHS at whatever level and whatever occupation. The figures do not mean that all the problems of health care have been magically solved overnight. I would never claim that and one of my criticisms of Opposition Front Bench spokesmen is that they tend to go in for that sort of promise. Like every health service in Europe, we are facing increasing demands from the rising number of elderly and from medical advance itself.
§ Mr. George Park (Coventry, North-East)
The Secretary of State has given the statistics for one side of the picture, but I ask him to give the House the statistics for the other side by giving details of the waiting lists.
§ Mr. Fowler
The waiting lists are set out in the annual report. When the Conservative Government took office they had an inherited waiting list of about 750,000. That list was reduced by about 100,000 until the health dispute of 1982. One of the results of that dispute was that the list lengthened again. I am glad to say that it is now reducing. The lesson and the logic of that is that it was the industrial action, backed by the Labour Opposition which sent up the waiting list. If the hon. Member for Coventry, North-East (Mr. Park) feels so strongly about the waiting lists, I wish that some Opposition Members had had the courage to condemn the industrial action that had that inevitable result.
§ Mr. Fowler
I shall not give way. Compared with the position that has been described, the figures show a picture of developing care. Compared with five years ago, the rate of perinatal mortality is down by nearly a third. There has been a rise of more than 50 per cent. in the number of new renal patients accepted for treatment. We have more than doubled the numbers of coronary artery bypass grants. Those are the health care figures. They show the Government's real commitment to an expanding and improving Health Service. They are the figures that give the lie to the Opposition Front Bench charges.
I am bound to say that we are not prepared to take lectures on patient care from the Opposition Front Bench. It is not simply that they do not have a monopoly on social concern; it is that their social record when in office simply does not stand up. Never can that which achieved so little have claimed so much. It was the Labour party when in Government that made the biggest cuts in the capital building programme in the history of the Health Service. It was the party that backed industrial action in 1982 and the party which unleashed record inflation of 110 per cent. over five years, which had devastating effects on the elderly, the poor and the sick and affected virtually every social programme.
The fact is that the Labour party's claims to protect the Health Service are as bogus as its charges that we have damaged it. The fact is that there is a range of challenges on health care that we must face with realism. There are, for example, the challenges of replacing old and outdated hospitals, of providing for the growing needs of our aging population, of making new forms of treatment available to patients throughout the Health Service, of providing care for the mentally ill and the mentally handicapped, of treating patients and the public as individuals, and of being more sensitive to their human needs and problems.
If we are to face those and the other challenges successfully, we need to ensure the best possible value for the money that we spend—the best possible use of resources. Lord Ennals, who was Secretary of State for Social Services, in his report on the Health Service for 1976 said:We must renew our efforts to get, and to give, full value for money…People have the light to be assured that the rnoney they pay in taxes and contributions is used to the best advantage.I agree with the noble Lord, and I am sure that the hon. Member for Oldham, West does also, although I am bound to say that he has never brought himself to say just that.
This is not the occasion to underline every one of the measures that we have taken to achieve better value for money in the Health Service, but let me take two. The Rayner scrutinies have revealed major opportunities for savings. The study of transport showed potential for savings of at least £15 million a year. Our survey of residential accommodation found that the Health Service owned property worth more than £1 billion—a fifth of which stood empty at any one stage. The potential to release resources for patient care should be clear. We are seeking also to dispose of surplus land in NHS ownership. Last year, we sold land worth more than £30 million. New opportunities have now been opened up. This August we implemented legislation to permit health authorities to maximise the value of land by obtaining planning permission before a sale. Taken together, the resources 225 locked up in surplus residential accommodation and land can surely be released and ploughed back into developments for patients.
The other example of the measures that we have taken to achieve better value for money is in the process of competitive tendering, which is already producing major savings inside the Health Service. The latest figures that I have show that, so far, 34 Health Service contracts let to private contractors will be producing total savings of more than £18 million during the next three years. Three individual hospitals have each saved more than £500,000 on cleaning contracts—in one case, a reduction of two thirds on previous costs. One health authority will save £1.4 million a year.
That is not all. There is another advantage from the programme of competitive tendering that we are following. As a result of the competition, there have been considerable reductions in the cost of contracts that have stayed in-house—savings of more than £100,000 a year in the case of one domestic contract and £100,000 a year in the case of a laundry contract. All that money is now available for patient care, and all that money would be lost to patients if Labour could ever carry out its conference resolution to end all competition and to ban private contractors.
Value for money is, therefore, a central objective—value for the taxpayer and, above all, for the patient.
§ Mr. Peter Rost (Erewash)
My right hon. Friend referred to the privatisation of cleaning services. We also know that some privatisation has taken place in catering. Is he aware that south Derbyshire health authority has privatised its energy and boiler services for its central laundry in Derby at a saving of more than £120,000 a year? What is he doing to draw to the attention of health authorities the savings that can be achieved by more efficient privatised energy services?
§ Mr. Fowler
I am grateful to my hon. Friend for that example. I also believe that Wakefield has done something further in that area. We shall clearly do our utmost to stress the benefits to the Health Service that flow from these policies. My central point is that the savings made can then be ploughed back into the Health Service and into patient care. That is what the policy is all about, and that is the policy that Labour Members are determined to try to defeat.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
The right hon. Gentleman talked about ploughing money back into patient care. Will he also reflect about the other side of the equation—those in the ancillary services who are at present contributing towards patient care? Will he comment on the view expressed by the Hospital Caterers Association, that the abolition of the fair wages resolution has, on average, led to a 20 per cent. reduction in the conditions of service for those in the ancillary sector?
§ Mr. Fowler
I do not accept that. I share the hon. Gentleman's concern for those working in the ancillary services, but it would be quite absurd for the Government to try to lay down from the centre all the terms and conditions of every outside contractor seeking a contract inside the Health Service. That would be an absurd position for the Government to get in.
226 The concept of value for money applies to all areas of the Health Service. As I said at Brighton four weeks ago, I do not exempt the drugs bill from that process. At present there are two proper causes of concern. First, there is the cost to the NHS of the drugs bill, which now totals nearly £1,400 million a year, compared with about £250 million 10 years ago. Secondly, there is concern over the fact that the public are demanding more drugs each year, the result being that doctors are now issuing 100 million more prescriptions each year than 25 years ago. Those prescriptions cover more than 17,000 different products, double the range used 25 years previously.
It is, of course, true that many of the increases are fully justified and reflect the enormous medical and pharmaceutical advances made in the last quarter of a century. But that is not true of all drugs that are now being prescribed under the NHS.
The clearest example is the wide range of branded medicines prescribed for minor conditions such as coughs and colds. In most cases those conditions will remedy themselves without medical intervention, and the medicines are prescribed for relieving the symptoms. By any standards they are the less important drugs. In fact, most can be bought over the counter from the local chemist without the need to consult a doctor or to obtain a prescription. Many people already buy them in that way. Nevertheless, these branded medicines—tonics, cold and cough remedies, indigestion and headache tablets and low dose vitamin pills—are currently costing the Health Service £120 million a year.
A second group are the tranquillisers and sedatives. Some of the branded sleeping pills come into that category. The use of those drugs has expanded dramatically in recent years—many doctors would say too far. Many different brand name products have been introduced which have essentially similar properties, and the cost to the NHS is now £40 million a year.
We have already made it clear that we do not intend to move over to a policy of indiscriminate generic substitution, which would both limit the freedom of the medical profession and have a serious effect on the research-based pharmaceutical industry in Britain. I see no reason, however, why in the two groups that I have set out the NHS should not limit itself to providing only the cheaper generic alternatives which are available. In other words, the patient can still obtain those kinds of medicines on prescription from his doctor under the Health Service, but they will be the cheaper generic alternatives. If the patient still wishes to go for a particular brand name, he will have the alternative of buying it over the counter from his local chemist or else asking his doctor to prescribe it privately. This is the kind of system that applies in many other countries already.
Clearly, I shall need to consult the professions and the industry to ensure that we do not accidentally exclude from NHS use a drug that is essential to the treatment of a particular condition. But I thought it right to tell the House in advance of the outline of those proposals. I shall be issuing a consultation letter later today, and my right hon. and learned Friend the Minister for Health will be taking the consultation process forward. He will also be opening discussions with the pharmaceutical industry on the implications of the report of the review board on Government contracts for the pharmaceutical price regulation scheme. Again, our aim will be to contain the costs falling on the NHS.
§ Mrs. Jill Knight (Birmingham, Edgbaston)
Can my right hon. Friend tell us whether any advance has been achieved in dealing with the problem that arises from the fact that many doctors issue repeat prescriptions of drugs such as valium, often continuing to do so for one, two and even three years? That problem, as I am sure my hon. Friend will accept, has worried many people.
Is it not the case that care has to be taken in the use of generic alternatives? A label or brand name gives some protection to the person who is taking the drug.
§ Mr. Fowler
I agree with what my hon. Friend said about repeat prescriptions, and I think that many doctors would also agree with her. Clearly, however, there are issues of professional freedom in that regard. We make advice available to doctors and we shall continue to do so.
With regard to reliability, I have no doubt whatever that, in the case of the drugs concerned—some of which one would describe as home remedies—the generic alternatives present no difficulties.
§ Mr. Michael Meadowcroft (Leeds, West)
I welcome the partial step that the Secretary of State has mentioned. I think that it will assist in dealing with the question of generic alternatives. He particularly mentioned the effect of generic substitution on research in the pharmaceutical industry. Has he investigated with the pharmaceutical companies the possibility of extending the patent life of products to, say, 30 years? I understand that the industry would be prepared to negotiate in that respect. It would enable us to move towards a system of generic substitution without harming research.
§ Mr. Fowler
We are talking to the industry about that matter. It is a point that is uppermost in the minds of those in the industry.
The hon. Member for Leeds, West (Mr. Meadowcroft) has also put his finger on the real concern about the pharmaceutical industry. None of us wants to damage the research-based British pharmaceutical industry, both because of the contribution that it makes to research and because of the employment consequences and the industry's contribution to the balance of payments. I have those issues very much in mind, and no one who reads what I have said could conclude that the drugs in question will damage anyone's research-based industry. They are not the most important drugs or the life-saving ones. I hope that both sides of the House will accept that this is a sensible step forward.
§ Mr. Michael Meacher (Oldham, West)
Bearing in mind that the Secretary of State has said that expenditure on drugs in the current year will amount to some £1,400 million, and as he always tells us that the Health Service budget amounts to some £17 billion a year, how much will be saved each year by the proposed change?
§ Mr. Fowler
It is difficult to give the hon. Gentleman an exact figure before the negotiations and discussions are held, but I believe that there may be a saving of the order of £100 million. Savings of that size are extremely valuable in an area where costs have risen considerably over the past few years.
We have already introduced new arrangements to ensure that parallel-imported drugs meet proper safety standards. I shall shortly announce further action to make sure that the Health Service does not lose out when exceptionally large discounts are offered to pharmacies by 228 the wholesalers from whom they buy their drugs. That would be a further step towards achieving better value for money in the NHS drugs bill.
§ Mr. Tony Favell (Stockport)
Is my right hon. Friend aware that many people both inside and outside the medical profession are concerned about the treating of doctors by drug firms to encourage the prescribing of brand names.
§ Mr. Fowler
I understand that my hon. Friend is referring to hospitality offered by drug firms. We have given clear guidance to the medical profession about what is expected and required in this area. If there are any questions of abuse, I shall gladly look into them.
§ Mr. Fowler
The Queen's Speech rightly underlined the importance of employment policies. The House will consider that question specifically on Monday, but it would be wrong to ring-fence consideration of the topic. For example, it is clear that policies on both pensions and social security can be central. In the case of pensions, it must be an aim of policy to remove artificial barriers that hinder people from moving jobs. We should extend freedom of choice, not only to enable people to fulfil their ambitions for themselves and their families but to encourage the generation of new wealth and new jobs. It is against that background that we shall present legislative proposals which, taken together, will represent the first major reform of occupational pension schemes for a decade. They will advance and develop the freedoms and rights of over 11 million people who are now members of occupational schemes, and remove injustices which still inhibit mobility and flexibility in the labour market.
There will be three main strands in the proposals. First, we shall be implementing reforms to protect the pension rights of people who leave an occupational pension scheme before pension age—the so-called early leavers. For far too long they have been treated by some—although not all—schemes as second-class citizens, with their residual pension rights frozen and depreciating in real terms. This is unfair to them and ultimately bad for the economy. The Bill that I shall shortly introduce will mean that in future employees who change jobs will have their pensions protected against inflation.
We shall require schemes to revalue preserved pension rights for those leaving schemes in line with the rise in prices, up to 5 per cent. a year. This solution represents the right balance between giving proper protection to members of occupational pension schemes, removing restrictions on job mobility and maintaining the essential role and interests of the schemes themselves.
Secondly, we have been consulting about our proposal to give people leaving an occupational pension scheme the right to a transfer value. This means that an employee who leaves an employer will be able to take with him the fair value of his pension rights. The transfer value could be used to obtain benefit rights in a new employer's scheme, or to buy the annuity of his own choice, or to invest in a personal pension. The proposal has been generally welcomed and I can now tell the House that we shall be implementing it in the Bill. It will help to make sure that all early leavers get a fair deal and more choice.
Thirdly, we shall be taking new steps to ensure that all members of pension schemes have more information about 229 those schemes. For many people, their occupational pension is the biggest asset they have—worth more even than their home. The Bill will give a right of access to a wide range of information about schemes and a full account of their entitlement.
I believe that these proposals will be widely supported. Certainly the response to our consultative documents confirmed that these reforms would be especially welcomed by individual scheme members. For too long people who change jobs have paid a pensions penalty. These are the proposals on which we are taking action now but, as the House will know, we have published proposals for a major new pension option—the personal pension. The proposals have aroused unprecedented interest. More than 32,000 copies of the consultative document have been distributed. The consultation does not finish until the end of this month and that is set out in the document. Although I understand the enthusiasm of some for immediate action, we must allow time to consider the comments that we have received. It is clear that people want to be free to choose their own pension arrangements. I assure the House that we intend to give them that freedom.
The occupational pensions measures that I have described concern only part of social security provision. They are important measures in their own right and are designed to improve the pension structure but we want to achieve much more than that. However, our examination goes much further than pensions. The approach that the Government adopted is to look rationally and carefully at virtually the whole of the social security system to see how it should be developed to serve the needs we face in the last years of the 20th century because the situation we face now and the needs we shall face in the future are very different. The social security budget is now more than £37 billion a year—some 30 per cent. of all public spending. That is a sixty-fold increase in cash spending since the inception of the welfare state and a doubling of the proportion of the GDP devoted to social security. Part of that growth has been due to increases in demand. There are, for example, 16.5 per cent. more people getting retirement pension than 10 years ago. Most of the increase, however has been accounted for by increases in the real value of benefits and the range of circumstances in which benefits are payable.
After this month's uprating, national insurance retirement pensions will have risen by nearly 84 per cent. since November 1978. That is more than enough to protect them against the likely rise in prices—76 or 77 per cent.—over the same period. From this month, supplementary pensioners aged over 65 will receive additional help with heating costs, and there will be extra help for those over 85. We have increased the real value of mobility allowance and made it tax-free. The Government therefore cannot be accused of making cuts and of dismantling the welfare state.
§ Mr. Fowler
However, there is one cause for special concern which has been caused by the protracted strike of a small minority of staff at the DHSS central office at Newcastle—fewer than 400 out of about 10,500. The dispute centres around management efforts to make full and economical use of the new generation of computer equipment now in use by three-shift working in areas 230 where it is needed, such as the retirement pensions computer, and by ending unnecessary shifts where they are no longer justified, such as in laser printing. There have been protracted negotiations, and an offer from management under which no shiftworker need lose any take-home pay. Two of the three unions involved—the Society of Civil and Public Servants and the Civil Service Union—have voted to accept the management proposals, and the national officials of the third union, the Civil and Public Servants Association, have also recommended acceptance. But members of the CPSA voted last week to continue their action. In effect, they are saying that the present shift arrangements must be preserved in perpetuity, without reference to any changes in the actual requirements of the job of paying benefits to claimants.
Let me make two things clear about the dispute. First, and foremost, I deplore attempts to hit pensioners and families with children in pursuit of an industrial dispute. That is precisely what has happened. Secondly, despite the disruption, I can reassure hon. Members that the benefit uprating will go ahead and that the Christmas bonus will be paid.
I urge those who are still taking action to reconsider swiftly their position and accept what is by any sensible criterion a fair and reasonable offer. Failing that, we shall have to consider what further steps are needed to restore the service that pensioners and the public are entitled to expect.
§ Mr. Roland Boyes (Houghton and Washington)
Will the Secretary of State explain what he means by a fair system? In my constituency workers who are on strike have been offered a pay cut of between £10 and £14 a week. Does the Secretary of State expect workers to accept pay cuts because they are in the Government's interest? That would be ridiculous. The workers want to return to work and to pay the benefits as quickly as possible, but they want a fair day's pay for a fair day's work.
§ Mr. Fowler
We have bent over backwards to do everything we can to preserve the interests of those who are working at Newcastle now. The hon. Gentleman's argument seems curious, considering that two of the three unions affected by the dispute have agreed to accept the offer and that the national leadership of the third has also recommended acceptance of the offer. To the objective outsider that shows that the case is not exactly as the hon. Gentleman seeks to present it, and that the Government have done everything in their power to make a reasonable offer. I hope that those who are on strike now will reconsider the offer urgently.
If there is one point on which the public are agreed it is that the social security system has by any standards become complex to administer and difficult to understand. That is to the disadvantage of claimants and staff alike. It is also worth underlining that it is very different from the system that Beveridge intended. He intended a fund which built up. However, we have not a funded scheme but a pay-as-you-go system in which today's contributions pay for today's benefits. Similarly, he did not perceive the growth in non-contributory benefits for families, the disabled and others, which has taken place, nor the role of supplementary benefit. The social security system of 1984 is not that proposed by William Beveridge, and the opponents of change should not seek to wrap themselves in Beveridge's mantle.
231 In the review which is now under way we have gone out of our way to an unprecedented extent to find out what people think about the issues facing us. We have invited individuals and organisations to submit evidence, we have held public sessions to discuss some of that evidence, and we have brought in people from outside Government to help us to assess the evidence. The response has been remarkable: more than 4,500 pieces of written evidence have been received and we have held 19 public sessions in the United Kingdom.
The task on which the Government are now engaged is to determine what should be done to improve the system, and in approaching that task we have several important considerations in mind. First, we must ensure that the resources provided are used to best effect. Secondly, we must take into account the issues that will confront us in the future. We know that although the real cost of pensions may not increase greatly before the end of the century, it will double after then. Moreover, that will happen at a time when the balance between the working and the retired population is worsening.
Thirdly, we must make the systems that we operate less complex for claimants and staff. The history of the development of social security since 1948 has been one of ad hoc change and additions. It has left us in a position where the civil servant attempting to determine the entitlement to supplementary benefit must refer to a guidance manual that contains 16,000 paragraphs of instructions. That cannot make sense.
§ Mr. Gordon Brown
The Minister boasts of an open review of the social security system, but will he also be open and frank with the House about what the social security review committees are doing? Will he confirm that, despite his promises to the House last July, and the promises of the Prime Minister, the committee that he chairs has been considering and costing detailed proposals to means-test child benefits, and considering proposals to remove the rights of teenagers to supplementary benefit? Will he confirm that the committee which is chaired by the Minister of State is considering removing the rights of pensioners to heating additions and to single payments? Will he admit that the welfare state is more in danger now than it has been at any time since Beveridge?
§ Mr. Fowler
I was probably right not to give way to the hon. Gentleman earlier. The Government are reviewing the entire social security system. The hon. Gentleman has just repeated a story that appeared in The Observer last Sunday, and I congratulate him on his memory of the details. We are considering all the options in child benefit and in supplementary benefit. He did not mention it, but we are also considering all the options in retirement pensions. That is what a review is about. There is no point in my carrying out such reviews if I am not prepared to consider all the options that are put to me. The Government are carrying out a review that should have been conducted years ago, but we are doing it only now, 40 years after Beveridge. It is absurd for the hon. Gentleman to believe that he can try to tie my hands as to what I should consider.
The review on housing benefit excepted, these are not separate reviews adopting different working methods and principles. We have embarked upon a review of almost the entire social security system. It is being carried out openly and without delay. It is being conducted in consultation 232 with not only the public and expert outside bodies, but with all relevant Government Departments. The Government are considering and will consider their proposals in conjunction with tax; that has never been at issue, and it would be absurd to do otherwise. The proposals, which I hope to make in the early part of the new year, will be the Government's proposals and will take into account all our objectives.
We cannot and should not consider social security in isolation. Indeed, my Department is accompanying the review with examinations of the family practitioner service and the personal social services.
The Government's record on health and social security is one of consistent and realistic commitment. We understand that the welfare state cannot survive without the underpinning of a sound economic policy—a point which Labour Members have never understood, either in Government or in Opposition. We also understand that the purposes for which the welfare state was created have still to be met. That is why we have identified a clear strategy for improving the management of the Health Service, so that it can provide the services we will need during the latter part of this century. That strategy is now showing results. The record levels of finance being made available to the Health Service are being used to provide services to still greater numbers of patients. In the coming months our examination of the social security system—the most fundamental in the past 40 years—will enable us to put forward a strategy there to ensure that our duty to help those in need can be met consistent with our responsibility to contain the burden on the taxpayer and national insurance contributor.
The Government are determined that economic and industrial recovery must also benefit the elderly, the poor, and the sick. That is the challenge, and that is the challenge that we will meet.
§ Mr. Michael Meacher (Oldham, West)
Eighteen months ago, the new Chancellor of the Exchequer revealed his fixation about cutting public expenditure by declaring in one of his first television interviews that his prime targets were health, social security and education. The experience of the past 18 months and the sheer lack of concern in the Queen's Speech for the steady arid remorseless deterioration of our once great Health Service and welfare state are abundant and tragic testimony 10 the ruthlessness with which the Government's anti-NHS arid anti-welfare state dogmas have been and are being pursued.
The deterioration in the Health Service is readily covered up, as it was today, by the Secretary of State's quotation of highly selective and misleading criteria on which to judge his NHS record.
§ Mr. Meacher
The Secretary of State should wait for what I am about to say in answer to that point.
On the other hand, the Secretary of State completely ignores much more relevant evidence.
Let me immediately refute the two central pivots on which the Secretary of State, yet again today, seeks to take credit for his record on the NHS. First, he says that the NHS treated nearly 650,000 more inpatient cases last year 233 than in 1978, together with nearly 2.5 million outpatient attendances. Even a moment's reflection shows that that is a dubious and open-ended criterion of improvement, and it can just as readily be interpreted as implying the reverse. It says nothing about the quality of care, and, as cuts and closures bite deeper, it may simply reflect pressure for premature discharge in the face of rising demand for new medical care for those left on mounting waiting lists.
Not only that, but this increase in treatment is not entirely of new patients. A proportion—for all we know, a growing proportion—consists of the same people returning because their original treatment did not suffice. We do not know that for sure, but it cannot be denied. Furthermore, we resent, and I believe that the nation resents, the Government seeking to take credit for the fact that doctors, nurses and ancillary workers have dealt with more cases, when the Government's policies, leading to mass unemployment, housing and urban decay and rising social stress, are major factors behind the increase in illness in the first place. We also resent the fact that the Government seek to capitalise on the statistic of medical throughput with blithe disregard and deliberate sabotage of the community care facilities into which these people are being discharged.
§ Mr. Fowler
Does the hon. Gentleman regard the number of patients treated as being a true measure of the effectiveness of the NHS or not? If not, why, in 1976, did the then Secretary of State, in whose Department I think the hon. Gentleman served, say that more people were treated in hospital than ever before and that the number of day patients was also a record? Why should a Labour Government claim credit for that and not a Conservative Government?
§ Mr. Meacher
The Secretary of State should look at his own documents. On page 1 of the Health Service in England report, he will see that, on all the criteria that he has mentioned, the record of outpatient and inpatient attendances in the five years previous to the last five years is almost identical to that in the last five years. But my point is that—[Interruption.] Perhaps the Minister for Health will listen to my answer. Neither in 1976 nor today is that an adequate measure of the performance of the NHS. It is an interesting and important one, and, as I said, we did as well as in the past five years, but it is not an adequate measure and Secretary of State is wrong to regard it as such.
The second arm of the Secretary of State's argument in defence of his NHS record is equally flawed. He pretends that there have not been cuts by talking up the 17 per cent. RPI increase in NHS expenditure over the past five years. In the previous five years, the increase in NHS expenditure under the previous Labour Government on exactly the same basis was 19 per cent. Much more important is that, in terms of what money will buy in the NHS—that is what really matters—the Social Services Select Committee made it clear that the increase was not 17 per cent. but, as my hon. Friend the Member for Brent, South (Mr. Pavitt) made clear earlier, 7 per cent. I am glad to note the presence of my hon. Friend the Member for Wolverhampton, North-East (Mrs. Short), who is chairman of that Committee and who has done sterling work. When account is taken of that, as it must be, of rising demographic factors among the elderly—
§ Mr. Meacher
I shall give way in a moment—and of the faster rising cost of medical technology, the increase was just about zero. That is the fact of the record over the past five years.
§ Mr. Meacher
I shall give way in a moment.
Indeed, Government figures published in Hansard on 16 January 1984—anyone can look at them—reveal that, after taking account of those necessary factors, expenditure on hospital and community health services in England over the past five years has declined by an average of 0.75 per cent. per year.
The House should remember that that is all against a background when the Government are already spending far less on health than any other comparable European country with, I think, the exception of Greece.
§ Mr. Meacher
If the hon. Lady persists in interrupting, I shall not give way.
We are seeing a decline in expenditure on hospital and community services—[Interruption.] I suggest that the Minister for Health looks at the figures himself. Here they are. That is against a background when the Government are already spending only 5.7 per cent. of GNP on health compared with 8 per cent. in France, 8 per cent. in Germany, 9.5 per cent. in the United States, and 10 per cent. in Sweden. The difference between those figures is billions.
§ The Minister for Health (Mr. Kenneth Clarke)
The hon. Gentleman has used that argument before. He carefully misuses figures. He will use those other figures as a measure of spending. There is only one measure of spending, and that is the amount of money spent compared with the increase in the general level of inflation. On that basis, the increase has been 17 per cent. The rest of the figures that he is producing are technological nonsense, by which he tries to produce a deficit. Our proportion of GDP is lower than that of western European countries, partly because we are more economical in the delivery of our services, but it has increased. A higher proportion of GDP is being spent now than throughout most of the period of the previous Labour Government.
§ Mr. Meacher
The Minister is beginning to lose control of the argument if he suggests that pay and prices in the NHS are not the relevant factor. The RPI is irrelevant. What matters is the cost of pay and the provision of facilities and equipment in the NHS. By that measure, expenditure has increased. The Select Committee, on which the right hon. and learned Gentleman's hon. Friends had a majority, in its unanimous report, said that the increase was 7 per cent. Even that does not take into account the increased number of the elderly and the faster rising costs of medical technology. When that is taken into account, the increase is zero.
§ Mr. Kenneth Clarke
We must resolve the matter by a more careful use of language. If one is talking about spending, one is talking about the amount of money that is spent compared with the rate of inflation. When measuring spending, one cannot ignore that proportion of it which includes pay over and above the level of inflation. The input volume figure is a rough approximation of the 235 amount that that extra spending can purchase in the NHS when one takes into account the higher than average unit costs that the service has had, particularly for pay. It is an interesting figure. We still publish it and the Select Committee makes use of it, but it is not very important or accurate. As an attack on the Government's spending record it is utterly useless. The only measure of spending is how much the Government take from the taxpayer and put into the Health Service, and how that compares with inflation. The figure is 17 per cent. up, despite five years of recession.
§ Mr. Meacher
If the figure is nonsense, why does it say on page 4 of the Government's report, which they issued a week ago, thatin terms of input volume — what money can buy for the Service — this means an increase of over 7 per cent.; this lower figure reflects the fact that Health Service costs rose faster than general inflation over this period."?What matters to patients is what the Health Service provides. It is not particularly impressive if the Minister for Health simply talks about an artificial RPI that does not apply to the NHS.
Of the two main claims on which the Secretary of State bases his Health Service record, the first is misdirected and the second is downright wrong. In any case, they are not the most relevant criteria for judging the performance of the Health Service. I shall suggest some alternatives that are much more relevant.
For example, waiting times are already far too long and are rapidly becoming worse. A recent BMA survey—I have the record with me and can show it to any hon. Member who so wishes—reveals that, for all of the six main specialties reviewed, a majority of district health authorities have experienced a lengthening of waiting times during this past year, when there were no industrial disputes. Perhaps, therefore, the Secretary of State should stop making excuses by continually referring to trade unions, because the last dispute was two or three years ago. A majority found that there was a lengthening of waiting times during this past year and that in every case the increase was as much as 40 to 60 per cent. That is not a small, but a heck of a big increase.
§ Mr. Tim Yeo (Suffolk, South)
How would the Labour party's policy of abolishing the private medical sector affect the waiting lists?
§ Mr. Meacher
I am glad to answer that question. Our policy would considerably improve waiting lists, because long waiting lists give people a strong incentive to go private. If we had parallel waiting lists, which I personally favour, it would cause a far bigger drop in NHS waiting lists than any of the Secretary of State's measures.
§ Mr. Pavitt
The Secretary of State made great play of the increase in numbers as a result of industrial disputes. Does my hon. Friend recall the two consultants' disputes in 1974 and 1975 and the junior hospital doctors' dispute, when waiting lists increased by 100,000, and that the Conservative party supported those disputes?
§ Mr. Meacher
That is relevant. We are always told that we are responsible for industrial disputes, but on that occasion consultants were involved rather than ancillary workers. Perhaps Government supporters should rethink their line on the issue.
§ Mr. Fowler
The difference is that we did not back that dispute. The hon. Gentleman is wrong. His hon. Friends explicitly back industrial action.
§ Mr. Meacher
That is simply because the Government's attitude to industrial relations in the National Health Service, as elsewhere, is exceedingly provocative. We are talking not so much about support for a union as about opposition to the anti-trade union industrial practices in which the Government regularly indulge.
A second criterion, which is more relevant than those criteria most often quoted, is international comparison. On that score Britain still treats fewer kidney patients per head of population, performs fewer bypass operations and has a worse perinatal mortality rate than many comparable countries.
A third criterion is staff morale, which directly affects patient care. Anyone who has been in a hospital recently will know that currently staff morale is extremely low because of continual cuts, pay restraint and an ever-increasing work load.
A fourth criterion is expenditure on prevention and community care. They are target areas for any future quantum improvement in the nation's health. Currently expenditure on prevention is peanuts and on community care stagnant.
A fifth criterion is difficult to measure, but tell-tale indicators are beginning to appear. The level of cross-infection in hospitals is beginning to rise. The real lesson of the Stanley Royd food poisoning disaster at Wakefield is that lives were lost not just because of errors in food handling, but because there were not enough staff or equipment once the poisoning was discovered to ensure proper barrier nursing. In other words, cuts can kill, and, under this Government, cuts are killing.
§ Mrs. Currie
The hon. Gentleman cannot have read pages 2 and 3 of the report by the Social Services Select Committee to which he referred. It says that there has been aa 50 per cent. increase in new patients treated for end-stage renal failure; more than double the number of coronary artery bypass grafts; District nurse staffing increased by 15 per cent between 1978 and 1983 and the number of old people treated by district nurses rose by nearly a quarter to nearly 1½ million.
Cross-infection is beginning to rise simply because more people are being treated in hospitals. I ant talking about many hundreds of thousands more patients.
More than half the 17 per cent. to which the hon. Gentleman referred is represented by the resources put into the Health Service by this Government. We have increased pay, particularly to nurses. I can remember, even if the hon. Gentleman cannot, the time under the last Labour Government when we could not fill the places available because the pay was so pathetic.
§ Mr. Meacher
Of course, there have been increases in particular areas of health expenditure. There were before 1979, and the figures form a continually rising graph in many respects, but whether that means an improvement in overall quality is by no means certain. Overall spending is being decreased. I could reel off a list of health care aspects for which standards are declining. If I had the time I would do that.
I have described the criteria by which we should judge the Government's record. By those standards our National Health Service—I say "our" because the Prime Minister 237 does not use it — has manifestly and seriously deteriorated under this Government. That deterioration has been gratuitously aggravated by the Government's obsession with privatisation. It is crystal clear that privatisation, as we have always said, is not about efficiency but about sleazy deals. It is about expense accounts, back-handers and lowered standards.
I shall cite some of the host of examples in the appalling record of privatisation. With the Sunlight Laundry, which operates for the Cheltenham and District health authority, only 15 per cent. of linen and pillowcases met the quality control standards. The DHSS recommends an acceptance level of 95 per cent. Seventy three per cent. of sheets were rejected. At the High Royds hospital in the Leeds Western health authority, the company involved is Hospital Hygiene Services. Dr. Terry Nelson, the head of the hospital's medical services committee, has complained to managers about erratic standards from the contractors. One senior nurse last week complained of faeces, urine and vomit on the floors.
A report by Dr. William Newsom, a bacteriologist from the Papworth hospital, revealed high levels of dust in clinical areas in the Hinchingbrooke geriatric hospital, Cambridgeshire, and concluded that there was a risk of patients being infected. The South West Thames authority noted that some laundry contractors would not accept badly soiled linen. Yet that is rather important for hospitals. Trent pointed out that private contractors could not always provide complex and special requirements as cheaply as the public sector.
Rather notorious is Crothalls at Barking in the Redbridge area. I quote a report by an independent health inspector commissioned by Redbridge community health council, which made some alarming observations — [Interruption.] The Minister of Health might find this funny, but I suggest that he listens to the consequences of what is happening to some of our people because of his policies.
In the kitchens, there were accumulations of dirt and grease in the corners of the preparation and cooking areas. Food debris had collected behind and beneath pieces of equipment that had not been removed for proper cleaning. There was a thick layer of grease and dirt under the utensils sink. The presence of dead and decomposing cockroaches showed the lack of regular and effective cleaning. I see that the Minister is not laughing now, because the position is serious. Several live cockroaches were also seen.
I want to give one more example that I know will impress the Minister for Health. A senior Conservative, Professor John Davis, who is one of the country's leading paediatricians, resigned a fortnight ago from Cambridge health authority in protest against political decisions to force hospital cleaning services to be privatised. In his letter of resignation, he said:You will know that my attitudes are essentially conservative, but there comes a time when one must be seen to live up to one's professed principles and true conservatism means recognising that the economy is made for man and not vice versa, given the necessary recognition that resources are not infinite.I suggest that Conservative Members take account of that message.
Such examples give the lie to the Government's claim that privatisation is about greater efficiency. It is about greater profits for Tory shareholders. I do not include the Secretary of State and the Minister for Health in that, but 238 I do include several of their colleagues, including some Conservative Back Benchers. They make their profits at the expense of forcing down the wages of some of the lowest paid people in our society.
The Barking hospital dispute is an illustration of that. The pay for cleaners is being cut by 40 per cent. Mr. Peter Pritchard, who was the chairman of Pritchards — the parent company of Barking hospital contractors, Crothalls—paid himself an additional £70,000 this year on top of his salary through a dividend increase because of record profits from privatisation. If those policies continue, the prospect that faces the NHS during the next five years is frightening.
According to a 17-page parliamentary answer that I received a fortnight ago, during the past five years 193 hospitals involving 14,000 beds have been closed by this Government. I accept that 35 hospitals have been opened, but there has been a net loss of 158.
The Secretary of State had the gall to speak today of 1 per cent. real growth in NHS resources. There was no growth last year, because the so-called Lawson cuts chopped 1 per cent. off the NHS budget. There will be no growth this year because the Secretary of State has forced health authorities to take out of their budgets for patient care a significant part of the pay award to nurses and ancillary staff. There will be no growth in future years, because, for example, the current draft South West Thames strategic plan reveals that that region is being forced by deepening Government cuts to halve the total of its acute beds over the next 10 years. That goes further than cuts. It is butchery.
It is planned that this process will be intensified. Many of those who defend the NHS and oppose cuts have been and continue to be blackballed off the RHAs and DHAs. That is being done in the most direct political manner possible. I have a hit list that has been drawn up by four Tory members of the South West Thames regional health authority selection panel. It shows, in the handwriting of one of the four Tory members, those who were not to be reappointed to the DHAs and the RHAs, those who were to be reappointed—all in strict accordance, as can be seen from the list, with party allegiance—and which of the four Tory members was to do the proposing at the committee meeting.
When all the opponents of cuts have been victimised, further cuts can be facilitated. That in itself encourages a further switch to private medical care. This process of steady decline for the NHS becomes circular and reinforcing with the announcement, which I take seriously, by the Secretary of State a month or so ago that the private sector has now grown so much that it must be taken into account when NHS funds are allocated. To rob the Health Service, which is already starved, of yet more money, on the ground that some well-off people have taken to using private clinics, would be as destructive and unfair as depriving state education of funds in areas where there are public schools. It would be to use the effects of a bad policy as a reason for making that bad policy even worse. Yet that is precisely the self-reinforcing pattern of decline that the NHS now faces.
Health authorities are stacked now with compliant Tory placemen. That opens the way for deeper cuts and encourages the development of private health care, and that is used to justify further cuts in the NHS. For the 239 Secretary of State and his ministerial colleagues to say that the NHS is safe in their hands is the final insult. It is about as safe as the Conqueror's logbook in the Belgrano affair.
§ Mr. Fowler
I noted what the hon. Gentleman wrote in his pamphlet on that score. There is no truth in what he says. I have not asked health authorities to do what he suggests. The hon. Gentleman has talked about political influence. Has he not written to all Labour members of health authorities asking them to identify Labour supporters on those authorities? Perhaps the hon. Gentleman will explain his reasons for doing so.
§ Mr. Meacher
The Secretary of State was reported as saying that as the private sector has grown significantly, it should be taken into account in the allocation of NHS funds. I am glad to hear that the right hon. Gentleman did not mean what he said, but he said it none the less.
I have written to Labour members of health authorities. I am sure that I was right to do so. I have written to those who are known to be Labour sympathisers—there are a few left — who are members of regional and district health authorities. I have asked them to make clear, according to their knowledge, the political affiliations of those who sit on the authorities. I want also a list of those who have not been reappointed or who have been removed from office, those who have been appointed in their place and, where it is known, the political affiliations of all those persons.
§ Mr. Meacher
I shall tell the right hon. and learned Gentleman what for. He has been pursuing a campaign of political victimisation against all those who support the NHS and oppose cuts. I intend to stop this Tory hit-listing by providing the public and the electorate with the details of what is happening.
§ Mr. Kenneth Clarke
The hon. Gentleman probably suspects that so many of the recipients of his letters have been outraged by their contents that I and many of my right hon. and hon. Friends have been shown copies of them. I am disgusted and so are members of health authorities. If he will place a copy of one of his letters before the House, it will make clear that he has been seeking information on the political affiliations of members of health authorities and trying to introduce a whipping or caucus system involving pre-meetings with local Labour parties and Labour groups. It is sheer humbug for him to complain about the introduction of politics in the Health Service and to criticise non-political appointments to authorities throughout the country.
§ Mr. Meacher
To accuse me of introducing politics into the NHS is the most incredible hypocrisy to come from the right hon. and learned Gentleman. When I have the facts, I think that they will support my case, not his. There is nowhere near a political balance in the membership of regional and district health authorities. I doubt whether there is more than a handful of district and regional health authorities where there is a Labour chairman. I suspect —I do not know the facts, but I shall get them—that about 80 per cent. of the chairmen of health authorities are Tories. If that is supposed to be even-handed and balanced membership, I suggest that the right hon. and learned Gentleman should use a dictionary.
§ Mr. Meacher
No, I shall not give way. I have been speaking for a considerable time, largely because of interruptions.
§ Mr. Meacher
I shall not give way.
Even this Government do not claim that the welfare state is safe in their hands. If they did, they would be stretching their credibility beyond the limit. Single pensioners are being robbed of £2.80 a week. which matters a great deal to those on that standard of living. Married pensioners are being robbed of £4.65 a week by the Government's break with the uprating link with earnings.
The Government's abolition of the earnings-related supplement to unemployment benefit robs the average unemployed man — there are almost 4 million in the dole queues — of about £16 a week. Unemployment benefit is being taxed for the first time under this Government. Yet, at the same time, they have handed out £360 million to the very rich—those with more than £100,000 of stocks and shares—with the abolition of the investment income surcharge. Perhaps worst of all, the Government apparently believe that those on long-term supplementary benefit with the heating addition are so well off that in three weeks' time £1 is to be knocked off their benefit by the iniquitous scale margin.
If the Secretary of State or other Ministers had to live out that to which they so glibly sentence others, they would not be so ready to grind the faces of the poor. The trouble is that the hard-nosed occupants of the Government Front Bench, from the Prime Minister and the Chancellor of the Exchequer downwards, have no idea of and no interest in what it is like to be condemned to poverty and despair in Thatcher's Britain.
I shall be able to deal quickly with social security in the Gracious Speech because it is rather like the Sherlock Holmes dog which failed to bark in the night — memorable by its virtual absence. Unmentioned are the so-called five Fowler reports, which the Secretary of State likes to call the most radical review in total of the welfare state since Beveridge. Given the Government record, that is Fowlerspeak for the most radical dismantling of the welfare state since Beveridge.
The Gracious Speech refers only to the already much heralded and much debated 5 per cent. annual revaluation of pensions for early leavers and the provision of more information for occupational scheme members. We agree in principle with the provision of more information for those in occupational pension schemes, but we wait to see whether that provision will go far enough in practice. The 5 per cent. annual revaluation is deeply flawed on two counts. The Government know that 5 per cent. is well below the historic trend figure for earnings. Secondly, and more importantly, it excludes existing pensioners because it applies only to benefits earned from next January. That is wholly unfair and discriminatory.
The Secretary of State has been a pushover for the drug, tobacco, food and Health Service equipment supply companies. He has become a soft touch to the occupational pension schemes. What a tragedy it is that the only people to whom the Secretary of State is apparently able to show his virility are those living in poverty—trade unionists working for him in Newcastle, from whom he arbitrarily stole bonuses of up to £14 a week, and miners, from whom 241 he purloined £15 a week, even when the NUM could not pay that money because its funds had been sequestrated. That is the type of policy in which the Secretary of State believes.
Even if the Queen's Speech is a mouse in social security terms, a counter-revolution — of course, it is unmentioned—is gathering pace against the welfare state, led, under this Government's leader, not by Robin Hood but by the Sheriff of Nottingham. Like everything else they have done, the Government have loaded the dice.
The Fowler reviews are anything but independent, unprejudiced inquiries; they are fixed up to the eyeballs. With the exception of one, which is headed by the chairman of the London Brick Co. Ltd.—obviously he was chosen because of his great knowledge of housing benefit — they are all chaired by Ministers. That is virtually unprecedented. The reviews are crammed with carefully-selected, card-carrying Tory party members, which makes it abundantly clear that the whole exercise is just one of going through the motions as camouflage for predetermined conclusions.
When I specifically asked by letter for a more balanced membership of the inquiries the Secretary of State refused. External contributors were given only two months to make submissions. Each review has been made subject to a nil extra cost constraint, which means that open-minded examination of what is required to meet identified needs—such an examination is needed—is impossible. When completed, the reviews will not be published. Even by this Government's standards of using power and patronage to eliminate all opposition, this is the most stitched-up con trick that I have ever come across in my political life.
§ Mr. Nicholas Soames (Crawley)
Many Conservative Members understand the hon. Gentleman's grave difficulty, in the context of the language of Socialism, of bringing perspective or relevance to the matters about which he is talking. Does he agree that it is prudent, sensible and right for the Government to conduct a thorough review of the welfare state, bearing in mind that no such in-depth review has been conducted since Beveridge in 1945?
§ Mr. Meacher
Of course I believe that it is right to do that. If I were conducting the reviews, I would have independent chairmen and a balanced membership and allow sufficient time for proper research and examination. I would not impose a nil cost constraint. I would publish the reviews' results. That is the difference.
§ Mr. Meacher
No, I shall not give way.
Even though it is all sewn up and the time scale is telescoped to a minimum—
§ Mr. Meacher
I shall not give way. I have been speaking for nearly an hour, and I am extremely conscious of the fact that I should draw my speech to a close, and I propose to do so.
The Government, despite the telescoping of the time scale, could not bear to wait even a few months to do the decent thing and let the reviews report. The Government want blood now. That is why we have had newspaper leaks of £3 billion cuts in the offing, including £1 billion of 242 social security cuts. The post "star chamber" Cabinet meeting to take final decisions on the cuts was held this morning, but in a monumentally diversionary speech this afternoon the Secretary of State contrived to say not one word about it. One wonders why.
I submit that it is a real abuse of the rationale of Parliament that we are called here to debate the relatively minor issues in the Queen's Speech including social security when the massive importance of those decisions on cuts which will dominate the lives of millions of our people and Parliament's programme for next year is completely ignored. Already, according to The Times of 25 June—that is hardly a pro-Socialist organ—social security cuts of £6.5 billion have so far been made by the Government. If further swingeing cuts are now made, as the leaks clearly reveal and the Government's record manifestly suggests, they will no doubt be done by means-testing, by taxing child benefit, by further major cuts in housing benefit, by uprating unemployment benefit by significantly less than the inflation rate or—I see that the Secretary of State is smiling — by uprating all benefits on less than an annual basis.
I have to tell the Secretary of State that any one of those measures would do enormous damage to the welfare of millions of people. If that is the only way in which the Government can balance the books—when, according to the Government's successive Budget statements, they have already handed out cumulatively no less than £13 billion to the richest 5 per cent. of the population—they should make way for an alternative Government whose health and social security policies reflect far more closely the priorities of the British people.
§ Mr. Michael McNair-Wilson (Newbury)
If the hon. Member for Oldham, West (Mr. Meacher) had not had any responsibility for the DHSS during the time of the last Labour Government, his strictures would have been more convincing. As it was, his speech was rather wild and woolly—in marked contrast to the superb speech of my right hon. Friend the Secretary of State, who addressed himself to the main issues facing the National Health Service and the social security system.
I was disappointed that no reference was made in the Queen's Speech to the Health Service. The Health Service is vital to our country and the issues revolving around it are so important that that was a curious omission. It may be argued that the Queen's Speech concentrated on the economy, and, because of that, that is the point at which I shall start.
As we know, the Government's view of the monetary disciplines within the economy is fundamentally that of maintaining supply and demand as the overriding criterion and their view could be described as almost fundamentalist. It is argued that demand will be the trigger for supply. The Government have eschewed any attempt to stimulate demand on the basis of the already being sufficient demand in the economy and in the Western world to increase supply. Some Ministers have argued, and continue to argue, that if only the Government took less in taxation there would be more demand in the economy from which supply would increase and jobs would be created — hence, the need to hold public spending. It is contended that to stimulate demand artificially is to stoke up inflation again, which could have disastrous effects.
243 In those two-dimensional terms, the logic of supply and demand seems to be irrefutable but, thanks to some research by my hon. Friend the Member for Holland with Boston (Mr. Body), I suggest that there is a third dimension that is seldom, if ever, referred to — need. The famine in Ethiopia is a classic example of need—the desperate need for food felt by hundreds of thousands of people. If they could receive that food only on the basis of their being able to pay for it, they would starve to death, but, thank goodness, our faith in economic disciplines is not so inflexible that we insist on payment before coming to their rescue. If Ethiopia demonstrates that need is a dimension that can never be left out of the economic argument—at least when it is a matter of life and death—does it not have a similar application in our nation? I believe that it does, in terms of health care, because health care is about life and death.
As some hon. Members may know, since last January I have been the victim of a rare kidney disease. Without kidney dialysis, I would be a dead man. In the months during which I have been receiving treatment in hospital, I have cost the National Health Service tens of thousands of pounds — much more than I could have afforded privately; and, although I am a member of BUPA, it is a service that it does not provide because of the expense. Had my treatment depended on my ability to pay, I would not be alive today. The NHS met my need for treatment without requiring me to show that I had funds to pay for it. It operated on supply and need, not supply and demand. That will always remain true of the NHS. That is why it is such a precious asset to us all.
It may be argued that, thank God, kidney failure is a fairly rare disease. It is not a common illness and requires expensive specialist services which do not apply to ordinary illnesses such as flu and colds. Therefore, while it may be reasonable to argue that need should dominate, when dealing with these more commonplace illnesses from which we all suffer, there is no reason why supply and demand—the ability to pay—should not at least play a part in considering how we should pay for the Health Service.
From that it may be inferred that, while need is an important consideration in judging the cost of the Health Service, supply and demand is a discipline which is also there and will remain a constant part. In those terms it is perfectly reasonable to look at the Health Service under an economic microscope to see where savings could be made. All of us must be impressed by some of the savings to which my right hon. Friend referred. In so far as those saving are going towards patient care, who could object to any of that money, if it is being wasted, being used where it is most needed?
I agree with my right hon. Friend's view, which is shared by many in the Health Service, that what Roy Griffiths has identified as the need for better administration is a crucial part of getting better value out of the Health Service. It is generally recognised that hospital administration has not been the profession that it should be. In some ways it bears resemblance to the management of hotels. After all, many of the services provided by hospitals are provided by hotels. I hope that we shall see a new breed of professional administrator who is used to dealing with the problems of providing beds and food, organising domestic help and ensuring adequacy of supplies.
244 We must also never forget that hospitals involve staffing—both doctors and nurses—the cost of drugs and the cost of specialist equipment. I am unhappy about the figures that have been given about the increase in the number of inpatients and outpatients and of doctors and nurses. We are told that the Health Service treated 450,000 more inpatients in 1983 than in 1978 as well as looking after 2.5 million more outpatients. Over that same period the number of hospital doctors has increased by 3,100. Therefore, each new doctor is being asked to treat 112 new inpatients or 800 outpatients.
Nursing numbers have increased by 38,700 — one new nurse to every 11 new inpatients. I can speak only for the hospitals that I have been in since I was ill in January, but there the ratio is approximately one nurse to six beds. Therefore, if we talk about one nurse to 11 beds, we talk about a nursing service that is desperately over-stretched. Those figures are the roughest of rough calculations. They allow nothing for reductions in nursing hours, which change the figure of 38,000 drastically, or for the intensive type of nursing that is often required, when frequently the ratio is one nurse to one patient, or even two or three nurses to one patient.
In the dialysis ward that I visit three times a week, the nursing level is officially for nine patients, yet there are 14 patients in the ward. Without the auxiliaries to support the nurses, the job could not be done. Even as it is, if there is any ill health among the nursing staff, the ward Js clearly desperately over-stretched. It may be argued that the nursing level is too high for nine beds, but we must be careful not to allow economies to distort nursing care too far the other way.
I know that many senior nurses and sisters believe that what is now happening is a cause for concern and that we ought to be asking whether we are allowing our nursing levels to become dangerously over-stretched. It may be argued that if there is slack in the service it is right to take it up before embarking on ever-increasing expenditure. As has been said so many times already, the NHS, which was costing £7.5 billion in 1978, is set to cost £17.5 billion in 1985.
The drugs bill, to which my hon. Friend referred, is always increasing, but I am not convinced that that is because the drug companies are making massive profits. We sometimes forget the enormous cost of producing new drugs and that on average only one new drug emerges from 10,000 originally synthesised. The period from patenting to commercial launch frequently lasts up to 10 to 12 years, and the cost of development can be about £60 million per drug.
When these considerations are weighed, perhaps the drug companies are not quite the profit-grasping organisations which it is sometimes suggested they are. Whatever the case, the drugs bill is another call on NHS resources, and I entirely accept that any Government, faced with the dilemma of increasing costs, meeting needs and knowing that they must maintain the service at a certain level, will have to make some difficult choices in their priorities.
Although I have misgivings about the present situation, I do not accept the argument that the shortcomings in patient-doctor relationships are the result of overworked doctors not having the time to get to know their patients, or that nurses are so run off their feet that they cannot find 245 time for gentle care. That is why I introduced my patients' charter in September, with its proposals for improving patients' rights.
§ Mr. Jack Dormand (Easington)
The Opposition very much welcome the hon. Gentleman's return to the House. He has been greatly missed, and is one of the nicest hon. Members. In addition, he always makes notable contributions to our debates; he is demonstrating that again today. In view of his recent experience, we are delighted to see him back.
The hon. Gentleman referred to priorities. One of the minor but important aspects of health is preventive medicine and health education. In real terms, the Government have reduced the resources allocated to health education and preventive medicine. Is that one of the priorities which ought to be cut or which should go lower down the scale?
§ Mr. McNair-Wilson
I thank the hon. Gentleman for his kind words about me. What he has said is one of the priorities which any Secretary of State should look at. It must be a matter of personal judgment as to where it should go in the list of priorities, but I recognise the hon. Gentleman's point.
The patients' charter which I introduced in September contained proposals for improving patients' rights. I sent a copy to the DHSS, but I am sorry to say that apparently it has made no impression on anyone there. I have not heard whether it is thought that it is not worth the paper it was written on or, indeed, whether it had ever been received. Perhaps the Department is making the same mistake as some of the medical staff whom I criticised in the preamble to the charter—of forgetting that patients are the reason why there is a Health Service. They are its customers, and their rights must be considered and safeguarded. Judging by the huge amount of mail that I have received about the charter, my concern is shared by many other people, including doctors and nurses, and I shall willingly make all my correspondence available to my right hon. Friend or his hon. Friends if they would like to see it.
Whether it be the prescribing of the wrong drugs by hospitals to patients with allergies when a telephone call to their GPs would prevent the mistake, or the unscheduled errors necessitating surgery and sometimes disfigurement, the patient is the sufferer, generally without any compensation unless something major has happened. My right hon. Friend will know that there are no national statistics on medical negligence claims, but he may also be aware that Action for the Victims of Medical Accidents estimates that there are more than 10,000 such claims current in England.
I have received marvellous treatment from so many doctors and nurses working in the National Health Service that I shall always be indebted to them and hope that I shall always be a champion of the service.
Modern medicine seems able to work miracles, to the point where I think some young doctors believe that they have most of the answers to whatever disease they are treating. That may be so, but the anxious patient that they are looking after is still a creature of flesh and blood, nerves and feelings. He still wants kindness, encouragement and hope, wants to know what is wrong with him and how he is to be treated. He wants his anxieties to be 246 allayed. It is the task of those working in the Health Service to meet his needs. It is the responsibility of all of us who have any responsibility for the Health Service to ensure that it has the means to do that, even if it results in more expenditure.
§ Mrs. Renée Short (Wolverhampton, North-East)
The hon. Member for Newbury (Mr. McNair-Wilson) has paid a moving tribute to the members of medical and nursing professions who have looked after him. I am sure that we are all delighted to see him back in the House. We warmly endorse what he said about the National Health Service.
I share the hon. Gentleman's view about the contents of the Gracious Speech. It must be the first one for a considerable period to omit any reference — with the exception of occupational pension rights—to the social services. There is nothing about the National Health Service, except an ominous statement that firm control of public spending will be maintained. We do not object to that, but we are concerned about the way in which that control is to be exercised and about those parts of the NHS which are likely to suffer as a result.
There is nothing in the Gracious Speech about nursery education. I am sorry that the Secretary of State for Education and Science has departed; I had hoped that he would stay for the debate. There is nothing about unemployment benefit or local authority housing. The latter is an area to which the Secretary of State for Social Services will look when his proposals for care in the community come to fruition, because local authority housing will have to undertake some of the burdens now carried by the long-stay mental illness and mental handicap hospitals. There needs to be some transfer of resources into that area, or the creation of additional resources, if the policy is to be carried out successfully.
There is nothing in the Gracious Speech about any attempt to curb smoking or cigarette advertising. There is nothing to deal with the problem of over-prescribing of drugs. If the Secretary of State wants to save Health Service expenditure, he can look fruitfully at that area. There is over-prescribing by doctors and by those, such as receptionists, whom they depute to write out repeat prescriptions. What is the Department doing about that problem?
There are great disparities in the periods for which drugs are prescribed. Receptionists write out repeat prescriptions without knowing why it is being done, the conditions for which the drugs are being prescribed, or the quantities which should be prescribed. It is a very serious situation. Those doctors who do not over-prescribe, and pharmacists who are on the receiving end of the prescriptions and see the waste of drugs, and therefore the waste of money and resources, are equally concerned about the problem.
I suspect that millions of pounds worth of NHS money are flushed down lavatories when people empty their medicine chests and throw away medicines and pills. Often they have forgotten the reasons why those medicines were prescribed. Something must be done about the problem, because it involves a dreadful waste of resources which should be used in other areas of the NHS which are at present under-financed.
The Gracious Speech refers to the decisions to abolish the Greater London council and the metropolitan councils, 247 including the one in the west midlands. The Prime Minister does not seem to like them any more than they like her, and I suppose that leaves us even.
There are doctrinaire proposals to remove the nationalised bus services. Those proposals will have a disastrous effect on rural areas in particular. They will involve great cost for all those who need public transport if they are to travel at all.
There are no proposals to deal with the urgent problem of replacing our outdated and derelict sewerage system or the water supply system. They are either inadequate or worn out and outdated. Those services should be provided, because they have a considerable bearing on the health of the community. The failure to replace those services also affects the level of unemployment.
There is no commitment to a building and construction programme to absorb even part of the massive number of unemployed. The Prime Minister knows as well as I do that that would be one of the most effective ways of injecting life into our depressed economy, providing jobs, and revitalising the building materials industry and the manufacture of appliances.
It is a major scandal that there is no mention of the plight of the NHS. There is no mention of the effects of the doctrinaire enforced privatisation of hospital services, with which my hon. Friend the Member for Oldham, West (Mr. Meacher) dealt effectively and at some length. There is no mention of the enforced closure of beds because of the lack of money to pay nurses. There is no attempt to maintain the commitment given to develop the maternity services or to replace ancient and outdated hospitals. They are, incidentally, hospitals in which a great deal of very good medicine is being practised, in spite of the buildings and conditions.
There is no mention of the commitment to appoint the consultant staff needed to provide a better and more effective service to patients. Long waiting lists still persist in practically every region. In my constituency, even patients suffering acute pain and very severe disability are still waiting four years for knee replacement operations. That is a very serious situation.
However, the Government have achieved what no other Government before them have achieved — the highest number of hospital staff during one year who have been forced to go on strike to defend their jobs. The Government have also achieved a serious fall in morale among medical staff, and among consultants at teaching hospitals, who have heavy responsibilities not only for the care of patients but for teaching and training the next generation of doctors. They are very concerned at the constant pressures that they have to meet because of the lack of resources, and the shortage of staff which is part of the problem of lack of resources.
Housing capital expenditure has fallen by 38 per cent. since 1979, total capital spending has fallen by 2 per cent., and local authorities are now unable to make use of accrued capital receipts for housing investment. Capital receipts are expected to fall sharply next year. Therefore, the outlook is very poor for improving the housing conditions of many people, including large numbers in depressed areas in the west midlands, who now live in substandard private housing and equally sub-standard and ancient local authority housing built in the first flush of publicly financed housing. They are doomed to spend much longer periods in sub-standard housing. There is serious disrepair in the public and private sectors.
248 I should like to say a few words to the absent Secretary of State for Education and Science. The teaching of science and technology is of crucial importance to Britain. We expect universities to respond to the needs of medicine, industry and commerce. Information technology, computer science and business administration are areas in which there is an urgent need to expand.
Research on high technology and involvement with industry are crucial, but our universities have suffered massive cuts in their UGC grants over the past four years. For example, Aston university has sustained an enormous cut of 40 per cent. It has been forced to reduce student numbers by 2,000, academic staff from 500 to 300, and non-academic staff from 1,000 to 650. All the technological universities have suffered comparable reductions, yet it is acknowledged that increasing our lead in technological and scientific research is an essential ingredient for maintaining our future. Perhaps the absent Secretary of State for Education and Science will explain why we are pursuing such a punitive and destructive policy, and why he tolerates it.
Our future depends to a large degree on our universities and polytechnics. Much of the research is long-term in character and cannot show results at the end of a given financial year or give an immediate cash return, yet it is of vital importance that it should continue. The Government, who pride themselves on the fact that the Prime Minister had a scientific education, show a complete lack of understanding of, and disregard for, the need to safeguard our future progress in science and to invest liberally in higher education. That is where our future lies—from the point of view not only of teaching and academic research, but of industrial progress. The Gracious Speech merely shows that the present narrow-minded monetarist policies are to be maintained.
The Social Services Select Committee has reported on the effects of the University Grants Committee cuts on medical teaching and research. It is the intention of the Committee to monitor progress during the next two and a half years and to see how the situation develops. I wonder what the Secretary of State intends to do to meet the demand for higher education from men and women students.
The Gracious Speech says nothing about any expansion of university teaching. However — I suppose that we ought to raise the flag about this—there is to be a Bill to allow parents to exempt their children from corporal punishment. The provisions will apply only in local authority schools. They will not apply to the public schools. Conservative Members will know more about that than I do, having been on the receiving end. What about those local authorities which still allow corporal punishment? We seem to be making very slow progress in that area.
I am delighted to see that the Secretary of State for Education and Science has returned to his place.
§ Mrs. Short
Not mutual? The hon. Gentleman does not know.
I wonder why the Secretary of State did not take his courage in both hands and ban corporal punishment in all schools. Of whom is he afraid? He should have second thoughts on the matter. To beat a child is a degrading and disgusting act, particularly for the petty offences with 249 which some head teachers seem to be obsessed. I am sorry to say that some Labour-controlled local authorities still allow corporal punishment in their schools. I urge the Secretary of State to get rid of corporal punishment once and for all. There are other ways of dealing with naughty schoolchildren.
No single year's programme could possibly rectify six years' devastation such as my own constituency has suffered. We have over 16 per cent. unemployment, our factories are closing, and many of those factories are disgusting places which need to be replaced. The whole of the west midlands is a gravely disadvantaged area. Our young people have no prospects of decent jobs. I have set this problem before the House on many occasions, but the Government seem to have it in for the west midlands. They seem to intend to allow the area to moulder away for the foreseeable future.
The Gracious Speach contains irrelevances, such as the abolition of the GLC and the metropolitan councils, including the West Midlands county council, and the insistence on futile and wasteful privatisation schemes in the midst of a ruinous coal strike. The Prime Minister seems determined to allow that strike to continue. She is not prepared to intervene.
The Gracious Speech marks the nadir of the Government's incompetence. I hope that the Secretary of State for Education and Science will be able to tell us where progress is to be made and where resources are to be provided in order to establish a base for the scientific progress that we need if we are to survive in the competitive world. I hope also that steps will be taken urgently to see that the coal industry strike, which has lasted for many months, will not be allowed to fester on for much longer. If the Government allow the strike to continue, the country will realise that they are not fit to govern.
§ Mr. John Ward (Poole)
The hon. Member for Wolverhampton, North-West (Mrs. Short) will forgive me if I do not continue in the same vein. I am grateful for the opportunity to take part in this debate, and I welcome the promise made in the Gracious Speech to continue with the control of public expenditure, and to increase the functions of the private sector wherever possible—in short, to continue to ensure that the taxpayer and the ratepayer get full value for money.
However, I must confess to disappointment that there is no reference in the Gracious Speech to the Warnock committee's report. I wish to refer briefly to two aspects of that report. In the previous Session, my hon. Friend the Member for Renfrew, West and Inverclyde (Mrs. McCurley) introduced a ten-minute Bill with the aim of controlling maternal surrogate clinics. She was given permission to bring in the Bill but, inevitably, it was lost through shortage of parliamentary time. As one of my hon. Friend's supporters on that occasion, I should like to remind my right hon. and learned Friend the Minister for Health of the great concern which still exists about this subject.
The arguments were well set out by my hon. Friend the Member for Renfrew, West and Inverclyde on 31 January 1984. It has, I believe, always been our concern that in family affairs the interests of the children should be 250 paramount. I therefore find it difficult to understand why we are allowing commercial activities to enter this field, with large sums of money changing hands in an attempt to provide a child for childless couples.
I do not underestimate the distress that inability to have a child, with the continual round of medical tests and examinations, can cause to a married couple. But we must also consider the well-being of any child which may be produced by surrogate motherhood, particularly when a commercial organisation is involved. The child would be illegitimate, with all the legal complications which that entails. Also, little consideration seems to have been given to what would happen if the surrogate mother produced a handicapped child. Would she keep it? Would the potential parents perhaps refuse to proceed with adoption? We should have acquiesced in the production of a human being more in need of love and affection than a normal child and yet, by the process of surrogate motherhood, have put its future happiness at risk.
Last September, my right hon. and learned Friend the Minister for Health condemned an American "babies for sale" scheme. Clearly he is as concerned as I am about such commercial activity. I hope that we shall shortly hear that he proposes to do something about the problem.
Speaking as someone with a scientific qualification—not in the medical field—I would be the first to agree that not all scientific progress is necessarily human progress. I have received much support in my objection to maternal surrogate clinics, and I believe that the House should be given an early opportunity to debate and to legislate upon the matter. The Government could do no better than examine again the Bill introduced by my hon. Friend the Member for Renfrew, West and Inverclyde, which would simply prohibit the operation of maternal surrogate clinics in the United Kingdom. Such a measure would receive support on both sides of the House.
The other matter that I wish to raise with my right hon. Friend relates to proposals in the Warnock report for the use of human embryos in medical research. The report recommends that research conducted on human in vitro embryos and their handling should be permitted only under licence. It also recommends that such embryos should be allowed to be kept alive for only 14 days. I have received an enormous amount of correspondence on this subject and every letter opposes such a proposal.
Most hon. Members probably instinctively find such a proposal distasteful, but it is our duty to examine its more long-term effects. For example, will 14 days be long enough? An argument is probably already being marshalled somewhere to the effect that experiments on embryos would serve humanity if they were allowed to proceed beyond the 14-day limit. Many of us have worked through organisations such as FRAME — the Fund for the Replacement of Animals in Medical Experiments—to reduce the use of animals in medical research. It would be intolerable if, when FRAME is having some success, a market should be established for human embryos—even under licence.
Other European countries have already had to consider this problem. The vast majority of British people probably agree with Sir John Peel, who said:You do not use a human as a guinea pig unless it is a bona fide attempt to improve the condition of that individual. No one can conceive that experimenting on an artificially-produced embryo can be to the benefit of that embryo. The argument that it might benefit others is a red herring.
251 It is easy to state the problems and the dilemmas which we shall face when we come to debate or, indeed, to pass legislation concerned with the Warnock report, but I hope that my right hon. and learned Friend the Minister for Health will acknowledge that this is a matter in which sensitivity is needed and that it is of great concern to many people who we represent in the House. It is no exaggeration to say that if legislation which would affect the matters about which I have been speaking is introduced, the vast majority of us hope that it will be on a free vote because it would be difficult to support some of the Warnock report's recommendations.
I nevertheless pay tribute to the work done by the Warnock committee. It has produced a document which will allow us to consider scientific progress and its effects on the human race for many years to come. It does not follow, however, that we must accept all of its recommendations. I hope that the House will shortly have the opportunity to make its views known on at least the two matters that I have mentioned this afternoon.
Genetic engineering opens a problem for humanity, and the House should not duck its responsibilities in this regard. These matters are of great concern to many deep thinking people in Britain. They are of great concern to the Council of Europe and, I suspect, other countries. I have the honour to be one of the House's representatives at the Council of Europe. The 21 nations that meet there have already become aware that human genetic engineering in all its aspects is a complicated, difficult and, above all, sensitive matter. I hope that the Government will cooperate with any international group that seeks their aid. Perhaps I might use a Chinese proverb: humanity must not travel too fast for its soul to follow.
A market has already been set up in the United States to provide babies for childless couples, and we can see the beginnings of such a market in this country. The Warnock report has produced the facts and some recommendations. It is for this House, I believe, to take the moral decision as to whether the report's recommendations should be implemented. I hope that we shall get the opportunity to make that decision soon.
Whatever arguments the House may adduce, and however we may divide on political lines on other subjects, we can surely agree that protecting our children and children yet to be born is a measure of our concern for civilisation itself.
§ Mr. Michael Meadowcroft (Leeds, West)
I shall not continue the line of thought taken by the hon. Member for Poole (Mr. Ward) in regard to the Warnock report, except to say that I agree that it considers matters that are of considerable concern to us all. I, too, hope that we shall have an opportunity to debate it. Dealing with moral arguments through legislation is fraught with immense problems. As the hon. Gentleman said, the House is not divided on partisan lines in such matters.
I regret that the Gracious Speech does not mention health and health care. I hope that that does not suggest that we can expect only a continuation of existing policy and practice. I am doubtful about the Government's continued concentration on management and efficiency and therefore on statistics that assist the Secretary of State in this compartment of the NHS. No one doubts that management and efficiency are an aspect of the Secretary of State's work but the difficulty is that they skew 252 examination of problems in the NHS. The key question that faces any Secretary of State is whether the country is more healthy. The Government keep saying that the NHS treats more patients than when Labour was in power. That does not indicate a healthy society but greater demand for treatment, which is quite different.
We should put far greater emphasis on helping individuals and communities to be healthier. The Secretary of State referred to his speech at the Conservative party conference at Brighton. I watched him make that speech. He reworked it today but, then as now, its great defect was its failure to mention prevention or self-help care. For example, the National Advisory Committee on Nutrition Education report on the effect of food and food additives on health has been suppressed, although we know that unhealthy eating kills. Each year, 30,000 men in Britain aged under 65 die from heart disease whereas other European countries have been able to reduce the incidence of such deaths. Moreover, 100,000 people die each year as a result of smoking-related diseases but we still permit cigarette advertising to be associated with sporting events, thus psychologically linking healthy pastimes and smoking. I deplore that.
Alcohol Concern has spotlighted the effects of alcohol abuse. Apart from the effects of alcohol abuse on health, road accidents and crime, it estimates that £2 billion is lost to industry each year because of dependence on alcohol or alcohol abuse. When other countries such as the United States are doing so much to wean people from alcohol addiction, why are we doing so little and to so little effect? Each year 2,000 women die from cervical cancer although statistics show that 90 per cent. of them have never been screened. Far more could be done to promote screening by broadening out remuneration to doctors and ending apparently restrictive age limits.
This morning, I was able to pay a brief visit to the spinal unit at the royal national orthopaedic hospital. The vast majority of cases there arise from road accidents. We know that motor cycle accidents are proportionally 27 times more common than those involving motor cars and yet we do not examine regulatory means of preventing people from damaging themselves. For example, the minimum age for driving a car is higher than that for driving a motor cycle. One means of inhibiting young people from riding motor cycles is to make the age limit the same.
There is a lack of linkage between services. Rate capping and rate penalties are deleterious to health care. The increased number of people who now have to do without home helps means that some will have to be drawn into hospital or other institutional care far earlier. The lack of a broader definition of people requiring attendance allowances means that people will require institutional care before they would otherwise need it.
Other Government Departments could also help massively to prevent people from needing treatment. It is well known that housing conditions contribute considerably to health, yet since 1979 the massive cuts in finance available for housing have meant that the general health level has declined considerably. Despite that, Conservative Members appear not to realise that present housing finance policy will mean that even more people will suffer a deterioration in their health as housing conditions decline. Local authorities may, in theory, have the alternatives of rehabilitation and redevelopment, but unless houses are rehabilitated on a regular basis every 15 253 or 20 years, they will have to be demolished. People will be forced increasingly into unsatisfactory accommodation because we do not look after our housing stock.
Similarly, our system to enable people to pay fuel costs is manifestly inadequate. A lack of attention to heating affects health. Social security support for fuel costs cannot meet the immense rises in energy costs of the past 10 years. Yet we do not link that with the possibility of preventing people from requiring health care. Health care is more expensive than helping people to pay their heating costs.
My final point regarding prevention relates to collaboration with the voluntary sector. I commend the Government's work on drug abuse. It is to their credit that they have given grant-aid to organisations that work to prevent drug abuse and to promote rehabilitation and treatment. The Government's approach has not been at all narrow-minded. I applaud their introduction of further measures.
However, it is sad that such local projects are not similarly treated in collaboration with the voluntary sector. We should learn from the experiments of women's movements, such as the well woman clinics. They have shown what can be done in health care, which men have failed to grasp in years past. There are many good practices going on in individual ways and we should examine them to see how they can be translated for the greater good. It is no use believing that care in the community can work by diktat. It will not be beneficial to move people out of institutions if we do not support the institutions required to help people in the community.
The hon. Member for Oldham, West (Mr. Meacher) has a point about partisan appointments to health authorities. The political credentials of appointees are undoubtedly being examined carefully. What is more, those appointments are now considered at ministerial level. Much anxiety is expressed about the diminution of pluralism in our democracy. We shall not be able to involve people in our democratic processes if they believe that they can be appointed to a body that exercises authority and influence only if they belong to a particular political party. Such a position would be dangerous.
It is sad that many organisations that are beneficial to the Health Service and the social services and that are funded by both local authorities and the Government are treated in the same way by the far Left as by the Right. A voluntary body in Hackney will find that its local authority will believe that if a job is worth doing it should be done by the state. If local authorities are to determine their grant-giving practices by political criteria, the same is true. I hope that the hon. Member for Oldham, West will condemn such a practice, if it is carried out by members of his own party, just as he condemned the Government for it in health authorities.
Social conditions are deteriorating generally. There are rare outbreaks of salmonella poisoning, but we should be worried about regular outbreaks of various kinds in institutional care. The public health aspect of care has brought the greatest good for the greatest number in our history. The extension of the expectation of life has not come through technology and surgical skills, but through the improvements of water supplies and the development of public health. Unfortunately, it is in those areas that our social conditions are deteriorating.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. John Patten)
I always listen with care to the hon. Member for Leeds, West (Mr. Meadowcroft). I am grateful for his remarks about the Government's drugs initiative, which I hope will receive all-party support.
I listened to the hon. Gentleman's voice that expressed, almost with J. B. Priestley-like reasonableness, such as we expect from an hon. Member from Yorkshire, many points, and suddenly heard him say, in a different tone, almost exactly the same scare-raising, hair-raising things about the state of the public health which were earlier said, totally unreasonably, by the hon. Member for Oldham, West (Mr. Meacher). That worries me. He must not make unsubstantiated assertions about threats of increased infection and outbreaks of food poisoning without quantifying the increase and giving the House evidence.
§ Mr. Meadowcroft
I accept what the Minister says. There is a danger that statistics are self-fulfilling. When the press becomes interested in an outbreak of salmonella poisoning, other outbreaks suddenly become public property. I accept that danger. However, I would expect him to be desperately worried about other aspects of public health which are not on the agenda, but which I would have expected to see there. In Bradford people are extremely worried about the incidence of dysentry—and not people who are prone to lay such things at the feet of our immigrant populations. The outbreak is mainly concentrated in old council estates on the periphery of the city. I would have hoped that the Minister would be worried about that.
The general problem is immense. Resources for health services will never match expectations, as the hon. Member for Eastleigh (Sir D. Price) continually tells the House. When a particular treatment or skill is known to be possible, everyone expects it to be generally available. Clearly, that demand cannot be met. In a sense the more glamorous a specialty the less is its impact on health care. The more expensive an individual treatment or individual technology is, the more difficult it is to make it generally available. We shy away from the fundamental problem of questioning clinical freedom. We avoid developing better evaluation of treatment and medical audit. At present the inhibition on clinical freedom is the waiting list, but we passively allow that to continue. It is time we examined ways and means of tackling the mismatch of expectations and resources for services.
It is sad for the NHS that the case against the Government's failure to tackle such matters is so badly handled by the Labour Opposition. The Government are let off the hook time and time again by the Labour party's obsession with antique clichés and, even worse, by its acceptance of the Government's terms of debate. A different agenda for debates on health matters is needed in the House. There is a crisis in the NHS and in social services. It is sad that neither the Government nor the Opposition Benches are aware of the fact that a new agenda is required, and that they cannot deal with it.
§ 5.9 pm
§ Mrs. Edwina Currie (Derbyshire, South)
I endorse what my hon. Friend the Member for Poole (Mr. Ward) said about the Warnock committee report. I hope that the House will have an opportunity to debate the problems outlined in the report, preferably before the Government 255 have made up their mind as to what they want to do. I hope that Ministers will ensure that, whatever comes before the House, hon. Members will have a free vote.
I wish first to discuss the annual report on "The Health Service in England", which came out recently. The NHS is the jewel in the crown of the DHSS, and its successes between 1978 and 1983, which were outlined by my right hon. Friend the Secretary of State, are worth hammering home. Inpatient treatments have increased by 648,000 a year, and outpatient attendances have increased by 2.5 million a year. Both have shown an increase about three times higher than under the Labour Government. There has been an increase of 19 per cent. in cases per available bed for inpatients, and day cases have increased by a further 250,000.
The National Health Service is rapidly becoming the largest employer in western Europe, certainly in terms of the numbers on its books. It is the right sort of employment for the services that it is intended to provide: consultant staffing has increased by 13 per cent.; district-nurse staffing has increased by 15 per cent.; nurse and midwife staffing generally has increased by 13 per cent.; and general practitioners and dentists have increased by 12 per cent. At the same time, the average doctor's list has decreased by 9 per cent., so that our family doctors have far more time to talk to us. Under the Conservative Government, full-time staff has increased by 60,000. There has been a reduction in ancillary staff, but 46,000 of those extra 60,000 are nurses and midwives. The Government should be immensely proud of that record.
The hon. Member for Wolverhampton, North-East (Mrs. Short), who has left the Chamber, talked about the terrible state of some hospitals. She should be aware that the capital programme is now 23 per cent. higher in real terms than it was under the Labour Government. Therefore, to answer the question about who is replacing our tatty old hospitals, we are, and we are doing it much faster than the Labour Government did when they had the opportunity.
The annual report shows some of the perils of throwing money at a problem and keeping one's fingers crossed. The 17 per cent. additional money over and above inflation that the Government have provided to the NHS has resulted in people throughout the country scratching their heads and asking, "Where has all the money gone?". I include among them many of the administrators responsible for the Health Service.
It is worth exploring the point in a little detail. Half of the 17 per cent. went on pay rises and the reduction in the average working week of a nurse. That is an improvement in service, whatever the hon. Member for Oldham, West (Mr. Meacher) might say, because there used to be an astonishingly high turnover in trained nurses. It used to be impossible to fill posts for trained nurses, and that still happens in specialty areas such as sick children's nursing. I commend to Ministers the possibility of extending special allowances, which are currently available for geriatric and psychiatric nursing, to other sorts of nursing to attract staff to those areas.
Half of what was left after the pay rises went on non-pay rises for NHS drugs and equipment. One would have thought that, with the purchasing power of the NHS being what it is, the NHS retail price index would be lower than the national retail price index, not several percentage points higher. That problem must be tackled and solved to the benefit of the Health Service and us all.
256 Part of the 17 per cent. went on the 1 to 1.5 per cent. demographic change—mainly the increased number of old people. I must tell Labour Members that that increased money was made available and that it became possible to maintain the same level of health services to the increased number of old people who presented themselves for care and treatment, many of them over and over again—and why not? An elderly person costs the Health Service nine times as much as a young person, and the Government have managed to maintain services. Indeed, there is even something left over from the 17 per cent.
I congratulate Ministers on that achievement. If the Labour Government had produced such a record on the Health Service, Labour Members would be shouting it from the rooftops. I remember only too well when I was a member of a health authority when Labour representatives were in charge that it was extremely difficult to get staff, our capital programmes vanished into thin air, and waiting lists became longer. I feel sorry for the hon. Member for Oldham, West, who has a difficult job in blabbing on about cuts when there are none.
While speaking about the social security budget of £39 billion, I shall mention a point that has been only briefly discussed hitherto, and that is pensions and pensioners. In 1982–83, total expenditure on contributory retirement pensions was about 13.5 billion, which represented 70 per cent. of the outgoings of the national insurance fund and nearly half of all social security benefits, excluding rent rebates and allowances. If we add to that the £1.4 billion spent in that year on supplementary pensions and the £40 million, which in that context was peanuts, for the over-80s who did not have a record of contributions, we discover that pensions represent one of the largest budgets in all public spending.
About 10 million people receive state retirement pensions, and for about half of them state benefits account for three quarters or more of their total incomes. Therefore, we are talking about an important part of the national economy. We have been told that the gap between pensioners and others is widening. It is worth recognising the promises that were made some years ago:Pensioners … can confidently look forward to sharing in the increased standards of living of the country as a whole."—[Official Report, 13 June 1979; Vol. 968, c. 439.]It will be difficult to fulfil that promise.
The present commitment is that pensions should be uprated in line with the retail price index. However, the working population is busy uprating itself way above the retail price index, as average earnings are soaring. That means that the gap between workers and the retired begins to widen, and it means especially that the expectations of those who retired, in relation to what they might have been earning had they still been in work, will be challenged.
That is in contradiction to recent history. The report, "Population, Pensions Costs and Pensioners' Incomes", which was published recently, stated that the basic pension, as a percentage of average net earnings for a male manual worker between 1951, when it was 30 per cent., and 1981–82, when it was 50 per cent., has been increasing steadily in the post-war period. We have raised expectations that pensions will continue to increase as a proportion of earnings, and those expectations may be difficult to challenge. The explanation will need careful presentation.
We should also recognise that, despite the increased number of pensioners, the share of personal disposable 257 income that has gone to pensioners during roughly the same period has increased much faster. We have been allocating a larger and larger proportion of our national income to pensions, and perhaps we should consider whether more of that money should go to the economy, training or education. We must find the right balance.
The objective of all Government policy towards pensions—
§ Mr. Frank Field (Birkenhead)
Before the hon. Lady leaves her point about the need to consider the commitments that we have made to pensioners, I should tell her that that commitment is enshrined in legislation. The Social Security Act 1975 contained a commitment to move pensioners' incomes closer to average earnings over a period of time. Is she suggesting that we should scrap the Act and tear up our agreement with pensioners, and therefore widen the gap between the earnings of pensioners and those of the rest of the community?
§ Mrs. Currie
No. As my pension date is getting closer, as it is for all of us, I hope that when I reach that stage my pension will be not 50 per cent. but a higher proportion of average earnings. I merely point out that such commitments are expensive and that we should be aware of what is happening in the national economy when we make them. I do not wish to trade party points with the distinguished hon. Member for Birkenhead (Mr. Field), but I recall that the 1983 Labour party manifesto stated that that commitment would be carried out "as soon as practicable."
The objective of all Government policy has been to provide adequate pensions on the basis that the old should not live in poverty. That policy has been set by all Governments, and the whole House endorses it. There has been much legislation, especially the 1975 Act, and the Government Actuary's report this year showed alarmingly how difficult and expensive it would be if the state alone had to provide those adequate pensions. Many Governments — certainly this Government — have developed a secondary objective, which is to try to spread the burden and to add more legs to the stool so that it does not eventually topple over. Therefore, we should welcome the review of pensions, and the reviews of other benefits that are under way. We should commend Ministers for the astonishing amount of effort and number of hours that they have put into ensuring that those reviews are doing their job. We have what must be the best-informed Front Bench on this difficult and complex subject that has ever been seen in the House. I compliment my colleagues on that.
In the opinion of many, Beveridge fails, and is likely to fail, to satisfy the demand, so we should turn to the private sector. One of the most interesting items in the debate recently has been the Centre for Policy Studies report, which came out in 1983. It said many things, but picked up two facets likely to be the subject of legislation—if not in this Session, in the next one—and one was mentioned in the Gracious Speech. One subject is early leavers and the other is portable pensions.
I share the objectives of encouraging mobility and a widening of choice. It must be possible for the best people to move around and to take their pension rights, if not their actual pensions, with them. Between 1969 and 1975, when the last legislation on this subject was introduced, I had four different jobs. Three of them were pensionable, 258 and I lost every penny that I had put into those pension schemes. I am never likely to see my money again. I resent that. It did not make much difference at the time, but in years to come I may wish that I had that money.
I see the objectives of the report as possibly conflicting with the original objective of avoiding poverty. If we get away from the compulsory nature of most company pension schemes and the Government scheme, I fear that we may end up with smaller private pensions, and eventually with a bigger burden on the state.
The Government Actuary estimates that there are 90,000 occupational pension schemes, of which about 79,000 have fewer than 30 members. We are talking about huge sums of money and a wide diversity of schemes, few of which are properly regulated.
One of the most interesting documents around is the National Association of Pensions Funds' survey of occupational pensions for 1983. It looked at 1,100 schemes, which covered £75 billion worth of funds by market value. It found that the total contributions to those schemes was £7.25 billion a year. The outlay on occupational pensions in lump sums was £4.75 billion a year and the pension outlay alone for those schemes has been rising extremely fast. Between 1982–83, it rose by 15 per cent. to £2.75 billion a year. In other words, on the occupational pensions side we are talking about a huge part of the economy. It is estimated that, in total, about £100 billion is involved, which works out at an average of £18,000 per employee — far more in many cases than people have in any other form of wealth.
It is not just the economic and social aspects of all this that concern me. We have to be sure that we change company law to protect the people involved. That is mentioned in the Gracious Speech, where it says:to ensure that members are able to obtain information about their schemes.I have tried ploughing through the accounting standards committee of the Institute of Chartered Accountants exposure draft 34, "Pension Schemes Accounts", and, having read it once, I am heartily glad that I decided not to be an accountant. However, we should welcome the interest of the accounting profession in getting company law right on this. No company is obliged to have a pension scheme and, if it does, few rules are in force.
Most pension schemes are trusts, but they do not have to be, and it is possible for a man to pay into a scheme for 20 years and not get a penny. This has happened to some of my constituents. It happens, for example, when a pensions fund is not kept separate from the accounts of the company and is drawn on as an asset of the firm. It happens particularly if a pension fund invests heavily in shares that go bust, even if it invests in the shares of its own company. If that company goes bankrupt, on the day that people go for their redundancy pay, they find that they do not have a pension. We must do something about that. There is a temptation, even for a good company, to go raiding a pension fund. Most countries raid their own pension funds, and we certainly do.
There is no clear statement of liability to pensions on the balance sheet, and when a company is taken over the purchasing company may not have the foggiest idea what liabilities it is taking on, partly because the original company may not even know. The accounts of a pension fund do not have to be audited or checked by an actuary. Even if the fund is run by a trust, there is no statutory 259 requirement on the trust at present to publish, or even to prepare, a report for the employees—the contributors—nor even for the trustees themselves.
There is a temptation, where that liability is known, to reduce the liability. For example, when British Airways recently offered an average of £6,000 per employee to encourage employees to change over to a less generous pension scheme, and to reduce their pension rights, I understand that 17,000 out of 26,000 eligible people took the money and reduced their pension rights. I think that they were mad to do that, and the day will come when they will rue it.
The accounting profession is concentrating its efforts on disclosure policy, but I have a feeling that that is rather akin to choosing what colour to paint the stable door. My concern is that, when my constituents retire and go to open the stable door, they should find a serviceable horse inside and not an unpleasant, smelly mess that somebody else will have to clear up.
The real problem is that we do not take pensions seriously enough. My generation could not care less, but it should, because it has to pay not only for its own future pensions but for the current pensions on the "pay-as-you-go" scheme. We do not realise how much pensions cost. Recently, the House voted to increase our pension contribution from 6 per cent. to 9 per cent. The policemen here in Westminster pay 11 per cent. for their pension, and one of the propositions on the table for the police is that that should go up to 14 per cent. My hon. Friend the Under-Secretary, who I think is about my age, would, if he were providing his pension entirely as a self-employed person, have to fork out 23 per cent. of his earnings. My right hon. Friend the Secretary of State, who is a little older than us both, would have to fork out 38 per cent. of his salary if he were having to provide for his pension himself.
Just for the Government schemes alone, employers and employees are forking out 18 per cent. of current earnings to the national insurance fund, and that is set to rise to 20 per cent. and higher. This is what bothers me. If we allow free choice, without minimum standards, then there are strong odds that the young and the middle-aged will not pay. They will make a conscious, or even sub-conscious, calculation of what the risks are to them of needing that pension or that survivor's pension soon. While the risks are low, the incentive will be low. At that age, the pressures of mortgages, cars, children and everything else will tend to take priority.
My most acute concern is for survivors of pension schemes. Typically, a good pension scheme provides two thirds of final salary for the pension contributor, but only 50 per cent. for the survivor, and in many cases survivors are not mentioned. Most of the elderly are women and most old women are widows, and many widows live in poverty. Even with an occupational pension from a company that is regarded as generous, there are occupational pension widows in my constituency who are having to rely on supplementary benefit to top up their pension to a reasonable standard.
If we are arguing for equality, we could say that women should do this themselves, but women find it much harder to provide for their own pensions. They have a shorter working life, not just because of the earlier retirement age, but because of time off for children. They are more likely to work part time and they are more likely to have low pay 260 —the figure is about 75 per cent. of male pay. They are more often given exemptions from superannuation, or they may find that they are not entitled to it.
Even where women pay the contributions, there is discouragement and they tend to lose out. A lady in her sixties in my constituency has been claiming £17 a week on her own contributions. Then her husband died and she started to receive the £47 a week widow's allowance on his contributions, so her £17 was stopped. If ever there was a discouragement to women to demand better rights and pay for them, that must be it. In the private scheme survey by the National Association of Pension Funds only just over half provided any pension at all to a dependent widower. So perhaps my male colleagues should be more worried about what may happen to them than I am about what may happen to the ladies.
I support the philosophy behind the CPS report. But unless the Government set clear enforceable minimum standards, we are heading for trouble. If we give people enough choice, I am afraid that they will choose not to fork out enough. If we give them enough mobility, they will move away from a realistic and knowledgeable assessment of what their expectations will cost in today's hard money. It is they and their survivors who will suffer and, most of all, their children and grandchildren who will be paying out in tax to keep their elders who should have known better but did not.
I am glad to support the Government and I shall watch developments with interest.
§ Mr. Jack Thompson (Wansbeck)
I listened carefully to the speech of the hon. Member for Derbyshire, South (Mrs. Currie). The energy and enthusiasm that she put into her speech were remarkable. am sure that she has earned the right to sit down because she must be completely exhausted.
At the beginning of her speech the hon. Lady produced a mass of statistics. Unfortunately, in my constituency pensioners do not live on statistics. They do not sit down to a plate of fish and statistics. Nurses do not go out to buy their shoes with statistics. It is cash that counts. The message that she was trying to put across at the beginning of her speech would not go clown well with the ordinary people in my area.
I want to speak today on education rather than social services. One sentence on the last page in the Queen's Speech covers a multitude of sins or a multitude of valuable prospects for the education service. It says:My Government will continue to develop policies to raise educational standards.It could be argued that that is a beginning rather than a continuation. That is the theory that has been put forward. The question arises on the practice. The Secretary of State for Education and Science was here a few seconds ago but he has just disappeared. He regularly makes pronouncements in the House and elsewhere about the need for innovation in educational standards. He is noted for his dreams. However, his achievements to date need some examination.
I am constantly reminded by educationists from the north of England of the right hon. Gentleman's address to the north of England education conference in January. He set some commendable objectives. According to the press notice issued by the Department, he set outto define the objective of the main parts of the 5 to 16 curriculum so that everyone knows the level of attainment that should be 261 achieved at various stages by pupils of different abilities; to alter the 16-plus examinations so that they measure absolute, rather than relative, performance; to establish, as a realistic objective, the aim of bringing 80–90 per cent. of all pupils at least to the level which is now expected and achieved in the 16-plus examinations by pupils of average ability in individual subjects; and to do so over a broad range of skills and competence in a number of subjects. Sir Keith said 'This is the objective which the Government now wishes to set itself and its partners in the education service in England and Wales.'I am certain that the right hon. Gentleman's partners would wish to consider his proposals and would probably, in the main, agree with his targets. But there is a major flaw in the progression of those aims. His partners, the local education authorities, are all suffering in various degrees from the reduction in expenditure demanded by the Government. I speak as a county councillor for 11 years, a chairman of school governors, a member of two other boards of school governors, the member of a board of governors of a technical college and with two years' experience as leader of a county council. Early on in my involvement in the education committee of my local authority I was reminded during discussions on priorities in education of a comment by one of my more elderly colleagues. He said that a teacher could teach a large class in a meadow without resources and would achieve a limited success. There would be an improvement by the provision of adequate resources and a greater improvement if teachers and pupils had a suitable building with adequate support facilities. That clearly illustrates the basic priorities. Teachers should be adequately trained with a good in-service training. There should be full and proper resources with suitable buildings, properly maintained and cleaned.
What is the reality? That is not the reality in my county which has poor in-service training, a serious lack of resources and in many cases unsuitable buildings, badly maintained and with inadequate support. That also seems to be the case in other shire counties. Therefore, the foundation upon which the Secretary of State wishes to build is crumbling.
Northumberland, the northernmost county in England, like other shire counties, has to provide almost 60 per cent. of its budget for education purposes. In that county that is £65 million out of £113 million in the current year. The penalising legislation introduced in recent years has caused serious problems for the county although there have been constant efforts to protect the education service against the worst effects of the reductions. Other services have had to pay the price.
Those difficulties were aggravated by 14 years of local Tory control, which produced poor pupil-teacher ratios and poor school buildings, built on the cheap and now causing expensive maintenance problems. In the past two years a high school, built in the 1960s, had part of its flat roof blown off in a high wind. The cost of replacing that roof was nearly £200,000—money that could have been usefully spent in other areas of the education service. Almost £250,000 was wasted on providing a new roof because of the cheap building system that had been used.
Betwen 1979 and 1981–82 the per capita allowances diminished in real terms by 32 per cent. in my county. That was before Labour took control in 1981. One of my last acts as leader of the council was to establish special funding on a one-off basis to attempt to restore the 262 necessary standard of service required in both resources and building. That action proved to be of great benefit but it probably will not be continued because it was on a one-off basis.
In the budget for 1979–80, £835,000 was provided which was not even considered to be adequate. In 1980–81, still under Conservative control, that was reduced to £735,000—a 12 per cent. drop. In ensuing years inflation has been added to that base figure of £735,000 to bring the total in 1984–85 to £1,361,150. Thus, in reality, £750,000 has been taken out of the repairs and maintenance element of my authority's responsibilities for education and buildings.
The special funding arrangements introduced by the Labour-controlled authority in 1983–84 and 1984–85 restored £650,000. But the lack of repair and maintenance during the 14 to 15 years of Conservative control will still cause significant problems. Of even greater importance is the pressure on high schools as a result of the teacher-pupil ratios. Proper curriculum development is difficult. Indeed, I must compliment the administration in my county, the teachers and the heads, on the efforts that they are making to protect the students from the worst ravages of staff reductions. In addition, there is a serious lack of proper remedial teaching and that is causing problems throughout the service, from the five-year-olds beginning school to those aged 16 and over.
In one of the primary schools in my constituency, of which I am proud to be a governor, there is a class of 32 children. Five of them have speech problems but, because of the lack of specialist resources, there is little opportunity to assist them during their early years in school. That will be a continuing problem for them throughout their school careers. One young girl had hearing and sight difficulties identified when she was in the reception class. She was under five years of age at the time. Six years later there was a response to her needs and she is now receiving treatment. Indeed, she has moved up from the first to the middle school. But when she was between five and nine years of age appropriate consideration was not given to her problems.
The concern felt by many in the county is reflected in the attempt earlier this year by representatives of the high school governors to meet the Secretary of State for Education and Science. He refused their application to see him, claiming that he was too busy. I understand that attempts are now being made by the governors of the middle school to arrange a meeting with all the middle school governors in the county, and to try to persuade the Secretary of State to meet them as well.
Recently I received a letter from a fellow chairman of middle school governors who comes from a more rural part of the county. He claimed to be speaking for his governors following a governors' meeting and said:We spend time each year listing items for repair in order of urgency, but knowing there is little chance of most of these items being dealt with. The fabric of our school is deteriorating.He went on to say that the governors deplored the low capitation allowance that deprived children of necessary equipment, books and so on. He said:We see our PTA being asked and expected to increasingly provide equipment that many would regard as essential. In the long term we see the danger that this will lead to inequalities between schools in poor, as opposed to wealthy areas.263 I should add that this weekend I shall be attending a PTA function to raise funds to provide essential facilities in the school. I am happy to do so but am sorry that it is necessary.
The governors see evidence of teachers staying in post rather than moving to gain experience and promotion, as job prospects are blocked by those who are reluctant to leave work temporarily because they may find themselves unable to find employment again later. The comments of that board of governors, through its chairman, confirm my recent impressions. During the recess I spent half of my time visiting schools in my constituency. There is a three-tier system in the area but in every school similar comments were made. As I had the time available, I was able to discuss the situation in detail with the staff and the heads. I received the same message as I heard from the chairman of that middle school in Northumberland. Among the staff and the heads there is an overriding feeling that morale is not as high as it should be. Teaching is becoming more and more difficult. If teachers could leave the profession for other jobs, I should imagine that quite a few of them would do so. Obviously, however, that is not possible in the present employment situation.
The falling rolls in Northumberland are broadly in line with the national average but there is one significant difference. The number of pupils is falling quite dramatically in rural areas but is increasing in urban areas. Consequently, there are half-empty schools in the rural areas and overcrowded schools in the urban areas. In the west and north of the county the school population is diminishing but in the south-east it is increasing. But the Government do not take that problem into account in the funding arrangements.
Another problem facing our county, and other counties with rural areas, is school transport. We spend almost 16 per cent. of the budget on transporting children round the county, taking them to and from school. That is a very heavy burden for a small authority such as ours. At present, the authority is trying to establish its budget for 1984–85 and is suggesting—I doubt whether with any success—a standstill budget for the third or fourth time. If that is agreed, it will take the authority £8 million above the Government target and about £17 million into penalty. That means that the authority will be severely penalised. However, if it decides to reduce the services that are already skinned to the bone, particularly in education, those services will be approaching a standard that is unacceptable in terms of the requirements of the Department of Education and Science and its inspectors.
The Secretary of State has not yet returned to the Chamber, but his pious dreams—albeit I support the principles outlined in his speech—cannot be superimposed upon the nightmare position of education in my county. One question that must always be raised concerns the Secretary of State's power of persuasion within the Cabinet and Treasury. He does not seem to have as much clout as some of his colleagues. But it should be remembered that the education service forms the basis for the future. One can talk about the social services—and I very much support the arguments for that service—and the economy, but the future lies in our education service. Education starts with the under-fives and ends at the 16-plus point. Indeed, it never really finishes. However, we must provide the resources and facilities to ensure that education, and with it the future, is protected as much as possible in present economic conditions.
§ Mr. Harry Greenway (Ealing, North)
I am grateful to you, Mr. Deputy Speaker, for calling me, as London Members of Parliament face some difficulty in trying to cope with a lobby and at the same time take part in this important debate. I was very interested in the speech of the hon. Member for Wansbeck (Mr. Thompson), which concentrated on the important subject of education. I intend to speak on the same subject, but first I should point out that I am sorry that the hon. Member for Oldham, West (Mr. Meacher) is not in his seat. He admitted that the Labour party has instituted a witch hunt requiring Socialists on health authorities to identify themselves and their allies. He made extraordinary accusations against the Government that are totally unsupportable.
If the hon. Gentleman had had the courage to give way to me, which he did not, I would have told him to go and have a look at some Labour-controlled education authorities that are appointing Socialist headmasters in a corrupt way, and have been doing so for a long time.
§ Mr. Deputy Speaker (Mr. Paul Dean)
I did not hear the hon. Member for Ealing, North (Mr. Greenway) say that about another hon. Member. But if he did, I am sure that he would want to rephrase his remarks.
§ Mr. Greenway
I simply referred to what another hon. Member said and replied to his argument. I am not surprised that hon. Members do not like it, but it is about time that Labour Members faced up to Labour tactics in local government and did something about it.
§ Mr. John Patten
Does my hon. Friend agree that it should be a cause at least for some discussion when one Labour-controlled borough in London appoints as its new director of social services the chairman of the social services committee of another Labour-controlled borough?
§ Mr. Greenway
I agree with my hon. Friend. The GLC appointments need looking at. The chairman of the London area enterprise board was the leader of the Labour group in Wandsworth. I put it no stronger, but the matter needs attention.
§ Mr. Frank Field
I cannot quite understand the hon. Gentleman's argument. Is he saying that our accusation against the Government over reappointing Conservative sympathisers to health authorities is justified because authorities in London and Wales appoint people to positions in schools even though they are not the most appropriate? Is he saying that one wrong justifies another or does he condemn both practices?
§ Mr. Greenway
I have too great a personal regard for the hon. Gentleman to break our friendship on that argument. It is unworthy of him. Labour's witch hunt of the health councils is unjustified and it is paralleled by 265 Labour appointments in schools and local authorities. The position is unsatisfactory and needs to be examined. It is as bad, disgraceful and corrupt as it is to support violence against the police. The situation is in that category and Labour must pull itself together.
We had an interesting debate on higher education recently. The Opposition spokesman, the hon. Member for Durham, North (Mr. Radice), when challenged by me, was not able to say that if a Labour Government were returned they would restore cuts in higher education spending.
The hon. Member for Wansbeck spoke of the Secretary of State in mixed terms. He spoke as an administrator rather than a practitioner. I do not mean that in a denigratory sense. The present Secretary of State has brought to education a quality of thought and stimulus of action which was matched by few of his predecessors. Everyone in education agrees with that. My right hon. Friend's particular concern is for the bottom 40 per cent., the deal for the underdog in schools. That is the type of child in whom I am especially interested; he or she is forgotten, ignored or kicked around. The quality of thought and stimulus that the Secretary of State has brought to such children's curricula is more than commendable.
The Secretary of State has initiated examination reform that has been overdue for tens of years. The 16-plus examination system is based on a format that is full of faults and that was established in 1917. This Secretary of State is the first to tackle the problem. That is a criticism of those who came before him. He is tackling the problem in a far-sighted and useful way.
Today the pupil-teacher ratio in schools is better than ever. Do the Opposition want resources to be spent on more and more teachers or do they think that there should be a mix of more teachers and other things? When I challenged an Opposition spokesman recently to say what he thought was the ideal pupil-teacher ratio he said that he did not know but that it should be better. That is an example of the fatuously thin thinking on the Opposition Front Bench.
Corporal punishment is mentioned in the Queen's Speech. It is no use trying to tackle behaviour problems in schools without doing something about religious and moral education. Children need to know the difference between right and wrong and they learn that best through religious and moral education.
In two thirds of primary schools teachers handling religious education are too confused to cope. Children are not taught the subject properly. In a quarter of secondary schools no religious or moral education takes place beyond the age of 14 or the third year. That is desperately unsatisfactory. Behaviour in schools and everywhere else is governed by individual self-discipline and by accepting moral standards. For me those are Christian standards, but each person comes to his own morality through his own religion.
§ Mr. Frank Field
The House will agree that we need to pay more attention to how children acquire moral standards. If the Government hold that view, is it not unsatisfactory that they should have disproportionately cut teacher training places at church colleges compared with other colleges?
§ Mr. Greenway
I do not want any cut in religious education training places. I hope that Ministers will consider a programme for religious education teachers similar to that used to produce more and better maths teachers. Both the Secretary of State and the Under-Secretary are extremely keen on religious education.
I am worried about the proposed Bill to deal with corporal punishment in schools. There are two levels of discussion on that important question. I do not say this in a party sense, but the Labour party's position is similar to that of the Society of Teachers Opposed to Physical Punishment. The Swedish attitude also is idealistic. The Labour party takes the naive view that all children are basically good and that punishment is therefore irrelevant and unnecessary. That is a dangerous approach. The Opposition say that it is wrong to use force to bend children to one's will. That may be right but they hold the view idealistically. There are times when even the most mild and idealistic parent uses force to bend a child to his or her will.
The Labour party and Swedish-type thinking supports the Rousseau approach, as in "Emile", that children are basically good, that they can be handled through their self-motivation and that their self-motivation can be related to their discipline. That is an intellectually interesting view, but we must move to the other level—the practical level of how children are, particularly in schools.
Thomas Arnold, a headmaster of the great Rugby school—similar to the public school attended by the hon. Member for Durham, North—once said:My aim is to produce Christian gentlemen; Christian boys I can scarcely hope to make.He put his finger on the matter.
The practical approach to discipline cannot be intellectual. Corporal punishment is not a cure for bad behaviour, but it can be a deterrent. The cane should be used sparingly until it eventually eliminates itself; it should not be eliminated by an Act of Parliament. It should be used only by the headmaster and his deputy. It can be effective, although it should be used only for major offences such as serious bullying. I once saw boys of 19 taking money from boys of 11. They made them jump in the air so that any money in their pockets would jingle. Such behaviour is quite unacceptable and must be handled firmly. In such a case corporal punishment is not out of place. Of course, I accept that one cannot use corporal punishment on youths of 19, but it can certainly be used on younger children.
Cases of vandalism could also be handled by corporal punishment. The children involved should be made to repair any damage. I am not, of course, suggesting that girls should be subjected to corporal punishment.
The Opposition must accept that there is tremendous teacher and parental support for corporal punishment. Happily, severe beatings are a thing of the past. There is no longer the appalling brutality about which children have written when they became adults. The essential point about discipline in schools is that there must be equal treatment for all children. The Bill will create unequal treatment. Some parents will not allow corporal punishment for their children while other parents will accept it. Corporal punishment should be immediate and never malicious.
What are the alternatives? Will there be "sin bins" with children driven off in shame? Will they be given lines or additional mathematics? What would that do to a child's 267 attitude towards mathematics? Will they be sent on runs? Will teachers use sarcasm? The lash of the tongue is more wicked than a reasonable lash of the cane. Bitter sarcasm destroys the mind — yet is not the mind a central responsibility for teachers? Is shouting at a child an alternative? Is suspension and expulsion? What happens to a child if he is expelled? That boy is the very boy who needs to be in school. What will he do if he is not in school?
If a pupil refuses all the alternative punishments that I have outlined, what is to happen then? There must be an end to the road. Should that child be referred to the juvenile courts? What will that do to him? An hon. Friend recently told me about a child who had been referred to a juvenile court because he had stolen 10p. A short wigging or a tap could have sorted out the problem. That child had to suffer appearing in a court — and that procedure was established by the Labour party. It is no good the hon. Member for Peckham (Ms. Harman) smiling. She must know that it is part of the Children and Young Persons Act 1969. Should the children be referred to a psychiatrist or to the psychological service? We must avoid that where we can for we would needlessly be making "cases" of them.
Headmasters and teachers must continue to stand in loco parentis. They must control discipline in schools within the guidelines laid down. Two systems of discipline cannot be applied in one school, as that would be a departure from the vital principle of equal treatment. The only way out is for parents to be asked to accept a discipline code before their children enter a school. Perhaps areas should have some schools that use corporal punishment and some that do not. Parents could then choose to which schools they would send their children.
Parents cannot judge or run school discipline from outside the school. Headmasters and teachers must handle discipline immediately, on the spot and with equal treatment for all children. I am concerned that the Bill may not allow that. I shall wait to see what my right hon. Friend produces in the Bill. In the meantime, I ask him to take account of the points that I have raised.
§ 6.6 pm
§ Mr. Laurie Pavitt (Brent, South)
The hon. Member for Ealing, North (Mr. Greenway) will not expect me to follow him on the subject of education. He will know that I wish to talk about the National Health Service. I listened to the hon. Gentleman with interest. I knew that he would get to Tom Brown's schooldays eventually, and he did. The hon. Gentleman's opening remarks tempt me to speak about political appointments in the Health Service and about the six regional health authority chairmen who were sacked and the six political appointees who took their places.
This is a mishmash of a debate, and I blame the usual channels for that. All Health Service debates are a bit of a mess, although not as bad as foreign affairs debates. The two important matters of the Health Service and social security always mean a mixed debate, but today's debate is rather like Gaul, in three parts, because we have the Health Service, social security and education.
A number of hon. Members have said that the National Health Service was not mentioned in the Queen's Speech. I have been a Member of the House for 25 years and have spoken in every debate on the Queen's Speech. I must be conservative in my old age for I speak on the same subject 268 as always, the NHS. This is the first time that I can recall there being no mention of the NHS in the Queen's Speech. There has been a little compensation in that the Secretary of State has shared his thoughts with the House, although he missed some important points.
I believe that three pieces of legislation should have been included in the programme for this Session. Many statistics have been presented to the House throughout the debate so far. The hon. Member for Derbyshire, South (Mrs. Currie) presented us with a good many. We keep on proving that we have a marvellous illness service. It is suggested that the NHS becomes better the more people it treats. That approach might be all right for industrial production, but it is not for the Health Service. The NHS has existed since 1948. We are all aware of demographic problems—and aging population—and the demands that these factors make on the service. However, the greatest gap in the Gracious Speech is a reference to the need to make inroads in prevention.
I should like the Government to introduce a Bill designed to prevent or reduce chest diseases. Secondly, I should like them to introduce a Bill designed to prevent or reduce dental caries. Thirdly, they should introduce a Bill to prevent excess profits in the drug industry. Such a measure would release considerable resources, which the NHS so badly needs.
When it comes to patients versus profits, the Government are always reduced to being a puppet. Thal has been evident in the Government's agreements with the tobacco-producing industry since they took office in 1979. It is common knowledge that the greatest single step in the prevention of chest diseases would be to stop the smoking of cigarettes. About 100,000 premature deaths—deaths between the ages of 45 and 65 years—could be avoided annually if the Government would act to prevent the smoking holocaust. As the Secretary of State for Education and Science is to reply on behalf of the Government, I shall not have many of my questions on health answered this evening. However, I am grateful to see the Minister for Health in his place. I am certain that he will write to me in response to the questions that I shall ask. He always does.
First, will the right hon. and learned Gentleman confirm that there are 100,000 premature deaths annually of those aged between 45 and 65 years? That is the figure that is referred to by the Royal College of Physicians and the British Medical Association. The most recent Government figure was given by the Prime Minister in 1980 when she spoke of 50,000 premature deaths—still too many — through the smoking of cigarettes. It is inevitable that the debate on premature deaths through smoking will continue and it will be helpful to have the Government's official figure.
Last year there were fewer than 5,000 deaths through road accidents in England and Wales. The Secretary of State for Social Services has come under pressure from hon. Members on both sides of the House because of their great concern about drug abuse and the increase in the use of heroin. It was thought that drug abuse was peaking 15 years ago. There was a trough in the late 1970s and the beginning of the 1980s, but there is now an increase in deaths as a result of drug abuse, including the use of hard drugs. Incidentally, I do not know why the Secretary of State never takes action on amphetamines. It is about time 269 that their part in the escalation was recognised. Despite increasing drug abuse, the number of deaths recorded last year as a result of the abuse was fewer than 3,000.
I commend the campaign that is designed to reduce or eradicate drug abuse, but if we can take that problem on our shoulders, which resulted last year in fewer than 3,000 deaths, we should surely be doing something to overcome cigarette addiction, which is causing about 100,000 premature deaths each year. Surely the weight of evidence demands that much higher priority should be given to the prevention of chest and heart diseases.
The House will recall that about 20 years ago Sir George Godber, the then chief medical officer of health, made a statement which was followed up by the World Health Organisation two years later. Sir George said that the greatest single step to preventing illness and overcoming the need for treatment would be to do something about cigarette smoking.
Since 1961 the main protagonist in this debate has been the Royal College of Physicians. At the BMA's conference last year the 600 delegates, representing the entire medical profession, carried nem con a motion that the Government must listen to medical opinion and cease to be the puppet of the tobacco industry. Dr. John Harvard, the secretary of the BMA, said:The tobacco industry spends millions of pounds employing advertising, public relations and promotional experts to help them promote a product we know—and they should know—is directly responsible for disease, illness and death. Advertising, sports and arts sponsorship, competitions, clothes bearing brand names and holidays are all part of the industry's attempt to fool their customers into believing that smoking is glamorous, healthy and desirable. These same consumers are our patients, and we know the truth—that smoking causes appalling illness and so many unnecessary deaths that the figure of 100,000 premature deaths each year is beyond comprehension.
The head of the BMA's professional division, Dr. John Dawson, has stated:We all know tobacco is a killer. Doctors know it, the public knows it and the tobacco industry ought to know it. Year after year, doctors at the BMA's Annual Representative Meeting have called for legal controls, but instead we have voluntary agreements, cosily agreed between successive Governments and the manufacturers. These agreements—as you can see—are a sick joke.
I have three questions for the Minister. First, will he and representatives of his Department meet the BMA to discuss in what way the Government can take action to prevent the holocaust?
§ Mr. Pavitt
I am grateful for that. I hope that there will be a continuing dialogue. It is important that the BMA's campaign, which is to be accelerated, should be well in tune with what the Government are doing. The Government should respond to what the BMA is trying to do.
Secondly, will the Department use its influence to provide time for a private Member's Bill aimed at reducing the smoking of cigarettes if the Government are not prepared to introduce such legislation themselves? In 1980, the previous Secretary of State for Social Services, now the Secretary of State for the Environment, the right hon. Member for Wanstead and Woodford (Mr. Jenkin), said that he felt it was time, although the Government did not wish to introduce legislation, that the House of 270 Commons, without the Whips, should come to its own conclusion on this issue. Indeed, the Whips did not intervene when subsequently two Bills were introduced by me, which were intended to deal with the cigarette-smoking problem. It seems that the Government have changed their policy since then, so I ask the Minister whether the Government are prepared to provide time for a private Member's Bill — it would have all-party support — to deal with the problem. I hope that the Minister will give an assurance that, if such a Bill were introduced, the Government would give it time and allow the House of Commons to make its own decision.
There is soon to be a statement on economics and finance. Against that background, will the Minister discuss with his right hon. Friend the Chancellor of the Exchequer the possibility of avoiding the problems that sport and the arts would face if the promotional activity of the tobacco industry is, as I hope, stopped? If taxation on a packet of cigarettes were to be increased by one tenth of a penny, an additional £6 million would be raised. That is the sum that the industry is spending to sponsor snooker, other sports and the arts, for example.
The Government are being made to look foolish. They are not prepared to accept the advertising of cigarettes on television, yet tobacco companies are using hundreds of millions of pounds of television advertising. We need legislation, not the customary agreements.
Information about another preventive measure was leaked, but the programme did not arrive. About £500 million a year is spent on dental services and there are about 250 million items of dental service. That is happening when the disease of dental caries is preventable. I hope that the Government will take their courage in their hands and bring forward a Bill to get rid of the muddle about fluoridation of water supplies. The Conservatives know that, under Prime Minister Macmillan, there were three years of intensive research into fluoridation, culminating in 1961. The resulting evidence shows that if fluoride were added to water in the proportion of 10:1,000,000 the spectrum of dental caries, especially in children, would be altered. At present, 33 different chemicals are added to the water drunk by hon. Members in the Palace of Westminster. Before we drink it, the contents of an average glass of water have been through the body six times. The idea that we must not touch the water supply is ludicrous.
Fluorides exist in large parts of the country, especially Derbyshire, in quantities 10 times greater than would be needed to prevent tooth erosion. No one ever suggests taking the fluorides out of water. As the Minister knows, the Strathclyde judgment last June makes it extremely difficult for water authorities to know how they are protected by the law if they decide, as has been done in Birmingham, to add fluoride to the water.
§ Mr. John Butterfill (Bournemouth, West)
Is the hon. Gentleman aware that there is profound and sincere apprehension among large numbers of the general public, becaue fluoridation represents compulsory medication? The treatment is not necessary for water purification. I and many other hon. Members probably receive more letters on this subject urging us not to accept the priniciple of compulsory medication through fluoridation than on any other subject.
§ Mr. Pavitt
That argument is well understood. An organisation, headed by Mr. Clavell Blount, inundates 271 hon. Members with that type of argument. I disagree with it, for the simple reason that there is no suggestion that there should be compulsory taking out of fluorides. This compulsory medicine is found naturally in Derbyshire. There is no reason why other parts of the country should not enjoy the same services. I advise the hon. Member for Bournemouth, West (Mr. Butterfill) to read the documents issued by the Department of Health and Social Security, the Medical Research Council and the British Dental Association. Dentists are trying to do themselves out of a job by ensuring that they do not have to fill any more teeth.
The Government have failed to support the generic substitution Bill which I have introduced three times. I hope to have the privilege of introducing that legislation again in the near future. Answers from the Under-Secretary of State to my questions show that a saving of £29 million can be made on 10 drugs by generic substitution. The Minister knows that the Pharmaceutical Society of Great Britain and the Pharmaceutical Services Negotiating Committee favour generic substitution, with safeguards. The Minister knows also, because he studied my Bill when it was printed last year, that it included those safeguards and did not interfere with clinical freedom. A doctor has only to say, "No substitute" and he gets the brand name he wants. If my legislation were on the statute book, there would be a saving of between £150 million and £200 million a year. One drug company representative calls on every nine general practitioners.
We know the arguments about the need for research. The last drug company that I had the privilege of visiting was spending £4 on promotion for every £1 on research. The Minister will know, because he has read the same statistics as I have read, that 73 per cent. of NHS drugs come from multinationals. In the main, drug research occurs elsewhere. I am sure that the Minister has seen the recently published survey showing that research on drugs in the United Kingdom is much less than claimed by drugs industries and the Association of British Pharmaceutical Industry. If the Government took the step of accepting my legislation, they would help to release the resources for patient care about which they talk so much. Just as the Government will not tackle the tobacco companies because big business rules OK, they will not tackle the drugs companies, because, once again, it is the companies and shareholders' profits that call the tune. The Government should have the courage to do what is right.
My great problem concerns death from not lung cancer but emphysema. We all have to die. Hon. Members will know what happens if they have been to a chest ward and watched elderly patients struggling for every breath. I have been round one such ward with a consultant. At the first bed I heard, "Hello, Bill," "Hello, doctor," as the patient gasped. As he walked away, the consultant said, "I think he will die by Friday." At the next bed again I saw the struggle for breath, and after his cheerful word to the patient the consultant said, "I think he will probably last another 10 days." At the third bed, hearing the struggle and gasps for breath, the consultant said, "This is a tragedy. He will be tortured for at least six weeks before he dies. I wish that there was some way in which he could be put out of his agony." The way in which those people die is criminal. The Government have a responsibility to do something about that problem rather than about the number of deaths. I hope that the British Medical Association's campaign will stir the Government at last to do something other than offer platitudes.
§ Mr. David Evennett (Erith and Crayford)
I am pleased to have been called to participate in the debate.
I disagree with the hon. Member for Brent, South (Mr. Pavitt), because I believe that people are interested in the wide issues involved in this debate on social services, the NHS, and education. Those issues affect everyone in society, and this is a good opportunity for the House to have a general debate on them.
I applaud the content of the Gracious Speech. I congratulate my right hon. Friend the Secretary of State for Social Services on his first-class speech. We must compliment my right hon. Friend and his Department for all the work that they have done during the past 12 months on the vital issues that affect people. I always regret the fact that, during wide-ranging debates of this type. the Opposition Front Bench presents the inevitable hysteria and manufactured outrage. It advocates more legislation and expenditure. That is not the answer to our problems. The answer lies not in the expenditure of more and more money but in the quality of service provided, the way in which money is used, and the results achieved. The Opposition Front Bench is bankrupt of ideas on these matters. Its contribution was regrettable for its lack of content.
Most debates on pensions in this Chamber centre on the state pension. I agree with my hon. Friend the Member for Derbyshire, South (Mrs. Currie), who, regrettably, is not in the Chamber at the moment, that there is a long overdue need for changes in the occupational pension schemes. About 12 million workers are covered by occupational pensions which are based largely upon the idea of a person remaining in one job for the whole of his or her working life, thereby penalising those who change jobs. This is still the case, even at a time when the Government are trying to encourage mobility within the nation's work force as part of their efforts to achieve economic recovery and lower unemployment.
Some people may resent the Government's proposed action in this area as such pensions are essentially a matter between employer and employee. However, considerable tax advantages are enjoyed by these schemes, and for the most part employees have little option but to participate in a company pension scheme, usually the only one offered to them. Indeed, it is often part of their terms and conditions of service.
Pension contributions are often the largest investment that employees ever make, and their financial well-being in retirement depends on their pension. However, most contributors have no control over this most important asset, nor in most cases do they have any knowledge about how their pension funds have performed. In addition, those who change jobs to meet employment demand or because of career advancement may jeopardise their financial security in later life. My hon. Friend the Member for Derbyshire, South said that she had changed jobs several times and had lost her pension contributions.
The changes needed to ensure that occupational pensions become a valuable asset in retirement are threefold. First, those who leave a job early must know that their pension will have some real value on retirement if it has been frozen. Currently an employee who leaves a job at the age of 35 will receive a pension at the age of 60 or 65 which is based on his earnings at 35. Some inflation-proofing is obviously needed.
273 Secondly, for those who change jobs but do not want their pensions to be frozen until retirement, the right to transfer needs to be greatly improved. For example, they could transfer current pension rights to the new employer or to some other individual or pension of their choice. The development of new types of pension plan, such as the portable pension, would be of great help.
Thirdly, members of pension schemes should have the right to information on the performance of such schemes. Pension funds have assets of about £100 billion, yet currently the members have no right to know how those funds are performing, and as a result comparison with the performance of other funds is precluded. Consequently, investors are unable to move their money to a better performing scheme simply because of the lack of information.
We must congratulate the Secretary of State and his Department on the great deal of consultation between the Government and the interested parties that has taken place during the past year. There has been much discussion, and finally we are to get the action which is required. That must be welcomed.
As a former teacher, education provision is dear to my heart. I was interested, as we always are, in the contribution of my hon. Friend the Member for Ealing, North (Mr. Greenway), who has had vast experience in education. I am particularly pleased that the Government are committed to the continued improvement of education standards. Since 1979 there has been a concerted effort by the Government to ensure that education standards are raised, and with considerable result. There have been better standards of teacher training, greater parental involvement, improvement in the school curriculum, examination changes and so on. These are all to be welcomed as positive advances in the past few years.
I am fortunate to represent a constituency within the London borough of Bexley. As an education authority, Bexley has always maintained high education standards and has been wise enough to retain a variety of education. It has maintained grammar schools alongside comprehensive schools.
Like many hon. Members, I have occasional disagreements with my local education authority on a specific issue, but I totally support its general approach to education, because the standard of education provided is extremely high. It always seeks achievement. My hon. Friend the Member for Ealing, North said that the Secretary of State had made a priority of under-achievers. Bexley has always tried to look after the under-achiever as well as to create standards of excellence for those with tremendous ability. If standards of education in Bexley are compared with those in inner London and other parts of the country, the results show that the authority's efforts to make education standards a top priority have been successful.
Education is important to the future of the nation, but it is perhaps even more important to the individual. A basic education forms the base for further education and training which, it is hoped, will make it easier to find worthwhile employment and to equip the individual for life. We must, however, start from basic education — we look for excellence and achievement later.
The present Government are the first for a long time to address themselves to the real problems in education. The 274 improvement in the quality of those entering the teaching profession has already been noted, and the issues dealt with in the recent past are real issues, rather than the bogus issues and sterile arguments which were advanced in the decade prior to 1979.
I am, however, unhappy about what the Gracious Speech says on corporal punishment. I have considerable reservations on this issue. As a former teacher, I am not keen on the cane, the slipper, the ruler or other methods of corporal punishment, but in many serious cases, especially when a teacher is assaulted, corporal punishment may be an effective remedy. I recognise that there may be parental objections to corporal punishment and I am aware of its limited advantages. If we suggest greater parental involvement, parental views must be respected, and a genuine objection to the use of corporal punishment must be respected.
However, I have some reservations about the proposed legislation, especially if it follows the Government's consultation paper. Compromise is often the worst of both worlds, and that could be so in this case. I await the Government's Bill with interest, but I ask the Minister to give attention to the problem of differing punishments for the same offence. Two pupils might commit the same offence and the teacher could impose different punishments. I seriously doubt whether the proposed legislation in this respect would work.
I said that legislation is not the answer to every ill. The Opposition seem to think that legislation and more money will solve the problem. They do not. I remain interested in the working parties set up by the Secretary of State for Social Services into the future of the social services. He suggested that a new Beveridge was needed, but that could not be incorporated in this year's Gracious Speech because the reviews have not been completed. I await the outcome with great interest. Undoubtedly, a wide-ranging and radical reform will have to be undertaken, and I hope that the next Queen's Speech will contain such a proposal as the beginning of a phased programme of social welfare reform. As with the changes in education that have taken place in the last five years, and the proposed changes in occupational pension rights, it is long overdue.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
I hope that the hon. Member for Erith and Crayford (Mr. Evennett) will forgive me if I do not follow him exactly on the question of pensions, because I want to stay at the Elephant and Castle and talk more about the social security aspect of the debate.
The hon. Member suggested that perhaps we could not expect too much in this Queen's Speech because everything is under review or always being called into doubt. If the Secretary of State is to make proposals on the occasion of a future Queen's Speech—I do not think that his timing involved that intention as we can expect action from him sooner—I hope that, following some of his remarks about what will happen to the system of benefits as a result of his radical overhaul and review, our worst fears will not be proven.
At the time of the Budget there was a Treasury Green Paper dealing with public expenditure into the 1990s. Even then it was clear that there would be great difficulty not only in the DHSS but in all the spending Departments towards the end of the decade and thereafter. The Green Paper acknowledged that the aim was to set spending in 275 real terms at a fairly stable level between now and about 1986, and that subsequent decisions would have to be made towards the end of the decade. At that time I asked the Secretary of State whether there was an inbuilt problem, to which the Prime Minister has referred as the ticking bomb.
Largely because of the nature of the system, the growth of medical technology and the growing number of elderly people, all the financial pressures build up, so that the Green Paper is optimistic if not downright complacent. In looking at the welfare state, the Secretary of State faces the enormous problem that any decisions that he wishes to take must be within the straitjacket of that problem and the guidelines set down by the Treasury. I notice that he is nodding either in comprehension of, or agreement with, my argument.
I recall that the Secretary of State was rather sceptical when I raised the point earlier in the year. He felt that it was not as great a problem as I was envisaging. As the reviews continue, leaks emerge from the DHSS about what is being considered. I appreciate the Secretary of State's point that in a proper review it is necessary to look at everything. But there are indications that the thinking behind the review is largely related to meeting the kinds of demands that were highlighted by the Green Paper and that have been highlighted since by the continuing pressure on public expenditure. That has placed the Secretary of State and his ministerial colleagues in an extremely difficult position.
I would argue that the reviews are fatally flawed. For a Government who preach the ethics and the business approach of the grocery shop in Grantham, it seems ridiculous, when looking at something as complex as the system of public expenditure as it manifests itself in benefits, to look only at the expenditure side of the account and not at the income side, particularly with regard to tax, and, most controversially, tax concessions.
It would seem to be cackhanded, to say the least, to suppose that anything approaching a fundamental or radical reappraisal of Beveridge — to use the Government's phrases since the reviews were announced —can be carried out when only one side of the scales is examined. The Secretary of State and his former colleague, who has gone to the Northern Ireland Office, will confirm that much of the evidence submitted to the reviews argued that there should be an integrated tax and benefit system; that the reviews should look at both tax and benefit and not just at benefit. The sense of disappointment or unease concerning the reviews is underlined by the fact that the stipulation that is frequently repeated is that they must be carried through on a revenue-neutral basis.
I hope that hon. Members in all parts of the House agree with the Secretary of State that there is a need for a radical and an unashamed look at the way the welfare state operates and at how it can be made more efficient—whether tax and benefits should be integrated and whether it is possible to be more selective. Will the Secretary of State agree that the points which have been put to him —more eloquently and in more detail than I can put them tonight—over the past few months are bound to undermine seriously the course of his investigation?
In the past two weeks it has become apparent that the Secretary of State is having to fight with the Treasury the age-old rearguard battle for his Department's spending. That hardly suggests that a radical reappraisal is taking place. It leads us to believe that ultimately the Treasury 276 will use the review as a means of cutting further areas of public expenditure, without allowing any attempt to introduce a better system.
It is, perhaps, not surprising that the Gracious Speech makes no reference to the reviews or the benefits system generally. Nevertheless, it is a considerable disappointment. It is easy —as the Labour party spokesman, the hon. Member for Oldham, West (Mr. Meacher), showed earlier — to oppose the Government from a very destructive point of view. But we have also to be constructive. If we cannot make reasonable suggestions, at least we should try to put down some reasonable markers to show our areas of concern.
The alleviation of poverty — an aim, presumably, with which all parties would agree—cannot be discussed without focusing the argument on the need for administrative efficiency. I think that the Secretary of State would agree with that. It should also focus on the extension of choice. I think that he would agree with that. As many have argued, we should try to move towards the elimination of the poverty trap and the unemployment trap. I think that there is a consensus in the House in that respect.
An increasing number of people are dependent on means-tested supplementary benefit. If the system were simplified, it could lead to a greater take-up of benefit. We should try to do something about the vast, complex network of means-tested benefits, and move towards a more straightforward basic benefit. That could then be topped up by housing credits, child benefits or child credits, or by clothing or heating benefits.
The computerisation of the PAYE system offers an excellent opportunity to integrate the tax and benefit system and to move towards direct payments in cash, if not in kind, and to increase the level of take-up.
When the Meacher committee examined many of the problems, a senior official at the Inland Revenue talked about computerisation. I cannot speak for the Treasury Bench, but I confess to having no knowledge of the problems raised by computerisation. It was disturbing that the Inland Revenue official made it clear that if the configuration of the computer brought in to computerise PAYE was not correct, it would be impossible to develop the system radically for many years thereafter. It is a crucial problem, and I put that to the former Minister for Social Security when I gave oral evidence to his review committee in the summer. Ministers must ensure that the correct type of computer configuration is used so that further development will be possible. The Government and future Governments should not be thwarted in any attempt to eradicate poverty simply because of a technical failure by the Inland Revenue.
There is heated debate within the Cabinet, the Government and the House about what is to happen to benefits. Like many others, I should like to make a special plea to the Secretary of State about supplementary benefit. If we can believe what we read, the Secretary of State has put up a courageous fight against the hard-faced men in the Treasury. He will have the full support of the Opposition Benches as he continues on his wet-ward way. On price protection and uprating, we hope that the right hon. Gentleman will be able to stick to what we had understood to be the stance of the Conservative party under the leadership of the present Prime Minister, particularly in relation to supplementary benefit and the long-term benefits.
277 In their 1983 general election manifesto, the Conservatives pledged that:In the next Parliament, we shall continue to protect retirement pensions and other linked long-term benefits against rising prices.As far as pensions are concerned the Government have stuck to that commitment, but there is now deep concern about the promise aboutother linked long-term benefits".
Those benefits were listed by the Chancellor in an answer to the right hon. Member for Bethnal Green and Stepney (Mr. Shore)—the shadow Leader of the House—on 11 July 1983. Long-term supplementary benefit itself was not included in the list. The doubts and concern were deepened by exchanges between the former Leader of the Labour party, the right hon. Member for Blaenau Gwent (Mr. Foot), and the Prime Minister about supplementary benefits and long-term linked benefits, in which it became clear that the Prime Minister was departing rapidly from the pledge that she seemed to have made.
Unemployment continues to bite hard and the numbers of the long-term unemployed are growing. It is surely inconceivable that the Government will not be able to pledge themselves to maintain the comparative value of long-term benefits. I hope that the Secretary of State will continue to make every effort both during and after the review process to ensure that they do.
I should also like to mention child benefit. In the 1983 election manifesto the Government reiterated their commitment to maintaining its value. The Prime Minister has reiterated that commitment again since the election, and on 27 June the Secretary of State repeated the promise in reply to a question from the then hon. Member for Islwyn (Mr. Kinnock). He had asked:Will the Secretary of State give a categorical assurance that there will be no introduction of means testing for child benefit, nor a reversion to a system of tax allowances?The Secretary of State said:On the first question, I give the hon. Gentleman a categorical guarantee about child benefit. We do not intend and never intended to change the basis of that benefit. That was just another scare during the election, which was denied at the time." —[Official Report, 27 June 1983; Vol. 44, c. 357.]More recently, the Secretary of State referred to the subject in Question Time. I hope that he will be able to stick to what he said then, not just until the dust settles over the current round of reviews, nor just during the longer term reviews, which he has described as the most radical since Beveridge, but as long as he occupies his present office. I hope that he will continue to set his face firmly against any increased selectivity or taxation of child benefit, which would be immensely damaging and would, I believe, be opposed not just by the Opposition but by significant quarters of the right hon. Gentleman's own party. To be fair, I believe that the Secretary of State shares our view. I wish him success in the battles that he will have to fight.
The Queen's Speech is thin in general, but nowhere is it thinner than in health and welfare. Perhaps we should breathe a sigh of relief that the Government do not wish to do too much this year.
§ Mr. Kennedy
The lack of health and welfare measures can only reinforce the view that, whatever is said at the Dispatch 278 Box or at party conferences, the Government are increasingly isolated and insulated from the problems which people face, especially in the north of England and in parts of Wales and Scotland. Poverty is biting more and more deeply. In that respect, the Government do not represent the majority of the people. They do not enjoy the confidence of the majority of the people. Nothing in the Queen's Speech will dispel the growing awareness that the Government are out of touch with those in poverty and have indeed increased their numbers, and have proved themselves supremely unable to combat the ravaging effects of their own policies. We cannot support the Government in that aspect of their policies but, where the Secretary of State is able to fight a valiant rearguard battle and to preserve benefits, he will have our full support.
§ Mrs. Virginia Bottomley (Surrey, South-West)
Reference has understandably been made in the debate to the Beveridge report on the welfare state. Those who established the welfare state would be disappointed that, in the face of mounting affluence and an enormous allocation of resources, there are still unmet needs in our society.
Seventy-seven per cent. of us own colour televisions, 81 per cent. have washing machines and 61 per cent. have cars. We should not forget our recent debates about Ethiopia, or forget that the average income in India is one fiftieth of the income of people on the poverty line in America. The Secretary of State has pointed to the huge allocation of resources by the Government to social security. Thirty per cent. of all Government spending is on social security — a budget of £37 billion a year. Every day, £100 million is spent on benefits. Of every £10 entering the family budget, £1.80 takes the form of benefits.
As some needs have been met, new needs have been uncovered. Some appear among the casualties of affluence, and others are connected with population changes.
During the next 30 years the number of those aged over 70 will increase by more than 15 per cent. and the number of those aged over 80 will increase by 50 per cent. It is in part a tribute to the success of the welfare state that life expectancy has been so greatly increased. Income maintenance is important to the elderly, and we must continue to produce the wealth from which we will pay the benefits, but it is even more important to create the economic stability which will release pensioners from the fear of inflation. Transport policies, housing programmes —I recently visited projects in my constituency which are examples of pioneering work in sheltered housing—and law and order are important for the elderly. Contrary to the statistics dealing with violence, many old people are afraid to go out. The police and the establishment of victim support schemes are therefore important in restoring their confidence. Health provision is vital to their welfare. My right hon. Friend has mentioned improvements in patient care which make a lot of difference to them. The 30 per cent. increase in hip replacement operations in five years has made more difference to the lives of the elderly than would have many other measures.
At Brighton last month, my right hon. Friend the Prime Minister said thatefficiency is not the enemy but the ally of compassion.279 It is right that money spent on the Health Service should be spent cautiously and well. I hope that the Government will encourage the establishment of "well elderly clinics". In many areas there are far more people caring for the elderly than for children. We make tremendous efforts to prepare people for parenthood but do little to prepare them for caring for an elderly relative. Monitoring their welfare, the overprescribing of drugs and undetected medical conditions are all part of providing a service for the elderly.
I welcome the choice in residential care for the elderly. There is local authority, voluntary, private and housing association provision. However, I urge the Government further to develop their range of measures that are designed to improve the registration and inspection of homes for the elderly and to set proper standards and procedures to maintain them. I also urge the Government to consider clarification and co-ordination of methods to finance the variety of provision and to examine some of the anomalies.
Shortly after Beveridge's report, George Orwell wrote "1984". When considering the welfare state, some people may think that the Big Brother world of "1984" is all too apparent. When we listen to speeches such as that made today by the hon. Member for Oldham, West (Mr. Meacher), who wants to establish a monopoly of provision and is suspicious of any private or voluntary contribution, we may feel that "1984" is here. As in the industrial world, welfare needs the "doers and go-getters" to provide diversity. I am vice-chairman of the National Council of Carers and their Elderly Dependants. It was founded by "a doer and a go-getter", Rev. Mary Webster, in 1965. She noticed that single ladies with elderly relatives were often absent from church. Being absent from church is a sure way of getting a voluntary organisation founded on one's behalf. That is how Edward Rudolph founded the Church of England Children's Society. The National Council provides support for people who care for elderly relatives at home. Some 95 per cent. of our elderly are at home and four-fifths of the over-85s are at home. The National Council provides advice, companionship, and informed lobbying and it urges respite care. It is in the best tradition of voluntary activity to meet a need.
My hon. Friend the Member for Poole (Mr. Ward) mentioned a Chinese proverb. I should like to repeat a proverb that I was told when I spoke at the India Welfare Society recently: "Light a candle; do not curse the darkness." We have many examples of people who have been prepared to light candles. This is the centenary year of the National Society for the Prevention of Cruelty to Children, which was established to meet a need. In my constituency there are many examples of welfare provision that individuals and groups have set up autonomously. The Phyllis Tuckwell memorial hospital cares for the dying. We have the Alzheimer's Disease society and a club that provides for the care of the mentally ill. It uses volunteers who provide a service for the mentally ill and educates the public about the implications of mental illness. I welcome my right hon. Friend's initiative, which was announced in July, "Helping the Community to Care" under which £10.5 million was allocated over three years to assist volunteers, families, neighbours and others to care for the elderly.
In the welfare state there is a great danger of recipients feeling patronised by the providers. I spent many years as a social worker and will always remember a colleague 280 telling me, "Teaching reading and writing in schools is really imposing middle-class values on working-class children." What absolute nonsense. Nor shall I forget the chairman of a school governing body telling me that when he selected staff he had to establish that they were ideologically committed to mixed-ability teaching because his primary goal was to achieve a classless society. That might be a laudable aim but riot from a chairman of a board of school governors. That principle certainly did not apply to his football team.
I welcome the plans of my right hon. Friend the Secretary of State for Education and Science to enhance the role of parents on school governing bodies. This is another example where the people involved often know as much as the experts. I welcome the decision of my right hon. Friend the Secretary of State for Social Services to consult the public in social security reviews.
Governments can allocate resources. They can ensure that they are competently and carefully administered. They can introduce legislation when valid grounds for introducing laws have been established. The Gracious Speech contains many such examples. Governments can also lead public opinion, respond to concern, promote debate and achieve good practice so that individuals, families, groups and communities, whether professional or voluntary, can work together to help the vulnerable, alleviate distress and meet disadvantage with the hope of improving the well-being of all of us.
§ 7.6 pm
§ Mr. Frank Field (Birkenhead)
One of the advantages of being called late is that one sees how other hon. Members have tackled the task of applying themselves to the Gracious Speech. I have an added advantage in that I am speaking after the hon. Member for Surrey, South-West (Mrs. Bottomley). I hope she does not mind my recalling that, some years ago—she does not look as though it was many years ago—we worked together in the Child Poverty Action Group which is concerned with the welfare of poor families. She talked of the importance of people who go out into the world and light a candle. In one important respect she lit a candle at CPAG. Since the second world war, no one other than she has studied how poor families have managed over time. Many studies have taken snapshots but they have studied different people. Although many people remain poor for a long time, the number of people who move in and out of poverty, even at today's level, is significant.
I should like to pay the hon. Lady another compliment. When she stood up I was not sure what she would say. It is a great compliment to be able to say that an hon. Member's speech is not predictable. I hope that we shall hear her often.
I hope that my speech is not so standard as to be predictable. I should like to examine two areas of Government policy in which the Government have clearly outlined objectives but which, on analysis of progress towards them, appear flawed. The first is the economy.. which I shall relate to the numbers of people in poverty. The Government are right to believe that it is foolish to try to separate the living standards of the community from the wealth generated by it. However, that should not be the only part of our debate as we should consider how to distribute wealth, whatever its level.
The Government's strategy to increase prosperity is clear. Hon. Members will forgive me if I remind them 281 what it is. The Government believe that the chances of increasing prosperity are increased if the rate of inflation is reduced. We must agree that the Government have succeeded in that, although some people have had to pay a considerable price for it. There has been a massive increase in the number of people unemployed. We cannot talk about a burden of unemployment which we share. Unemployment is not spread fairly throughout the community, but is borne by a minority. The price of reducing inflation is being borne by a minority of people.
Secondly, the Government say that reduced taxation will increase incentives. Their record on that is, at best, mixed. Thirdly, and most important, the Government believe that they can generate business prosperity by controlling interest levels.
That brings me directly to the debate which the Cabinet held this morning about the level of Government expenditure, and especially the level of Government borrowing. The Government claim that, if expenditure is not met by taxation, the difference must be met by borrowing. One can increase Government borrowing only if one borrows in the money market at increasingly favourable rates of interest. Therefore, the Government have set a target to reduce the public sector borrowing requirement as a percentage of the gross national product. There is a weakness in that strategy. In every other recession or trade cycle Government borrowing has increased. It has almost acted as Adam Smith's hidden hand. It has been the mechanism built in the economy to push the economy from the bottom towards growth. The Government have sought to reduce public sector borrowing in order to reduce interest rates and encourage business prosperity. That belief is central to their strategy.
I question whether the Government strategy can be successful because the natural mechanism in the economy to restore the movement back to full employment has been butchered by their intention to reduce PSBR as a percentage of national income. Therefore, the general prosperity for which they hope will not occur and there will be less money for the poor.
I turn to the objectives which the Government have set themselves regarding the poor. They seek to decrease the number of poor people and to increase the number of people who can free themselves from poverty. Yet in the Gracious Speech there is no mention of the Government's intentions regarding poverty. That is not because they have been successful in reducing the number of poor people. Perhaps the Secretary of State will at some stage tell the House when it can expect the next round of figures on the numbers of people on low incomes. The most recent figures relate to 1981. The Government must have the 1983 figures to hand. When they are published, hon. Members will not be surprised to see an increase in the number of poor people measured by the number living on supplementary benefit.
There is another contradiction in the Government's programme to free people from poverty and to give them an income above the poverty line as of right.
§ The Secretary of State for Education and Science (Sir Keith Joseph)
The hon. Gentleman's speech is so interesting that I wish to ask whether by "low incomes" he 282 means individual low incomes, which may go to someone who is a member of a relatively prosperous household, or household low incomes.
§ Mr. Field
I mean household low incomes, because that is how the Government analyse the figures. In the analysis of low income families made by the hon. Member for Surrey, South-West she showed how important additional incomes, especially those of children, were to a household in raising the household income above the poverty line. The Government are considering that point in their review, and I hope that they will read what the hon. Lady said.
I come to the inconsistency in the Government's social programme. We must consider the level of national insurance benefits if we are to be successful in giving people an income which raises them above the poverty line. Yet the Government's record shows a list of national insurance cuts. I could give a list of social security cuts, but it is more difficult to give a list of health provision cuts. I hope that the Secretary of State managed to fight his corner with the Treasury by pointing out cuts which it had previously made in his budget.
As most people do not have large bank balances to fall back on, if national insurance cuts continue, they will be thrown back on the supplementary benefit system. Therefore, the number of people on low incomes and on means-tested low incomes will increase. If we seek to build a welfare state which will act as a floor on which people can build by their own efforts and free themselves from poverty, we must question an overall strategy which pushes more and more people to means tests, builds a ceiling over them and makes it immensely difficult for them to free themselves from poverty.
Child benefit has been alluded to by many hon. Members. It is a topic which the Government are currently reviewing. There is talk that the level of child benefit should be taxed. Before the Government announce their decision, I hope that we shall have an open debate about the pros and cons of such a move. I would not oppose the taxing of child benefit if all the revenue that accrued from it were ploughed back into the child benefit scheme. The Secretary of State could then announce an increase of about £2.30 a week in child benefit. As other hon. Members have pointed out, the Government have met their commitment to maintain the child benefit level in real terms; indeed, it is at a record level.
The Secretary of State will agree that, although the value of child benefit has been maintained, we have not maintained it at a sufficiently adequate level to keep it in line with changes in the tax threshold. Because of that there has been a change in the tax burden, both from rich to poor people and from those who are single without children to those with children. Another Government objective is to protect the family. I am worried about the change in the tax burden from those without children to those with children because we have not increased child benefit in line with changes in the tax threshold. Such a change would give the Government leeway to make up lost ground, but the lost ground will not be made up if the Secretary of State must surrender to the Chancellor of the Exchequer the revenue that results from taxing child benefit, because the Chancellor would use it to make other changes in the Government's programme rather than to increase child benefit.
283 Another reason why I urge such a change is that the more we consider the relativities of benefits and tax levels, the more we discover that they derive from the work done by Steven Rowntree at the turn of the century. Although he was fairly accurate in working out the minimum needs of men, he guessed the minimum needs of women and children. We know from what our European neighbours and the Americans have achieved in their budgetary studies that the benefits we pay to children are inadequate compared with those paid to adults. A change in child benefit financing such as I have outlined would allow the Secretary of State considerable revenue to make a major change in the welfare state that would begin to redress that historic grievance.
Above all, such a change would mean that the higher child benefit becomes, the more secure is the floor on which families can build futures for themselves. Although Labour Members say that that strategy alone is inadequate, we would be foolish to deny that it is part of the strategy that we wish to adopt.
I have raised some questions about the Government's economic strategy, which I believe is faulty. There are also faults in the social security system. However, I have ended with what I hope will continue to be a note of agreement across the Chamber about the importance of child benefit and the slow but sure steps that we should make in public debate about child benefit. If child benefit is taxed, we should use the revenue to increase child benefit rates.
I have ranged wide of the Gracious Speech, but I justify my contribution by saying that, although the subjects were not mentioned in the Gracious Speech, they will begin to dominate Parliament as the months go by. It is perhaps better to discuss some of them in a rather cooler atmosphere this evening.
§ Mr. Walker
I misread the list of Members. I knew that it was the Liverpool or Birkenhead area, because the hon. Gentleman is not appreciated by some people in the Labour party to the same extent as he is appreciated in the Chamber. His contribution was valuable and constructive, and although I do not agree with everything he said, it was put in a way that would not give offence; many of his colleagues could learn from that. I wish that we could transfer abilities that are valuable in the Chamber to our constituencies, where perhaps they would be properly understood.
I am sorry that the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) is not here. He said that unemployment in Scotland was especially ghastly, and I would have wished to have drawn to his attention the position in the Western Isles. The crofters there live on and work their crofts, yet they register as unemployed and obtain unemployment benefit. More importantly, they register as long-term unemployed. They and we know that the chances of their being offered jobs are extremely remote —I wonder whether some of them want jobs. They have helped substantially to distort the unemployment figures.
The Select Committee on Scottish Affairs recently visited Norway to consider the position of similar crofters 284 in northern Norway. Their incomes are made up, by an organisation equivalent to the Scottish Development Agency, to about the national average wage for industrial workers. The amount involved is about the same, but the impact is different when one considers statistics. One country has low unemployment in its remote, sparsely populated areas, whereas in western Scotland and other remote areas of Scotland the unemployment figures are horrendous. Perhaps we could learn a lesson from Norway.
Along with many hon. Members, I must draw attention to something that the Queen's Speech did not say. I am sorry that there are no proposals to change the Civil Aviation Authority, and I am especially disappointed by the absence of a proposal to introduce a formal appeals procedure against decisions by national air traffic services. Parliament has given the CAA quango dictatorial powers against which there is no formal appeals procedure. That cannot be good for the quango, it cannot be good for the individuals who are affected by it, and it is certainly no way to run affairs in a democracy.
Today's debate is about education, health and social services, and I shall talk about their position in Scotland. Although my proposals and thoughts are primarily about Scotland, they are relevant to other parts of the United Kingdom. In some Scottish schools, there are disruptions and forced breaks in children's education. The teachers tell us that they are on strike. I suggest that some of them are behaving like members of an industrial trade union, not like members of a professional body, as they keep telling us they are.
Teachers behaving in this way cannot expect to enjoy the continued support of taxpayers for the maintenance of their professional terms of employment. They cannot expect to continue to receive support for the job-for-life element. In these difficult times, when we are all properly concerned for the many whose jobs have vanished and who are unemployed, how can hon. Members support or justify such a job-for-life element for individuals who have abandoned the most basic of their professional requirements — their duty to the children, the maintenance of standards and the setting of examples?
I suggest to my right hon. Friend the Secretary of State for Education and Science that, when consideration is given to any request that teachers' pay and conditions be examined by an independent review body, one condition for the acceptance of such a proposal should be the introduction of measures to put teachers on the same basis as industrial workers whose practices those teachers are emulating. If they act unprofessionally and strike to the detriment of children, they should be treated in that way. In future, teachers should reap the rewards of their actions and be given terms of employment covered only by the employment protection legislation.
In that way, teachers will be in a position similar to that of unprofessional bodies, which have never claimed to be professional but which use the strike element as a means of putting pressure—properly in a democracy—on their employers. However, it is improper for people who claim to be professionals to expect to enjoy professional codes, of conduct and conditions of employment, but then to behave unprofessionally.
In Scotland, the time has come for the Government to take a cold, hard, look at how we fund Scottish Health Service facilities. Much of the aggravation that we, as hon. Members, face, particularly about health provision, 285 is created by local demand to maintain facilities and services. I cite the example of the cottage hospitals, and the ever-increasing pressure by health boards for centralisation of services in large cities, with the consequent closing of cottage hospitals. This leads to demands by people living in rural areas for changes in the way that decisions are made, and pressure is put on the Secretary of State each time a cottage hospital comes up for closure for him to veto that closure.
That is why we should be looking also at the way that health boards in Scotland are managed and run. If we accept that the challenge of future funding will call for a dramatic new approach, I recommend that the Government examine the viability of handing over to the regional councils the responsibility for running and managing health boards in Scotland. It happens that the regional areas are the same as the health board areas. At the same time, the Government could look into the practicality of doing away with the local authority rates, a measure that I am confident will receive widespread support both in the House and outside. The alternative fund-raising—we all realise that funds have to be raised —could be done by introducing a local income tax in Scotland, making use of the computer facilities that already exist at centre 1.
There could also be a provision for local income tax to be raised at regional level. If these two changes were implemented, they would remove control from the unelected health boards, which are described by many in Scotland as being run by nameless and faceless people. No matter how good or dedicated they are, they are unknown and are appointed, so the public rarely knows who they are. Control could then be transferred to the regional councillors, who would be faced with elections at regular intervals, and so should be more responsive to local demands and situations. In this way, we would make the whole system more democratic but, more important, the funding and the raising of funds would be spread over all the taxpayers in the way that it is not at present in local authority spending.
There would also be advantages for other sectors, but as today's debate is about health and not about police and fire services, I shall not mention them. However, there would be tremendous advantages in making the local people pay for the local services provided, and what is more important than Health Service facilities?
In the remote part of Scotland that I represent, every time that there is a demand by the local health board for a change in health provision, pressure groups build up. They base their case largely on the problems that arise in the winter months, when many communities are isolated. It is not unusual for communities to be isolated for weeks at a time, and last year there was the appalling situation when many thousands of skiers were isolated at the head of Glen Shee in my constituency.
Therefore, we require both emergency facilities that are readily available and hospital facilities. Any pressure to close hospitals close to Glen Shee would receive short shrift, but other parts of Scotland have similar problems, with roads that are regularly closed. It is unwise to have all the health care located in large cities, because the distance from these cities to many points where problems 286 may occur can be long, and in the winter months can mean the difference between life and death for critically ill patients.
At the moment we are looking at and reviewing local authority funding. Would this not be a unique opportunity to give health care to those who are represented locally and elected locally, instead of to appointees?
Earlier in the debate, the hon. Member for Brent, South (Mr. Pavitt) made some observations about the tobacco industry. I have no interest in the tobacco industry. I am a non-smoker, and have never smoked. I am concerned because the hon. Gentleman continues to promote the idea that somehow the Government can take action to stop people smoking. There is only one way to do so, and that is by education and by encouraging people to change their ways. He seems to ignore the contribution that the tobacco industry makes world-wide to the economies of so many nations, and in particular to the well-being and education of Third world farmers. It provides training in crop rotation and husbandry, as well as giving the necessary funds to carry out these changes.
If we follow the logic of the hon. Member for Brent, South, he is asking us to ban all car driving because there are so many accidents on our roads. That is nonsensical as well. I do not doubt that the hon. Member for Brent, South cares deeply about this matter, as do many of us —I care deeply myself. However, I do not believe that the House or the Government should consider introducing nanny-type Acts which would probably fail because, like prohibition in the United States, they would not work.
§ Mrs. Ann Clwyd (Cynon Valley)
I have been listening all afternoon to the interesting speeches from the Conservative Benches. They have accused us of being devoid of ideas on the NHS. I commend to their attention the report of the Royal Commission on the National Health Service, on which I had the good fortune to serve for three years up to 1979. The report had the misfortune of landing on the desk of a Conservative Secretary of State for Social Services. Unfortunately, most of the recommendations in the report have not been implemented by the Government. If they are looking for ideas to promote the NHS, I suggest that they look again at the main recommendations of the report.
My hon. Friend the Member for Oldham, West (Mr. Meacher) mentioned the resignation from the Cambridge area health authority of one of our leading paediatricians, Professor John Davies. My hon. Friend read extracts from the letter of resignation, a letter that is well worth reading again. Professor Davies said:You will know that my attitudes are essentially conservative, but there comes a time when one must be seen to live up to one's professed principles and true conservatism means recognising that the economy is made for man, and not vice versa … If we are not prepared to pay the economic price for acting morally, we may end up by paying the moral price for acting economically.
The Secretary of State for Education and Science is here now, and I remember him giving evidence to the Royal Commission on the National Health Service. He was asked whether the reorganisation of the NHS in 1974 was, in his opinion, a good or a bad thing. He gave the question a good deal of thought and in reply said that, on reflection, he thought that it was a bad thing. Perhaps the right hon. 287 Gentleman will also think that some of the cuts that the Government are now inflicting on the NHS are bad things when he comes to reflect in three years' time.
I want to deal specifically with the implications to the NHS of rate capping. Paragraph 16.2 of the Royal Commission's report on the NHS said:Good co-operation between the NHS and local authorities is important because their responsibilities overlap. The most common example of joint responsibility is the care of infirm elderly people. Many of them can be looked after at home without over-burdening the family if the local authority is able to provide a home help and meals on wheels, or day care and social work support, or sheltered housing; and the NHS provides family practitioner, health visiting and home nursing services. If these services are not available and properly co-ordinated where they are needed, an elderly person may need to go into an old people's home, or hospital. Effective co-operation is similarly important to the other main patient and client groups who require help from both NHS and local authority services — the mentally ill, the physically disabled and the mentally handicapped — and for the individual person at risk. Cost considerations apart"—I am sure that Conservative Members will agree with this—most of us would prefer to live at home rather than in an institution or hospital, however congenial. It is obviously desirable that services should be provided in a way which makes the life of the patient as independent and satisfying as possible.
In his excellent pamphlet, Dr. Peter Draper has written at length about the health implications of rate capping. He has come to the conclusion:Demands on community care services"—and "community care" is a phrase much favoured by the present Government—are currently increasing for three main reasons. First, there is the age factor—the absolute and proportionate number of the old and very old is still increasing— and, secondly, Health Service policies to close large psychiatric and mental handicapped hospitals create new and substantial needs for community care. Thirdly, new social legislation has increased the statutory services which a local authority must provide. The Criminal Justice Act 1982 is an example.
Government policy has encouraged the development of voluntary organisations as an economic way of providing services. Voluntary organisations generally are involved in initiating new projects and providing services for the less popular groups such as alcoholics and problem drug users. Such services are mainly or sometimes exclusively funded by local and central Government.
The probable impact of rate capping on community care is serious. While the probable effect of rate capping on local government services relevant to prevention and health promotion are on their own disturbing, the impact on community care, if the proposals are fully implemented, can only be described as catastrophic. The existing services are at the moment under considerable strain. For example, an inner London health visitor recently said:We estimate that on our patch there are at least six families which need social work input. They are not getting it because there is such a shortage of staff. Area offices just cannot accept any more case load. Health visitors and district nurses are doing quite a lot of work which should be undertaken by social services. We no longer even try to refer some things because it is no use.
There are three main reasons for concern about the impact of rate capping on community care. First, the Government's estimates of appropriate personal social service spending are strikingly lower than those judged necessary by local councillors and officers. For example, the Association of Directors of Social Services calculates the difference for London as being £126 million which 288 would necessitate cuts equivalent to the total spending on homes for the elderly and home help services in London. For inner London, Government calculations allow for only 72 per cent. of planned spending.
The second reason for concern is that increasingly spending is falling on local government because of Government policy to shift care to the community and away from hospitals. That is universally seen as more desirable from the individual's point of view as well as a cheaper way of providing the same service. Joint financing arrangements with the NHS were introduced to assist that process which was aimed particularly at closing large hospitals for the mentally ill and the handicapped. Under those arrangements central funds are available for health authorities to work with local authorities to set up community-based services. However, over a few years local authorities are expected to take over the revenue consequences. Therefore, while Government funds are saved, local government picks up an increasing share of the bill for community services.
What joint financing means in practice can he illustrated by some figures from the London borough of Islington. With 340 Islington people in long-stay hospitals for the mentally handicapped and about 300 people in mental hospials, even if only 500 were returned to the community, about half of them because of the financial responsibilities of the borough, spending would be increased by £2.3 million. Currently, that additional spending would incur block grant penalties of £6 million.
That bleak climate affects those who are responsible for trying to plan and improve community care. The district medical officer of west Lambeth said:The main danger is to our carefully laid plans for care in the community. We envisage taking responsibility in the community for some 400 elderly, mentally ill and handicapped people over the next 10 years, opening seven residential homes a year together with associated day care all over the district. We are utterly dependent on the local authority and its ability to support these initiatives.
The third reason for concern is the impact on voluntary organisations which rely so heavily on local authority funding. As one community health council secretary put it recently:At present the council fund a wide variety of voluntary groups, including community transport, MIND, contact to family, the local disablement association. All those groups supply services to help maintain individuals in the community. Rate-capping will seriously affect this work and could lead to many organisations folding.
The voluntary organisations providing services for alcoholics, for the single homeless and for problem drug users face particular difficulties as the services they provide are not seen primarily as a local responsibility. for example, in 1983–84 services for drug takers in Greater London received £388,400 from the Government. Of that, £155,000 came from DHSS pump priming grants, and local funding is required to take on those services in the next few years. But given the present constraints, even previously sympathetic councils are not able to provide or promise future funding under the scheme. So future funding for those services is seriously threatened.
For the Government, one of the attractions of the move to community care has been the hope that financial savings might be made. However, that is not borne out by many authorities. For example, the director of social services in Newcastle recently estimated that a scheme for the mentally handicapped worked out by his department would cost £15,000, instead of £8,200 for institutional 289 care. A very important article in the journal Public Administration looks at spending trends in joint finance, and concludes:The way in which these resource trends have impacted on personal social services and the community care strategy in particular can be summarised as follows. First, recent Government policy has tended to squeeze out cost effective community care by the severity of the constraints placed on local authority spending. An attempt has been made to mitigate this by the use of joint finance, but in a harsh resource environment local authorities have a very limited capacity to pick up committed growth of this kind and are likely to make less effective use of such moneys. There has been a tendency to give higher priority to the mentally handicapped partly as a result of joint finance, but this has been accompanied by a worsening position for the elderly.
The move to discharge patients from mental illness and handicap hospitals has led to an increase in the current boarding and lodging allowances paid by the DHSS. The rapid growth in the number of private homes for the elderly has also increased social security spending in that area, especially as the Government's financial commitment has appeared to be open-ended. In a report to the Select Committee on Social Services the Association of Directors of Social Services alleged that private lodging-house owners were receiving as much as £80 a week from social security in order to house mentally ill and handicapped people in shared rooms. The association's president stressed that the potential waste of public money was enormous.
The British Association of Social Workers, in evidence to the Select Committee on Social Services, said that more than one fifth of all local authorities were refusing to take on further commitments in joint finance. Much of the evidence to the Select Committee on Social Services which considered community care commented on the need for more finance to promote a real shift towards the community and on a need to measure the results of extra resources.
Although much concern has been expressed about the slowness of the move towards community care, many people are worried about the effects of the initiatives that have already taken place. Large institutions are closing without the necessary facilities being available to care for ex-patients. When the Secretary of State for Education and Science was Secretary of State for Social Services, I was on the board of a regional health authority which thought that its duty was to close as many mental handicap hospitals and institutions as possible and to cut their populations by half. Many of those people were discharged into the community without adequate resources being made available. Some of them were readmitted to those hospitals because of malnutrition while they were being looked after in so-called community homes.
The Richmond Fellowship produced a report in 1983 on mental health policy entitled "Mental Health and the Community". It said that the number of hospital beds was being reduced at a far faster rate than the replacement community option was being constructed. An article in the magazine World Medicine describes the difficulties of mental patients after discharge which have resulted in a surge in the number of suicides shortly after discharge. In its evidence to the Select Committee on Social Services, the Campaign for Mentally Handicapped People expressed doubts about private residential homes for the mentally 290 handicapped which might not meet other needs such as day-time occupation, a full and varied leisure life and access to medical and paramedical services. I certainly share that concern.
Similar anxieties have been expressed about private residential care for the elderly. An article in the Health and Social Services journal in July, entitled "Options in the NHS", argues the case for specialist geriatric services against private nursing homes. The National Schizophrenia Fellowship has strongly condemned inadequate after-care for discharged patients most recently in its evidence to the Select Committee. The implications of so-called community care for women are well documented. Often the phrase "community care" means that women are expected to care. The real costs of care are, therefore, disguised.
The Equal Opportunities Commission, in a report in 1982 called "Care for the Elderly and Handicapped—Community Care Policies and Women's Lives", concluded:The expectation that a woman will provide the necessary care within the family, whatever the cost to herself, still underpins the reality of community care. Cuts in health and social services and cash benefits intensify the demands placed on carers. They mean that there are less physical resources to aid them, less alternatives to relieve them and less money to support them. Savings in public spending increase the cost to the carer in terms of her social life, her employment prospects and ultimately her physical and mental well-being. These costs are borne individually and do not figure in any public spending accounts. The price paid is the restriction placed on women's opportunities.
Rate capping is bad for all of us, and particularly for the health of us all. We have a deceitful Government who have no scruples about saving at the expense of the old, the sick and the disabled. I have been told that this evening the Minister for Housing and Construction is jubilant at the agreement to trim spending on housing by only £65 million. In a country in which 78,000 people are homeless, 1.2 million people are on housing waiting lists, 192,000 families live in overcrowded houses, 1.1 million houses are unfit for human habitation and 390,000 dwellings do not have a bath or inside toilet, it is a disgrace for any housing Minister to claim that he is jubilant. Less money for housing repairs and improvements can lead only to a decline in housing standards, which we all know are directly linked to the health of everyone in this country.
§ Mr. John Butterfill (Bournemouth, West)
One of the pleasures of this debate has been the undoubted sincerity and compassion of hon. Members on both sides of the House when dealing with health and social security. I pay tribute to the hon. Member for Brent, South (Mr. Pavitt), who has had a lifetime of concern for the sick and disabled. But, unlike him, I was not surprised that the Gracious Speech did not contain any reference to the Health Service.
My right hon. Friend the Secretary of State pointed out clearly that the Government are committed to the Health Service and have demonstrated that by the fact that they have more than doubled expenditure on it since coming to power. Not only have the Government increased revenue expenditure on the Health Service; they have reinstated the capital-intensive building programme which the Labour party scrapped when it was last in power.
My constituency has been a beneficiary of Government policy towards the National Health Service in that its long 291 awaited new hospital at Castle Lane is to be constructed shortly. The whole of the Wessex area, which has been seriously underfunded compared with other regions, is benefiting from the Government's review of relative funding which has resulted in an acceptable increase in available resources. I am happy with what the Government are doing and have every confidence in my right hon. Friend the Secretary of State and his team.
I was not surprised that there was no direct reference to benefits and social services in the Queen's Speech because my right hon. Friend is conducting one of the most serious and far-reaching reviews of the benefits system ever undertaken. Unlike the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy), I do not agree that my right hon. Friend should seek to exclude means testing for certain benefits. I believe that one of the scourges of the present system is that benefits are not means tested. Given that we shall always have finite resources, it does not make sense to spread resources as thinly as possible over the entire population when we could, by means testing, direct resources to those most in need.
The Secretary of State should consider child benefit in particular. All hon. Members with children are entitled to receive child benefit—or rather their wives are entitled to receive it. It is ludicrous that my wife and the wives of other hon. Members should receive child benefit when, as members of the more affluent section of society, we do not need it and when poorer people rely upon it to feed and clothe their children. Through means testing we could adjust the balance. We could give more to those most in need and nothing to those who do not need it.
Similarly we should carefully examine the death grant. It is ludicrous that the grant is set at £30. It has remained unchanged for many years. We are all entitled to receive it, whereas the overwhelming majority of people do not need it. Most estates are capable of providing sufficient funds to pay for a funeral. Even in my constituency, which is widely regarded as being relatively affluent —although it has its poorer pockets—elderly people have said to me, "I cannot afford a funeral when I die. I am desperately worried about it and about imposing an intolerable burden upon my children." They say that they are terrified of going to a pauper's grave.
Some form of means testing should be used. For the death grant the form would be simple. Every person who dies has a return of probate. When the level of probate is above a certain set level the death grant should be refused. When the executors of an estate believe sincerely, and make a declaration to that effect, that the estate is expected to be such that funeral expenses would place an intolerable burden upon relatives, the death grant should be paid. We should also have power of recovery if a false declaration is made as well as a penalty if it is made knowingly. Such a scheme would be simple to administer and it would give great comfort to those who are worried about dying. At the same time, it would save a great deal of money which the Treasury could spend on the more needy.
It will not surprise hon. Members to learn that I consider the blind to be a needy group because recently I tabled an early-day motion on the blindness allowance. Before I was elected I believed, with the majority of people, that blind people received an allowance because they were blind. I was shocked and appalled to find that they received no such allowance. No special payment is made by the state to the blind. Indeed, blind people do not normally qualify for mobility allowance, invalidity 292 allowance or attendance allowance. Only if a blind person suffers from an additional infirmity does he qualify for allowances.
If a blind person is so poor that he has to rely upon supplementary benefit, he may receive an addition to that benefit because he is blind. That addition is £1.25 a week. That is to compensate the poorest in our society for the disadvantages of being blind. It does not go anywhere near covering the costs of being blind. It does not cover additional transport costs, books in brail or the million and one additional costs incurred by the blind because they are blind.
The blindness allowance has not been raised since 1969. It was first introduced in July 1948 at 15 shillings a week. According to a parliamentary answer last year, the current purchasing value of that 15 shillings is over £8. It might now be nearly £9.
We have a duty to do something about the plight of the blind. I recognise that the Government have tried to do something for them. For example, they doubled the tax allowance, which now stands at £360 a year. However, that is giving money to the one section of the blind that least needs it—those receiving income and paying tax. Seventy per cent. of the blind do not earn enough to pay tax, so the money is being given to the wrong people.
My early-day motion suggests replacing the existing benefits, such as they are, with a single, means-tested blindness allowance. I emphasise "means-tested" because it is no use taking what limited funds the Treasury can give to the blind and spreading them thinly over their entire number. We must in this, as in all benefits, ensure that they are directed to the poorest and neediest in our society. Only then can we fulfil our obligation to look after the weak.
§ Mr. Frank Haynes (Ashfield)
I welcome the compassionate speech of the hon. Member for Bournemouth, West (Mr. Butterfill). I, too, have listened to all the speeches today and there has been great compassion in those of Conservative and Labour Back Benchers alike. But there was no compassion in the speech from the Secretary of State, yet that is where it is needed. We criticise him strongly for that.
I agree with the hon. Member for Bournemouth, West about the raw deal experienced by the blind. Like him, they tell me of their problems when they come to my Saturday morning surgeries. I hope that the message will be heard by the Government and that they will take action.
The death grant is another area that needs a compassionate approach. The Secretary of State stood at the Dispatch Box today but showed no compassion. The right hon. Gentleman's speech was wicked in many respects. He spoke about the pharmaceutical industry and its profits, but did not say that he would take action to stop profits being raked off from the NHS and from those who have to pay for their prescriptions. I understand from the press that the Chancellor will announce another increase in prescription charges when he makes his autumn statement next week. That is not compassion; it does not help those in need.
§ Mr. Haynes
I cannot give way as there is little time left and many other hon. Members wish to speak.
293 I can understand why the Secretary of State does nothing about the massive profits of the pharmaceutical industry — it contributes to Conservative party funds. The hon. Member for Bournemouth, West can shake his head, but I know that that is true.
The waiting lists in the NHS are shocking. The Secretary of State says that he is pouring money into the NHS, yet the waiting lists in many areas become longer and longer. I know of many people who require orthopaedic surgery—they have made their contribution to our nation, but the Government are not prepared to help them. The Government help their own and pour money into their pockets. In 1979 they reduced income tax by 26p in the pound to help those who contribute to Conservative party funds. They will not help those in real need.
The Government ask for cost-cutting exercises and more efficiency in the public sector. Perhaps there could be more efficiency in hospital theatres, where millions of pounds' worth of equipment stands idle for many hours a day. Why do not the consultants and physicians work at night for a change, as do others in the NHS? Why do they not perform their operations at night, thereby helping more people and cutting down waiting lists? They will not do so because that would mean that they could not play golf or work in the private sector. They even make the excuse that if more people had operations there would be insufficient beds for them. The answer is that the Government should cease their rate-capping exercise because community services are crucified by the cuts. Local authorities should be given sufficient money to provide proper services so that people could leave hospital sooner and be looked after properly at home. That would make more beds available.
The Government must consider the matter sensibly. Conservative Ministers are not prepared to listen to sensible suggestions. It is political dogma. Not long ago Scotland Yard referred to the number of its officers who belonged to the Freemasons. My district health authority is loaded with people belonging to the Freemasons. What will the Government do about that?
§ Mr. Haynes
My hon. Friend is right. The Government are not prepared to listen—to them, it is water under the bridge. The Government should show a more compassionate approach and provide the finance to help those in real need.
Elderly people speak to me about their fears that they will either have a pauper's grave or have to sell their treasured possessions to meet the undertaker's bill. The Secretary of State for the Environment stood at the Dispatch Box more than two years ago and said that, following talks with the national conference of the British Legion, the death grant would be fixed at a higher rate within six months. Yet the death grant has not been sorted out — the Government are kicking it around like a football. They could not care less.
There is a shortage of nursing staff in our hospitals. We have an opportunity during the summer recess to make visits in our constituencies and to attend meetings to discover what is happening in the areas that we represent. I found that within the district health authority in my constituency there is a shortage of nurses in the mentally handicapped and geriatric services. In one instance there 294 were two nurses on night duty looking after 143 mentally handicapped patients. The fire prevention officer told me that there would be serious loss of life if there were a fire. What is to be done about that? Money can be found to buy weapons of destruction but it seems that we cannot find enough money to provide proper facilities to help the seriously ill and to provide equipment to save life. It is shocking that the Government cannot make that provision.
When I learnt that there was a nursing shortage within the health authority in my constituency I stepped back three years. The training school for nurses in my constituency has a complement of 52 but the NHS cuts led to the nursing budget being cut within the authority. The result was that only 36 young lasses were trained as nurses. Three years have passed and the authority finds that it does not have enough nurses for the mentally handicapped and geriatric services. That is an example of what the Government are doing.
I hope that Ministers and Conservative Members will wake up to what is happening. My right hon. and hon. Friends know what is going on. I had the pleasure of listening to my hon. Friend the Member for Oldham, West (Mr. Meacher) addressing the House from the Opposition Dispatch Box. Earlier, the Secretary of State for Social Services had ducked about all over the place to dodge the questions which were put to him. Those who read tomorrow's edition of Hansard will learn exactly what took place at the beginning of the debate.
What will be the end result of the Government's cost-cutting and inefficiency? I understand that there is a review taking place of the ambulance and fire services, our emergency services. Are they to be subjected to a cost-cutting exercise? If the Treasury Bench moved in that direction, that would be the limit. The Government Front Bench should be thinking again if that is the intention. If the Government are carrying out a review to improve the emergency services, I shall go along with it, but there should be no cost-cutting exercise for the emergency services.
It seems that those outside this place are not aware of the effect of the Government's cuts. I hope that the Secretary of State for Education and Science will listen to what I am saying instead of talking to his Parliamentary Private Secretary.
There will be a massive problem in my constituency in 1985 when children move from primary to comprehensive schools. The Secretary of State for Education and Science travels throughout the country talking about parental choice but that is a load of rubbish. In my area there are two primary schools that feed into two comprehensive schools. If the parents decide that all their children should go to one of the two comprehensive schools, there will be an obvious problem. The right hon. Gentleman will understand the problem and he should be aware that it is arising. Why does he travel the country telling parents that they can have a choice? The county councils' education committee in my consitituency has to determine how many children can go to one school and how many can attend the other. It is necessary to maintain the right balance because otherwise one school would be overloaded as a consequence of parents exercising their choice.
Conservative Members must realise, as I do, that from time to time a boundary has to be changed because the birth rate on one side of a town is higher than on the other. There has to be a balance and so the boundary is moved. Everybody understands that. It is wrong for the Secretary 295 of State to say at the Dispatch Box and at various conferences that there is parental choice. I wish that he would drop that, because so-called parental choice is thrown in my face when I live up to my responsibilities, meet my constituents and answer their questions as well as I can. The fact remains that the right hon. Gentleman is talking about parental choice and I am not.
§ Sir Keith Joseph
My colleagues and I try always to talk in terms of giving parents a chance to state and obtain, if possible, their preference. I agree that we cannot give them choice because of many factors, some of which have been mentioned by the hon. Gentleman.
§ Mr. Haynes
I understand that to a certain extent. The right hon. Gentleman must understand that in many areas eight or 10 parents obtain their choice of schools for their children and the rest do not. The Government must be careful in what they say. People latch on to what they say and I get kicked up the backside instead of the Secretary of State. I am not responsible for his statements and I hope that he will consider what I have said.
§ Mr. Timothy Wood (Stevenage)
I was delighted to see my hon. Friend the Member for Newbury (Mr. McNair-Wilson) in his place earlier this evening. It is extremely pleasing that someone who has been treated within the National Health Service is able to be with us once more. I endorse what he had to say about patients' rights. We must ensure that we have a Health Service that provides for the concerns of individual patients. All too often patients' private worries may not be considered sufficiently when a consultant or a nurse is endeavouring to care for a large group of patients.
I welcome the announcement of reviews of various parts of the social security benefit system which were made earlier in the year. I hope that these several studies will result in a comprehensive change to the benefit system. Over the years, as my right hon. Friend the Secretary of State for Social Services said, a variety of Governments have had many good reasons for modifying and adding to the original system, and the objectives of the system have become muddled. More importantly, the intended beneficiaries are confused. Those who administer the system have to battle through a mass of documentation and advice. There are many variations in individual needs, the complexities of the system are absurd and there is a pressing need for simplification. At the same time, income and means-tested benefits create the so-called poverty and unemployment traps.
It is indefensible, for example, that a married couple with two children can move from weekly earnings of about £60 to about £110 with virtually no change in their disposable income. For a significant band of people an increase in weekly earnings can result in less money for a family to spend. One of the causes is income tax. It is nonsense that, on the one hand, income tax may be charged while, on the other, various income and means-tested benefits are given. Yet more than 1 million families who pay tax receive housing benefit. That cannot be sensible. It is stupid.
I agree with much of what my hon. Friend the Member for Bournemouth, West (Mr. Butterfill) said on child benefit, death grant and blindness allowance, but I hope that we will not introduce a whole series of individual 296 means tests. By all means, if necessary, consider the income received through various grants and benefits within the income tax structure and assessment of total income, but let us not have further individual means rests. The position is confusing enough without introducing yet more means-tested benefits.
Our means-tested benefits are illogical and costly to administer. They are often unfair in their implementation and, furthermore, a significant disincentive to employment. For many people, if employed, they are a disincentive to work and progress. Some complain about the standard rate of income tax at 30 per cent. being a disincentive to advancement, but the poverty and unemployment traps create disincentives of a completely different magnitude.
I welcomed the substantial increase in tax thresholds earlier this year. I believe that the highest priority in any further tax changes and reductions must be to raise still further the tax thresholds and reduce the overlapping of taxes and benefits. I emphasise that this is not a new problem. Indeed, when my right hon. Friend the present Secretary of State for Education and Science was responsible for the Department of Health and Social Services, the problem was similar. Governments may come, Governments may go; but this problem has not been resolved. It is high time that it was. I hope that eventually a tax credit scheme will be introduced. I hope that, in the review of the present system, the rationalisation of the present creeping system will be directed to that objective. I hope also that a future Gracious Speech will make that commitment.
My second issue relates to education. I am concerned that some of the major industrial firms in my constituency repeatedly tell me that they are experiencing, even now, great difficulty in recruiting people for development work or other highly skilled occupations. I have been greatly impressed by the initiatives that have been taken during the past year by my right hon. Friend the Secretary of State, I strongly support the objectives set for secondary education and those in the examination system, but I remain concerned as to whether we are sufficiently extending and developing enough individuals to play leading roles in the industrial and commercial activities of the future. It is essential to our success in a highly competitive world that we exploit to the full the abilities of our people. I believe that we need to encourage more people to participate in higher education and that it is necessary to provide places for them. Only by making that investment will the more able be equipped to create the wealth and the jobs to help the less able, the weak and the elderly.
I am aware that there are cost implications in both the issues that I have raised. In the second of those issues, I believe that those cost implications are more than justified, because that investment is essential for our future industrial well-being. I do not wish to go back in another five years to the firms in my constituency and have them still complain that we are not doing enough to prepare individuals for the new technologies. If those firms are complaining in five years, this country will not have the funds at its disposal to provide for the weak and the elderly.
Similarly, on the first issue, I recognise that swiftly to change to a tax credit scheme would be immensely expensive. However, if we move gradually to such a scheme and remove some of the anomalies and stupidities 297 of the present system, we will create an arrangement that is more understandable and has more scope for help for those who need it and for incentive for those who could benefit by being able to advance in their jobs or to obtain jobs. I hope that, despite the small numbers here this evening, there will be plenty of people who will hear and read my comments.
§ Mr. Roland Boyes (Houghton and Washington)
In the short time available to me, I want to correct something that is said regularly by the Government about the DHSS strike in my constituency and my hon. Friends' constituencies in north-east England. The House and the country at large are deliberately and maliciously misled about the strike's causes, and I hope that this evening the record will be corrected and straightened out. On 22 October, in the other place, the noble Lord speaking on behalf of the Government did not once give the reasons for the strike. Speaking on 23 October 1984, answering questions in the House, the Prime Minister never mentioned the real causes of the strike. Today, the Secretary of State for Social Services mentioned the strike but not its reasons.
I do not believe that people strike for nothing. If workers go on strike, there is an underlying cause. I want to explain why the people in the north-east are taking strike action against the Government's proposals and, acting on the Government's behalf, the management.
As we know, the Government have instructed management in DHSS centres and other centres to carry out a cost-cutting exercise. The Government asked for a saving of £700,000 in the computer centres in the northeast. Without much ado, trade union members and management were able to save £650,000. The argument is, therefore, about a residual amount of about £46,000. To save that £46,000, the DHSS management decided to have a ridiculous and stupid head-on clash with the trade unions. Consequently, the wages of workers were cut by between £8 and £14. Surely, at this time, with escalating prices and indeterminate inflation, one could not expect people in the north-east of England easily to accept a cut in wages. No one in his right mind would accept that without an argument. But the DHSS management was under Government instructions, and, as we have seen on a number of issues, the Government prefer clashes to peaceful and sensible negotiations. They wanted this strike for reasons which they will eventually have to explain.
The public, not to mention hon. Members, have never been told of the consequences of this strike. In order to save £46,000 the people of Britain are already facing a bill of more than £100 million, and it is steadily growing. The latest estimate is that it is now approaching £120 million. That bill will have to be paid because of the intransigence of the Secretary of State and his ministerial colleagues. At a conservative calculation, it will take about 2,000 years to recoup what this strike has already cost. We shall still be paying the bill in the year 4000. That is the stupidity of what is happening.
Up to now, the strike has cost between £37 million and £40 million for Post Office emergency payments, £33 million in overtime payments throughout DHSS offices, and £11 million at the Washington child benefit centre. Millions of pounds have been overpaid, and that will have to be corrected. Indeed, there is a rumour that the Minister 298 was overpaid this month, but as he is not present he will be unable to comment. Up to now, 3,800 extra DHSS staff have been taken on. The total cost in a full year will be about £38 million. In addition, 260 new recruits have been taken on to prepare Giros and other cheques.
I stress again that the Government are trying to save £46,000, yet they are prepared to let the strike continue. Conservative Members have the audacity to claim that this strike action has been taken by uncaring people. I and my hon. Friend the Member for Jarrow (Mr. Dixon) have regularly spoken to these workers. We know that they care a lot more than Conservative Members about those who are in need of these payments. The Government pretend to care, but they show that they do not by not settling this strike through sensible agreement.
The Secretary of State told us this afternoon that, of the three unions involved, two had settled. That suggests that the majority of staff have settled on the management's offer. One of the unions, the Civil Service Union, has six members; the Society of Public and Civil Servants has 45 members; and the Civil and Public Services Association, the largest union, has 280 members. When the CPSA members voted, they rejected the management offer by 227 votes to 23. Although I do not speak on behalf of the two smaller unions, I understand that they have accepted the offer only in principle.
Extra cash is given to the staff because they work irregular hours under a shift rostering system. They receive 20 per cent. for a three-shift roster and 10.5 per cent. for a two-shift roster. The sum they receive is similar to the disturbance grant. During the last negotiations, management's proposals for the rerostering schedules were not at all clear. Consequently, it was impossible for the unions to ascertain the wages implications of the offer. Logically and sensibly, they rejected it. Management was also unable to guarantee that all those who wished to work a three-shift roster would have the opportunity to do so.
Let me add further confusion by quoting what the Government spokesman in the other place said. In reply to one noble Lord he said:and who are affected or could be affected by the changes that have been proposed, will in fact continue to be paid at the rate that is in hand at the moment.That sounds fine, but two or three minutes later he said in the same reply to another noble Lord:In this dispute the unions appear to want the existing shift patterns to be set for all time. Obviously, this questions management's right to manage. This is something that the department cannot, and should not, accept.—[Official Report, House of Lords, 22 October 1984; Vol. 456, c. 5–6.]Having first said that everything was fine, he then said that it was not because the department would demand the opportunity to manage the staff.
It should be noted that there will be a full review of the system in 1986, and although the staff may get what they want now the management has made it absolutely clear that, as a consequence of the 1986 review, it would not guarantee any changes in permanency of service.
§ Mr. Boyes
I usually do, but on this occasion I shall not. Some of the hon. Gentleman's hon. Friends still wish to participate and I have promised my Whips that I shall finish at 8.50 pm. If the hon. Gentleman intervenes, he will merely deprive his hon. Friends of time and I am sure that he would not wish to do so.
299 In the case of the miners, the Government are prepared to cost the taxpayers any amount of money. They do not care whether the bill rises to £2 billion, £3 billion or £4 billion. Out of wicked political vindictiveness they are prepared to make the taxpayers foot the bill. The same applies to the DHSS strike. In order to save a paltry £46,000, the country will have to pay hundreds of millions of pounds. That is unacceptable to the Opposition. I only wish that the Government would find it unacceptable and would tell the managers in the computer centres in Washington and other parts of the north-east, "Get our people back to work. Get these Giros paid to those who need them."
§ Mr. Don Dixon (Jarrow)
Is my hon. Friend aware that there was a complete lack of consultation prior to the management vindictiveness against the workers in Washington and Newcastle?
§ Mr. Boyes
My hon. Friend is absolutely right. He and I have met the unions and know what the situation is. No consultative procedures were carried out.
This strike could be ended tomorrow morning if the Secretary of State for Social Services told his permanent officials in the DHSS, "Give those people the shift rostering payments to which they are entitled. Get the computers running again. Begin proper negotiations."
As I have already said, the people of the north-east have already given up £650,000 out of £700,000 without any problem. They surely have a right to proper talks on the remaining £46,000. I hope that the Minister will confirm that he will get these people back to work on proper pay.
§ Mr. Roger Sims (Chislehurst)
I can understand the hon. Member for Houghton and Washington (Mr. Boyes) wanting to argue the case that he has, and he will not expect me to answer it at this hour. At least he has put the case in the way that it should be put in this arena or across the conference table. It is unfortunate that he appears to be supporting a strike which is causing a great deal of inconvenience and distress to many pensioners who are innocent parties. Surely there are better ways than that of settling industrial disputes.
I particularly welcome the commitment in the Gracious Speech to increase efficiency in the public sector, and there is no larger public sector than the National Health Service. I congratulate my right hon. Friend the Secretary of State on his production of the annual report on the Health Service. It is a first-class document. Its style, content and presentation are admirable. It should be required reading for all hon. Members, particularly those on the Opposition Benches who are sometimes somewhat selective in their comments on the Health Service.
I suspect that it is unlikely that our constituents — who, after all, pay for and are the users of the Health Service—will have the opportunity in large numbers, or the inclination, to study the material in the report, quite apart from the fact that it costs nearly £7. My right hon. Friend might like to consider producing a popular version of the report—perhaps in leaflet form—which could be available in doctors' waiting rooms, hospitals, libraries, and so on, so that our constituents could see exactly what the Health Service is doing, what its resources are, and how it uses them.
The task of the National Health Service is to restore the sick and injured to full health and to seek to maintain the 300 healthy in that condition. It is a health service; it is not a cleaning service, catering service or a laundry service. Therefore, I warmly support the efforts of my right hon. Friend and his Ministers to encourage competitive tendering for those parts of the operation of the service.
In his speech, my right hon. Friend referred to a health authority which was saving £1.4 million on domestic services. I think that he was referring to my local health authority in Bromley, which has now, in one of its hospitals, put catering out to tender. In one hospital the projected annual saving is £40,000. Extrapolating that figure throughout the country, the potential for savings can be seen to be enormous. It would make more resources available for the care of the patient. It is the exercise not of party dogma, but of good housekeeping.
There is scope for savings in the prescribing of drugs. I welcome my right hon. Friend's announcement about the discussions that he intends to undertake as to the extent to which generic drugs can be prescribed. My right hon. Friend also referred to the quantities in which they are prescribed. It is understandable that doctors do not want to have their patients coming back continually for repeat prescriptions, and that therefore they tend to be rather generous. I am sure that we all know of cases where people have been given a prescription for far more tablets or medicine than they need to use. Medicine chests in homes throughout the country are full of unwanted pills, ointments and medicines.
I draw my right hon. Friend's attention to a report of a two-week campaign by local pharmacists in Cornwall to have unwanted pills and other medicaments returned. The value of the products which had to be destroyed after being returned was £150,000. On a national scale, that would amount to a saving of about £20 million. It was a small exercise in a small area, and I am not suggesting that it is necessarily typical, but it suggests that there is scope for substantial savings in the quantity of drugs prescribed.
I was interested to note that my right hon. Friend referred to tranquillisers. I have had some disturbing evidence of the extent to which they are prescribed for people in times of particular stress—perhaps a family quarrel, a divorce or a bereavement. The prescription having been given for that purpose, it is often repeated indefinitely, despite the fact that originally it was presumably for a transient matter.
In an intervention, my hon. Friend the Member for Birmingham, Edgbaston (Mrs. Knight) spoke of people having tranquillisers for two or three years. I know of a case in my constituency where a man was on tranquillisers for 17 years. That is extraordinary because, apart from the distress caused to the man in being continually tranquillised, he became, as it were, addicted and went through a very difficult time when he finally decided, of his own accord, to come off the tranquillisers. Apart from all the human misery involved, a considerable sum of money was spent unnecessarily.
With regard to the abuse of drugs, the Department has taken several initiatives. The problem has been the subject of debate in the House. This is an area in which an attempt is being made to prevent people from needing the services of the NHS.
Several initiatives have been taken by the Department in encouraging the sensible use of alcohol. Most people enjoy alcohol, and it can be positively beneficial, but the Department is right to be concerned about the 1 or 2 per cent. of users of alcohol who abuse it.
301 I wish that I could be equally complimentary about another area of preventive medicine. I refer to page 11 of the report on the NHS, where it says thatsmoking remains the major avoidable cause of death and disease".I warmly endorse the remarks of the hon. Member for Brent, South (Mr. Pavitt), who has fought a campaign in the House on the issue for many years. I hope that before long we can have a debate devoted to the subject. Although the Department supports Action on Smoking and Health and the Health Education Council financially, Government action amounts to very little. The sponsoring of sports and the arts by tobacco companies now extends into an area where some of the tobacco companies associate their brand names with holidays and, by inference, good health. To use the hon. Gentleman's words, that is making a fool of the Government. The free advertising given to cigarettes on television—including the so-called non-commercial BBC — would be laughable if it were not tragic in the influence that it has on young people.
There are several points that I should like to pursue with my hon. Friend the Member for Tayside, North (Mr. Walker) if time allowed. Perhaps I shall have some other opportunity to do so.
Proposals are outlined in the Gracious Speech which, if Parliament approves them—after, no doubt, a good deal of argument—will be the law of the land by this time next year. The rule of law is the system under which we operate. Our whole way of life is based on the assumption that the law will be complied with. No political party, no trade union, no individual, can pick and choose between the laws that they wish to obey and those that they wish to ignore. It would be impertinent of me to add to the words of my right hon. Friend the Prime Minister on that subject when she opened the debate on Tuesday, save to say that those who deny the rule of law put in peril not only themselves but the whole nation.
§ 9.1 pm
Mr. Tony Fayell (Stockport)
I am grateful to my hon. Friend the Member for Chislehurst (Mr. Sims) for giving me an opportunity to make some brief remarks.
The question of housing benefits was referred to by my hon. Friend the Member for Stevenage (Mr. Wood). Housing benefits cost the nation £3.9 billion a year—a tenth of the social security budget. There has been an increase of 140 per cent. in real terms in housing benefits over the past 10 years. That is an alarming increase. Why should that increase have taken place when incomes, in real terms, have increased? I suggest that the answer is that 90 per cent. of housing benefit goes to local authorities, and that their expenditure has outstripped income. More and more households now find it impossible to meet their rent and rate demands in full because of the unwarranted increase in local authority expenditure, and a third of all households in the United Kingdom are now eligible for housing benefit. I therefore welcome the housing benefit review.
However, the members of the review team will have an impossible task. They will find that families on low incomes will still require help with rent and rates. They may tinker with the system, but the same 7 million 302 households will still require help with rent and rates, because local authority expenditure is too high and the system of financing local authorities is wrong.
Housing benefit now means that only a third of all local authority electors pay full domestic rates. The ratepayer therefore no longer has control over local authority spending, and, because of the existence of housing benefit, the local authorities no longer have to answer to the ratepayer. It is a vicious circle. As housing benefit increases, the more families are thrown on to housing benefit. The more families are thrown on to benefit, the less answerable financially local authorities become to those who elect them. The social security team will find that the domestic rating system requires a thorough overhaul. That nettle will have to be grasped in the end, because otherwise housing benefit will continue its relentless increase.
§ 9.3 pm
§ Mr. Giles Radice (Durham, North)
We have had a wide-ranging debate on social services and education. Such debates are perhaps more common in the United States than in this country, but they are none the worse for that. Social services and education are the services which are most important to the well-being of our people.
We have heard many good speeches. In particular, I should like to mention the speeches of my hon. Friend the Member for Brent, South (Mr. Pavitt), my hon. Friend the Member for Birkenhead (Mr. Field), with his great knowledge of the subject, my hon. Friends the Members for Cynon Valley (Mrs. Clwyd), and for Ashfield (Mr. Haynes) and my hon. Friend and neighbour the Member for Houghton and Washington (Mr. Boyes). The arguments about health and social security have been expressed ably and eloquently by my hon. Friend the Member for Oldham, West (Mr. Meacher).
I know that the Secretary of State was to have received a deputation from organisations of the deaf to discuss the need to remove restrictions which discriminate against suitably qualified deaf people training as teachers of the deaf. The meeting was postponed because of today's debate but I am anxious, at the request of my right hon. Friend the Member for Manchester, Wythenshawe (Mr. Morris), to get some idea of the Government's stance on this important matter. My right hon. Friend asked me to ask the Secretary of State why there has been so much delay in responding to the case for allowing qualified deaf teachers to teach the deaf. My right hon. Friend would have questioned the Secretary of State himself but has had to leave for the north-east to preside over the annual conference of the north of England regional association for the deaf.
The Queen's Speech contains two sentences on education. The first promises a Bill to give parents the right to exempt their children from corporal punishment. The second gives a puff to the Secretary of State's policies for raising standards in schools. The Corporal Punishment (Exemption) Bill, as it might be called, arises out of the decision of February 1982 by the European Court of Human Rights in the Campbell and Cosans case. The court decided that when a parent holds a conviction against punishment of this type it amounts to a philosophical conviction under the terms of the European Convention on Human Rights. That decision has created quite a problem for the Secretary of State.
303 It is well known that many Conservative Members strongly believe in the value of corporal punishment. In the consultative document which the Secretary of State issued in July 1983 he said that sanctions, including corporal punishment, form an important aspect of discipline. On the other hand, the decision of the European Court of Human Rights is binding on the United Kingdom.
The Secretary of State has tried desperately to square the circle between his and his party's convictions and the decision of the European Court. Hon. Members will note that the consultative document was produced 17 months after the decision of the European Court of Human Rights. Nor is it that the consultative document was lengthy—it was about four small pages long. Instead of coming out for abolition, the consultative document proposed a compromise. It proposed a system of opt-out for the children of parents who opposed corporal punishment. Subject to that new condition, the decision whether to retain corporal punishment would be left with the school governors. In the consultation exercise that followed, the compromise has been widely condemned. The Association of Metropolitan Authorities called the proposals "unworkable". The Association of County Councils said:a system which allowed different sanctions for the same misdemeanour … would be difficult to justify and might be regarded by some as lacking morality.The Campaign for State Education said that the European Court has made the use of corporal punishmentinequitable, illogical and above all impractical".The Assistant Masters and Mistresses Association had the gravest reservations—I think rightly—about the wisdom of creating two disciplinary systems. The National Union of Teachers said that the Government's policy was "ill conceived".
Perhaps the most significant comment came from the National Association of Head Teachers. Hon. Members will remember that the consultation document said that the head should have a central role in discipline. Nevertheless, the NAHT warned the Government that there was a basic conflict between their decision not to abolishand its decision to retain a sanction which will be implemented on a totally unsatisfactory basis. This is doubly unsatisfactory bearing in mind the fact that the Government, in its own submissions to the European Court, emphasised the wholly undesirable effect that would be in terms of discipline and the administration of schools arising from the right of parents to withdraw their children from this particular sanction".
In view of those devastating criticisms from the overwhelming majority of leading authorities in the education community, will the Secretary of State tell the House how many of the more than 100 organisations and individuals who commented on the consultative document supported an exemptions system? I suspect that the number could be counted on the fingers of one hand.
It is a tragedy that, despite all the objections, the Government have chosen to exclude professional and authoritative advice and to proceed with the unworkable exemption compromise. The Secretary of State has not had the courage—that is not a charge which I usually make against him — to take the only feasible course and abolish corporal punishment. He should have taken the advice of the Society of Education Officers when it said that it would be preferable for the Government to grasp the nettle immediately and issue a policy statement announcing the abolition of corporal punishment in all schools within a specific time.
It is interesting that the Secretary of State for Scotland has taken a much more intelligent and courageous line. In 304 answer to a parliamentary question on 10 July he said that the general aim in Scotland remained the elimination of corporal punishment. Instead of sitting on his hands, he wrote to regional councils urging them to abolish corporal punishment. That did not happen in England.
Although the Bill will cover Scotland, that answer to a question put down by the hon. Member for Tayside, North (Mr. Walker) is different in tone and style from a reply given by the Secretary of State for Education and Science. He said:Subject to compliance … decisions on the use of corporal punishment should be left to the schools themselves."—[Official Report, 26 October 1984; Vol. 65, c. 735.]
The Secretary of State for Scotland said:Compliance with the Court's judgment … would be best secured by completion of the voluntary process of elmination of corporal punishment in education authority schools which has been the long-standing general aim in Scotland." — [Official Report, 10 July 1984; Vol. 63, c. 448.]Not for the first time the Scots take a more progressive view of education than the English.
The Secretary of State for Education has ducked the issue. The only sensible, practical and humane policy is to abolish corporal punishment. The Opposition will take every opportunity to convert the exemption Bill into an abolition Bill. If the Secretary of State is not prepared to respect the results of his own consultative exercise and accept amendments to his Bill, we shall have to consider our position on the whole Bill.
§ Mr. Radice
I shall give way, but I am amazed that the hon. Gentleman wishes to intervene on this issue.
§ Mr. Greenway
The hon. Gentleman's words will carry more weight if he suggests feasible and workable alternatives. He has not done that, nor has the Labour party.
§ Mr. Radice
If the hon. Gentleman were to visit all the other countries of western Europe, none of which allows corporal punishment, he might find out. As those other systems of education have shown, it is possible to run education without corporal punishment. As the hon. Gentleman knows perfectly well, the best teachers can keep order without needing that deterrent. If there are problems with discipline, the many authorities that have already abolished corporal punishment have found alternative methods for dealing with it. It would not be such a difficult problem as the hon. Gentleman suggests.
The second matter mentioned in the Gracious Speech is educational standards. Hon. Members will remember that on 6 January 1984 in Sheffield, the Secretary of State, with a great fanfare of publicity that was ably organised by his Department, announced a plan for raising pupils' achievements and standards in schools, which he claimed modestly was bold, ambitious and realistic. On behalf of the Opposition, on 20 January, I welcomed some part of that speech in the House and I especially welcomed the Secretary of State's statement that there was abasis of quality and past success inthe state education system, and thatour schools are offering more pupils a broader education, and a larger proportion of pupils are successful in examinations at 16-plus.
The latest figures from the Department show that that improvement has continued. The facts contradict the 305 mindless attacks on the comprehensive schools and the ill-informed abuse of the state system of education which are indulged in too often by Conservative Members, who should know better, and too often by the popular press.
I also welcome the Government's abandonment of the fruitless chasing after educational hares such as vouchers, open enrolment and the return of selection, and I welcome the fact that the Government are addressing themselves to the real issues such as curriculum reform, the examination system of the improvement of teacher quality. We share the objective of raising the level of achievement in schools, although our definition of achievement is much wider than that of the Secretary of State. We wish to raise the level of achievement of all children, not just the few. I warned the Secretary of State—
§ Sir Keith Joseph
The hon. Gentleman generally tries to be fair. The emphasis of the Government throughout has been on raising the achievements and performance of children of all abilities, and I hope that the hon. Gentleman will be fair enough to acknowledge that.
§ Mr. Radice
Yes, I am fair enough to acknowledge that that is the Secretary of State's position. Unfortunately, it is not always the position of Conservative local authorities or, indeed, of members of the Conservative party.
I warned the Secretary of State that he could not hope to be successful unless he was prepared to put his money where his mouth was. I also said that many local education authorities were already experiencing great difficulties in meeting their statutory obligations and I quoted the words of his advisers, Her Majesty's Inspectorate, who said:In most secondary schools, existing levels of resources could not now be stretched to meet the demands legitimately placed on them by the community at large, nor could they in all cases maintain the existing basic provision.
In reply—I will be fair to the Secretary of State and use his arguments—the Secretary of State said that not all problems could be solved with money. He also argued that in nearly all authorities there was considerable scope for redeployment. However, he said that where money was needed and where there was no scope for redeployment, he might have to try to convince his colleagues that more must be made available. I remind the Secretary of State of those words, because it is our contention that, 10 months after the launch of the so-called bold, ambitious but realistic plan, his strategy is running into the sand.
There are two reasons for this. The first is due to lack of resources, and the second is the manner in which the Secretary of State has attempted to carry through his plans. I do not propose to pursue the second matter tonight because, as the House knows, we shall have further opportunity to discuss these issues next Wednesday.
This evening, I shall say something about resources. It is ironic that in the same week that the Secretary of State was complacently puffing his policies to raise educational standards, his advisers—the HMI—sounded alarm bells about educational provision in Norfolk, a county that I visited last week, where I saw for myself what was happening. The HMI report said:The officers, advisers and teachers are fully conscious of their responsibilities but it is clear that they are all operating in a system that not only has no slack in it, but which is already decidedly over-stretched and showing signs of inadequate levels of provision of staffing and materials.306 The report goes on to discuss some of the issues raised by the Secretary of State in January and bluntly warns him:If the local education authority is to set out to spread more widely the examples of good practice that exist: to make more equitable the access to educational opportunity of all its pupils and to improve the 5–16 curriculum in order to raise standards in line with national policy intentions"—in other words, what the Secretary of State is saying—the Authority as a whole will need to review its policies for education, including its financial provision and the priority should be given to educational needs in the context of all other calls it has upon its resources.
Unfortunately, the case of Norfolk is not atypical. Its spending is not below the average for the shires. It is spending up to its grant-related expenditure level. What should be worrying the Secretary of State is that if Norfolk follows the advice of the inspectors and gives educational spending priority, it will run up against the Department of Environment targets and penalty system. This point has not just occurred to me, but was mentioned by the chairman of the Norfolk education committee, whom I am sure the Secretary of State knows well.
Norfolk and many other local education authorities are in a "Catch 22" situation. They are told that they will get less from central Government next year. However, they are penalised if they raise locally the resources that they need to tackle the educational problems that have been identified by the HMI. What is happening is that the Secretary of State's plan to raise educational standards is being undermined by the squeeze on resources imposed by the Treasury via the Department of the Environment.
What success is the Secretary of State having in persuading his colleagues to provide the extra resources for education that the HMI says in a number of cases is now urgently needed, or has he allowed his obsession for public spending to overcome his concern for education? We shall learn the harsh truth on Monday afternoon and we shall be able to debate the outcome on Wednesday.
What is clear is that this thin Queen's Speech will do little to improve our welfare and education services. Sadly, we shall be reminded on Monday that, whatever the desires of their respective Ministers, policy on education, health and social security is, in reality, largely determined by the Chancellor of the Exchequer and the Prime Minister. We shall also be reminded that, with this Government, it is their ideological commitment to monetarism and cutting public expenditure that shapes policy, not the needs of the people. We believe that as a nation we must change priorities and put the needs of people first. In the coming Session, we shall be arguing that case not just in the House but in the country as a whole.
§ The Secretary of State for Education and Science (Sir Keith Joseph)
I cannot just enjoy myself by talking about education; I must also try to reply to some of the comments that have been made on health and social security.
The hon. Member for Oldham, West (Mr. Meacher) tried as hard as he could to avoid facing the facts, but he could not get away from the two central truths. The Government have shown the priority that they give to the NHS by increased spending. The key figure there is how much it has cost to provide the service. In the past five years the cost of the NHS to the economy as a whole has increased by 17 per cent. — 10 per cent. more than public spending as a whole.
307 The hon. Gentleman's attachment to input volume figures is just another demonstration of his desire to avoid talking about the real measure of NHS performance—the number of patients treated. He cannot get away from the fact that in 1983—in just one year—the number of patients treated in the NHS increased by as much as during the whole five years of the previous Labour Government.
Nor could the hon. Gentleman escape from the formidable speech of my hon. Friend the Member for Derbyshire, South (Mrs. Currie), who catalogued a list of record services in highly technologically advanced areas as well as in more mundane areas of service that the NHS has been able to clock up.
Moreover, I must remind the House that it is impossible to escape the improvement that the NHS is, with all its blemishes, providing for the public, by pretending that the country, as the hon. Member for Oldham, West most disingenuously pretended, is suffering from a serious decline in health. The present generation, with all the problems that it has, is enjoying longer life expectancy and a record low infant mortality. I do not at all discount some of the real problems that go with poverty, but nevertheless one of the biggest characteristics of current demand on the NHS is that it is seeking to cure people of the problems of affluence.
The hon. Gentleman did not give a convincing case on the NHS, but it was rather better than his attempt to wave away what the Government are doing to improve the position of early leavers from occupational pension schemes. His case was pitiful. The Labour Government gave no statutory protection whatever against inflation to the preserved rights of early leavers in their legislation on occupational schemes. We are putting that failure right.
Yet the hon. Gentleman has the nerve to complain that we put an upper limit of 5 per cent. on the annual increase which has to be made. We have to balance the rights of early leavers against the interests of the schemes and avoid putting excessive burdens on them. More importantly, we think that 5 per cent. is a reasonable ceiling because the Government have not only brought inflation down to 5 per cent., but they intend to bring it down still further. The truth of the matter is that, if the Labour party were ever to regain power, 5 per cent. would be nowhere near enough to cover the inflation which would be the result of its profligate policies.
§ Mr. Meacher
It is good to hear the Secretary of State returning to those areas where his policies on NHS reorganisation were such a success in 1973–74. Perhaps he will accept that what matters is what money will buy within the NHS and that the 17 per cent. figure which relates to the RPI is not directly relevent to the NHS. That is the simple point that I am making.
All that I said about the 5 per cent. revaluation was that 5 per cent. is less than the other recommended figure of the Occupational Pensions Board, which is 8.5 per cent. The key point that I made, which the right hon. Gentleman has not answered, is that it applies only to existing pensioners and will relate only to benefits paid after next January. Why should millions of pensioners lose out because of the failure to protect them in the past? Is it because the Government are more concerned about the occupational pension scheme than its members?
§ Sir Keith Joseph
The hon. Gentleman has been let down by his memory. The recommendation of the 308 Occupational Pensions Board was a 5 per cent. limit. It was the TUC that recommended an 8.5 per cent. limit. The hon. Member for Leeds, West (Mr. Meadowcroft) repeated something that has been said frequently by hon. Members on both sides of the House and that is that there is a virtually insatiable demand on the Health Service, particularly with the technological advances that are constantly being offered to the public. In the NHS there is a sort of rationing by queueing. But, although the waiting lists are still far too high, they are substantially lower than they were when the Conservative party first came to office. In March 1979, the waiting lists amounted to 750,000, but five years later the figure was 690,000. That fall occurred despite the adverse effect of the 1982 NHS strike.
The hon. Member for Leeds, West may be comforted by the knowledge that he was wrong to refer to a fall in the number of home helps. There are now more home helps in action than there were five years ago.
§ Mr. Ward
I hope that my right hon. Friend will highlight the fact that, despite all that the hon. Member for Oldham, West said, he did not once refer to the need to raise the money from hard-pressed taxpayers and ratepayers. I hope that my right hon. Friend will emphasise the need for budgetary control throughout all the services provided by the Government.
§ Sir Keith Joseph
I regret to tell the hon. Member for Oldham, West that he is not unique in that regard. All his right hon. and hon. Friends suffer from the same Utopian ignoring of resources.
§ Mr. Meadowcroft
I was trying to say that the number of home helps had not necessarily been reduced in every case. Of course, because of the rate penalties. some authorities have reduced the number of home helps and they may be the very authorities to have the most serious problems. The point is that when making a financial equation, let alone a social equation, the cost of home helps is minimal compared with the cost of keeping people in institutions. If only on financial and not social grounds, we should be massively increasing the number of home helps.
§ Sir Keith Joseph
I am almost a fanatical admirer of the home help service and those who work in it, so I agree with the hon. Gentleman; but he is guilty of ignoring constraints. One would have thought that the hon. Gentleman did not think that there were any financial constraints on Government. He spoke as if he was quite unaware of opportunity costs. He catalogued all the areas in which the Government could spend more money and showed a blissful indifference towards the effect on jobs and inflation.
As always, the hon. Member for Birkenhead (Mr. Field) made a very interesting speech. He recognised the Government's success in reducing inflation but claimed that it has led to rising unemployment. He also recognised the Government's intent to enable the poor to escape from poverty. Without presenting the Government or management as perfect, I would say that the greatest cause of rising unemployment and continued poverty has been the many trade union leaders who have encouraged their members to price themselves out of jobs. The hon. Member for Easington (Mr. Dormand) has a very nice smile and thinks I am not serious, but I am. Over the years, 309 those trade union leaders have obstructed the rising productivity that releases people from poverty. There is no way in which the whole population can escape from poverty except by the community as a whole, including them—
§ Mr. Dormand
Is it in order to accept or refuse an intervention on the basis of one's smile?
In 1979 when this Government came to power the right hon. Gentleman used a word which became a byword outside the House. He said that the new Tory Government and the new freedom from controls would mean that entrepreneurs would be "galvanised" into action. We heard that week in and week out. Does the right hon. Gentleman think that entrepreneurs have been galvanised into action now that 4 million people are unemployed?
§ Sir Keith Joseph
Yes, but not enough of them. If the hon. Gentleman thinks that his region and others will recover their vitality and full employment without lots of entrepreneurs, he is making a great mistake.
My hon. Friend the Member for Surrey, South-West (Mrs. Bottomley) made a short but splendid speech. She reminded us of the crucial pioneering role in social services of those who lit a candle by identifying social needs and setting out to create voluntary societies. I was the honorary treasurer to the Rev. Mary Webster, of whom my hon. Friend spoke. I pay tribute to people like Mary Webster, Chad Varah of the Samaritans, the remarkable Dame Cicely Saunders of the Hospice movement, the late Megan Du Boisson who founded the Disabled Income Group and Alec Dickson of the community service volunteers. All hon. Members could add to that list of people who have lit a candle by identifying needs to lead the Government. In many cases action has been taken without the Government. I am glad that my hon. Friend spoke in that way.
My hon. Friend the Member for Stevenage (Mr. Wood) spoke with legitimate intensity about the poverty trap and yearned for the introduction of a tax credit scheme, but he was good enough to recognise how expensive and difficult that would be. My hon. Friend the Member for Stockport (Mr. Favell) spoke of the housing benefit. My hon. Friend the Member for Chislehurst (Mr. Sims) congratulated my right hon. Friend on the annual National Health Service report, its presentation and contents, but urged my right hon. Friend to bring down the price of it so that it could be more widely read.
My hon. Friend the Member for Bournemouth, West (Mr. Butterfill) spoke with strong feeling about the need to consider blind people and their needs. I do not dare comment on the speech by my hon. Friend the Member for Tayside, North (Mr. Walker) about how Scottish funding should be done. I regret that I was not here to listen to all that was said by the hon. Members for Cynon Valley (Mrs. Clwyd), for Brent, South (Mr. Pavitt), for Houghton and Washington (Mr. Boyes), for Ross, Cromarty and Skye (Mr. Kennedy) and by my hon. Friend the Member for Newbury (Mr. McNair-Wilson).
310 I turn with some pleasure to the subject of education. The hon. Member for Durham, North (Mr. Radice) put to me a question on behalf of the right hon. Member for Manchester, Wythenshawe (Mr. Morris). We are in the midst of consultation on the response that we shall give to recommendations about the teaching of the deaf. The hon. Member for Durham, North mounted his familiar charger and accused me and the Government of not providing enough resources to fulfil the educational objectives that he and the Government share—to raise standards. It is not an indictment—
§ Mr. Radice
Will the right hon. Gentleman answer my question about the number of organisations that agree with his opt-out scheme for corporal punishment?
§ Sir Keith Joseph
Perhaps the hon. Gentleman will criticise me for it, but I had intended to deal with that matter later. The hon. Gentleman was not the only person who raised that subject. I must also account to several of my hon. Friends.
Together with the hon. Member for Oldham, West the hon. Gentleman lives in a never-never land where there is no shortage of resources. The first duty of any Government is to do their best to ensure that money from the taxpayer and ratepayer is well used, especially when there is as much money as there is available to education authorities. I agree that it is difficult in a period of falling school rolls to cope with diseconomies of scale and provide the services expected. However, some authorities do better than others with the money available. Some allow more waste, some are downright profligate, some are extremely prudent.
This Government did not invent financial prudence. If only previous Labour Governments had been more prudent, we would not be in this plight today. It was the right hon. Member for Leeds, East (Mr. Healey)—and I give him credit for it—who attained the largest fall in public spending in one year that has been recorded since the second world war. Who invented cash limits? It was the Labour Government, and quite right they were. They sought to limit public spending. They did not do that very well, and they left the country in a terrible state.
The hon. Gentleman must answer one question. He must tell the House and the country whether he will commit a future Labour Government, if there ever is one, to provide more money for education via the local education authorities.
§ Mr. Radice
I remind the right hon. Gentleman that his Government are planning to spend in 1985–86 £3.5 million more on defence than on education. The Labour Government spent £600 million more on education than on defence while they were in power. That is the right priority and we will seek to ensure that more is spent on education than on defence. We will try to ensure that local authorities have a properly resourced education service.
Does the Secretary of State believe that Norfolk is a profligate authority?
§ Sir Keith Joseph
The House will judge whether that was a commitment on behalf of a future Labour Government—I suspect that it was not.
The hon. Gentleman legitimately asked whether I would follow my pledge given at Sheffield 10 months ago to seek more money from my colleagues—
§ Sir Keith Joseph
I shall come to Norfolk. We shall see what happens there as a result of the report.
The hon. Gentleman asked whether I had yet approached my right hon. Friends for additional money because I believed that more was needed. I am not yet convinced that, overall, more is needed. I have said publicly, and I say it again, that if the local education authorities and the teachers' associations manage to agree a settlement under which teachers undertake certain defined responsibilities and accept—
§ Sir Keith Joseph
That is the hon. Gentleman's proposition, not mine. If they accept that there shall be a regular professional appraisal of their effectiveness as teachers, if the local education authorities undertake to deploy their teaching force and the training and retraining of that force according to such assessments, and if I judge the agreement to be a good bargain for the children, parents and the public generally, I shall go to my right hon. Friends and seek the necessary money. However, I cannot guarantee the results having discussed the matter with my right hon. Friends. I eagerly await the settlement that I very much hope will emerge.
The hon. Member for Wolverhampton, North-East (Mrs. Short) chided the Government for omitting to refer to nursery schooling in the Gracious Speech. We do not believe that there are sufficient resources to universalise public money on nursery education and so we concentrate on the compulsory schooling period. However, we are maintaining nursery education on the taxpayer for about 40 per cent. of the children of the relevant age group, especially in areas where social need is greatest.
My hon. Friend the Member for Poole (Mr. Ward) urged the Government to take intensely seriously the reactions which he reported to the Warnock committee. My right hon. Friend the Secretary of State for Social Services is coming to the end of consultation on the Warnock committee's report and the Government will come to their decision when the results of the consultation have been studied.
My hon. Friend the Member for Ealing, North (Mr. Greenway) urged the Government to tackle the problems of matching the teachers of religious education to the needs for them. The Government have not reduced the number of training places for the teachers of RE. The number of places has been maintained, and the difficulty is that we cannot always fill them. Paradoxically, there are unemployed RE teachers who cannot find jobs. We are facing a considerable problem. My hon. Friend knows that the Government are eager to find a way to help improve the position. If he wishes to talk to me on this subject, which I know interests him intensely, I shall always be ready to listen to him.
My hon. Friend the Member for Ealing, North and my hon. Friend the Member for Erith and Crayford (Mr. Evennett), in alliance with the hon. Member for Durham, North denounced me—
§ Sir Keith Joseph
I thought of the term but decided not to use it. My hon. Friend and the hon. Gentleman denounced me for the option that I have chosen on corporal punishment as a result of the European Court's decision. I was denounced by my hon. Friends for not allowing some 312 preservation of caning in instances which, in the view of my hon. Friends, thoroughly warrant that punishment. I have been denounced from the Opposition Benches for not going so far as to abolish corporal punishment.
If the Government had chosen another option, I would have been denounced just as fiercely. Whatever option we choose, there will be many who disagree with us. The Government believe that we should leave the decision, with all the attendant untidiness and untidy consequences, to parents, teachers and governing bodies. The House will have a chance to consider this policy when we come to legislation.
My hon. Friend the Member for Stevenage rightly emphasised the need for technological training.
§ Sir Keith Joseph
I hope that my hon. Friend will forgive me for not giving way. I have much ground still to cover.
My hon. Friend the Member for Tayside, North came south of the border to denounce the behaviour of some teachers. I agree with what he said. I have seen reports to the effect that many schools were closed and others disrupted as ILEA teachers participated in the day of action, which, I understand, was supported by NALGO, TGWU, NUPE and the inner London branch of the NUT, to protest against the Government's plans for rate capping and the abolition of the GLC. I am sad to learn that teachers are thus prepared to damage the service that they claim to support—all the more so because ILEA is not to be abolished under the Government's plans but is merely to be made more directly accountable to the ratepayers who foot its bills.
Recently, Mrs. Morrell, the leader of ILEA, made some strange statements to the ILEA education committee in which she sought to denounce the Government on a wide range of issues. She has asked to see me to discuss two of her criticisms, and I hope to clarify them then. I shall not let the more serious points rest unanswered in the meantime. First, Mrs. Morrell sought to give the impression that the requirement in the paving Act to seek ministerial consent for contracts valued at more than £100,000 and for all lettings of school facilities to out: side groups has imposed a serious burden on ILEA. The facts are that general consents were issued on 2 August in respect of most transactions involving ILEA, and further general consents were issued on 31 October covering lettings. I understand that ILEA obtains its supplies of goods, materials and equipment generally from the GLC supplies division and that there is no requirement to seek approval on its transactions with the supplies division. The Government cannot apply a general consent to contracts that are placed by the GLC supplies division with outside suppliers, most of which are not placed exclusively for ILEA.
Secondly, Mrs. Morrell has claimed that I have, without consultation or justification, introduced an administrative memorandum requiring that any proposal for a new nursery class must receive the formal permission of the holder of my office. The facts are that ILEA officers saw the memorandum in draft; the interpretation of the legal decision regarding the addition of nursery classes to private schools is generally accepted by LEAs — although an authoritative decision can be given only by the 313 courts—and the only proposals that need to be seen by the holder of my office are those that attract statutory objections or involve a voluntary school.
Thirdly, Mrs. Morrell has accused me of casting a slur on the efforts of London children and their teachers when I said that ILEA expenditure was out of proportion to the results achieved for the children. I noted with interest that she sought to rebut my statement by referring to the fact that ILEA examination results were the best since 1978. I readily grant that point. ILEA's actual examination results are close to those predicted by statistical analysis of the social and economic characteristics of the inner London education area. Mrs. Morrell does not seem to understand that my comment is not so much on the quality of the education in ILEA, although I certainly share with ILEA the aim to improve it, but on the amount of money spent by the authority in relation to those results. I expressed a strong doubt that the results would have been any the worse if the expenditure had been much less.
§ Sir Keith Joseph
Alas, a very large proportion does not take exams in other parts of the country, too. [Interruption.] No; it is a question of the relevance of the curriculum, the effectiveness of the teachers, and the support from the home.
Fourthly, there is the matter of the underspend of £24 million in 1983–84. Mrs. Morrell has now explained the elements that go to make up the underspend, as if that excused it. The fact is that the budget is estimated net — expenditure minus income — and there was an overestimate of £24 million.
Finally, Mrs. Morrell asked for the plans to evict ILEA from county hall to be scrapped. There are no such plans. Mrs. Morrell has said that ILEA's accommodation requirements are such that they could occupy a large proportion of county hall. I look forward to hearing about that in more detail when Mrs. Morrell comes to see me.
I pay tribute to the sheer difficulty of being an effective teacher. Teaching is a demanding job.
I have read the claims of the teachers' unions for pay increases for April 1985 presented to the Burnham committee on 1 November. It is quite clear to me that the expectations of the teachers' unions are entirely unrealistic as, indeed, they were last year. As a nation, there must be limits to what we can afford to spend on public services, including education. This Government have fought and won two elections on a clear commitment to restrain public spending, so freeing a greater proportion of national effort for the manufacturing and trading sector on which ultimately economic health, jobs and all the nation's services, social and public, must depend. That remains our position.
I must therefore ask for realism among those who would seek to set public service pay by comparisons. Let us suppose that any particular group managed to increase the pay of its members in relation to some recent or long-past comparison study. Does that group think that every other group would fail to try to follow suit? There would be a whirlwind of competing claims leading to rocketing inflation and increasing unemployment.
That is why I believe that the teachers are doing themselves a great injustice in putting forward a totally unrealistic set of claims, unwelcome as that may be to 314 them. The answer must be that pay, including even that of teachers, must be settled principally by reference to what can be afforded for the service in question, informed by considerations—in relation to the necessary qualities—of recruitment, retention and motivation.
That is not to say that I regard the present teachers' pay arrangements as satisfactory. I hanker after a more relevant relationship between pay and performance — [Interruption.] The hon. Member for Oldham, West thinks that that is funny. The interests of the children require that teachers should be encouraged to be effective. Some teachers deserve more pay because they are more effective in the classroom. That is why I spoke with such concern about the outcome of the negotiation which is shortly to be resumed between the local education authorities and the teachers' unions in the working party established under the aegis of the Burnham primary and secondary committee.
I hope for a successful outcome to the deliberations of that committee, but I must recognise that there are many obstacles to be overcome. Any new arrangements for teachers' pay and professional commitment will have to satisfy stringent tests as to acceptability and affordability. On acceptability there is the prior question of whether teachers' employers — chiefly the local education authorities, which run the maintained school system—and the holder of my office jointly consider that the proposed changes would produce a worthwhile improvement in the delivery of the curriculum in schools. We must all return to that test as the essential baseline for our judgment.
Linked with that is whether the profession might share our views. As yet I do not know the answer which the teacher associations might offer to such a question. We must await the outcome of continuing discussions with the teacher associations.
Affordability is the second test—whether the ideas now in circulation can be refined to produce a package which will substantially benefit the education of our children, and which should therefore be regarded as a reasonable claim on scarce public resources. Again, I have no ready answers to that. The next meeting of the relevant working party of the Burnham committee is on 15 November. I shall not try to anticipate the outcome. Equally, I recognise that the employer and teacher associations may well require more time to consider whether they can agree on a package for consideration by the Government in due course. Mr. Teacher — [Laughter.] I do not think, Mr. Speaker, that you will be insulted by that mistake. There is, Mr. Speaker, the very important question of the deployment of teachers.
Recently the Department has set out a range of policies for raising standards in schools, as the hon. Member for Durham, North reminded us. Some of those policies may be more demanding of teacher time or may require a different emphasis in the use that schools make of the teacher time now available to them. Those issues were addressed in the discussion paper, "Schoolteacher Numbers and Deployment in the Longer Term" that we issued in September. I shall be discussing that paper with the representatives of local authorities and look forward to receiving their and other views on it.
In the paper, we identified a number of claims on teacher time in connection with in-service training, the preparation of the curriculum in secondary schools—
§ It being Ten o'clock, the debate stood adjourned.315
§ Debate to be resumed tomorrow.