Hospitals

HC Deb 16 June 1986 vol 99 cc762-811

Mr. Speaker

I have selected the amendment in the name of the Prime Minister.

3.38 pm

Mr. Frank Dobson (Holborn, and St. Pancras)

I beg to move, That this House condemns the policies of Her Majesty's Government, which have undermined the capacity of the big city hospitals to provide care for all their patients, satisfactory training opportunities for doctors and nurses, reasonable working conditions for all staff or adequate facilities for research into improved care for patients and the promotion of good health. On Friday 11 May in Perth the Prime Minister, speaking of her Government's record on the National Health Service, said: We have a marvellous record, which we should shout from the rooftops. Before the month was out, staff at the Maudsley hospital in south London had been told that, for reasons of economy, they were to reduce the amount of jam used in sandwiches in the children's ward. Nothing could better illustrate the gulf between the isolated world of the Prime Minister and the reality of the crisis facing the big city hospitals in England, Wales and Scotland.

Skimping on the children's jam ration was not the only, or indeed the most important, damaging change that was being forced on the patients and staff at the Maudsley. All consultant and nursing posts were to be frozen. There was the weekend closure of the neurosurgery ward, so that patients who had had their heads opened up and undergone brain surgery were to be shifted from their beds to save the cost of weekend working. Closing half the beds serving chronically mentally ill patients, shifting the children from their special in-patient unit to a general hospital ward, closing the alcohol in-patient unit — all that and more at Britain's oldest psychiatric hospital, not because there were not the patients; not because psychiatric illness was on the way out; not because we did not need doctors and nurses trained in the best and most up-to-date techniques; not because we could afford to do without the research done jointly by that hospital and the Institute of Psychiatry, the funds of which the Government have also cut. The reason was that the Government would not find the money.

That hospital is, in theory, so important that it is run by a special health authority, reporting direct to the Secretary of State. I understand that there may be better news. Last Thursday, after this debate had been announced, representatives of the Maudsley met the Under-Secretary. They were told that they could overspend their budget this year. What a pity they had to divert vast amounts of energy and effort just to get a sensible level of funding.

However, several questions arise. Will the Government make up this year's deficit at the Maudesly, or will the hospital have to carry it forward and fund it out of next year's allocation? Will all hospitals in financial difficulties be allowed to overspend, or will it just be those that happen by chance to meet Ministers a day or two before a debate in the Commons? Those are important questions, because what is happening at the Maudsley is happening elsewhere. It is happening to the other special health authorities such as Great Ormond street and the National Hospital for Nervous Diseases.

The postgraduate research institutes associated with those famous hopitals—centres of excellence, of world renown in the struggle against pain and suffering—have seen their staff and work reduced, their capacity to teach diminished, their research curtailed. But it is not just those hospitals that are suffering. The Prime Minister may claim that she is spending more on the National Health Service than ever before, but it is not true. The extra funds do not match the combined effects of the increase in the cost of health care, the growing cost of medical technology and the increased health needs of the growing number of old and unemployed people.

Mr. Tony Favell (Stockport)

Will the hon. Gentleman give way.

Mr. Dobson

I shall not give way just now.

Even so, the NHS might have just about got by with that level of funding if the Government had not added a further costly element to the equation. That element is change. The Government are demanding massive changes in priorities, endless changes in structure and management, massive redirection of effort and huge geographical shifts of resources. But change costs money. Surely Tories understand that. The cost of change has always been the bulwark of the case for Conservatism, if it has any case at all.

Many of the changes envisaged would command the support of most of those involved if, but only if, the time scale were extended and additional resources provided, at least during the transition period.

Let me give an example of what I mean. Hampstead health authority, which is responsible for the Royal Free hospital, wishes to close the old workhouse at New End and provide a better place for the elderly near Hampstead Heath. The Government will not give the authority the money to build the new unit, so it is forced to close New End, sell it and use the proceeds to build the new unit. That may sound fine, but the problem remains of the existing patients at New End. The suggestion is to turn over to the elderly the wards presently used for other purposes at the Royal Free until the new unit is built. Other groups of patients will suffer because the money for the new unit for the elderly is not available.

This is not simply a London problem. It occurs in every big city in Britain. In all our big cities, the NHS is suffering from reduced funds and demands for massive change. That cannot be done except at the expense of patients and staff.

Ms. Clare Short (Birmingham, Ladywood)

Is my hon. Friend aware that one solution offered is for private American companies to build and run National Health Service psychiatric hospitals? Such a proposal is being considered in Birmingham. It is widely thought in Birmingham that that hospital will he a loss leader so that those companies can build private profit-making psychiatric hospitals in all our big cities. Would my hon. Friend comment on that?

Mr. Dobson

Yes, I shall comment on that point. My basic comment would be that I am dubious about any American company becoming involved in health care in Britain. I am especially worried about the idea of a psychiatric hospital run by a company which produces drugs used on psychiatric patients. There is bound to be a conflict of interest.

Mr. Favell

Is the hon. Gentleman aware that that American company is prepared to build that hospital at half the cost for which the district health authority would build it and will provide the same services? Is he interested in patients or in lining the pockets of those who support him?

Mr. Dobson

I am interested in the record of American companies in the United States. When the American commercial companies can ensure that adequate health care is provided for the 30 million Americans who have no health cover in the most powerful and prosperous nation in the world, they may be able to contribute something to health care in Britain.

Big city hospitals were built where they were by the Victorians, or earlier, because that was where people were poorest and sickest. The Royal Victoria in Newcastle, Manchester Royal infirmary, Leeds General infirmary, Bart's Guy's and St. Mary's were built where they were needed — and they are still needed. The communities that they serve are still among the poorest and least healthy. The common measure of the health of a locality is perinatal mortality. The big city figures are bad. Against the national average of 10 deaths per 1,000 Newcastle upon Tyne has 16, north Staffordshire—serving the city of Stoke on Trent—has 15.9, east Birmingham has 14.7, and Tower Hamlets has 13.7.

The big cities have more deaths from cancer and heart disease, but in addition to the old diseases, they also have the highest incidence of alcoholism, drug abuse and AIDS. They also have the longest hospital waiting lists: 22,000 in Birmingham, 14,000 in Bristol, 13,000 in Manchester, 11,000 in Sheffield, 10,000 in Leeds, 8,000 in Newcastle, 8,000 in Nottingham and 8,000 in Liverpool. In inner London, waiting lists are soaring. Small wonder, when £35 million has been cut from the budgets of the inner London health authorities.

One example is Lewisham and North Southwark, where hospital waiting lists increased by more than 1,000 in the six months between September 1985 and March 1986.

Mr. Rob Hayward (Kingswood)

The hon. Gentleman said that the waiting list in Bristol was 14,000. Can he confirm that? Information received from the chairman of the Bristol and Western health authority this morning gives the figure for 1986 as 7,944.

Mr. Dobson

I should have thought that a Member from Bristol would have known that that great city is served by no fewer than three separate health authorities.

I will give some more examples of what is happening in the big cities.

In Newcastle it is proposed to close an orthopaedic ward at the Freeman hospital although there are 855 people on the orthopaedic waiting list. A children's ward at Newcastle general hospital is to be closed and two surgical wards at the Royal Victoria infirmary are to go, as is the entire Fleming Memorial children's hospital. Demand for some of the services now provided in Newcastle may eventually decline after the building of the new district general hospital at Ashington, but that is scheduled for 1993 and Newcastle is being asked to make cuts now. So the patients will suffer—more than 900 urgent cases have been waiting more than a month for treatment.

Central Manchester health authority has suffered cuts of more than £2 million and is threatened with a further loss of £3 million in the next two years. Reductions in provision at the Royal infirmary are bound to follow and patients will be turned away. Poorer, less healthy people in Stretford and Old Trafford are being told that they will not be able to go to the Royal infirmary any more, although it is nearer and there is good public transport. They must wait until alternative facilities are provided in a few year's time in the southern part of Trafford, even though it is further away and not so easy to reach by public transport. There are also fears for the future of the Manchester foot hospital.

Proposals for improved facilities for Hope hospital in Salford for neo-natal special care for babies in Salford and other parts of the north-west have been denied funds. The consultants involved have therefore decided that their first duty is to Salford babies and that from the end of this month they will be unable to accept referrals from elsewhere.

In Cardiff, the University hospital of Wales has just closed and padlocked its first ward, and no doubt others will follow. No one could call that a rational response to a waiting list of 5,300 people.

The Greater Glasgow health board has just been told by its general manager that it must cut spending by no less than £20 million per year, involving what he described as fundamental changes in the level of provision". Few Scots believe that the intention is to level up, because levelling down is the message in the Health Service nowadays.

In Trent region, described as a major beneficiary of resource allocation changes, stands the famous city of Nottingham. These days the hard-faced sheriff is more in evidence than Robin Hood. The Government have robbed the regions that they describe as rich. but they still do not fund the poor. Phase 2 of the Queen's Medical Centre was completed as long ago as 1979, but it still stands mainly empty because the health authority cannot afford to run it. Indeed, things are getting worse. One existing ward for vascular surgery is to be closed and there is even a threat to reduce staff at the highly successful special care baby unit at the city hospital. The story is similar in every big city. At Guy's, which serves north Southwark and Lewisham, we discover from the Daily. Mirror—because officialdom will not tell us — that life-saving heart operations for children have been stopped because the hospital has not the cash to nurse all the post-operative intensive care beds. It must be pointed out, of course, that cash for cardiac treatment at Guy's has suffered because no less than £376,000 of National Health Service money was spent subsidising heart operations on private patients, as the recent report of the Comptroller and Auditor General reveals.

In Bristol the health authority's plans are dominated by closures and proposed closures of small hospitals such as the Wendover hospital maternity unit and Ham Green hospital. However, experience suggests that it is no good big hospitals and fashionable consultants offering their smaller neighbours as human sacrifices. It does not work. In Kipling's immortal words: once you have paid him the Dane-geld You never get rid of the Dane. The calls for cuts will increase and the big hospitals will start to lose funds.

Mr. Michael Cocks (Bristol, South)

My hon. Friend mentioned Bristol. While I do not wish to exonerate the Government from any blame, may I remind my hon. Friend that a great deal of the problem there has been due to the university medical school and private consultants concentrating on rebuilding on an unsuitable site? Nevertheless, I am not against teaching hospitals. From my experience at the Westminster hospital, I have nothing but praise and admiration for its care and treatment. Will my hon. Friend bear in mind that sometimes university teaching facilities override the needs of ordinary patients?

Mr. Dobson

There is something in what my right hon. Friend says. The big hospitals in Bristol, Leicester and elsewhere should regard small hospitals not as sacrifices, but as outposts. They should learn that the loss of those outposts exposes their central citadel to the next round of attacks.

Problems are arising all over Birmingham, but one example will illustrate what is going on. The Secretary of State wrote an article for the Birmingham Evening Mail entitled—would you believe it Mr. Deputy Speaker?— Health crisis? What Crisis? The East Birmingham health authority is being forced to close three wards while central Birmingham is limiting the number of cardiac operations and closing a ward at its children's hospital. No wonder the Birmingham Evening Mail in an editorial on the same day contrasted what it called the statistics and the reality.

The Government talk about efficiency and improving the management of resources, but what is happening in big city hospitals is putting a premium on inefficiency. Careful studies show that closing wards in a hospital which remains open does not save much money. The gearing is all wrong. A 20 per cent. cut in services gives only a 4 per cent. to 5 per cent. saving in costs. Conversely, a 4 per cent. to 5 per cent. increase in investment would lead to a 20 per cent. increase in services. Needless to say, this penny-wise, pound-foolish Government choose the wrong option.

The most spectacular example of that was in my constituency when the Middlesex and University College hospitals were closed to ordinary admissions for one month — for the non-mathmaticians on the Tory Benches, that is one twelfth of the year. It was intended to save £450,000 on a budget of about £120 million. In the end, they did not even save that—but at what costs to patients turned away and lengthening waiting lists? Such cuts do not merely affect patients but reduce the capacity of hospitals to provide adequate training for the doctors and nurses of the future.

All the changes that I have mentioned are leading to imbalanced admissions of patients, which mean that student doctors and nurses do not encounter the cross-section of patients required for their proper training. That is only the start. Cuts in spending on trained nurses mean that there is now an overdependence on trainees at night. Trainees are working excessive night duty. At UCH, the English National Board noted that a registered sick children's nurse was not always available on children's wards where learners undertook night duty. That is a disgrace.

Cuts in support services are forcing nurses, both trained and in training, to take on tasks which were previously the duty of clerical, cleaning and porlering staff. So much for the efficiency savings on ancillary workers which we have heard about. If the Minister does not like what I am saying, I issue this challenge: to publish the English National Board's reports on nurse training in the big city hospitals over the past few years.

It does not stop there. Junior doctors are also suffering. The only excuse for calling highly qualified hard-working doctors "juniors" is that officially they are still learning. Yet, because of cuts in budgets, they are being refused study leave to learn the new techniques essential for their next jobs. Without that study leave, the training posts they occupy may lose accreditation with the authorities and disappear, and so the cycle of degradation will continue.

The big city hospitals are also rightly famous for their research into the causes of disease, into improved methods of treatment and into ways of promoting better health—some in specialist hospitals, some in the general hospitals. All this is being reduced or threatened at the moment. In one year the Medical Research Council awards to medical students have fallen from 380 to 342, research studentships from 230 to 160, advanced course studentships from 100 to 70. Project grants have been cut by 4 per cent., programme grants by some 12 per cent. Government funds to help with general running costs of research units have fallen so low that, because they cannot afford the general running costs, the research units are having to turn down projects which would otherwise be funded privately. That is not very efficient. Over 200 clinical academic posts have disappeared in the last few years. All this damages vital research, the related teaching and the treatment of patients which is also provided in the teaching hospitals by clinical academic staff.

All the work that is done in the units is intended to relieve human misery, the pain of sick children, the nightmare of psychiatric illness, the horrors of cancer. It is of worldwide renown. It is work of which the researchers and all of us in Britain can be proud. It is practical and purposeful. But it is not being properly funded by a Government who continue instead to pour millions of pounds into weapons research and nuclear power generation. I challenge the Minister or the Secretary of State to come with me to Great Ormond Street Hospital for Sick Children and see the patients, their parents and the staff, and tell them face to face why the necessary funds are not available for that famous hospital and for the Institute of Child Health.

Mr. Roger Sims (Chislehurst)

The hon. Gentleman keeps on about funding. The entire burden of his speech, as of the motion to which he is addressing his speech, has been critical and negative. Before he sits down, will he tell us something positive — in particular, what the Opposition would do if they were in power? What has happened to the commitment of a 3 per cent. increase in the payment to the NHS in view of reports in the medical press this week that the Labour party has reneged on its commitments?

Mr. Dobson

The Tories had better learn that there is nothing negative about defending what is left of the NHS. It is the most positive thing that an Opposition can do until they are in power. When we are in power we shall find the funds that are necessary to restore the NHS.

I hope that the Minister will not dismiss the examples that I have given as anecdotes. They are facts; they are what are called evidence in a court of law. They are certainly more truthful than the figures he and his colleagues keep peddling. The Government leave no figure unfiddled in their pursuit—fruitless, as it turns out—of popularity. We now hear they are to try to reduce hospital waiting lists, but they have done it already. First, they left off the day cases. They trumpet about day cases when they are talking about people treated, but they change the rules to exclude day cases waiting for treatment from the waiting lists. More recently they conducted an administrative cull, the object of which was to reduce the list by a further 10 per cent. The doctored list is 661,000—10 per cent. of that is, as near as damn it, 66,000. So comparing like with like the real total is 727,000. That is higher than it was during the industrial dispute in 1982 and even 29,000 higher than the first figures produced after the "winter of discontent".

Our concentration today on the big city hospitals does not mean that the situation in the NHS outside the big cities does not concern us. Of course it does. We need a new approach to the whole of the NHS—supportive and helpful. But the reason why we have concentrated on the big city hospitals is that they and the people that they serve are suffering most from the Government's policies. Of course, many of the people that they serve come from outside the big cities anyway. But it is on the areas suffering most damage that we must concentrate most effort.

Fortunately, between the Government and their objective of undermining the NHS stands one insuperable barrier — the British people. Our people treasure the NHS, which has served them so well. Whenever and wherever it is threatened, local people join the staff involved to resist. Whether in Leeds, Liverpool or London, Birmingham or Bristol, Cardiff or Edinburgh, people resist. They will not forget or forgive the Government's attack on their hospitals. The Labour party, whose proudest boast is that we founded the NHS, is involved in that resistance up and down the country. We promise to protect the NHS, to restore it and to improve it.

Mr. Roy Galley (Halifax)

Will the hon. Gentleman give way?

Mr. Dobson

No, I certainly shall not.

But we promise more than that. We will change society and attack ill health at its source. We will reduce poverty by the introduction of a national minimum wage and increased pensions and benefits. We will tackle homelessness and improve housing conditions, we will improve health and safety at work, we will make healthy foods available at prices all our people can afford and we will turn back the sickening rise in unemployment. Here again, the communities in the big cities can expect to benefit especially from this investment in good health. We are confident that the people of this country will support us. We are confident that, with the help of the people. the big city hospitals will survive the current crisis. We are equally confident that this Tory Government will not.

4.6 pm

The Minister for Health (Mr. Barney Hayhoe)

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: commends the Government on the increased resources it has made available for the National Health Service; congratulates the dedicated Health Service staff for their improved performance in delivering high quality health care; reaffirms the principle of equality of access to health care underlying the Government's resource allocation policy; and endorses the Government's decision to review the Resource Allocation Working Party formula under which the allocation of revenue funds is determined.". The hon. Member for Holborn and St. Pancras (Mr. Dobson), in an exaggerated and distorted account of the NHS, made no reference to the Labour party's plans except to say, in response to an intervention, that it would spend more—but not how much more. There was no sign at all of what increased resources would be made available, nor any real sign of where the money would be spent.

Those outside who follow these affairs will see that the hon. Gentleman's speech was nothing more than a distorted account of difficulties and problems, often exaggerated. There was no constructive element in the speech at all. Indeed, even when the hon. Gentleman talked about perinatal mortality, which is of vital concern to us all, he made no mention of the fact that the rate of 15.4 deaths per thousand which we inherited in 1979 had come down by 1984 to 10 per thousand. There was no reference to that significant improvement which resulted from the dedicated and devoted efforts of the staff involved.

Mr. Galley

rose—

Mr. Hayhoe

Nor was there any sign in the hon. Gentleman's speech that the NHS commands a high level of satisfaction from those who have personal or family experience of the vital services that it provides.

The latest poll commissioned by the National Association of Health Authorities and the Health Service Journal has shown that about 88 to 89 per cent. of people are satisfied, very satisfied or fairly satisfied with the quality of care and treatment. This level of satisfaction is probably higher than for any other institution or organisation in the country.

Mr. Galley

In contrast to what the hon. Member for Holborn and St. Pancras (Mr. Dobson) said, is it not the proudest boast of this Government that the health of people has consistenly improved during their tenure of office? There are now more kidney transplants, more kidney patients, more heart operations, more hip replacements and an improvement in the rate of perinatal mortality. Is it not also our proud boast that resources have consistently grown and have not been cut, as they were under the Labour Government? We may have curtailed growth in places but we have not cut the service.

Mr. Hayhoe

I am grateful to my hon. Friend for making some of the positive and constructive points which, for reasons of time, I shall not be able to include in my speech. Of course constructive criticisms can be made of the present situation, but it is perfectly clear from the speech by the hon. Member for Holborn and St. Pancras (Mr. Dobson) that I must await speeches from Government Members in order to hear responsible comment and helpful suggestions.

I welcome this opportunity to reaffirm the Government's record on the National Health Service and, perhaps even more important, to pay tribute again to the hard work, dedication and excellence of the hundreds of thousands of men and women who work in hospitals, clinics and day centres throughout Britain. By their efforts day in and day out, it is they, not Ministers or DHSS officials, who ensure that we have a National Health Service of which we can all be proud.

The Health Service does not exist in a vacuum. We can have a good Health Service only if we can afford to pay for it, and health services depend on a healthy economy. The basis of a healthy economy is the prudent management of financial affairs so as to ensure economic growth and low inflation. In 1985 the United Kingdom topped the league of EEC countries in terms of economic growth. Indeed, the 3.5 per cent. growth in 1985 was faster than in the United States, and the fastest rate of economic growth in this country since 1973. Our national income is at an all-time high and this is accompanied by an inflation rate of 2.8 per cent. which is the lowest since the 1960s. Lower costs are good for the Health Service and for its patients, just as they are good for other people in Britain.

The improvement in economic performance has been due to sound finance, an important element of which has been the responsible control of public expenditure. Within this overall control, priority has been given to the National Health Service. That is why Health Service expenditure has grown as a proportion of public expenditure from 12 per cent. when the Labour party left government to 14 per cent. now. That is why, when public expenditure generally has grown by 8 per cent. in real terms, spending on the National Health Service has gone up by 24 per cent.

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

rose—

Mr. Hayhoe

The hon. Member for Workington (Mr. Campbell-Savours) is nodding, so there is no need for me to give way to him.

The Health Service has not only shared in the record growth of the economy, because health expenditure has increased its share of the GDP from 5.3 per cent. when the last Labour Government left power to over 6 per cent. now. If that is what the Opposition mean by undermining the Health Service, then words have simply ceased to have any meaning at all. Let me translate all this into what it means for the National Health Service. Spending is up from £7.75 billion when Labour left office to £18.75 billion in 1986–87. This represents a real increase after allowing for inflation of 24 per cent. If Labour's level of spending had been maintained, present spending would be £3.5 billion lower than it is now. Our record is hardly a record of neglect.

Capital spending to replace and improve the hospitals we have inherited and to provide new hospitals and community care facilities will be well over £900 million this year—that is £20 million worth of capital spending every week of the year. A total of 159 new hospital projects each worth over £2 million are presently being planned, designed or built in England alone. Perhaps this is what the Opposition, who cut the capital programme for the NHS when they were in power, mean by undermining the Health Service.

The foundation of a successful and developing Health Service is its staff. We are lucky that the National Health Service recruits so many of the very best people. Since this Government came to power, the National Health Service has taken on more than 60,000 extra nurses and midwives, 36,000 extra after allowing for the shorter working week that was introduced by this Government. We have 5,800 more hospital doctors and 4,000 more GPs than there were under the last Labour Government. Manpower generally is now under proper management control, with the result that far more of the staff are engaged in patient care. Doctors, nurses and professional and technical staff now make up 64 per cent. of total staff, compared to 58 per cent. in 1978. At the same time, the expenditure on management has fallen. Better value for money is just as important as spending more money on the NHS.

Mr. Simon Hughes (Southwark and Bermondsey)

The Minister is obviously seeking to show his concern for National Health Service staff. Does he not accept that of late, in London, Health Services staff have been telling him that, although there has been an increase in finance, there has been a greater increase in need, and that the money is not enough? How can he answer a consultant orthopaedic surgeon in Guy's hospital who wrote to me only last week: Of course the problems are caused by inadequate funding of our unit, which is extremely busy and in great demand. It would help us all if somebody in your position could help to redress the gross imbalances in the Health Service"? I am sure that letter is typical of hundreds that the Minister must know about. How does the Minister answer that person, a surgeon who is trying to do a job as a member of the National Health Service but who cannot cope because the money is inadequate'?

Mr. Hayhoe

I shall say something about those matters in the course of my speech.

More money and more staff, together with improved efficiency, mean that it is possible to treat more patients and improve the service. The record speaks for itself. The Health Service in 1984 treated nine in-patients for every eight treated in 1978; three day cases for every two treated in 1978; and 11 out-patients for every 10 treated in 1978. That is hardly a service in decline or in retreat, as the Opposition and some trade unions would have us believe.

Mr. Laurie Pavitt (Brent, South)

I should like to make two brief points. First, will the Minister include the figure for repeat referrals for out-patients and in-patients? Because of efficiency savings, such people do not spend the right amount of time in hospital. Secondly, the number of patients to which he has referred includes a number of patients who come to hospital three or four times. Will he confirm that in his figures for the total number of nurses he is including for the first time 100,000 nursing auxiliaries?

Mr. Hayhoe

There is no justification for the first point made by the hon. Member for Brent, South (Mr. Pavitt). I well recognise his long and close attachment to and support for health issues. The figures I have seen would not support his contention. He is arguing about 1,000 in an increase of 58,000. If that is his case, there is not a great deal of difference between us, and the hon. Gentleman ought to be applauding the substantial increase that has been made.

The Health Service is a dynamic and developing institution. It is not a museum reflecting and preserving the past. I listened to the Opposition bemoaning any sign of change or progress, and I am sure that if they could they would attack us for the reduction in the number of leeches available in NHS hospitals. Britain is changing. Medical technology and practice is changing and if the Health Service is to provide the sort of first-rate health care that a modern people demands, it must change also.

Let me give some examples of those changes. There are now many more very old people. The proportion of people aged 75 and over has increased from 5 per cent. to 6.5 per cent. of the population over the past 10 years — an increase of 700,000, at a time when the population generally has remained relatively constant. Those numbers will go on increasing.

The population living in cities has declined. Between 1971 and 1981 the population of inner London fell by one sixth, from more than 3 million to 2.5 million. and the population of the former metropolitan counties fell by 500,000, while the population of the rest of the country rose by 1.5 million.

People want health services conveniently available where they now live and not where their grandparents used. to live. The Health Service must change and adapt and adjust its service provision to the new realities.

However, the change in demography is not the only significant change. Medical techniques and medical practice are constantly developing. For example, one in every six cases treated nowadays is a day case, compared with fewer than one in 10 in 1976. The average length of stay in hospital for surgical cases has fallen by 20 per cent. over the past 10 years; that represents an advance in patient care. Opposition Members seem to wish patients to stay longer away from their families and to be maintained at a substantial cost to the taxpayer, simply to keep beds open. Here, as in other areas, Opposition Members are true to their Luddite traditions.

The Government are concerned not simply to provide more money, but to ensure that it is spent better. One element in that aim is a fairer geographical distribution of resources. In 1978–79, there was a gap of about 22 per cent. between the three most deprived regions and the three that were highest above their target. By 1986–87 that gap had been more than halved and is now below 10 per cent. For the first time ever, no region is more than 4 per cent. below its target fair share of resources.

Sir Geoffrey Finsberg (Hampstead and Highgate)

Will my right hon. Friend accept it from me that, as one who opposed the Resource Allocation Working Party system from the time it was dreamed up by the last Labour Government and introduced by the present leader of the Social Democratic party when he was the Health Minister, I know that areas such as my own have suffered time and again? It is precisely because the centres of excellence—the big teaching hospitals—have been losing money to other places over the years that the scare stories that the hon. Member for Holborn and St. Pancras (Mr. Dobson) can trot out ad nauseam have partly come true.

Mr. Hayhoe

I am grateful to my hon. Friend, who speaks on these matters with considerable authority.

The Government remain firmly committed to improving access to health services throughout the country, both at national and at local level. Nationally, that is done through the RAWP formula, which allows for age, morbidity and patient flows to produce a target for each region. At regional and district level, the emphasis shifts from the allocation of funds to achieving the real aim of the whole process—improving equality of access to services. In essence that means providing local services.

It is certainly right to concentrate specialist services at centres of excellence; patients are happy to travel to the city teaching hospitals and similar centres for specialist treatment. However, a wide range of services are best provided locally. Examples include the "bread and butter" acute services. Elderly people are the major users of those services, and helping them to return home is a crucial part of their care.

People rightly expect to have access to local maternity and children's services, but too many of our health services reflect population patterns of 50 or 100 years ago, rather than today's needs. It is right that health authorities should be planning to take acute services to the growing populations of the suburbs and shire counties and that they should be working for a better balance of services in the inner cities, where local people need good community services alongside the centres of excellence at the teaching hospitals.

None of that can be achieved by financial formulae.

Mr. Campbell-Savours

Is the Minister aware that there is hardly a health district in the country where some argument is not going on about local provision, its reduction and closures? Is he aware that Conservatives are involved in many of these little campaigns and they say that they do not understand why the Government have to cut taxes and cut services? They want to pay higher taxes and retain better services. How does the right hon. Gentleman reply to those Conservatives?

Mr. Hayhoe

The Government have made more resources available. I understand those who argue that even more should be made available and I shall comment on them towards the end of my speech.

Mrs. Elaine Kellett-Bowman (Lancaster)

Will my right hon. Friend accept that some superb facilities have been provided in Lancaster and that will inevitably entail the closing of much-loved little hospitals such as the Beaumont hospital, which was a fever hospital in the first world war and cannot be remotely economic?

Mr. Hayhoe

I am grateful to my hon. Friend. She makes the sort of constructive and helpful comment which I said earlier was most likely to be made from the Government side of the House.

I make it clear that London must, of course, retain its centres of excellence, but London is more expensive and, because of recruitment problems—the hon. Member for Holborn and St. Pancras referred to some of those problems — it is sometimes more difficult to provide services in London than elsewhere. So it makes no sense, as a long-term aim, to bring people into London for treatment that can be equally well provided for them locally. Local provision is also much more convenient for patients and their families.

A fairer regional distribution of available money is not enough. It is also important that that money is directed towards the groups that the Government have identified as deserving priority—the elderly, the mentally ill and the mentally handicapped. The increasing costs of acute medicine and the influence and status of those who practise it could mean that the weakest in our society come off second best. I am anxious to ensure that that does not happen and that the elderly, the mentally ill and the mentally handicapped are not disadvantaged.

Expenditure on the priority groups has increased by more than £400 million—a doubling in cash terms, from £1.3 billion to £2.6 billion—and that is in addition to the help given to elderly people by the acute services. Those priority services also benefit from the increased number of mental illness and mental handicap nurses, which has risen by 16 per cent. since 1978, even after allowing for the shorter working week.

It has been generally recognised for many years that, for historical reasons, inner-city areas have tended to be over-provided with acute beds. The London health planning consortium set up under the last Labour Government concluded that the number of acute beds in London needed to be substantially reduced. Patients in inner cities, such as London, are still more likely to go into hospital and to stay longer than are their counterparts outside the big cities. That is due, at least in part, to the historic pattern of care in the inner cities, with its emphasis on the provision of acute beds in teaching hospitals. Those hospitals include specialists' work in their case load, but in big city districts there are 50 per cent. more senior doctors per case treated than there are in other districts.

Although inner cities tend to be over-provided with acute beds, they tend to be under-provided with primary care, as the Acheson report found for London some years ago. High standards of general practice can make a major contribution to tackling the health problems associated with social deprivation in inner cities. Some outstanding work is already being done in that area and the Government have provided extra money, in the form of financial incentives to GPs to form group practices and 60 per cent. grants to improve the quality of practice premises.

Mr. Dobson

Can the right hon. Gentleman tell us how many of the 114 recommendations of the Acheson report have been implemented?

Mr. Hayhoe

Not without notice.

Standards of practice are still variable in inner cities. That is why the discussion document on primary health care, which was published in April, lays particular stress on the importance of improving standards in inner cities.

Of course the challenges faced by the Health Service, such as the need to take account of demographic change and changes in medical techniques and medical practices, as well as the need to ensure a fairer distribution of resources between and within regions and between priority groups, can often give rise to problems. But the NHS is facing up to those challenges, and I pay tribute to Health Service managers and staff for the way in which they have managed, and are managing, the rapid rate of change that is necessary to improve Health Service care.

But inevitably problems and pressures come together in the city districts, where the job of readjusting to a new pattern of care causes particular difficulties. Very often, those districts must also adjust their education and training responsibilities while at the same time, for historic reasons, their hospitals are located in older buildings, which all have their passionate supporters for retention.

The Government are acting to ease the process of change on several fronts. First, they are improving significantly the capital stock of the Health Service. A listing of all the projects would take until 7 pm, so I shall just mention a few: the redevelopment of the Royal Victoria infirmary in Newcastle at a cost of £20 million, the Leicester Royal infirmary development costing £13 million, the new Good Hope district general hospital in Birmingham on which £12 million is being spent, provision in Manchester, expenditure on the Mayday hospital in Croydon, the redevelopment of St. Mary's, Paddington, phase 2 of the development a t St. George's, Tooting, phase I of the Homerton hospital, and the upgrading of St. Thomas's hospital across the river. That hardly sounds like undermining the Health Service in inner cities or observing its collapse.

I am pleased to announce today that I have given approval for phase 2 of the Derby city hospital redevelopment at a cost of nearly £9 million, and that work on the construction of the new national heart and chest hospital on the Brompton site begins today. That adds to the long list of schemes that we have recently approved, many of which deal with patients living in our largest cities, or who would otherwise be treated there. The development at St. Luke's, Bradford, two schemes in Liverpool, the commencement of work in the south-east Thames region on three major new district hospitals, and the undertaking of further work on the new district general hospital at Milton Keynes in the Oxford region all represent increases in the capital programme. The Labour Government cut that capital programme.

Health services are improving in the big cities. Our statistics show that, for all large city districts, the number of in-patients treated rose by 11 per cent. between 1979 and 1984, with nearly 6 per cent. more out-patients treated and nearly 60 per cent. more day cases. It is absolutely moral humbug for trade union leaders to complain about increases in waiting lists, when they and their members were responsible for the damaging strikes of 1978–79 and 1982, which led to record increases in waiting lists and record lengths of waiting lists.

Another issue that is often used to whip up a sense of crisis is that of hospital closures. In any developing service, some hospitals arc bound to close while others are opening. To look only at the closures makes as much sense as reading the deaths column in the newspaper and ignoring the births column, and thereby assuming that the population is dying out. Opposition Members have distinctly selective memories in that area. Although 227 hospitals closed in the first six years of this Government, 270 hospitals closed in the five years of the previous Labour Government. But what count are services, not hospitals, and patients, not beds. As I have said, under this Government services have continued to improve and the number of patients treated continues to increase.

The Government recognise that inner-city districts have particular problems in coping with change. But they must also look critically at their activities and resources. It is right that health authorities that have fared well in the past should re-examine the use that they make of expensive estate and the resources that they have tied up in non-clinical work. It is significant that the Thames regions' cost improvement achievements and plans have been significantly above the national average in every year of the cost improvement programmes. For 1986–87, the Thames regions plan cash-releasing cost improvements equivalent, on average, to more than 2 per cent. of their allocations compared with a national average of some 1.5 per cent. Those are not Government-imposed targets but the regions' and districts' own plans.

Since much of the clamour about a shortage of resources has come from the consultants in London teaching hospitals, it is perhaps worth asking whether those hospitals have looked carefully enough at the cost-effectiveness of the services that they are using to support their clinical activity.

Mr. Simon Hughes

They certainly have.

Mr. Hayhoe

Well, my Department's performance indicators show that, after making allowance for extra costs in London, many of those hospitals have higher catering costs, higher domestic service costs, higher linen service costs, higher operating theatre costs and higher pathology and portering costs. Is it not incumbent upon those who resist change and who demand extra resources to look carefully at whether existing costs need to be so high compared with other teaching districts and the rest of the country generally?

The Government recognise the particular problems of big city districts. I have already referred to the major capital programmes and to the review of primary care, but I must mention two other things that we are doing which should help the health services in the big cities. I turn first to the review of RAWP, which was referred to by my hon. Friend the Member for Hampstead and Highgate (Sir G. Finsberg). It has been suggested that, although substantial progress has been made in redistributing resources, the present RAWP formula needs to be refined to improve its measurement of need.

The Government have therefore set up a review of RAWP, which will consider among other issues whether proper account is taken of social deprivation and inner-city problems, teaching hospital costs and patient flows across regional boundaries. Those are all issues of particular concern to the big cities. I am anxious to see good progress on that review, and have asked the management board to report by the end of the year.

Secondly, the Government have recently added an extra £50 million to health authority cash limits in England, following decisions on this year's pay awards. Of that money, more than £16 million will go to the Thames authorities and to the special health authorities in London, £7 million will go to the north-western and Mersey regions, £5 million will go to the west midlands and over £3 million will go to both Yorkshire and the northern regions. Those are substantial additions for regions that contain most of the big cities.

That has been done in a year when we have already allocated some £650 million more to hospital and community health services in England. With the extra £50 million, we are talking about growth, in real terms, of 3.8 per cent.—the highest figure since 1980–81. In addition, health authorities, with their cost improvement programmes, plan to release a further £150 million this year, with further planned increases in activity and productivity within existing resources. Health authorities are also benefiting from the fall in general inflation brought about by the Government's policies. The reduction in inflation below that assumed when setting cash limits will be worth £20 million on non-pay expenditure.

Of course I am not suggesting that more could not be done, that no improvements could be made or that there are not problems and pressures. Health care generates demand upon demand. Its needs are never satisfied. But this Government have shown their commitment to the Health Service as a whole, and that is reflected in the improvement of health services in our cities. The Opposition's contention that we are undermining health services does not stand up to any critical consideration, and I ask the House to reject the motion and to support the Government's amendment and their efforts to improve health services for all.

4.39 pm

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

The Minister is becoming quite a juggler. In the speech that he has just made he sounded almost as good as the Secretary of State for Employment with his figures showing conclusively that unemployment is spiralling downwards. The Minister's figures are questionable and designed to show that far more money is being spent on the National Health Service. People's experience belies the figures and contradicts the picture painted by the Minister of a growing and expanding National Health Service.

The Minister said that there was a high level of satisfaction with the National Health Service. People would laugh their heads off at such a statement. However, we discovered that the Minister is not really speaking about the attitude towards the Health Service as a whole. He was speaking of comments in the Health Service Journal in which the quality of care was being discussed. People do not like criticising doctors and nurses. They are only too anxious to pay tribute to them. Such a comment gives a false impression about what people really think about National Health Service provision, which is disastrous in many areas. The Minister fails to take note of the anxieties and very real concern expressed by thousands of people.

The hon. Member for Hampstead and Highgate (Sir G. Finsberg) spoke about the excellence of teaching hospitals in London and of the scare stories from some areas. He does not know what he is talking about. I support centres of excellence in London and elsewhere, but it is not scare stories that come from the regions.

I have a horror story to tell the House today which I hope to confine to 10 minutes. It is a horror story of what has happened in Stoke-on-Trent and in north Staffordshire. I emphasise my support for my hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) and others who want the centres of excellence to be assisted, but that must be done by giving new resources to those centres of excellence, not by sapping their income and transferring the funds to the regions. That is wrong.

My main concern today is to put the case for helping the scandalously deprived, underprivileged areas such as north Staffordshire, which has been deprived for a long time. The tendency is for the Government and the public to accept that deprivation with complacency. The appalling inequalities have existed for far too long.

I shall illustrate the massive disparities by referring to red alerts. A few months ago there was a red alert at a London hospital. My hon. Friend was the first to shriek and condemn it. The people of London agreed that it was disastrous. The red alert meant that only emergency cases were admitted to hospital. There was a stop on other admissions.

North Staffordshire experienced red alerts in September—that was not even in winter—from the first part of November until December, for over six weeks from January into February, from February to early April and from mid-April to 6 May. North Staffordshire experienced red alerts for almost the entire winter. There was a stop on admissions and only emergency cases were admitted.

One can imagine the suffering caused to the sick people of north Staffordshire by that interminable period of red alerts. It was not one crisis, but a perpetual crisis. I hope that the House will take note of that scandal. We must do something about it because the sick people of north Staffordshire are suffering. The medical staff are bearing a heavy burden.

The Minister referred to the resource allocation working party which is dealing with the reallocation of resources. According to RAWP, north Staffordshire is 12.5 per cent. below target. Planned progress for improvement has been extremely slow, even without interference with the RAWP formula, so that by 1990 north Staffordshire would still have been 9 per cent. below target—the third worst district in the west midlands region.

According to the DHSS figures published last summer on the value of National Health Service provision for people in all health districts, north Staffordshire is seventh from the bottom. The value of acute services received is only £58.45 per person. Those at the top of the scale—the first 15—are all London district health authorities. They are receiving over twice as much as the people in north Staffordshire. The Minister cannot justify that disparity. He cannot deny the people of north Staffordshire. He cannot give them only half of what Londoners receive. That is wrong and cannot be justified.

I recognise that those figures are not a perfect measure of Health Service deprivation, but they are a significant indicator and should be taken into account by the House.

What I have described makes a mockery of the rhetoric in the Government amendment about reaffirming the principle of equality of access to health care. I do not criticise the Minister on that score because he says that he intends to review RAWP, which I welcome. But I hope that he does not mean that resources will be cut so that deprived regions will suffer still further cuts.

The people of Stoke-on-Trent are suffering gross inequality in access to health care. That inequality is not vague or hypothetical; it leads to genuine human suffering. People who are desperately ill and in pain are suffering unnecessarily. The House should do something about it.

In Stoke-on-Trent people in severe pain because of an arthritic hip joint, for example, have to wait for up to 46 weeks for a first appointment with a consultant. There can be no justification for that. About 60 per cent. of people in my area whose cases are not regarded as "urgent"—that is a medical definition—as most orthopaedic cases are not. have to wait for over one year for an operation. Last December, overall in north Staffordshire, 3,336 people had been waiting for a so-called "non-urgent" operation for over a year. Such cases might be non-urgent in medical terms, but that phrase masks great human suffering.

Urgent cases, naturally, receive quicker treatment, but even that can be appalling. No less than 75 per cent. of "urgent" cases in general surgery wait for over one month. One can imagine what it is like to be told, "You are very ill. You need an urgent operation, but come back in a month's time."

Because of the revelations about unfair allocation, together with pressure from myself, my parliamentary colleagues and officials of the district health authority in north Staffordshire, the West Midlands regional health authority has begun to move and has given a £10.5 million boost over the next five years, which I welcome and appreciate. That authority also has problems, but fortunately it is shortly to receive an additional £40 million. I regret that the boost for north Staffordshire is far from adequate and cannot possibly solve the problems, although it is a move in the right direction towards the RAWP recommendations. However, some people in the south-east are now suggesting that we drop or change the RAWP formula. The hon. Member for Hampstead and Highgate spoke of scare stories in my area. They are not scare stories; they arc true.

I conclude with this plea—that RAWP will not be invalidated in any way. If the Government want to refine it, that is all right—but please do not interfere with the reallocation of funds from the better-off south-east to neglected areas such as mine. I hope that the use of the word "review" will not be a euphemism for stopping reallocation. The Government must face reality—they cannot provide a fair allocation of resources and good health treatment if they do not increase the total resources available. The answer to the problem must be increased resources. Reallocation is important, but juggling with figures is no substitute for increased cash for the NHS. I hope that the Minister will win his battle with the Treasury to increase funding for the NHS.

5.2 pm

Mr. Edward Heath (Old Bexley and Sidcup)

I offer my apologies to the Opposition spokesman for not being here during the opening speech. That was due to circumstances beyond my control. It is unlikely that I shall repeat exactly what the hon. Member for Holborn and St. Pancras (Mr. Dobson) said, because I intend to devote my speech entirely to my constituency of Old Bexley and Sidcup, the borough of Bexley and the Bexley health authority.

It is many years since I made a speech in this House about matters concerned solely with my constituency—indeed, it must be more than 35 years—but I find the current position intolerable and I cannot remain silent any longer. Some of us have held our peace when believing that wrong decisions were taken, but it is apparent that the damage is becoming so great that the facts must be stated. I do not blame my right hon. Friend the Minister, who is a prisoner of the system. It is the system that must be changed. I am glad that there is to be a review of the system, but we cannot wait very long to change it because of the damage it is causing to Bexley.

This country apportions about 6.2 per cent. of gross national product to health services. The general figure for countries of comparable size and wealth is 8.5 per cent. That, therefore, is our first lesson. We must be prepared to devote more of our resources to health, both private and public.

Secondly, I do not believe that allowing the Health Service to go private is the answer, other than to a limited extent. Those who suggest that we follow the American system are urging something that is wholly unacceptable in this country. The United States, its President and Congress are large enough to ignore the fate of millions of their under-privileged citizens. We are not only unable to ignore it, but are not prepared to ignore it. That is why we cannot follow that system. By all means, let us encourage those who can afford it to indulge in private health care, but the great majority cannot afford it.

Thirdly, as I have said many times, the Government are wrong if they think that the first priority is to reduce taxation still further. I know that taxation is still much higher than it was in the years 1970 to 1974, but that is no justification for saying that it must be reduced still further. If I ask my constituents, "Do you want your taxes reduced?", they will say yes. Indeed, I would say yes. However, if we ask them, "Do you want your taxes reduced at the expense of the education of your children and the health of your family?", the immediate answer is no. Yet that is what is happening.

Bexley is part of the great city of London; it is not part of a declining inner city. The population in 1981 was 217,000, in 1985 it was 218,500, and it is projected that by 1996 it will be 220,000. It is an expanding population, with a great demand on services, especially health. Moreover, there is an increasing elderly population. In 1981 the percentage was 29.8, in 1985 it was 31.2, and it is projected that by 1991 it will be 32 per cent. Bexley, therefore. meets the requirements set out by the Minister that it should be an increasing, not declining, population with an increasing, not declining, proportion of elderly people.

As the Minister said, people expect to be treated locally, and I can tell him that the people of Bexley expect to be treated in Bexley. My right hon. Friend was wrong to suggest that people needing specialist treatment are willing to travel to teaching hospitals and for relatives to have to travel to visit them after a serious operation.

That is precisely the argument that has been taking place over the Brook hospital cardiac unit. I am grateful to my right hon. Friend the Secretary of State for overruling the regional committee and keeping the unit there. However, the argument took seven years. That is an example of the bureaucratic incompetence of regional committees. They can argue for a long time about such a major facility as the cardiac unit at the Brook hospital. Indeed, that unit has a better success record than the teaching hospitals, and the cost of operations is cheaper than in the teaching hospitals, for obvious reasons.

Yet the same argument is taking place about the neurological unit at the Brook hospital, and that, too, has been going on for seven years. We still do not have a settlement, review after review goes on, and that is just not tolerable. I hope that I have established that Bexley has an expanding population with a larger proportion of elderly people who want to be treated with the necessary facilities.

I shall now deal with existing facilities, which is the real point of the argument. Bexley has Queen Mary's hospital which was built just over 10 years ago. It was opened by the then Labour Minister for Health. It has 556 beds, an outstanding maternity unit, many effective specialised departments and a major accident unit. It is up to date. It is a modern creation, yet it is being damaged because it is being refused the money to carry out its services.

I fully support equalising health treatment throughout the country. After all, I spent a large part of my political life trying to obtain a better deal for Scotland, Wales and the north-east of England. As Secretary of State for Industry, Trade and Regional Development in 1963–64, I dealt with this matter in the context of north-eastern regional development. Alas, those policies have been abondoned by this Government. I am in favour of equalisation, but not at the cost of the nonsense of refusing to use the modern facilities that we already have. That cannot make sense by any criteria.

Surely the first priority must be to ensure that modern hospitals with all the facilities are used, and then go on to build additional hospitals that are required to replace the older hospitals. One problem with the present formula is that when an area has to build a modern hospital to replace, for example, two older hospitals, as is happening in north and east London, extra money is required to run the two older hospitals while building the new one. That is why Bexley is suffering from less money. We cannot make use of the modern hospital that we have. The system is based on a fallacy and the Government took a wrong policy decision.

The Bexley health authority found that for 1986–87 it was due to have a deficit of £750,000 and that in 1989–90 the deficit would increase to nearly £1.5 million. Bexley has been told that it must meet the deficit by cuts or increased efficiency. Queen Mary's hospital is proven to be well above the national average in terms of efficiency, the speed of its throughput is faster than the national and regional average, and the cost per patient is lower than average. What more can be asked of it than that? A stage is reached when it is not possible further to increase efficiency and make cuts of up to £1.5 million.

The Government say that they are spending 20 per cent. more on real resources for the hospital service, but we know that 70 per cent. of this spending goes on nurses' salaries. That leaves a much smaller sum to make improvements elsewhere in the country. As there are shorter working hours for nurses, the burden on them and the demand for nurses is much greater than it was. That cannot be taken into account merely by saying, "Greater efficiency."

I have often been accused of being a technologist who is keen only on management. I am interested in management, but I have never suggested that someone who is a good Army officer or good at running an electronics factory will be admirable at running a hospital. If I have to go into hospital, I do not want someone running the show who has only just left the Royal Air Force. Nor do I want someone in charge who is especially good at producing television screens. I would want a good matron, and on that basis I would know where I was.

As my hon. Friends the Member for Bexleyheath (Mr. Townsend) and for Erith and Crayford (Mr. Evennett) are present, I should say that the Bexley mental hospital, which has 907 beds, is affected by the Government's policy. Similarly, the Erith district hospital, which has 31 beds, is affected by the cuts.

In dealing with the Government's demands, cuts are being made. What is the result? One ward has already been closed at Queen Mary's hospital. That means that the modern facilities in which the Government have invested capital are not being used. That ward will remain closed. There was a threat that the ward for disabled young people would be closed. We have been able to avert that threat purely by blackmail. Bexley has said, "A great deal of private money has been provided and if you dare close the ward you will never get any more money for a hospital in Bexley." The ward has not been closed. Unfortunately, a general ward remains closed.

In addition, one operating theatre is to be closed. That will reduce operating capacity by 20 per cent., or 1,760 operations a year out of 8,800. That will happen and that will be the direct result of the Government's policy.

There is to be a reduction in the number of beds in the surgical wards because of the closure of one operating theatre. As a result, there will be a reduction in emergency admissions. That follows logically from the closure of the operating theatre.

Less than a month ago one of my constituents said, "I know that you can do nothing about this, but you should know that my wife was taken seriously ill. I called her doctor and he came at once. He told me that she must have an immediate operation. We rang Queen Mary's and were told that no emergency place was available. We telephoned Dartford and were told, 'There is a ward, an operating theatre and a surgeon; bring her over,' only to find that there was no bed available for her after the operation. We were told that Dartford could not accept her. Finally, she was taken to Gravesend." For someone living in Sidcup, that is a considerable distance to travel. That is an example of what is already happening, and that is why the situation has become intolerable. I must make it plain that that is so.

In addition, the family planning surgical service at Queen Mary's hospital is to be abolished. That is surely a loss. My constituents do not understand why cuts are being made on their doorstep when the Government say that many millions of pounds of extra money are being provided for the NHS.

The Bexley mental hospital is to be closed eventually. Twenty old ladies who are psycho-geriatric patients have been taken from their ward—they were accustomed to it, as were those who looked after them—and spread around the hospital so that the ward can be closed. That is certainly not a step towards perfection. That is not making the hospital more effective. To move patients in that way is damaging and should not be allowed to happen.

The operating theatre at the Erith district hospital is to be closed. All consultants' beds are to disappear, along with the loss of 15 general practitioners' beds in one ward. That is because the necessary money is not to be made available, and not because of inefficiencies.

The community services will suffer as well. Two clinics are to close. Three dental clinics are to close, and there is to be a reduction of dental staff. The number of family planning clinics will be reduced from 10 to four. When these things are happening, how can I say to my constituents that they are getting a better health service and better individual care? It is not possible for me to say that that is happening. If I were to say that it was, I would he incredible, and I do not wish to be incredible.

Mr. Cyril D. Townsend (Bexleyheath)

I support what my right hon. Friend is saying. Does he agree that, far from having too many hospital administrators in the Bexley health area, we have rather too few?

Mr. Heath

That is the case. My hon. Friend and I have spent a vast amount of time talking to hospital administrators, to the Bexley health committee and to the chairman of the regional health authority. It is easy to say that a reduction in the number of administrators will bring about the savings that are required, but a point is reached when it is damaging to the service to reduce the administrative staff.

The ambulance service will be cut because of the abolition of the GLC. Many chair cases will not be taken by ambulance and walking cases will have to find other means of transport to get to the hospital when required. This is happening already.

Mr. Tony Banks (Newham, North-West)

Will the right hon. Gentleman give way?

Mr. Heath

I have taken too long already. I know the point that the hon. Gentleman wishes to make. We have sometimes been in agreement about the GLC.

I have outlined the facts with which we must deal. It is intolerable that Bexley should have its modern services damaged because new services are going to be made available in other parts of the country. New services can be provided only if we have an expanding economy and are prepared to use a greater share of our wealth to support the Health Service. If we try to take the opposite approach, we shall damage the new resources which have already been provided. That is no answer to the problem. If the Minister is bound to have the review of RAWP, so be it, but I ask him to ensure that it is done quickly. I would much prefer no review to be undertaken. It would be better if he took the action which he knows to be necessary, my colleagues and I having had long talks with him.

Mr. Nicholas Budgen (Wolverhampton, South-West)

My right hon. Friend may know that there are some who criticised the last part of his period in power on the ground that the money supply was growing too fast. Sterling M3 has grown over the past three months at an annualised rate of 39 per cent. What measure of growth would he like to see? By how much more would he like to see credit expanding?

Mr. Heath

I appreciate my hon. Friend's anxiety. The most recent figures show that M3 money supply is growing at one and a half times the maximum rate at which it grew between 1970 and 1974. It is natural that my hon. Friend is alarmed when we have a Government whom he supports, which was not the case with my Government. My hon. Friend is out of date on M3. He must listen to the Chancellor of the Exchequer, who says that M3 no longer matters. My right hon. Friend has already abolished M3, M2 and M1. We are back to MO. Perhaps my hon. Friend will wish to follow him and to take up MO, which suggests that everything is all right. That will mean that we can have more money, which will stop the Government ruining a good service. That is why I urge my right hon. Friend the Minister not to waste a great deal of time on reviews. He has seen the problem clearly. It is necessary to let those of us who are fortunate to have modern resources to use them effectively and to keep them. We cannot justify to the electorate doing otherwise.

5.10 pm

Mrs. Renée Short (Wolverhampton, North-East)

The right hon. Member for Old Bexley and Sidcup (Mr. Heath) described perfectly what is happening in every constituency. I am sure that if Conservative Members were willing to ascertain what is happening in hospitals in their constituencies they would find cases similar to those that the right hon. Gentleman described. The Select Committee has spent some time considering the problems. We have ventured into areas, as the right hon. Gentleman said, where there is considerable pressure on hospitals. I am not surprised that the Minister for Health did not refer in his opening speech to the catastrophe that has befallen him in the resignation of Mr. Victor Paige. Mr. Paige, who was in post for a matter of months only, was head-hunted at an enormous salary. He decided that he could no longer continue in the job. The Select Committee will probably want to pursue that matter in the near future.

Mr. Paige gave evidence to the Public Accounts Committee some two months before the Secretary of State for Social Services announced the resignation. In that session with the PAC, Mr. Paige listed his achievements. In 1985–86, there was a cost improvement of £150 million, of which £120 million was cash-releasing. Short-term programmes for the regions for 1986–87 also show a cost improvement of £150 million, cash-releasing — an increase of £30 million over 1985–86. Taking those figures back to 1984–85 and up to 1986–87, a total of £700 million cash-saving will be produced for the National Health Service. By the end of 1986–87, that will produce £400 million for the National Health Service on a recurring basis. When the 1987–88 CIP commences, a base of £400 million will be rolled on and repeated. Anything achieved then under cost improvement cash-releasing will be over and above the £400 million. That sounds absolutely marvellous. Hon. Members might say, "What are we worrying about? All that lovely lolly is available for all the development that we have not been able to fund." The challenge is, as Mr. Paige admitted, that savings must be made and retained to keep on improving services. Certainly, this year the regions are committed to delivering a cost improvement, cash-releasing programme of £150 million.

The other part of the package is that manpower savings must be made. Mr. Mills, from the Department, told the PAC that for every million pounds released by any region we could expect to see at least 100 people being reduced from the payroll. That is, in a full year. There is the rub. Those considerable savings are expected to be made. but they must not include the withdrawal of services or service reductions. The North East Thames regional health authority was examined and the board was satisfied that it was not trying to hide service cuts within a CIP.

However, the Select Committee discovered, in reply to questions on 4 June, that the volume of resources going into hospital and community health services has increased by only 6.3 per cent. since 1979–80—about 1 per cent. per annum—and most of that was in the earlier years. Since 1980–81, the increase over five years has been only 3.1 per cent. In fact, in the three years since the last election the increase has been less than over half of 1 per cent. In other words, the purchasing power of the hospital service has been at a standstill for three years. That is where all the problems lie.

Hospitals, especially those in the London region and in all the large cities, are struggling with an increasing number of elderly patients, with finding resources to introduce and develop further medical advances. Ministers have generally agreed that we need a service growth of 2 per cent. per annum. That that is not forthcoming is a matter of acute concern to the medical profession—the nurses, the paramedics, and so on. That is what led the leaders of 12 teaching hospitals last Monday to describe the crisis they are facing after inner London had suffered cuts of £35 million last year. We cannot cut that amount out of a large city without damaging the fabric of the Health Service. The consultants, those responsible for delivering expert care and those who have academic teaching responsibilities have complained. Dr. Croft of St. Thomas' hospital has said: The crisis was a national disgrace, many useful and productive human lives have been lost and staff, including nurses, secretaries and porters are leaving because of their rotten pay. Beds are being closed and waiting lists increase. We cannot overlook the effects of the review body awards to doctors, nurses, and other NHS staff. Morale falls when pay levels to all but the highest paid are well below the average. Whitley staff, in particular, have become very disillusioned.

The Secretary of State has the following questions to answer. First, can pay settlements be adjusted and cost improvements contrived, as far as he requires them to be, without harming patient services still further? If not, will he provide additional resources to maintain growth? Secondly, is he satisfied that the NHS management board's new accounting framework can properly assess, monitor and provide information about local value-for-money strategies? Thirdly, I ask what response he makes to Mr. Paige's reference in his letter of resignation to the different perspectives, priorities, objectives and restraints of Ministers and the Chairman of the Management Board". Fourthly, how is he facing up to the problem—which he and his predecessor embraced wholeheartedly—of the growing cost to community care of those patients discharged from long-stay hospitals and the effects of that both on NHS and local authority expenditure? The problem affects every region, large city and local authority. What is the answer to the question? The Select Committee has referred to it, but we have not had a satisfactory answer. Fifthly, it is generally agreed that we need 2 per cent. growth per annum. Will the Secretary of State tell us whether that will happen?

My hon. Friend the Member for Holborn and St. Pancras (Mr. Dobson) referred to the Institute of Psychiatry. The Minister will have read the letter that appeared in The Times on 27 May from Professor Griffith Edwards who runs an important and internationally known alcohol abuse clinic at the Maudsley hospital. The Minister will know exactly what was said in the letter signed by various consultants, some of whom are acting as advisers to the Select Committee in its inquiry into the prison medical service. We hope that in the not-too-distant future the results of the inquiry will be published. I can promise the Minister that the inquiry will show some serious problems that need urgent attention. I do not suppose that that will surprise him.

The consultants at the Institute of Psychiatry also wrote to me on the same day as the letter appeared in The Times pointing out that the work they do concerns important areas that the Government have said require attention as a matter of priority. They referred to the aspects which I have mentioned—mental illness and mental handicap—as well as to drug and alcohol abuse and caring for the elderly. They stated: the hospital's DHSS grant has failed to keep pace with inflation in recent years, and in consequence the hospital is underfunded by approximately £400,000 per annum and has accumulated an £800,000 deficit. The health authority's initial plan to recover this deficit involved closing our … Alcoholism Treatment Unit (directed by Professor Griffith Edwards), substantial portions of the Child Psychiatry Department … a neurosurgical ward, and part of the Mental Handicap Unit. Because of the public outcry the Special Health Authority has postponed these closures". Unless the money is forthcoming, those closures will take place.

The dean, who wrote to me, said that the second reason for the institute's difficulties arose from the progressive squeeze on universities. He said: The Institute of Psychiatry receives approximately £2 million per annum from the University Grants Commission via London University for its teaching responsibilities. It gets another £4 million from other sources, such as research councils, industry and charities. The institute's basic university income provides the salaries for those who seek the additional funds. The erosion of the university grant means that the institute is running a deficit of about £200,000 a year.

The squeeze on academic salaries adds to the problem. The Institute of Psychiatry has already lost three professors and five clinical posts, which is a serious loss for a teaching hospital. I hope that the Under-Secretary of State will paint a more convincing picture than the Minister for Health.

5.21 pm

Mr. Roy Galley (Halifax)

The hon. Member for Wolverhampton, North-East (Mrs. Short) made a number of valid points but was rather selective in citing the statistics given to the Select Committee.

Mrs. Renée Short

One always has to select such statistics.

Mr. Galley

Of course, but by selecting statistics one can slant the argument in a particular direction. The hon. Lady did not fully recognise the enormous growth in resources and the improvements in the family practitioner service which inevitably have caused problems for expenditure on hospitals. She did not recognise that the increased pay for NHS staff, especially nurses and doctors, has imposed pressure on NHS resources, or that the squeeze on NHS revenue, pay and capital between 1974 and 1979 has caused a backlog which has since had to be cleared.

The implication of the Opposition's motion, which was so vividly portrayed by the right hon. Member for Stoke-on-Trent, South (Mr. Ashley), is that the big conurbations, which already attract disproportionately large resources across so many aspects of Government activity, should receive further preferential treatment. One accepts that there are problems, but, in round terms, that proposal should rightly be resented in smaller provincial towns. The previously bipartisan policy of the fairer distribution of resources has meant improvements in health facilities for smaller towns, such as the one that I represent. The Calderdale area health authority has still not reached its target under the resource allocation working party formula but has improved its position by more than 2 per cent. in the past five or six years. That has meant £500,000 extra to provide services. It is right and fair that there should be such an improvement in the provinces where there has been inadequate resourcing. The aim of the Opposition's motion is effectively to reverse that trend.

The Opposition may object to what I have said and say that that is not what they want and that they want to increase resources across the board—plucking funds, as ever, from the magical money tree. The unit costs of providing services in these urban areas often exceed the unit costs in smaller, more efficient hospitals. London receives a disproportionate share of resources for its population and, even taking account of London weighting, unit costs for the provision of particular items of service can be as much as 30 per cent. higher than in other parts of the country. In effect, the Opposition's motion is saying that the provinces should subsidise London and the other conurbations underwriting and ingraining those inefficiencies. [HON. MEMBERS: -No."] Of course there are particular problems, but, in general terms, that is what the motion seeks to do.

There will be additional resources during this financial year. Inflation will be significantly lower than projected. Oil prices have been significantly reduced. Those facts as well as prudent management in parts of the Health Service mean that there will be money for considerable expansion on a national basis. It may not affect every area, but in certain parts of the country there will be scope for considerable increases in expenditure. No doubt, given all the information that we have received in this debate, there is a case for a modest and carefully allocated increase in resources and for looking again at the formulae for teaching hospitals. No doubt, there are grounds for gearing allocations to take account of socio-economic factors as well as population changes. No doubt, the numbers of people who are working, but not necessarily living, in the cities is a relevant factor which present policies do not fully recognise. But essentially the problem is one of management. Some parts of the NHS are better managed than others. All of it could be better managed. We must not retreat from encouraging that improved management and stopping the subsidy of inefficiency.

When some services can be provided by the private sector at half' the cost of the NHS, we cannot give up the fight for better management and more efficiency. When one hospital, for example, loses, as a result of pilfering, 25 per cent. of its linen budget each year, we cannot give up. When, for ideological reasons, health authorities lose the taxpayers' money by failing to co-operate with the private sector, we cannot give in to inefficiency.

The Opposition pretend that better management is not caring. They claim that inefficiency is caring. It is the reverse. The efficient use of resources—I do not claim that all the resources are used efficiently—allows more people to be treated, which means more, not less, caring. We do not want a health service that will be judged to be successful by the number of sick people in beds. We want one where success means more well people.

Ultimately, I become angry about the Opposition's two-faced hypocrisy. They are seeking to make political capital from people's suffering. The Labour Government cut the hospital building programme by one third, and for two consecutive years cut revenue spending. They did not curtail the rate of growth; they cut expenditure. I became angry that some consultants and some people in organisations such as the Royal College of Nursing aid and abet the Opposition when part of the problem is that they have had such a good deal, in terms of pay and conditions, from this Government, in stark contrast to the shabby way in which they were treated by the last Labour Government.

Mr. Tony Banks

rose—

Mr. Galley

The struggle for better management will be long and arduous.

Mr. Pavitt

rose—

Mr. Galley

We need to stop the Health Service from being a political football and to allow managers to manage in a caring way. Radical steps may well be needed to achieve that. We should consider putting the NHS at one remove from political control and creating a quasi-nationalised industry concept. We need the NHS management board to manage We should look again at health authorities and community health councils, replacing them with a more effective consumer voice.

Parliament and Government must be involved in health, but the day-to-day management of such a vast service with 1 million employees cannot be controlled centrally by Government. It needs to be effectively devolved with a more independent supervisory national board. Government and Parliament should determine the policies and the principles of the Health Service but leave the daily management to Health Service professionals. That concept has worked well with other services provided on a national basis and it can work with health.

Of course, funding would be a problem if independence was to be established. We would need to consider a devolved structure with perhaps a system of regional health charges on the lines of the community charges which are now proposed, so that people would know what they were paying for health and could monitor service improvements in direct relation to the increased taxation. There would always need to be an element of central funding to take account of special health authorities, medical education, specific circumstances and problems, but management and funding need to be devolved, in the interests of the patients in the hospitals, if our already successful Health Service is to meet successfully the challenges of the future. One of the greatest challenges to the Government during the next few years will be to take people's health and children's education out of the forefront of the political arena within the principles set down by Parliament.

5.31 pm

Mr. Archy Kirkwood (Roxburgh and Berwickshire)

I listened with great interest to the speech of the hon. Member for Halifax (Mr. Galley). If I am correct in saying that he is the chairman of the Conservative Back-Bench committee on health, it augurs ill for the future development of Conservative policy on health. If the thoughts that the hon. Gentleman expressed this evening are typical of the thoughts and the new development of ideas in Conservative circles and in the Back-Bench committee, I fear for the future of the Health Service. I could devote my entire speech to responding to the hon. Gentleman's comments, but I had better resist that temptation.

I shall recommend to my Liberal and SDP colleagues that they should support the principal motion tabled by the leader of the Labour party. We are discussing an Opposite motion which contains the main elements of health care that worry us. Care for everyone, training problems for doctors and nurses, conditions in which staff work, research facilities and the promotion of good health are issues which also give us cause for anxiety.

I was deeply impressed by the speech made by the right hon. Member for Old Bexley and Sidcup (Mr. Heath). I have rarely heard such a powerful exposition of local problems that demonstrated the challenges that face us nationally. The Government are obliged to take account of everything said by a right hon. Member of such experience and substance in the House.

I support the Conservative amendment to the motion in so far as it refers to the dedication of the staff. The staff of the National Health Service are under a pressure which they have never experienced before. I had direct experience of that pressure when I took up a challenge offered by the Nursing Standard to be a porter in an accident emergency unit in Whipps Cross hospital earlier this year. I spent a 10-hour night shift there and learnt a great deal about the pressure under which the staff operate. I hope that the Government will bring forward the review of the resource allocation formula. I hope that changes will be implemented soon after the review reports to the Department later this year.

I did not agree with the hon. Member for Halifax that money should be removed from London to fund the provinces. The difficulties in big city hospitals are caused by matters such as the extent of social deprivation, the teaching costs inevitably incurred in the big teaching hospitals and the cross-regional and cross-district flows. When the Minister for Health referred to the RAWP review, he mentioned those problems specifically. I hope that those matters will be urgently considered and urgently acted upon when the Minister receives the report.

The quality of care in the big city hospitals is under threat. The statistics that the Government frequently throw from the Dispatch Box do not face up to the difficulties of achieving and maintaining the quality of care. The statistics may show increased throughput of patients, but the statistics on the use of beds do not refer to readmissions and the damage that is often caused to patients by being chucked out of wards earlier than their medical condition would warrant.

I read an article in The Guardian this morning about waiting lists, which said that DHSS Ministers are to put up a stiff fight to try to get some extra resources from the Treasury to reduce the appalling level of waiting lists across the country and particularly in our big city hospitals. I would give the Minister for Health every support to try to obtain extra resources, not just as a cynical political guise to get him through a general election but because the need is there, and evident to all.

Dr. John Marek (Wrexham)

I wish to follow the hon. Gentleman's point about readmissions. There may be extra readmissions simply because of discharges made prematurely. The Minister said that the figures that he has seen did not lead him to consider the figures he was quoting differently. Does the hon. Gentleman agree that it would be good for the public and for the House to know what figures the Minister was considering which led him to make that comment earlier this afternoon?

Mr. Kirkwood

I shall take up that helpful intervention. I ask the Minister to take notice of that point, take it back to his Department and consider writing to hon. Members who are interested in those matters, such as myself and the hon. Members for Wrexham (Dr. Marek) and for Holborn and St. Pancras (Mr. Dobson), and give us the evidence used in the Minister for Health's statement earlier this evening.

I shall make some comments about the Liberal party's attitude to helping the plight of the big city hospitals. First, we must start—the right hon. Member for Old Bexley and Sidcup made a powerful argument for this at the beginning of his speech — by devoting an increased proportion of our gross domestic product to the Health Service. Having considered the issues, I believe that an annual increase of at least 2 per cent. is required just to stand still in terms of funding the health budget. The Liberal party would commit itself to attempt that, as far as it was possible to do so.

In terms of the problems that exist, we would try to give more emphasis to the prevention of illness and community care. If more was spent on prevention and on community care, much of the pressure would be removed from the big city hospitals. Even such things as general practitioner hospitals in big cities and in rural areas could be used to give general practitioners the opportunity to practise in some of those smaller hospitals which Conservative Members are so keen to close in order to put people into huge palaces of high technology medical care. More could be done to save some of those general practitioner hospitals to keep some of our elderly people in acute beds closer to their families. An example of that exists in the border region where the Government are putting in a new district general hospital, which is small by national standards, but we are in the process, on a supposedly temporary basis, of closing Sekirk cottage hospital in the surrounding area as a consequence of lack of finance.

The problems of big city hospitals could be alleviated substantially by making proper and prudent use of some of the smaller hospitals and using them as general practitioner beds.

With regard to London, I underline what the hon. Member for Holborn and St. Pancras said about the Maudsley. That is an absolute litmus test of the Government's attitude towards those hospitals and institutions which have not only a national but an international reputation. The Maudsley does valuable work in the prevention of alcohol problems, drug abuse and adolescent problems. It is a litmus test of how the Government will proceed in future. If the Government do not provide the resources that that institution and others like it need, how will they manage to survive the financial pressures that they are under?

In terms of the problems outside London, I understand that the latest estimate is that about £1.7 billion needs to be spent on the fabric of our big city hospitals. One could not expect to achieve such a capital expenditure programme during one Parliament. However, I get the impression that the capital allocations mentioned this evening by the Minister do not meet the problems. They ignore the difficult new pressures, including AIDS, which face the institutions in our big cities.

The Government have not devoted anything like enough money to research into the prevention and cure of AIDS, nor have they devoted enough money to the provision of the intensive nursing facilities that are required to deal with the effects of the virus. Not only do the staff at St. Mary's hospital at Paddington deserve much more recognition for their dedication and their work; they require extra resources.

The problems are enormous and are exacerbated by poor housing and bad social conditions. The method of funding must be changed to take account of the underlying important root causes of illness and poor health, especially as they affect the elderly. The provincial services must be allowed to improve, but not at the expense of the major London teaching hospitals. many of which carry out important research into the prevention of disease. The staff must be properly motivated and rewarded for their dedication. I was especially upset to hear the hon. Member for Halifax say that nurses are well rewarded. If one visited any hospital and suggested that this was the case, especially against the background of the past two years—

Mr. Galley

Will the hon. Gentleman give way?

Mr. Kirkwood

No, I do not have time.

Last year, the nurses' long overdue and meagre increase was phased, and this year three months' worth of their increase was sliced off the top. If the hon. Gentleman considers that to be proper treatment, he and I define the phrase differently.

The aging population, increasing specialisation in surgery, new viruses such as AIDS, the abuse of heroin and alcohol, and tobacco-related diseases have created demands on our big city hospitals. Community care, prevention and education also create extra demands for resources. The need for these resources is urgent, and action is necessary now — or the hospital system may collapse.

5.42 pm

Mr. Rob Hayward (Kingswood)

First, I should take up a comment made by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwoocl). I was surprised that he did not give way to my hon. Friend the Member for Halifax (Mr. Galley) in comparing nurses' real take-home pay. My hon. Friend did not refer to this year's award. He compared their real take-home pay under the Labour Government with the current position.

It is not surprising that the hon. Member for Holborn and St. Pancras (Mr. Dobson) did not refer to the achievements or failures of the Labour Government. He was not a Member of Parliament at the time and did not, therefore, have to suffer the tidal wave of complaints, which some Opposition Members may recall, from constituents because the Labour Government cut the Health Service.

I wish to quote the Labour Member of the European Parliament who represents Greater Manchester, North who wrote in her diary: All things bright and beautiful, All projects great and small, All things wise and wonderful, Denis Healey CUTS them all. Healey cuts the Old Age Pension, Although he cuts by stealth, And when he looks for savings, Healey cuts the National Health. The hon. Member for Wolverhampton, North-East (Mrs. Short) made a series of calculations which bear careful consideration because inflation can be calculated differently for different areas of the economy. The hon. Lady came to the conclusion that in the past three years there has been a standstill in expenditure on the National Health Service. A Labour Member's calculations have thus laid to rest her party's accusations that there have been cuts in the NHS. The word was "standstill", not "cuts". I disagree with some of her calculations, but at least she made them logically and carefully.

As far as I can recall, the hon. Member for Holborn and St. Pancras also rewrote history in the House. He was the first Labour Member who made any reference to or acknowledgement of the winter of discontent of 1978–79. It is worth considering hospital waiting lists, which the hon. Gentleman dealt with in substantial detail. He tried to cover up the changes in hospital waiting lists. The figures that he used were provided in a written answer of 18 April at columns 536–37. The latest hospital waiting list is 674,000 people. When we replaced the Labour Government in 1979, they left a waiting list of 752,000 people. Therefore, according to those statistics, the Government have reduced it by about 80,000. The hon. Gentleman made a series of calculations claiming them to be fiddled figures. In 1974, the Labour Government inherited a hospital waiting list of 508,000. They managed to add 50 per cent. to the waiting list in their five years of government.

Mr. Pavitt

The hon. Gentleman forgets the consultants' strike of 1974 and the junior hospital doctors' strike of 1975. The increase in the figures was due to the backlog caused by the strikes. The hon. Gentleman mentioned the winter of discontent, but when the doctors went on strike no one mentioned it. The Tory party supported the doctors.

Mr. Hayward

That intervention was absolutely fascinating, because—

Mr. Robert Wareing (Liverpool, West Derby)

It was truthful.

Mr. Hayward

It was not truthful. There was a reference to the dispute of 1974. In December 1973 the waiting list was 508,000, in June 1974 it was 508,000, and in December 1974 it was 517,000. That first dispute, which the hon. Gentleman tried to identify as one cause of the increase, had no impact on the figures. The Labour Government managed to increase hospital waiting lists during a period without disputes. When they had the opportunity to run the NHS as efficiently as possible. they increased hospital waiting lists by almost 25 per cent. That was the Labour party's achievement, which we inherited. They now try to massage the figures to suggest that we have not reduced the waiting lists.

The latest figure is 661,000. There has been a further progressive decrease in waiting lists—

Dr. Marek

They have been going up.

Mr. Hayward

The hon. Gentleman intervenes from a sedentary position with the comment, "They have been going up." The figures given to the hon. Member for Holborn and St. Pancras, which he did not challenge in his speech, show that for each half year since 1983 there has been a decline in hospital waiting lists.

Dr. Marek

If the hon. Gentleman read the figures for the past four half-yearly periods, he would see that waiting lists have been increasing. It is all very well to take selective figures at certain periods, but the special circumstances explain them. The net effect since the Government took office is that waiting lists have increased.

Mr. Hayward

The waiting list went from 752,000 in March 1979 to 674,000 in March 1985. It is a fascinating juggling of figures. I wonder where the hon. Gentleman obtained his degree if that is what he calls "going up." By anyone's calculations, it is a reduction of 80,000.

The hon. Member for Holborn and St. Pancras attempted to give me a geography lesson on Bristol. I wish he had not tried. I intervened and queried the issue of the hospital waiting lists. He said that I should know that three health authorities cover Bristol. I am well aware of that and I can name them—Southmead, Frenchay and Bristol and Weston. When he produced his cumulative figure, he failed to identify the fact that they cover not only Bristol but five other parliamentary constituencies.

The hon. Gentleman went on to mention Wendover hospital which was closed three years ago. He said that the Government are trying to close it, so he is obviously not aware of the fact that it has already been closed. That hospital is not even in Bristol; it is in Kingswood. It is outside the city to which he thought he was referring.

Even if the waiting lists for Bristol and Frenchay are combined, which would cover most of the city, the totals have gone down. The investment in the health authority is visible for anyone to see. The right hon. Member for Bristol, South (Mr. Cocks) made an intervention, if the hon. Member for Wrexham (Dr. Marek) can remember. The right hon. Gentleman referred to investment in the Bristol Royal infirmary and the Bristol eye hospital, both of which are university teaching hospitals, in which several million pounds have been invested. I believe that there is £4 million of investment in the Bristol eye hospital. Frenchay hospital, which is the other major general hospital on the eastern side of the city, has just announced phase one of a redevelopment programme, involving investment of £6 million, which will serve the eastern side of the city. There are not only those investments, but the continuing construction of the Weston hospital, which is a major new general hospital, and investments in smaller projects such as—

Dr. Marek

In The Guardian on 3 June 1986 there was an article which began: Most medical schools face budget deficits of between 2 and 11 per cent next year because of Government cuts, the British Medical Association said yesterday. If that is the case and the hon. Gentleman's area is not having those cuts, I suggest that it is at the expense of even greater cuts almost everwhere else in the country.

Mr. Hayward

I was referring to capital expenditure, which was a point made in the speech of the hon. Member for Holborn and St. Pancras. The hon. Gentleman attempted to deny that capital expenditure was taking place. I was identifying investments of substantial size within Bristol and the immediate area.

If one looks at smaller projects, there are investments in major health centres, such as Cadbury Heath, and a new ambulance station at Sandwell. Projects of that type are going on all the time and are part of a major improvement in the Health Service which did not take place under the previous Labour Government.

I should like to raise one or two specific points which relate to my constituency. We have heard a number of contributions relating, quite reasonably, to the problems of the resource allocation working party. The right hon. Member for Stoke-on-Trent, South (Mr. Ashley) identified extremely well the problems faced by the provinces. We all know, if we are outside the main home counties, that there has been a gross imbalance, and it is not right that that should continue. It may be that RAWP has to be looked at to ensure that some of the anomalies identified by my right hon. Friend the Member for Old Bexley and Sidcup (Mr. Heath) do not continue. However, it is not right that a constituent of mine can be told that he has to wait between 12 and 18 months for a heart bypass operation when, if he were in London, he would have to wait for only three months. We cannot continue to accept that.

Mr. Tony Banks

How long does the hon. Gentleman want him to wait?

Mr. Hayward

I would not want him to wait at all. There is a regional imbalance which we must recognise and resolve.

I deal now with expenditure in terms of management. There have been cases identified of odd or unnecessarily high expenditure. References have been made to linen contracts, catering contracts, and so on. People are still being asked to cut their services and to reduce the number of hours worked. At the same time they are asked what design of Laura Ashley wallpaper they should have in the wards around them. That is a gross misdirection of money, and we should address ourselves to such issues.

There is no doubt that the recent decision on nurses' pay has had a serious impact on morale. The award was intended to be over a full year. I think that all nurses and hon. Members of both sides will be extremely disappointed that it has not proved possible to make that award for the full year. However, as my hon. Friend the Member for Halifax said, the overall terms and conditions are improving and should continue to be improved.

5.55 pm

Mr. Lewis Carter-Jones (Eccles)

I believe that the right hon. Member for Old Bexley and Sidcup (Mr. Heath) spoke for every hon. Member. Anyone who has spent any time in the House can recall in some form or another the problems that he enunciated. I pay that tribute to him. It is the first time in 22 years that I have heard him make a constituency speech, and he spoke for hon. Members on both sides of the House.

In his opening speech the Minister placed great stress on the fact that they have reduced the rate of perinatal mortality and handicap. Hon. Members who have been here for some time will know that I fought that battle about 12 years ago. I take no great credit for it. It was brought to my notice by the Spastics Society which felt that, although it was caring for children with cerebral palsy, it should try to do something about prevention. James Loring of the Spastics Society started the campaign, and I suppose that I was the House of Commons postman. I delivered the parliamentary questions with the help of people such as Mary Holland, who is now the researcher for MENCAP, and Peter Mitchell, who is now the researcher for the Royal Association for Disability and Rehabilitation. People gradually became aware of the problem. If one read all the reports on perinatal care and the prevention of disability from 1920, one would swear that the same man wrote every conclusion. The one thing that was common to them all was the need of special baby care units.

The perinatal mortality rate is down, but the Minister should not take too much credit for it because the campaign was started long ago. My hon. Friend the Member for Wolverhampton, North-East (Mrs. Short) chaired the Select Committee which looked into neonatal care. One of the strange things that happened was that the Select Committee was allowed to take its evidence through from one Parliament to another. The Committee reported in 1979 and made the same observation — that we needed special baby care units and minimum standards of maternity care.

If the Minister wants to lake credit for the decline in perinatal mortality, he must also take responsibility for the omissions. If special baby care units reduce perinatal mortality and, above all, reduce baby disabilities, then, in the long run, the Minister can save money. Imagine my feelings when I received a letter from two eminent pediatricians in my constituency at the Hope teaching hospital, men for whom I have the highest regard and who have great dedication, which said: In view of the Region's inability to support the modest capital development, we are unwilling to continue to accept the pressures which the provision of a Regional Neonatal Service entails and in the absence of a firm and early starting date for the proposed expansion, will be ceasing to accept neonatal referrals as of 1 July 1986. If the Minister wants the credit he must face the reality. There is not a large sum of money involved and, as the right hon. Member for Old Bexley and Sidcup said when he talked about the problems of his constituency, that can be multiplied up and down the country. Special baby care units will reduce perinatal mortality and disability. In the short run, they will save considerable sums. If the Minister wants credit, he can have it. However, with the credit he must accept the responsibilty for Hope hospital unit and all the others involved.

Mr. Favell

Is it not a fact that as facilities improve elsewhere in the region, for example in my district of Stockport, there will be less demand for the excellent services given at Hope? Consequently, people will not come from Stockport to Hope, and there will be less demand there. Should not people cut back at Hope so that we can spread resources elsewhere?

Mr. Carter-Jones

I fear that the hon. Gentleman has missed the point. A special baby care unit cares for those in urgent need. One does not need a large multiplication of units. The units should be spread at reasonable distances so that the babies can be brought in quickly. If I had my way, part of the Royal Air Force helicopter training exercise would be to bring pregnant mothers quickly from distant places to the units. That is the key. We want more special baby care units, but they should be distributed so that they can he easily reached. That is the point. Indeed, I understand that there may be; some developments in that area.

There is a distinct possibility that other hon. Members on both sides of the House wish to speak, so I shall be brief. Let me ask a few questions. There was a specially leaked news item in today's edition of The Guardian—[Interruption.] I am delighted that David Hencke got it right without the Minister having to be consulted.

Under the allocation of money to the Manchester area, and as Salford has teaching hospitals, will money be supplied to the Salford district health authority?

Ministers have given us a considerable lecture on Griffiths. Administrators from the outside world can bring great quality and skill to hospitals. Indeed, the right hon. Member for Old Bexley and Sidcup had a thing or two to say about that. Will the Minister explain to hon. Members who represent constituencies in the north-west why the Department of Health and Social Security auditor has discovered that millions of pounds have not been spent on treating patients, paying nurses or looking after doctors, but have been wasted on buying a computer? The documents relating to the bids have not been discovered, according to up-to-date information from today's edition of the Daily Telegraph.

If people want to talk about care in the community, they should not pay lip service to it. If rehabilitation can be and is properly practised, they should make sure that those who are rehabilitated are not returned to the conditions that caused their ill health or suffering.

We talk about joint funding. This matter has been raised time and again with the Department. Mentally ill people from Prestwich hospital cannot be returned to the community because there are no facilities for them. That problem should be resolved. If we pay lip service to the concept of returning them to the community, but do not do so, that is no reason for running down the hospitals in which they have to stay. That should be borne in mind. If we are efficient in rehabilitating the elderly, as we are at Ladywell hospital in my constituency, we should not return them to the homes and conditions that caused the decline in their health.

I make one final plea for the regions. The Minister would do us all a favour if he had words with the Department of Education and Science about the way in which limited resources for the Medical Research Council are distributed. We are not morons in the outstations. All talent does not lie south of Cambridge, yet the Medical Research Council, in allocating its resources, employs about 1,500 people south of Cambridge and 150 north of it. When I draw the line north of Cambridge, as a former RAF navigator, I can swing it sharply down to hit the coast somewhere near Bournemouth, so one can see that 1,500 researchers are employed by the M RC in the area on the line from Bournemouth to Cambridge whereas the rest of England has 150.

I ask the Minister to have discussions with his colleagues in the Department of Education and Science to find out whether there can be a fairer allocation to the inner city areas and teaching hospitals in the north-west, the north-east, the midlands and the south-west.

6.5 pm

Mr. Andrew Rowe (Mid-Kent)

My right hon. Friend the Member for Old Bexley and Sidcup (Mr. Heath) may have reservations about committing himself, when he is not well, to a service run by the Royal Air Force, but I am delighted to follow an hon. Member—the hon. Member for Eccles (Mr. Carter-Jones)—whose aspiration is that large numbers of babies should begin their lives thanks to the benevolence of the RAF.

The public should understand some of the statistics that are bandied about in the House. What my right hon. Friend the Minister for Health said about the proportion of the gross domestic product devoted to the NHS having increased sharply since the Government came to office is not only true, but should be understood. The amount of money being spent on the NHS in real terms has also increased sharply since the Government came to office. Those are important refutations of the campaign of misrepresentation which the Opposition have sought to spread over the country to denigrate the Government's achievements. But, at the end of the day, the public will not be very interested in statistics. They will be interested in the realisation that the problems of the NHS are not just of the past so many years, but were endemic from the day the NHS was brought into being.

The real problem is that, out of 1,000 people, about 750 will show a symptom, and of them 250 may go to a doctor. Of that 250, about 10 may get into a hospital, and of that 10 one may end up in a teaching hospital. Yet it is the teaching hospitals, looking after that minute proportion of patients, which still dominate the NHS and the sympathy of the public.

The 15 teaching hospitals in London were all built within a cab ride of Harley street. That mix of interests persists and still distorts NHS provision. I ask my hon. Friend the Under-Secretary whether the time has come for a serious look at whether the persistence with the special teaching districts should now be done away with.

I spent 12 years of my life working in Health Service administration and teaching in Scotland. There are no special teaching districts in Scotland. The Scots took a decision from the beginning that the NHS in Scotland would benefit greatly from the inclusion of those centres of excellence in the general body of the NHS. The time has come to look seriously at whether the continuance of those extraordinary survivors is to the benefit of the NHS as a whole. I want to see centres of excellence elsewhere in the country. It is wrong to allow the great consultants' dependency on their private practices to slow down or thwart the transfer of teaching from the great cities to places where people live now.

My right hon. Friend the Member for Old Bexley and Sidcup was grossly unfair to the Government in much of what he said. However, he was absolutely correct on one point: where there are modern, up-to-date facilities of the highest standard, it is lunacy to insist that very expensive technology should be placed in Victorian hospitals where standards of cleanliness make it more dangerous to go into hospital than to remain outside. We want centres of excellence in modern facilities in other places spread around the country. If the facilities were placed where it was convenient not for the consultants — as they are presently organised — but for the patients, the consultants would soon move to the equipment rather than the people to the consultants.

Why should the Medway health district—one of the health districts in my constituency—which still has only 77.2 per cent. of its entitlement under RAWP, despite the Government's real assistance to the district, lose £3 million a year ferrying patients from Medway to London, through heavy traffic, to receive treatment which ought to be available in the district and which the district is keen to provide?

It is bad economics, bad health care and bad policy for people to be treated in high-cost hospitals, in densely populated areas, when they could be perfectly well treated in places where accommodation and bed costs are cheaper and where the standard of living of the staff would be higher. I am in favour of a review of RAWP and I support the Government's amendment. However, that review should not under-estimate the facts. Medway's population is 326,000 and it received £42.9 million this year. Lewisham and North Southwark has a population of 318,000 but it will receive £101 million this year.

It is a grave disservice to the National Health Service for people to bandy about sums of money to imply that we are damaging the Health Service. We are beginning slowly to move facilities to where people live now. My hon. Friend the Member for Medway (Mrs. Fenner) and my hon. Friend the Member for Gillingham (Mr. Couchman) will support me on that issue. However, in this I believe that my right hon. Friend the Member for Old Bexley and Sidcup and other hon. Members were correct: that there comes a time when re-cutting the cloth may provide a more fashionable garment; it also provides a very short garment. We must now try to close the gap between the proportion of gross domestic product spent on health by many of our overseas competitors and the proportion spent here. It is a great credit to the Government that we spend so much more than we used to spend, but we must spend more.

Finally, there is in the National Health Service, as there is in education or the social services, a real problem of presentation in public debate.

Mr. Tony Banks

The hon. Gentleman means that people do not believe him.

Mr. Rowe

I do not suppose that people would believe the hon. Member for Newham, North-West (Mr. Banks), whether he were speaking on his feet or from a sedentary position.

I expect that all hon. Members know of consultants who are on nine elevenths contracts but who put in fewer hours than that and use their juniors to cover for them. We all know of general practitioners who work perfunctorily or who issue certificates or prescriptions irresponsibly. We all know that there is no establishment more tightly knit or more protective of its powers of patronage than the medical establishment. Yet when Governments, as the Government have courageously begun to do, begin to move against these abuses, the robbery of the public—

Mr. Dobson

If the hon. Gentleman is so impressed by the Government's moves against fiddling by consultants, does he approve of the change in the consultants' contracts which used to give them a 10 per cent. bonus for working 100 per cent. of their time in the National Health Service but which now gives the same bonus for working only 90 per cent. of their time in the Health Service?

Mr. Rowe

I think that it is absurd to give anyone a bonus for honouring his contract.

When we try to do something about abuse, it is not the villains who are put up to scream foul. The exemplary consultants and model GPs, of whom there are many, appear in the media to castigate the Government for interfering with the Health Service. As a result, every time that a change is mooted or a check on malpractice is introduced, the most conscientious, caring and manifestly admirable medical team is put up to argue against the alteration. By a sleight of hand, of which the medics are becoming increasingly the masters, they turn the argument into one of a devoted Health Service profession fighting for its life against a crude, unfeeling Government. That is balderdash in most cases. That is an attempt to con the public that any attempt by the Government to break open cosy cabals of incompetence is an assault on patient care.

The Government's record with the Health Service shows that the service is safe in our hands. I also believe that a great deal more can be done. There should be more resources for the Health Service, but I want to ensure that the increased resources do not go to bolster up Victorian distribution of resources when account should be taken of regions such as mine.

6.17 pm

Mr. David Young (Bolton, South-East)

On 27 January 1981, I had an Adjournment debate in which the former Under-Secretary of State for Health and Social Security conceded the argument for the necessity of concentrating the acute facilities in Bolton on one hospital site. It was estimated that the first phase of the hospital should start in 1984–85. Since then, the programme has consistently slipped. On 5 April this year, the regional planning team and the Bolton district team argued that a start could be made in 1988. However, within weeks, the programme was again held back for 18 months.

I would like to describe that programme to the House. It is disgraceful for any Government to allow this state of affairs to continue. The programme involves the main base for acute treatment in Bolton. The programme called for 148 acute beds in phase 1. The hospital is based on an old poor law hospital, and much of the facility must be demolished before the new facility is built. Of the 148 beds requested, 54 will replace beds in wards that will have to be demolished.

It was hoped that, with that provision, the children's facility would be allocated on one site and that was extremely necessary. It was also argued that the positioning of the accident and emergency unit on the same site as the medical emergency unit would use nursing power and medical resources to the best effect.

At present there are no day beds on the main site. It was proposed that phase 1 should provide 17. It is an outstanding disgrace that there are no intensive care beds on the site of the main hospital in Bolton. Eight were to be provided under phase 1, which would still have been five fewer than the number required. Phase 1 also provided that, as six coronary care beds would be lost through demolition and other factors, eight such beds should be included. X-ray facilities are extemely important. Concern has been expressed by consultants and by the Health and Safety Executive about the facilities at Bolton. It is a disgrace that the chest X-ray machine dates from 1956 and cannot he maintained even by the manufacturers after December this year.

Those are some of the problems that we have faced as a result of the holding back of the new facilities. An increasing worry is the lack of confidence among medical staff about whether phase 1 will ever take place. Consultants are being encouraged to leave the authority area due to lack of resources and facilities. Under phase 1 it was hoped to locate the department dealing with AIDS in buildings now occupied by the Bolton Royal Infirmary. At present, it is accommodated in the basement of a building leased from the local authority. The incidence of AIDS is increasing, especially in inner-city areas, and we are lucky to have people of reputation dealing with it in Bolton, but how can we attract consultants of stature if we fail to plough in the resources needed to maintain this essential service?

The district authority told me this morning that, due to the 18-month delay on phase 1, necessary holding measures must include an ophthalmic theatre adjoining Kitchener ward at the royal infirmary at a cost of £80,000. That would normally have been encompassed in phase 1. The refurbishing of D block at Bolton general hospital covering four wards will cost £600,000. There is also a need to create a dental laboratory. Without this we shall lose royal college registrar status and the ability to take postgraduate students. The total cost of holding operations necessitated by the delay is between £830,000 and £1 million. That is not good bookkeeping, even for a Government and a regional authority who seem to put money before patients. The essential point is not the increased amount spent but the amount required to be spent to meet need. Human suffering and medical need cannot be categorised in terms of a balance sheet.

I challenge the Minister to come to Bolton with me and to meet the district health authority and the consultants. Let us have a little less talk in the House and a little more meeting of minds where it is required. I hope that the Minister and the regional authority will see fit to create a system in which those who allocated money to the National Health Service must say whether they are members of private health schemes, which seem to be milking the Health Service dry in Bolton and elsewhere.

We are asking for health for the people of Bolton. Year after year we have been bottom of the regional allocations list. To judge from the Black report, Bolton is the best place to go if you want an early death. We require health for our people. I issue an outright challenge to the Minister to come to Bolton and defend his policy with the people who have to use the hospitals there, many of which are out-dated, lacking in facilities and with departments divided between two sites. We thought that we had convinced the previous Health Minister—now Minister for Housing, Urban Affairs and Construction—but the Government's appointees on the regional health authority clearly regard Bolton and its people as of no consequence. I hope that the Minister will accept this request on behalf of my constituents. Incidentally, the people of Bolton also elected two Tory Members. It might be in those Members' interests if the Minister came to Bolton and showed that he was not content merely to view our problems from afar.

6.26 pm

Mr. Tony Favell (Stockport)

The National Health Service involves three main interest groups. First, the Government—by courtesy of the taxpayer—provide the wherewithal. The second is the 1,250,000 people who are employed by the Health Service. Thirdly, and most important, there are the patients. We hear constantly from the Opposition about the crisis in the National Health Service, but for which of the three groups is there a crisis'? We have heard from my right hon. Friend the Minister for Health that the vast majority of people — about nine tenths—are satisfied with the Health Service.

Mr. Tony Banks

Has the hon. Gentleman seen the advertisement on the front page of The Guardian today? It says: You may well he waiting months— even years—for non-urgent treatment under the National Health Service. Simply because it is over-stretched and can't cope with the demands made upon it. That came from Health First, a private medical aid company.

Mr. Favell

I heard about that advertisement, although I did not read it. I have no doubt that my hon. Friend the Under-Secretary of State will deal with that. I shall have something to say about waiting lists in due course.

Some people are of course dissatisfied with the National Health Service, but they are very rarely dissatisfied with the treatment that they receive. They are dissatisfied at having to wait for it. Waiting lists have been reduced since the Government came to power and since the winter of discontent, but there is still much to be done. More often that not, however, extra money is not the answer. There are wide variations in waiting lists between districts, often with identical resources. Why should that be? I shall return to that, too, later in my speech.

Mr. Banks

The hon. Gentleman does not have that long.

Mr. Favell

I have three or four minutes.

If the patients do not recognise a crisis in the National Health Service, is there a crisis for the Government? There will be a crisis for the Government — I hope that my right hon. Friend the Minister for Health is listening—if we do not get our message right. We have a good message, and a good record since 1979. Even the Shadow Chancellor does not dispute that there are 58,000 more nurses, 10,000 more doctors and dentists, and 73,000 more in-patients and 3 million more out-patients being treated. That is all very good news. Moreover, spending has risen by one fifth since 1979.

Mr. Banks

Why does the Prime Minister go private, then?

Mr. Favell

I have mentioned the patients and the Government. What of the 1,250,000 employees? Are they satisfied? Clearly Mr. Victor Paige was not, because he resigned. Mr. Freddie Lucas, the central Birmingham district health authority general manager, resigned following his one and only report to his health authority because he had been rendered impotent by politically motivated pseudo-general managers. He listed a number of improvements which he wanted to make to the authority. He pointed out that there was an £80,000 taxi bill, that £52,000 was paid for 100 private telephone lines which bypassed the switchboards, that £500,000 was being spent on a sterile fluids production unit which had not been in use for two years, and that £5,500 was being spent on a mural. What was the result? He got the elbow.

Many people in the NHS are absolutely appalled by such reports. They want to see, not waste, but money put to good use. They realise that, when money is wasted, lives are lost. Mr. Lucas also pointed out that a private company, admittedly an American company, which had to operate at a profit could build a psychiatric hospital at almost exactly half the cost which the health authority could, and give identical service. Dedicated people in the NHS are appalled at that news. They want money to be directed to saving patients' lives.

It is a question not merely of spending more money, but of making better use of resources, and many people know that. Many people can contribute to saving resources. My hon. Friend the Member for Mid-Kent (Mr. Rowe) criticised consultants — and, indeed, many deserve criticism. They should examine exactly what they do. When they have a long waiting list, do they refer patients to colleagues who do not? Recently I came across two orthopaedic surgeons operating in the same district health authority, one of whom had a waiting list of almost a year and the other who had none whatever.

Mr. Alex Fletcher (Edinburgh, Central)

There may be a reason for that.

Mr. Favell

There may be a reason, but the orthopaedic surgeon without a waiting list was highly popular with his patients, and highly unpopular with his colleagues.

Do consultants consider referring patients to other parts of the region which have shorter waiting lists, as they are entitled to do? People can even go to Scotland. As my hon. Friend the Member for Edinburgh, Central (Mr. Fletcher) knows, 25 per cent. more resources are available to the Scottish Office and the waiting lists are not so long in Scotland. Why should people not be referred there or to other parts of England?

General practitioners should ensure that patients are referred to consultants who do not have long waiting lists, and when consultants have long waiting lists they should consider how much time they spend on committees, how often they attend conferences and how often they deliver papers.

Are nursing sisters looking to see where savings can be made on wards? Do they find out whether there are empty beds? Are they ensuring that consultants make full use of the beds available, and that half of them are not standing empty? Do they ensure that nurses are not hanging around because consultants have not referred patients to beds as they should?

Last week I visited a kidney dialysis unit in Carmarthen which is operated by private enterprise. The patients there were highly delighted and the district health authority was also highly delighted because the number of kidney patients going without treatment in Wales has been reduced substantially since that unit opened. The Government should also be delighted because those patients are being treated at £12,000 a year each, whereas in the Yorkshire regional health authority, for example, it costs £16,320 a year each.

Mr. Tony Banks

Will the hon. Gentleman give way?

Mr. Favell

No. I must finish in just two minutes.

Why are those savings being achieved in the private sector and not in the NHS?

Mr. Tony Banks

The private sector does not have the same costs.

Mr. Favell

The reason is that the private sector minimises its administrative overheads and has flexible staffing patterns. The NHS should offer that sort of service. Then there would be no private sector to talk about and Opposition Members would have nothing to bleat about. Many people within the NHS, indeed the vast majority, wish to offer that sort of service. They know that saving money saves lives, as has been proved during the past two years by that wonderful kidney dialysis service introduced in Wales.

The NHS exists for patients. It does not exist for those who work in it, as is recognised by 999 out of each 1,000 people who work there.

6.34 pm

Mr. Laurie Pavitt (Brent, South)

In the presence of the right hon. Member for Old Bexley and Sidcup (Mr. Heath), I should like to repeat what has been said on many occasions during his absence. On one historic occasion a voice below the Gangway said "Speak for Britain." The right hon. Gentleman need not have apologised for speaking about his constituency, because it reflected what is happening in almost all constituencies. The House is grateful for his contribution which has been the most important in the debate so far. It epitomised the problem in all constituencies.

To apply a commercial bureaucratic mind to the NHS is crass stupidity and complete nonsense. Neither the Minister nor the Department realise that there are interrelations between big city hospitals and others, between departments within hospitals, between medicine and surgery, and between community medicine and hospitals. The Department is compartmentalising each sector so that it is considered separately. As a result, all sectors, including teaching hospitals and their relationship with district general hospitals, are being eroded to such an extent that there is chaos on admissions.

The rationalisation that is going on applies to industry, but not to the NHS. If a department or a ward in a teaching hospital or if a geriatric hospital is closed—in my constituency two are facing closure — it has an immediate effect on other hospitals. In industry one can close down two factories, sack some workers, produce fewer goods and make a profit. The object in the NHS is not merely to save money. One can save money only at patients' expense. At present health authorities are, in effect, selling furniture to pay the rent.

I am eternally grateful to Westminster hospital because it excised cancers from my wife and from me. It is now under threat from the salami-slicing attitudes of this Administration. They do not close a hospital. A chunk of a hospital is closed and then another chunk is closed. Westminster has already lost ophthalmology. I envy the right hon. Member for Old Bexley and Sidcup, for when he was fighting for the Brook cardiac unit, I was fighting for cardiac surgery at Westminster. I wish that I had taken lessons from him, because he won and I lost. Cardiac surgery was closed to save £100,000 but it has not been saved. This year's figures show that that money has again been paid for Westminster patients treated elsewhere.

The radiotherapy and oncology departments are now threatened with closure. That is the biggest nonsense under the sun. If those departments are closed, the hospital will close because patient diagnosis, haematology, pathology, diagnostic X-ray, general cancer surgery, and the department of medicine and nursing will be affected. I plead with the Minister to save those departments, especially as a new computerised cancer machine, costing £1,200,000, has just been installed. The concrete roof alone cost thousands. If that department is closed, what will he done with it? Will it be sold for scrap? That would be complete nonsense in terms of managerial efficiency.

Outer city areas, such as Bexley, affect the teaching hospitals. Recently a patient from Bexley wanted emergency treatment. Thirteen London hospitals were asked to take the admission and the last one, St. Bartholomew's, was able to admit the case. There has been a rationalisation of acute beds, but, as acute beds are closed in one area, they must be provided elsewhere. If there are no beds, the big city hospitals must find beds for emergencies.

There is a shortage of nurses. A number of letters from Hammersmith hospital and elsewhere has shown that acute beds are unoccupied, because of the shortage not of money but of nurses. I am sorry that I do not have more time to devote to that subject. The Middlesex hospital is likely to lose its nursing school and Bart's has 32 places for students which will be unfilled this year.

I know that the Minister never pays attention to newspaper reports, but will he deny the existence of a bonus for managers who close hospitals? Will he deny that the bonus rate for regional managers is £1,660 a year—5 per cent. of their salary—and for district managers £3,160 a year for closing hospitals? The Government may think that the NHS is safe in their hands, but I hope that when the Minister replies he will refute that and say that it is just newspaper talk. For the Government to pay a premium for shutting down the NHS is even bigger nonsense than most of the other things that they have been doing in recent years.

6.40 pm

Dr. John Marek (Wrexham)

This has been art important debate, as has been evidenced by the number of hon. Members in the Chamber and by the number of those who have wanted to speak. I am sorry that several of my hon. Friends have been unable to make their important contributions to one of the vital aspects of the country's life.

I do not have much time, but I want to mention one or two points which have emerged from the debate.

Mr. Tony Banks

Take it all.

Dr. Marek

It would not be fair to take it all.

When the Minister replies, I would welcome it if he admitted that the 24 per cent. increase in money for the NHS is not what it seems and that there are differences between the NHS now and in 1979.

The Minister for Health said that we were getting older as a nation, that medical techniques were developing, and that just to stand still the NHS must have extra finance and resources. However, it is a great pity that the Minister did not continue that list and talk about the Clegg award. Five or six years ago the Labour Government were heavily criticised by the Conservative party for making resources available to the NHS in order to lift the morale of its workers. We were heavily criticised for setting up the Clegg pay review body, whose recommendations had to be implemented by the Conservative party in government. Five years later we hear nothing of that. The Government subsume those increases and take credit for them. The Government would never have implemented those recommendations if the previous Labour Administration had not organised them.

It is a great pity that the Minister said nothing about the huge increase in unemployment and the resulting extra sickness. I hope that next time he speaks he will put that right.

It is a pity that the Minister did not say that the medical retail prices index is much higher than the ordinary retail prices index. At certain parts in his speech the Minister talked in cash terms. A few months ago Government figures showed that hospital spending would rise by 6.7 per cent. this year when inflation would be only 4.5 per cent. The Government made great play of that. What had to be forced out of them was that half of that money had to be found by the health authorities themselves from greater efficiency in the use of resources. What type of arithmetic is that? The Government say that they are providing extra finance, but through the back door health authorities have to provide part of that finance from their own resources by extra efficiency and savings. If the Government challenge that, let the Minister say so when he replies so that it is on the record.

It is true that over the past year hospital waiting lists have gone down, but there was a huge increase between March 1982 and September 1982. I have a chart, which clearly cannot go into Hansard, but it shows that there was a sharp narrow plateau of high waiting lists during the winter of discontent—no one would want to get away from that—but since 1982 waiting lists have on average reached an unparalleled high level. [Interruption.] I have the figures here and hon. Members can see the plateau.

The hon. Member for Kingswood (Mr. Hayward) tried to pretend, using three selective figures, that waiting lists were low, but let us look at the figures. I quote from a pamphlet entitled "Health Expenditure in the UK," published by the Office of Health Economics. Let us look at the waiting lists per available bed for the years from 1975. I shall not be selective; I shall read them year by year. They are 1.4, 1.5, 1.5, 1.7, 1.8, 1.7—that is in 1980, the first year of the Tory Administration — 1.7, 2.0, 1£.9 and 2 for 1984. Those calculations show a high plateau in recent years.

What we can draw from that is that it is easy to prove one proposition or another with statistics. But the Government will never fool all the people all the time. My hon. Friends have given concrete examples of hospitals and wards that are closing and of patients who are being turfed out early. We have also heard that in responsible speeches from not one but many Conservative Members who are genuinely concerned about what is happening to the NHS.

If Ministers came down from their office blocks at the Elephant and Castle and went into hospitals and spoke to some of the people within the NHS, a different story might emerge. The Government stand condemned on their handling of the NHS not only by the House but by the public. I urge the House to pass the motion that has been tabled by my right hon. Friend the Leader of the Opposition.

6.46 pm

The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)

I start with two points of agreement with the hon. Member for Wrexham (Dr. Marek). First, it has been an important and interesting debate, and, secondly, it is important that Ministers with responsibility for health should visit hospitals. That is why I am glad that my right hon. Friend the Minister for Health and I spend so much of our time visiting hospitals. My average at the moment is about three hospitals a week. I would be surprised if what we have heard this afternoon suggests that Labour Members visit hospitals.

Certainly, we welcome the debate and I hope that the Opposition will continue to give up their Supply days so that we can have more debates on the NHS for the opportunity that that will give us to nail the lies that Labour Members trail around the country. I also welcome the opportunity that the debate gives for us to pay tribute yet again to those who recorded such an impressive list of achievements in the steady development and modernisation of our Health Service.

It is entirely natural that parties in opposition should attack the Government's stewardship in most, if not all, areas of our national life. That is the stuff of democratic politics. It might even be expected of the Social Democratic and Liberal parties, although it has been a particular feature of the debate that not for a second has a member of the Social Democratic party been present and no doubt that is something that they will explain to the electorate. But even for the Social Democratic and Liberal parties it has been more difficult to justify this sort of attack on an intellectual basis when their main, and, indeed, most would say their only, stock in trade since their existence has been to suggest that they have somehow discovered a magic elixir which lifts them above the mere sordid dogfight of party politics. However, the harsh realities have now broken in.

I understand the sensitivity of the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) in the absence of his former hon. Friends, given the present state of relations. But now that they accept the realities of party politics, they can indulge in the sort of parliamentary politics that we have seen among Labour Members and attack the NHS. If those attacks are to have any validity, two requirements must be fulfilled. First, the Opposition must be able to show that the Health Service is in decline. This they have manifestly failed to do either in this debate or elsewhere, and they have been unable to do so because the Health Service is now treating far more patients more effectively than it has ever done before, with better funding and better management. Secondly, they would need to offer some evidence that they would be able to achieve greater progress should the Health Service ever again come under their control.

Their record when in government both for the conduct of the economy and of the Health Service—and I refer to the record of the Labour party and the record of those absent friends the hon. Members of the Social Democratic party who cannot escape their share of responsibility for the failures before 1979—leaves no room for optimism. They would have to show that they have discovered policies which would create an even stronger economic recovery than has been achieved under this Government, and thus produce an economy which could divert still more resources than we are diverting to the National Health Service. For the Opposition to seek to make such claims would be an unusually sick joke even by the extraordinary standards of the right hon. Member for Birmingham, Sparkbrook (Mr. Hattersley) and his happy plans to increase public spending by no less than £24 billion.

My right hon. Friend the Minister has already effectively reminded us of the sorry record when Labour and the present Social Democrat leadership were last in office. Health expenditure then represented only 5.3 per cent of the national income, whereas now it is 6 per cent.

Mr. Kirkwood

The Minister has not yet answered a single question.

Mr. Whitney

The hon. Member for Roxburgh and Berwickshire spoke for 10 minutes demanding more expenditure and giving no answers. He spoke about the need to deal with AIDS and totally ignored our expenditure on that illness. Under the policies of the hon. Gentleman's colleagues in the Social Democratic party when it sustained the Labour party in office 5.3 per cent. of the national income was spent on health care. We are spending 6 per cent. on health care. If the hon. Gentleman does not think that 6 per cent. is enough, how much does he suggest should be spent and how much will his party produce? The policies advocated by the Opposition parties would take us straight back down the inflationary spiral from which we have so painfully but successfully recovered, and they would destroy all hope of funding the National Health Service in the way in which, no doubt, all of us wish to see it funded.

Given such unconvincing Opposition parties, we must look for other and perhaps more substantial causes for the concern which undoubtedly exists among many people about the state of the National Health Service. Certainly there are pressures, most if not all of which are also being suffered by other countries. The acknowledgement of these pressures seemed to come as some surprise to the hon. Member for Wrexharn. My right hon. Friend the Minister made a point which we consistently recognise: that an ageing population makes greatly increased calls on the medical services. There is also the pressure of medical advance with its new and costly techniques which are providing great improvements in patient care.

As services develop and expand, expectations and aspirations increase even faster, putting the Health Service under still more pressure. For example, total hip replacements in England increased from just over 18,000 in 1979 to 25,500 in 1984, and more elderly people now hope and expect to receive this treatment. Priority has been given to new treatments for life threatening diseases. For example, the number of patients receiving kidney treatment has risen from 5,400 in 1978 to over 11,000 in 1984 in the United Kingdom. Understandably, this creates new demands on doctors and patients alike and waiting lists grow for treatments which were simply not available a few years ago. Set against the overall decline in waiting lists, that is an impressive record.

Most of the pressures are to be welcomed as manifestations of a successful Health Service, but they have to be set against financial realities from which no one can escape. That is a proposition which Opposition parties often seem determined to ignore or not to comprehend. There are also the pressures of pay settlements in the NHS. Like other employers, the Health Service needs to ensure that the pay of its staff is sufficient and rewards hard work and merit. The pay of nurses has risen by a third above the rate of inflation since 1979. Like other employers, the NHS cannot cast aside the responsibility for funding settlements and give carte blanche to the negotiators. But we have this year provided a 6.7 per cent. increase in NHS funding, against an inflation rate which is now much less than half that, and have just announced a further £50 million to help with the impact of the review bodies' pay award for doctors, nurses and others.

Mr. Kirkwood

Will the Minister give way?

Mr. Whitney

I am sorry, I have no time.

Mr. Kirkwood

If the Minister will not answer me, perhaps he will reply to his right hon. Friend the Member for Old Bexley and Sidcup (Mr. Heath).

Mr. Whitney

If the hon. Member for Roxburgh and Berwickshire will allow me, I shall go on to speak about that. Problems about funding health services are not specific to the United Kingdom, but we do have specific problems about the cities. As my right hon. Friend the Member for Old Bexley and Sidcup (Mr. Heath) said, there are certainly problems, as my right hon. Friend the Minister for Health has recognised, in connection with the impact of the RAWP formula.

My right hon. Friend the Member for Old Bexley and Sidcup was unable to be in the Chamber during the speech of our hon. Friend the Member for Mid-Kent (Mr. Rowe) but I hope that he will consider the points that our hon. Friend made, because in the time available I shall not be able to go into those in detail. The points made by my hon. Friend the Member for Mid-Kent about the impact on the health services in the south-east Kent region are worthy of my right hon. Friend's consideration.

The Government have accepted the need for a review of the operation of RAWP within the general framework of RAWP principles, but it is important to understand that we must continue to apply discipline. I recognise that some of the features that have developed in Bexley are unfortunate, but some of them have been coming for two or three years and some of them can be attributed to a failure to come to grips with the problem. Bexley's record and the record of other health authorities on competitive tendering suggests that more could be done.

Mr. Heath

It is acknowledged in my hon. Friend's Department and outside that the services which I described in my constituency are way above the national average and have increased in efficiency. We are closing down the most modern facilities in the south of England. That is nonsense and what reason can my hon. Friend give for doing that?

Mr. Whitney

The services are constantly being improved.

Mr. Heath

They are being closed down.

Mr. Whitney

The resources are constantly increasing. My right hon. Friend the Member for Old Bexley and Sidcup should bear in mind the new facilities that are being created. If he does that, he will understand that Health Service resources are being wisely used. My right hon. Friend suggests that the 6.2 per cent. of GNP which we devote to Health Services should be increased to 8.5 per cent. That is the inference of what he said, and that would imply spending about £7 billion or £8 billion more.

Nothing that I or my right hon. Friend the Minister for Health have said should be misrepresented or misunderstood as an assertion that the Government are satisfied' with the present state of the NHS. However, we take pride in the substantial real increases in resources that we have been able to devote and generate—

Mr. Frank Haynes (Ashfield)

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

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

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

The House divided: Ayes 184, Noes 254.

Division No. 224]	[7. pm
AYES
Abse, Leo	Beith, A. J.
Adams, Allen (Paisley N)	Bell, Stuart
Alton, David	Benn, Rt Hon Tony
Anderson, Donald	Bermingham, Gerald
Ashley, Rt Hon Jack	Bidwell, Sydney
Ashton, Joe	Blair, Anthony
Atkinson, N. (Tottenham)	Boothroyd, Miss Betty
Bagier, Gordon A. T.	Boyes, Roland
Banks, Tony (Newham NW)	Bray, Dr Jeremy
Barnett, Guy	Brown, Hugh D. (Provan)
Barron, Kevin	Brown, N. (N'c'tle-u-Tyne E)
Beckett, Mrs Margaret	Brown, R. (N'c'tle-u-Tyne N)

Bruce, Malcolm	Lambie, David
Buchan, Norman	Lamond, James
Callaghan, Rt Hon J.	Leadbitter, Ted
Callaghan, Jim (Heyw'd & M)	Leighton, Ronald
Campbell, Ian	Lewis, Ron (Carlisle)
Campbell-Savours, Dale	Lewis, Terence (Worsley)
Canavan, Dennis	Lloyd, Tony (Stretford)
Carter-Jones, Lewis	McCartney, Hugh
Cartwright, John	McDonald, Dr Oonagh
Clark, Dr David (S Shields)	McKay, Allen (Penistone)
Clarke, Thomas	McKelvey, William
Clay, Robert	MacKenzie, Rt Hon Gregor
Clelland, David Gordon	McNamara, Kevin
Clwyd, Mrs Ann	McTaggart, Robert
Cocks, Rt Hon M. (Bristol S)	Madden, Max
Cohen, Harry	Marek, Dr John
Cook, Robin F. (Livingston)	Martin, Michael
Corbyn, Jeremy	Mason, Rt Hon Roy
Craigen, J. M.	Maxton, John
Crowther, Stan	Meacher, Michael
Cunliffe, Lawrence	Meadowcroft, Michael
Cunningham, Dr John	Michie, William
Dalyell, Tam	Mikardo, Ian
Davies, Rt Hon Denzil (L'lli)	Morris, Rt Hon J. (Aberavon)
Davies, Ronald (Caerphilly)	Nellist, David
Davis, Terry (B'ham, H'ge H'I)	O'Brien, William
Deakins, Eric	Owen, Rt Hon Dr David
Dixon, Donald	Park, George
Dobson, Frank	Patchett, Terry
Dormand, Jack	Pavitt, Laurie
Douglas, Dick	Pendry, Tom
Dubs, Alfred	Penhaligon, David
Duffy, A. E. P.	Pike, Peter
Eadie, Alex	Prescott, John
Eastham, Ken	Radice, Giles
Edwards, Bob (W'h'mpt'n SE)	Randall, Stuart
Evans, John (St. Helens N)	Raynsford, Nick
Fatchett, Derek	Rees, Rt Hon M. (Leeds S)
Faulds, Andrew	Richardson, Ms Jo
Field, Frank (Birkenhead)	Roberts, Allan (Bootle)
Fields, T. (L'pool Broad Gn)	Roberts, Ernest (Hackney N)
Fisher, Mark	Robertson, George
Flannery, Martin	Robinson, G. (Coventry NW)
Forrester, John	Rogers, Allan
Foster, Derek	Rooker, J. W.
Foulkes, George	Ross, Ernest (Dundee W)
Fraser, J. (Norwood)	Ross, Stephen (Isle of Wight)
Freeson, Rt Hon Reginald	Rowlands, Ted
Freud, Clement	Ryman, John
George, Bruce	Sedgemore, Brian
Gould, Bryan	Sheldon, Rt Hon R.
Gourlay, Harry	Shields, Mrs Elizabeth
Hamilton, James (M'well N)	Shore, Rt Hon Peter
Hamilton, W. W. (Fife Central)	Short, Ms Clare (Ladywood)
Hancock, Michael	Short, Mrs R. (W'hampt'n NE)
Harman, Ms Harriet	Silkin, Rt Hon J.
Harrison, Rt Hon Walter	Skinner, Dennis
Hart, Rt Hon Dame Judith	Smith, Rt Hon J. (M'ds E)
Hattersley, Rt Hon Roy	Snape, Peter
Haynes, Frank	Soley, Clive
Healey, Rt Hon Denis	Spearing, Nigel
Heffer, Eric S.	Stott, Roger
Hogg, N. (C'nauld & Kilsyth)	Strang, Gavin
Home Robertson, John	Straw, Jack
Howells, Geraint	Thomas, Dr R. (Carmarthen)
Hughes, Dr Mark (Durham)	Thompson, J. (Wansbeck)
Hughes, Robert (Aberdeen N)	Thorne, Stan (Preston)
Hughes, Roy (Newport East)	Tinn, James
Hughes, Simon (Southwark)	Torney, Tom
Janner, Hon Greville	Wainwright, R.
Jenkins, Rt Hon Roy (Hillh'd)	Wardell, Gareth (Gower)
John, Brynmor	Wareing, Robert
Johnston, Sir Russell	Weetch, Ken
Jones, Barry (Alyn & Deeside)	Welsh, Michael
Kaufman, Rt Hon Gerald	Wigley, Dafydd
Kennedy, Charles	Williams, Rt Hon A.
Kilroy-Silk, Robert	Wilson, Gordon
Kinnock, Rt Hon Neil	Winnick, David
Kirkwood, Archy	Woodall, Alec

Wrigglesworth, Ian	Tellers for the Ayes:
Young, David (Bolton SE)	Mr. John McWilliam and
	Mr. Chris Smith.

NOES
Adley, Robert	Hayward, Robert
Alexander, Richard	Heathcoat-Amory, David
Alison, Rt Hon Michael	Henderson, Barry
Ancram, Michael	Hickmet, Richard
Arnold, Tom	Hicks, Robert
Ashby, David	Higgins, Rt Hon Terence L.
Atkins, Rt Hon Sir H.	Hill, James
Atkinson, David (B'm'th E)	Hirst, Michael
Baker, Nicholas (Dorset N)	Holland, Sir Philip (Gedling)
Baldry, Tony	Howarth, Gerald (Cannock)
Beaumont-Dark, Anthony	Howell, Rt Hon D. (G'ldford)
Bendall, Vivian	Howell, Ralph (Norfolk, N)
Best, Keith	Hunt, David (Wirral W)
Biffen, Rt Hon John	Hunt, John (Ravensbourne)
Biggs-Davison, Sir John	Hunter, Andrew
Boscawen, Hon Robert	Hurd, Rt Hon Douglas
Bottomley, Mrs Virginia	Irving, Charles
Brittan, Rt Hon Leon	Jessel, Toby
Buchanan-Smith, Rt Hon A.	Johnson Smith, Sir Geoffrey
Buck, Sir Antony	Jones, Robert (Herts W)
Budgen, Nick	Jopling, Rt Hon Michael
Bulmer, Esmond	Joseph, Rt Hon Sir Keith
Burt, Alistair	Kellett-Bowman, Mrs Elaine
Butterfill, John	Kershaw, Sir Anthony
Carlisle, John (Luton N)	Key, Robert
Carlisle, Kenneth (Lincoln)	King, Roger (B'ham N'field)
Carlisle, Rt Hon M. (W'ton S)	Knight, Greg (Derby N)
Cash, William	Knowles, Michael
Chalker, Mrs Lynda	Knox, David
Chapman, Sydney	Lamont, Norman
Clark, Sir W. (Croydon S)	Lang, Ian
Clegg, Sir Walter	Latham, Michael
Cope, John	Lawrence, Ivan
Couchman, James	Lawson, Rt Hon Nigel
Currie, Mrs Edwina	Lee, John (Pendle)
Dorrell, Stephen	Leigh, Edward (Gainsbor'gh)
Douglas-Hamilton, Lord J.	Lennox-Boyd, Hon Mark
Dover, Den	Lester, Jim
Dunn, Robert	Lewis, Sir Kenneth (Stamf'd)
Durant, Tony	Lightbown, David
Eyre, Sir Reginald	Lilley, Peter
Favell, Anthony	Lloyd, Ian (Havant)
Fenner, Mrs Peggy	Lloyd, Peter (Fareham)
Finsberg, Sir Geoffrey	Lord, Michael
Fletcher, Alexander	Lyell, Nicholas
Fookes, Miss Janet	McCrindle, Robert
Forman, Nigel	McCurley, Mrs Anna
Forsyth, Michael (Stirling)	Macfarlane, Neil
Fowler, Rt Hon Norman	MacKay, Andrew (Berkshire)
Fox, Marcus	Maclean, David John
Franks, Cecil	McLoughlin, Patrick
Freeman, Roger	McNair-Wilson, M. (N'bury)
Galley, Roy	McNair-Wilson, P. (New F'st)
Gardiner, George (Reigate)	Madel, David
Garel-Jones, Tristan	Major, John
Goodlad, Alastair	Malone, Gerald
Gow, Ian	Maples, John
Gower, Sir Raymond	Marland, Paul
Greenway, Harry	Marlow, Antony
Gregory, Conal	Marshall, Michael (Arundel)
Griffiths, Peter (Portsm'th N)	Mates, Michael
Grist, Ian	Mather, Carol
Ground, Patrick	Maxwell-Hyslop, Robin
Grylls, Michael	Mayhew, Sir Patrick
Hamilton, Hon A. (Epsom)	Meyer, Sir Anthony
Hannam, John	Miller, Hal (B'grove)
Hargreaves, Kenneth	Mills, Iain (Meriden)
Harris, David	Mills, Sir Peter (West Devon)
Harvey, Robert	Miscampbell, Norman
Haselhurst, Alan	Mitchell, David (Hants NW)
Hawkins, C. (High Peak)	Moate, Roger
Hawkins, Sir Paul (N'folk SW)	Monro, Sir Hector
Hawksley, Warren	Montgomery, Sir Fergus
Hayes, J.	Morris, M. (N'hampton S)
Hayhoe, Rt Hon Barney	Moynihan, Hon C.

Mudd, David	Spicer, Jim (Dorset W)
Murphy, Christopher	Spicer, Michael (S Worcs)
Needham, Richard	Squire, Robin
Nelson, Anthony	Stanbrook, Ivor
Newton, Tony	Stanley, Rt Hon John
Nicholls, Patrick	Steen, Anthony
Norris, Steven	Stern, Michael
Onslow, Cranley	Stevens, Lewis (Nuneaton)
Oppenheim, Phillip	Stewart, Allan (Eastwood)
Oppenheim, Rt Hon Mrs S.	Stewart, Ian (Hertf'dshire N)
Ottaway, Richard	Sumberg, David
Page, Richard (Herts SW)	Tapsell, Sir Peter
Patten, Christopher (Bath)	Taylor, John (Solihull)
Pawsey, James	Taylor, Teddy (S'end E)
Percival, Rt Hon Sir Ian	Tebbit, Rt Hon Norman
Porter, Barry.	Temple-Morris, Peter
Portillo, Michael	Thatcher, Rt Hon Mrs M.
Powell, William (Corby)	Thomas, Rt Hon Peter
Powley, John	Thompson, Donald (Calder V)
Prentice, Rt Hon Reg	Thompson, Patrick (N'ich N)
Price, Sir David	Thorne, Neil (Ilford S)
Proctor, K. Harvey	Thurnham, Peter
Pym, Rt Hon Francis	Townend, John (Bridlington)
Raffan, Keith	Townsend, Cyril D. (B'heath)
Raison, Rt Hon Timothy	Trippier, David
Rathbone, Tim	Twinn, Dr Ian
Rees, Rt Hon Peter (Dover)	van Straubenzee, Sir W.
Renton, Tim	Vaughan, Sir Gerard
Rhodes James, Robert	Waddington, David
Rhys Williams, Sir Brandon	Wakeham, Rt Hon John
Ridley, Rt Hon Nicholas	Walden, George
Ridsdale, Sir Julian	Walker, Bill (T'side N)
Rippon, Rt Hon Geoffrey	Wall. Sir Patrick
Roberts, Wyn (Conwy)	Waller, Gary
Robinson, Mark (N'port W)	Walters, Dennis
Roe, Mrs Marion	Ward, John
Rossi, Sir Hugh	Wardle, C. (Bexhill)
Rowe, Andrew	Warren, Kenneth
Ryder, Richard	Watson, John
Sainsbury, Hon Timothy	Watts, John
Sayeed, Jonathan	Wells, Bowen (Hertford)
Shaw, Giles (Pudsey)	Wells, Sir John (Maidstone)
Shaw, Sir Michael (Scarb')	Wheeler, John
Shepherd, Colin (Hereford)	Whitney, Raymond
Shepherd, Richard (Aldridge)	Wiggin, Jerry
Shersby, Michael	Wolfson, Mark
Silvester, Fred	Wood, Timothy
Sims, Roger	Woodcock, Michael
Skeet, Sir Trevor	Young, Sir George (Acton)
Smith, Tim (Beaconsfield)	Younger, Rt Hon George
Soames, Hon Nicholas
Speed, Keith	Tellers for the Noes:
Speller, Tony	Mr. Francis Maude and
Spencer, Derek	Mr. Michael Neubert.

Question accordingly negatived.

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

Mr. Deputy Speaker

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

Resolved, That this House commends the Government on the increased resources it has made available for the National Health Service; congratulates the dedicated Health Service staff for their improved performance in delivering high quality health care; reaffirms the principle of equality of access to health care underlying the Government's resource allocation policy; and endorses the Government's decision to review the Resource Allocation Working Party formula under which the allocation of revenue funds is determined.