§ 7 pm
§ Mr. Frank Field (Birkenhead)
The House is indebted to you, Mr. Deputy Speaker, for the choice of this debate. It is highly appropriate that we should spend some time this evening considering the implications of the privatisation of the National Health Service, for earlier this week the press carried a number of reports which suggested that the Prime Minister is unhappy with the performance of her Secretary of State for Social Services in privatising the National Health Service. Being a good judge of her Ministers, she has, no doubt with due care, chosen the Under-Secretary of State for Health and Social Security who is to respond to this debate to be the agent to spearhead the next stage of the privatisation of the National Health Service.
Earlier this week, a report in The Guardian gave us the news that the Under-Secretary of State is to have special responsibility for this campaign. We were also told why the campaign is so important. The Guardian report said:The savings would form part of a campaign to be launched at this year's Conservative Party conference highlighting the Government's efficiency.The report went on to note that the Under-Secretary of State's attention was being drawn to those areas of the NHS that are "ready", to use the word in The Guardian report, for privatisation; and particularly marked down for his careful attention are hospital catering departments. We learn from the report that only seven out of 2,500 hospital contracts have been won by private companies.
There is also a somewhat sinister aspect to the report. It refers to the reaction of one of our biggest contracting companies, Gardner Merchant, and to its feelings about the second stage of the Government's war on privatisation. Gardner Merchant does not want a move towards ordinary privatisation. According to its general manager, it is seeking long-term contracts with health authorities with fixed fees and no penalty clauses. I congratulate the private sector upon knowing on which side its bread is buttered.
My only other experience of that kind of offer being made is in defence contracts—or perhaps I should say, was in defence contracts, because the Government have gone to considerable lengths to bring Mr. Peter Levene into the Ministry of Defence to break up fixed-price contracts. This is because, in the words of the then Secretary of State for Defence, they were not a good deal for the taxpayer.
When the Under-Secretary of State replies to the debate, I hope that he will be able to tell the House about the next stage of the Government's privatisation programme. Will it take the traditional form of firms competing without knowing about the bids of their competitors? What is more important, will penalty clauses be included for use against those companies that fail to fulfil the terms of their contract?
Before the end of the debate, I hope that I shall have had time to mention the way in which privatisation has affected the constituency that I represent. I hope to refer specifically to how privatisation has affected the National Health Service, but I hope also to refer to how it has affected other services. The Wirral was proud—I use that word advisedly, as the Prayer Book tells us to do—of its pathfinding record. It was one of the first authorities 1133 to privatise its waste disposal service. Now it has another record. It has one of the worst waste disposal services in the country.
Many areas of the town are swept only by the wind blowing the rubbish around. The Conservative majority on the council is so concerned about efficiency and about a decent deal for taxpayers that not once has it invoked the penalty clauses that could be invoked to try to improve the standard of the service to ratepayers. When the Under-Secretary of State sums up, I hope that he will have time to say a little more about how he views his commanding role in opening up the second front of the privatisation of the National Health Service.
I think that it would be helpful, both to hon. Members who are present in the Chamber and to the electorate, to look at the progress that has been made so far and to consider whether some of the grand claims that have been made for privatisation have been fulfilled. In order to do that, I shall move around the country to see just how effectively the Government's privatisation measures are working. We shall notice, in the contributions from both Opposition Members and, no doubt, from Conservative Members, that certain words will come quickly to our lips when looking at the gains that are supposed to have been made from the privatisation programme. I shall hear about economy, efficiency, savings—words that warm the cockles of our hearts. However, before the debate ends I hope to look at what those words mean for patients and at what those words—economy, efficiency and savings—innocent though they may sound, mean for workers who face the privatisation of their industry.
I shall move around the country to show just how well the Government's privatisation programme has worked out. My first port of call, to use a nautical phrase, since I am to deal with such a great shipbuilding constituency, although I am fully aware that it is landlocked, is the Attenborough hospital at Cambridge.
Earlier this year, the press carried a report from the hospital administrator about its privatisation service, which is run by Hospital Cleaning Services. The report said that nurses and doctors found blood and bone on the floor of the operating theatre when they arrived on Friday morning to perform a hip replacement operation that was expected to take place that day. Needless to say, the operation did not take place because of the dangers of infection. However, the hospital administrator went on to note that it was the second time in two days that blood had been found on the floor of the operating theatre. This happened more than once. It was not just an odd bit of bad work because somebody wanted to get home.
That was the beginning of a trend in that Cambridge hospital. The report said how surprising it was that the health authority knew so little about the range of cleaning work that needs to be undertaken if operating theatres are to be safe for operations. According to the press report, the hospital administrator said:They are contracted to clean ceiling vents but this theatre has a special airflow unit and we did not allow for this in our contract specifications.These experts were therefore pushing out to private contract work that was supposed to be done by the private sector. However, when it was found that the operating theatre could not be used they discovered that the special air vents had been cleaned by hospital cleaners. Nobody 1134 had to tell them to do this; they just did it. Those at the top—who do not know the people whom one might euphemistically describe as being at the bottom of the pile—did not know what was entailed in this contract. But they learned. So did the patients at that Cambridge hospital. When the Under-Secretary of State replies, I hope that he will be able to provide details to update the report about this hospital in Cambridge.
I move away from Cambridge to a second port of call which is also landlocked—Croydon. The district health authority published a report that drew attention toStained lavatories, dirty surgeries, and potentially dangerous security lapsesas a result of the privatisation of its cleaning services. Again I must thank the media for this confidential report which was drawn up by Mr. Roberts, Croydon's general manager. A senior Croydon official said:the authority was 'extremely angry' at the 'appalling standards' since the firm took over from health service cleaners in June".That was June of last year. The general manager said in his report that by the end of the first monthstandards had already deteriorated and most premises were looking scruffy. There was an excess of dust on ledges, sills, and pipes. Toilets and handbasins were becoming stained. … The specification had definitely not been fully met in any of the 12 locations.Mr. Roberts reported that by August of last year the car parks were "accumulating litter" and "many areas were skimped." By October toilet brush holders and bins were not cleaned and the bases of sinks had a build-up of soap and dirt under the rim. By November of last year toilet areas were still below standard and furniture had not been moved for cleaning floors. That dismal report on Croydon shows one aspect of the new broom of privatisation.
The confidential report highlighted another area which I should not have thought of immediately; I dare say the officials at the top did not think of it but when the privatisation programme was under way it became clear. Again I quote:Security and locking procedures were a problem because of the high staff turnover, Mr. Roberts reports. Eighty-seven people had held 25 posts in five months.We may ask why. Was it because of the standards of the hospital? Was it a grotty hospital to work in—although presumably staff had not had that problem before? Was pay a problem, or was it because of a nasty individual who ran the private contracts? Again, I hope the Minister will not only update us on the state of play in Croydon's hospitals but will comment on the security lapses.
Not so long ago Ministers were answering questions about hospitals being locked at night because of the need to keep people out. We had the horrendous story of a mother giving birth to her child on the doorstep of a hospital because it was locked. I suppose one advantage of privatisation is that the doors in Croydon will be open because security lapses are such that security cannot be guaranteed. That is an unintended result. Given the state of many inner cities and of the area I represent, I fully understand why hospital doors are locked at night. If privatisation is to lead to what the report talked of as "security lapses", we should be grateful for the Minister's views.
We have been to Cambridge and we have called in at Croydon to consider progress. My next stop is Barking. The cleaning company there, Crothall, is one to which I pay particular attention because it is the leading bidder for the cleaning contract at Clatterbridge hospital in the area which I represent. I hope the Minister can answer certain 1135 questions which I shall put to him about that company. We learn that it had been cleaning a hospital in Barking for 16 years. Under the pressure of the Government's privatisation measures it had cut the cost of cleaning from £367,000 to £211,000, a big cut. If we took the argument no further than the Government's wish for efficiency savings and good buys for taxpayers, Ministers could claim that ground was being made, but if expenditure on a cleaning contract is cut from almost £400,000 to a little over half that, adjustments have to be made somewhere. It is no surprise to discover where the adjustments were made in Barking, as they were made elsewhere. We learn that the company managed to balance its books by lopping 41 per cent. off the hours that it thought would be necessary under the new arrangements to keep the hospital clean.
I pause for a moment in my debate with the Minister on privatisation to ask what the Government did when the contracts were put in. If the company is now seriously saying that it can clean the hospital in 41 per cent. fewer cleaning hours, was it not overcharging during the 16 years that it was cleaning the hospital previously? Is there not an issue which the Government should examine if they are so concerned about a fair deal for taxpayers?
As well as being concerned about taxpayers, as the Opposition rightly are—I cannot emphasise that enough, knowing the whims of some of my colleagues—we are also concerned about the deal for patients and for people who work in our hospitals. Let us consider what privatisation meant in Barking.
The women who clean the hospital were told that their hours would be cut; not only would they lose drastically because of the number of hours worked each week but they would have to work a three-week rota of one week of mornings, one week of afternoons and one week of evenings. For those at the top of the Civil Service or, dare I say it, even for MPs, that may seem easy enough. We may ask what is wrong with working such a rota. But many of those who do this crucial work in our hospitals have other concerns; they may have to look after children.
Many cleaners at Barking said that such a contract was impossible for them to fulfil. They maintained that they could not give a first-class service to their children if their working hours changed like that. Not only were there changes in their working hours, but they suffered considerable cuts in pay. Cleaners at Barking reported that the hourly rate of £2.03 was not cut but that fewer hours of work reduced pay by an average of 35 per cent. In some cases hours were cut by 60 per cent.
The report that I draw on to show the effects of privatisation in Barking outlines how one cleaner viewed her work. I hope the Government want to foster the concern of cleaners rather than break it. According to the report, the cleaner said:When I first started working at the hospital 16 years ago I was working a 30-hour week. Then my hours were cut to 25. Even then I felt I'd like to have another hour to get it really clean. Now Crothall are saying I've got to do the work in 15 hours. Well, there's no way I could do that. Housework you can neglect, but not a hospital—not when you've got babies in intensive care.I should have thought that was a feeling that hon. Members on all sides of the House should encourage rather than cripple.
I move back to Cambridge because, although the Minister nodded when I asked him to report progress on Cambridge, I have progress to report to him. I was quoting 1136 an earlier report on privatisation in Cambridge, but things have moved on. By the end of October Professor John Davis, one of the country's leading paediatricians, had resigned. I quote his reasons; he was protesting against "political decisions" to force hospital cleaning services to be privatised. He said:
You will know that my attitudes are essentially conservative".So Professor Davis, who is not a fellow traveller but probably a member of the Minister's party, is openly and honestly declaring where his political prejudice or principle—whichever word we want—lies. He continued:there comes a time when one must be seen to live up to one's professed principles and true conservatism means recognising that the economy is made for man and not vice versa".No doubt that will be the theme tune of the debate. The professor said that his reason for resigning was theso-called privatisation of the hospital cleaning services and the terms of the contract that we have accepted.He continued:I believe that to save money by further separating the status of the professional from that of ancillary staff would not serve this end if it means employing the latter as casual labour. On my wards we value very highly the responsible and loyal work of our cleaners and the personal help often given to our patients and their parents … I am not against privatisation but it should be left to the decision of the authority. We should be able to judge it on its merits.That is a direct challenge to the Minister, as he has been given special command by the Prime Minister to open up this second front of privatisation in the NHS. Will the battle be won in the old Tory tradition of letting people at grass roots level, who we always used to be told know the problems, to set policy, or will we have the Big Brother approach and direction from the centre?
While making such allegations, the Labour party should note that it is no use, while our backsides are on this side of the House, drawing attention to the high-minded attitudes and actions of the Government if we behave exactly the same if our backsides ever touch down on the other side of the House and we form the Government. If we think that it is wrong to have such central direction of services—I do—we must keep Labour Ministers up to the mark if and when we form the next Government.
I now want to take the debate up to the north and to my constituency. As is revealed in parliamentary answers, we are unfortunately in the area that has privatised cleaning services the most. I want to consider the effect of privatisation on Arrow Park—our new, grand, modern hospital which serves all four Wirral constituencies. In its wisdom, my constituents return a Labour Member of Parliament, but others are a little slower to see such wisdom, as Birkenhead has, and return Tory Members.
The Minister will know that the health authority is Tory controlled. It wrote a letter, which every member signed, saying that it was appalled at having to push through the privatisation measure and that it did not like it. It said that it had accepted the in-house contract because it was the cheapest, but that it would have preferred not to privatise the service. Those Tories and the minority Labour section have been proved right by what privatisation has meant to those who work in the Health Service in the Wirral.
Women workers are the majority and have been divided into two groups—those who work 15 hours and those who work 30 hours. The former group are the majority and the latter will pick up £39.40 a week. Before the new 1137 contract, they will have been working full time, able to work overtime, and Saturdays and Sundays when required, and to gain bonuses. If they worked long hours, they would have been able to notch up £100 a week. That is not the type of salary that Members of Parliament would want, but it is far above the £40 a week that they are being offered now. They face a cut of £60 a week. All the men have been offered 30 hours a week. That is discrimination for you, assuming that men's needs are greater than women's. All the men are being offered £39 a week. I shall give the example of a 57-year-old male constituent who has worked in the hospital for 15 years and who used to take home £100 a week after shift work, Sunday work, bonuses and the rest. He is now offered £40 a week. He is substantially worse off working than signing on the dole and drawing benefit.
Has the privatisation resulted in efficiency, savings and all those grand phrases? It may have done if one takes a very one-sided view of the issue. However, I have talked to my constituents, who have been on the receiving end. Many of them, who have worked in our hospitals for much of their working lives, have had their pride broken. They thought that their job was important to the community, but their terms of contract have been torn up. Some used to cycle through the night and the early hours of the morning to arrive on time at hospitals in the Wirral, but they have been told that their services are no longer wanted. Many single parents, who are now faced with the new contracts of 15 hours a week, have decided that the only thing that they can do is sign on for benefit.
The Government's privatisation measure has been enacted in full force in the Wirral which has experienced a far greater spread of privatisation than most other areas. Supposed savings have been achieved through crippling the staff and destroying their pride. It is difficult to draw the words together to tell the Minister what it has been like in my surgery as worker after worker has come to tell me privately how broken he feels.
I do not want this misery to spread throughout the country, but the Minister has not experienced people coming in, nervously clutching the end of the table as though it can be peeled, not quite knowing how to start the sentence or even whether they will get through to the end of the sentence without breaking down and crying, saying what it means to have their pay cut, their terms of contract torn up and their usefulness to the community devalued. Perhaps the Minister would comment on those personal experiences as well as on the more general aspects of the debate.
I want to ask the Minister about Crothall, the contract cleaning company, because I gather that it heads the bids for Clatterbridge hospital, the second biggest hospital in Wirral. Much to its credit, the health authority, which is Tory-dominated, is loth to accept that bid. I suspect—I do not know because I am not party to its conversations—that it is loth to accept the bid because of the company's record elsewhere. I ask the Minister therefore whether he will undertake to ensure that no pressure is put on the Wirral health authority to force it to privatise its cleaning services at Clatterbridge with that company.
I have five questions for the Minister concerning privatisation in the National Health Service. First, can he give the House, the country, voters, taxpayers, patients and workers an undertaking that he is satisfied that 1138 privatisation has improved standards of service, or say whether he has any doubts? If so, what will he do about it? Will he press ahead, as the Prime Minister tells him, or will he slow down the privatisation programme?
Time after time, Ministers have come to the Dispatch Box and told us that cuts in wages will lead to additional jobs. We have had cuts in wages in the Wirral on a vicious scale, cuts such as we did not see even in the 1930s, and people have lost their jobs. Will the Minister tell us how many new jobs have been created in the Wirral as a result of the Government's privatisation measures and—I do not want this to be concerned just with my own area—how many extra jobs in the rest of the country have resulted from cuts in wages?
Thirdly, is the Minister proud of the record of increasing the number of people who draw poverty wages? Is that the sort of thing that he wants to encourage in this country? Before 1979, a person who was aspiring to be Prime Minister said that our children should grow tall—let them grow to a thousand different heights. Yet, when it comes to those at the bottom of the earnings pile, there is no encouragement, no floor to put under them; instead, there is a policy which makes not just marginal adjustment to their pay but, as I quoted in the cases of some of my constituents, cuts of 60 per cent. Is that the record of privatisation elsewhere in the country? Is that what the Government want, and will the second front of privatisation bring us even more people earning poverty wages than there are at present?
Fourthly, are the Government proud of their record of destroying the self-respect of the workers that I have described to the House? The Minister looks puzzled and shakes his head, but he makes a note, and I am grateful for that. I find it difficult to contain myself or to draw adequately on the language at my command to convey the pain involved in this whole process of people being treated in this way. The Minister will know that I am not someone who goes over the top, I am not someone—I think that I am correct in saying this—who tries to make an easy debating point, but I have been appalled by the response of hospital cleaning workers in the Wirral. I want to draw the Minister's attention to that and ask him to take it on board before he starts the next stage of his privatisation programme.
Fifthly, some of my constituents will be worse off than if they were drawing the dole if they continue to work for the private company. What is the Minister's advice to my constituents? Should they reduce their living standards even further by remaining in work rather than signing on and drawing the dole? Do not the Government have some responsibility here—a responsibility to ensure that wage levels are not below what is paid to people who are unable to work? That is the fifth important question that I pose.
When the Select Committee on Social Services, in its sixth report, looked at privatisation it made a plea to the Government. This again was a Committee dominated by Government Members. It asked the Government, before continuing its privatisation programme, tosponsor a wide-ranging study of the past and present experiencebefore embarking on any new stages of privatisation.
If this debate does nothing but get the Government to concede that point, it will have been well worth while.
§ Mr. Laurie Pavitt (Brent, South)
When I applied to Mr. Speaker to take part in a debate on this subject I did not realise that my hon. Friend the Member for Birkenhead (Mr. Field) had also applied. I am most grateful to him, because we have just listened to the sort of speech which this House believes represents the House at its best—that is, a speech which puts a very human face on people's problems. He has been able to make very real some of the facts, figures, statistics, papers, documents and circulars by putting into his speech the real people whom we all meet in our surgeries, the people who are doing the jobs as cleaners, the nurses, the patients and all the ancillary staff in hospitals and, of course, the people in the community too. I am, therefore, more than grateful that when it came to the choice my hon. Friend's speech, not mine, was made first. It was one of the clearest expositions that I have heard for some time, and, as you know, Mr. Deputy Speaker, I am not without knowledge of the National Health Service. I hope that it will have its due effect on the Under-Secretary.
In 1979 this Government's famous document entitled "Patients First" appeared. After six years, the policy could now read "profits first". This is not the first time that the Tory party has done a U-turn. As I recall, the first U-turn was by the right hon. Member for South Down (Mr. Powell), and the late Iain Macleod, who wrote a most devastating pamphlet about how they were going to destroy the NHS when the Tory party got into office. Both were intelligent people, so what happened was that the right hon. Member for South Down became a very good Minister of Health for a short period, and the best Minister of Health the Conservatives have ever had in the House was the late Iain Macleod. I will go even further and say that the best Tory Minister on the Front Bench that I can recall was the late Iain Macleod.
I therefore draw the attention of the Minister to the fact that there is a very good case to be made for U-turns from time to time, and if anything that my hon. Friend has said causes him to take another look at the Prime Minister's diktat that there must be more privatisation, he has very good precedents to follow.
Tomorrow we shall be debating the collapse of nursing morale due to another report, the Griffiths report, but tonight we are drawing attention to a further disaster area for nurses—the whole field of privatising following the Government's acceptance of the Rayner report. As the Under-Secretary will recall, the House did not have the opportunity of a debate on that report, which was a pity. By the Consolidated Fund process we have been able, at long last, to get a debate tonight. The actions that have followed the publication of the Rayner report have been devastating for the National Health Service in the three areas concerning patient care—catering, cleaning and laundry. I hope that the Under-Secretary will take the opportunity of re-reading "Patients First". It is always a good thing to go back and see what was said originally. I wish that the Prime Minister would re-read St. Francis of Assisi at some time and perhaps change her mind about some of the things that happened following that original quotation.
Of the three areas affecting patient care—catering cleaning and laundry—it is catering and cleaning that have the most disastrous effects on our nursing services. When we talk about nursing standards we are talking not 1140 about something in a White Paper, but about the 100 years of tradition and experience since Florence Nightingale. Those standards were set by what used to be called the dragons of matrons, and they operated at nursing level where nurses met patients on the ward. The key person was the ward sister. She was in charge; it was her ward, her patients, her staff, her cleaners and her command over the food that went to the patients. If she was good—and 99.9 per cent. of the ward sisters were—that organisation was the finest management organisation ever seen, because she took a pride in what she was doing, in her ward and in her standards. It did not matter that she worked long hours. She did far more than her regular hours because a good ward sister will see her night nurses off at 7 o'clock in the morning and the next team of night nurses on at 7 o'clock in the evening.
Into this comes the privatising of cleaning and catering. No longer is the ward sister in charge. These things are out of her control and as standards slip this has an effect upon the nurses over whom she has authority, because, if it is good enough for the National Health Service to have standards of that kind, why should they slave their insides out to preserve their higher standards and traditions? The concept that ward sisters had pride and a personal interest in each of their suffering patients has been eroded by the privatisation of cleaning services.
I could quote several cases, but I wish to quote from a letter of which the Under-Secretary of State has received a copy. I was so appalled by what happened to a patient that I raised the matter with the hospital administration, the district health authority, the general manager of the regional health authority, Mr. Victor Paige, and the Minister for Health. Since I knew that the Under-Secretary of State would have to pick up the pieces for the Minister for Health, I made sure that he received a copy of the letter. It states:Yesterday I left … after an operation and two weeks' stay. As usual the medical and nursing care couldn't be bettered but I am dismayed by the state of cleanliness in the ward.When I was admitted the Sanibin in the ward lavatory was full to overflowing. Unfortunately patients continued to use it and it became really offensive. There was a bowl half full of dirty water behind the lavatory. Floating on top of the water was dirty toilet paper. On Saturday I spoke to the Charge Nurse about both of these things, she was able to get the water emptied but told me the Sanibin couldn't be emptied because it was the week-end. It was finally emptied on the Tuesday, in the meantime the lavatory was smelly and unpleasant.The lavatory itself was never cleaned in the 2 weeks I was in the ward. The up and walking patients had no problem, they were able to use the lavatories in other areas during the day but this wasn't possible at night for patients with drips. On one occasion the lid, seat, under the seat, the rim of the pan and the pan itself was splashed with excrement. As I had to use the lavatory at night I had to clean it, and this I did twice.The bathroom was thick with dust. I had to clean the surfaces of the table and the chair before I could put things down. I left the bottom shelf of the table so that you could see the state of place.Whilst I was in the ward the cleaners came in twice. The first time one man went round the bits that were free with the vac. Another man sloshed a mop over the same bits and then the first went over with a polisher. At no time was any of the furniture moved"—of course, it is a housewife speaking—
in fact it was fascinating to see the appliances go round patients' slippers and even visitors' feet. The floor at the back of the beds and lockers was never touched and was filthy.At no time during the 2 weeks were the lockers and bedside tables wiped over. I was able to do my own but for patients confined to bed I found this disgusting.1141Walking round the corridors on other floors there was the same look of dirt and neglect.A great pity that a great hospital should come to this.Patients first'? Patients must get out of bed and clean lavatories, yet the Government talk about putting patients first?
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
The hon. Gentleman has the advantage over me in that there are 600 major hospital units and I am not carrying the details of this case in my head. Will he confirm that the cleaning at that hospital was carried out by a private contractor?
§ Mr. Pavitt
I was about to do so. The hon. Member for Cambridgeshire, South-West (Sir A. Grant) has tried to persuade the Government to privatise hospital services. I do not wish to attack the hon. Gentleman, with whom I have had friendly relations on this issue, but he has business interests in the privatisation of hospital cleaning. As the House knows from the Official Report, 28 Conservative Members have business interests in cleaning firms. I mentioned this case to the hon. Gentleman in the Corridor because I have known him for some time. In consequence of that, I received a letter—my hon. Friends will not be surprised by this—from Messrs. Crothall and Co. which had provided the service at that hospital. The letter stated:
We have found that the type of person presenting themselves for employment as domestics is not always of good 'professional' calibre.What can we expect when firms pay the sort of wages that were mentioned by my hon. Friend the Member for Birkenhead? Wages and time are skimped and no proper training is given. There are no induction courses and no proper monitoring. What else can one expect from tendering? The point of tendering is to obtain a contract by putting in the lowest tender, so firms inevitably scrape the bottom of the barrel. They exploit the labour market.
The sad aspect of my hon. Friend's speech was his reference to the people—I know them well—who for years have proudly scrubbed floors in hospitals because they wanted to work there, but who no longer feel pride in working for such meagre wages.
After I received that letter, I examined the matter more seriously. I received a letter from a friend who is a hospital doctor who became a patient in another hospital where the cleaning services were contracted out. It is a different hospital, and Crothalls did not provide the cleaning services. His letter states:
The only time I saw a supervisor during my various stays was when she came to quarrel with me over my complaints about the standard of cleaning. As I was receiving cytotoxic drugs at the time I did not pursue the argument with her.On that occasion my wife had cleaned all the horizontal surfaces in the room using the chlorhexidine hand soap and hand towels, including the sink in the bathroom and the toilet seat which was stained! She also got rid of the dead flies on the window ledge.We are talking about the finest hospitals, not just in the country but in the world. The world follows what Britain does. But because some grubby little accountants are trying to make what they call economy savings, which are supposed to benefit patients, and are scrabbling about presenting documents to show that we have more money than ever before when in reality we have less, this sort of thing is bound to happen.
1142 The ward sisters' position has changed in relation to catering services. The ward sister used to be proud of the fact that she had direct contacts with the in-house catering service, that she had known the chef and other workers for years, and that if her patients were not getting what she thought was the right food she could put the matter right directly and immediately. There was no question of her having to go through a unit manager, a district manager or a hospital administrator. Now, if patients are dissatisfied, they become like bus passengers who have waited a long time for a bus—they take it out on the conductor, not on the service. If the food is not right in a hospital, the nurses are on the receiving end of complaints. Just as the caterer must cut his tender to the limit to obtain the contract, so the food is cut. Sometimes the meat is cut with a razor blade.
Dissatisfied and unhappy patients complain to their nurses, who in turn complain to the kitchen. The complaint is probably recorded on a triplicate form, the hospital administrator brings it to the attention of the district health authority, and six months later, after the patient has been long dead or has gone home, something may be done. It is a wearisome business, and I do not blame good nurses for thinking that this is not what they were trained for and that they should not have to face such hazards. Ward morale has decreased greatly. Although the ward sister used to think in terms of, "My ward and my patients under my control", now she might say, "I am not too far away from retirement, and perhaps I can manage until then."
On the privatisation of laundry services, the Under-Secretary of State may not realise that I was able to effect a change when laundry services in my area were privatised. I represent a constituency in north-west London, yet the contract was given to a firm in Birmingham. I do not understand how that happened. I have two major district general hospitals. One is the Central Middlesex, world-famous at one time for gastroenterology; the other is Northwick Park, which was funded jointly with the Medical Research Council. Strangely enough, I was on both the regional board and the health council at the time when that hospital was created as a clinical research centre.
A few years ago the Central Middlesex hospital laundry was entirely refurbished at a cost of nearly £500,000, so that it could take on the laundry work of Northwick Park, a sensible management arrangement. What happened? The Northwick Park contract was put out and accepted by a private company. This meant that the whole of that investment was made redundant. I ask the Minister whether he will consider this matter. Does he realise that, when an in-house tender is defeated by a lower tender from outside, he is dealing with a three-year contract? At the end of that period, if the whole of the laundry machinery has been sent for scrap metal elsewhere and dismantled the hospital is entirely at the mercy of whatever price the laundry company demands.
The Government's case is that money can be saved towards the expense of running the service if it is privatised. In other words, although shareholders must be paid a large profit, a better service will be obtained, money will be saved and that money can reduce the demands on the Exchequer from the Department of Health and Social Security. In reality, this saving is made at the expense of nurses, patients and hospital staff. I cannot think of a better illustration of this than was given by my hon. Friend the 1143 Member for Birkenhead. I will treasure what he said, because he dealt with everything that I would have like to say, in a far more succinct fashion, on behalf of all of us who, at some time or another, have needed the care and attention for which we will be eternally grateful.
Privatisation is like a cancerous growth, imported from another world with other techniques, other approaches to things rather than to people, interested purely in material gain and money to be turned over. That cancer is eating at the heart of one of the greatest health services in the world.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
I recall the advice that I was once given, that if I were ever to make a public speech I should not make apologies in the course of it. I have to begin with two apologies, which makes it a doubly bad effort. The first is to you, Mr. Deputy Speaker, and others, particularly the hon. Member for Birkenhead (Mr. Field), for being late and missing the beginning of his speech. The other is in advance to the Minister for perhaps not being able to stay to hear the whole of his reply to the debate. Given that I am heading north to Ross, Cromarty and Skye very shortly, he will appreciate that my time is somewhat limited. With those two caveats, I am grateful for the opportunity to contribute to the debate.
What we have heard—and I hope that the Minister will concur—are two profoundly sensible contributions, in that neither speaker tonight has gone for straight opposition to Government policy, nor dismissed the need to find savings within the health budget, which all of us recognise are there to be found. Legitimate savings can be ploughed back, as Government rhetoric says, into better standards of patient care. They have instead pointed out the difficulty, and, indeed, the stupidity at times, of putting a political doctrine in the way of finding genuine solutions at local level, for better standards of care, through more money released by means of greater efficiency and effectiveness.
What disturbs and annoys me greatly about the whole health and welfare state debate is that it is always the Government who portray themselves as the only ones concerned about getting value for money, which is not true. We are all concerned about achieving that objective. Where we begin to part company from the Government is in believing that what is at times a ruthless pursuit of predetermined political criteria is the only means by which value for money can be achieved. I am not convinced of this. From what I have seen—and the privatisation debate is the classic example—the most sensible approach, as the hon. Member for Birkenhead pointed out, is to leave health authorities to decide how best to run things in their own area.
Ross, Cromarty and Skye is perhaps not absolutely typical of the rest of the country, but I can think of examples where it is impossible in my own area to have in-house ancillary services of one sort or another. They have to be privatised, and it has always been so. But it strikes me that when a health authority, or a health board, as it is north of the border, such as the Highlands health board—which is neither true blue nor about to fly a red flag above its headquarters in Inverness—finds that the circulars which it receives from the Scottish Home and Health Department continually emphasise the need to go further with privatisation, and this causes it administrative 1144 problems and runs counter to the commonsense organisation of health care in that part of the country, the Government should think twice about being quite so dogmatic—if I may use that favoured, SDP-ish word—in their approach.
As the debate is about the effect of the privatisation policy on carers, I am in one respect rather relieved that we are not now going into the situation of and arguments about carers, because the subject of carers is worthy of a full-scale parliamentary debate. I know that other Members present take an interest in this matter. It is an aspect on which the privatisation programme can have a profound effect. In my own party, I have in the past two years been involved in drawing up a carers' charter. I shall not stand on a soapbox and read out all the details of that charter, but I believe that what it suggests would command cross-party support. Indeed, I know that it does.
When we are examining any system of delivery of health care to help the informal section of the welfare state, without which the welfare state would collapse, under any political programme, we must take particular account of privatisation because it can greatly affect the ability of the carer to have access to the sources of information and to the support mechanisms available in the community, particularly with the care in the community programme, the difficulties facing social services departments because of rate support grant policy, and so on. That is a huge debate in itself and I do not want to get into it tonight, but it is worth considering.
One cannot take a national view on privatisation. There are different circumstances in different localities. The best way to run the Health Service is to run it at local level, or as near to that as is attainable consistent with a National Health policy, in a way which reflects the needs and aspirations or demands of a particular community.
One of the difficulties about privatisation is the effect upon those in the ancillary services, who find a privatisation policy being railroaded through against the better discretion of those at local level, as we have heard vividly this evening. Therefore, the position of staff, be it in terms of the Whitley rates, conditions of employment or whatever, is seriously eroded.
One cannot have a business which is the biggest civilian employer in western Europe without some wastage and inefficiency. That is self-evident. But all who support the Health Service must also recognise that the marvellous thing about it is the sense of community within the hospitals. Every time I visit a hospital I am struck by the fact that the patient, who is, after all, the end product and what we are most concerned about, responds, not only to the care that he is given by the nurse, the doctor, or the consultant, but also, as has been pointed out, to the physical environment around him. Therefore, to try to hive off parts of the Health Service which are regarded as almost expendable is an act of folly if that is pursued ruthlessly with no regard to the circumstances in a particular hospital. That is the great danger of the privatisation programme that is being pushed through by the Government. There is somehow a suggestion in the phrase "ancillary services" that they are peripheral to the concept of recovery and care, yet we know that they are not. Those who provide food and make sure that the facilities are clean are as important as those who provide the immediate nursing and the medical talents for diagnosis and cure.
1145 It is when one begins to lose sight of the human dimension and begins to subject human beings to the rigours and tyranny of the profit and loss account of a balance sheet that one begins to lose sight of the principles and ethics which underlie Britain's Health Service.
I welcome this brief debate. I hope that the Minister will take cognisance of the fact that savings, efficiency and so on are extremely important. Where they lead to greater money being released for improved patient care they are welcome. However, one cannot subjugate entirely the importance of patients, a community and a team spirit, particularly within a hospital, to such rigours. The danger, as we have seen from the Griffiths report and the appointment of general managers and the privatisation programme, is that Ministers are too willing to intervene to push their policy in the face of higher standards which could be achieved and yet which, sadly, in many cases, as we have heard, are not being achieved.
§ 8.4 pm
§ Ms. Harriet Harman (Peckham)
My hon. Friends the Members for Birkenhead (Mr. Field) and for Brent, South (Mr. Pavitt) have dealt comprehensively and tellingly with the effect of privatisation on the Health Service. I should like to add an extra dimension, the effect of privatisation on the social services.
By definition, it is the most vulnerable and dependent members of a community who need social services—people who are physically or mentally disabled, children and the very elderly. Moreover, all families will need support services at some stage, whether it be a nursery place for a small child or help at home for elderly people, perhaps living on his own or with a family to help the family to cope.
The most vulnerable and dependent people need services on which they can depend. We in the community are entitled to expect that frail and vulnerable people will be properly looked after; that they receive the services that they want; that the services are of a high quality; that they should have a say in those services; that services will help their families to care rather than leaving them overburdened; that they should have a continuity of service on which they can rely; that the services should be provided by staff who are properly trained; and that the services are planned to meet people's needs.
Those objectives can best be met, and are met, by services provided by the community for the community—that means local authorities, health authorities and also the contribution made by voluntary organisations where they are properly funded by the Government or at local level.
I am not complacent about public sector social services or voluntary sector welfare services. Although there are many excellent and popular services in the public sector, there are still many problems. Those problems could be minimised if the Government took a lead in encouraging good practice and provided local authorities with the resources which they need and which they say they want in order to expand, develop and improve the services that their communities need. But that is not happening. The Government are telling councils to spend less and to contract out existing social services.
Councils throughout Britain are meeting an increasing demand for social services. Handicapped babies who 1146 might in earlier times have died at birth or had a short life expectancy can now be saved and look forward to a normal life span, but they and their families need support services. People who have disabling accidents or disabling diseases which in the past may have killed them now have a much greater life expectancy, but again they and their families need support services. An increasing number of elderly, particularly the very elderly, need support services, and there is an increasing demand for services due to unemployment. That has been well documented by the Association of Directors of Social Services. The increasing number of mothers with small children seeking work means a growing demand for services for children.
Yet the Government brand as irresponsible councils which want to expand such services to meet the growing need that they see in their areas. At the same time as the Government are telling councils to spend less, the Government are apparently prepared to spend limitless sums to finance an explosion in private profit-making companies providing welfare services.
The problems of privatisation of welfare services are vividly illustrated in the privatisation of services for the elderly. Let us consider residential care for the elderly. The Government are telling councils to hold social services spending. With the growing number of elderly, that will mean that services to people in their own homes, such as home helps, are spread more and more thinly. Home care services are real care in the community. They enable people to remain independent in their own homes for as long as possible; people who might otherwise be at risk from a fall or sudden illness. The home care service can also support families coping with a disabled relative who, without that support, might well feel that they could not go on caring.
Therefore, the Government's squeeze on council spending, which prevents council domiciliary services from expanding to meet the growing need, means that people who might otherwise have remained at home must go into an institution, which is the very opposite of care in the community.
Council provision of residential care has been at a virtual standstill because of the Government's spending squeeze in the past few years. Therefore, the increase in demand for residential care, which is fuelled by the lack of domiciliary services, as well as by the aging population, is pushed into the mushrooming private profit-making sector. Really, it is a misnomer to call it a private sector because, although it is profit-making, it is booming at public expense. The Department of Health and Social Security pays up to £180 per person per week in a private residential home. A modest 20-bed home can therefore earn £3,600 per week at the expense of the DHSS. At a time when the Government are nailing council spending to the floor, DHSS spending on private old folks' homes rose from £10 million per year in 1979 to £190 million per year in 1984. That is, on the Government's own figures, an increase of over 2,000 per cent. Taxpayers' money has been deliberately diverted from care in the community, provided by the community, towards institutions run for profit.
The risks faced by the elderly and vulnerable people in the private residential care sector are well known. The evidence from America, where private residential care is well established, is all bad. Not only are there cases of gross neglect and exploitation, where home owners put profit before care; it is also clear that the services provided 1147 are the services which are profitable rather than those which are needed. What is profitable is long-term institutionalisation. Therefore, regimes to rehabilitate elderly people or services to keep people at home disappear. One cannot plan on the basis of good social policy when the free market provides services only when and where it is most profitable.
The American pattern is already beginning to take a grip here. Numerous cases of appalling conditions in private old folks' homes have come to light. I have often complained to the Government about particular homes. For example, I complained about the Inglehurst nursing home in Blackpool, where the owners engaged in twice-daily drinking sprees, failed to adminster drugs safely and fed their residents inadequately, and where there was inadequate staffing and residents were kept in squalor. After I raised that case with the Government, the Minister investigated and the home has since been closed, but not before receiving £50,000 a year from the DHSS—a direct subsidy from the public to the private sector. It is not just physical ill-treatment of the elderly in private homes that causes concern; there is also the problem of fraud.
§ Mr. Whitney
While the hon. Lady is dealing with badly run homes, would she tell the House about the problem of Nye Bevan lodge with which she is rather familiar?
§ Ms. Harman
The Southwark council investigated the allegations about Nye Bevan lodge. That investigation was submitted to the officials of the DHSS. The DHSS was directed to conduct a further inquiry into residential care of the elderly and children in Southwark and found good standards of care and residential provision. Therefore, the matter has been settled; I am surprised that the Minister raised it.
§ Mr. Simon Hughes (Southwark and Bermondsey)
I am sure that the hon. Lady would not wish to mislead the House. The inquiry was into other homes and other residential provisions. There are still matters relating to Nye Bevan lodge in terms of internal administration and reforms, which are the responsibility of the local authority, on which we have not had any final report or any disciplinary or other action.
§ Ms. Harman
The reason why the inquiry of the DHSS was into residential care homes other than Nye Bevan lodge is that DHSS officials were satisfied with the council's internal inquiry into the lodge. It would have been a scandalous waste of public funds to investigate the same incident twice.
When I raised two cases of fraud on the DHSS by private homes in Kent, the Government took no action. It is impossible to guarantee the maintenance of high standards behind the closed doors of a private old folks' home. The Government will no doubt point to the code of practice "Home Life", which is excellent, but which is not legally enforceable. The Government might point to the new fees for private homes, but they have still to bring them before the House and, in any case, they are still not enough.
There is still a basic problem in trying to enforce any standards in private homes. There is a built-in and serious disincentive to councils taking action against private homes which fall below standard, because there is only 1148 one sanction—de-registration. If a council de-registers, it knows that it will have the old folk from that home on its doorstep. Councils cannot cope with existing demands, let alone deal with additional people who would need care if they were to close substandard private homes in their areas. Even the best intentioned councils are affected by that severe disincentive, because it is the council which has to inspect the homes and register them or apply for them to be de-registered, and it is the council which has to deal with the effect of that de-registration. Private companies know that, and they are cashing in on care in a big way.
It is not only the Conservative party which puts the interests of private business before the needs of our elderly. It is also the Liberals. The Liberals on Hammersmith and Fulham council voted only last night to continue with the sale of Stewart lodge, a council old people's home, to a private company—Associated Nursing Services Ltd. The council plans to sell Stewart lodge as a job lot, the home and the people in it. The 29 residents—whose average age is 88 years—are to be sold with the building, whether they like it or not. Associated Nursing Services Ltd. will apparently arrange a share issue to finance this lucrative purchase.
§ Mr. Frank Field
The hon. Member for Southwark and Bermondsey (Mr. Hughes) was quick on his feet inviting my hon. Friend the Member for Peckham (Ms. Harman) to denounce Southwark council, which I hope she did. Will he now willingly spring to his feet and dissociate himself from the extraordinary sale in Fulharn?
§ Ms. Harman
I can advise my hon. Friend that the hon. Member for Southwark and Bermondsey (Mr. Hughes) has already said that he disapproves of the sale.
I have mentioned that if Associated Nursing Services Ltd. can win this contract it will make a share issue to finance it. I should like to read to the House from an investment brochure such as is likely to be sent out by Associated Nursing Services Ltd. It is a different brochure, but it is on the same lines. The brochure sets out how companies attract investment to expand.
The brochure was issued by Investment and Pensions Advisory Service in Surrey. It says:The first absolute priority for Mrs. Thatcher and her Government is to bring public spending under greater control, and already there has been much talk about cutbacks in the National Health Service. This is of course a very emotive move—so the Government can undoubtedly be expected to seek reductions in the most painless manner possible.It is hardly surprising, then, to learn that they have indicated their wish to ease the burden on the community of looking after the aged and infirm. These people can hardly be regarded as a 'vociferous pressure group,' after all!The brochure goes on to say:Financial experts now take the view that nursing homes for elderly people are likely to become a growth industry. And that, because of the special circumstances described above, this growth will continue through bad years as well as good.Through the business expansion scheme where investment is subsidised by the Government, Mrs. Thatcher can effectively influence the switch of emphasis to private care in this area.That is exactly what she has been doing.
The brochure finally says that investment in old folks' homes is alucrative long-term opportunity for large-scale capital growth.That is how the Tories and the Liberals in Fulham see our elderly—merely as fodder for a lucrative long-tern opportunity for large-scale capital growth. Even if the 1149 council can claim that Associated Nursing Services has never been caught out ill-treating the elderly from whom it is making its money, what is to stop Associated Nursing Services from selling the home to a disreputable company? Fulham council must think again.
In a letter dated 11 March, the right hon. Member for Tweeddale, Ettrick and Lauderdale (Mr. Steel), the leader of the Liberal party, admitted to me:It is not Liberal Party policy to privatise homes without consultation with residents and their families.That is exactly what is happening in Fulham. Unfortunately, the right hon. Gentleman went on to wash his hands of it all and to say:it is not our policy for the party centrally to dictate to local councils what actions they should take".
§ Mr. Simon Hughes
The hon. Lady said, fairly, that, when she raised the matter with me, I stated my view to her. She has quoted the letter of my right hon. Friend the Member for Tweeddale, Ettrick and Lauderdale (Mr. Steel). These are important points. I hope that the hon. Lady agrees that it is not the job of the law to dictate to local authorities. The Labour party and my party stand up strongly for that. The concern that this issue arouses is sufficient, without either my right hon. Friend or me knowing the facts, for me to assure the hon. Lady that tomorrow I shall find out the facts from colleagues in Hammersmith and Fulham. My right hon. Friend proposes to deal more fully and helpfully with the specific issue. Clearly, we cannot comment on that issue until we know the facts, the motivation and the thinking behind the actions of borough councillors.
§ Ms. Harman
The hon. Gentleman should have obtained the facts before, because I raised this issue with him last week. He has had a number of days to look into it. I wrote to the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) about a week ago on this issue. If he is staying quiet about it, it is because he has something to hide rather than because he does not know about it.
§ Mr. Charles Kennedy (Ross, Cromarty and Skye)
What the hon. Lady has just said is accurate. Can she confirm that I have not stayed quiet? In fact, we have discussed the matter.
§ Ms. Harman
I do not remember that issue being discussed by the hon. Gentleman and me. If we have discussed it, perhaps the hon. Gentleman will take the opportunity to remind the House of his position—whether he is for or against the sale, whether he is for the principle of services being provided by the community for the community or, indeed, whether he has any principles at all.
§ Mr. Kennedy
I think that the hon. Lady genuinely believes that we have not discussed the issue. We have discussed it. I hope that she recalls that I said that I would investigate the facts more fully but that my view was exactly in line with the view just expressed by my hon. Friend the Member for Southwark and Bermondsey (Mr. Hughes). Does the hon. Lady agree that that is the sensible view to take? I hope that she is not taking the draconian view on local choice and decision making which is the hallmark of the Conservative party.
§ Ms. Harman
We are certainly in the forefront of those opposing the Government's measures in replacing local 1150 government by edicts from Whitehall. We stand firmly for principles. In this case, we are discussing principles of defence and a determination to protect the elderly and the most vulnerable in the community.
§ Mr. Frank Field
It is extraordinarily interesting to see the hon. Members for Southwark and Bermondsey (Mr. Hughes) and for Ross, Cromarty and Skye (Mr. Kennedy) jumping around giving us their line. The real question is: where does the candidate in Fulham stand? Does the candidate back the local council or the leader of the Liberal party?
§ Ms. Harman
In America they call it granny farming. Is that what the Liberals in Fulham are backing? The Labour group of councillors in Fulham, who would be in the majority were it not for the Liberals uniting with the Tories, are strenuously opposing the sale. I hope that they will succeed.
It is also the staff who suffer when welfare services are privatised. To boost profits, companies cut costs. By far the major cost in social services is staff wages. Caring staff are already low paid and, in the private sector, they get poverty wages. This means that there is a high turnover of staff as well as exploitation, which means poorer services, as staff are demoralised, lack of continuity and lack of experience.
The Government have a deliberate policy of undermining community services and using public money to finance private welfare services. We really need a good range of welfare services at local level provided according to who needs them, not just to those who can afford them, so that the individuals can choose the service that suits them. Those services should be provided by the community for the community. We must go no further down the American road.
§ The Parliamentary Under-Secretary of State for Health and Social Security (Mr. Ray Whitney)
We have had a particularly interesting debate in which, at one stage, it seemed that Conservative Members were redundant, given the interesting exchanges between the various Opposition parties.
The hon. Member for Birkenhead (Mr. Field) started the debate on an odd note. The Government were either congratulated or accused—one can take one's pick—of launching a second front in competitive tendering. The hon. Gentleman said that that concept was based on reports in several newspapers in the past few days, but as he continued it became clear that it was based on one small report in his favourite newspaper, by, I suspect, his favourite correspondent. That story was garnered at lunchtime on Monday when our mutual friend, the correspondent, was invited to a buffet lunch given by a contracting firm to which we have not awarded contracts and which is rather upset that we have not done so.
§ Mr. Frank Field
The hon. Gentleman seems to prove the Prime Minister's point—that there is no such thing as a free lunch.
§ Mr. Whitney
I hope the hon. Gentleman understands that he should be careful in his newspaper reading and not believe everything that he reads in the press. Basing much of his speech on the press has proved to be his undoing.
The hon. Gentleman was indignant about the idea of a management fee approach. In effect, he said that it was a 1151 licence to print money. He is probably right. That is why, as far as I know, none of the contracts awarded by the health authorities has been given on that basis. Those contracts are not within the direct gift of the DHSS. Not surprisingly, therefore, the hosts at the lunch were not pleased with the competitive tendering policy. Our mutual friend, the correspondent, had a jolly little lunch and at least gave the hon. Member for Birkenhead the starting point of his speech.
Much the same applied to our rather truncated tour around the country. I accept that this is a serious subject, but the hon. Gentleman tried to take us to the Attenborough hospital. Attenborough is all to do with wildlife and making films about Gandhi. The hon. Gentleman was referring to Addenbrooke's in Cambridge. I assure the hon. Gentleman that I have visited that hospital and was deeply impressed. Of course I asked, "What is this story we are told by the Opposition?" The story was told twice tonight. I should imagine that the same story has been recycled by the Opposition 100 or 200 times in Hansard. Far from finding deep, dissatifaction among the patients, nurses or any of the other 5,000 staff working in Addenbrooke's hospital, I found general satisfaction with the contracting services there.
§ Mr. Pavitt
I had the privilege last Wednesday of speaking to the Royal College of Nursing in Cambridge. I assure the Minister that the impression that I gained was the opposite to his.
§ Mr. Whitney
We shall have to rest with our differences. The hon. Member for Brent, South (Mr. Pavitt) may have been looking for different things, but the first thing that I was looking for was the level of satisfaction at that hospital.
I would not claim, as I said in an earlier intervention, to be able to provide instantly details of every hospital contract in Croydon. If there are mistakes or failures to meet standards they must be rectified, and rectified rigorously.
The hon. Member for Birkenhead seemed to be concerned about the situation in Barking. He seemed to be concerned about the reduction in the annual Health Service bill there from £367,000 to £211,000. To most people, the concept of a £157,000 saving to put back into the Health Service, into patient care, to pay nurses or for other purposes would be welcome. One might even have thought that such a concept would be welcome to Opposition Members.
As the debate progressed, the other main element of the Opposition's concern was revealed. The Opposition are concerned about the staff. We are all concerned about the staff and there must be good working conditions and adequate wage rates. We must, however, get our priorities right.
The hon. Member for Brent, South justly reminded the House of the excellent pamphlet issued by my party "Patients First". I assure the House that that policy has by no means changed. We believe that the patients come first. Therefore, the employees must not come first. Of course there must be proper treatment for employees, but the balance must be right. The Health Service, the Army and the Civil Service do not exist primarily, first and last, for those who work in those institutions. The Health Service is for patients, and we must use our resources to maximum 1152 effect. I was grateful to the hon. Member for Brent, South for underlining what is happening in Barking as an example of the achievements that are being recorded.
§ Mr. Field
I do not really want to interrupt the Minister in his stride, as he is well into his speech now and it is a pleasure to hear him in this form. I did not say, when using the Barking example, that the contract was not being fulfilled. I did not give any information that that contract was not being fulfilled. However, I wanted to know whether the Minister found it disturbing that a price tag of £367,000 had been reduced to £211,000. In this situation, either the company is getting a fair return and doing its job properly, which is to the good and we are pleased about that—
§ Mr. Whitney
I agree with the hon. Gentleman and I welcome him aboard. He spoke about the concept of companies making profits. I agree with him that if for 16 years we had been spending too much in that direction—I make no party point about which Government were in power—we should bear the blame equally.
§ Mr. Whitney
I shall shortly come to the contribution made by the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy). I hope we can agree that the situation should have been put right 15 or 16 years ago. We must now agree that the situation has been put right.
§ Mr. Whitney
The hon. Gentleman is seeking to take me further on and I hope to respond to most or all of his points in my speech. Obviously I can make no comment on a particular bid of a particular company in a particular health authority. That is for the health authority to decide.
Our policy is clear, and if the hon. Gentleman will allow me to do so I should like to pursue it. We believe in patients first, and we agree that the employees of the Health Service deserve, and must have, proper treatment. The hon. Member for Birkenhead and the hon. Member for Brent, South came close to, indeed I believe that they arrived at, the point where they suggested that the Health Service exists for the benefit of the employees.
§ Mr. Pavitt
I apologise for interrupting so often in the Minister's speech, but he is wrong in the parallels that he is drawing, because employees, patients and all the staff—medical, ancillary and persons in the professions supplementary to medicine—are one unique organisation. The Civil Service, Army and industry are different bodies entirely. His equation of those two things does not match the experience of caring for patients and the integration of those working with and for the patients and the patients themselves. Therefore, by regarding 1153 employees as one lot and patients as another, the Minister is showing his ignorance of the concept of the Health Service.
§ Mr. Whitney
If the hon. Gentleman goes round the wards at Addenbrooke's hospital, for example, he will find, as I found by talking to the staff and to the patients, that there has been no diminution of the high quality factors to which the hon. Gentleman referred and understands very well and which I modestly claim I recognise and to which the Government aspire.
We are looking for resources to put to patients. The hon. Member for Birkenhead wanted to know whether the Government are satisfied that privatisation has increased the standard of service. I cannot answer that globally, because there are so many contracts. The great majority are in-house—the same people are involved—and consist of similar teams to those to which the hon. Member for Brent, South referred. These teams are producing the tenders and are winning many of them. We make sure that that is done on a fair and level basis. We have had to issue guidance on that. I am glad that that has been done and copies of the guidance are available in the Library.
We must be clear. The suggestion seems to be that before the policy was introduced—it is not a startlingly new policy, as it is now about two years old—all was perfect sweetness and light. The impression is that everything was clean before and the sister wiped her finger on the surface and nothing came away. Hon. Gentlemen will know that that was not the case. If they do not know that, they should talk, as I have done, to the ladies of the WRVS, who work in hospitals all over the country. They will tell hon. Gentlemen that standards were falling. What about the Wakefield inquiry and the problems at Stanley Royd? Appalling things went on there. Were they due to privatisation and to an outside contractor? Of course they were not.
We should not accept that everything is wonderful in the public sector because everything is devoted to the common good and that no supervision or management is necessary, or that everything is bad in the private sector. Each sector has its problems, and each requires its own management.
I must make it clear that, before the contents of a bid are agreed, health authorities must draw up careful specifications, and consult carefully with all those concerned, including the staff side. They will write into contracts a whole variety of additional points, including the provision of flowers in the wards or whatever. There are perfectly good opportunities to ensure that those standards are monitored, and monitored they are. In some cases fines have been imposed on contracting companies where those standards have not been met.
I remind the House that we are considering the expenditure of nearly £1 billion on three areas. Savings to the end of September were running at about £29 million a year, and we shall look for more up-to-date figures shortly. Certainly those savings are worth while and are going back into the NHS for patient care. I hope that the hon. Members for Birkenhead and for Brent, South will be prepared to look more favourably at that, given their known concern for the care of patients.
I was at a loss, as I often am, to discover the particular view of the hon. Member for Ross, Cromarty and Skye 1154 (Mr. Kennedy), charming though he is. He was in favour of savings, the economic use of resources, the community, team spirit, and something which I think he called "patriotism". I, too, am in favour of all that. That is splendid. However, I was not sure whether he was in favour of privatisation.
§ Mr. Kennedy
I made the point extremely clearly, and it stuck in my mind because I noticed nods from both sides of the House, and I thought I saw a look of comprehension on the Minister's face. That shows how beguiling he can be. I said that if we wanted efficiency and savings to be ploughed into patient care, as we all do, the most sensible policy was to allow health authorities to decide on the most prudent, commonsense standard and nature of delivery of service in their area. I mentioned my constituency, where a privatised service makes no sense because we have no competition as it is such a remote part. Therefore, the service must be in-house. I cannot understand why the Minister cannot comprehend my point, although I can understand the Whip not comprehending it, as he was not present.
§ Mr. Whitney
I am glad to welcome the hon. Gentleman on board our basic policy of devolving responsibility to health authorities. However, that does not imply a complete abandonment of policies from the centre, because the Government are responsible for taxpayers' money. The hon. Gentleman may never have that experience, but central Government are responsible for allocations. He cannot get away with the easy happy-to-agree-with platitude of having as much local autonomy as possible, and team spirit.
§ Mr. Frank Field
The Minister said that he welcomed the hon. Member for Ross, Cromarty and Skye (Mr. Kennedy) on board for his policy of delegating power, but that is the opposite of what the Government have done. Will the Minister tell us where he stands? Is he 100 per cent. behind the Tory-controlled Wirral health authority, which wrote to him deploring the fact that the Government were forcing it to privatise a cleaning service? Do the Government believe in local control, or in "daddy knows best", as we have seen tonight? I suspect that the latter is their philosophy.
§ Mr. Whitney
The hon. Gentleman was a little too quick to intervene. He intervened halfway through my remarks and failed to hear the second part, which is that the Government dispense such huge sums as £17 billion and so must strike a balance. Our policy makes it clear that we believe that competitive tendering provides more money for the NHS, and so for patient care. I am grateful to the hon. Gentleman for providing the striking example of Barking health authority, which produced a 60 per cent. saving in one small area for patient care.
§ Mr. Kennedy
We are overstaying our welcome, but the Minister accused me of wanting it both ways. He then gave us a big lecture about decentralisation and said "On the other hand, we are expending vast sums of taxpayers' money and must have responsibility". Will he come off the fence and tell us whether he is wet or dry? What is he saying? Does he believe in devolved powers or not?
§ Mr. Whitney
I am grateful to my hon. Friends for identifying where I stand on that spectrum. I am still at a loss to know whether the hon. Gentleman supports the 1155 Government in our concept that competitive tendering is producing good results for the NHS. To the end of September 1985 it produced annual savings of £29 million. If we had followed the hon. Gentleman's "hands-off" policy, that saving would not have been made, and £29 million would not have been available for patient care.
I have detained the House for longer than I intended, because of our stimulating exchanges, but I do not wish to sit down until I have answered the points raised by the hon. Member for Peckham (Ms. Harman). As is customary from the Front Bench, she produced a shopping list of expenditure which we were invited to consider. She suggested that great damage had been done. I offer the House some figures which will show that the hon. Lady is somewhat misguided about the impact of Government policies on personal social services since 1979.
Expenditure on the NHS has increased in real terms by more than 20 per cent., and the House knows the figures for the increase in patient care. At the same time, similar increases have occurred in the coverage of social services. Local authority personal social service expenditure between 1978–79 and 1984–85 increased by 19 per cent. in real terms. The number of social workers increased by no less than 25 per cent. The impression that some terrible harm has been done to social services does poor justice to the way in which local authorities have managed their affairs, given the significant increases in real terms both in financial and human resources.
§ Ms. Harman
Does the Minister accept that the increase in spending on social services can barely keep pace with the enormous increase in demand, which I outlined, and that the increase in spending is largely attributable to Labour local authorities refusing to accept the Government's strictures to make cuts? The Minister cannot have it both ways, and both claim the credit for an increase in spending and seek to make cuts. He will undoubtedly hope that rate capping will bring an end to that increased spending which Labour councils have valiantly maintained.
§ Mr. Whitney
I am ready to agree that too many Labour councils have had to be rate capped because of the increase in their local authority's spending. Such an increase is not necessarily spending on personal social services. It may well be on newsletters for strange sects, minority groups or whatever. The figures show that personal social services have increased by 19 per cent. and the number of social workers has increased by no less than 25 per cent.
§ Mr. Pavitt
I thank the hon. Gentleman for giving way, and I am sure that he will forgive me. Such global 1156 figures never look the same in our own patch. My authority is rate capped. We have more social workers, but the demand for them is fantastically much higher. We had the tragic case of child abuse—the Minister has seen the report—of Jasmine Beckford. If the Minister goes through the report—the result of that case—he will see that there were insufficient funds available during the period of rate capping. More social workers are needed for child abuse cases.
§ Mr. Whitney
I am sure the hon. Gentleman will agree that the tragic and desperate case of Jasmine Beckford and the other awful cases have nothing to do with a shortage of resources. The tragic case of Jasmine Beckford was due to failure of supervision and failure of management. It was certainly nothing to do with a shortage of resources.
The hon. Member for Peckham dwelt at some length on the question of providing more home helps. We agree that there should be more home helps. I am therefore glad to take the credit for the fact that since we came to power there has been an increase of 13 per cent. in the number of home helps.
I was extremely puzzled by the title of the motion, which refers to carers and the privatisation of welfare services, because the foundation of our welfare services continues to be based on statutory provision—the National Health Service and the social services departments in the local authorities. Opposition Members are disturbed by the fact that we are seeking to use those services more economically, to generate more services to be used for those who require care—patients in hospitals or the young or elderly—and by the fact that we are looking forward in the personal social services area to mobilising society. We do not wish to see care left entirely to statutory provision and we are introducing methods whereby we can support individual carers—friends, the family and voluntary organisations.
Government support to voluntary organisations has increased from £7.5 million to no less than £30 million. The hon. Member for Peckham objected to the fact that our increase in the amount of social security spending on residential care provision has increased—I shall use her figure, which I shall accept for the moment—by 2,000 per cent. The hon. Lady seemed to find that objectionable.
We have a fine record in combining the benefits of state provision—we have increased that provision, as has been shown by the magnitude of the figures—and at the same time we have created a framework whereby the people need not rely solely on the state, solely on the local authorities, which is what the Labour party looks for. We have brought about greater co-operation and co-ordination of provisions. We are proud of that record.