National Health Service Hospitals

HC Deb 26 November 1987 vol 123 cc397-480

Mr. Speaker

We now move to the Opposition debate entitled "Financial pressures on National Health Service hospitals."

I have selected the amendment in the name of the Prime Minister. May I repeat to the House what I said a moment ago; a very large number of right hon. and hon. Members, including a maiden speaker, wish to take part in the debate. It will be impossible to call all those hon. Members, but many more will be called if we can limit speeches today to not more than 10 minutes. That would be very helpful.

4.25 pm

Mr. Robin Cook (Livingston)

I beg to move, That this House notes that most district health authorities anticipate a deficit at the end of the current financial year; further notes that many of them are responding by delaying admissions and postponing treatment; is concerned that cuts in service may result in an inadequate supply of bed spaces to cope with the winter peak of admissions of elderly patients; and calls upon Her Majesty's Government to provide additional resources to meet the immediate budget shortfalls and to undertake to fund fully next year's pay awards for nurses and other staff. As we meet to debate the motion, Shropshire district health authority will meet in five minutes time to debate the cuts that will be necessary in its budget to fit in with the West Midlands regional health authority plans for 1990–91. There will be three options before the district health authority. The first is to close 10 of the 15 cottage hospitals within the district at a loss of 364 beds. The second is not to open the new hospital in Telford that is due for completion in 1989 when the key would be turned in its doors. The third option is to close the Robert Jones orthopaedic hospital at Oswestry with the loss of 300 beds to the district.

Knowing as we do the politics of the Conservative party, we suspect that were the Prime Minister present she would wish them to focus on the Oswestry solution. As it is, the officials have recommended the cottage hospital option. Any option will result in a sharp reduction in bed spaces in a district health authority which is already among the 25 district health authorities with the longest waiting lists.

Shropshire is no inner city area where the pressures of social deprivation have brought public services to breaking point. Nor, as far as I am aware, is it a nest of rebellious Marxists bent on embarrassing the Government for the sake of it. Yet Shropshire, in this matter at least, is typical of the nation. The dilemma that the health authority faces this afternoon is exactly the same as the choices confronting health authorities across Britain. I state that fact with some confidence, because this week I waded through the replies from 164 district health authorities that have informed me about their current financial positions. A total of 101 of them project a deficit to the end of the financial year. That is a clear majority of all the district health authorities in England and Wales. Even more alarmingly, that figure represents three out of every five district health authorities that responded to my questionnaire.

Most of the authorities project deficits ranging from a third of a million pounds to £1 million. Some comfortably break the £1 million barrier. Cambridge and Oxford health authorities predict deficits of almost £2 million. Sheffield predicts a deficit of more than £2 million. Paddington and North Kensington predicts a deficit at a record high of £3 million. As those cases show, the problem is spread right across England. They are spread from Cornwall in the west, which expects a deficit of £400,000, to Suffolk on the east coast, which expects a deficit of £916,000. They range from Winchester in the south, with a projected deficit of £530,000, to Northumberland on the Scottish border, which expects a deficit of £350,000.

There are 14 regional health authorities in England. In all but one, the majority of district health authorities report a deficit in the current financial year. I hope that when the Minister replies we will hear no shuffling off of the financial deficits as local problems caused by poor local management, which then, in a remarkable leap of logic, can be left to be solved by the same poor local management. This is a national problem. It has a common source in the inadequate funds provided by the Government and it can have a common solution only in more funds from the centre.

What makes the deficits all the more striking is that none of the district health authorities is legally permitted to run a deficit. Most of them have already striven to contain their budget by cuts in the first six months of this year. The deficits that I have reported are the residue left behind after every other attempt to balance the books. If those health authorities are now to be required to meet their legal obligations, they can do so only by making even worse cuts. Futher cuts do not bear contemplation.

Let us consider the measures already taken. The most obvious and most common this year has been a dramatic reduction in beds. Already — from 1979 to 1986 — the nation has lost 40,000 bed spaces under this Government. It is manifest from the figures that I have received that this year the number of beds is shrinking at a rapidly accelerating rate. In the South East Thames region in the past week there have been two separate estimates of the number of beds lost since the start of the financial year. The region's medical advisory committee puts the loss at 500 beds, while the regional association of community health councils puts the figure at 800. Many beds are described as temporarily closed—a device used by many regions to avoid the legal consultation procedures which are triggered only if beds are permanently closed. The fact is that in present financial circumstances many of the temporarily closed wards have no realistic prospect of opening again.

The medical advisory committee of South East Thames is blunt about what that means for patient care. It reports that in the first nine months of this year waiting lists in the South East Thames area have increased by one fifth and it projects that by the spring, at the start of the next financial year, waiting lists will have increased by one third. The committee reports that there are cases of women requiring operations for breast cancer having their operations postponed four or five times. The House will understand the distress that such cancellations must cause to a woman who has a malignant tumour which she knows can be successfully operated on only if it is operated on early enough.

In all four Thames regions, doctors in accident and emergency units repeatedly find themselves spending hours looking for some flat space into which they can squeeze another emergency case. A consultant at the Royal Free hospital in Hampstead described one Sunday night in the accident and emergency unit: At the same time, all beds in George Quist ward were full, all the trolley bays were full, extra trolleys were used for patients in the corridor and even the trolley in the isolation room was full, as well as a mattress on the floor in the corridor. Two of the patients in the corridor had suffered acute heart attacks and were on cardiac monitors as no beds could be found … for them. There were also several patients in the waiting room, three of whom had suspected heart attacks. However, there were no vacant trolleys upon which they could be placed". That occurred in August during the season when admissions to hospital are normally still slack. The peak season for admissions is yet to come. It will come when the cold begins to bite and when general practitioners seek hospital places for the elderly and frail who will not survive the winter if they have to stay alone in a home that they cannot afford to heat. It is plain that there are now no beds for them.

Already this month Maidstone district general hospital is on amber alert and will accept emergency cases only. It is rare for any general hospital to be on amber alert before January. Doctors will succeed in having elderly patients admitted only by taking surgical beds at the expense of those waiting for operations. That very point is made in a letter signed by 200 consultants in Birmingham: we have grave doubts that our hospitals will have adequate beds to cope with the inevitable increase in acute medical admissions expected during the winter months, without severely compromising surgical admissions and waiting lists. The effect of an influenza epidemic could be nothing short of disastrous. Given that the beds are not there, it is perhaps prudent that operations have been the other major target for cuts. Doncaster district health authority has postponed 1,000 operations to the next financial year. Gwent district health authority has cancelled 14 operating sessions per week, involving the postponement of 1,500 operations until the next financial year. West Berkshire district health authority has postponed 3,000 operations until the next financial year. The mind boggles at the idea of doctors having to advise patients that they can come back in April because that is when the new accountancy year begins.

Mr. John Redwood (Wokingham)

Given that there has been a massive increase in funding and a big increase in the number of doctors and nurses, will the hon. Gentleman explain how he can say that the management of the Health Service is in no way responsible for cutting beds?

Mr. Cook

The hon. Gentleman should return to his constituency and enter discussions with doctors who work there. They will explain to him readily and freely—as they will to anyone—that the resources with which they have to work are hopelessly inadequate. If the hon. Gentleman cannot be troubled to go back to his constituency, he could look in his own local paper where he will find an advertisement placed by those doctors. I welcome the new spirit of glasnost in the Health Service. I am glad that the events of the past six months have provoked so many consultants to speak out. I rather wish that some of them had spoken out before June, but no matter.

I cannot say that every Conservative Member welcomes the fact that consultants are speaking out. I have a letter from the Secretary of State for the Environment addressed to the Minister for Health. The letter has the authentic ring of his prose about it. The Secretary of State complained that a consultant had advised one of his constituents to write to her Member of Parliament and addressed the Minister for Health in the following terms: It seems to me intolerable that employees of the Health Service should openly criticise their health authorities and the Government … I would be glad if you could investigate this and see that the necessary action is taken to silence Mr. Guy. I find it fitting that under this Government responsibility for local democracy should be in the hands of a right hon. Member who shows such sensitivity for freedom of speech. I am happy to say that the Minister did not succeed in silencing Mr. Guy. or, indeed, the doctors at the Royal Berkshire hospital.

The Minister for Health (Mr. Tony Newton)

In relation to this rather elderly story, may I make it clear that the Minister did not seek to silence the consultant. I simply made inquiries and established that some of his remarks did not correspond with the reality in the health authority.

Mr. Cook

I am glad that I gave the Minister the opportunity to clarify the matter and tell us that he did not attempt to silence Mr. Guy. I would not have expected him to have done so. However, he will concede that it is clear from his intervention that he did, indeed, receive the letter from the Secretary of State for the Environment. We complained of the letter, not of what followed it.

The doctors at the Royal Berkshire hospital have placed an advertisement in their local paper in which they spell out the consequences of the cuts. Patients will be left in pain with hernias. Patients will be left going blind from cataracts. Women will be left in discomfort from vaginal bleeding that requires hysterectomy. All of them will be told to come back again after April.

As if to underline the lunacy of that situation, the National Audit Office has this week helpfully produced its report on the use of operating theatres. The report found that for half the time operating theatres are not in use. Reasonably, the office suggests that an increase in the scheduled time for which they are used would have a major impact on waiting lists.

The hon. Member for Stockport (Mr. Favell) called during business questions for a debate on that report. It is a matter of regret that he has left the Chamber for this debate. He appeared to think that increasing the use of operating theatres was merely a matter of greater efficiency. Unfortunately, I must tell him that on average it costs £450 for every hour that an operating theatre is in use.

Unfortunately, the district health authorities cannot afford to maintain even the present rate of use and are planning to reduce it still further. They are caught in a catch-22: to cut the waiting lists they need to run the operating theatre more efficiently; to meet cash limits they must run the operating theatres inefficiently.

Some authorities cannot afford to use the resources that they have, but elsewhere operations have been cancelled because of the scarcity of resources. The House and the nation are familiar with the case of David Barber whose operation was postponed five times in six weeks. Today we learn that 70 operations have been cancelled by the same unit in the last five months alone.

I know that the problems of that unit cannot be solved tomorrow by throwing money at it. I know that they can be solved only by increasing the intensive care places available in Birmingham and by training the staff for them. I know that those are long tasks, but precisely because of that, the sooner we start on that task the better.

I have to report that, under the pressures that it faces, the West Midlands regional health authority has been obliged this past month to suspend its capital programme. One of the casualties of that is the new children's hospital which was to be built on the Queen Elizabeth site and would include increased intensive care units for children.

This month, the doctors who were obliged to postpone the operation on David Barber were advised that the start on that new hospital has been indefinitely delayed. That condemns children in the West Midlands regional health authority to an indefinite future of the same delays and uncertainties that were experienced by David Barber.

I am told that Sir James Ackers, chairman of the West Midlands regional health authority, was seen in the House at 5 o'clock yesterday afternoon, walking down the Prime Minister's corridor. I hope that the Minister will take the opportunity to clarify whether it was the Prime Minister or Sir James Ackers who was offering to resign because of the crashing problems of the Health Service in the west midlands.

Nor is the Queen Elizabeth hospital the only children's hospital that has brought its problems before the nation. Earlier this month, the nation was startled to open its newspapers and discover full page advertisements from the Great Ormond street hospital inviting voluntary donations towards a £25 million renovation fund.

I can think of no more damning indictment of the Government's stewardship of the NHS than that they have driven that great hospital, with its long record as a centre of specialist excellence, into the arms of professional fund raisers. I do not accept that the Health Service should be funded through public relations accounts handled by the advertising industry, or by direct mail shots for the wealthy, or by inviting community groups to run bottle stalls and hold jumble sales. The funding of essential patient care is the proper responsibility of Government and there is no more important duty with which they are charged.

Now let me take up the point made by the hon. Member for Wokingham (Mr. Redwood). I have not the slightest doubt—on the contrary, I have every confidence—that, since this debate was announced this time last week, teams of statisticians at the Elephant and Castle have been sweating blood to find the best index and the most flattering base year to create the best illusion of increasing resources. When the Labour Government were in office those of use who were Back Benchers were at least able to take the statistics at face value. We may not have liked them, but we were able to take them at face value. Today the statistics are bogus.

The health statistics that we get are bogus, because they take credit for efficiency savings as if they were releasing resources instead of cutting them. They are bogus because they take credit for the increased revenue from increased charges. The Minister demonstrated that yesterday, when he took the credit for increasing resources for primary care by £170 million by increasing the charges for dental services and eyesight tests, as if he himself had signed the cheque. They are also bogus becaue they take no account of the fact that price inflation in the Health Service outruns the general rate of inflation. Therefore, any use of the retail price index is bound to give a flattering impression of an increase in real resources.

The truth, as the Under-Secretary the hon. Member for Derbyshire, South (Mrs. Currie) revealed, is that resources are getting tighter. The hon. Lady addressed a conference of the Institute of Financial Managers in the Health Service earlier this month. She said that the Health Service can expect its share of GNP to decline over the next three years. As I found that a startling new statement of Government policy, I checked with the hon. Lady's office and was advised that the hon. Lady's speech was not scripted but was accurately quoted, from which I divine that somebody in her office no longer takes entire responsibility for what she says. Why on earth the Government should wish to reduce the share of GNP going into health when, except for Greece and Portugal, we already spend the lowest proportion of GNP on health, I cannot imagine.

But let me offer to meet the Minister half way.

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

Does my hon. Friend accept that there is a clear distinction between the views of Conservatives in the House and Conservatives in the country? Is it not true that wherever we meet Conservatives they are embarrassed by the way in which the Government are running the NHS, that they, as much as anyone in Britain, want expenditure to be increased, and that they are tired, sick and fed up of the Government's indifference to public protests over what is happening? Why do not the Government respond? Will my hon. Friend confirm that that is the view of many of the people whom we meet in our travels?

Mr. Cook

If my hon. Friend will bear with me, I shall deal with what he has just said in a moment because there is a lot of truth in it. Indeed, I suspect there is even more truth than he has put before the House.

Let me, in a spirit of bipartisanship, offer to meet the Minister halfway. The crisis in the NHS is profound. I am willing to rise above partisan considerations, so I will offer to concede that there have been some increases in resources — though not as much as the Minister will pretend, or statisticians try to tell us with all their tricks with mirrors—if the Minister in turn will concede that it is not enough to keep the service going. I beg the Minister for Health not to show the incandescent complacency that shines out of the Government's amendment, which must have been drafted by the hon. Member for Derbyshire, South, his junior Minister. Given the cash crisis across the nation that I have quoted and the effect in real terms of that cash crisis of which I have told the House, I beg the Minister to recognise that there is a problem, even if he is prepared to do nothing about it.

In the event that the Minister is prepared to do nothing about it, I must turn from my appeal to the Minister to the even stonier path of appealing to Conservative Back Benchers. Here I want to pick up the point made by my hon. Friend the Member for Workington (Mr. Campbell-Savours). It is not just that the Conservatives whom we meet in the country show anxiety for the state of the local Health Service in a way that we do not hear in the Chamber. When we meet Conservative Members in the country, they are expressing concern about the effect in their constituencies.

Over the past three months I have been reading quotes from many Conservative Members in their local papers. I particularly cherish the quote from the hon. Member for Reading, East (Sir G. Vaughan) who, in talking about the cuts at the Royal Berkshire hospital, said: These cuts are totally unacceptable. That was said by an hon. Member who was Minister for Health in this Government for three years. I understand the dilemma faced by Conservative Back Benchers. I have been through it myself. As I said earlier, I did not hold office in the last Labour Government and occasionally I was unable to give them my wholehearted support. Some of my right hon. and hon. Friends who are present this afternoon were in the same situation. My right hon. Friend the Leader of the Opposition, who was the hon. Member for Bedwellty, often joined me on those occasions. Fittingly, Bedwellty has disappeared from the Register of Members of the House.

I know the pressures and the tourniquets that can be applied. I know all the tricks of the Whips' trade—the visit from the heavy one who threatens to break your career, and then the soft one who takes you for a drink and urges you to be one of the boys and says that there might even be a PPS in it for you. I have been through it, too. The trouble is that it seems to work with Conservative Members. If we had a secret ballot at the end of the debate, we might carry our motion, or at least it would have a sporting chance, but since it is a recorded vote in which hon. Members will have to run the gauntlet of their Whips, I fear that it will be flung out.

I believe that the nation is badly served by the Minister, and is even worse served by Conservative Back Benchers who know that the Government are wrong and are acting against the interests of their constituencies, but who still go on voting for the Government in the Lobbies. Tonight I offer an opportunity to all those Conservative Back Benchers whose words of anxiety and concern I have been reading in their local press for the past month. If they really mean what they said, I invite them to join us in our Lobby, and to vote with us for the extra resources that they know the Health Service needs, so that we can start rebuilding a Health Service in which our constituents can once again have confidence, and in which Parliament can once more have pride.

4.51 pm

The Minister for Health (Mr. Tony Newton)

I beg to move, to leave out from "House" to the end of the Question and to add instead thereof: welcomes the increased number of people being treated in the hospital and community health services, and recognises and applauds the work of all groups of staff that have made this possible; congratulates the Government on again maintaining the National Health Service programme of hospital building and providing a high level of investment in the service next year; reaffirms its intention to continue the promotion of a comprehensive health service; and recognises the Government's achievement in establishing the sound economy necessary to support the continued development of the health service. Despite the observations of the hon. Member for Livingston (Mr. Cook) in the last few minutes, I make no apology for beginning my speech by setting out the essential facts that should form the foundation of any debate on the NHS and the Government's record of commitment to it. [HON. MEMBERS: "The hon. Gentleman means statistics."] I mean the statistics, and when I look back at the statistics of what happened under the last Labour Government, I am not surprised that the hon. Gentleman spent at least three minutes of his speech effectively apologising for the record of the Government whom he supported.

Mr. Kevin Barron (Rother Valley)

The Minister says that his only defence of current spending is based on statistics. What correlation is there between the statistics that he reads out and the needs of patients in the NHS?

Mr. Newton

I shall seek to deal with that as my speech develops. To start with, let me remind the House that in 1978–79, the last year in which the Labour Government were in office, the NHS in England cost just over £6,400 million. This year, we shall be spending more than £ 17,000 million. That is an increase of nearly one third in real terms, and it is an increase in any terms, whatever statistical analysis the hon. Gentleman applies.

During the last few minutes we have heard something about the percentage of the GDP that the NHS takes. The hon. Gentleman knows that whatever may happen during the next two or three years — and that is difficult to predict with any precision—it will take more than 5 per cent., and probably significantly more than that. Does he know what it was in the last year of the last Labour Government? I shall tell him. It was 4.8 per cent., which was significantly less.

This morning I asked the Department to do some statistical calculations for me. I asked for a rough idea, taking into account the greatly increased percentage of GDP that we are spending on the Health Service compared with what the Labour Government managed to achieve, of what the effects of that improvement would be. Back came the calculation that we are spending about £1 billion or more a year on health than would be the case if the miserable percentage of the last Labour Government had been maintained.

Mr. Alistair Darling (Edinburgh, Central)

My hon. Friend the Member for Livingston (Mr. Cook) outlined the difficulties that health boards have encountered throughout the country. If the Minister is right about the increased spending, and if he is right that everything about health spending is wonderful, how is it that the health board has had to cut £7 million from the current year's expenditure of the Royal infirmary in Edinburgh, in my constituency? Every night the hospital has difficulty in getting enough staff to staff the wards. In regard to capital expenditure, one operating theatre cannot be used, and another is about to be condemned. That sort of thing happens throughout the country. Does the Minister accept that, no matter how much is spent, hospitals throughout the country have serious problems which need money to be spent on them now?

Madam Deputy Speaker (Miss Betty Boothroyd)

Order. This is a tremendously long intervention in a short debate. Will the hon. Member come to his point?

Mr. Darling

I think that I have made the point. Will the Minister answer that question?

Mr. Newton

I shall deal with some of the pressures that exist. I ask the hon. Member for Edinburgh, Central (Mr. Darling) and his right hon. and hon. Friends to reflect upon how much more difficult those pressures would be if it were not for the very substantial increases in expenditure undertaken by the Government. I readily accept that there is endless scope for argument about the statistics on expenditure figures.

Mr. Martin Flannery (Sheffield, Hillsborough)

There is no argument about the measure.

Mr. Newton

There is no room for argument about another important measure of the increase in the resources that we have devoted to the Health Service, which is the increase in the number of staff. There are now nearly 15 per cent., or 5,400, more hospital and community doctors and dentists than there were in 1978—and those figures are for 1986. There are more than 12 per cent., or 4,000, more general medical practitioners and dental practitioners. There are nearly 15 per cent., or 50,000, more hospital and community nurses and midwives. Those are huge increases of nearly one third in those important professional and technical staffs who underpin so many of the screening programmes. No one can tell me that that is a record of cuts.

Mr. Ieuan Wyn Jones (Ynys Môn)

Does the Minister accept that one of the reasons for the serious underfunding of area health authorities is that they are not given adequate resources to pay wage awards? That is a simple fact. Does he not see that Gwynedd health authority, for example, will overspend by £1.6 million this year, whereas it is underfunding wage awards by £2 million?

Mr. Newton

Perhaps one of the reasons for the pressures to which the hon. Gentleman refers is the Government's record of improving the pay and conditions of nurses. If he casts his mind back to the record of the Government that I presume he would have supported had he been here, he will register the fact that what happened then was a cut, in real terms, of the pay of nurses. No wonder there was less of a funding problem, because there was more of a nurses' problem.

Mr. Denis Howell (Birmingham, Small Heath)

Will the Minister give way?

Mr. Newton

I cannot go on giving way at this rate, or I shall take up too much time, but I shall give way to the right hon. Gentleman.

Mr. Howell

I am grateful to the Minister for giving way. Although we take on board what he tells us about increased funding for nurses, the only thing that matters is whether we are treating the patients who require treatment now. Is he aware that I received a letter today from the Children's hospital, of which his hon. Friend the Parliamentary Under-Secretary of State used to be chairman, telling me that 45 beds have been lost and that a further 59 beds will go by the end of December? That situation never occurred under a Labour Government.

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

Oh yes, it did.

Mr. Howell

Oh no, it did not.

Mr. Newton

Well, well, well. In view of what the right hon. Gentleman has just said, may I quote something that I suspect my hon. Friend the Under-Secretary of State might have wished to use later, and I apologise, therefore, for using it. It is an extract from The Daily Telegraph of 16 January 1979. What is it headed? Patients Sue Ennals Over Hospital Waits". The article says: Four patients yesterday accused Mr. Ennals, Social Services Secretary, of failing in his duty to provide an efficient Health Service. The patients complained in the High Court to Mr. Justice Wren—in the first challenge of its kind—of long delays for orthopaedic operations because of the shortage of beds and operating theatres in the Birmingham area. The right hon. Gentleman said that that had never happened under the Labour Government. I call on him to withdraw his comment.

Mr. Denis Howell

I shall not withdraw it for the simple reason that I said on the record that by December 90 beds would be closed at the Children's hospital, Birmingham. That never happened under any Labour Government.

Mr. Newton

The flavour of the right hon. Gentleman's remarks, as he well knows, was calculated to convey the impression that the sort of problems about which he is concerned never occurred under the Labour Administration. That is simply not true.

Let me address myself to the point that is rightly of primary concern to the House, which is not the input of money or even in some respects of staff, but the output of patient care. Again, I make no apology for repeating the figure of the 1 million extra in-patients now being treated each year by comparison with the figure when the Government came to office, the doubling in the number of day cases, or the huge increase in the number of outpatient attendances.

Mr. Sam Galbraith (Strathkelvin and Bearsden)

I take it that the Minister's remarks are intended to convey that that is due to Government practice or policy. Will he reflect on the fact that more patients are treated simply because of a change in medical practice? That is unrelated in any way to Government policy. I well remember the days when someone who had had a heart attack would have been in bed for six weeks. Now, if it is uncomplicated, the person is home in five days. Therefore, there is scope for treating more patients. That is due to a change in medical practice, not in Government policy.

Mr. Newton

I recognise that much of the progress is the result of the dedication of all who work in the Health Service, but they would not have been able to increase their output as they have done without the extra resources that we have put in. That is the point on which the Opposition should focus.

Let me measure also, in perhaps more direct and down to earth terms, particular conditions and types of treatment and ask the hon. Member for Livingston whether he is aware of where things were when the Labour Government left office and where we have come to. [Interruption.] Yes, we have been in government for a considerable time. What I am about to give the House are some further details of what we have achieved in important ways for some important people. The number of kidney transplants went up from fewer than 1,000 in 1978 to nearly 1,500 in 1986. The number of people being treated for serious renal failure more than doubled from slightly over 5,000 in 1978 to over 12,000 in 1985. The number of hip replacements has gone up from 28,000 to over 38,000. I wonder whether the Opposition can tell me how many heart transplants were performed in this country in the year that Labour left office. [Interruption.]

Madam Deputy Speaker

Order. The Minister must be heard.

Mr. Newton

Opposition Members obviously do not like this. [Interruption.] If the hon. Gentleman will be quiet for a moment, I shall give him this important information. The number of heart transplants performed in 1979 was three. Does the hon. Gentleman know—

Several Hon. Members

rose—

Madam Deputy Speaker

Order. If hon. Members have anything to say, and if the Minister is willing to give way, that is in order. The Minister is obviously not giving way, and the House must hear him.

Mr. Newton

There is a notorious and notable reluctance among the Opposition to hear this, but my hon. Friends are anxious to hear the information. The number of heart transplants carried out in 1986 was not three, but 176. [Interruption.] It is no good anyone saying that that is just the result of improved medical practice. It is the result of the designation by the Government of two new heart transplant centres and of their making available the necessary resources. They now intend to designate a fourth centre.

Mr. Mark Fisher (Stoke-on-Trent, Central)

I ask the Minister to reconsider his remarks. People all round the country who have been following the case of David Barber will be appalled and disgusted by the way in which the Minister is seeking to congratulate his Government on advances in surgery, while the Government sat there and did nothing when David Barber's operation was cancelled five times.

Mr. Newton

I make no apology for what I have said about the Government's action in increasing resources for heart transplant surgery, in designating new centres and in creating for a significant number of people the chance of a new life which otherwise they would not have had. That, in the end, is what the Health Service is about and I am proud that we have done it.

I have made it clear to the House on several occasions in the last two days that I am not prepared to engage in the kind of political debate which some hon. Members, though not, I accept, the hon. Member for Stoke-on-Trent, Central (Mr. Fisher), have sought to generate from the case of David Barber. I shall stick to what I have said on both previous days in the House, that I am glad that the improvement in the position at that unit at Birmingham Children's hospital was such as to enable David to have his operation yesterday. That is something that we all wanted. I wish him well, and I shall rest on that for the moment.

Mr. Jeff Rooker (Birmingham, Perry Barr)

None of us would disagree with what the Minister has said about advances in surgery and the numbers being treated. How, therefore, can he explain the fact that a coach load of kidney patients from the Queen Elizabeth hospital in Birmingham in the west midlands went to Downing street to deliver a letter and then came to the House to meet hon. Members on both sides representing constituencies in Birmingham? The coach was delayed by several hours because it had to stop on half a dozen occasions so that the patients could undergo treatment for self-dialysis while on the way here to ask that they should not lose that provision next April. Why do people in that position—with life-support units—have to be carried around the country by coach to come and plead for extra resources? With all that is said about the Government's success, that is bizarre in the extreme.

Mr. Newton

I hope that I have already said enough to make it obvious that the number of people receiving such treatment is, happily, a great deal higher than it was when the Government came to office. In this, as in many other areas, it remains our wish to build further on what we have achieved. However, I am not willing to hear Opposition Members voicing suggestions about the Government's record that are manifestly belied by the figures that I have been giving about the increases in almost every aspect of essential treatment.

Mr. Matthew Taylor (Truro)

I am pleased that the Minister is giving hon. Members an opportunity to intervene in the debate, and I am interested to hear his comments on new buildings, reductions in waiting lists, and so on. Would the Minister care to comment on the fact that, five years ago, ward 12 was built in Treliske hospital? It was not opened until the beginning of this year, when it was opened temporarily for emergency work to be done to cut the waiting list. It will close again at the end of this year. Will we have to wait until the next general election before the Minister opens it again?

Mr. Newton

I am not denying that there are pressures on the Health Service, including those arising from its development and expansion. I am saying that those pressures are on a service that is expanding, developing and building new hospitals, and I would rather have those pressures than the ones that we inherited, which were those of a Health Service whose building programme had been smashed because the economy over which Opposition Members presided was incapable of sustaining it.

I could make a number of other points about the expansion of treatment that has taken place. Almost everywhere one looks, one sees a striking record of more patients being treated and improvements in the pattern of health care. These are the facts. They are measures of an achievement of which all Conservative Members are proud. That achievement goes far beyond anything to which the hon. Member for Livingston and his hon. Friends can lay claim. In stating these achievements, I do not seek to conceal the real pressures that the service faces. These facts are merely the starting point for any serious debate on the issues.

The second element in any serious debate on the issues is to assess in a more practical and realistic way than did the hon. Member for Livingston some of the reasons why pressures arise. Some of them result from our continued view that it is right to take steps to ensure the fairer distribution of health services around the country. I know that some of my hon. Friends represent as I do, constituencies in the Thames region, where there are difficult transitional problems, but I have never heard the basic policy — arguments about RAWP aside — questioned.

The aim is to ensure that some parts of the country, in particular the north and parts of the midlands — including the west midlands—that have previously had less than their fair share of the health services as a result of historical and geographical accidents have their position improved. By the redistribution of revenue, of capital and of building, those defects are being remedied — perhaps not as quickly as the hon. Member for Livingston or even I, in some aspects, would want—to a significantly greater extent than before the Government came to power.

Mr. Matthew Taylor

Will the Minister consider the position in Cornwall, where it is estimated that, according to the RAWP formula, we are at least £2 million, and possibly £4 million, underfunded? Will that be tackled?

Mr. Newton

The South Western region, along with some others—including the West Midlands and North Western regions — is among those which, when the Government came to power, were about 10 per cent, underfunded by the RAWP formula. Now they are less than 4 per cent, underfunded. That is another measure of the progress that we have made in some of the areas in which all hon. Members are interested.

Let us consider demographic trends, in particular, the rising number of elderly people, which, as all hon. Members know, is steadily increasing the pressures on the Health Service and the demands on it. As it happens, because of the increase in resources that we have allocated, we have kept ahead of the measured need resulting solely from that demand, but it continues to create pressure and will continue to do so whatever the colour of the Government in office. Similarly, the medical advances that underlie some of the achievements to which I referred earlier contribute to developing pressures on the health services. They often interact with the rising numbers of elderly people. Improved techniques of anaesthesia and operating, and improved technical and medical skills, steadily increase our capacity to deal with the growing numbers of elderly people. I recognise the pressures that are reflected in some of the anxieties that have been expressed in the House this afternoon, but alongside them, our success in introducing new services, meeting new demands and keeping alive babies who would previously have died contributes to further increases in demand.

Many new increases in demand arise from the success of the capital programme of building new hospitals. Coping with those pressures entails choices: for example, between meeting additional demands for existing services, or maintaining those services unchanged, or undertaking new developments. It certainly involves examining the pace at which new developments can be introduced. Such problems are faced by every Health Minister in every country of the world, and would be faced by any Health Minister of any political colour at this Dispatch Box. Any speech that pretends—the hon. Member for Livingston pretended to some extent, though less so than did his predecessor — that these problems can be overcome by some easy solution involving resources is misleading the House and the country.

Mr. Chris Mullin (Sunderland, South)

Is the Minister aware of the impending closure of a ward in Sunderland general hospital? If so, will he inquire into the reasons for that? The staff of the hospital are labouring under the illusion that it has something to do with shortage of funds, but I am sure that they are wrong. Will the Minister find out the cause and report back to the House, so that we can correct the misapprehension under which they are presently labouring?

Mr. Newton

In view of the calm and reasonable way in which the hon. Gentleman made his intervention, I shall look into his point. I hope that he will understand if I say, equally calmly, that the Northern region and its health authorities is among those that have gained most significantly from the policies and additional resources that the Government have made available to the Health Service.

I acknowledge that we want to make more resources available on top of those that we have already provided. Within the last few weeks we have demonstrated our willingness to do that. We have said that next year a further £700 million will be provided for the hospital and community health services in England, and that still further additional sums will be made available in the two years after that.

Secondly, I ask the House to recognise that however much money we make available from the taxpayer—and we have made it available in significant, additional extra amounts—it will always be possible, for the reasons that I have described, to use more. We have set about tackling that problem by, for example, the emphasis that we have placed on surplus land sales. This year alone that will bring nearly £250 million additional money into the Health Service, and that will support the capital programme and those growing services that the system provides.

Only yesterday we launched legislation designed to enhance still further the capacity of health authorities to generate additional revenue. The hon. Member for Livingston called that tuck-shop money. If that money were available now to health authorities, it would be of significant additional help to them in tackling some of the pressures that the hon. Gentleman described. In the short term we do not think that the yield could be as large as the hon. Gentleman and his hon. Friends have suggested. Whether it is £20 million—as we expect next year—or £70 million in three years' time, it will be a useful addition to whatever amount the taxpayer is able to make available. We know that if the Labour party had its way those additional sums would not be available, because the party has set its face against those sensible and pragmatic policies.

Mr. David Young (Bolton, South-East)

Bolton is 186 full-time equivalent nursing staff short of the number for which it is funded. Does the Minister think it helps his case to say that he is short of resources when he allows private hospitals to recruit staff trained by the NHS? Those private hospitals have contributed nothing to training. In Bolton our key worry is a shortage of nurses, and because of the aged and the mentally handicapped in the area we want to see that remedied. Our problem is the wastage of trained nurses, not recruitment. Those resources are being syphoned off to private health — a system that the Minister supports only for the sake of convenience.

Mr. Newton

It helps that many people in Britain, in addition to the sums that they pay in taxation, are prepared to put some of their money into private health services. That generates additional resources for health as a whole, and for many of the schemes under our waiting-list initiative we have been able to harness those resources in a practical and sensible way for the use and service of NHS patients. I make no apology for saying that we welcome people's willingness to put money into health, because it is money in addition to that which we take from them in taxation and contributes to the health provision of the nation as a whole. As I say, it creates resources that we can use for the NHS in the way that we have sought to do.

Mrs. Elaine Kellett-Bowman (Lancaster)

Is my hon. Friend aware that, roughly speaking, 50 per cent, more is spent in the United States on private health care than on public health care? When we add together private health care and NHS health care in the United Kingdom we see that we are well up the league.

Mr. Newton

The totality of spending on health in Britain is a good deal higher than Opposition spokesmen sometimes give us credit for. My concern is to make the NHS as good as we all wish it to be. That is what the Government have been doing, and it is reflected in improved treatment, increased numbers of staff and additional resources. I welcome the opportunities that we often have to assist NHS patients in using resources from the private sector.

The exchanges of the last few minutes clearly illustrate one of the other matters that the House and the country should recognise in assessing the speech by the hon. Member for Livingston and the words of the motion. I have already said that if a Labour Government were in power I doubt whether the Health Service would receive £250 million in the present year from surplus land sales. That is because the Labour party does not like that sort of thing. I doubt whether the Health Service would have the prospect of £20 million, £30 million, £70 million, or whatever the figure turns out to be, per year extra from the income-generation proposals that we announced yesterday. It would certainly not have the benefit of the effective additional £600 million a year that has already been made available because of the success of the cost improvement programmes. Quite certainly it would not have the benefit of the £ 100 million a year within that £600 million that has been made available by competitive tendering so that basic services are provided more efficiently.

We heard much rhetoric from the hon. Member for Livingston, but we know that the last Labour Government spent less on health in absolute terms and in proportion to the nation's income than we have done. The Opposition have set their faces against almost every sensible way of improving resources for the Health Service. The only result of the re-election of a Labour Government, especially given what that would do for the economy, would be seriously to damage the NHS and make worse and more difficult to resolve all the pressures about which the hon. Member for Livingston spoke.

Mr. Robin Cook

What provokes my hon. Friends is that they cannot reconcile the picture that the Minister paints with what they see in their constituencies. Before the Minister finishes his speech, may I invite him to answer a simple question? Is there nowhere in the NHS where he at present sees failings and shortcomings? If he cannot see them, he does not deserve to be the Minister for Health.

Mr. Newton

I have already said a number of times that I can see many pressures. I can see many things that I would like to do on top of what we have already done. There are pressures on the Health Service, and there always have been, as I clearly said when I spoke about the last Labour Government. I have no doubt that there will always be pressures. However, the pressures now compared to those that we inherited — the pressures of economic decline and no prospect of recovery — arise from expanding services, backed by an expanding economy and providing more and better care than ever before. We intend to build on that.

5.27 pm

Mr. Terry Davis (Birmingham, Hodge Hill)

I am grateful for the opportunity to take part in the debate at such an early stage. Most of my hon. Friends would agree that the west midlands may well have the worst Health Service crisis in Britain, and I must tell the Minister that, although I listened carefully to his speech, I do not think that he appreciates the scale and depth of today's crisis in the Health Service in Birmingham and the west midlands.

The chairman of the regional health authority has told us that one third of the district health authorities in the west midlands are now spending more money than they have been allocated for this year. He has also told us that two thirds of the district health authorities will be spending more than they have been allocated by this time next year. That is despite all the economies that they have made, and despite all the improvements that the Minister has described. Moreover, it does not take account of the economies and cuts and closures that have taken place in the other one third of the district health authorities. Sometimes we too readily forget that. All over the west midlands district health authorities are closing wards and beds in hospitals.

My hon. Friend the Member for Livingston (Mr. Cook) described the cuts taking place in Shropshire, but one can go from Shropshire to north Staffordshire and find the same story. One can go from north Staffordshire to north Worcestershire and find that the Bromsgrove and Redditch health authority has just closed an operating theatre, nine children's beds and an adult ward. The Tory chairman of the district health authority was scared to allow Labour candidates to enter that hospital during the election campaign because of what they might find.

The crisis in Birmingham is particularly severe, and it is particularly important because Birmingham hospitals, such as Birmingham Children's hospital, contain a number of regional specialties which treat people from all over the region. When the Under-Secretary of State visited Birmingham, the only answer that we received from her was the suggestion that Birmingham hospitals should stop treating people from outside the city. What a message from an Under-Secretary of State for Health and Social Security. Hardly a day passes in Birmingham without news of yet another cut, closure or reduction in the level of health provision.

The whole House—indeed the whole country—knows about the crisis at the Birmingham Children's hospital as a result of the David Barber case. The crisis has affected other children who are waiting for heart operations. As my hon. Friend the Member for Livingston said, David Barber had his operation cancelled five times in six weeks, but Birmingham Members know of a nine-year old child whose operation was cancelled five times in two weeks. The operation was performed only after her mother had spent 14 nights sleeping in an armchair next to her hospital bed and after she had telephoned the chairman of the regional health authority. The action that was taken by that mother, who was at her wits end, and the campaign by David Barber's parents shows what it takes to get an operation at the Birmingham Children's hospital.

The crisis affects not only children but adults. I have a constituent who was told by a surgeon in October that he should have an operation the next day and that he would probably be admitted within two weeks. That was four weeks ago, and my constituent has now been told that he will be lucky to see the doctor in eight weeks, let alone have his operation. All my hon. Friends from Birmingham could tell similar stories.

The crisis does not apply only to heart patients. The whole of Birmingham knows about the problem of kidney patients as well, and it affects not only patients at the Queen Elizabeth hospital but also those at East Birmingham hospital, which caters for my constituents. A few weeks ago, a consultant at the Queen Elizabeth hospital was told that if he dared to treat a new kidney patient he would be dismissed. That is the level to which the Health Service in Birmingham has been reduced. That threat was withdrawn only because of the publicity that surrounded it when it was made public by the press.

Mrs. Currie

rose—

Mr. Davis

The hon. Lady knows quite well the doctor to whom I am referring, because that doctor wrote to her in July and reminded her that she issued the same sort of instructions when she was chairman of the district health authority a few years ago.

Mrs. Currie

We all know that particular doctor very well indeed. Will the hon. Gentleman acknowledge two matters? First, about £250,000 has been allocated to the two units at Queen Elizabeth hospital and at East Birmingham hospital, which are two of the seven units that perform dialysis. Secondly, that doctor and his colleagues have a substantially underspent budget for kidney transplants. Spending the money that is provided is the permanent solution for many of these patients.

Mr. Davis

If the hon. Lady had not intervened I would have referred to the £250,000, for which she can take no credit, because she played no part in its allocation. It came as a result of an all-party delegation of five Conservative and five Labour Members from Birmingham, who went to see the Secretary of State for Social Services. The right hon. Gentleman saw us and said that he was impressed by the strength of our arguments. He spoke to the Minister for Health, not the hon. Lady, and the Minister found the £250,000. But where did he find it? It was not new money for the region; it came from the special allocation to reduce waiting lists. What the Minister for Health and Sir James Ackers did was to rob Peter to pay Paul. They took money that was to be used for other people's operations — in many cases life-saving operations — to get out of the heat of the kidney patients' problem. It was not new money, and I would have more respect for the hon. Lady and for the Minister for Health if they had come up with £250,000 of new money as the all-party delegation had expected when we went to see the Secretary of State.

Mrs. Currie

It was new money.

Mr. Davis

We all know the hon. Lady in Birmingham. I shall not waste time giving way.

What will happen after next April? What will happen to the people who will need renal dialysis after next April? The kidney patients have asked, "What will happen after Easter?"

Every hon. Member who represents a Birmingham constituency also has constituents waiting for radiotherapy treatment. Every hon. Member understands that radiotherapy is given to people who have cancer— usually terminal cancer. We have constituents who cannot have that treatment, and they have been told by the doctor that the beds have been closed. That is not an allegation from a Socialist or a member of the Labour party. That is what doctors are telling our constituents. Some 27 out of 68 beds in the radiotherapy department at the Queen Elizabeth hospital have been closed this year. We have it on the authority of the chairman of the division for radiotherapy that patients have died as a result.

The acute hospitals in Birmingham have only been kept going at the expense of other parts of the Health Service, especially community services. The chairman of the regional health authority has publicly admitted that community-based services for the mentally handicapped and mentally ill have been casualties of this funding crisis in Birmingham, but it does not end there. We are all aware of the pain, suffering and misery that is caused by elderly people having to wait for chiropody treatment.

Matters have now become so bad in Birmingham that in some parts there is a waiting list for aids for incontinence. In 1987, this is the level to which the community-based services have been reduced — that people are put on a waiting list for aids for incontinence.

No one is claiming that the Government are not putting more money into the Health Service. The Minister does not understand the argument, even though in parts of his speech he answered it. Nobody in Birmingham — Members of Parliament, community health councils or the members of district health authorities—denies that there is more money going into the Health Service in Birmingham.

Mrs. Currie

Oh!

Mr. Davis

The facts speak for themselves, but if the hon. Lady can restrain herself I shall return to her in a moment.

More money is going into the Health Service, but the point is that it is not enough. The chairman of the regional health authority has said that the demand for acute hospital services continues to expand at a faster rate than the increase in provision of resources. The Minister for Health himself said that the Government must increase the amount of money that they give to the Health Service every year, just to keep pace with demographic change. There are more elderly people and the demand and need are greater, so unless provision is increased to cover that, the service is not even standing still.

Mr. Newton

rose—

Mr. Davis

If the Minister will wait a moment I shall give him the figures for Birmingham, which are taken from the Official Report, so he cannot deny them.

We must consider the effects of new techniques and of being able to treat people who could not be treated before. The budget for the Health Service must be increased nationally by 2 per cent, every year in real terms. What is happening in Birmingham is clear from the Department's figures. The Minister's comments are in the Official Report. She told us that in the three years from 1982–83 to 1985–86 — I am not going back to the Labour Government; I am referring to this Government's tenure of office — which is a reasonable period, more money had gone into the Birmingham Health Service. That is true, but the increase over those three years was only 2.9 per cent in real terms. Those are her figures. However, 2 per cent a year for three years means that the increase should have been 6.1 per cent. On the Minister's own figures, the shortfall in Birmingham, let alone the west midlands, is 3.2 per cent, which is more than £8 million. The Government cannot deny the figures. That is a real cut in resources as a result of demographic change and new techniques.

On top of that, money has not been provided for nurses' wages. In my experience, the nurses bitterly resent the way in which Ministers take credit for the increase in nurses' wages, when the fact is that the Government have failed, neglected and refused to provide the money to pay such extra wages. They have left it to the health authorities to fund increased wages at the expense of patient care, and the nurses know it. That is robbing Peter to pay Paul, too. That is the truth. That is why the chairman of the regional health authority — the Government's own chairman; their political appointee — Sir James Ackers, said that the crisis in the west midlands is largely the result of the Government underfunding pay increases for nurses and other staff.

The five community health councils in Birmingham have calculated that the extent of that underfunding because of technological change, demographic change and pay awards, from 1982–83 to 1986–87, totals £17 million. Is it surprising that each district health authority is having to choose which beds and wards to close, to say which patients cannot be treated, and which doctors must be told that they will be dismissed if they treat another patient? That is the situation in Birmingham at the moment.

Referring to the level of health services in Birmingham a year ago, the community health councils have calculated that they need £10 million. That is not going back to the Labour Government — it is not even going back five years—it is going back to last year. We need £10 million new money, not £10 million taken from some other part of an already poorly funded Health Service. We need £10 million just to take the Health Service back to where it was before the general election.

Ministers must take responsibility for that. When we see Ministers, they send us to the regional health authority. When we see the chairman of the regional health authority, he sends us to the district health authority. When we see the chairman of the district health authority, he sends us back to the regional health authority. In fact, the buck stops with the Minister for Health because there are only two alternatives: either not enough money is being given to the Health Service, or the people who are running it are spending it badly. It is either underfunding or it is overspending — one or the other. If it is overspending, the Minister should sack the chairman of the regional health authority, and the chairman of the regional health authority should sack the members of the district health authority. That has not happened because the chairman of the regional health authority knows that he is not giving enough money to the districts and the Minister has not sacked the chairman of the regional health authority — instead he has given him a knighthood—because the Minister knows that he is not giving enough money to the regional health authority. That is the truth of the matter. The Government will not provide the money.

In the Government's scale of priorities, tax cuts come before the National Health Service. I have yet to meet anybody—Labour or Conservative—who will put a tax cut before an increase in funds for the National Health Service. That is the charge that we make to the Government — not that they have not given more money, but that they have not given enough money. They have not given the Health Service as much money as the people want them to give. If that means that they have not taxed the people of this country enough, so be it; the logic is there.

People in my constituency and in Birmingham believe that the Health Service is in a state of collapse. It is the Minister's responsibility.

5.43 pm

Sir Barney Hayhoe (Brentford and Isleworth)

I think that all hon. Members will share my regret that illness has prevented the Secretary of State from being here this afternoon. One wishes him a speedy recovery. I congratulate my hon. Friend the Minister for Health, who has stepped into what must be one of the busiest weeks that the Secretary of State would have dealt with — including Question Time on Tuesday, a major statement introducing a White Paper yesterday, and the first major speech on health in this new Parliament.

My hon. Friend presented the Government's case today with great skill, as he did yesterday when he introduced the White Paper promoting better health. As someone who had a personal involvement in the early preparatory work, I thought that the Department of Health and Social Security content of the White Paper was extraordinarily good. What worried me was what one might describe as the Treasury inserts. The DHSS contribution placed greater emphasis on prevention which I hope all hon. Members will support, the opportunity for wider patient choice, a service that will be more responsive to patients' needs — in the past, one has sometimes thought that patients were to suit the convenience of the professionals; that is not a proper way in which to examine the matter — or to seek better value from the substantial sums of money that we spend on primary health care.

Mrs. Julia Cumberlege's suggestions for community nursing and the way in which the Government have taken note of them deserve congratulations and support, as does the work that has been started in inner cities and remote rural regions.

I hope I speak with some authority—although with no knowledge of the detail of what is going on—as a former Treasury Minister and former Minister for Health when I say that I suspect that the Treasury input involved the new charges that were imposed. I refer to the abolition of free sight testing and free dental examinations. All those concerned deserve no congratulations for their political ineptness in including those two items in what otherwise was a constructive, imaginative and useful input which, at the end of the day, will lead to an improvement in primary care services.

That lack of political judgment leads me to a more general comment about politics. The exchanges that took place during the first part of the Minister's speech underline and emphasise the point that there is too much politics of the yah booing kind in respect of health. All hon. Members have a considerable, detailed and sincere interest in health, and they wish to express it. In some ways, the subject is too important to be involved in the highly party political exchanges that often occur. Although such exchanges are inevitable at election time, such an attitude at the beginning of a new Parliament, when a general election is remote from us, is inappropriate and, perhaps, damaging to the interests that all of us hold as important.

Trading selective statistics and the carefully drafted assertions that are made by civil servants or advisers to Opposition spokesmen — perhaps they are inevitable in such a debate—hardly carry forward patients' interests, which should absorb our attention. For example, it is absurd to accuse the Government of cutting the Health Service. Such accusations are made from all angles at all times. The hon. Members for Livingston (Mr. Cook) and for Birmingham, Hodge Hill (Mr. Davis) did not attempt to deny that more resources are going into the Health Service. The increase of 31 per cent, in real terms, based on the Treasury's GDP deflator, cannot be denied. That increase must be contrasted with the 14 per cent, increase in real terms, again using the same GDP deflator, for public expenditure generally during the lifetime of the Government. There can be no doubt that the Government have given the Health Service priority over other expenditure items.

However, that 31 per cent, real terms increase, which is very substantial in comparison with other programmes, needs to be looked at more carefully. It contains within it the 43 per cent, increase in the family practitioner services set out in the White Paper yesterday. Spending on those services amounts to about a quarter of the total expenditure on the National Health Service. Therefore, the increase relating to the hospital and community health services has not been 31 per cent., but about 26 or 27 per cent.

The fastest growth since the Conservative Government took over in 1979 occurred in the first few years, particularly in 1980–81, as a result of the Clegg pay awards. I shall not enter the earlier exchange about the relative position of the nurses, except to underline the incontrovertible point that their relative and absolute positions declined under the Labour Government. As we all know, that was part of the reason for the "winter of discontent". That Government's pay policy was imposed strongly on the public services, while elsewhere in the economy increases were proceeding at a much faster rate.

The time of reckoning had to come; it was inevitable. That was the reason for the Clegg pay awards. However, it has meant that, of the 26 or 27 per cent, real terms increase available to the hospital and community health services, a sizeable chunk — probably a third — was occupied in putting nurses' pay reasonably back into line at the beginning of the Conservative Administration.

Real terms figures are useful when comparing different Ministries and ministerial programmes. The Treasury has to involve itself in such calculations and balancing acts. However, real terms figures do not take full account of the relative movements of pay and prices within the NHS. In volume terms, taking account of NHS pay and prices, there has been a very small increase in current expenditure on the hospital and community health services. The volume increase in capital expenditure has been much more significant, and is the basis of the expanded capital building programme which has been gathering pace in recent years.

We must consider the claims of demography. An increase of 1 per cent, in effective services is needed—not necessarily in money terms — to deal with the increasing number of older people. We need about another 0.5 per cent, to deal with medical advance, and a further 0.5 per cent, for medical priorities. That is the basis of the 2 per cent, increase in services, the source being a letter that I wrote, following Nick Bosanquet's report, at the beginning of 1986.

In volume terms, no money has recently been available for the hospital and community health services to take account of demography, medical advance and increases in services; these have had to come out of cost-improvement programmes. But there is another way of looking at it. In the budgets agreed with the Treasury earlier in the year, or in the year before, there is an allowance for demography, medical advance and so forth. However, insufficient money has been made available for pay awards, and that insufficiency has largely had to come out of the cost-improvement programme. I do not consider that that is the right way to motivate staff. It is bad for their morale if they see little or none of the cost-improvement money going towards improving patient care in a tangible fashion that they can understand.

I have been talking in overall terms. However, my constituency, like the Minister's, is within the Thames regions, in London and the south-east. We have been RAWPed, experiencing a decline in available resources, while other more fortunate regions such as East Anglia and the north—to which my hon. Friend the Minister referred—have done rather better as a result of RAWP. The volume reductions in the Thames regions during recent years have led to cuts in services in many districts, despite vigorous and effective cost-improvement savings achieved by their district health authorities. Sensible competitive tendering arrangements, for instance, have led to a more effective use of the available resources, which have not been wasted in ways remote from patient care.

Another problem, particularly in the south-east, has been insensitive sub-regional RAWPing. The language is involved and technical, but it translates into real human problems, and sometimes human tragedies. Those at the giving end of sub-regional RAWP in the Thames regions give up some share of their limited resources to other districts in their region despite the fact that their region is receiving less than the average share across the country.

The main reason for the present difficulty is the cumulative underprovision for pay increases over many years. The Government must re-examine their public-sector pay policy, particularly its application to the National Health Service. The establishment of the pay review body was an advance and an achievement. It has benefited nurses and the professions allied to medicine, and has contributed towards useful change within these professions. However, the pay review bodies work on an annual basis while the world outside is now increasingly involved in two-year and three-year pay deals.

The Government should ask the pay review bodies to look beyond an annual award or recommendation, and to do so over a longer period of at least two or three years. It will then be possible for the Treasury to know much more clearly what the pay increase position will be in future years and, in the discussions during the public expenditure round, proper account can be taken to ensure that the funds are there to meet the agreed increment.

As I said earlier, at the heart of the problems facing the districts in trying to live within their budgets is the cumulative underfunding of pay awards, over which the districts have no control. Thankfully, this year — the reason is probably not entirely disconnected from the general election—the funding of the awards was more prompt and nearer complete than in past years. If I know Treasury logic, it will do its damnedest in the coming year to avoid making good any underfunding that may result from the pay awards that come through in the months ahead. If that happens on top of the already acute position, we shall be in great difficulty.

I recommend longer-term deals that could help improve career structures, particularly for nurses who, as they look to the future, are now seeing ever more uncertainty and, as a result, many are leaving the profession. I am delighted that work is going ahead on what has been called "achieving a proper balance" for hospital doctors and consultants. Better relationships between junior doctors and consultants will be achieved over time and that will make the career prospects for junior doctors more attractive and, I hope, improve recruitment.

We need to improve the career structure for nurses. Although I am talking about nurses, there are similar problems for others in the NHS. We are now failing to recruit and retain sufficient nurses for the proper operation of the NHS. It is true that the pay increases for nurses during the lifetime of this Administration have been over 30 per cent., but that is now clearly insufficient to recruit and retain nurses. In all the discussions in which I have been involved relating to public service pay, the magic words have been "recruit and retain". We are not doing that for nurses. Therefore, urgent action is required.

Wastage from the nursing profession is still occurring at an alarming rate. I do not know what the precise figure is for nurses in training, but I was told recently that it was approaching 50 per cent. That is a tremendous drop-out rate. We know that about 10 per cent, of nurses retire voluntarily each year and, therefore, there is a great haemorrhage of trained man and womanpower from the service. Something needs to be done about it.

The shortage of nurses and money is affecting services to patients. The general morale within the professions is certainly not increasing as a result. In fact, in many areas, it is declining. In my district, emergency action is being taken by the district health authority to reduce the potential overspend this year. However, apart from that, my local hospital, the West Middlesex University hospital, is functioning with severe restraints, partly flowing from its lack of funds and partly from an inability to recruit sufficient nurses. Two geriatric wards have been closed as have one medical ward, one surgical ward, and half a gynaecological ward. We are 90 to 140 nurses short and there is too great a reliance on agency nurses, who are costly and not as effective on the wards. The hospital's intensive care unit of five beds is often partially closed. Yet when there was the ghastly crash on the M4 recently the West Middlesex University hospital provided the most superb, dedicated service to the many casualties transferred and taken to it.

The shortage of nurses means that the nation's expensive investment in high-tech equipment and highly skilled, experienced doctors, some of them at the top of their class in the world, is not being used effectively. That is a terrible waste of resources. The waiting lists and, more important, the waiting times—it matters not where one is on the list, but how long one has to wait—in many areas are getting longer.

I urge the Minister and, through him, the Chancellor of the Exchequer and the Chief Secretary to the Treasury—they ought to be here listening to the debate—to take urgent action. Special measures are required, particularly in London and the south-east, but also in some of the other large cities where nurse shortages and other problems are causing acute difficulties for the whole service.

Perhaps we should increase the London allowance and improve child care facilities and attempt to attract more people back to the Health Service after a career break. There are all sorts of things of that kind that must be looked at more urgently. One cannot avoid recommending another look at the expenditure plans for the NHS for 1988–89 and beyond. The Chancellor of the Exchequer will be making his Budget statement from the Dispatch Box in about four months. If he included a short passage saying that after careful consideration with his colleagues he had decided that it would be right to forgo a possible tax cut in order to provide more money for the NHS, he would be cheered warmly from both sides of the House.

The Government can be rightly proud of their NHS record as far as it goes. There are more doctors and nurses treating more patients more effectively than ever before. The Government can be proud of their record on hospital building. If I may make a local plug, I hope that there will be no delay in the approval of phase one of the new West Middlesex hospital. Improved management has meant reduced waste and increased cost-effective use of resources.

However, much more remains to be done, as the report of the National Audit Office on the use of operating theatres has shown. There is great scope for improved management of the resources, but the problems will be eased if more money is made available and that is my message to Treasury Ministers. As my hon. Friend the Minister for Health knows, relatively small sums of money—small in the context of all our public expenditure and even in the context of the £20 billion we spend on the NHS — will bring substantial rewards in improved effectiveness, higher morale and increased patient care. That is something which all of us would support.

Several Hon. Members

rose—

Mr. Deputy Speaker (Mr. Harold Walker)

Order. Nearly 40 right hon. and hon. Members wish to take part in the debate. Unless speeches are much shorter many of them will be disappointed.

6.7 pm

Mr. Ronnie Fearn (Southport)

In my opinion, the NHS, although not yet 40 years old, is heading for the scrap heap in favour of a new model bought on the free market. It is obvious by their actions that the Government have a vision in which the NHS is treated as just another force in the free market system, where health care is bought and sold like any other commodity. They can deny that as much as they like and employ all the arts of creative accounting in claiming that the NHS is "safe in their hands". However, the public are no longer fooled. The people's perception is at the grass roots. The evidena; is plain. They know that the NHS is being squeezed by cash limits. The public bear the brunt when hospitals are closed and the Government escape.

As Liberals, we believe in the interchange of services and cash between districts to make more effective use of the resources, which in some areas are not used to capacity. However, we do not believe that the NHS should be left to the unbridled forces of the free market which is where the actions of the Government appear to be leading it.

Our hospitals are in crisis and the Government must share the guilt for the consequences of ward and bed closures. It is commonly agreed that the NHS hospital service still needs about 2 per cent, real growth per year after meeting the cost of NHS prices. The Government have not funded the full cost of the pay awards, forcing health authorities to meet part of the cost from their growth money. They have called endlessly for efficiency savings, now known by the new in-phrase of "cost improvements", or, in plain man's language, cuts. Even when the Government respond to genuine needs such as the recent initiative to reduce waiting lists—a measure the Government shouted from the roof tops—there is not an injection of new cash but it is paid for merely by a reduction in the growth money intended for hospitals. The recent, well-advertised £250,000 that was made available to the renal department at the Queen Elizabeth hospital was not new cash, but was taken from money that had been earmarked to reduce waiting lists in 1988–89. In other words, the Government were giving with one hand, but taking with the other.

Mrs. Currie

Anybody would think that the only renal unit in the west midlands was at Queen Elizabeth hospital, but that is not true. Half of the additional money went to East Birmingham hospital. A new unit at Wolverhampton was opened earlier this year and over £600,000 extra has been given to renal dialysis this year as part of the considerable development that is taking place in that treatment in the west midlands.

Mr. Denis Howell

The hon. Member for Southport (Mr. Fearn) should keep going because he is right.

Mr. Fearn

I agree—I was right.

The RAWP policy to improve the position of the poorer regions is paid for by cuts in the growth money in other regions, with disastrous effects, as was witnessed in the London region. At the time of the publication of the NHS Management Board's report on its review of the RAWP formula, the then Secretary of State said in a press release: I firmly endorse the report's conclusions that allocating to Districts must be based on a realistic and manageable plan for services, not the mechanistic application of financial formula". However, that is exactly what happened in the London region. The system has been applied mechanically. Pressures from lack of funds, the need to find efficiency savings, the lower than expected return from bed cuts and the increase, rather than the expected decrease, in the utilisation of acute services have left London in an unenviable position. To relieve pressure in one area, cash changes hands, but because of constant crisis there is no time to plan and follow up with the interchange of staff and services.

We are all well aware of the crisis in our hospitals, but it has only just begun and things will get worse. Bloomsbury health authority, for instance, is expecting to overspend this year by £11.5 million. It estimates that £6.6 million of that is underfunding of inflation. The total inflation shortfall borne by that region since 1983–84 is about £32 million. However, it does not stop there and the authority is already estimating a shortage of £4.58 million for next year. Bloomsbury's plan of action includes the closure of wards and of accident and emergency units, other reductions in patient services and the freezing of vacancies—in an area that has vacancies of 13 per cent, and encompasses a 50 per cent, staffing deficiency in its pharmaceutical department.

I draw to the Minister's attention the appalling plight of the Cornwall and Isles of Stilly area health authority which, as a result of a likely overspend of £1.2 million, has taken emergency action and closed the Bolitho maternity unit in Penzance and the Falmouth hospital casualty department, and has halted its car service. Ministers in London are unlikely to appreciate that such a service is vital to a rural area such as Cornwall.

Mr. Matthew Taylor

Does my hon. Friend agree that, in a rural area such as that of the Cornwall and the Isles of Stilly health authority, sadly the problems of transporting patients are not reflected at present in the RAWP formula, which does not take sufficient account of rural scatter?

Mr. Fearn

I agree that that service is sadly underestimated, especially in London.

I reiterate the case of the Birmingham community health council. It estimates that it has been underfunded by the Government to the tune of £17 million in the years 1982–83 to 1986–87. Even taking 1986–87 as the year on which calculations are based, it will need a further £10 million in the present year to reinstate the level of service to what it was at the beginning of the current year. It too has a long list of cuts and closures across all services, including the non-removal of asbestos from Highcroft hospital and the degrading position of being able to supply only one bath per week for the elderly in the North health authority. Indeed, there is not a health authority in the country that is not now feeling the pinch. We hear of possible closures of maternity wards as far apart as Penzance and Alnwick, with expectant mothers facing the prospect of travelling between 30 and 50 miles before they can give birth. Cancer units are being closed and bed capacity is being reduced.

We all recognise the plight of kidney patients at Queen Elizabeth hospital and their "right to life" petition — a problem that is repeated across the country. However, what of those patients about whom we do not hear so much? A consultant at the once prestigious Royal Victoria infirmary in Newcastle-upon-Tyne has had to defer operating on a patient with an aortic aneurysm and has sent him home to Berwick where there are no major surgery facilities. That deferral was because four of the beds in use in the intensive care unit are full and the other four beds are closed through lack of staff. If the patient is operated on now, he will have a 90 per cent, chance of survival. As the consultant concerned has pointed out, the NHS has already spent £2,500 on this patient, before surgery. The loss from three or four similar cases would pay for one ICU nurse for one year.

We should also consider the quality of care of the patients who do get a bed. A recent victim of a heart attack, a single working mother, left her own sick bed in a London hospital to feed and tend two elderly and confused patients with whom she shared a ward. She found their constant cries for help stressful and difficult to cope with. She could not do anything to relieve the discomfort when those incontinent patients were left unchanged for eight hours. They had been in the hospital for six months, waiting to be cared for in the community. The hard-worked and dedicated staff were as stressed as the other patient with their inability to administer as their training and will dictated. The same single mother was discharged from her bed, which was immediately filled by another emergency case. The discharged patient had to wait three hours for her medication and then make her own way home. It is no wonder that the acute services in London are being utilised more than was envisaged. I guarantee that much of that increase is from the readmission of patients who do not fully recover because of the throughput pressure and lack of adequate care while in our hospitals.

We read yesterday in the report of the Comptroller and Auditor General that our operating theatres are underutilised by as much as 40 or 50 per cent, due to staffing, communication and information deficiencies. We know that every region is suffering from lack of staff in both the administrative and caring sectors of hospitals but, due to financial difficulties, health authorities are freezing vacancies.

Hospitals are faced with two problems. First, they cannot attract staff because of low pay, low morale and poor conditions, which will be made even worse by the threat to link the clinical grading structure to special payments. Secondly, even if they could attract staff, they would not be able to pay their salaries because of the Government's policy of not fully funding pay awards. It is ridiculous that hard-pressed health authorities must pay for agency nursing.

It is obvious to all that the Government do not value the NHS. They treat it as a necessary evil and that atmosphere filters through the entire system. The nursing profession has lost its value and status and can no longer attract the recruits that it requires. The dedication of the current staff is rewarded with more and more pressure. Nurses constantly work under stress and in a crisis. Our junior doctors work long and hard hours, which raises the risk to patients. An average working week for junior doctors is 86 hours and some work for as many as 100 hours.

The Government say that they believe in community care, but they have not provided the funds to ensure that that programme can be carried out. When long-stay hospitals are run down, to be replaced by community care services, there is a transfer of funds from the hospital to the care services. However, hospitals need to maintain a full range of services during the interim period. The Government should have provided bridging funds, on top of development additions.

Social services are already under great pressure. However, as a result of Government cuts, they are finding themselves even more hard-pushed with the consequence that many beds in hospitals are blocked by patients who should be cared for in the community. We must call a halt to this state of affairs. It is time that the Government recognised that the savings from cost-improvement schemes have outlived their usefulness. Indeed, 1986–87 was probably the last year when any region could make savings without reducing services.

It is time that the Government withdrew their constraints on pay in the NHS so that the standard of living of the staff no longer fell behind the private sector. They must ensure the supply and training of all staff, particularly nurses, to the best advantage. We must improve our position in the league table of health expenditure as a percentage of gross domestic product. Other countries spend more per head without wrecking their economies. Why not us?

It is time that the Government converted to a full-hearted support of the NHS and committed themselves to a cash increase per year representing 2 per cent, real growth. It is time that they recognised that there is a consensus of public opinion to improve the Health Service. All it requires is the political will to provide a reasonable growth of resources for the NHS within the limits of growth of the national real economy.

With the advance of medical and scientific techniques, public expectations have grown. They are difficult to meet, but we can certainly go a long way to fulfilling those expectations if we have the will to do so. As a nation, we do not have the right to call ourselves prosperous until we can provide a service that ensures the health and welfare of our citizens.

6.21 pm

Mr. Hal Miller (Bromsgrove)

If the hon. Member for Southport (Mr. Fearn) will forgive me, I will not dwell at length on his speech. However, it is difficult to take political will seriously when it comes from the party that many of us remember in the Lib-Lab pact. That pact sustained a Government that cut nurses' pay. Therefore, I do not believe that we will take many lectures from that quarter about what needs to be done.

I congratulate the Minister on making the valid point that we have had some definite successes regarding spending, recruitment and building within the NHS. It is important to get the gripes that have been paraded by Opposition Members in a highly emotional manner — that is all right — into context. The level of under-funding in the west midlands—I shall come to the point made by the hon. Member for Birmingham, Hodge Hill (Mr. Davis) later — is £11 million in the current year. Over the past four years it has totalled £30 million. However, those figures compare with a budget for this year of £1,100 million. For Opposition Members, with their record, to suggest that they would have done better is ludicrous to those of us who were present when they were last in government. We remember what they did to nurses' pay and the hospital building programme. The situation was reached when porters were deciding who was to be admitted to hospital and the dead were left unburied—[Interruption.] Oh yes! We know what their care of the NHS meant and we will not let them forget it.

What is so despicable about the manner in which Opposition Members have paraded their emotional concern is the fact that they have not addressed any of the real issues. It was left to my right hon. Friend the Member for Brentford and Isleworth (Sir B. Hayhoe) to provide some analysis of what is going on in the Health Service and where further consideration must be given. I shall also try to provide such an analysis.

We must recognise the fact that there is a serious decline in the morale of those who work in the NHS. That lack of morale has been communicated to patients and their relatives. It has also manifested itself in some perfectly disgraceful examples of unprofessional conduct by consultants—[HON. MEMBERS: "Come on!"] Yes, I am going to say it—who have been parading their patients on television and splattering cases all over the newspapers. What about patient confidentiality? What about the best interests of the patient?

Mr. Galbraith

Will the hon. Member give way?

Mr. Miller

No, I will not give way. I have plenty to say.

We remember those doctors who, when the limited drugs list came in, put wrappers round the pill boxes and said, "You will not be able to get this under this Government". That was an absolute tissue of lies — [Interruption.] Oh yes! This disgraceful behaviour from people in the medical profession is a manifestation of the low morale that they feel—

Mr. Galbraith

Will the hon. Gentleman give way?

Mr. Miller

No; I am making a fair point.

They feel that they have been driven to such excess lengths, but that has caused great concern to many of their colleagues who have behaved with what they consider to be greater restraint.

We must consider how consultant contracts are held and their responsibilities. I am not shirking from a fundamental re-examination of the NHS. One of the matters that I would like examined is the appointment of consultants. How are their contracts to be held, and how are they to perform their duties to their patients?

I agree with much of the speech of my right hon. Friend the Member for Brentford and Isleworth. I will not elaborate further on under-funding except to point out that, although the Autumn Statement gave the promise of extra resources for the NHS, it has been estimated that my health district will incur a penalty of £400,000. That will be a further pinch on resources in that health district next year as a result of previous under-funding of £300,000.

When our economy is recovering—I am glad to say that the economy of the west midlands is also recovering — it is difficult for people to accept that it is not possible to fund fully pay awards and to meet prices. In the west midlands we are facing great difficulties — again, let it be noted, arising from success — with the capital programme. Because that programme overspent and was over-successful, we are now running into difficulties regarding the burdens on the recurrent programme. I wish that the Government would pay attention to the suggestions put forward by the West Midlands regional health authority for helping to alleviate those capital difficulties, whether by sale or lease back, contract hire or joint venture. They are all short-term, defined objectives designed to reduce running costs. If the Health Service is being told all the time to run itself more efficiently and more commercially, surely the Treasury should permit it to adopt commercial measures to reach those objectives.

Let us consider priorities, a matter that has not been properly considered. Reference has been made to robbing Peter to pay Paul, and there must be a re-examination of priorities within the NHS. How is it that the family practitioner service is not subject to cash limits but acute hospital services are? I cannot tell when I will run under a bus or when I will have a serious disease requiring hospital admission.

I cannot see the basis for the distinction between family practitioners and hospital consultants, except from the experience of the Opposition's National Health Act 1975 and the superior political muscle of the general practitioners. It is time that that was re-examined. In the Autumn Statement, it is significant that proportionately greater funds were given to the family practitioner service than to the acute hospital services. That is what I mean by the need for a fresh look at the priorities within the National Health Service.

I cannot excuse my hon. Friend the Member for Derbyshire, South (Mrs. Currie) for announcing the priority for smears but not providing funds. Attempts to meet those priorities in our health district will be at the expense of mental patients, who were supposed to be helped under the community development programme. Ministers understandably have priorities but, while it is acceptable that they may wish to change them, time has to be allowed for those changes to take effect. Ministers have to give consideration to funding new commitments. Could we not have had a clearer decision from the Department about the validity of DHSS payments to patients in homes? In my own district, there is an unexpected additional cost burden of £150,000 per year.

Many people feel that they are unable to influence decisions made by the NHS and that those decisions are made solely by the medical profession. It could almost be described as a restrictive practice. For example, there is now a proposal to appoint three extra consultants when we cannot even afford the ones that we have. How are we supposed to finance three additional consultants? Of course, that proposal was made by the Royal College of Surgeons. I will not absolve the Minister, because that was also partly in response to the Government's proposal to provide better promotional prospects for junior doctors. Again, the proposal was not funded.

Mrs. Currie

It was.

Mr. Miller

Those funds have not yet percolated through to the Bromsgrove and Redditch health district.

One should not overlook the opening of the new Alexandra hospital at a cost of some £27 million. It has treated 4,000 more in-patients and 8,000 more outpatients. It has a striking record, for which tribute should be paid to all concerned. However, it has sucked funds out of the rest of the health district. Hilltop hospital is to close. We are to lose our casualty service even though specific assurances were given by Ministers that it would be retained and additional funds provided for its maintenance. Those funds have been sucked into the new general hospital without regard to the efficacy and the level at which casualty services should be provided, which is why I question the decision-making process. I believe that my hon. Friend the Health Minister has experienced the closure of a cottage hospital in his own health district. Minor casualties can be treated more effectively, quickly and satisfactorily at such a hospital than at a district hospital that is further away and where the patients occupy expensive and valuable time. How are those matters to be properly examined, and how are the people to have an input into decision making?

The record of the Government in the Health Service is one of success. It is at the margin that we are discussing improvements, the reassessment of priorities and the decision-making process. The correct strategy should be to build on the success that the Government have achieved. There is widespread public support, which I share, for additional funding for the NHS, whether by way of tax, charge, insurance or fee. We have to look at additional sources of finance because the Government are concerned to protect and promote the National Health Service, and that is the wish of our constituents.

6.36 pm

Mr. John Hughes (Coventry, North-East)

I am grateful for this opportunity to make my maiden speech and to refer to my predecessor, George Park, who commanded the respect of the Chamber and of his constituents. I seem fated to dog his footsteps as I was elected to the seat that he vacated on Coventry city council when he was elected to the House. A similar sequence of events determined that I follow him to the House. On each occasion I have been proud to follow him, but the last occasion is the most daunting. His industry and commitment have presented me with the most difficult task of emulating his parliamentary record of excellence. He held office from 1974 until 1987 and performed that 13 years of service with good will, which endeared him to all hon. Members. It is a tribute that all hon. Members have requested me to convey their best wishes to him on his retirement.

During those 13 years, tremendous changes have taken place in my constituency and the city of Coventry. Since 1979, 62,000 jobs have been lost. Prestigious car manufacturers have been erased from the industrial scene. The site of the Morris engine factory is now a heap of rubble. Alfred Herbert and Webster Bennett, machine tool manufacturers of world repute, are derelict and boarded up. The car manufacturers such as Triumph, Rover, Climax and Standard—companies that were previously a magnet for Britain's unemployed — are now famous only as collectors' items. That is the sorry state of affairs in my constituency. Unemployment is 28 per cent, in the Foleshill ward.

The unacceptable levels of unemployment, poverty and deprivation mean greater health risks. As winter approaches, those health risks have been compounded because the inhumane privatised gas board has, without compunction, cut off gas to low-income families. In my constituency the standard of health care is alarmingly low and ordinary people's lives are at risk.

Against that background, there are further health cuts and the closure of a further four wards in local hospitals, with the loss of 82 beds. The Coventry local medical committee forecasts that those circumstances could lead to an outbreak of winter illnesses or infectious diseases which doctors and nurses would be unable to cope with. I can add to that the proposed closure of the Coventry Whitley hospital that is located on a prime city site. The hospital was previously scheduled for expansion. It is dear to Coventry citizens and served by the most dedicated staff of doctors and nurses who, with unions across the city and the three Coventry Labour Members of Parliament, are determined that the hospital will not be handed over to a private housing association. They are determined to resist the handover which is solely attributable to under-funding. That under-funding is having a most horrendous effect on the Coventry and west midlands health service.

The most serious health problems will not be solved because a Member of Parliament intervenes, for example, to save a child's life which ironically was put at risk by the cuts that the Minister supported. Cuts have led to the cancellation of 33 child heart surgery operations at the Birmingham Children's hospital during September and October.

Nothing is sacrosanct and the midlands and Coventry are not unique. In my short time in the House I have heard other hon. Members describe mirror circumstances. The same soul-searching problems occur in constituency after constituency. There are hospital closures and huge waiting lists for all kinds of medical care. In every constitutency the blame is attributed to under-funding. Doctors and nurses the length and breadth of the country are speaking out and hon. Member after hon. Member, day after day, is pointing to the under-funding. Thousands of people are waiting for renal treatment, hip operations and prostate gland operations.

Why are the Government not aware of what is happening? They have listened to Members making these points eloquently, logically and passionately. Obviously eloquence and logic have failed to distract the Government from their uncaring policies. They have an Edgar Allan Poe mentality. They relish the pain that their policies inflict and their policies are physically brutal. I have sat in the House and wondered how to break through that callous barrier.

How can we communicate with people who treat the Health Service like a huge supermarket? How can the Government understand the problems of the elderly whose supply of incontinence pads has been halved? How can the Government fail to understand the lives led by elderly people in their homes where they are constrained by low incomes and experience major difficulties coping with problems of incontinency? What was a home with friends becomes a lonely hell when the smell of urine, which is actuely embarrassing, forces the elderly to close their doors to visitors. No economic argument can sustain or validate those circumstances.

An understanding of the problem will not be gained in a private hospital. The problem will not go away because an Under-Secretary of State, cavorting in a track suit in a gymnasium before the television cameras, advises the elderly to take up jogging. The problem will go away only when she gets rid of her track suit and puts on an incontinence pad saturated with urine and sits down for a couple of hours in a cold room in conditions conducive to hypothermia. Perhaps then the message will get through to the parts of the body which other messages fail to reach. I venture to suggest that that is an educational method from which all hon. Members could learn.

I have been in touch with members of Birmingham city council this morning. Because of their concern at the low standard of care in the midlands, they have gone on record calling for the Government to maintain, increase and improve the Health Service in the midlands. They have also expressed their most serious concern for the children waiting for cardiac treatment at the Birmingham Children's hospital. To reach a solution to that problem, they are inviting the Secretary of State for Social Services, the Under-Secretary of State responsible for hospital services and every hon. Member between Stoke-on-Trent and Stratford to attend a meeting in the Birmingham city council chamber. I anticipate that questions will be asked at that meeting which will be posed from other areas of concern. The questions might include, do Members of Parliament accept that kidney consultants should have been told to send persons home to die? Do they accept that 40 per cent, of cancer treatment beds should be cut? Do they accept that 500 patients should wait two years for prostate gland operations?

Finally, I want to refer to a letter from Baron Beaumont, the chairman of the Queen Elizabeth hospital kidney patients association. He poses a question for all midlands Members: As an MP, you represent the patients in the West Midlands who are suffering from this extreme under-funding of the NHS. Please will you let us know exactly what steps you will take to insist that the Government takes urgent steps to improve the situation? I want to put it on record that if I fail to improve the position by the ritualistic debating process of this House, I am physically prepared to make my presence felt in this House.

6.46 pm

Sir Julian Ridsdale (Harwich)

It falls to me to congratulate the hon. Member for Coventry, North-East (Mr. Hughes) on the confident way in which he spoke to the House. I am sure that all hon. Members will look forward to hearing from him again. The Conservative Members who will speak in this debate have something in common with the hon. Member for Coventry, North-East as we face cuts in the hospital services in our constituencies. Indeed, I will refer shortly to the closing of a ward. The hon. Member for Coventry, North-East referred to engineering. As chairman of the all-party engineering development group, I hope that I will recruit the hon. Gentleman.

My hon. Friend the Minister for Health was right to draw the attention of the House to the fact that we are spending considerably more on the Health Service than ever before and to underline the importance of the fact that next year we will find £700 million more to be spent on the hospital services. I stress that the regional health authority in my constituency has been given 5 per cent, more this year and help towards nurses' pay. I want to ensure that my district health authority receives a fair share of that increase, but I am in a dilemma, because I am not satisfied with the administration of my district health authority, and the way in which it chooses its priorities.

It was right for my hon. Friend the Member for Bromsgrove (Mr. Miller) to refer to priorities. If we are not to receive the funds until next year, we must examine the way in which the district authorities administer the districts. I do not believe that we are getting value for money from the way in which my district authority is spending its budget. In that context I want to ask my hon. Friend the Minister about the £6.5 million new hospital in my constituency. I apologise to the House for referring to what may appear to be a constituency interest, but this has caused great feeling in my constituency.

I have always regarded a new hospital on which £6.5 million has been spent as a community hospital. However, the closure of a casualty ward and the recent closure of the children's ward have turned the hospital into one for elderly people. It is no longer a balanced community hospital.

The move led to a public meeting of protest held a few weeks ago and attended by 700 people and to a petition carrying 17,000 signatures. Last week 3,000 people marched through the streets of Clacton in protest. At the public meeting I pledged that I would do my best to ensure that the hospital remained a community hospital and to prevent the closure of the casualty and children's wards. I have received more than 1,000 letters supporting my action and protesting against the health authority's action.

It is difficult to be rational in such circumstances. Most of us take the view that no country can ever have enough money to spend on its health service. However, it is our task as hon. Members to ensure that we get our priorities right and that we get value for money from the enormous sums that we spend on the Health Service, which increase each year as our national wealth increases. The Prime Minister's amendment underlines that.

In our system, the battle for the right priorities is largely between the regional and district health authorities. I realised that in my area of North-East Essex there would be a hard battle between the health authority region and district this year and that the Secretary of State, too, would be involved, especially as there were signs that the region was not passing to the district some of the increases that had been received from the Government.

I arranged a meeting of the district health authorities and local hon. Members, who included the Leader of the House and the Minister for Health. It was agreed at that meeting, which was held in mid-October, that before any action was taken by the authority, consultations would take place with the chairman of the North-East Essex regional health authority and the Secretary of State — especially in view of what the district had told us about the difficulties.

I am sure that the House will understand my concern. Before we had time to begin the consultations, I heard of a notice to close the children's ward in Clacton hospital at once and of plans to take action that would have led to the closing of the casualty department. That led to an early-day motion tabled by the hon. Member for Peckham (Ms. Harman) who did not consult me as the local hon. Member.

The undemocratic and dictatorial attitude of the health authority, which broke the agreement made with me at the meeting in the Lord Privy Seal's rooms, angered me immensely, as I realised what the consequence would be. The results of that action were the public meeting attended by 700 people, the petition carrying 17,000 signatures of local people, the march of 3,000 people last Saturday and the 1,000 letters that I have received. I knew that that would follow the high-handed action of the health authority.

People have regarded the manner in which the closures have been conducted as a sinister move to get round the clear procedures laid down for ward and hospital closures, which call for public consultation followed by the approval of the closure by the Secretary of State. By far the most sinister aspect of the closures of the children's and casualty wards is the unscrupulous way in which the health authority has closed the facilities without giving any notice to patients or staff. Staff returning from holiday found that they had no ward in which to work. They feel that the health authority's action was a blatant attempt to get round processes laid down by law and to present the closures as an accomplished fact. That is why I ask the Minister at least to instruct the health authorities to reopen the closed services immediately so that the consultation procedure can be fully completed. Surely a democratic process is one that can be seen to be a democratic process.

I have received very few letters asking for more money. Those who have written to me have been almost united in their view that the health authorities have got their priorities wrong. General practitioners and other doctors despair because no consultations are taking place. The big issues involved are overcentralisation and the conversion of a £6.5 million community hospital into a hospital for the old.

Is it right that a casualty ward that dealt with 22,118 patients between 1 October 1986 and 30 September 1987 should be closed, so that patients have to be treated at a hospital 18 miles away and face the hazards of winter weather and summer traffic jams? The same applies to patients of the children's ward, except that many parents are not well off and do not have cars. Two years ago the health authority agreed to keep the children's ward as a special case. Why has it changed its view now, when the population of the area has increased?

In 1986 the Clacton casualty ward cost £227,000, which is £106,000 less than the cost of the geriatric ward. In the three or four weeks since the decision was made, the cost to the ambulance service has been £18,000 extra. At a conservative estimate that amounts to about £187,000 a year.

I make this challenge to ensure that we get value for money. At the moment, we do not get value for money because the priorities are wrong. I ask the Minister to order an inquiry into the administration of the North-East Essex health authority. There has been no consultation with doctors. I only wish some of the administrators in the health authorities would talk to some of the very practical general practitioners who have to deal with patients and are in the front line in dealing with problems. The health authority is working a policy of centralisation and shows no understanding of its effects on a district such as Clacton, with a population of 50,000, which becomes 150,000 in the summer.

I am determined to keep the Clacton hospital as a community hospital. I know that it would be easy for me to press the Government for more money. However, we should first examine whether we can get money out of more efficiency in the North-East Essex health authority. We must ensure that we get our priorities right. We must consult the experts and general practitioners more. If we can get the money by savings—I believe that we can— we shall be able to save the community hospital. If not, we shall have to press for other means. I hope that we can achieve our aim by savings.

6.58 pm

Mr. Frank Cook (Stockton, North)

I am in the enviable position of congratulating my hon. Friend the Member for Coventry, North-East (Mr. Hughes) who is just leaving the Chamber to take his repast. I shall do so with relish. My hon. Friend rightly paid tribute to his predecessor Mr. George Park. I had the privilege of having the desk adjoining George Park's desk in the dreaded cloisters for about four years. My hon. Friend rightly expressed pride at following in Mr. Park's footsteps. Having followed the pertinence of my hon. Friend's logic and the confidence of his presentation, I can assure him that in my position Mr. Park would be expressing a similar pride in his performance. We all look forward to further contributions from him.

In answer to my hon. Friend the Member for Sunderland, South (Mr. Mullin), the Minister said that the Northern regional health authority was boasting about its additional resources. I hope that the Under-Secretary is listening carefully, because she may have to qualify that claim.

On Monday I applied for an emergency debate under Standing Order No. 20 on bed closures and the reduction of operating theatre sessions. I was unsuccessful, but, perhaps as a direct result of that attempt, I received a letter from the community health council which said: Last Thursday the District Nursing Officer and the District General Manager announced the closure of 2 elderly care wards,"— this is in a modern hospital— in addition to 44 surgical beds. In the case of the former, we are in a position in North Tees where we have a 25 per cent. reduction in beds available to care for the elderly and in the latter a reduction in surgical beds will inevitably lead to high waiting lists. I should point out that in the case of the waiting lists, orthopaedic and gynaecology are beginning to increase prior to the announcement of the closure of surgical beds. This, unfortunately, is only the beginning of a proposed series of closures and bed reductions. Whilst we may have difficulties in staffing these wards, I have a suspicion that there is a financial connection that needs to be investigated here."' The Minister has already said that he is good at investigations, so we shall see.

The letter goes on: I don't wish to be alarmist, but the situation in North Tees is deteriorating rapidly. We have only one District General Hospital in North Tees, and I am told by Dr. Gibbins, Consultant Physician with special responsibility for the care of the elderly, that his service has been set back 20 years. In 1967 he could make more beds available to patients than he can today. The point to bear in mind here is this, the elderly and their relatives in North Tees are now faced with the prospect of no relief due to sickness or dementia, etc. There will no longer be any emergency admissions or weekend relief, services which are normally made available to the elderly. This is not the ghost of Christmas past, but the actuality of Christmas present. The evidence demonstrating that the Health Service is not safe in the Government's hands is incontrovertible. The House, and indeed the nation, has been subjected to a barrage of culpable misinformation and deliberate inaccuracies on the state of Britain's Health Service.

However, rather than engage in shallow rhetoric about the Government's record on the Health Service, I should prefer to have the facts of the matter examined in detail and placed on the record for the nation to make its own judgment, free from misleading party political propaganda.

I should like hon. Members on both sides of the House to consider the position of North Tees district health authority as an example of an authority which has striven over a number of years to maintain a high level of service to its people.

I should like hon. Members to take particular note of the fact that, although North Tees district health authority is one of the smallest in England and Wales—but by no means the least important—it has proved itself time and again to be most efficient and cost-effective, at least until recent times when the full effects of the Government's hidden agenda for the Health Service forced the authority to reduce its services to patients and thereby directly and, sadly, adversely affect the standards of patient care. The medical, administrative, clerical, paramedical, and, indeed, every other category of staff within North Tees have striven strenuously to follow to the letter and the spirit the principles and practices on which the Health Service was founded. For those with short memories, or, indeed, for those who no longer care, I want to remind the House of those principles and practices.

The Health Service was established in the first instance to ensure that everyone in the country, irrespective of means or age, of sex or occupation, should have equal opportunity to benefit from the best and most up-to-date medical and allied services available. Secondly, the Health Service was created to provide, for all in need, a comprehensive service covering every branch of medical and allied activity, from the care of minor ailments to major medicine and surgery, to include the care of mental as well as physical health, with all specialist services, for example, for tuberculosis, cancer, infectious diseases, for maternity, fracture and orthopaedic treatment, and many others. It was also intended to include all normal general services—for example, the family doctor, midwife and nursing provision, care of teeth and eyes, the day-to-day care of the child, and all necessary drugs and medicines and a wide range of appliances.

Finally, and perhaps most important, the Health Service was created to divorce health care from personal means or other factors irrelevant to health considerations; to provide the service free of charge and to encourage a new attitude to health. Those principles comprise two components, one of which, no doubt, has given rise to the Government's determination not only to undermine the principles to which I have referred but to create an agenda — a grand plan — for the gradual dismantling of the Health Service as we know it.

The first component to which I refer is a medical one. It was the express wish of the founders of the Health Service to take medicine out of the market place and to elevate it to a social service in which the skilled doctor could apply all professional knowledge and expertise to the care of the individual patient and the community without any deference to squalid cost factors or the financial or social standing of the sick person requiring attention.

For the doctor who had any sense of vocation, any true calling, that was liberation—a great freedom, far above all other freedoms to which we might aspire. It was a freedom that places the physician or surgeon, the nurse or auxiliary — indeed, anyone associated with the direct care of patients — in a unique position, exceeded only perhaps by their unique role in matters of life and death.

The second component to which I refer is a political one. That involves placing on a Minister for Health, answerable to Parliament, and, through Parliament, to the people, responsibility for the quantity and quality of services being supplied. It was to be comprehensive and available to all citizens, and so, by implication, adequate in scope and of top quality. It was to provide for the prevention of disease, for the treatment of all diseases, for rehabilitation and for the education of people on health matters. It was to be paid for out of general national income.

The National Health Service Act 1977 embodies the principles and components to which I have referred to the extent that it is the Secretary of State's duty to continue the promotion in England and Wales of a comprehensive Health Service, designed to secure improvement in the physical and mental health of the British people, and in the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with the Act. Moreover, the services so provided shall be free of charge. The remainder of the Act sets out the Secretary of State's duty regarding the nature of the provision of services throughout England and Wales.

However, what is the reality in relation to the principles which should influence the provision of resources for the NHS, the most essential of our social services? Although what I am about to say on the plight of my health authority could be echoed by any hon. Member about their health authorities, I suggest that the position in North Tees is not only a measure of the disastrous effects of the Government's policies on the NHS, but an accurate indicator of the eventual and intended fate of the NHS under the Government.

I say that, because North Tees has always conscientiously and diligently carried out its role and responsibilities in relation to national, local and regional policy, whether in the area of financial management or the delivery of services to the community. Let me cite a few of the authority's valiant efforts to protect and maintain its services, notwithstanding the cumulative devastation visited on it by the Government's policies on health care. Prior to the diktats of successive Conservative Ministers for Health, North Tees tried for many years to make efficiency savings. When cost-improvement programmes were imposed from on high, North Tees had already made effective efforts in that direction. North Tees has saved many millions of pounds by its measures and there is no room for more savings.

The consequences of the district health authority's past efficiency has in some respects been its undoing. Another area in which North Tees district health authority has excelled is in piloting certain schemes on behalf of the Department. North Tees has had a pioneering role in management budgeting. It was one of the four pilot sites in Britain to formulate and implement management budgeting programmes. Its efforts were so successful that it has been used as a model for other districts and regions in England and Wales to aspire to.

Along with 15 other districts in the region, North Tees assisted the regional health authority in piloting performance indicators. Whatever hon. Members may think of performance indicators, North Tees has skilfully utilised the data that has been generated as a means of comparing its performance with that of other districts within its own region and nationally. North Tees was also involved in piloting some earlier elements of the Köner initiative, especially in paramedical data.

North Tees district health authority and its surgeons made valiant efforts for several years to reduce its waiting list and increase its throughput of patients, long before that approach became the flavour of the month with the Government. It did that without extra financial assistance. Paradoxically and ironically, those districts that have been less efficient and have been unable to reduce their waiting lists have received financial help.

Mr. Jerry Hayes (Harlow)

On a point of order, Mr. Deputy Speaker. Is it not very selfish for hon. Members to read long and boring speeches when many hon. Members on both sides of the House wish to speak?

Mr. Deputy Speaker

Order. The hon. Gentleman may refresh his memory from notes. I repeat my earlier plea for brevity. As I have mentioned to the House, nearly 40 right hon. and hon. Members are seeking to catch my eye, and many of them will be disappointed. Long speeches are made only at the expense of the rights of other hon. Members.

Mr. Cook

Thank you, Mr. Deputy Speaker, for the advice that you offered to the House. I would point out that I would have got much further into my speech had the hon. Member for Harlow (Mr. Hayes) not had the effrontery to try to impose his efforts on an Opposition day.

All the achievements to which I referred occurred despite a reduction in the growth of money and despite an indication by the region that North Tees will move steadily away from its resource allocation working party target over the remainder of the strategic planning period.

It should be remembered that the number of operations performed is a direct result of an increase in the number of references made by general practitioners to the specialists in North Tees. Furthermore, the health authority's effort to maintain an even keel financially has been jeopardised by the effect of inflation on prices during the current and forthcoming financial years.

I should like to give the House the figures on that effect. The result of all the efforts and initiatives by the North Tees district health authority has been quite simply that it has worked itself into the ground and into debt, trying to fulfil its obligations to the community it serves. Its shortfunding for pay awards for 1986–87 totalled £.172,000. The 1987–88 review body pay award shortfunding comes to £136,000. The 1987–88 non-review body pay award shortfunding comes to £117,000. Its prices shortfunding totals £100,000. Its development programme is costing £150,000. Its cost-improvement programmes for 1986–87 will total £170,000 and non-recurring commitments total £70,000, which leave the health authority facing a deficit of £575,000 by the end of the financial year.

I fail to understand why Conservative Members find that amusing. It does not need a dinky whizz-kid from the City to appreciate the fact that providing a service in an efficient manner requires appropriate funding. Furthermore, we should all remember that it is the National Health Service — the Health Service of the nation—and not a profit-making business. It requires at least sufficient funding to cover the costs it incurs.

I have a lot more that I could say, but would like to leave you, Mr. Deputy Speaker, with one particular health case, which starts like this: But he, desiring to justify himself, said to Jesus, 'And who is my neighbour?' That is the beginning of the parable of the Good Samaritan. I will not take up the time of the House by reading it all; I will read just the end of it where Jesus said: 'Which of these three, do you think, proved neighbour to the man who fell among the robbers?' He said, 'The one who showed mercy on him.' And Jesus said to him, 'Go and do likewise.' That was 2,000 years ago. We in the post-war Labour party thought that society had advanced since then. Since 1979 we have seen the clock turned back atrociously, but we are ready to put the record right when we return to power.

7.15 pm

Mr. Charles Wardle (Bexhill and Battle)

I listened with care to the hon. Member for Stockton, North (Mr. Cook), and now I feel that I know a great deal more about North Tees than I did not so long ago.

I am grateful for the opportunity to take part in the debate, because this is the first time in four and a half years that I have had the chance to speak in the House on the National Health Service. Having served as a Parliamentary Private Secretary to my right hon. Friend the Secretary of State for Employment when he was responsible for the DHSS in the last Parliament, I listened to countless debates in the manner required of all Parliamentary Private Secretaries, with an almost Trappist bearing. I say "almost" because it is not always possible for even the most assiduous of PPSs to refrain from the occasional sedentary intervention.

I can think of occasions in the last Parliament, when exchanges between my right hon. Friend and the hon. Member for Oldham, West (Mr. Meacher) reached their liveliest, when intervening was a temptation that one could not resist. It is an instructive experience and I am grateful for it. Certainly there was ample scope for learning about the National Health Service and hearing conflicting views. It is an intensely complex subject about which feelings run high. From all the discussions and debates that I heard, my impression was that four unassailable truths, four facts of life, emerged time and again.

The first is that the National Health Service has become a constant political battleground, very much to the detriment of all involved — practitioners and patients alike. The reasons for keeping up the barrage of Left-wing criticism is only partially connected with the current condition of the Health Service.

The second fact of life is that the Government have made remarkable progress over the past eight years in patient care, health standards, medical technology and hospital building. Such progress could not have been contemplated in the late 1970s under the Labour Government.

Thirdly, in spite of all that progress, and notwithstanding yesterday's welcome statement, a great deal remains to be done if the vast NHS organisation is to work cohesively and effectively for the benefit of all its patients. Challenges still exist in long waiting lists and the demand for new equipment and greater numbers of skilled staff. Of course, there is still inexorable pressure on health authority budgets.

The fourth fact of life is that the solution to the financial challenges that remain cannot be solved by efficiency initiatives alone, although yesterday's announcement of so many enterprising new measures will undoubtedly help. Nor is it likely that the problems will be solved simply by increasing the funding assumption made by the Treasury of the inflationary cost plus an additional margin. Above all, they will never be solved by the economics advocated in the last Parliament by the hon. Member for Oldham, West.

I recall that in one week the hon. Gentleman boasted that he would see additional funds of £500 million put into the Health Service and virtually in the same breath he said that he would abolish pay beds and prescription charges and would bring in a minimum wage in the National Health Service. In other words, in that same week, virtually in the same breath, he had spent the £500 million or more. So much for Labour economics for the National Health Service.

The subject is a battleground. I suspect that the reason is that Socialists recognise that the realities of responsible government, when they had their opportunity, have clashed with their idealised notions—

Mr. John Battle (Leeds, West)

rose—

Mr. Wardle

No, I will not give way. The hon. Gentleman will have an opportunity to speak.

The Labour party's idealised image of the Health Service has clashed with the reality of responsible government. It was a landmark achievement by the Attlee Government to create the Health Service, but that same Government had to introduce charges. The Wilson Government promised to abolish prescription charges, did so, and then had to do a humiliating U-turn. Under the 1974–79 Labour Government we saw an axed hospital programme, the pay of nurses falling behind inflation and waiting lists going up. They could not even manage the economy to provide the resources that were so necessary. By contrast, this Government have a formidable record of achievement. The sum of £21 billion is being spent on the National Health Service—

Mr. Battle

rose—

Mr. Wardle

I had hoped that by now the hon. Gentleman would have taken the hint that I have no intention of giving way. He will have his opportunity if he lets me get on.

Let me continue with the Government's record. It is one of cuts in administration, more being spent on patient care, competitive tendering producing £100 million of savings, the bold initiative of the selective list of drugs, nurses' pay up by 30 per cent, in real terms, more nurses, more midwives, more doctors, more dentists, 200 major hospital building projects begun and completed by the Government, 6 million more patients—day-care patients, in-patients and out-patients — than eight years ago, an initiative on general management within the Health Service, and, above all, the sound management—

Mr. Battle

rose—

Mr. Wardle

—of an economy which creates the means by which the Government can afford to care. What the Opposition always choose to forget is that if they do not manage the economy sufficiently well they cannot create the means by which they can afford to care. That is always the missing part of the equation.

Mr. Battle

rose—

Mr. Deputy Speaker

Order. The hon. Member for Bexhill and Battle (Mr. Wardle) has made it clear that he is not prepared to give way. The hon. Member for Leeds, West (Mr. Battle) must not persist.

Mr. Wardle

Thank you, Mr. Deputy Speaker. Lest the hon. Member for Leeds, West (Mr. Battle) has not got the message, let me say that I do not intend to give way to him.

Yesterday's proposals are important, not simply because of the £150 million of savings to be generated in the current year, but because of the spirit of enterprise and competition that will be encouraged within the medical world. Hospitals will be able to subcontract more of their facilities and deal more with the private medical sector. Where does the pressure on finance come from? It comes from more new medical technology and ever higher standards of treatment, with more and more general practitioners referring more and more patients for cataract operations, hip replacements and so on.

However, there is no escaping the fact that district health authorities are underfunded. There are problems because of the RAWP formula in South West Thames. [Interruption.]Yes, I acknowledged it earlier and I repeat it. A classic example is the Eastbourne district health authority. [Interruption.] The Opposition may laugh, but there has been a 30 per cent, increase in population in Eastbourne, with an above average increase among the over-85s. Yet Eastbourne remains at the bottom of the RAWP league table in South West Thames.

Sir Geoffrey Johnson Smith (Wealden)

Does that not indicate that there is something wrong with the RAWP system?

Mr. Wardle

Yes. I have long said that there is something wrong with the RAWP system. If my hon. Friend will wait for a moment, he will hear my recommendations on that.

Radical changes are required in the Health Service. They go beyond the call by my right hon. Friend the Member for Brentford and Isleworth (Sir B. Hayhoe) for increased funding from the Treasury. I hope that my hon. Friends on the Treasury Bench will consider carefully further innovations in the economic framework in which the Health Service operates and also an increase in the freedom of health authority managers to manage.

Because of the constraints upon time, I shall list just a few examples. I hope that my hon. Friends will establish the freedom beyond all dispute of health authorities to go outside their geographical areas for patients and to compete to fill odd corners of their capacity, thereby taking the pressure off waiting lists elsewhere. I hope that health authorities will be able to build up their own units of specialised excellence and sell them beyond their boundaries. I hope that they will be able to subcontract yet more work to private hospitals when it is effective to do so and when it will reduce waiting lists. I hope that small community hospitals will be considered for joint ventures with the private medical sector. When a community hospital is faced with closure — perhaps when a new district general hospital is coming on stream—and the option to keep it open is at the expense of other priorities, why not consider the possibility of forming a charitable trust, possibly with the local League of Friends, and sharing services between the NHS and private medicine? The NHS might perhaps deal with geriatric beds, GP beds and out-patients, and the private sector with surgery.

Of fundamental importance, however, is my hope that my right hon. and hon. Friends on the Treasury Bench will persuade the Chancellor of the Exchequer in the coming months to give tax relief on health insurance, thereby moving more patients willingly into the private sector. That would leave intact the vital principle of the Health Service, which is the provision of free health care for everyone who needs it.

I also hope that my hon. Friends will bear management freedom in mind. It would be no bad thing if they and DHSS officials could persuade themselves to stand back from the NHS supervisory and management boards, set clear objectives and then allow first-class managers to manage. Perhaps one day they will consider abolishing regional health authorities and having fewer, larger health authorities. Perhaps in the course of their management review they will consider introducing serious five-year contracts for consultants, with a review after four years, and a one-year roll-over basis. I notice that the hon. Member for Kirkcaldy (Dr. Moonie), who is a member of the medical profession, is nodding agreement with that idea.

I hope that my hon. Friends will grasp the nettle and consider forming a separate health authority for the London teaching hospitals, so that the accounting of those hospitals can be examined in a straightforward fashion. If they feel sufficiently radical at some stage, they might even contemplate privatising one of the teaching hospitals so that it can be funded in the way in which some outstanding hospitals in the United States are funded. That would be no bad thing, either.

Those are just a few of the remedies that I hope my hon. Friends will consider and pursue in the course of time, in spite of the political excitement to which some of the remedies will give rise. The Government's record in health care is excellent. They have won many battles on behalf of the National Health Service. If they are to win the war, they will have to be still more radical, so that progress can continue on an accelerated basis.

7.29 pm

Mr. Sam Galbraith (Strathkelvin and Bearsden)

I was rather surprised by the speech of the hon. Member for Bexhill and Battle (Mr. Wardle). He started by saying that he did not like the Health Service being a political football, and then went on to make a superficial, fractious and highly political speech. One reason why the Health Service is a political issue is that when the Labour Government tried to introduce it in 1945 it was bitterly opposed by Conservative Members.

Mr. Ray Whitney (Wycombe)

That is not true.

Mr. Galbraith

I do not pretend to have all the answers to the problems of the Health Service. Indeed, I agree with the Minister's remarks about the difficulties that it faces. There are priorities to be assessed, and if spending was open-ended there would be no limit to the demand. I agree with all of that. However, we must try to decide how best to achieve those priorities. We believe that the National Health Service is the best way of deciding and funding them, and that is why we are here to defend it today.

Most of us use the National Health Service constantly, which is why we speak with some generosity of spirit and sincerity. I hope that Conservative Members will accept that that is so. We have heard great claims from the Government about how much more funding is going into the Health Service, but we must be careful about their figures. We should try to relate funding to the real world. We must test our own experiences and adopt an empirical approach.

If one asks people throughout the country, one finds that they agree that the National Health Service has deteriorated significantly since 1979. In my area, hospitals and beds have been closed and patients have come for operations and been turned away. Why are we so surprised about the recent case when such things go on every week? Only last weekend a consultant colleague of mine told me that, on average, he turns away five cases a week. My own hospital is only 10 years old, yet the linoleum is held down with Elastoplast. When I was looking for another important piece of equipment, I could obtain the money for it only from charity. But the National Health Service was set up so that we would not have to rely on charity for care.

How do these experiences equate with the Government's claims and figures? Why do they tell us that everything is improving when the rest of us know that everything is going downhill? It is what is known as the electric brae phenomenon — as my hon. Friend the Member for Cunninghame, North (Mr. Wilson) knows; the electric brae is in his constituency. It is no good merely looking blandly at the figures and the increases — they must be corrected in several ways. The way to correct National Health Service figures is by means of the deflator of NHS pay and prices, not by using any other deflator. Once the figures are corrected in that way, the increase for 1981 was 1 per cent.; for 1981–82, 3.2 per cent.; for 1982–83, 1.4 per cent.; for 1983–84, 0.7 per cent.; and the percentages for the succeeding years were 1.3,0.1, 1.2 and 0.4. According to that deflator, it is projected that the next two years will show a decrease of 2 to 3 per cent. That explains the problem. The use of the correct deflator shows that the increase over the past years has been running at about, if not just under, 1 per cent.

I am sure that the Minister will admit that 1 per cent, is needed merely to cope with demographic changes— people are getting older, and so on. It is true that we can now treat more elderly people, and it costs 10 times more to treat someone over the age of 65 than someone under that age. So we need that 1 per cent, just to stand still. We need another 1 per cent, for the increase in technology about which all hon. Members have spoken. I used to do an operation that one could do with a simple glass suction apparatus. It cost very little. Along came a thing called the ultrasonic scalpel. It cost £60,000, and every time I use it, it costs £500. I am not doing anything more — I am doing the same thing, but because of the increased technology it costs much more to perform.

Another increase is necessary for new development. We can sometimes find money for new developments such as the treatment for AIDS or heart transplants, as long as they are high profile activities, although the money generally comes from other parts of the Health Service. However, many other new developments are never carried out because they do not have a high profile, so we do not spend enough on them. Take, for example, the rehabilitation service in the west of Scotland, an area that looks after 2.7 million people, and that has no rehabilitation unit. One has been on the cards for four or five years, but the prospect of obtaining money for it is nil. As a result, people leave the unit in which I used to work after extensive operations without rehabilitation — so their recovery is delayed, if not permanently impaired.

People do not die as a result of the things that I am discussing, but there is no question but that the quality and length of their lives is severely affected. One might say that I am being partisan and I can accept that criticism.

Two important things that were a great surprise to me happened in this decade and they should make us wonder if what I am saying is correct. The first concerns the British Medical Association. As we know, the BMA is not a hotbed of militant Marxism. It has a record of rolling over every time the Government speak to it. The hon. Member for Stirling (Mr. Forsyth) does not remember the 1970s and the behaviour of the British Medical Association at that time. This decade the BMA found it necessary to go to the Government and tell them that the Health Service was inadequate and that it required more funding. That was from a body that used to to give unequivocal support to this Government.

Most hon. Members know that the General Medical Council is the body that disciplines doctors, but it has other roles. It has an important role in overseeing and determining standards in medical education. When I went to a council meeting last year, much to my surprise I saw a minute from the education committee. The heading on it said: The standards of and resources for medical education". The minute read: the Committee reported to the Council its serious concern at reports from medical schools that reductions in funding of universities and financial constraints within the National Health Service are endangering standards of medical education. The Committee proposed to draw its concern to the attention of the Department of Education and Science, the Department of Health and Social Security … That is unheard of for the General Medical Council, which is an apolitical body.

Mr. Whitney

Is the hon. Gentleman telling the House that the British Medical Association did not have disputes with Aneurin Bevan, Richard Crossman, Barbara Castle and Lord Ennals, as he now is?

Mr. Galbraith

It most certainly did, but it was always over pay and the fact that it was not enough. Some hon. Members will remember the disputes that it had with Harold Wilson when he cut the review body recommendation. Apart from last year, this Government have cut that recommendation every year since they came to power in 1979.

I know that many hon. Members wish to speak, so I shall not continue for much longer. I had hoped to talk about the way forward because there is no point in just pointing out what has been wrong. It is important that we put forward ideas on how to improve the Health Service, its efficiency, its delivery and its care. We also need ideas on how we can use our operating theatres to better advantage, and that was highlighted in the Comptroller and Auditor General's report. We also need ideas on how to increase throughput and cut waiting lists. I shall return on another occasion to these matters because I intend to be an MP for a long time.

Any improvement in efficiency and in the delivery of care will require extra resources. Money is not the only thing that is required in the Health Service, but it is a necessary condition. Although current funding has been increased under the Government, the increase has barely been enough to cope with the demographic changes, and certainly not enough to cope with new technology and further developments. I urge the Government to look again at the funding of the Health Service and significantly to increase it in future years.

7.38 pm

Dame Jill Knight (Birmingham, Edgbaston)

The Opposition seek to paint a picture of the Government that would make Scrooge look like Father Christmas. They accuse the Government of hard-heartedness and meanness and of wanting to get rid of the National Health Service. Charges are flying as fast as Indian arrows at Custer's last stand. However, their charges simply do not stick. The enormous extra funding of the National Health Service outlined by the Minister and the undeniable truth that many more patients are being treated in many specialties are absolutely clear and on the record. [Interruption.] Opposition Members should stop muttering and listen. I could then get on with my speech more quickly.

There is not a Birmingham MP — and possibly few others—who does not have cause for concern about the present state of the National Health Service. We know that waiting lists for cancer therapy at the Queen Elizabeth hospital are now up to eight weeks. That is hard for a cancer patient to face. We know that the number of renal patients is restricted and some cannot be treated at the moment. We know about widespread ward closures and of operations cancelled, sometimes at the door of the operating theatre.

Baby Barber received a lot of publicity and some people will think that because of that he had his operation and now has his life. However, there are scores or hundreds of unsung and unreported baby Barbers. I was told recently about a little girl of nine who was born with heart problems and who had her operation cancelled five times. On one occasion this little soul had had the pre-med injection but woke up to be told, obviously by a worried and embarrassed nurse, that she had not had the operation and would have to go through the preliminaries again. Things like that concern us greatly.

On the matter of nurses, I do not think that it is just a question of nurses' salary. There is also the matter of morale which falls when hospitals are badly decorated or not repaired as they should be. Those things have a lot to do with nurses' morale. Of course it is true that the Government are pumping more and more money into the NHS all the time. There can be no fair charge of meanness and no just charge that the Government do not care about the Health Service. Despite the £21,000 million—that is a great deal of money — that is spent every year, the problems to which I have alluded exist and are getting worse.

The problems have arisen not because the Government have not been generous with money, but because doctors are able to cure or to treat medical conditions from which only a couple of years ago the patient would have died. That is wonderful and we are all delighted at the expertise that our doctors are now showing. Unfortunately, the ability to carry out a new operation does not automatically carry with it a flood of gold from somewhere to pay for all the extra expense involved in carrying out that operation. That is the difficulty. We are the victims of our own success.

Even bearing in mind all those circumstances, I am afraid that it is just not good enough for the Government to say that hospitals must work within their financial limits. The public will not accept doctors saying to patients, "Yes, old man, I can treat you and I know how to treat you. I know that I can make you better or control your illness, but I am sorry, I am afraid that you will have to go home and die or wait because we do not have the money to treat you. Health authorities, you see, have to live within their budgets." That is simply not acceptable. We must face the fact that the money has to come. I appreciate what has been said about the open-ended character of treatment nowadays and one knows the difficulties that that creates.

Hon. Members could stay here all night giving examples of difficult NHS problems in their constituencies. Finally, it all comes down to money. We must have far more money than the amount that is required just to keep up with medical expertise. That is because more people are getting into the older age group and AIDS will cost an enormous amount. I do not think that it has yet been quantified. It looms ahead as a terrifying input to the health budget.

Bearing all those matters in mind, the time has come for radical change to obtain extra money for the National Health Service. People are ready, willing and able to pay more. Often that has not been true in the public sector, but it is now; people are willing to pay more.

Two points must be made about the beginnings of the National Health Service. At that time it was a much poorer service in terms of its ability to treat; we now have many more expert doctors and more treatments. On the other hand, there are more richer people in Britain. In 1948 one did not often see two cars in the family garage or a family taking holidays abroad, but one does today.

It is a better service today, and because people are better able to pay, I hope that the Government will seize the hour and announce new methods for obtaining new resources. One may ask, "What new methods?" Earlier, the possibility of the Chancellor forgetting about tax cuts, leaving levels of taxation as they are and giving extra money to the Health Service was raised. I agree that that is an attractive argument and many people support it. Unfortunately, if we did that, nurses — who are the people about whom we are most concerned — would have to pay the same amount of tax as they do at present, which they strongly resent. Nurses have to pay tax—the hon. Member for Wakefield (Mr. Hinchliffe) shakes his head; perhaps he does not know any nurses — but the point with regard to tax cuts is that we want to exclude poorer people, and nurses are in that group, from paying tax.

I tabled a parliamentary question to my hon. Friend the Minister about whether he would consider alternative methods of funding. The answer was a bit disappointing. He said: Health Authorities are already encouraged to dispose of surplus land and buildings, and such sales are currently releasing some £200 million a year". That money is welcome, but the land around a hospital can be sold only once. Once one has the money from that sale that is the end of the source. I am asking for continuous sources of funds.

One matter that has concerned the hospital boards is that the money from such sales does not go to the hospital concerned, but gets lost in a vast budget somewhere outside.

I well remember the Labour Government pushing through an Act against private medicine. They were determined to get rid of private beds and I remember the cancer consultant at the Queen Elizabeth hospital bewailing the fact that he would lose money for his cancer unit when all the private beds went from the hospital. When we look back on the Labour party's management of the Health Service we remember some pretty grim problems.

My hon. Friend's answer continued: We shall also be encouraging them to seek ways of generating extra revenue from the non-National Health Service use of appropriate facilities, such as selling refreshments to visitors and advertising. I do not believe that that will bring in nearly enough money. One cannot pay a bill of billions of pounds by selling buns.

Should we make more economies? To their credit, the Government have made many economies within the National Health Service; much money has been saved, particularly in Birmingham. The Government are proud of some of the ways in which they have been able to increase efficiency and stop waste. I do not think that there is a lot more money to be gained in that way.

I do not think, as some people do, that we shall solve the problems of the costs of the Health Service by making more economies in administration. I was interested to see the report of the National Association of Health Authorities in England and Wales, which pointed out that theft in the Health Service is a serious problem. Millions of pounds simply walk away from the Health Service kitchens, wards and stockrooms in the loss of sheets, pillowcases and nightgowns, which cost the National Health Service a great deal. I have even heard of sides of bacon disappearing. Labour Members doubtless think that it is a little perk of the Health Service to be able to take a pack of butter, or something like that.

Several Hon. Members

rose—

Dame Jill Knight

That report was not made by me or my hon. Friends; it is an independent report that points to the amount of money that is lost through theft.

Mr. Brian Wilson (Cunninghame, North)

Will the hon. Lady give way?

Dame Jill Knight

No. I am trying to be quick.

Even doctors working in the hospital do not have a very good idea of how much money they want. Reference has already been made to the letter from 200 consultants in the Birmingham health district. It says: The Government must be persuaded that the Health Service can only be safe with a modest increase in the level of funding. We do not need a modest increase; we need hundreds of millions of pounds. However, the doctors do not think so, unless they call hundreds of millions of pounds a modest increase.

Should we consider other means of fund raising, such as a lottery? One travels all around the world and finds old ladies selling lottery tickets in the streets. I am told that it raises quite a lot of money; certainly there is a lot of support for it. I suggested such a scheme in a newspaper recently and I have been deluged by letters strongly supporting it.

Mr. Geoffrey Lofthouse (Pontefract and Castleford)

Will the hon. Lady give way?

Dame Jill Knight

No, I am trying to keep within my time.

In many countries charges of a hotel character are made for hospital beds, and that is a possibility which we should consider. There should always be exemptions for people who cannot afford to pay charges, but we must eat whether we are in hospital or not, so I cannot see anything wrong in charging for food when someone is in hospital.

We could bring back the almoner and the matron—hospitals ran better when we had them. If we brought back the almoner, realistic hospital charges could be made. We could have a tax-related payment for treatment, which has been advocated in various publications. We could — I am very drawn to this suggestion—have a new stamp especially for health care. Currently, the stamp is universal and covers pensions, benefits, supplementary benefits, disablement benefit and a little for the Health Service. We should have a special stamp for health care alone, and all the revenue from that stamp should go to health care. I do not think that the public would object to that, and I think that it would be a good idea.

I have tried to outline a number of ways in which money can be obtained for the Health Service, bearing in mind that we are talking about billions of pounds and not peanuts. We must have money available to meet our immediate needs. The cases of people who cannot receive treatment worry us very much.

I beg the Government to look at the problems of extra funding in the long term. I ask them to provide more money to meet the agonies of decision that are facing our doctors and nurses in our hospitals.

7.54 pm

Mr. Denis Howell (Birmingham, Small Heath)

I sympathise with the Secretary of State, who is not able to be here, and wish him a speedy recovery. Along with the Minister for Health, the right hon. Gentleman has provided a little relief for Birmingham. We were grateful—although he will understand that we were critical—for that small amount of relief.

I did not agree with all the fund-raising schemes that were mentioned by the hon. Member for Birmingham, Egbaston (Dame J. Knight). In my many years' association with the Health Service I have certainly not met any Birmingham chefs who have been stealing sides of bacon.

The right hon. Member for Brentford and Isleworth (Sir B. Hayhoe) made a helpful and constructive speech. We should acknowledge it. Although hon. Members are critical, it does us no good to get into the trenches of old, worn-out political dogma, and that is where we have landed ourselves for much of the debate.

I raise a fundamental right—the right of a patient to live. It arises from the decision of the Master of the Rolls in the High Court yesterday. The Government's move towards a corporate state—that is what they are doing in education, local government, health and, I am sorry to say, sport — is one cause of our problems. We have heard from hon. Members from all over the country about the terrible concern of regional authorities and district hospitals which cannot meet their obligations. Not one regional chairman has thought it right to resign. One of the reasons is that the Government's placemen and placewomen now abound. I do not object to people being paid for their services, but, having served as chairman of a hospital for 16 years and never having charged a penny for having done so, I believe that the present movement reacts against the public interest and should be examined.

One of the unfortunate developments in the debate has been the pernicious attacks on consultants who, in the absence of their authority chairmen, have thought it right to stand up for their health authority. We have heard about the threat from the Secretary of State for the Environment. In a brilliant speech, my hon. Friend the Member for Birmingham, Hodge Hill (Mr. Davis) mentioned the threat that was made to a Birmingham consultant.

We heard demands from the hon. Members for Bexhill and Battle (Mr. Wardle) and for Bromsgrove (Mr. Miller) for shorter consultant contracts. Their views were couched in language that suggested that people who had the audacity to put their public duty and their Christian conscience, as they saw it, before any bureaucratic convenience might be got rid of, written to or threatened. I hope that the Under-Secretary of State will take the opportunity to denounce that and declare total freedom for consultants to bring such matters into the public domain.

I pay tribute to the consultants in Birmingham. The hon. Member for Edgbaston and I have led delegations to them. I pay tribute also to the hon. Lady and her colleagues. We in Birmingham have been united in trying to stand up for our constituents' interests. None of us would have harangued Ministers had consultants not brought those matters to our attention. More consultants told us "We are being ordered not to treat patients who will die if we do not do so." Thank God they did so. They were carrying out their duties as civilised members of society, not just as doctors or administrators. We must take account of that fact.

All hon. Members delight in the success of the operation that was carried out on the girl who has been mentioned several times today. The other child, who was mentioned by the hon. Lady, happens to come from my constituency. I shall not go over that ground again. After four or five cancellations of a hole-in-the-heart operation, it was appalling for that girl, even after a pre-med, to find that the operation had been cancelled. This is happening all the time. It is an appalling blot on our society.

Twelve months ago my hon. Friend the Member for Hodge Hill and I went to see the chairman of the West Midlands regional health authority about problems at the East Birmingham hospital, which serves my constituency and those of other hon. Members. He explained the terrible growing financial crisis. He horrified me when he said to us, as Members of Parliament, "I have to tell you that there will be deaths." I cannot think of anything more catastrophic than for a Member of Parliament to be told by a regional chairman that because we are overspent and £30 million over-committed, there will be deaths.

I praised the chairman for his honesty, and I do so again tonight, but it raises the question whether the citizen has the right to live. At the end of the day, that is what the debate is about. I give all the credit that the Government want for increased expenditure, and increased staffing levels and activity in hospital out-patients' and in-patients' departments, but that is all totally irrelevant if one is about to die or if a consultant says, "You will die unless I operate on you next week, and I have been instructed not to do so."

What is the legal position of any administrator or chairman of a local health authority who instructs a consultant not to carry out an operation when he is willing to do it and when the necessary equipment exists? In my judgment, if that patient dies, it amounts to unlawful killing.

The orthopaedic case involving our former colleague David Ennals was fairly raised. The same point was raised in the courts yesterday in a case concerning Angela Tongue. She came to see me in the first instance because she needed dialysis and kidney treatment. The consultant had been instructed not to admit her or anybody else. It was quite clear that she was going to die. I saw the consultant in Birmingham this morning, and he told me that she was admitted literally at the forty-fifth minute of the eleventh hour. She was admitted because, first, 10 Birmingham hon. Members complained bitterly, and, secondly — I ask the Minister to comment on this — because the legal officer of the regional health authority advised the chairman, who was still standing firm, that the case would be indefensible in law if the girl were not admitted and she died. That is true.

Yesterday, in the Court of Appeal, the Master of the Rolls, in rejecting the case of the young lady whom I have mentioned, Angela Tongue, said that the basis of his rejection was that financial resources were finite and always would be. According to today's edition of The Times, he went on to say: Other circumstances might arise where it would be appropriate, but if the court did entertain an application further resources would be expended by the NHS in meeting the complaints. There was therefore a very delicate balance to be struck. In 33 years, I have never criticised the judgment of the House, but the Master of the Rolls held the balance and decided that an individual's right to live was inferior to the right to support the bureaucracy in not providing the funds to enable a person to live. That cannot be a tenable proposition, and I hope that the courts will think again. The Master of the Rolls admits that the court had jurisdiction and that, in another case, he might make a different decision. I do not know where he might find a more serious case than that of David Barber, or a lady who is told that she will be dead if she is not admitted to hospital.

I agree with what the Medical Defence Union has said. A legal opinion appeared in The Lancet when the previous matter arose. In response to my letter the Secretary of State courteously wrote to me drawing my attention to the Hinkes case — the orthopaedic case. No reasonable Member would ever say that the right to go to hospital and demand treatment for a hip operation was commensurate with the right to live. It is, of course, very distressing for people who need hip operations and are in terrible pain, but that is nowhere near as serious as the plight of people who are told that they will be dead next week unless they have an operation.

I raised the point, as a layman, with Sir James Ackers nearly 12 months ago and again with the Minister. I think that I am absolutely right. Let me say to the Master of the Rolls, and to the Minister that we are not dealing with the civil law. If anyone in my constituency dies as a result of medical neglect because a consultant has been ordered not to treat him, I shall regard it as a criminal matter. There will have to be a coroner's inquest and a police investigation. I think that the legal adviser from the West Midlands regional health authority was right to say, in the case of Angela Tongue, that it would be indefensible in law if she was prevented from having treatment that was available to her.

Mr. Lofthouse

May I mention a case in my constituency? The health authority decided to spend the allocation allowed to it to shorten waiting lists in a private hospital that would cover 302 operations, rather than in the National Health Service, where the same amount of money would have covered some 660 operations. If one of 360 people waiting for operations died as a result of such a decision, would the same apply?

Mr. Howell

Everyone has the right to live, and anyone who brings about a death commits an offence under the criminal law. I see no distinction between telling a consultant not to allow someone to live by admitting that person to his ward, and an ambulance driver being told not to take to hospital someone who has been knocked down in the street. We all have a duty to go to the aid of a fellow citizen in such circumstances.

I think that we need a right-to-live Bill, and, if I have the good fortune to be able to introduce a private Member's Bill, I shall try to bring one in. If the Master of the Rolls' decision is interpreted to mean that no one has the right to make demands on the National Health Service, even in extremis, when he is likely to die unless help is provided, that is not a position that a civilised Parliament could allow to continue. It must be put right, and I hope that the Government will put it right.

I join those who say that we want money immediately, and I hope that even at this late hour the Under-Secretary of State will announce the provision of that money, particularly for the Central Birmingham health authority. When I intervened in the Minister's speech, I said that 90 children's beds had been closed; in fact, the figure is 104. At the Queen Elizabeth hospital, 146 beds have been closed. That has never happened before. I do not want to make a political point: I am merely saying that it has not happened before in our administrative history.

On behalf of the doctors, I express admiration for the emergency action taken by the Minister to provide £225,000 to keep the kidney unit open, despite the Under-Secretary saying on television that there was no more money. I am glad that there have been second thoughts, but what will happen after the money runs out on 31 March? Surely none of us wants to return to the days of deputations and all the television dramas that we experienced. Can the Under-Secretary give us an undertaking tonight that next year's financing will be sufficient to keep open the vital cancer and kidney units? At the Children's hospital, paediatric skin services are now facing a grave crisis. I was told about that in a letter that I received today.

This problem does not affect only babies with a hole in the heart. It applies to all specialties because of the regional significance of teaching hospitals. We need emergency money now. There would be unity across the Floor of the Chamber if the Minister announced that she would provide it, and it would ensure that such traumas never face us again in the National Health Service, which we all cherish so much.

A consultant, while talking to me the other day about Ministers, said, "Why is there no compassion in the Health Service?" I had to tell him, with the greatest regret, that under the present Government compassion does not have a price. That is why it is not relevant to the thinking of administrators in our Health Service today.

8.11 pm

Mr. Richard Page (Hertfordshire, South-West)

I am told that there is a thin line between bravery and foolhardiness and that occasionally, by accident, it is possible to slip across that line. Tonight the Opposition have not merely slipped over the line; they have charged across it.

I would have welcomed a constructive debate on the future of the National Health Service. No one wishes to try to avoid or hide the difficulties that lie ahead. I fear, however, that I found the faintly sanctimonious approach of Opposition Members very upsetting, and the mesmeric effect of the Opposition Dispatch Box still seems to be working. None of the lessons of the last period of government seem to have got through. Every time in the last Parliament that an Opposition spokesman put his hand on the Dispatch Box, he was promising that the Labour party would spend more money. It reached the point where they were promising to spend billions of pounds more. Halfway through the last Parliament, they were going to spend £17 billion on health and housing. No wonder that the right hon. Member for Birmingham, Sparkbrook (Mr. Hattersley) must have breathed a sigh of relief when Labour lost the election, for Labour could not possibly have raised the money to pay for all those promises.

However, I would accept all that if Opposition Members had a shining example to set before us. Let us look at their record. I vividly remember my right hon. Friend the Prime Minister coming to the Dispatch Box a couple of years ago and quoting an excerpt from the diary of Barbara Castle—which, by a lucky chance, I have before me now. It ran: 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."—[Official Report, 6 November 1985; Vol. 86, c. 20.] He jolly well did, twice. That is why I find it rather upsetting to receive a lecture about how dreadful Conservative Members are when we have increased NHS expenditure by 32 per cent.

If anyone visits my constituency and walks a few hundred yards to the constituency of my hon. Friend the Member for Watford (Mr. Garel-Jones), he will see a brand new hospital, opened last year by Princess Michael of Kent. It cost some £18 million and has 367 beds. At the western end of my constituency, a few hundred yards into Hemel Hempstead, we come to the constituency of my hon. Friend the Member for Hertfordshire, West (Mr. Jones). There we find the Tudor wing, a £8 million project. That was cancelled under the Labour party but built under the Conservative party. That is the difference. When my constituents visit the constituency of my hon. Friend the Member for Hertfordshire, West, who I see in the Chamber, they see the physical results of the Conservative party's support for the NHS as opposed to the cancelled projects of the Labour party.

Mr. Robert B. Jones (Hertfordshire, West)

Perhaps my hon. Friend would like to draw attention to the fact that not only is there a new hospital project in Hemel Hempstead and further projects in the pipeline, but there are 25 per cent, more nurses than when the Labour party left office.

Mr. Page

My hon. Friend has made the point for me and I appreciate what he said.

I should like to be a little more practical and talk about obtaining value from the NHS. We must deal with the question of finance. I am afraid that I find great similarity between the NHS and the escalating cost of military hardware. Decades ago the treatment was an aspirin and a lot of TLC. But now with new drugs and fantastic surgery techniques we can save lives which were previously lost. However, the cost is escalating.

I have to say to the House and to my hon. Friend the Minister who will be replying to the debate that I am convinced that whatever sums of money we give the NHS, within a few months there will be a requirement for even more. The problems that we would solve today would be back with us within a year and, therefore, I believe we have to take up the message given to the House by my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight).

We have to look at all forms of revenue that can be employed to support the Health Service. If that means charging, lotteries, insurance policies or giving tax rebates for insurance policies for health, so be it. We have to look at the whole question in a new and open fashion and not assume that we can just overcome the problem with a few more pounds. We have put billions more pounds into the NHS, but we still face problems.

I should now like to raise queries about finance under the present system as it operates locally. My constituency covers two district health authorities, South-West Hertfordshire and North-West Hertfordshire. Both my hon. Friends the Members for Hertfordshire, West and for Watford are involved in these queries and concerned. In those two districts we face the problems of success. In the South-West Hertfordshire district health authority over the past three years the number of treatments in hospital, not including out-patients, has increased by 32 per cent. That is a fantastic improvement. The cost per case has come down from £748 to £737. In North-West Hertfordshire district the cost of a bed is £726. That is the standard charge for every patient admitted to hospital. There has been a huge increase in the number of treatments and that position has been reached simply through efficiency. However, it cannot be sustained if the funding mechanism within the North-West Thames regional health authority takes two years to recognise those facts and arrange the necessary transfer of resources.

It would be invidious of me to start naming the London hospitals that make up the North-West Thames region along with my hospitals. However, the cost per case in one of the London hospitals is £1,121. In another hospital the cost is £1,160 and in another it is £1,198. A couple of hospitals can do it cheaply and manage £843 per case or £867. It means the hospitals on the borders of my constituency in Watford and Hemel Hempstead make a saving per case of between £100 and £400.

In some of the hospitals in London the deaths and discharges have gone down. However, in my region they have gone up by 9 per cent. I know that there is a changing pattern of treatment. The people in my constituency no longer have to go to London for their operations. They are having their operations locally, and very successfully too. The situation is self-explanatory. On behalf of myself and my hon. Friends the Members for Hertfordshire, West and for Watford, I ask the Minister to look at the problem. It cannot be right for the hospitals in my district to be held back while the London hospitals some 20 miles away sort themselves out.

I know that a deputation is going to see the Minister and that it will include my hon. Friends the Members for Hertfordshire, West and for Watford and myself. I hope that at that time some solutions will be put forward to solve the dilemma.

I should like to deal with the effective use of operating theatres. The hon. Member for Livingston (Mr. Cook) tended to leave the impression with the House that the under-utilisation was due to a lack of resources. I should like to point out that in 1981 the Duthie report, which dealt with the use of operating theatres, said: we are in no doubt that poor management of waiting lists, inefficient admission and discharge planning and the lack of co-ordination of aftercare facilities exacerbate the problem and lead to waste of the resources which are available". Those are almost the same words as those in the report of the National Audit Office.

One of the sentences near the end of the National Audit Office report says that computers are not being used for the admission process. I hope that my hon. Friend the Minister will make every effort to see that hospitals the length and breadth of the country introduce computerisation at a faster rate because that is the only way that we will obtain more efficient use of the resources within the Health Service. It would also reduce the frustration felt by so many people who have turned up for treatment and been turned away or who have had to wait a considerable time.

I should like to talk about other areas in which I think that the Health Service could save money and where it could provide extra resources for more treatment. I was hoping to spend some time going through the savings that could be made from tendering for support services. Already £100 million has been saved and I believe that it has been estimated that another £50 million could be saved if all the health regions employed competitive tendering. I urge my hon. Friend the Minister to do what she can to ensure that all regions take full advantage of the competitive tendering process.

I should like to have developed my speech on the requirements for efficiency and saving, but I am aware that many right hon. and hon. Members want to speak. Therefore, I shall draw my remarks to a close. If we strip away all the political froth from the debate we all accept that there will never be enough money for the Health Service. That has been proved by the fact that we have provided a vast increase of over 30 per cent, in real terms but it is still not enough. I urge my hon. Friend the Minister to look at every available source from which more money can be raised to provide the health care that the country wants.

There have been vast increases in funding and in hospital treatments and that has created a good base on which we can build an even better Health Service. The Government should be congratulated, not castigated.

Mr. Deputy Speaker (Sir Paul Dean)

The House will wish to know that the winding up speeches are expected to begin at about 9.20 am. Time is short and many hon. Members wish to speak. I hope that those who are fortunate enough to be called will bear in mind that many others hope to catch my eye later.

8.24 pm

Mr. David Hinchliffe (Wakefield)

Most hon. Members who have spoken, with the exception of the hon. Member for Hertfordshire, South-West (Mr. Page) who seemed to me to be rather blinkered, have considered the issues that affect patient care in their constituencies and home areas. I should like to do that later, but I wish to start by considering an issue that has not been touched on so far and I have sat here throughout the debate. That is the way in which the financial situation in the National Health Service is leading certain district health authorities to bring in questionable practices in their catering.

Most hon. Members will recall what happened at Stanley Royd hospital in Wakefield in 1984. I know that my hon. Friend the Member for Pontefract and Castleford (Mr. Lofthouse) lost a member of his family when 19 people died from the salmonella outbreak. Following the outbreak there was an investigation and a public inquiry. The committee of inquiry, which reported in January 1986, made one of its central points on page 106 of its report, which stated: To state that food should be cooked and served the same day … is to state what is or should be obvious to everyone employed in a kitchen". The following month, Wakefield district health authority decided to introduce a cook-chill system of catering that went totally against the central recommendation of the inquiry. It is my belief—I was at the time a member of the Wakefield district health authority—that the health authority was bounced into its decision to move towards cook-chill by the district general manager, who was new to the appointment and had come into the post direct from the private catering training industry. He argued that savings of about £300,000 per year could be achieved from the system. He had grandiose ideas about outside catering and I am sure that at the back of his mind was the fact that it would be a lot easier to privatise the catering system in due course. It has since become apparent—this is an important point — that, despite the Stanley Royd experience, the decision to move towards cook-chill was not discussed with the district health authority's control of infection officer, the DH A's control of infection committee or with its own consultant microbiologist, who was involved in the Stanley Royd inquiry, Professor Richard Lacey of Leeds university.

Following the decision to implement cook-chill, the Wakefield district health authority was criticised by a number of individuals and bodies. The London Food Commission issued a report in December 1986 which stated that it was highly critical of the scheme that was to be introduced in Wakefield. Professor Lacey, the microbiologist employed by the health authority, stated publicly that Wakefield's proposals were "microbiologic-ally unsafe and nutritionally unsound" and that they breached DHSS guideliness.

It is also worth noting that in September the Institution of Environmental Health Officers drew attention to its concern about cook-chill systems in various hospitals. According to its report, almost one third of the 127 hospitals using the system were not complying with DHSS guidelines. On 4 November a briefing document from the Association of Community Health Councils of England and Wales stated: New hospital kitchen systems could lead to a catering disaster and it may be just a matter of time before a major food poisoning outbreak occurs … The fear must be that under pressure to keep costs down, cook/chill systems will be introduced on the cheap and that sooner or later a catering disaster will occur and lives will be lost through food poisoning outbreaks. The report suggested: Some health authorities are planning to do without adequate reheating facilities on hospital wards". That is a clear reference to the fact that the likes of Wakefield district health authority plan to cut corners in introducing cook-chill as a means of achieving savings.

My central concerns about cook-chill focus on three main points that are relevant to the debate. First, the food that is produced by that process is subject to nutrient loss and, as a consequence, is unsuitable for people who are in hospital, weak, elderly or ill. Secondly, the acceptability of food to the patient is reduced in terms of smell, taste and appearance. Thirdly, there is an increased risk of microbiological contamination during the reheating and holding processes.

It is interesting to note that the critics of cook-chill, especially Professor Lacey, have been subjected to hysterical attack from certain quarters for expressing what I regard as their legitimate concerns. I give as an example an organisation called the Food Hygiene Bureau, a supposedly independent body in which I believe the hon. Members for Upminister (Sir N. Bonsor) and for Aldridge-Brownhills (Mr. Shepherd) have some interests. On 16 July that organisation held a press briefing at the London Hilton at which it described Professor Lacey's remarks as fundamentally incorrect, misleading and scaremongering". Incidentally, I understand that—surprise, surprise—the meeting at the Hilton was funded by the equipment manufacturers who are promoting cook-chill. Central to my concern about this issue is the fact that vast amounts of money are to be made from cook-chill by private companies which become involved with the privatisation of catering in DHAs and, no doubt, in future in local authorities. Big money can be made from the system.

I refer now to the treatment of Professor Lacey by the Wakefield district health authority and the Yorkshire regional health authority. I hope that the Minister is listening because I shall expect to hear some comments from her. I have tried to raise the subject on several occasions, and she is once again totally ignoring me.

Mr. Tom Clarke (Monklands, West)

On a point of order, Mr. Deputy Speaker. As you know, my hon. Friend has sat through the entire debate and has listened to every hon. Member who has spoken, including the speeches from the Dispatch Box. Would it not be a courtesy for the Minister to reciprocate?

Mr. Hinchliffe

The treatment of Professor Lacey by the Wakefield district health authority and the Yorkshire regional health authority has been disgraceful. I shall cite one or two instances of what has happened to this gentleman who raised reasonable criticisms about the system. As a member of Wakefield district health authority, I personally witnessed the tremendous pressure that was placed upon Professor Lacey to withdraw his comments on cook-chill by certain members and officers of the Wakefield district health authority on several occasions. I also personally witnessed on several occasions some highly dubious tactics being employed to discredit Professor Lacey and his views. A private letter that was received from an outside body criticising Professor Lacey's manners was included on the DHA agenda papers by the general manager of Wakefield district health authority, without the knowledge of the district health authority chairman. Surprise surprise, it was included as an item immediately before the subject of cook-chill.

I should mention two other points that are relevant to the situation in Wakefield and to the general situation regarding cook-chill and the current catering pressures. First, during the late summer, Leeds university's nomination for membership of the Wakefield district health authority, Dr. E. G. V. Evans, was rejected by the Yorkshire regional health authority. That was an unprecedented situation. Apparantly, the regional health authority found him unacceptable because he works in Professor Lacey's department.

Secondly and more recently, it has become apparent that Yorkshire regional health authority has excluded Professor Lacey and members of his department from membership of the appointing committee for a new-time post of consultant microbiologist in the Wakefield district health authority, despite the fact that he and his colleagues would normally be involved.

In a letter to me dated 21 October, Professor Lacey states — I hope that the hon. Member for Derbyshire, South (Mrs. Currie) is listening: This is a unique precedent and it does seem the two health authorities are deliberately structuring the Appointing Committee and the membership of Wakefield health authority in order to defend their previous actions. In particular, it is completely unacceptable to engineer an Appointing Committee so that the opinions and attitudes of potential candidates will be consistent with a specific policy … I have heard from an authoritative source that any applicant who might be appointed to the Wakefield post must be sympathetic towards the cook/chill proposals. The Yorkshire regional health authority so-called "expert committee"—it has been referred to nationally—the expert body on cook/chill, was set up during the summer to consider the matter and clear up the difficulties. Without doubt, that committee was designed to smooth the way for the wholesale introduction of that process into NHS hospitals. In common with the appointments committee, that committee did not have anyone on it who was known to be opposed to cook-chill.

The district health authority in Wakefield is pressing ahead with the introduction of a slightly modified cook-chill process which, from the outset, is likely to be in breach of DHSS guidelines. In the light of the Stanley Royd outbreak, the situation that I have outlined gives cause for great concern, especially as Wakefield is likely to privatise its catering services at the same time as it moves to cook-chill.

I smell various rats regarding this matter. I suspect other hon. Members do as well. I have previously raised this issue through parliamentary questions and an early-day motion, but I have had no response from the Minister. I want to know what the Government will do about what the Association of Community Health Councils of England and Wales described as the possibility of cook-chill becoming "cook-kill."

So far I have concentrated on catering. However, there are wider issues of concern about what is happening as the result of health policies within my district. Wakefield, in common with every other area of the country, has a history of constant cuts and closures. I shall quote one or two, but there are many. Sandal Grange geriatric hospital was closed because it was unsuitable for the care of elderly patients, but, surprise, surprise, it was reopened immediately afterwards for the private care of the elderly. Since then the standard of treatment at the hospital has been a cause of concern to the local authority on several occasions.

Carr Gate hospital, in the constituency of my hon. Friend the Member for Normanton (Mr. O'Brien), served my constituents, and it was closed because it was considered an isolated institution and unsuitable for the care of patients. However, subsequently it reopened as a private institution. Snapethorpe hospital, the subject of an early-day motion, which is my constituency's most modern hospital, was "temporarily" closed in 1984. One of the reasons given for the closure was that the consultant at the district general hospital, two miles away, found it too far to travel to that hospital. However, I have noticed that quite a number of consultants have been falling over themselves to travel at least three times further to a private hospital within Wakefield to practise outside the NHS.

It is proposed to sell off Snapethorpe hospital, no doubt to the private sector. In my area 100,000 people petitioned to save that hospital. It was totally ignored by the DHA, which I believe is totally unrepresentative of local opinion. It is worth mentioning that one third of the members of Wakefield DHA live in one electoral ward, the only ward in the entire 63 in the Wakefield metropolitan district that continues to elect Conservative councillors. Is it any surprise that only yesterday the chairman of the Yorkshire regional health authority refused to tell me who nominates the people to that DHA?

Wakefield health authority is currently staggering from one financial crisis to another because of Government underfunding. In April 1987 £1,400,000 was cut, including ward closures and various other reductions in services. On 17 August there was a crisis meeting, and a further package of cuts, bed reductions and ward closures was proposed totalling much more than £1 million.

It is interesting to note that the proposals to make such cuts and closures were seconded by Mr. Graham Bird, a consultant surgeon who operates within Wakefield and who has a large private practice. He also has interests in Methley Park private hospital that has been referred to by my hon. Friend the Member for Pontefract and Castleford. It could be argued — I certainly argue it— that that consultant stands to gain from bed reductions and longer waiting lists because more people will be forced into the hands of the private sector. Such a situation would never be tolerated within local authorities. It is disgraceful that it is accepted within the NHS.

The minutes of the August meeting report the comments of Mr. John Settle, a consultant representative on the Wakefield DHA. He said that the consultant opinion was that the revenue allocation to the acute unit was inadequate, and that any significant reduction in the service provided would affect morbidity and mortality in Wakefield.

The August package was put on ice after the Yorkshire RHA was embarrassed and intervened. However, in October that package was reintroduced and broadly agreed — the fears of Dr. Settle were realised at the October meeting. I appreciate that we are tight on time, but I wish to go through the package. I have heard the Prime Minister say that RAWP has pushed money into the north, but as a northern Member of Parliament I should like to know where it has gone. Let us consider the package.

Mr. Hayes

On a point of order—

Mr. Hinchliffe

If the hon. Gentleman does not want to hear, he can go out.

Mr. Hayes

On a point of order, Mr. Deputy Speaker. We have been listening to the hon. Member for Wakefield (Mr. Hinchliffe) for the past 15 minutes — indeed, it seems longer than that. There are many hon. Members on both sides who wish to speak.

Mr. Deputy Speaker

That is not a point of order. However, I appeal again to any hon. Member who has the Floor to be brief, otherwise many other hon. Members will be disappointed. I hope that the hon. Member for Wakefield (Mr. Hinchliffe) will come to a quick conclusion.

Mr. Hinchliffe

A few weeks ago I sat here for five hours listening to the health debate, but I did not get called. I have applied for several Adjournment debates on this issue, but have not been granted them. I intend to pursue the matters that I am here to raise on behalf of my constituents.

The closure package included nine beds in a young, disabled unit and two neuro-surgical beds — there is a waiting list of 59 people for such in-patient treatment; the closure of four ophthalmic beds—there is a waiting list of 287; the closure of nine orthopaedic beds — the present waiting list is 376 compared with 260 last year; the closure of four plastic surgery and dental beds — the plastic surgery waiting list stands at 280 compared with 209 a year ago, a 44-week wait for treatment. This is what my constituents experience with the National Health Service.

The orthodontic waiting list is 363 compared with 263 a year ago. Four ear, nose and throat beds have been closed. There are 313 on the waiting list compared with 222 a year ago. Six gynaecology beds have been closed. The waiting list for gynaecological treatment has been of great concern for many years in Wakefield. At present there are 406 on the waiting list compared with 292 a year ago. A geriatric ward, recently upgraded at great expense, is still closed. Further privatisation measures have been included in the package, which, from experience, will drive down the wages of the work force and worsen the conditions that the patients must bear.

The package also includes staff reductions amounting to the equivalent of 57 full-time posts, including 18 nursing jobs. All this is happening at a time, as has been referred to earlier, when the National Audit Office report, which was published this week, specified that Wakefield is using its operating theatres for only 50 per cent, of the time because of staff shortages and underfunding.

The most obscene part of this situation is that under the new Griffiths management structure the general managers on performance-related pay—many of them spivs and cowboys from the private sector with no commitment to the NHS—stand to gain financial bonuses for delivering cuts and closures and damaging the service.

Since my election I have met the chairman of the DHA who told me that there was no more money and that more should be obtained from the RHA. I have met the chairman of the RHA who told me that there was not enough money from the Government. I met the Minister on 14 September and she said that the Wakefield DHA should be able to manage on its budget. She promised to write to me about bed usage, but I am still waiting to hear.

It is clear that the Wakefield DHA is introducing an unsafe system of catering to assist privatisation and the achievement of savings. The pattern is one of huge increase in waiting lists and massive bed reductions leading, as a consultative representative on the DHA has said, to more people being ill and more people dying. I do not believe that the present situation has been arrived at by accident. I believe that the underfunding of the NHS is deliberate. In my area and elsewhere we are witnessing a deliberate attack on the NHS. This is taking place because the Tory party has never believed in the concept of the NHS. Bed reductions and increased waiting lists push more and more people into the hands of the private sector. It is a deliberate process, actively encouraged by the" Government. It is time that the Government owned up to their real intentions—the total destruction of the National Health Service and its replacement with private health schemes. Why do not the Government come clean?

8.44 pm

Mr. Ray Whitney (Wycombe)

May I first add my voice to those hon. Members who have expressed sympathy to my right Friend the Secretary of State. I wish him a speedy recovery and return to his duties.

One theme that has been generally agreed by hon. Members on both sides of the House is that we should spend more on our health. That is not in contention, and there has even been a good deal of acceptance by Opposition Members that the Government have spent 31 per cent, more and have produced all the results with that spending to which my hon. Friend the Minister for Health referred in his opening remarks. Conservative Members recognise that those results can be achieved only in a strong economy, which the policies of the Government can produce, but which the policies of the Labour party manifestly cannot. The fact that there can be that degree of agreement, yet still the degree of dissension and concern —this has been a troubled and bad-tempered debate—is a measure of the problems that we face.

Another measure of the problem that faces us is international comparisons. This year, thanks to the achievement of the Government, we shall spend per capita £364. The United States, of course, is out of sight, with spending at £1,388 per head. I would not expect to compare our spending with that of the United States, but I would expect us to aspire to a similar level of spending as that of our European partners, particularly France and Germany. France spends £616 per head, and West Germany spends £722 per head.

Mr. Frank Cook

Twice as much.

Mr. Whitney

That is more than twice what we spend, as the hon. Gentleman brilliantly picked up. The difference is that what is spent by this Government is significantly more, as a percentage, than is spent by those other Governments. The difference is the system. We spend 6 per cent, of our GNP while the average of Western countries tends to be about 9 per cent. We have seriously to face that fact with the minimum possible level of political emotion. If we are to move to the 9 per cent, level of our Community partners, we are talking about, not hundreds, but thousands, of millions of pounds. To be precise, if we add together the public and private sector spending, this year it will be £23 billion. If we are to increase that by 50 per cent., which those figures demonstrate is necessary, we are talking of an increase of a further £11 billion.

We have achieved a great deal because, as we sadly know, there are low levels of pay in the Health Service. Those levels are certainly low by international standards, and we benefit from the terrific dedication and commitment of the vast majority of those who work in the Health Service, to whom we all pay tribute. We benefit, too, from the low cost of administration. However, there is no way that we can achieve those modern levels of spending and care at our level of national spending. We have to look at a different system, and it is about time that people had the intellectual courage to recognise that the Bevan proposals were fundamentally and absolutely flawed. Those proposals were for an acute service for postwar Britain, when the social and economic situation was extremely different. We are now faced with three different spending pressures. They are the aging process, high technology and the aspiration of people, which is so strong now and which is showing through in the debate.

Opposition Members, including the hon. Member for Stockton, North (Mr. Cook) who gave us the benefit of his computer print-out, refuse to understand the facts which countless Health Ministers have faced. More than 20 years ago the right hon. Enoch Powell recognised the difficulty and wrote a book about the problem we are now discussing. Richard Crossman wrote in the same vein of the impossibility of the structure to meet our demands. Enoch Powell walked away from the problem and said that to change and reform the system would "daunt the stoutest political heart." It is time that we looked at the problem. We have a long and honourable tradition in this country, and it is rubbish to suggest, as one or two Opposition Members have done, that the Conservative party has never been interested in the National Health Service. That is manifest nonsense.

In 1911 Lloyd George introduced the Liberal National Insurance Act, which we supported. It was opposed by the doctors, but when they discovered that it worked to their advantage, they also supported it. What emerged as the NHS was drafted in 1920 by the committee under Lord Dawson of Penn. The mainstay of the Health Service was the 1944 White Paper under the leadership of the Conservative Health Minister of the wartime coalition Cabinet, Henry Willink. The suggestion that the National Health Service is a Labour party invention in which the Conservative party played no role is absolute nonsense. On the contrary, the shape and structure of the Health Service which eventually emerged, and which I submit is manifestly the wrong one for today, was opposed at the time, not by those in the Conservative party, but by pillars of the Labour party. For example, Herbert Morrison said that Bevan's scheme "would produce bureaucratic overcentralisation". Bevan recognised some of the dangers and said: Admittedly, this is a field in which there is room for development in the techniques of government but the problems that will arise should not be incapable of solution. Forty years of experience have demonstrated that the problems have proved to be incapable of solution.

Six weeks before Bevan came to the House on 15 February 1946 to give his Second Reading speech ushering in the National Health Service Bill, Herbert Morrison said: The view of the Minister of Health and the Government was that it would not be right to take the hospitals over into a national concern. I do not make that submission in a party spirit, but to show that it was not a party-political issue at that time.

Another extraordinary phenomenon at the time of the creation of the Bevanite Health Service with which we are now wrestling was the extraordinary view, shared by hon. Members on both sides of the House, that once we had a working, effective Health Service, the demand for health care would fall. As the right hon. Enoch Powell said, that was a miscalculation of sublime proportions. That is what we have been saddled with.

The nation took a wrong turn in 1946–48, and we have had 40 years of tinkering. I am sorry to say that we had more tinkering yesterday, when it was suggested that we would have income generation of £20 million this year and £70 million later, the one-off sale of real estate to bring in some hundreds of millions of pounds and cross-improvements that would bring in some further hundreds of millions of pounds. However, if we are to get to the international level that the people have a right to expect and to aspire to, we are talking about £10 billion or £11 billion and about a debate on a new system.

For many years my right hon. Friend the Prime Minister has said that the National Health Service is "safe in our hands." As the figures given by my hon. Friend the Minister for Health today have shown, it is certainly a great deal safer in our hands than in the hands of any other party. However, it is really safe in no one's hands, for the reasons that I have given. There is a need for a national debate on the matter.

Of course, there will be an outcry from the Neanderthals on the Opposition Benches. The NHS represents all that is left of the mistakes of the Attlee Government. I could recount those mistakes, but time does not permit. There will be an outcry from the spokesmen of the medical profession. There will be no outcry from the real workers, but an outcry from the people who hit the headlines. They objected to the Lloyd George reforms of 1911, but when they discovered that they were in their interest, they became enthusiastic and accepted them. Similarly, they objected to the National Health Service reforms of 1946 until they discovered that they were in their interest, when they became enthusiastic about them. They will object to the new changes—

Mr. Lofthouse

Will the hon. Gentleman give way?

Mr. Whitney

Certainly not.

There will be objections from the medical profession tonew changes, but when they understand how much those changes will benefit the medical and nursing professions, and above all the people of this country—

Mr. Lofthouse

Give way.

Mr. Whitney

No — they will understand that the profession must support those changes. The time has come for courageous and clear thinking. That is what we expect from our Government.

8.55 pm

Mr. Andrew Welsh (Angus, East)

I will be as brief as possible to allow other hon. Members to take part. I hope that Hansard can cope with speed writing.

The Government are keen to claim that the Health Service is safe in their hands. I do not believe them. Like many citizens, I am worried about the future provision for the services offered by the NHS which we all take for granted, which it has performed over decades and which every citizen relies on at some stage in his life.

One of the big problems about debating the Health Service is that the debate becomes bedevilled by statistics. It is difficult to compare like with like to understand the existence and nature of cuts or whether we should accept the Government's claim that they are pouring extra money into the service. Year by year, comparisons of NHS costs using different systems of constant prices produce such widely variable results that it is difficult to believe that they are measurements of the same variable. That makes it difficult to reach a logical conclusion about what is happening.

It is, however, clear that from the inception of the NHS in 1948 until 1973 the service received the necessary extra money that it needed — inflation plus 2 per cent, or more. As a result, the NHS was the envy of the world because of its provision for the people. Since 1973 the increases have been inadequate to maintain standards.

Since 1973, the NHS has gradually tightened its belt, made economies and somehow managed to get by. Now, further trimmings are simply impossible. To maintain the service in vital areas, real cuts are being made under this Government, involving closures, sackings and so forth. It must be remembered that that process has been maintained under both Labour and Conservative Governments.

It is worth noting that between 1983 and 1984 there was a 0.7 per cent, fall in the manpower in the Scottish Health Service at a time of a continued increase in workload. Therefore, a greater workload is being borne by fewer people in the service. That is a major problem and we have heard the symptoms described tonight.

The Scottish National party, in common with the great majority of the Scottish people, supports the concept of a comprehensive Health Service of the highest standard financed from general taxation and available to all at the time of need. That is simply not happening now. The best way to discover the truth about what is happening in the Health Service is to look at what is happening in our hospitals. Such an investigation must lead us all to an indictment of Government policy.

We have heard eloquent testimony from Members of all Opposition parties about the problems that are being created. If the Minister for Health does not believe me, I invite him to visit the casualty ward of any hospital on any Saturday night anywhere in the country. He will see the truth then.

Scotland has the worst health record in the whole of Europe. I regret that the Parliamentary Under-Secretary of State for Scotland is not present, but I know that he will read Hansard. He was certainly in the Chamber earlier. In spite of four excellent medical schools in Scotland, the Scottish health record is the worst in western Europe. No matter how much medical care is provided, it cannot counteract the basic problems in our society of social deprivation, poor housing, poverty and unemployment. Until those social issues are tackled, we will never solve the health problem properly.

Mrs. Currie

I was just about to pick up that point. The hon. Gentleman will be aware that Scotland has more hospitals, doctors and health spending per head of population than the rest of the United Kingdom. It also has the worst health, with a high incidence of preventable disease, especially heart disease. Does not that show that health spending may have rather less to do with preventing disease than the hon. Gentleman thinks? Perhaps lifestyle, including smoking and drinking, may have something to do with it.

Mr. Welsh

They could be factors, but the basic problem involves finance and the tackling of the more general matters that I mentioned. The Government have signally failed to do that. Indeed, they have exacerbated the problem. Their cuts have had a devastating effect on Scotland. For example, Glasgow was faced with £15 million worth of cuts, which meant the loss of 30 consultants, 70 junior doctors and 500 nurses as well as many other staff. That is the reality of the effects of cuts in services.

It is SNP policy to increase the resources available to the National Health Service by approximately 15 per cent, to bring us into line with other EEC countries—and we heard international comparisons made earlier. If that were done, it would make an enormous difference to the National Health Service, but it is not being done. The United Kingdom falls well below the OECD average for health spending.

Every part of the National Health Service in Scotland is short of money, but in certain parts of the service the problem is acute. Finance is required urgently for geriatric and psycho-geriatric care. We need to provide more hospital beds and staff and to release beds in general wards. However, as an interim measure will the Government immediately consider making extra provision for respite facilities for families who look after such patients? Organisations such as Crossroads do an immense amount of work in providing volunteers and help families and carers enormously. However, National Health Service hospitals can also play a greater part if resources are made available for this important aspect of caring. The Government should consider the matter seriously.

We are far from satisfied with NHS provision. We need action and finance now. We need action on waiting lists. Last year, 80,708 people were on hospital waiting lists in Scotland — a 40 per cent, increase on the 1985 figure. The Government say that there are no cuts and no problems. However, I have a letter from Angus local health council whose experience must be typical of that throughout the country. It states: The Council is well acquainted with the cuts in Health Service spending but it is continually informed that patient services have not been affected. However, it has come to light that there is a lack of middle grade support in the Orthopaedic service in Angus which, presumably, has an effect on waiting times and would seem to refute that statement. Angus Local Health Council respectfully requests that Tayside Health Board gives urgent consideration to the employment of a Registrar to assist the Consultant in Angus in an effort to bring waiting times in Orthopaedics down to a tolerable level, thus alleviating the pain, and possible harmful effects of having to take pain-killing drugs over a long period, endured by patients. That illustrates the reality of the cuts that the Government are imposing on the Health Service.

I appeal to the Government to examine the effects of centralisation policies. It seems that for them a cost accountancy measure is more important than health care. There is an acute problem in the town of Arbroath, and it is a sensitive matter. We have lost our specialist acute services at our hospital and every individual and family in the town is having to pay the price of the decision in travelling and other costs. The burden of the cuts is being borne by individual citizens. I ask the Government to reverse the trend of centralising services in the large cities to ensure that towns and rural areas are not left out as is happening in Grampian and Tayside and other areas of Scotland.

Something must be done about nurses' pay and conditions. We are about 9,000 nurses short in Scotland. A report by the National Audit Office directly blames constraints on finance for that. The report says that in 12 of Scotland's health boards the average number of nurses employed represents only 85 per cent, of the establishment indicated by the Aberdeen formula.

We are fortunate in the dedication and selflessness of the nursing profession, but we have taken that far too much for granted in the conditions of service, pay and opportunities that we offer. Investment in our hospitals' work force is essential and must have greater priority.

Will the Minister comment tonight on the pay, conditions of employment and professional status of medical laboratory services officers and other related staff? That important sector of the NHS must get justice. I hope that the Government will listen to their case and give them the priority that they deserve.

Linked to that problem is the provision of cytology services for cervical cancer screening. In Scotland the screening programme is poorly publicised, inadequately funded and sometimes badly organised. It has managed to keep the incidence of the disease steady over the past 15 years, but some 200 women die annually and some of them could be saved if there were the will and the money to set up an effective screening programme.

Finland has shown that that can be done. In that country 90 per cent, of women between the ages of 30 and 59 are screened and the incidence of cervical cancer has been halved. If Finland can do that, we certainly can.

I wish that the Minister would listen, because I should like her to know that the NHS belongs to the people and its success can be seen in the health and personal welfare of each citizen.

Mr. Tom Clarke

Is it not deplorable that, for the second time this evening, the Minister is not listening? Does the hon. Gentleman agree that it is bad enough for the Scottish people to hear lectures from the Chancellor of the Exchequer without hearing from the hon. Lady? Does he further agree that the Select Committee on Scottish Affairs concluded that it cost 20 per cent, more to heat a house in Glasgow than in the Under-Secretary's constituency?

Mr. Welsh

I agree with the hon. Gentleman. I speak for the SNP and Plaid Cymru, but I think that I also speak for every Opposition party when I say that we stand by the NHS. Our message to the Government is that no amount of propaganda or excuses will ever substitute for the finance that our NHS needs and it is about time that the Government listened to that message.

9.7 pm

Mr. Andrew Mitchell (Gedling)

The motion underlines the difficulties and challenges faced by the NHS at this time. No one can be unmoved by the stories of unsatisfied need that have appeared in the press. They were rightly headline stories, but headlines can never record the hundreds of thousands of success stories which occur daily in the NHS.

To a great extent, the problems of inner London are the result of the resource allocation working party. Inner London is losing, and, relatively, will continue to lose, resources with the very great strain that such a policy inevitably imposes on planning and service development. That is the nature of RAWP. As a result, other areas such as that which I represent in Nottinghamshire, which have hitherto been denied their fair share of Health Service resources, have been massive gainers. Of course, we would like more, and, given half a chance, we will lobby, push and shove for more resources. We are still 5 per cent, under our RAWP target, but we have been fortunate.

During the summer, I spent a week visiting the NHS facilities used by my constituents. I cannot think of any other week when I met so many devoted, committed and hard-working individuals. The Health Service is characterised by such people.

Since 1983 the number of doctors in Nottingham has increased by 14 per cent, and waiting lists have been reduced by nearly 30 per cent. There has been exceptional growth in acute services; hardly a month passes by without some new facility coming on stream. There is further evidence of progress, both in priority services and elsewhere, especially in care for the elderly and the mentally handicapped. We are reaping the benefit of RAWP, just as London is feeling the effect of it, yet, compared with my constituents, there is still far more per head spent in London — after allowances for RAWP-determined needs — than in areas such as the Trent region.

I recently completed two and a half years on the Islington health authority. Islington is a heavily RAWPed inner-London district. In the two and a half years that I served on that authority, we had to make some difficult decisions, but Ministers may find a close study of the Islington health authority encouraging. Changing resource allocation has made heavy demands on all who work in the service at every level. I gladly pay tribute to their dedication and hard work.

The authority made a massive saving of £4 million, or 8 per cent, of its total budget, in just over four years. There has been no increase in the waiting lists and the service level has been maintained, although the capacity has been reduced in line with the RAWP requirements. There has been a substantial increase in bed usage. Through competitive tendering there have been no redundancies and more than £250,000 saved in that one district authority alone. At the same time, services have been developed. The much needed colposcopy service, led by Dr. Albert Singer, has come to Islington. The development of Islington's Whittington hospital in three phases—£20 million of major investment in this new district hospital — started only a few days ago. Here, in the heart of London, a heavily RAWPed authority has so far managed to make the necessary structural changes without diminishing its services to the community. That was achieved, at least in part, because Islington has a highly effective and skilled Griffiths management team. Paradoxically, if four years ago the Government had said, "We won't face up to the changes imposed by RAWP in Islington; they are too draconian; we will bail them out and maintain status quo", the service today would be less efficient and more costly than it now is.

Mr. Jeremy Corbyn (Islington, North)

Lest the House should be beguiled by that rosy picture of the Islington health authority, perhaps I should say that the Royal Northern hospital will be completely closed over Christmas because of a cash shortage. It is planned to close the building and possibly to sell the site. In addition, the mid-year crisis has resulted in immediate cuts of £200,000 and there is a constant shortage of beds in the Whittington hospital. Islington does not need the Government vaunting the local staff, which I am happy to do also, but it needs cash now.

Mr. Mitchell

I dispute the facts that the hon. Member for Islington, North (Mr. Corbyn) has put before the House. I have checked the information carefully with the authority today just in case my memory has deteriorated in the two months since I left. In my view, and in that of other members of the authority, the Royal Northern hospital's acute beds should have been closed before now, and it may be to the detriment of the service overall that they have not been.

I fear that London's regional structure may not prove to be an advantage in future. No matter how skilled and dedicated those who run the four regions may be, the job of the four regional management teams is increasingly an impossible one with lines drawn on maps which make meaningless boundaries.

Notwithstanding the Minister's justifiable alarm at reorganisations, I hope that my hon. Friend will keep under review the possible benefits which may be gained from one London-wide regional authority. I hope that he will also bear in mind the need for incentives, motivation and encouragement for districts such as Islington, which have got on with the job of implementing these difficult structural changes.

The real issue before the Health Service where funds are increasing year by year is not how to persuade the Government to dig deeper into the taxpayer's pocket, but how to get more out of what we are already spending and providing, how to improve the quality of the Health Service and how to deliver a better service for the patient. The demands on the National Health Service are infinite. No matter how much money the Government provide, there will always be good claims for more, and the question is this: how can we improve the quality of the service within the existing growing provisions that we are making?

I suggest three key ways in which to do that: first, by putting a major emphasis on developing the internal market within the National Health Service; second, by throwing away the old shibboleths about the private sector and using it in a far more creative way; and, third, by pursuing vigorously the imaginative and innovative ways forward in the field of preventive medicine. All three ideas are improving and will improve the supply of health care to the patients on a universal basis.

On the first, the development of the internal market, progress in information technology will play a vital part. Much more can be done through the implementation of Dr. Köner's proposals on computerising the service. We have the example from the Radcliffe in Oxford where progress has been made in costing different treatments for similar surgical problems. In adjacent areas there are districts with waiting lists for hip replacements and districts without waiting lists. Adjacent areas have duplicated specialties.

The special fund set up by the Government to channel resources directly into reducing waiting lists has had a beneficial side effect in this respect. Coronary by-pass operations in one London hospital cost £3,700 each; in an adjacent hospital not a mile or so away the cost was just one-third, at £1,300. If we strip away the obvious medical and clinical local interests, is it not self-evidently correct that if a region calculates that it needs to undertake, say, 2,000 cardiac operations in the following year, it should set in motion an internal tender to assess where such operations could be done most cost effectively? This sort of internal competition must be supported and developed. It cannot be sensible for every district to seek to do everything. Major savings could be made through the development of the internal market in the National Health Service. Such savings would feed through directly to the benefit of patients and of patient care.

The second suggestion that I support is for closer cooperation with the private sector. That means using each other's facilities certainly, but it also means marketing clinical services within the NHS to generate income for patient care. The Secretary of State has already mentioned the use of pathology laboratories as an example. The general manager of City of London and Hackney health authority has demonstrated another way forward. St. Bartholomew's has excellent breast cancer screening facilities. Certain firms have recognised that this service should be provided privately for the convenience of their female staff. Bart's has bid for and won a contract to supply that service. There is already a mammography machine at the hospital which is used by the NHS between 9 o'clock in the morning and 5 o'clock in the evening. The service is now available in the evening to carry out private screening. The depreciation on the machine is minimal. The staff are happy to work and to be reimbursed at overtime rates. Those staff are on low salaries and they benefit from the extra income.

Such additional income generation should be actively encouraged, particularly in London teaching hospitals. The NHS should seek to participate profitably in an expanding private sector. By doing so the service will get the benefits for staff and for patients.

The third way forward is to pursue vigorously the welcome emphasis already laid on preventive health care. I accept that this is a wider issue involving education from an early age, but the Health Service spends millions, indeed billions, on helping people back to a full and healthy life where better preventive information and testing could have saved an individual from hospitalisation.

I give the example of coronary heart disease. This is the major cause of premature death for men in Britain and the second major cause for women. The British death rate from coronary heart disease is the worst in the world. The cost per year of treating this terrible disease in hospitals is enormous. Through a sustained campaign of education, through assessment of risk carried out at general practice level, and through a national awareness campaign, the cost to the Health Service of treating this disease can be reduced radically. How much could be done has been graphically demonstrated by the success of the AIDS campaign.

My opposition to the motion rests upon the premise that for far too long the Health Service has been regarded as a sacred institution where the only response to almost any question asked of it has been "We must have more money." As discoveries and new technological breakthroughs take place, the same cry inevitably goes up again. We cannot go on like that alone. The emphasis must be on securing more patient services and better health care by using new and creative means of making funds stretch further.

Above all, it is a question of planning. The Griffiths management system has made an excellent start. Those of us who believe in and support the National Health Service—even as I speak, my wife is about to give birth at UCH, one of our great inner-London hospitals—[HON. MEMBERS: "Hear, hear"]—and who have benefited from it are not treacherous because we refuse to take the easy option of always demanding yet more funding from the Secretary of State. In pursuit of better patient care, there are these other ways as well of ensuring that universal health care can be strengthened and promoted.

9.20 pm

Ms. Harriet Harman (Peckham)

I congratulate my hon. Friend the Member for Coventry, North-East (Mr. Hughes) on his welcome maiden speech. I hope that he will continue to make such contributions on this issue which is important to his constituents as well as to us.

It was astonishing that the Minister did not once mention the cuts in services that are the subject of the debate. It is astonishing, too, that against a background of growing complaints from all parts of the country the Government are still saying, "Cuts? What cuts?". It is clear from the speeches on both sides of the House that there are widespread cuts in hospital services throughout the country.

In Cornwall, for instance, in order to avoid a budget deficit, the district health authority has decided to close—temporarily it says—the maternity unit in Penzance. That could mean more than a hour's journey for a woman in labour, which, for some, will be too long and they will arrive too late. It also plans to close Falmouth casualty unit and a medical ward in the hospital in Redruth, and to scrap the hospital car services, which, in a sprawling rural area, would be disastrous.

Cornish Members complain in their constituencies about the cuts, but they have not taken part in the debate and no doubt they will not vote against the cuts that are so damaging to health services in their constituencies. If they are to be believed when they say that they care about their constituents and the Health Service, they must vote for the motion or lose their credibility with their constituents.

Similarly, the Bath health authority is looking to well-woman clinics to make savings to meet a £500,000 budget shortfall. If well-woman clinics are to go under the axe, so much for the prevention of ill health. Incidentally, where is the hon. Member for Bath (Mr. Patten) tonight?

East Anglia has also been hit. Clacton hospital's casualty unit is threatened and the children's unit was closed last month. I have a picture of Lady Ridsdale, the wife of the hon. Member for Harwich (Sir J. Ridsdale), taking part in a protest march against the cuts in Clacton. It is a pity that her husband does not have the guts to vote against the cuts which are so hurting his constituents.

Sir Julian Ridsdale

I hope that the hon. Lady listened to my speech. I am advocating value for money from the North-East Essex health authority before pressing the Government for more funds.

Ms. Harman

The hon. Gentleman's constituents in the protest march in which his wife took part were complaining about the cuts in Clacton hospital's services, and the idea that the fault can be attributed to inefficiencies is nonsense.

Berkshire is also suffering tremendous health cuts. £1.3 million is being cut through the cancellation of operations on 3,500 patients, many of whom have already waited months for their operations. The hon. Member for Reading, East (Sir G. Vaughan) is quoted in a newspaper as saying: This is not on—we will not put up with these cuts". I say to him: absolutely right. Now is the hon. Gentleman's chance to show that he means what he says. He must vote with us if he wants to show the Government that he means business, or it will be clear to those on frozen waiting lists in Berkshire that he is engaging in a cynical public relations exercise.

Recently, I was amazed to hear the right hon. Member for Castle Point (Sir B. Braine) roaring like a lion in a meeting with a couple of hundred people concerned about the closure of Southend's cancer unit. He roars like a lion when talking to his constituents, but he is like a mouse here—he will troop behind the Government into the lobby to vote for cuts that will finish off the cancer unit in Southend.

The Government's failure to fund Shropshire health authority adequately—

Mr. Newton

I am sorry to interrupt the hon. Lady, but I notice that my right hon. Friend the Member for Castle Point (Sir B. Braine) is not in the Chamber. I should make it clear that he and all the other hon. Members concerned with Southend had a meeting with my right hon. Friend the Secretary of State and made their points very forcefully. As I suspect the hon. Lady knows, the North-East Thames proposals for cancer services in Essex can in no sense be described as cuts. They entail additional expenditure.

Ms. Harman

When the right hon. Member for Castle Point was speaking to his constituents, he said that it was cuts because of underfunding.

In Shropshire the failure of the Government adequately to fund the health authority has led to plans to close Ellsmere cottage hospital, Market Drayton cottage hospital, Monkmore hospital, Much Wenlock cottage hospital, Newport cottage hospital, Oswestry and district hospital and the Wellington cottage hospital and to introduce further bed reductions at the Royal Shrewsbury hospital. I hope that hon. Members representing the people who will lose those local services in Shropshire will join the Opposition and say to the Government that Shropshire should get the new Telford hospital and be allowed to keep the much needed local services.

London has also been hard hit.

Mr. Bruce Grocott (The Wrekin)

I entirely endorse what my hon. Friend says about Shropshire. I assure her that at least one Shropshire Member will be voting against the Government. I assure my hon. Friend and the House that before the last general election trade unions in the Health Service and the whole of the Labour party in Shropshire warned the public about the impending cuts and were accused by their political opponents of scaremongering. We now see who was right.

Mr. Corbyn

Is my hon. Friend aware that London Health Emergency has just produced a report that has been published today in the London Evening Standard? It shows that mid-year budget cuts of £22 million are being made in London authorities. It says that 600 beds have been closed in London in the financial year since April, that every hospital in London is in some kind of crisis and that the London ambulance service is in permanent crisis.

The report says that there are only 30 controllers on at any one time and that at last week's King's Cross fire 85 ambulances should have been available but there were only 40. Should a major tragedy occur in London of much greater proportions than the King's Cross tragedy, the emergency services in the hospitals or the ambulance service will not be there to meet it. We do not need another decade of £100 million worth of cuts in London, but an urgent and immediate injection of cash into London.

Ms. Harman

My hon. Friend the Member for Islington, North (Mr. Corbyn) is right about the pressure on services in London. It is a bitter irony that the doctors and nurses who are caring in University College hospital for the victims of the King's Cross fire are demoralised because there is not a proper burns unit. They fear that the application by the district health authority to the regional health authority for a proper burns unit will be turned down and that they will have to carry on in the temporary accommodation that they have been in for the last two years, and that they have to share with other surgeons.

My hon. Friend the Member for Birmingham, Hodge Hill (Mr. Davis) spoke about the sad state of the health services in Birmingham and told us about an all-party deputation to the Minister to ask for more money. I hope that the five Conservative Members who went with him in that delegation to the Minister will also vote to back that pressure for more money in the region.

We have heard much hypocrisy from Conservative Members about cuts in the Health Service. They are prepared to defend it locally, but will do nothing nationally to improve its circumstances. The cuts that I have mentioned and those that have been listed by other hon. Members are inevitably bound to lead to longer waiting lists. The tragedy of the waiting list is not just the pain that people suffer while they are waiting. It also means that they are less likely to make a full recover} when they are finally treated, because their condition may have deteriorated.

The man who waits months for a hernia operation may find that he has lost his job by the time that he is treated and again fit for work. The elderly woman waiting for a hip replacement may find that she never makes a lull recovery and gets back to leading a full life after her operation because months of isolation and immobility have made it impossible for her to get back to her normal life.

Long waiting lists are inefficient. The best way to treat people is when they need to be treated, not when they finally come to the end of a long queue.

I suspect that the Government are not unhappy about waiting lists. Like my hon. Friend the Member for Wakefield (Mr. Hinchliffe), I believe that they are content to watch queues grow so that more people will become desperate and be driven into the commercial health care sector for treatment.

Cuts waste Health Service facilities. A recent National Audit Office report showed that only about half of available Health Service theatre time was being used; expensive operating theatres lie idle as waiting lists grow. After the cuts that have been made—many more are in the pipeline — there will be even less use of valuable facilities.

It is clear that hospitals are short of money for three reasons. First, the Government have failed to give health authorities enough to cover medical inflation. Secondly, they have failed to give health authorities enough to cover pay awards; low pay is still endemic in the Health Service. Thirdly, they have failed to give health authorities enough money to meet the increasing demand for health care by a growing number of elderly people.

The Secretary of State and his Ministers have fallen into the habit of talking about "the insatiable, escalating demand of the Health Service." We are hearing that more and more, but one must bear in mind when one hears those words that our Health Service is a bargain.

Mr. Whitney

rose—

Ms. Harman

I shall give way to the hon. Member in a minute.

We spend far less on health care than the United States because we have a better system. For the amount that we spend we receive a better service. Far from being insatiable, our Health Service is run on a shoestring. The increase in demand is not escalating, which could have been predicted, and it is growing no faster or slower than the service in any other comparable country.

The Government see medical advance as a problem, because it creates demand for extra resources. We do not see medical advances as a problem but as an enormous and marvellous opportunity to cure and heal people who could not have been cured in the past. The "insatiable escalating demand" myth is put about to soften everyone up for major changes in the way that our Health Service is funded, and that is what the Government are aiming for.

People such as the hon. Member for Wycombe (Mr. Whitney) say that we cannot afford it out of taxes, so the Government will have to find other ways of funding the Health Service system. In that way he is a stalking horse for the Government's hidden agenda.

Mr. Whitney

Does the hon. Lady understand that there is a difference between the two propositions that she is trying to put to the House? First, she says that the NHS is run on a shoestring; I prefer to say that its administrative costs are low, as indeed they are. The second proposition, which she is trying to link with it, is that the only people who say that the Health Service costs are insatiable are Conservative Ministers. If she knew anything about history she would know that every Labour Minister of Health or Secretary of State for Social Services, from Aneurin Bevan to Lord Ennals, has said that demand is insatiable.

Ms. Harman

It is true that the Health Service needs extra money; it needs an extra £200 million, not the extra hundreds of billions that the hon. Gentleman is talking about. It is perfectly possible for Health Service needs to be met from a tax-based system. It would be disastrous if we were to move away from that.

We should be striving to improve the quality of care in the Health Service. The Government should be urging managers and administrators to find new ways to improve services. Instead the Government are urging managers and administrators to divert their attention to making more money. We want the Health Service to give priority to surgery, not supermarkets. We want it to be concerned about cancer, not caravan sites.

Let no one believe that there would be extra money for the Health Service. If any health authority managed to make money the Government would immediately say that it needed less from public funds. It is a tragedy, at a time when medical advance can do so much more, that the Health Service, which should be reaching out for new opportunities to treat illness, is being hobbled by spending restrictions. We should seize the opportunity dramatically to improve the chances of restoring to full recovery those who previously would have had no chance of getting well.

I shall mention some points relating to nurses. The matter has been highlighted by the right hon. Member for Brentford and Isleworth (Sir B. Hayhoe) and by my hon. Friend the Member for Bolton, South-East (Mr. Young), although he failed to get any response from the Minister. There has been enormous public concern, particularly focused on baby David Barber. Everyone must have been touched by the ordeal of parents who, to get their child the operation that he needed, had to resort to taking up their case with the media and, finally, taking it to court. Sadly, that is not an isolated case. Throughout the country, in all constituencies, beds and wards are being closed and operations are being postponed because of a shortage of nurses.

The Health Service is losing experienced nurses at the rate of 30,000 every year. Of course, the problem is particularly acute in London and Birmingham, but the shortage occurs in all parts of the country, as far apart as Norwich, Gwent, Cumbria and Oxfordshire. Patients suffer when there are not enough nurses. When patients finally go into hospital, nurses do not have enough time to nurse them in the way in which they want.

Obviously, it is important to do what we can to step up recruitment, but, of itself, recruitment is not enough to solve the problem. We cannot recruit fast enough, particularly for specialties such as theatre work, eye work, and orthopaedic nursing work. With recruitment, we are replacing experienced nurses with inexperienced nurses. Anyway, there is a growing problem with recruitment. Yesterday, the Norwich health authority told me that, two years ago, it had 3,000 applications for 200 places in its school of nursing. This year, it had barely 200 applicants. It cannot pick or choose. It has hardly enough applicants to fill the places. If the poll tax is imposed on student nurses, recruitment will no doubt be further choked off.

The Government have been blinking with disingenuous concern about the shortage of nurses. It has been exasperating to see Ministers appear on television and say, "Yes, we are so worried about the nursing shortage. Nothing to do with us; nothing to do with resources." But it has everything to do with the Government and everything to do with money.

I was astonished that the junior health Minister has tried to deny that nurses are low paid. Let me remind her of the facts. After three years' training, a nurse who has worked during her training gets no more than £7,300 a year. Take the case of Jackie Eliott, who has just set up the new AIDS ward in Middlesex hospital. As part of her job, she has twice had to appear on Terry Wogan's show, she has had to put together a new nursing team, and she has the clinical challenge of dealing with a new area of medicine. What does she get paid for that? She gets less than £12,000 a year.

Nurses are leaving because of low pay, stress and overwork, and because the anti-social hours of their work do not fit well with the child care responsibilities that fall on women in this society. As the right hon. Member for Brentford and Isleworth rightly said, if the Government actually wanted to solve the problem of the shortage of nurses, they would do three things. First, they would put up nurses' pay; secondly, they would make district health authorities arrange more flexible hours for nurses who have children, to encourage them back after maternity leave; and, thirdly, they would make child care provision for nurses' pre-school age children, again to provide a powerful incentive for married nurses with children to stay in the Health Service. But they do not do that, do they? The reason is that they are happy to see district health authorities underspend on their nursing budgets because, as far as the Government are concerned, that is a great way of saving money.

The nurse managers to whom I have spoken in the past few days say that they have already had to impose a recruitment freeze in their district health authorities to try to meet this year's deficit. Next year, they will have no option but to go for a recruitment freeze in respect of nurses, too. If the Government do not take steps to avoid that disaster, they will be held directly responsible for the dreadful effects that the growing shortage of nurses will cause.

Hon. Members have made it quite clear that, in every town, city and village, and in urban and rural regions in the north and south of the country, as a matter of their personal everyday experience, people feel that health services are being cut. The Government must act to protect and improve our Health Service, because it is one of the most valuable assets that the people of this country have.

9.39 pm

The Parliamentary Under-Secretary of State for Health and Social Security (Mrs. Edwina Currie)

This has certainly been a lively debate. Sadly, it has not always been a good humoured one.

My right hon. Friend the Secretary of State would, I am sure, wish me first to thank hon. Members for their good wishes for his speedy recovery. The House may also wish to join me in the hope that he has had a happy and restful 50th birthday.

I add my congratulations to those of the hon. Member for Peckham (Ms. Harman) to tonight's maiden speaker, the hon. Member for Coventry, North-East (Mr. Hughes). I merely say to him that his concerns about the Morris engine factory are recognised, but that he may want to think how many of his hon. Friends are toddling around in foreign cars and whether they might give that company a little more support. [Interruption.] I drive a British car.

Some 20 hon. Members have spoken in the debate, and many have expressed concern about the allocation of money. There have been faults of fact, and faults of emphasis. However, let me make it clear that every one of the health authorities about which we have heard tonight has had more money under the present Government. Nearly all of them have had more direct care staff—in many cases considerably more—and they are all caring for far more patients than ever before. The debate has therefore been a little disappointing for many hon. Members who have not addressed themselves to the question other than in a very superficial way. At least the new hon. Member for Strathkelvin and Bearsden (Mr. Galbraith) had the grace to say that he did not know the answers. For all his words about initial opposition to the Health Service when it was first established in 1948, it was most bitterly opposed by the consultants. One of the reasons was that they feared that their incomes would be cut, a fear that proved unfounded.

My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) asked whether we could fund the Health Service through a new stamp. That, however, would merely be another form of taxation, and it would end up coming out of the same pocket as the present system.

Many hon. Members from the west midlands have spoken tonight. It is probably worth remembering that Birmingham is not the whole of the west midlands, and that currently under construction as part of the West Midlands regional health authority's capital allocation, which is the biggest in the country, are the £25 million district general hospital at Telford, the £21 million development at Stoke City general hospital and developments at Cheadle, Nuneaton, Warwick, Dudley, Sandwell and Walsall — the latter being a £20 million development at the Manor hospital. We have not heard much from the hon. Members representing those areas, because they do not have much to whinge about.

Ms. Joan Walley (Stoke-on-Trent, North)

We have heard a good deal about what has happened to the West Midlands health authority. However, following the comments made earlier about the political aspects, may I ask why the West Midlands regional health authority was allowed to build up its budget in excess of £20 million in the pre-election period?

Why do we now have such a large overspend? The answer is that we have marginal seats throughout the west midlands, which the Government needed to win. Moreover, I now understand that, as a result of a meeting yesterday, the capital schemes to which the Minister referred will be cut back over the coming year and we shall lose those projects.

Mrs. Currie

I am afraid that I did not catch all of what the hon. Lady said. However, I know that there is a meeting on 9 December at which the regional health authority will sort out the capital programme. It is not true that the new children's hospital is being postponed indefinitely.

Another west midlands Member, the hon. Member for Birmingham, Perry Barr (Mr. Rooker), complained bitterly about some of his constituents undergoing dialysis on the bus coming down here. The hon. Gentleman probably misunderstood their form of dialysis. They are undergoing CAPD, or continuous ambulatory peritoneal dialysis. They receive it all the time, and can move around while they receive it. In fact, they are receiving their dialysis whether on a bus or anywhere else. He should not complain about those people.

In his opening speech my hon. Friend the Minister for Health acknowledged that the Health Service has problems. I hope to argue that the sole solution of additional resources put forward by the Opposition in their motion is not the answer, or at least not the sole answer. We have been putting additional resources into the Health Service, and we will be putting more resources in. Funding is running at record levels and the largest amount of cash ever entrusted to the Health Service since its formation is now being spent. Hon. Members will say that that is not enough. I say that it never was enough and it never will be enough.

Mr. Lofthouse

It was better than this.

Mrs. Currie

Oh no, it was not.

My hon. Friend the Member for Bexhill and Battle (Mr. Wardle) was right in saying that the nature of the demand for health care is that it grows to outstrip all resources put into it. It always has and it always will. There will always be a gap between expectations, which rise without limit, and resources, which are finite, which are increased year by year to try to meet those expectations but never succeed. That is why part of the answer is to do as my hon. Friend the Member for Gedling (Mr. Mitchell) said in his first-class speech. We should use what we have more efficiently, do all that we can to keep people fit in the first place and help them get better quicker when they are ill. These are not new problems. They are not new to this Government, and they are not new to Britain.

Mr. Robin Cook

If what we are experiencing is the same old story that has been going on for years, will the Minister comment on today's statement by Julia Cumberlege, the chairwoman of the National Association of Health Authorities, who observed: I cannot remember the service being as short of funds as it is at the moment."?

Mrs. Currie

Mrs. Cumberlege is a brainy lady. Part of the answer lies in a quotation from a paper written by another brainy lady, who said: demand will always outstrip our capacity to meet it. That was said by Mrs. Barbara Castle when she was Secretary of State 10 years ago.

The Health Service, as has been said repeatedly, is partly a victim of its own success. In 1975, 11 babies in every 1,000 born alive died within the first month of birth. Now it is fewer than half that. Ten years ago — [Interruption.] The hon. Member for Rhondda (Mr. Rogers) is not interested in what happens to sick babies.

Ten years ago only 200 babies born weighing under 1,000 g survived. The figure is heading for 1,000 babies this year. A total of 3,000 babies are alive every year who could not have survived 10 years ago, and they include many of the babies about whom such concern has rightly been expressed this week.

The hon. Member for Perry Barr spoke about dialysis. We have heard about that from several hon. Members tonight. We have more patients in this country with a successful transplant — over 7,000 — than any other country in Europe. We do more transplants — 1,600 a year—than any other country. In 1980 only three out of five patients with a kidney transplant would have had that kidney functioning after a year. By 1985 the figure was 77 per cent. That is marvellous, but it puts—

Mr. Galbraith

Will the Minister give way?

Mrs. Currie

I have given way twice and that is enough. I wonder how many—

Mr. Galbraith

rose—

Mr. Speaker

Order. If the Minister does not give way—

Mr. Frank Cook

On a point of order, Mr. Speaker.

Mr. Speaker

Is it a point of order?

Mr. Cook

Yes, Sir. I must seek your guidance. I have never been in a debate where a Minister has intervened more than the Minister did tonight. The Minister has had many chances to intervene in other speeches, and Back Bench Members should have a chance to intervene in the Minister's speech.

Mr. Speaker

Order. The principle remains that if the Minister does not give way the hon. Gentleman must sit down.

Mrs. Currie

If Opposition Members are so keen on dialysis, they should encourage everyone to carry a kidney donor card, because that would help many patients.

Mr. Galbraith

rose—

Mrs. Currie

No, I shall not give way.

Life expectancy in this country is rising fast, at the rate of two years every decade. A baby girl born today can reasonably expect to reach the year 2067, when she will be 80. By the end of this century, we expect to have 4.5 million people who are over the age of 75. We already have the largest proportion of retired people to population in the world, barring Sweden. Our life expectancy is much higher than in many other countries which spend far more on health, such as the United States.

Those are the successes of the Health Service, but they do not come cheap. A heart transplant costs about £10,000, bone marrow transplants about £15,000 and the daily cost of an in-patient is £84 today, compared with less than £40 in 1978. The cost in a London post-graduate hospital, such as the Brompton or the National Heart hospital, varies per patient between £1,600 and £1,900 per week. Costs are rising sharply, and not only for acute care. Anyone who reads Hansard carefully will have spotted a debate on Tuesday on the special hospitals at Rampton and Broadmoor. The cost of keeping one patient in such a hospital was about £14,000 per year in 1980, but was £32,000 last year.

We are faced with rapid escalations of medical possibilities and, as a result, rapid increases in demand. There are also pressures on intensive and specialist facilities. We recognise that and the pressure that that places on the skilled and scarce staff who are required. However, costs have a nasty tendency to spiral right out of control.

Hon. Members of all parties talk constantly as if there was a correct level of NHS funding, which was once achieved or which might be achieved. But that is not true, and it has never been true. If we go back to the heady days of 1946, so eloquently described by the hon. Member for Stockton, North (Mr. Cook) — we wonder whether he wrote his speech and understands what the Korner reforms really are—it was said then that it might prove a little costly to make a once-and-for-all improvement in the health of the population, but that all that would be required after thatwould be a modicum of expenditure to keep people well. How wrong they were. Nobody seemed to realise that there would be virtually unlimited demand for health care.

Mr. Frank Cook

rose—

Mrs. Currie

I understand that fact, and if the hon. Gentleman sits down I shall tell him.

Mr. Cook

rose—

Mr. Speaker

Order. The hon. Gentleman knows perfectly well that if the Minister does not give way he must not persist.

Mrs. Currie

I am so sorry if I have insulted the hon. Gentleman.

Health Ministers in Sweden, Italy, France and Australia all understand that there is virtually unlimited demand for health care. Even Health Ministers in the Soviet Union recognise that. I have a copy of an article that appeared in The Health Service Journal on 15 October 1987, headed: Soviet union may opt to boost private healthcare". I understand that in mid-August the Soviet Council of Ministers issued an extensive policy on restructuring the health service, which included, reorganising hospitals on a cost-efficiency basis. My hon. Friends and I know that there is virtually unlimited demand for health care and that it can never be satisfied and even the Soviet Union knows it. Why do Opposition Members not understand it? Every Minister who stands at the Dispatch Box knows it.

There is no correct level of funding at which all the problems would disappear; nor is there a correct level of pay at which we should suddenly be able to recruit all the staff that we need. We already employ more than 1.25 million people in the Health Service. We are the third largest employer in the world, after Indian railways and the Red Army.

Mr. Ray Powell (Ogmore)

On a point of order, Mr. Speaker.

Mr. Speaker

Order. I hope that it is a point of order and not a point of argument.

Mr. Powell

I am begging your indulgence, Mr. Speaker. I believe that you are here to protect the interests of all Members of the House, and in particular Back Benchers. I appeal to you to ask the Minister, when she names individual hon. Members, at least to have the courtesy to allow them to intervene in the debate.

Mr. Speaker

Order. Every hon. Member and even every Minister must make his or her own speech—it is not a matter for the Chair—provided that it is in order.

Mr. Powell

The Minister has made nine speeches tonight.

Mrs. Currie

I wish to raise only two more points, as Opposition Members, with their spurious points of order, have pinched most of my time. First, what would happen if we took Labour's advice and let go with the finance? Secondly, what sort of NHS would we have again if the Labour party was in control? Suppose we were to say "OK, spend as much as you want." We are already spending £21 billion on the NHS.

Ms. Harman

Will the Minister give way?

Mrs. Currie

How much money would be enough— £30 billion, or £40 billion? If we had increases—

Ms. Harman

Will the Minister give way?

Mrs. Currie

No. Sit down! — we would see an immediate and swingeing increase in tax. We would see rapid rises in inflation and we would see a reversal of recent improvements—[Interruption.]—in the economy.

Mr. Speaker

Order. There are four minutes to go and I appeal to the House to hear the Minister.

Mrs. Currie

We would see an increase in unemployment instead of a fall.

Ten years ago a British Chancellor, who had cheerfully let rip with pay rises and spending increases, was hauled off a plane at Heathrow and forced to go to the IMF, not as one of the wealthy lender nations, which we are now, but cap-in-hand like some poverty-striken Third world country to beg for help to pay his debts [Interruption.] We were bankrupt. Then what happened to the NHS? That year the nurses had a 5 per cent, pay rise—that does not compare with this year's 9.5 per cent, pay award— and inflation was 15 per cent. As my hon. Friends have said, nurses had a 10 per cent, cut in pay that year, the following year and the year after that. By the time the Labour party lost power the real income of, nurses had declined by more than 20 per cent, and it took a long time to catch up.

The Labour party closed beds and hospitals. Indeed, under the previous Labour Government more than 270 hospitals were closed—far more than we are ever likely to close. We could increase spending, but if we did what the Opposition wanted—[Interruption.]—They do not like it do they?—we could increase spending but once. The following year the bills would come in and they would have to be paid. It is far better to have steady real growth of 1 or 2 per cent, a year, because we could then have a strong economy, the envy of the world and a strong Health Service, with the firm knowledge of more to come for years to come.

What sort of Health Service would we have if the Labour party was in charge? It would abolish charges, and as a result the Labour party would lose the NHS £500 million without any improvement in the services to patients. It would lose the NHS £300 million by the stopping of competitive tendering and the sale of property. It would do all in its power to stop income generation, which we believe will bring us £70 million. It would abolish pay beds, with all the money that they bring in. The Labour party would squeeze the drug companies so that many would stop undertaking research. And then the Labour party would nationalise them. That is the kind of Health Service that the Labour party would run.

Worst of all, the Opposition would run the Health Service, not for the benefit of the patient, but for the benefit of the unions, their paymasters — [HON. MEMBERS: "Hear, hear."]—who wrote their speeches for them tonight. That is how they did it last time, and that is how they will do it again. The results of the Opposition running the Health Service were record waiting lists of three quarters of a million people.

Mr. Don Dixon (Jarrow)

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, 205, Noes, 326.

Division No. 84]	[10 pm
AYES
Abbott, Ms Diane	Gordon, Ms Mildred
Adams, Allen (Paisley N)	Gould, Bryan
Allen, Graham	Graham, Thomas
Alton, David	Griffiths, Win (Bridgend)
Anderson, Donald	Grocott, Bruce
Archer, Rt Hon Peter	Hardy, Peter
Armstrong, Ms Hilary	Harman, Ms Harriet
Ashley, Rt Hon Jack	Hattersley, Rt Hon Roy
Ashton, Joe	Haynes, Frank
Barnes, Harry (Derbyshire NE)	Heffer, Eric S.
Barnes, Mrs Rosie (Greenwich)	Henderson, Douglas
Barron, Kevin	Hinchliffe, David
Battle, John	Hogg, N. (C'nauld & Kilsyth)
Beckett, Margaret	Holland, Stuart
Bell, Stuart	Home Robertson, John
Bennett, A. F. (D'nt'n & R'dish)	Howell, Rt Hon D. (S'heath)
Bermingham, Gerald	Howells, Geraint
Bidwell, Sydney	Hoyle, Doug
Blair, Tony	Hughes, John (Coventry NE)
Boateng, Paul	Hughes, Robert (Aberdeen N)
Boyes, Roland	Hughes, Roy (Newport E)
Bradley, Keith	Hughes, Sean (Knowsley S)
Bray, Dr Jeremy	Hughes, Simon (Southwark)
Brown, Gordon (D'mline E)	Illsley, Eric
Brown, Nicholas (Newcastle E)	Ingram, Adam
Brown, Ron (Edinburgh Leith)	Janner, Greville
Buchan, Norman	John, Brynmor
Buckley, George	Jones, Barry (Alyn & Deeside)
Callaghan, Jim	Jones, Ieuan (Ynys Môn)
Campbell-Savours, D. N.	Jones, Martyn (Clwyd S W)
Canavan, Dennis	Kilfedder, James
Cartwright, John	Lamond, James
Clark, Dr David (S Shields)	Leadbitter, Ted
Clarke, Tom (Monklands W)	Leighton, Ron
Clay, Bob	Lewis, Terry
Clelland, David	Litherland, Robert
Cohen, Harry	Livingstone, Ken
Coleman, Donald	Livsey, Richard
Cook, Robin (Livingston)	Lloyd, Tony (Stretford)
Corbett, Robin	Lofthouse, Geoffrey
Corbyn, Jeremy	Loyden, Eddie
Cousins, Jim	McAllion, John
Cox, Tom	McAvoy, Tom
Crowther, Stan	McCartney, Ian
Cryer, Bob	Macdonald, Calum
Cummings, J.	McFall, John
Cunliffe, Lawrence	McKay, Allen (Penistone)
Cunningham, Dr John	McKelvey, William
Darling, Alastair	McLeish, Henry
Davies, Rt Hon Denzil (Llanelli)	McWilliam, John
Davis, Terry (B'ham Hodge H'l)	Madden, Max
Dixon, Don	Mahon, Mrs Alice
Dobson, Frank	Mallon, Seamus
Doran, Frank	Marek, Dr John
Douglas, Dick	Marshall, David (Shettleston)
Duffy, A. E. P.	Marshall, Jim (Leicester S)
Dunnachie, James	Martin, Michael (Springburn)
Eadie, Alexander	Martlew, Eric
Eastham, Ken	Maxton, John
Ewing, Mrs Margaret (Moray)	Meacher," Michael
Fatchett, Derek	Meale, Alan
Faulds, Andrew	Michael, Alun
Fearn, Ronald	Michie, Bill (Sheffield Heeley)
Field, Frank (Birkenhead)	Michie, Mrs Ray (Arg'l & Bute)
Fields, Terry (L'pool B G'n)	Millan, Rt Hon Bruce
Fisher, Mark	Mitchell, Austin (G't Grimsby)
Flannery, Martin	Moonie, Dr Lewis
Flynn, Paul	Morgan, Rhodri
Foot, Rt Hon Michael	Morley, Elliott
Foster, Derek	Morris, Rt Hon A (W'shawe)
Foulkes, George	Morris, Rt Hon J (Aberavon)
Fraser, John	Mowlam, Mrs Marjorie
Fyfe, Mrs Maria	Mullin, Chris
Galbraith, Samuel	Murphy, Paul
Galloway, George	Nellist, Dave
Garrett, John (Norwich South)	Oakes, Rt Hon Gordon
George, Bruce	O'Brien, William
Godman, Dr Norman A.	O'Neill, Martin

Orme, Rt Hon Stanley	Spearing, Nigel
Patchett, Terry	Stott, Roger
Pendry, Tom	Straw, Jack
Pike, Peter	Taylor, Matthew (Truro)
Powell, Ray (Ogmore)	Thomas, Dafydd Elis
Prescott, John	Thompson, Jack (Wansbeck)
Primarolo, Ms Dawn	Turner, Dennis
Quin, Ms Joyce	Vaz, Keith
Radice, Giles	Wall, Pat
Redmond, Martin	Wallace, James
Rees, Rt Hon Merlyn	Walley, Ms Joan
Reid, John	Wareing, Robert N.
Richardson, Ms Jo	Welsh, Andrew (Angus E)
Roberts, Allan (Bootle)	Welsh, Michael (Doncaster N)
Robinson, Geoffrey	Williams, Rt Hon A. J.
Rogers, Allan	Williams, Alan W. (Carm'then)
Rooker, Jeff	Wilson, Brian
Ross, Ernie (Dundee W)	Winnick, David
Rowlands, Ted	Wise, Mrs Audrey
Ruddock, Ms Joan	Worthington, Anthony
Salmond, Alex	Wray, James
Sedgemore, Brian	Young, David (Bolton SE)
Sheldon, Rt Hon Robert
Shore, Rt Hon Peter	Tellers for the Ayes:
Skinner, Dennis	Mrs. Llin Golding and Mr. Frank Cook.
Smith, Andrew (Oxford E)
Soley, Clive

NOES
Aitken, Jonathan	Carttiss, Michael
Alexander, Richard	Cash, William
Alison, Rt Hon Michael	Chalker, Rt Hon Mrs Lynda
Allason, Rupert	Channon, Rt Hon Paul
Amess, David	Chapman, Sydney
Amos, Alan	Chope, Christopher
Arbuthnot, James	Churchill, Mr
Arnold, Jacques (Gravesham)	Clark, Hon Alan (Plym'th S'n)
Arnold, Tom (Hazel Grove)	Clark, Dr Michael (Rochford)
Ashby, David	Clark, Sir W. (Croydon S)
Aspinwall, Jack	Clarke, Rt Hon K. (Rushcliffe)
Atkins, Robert	Coombs, Anthony (Wyre F'rest)
Baker, Rt Hon K. (Mole Valley)	Coombs, Simon (Swindon)
Baker, Nicholas (Dorset N)	Cope, John
Baldry, Tony	Couchman, James
Banks, Robert (Harrogate)	Cran, James
Batiste, Spencer	Critchley, Julian
Bellingham, Henry	Currie, Mrs Edwina
Bendall, Vivian	Curry, David
Bennett, Nicholas (Pembroke)	Davies, Q. (Stamf'd & Spald'g)
Benyon, W.	Davis, David (Boothferry)
Bevan, David Gilroy	Day, Stephen
Biffen, Rt Hon John	Devlin, Tim
Biggs-Davison, Sir John	Dickens, Geoffrey
Blaker, Rt Hon Sir Peter	Dicks, Terry
Body, Sir Richard	Douglas-Hamilton, Lord James
Boswell, Tim	Dover, Den
Bottomley, Peter	Dunn, Bob
Bottomley, Mrs Virginia	Durant, Tony
Bowden, A (Brighton K'pto'n)	Dykes, Hugh
Bowden, Gerald (Dulwich)	Eggar, Tim
Bowis, John	Emery, Sir Peter
Braine, Rt Hon Sir Bernard	Evans, David (Welwyn Hatf'd)
Brazier, Julian	Evennett, David
Bright, Graham	Fairbairn, Nicholas
Brittan, Rt Hon Leon	Fallon, Michael
Brooke, Hon Peter	Farr, Sir John
Brown, Michael (Brigg & Cl't's)	Favell, Tony
Browne, John (Winchester)	Fenner, Dame Peggy
Bruce, Ian (Dorset South)	Field, Barry (Isle of Wight)
Buchanan-Smith, Rt Hon Alick	Finsberg, Sir Geoffrey
Buck, Sir Antony	Fookes, Miss Janet
Budgen, Nicholas	Forsyth, Michael (Stirling)
Burns, Simon	Forth, Eric
Burt, Alistair	Fowler, Rt Hon Norman
Butcher, John	Fox, Sir Marcus
Butler, Chris	Franks, Cecil
Butterfill, John	Freeman, Roger
Carlisle, John, (Luton N)	French, Douglas
Carlisle, Kenneth (Lincoln)	Fry, Peter
Carrington, Matthew	Gale, Roger

Gardiner, George	Lamont, Rt Hon Norman
Garel-Jones, Tristan	Lang, Ian
Gill, Christopher	Latham, Michael
Gilmour, Rt Hon Sir Ian	Lawrence, Ivan
Glyn, Dr Alan	Lawson, Rt Hon Nigel
Goodhart, Sir Philip	Leigh, Edward (Gainsbor'gh)
Goodlad, Alastair	Lennox-Boyd, Hon Mark
Goodson-Wickes, Dr Charles	Lightbown, David
Gorman, Mrs Teresa	Lloyd, Sir Ian (Havant)
Gow, Ian	Lloyd, Peter (Fareham)
Gower, Sir Raymond	Lord, Michael
Grant, Sir Anthony (CambsSW)	Luce, Rt Hon Richard
Greenway, Harry (Ealing N)	Macfarlane, Neil
Greenway, John (Rydale)	MacKay, Andrew (E Berkshire}
Gregory, Conal	Maclean, David
Griffiths, Sir Eldon (Bury St E')	McLoughlin, Patrick
Griffiths, Peter (Portsmouth N)	McNair-Wilson, M. (Newbury)
Grist, Ian	McNair-Wilson, P. (New Forest)
Ground, Patrick	Madel, David
Grylls, Michael	Major, Rt Hon John
Gummer, Rt Hon John Selwyn	Malins, Humfrey
Hamilton, Hon A. (Epsom)	Mans, Keith
Hamilton, Neil (Tatton)	Maples, John
Hampson, Dr Keith	Marland, Paul
Hanley, Jeremy	Marlow, Tony
Hannam, John	Marshall, John (Hendon S)
Hargreaves, A. (B'ham H'll Gr')	Marshall, Michael (Arundel)
Hargreaves, Ken (Hyndburn)	Martin, David (Portsmouth S)
Harris, David	Maude, Hon Francis
Haselhurst, Alan	Mayhew, Rt Hon Sir Patrick
Hawkins, Christopher	Mellor, David
Hayes, Jerry	Miller, Hal
Hayward, Robert	Mills, Iain
Heathcoat-Amory, David	Miscampbell, Norman
Heddle, John	Mitchell, Andrew (Gedling)
Hicks, Mrs Maureen (Wolv' NE)	Mitchell, David (Hants NW)
Higgins, Rt Hon Terence L.	Moate, Roger
Hill, James	Monro, Sir Hector
Hind, Kenneth	Montgomery, Sir Fergus
Hogg, Hon Douglas (Gr'th'm)	Morris, M (N'hampton S)
Holt, Richard	Morrison, Hon C. (Devizes)
Hordern, Sir Peter	Morrison, Hon P (Chester)
Howard, Michael	Moss, Malcolm
Howarth, Alan (Strat'd-on-A)	Moynihan, Hon C.
Howarth, G. (Cannock & B'wd)	Neale, Gerrard
Howe, Rt Hon Sir Geoffrey	Needham, Richard
Howell, Ralph (North Norfolk)	Nelson, Anthony
Hughes, Robert G. (Harrow W)	Neubert, Michael
Hunt, David (Wirral W)	Newton, Tony
Hunt, John (Ravensbourne)	Nicholls, Patrick
Hurd, Rt Hon Douglas	Nicholson, David (Taunton)
Irvine, Michael	Nicholson, Miss E. (Devon W)
Irving, Charles	Onslow, Cranley
Jack, Michael	Oppenheim, Phillip
Jackson, Robert	Page, Richard
Janman, Timothy	Paice, James
Jessel, Toby	Patnick, Irvine
Johnson Smith, Sir Geoffrey	Patten, Chris (Bath)
Jones, Robert B (Herts W)	Patten, John (Oxford W)
Jopling, Rt Hon Michael	Pattie, Rt Hon Sir Geoffrey
Kellett-Bowman, Mrs Elaine	Pawsey, James
King, Roger (B'ham N'thfield)	Peacock, Mrs Elizabeth
King, Rt Hon Tom (Bridgwater)	Porter, Barry (Wirral S)
Kirkhope, Timothy	Porter, David (Waveney)
Knapman, Roger	Portillo, Michael
Knight, Dame Jill (Edgbaston)	Powell, William (Corby)
Knowles, Michael	Price, Sir David
Knox, David	Raffan, Keith

Raison, Rt Hon Timothy	Taylor, Ian (Esher)
Rathbone, Tim	Taylor, John M (Solihull)
Redwood, John	Taylor, Teddy (S'end E)
Renton, Tim	Tebbit, Rt Hon Norman
Rhodes James, Robert	Temple-Morris, Peter
Rhys Williams, Sir Brandon	Thatcher, Rt Hon Margaret
Ridley, Rt Hon Nicholas	Thompson, D. (Calder Valley)
Ridsdale, Sir Julian	Thompson, Patrick (Norwich N)
Rifkind, Rt Hon Malcolm	Thorne, Neil
Roberts, Wyn (Conwy)	Thurnham, Peter
Roe, Mrs Marion	Townend, John (Bridlington)
Rost, Peter	Townsend, Cyril D. (B'heath)
Rowe, Andrew	Tracey, Richard
Rumbold, Mrs Angela	Tredinnick, David
Ryder, Richard	Trippier, David
Sackville, Hon Tom	Twinn, Dr Ian
Sainsbury, Hon Tim	Vaughan, Sir Gerard
Scott, Nicholas	Viggers, Peter
Shaw, David (Dover)	Waddington, Rt Hon David
Shaw, Sir Giles (Pudsey)	Wakeham, Rt Hon John
Shaw, Sir Michael (Scarb')	Waldegrave, Hon William
Shelton, William (Streatham)	Walden, George
Shephard, Mrs G. (Norfolk SW)	Walker, Rt Hon P. (W'cester)
Shepherd, Colin (Hereford)	Waller, Gary
Shepherd, Richard (Aldridge)	Walters, Dennis
Shersby, Michael	Ward, John
Sims, Roger	Wardle, C. (Bexhill)
Skeet, Sir Trevor	Warren, Kenneth
Smith, Sir Dudley (Warwick)	Watts, John
Smith, Tim (Beaconsfield)	Wells, Bowen
Soames, Hon Nicholas	Wheeler, John
Speed, Keith	Whitney, Ray
Speller, Tony	Widdecombe, Miss Ann
Spicer, Jim (Dorset W)	Wiggin, Jerry
Spicer, Michael (S Worcs)	Wilshire, David
Squire, Robin	Winterton, Mrs Ann
Stanbrook, Ivor	Winterton, Nicholas
Steen, Anthony	Wolfson, Mark
Stern, Michael	Wood, Timothy
Stevens, Lewis	Yeo, Tim
Stewart, Allan (Eastwood)	Young, Sir George (Acton)
Stewart, Andrew (Sherwood)	Younger, Rt Hon George
Stradling Thomas, Sir John
Sumberg, David	Tellers for the Noes:
Summerson, Hugo	Mr. Robert Boscawen and Mr.Stephen Dorrell.
Tapsell, Sir Peter

Question accordingly negatived.

Question, That the proposed words be there added, put forthwith pursuant to Standing Order No. 30 (Questions on amendments), and agreed to.

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

Resolved, That this House welcomes the increased number of people being treated in the hospital and community health services, and recognises and applauds the work of all groups of staff that have made this possible; congratulates the Government on again maintaining the National Health Service programme of hospital building and providing a high level of investment in the service next year; reaffirms its intention to continue the promotion of a comprehensive health service; and recognises the Government's achievement in establishing the sound economy necessary to support the continued development of the health service.