§ Mr. Speaker
I must announce that I have selected the first Opposition amendment in the name of the Leader of the Opposition. I must tell the House that again many right hon. and hon. Members have written to me to say that they wish to participate. I propose to put a 10-minute limit on speeches between 6 pm and 8 pm. I ask those called before that time and afterwards to bear in mind that limit.
§ Mr. Graham Allen (Nottingham, North)
On a point of order, Mr. Speaker. This is the first day of oral questions since we returned. Several Ministers have made it their practice to reply lengthily to questions. Will you consider this matter and perhaps, if necessary, make some recommendations? As today is the first day of questions, it is important to set the right precedent.
§ Mr. Speaker
The House knows that the Chair is not responsible for answers given to questionsx2014;or, indeed, for their length. Nor am I responsible for the length of supplementary questions. However, it is a fact that, the longer the answers and the questions, the fewer questions we deal with.
§ Mr. Beaumont-Dark
We all accept the view that speeches should be brief. Why is it, sir, that the 10-minute rule comes into force only at 6 pm? Why is it that senior Members—right hon. Members—can speak for longer? Why not make the rule from the word go?
§ Mr. Speaker
I sometimes wish that I had that authority, but I have not. It is written into Standing Orders that the Chair may designate a limit of 10 minutes on speeches between 6 pm and 8 pm or between 7 pm and 9 pm. the hon. Member should go back to the Procedure Committee—he may be a member of it—to see whether he can have the time limit extended.
§ Mr. Robin Cook (Livingston)
I beg to move, at the end of the Question, to add:But humbly regret the Government's failure to safeguard the National Health Service; are concerned at the evidence that members of the public cannot secure access to the treatment they need; regret Her Majesty's Government's intention to proceed with its legislation to undermine the National Health Service and to commercialise health care; believe that the pressure for competition on the basis of cost will be at the expense of quality of care and the necessary treatment required by patients with chronic and expensive conditions; are alarmed that the proposals for care in the community threaten the public provision of social services and fail to provide a designated central grant to fund local responsibilities; note that the Government has no mandate for these proposals which have never been put before the electorate at any election and have been consistently opposed by every measure of public opinion since they were first published; reject the decision of Her Majesty's Government to persist in ignoring democratic opinion; and commit ourselves to defending the National Health Service as a public service free at the time of need.Before I turn to the gravamen of the amendment to the Gracious Speech, and as I have a rare opportunity to speak before the Secretary of State for Health, may I invite him to comment on a development last week in the ambulance dispute, which is now concluding its third month? Last Wednesday, the Secretary of State repeatedly attacked—first in his press conference on the proposed NHS Bill and subsequently on television—an ambulance crew for refusing to answer an emergency call to attend a new-born baby. The Secretary of State was wrong on two counts. The emergency call was not refused by the ambulance station but referred to a nearer station by the crew at the first; and the baby was not new-born. When the crew eventually arrived at the scene, it found a corpse which, understandably, the police refused to allow the ambulance crew to move, on the grounds that it would interfere with their inquiries.
Although the Secretary of State was anxious to hand round allegations when he was badly informed, by contrast he has been unusually quiet since the truth came out. Last Thursday, he put up a spokesman to field inquiries about the allegation, who said that the Secretary of State had acted in good faith and that he did not think that he would say sorry. I am happy to set the mind of that spokesman at ease. I do not imagine that the Secretary of State will ever say sorry.
The most pressing matter is not whether the Secretary of State will apologise. The really interesting question is whether he wants to resolve the ambulance dispute. What he said last Wednesday and every other recent intervention in the dispute might have been calculated to undermine opinion and prolong the dispute rather than to resolve it.
The Secretary of State has already lost the dispute. This Chamber is probably the only place in Britain where he would not lose a vote on the ambulance staff claim. Nor will he roll back the public tide of support for the ambulance staff by the advertising campaign which we read is about to start. He will not convince the public that he has a case by buying advertisements in the press. He will convince the public that he has a case only if he has sufficient faith in his own case to put it to arbitration. So long as he continues to refuse arbitration, he shows that he has no confidence in his case.
Having given the Secretary of State notice of what he may wish to tell the House and of what we expect him to 443 say about the ambulance dispute, I shall turn to the Government motion and the Opposition amendment before the House.
Today and tomorrow we conclude the debate that commenced last week on the Gracious Speech. The visit of the sovereign to read a speech written by Ministers elected by the people is an annual symbol in the British constitution of our claim to be a country free of arbitrary Government, and of Parliament's claim to represent the people who elect us. It is an offence against both those claims that this year the Queen's Speech contains the Government's intention to persist with the unloved, unworkable changes to the National Health Service, on which not one hon. Member was elected.
Last week I noticed something of an epidemic of Tory Back Benchers desperate to intervene before 5 pm. I propose, therefore, to make a public service announcement, which I hope will cure that fever: I shall happily give way to any Tory Member who can confirm that in his or her election address he or she warned the electorate that the Government whom they would support would encourage local hospitals to opt out, would limit general practitioners' spending on drugs—[Interruption.] If Tory Members object to my words, I am happy to accept the word of any hon. Member who can confirm that his or her election address included any form of words about self-governing hospitals opting out, how the Government would limit GPs' spending on drugs or how they would direct patients to a hospital, not of the patient's choice, but where the health authority got the cheapest bargain.
§ Mr. Hamilton
In his election address in 1974, did the hon. Gentleman tell the British people that the Labour Government would reduce spending on the Health Service over the following five years by 30 per cent. in real terms?
§ Mr. Cook
The Government do not have a mandate for these changes. Nor have they been able to obtain any support for the proposals since they were published.
In a press conference last week, the Secretary of State was pressed to name one health organisation which supported his Bill. I am told that he answered with the Institute of Health Services Management. The only support that he can claim from the IHSM is that it chose not to publish the survey of its members. I can tell the Secretary of State that that survey showed that 37 per cent. of its members were in favour of the hospitals in their districts becoming self-governing and 56 per cent. were opposed; and that 37 per cent. were in favour of GP's having practice budgets and 62 per cent. were opposed. It is a sign of desperation that that body is the nearest that. the Government can get to an organisation which supports their proposals.
444 The Secretary of State keeps advising us that what matter are not the views of the staff in the National Health Service but the views of the patients that the NHS exists to serve. He has gone out of his way to make it clear that he does not pay any attention to the views of the people who work in the Health Service. The problem of turning to the views of the patients is that every patients' organisation is overwhelmingly against the White Paper. I have now received 37 replies to the questionnaire that I circulated to associations representing patients in the NHS. They included the Spastics Society, the Asthma Society, the Haemophilia Society and the Royal Association for Disability and Rehabilitation. I asked them whether hospitals should be encouraged to become independent and self-governing. I did not use the contentious term "opt out", which causes such pandemonium among Conservative Members. Out of the 37 who responded, 35 disagreed with that statement.
I cheerfully concede to Conservative Members that the people responding to that question do not represent the public as a whole. They differ from the public as a whole and from hon. Members in that, between them, they have more first-hand experience of the National Health Service. They use the service most regularly, they understand it best and they need it most. They refuse to swallow the Secretary of State's prescription.
At the end of the day, the importance of the National Health Service is that we are all potential patients. Its future is a central political issue because it is a public service that serves every member of the public. Therefore, major surgery to that service should not be attempted unless there is sufficient consensus among the public whose health is at stake. However, Parliament is about to be asked to pass changes which enjoy a degree of public support that is barely greater than the ratings of the Liberal Democrats in current opinion polls. Not one opinion poll since the White Paper was published has failed to produce a majority against the proposals of more than 3:1 or 4:1.
The Secretary of State has an answer to that too. He dismisses these measures of public opinion on the grounds that the public do not understand the proposals and therefore are not entitled to a view. The problem for the Government is that, the more the public know about the proposals, the less they like them. In the 10 months since the White Paper was published, there has been a vigorous debate on the proposals, and over that time opposition to all the key proposals has hardened.
What about Conservative voters? Surely Conservative Members will not tell us that Conservative voters are easily misled or that they misunderstand what Conservative Governments intend to do. We know what Conservative voters think about the proposals, because the MORI omnibus poll carried out in September asked them. On each of the key proposals, more Conservative voters oppose what the Conservative Government are doing than support them.
I have a warning for Conservative Members. They can ignore the views of the people who elected them and spend two busy years pushing through this uniquely despised measure and taking apart the NHS to make it fit the design that they have wished upon it. But they must not imagine that their voters will forgive them for being ignored. One in eight Conservative voters say that they are likely to switch their vote if the Bill goes ahead. Conservative 445 Members have six hours in which to ponder that statistic. In case they missed its significance, that shift alone is sufficient to wipe out the Government's majority of 100.
We can tell that the Government are embarrassed by the unpopularity of the proposals because of where we find the reference to the NHS in the Queen's Speech. Where does the Secretary of State's grand design for the Health Service rank in the order of the Queen's Speech? What prominence is given to his plans to reshape the Health Service as NHS plc? The proposals are 10th in the Queen's Speech, just above legislation for Scotland. As a Scottish Member of Parliament, I understand just how marginal that is in the Government's priorities.
Since the Queen's Speech, we have had the Secretary of State's Bill. The evidence of the comments from outside Whitehall shows how unpopular the Bill will be, and the evidence of the Bill from inside Whitehall shows how unworkable it will be. We warned that the plans would represent a threat to the continuity of care. We warned that the White Paper had been written on the model of a patient who falls ill and who is then taken off to hospital for surgery and put back out repaired. It is the garage repair service model of health care. That is the model that has been adopted by the private sector, which picks on conditions which can be put right on the basis of a quick fix and fast profit. Unlike the public sector, it is a model which is designed for those of working age who are basically fit and who require health care only for episodes when they are ill.
The bulk of the activity of the National Health Service is related to chronic long-term conditions which cannot be treated by that quick fix. It is for the elderly, the chronically sick and the disabled, who require long-term care. That care is best provided by co-operation and teamwork between general practice, community nursing and hospital services. No one from the Government Benches has ever explained how that teamwork will be improved by breaking up the Health Service and the co-operation between the different parts and re-forming each of them as a separate business enterprise that is supposed to seek the cheapest contracts from the other enterprises.
§ Mr. Andrew Rowe (Mid-Kent)
In giving this long catalogue of misrepresentation—that is what it is, to a considerable degree—will the hon. Gentleman explain how it is that so many of those who use the NHS are concerned that those who are most successful at carrying out operations are the very people who are most likely under the present arrangements to be forced to close their wards? Will he explain how it is that, throughout the NHS, there are well-authenticated tales of extravagance? How does he suggest that he would achieve local management efficiency under any scheme that he is likely to propose?
§ Mr. Cook
I am happy to respond to the hon. Gentleman's intervention. Is he suggesting that the provisions in the Bill will increase local management discretion? I do not know whether the hon. Gentleman has read the Bill. If he has, he will have found in almost every page of it that a panoply of new powers will be given to the Secretary of State and not to local management.
We have warned the House that the Bill will not provide a model that will devolve local control. Instead, the Bill 446 will increase central control. That is clear in the Bill. The Secretary of State will appoint every member of the regional health authorities. It is he and the regional health authorities that will appoint every member of the district health authorities. It is he who will then direct those authorities. He will tell them what to do.
If the hon. Gentleman is seeking local discretion, there is only one central power and control that I can find that will be relaxed as a result of the Bill's enactment. I refer to the Secretary of State's power to limit the number of pay beds in NHS hospitals. It is significant that that is the only issue on which the Secretary of state will give more discretion to local managers and therefore relinquish his own controls.
§ Mr. Cook
I shall not give way now. If the hon. Gentleman contains himself, I shall give way to him at an appropriate moment. I hope that he will forgive me when I say that I wish to proceed with my speech. I do not like to disappoint the hon. Gentleman, who I think has intervened in almost all my speeches. I would not wish to be churlish by making an exception in this instance.
My right hon. and hon. Friends and I have warned that the Bill will reduce patients' rights. Patients will lose the right to go to the hospital of their choice. They will be sent to the hospital where the health authority has a contract. Anyone who has any doubts about that should read clause 3, which wrestles with the problem of emergency patients. It offers an interesting solution to the emergency patient who is from a health area where the health authority has no contract with the hospital concerned. The clause states that the patient will be admitted ifthe condition of the individual is such that he needs those goods or services and, having regard to his condition, it is not practicable before providing them to enter into an NHS contract for their provision.That text makes it clear that, with the single exception of the direst emergency, the Bill provides not for money to follow patients but for patients to follow money. It will not be doctors who decide which hospitals give their patients the best treatment, but accountants who will choose which hospitals are the best buy for those patients.
That brings us to the Bill's financial effects. We warned also that the proposals would result in wasted expenditure on paperwork. The scheme proposed by the Government is for an internal market that will run on paper. It will need more paperwork, administrators and overheads. It will result in a National Health Service that will be both less fair and less efficient. Anyone who doubts that has only to examine the explanatory memorandum to the Bill on the effects on public service manpower, which state that the Bill will result in a need in the Health Service for 4,000 extra staff. The memorandum describes them as "certain specialist staff". Will they be specialists in paediatrics, cardiology or ear, nose and throat? No, the specialties frankly spelt out in the financial memorandum are finance, personnel and information technology.
When the Secretary of State for Health addressed this year's Conservative party conference, he promised that the Bill would change the bureaucracy of the NHS. Certainly he is changing its bureaucracy, by offering it the longest gravy train ever seen in the history of the Health Service. Immediately before I entered the Chamber for this debate, I was given the front page from today's Glasgow Evening 447 Times, reporting that not one of 24 state registered nurses who have just graduated with a BA in nursing studies is able to find a vacancy in today's Health Service. Our advice to any young person watching this debate and thinking of looking for an opening in the NHS is that they should forget about studying medicine or nursing and instead obtain a degree in accountancy—[Hon Members: "Disgraceful".] That is the type of opportunity that is offered by the Government's scheme.
§ Mr. Hayes
Apart from that appalling slur on the nursing world, which recommended Project 2000, which my right hon. and learned Friend accepted, I refer to the hon. Gentleman's long catalogue of woe about the Bill. Does he not accept that the British Medical Association and the president of the Royal College of Nursing welcome medical audits, resource management, and money travelling with the patient? Those aspects account for 80 per cent. of the Bill. Will the hon. Gentleman have the honesty and grace to accept the truth of that?
§ Mr. Cook
As I pointed out earlier, the Bill is not about money following the patients but about patients following the money. It is a Bill about patients going where contracts are placed by the health authority. The 4,000 new jobs that the Bill creates will not include any openings for nurses or doctors of the kind that the Health Service desperately needs. The people who obtain employment under the Bill will be those responsible for controlling costs, not serving patients.
The Queen's Speech refers to the legislation asA Bill … to improve the National Health Service".If the House and the country are to believe that, we must have regard to the Government's record on improving the NHS. Let us examine the recent evidence. Almost the first information that we received on our return was the waiting-list figures for March, which reveal that the number of patients who had been waiting for an operation for more than a year had risen by 17,000. I know that those cases have been classed as non-urgent, but they include cardiac patients who are breathless, distressed and unable to work, elderly people waiting for hip operations who are in pain, housebound or bedridden, and women waiting for hysterectomies who are in acute discomfort.
We need not look far for the reason for such a rapid increase in those figures. The same tables show that, in the same year, the number of operations fell—March being before the start of the new financial year. Announcing the spending plans for the current financial year, the Secretary of State promised a "spectacular boost" to health spending. We are now two thirds of the way through the financial year, and in the month since those waiting-list figures were presented to the House there have certainly been many spectacular cases; but none provides evidence of a boost in spending. Each demonstrates a spectacular cash squeeze in Britain's hospitals.
§ Mr. Thurnham
The hon. Gentleman cannot get away with what he has said. The present Government's Health Service record has been immeasurably better than that of the last Labour Government: that is why the electorate 448 have voted again and again for a Conservative Government. The Government's plans for the Health Service were in the Conservative party manifesto.
The hon. Gentleman talked about the removal of discretion from the local health authorities. Why does the Labour party propose to remove discretion for competitive tendering, which has saved at least £40 million for patient care?
§ Mr. Cook
I am absolutely confident that the next Labour Government will return discretion for competitive tendering, and will take away the compulsion. If the hon. Gentleman wishes to claim that the NHS is in a better state now than it was in 1979, he had better explain to the public outside why one in seven acute beds and one in five non-acute beds have been closed, and why 170,000 more people are on waiting lists for operations.
§ Mr. Cook
No, I will not.
My hon. Friends know how intense is the cash squeeze on the inner-city areas that they represent. I have no doubt that they will tell the House what Government under-funding means to their constituents. But the same applies to Conservative constituencies. Let me share with the House what that under-funding means to them. In a letter to his consultants, the general manager of Queen Mary's hospital, Bexley, explains that the hospital is under-funded for the current year. He writes that. with effect from 9 October, he hasdecided to increase the average monthly cancelled operating theatre lists fom 26 per month to 56 per month … Cancelled lists for the 5 week period … are attached.There follows a four-page list of cancelled operating sessions. The Government will no doubt put that down as a saving, but it is not a saving; it is an expensive waste of resources and skilled personnel, which will result in a less efficient hospital and longer waiting lists.
I am pleased to see that the hon. and learned Member for Colchester, North (Sir A. Buck) is in the Chamber. Colchester general hospital is under-funded by £2 million, and with effect from the week beginning 27 October it has closed 86 beds, including half its paediatric beds. As the hon. and learned Gentleman will know, the hospital's consultants have written to all the Members of Parliament who serve the area, expressing the view thatThe effect on our services is going to be disastrous. It will mean that we can barely provide an emergency service.
§ Sir Antony Buck (Colchester, North)
Of course one is concerned about the under-utilisation of a magnificent facility that this Government have provided, in the form of a new general hospital. Does the hon. Gentleman acknowledge that it was a Conservative Government who provided that new general hospital, whereas the previous Labour Government promised it but never provided it?
§ Mr. Cook
I do not have the slightest difficulty in acknowledging that Colchester general hospital was built during the last five years. I have visited the hospital. However, I must invite the hon. and learned Gentleman to acknowledge that the result of the Conservative Government's under-funding is that 86 of the beds in that new hospital have just closed. There is not much point in taking credit for building a hospital if it cannot be kept open when it has been built.
449 The Royal United hospital, Bath, is equipped with 21 intensive care cots. It can currently afford to staff only seven of them. A fortnight ago, a mother in Somerset went into premature labour. The ambulance was turned away from the Royal United hospital in Bath because no intensive care cots were available. The ambulance took her to Bristol maternity hospital, where again she was turned away because no intensive care cots were available. She was then taken to Southmead hospital in Bristol, where she was again turned away because no intensive care cots were available. She was finally admitted to the Royal Gwent hospital in Newport.
If, after listening to this debate, hon. Members were to go to the television lounge and flick through the television channels, they would find on one channel pointed comment on the funding of maternity services. This year's Blue Peter appeal is for tin cans to sponsor an intensive care cot. I am aware that some Conservative Members regard that as an appropriate way to fund the National Health Service. Last week, the hon. Member for Battersea (Mr. Bowis) tabled a parliamentary question to the Leader of the House inviting him to place receptacles in the cafeterias and bars of this place so that hon. Members might improve the NHS by contributing their tin cans to the Blue Peter appeal. That is the economics of the primary school. It is not the job of Tory Members of Parliament to fund intensive care cots by saving up their beer cans. Their job is to vote the funds so that women in labour can find intensive care cots without having to tour four alternative hospitals across two different countries in Britain.
I began by saying that these changes will be imposed on a public who do not want them, by a Government who do not have a mandate for them. I end with a warning to the House—that apparently our powers of scrutiny are to be curbed in the process. I have an extract from the minutes of a meeting of regional co-ordinators for self-governing units, held on 20 September 1989 at Richmond house. Paragraph 3.4 says that there will beinevitable Parliamentary interest in the next session". My hon. Friends and I can guarantee that.current intention to give low key answers to P. Qs as and when made.What that sentence betrays is a Government who are too embarrassed by the unpopularity of their proposals to answer questions about them frankly, a Government who have given up on the hopeless task of convincing the public that a commercialised Health Service would be good for them, a Government who know that their only chance of foisting this idea on a rebellious people is to proceed by stealth under cover of low priority parliamentary answers.
I warn them now that breaking up the National Health Service will not be a low-key affair. We shall put it centre stage throughout the Session. We shall expose and challenge it at every stage. In every week of the Bill's passage, we shall appeal to the majority of people who are against it, either to join us in defeating it before it can be passed or to join us in defeating the Government before the legislation can be implemented.
§ 4.9 pm
§ The Secretary of State for Health (Mr. Kenneth Clarke)
I am glad to say that the Gracious Speech reveals that the agenda for the new Session of Parliament will be very much dominated by social affairs and social issues of many 450 kinds. That is because we have now reached the stage where we are determining the nature of the modern welfare state and the nature of our great public services for the next decade. After 10 years of this Government, we have produced a position in which the country is much more able than ever before to create wealth and earn prosperity. I therefore believe that we have a greater duty than any previous generation to provide high quality public services and to care effectively for the vulnerable members of society. That should be the aim of all Members on all sides of the House.
That aim will not be contributed to by the kind of speech made by the hon. Member for Livingston (Mr. Cook), who is the Opposition spokesman on National Health Service matters. Frankly, at times his debating points were childish in their inaccuracy and wide of the point of our proposals.
§ Mr. D. N. Campbell-Savours (Workington)
On a point of order, Mr. Deputy Speaker. How can the Secretary of State make allegations about the speech made by my hon. Friend the Member for Livingston (Mr. Cook) when those allegations were written down on a piece of paper which was handed to him prior to the debate commencing?
§ Mr. Deputy Speaker (Sir Paul Dean)
That is not a point of order for the Chair; it is a matter for debate.
§ Mr. Clarke
The comments are written in my own fair hand because those thoughts occurred to me while listening to the speech made by the hon. Member for Livingston. The hon. Member for Workington (Mr. Campbell-Savours) may not be so capable of spontaneous thought or writing that down as he thinks of it. However, some of us can do that.
Debate in this House has reached the stage where we should move beyond posters, postcards and slogans of the kind produced by the hon. Member for Livingston. During the winter, we will debate the most important piece of legislation to affect the NHS since its foundation in 1948. When the hon. Member for Livingston is forced to debate, clause by clause, proposal by proposal, he will find that the issues posed deserve far greater accuracy than he brought to them this afternoon. They deserve far more serious consideration. If he continues as he has done, the poverty of ideas about the modern welfare state in today's Labour party will rapidly be exposed.
The Health Service Bill will indeed be controversial. However, the outside world, which is seeing us to a greater extent than ever before, may be surprised to discover that the House is united on the principles that lie behind the NHS. I do not believe that any hon. Member from any political party will challenge the principle that medical treatment should be given free to NHS patients at the time of delivery. Everyone shares the objective of providing a comprehensive medical service accessible to all members of the population, regardless of their means. We are all contemplating a National Health Service to be financed out of general taxation.
Frankly, it is rather silly for the Opposition to try to invent a division on principle between us when they argue about commercialisation, privatisation and patients following money—whatever that is meant to mean—to create a political debate on a subject about which there is no division of intention between us.
It should be taken as axiomatic in all debates on this subject in the House that the basis of all judgments on 451 health care matters should be the aim of curing disease and caring for disability. The sensible debate between us should be about how best to deliver the high quality care and best treatment required in a great public service.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
Does the Secretary of State accept that one of the questions requiring an answer is what resources must be applied to the reforms? As neutrally as I can, can I ask him whether the British public would be in favour of increasing expenditure substantially on the NHS if the matter was put to the public properly?
§ Mr. Clarke
I agree. Again, before we launch into the actual amounts, it is fair to say that all hon. Members have agreed that the National Health Service will cost the British taxpayer more. When we look ahead and see the demands that will come upon us in the next decade, it is quite obvious that it will cost the taxpayer much more.
§ Mr. Clarke
I will gladly give way on resources, when I have finished dealing with how we should find the resources and the extent to which it is realistic to look for them. In health care debates it is too easy for our opponents, from whatever party, to listen to our description of the sums of money that we are putting in and then simply outbid us, as though, somehow, despite Labour's record, they would be capable of finding more than the present Government have found.
So far, I have been involved in two public spending rounds since I came back to this Department and came to my present office in July of 1988. When I took over my position as Secretary of State, gross expenditure in the National Health Service was estimated to be £23.49 billion per annum. After the two public spending rounds that I have been through, planned expenditure for 1990–91 is £28.71 billion.
That is a cash increase, in two public spending rounds, of £5.2 billion. That is an increase in two public spending rounds of 22 per cent. in cash. Spending on the Health Service has gone up. The average rate of spending has gone up by over one fifth in cash terms. The real-terms increase in spending that that represents over and above inflation —actual inflation last year and anticipated inflation now —is 8.8 per cent.
This Government, in two public spending rounds, plan to increase annual spending on the National Health Service by almost one tenth in real terms. That is a considerable achievement, first, for two Chief Secretaries to the Treasury, the present Chancellor of the Exchequer, my right hon. Friend the Member for Huntingdon, (Mr. Major) and the present Chief Secretary, my right hon. Friend the Member for Kingston upon Thames (Mr. Lamont), and secondly, for this Government. That enormous increase in resources represents a deliberate choice by this Government to give the very highest priority to spending on the National Health Service, among all the other demands on the public purse.
Therefore, if we are to be faced by people claiming that they can simply outbid us in public spending terms, they must reflect on the fact that, in 1990–91, the level of spending of taxpayers' money on the National Health Service will be 45 per cent. higher in real terms, over and above inflation, than when we took over from the Labour party in 1979.
§ Mr. Dennis Turner (Wolverhampton, South-East)
Will the Secretary of State please accept that people have the greatest difficulty in coming to terms with his credibility? The right hon. and learned Gentleman is trotting out all those figures, but 127 beds have been closed in my area of Wolverhampton. We have a longer waiting list that will not be met, even with his last bonanza. We can do nothing about the fabric of our hospitals. People are dying. They cannot get into our hospitals. The Secretary of State tells us that everything is going well. The people know that they have a service that the Secretary of State set for them at 1986 standards. For our electors we want standards for the 1990s, not for the 1980s.
§ Mr. Clarke
The Wolverhampton district health authority is spending more money now than it did last year, over and above inflation, and it is treating more patients this year than it was last year. I will refer to Wolverhampton district health authority and others—
§ Mr. Clarke
The hon. Gentleman says that that is untrue, but he is not familiar with what is happening in his own hospitals. Wolverhampton is spending more money and treating more patients than last year. I shall turn to short-term promises—[Interruption.] I have just explained that we have increased spending now by 45 per cent. in real terms over and above the level of spending that we inherited from the Labour Government who, in 1979. were spending £8 billion in total on the National Health Service —[Interruption.]
§ Mr. Clarke
It is plain that the Labour party is claiming that it can somehow exceed the public spending rounds in which we have raised public spending now by over £5 billion in two spending rounds alone. However, no Opposition spokesman has ever given any substance to that claim. Against our record of increased spending, the nearest that the Labour party has ever got to explaining what it would do about National Health spending was earlier this year when the right hon. Member for Islwyn (Mr. Kinnock) gave a press conference setting out what he expected would happen to NHS spending.
My source is the Evening Standard of Thursday 8 June 1989. Charles Reiss, the political editor, whose accuracy as a journalist is rarely if ever challenged in this House, quotes the Leader of the Opposition as follows:The Health Service cannot expect a blank cheque from next Labour Government, Neil Kinnock said today.Although the aim would be 'only the best', he said that the NHS would have to live in the real world where resources were limited.
'We would not taunt the National Health Service with the implausible idea of a blank cheque. Indeed, that would be very inefficient in NHS terms.
§ Mr. Clarke
The article continues:Mr. Kinnock said that 'over a period of Government"—which I take to mean the lifetime of a Government—'Labour would make up the shortfall in health service funds, reckoned to be running at £3 bn a year. The extra money would have to be delivered over time, and based on 'properly calculated needs—whatever that may mean. A Labour Government obviously would not employ any staff to discover what those needs would be.
453 Opposition Members who think that they can win the argument—
§ Mr. Neil Kinnock (Islwyn)
Before the Secretary of State leaves that point, I am sure that he will be well aware that the figures to which I and many others have referred arise from the calculations efficiently made by a Select Committee of this House, demonstrating the difference between the Government's expenditure, related to the general rate of inflation, and the actual rate of rising costs to the National Health Service to meet the needs of the elderly in our society and the development costs facing the Health Service. The difference between the two sums is calculated by experts outside this place and by the Select Committee to be around £3 billion.
That is the target at which we should be aiming, in addition to what the Government were committed to spending. If the Secretary of State does not understand that, he is not only deficient in his commitment to meet the realities facing the National Health Service, he is deficient in his arithmetic as well.
§ Mr. Clarke
The sums of money that I have just described and the most enormous increase in real terms expenditure have run ahead of the demands on the Health Service, as we inherited them, and have enabled us to expand the service as never before. I ask the public to make a comparison between the protestations of the Labour party to outbid us and our real record of putting money in. A proper comparison is between the over £5 billion that we have produced in the last two public spending rounds and the half-baked promise of £3 billion over a lifetime of a Government, which is all that the Opposition have put forward—
§ Mr. Clarke
Well, let me just turn to where the money actually goes as a measure of whether our increased expenditure has enabled the Health Service to expand and whether the public are getting the benefit of the extra expenditure I am talking about.
As one of my hon. Friends pointed out earlier, the main effect of a 45 per cent. real terms increase in expenditure has been a great expansion in the number of patients treated and in the number of front-line staff-not accountants and so on—employed in the National Health Service.
In the past decade, the number of people treated each year in hospital has risen from 5.3 million to 6.6 million. For every five patients treated in 1979, six patients are now treated and they are receiving better and more sophisticated care as standards of medical treatment have advanced. There are 67,000 more nurses and 14,000 more doctors working in the Health Service now than there were in 1979, and they are better paid, as their pay had declined under the previous Labour Government. All that represents the best and most accurate reflection of the resources put in.
§ Mr. Geoffrey Lofthouse (Pontefract and Castleford)
The Secretary of State has referred to an expansion in services. Twelve months ago, the Pontefract health authority transferred money that had been made available by his Department to ease waiting lists to a private hospital, Methley Park hospital. The operations were 454 carried out by the same consultants who work for the NHS in Pontefract. The money covered 230 operations in the private sector, but it could have covered 500 at the Pontefract general infirmary. How can the right hon. Gentleman agree with a health authority passing over funds when 300 of my constituents are still on the waiting list because of that transfer of money to the private sector?
§ Mr. Clarke
If the hon. Gentleman puts that in a letter, I shall check out the accuracy of his claims. Contracts with private-sector hospitals of the kind described by the hon. Gentleman are made only when health authorities find that they can increase the level of service that they give to their patients in a cost-effective manner, which is acceptable to those patients. If the hon. Gentleman gives me the opportunity to do so, I shall check out his allegations.
§ Mr. Clarke
I must get on. In reality, there has been a huge expansion of resources, which has been matched by an expansion in the number of patients treated and the professional staff employed. How is it then that, each year, hon. Members on both sides of the Chamber, especially Opposition Members, leap to their feet at this stage of the financial year to talk about beds being closed? They always talk about the furniture rather than the patients. They talk about beds being closed and apparent cuts in the service provided in their locality. Each year, regardless of how much money is put into the Health Service to expand it, many district health authorities find that they are subject to end-of-year pressures and find that they must make sudden adjustments to their plans. That practice shows the need for reform in the way in which the large sums of money I have described are spent, which the Government are committed to put into the Health Service.
§ Mr. Clarke
Before the hon. Gentleman gets in with his constituency example, I want to try to catch up with some of the examples already given.
I dare say—I challenge any hon. Member to prove me to the contrary—that every district health authority in this country, by which I mean England for which I am responsible for this purpose, is spending more money in real terms than it was last year. They have all received much larger sums of growth money than they have had before. All district health authorities are treating more patients than they were this time last year, they are expanding their services and carrying out service developments. The trouble is that, as things are presently organised in the NHS, they have no means of controlling the pace at which they expand their services or of matching the release of resources to the growth of patient services to avoid the chopping and changing and other short-term expedients.
The hon. Member for Livingston intervened with the example of St. Mary's, Sidcup. I have just written a letter in response to the rather startling assertions by a consultant at that hospital who said that services are being cut. That is total nonsense. The regional allocation to that district health authority is carried out by the regional health authority, not by me. I give money to the region, and it in turn decides how best to distribute that among its 455 individual districts, but within certain guidelines issued by us. I believe that that would be the case under any Government. My letter states:the Region and the District are spending their share of record-breaking levels of public spending on the NHS this year. I allocated £1,083 million to South East Thames for 1989/90, which is a 4.2 per cent increase on the previous year.As for the supposed cuts at Queen Mary's hospital, as I say in my letter:The position is, in fact, that acute patient activity is presently expanding so quickly that it is running about 4 per cent ahead of the level planned for 1989/90. That clearly has financial consequences, so in order to comply with its original plans, Bexley Health Authority is controlling the level of patient activity by reducing the volume of facilities which are available for up to three months by a net reduction of 17 surgical beds. The important point is that the number of patients treated will be maintained at the levels planned for 1989/90. This will be nearly 500 more patients than were treated in 1988/89,".That position could be repeated. My guess is that it is repeated in Colchester and Wolverhampton. The hon. Member for Nottingham, North (Mr. Allen) is trying to get in for Nottingham. He and I constantly talk about such matters in the Nottingham area. All these authorities are treating more patients than last year. At the moment, the way in which the system is run means that they have no means of knowing how to respond when their expansion runs ahead of their plans, and they often have to cut facilities to ensure that growth in their services does not outrun the extra money which they have received.
This does not mean that there is a lack of money going into the service. Instead of defending the way in which the NHS is currently run, protesting that it needs no reform and that it is sensible to have a row every winter in Wolverhampton about which beds should be closed when expansion occurs too quickly, hon. Members representing Wolverhampton should press for more common sense to be used in running the system.
As my hon. Friend the Member for Mid-Kent (Mr. Rowe) said, the hospitals which expand their services most quickly tend to get into most trouble. The unreformed National Health Service, run as it has been for so many years, tends to lead to the best units getting into difficulty and the poorest and weakest units having a quiet life. It is that system which the hon. Member for Nottingham, North wishes to preserve.
§ Mr. Michael Grylls (Surrey, North-West)
My right hon. and learned Friend has described in great detail this afternoon the huge and increasing sums of taxpayers' money being put into the Health Service. Does he agree that, as it is likely that this will be a permanent, large part of the British budget, it is absolutely essential to give good value for money in the Health Service if we are to get the best pound for pound out of it? Therefore, is that not a good reason to support the Government's reforms, a large number of which are aimed at giving good value for money?
§ Mr. Clarke
I entirely agree with my hon. Friend. The Opposition seek to dismiss the vast sums of money coming in and respond with vague descriptions of how much extra they would put in. They are not remotely interested in the number of extra patients treated and dismiss the fact that the service is expanding in all their district health authorities, as it is in ours. They obstinately oppose any attempt to improve the way in which we spend the money 456 in order to maximise what we receive for it, avoid the frustrations faced by consultants year in and year out and maintain patient growth.
§ Mr. Clarke
I must get on.
My hon. Friend for Surrey, North-West (Mr. Grylls) is right to say that we must pave the way in our legislation for reforms to obtain certain self-obvious goals which no future Government could go back on. We need to match the growth in money with the growth in services which we want. The National Health Service must have greater ability to decide where the public need for growth in services is currently greatest. It needs better management to target growing resources on the units best able to meet public need. Those are self-obvious observations. Future generations will wonder why the Labour party lined itself up with reactionary vested interests inside the service to try to oppose the reforms.
We shall tackle the problems I have just described by making it much clearer where responsibility lies for deciding which are the most urgent public needs in each locality. It will fall to the district health authority to decide what the public need for services will be, using judgments based on quality, convenience for patients and the need to raise the quality of care for their residents. It will not be based, as the hon. Member for Livingston casually claimed, on an appraisal of costs alone. The district authorities will also have a duty to base the contracts. which the hon. Gentleman so bitterly attacked, on the advice of GPs and, as far as is practicable, to reflect their wishes.
Certain general practitioners will, if they wish, take the responsibility for handling funds so that they can determine where those resources are best targeted for the benefit of their patients.
Rather than increasing central control, it is our desire to devolve more of the responsibility for management and decision making to the sharp end. Local managers, doctors and nurses, and others responsible in hospitals and in community units will have more freedom to determine how the units run and what their priorities are, under the proposals which I have made. In those places where we have put together self-governing National Health Service trusts, people will be free from the bureaucracy and many of the frustrations which come from the present inadequate way of doing things. They will be able to put their best efforts into forging closer links between local hospitals and local people and developing services in the best way.
Difficult problems have to be tackled to put this in place. We must measure the quality of care in the National Health Service and find out what the costs are and where the money is being spent.
As has been said, everyone in the service understands the need for a better system for measuring quality. The British Medical Association has joined me in saying that we must have better financial management and control. It has said that the NHS could benefit if it knew where the money went and what the costs were. That is why the clinical auditing proposals have received widespread(welcome throughout health care professions and among doctors and nurses, and why the development of resource 457 management systems in the Health Service has the full and active support of doctors and nurses throughout the country.
Our reforms will produce a system which can match the huge sums of money that we are putting in with better quality and work load.
Everyone in the service will be responsible and accountable. They will know exactly what their units are meant to deliver and what resources are available for them to deliver it with. The whole system will be made for the consumer.
I heard somebody ask why the public do not believe that. Right hon. and hon. Members are challenging the public's reaction. We must compare the two reactions that we have had to the present state of our NHS proposals. The hon. Member for Livingston rarely addressed the contents of the Bill which is to be introduced, but he referred again and again to opinion polls and the public reaction. Today, we have seen the products of Labour's post a protest campaign and, as a contrast, the launching of the Health Reform Group, which is made up of professionals who support our reform.
In my opinion, like the British Medical Association's opinion polls in the summer, the Labour party's postcard campaign is a measure of the number of people who they have succeeded in misleading and frightening the public about the contents of our reform.
I have in my hand a document issued by the Labour party as part of its postcard protest campaign. It does not contain a solitary true statement about the reforms in the Bill. It is clearly being used for two purposes—first, to get people to send in sackfuls of postcards and secondly, to get people to contribute to Labour party funds, which are obviously urgently in need of replenishment.
The headlines on the back of the document say:The Government wants to give your doctor a fixed budget.That is not true. The fund-holding and practice budget proposals will be taken up by those doctors who wish to manage the funds and who find that it is to the advantage of their practice to do so. The document then says:If the money runs out you could pay with your health.Most definitely not true. I cannot believe that hon. Members in this honourable House will nod, apparently in assent, at a statement which they know to be a lie. It has been explained to them repeatedly that, if a budget-holding doctor runs above his budget, the penalty will be his being deprived of the right to control the budget. No penalties fall on his patients.
The postcard highlights four issues and says:Doctors compete for extra patients—even though that means less time for each patient.I believe that GPs will attract patients to their lists by responding to their greatest need, which is more time. As I explained when we debated this subject, it is plain what will happen as a result of GP contracts. The postcard continues:Local hospitals should opt our of local health authority control. Then they no longer have to offer a comprehensive range of services—which could mean fewer accident and emergency and maternity wards.I shall save for another occasion the tortuous and fanciful argument which leads to the claim that there will be fewer accidents and emergency and maternity wards. The postcard repeats the allegation: 458No one knows what will happen 'when the money runs out—a quotation which has no source.
When you want an operation, your GP or your health authority arranges a contract so your operation could be in a hospital miles away, simply because that's cheaper.That is simply not true either. There is no point in declaring to the House that one has postcard and opinion poll results showing that people oppose reforms when the postcards have been systematically collected by asserting untruths.
§ Mr. Robin Cook
I am most grateful to the Secretary of State for flattering me by encouraging the view that I and my hon. Friends alone can influence so many people. While I entirely accept the flattering assertion that I have been able to get, allegedly through misrepresentation, such support among people who vote Labour against these proposals, can the right hon. and learned Gentleman enlighten us as to why more Conservative voters oppose the proposals than support them? Is he saying that that is entirely down to the influence of the hon. Member for Livingston and his right hon. and hon. Friends? Is there nowhere in the Secretary of State's mind lurking the possibility that the electorate have minds of their own, and intelligence, that they have applied their intelligence and have been unconvinced by his proposals, and that, for once in his life, he ought to listen to what people are trying to tell the Government?
§ Mr. Clarke
I believe that patients will steadily be reassured as they discover that nobody will privatise the National Health Service, that nobody will deprive their doctor of the ability to prescribe the drugs that they require and that nobody will stop a doctor giving treatment when he has taken a fund-holding budget. As time goes on, and as we debate these proposals more seriously, that type of attack will be exposed as fraudulent, and indeed scandalous, from a party which purports to support the NHS.
I contrast the complaining and the speech made by the hon. Member for Livingston with today's announcement of the formation of the Health Reform Group. I commend to Opposition Members the article that appeared today—[Interruption.] It is by Dr. Colin Leon—[Interruption.]—and appears in the Daily Mail [Interruption.] If it has not yet come to Opposition Members' notice, perhaps they will let me read it. Dr. Leon wrote:I have always voted Labour and have always believed socialism to be more attractive than capitalism, but I do not share Labour's belief that the Health Service is under threat from these reforms.Labour's opposition has nothing to do with logic—it is mere party politics. The truth is that, whichever party were in power, only a fool would deny the need for thorough reform —The Government has proposed that large hospitals will have the right to 'opt out', to become self-governing, with freedom to develop the services their patients need, and fix their own rates of pay, and staff numbers.Opponents say this will produce hospitals run by accountants for the sole purpose of making profits. What nonsense. Hospitals which 'opt out' will not leave the NHS but will be given more responsibility for their activities and more opportunities to manage their own affairs. What doctor could oppose that?Hospitals need less bureaucracy and stronger management.It's about time the medical profession accepted the need for some kind of accountability. We spend public money so should be called upon to explain what we do with it." I commend that article to the House.459 I remind Opposition Members of the welcome for our reforms, which I have mentioned in previous debates, that appear in the columns of Marxism Today and the New Statesman. People with a wide range of political opinions on other subjects are united in the desire to have a better National Health Service. They accept the case for better management. They accept that it is possible to improve the service by getting better value for all the extra money that we put into it.
I look forward to dealing with the Health Reform Group, as it is made up of people who want to support our reforms and to make a constructive contribution to their implementation. Of course the Government will listen, and of course we need a contribution from the medical and nursing professions. We also need a contribution from people of all political views if they are genuinely motivated by a desire to have the Health Service run more sensibly. That is why, when we talk about the possibilities of GPs fund-holding and holding practice budgets, we are asking GPs to volunteer to develop that idea with us. We are working with doctors who want to make a success of the reforms for the benefit of their patients. That is why, when we talk about self-governing NHS trusts, we are looking for local groups of doctors, nurses and leading business men to come together and make propositions explaining what they want to do with their local services and then work with us on the experiment to make it a success.
I believe that such an approach, and looking for people of good will in the service to work with us to preserve what is best in the NHS but to run it better in the 1990s, will in the end win more support for the Government than can possibly be swept away by the silly postcards, the silly posters and the foolish attacks of the Labour party.
§ Mr. Campbell-Savours
My hon. Friend the Member for Livingston (Mr. Cook) asked the Secretary of State for a clear answer in regard to an incident in London and the ambulance service. Can we have an answer? Secondly, can the right hon. and learned Gentleman give us an assurance that he is not trying to press privatisation of the ambulance service during the ambulance dispute?
§ Mr. Clarke
I know when the Labour party has had enough of the Health Service—it gets back to the shop stewards hit, the strikes and the pay claims. That is when the Labour party comes to life when we are debating our great public services. [HON. MEMBERS: "Answer the question."] Of course I shall answer.
§ Mrs. Alice Mahon (Halifax)
On a point of order, Mr. Deputy Speaker, I have been trying to ask the Secretary of State whether he will give the House—
§ Mr. Clarke
I apologise to the hon. Lady for the lack of time. We have moved off the NHS reforms now. We have moved to the point at which the hon. Member who aspires to be Secretary of State for Health acts as a shop steward for the National Union of Public Employees and presses 460 its current pay claim. The hon. Member for Workington (Mr. Campbell-Savours) also wishes to press a pay claim against the service.
The fact that there is a dispute with the ambulance men is obviously a source of regret to the whole House. It should be resolved as soon as possible. I never want management of the NHS to have a conflict with the ambulance men and I deeply regret that the trade unions who lead the ambulance men have brought us to the present position. The hon. Members for Livingston and for Workington pursue every claim the union makes and, as far as I can see, press resolutely on with their support for extreme industrial action in support of a very high claim.
I repeated last week the reports that have come to me from the management of the London ambulance service and that of the west midlands service, who have lost patience at the gap between the public assertions of the trade union leaders involved and what was happening in those great cities. I readily accept that, in the bulk of the country, ordinary ambulance men and women will not withdraw the accident and emergency service. Although I may disagree with their taking action against the non-emergency services, I am not aware of anybody in my county of Nottinghamshire failing to respond to an accident or emergency call, but in London they did.
§ Mr. Clarke
The London ambulance service referred 1.0 the difficulty of obtaining a response to a call—
§ Mrs. Dunwoody
On a point of order, Mr. Deputy Speaker. Is it in order for the Secretary of State to mislead the House?
§ Mr. Deputy Speaker
Order. The Secretary of State has made it clear that he does not wish to give way.
§ Mr. Clarke
Mr. Crosby described two cases. In the first, a station refused to respond to a call to what turned out to be a stillborn baby found in a ditch somewhere in London. The hon. Member for Livingston used a report in the Daily Mirror about that incident as a source of attack upon me. I read the story in the Daily Mirror, which did not support its editorial. The newspaper had clipped extracts from a telephone conversation in which a London ambulance service controller plainly confronted the person in the station with refusing to accept a call, which was answered by another station.
In another case, a station refused to answer a call to a man who had been shot and the police were obliged to take the victim to hospital. As far as I am aware, that claim has never been challenged. A similar event took place in Birmingham. A man who had lost a foot was refused by one station and taken to hospital by a crew from another station. For 48 hours, Bristol road station did not accept 999 or emergency calls. I trust that, having reached that stage, common sense and civilised behaviour will prevail on both sides of the dispute.
461 If the national union leaders mean what they say and do not wish to threaten the accident and emergency service, they will ensure that their men follow the guidelines, answer 999 calls and take doctor emergency referrals to hospitals which are just as important. I hope that the unions will stop fooling about with 14-point work-to-rule plans and arguing about how one works a radio telephone. I hope that we can return to normal operation of the accident and emergency service. That is what ambulance men in most services are doing.
The extremists in the unions are represented by Opposition Members who, when I said that ambulance staff should resume their duties, replied, "Pay them." They support the extremist view that workers in the accident and emergency service have no obligation to respond to calls unless they get their money.
The management of the NHS has tried to resolve the dispute in every possible way. It proposed a greatly improved pay offer to the union leaders about a week ago, which was rejected angrily and aggressively by Mr. Roger Poole. An organisation called the Association of Professional Ambulance Personnel is not represented on the staff side of the Whitley council.
§ Mr. Clarke
It is regarded as a joke by the hon. Member for Workington (Mr. Campbell-Savours) because it is not affiliated to the TUC or the Labour party. It represents many more ambulance men and women than most of the trade unions involved in organising the industrial action, which are on the staff side of the Whitley council. The association has produced convincing evidence that it represents more than 20 per cent. of ambulance men and women. However, it is excluded from all staff side participation because it is not politically acceptable to the hon. Gentleman and his hon. Friends.
Therefore, I have proposed—it is only a proposal at this stage—that it should begin negotiations with management through a separate negotiating council. It must be a separate council, because the TUC unions bar it from the Whitley council. To make sure that we all know what is on offer, the management have made the sensible decision to embark on a limited period of advertising—just one day —to set out clearly the nature of Duncan Nichol's offers for ambulance men and women who do not know what their union refuses to discuss.
§ Mr. Allen
The Secretary of State knows, as everybody in the country knows, that there is a clear, easy and simple way to resolve the dispute, allow ambulance staff to return to full working and ensure that all calls are answered. He should allow the matter to go to arbitration. Will he now allow the dispute to be settled or explain why he insists that the dispute must persist?
§ Mr. Clarke
If a future Labour Government run the National Health Service on the basis that, every time a group of workers takes strike action, the claim is referred to arbitration to settle the difference between the claim and the offer, they will reduce it to the same shambles as when they were last in power. To be fair to the previous Labour Government, I do not recollect that they ever referred an industrial dispute in the Health Service to arbitration. Clearly, it is an absurd way to manage such a huge service. 462 It would result in group after group undermining the management's ability to control NHS funding by going to arbitration.
The claim must be resolved satisfactorily, but the nature of the claim supported by the unions' extreme action is clearly excessive. Many employers could not afford 11 per cent. pay settlements in last year's pay round, and NHS management are clear that they are one of them. Unlike other employers, they cannot put up prices. They cannot afford to increase fares like British Rail. They cannot afford to increase the community charge as local government can. They would have to cut services to accommodate the increased pay of ambulance staff.
The comparisons with the ambulance service are fanciful and optimistic. The public have suddenly begun to realise that only one mile in 10 covered by ambulances is for an accident or emergency and only one patient in 10 is an accident victim. The bulk of ambulance staff carry out the caring and responsible work of taking non-emergency patients to out-patient clinics. That work is not distinguishable from that of countless other groups of dedicated and caring Health Service staff. As an observer of the dispute, I cannot see why, if nine tenths of patients go to out-patient clinics, ambulance staff can be compared with fifth-year firemen or any other such group.
I was asked about the future of the service and I shall answer that before I finish my speech. The management have already said what they see as the future of the service. They have suggested a two-tier service with separation of accident and emergency from non-emergency services. We need more paramedical personnel in the accident and emergency service and more extended training of the type already provided. The status of men and women in that part of the service must be recognised, as the management acknowledge in their proposals. Duncan Nichol has offered to make available an extra £500 next year—new money in anyone's book—for all staff with a specified level of extended training.
The TUC unions dismiss that. They say that it is elitist and divisive. Many of their members do not have such training, so they do not want such an arrangement. But many people see it as a way forward. People may make comparisons with other groups, but the main determinant of pay must be not comparison but freedom to recruit and obtain the quality of staff needed to work in a dedicated paramedical accident and emergency service.
The second tier should be paid better, but in some cases it will be contracted out. That has happened in Wiltshire and Northumberland. I know that people are worried about that and that the unions are opposed to it, but the industrial action is hastening the day when managers move in that direction.
§ Mr. Clarke
They are not threats. The history of the past 10 or 15 years shows that irresponsible industrial action pressed too far has cost many groups of staff money and many jobs. I hope that that can be avoided in the NHS, particularly with the introduction of a more responsible trade union into the negotiating process, and that we can achieve a satisfactory outcome.
§ Mr. Clarke
I have spoken for too long, yet not given way nearly enough to the many hon. Members who wish to intervene. Clearly, we have had a taste of the controversy and of the conclusions. The Labour party will not introduce an original, serious proposition on the reform of the NHS, or give any sign of how it would change the way in which the NHS is run. It is more anxious to preserve the 1948 system as a museum piece and to exploit the understandable uncertainties about change for party political reasons. Its real enthusiasm is reserved for strikes in the public sector. That has been its greatest contribution in the past as it will be in the future, until such time as we hear a Labour party spokesman condemn industrial action in the NHS.
§ Mr. Tam Dalyell (Linlithgow)
On a point of order, Mr. Deputy Speaker. Is it not incumbent on the Secretary of State for Health to say something about embryo research?
§ Mr. Clarke
I share the hon. Gentleman's predilection. I have here some pages on embryo research which I abandoned when I realised that the number of interventions and my responses to them would run me out of time. The public will draw our attention to embryo research more than to any other subject this winter, and we shall have opportunities to discuss the matter.
In all these subjects we are concerned about our quality of life, which depends on the quality of great public services such as the NHS. We have never spent so much money on them. We are spending as much as we can afford. We never employed so many doctors and nurses or treated so many patients. The service has never received so much attention from a Government determined to improve how it is run and to prepare it for greater things.
A healthy welfare state cannot simply be preserved. It needs to evolve to meet the changing needs of society. Under this Government, our welfare state will change for the better. Our programme for this Session set out in the Gracious Speech will help us to achieve the aim of making the NHS, which is already a great public service, a greater service still in the decade ahead.
§ 5.1 pm
§ Mr. Alfred Morris (Manchester, Wythenshawe)
The short but conclusive answer to the Secretary of State's speech is that he is still totally unable to persuade even a substantial minority of the British people to support him. Time is at a premium, of course, and I shall move quickly in my speech to address, for reasons the House will understand, some implications of the Government's health and community care proposals of special concern to people with disabilities, their families and others who care for them day by day.
First of all, however, I must challenge the Government on their contemptuous treatment of the House last Thursday, shown by the way in which they announced the woefully inadequate ex gratia award of £20,000 to people with haemophilia who, tragically, in the course of treatment under the National Health Service, were infected with the AIDS virus. It is utterly disgraceful and scandalous that an announcement of such importance was made in reply to a ministerially inspired question for 464 written answer, thus avoiding the detailed questioning of the Secretary of State on the Floor of the House that should have followed the announcement last Thursday.
The Prime Minister and her unelected news manager-in-chief in Downing street apparently now insist that, except for "Question Time" and "Any Questions?", most Ministers must not appear on television or radio with shadow Ministers. For the Government to have insisted in the crucially important case of last Thursday's announcement that such direct exchanges are impermissible even in this House must be the most damaging outcome to date of the Prime Minister's known opposition to the televising of our proceedings.
Nothing proves more conclusively than the handling of that announcement the Prime Minister's sense of shame about the sum offered to the 1,200 victims of a monumental catalogue of mistakes that has already killed more than 100 of them. Many more, young people as well as older victims, have scant hope of living to see a court settlement of their claims to just compensation. The judgment of The Sunday Times yesterday is irrefutable. In striking reproof of Ministers, the paper states:The quality of the Government's mercy is so strained as to be morally reprehensible. £20,000 is hopelessly out of proportion to the nature of the 'injury'. The latest criminal injuries compensation board awards show that £20,000 was the sum paid to a 60-year-old man with a crushed hand and to a 20-year-old woman psychologically damaged by facial scars.How do the Government respond to the statement of John Williams, administrator of the Macfarlane Trust—the charity which has been told to handle the ex gratia payments? Mr. Williams says that the trust has been put in an "impossible situation". A spokesman for the Charity Commission has described as "outrageous" the Government's decision that the trust must "lend" £5 million of the cost of the ex gratia payments from its existing funds. Is that not a shocking indictment of the Government's handling of this deeply grievous affair? Can we at least have today a definite guarantee that the ex gratia payments will be made before Christmas?
§ Mr. Robert Key (Salisbury)
I find it upsetting that the right hon. Gentleman takes this line. What impressed me last week was the speed with which the Government were not just prepared to provide the sum of money which, I agree, can never be sufficient, but decided to abandon the principle to which they had previously held, which was that the Government could not make ex gratia payments in a lump sum non-means-tested. That was an enormous move forward and the Haemophilia Society acknowledged it.
§ Mr. Morris
The hon. Gentleman will have heard from both sides of the House concern about his odd use of the word "speed". I quoted only from The Sunday Times, but may other organs of opinion have expressed very strong reservations.
Voluntary organisations that work to help disabled people and their families are worried about the Government's NHS and community care proposals. The Association of Crossroads Care Attendant Schemes, of which I am a patron, fears that inadequate funding will lead tocrude and insensitive service provision",even for people with the most severe disabilities, and that 465carers will remain a low priority for hard-pressed local authorities faced with a growing demand for services from the increasing numbers of elderly and highly dependent people living in the community.The John Groom's Association for the Disabled speaks ofThe enormous reluctance of doctors to be involved with disabled people, who they regard as wanting more care.The association quotes a letter from the Essex family practitioner committee to the effect that, if disabled people need extra services, the general practitioner is entitled to demand a fee.
Maggie Oxby of the Snowdon award scheme, of which I am a trustee, quotes the case of Colin Hughes, who has muscular dystrophy and uses a wheelchair, to demonstrate how cruel is the lot already of young disabled people whose problems the community care proposals do nothing to address. She reports to me that Colin, a university graduate who worked for the BBC:… may now have to move back into care from his adapted flat because he just cannot afford to keep going.In a letter to the trustees earlier this month Colin said:I now no longer work at the BBC in Cardiff. Extremely disappointingly for me, I was forced to give up the job because I was unable to secure suitable accommodation in the Cardiff area … I was also relying on the independent living fund granting me an allowance to fund the cost of the care I need.However, despite the fact that I applied in early June, I still have not received confirmation that I will be receiving help from them. Thus sadly the combination of those two factors has made it impossible for me to continue working for the BBC in Cardiff. I am now unemployed.That unemployment is not his fault and it is certainly not the fault of the BBC. Yet none of the Government's proposals gives any promise of immediate help to Colin Hughes, while some of the NHS proposals, as the John Groom's Association has said, could make his plight even worse.
Recent briefings for the all-party disablement group quote the fear of Arthritis Care that "budget holding" could bring actual disadvantages to patients with chronic diseases, while Mencap says:… A healthy emphasis on costs will become unhealthy if not accompanied by an equal emphasis on quality.It strongly criticises the NHS review on the grounds that mental handicap and other community care issues are left almost entirely to the reader's imagination with no real indication that they will be considered.
Moreover, what do any of the Government's proposals do for people dying of AIDS whose principal financial need—I have written to the Minister with responsibility for the disabled about this and have not so far received a definitive reply—is for adequate nutrition and not attendance? In 1988, when prices were much lower than they are now, the Royal Victoria infirmary estimated that £32.75 was the cost of a diet for someone with AIDS/ARC. That compares with the current total basic income support of £27.40 for someone under the age of 25. That is a cruel anomaly and for many, in the view of experts, it can have fatal consequences.
The document "Caring for People" is really two documents that are interleaved. One displays the professional social work approach. The other has been written by the finance department of the Department of Health on instructions from the Treasury and is designed to ensure that the model of care never works in practice. The sole purpose of the authors of the second document is to stem the current outflow of public funds to residential 466 homes. Unfortunately for them, their contributions incorporate an approach that has been shown to be unlawful.
The Bill, on the other hand, pays little attention to the White Paper. It is significant that much of the philosophy, and even the language, of the White Paper echoes that of the Disabled Persons (Services, Consultation and Representation) Act 1986 which was introduced and piloted through the House by my hon. Friend the Member for Monklands, West (Mr. Clarke). But the Government are still dragging their feet over the full implementation of that important Act. The paragraphs on assessment, in paragraph 3.2, are very similar to section 3 of the 1986 Act, although they do not include an appeals procedure.
Only a few days before the White Paper on community care was published, the Under-Secretary of State for Health finally said that discussions would soon begin with local authority associations on implementation of sections 1, 2 and 3 of the Act. Perhaps when he is replying the Minister will tell us how the discussions will mesh with those mentioned in paragraph 3.2.13 of the White Paper. I trust that the discussions on sections 1, 2 and 3 will not mirror the farce of those on section 7 where the Department has prevaricated for two years. Even now it is not clear whether the Government are refusing to implement section 7 because it goes too far or not far enough.
Over the past two years, Ministers have usually quoted the figure of £100 million as the cost of implementing the assessment procedures of the 1986 Act. I have failed to find any costings of the approach recommended in chapter 3. Will extra money be given to local authorities? Ministers have also recently received guidelines for assessment of people under section 7 from the organisation Act Now. The vital difference between those guidelines and drafts emanating from the Department of Health is that they tackle all of a person's needs in the community, including housing, education, employment and social security.
Ministers are fully aware of the existing requirements of section 1 of the Chronically Sick and Disabled Persons Act 1970, as amended by section 9 of the Disabled Persons (Services, Consultation and Representation) Act 1986. Will they insist in any guidance that assessments cover all of a person's social and health needs, such as those of Colin Hughes, and not just those for which the Department of Health is ultimately responsible?
I was pleased to receive a letter dated 14 November from the Minister of Health. It says:People's rights under existing disablement legislation will remain unaltered.I must therefore tell the Minister that, in relation to the Chronically Sick and Disabled Persons Act, paragraph 3.2.12 of the White Paper skates very close to recommending unlawful action. The key sentences state:Assessments will, therefore, have to be made against a background of stated objectives and priorities determined by the local authority. Decisions on service provision will have to take account of what is available and affordable.In August 1970, the then Sir Keith Joseph, who was Secretary of State for Social Services, issued circular 12/70 on the Chronically Sick and Disabled Persons Act. The circular included the sentence:Criteria of need are matters for the authorities to determine in the light of resources.It took five years and a change of Government before that sentence was officially admitted to be a grave misstatement of the law.
467 I draw the Minister's attention to the sixth report of the Parliamentary Commissioner for Administration 1975–76, case 12/k, House of Commons Paper 665. The Ombudsman reported that the Department of Health had admitted that mention of resources in the circular might have "muddied the waters" and that its legal advice now was thatA local authority could not plead lack of money as a reason for not meeting need.That was also my legal advice when I became Minister for the Disabled, and subsequent Ministers have told me in parliamentary replies that they have had exactly the same advice.
The Bill, by way of clauses 41 and 42, creates even more confusion, although the Government's lawyers may be attempting to evade the illegalities that I have just mentioned. Clause 41 lists the "community care services" and there is one blatant omission—section 2 of the Chronically Sick and Disabled Persons Act. This creeps in at clause 42(2) through the references to section 4 of the Disabled Persons (Services, Consultation and Representation) Act. However, as section 2 services of the 1970 Act are technically provided under section 29 of the 1948 Act, the loophole does not exist.
Section 2 of the 1970 Act is, of course, one of the welfare enactments covered by the provisions of the 1986 Act. If section 3 of that Act is implemented, two of the community care services will be covered by its procedures —part III of the National Assistance Act 1948 and schedule 8 of the National Health Service Act 1977—but not section 45 of the Health Services and Public Health Act 1968. Clause 42(4) contains the magnificent statement:This section is without prejudice to section 3 of the Disabled Persons (Services, Consultation and Representation) Act 1986.Ministers should recognise that the job of local authorities is to provide services and that it is quite impracticable for them to operate different procedures for different pieces of legislation when they often refer to the same services but for different people. The only sensible course is to extend section 3 of the 1986 Act to all community care services.
Paragraph 8.24—the Treasury paragraph par excellence—makes it clear that the good intentions of the Minister for Health may be hamstrung even before the new arrangements come into effect. However, I can assure the Government that any whiff of illegality will be relentlessly pursued by hon. Members in all parts of the House. In that context, I ask for an assurance now that the revised default powers of the Secretary of State in clause 44 will give people with disabilities equal rights of complaint to him as does the current section 36 of the 1948 Act. Will he have a duty to conduct a formal inquiry as at present?
§ Mr. Tom Clarke (Monklands, West)
My right hon. Friend has outlined the various Acts which the Government are not prepared to implement urgently. Will he invite the Minister of State, the right hon. Member for Chelsea (Mr. Scott), or the Secretary of State, who presented two versions of section 7 of the Disabled Persons (Services, Consultation and Representation) Act 1986—first, to the all-party group and, secondly, while that measure was passing through the House, both of them different from the White Paper—to explain what has influenced the Government to desert their clear commitments?
§ Mr. Morris
My hon. Friend makes a valid point. He does so authoritatively as the Member who piloted the 1986 measure through the House. I hope that there will he a positive response to him from Ministers in this debate. There is a most pressing need now to allay the fears of people with disabilities, their families and their carers on the issues to which I have referred. I urge Ministers to do so tonight.
§ Sir Bernard Braine (Castle Point)
Health is a subject of enormous importance to every family in the land, and on this occasion we are debating it in the context of the Gracious Speech. I shall make a brief reference therefore to a Bill that is concerned not merely with health but with life itself. I welcome the Human Fertilisation and Embryo Bill. We are told that it will deal with the issues raised in the Warnock report. It is not before time. Legislation to control experimentation on the human embryo is long overdue. More than five years have passed since the Warnock committee reported to Parliament, albeit with a divided voice. There was an immediate outcry against its recommendations. More than I million people signed a petition protesting against the recommendations. Both Houses of Parliament—I participated in the debate in this House—were highly critical of the recommendations.
The Warnock report was followed by the attempts of several Members to introduce legislation prohibiting the creation of human embryos purely for research. The House has demonstrated repeatedly its support for such measures and yet on every occasion has been frustrated by a few opponents, with the Government of the day standing on the sidelines and not prepared to lift a finger. The will of the majority in the House on this subject has never been allowed to prevail. In the meantime, experimentation with embryos has continued unregulated.
No one knows what has been done behind closed doors. There have been voluntary watchdogs, but who appointed them? What have they discovered about such research and the means by which it is carried out? It is a relief therefore to many of us that the Government have at long last honoured their commitment to introduce a Bill. We shall debate the Bill later, and this is not the time to talk in any detail about it. However, having read the Bill it is essential for me, as chairman of the Pro Life committee of both Houses, to sound a warning note now. In clause 11, which is crucial, there appear the alternative clauses that were promised by the Government. We are to be given a choice between provision for treatment, service, storage and research, or treatment and storage without research. That is not a clear choice, as I shall show, and it was not what we were promised.
Let us consider the activities that will be licensed, whichever way we vote. The treatment services outlined in schedule 2 includepractices designed to secure that embryos are in a suitable condition to be placed in a woman or to determine whether embryos are suitable for that purpose".What does that mean? It must involve research—which, incidentally, is not defined anywhere in the Bill. There then appears the following passage:Such other practices as may be specified in, or determined in accordance with, regulations.What does that mean? What shall we be voting for? This is nothing more than a thinly disguised attempt to introduce research on human embryos no matter what 469 Parliament decides. To borrow the words of Winston Churchill—my Pro Life Committee and I—"Up with that we will not put."
§ Mr. Dafydd Wigley (Caernarfon)
Does the right hon. Gentleman accept that opinion polls show that an overwhelming majority of 2:1 is in favour of continued research into congenital diseases—research of a kind that would be banned if he had his way?
§ Sir Bernard Braine
I do not accept that for one moment. I have always respected the hon. Gentleman's position, and if he wishes to press me, I can go into considerable detail.
There is not an overwhelming majority for experimentation on human embryos. There is a deep sympathy and understanding, which we all share, for the plight of those who have handicapped children, but there are other ways of dealing with the problem. My committee is advised by some of the most prestigious names in science and medicine in the world. They tell us that it is not necessary to experiment on the human embryo, and certainly not up to the 14 days recommended in the Bill. Incidentally, I remember Baroness Warnock saying in an unguarded moment that 14 days would do for a start.
To cite just one example, fundamental research has been taking place into Down's syndrome. Some of the most important discoveries have been made by the eminent French scientist Professor Jerome Lejeune, who managed to achieve his results without any experimentation on the human embryo. I sympathise with the position of the hon. Member for Caernarfon (Mr. Wigley), but I think that we shall have to differ on the methods by which we arrive at the goal that he desires.
I wish also to make clear the Pro Life committee's position on the proposed statutory licensing authority. The committee has no faith in the sort of authority that is proposed in the Bill. That would involve an intricate system of an authority, licensing committees, subcommittees and the involvement in some of the committees of people who not members of the authority. That is the best recipe for a quango that I have seen in nearly 40 years in Parliament. I suspect that it is designed to ensure that no one can get at what is really going on.
Worse still, after its first year of operation the authority will have to report to the Secretary of State only biennially. That simply will not do. We in the Pro Life movement believe that it is essential that the issuing of licences for any lawful procedures for creating human embryos should be in the hands of the Secretary of State, and that any licensing authority should act only as a watchdog. Furthermore, an effort should be made to secure a balance between known differences of view within the authority. There is no provision for that in the Bill, but there is a precedent for such powers to be exercised by the Secretary of State.
Licences for animal experimentation are issued through the Home Office, making the Secretary of State for the Home Department directly responsible for deciding the purpose of each experiment and the methods by which it is to be undertaken. It is wholly reasonable to request that a similar system be enacted in respect of experimentation with human embryos. It would be wholly incongruous if we did not accord to human embryos at least the same 470 degree of protection that we give to animals—not that the protection that they receive in this respect is satisfactory. Indeed, recent revelations in respect of animal experiments have alarmed and sickened many right hon. and hon. Members and a large number of our constituents.
I turn now to the danger of a statutory licensing authority being dominated by those who, for whatever reason, support experimentation on human embryos. If that is allowed, effective control will be lost and might not be recovered for many years. If the composition of the Warnock committee is anything to go by, our fears are well founded, for it did not include one human embryologist, although I concede that it did include a zoologist. The two eminent gynaecologists who served on that committee are both well known pro-abortionists. It is hardly surprising that a minority report was presented by the distinguished professor of neurology, John Marshall, and there were other dissentients. As a result, the Warnock report, which appears to be the basis for the Human Fertilisation and Embryology Bill, received the support of only the smallest possible majority of the committee's members. The committee's report gave rise to expressions of dissent by seven of its 16 members.
I also note the shifting of the goal posts in the definition of the word "embryo". The Bill states:fertilisation is not complete until the appearance of a two-cell zygote.That is a significant departure from the definition given in the Warnock report, which defines an embryo as beginning with the meeting of sperm and egg at fertilisation. That change of definition is important to note.
With regard to the upper time limit for abortion, we understand that that aspect can be decided at a later stage, although the Bill as drafted makes no reference to it. Happily, it is so drafted that an amendment or amendments can be tabled later. It would be not just morally repugnant but totally ludicrous if Parliament decided to give protection to the human embryo, or even the very limited protection of allowing experimentation only up to 14 days, yet denied any protection to a child in the womb, at a later stage of its journey into life when it is already a recognisable and sentient human being who recognises its mothers voice and can feel pain.
§ Miss Ann Widdecombe (Maidstone)
Does my right hon. Friend agree that the Polkinghorne report, which was implemented without any parliamentary debate, also deals with the use of foetal parts at a later stage of life, and that we are wrong to restrict ourselves to repealing the law only in respect of the earliest stage of pregnancy?
§ Sir Bernard Braine
My hon. Friend is right. I hope that there is no question of restricting ourselves. Parliament is the grand forum of the nation. The public expect us to focus attention on such issues, to confront them courageously, and to speak our minds. I feel certain that my hon. Friend the Member for Maidstone (Miss Widdecombe) and right hon. and hon. Members in all parts of the House agree. This is not a party issue. Indeed, it is one that even unites all elements in Northern Ireland, where there is a remarkable degree of unanimity between Catholics and Protestants on the matter. I am glad to report that the pro-lifers' arguments have the support also of Christian leaders and the Jewish and Islamic communities. My hon. Friend the Member for Maidstone is right, and I and many others will combine to ensure that these grave issues are faced properly for the first time.
471 For years, successive Governments fudged the issue and were frightened to face up to it. Whenever there has been a vote in the House, immense majorities have been in favour of reform. That was the case with Mr. Enoch Powell's Bill and other Bills which followed. Did the Government respond? No, they stood back—yet the Abortion Act 1967 itself could not have reached the statute book had not the Administration of the day given Government time to its completion. I have a long memory in this matter, and many of us are determined, for as long as we are in Parliament, to see things through. I am grateful to my hon. Friend the Member for Maidstone for her intervention.
I remind the House of the fundamental principles of medical ethics, which have stood the test of time and have guided medical practice for many years. First, there is the Geneva convention code of medical ethics, which was adopted by the World Medical Association in 1948. A modern restatement of the principles of Hippocratic medicine, it says simply;I will have the utmost respect for human life from the time of conception.There is also the Helsinki declaration of the World Medical Federation, which was adopted in 1964 and amended in 1983. It states:In research on man the interests of science and society must never take precedence over the well-being of the subject.Those restrictions apply to all areas of medical research, and they should apply also to research on the human embryo. There is no justification for rewriting them now.
I hasten to add that we in the pro-life movement do not oppose research into infertility—we do not even oppose the idea that some research should be undertaken on human subjects—but we are concerned that all research on human subjects should be governed by the accepted principles of medical ethics worldwide. The human embryo is, from conception, a living member of our species and must be treated as such.
§ Mr. Archy Kirkwood (Roxburgh and Berwickshire)
I do not intend to follow the right hon. Member for Castle Point (Sir B. Braine), whose views are well known. He stated his case with emotion and passion, and I feel sure that we shall return to the question of embryo research, which will be an important feature of our future debates on health and welfare.
Many other items should be on the Government's agenda but are not, and neither have they been mentioned today. They include provision for the homeless, social security measures, the problems that flow from AIDS, war widows' pensions and other important matters.
I want to refer specifically to the Secretary of State for Health's initial exchanges across the Dispatch Box with the official Opposition about resources, which are at the heart of the problems affecting the Health Service. I become profoundly frustrated and depressed when I hear Ministers trotting out statistics about the number of new doctors and nurses and about real increases in expenditure, while Opposition Members mouth statistics on the number of hospital and ward closures and the difficulties that they confront in their constituencies. It must be difficult for the general public to make any sense of arguments conducted in these terms. I often wonder 472 what the public, and patients in particular, make of our debates. They do not always help to inform or improve the situation.
Any Government would have difficulty in producing the sums of money that I would like to see spent on the Health Service, but of course Governments are constrained by having to husband the public purse. Although £29 billion is a good deal of money in absolute terms, it is not such a large sum in relative terms, when compared with the amount that our sister European democracies are devoting to finance their health services. It is worth remembering that the proportion of national wealth that we provide for the NHS is certainly not wildly in excess of the equivalent proportions provided by those countries.
Opposition Members, of course, make endless demands for more money for the NHS. The increases that the Government have secured over the past two public expenditure rounds were very welcome—£5.2 billion is a lot of money—but the professions and others who work within the NHS would like to know whether the increases announced so proudly by the Secretary of State this afternoon represent a regular level of increase that may be sustained in the future. They would be willing to learn to live with that, but the trouble is that this welcome expenditure has been wrung from the Government like blood from a stone.
I understand the Secretary of State's concern about those successful hospital units that develop new techniques and provide a high level of patient care which run out of funds early in the financial year. A way around that problem, however, would be to introduce a rolling programme of expenditure, which would give district and regional authorities some idea of the amounts available to them over the coming years. We need to agree on a funding formula. In my view, the best formula is that suggested by the Select Committee on Social Services, which recommended that base funding should consist of the real cost of inflation to the NHS, plus 2 per cent. That, I feel, would lead to better organisation in the long term.
§ Mr. Jeremy Corbyn (Islington, North)
Does the hon. Gentleman agree that one way of improving expenditure on health care would be to reduce arms expenditure, at least to the same level as in other western European countries? That would lead to a saving of some £5 billion, which would provide at least some of the resources that are urgently needed to stop hospital closures and the loss of hospital beds in every district health authority.
§ Mr. Kirkwood
That conveniently illustrates a different point. It is, of course, difficult to assess precisely the amounts required by the NHS, but it does not take a genius to work out that the money spend in the NHS is dominated by staff costs—which are spiralling above the retail price index—and that NHS expenditure must increase by substantially more than inflation. It is no use the Government talking about real increases without taking that factor into account. Nor is there any point in the Secretary of State's beating his chest about the money that he has managed to squeeze out of the Treasury: that money should be seen against a 10-year-old background of under-funding. According to the Select Committee, £20 billion is needed just for capital investment in the fabric of our hospitals, wards and community health centres.
473 No doubt hon. Members on both sides of the House find that the current demographic changes are reflected in their constituency work. As a larger proportion of the population are now aged 75 or more, the demands on the Health Service must of course increase. It costs £3,500 to look after the average 85-year-old, while only one tenth of that is needed to look after the average Member of Parliament who is—as I am—rapidly approaching middle age. [Interruption.] I am older than I look, and this business does not make any of us look any younger.
§ Mr. Kirkwood
It is indeed.
We all welcome the technological developments that are now benefiting our constituents, and those developments must continue apace; but there is no point in scientists and research technologists devising new methods of treatment if those methods are not made as widely available as possible. Let me make a plea for a measure of continuity and agreement in regard to the amount of money that we need to maintain standards—which is all that the Select Committee was trying to achieve—before considering what potential enhancements are possible. We are talking about big money.
If the Government take a Treasury view of life, the Health Service will never escape from the bind that it is in now. We must take a wider view. I am not arguing for profligate expenditure; I believe that the public would respond to a sensible, moderate approach. We must, of course, get the management structures right, but I think that the Government would be pleasantly surprised by public reaction to a sensible commitment to continuous increases in real-term expenditure on the NHS.
In many respects, the Government's approach has been irresponsible—and I say that as one who is not given to extreme language. The confidential basis on which the NHS review was conducted was scandalous: there was no participation by any of the professional bodies or pressure groups. The Secretary of State made matters worse by gratuitously alienating health professions—the GPs in particular—by accusing them of being interested only in their own incomes.
That is a scandalous calumny. I have talked to doctors throughout the country who are perfectly happy to accommodate the Government with peer group reviews, medical audits and many other positive aims which could have been pursued much more vigorously and successfully had the Government approached the professions with more humility and common sense.
The hon. Member for Livingston (Mr. Cook) was right to say that there was no mandate for this reform: certainly the last Conservative manifesto did not mention it. Now the Government are railroading it through in the teeth of opposition—and not only from the public. I sympathise with the Government's objection to some of the statements made by the more extreme pressure groups, which may indeed misrepresent the Government's position, but I do not believe that the public will support this measure when they come to understand it more fully.
It is a pernicious attempt to tinker with the administration and to put in place a system that will enable the Government to keep down costs. If that policy is 474 pursued religiously, as I am sure that it will be, and whipped through the House, there will be a massive drop in the morale of those who work in the National Health Service. If the Government think that they can survive such a drop in morale for a long time, especially with the manpower crisis, most of all in the nursing profession, they are very much mistaken. That would be bad news for the House of Commons, bad news for the Government and, worst of all, bad news for patients.
§ Mr. Paddy Ashdown (Yeovil)
Last Thursday night there was a parish ballot in my constituency—the first of its kind in Britain—on the Government's proposals, particularly on the question of the local hospital opting out of the National Health Service. The result of the ballot was that 97 per cent. were against opting out.
§ Mr. Kirkwood
I am not surprised to hear that. It is the general outcome of such ballots.
As these measures are considered by the House of Commons, the amount of opposition will increase. At the next general election, the Government will find it very difficult to defend their legislation. I hope that they will get their comeuppance. If they do, they will deserve to lose all the seats that they then lose.
§ Dame Jill Knight (Birmingham, Edgbaston)
In Health Service matters there is an unholy alliance between the press and the Opposition to make good seem bad, advance seem retreat and truth seem lies. Good news does not sell papers, and it does not win votes for the Opposition.
In another context, my hon. Friends will have noted that, whenever there is a reduction in unemployment, the Opposition are glum and miserable. Down, therefore, with any good news—do not print it, do not mention it, or better still, manipulate it in to seeming bad news. It is much more clever, they say, to trumpet from the housetops that such and such a hospital is closing. If it is old and has been open for a long time, they think that there must be many people who have received treatment there who will speak of it with gratitude and affection and will regret its closure. The Opposition try to get those aspects in front of the cameras, and they like to talk about them in the House. They never let on for a moment that a beautiful new hospital is opening instead. They keep quiet about that. They never let on that the new hospital will provide better treatment, new wards and better conditions.
There was a perfect example of that in Birmingham, when the old children's hospital was closed. Some of us had been trying to get a new children's hospital for years. Children had to be wheeled across an open yard to the operating theatre. We succeeded in getting a new children's hospital, but did the Opposition say one word about it? Dear me, no—all that we heard about from them was that the old hospital was being closed.
Under this Government, 270 major hospital schemes in England alone have been started and completed, and 530 more schemes are in hand.
§ Dame Jill Knight
What a silly comment that was. It does not matter if a hospital closes, so long as a better and more modern hospital where patients can be treated is opened.
§ Dame Jill Knight
If the hon. Gentleman wants to make such silly remarks, he might as well tell us all.
§ Mr. Corbyn
During the last 10 years, however, a very large number of hospital beds have been lost to the NHS on account of closures. When new hospitals have been opened, fewer beds have been made available in many of them—hence the very long waiting lists. The experience of most people is that they are getting a much worse service now from the NHS than they did 10 years ago.
§ Dame Jill Knight
That is what the hon. Gentleman wishes were the case, but it is not true. I do not know how the hon. Gentleman has the nerve to get up and talk about hospitals when not one new hospital was opened when a Labour Government were in office. There were plenty of ward closures at that time, too.
All that the Opposition want to do is to turn good news round and hide it. They say, "Let us find a tired nurse, play up how hard she works for her patients and say how dreadful it is that she cannot be paid more." They do not breathe a word to the effect that her pay has increased, on average, by 44 per cent. under this Government, and that is after taking inflation into account. There is no reason why the Opposition should not mention that nurses may be tired, but they never mention that they are now paid more than they were under Labour.
The Opposition also say: "Let us find a baby who is going to die on account of complications after a premature birth, but whatever we do, we must not let the news get out that many, many babies who certainly would have died 10 years ago are able to be saved today." Premature babies present very difficult problems, but about 35 per cent. of those who would certainly have died a few years ago are now being saved. Of course that is a tribute to the cleverness of the medical profession and the doctors, but let nobody think that it is done without money. That work is being funded.
The Opposition employ the same tactics in relation to Health Service review. It is portrayed as an attack on the NHS, but it is a vital life-saving measure. New treatments, new operations and new drugs are very expensive. We cannot continue to waste money in the way that it was wasted for so many years. Of course patients should be given a better service, and it should be universally good in the NHS. Why, I ask myself—I am sorry that Opposition Members do not ask themselves the same question—should patients in Merseyside have to wait three times longer for a hip operation than patients in London? Why do some doctors prescribe valium and mogadon for years on end instead of treating their patients? I know of one young woman who was prescribed valium for seven long years without one medical examination by her doctor. That is wrong for both the patient and the NHS.
§ Dame Jill Knight
No, the hon. Lady wants to finish her speech because other hon. Members want to take part in the debate. [Interruption.] The hon. Gentleman will, I am 476 sure, have an opportunity to make his speech. He has not been here throughout the debate, as I have, and I am determined to make my speech in my own way.
Why do some orthopaedic surgeons carry out more operations in one month than others do in six? Why are some hospitals user-friendly while others are a misery to enter? There is undoubtedly a need for big improvements in the NHS. That is what the review is about. The object of the review and of the Bill is to improve services for patients. The hon. Member for Wolverhampton, South-East (Mr. Turner) was in danger of being struck down with apoplexy in the Chamber when he made a great hoo-hah about waiting lists. A lot of people who have been sent for hip operations could not have had them at all 15 or 20 years ago. We now are all aware of people who have had those operations.
There is no doubt that we must work harder to get rid of the waiting lists, and the Government have devoted a great deal of money to that end. I do not like the fact that my constituents waiting for kidney operations are told that only a certain number of operations can be carried out because of money constraints. When it is possible to alleviate a medical condition, it should be alleviated without delay. Those who imagine that we can continue to waste money without trying to improve the Health Service know nothing about the NHS.
Why has the British Medical Association conducted its campaign against the improvements? The answer is simple. The BMA reacts with vehement objections to any suggestion of change at any time to any part of the Health Service. Not one reform has been mooted for the Health Service in the past 40 years to which the BMA has not reacted in that way. If any action is contemplated, the BMA believes that it must be wrong. I have a twin brother who was a rather mischievous child, and I recall that when I was young my mother used to say, "Go and see what John is doing and tell him to stop it." The BMA is like that. Its response to the review is "There is a review, something is being done about the Health Service—we must stop it at once." The BMA has not bothered to find out what the review means.
The document which the BMA produced against the review was full of phrases like "might be", "possibly", "could" and "maybe". I remember speaking to representatives of the BMA in my constituency months ago. I pointed out that many of the BMA's objections were pure conjecture. The BMA's response was completely negative and I am pleased that a counterblast is under way.
One of the sillier objections to the review of the Health Service has been repeated today—that the review and the Bill have been sprung on the medical profession. That is nonsense. For months we have been debating the details and there has been no secrecy about the leaflets and documents explaining what was intended in the review. Those documents were available to anyone who wanted them. We have already had months of debate and we shall soon be debating the Bill. A great deal of debate will take place shortly during the Committee stage.
All Conservative Members recognise that there are faults in the Health Service. We are determined to put them right and we are not afraid to say what worries us. I am worried about community care for the mentally handicapped. One of my ministerial colleagues said recently that something is to be done about that problem. 477 Much concern has been occasioned by people who have been let out of mental hospitals who could not manage by themselves in the outside world. That must stop.
The Health Service Bill should also contain positive proposals to obtain more organs for transplants. The advance of our Health Service has been remarkable. However, with regard to transplants, the shortage of organs—not a shortage of money—is holding up operations. I have one or two ideas of my own on that subject which I may have the opportunity to put forward in Committee.
The terms of the amendment before us today are hypocritical. The object of the review is to safeguard the National Health Service. The Labour party is all about the failure to safeguard the Health Service. It could never produce enough money or care. Labour could not stop the waste or deal with the difficulties in order to safeguard the Health Service properly. Conservative Members are the most anxious Members in the House when the public cannot get access to treatment. The amendment is rubbishy and stupid and I hope that it will be defeated.
§ Madam Deputy Speaker (Miss Betty Boothroyd)
Order. The House will recall that Mr. Speaker determined that speeches should be limited to 10 minutes between 6 pm and 8 pm.
§ 6.4 pm
§ Mr. Jack Ashley (Stoke-on-Trent, South)
The House always listens with respect to the hon. Member for Birmingham, Edgbaston (Dame J. Knight). However, if she really believes that the crisis in the National Health Service has been got up by the press, by Labour Members and by the BMA, she is out of touch with reality. I do not want to pick up those points, because I want to deal with some problems affecting disabled people.
For the past 10 years, this Government have been expressing deep concern about the disabled, and we should expect a pretty picture. However, instead, the picture is very disturbing. That situation has not been got up by the press, by Labour Members or by the BMA.
Disabled people are disregarded people in Britain today. They are underprivileged and mainly very poor. Many of them are denied an adequate income for the additional costs of disability. They are also denied access to buildings and to public transport. Sometimes they are patronised, humiliated and neglected. Very often they suffer gross discrimination.
It is amazing that, while it is illegal to discriminate on grounds of sex or race in Britain, it is perfectly legal to discriminate on the grounds of disability. That is quite incomprehensible.
Last Friday the BBC television programme "Public Eye" showed a damning indictment of society and of the Government's attitude towards disabled people. A disabled child was bombarded with abuse:You are a spastic bastard. You are too thick to walk.That is what people said to a severely disabled child. The programme showed how a local authority had no power to act against the ignorant thugs who used that language because the Government have failed to accede to or accept 478 legislation to outlaw discrimination. The people who harassed that child because he was disabled were perfectly entitled to do so.
That programme also referred to an intelligent, qualified, computer-trained young man who sent 400 applications for jobs. All were rejected because of his deafness. I cannot see how we can allow that kind of discrimination to continue. Parliament's existing laws, which should help that young man, are frustrated by the Department of Employment's negative attitude. One committed official at the Department who was anxious to prosecute a firm for refusing to comply with the statutory requirements was told by her seniors:We don't want to know. Prosecution is not our policy.A categorical statement in an internal review document states:Work with disabled people is given little status and even less priority in the Employment Service.I am sure that the Minister with responsibility for the disabled will be interested in that document, and I hope that he will read it after this debate.
What we have long suspected has now been officially stated—little status and even less priority. What an astonishing and despicable state of affairs in the department of Employment. With such attitudes, it is no wonder that the employment quota system, which was designed to provide jobs for disabled people, is being disregarded. The Department of Employment must answer some probing questions and revolutionise its attitude.
Other countries are leaving us far behind. West Germany has an effective quota and levy system to provide jobs for disabled people. The United States Senate has just passed the Americans with Disabilities Act. It is a marvellous Act, which stops discrimination in jobs, housing, education, transport and access generally. We should have such an Act. We should be leading the world but we are not: the Germans and the Americans are leaving us far behind. Our record is deplorable. The Government have rejected three Bills to outlaw discrimination. It is wrong for the Government to oppose Bills of that kind, especially when the Germans are doing so well with their legislation, and especially when the United States is leading the world in fighting for and protecting disabled people. Why can Britain not lead for a change? Why must we lag behind? I hope that the Minister will tell hon. Members about some innovation and some new ideas, and inform us what the Government intend to do.
One of the most serious and striking manifestations of the Government's failure to protect vulnerable disabled people is the lack of community care. The system is not only inadequate but beginning to collapse. The slick and easy way of side-stepping the problem is to pass it to families. That is exploitation of loving family relationships, and the Government have given no commitment to extra help. They should have done so. The White Paper and Ministers state that we must have simple and cost-effective provisions. "Cost-effectiveness" is a reasonable concept to most people but not when it comes from Ministers' mouths. To some Ministers, cost-effectiveness means cutting and reducing.
I appeal to the Minister: we need not the patchy implementation of present community care nor inadequate implementation of the Disabled Persons (Services, Consultation and Representation) Act 1986, but full, 479 comprehensive implementation of community care for all disabled people who need it, and full implementation of the Act. That would go a long way towards helping the disabled people of Britain. I hope that the Minister will act.
§ Mr. Timothy Raison (Aylesbury)
I will not repeat the remarks of the right hon. Member for Stoke-on-Trent, South (Mr. Ashley), but I will refer to aspects of community care in a minute or two. I pick up the point by the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood) on behalf of the Social and Liberal Democrats. It is a travesty to say that the Government are not spending substantially on the National Health Service. There have been enormous increases last year and this year. I congratulate my right hon. and learned Friend the Secretary of State for Health on playing such a big part in bringing that about. It is unreasonable to expect that we can go much beyond that, as other matters are making great demands on the Government. Although I have withdrawn slightly and temporarily from education, the case for greater educational spending is particularly powerful. We must be realistic about the extent to which we can spend on the Health Service, important though it is.
Hon. Members will soon consider a Bill on embryo research. My right hon. Friend the Father of the House, the right hon. Member for Castle Point (Sir B. Braine) spoke with absolute certainty about what is right, and we all respect that. I must confess that I am one of those who have not yet made up their minds about what is right. I want to listen to the debate. It would be of great help if hon. Members were able to pursue more fully the latest and most up-to-date scientific views on what research is necessary and whether it has real value.
I suggest to my right hon. and learned Friend the Leader of the House that this is surely a case for bringing into action the pre-legislative Committee that was introduced a few years ago but which now seems to have been dropped. That Committee could be uniquely valuable in summoning scientists before it to probe what they understand about the subject.
Reference has been made to AIDS. Although I respect my hon. Friend the Minister for Health, I have some queries about her latest announcement. Is it wise to carry out substantial testing for AIDS on the basis that no practical use is to be made of the findings? I believe as strongly as most people in the importance of statistics. I believe in social science; it is an essential part of our apparatus. However, if we turn up information which discloses people suffering from that terrible disease, it seems perverse to make it impossible to make practical use of that information. By all means let people stipulate that, in their individual cases, no use must be made of the information, but it is wrong to reject the source of information. I hope that the Government will think again about that matter.
I now refer to the National Health Service and Community Care Bill. I am happy to stress the second part of the Bill as well as the first. A year ago, I had two fears about those topics. One was that the Government would opt for an insurance-based National Health Service, and the other was that the Government would reject the Griffiths report. I am delighted that the essence of the Bill 480 is to reject the insurance-based service and to accept the Griffiths report. It is important to state again and again that the National Health Service remains unchanged in its fundamental task of providing care for all who need it. I do not believe that the Opposition have begun to make a case against that.
I strongly welcome the self-governing hospital and the fund-holding GP practice. It must be repeated that they are options rather than compulsory ingredients in the Government's scheme. Hon. Members who say that 99 per cent. of their constituents, including doctors and everybody else, are against those options can presumably derive satisfaction from knowing that, in that case, they will not come about. They will not happen unless people want them. There is no need to worry.
Exactly the same applies to practice budgets. Again, they will be picked up only if doctors want them. I know NHS practitioners who consider the practice budget exciting rather than terrifying. They are right to do so. Like the self-governing hospital, the practice budget gives scope for the enterprising and decentralised leadership for which many people have been crying out over the years. Goodness knows how many times I have heard doctors in particular complain about centralised bureaucracy and the administrative burdens of the NHS. If something is done to try to relieve them, we should welcome it rather than collapse into a dismal gloom and say that nothing new can possibly work.
I have only one significant concern about the Bill as presented; it relates to the question of choice. I have always believed that it would be an asset if we could honestly say that, among other things, the NHS reforms will offer everybody a greater choice of hospital, consultant and specialist, following the advice of, and in partnership with, one's general practitioner. However, the Bill as it stands does not achieve that. If I understand the provisions correctly, it is true that, in emergencies, it will be possible to bypass the contracts, but otherwise it looks as though the contract system will still present rigidity, which is a pity. If the Minister for Health can assure me otherwise, and if I have misunderstood the provisions, I shall be delighted, but if my understanding is correct, the Government should think hard about whether they can inject into the Bill more choice than there appears to he at present.
As I have said, I support not only the health side of the Bill, but the community care side also. I understand—I think that we all understand—that this is perhaps the most difficult area facing the Department of Health in terms of implementing the legislation. It is astonishingly difficult. All of us have either seen harrowing programmes on television or come across harrowing cases in our constituencies of people being released from long-term care in a hospital or wherever, with unhappy results, sometimes leading to murders and suicides. We all know about that, and we must accept that the notion of community care embodies some degree of risk which is averted if people remain locked up or confined to institutions. Nevertheless, I am absolutely sure that the principle of community care is right.
I say that with perhaps greater certainty than some hon. Members could because in my part of the county of Buckinghamshire I have seen the promising start that has already been made in implementing a policy which, although it comes ahead of the Bill, is remarkably close to it in application. We have developed the sort of 481 partnerships that are needed, and the Bill will facilitate such provision across the country. Above all, its great merit is the clear allocation of the responsibility for coping with such individuals that is assigned to local government. I profoundly hope that there will be no attempt to whittle away the essence of the Bill, however deeply we should be concerned about ensuring that we pick up all those in greatest need.
Finally, the question of housing provision runs parallel to that of community care. Although this was not in the Gracious Speech, we know that the Government have just said that they are going to put more money into tackling homelessness. That will be welcomed on all sides. However, we know not only that the whole question of homelessness is bound up with that of community care, but that it is still one of the major social problems affecting us today. Since 1979, we have had enormous success with the triumph of the right-to-buy programme, which I believe will never be reversed. However, I am frankly concerned about low-cost provision and about cheap rented housing in areas such as my constituency and other parts of the country. We should remember that this problem does not relate only to homelessness—serious though it is in, happily, limited parts of the country—but also to low-cost housing in a wider sense.
The Government put great emphasis on housing associations, which I support because they have an extremely good record. The Government are also trying as hard as they can to develop the private rented sector, and I support that also. In the long term, it seems nonsense that so little has been done to bring forward private provision. However, I am bound to say that we also need old-fashioned local authority council house building. I am not saying that that applies everywhere—I am sure that hon. Members can tell me of parts of the country where it is not necessary, but in some parts of the country, such as my own, it is necessary. Neither the private rented sector nor housing association provision leads to the right to buy, whereas building council houses does, and I firmly believe that the Government should not neglect that important part of the package.
§ Dr. Kim Howells (Pontypridd)
I shall examine some of the claims that the Secretary of State made in defence of the Government's performance in looking after the National Health Service. I shall try to explain why a great many people deem the White Paper to be wholly inadequate to meet the enormous challenges facing those who administer and deliver the Health Service in our hospitals.
The Health Service in Mid Glamorgan is particularly stretched. It is not a rich county; it is a county with high morbidity rates and prevalence of illnesses, especially respiratory illnesses. Two years ago the health authority called in a private management consultancy, which recommended that the Mid Glamorgan health authority should have a replacement hospital in east Glamorgan. The district general hospital is now dilapidated and serves a population of no fewer than 180,000 people in the Rhondda and Taff-Ely valleys. The construction of that replacement hospital should have begun by now, but it has not.
482 The private consultants who carried out the survey recommended a replacement hospital of 780 beds and considered that to be the absolute minimum for the existing and future needs of the district health authority. In turn, the health authority said that under no circumstances could it find the funding for more than 500 beds, which is even fewer than the 540 beds that we have at present. In the past few weeks, it has not been clear whether there will be sufficient funds to cover even that reduced number of beds.
Faced with that rapid deterioration in the hospital—there is talk of patients being turned away and of people dying because they cannot be treated—the consultants have gone public in demanding action. Things have come to a pretty pass. That militates against the views of the Secretary of State, who painted a picture suggesting that everything was all right and who said that the Government were doing very well in looking after constituencies such as mine.
I have therefore brought along a letter sent to me this week by Mrs. Olwen Williams, the consultant physician at East Glamorgan general hospital. She said:Because of cumulative under-funding and under-investment, nearly every part of the service provided at EGGH is under strain — There is … a growing sense of anger and frustration among the senior staff that successive generations of managers and administrators seem unable or unwilling to provide the resources the hospital needs.Estimated costs of outstanding maintenance work … are £4.5 million … There is a global shortage of beds, as we currently run at only slightly over half the recommended number for the population and workload. This has led to the closure of the hospital as a whole on one occasion this year, to the reduction and cessation of cold surgical operating on two occasions, to the admission of patients inappropriately to non-acute beds, to inappropriate early discharge of patients, and to the transfer of medical patients to surgical wards, geriatric patients to medical wards, patients sent home from Casualty rather than admitted, and a number of other undesirable practices … Over the last 2 to 3 years, children have been nursed on the same ward as acutely ill adults, the Department of Gynaecology has been unable to use all its operating sessions, for lack of beds, even though they have long waiting lists".Mrs. Williams also writes that the hospital is short of operating theatres, intensive care beds, coronary care beds and medical equipment. She states:Current requests for equipment exceed £400,000. This year's allocation was £42,000.The hospital is 40 nurses short. Mrs. Williams continues:There is an urgent need for a third consultant in Trauma and Orphopaedics, a third Geriatrician, a second Rheumatologist, a second Histopathologist, a fifth General Physician, a fourth General Surgeon, at least one more Anaesthetist and another Radiologist. As a Consultant Physician with an interest in diabetes, I am responsible for the diabetic population of 180,000.Those facts cannot be defined, by any stretch of the imagination, as the record of a Government who are doing their best for the Health Service. That record is an absolute shambles and a disgrace. Those figures relate to just one hospital in a deprived area, but I am sure that many other right hon. and hon. Members could quote similar figures.
If there is any proper measure of humanity and intelligence of a civilised community, it is the provision of care for those who do not enjoy good health and who have no other means of looking after themselves. In constituencies such as mine there is no excess income to spend on private medicine. It is impossible for those people to take short cuts; they need the Health Service. They look 483 at the White Paper in desperation because they see that it does not meet their needs. Nor is there any suggestion as to how the shortages will he rectified.
The general hospital has tried to save money in many ways. It has put out to competitive tender all kinds of services. I have with me the pay slip of a woman in her 50s, Miss P. M. Coles, who works as a domestic at East Glamorgan hospital, as an illustration of the sacrifices made by my constituents so that the hospital can cut costs. The week before last that woman worked 36 hours and her take-home pay—it is here for anyone to see—was £76.91. That is what competitive tendering is all about. Those are the sacrifices that are being made by real people at a real hospital. If we are prepared to accept that that is a proper way for a civilised society to treat not only its sick, but those who take care of them, future generations will look on us as uncivilised and will believe that we ignored our duty. We do so at our peril.
I am not calling for greater sympathy for people who have nowhere else to turn, but if we are to compete with other countries and other economies, as we are constantly exhorted so to do, one piece of our infrastructure that we must get right is the health of the nation. If areas are allowed to deteriorate to a state where high levels of chronic illness prevail, as is already happening in some constituencies of the coalfields, we cannot be confident about the future and our ability to compete.
The civilising influences of the late 19th century had to be dragged in. We had to drag the most deprived communities towards the 20th century by arguing that health had to be improved, that civic pride had to be engendered and that we should have pride in looking after each other. We are sacrificing that tradition of excellence on the altar of a dogma that, every day, is proving to be a false one. If we continue down that path we will be attempting to take a shortcut that leads us nowhere. That shortcut will not help us to compete
§ Madam Deputy Speaker
Order. It really hurts me to stop hon. Members when they are in full flow, but I must apply the Standing Order.
§ Mr. Ray Whitney (Wycombe)
I do not have the benefit of knowing the constituency of the hon. Member for Pontypridd (Dr. Howells), but I am certain that the Welsh health authority—in my experience an extremely good one —has shared in the increase in funding that all regional health authorities have enjoyed. That increase has led to more nurses and more doctors. If the picture that the hon. Gentleman painted of his constituency is the truth, he should go to the Welsh health authority to demand better treatment. I suspect that he will find that his constituency has also shared in the increase in funding, nurses and doctors. We all agree that we have not reached Utopia, and that is why we need to take a new look at the National Health Service.
Sadly, the hon. Member for Pontypridd, in common with the Opposition Front Bench spokesman, the hon. Member for Livingston (Mr. Cook), provided the same old litany and not a single new idea. Regrettably, that was the contribution, or should I say lack of contribution, from the spokesman for the Liberal Democratic party, the hon. Member for Roxburgh and Berwickshire (Mr. Kirkwood). All we hear about is the need for more 484 funding. I should like to consider the question of resources and to go back to the situation that prevailed in the spring of 1979.
The House will recall that, in 1979, we were coming to the end of a period of Labour government. That period saw an actual cut of 20 per cent. in real terms in nurses' pay and a 30 per cent. cut in the hospital building programme. It was the time of the winter of discontent, and spending on the NHS stood at £8,000 million.
Imagine if my party, the Conservatives, had stood on a platform during the 1979 election campaign and promised that, within 11 years, spending on the Health Service would have increased by 45 per cent. Imagine if we had run on a campaign that claimed that, in the forthcoming decade, there would be 67,000 more nurses, whose pay would, on average, be 43 per cent. higher in real terms than it was in 1979. Imagine if we had told the electorate in 1979 that there would, in 10 years, be 14,000 more doctors and 20 per cent. more general practitioners, that the average list size of GPs would decline by 300 and that those doctors would be paid, on average, 37 per cent. more in real terms than they were in 1979. If we had said that spending on health would increase by 1 per cent. of gross domestic product—our GDP is much higher than it was under the Labour Government—what would have been the reaction of the Opposition parties? They would have scoffed and scorned as they are doing now.
What would have been the reaction of the media? We can imagine the editorials of the Daily Mirror and we might even imagine the editorials of some of the more moderate and balanced papers advising us not to be so ambitious or so boastful. What would have been the reaction of the British Medical Association or some of the royal colleges? They, too, would have scoffed, and they would not have believed our claim. If we had been able to convince the BMA that we were speaking the truth arid that we could make the economy so strong that we could deliver that increase in funding and staffing, what would the BMA then have said? It could have said nothing but that its troubles were, to a significant extent, over, and that we would have a Health Service that satisfied all our demands.
We all know the reality, and we know that demands are far from satisfied—no Conservative Member would dream of suggesting that those demands have been met. We should all understand the pressures that have caused that shortfall. We have the pressure of an aging population —I am happy that that is so—and the huge expense in medical care required as one moves into one's later years. There is also the pressure of medical advance, which we all welcome, which is tremendously expensive and demanding on resources. The Health Service also faces the pressure of rising aspirations. As a number of my hon. Friends have already said, Opposition Members mention the failures and the problems, but they never mention the great successes and advances that have taken place in prenatal care, old-age care and whatever else.
Great advances have been made, but great challenges still lie before us. If people were to look at this subject objectively, they would say that we have had 40 years of a basic structure, endless commissions and royal commissions, inquiries, surveys and reports, but that fundamentally the structure that was put in place in 1948, and opposed by the British Medical Association, is no longer able to stand up.
485 Opposition Members should remember that the Conservative party was fully behind the then Minister for Health who, in 1944, introduced the White Paper which first established the principle of a National Health Service in this country which was available for all and free at the point of delivery. That is the principle to which we have adhered and on which the present proposals are founded. With the experience of the past 10 years and with the huge —in 1979, literally unbelievable—increase in resources, we have reached a point where it must be clear to all but the most closed minds that simply providing more money is not the answer and will not possibly produce the answer.
We have come to expect closed minds among the Opposition and listen in vain for any new idea from the Labour party and what remains of the centre parties. However, we are deeply dismayed that the minds of those in the medical profession so often seem to be closed. Fortunately, there is now a sign that their minds are being opened. Contrary to what the hon. Member for Livingston said, there are signs that good sense is at last breaking out among a number of those in the medical profession. The 2,700-strong Hospital Consultants and Specialists Association rightly condemned the British Medical Association's appalling propaganda campaign and welcomed intelligent debate about the proposals which the Government have sensibly put forward.
People who are worried that so many doctors and the British Medical Association are against the proposals and believe that therefore those proposals must be wrong, must take account of the British Medical Association's record. In an otherwise excellent speech, my hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) was wrong about one point. She said that the BMA had opposed medical advance for 40 years. It has actually opposed it at least from 1911, from the time of Lloyd George's National Insurance Act 1911. Once the Act had been in operation for two years and was seen to work, the BMA supported it wholeheartedly. Once our proposals are in operation and seen to work, the BMA and the rest of the medical profession will support them.
I lament the fact that the Opposition have not proposed a single new idea. I applaud the deep commitment which the Government have shown to the National Health Service by the huge increase of resources that they have committed, and continue to commit, to it. I call upon the House to reject the amendment.
§ Rev. Martin Smyth (Belfast, South)
I followed with interest the contribution of the hon. Member for Wycombe (Mr. Whitney), particularly the valid points he made. When the Select Committee on Social Services brought out its first report on the financing of the Health Service, the Government's response was that we were plucking figures from the air. At that time we said that it would take £2 billion to bring the service into line. I welcome the fact that since then about £5 billion has been added. Therefore, we were not plucking the figures from the air, but moving in the right direction.
The hon. Member for Pontypridd (Dr. Howells) talked about the problems in Wales. I realise that there is a disparity of practice throughout the country. For example, during last Thursday's lobby, I was informed that staff 486 midwives were graded in an interesting way. Of those midwives, 75 per cent. were graded F in Wales, 30 per cent. in Scotland, 12 per cent. in England and 1 per cent. in Northern Ireland. There is a place for a proper balance in the National Health Service, because such grading creates discontent among people doing the same job.
§ Mr. Campbell-Savours
Does my hon. Friend understand that the midwives to whom he referred were graded on the basis not of skill but of the budget available for that particular discipline?
§ Rev. Martin Smyth
I realise that certain guidelines are given. Boards are concerned that when they carry out reviews and upgrade people to the proper grade, the Government should provide the necessary finance.
I and my colleagues in the Ulster Unionist party welcome the statement in the Queen's Speech that the Government will continue to encourage greater involvement of locally elected representatives in the affairs of Northern Ireland. If the Government are committed to that idea, perhaps they will allow local representation of political parties in Northern Ireland to have a debate about the measures proposed for the Health Service and community care, as well as social security.
Earlier this afternoon, in another context, the Secretary of State for Health said that there was no point in coming to this House. In a sense, that observation is applicable to the Members representing Northern Ireland, because the National Health Service and Community Care Bill published last week does not apply to Northern Ireland. Clause 60 provides that the Bill should be applied to Northern Ireland by order. It is appalling that such important measures as GPs' budgets, self-governing hospitals and community care—the subject of widespread public anxiety and national debate—should be applied to the Province as a postscript, or afterthought. That shows no sensitivity for the need for democratic debate on matters affecting Northern Ireland.
I know that I shall be told that there is a different legislative framework in Northern Ireland. There is a different legislative framework in Scotland, yet the Bill includes Scotland. There is no reason why Northern Ireland should not be included in the Bill. We are told that the Bill applies to Northern Ireland in relation to National Health Service trusts because people might go there for treatment. It also applies in relation to holders of offices of profit under the Crown, including health board officers and chairmen in Northern Ireland. But the real meat of the Bill will come in an Order in Council, so there will be no opportunity to probe the legislation.
I support the recommendation of the right hon. Member for Aylesbury (Mr. Raison) that a Special Standing Committee should examine the Human Fertilisation and Embryology Bill.
I call upon the Secretary of State for Northern Ireland to grant us a local forum such as a regional council or even directly elected local health and social services boards to ensure proper scrutiny and value for money of the work done in the Health Service in Northern Ireland. Before the Secretary of State dismisses such an idea, will he look into the cost of the continuing IRA campaign on Health Service resources? Genuine consultation and the proper involvement of local politicians would diminish the IRA campaign and save NHS costs.
487 In that context, the Secretary of State should remove the veto that the SDLP and Sinn Fein have had over political progress and announce a revamped local government social service health structure as soon as possible. To enable us to find out the problems, and for several other reasons, my colleagues have suggested that there should be a Northern Ireland Select Committee. One reason is the reform of the National Health Service, and particularly the issue of patient choice, which is a subject dear to the Prime Minister's heart.
I have received a letter from a consultant in Northern Ireland who is sympathetic to the review, but he says that, in the initial guide issued by the Department, outlining steps self-governing status for hospitals,boards would have the right to refuse to fund cases where the patient chooses to attend a hospital with which the board have no contract.Last week the right hon. Member for Plymouth, Devonport (Dr. Owen) raised the same matter. He emphasised that patient choice Hill not work out as many patients fondly believe it will.
There are serious implications for patients. They should be able to go elsewhere in the United Kingdom for treatment if they so wish, and if they believe that a specialist at a particular hospital can provide the best treatment for them, on the advice of their general practitioner. What is more important is that, despite the concept of decentralisation, the Bill will allow bureaucracy to build up, as boards choose who they want to have contracts with. That will be under the supervision of the Department.
Another issue that concerns us in Northern Ireland is the operation of the social fund by the Department of Health and Social Services. I believe that the social fund does not meet certain genuine cases of need, and that the money is running out. The Government have said that allocations to the social fund do not need to be increased, as they will be able to meet demand with the existing fund. I question that.
A social security office in my constituency has been extremely helpful by providing me with social fund priorities. The picture is alarming. Social fund officers place need for community care into a low, medium or high category. According to figures that I have been given, 65 per cent. of applications for community care grants were turned down between April and August this year, in constrast to the period between April 1988 and March 1989, when only 25 per cent. of applications were refused. Many more people applied for community care grants because of publicity, but that did not result in a higher take-up, because local officers could not pay out.
Budgeting loans are being paid only to people who have high priority. Many people who approach the DHSS for help with the cost of washing, travel to hospital, household items and for payment of debts that they may have run up while looking after relatives, may not get anything because they are in a low or medium priority group. That is happening in Northern Ireland and in other parts of the United Kingdom.
I urge the Minister to state the position. I understand that many local social security officers are unable to issue budgeting loans. Will the Minister provide figures which show the pattern, circumstances and priority of those people who have been refused help by DHSS officers? I emphasise that the staff who have to work the system are extremely unhappy with it.
488 I join the right hon. Members for Stoke-on-Trent, South (Mr. Ashley) and for Manchester, Wythenshawe (Mr. Morris), in urging the Minister to implement the Disabled Persons (Services, Consultation and Representation) Act 1986.
§ Mr. Bob Dunn (Dartford)
I congratulate the Government on the Queen's Speech and the proposal for legislation on health and community care.
When the Health Service was constructed in the late 1940s it was relevant to the time. During the decades since, changes have been made to make it more relevant to the needs of modern society. If we do not continue to make progress in health and community care provision we must, of necessity, fall back.
During the debate, I have listened for new ideas other than the constant emphasis on extra resources. Many hon. Members accept, as I do, that there is a need for adequate and substantial resources to fund health care in Britain. However, there have been no new ideas from Opposition Members, nor did I expect them. I would not be so foolish as to believe in that fantasy.
We need new ideas to deal with the problems of health care—for example, operations which 10 years ago would have been considered impossible. We need new initiatives to care for the elderly, as no hon. Member can be unaware of the fact that there were 530,000 people over the age of 85 in Britain in 1980; by 1989 that number had risen to 750,000, and by the year 2000 there will be over I million people aged 85 and over. There will be a commensurate increase in the number of people aged 65 and over.
Accordingly, I welcome the Government's care proposals, and I endorse the two principles behind them. First, people should be enabled to live as normal a life as possible in their own homes, or in an environment similar to their homes in the local community. Secondly, people should be given the right amount of care and support to enable them, as individuals and as members of a family, to achieve maximum independence.
Thus, the proposal which gives me the greatest heart is the one to give practical support to carers and to give them a higher priority. The new carers' premium, introduced in income support, will direct an extra £15 million a year to those caring for the severely disabled—some 30,000 beneficiaries.
That is my message of congratulation, and now I have some problems for my hon. Friend the Minister for Health. First, will she undertake to re-examine the formula for the Resource Allocation Working Group? It seems that the formula militates against the south-east, to the benefit of other regions. Consequently, there is a need to reflect on the age of some of the hospitals in my constituency. In the health district which I represent, there were nine hospitals in 1979, and with rationalisation that number has fallen to six. However, those hospitals are old. They were built for a different purpose to that for which they are now being used—as fever or isolation hospitals, workhouses and asylums. That needs to be changed. The Resource Allocation Working Group formula needs reexamination.
I also urge my hon. Friend to use her considerable influence to bring unity of purpose between the Departments of Health and the Department of the Environment to deal with derelict and unneeded, unused 489 hospital land in the home counties and the south-east. Indeed, my first Adjournment debate in the House, more than 10 years ago, was about hospital structures in the Dartford and Gravesham health authority. During that debate, I said that there were hundreds of acres of unused and derelict hospital land which could be released to provide for housing, industry and roads, and which could make a major financial contribution to funding the Health Service. I hope that my hon. Friend the Minister will take account of those feelings and perhaps give me the answer that I deserve and which I hope to get tonight.
I was disappointed by the speech of the hon. Member for Livingston (Mr. Cook). He was clearly a bit off colour. The Opposition are on trial tonight. We need to know what they intend to do when they have finished making their parrot-like call for more money, What are their plans? How much will they spend? More important, how much will they spend as a commitment, because they are likely to spend only as much as Mr. Mandelson lets them spend? We have had from Labour views, policy changes and policy initiatives, only to have them withdrawn again on the orders of Maison Mandelson. We know that the policy announcements made by Labour are as relevant as a stale pork pie in Hartlepool's Labour club, but we hope to get more information from the hon. Member who is to wind up for the Opposition at the end of the debate.
I also hope for some honesty. My hon. Friend the Member for Birmingham, Edgbaston (Dame J. Knight) was right to touch that chord. The Health Service has problems and needs major reform, but it is also doing sterling work in every area of human activity relating to health care. Constantly to denigrate the Health Service, as the Labour party likes to do, is continually to slur many thousands of people who work in it. I hope that the Labour party will step off the fence and start walking on terra firma. I know that is hard, in the light of the changes of style which are being recommended by Mr. Mandelson, but if we had some honesty, some beef on which to chew, all of us would be happy.
Finally, the high-speed rail link is a topic to which I intend to return time and again—[Interruption.] Opposition Members may laugh at what I say. My constituents will be told that they laughed. Many hundreds of my constituents are suffering stress, anxiety and mental breakdown because of the high-speed link that is to come through north-west Kent. I pay tribute to the Health Service and counselling services in north-west Kent for the sterling work being done to help real people in real need.
§ 7.2 pm
§ Mr. Terry Fields (Liverpool, Broadgreen)
It should, but it never ceases to amaze me what attitude Conservative Members take on issues that we discuss here. We know of the wave of opposition to the Government's policies on the NHS—the facts, figures, opinion poll results and statistics are clear—but Conservative Members persist in their old arguments, as did the hon. Member for Dartford (Mr. Dunn).
An ounce of experience is worth a ton of theory, as Vladimir Ilyich Lenin once said. Conservative Members get their experience in the same way as that woman in 490 Downing street. She goes to hospital only for a photo-call after a tragedy. It is no wonder that Conservatives are ignorant about the Health Service.
Merseyside has been mentioned. In Liverpool, five hospitals are to close in the next round of cuts. Some 1,000 beds are going. In my constituency, the accident and emergency unit, which is half a mile from the M62 and covers that area, is to close. People for whom minutes and seconds are important will have to go all the way into town to the Liverpool teaching hospital, which is overstretched and has staff and bed shortages. The staff there are being run into the ground.
Members of the working class in Liverpool have always had community care. We have always looked after our own. There have always been people to act as carers for those who cannot look after themselves. We do not need any lessons about care in the community from Conservative Members.
In my constituency, the Park and Rathbone hospitals are being closed. In theory, people are being put back into the community, but there are no resources with which to tend them once they are there. The latest move is to put them into homely homes. Hundreds of people are going through the Park and Rathbone hospitals. Homes for about 20 people will be built at some time in the future, but we do not know when. Everyone else will be thrown out into the community. Old men and women, some of them mentally subnormal, will be left to wander around Liverpool. They may end up in cardboard boxes at night because they have nobody to look after them. The staff at the hospitals are devoted and commited to the people they work with. As part of a campaign throughout the Liverpool area, they are organising to defend their jobs and, more important, care and attention for people who are unable to look after themselves.
At our teaching hospital, between 400 and 500 nurses have been given notice that if they do not comply with new rotas to be imposed by management by 1 January, which means £70 or £80 being taken out of their pay packets each year, they will all be sacked as from 2 January. That is how the Government, and the management they put in, treat staff. The Government talk of the Health Service getting all this money. If people want to know where it has gone, I can tell them. It is being used to employ management whose sole job is to butcher the Health Service. They are people with no connection with the Health Service. They have established a record of sacking workers on the docks and that is the principal criterion for employing them.
Women will be most affected by the hospital closures. Maternity services will suffer. Gynaecology and family planning are not included in the Government's list of core services. It is proposed to open an old condemned Victorian building—the old Royal hospital. It is considered good enough for the women of Merseyside to close down good units and to reopen an old Victorian building which was condemned as unfit for habitation some time ago—and all this in an area with the highest incidence in the north-west of death from breast and cervical cancer. Services for women in Liverpool will be non-existent.
I am sickened, and workers I know have had it up to here with stupid statements from the Government claiming that they are spending more in real terms on the Health Service. In May I asked the House Library to find out what percentage of gross domestic product has been spent on the National Service. In 1949–50 we spent 3.6 per 491 cent., and in 1987–88 we spent 4.8 per cent. of GDP on the NHS. To use the Government's phrase, in real terms, spending has increased by only 1.2 per cent. in 40 years. Since the Government came to power, the increase has been less than 0.5 per cent. Those are the real figures.
The ambulance staff dispute is symptomatic of what is happening in the Health Service. I spent two years doing national service and worked in a field ambulance, so I know the level of training that ambulance personnel in the armed forces receive. I am not denigrating them, but young people in the armed forces are nothing but economic conscripts. They are not there to fight for the Union Jack. They are there because there is sod all else to do in places like Liverpool. They are in the front line of a life and death struggle provoked by the Government and by the Secretary of State for Health, who is playing Russian roulette with people's lives. I had first-hand contact with the troops called in during the 1977–78 fire service dispute. They were unable to man the green goddesses and to deal with emergencies just as the troops are incapable of dealing with emergencies in the present dispute. Yet the Government were still prepared to call in the troops in the ambulance dispute.
Whether the Government admit it or not, privatisation is on the agenda for the National Health Service. Movement towards the American method of health care is on their agenda.
§ Mr. Fields
As my hon. Friend says, that is absolutely true.
I spoke earlier about experience. In May this year I went to New York at the invitation of the American health service workers who wanted to learn about the NHS in Britain. Workers in America have had a bellyful of private medicine. In the United States between 37 million and 40 million people have no health insurance. Millions of families have inadequate health cover or none at all, and their life savings are wiped out at a stroke if they are ill.
We are moving in the direction of the United States system of health care. In a Harris poll conducted in 1988, 89 per cent. of American people called for a fundamental change in the profit-based health care system and 61 per cent. pointed to the national health care service in Canada as a system that they would prefer. The polls show that 75 to 80 per cent. of people in the United States favour a national health system. Indeed, the president of the Lous Harris organisation said that the pollconfirms all one's worst fears about the American system. We have the most expensive—least well-liked—least equitable and in many ways the most inefficienthealth service in the world.
An organisation called Physicians for a National Health Service was set up two years ago, made up of 1,200 doctors campaigning for a national health service. The New England Journal of Medicine, an authoritative medical journal, contained an editorial entitled "Universal health insurance—its time has come." Yet the Government continue to devastate the National Health Service in this country.
Conservative Members have said that the Opposition have no ideas on the NHS. We admit that it needs more funding. As my hon. Friend the Member for Islington, North (Mr. Corbyn) said, the Labour party would provide 492 more funding by diverting into the NHS some of the finance devoted to weaponry and destruction. Another way would be to nationalise the drug companies—
§ Dame Elaine Kellett-Bowman (Lancaster)
I am happy to follow the hon. Member for Liverpool, Broadgreen (Mr. Fields), who was absent at Question Time and failed to—
§ Mr. Terry Fields
On a point of order, Madam Deputy Speaker. Is it in order for an hon. Member to raise that matter in ignorance of the difficulties on the motorways which prevented me from being here earlier?
§ Madam Deputy Speaker
Order. Let me deal with this. The hon. Lady knows that she should not raise that matter and that the Chair cannot resolve it.
§ Madam Deputy Speaker
Order. It seems that I am being asked why it is not a matter for the Chair to resolve. The Chair is not responsible for an hon. Member arriving at a particular time.
§ Dame Elaine Kellett-Bowman
My right hon. Friends on the Front Bench know that I am an enthusiastic supporter of the principle of money following the patient, from which Lancaster health authority will benefit substantially. My right hon. and learned Friend the Secretary of State knows that in Lancaster health authority hospitals are well run and attract a large number of patients from outside our district. He has seen the excellent pie charts produced by the district health authority showing patient flow across the district border. It is a staggering fact that in one specialty 49 per cent. of patients come from outside the district. That is a great compliment to all who work in our local hospitals, but it puts a great strain on resources under the present method of funding.
In Lancaster we were delighted to hear that 100 new consultants and teams were to be appointed, but we were sad that we did not get one of the first 35 appointments. We desperately need another orthopaedic surgeon. Twenty-nine per cent. of orthopaedic beds are occupied by patients from outside the district and the strain on our staff is enormous. It is an astonishing and distressing fact that in Lancaster, no orthopaedic surgeon has ever lived to retire and the last one died in his forties. We did not get an extra appointment because, our bid was slightly above the £500,000 target. As I explained to the Minister for Health, that was partly because, until we get phase 3 of our hospital building programme, which the Secretary of State has confirmed, our costs are higher because we have a split site. Nevertheless we have managed to prune our costs and brought them below £500,000. That being so, we are very anxious for an early appointment. Now that we have hit the target, we should like an immediate go-ahead for an extra orthopaedic consultant immediately after Christmas. It would be a lovely Christmas present.
We also need an extra urologist, and have put in a good case for that. However, those reforms cannot help us next year. We are in an unique position in Lancaster. The 493 population in the north-west of the region is falling, but in Lancaster it is rising. My hon. Friend the Minister has seen the bar charts showing population rises in Lancaster and we need more funding to cope with such rises.
We have two Victorian hospitals in the district, one for the mentally abnormal and one for the mentally deficient. They are expensive to maintain because the buildings are old. We are delighted but not surprised that my right hon. Friend the Secretary of State succeeded in obtaining an extra £2.6 billion for the Health Service in the autumn spending review. I have already put in a bid with my right hon. and learned Friend and with the North Western regional health authority for a substantial share of the increase. We know that his prudent planning assumptions of a reduction of 0.3 per cent. was to ensure that no district health authority exceeded its subsequent allocation in advance of the Autumn Statement. Now that the figures are known, I look for a proper increase to cover our local, legitimate health needs.
One point worries me. There is no mention of midwifery among the core services. We have an excellent maternity hospital in Lancaster, but my midwives are anxious for those who are less fortunate. I ask my right hon. and learned Friend the Secretary of State and his team to look again at this point. Above all, please may we have an extra consultant at the earliest possible moment?
§ Mr. Gerry Steinberg (City of Durham)
I have listened carefully to the debate this evening. Some of the comments from Conservative Members appalled me. They do not live in the real world and I am sure that they do not see what is happening in their own constituencies. I also listened to the Queen's Speech with dismay. The measures proposed in it will only reduce the quality of life of most of my constituents. It is proposed to maintain a policy of high interest rates, which will mean high mortgage repayments.
The Queen's Speech included a Bill that will take the first steps to privatise the coal industry, a Bill to cripple the trade unions, a Bill to reduce the quality of our television, a Bill which will by no means adequately protect the environment, a Bill to introduce student loans which will further restrict working-class young people from entering higher education and, worse of all, a Bill on the National Health Service.
On 10 August, the Select Committee on Social Services, the majority of whose members are Tories, reported that the White Paper was ill-conceived, moved far too quickly and, if implemented, would not meet the needs of the NHS. Have the Government listened to that report? No, they have taken no notice whatever. The legislation will create a two-tier system. It will take us back to the 1940s, when private hospitals competed with the voluntary sector, and people were brought to the edge of bankruptcy. The Bill will create an internal market for health, with NHS hospitals and GPs competing with the private sector.
A vast new system will be needed for cross-charging patient treatment between hospitals and health authorities, between opting-out hospitals and between GPs and hospitals. Every injection, bandage and therapy, and every minute of staff time, will have to be accounted for, costed and allocated to the patient. Then the bill will be sent to the health authority. The debate started in the first place 494 because of the lack of funding for the Health Service, yet the White Paper never mentions funding. Tremendous additional administration will be required to carry out the system that it describes.
The key proposal in the legislation is opting out for hospitals. [HON. MEMBERS: "No."] Tory Members like to talk about self-governing hospitals, but I prefer to speak about opting-out hospitals, as do my colleagues, because that is exactly what they will be. We are not told how the procedure will work. We are told that a hospital may show an interest in opting out and produce a prospectus. There will be limited discussion between managers and senior doctors and no staff involvement within the hospital. Cleaners, porters and nurses will not be allowed to express their opinion. Neither the staff nor those living in the area which the hospital covers will be balloted. The decision will be taken by the senior management of the hospital, and the Secretary of State will make the final decision. That is the democracy that we have come to expect from this Tory Government.
Some opting-out hospitals will be successful, but others will not. Those that cannot cope in the system will decline. Will they close or will they be accepted back into the Health Service? We do not know. Those that remain within the Health Service will become second-class and have limited functions. The logical progression from opting out is privatisation. The result will be a two-tier system of health care, with the less desirable cases—the chronically sick and elderly—having to go to health authority hospitals. Opting-out hospitals will specialise in profitable activities and drop all other functions. As a result, local communities will not receive the guaranteed comprehensive service that they are used to and deserve. Opting-out hospitals will have financial incentives to treat patients who will bring the hospital the most profit.
Opting-out hospitals will have the option of paying their own salary rates and operating their own conditions of work. They will be able to attract the so-called best members of staff, leaving the remainder to the health authority hospitals. I always thought that the NHS was established to stop such inequalities. The service will be returned to the days when inequalities were the norm. That is what the Government are encouraging in this legislation.
The Government are designing an NHS for acute services only. They are ignoring the rest of its functions. We hear about core services, yet within that term there is no mention of maternity, paediatric care or family planning. The people who will suffer most will be women. The core services guarantee accident and emergency services, immediate admission to surgery and so on, but not less urgent work. District health authorities will have to shop around and purchase that care from opting-out hospitals, health authority hospitals, other district hospitals or the private sector. That is not how the NHS should progress but, unfortunately, it is how it will progress under this Government.
The second major element is the change in GP services. GPs with large practices of 11,000-plus will become budget holders. They will have to buy all their patient care, including hospital treatment, from any of the options available. Budgets will be limited, so GPs will be discouraged from taking on heavy consumers of drugs and services. A pool of problem patients will find it difficult to get on doctors' lists. I am not an expert on this, but I am relating information that doctors have given me. Obviously, if a doctor has the choice of a healthy 495 30-year-old or a 60-year-old with arthritis, Parkinson's disease or diabetes, he or she will choose, not the 60-year-old, but the healthy 30-year-old.
Budgets will put doctors in an invidious position. They will always have to seek savings, for example by postponing referrals to hospitals. If the patient has severe or advanced symptoms, the doctor may wait to see how they develop. The patient may then become an emergency case and have to be rushed to hospital. If the doctor has not sent the patient to hospital, the cost will not be taken from his or her budget. As a result, patients will wonder whether that consideration has anything to do with the doctor's decision, and patients' trust in their doctor will be considerably undermined.
§ Sir David Mitchell (Hampshire, North-West)
I will not follow the flights of imagination of the hon. Member for City of Durham (Mr. Steinberg) about the development of the National Health Service. I know that others want to catch your eye, Madam Deputy Speaker, so I shall make a brief speech about the ambulance dispute, the question of arbitration and other NHS matters.
The ambulance men's union has identified an emotive group for whom there is much public support and sympathy. All of us should recognise that fact. But much of that public support is misplaced. The NHS has some 1 million staff engaged in a whole range of different skills and activities. The ambulance men are part of that team and spend 70 per cent. of their time on routine, not emergency, work.
Within the National Health Service, there are carefully balanced relativities on wages and salaries that have been agreed through the Whitley negotiating machinery. NUPE wants 11.2 per cent. for the ambulance men. That would wreck those relativities and would immediately lead to leapfrogging claims by other groups of workers. That has not been sufficiently appreciated by some of the ambulance men, and certainly not by the general public.
About 300,000 National Health Service workers have already settled for 6.5 per cent. Nurses have settled for 6.8 per cent. If the ambulance men receive 11.2 per cent. that will cause disappointment, and other groups that have settled at lower rates will want to restore the relative pecking order. The Government have announced substantial additional funding for the Health Service and there is a battle over whether the money should go to the staff or the patients. I agree with most of my constituents who, I think, want the money to be spent on patient services.
The hon. Member for Livingston (Mr. Cook) called for arbitration to settle the ambulance dispute. The problem with arbitration is that the arbitrators invariably split the difference, and in the case of an extravagant claim that means an extravagant settlement. However, it is not an arbitrator's money: it belongs to the management of the Health Service. An arbitrator can withdraw from the scene after delivering his judgment and it is left to the unhappy management of the Health Service to decide how many beds will be closed or how many operations will have to be delayed to find the money that the arbitrator gave to the staff instead of to improvements in the service. We should all bear that in mind.
The hon. Member for Livingston challenged us to say whether any Conservative candidate or manifesto at the 496 last general election had set out a programme for the reform of the National Health Service. He knows perfectly well that no such programme was set out because it was not until after the general election that we started to get a groundswell of complaints about the Health Service. Those complaints were hugely orchestrated by Opposition Front-Bench spokesmen. Time and again small cases were picked out, thrown into relief and made subjects for debate in the House. Of course the Government have reacted, and the hon. Gentleman now complains about that reaction.
The hon. Member for Livingston spoke about hospital waiting lists and growing problems. He told us about a patient taken from hospital to hospital without being admitted. Those matters show that there is something wrong with the Health Service, yet for some extraordinary reason the hon. Gentleman and his colleagues spend their time lambasting the Government for seeking to do something about it. The country should take note of that.
I want to turn from dealing with the ambulance men's militant trade union to deal with another militant trade union, the British Medical Association. It has sought to use patients, and I employ the word "use" in its worst sense.
§ Mr. Jimmy Hood (Clydesdale)
The hon. Gentleman talks about militant trade unions. Is he aware that the Police Federation fully supports the ambulance workers? Would he say that the Police Federation is a militant trade union?
§ Sir David Mitchell
I was addressing the use by the BMA of patients as a means of extracting concessions for the doctors in negotiations with the Secretary of State. The BMA has gone over the top in a big way, and the public now recognise the fact. In terms of its advertising campaign, it has gone over the top in an expensive way as well.
My constituents have three worries about the National Health Service. Their first is that budgets will mean that, three quarters of the way through the year, practices may run out of money and be unable to prescribe the drugs that patients need. Some of my constituents have been frightened by that aspect of the BMA's campaign. It is disgraceful that the BMA has tried to put the frighteners on patients so that they will lobby Members of Parliament to persuade the Secretary of State to give doctors a limitless budget.
Some doctors spend 50 per cent. more on prescribing than other doctors with similar profile practices. It is right that such doctors should be asked to explain if they overshoot the notional budget. Let us be absolutely clear: the budget is notional and doctors who overrun it will be asked for an explanation. There may be a perfectly good explanation—perhaps a unique characteristic among patients in a certain area—in which case the doctors will be allowed the additional resources that they need. If there is not an adequate reason, it is right that the public purse should seek value for money. I understand from the Minister—I hope that it will be repeated—that in no case will patients go without drugs because a doctor has overshot his notional budget.
The second anxiety of my constituents relates to the capitation fee, which, it is alleged, will force doctors to take on many more patients and therefore have less time for each patient. Where will the extra patients come from? Will there be a sudden and huge increase in the 497 population? Of course not. Like Members of Parliament and people in other professions, doctors have different characteristics. Some of them are ambitious and want to build up a big list and do a great deal of work. Others want to take life more easily because they see life in a different hue. They are less ambitious and would rather enjoy life, so they have a smaller list.
There is nothing revolutionary in the concept that doctors with large lists should be paid more than doctors with smaller lists. I have discussed the matter with doctors in my constituency, and when I probed I was fascinated to discover that most of them have above-average lists and would gain from the capitation fee change. Certainly they will not need to take on more patients. Some of them could shed some patients and give a bit more time to those who remain. The fear about capitation is quite widespread and I hope that it can be laid to rest. The third worry of my constituents is that they will have to travel long distances to hospital. That will be entirely at the discretion of the patient and the doctor in consultation.
§ Mr. Jimmy Wray (Glasgow, Provan)
It is difficult to understand how Conservative Members can say that they care. They have spent most of their time in the debate criticising my hon. Friend the Member for Livingston (Mr. Cook). The Minister attacked my hon. Friend and then went on to attack my right hon. Friend the Leader of the Opposition. This is an important debate for the Opposition and we shall not stand for hypocrisy from the Minister. He may not understand what privatisation means, but we do.
I have just visited 15 hospitals in my city of Glasgow. The people there understand what privatisation means and every health worker is sweating in case he loses his job. I should be grateful to be presented with a clear definition of competitive tendering. Despite the explanations offered by some Conservative Members, I see it as privatisation. In this year alone, 17 per cent. of the domestic, catering, laundry and portering staff in Glasgow's hospitals have been the subject of privatisation. That is just the start. There remain for tendering transport, radiology, medical reports, payroll functions and pharmacy, laboratory and clinical support. What will be percentage of privatised sectors when those services have been subject to the tendering process? The Secretary of State said that he was angry at the suggestion that the Government are privatising the Health Service, and even the Prime Minister denies that it is being done. I cannot understand that reaction.
The Greater Glasgow health board seems to be the Government's politburo—hellbent on implementing everything that the Government have introduced. The board must surely be aware that the Government have an appalling record. The Secretary of State has told us that he is spending billions of pounds, but there has been neglect over the past 10 years. If so much money has been pumped into the Health Service, why is there a shortage of 87,000 beds? Why are operations being cancelled? Why is that happening when the Government claim to be spending more money?
The Greater Glasgow health board has produced a document which reflects its concern about health care in 498 the 1990s. I represent one of the most impoverished constituencies in Europe, with the worst health record and the worst infant mortality rate. It has the worst mortality rate for those aged between 40 and 65 years and the worst cervical cancer rates for females aged 16 to 25 years. There are appalling health conditions in the constituency. Why has there been no improvement in the past 10 years? It is because the money has been wasted. It has been paid to high fliers and bureaucrats who are interested only in making savings. The other month, the bureaucrats in one hospital said that savings could be made by cancelling six packets of Alpen and four pints of milk each day. That is the mentality of the managers.
The Queen Mother's hospital and the Glasgow Royal maternity hospital at Rottenrow—two strategic maternity hospitals in Glasgow—are being closed. If the Greater Glasgow health board believes in community health care, why is it ignoring the advice of all the obstetricians, paediatricians, and other clinicians? Having listened to all those who have been involved in the consultation exercise, the board still wishes to site its maternity units at Stobhill and Yorkhill. The response to that policy has been complete opposition. My constituency lies in the east of Glasgow, and my constituents and I want centralisation.
The hon. Member for Hampshire, North-West (Sir D. Mitchell) attacked the BMA. He described it as militant. If I were a member of the BMA, I would take a shotgun to the Government. In 1985, the then Minister for Health met the BMA and asked its members what their priorities were. They responded by participating in discussions and giving the matter careful consideration. They produced a list of 16 priorities, at the top of which was an extension of the cervical cancer cytology screening programme to include all women over 20 years at three-year intervals. The Government have failed to respond to that priority. They have introduced a five-year screening. The result is that every year 2,000 women die needlessly.
Another priority was a comprehensive scheme for paediatric surveillance at general practice level. It was wished to encourage general practitioners to carry out minor surgery. There were another 14 priorities. None of the priorities has yet been implemented. That shows the extent of the Government's concern about the health of the nation.
Who cares about your White Paper? Who cares about your "Working for Patients"? On 28 November 1987, the Government published a White Paper entitled "Promoting Better Health". During the discussions that ensued, the Government introduced "Working with Patients." That happened before the practitioners had had a chance to discuss the previous White Paper. The Government decided to open Pandora's box. Despite what we have been telling you today, you still do not understand. The shadow Minister, my hon. Friend the Member for Livingston (Mr. Cook), has told you. Nobody wants your Bill. Nobody wants your White Papers. Nobody wants changes. We do not want Americanisation of the NHS.
§ Dame Jill Knight
On a point of order, Mr. Deputy Speaker. Is it not the normal practice in the House that hon. Members must not refer to you?
§ Mr. Wray
I take the point, Mr. Deputy Speaker.
On 21 June, the Glasgow medical committee discussed your White Papers; they were rejected by 160 votes to 150. That, however, was not enough. It seemed that the Government wanted the opinion of all doctors throughout the country. A referendum shows that 82 per cent. of all doctors have rejected the Government's White Papers.
Unfortunately, I have only one minute left to me. I would have needed an hour and a half to explain the damage that that gang of crooks on the Government Benches have done to the NHS. [HON. MEMBERS: "Withdraw."] They are playing with the NHS and with the lives of innocent men and women. Let them pay the ambulance men and women what they deserve. The Government should understand that they provide an essential service and treat them in the same way as the police and the firemen.
§ Mr. Peter Robinson (Belfast, East)
I am delighted to be able to take up the remarks of the hon. Member for Glasgow, Provan (Mr. Wray). I understand many of the concerns that he has expressed, and I share the anxiety that has been voiced by many other hon. Members about the state of the National Health Service. It is no better in Northern Ireland than it appears to be in the rest of the United Kingdom. I must ask for your forgiveness, Mr. Deputy Speaker, for attempting to drag the House away from the theme of the debate to discuss the situation in Northern Ireland.
I read the Gracious Speech with great interest, and especially the remarks about Northern Ireland. Perhaps I could be forgiven for being delighted initially to see that the Government were advocating the defeat of terrorism in Northern Ireland. I said that I could be forgiven for so thinking, because unfortunately the Secretary of State for Northern Ireland made remarks that gave encouragement and succour to the men of violence, when he indicated that the IRA could not be defeated.
I cannot for the life of me believe that, in his senses, the right hon. Gentleman could really have meant the remarks that he made. I hope that the Minister who winds up the debate will take the opportunity to lay at rest the Secretary of State's remarks—not to replace them with the neutral comment that neither can the IRA win. The people of Northern Ireland want a clear and unambiguous statement that the Government are not only prepared to defeat terrorism but believe that they can do so and that their policies are aimed in that direction.
If the Government cannot give such an undertaking, they are saying to the widows of policemen, UDR men and soldiers that their loved ones died in vain, in a cause that is useless and cannot be won. They are saying to the men who put on a uniform and who comb the streets and patrol the roads of Northern Ireland, "You are putting your lives in jeopardy for nothing. You cannot win this war against terrorism." Is that the message that the Government want to give their forces in Northern Ireland? Is that the message the Government want to send to the long-tried and hard-pressed people of Ulster? The Government should take the opportunity to make it clear that the IRA can be defeated and that it is Government policy to defeat terrorism in Northern Ireland.
If the Government will not make that declaration, then tonight I shall say that terrorism can be defeated. At 500 present, it is not the Government's policy to defeat terrorism but to react to it—to wait until the IRA strikes and then try to parry the blow. That is not the way to defeat terrorism. There must be a strong and resolute security initiative against the IRA. The Government must be prepared to corner and to catch the IRA, and when the terrorists are caught to ensure that they are given a sentence that fits the crime.
I do not believe that the Secretary of State for Northern Ireland was acting in the best interests of the Province when he suggested that at some time in the future, there may be an opportunity for IRA representatives to sit down with the Government. Such a comment is an act of folly and encourages terrorism. Terrorists breed on hope—the hope that they can achieve by violence that which they could never achieve through reasoned debate, argument or the ballot box. The IRA believes that, if it can continue to press the Government to appease it, then the IRA is on the winning road. Comments such as those made by he Secretary of State give the succour that the IRA wants and the justification that it needs among its own people to continue its campaign of violence.
I do not deny that the task of defeating terrorism would be made easier even if Northern Ireland had a stable political structure, and neither do I believe that the search for one should be halted until the IRA is defeated. Nor do I believe that the battle against the IRA should wait until the Province has a stable political structure. The search must go on for a means whereby Northern Ireland can be governed in peace and enjoy reconciliation. However, the means by which Northern Ireland is presently governed will not produce peace, stability and reconciliation. The Anglo-Irish Agreement is not working; it has failed. We must search for an alternative, and I urge the Secretary of State for Northern Ireland and the Government to show some flexibility in relation to negotiating an alternative.
It is interesting that leading players in the Republic have shown greater flexibility than the British Government in a suspension of the Anglo-Irish Agreement to allow new negotiations to begin. There has been a clear indication from the leader of the SDLP that he is prepared to negotiate an agreement that would transcend in importance the Anglo-Irish Agreement. The two Unionist party leaders have indicated that they are prepared to negotiate an alternative to and the replacement of the Anglo-Irish Agreement. I urge the Government to make that their second priority in Ulster. Their first priority should be the defeat of terrorism and their second the attainment of stable political structures in the Province so that our people can consider, as can the people of Britain, the social and economic matters that concern all of us in the Province but which must come behind the primary issues of the life and death of our fellow citizens in Northern Ireland.
§ Mr. Dafydd Wigley (Caernarfon)
I shall not follow the hon. Member for Belfast, East (Mr. Robinson) down the road to Northern Ireland, although I am sure that right hon. and hon. Members in all parts of the House join him in hoping that there will be growing peace in the Province.
I shall first take up a point made by the hon. Member for Hampshire, North-East (Sir D. Mitchell) in respect of the possible conflict of interests that might arise in the allocation of National Health Service resources—whether 501 they would be better spent on patients or on people making wage claims. I suggest that such is an artificial divide. If patients are to receive the level of service that they need, they must enjoy back-up facilities such as the ambulance service. I place it on record that the ambulance workers of Wales and particularly of my own county of Gwynedd have my wholehearted support for the stand that they are making. I cannot fathom why the Government are not prepared to go to arbitration, other than to dictate that ambulance workers must be employed on the Government's terms alone and because the Government are not prepared to yield an inch even if independent arbitration attempts to move them in that direction.
The right hon. Member for Castle Point (Sir B. Braine), the Father of the House, referred to the Human Fertilisation and Embryology Bill, which I understand will go first to another place before coming to this Chamber. I hope that the House will give the utmost consideration and sympathy to those people who are experiencing difficulty in having children and who need to resort to in vitro fertilisation techniques—techniques that would not be available today had the restrictive clause that is now to be considered been on the statute book 30 years ago.
I ask the House to consider also the plight of those families with children suffering from genetic diseases. There is hope of progress being made in respect of conditions such as muscular dystrophy and cystic fibrosis, and it would be a tragedy and a crime if we were to close the door to the research that is now being undertaken. I regret that questions relating to abortion and to implementation of the Warnock report should be mixed together in one Bill. Both issues are important, but they should be treated on their own merits. I hope that that may yet be the case.
I want to set the question of the Health Service, social services and care in the community in Wales in the context of the politics of my country and of the Queen's Speech. The Gracious Speech had little relevance to Wales. We are governed by the Welsh Office, which has a budget of £3.5 billion per year. The Secretary of State for Wales has 2,500 staff, yet as a Department the Welsh Office has not brought forward any legislation in the past 10 years. There are different aspirations in Wales, as can be seen from the political pattern of election after election.
I do not mean to be unkind to Conservative Members, but never in 120 years have the people of Wales elected a majority of Conservative Members of Parliament. Nevertheless, we are governed by a Welsh Office that is headed by someone akin to a governor-general, who promotes policies that may suit the hopes and aspirations of south-east England but which certainly do not suit the hopes, aspirations and community values of the people of Wales.
We celebrated only last week the 25th anniversary of the Welsh Office, which has responsibility for health in Wales, and I hope that its Ministers will take heed of a comment made yesterday on radio by a former senior civil servant from their midst, Mr. Richard Hall-Williams, that the overriding question now is how democratic accountability can be achieved for the Welsh Office, which currently is not democratically answerable to the people of Wales.
502 We hope that, in the course of the parliamentary year, policies relevant to Wales will be developed. Regrettably, the priorities of the NHS Bill are not those that we seek. Only a handful of doctors' practices in Wales would cross the 11,000 threshold, and none of our hospitals has shown any interest in self-government. The first part of the Bill is irrelevant to Welsh circumstances, while the second part does not appear to have responded to the Welsh community care angle.
The Secretary of State for Health today said candidly that he spoke as Health Secretary for England, and that explains much of what we see, and do not see, in the Bill. A few weeks ago, at the Conservative party conference, he made considerable play of the importance of cottage hospitals, whose protection, he said, was part of the rationale for the legislation. It is ironic that the present incumbents in the Welsh Office are rapidly closing down community hospitals in Porthmadog, Caernarfon and Llangefni in my constituency—and, indeed, throughout Wales. Last week the hon. Member for Cardiff, Central (Mr. Grist)—the Parliamentary Under-Secretary of State for Wales responsible for health—said that the Welsh Office did not recognise the concept of the cottage hospital. There are times when I would take the word of the Secretary of State for Health in England before I would take that of the Welsh Office.
The White Paper on care in the community—published only a few hours before the Queen's Speech: this must be one of the most rapid metamorphoses from White Paper to legislation—contains a section relating to the needs of Wales. The latter section referred to those needs in detail, and said that a separate section to deal with them was necessary because of the different circumstances of Wales; the Bill, however, makes no independent provision for Wales.
Conservative Members have raised another matter that affects health care—that of housing standards. A housing crisis is developing in some areas, including mine. Housing waiting lists are shooting up: in the past two years they have risen from 800 to 1,400 in the Arfon borough, and from 350 to 550 in the Dwyfor district, both areas in my constituency. People who have bought their council houses have found themselves in difficulties, and have been forced to sell them and go back on to the council house waiting list; young people with no hope of being able to buy their houses are unable to rent in the private sector because rents are too high. Given the available resources, surely we can overcome our housing crisis.
We hoped that the Queen's Speech would deal with regional economic problems by attempting to redress the balance between the overheating of the economy in the south-east of England and the continuing high unemployment levels in many of the Welsh valley areas, as well as rural north-west and south-west Wales. Unfortunately, it made no reference to such problems. When unemployment is between 10 and 12 per cent. in some areas and down to 2 per cent. in others, something is clearly wrong. As we approach 1992, and as the forces of the European Community superimpose themselves on the centralising forces that already exist, we need a much more radical regional policy if we are to retain a semblance of balance between developments in the various countries and regions in these islands.
The Disabled Persons (Services, Consultation and Representation) Act 1986—of which the hon. Member for Monklands, West (Mr. Clarke) was the author—has still 503 not been fully implemented, although, as other hon. Members have pointed out, many parts of it are an essential feature to any provision for community care. That Act should be implemented in full. If the Government do not intend to give the starting orders for that to happen, they should spell out clearly what alternative provision is made in this or other legislation to meet the needs of disabled or mentally ill people who are transferred from hospitals into the community.
The Queen's Speech is largely irrelevant to Wales; the NHS Bill does not meet our needs. Until Wales has its own Parliament, which can make decisions in line with the needs and hopes of its people, we do not believe that we shall be given the justice that we deserve.
§ 8.4 pm
§ Mrs. Edwina Currie (Derbyshire, South)
I shall follow the remarks of the hon. Member for Caernarfon (Mr. Wigley) about the Human Fertilisation and Embryology Bill and community care in a moment. First, however, let me say that several items in the Queen's Speech are very good news. Any of us who have ever worked in that appalling building at Elephant and Castle will be delighted to learn that the demise of the Property Services Agency is on the cards; if ever there was a case for getting rid of direct labour and the old gang, this is it, and it should have been done years ago.
The news that there is to be a Bill on food safety is also immensely welcome. That will put us ahead of the rest of Europe. It will bring us into the age of the microwave and the blast chiller, intensive farming and irradiation. We do not yet know whether the general public will accept irradiated food; the point is, however, that consumers want to know that health and hygiene standards are strictly monitored and controlled, and they want more information. That will mean better labelling—not just little lions—to give them some choice.
The food safety legislation has been in preparation for a long time. Perhaps, if it had been in last year's Gracious Speech, we should all have been spared a good deal of trouble. Nevertheless, I welcome the Bill and urge hon. Members on both sides of the House to do the same.
We should reflect on the extra money for the NHS that my right hon. and learned Friend the Secretary of State mentioned so proudly: an extra £2.4 billion this year, or £2.6 billion when increased efficiency is taken into account —sales of surplus stock, for example. As my right hon. and learned Friend pointed out, it means a total of £5.2 billion in cash over two years. That is the biggest increase that the NHS has ever seen, and compares with the total of just over £7 billion that the Opposition parties put into it 10 years ago. It will help to raise all activity to record levels, including staff, the capital programme and patient care. It gives the lie to Opposition claims that we intend to destroy the NHS. No wonder they sat there looking glum as the Chancellor announced the extra cash in his Autumn Statement.
The only solution offered by such people as the hon. Member for Liverpool, Broadgreen (Mr. Fields)—who, having made his intervention, has now left—was the nationalisation of the pharmaceutical companies. Let me put on record that many of my constituents work at Boots in Nottingham; we shall remember the Labour party's 504 offer, and we shall make darned sure that the general public are reminded of it in Nottingham, in Derbyshire and everywhere else.
Here is the precious balm of more money: let me rub it in a little more. This is the first Government to spend more on health than on defence. Perhaps that means that the House should change some of its procedures. At present we have a two-day debate on the defence estimates, and other debates on the Army, the Air Force and the Navy; but we have no debate on NHS estimates. Yet we spend far more on the Health Service than on defence. Perhaps the time has come to have such a debate: certainly my right hon. and hon. Friends on the Front Bench need no longer feel defensive about NHS funding.
It is also worth reflecting that the Labour party has voted against every one of the proposals that have brought about these developments. I have no doubt that they will fight to the last ditch the proposals in the Gracious Speech to help the NHS to use its money better. Left to their devices, we would never close a clinic or a hospital, even to replace it with a new one in a more convenient place. There are 10 hospitals in the centre of Liverpool, all within a mile of each other. It makes no sense to spend money on such property when it could go into patient services.
If matters have been left to the Labour party, we would never have made the progress on preventive medicine—;not in a million years. When Opposition Members talk about women's health and cervical cancer, I wonder what they are doing to encourage their women constituents to take advantage of the screening programmes that we have introduced and that are already in place. They could be used far more by their constituents. The Opposition have opposed every effort made by my right hon. and learned Friend to improve the dreadful old contract for doctors, which had not been changed for a quarter of a century. They should be ashamed of their opposition to change.
Left to the Opposition, a new telephone system would never be installed in a hospital, a filing cabinet would never be replaced by a desk-top computer, just because somebody in NUPE might be miffed about it. Left to the Opposition, we should not have the foggiest idea of how much anything in the NHS cost. That information is essential when trying to work out whether one form of treatment is more attractive than another. The Opposition would rather waste money and trust to luck.
Left to them, NHS employees and workers in many other essential services who take industrial action would be paid more than those who do not and who will not take industrial action. That cannot be countenanced by a fair and just society. Fortunately, it is not left to the Opposition. It is all right, left to us.
The National Health Service and Community Care Bill includes the Griffiths reforms of community care. It is in the nature of care in the community that patients become ex-patients. They disappear and lose contact with those who are employed to help them. I am therefore glad that the Department of Health has already announced that it is to tighten up its supervision of the hospital closure programme.
The large-scale transfer of funds to local authorities to enable them to purchase community care does not mean that the Government can wash their hands of it and feel satisfied. In a county such as Derbyshire, there is no guarantee that all the funds will be used for their intended purpose. The county's pension funds, for example, are not all used for their intended purpose. There is some 505 likelihood that the rather dotty version of the Labour party that is now in control in Derbyshire will deliberately discriminate against the excellent private sector in favour of its own council-run homes. I hope that the principles of strict standard setting and of monitoring, inspection and enforcement, which are so much a feature of other proposed legislation in the Gracious Speech, will also be part of the Griffiths reforms; otherwise, the Government will be spending money but leaving my constituents no better off.
The hon. Member for Caernarfon (Mr. Wigley) and my right hon. Friend the Member for Castle Point (Sir B. Braine), the father of the House, referred to the Warnock reforms. I agree with my right hon. Friend that the reforms are long overdue. It is iniquitous that so many dreadful practices, such as cloning and the creation of hybrids, have been legal in this country for so long. Even if they have not been practised, they have not been banned by law. It is good that that legislation is to be introduced. However, much though I respect my right hon. Friend the father of the House and understand the sincerity and the passion with which he speaks, I believe that to legalise some research within very strict limits is sensible and desirable. I am happy to vote for it. When I look at my own two healthy children, I wish every family in the country to have the same opportunity. Therefore, I have to vote for any possibility of extending such an opportunity to others.
We should, however, put on record our thanks to Lady Mary Donaldson, whom I met last year. She has led the voluntary licensing authority with great skill and tact. She has taken up the cudgels against a few doctors and hospitals who seem to think that anything goes in this most difficult and emotive field. Of course it does not.
If it is the will of the House, I should like to serve on the Committee that considers the Bill. I hope that we shall also have an opportunity to debate changes to the Abortion Act 1967. That, too, is out of date, but most people do not want it to be drastically altered. It would be sufficient to bring down the 28-week limit to 24 weeks, or perhaps a little less, if the legislation is to hold good for more than just a year or two. I hope that there will be an opportunity in Government time during this Session to hold such a debate to settle the matter once and for all.
§ Miss Widdecombe
Does my hon. Friend also hope that, even if the limit were lower than that which she would welcome, the House should have an opportunity to vote freely and fairly and that this House should decide the matter?
§ Mrs. Currie
I understand that, if motions to that effect are tabled, the Government do not intend to force hon. Members to vote in a particular way. I hope that there will be an opportunity in this House this Session in Government time for right hon. and hon. Members to debate the matter. We cannot continue for very much longer with legislation that is so much out of kilter with scientific fact and that is clearly not what people want. However, I repeat that I believe that most people do not want a wholesale change in the legislation; they want it to be more closely in line with scientific developments.
The Gracious Speech has set out a programme of dramatic reforms in health and community care and many related issues. It will take us well and strongly into the 506 1990s. It will keep everyone, Front Benchers and Back Benchers, very busy indeed. I am glad to give it my support.
§ Mr. Eric Martlew (Carlisle)
I am pleased to be following the hon. Member for Derbyshire, South (Mrs. Currie). I remind the House that if it had been up to the hon. Lady, there would be no hens left in the country.
The Government intend to ensure that legislation is passed that will get the National Health Service ready for privatisation. Conservative Members are often dishonest about such matters. We have listened to some of their propaganda today. One would think that the National Health Service had not been reformed since 1948. The Secretary of State for Health referred to it as a museum piece. The hon. Member for Dartford (Mr. Dunn) said that it had not been reformed for 41 years. The National Health Service is very different from what it was then. This will be the fourth reorganisation since 1974.
Each reorganisation has taken place under a Conservative Government, and on each occasion they said that it was needed to improve efficiency. The 1974 White Paper said:We are issuing a White Paper, and promoting legislation about the administration of the National Health Service, solely in order to improve the health care of the public. Administrative reorganisation within a unified health service that is closely linked with parallel local government services will provide a sure foundation for better services for all.It was signed by Keith Joseph, the former Secretary of State for Social Services, now Lord Joseph.
That reorganisation did not last very long. In 1979 there was another White Paper, which said:It is clear that the organisation of the NHS—the way it delivers health care to the individual patient—also needs to be reformed.That was signed by Patrick Jenkin, now Lord Jenkin. In 1984, a report was prepared by Sir Roy Griffiths—soon, I am sure, to become Lord Griffiths. He said that we needed to reorganise the management of the NHS. That led to the appointment of regional and district general managers, the ayatollahs of the NHS, in 1984. Now, in 1989, we have "Working for Patients." That is signed by the Prime Minister. I have a feeling that she will soon be ennobled and in another place as well.
We do not need another reorganisation in the Health Service. We need organisational stability. There is nothing wrong with the Health Service that a good dose of money could not cure. Conservative Members said that last year the Government put £24 billion into the NHS. That is all very well, but it means nothing unless it can be compared with something else.
As time is pressing and other hon. Members want to speak, I shall be brief. Unfortunately, my figures are not up to date. They are in dollars and were calculated before the fall in the pound since the former Chancellor of the Exchequer resigned. In 1987–88, the United Kingdom spent $627 per head of population on health care. Germany spent $983, France spent $1,072 and the United States spent $1,776. That shows that our Health Service is grossly under-funded in comparison with our economic competitors and partners. It also shows that we get very good value for money and that our Health Service is very efficient. Therefore, why are we saying that it must become more efficient—
§ Mr. Martlew
I will not give way. Some of the hon. Gentleman's Conservative colleagues were very mean and did not give way earlier.
There have been four reorganisations of the NHS, but gross underfunding has taken its toll on the service and on the morale of its workers. Morale is probably lower than at any time since 1948. To prove this, I cite representations from speech therapists at my surgery on Friday. They complained rightly that they were being offered a 6.5 per cent. pay rise when inflation is nearly 8 per cent. They were as appalled as I was that speech therapists are being asked to take a cut in their standard of living. I hope that the Minister will consider that.
I also received representations from midwives, whom I will meet next Monday. They complained about the disgraceful regrading which is affecting them and the nurses. That is a totally inept piece of management by the Government.
I also received representations from the ambulance workers, to whom I was glad to give my total support. I was pleased to go into the beautiful centre of Carlisle on Saturday morning with the ambulance workers. We demonstrated and 6,000 people signed our petition. I have been involved in a great deal of political action over the years, but I have never before seen people queuing up to give money. In four hours we collected £1,800 for the ambulance workers.
My constituents are totally behind the ambulance workers and will not see them starved back to work. They will not see the ambulance workers' children going without a Christmas—if that is what the Government are planning. The Government should settle the ambulance dispute now because they cannot win it. They should also scrap the new reform of the NHS and give the Health Service more money. Through this reorganisation, the Government are helping to destroy the service and they will also destroy their chances in the next election.
§ Mr. Stephen Day (Cheadle)
I want to confine my comments to the health reforms. The hon. Member for Carlisle (Mr. Martlew) said that only the Tories have reformed the Health Service. That says something about the Labour party's attitude to the Health Service, of which the Labour party claims to be the friend. However, if it was wrong for us to reform the NHS on so many occasions, it would apparently be right that a system designed to meet the needs of the 1940s should be left to meet the needs of the 1980s and 1990s. That is plainly nonsense. Conservative Governments have reformed the NHS to ensure that it meets the needs of the people in any given decade of its history. That remains the case with the present proposals.
On occasions I have not supported the Government on health issues. If I believe that half the allegations made against the reforms were true, I would not support the Government. However, today I have heard only wild accusations, none of which has been substantiated and which have been repeated around the country in leaflets distributed by the BMA.
The hon. Member for Livingston (Mr. Cook) said that Conservative Members should be aware of the dangers of not listening to our electorate. I am aware that many of my 508 constituents do not support the reforms. I am not surprised about that because if I had not taken pan in debates in the House or read the briefing notes or the BMA material properly, I would perhaps not be so infon-necl as I should be. If that was the case and I had read in a BMA leaflet or been told by Opposition Members that I would have to go without the drugs that I need and that my hospital would be made private and independent and leave the NHS, perhaps I might be concerned. Perhaps I would vote against the reforms in a poll in a Labour constituency. However, that is manifestly not the case. The charges have not been substantiated by the BMA or by the Opposition.
One of the main charges set out in letters that I have received from my constituents is the accusation that patients will not receive the drugs that they need. I have not heard one Opposition Member make it clear to the House or to his electorate that the BMA has withdrawn its opposition to the indicative drugs budget. The BMA has stated clearly that it firmly accepts the assurances of my right hon. and learned Friend the Secretary of State for Health that no patient will go without the drugs that are required.
If that is the case, why has the BMA not withdrawn from surgeries around the country leaflets containing claims which the BMA now says are not true? I have seen those leaflets in many surgeries. Hon. Members must make that important matter clear. I welcome the National Health Service and Community Care Bill because we can begin to deal with the real issues and aims of the legislation. When the Bill becomes law, with my support and that of the vast majority of my colleagues, it will become clear that the charges against it were not true.
Perhaps the hon. Member for Livingston will consider his charge about the concern of Conservative Members. When it is clear that the charges are not true, the Opposition will pay the price at the hands of the public who have been worried and alarmed unnecessarily by those accusations. I have seen patients who attend doctors regularly enter my advice surgery almost in tears. They were worried sick that they would not get the drugs that they need. That shows that the Opposition's real purpose today is to disparage what the Government are trying to do.
Any responsible Government with the interests of the NHS at heart must ensure that we have an NHS to go to. The pressures on the National Health Service are enormous and they will increase. If the answer to the problems of the NHS was to throw money at it, the Government would have solved the problems years ago. Year after year they have put extra finance into the NHS. Of course that alone does not solve the problems. To tell patients that it does is to mislead them into thinking that matters are easily solved. That is no answer to the problems of the NHS. We must increase funds—the Government recognise that—but that is merely to keep pace with today's demands.
To ensure that the NHS exists for future patients, we must bring it into the 1990s. That is what the reforms are about. That is why I shall support the Government and why, when the proposals are in place, people will thank us for them.
§ Mrs. Rosie Barnes (Greenwich)
There is consensus about what should be achieved within the National Health Service. There is a commitment to the best clinical practices and a growing acceptance of the best management practices and the best use of resources. Patients' rights and choices are coming to the forefront. Everyone wants quality assurance. However, we should also consider a degree of patient or consumer responsibility. People want the finest National Health Service. They want to know that whatever technical innovation is developed will be available for them and their families if they need it. They must be prepared to pay for it. Survey after survey has demonstrated that they are prepared to pay for their National Health Service out of their direct taxation.
I have looked carefully at the Government's proposals as they have evolved. I was not one of those who were against further reform of the National Health Service. I did not consider that a large dollop of money and a good stir would sort out the problem. I recognised the need for innovation and change and a more responsive and sensitive Health Service if it is to serve us as well in the next 40 years as it has in the past.
For several key reasons, I reject the proposals. The speed with which they will be introduced is a travesty. There have been management studies of what is proposed and how such plans would be affected if they were in the private sector. They would be given a decade to be implemented—slowly but surely, one stage at a time, and one bit built on the next, not thrown willy-nilly into a service which is totally ill-prepared, unsuited and ill-equipped to cope. The medical audits which are gaining acceptance are inadequate to cope with what is suggested. No account has been taken of the massive organisational changes involved. The fact that there is no pilot study for such a major change will haunt the Government in the long run.
The lack of proper consultation with the professionals is another matter of concern. My major objection to the proposals is that their oucome will be contrary to the Government's objectives. I will dwell on patients' rights and choice and whether they will be enhanced by the proposals.
When hon. Members were considering the Health and Medicines Act 1988, I tabled an amendment suggesting some form of patients' rights or an internal market for the Health Service. The term "internal market" has been hijacked and abused by the proposals. My party suggested that we should make the Health Service a National Health Service, rather than the series of local services that we have at present. As hon. Members know, if one needs a hip replacement, depending on where one lives, one may get one in three months, three years, or not at all. That is not right.
My amendment in Committee suggested that, for every specialty, we should take the current good practice, perhaps based on the top 20 per cent. of health authorities in the area, and the average delivery time of the service concerned, and make them the national benchmark. With hip replacements, if it turns out that the average for good health authorities is eight months—that is, not a pie in the sky figure but one based on current good practice—it should become the national benchmark for hip replacement availability. If a health authority is not able to 510 deliver a hip replacement within eight months, a patient should have the right to go to another health authority or to the private sector through their health authority if the price can be agreed and the money can follow the patient.
Many Conservative Members have said that the Bill will be about patients' choice and patients' rights. It will not. The proposals for which I strongly argued in Committee would provide patients' rights. It would give them some control over their share of National Health Service money. It would also give health authorities an incentive to be efficient and to deliver effective services. It would also make it sensible, where health authorities are close together, as in London, for there to be cross-fertilisation and specialisation. That constitutes patients' rights and giving patients more control over their money and destiny within the Health Service.
The Bill will be quite different. It will give doctors and health authorities more rights and it will make money a more determining factor than it has been to date, but patients will have fewer rights. For example, if a GP becomes part of a group practice, patients will have to go where the GP decides to contract his services. If one's GP is not contracted, one will have to go where the health authority says. As a patient, one will have no right to go to a certain hospital because it is nearer or its service is quicker. Although there is a case for saying that the money will follow the patient, it will not follow the patient at the instigation of the patient: it will follow the patient only if the doctor or the health authority says so.
We must also consider what is proposed for self-governing hospitals. Core services must be provided within a health authority, but not necessarily within each hospital. Certain basic services may be lacking in particular communities. I refer to geriatric services and psychiatric services. Even midwifery is not listed as a core service. Hospitals that choose to become self-governing first will be able to pick what services they can drop. The Cinderella services will be the first to go. Some patients may find that their health authority draws the line and says, "No, this must be included in your area." That may encourage a rush to become self-governing.
Practice budgets change the relationship between a doctor and a patient. As never before, when patients consult doctors, they will have in their minds the query that a financial consideration will determine what the doctor prescribes or where he sends them. I accept the Government's assurance that no one will go short of drugs at the end of a financial year. Nevertheless, there is a financial consideration in the doctor-patient relationship which has never existed before, and it is a distortion of what was once a much more professional and ethical relationship.
I should like to conclude now to enable those hon. Members who have waited so patiently to have a chance to speak. Perhaps the Government can get off the hook in their dilemma by looking more seriously at what some health authorities are interested in doing for themselves, which we in the SDP have certainly supported. This is the possibility of health authorities themselves becoming self-governing, as opposed to the hospitals within them. That would eliminate a major dilemma for self-governing hospitals, because it would enable the health authority to have a proper comprehensive strategy for its whole area and to take into account the needs of all its citizens, whenever and wherever they may require its services. In many ways, that proposal has some of the best features of 511 the idea of self-governing hospitals—I admit that there are some—while avoiding many of its major pitfalls. It should be looked at far more carefully.
§ Mr. Andrew Mitchell (Gedling)
I am grateful for the chance to follow the hon. Member for Greenwich (Mrs. Barnes) and find encouraging the extent to which, from what she said, the Government can expect to receive support from the Social Democratic party when the health Bill which was published last week comes before the House.
Although we are primarily discussing health today, this is a debate on the Loyal Address and I should like to comment on one or two other matters in the Gracious Speech. I am one of those hon. Members who voted against televising the House, but I must admit that I have been pleasantly surprised by the effect of the first week. However, I hope that our approach to debates will not become too sanitised. Indeed, this afternoon's performance by the two Front-Bench spokesmen makes it reasonably clear that the effect of television on the House is already wearing off, which must be a good thing. I hope that we shall range widely in the next few months before the experiment draws to a close in July, because it is important that our constituents get the feel of this place. After all, it is the people's Parliament. At the moment, we are focusing too much on the man with the ball, and not enough on the whole football pitch, but I hope that that can be remedied in the period between now and the end of the experiment.
The Gracious Speech includes important measures that will be of great advantage to my constituents. I was especially pleased to see that there will be legislation on food safety and consumer protection, and a Bill designed to improve co-operation with other countries in the investigation of crime. Those Bills are extremely important and I hope that they will command widespread support in the House.
The third measure that I was delighted to see was the environment Bill. A co-ordinated approach to the environment at local, national and international level is extremely important. At the international level, it is vital that we achieve two things: first, a wide consensus, among as many countries as possible on the measures to which the international community agrees; and, secondly, as wide a scientific consensus on the major problems as possible. I refer especially to the problems of climate change.
In respect of our national policy on the environment, I was delighted to see that the principle of the "polluter pays" will be enshrined in the Bill and that industry will be seen not so much as the problem, but as the solution to many of the difficulties.
In my constituency, I have been pleased by the environmental sensitivity shown by Gedling borough council. It is justly known as a trail blazer in environmental matters in the east midlands. Litter irritates many of our constituents enormously. Indeed, no issue irritates my constituents more. The Government have listened and I was grateful to have been able to join my hon. Friend the Member for Chelmsford (Mr. Burns) in co-sponsoring his excellent Control of Litter (Fines) Bill, much of which has been taken on board by the Government.
512 If I might make one mild criticism, it is that I wish we could have gone a little further on graffiti. I understand the difficulties facing local authorities when given the power to deal with grafitti, such as the question of legal responsibility, but if the local authority is not responsible for removing grafitti from public buildings, who on earth is?
With the hon. Member for Mansfield (Mr. Meale), who in this respect alone is perhaps my hon. Friend, I am hoping to bring before the House legislation to enable the courts to take more effective action against people convicted of badger-baiting. We are in an advanced state of agreement with the Home Office and I hope that the House will unanimously pass the Bill.
There are two measures in particular this year, Mr. Deputy Speaker, upon which I hope to catch your eye from time to time. One is health, which I shall discuss in a moment, and the other is the Coal Industry Bill which I understand will come before the House next week. I have a particular constituency interest, as well as a personal interest, in that Bill. I look forward to the time when our coal industry has made as much progress as the steel industry. We should recognise the reconstruction that has already taken place in coal and the success that has already been achieved, in terms of competitiveness and productivity, especially in the Nottinghamshire coalfields. One can see that success from the figures. Manpower is now one third what it was before the strike. Although the number of pits has decreased from 190 to 74, production has decreased by only 15 per cent. At a time of a 70 per cent. increase in world coal prices, there has been a £1 billion reduction in the cost of British coal to its customers.
We must support new coal technologies and advanced coal technologies because they will increase efficiency, improve the economics of the industry and reduce greenhouse gases. That must be our goal if we are to make the industry truly march along with the tide of time. I look forward to the Second Reading of this very good Bill.
Health is a particular interest of mine, and I shall have a number of detailed points to make in support of the Bill, perhaps on Second Reading or in Committee. My right hon. and learned Friend the Secretary of State is to be congratulated on the remarkable fact that he has managed to keep the Bill to a reasonable size. Some of us feared that it might be a lot longer than it is, but given how much is in it, it seems manageable.
I am not prepared to take lessons from the Opposition on devotion to the National Health Service. I spent two happy years serving on a health authority and my wife is a doctor in the NHS and gives more hours to it than I care to mention. I am a passionate and devoted supporter of the Health Service. However, I share with Opposition Members a sense of frustration that, although we are putting so much money into the Health Service, the queues still seem to lengthen. There is nothing more frustrating than hearing from my constituents that they cannot receive the treatment which I believe that they should receive at once.
But we also hear that there are 20 per cent. more doctors and an unprecedented capital building programme. I believe that at the moment no fewer than 530 capital projects worth £1 million or more are in the pipeline. This year there has effectively been an 11.5 per cent. increase in resources. Therefore, the funding is there. We know that it is there and the record speaks for itself, yet we are not getting to grips with these difficult problems.
513 I was astonished to hear the Leader of the Opposition, when he replied to the Loyal Address, say that competition has no place in the National Health Service. I thought that Labour's policy review had established that competition works for the good of the customer, the client, and the patient. It may be controversial, but the process that district health authorities are undertaking to specify what they need and on what terms they are prepared to pay has been singularly lacking throughout the history of the National Health Service, which has been concerned almost entirely with what we put into the service, without looking at what we get out of that enormous investment.
I have come to the conclusion that the National Health Service is not primarily short of funds. Many Opposition Members have said that it needs a 3 per cent. real increase in funding, but it has had that. As far as I can see, this year the increase has been nearly 6 per cent. The critical area that the Health Service must now get right is effective management. Sir Roy made a great start on that earlier in the 1980s with his new system of management, and I believe that the bulk of what my right hon. and learned Friend the Secretary of State is proposing will build on the excellent reforms of the 1980s. Sir Roy has made a start and this excellent legislation must follow that.
I welcome the devolution enshrined in the health Bill. We have always encouraged such devolution in Nottingham, which has some excellent managers and a great pool of talent. It operates, however, with one hand tied firmly behind its back and I welcome the fact that, in future, we shall be able to determine locally the terms and conditions of those who work in the Health Service.
It is extremely important that we stop looking at the NHS as one big amorphous organisation. We know that there are huge differentials in the quality of service across the country. We know that some surgeons undertake only 20 per cent. of the work load of other colleagues in exactly the same discipline. In London the cost of a particular operation can be four times as much in one hospital as it is in a hospital a quarter of a mile away. The NHS is a vastly different organisation with varying levels of efficiency, medical standards and costs. The sooner we realise that the better.
The concept of money following the patient is excellent. My hon. Friends and the hon. Member for Greenwich (Mrs. Barnes) have already drawn attention to the absurdity of the present system under which highly efficient units spend their budgets and must then close. Under the new system, I hope that good management will be rewarded instead of being shot in the foot. The clarity offered by the separation of the provider from the purchaser is a major step forward. Even without competition, the district health authority will now be able to concentrate on its crucial area of responsibility—determining need and how best to meet it—without the confusion and conflict inherent in managing its services.
That means, however, that management must be able to manage its resources and assets, including its senior medical staff. We cannot have employees, no matter how senior, leapfrogging unit managers in a bid for support outside the unit. The need for a better and more efficient management of the service goes to the heart of the relationship between the management of that service and the clinicians who work in it.
514 Clause 19 ensures that the Audit Commission will be more involved with the NHS, which is an excellent step forward. The commission should do as much value-formoney work as possible. I am glad that the Secretary of State listened to what my hon. Friends and I have said about the commission.
Clause 18 deals with capital charging, which is an extremely complex area. It must not become an accountant's dream and no one else's. I hope that such charging will get us away from present practices when, all too often, NHS management reach for new projects and new build instead of maintenance. The NHS is not charged for the cost of the capital projects, but is charged in a different way for maintenance work. I hope that the clause will deal with that problem.
I welcome the great investment in new management systems for the NHS. Those systems were stimulated by the White Paper as well as by the review of the NHS. In the past the NHS has suffered greatly from the lack of accurate, rapid information to help managers to manage. My right hon. and learned Friend will know that Nottingham has been at the forefront in dealing with that problem and in recent years the district has spent more than £2 million a year on it. It is already seeing the benefit of that investment, but there is still a considerable way to go.
I welcome the Gracious Speech and I look forward to the measures enshrined in it passing into law. If I am successful in catching the eye of the Chairman of the Committee of Selection, I particularly look forward to serving on the Committee which will deal with these momentous and important health changes.
§ Mr. David Hinchliffe (Wakefield)
One area that has received scant attention in today's debate is community care. The people concerned about that issue have been treated shabbily by the Government in terms of the time scale allowed for consideration of community care. After the report published by Sir Roy Griffiths, we had to wait 18 months for the Government's response. After the publication of the White Paper last week, we effectively had three working days for consultation before publication of the National Health and Community Care Bill. Such consultation is inadequate, given the serious implications of the proposals for those concerned with community care.
As community care is included in the Bill, I am extremely worried that that aspect will be overlooked and forgotten because of the understandable concerns about the other radical proposals relating to the NHS. I note that part III of the Bill relates to community care. I suspect —I would place money on it if I were a betting man—that the guillotine will be operating by the time we come to discuss community care.
The Government have treated with contempt the many thousands of people who work in community care, the many people who are carers and who voluntarily look after those less fortunate. Above all, the Government have treated with contempt those people who depend upon that community care.
When the Secretary of State responded to a point of order raised shortly before Prorogation he said that the White Paper on community care was non-contentious. I take exception to that, because I take exception to the 515 Government's basic definition of community care as set out in that White Paper. By their definition, isolated private institutional settings are deemed to be part of community care. The process of discharging the mentally ill and the mentally handicapped from isolated, Victorian public institutions to isolated, Victorian private institutions is deemed to be community care. In my view, community care means that people are based in the community, whether that means residential care or not. Because of the Government's policy on community care, people are now moving miles from their homes and their communities into isolated institutions. In no way can those institutions be described as part of the community.
The White Paper is riddled with a number of fundamental contradictions. The central priority in the White Paper—I believe it is the right one—is to avoid unnecessary institutional care. That aim, however, is contradicted by the key objective of a flourishing independent sector. With the development of the independent sector, more and more people have been pushed into institutional care which, in many instances, they do not need. The independent sector has shown no interest in alternatives to the provision of institutional care, because the easiest way to make profits is to provide such care. That is not the answer to the needs expressed by vast numbers of people in the community who require some form of domiciliary, preventive support to remain in their homes.
The other fundamental contradiction is that the White Paper makes it virtually impossible financially for local authorities to continue directly to provide their own part III residential care for the elderly and handicapped. Given the financial arrangements introduced by the Bill, it will be virtually impossible for local authorities to provide such care. The White Paper, however, states:The Government will expect local authorities to retain the ability to act as direct service providers, if other forms of service provisions are unforthcoming or unsuitable.In other words, the local authorities are expected to continue to provide residential care when the private sector says, as frequently happens, "I am sorry, my friend, you are unsuitable. You cannot pay the money we want from you." When that happens, those people are dumped into local authority part III accommodation. That is a fundamental contradiction which should be sorted out, because it will give local authorities an impossible task.
The White Paper is based on a series of myths; the central one is the idea of promoting choice. "Choice" is a nice word which the Government have brought in, but in reality choice is different. What choice do the majority of people have who enter residential care, and what choice will they have when the Bill is enacted? Experience has shown us that the only choice that they have will be determined by where there is a vacancy for them when they need residential care.
What choice will there be for people who want to enter local authority care—not private care—when local authorities can no longer offer that care? What will the choice be for many of the people of my constituency who do not want to go into private care? Such people will say, "I grew up under the welfare state. I fought for a welfare state and I want to go into my own local authority's accommodation in my home area on my estate." What choice will they have when the residential care they want is not available because of the new funding arrangements in the Bill?
516 What choice will the senile, confused wanderer—whom I and no doubt other hon. Members come across quite frequently—or other cases referred to us have when the private sector does not want to know? Those in the private sector will run a mile because they cannot manage such people and, in the end, those people are dumped in the hands of the caring local authorities. When those hands are tied and can no longer provide that accommodation, what will happen to those poor unfortunate individuals?
Another myth contained in the White Paper is that local authorities are monopolistic providers. Local authority social services have never been monopolistic providers, but always enablers. I worked for 12 or 13 years in social services in the Leeds area and much of my time as a social worker was spent referring people to other local agencies—voluntary, non-statutory and sometimes private agencies. That was part and parcel of the local authorities' role, which has been established since the welfare state began. The idea of a monopoly is utter nonsense.
The White Paper's aim is the introduction of competitive tendering disciplines to residential and nursing homes. Does competition have a place in caring? What will the implications and consequences be of competitive tendering disciplines in caring? I shall give one or two current examples: the bribery of social workers in Norfolk by proprietors to force admissions to their homes.
Care Weekly exposed an issue this week when it showed that Univent Ltd was letting people's rooms in private homes when people went to hospital or on holiday. It was clearing out people's personal prized possessions which may have been the only reminders they had of their husbands or wives who had since died. These possessions were cleared out without any consent or consultation. That is the reality of competition.
I know that my time is limited, and I shall sum up with one or two important points. The White Paper is a restatement of an extreme political ideology, not a genuine attempt at a coherent strategy on community care. There is a desperate need for planning, but there is not a whiff of it in the White Paper. There is also a desperate need for innovation and new ideas, but this is lacking and there is not a scrap of a new idea in the White Paper about preventive services or keeping people out of institutions. It reflects the same tired and rotten philosophy which underpins every other Government policy. Nowhere is this philosophy of profit and the market less appropriate than when talking about caring for the most dependent and needy people in our community.
§ 9.2 pm
§ Mr. Edward Leigh (Gainsborough and Horncastle)
am grateful to the hon. Member for Oldham, West (Mr. Meacher) for delaying his wind-up speech for a few minutes to allow me to say a few words at the end of this long and interesting debate. I am particularly interested in two aspects of the Queen's Speech and current policy: the sovereignty of the individual as a citizen of the community of the state and the sovereignty of the state as a member of the community of nations. In the context of this health debate I can deal only with the first issue.
Over the years, we have seen three stages in the development of the welfare state. The first is the elimination of widespread poverty and disease. Both great parties of state have had an honourable record on that. The second is the creation of the welfare state, and again 517 both parties in the wartime coalition during the years of the Beveridge report have an honourable record. We are approaching the third stage—the key to the debate—in which the welfare state may become a victim of its own success, and health provision may become a victim of an aging population which rightly demands ever-increasing, more expensive and technologically based health care. How do we as a nation find the resources to meet those demands as we all want?
I do not want to make a party political point, but the Conservative party has increased spending so that we now spend £1.40 for every £1 which the Labour Government spent on the Health Service, which shows that we are committed to the National Health Service. A problem which either party would face and which is illustrated by 'the vagueness of the Labour party's spending proposals is how to increase resources from a tax base.
We can win the controversy over these reforms provided that we do not speak to the public in terms of millions and billions of pounds—unless one is of Italian descent, because the Italians, with their currency, understand billions. This is the way that we have to explain the reforms. We have to explain that every family is spending more than they have ever spent before on the National Health Service through their taxes. We employ more than 1 million people in the NHS. Ordinary people who pay taxes have a right to demand to expect some accountability from the I million people who work for them. If we explain the reforms in that way, I am sure that we can make them stick and make them successful.
There is a limit to how far we can go along that road. The controversy which has been stirred up by vested interests as we have attempted to bring in reasonable reforms, shows some of the difficulties that we face. We should consider what we can do, not now, but perhaps next year, or in the next Parliament.
The part of the Bill which states that pensioners will enjoy tax relief on private health insurance is important. Perhaps we should think in terms of becoming a savings and not a spending society, of being a planning rather than a spendthrift society. We must do that as individuals and not just as a nation.
There is nothing wrong with people planning for their old age and their health care through private health insurance. They would be saving resources which could be given to people in greater need.
Perhaps we should now consider reforming the tax system to encourage saving and planning on that basis. Then we will create a society which is planning for the future and which does not demand ever-greater spending. People think that by spending another £1 million or £1 billion they can solve the problem. We know that that is not right.
However, that is for the future. This Bill is a modest reform, which makes the Health Service more accountable. On that basis, I shall support it in the Lobby on Second Reading.
§ 9.6 pm
§ Mr. Michael Meacher (Oldham, West)
As is customary in winding up, I had intended to make commendatory references to those speakers who had made an important contribution during the second half of the debate—the 518 social security element of the old health and social security portfolio. However, in view of the balance of the debate, I shall confine myself to the Queen's Speech.
From the somewhat cursory reference in the Queen's Speech to a social security Bill involving the revaluation in occupational pension schemes, one would think that the broad structure of social security in Britain was working satisfactorily, and that it does not need much further attention. In fact, it is in a state of unprecedented turmoil. For groups such as the young homeless and the casualties of the social fund, the Department of Social Security has become a bitterly cynical misnomer. One would not guess that from the Prime Minister's opening speech, however. Last Tuesday she proclaimed:Not only have we had extensive growth and created extra wealth but we have shared the success."—[Official Report, 21 November 1989; Vol. 162, c. 26.]That must come as a novel idea to the 150,000 homeless people sleeping rough in London, and to the beggars who have reappeared in the streets and tube stations of London for the first time since the war.
The Prime Minister went on to say:a family with two children, and the husband on average earnings, now gets an extra £55 a week in take-home pay, after allowing for the increase in prices."—[0fficia/ Report, 21 November 1989; Vol.162, c. 26.]What she did not add was that the 2 million pensioners who depend wholly on the state pension, over the same period that she has been in office and after allowing for rises in prices, have had an increase of precisely 18p a week. That is the trickle-down theory of economic growth so beloved of the Government.
The other day, Lord King, whom the Prime Minister would no doubt describe as "one of us," paid himself a rise of £4,000—and that is not per year, but per week. The worker on average pay gets an extra £3 per week this year in real terms, but pensioners get a few paltry pence. One might call it the trickle-up theory.
By breaking the link with earnings, and by indexing pensions only with prices, the Government have saved themselves £4 billion at the expense of pensioners. I trust that when the Chancellor, no doubt proudly, proclaims in the Budget next March that he is running a £15 billion surplus, he will have the honesty to tell the country that the pensioners have paid for more than a quarter of it.
If the Prime Minister were true to her word about sharing national prosperity, why was one of her first acts on coming to office the breaking of the link between pensions and earnings? Had she not done that, the single pension would be £12.65 per week higher and the married couple's pension £20 per week higher than it will be next April. Far from sharing in national prosperity, pensions as a proportion of average earnings have fallen from 30 per cent. to about 23 per cent. Putting it straight, pensioners have lost about one quarter of their pension in the past decade.
§ Mr. Whitney
What was the impact on pensioners of the fall in value of their savings due to the inflation record of the Labour Government?
§ Mr. Meacher
Despite the high inflation of the 1970s —there was high inflation in the early 1980s too—the state pension increased by more than 20 per cent. under Labour, after taking account of prices, compared with a 0.5 per cent increase under this Government.
I want to be fair to the Prime Minister. She added last Tuesday: 519we gave extra help"–I think that the Secretary of State referred to it again today—to the 2.5 million pensioners who need it most".—[Official Report, 21 November 1989; Vol. 162, c. 27.]One has to admire the way in which the Prime Minister and the Secretary of State for Health make a virtue of necessity. That is, of course, a reference to the Lawson gaffe. The former Chancellor dropped the bombshell that he was thinking of targeting—for which read "meanstesting"—pensions. His red-faced colleague, the then Secretary of State for Social Security, was forced to wheel out a new premium for the aged to explain away what he meant. I note that the Prime Minister is now quoting this embarrassment bonus, as I prefer to call it, as an achievement, but it was no great achievement—it was simply handing hack with one hand what had been taken away only 18 months before in the Fowler reviews.
The poorest pensioners are not the only ones for whom the Prime Minister's share of prosperity is not so much a mirage as a sick joke. There are today 250,000 people in receipt of transitional protection who had no rise in April 1988, no rise in April 1989 and who will get no rise in April 1990. By definition, people on transitional protection are among the poorest in society yet by next April their standard of living will have fallen by some 18 per cent. in the past three years.
The disabled, too, would be surprised to hear that they have shared in rising prosperity. In 1979, the Tory party manifesto said:Our aim is to provide a coherent system of cash benefits to meet the costs of disability, so that more disabled people can support themselves and lead normal lives. We shall work towards this as swiftly as the strength of the economy allows.Five years later, the Government smugly declared themselves satisfied with the level of economic growth, but declared that they needed more information about the number of disabled people and the services that they used. Another five years and six OPCS reports later, the Government's promised comprehensive review of benefits for the disabled still has not surfaced. It appears that in social security matters advisers may advise, but Ministers are incapable of deciding.
The Prime Minister was again misleading in the House last Tuesday when she said:Spending on people who are sick and disabled has nearly doubled under the Government, again after allowing for inflation."—[Official Report, 21 November 1989; Vol. 162; c. 27.]That sounds very good, but she did not admit that almost all that increase was due to greater take-up of the benefits, not to an improvement in the level of benefit. In other words, the increase in Government expenditure has resulted in more people claiming inadequate benefits, not in disabled people being better off.
Ten years after the Government's original promise, the disabled are still waiting. I acknowledge that in the uprating statement the Secretary of State announced an extra £100 million for benefits for the disabled. That £100 million is welcome, but it does not come from outside the social security system—it is money saved through freezing child benefit for the third year running. The Government must understand that it is not acceptable to transfer money from one group of claimants to another.
The Opposition's main charge in this debate is not that the Government have failed to meet our objectives for social security—the jury needs no persuasion about that —but that they have failed to achieve their own objectives 520 after 10 years in power and all the upheavals of the Fowler reviews. The Government have always set themselves the task of ending the dependency culture and giving people incentives to work. Perversely, because of their drive to cut expenditure on every occasion they have repeatedly ended up doing exactly the opposite.
For example, under the old benefit system, help was given with work-related expenses to encourage more people into work. Now, under income support, that help is withdrawn. Another example is that unemployed people on income support receive help with their mortgage payments. If they go back to work and receive family credit instead, they do not get that help. That is a major disincentive to unemployed people returning to work.
The Government have recently increased from £12 to £15 per week the earnings that can be offset against income support so that some lone parents can be encouraged to go back to work. That is fine, but at the same time the Government stopped the cost of child care being offset against income support, with the result that more lone parents are forced out of work and back into dependency. To cap it all, the Government now propose to introduce a £43 per week means test on unemployment benefit. A part-time worker who works one day or more a week will lose a whole week's benefit. That is a major disincentive to people taking up part-time work.
Perhaps the worst example of the Government's failure to reduce dependency is the double bind in which they have put 16 to 17-year-olds seeking work, who cannot get a job until they have somewhere to live and cannot get somewhere to live unless they can put up a fairly substantial sum in advance. Yet the Government have cut off virtually all their benefit so that they cannot make that advance. That puts young people into an impossible catch-22 situation which is the opposite of what the social security system should do. Far from reducing the dependency culture, the Secretary of State and his collesgues have been intensifying it.
Another objective that the Government repeatedly talk about is concentrating resources on those in greatest need. Even the Tory-dominated Select Committee on Social Services in a recent report recognised the Government's failure to do that when it stated:help can be targeted more accurately or the benefit system can be made simpler to operate, but not both at the same time.Simplification, which under this Government is a code word for cutting expenditure, has invariably taken precedence.
Child care is a classic example of how badly the Government have failed. They rejected child benefit, which has a 100 per cent. take-up, goes directly to the mother and provides no disincentive to return to work, and instead tried to target family credit on the poorest families. The Government missed their target because nearly half the families for whom it was intended did not take it up.
I was surprised to hear the Secretary of State talk of it with some pride. He should be ashamed. In desperation, the Government spent £8 million on an advertising and promotion campaign which increased the take-up by all of 8 per cent., so it cost £165 in advertising for each extra family claiming. That is about as effective targeting as using a double-barrelled shotgun to hit a fly. Rather than frittering away money on glitzy advertising which does not 521 work, the Minister would do far better to direct that money to increasing child benefit, which is a proven success.
We see the meaning of targeting in the social fund. It is not targeting the Government's limited resources on claimants in greatest need, but targeting claimants with least resources on the Government's need to save money for the next tax handout to those with ample resources. First, the social fund budget has been halved, compared with the single payments that preceded it. Now it has been frozen for the second year running, although the number in poverty needing it has risen at the same time as the real value of the money available to meet that need is falling.
Already, DSS offices in Manchester Cheatham, Birmingham Northfield, Mansfield, Blackburn, Burnley, Folkestone and Greenock, to mention but a few, will be out of social fund money by the end of January—three months before the end of the financial year. Refusal rates are already running at 40 to 60 per cent. and in Dewsbury they are 77 per cent. What is the use of a safety net system in the form of the social fund if claimants are told, "Yes, you are eligible but there is no money to pay you"?
I will give the House an illustration. Recently a person contacted me from outside my constituency. He is a 60-year-old man in Salford who is redundant and living on benefit, which has not increased since April 1987 because he is on transitional payment. He lives on his own and has no family or relatives to help. He had a burglary. The thieves broke into his gas and electricity meters and took the contents. They also took his savings, which were to pay his rent and rates, his only overcoat and his portable television. They used his only towels as toilet paper and stuffed them down the toilet. Because his meters were broken he did not have a hot meal for a week. He asked for help from the social fund and filled in 11 pages to make his claim. He waited three weeks and was told that he could be given no help. If that man cannot be given any help, what is the point of a social fund?
Ministers think that the social fund is a great success. In February 1989, the then Secretary of State said:The Social Fund is now working well. Interest-free loans are providing exactly the sort of additional help with unexpected expenses that was needed … people are getting a much quicker service. They know where they stand in a matter of days in most cases— … it is now proving a flexible and imaginative way to help people to meet unforeseen expenses and to live in the community".The Secretary of State who said that certainly found out where he stood a few months later in the July reshuffle —and not a moment too soon, with views like that.
Does the present Secretary of State repudiate those views or is it his view that that is exactly what the social fund was set up to do—to target not poverty but the poor? Perhaps the Secretary of State could direct his answer to Cleveland welfare rights service, which recently encountered some people who are completely without money. No help is available from other sources and those people are clearly at risk, but they were refused crisis loans because they have no money with which to repay them. It is the ultimate absurdity to require loans to be repaid and then to refuse them to the poorest because they are too poor to repay.
The Tories are always talking about getting value for money. Our charge is that, after 10 years of Tory Government, the national insurance system represents 522 such exceedingly poor value for money that if the directors —that is, the Cabinet—had to subject themselves to a vote by the shareholders—that is, the claimants who use the system—they would all be promptly sacked. While earnings have risen net of inflation by 25 per cent., benefits for pensioners and others have risen net of inflation by a niggardly 0.5 per cent. under a national insurance fund which now has a cumulative surplus of about £10 billion.
Some insurance benefits for which people have contracted for years to pay contributions, such as earnings-related unemployment benefit and death benefit, have been unilaterally chopped. No private insurance company in the world would be allowed to get away with that. Unemployment benefit, which is a contractual insurance benefit, has been halved in value relative to earnings in the past 10 years. The Government are fleecing all national insurance contributors by using £3 billion of our money without our permission to bribe people to leave SERPS and take out private personal pensions. That is about as moral as giving someone a backhander to steal their own family silver.
Another Tory claim is that theirs is the party of the family. That is a bit rich from a party which has just frozen child benefit for the third year running. If all the cuts were made good, child benefit would stand next April at £9 per week. That means that the average two-child family has seen the purchasing power of child benefit drop in recent years by no less than £182 per year. So much for the cynical Tory election manifesto pledge of 1987 that child benefitwill continue to be paid as now, and directly to the mother.On top of that there is the poll tax, which might well be described as the Tory anti-family tax. Families will be penalised if they care for an elderly relative at home, although offloading such responsibilities on to the family is precisely what the Government's community care policy is all about.
§ Mr. Meacher
If the hon. Lady would care to listen, she might learn something herself. Families will also be penalised if they do not turf out their children as soon as they reach the age of 18 and become liable to the tax.
§ Mr. Meacher
I will give way in a moment.[Interruption.] The hon. Lady must learn to contain herself. I know that she finds that difficult.
The family will also be penalised—
§ Mr. Meacher
If the hon. Lady persists, I shall not give way.
Families will be penalised if they fail to turf out their children when they reach the age of 18 years and become liable to the tax. At the same time, other Government policies disqualify young people if they move away from their homes. Presumably those policies are designed to drive young people back to their homes. Either way, the family loses.
§ Dame Elaine Kellett-Bowman
The hon. Gentleman should know—if he does not, it is time that he checked the facts—that individuals are not assessed on the earnings of the head of the household. If people are caring for an 523 elderly relative, that relative will be assessed on his own income and not on that of the head of the household, and payment will be rebated accordingly. Moreover, pensions will increase by 20 per cent. Will the hon. Gentleman kindly learn the facts? He should not mislead the House.
§ Mr. Meacher
I should have used my better judgment and not allowed the hon. Lady to intervene to indulge in a silly rant of that sort.
Of course the poll tax will still be a disadvantage and a deterrent to the family. Of course the family will continue to be worse off. I do not know where the hon. Lady sees a 20 per cent. increase in pensions, unless she is foreseeing the advent of another Labour Government.
What we are seeing is all part and parcel of the Government's policy to drive women out of the Labour market and back into the home. As one of the Secretary of State's predecessors strikingly put it:Quite frankly, I do not think that mothers have the same right to work as fathers. If the good Lord had intended us to have equal rights to go out to work, he would not have created man and woman.That was said by the then right hon. Member for Wanstead and Woodford, Patrick Jenkin, who is in another place now. One might be excused for thinking that if the good Lord had intended women to have a fair deal, he would not have created the Prime Minister.
I conclude, as the Prime Minister would wish, with her favourite theme—how she is leading the way in Europe.
Her paranoid opposition to the European social charter has damaged workers' rights in Britain. At the same time, she is preventing pensioners from getting the fair deal that they receive in Europe. After 10 years of falling back, the single pension in Britain now represents an average of only 46 per cent. of previous net earnings. In France, it is double that representing 92 per cent. of previous earnings, and in Germany it is nearly double.
The Prime Minister has consistently set her face against the introduction of any EC proposal, however beneficial, if it impinges on her social policy. It is the British pensioners who have lost out. The latest example of that is the Government's rejection of Europe-wide concessionary bus and travel passes. It is a disreputable record to reject cut-price travel and at the same time to insist on cut-price pensions.
In yesterday's edition of The Sunday Times—not exactly a bastion of the Labour party—it was clear that the truth was beginning to seep out. There is a large and growing underclass. This is not an academic argument about the precise definition of poverty. There is evidence that cannot be ignored of raw hardship, bitter frustration, endless bureaucracy and growing despair. That is the daily experience of up to one fifth of the population, and nothing in the Queen's Speech will alleviate a fraction of it. Indeed, much of what is proposed will intensify it. That is why, in the name of the forgotten Britain, we shall reject the Queen's Speech today.
§ The Secretary of State for Social Security (Mr. Tony Newton)
Like the hon. Member for Oldham, West (Mr. Meacher), and perhaps slightly against the trend of much of the debate, I shall concentrate most of my remarks on social security. If there are issues to which I can helpfully respond on other aspects of the debate, I shall seek to do so as I go along.
524 In the light of the comments of the hon. Member for Oldham, West and a number of his hon. Friends, I shall place on record the increasing size of the social security budget over the past decade. As the hon. Gentleman has obviously undertaken a great deal of research involving a wide variety of figures, he will know that over that time, social security spending has increased by no less than £13,000 million, or by 35 per cent. in real terms. Sizeable chunks of that huge increase on an already huge bill, which has risen as a proportion of Government expenditure and is far and away the largest of the Government's spending programes, have gone to two of the groups on which the hon. Gentleman reasonably focused many of his remarks: people over retirement age and the long-term sick and disabled. On the elderly, spending is up by more than one quarter, by something like £5 billion.
§ Mr. Newton
I shall give figures per head in due course. The hon. Lady is welcome to encourage me, because I shall be able to respond to her blandishments.
Real spending on the elderly has been in the region of £5,000 million, and £3.5 billion has been spent on the long-term sick and disabled and their carers. Those figures have been increased again by my uprating statement of one month ago and by the Autumn Statement of my right hon. Friend the Chancellor of the Exchequer a week or two ago. The increase announced by my right hon. Friend demonstrates the Government's continued commitment to a social security system that directs substantial and substantially increased help to those in need.
§ Mr. Allen McKay (Barnsley, West and Penistone)
Can the Secretary of State explain to my constituent, Mr. Hensall, why it is that under the transitional arrangements he has not received an increase in benefits for three years, and why under income support he has now lost his heating and diet allowance, as well as the special allowance that he received for his dialysis treatment?
§ Mr. Newton
I would say to the hon. Gentleman's constituent and to others that the change from the incredible complexities of the old supplementary benefit system to income support and its clear structure of premiums cannot be achieved without some difficulties. We have never attempted to disguise that. However, the new premiums are in general far higher than the additional requirements payments included in the previous system.
When I was at the Department of Health and Social Security in the job now being done by my right hon. Friend the Minister for Social Security, it was clear that, under the old system, far too few people received the benefits to which they were entitled. Not only did the claimants barely understand the system: nor did many of the Department's staff. It was right to introduce the simplified structure, which in most cases has led to considerable improvements—especially for many long-term sick and disabled people—by comparison with the entitlements under the previous system.
Over the next three years, the real growth in social security expenditure is expected to reach an average of 4 per cent. a year. That is growth—not cuts or reductions, but an increase. That is why I have been able to pursue a policy of directing additional resources where they are most needed.
525 The hon. Member for Oldham, West mentioned national insurance contributions. All the achievements that I mentioned have been against a background of substantial reductions in national insurance contributions within the last month, bringing a benefit of at least £3 per week to most families and of £6 per week to many families. That has helped many people who do not have large incomes to improve their take-home pay and to benefit their standard of living.
The massive increase in social security expenditure has been made possible by the fact that our economy has been much more successful in generating economic growth in the past decade than in the one before. That is the context of today's debate, and the context in which Opposition Members are suggesting ways of building on improvements that we have already achieved.
Much of the debate, and a good part of what was said by the hon. Member for Oldham, West, has concerned pensioners' interests; as I said earlier, I find that understandable and indeed welcome. Again, however, I believe that discussions of such matters should be based on at least an understanding of the considerable improvements in conditions for our growing retired population —although the hon. Gentleman and his hon. Friends may not always like what they hear. Some of the figures involved came up during social security questions this afternoon, but I should like to put the facts clearly on the record now. According to the latest available information, pensioners' average total net income increased in real terms by 23 per cent. between 1979 and 1986.
§ Mr. Newton
I accept that, and I shall deal with the hon. Gentleman's point in a moment. The 23 per cent. increase, however, compares with a real-terms increase of only 3 per cent. when Labour was in office.
§ Ms. Short: That is not true.
§ Mr. Newton
If the hon. Lady can demonstrate to me that it is not true, I will gladly listen to her explanation —or her attempt at one. I did not invent those figures, however.
§ Ms. Short
We are all familiar with the way in which the Government manipulate, distort and fib with statistics. We also know that pensioners' income have risen more slowly than general well-being in society, and that they are relatively worse off than they were when the Government first came to power.
§ Mr. Newton
I am afraid that that simply is not true. I have already given the figure for the real growth in pensioner's average total net incomes. They have risen by roughly a quarter—per cent., to be precise—increasing twice as fast as the income of the population as a whole.
Moreover, far fewer pensioners are on the lowest income than in 1979, when 38 per cent.—nearly two fifths —were in the bottom fifth of the scale of national income distribution. That figure has now fallen to slightly less than a quarter—24 per cent. I accept that there are variations within the group of pensioners, but as a whole that group has improved its position under the stewardship of the present Government.
§ Mr. William McKelvey (Kilmarnock and Loudoun)
Does the Secretary of State accept that, had we retained the original formula whereby pensions increased in line with rises in either inflation or wages, pensioners today would be £18 a week better off? If he agreed with that, pensioners might start to understand the argument that he is trying to advance.
§ Mr. Newton
There are a number of levels on which one can respond to that question—[Interruption.] The hon. Member for Oldham, West laughs, but he did not laugh when he was Minister with responsibility for social security in the last Labour Government. The Government of which he was a member were unable to fulfil their undertaking to uprate pensions. They ran out of money and the International Monetary Fund would not allow them to go on spending. The Labour Government generated so much inflation that large parts of pensioners' incomes other than their pensions were decimated.
§ Mr. Norman Buchan (Paisley, South)
The right hon. Gentleman accuses the previous Labour Government of being unable to fulfil their undertakings. Is not the crime infinitely worse when the Minister claims that the Government would have been able to uprate pensions but instead cut them?
§ Mr. Newton
The hon. Gentleman, who was also a Minister in the Labour Government, will recall that in the mid-1970s the Labour Government were confronted with a public expenditure overrun and an astonishing increase in inflation—well into double figures—that led to a change in the uprating basis and to the taking of probably over £1 billion from pensioners, at current prices, to rescue themselves from their inability to keep the promises that they had made.
I promised to return to the point about figures that was made by the hon. Member for Birmingham, Ladywood (Ms. Short) from a sedentary position. My figures go up to 1986, and I shall tell her what happened to the component parts of pensioners' incomes. They are relevant. They are weekly figures and the comparison is drawn between 1979 and 1986. During that period, pensioners' incomes from total social security benefits rose in real terms from £48.50 to £57.70—a very substantial increase. Their income from occupational pensions also rose very fast, from £12.70 to £19.80. Perhaps most striking of all in terms of the increases, their income from savings rose from £8.70 to £14.20.
It is in the last figure that the crucial clue emerges as to the difference between what has happened to pensioners under this Government and what happened under the previous Government. Whereas income from savings rose by about 64 per cent. under this Government, the weekly income that pensioners enjoyed from their savings during the period of the Labour Government fell by 16 per cent. The inflation that had been generated by the Labour Government had the effect of cutting pensioners' incomes from other sources.
Our first priority has been to protect the value of the state pension. That we have fully and faithfully done, and we shall continue to do it by means of the uprating that I announced a month or so ago—[Interruption.] I wish that the hon. Member for Ladywood would not shout from a sedentary position that facts which can be established are lies. Even the hon. Member for Oldham, West acknowledged that there had been, at the very least, full 527 protection of the basic state retirement pension. During the last month we have enhanced its value for about 400,000 pensioners by abolishing the earnings rule, so that those who were unable previously to enjoy the full value of their state retirement pension can now do so.
Beyond the priority that we have given to protecting the value of the state retirement pension, we have set out to achieve two major aims. The first, as is clear from the statistics that I have just given, is to protect the value of pensioners' increasingly important other income—from occupational pensions and, above all, from savings, which were reduced by the inflation that was generated by the previous Labour Government. Our success on that front has contributed to a considerable degree to the general improvement for many pensioners.
§ Mr. David Winnick (Walsall, North)
Is the Minister aware that a parliamentary answer to me stated that 25 per cent. of all single pensioners had a total income of less than £60 a week? Why does not the Minister recognise that hundreds and thousands of pensioners face this winter with very small incomes and that they are desperately concerned about food and fuel? They do not know how they will make ends meet. The Minister's pious words are no consolation to my constituents who are poor pensioners.
§ Mr. Newton
The hon. Gentleman leads me naturally to my next point about our aims alongside the clear protection of the basic state pension. We have sought to ensure that pensioners enjoy the advantage of the growing amount of occupational pensions which are payable to an increasing number of pensioners. The great majority of newly retired pensioners receive occupational pensions and have savings. We are determined to ensure that we protect the income from those sources, because they are very important to pensioners' standards of living.
The next element in our strategy is that we recognise clearly that a significant number of pensioners retired before occupational pensions were widespread or retired without being able to build up the savings that more recent pensioners have accumulated. We have openly and directly said that it would be right for the Government, when we can make additional resources available, to steer them towards the pensioners who are least well off. We have done precisely that within the past month with increases in the income support premiums for older pensioners and disabled pensioners on income support which has brought up to £3.50 a week of additional help to about 2.5 million pensioners.
§ Mr. Ted Rowlands (Merthyr Tydfil and Rhymney)
Is not the Minister clawing back some of that increase through the transitional allowances?
§ Mr. Newton
No. The increases in pensioner premiums paid at the beginning of October did not affect transitional protection. Hon. Members on both sides of the House would acknowledge that.
One key element in our approach which is reflected in the Gracious Speech is to seek to bring about and encourage still further the growth of personal and occupational pensions which has been such an important ingredient in the improvement of living standards for so many pensioners in recent years. Although the hon. Member for Oldham, West (Mr. Meacher) may not like this, he knows that my right hon. Friend the Secretary of 528 State for Employment in his previous position introduced measures to promote the growth of personal pensions in April 1988. Those have proved to be an outstanding success.
Since April 1988, about 3.5 million people have taken out personal pensions. That reflects the creation of about 13,000 money-purchase schemes and 3,000 salary-related schemes to enhance and encourage the growth of that additional pension provision which is so important to so many people.
The hon. Member for Oldham, West will be aware that the Gracious Speech refers to a range of new proposals which we expect to include in the new Social Security Bill. Those are intended to improve benefit security for many people in occupational and personal pension schemes, and not least to improve consumer protection and the range of consumer advice and help available either through an ombudsman, the occupational pensions advisory service or through a new tracing service which contributes to the security and self-confidence of people investing in those schemes. That will be a significant further contribution, as set out in the Gracious Speech, to the important development of higher standards of living for pensioners, based on the full protection of the state pension and help to less well-off pensioners in the way that I have described, and through the growing benefit of the advantage of investing in one's own pension scheme with the security and flexibility that that provides.
The second major thrust of the debate has been the interests and needs of the long-term sick and disabled, a matter on which many right hon. and hon. Members have spoken with some vigour. Again it is important that hon. Members should understand what has happened over the past 10 years. In that period, expenditure increased by about £4 billion in real terms. From time to time, the hon. Member for Oldham, West and others have made some play of the fact that a significant part of that increase is the result of improved take-up—of increased numbers of disabled people getting the benefits that we want them to get.
I make no apologies for that. One of my aims, as Minister for Social Security, Minister for the Disabled and now as Secretary of State for Social Security has been to do everything that I can to ensure that disabled people, among others, benefit from the structure that we create to bring them help. I regard that as a real improvement in our help to disabled people. Hon. Members should bear in mind the fact that mobility allowance, which was claimed by fewer than 100,000 people when the Government came to office, is now claimed by nearly 600,000 people. Whatever the academic niceties of the argument, for nearly half a million people that is a substantial real increase in benefit.
§ Mr. Newton
I do not have time to give way now.
Much the same is true of attendance allowance. Numbers have roughly trebled in the same period, bringing up to £40, at next April's rates, to about half a million people who would not have been getting it about 10 years ago.
§ Mr. Newton
I cannot allow the right hon. Gentleman to intervene now, given the short time left for my speech. I hope that he will understand. I will read carefully what he said.
There may be those who thought it remiss of me at the outset not to welcome the hon. Member for Oldham, West to his new position, or rather, his return to his old position. I hasten to assure the House that it was not through any desire to be discourteous to the hon. Gentleman but only because I was saving my welcome, perhaps rather oddly, for the end of my speech.
It is singularly appropriate that the hon. Gentleman should be back in his position, because he and the right hon. Member for Salford, East (Mr. Orme) are the living embodiment of what happens to Labour promises to pensioners. Hon. Members will recall that earlier this afternoon the right hon. Member for Salford, East was unwise enough to ask me about the Christmas bonus. My answer was that at least we are paying it, whereas the Government in which he was Minister for Social Security failed to pay it two years running.
This evening, the hon. Member for Oldham, West regaled the House with promises of what he would do. I invite those who might be tempted to read an article in The Times of 11 March 1976, which states:Minister shouted down at pensions rally. Old-age pensioners shouted down Mr. Meacher, Under-Secretary of State at the Department of Health and Social Security yesterday as he tried to explain his Government's record on pensions. More than 2,000 pensioners from all over the country gathered in central hall, Westminster, to hear a number of speakers and to lobby MPs. The meeting was organised by the British Pensioners and Trade Unions Action Committee.This Government have kept and will continue to keep their promises. We have fully protected the national insurance pension. We have advanced the living standards of pensioners generally. Not least, we have steered additional help to those who are least well off and who most need the help of the rest of the community. Just as the pensioners shouted down the hon. Member for Oldham, West 13 years ago, so the House will vote him down tonight.
§ Question put, That the amendment be made:—
§ The House divided: Ayes 229, Noes 339.533
|Division 1]||[10 pm|
|Abbott, Ms Diane||Bennett, A. F. (D'nt'n & R'dish)|
|Adams, Allen (Paisley N)||Bermingham, Gerald|
|Allen, Graham||Bidwell, Sydney|
|Alton, David||Blair, Tony|
|Anderson, Donald||Blunkett, David|
|Archer, Rt Hon Peter||Boateng, Paul|
|Armstrong, Hilary||Boyes, Roland|
|Ashdown, Rt Hon Paddy||Bray, Dr Jeremy|
|Ashley, Rt Hon Jack||Brown, Gordon (D'mline E)|
|Ashton, Joe||Brown, Nicholas (Newcastle E)|
|Banks, Tony (Newham NW)||Brown, Ron (Edinburgh Leith)|
|Barnes, Harry (Derbyshire NE)||Buchan, Norman|
|Barnes, Mrs Rosie (Greenwich)||Buckley, George J.|
|Barron, Kevin||Caborn, Richard|
|Battle, John||Callaghan, Jim|
|Beckett, Margaret||Campbell, Menzies (Fife NE)|
|Beith, A. J.||Campbell, Ron (Blyth Valley)|
|Bell, Stuart||Campbell-Savours, D. N.|
|Benn, Rt Hon Tony||Carlile, Alex (Mont'g)|
|Cartwright, John||Janner, Greville|
|Clark, Dr David (S Shields)||Jones, Barry (Alyn & Deeside)|
|Clarke, Tom (Monklands W)||Jones, Ieuan (Ynys Môn)|
|Clay, Bob||Jones, Martyn (Clwyd S W)|
|Clelland, David||Kennedy, Charles|
|Clwyd, Mrs Ann||Kinnock, Rt Hon Neil|
|Cohen, Harry||Kirkwood, Archy|
|Coleman, Donald||Lamond, James|
|Cook, Frank (Stockton N)||Leighton, Ron|
|Cook, Robin (Livingston)||Lestor, Joan (Eccles)|
|Corbett, Robin||Lewis, Terry|
|Corbyn, Jeremy||Litherland, Robert|
|Cousins, Jim||Livingstone, Ken,|
|Cox, Tom||Livsey, Richard|
|Crowther, Stan||Lloyd, Tony (Stretford)|
|Cryer, Bob||Lofthouse, Geoffrey|
|Cummings, John||McAvoy, Thomas|
|Cunliffe, Lawrence||McCartney, Ian|
|Cunningham, Dr John||Macdonald, Calum A.|
|Dalyell, Tarn||McFall, John|
|Darling, Alistair||McKay, Allen (Barnsley West)|
|Davies, Ron (Caerphilly)||McKelvey, William|
|Davis, Terry (B'ham Hodge H'I)||McLeish, Henry|
|Dewar, Donald||Maclennan, Robert|
|Dixon, Don||McNamara, Kevin|
|Dobson, Frank||McWilliam, John|
|Doran, Frank||Madden, Max|
|Douglas, Dick||Mahon, Mrs Alice|
|Duffy, A. E. P.||Marek, Dr John|
|Dunnachie, Jimmy||Marshall, David (Shettleston)|
|Dunwoody, Hon Mrs Gwyneth||Marshall, Jim (Leicester S)|
|Eadie, Alexander||Martlew, Eric|
|Evans, John (St Helens N)||Maxton, John|
|Ewing, Harry (Falkirk E)||Meacher, Michael|
|Ewing, Mrs Margaret (Moray)||Meale, Alan|
|Fatchett, Derek||Michael, Alun|
|Faulds, Andrew||Michie, Bill (Sheffield Healey)|
|Fearn, Ronald||Michie, Mrs Ray (Arg'l & Bute)|
|Field, Frank (Birkenhead)||Mitchell, Austin (G't Grimsby)|
|Fields, Terry (L'pool B G'n)||Molyneaux, Rt Hon James|
|Fisher, Mark||Moonie, Dr Lewis|
|Flannery, Martin||Morgan, Rhodri|
|Flynn, Paul||Morley, Elliot|
|Foster, Derek||Morris, Rt Hon A. (W'shawe)|
|Foulkes, George||Morris, Rt Hon J. (Aberavon)|
|Fraser, John||Mowlam, Marjorie|
|Fyfe, Maria||Mullin, Chris|
|Galloway, George||Murphy, Paul|
|Garrett, John (Norwich South)||Oakes, Rt Hon Gordon|
|Garrett, Ted (Wallsend)||O'Brien, William|
|George, Bruce||O'Neill, Martin|
|Gilbert, Rt Hon Dr John||Orme, Rt Hon Stanley|
|Godman, Dr Norman A.||Paisley, Rev Ian|
|Gordon, Mildred||Parry, Robert|
|Gould, Bryan||Patchett, Terry|
|Grant, Bernie (Tottenham)||Pendry, Tom|
|Griffiths, Nigel (Edinburgh S)||Pike, Peter L.|
|Griffiths, Win (Bridgend)||Powell, Ray (Ogmore)|
|Grocott, Bruce||Prescott, John|
|Hardy, Peter||Primarolo, Dawn|
|Harman, Ms Harriet||Quin, Ms Joyce|
|Hattersley, Rt Hon Roy||Radice, Giles|
|Haynes, Frank||Randall, Stuart|
|Healey, Rt Hon Denis||Redmond, Martin|
|Heffer, Eric S.||Rees, Rt Hon Merlyn|
|Henderson, Doug||Reid, Dr John|
|Hinchliffe, David||Richardson, Jo|
|Hoey, Ms Kate (Vauxhall)||Robinson, Geoffrey|
|Hogg, N. (C'nauld & Kilsyth)||Robinson, Peter (Belfast E)|
|Home Robertson, John||Rogers, Allan|
|Hood, Jimmy||Ross, Ernie (Dundee W)|
|Howarth, George (Knowsley N)||Ross, William (Londonderry E)|
|Howell, Rt Hon D. (S'heath)||Rowlands, Ted|
|Howells, Geraint||Ruddock, Joan|
|Howells, Dr. Kim (Pontypridd)||Sedgemore, Brian|
|Hoyle, Doug||Sheerman, Barry|
|Hughes, John (Coventry NE)||Sheldon, Rt Hon Robert|
|Hughes, Robert (Aberdeen N)||Short, Clare|
|Hughes, Roy (Newport E)||Skinner, Dennis|
|Hughes, Simon (Southwark)||Smith, Andrew (Oxford E)|
|Smith, C. (Isl'ton & F'bury)||Walley, Joan|
|Smith, Rt Hon J. (Monk'ds E)||Wardell, Gareth (Gower)|
|Smith, J. P. (Vale of Glam)||Wareing, Robert N.|
|Smyth, Rev Martin (Belfast S)||Watson, Mike (Glasgow, C)|
|Soley, Clive||Welsh, Andrew (Angus E)|
|Spearing, Nigel||Wigley, Dafydd|
|Steinberg, Gerry||Williams, Rt Hon Alan|
|Stott, Roger||Williams, Alan W. (Carm'then)|
|Strang, Gavin||Winnick, David|
|Straw, Jack||Wise, Mrs Audrey|
|Taylor, Mrs Ann (Dewsbury)||Worthington, Tony|
|Taylor, Matthew (Truro)||Wray, Jimmy|
|Thomas, Dr Dafydd Elis||Young, David (Bolton SE)|
|Thompson, Jack (Wansbeck)|
|Turner, Dennis||Tellers for the Ayes:|
|Vaz, Keith||Mrs. Llin Golding and|
|Wall, Pat||Mr. Ken Eastham.|
|Adley, Robert||Colvin, Michael|
|Aitken, Jonathan||Conway, Derek|
|Alexander, Richard||Coombs, Anthony (Wyre F'rest)|
|Alison, Rt Hon Michael||Coombs, Simon (Swindon)|
|Allason, Rupert||Cope, Rt Hon John|
|Amery, Rt Hon Julian||Cormack, Patrick|
|Amess, David||Couchman, James|
|Amos, Alan||Cran, James|
|Arbuthnot, James||Critchley, Julian|
|Arnold, Jacques (Gravesham)||Currie, Mrs Edwina|
|Arnold, Tom (Hazel Grove)||Davies, Q. (Stamf'd & Spald'g)|
|Ashby, David||Day, Stephen|
|Aspinwall, Jack||Devlin, Tim|
|Atkins, Robert||Dicks, Terry|
|Atkinson, David||Dorrell, Stephen|
|Baldry, Tony||Douglas-Hamilton, Lord James|
|Banks, Robert (Harrogate)||Dover, Den|
|Batiste, Spencer||Dunn, Bob|
|Beaumont-Dark, Anthony||Dykes, Hugh|
|Bellingham, Henry||Eggar, Tim|
|Bendall, Vivian||Emery, Sir Peter|
|Bennett, Nicholas (Pembroke)||Evans, David (Welwyn Hatf'd)|
|Benyon, W.||Evennett, David|
|Bevan, David Gilroy||Fairbairn, Sir Nicholas|
|Biffen, Rt Hon John||Fallon, Michael|
|Body, Sir Richard||Favell, Tony|
|Bonsor, Sir Nicholas||Fenner, Dame Peggy|
|Boscawen, Hon Robert||Field, Barry (Isle of Wight)|
|Boswell, Tim||Finsberg, Sir Geoffrey|
|Bottomley, Peter||Fishburn, John Dudley|
|Bottomley, Mrs Virginia||Fookes, Dame Janet|
|Bowden, A (Brighton K'pto'n)||Forman, Nigel|
|Bowden, Gerald (Dulwich)||Forsyth, Michael (Stirling)|
|Bowis, John||Forth, Eric|
|Boyson, Rt Hon Dr Sir Rhodes||Fowler, Rt Hon Norman|
|Braine, Rt Hon Sir Bernard||Fox, Sir Marcus|
|Brandon-Bravo, Martin||Franks, Cecil|
|Brazier, Julian||Freeman, Roger|
|Bright, Graham||French, Douglas|
|Brown, Michael (Brigg & Cl't's)||Gale, Roger|
|Browne, John (Winchester)||Gardiner, George|
|Bruce, Ian (Dorset South)||Garel-Jones, Tristan|
|Buck, Sir Antony||Gill, Christopher|
|Budgen, Nicholas||Gilmour, Rt Hon Sir Ian|
|Burns, Simon||Glyn, Dr Alan|
|Burt, Alistair||Goodhart, Sir Philip|
|Butler, Chris||Goodson-Wickes, Dr Charles|
|Butterfill, John||Gorman, Mrs Teresa|
|Carlisle, John, (Luton N)||Gorst, John|
|Carlisle, Kenneth (Lincoln)||Gow, Ian|
|Carrington, Matthew||Grant, Sir Anthony (CambsSW)|
|Carttiss, Michael||Greenway, Harry (Ealing N)|
|Cash, William||Greenway, John (Ryedale)|
|Channon, Rt Hon Paul||Gregory, Conal|
|Chapman, Sydney||Griffiths, Sir Eldon (Bury St E')|
|Chope, Christopher||Griffiths, Peter (Portsmouth N)|
|Churchill, Mr||Grist, Ian|
|Clark, Hon Alan (Plym'th S'n)||Ground, Patrick|
|Clark, Sir W. (Croydon S)||Grylls, Michael|
|Clarke, Rt Hon K. (Rushcliffe)||Gummer, Rt Hon John Selwyn|
|Hague, William||Marland, Paul|
|Hamilton, Hon Archie (Epsom)||Marlow, Tony|
|Hamilton, Neil (Tatton)||Marshall, John (Hendon S)|
|Hampson, Dr Keith||Marshall, Michael (Arundel)|
|Hanley, Jeremy||Martin, David (Portsmouth S)|
|Hannam, John||Mates, Michael|
|Hargreaves, A. (B'ham H'll Gr')||Mawhinney, Dr Brian|
|Hargreaves, Ken (Hyndburn)||Maxwell-Hyslop, Robin|
|Harris, David||Mayhew, Rt Hon Sir Patrick|
|Haselhurst, Alan||Mellor, David|
|Hawkins, Christopher||Meyer, Sir Anthony|
|Hayes, Jerry||Miller, Sir Hal|
|Hayhoe, Rt Hon Sir Barney||Mills, Iain|
|Hayward, Robert||Miscampbell, Norman|
|Heath, Rt Hon Edward||Mitchell, Andrew (Gedling)|
|Heathcoat-Amory, David||Mitchell, Sir David|
|Heddle, John||Moate, Roger|
|Heseltine, Rt Hon Michael||Monro, Sir Hector|
|Hicks, Mrs Maureen (Wolv' NE)||Montgomery, Sir Fergus|
|Hicks, Robert (Cornwall SE)||Morris, M (N'hampton S)|
|Higgins, Rt Hon Terence L.||Morrison, Sir Charles|
|Hill, James||Morrison, Rt Hon P (Chester)|
|Hind, Kenneth||Moynihan, Hon Colin|
|Hogg, Hon Douglas (Gr'th'm)||Mudd, David|
|Holt, Richard||Neale, Gerrard|
|Hordern, Sir Peter||Nelson, Anthony|
|Howard, Michael||Neubert, Michael|
|Howarth, Alan (Strat'd-on-A)||Newton, Rt Hon Tony|
|Howarth, G. (Cannock & B'wd)||Nicholls, Patrick|
|Howe, Rt Hon Sir Geoffrey||Nicholson, David (Taunton)|
|Howell, Ralph (North Norfolk)||Nicholson, Emma (Devon West)|
|Hunt, David (Wirral W)||Norris, Steve|
|Hunt, Sir John (Ravensbourne)||Onslow, Rt Hon Cranley|
|Hunter, Andrew||Oppenheim, Phillip|
|Hurd, Rt Hon Douglas||Page, Richard|
|Irvine, Michael||Paice, James|
|Irving, Charles||Parkinson, Rt Hon Cecil|
|Jack, Michael||Patnick, Irvine|
|Jackson, Robert||Patten, John (Oxford W)|
|Janman, Tim||Pattie, Rt Hon Sir Geoffrey|
|Jessel, Toby||Pawsey, James|
|Johnson Smith, Sir Geoffrey||Peacock, Mrs Elizabeth|
|Jones, Gwilym (Cardiff N)||Porter, Barry (Wirral S)|
|Jones, Robert B (Herts W)||Porter, David (Waveney)|
|Jopling, Rt Hon Michael||Portillo, Michael|
|Kellett-Bowman, Dame Elaine||Price, Sir David|
|Key, Robert||Raison, Rt Hon Timothy|
|Kilfedder, James||Rathbone, Tim|
|King, Roger (B'ham N'thfield)||Redwood, John|
|Kirkhope, Timothy||Renton, Rt Hon Tim|
|Knapman, Roger||Rhodes James, Robert|
|Knight, Greg (Derby North)||Riddick, Graham|
|Knight, Dame Jill (Edgbaston)||Ridley, Rt Hon Nicholas|
|Knowles, Michael||Ridsdale, Sir Julian|
|Knox, David||Rifkind, Rt Hon Malcolm|
|Lamont, Rt Hon Norman||Roberts, Wyn (Conwy)|
|Lang, Ian||Roe, Mrs Marion|
|Latham, Michael||Rossi, Sir Hugh|
|Lawson, Rt Hon Nigel||Rowe, Andrew|
|Lee, John (Pendle)||Rumbold, Mrs Angela|
|Leigh, Edward (Gainsbor'gh)||Ryder, Richard|
|Lennox-Boyd, Hon Mark||Sackville, Hon Tom|
|Lightbown, David||Sayeed, Jonathan|
|Lilley, Peter||Scott, Rt Hon Nicholas|
|Lloyd, Sir Ian (Havant)||Shaw, David (Dover)|
|Lloyd, Peter (Fareham)||Shaw, Sir Giles (Pudsey)|
|Luce, Rt Hon Richard||Shaw, Sir Michael (Scarb')|
|Lyell, Sir Nicholas||Shephard, Mrs G. (Norfolk SW)|
|Macfarlane, Sir Neil||Shepherd, Colin (Hereford)|
|MacGregor, Rt Hon John||Shepherd, Richard (Aldridge)|
|MacKay, Andrew (E Berkshire)||Shersby, Michael|
|Maclean, David||Sims, Roger|
|McLoughlin, Patrick||Skeet, Sir Trevor|
|McNair-Wilson, Sir Michael||Smith, Sir Dudley (Warwick)|
|McNair-Wilson, Sir Patrick||Smith, Tim (Beaconsfield)|
|Madel, David||Soames, Hon Nicholas|
|Major, Rt Hon John||Speed, Keith|
|Malins, Humfrey||Speller, Tony|
|Mans, Keith||Spicer, Sir Jim (Dorset W)|
|Maples, John||Spicer, Michael (S Worcs)|
|Squire, Robin||viggers, Peter|
|Stanbrook, Ivor||Waddington, Rt Hon David|
|Stanley, Rt Hon Sir John||Wakeham, Rt Hon John|
|Steen, Anthony||Waldegrave, Hon William|
|Stevens, Lewis||Walden, George|
|Stewart, Allan (Eastwood)||Walker, Bill (T'side North)|
|Stewart, Andy (Sherwood)||Walker, Rt Hon P. (W''cester)|
|Stewart, Rt Hon Ian (Herts N)||Waller, Gary|
|Stokes, Sir John||Walters, Sir Dennis|
|Stradling Thomas, Sir John||Ward, John|
|Sumberg, David||Wardle, Charles (Bexhill)|
|Summerson, Hugo||Warren, Kenneth|
|Tapsell, Sir Peter||Watts, John|
|Taylor, Ian (Esher)||Wells, Bowen|
|Taylor, John M (Solihull)||Whitney, Ray|
|Taylor, Teddy (S'end E)||Widdecombe, Ann|
|Tebbit, Rt Hon Norman||Wiggin, Jerry|
|Temple-Morris, Peter||Wilkinson, John|
|Thatcher, Rt Hon Margaret||Wilshire, David|
|Thompson, D. (Calder Valley)||Winterton, Mrs Ann|
|Thompson, Patrick (Norwich N)||Winterton, Nicholas|
|Thorne, Neil||Wolfson, Mark|
|Thornton, Malcolm||Wood, Timothy|
|Thurnham, Peter||Woodcock, Dr. Mike|
|Townend, John (Bridlington)||Yeo, Tim|
|Townsend, Cyril D. (B'heath)||Young, Sir George (Acton)|
|Tracey, Richard||Younger, Rt Hon George|
|Trippier, David||Tellers for the Noes:|
|Trotter, Neville||Mr. Alastair Goodlad and|
|Twinn, Dr Ian||Mr. Tony Durant.|
|Vaughan, Sir Gerard|
§ Question accordingly negatived.
§ It being after Ten o'clock, the debate stood adjourned.
§ Debate to be resumed tomorrow.