HC Deb 19 December 1990 vol 183 cc357-76 8.10 pm
Mrs. Gwyneth Dunwoody (Crewe and Nantwich)

There is no better time for us to consider some of the exciting events which are now taking place than at Christmas because one of the joys of Christmas is the many myths which are perpetuated at this time. We have our pantos and our theatres. We tell more fairy stories and have more excitement every day. We can almost inevitably expect a little panto from Her Majesty's Government. It usually has about as much relation to reality as Jack and the Beanstalk. They usually tell us how extremely lucky we are to have a national health service funded to a greater and greater degree by a benificent, kind, committed and caring Government. [HON. MEMBERS: "Hear, hear."] I am glad that the chorus is suitably rehearsed, if not very numerous or genuine.

Yesterday we had a couple of examples of the Government's pantomime. The Minister of State, Department of Health—I hope that I am not promoting or demoting him—

The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

The hon. Lady is promoting me.

Mrs. Dunwoody

I am promoting the Minister, but it is almost always more tactful to promote people than to mention their correct station in life. We had a statement from the Department yesterday which purported to be about the commitment of new funds to the NHS.

It will not hurt for a few minutes to consider the problem of what is happening in the NHS, not least because it affects every citizen in this country. There have been several major reforms of the health service since 1947, all of them major and carried out by Conservative Governments. They were usually exceedingly ill-thought-out and badly based and they produced some bizarre results. Yet every time that we have a Conservative Government we are told that what is really needed is a means of making the entire service more efficient and to obtain better value for money and better results. Indeed, the previous Prime Minister became famous for saying that the national health service was safe in the hands of the Conservative party. However, the reality of the Government's management of the health service is announcements such as we had yesterday.

The opportunity of Health Question Time in the House was not taken yesterday to announce the new sums of money which were supposedly to be committed to the NHS. Although various written questions in Volume 183 ofHansard for Tuesday 18 December were relevant to the subject, a full statement of what the Department issued as a press notice was not given. For that information, one had to go elsewhere. One soon begins to realise that the Government are in considerable difficulty.

One of the Government's hobby horses is that one obtains better value from health care only when people appreciate its cost—not its value, only its cost. To that end we are told that the establishment of what is called an internal market is necessary. That appears to consist of bringing in large numbers of accountants with no medical training to assess the cost of various services within the NHS. Suffice it to say that that has not been one of the most successful ideas that the Conservative Government have pushed forward, not least because the reforms were put in train without any research into either their efficiency or the way in which they will operate when they are introduced next April.

On top of that reform, a new set of hospital organisations—the so-called opted-out independent trusts —has been created. We were told that, of course, the Government would not consider "political" objections to such trusts; they were interested only in facts. The reality of discussing opt-out applications has been that the Government have not discussed the facts at any point. The facts and finance have not been revealed to the national health service. Those of us who subjected the business plans for our areas to close examination were not given any sensible answers to any of the questions that we put to the Department of Health.

The assumptions in the business plan for Crewe are not only wholly unrealistic but unrealisable. Even the population figures on which much of the planning is based cannot be confirmed by any independent source. In the business plan they are described as the result of informal discussion with the chief executive of the local authority. No Government Department would be prepared to produce and bring before the House of Commons a plan based on an informal assessment of population growth.

Coopers and Lybrand, along with other highly expensive firms of accountants, produced several assessments of the so-called business plans. The information in those assessments has not been forthcoming. No hon. Member has been given the opportunity of seeing the assessments of the reality of the figures.

Yesterday we were told that suddenly, halfway through the financial year, the Government had decided to give a lot of new money to the national health service because they were anxious that the people who move to the new system in April should not suggest that they had a shortfall in their budget. Why has the shortfall amounted to £40.5 million in the underlying deficit? Why have the Government decided that that figure is not acceptable? Is it because the number of bed closures, which happen not only week by week but day by day throughout the health service, have given rise to considerable anxiety among Conservative Members? Almost every day the newspapers carry an account of a delegation from a frantic Conservative Member in a marginal seat and his constituents going cap in hand to the Secretary of State for Health. The hon. Member demands that his—inevitably it is his, not her—hospitals should be protected and that other hospitals should be required to become more efficient by being shut down.

Lest we are in any doubt about that, we can examine the average daily available beds in England. The Government do not publish bed closure statistics; we can assess the net changes only on the average number of available beds during the year. An examination of those figures for the years 1979 to 1989–90 reveals some interesting facts. In 1979, there were 149,000 acute beds and 362,000 beds in total. In 1983, there were 142,000 acute sector beds and 343,000 beds in total—a drop on the previous year's figures of 2,000 in the acute sector and 5,000 in the total. In 1985, there were 136,000 beds in the acute sector and 325,000 in total—a drop of 3,000 and 8,000 respectively. In 1989–90, there were 121,000 beds in the acute sector and 270,000 in total. Between 1979 and 1989–90, we have lost 28,000 beds in the acute sector and 92,000 beds in total.

That means that we have lost 18.8 per cent. of the beds in the acute sector and 25.4 per cent.—one quarter—of the total number of beds.

We are told, "Do not worry. We are always looking for new beds, new hospitals, new input and new investment, all of which will produce a much higher level of patient care." In reality, the intention behind opt-out hospitals is that the market will achieve for the Government what they have not the guts to do while they have to fight elections. They hope that, as soon as a charging procedure is in place and as soon as the district health authorities have to bargain with each other for payment for different sectors, they will find it difficult to balance their books and more and more of them will close more and more beds.

An assessment by the National Association of Health Authorities and Trusts of the finance available for the NHS shows a shortfall in NHS funding since 1980–81 of £806 million. There is no suggestion that yesterday's announcement of RHA allocations, which we are told represent a real increase of 5 per cent. in hospital and community health service revenue spending, will give any benefit to the NHS. To start with, the announcement does not take into account the fact that, as the Minister knows, NHS inflation is very much higher than the normal inflation rate. We must have 1 per cent. real growth for an increasingly elderly population, a further 1 per cent. for new health initiatives. The remaining 3 per cent. is likely to be eaten up by the difference in NHS inflation and inflation in the economy as a whole. The National Association of Health Authorities and Trusts has suggested that that figure is likely to be 8.5 to 9 per cent., which can be contrasted with the 6 per cent. against which the Government calculate their real terms figures.

Let us talk about facts, not fantasy. How is it that the annual shortfall on target funding for the hospital and community health services, in terms of actual spending, cash allocations, inflation, cost improvement programmes —including the amounts that the Government have put in for what they call "funding for improvements in salaries and wages", although they are careful never to give the right amounts—was £17 million in 1981–82, £55 million in 1982–83, £283 million in 1983–84 and so on? The final target is £806 million.

Mr. Robert G. Hughes: (Harrow, West)

Did the hon. Lady use the same logic when she and her hon. Friends forced through the House a 16 per cent. cut in real terms in capital spending?

Mrs. Dunwoody

The hon. Gentleman parrots the usual central office handout. He does not seem to have understood the position. People know that, waiting lists are getting longer and longer. Conservative Members know that hospital beds in their constituencies are closing at a faster rate this year than they have closed for many years. They know that when the electors register their vote in the next general election they will be only too aware of the realities of NHS funding. That is why they are leaping up and down demanding that their constituencies are protected, but that will not in any way cozen their constituents. They will know that, far from committing new moneys, and far from producing improvements in health care, the Government are seeking to cushion their plans between now and next year because that will give them an opportunity to call a general election. If they genuinely believed that their plans for the NHS would produce much better care, they would not have railroaded through the House the damaging changes that have produced independent opted-out trusts.

Mr. Dorrell

The subject of the debate is NHS funding. Will the hon. Lady soon explain to the House why she thinks that, under this Government, total NHS funding has risen by 3 per cent. per annum for nearly 12 years while it rose — by 1.5 per cent. in real terms during the Labour Government's term of office?

Mrs. Dunwoody

Certainly. I shall have no difficulty in doing that because, unlike the Minister, I have spent a great deal of my time dealing with the NHS.

There is one thing that the Government have not been able to do during the past 10 years: they have not been able to control NHS spending in the GP sector. That is why they have pushed through changes in the GP contract. The Minister knows perfectly well that, although the Government have set out to cut funding in the hospital and acute sectors and to transfer much of the work on to community care without offering funding, they have riot been able to control the amount of money that GPs spent.

Mr. Dorrell

Will the hon. Lady give way?

Mrs. Dunwoody

I am happy to give way, although I thought that the Minister would make his own speech.

Mr. Dorrell

I shall not make a habit of intervening, but, as the subject that the hon. Lady suggested for debate was NHS funding, it seems sensible that I should allow her to answer some of the points that I may make before I make them. She will be able to retaliate in advance.

The hon. Lady correctly alluded to the substantial growth in spending on primary health care under this Government and suggested that that was not an appropriate use of public money. Perhaps she will explain to the House which aspects of expenditure on primary health care she would like to be cut.

Mrs. Dunwoody

My goodness, it is not difficult to see that we are approaching a general election. If I want to say something in the House, I am perfectly capable of using my own words. I merely said that the Government could not control expenditure on primary health care. I did not say that the expansion of primary health care was not a good thing; I said that the Government had sought to pretend that they were committing new moneys when they were not. They are rearranging the figures that they gave in the autumn statement to make a general presentation to the public. The Minister said that he thought that it would be a good idea if many health authorities had public relations spokesmen.

Mr. Andrew Mitchell (Gedling)

Will the hon. Lady give way?

Mrs. Dunwoody

The hon. Gentleman will have an opportunity to speak. In any case, I thought that this was a serious debate.

The Minister said that he thought that it would be a good idea to appoint some public relations spokesmen. That is presumably because many health authorities are not capable of presenting the figures in the bizarre way in which he has presented them.

When the hon. Member for Buckingham (Mr. Walden) said that a serious situation was developing and spoke of the difficulties of a particular hospital in making ends meet before the new regime came in, the Secretary of State said: It is understood that some of the London districts will not have to remove their deficits before the beginning of the new system. However, it would be a bad managerial signal to allow those that have overspent their budgets again to pre-empt resources that should be available to the whole of the health service".—[Official Report, 18 December 1990; Vol. 183, c. 148.] That was at a time when his own Department was announcing that it was deliberately going to attempt to cushion the deficit in order to gain what it saw as a short-term political advantage.

A written answer on 18 December gives a clear view of the number of regional health authorities that will be in deficit. It says that the numbers have fallen from 122 in 1989–90 to an end-of-September estimate of 51 in 1990–91."—[Official Report, 18 December 1990; Vol. 183, c. 156.] The reason for that is that many of those hospitals have been not only cutting services but reducing the number of beds and are increasingly faced with the prospect of having to shut down even more services in the new year. It is not a matter of them simply being able to deal with a budgetary deficit; they know that they will have to remove from the general public services that are most desperately needed.

The list of districts in deficit shows that almost every region has a district that is at least £1.2 million in deficit. Many of those in the London district, which includes the teaching hospitals, are more than £1.7 million in deficit. In West Lambeth, the deficit is £3.1 million and in Camberwell it is £2.3 million. The reality is that the Government suddenly discover just before Christmas that, in the three months immediately after the House reassembles, there will be an accelerating programme of bed reductions and pressure on services that will make it impossible for them to disguise from the electorate what is actually happening as opposed to what they say is happening. Their response was to seek some way of immediately putting a large plaster on top of the haemorrhage.

A business plan was prepared for Leighton hospital, a district general hospital. Many of its assumptions were wrong and the people referred to throughout the document as the agents—I know them as general practitioners—made it clear in the detailed questionnaire that I submitted to them, copies of which have been deposited with the Secretary of State, that they had no intention of changing their referral patterns and saw no future possibility of dealing with any extra patients in that hospital. They asked, if there were to be a means of attracting new patients to the hospital, what would happen to the existing waiting lists, which were lengthening again after considerable difficulties in the past.

The Department of Health has answered none of their questions. Having told me that it would look at the logic, the figures and the business plan, the Department simply issued a straightforward statement saying that the hospital should be allowed to opt out. It never answered the questions or responded to any of the doctors' worries, and there was no consultation procedure to take into account the wishes of my constituents or the health service professionals. They were of no interest to the Government because, fundamentally, they do not believe in the provision of free care at the point of use. Their interest is quite different—to set up an extremely complex, unworkable and expensive form of financing which, with any luck, if there is any difficulty with moneys, will result in a lowering of health care standards throughout my constituency. That has been the purpose and clear intent of the reorganisation, which is why the Department of Health has suddenly realised the implications of its actions.

The Department does not want to enter the spring with the NHS facing even more closures and pressures, and with constituents suddenly becoming aware of the real intent of the Government's health policy. The Minister does not want to talk about that and would much rather trot out figures which have no relationship to what we have been talking about. However, the reality of health care under the Conservatives is that it is a declining force and will continue to be so, irrespective of the Will Hay form of mathematics that seems to be practised in Whitehall.

However, for those people who need health care—the young, the old, and the increasing number of men and women in my district who suffer from major coronary problems and need better care—the future is bleak. We can only hope that the next general election will fundamentally change the future for health care in this country.

8.35 pm
Mr. Robert G. Hughes (Harrow, West)

The speech of the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) was an easy speech for a Labour Member to make. A friend of mine in the Labour party explained to me why Labour members speak in such terms. He said that it did not matter what the Labour party did in the NHS —he admitted that Labour had a pretty awful record when in government—because everyone believed that the Labour party cared about the health service. He said that, conversely, it did not matter what a Conservative Government did to the health service, because no one would believe them.

Therefore, it was possible for the hon. Member for Crewe and Nantwich to make a speech giving the problems—some of them real—and gaps in the health service. It was easy for her to say that some people who need treatment cannot receive it when they want it, and use that as an argument to pretend—that is all she is doing —that the national health service is being reduced in size and having funds taken away from it by the Government. To be fair to the hon. Lady, she knows that her argument is a pretence, and she is simply making it for narrow political reasons.

The reality is that, if the Labour party had this Government's record in the NHS, it would be crowing about it. If a Labour Government had managed to spend more on the health service than they did on defence, they would say that that was fantastic and showed their commitment to the health service. Year after year, the hon. Lady voted for a health service budget smaller than the defence budget, but she shows no shame about that.

Mr. Andrew Mitchell

1 share my hon. Friend's desire not to let this debate descend into a party-political wrangle. In his important intervention during the speech of the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) he spoke about the incontrovertible fact that the last Labour Government cut expenditure on the National Health Service, whereas this Government have massively increased it. During his speech, will he press the Opposition spokesmen and women to give an absolute commitment that, in the unlikely event that the Labour party is ever returned to power, it will not repeat its previous appalling record on health?

Mr. Hughes

My hon. Friend makes an important point. I served on a community health council during the last few years of the last Labour Government, and I remember the enormous problems caused in our health district by the antics of that Government. There were cuts in budgets—not in the hoped-for increases but in the actual budgets—and we had to close some of the private beds without any increase in Government funding.

Those private beds brought in about £500,000 a year, which was a lot of money to us in those days, and there was no replacement for that money. Labour Ministers ordered us to get rid of the private beds, but they did not replace the funding. Their record was shameful. The assurance that my hon. Friend the Member for Gedling (Mr. Mitchell) asks for is important—

Mr. Allen McKay (Barnsley, West and Penistone)

Spending on the health service has had to increase for a number of reasons that have been forced on the Government—increased numbers of nurses and doctors, for example. The Government did not volunteer that. If their record is so good, why have 3,000 beds already been closed?

Mr. Hughes

I shall come to the point about beds because it is important, as is the number of people being treated in hospital. It is interesting to compare closed beds statistics in our health service with those for health services in other countries. A larger number of cases are being treated in this country.

The Opposition will not like it, but we should look at the facts about NHS activity. In the 10 years to 1988–89, the number of acute in-patients treated rose — by 20 per cent. to 5 million; the number of acute day cases treated doubled to 1.1 million. Acute out-patient attendances rose — by 6 per cent. to 30 million; geriatric in-patients treated rose — by 9 per cent. to 450,000. The number of maternity in-patients rose — by 17 per cent. Courses of dental treatment increased by 18 per cent. to almost 33 million. Of course there are more doctors and nurses—that is an important part of the health service. They did not come from nowhere: they came as a matter of policy. It has been the policy of this Government to spend more and to pay the doctors and nurses better. I hope that the Opposition welcome that.

The number of GPs rose — by 20 per cent. to almost 20,000, and the number of dentists by 25 per cent. to 15,000. The number of hospital doctors rose — by 12 per cent. to 44,000, and the number of nurses and midwives by 3 per cent. to 400,000.

I am proud of this record, as the Labour party would have been proud of it had it been able to achieve it. It is certain, however, that the Labour party would not have spent as much on the national health service in the past 11 years, because we have proof for at least the first three of those years. Spending plans left by the last Labour Government show that, in those three years, they would have spent less than the Conservative Government on the health service. We want no nonsense from the Labour party about this.

Of course there are gaps, as those of us who invariably use the NHS understand, but that is not an argument for pretending that the Government have tried to cut health services.

The Opposition have been schizophrenic about management in the health service. I have heard the hon. Member for Peckham (Ms. Harman) speak in the House about the need for new management techniques in the health service. I have heard her arguing for money following patients. I have even heard her argue— although the words could not cross her lips in exactly this form— for a sort of internal market in the health service. To give it credit, the Labour party understands that we need reforms in the hospital services, but Opposition Members have voted against every reform that we have tried to introduce.

Ms. Harriet Harman (Peckham)

I should like to put the record straight. The hon. Gentleman is engaging in a shameful trick when trying to imply that we are somehow in favour of the internal market. I shall make it absolutely clear to him, as I have done every time I have spoken and as my hon. Friend the Member Livingston (Mr. Cook), the shadow Secretary of State, has too, that we are against I he internal market. When we come to government we shall abolish it, for two principal reasons. We have consistently argued that there will be competition on costs, and when costs are cut, corners are cut and lives will be lost. Our object is not to squeeze resources out of the health service—one of the intentions of the internal market. We think it necessary to invest more resources in the health service.

It is not a question of money following the patient: the internal market will mean the patient following the contract. We are against the internal market because we are in favour of patients choosing where they are treated —a choice that they can exercise in discussion with their GPs. Under the internal market they would have to go where the district health authority manager had decided to place the cheapest contract. So I should be grateful for a little integrity in the debate.

Mr. Hughes

That would indeed be useful. The hon. Lady and her colleagues have spent so long shamefully parodying our reforms that they have probably started to believe the parody. They recognise that there are serious problems in the way in which hospitals are managed. Of course some health authorities run out of money; that is inevitable in our system. However much money is provided, it is inevitable, given that authorities must budget for a whole year on the basis of how many patients they may or may not treat, that the money will run out at some stage—sometimes for good reasons and sometimes because of bad planning.

When the hon. Member for Peckham tries to deal with this problem, she knows that she will have to go in the same direction as we have gone. Even if the Opposition had the chance, they would not abandon these reforms, because they know that that would cut patient care.

The Labour party has been dishonest about our performance and reforms, and has also sought to undermine some of the other changes. First, the Opposition complained about the new slimline health boards, which are extremely valuable. The problem with some of the old health authorities and family practitioner committees was that they were more like group therapy sessions than real meetings. I went to meetings of both kinds and found the quality of decision making poor. I do not believe that local councillors serving on health boards make them representative of anything, except in so far as those councillors claim to make health authorities representative. We want the best management available. Resources would be finite, as a Labour Government would also find. Given finite resources, they must be properly managed, and the best value for money must be obtained for the patient.

Several health authorities have used capital money—taxpayers' money meant to be used for health care and the building of new health service resources—to build laundries. Those laundries are run at a loss. They seek to compete with the private sector and undercut it, but they cannot possibly truly undercut it. So I accuse some health authorities of wasting capital money on building these laundries and using revenue money to support them, while their accounts show a profit on using their own resources, which cannot be true. Information given to the Department proves that these authorities are wasting a great deal of money.

Mr. Allen McKay

Where have these laundries been built? Most hospitals are designed with internal laundries.

Mr. Hughes

With the greatest respect, the hon. Gentleman is wrong. I have a fair amount of information about this—

Mr. McKay

Where?

Mr. Hughes

I believe there is one in Dyfed— Mr.

McKay

Only one, then.

Mr. Hughes

It is one of many examples. The hon. Gentleman's attitude is ridiculous, but that is not unusual. If he goes to the Library and looks at the questions and answers on this topic he will find that he is absolutely wrong. After that, perhaps he will apologise, but I doubt it.

That laundry cost £4.3 million of public money to build. It is undercutting private local laundries, but the prices that it charges for outside work must mean that the laundry is operating at a loss. That is shameful, and results in money being taken from real patient care.

Health authorities are hanging on to land that they are not using for health care purposes. My health authority in Harrow has had a piece of such land for at least 20 years. It was bought for all sorts of good reasons, but the authority found that it could not get planning permission because it was green belt and Crown land. Instead of disposing of the site and using the money for health care, the council is hanging on to it. I do not think that it will ever be possible to build on that land. That is a shameful waste.

Mrs. Dunwoody

Has the hon. Gentleman not noticed that property prices, even in the absolute nirvana of Harrow, are falling rather than rising?

Mr. Hughes

There might have been an occasional opportunity to sell the land at some time in the past 20 years when land prices were not falling. This might not be the right time to sell the land, but the authority has been hanging on to it for a long time. I hope that the hon. Lady does not disagree with the principle of my point.

Mrs. Dunwoody

The health service is developing and improving and will need new sites. No one could seriously tell an inner London health authority—perhaps I should not call it that, because the name may be rather posher —or a health authority in any conurbation to get rid of land that could be used to provide better facilities for the mentally handicapped, for children or for other highly developed services. Such a suggestion is highly irresponsible and boringly commercial in the narrowest and most unimaginative sense.

Mr. Hughes

I am sure that the mentally handicapped in Harrow will be grateful to know that the empty land at Clamp hill is providing good service for them. I can assure the hon. Lady that it is not. The money realised from the sale of that land could be put to good use. By her intervention, the hon. Lady reveals her empty posturing about the health service. It is nonsense to say that an empty piece of land in Harrow helps the mentally handicapped, and the hon. Lady knows it.

In a muddled and confused part of her speech, the hon. Lady talked about GP spending and seemed to suggest that we should cut spending in that area. When she reads her speech inHansard she will see why she gave that impression.

Ms. Harman

Rubbish.

Mr. Hughes

I do not think that the hon. Member for Peckham (Ms. Harman) was in the Chamber at that point in her hon. Friend's speech.

Ms. Harman

On a point of order, Madam Deputy Speaker. I was in the Chamber from the time that my hon. Friend started to speak.

Mr. Hughes

I apologise to the hon. Lady. It is a pity that she was not listening to her hon. Friend's speech.

Nobody who looks at the general practitioner service in any part of the country could say that there has not been a massive increase in funding. There are new GP surgeries with marvellous facilities and many more GPs, and fewer patients are being treated by each general practitioner. Those are the marks of what the Government have done, because they have improved services enormously.

GPs are providing many services that were not provided before. The GP contract has meant that even reluctant general practitioners are now providing services that they would never have thought of providing before. As a result of that contract, the rates of immunisation are impressive. The Labour party opposed that policy point by point, and said that immunisation rates would go down. That shows that Labour is interested only in playing politics, and does not want to look at the facts. The health service has been safe in the hands of the Government and it will continue to be.

8.54 pm
Mr. Gareth Wardell (Gower)

It is a great pleasure to speak on this non-partisan occasion, when the true spirit of Christmas pervades the House. I should like to speak about some of the health issues affecting the people of Wales, and I am sure that the Minister will deal adequately with my questions. First, I shall deal with elective or cold surgery in the three new regional centres in Wales. They are the centre at Bangor for cataract operations, the centre for hernia operations at Bridgend and the centre for hip replacement operations at Rhydlafar in Cardiff.

What is the success rate of those three regional centres in terms of the way in which health authorities outside those areas send patients to them? A GP may wish to refer a patient from my constituency to Bangor in north Wales. That is a good five-hour drive, because Wales does not yet have a north-south link. Some people argue that that is not a bad thing, but I take the contrary view.

As a consequence of sending patients that distance, the health authority may not have enough patients in its teaching hospital to train new doctors. Have the three regional centres been a success, or does elective surgery give rise to problems of family support and so on when the hospital is some distance away? If an operation goes wrong and the patient is a long way from home, the familial community system that we have retained in Wales is not available to support him.

My second topic is drug prescribing. Will the Minister identify the problems and name the drugs that are involved? Where do the problems exist, and what is the relationship between hospital consultants and GPs? I shall deal with one drug, but I should like the Minister to tell us the problems that have arisen with others.

The drug I wish to speak about is one used in the treatment of renal patients who are acutely anaemic and is called erythropoietin. I have some information about the limited experience of some consultants in Wales. Until recently, when the unit administrator in the hospital was unwilling to fund the use of this drug, a consultant could persuade a general practitioner to fund the prescription for him. Now, general practitioners are being told, partly because of possible cases of negligence against them and partly because they can be subject to disciplinary proceedings, not to do this unless they are monitoring the patient and are responsible for the administration of the drug.

Mrs. Dunwoody

Is my hon. Friend aware that this is a problem throughout the country, as fewer and fewer renal units are able to give full courses of drugs? They give half the dosage and patients then have to travel, often long distances, to go back for the other half of the treatment.

Mr. Wardell

I am grateful for that helpful intervention. I am aware of some cases in Wales of people travelling long distances for treatment.

I should like the Minister to tell me how many drugs, like this one, have been prescribed over the past few years by general practitioners, which they can no longer prescribe. Is he confident that consultants will be able to continue to prescribe such drugs, to ensure that patients get the treatment they need?

Although I do not want to burden the Minister or his officials so close to Christmas, perhaps he could look at the use of another drug, alpha interferon, which is used for the treatment of leukaemia patients. The same problem arises with this drug in that in some parts of the country, under a similar relationship, when consultant haemotologists have had difficulty with the unit administrator, the general practitioners have been helpful in prescribing the drug. However, that has changed.

As we approach Christmas, I should like the Minister to tell us that we shall not have the kind of situation with which I was faced recently. A consultant in haemotology at the University hospital of Wales, Dr. Whittaker, told me that he was prevented from prescribing alpha interferon. The only way that the patient could have the drug was for a charity to pay for two months' treatment in the bone marrow transplant unit.

I am sure that the Minister will agree when I say that I should not like to see a spectre haunting us—that of large numbers of people, perhaps children, appealing on television, on local radio or in the newspapers and saying things such as, "Please, please where is the money for me to have the drug that I need to save my life?" Will that happen, or can we be confident that adequate money will be provided for the prescribing of such drugs? That concerns me, because I know of several similar cases.

My third point concerns the case of urgent open heart surgery in the University hospital of Wales. This is a regional centre, funded as a regional service by the Welsh Office. In the Welsh Office commentary published in March this year on public expenditure in Wales 1990–91 to 1992–93, in paragraph 429 on page 159, the Welsh Office says: The cardiac services for adults in South Wales have been the subject of a review by members of the Cardiology Committee of the Royal College of Physicians. The review confirmed Welsh Office planning policies for cardiac services in pointing to the need for about 1,300 open heart operations per year". Some 1,200 of these are for adults.

The Royal College of Physicians accepts that we need the facility in Wales for carrying out about 1,200 adult open-heart operations a year. The view of the college reiterates the view of the specialist cardio-thoracic team that reported in 1980. In 1984, the then Secretary of State for Wales, now Lord Crickhowell, accepted that there was a need for well over 1,100 open heart operations in Wales a year as a regional service. During the latest year for which figures are available, which is 1988–89, 591 such operations were performed at the University hospital of Wales, Cardiff.

As Wales has one of the highest incidences of heart disease of any developed country in the world, I ask the Minister to tell the House when the 1,200 open heart operations that are needed to be carried out each year within the Principality will be carried out. I am sure that he will give enormous Christmas cheer to the people of Wales if he will give us a target date.

We in Wales are delighted that the Government are putting in place a new paediatric cardiology unit at the University hospital of Wales. In the spirit of Christmas cheer, we are pleased to hear that. It would be additionally beneficial for the people of Wales to know the target date for what the Royal College of Physicians, the previous Secretary of State for Wales and the cardio-thoracic team set as one of the needs of the Principality.

9.7 pm

Mr. Andrew Mitchell (Gedling)

It is a great pleasure briefly to take part in the debate, especially as my hon. Friend the Under-Secretary of State for Health, who is to reply, is a near neighbour of mine in Nottinghamshire. From time to time, in his former incarnation, he used to advise me of the importance of certain debates, some of which took place on a Friday.

It is a great pleasure to be able to take up some of the remarks of the hon. Member for Gower (Mr. Wardell). It is unusual to hear someone from the Opposition Benches, but no less welcome for that, paying tribute to the Government's work in the national health service. I am sure that the entire House was pleased with the fair way in which he presented his arguments.

We are debating funding within the NHS, and I wish to take the hon. Member for Crewe and Nantwich (Mrs. Dunwoody) gently to task. There is nothing between us when it comes to recognising the need for improving and enhancing the quality of the health service. In our postbags each week and each month, we read of instances where individuals are competing for resources within the service. They are competing for care. We share the frustrations of our constituents and we try to ensure that they receive the care that they deserve.

Those sentiments, which are shared by hon. Members on both sides of the House, are not the same as recognising that there are funding difficulties within the NHS. It would be impossible to fund it to the full extent that all of us wish were possible. It is a truism that the United Kingdom's entire gross domestic product could be spent on the health service without meeting demand. There has to be a sensible mechanism for dealing with funding to ensure that there is an increase year on year—I maintain that that has been made possible by the success of the Government's economic reforms during the 1980s—and that those funds are spent effectively.

Secondly, I gently chide the hon. Member for Crewe and Nantwich about the myth that Conservative Members do not use the health service. That is nonsense. Most of us use the national health service. We are children of the NHS, we were born in it, we venerate it and we revere the work that it does. We applaud the tremendously hard work of the NHS staff.

It is a myth that Tory Members have private care and do not use the National Health Service. I speak with some feeling, as I have just spent a few days in a hospital not far from here, where my wife was giving birth to our second child. She is a doctor in the National Health Service. It is wrong to suggest that Tory Members are divorced from reality and do not support the National Health Service. The hon. Member for Crewe should not dwell on that too long because it adds no weight to her agrument.

I wish to talk about resources, before coming to the Government's enviable record, which was so admirably outlined by my hon. Friend the Member for Harrow, West (Mr. Hughes). I am a great supporter of the Audit Commission. If I am successful in the ballot for an Adjournment debate, I shall choose as a subject the future direction of the Audit Commission and how its role can be enhanced and increased. It is important to recognise the valuable role that the Audit Commission has already played in the National Health Service, and the fact that it can continue to play, in ensuring that we achieve the best value for money.

The Audit Commission rightly receives the support of hon. Members on both sides of the House. It has already done a great deal of valuable work in the National Health Service. I am thinking especially of its report on the care of the elderly. Of course, that was some time ago, but it has also produced many other reports that have been of great benefit to the health service. It is important that the Audit Commission has full access so that it can carry out a whole range of work and produce the necessary reports.

My hon. Friend the Minister may remember that, during the passage of the National Health Service and Community Care Bill last year, there was initially some reluctance to accept an expanded role for the Audit Commission in the National Health Service. However, my hon. Friend and members of the Opposition Front-Bench team supported the amendment that I tabled, which is now enshrined in law. I hope that the Audit Commission will be given the scope to carry out in other areas the sort of work that it has done in the National Health Service. That is essential if we are to get the best possible value for money.

The area that I represent is covered by the Nottingham health authority, which has had an annual increase in funding of 8.6 per cent. over the past five years. That is a 13.1 per cent. real increase in resources over that period. In any debate on National Health Service funding, it is important to stress the very large increase in the funds that have been put into the National Health Service. I am especially proud that it has been possible to do that in the area that I represent. We have benefited greatly from the time that my right hon. and learned Friend the Member for Rushcliffe (Mr. Clarke) was Secretary of State for Health. He, like me, has a close relationship with the local health authority.

We should pay tribute to the large increase in funding and the great benefit that has accrued to Nottingham. The City hospital is currently undergoing a multi-million pound expansion, to which my constituents look forward. The Queen's medical centre is arguably the best hospital in Europe. It is enormous, and sometimes we have difficulty finding our way around it. It is a great centre of excellence. We have benefited greatly from all that is being achieved in those two hospitals, as well as from the myriad other excellent health facilities in the city.

It is right to pay tribute to the work of David White, chairman of Nottingham health authority, and David Banks, general manager, day in and day out, on behalf of all those covered by that health authority. Only last Friday, I was at the City hospital visiting a hospice, Haywood house, where so much good and caring work is done by those who work there. At this time of year, it is especially important to say in this place how much we owe to the people who work in the Nottingham health authority and who provide such a caring service to my constituents.

We are all pleased that people live longer, but we must recognise that that inevitably puts pressure on the health service. It is also important to recognise the magnificent advances in medical science, particularly during the past 10 years. Today we can do so much more than we could before, but that too costs more money, and it requires successful economic policies to deliver the sort of growth that the NHS will need if it is to continue to make the sort of progress in the 1990s that it made in the 1980s.

I am particularly pleased, not least because of my wife's work, that the problem of junior hospital doctors now appears to be being tackled. I know from first-hand experience that many junior hospital doctors work well in excess of 100 hours a week, and it is a scandal that that should have been the case for so long. It is important to recognise that it is not the Government who are to blame for that, although inevitably the health administration must take its share of the blame; but the medical authorities, the consultants and the British Medical Association, who have failed to recognise that a solution must be found.

Within the last few days, we have heard that junior hospital doctors are to have their hours cut to 72 hours over a period, and eventually to much fewer than that. We must recognise the importance of getting the figure below 72 hours, but 72 is a good start. I am delighted that we are to look at shift working, because that is the right way forward, the more flexible use of part-time doctors and cross-cover, which all have a major role to play. Above all, the 200 new consultants and 50 new staff grades are extremely important and will make a big difference.

Finally, I reinforce a point already made so eloquently by my hon. Friend the Member for Harrow, West. In a debate about NHS funding we should stick to the facts. Let us recognise that total NHS spending in England this year will be a record £23.7 billion, an increase of nearly 45 per cent. in real terms since 1978–79. Let us recognise that the spending plans recently announced for next year bring that figure to £26.2 billion and will mean that the NHS is spending 50 per cent. more in real terms than it did when the Government took office in 1979.

Those are immensely impressive and important statistics; whatever else divides us in the House on the thrust and future of health care, let us at least recognise that we share a common assessment of the aims and objectives of what is required in health care in Britain to make the NHS a better service. But let us also recognise the significant success that has been achieved in terms of increased funding and all that that means for the NHS and for all our constituents who use it.

9.17 pm
Ms. Harriet Harman (Peckham)

I thank my hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) for choosing this subject for debate. I welcome the opportunity to debate the funding crisis in the NHS and to press on the Minister the demand that is being made throughout Britain and on both sides of the House for beds that have been closed to be opened and for an end to the cancellation of operations and out-patients' appointments. Special action is also needed to meet the crisis in London.

I could give hundreds of examples. My hon. Friend has given examples from her constituency and my hon. Friend the Member for Gower (Mr. Wardell) gave examples from his constituency in Wales. I mention King's College hospital in my constituency. The Minister knows about that because I saw him about it in the summer with an all-party delegation of south London Members of Parliament, and I have had occasion to talk to him about it again this week and last week.

I visited the accident and emergency department of King's College hospital last Wednesday. I went there after receiving desperate phone calls from patients, staff and the community health centre. I witnessed a horrifying scene at one of London's greatest and finest teaching hospitals. I found at one of our centres of excellence a situation not unlike that which might be encountered in Romania. Its accident and emergency department was crowded, with 17 patients lying on trolleys, side by side, with not even a gap between them. They had been there all night and although doctors had said that those people needed to be admitted, it could not be done because the financial crisis affecting our entire hospital service meant that in Camberwell health authority in the summer more than 100 beds were closed—one in 10, including those in the emergency admission wards.

The Government responded not by providing extra money but by threatening doctors who admit patients other than from accident and emergency departments with disciplinary action. It is not as though the patients in question can simply be transferred to other south London hospitals. We all know that the situation at St. Thomas's and at Guy's is no better. I understand that there are plans to close two more operating theatres at Guy's, so that four of its 11 operating theatres will be closed. I understand that more than half the obstetrics and gynaeocology beds will be closed, and that there will be no more cardiac or gynaecology surgery at that hospital after Christmas, except in emergency cases.

It is not just Labour Members who are expressing concern about the situation—although it is unfortunate that the hon. Member for Harrow, West (Mr. Hughes) could not make even a passing reference to the concern felt by his constituents, many of whom remain on waiting lists. However, I shall make sure that the hon. Gentleman's local press receives a copy of the Official Report containing his speech, to see whether his constituents feel that they are being properly represented by their Member of Parliament.

The hon. Member for Harlow (Mr. Hayes) warned: Things have got so serious now that there has to be a tranche of cash to get us through the winter. I cannot guarantee West Essex…that, in the next few weeks, if we go on as we are, someone is not going to die on the trolley in an emergency. The same situation exists throughout the country. Last month, Watford general hospital decided that no more emergency operations would be performed there after Christmas. A local general practitioner, Michael Ingrain, reflected the views of many people when he said: Highly trained and highly paid surgeons will have nothing to do, theatres will lie empty, and my patients will just have to sit at home in pain, praying that the Government allows the hospital to re-open its wards. The result of such developments in hospitals across London is the cancellation of out-patient appointments and of non-emergency operations. Those whose operations are cancelled must wait in pain, suffering arid anxiety. Some will suffer irreparable permanent damage to their health. I cite the case of Ivy Stanley, a woman of 78, who needs constant supervision because she suffers from a diabetic eye disease. Her last appointment at Charing Cross hospital with Mr. Knowden was in August. She expected a further appointment yesterday, but received a letter from the district health authority saying that it had been cancelled and that another could not be arranged until 19 April 1991. A laser intervention can make the difference between someone's sight being saved or lost.

The consequence of desperate financial problems is block cancellations, irrespective of whether the outcome is not just pain, suffering and anxiety for the individual concerned but the risk of irreparable damage to his or her health. I hope that the Minister will address those points this evening, and will acknowledge the damage that is done to people's health by the cancellation of out-patient appointments and of operations.

No account is taken of the patient's health, only of the district health authority's bank balance. Everyone in London, perhaps with the exception of the hon. Member for Harrow, West, knows that the situation is desperate. The Department of Health knows it, too. Figures issued yesterday by the Department show that, from April 1989 to April this year, the four Thames regions lost 5 per cent. of their beds—4,311 beds lost in one year. Those figures are devastating. They reflect the picture until April this year. Since April, because of the financial crisis and the action taken to divert deficits, the position has got even worse, and the pace of bed closures has accelerated.

A survey undertaken by The Independent Magazine showed that in 25 of the districts of the four Thames regions, since April this year, a further 1,762 beds have been cut. Patients are anxious and in pain and doctors and nurses are in a permanent state of crisis, as managers are pushed to take more and more drastic action. There seems to be no light at the end of the tunnel.

I hope that when the Minister responds he can tell us that there is some hope for people whose operations have been cancelled, and for the doctors and nurses who see that beds have been closed. No Minister with even the remotest commitment to the health service could allow this to continue and seek to justify it.

People in London will judge the Government by their experience of what is happening to their health care, rather than by the quantity of press releases issued by the Department of Health. The Secretary of State must take action to end the crisis in London's hospitals. He should undertake an emergency review of the situation there, and make a statement to the House when we return in the new year. His response cannot be to continue to confine the flame to supposed bad management and to announce new money which is not actually there.

In the past decade we have lost 16 per cent. of hospital beds—71,149 beds have been cut from the national health service between 1979 and 1989. Throughout the country the situation is worsening this year.

I refer the hon. Member for Gedling (Mr. Mitchell) to the fact that in central Nottinghamshire, since April, 24 beds have been cut, and in Nottingham between April and November a further 70 beds were cut. It is unfortunate that he did not see fit to mention that in his speech.

Mr. Andrew Mitchell

rose—

Ms. Harman

I had better get on. The hon. Gentleman has had his chance to speak, and I do not want to take up the Minister's time, because we are all hoping that there might be light at the end of the tunnel.

The examples from Lothian, Wakefield, Christie hospital in Manchester and throughout the country show the same picture—beds closed and operations cancelled.

Last night, the Secretary of State issued a press statement, which was clearly intended to give people the impression that help was on its way. My hon. Friend the Member for Crewe and Nantwich (Mrs. Dunwoody) mentioned that. Sadly, help is not on its way. It is bad enough for the Government to preside over the closure of beds and wards, and the cancellation of operations, but it adds insult to injury to give people false hope that things will get better. The Secretary of State's press release was entitled, "Cash Increases for All Regions". However, he was merely re-announcing sums already announced in the autumn statement. His statement last night will not reopen one single closed bed.

Tonight, the Minister has the chance to say which closed beds, in all the areas that I have mentioned throughout the country, will be reopened. Will a single bed be reopened as a result of last night's announcement? Which cancelled operations will be reinstated as a result of the announcement made last night? Will it make any difference to people who have to wait overnight on trolleys in King's College hospital? I fear that it will not.

I welcome the announcement that the Government are slowing the pace towards the introduction of capitation-based funding, but it appears to be a slowdown in the creation of the infrastructure of the internal market. Apparently, they are not ready to recognise, and to take practical steps to redress, the underfunding of the NHS. It is a pity that the slowdown in the introduction of the capitation-based funding does not signal a change of mood in the Department, following the arrival of a new Prime Minister and a new Secretary of State. If there had been such a change of mood, the first act of the new Secretary of State would not have been to opt 56 hospitals out of the national health service, against the wishes of local people.

People are waiting for their hospitals to be restored so that they can obtain the treatment and care that they need, when they need it. They do not want a two-tier system, which forces them to "go private" because that is the only alternative to waiting in pain and suffering; nor do they want the NHS to be commercialised, with hospitals competing to offer the cheapest contract. It is because we listen, and know what people want, that the next Labour Government—despite what was said by the hon. Member for Harrow, West—will abolish the internal market, return the hospitals that have opted out to the local health service and end the underfunding of that service.

Even when fully funded, the NHS is not perfect. It needs to change and to move forward—but the most fundamental change that it needs is a change of Government.

9.30 pm
The Parliamentary Under-Secretary of State for Health (Mr. Stephen Dorrell)

The House is indebted to the hon. Member for Crewe and Nantwich (Mrs. Dunwoody), who tabled this subject for debate. I am particularly indebted to her for the opportunity to assess the respective NHS funding records of the present Government and their predecessor. Understandably, the hon. Lady did not speak on the subject that she had tabled, except when my hon. Friends and I intervened.

The fact is that, since 1979, the present Government have increased the total funding of the NHS by an average of 3 per cent. per annum in real terms, while the last Labour Government increased it by a real-terms average of 1.5 per cent. We have increased the funding at twice the rate of our predecessor. To talk of a funding crisis, as the hon. Member for Peckham (Ms. Harman) has done, is to prompt the question: how much worse would the position be if Labour had remained in office, increasing funds at the rate that it was able to achieve?

As my hon. Friend the Member for Harrow, West (Mr. Hughes) pointed out, this is the first Government in the history of this country to be able to demonstrate that we fund the NHS more generously than we fund the defence budget. The last Labour Government cut the NHS capital programme by 16 per cent. in real terms, whereas we have increased it by 62 per cent. That is our record, and that is why I am so grateful to the hon. Member for Crewe and Nantwich for giving us the opportunity to debate it.

NHS funding, however, is not the whole story. What matters to patients is not the level of funding, but the level of activity—the number of patients whose conditions are treated by the NHS, and the number of ill people who present themselves for treatment and leave in an improved condition. Since 1979, the NHS has provided its patients with a dramatically improved service: as my hon. Friend the Member for Harrow, West pointed out, we have seen a 20 per cent. increase in the number of in-patients treated, and a virtual doubling of the number of day cases treated. Whether we measure the service in terms of the resources put into it or in terms of the number of patients treated, the present Government's record is one of which we can and should be proud.

Mrs. Dunwoody

Will the Minister tell us whether his waiting lists are going up or down?

Mr. Dorrell

With pleasure. The waiting list for in-patients is now 6 per cent. lower than it was when we came to power in May 1979. Although the total number of in-patients treated has risen by 20 per cent., the number waiting to be treated has fallen. Moreover, half the total number of patients treated by the NHS as in-patients are admitted immediately, without having to go on to a waiting list, while 50 per cent. of the other half are admitted within six weeks. Some patients have to wait a long time for treatment, but the great majority of NHS patients are not the victims of long waiting lists.

The hon. Member for Crewe and Nantwich suggested that, in his announcement yesterday, my right hon. Friend the Secretary of State for Health attempted to fudge his way, as the hon. Lady put it, out of the problems that face a few district health authorities this year. There was some coverage of that issue in this morning's papers. The £81 million that has been set aside to reduce the unacceptably high level of NHS creditors has not been properly reported and is in danger of being misunderstood. That money is to be provided in next year's budget. It will not be provided in the current financial year. The money will be the subject of an accurately targeted programme to ensure that it is used to reduce the number of creditors. They are the residue of inadequate financial control in previous years. The money will not provide us with the opportunity to fudge our way out of some of the undoubted difficulties that face a few district health authorities this year.

Both the hon. Member for Crewe and Nantwich and the hon. Member for Peckham (Ms. Harman) spoke at length about bed closures. Labour spokesmen find that bed closures are the best means to demonstrate what they believe to be our inadequate provision of NHS beds. Bed closures are, in part, a measure of the improvements in the quality of health care that is offered by the NHS. The majority of treatments now available under the NHS require shorter stays in hospital. There are fewer beds in the NHS, but we treat more patients. Patients do not want to spend time in hospital. If we are ill, we want treatment in hospital and then to be allowed to go home. If we treat more patients in fewer beds, that does not mean tighter management but the delivery to patients of a better health service. Advances in modern medicine enable conditions to be treated in a way that is less traumatic for the patient, which means that they have to spend shorter periods in hospital.

Ms. Harman

Would the Minister have us believe that the cuts in NHS beds throughout the country, in response to the financial crisis, are good?

Mr. Dorrell

If by any mischance the hon. Lady ever became a Department of Health Minister, I hope that she would recognise that there is no point in keeping open beds that reflect the health treatment patterns or methods of 10 or 20 years ago. We can treat conditions now that entail shorter stays in hospital because modern medicine is less traumatic for the patient; he or she is able to recover from the operation or treatment in a shorter period. That benefits the patient. There is no need for us to apologise about that. It reflects medical progress, about which I, at least, am proud.

My hon. Friend the Member for Harrow, West referred to laundries and insisted that it was in the interests of the NHS that they should be the subject of competitive tendering. I agree with him entirely. During the past 10 years competitive tendering has saved the NHS £200 million. That money is now available for better quality health care for NHS patients. That is important progress. My hon. Friend also drew attention to the difficulties caused when health authorities hoard land. I agree that that is an inappropriate use of public resources.

The hon. Member for Gower (Mr. Wardell) asked about prescribing methods, particularly the prescription of a drug that he pronounced in full but which, if he will forgive me, I shall confine myself to describing, as most doctors do, as EPO. The relevant factor in that case is which doctor has clinical responsibility. It is important that a patient who is prescribed a drug is confident that the doctor prescribing it is clinically responsible for managing his condition. That criterion has always determined such matters in England, and I am sure that the same is true in Wales.

I shall draw the hon. Gentleman's questions on he regional elective surgery centres and the future of the open-heart surgery centre to the attention of my hon. Friends in the Welsh Office, who I am sure will reply to him.

My hon. Friend the Member for Gedling (Mr. Mitchell) asked about the importance of the Audit Commission. He played a distinguished role in ensuring that it was given the opportunity to comment on conditions in the NHS, and I am glad to join him in welcoming its contribution.

The hon. Member for Peckham asked for an element of integrity in this debate. I entirely agree and should like to conclude by making an offer to her—that in approaching the subject we start by accepting each other's bona fides. If the Government had wanted to dismantle the national health service, they have had 12 years in which to do so. We have not done so, because we believe in its future and want to develop it. Our record shows that we have been able to develop it, and we shall go on developing it because we believe in it.