HC Deb 27 March 1990 vol 170 cc303-24 9.40 pm
Miss Kate Hoey (Vauxhall)

I am very pleased to have been drawn No. 2 in this night of debating. Some people said to me, "You are lucky that you will not be here in the early hours of the morning. There will be many Members in the Chamber for your debate." When I see the number who are here at 9.40 pm, I do not know what the attendance will be like at 4.40 am. Perhaps it is time that the House examined some of the anachronisms about the way it is run.

I am pleased to have the opportunity to discuss the National Health Service and its underfunding. It is no surprise to me that people generally are concerned about what is happening to the National Health Service. When I was speaking today to my hon. Friend the Member for Mid-Staffordshire (Mrs. Heal), it was clear from what she was saying that one substantial reason why large numbers of people shifted their vote to Labour last week was their dissatisfaction about the way the Government are running the National Health Service and their underlying fears about the future. The Government will ignore that message at their peril.

The fear is justified, particularly when we consider that the Government chose last week to guillotine arbitrarily the debate on the National Health Service and Community Care Bill. The guillotine resulted in nearly 100 amendments not being debated. I hope that we can concentrate on the underfunding aspect of the Health Service.

The Government have attempted to defend their record on the Health Service. It is like trying to defend the indefensible. With nearly 1 million people waiting for hospital treatment, the Government's statements ring false. In my constituency people's everyday experience of what is happening to them when they seek treatment under the National Health Service speaks much louder than any single Government statistic. As we reach the end of the financial year, and as regional and district health authorities face the increasing need for money, they are having to struggle desperately to keep within their cash-starved limits.

The first casualty in West Lambeth health authority has been bed closures—the so-called temporary closure of beds that soon becomes permanent. That is happening not only in West Lambeth but throughout the country. The district health authority has recently had to make some savage cuts to meet the spending limits and a shortfall that was much greater than it had expected. Some of those cuts have been spelt out clearly in letters to the Secretary of State for Health from the community health council.

Some of the worst effects of those cuts are felt in a hospital that does not receive the publicity that St. Thomas' hospital does—I refer to the South Western hospital in West Lambeth district health authority. The staffing levels in psychiatric wards there were reduced at short notice to such an extent that even the unit manager said publicly that he no longer felt that the hospital was able to provide health care and that it was simply acting as a place in which people could just about be kept safe. As a result of the outcry about what was happening, there has been some temporary improvement, but the morale of the staff in the hospital is low. The cuts have affected the way in which people work and operate and mean that they cannot do their jobs as they would like. There have been cuts in the paramedical staff, and the dismissal of the agency occupational therapists has severely affected both the Tooting Bec and the South Western hospitals. Physiotherapy activities, which are so important in such hospitals, have been reduced to a minimum.

There have also been what may seem to be minor but which are very sad cuts. I refer to cuts in the clothing supply and even in the food supply. One resident has stated publicly that it is like living on war rations. There are such shortages of food on some wards that a hospital sister was triumphant and happy at managing to get some extra eggs from another section. No wonder that people are feeling extremely concerned about what is happening in our National Health Service.

West Lambeth district health authority runs the Lambeth community care centre, which is a unique project. Reductions in its nursing staff mean that the centre has to manage its caseload to ensure that it does not have too many high dependency patients at any time. That means that that facility is being used at less than its full capacity. People who could otherwise have benefited from it are now having to use the more expensive acute hospital beds.

Those are just some of the events of the past couple of months. However, we must also consider what will happen after 1 April. The health authority is having to consider drastic cuts which, if implemented, will mean that about 150 staff posts will disappear and that another four wards may be closed. That will mean an increase in the number of people waiting to become patients.

In an answer to me on Tuesday last week, the Secretary of State for Health told me that funding for the West Lambeth district health authority had been increased this year by 7 per cent. in real terms. I have never been very good at maths, but I remind the Secretary of State that this year's allocation for West Lambeth was £103 million, which was only a 5.5 per cent. increase over last year's funding of £97.6 million. Therefore, his answer last week was incorrect. Furthermore, that increase did not take inflation into account. As is happening all over the country, the increase did not take into account the full funding of the staff pay awards. At the moment, the health authority is facing a projected shortfall for next year of £7.5 million. Cuts will have to be made somewhere, unless the Secretary of State intervenes.

I welcome the increase in capital expenditure for West Lambeth, but what is the logic of giving extra capital and of providing capital funds if the Government deprive the health authority of the revenue funding to maintain its services? The Government are inconsistent with their funding. Often they place an unacceptable burden of services that are used nationally on local health authorities.

In West Lambeth district health authority there are two specialist units which receive no national funding. We are proud of the Lane Fox unit. Indeed, the Minister was present at its opening at St. Thomas's hospital. It is the only specialist respiratory unit in the country. Its patients come from far and wide. Yet no extra money is given to the health authority from central funds for the unit. It costs approximately £1.25 million a year. We want the unit at St. Thomas's, but the Government must recognise that it is not used only by people in the health authority area. Similarly, St. John's Hospital for Diseases of the Skin, which moved to premises at St. Thomas's recently, serves the whole community. It has been refused national recognition for central funding. Those two examples show not merely the unfairness of Government spending on the Health Service but how deliberate underfunding is hidden. The change in Government funding of the regions was welcome. But was it really necessary for the increased funding for some of the regions to be paid for by patients in inner-city areas such as Lambeth?

St. Thomas's is classed as a major accident and emergency unit. Up to 70 per cent. of patients who come into the hospital are booked in through the accident and emergency unit. Obviously, that adversely affects what is euphemistically referred to by people involved in the Health Service as non-urgent surgery. The majority of such surgery is for local residents.

Just last night, when the health authority was asked to make drastic cuts, it refused to do so and said that it wanted the proposals to be reconsidered. It was not prepared to cut another 160 beds. The health authority knows that cutting 160 beds will mean an even greater cut—a 10 per cent. cut—in out-patient appointments. Currently there are some 300 cancelled admissions every month. It is important to consider what that means. It means that sick people who expect to go into hospital on a certain day are turned away for lack of a bed on the morning of their admission or when they arrive at the hospital doors. The figure given—300 a month—cannot disguise the suffering and distress to individuals who may have already waited for months for an operation.

I have received several letters from people who have suffered in that way. I have one recent letter here. The lady —I shall not give her name—said: On the day of my operation the Hospital staff phoned me to say they had no bed. I'm trying to keep my job … Some days I can hardly walk by the time I have finished. How much longer do I have to wait? To them it's not an emergency—to me it is … I thought I would tell you my story and I'm sure there are thousands more like mine. There are thousands more like this lady. That is the personal side of bed closures.

At a teaching hospital, when there are fewer beds and operations, student doctors and nurses do not get experience. That creates a vicious circle. It does not help when it comes to recruiting to a hospital such as St. Thomas's.

The Secretary of State has implied to me that the problems of West Lambeth district health authority all stem from financial mismanagement. I have questioned the financial management at West Lambeth. Certainly the allegations which the regional health authority is currently investigating require an explanation. It is ironic that, while investigating the person who is responsible for the financial mismanagement, the regional health authority has given him a consultancy worth a substantial amount of money. The impartiality of the investigation must be questioned.

The financial mismanagement amounted to public awareness of the shortfall being delayed for approximately five months. It had nothing to do with the actual shortfall and underfunding. In future, whenever anything is raised about funding in West Lambeth, it would be sad if financial mismanagement was cited as the reason for underfunding.

As a direct result of the Government's suggestions and plans for the NHS, West Lambeth district health authority and St. Thomas's now have an army of accountants and management consultants employed by the regional health authority. The Secretary of State has admitted that the total spent by his Department and the district and regional health authorities to prepare for implementing the National Health Service and Community Care Bill is more than £80 million.

I know that the Under-Secretary of State knows St. Thomas's well and has had personal experience of the hospital. I hope that he realises that it is absolutely imperative for more negotiations to take place between the regional health authority and West Lambeth district health authority about the amount of money allocated for the coming year. It is not too late for the RHA to recognise the specific difficulties of West Lambeth district health authority, the needs of its area, and its peculiar problems.

It must be as unacceptable to the Minister as it is to me that there will be further reductions in services. We cannot accept a 10 per cent. cut in out-patient services or one more bed closure. We cannot allow more people to suffer the indignity of being told that their operation will no longer take place. Year after year West Lambeth district health authority has been told that if it just makes a few more sacrifices, if it just manages to close a few more beds and fiddle a few more figures, it will help to bring the district's finances under control. It is then told that, next year, everything will be all right. Year after year, however, things have got worse and we are now in a worse financial position than ever before.

The time has come to say that such a level of cuts is simply unattainable and that the health authority's priority is to maintain services to patients. The managers of that health authority have already said that they cannot carry out the wishes of the RHA and the Government to make cuts to enable them to provide a health service, let alone a decent one. Surely the time has come for the Government to make extra resources available to prevent the health services in West Lambeth from collapsing.

I hope that it is not too late for the Minister to listen, intervene and accept that the needs of West Lambeth district health authority and the people of West Lambeth are much greater than he, his fellow Ministers and the RHA have said. I hope that the Minister will respond to the points that I have made.

9.58 pm
Mr. Ieuan Wyn Jones (Ynys Môn)

First, I congratulate the hon. Member for Vauxhall (Miss Hoey) on her good fortune in the ballot and also on the way in which she deployed her argument about Health Service underfunding in her area. Her story could be repeated in many parts of England and Wales. Her good fortune also means that those of us who want to comment on cuts in the Health Service can do so in this debate.

It is highly opportune that this debate is taking place tonight because yesterday evening Gwynedd health authority, which covers my constituency, had a meeting, yet again, to try to avert financial disaster. This is not the first time that Gwynedd health authority has been in that position. It has happened every year since at least 1984. During the past two years, particularly since I was elected to the House, I have warned the House and Ministers in the Welsh Office that the authority's chronic financial plight must he sorted out. Hitherto, my plea in the House and elsewhere has fallen on deaf ears.

Last year, I went so far as to call on the Secretary of State for Wales to use his powers under existing legislation to intervene directly in the affairs of Gwynedd health authority. Sadly, on that occasion he refused to do so. The matter is vital because it affects the health care of nearly 250,000 people in north-west Wales.

A year ago I told the House that I was gravely concerned about the financial crisis which then faced Gwynedd health authority. As a result of decisions taken 12 months ago, a number of hospitals in Gwynedd are to close and vital community provision is being cut. I said then, and I repeat, that one of the major reasons why the health authority had to cut back last year was that it suffered chronic underfunding, but I accept that there are other reasons. Unfortunately, for some years, Gwynedd health authority has suffered from poor management control.

When I made these points last year, the Minister of State, Welsh Office, said that, although the health authority had suffered from particular management problems in the past, he believed that significant improvements had been made which would lead to the problems being solved. Unfortunately, this year Gwynedd health authority is in exactly the same position. Therefore, the best that one can say about the Minister's reply is that it was complacent in the extreme.

The difficulty for hon. Members and the public is that the health authority blames the Government for underfunding and the Government blame the health authority for mismanagement. That has already been said in this debate. It does not matter to the patient who is right or wrong. The problem is one of immediate concern to the patient who will not have his or her operation because wards have closed.

This year Gwynedd health authority estimates that unless cuts are made it will overspend by more than £2 million, and that sum will increase to £4 million next year. It blames the Welsh Office for underfunding. The crisis this year has already led to the closure of one ward at Gwynedd hospital in Bangor, which means that 23 operations have had to be cancelled, six of which were hip replacements. Yesterday, the area health authority gave its managers authority to make further cuts which could lead to the loss of 200 jobs and further ward closures in the next few years. That is an absolute scandal and should be stopped.

How can the health authority discharge its duties to provide a comprehensive health service to the people of Gwynedd when, during the past 15 months, it has taken a number of steps: first, to close several community hospitals; secondly, to sack 200 employees; thirdly, to close wards and day centres; fourthly, to freeze vital medical posts; and, fifthly, to cut essential community services. What sort of health authority and what sort of Government allow that to happen? I have a copy of the speech of the Secretary of State for Health to last year's Conservative conference, in which he said: A lot of small hospitals are very popular and very threatened under the old way of doing things. In future thanks to the new funding arrangements which I propose, popular units and popular cottage hospitals will thrive if they attract patients. That is precisely how the new funding will operate, to provide wider choice and more local say. I wholeheartedly endorse those sentiments, but how can Gwynedd health authority live up to that sort of statement if hospitals have already been closed? There is no way in which a health authority can provide community provision if five hospitals in the county have been closed. If the Government are serious about providing decent community hospitals, they must reverse the closures.

The latest decisions on job losses and ward closures were confirmed late yesterday afternoon. The implications are staggering, especially for the elderly and the disabled. Unfortunately, the health authority has a reputation for cutting its community provision as it struggles with the finances of the main acute general hospital at Bangor. There is already a massive shortfall in community nursing, speech therapy, occupational therapy and all the other attendant services. I have no hesitation in saying that something must be done to improve health provision and health care in Gwynedd.

I was astounded to learn that from today no elective orthopaedic surgery is taking place within the NHS in Gwynedd. That is a scandal. The managers already have powers—they were passed through the area health authority yesterday—to close other wards as and when the need arises because there is a shortage of nurses and staff. The Secretary of State for Wales—I am sure that my comments will be passed on to him by the Under-Secretary of State for Health—cannot further abdicate his responsibility. He must intervene now to save the Health Service in Gwynedd.

I shall quote from the document which the health authority provided to its members in reaching the decision for further cuts yesterday. It is very much as the hon. Member for Vauxhall said—that if a few cuts are made here and there during one year, the authority concerned will be in a better position the following year. That is precisely what the Welsh Office told Gwynedd health authority last year. It implemented the cuts which the consultants who were asked by the Welsh Office to examine the Health Service in Gwynedd said that it should make.

Those cuts, however, were not enough. The general manager of the health authority told the members yesterday: The interim strategy was the Action Plan,"— the action plan is to close the hospitals— which has not succeeded in the aim of bringing the Health Authority back into balance. This has largely been due to the accelerating pressures of inflation and under-funding of wage awards and regrading exercises, continued increase in workload and delays in obtaining decisions on the rationalisation proposals. He also told me that the Welsh Office criteria for providing funding for Gwynedd health authority do not take into account the increase in the workload to meet demands caused by the increase in the elderly population as a proportion of the population as whole.

Is it not appalling that, according to the Western Mail, the general manager of Gwynedd health authority said: The best way to get more money is a good cholera outbreak while the Welsh Office base their allocation of funds on standard mortality ratios. It is as stupid as that. If that is the view of the general manager of health services in Gwynedd, it is a sorry state of affairs. Without direct Government intervention, Gwynedd health authority will collapse under the financial strain. I urge the Minister to pass my comments on to his colleagues at the Welsh Office.

10.10 pm
Mr. David Hinchliffe (Wakefield)

I commend my hon. Friend the Member for Vauxhall (Miss Hoey) on being lucky in the ballot and on her opening speech. It is my pleasure to reside in her constituency during the week and I am glad to know that she is actively representing my London interests tonight.

The central question to which we must address ourselves is why a Government who have had a huge pile of Exchequer resources, throughout their period in office and certainly in recent times, have found it necessary to underfund the National Health Service to the extent that they have. We know that they have had about £83 billion in North sea oil revenues and it is calculated that revenues from privatisation—the sale of state assets, council house sales and land sales—and other income have amounted to about £50 billion. Why have a Government with resources above and beyond those available to any previous Government chosen to do so little to increase National Health Service funding? My answer to that question is that they have deliberately chosen not to fund the National Health Service properly as part of a longer-term political strategy involving the transformation of the NHS as we have known it since just after the second world war.

About a year ago I read in the press the remarks of David Willetts, who appeared on "Question Time" a couple of weeks ago. David Willetts was the Prime Minister's previous health care adviser at No. 10 Downing street. About a year ago, he was reported in the press as having asked a senior civil servant what he would do with the Health Service if he were a Minister. The reply was interesting: I'd either leave it entirely alone because it's too politically dangerous. Or I'd de-stabilise it and see what happened. I believe that the Government have chosen a policy of destabilisation to pave the way for a different form of health care—the direct result of the National Health Service and Community Care Bill passed by this House a couple of weeks ago.

It is important to examine the destabilisation process. I believe that the Government have deliberately provoked industrial disputes in the National Health Service so that they can say to the public, "We have to do something about the National Health Service." The dispute with the nurses dragged on for far longer than it should have done; indeed, many nurses are still dissatisfied with the outcome of their grading appeals. More recently, there was the ambulance dispute—and one cannot but conclude that that dispute was inflamed by comments made by the Secretary of State for Health on a number of occasions.

Without doubt, the Government have deliberately underfunded the Health Service although, as I said, they had the resources available to do things that previous Governments could not. Year after year, we have shortfalls in the funding available to the NHS.

Figures provided by the National Association of Health Authorities indicate that there has been a shortfall every year since 1982–83. The figures are as follows: 1982–83, £67 million; 1983–84, £209 million; 1984–85, £334 million; 1985–86, £495 million; 1986–87, £550 million; 1987–88, £429 million; 1988–89, £472 million; 1989–90, £490 million. In addition, the capital improvement works needed to deal with the crumbling infrastructure of the Health Service will take £1.8 billion. Why have the Government done so little with all the money that has been available to them over this period? They have failed completely to estimate the huge increase in the costs of the National Health Service. The cost of equipment, for instance, has increased well beyond the rate of inflation.

The Government have also failed to anticipate the huge increase in demand for services, much of which arises directly from their own social and economic policies. One thinks of the mass unemployment and poverty that have occurred under the present Government. I could reel off statistics from one research document after another, indicating the clear connection between the increased incidence of ill health and increased unemployment and poverty. The connection must be obvious to anyone, whatever their politics. Obviously the Government have underestimated it. They have also underestimated demographic changes, especially in terms of the number of elderly people and the increased expectations of better health care that people rightly have.

The Government have attempted to foster the idea that we can no longer afford a National Health Service and that we have to go back to the situation which prevailed in the last century and in the early days of this century. My parents have told me about that. I have heard about the appalling ways in which people had to scratch around to raise money for hospital beds. Nowadays there seems to be an increasing notion that health care can be improved only by raising money charitably. Recently I had a discussion with a lady who is involved in the hospice movement in Wakefield. On her arrival in Wakefield from elsewhere, she said that she was amazed at the number of charitable ventures by which money was being raised for health care —for basic facilities which ought to be provided within the National Health Service. That situation is giving rise to great concern, yet I believe that the Government, through their policies, are actively encouraging it.

We must also consider the implications of the Health and Medicines Act 1988. I had the questionable honour of serving on the Standing Committee which considered the Bill and I recall the efforts that were made to defeat proposals which we felt would be detrimental to the Health Service. At local level we now have commercial managers coming up with all sorts of bizarre ways of raising money. The Under-Secretary of State is aware of some of the problems in Wakefield. He will know that the health authority there has proposed that patients who do not turn up at clinics should be fined. What a way to encourage people to take preventive measures. People are not to be asked why they did not attend but simply fined for non-attendance.

The Minister is aware of the classic case in Wakefield. I refer to the introduction of a charge for measuring bodies before removal from the hospital mortuary—at £5 a throw. The district general manager, in defence of the charge, asked why a public body like the NHS should subsidise private industry such as undertakers. Clearly, that official failed to understand that the charge is being passed directly to the bereaved families.

Another matter which is causing great concern and anger in Wakefield is the fact that Wakefield health authority is about to introduce car parking charges for people going to hospital. People who go for treatment will be charged for parking their car and people visiting their loved ones will also have to pay for the privilege. That is appalling. My concern is that if the Government remain in power much longer, the next stage in the process will be that a person will have to pay to park his or her body in a bed.

We should consider the implications of the introduction of charges within the NHS because that process is part and parcel of the creation of a different climate and a different attitude towards health care. Under the Government there has been a massive increase in prescription charges from 20p to £3, without any commitment being stated in their manifesto, and charges for dental and eye checks have been introduced. The Under-Secretary of State will be aware of the huge drop in attendance for preventive checks at dentists and opticians and the appalling consequences that that will have for the nation's health in due course.

It is important that we understand why the Government have acted as they have. They did not need the money—they needed to introduce the idea that people will have to pay for health care. That is the important point to understand. We are moving towards a different form of health care in Britain. The Government are seeking to transform the public perception of health care, putting it on a more commercial basis. They are creating a crisis to make people believe that there is a need for the damaging reforms that they are introducing.

The hon. Member for Ynys Môn (Mr. Jones), whose constituency I had the pleasure to visit last week, and my hon. Friend the Member for Vauxhall have said that certain services are being slashed right, left and centre, but alongside those cuts we are seeing the introduction of financial incentives for health authorities to opt out and form self-governing trusts. In a recent paper, the district general manager of the Wakefield health authority proposed that Wakefield health authority should opt out all its services, not just hospital services, but community services as well. He said: It is already apparent that units identified for self-governance are receiving preferential funding to strengthen their skills, resources and market advantage. He went on to say: Concern has been expressed that any district not engaging in the new open market culture might become a Cinderella service of the NHS.

The Wakefield health authority has problems. As the Under-Secretary of State is aware, the health authority's treasurer has recently been sacked, for a variety of questionable reasons which I hope to raise on a subsequent occasion in the Chamber. He said, among other things, that nurse staffing levels were dangerously low but that money was being spent—irresponsibly in his view—on the opting-out process. The district general manager says that that is not true, but a consultant agrees that nurse staffing levels are dangerously low. District health authorities are being bribed to opt out in order to obtain the money that they need to provide a basic health service, and that is worrying.

I conclude by restating the point that underfunding needs to be seen in the wider context of the Conservative view of the NHS, which is one of hostility to state health care. The Conservatives oppose the forms of collective provision which we have had since 1946 and which are the envy of the world. They believe that only things which are bought and sold are valued.

The Government have completely misread the view of the British people on the issue and the extent to which the British people deeply believe in the Socialist principles of the NHS. The National Health Service is the main reason above all the other reasons why the Government will very shortly—but not before time—be swept from power.

10.24 pm
Mr. Keith Vaz (Leicester, East)

There has been an element of deja vu in these proceedings for those hon. Members who sat in the Chamber for the National Health Service and Community Care Bill. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) made a compassionate and passionate speech. My hon. Friend the Member for Monklands, West (Mr. Clarke) has brought his deep knowledge of Health Service issues to this debate as he has done to many other such debates. The hon. Member for Ynys Môn (Mr. Jones) has told us of the cuts occurring in the Health Service in Wales.

That element of deja vu will be repeated when the Under-Secretary gets up to speak. He will tell us the usual story, as all Ministers do, but especially this one. I do not wish to be unkind, as he seems to be a decent person who is trying to defend an indecent set of policies, but he is an identikit Conservative Minister who has to come forward to read the standard brief provided by No. 10 Downing street, telling Opposition Members that more money has been spent on the Health Service by the Government.

Someone suggested to me that the Under-Secretary seems to have been knitted by the Prime Minister on one of her days off because he is so similar to so many other Ministers in other Departments. He was the best of the Ministers who came before us in Committee. The Secretary of State was hardly ever present. He was spending his time battering the ambulance men. The Minister for Health was not present. She came to the Committee occasionally and disappeared halfway through discussions on vital clauses. At least the Under-Secretary was present and had some understanding of what was going on.

The Under-Secretary kept telling us that more money was being spent under this Government on the Health Service than under any other Government. I have news for him. Recently in Leicestershire the health authority announced the largest number of cuts ever announced by the health authority—a total of £30 million—as a result of this Government's policies. I congratulate my hon. Friend the Member for Vauxhall (Miss Hoey) on initiating this debate. When the Under-Secretary replies to the debate, I would like him to tell us what the Leicestershire health authority is going to do now it has frozen those plans.

The royal infirmary, the flagship of Leicestershire health authority, whose employees were praised by the Prime Minister and hon. Members on both sides of the House after the terrible aeroplane crash at Kegworth, is going to freeze millions of pounds which should have been part of its spending plan. Two million pounds is to be frozen in spending on the new infectious disease unit; £300,000 on urgent repairs to the operating theatre floors; £300,000 on facilities for elderly patients; £200,000 on the conversion of adult wards to provide a large children's ward; £330,000 on the entrance to phase 4 of the new developments at the infirmary; £270,000 on storage facilities for records; £168,000 on the replacement of radiotherapy equipment; £660,000 on the upgrading of training facilities; £1,270,000 on the relocation of the medical, ear, nose and throat out-patients departments; £540,000 on upgrading the gastro-intestinal unit. At the Leicester general hospital, £645,000 of the ward rationalisation programme will be frozen and £500,000 of the spending on the planned new pharmacy unit. Those cuts will affect the people of Leicestershire and my constituents. They total £30 million.

One of the features of Leicestershire is the way in which hon. Members from both sides of the House frequently meet the chairman and members of the health authorities. The Minister will encounter a good deal of difficulty when he hears the representations of Leicestershire Members. I should like to know how he can justify £30 million of cuts in the amount allocated to Leicestershire.

Why was it necessary for the health authority to make those cuts? The answer is quite simple. The outgoing chairman of the authority, George Farnham—a former Conservative councillor, and once chairman of Conservative-controlled Leicestershire county council—firmly believed that the reason was Government policy. He said that he had pressed Ministers and other Members of Parliament for years about Leicestershire's growing financial difficulties, but that his appeals had fallen on deaf ears.

Let us note what the experts are saying. Mr. Roger Austin, a consultant orthopaedic surgeon at the general hospital, is quite clear where the blame lies: he has pointed out that surgeons in the hospital are more than willing to conduct hip replacement operations, but cannot do so because so many beds have been taken out of use and so many theatres are lying idle. According to Mr. Austin, the surgeons themselves have had to fight off possible closures of the orthopaedic ward in the past year.

I am sure that my next example will ring a bell with the Minister, as I raised it with him just after my Adjournment debate a year ago, when we discussed the occupational therapy service and the need to provide more resources to encourage more people to be part of it. I described to him then the problems faced by the general hospital's renal unit. I told him that the new unit had been established 18 months before—at a cost of some millions to the Health Service in Leicestershire—and that there were not enough funds to open all the beds.

I am pleased to say that the bed problem has now been solved: there are enough beds for patients. Because the renal unit has been so successful, however, it has now run out of money, and Trent region has told the Leicestershire health authority that it is no longer prepared to provide any extra resources.

Professor Bell—head of the renal unit, and a respected person in the Leicestershire NHS—had this to say: Somebody has to tell the patients they cannot be treated. They will have to go away and die somewhere. I won't tell them". Those are the words of a senior Health Service figure who is not given to making outlandish statements. He also said that, unless he is provided with the resources necessary to run his unit effectively, people will have to die because they will not be able to obtain the treatment that they so desperately need.

We are very proud of the general hospital's renal unit: we are proud that it is regarded as a sub-regional unit, and that the staff who currently work there are respected for what they do. If the funds are not available, however, they cannot carry out that work efficiently and effectively. I urge the Minister to give us an assurance that he will go back to the regional health authority and demand that it provide the necessary resources.

The human suffering that people are having to undergo was demonstrated to me at my surgery last Saturday. There—in my office in Uppingham road—I met a man called Mr. George Brown. He is no relation to the George Brown who used to be a Member of Parliament; I asked him, and he confirmed that they were in no way related. Mr. Brown is in his 70s, and had difficulty in communicating with me: he is hard of hearing, and has no hearing aid. Mr. Brown has been told that he will have to wait for six months before his hearing aid is fitted, because of the delays at the royal infirmary. I asked the infirmary to provide me with the current waiting list. In December 1989, 684 people were on the waiting list for hearing aids. The vast majority are elderly people, like Mr. Brown.

Mr. Brown suffers because he cannot lead an ordinary life. He cannot listen to the radio or television because he cannot hear what is said. He cannot go out on his own in Leicester, because he cannot hear traffic when he tries to cross the road. He cannot communicate with his Member of Parliament except through a third party, because he cannot hear what I have to say to him. That is human suffering, the face behind the statistics.

I pay tribute to the general manager of the royal infirmary, Mr. Paul Barker. I know that he is doing his best and that the infirmary has tried to cut the waiting list. However, it says that it does not have the funds to pay clinical and laboratory assistants the kind of salaries they need in order to staff the unit effectively. No money is available to pay them overtime to clear the waiting list. Therefore, Mr. Brown, and thousands of other people like him throughout the country, have to lead unnatural lives. One of them said to me a few weeks ago that he confidently expected that he would be dead before the hearing aid arrived. Then, of course, it will be too late.

I echo what my hon. Friend the Member for Wakefield (Mr. Hinchliffe) said about the Health and Medicines Act 1988. The information officer of the Leicestershire branch of the Association of Optometrists published a report last week that was widely publicised in the local press. It suggested that the number of people who had had eye examinations was 30 per cent. lower than before the introduction of charges. He said: The importance of proper eye care has been reduced by the way the Government has behaved. He is clear about where the blame lies.

A new campaign has been started by a consultant paediatrician at the Leicester royal infirmary. Dr. Una MacFadzean would like the Department of Health and the Department of Transport to work together in order to provide concessionary fares for parents when visiting their sick children in hospital or when they accompany their children to out-patients departments. She feels that, because of the social fund and community care grant changes, parents are having to pay enormous sums of money to be with their children. She says that parents ought to be encouraged to be with their children when they are in hospital, because it helps them to get well soon.

I urge the Minister to take heed of that campaign, but I know exactly what he is going to say: that the Government have provided more money for health care than any other Government in history. However, I do not want a jumble sale Health Service in Britain. I do not want people to have to give money to jumble sales to support the Health Service. When I visited America last year, I went to some hospitals there. I saw the future of the National Health Service in Britain when I was there, and I did not like what I saw. People in America have to pay for medical services.

Miss Ann Widdecombe (Maidstone)

indicated dissent.

Mr. Vaz

The hon. Member for Maidstone (Miss Widdecombe) shakes her head, but in a casualty ward in an American hospital, I saw a person who wanted treatment turned away because he did not have a private medical insurance card.

For the next two and a half years, before the return of the next Labour Government, the Opposition will continue to press the Government for improved health care. We demand for the people of Britain a service that is free at the point of need and available to all. If the Minister will direct his comments to the matters that we have raised, I hope that we shall be able to return to our constituencies with some reassurance. Somehow, I believe that, when he speaks, we shall yet again be bitterly disappointed.

10.40 pm
Mr. Tom Clarke (Monklands, West)

I join my hon. Friends in congratulating my hon. Friend the Member for Vauxhall (Miss Hoey) on her good fortune in gaining a place in the ballot, on her good judgment in choosing this subject for debate, and on her splendid presentation of her case. Her presence is a reminder—today of all days, when my hon. Friend the Member for Mid-Staffordshire (Mrs. Heal) took her seat for the first time—of the number of excellent women who are joining the ranks of the parliamentary Labour party and who will be doing so in greater numbers at the next general election.

This debate, like many we have had in recent times, including the Committee stage of the National Health Service and Community Care Bill, as my hon. Friend the Member for Leicester, East (Mr. Vaz) reminded us, is mainly about the problem of underfunding. My hon. Friend the Member for Vauxhall dealt with the issues at West Lambeth. My hon. Friend the Member for Wakefield (Mr. Hinchliffe) pointed out that, in addition to the problems of underfunding, there are industrial disputes, one of which—to which I shall refer later—is going on in my constituency, involving the Greater Glasgow health board. The hon. Member for Ynys Môn (Mr. Jones), in describing the problems in Gwynedd, said that in Wales, as in the rest of the country, the problems of underfunding will not go away, however glossy the Government make their presentations and however persuasive the Minister tries to be tonight.

Hon. Members have the opportunity to find out precisely what is going on. We speak to our friends and constituents, and I begin by referring to some comments that were made to me today by two of my friends. My constituent, Janette Watson, a staff nurse from the mining village of Waterside in Strathkelvin, has worked for the Greater Glasgow health board for 24 years. She, in common with many of her colleagues, is now in dispute with the board.

My hon. Friend the Member for Glasgow, Rutherglen (Mr. McAvoy), who was present for much of the debate, would agree that it is one of the most dictatorial boards in Britain. Its attitude to this dispute—I regret that the hon. Member for Stirling (Mr. Forsyth), the Under-Secretary of State for Scotland, is not in his place—is an indication of that dictatorial approach to serious problems in the NHS.

What do the decisions of that board mean for Janette Watson? The board has imposed on her a decision which means that, instead of working an average 10 or 11-hour shift, she will work a shift of 9 hours 22½ minutes. This woman, who has given virtually a lifetime's service to the NHS in Greater Glasgow, will lose £450 a year. There are many equally unacceptable cases, all arising from the problem of underfunding.

Another friend with whom I talked today is Andrew MacKinlay, the prospective parliamentary Labour candidate for Thurrock. He showed me a document headed "Private and confidential"—it is not meant to be available to the public, including the taxpayers who pay for the NHS in that important area—which is to be discussed by his health authority on Thursday of this week. Some plans make even my hair stand on end, yet they are being seriously considered, not because they will lead to greater efficiency or because the Health Service in that district will be better served but because the people who will consider that secret document on Thursday are compelled to think about the problems of underfunding which have dominated this debate.

What are some of the options that will be considered by that authority on Thursday? The closure of the accident and emergency unit at Orsett hospital will mean that people will have to travel a considerable distance to Basildon. We are told that, for 80 per cent. of those patients, the maximum travelling time to an accident and emergency unit will be 20 minutes and for the rest it will be 30 minutes. We are told in this secret and confidential document that the average travelling time by car to the accident and emergency unit will rise from 10 minutes to 14 minutes. Perhaps most staggering of all is the prediction that, if the report is approved on Thursday: It is further estimated that the total number of new patient attendances in the District would decrease by 21 per cent. on closure of Orsett Hospital A & E department.

Mr. Jimmy Hood (Clydesdale)

It seems that the Greater Glasgow health board is imitating some of the actions of the Lanarkshire health board. The same trick has been carried out at Stonehouse general hospital in my constituency. Two years ago, the board cut away the accident and emergency service. If someone has a heart attack now in Stonehouse, instead of it taking five minutes to reach a general hospital with an accident and emergency service, it takes half an hour to reach the next general hospital in my constituency, which is Law hospital. Such incidents are not happening only in Glasgow; it seems to be a tactic in Scotland which, as my hon. Friend rightly says, is deeply worrying.

Mr. Clarke

My hon. Friend is absolutely right. It is staggering that any health authority, as a result of underfunding, is taking a deliberate decision which will mean that it will take longer for people to arrive at the accident and emergency unit.

All of this, including the problems that my hon. Friend the Member for Clydesdale (Mr. Hood) mentioned—and I was delighted to be in his constituency on Sunday evening and to know how well his constituents think of him—is caused by underfunding, by the shortfall that has been identified in virtually every authority in the country and by the simple fact that the proportion of national wealth devoted to health under this Government is far less than the proportion that would be expected and endorsed by the British people.

The consequences of that underfunding are clearly profound. Patients, staff and communities are concerned about what is happening to the Health Service as we understand it. The Minister will, of course, tell the House that, since 1979, expenditure on the NHS has increased —and no one has ever denied that. In the light of demography, inflation and other factors, it would be astonishing if that were not so. However, even with that increase, the Government, including in this financial year, have failed to take into account a number of important factors, including inflation. The 5 per cent. figure included in the current figures is clearly nowhere near the target that authorities must realistically face.

Moreover, the cash resources, limited as they are, are unevenly spread within the regions and from one part of the country to another. My hon. Friends have identified the problems and we know that there is a challenge to the hospital and community health services, on the one hand, and to the family practitioner services, on the other. The challenges are not being met by the fiscal and economic priorities that the Government have offered to those who take decisions.

The fact is that real growth is necessary in the NHS in order to stand still, and nobody wants an NHS that simply stands still. We want to respond to the problems of the increasing number of elderly people, the new developments in technology and the need to implement central Government.

My hon. Friend the Member for Vauxhall referred to community care. I do not know how serious the Government are being about the objectives that they set themselves in their White Paper, but I do know that my hon. Friend is absolutely right when she identifies yet again a decision on capital expenditure that is not met by revenue expenditure so as to make a reality of the original commitment.

On inflation alone, apart from the other factors that authorities have to deal with, there is a shortfall in England and Wales amounting to £140 million. Therefore, it is not surprising that the National Association of Health Authorities calculates that the shortfall between needs and income for this financial year, 1989–90, is £490 million. There is a very big difference betwen the £67 million in 1982, the year in which I came to the House, and the £490 million shortfall which that distinguished organisation identifies now.

In a reply recently to my hon. Friend the Member for Peckham (Ms. Harman) we learned that the backlog of maintenance and repairs was over £1.8 billion. This issue is very important in almost all our constituencies, as I saw recently when the Woodilee hospital in my own constituency, a hospital for geriatric patients, including some psycho-geriatric patients, literally fell apart and patients had to be removed to other hospitals in Greater Glasgow, some of them in the middle of the night. The outstanding amount of £1.8 billion for repairs and maintenance is a reality which authorities have to face and which the Government clearly have to take on board.

Investment has fallen as a proportion of national wealth in terms of our commitment as a nation to the future of the NHS. When the Minister, in replying to the debate, refers to Government investment, perhaps he will bear in mind comparisons which the British people will find unacceptable. Britain compares badly with other developed countries in terms of gross national product spent on health care. Between 1977 and 1987, Italy's GNP contributed 19 per cent., France's 14 per cent., the United States' 25 per cent., Belgium's 19 per cent. and the United Kingdom's 12 per cent.

When we consider our commitment and the need for investment in the Health Service, it is reasonable that we should look elsewhere to see what other countries are doing, and we find very little comfort indeed. In 1987, Britain devoted 5.8 per cent. of GNP to health. This compared very unfavourably with the United States at 11.1 per cent., Sweden at 8.9 per cent., Belgium at 7 per cent., Canada at 8.3 per cent. and West Germany at 9 per cent.

Because of the lack of investment, because the Government have in no way managed to keep up with the demands of inflation, because authorities have to take on board the real levels of wage settlements and the demands of increasing drugs bills—and I find it very surprising that we hear so little about that—there are many problems, which my hon. Friend the Member for Vauxhall has been right to draw to our attention.

I will refer briefly to only three articles, all in newspapers of different political complexions. The Daily Mirror had this to say on 30 January: Heart patient Fred Brinkman lay in hospital for five weeks while health bosses squabbled over his bill. Doctors agreed that 62 year old Fred needs a life-saving operation. But two hard up health authorities couldn't agree as to which one of them should pay for his treatment". If the Daily Mirror is unattractive to Conservative Members, let me quote The Daily Telegraph of 22 February: A coroner called for an urgent review of intensive care facilities throughout Britain yesterday after a woman died when no bed could be found for her at 20 hospitals. On 22 February The Guardian reported: A health authority"— Hounslow and Spelthorne— facing budget problems is to move elderly mentally ill patients into hospital buildings categorised three years ago as 'fit only for demolition'.

The National Health Service as presented by the Government certainly is not fit for the approval of the House or of the people. It was therefore right that my hon. Friend the Member for Vauxhall should have introduced the debate as she did. She did a great service not only to the House but to patients in Great Britain, to those who are committed to the Health Service and to those who work for it. It is on their behalf that I endorse my hon. Friend's remarks and look forward with anticipation but not with much confidence to the Minister giving a response worthy of the problems which have been brought to the Floor of the House.

10.55 pm
The Parliamentary Under-Secretary of State for Health (Mr. Roger Freeman)

We have had a very interesting debate. I congratulate the hon. Member for Vauxhall (Miss Hoey) who concentrated, as Opposition Members have said, on the underfunding of the Health Service. I have to say to the hon. Member for Leicester, East (Mr. Vaz), who somewhat taunted me, that the text has not been written at 10 Downing street—it is entirely mine, and the comments are entirely my own beliefs, representing my colleagues in the Department of Health. I take seriously the points made and I shall attempt to provide serious answers. I shall not give a long catalogue of achievements over the last 10 years. The hon. Gentleman has heard that before. I want to treat the comments made with greater seriousness.

Mr. Hood


Mr. Freeman

If the hon. Gentleman will forgive me, I shall not give way as I have only 13 minutes in which to reply.

I shall pass the comments of the hon. Member for Ynys Môn (Mr. Jones) to my colleagues at the Welsh Office. Perhaps he will forgive me if I do not pursue the points that he raised.

The health and community health services are cash-limited. They have been cash-limited for almost 15 years. The process was started by a Labour Government in the late 1970s. I have always assumed that a future Labour Government would continue the process of cash-limiting the hospital service, although not the family practitioner service. Apart from certain elements of that service, we do not cash-limit primary care. We have just announced £360 million for next year for practice staff and cost rent allowances for the family practitioner service, but essentially that service is not cash-limited.

When the hospital service is cash-limited, there is inevitably a clash of finite resources and almost infinite demand because it is a free service. In a service which does not have the sophistication of planning non-emergency services and case loads we do not yet have the ability to forecast as clearly as we should the pressures on the Health Service during the course of a year. We therefore have the problems to which the hon. Lady has referred. They are not entirely due to an inability to predict staff increases, which is certainly the case in the hon. Lady's own health authority, or patient admissions. It is a commentary on our Health Service that we do not have that sophistication at present.

Time prevents my reading out a list of our achievements in the past 10 years, but I will comment briefly that in 1990–91 the Health Service in the United Kingdom will spend some £29,000 million, which is equivalent to £500 per man, woman and child. It is an interesting comparison as the hon. Member for Monklands, West (Mr. Clarke) was referring to the proportion of GDP, which is a relevant measure. Nevertheless, in real-terms—that is, at current prices—the money that was spent in 1978–79 was £338 per head, and it is now £500. Measured in terms of the retail price deflator, after allowing for general inflation, there has been a 45 per cent. increase in Health Service expenditure over the 10-year period. We now have a budget larger than that for defence.

I am sure that the hon. Member for Monklands, West will agree that because we are dealing with such a large chunk of public expenditure—12 per cent. now goes to the NHS—it is not possible to plan other than by way of cash limits. The hon. Gentleman cannot seriously suggest volume planning and indexing the cost of health care during the course of a year if inflationary pressures rise. I am sure that he is not suggesting that, as it is clearly impractical in terms of managing public expenditure.

The hon. Member for Wakefield (Mr. Hinchliffe) thought that there was some sinister plan behind the White Paper and the National Health Service and Community Care Bill. He referred to deliberate underfunding and to destabilisation and said that Conservatives believe that only things that are bought and sold are valuable. I entirely dissociate myself from all those value judgments, as do my hon. Friends on the Back Benches. The hon. Gentleman also talked about the "Socialist principles" of the NHS. I hope that we have a bipartisan approach to the NHS. The Conservative, Labour and minor parties all have a common shared heritage in the NHS, of which we are all proud, and the Conservative Government are determined to ensure that both the quality and the quantity of its care improve.

Opposition Members have talked for an hour and a quarter about underfunding in the Health Service and I have stated the record to date. Not one Opposition Member—certainly not the hon. Member for Monklands, West—has said anything about the scale of real terms increases in expenditure that a Labour Government would introduce. I honestly believe that one advantage of our democratic system of government, in which the party in government periodically changes—[Interruption.] I do not deny the history of the past 100 years and I am not making any forecasts about the future, but one advantage of our democratic system of government is that it provides a cold douche of reality for Opposition parties when they realise that they have to deal with real resources. As I have said, I have listened to one hour and 15 minutes of speeches about underfunding without hearing any view from Opposition Members about the level of resources that they feel are needed. I shall be happy to give way to the hon. Member for Monklands, West if he would care to enlighten the House about the increase in expenditure that he is recommending. Obviously, the hon. Gentleman is unable to comment. Indeed, that was the attitude of the Opposition during the passage of the National Health Service and Community Care Bill.

The House is entitled to know the level of increase in funding that the hon. Member for Livingston (Mr. Cook) is recommending. The hon. Gentleman is quoted as saying that an extra £3,000 million is required immediately for the Health Service. I hope that I have quoted him correctly. I also hope that the hon. Member for Livingston will tell the House, at some appropriate time, what additional expenditure he envisages and where that money will come from.

Mr. Tom Clarke

The Minister began his speech by refusing to give way to my hon. Friend the Member for Clydesdale (Mr. Hood), saying that he had only 13 minutes in which to reply to the debate, but he has since steadfastly refused to reply to the points made in it. I refer the Minister to the Budget debates last week, in which his questions were answered time and again. Will he now answer our questions and tell us why the NHS has been so disgracefully treated by this Government who, unlike the last Labour Government, have had more than one spoonful of oil? What are they doing with the oil revenues? Why are they not investing some of it in the NHS?

Mr. Freeman

The hon. Gentleman will know that the shadow Chief Secretary has studiously refused to commit a future Labour Government to any increase in National Health Service spending. A commitment has been made only to increasing child benefit—part of the social security budget. I am not aware of any other commitments that have been made.

In addition to the 8.5 per cent. cash increase for the hospital and community health service next year, it is fair to include the value of cost improvement programmes at £150 million and income generation at £25 million. Both have an important role to play.

Miss Hoey

Will the Minister give way?

Mr. Freeman

If the hon. Lady will forgive me for a second, I shall certainly give way before I conclude. I am trying to answer the points raised in the debate.

The one specific comment about the Health Service in the Labour party's manifesto is that a Labour Government would eliminate compulsory competitive tendering. That would remove a contribution of the order of £100 million per annum. I admit that the consequences of inflation this year and next year for the Health Service are significant. The assumption of 5 per cent. inflation for the year 1991, which applies to the health authority of the hon. Member for Vauxhall, looks unrealistic. Therefore, it is not surprising that the 14 English regional health authorities are advising the districts to plan for about 6.5 per cent. That is not the full retail prices index forecast for next year because health authorities do not pay mortgage interest rates and several other ingredients of the RPI do not apply to them. Nevertheless, there is pressure on them. The year 1990–91 will be difficult for many district health authorities simply because the additional cash provision now looks less generous than it was at the time of the public expenditure survey last year. That is even more reason why it is important to control inflation next year. It is important for a cash-limited service that the Chancellor should succeed.

I understand the points that the hon. Member for Vauxhall made about her health authority and I shall reflect them to the regional chairman. We have suffered a reduction in capital expenditure plans for the coming year largely because sales receipts from surplus land are substantially down. I hope that that is cyclical and will be reversed. I hope that plans that have had to be postponed or dropped in the constituencies of Vauxhall, Leicester, East and others will be reinstated when sales receipts begin to pick up again.

I hope, too, that one of the principal advantages of capital charges will be that they will tip the balance at the margin towards proper maintenance of buildings, rather than the provision of new buildings, much as we would like to see that.

The hon. Member for Vauxhall spoke of the pressure on the Thames regions and on her district health authority. Over the next five years or so the four Thames regions will have to move resources relatively out of inner London and towards the shire districts. That is reflected in the figures on expenditure in relation to the resources allocation working group targets. Even by the measure of weighted capitation, which is the basis for allocation of funds in the future, regions must engineer a relative shift of resources out of London simply because patients have moved out of London. However, I agree with the hon. Lady, and I can provide her with some comfort on this, that when the regions allocate resources to the inner London districts, we expect and understand that they take social deprivation into account. That is a legitimate factor for the regions to take into account. It influences the cost and nature of health provision.

We hope that, through our White Paper reforms, better financial management and planning will avoid some of the problems in her district health authority that the hon. Lady cited. That will be done, for example, through the resource management initiative and the initiatives in the White Paper on contracting. Therefore, the hon. Member for Leicester, East should note that the renal unit of Leicester royal infirmary will not run out of cash if patient flow continues. The hon. Gentleman should welcome our proposals as they will enable money to follow patients. Hospitals will not fall into the efficiency trap, which catches so many, whereby if the consultant runs out of money activity has to stop.

I join the hon. Members for Monklands, West and for Vauxhall in paying tribute to the NHS managers for a change. They have a difficult task—

Mr. Tom Clarke

The Minister has not answered the debate.

Mr. Freeman

I have.

Those managers have a difficult task in balancing finite resources with almost infinite demand. Although there are exceptions, they do a good job and the House should stand by them and congratulate them.